Posts Tagged Postural balance

[ARTICLE] Whole-Body Vibration in Horizontal Direction for Stroke Rehabilitation: A Randomized Controlled Trial – Full Text

Abstract

Background

As most of the existing whole-body vibration (WBV) training programs provide vertical or rotatory vibration, studies on the effects of horizontal vibration have rarely been reported. The present study was conducted to investigate the effect of WBV in the horizontal direction on balance and gait ability in chronic stroke survivors.

Material/Methods

This study was designed as a randomized controlled trial. Twenty-one stroke survivors were randomly allocated into 2 groups (whole-body vibration group [n=9] and control group [n=12]). In the WBV group, WBV training in the horizontal direction was conducted for 6 weeks, and a conventional rehabilitation for 30 min, 3 days per week for a 6-week period, was conducted in both the WBV and control groups. Outcome variables included the static balance and gait ability measured before training and after 6 weeks.

Results

On comparing the outcome variables before and after training in the WBV group, significant differences were observed in the cadence and single support time of gait ability. However, there were no significant differences in other variables, including velocity, step length, stride length, and double support time. In addition, after training, no significant differences in all variables were observed between the 2 groups.

Conclusions

The results of this study suggest that WBV training in the horizontal direction has few positive effects on balance and gait function in chronic stroke survivors. However, further investigation is needed to confirm this.

Background

Stroke survivors suffer from central nervous system damage, with sensory and motor system damage, which leads to consequences such as decreased control of muscle tone, delay in muscle contraction, and absence of selective movement [1,2]. In addition, stroke survivors have unstable balance and poor gait ability, which naturally limits their activities of daily living and participation in the community, while losing independence [2,3]. Consequently, the first priority for stroke survivors is recovery of independent activities, and for this, the recovery of balance in a standing posture and gait abilities is essential.

For functional recovery of stroke survivors, various methods have been suggested [4], and whole-body vibration (WBV) is a relatively novel form of exercise intervention that could improve functional recovery [5]. WBV involves the use of a vibrating platform in a static position or while performing dynamic movements. In previous studies, it was suggested that WBV training could improve physical functions. Castrogiovanni et al. [6] reported that a multi-component training, including aerobic activity and other types of training (resistance and/or strength exercises), is the best kind of exercise for improving bone mass and bone metabolism in elderly people and especially in osteopenic and osteoporotic women. With regard to whole-body vibration training, studies have suggested that it could be a valid method. Pichler et al. [7] reported that mechanical stimulation such as treadmill and vibration stimulation training inhibits the activity of RANKL in osteoporosis. In addition, Musumeci et al. [8] suggested that, in certain diseases such as osteoporosis, mechanical stimulation including treadmill and vibration platform training could be a possible therapeutic treatment. Based on their results, they proposed the hypothesis that physical activity could also be used as a therapeutic treatment for cartilage diseases such as osteoarthritis. Van Nes et al. [9] introduced WBV as a means of somatic sensory stimulation for functional recovery of stroke survivors. They also reported that somatosensory stimulation through WBV can significantly improve muscle performance, balance, and daily activities. Balance, defined as the ability to maintain the center of pressure (COP) on the support surface in given circumstances, can be held through adjusted harmony of visual, vestibular, and somatic sensory system [10], and vibration stimulation is reported to cause small changes in the skeletal muscle length of the human body and affect the motor neurons to facilitate activation of the spinal reflexes through short spindle-motor neuron connections [11].

Balance is a major component required for controlling or maintaining the COP in mobility and locomotion in which the support surface changes [12]. The information on changes of the support surface along with the biomechanic information needed for movement control is passed on to the central nervous system by muscle spindles, Golgi tendon organs, and joint receptors in the proprioception sense; thus, they have a very important role in controlling balance [13,14]. In addition, Muller and Redfern [15] performed a comparative analysis of the latency of beginning muscle activity by measuring electromyogram (EMG) activation degree of muscle strength of the lower extremities caused by movement of the COP while the support surface moved back and forth. Consequently, the latency of activation of the tibialis anterior muscle was rapid on the support surface moving forward and that of the soleus muscle was rapid when moving backward. Given these reports, for recovery of balance ability, the horizontal vibration in all directions might be needed more than the vertical or rotatory vibration provided by the original WBV training. Additionally, our bodies maintain standing posture using ankle strategy, hip strategy, or both [16]. The ankle strategy, which is the postural control strategy that starts first in postural sway, enables immediate recovery of standing balance through ankle joint muscle contraction [16]. Horizontal vibration, therefore, may significantly activate not only stimulation of somatosensory, but also ankle strategy or hip strategy.

However, since most of the existing WBV training programs provide only vertical or rotatory vibrations, studies on effects of horizontal vibrations have been rarely reported. Accordingly, the present study examined the effects of horizontal WBV in an antero-posterior or medio-lateral direction on balance and gait abilities of stroke survivors.[…]

Continue —> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408868/#__sec6title

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Figure 2
Whole-body vibration in horizontal direction.

