Posts Tagged balance training
[ARTICLE] The effect of virtual reality-based balance training on motor learning and postural control in healthy adults: a randomized preliminary study – Full Text
Adults with sedentary lifestyles seem to face a higher risk of falling in their later years. Several causes, such as impairment of strength, coordination, and cognitive function, influence worsening health conditions, including balancing ability. Many modalities can be applied to improve the balance function and prevent falling. Several studies have also recorded the effects of balance training in elderly adults for fall prevention. Accordingly, the aim of this study is to define the effect of virtual reality-based balance training on motor learning and postural control abilities in healthy adults.
For this study, ten subjects were randomly allocated into either the conventional exercise (CON) or the virtual reality (VR) group. The CON group underwent physical balance training, while the VR group used the virtual reality system 4 weeks. In the VR group, the scores from three game modes were utilized to describe the effect of motor learning and define the learning curves that were derived with the power law function. Wilcoxon Signed Ranks Test was performed to analyze the postural control in five standing tasks, and data were collected with the help of a force plate.
The average score was used to describe the effect of motor learning by deriving the mathematical models for determining the learning curve. Additionally, the models were classified into two exponential functions that relied on the aim and requirement skills. A negative exponential function was observed in the game mode, which requires the cognitive-motor function. In contrast, a positive exponential function was found in the game with use of only the motor skill. Moreover, this curve and its model were also used to describe the effect of learning in the long term and the ratio of difficulty in each game. In the balance performance, there was a significant decrease in the center of pressure parameters in the VR group, while in the CON group, there was a significant increase in the parameters during some foot placements, especially in the medio-lateral direction.
The proposed VR-based training relies on the effect of motor learning in long-term training though different kinds of task training. In postural analysis, both exercise programs are emphasized to improve the balance ability in healthy adults. However, the virtual reality system can promote better outcomes to improve postural control post exercising.
Trial registration Retrospectively registered on 25 April 2018. Trial number TCTR20180430005
Electronic supplementary material
The online version of this article (10.1186/s12938-018-0550-0) contains supplementary material, which is available to authorized users.
The incidence of falls can occur in people of all ages and is not exclusively restricted to the elderly population . Although the causes of falls are different for each age group, the decline in balance ability is a major factor for the high risk of falls. In older people, the decline in balance ability may occur due to physiological deterioration, pathological factors, problems of ambulation, and endurance reduction [2–7]. In addition, the physical activity level of children and middle-aged adults has decreased due to the development of technology, which has resulted in restriction of movement. This has led to the worsening of health conditions due to the deterioration of the neurotransmitter system  and muscle mass and strength [6, 9], giving rise to chronic diseases  as well as cognitive decline , which may induce a higher risk of falls in the future. People who suffer from these tend to get injured easily, which results in worsening of self-efficacy and functional dysfunction, even though they are disturbed by a small disturbance [12, 13]. Increasing physical activity, such as exercise, has a positive effect on several aspects, including postural stability and falling prevention .
Exercising is important, as it improves humans’ individual or systematic system, which is related to balance performance [2, 9, 13–17]. Exercises employ help prevent physiological deterioration by increasing strength and endurance of the body. For example, challenging the sensory system during postural tasks can enhance balance ability by reweighting the functional sensory inputs . However, significant differences have been observed among various exercise programs, and some exercises have little effect on the balance function [9, 17–19]. Balance exercise programs may be made ineffective because of several reasons. First, various physiological systems are used to achieve the postural task [20, 21]. Second, the activities, which require balancing ability, can be achieved by coordinating between motor skills and cognitive activities . Moreover, the training program with clinical guidelines is more effective than the program without any instruction . Therefore, a combination of the exercise approach and the feedback during training process is used to improve the body’s functional ability, including balance performance [18, 22].
Using the gaming with the biofeedback system, such as the virtual reality (VR) system, is widely used for rehabilitation [12, 23–25]. It is due to the fact that the VR system can make the treatment more interesting, reduce the difficulty of rehabilitation, and increase safety [25–27]. One advantage of VR-based training is that this technology allows altering the neural organization, encouraging neuroplastic changes in neurological patients , reducing the fear of falling, and transferring into the real-world task through motor learning . However, some VR-based balance training requires a specific balance platform, including Wii Fit balance board, to supply the sensory feedback information that may be restricted during the training process due to the requirement of a specific movement . For this reason, popular sensors, e.g., the Microsoft Kinect sensor, have been used to show improvement in balance ability in several studies. This is due to the fact that Kinect sensor provides three-dimensional positions without using markers. These positions are used as input for the VR-system to improve balance function and reduce the fear of falling in older adults [29, 30].
In several studies, there were significant differences in clinical balance measures among participants who had trained with the help of conventional balance exercises, including the VR system [18, 27, 31, 32]. Additionally, most studies focused on their applications in improving balance for patients with neurological disorders [33–36] or elderly people [18, 25, 28]. Therefore, the aim of this study is to investigate the effects of VR-based balance training in healthy adults through motor learning and postural control. The questions included in the proposed study are (a) how does the VR-based balance exercise rely on the effect of motor learning? (b) how do the different exercise modalities influence the impairment of balance ability through comparison of balance performance before and after exercise? We hypothesize that the VR system affects postural control through motor learning. In addition, both balance exercise programs influence the postural control, but the balance performance in the VR-based balance exercise is better than the outcome of the conventional exercise.
