Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation The Effects of a Motorized Aquatic Treadmill Exercise Program on Muscle Strength, Cardiorespiratory Fitness, and Clinical Function in Subacute Stroke Patients: A Randomized Controlled Pilot Trial Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. Improvements in Speed-Based Gait Classifications Are Meaningful 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 Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients Balance and walking performance are improved after resistance and aerobic training in persons with chronic stroke Aquatic Therapy Improves Outcomes for Subacute Stroke Patients by Enhancing Muscular Strength of Paretic Lower Limbs Without Increasing Spasticity: A Randomized Controlled Trial The Effect of Obstacle Training in Water on Static Balance of Chronic Stroke Patients Detecting change in patients with stroke using the Berg Balance Scale. Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients: A PILOT TRIAL Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The effect of aquatic therapy on postural balance and muscle strength in stroke survivors — a randomized controlled pilot trial Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: a randomized controlled trial Effect of Underwater Exercise on Lower-Extremity Function and Quality of Life in Post-Stroke Patients: A Pilot Controlled Clinical Trial. The effect of water-based exercises on balance in persons post-stroke: a randomized controlled trial
Abstract Background : Patients with stroke present an asymmetric posture , severe balance dysfunction with delayed and disrupted equilibrium reactions , exaggerated postural sway and abnormal gait with an increased risk of falling . The aim of this study is to evaluate the efficacy of hydrokinesytherapy on stance , balance and gait in individuals after stroke . Methods : In this single-blinded r and omized controlled trial , patients with stroke were divided into two groups : an experimental one ( G1 ) , performing hydrokinesytherapy ( 3 times/week ) in addition to a conventional physical therapy ( 3 times/week ) and a control one ( G2 ) , performing only a conventional physical therapy ( 6 times/week ) . All of the participants underwent a proper clinical and baropodometric evaluation before and after 8 weeks of treatment . Results : The two groups presented similar clinical and instrumental features at enrolment ( mean modified Rankin Scale of 3 , and a disease duration of 6.3 ± 1.4 months ) . After treatment , the patients undergoing hydrokinesytherapy showed a significantly greater improvement than those undergoing traditional training . Conclusions : Hydrokinesytherapy may be considered a promising treatment in improving gait and balance in individuals following stroke Objective The aim of this study was to assess whether the effects of a motorized aquatic treadmill exercise program improve the isometric strength of the knee muscles , cardiorespiratory fitness , arterial stiffness , motor function , balance , functional outcomes , and quality of life in subacute stroke patients . Design Thirty-two patients were r and omly assigned to 4-wk training sessions of either aquatic therapy ( n = 19 ) or l and -based aerobic exercise ( n = 18 ) . Isometric strength was measured using an isokinetic dynamometer . Cardiopulmonary fitness was evaluated using a symptom-limited exercise tolerance test and by measuring brachial ankle pulse wave velocity . Moreover , motor function ( Fugl-Meyer Assessment [ FMA ] and FMA-lower limb [ FMA-LL ] ) , balance ( Berg Balance Scale [ BBS ] ) , Activities of daily living ( Korean version of the Modified Barthel Index [ K-MBI ] ) , and quality of life ( EQ-5D index ) were examined . Results There were no intergroup differences between demographic and clinical characteristics at baseline ( P > 0.05 ) . The results shows significant improvements in peak oxygen consumption ( P = 0.02 ) , maximal isometric strength of the bilateral knee extensors ( P < 0.01 ) and paretic knee flexors ( P = 0.01 ) , FMA ( P = 0.03 ) , FMA-LL ( P = 0.01 ) , BBS ( P = 0.01 ) , K-MBI ( P < 0.01 ) , and EQ-5D index ( P = 0.04 ) after treatment in the aquatic therapy group . However , only significant improvements in maximal isometric strength in the knee extensors ( P = 0.03 ) and flexors ( P = 0.04 ) were found within the aquatic therapy group and control group . Conclusions Water-based aerobic exercise performed on a motorized aquatic treadmill had beneficial effect on isometric muscle strength in the lower limb . