Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial

[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the paretic lower limb. The BTG completed strength training in the paretic and non-paretic lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results] In both groups, the lower limb strengthening exercise for balance and walking significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke patients.

[1]  T. Matyas,et al.  Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? , 2000, Disability and rehabilitation.

[2]  S. Bagg,et al.  The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting. , 1999, Archives of physical medicine and rehabilitation.

[3]  Richard S. J. Frackowiak,et al.  The functional anatomy of motor recovery after stroke in humans: A study with positron emission tomography , 1991, Annals of neurology.

[4]  Post-stroke hemiplegia; crural muscle strength and structure. , 1980, Scandinavian journal of rehabilitation medicine. Supplement.

[5]  E Knutsson,et al.  Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function. , 1995, Archives of physical medicine and rehabilitation.

[6]  S. Olney,et al.  Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. , 1999, Archives of physical medicine and rehabilitation.

[7]  J. Eng Strength Training in Individuals with Stroke. , 2004, Physiotherapy Canada. Physiotherapie Canada.

[8]  J. Judge,et al.  Functional base of support decreases with age. , 1994, Journal of gerontology.

[9]  R W Bohannon,et al.  Association of paretic lower extremity muscle strength and standing balance with stair-climbing ability in patients with stroke. , 1991, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[10]  Richard W. Bohannon,et al.  Discharge Function and Length of Stay for Patients with Stroke are Predicted by Lower Extremity Muscle Force on Admission to Rehabilitation , 2001, Neurorehabilitation and neural repair.

[11]  C. Richards,et al.  Mechanisms of disturbed motor control in ankle weakness during gait after stroke. , 2002, Gait & posture.

[12]  S. Hawkins,et al.  Expression of the bilateral deficit during reflexively evoked contractions. , 2003, Journal of applied physiology.

[13]  S. Gandevia,et al.  The distribution of muscle weakness in upper motoneuron lesions affecting the lower limb. , 1990, Brain : a journal of neurology.

[14]  Eli Carmeli,et al.  Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke , 2009, Disability and rehabilitation.

[15]  Richard W. Bohannon,et al.  Limb Muscle Strength is Impaired Bilaterally after Stroke , 1995 .

[16]  Richard W. Bohannon Selected determinants of ambulatory capacity in patients with hemiplegia , 1989 .

[17]  S. Studenski,et al.  Functional reach: a new clinical measure of balance. , 1990, Journal of gerontology.

[18]  R L Hewer,et al.  Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[19]  J. Eng,et al.  Reliability of lower extremity strength measures in persons with chronic stroke. , 2002, Archives of physical medicine and rehabilitation.

[20]  J. Stinear,et al.  A paradox: after stroke, the non‐lesioned lower limb motor cortex may be maladaptive , 2010, The European journal of neuroscience.

[21]  R W Bohannon,et al.  Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke. , 1992, Archives of physical medicine and rehabilitation.

[22]  Corticospinal tract integrity correlates with knee extensor weakness in chronic stroke survivors , 2011, Clinical Neurophysiology.

[23]  J. Hidler,et al.  Understanding Motor Impairment in the Paretic Lower Limb After a Stroke: A Review of the Literature , 2009, Topics in stroke rehabilitation.

[24]  A. de Haan,et al.  Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke , 2008, Clinical physiology and functional imaging.

[25]  R L Hewer,et al.  Motor loss and swallowing difficulty after stroke: frequency, recovery, and prognosis. , 1987, Acta neurologica Scandinavica.

[26]  S. Studenski,et al.  Functional reach: predictive validity in a sample of elderly male veterans. , 1992, Journal of gerontology.

[27]  Ray-Yau Wang,et al.  The relation between ankle impairments and gait velocity and symmetry in people with stroke. , 2006, Archives of physical medicine and rehabilitation.

[28]  P. Crenna,et al.  A motor programme for the initiation of forward‐oriented movements in humans. , 1991, The Journal of physiology.

[29]  A. de Haan,et al.  Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke. , 2009, Archives of physical medicine and rehabilitation.

[30]  J. Whitall,et al.  Repetitive Bilateral Arm Training With Rhythmic Auditory Cueing Improves Motor Function in Chronic Hemiparetic Stroke , 2000, Stroke.

[31]  Y. Kim,et al.  Ipsilateral motor pathway confirmed by combined brain mapping of a patient with hemiparetic stroke: a case report. , 2004, Archives of physical medicine and rehabilitation.

[32]  W. Byblow,et al.  Functional potential in chronic stroke patients depends on corticospinal tract integrity. , 2006, Brain : a journal of neurology.

[33]  R Langton-Hewer,et al.  The hemiplegic arm after stroke: measurement and recovery. , 1983, Journal of neurology, neurosurgery, and psychiatry.

[34]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[35]  A. Shumway-cook,et al.  Predicting the probability for falls in community-dwelling older adults. , 1997, Physical therapy.

[36]  P A Wolf,et al.  Residual disability in survivors of stroke--the Framingham study. , 1975, The New England journal of medicine.

[37]  J. Eng,et al.  The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. , 2003, Physical therapy.

[38]  S. Olney,et al.  Hemiparetic gait following stroke. Part I: Characteristics , 1996 .

[39]  D. Bourbonnais,et al.  Weakness in patients with hemiparesis. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[40]  R. Neptune,et al.  Does unilateral pedaling activate a rhythmic locomotor pattern in the nonpedaling leg in post-stroke hemiparesis? , 2006, Journal of neurophysiology.