This study will be a single blinded randomized controlled trail. Non probability convenience sampling will be used to recruit the patients of either gender, aged 40-65 years, patients with the subacute phase (\>3months post stroke) and able to follow the instructions. This study will be carried out in Gulab Devi Hospital and Sahet Medical Complex Lahore. These participants will be randomly allocated to Group A will receive bilateral task specific training with visual feedback, whereas Group B will receive unilateral task specific training with visual feedback. Both group will perform their respective exercises 40 minutes, five days a week for 6weeks. The Participants will be evaluated at the start and end of the exercise program through Berg Balance scale to assess balance, 10 Meter Walk Test to assess gait and Fugl Meyer Assessment of lower extremity to assess sensation. Data will be analyzed by SPSS version 27.
Stroke is a neurological deficit due to vascular lesion. It occur due to blood flow obstruction and by the rupture of blood vessels. It causes neurological damage such as weakness, numbness, impaired balance, gait and loss of proprioception. These impairment lead to decrease mobility, increase risk of fall and reduce the quality of life. Task specific training focus on repetitive practice with meaningful, goal directed task to facilitate motor relearning. Visual feedback promote motor recovery and brain plasticity. Task specific training with visual feedback has been shown to enhance motor relearning and sensory integration. However most rehabilitation program focus only the affected limb. The aim of this study is to determine effects of unilateral versus bilateral task specific training with visual feedback on lower limb on balance, gait and sensation in post stroke patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
The group will received bilateral task specific training along with visual feedback on lower limb. Bilateral training is used in rehabilitation to promote functional recovery of impaired limbs by engaging both affected and non-affected sides. Task specific training include weight shifting, sit to stand, stepping forward / lateral and bilateral walking over uneven surfaces. Visual feedback will be given by mirrors and visual targets place on the floor. Visual feedback helping patients to improve balance and body awareness, particularly for individuals with sensory or motor impairments following a stroke. Bilateral task specific training with visual feedback will perform for five days per week for six weeks. The participants in this group underwent 40 minutes of bilateral lower limb training. Pre and post intervention values will be recorded to assess the effectiveness
This group received unilateral task specific training with visual feedback on affected limb. Task specific training include weight shifting, seated marching, stepping forward / lateral, and walk on uneven surface. Unilateral task specific training with visual feedback will perform for five days per week for six weeks. The participants in this group underwent 40 minutes of unilateral lower limb training. Pre and post intervention values will be recorded to assess the effectiveness.
Department of Physical Therapy, Sahet Medical complex Lahore
Lahore, Pakistan
Berg Balance Scale
Berg balance (BBG) is a widely used clinical test to assess a person's static and dynamic balance abilities. It consist of 14 performance based tasks each scored on a 5 point scale from 0 to 4 for a maximum total score of 56. It used for individuals with balance impairments such as post stroke patients. In scoring criteria 4 score perform task independently and safely, 3 score perform with supervision or slight assistance, 2 score perform with moderate assistance or deviation, 1score perform with major assistance and 0 score unable to perform The scoring range 41-56 low risk balance impairment, 21-40 moderate risk balance impairment and 0-20 high risk balance impairment Test retest (ICC =0.96; 95% CI, 0.93-0.98) and inter-rater (ICC=0.93; 95% CI, 0.87=0.97) reliability was excellent
Time frame: 6 weeks
Meter Walk Test (TMWT)
10 meter walk test is use to assess the gait and gait speed over a short distance. It is an important predictor of functional independence, fall risk and community mobility. It is perform by the patient to walk a total 14 meter at a comfortable speed, only the middle 10 meter are timed to eliminate acceleration and deceleration bias. First 2 meter acceleration, middle 10 meter time walking and last 2 meter deceleration. Repeat the test twice. The Scoring of 10 meter walk test have predicted values, gait speed \< 0.4 m/ s functional status (household ambulation), 0.4 - 0.8 m/s limited community ambulation, \> 0.8 m/s community ambulation and \> 1.2 m/s safe for crossing the street
Time frame: 6 weeks
Fugl- Meyer Assessment - Lower Extremity
Fugl Meyer Assessment Lower Extremity is widely used outcome tool to measure in rehabilitation, particularly for stroke patients. To measure the sensation, it include light touch sensation and proprioception. The scoring criteria each item is on a 3 point scale; 0 unable to perform the task, 1 impaired and 2 normal. The total score ranges from 0 to 10. Light touch 2 sites and 2 points total score 4. Proprioception 3 joints 2 points total score 6
Time frame: 06 weeks
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