Τhe Effectiveness of Hydrotherapy Exercises on the Rehabilitation of Hemiplegic Patients

Study Overview
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Brief Summary
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The purpose of this current prospective study is to assess and compare the effects of a hydrotherapy exercise programme against a conventional land-based exercise programme in individuals with hemiplegia. Both exercise interventions aim at improving posture, balance and weight-bearing capability. Patients were randomized to the hydrotherapy or conventional therapy groups according to balance function (Berg Balance Scale score) and age (age<59 and >60 years). The physical examination consisted of (1) a lower-limb motor function recovery of the paretic side score according to the 6-stage Brunnstrom scale, (2) the hemiplegic limb strength measured by the Motricity Index, (3) the strength of ankle dorsiflexors and plantarflexors by manual muscle testing, (4) the spasticity of the ankle score by Modified Ashworth Scale, (5) the trunk function through the Trunk Control Test, (6) the postural control assessed by Postural Assessment Scale for Stroke Patients and (7) the functional status measured with the Functional Independence Measure. Postural sway was evaluated with a pressure platform by using the variables of center of pressure (COP) displacements in the mediolateral (ML) and anteroposterior (AP) directions. The results will be collected and evaluated using statistical programme SPSS.

Conditions
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Hemiplegics

Intervention / Treatment
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* Procedure: Hydrokinesiotherapy Intervention
* Procedure: Land-based exercise intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: hemiplegia or hemiparesis after stroke or traumatic brain injury at least 6 months post-stroke from a single cerebrovascular accident independent in walking (with or without assistive device) clinical stable Exclusion Criteria: unstable cardiac conditions epilepsy urinary or faecal incontinence open wounds significant musculoskeletal problems in lower extremities from conditions other than stroke Alzheimer Parkinson's disease polyneuropathy vestibular disorders current participation in an exercise program

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 75 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: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hydrokinesiotherapy<br>A 6-week water-based exercise program that focused on balance and weight bearing exercises (3 days a week for 1 hour a session) | Procedure: Hydrokinesiotherapy Intervention<br>* The hydrotherapy exercise intervention consisted of 5 minutes of warm-up, 10 minutes of lower-extremity stretching exercises, 10 minutes of lower-extremity strengthening exercises, 20 minutes balance and gait training (water walking, running, side stepping), 5 minutes of a light cool down (marching on the spot), and 10 minutes of gentle stretching in the water.<br>|
| Active Comparator: Conventional exercise intervention<br>A 6-week land-based exercise program that focused on balance and weight bearing exercises (3 days a week for 1 hour a session) | Procedure: Land-based exercise intervention<br>* The conventional exercise intervention used no water-based exercises but land-based exercises. The exercise program consisted of 5 minutes of warm-up, 10 minutes of lower-extremity stretching exercises, 10 minutes of lower-extremity strengthening exercises, 20 minutes balance and gait training (walking, side stepping), 5 minutes of a light cool down, and 10 minutes of gentle stretching out of the water.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of postural and sitting balance at six weeks | Postural balance and weight-bearing ability measured by vertical ground reaction force during standing, sitting and four standing tasks (rising from a chair and weight-shifting forward, backward and laterally) | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of balance at six weeks | Berg Balance Score | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 
| Change of spasticity at six weeks | with ashworth test | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 
| Change of leg's strength at 6 weeks | 6-stages Brunnstrom scale | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 
| Change of trunk control at 6 weeks | Trunk Control Test (TCT) | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 
| Change of function at 6 weeks | Functional Indepedence Measure (FIM) | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 
| Change of leg's motion at 6 weeks | Motricity Index | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 
| Change of posture at 6 weeks | Postural Assessment Scale for Stroke Patient (PASS) | At the time of admittance to the rehabilitation department (at baseline) and after six weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hemiplegic, balance, hydrotherapy