KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION1. / Name of the Candidate
And
Address
(in block letters): / DONIL JOSE
KURUVITHADAM HOUSE
PERUMBALLOOR (P.0)
MUVATTUPUZHA
ERNAKULAM (DIST)
KERALA- 686 673
2. / Name of the Institute : / LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY, MANGALORE.
3. / Course of study and subject : / MASTERS OF PHYSIOTHERAPY (MPT)
TWO YEARS DEGREE COURSE
NEUROLOGICAL AND PSYCHOSOMATIC DISORDERS
4. / Date of Admission to Course : / 2ND MAY 2011
5. / Title of the topic: / EFFICACY OF TASK ORIENTED APPROACH IN SIT TO STAND PERFORMANCE IN SUBJECTS WITH SUBACUTE STROKE – AN EXPERIMENTAL STUDY
6. / Brief Resume of the Intended Work:
6.1 NEED FOR THE STUDY
· Stroke define as an acute vascular event in the brain and is a leading cause of death and disability. Ischemic stroke results from decreased blood flow to a portion of the brain with consequent cell death. Sub acute stroke phase is generally defined to be more than three weeks and within six months post stroke.1
· A stroke disrupts the flow of blood through the brain and damages brain tissue. There are two chief types of stroke.
· The most common type —
- Ischemic stroke
- Hemorrhagic stroke
- A Transient Ischemic Attack (TIA) — sometimes called a mini stroke.
· Functional problems caused by stroke are trouble with walking, speaking and understanding, Paralysis or numbness on one side of the body or face, trouble with seeing in one or both eyes.1
· Rehabilitation focuses on assisting people with a disability or chronic illness to attain maximum functional ability, maintain optimal health and adapt to an altered lifestyle.2
· Stroke rehabilitation is an organized endeavour to help patients to maximize all opportunities for returning to an active lifestyle.
· Neuro-rehabilitation is a method for relearning a previously learned task in a different way, either by compensatory strategies or by adaptively recruiting alternative pathways.3
· Commonly-used treatment approaches that focus on impairments and seek to regain a normal movement pattern, such as neuro developmental treatment (NDT), have proved ineffective.4
/ · Unfortunately, no conclusive definition of a task-oriented approach exists in the literature. In the task-oriented approach, movement emerges as an interaction between many systems in the brain and is organized around a goal and constrained by the environment.
· While stroke is an important cause of disability, there is no generally accepted method for rehabilitating stroke survivors.1
· The use of neuro developmental treatment in the daily care of stroke survivors does not improve clinical outcomes.4 Therefore other forms of rehabilitation intervention, including task-oriented rehabilitation are being practiced.
· Task-oriented approach includes a wide range of interventions such as treadmill training, walking training on the ground, bicycling programmes, endurance training and circuit training, sit-to-stand exercises, and reaching tasks for improving balance. In addition, use is made of arm training using functional tasks such as grasping objects, and mental imagery.6
· Despite the growing number of studies showing evidence on task-oriented interventions, recommendations for daily interventions are lacking.6
· There are no experimental studies available in the literature which shows the efficacy of task oriented approach in sit to stand performance in subjects with sub-acute stroke, hence there exist a purpose and background for genesis of this study.
HYPOTHESIS
Null Hypothesis (H0):
There may not be significant effect of task oriented approach in improving the sit to stand performance in sub acute hemiplegics.
Alternate Hypothesis (H1):
There may be significant effect of task oriented approach in improving the sit to stand performance in sub acute hemiplegics.
6.2 REVIEW OF LITERATURE
· Struijs et al stated that Stroke is the second leading cause of death and one of the leading causes of adult disability.It is estimated that the incidents of stroke will increase from 1-8 per 1000 inhabitants in 2000 to 2-8 per 1000 in 2020.6
· Marijke Rensink, Marieke Schuurmans in their study on task oriented training concluded that active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life.6
· Pollock et al in his study, three small studies of good quality focusing on task-oriented exercises and using functional outcome measures were identified and reviewed.7
· Howe et al in his study has shown balance feedback training and task-specific training improved symmetrical weight distribution in patients with acute hemiplegia. In a small study of patients in the chronic phase, task-related training was more beneficial than resistance training for patients’ functioning on a lower level.8
· Dean Shepherd (1997), Dean et al. 2007 in his two studies showed that restriction of trunk movements with reach and grasp training led to further arm reaching with diminished trunk bending while grasping an object.9
· Katz-Leurer et al. 2006 in his two studies performed with patients in the chronic phase has shown. In one study that the effects on stroke survivors of a task-oriented exercise programme were compared with altered sensory input. Those receiving exercise assisted by sensory manipulation improved statistically significantly in standing balance, but the effect did not extend to walking.10
· Thielman et al. (2004) In two small studies has shown that in sub-acute and chronic phases of hemiplegia, sitting balance improved after practice, resulting in better and further reaching and faster standing up.11
· Bayouk et al. (2006 ) in his study on acute stroke patients has shown that the group trained with an agility exercise program showed greater improvement in step reaction time and had fewer falls when balance was challenged.12
· Blum, Lisa et al reports that the Berg Balance Scale is the most commonly used assessment tool throughout stroke rehabilitation, and found it to be a sound measure of balance impairment in patients following a stroke.13
· Feber MJ et al in their studies, stated that Performance Oriented Mobility Assessment (POMA)measures both static and dynamic balance using tasks testing balance and gait.
· Feber MJ et al in their studies concluded that POMA Scale is reliable and valid for assess mobility.14
/ 6.3 AIM OBJECTIVES OF STUDY
· To evaluate the efficacy of repetative sit to stand training(Task oriented approach) in increasing the sit to stand performance in sub-acute hemiplegics.
