Effect of Task-Based Mirror Therapy on Motor Recovery of the Upper Extremity in Chronic Stroke Patients: A Pilot Study

Abstract

Background and Aims: Mirror therapy (MT) is an alternative therapeutic intervention that uses the interaction of visuomotor-proprioception inputs to enhance movement performance of the impaired limb. Despite strong evidence for task-specific training in stroke, MT has been investigated using nontask movements. The aim of this pilot study was to assess the effectiveness of task-based MT on motor recovery of the upper extremity in chronic stroke patients. Method: In a pretest-posttest single-group design, a convenience sample of 13 chronic stroke patients at an occupational therapy department of a rehabilitation institute was assessed on a task-based MT intervention. Participants received a task-based MT program, performing various tasks by the less affected upper extremity and observing in the mirror box along with conventional management, 4 days per week for 4 weeks. Fugl-Meyer Assessment (FMA), which includes subsection upper extremity (FMA-UE) and subpart upper arm (FMA-UA) and hand (FMA-WH), was used as an outcome measure. Results: Participants showed no significant improvement for FMA-UE and FMA-UA at postassessment. FMA-UE changed from 43% to 51%. Post FMA-UA score showed only 2% improvement. However, there was statistically significant improvement on mean scores of FMA-WH at postassessment (16.21 ± 3.06) as compared with the prescores (12.29 ± 3.1; P < .05). FMA-WH improved from 41% to 54%. Conclusions: The preliminary findings suggest that task-based MT is effective in improving wrist and hand motor recovery in chronic stroke patients. Further studies in the form of randomized trials are needed to validate its effectiveness.     

Effect of intensive motor training with repetitive transcranial magnetic stimulation on upper limb motor function in chronic post-stroke patients with severe upper limb motor impairment

Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment.

Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment.

Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl–Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention.

Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6–18.0; WMFT: 3.6–3.3, p < 0.001).

Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.     

Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: A pilot,randomized controlled trial

ABSTRACT

Objective: To assess the effect of interactive video gaming (IVG) with Nintendo Wii (Wii) supplemented to conventional therapy in rehabilitation of children with cerebral palsy (CP). Design: Randomized, controlled, assessor-blinded study. Participants: Children with CP; 10 children each in the control and intervention groups. Intervention: IVG using Wii, given as a supplement to conventional therapy, for 45 min per day, 6 days a week for 3 weeks. The children in the control group received conventional therapy alone. Outcome Measures: Posture control and balance, upper limb function, visual-perceptual skills, and functional mobility. Results: Significant improvement in upper limb functions was seen in the intervention group but not in the control group. Improvements in balance, visual perception, and functional mobility were not significantly different between control and intervention groups. Conclusions: Wii-based IVG may be offered as an effective supplement to conventional therapy in the rehabilitation of children with CP.     

Efficacy of modified constraint induced movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: A randomized controlled trial

Purpose: The objective of this randomized single blind (outcome assessor) controlled trial was to evaluate the efficacy of 4 weeks of modified constraint induced movement therapy (mCIMT) in improving upper limb function in 3–8 years old children with hemiplegic cerebral palsy. Methods: Thirty-one children were randomly assigned to receive the mCIMT (N = 16) with conventional therapy or conventional therapy alone (N = 15). Children were evaluated three times (at enrollment, follow up at 4 weeks and 12 weeks). The primary outcome measure was difference in “change in mean total QUEST scores” at 4 weeks of intervention between the intervention and the control arm. Results: After 4 weeks of intervention, mCIMT group showed significant change in the affected upper limb in QUEST scores (10.7 ± 5.2 vs 1.4 ± 1.7, p < 0.001) and time (s) to complete nine-hole-pegboard test compared with control group [60(0–130) vs 5(−12 to 30), p < 0.001]. The improvement observed in upper limb function after 4 weeks of intervention persisted 8 weeks after discontinuation of intervention in mCIMT group. Conclusion: The modified constraint induced movement therapy appears to be effective in improving upper limb function in 3–8 years old hemiplegic cerebral palsy children.     

Study to assess the effectiveness of modified constraint-induced movement therapy in stroke subjects: A randomized controlled trial

Background and Purpose:

The purpose of this study was to assess the effectiveness of modified constraint induced movement therapy (m-CIMT) in stroke subjects.

