Perturbation Based Training And Bobath-Based Trunk Exercises On Gait , Postural Control And Mobility

Study Overview
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Brief Summary
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This study compares two approaches for rehabilitating stroke patients: Perturbation-Based Training and Bobath-Based Trunk Exercises. The perturbation based training focuses on challenging patients with unexpected movements to improve their balance and stability. While the Bobath method, concentrating on facilitating normal movement patterns. The study aims to determine which approach yields better outcomes in terms of trunk control, balance, and functional recovery for stroke patients. This study will also enable the individual to be more independent and minimize their falls.

Detailed Description
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Cerebrovascular is a leading cause of physical impairment and long-term disability in the globe. The complication of stroke is mobility impairment like balance, gait, and posture disorders. This impairment leads to a higher risk of falls, reduced ability in daily activities, and difficulty restoring the overall health and quality of life. Cerebrovascular accident is the second cause of fatality.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.Several approaches have been utilized to improve these impairments, including perturbation-based training and Bobath-based trunk techniques. Perturbation-based training involves exposing patients to external disturbances that challenge their balance and require them to actively respond and adjust their movements. The goal of this training is to improve patients' ability to recover from balance perturbations and reduce their risk of falling. This training aims to activate the adaptive response to external forces, thereby improving motor function and balance control. Bobath-based trunk techniques, on the other hand, focus on modifying the posture and alignment of the trunk and pelvis to enhance the patient's movement patterns and functional goals.Through this study we want to improve postural stability through rocker based training as well from bobath 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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Effects of Perturbation Based Training and Bobath-Based Trunk Exercises on Gait, Postural Control and Mobility in Post Stroke Patients

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: Able to walk with or without ambulatory aids Able to follow commands. Patients in the subacute and chronic stages associated with stroke hemiparesis (time since stroke onset 6 months- 1 year) Scoring > 21 on MMSE Exclusion Criteria: Patients who have severe limitations in passive range of motion at lower extremities Visual and sensory deficits Patient who has contracture Orthopedic or any other neurological disorder which impair balance. Patients undergoing any other balance training protocol. Patients with recurrent strokes Participants who are currently participating in another clinical trial or research study

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
Interventional Model Description: Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: perturbation based training<br>Stretching of the erector spinae, latissimus dorsi, gluteus Medius, gluteus minimums, and gluteus maximus (knee to chest) Pelvic Bridging Exercises Strengthening Exercises of latissimus dorsi muscle Pelvic Bridging Exercises include the gluteus maximus and quadriceps Rocker board: 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>* Then intervention will be applied to the perturbation group as mention below at Rocker board (50 x 45 cm).the group will perform 36 sessions (4 times per week over 8 weeks) and effects of interventions will be measured before treatment, at 4th and after8th week (pre, mid and post intervention). 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.<br>* Other names: Experimental group;|
| Experimental: bobath based training<br>Stretching of the latissimus dorsi muscle Functional use and strengthening of the latissimus dorsi. Functional strengthening of abdominal and oblique abdominal muscles Placing exercises to facilitate trunk extension Rotations and counter-rotations (right and left) of the hips with the trunk extended Training of lumbar spine stabilizers Functional reach of shoulder, anterior, right, and left sides. | Other: Stable surface training<br>* the group will perform 36 sessions (4 times per week over 8 weeks) and effects of interventions will be measured before treatment, at 4th and after 8th week (pre, mid and post intervention).<br>* Other names: Experimental group;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| 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 | 
| Postural Assessment Scale for Stroke Patient | It is used for the assessments of postural control in stroke patients. 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 | 

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 |