The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients

The effect of exercise on balance function in stroke patients: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

A growing body of studies has examined the effect of exercise on balance function in stroke patients, with conflicting findings. This study aimed to investigate the effect of exercise on balance function in stroke patients and to determine the optimal exercise prescription for stroke patients.

METHODS

We conducted an extensive search across various databases, including PubMed, Web of Science, EBSCO, Cochrane, and Scopus. The search was conducted until March 11th, 2024. Data were pooled using the weighted mean difference (WMD) and 95% confidence interval.

RESULTS

Twenty-nine studies fulfilled the inclusion criteria. Exercise significantly improved Berg balance scale (BBS, WMD, 5.24, P < 0.00001) and timed up and go test (TUG, WMD, - 2.91, P < 0.00001) in stroke patients. Subgroup analyses showed that aerobic exercise (WMD, 6.71, P = 0.003), exercise conducted ≥ 8 weeks (WMD, 6.43, P < 0.00001), > 3 times per week (WMD, 6.18, P < 0.00001), ≥ 60 min per session (WMD, 6.40, P < 0.0001), and ≥ 180 min per week (WMD, 7.49, P < 0.00001) were more effective in improving BBS.

CONCLUSIONS

Exercise improved balance function in stroke patients, and aerobic exercise might be the most effective intervention. To improve balance function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in a minimum of 8 weeks of exercise at least 3 times per week for more than 60 min per session, with a goal of 180 min per week being achieved by increasing the frequency of exercise.

Effects of rebound exercises on balance and mobility of people with neurological disorders: A systematic review

BACKGROUND

Therapeutic rebound exercise is gaining popularity among the general population, but its effectiveness in individuals with neurological impairments remains uncertain. To shed light on this, a systematic review was conducted between November 2021 and March 2023 to study the impact of rebound exercise on balance and mobility in this group.

METHODS

Six databases were searched. Studies were included if written in English, peer-reviewed, had original research data and assessed the effect of rebound exercise in adults with neurological disorders. The outcomes measured were balance and mobility. Two reviewers independently appraised study quality using the Critical Appraisal Skills Program for Randomized Controlled Trials. Finally, a meta-summary of the included studies was completed, and a meta-analysis was performed using RevMan software version 5.3 to determine the effectiveness of the intervention.

RESULTS

Five studies were included comprising 130 participants aged 31.32±7.67 to 58±12 years, 72% male and 28% female. Participants were in-patients with stroke (49%), multiple sclerosis (24%), Parkinson's disease (15%) and spinal cord injury (12%). The included papers had moderate to high methodological quality. The timed up-and-go test revealed that the rebound group participants could walk 6.08 seconds quicker over three to eight weeks. Pooled results show that rebound exercise significantly improves mobility (-0.53[-0.94, -0.11], p = 0.01), but no significant improvement was observed in balance.

CONCLUSION

Rebound exercise has shown the potential to improve mobility in people with neurological disorders. However, the findings should be in the context that the included studies are few and participants were in in-patient settings. PROSPERO registration: CRD42021298030.

Lisbon Intensive Falls Trampoline Training (LIFTT) Program for people with Parkinson's for balance, gait, and falls: study protocol for a randomized controlled trial

BACKGROUND

Falling and gait difficulties in people with Parkinson's disease (PD) are associated with impaired reactive postural adjustments and impairments in attentional resources. Combined intensive balance motor and cognitive exercise can be beneficial. However, uncertainties persist regarding the true effects and safety when applying such training. Using trampoline beds may be a favorable safe environment for a highly intensive, cognitive, and balancing training approach. The primary goal of this randomized controlled trial is to assess the effects of an intensive cognitive-motor training program in a safe trampoline environment in addition to usual care on balance impairment, gait, physical capacity, fear of falling, falls frequency and severity, cognition, and clinical impairments in people with mild or moderate PD.

