Influence of visual feedback on dynamic balance control in chronic stroke survivors

Wii Fit-Based Biofeedback Rehabilitation Among Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

BACKGROUND

Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors.

METHODS

We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted.

OBJECTIVE

To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors.

RESULTS

22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used.

CONCLUSION

Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.

Effect of Balance Training in Sitting Position Using Visual Feedback on Balance and Gait Ability in Chronic Stroke Patients

Chronic stroke often results in balance and gait impairments, significantly impacting patients' quality of life. The purpose of this study was to investigate whether the combined effect of unstable surface balance training and visual feedback, based on proprioceptive neuromuscular stimulation in patients with chronic stroke, is effective in restoring balance and gait ability. A total of 39 chronic stroke patients were randomly assigned to a visual feedback combined with unstable surface balance training group (VUSBG), an unstable surface balance training group (USBG), or a conventional physical therapy group (CG). This study was conducted with the Trunk Impairment Scale, the Bug Balance Scale, the Timed Get Up and Go Test, and Gait Analysis. VUSBG and USBG improved function and gait (stride length and hip/knee flexion angle), but there was no significant difference in the CG group. Specific results showed that the stride length in the VUSBG improved by 25% (p < 0.05), and the hip/knee flexion angle improved by 18% (p < 0.05). The post-hoc analysis revealed that VUSBG had a greater impact on the hip/knee flexion angle relative to the other two groups, as well as gait velocity and stride length relative to CG. Visual feedback complex exercise based on the principle of proprioceptive neuromuscular facilitation could be an intervention strategy to improve gait speed, trunk stability, and mobility in chronic stroke patients.

Control of center of mass during gait of stroke patients: Statistical parametric mapping analysis

BACKGROUND

The control of the center of mass is essential for a stable and efficient gait. Post-stroke patients present several impairments, which may compromise the control of the center of mass during gait in the sagittal and frontal planes. This study aimed to identify changes in the vertical and mediolateral behavior of the center of mass during the single stance phase of post-stroke patients using the statistical parametric mapping analysis. It also aimed to identify alterations in the center of mass trajectories regarding the motor recovery stages.

METHODS

Seventeen stroke patients and 11 neurologically intact individuals were analyzed. The statistical parametric mapping approach was used to identify changes in the center of mass trajectories between stroke and healthy groups. The trajectories of the center of mass of post-stroke individuals were compared according to their motor recovery status.

FINDINGS

A near-flat vertical trajectory of the center of mass was indenfitifed in the stroke group compared to their healthy counterparts, especially on the paretic side. The center of mass trajectories in both directions (vertical and mediolateral) presented substantial alteration at the end of the single stance phase in the stroke group. The trajectory of the center of mass of the stroke group was symmetrical in the mediolateral direction between the sides. The trajectories of the center of mass presented similar pattern irrespective of the motor recovery status.

INTERPRETATION

The statistical parametric mapping approach showed to be suitable for determining gait changes in post-stroke individuals, irrespective of their motor recovery stage.

The effect of telerehabilitation on balance in stroke patients: is it more effective than the traditional rehabilitation model? A meta-analysis of randomized controlled trials published during the COVID-19 pandemic

Objective

Telerehabilitation and telemedicine have gradually gained popularity. In 2019, the outbreak of COVID-19 started in Wuhan and then spread across the world. To date, most countries have opted to coexist with the virus. However, patients, especially those who have suffered a stroke, should take measures to avoid being infected with any disease as much as possible since any infectious disease can lead to adverse events for them. Telerehabilitation can be beneficial to stroke patients as they are less likely to be infected by the virus. In recent years, several studies on telerehabilitation have been conducted globally. This meta-analysis aimed to investigate the effects of telerehabilitation on the balance ability of stroke patients, compare the efficacy of conventional rehabilitation with telerehabilitation, explore the characteristics of telerehabilitation and conventional rehabilitation, and provide recommendations for rehabilitation programs in the context of the global pandemic.

Methods

We searched Pubmed, Embase, the Web of Science, and The Cochrane Library databases from 1 January 2020 to 31 December 2022 for randomized controlled trials published in English that evaluated the improvement of balance function in stroke patients after telerehabilitation and compared the differences between telerehabilitation (TR) and conventional rehabilitation (CR). The random-effects model was utilized to calculate mean differences (MDs) with 95% confidence intervals (CIs) to estimate intervention effects. Statistical heterogeneity was assessed according to the I² values. The risk of bias was measured using the Cochrane risk-of-bias assessment tool.

