Upper Extremity Training for Improving Balance Control Post-Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Postural balance control is based on complex mechanisms involving several sensory and motor
      systems. Maintaining postural equilibrium requires muscle activation to oppose the balance
      threats. Stroke may be associated with a variety of deficits, including impaired upper limb
      functions , poor postural stability, impaired reactive balance control, and delayed responses
      to external balance perturbations. Individuals with stroke are at high risk for falls in all
      post-stroke stages. Falls may have long-term serious consequences and can lead to more
      disability. Upper extremity movements have a relevant contribution in controlling balance and
      enhance the ankle and hip strategies for maintaining upright postural stability among healthy
      adults. Upper extremities movements also, constitute important elements in both equilibrium
      and protective reactions. Appropriate corrective responses of both the upper and lower
      extremities are essential to regain balance control and reduce the risk of falls. More
      studies are required to know about the impact of arm movements on postural balance control in
      individuals post-stroke. The purpose of this study is to investigate the effect of the
      improvement of the upper extremity functions on postural balance control in patients with
      stroke.
    

Detailed description: 
      Stroke is defined as rapidly developing clinical signs of focal (or global) disturbance of
      cerebral function, leading to death, with no apparent cause other than that of vascular
      origin. It considered the biggest burden cause of disability all over the world, 16 million
      people suffer from a stroke every year with great economic and social repercussions.
      Following a stroke, a number of impairments may influence the patient's ability to perform
      functional activities. These include weakness, alterations in tone, sensory loss,
      uncoordinated response, reduced balance mechanisms, and walking problems. Upper limb
      involvement is usually more pronounced than the lower limb. The effects of stroke on the
      upper limb functions are common and a significant cause of long-term disability. Balance
      impairment is one of the most common deficits in patients post-stroke. After a stroke,
      balance abilities are reduced due to abnormal muscle activity and asymmetric posture.
      Impaired Balance not only increases the risk of falls but also adversely affects physical
      activity and social participation. The inﬂuence of arm movements on postural control only
      appears to be evident in case of impairs upper extremity functional performance. Arm
      movements play a functional role in postural stability during standing and walking. Arm and
      hand movements can also serve a protective role to prevent head injury in case of falling.
      Rehabilitation programs aiming for improving upper extremity impairments and improving
      balance performance can reduce the fall risk in individuals with stroke. Recently, virtual
      reality-based training exercises, are used to improve upper limb functions, balance, gait,
      and quality of life in stroke survivors. Many studies supported that virtual reality-based
      programs are suitable and have a potential value for patients with stroke. The purpose of
      this study is to investigate the impact of the improvement of the upper motor abilities by
      using virtual reality-based training on balance control in patients with chronic stroke.
    

Intervention name(s): Traditional Physical Therapy Program; ArmeoSpring Virtual Reality Device (Upper Extremity Training Device with Virtual Reality Technology)
Intervention type(s): Other; Device
Intervention description(s): This intervention included:
Strengthening and facilitation exercises for the affected upper extremity muscles.
Stretching and mobilization exercises for the affected upper extremity muscles and joints.
Postural reactions exercises.
Facilitation of arm-reaching and arm-hand skills for the affected upper extremity.
Facilitation of manipulative tasks (grasp and release activities) for the affected upper extremity.
Training of daily living activities for the upper extremities.; ArmeoSpring virtual Reality Equipment is a functional upper extremity rehabilitation device that provides specific therapy with augmented feedback. The ArmeoSpring instrument facilitates intensive task-oriented upper extremity therapy after stroke, traumatic brain injury, or other neurological diseases and injuries. It combines adjustable arm support, with augmented feedback and a large 3 D workspace that allows functional therapy exercises in a virtual reality environment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Upper Extremity Functions; Balance Control; Postural Stability; Virtual Reality; Conventional Exercise Training