Innovative Physiotherapy in Stroke Rehabilitation

Primary outcomes

1. Barthel Index

   Time frame: The beginning of study and after 6 weeks

   The Barthel Index (BI) is a widely used functional assessment tool developed to assess an individual's level of independence in activities of daily living. It assesses ten basic categories, including feeding, bathing, grooming, dressing, bowel and bladder control, toilet use, transfers (bed to chair), mobility on flat surfaces, and stair climbing. Each category is scored based on the level of assistance the individual requires; the total scores ranges from 0 to 100, with higher scores indicating greater functional independence. Score between 0-20 indicate severe dependency, 21-60 moderate dependency, 61-90 mild dependency, 91-99 near-complete independence, 100 complete independence. The Turkish version of the Barthel Index has been validated for clinical use.

2. The Montreal Cognitive Assessment

   Time frame: The beginning of study and after 6 weeks

   The Montreal Cognitive Assessment (MoCA) is a short, multidimensional cognitive assessment tool developed to detect mild cognitive impairments in the early stages. The test aims to measure performance in various cognitive domains such as attention and concentration, executive functions, memory, language, visual-spatial skills, abstraction, calculation, and orientation in time and space. The MoCA is scored out of a total of 30 points, and based on generally accepted thresholds, a score of 26 and above indicates normal cognitive functioning, while a score of 25 and below indicates a risk of cognitive impairment. Since educational level may affect the result, it is recommended to add one point to the final score for individuals with less than 12 years of education. A validated Turkish version of the MoCA is used in this study.

3. Modified Falls Efficacy Scale

   Time frame: The beginning of study and after 6 weeks

   The Modified Falls Efficacy Scale (MFES) is a self-report-based tool that assesses the fear of falling individuals experience while performing their daily activities. The scale consists of 14 items, each scored between 0 (no confidence) to 10 (complete confidence). The highest possible total score is 140, with an average score of up to 10. Higher average scores indicate a low fear of falling during the activity, while lower scores indicate a high level of fear. The Turkish version of the MFES has been validated for use in clinical assessments.

4. Fugl-Meyer Assessment

   Time frame: The beginning of study and after 6 weeks

   Fugl-Meyer Assessment (FMA) originally evaluates five components: lower extremity motor function (FMA-LE, maximum score 34) and upper extremity motor function (FMA-UE, maximum score 66), sensory function (maximum score 24), balance (maximum score 14), range of motion (maximum score 44) and joint pain (maximum score 44). Two areas will be evaluated in this study: FMA-LE and FMA-UE. FMA-LE includes six categories such as basic reflex movements in the lower extremity, voluntary movements with muscle synergies, coordination and movement speed (tremor, dysmetria, timing). Most tasks are scored between 0 and 2; 0 indicates no movement, 1 partial movement and 2 correct movement. The FMA-UE assesses nine categories for the upper extremity: primary reflexes, flexor synergy, extensor synergy, combined synergy movements, out-of-synergy movements, wrist movements, hand movements, and coordination (tremor, dysmetria, speed). Most tasks are similarly scored from 0 to 2.

5. Wolf Motor Function Test

   Time frame: The beginning of study and after 6 weeks

   The Wolf Motor Function Test (WMFT) is a timed-based, task-oriented performance test developed to assess upper extremity motor function following stroke. This test, which consists of 15 tasks in total, allows for the monitoring of changes in motor skills over time. The first six tasks involve timed movements of joint segments, while the remaining nine tasks evaluate holistic functional movements. Each task is scored both for completion time (in seconds) and movement quality on a scale from 0 to 5 with the maximum score is 75. The WMFT provides both qualitative and quantitative data, making it a reliable tool for tracking rehabilitation progress.

6. Berg Balance Scale

   Time frame: The beginning of study and after 6 weeks

   The Berg Balance Scale (BBS) is a highly clinically valid and reliable tool used to assess balance performance. It is especially preferred for older adults and individuals with neurological disorders such as stroke, to determine the risk of falling due to balance issues. The scale consists of 14 tasks, each scored from 0 to 4, with a maximum total score of 56. The tasks include sitting, standing, turning, bending, and standing on one leg, covering a range of functional balance abilities. Lower scores are associated with a higher risk of falling; scores below 45 are generally considered clinically significant for fall risk.

7. Timed Up and Go Test

   Time frame: The beginning of study and after 6 weeks

   The Timed Up and Go Test (TUG) is a time-based test used to measure functional mobility and fall risk by assessing how long it takes for an individual to complete a sequence of daily movements. It is frequently used to objectively assess mobility levels in older adults and patients with neurological or orthopedic conditions. During the test, the individual rises from the chair, walks three meters forward, turns around, walks back to the starting point, and sits down again. This process is timed in seconds using a stopwatch. Times under 10 seconds are considered normal levels of mobility; values between 11 and 14 seconds indicate mild mobility limitation; times over 15 seconds are associated with reduced functional independence and increased fall risk. Times above 20 seconds may raise concerns about the ability to live independently; and times exceeding 30 seconds indicate severe mobility impairment and a high risk of falls.