Hemiparesis: Inserts help the statics

19. October 2012

In the event of balance disorders from stroke, physiotherapy is effective – but sometimes only as long as it is actually done. Weakness on one side of the body and its related balance disorders can possibly be dealt  with using shoe inserts.

Stroke is in developed countries a major cause of serious long-term disabilities. In the U.S. approximately 800,000 people suffer a stroke each year; about half survive. In Germany a study by the Competence Network: Stroke came to the conclusion that each year 195,000 primary and 66,000 repeated strokes occur. 63,000 deaths per year meant that in 2008 it accounted for the third largest group in the death statistics.

Patients with hemiparesis show asymmetry while they are in static positions and under functional stress. Detectable aspects include motor weakness, asymmetric muscle tone and somatosensory deficits. Possible consequences of this instability include dangerous falls, something which restricts the affected person further.

Shoe inserts for the healthy side

Various treatment approaches in rehabilitation for improving balance are based on arbitrary displacements of body weight on to the weak side. However they do not help every patient in the long term. Researchers at the University of Illinois have now found a relatively simple and also inexpensive way of improving balance in an enduring way: shoe inserts, which train the brain and compel the shifting of body weight. This treatment, going by the name of “Compelled Body Weight Shifts” (CBWS), consists of inserts which raise the body and allows weight to tilt onto the impaired body side so that balance is restored. The advantage of this method is that the patient does not need to think about the process.

Experimental vs. Conventional

The effectiveness of the inserts was studied by Alexander Aruin and colleagues on two small groups of patients. Eleven patients of mean age 49 years who had on average experienced their first stroke 15 days beforehand were randomly divided into an experimental group and a control group. In the experimental group, the patients received for two weeks – six days a week for 90 minutes – conventional physiotherapy combined with CBWS. Control patients participated only in conventional rehabilitation. The conventional therapy consisted of physical therapy involving various interventions such as therapeutic exercises, resistance exercises with a Thera-Band, motor retraining and gait training.

Shift to long-term success

The manufacturing of the inserts was based on purely biomechanical reasoning. The sound side was raised mechanically, a process requiring an increase in the shoe insole. The weight distribution of the two sides of the body should work out to be 50/50. This biomechanical approach contrasts with another well-known approach of treatment via foot inserts: so-called propioceptive insoles are supposed to help in regulating the muscle tone by means of specific pressure pulses. Tests before and after the experimental period revealed that the weight load on the affected side was increased among patients in the experimental group, whereas this had decreased in the control group. Walking speed increased significantly in both groups, however in the group with inserts this occurred more markedly.

Just following up

Three months after the completion of the test period with the inserts, the researchers reexamined the ability to maintain balance. It was found that both groups benefited from the physical therapy, those who were previously insert wearers demonstrated however that they had some advantages. Their body weight distribution was more symmetrical and more emphasis was placed on the affected side. The study was small and the authors hope that as many therapists as possible try in cases of stroke to employ additional treatment using the inserts. Perhaps success could possibly also end up being recorded when the stroke itself took place at some earlier point in time.

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Medicine, Neurology
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