Results

We included nine studies in the system evaluation, all of which were included in the pooled analysis. All outcomes in the experimental and control groups improved over time. The comparison between groups concluded that people who received the telerehabilitation intervention had a significant improvement in the Berg Balance Scale (MD = 2.80; 95% CI 0.61, 4.98, P < 0.05, I2 = 51.90%) and the Fugl-Meyer Assessment (MD = 8.12; 95% CI 6.35, 9.88, P < 0.05, I2 = 0) compared to controls. The Timed Up and Go test (MD = -4.59; 95% CI -5.93, -.25, P < 0.05, I² = 0) and Tinetti Performance-Oriented Mobility Assessment-Balance (MD = 2.50; 95% CI 0.39, 4.61, P < 0.05) scored better in the control group than in the experimental group. There were no significant differences in other outcomes between the two groups.

Conclusion

Studies on changes in medical conditions during the COVID-19 pandemic also demonstrated that, for stroke patients, telerehabilitation achieves similar effects as the conventional rehabilitation model and can act as a continuation of the conventional rehabilitation model. Owing to the different equipment and intervention programs of telerehabilitation, its curative effect on the static balance and reactive balance of stroke patients may be different. Currently, telerehabilitation may be more conducive to the rehabilitation of patients' static balance abilities, while conventional rehabilitation is more effective for the rehabilitation of patients' reactive balance. Therefore, further studies are needed for investigating the difference in efficacy between varied devices and telerehabilitation programs. Further research is needed on static and reactive balance. In addition, such research should have a large body of literature and a large sample size to support more definitive findings based on the context of the COVID-19 pandemic.

Systematic review registration

CRD42023389456.

Automatic characterization of stroke patients' posturography based on probability density analysis

OBJECTIVE

The probability density analysis was applied to automatically characterize the center of pressure (COP) data for evaluation of the stroke patients' balance ability.

METHODS

The real-time COP coordinates of 38 stroke patients with eyes open and closed during quiet standing were obtained, respectively, from a precision force platform. The COP data were analyzed and characterized by the commonly used parameters: total sway length (SL), sway radius (SR), envelope sway area (EA), and the probability density analysis based parameters: projection area (PA), skewness (SK) and kurtosis (KT), and their statistical correlations were analyzed. The differences of both conventional parameters and probability density parameters under the conditions of eyes open (EO) and eyes closed (EC) were compared.

RESULTS

The PA from probability density analysis is strongly correlated with SL and SR. Both the traditional parameters and probability density parameters in the EC state are significantly different from those in the EO state. The obtained various statokinesigrams were calculated and categorized into typical sway types through probability density function for clinical evaluation of the balance ability of stroke patients.

CONCLUSIONS

The probability density analysis of COP data can be used to characterize the posturography for evaluation of the balance ability of stroke patients.

The effects of treadmill training with visual feedback and rhythmic auditory cue on gait and balance in chronic stroke patients: A randomized controlled trial

BACKGROUND: Many stroke patients show reduced walking abilities, characterized by asymmetric walking patterns. For such patients, restoration of walking symmetry is important. OBJECTIVE: This study investigates the effect of treadmill training with visual feedback and rhythmic auditory cue (VF+RAC) for walking symmetry on spatiotemporal gait parameters and balance abilities. METHODS: Thirty-two patients with chronic stroke participated in this study. Participants were randomized to either the VF+RAC (n = 16) or the Control (n = 16) group. The VF+RAC group received treadmill training with VF and RAC, and the Control group underwent treadmill training without any visual and auditory stimulation. VF+RAC and Control groups were trained three times per week for eight weeks. After eight weeks of training, the spatiotemporal gait parameters, Timed up and go test, and Berg balance scale were measured. RESULTS: The VF+RAC group significantly improved balance and spatiotemporal parameters except for non-paretic single limb support compared to the Control group. CONCLUSIONS: This study demonstrated that treadmill training with VF+RAC significantly improved spatiotemporal gait symmetry, including other gait parameters, and enhanced balance abilities in stroke patients. Therefore, treadmill training with VF+RAC could be a beneficial intervention in clinical settings for stroke patients who need improvement in their gait and balance abilities.

Effects of dual-task training on gait and balance in stroke patients: A meta-analysis

OBJECTIVE

To assess the effects of dual-task training on gait and balance in stroke patients.Data sources: A systematic review of PubMed, Web of Science, Embase and Cochrane Library from their inception through 20 August 2021.

