[Effect of weight bearing symmetry modification on balance and gait function in individuals with chronic stroke]

The aim of this study was to assess the effect of compelled weight bearing with therapeutic exercise on functional test results of balance and gait in individuals with stroke. 32 hemi-paretic patients in experimental and control groups [16 patients in each group] participated in this study. Patients in the experimental group wore shoes for 6 weeks with a lift of 6 mm thickness embedded in non-paretic side to increase weight symmetry and performed balance and gait re-education exercises for 90 minutes daily. Patients of the control group only received therapeutic exercises. Assessments were included percentage of body weight on the affected limb, gait velocity; stride length, timed up and go and Berg Balance Scale tests that were recorded in both groups before and after treatment and 3 months after the end of treatment. All variables showed significant improvement following treatment and improvement effects were maintained during follow up examinations. In the experimental group, percentage of weight bearing on the paretic limb also increased significantly in follow up. The percentage of weight bearing on the paretic limb and BBS score increased more in the experimental group than in the control group [P=0.001]. Compelled weight bearing on the paretic limb and re-education of balance and gait caused more improvement in weight symmetry and functional balance in individuals with chronic stroke

[Study the effect of "constraint-induced movement therapy" on symmetry of spatiotemporal gait parameters in hemiparetic patients]

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently, so more studies addressing causes of these complications and presenting efficient treatment protocols are crucial. Concerning the significant effect of Constraint Induced Movement Therapy on treatment of upper limbs motor impairments in hemiparetic patients, the goal of this study is to assess the effect of "Constraint Induced Movement Therapy" on symmetry of spatiotemporal gait parameters and velocity of gait in hemiparetic patients. Thirty hemiparetic patients [aged from 40 to 60 years] participated in this study. Patients were divided randomly into 2 groups. They received constraint induced movement therapy [group1] and mass practice [group 2] for 3 weeks. Experimental assessments of patients included stride velocity and symmetry of spatiotemporal gait parameters [spatial step symmetry, temporal stance symmetry, temporal swing asymmetry, overall temporal asymmetry] that were recorded and compared before and after treatment. In addition, the amount of weight bearing asymmetry was assessed via dual force platform. In both groups, stride velocity increased [p=0.03, p=0.01]. In group A, spatial step symmetry increased [p=0.02].Temporal swing asymmetry and overall temporal asymmetry decreased [p=0.01]. In group B, only temporal swing asymmetry decreased [p=0.02]. Physical therapy by "constraint induced movement therapy" can improve symmetry of spatiotemporal gait parameters efficiently through overcoming the "learned non use" phenomenon and improving the somatosensory deafferentation to motor controller centers

[Effect of bobath's therapeutic approach on spasticity and quality of movement patterns in hemiplegic patients]

Hemiplegia is a complication, results from upper motor neuron lesions and is usually associated with spasticity and movement disorders. To control spasticity and accomplish functional activities, several approaches have been presented such as Neurodevelopment treatment [NDT], according to Bobath's assumptions. Although lower limb spastic hemiplegia is common and its management is time-consuming, in this study we were intended to examine the effectiveness of this therapeutic approach on spasticity management and quality of lower limb movement patterns. Fifteen hemiplegic patients [age range, 44-75] participated in this study. Baseline assessments before and after the treatment included: spasticity measurement of plantar flexor muscles of ankle according to the Original Ashworth Scale [OAS], measurement of active and passive range of motion of ankle dorsiflexion and defining the quality of lower limb movement patterns according to "Standing test" of Bobath's approach. Following intervention [20 sessions], there was a significant decrease in spasticity and a significant increase in an active and passive range of motion and quality of movement patterns. According to the obtained results, by modification of excitation - inhibition in CNS and transmitting it to the peripheral region [muscles], Bobath's approach can reduce the spasticity of plantar flexor muscles, subsequently, the dorsiflexion range of motion increases. Indeed, this therapeutic approach increases coordination in movement patterns and improves quality of movement patterns by retraining balance in various positions. Results of this study may be used extensively in management of patients with upper motor neuron lesion referred to rehabilitation centers