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Jeong T, Chung Y. The effects of visual information deprivation and feedback balance training on balance in patients with stroke. NeuroRehabilitation 2024; 54:435-448. [PMID: 38607770 DOI: 10.3233/nre-230358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. OBJECTIVE The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. METHODS The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. RESULTS The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. CONCLUSION The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.
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Affiliation(s)
- Taewoong Jeong
- Department of Physical Therapy, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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2
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Nam SM, Lee DY. Effects of Visual Cue Deprivation Balance Training with Head Control on Balance and Gait Function in Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:629. [PMID: 35630046 PMCID: PMC9148052 DOI: 10.3390/medicina58050629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Visual cue deprivation is the instability of head control is increased. The purpose of this study is to investigate the effects of visual cue deprivation balance training by applying head control feedback to the balance and gait ability of stroke patients. Materials and Methods: The study was conducted on 41 patients diagnosed with hemiplegia due to stroke. Subjects were randomly assigned to any of the following groups: the experimental group I, the experimental group II or the control group. The randomization method used a simple randomization method. To evaluate changes in balance function, a LOS (Limit of Stability) and a BBS (Berg Balance Scale) were performed. In addition, to evaluate changes in ST (stride time), SL (stride length), and cadence, a LEGSys were performed. Results: A two-way repeated ANOVA was conducted to analyze the differences between groups. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in SL and cadence for the gait function. Conclusions: Visual cue deprivation balance training applying head control feedback is effective in improving dynamic balance ability and cadence. It is necessary to constantly maintain the head orientation by feedback and to properly control the head movement.
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Affiliation(s)
- Seung-Min Nam
- Department of Sports Rehabilitation & Exercise Management, Yeungnam University College, Daegu-si 42415, Korea;
| | - Do-Youn Lee
- Department of Physical Therapy, Daegu University, Gyeongsan-si 38541, Korea
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3
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Krasnikova VV, Bagramyan SA, Demchenko EA. [Comparative effectiveness of various methods of physical rehabilitation in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:23-31. [PMID: 35485657 DOI: 10.17116/kurort20229902123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Dyscirculatory encephalopathy is a complex of functional and structural changes in the brain that occur against the background of chronic insufficiency of cerebral blood flow. The high prevalence of this pathology, as well as a pronounced impact on the quality of life and working capacity of patients, determines the importance of optimizing rehabilitation measures and developing the most promising strategies for physical rehabilitation. OBJECTIVE To compare the effectiveness of a special complex of therapeutic (vestibular) gymnastics and training with biofeedback (BFB) on a stabiloplatform in the rehabilitation of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome. MATERIAL AND METHODS A cohort prospective single-center randomized comparative study of the clinical effectiveness of the author's complex of therapeutic exercises and stabilometric training with BFB in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome was carried out. The study involved 40 patients aged 65-89 years who were randomized into 2 equal groups. Patients of the 1st group, against the background of drug therapy and physiotherapy, were trained on a stabiloplatform with BFB (a training game according to the manufacturer's instructions). Patients of the 2nd group performed a complex of therapeutic (vestibular) gymnastics specially designed for this study. The effectiveness of physical rehabilitation was assessed by the dynamics of (1) subjective symptoms (complaints of patients), (2) indicators of stabilometry (symmetry index, the sum of the coordination indices for the right and left legs, fluctuation) and (3) the results of functional testing using the Get up and go test, the Berg balance scale and the Tinetti mobility scale. RESULTS In the group of patients who performed vestibular gymnastics, in contrast to patients who participated in training using a multifunctional stabiloplatform with BFB, a statistically significant improvement was revealed when assessed by the Get up and go test and the Berg balance scale. In none of the groups, a distinct dynamics of stabilometry indicators was registered. No correlation was found between the main indicators of stabilometry and the data of functional tests. CONCLUSION Thus, vestibular gymnastics has demonstrated greater effectiveness in the rehabilitation of patients with dyscirculatory encephalopathy and vestibulo-atactic syndrome in comparison with stabilometric training with biofeedback. The discrepancy between stabilometry indicators and the results of functional testing in patients requires a targeted study.
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Affiliation(s)
- V V Krasnikova
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - S A Bagramyan
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - E A Demchenko
- Almazov National Medical Research Center, St. Petersburg, Russia
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4
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Gill-Body KM, Hedman LD, Plummer L, Wolf L, Hanke T, Quinn L, Riley N, Kaufman R, Verma A, Quiben M, Scheets P. Movement System Diagnoses for Balance Dysfunction: Recommendations From the Academy of Neurologic Physical Therapy's Movement System Task Force. Phys Ther 2021; 101:6307337. [PMID: 34160028 DOI: 10.1093/ptj/pzab153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022]
Abstract
UNLABELLED The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession's vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past 2 years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy, focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the task force that followed a systematic process to review available diagnostic frameworks related to balance, identify 10 distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the Academy of Neurologic Physical Therapy Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to (1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses; (2) report the recommended diagnostic labels and associated descriptions; (3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care; and (4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. IMPACT The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The 10 balance diagnosis proposed can aid in clinical decision making regarding intervention.
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Affiliation(s)
| | - Lois D Hedman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Plummer
- Physical Therapy Department, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Leslie Wolf
- Outpatient Neurologic Rehabilitation, OhioHealth, Columbus, Ohio, USA
| | - Timothy Hanke
- Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Nora Riley
- Physical Therapy Department, St. Ambrose University, Davenport, Iowa, USA
| | - Regina Kaufman
- Department of Physical Therapy, Springfield College, Springfield, Massachusetts, USA
| | - Akanshka Verma
- Inpatient Rehabilitation Unit & Acute Neurology Service, New York- Presbyterian Hospital, New York, New York, USA
| | - Myla Quiben
- Department of Physical Therapy, School of Health Professions, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Patricia Scheets
- Quality & Clinical Outcomes, Infinity Rehab, Wilsonville, Oregon, USA
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5
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Effect of an EMG-FES Interface on Ankle Joint Training Combined with Real-Time Feedback on Balance and Gait in Patients with Stroke Hemiparesis. Healthcare (Basel) 2020; 8:healthcare8030292. [PMID: 32846971 PMCID: PMC7551751 DOI: 10.3390/healthcare8030292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the effects of an electromyography-functional electrical stimulation interface (EMG-FES interface) combined with real-time balance and gait feedback on ankle joint training in patients with stroke hemiplegia. Twenty-six stroke patients participated in this study. All subjects were randomly assigned to either the EMG-FES interface combined with real-time feedback on ankle joint training (RFEF) group (n = 13) or the EMG-FES interface on ankle joint training (EF) group (n = 13). Subjects in both groups were trained for 20 min a day, 5 times a week, for 4 weeks. Similarly, all participants underwent a standard rehabilitation physical therapy for 60 min a day, 5 times a week, for 4 weeks. The RFEF group showed significant increases in weight-bearing lunge test (WBLT), Tardieu Scale (TS), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), velocity, cadence, step length, stride length, stance per, and swing per (p < 0.05). Likewise, the EF group showed significant increases in WBLT, TUG, BBS, velocity, and cadence (p < 0.05). Moreover, the RFEF group showed significantly greater improvements than the EF group in terms of WBLT, Tardieu Scale, TUG, BBS, velocity, step length, stride length, stance per, and swing per (p < 0.05). Ankle joint training using an EMG-FES interface combined with real-time feedback improved ankle range of motion (ROM), muscle tone, balance, and gait in stroke patients. These results suggest that an EMG-FES interface combined with real-time feedback is feasible and suitable for ankle joint training in individuals with stroke.
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Madhavan S, Pradhan S. Relationship between Nintendo's Wii balance board derived variables and clinical balance scores in individuals with stroke. Gait Posture 2020; 79:170-174. [PMID: 32417647 PMCID: PMC7306165 DOI: 10.1016/j.gaitpost.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Wii Balance Board (WBB) is widely studied as a balance testing platform and is reliable in detecting changes in the body's center of pressure (COP). However, the relationship between WBB derived measures and clinical tests of balance is currently unknown. RESEARCH QUESTION To investigate the association between static and dynamic COP measures from the WBB with balance tests commonly used in chronic stroke. METHODS This retrospective study included sixty-nine individuals with stroke who performed the Berg Balance Score (BBS), the Mini-BESTest and WBB assessments as a part of their baseline measurements. The WBB assessments included body weight symmetry and a dynamic target matching task that measured Reaction Time (RT) and Completion Time (CT). RESULTS Body weight symmetry performed with eyes open was significantly different between participants who were classified as high and moderate balance using the Mini-BESTest (p = 0.03). A significant negative linear correlation was observed between the BBS and CT (rho = -0.29, p = 0.021) and between the Mini-BESTest and RT (rho=-0.246, p = 0.05). SIGNIFICANCE We provide preliminary but weak evidence supporting the relationship between WBB derived variables in relevance to the BBS and Mini-BESTest. Further research is needed to fully understand the clinical utility of the WBB especially in a larger sample and to generalize these results to stroke survivors at all levels of ability.
