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The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery
Thesis (PhD (Physiotherapy))--University of Pretoria, 2016.
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| Language: | English |
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2026
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| _version_ | 1867613523072253952 |
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| access_status_str | Open Access |
| author2 | Eksteen, Carina A. |
| author_browse | Eksteen, Carina A. |
| author_facet | Eksteen, Carina A. |
| collection | Thesis |
| description | Thesis (PhD (Physiotherapy))--University of Pretoria, 2016. |
| format | Thesis |
| id | oai:repository.up.ac.za:2263/110000 |
| institution | University of Pretoria (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:37:29.889Z |
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| provenance_str_mv | Harvested via OAI-PMH from UPSpace — University of Pretoria Institutional Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| record_format | dspace |
| source_str | UPSpace — University of Pretoria Institutional Repository |
| spelling | oai:repository.up.ac.za:2263/110000 The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery Eksteen, Carina A. cochrane.m2@gmail.com Olivier, B. Cochrane, Maria Elizabeth Stair-descent raised-heel lower limb postural control functional ambulation post-stroke sub-acute quality of life International Classification of Health Disability and Function. Thesis (PhD (Physiotherapy))--University of Pretoria, 2016. Background Many patients who sustain a stroke are unable to ambulate functionally after receiving rehabilitation. Functional ambulation entails walking at a speed of 0.8 metres per second, negotiating uneven surfaces and climbing stairs. Patients who do not reach a level of functional ambulation experience decreased perceived quality of life (QOL). Stair-descent is retrained during rehabilitation but no literature provides evidence that regular stair-descent exercises facilitate the optimal biomechanical sequence of movement that will translate to improved propulsion during gait. The hypothesis was that: raised-heel stair-descent exercises improve the postural control that influences movement and functioning of the lower limb during ambulation significantly more than regular stair-descent exercises. Method A single-blind cluster randomised controlled trial (RCT) was conducted to determine the effectiveness of raised-heel stair-descent exercises compared to regular stairdescent exercises. Thirty-two participants, in the sub-acute phase of recovery poststroke were recruited at three rehabilitation centres. Patients suffering from multiple strokes, uncontrolled co-morbid diseases; and severe hemispacial neglect, were excluded from the study. Upon providing consent, participants were clustered to either a control- or experimental group. All participants were assessed with: the Functional Gait Analysis (FGA); Qualisys© motion analysis; the Timed Ten Metre Walk Test (10MWT); the Physiological Cost Index (PCI); and the Lower Extremity Functional Scale (LEFS). Participants in both groups received 45 minutes taskorientated rehabilitation. Experimental group participants received 20 repetitions of raised-heel stair-descent exercises and control group participants 20 repetitions of regular stair-descent exercises five days a week, for two weeks. The LEFS was repeated telephonically at three- and six- months post-discharge to determine the long term perceived QOL. vi Results The 2D motion analysis indicated significantly more symmetry in the experimental group’s joint angles compared to the control group (p=0.0075) in the frontal plane. Saggital plane measurements during heel-strike and mid-stance showed that the ankle-, knee- and hip- joint ranges were also significantly more symmetrical in the experimental group. Comparison between the groups with regard to energy expenditure did not yield significant differences. Functional gait of the experimental group improved significantly more than the control group (p=0.0206). The postintervention perceived QOL analysis did not reveal statistically significant differences between the control- and experimental groups (p=0.1723), but the three- and sixmonth telephonic follow-up showed significant improvement for the experimental group (p=0.0000). Discussion The symmetrical alignment of the lower-limb joints increased upper trunk stability and created the ideal circumstances for anticipatory postural adjustments to occur. The correct sequence of lower-limb muscle activation was also facilitated by the symmetrically aligned joints. The impairment-level improvements resulted in decreased physiological effort during gait and increased contra-lateral step lengths. Functional improvements included faster gait speed and the ability of experimental group participants to clear obstacles; walk with closed eyes and climb stairs. The functional improvements that were gained improved the long-term functioning and QOL of the experimental group as well. Although participants in the control group did not show significant improvement at the mid- and long-term follow-up, they did not regress from the post-intervention assessment. The raised-heel stair-descent exercises are more beneficial than regular stair-descent exercises in improving short- and long-term outcomes on impairment-, activity- and participation levels. Physiotherapy PhD (Physiotherapy) 2026-05-15T17:26:01Z 2026-05-15T17:26:01Z 17/06/20 2016 Thesis http://hdl.handle.net/2263/110000 en application/pdf |
| spellingShingle | Stair-descent raised-heel lower limb postural control functional ambulation post-stroke sub-acute quality of life International Classification of Health Disability and Function. The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery |
| title | The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery |
| title_full | The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery |
| title_fullStr | The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery |
| title_full_unstemmed | The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery |
| title_short | The effect of raised-heel stair-descent exercises on lower limb postural control and functional ambulation in the sub-acute phase of post stroke recovery |
| title_sort | effect of raised heel stair descent exercises on lower limb postural control and functional ambulation in the sub acute phase of post stroke recovery |
| topic | Stair-descent raised-heel lower limb postural control functional ambulation post-stroke sub-acute quality of life International Classification of Health Disability and Function. |
| url | http://hdl.handle.net/2263/110000 |