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Published on: October 11, 2024
Effect of comprehensive bilateral training protocol on motor recovery in post-stroke hemiplegia- A randomized
Pallavi Harjpal1, Moh'd Irshad Qureshi2, Rakesh Krishna Kovela3
1Assistant Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India.
Background And Purpose:
Most physiotherapists focus on the affected (hemiparetic) side when developing a rehabilitation plan for a hemiplegic patient. The less-affected side is left inactive and begins to lose its qualities, which deconditions the patient's overall rehabilitation. The objective of the study was to compare between extensive bilateral training and traditional rehabilitation methods for motor recovery.
Methods:
Forty hemiplegic patients were selected for this randomized controlled trial. Patients were randomly assigned to two groups: Group A (Conventional Physiotherapy) and Group B (Comprehensive Bilateral Training) using a 1:1 simple randomization scheme. Ethical clearance was obtained from the Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research (DMIHER, DU), Wardha (Ethical permission number: DMIHER.[DU]/IEC/2024/310), and the study was registered with the Clinical Trials Registry of India (CTRI/2024/11/077143). Eligible participants with subacute stroke were randomly allocated to either Group A (Conventional Physiotherapy) or Group B (Comprehensive Bilateral Training), using the Sequentially Numbered Opaque Sealed Envelope (SNOSE) method. Enrolment in the study, intervention procedures, and outcome assessment followed Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) standards. Patients in Group A received task-oriented approach-oriented training for the affected side, and Group B received strength training for the lower limb using a protocol identical to that of Group A for the unaffected side, for 5 days/week for 6 weeks. A strengthening regimen was designed for the unaffected side, based on the FITT (frequency, intensity, time, type) principles of the American College of Sports Medicine (ACSM). The Fugl-Meyer Assessment of the Lower Extremity (FMA-LE) and the Brunnstrom Stage of Recovery were assessed at baseline and post-rehabilitation.
Results:
Both groups showed significant improvement (p < 0.05). Group B showed more significant results both statistically and clinically. The mean total FMA score difference was 7.15 ± 1.84 in Group A and 8.45 ± 2.19 in Group B, reflecting more improvement in Group B. The improvement in the FMA-LE scores indicated a stroke-specific index of disability improvement in both groups. Similarly, the Brunnstrom stage of recovery also showed an excellent improvement in both groups. The mean change was 1.50 ± 0.65 in Group A and 2.70 ± 0.68 in Group B, with a significant between-group difference (p = 0.0001).
Conclusion:
The findings of this study reveal that, compared with the Affected Side Training Group, both side groups had favourable effects on the stroke-specific disability index in subacute hemiparetic stroke patients, aiding early recovery.