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Affiliation(s)
- Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA.,Corresponding author at: Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA. (Sangeetha Madhavan)
| | - Sonia Pradhan
- Brain Plasticity Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA.,Graduate Program in Rehabilitation Science, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
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7
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Ambrosini E, Peri E, Nava C, Longoni L, Monticone M, Pedrocchi A, Ferriero G, Ferrante S. A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med 2019; 56:24-33. [PMID: 31556542 DOI: 10.23736/s1973-9087.19.05847-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke. AIM The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery. DESIGN Randomized controlled trial (NCT02439515). SETTING Inpatient rehabilitation facility. POPULATION Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old. METHODS Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale. RESULTS Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008). CONCLUSIONS The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training. CLINICAL REHABILITATION IMPACT The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.
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Affiliation(s)
- Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy -
| | - Elisabetta Peri
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Claudia Nava
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Luca Longoni
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giorgio Ferriero
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy
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8
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Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews. PLoS One 2019; 14:e0219781. [PMID: 31323068 PMCID: PMC6641159 DOI: 10.1371/journal.pone.0219781] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a “low or critically low” quality, 23% “moderate” quality and 22% “high” quality. Conclusions There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.
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9
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Liao WC, Lai CL, Hsu PS, Chen KC, Wang CH. Different weight shift trainings can improve the balance performance of patients with a chronic stroke: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e13207. [PMID: 30407361 PMCID: PMC6250502 DOI: 10.1097/md.0000000000013207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Improving balance ability, increasing walking ability, and reducing the occurrence of falls are important objectives in the rehabilitation of stroke patients. Do the posture balance training and the intervention of lateral wedge insoles to improve of balance function and increase walking ability in patients with a chronic stroke? METHODS A randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors. Participants who had a chronic stroke (onset >6 months) were recruited from the rehabilitation and neurology departments of a hospital in central Taiwan. Subjects were divided into 3 groups: a visual biofeedback balance training group, a lateral wedge group, and a control group; apart from their usual rehabilitation program, and both experimental groups received a 6-week training session program. The primary outcome was the balance computerized adaptive test (balance CAT), and secondary outcome was timed up and go (TUG) test. All subjects were evaluated at the baseline, posttraining (6-week), 1st follow-up (10-week), and 2nd follow-up (18-week). RESULTS A total of 56 subjects were participated in this study, including 38 males and 18 females. The mean age of the subjects was 59.1 years old, and the mean time was 43.7 months after the onset of the stroke. This study found the interaction in groups and measurement time points reached statistical significance of the balance CAT and TUG test (F = 5.740, P < .001; F = 2.926, P = .011; respectively). In addition, the performance of both the visual biofeedback training and lateral wedge group was superior to that of the control group. CONCLUSION Six-week visual biofeedback training and intervention of 5° lateral wedge insoles can improve the balance ability of patients with a chronic stroke. TRIAL REGISTRY http://www.chictr.org.cn, ChiCTR-IPR-15007092.
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Affiliation(s)
- Wan-Chun Liao
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare
| | - Chung-Liang Lai
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare
- Department of Occupational Therapy, College of Medical and Health Science, Asia University
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare
| | - Kun-Chung Chen
- Department of Physical Therapy, Chung Shan Medical University, and Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hou Wang
- Department of Physical Therapy, Chung Shan Medical University, and Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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10
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Lee MM, Lee KJ, Song CH. Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke. Med Sci Monit 2018; 24:2590-2598. [PMID: 29702630 PMCID: PMC5944399 DOI: 10.12659/msm.906451] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke. Material/Methods Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups. Results At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (p<0.05). However, postural balance and upper extremity function were significantly improved in the experimental group when compared with the control group (p<0.05). Conclusions Game-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.
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Affiliation(s)
- Myung Mo Lee
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| | - Kyeong Jin Lee
- Department of Physical Therapy, Kyungdong University, Gangwon, South Korea
| | - Chang Ho Song
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
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11
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Kumar D, González A, Das A, Dutta A, Fraisse P, Hayashibe M, Lahiri U. Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System. Front Bioeng Biotechnol 2018; 5:85. [PMID: 29359128 PMCID: PMC5765271 DOI: 10.3389/fbioe.2017.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/18/2017] [Indexed: 01/05/2023] Open
Abstract
Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one’s center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one’s individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one’s overall performance in balance-related tasks belonging to different difficulty levels.
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Affiliation(s)
- Deepesh Kumar
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Alejandro González
- INRIA Camin team and LIRMM, University of Montpellier, Montpellier, France.,Conacyt-Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Abhijit Das
- AMRI Institute of Neuroscience, Kolkata, India
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Philippe Fraisse
- INRIA Camin team and LIRMM, University of Montpellier, Montpellier, France
| | - Mitsuhiro Hayashibe
- INRIA Camin team and LIRMM, University of Montpellier, Montpellier, France.,Department of Robotics, Tohoku University, Sendai, Japan
| | - Uttama Lahiri
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
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12
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Li Z, Wang XX, Liang YY, Chen SY, Sheng J, Ma SJ. Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial. PeerJ 2018; 6:e4244. [PMID: 29340245 PMCID: PMC5768172 DOI: 10.7717/peerj.4244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Force platform training with functional electric stimulation aimed at improving balance may be effective in fall prevention for older adults. Aim of the study is to evaluate the effects of the visual-feedback-based force platform balance training with functional electric stimulation on balance and fall prevention in older adults. METHODS A single-centre, unblinded, randomized controlled trial was conducted. One hundred and twenty older adults were randomly allocated to two groups: the control group (n = 60, one-leg standing balance exercise, 12 min/d) or the intervention group (n = 60, force platform training with functional electric stimulation, 12 min/d). The training was provided 15 days a month for 3 months by physical therapists. Medial-lateral and anterior-posterior maximal range of sway with eyes open and closed, the Berg Balance Scale, the Barthel Index, the Falls Efficacy scale-International were assessed at baseline and after the 3-month intervention. A fall diary was kept by each participant during the 6-month follow-up. RESULTS On comparing the two groups, the intervention group showed significantly decreased (p < 0.01) medial-lateral and anterior-posterior maximal range of sway with eyes open and closed. There was significantly higher improvement in the Berg Balance Scale (p < 0.05), the Barthel Index (p < 0.05) and the Falls Efficacy Scale-International (p < 0.05), along with significantly lesser number of injurious fallers (p < 0.05), number of fallers (p < 0.05), and fall rates (p < 0.05) during the 6-month follow-up in the intervention group. CONCLUSION This study showed that the visual feedback-based force platform training with functional electric stimulation improved balance and prevented falls in older adults.
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Affiliation(s)
- Zhen Li
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Geriatrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiu-Xia Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan-Yi Liang
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Yan Chen
- Department of Geriatrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sheng
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shao-Jun Ma
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Pellegrino L, Giannoni P, Marinelli L, Casadio M. Effects of continuous visual feedback during sitting balance training in chronic stroke survivors. J Neuroeng Rehabil 2017; 14:107. [PMID: 29037206 PMCID: PMC5644142 DOI: 10.1186/s12984-017-0316-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postural control deficits are common in stroke survivors and often the rehabilitation programs include balance training based on visual feedback to improve the control of body position or of the voluntary shift of body weight in space. In the present work, a group of chronic stroke survivors, while sitting on a force plate, exercised the ability to control their Center of Pressure with a training based on continuous visual feedback. The goal of this study was to test if and to what extent chronic stroke survivors were able to learn the task and transfer the learned ability to a condition without visual feedback and to directions and displacement amplitudes different from those experienced during training. METHODS Eleven chronic stroke survivors (5 Male - 6 Female, age: 59.72 ± 12.84 years) participated in this study. Subjects were seated on a stool positioned on top of a custom-built force platform. Their Center of Pressure positions were mapped to the coordinate of a cursor on a computer monitor. During training, the cursor position was always displayed and the subjects were to reach targets by shifting their Center of Pressure by moving their trunk. Pre and post-training subjects were required to reach without visual feedback of the cursor the training targets as well as other targets positioned in different directions and displacement amplitudes. RESULTS During training, most stroke survivors were able to perform the required task and to improve their performance in terms of duration, smoothness, and movement extent, although not in terms of movement direction. However, when we removed the visual feedback, most of them had no improvement with respect to their pre-training performance. CONCLUSIONS This study suggests that postural training based exclusively on continuous visual feedback can provide limited benefits for stroke survivors, if administered alone. However, the positive gains observed during training justify the integration of this technology-based protocol in a well-structured and personalized physiotherapy training, where the combination of the two approaches may lead to functional recovery.