7
/ MATERIALS AND METHODS:
STUDY DESIGN: Randomized controlled design – An Experimental study
7.1 SOURCE OF DATA:
30 symptomatic subjects of both sex fulfilling inclusion criteria will be selected from AJIMS wards.
/ 7.2 METHOD OF COLLECTION OF DATA
SAMPLING TECHNIQUE: Simple random sampling
INCLUSION CRITERIA:
· Both male and female included.
· Age of 45-70
· Sub-acute hemiplegics
· Both Ischemic and Hemorrhagic stroke patients
· Comprehensive
· Patients stands with balance problem
EXCLUSION CRITERIA :
· Subjects with other neurological complications like in-co ordination and ataxia
· Handicapped subjects
· Cognition /perceptual disorders
· Arthritis
· Fractures in upper and lower extremities
MATERIALS USED:-
· Chair
· Mat
· Table
· Mirror
· Pen paper
TECHNIQUE OF APPLICATION:
PROCEDURE:
· 30 sub-acute hemiplegic patients diagnosed by a neurologist were included in the study and were divided into two groups of 15 each.
· Task oriented training will be given five days a week for 3 weeks.
· GROUP-A : Control group of 15 subjects will receive conventional therapy.
It includes neuromuscular facilitation techniques, functional electric stimulation, mat exercises, sit to stand training etc.
· GROUP-B : Experimental group of 15 subjects will receive conventional therapy(as mentioned above) along with task-oriented sit to stand exercise.
· Subjects will be seated on a chair in front of a mirror. The feet will be placed parallel to the floor, with the medial border of the feet 10 to 15cm apart. Each subject's ankle will be placed at about 10° of dorsiflexion, and the knee angle about 100° to 105° of flexion. Subjects will be instructed to rise from the chair in their usual manner (ie, at a self-paced, comfortable speed). After standing for about 30 seconds, they will be instructed to sit down as they usually do by using trainer’s visual and auditory signals. For each strategy, 3 trials will be performed and used for further analysis. The subject will be once again asked to rise from chair and stands for 15 minutes.
· All subjects in both groups will be assessed at the first day of treatment and again assess at the last day of treatment.18
/ STUDY DURATION: 6 Months
OUT COME MEASURES – USED :
· Bergs Balance Scale-(BBS)-sit to stand subdivision only
· Performance Oriented Mobility Assessment Scale-(POMA)
STATISTICAL ANALYSIS:-
Student’s t- test.
RESEARCH QUESTION:-
Will task oriented sit to stand performance be effective in sub-acute stroke patients?
/ 7.3 Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals? If so, please describe briefly.
Yes, Task Oriented sit to stand performance.
/ 7.4 Has ethical clearance been obtained from your institutions in case of 7.3
Obtained.
8 / List of References:
1. O'Sullivan, Susan, Schmitz, Thomas (2007). Physical Rehabilitation (Fifth ed.). Philadelphia: F.A. Davis Company. pp. 705-729.
2. Pomeroy V.M. Tallis R. (2000) Physical therapy to improve movement performance and functional ability poststroke. Part 1. existing evidence. Reviews in Clinical Gerontology 10, 261–290.
3. Aichner F., Adelwohrer C. Haring H.P. (2002) Rehabilitation approaches to stroke. Journal of Neural Transmission. Supplementum63, 59–73.
4. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363(9411):768-743.
5. Marler J, Tilley BC, Lu Y, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000;55(11):1649-55.
6. Marijke Rensink, Marieke Schuurmans2, Eline et al in Task oriented training in rehabilitation after stroke: systemic review.
7. Pollock A.S., Durward B.R., Rowe P.J. Paul J.P. (2002) The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial. Clinical Rehabilitation. 16(5), 473–480.
8. Howe T.E., Taylor I., Finn P. Jones H. (2005) Lateral weight transference exercises following acute stroke: a preliminary study of clinical effectiveness. Clinical Rehabilitation 19(1), 45–53.
9. Dean C.M. Shepherd R.B. (1997) Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. Stroke 28(4), 722–728.
10. Katz- Leurer M, Sender I, Ofer K et al(2006) The influence of early cycling training on balance in stroke patients at the sub-acute stage. Result of a preliminary trial. Clinical Rehabilitation 20(5),398-405.
11. Thielman G.T., Dean C.M. Gentile A.M. (2004) Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Archives of Physical Medicine and Rehabilitation 85(10), 1613–1618.
12. Bayouk J.F., Boucher J.P. Leroux A. (2006) Balance training following stroke: effects of task-oriented exercises with and without altered sensory input. International Journal of Rehabilitation Research 29(1), 51–59.
13. Blum, Lisa; Korner-Bitensky, Nicol (May 2008). "Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review". Physical Therapy 88 (5): 559–566.
14. Feber M J, Bosscher RJ, Van Wieringen PC, in clinimetric properties of the performance – oriented mobility assessment.Phys.Ther.2006:jul.86(7):944-54.
15. Furlan A, Higashida R, Wechsler L et al. Intra-arterial prourokinasefor acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism.[comment]. JAMA 1999; 282(21):2003-11.
16. Clark WM, Wissman S, Albers GW, et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy inIschemic Stroke.[see comment]. JAMA 1999; 282(21):2019-26.
17. Ada L., Dorsch S. Canning C.G. (2006) Strengthening interventions increase strength and improve activity after stroke: a systematic review. The Australian Journal of Physiotherapy 52(4), 241–248.
18. Cheng P-T, Wong AMK et al.Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention.Arch Phys Med Rehabil-2001;82:1650-4.