FALL PREVENTION THERAPIES FOR INDIVIDUALS WITH STROKE: A SURVEY

摘要

Stroke basically consists in brain-cells death due to lack or excess of blood. Stroke has many important consequences and falls are one of the most concerning. Falls can produce several injures from minor lacerations to fractures and death. It has been found that balance and gait impairments after stroke are important risk factors for fall. Hence, improving balance and gait ability in stroke survivors can significantly reduce falls rate. In this literature review, we review the main characteristic and the therapeutic results of different therapeutic interventions aimed at improving balance and walking ability. The main therapeutic interventions included are the Bobath therapy, exercise-based interventions, orthotic and assistive devices, modality treatments, alternative therapies, robotic-assisted training, and computational-based interventions. The parameters considered as evidence of balance and/or gait recovery after a specific intervention are: walking speed (WS), cadence, endurance, stride/step length, weight/walking symmetry, and sway. Our main findings are: 1) The wide use of the Bobath concept is not well supported by evidence due to its performance has been found to be inferior to some exercises-based interventions such as walking training; 2) exercises-based interventions were classified as strength and task-specific training. The former improves muscular and bone health, aerobic capability, and prepares the patient to perform a more demanding activity. The latter is designed as a repetitive training of a functional activity, mainly walking, and sit to stand exercises, which improve both gait and balance. Orthotic and assistive devices have effects on balance and gait but only while they are worn or used; 3) robotic assisted walking-training presented similar results to overground or treadmill walking training in terms of walking speed and balance recovery. However, the most important advantage lies on the reduction of burden for therapists; 4) thee most important use of motion analysis is as a tool for identify the causes deficits in a patient and the to design a therapy in accordance; 5) motion synthesis can be used as a tool to answer very specific questions related to capabilities/limitations of a patient. For instance, "what would be the effect of increasing hip-torque capability of a stroke survivor on the walking-symmetry?" The answer to this question would either help to design an exercise/intervention or to discard such intervention due to low impact; 6) some treatments are added to a main therapy to increase its effect on a given parameter. Functional electrical stimulation, which is added to cycling training to improve motion patterns. Biofeedback is used during balance training to reduce weight-asymmetry. And virtual reality and video games are used to increase motivation and permanence of patient on a therapy; 7) we found some alternative or no widely used therapies. Among the most promising we can mention Tai-Chi exercises, which integrates physical and mental activities to improve balance and gait and rhythmic auditory stimulation that improves WS and weight-symmetry; and 8) orthotics devices help to reduce falls by extending the base of support but the effect appears only while they are worn. In general, there is not an ultimate therapy able to fit to every patient. The choice should depend on patient's goals and conditions. Moreover, falls can not be eliminated but they can be substantially reduced by improving balance and gait.