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Affiliation(s)
- Laura Pellegrino
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia, 16145, Genoa, Italy.
| | - Psiche Giannoni
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia, 16145, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, L.go Daneo, Genoa, 16132, Italy.,Department of Neuroscience, Ospedale Policlinico San Martino, L.go R. Benzi, Genoa, 16132, Italy
| | - Maura Casadio
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia, 16145, Genoa, Italy
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Hugues A, Di Marco J, Janiaud P, Xue Y, Pires J, Khademi H, Cucherat M, Bonan I, Gueyffier F, Rode G. Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e013348. [PMID: 28137928 PMCID: PMC5293873 DOI: 10.1136/bmjopen-2016-013348] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective. METHODS AND ANALYSIS We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the 'weight-bearing asymmetry' (WBA), the 'centre of pressure' (COP) and the 'limit of stability' (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and full-text articles, evaluate the risk of bias and will perform data extraction. In addition to the outcomes, measures of independence will be analysed. This study will aim at determining the effects of PT on the function (WBA, COP, LOS), the activity (BBS, PASS) and the independence of patients. Subgroup analyses will be planned according to the location of brain lesion (hemispheric, brainstem or cerebellum), the time since stroke (early, late, chronic), the PT (type, main aim (direct effect or generalisation), overall duration), the type of approaches (top-down or bottom-up) and the methodological quality of studies. ETHICS AND DISSEMINATION No ethical statement will be required. The results will be published in a peer-reviewed journal. This meta-analysis aims at managing the rehabilitation after postural imbalance by PT after a stroke. TRIAL REGISTRATION NUMBER Prospero CRD42016037966;Pre-results.
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Affiliation(s)
- A Hugues
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France
- Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - J Di Marco
- Service de médecine physique et réadaptation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France
| | - P Janiaud
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
| | - Y Xue
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - J Pires
- Rovisco Pais Rehabilitation Centre, Tocha, Portugal
- Medicine Faculty of Oporto University, Oporto, Portugal
| | - H Khademi
- International Agency of Research on Cancer, World Health Organisation, Lyon, France
| | - M Cucherat
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
| | - I Bonan
- Service de médecine physique et de réadaptation, CHU Rennes, Rennes, France
| | - F Gueyffier
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
- Service de Pharmacologie Toxicologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - G Rode
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France
- Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
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15
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Hofheinz M, Mibs M, Elsner B. Dual task training for improving balance and gait in people with stroke. Hippokratia 2016. [DOI: 10.1002/14651858.cd012403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Hofheinz
- IFEP-Dresden; Department of Physiotherapy; Dresden Germany 01219
| | | | - Bernhard Elsner
- Dresden Medical School, Technical University Dresden; Department of Public Health; Fetscherstr. 74 Dresden Sachsen Germany 01307
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Ciou SH, Hwang YS, Chen CC, Chen SC, Chou SW, Chen YL. Balance training using an interactive game to enhance the use of the affected side after stroke. J Phys Ther Sci 2015; 27:3855-61. [PMID: 26834368 PMCID: PMC4713807 DOI: 10.1589/jpts.27.3855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Stroke and other cerebrovascular diseases are major causes of adult mobility
problems. Because stroke immobilizes the affected body part, balance training uses the
healthy body part to complete the target movement. The muscle utilization rate on the
stroke affected side is often reduced which further hinders affected side functional
recovery in rehabilitation. [Subjects and Methods] This study tested a newly-developed
interactive device with two force plates to measuring right and left side centers of
pressure, to establish its efficacy in the improvement of the static standing ability of
patients with hemiplegia. An interactive virtual reality game with different side reaction
ratios was used to improve patient balance. The feasibility of the proposed approach was
experimentally demonstrated. [Results] Although the non-affected-side is usually used to
support the body weight in the standing position, under certain circumstances the patients
could switch to using the affected side. A dramatic improvement in static standing balance
control was achieved in the eyes open condition. [Conclusion] The proposed dual force
plate technique used in this study separately measured the affected and non-affected-side
centers of pressure. Based on this approach, different side ratio integration was achieved
using an interactive game that helped stroke patients improve balance on the affected
side. Only the patient who had suffered stroke relatively recently benefited
significantly. The proposed technique is of little benefit for patients whose mobility has
stagnated to a certain level.
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Affiliation(s)
- Shih-Hsiang Ciou
- Department of Electronic Engineering, National Taipei University of Technology, Taiwan
| | - Yuh-Shyan Hwang
- Department of Electronic Engineering, National Taipei University of Technology, Taiwan
| | - Chih-Chen Chen
- Department of Information Management, Hwa Hsia University of Technology, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University and Hospital, Taiwan
| | - Shih-Wei Chou
- Department of Mathematics, National Central University, Taiwan
| | - Yu-Luen Chen
- Department of Digital Technology Design, National Taipei University of Education, Taiwan
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Huh JS, Lee YS, Kim CH, Min YS, Kang MG, Jung TD. Effects of Balance Control Training on Functional Outcomes in Subacute Hemiparetic Stroke Patients. Ann Rehabil Med 2015; 39:995-1001. [PMID: 26798615 PMCID: PMC4720777 DOI: 10.5535/arm.2015.39.6.995] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/29/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of balance control training using a newly developed balance control trainer (BalPro) on the balance and gait of patients with subacute hemiparetic stroke. METHODS Forty-three subacute stroke patients were assigned to either a balance control training (BCT) group or a control group. The BCT group (n=23) was trained with BalPro for 30 minutes a day, 5 days a week for 2 weeks, and received one daily session of conventional physical therapy. The control group (n=20) received two sessions of conventional physical therapy every day for 2 weeks. The primary outcome was assessment with the Berg Balance Scale (BBS). Secondary outcomes were Functional Ambulation Category (FAC), the 6-minute walking test (6mWT), Timed Up and Go (TUG), the Korean version of Modified Barthel Index (K-MBI), and the manual muscle test (MMT) of the knee extensor. All outcome measures were evaluated before and after 2 weeks of training in both groups. RESULTS There were statistically significant improvements in all parameters except MMT and FAC after 2 weeks of treatment in both groups. After training, the BCT group showed greater improvements in the BBS and the 6mWT than did the control group. CONCLUSION Balance control training using BalPro could be a useful treatment for improving balance and gait in subacute hemiparetic stroke patients.
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Affiliation(s)
- Jin Seok Huh
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
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18
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Kim JH, Sim WS, Won BH. Effectiveness of elastic band-type ankle-foot orthoses on postural control in poststroke elderly patients as determined using combined measurement of the stability index and body weight-bearing ratio. Clin Interv Aging 2015; 10:1839-47. [PMID: 26622174 PMCID: PMC4654550 DOI: 10.2147/cia.s92888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Poor recovery of postural stability poststroke is the primary cause of impairment in activities and social participation in elderly stroke survivors. The purpose of our study was to experimentally evaluate the effectiveness of our new elastic ankle–foot orthosis (AFO), compared to a traditional AFO fabricated with hard plastic, in improving postural stability in elderly chronic stroke survivors. Patients and methods Postural stability was evaluated in ten chronic stroke patients, 55.7±8.43 years old. Postural stability was evaluated using the standardized methods of the Biodex Balance System combined with a foot pressure system, under three experimental conditions, no AFO, rigid plastic AFO, and elastic AFO (E-AFO). The following dependent variables of postural stability were analyzed: plantar pressure under the paretic and nonparetic foot, area of the center of balance (COB) and % time spent in each location, distance traveled by the COB away from the body center, distance traveled by the center of pressure, and calculated index of overall stability, as well as indices anterior–posterior and medial–lateral stability. Results Both AFO designs improved all indices of postural stability. Compared to the rigid plastic AFO, the E-AFO produced additional positive effects in controlling anterior–posterior body sway, equalizing weight bearing through the paretic and nonparetic limbs, and restraining the displacement of the center of pressure and of the COB. Conclusion Based on our outcomes, we recommend the prescription of E-AFOs as part of a physiotherapy rehabilitation program to promote recovery of postural stability poststroke. When possible, therapeutic outcomes should be documented using the Biodex Balance System and foot pressure system, as used in our study, to provide evidence needed to support the development of a larger controlled trial to generate high-quality evidence on the effectiveness of E-AFOs.
