Professional Documents
Culture Documents
Volume 5 Issue 1, November-December 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
INTRODUCTION
Stroke is the sudden loss of neurological function caused by health problem with an annual incidence of 0.2 to 2.5 per
an interruption of the blood flow to the brain (Sussan B. O’ 1000 population. Sudden onset of stroke leads to the
Sullivan).It is the leading cause of adult disability and second paralysis of one side of body causing difficulty in mobility,
leading cause of mortality worldwide(WHO,007).It’s a global ambulation and dependence in activities of daily living.
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Functional ambulation is defined as the ability of a person to Task oriented approach: Unfortunately, no conclusive
walk with maximal independence and in the least time under definition of a task-oriented Approach exists in the
various environmental circumstances. Post stroke literature. In the task-oriented approach, movement emerges
individuals may have difficulty adapting to environmental as an interaction between many systems in the brain and is
demands such as rising from a chair, stepping over an organized around a goal and constrained by the environment
obstacle, ascending stairs and walking along inclines and (Shumway Cook & Woollacott 2001).Task-oriented approach
uneven surfaces as they may have compromised the ability for stroke patients is based on the recognition that the goal
to regain balance, control movement or adjust energy of motor control is the control of the movement required to
expenditure. Turnbull et al. had also suggested that gait approach a particular task, and this includes the acquisition
deficiencies observed in post stroke individuals are likely of motor skills as a consequence of repetitive practice
limitations for their ability to respond to environmental (Shepherd RB).
demands.
The purpose of this study was to investigate both task
Ottenbacher and Jannel (1943) found that improvement in oriented approach and PNF technique was beneficial for
performances appears to be related to early initiation of functional ambulation of stroke patients, wheather feasible
treatment, age and study design but not to duration of and satisfied by the stroke survivors or not. Had its clinical
intervention. Early intervention in acute stroke implication on treating the stroke patients..
rehabilitation plays a major role in restoration of function
and reducing the degree of disability and dependence for AIMS AND OBJECTIVES
ADL’s and ambulation.(Edzard,1990). Aim of the study is to compare whether task oriented
approach is better than propioceptive neuromuscular
Stroke rehabilitation is an organized endeavour to help facilitation on functional ambulation of stroke patients.
patients to maximize all opportunities for returning to an
active lifestyle (Gresham et al. 1997, Aichner et al. 2002). HYPOTHESIS:
Neuro-rehabilitation is a method for relearning a previously Task oriented approach is more effective on functional
learned task in a different way, either by compensatory ambulation as compared to propioceptive neuromuscular
strategies or by adaptively recruiting alternative pathway facilitation within stroke population.
(Matthews et al. 2004).Selection of appropriate and best
neurorehabilitation is critical. NULL HYPOTHESIS:
Task oriented approach has no difference in effect on
The historical perspective of neurorehabilitation approaches functional ambulation as compared to PNF within stroke
evolved from reflex theory of motor control. Approaches population.
based on this concept are sensory motor approach (Roods
1940), movement therapy approach (Brunstrom, 1950), METHODOLOGY
Bobath approach (1960_70s), propioceptive neuromuscular SETTINGS: Department of Occupational Therapy, SV
facilitation (PNF) approach (knotandvoss, 1960_70s). NIRTAR
According to the theories of motor control system theory of PARTICIPANTS: A total of 30 stroke patient fulfilling the
motor control ,dynamic theory of motor control, and inclusion criteria were selected for the study purpose. The
biomechanics and new approaches developed .Based on selection of subjects was done by convenient sampling. The
dynamic theory of motor control concepts different task patients have been explained about the purpose of study.
specific training approaches are developed such as Motor Consent of participation in written form has been obtained
Relearning Program for Stroke , sensory integration and from the patient prior to study.
CIMT to advance concepts of robotic therapy, mental
imagery, virtual reality and locomotors trainings with body INCLUSION CRIETERIA
weight supported treadmill training and strength training. Population-All stroke survivors: Male and female both.
Types of event-Ischemic or hemorrhagic.
But still Roods approach; PNF, Brun srtom approach and No more than one stroke episode.
Bobath are commonly practiced and taught in India Can walk at least one minute without support.
(Davidson et al 2000). While stroke is an important cause of No incidence of any other significant neurological
disability, there is no generally accepted method for disorder.
rehabilitating stroke survivors. Commonly-used treatment Ability to communicate verbally.
approaches that focus on impairments and seek to regain a
‘normal’ movement pattern, such as neurodevelopmental EXCLUSION CRITERIA
treatment (NDT), have proved ineffective (Pomero & Tallis Seizure disorder.
2000, Paci 2003, Hafsteinsdottir et al. 2005, Kollen et al. Primary hearing impairment
2006, Lennon et al. 2006). Severe visual impairment
An orthopedic condition affecting their natural gait.
