ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2021 February;57(1):4-12

DOI: 10.23736/S1973-9087.20.06183-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

The effects of lower extremity cross-training on gait and balance in stroke patients: a double-blinded randomized controlled trial

Chanhyun PARK ¹, Hohee SON ² ✉, Bokgi YEO ¹

¹ Department of Physical Therapy, Team of Rehabilitation, Keunsol Medical Hospital, Busan, South Korea; ² Department of Physical Therapy, College of Health Science, Catholic University of Pusan, Busan, South Korea

BACKGROUND: Cross-training is an indirect intervention to promote muscle activity on the affected side by applying resistance exercise to stronger parts of the body. Indirect interventions are useful for treating patients who have difficulty with direct interventions. Previous studies have focused on measuring increased muscle strength and muscle activity in healthy individuals.
AIM: This study aimed to investigate the effects of cross-training on gait and balance in hemiplegic patients when applied to the affected and unaffected lower extremities.
DESIGN: Double-blinded randomised controlled trial.
SETTING: In-patients attending the rehabilitation treatment room of a single center.
POPULATION: Fifty-two stroke patients were randomly allocated to a control group (N.=19), affected side cross-training group (N.=15), and unaffected side cross-training group (N.=18).
METHODS: Patients were administered general neurological physiotherapy for 30 mins, twice daily, 5 days/week for 4 weeks. The two intervention groups underwent 30 mins of cross-training instead of general neurological physiotherapy once daily, 3 days/week for 4 weeks (postintervention). For data analysis, one-way ANOVA for between-group comparisons and paired t-tests were performed for within-group comparisons between pre- and postintervention groups (significance level of 0.05).
RESULTS: In the Timed Up and Go Test (TUG), comparing pre- and postintervention, the control group showed no significant change (P>0.05), while the affected side and unaffected side cross-training groups showed significant improvements in function (P<0.05). In the 10-meter Walk Test, the control group showed no significant change (P>0.05), while the affected side and unaffected side cross-training groups showed significant increases in speed (P<0.05). In balance testing, the limits of stability showed a significantly increase in all three groups (P<0.05). There were no pre- or postintervention differences in gait or balance between the groups (P>0.05).
CONCLUSIONS: Gait and balance improved in hemiplegic stroke patients who participated in cross-training, regardless of the intervention applied to the affected or unaffected side.
CLINICAL REHABILITATION IMPACT: In clinical settings, for patients who experience difficulties with direct interventions on the affected side, we propose indirect interventions to improve gait and balance.

KEY WORDS: Stroke; Rehabilitation; Lower extremity