Cawthorne-Cooksey Exercises and Frenkel Exercises on Balance and Coordination in Stroke

Riphah International University22 enrolled

Overview

Stroke, often caused by cerebral circulation disruption can lead to transient or permanent brain function deficit it is a leading cause of disability and death globally, with a particularly high burden in low- and middle-income countries like Pakistan. Balance and coordination impairments are common post-stroke, severely impacting patients' mobility and quality of life. While Cawthorne-Cooksey and Frenkel exercises are low-cost rehabilitation techniques known to aid balance and coordination, there is limited evidence comparing their effectiveness in stroke patients. This study aims to evaluate and compare the effects of Cawthorne-Cooksey and Frenkel exercises on improving balance and coordination in post-stroke patients. Specific goals include determining which protocol leads to faster and more sustained improvements and providing evidence-based recommendations for stroke rehabilitation. A randomized controlled trial (RCT) will be conducted with 22 stroke patients aged 40-75, 3-6 months post-stroke. Participants will be randomly divided into three groups: Cawthorne-Cooksey exercises (n=11), Frenkel exercises (n=11). Interventions will last 6 weeks, with sessions held four times weekly. outcome measures include the Berg Balance Scale and Lower Extremity Motor Coordination Test (LEMOCOT). Assessments will occur at baseline and post-intervention, and follow-up. Statistical analysis will use the Paired t-test and the independent t-test to evaluate changes across time and groups. This study addresse

Study Type

INTERVENTIONAL

Allocation

Interventions

Cawthorne-Cooksey ExercisesOTHER

Warm up like ankle pumping and circles will be performed before starting the session for 5- 10 minutes. Cool down exercises like deep breathing will be performed for 5-10 minutes after intervention. A. In Supine Lying 1. Eye movements: at first slow, then quick. * Up and down. * From side to side. * Focus on finger moving from 3ft to 1ft away from face. 15 2. Head movements: at first slow, then quick. Later with eyes closed. * Bend backwards and forwards. * Turn from side to side. B. Sitting * 1 and 2 - as above * Shoulder shrugging and circling * Bend forward and pick up objects from the ground C. Standing As A1, A2 and B3 * Change from sitting to standing with eyes open, then eyes closed. * Throw a small ball from hand to hand (above eye level). * Throw a ball from hand to hand under the knee. * Change from sitting to standing and turn round in between. * Weight shifting on alternate legs

Frenkel ExercisesOTHER

Warm-up, such as ankle pumping and circles, will be performed before starting the session for 5-10 minutes. Cool-down exercises like deep breathing will be performed for 5-10 minutes after the intervention. A. Lying (Supine) Exercises: Typically performed with the head raised, limbs fully supported: * Hip and knee flexion/extension: slide heel to therapist's hand or along a marked path. * Hip abduction/adduction: leg moves sideways along the plinth surface. Targeted placement practice: placing the heel on the therapist's hand or on a mark. B. Sitting Exercises Patient sits (may use support) and: * Heel-to-mark sliding: extend and lift heel or toe to visual guide Alternate heel/toe lifts: enhancing proprioceptive control * Stride sitting: stand, then sit, shifting trunk forward, possibly using wall bars for support. * Upper limb tasks: reaching loops, placing objects, hand-mouth coordination. 16 C. Standing Exercises Focus on balance and coordination: • Stride standing: weight transfer

Eligibility

Sex: ALLMin age: 40 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 40-75 years * First-time ischemic or hemorrhagic stroke, diagnosed within the past 3-6 months (subacute phase) * Berg Balance Scale (BBS) score between 21-40 (indicating moderate balance impairment) * Ability to follow instructions (Mini-Mental State Exam score ≥ 24) * No previous participation in a rehabilitation program Exclusion Criteria: * History of multiple strokes or recurrent strokes * Individuals with a history of neurological deficits other than stroke, such as Parkinson's disease or multiple sclerosis * Severe musculoskeletal disorders, visual or auditory impairments * Any contraindications to start rehabilitation (i.e. severe uncontrolled hypertension, uncontrolled diabetes or unstable angina) * Use of assistive devices

Outcomes

Primary Outcomes

Berg balance Scale

The Berg Balance Scale (BBS) is designed to evaluate static and dynamic balance through 14 functional tasks, each scored from 0 to 4 points, with a total possible score of 56. A higher score indicates better balance performance, while a lower score reflects greater fall risk and impaired balance

Time frame: 6 weeks

Lower Extremity Motor Coordination Test

The Lower Extremity Motor Coordination Test (LEMOCOT) is a performance-based measure used to assess motor coordination deficits after stroke. The scoring system for LEMOCOT is based on the ability to move the big toe as fast and accurately as possible between targets marked on an electronic mat equipped with force sensors. The scoring involves calculating the contact surface area, endpoint location, center of pressure (COP), and distance between them. The absolute and variable errors of the endpoint are also calculated to assess the performance of the lower extremities.