Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial A Comparison of 12 Weeks of Pilates and Aquatic Training on the Dynamic Balance of Women with Mulitple Sclerosis Impact of aerobic training on fitness and quality of life in multiple sclerosis The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. The Effect of Obstacle Training in Water on Static Balance of Chronic Stroke Patients Aquatic therapy versus conventional land-based therapy for Parkinson's disease: an open-label pilot study. Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. Physical therapy in Parkinson’s disease: an open long-term rehabilitation trial The effect of aquatic therapy on postural balance and muscle strength in stroke survivors — a randomized controlled pilot trial Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma.
OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Objective : To evaluate the effects of an aquatic physiotherapy method ( Halliwick-Therapy ) upon mobility in the post-acute phase of stroke rehabilitation . Design : R and omized controlled trial . Setting : Hospital for neurological rehabilitation . Participants : Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30 ) . Interventions : In the Halliwick-Therapy group ( n = 14 ) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week . Subjects in the control group ( n = 16 ) received conventional physiotherapeutic treatment over a period of two weeks five times per week . Outcome measures : The primary outcome variable was postural stability ( Berg Balance Scale ) . Secondary outcome variables were functional reach , functional gait ability and basic functional mobility . Results : Compared to the control group , significantly more subjects in the Halliwick-Therapy group ( 83.3 % versus 46.7 % ) attained significant improvement of the Berg Balance Scale ( P < 0.05 ) . Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group ( mean ( SD ) 1.25(0.86 ) ) than in the control group ( mean ( SD ) 0.73 ( 0.70 ) ) ( P < 0.1 ) . The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups . Conclusions : This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility Background : Multiple Sclerosis ( MS ) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated . The objective of this study is to underst and the effect of Pilates exercises and aquatic training for a 12 week period on the dynamic balance of MS patients . Methods : The research method is semi-experimental . As a result , among the female patients visiting the MS clinic of Kashani hospital in Esfahan , 57 patients with disease intensity levels between 0 and 4.5 were taken as sample s. The average length of the disease was 8 ± 2 years , 20;40 years old , and they were r and omly divided into three groups of Pilates exercise group , aquatic training group , and the control group . The exercise schedule for the experiment groups consisted of 12 weeks , three sessions per week , and 1 hour for each session . The dynamic balance of the patients , before and after the exercises was measured by Six Spot Step Test . Results : The adjusted mean differences of Timed Up and Go Test ( TUGT ) scores of the experimental groups are significantly different ( P<0.05 ) . Therefore , it can be said that Pilates exercise interventions and aquatic training can significantly increase the dynamic balance of the examinees in the post-experiment stage . Conclusions : Performing the Pilate exercises and aquatic training  increases dynamic balance of the MS patients . Considering the role of dynamic balance on physical fitness and enabling the person in doing is daily chores and routines , and its direct effect on the quality of life , it leads the specialists in applying these exercises as a supplementary treatment along with the medicinal treatments for MS patients Fifty‐four multiple sclerosis ( MS ) patients were r and omly assigned to exercise ( EX ) or nonexercise ( NEX ) groups . Before and after 15 weeks of aerobic training , aspects of fitness including maximal aerobic capacity ( Vo2max ) , isometric strength , body composition , and blood lipids were measured . Daily activities , mood , fatigue , and disease status were measured by the Profile of Mood States ( POMS ) , Sickness Impact Profile ( SIP ) , Fatigue Severity Scale ( FSS ) , and neurological examination . Training consisted of 3 × 40‐minute sessions per week of combined arm and leg ergometry . Exp and ed Disability Status Scale ( EDSS ) scores were unchanged , except for improved bowel and bladder function in the EX group . Compared with baseline , the EX group demonstrated significant increases in Vo2max , upper and lower extremity strength , and significant decreases in skinfolds , triglyceride , and very‐low‐density lipoprotein ( VLDL ) . For the EX group , POMS depression and anger scores were significantly reduced at weeks 5 and 10 , and fatigue was reduced at week 10 . The EX group improved significantly on all components of the physical dimension of the SIP and showed significant improvements for social interaction , emotional behavior , home management , total SIP score , and recreation and past times . No changes were observed for EX or NEX groups on the FSS . Exercise training result ed in improved fitness and had a positive impact on factors related to quality of life OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Over