File
Cochrane M.E.1, Eksteen C.A.1, Olivier B.2
1Sefako Makgatho Health Sciences University, Physiotherapy, Pretoria, South Africa, 2University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa
Background: Many patients who sustain a stroke are unable to ambulate functionally after receiving rehabilitation. Functional ambulation entails walking at a speed of 0.8 metres per second, negotiating uneven surfaces and climbing stairs. Patients who do not reach a level of functional ambulation experience decreased perceived quality of life (QOL). Stair-descent is retrained during rehabilitation but no literature provides evidence that regular stair-descent exercises facilitate the optimal biomechanical sequence of movement that will translate to improved propulsion during gait.
Purpose: The aim of this study was to determine if raised-heel stair-descent exercises improve the postural control that influences movement and functioning of the lower limb during ambulation significantly more than regular stair-descent exercises.
Methods: A single-blind cluster randomised controlled trial (RCT) was conducted. Thirty-two participants, in the sub-acute phase of recovery post-stroke were recruited from three rehabilitation centres. Patients suffering from multiple strokes, uncontrolled co-morbid diseases; and severe hemispacial neglect, were excluded from the study. Upon providing consent, participants were clustered to either a control- or experimental group. All participants were assessed with: the Functional Gait Analysis (FGA); Qualisys© motion analysis; and the Timed Ten Metre Walk Test (10MWT). Participants in both groups received 45 minutes task-orientated rehabilitation. Additionally, the experimental group received 20 raised-heel stair-descent exercises and the control group 20 regular stair-descent exercises five days a week, for two weeks.
Results: The 2D motion analysis indicated significantly more symmetry in the experimental groups joint angles compared to the control group (p=0.0075) in the frontal plane.
Saggital plane measurements during heel-strike and mid-stance showed that the ankle-, knee- and hip- joint ranges were also significantly more symmetrical in the experimental group(p=0.0000). On the FGA the experimental group improved significantly more than the control group (p=0.0206).
Conclusion(s): The symmetrical alignment of the lower-limb joints increased upper trunk stability and created the ideal circumstances for anticipatory postural adjustments to occur. The correct sequence of lower-limb muscle activation was also facilitated by the symmetrically aligned joints. The impairment-level improvements resulted in decreased physiological effort during gait and increased contra-lateral step lengths. Functional improvements included faster gait speed and the ability of experimental group participants to clear obstacles; walk with closed eyes and climb stairs.
Implications: The results from this study indicate that raised-heel stair-descent exercises are more beneficial than regular stair-descent exercises in improving short-term outcomes on impairment-, activity- and participation levels.
Funding acknowledgements: The NRF staff replacement grant
Topic: Neurology: stroke
Ethics approval: University of Pretoria, Faculty of Health Sciences Research Ethics Committee; South Africa
All authors, affiliations and abstracts have been published as submitted.
