| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 97 === Imbalance is a major disability following stroke which contributes to the activity of daily living in these patients. In recent years, task-oriented approach has become a main stream for balance training in physical therapy for the stroke patients. Literature revealed that task-oriented approach may lead to significant improvements in balance function, postural control, balance confidence, walking speed and walking endurance. Impairment of sensory integration for balance is a major contributing factor for imbalance after stroke. Based on the concept of system-based task-oriented approach, a task-oriented approach balance function training combines sensory manipulation may lead to improvement in both balance impairment and balance function more efficiently, hence requiring less training time to result in significant improvement.
Previous study showed that after a 16-hour task-oriented balance training with sensory manipulation, stroke patients improved their postural control. The effect on balance function was not investigated in this previous study. The aim of our study was to investigate the immediate and long term treatment effect of a 6-hour task-oriented balance training with sensory manipulation on postural control and balance function in stroke patients.
The design of this study was a single-blind randomized controlled trial. The sample size was 39. Patients with stroke were recruited from the Department of Physical Medicine and Rehabilitation, Department of Neurology in National Taiwan University Hospital, other hospitals, community and family support groups. After consent, subjects were randomized to either the balance training group or a control training group. Both groups received 60 minutes/day, 2 days/week for a total of 3 weeks of exercise training. Outcome tests included the Berg Balance Scale, the Timed Up and Go Test, the Dynamic Gait Index and the dynamic posturography (Sensory Organization Test, Limits of Stability of the NeuroCom Smart Balance Master system). These tests were conducted during baseline, immediately after training and at 4 weeks after training. Two-way ANOVA with repeated measure followed by post hoc tests was used for analyzing the differences between two groups. A two-way ANCOVA was used to analyze the Equilibrium Score in the eyes open, sway referenced surround and support condition. The relationships between outcomes and changes were analyzed by Pearson’s correlation coefficient. The results were accepted as statistically significant at p<0.05.
There were no significant group differences in baseline data except the equilibrium score in eye open, sway reference surround and support condition derived from the Sensory Organization Test. After the 6-hour balance training, no significant differences were found between experimental and control groups in all variables. Significant within-group improvement was noted in the Berg Balance Scale, the Timed Up and Go Test, the Dynamic Gait Index, the Composite Equilibrium Score, the Equilibrium Score in the eyes open, sway referenced support condition, the eyes closed, sway referenced support condition and the eyes open, sway referenced surround and support condition. Further analysis suggested small differences in favor of the experimental group.
No evidence was found for the superiority of the task-oriented balance training with sensory manipulation in stroke patients. This was possibly due to the wide between-group variation, small sample size, appropriateness of outcome measures and the content of balance training program. However, balance function and postural control improved more in the balance training group than in the control group from pre-test to post-test. Therefore, this study showed that a 6-hour task-oriented balance training improved balance function and postural control in stroke patients. Further studies are recommended.
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