Effectiveness of exercise on rehabilitation after stroke
ASSIGNMENT DRAFT
| 1. Introduction | The relevance of research in Practice |
| 2. Topic choice (Effectiveness of exercise on rehabilitation after stroke) | : Choose a topic which is relevant to your interests or careers or circumstances: Health and social care or, Social services, or Paramedic area or Medicine |
| 3. Search Strategy & Inclusion & Exclusion criteria using either the PICO or PECO | : Develop your PICO or PECO or PESO table |
E.G my (PICO)
Effectiveness of exercise on rehabilitation after stroke
| Population | Stroke OR hemorrhagic stroke OR ischemic stroke OR cardiovascular stroke OR adults OR the elderly OR 40 years or older |
| Intervention | Exercise rehabilitation or physiotherapy OR physical fitness training OR repetitive task training |
| Outcome | Gain mobility OR strength muscles OR posture and balance control OR reduction in Mortality OR death |
| 4. Study selection | : How you used your PECO or PICO or PESO to decide which studies to include as part of your evidence learning process |
| 5. Results |
In this review identified 5 studies and these studies were done in a and c etc Whwwhwhwhwhwhwwhwhwhwwhwh (see Table 1)
Table 1: Characteristics of included studies
| Study ID | Title of the article | Interventions or Exposures | Setting |
Outcomes No 1: Effectiveness of exercise on rehabilitation after stroke
Table 2: Outcomes: Rates on rehabilitation after stroke
| Study ID | Mean No of per year | Difference | |
| Intervention | Control group | ||
Outcome No 2: Health-related quality of life
Among the 5 included studies indicated that there is an association
Table 3: Outcome No 2: Associated
| Study ID | Mean Health-related Quality of Life ( HQOL) score | Difference | |
| Intervention | Control group | ||
Outcome No 3:
Table 4: Association between healthy lifestyle and normal
| Study ID | Mean HQOL score | Difference | |
| intervention | Control group | ||
6. Discussion and Conclusion
Based on the 5 studies you included in your results above, what would you say??
Evidence from the 5 included studies indicate that there is an association between lifestyle etc…..
7. Recommendation
Based on results from the studies you have included in your review, what do you recommend to practitioners??
You can also advice future researchers, on that is the direction of future research. These recommendations are supposed to be based on the shortfalls you noted in the so far available research, what the loopholes were and what is remaining for research to address further.
ASSIGNMENT DRAFT
| 1. Introduction | The relevance of research in Practice |
| 2. Topic choice (Effectiveness of exercise on rehabilitation after stroke) | : Choose a topic which is relevant to your interests or careers or circumstances: Health and social care or, Social services, or Paramedic area or Medicine |
| 3. Search Strategy & Inclusion & Exclusion criteria using either the PICO or PECO | : Develop your PICO or PECO or PESO table |
E.G my (PICO)
Effectiveness of exercise on rehabilitation after stroke
| Population | Stroke OR hemorrhagic stroke OR ischemic stroke OR cardiovascular stroke OR adults OR the elderly OR 40 years or older |
| Intervention | Exercise rehabilitation or physiotherapy OR physical fitness training OR repetitive task training |
| Outcome | Gain mobility OR strength muscles OR posture and balance control OR reduction in Mortality OR death |
| 4. Study selection | : How you used your PECO or PICO or PESO to decide which studies to include as part of your evidence learning process |
| 5. Results |
In this review identified 5 studies and these studies were done in a and c etc Whwwhwhwhwhwhwwhwhwhwwhwh (see Table 1)
Table 1: Characteristics of included studies
| Study ID | Title of the article | Interventions or Exposures | Setting |
Outcomes No 1: Effectiveness of exercise on rehabilitation after stroke
Table 2: Outcomes: Rates on rehabilitation after stroke
| Study ID | Mean No of per year | Difference | |
| Intervention | Control group | ||
Outcome No 2: Health-related quality of life
Among the 5 included studies indicated that there is an association
Table 3: Outcome No 2: Associated
| Study ID | Mean Health-related Quality of Life ( HQOL) score | Difference | |
| Intervention | Control group | ||
Outcome No 3:
Table 4: Association between healthy lifestyle and normal
| Study ID | Mean HQOL score | Difference | |
| intervention | Control group | ||
6. Discussion and Conclusion
Based on the 5 studies you included in your results above, what would you say??