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Affiliation(s)
- Jong Hyun Kim
- Usability Evaluation Technology Center, Advanced Biomedical and Welfare R&D Group, Korea Institute of Industrial Technology, Cheonan-si, Chungcheongnam-do, South Korea
| | - Woo Sang Sim
- Usability Evaluation Technology Center, Advanced Biomedical and Welfare R&D Group, Korea Institute of Industrial Technology, Cheonan-si, Chungcheongnam-do, South Korea
| | - Byeong Hee Won
- Usability Evaluation Technology Center, Advanced Biomedical and Welfare R&D Group, Korea Institute of Industrial Technology, Cheonan-si, Chungcheongnam-do, South Korea
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Jeon SH, Lee SM, Kim JH. Therapeutic effects of reaching with forward bending of trunk on postural stability, dynamic balance, and gait in individuals with chronic hemiparetic stroke. J Phys Ther Sci 2015; 27:2447-51. [PMID: 26357423 PMCID: PMC4563287 DOI: 10.1589/jpts.27.2447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to perform forward bending of the trunk and
reaching training in chronic stroke patients and to investigate subsequent changes in
trunk control, dynamic balance, and gait. [Subject] Twenty-three chronic stroke patients
were randomly divided into two groups, with 10 patients in the forward bending of the
trunk and reaching group and 13 patients in the control group. [Methods] Both groups
underwent 30 minutes of rehabilitation therapy, five days a week, for four weeks. The
forward bending of the trunk and reaching group additionally performed forward bending of
the trunk and reaching training five times a week for four weeks, which involved four sets
of pressing buttons 35 times, for a total of 140 button presses per session. The subjects
were tested before and after training using the Trunk Impairment Scale, Berg Balance
Scale, Timed Up and Go Test, Six-Minute Walking Test, and 10-Meter Walking Test. Trunk
control, dynamic balance, and walking ability were compared between the two groups.
[Result] The results of the study showed that the results of the Trunk Impairment Scale,
Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test improved significantly
in the FBR group, while there were no significant differences in the control group.
[Conclusion] This study results suggest that forward bending of the trunk and reaching
training can be an effective exercise method for chronic stroke patients.
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Affiliation(s)
- Seo-Hyun Jeon
- Department of Physical Therapy, The Graduate School, Sahmyook University, Republic of Korea
| | - Suk-Min Lee
- Department of Physical Therapy, College of Health Welfare, Sahmyook University, Republic of Korea
| | - Jung-Hyun Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Republic of Korea
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20
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Lee HY, Kim YL, Lee SM. Effects of virtual reality-based training and task-oriented training on balance performance in stroke patients. J Phys Ther Sci 2015; 27:1883-8. [PMID: 26180341 PMCID: PMC4500004 DOI: 10.1589/jpts.27.1883] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/07/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the clinical effects of virtual reality-based
training and task-oriented training on balance performance in stroke patients. [Subjects
and Methods] The subjects were randomly allocated to 2 groups: virtual reality-based
training group (n = 12) and task-oriented training group (n = 12). The patients in the
virtual reality-based training group used the Nintendo Wii Fit Plus, which provided visual
and auditory feedback as well as the movements that enabled shifting of weight to the
right and left sides, for 30 min/day, 3 times/week for 6 weeks. The patients in the
task-oriented training group practiced additional task-oriented programs for 30 min/day, 3
times/week for 6 weeks. Patients in both groups also underwent conventional physical
therapy for 60 min/day, 5 times/week for 6 weeks. [Results] Balance and functional reach
test outcomes were examined in both groups. The results showed that the static balance and
functional reach test outcomes were significantly higher in the virtual reality-based
training group than in the task-oriented training group. [Conclusion] This study suggested
that virtual reality-based training might be a more feasible and suitable therapeutic
intervention for dynamic balance in stroke patients compared to task-oriented
training.
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Affiliation(s)
- Hyung Young Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - You Lim Kim
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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21
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An fMRI Study of Local Synchronization in Different Subfrequency Bands during the Continuous Feedback of Finger Force. BIOMED RESEARCH INTERNATIONAL 2015; 2015:273126. [PMID: 26180789 PMCID: PMC4477192 DOI: 10.1155/2015/273126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/04/2015] [Indexed: 01/09/2023]
Abstract
Conventional functional magnetic resonance imaging (fMRI) studies on motor feedback employ periodical blocked paradigm which does not allow frequency analysis of brain activity. Here, we carried out an fMRI study by using a continuous paradigm, that is, continuous (8 min) feedback of finger force. Borrowing an analytic method widely used in resting-state fMRI studies, that is, regional homogeneity (ReHo), we compared the local synchronization in some subfrequency bands between real and sham feedback, and the subbands were defined as Slow-6 (0.0–0.01 Hz), Slow-5 (0.01–0.027 Hz), Slow-4 (0.027–0.073 Hz), Slow-3 (0.073–0.198 Hz), and Slow-2 (0.198–0.25 Hz). Our results revealed that the five subfrequency bands of brain activity contributed to the changes of ReHo between real and sham feedback differently, and, more importantly, the changes in basal ganglia were only manifested in Slow-6, implicating the fact that ReHo in ultraslow band may be associated with the functional significance of BG, that is, motor control. These findings provide novel insights into the neural substrate underlying motor feedback, and properties of the ultraslow band of local synchronization deserve more attention in future explorations.
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22
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Baud-Bovy G, Tatti F, Borghese NA. Ability of Low-Cost Force-Feedback Device to Influence Postural Stability. IEEE TRANSACTIONS ON HAPTICS 2015; 8:130-9. [PMID: 25398181 DOI: 10.1109/toh.2014.2369057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Low-cost gaming technology offers promising devices for the rehabilitation of stroke patients at home. While several attempts have been made to use low-cost motion tracking devices (Kinect) or balance boards (Wii Board), the potential of low-cost haptic devices has yet to be explored in this context. The objective of this study was to investigate whether it is possible to influence postural stability with a low-cost device despite its technical limitations, and to explore the most promising modes of haptic interaction to increase and decrease postural stability. Two groups of younger subjects used a high-end (Omega.3) and a low-cost (Falcon) device respectively. A third group of older subjects used the Falcon. We show that light touch contact with the device improves stability, whereas the force tasks decrease it. The effects of the different tasks are consistent in the two age groups. Although there are differences in the participants' interaction with the two devices, the effect of the devices on postural stability is comparable. We conclude that a low-cost haptic device can be used to increase or decrease postural stability of healthy subjects with an age similar to that of typical stroke patients, in a safe and controllable way.
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23
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Ordahan B, Karahan AY, Basaran A, Turkoglu G, Kucuksarac S, Cubukcu M, Tekin L, Polat AD, Kuran B. Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study. Hippokratia 2015; 19:125-130. [PMID: 27418760 PMCID: PMC4938102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this study was to determine the efficacy of the exercises administered to stroke patients with the balance trainer (BALANCE-trainer, art.nr. 07001-001(TM)) on balance, level of independence and ambulation parameters. MATERIAL AND METHOD Fifty patients with hemiplegia were randomized into either study group or control group. Patients in the control group received 30 sessions of conventional rehabilitation program and patients in the study group were trained with balance trainer in addition to conventional rehabilitation program. Balance level and postural control were evaluated with Berg Balance Scale (BBS) and Timed-Up and Go Test (TUG). Their functional statuses were evaluated using Functional Independence Measure (FIM). Evaluations were repeated following the six-week rehabilitation program. RESULTS Of the 50 participants, 19 were women (38%) and 31 were men (62%). The mean age was 57.1 ± 9.2 years. The time that elapsed after stroke was 87.3 ± 26.3 days. Statistically significant improvements were noted in BBS, TUG and FIM in intra-group evaluations for both groups. Statistically significant improvements were documented in BBS and TUG levels for inter-group evaluation (respectively p =0.038, p =0.025), while the difference in FIM levels was not statistically significant (p >0.05). CONCLUSION Positive impact of balance trainer on balance and postural control was demonstrated in stroke patients in the current study. Hippokratia 2015; 19 (2):125-130.
