| Control Group |
conventional physical therapy program for stroke patients |
three days a week |
six weeks |
1. Stretching exercises: a prolonged stretch was done for the calf muscle (gastrocnemius and soleus) so maintain and improve its flexibility which when affected can limit voluntary movement done by the dorsiflexors, the stretch was performed at the start of each session for a period of 30 secs and repeated three to four times.
2. Facilitation for weak muscles: by using the principles of the length tension relationship and other facilitatory techniques such as light resistance, isometric and eccentric contractions and tapping.
3. Strengthening exercises: to improve the strength of the muscles exceeding grade 3 in the affected lower limb such as:
a) Straight leg raising exercise: to improve hip flexors and knee extensors strength which are commonly affected after stroke, patients were instructed to flex the affected lower limb while maintaining their knees in extension, hip in neutral position and their ankle in dorsiflexion. The exercise was done for 3 sets, each set ranged from 10 to 15 repetitions.
b) Clamshell exercise: for improving hip abductors and external rotators strength. Patients were instructed to lie on their unaffected side with their knees and their hips flexed at 45-degree angle, patients were asked to open between their knees while maintaining both their ankles on top of each other and their pelvis stable, the exercise was repeated for 3 sets, each set included 10 to 15 repetitions.
c) Bridging exercises: to improve the strength of hip extensors, abductors and ankle stabilizers. Patients were instructed to lay in a hock lying position and elevate their pelvis while bearing their weight on their feet and upper trunk, the exercises was done for 3 sets, each set included 10 to 15 repetitions, at first it was done bilaterally and then progressed to unilaterally on the affected limb.
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15 |
Active-Treatment of Control Group |
| Experimental Group |
Active sensory training |
three days per week |
six weeks |
. the active sensory training method that was used was a proprioceptive training program. The program consisted of three phases of training done in a step standing and standing position; the first phase was done using a soft stable surface (a block), and in the second and the third phases of training was done by using an unstable surface (a two-dimensional balance board). Each phase had a series of tasks done in both eyes opened and closed conditions. Five trials were done for each task, and they were considered a set, between each trial the patient was allowed to take a break for 10 seconds, the patient was asked to perform five sets of each task to be considered completed and move on to the next.
Phase 1
Task 1: Patient assumed step standing position with his affected limb on the block and the unaffected limb on the ground. The patient was asked to maintain the position for 20 secs.
Task 2: Patient assumed step standing position with his affected limb on the block and the unaffected limb on the ground and was asked to perform upper limb movement or reach in all directions for the purpose of weight shifting while maintaining stability
Task 3: Patient assumed step standing position with his unaffected limb on the block and his affected limb on the ground and asked to maintain this position for 20 secs.
Task 4: Patient assumed step standing position with his unaffected limb on the block and his affected limb on the ground and was asked to perform upper limb movement or reach in different directions for the purpose of weight shifting while maintaining stability.
Phase 2
Task 1: patient assumed step standing position with his affected limb on the balance board and the unaffected limb on the ground. The patient was asked to maintain the position for 20 secs.
Task 2: patient assumed step standing position with his affected limb on the balance board and the unaffected limb on the ground, reaching exercises and upper limb movements were done to encourage patients to shift their weight in all directions
Task 3: patient assumed step standing position with his unaffected limb on the balance board and his affected limb on the ground and asked to maintain this position for 20 secs.
Task 4: patient assumed step standing position with his unaffected limb on the block and his affected limb on the ground. reaching exercises were done and upper limb movements to encourage patients to shift their weight in all directions
Phase 3
Task 1: Patients were asked to assume standing positing on the 2-dimensional balance board and remain stable for 20 secs
Task 2: Patients were asked to assume standing position on the 2-dimensional balance board while been asked to reach in multiple directions or perform upper limb movements for the purpose of achieving weight shifting.
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15 |
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