Evidence from the 5 included studies indicate that there is an association between lifestyle etc…..
7. Recommendation
Based on results from the studies you have included in your review, what do you recommend to practitioners??
You can also advice future researchers, on that is the direction of future research. These recommendations are supposed to be based on the shortfalls you noted in the so far available research, what the loopholes were and what is remaining for research to address further.
SAMPLE PAPER
Effectiveness of exercise on rehabilitation after stroke
| Population | According to Ordahan, et al, (2015) the study target patient recovering from a stroke that can be hemorrhagic, ischemic stroke, cardiovascular stroke, adults or the elderly or people with 40 years or above. This is because across the world there are about 4.8 million stroke survivors with around 1.1 million suffering from long-term disabilities. However, these disabilities vary depending on the part of the brain that is affected. The most common stroke-induced impairment affects the arm and leg on one body side and is known as hemiparesis. Most stroke patients experience complications such as falls and that emanates from balance disorder. Studies show that 50 % to 70 % of stroke patients experience falls while in hospital or at home. Thus, due to fearing to fall, balance disorder and fractures of the femur reduces the physical activity of the stroke patients. According to Pintado-Izquierdo, et al, (2020), the average incidence of stroke is around 200 new cases per 100,000 inhabitants/year. Pintado-Izquierdo, et al, (2020) argues that patients suffering from stroke benefit immensely from information and communication technologies especially if they are suffering from motor, sensory and cognitive diseases when exposed to commercial video games such as video consoles which derive from motion capture. Video games are gaining prominence as therapeutic tools for treating posture and balance-related disorders in stroke patients. The study aims to compare video games therapeutic impact on stroke patients concerning balance and posture and other available treatment options. The study had a literature review of 18 papers that covered 479 patients that made use of video consoles concerning other rehabilitative techniques to enable the patient to gain posture and balance. In the study, the intervention groups recorded a positive outcome with 10 of the 17 analyzed recording positive outcomes from video consoles. |
| Intervention | The intervention used during recovery is rehabilitation exercises or physiotherapy that entails physical fitness training, repetitive task training (Ordahan, et al, 2015). According to Pintado-Izquierdo, et al, (2020) a system of commercial video game used together with conventional rehabilitation were used to see the impact on the balance and gait of the post-stroke patients. |
| Outcome | The exercise is aimed at making the patient gain mobility, muscular strength, or a strong posture with balance control (Ordahan, et al, 2015). Also, exercise helps in reducing mortality or death among the recovering patients. According to Pintado-Izquierdo, et al, (2020) patients who are exposed to current technology that integrates video consoles with other conventional methods in therapeutic exercises after suffering stroke will be more likely to regain their balance and posture earlier than the patient relying only on the conventional therapeutic methods. |
| 4. Study selection | In choosing the study to include in the work the use of exercise as a post-stroke rehabilitation procedure was emphasized. Also, the ability to use the intervention for both the study and control group was emphasized due to the ability to influence the study outcome. The potential for comparative analysis between the scholarly articles done on the topic was also given prominence in the study criteria in informing the selection process (Ordahan, et al, 2015). The use of different research methodology played an instrumental role in emphasizing the evidenced-based data that can be used in the clinical study touching on the rehabilitation of stroke patients. In selecting the study by Pintado-Izquierdo, et al, (2020) emphasis was given to the study that entailed the use of descriptive and qualitative statistics due to the quality of its literature review and use of quasi-experimental methods. The study provided a great opportunity to amass a wealth of evidence-based research generated from multiple studies that were covered to generate credible conclusions for the study purpose. Due to the review of several studies, the reliability of the study and data was assured (Pintado-Izquierdo, et al, 2020). Also, through the study’s use of quasi-experimental analysis, the audience was able to get a clue of the approach used in the conventional and video games intervention methods that were essentials in arriving at the desired outcome of the study. The study meant all the essential elements of PICO such as problem afflicting the patients, the intervention used, data comparison, and the credibility of the outcome. |
