Protocol for restoring weight distribution symmetry between lower limbs in chronic hemiparetic individuals

Abstract

Introduction: Asymmetrical weight bearing among lower limb is an usual finding in chronic hemiparetic individuals after stroke. This asymmetry might affect gait and the ability to perform activities of daily living independently with an impact on quality of life. It was already demonstrated a significant relationship between the strength of the lower limbs and loading ability over the affected leg while standing. In addition, task-oriented training is effective for recover muscle strength and gait related activities in stroke patients. Therefore, to add muscle strengthening and the dynamic weight bearing during the training of tasks related to ADL may be relevant to the recovery of the body symmetry of these individuals. Objective: The purpose of this study was to evaluate the efficacy of a protocol of therapeutic exercises for muscle strengthening and weight bearing on the restoration of symmetry in the weight distribution between the lower limbs of chronic stroke patients. Methods: For this, fourteen individuals with chronic (5+3,7 years; mean+SD) post-stroke hemiparesis (age 57+12 years; mean+SD) that presented weight bearing asymmetry participated in the study. Participants were assessed before and after the intervention. The instruments of assessments employed were: a posturographic exam to quantify the percentage of body weight distributed between legs (%BW); kinematic gait analysis; Fugl-Meyer scale to motor (FMLE) and balance functions (FMB); Berg Balance Scale (BBS); Dynamic Gait Index (DGI) and Stroke Impact Scale (SIS). The intervention was composed of a protocol of exercises aimed to lower limb strengthening and improvement in weight bearing of the paretic limb. The protocol comprised two sessions by week, with 50 minutes each for 10 weeks, in a total of 20 sessions. Results: After the intervention, it was observed a significant improvement in all parameters tested. Conclusion: We concluded that the protocol proposed here was able to increase the weight-bearing symmetry of chronic stoke patients with significant improvements on gait and balance performance, fall risk and quality of life.