Ischemic versus Hemorrhagic Stroke: Who Can Best Benefit from Gait and Balance Training

Background and Aim : There exists a high degree of variability among individuals with stroke which can be considered as a major source of bias of studies aiming to determine the effect of rehabilitation interventions. The rationale for investigating the influence of lesion etiology (ischemic, hemorrhagic) on motor performance in this study is based on the different pathophysiological mechanisms that could be expected to have consequences for rehabilitation outcomes.The aim of the current study was to compare gait and balance measures between ambulatory individuals with ischemic and hemorrhagic stroke who received a similar 6 weeks intervention including gait and balance re-education.Methods : This study involved a cross-sectional, retrospective review of data from persons with stroke who underwent outpatient stroke rehabilitation. Fifty-six individuals with stroke were divided into two groups, according to their stroke lesion: an ischemic group (IG) (n = 37) and a hemorrhagic group (HG) (n = 19), as classified using MRI or CT. All subjects participated in a 6-week rehabilitation intervention including the re-education of gait and balance. The outcome measures were: quiet standing balance including weight bearing asymmetry (WBA), total anterior-posterior (AP) & medial-lateral (ML) center of pressure (COP) velocity, AP & ML COP velocity asymmetry, AP & ML Romberg quotient, AP & ML COP velocity during arm raise and also gait measures including gait velocity and spatiotemporal asymmetry measures (stance, swing time and step length asymmetry) which were recorded before and after intervention in the two groups. A repeated measure multivariate ANOVA was used to assess the effects of treatment. Multiple linear regression analysis was also performed to determine the association between lesion etiology (independent variables) and the difference between the baseline (t1) and after intervention (t2) measures for gait and balance (dependent variables). All regression models were adjusted for age and sex.Results : After a six-week intervention, gait velocity increased significantly in the HG compared to the IG (P = .003). WBA, AP & ML COP velocity also decreased significantly in the HG compared to that with the IG (P = .005, .004, and .001, respectively). No significant difference was identified in other parameters between the two groups. Multiple linear regression analysis revealed that having suffered a hemorrhagic stroke was related to greater increased in gait velocity, and also greater decreased in WBA, and AP & ML COP velocity during standing after a six-week intervention (P < .05).Conclusion : According to the current results, the improvement of some gait and balance measures after a rehabilitation intervention may be different in relation to the type of stroke lesion. Studies considering the lesion etiology might result in the recruitment of a more homogeneous sample. This factor could also be helpful in prescribing the best rehabilitation intervention to achieve gait and balance improvements.

کلیدواژه ها:

Gait ، Balance ، Neurology ، Rehabilitation ، Stroke