 Geiger R. A., Allen J. B., O'Keefe J., & Hicks, R. R. (2001).

Balance and mobility

following stroke: effects of physical therapy interventions with and without
biofeedback/forceplate training. Phys Ther, 81(4), 995-1005. PEDro: 3
Country: USA

13 outpatients with hemiplegia were randomized to receive 1 of 2 treatment

groups: (1) visual biofeedback/ forceplate training using the NeuroCom
Balance Master; or (2) regular balance training therapy. Both groups
received interventions to improve balance and mobility 2-3 times a week for
50 minutes for 4 weeks while the experimental group received an additional
15 minutes of biofeedback training. Participants were assessed using
cognitive and visual-perceptual skills, as well as the Berg Balance Scale and
the Timed "Up and Go" (TUG) test. At 4 weeks, significant improvements
were demonstrated in both groups, however there was no added benefit
apparent for those who received visual biofeedback/forceplate training
interventions.

 PEDro: 4
Country: France

26 individuals were randomized to receive 1 of 2 treatments: (1) Standing

balance training by biofeedback coupled with standard physical therapy; or
(2) standard physical therapy (control). The time between onset of stroke
event and time when individual started to walk post-stroke was recorded.
Other measures included gait velocity and walking pattern. Individuals in
both groups improved significantly thus there were no significant
differences between groups on these measures.

Middle Cerebral Artery Stroke: Treatment & Medication

Author: Daniel I Slater, MD, Medical Director, Department of Physical Medicine and Rehabilitation, St. Mary's Hospital
Coauthor(s): Sarah A Curtin, MD, Staff Physician, Department of Family Practice, St Mary's Hospital; Jeffery S Johns, MD, Associate Hospital Medical Director, Medical Director of Spinal Cord Injury
Program, Brooks Rehabiliation Hospital; Cindy Schmidt, MPT, Physical Therapist, Department of Physical Medicine and Rehabilitation, St Mary's Hospital
Contributor Information and Disclosures
Updated: Apr 12, 2010

Treatment

Rehabilitation Program
Physical Therapy

Rehabilitation can be explained as the planned withdrawal of support in order to enable the patient to
become as independent as possible. This is achieved by an interdisciplinary team of professionals, one
member of which is the physical therapist. Physical therapists work with patients to help them regain motor
control,20 strength, physical conditioning, and mobility and to help them return to independent living.
The emphasis in rehabilitation for patients who have suffered a middle cerebral artery stroke is on patient
and family/caregiver education, which includes involvement of the patient and the family in goal setting and
in planning and implementing treatments. Within all disciplines, attention must also be given to
psychological and social issues. All team members are involved in developing a comprehensive discharge
plan for which the goal is a smooth transition to the community. This includes promotion of social
reintegration and resumption of roles in the home and family, as well as in the recreational and vocational
domains.
Physical therapy in a rehabilitation facility begins with a comprehensive evaluation of motor function,
mobility, balance, coordination, sensation, and proprioception. Tests used to measure these include, but
are not limited to, manual muscle testing, postural evaluation, gait analysis, functional assessment, and the
Berg balance scale test. The team also evaluates family/caregiver support and the patient's living
environment, which aides in the discharge plan. Goals that are measurable and realistic are set by the
patient, family, and rehabilitation team, and these goals are reevaluated at regular intervals.
In order to achieve the goal of enabling the patient to become as independent as possible, several different
treatment techniques are used by the physical therapist. Some of these include neurodevelopmental
technique (NDT), proprioceptive neuromuscular facilitation (PNF), balance training, manual therapy,
neuromuscular electrical stimulation (NMES), biofeedback, aqua therapy, myofascial release, frequency-
specific microcurrent, and cardiovascular training. For example, independent ambulation is often an
important goal that requires several stages of recovery.
Initially, patients exhibit poor trunk control, are unable to bear weight on the affected extremity, and are
unable to advance the leg during the swing phase of gait. Initial physical therapy focuses on posture, trunk
control, and weight transfer to the hemiparetic lower extremity. Treatment often begins with NDT- or PNF-
based mat exercises or with balance work on a Swiss ball to gain trunk control. Progression is to standing
weight-bearing and weight-shift exercises, which lead to the patient taking his/her first steps in the parallel
bars; this may be coupled with NMES to enhance muscle function.
Partial body weight–supported gait training may be performed on or off the treadmill, with the patient safely
secured in a harness system that supports varying degrees of the patient's body weight. This allows the
therapist to assist the patient in achieving a more natural, sustained gait pattern earlier in the stages of
recovery than would otherwise be possible. The final step is gait either with or without an assistive device,
such as a walker or cane, depending on the patient's level of function.
Many different types of adaptive devices and durable medical equipment are also available to assist the
patient in becoming more independent. For example, many patients have weakness of ankle dorsiflexion
and require an ankle-foot orthosis to prevent foot drop and maintain knee extension during weight bearing.
Physical therapists also assist in proper fitting of a wheelchair for a patient to allow more immediate
increased independence from a wheelchair level while continuing to work towards independence with
walking.
Rehabilitation after a stroke is very team oriented, with the physical therapist as an integral part. However,
the most important part of that team is the patient, and his or her drive to succeed is imperative for a
successful outcome.