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Pegito I1,2, Lambeck J3, Torres-Parada M2, Vivas Miranda JG4, Vivas Costa J2
1School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland, 2Faculty of Physiotherapy, University of A Coruña, A Coruña, Spain, 3Zhongshan Vocational College, Nanjing, China, 4Universidade Federal da Bahia, Physics Institute, Biosystems Lab, Salvador da Bahia, Brazil
Background: A large number of people having sustaining a stroke present varying degrees of permanent aftermaths, making it the leading cause of complex and long-term disability in adults. Positive cortical reorganization after stroke is driven by repetition of the same task ends up establishing the original body scheme due to the phenomenon of neuronal plasticity. Several studies have shown that task specificity is determining functional improvement after stroke. Circuit Class Training (CCT), offers a practical and efficient way to promote structured practice of task-specific daily activities during stroke rehabilitation. This provide an adapted intervention in order to direct rehabilitation to functional activities. On the other hand, there is increasing scientific evidence on the benefits of aquatic therapy (AT) to recover motor skills in people after stroke. Aquatic therapy is known for providing motor and sensory stimuli that could induce plasticity. Water immersion may enhance the efficacy of physical therapy by providing priming activation to affected areas of the cortex, thereby enhancing signal processing and learning. Therefore, circuit exercises in the aquatic environment could increase the benefits for these patients.
Purpose: This single-blinded randomized controlled trial aimed to determine the effects of aquatic-based circuit class training versus land-based circuit class training, on gait, balance and upper limb function, in people with stroke.
Methods: Twenty-three participants within 3 years of stroke diagnosis, with hemiparesis and able to walk at least 10 m without assistance, were randomized into two groups: aquatic (n=11) and land (n=12). Both groups received 7-weeks of circuit class training, 3-times weekly, totalling 20 sessions, 60 minutes each. The intervention for both groups included ten workstations focused on: aerobic training (5), balance (3) and upper limb function (2). Both interventions were matched in terms of exercises features. Blinded assessors conducted evaluations at baseline, post-intervention and 20 days of follow-up. Standardized tools included The 10 Meters Walk Test, 2 Minute Walk Test, Timed Up & Go Test, Berg Balance Scale, Fugl-Meyer Assessment of Motor Recovery after Stroke, Box & Block test, Functional Reach Test, the Activities-Specific Balance Confidence Scale and a Movement Analysis software (Cvmob).
Results: At baseline, the groups were similar in all variables analyzed. Both aquatic and land-based training were effective in the evaluated outcomes. There were differences (p=.024) on the Berg Balance Scale between the AT group and the land group in post-intervention assessment. Only within the AT group there were significant differences in the stride length (p=.001) and the stand-up speed (p=.005) in post-intervention scores. There was a main effect for both groups of therapies in gait (10MWT, 2MWT and stride speed), balance (TUG) and upper limb function (FMA and BBT) in post-intervention and follow-up scores. There was no difference in either of the two groups for the Functional Reach Test and the Activities-Specific Balance Confidence Scale.
Conclusion(s): Circuit class training in water or land lead to improvements in gait, balance and upper limb function following stroke.
Implications: Circuit class training in water or land may be useful therapeutic approaches for gait, balance and upper limb functional impairments in people after stroke.
Keywords: Circuit class training, Stroke, Aquatic therapy
Funding acknowledgements: This study was supported by a Research grant- CoFiGa 2016-2017 from Official College of Physiotherapists of Galicia, Spain.
Purpose: This single-blinded randomized controlled trial aimed to determine the effects of aquatic-based circuit class training versus land-based circuit class training, on gait, balance and upper limb function, in people with stroke.
Methods: Twenty-three participants within 3 years of stroke diagnosis, with hemiparesis and able to walk at least 10 m without assistance, were randomized into two groups: aquatic (n=11) and land (n=12). Both groups received 7-weeks of circuit class training, 3-times weekly, totalling 20 sessions, 60 minutes each. The intervention for both groups included ten workstations focused on: aerobic training (5), balance (3) and upper limb function (2). Both interventions were matched in terms of exercises features. Blinded assessors conducted evaluations at baseline, post-intervention and 20 days of follow-up. Standardized tools included The 10 Meters Walk Test, 2 Minute Walk Test, Timed Up & Go Test, Berg Balance Scale, Fugl-Meyer Assessment of Motor Recovery after Stroke, Box & Block test, Functional Reach Test, the Activities-Specific Balance Confidence Scale and a Movement Analysis software (Cvmob).
Results: At baseline, the groups were similar in all variables analyzed. Both aquatic and land-based training were effective in the evaluated outcomes. There were differences (p=.024) on the Berg Balance Scale between the AT group and the land group in post-intervention assessment. Only within the AT group there were significant differences in the stride length (p=.001) and the stand-up speed (p=.005) in post-intervention scores. There was a main effect for both groups of therapies in gait (10MWT, 2MWT and stride speed), balance (TUG) and upper limb function (FMA and BBT) in post-intervention and follow-up scores. There was no difference in either of the two groups for the Functional Reach Test and the Activities-Specific Balance Confidence Scale.
Conclusion(s): Circuit class training in water or land lead to improvements in gait, balance and upper limb function following stroke.
Implications: Circuit class training in water or land may be useful therapeutic approaches for gait, balance and upper limb functional impairments in people after stroke.
Keywords: Circuit class training, Stroke, Aquatic therapy
Funding acknowledgements: This study was supported by a Research grant- CoFiGa 2016-2017 from Official College of Physiotherapists of Galicia, Spain.
Topic: Neurology: stroke; Neurology
Ethics approval required: Yes
Institution: Autonomic Committee of Research Ethics of Galicia, Spain
Ethics committee: Committee of A Coruña-Ferrol
Ethics number: 2015/732
All authors, affiliations and abstracts have been published as submitted.