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Affiliation(s)
- B Ordahan
- Physical Medicine and Rehabilitation Department of Beyhekim State Hospital of Konya, Turkey
| | - A Y Karahan
- Physical Medicine and Rehabilitation Department of Beyhekim State Hospital of Konya, Turkey
| | - A Basaran
- Physical Medicine and Rehabilitation Department of Beyhekim State Hospital of Konya, Turkey
| | - G Turkoglu
- Physical Medicine and Rehabilitation Department of Beyhekim State Hospital of Konya, Turkey
| | - S Kucuksarac
- Physical Medicine and Rehabilitation Department of Beyhekim State Hospital of Konya, Turkey
| | - M Cubukcu
- Physical Medicine and Rehabilitation Department of Denizli State Hospital of Denizli, Turkey
| | - L Tekin
- Physical Medicine and Rehabilitation Department of Beyhekim State Hospital of Konya, Turkey
| | - A D Polat
- Physical Medicine and Rehabilitation Department of Afyon State Hospital of Afyon, Turkey
| | - B Kuran
- Physical Medicine and Rehabilitation Department of Şişli Etfal Training and Research Hospital Istanbul, Turkey
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Ankylosing spondylitis and posture control: the role of visual input. BIOMED RESEARCH INTERNATIONAL 2015; 2015:948674. [PMID: 25821831 PMCID: PMC4363712 DOI: 10.1155/2015/948674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/09/2014] [Indexed: 01/21/2023]
Abstract
Objectives. To assess the motor control during quiet stance in patients with established ankylosing spondylitis (AS) and to evaluate the effect of visual input on the maintenance of a quiet posture. Methods. 12 male AS patients (mean age 50.1 ± 13.2 years) and 12 matched healthy subjects performed 2 sessions of 3 trials in quiet stance, with eyes open (EO) and with eyes closed (EC) on a baropodometric platform. The oscillation of the centre of feet pressure (CoP) was acquired. Indices of stability and balance control were assessed by the sway path (SP) of the CoP, the frequency bandwidth (FB1) that includes the 80% of the area under the amplitude spectrum, the mean amplitude of the peaks (MP) of the sway density curve (SDC), and the mean distance (MD) between 2 peaks of the SDC. Results. In severe AS patients, the MD between two peaks of the SDC and the SP of the center of feet pressure were significantly higher than controls during both EO and EC conditions. The MP was significantly reduced just on EC. Conclusions. Ankylosing spondylitis exerts negative effect on postural stability, not compensable by visual inputs. Our findings may be useful in the rehabilitative management of the increased risk of falling in AS.
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25
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Yom C, Cho HY, Lee B. Effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait of stroke patients. J Phys Ther Sci 2015; 27:845-9. [PMID: 25931744 PMCID: PMC4395728 DOI: 10.1589/jpts.27.845] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the therapeutic effects of virtual
reality-based ankle exercise on the dynamic balance, muscle tone, and gait ability of
stroke subjects. [Subjects and Methods] Twenty persons who were in the chronic stroke
subjects of this study and they were included and assigned to two groups: experimental
(VRAE; Virtual Reality-based Ankle Exercise group) (n=10) and control groups (n=10). The
VRAE group performed virtual environment system ankle exercise, and the control group
watched a video. Both groups performed their respective interventions for 30 minutes per
day, 5 times per week over a 6-week period. To confirm the effects of the intervention,
dynamic balance, muscle tone, and spatiotemporal gait were evaluated. [Results] The
results showed that the dynamic balance and muscle tone was significantly more improved
after the intervention compared to before in the VRAE group (dynamic balance: 5.50±2.57;
muscle tone: 0.90±0.39), and the improvements were more significant than those in the
control (dynamic balance: 1.22±2.05; muscle tone: 0.10±0.21). Spatiotemporal gait measures
were significantly more increased in the paretic limb after the intervention compared to
before in the VRAE group and the improvements were more significant than those in the
control group. [Conclusion] This study demonstrated that virtual reality-based ankle
exercise effectively improves the dynamic balance, muscle tone, and gait ability of stroke
patients.
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Affiliation(s)
- Changho Yom
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Republic of Korea
| | - ByoungHee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Kiefer AW, Kushner AM, Groene J, Williams C, Riley MA, Myer GD. A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes. J Sports Sci Med 2015; 14:1-8. [PMID: 25729282 PMCID: PMC4306760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/02/2014] [Indexed: 06/04/2023]
Abstract
Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT) is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline) objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance. Key pointsSpecific, targeted interventions that isolate injury risk factors and can help correct modifiable neuromuscular deficits are essential.Current training interventions for anterior cruciate ligament (ACL) injury prevention have only demonstrated limited effectiveness and have not achieved the widespread acceptance necessary to promote full adoption to reduce ACL injury rates.The paper provides an overview of innovative strategies and technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement neuromuscular training (NMT) including electromyography, force plates, motion sensors, and camera-based motion capture systems.These strategies utilize biomechanical, physiological, or neuromotor variables for training, automate the quantitative measurement of those variables through a variety of technological modalities, and then feed those measured variables via software to provide information in simplified form for online, visual biofeedback displays.
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Affiliation(s)
| | - Adam M Kushner
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH USA
| | - John Groene
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH USA
| | - Christopher Williams
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH USA
| | - Michael A Riley
- Center for Cognition, Action and Perception, Department of Psychology, University of Cincinnati , Cincinnati, OH USA
| | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH USA ; Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH USA ; The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University Medical Center , Columbus, OH USA ; The Micheli Center for Sports Injury Prevention , Waltham, MA, USA
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Kim GM, Oh DW. Neck proprioceptive training for balance function in patients with chronic poststroke hemiparesis: a case series. J Phys Ther Sci 2014; 26:1657-9. [PMID: 25364136 PMCID: PMC4210421 DOI: 10.1589/jpts.26.1657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/10/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effects of neck proprioceptive training on the balance of patients with chronic poststroke hemiparesis. [Subjects] Three patients with chronic stroke were recruited for this study. [Methods] The subjects underwent neck proprioceptive training using the red light of a laser pointer (30 min daily, five times per week for 4 weeks). Outcome measures included the stability and weight distribution indices measured with a Tetrax system and Timed Up and Go (TUG) and proprioception tests. [Results] For all subjects, the stability and weight distribution indices increased by 1.87-9.66% in the eyes-open and eyes-closed conditions, and the TUG and proprioception test scores improved by 2.49-15.27%. [Conclusion] Neck proprioceptive training may be a good option for improving the balance function of patients with chronic poststroke hemiparesis.
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Affiliation(s)
- Gyoung-Mo Kim
- Department of Physical Therapy, Division of Health Science, Baekseok University, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health Science, Cheongju University, Republic of Korea
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De Nunzio AM, Zucchella C, Spicciato F, Tortola P, Vecchione C, Pierelli F, Bartolo M. Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis. FUNCTIONAL NEUROLOGY 2014; 29:127-34. [PMID: 25306123 PMCID: PMC4198161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Weight bearing on the paretic lower extremity and transfer of weight from one lower extremity to the other are important goals of stroke rehabilitation. Improvements in these limb loading and weight transfer abilities have been shown to relate to improved performance of many functional activities. Unfortunately, valid and practical clinical measures of paretic lower extremity loading and weight transfer have not been identified. The purpose of this study was to quantitatively assess, through center of foot pressure (CoP) analysis of quiet upright stance control, recovery of paretic limb loading as a measure of weight transfer in early stroke subjects, testing the effectiveness of a targeted rehabilitation intervention based on audiovisual biofeedback. Thirty-seven adults with lower extremity motor impairment following unilateral, non-cerebellar stroke, were Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis tested twice, at an interval of at least one month post stroke and following rehabilitation intervention aimed at correcting their asymmetrical weight bearing. The intervention was performed with (Study Group, SG) or without (Control Group, CG) a postural audio-visual biofeedback approach. Indices of postural stability and of balance control asymmetry were estimated by acquiring the movements of the CoP during quiet upright stance condition with or without visual input (eyes open, EO and eyes closed, EC). Clinical scales were also administered. Both the CG and the SG subjects showed improved control in upright stance posture as documented by significant improvements in the scale scores and indices of stability during both the EO and the EC condition. Only the SG showed a significantly reduced CoP index of asymmetry. The CoP index of asymmetry, correlating with clinical motor scales, is a valid measure of paretic limb loading during stroke recovery. Postural audio-visual biofeedback represented the more effective approach for reducing weight loading asymmetry of the lower limbs in stroke.
