Efficacy of Isokinetic Strength Training and Balance Exercises on Lower Limb Muscles in Subjects with Stroke

Introduction: Stroke is leading cause of major disability with significant muscle weakness and balance. Although most motor and functional recovery occurs in the first 3 months after stroke, evidence tells us that lack of strength and balance are hindering the functional performance of stroke.

AIM: To evaluate the efficacy of isokinetic strength training and balance exercises on lower limb muscles with subjects with stroke.

Objectives:

1. To evaluate the efficacy of isokinetic strength training through isokinetc device in subjects with stroke.

2. To evaluate the efficacy of balance exercises through berg balance scale in subjects with stroke.

Methodology: 40 stroke subjects were divided into two groups, Experimental group received Isokinetic strength training and balance exercises (n=20) and Control group received conventional physiotherapy.

Research Design: Prospective randomized experimental control study.

Setting: College of Physiotherapy, svims, Tirupati, A.P, India

Sampling Method: Simple Random sampling

Sample Size: 40 subjects divided into two groups.

Inclusion Criteria:

• Age: 40-60 years.

• Gender: both male and female.

• Side: Both right and left hemiplegics.

• Subjects with first time onset of stroke.

• Subjects with Modified Ashworth scale of 1+, 2.

Exclusion Criteria:

• Subjects with hemianopsia.

• Contractures in lower limb.

• Any cognitive or sensory deficits are stroke patients.

• Other neurological and musculoskeletal conditions.

• People with cardiovascular diseases.

• Recurrent stroke.

• Participants who cannot comprehend and obey verbal commands.

Intervention: Subjects who fulfilled inclusion criteria are randomly selected into 2 groups and each group has 20 subjects.

GROUP I: (The experimental group underwent Isokinetic strengthening and balance exercises) A 6 week program which includes 5 min warm-up on stationary bicycle at low resistance followed by 65seconds stretches for hamstrings and quadriceps group of muscles on effected side. Strength training with knee extensors on isokinetic machine. 3 Sets of 6 to 8 repetition of maximum efforts followed by cool down section of 5 min of cycling, followed by balance exercises they are as follows:

The Balance Exercises Include Static Balance Exercises:

I Sitting Balance

II Standing Balance

Dynamic Balance

GROUP II: (The control group underwent conventional training)

Conventional Physiotherapy Treatment: A 6 weeks program which includes Active exercises for all groups of muscles in lower limb on effected side, Pelvic bridging followed by Modified pelvic bridging, resistance exercises for all group of muscles in lower limb with one kg weight cuff and manual resistance, weight bearing exercise in quadripod position, kneeling, half kneeling, standing, standing with single limb support, manual perturbations with wider base of support in forward, backward, sideways and finally progressing manual perturbations to narrow base of support.

Outcome Scale: Isokinetic device to measure peak torque of knee extensors on paretic leg. Berg balance scale to measure balance.

Statistical Analysis: Paired T-test has been carried out to observe the treatment impact between the groups before and after the treatment.

Results: After a 6 week treatment period, the subjects in the Group I (strength training and balance exercise) compared with the subjects in the Group II (conventional physiotherapy) had shown a statistically significant improvement with the outcome measures at 0.05 level.

Conclusion: Isokinetic strength training and balance exercise was found much effective in improving strength of quadriceps lower limb and balance in subjects with stroke.