Effects of Backward Gait Training in Chronic Stroke Patients

Study Overview
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Brief Summary
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Loss of motor control after stroke, muscle weakness, abnormal movement patterns, spasticity, range of motion limitations and sensory dysfunction, resulting in a decrease in the load transferred to the affected limb, changes in gait pattern and balance skills. Post-stroke muscle weakness has been shown to occur not only in the lower and upper extremity muscles but also in the respiratory muscles. It was found that the plantar pressure distribution in the affected side feet was decreased in individuals with stroke and this situation negatively affected the walking function. A systematic review of treadmill training revealed that treadmill training significantly increased walking speed and walking distance. Learning to walk backwards is also recommended to improve the movement components required for walking forward. As a result of the investigations, although there are studies about the effects of back-walking training on walking and balance function in chronic stroke patients, there is no study investigating the effects on plantar pressure distribution and respiratory parameters. Therefore, this study, which planned to investigate the effects of treadmill retching training on balance, plantar pressure distribution and respiratory parameters in chronic stroke patients, will contribute to the literature.

Official Title
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Investigation of the Effects of Gait Training on Balance, Plantar Pressure Distribution and Respiratory Parameters in Chronic Stroke Patients

Conditions
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Chronic Stroke Patients

Intervention / Treatment
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* Other: Backward Walking Training
* Other: Forward Walking Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Volunteering to participate in the study More than 6 months have passed since the onset of stroke First time stroke diagnosis Being between the ages of 40-65 Spasticity severity in lower extremity less than 3 according to Modified Ashworth Scale, Being medically stable Ability to walk 10 meters and above without assistance Exclusion Criteria: Presence of other neurological or orthopedic diseases that affect standing and walking involving the lower limbs Uncontrollable Hypertension Having been diagnosed with any pulmonary disease Severe cardiac conditions Uncontrollable DM Lack of cooperation

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Backward Walking Group<br>Conventional therapy + Backward Walking Training | Other: Backward Walking Training<br>* The training speed will start at the basic walking speed and will increase by 5% of the starting speed each week. The training, which will take 30 minutes, will be as follows: 5 minutes forward walking (warm-up phase), 20 minutes backward walking (intervention phase) and 5 minutes forward (cooling phase). -three times a week for six weeks<br>|
| Other: Forward Walking Group<br>Conventional therapy + Forward Walking Training | Other: Forward Walking Training<br>* The training speed will start at the basic walking speed and will increase by 5% of the starting speed each week. It will be in the form of walking forward for 30 minutes. -three times a week for six weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plantar pressure assessment | Plantar pressure distribution will be evaluated. | 6 weeks | 
| Balance assessment | Static and dynamic balance will be evaluated with The Korebalance Premiere device. | 6 weeks | 
| Pulmonary function (Forced vital capacity (FVC)) | Pulmonary function will be evaluated with the spirometry. Dynamic lung volume measurements will be made according to American Thoracic Society and European Respiratory Society criteria. With the device, forced vital capacity (FVC) will be evaluated. | 6 weeks | 
| Pulmonary function (Forced expiratory volume in the first second (FEV1)) | Pulmonary function will be evaluated with the spirometry. Dynamic lung volume measurements will be made according to American Thoracic Society and European Respiratory Society criteria. With the device, forced expiratory volume in the first second (FEV1) will be evaluated. | 6 weeks | 
| Pulmonary function (FEV1 / FVC) | Pulmonary function will be evaluated with the spirometry. Dynamic lung volume measurements will be made according to American Thoracic Society and European Respiratory Society criteria. With the device, FEV1 / FVC will be evaluated. | 6 weeks | 
| Pulmonary function (Flow rate 25-75% of forced expiratory volume (FEF 25-75%)) | Pulmonary function will be evaluated with the spirometry. Dynamic lung volume measurements will be made according to American Thoracic Society and European Respiratory Society criteria. With the device, flow rate 25-75% of forced expiratory volume (FEF 25-75%) will be evaluated. | 6 weeks | 
| Pulmonary function (Peak flow rate (PEF)) | Pulmonary function will be evaluated with the spirometry. Dynamic lung volume measurements will be made according to American Thoracic Society and European Respiratory Society criteria. With the device, peak flow rate (PEF) will be evaluated. | 6 weeks | 
| Respiratory Muscle Strength | Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) will be measured using portable, electronic, oral pressure measuring device | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic Stroke Patients, Balance, Plantar Pressure Distribution, Respiratory Parameters, Backward Gait Training