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to : ( 1 ) Articulate the rationale for including walking on an aquatic treadmill in the rehabilitation of subacute stroke patients ; ( 2 ) Describe the beneficial effects of a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients ; and ( 3 ) Determine the appropriate indications for incorporating a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients . Level : Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians . The Association of Academic Physiatrists design ates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should only cl aim credit commensurate with the extent of their participation in the activity Background When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke QUESTION Does progressive resistance training improve strength and activity after stroke ? Does any increase in strength carry over to activity ? DESIGN Systematic review of r and omised trials with meta- analysis . PARTICIPANTS Adults who have had a stroke . INTERVENTION Progressive resistance training compared with no intervention or placebo . OUTCOME MEASURES The primary outcome was change in strength . This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention . The secondary outcome was change in activity . This measurement had to be a direct measure of performance that produced continuous or ordinal data , or with scales that produced ordinal data . RESULTS Eleven studies involving 370 participants were included in this systematic review . The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8 , representing medium quality . The effect size of  progressive resistance training on strength was 0.98 ( 95 % CI 0.67 to 1.29 , I2=0 % ) . The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies . The effect size of progressive resistance training on activity was 0.42 ( 95 % CI -0.08 to 0.91 , I2=54 % ) . CONCLUSION After stroke , progressive resistance training has a large effect on strength compared with no intervention or placebo . There is uncertainty about whether these large increases in strength carry over to improvements in activity . REVIEW REGISTRATION PROSPERO CRD42015025401 . [ Dorsch S , Ada L , Alloggia D ( 2018 ) Progressive resistance training increases strength after stroke but this may not carry over to activity : a systematic review . Journal of Physiotherapy 64 : 84 - 90 ] Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity 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 [ Purpose ] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients . [ Subjects and Methods ] Twenty stroke patients were r and omly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group ( n = 10 each ) . Both the groups underwent neurodevelopmental treatment , and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater . Balance was measured using the Berg Balance Scale and Functional Reach Test , and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test . To compare in-group data before and after the intervention , paired t-test was used . Independent t-test was used to compare differences in the results of the Berg Balance Scale , Functional Reach Test , 10-Meter Walk Test , and Timed Up and Go Test before and after the intervention between the groups . [ Results ] Comparison within the groups showed significant differences in the results of the Berg Balance Scale , Functional Reach Test , 10-Meter Walk Test , and Timed Up and Go Test before and after the experimental intervention . On comparison between the groups , there were greater improvements in the scores of the Berg Balance Scale , Functional Reach Test , 10-Meter Walk Test , and Timed Up and Go Test in the experimental group . [ Conclusion ] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients Abstract Purpose : To investigate the effect of different types of physical training on balance performance and whether improved balance correlates with improved walking performance . Methods : Forty eight participants with chronic stroke were r and omly assigned to aerobic training on cycle ergometer ( AT-group ) , resistance training of the lower extremities ( RT-group ) , or sham training of upper extremities ( ST-group ) . Participants exercised 3 d/week for 12 weeks . Balance ( Berg Balance Scale ) , peak oxygen uptake rate , isometric knee extensor strength , maximal gait speed , and 6 minute walk test were measured at baseline and after 12 weeks . Results : Training specific effects were observed ; the AT-group improved peak oxygen uptake rate by 15.5 (6.0–25.0)% , the RT-group improved non-paretic knee extensor strength by 35.1 (18.3–51.9)% and the ST-group improved non-paretic knee extensor strength by 8.9 (0.7–17.1)% . All groups improved balance ( 6.0 ( 95 % CI : 3.2–8.8)% ) , maximal gait speed ( 10.2 (6.5–14.0)% ) , and 6 minute walk distance ( 12.4 (8.8–15.9)% ) but balance improvements did not correlate with improvements in muscle strength , peak oxygen uptake rate , or walking . Conclusions : Physical exercise improves balance and walking performance , but improved balance is not a prerequisite for functional improvements in chronic stroke . Implication s for Rehabilitation Aerobic training and progressive resistance training show small significant improvements in balance and walking , indicating a possible clinical relevance of these training modalities . Improvements in balance may not be a prerequisite for improvements in walking distance when assistive devices are allowed during walking tests Purpose The aim of this study was to