This randomized clinical trial will be conducted at various physical therapy clinics of Faisalabad over a six-month period, enrolling a total of 32 participants selected through non probability convenience sampling technique. Participants will be randomly assigned to one of two groups: those undergoing Neuropilates and those performing Otago exercises, with each group consisting of 16 individuals. Assessments will utilize the TUG (Timed Up and Go) to evaluate balance, the Postural Assessment Scale for Stroke Patients (PASS) for posture, and the Functional Independence Measure (FIM) for functional independence. Pre-intervention assessments will establish baseline measures, followed by evaluations at 4 weeks, and post-intervention to track progress. Data analysis will be conducted using SPSS 26 software, allowing for a comprehensive comparison of the interventions' effectiveness. The findings from this study will contribute valuable insights for clinicians and rehabilitation specialists, enhancing therapeutic strategies to support chronic stroke patients in regaining their independence.
Age 40-70 years
Both male and female
Chronic stroke, 6-18 months post-stroke
Stroke severity score >6 on NIHSS
• Symptoms of global or receptive aphasia
Other neurological disorders: tumors, anoxia, TBI, neurodegenerative diseases, ataxia.
Significant cardiorespiratory conditions
Currently receiving other complementary interventions
Parallel
neuropilates
Other intervention50 minutes session of Neuropilates thrice a week for total of eight weeks which will include activation warm-up exercises for 10 minutes, main exercises for 30 minutes and cool-down exercises for 10 minutes
otago exercises
Other intervention50 minutes each session of Otago exercise thrice a week for total of eight weeks which will include, muscle strengthening, balance training and 2x week 30 minutes walking session. Depending on the individual's strength and mobility, the exercises will be progressed, by increasing the amount of repetitions or weight
The Postural Assessment Scale for Stroke (PASS)
The Postural Assessment Scale for Stroke (PASS) is designed to evaluate postural control after stroke. It consists of 12 four-level items assessing the ability to maintain or change positions in lying, sitting, and standing. Scores range from 0 to 36, with 0-12 indicating poor, 13-24 moderate, and 25-36 good postural control. The PASS has excellent inter-rater reliability (α = 0.88, range 0.64-1) and total score reliability (r = 0.99, p \< 0.001). Test-retest reliability in chronic stroke patients is also high (ICC = 0.84-0.97).
The Functional Independence Measure (FIM)
The Functional Independence Measure (FIM) is used to assess the functional independence of individuals recovering from illness or disability. It includes 18 items covering self-care, mobility, locomotion, communication, and social cognition. Each item is rated on a 7-point scale (1 = total dependence to 7 = complete independence), giving a total score between 18 and 126. Higher scores indicate greater independence. The FIM demonstrates high inter-rater reliability (ICC = 0.86-0.88).
Timed Up and Go (TUG)
The Timed Up and Go (TUG) test is a simple, quick, and reliable tool used to assess mobility, balance, and fall risk in individuals with neurological or musculoskeletal conditions. It measures the time taken to stand up from a chair, walk three meters, turn, return, and sit down. A cut-off time of 12 seconds or more indicates a high risk of falling. The test is suitable for people with stroke, Parkinson's disease, multiple sclerosis, hip fracture, or joint replacement. It requires only a chair, stopwatch, and three-meter mark and allows observation of gait, stability, and use of aids. The test shows a sensitivity and specificity of about 87% for identifying fall risk in the elderly population.
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