A Water-based Sequential Preparatory Approach and Stroke
A Water-based Sequential Preparatory Approach and Stroke
Many studies hypothesize that people who have suffered stroke could benefit from water-based
 exercises to improve their strength and ability to perform the activities of daily living.

 A Cochrane Review systematically synthesized and compared the effects of aquatic and
 land-based therapies on the activities of daily living (ADL) of patients following stroke and
 found that water-based exercises improved strength and ADL. A recent review indicates that
 RCTs comparing aquatic methods in both environments are lacking. The same movements in water
 and on dry land that target postural stability and gait require different competences. For
 example, the postural instability that occurs while squatting in water was enacted on land by
 sitting on a therapy ball. Furthermore, land-based conventional rehabilitation is generally
 task oriented, customized and challenging and follows a specific preparatory sequence of
 exercises according to patients' disabilities. Therefore, the investigators believe that a
 sequential preparatory approach (SPA), based on increasing difficulty and following a
 specific sequence of preparatory exercises (from the simplest to the most complex), should
 also be used in an aquatic environment.
Inclusion Criteria:

 -  Stroke with unilateral hemiplegia within the previous six months;

 -  Ability to walk without any device or need of continuous physical assistance to
 support body weight or maintain balance (Functional Ambulation Classification ≥ 3);

 -  Acclimatization to water.

 Exclusion criteria:

 -  Cognitive deficits affecting the ability to understand task instructions (Mini-Mental
 State Examination > 24);

 -  Severe unilateral spatial neglect (diagnosed with a test battery that included the
 Letter Cancellation test, Barrage test, Sentence Reading test and the Wundt-Jastrow
 Area Illusion Test);

 -  Severe aphasia (diagnosed by means of neuropsychological assessment);

 -  Presence of other neurological diseases;

 -  Presence of cutaneous and mycosis infections;

 -  Presence of open wounds, eczema, skin ulcers, decubitus lesions, severe burns;

 -  Presence of PEG (Percutaneous endoscopic gastrostomy);

 -  Presence of tracheostomy;

 -  Urinary incontinence;

 -  Presence of otitis

 -  Presence of orthopedic or cardiac comorbidities that would limit participation in the
 experimental and conventional training (all of which were clinically evaluated).