Perturbation Based Training And Bobath-Based Trunk Exercises On Gait , Postural Control And Mobility

Not Applicable

Completed

Brief Summary: This study compares two approaches for rehabilitating stroke patients: Perturbation-Based Training and Bobath-Based Trunk Exercises. The perturbation based training focuses on challenging patients with unexpected movements to improve their balance and stability. While the Bobath method, concentrating on facilitating normal movement patterns. The study aims to determine which approach yields better outcomes in terms of trunk control, balance, and functional recovery for stroke patients. This study will also enable the individual to be more independent and minimize their falls.

Detailed Description: Cerebrovascular is a leading cause of physical impairment and long-term disability in the globe. The complication of stroke is mobility impairment like balance, gait, and posture disorders. This impairment leads to a higher risk of falls, reduced ability in daily activities, and difficulty restoring the overall health and quality of life. Cerebrovascular accident is the second cause of fatality. Hence, one of the primary objectives in stroke rehabilitation is to restore postural stability and functional balance, which is a combination of dynamic, static and reactive balance. For improving postural stability and balance one such technique is the utilization of a rocker board, where a platform positioned on an unstable surface is used to challenge balance. Whilst rocker boards have been used effectively for, postural stability, injury prevention, rehabilitation and balance enhancement. Improvements in rocker board performance may be attributable to one or more of the following: muscle strengthening, enhanced intersegmental coordination, increase in brain activity in the supplementary motor area and/or enhanced feed-forward and feed-backward postural control mechanisms.

Recruitment & Eligibility

Inclusion Criteria

Able to walk with or without ambulatory aids
Able to follow commands.
Patients in the subacute and chronic stages associated with stroke hemiparesis (time since
stroke onset 6 months- 1 year)
Scoring > 21 on MMSE

Exclusion Criteria

Patients who have severe limitations in passive range of motion at lower extremities
Visual and sensory deficits
Patient who has contracture
Orthopedic or any other neurological disorder which impair balance.
Patients undergoing any other balance training protocol.
Patients with recurrent strokes
Participants who are currently participating in another clinical trial or research study

Arm && Interventions

Group	Intervention	Description
bobath based training	Stable surface training	1. Stretching of the latissimus dorsi muscle 2. Functional use and strengthening of the latissimus dorsi. 3. Functional strengthening of abdominal and oblique abdominal muscles 4. Placing exercises to facilitate trunk extension 5. Rotations and counter-rotations (right and left) of the hips with the trunk extended Training of lumbar spine stabilizers Functional reach of shoulder, anterior, right, and left sides.
perturbation based training	Rocker board training	1. Stretching of the erector spinae, 2. latissimus dorsi, gluteus Medius, gluteus minimums, and gluteus maximus (knee to chest) Pelvic Bridging Exercises 3. Strengthening Exercises of latissimus dorsi muscle 4. Pelvic Bridging Exercises include the gluteus maximus and quadriceps 5. Rocker board: Trunk control exercises on Rocker Board in standing position first in medio-lateral direction for 10 min and then in anterio-posterior direction for 10 min with breaks in between.

Primary Outcome Measures

Name	Time	Method
Postural Assessment Scale for Stroke Patient	6 weeks	It is used for the assessments of postural control in stroke patients. It measures the ability of an individual with stroke to maintain stable postures and equilibrium during positional changes. It consists of a 4-point scale where the items are scored from 0 to 3, and the total scoring ranges from 0 to 36. "Change will be measured from Baseline to 6 weeks"
Timed Up and Go Test	6 weeks	It is for the assessment of lower extremity function, mobility and fall risk. scoring criteria \< 10 seconds = normal. \< 20 seconds = good mobility; can walk outside alone; does not require a walking aid. \< 30 seconds = walking and balance problems; cannot walk outside alone; requires walking aid. "Change will be measured from Baseline to 6 weeks"
Trunk Impairment Scale	6 weeks	It is used to measure motor impairment of the trunk after stroke. The total score for TIS ranges between 0 for a minimal performance to 23 for a perfect performance "Change will be measured from Baseline to 6 weeks"
Functional Gait Assessment	6 weeks	It is for assessment of postural stability during walk. 3 Normal is able to ambulate for 10 steps heel to toe with no staggering. 2 Mild impairment, ambulates 7-9 steps. 1 Moderate impairment, ambulates 4-7 steps. 0 Severe impairment, ambulates less than 4 steps heel to toe or cannot perform without assistance. "Change will be measured from Baseline to 6 weeks"

Secondary Outcome Measures

Name	Time	Method
Stroke Self-Efficacy Questionnaire	6 weeks	It evaluate self-efficacy as a result of being able to successfully perform a specific action in stroke patients. It is a self-reported questionnaire about level of confidence reported on a 0 to 10 scale (0 = not confident, 10 = very confident) when completing 13 activities of daily life following stroke. "Change will be measured from Baseline to 6 weeks"