a Water Training Program to Improve Balance in Chronic Stroke Patients
Condition: Chronic Stroke Patients
MeSH terms: Stroke
Study type: Observational

Summary: 
      The proposed project is a case control study design. Subject's suffer from stroke willing to
      participate in the study will be shortly interviewed to assess eligibility according to the
      inclusion-exclusion criteria. Subjects suffer from chronic hemiplegia that upon questioning
      was judged to meet the following inclusion criteria: (a) able to stand independently 90
      seconds; (b) able to walk 10 meters (with cane if necessary); (c) able to understand verbal
      instructions. The exclusion criteria will be: (a) Serious visual impairment; (b) Inability to
      ambulate independently (cane acceptable, walker not). (c) Severely impaired cognitive status
      (score less then 24 in Mini Mental State Examination). (d) Persons with impaired
      communication capabilities.

      The whole project will be conducted over a period of 3 months. A total of 36 subjects will be
      assigned to water based exercise program. The exercise group will meet on 24 occasions over a
      period of 12 weeks (2 times/week). The subjects of the exercise group will be recruited from
      Sha'ar Ha'negev Swimming pool and from patients that get a Physical Therapy treatment Kupat
      Holim Clalit.

      Gait and balance function will be tested in both groups with well established measuring
      techniques before and after the training period. The measuring techniques 1) Medical
      background variables. 2) Berg Balance Scale. 3) Late life Function and Disability Instrument.
      4) Get up and go test - stand up and walk 3 meters turn around and walk back to the chair. 5)
      step execution test under single and dual task; 5) stability tests. 6) also fall will be
      monitored a year after the completion of the study. The water training intervention is
      performed on different levels where each level reflects different increasing demands on the
      postural control system. For example, the instructor can increase the difficulty of a certain
      water-exercise by instructing a participant to use less external support, close the eyes,
      decrease the support area (stand on one leg or narrow the stance, or on unstable surface).
      These "tools" allow the instructor to implement step exercises on a group level that are
      still challenging for each individual even if the skill level in the group varies. The water
      exercises also include perturbation exercises that trigger specific reflex-like balance
      responses. On each level the instructor can instantly modify an exercise to be more or less
      challenging for each participant.
    


Intervention name(s): water based training program to improve balance
Intervention type(s): Other
Intervention description(s): The exercise group will meet on 24 occasions over a period of 12 weeks (2 times/week), 45 minute training session.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The subjects of the exercise group will be recruited from Sha'ar Ha'negev Swimming pool and
        from patients that get a Physical Therapy treatment Kupat Holim Clalit.
      
Keywords: Balance; Water based training; Physical functioning; stepping behavior