Comparison of Otago Exercises Versus Resistance Training on Functional Performance in Stroke Patients
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Otago techniques are well known for addressing balance and strength deficiencies in healthy
      older population with fall risk. Despite this, there is limited literature about the Otago
      approaches' effectiveness in stroke patients. To the best of our knowledge, no research has
      been done in Pakistan to determine the effects of Otago exercises on chronic stroke
      patients.Otago exercises are easy to learn and create a sense of motivation and pleasurable
      activity when performed. To determine the effect of Otago exercises in treating poor balance
      control and reduced strength, the current study has chosen chronic stroke patients as its
      target population. The results of this study will serve as a manual for physical therapists
      on how to efficiently incorporate Otago Intervention into their treatment plans for better
      outcomes.
    

Detailed description: 
      Stroke is a focal neurological deficit. It causes functional impairments and activity
      limitation in the body after survival from the sudden attack, which includes disorders in
      language, movement, cognition and eating difficulties. Motor deficits are most common in
      stroke, it is directly related to reduction in strength, balance, gait speed and quality of
      life. Emotional and physical changes also occur, these factors combine to affect everyday
      activities. By improving functional performance and strength in lower extremity, it will
      improve gait speed and balance control.

      Around the world among the major causes of death, stroke stands on the third number.
      Task-specific progressive resistance training uses the preserved energy in muscles to
      increase strength and balance. Training has to be carried out at a specific intensity and
      increase progressively which will lead to improvement in fitness and strength level.
      Progressive resistance training is an umbrella that consists of multiple different and unique
      set of interventions being used worldwide all with one primary target that is to use
      resistance and improve muscle strength. Because strength training has been proven to be
      beneficial in improving stroke symptoms, it has been included in this study.

      Otago Exercise is an evidence-based strength and balance program. It has been shown to be
      effective in reducing the number of fall and fall-related injuries by 35%. The advantages of
      Otago exercise are that it is cost-effective, the exercise protocol is easy to learn and easy
      to perform. Once learned they can be performed at home by the patient without assistance or
      by using action observation technique. They are effective in improving lower extremity
      strength, balance and gait parameters in healthy older adults or people with disorders. This
      exercise program strengthens the antigravity extensors and increases proprioceptive input of
      the body by a stable base of support during mobility, thus improving muscle strength and
      overall improvement in balance control, walking speed and strength. Repeated movement will
      produce the effect of neuroplasticity in the brain producing efficient, controlled and
      meaningful movement.

      Although Otago exercises have been used in previous studies worldwide and showed
      effectiveness in participants' strength and balance control. Recent evidence suggests that
      Otago exercises provide high-quality results to support its beneficial effects on reducing
      falls in osteoarthritic patients. It was also observed that this exercise program was safe
      and helped in improving balance and mobility in Alzheimer's disease. However, to our
      knowledge, there is limited literature available on the use of Otago exercises in chronic
      stroke patients in Pakistan.
    

Intervention name(s): Resistance training; Otago Exercises
Intervention type(s): Other; Other
Intervention description(s): Task oriented resistance training will be performed, there will be 10 workstations:
Sitting at a table and reaching in different directions for objects located beyond arm's length.
Sit to stand from various chair heights
Stepping forward, backward and sideways onto blocks of various heights.
Heel lifts in standing
Standing with narrow base of support, feet in parallel and tandem stance and reaching for objects, including down to the floor.
Reciprocal leg flexion and extension.
Sit ups
Standing up from chair, walking a short distance and returning to the chair.
Walking races between participants
Walking over various surfaces and obstacles; It has total 17 exercises, out of which 12 exercises are performed to improve balance and 5 are performed to improve strength.
1. First component of intervention starts with head movements followed by neck movements, back extension, trunk movements and ankle movements.
2. Second component is muscle strengthening exercises, it includes: i. Front knee strengthening exercise ii. Back knee strengthening exercise iii. Side hip strengthening exercise iv. Calf raises (with support and without support) v. Toe raise (with support and without support). 3. Third component is balance exercises, it includes: i. Knee bends ii. Backward walking iii. Heel toe standing iv. Heel toe walking v. One leg stand vi. Heel walking vii. Sideways walk viii. Toe walking ix. Heel toe walking backwards x. Walk and turn around (figure of 8) xi. Sit to stand xii. Stair walks
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The participants are divided into two groups, group A will be given Otago exercises and grouo B will be given Resistance training.
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Otago Exercises; Resistance Training; strength