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S. Ganapathy1, R. Vasanthan2, K.P. Suresh3
1The Oxford College of Physiotherapy/Rajiv Gandhi University of Health Sciences, Bengaluru, India, 2The Oxford College of Physiotherapy, Bengaluru, India, 3Animal Diseases Monitoring and Surveillance (PD_ADMAS), Biostatistician, Bengaluru, India
Background: The walking proficiency in person with chronic stroke ranges from physiological walker to a community walker. It has been observed that one-third of stroke survivors don’t achieve community ambulation. This may lead to locomotor activity limitations and participation restrictions in society.
Purpose: A novel gait training program that includes exposure to environmental constraints has been developed. This study is conducted to know the effect of such novel community ambulation training in improving ambulatory status and quality of life of a person with a stroke.
Methods: Design: Multicenter, parallel randomized, open-labeled, controlled trial. A computerized random generation of the group through concealed allocation.
Participants: This Study included a person with chronic stroke(n=34). After adjusting the drop out who fulfill the inclusion and exclusion criteria were included (n=30).The age group of 45 to 65 with 6 months and above a duration of stroke. The experimental(N=15) and control group (n =15).
Intervention: The control group received conventional physiotherapy training including gait training in a clinical environment for 60 meters. The experimental group received simulated community ambulation training(SCAT) included overground walking of 60 meters with five different environmental constraints which include,
1. Temporal factors: The subject walked at three different speeds. I e slow, self-selected and fast speeds.
2. Ambient conditions: The subject walked in a brighter environment first and then a darker environment by wearing a darker spectacle.
3. Attention demands: The subjects were asked to talk while walking by answering the questions asked by the therapist.
4. Terrain Characters: An obstacle of two different height and length were placed in path. The subjects were asked to cross the obstacle and walk.
5. Physical load: The subjects were asked to lift and carry 1 kg fruit bag/basket with the unaffected arm and walk in all conditions.
Outcome measures: pre- and post-training and after a follow-up period of 1 month were measured using a community balance and mobility scale and activity-specific balance confidence scale, walking ability questionnaire, and stroke-specific Quality of Life.
Participants: This Study included a person with chronic stroke(n=34). After adjusting the drop out who fulfill the inclusion and exclusion criteria were included (n=30).The age group of 45 to 65 with 6 months and above a duration of stroke. The experimental(N=15) and control group (n =15).
Intervention: The control group received conventional physiotherapy training including gait training in a clinical environment for 60 meters. The experimental group received simulated community ambulation training(SCAT) included overground walking of 60 meters with five different environmental constraints which include,
1. Temporal factors: The subject walked at three different speeds. I e slow, self-selected and fast speeds.
2. Ambient conditions: The subject walked in a brighter environment first and then a darker environment by wearing a darker spectacle.
3. Attention demands: The subjects were asked to talk while walking by answering the questions asked by the therapist.
4. Terrain Characters: An obstacle of two different height and length were placed in path. The subjects were asked to cross the obstacle and walk.
5. Physical load: The subjects were asked to lift and carry 1 kg fruit bag/basket with the unaffected arm and walk in all conditions.
Outcome measures: pre- and post-training and after a follow-up period of 1 month were measured using a community balance and mobility scale and activity-specific balance confidence scale, walking ability questionnaire, and stroke-specific Quality of Life.
Results: The mean age of the control group was 54±.60 and the experimental group with the mean age of 52.93± 5.99 with a male-female ratio of 12:3 in each group. The experimental group showed statistically significant improvement in the perceived balance confidence with the ABC scale improved from 53% to 76% and the effect was consisted at 1 month follow up(P = 0.001) and the effect persisted at a month follow up period at P = 0.001 when compared with the control group. But there was no statistical difference in other outcome measures. No Harm was reported in any group.
Conclusion(s): The SCAT is feasible in stroke rehabilitation and it may improve the balance confidence to perform activity and participation in the society. However future large sample studies may confirm the findings observed here.
Implications: The simulated community ambulation training may be useful in stroke rehabilitation programs to prepare stroke survivors to improve their quality of life.
Funding, acknowledgements: NIL.
Keywords: Simulated Community Ambulation, Chronic Stroke, Gait training
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: The Oxford college of Physiotherapy,Bengaluru,India
Committee: TOCPTRBER
Ethics number: TOCPTRBER/07MT672/2008
All authors, affiliations and abstracts have been published as submitted.
