The effects of balance training on rehabilitation of acute and subacute stroke patients

Abstract

Purpose: Aim of this study is to evaluate effects of balance education with Balance Trainer, according to clinical and laboratory measurements for locomotor performance and daily life acitivities when added to traditional rehabilitation program in stroke patients.
Materials and methods: This randomised controlled study included 30 stroke patients who hospitalized in our clinic between dates of January 2011-May 2012. At least six month after stroke were excluded from the study. Patients were randomly assigned into two groups, the control group and trained group. All patients evaluated with Brunnstrom stages of motor recovery, spasticity with modified Ashworth scale, sense of touch, sense of joint position, cerebellar findings, neglect phenomen with star erasing test, ambulation with Functional Ambulation Scale (FAS) and daily life activities with Functional Independence Measurement (FIM). Their balance was assessed clinically with Berg Balance Scale (BBS), Trunk Control Test (TCT) and Fugl-Meyer Assessment Scale (FMAS). Visual feedback balance training with the Balance Trainer was used in the trained group. Balance training consisted of a 15 minute training session three times a week for a 6 week period. The control group were exercized only conventional physical therapy. Data of patients in the trained group (1^st group) and control group (2^nd group) were collected before training and after completing the training program.
Results: In our study after the rehabilitation period, Berg Balance Scale and Trunk Control Test values in both groups improved significantly. In addition, FIM and FAS values were significantly higher in both groups. Compared top ast-treatment changes at BBS, TCT and FAS values were not different between the groups. It was found that both conventional stroke rehabilitation and additional balance training with Balance Trainer showed improvement in the parameters (balance and activities of daily living (ADL) However, they do not have a statistically significant advantage over each other.
Conclusion: We observed that both conventional stroke rehabilitation and Balance Trainer exercise program provides improvement in clinical parameters of balance but there was no statistically significiant difference between each other. And we have found that, patients with better Brunnstrom motor recovery score in lower extremity had better balance.

Keywords

• Stroke
• rehabilitation
• balance trainer

Akut ve subakut inmeli hastaların denge eğitiminin rehabilitasyon üzerine etkileri

Öz

Amaç: Bu çalışmanın amacı; inmeli hastalarda konvansiyonel inme rehabilitasyonuna ek olarak denge egzersiz cihazı ile denge eğitiminin dengenin klinik ölçümleri ile lökomotor performans ve günlük yaşam aktivitesi üzerine etkilerini değerlendirmektir.
Gereç ve yöntem: Çalışmaya Ocak 2011-Mayıs 2012 tarihleri arasında kliniğimizde yatarak rehabilitasyon gören 30 inmeli hasta dahil edildi. Serebrovasküler olay (SVO) üzerinden en fazla altı ay geçmiş olan 30 hasta, çalışma (Grup 1) ve kontrol (Grup 2) grubu olarak 2’ye ayrıldı. Her iki gruptaki hastalar Brunnstrom’a göre motor iyileşme düzeyi, Modifiye Ashworth skalasına göre spastisite, yüzeyel duyu, eklem pozisyonu, serebellar testler, yıldız silme testi ile ihmal fenomeni, Fonksiyonel Ambulasyon Skalası (FAS) ile ambulasyon yeteneği ve Fonksiyonel Bağımsızlık Ölçütü (FBÖ) ile günlük yaşam aktivitesi açısından değerlendirildi. Denge ve postural kontrol klinik olarak Berg Denge Ölçeği (BDÖ), Gövde Kontrol Testi (GKT) ve Fugl Meyer Değerlendirme (FMD) ölçeğinin denge kısmı ile değerlendirildi. Çalışma grubuna (1. grup) altı hafta boyunca konvansiyonel egzersiz programına ek olarak haftada üç gün 15 dakika denge egzersiz cihazı ile egzersiz programı verildi. Kontrol grubu (2. grup) ise sadece konvansiyonel egzersiz programına alındı. Hastalar altı hafta sonra aynı testlerle tekrar değerlendirildi.
Bulgular: Çalışmamızda altı haftalık rehabilitasyon periyodundan sonra her iki grubun da kendi içlerinde BDÖ, GKT değerleri anlamlı olarak düzelmiştir. Ek olarak her iki grupta FBÖ ve FAS değerleri de anlamlı olarak düzelmiştir. Tedavi sonrasında BDÖ, GKT ve FAS değerlerinde oluşan değişimlere bakıldığında, iki grup arasında farklılığa rastlanmamıştır. Dolayısıyla konvansiyonel inme rehabilitasyonun ve denge egzersiz cihazı ile yapılan ek denge eğitiminin, denge ve günlük yaşam aktivitelerini (GYA) gösteren parametrelerde birbirlerine istatistiksel olarak anlamlı üstünlükleri olmadan düzelme gösterdikleri gözlenmiştir.
Sonuç: Konvansiyonel egzersizler ve buna ek olarak uygulanan denge egzersiz cihazı ile verilen denge eğitimi akut ve subakut dönemdeki inmeli hastaların denge rehabilitasyonunda katkı sağlar. Ancak bu yaklaşımların birbirine üstünlüğü saptanmamıştır. Çalışmamızda ayrıca; alt ekstremite Brunnstrom motor evrelemesi yüksek olan hastalarda dengenin daha iyi olduğu da bulunmuştur.

Anahtar Kelimeler

• İnme
• rehabilitasyon
• denge eğitimi

Kaynakça

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