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Affiliation(s)
- Alessandro Marco De Nunzio
- “INM-Motion Lab” Laboratory of Multifactorial Biomechanics - Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
| | - Chiara Zucchella
- Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
- Department of Neurological Sciences, University of Pavia, Pavia, Italy
| | | | - Paolo Tortola
- Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
| | - Carmine Vecchione
- Vascular Physiopathology Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Francesco Pierelli
- Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Michelangelo Bartolo
- “INM-Motion Lab” Laboratory of Multifactorial Biomechanics - Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
- Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy
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Ha H, Cho K, Lee W. Reliability of the good balance system(®) for postural sway measurement in poststroke patients. J Phys Ther Sci 2014; 26:121-4. [PMID: 24567689 PMCID: PMC3927022 DOI: 10.1589/jpts.26.121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/17/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine test-retest reliability of the Good
Balance system® for measurement of postural sway in poststroke
patients. [Subjects] Sixty chronic stroke patients (40 men and 20 women; age 63.08 years;
stroke duration 16.45 months) participated in this study. [Methods] Postural sway was
evaluated using a force platform system (Good Balance system, Metitur Oy, Jyvaskyla,
Finland). Two examiners measured postural sway for all participants during two separate
testing sessions. The second measurement was performed one week after the first
measurement. Intraclass correlation coefficients [ICC(2,1)] were used for
estimation of reliability. [Results] The ICC (95% CI) for intra-examiner reliability was
good to very good, ranging from 0.69 to 0.93 (0.53–0.96), and the ICC for inter-examiner
reliability was good to very good, ranging from 0.85 to 0.98 (0.77–0.99). [Conclusion] The
results of the current study indicated that the intra- and inter-examiner reliability of
the Good Balance system® for measurement of postural sway was good
to very good. Therefore, we suggest that measurement of postural sway using the Good
Balance system® would be useful for clinical assessment in
poststroke patients.
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Affiliation(s)
- Hyungeun Ha
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Kihun Cho
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Research Institute, Republic of Korea
| | - Wanhee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Singh DKA, Mohd Nordin NA, Aziz NAA, Lim BK, Soh LC. Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. BMC Neurol 2013; 13:199. [PMID: 24330250 PMCID: PMC4029492 DOI: 10.1186/1471-2377-13-199] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. METHODS In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board. RESULTS Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements. CONCLUSION Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.
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Affiliation(s)
- Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Nordin
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Medical Faculty, University Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Beng Kooi Lim
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Li Ching Soh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Barcala L, Grecco LAC, Colella F, Lucareli PRG, Salgado ASI, Oliveira CS. Visual biofeedback balance training using wii fit after stroke: a randomized controlled trial. J Phys Ther Sci 2013; 25:1027-32. [PMID: 24259909 PMCID: PMC3820213 DOI: 10.1589/jpts.25.1027] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/10/2013] [Indexed: 01/29/2023] Open
Abstract
[Purpose] The aim of the present study was to investigate the effect of balance training with visual biofeedback on balance, body symmetry, and function among individuals with hemiplegia following a stroke. [Subjects and Methods] The present study was performed using a randomized controlled clinical trial with a blinded evaluator. The subjects were twenty adults with hemiplegia following a stroke. The experimental group performed balance training with visual biofeedback using Wii Fit(®) together with conventional physical therapy. The control group underwent conventional physical therapy alone. The intervention lasted five weeks, with two sessions per week. Body symmetry (baropodometry), static balance (stabilometry), functional balance (Berg Balance Scale), functional mobility (Timed Up and Go test), and independence in activities of daily living (Functional Independence Measure) were assessed before and after the intervention. [Results] No statistically significant differences were found between the experimental and control groups. In the intragroup analysis, both groups demonstrated a significant improvement in all variables studied. [Conclusion] The physical therapy program combined with balance training involving visual biofeedback (Wii Fit(®)) led to an improvement in body symmetry, balance, and function among stroke victims. However, the improvement was similar to that achieved with conventional physical therapy alone.
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Lee SW, Shin DC, Song CH. The effects of visual feedback training on sitting balance ability and visual perception of patients with chronic stroke. J Phys Ther Sci 2013; 25:635-9. [PMID: 24259819 PMCID: PMC3804977 DOI: 10.1589/jpts.25.635] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/22/2013] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of visual feedback
training (VFT) in the sitting position on sitting balance ability and visual perception of
chronic stroke patients. [Subjects] Twenty-two hospitalized subjects who had experienced a
stroke more than six months earlier were included in this study. [Methods] Subjects in
both the experimental group (n=12) and the control group (n=10) participated in a
conventional rehabilitation program involving a 60-minute session five days per week for a
period of four weeks. Subjects in the experimental group additionally practiced VFT
30-minute sessions, five days per week, for a period of four weeks. [Results] After the
intervention, the experimental group showed significantly improved static sitting balance
ability (left∙right, anterior∙posterior moment, and velocity moment), and dynamic sitting
balance ability (anterior∙lateral moment). In visual perception tests, motor free visual
perception test (MVPT) scores showed a significant increase of approximately 17% in the
experimental group after the intervention. [Conclusion] The results of this study
demonstrate the effectiveness of VFT in enhancing body function, as evidenced by improved
sitting balance and visual perception of chronic stroke patients.
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Affiliation(s)
- Seok Won Lee
- Department of Physical Therapy, Sahmyook University
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Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil 2013; 10:60. [PMID: 23777436 PMCID: PMC3687555 DOI: 10.1186/1743-0003-10-60] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/06/2013] [Indexed: 12/22/2022] Open
Abstract
This paper reviews the literature relating to the biofeedback used in physical rehabilitation. The biofeedback methods used in rehabilitation are based on biomechanical measurements and measurements of the physiological systems of the body. The physiological systems of the body which can be measured to provide biofeedback are the neuromuscular system, the respiratory system and the cardiovascular system. Neuromuscular biofeedback methods include electromyography (EMG) biofeedback and real-time ultrasound imaging (RTUS) biofeedback. EMG biofeedback is the most widely investigated method of biofeedback and appears to be effective in the treatment of many musculoskeletal conditions and in post cardiovascular accident (CVA) rehabilitation. RTUS biofeedback has been demonstrated effective in the treatment of low back pain (LBP) and pelvic floor muscle dysfunction. Cardiovascular biofeedback methods have been shown to be effective in the treatment of a number of health conditions such as hypertension, heart failure, asthma, fibromyalgia and even psychological disorders however a systematic review in this field has yet to be conducted. Similarly, the number of large scale studies examining the use of respiratory biofeedback in rehabilitation is limited. Measurements of movement, postural control and force output can be made using a number of different devices and used to deliver biomechanical biofeedback. Inertial based sensing biofeedback is the most widely researched biomechanical biofeedback method, with a number of studies showing it to be effective in improving measures of balance in a number of populations. Other types of biomechanical biofeedback include force plate systems, electrogoniometry, pressure biofeedback and camera based systems however the evidence for these is limited. Biofeedback is generally delivered using visual displays, acoustic or haptic signals, however more recently virtual reality (VR) or exergaming technology have been used as biofeedback signals. VR and exergaming technology have been primarily investigated in post-CVA rehabilitation, however, more recent work has shown this type of biofeedback to be effective in improving exercise technique in musculoskeletal populations. While a number of studies in this area have been conducted, further large scale studies and reviews investigating different biofeedback applications in different clinical populations are required.
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Affiliation(s)
- Oonagh M Giggins
- Clarity Centre for Sensor Web Technologies, University College Dublin, Belfield, Dublin 4, Ireland.
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Kim SH, Reed KB. Robot-assisted balance training for gait modification. IEEE Int Conf Rehabil Robot 2013; 2013:6650421. [PMID: 24187239 DOI: 10.1109/icorr.2013.6650421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diminished balance control while walking is a main concern for people with stroke. An appropriate training method would help improve their balance during walking. In this study, we examined if a novel robot-assisted balance training (RABT) program could change human gait patterns. Five healthy individuals underwent a RABT program with either stepping or standing movements. An external perturbation using a force field was applied to the lower trunk to alter weight distribution patterns during training. The results showed that people who had a RABT with stepping movements demonstrated a greater change in gait patterns compared to those who had the RABT with standing movements. This suggests that the RABT program with stepping movements can be used as a rehabilitation approach to facilitate an adaptation of a new balance control pattern in human beings.