METHODS

Sixty participants diagnosed with idiopathic PD, in stage 2-4 Hoehn and Yahr, with a clinical history of gait deficits and a fall history (at least one fall in the last 6 months) will be recruited and randomly allocated to an intervention group receiving cognitive-motor trampoline training or a control group undergoing their usual care. The intervention will consist of 8-week individual training sessions (1-h training, 3 days per week) led by specialized physiotherapists that will provide progressive, challenging training, and guarantee safety. Assessment will be conducted prior to and immediately after the 8-week intervention and at 3 months follow-up after participating in the study. Primary outcome measures will be balance performance (assessed using the Mini-BEST Test and nonlinear analysis) and change in gait parameters (Motor and Cognitive Timed-Up-Go and nonlinear analysis). Secondary outcomes will be change in clinical improvement (Movement Disorder Society Unified Parkinson's Disease Rating Scale), falls (falls weekly registry), fear of falling (assessed using the Falls Efficacy Scale), physical capacity (6-min walk test), and cognition (Montreal Cognitive Assessment).

DISCUSSION

This study will provide new evidence on the benefits of intensive cognitive-motor balance training on a trampoline for people living with PD. Better guidance on how professionals can apply safer dual-task balance and gait training in rehabilitation is needed.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN13160409 . Retrospectively registered on February 23, 2022.

A Public Health Review into Two Decades of Domestic Trampoline Injuries in Children within Queensland, Australia

Trampolining as an activity brings enjoyment and many health benefits, but at the same time it carries an injury risk. Most domestic trampoline users are children who are developing in skill, cognition, risk perception, physical strength and resilience to injury. Several common patterns of child trampoline injuries have been identified and countermeasures outlined in standards have been taken to reduce higher risk injury mechanisms, such as entrapment and falls from the trampoline through design, product and point of sale labelling. In Australia, the first national trampoline standard was published in 2003 which introduced improvements in trampoline design and requirements for labelling and padding. This work investigated the potential impact of these and subsequent changes based on almost two decades of emergency department trampoline injury data collected in Queensland, Australia. These data describe the changing representative proportion and pattern of trampoline injuries in Queensland over time by age, mechanism, gender, severity and nature of injury of injured persons up to the age of 14 years. The interrelationships between different injury characteristics were also analysed to propose the main factors influencing injury occurrence and severity. These findings seem to indicate that safety evolution in the form of enclosure nets, frame impact attenuation and entrapment protection have likely improved domestic trampoline safety. Other factors, such as adult supervision, minimum age and avoidance of multiple users, could further reduce injury but are harder to influence in the domestic setting.

Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction

OBJECTIVE

To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction.

METHODS

Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience.

RESULTS

There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups.

CONCLUSION

Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Investigation into the Trampoline Dynamic Characteristics and Analysis of Double Bounce Vibrations

Double bounce is an unusual and potentially very hazardous phenomenon that most trampoline users may have experienced, yet few would have really understood how and why it occurs. This paper provides an in-depth investigation into the double bounce. Firstly, the static and dynamic characteristics of a recreational trampoline are analysed theoretically and verified through experiments. Then, based on the developed trampoline dynamic model, double bounce simulation is conducted with two medicine balls released with different time delays. Through simulation, the process of double bounce is presented in detail, which comprehensively reveals how energy is transferred between users during double bounce. Furthermore, the effect of release time delay on double bounce is also presented. Finally, we conducted an experiment which produced similar results to the simulation and validated the reliability of the trampoline dynamic model and double bounce theoretical analysis.

