Effects of Multi-direction Stepping and Weight Shifting Exercises in Stroke Patients

Study Overview
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Brief Summary
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Stoke is a leading cause of disability that results not only in persistent neurological deficits but also profound physical de-conditioning that propagates stroke-related secondary disability. Several kinds of research have reported that there has been asymmetrical weight bearing on the affected side while sitting and standing resulting in impaired performance especially reaching in sitting, rising from the chair, walking, and climbing stairs. Despite the stroke patient being able to walk independently with or without the walking aids, the patient still lacks the normal movement pattern especially weight transfers on the affected side while performing such activities which subsequently decreases the patient to restrain the challenges while walking, decrease confidence in functional activities. Also, further, there hasn't been enough literature on this topic. Therefore, the objective of this study is to find out the effectiveness of multidirectional stepping and weight shifting exercises to improve dynamic balance and gait speed in stroke patients.

Detailed Description
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The twenty-four subjects who fulfilled the inclusion criteria were selected for the study and were randomly assigned into two groups of 12 subjects each by simple random sampling based on inclusion criteria. First, all the subjects were assessed with a detailed neurological assessment form after the consent form was taken from the patients. The experimental group was given multidirectional stepping exercise with conventional therapy whereas are control group was given only conventional therapy.

Official Title
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Effects of Multi-direction Stepping and Weight Shifting Exercises on Balance and Gait in Stroke Patients

Conditions
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Stroke

Intervention / Treatment
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* Other: Multidirectional stepping exercises
* Other: Conventional physiotherapy group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with stroke via CT Scan or MRI Maintain the independent standing posture for 30 sec Ability to walk 3 meters independently without an assistive device Mini-Mental status examination score >21 points Could communicate and understand therapist's verbal command Voluntary agreed to participate in the study Age above 18 years old Medically stable (e.g. recent myocardial infarction, unstable angina, ventricular tachycardia) Exclusion Criteria: Visual disorders and visual deficits History of any neurological pathology like Parkinson's or Alzheimer's disease Conditions affecting balance like vertigo Medications affecting balance Dementia Impaired conscious level or concomitant medical illness Lower Motor Neuron lesions Anti-spasmodic medication (e.g. Baclofen, Dantrolene Sodium, etc.) Severe orthopedic diseases in lower extremities (e.g. Osteoarthritis, fracture, sprain, strain)
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
Interventional Model Description: Two arms parallel design
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multidirectional exercise group<br>Multidirectional stepping exercises along with conventional physiotherapy were provided to the patients. Conventional physiotherapy included one-to-one range of motion exercises (10min), Strengthening exercises (10 min), Functional mat exercises (10 min), Stretching exercises (5 min), and Gait exercises (10 min). | Other: Multidirectional stepping exercises<br>* These exercises included stepping of the legs in different directions i.e. sideways, sideways and forefoot (forward), sideways and heel (backward).<br>|
| Active Comparator: Conventional Physiotherapy Group<br>One-to-one range of motion exercises (10min), Strengthening exercises (10 min), Functional mat exercises (10 min), Stretching exercises (5 min), and Gait exercises (10 min) were provided to the patients. | Other: Conventional physiotherapy group<br>* Conventional physiotherapy included a one-to-one range of motion exercises (10min), Strengthening exercises (10 min), Functional mat exercises (10 min), Stretching exercises (5 min), and Gait exercises (10 min)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Berg Balance Scale | The Berg Balance Scale (BBS) is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks. It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function. Minimum possible value is 0 and maximum possible value is 56. Higher score represents better outcome. | 4 weeks. | 
| Functional gait assessment | The Functional Gait Assessment (FGA) assesses postural stability during walking tasks in persons with gait impairments. | 4 weeks. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke, Balance, Gait, Berg balance scale, Functional gait assessment