| 5. Results According to Ordahan, et al, (2015), the hemiparetic gait experienced after stroke can be attributed to the reduced walking velocity, shortness of the stride with imbalanced posture as the patient use supporting apparatus, and the length of time taken to move lower limbs. Further walking performance of any patient will be determined by the possession of good skills for balance this affects locomotor functions. The author holds the view that TUG performance will be reduced after the stroke. The test is instrumental in identifying the risk of falling in patients recovering from stroke. The exercise used to rehabilitate the stroke patients help in weight-bearing for the lower extremity during posture treatment, and functions involving balance and walking among hemiparetic adults (Ordahan, et al, 2015). The motor function of the patients will occur as they attain spontaneous recovery, learning, and practice as their brain become reorganized which is promoted by intensive tasks. Pintado-Izquierdo, et al, (2020) argues that after suffering a stroke in the first year the patient will suffer from impaired functions and depends on other people to perform certain critical aspects of daily life. However, with continued rehabilitation, the patient will record improvement in their daily routine. Inpatients in their chronic phase exercising will benefit immensely from the continued rehabilitation program since there will be control from entry into functional deterioration. There was recorded improvement in both balance and posture in the post-treatment study. |
Table 1: Characteristics of included studies
| Study ID | Title of the article | Interventions or Exposures | Setting |
| 1 | Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study | The interventions entailed the use of a balance trainer to guide the patients through balance and posture control levels. The stroke patients were subjected to Berg Test, timed up and go test that used functional independence measure (FIM) during the 6-week rehabilitation program that had 30 sessions. | There was the involvement of the trainer during the thirty training sessions where evaluation tests were conducted. The patients were selected randomly. |
| 2 | Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review. Applied Sciences, 10(18), 6426. | The paper compared 13 studies results using video game programs after electronic database scanning of the papers. The video games used had to have used the Nintendo Wii console facilitating comparison with other rehabilitation programs. The author used the Wii balance board since the players were allowed to stay in the limit of the table and change weights or transfer loads between feet. Some consoles facilitated the player to engage in other games such as tennis and displace the various weights. | The study entailed paired systemic review that was conducted per Cochrane manual recommendations, bibliographic searches on the electronic databases such as PubMed and Scopus for articles that were authored between January 2005 and June 2020. The author used computerized application COVIDENCE where the PICO framework was used in guiding the participants’ eligibility criteria. |
Outcomes No 1: Effectiveness of exercise on rehabilitation after stroke
Table 2: Outcome – Rates on rehabilitation after stroke
| Study ID | Mean No of years 57.1 plus or minus 9.2 years, time after stroke 87.3 plus or minus 26.3 days | Difference | |
| 1 | Intervention Thirty sessions of conventional rehabilitation protocol were administered to the control group. Motion exercises, balance and exposure control, walking training, and occupational therapy were used. | Control group Control group patients were slotted in a 30-session rehabilitation program that covered areas such as motion exercises, balance, coordination and postural control exercises, walking training, and occupational therapy. The Patients slotted in the study group were trained for 20 minutes each day for five consecutive days a week for a total of six weeks with the balance trainer. | There was no significant difference statistically in terms of the descriptive features used for both control and study groups. However, differences existed between the study group and the control group since the study group used visual feedback during trainings. Also, the subjects were encouraged to maintain posture as they stand on a balance trainer. |
| 2 | Intervention In respect to the commercial video games systems 13 studies used compared the results generated on balance using a program having Nintendo Wii® (Nintendo Co., Ltd., Kyoto, Japan) console compared to existing rehabilitation treatments. Both commercial software required the use of the Wii Balance Board® (Nintendo Co., Ltd., Kyoto, Japan) for some games based on the fact that the player has to stay in the limits of the table and work on changing the weight, transferring loads from one foot to another and/or back and forth. Three of the studies used analyzed the impact of using Kinect-Xbox Microsoft® console compared to an outpatient physiotherapy program. | The participants used in the study were 479 who took part in 18 studies.247 of the participants were involved in the experimental intervention and 232 in the control intervention with mean both studies being 26.61 ± 10.21 (mean ± standard deviation), with an average age of 58.92 ± 6.47 years in the experimental group (EG), and in the control group (CG), the average ages were 58.17 ± 6.83 years and 59.66 ± 6.20 years, respectively. | On the issue of balance in bipedestations, four studies showed no change in both experimental intervention and comparison. In four of the studies, there were significant statistical differences in pre-treatment in each group but not both groups. In three studies there were significant statistical differences as regards pre-post-treatments in each group and between both groups and in one of them, differences in each group and differences between groups in the follow-up assessment were evidenced. There were no any observed posture changes in both groups as far as treatment was concerned. |
Outcome No 2: Health-related quality of life
The patients experienced improved quality of life after the training with the guidance of experienced staff due to improved balance, posture strength, and walking speed.
