Comparison of Rocker Board and Stable Surface Training on Postural Stability, Balance and Gait

Study Overview
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Brief Summary
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There is limited literature for the evaluation of comparison between effectiveness of postural control and balance training program on stable surface and unstable surface. So this study will help to improve reactive postural control in stroke patients which ultimately improve their walking capability, mobility and level of independence. This study will also enable the individual to be more independent and minimize their falls.

Detailed Description
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Stroke is the second cause of death and the third cause of disability worldwide. It leads towards severe disability having a great impact upon independent activities of daily living. Postural stability and balance is often affected by strokes. Balance is a complex function with dynamic and static components. It is a major determinant of community ambulation and gait performance following strokes. Falls in post-stroke patients commonly occur due to impairment of balance. Hence, one of the primary objectives in stroke rehabilitation is to restore postural stability and functional balance, which is a combination of dynamic, static and reactive balance. For improving postural stability and balance one such technique is the utilization of a rocker board, where a platform positioned on an unstable surface is used to challenge balance. Whilst rocker boards have been used effectively for, postural stability, injury prevention, rehabilitation and balance enhancement. Improvements in rocker board performance may be attributable to one or more of the following: muscle strengthening, enhanced intersegmental coordination, increase in brain activity in the supplementary motor area and/or enhanced feed-forward and feed-backward postural control mechanisms. Postural instability limits lower limb functional activities, hence; rapid and optimal improvement of postural control in stroke patients is essential for their independence, social participation and general health. Improvement in postural stability have a great impact upon balance and gait. Rocker board training is also effective for gait and trunk balance in stroke patients. Postural stability increases due to unstable surface because perturbations felt by patients and consequent trails to compensate while doing exercises on the tilted Rocker Board activate the motor system of the patients. Neural plasticity may be enhanced by regular and repeated administration of this training. The trunk exercises on an unstable surface sensitize the muscle spindle through gamma motor neurons, thereby improving motor output which influences the stability of joint. Exercises on an unstable surface increases the external swing which more effectively encourages postural orientation by forcing faster modifications of the sensory and motor systems and also assists in the postural strategy of self-postural control. The trunk stabilization in stroke patients in an important prognostic factor of the recovery of balance ability and functional ambulation. The gait and balance improvement is because the motor cortex precedes from proximal to distal, the improved level of proximal trunk control leads to improvement in distal lower limb control which helped in altering better balance and gait. The relationship between postural control and improved mobility is already established. Through this study we want to improve postural stability through rocker based training and ultimately patient's dynamic balance and gait so functional capability of stroke patients can be enhanced.

Official Title
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Comparison of Rocker Board and Stable Surface Training on Postural Stability, Balance and Gait in Stroke

Conditions
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Stroke

Intervention / Treatment
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* Other: Rocker board training
* Other: Stable surface training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Both genders Age: between 40-60 years. Unilateral hemiplegia. ACA and MCA lesions only. Subacute and chronic stroke patients. First time affected. No visual and sensory deficits. Ambulatory stroke patients scoring 21 to 40 on Berg Balance Scale. Scoring > 21 on MMSE. Exclusion Criteria: ● Any other neurological deficits as multiple sclerosis, Parkinsons disease etc. Any musculoskeletal disorders like OA, ligament injury etc. Non-ambulatory patients

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 60 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: Rocker board training<br>Stretching Exercises (Heel drop, heel raises, Hamstring stretch, quad stretch, half kneel, IT band stretch, half squats). Hold the stretch for 20 seconds and repeat 10 times. Isometric Strengthening Exercises of calves, hamstrings, quads, hip flexors, gluteus, dorsiflexors and plantarflexors. Hold for 20 seconds and repeat 10 times. Pelvic Bridging Exercises. Trunk control exercises on Rocker Board in standing position first in medio-lateral direction for 10 min and then in anterio-posterior direction for 10 min with breaks in between. | Other: Rocker board training<br>* Patients will perform 24 sessions (4 times per week over 6 weeks) and effects will be measured before treatment, at 3rd and after 6th week.<br>* Other names: Experimental group;|
| Other: Stable surface training<br>Stretching Exercises (Heel drop, heel raises, Hamstring stretch, quad stretch, half kneel, IT band stretch, half squats). Hold the stretch for 20 seconds and repeat 10 times. Strengthening Exercises calves, hamstrings, quads, hip flexors, gluteus, dorsiflexors and plantarflexors. Hold for 20 seconds and repeat 10 times. Pelvic Bridging Exercises. Trunk balance exercise (flexion, extension of lower and upper trunk, rotation of lower and upper trunk, forward and lateral reach) on plain surface. | Other: Stable surface training<br>* Patients will perform 24 sessions (4 times per week over 6 weeks) and effects will be measured before treatment, at 3rd and after 6th week.<br>* Other names: Control group;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Beg Balance Scale | It is used to assess balance. , Change will be measured from Baseline to 6 weeks | 6 weeks | 
| Trunk Impairment Scale | It is used to measure motor impairment of the trunk after stroke. Change will be measured from Baseline to 6 weeks | 6 weeks | 
| Postural Assessment Scale for Stroke Patients | It is used for the assessments of postural control in stroke patients. Change will be measured from Baseline to 6 weeks | 6 weeks | 
| Timed Up and Go Test | It is for the assessment of lower extremity function, mobility and fall risk. Change will be measured from Baseline to 6 weeks | 6 weeks | 
| Functional Gait Assessment | It is for assessment of postural stability during walk. Change will be measured from Baseline to 6 weeks | 6 weeks | 
| Timed Walking Test | It is used for assessing functional status or fitness. Change will be measured from Baseline to 6 weeks | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stroke Self-Efficacy Questionnaire | It evaluate self-efficacy as a result of being able to successfully perform a specific action in stroke patients. Change will be measured from Baseline to 6 weeks | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rocker board training, postural stability, balance, gait