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Platforms, Thematic Posters, and Posters for CSM 2007: POSTERS

THE EFFECTS OF INTENSE MASSED PRACTICE ON BALANCE AND AMBULATION POST-STROKE

A PILOT STUDY

Carlson, T. D.1; Cahn, L.1; Leloup, B.2

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Journal of Neurologic Physical Therapy: December 2006 - Volume 30 - Issue 4 - p 211
doi: 10.1097/01.NPT.0000281305.24528.98
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Purpose/Hypothesis: Balance after stroke is a common impairment needing intervention by physical therapy. A variety of approaches are used to retrain balance and improve gait dynamics. Recent evidence using massed practice models in constraint-induced movement therapy has demonstrated gains in upper extremity function. Similar research models that focus on mobility or lower extremity function are emerging. Therefore, this study investigated the effects of intense massed practice on balance, gait speed, and weightbearing ratios. Number of Subjects: Eleven subjects with hemiparesis (6 left, 5 right) participated in this study. Mean stroke chronicity was 27.9 months. Subjects were randomized into treatment (n=6) and control (n=5) groups. Materials/Methods: Treatment subjects received intense massed practice for 3 hours/day for 2 weeks with interventions focused on forcing use of the affected lower extremity. Control subjects did not receive any intervention. Outcome measures included the Berg Balance Scale, self-selected gait speed over 10 meters, weightbearing ratios in quiet standing (WB-S), and weightbearing ratios during ambulation (WB-A). Testing was performed at pre-test, post-test, and again at 3-month follow-up. Results: Treatment subjects improved Berg balance scores by an average of 4 points at post-test, versus 1 point for the control group. Statistical significance (Mann-Whitney Test) was found for Berg balance scores between pre-test and post-test (p=.028), but not between pre-test and follow-up (p=.988). Gait speed improved for treatment subjects by 1.05 seconds more than the control group. All treatment subjects showed improvement in WB-A at post-test, but not with WB-S. Although improvements in gait speed and WB-A were observed, calculations were not statistically significant. Conclusions: Our data supports using massed practice as a viable method to improve balance in individuals post-stroke. However, improvements in balance were not maintained after 3 months. Clinical Relevance: This study supports emerging research that massed practice post-stroke improves balance. Therefore, clinicians retraining balance post-stroke should consider increasing the intensity of their services when feasible. As massed practice research grows, it will be important to compare outcomes in massed practice models versus standard physical therapy models.

© 2006 Neurology Section, APTA