an 18-month period , all incident cases of neurological disorders were ascertained prospect ively in an unselected urban population based in 13 general practice s in the London area by a General Practice Linkage Scheme with the National Hospital for Neurology and Neurosurgery . In three of these practice s , the lifetime prevalence of neurological disorders was also assessed . A population of 100 230 patients registered with participating general practice s was followed prospect ively for the onset of neurological disorders . Multiple methods of case finding were used to maintain accuracy . The age- and sex-adjusted incidence rates of neurological disorders were calculated . The lifetime prevalence of neurological disorders was surveyed in 27 658 of the patients . The age- and sex-adjusted incidence rates were calculated for major neurological conditions . [ These are expressed as rates per 100 000 persons per annum , with 95 % confidence intervals ( CI ) in parentheses ] . The commonest of these were first cerebrovascular events , 205 ( CI : 183 , 230 ) ; shingles , 140 ( CI : 104 , 184 ) ; diabetic polyneuropathy , 54 ( CI : 33 , 83 ) ; compressive neuropathies , 49 ( CI : 39 , 61 ) ; epilepsy , 46 ( CI : 36 , 60 ) ; Parkinson 's disease , 19 ( CI : 12 , 27 ) ; peripheral neuropathies , 15 ( CI : 9 , 23 ) ; CNS infections , 12 ( CI : 5 , 13 ) ; post-herpetic neuralgia , 11 ( CI : 6 , 17 ) ; and major neurological injuries , 10 ( CI : 4 , 11 ) . Lifetime prevalence rates are also reported ( expressed as rate per 1000 persons with 95 % CI ) . The most prevalent conditions were : completed stroke , 9 ( CI : 8 , 11 ) ; transient ischaemic attacks , 5 ( CI : 4 , 6 ) ; active epilepsy , 4 ( CI : 4 , 5 ) ; congenital neurological deficit , 3 ( CI : 3 , 4 ) ; Parkinson 's disease , 2 ( CI : 1 , 3 ) ; multiple sclerosis , 2 ( CI : 2 , 3 ) ; diabetic polyneuropathy , 2 ( CI : 1 , 3 ) ; compressive mononeuropathies , 2 ( CI : 2 , 3 ) ; and sub-arachnoid haemorrhage , 1 ( CI : 0.8 , 2 ) . Overall , the onset of 625 neurological disorders was observed per 100 000 population annually . Six percent of the population had at some time had a neurological disorder . This is the first study of the incidence and lifetime prevalence of neurological disorders in recent times ; we found that these disorders give rise to significant morbidity in the community [ Purpose ] This study evaluated the effects of water and l and -based obstacle training on static balance of chronic stroke patients . [ Subjects ] The subjects were r and omly allocated to an  aqua group ( n=15 ) and a l and group ( n=15 ) . [ Methods ] Both groups trained for 40 minutes , 3 times a week for 12 weeks . Static balance was assessed by measuring the mean velocities of mediolateral ( ML ) and anteroposterior ( AP ) , and sway area with the eyes closed . [ Results ] Following the intervention , both groups showed significant changes in ML velocity , AP velocity , and sway area . The static balance of the aqua group was significantly better than the l and group . [ Conclusion ] The results of this study suggest the feasibility and suitability of obstacle training in water for stroke patients OBJECTIVES To assess and compare 2 different protocol s of physiotherapy ( l and or water therapy ) for people with Parkinson 's disease ( PD ) focused on postural stability and self-movement , and to provide method ological information regarding progression within the program for a future larger trial . DESIGN R and omized , controlled , open-label pilot trial . SETTING Out patients , Parkinson 's disease Center of Ferrol-Galicia ( Spain ) . PARTICIPANTS Individuals ( N=11 ) with idiopathic PD in stages 2 or 3 according to the Hoehn and Yahr Scale completed the investigation ( intervention period plus follow-up ) . INTERVENTIONS After baseline evaluations , participants were r and omly assigned to a l and -based therapy ( active control group ) or a water-based therapy ( experimental group ) . Participants underwent individual sessions for 4 weeks , twice a week , for 45 minutes per session . Both interventions were matched in terms of exercise features , which were structured in stages with clear objectives and progression criteria to pass to the next phase . MAIN OUTCOME MEASURES Participants underwent a first baseline assessment , a posttest immediately after 4 weeks of intervention , and a follow-up assessment after 17 days . Evaluations were performed OFF-dose after withholding medication for 12 hours . Functional assessment s included the Functional Reach Test ( FRT ) , the Berg Balance Scale ( BBS ) , the UPDRS , the 5-m walk test , and the Timed Up and Go test . RESULTS A main effect of both therapies was seen for the FRT . Only the aquatic therapy group improved in the BBS and the UPDRS . CONCLUSIONS In this pilot study , physiotherapy protocol s produced improvement in postural stability in PD that was significantly larger after aquatic therapy . The intervention protocol s are shown to be feasible and seem to be of value in amelioration of postural stability-related impairments in PD . Some of the method ological aspects detailed here can be used to design larger controlled trials BACKGROUND The fear of falling may cause elderly people to limit their movement . As movement errors are known to facilitate