Volume : 4, Issue : 11, NOV 2018

EFFECTIVENESS OF STASTIONARY CYCLING EXERCISE ON PLANTAR FLEXOR SPASTICITY AND DYNAMIC BALANCE IN CHRONIC STROKE PATIENTS.

DR. P. HEMA, DR.V.SRIKUMARI, DR.G.KAMESWARI, DR.K.MADHAVI

Abstract

INTRODUCTION: STROKE is the most common cause of death and disability in India. Stroke patients are known to be more likely to have increased spasticity and shortended gastronomies which reduced the range of motion of ankle dorsiflexionon the paretic side. This may induce incorrect transmission of somatesthesia from the joint or the muscle receptors or motor response, accompanied by in appropriate ankle strategy, causing difficulty in balance control. All the movements in the ankles including dorsiflexioncontrols the interactions between the feet and the ground, which acting as an essential factor in balance and gait. Post stroke patients with gait problem are more common and it affects functional ambulation. Cycling can improve functional mobility and acts as a pseudo walking task-oriented exercise. AIM: To find out the effectiveness of stationary cycling exercise on plantar flexor spasticity and dynamic balance in chronic stroke patients. OBJECTIVES: To evaluate the effectiveness of stationary cycling exercise on plantar flexor spasticity by using Modified Ashworth Scale. To evaluate the effectiveness of stationary cycling exercise on dynamic balance by using Dynamic gait index. METHODOLOGY: 30 chronic stroke patients were taken and divided into two groups, experimental group (n=15) received stationary cycling exercise along with conventional therapy and control group (n=15) received conventional therapy (cryo-stretches and electrical stimulations) for 5 days in a week for 6 weeks. Research design: Randomised control trial Sampling method: Simple random sampling. RESULTS: After six weeks of treatment period, the experimental group were compared with control group. Results shown that there was a significant improvement at 0.05 level. CONCLUSION: Stationary cycling exercise was shown significant effect on spasticity and dynamic balance in chronic stroke patients.

Keywords

CEREBRO VASCULAR ACCIDENTS, STATIONARY CYCLING, SPASTICITY AND DYNAMIC BALANCE.

