Effects of modified sit-to-stand training on balance control in hemiplegic stroke patients: a randomized controlled trial

Abstract

Objective:

To explore the effectiveness of modified sit-to-stand training on balance function in hemiplegic stroke patients.

Design:

Randomized controlled trial.

Setting:

Rehabilitation medical centre.

Participants:

A total of 50 hemiplegic patients with stroke were randomly assigned to the control and experimental groups (n = 25 for each group).

Interventions:

Patients in the control group received the sit-to-stand training with symmetrical foot position, while patients in the experimental group were given the modified sit-to-stand training in which the paretic foot placed posterior. Subjects in both groups received 30 minutes of sit-to-stand training, five times a week, for four weeks.

Main outcome measures:

The time and weight-bearing distribution during sit-to-stand movement, the centre of pressure sway length during quiet standing, the centre of pressure sway areas during dynamic standing and Berg Balance Scale were assessed before and after completing the four-week sit-to-stand training.

Results:

Our data showed significant improvements in standing balance and the sit-to-stand movement for two groups in the post-training compared with the pre-training. After training, the rise time shortened more significantly in the experimental group (mean change, 0.90 ±0.25 seconds) than the control group (mean change, 0.42 ±0.18 seconds). Weight-bearing asymmetry showed significantly greater improvement in the experimental group (mean change, 0.17 ±0.10) than in the control group (mean change, 0.06 ±0.05). Centre of pressure sway length was significantly smaller in the experimental group (mean change, 27.85 ±10.58 cm) than in the control group (mean change, 21.95 ±8.19 cm). Centre of pressure sway areas was significantly larger in the experimental group (mean change, 84.24 ±26.48 cm²) than in the control group (mean change, 67.74 ±22.84 cm²) (P = 0.027). The Berg Balance Scale was significantly higher in the experiment group (mean change, 8.4 ±3.1) than the control group (mean change, 5.8±2.8).

Conclusions:

A modified sit-to-stand training improves the balance function in hemiplegic stroke patients.

Keywords

Stroke sit-to-stand balance

Get full access to this article

View all access options for this article.

References

Johnson

. The acquisition of skill. In: Smyth

Wing

(eds) The psychology of human movement. Academic Press, 1984, pp.232–234.

Pohl

Werner

Holzgraefe

. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: A single blind, randomized multicentre trial. Clin Rehabil 2007; 21: 17–27.

Khemlani

Carr

Crosbie

. Muscle synergies and joint linkages in sit-to-stand under two initial foot positions. Clin Biomech 1999; 14: 236–246.

Tiedemann

Shimada

Sherrington

. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing 2008; 37: 430–435.

Lee

Wang

Yang

. Correlations among balance and mobility measures for patients with stroke. Formos J Phys Ther 2003; 28: 139–146.

Sackley

. Falls, sway, and symmetry of weight-bearing after stroke. Int Disabil Stud 1991; 13(1): 1–4.

Nyberg

Gustafson

. Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke 1995; 26: 838–842.

Cheng

Liaw

Wong

. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil 1998; 79: 1043–1046.

Engardt

Ribbe

Olsson

. Vertical ground reaction force feedback to enhance stroke patients’ symmetrical body-weight distribution while rising/sitting down. Scand J Rehabil Med 1993; 25: 41–48.

10.

Hesse

Schauer

Petersen

Jahnke

. Sit-to-stand manoeuvre in hemiparetic patients before and after a 4-week rehabilitation programme. Scand J Rehabil Med 1998; 30: 81–86.

11.

Tung

Yang

Lee

Wang

. Balance outcomes after additional sit-to-stand training in subjects with stroke: A randomized controlled trial. Clin Rehabil 2010; 24(6): 533–542.

12.

Briere

Lauziere

Gravel

Nadeau

. Perception of weight-bearing distribution during sit-to-stand tasks in hemiparetic and healthy individuals. Stroke 2010; 41(8): 1704–1708.

13.

Boyne

Israel

Dunning

. Speed-dependent body weight supported sit-to-stand training in chronic stroke: A case series. J Neurol Phys Ther 2011; 35: 178–184.

14.

Lecours

Nadeau

Gravel

Teixera-Salmela

. Interaction of foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat-off when rising from a chair in healthy controls and the persons with hemiparesis. J Rehabil Med 2008; 40: 200–207.

15.

Tsaklis

Grooten

Franzen

. Effects of weight-shift training on balance control and weight distribution in chronic stroke: A pilot study. Top Stroke Rehabil 2012; 19(1): 23–31.

16.

Cheng

P-T

S-H

Liaw

M-Y

. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil 2001; 82: 1650–1654.

17.

Berg

Wood-Dauphinee

William

Gayton

. Measuring balance in the elderly: Preliminary development of an instrument. Physiother Can 1989; 41: 304–311.

18.

Berg

Wood-Dauphinee

Williams

. The balance scale: Reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995; 27(1): 27–36.

19.

Hemmen

Seelen

. Effects of movement imagery and electromyography-triggered feedback on arm hand function in stroke patients in the subacute phase. Clin Rehabil 2007; 21: 587–594.

20.

Schmidt

. Motor learning principle for physical therapy. In: Lister

(ed.) Proceedings of II STEP conference contemporary management of motor problem, Foundation for Physical Therapy, Alexandria, 1991.

21.

Winstein

Gardner

McNeal

Barto

Nicholson

. Standing balance training: Effect on balance and locomotion in hemiparetic adults. Arch Phys Med Rehabil 1989; 70: 755–762.

22.

Smith

Akhtar

Garraway

. Proprioception and spatial neglect after stroke. Age Ageing 1983; 12: 63–69.

23.

Gruber

Gollhofer

. Impact of sensorimotor training on the rate of force development and neural activation. Eur J Appl Physiol 2004; 92: 98–105.

24.

Jung

Kim

Chung

Hwang

. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. Tohoku J Exp Med 2014; 232: 195–199.

25.

Davies

Bruhwiller

. Steps to follow: The comprehensive treatment of patients with hemiplegia. Springer 2000; 429–468.

26.

Krishnan

. Relearning of locomotion in injured spinal cord. New directions for rehabilitation programs. Int J Neurosci 2003; 113(10): 1333–1351.