Materials and Methods:

A total of forty sub-acute stroke subjects were randomly assigned to either a m-CIMT (n = 20) or in a control group (n = 20). The m-CIMT group (14 men, 6 women; mean age = 55.2 years) consisted of structured 2 h therapy sessions emphasizing affected arm use, occurring 5 times/week for 2 weeks. A mitt was used to restrain the unaffected arm for 10 h/day for 2 week. The control group (11 men, 9 women; mean age = 56.4 years) consisted of conventional rehabilitation for time-matched exercise program. The outcome measures were evaluated at pre- and post-intervention by using the Wolf Motor Function Test (WMFT) and Fugl-Meyer assessment (FMA) of motor recovery after stroke.

Results:

After intervention significant effects were observed in m-CIMT group on WMFT (pre-test and post-test score was 28.04 ± 6.58, 13.59 ± 2.86; P =0.003). Similarly on FMA (pre- and post-test score was 31.15 ± 6.37, 55.7 ± 6.4; P = 0.00).

Conclusion:

There is a significant improvem ent in upper extremity function so it indicates that m-CIMT is effective in improving the motor function of the affected arm in stroke subjects. However, its long-term effect has not proved since there was no follow-up after intervention.     

Effects of Repetitive Facilitative Exercise on Spasticity in the Upper Paretic Limb After Subacute Stroke

Background

Repetitive facilitative exercise is an effective method for recovery of the affected limb in stroke patients. However, its effects on spasticity are unknown. We aimed to determine the effects of repetitive facilitative exercise on spasticity using the Modified Ashworth Scale (MAS) and the F-wave, and to determine the relationship between the changes in spasticity and functional recovery of the hemiplegic upper limb.

Active Video-Gaming Effects on Balance and Mobility in Individuals with Chronic Stroke: A Randomized Controlled Trial

Abstract

Background: Treatments that provide feedback, increase practice with multiple repetitions, and motivate patients are essential to rehabilitation post stroke. Objective: To determine whether playing active video games results in improved balance and mobility post stroke. Methods: Thirty participants with chronic (time since stroke = 3.0 [2.9] years) hemiparesis post stroke were randomly assigned to a gaming group or normal activity control group. Gaming systems provided participants with an interactive interface of real-time movement of either themselves or an avatar on the screen. Participants played games 50–60 minutes/day, 4 days/week, for 5 weeks. The intervention was strictly game-play, in standing position, without physical therapy. The control group received no special intervention and continued with normal activity. Both groups were tested prior to, following the 5 weeks (post test), and 3 months following the completion of the study. Outcome measures included the Fugl-Meyer Assessment, Berg Balance Scale, Dynamic Gait Index, Timed Up & Go, 6-minute walk test, 3-meter walk (self-selected and fast), and perception of recovery. Results: No statistically significant differences between or within groups were found through analysis of covariance (covaried for side of hemiparesis) at post test or follow-up. Although the within-group effect sizes were primarily indexed as “small” (< .36), the gaming group exhibited higher within-group effect sizes before and after testing than did the control group on all 7 dependent variables analyzed. Conclusions: Even though the only intervention was game-play, there were small positive effects. Therapist assistance in making more optimum movement choices may be needed before significant improvements are seen with commercially available, general purpose games.     

表面肌电信号对脑卒中患者远程居家康复指导的效果研究

目的探讨表面肌电信号对指导脑卒中患者居家远程康复的效果。方法筛选2014年7月至2015年6月在上海市第五人民医院神经内科住院治疗的脑卒中患者78例,78例患者通过SPSS统计软件按1:1的比例分成两组,分别为表面肌电信号指导进行居家康复的治疗组(39例)与无表面肌电信号指导居家康复的常规组(39例)。采用简化FuglMeyer运动功能量表(FMA)评定上肢功能,通过均方根值(RMS)测定肌肉收缩时的收缩强度。结果康复治疗前,两组患者上肢FMA评分与RMS评分比较,差异无统计学意义(P0.001)。康复治疗后,两组患者上肢FMA评分与RMS评分均较康复治疗前增加,差异具有统计学意义(P0.001)。康复治疗后,治疗组上肢FMA评分与RMS评分均较常规组增加,差异具有统计学意义(FMA:P=0.02;RMS:P=0.018)。结论康复过程中进行表面肌电信号调整康复方案可增强运动功能康复的效果。     

Improving motor imagery practice with synchronous action observation in stroke patients

Background: Action observation (AO) has the potential to improve motor imagery (MI) practice in stroke patients. However, currently only a few results are available on how to use AO effectively.

Objective: The aim of this study is to investigate whether MI practice can be improved more effectively by synchronous AO than by asynchronous AO.

