Dance for the Improvement of Balance and Gait After Stroke (DASRCT)

Stroke can drastically impact the ability to walk and keep your balance. In addition people with chronic stroke feel social isolated, become less satisfied with their walking and lose confidence in their ability to move without falling. Ned new treatments are needed for walking and balance. Dancing is a fun, social activity that has similar benefits to traditional exercise. Another benefit of dancing is the use of music, which improves mood, increases motivation and can even improve motor performance. Finally, moving in synchrony with other people during dancing can make people feel connected. We believe that dance classes can benefit people with stroke, but few studies have been done. The objective of our project is to conduct a randomized controlled trial to test whether dance can improve balance and walking for people with chronic stroke. The investigators are also interested in whether dancing improves people's confidence in their ability to do activities without losing their balance (i.e. balance confidence), decreases their feelings of isolation and increases their quality of life.

This study is a randomized controlled trial to investigate the effects of an adapted dance program for people with chronic stroke. Participants with stroke living in the community will be randomly assigned to either the dance group or the control group. Participants will attend classes 2 times a week for 12 weeks. The primary outcomes are change in balance balance (measured with the Mini BESTest) and change in gait speed. Participants will be assessed before and after the 12 week program.

Two groups of participants. One group receives the dance intervention. The control group will receive mindful meditation, strengthening & stretching exercises.

Participants will receive a 1-hour group dance class twice a week for 12 weeks. Classes will include a seated warm up, dance exercises in standing, dance activities moving across the floor, throughout the space and conclude with a bow exercise. Music and dance styles will vary and personal preference of participants will also be taken into account.

Participants will receive a 1-hour group exercise class twice a week for 12 weeks. Classes will include resistance training exercises with resistance bands, stretching and range of motion exercises in seated and standing positions. Classes will also include mindfulness exercises. During active exercises music will be played and personal preference of participant will be taken into account.

One-hour class, twice a week. Classes include dance warm up exercises, various dance movements and choreography that include coordinated whole body movements through space synchronized to music.

One hour class, twice a week. Classes include upper and lower extremity stretching and resistance exercises and mindfulness meditation, that includes body scan technique and breathing exercises.

Mini-Balance Evaluation Systems Test (Mini-BESTest) The Mini-BESTest is a 14-item performance-based clinical scale that will be used to measure balance during standing and walking activities. There are 4 subscales in the miniBESTest and the scores on the subscales are summed to create the total score. The miniBESTest total score can range form 0-56 and higher scores indicate better balance. The Mini-BESTest shows good inter- (ICC 0.96) and intra-rater (ICC=0.97) and test-retest reliability (ICC=0.98) in the stroke population.

Friendship scale The Friendship scale is a short (6-item) and user-friendly measure of perceived social isolation developed for older adults. It has a maximum score of 24 and lower scores indicate higher levels of social isolation. It has internal structure (RMSEA=0.02) and reliability (Chronbach α=0.83)

Stroke Specific Quality Of Life scale (SS-QOL) The SS-QOL is a self-report scale containing 49 items in 12 domains ranging from mobility and energy to mood and language. The SS-QOL has both domain scores and an overall SS-QOL summary score. The domain scores are unweighted averages of the associated items while the summary score is an unweighted average of all twelve domain scores. The scores can range from 0 to 5 and higher scores indicate better quality of life. The SS-QOL had good internal consistency (range Chronbach α=0.75-0.89), test-retest reliability (r=0.92) and inter-rater reliability (r=0.92).

Activity Balance Confidence Scale (ABC) The ABC is a 16-item self-report scale that requires individuals indicate their confidence in performing various activities without losing their balance or becoming unsteady. The ABC total score is calculated as an average of the ratings for the 16 items. The score ranges from 0-100 and higher scores indicate greater confidence. The ABC scale has good internal consistency (α=0.94) and test-retest reliability (ICC =0.85) in individuals with chronic stroke living in the community

active range of motion of the shoulder assessed using a measuring tape and a ruler to quantify arm elevation, lateral rotation and medial rotation.

Inclusion Criteria: > 6 months post stroke Ability to transfer sit to stand and stand to sit with minimal use of arm rests Ability to stand without physical support from an aid or another person for 30 seconds Ability to walk 10m without physical assistance from a walking device, but with standby assistance from another person if needed Ability to follow 2-3 step instructions with minimal prompting from another person Have received clearance from their physician to participate in exercise. Exclusion Criteria: Severe hearing loss Pre-existing conditions that significantly impact gait and balance (e.g. osteoarthritis) Other neurological conditions that impact gait and balance (e.g. PD). Have participated in a dance class within the past 12 months

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