Effect of Pilates on balance and sit to stand performance in chronic stroke patients : A Randomized controlled trial.

INTRODUCTION

Stroke , also called as cerebrovascular accident ( CVA) is sudden loss of neurological function caused by interruption of blood flow to the brain. Motor deficits of hemiplegia , sensory dysfunction , balance impairment , communication disorder , visual field defect , cognitive impairment are the symptom of CVA .

Balance impairment can be direct effect of CVA as well as strength deficit post CVA these deficit often lead to significant difficulty completing activity of daily living ( ADLs) after extensive rehabilitation up to 50% of stroke survivors experience lingering motor problem and balance problem . This balance impairment is the cause of high risk of fall in this population it is reported that stroke patients are  at high  risk of fall with 1.3 – 6.5 fall / person / year occurring and highest rates, 8.7 falls / person / year , occurring after discharge from hospital . Fall may lead to increased fear of falling , fracture which further cause activity restriction and hence depression .

Most of the rehabilitation in stroke patients revolves around functional retraining along with balance and gait .  trunk musculature weakness can affect balance , stability and functional abilities Jung – Hyun Kim et .al. studied the effect of balance training on hemiplegic stroke patients and have stated that stroke impairs trunk control which is required during weight shifting and equilibrium reaction training for trunk control and balance involve core stability exercise , strategy training , weight shift.

The ability to stand up from seated position is very important in performing activity of daily living independently .It is also prerequisite for gait study revealed that 37.2% of fall in stroke survivours occurred while changing position from sit to stand . Sit to stand movement is the bridge between static position and dynamic body activity from the biomechanical view and defined as a trasitional movement to upright posture . Galli and co -worker found prolonged sit to stand in ascending phase and different vertical force in people after stroke in comparison with healthy control

Study on Sit to stand reported a wide variety of testing protocol , including difference in seat height , initial joint angle , foot placement which lead to different kinematics and kinetic people with stroke decreased maximal hip flexion angle during forward transfer of trunk when compared with healthy adult before standing up from a seated position . the inability to achieve full hip extension  and knee extension in lock position with stroke might be related to the weakness of the gluteus maximus and quadriceps femoris muscle.

Unequal GRF between affected and unaffected side .Impairment in muscle strength , postural control , balance were factor previously known that contributed to asymmetrical weight – bearing in patient with stroke all these finding suggested that  balance and weight bearing training were needed for people with stroke to improve their motor function and posture control to gain ability of sit to stand .

Pilates is one technique which is recently gaining more popularity . It help in strengthening and conditioning of the body . This technique aim to improve core stability , balance by strengthening core muscle of body – diaphragm , transverse abdominis , multifidus , pelvis floor presently there is availability of study which show the effect of Pilates exercise on sit to stand in chronic stroke is limited. Purpose of this study was to investigate the effect of Pilates training on balance and sit to stand in chronic stroke patients .

 NEED OF STUDY

Population with stroke impairment who are having balance related difficulties leading to decrease in their confidence and social withdrawal due to fear of fall. Physiological change and other reason such as muscle weakness, strength, atrophy change , muscle tone due to stroke . Trunk muscle weakness can affect balance, stability, functional ability.

Stroke impair trunk control which is required during weight shifting and equilibrium reaction , training for trunk control and core stability exercise, weight shift. Ability to stand up from seated position is very important in ADLs. It is prerequisite for gait . Sit to stand is bridge between static position and dynamic body activity .

Sit to stand reported a wide variety of testing protocol , including difference in seat height , initial joint angle foot placement which lead different kinematics and kinetic . People with stroke  decreased maximal hip flexion angle  during forward transfer of trunk before standing up from a seated position .

In ability to achieve full hip and knee extension in lock position with stroke might be related to weakness of the gluteus maximus , quadriceps femoris muscle .Unequal GRF between affected and unaffected side , impairment in muscle strength , postural control , balance ,were factor previously known that contributed to asymmetrical weight bearing in stroke patients .

All these finding suggested that balance and weight bearing were needed for people with stroke to improve their motor function and posture control to gain ability of sit to stand. Presently , there is effect of  Pilates exercise on balance and sit to stand is limited .Purpose of this study to investigate the effect of Pilates exercise on balance and sit to stand in chronic stroke patients .