ABSTRACT
Aims: Plantar flexor spasticity affects walking ability after stroke. Spasticity is clinically tested by modified Ashworth Scale (MAS) and it is fairly reliable. The aim of this study was to test the correlation between MAS and alpha motor neuron excitability indicators of F-wave in spastic soleus muscles early after stroke. Place and Duration of Study: Neurophysiology laboratory, Kasturba Medical College, Mangalore, India and between June 2010- August 2012. Methodology: Twenty three people with post stroke duration of 2.26 (1.18) months and MAS score > 1 on soleus muscle participated in this cross-sectional study. Modified Ashworth Scale and F-wave procedures were administered on spastic soleus muscle and the relationship was tested by Spearman’s rank correlation coefficient. Results: The correlation of MAS to persistence of F-wave was high (r=0.842; p=<0.0001), but not with latency of F-wave (r= -0.264; p=0.223). A moderate correlation was found for post stoke duration to F-wave persistence (r=0.45; p=0.013) and the relation was nonlinear with latency of F-wave (r=0.016; p=0.950). Conclusion: Modified Ashworth scale may be a tool to measure the neural aspects of soleus muscle spasticity i.e. alpha motor neuron excitability in people with early stage stroke.
ABSTRACT
Aims: To evaluate the effectiveness of individualized progressive resistance strength training (PRT) program in improving the confidence level among the institutionalized elderly with balance impairment, in comparison with traditional balance exercise (TBE), and combination of both (COMBI). Place and Duration of Study: The study was conducted between June 2008 and December 2012 in the geriatric care homes, Mangalore, India. Methodology: The eligible subjects were assigned to 3 groups (TBE, PRT and COMBI) using block randomization technique and allocation concealment was done. PRT group received strength training for the key muscles (hip flexors, extensors and abductors, knee flexors and extensors, ankle dorsiflexors and plantar flexors) essential for maintenance of balance. TBE group received conventional balance training and the participants of the COMBI group received TBE and PRT interventions alternately. All the three groups received their respective interventions 4 times a week for 6 months. The data was collected at baseline, 3rd and 6th month and the analysis was performed using Statistical Package for Social Sciences (SPSS) version 15. Both per-protocol and intention to treat methods of analyses were used. Results: Mean age of the 54 elderly participants (18 in each group) was 75.17 years and the comparison of the baseline variables revealed homogeneity between the groups. Between the baseline and six months, all the three groups showed notable reduction in Falls Efficacy Scale (FES) scores. The change scores (pre-post intervention) of FES were notable for all the three groups, but the statistical test did not reveal any significant differences between the groups. Conclusion: Individualized structured PRT intervention targeting the key muscles of lower limbs for balance maintenance, for a period of 6 months, is comparable to TBE in improving the falls efficacy. This in turn reduces self-induced functional restrictions among the non-frail elderly people living in geriatric homes.