REVIEW METHODS

The bibliography was screened to identify randomized controlled trials that applied dual-task training to rehabilitation function training in stroke patients. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the Cochrane tool of bias. The primary outcome was the gait and balance parameters.

RESULTS

A total of 1992 studies were identified and 15 randomized controlled trials were finally included (512 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on rehabilitation training was found. Compared to patients who received conventional rehabilitation therapy, those who received dual-task training showed greater improvement in step length (MD = 3.46, 95% CI [1.01, 5.92], P = 0.006), cadence (MD = 4.92, 95% CI [3.10, 6.74], P < 0.001) and berg balance scale score (MD = 3.10, 95% CI [0.11, 6.09], P = 0.040). There were no differences in the improvements in gait speed (MD = 2.89, 95% CI [ - 2.02, 7.80], P = 0.250) and timed up and go test (MD = -2.62, 95% CI [ - 7.94, 2.71], P = 0.340) between dual-task and control groups.

CONCLUSION

Dual-task training is an effective training for rehabilitation of stroke patients in step length and cadence, however, the superiority of dual-task training for improving balance function needs further discussion.

Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke

BACKGROUND

Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry.

OBJECTIVE

This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback.

METHODS

Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for a calculated symmetry index, in addition to heel % and toe % temporal values.

RESULTS

Velocity and cadence were significantly decreased when visual feedback was provided (p< 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p< 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p< 0.05). The toe-on time significantly improved on the affected side with visual feedback (p< 0.05).

CONCLUSION

This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.

Effects of virtual reality in post-stroke aphasia: a systematic review and meta-analysis

OBJECTIVE

To investigate whether virtual reality (VR) interventions have beneficial effects on the functional communication and language function of patients with post-stroke aphasia (PSA).

METHODS

We searched nine electronic literature databases and two clinical registry platforms to identify randomized controlled trials (RCTs) and quasi-RCTs performed up to September 2020. Screening, quality assessment, and data collection were performed by two authors independently, using standard protocols. Data aggregation and risk of bias evaluation were conducted using Review Manager Version 5.4. The quality of evidence was evaluated with GRADEpro.

RESULTS

A total of five studies involving 121 participants met the inclusion criteria and were appraised. Four studies were included in the quantitative synthesis. VR reduced the severity of language impairment with borderline significance [SMD (95%CI) = 0.70[0.01, 1.39], P=0.05]. The meta-analysis showed no statistical difference in functional communication [SMD (95%CI) =0.41[-0.29, 1.12], P=0.25], word finding [SMD (95%CI) =0.42[-0.24, 1.08], P=0.21], and repetition [SMD (95%CI) =0.16[-0.62, 0.94], P=0.68] between VR group and the control group.

CONCLUSION

This review demonstrated a borderline positive clinical effect of VR for the severity of language impairment when compared with conventional rehabilitation therapy. Conversely, VR had no effect on functional communication, word finding, and repetition. Further research is warranted to reach more definite conclusions.

Effects of Visual Feedback During Recumbent Stepping in Individuals With Chronic Stroke

Objective

To investigate the effects of intermittent visual feedback (using the Balanced Power program on the NuStep Transitt) during recumbent stepping on strength, balance, and functional mobility in individuals with chronic stroke.

Design

Quasi-experimental 1-group pretest-posttest study.

Setting

Human performance research laboratory.

Participants

Adults (N=11; 7 female; mean age, 58.7±13.6y), >6 months post stroke.

Interventions

Eight 45-minute training sessions on the NuStep Transitt (visits 2-9) twice a week (5-minute warm-up and cooldown with 35 minutes of training [5min with and then without visual feedback regarding left/right lower extremity percentage effort]). Visits 1 and 10: pre- and post assessment.

Main Outcome Measures

Self-selected and fast gait speeds; maximum voluntary contractions (MVCs) of knee extension and flexion and ankle dorsiflexion and plantarflexion; and 5 times sit-to-stand (5TSTS).

Results

Significant improvements in 5TSTS (14.2s, P=.007) and fast gait (hemi: 4.9 cm [P=.024], nonhemi: 4.5cm (P=.019) stride length; nonhemi step length 2.3 cm (P=.024]). MVC and self-selected gait parameters showed no significant changes.

