Added Effect of Pilates Mat Exercises on Balance and Limits of Stability in Chronic Stroke Patients: A Pilot Study

Abstract

Background and Purpose: Stroke rehabilitation targets functional retraining of the limbs along with balance and gait. Even after extensive rehabilitation, up to 50% of stroke survivors experience motor deficits and balance problems that linger due to which the individuals are at high risk of falls. Trunk impairments though common do not manifest themselves as an individual problem and can impact balance. The purpose was to study the effect of Pilates mat exercises on balance and limits of stability in chronic stroke patients. It was hypothesized that since core training is not the point of focus in stroke rehabilitation, training the same through Pilates method could give better improvements in balance.Subjects and Methods: 9 individuals were randomly allocated to either Pilates exercise group (PG, n=5) or Control Group (CG, n=4).the CG attended a regular rehabilitation program for stroke & the balance exercises were progressed week-wise. The PG, in addition to conventional treatment, attended 18 Pilates exercise sessions over a period of 6 weeks (3 sessions / week). Tinetti Performance Oriented Mobility Assessment Scale (POMA) and Limits of Stability (LOS) including Reaction Time (RT), End Point Excursion (EPE), Maximum Excursion (MXE), Movement Velocity (MVL), and Directional Control (DC) were measured before and after the exercise program & compared to assess the training effects.[Results]: Pilates exercises positively affected both dynamic balance and LOS in Chronic Stroke patients. For LOS, the RT (0.0427) and MXE (0.0292) components showed significant improvement in the PG while the improvements in CG were not significant. Other components of LOS-EPE, MVL, DC showed improvements clinically in both PG and CG but were not statistically significant via unpaired 't' test. For dynamic balance, the improvements in POMA score were more in PG than CG (p=0.05) and were significant. Conclusion: This pilot study provides initial evidence that Pilates exercises may help improve balance and LOS in chronic stroke patients.

The effects of the Pilates method in individuals after stroke: a systematic review with meta-analysis

“…The manual search returned one study that was also included after analysis. Thus, a total of seven articles were included and described in the present study (6,(10)(11)(12)(13)(14)(15) . The main reasons for excluding studies were studies with healthy people, studies comparing Pilates with other interventions, articles that addressed other diseases, trials non-randomized, and repeated studies.…”

“…The studies included nine to 60 participants, with an average age of 58 to 68 years. Six studies were carried out in chronic patients (> 6 months) (6,(10)(11)(12)(13)15) , while 1 was carried out in acute patients (< 6 months)14. Regarding the intervention, four studies (10,11,13,14) performed Pilates in the experimental group and conventional physiotherapy in both groups, and three studies (6,12,15) performed Pilates in the experimental group and no treatment in the control group.…”

“…Six studies were carried out in chronic patients (> 6 months) (6,(10)(11)(12)(13)15) , while 1 was carried out in acute patients (< 6 months)14. Regarding the intervention, four studies (10,11,13,14) performed Pilates in the experimental group and conventional physiotherapy in both groups, and three studies (6,12,15) performed Pilates in the experimental group and no treatment in the control group. Regarding outcome measures, two studies evaluated gait speed (Gait speed test -10 meters -TM10M) (10,12) , four studies evaluated balance (Berg balance scale -EBB, center of pressure oscillation, Functional Reach Test -TAF, and Tinetti Performance Oriented Mobility Assessment -POMA) (6,10,13,14) , three studies evaluated mobility (Timed Up and Go -TUG, which in addition to walking includes other activities, such as turning and sitting /lift) (10, 11 ,14) , two studies assessed quality of life (Stroke Specific Quality of Life Scale -SSQol -and Korean Stroke Specific Quality of Life Scale -KSSQoL) (14,15) , and only one study for each one of the following outcome measures: motor function of the lower limbs (Fugl-Meyer Scalelower limbs -EFM-LL) (10) , cardiopulmonary function (Submaximal treadmill test) (11) , step length (System for analysis of 3D movement) (12) , and gait ability , (Dynamic Gait Index -IMD, which evaluates the ability to walk, in different situations, such as shaking the head and moving around objects) (14) .…”

“…One study (13) , involving 9 participants, and with a methodological quality of 4, investigated the effects of Pilates on balance but did not report sufficient data for inclusion in the meta-analysis. The authors reported significant results (p<0.05), showing that Pilates improved balance, assessed by POMA.…”

Efficacy Of Core Strengthening Exercises On Swissball Versus Conventional Exercises For Improving Trunk Balance In Hemiplegic Patients Following Stroke

“…Balance is de ined as the ability to maintain functional equilibrium (Taly et al, 1998). Balance is a complex process which includes the integration and reception of sensory inputs and (Das, 2016), the visual, proprioceptive and vestibular system, along with the central functions of planning and execution of movement (Sathe et al, 2018).Anticipatory postural adjustments (APA) predicts the level of balance impairment and related danger of mobility, as well as falls and, are signi icant neuromuscular biomarkers (Lee and You, 2018).…”