evaluate the effects of an aquatic exercise program design ed to enhance muscular strength in paretic lower limbs in subacute stroke patients . Method Thirty-six subacute stroke patients were r and omly divided to a conventional or an aquatic group ( n = 18 each ) . Outcome measures were assessed at baseline and after 8 wks of training . For the paretic lower limbs , maximum isometric voluntary contraction strength of the rectus femoris and biceps femoris caput longus and the tibialis anterior and lateral gastrocnemius was measured . Cocontraction ratios during knee extension and flexion and ankle dorsiflexion and plantarflexion were calculated respectively . In addition , Modified Ashworth Scale , Functional Ambulation Category , and Barthel Index were assessed . Results Compared with the conventional intervention , the aquatic intervention result ed in significantly higher knee extension ( P = 0.002 ) and ankle plantarflexion torque ( P = 0.002 ) , accompanied with a significantly lower knee extension cocontraction ratio in the paretic limb ( P = 0.000 ) . Functional Ambulation Category ( P = 0.009 ) and Barthel Index ( P = 0.024 ) were greater in aquatic group than conventional group posttreatment . Modified Ashworth Scale scores did not show any differences between groups . Conclusions Aquatic exercise enhanced muscle strength in paretic lower limbs and improved muscle cocontraction without increasing spasticity in subacute stroke patients [ 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 The  Berg Balance Scale ( BBS ) was design ed to help determine change in functional st and ing balance over time . The purpose of this paper was to estimate the minimum detectable change score ( MDC ) using the st and ard error of measure ( SEM ) , thereby providing a means to decide if genuine change had occurred . Calculation of the agreement regarding the presence of change as determined by the MDC and clinicians ' perceptions was performed to give an indication of the validity of this criterion value . Forty-eight subjects who were receiving inpatient rehabilitation after stroke were assessed on consecutive days by two raters using the BBS . The MDC analysis suggests that a change of + /- 6 BBS points is necessary to be 90 % confident of genuine change . Only 25/45 subjects showed agreement between the statistically derived presence of change and clinicians ' perceptions of change . The lack of agreement may relate to the validity of the SEM/MDC methodology to determine the criterion BBS value , the heterogeneity of the subjects , or the use of clinician gestalt impressions of change Objective : To assess the feasibility and safety of a 6-week course of water walking performed using a motorized aquatic treadmill in individuals with subacute stroke for cardiorespiratory fitness , walking endurance , and activities of daily living . Methods : Twenty subacute stroke patents were r and omly assigned to aquatic treadmill exercise ( ATE ) or l and -based exercise ( LBE ) . The ATE group ( n = 10 ) performed water-based aerobic exercise on a motorized aquatic treadmill , and the LBE group ( n = 10 ) performed l and -based aerobic exercise on a cycle ergometer . Both groups performed aerobic exercise for 30 minutes , 5 times per week for 6 weeks . Primary outcome measures were 6-minute walk test for walking endurance and cardiopulmonary fitness parameters of a symptom-limited exercise tolerance test , and secondary measures were Korean version of the Modified Barthel Index ( K-MBI ) for activities of daily living . All variables were assessed at baseline and at the end of the intervention . Results : The ATE group showed significant improvements in 6-minute walk test ( P = .005 ) , peak oxygen uptake ( O2peak ; P = .005 ) , peak heart rate ( P = .007 ) , exercise tolerance test duration ( P = .005 ) , and K-MBI ( P = .008 ) . The LBE group showed a significant improvement only in K-MBI ( P = .012 ) . In addition , improvement in O2peak was greater in the ATE than in the LBE group . Conclusion : This preliminary study showed that a 6-week ATE program improved peak aerobic capacity and walking endurance in patients with subacute stroke . The improvement in O2peak after an ATE exercise program was greater than that observed after an LBE program . Therefore , ATE effectively improves cardiopulmonary fitness in patients with subacute stroke Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made 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 Objective : To investigate the effects of hydrotherapy on walking ability and balance in patients with chronic stroke . Design : Single-blind , r and omized controlled pilot trial . Setting : Outpatient rehabilitation clinic at a tertiary neurological hospital in China . Subjects : A total of 28 participants with impairments in walking and controlling balance more than six months post-stroke . Intervention : After baseline evaluations , participants were r and omly assigned to a l and -based therapy ( control group , n = 14 ) or hydrotherapy ( study