Objective: To investigate the effect of early cycling training on balance and motor abilities of stroke patients in their subacute stage.
Design: Randomized clinical trial.
Setting: Inpatient rehabilitation.
Subjects: Twenty-four patients who had had a first stroke were randomly assigned to a cycling training group (n = 10) or to a control (n = 14) group.
Intervention: All subjects received their usual rehabilitation programme; the cycling training group received in addition a daily session of leg cycle ergometer, lasting three weeks. Both groups were followed for six weeks.
Main outcome measurements: Balance was assessed using the Postural Assessment Scale for Stroke Patients (PASS) and the standing balance test. The motor function of the lower extremity was also assessed by the Fugl-Meyer Assessment (FMA).
Results: In the within-group comparison, both the exercise group and the control group had improved significantly (P B=0.01) with time with respect to PASS total (exercise group 18.79=2.8 to 31.19=2.2, control group 18.19=3.2 to 26.49=3.8) and PASS subscores, as well as the FMA score (exercise group 17.29=7.5 to 29.19=5.9, control group 16.69=6.4 to 22.19=6.8). In addition there was a significant group=time interaction effect, with exercise group patients demonstrating better performance in both the total PASS score and PASS subscores and FMA score relative to the control patients (P B=0.01).
Conclusions: These preliminary findings suggest that stroke patients in the subacute stage can improve their motor and balance abilities after an early short duration of cycling training.
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References
1.
1 Hesse S, Bertelt C, Jahnke MT, et al. Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke1995; 26: 976-981.
2.
2 Hesse S, Uhlenbrock D, Sarkodie-Gyan T. Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support. Clin Rehabil1999; 13: 401-410.
3.
3 Kosak MC, Reding MJ. Comparison of partial body weight-supported treadmill gait training versus aggressive bracing assisted walking post stroke. Neurorehabil Neural Repair2000; 14:13-19.
4.
4 Inaba M, Edberg E, Montgomery J, Gillis MK. Effectiveness of functional training, active exercise, and resistive exercise for patients with hemiplegia. Phys Ther1973; 53:28-35.
5.
5 Nugent JA, Schurr KA, Adams RD. A dose-response relationship between amount of weight-bearing exercise and walking outcome following cerebrovascular accident. Arch Phys Med Rehabil1994; 75: 399-402.
6.
6 Katz-Leurer M, Shochina M, Carmeli E, Friedlander Y. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. Arch Phys Med Rehabil2003; 84: 1609-1614.
7.
7 Raasch CC, Zajac FE. Locomotor strategy for pedaling: muscle groups and biomechanical functions. J Neurophysiol1999; 82: 515-525.
8.
8 Ting LH, Kautz SA, Brown DA, Zajac FE. Phase reversal of biomechanical functions and muscle activity in backward pedaling. J Neurophysiol1999; 81: 544-551.
9.
9 Kautz SA, Brown DA. Relationships between timing of muscle excitation and impaired motor performance during cyclical lower extremity movement in post-stroke hemiplegia. Brain1998; 121: 515-526.
10.
10 Benaim C, Perennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke1999; 30: 1862-1868.
11.
11 Bohannon RW. Standing balance, lower extremity muscle strength, and walking performance of patients referred for physical therapy. Percept Mot Skills1995; 80: 379-385.
12.
12 Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post stroke hemiplegic patients. A method for evaluation of physical performance. Scand J Rehabil Med1975; 7:13-31.
13.
13 Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil1987: 6-18.
14.
14 Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the tone assessment scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil1999; 80: 1013-1016.
15.
15 Morris SL, Dodd KJ, Morris ME. Outcomes of progressive resistance strength training following stroke: a systematic review. Clin Rehabil2004; 18: 27-39.
16.
16 Kuo AD, Zajak FE. Biomechanical analysis of muscle strength as a limiting factor in standing posture. J Biomech1993; 26: 137-150.
17.
17 Hassid E, Rose D, Commisarow J, Guttry M, Dobkin B. Improved gait symmetry in hemiparetic stroke patients induced during body weight-supported treadmill stepping. J Neuro Rehabil1997; 11:21-26.
18.
18 Carr JH, Shepherd RB. A motor learning model for stroke rehabilitation. Physiotherapy1989; 75: 372-380.
19.
19 Johansson RS, Westling G. Roles of glabrous skin receptors and sensorimotor memory in automatic control of precision grip when lifting rougher or more slippery objects. Exp Brain Res1984; 56: 550-564.
20.
20 Tinson DJ. How stroke patients spend their days. An observational study of the treatment regime offered to patients in hospital with movement disorders following stroke. Int Disabil Stud1989; 11:45-49.
21.
21 De Wit L, Putman K, Dejaeger E, et al. Use of time by stroke patients: a comparison of four European rehabilitation centers. Stroke2005; 36: 1977-1983.