the acquisition of motor skills , the elderly may inadvertently cause the loss of postural skills by constraining their movements , and hence avoid potential movement errors . It was hypothesized that by having elderly individuals exercise in a risk-free environment-water was utilized in this experiment-their postural capabilities would improve . METHODS Four groups of elderly subjects ( 80 + /- 5.8 years old ) were placed into four groups : Water Exercisers ; L and Exercisers ; Water Sitters ; and L and Sitters . Each group met twice per week for 45 minutes for 5 weeks of simple exercises or socializing in the design ated medium . The distance each individual could reach ( Functional Reach , FR ) was measured at the end of each week . RESULTS Initially , each group was at risk ( FR < 10 inches ) for falling Statistical testing showed that the Water Exercisers ( WE ) increased their FR almost every week ; the L and Exercisers ( LE ) increased only during the first week ; and the Water Sitters ( WS ) and L and Sitters ( LS ) did not increase at all . The FRs after 5 weeks were 13.4 + /- 1.6 ( WE ) , 11.3 + /- 1.5 ( LE ) , 9.6 + /- 1.3 ( WS ) , and 9.3 + /- 0.71 ( LS ) inches for each group , respectively . CONCLUSIONS The data showed that the postural capabilities in these elderly people , as measured by the FR , were enhanced by the production of movement errors that was facilitated in a water environment ( in the case of the Water groups ) or the initiation of a novel exercise program ( L and Exercisers ) . Alternative explanations , and implication of these results , are discussed Abstract .The aim of this study was to evaluate the effects of prolonged physical therapy on disability in patients with Parkinson ’s disease . The study was design ed as an open long-term trial over 20 weeks . Twenty slightly to moderately affected parkinsonian patients were included ( Hoehn & Yahr stages : 1.5–3 ) . A comprehensive rehabilitation program was applied three times a week in all patients . Pharmacological treatment was kept stable . Evaluations were performed at baseline , at the end of treatment and after 3 months . Following physical rehabilitation , there was a significant improvement in UPDRS ( ADL and motor sections ) scores , Self- assessment Parkinson ’s disease Disability Scale , Ten-Meter Walk test and Zung scale for depression . At 3-month follow-up clinical improvements were largely maintained . A sustained improvement of motor skills in PD patients can be achieved with a long-term comprehensive rehabilitation program Objective : To evaluate the effect of an aquatic therapy programme design ed to increase balance in stroke survivors . Design : A r and omized , controlled pilot trial . Setting : Rehabilitation department of a university hospital . Subjects : Ambulatory chronic stroke patients ( n = 25):13 in an aquatic therapy group and 12 in a conventional therapy group .  Interventions : The aquatic therapy group participated in a programme consisting of Ai Chi and Halliwick methods , which focused on balance and weight-bearing exercises . The conventional therapy group performed gym exercises . In both groups , the interventions occurred for 1 hour , three times per week , for eight weeks . Main measures : The primary outcome measures were Berg Balance Scale score and weight-bearing ability , as measured by vertical ground reaction force during four st and ing tasks ( rising from a chair and weight-shifting forward , backward and laterally ) . Secondary measures were muscle strength and gait . Results : Compared with the conventional therapy group , the aquatic therapy group attained significant improvements in Berg Balance Scale scores , forward and backward weight-bearing abilities of the affected limbs , and knee flexor strength ( P<0.05 ) , with effect sizes of 1.03 , 1.14 , 0.72 and 1.13 st and ard deviation units and powers of 75 , 81 , 70 and 26 % , respectively . There were no significant changes in the other measures between the two groups . Conclusions : Postural balance and knee flexor strength were improved after aquatic therapy based on the Halliwick and Ai Chi methods in stroke survivors . Because of limited power and a small population base , further studies with larger sample sizes are required In this pilot study , the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma . The research followed a pretest-posttest crossover design wherein each subject served as her own control . Blinded examiners recorded respiratory excursion , peak expiratory flow rates , and subjective measures of asthma symptoms . Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures . Changes in peak expiratory flow rates and asthma symptoms were not statistically significant
Background Multiple sclerosis , Parkinson 's disease , and hemiplegia are common disorders that directly cause impairment of balance and gait .
Aquatic exercises are used for neurological rehabilitation .
It is suggested that the contributing factors of the water setting such as buoyancy , viscosity , and hydrostatic pressure offer an ideal environment for rehabilitative programmes .
Objective To conduct a systematic review of studies that assess the effect of aquatic exercises on balance in neurological patients ( i.e. , patients with multiple sclerosis , Parkinson 's disease , and hemiplegia ) .