group , n = 14 ) . Participants underwent individual sessions for four weeks , five days a week , for 45 minutes per session . Main measures : After four weeks of rehabilitation , all participants were evaluated by a blinded assessor . Functional assessment s included the Functional Reach Test , Berg Balance Scale , 2-minute walk test , and Timed Up and Go Test . Results : After four weeks of treatment , the Berg Balance Scale , functional reach test , 2-minute walk test , and the Timed Up and Go Test scores had improved significantly in each group ( P < 0.05 ) . The mean improvement of the functional reach test and 2-minute walk test were significantly higher in the aquatic group than in the control group ( P < 0.01 ) . The differences in the mean values of the improvements in the Berg Balance Scale and the Timed Up and Go Test were not statistically significant . Conclusion : The results of this study suggest that a relatively short programme ( four weeks ) of hydrotherapy exercise result ed in a large improvement in a small group ( n = 14 ) of individuals with relatively high balance and walking function following a stroke OBJECTIVES To date , controlled clinical trials evaluating the efficacy of underwater exercise in improving the lower-extremity function and quality of life ( QOL ) in post-stroke patients have yet to be conducted . The purpose of the present study was to determine whether repeated underwater exercise enhances the therapeutic effect of conventional therapy for post-stroke patients . DESIGN This was a pilot controlled clinical trial . SETTING The study took place in a research facility attached to a rehabilitation hospital . PATIENTS This prospect i ve trial included 120 consecutive post-stroke in patients with hemiplegic lower limbs ( Brunnstrom stage 3 - 6 ) . Patients were assigned to either an experimental or a control group . Patients in the experimental group received both repeated underwater exercise and conventional rehabilitation therapy . INTERVENTIONS The underwater exercise consisted of 30-min training sessions in a pool with a water temperature of 30 - 31 ° C in which patients followed the directions and movements of trained staff . Training sessions were conducted once a day on 2 days of the week for a total of 24 times . Patients in the control group received only the conventional therapy . OUTCOME MEASURES The 10-Minute Walk Test ( 10MWT ) , the Modified Ashworth Scale , and the 36-Item Short Form Health Survey were the outcome measures used . Lower-extremity function and QOL were assessed before and upon completion of the 12-week program . RESULTS Improvements in 10MWT results and spasticity parameters were greater in the experimental group than they were in the control group ( p < 0.01 ) . Significant differences between the groups were observed in magnitudes of changes of all QOL parameters ( p < 0.01 ) . CONCLUSIONS Combining conventional therapy with repeated underwater exercise may improve both lower-extremity function and QOL in post-stroke patients Abstract Objective : Water-based exercises have been used in the rehabilitation of people with stroke , but little is known about the impact of this treatment on balance . This study examined the effect of water-based exercises compared to l and -based exercises on the balance of people with sub-acute stroke . Methods : In this single-blind r and omized controlled study , 32 patients with first-time stroke discharged from inpatient rehabilitation at West Park Healthcare Centre were recruited . Participants were r and omized into W ( water-based + l and ; n = 17 ) or L ( l and only ; n = 15 ) exercise groups . Both groups attended therapy two times per week for six weeks . Initial and progression protocol s for the water-based exercises ( a combination of balance , stretching , and strengthening and endurance training ) and l and therapy ( balance , strength , transfer , gait , and stair training ) were devised . Outcomes included the Berg Balance Score , Community Balance and Mobility Score , Timed Up and Go Test , and 2 Minute Walk Test . Results : Baseline characteristics of groups W and L were similar in age , side of stroke , time since stroke , and wait time between inpatient discharge and outpatient therapy on all four outcomes . Pooled change scores from all outcomes showed that significantly greater number of patients in the W-group showed improvement post-training compared to the L-group ( p < 0.05 ) . More patients in W-group showed change scores exceeding the published minimal detectable change scores . Discussion : A combination of water- and l and -based exercises has potential for improving balance . The results of this study extend the work showing benefit of water-based exercise in chronic and less-impaired stroke groups to patients with sub-acute stroke
BACKGROUND Water-based exercises have the potential to reduce impairments and walking limitations after stroke .
OBJECTIVE To examine the effects of water-based exercises on walking speed , balance , and strength after stroke .