Methods: Ten patients with upper limb motor dysfunction following stroke were selected as the participants. They were divided into two groups to perform MI practice combined with a daily conventional rehabilitation for four consecutive weeks. The control group was asked to perform MI guided by asynchronous AO (MIAAO), and the experimental group was asked to perform the same MI but guided by synchronous AO (MISAO). The event-related power decrease (ERD) in sensorimotor rhythms of electroencephalograph was calculated to reflect the sensorimotor cortex activation and to assess the cortex excitability during MI. Fugl-Meyer assessment (FMA) and pinch strength test (PST) were used to assess the limb motor recovery.

Results: The ERD pattern of the experimental group not only had greater amplitude and longer duration, but also included more frequency components. Furthermore, the effect sizes of ERD values between the two groups continuously increased (d_ES > 0.8) during the course of treatment. Moreover, the FMA and PST scores achieved with MISAO were also significantly higher than those achieved with MIAAO (p < 0.05).

Conclusions: Compared with MIAAO, MISAO can enhance the excitation of sensorimotor cortex more effectively and lead to a more rapid neurorehabilitation of stroke patients.     

The effect of upper-extremity aerobic exercise on complex regional pain syndrome type I: a randomized controlled study on subacute stroke

Abstract

Background and purpose:

Complex regional pain syndrome type I (CPRS I), is a complex of symptoms characterized by diffuse pain usually with associated swelling, vasomotor instability, and severe functional impairment of the affected extremity in stroke patients. Pain is a prominent feature and is often refractory to variety of treatment.

Methods:

To investigate the clinical, functional, and psychosocial effects of upper extremity aerobic exercise (UEAE) and compare the effect of aerobic exercise with that of conventional physiotherapy in patients with CPRS type I following stroke as a randomized controlled assesor blinded 4?week-study. A total of 52 inpatients with stroke [mean age: 65.95?±?8.7 (min.?=?53, max.?=?80) years, and the mean age of the control group was 67.50?±?11.2?years], all within 6?months post-stroke and diagnosed with CPRS I. The UEAE program consisted of an arm crank ergometer (10?W/min), in addition to a conventional physiotherapy (whirlpool, TENS, retrograd massage). Primary outcome measures were CPRS clinical determinants (pain, hyperalgesia, allodynia, and autonomic abnormalities) secondary outcome measures were functional independence measure (FIM), Nottingham Health Profile (NHP), and Beck Depression Scale scores that were performed at 0?month (baseline) and 4?weeks (post-treatment).

Results:

In UEAE group, patients reported significant pain relief (89.9%) and significant decline in CRPS signs and symptoms. The mean change in pain at shoulder, pain at the hand as well as and NHP and BDS scores between groups were statistically significant (P?<?0.05).

Conclusions:

UEAE made an excellent improvement in the symptoms and signs of CRPS I. Combined treatment of conventional physiotherapy and aerobic exercises may be an excellent synthesis for this syndrome in these patients.     

Neuroimaging,serum biomarkers,and patient characteristics as predictors of upper limb functioning 12 weeks after acute stroke: an observational,prospective study

Objective: To evaluate the potential of neuroimaging, serum biomarkers, stroke etiology, and clinical characteristics as predictors of upper limb functioning 12 weeks after stroke.

Methods: This was a prospective, observational study of patients (18–85 years-old) hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery. Patients were hospitalized at a stroke rehabilitation center, where they underwent a standardized rehabilitation program. Clinical, imagiology, laboratory (biomarkers: C-reactive protein, D-dimer, and fibrinogen, and S100 calcium binding protein β [S100β]), and functionality assessments were conducted four different times: within 24 hours, and at 48 hours, 3 weeks, and 12 weeks after acute stroke.

Results: Upper limb functioning at 12 weeks was significantly associated with Alberta Stroke Program Early CT Score (ASPECTS) score (OR:2.012 [CI:1.349–3.000]; P = 0.001) and S100β protein levels (OR:0.997 [CI:0.994–0.999]; P = 0.007). Advanced age was associated with poor upper limb functioning. S100β protein levels < 140.5 ng/L at 48 hours and ASPECTS scores ≥ 7.5 within 24 hours of admission predicted good hand functioning at 12 weeks. Upper limb functioning and general functioning were significantly correlated (P < 0.001), with strong negative correlations (all correlation coefficients ≤–0.586) for all comparisons.

Conclusion: ASPECTS score ≥ 8 within 24 hours and S100β protein < 140.5 ng/L at 48 hours predict better upper limb functioning, while advanced age predicts worse upper limb functioning 12 weeks after stroke.     

