The Effects of Somatosensory and Vestibular Rehabilitation Additional Conventional Therapy on Balance in Patients With Acute Stroke.
Condition: Exercise; Acute Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      This study was planned to evaluate the effects of somatosensory and vestibular rehabilitation
      additional conventional therapy on balance in patients with acute stroke.
    

Detailed description: 
      Stroke or unsufficient cerebral circulation is a non-traumatic disease due to occlusion or
      rupture of brain blood circulation characterized by neurological deficits such as loss of
      motor control, cognitive impairment, oral disorder or sensory changes in one half of the body
      resulting from changes. The resulting hemiplegia in the stroke result in half of the body's
      neuromuscular vascular syndrome characterized by impairment. The largest stroke
      classification that currently holds validity is based on etiology by the National Institutes
      of Health Stroke Scale (NIHSS). The stroke is due to ischemic and hemorrhagic disorder.
      Ischemic stroke results in the formation of thrombosis (40%), emboli (30%) and lacunar
      infections (20%). Increased intracranial pressure in the haemorrhage results in increased
      load on the vessel, which causes the wall to rupture. The blood is then poured into the brain
      tissue and forms 10% of all the stomachs. In the anterior circulation, the anterior carotid
      interna, the anterior cerebri media and the cerebri anterior are affected. In the posterior
      circulation a.vertebralis, a.basillaris and a. cerebri posterior is affected. Eighty percent
      of patients have a carotid system lesion and affect the cerebral hemispheres and cause
      hemiplegia. Cardiac-derived emboli migrate more towards the middle cerebral artery. The brain
      stem-fed system is posterior circulation and although there is better posterior circulation
      Cerebro Vascular Damage (CVD) prognosis, the presence of vital sites such as respiration and
      cardiac increases vital danger. The clinical findings of the lesion of the middle cerebral
      artery show marked contralateral hemialgia, astereognosis, agnosia, alexia, hemianopsia,
      extremity kinetic apraxia in the upper extremity. The anterior cerebral artery lesion has
      marked contralateral hemiplegia, grip and sucking reflexes, amnesia, echolalia and urinary
      incontinence in the lower extremity. Bilateral homonomous hemianopsia, ocular failure is seen
      in the posterior artery peripheral field lesion, paralysis in vertical eye movements,
      postural tremor and hemiballismus are seen in the central lesion. Contralateral hemiplegia
      due to internal carotid artery lesion, aphasia occurs. Coma and quadriplegia are seen due to
      basilar artery involvement. Anterior superior cerebellar artery involvement, especially lower
      extremity vibration, decreased position sensation, horizontal nystagmus, contralateral Horner
      syndrome are seen. Facial paralysis on the same side due to inferior cerebellar artery
      involvement, decreased pain and temperature on the opposite side, tinnitus and ataxia are
      seen anteriorly. In vertebral artery involvement, decrease in pain and heat sensation on
      opposite side, facial hemianesthesia on the same side, tactile and proprioceptive sensory
      loss, ptosis are seen. In general, visual, proprioceptive and vestibular loss is observed in
      stroke patients. There is an associated loss of balance which increases the patient's risk of
      falling. The aim of the patient is to prevent progression of the deformity and complications,
      correction of the deformity and preservation of the obtained correction.To determine the type
      of stroke, Computerized Tomography (CT) should be taken within the first 30 minutes of
      stroke. Imaging of lacunar infections and vertebro basilar arterial infections after 12 hours
      of (Computerized Brain Tomography) CBT is also unsuccessful. In this case MRI (Magnetic
      Resonance Imaging) should be withdrawn. In patients with suspected subarachnoid haemorrhage,
      digital subtraction angiography (DSA) should be performed for patients with lumbar puncture,
      candidates for carotid endarterectomy, Transesophageal Echocardiography (ECHO) for patients
      with embolism, and Holter monitoring test if paroxysmal atrial fibrillation or other
      arrhythmias are considered. A lot of static and dynamic testing and ability of gait record
      with used by physical therapists such as standing in the romberg position on only foot with
      open after closed eyes for difficulties of exercises gradually. If clinicians want to
      reinforce of the force, they can change the surface of support tasks gradually, eyes open or
      closed, combined head or arm movement to maintain of postural stability excessively,
      increased step and sway. Similar with our device for evaluation of balance known as clinical
      test of sensory integration and balance. It consists of 4 different conditions open/closed
      eyes and firm/compliant surface progressively difficulties. Patients need to stand on the
      ground for up to 30 seconds on these stance positions. Our study included Kore Balance which
      evaluate dynamic and static balance with stroke and pressure of flor is arranged by physical
      therapist in order to test patient's ability to somatosensorial, vestibular and visual
      stimulation for postural control. Stroke treatment has primary and secondary prevention
      strategies. Conservative treatment includes physical exercises, orthosis, electrical
      stimulation, manipulation, and physiotherapy. Some of these treatments have insufficient
      evidence. It is said that electrical stimulation is not effective in reducing thrombosis and
      reducing dizziness and headache. There is evidence of increased interest and efficacy in the
      literature in terms of exercises. The efficacy of Johnstone splint therapy has been proven in
      studies. It is also part of the treatment of mandatory use therapy, pressure faradism, mirror
      therapy, Bobath weight transfer, active assistive manipulation of in-bed ROM (Range of
      Motion) movements, interventional brain stimulation, serotonin reuptake inhibitor drugs.
      Apart from surgery, Johnstone plays a major role in the treatment of the PNF (Proprioceptive
      Neuromuscular Facilitation) method, in which feedback from the motor learning program is
      crucial to Brunnstrom, abdominal contractions become apparent, and maximal resistance is
      activated by force propagation on the plegia side. The neurophysiologic approach provides
      proprioceptive, spatial and sensorial sensory enhancement with traction and approximation,
      and posture reflex is removed. In the Brunnstrom method, motor synergies (flexor and extensor
      synergy) are first created by using pathological reflexes, then these synergies are used
      together with antagonist synergists and disintegrated to normal motion. Mainly
      Cawthorne-Cooksey and Frenkel exercises based on visual, vestibular and proprioceptive
      senses. Early movements after stroke, we were aimed to present compensatory behaviors,
      neglect syndrome and fear of falling. Also, vestibular and somatosensorial exercises improved
      vestibulospinal compensation and provided postural stability. Main purpose of this study is
      that the effects of somatosensory and vestibular rehabilitation additional conventional
      therapy on balance in patients with acute stroke.
    

Intervention name(s): Somatosensorial and Vestibular Exercises; Conventional Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In the experimental group, the subjects who were taken to the somatosensorial and vestibular exercises program after pre- treatment evaluations. The subjects in this group were given classical physiotherapy and somatosensorial combined with vestibular exercise performed 5-7 days a week, 1 set of 10 times with physiotherapist control. In the content of the training, in addition to the general physiotherapy program applied for Brunnstrom and Bobath exercises and spasticity inhibition according to in-bed mobility, Flask and spasticity conditions in the experimental group, a mutual study program was prepared with Cawthorne-Cooksey and Frenkel exercises in the bed, then balance and walking will be performed with the exercises; In the control group, The subjects who were taken into the study were taken to the classical physiotherapy based on Bobath and Brunnstrom will be applied to increase the mobilization and spasticity up to the discharge stage known as 5-7 days a week
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Experimental, Randomized Controlled Study
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Stroke; Vestibular; Somatosensory; Rehabilitation; Balance