A Measurement of 'Walking-the-Wall' Dynamics: An Observational Study Using Accelerometry and Sensors to Quantify Risk Associated with Vertical Wall Impact Attenuation in Trampoline Parks

This study illustrates the application of a tri-axial accelerometer and gyroscope sensor device on a trampolinist performing the walking-the-wall manoeuvre on a high-performance trampoline to determine the performer dynamic conditions. This research found that rigid vertical walls would allow the trampolinist to obtain greater control and retain spatial awareness at greater levels than what is achievable on non-rigid vertical walls. With a non-rigid padded wall, the reaction force from the wall can be considered a variable force that is not constrained, and would not always provide the feedback that the trampolinist needs to maintain the balance with each climb up the wall and fall from height. This research postulates that unattenuated vertical walls are safer than attenuated vertical walls for walking-the-wall manoeuvres within trampoline park facilities. This is because non-rigid walls would provide higher g-force reaction feedback from the wall, which would reduce the trampolinist's control and stability. This was verified by measuring g-force on a horizontal rigid surface versus a non-rigid surface, where the g-force feedback was 27% higher for the non-rigid surface. Control and stability are both critical while performing the complex walking-the-wall manoeuvre. The trampolinist experienced a very high peak g-force, with a maximum g-force of approximately 11.5 g at the bottom of the jump cycle. It was concluded that applying impact attenuation padding to vertical walls used for walking-the-wall and similar activities would increase the likelihood of injury; therefore, padding of these vertical surfaces is not recommended.

Physical fitness training for stroke patients

BACKGROUND

Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function.

OBJECTIVES

The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function.

SEARCH METHODS

In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field.

SELECTION CRITERIA

Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses.

MAIN RESULTS

We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons.

AUTHORS' CONCLUSIONS

Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.

Trampoline Versus Resistance Training in Young Adults: Effects on Knee Muscles Strength and Balance

Purpose: Trampoline parks are becoming popular in many countries, providing recreational facilities for children and adults. This study investigated the effects of trampoline training on knee muscles strength and balance in young adults. Methods: Twenty-six participants (14 males, 12 females) were randomized into trampoline training (TT) and resistance training (RT) groups to undergo a 6-week supervised intervention program (2 × 30 min per week). TT group performed basic trampoline exercises while the RT group performed resistance training targeting lower extremities muscles. Peak knee extension and flexion torque, postural sway characteristics, and Y balance test (YBT) performance were evaluated before and after the intervention. A mixed model analysis of variance (group × time) was applied. Results: After training there were significant improvements in knee extension torque (mean difference_post-pre [95% CI], TT: 0.27 [0.00, 0.54] N∙m/kg, RT: 0.31 [0.09,0.54] N∙m/kg, p = .001), knee flexion torque (TT: 0.25 [0.17,0.33] N∙m/kg, RT: 0.21 [0.08,0.34] N∙m/kg, p < .001), and dynamic balance (YBT composite scores, mean difference_post-pre [95% CI], TT: 4.9 [-0.3, 10.2]%, RT: 5.2 [2.4,8.0]%, p = .001). No difference between groups was found. Conclusion: Trampoline training can be as effective as resistance training for improving knee muscles strength and dynamic balance in young men and women.

Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis

INTRODUCTION

Multiple rehabilitation therapies have been reported to be effective for poststroke balance impairment. However, the comparative effectiveness of these rehabilitation therapies is still unclear. Therefore, the aim of this study is to summarise evidence and identify the most effective rehabilitation therapy for poststroke balance impairment.

METHODS AND ANALYSIS

The following databases will be searched: China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Data, the Chinese Science and Technology Periodical Database, Medline, Excerpt Medical Database (EMBASE), Web of Science, the Cochrane Library, from inception to June 2019. All randomised controlled trials that have used rehabilitation interventions to treat poststroke balance impairment will be included. The primary outcomes are the Berg Balance Scale, the Fugl-Meyer Assessment (balance), the Postural Assessment Scale for Stroke, as well as the function in sitting test, the Sitting Balance Scale, the Ottawa Sitting Scale, the Activities-specific Balance Confidence Scale, the Overall Balance Index and the Brunel Balance Assessment. The secondary outcomes include the Barthel Index, the Functional Ambulation Category Scale, fall rates, the Timed Up and Go test, the MOS 36-Item Short-Form Health Survey, and adverse events. To ensure that all relevant studies are included without personal bias, study selection, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. Review Manager V.5.3 software will be used to make bias risk diagram and pairwise meta-analysis, while network data synthesis will be performed using WinBUGS V.1.4.3 and R software.