A Personalized Sensor-Controlled Microstimulator System for Arm Rehabilitation Poststroke. Part 2: Objective Outcomes and Patients’ Perspectives

Objective: To examine the effect of home‐based electrical stimulation using closed‐loop control of implanted microstimulators on upper limb function and impairment, and subjects' perception of the system. Materials and Methods: Six subjects with poststroke hemiparesis, and reduced upper limb function, who had taken part in Phase 1 of the study, were fitted with a personalized closed‐loop control system (Phase 2) and used it at home during performance of functional tasks for 12 weeks (Phase 3). Main outcome measures were: Action Research Arm Test (ARAT), Fugl‐Meyer upper limb assessment (FMA), and motor control (Tracking Index). Subjects' perception of the system was assessed in a structured interview. Results: Improvement in ARAT (p= 0.05), FMA (p= 0.02), and Tracking Index (p= 0.03) during Phase 3. Five subjects said using the system had changed their lives and improved their function, all performed functional tasks with the system, but external components were inconvenient. Conclusions: Closed‐loop control improved in function. Subjective assessment identified that the external sensors were effective.     

抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的作用

目的探讨抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的临床效果。方法将40例脑卒中后上肢痉挛的患者随机分为两组,对照组进行常规的康复训练,治疗组在常规康复训练的基础上加用抗痉挛治疗仪进行治疗;分别采用上肢改良Ashworth量表(MAS)、疼痛视觉模拟评分法(VAS)及简化Fugl-Meyer运动功能评定量表(FMA)上肢部分对两组患者治疗前及治疗30d后上肢痉挛程度、疼痛程度及上肢运动功能的变化进行比较。结果治疗前两组MAS分级,VAS评分及FMA评分比较,差异均无统计学意义(P0.05)。治疗后两组MAS分级及VAS评分显著低于治疗前(P0.05),且治疗组降低程度更加显著;两组FMA评分均有显著提高,且治疗组提高程度优于对照组。结论抗痉挛治疗仪能有效降低脑卒中患者肱二头肌痉挛程度,并能缓解疼痛,提高其运动功能。     

镜像疗法结合循经按摩对脑梗死偏瘫患者上肢功能的疗效观察

目的观察镜像疗法结合循经按摩对脑梗死偏瘫患者上肢运动功能及日常生活活动能力的影响。方法将贵州中医药大学第二附属医院神经内科病房的60例脑梗死偏瘫患者随机分为镜像组、循经按摩组、结合组,每组20例。3组均采取常规治疗及康复,在此基础上,镜像组采用镜像视觉反馈康复训练,循经按摩组采用循上肢手阳明大肠经按摩,结合组在镜像视觉反馈的基础上结合循经按摩。于干预前及干预3周后,比较各组患者患侧上肢Fugl-Meyer运动功能(FMA)、改良Ashworth痉挛评定、改良Barthel指数(MBI)评分。结果3组患者干预前患侧上肢FMA、MBI评分及Ashworth痉挛评定比较,差异均无统计学意义(P>0.05);干预3周后,3组患者患侧上肢FMA、MBI评分均较干预前提高,差异有统计学意义(P<0.05);干预后结合组患侧上肢FMA、MBI得分较镜像组和循经按摩组更优(P<0.05);干预后镜像组Ashworth痉挛评定结果无明显差异(P>0.05),循经按摩组及结合组Ashworth痉挛评定级别均降低,差异有统计学意义(P<0.05);相比镜像组,干预后结合组Ashworth痉挛评定差异有统计学意义(P<0.05)。结论镜像疗法结合循经按摩可以有效降低脑梗死偏瘫患者肌张力,改善患侧上肢运动功能,提高日常生活活动能力,治疗效果优于单独使用镜像疗法和单独使用循经按摩。     

A Randomized Trial Investigating the Influence of Strength Training on Quality of Life in Ischemic Stroke

Background: Strength training post stroke is widely acknowledged as an important part of a rehabilitation program. Muscle strength has been shown to be a significant contributor to physical disability after stroke, which in turn has an immense impact on the reintegration of patients into society, affecting their quality of life.

Objective: This was a randomized intervention trial to determine the effect of a resistance training program on the quality of life in patients with stroke.

Methods: An experimental group (EG), consisting of 11 subjects aged 51.7 ± 8.0 years, and a control group (CG), consisting of 13 subjects aged 52.5 ± 7.7 years, were studied before and after 12 weeks. EG underwent 12 weeks of strength training three times a week. The CG did not undergo strength training during the 12-week study period.