Conclusions

The NuStep Transitt is a valuable tool that provides real-time feedback about percentage of use of the hemiparetic leg. This intervention study has demonstrated that the addition of visual feedback about left/right percentage effort while exercising on the Transitt has significant and clinically relevant effects on the functional mobility of individuals with chronic stroke.

Winning compensations: Adaptable gaming approach for upper limb rehabilitation sessions based on compensatory movements

Recent research has been using automatic difficulty adjustment techniques as an effective channel to improve the quality of physical rehabilitation. Notably, these approaches often incorporate adaptation metrics such as emotions and performance. Nonetheless, compensatory movements, which hinder movement correctness and are considered as a core quality evaluation criterion of rehabilitation, have not been considered as an adaptation metric. Weighting how visual feedback interfaces increase patient engagement, we leverage an interactive system with a compensatory movements-based difficulty adjustment framework to enhance the upper-limb physical rehabilitation process. We conducted user tests with professionals (N = 15), which included observation sessions, co-design workshops, semi-structured interviews, and usability testing, to evaluate our prototype. Results showed that our interactive system achieved scores of perceived usability between 74 and 78.17, along with participants praising both the dynamic and manual customization of difficulty parameters. Our findings empower physical therapists and health professionals by reducing their burden on physical rehabilitation monitorization.

Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series

Stroke is a neurologic disorder considered the first cause of disability worldwide due to motor, cognitive, and sensorial sequels. Balance dysfunctions in stroke survivors increase the risk of falls and physiotherapeutic rehabilitation is essential to reduce it. Virtual reality (VR) seems to be an alternative to conventional physiotherapy (CT), providing virtual environments and multisensorial inputs to train balance in stroke patients. The aim of this study was to assess if immersive VR treatment is more effective than CT to improve balance after stroke. This study got the approval from the Ethics Committee of the University of Almeria. Three chronic ischemic stroke patients were selected. One patient who received 25 sessions of immersive VR intervention for two months was compared with another patient who received equivalent CT and a third patient with no intervention. Balance, gait, risk of falling, and vestibular and visual implications in the equilibrium were assessed. After the interventions, the two patients receiving any of the treatments showed an improvement in balance compared to the untreated patient. In comparison to CT, our results suggest a higher effect of immersive VR in the improvement of balance and a reduction of falls risk due to the active upright work during the VR intervention.

Sensorimotor Strategies in Individuals With Poststroke Hemiparesis When Standing Up Without Vision

This study investigated the sensorimotor strategies for dynamic balance control in individuals with stroke by restricting sensory input that might influence task accomplishment. Sit-to-stand movements were performed with restricted vision by participants with hemiparesis and healthy controls. The authors evaluated the variability in the position of participants’ center of mass and velocity, and the center-of-pressure position, in each orthogonal direction at the lift-off point. When vision was restricted, the variability in the mediolateral center-of-pressure position decreased significantly in individuals with hemiparesis, but not in healthy controls. Participants with hemiparesis adopted strategies that explicitly differed from those used by healthy individuals. Variability may be decreased in the direction that most requires accuracy. Individuals with hemiparesis have been reported to have asymmetrical balance deficits, and that meant they had to prioritize mediolateral motion control to prevent falling. This study suggests that individuals with hemiparesis adopt strategies appropriate to their characteristics.

Center of mass in analysis of dynamic stability during gait following stroke: A systematic review

BACKGROUND

The Center of mass (CoM) analysis reveals important aspects of gait dynamic stability of stroke patients, but the variety of methods and measures represents a challenge for planning new studies.

RESEARCH QUESTION

How have the CoM measures been calculated and employed to investigate gait stability after a stroke? Three issues were addressed: (i) the methodological aspects of the calculation of CoM measures; (ii) the purposes and (iii) the conclusions of the studies on gait stability that employed those measures.

METHODS

PubMed and Science Direct databases have been searched to collect original articles produced until July 2017. A set of 26 studies were selected according to criteria involving their methodological quality.

RESULTS

A compromise between accuracy and feasibility in CoM calculation could be reached using the segmental method with 7-9 segments. Regarding their purposes, two types of studies were identified: clinical and research oriented. From the first ones, we highlighted: the margin of stability (MoS) in the mediolateral (ML) direction, and the angular momentum in the frontal plane could be indicators of dynamical stability; the MoS in the anteroposterior (AP) direction might be able to detect the risk of falls and the symmetry of vertical CoM displacement could be used to analyze energy expenditure during gait. These and other CoM measures are potentially useful in clinical settings, but their psychometric properties are still to be determined. The research oriented studies allowed to clarify that stability is not improved by widening the step in stroke patients and that the impaired control of the non-paretic limb might be the main source of instability.