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Chen HY, Wing AM. Independent control of force and timing symmetry in dynamic standing balance: Implications for rehabilitation of hemiparetic stroke patients. Hum Mov Sci 2012; 31:1660-9. [DOI: 10.1016/j.humov.2012.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/05/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
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Lee SH, Byun SD, Kim CH, Go JY, Nam HU, Huh JS, Jung TD. Feasibility and effects of newly developed balance control trainer for mobility and balance in chronic stroke patients: a randomized controlled trial. Ann Rehabil Med 2012; 36:521-9. [PMID: 22977778 PMCID: PMC3438419 DOI: 10.5535/arm.2012.36.4.521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/29/2012] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the feasibility and effects of balance training with a newly developed Balance Control Trainer (BCT) that applied the concept of vertical movement for the improvements of mobility and balance in chronic stroke patients. Method Forty chronic stroke patients were randomly assigned to an experimental or a control group. The experimental group (n=20) underwent training with a BCT for 20 minutes a day, 5 days a week for 4 weeks, in addition to concurrent conventional physical therapy. The control group (n=20) underwent only conventional therapy for 4 weeks. All participants were assessed by: the Functional Ambulation Categories (FAC), 10-meter Walking Test (10mWT), Timed Up and Go test (TUG), Berg Balance Scale (BBS), Korean Modified Barthel Index (MBI), and Manual Muscle Test (MMT) before training, and at 2 and 4 weeks of training. Results There were statistically significant improvements in all parameters except knee extensor power at 2 weeks of treatment, and in all parameters except MBI which showed further statistically significant progress in the experimental group over the next two weeks (p<0.05). Statistically significant improvements on all measurements were observed in the experimental group after 4 weeks total. Comparing the two groups at 2 and 4 weeks of training respectively, 10mWT, TUG, and BBS showed statistically more significant improvements in the experimental group (p<0.05). Conclusion Balance training with a newly developed BCT is feasible and may be an effective tool to improve balance and gait in ambulatory chronic stroke patients. Furthermore, it may provide additional benefits when used in conjunction with conventional therapies.
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Affiliation(s)
- So Hyun Lee
- Department of Rehabilitation Medicine, Kyung-pook National University College of Medicine, Daegu 700-721, Korea
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Duclos C, Miéville C, Gagnon D, Leclerc C. Dynamic stability requirements during gait and standing exergames on the wii fit® system in the elderly. J Neuroeng Rehabil 2012; 9:28. [PMID: 22607025 PMCID: PMC3408325 DOI: 10.1186/1743-0003-9-28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 05/20/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In rehabilitation, training intensity is usually adapted to optimize the trained system to attain better performance (overload principle). However, in balance rehabilitation, the level of intensity required during training exercises to optimize improvement in balance has rarely been studied, probably due to the difficulty in quantifying the stability level during these exercises. The goal of the present study was to test whether the stabilizing/destabilizing forces model could be used to analyze how stability is challenged during several exergames, that are more and more used in balance rehabilitation, and a dynamic functional task, such as gait. METHODS Seven healthy older adults were evaluated with three-dimensional motion analysis during gait at natural and fast speed, and during three balance exergames (50/50 Challenge, Ski Slalom and Soccer). Mean and extreme values for stabilizing force, destabilizing force and the ratio of the two forces (stability index) were computed from kinematic and kinetic data to determine the mean and least level of dynamic, postural and overall balance stability, respectively. RESULTS Mean postural stability was lower (lower mean destabilizing force) during the 50/50 Challenge game than during all the other tasks, but peak postural instability moments were less challenging during this game than during any of the other tasks, as shown by the minimum destabilizing force values. Dynamic stability was progressively more challenged (higher mean and maximum stabilizing force) from the 50/50 Challenge to the Soccer and Slalom games, to the natural gait speed task and to the fast gait speed task, increasing the overall stability difficulty (mean and minimum stability index) in the same manner. CONCLUSIONS The stabilizing/destabilizing forces model can be used to rate the level of balance requirements during different tasks such as gait or exergames. The results of our study showed that postural stability did not differ much between the evaluated tasks (except for the 50/50 Challenge), compared to dynamic stability, which was significantly less challenged during the games than during the functional tasks. Games with greater centre of mass displacements and changes in the base of support are likely to stimulate balance control enough to see improvements in balance during dynamic functional tasks, and could be tested in pathological populations with the approach used here.
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Affiliation(s)
- Cyril Duclos
- Pathokinesiology laboratory, Centre for Interdisciplinary Research in Rehabilitation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 6300 avenue Darlington, Montréal, QC, H3S 2 J4, Canada
- School of Rehabilitation, Université de Montreal, 7077, avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Carole Miéville
- Pathokinesiology laboratory, Centre for Interdisciplinary Research in Rehabilitation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 6300 avenue Darlington, Montréal, QC, H3S 2 J4, Canada
- School of Rehabilitation, Université de Montreal, 7077, avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Dany Gagnon
- Pathokinesiology laboratory, Centre for Interdisciplinary Research in Rehabilitation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 6300 avenue Darlington, Montréal, QC, H3S 2 J4, Canada
- School of Rehabilitation, Université de Montreal, 7077, avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Catherine Leclerc
- Pathokinesiology laboratory, Centre for Interdisciplinary Research in Rehabilitation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 6300 avenue Darlington, Montréal, QC, H3S 2 J4, Canada
- School of Rehabilitation, Université de Montreal, 7077, avenue du Parc, Montréal, QC, H3N 1X7, Canada
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Cho KH, Lee KJ, Song CH. Virtual-Reality Balance Training with a Video-Game System Improves Dynamic Balance in Chronic Stroke Patients. TOHOKU J EXP MED 2012; 228:69-74. [DOI: 10.1620/tjem.228.69] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ki Hun Cho
- Department of Physical Therapy, Seoul Bukbu Hospital
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Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Arch Phys Med Rehabil 2011; 92:1364-70. [PMID: 21878206 DOI: 10.1016/j.apmr.2011.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. DESIGN Prospective multicenter research design. SETTING Outpatient rehabilitation clinics. PARTICIPANTS Patients (N=29) with chronic stroke. INTERVENTIONS Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. MAIN OUTCOME MEASURES The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. RESULTS There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. CONCLUSIONS Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.
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Affiliation(s)
- Mary Beth Badke
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.
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Abstract
Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice.
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Affiliation(s)
- Peter Langhorne
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Royal Infirmary, Glasgow, UK.
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Pollock A, Morris J, Wijck FV, Coupar F, Langhorne P. Response to Cauraugh, J. H., et al. Bilateral movement training and stroke motor recovery progress: A structured review and meta-analysis. Human Movement Science (2009), doi: 10.1016/j.humov.2009.09.004. Hum Mov Sci 2011; 30:143-6; author reply 147-9. [DOI: 10.1016/j.humov.2010.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 09/29/2010] [Accepted: 10/11/2010] [Indexed: 11/28/2022]
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Zijlstra A, Mancini M, Chiari L, Zijlstra W. Biofeedback for training balance and mobility tasks in older populations: a systematic review. J Neuroeng Rehabil 2010; 7:58. [PMID: 21143921 PMCID: PMC3019192 DOI: 10.1186/1743-0003-7-58] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 12/09/2010] [Indexed: 11/10/2022] Open
Abstract
CONTEXT An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity. OBJECTIVE To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults. DATA SOURCES PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists. STUDY SELECTION For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task. DATA EXTRACTION Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated. RESULTS AND CONCLUSIONS Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery. IMPLICATIONS Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.
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Affiliation(s)
- Agnes Zijlstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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The Effect of Task-Oriented Sensorimotor Exercise on Visual Feedback Control of Body Position and Body Balance. HUMAN MOVEMENT 2010. [DOI: 10.2478/v10038-010-0013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med 2010; 38:S156-81. [PMID: 20117590 DOI: 10.1016/j.amepre.2009.10.023] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 07/15/2009] [Accepted: 10/08/2009] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Military Training Task Force of the Defense Safety Oversight Council chartered a Joint Services Physical Training Injury Prevention Working Group to: (1) establish the evidence base for making recommendations to prevent injuries; (2) prioritize the recommendations for prevention programs and policies; and (3) substantiate the need for further research and evaluation on interventions and programs likely to reduce physical training-related injuries. EVIDENCE ACQUISITION A work group was formed to identify, evaluate, and assess the level of scientific evidence for various physical training-related injury prevention strategies through an expedited systematic review process. Of 40 physical training-related injury prevention strategies identified, education, leader support, and surveillance were determined to be essential elements of a successful injury prevention program and not independent interventions. As a result of the expedited systematic reviews, one more essential element (research) was added for a total of four. Six strategies were not reviewed. The remaining 31 interventions were categorized into three levels representing the strength of recommendation: (1) recommended; (2) not recommended; and (3) insufficient evidence to recommend or not recommend. EVIDENCE SYNTHESIS Education, leadership support, injury surveillance, and research were determined to be critical components of any successful injury prevention program. Six interventions (i.e., prevent overtraining, agility-like training, mouthguards, semirigid ankle braces, nutrient replacement, and synthetic socks) had strong enough evidence to become working group recommendations for implementation in the military services. Two interventions (i.e., back braces and pre-exercise administration of anti-inflammatory medication) were not recommended due to evidence of ineffectiveness or harm, 23 lacked sufficient scientific evidence to support recommendations for all military services at this time, and six were not evaluated. CONCLUSIONS Six interventions should be implemented in all four military services immediately to reduce physical training-related injuries. Two strategies should be discouraged by all leaders at all levels. Of particular note, 23 popular physical training-related injury prevention strategies need further scientific investigation, review, and group consensus before they can be recommended to the military services or similar civilian populations. The expedited systematic process of evaluating interventions enabled the working group to build consensus around those injury prevention strategies that had enough scientific evidence to support a recommendation.
