Core Stabilization Exercises in Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke is one of the leading causes of disability and death worldwide. Falling is defined as
      a person accidentally lying on a floor or another low level with or without injury. In
      patients with stroke occur motor, sensory, functional and cognitive disorders which are
      increased the rate of falls after stroke. Physiological and psychological complications that
      occur as a result of a fall are exhausting for both the patient and the therapist. Because
      while the patients regress physiologically even more, the 'fear of falling again', which
      occurs with falling, reduces the patient's participation in rehabilitation.When looking at
      the risk factors determined for falls in stroke patients, reduced mobility and impaired
      balance functions are in the first place and that is evidenced with most of falls occur
      during walking and transfers the most frequent.The main reason of affected mobility is the
      weakness in the deep trunk muscles and insufficient stability, except for the loss of
      strength in the affected lower extremity. In the literature, it is stated that having strong
      core muscles can contribute to the efficient use of the lower extremity. According to the
      previous studies, applied stabilization exercises in addition to traditional rehabilitation
      improve the balance and mobility functions of patients with subacute stroke. However, there
      is not enough information about the benefits of these exercises in patients with chronic
      stroke. Most falls occur at home specially in the bedroom and bathroom in patients with
      stroke. This indicates that environmental factors should be taken into consideration in the
      rehabilitation program besides physical factors, that is, a "multifactorial falls prevention
      program" should be implemented. Based on these information, the aim of our study is to
      investigate the benefits of core stabilization exercises which is included in a
      multifactorial training on falling number, fear of falling, lower extremity function and
      balance in patients with chronic stroke who have a history of falling.
    

Detailed description: 
      The volunteers to be included in our study will be selected from chronic stroke patients who
      are receiving physical therapy at Bursa İlker Çelikcan Physical Therapy and Rehabilitation
      Hospital and have a history of falling. The study will consist of two separate groups, core
      stabilization and multifactorial education group. Patients who suitable the inclusion
      criteria will be randomized according to the order of initiation of the physical therapy
      program in the hospital and divided into groups. Both groups will participate in a
      multifactorial education program. In this program program, there are physical therapy and
      rehabilitation practices that are routinely applied in stroke rehabilitation and that
      patients will receive at the specified hospital. In the content of these applications;
      patient-specific upper and lower extremity stretching, relaxation and strengthening
      exercises; balance, coordination and gait training are included.In addition to these,
      patients in the intervention group will perform core stabilization exercises under the
      supervision of a physiotherapist. The exercises will be applied 5 times a week for 6 weeks.
      First of all, activation of the "transversus abdominis" muscle, which forms the basis of core
      stabilization, will be taught to patients. "Chattanooga Stabilizer Pressure Biofeedback
      Device" will be used in order to teach this activation and to observe whether the patient is
      doing it correctly during exercises. The exercises will be made more difficult by adding
      extremity movements to this activation. Evaluations will be made twice, at the beginning (0.
      week) and end of the treatment (13. week).In order to evaluate the effect of the treatment on
      the fall, the number of falls that occurred within 3 months after the end of the treatment
      will be questioned by phone.
    

Intervention name(s): Core stabilization exercises; Multifactorial Education Program
Intervention type(s): Other; Other
Intervention description(s): In our study, core stabilization exercises to be applied in the intervention group are arranged according to the patients with stroke and will be at three different difficulty levels. Exercises will be done on the back (hooked) and sitting positions where the risk of falling is low. First of all, activation of the "transversus abdominis" muscle, which is the basis of core stabilization, will be taught to patients. With this activation at the first level, the healthy side, at the second level the affected side, and at the third level, reciprocal upper and lower extremity movements will be requested. In addition to these, there will be exercises to bridge and curl up in supine position, and weight transfer in sitting position. In order to increase the difficulty level of the exercises, first of all, the number of exercises will be increased and then it will be asked to move on to the next level.; The content of this program includes rehabilitation practices that are routinely applied in stroke rehabilitation and that patients will receive at the specified hospital. In the content of these applications; patient-specific upper and lower extremity stretching, and strengthening exercises; application of functional electrical stimulation (FES) to upper and lower extremity muscles; balance, coordination and gait training are included. he content of multifactorial fall prevention training includes the first brochure titled '' General Recommendations for the Prevention of Fall in Chronic Stroke Patients '', which will include general recommendations for preventing falling according to the fall risk factors specific to the stroke, and the recommendations to minimize the risk of falling in the home. A second brochure titled 'Suggestions for Making Your Home Safer' will be given. The information in these brochures will also be communicated to patients face to face verbally
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Stroke; Falling; Fall; Core stabilization; Core exercising; Cerebrovascular Accident; Fall prevention