[ARTICLE] Effect of home-based training using a slant board with dorsiflexed ankles on walking function in post-stroke hemiparetic patients – Full Text PDF

Abstract.

[Purpose] To investigate the effects of a 30-day rehabilitation program using a slant board on walking function in post-stroke hemiparetic patients.

[Subjects and Methods] Six hemiparetic patients with gait disturbance were studied. The patients were instructed to perform a home-based rehabilitation program using a slant board, thrice daily for 30 days, the exercise included standing on the slant board for 3 minutes, with both ankles dorsiflexed without backrest. For all patients, the Brunnstrom Recovery Stage, Barthel Index, range of motion of the ankle joint, modified Ashworth scale scole for calf muscle, sensory impairments with Numeral Rating Scale, maximum walking speed, number of steps, and Timed “Up and Go” test were serially evaluated at the beginning and end of the 30-day program.

[Results] The program significantly increased walking velocity, decreased the number of steps in the 10-m walking test, and decreased Timed “Up and Go” test performance time.

[Conclusion] This rehabilitation program using the slant board was safe and improved walking function in patients. The improvement in walking function could be due to a forward shift of the center of gravity, which can be an important part of motor learning for gait improvement.
INTRODUCTION

Fig. 1. The slant board used in this study The slant angle was set at 20 degrees

Stroke is a leading cause of long-term disability, and the absolute number of patients with stroke is increasing. Of the neurological sequelae that cause functional disability, hemiparesis is the most common. The incidence of gait disturbance due to hemiparesis is reportedly relatively high among chronic stroke patients1, 2). The occurrence of this disability leads to marked impairment of quality of life and the sense of well-being3, 4). In addition, the burden of caregivers is anticipated to increase when patients are in need of assistance for walking5). Improved walking ability is one of the most common goals for post-stroke hemiparetic patients6, 7). A slant board has been used as a therapeutic device for patients with spastic lower hemiparesis. Standing on the toe-up inclination surface stretches the calf muscles, which reduces the pathologically increased lower limb muscle tone in post-stroke hemiparetic patients. Standing without a back rest on the slant board can produce a forward shift in the center of pressure in healthy adults and hemiparetic patients, as reported in our previous study. Kluzak reported that standing on an inclined surface resulted in an after-effect of learning in healthy, blindfolded subjects when they returned to standing on a horizontal surface8). Subjects leaned forward after they stood on a toes-up inclination surface. Recent reports described other benefits of using the board in healthy adults and hemiparetic patients, such as movement of “center of pressure”9), and possible increase in the maximum range of “center of gravity” in the antero-posterior direction10).
Neurophysiological studies have also demonstrated increased contraction of the anterior tibialis muscle in healthy subjects standing on the slant board11). Daily home-based rehabilitation using the slant board was hypothesized to improve gait in post-stroke hemiparetic patients. To test the hypothesis, the present study investigated the effects of a 30-day home-based daily rehabilitation program using the slant board on walking function in post-stroke hemiparetic patients.

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