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Simon AM, Kelly BM, Ferris DP. Preliminary trial of symmetry-based resistance in individuals with post-stroke hemiparesis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:5294-9. [PMID: 19964119 DOI: 10.1109/iembs.2009.5333512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We tested a novel control strategy for robotic rehabilitation devices used by individuals with post-stroke hemiparesis. Symmetry-based resistance increases resistance when limb forces become more asymmetric during bilateral exercise. The underlying rationales for the control mode are that it will guide patients to increase paretic limb activation while teaching them to accurately gauge paretic limb force production relative to the non-paretic limb. During a one day training session, seven subjects post-stroke performed lower limb extensions in symmetry-based resistance mode on a robotic exercise machine. Subjects improved lower limb symmetry from 28.6%+/-3.9% to 36.2%+/-4.3% while under symmetry-based resistance training (ANOVA, P = 0.03), but did not maintain the improved lower limb symmetry during a constant resistance post-test. Two subjects that showed the large improvements in symmetry during the one day session performed additional days of training. Those results suggest that some patients demonstrate long lasting benefits with symmetry-based resistance training.
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Affiliation(s)
- Ann M Simon
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
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Abstract
Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. In this Review, we aimed to provide an overview of the available evidence on interventions for motor recovery after stroke through the evaluation of systematic reviews, supplemented by recent randomised controlled trials. Most trials were small and had some design limitations. Improvements in recovery of arm function were seen for constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, and robotics. Improvements in transfer ability or balance were seen with repetitive task training, biofeedback, and training with a moving platform. Physical fitness training, high-intensity therapy (usually physiotherapy), and repetitive task training improved walking speed. Although the existing evidence is limited by poor trial designs, some treatments do show promise for improving motor recovery, particularly those that have focused on high-intensity and repetitive task-specific practice.
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Gok H, Geler-Kulcu D, Alptekin N, Dincer G. Efficacy of treatment with a kinaesthetic ability training device on balance and mobility after stroke: a randomized controlled study. Clin Rehabil 2008; 22:922-30. [DOI: 10.1177/0269215508090673] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate whether the addition of a kinaesthetic ability training device could enhance the effect of a conventional rehabilitation programme on balance and mobility in hemiparetic patients late after stroke. Design: Randomized, controlled, assessor-blinded trial. Setting: The rehabilitation ward of a university hospital. Thirty hemiparetic patients (mean age (SD) of 57.4 (8.1) years) late after stroke (mean time since stroke (SD) 545.2 (99.9) days) were assigned randomly to an experimental or a control group. Interventions: The control group (n = 15) participated in a conventional rehabilitation programme. The experimental group (n = 15) participated in balance training with a kinaesthetic ability training device in addition to a conventional rehabilitation programme for four weeks, five days a week. Outcome measures: Kinaesthetic ability training static and dynamic balance indices, balance and lower extremity subscores of the Fugl-Meyer Stroke Assessment Instrument (FMA), total motor and locomotor subitem scores of the Functional Independence Measure (FIM) were evaluated at baseline and after treatment. Results: The experimental group had greater improvement in measures of balance including static (P = 0.045) and dynamic balance index (P = 0.001) and FMA balance score (P = 0.001) than the control group. No between-group differences were detected in subscore of FMA, total motor and locomotor subscores of FIM. There were significant improvements in balance subscores of FMA, static and dynamic balance indexes in the experimental group and in sub-item scores of FIM and lower extremity scores of FMA in both groups. Conclusion: Kinaesthetic ability training in addition to a conventional rehabilitation programme is effective in improving balance late after stroke. However, this improvement is not reflected in individual functional status.
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Affiliation(s)
- H. Gok
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara
| | - D. Geler-Kulcu
- Department of Physical Medicine and Rehabilitation, Yeditepe University, Faculty of Medicine, Istanbul,
| | - N. Alptekin
- Department of Physical Medicine and Rehabilitation, Yasam Medical Center, Kirikkale
| | - G. Dincer
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
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Yelnik AP, Le Breton F, Colle FM, Bonan IV, Hugeron C, Egal V, Lebomin E, Regnaux JP, Pérennou D, Vicaut E. Rehabilitation of Balance After Stroke With Multisensorial Training: A Single-Blind Randomized Controlled Study. Neurorehabil Neural Repair 2008; 22:468-76. [DOI: 10.1177/1545968308315996] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To compare 2 rehabilitation strategies to improve balance after stroke: (1) a multisensorial approach based on higher intensity of balance tasks and exercise during visual deprivation and (2) a conventional neurodevelopmentaltheory-based treatment (NDT) that used a general approach for sensorimotor rehabilitation. Methods . This prospective, multicenter, randomized, parallel-group study measured outcomes with blinded assessors. Sixty-eight patients able to walk without human assistance were entered from 3 to 15 months (mean, 7 months) after a first hemispheric stroke. They received 20 sessions in 4 weeks of NDT or multisensorial rehabilitation. On day 0, day 30, and day 90, assessment included the Berg Balance Scale (BBS), posturography, gait (velocity, double stance phase, climbing 10 steps, amount of walking per day), the Functional Independence Measure, and the Nottingham Health Profile. Results. All subjects improved significantly in balance and walking parameters. Regarding the main dependent variable (BBS on day 30), no difference between groups was found. Analysis of secondary outcomes suggested small differences in favor of the experimental group, but the differences are not likely to be clinically relevant. Conclusion. No evidence was found for the superiority of a multisensorial rehabilitation program in ambulatory patients with impairments beyond the time of inpatient therapy. Additional studies are recommended.
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Affiliation(s)
- Alain P. Yelnik
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris,
| | - Frederique Le Breton
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Florence M. Colle
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Isabelle V. Bonan
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Caroline Hugeron
- Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches
| | - Véronique Egal
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Elizabeth Lebomin
- Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches
| | - Jean-Philippe Regnaux
- Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches
| | | | - Eric Vicaut
- Unité de Recherche Clinique, G.H. Lariboisière-E.Widal, Université Paris 7, Paris France
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Yelnik AP, Bonan IV, Simon O, Gellez-Leman MC. Riabilitazione dopo un ictus cerebrale. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yavuzer G, Eser F, Karakus D, Karaoglan B, Stam HJ. The effects of balance training on gait late after stroke: a randomized controlled trial. Clin Rehabil 2007; 20:960-9. [PMID: 17065539 DOI: 10.1177/0269215506070315] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the effects of balance training, using force platform biofeedback, on quantitative gait characteristics of hemiparetic patients late after stroke. DESIGN Randomized, controlled, assessor-blinded trial. SETTING Rehabilitation ward and gait laboratory of a university hospital. SUBJECTS Forty-one patients (mean (standard deviation; SD) age of 60.9 (11.7) years) with hemiparesis late after stroke (median time since stroke six months) were randomly assigned to an experimental or a control group. INTERVENTIONS The control group (n = 19) participated in a conventional stroke inpatient rehabilitation programme, whereas the experimental group (n = 22) received 15 sessions of balance training (using force platform biofeedback) in addition to the conventional programme. MAIN OUTCOME MEASURES Selected paretic side time-distance, kinematic and kinetic gait parameters in sagittal, frontal and transverse planes were measured using a three-dimensional computerized gait analysis system, one week before and after the experimental treatment programme. RESULTS The control group did not show any statistically significant difference regarding gait characteristics. Pelvic excursion in frontal plane improved significantly (P = 0.021) in the experimental group. The difference between before-after change scores of the groups was significant for pelvic excursion in frontal plane (P = 0.039) and vertical ground reaction force (P = 0.030) in favour of experimental group. CONCLUSION Balance training using force platform biofeedback in addition to a conventional inpatient stroke rehabilitation programme is beneficial in improving postural control and weight-bearing on the paretic side while walking late after stroke.
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Affiliation(s)
- Gunes Yavuzer
- Ankara University Faculty of Medicine, Department of Physical Medicine & Rehabilitation, Ankara, Turkey.
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