SIGNIFICANCE

This review provides recommendations on the methods for estimating CoM and its measures, identifies the potential usefulness of CoM parameters and indicates issues that could be addressed in future studies.

Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis

OBJECTIVE

The objective of this study was to systematically review the effect of virtual reality on balance as compared to conventional therapy alone poststroke.

METHODS

The databases of PubMed, Cochrane, and Ovid were searched using select keywords. The randomized controlled trials published between January 2000 and August 2017 in English language were included if they assessed the effect of virtual reality on balance ability compared to conventional therapy alone in adults' poststroke. The Physiotherapy Evidence Database scale was used to assess the methodological quality.

RESULTS

Fourteen papers were included in this review. The experimental groups largely (n = 13) used virtual reality in combination with conventional therapy. Among the high quality studies, significant between-group improvement favoring virtual reality in combination with conventional therapy was found on Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 7) when compared to conventional therapy alone. The studies were limited by low powered, small sample sizes ranging from 14 to 40, and lack of blinding, concealed allocation, and reporting of missing data. Thirteen homogenous (n = 348, I² = 37.6%, P = .083) studies were included in the meta-analysis using Berg Balance Scale. Significant improvement was observed in the experimental group compared to control group with a medium effect size of .64, confidence interval of .36-.92.

CONCLUSIONS

The findings of this review indicate that virtual reality when combined with conventional therapy is moderately more effective in improving balance than conventional therapy alone in individuals' poststroke.

Effect of visual feedback on the performance of the star excursion balance test

INTRODUCTION

Visual feedback is an effective method to enhance postural and balance control in clinical and sports training. The aim of this study was to explore the effect of real-time visual feedback provided by a video camera on the performance of a dynamic balance test, which is the star excursion balance test in healthy subjects.

METHODS

We compared the performance of the star excursion balance test using the maximum reach distance in 20 healthy participants (10 male and 10 female, 26.8 ± 3.7 years) under two conditions: without feedback and whilst they viewed their movements in real-time on a screen in front of them via a video camera.

RESULTS

The results showed that real-time visual feedback had a significant effect on maximum reach distance of the star excursion balance test in the posterolateral direction (P < 0.001). There was a non-significant increase in the maximum reach distance in the anterior and posteromedial directions.

CONCLUSION

The result indicates that the real-time visual feedback appears to be an effective means for improving the performance of the star excursion balance test in the posterolateral direction, and may be a promising tool for clinical rehabilitation and athlete training to enhance dynamic postural control.

Influence of visual feedback and rhythmic auditory cue on walking of chronic stroke patient induced by treadmill walking in real-time basis

BACKGROUND

Many patients who have suffered from a stroke show decreased walking ability, characterized by asymmetric gait. For such patients, the recovery of symmetry in walking is important.

OBJECTIVES

The purpose of this study is to investigate the effect of visual feedback with rhythmic auditory cue on treadmill gait in persons with chronic stroke.

METHODS

Seventeen chronic subjects who have been diagnosed at least six months or before were recruited in G Hospital, located in Incheon. The subjects who were enrolled in this study were instructed to walk randomly on a treadmill: treadmill with visual feedback and rhythmic auditory cue (VF+RAC), treadmill with visual feedback (VF), general treadmill (Control; non-feedback). Three factors were observed and estimated: paretic step length, non-paretic step length, spatial asymmetry ratio at comfortable speed. Also, in VF and VF+RAC, calibration of feedback accuracy was measured.

RESULTS

Results showed that paretic step length and spatial asymmetry ratio were significantly improved in VF+RAC compared to that of the VF and control (p < 0.05). Accuracies of paretic and non-paretic leg were significantly increased in VF+RAC than that of the VF (p < 0.05).

CONCLUSIONS

According to this result, it seems that application of VF+RAC in treadmill gait significantly improved gait of these patients. Also, we can conclude that VF+RAC in treadmill gait is thought to be useful in clinical settings where there are many chronic patients who are in need of improvement in their gait ability.