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References

1. Jeyraj Durai Pandian, Paulin Sudhan. Stroke epidemiology and stroke care Services inindia. Journal of Stroke 2013;15(3):128-134. 2. Valery L. Feign, Bo Norrving, George A. Mensah. Global burden of stroke. Circ Res.2017;120:439-448. 3. Sung-Jin Kim, PT, MS, Hwi-young Cho, PT, PhD, You Lim Kim, PT, MS, Suk-Min Lee, PT, DDS, PhD. Effects of Stationary cycling exercise on the balance and gait abilities of chronic stroke patients. J. Phys. Ther. Sci.27: 3529-3531, 2015. 4. Ki-SukPark, Jong-DukChoi. The effect of balance training with plantar flexor stretching on range of motion,balance, and gait in stroke patients: a randomized controlled pilot trial. Phys TherRehabilSci 2015, 4 (2), 66-72. 5. David A. Brown and Gary A. Debacher. Bicycle ergometer and electromyographic feedback for treatment of muscle imbalance in patients with spastic hemiparesis. Volume 67, number 11, 1987. 6. David A Brown, Sabina Nagpal, Sam chi. Limb-loaded cycling program for locomotor intervention following stroke. Phys Therapy 2005; 85;159-168. 7. S. A. Kauutz and C. Patten. Interlimb influences on paretic leg function in post stroke hemiparesis. J Neurophysiol 2005, 92: 2460-2473. 8. RenataHorst, Horst Hummelsheim and caroline IE Renner. Effects of increase in plantar flexor strength on gait impairement after stroke; study protocol of a randomized controlled trial.Austin Phys Med 2017:1(1);1004. 9. Jules G. Becher, MD; JaapHarlaar, MSC. Measurement of impaired muscle function of the gastrocnemius, soleus, and tibialis anterior muscles in spastic hemiplegia; A preliminary study.Journal of Rehabilitation research and Development vol. 35 No. 3, july1998 pages 314-326. 10. LynneRomeiser Logan, PT. Rehabilitation techniques to maximize spasticity management. Top Stroke Rehabil2011:18(3);203-211. 11. Katharina StibrantSunnerhagen. Predictors of Spasticity After Stroke. CurrPhysMedRehabil Rep (2016) 4:182-185. 12. MdHaider Ali*, ShubhangiGaikwad and Jince Thomas Mathew. A comparative study between hold relax technique and static stretching to improve gait parameter of hemiplegic stroke patients. Int J Neuro rehabilitation Eng 2015, 2:4. 13. Stacey E. Aaron et al. Dynamic gait index post-stroke. What is the item hierarchy and what does it tell the clinician? A Rasch analysis. Edorium J Disabil Rehabil2016; 2:105-114. 14. Ralph L. Sacco, MD, MS, FAHA, FAN, Co- Chair*et al. An updated definition of stroke for the 21st century. American Stroke Association. 2013; 44:2064-2089. 15. J. Abraham, M.D., P. S. S. RAO,* S.G.Inbaraj, G. Shetty, M.D., and C. J. Jose, M.D. An Epidemiological Study of Hemiplegia due to Stroke in South India. Stroke Vol. 1, November- December 1970. 16. MS JahirulHoqueChoudhury, MdTauhidul Islam Choudhury, Abu Nayeem, WasekaAkterJahan. Modifiable and Non Modifiable Risk Factors of Stroke: A Review Update. Journal of National Institute of Neurosciences Bangladesh, January 2015, Volume 1, Number 1, 2015:1(1); 22-26. 17. P. Amarenco, J. Bogousslavsky, L.R. Caplan, G.A.Donnan, M.G.Hennerici. Classisfication of Stroke Subtypes. CerebrovascDis 2009;27:493-501. 18. K. Diserens et al. The effect of repetitive arm cycling on post stroke spasticity and motor control Repetitive arm cycling and spasticity. Journal of the Neurological Sciences 253 (2007) 18-24. 19. RazvanAlexanruRadu, Elena OanaTerecoasa, OvidiuAlexandruBajenaru, Cristina Tiu. Etiological classification of ischemic stroke. Clinical Neurology and Neurosurgery 159 (2017) 93-106. 20. Sheng Li andGerad E. Francisco. New insights into the pathophysiology of post-stroke spasticity. Frontiers in Human Neuroscience.9:192. 21. Hyung-Sikkim, PhD, et al. Primary and secondary gait deviations of stroke survivors and their association with gait performance. J. Phys. Ther. Sci. 28:2634-2640, 2016. 22. Juan-Manuel Belda-Lois , et al. Rehabilitation of gait after stroke: a review towards a top-down approach. Journal of Neuro Engineering and Rehabilitation2011, 8:66. 23. AuroreThibaut, et al. Spasticity after stroke: Physiology, assessment and treatment. Brain Injury, Early Online: 1–13 (2013). 24. Cinara Stein, MSc; Carolina Gassen Fritsch, Ft; Caroline Robinson, MSc; GracieleSbruzzi, Rodrigo Della MeaPlentz, DSc. Effects of Electrical Stimulation in Spastic Muscles After Stroke: Systematic Review and Meta Analysis of Randomized Controlled Trials. Stroke. 2015;46. 25. Chun-yuyeh, PhD, PT, Kuen-Horng Tsai, PhD, Fong-Chin Su, PhD, Hsin-Chang Lo, PhD.Effect of a Bout of Leg Cycling with Electrical Stimulation on Reduction of Hypertonia in Patients with stroke. Arch Phys Med Rehabil 2010; 91; 1731-6. 26. Hsin-Chang Lo, PhD, Kuen-Horng Tsai, PhD, Guan-Liang Chang, PhD and Chun-Yu Yeh, PhD, PT. Effects of A Functional Electrical Stimulation-Assisted Leg-Cycling Wheelchair on Reducing Spasticity of Patients After Stroke. J Rehabil Med 2009; 41: 242-246. 27. Lorie Thein Brody, Carrie M. Hall. Therapeutic Exercise, Moving TowardFunction.Third edition, page no.115-117. 28. Neural plasticity and disorders of nervous system by Dr. AAGE. R. MOLLER. 29. Susan B. O’Sullivan, Thomas J. Schmitz, GeorgeD.Fulk. Physical rehabilitation- 6th edition, page no.645-655. 30. Amir H Bakhtiary and ElhamFatemy. Does electrical stimulation reduce spasticity after stroke? A randomized controlled study. Clinical Rehabilitation 2008; 22: 418-425. 31. Janine M. Gregson, MRCP. Reliability of the Tone Assessment Scale and the Modified Ashworth Scale as clinical tool for assessing post stroke spasticity. Arch Phys Med Rehabil 1999; 80:1013-6. 32. Johanna Jonsdottir, ScD, DavideCattaneo, PT. Reliability and validity of the dynamic gait index in persons with chronic stroke. Arch Phys Med Rehabil 2007; 88:1410-5.