Effects of progressive neuromuscular control training  on the functional mobility in stroke with bilateral osteoarthritic knee

Sachi  Rajeev Jain; Shamika  Shamsundar Baraskar; Sandeep  Shinde

Authors

Sachi Rajeev Jain Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
Shamika Shamsundar Baraskar Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
Sandeep Shinde Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India

Keywords:

Elderly mobility scale (EMS), gait, neuromuscular control training, osteoarthritis, stroke

Abstract

Background: In low- and middle-income nations such as India, cases of stroke are increasingly being reported to contribute to premature mortality and disability. In fact, 29.0–32.0% of individuals impacted by stroke experience musculoskeletal problems. Musculoskeletal disabilities such as osteoarthritis (OA) limit functional mobility and interfere with rehabilitation. In addition to reduced muscle strength, patients with degenerative pathology of the knee have impaired proprioceptive acuity, damaged sensory receptors, and a deficiency in muscle activation.

Objective: To determine the effects of progressive neuromuscular control training on functional mobility in stroke patients with bilateral knee OA (KOA)

Methods: A total of 100 participants aged 45–75 years were randomly assigned to two equal groups for this case-control study: the experimental group received an 8-week neuromuscular control training program, while the control group received the standard therapy. The participants were all stroke survivors in the third stage of the Brunnstrom stages of recovery and had either Grade 1 or 2 OA of both knees.

Results: Both the Visual analog scale (VAS) at rest and the VAS during activity in the intervention group were significantly lower than in the control group (P < 0.0001). The range of knee flexion of the hemiparetic side was not significant between the two groups (P = 0.8532), but that of the nonhemiparetic limb in the intervention group was significantly lower than that in the control group (P = 0.0029). The hemiparetic limb’s foot progression angle showed no significance, whereas the nonhemiparetic limb’s foot progression angle was significantly lower in the intervention group than in the control group (P < 0.0001). The walking velocity, voluntary control grading, and the elderly mobility scale in the postintervention group were significantly greater than those in the control group (P < 0.0001).

Conclusion: Progressive neuromuscular control training was observed to improve pain, spatial and temporal gait parameters, voluntary control, and functional mobility. There was a lack of effect on the range of knee flexion and the degree of toe out of the hemiparetic limb and only a little effect on the range of knee flexion and the degree of toe out of the nonhemiparetic side.

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