Discussion and Conclusion
A significant improvement was noted between the FIM motor, FIM cognitive, and FIM total measures in both the control and study group after the exercise therapy. Also, there was significant statistical improvement observed in BBS and TUG measures in both groups after the treatment. Most stroke patients will suffer in their walking ability due to reduced balance and fear of falling that manifest itself subconsciously in their mind (Ordahan et al, 2015). The patient will have the potential of reduced walking velocity and dependence on a walking stick or gear to safeguard them from potential fall. However, through engagement in exercise-related therapy, they will show significant improvement in their posture resulting in better balance and walking ability due to ensuing muscular strengths. Balance training was found to be task-specific and thus not directed to general body health and functions.
The study by Pintado-Izquierdo, et al, (2020) was able to investigate the impact of commercial video games as cost-effective methods that use low immersiveness virtual reality to help in overcoming the gait and balance challenges of stroke patients and give insights into the differences surrounding different devices and video games used. The study was guided by the previous studies that have shown positive effects of using immersive VR systems on balance and gait in different neurological conditions (Pintado-Izquierdo, et al, 2020). The study reported positive effects on the factors under investigation such as balance and gait of the post-stroke patients. Further, the participants used in the study were homogeneous in terms of age, gender, and type of stroke. However, homogeneity was not observed in terms of stroke progression time, participant stroke states such as chronic and subacute. In the current study, there was no observed difference in terms of patient age and progression times as depicted in other studies. Commercial video game systems combined with conventional rehabilitation treatments have shown positive effects in treating balance and gait disorders in post-stroke patients.
Recommendations
- There is a need for more recovering stroke patients to be involved in balance trainer therapy rather than conventional therapy
- More stroke patients ought to engage a balance trainer since it will result in improved balance and posture for the patient among those suffering from stroke giving them the ability to perform some tasks with ease.
- Further studies should be undertaken on the impact of dynamic balance function when integrated in balance trainer to herald better improvement opportunities for the stroke patients’ recovery.
- Video game consoles need to be prescribed under the supervision of experienced staff as the post stroke patients maintain their conventional treatments.
- Commercial video game consoles for balance and gait rehabilitation purposes need to match the functional state of the patient to carry out the necessary adaptations during the rehabilitation sessions.
- Post-stroke patients should be encouraged to engage in physical exercises albeit minimally but regularly since they have the potential of improving their ability to engage in routine activities with minimal assistance in the future. However, the exercise they are engaged in should receive regular review from experienced therapists.
References
Ordahan, B., Karajan, A. Y., Basaran, A., Turkoglu, G., Kucuksarac, S., Cubukcu, M., & Kuran, B. (2015). Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study. Hippokratia, 19(2), 125.
Pintado-Izquierdo, S., Cano-de-la-Cuerda, R., & Ortiz-Gutiérrez, R. M. (2020). Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review. Applied Sciences, 10(18), 6426.