ETHICS AND DISSEMINATION

Ethics approval is not required for systematic review and network meta-analysis. The results will be submitted to a peer review journal or at a conference.

TRIAL REGISTRATION NUMBER

PROSPERO (CRD 42018107441).

Effects of Adaptive Bungee Trampolining for Children With Cerebral Palsy: A Single-Subject Study

PURPOSE

To assess effects of adaptive bungee trampoline training for children with cerebral palsy.

METHODS

This was a single-subject intervention study, A-B-A, with 4 children aged 6 to 11 years. Measurements included muscle strength, balance, functional muscle strength, functional mobility, selected Gross Motor Function Measure items, heart rate, enjoyment, and for adverse effects-range of motion and spasticity. Goals were measured using the Canadian Occupational Performance Measure.

RESULTS

Lower limb muscle strength improved in 3 children, and balance and functional strength in 2 children. The child who was not walking increased sitting and supported standing times. All participants had clinically significant increases on the Canadian Occupational Performance Measure. Adherence and enjoyment were high, with no adverse effects.

CONCLUSION

Adaptive bungee trampoline training can improve strength, balance, and functional mobility in children with cerebral palsy.

Effects of 3-Dimensional Lumbar Stabilization Training for Balance in Chronic Hemiplegic Stroke Patients: A Randomized Controlled Trial

Objective

To investigate the effects of the newly developed Spine Balance 3D system on the balance and gait abilities of hemiplegic stroke patients.

Methods

Twenty-eight hemiplegic patients with chronic stroke were randomly assigned to an experimental (n=14) or control group (n=14). The experimental and control groups performed balance training by using the newly developed Spine Balance 3D system and the well-known Biodex Balance System 30 minutes per day, three times a week for 7 weeks. The Berg Balance Scale (BBS), 10-m walking test (10mWT), Timed Up and Go Test (TUG), Functional Reach Test (FRT), the Korean version of the Fall Efficacy Scale-International (KFES-I), trunk muscle strength and stability were evaluated before and after 7 weeks of intervention.

Results

The 10mWT improved significantly (p=0.001) in the experimental group (using the Spine Balance 3D system) but not in the control group, and core muscle strength, which we checked using Spine Balance 3D system evaluation program, improved more in the experimental group as well. The results of the BBS, FRT, TUG, KFES-I, and Biodex Balance System evaluation program improved in both groups after 7 weeks of balance training.

Conclusion

We suggest that the newly-developed Spine Balance 3D system can be a more useful therapeutic tool for gait and dynamic balance rehabilitation in hemiplegic patients than a conventional 2D-based balance training system. A large-scale randomized controlled study is needed to prove the effect of this system.

Post-stroke depression inhibits improvement in activities of daily living in patients in a convalescent rehabilitation ward

[Purpose] There have been no investigations into the improvement of activities of daily living among patients suffering from post-stroke depression on admission to convalescent rehabilitation wards in Japan. This study aimed to assess the improvement of activities in daily living in patients with or without post-stroke depression at the time of admission to a convalescent rehabilitation ward. [Subjects and Methods] This retrospective study included 108 stroke patients divided into two groups according to their Geriatric Depression Scale 15-item short form scores. Activities of daily living were assessed using the Functional Independence Measure. The degree of improvement on the Functional Independence Measure was defined as the difference between scores on admission and at discharge. [Results] The Functional Independence Measure gain score was significantly different from the Functional Independence Measure total score. There was a significant interaction between time period and post-stroke depression factors for the Functional Independence Measure total score. A multiple regression analysis revealed a significant association between Geriatric Depression Scale score and Functional Independence Measure total score. [Conclusion] The present study suggests that post-stroke depression has a negative impact on recovery of activities of daily living and on rehabilitation outcomes in a convalescent rehabilitation ward setting.