[ARTICLE] Effects of Functional Limb Overloading on Symmetrical Weight Bearing, Walking Speed, Perceived Mobility, and Community Participation among Patients with Chronic Stroke – Full Text HTML

Abstract

Background. Stroke is a leading cause for long-term disability that often compromises the sensorimotor and gait function accompanied by spasticity. Gait abnormalities persist through the chronic stages of the condition and only a small percentage of these persons are able to walk functionally in the community.

Material and Method. Patients with chronic stroke were recruited from outpatient rehabilitation unit at Department of Neurology & Neurosurgery, All India Institute of Medical Sciences, having a history of first stroke at least six months before recruitment, with unilateral motor deficits affecting gait. The patients were randomly assigned to either the functional limb overloading (FLO) or Limb Overloading Resistance Training (LORT) group and provided four weeks of training.

Result. We found that there was an improvement in gait performance, weight bearing on affected limb, and perceived mobility and community participation.

Conclusion. To the best of our knowledge, this is the first study that has evaluated the effects of functional limb overloading training on symmetric weight bearing, walking ability, and perceived mobility and participation in chronic hemiplegic population. The study demonstrated a beneficial effect of training on all the outcomes, suggesting that the functional limb overloading training can be a useful tool in the management of gait problems in chronic stroke patients.

1. Introduction

Stroke is becoming a rapidly increasing problem and an important cause of disability and deaths worldwide. Incidence and prevalence of strokes in Saudi Arabia are comparatively lower than western countries, which could be because of the predominance of the younger age groups in this region [1]. The annual stroke incidence ranged from 27.5 to 63 per 100,000 population and prevalence ranged from 42 to 68 per 100,000 population [2].

Stroke is a leading cause for long-term disability due to compromised sensorimotor function. Approximately 85% of stroke survivors learn to walk independently by 6 months after stroke, but gait abnormalities persist throughout the chronic stages of the condition. Only a small percentage of stroke survivors are able to walk functionally in the community [3, 4].

The objective of stroke rehabilitation is to enable individual patients to maximize benefits from training in order to attain the highest possible degree of physical and psychological performance. The ultimate goals for many stroke patients are to achieve a level of functional independence necessary for returning home and to integrate as fully as possible into community life.

Ng and Hui-Chan [5] have noted that weakness in hemiplegic stroke patients is sometimes overshadowed over concerns about treatment of spasticity and synergistic movements. Studies have revealed positive correlations between the strength of specific muscle groups and a variety of functional attributes [6]. Furthermore, a nonlinear relationship between walking performance and muscle strength in the lower extremities has been suggested [7]. However, as the protocols were multifaceted, it was not possible to determine the precise role that the strength-training component may have played in improving walking function.

A number of studies have shown that task specificity and intensity of training are the main determinants of functional improvement after stroke [6, 8, 9]. Moreover, there is growing evidence suggesting that intensive task-oriented practice can induce greater improvement in walking competency than usual practice in stroke survivors [10–12].

Yang et al. [13] in their study on stroke patients undergoing progressive lower limb strengthening using functional weight bearing activities found moderate increases in walking speed. Sullivan et al. [14] found that task-specific training with body-weight support is more effective in improving walking speed but lower limb strength training did not provide any added benefit to walking outcomes.

A major limitation to the conclusions from these studies and systematic reviews is the lack of consistency in the intervention and specified protocols [15–17]. Despite the number of studies dedicated to task-oriented training, none of these studies had combined functional task training with prolonged resistance in the form of limb overloading applied 90% of the awake time. Therefore, we designed this study to address the evidence related to our training protocol to enhance symmetric weight bearing and walking speed and its impact on perceived mobility and community participation in patients with chronic stroke.

We hypothesized that intervention programs that combine lower limb overload with functional task training would be more effective at improving walking outcomes and community participation than lower limb overload training alone.

The design of our study was influenced by the literature on lower extremity strength training and task-specific locomotor training [14, 18, 19]. The use of this design should provide…

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