EFFECTS OF POSTURAL TRAINING ON WALKING SPEED IN PATIENTS WITH CHRONIC STROKE
Keywords:kinesitherapy, postural control, stroke, chronic period
Walking speed measurement is an easy and accessible tool that provides information about the functional capacity of patients. It is used as a "sixth vital sign", because is a potential variable risk factor after monitoring blood pressure, pulse, respiratory rate, temperature, and pain (Fritz, Lusardi, 2009). It has been found that measuring gait speed in an outpatient setting can allow the detection of healthy adults at risk of adverse events (Montero-Odasso, Schapira, Soriano et al., 2005). Gait speed is a powerful indicator of function and prognosis in stroke patients. Increasing it leads to a transition to a higher class of ambulation, which leads to better function and quality of life (Schmid, Duncan, Studenski et al., 2007). Studies present the factors influencing gait speed in stroke patients. Velocity is mainly influenced by the weakness of the affected hip flexors and knee extensors, while gait asymmetry is mainly influenced by the degree of spasticity of the affected plantar flexors (Hsu, Tang, Jan, 2003). Another important factor in improving gait speed is energy expenditure, which decreases with faster and more symmetrical gait in patients with chronic stroke (Awad, Palmer, Pohlig et al, 2015). Stroke patients have atypical patterns of step initiation and premonitory posture corrections (Delafontaine, A., Villaeron, T., 2019). The ability to maintain control of the body is essential for movement, which can be significantly impaired and to reduce movement speed and balance (Yang, Park, Kim, 2020). Other studies report that gait speed and symmetry are improved through exercises for the torso, which may be due to the increase in weight that is transferred to the affected leg during walking due to improved symmetrical pelvic movement. Carcass exercises performed on an unstable surface also significantly improve body muscle activation, postural control, and gait speed in stroke patients (Jung, Cho, 2016). Robotic body control training combined with kinesitherapy also shows positive effects on balance, ability and gait speed (Lim, 2020). The aim of the present study was to investigate the effect of postural training on gait speed in patients with chronic stroke. A specialized kinesitherapy technique was applied to a routine approach to motor therapy, covering 46 patients with chronic stroke, and the experimental group included 34 patients - 16 men and 18 women, with a disease duration of 27.15 ± 17.61 months, and the control group, including 12 patients - 5 men and 7 women, with a disease duration of 19.5 ± 14.68 months. Evaluation of early, intermediate and late effects of the performed kinesitherapy was performed, respectively on the 10th day, 1st month and 3rd month from the beginning of the program, using a 10 meter test, which shows excellent reliability in retesting (Cheng, Nelson, 2020). The study showed a significant improvement in gait speed in patients in the experimental group. In conclusion, the application of motor therapy aimed at postural control in patients with chronic stroke shows lasting improvements in movement speed. It is recommended that the motor program be modified according to the patient's needs. The individual orientation and the performance of kinesitherapy in outpatient conditions lead to an increase in the patient's motivation and the achievement of the set goals
Awad, LN., Palmer, JA., Pohlig, RT., et al. (2015). Walking speed and step length asymmetry modify the energy cost of walking after stroke. Neurorehabil Neural Repair 2015;29(5):416-423.
Cheng, D., Nelson, M., Brooks, D., & Salbach, N. (2020). Validation of stroke-specific protocols for the 10-meter walk test and 6-minute walk test conducted using 15-meter and 30-meter walkways, Top Stroke Rehabil.;27(4):251-261. doi: 10.1080/10749357.2019.1691815.
Delafontaine, A., Vialleron, T., Hussein, T., Yiou, E.,Honeine, L., & Colnaghi, S. (2019). Anticipatory postural adjustments during gait initiation in stroke patients, Front. Neural., https://doi.org/10.3389/fneur.2019.00352
Fritz, S., & Lusardi, M. (2009). White paper: “Walking speed: the sixth vital sign.” J Geriatr Phys Ther 2009;32(2):46-49.
Hsu, AL., Tang, PF., & Jan, MH. (2003). Analysis of impairments influencing gait velocity and symmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 2003;84(8):1185-1193.
Jung, K., Cho, H., & In, T. (2016). Trunk exercises performed on an unstable surface improve trunk muscle activation, postural control, and gait speed in patients with stroke, J Phys Ther Sci. 28(3): 940–944., doi: 10.1589/jpts.28.940
Lim, Ch. (2020). Effests of trunk control robot training on balance and gait abilities in persons with chronic stroke, Physical Therapy Rehebilitation Science 2020;9:105-12, https://doi.org/10.14474/ptrs.2020.9.2.105
Montero-Odasso, M., Schapira, M., Soriano, ER., et al. (2005). Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 2005;60(10):1304-1309.
Schmid, A., Duncan, PW., & Studenski, SA. (2007). Improvements in speed-based gait classifications are meaningful. Stroke 2007;38(7):2096-2100.
Yang, J., Park, S., & Kim, S. (2020). Effects of diagonal pattern self-exercise on trunk control, balance and gait ability in chronic stroke patients, https://doi.org/10.20540/JIAPTR.2020.11.2.2028