Evaluation of effect of balance training at neurological rehabilitation in stroke patients

Purpose And Hypothesis:Loss of balance after hemiplegia links with decreasing of proprioception and muscle strength. In a rehabilitation program, providing stable standing is an important step.Although there are variable theurapeutic managements which target neurophysiology, orthopedic principles and motor learning; none of them is specific for balance and there is no evidence about which one is more effective for improving balance and postural control. For this reason, new theurapeutic evaluations developed for balance training like task spesific balance exercises and balance training devices which give feedback to patients to hold center of gravity in limit of balance.Aim of this study is to evaluate effects of task specific balance exercise education or balance education with Sport Kat Kinestethic Ability Trainer, according to clinical and laboratory measurements for locomotor performance and daily life acitivities when added to traditional rehabilitation program in stoke patients. Also, we aimed to evaluate correlation of clinic and laboratory balace measurements.Material And Methods:30 stroke patients from hemiplegia policlinic of Physical Medicine and Rehabilitation are included in this randomised controlled study. At least six months after stroke asked for inclusion. 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) and for laboratory measurements of balance Sport Kat was used by calculating balance index (Bİ).All patients randomised into three groups after evaluation. All groups underwent rehabilitation program for eight weeks, two times in a week. First group was exercised 15 minutes with SportKat Kinestethic Ability Trainer in addition to traditional program. The patients in second group were exercised only with traditional program. Third group was exercised with task specific balance exercise in addition to traditional program. Patients were evaluated at the end of eight week.Results:In this study there was significiant improvement in BBS in all treatment groups after rehabilitation period of eight weeks. In addition to improvement in BBS, BI was significiantly reduced in Sport Kat group and FAS and BI was significantly better in group with balance specific exercises. When groups are compared together after treatment, FAS and BI values were significiantly better in group 1 from group 2, and group 1 and 3 were significantly better from group 2 according to BBS. But, when the difference in FAS and BBS compared with initial values before treatment, there were no predominance between groups.BBS for clinical evaluation of balance, FAS for ambulation, FIM for daily activities were not correlated significantly with BI which is an objective balance measurementI. We have found that, patients with better Brunnstrom motor recovery score in lower extremity had better balance.Conclusion:We observed that conventional stroke rehabilitation provides improvement in clinical parameters of balance. Sport Kat and task spesific balance exercise program were better in balance and in daily life activity parameters but there was no statistically significiant difference between each other.Key words: Stroke, balance, task spesific balance exercise, kinaesthetic ability training device