The PNF approach emphasizes the patient’s abilities and Any other significant neurological or orthopedic
potential so that strengths assist weaker components. disorders of gait including amputation.
Strengths and deficiencies are assessed and addressed in
treatment within total patterns of movement and posture. A WITHDRAWL CRITERIA:
battery of techniques is superimposed on these total Any subsequent episode of stroke.
patterns to enhance motor response and facilitate motor Any other medical condition that would prevent regular
learning (PEDRETTI 5th EDITION). participation in the study
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International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
OUTCOME MEASURES
FUNCTIONAL GAIT ASSESSMENT SCALE
The FGA is a 10-item clinical gait test during which
participants are asked to perform the following gait
activities: walk at a normal speed at fast and slow speeds,
with vertical and horizontal head turns, with eyes closed,
over obstacles, in tandem, backward, and while ascending
and descending stairs. The FGA is scored on a 4-level (0 – 3)
ordinal scale; scores range from 0-30, with lower scores
indicating greater impairment.
STUDY DESIGN:
Single centre randomized control trial.
SAMPLING:
Convenient sampling with random assignment.
PROTOCOLS:
PNF: Lower extremity:
Flexion-abduction-external rotation (knee flexed and
knee extended)
Extension-adduction-internal rotation (knee flexed and
knee extended)
Flexion-adduction-internal rotation (knee flexed and
knee extended)
Extension-abduction-external rotation (knee flexed and Figure 2 Patient performing TOA (walking over a
knee extended). balance beam)
Upper extremity:
Flexion-abduction-external rotation (elbow flexed and
elbow extended)
Extension-adduction-internal rotation (elbow flexed and
elbow extended)
Flexion-adduction-internal rotation (elbow flexed and
elbow extended)
Extension-abduction-external rotation (elbow flexed
and elbow extended)
Each protocol given 45minutes per session 5 days a week for Figure 3 Performing PNF diagonal pattern (lower
two months. extremity flexion-abduction-external rotation , knee
flexed)
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International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
DATA ANALYSIS
The test measurements were compared before and after
therapy. Statistical calculation were performed with SPSS
version 23.Statistical test were carried with level of
significance set at p<0.05
Test Statistics
FGApo – FGApre Graph 2 Significant improvement in experimental
Z -3.422b group B within the group
Asymp. Sig. (2-tailed) .001
Table -4: MAN WHITNEY TEST FOR IMPROVEMENT SCORE
a. Wilcoxon Signed Ranks Test
OF TWO experimental groups
b. Based on negative ranks.
Ranks
This table shows a significant improvement in experimental
group A within the group with a p value of 0.001 Mean Sum of
Group N
Rank Ranks
Task Oriented
15 15.53 233.00
Approach
Improvemet
PNF 15 15.47 232.00
Total 30
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International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
Test Statisticsa months and there was significant improvement within the
Improvement two experimental group. By the help of this study we infer
Mann-Whitney U 112.000 that TOA and PNF are efficacious methods of improving
Wilcoxon W 232.000 functional ambulation in strokes patients.
Z -.021
Asymp. Sig. (2-tailed) .983 Lee and Van Doukleaar, 1995, said that there is a certain
Exact Sig. [2*(1-tailed Sig.)] 1.000b period of time, in which plastic changes of the brain after
a. Grouping Variable: group stroke can be influenced by therapeutic intervention.
b. Not corrected for ties. According to Laura and Jeanne the efficacy of standard
physical therapy (based on the task-oriented approach) has
This table shows there is no significant difference between a significant results in balance retraining with poststroke
post score data of both experimental group with a p value patients.
1.000.
A systemic review on task oriented training studied by
Graph Showing difference between the improvement score Marijke Rensink, Marieke Schuurmans shows that Active
in post test score of experimental groups A and B use of task-oriented training with stroke survivors will lead
to improvements in functional outcomes and overall health
related quality of life.
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The PNF protocol used in this study led to improvements in walking in individuals with poststroke hemiplegia. J
FGA scores and consequently overall functional ambulation. Rehab Res Dev 2004; 41(3A): 283-292.
Inclusion of PNF in any treatment plan for post-stroke
[9] Darsi A. Umphred: Neurological Rehabilitation, 6th
individuals may be of benefit, especially when improved
edition.
functional ambulation is a key part of treatment goals. At the
moment there was no evidence found through this [10] Diane M Wrisley, Gregory F Marchetti, Diane K
experiment favorable to a specific approach .Both the Kuharsky, and Susan L Whitney: Reliability, Internal
approaches should be used with therapists’ own experiential Consistency, and Validity of Data Obtained With the
view but a larger study ultimately will bring about Functional Gait Assessment.
conclusive evidence.
[11] Glen Gillen,Ann Burkhardt : Stroke rehabilitation-A
function based approach.
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