PCA-based selection of distinctive stability criteria and classification of post-stroke pathological postural behaviour

In this paper, we study the postural behaviour of two categories of people: Post-CVA subjects suffering from cerebrovascular accident syndromes and healthy individuals under several levels of anterior-posterior and medial-lateral sinusoidal disturbances (0.1-0.5 Hz). These perturbations were produced from an omnidirectional platform called Isiskate. Afterwards, we have quantified seventy postural parameters, they were combined of linear stabilometric parameters and non-linear time dependent stochastic parameters using stabilogram diffusion analysis and some spectral attributes using power spectral density. The aim of our analysis is to reduce data dimensionality using principal component analysis (PCA). Furthermore, we proposed a new PCA-related criterion named: criterion of contribution in order to evaluate the contribution of every variable in the resulted system structure, and thus to eliminate the redundant postural characteristics. Afterwards, we highlighted some interesting distinctive parameters. The selected parameters were used thereafter in comparison between the studied groups. Finally, we created a classification model using support vector machines to distinguish stroke patients. Our proposed techniques help in understanding the human postural dynamics and facilitate the diagnosis of pathologies related to equilibrium which can be used to improve the rehabilitation services.

Training using a new multidirectional reach tool improves balance in individuals with stroke

BACKGROUND AND PURPOSE

Previous studies suggested that limits of stability (LOS) training with visual feedback using commercial equipment could be used to improve balance ability in individuals with stroke. However, this system is expensive. In this study, we created a new tool from inexpensive elements based on LOS training using visual feedback. The aim of this study was to investigate the effect of training using a new multidirectional reach tool on balance in individuals with stroke.

METHODS

A single-blind randomized control trial was conducted. Individuals with stroke (n = 16; age range 38-72 years) were recruited. Participants in the experimental group were trained with the multidirectional reach training for 30 min and conventional physical therapy for 30 min per day, 3 days a week for 4 weeks. Participants in the control group received conventional physical therapy for 30 min per day, 3 days a week for 4 weeks. The outcomes were LOS, weight-bearing squat, and Fullerton Advanced Balance scale. All of the outcome measures were measured at pretraining, post-training, and 1 month follow-up.

RESULTS

At post-training and 1-month follow-up, the participants in the experimental group had an improvement of dynamic balance than the control group. Furthermore, the activity assessment by Fullerton Advanced Balance scale was more improved at 1 month follow-up in the experimental group than control group.

CONCLUSION

The results of this study provide evidence that training using a new multidirectional reach tool is effective for improving balance in individuals with stroke.

Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review

Objective. To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population. Method. A systematic review of randomized controlled trials published between January 2006 and December 2015 was conducted. Databases searched were PubMed, Scopus, and Web of Science. Studies must have involved adult patients with stroke during acute, subacute, or chronic phase. All included studies must have assessed the impact of virtual reality programme on either static or dynamic balance ability and compared it with a control group. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. Results. Nine studies were included in this systematic review. The PEDro scores ranged from 4 to 9 points. All studies, except one, showed significant improvement in static or dynamic balance outcomes group. Conclusions. This review provided moderate evidence to support the fact that virtual reality training is an effective adjunct to standard rehabilitation programme to improve balance for patients with chronic stroke. The effect of VR training in balance recovery is less clear in patients with acute or subacute stroke. Further research is required to investigate the optimum training intensity and frequency to achieve the desired outcome.

Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis

BACKGROUND

Virtual reality (VR) training is considered to be a promising novel therapy for balance and gait recovery in patients with stroke.

PURPOSE

The aim of this study was to conduct a systematic literature review with meta-analysis to investigate whether balance or gait training using VR is more effective than conventional balance or gait training in patients with stroke.

DATA SOURCES

A literature search was carried out in the databases PubMed, Embase, MEDLINE, and Cochrane Library up to December 1, 2015.

STUDY SELECTION

Randomized controlled trials that compared the effect of balance or gait training with and without VR on balance and gait ability in patients with stroke were included.

DATA EXTRACTION AND SYNTHESIS

Twenty-one studies with a median PEDro score of 6.0 were included. The included studies demonstrated a significant greater effect of VR training on balance and gait recovery after stroke compared with conventional therapy as indicated with the most frequently used measures: gait speed, Berg Balance Scale, and Timed "Up & Go" Test. Virtual reality was more effective to train gait and balance than conventional training when VR interventions were added to conventional therapy and when time dose was matched.

LIMITATIONS

The presence of publication bias and diversity in included studies were limitations of the study.

CONCLUSIONS

The results suggest that VR training is more effective than balance or gait training without VR for improving balance or gait ability in patients with stroke. Future studies are recommended to investigate the effect of VR on participation level with an adequate follow-up period. Overall, a positive and promising effect of VR training on balance and gait ability is expected.