Science

Risk of falling –
end-effector gait training after a stroke

Falling is a common complication after a stroke. The proportion of patients who fall increases to 23–45 per cent six months after the stroke occurs and 40–73 per cent after 1 to 2 years. This is usually because the body no longer possesses enough stability and balance and any correction or adaptation takes place too late or not at all. This means that it is important to detect potential fall risks at an early stage as part of the rehabilitation and performance of effective training. Research has already identified the positive effects of end-effector gait training on the improvement and restoration of walking ability after a stroke over the past years. The intensive, repetitive and task-oriented training stimulates the development of synapses and their connections. Frequent repetition also encourages motor learning.

“End-effector training enables 1000 steps in one therapy session, compared to 100 steps per session with conventional gait training.”

Objective: The aim of this study was to examine the effects of end-effector gait training using the example of the THERA-Trainer lyra in relation to the risk of falling among stroke patients in order to determine whether the training can minimise the risk of falling. This would give patients the chance to lay the groundwork for greater independence and safety in everyday life during the rehabilitation phase and the training equipment would play an additional role in the effectiveness of fall prevention.

Methodology: As part of a randomised, controlled study, 16 patients were recruited from a rehabilitation facility and allocated to an intervention and control group at random. Both groups received six therapy applications, each lasting thirty minutes, over a three-week intervention period. The intervention group conducted end-effector gait training and the control group conventional gait training. Pre-testing and post-testing were carried out to investigate the risk of falling. The Timed Up and Go, Berg Balance Scale and Short Falls Efficacy Scale International were the assessments used.

Results: Improvements were able to be recorded for all assessments in both groups, with the improvements in the intervention group each higher than those of the control group. The results of the Timed Up and Go improved by an average of 29.2% in the intervention group. In the Berg Balance Scale, an improvement of 21.1% of average values in the intervention group was achieved and the Short Falls Efficacy Scale International showed a percentage-based improvement of 19.8% for patients. For the intervention group, significant results were obtained in the intragroup comparison for the Timed Up and Go (p = .045), the BBS (p = .003) and the Short Falls Efficacy Scale International (p = .008) and in the intergroup comparison for the Short Falls Efficacy Scale International (p = .047).

Conclusion: The results of the investigation show that a statistically significant improvement could be demonstrated through end-effector gait training in patients after a stroke using the TUG, BBS and Short FES-I. A positive correlation of the end-effector gait training on the risk of falling can be assumed due to stronger improvements in the intervention group compared to the control group, despite incomplete, significantly statistical results. Greater improvements in the intervention group over the control group could be attributed to the much higher number of step repetitions that the patients in the intervention group could achieve.

It can be assumed that the patients in the intervention group were able to achieve greater progress in relearning motor functions through repetitive training.

More concrete statements on this issue require further research, including a larger sample and follow-up investigation.

The psychosocial consequences of a fall mainly include a fear of further falls. This affects one-third of older people who fall. Aside from the consequences of a fall, this developing fear of falling also poses a risk factor for another fall, which can lead to restrictions in participation and activity, waning confidence in their own abilities and loneliness in the person affected.

Chiara Winter
B.Sc. Physiotherapy – most recent position as an intern in the “Waldklinik Jesteburg” in the
field of early neurological rehabilitation. Currently enrolled as a student at the University of Rostock in the Faculty of Human Medicine.