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[ARTICLE] The effect of aquatic and treadmill exercise in individuals with chronic stroke – Full Text

ABSTRACT

We compared the effect of gait training on treadmill versus deep water on balance and gait in 12 ischemic stroke chronic survivors randomly sorted to the Pool or Treadmill Groups. Berg Scale (BBS) and timed up and go test (TUG) were applied before and after the interventions. Just one person applied all tests and she was blinded for the aims of the study. Surface EMG of the paretic and non-paretic (NP) side muscles were recorded during walking on a treadmill. Three 100-ms epochs were extracted from the EMG related to gait phases: weight acceptance; propulsion; and pre-strike. For each epoch, we calculated the RMS of the EMG signal. Participants did gait training for 9 weeks (3 times/week, 40 minutes/session). The Pool group did the deep-water walking with a swimming belt. The Treadmill group walked on the treadmill at the maximum speed they could stand. The Manova group compared the effect of training, group, side, muscles, and gait phase into the EMG. Anova was used to test the effect of training, group side, and gait phase into BBS, TUG and EMG variables. Pool and Treadmill had increased balance and agility. The highest EMG RMS occurred at the paretic side, for the Treadmill and after training. The mm. tibialis anterior, gastrocnemius lateralis, vastus lateralis, and biceps femoris presented the highest RMS for the NP side; while for mm. rectus femoris and semitendinosus, the paretic side presented the highest RMS. Thus, the both types of exercise lead to similar functional adaptations with different muscular activations during walking.

INTRODUCTION

Stroke is the second most common cause of death worldwide and the primary cause of chronic disability in adults1), (2. Without intense rehabilitation during the early days after the stroke, neural injuries gradually develop more pronounced motor impairments due to muscle weakness, spasticity and coordination loss3. Later, stroke survivors with chronic impairment become less independent to perform daily life activities, have less social interaction and are more concerned about their future4. Such dependent person with less social life can be considered as having lost motivation. This deprivation occurs because chronic stroke survivors have small resistance to fatigue4)- (6. They do not feel motivated to move continuously or for long periods since they get easily fatigued; as such, rehabilitation programs for such population should spare their activities between motor rehabilitation and increase in physical fitness in order to increase their resistance to fatigue.

In fact, about 80% of stroke survivors can walk without assistance; but their slow walk constrains their daily life activities7), (8. Walking speed is an important outcome for performance evaluation and for functional evaluation in stroke9), (10. The slow walking is due to the lower limb muscles spasticity11)- (14, muscle weakness, postural imbalance and fear of falling. Those clinical impairments also change the gait biomechanics15), (16, inducing asymmetrical, stereotyped and low ranged compensatory movements17. At the early stage of the rehabilitation program, efforts should be addressed to improve body functions in enhance resistance to fatigue.

The aerobic training applied to stroke people enhances physical ability and improves life independence and quality, reducing morbidity and mortality18. Standard aerobic training is usually developed with walking and running. Treadmill protocols to stroke people can recover impaired gait, improve gait parameters and reduce walking asymmetries19. On the other hand, water walking enhances the afferent sensory inflow and improves peak aerobic capacity and walking endurance, being able to affect gait kinematics in patients with stroke18), (20)- (22. It is not clear whether walking on water would provide the same or more benefits compared with the standard treadmill walking for chronic stroke people. In fact, little information is available to support a rehabilitation program for chronic stroke people with reduced mobility. The aim of this study was to compare the effect of aerobic training treadmill versus aerobic training in water for balance and gait in chronic stroke people. We expect that standard treadmill walking training and water walking training will not have similar biomechanical and functional results; therefore, both types of walking training will lead to similar functional results, but the electrical activity of lower limbs will show different behavior after training. Our first hypothesis is that treadmill gait training and deep-water gait training will lead to similar functional adaptations. Our second hypothesis is that treadmill gait training and deep-water gait training will induce different muscle adaptations that will provide different kinds of muscle activation during the walking test. We believe that training will improve participants’ overall fitness, but training specificity will lead to differing muscle activation during the gait test.[…]

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[PDF] Exercise and Traumatic Brain Injury.

Objectives

✤Understand the impact of traumatic brain injury on human metabolic capacity and its effects on the physiologic response to exercise

✤ Understand the potential positive effects of aerobic training following TBI

✤ Understand the key components in the prescription of exercise following TBI

[PDF] Exercise and Traumatic Brain Injury

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