Efficacy of Arm Sling on Balance Control and Gait Performance in Hemiparesis Patients after Stroke: A Randomized, Crossover Study

Abstract Description

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Authors (including presenting author) :

Wong GHS(1), Fong WC(2), Cheung YF(2), Chao CYL(1), Liu BKP(1), Wan SPC(1), Chan VYL(1), Poon MKM(1), Chan ACM(1)

Affiliation :

(1) Physiotherapy Department, Queen Elizabeth Hospital (2) Department of Medicine, Queen Elizabeth Hospital

Introduction :

Stroke survivors are often left with varying degrees of motor deficits, impairing their ability to walk and subsequently affecting the balance control leading to high fall incidence among them. One of the ultimate goals of stroke rehabilitation is to regain the balance and gait performance in the best possible spatiotemporal gait symmetry and stability. Recent evidence suggests that arm slings may also have positive influences on balance control and gait performance in patients with hemiparesis after stroke. However, there is a lack of research done on comparing the effects of different types of arm slings on tackling walking performance and stability problems in stroke patients.

Objectives :

To investigate the immediate effects of using different types, straight or bent elbow arm slings, versus no arm sling in gait performance and balance control in stroke survivors.

Methodology :

It was a randomized, crossover study design. Ethical approval was obtained from the research committee (KC/KE-16-0171/ER-2). Patients diagnosed with stroke and presented with hemiparesis that affected the walking performance were recruited. All subjects were independent community walkers with or without aids and with Brunnstrom stages of recovery for the upper extremity not more than 3. Eligible stroke survivors were acted as their own control in undergoing three testing conditions of using (i) no arm sling, (ii) straight arm sling, and (iii) simple arm sling with elbow bent. The order of testing conditions was randomized. Gait parameters including step length and stride length of bilateral legs, cadence, walking velocity and duration of single limb support in terms of percentage of gait cycle of bilateral legs were evaluated using the GAITRite walkway foot-pressure system. The balance control was measured using Berg Balance Scale (BBS) and Timed Up and Go Test (TUG).

Result & Outcome :

Thirty stroke patients (17 males and 13 females; mean age: 60.0±15.3 years) were recruited. BSS score was significantly higher under the testing conditions of using arm slings, either straight arm (44.5±9.8; p=0.015) or elbow bent type (44.3±10.1, p=0.029) as compared with no arm sling (42.7±9.6). Similarly, the TUG was also significantly lower between straight arm (27.3±14.7; p=0.004) or elbow bent type (26.7±14.2; p=0.001) as compared with no arm sling condition (29.6±16.9). Post-hoc analysis did not reveal any significant difference between the straight vs. elbow-bent arm sling. There was a greater trend of improvement in the entire spatiotemporal gait parameters including step and stride length, walking velocity, cadence and gait symmetry in arm slings conditions vs. no arm sling but the improvement did not reach statistically significant (p>0.05). The use of arm slings, both straight and elbow bent types, enhanced the balance performance, step and stride length and walking speed in stroke survivors presented with hemiparesis. Both elbow straight or bent type exerted similar beneficial effects. Appropriate prescription of arm slings could be one of the inexpensive and feasible means for improving balance control, promoting gait symmetry and potentially reducing fall incidence in ambulatory stroke survivors with moderate severity of paresis of the affected upper extremity in clinical practice.