The aim of this study is to investigate the positive effects of deep, slow breathing exercises and suboccipital relaxation, when added to a routine physiotherapy and rehabilitation program, on autonomic, motor, cognitive, and emotional status functions in individuals who have experienced a stroke, and to examine their superiority compared to routine physiotherapy and rehabilitation alone.
Deep, slow breathing exercises have been reported in the literature to positively affect lung function, balance, and gait. Studies have also shown that slow and deep breathing can improve cognitive function. Current evidence indicates that these exercises significantly enhance baroreflex function, heart rate variability (HRV), and blood pressure regulation, as well as improve sleep quality and emotional conditions such as stress, anxiety, and depression. Suboccipital relaxation has been identified as a beneficial therapeutic approach for improving balance and gait ability in individuals with chronic stroke. Additionally, cervical mobilization has been suggested as a supportive intervention in stroke rehabilitation. Suboccipital relaxation is noteworthy due to its potential to influence the parasympathetic nervous system, which plays a key role in regulating various bodily functions, including heart rate, digestion, and stress responses. Furthermore, the combined use of cervical joint mobilization and diaphragmatic breathing in individuals with chronic stroke has been reported to improve lung function and craniovertebral angle. Although the literature reports positive effects of deep, slow breathing exercises and suboccipital relaxation individually, these methods have primarily been studied separately. To date, no study has evaluated their combined or comparative effects in stroke rehabilitation. In this respect, the present study is both clinically and methodologically novel. It aims to generate scientific evidence for multidimensional recovery processes after stroke, provide a theoretical and practical foundation for the development of comprehensive rehabilitation protocols, and ultimately contribute to reducing the global burden of stroke.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
54
Individuals assigned to Group 1 will receive deep breathing exercises in addition to the hospital's routine physiotherapy and rehabilitation program, for a duration of 6 weeks, 3 days per week, with each session lasting 20 minutes. During the application of the breathing exercises, stroke patients will be positioned in a supine position, and the procedure will be conducted according to previously described protocols. The total 20-minute session will consist of breathing cycles with 4 seconds of inspiration and 6 seconds of expiration (6 breaths per minute). At the beginning, participants will be given verbal instructions and will be guided with visual cues during the exercise. Participants will be instructed to fully inflate their lungs during inspiration and completely empty their lungs during expiration. After the breathing exercise is taught, rest intervals will be provided as needed based on the patient's condition.
Individuals assigned to Group 2 will receive the hospital's routine physiotherapy and rehabilitation program. In addition, suboccipital release will be applied for 6 weeks, 3 days per week, with each session lasting 20 minutes. Before initiating the suboccipital release procedure, the patient will be positioned in a supine position, and the practitioner will be seated on a stool at the head of the bed. The bed will be adjusted so that the patient's head is at the level of the practitioner's abdomen, allowing the practitioner to perform the technique with approximately 90° of elbow flexion and proper ergonomics. Once the patient is positioned comfortably and correctly, the practitioner will sit at the head of the bed and place both hands under the patient's head, in the occipital region. The practitioner will then palpate along the occipital ridge and gently move the hands inferiorly until muscle tissue is identified. Subsequently, the practitioner will flex the fingers upward toward t
Afyonkarahisar Health Sciences University Health Practice and Research Center
Afyonkarahisar, Turkey (Türkiye)
RECRUITINGHeart Rate Variability (HRV)
Heart Rate Variability (HRV) will be measured using the Polar H10 chest strap sensor. The device is placed below the chest and transmits data via Bluetooth to the Elite HRV mobile application. The following HRV parameters will be recorded: RMSSD(Root Mean Square of Successive Differences), SDNN(Standard Deviation of Normal-to-Normal intervals), low-frequency (LF) power (ms²), and high-frequency (HF) power (ms²). RMSSD and HF reflect parasympathetic activity, while SDNN represents overall autonomic activity. LF reflects both sympathetic and parasympathetic activity but is mainly associated with sympathetic modulation. HF is influenced by respiration and increases during relaxation and deep breathing.
Time frame: Baseline and after 6 weeks of intervention
Berg Balance Scale (BBS)
This test evaluates an individual's ability to maintain balance during functional activities. As the functional tasks progress, the base of support is reduced, increasing the level of difficulty. The assessed activities include sit-to-stand, standing unsupported, sitting unsupported, stand-to-sit, transfers, standing with eyes closed, standing with feet together, reaching forward while standing, picking up an object from the floor, turning to look behind, turning 360 degrees, placing one foot on a stool, tandem standing, and standing on one leg. The test consists of 14 functional tasks, each scored on a scale from 0 (poor) to 4 (best performance). The maximum total score is 56, indicating optimal balance. Scores between 0-20 indicate a high risk of falling, 21-40 indicate a moderate risk, and 41-56 indicate a low risk.
Time frame: Baseline and after 6 weeks of intervention
Motor Activity Log-28 (MAL-28)
The Motor Activity Log-28 (MAL-28) consists of two subscales that evaluate the use of the affected upper extremity during daily activities (e.g., opening a drawer, washing hands): the Amount of Use (AOU) scale and the Quality of Movement (QOM) scale. Participants are asked to rate themselves on a scale from 0 to 5 (0 = not used at all, 5 = used as frequently as before the stroke). The total score is calculated by dividing the sum of the item scores by the number of items. Higher scores indicate better frequency of use and quality of movement of the affected limb.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Individuals assigned to Group 3 will receive only the hospital's routine physiotherapy and rehabilitation program. All participants will be included in this standard program, which consists of gait training, balance training, and upper extremity rehabilitation commonly applied to stroke patients. Under the supervision of a physiotherapist, patients will perform normal range of motion exercises in bed, upper extremity exercises in a sitting position, and functional activities such as walking, stair climbing, and ball throwing and catching while standing. This program will be standardized for all patients in terms of session frequency and duration, with each session lasting approximately 45-50 minutes according to the routine protocol.
Time frame: Baseline and after 6 weeks of intervention
Fugl-Meyer Assessment - Upper Extremity (FMA-UE):
The Fugl-Meyer Motor Assessment for the upper extremity is based on stages of motor recovery in stroke patients. It consists of 33 items evaluating the shoulder, elbow, forearm, wrist, and hand (grip function), as well as reflex activity, coordination, and speed. Each item is scored on a 3-point scale from 0 to 2: 0 = cannot perform, 1 = performs partially, and 2 = performs fully. The maximum possible score is 66.
Time frame: Baseline and after 6 weeks of intervention
Montreal Cognitive Assessment (MoCA):
The MoCA is an easy-to-administer screening tool used to assess mild cognitive impairment, with an approximate administration time of 10 minutes. It includes subdomains evaluating attention, concentration, executive functions, memory, language, visual-structural skills, abstract thinking, calculation, and orientation. The total score ranges from 0 to 30, with higher scores indicating better cognitive function.
Time frame: Baseline and after 6 weeks of intervention
Beck Depression Inventory (BDI):
The Beck Depression Inventory is used to assess mood disorders. It consists of 21 items, each scored on a scale from 0 to 3. The maximum possible score is 63, with higher scores indicating more severe depressive symptoms.
Time frame: Baseline and after 6 weeks of intervention