EFFECT OF HAPTIC ANCHOR SYSTEM ON REHABILITATION OF DYNAMIC BALANCE AND GAIT IN PATIENTS WITH CHRONIC STROKE

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 EFFECT OF HAPTIC ANCHOR SYSTEM ON REHABILITATION OF DYNAMIC BALANCE AND GAIT IN PATIENTS WITH CHRONIC STROKE

Shams K. A. Elbaz1 , Mohammed Sadek Badawy1 , Amr Hassan 2 , Ahmed S. Ali 3,1 1 Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Egypt; 2 Professor of Neurology, Department of Neurology, Faculty of Medicine, Cairo University, Egypt; 3 Assistant Professor of Physical Therapy, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al-Qurayyat, Jouf University, KSA. 

 

Abstract 

 

Background: 

 

Motor impairment and loss of balance and gait are the main factors affecting the independent function and activity participation of stroke patients. Haptic Anchor System is one of the modalities that can be used in physiotherapy and has a great effect on different impairments like improving postural control, trunk stability during balance tasks, and balance control during walking. 

 

 Objective: 

 

To determine the effect of the haptic anchor system on the rehabilitation of dynamic balance and gait in patients with chronic stroke. Patients and Methods: Thirty patients with unilateral ischemic stroke of both sexes participated in this study, whose ages ranged between 45 to 60 years. They were randomly distributed into two equal groups: the control group (GA) and the study group (GB). The control group received a designed physical therapy program including a conventional balance and gait program, and the study group received the same designed physical therapy program given to the control group for balance and gait in addition to the haptic anchor system. The treatment was conducted for 12 sessions (2 sessions/week) 45 minutes for each session. The study was conducted a 6-week period in which all patients were assessed for dynamic balance and gait at baseline and after a 6-week intervention by using Biodex Balance System (BBS), Biodex gait trainer 2 TM treadmill, dynamic gait index (DGI) and timed up and go test (TUG). 

 

Results: 

 

Comparison post-treatment results for both groups revealed statistically significant improvement of the step length, ambulation index, walking speed, LOS, TUG, APSI, and OASI in study group B compared to the control group A (P<0.05). Comparison between both groups revealed no significant difference regarding DGI (p = 0.33) and MLSI (p = 0.30) post-treatment. 

 

Conclusion: 

 

Conventional balance and gait trainings alone may be not sufficient to improve balance and gait in chronic stroke patients .Adding the haptic anchor system to the rehabilitation program seems to be favorable approach in improving dynamic balance parameters (APSI, MLSI, OASI, and LOS) and gait parameters (step 320Revista I b eroamericana d e P sicología d el E j ercicio y el D eporte. V ol. 19, n º 3 ( 2024)length, ambulation index, walking speed, DGI, and TUG) in the rehabilitation ofpatients with chronic stroke than conventional program alone.Keywords: Dynamic balance, Gait, Haptic anchor system, Stroke. BiodexBalance System, Biodex gait trainer, Timed up and go test.

 

 Introduction

 

 According to Coupland et al. (2017), stroke is a neurological disorder that results from an immediate focused injury to the central nervous system (CNS)resulted from vascular issues including cerebral infarction, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage. It is a leading etiology of impairment and mortality globally.Regarding to Rajsic et al. (2019), stroke is a major cause of morbidity anddisability that entails high financial expenses for post-stroke care. According to Charvet et al. (2015), almost 50% of individuals who have had a persistent stroke experience motor impairment. Among these, one of the main functional deficiencies in stroke survivors has been found to be difficulty walking (Winsteinet al., 2016). Stroke incidence varies throughout Middle Eastern nations, and the condition is steadily growing in importance (Habibi-koolaee et al., 2018).The primary characteristics influencing stroke patients' ability to function independently and participate in activities are motor dysfunction, loss ofbalance, and gait (Zhang et al., 2021). Stroke survivors may experience significant consequences from walking difficulties, including diminished quality of life (QoL) and limited capacity to carry out daily tasks independently (Arientiet al., 2019).Walking-related loss of balance is common following a stroke; according to Beyaert et al. (2015), 70% of stroke survivors report falling within a year of their stroke. Reduced walking speed is a hallmark of post-stroke gait and is caused by muscle weakness and lack of voluntary motions, which are common issues in the early stages of a stroke (Wonsetler and Bowden, 2017).Moreover, a significant number of post-stroke patients have strong temporal and spatial inter-limb asymmetries, which range from 48% to 82% and 44%to 62%, respectively. These asymmetries are linked to poor standing balance control during locomotion (Boehm et al., 2016). Stroke patients' reduced preferred walking speed, stride length, and cadence are characteristics of their gait (Rinaldi and Monaco, 2013). The anchor system was created by Mauerberg-Decastro in 2004 with the goal

of enhancing physical stability. It functions as a haptic information mediator between the participant's body and the ground. By actively exploring the static or dynamic environment and interpreting spatiotemporal stimuli as they interrelate with various mechanoreceptors types, the haptic anchor system, also known as touch feedback, functions (Coelho et al., 2017). Depending on the kinesthetic mechanoreceptors’ input in the arms and cutaneous mechanoreceptors in the fingers and hands, these haptic anchors offer data about the body's posture in relation to the supporting surface (Batistela et al., 2020). In both younger and older persons, the haptic information supplied by the anchors decrease trunk acceleration and enhances balance control during gait (Da Silva Costa et al., 2015). The anchor system appears to improve the moving body's contact with its surroundings, allowing information regarding the body's direction with respect to the ground to be transmitted more easily. It has been demonstrated that the anchor system gives trunk stability during balancing exercises and enhances postural control in the elderly (Costa et al., 2018). There have been a few reports, nevertheless, regarding this system's advantages for those who have had chronic strokes. 

Results Subject characteristics (Table 1) showed the subject characteristics of group A and B. There was no significant difference between groups regarding age, weight, height, BMI, sex and affected side distribution (p > 0.05). Effect of treatment on step length, ambulation index, walking speed, DGI, TUG, balance indices and LOS Mixed MANOVA revealed a significant interaction effect of treatment and time (F = 8.04, p = 0.001). There was a significant main effect of treatment (F = 2.61, p = 0.03). There was a significant main effect time (F = 56.13, p = 0.001). Within group comparison: There was a significant increase in step length, ambulation index, walking speed and DGI and a significant decrease in TUG post-treatment compared with pretreatment in both groups (p > 0.05). The percent of change of step length, ambulation index, walking speed, DGI and TUG of group A was 13.63, 7.24, 18.60, 28.78 and 13.87% respectively; and that in group B was 28.57, 10.57, 54.76, 42.49 and 29.49% respectively (Table 2). There was a significant decrease in APSI, MLSI, OASI and a significant increase in LOS post-treatment compared with pretreatment in both groups (p > 0.01). The percent of change of APSI, MLSI, OASI and LOS of group A was 20.30, 13.93, 17.98 and 8.06% respectively; and that in group B was 39.90, 29.01, 38.53 and 27.68% respectively. (Table 3). Between group comparison: There was a significant increase in step length, ambulation index, walking speed and LOS of group B compared with that of group A post treatment (p < 0.05). There was a significant decrease in TUG, APSI and OASI of group B compared with that of group A post treatment (p < 0.05). There was no significant difference in DGI and MLSI between groups post treatment (p > 0.05) (Table 2-3).

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