The experiment in this study was designed as the pilot study. Community-dwelling healthy adults around the area of Mahidol University were recruited for the study. The inclusion criteria were (a) 40–60 years of age, (b) no history of injuries or diseases that influence balance function, (c) no intake of medications that affect postural control system, at least 12 h prior to the experiment, (d) no alcohol consumption 12 h prior to the experiment. The exclusion criteria were (a) individuals with dependent ambulation, (b) individuals who cannot communicate in the Thai language, and (c) individuals who have any disease that affects balance function.
Prior to data collection, all participants signed informed consent, which was approved by the Mahidol University Central Institutional Review Board (MU-IRB: 2014/112.1508). Demographic data and health information of the participants were obtained, following which they were randomly categorized into two groups, the virtual reality exercise (VR) group and the conventional balance exercise (CON) group, by blindly drawing a sealed piece of paper. The VR group (n = 5) received the dual-task virtual-reality balance training system (DTVRBT), while the CON group (n = 5) was assigned the conventional balance exercise.
The experimental protocol comprised three steps: the pre-test of balance performance, the balance training session, and the post-test for the evaluation of the balance ability after training. In the study, five standing tasks, including standing unsupported with eyes open (EO) and close (EC) conditions, standing with both feet together, tandem, and one-leg stance were evaluated. Results of balance evaluation in each task were collected for 10 s/trial, with three trials, and the testing focused on the dominant leg in tandem and the one-leg stance. The total of time duration for data analysis was 30 s. In this study, the MatScan® model 3150 (Massachusetts, USA) was used to assess the center-of-pressure (CoP) in the anterior–posterior (AP) and medio-lateral (ML) directions with the sampling rate was 64 Hz. The data of each subject was exported with the Sway Analysis Module (SAM™). The training session started after 1 week of completion of the pre-test, and the post-test was performed within 1 week of finishing the training session. All participants received twelve 45-min sessions of training in the DTVRBT or the conventional balance exercise program. Moreover, three sessions were held per week for a period of 4 weeks. The same physical therapist conducted the training for both groups.
Dual-task virtual reality balance training system
The DTVRBT consists of a laptop and the Kinect sensor (Washington, USA) as shown in Fig. Fig.1.1. This sensor can construct 3D images from the functional integration of two components, an RGB camera and an infrared sensor [29, 32]. The 3D information from this sensor allows users to interact with the object in the virtual environment. In this study, the virtual environment was created with the Unity3D® version 5.3.2. (San Francisco, USA).
What’s in the ankle? A physically active body must achieve a stable balance around each active joint for top performance. Ligaments connect the bones to each other, and provide much of the joint’s stability. Muscles are connected to bone by tendons, allowing for movement at the joints.
Although the ligaments connecting the bones in the ankle are necessary for proper function, there are several muscles that also help support the ankle during any type of activity. Building strength and proprioception, or special awareness, in these muscles helps to prevent injury and improve performance.
Why is it important to keep the ankle strong? When an athlete performs any movement–whether running or jumping–the ankle and surrounding muscles are put under a great deal of stress. If the ankle musculature is strong, the athlete can withstand greater force before an injury is sustained. In addition to decreasing ankle injuries, strengthening lower leg muscles will help prevent chronic conditions such as shin splints and Achilles tendonitis.
Proprioception Proprioception is the body’s ability to realize its place in space. If an athlete is moving into a position that could sprain his or her ankle, increased proprioception can decrease the risk by alerting the athlete to the danger. Proprioception can also increase an athlete’s performance. An athlete with superior balance and awareness will be able to control his or her body more effectively. This is especially true in sports like basketball and soccer, but valuable in all sports or training. Proprioceptive training is done with balance exercises.
- Standing on one leg: Hold for 30 seconds, working up to one minute per leg.
- Balance and catch: Standing on one leg, catch and throw a ball with a partner. Make certain to throw the ball right, left, high, low. Perform three sets of 30.
- One leg mini squats: On one leg do a half squat with the opposite leg out front for 10 reps, out to the side for 10 reps and behind for 10 reps. Repeat three times.
The objective was to examine the effectiveness of a 3-week balance training program using the Nintendo Wii Fit gaming system (Nintendo Wii Sports, Nintendo, Redmond, WA) on lower limb corticomotor excitability and other clinical measures in chronic stroke survivors.
Ten individuals diagnosed with ischemic stroke with residual hemiparesis received balance training using the Wii Fit for 60 min/day, three times/week, for three weeks. At the end of training, an increase in interhemispheric symmetry of corticomotor excitability of the tibialis anterior muscle representations was noted (n = 9).
Participants also showed improvements in reaction time, time to perform the Dual Timed-Up-and-Go test, and balance confidence. The training-induced balance in corticomotor excitability suggests that this Wii-based balance training paradigm has the potential to influence neural plasticity and thereby functional recovery.
TYROMOTION is one of the world-wide leading providers and distributers of robotic- and computer aided rehabilitation devices. The company with the headquarters in Graz, Austria, has subsidiaries in Germany and the United States as well as two therapy institutes in Germany and Austria. The distributer-network spread across the globe. The company is focused on the research & development of innovative rehabilitation technologies for the sector of neurorehabilitation for the upper extremity.
With the products AMADEO (Finger-Rehabilitation), PABLO (Hand-Rehabilitation), TYMO (postural control as well as balance training) and DIEGO (arm-rehabilitation), a portfolio for all phases of upper extremity rehabilitation was developed. In addition to that, the therapy software provides with a pool of feedback- and measurement modules and different therapy games for the rehabilitation. The rehabilitation-solutions are for children and adults with neurological and orthopaedic injuries.