Results: There was a significant increase in quality of life from pre-test to post-test (Δ% = 21.47%; p = 0.021) in EG. There were significant differences in all indicators of quality of life between groups at 12 weeks. There were greater gains in strength in EG than in CG (p ≤ 0.05). There was a negative correlation between the strength gains as determined with the 1RM test and the quality of life, especially in lower limb exercises.

Conclusion: The results of this study indicate that there was an improvement in the measures of strength in EG, and that there was a correlation between improvements in strength and quality of life in these patients who had previously suffered a stroke at least one year prior to study.     

Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients

Abstract

Background:

The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed.

Objective:

To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients.

Methods:

The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl–Meyer scales were used to evaluate the patients.

Results:

After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl–Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner.

Conclusion:

Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.     

Effectiveness of mirror therapy on lower extremity motor recovery,balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

Objective:

To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke.

Design:

A randomized, sham-controlled, assessor blinded, pilot trial.

Setting:

Inpatient stroke rehabilitation unit.

Subjects:

First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled.

Intervention:

Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups.

Outcome Measures:

Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC).

Results:

Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11) and control group (N = 11). Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02). Significance was set at P < 0.05.

Conclusion:

Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility.Key Words: Acute stroke, balance, mobility, mirror therapy, motor recovery     

Relationship Between Motor Function,DTI, and Neurophysiological Parameters in Patients with Stroke in the Recovery Rehabilitation unit

ObjectivesWe investigated the relationship between pyramidal tract evaluation indexes (i.e., diffusion tensor imaging, transcranial magnetic stimulation (TMS)-induced motor-evoked potential (MEP), and central motor conduction time (CMCT) on admission to the recovery rehabilitation unit) and motor functions at discharge in patients with ischemic or hemorrhagic stroke.Materials and MethodsSeventeen patients were recruited (12 men; 57.9 ± 10.3 years). The mean fractional anisotropy (FA) values of the right and left posterior limbs of the internal capsule were estimated using a computer-automated method. We determined the ratios of FA values in the affected and unaffected hemispheres (rFA), TMS-induced MEP, and the ratios of CMCT in the affected and unaffected hemispheres (rCMCT) and examined their association with motor functions (Fugl–Meyer Assessment (FMA) and Action Research Arm Test (ARAT)) at discharge.ResultsHigher rFA values of the posterior limb of the internal capsule on admission to the recovery rehabilitation unit led to a better recovery of upper limb function (FMA: r = 0.78, p < 0.001; ARAT: r = 0.74, p = 0.001). Patients without MEP had poorer recovery of upper limb function than those with MEP (FMA: p < 0.001; ARAT: p = 0.001). The higher the rCMCT, the poorer the recovery of upper limb function (ARAT: r = ?0.93, p < 0.001). However, no association was observed between the pyramidal tract evaluation indexes and recovery of lower limb motor function.ConclusionsEvaluating the pyramidal tract is useful for predicting upper limb function prognosis, but not for lower limb function prognosis.     

Improving balance with wobble board exercises in stroke patients: single-blind,randomized clinical trial

Background: A primary objective in stroke rehabilitation is to restore functional balance, in order to reduce falls.

Objectives: To identify the efficacy and safety of wobble board exercises when combined with conventional physiotherapy, in improving balance in hemiplegic patients following ischemic strokes.

Methods: A block-randomized, controlled, observer blinded, superiority trial was conducted on ambulatory hemiplegic patients following ischemic strokes of middle cerebral artery territory. Subjects in the control group received a conventional physiotherapy regime. Subjects in the intervention group received training on a wobble board combined with conventional physiotherapy. Main Outcome measures were the improvement of Four-Square Step Test (FSST) and the Berg Balance Scale (BBS), both of which assess functional balance at the end of 6 weeks.

Results: Thirty patients were randomly assigned for intervention (n = 15) and control (n = 15) groups. One patient dropped out from the study, leaving 29 eligible for the analysis. Intervention and control groups were comparable in sociodemographic characteristics and pre-test scores of balance. A repeated-measures MANOVA showed a significant difference in improvement of balance between the two study groups after 6 weeks [F(1,28) = 32.6,p = .000; Wilk’s lambda = .46]. The improvement of mean score of balance in interventional group was greater than in the control group [BBS:9.5 (intervention group),5.5 (control group); FSST:3.9 (intervention group),1.7 (control group)]. There were no injuries in both groups.

Conclusions: Wobble board exercises, when combined with the conventional physiotherapy, are safe and effective in restoring functional balance in patients with hemiplegia following ischemic strokes.