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[Abstract] Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial

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BACKGROUND: When solely mirror therapy is applied for a long period of time, spatial perception and attention to the damaged side may decrease, and the effect of mirror therapy may be limited. To overcome this limitation, it has recently been suggested that the combination of mirror therapy with mirror treatment is effective.
AIM: The aim of this study was to investigate the effects of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors.
DESIGN: A randomized controlled trial.
SETTING: Rehabilitation center.
POPULATION: Thirty stroke survivors were randomly assigned to two groups: the experimental group (n = 15) and the control group (n = 15).
METHODS: Participants of the experimental group received afferent electrical stimulation with mirror therapy, and participants of the control group received sham afferent electrical stimulation with sham mirror therapy for 60 minutes per day, 5 days per week, for 4 weeks. Motor function was measured using a handheld dynamometer and the Modified Ashworth Scale, balance was measured using the Berg Balance Scale, and gait was assessed using the GAITRite at baseline and after 4 weeks.
RESULTS: The experimental group showed significant differences in muscle strength, Modified Ashworth Scale, and Berg Balance Scale results, and velocity, cadence, step length, stride length, and double support time of their gait (p <0.05) in the pre-post intervention comparison. Significant differences between the two groups in muscle strength, Berg Balance Scale, gait velocity, step length, and stride length (p <0.05) were found.
CONCLUSIONS: Mirror therapy with afferent electrical stimulation may effectively improve muscle strength and gait and balance abilities in hemiplegic stroke survivors.
CLINICAL REHABILITATION IMPACT: Afferent electrical stimulation combined with mirror therapy can be used as an effective intervention to improve lower limb motor function, balance, and gait in chronic stroke survivors in clinical settings.

via Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial – European Journal of Physical and Rehabilitation Medicine 2019 Mar 22 – Minerva Medica – Journals

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[A CLINICAL PRACTICE GUIDELINE] A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient’s status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings.

Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy’s Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions.

Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient’s balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care.

Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

TABLE OF CONTENTS

  • INTRODUCTION AND METHODS
  • Levels of Evidence and Grades of Recommendations ………………………………………………..178
  • Summary of Action Statements ………………………………………………..179
  • Introduction ………………………………………………..181
  • Methods ………………………………………………..182
  • OUTCOME MEASURE RECOMMENDATIONS
  • The Core Set of Outcome Measures for Neurologic Physical Therapy ………………………………………………..191
  • Action Statement 1: Static and Dynamic Sitting and Standing Balance Assessment ………………………………………………..191
  • Action Statement 2: Walking Balance Assessment ………………………………………………..195
  • Action Statement 3: Balance Confidence Assessment ………………………………………………..197
  • Action Statement 4: Walking Speed Assessment ………………………………………………..199
  • Action Statement 5: Walking Distance Assessment ………………………………………………..203
  • Action Statement 6: Transfer Assessment ………………………………………………..207
  • Action Statement 7: Documentation of Patient Goals ………………………………………………..208
  • Action Statement 8: Use of the Core Set of Outcome Measures ………………………………………………..209
  • Action Statement 9: Discuss Outcome Measure Results and Use
  • Collaborative/Shared Decision-Making With Patients ………………………………………………..211
  • Guideline Implementation Recommendations ………………………………………………..212
  • Summary of Research Recommendations ………………………………………………..215
  • ACKNOWLEDGMENTS AND REFERENCES
  • Acknowledgments ………………………………………………..217
  • References ………………………………………………..217
  • TABLES
  • Table 1: Levels of Evidence ………………………………………………..178
  • Table 2: Grades of Recommendations ………………………………………………..178
  • Table 3: Outline of the CPG Process ………………………………………………..183
  • Table 4: Inclusion and Exclusion Criteria for Article Review ………………………………………………..187
  • Table 5: COSMIN Ratings for Strength of Statistics ………………………………………………..189
  • Table 6: Process Used to Make Recommendations ………………………………………………..190
  • Table 7: Evidence Table, Berg Balance Scale ………………………………………………..192
  • Table 8: Evidence Table, Functional Gait Assessment ………………………………………………..196
  • Table 9: Evidence Table, Activities-specific Balance Confidence ………………………………………………..198
  • Table 10: Evidence Table, 10 meter Walk Test ………………………………………………..201
  • Table 11: Evidence Table, 6-Minute Walk Test ………………………………………………..205
  • Table 12: Evidence Table, 5 Times Sit-to-Stand ………………………………………………..208

[…]

Continue —>  A Core Set of Outcome Measures for Adults With Neurologic Co… : Journal of Neurologic Physical Therapy

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[ARTICLE] 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 – Full Text

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.

Background

The maintenance of the core or upper body control, is essential for maintaining posture and stability while changing positions, performing activities of daily living (ADL), and ambulating [1,2]. Patients who are undergoing physical rehabilitation following stroke, tend to deviate towards the affected side, as a result of postural instability, which induces both asymmetrical trunk movement and trunk muscle weakness. Upper body instability makes it difficult to maintain postural control when performing tasks and leads to functional disability [3]. The lack of postural stability also affects the balance of patients following stroke, increasing the risk of falls, and negatively impacting on patient independence and safety. For example, it has been reported that up to 73% of patients with stroke experience a fall within six months after leaving hospital [4]. Falls following a stroke can have severe consequences, including hip fractures and reduced physical activity due to fear of repeat falls [5]. Therefore, because these factors can have a negative impact on patient rehabilitation following stroke, the improvement of postural stability is an important goal of patient rehabilitation following stroke [6].

Sports that involve paddling with a single oar, such as canoeing and kayaking, are effective outdoor activities that improve postural stability and upper body stabilization [7]. Continuous body adjustment and compensation are required during the single-oar paddling motion to maintain balance during perturbations caused by the movement of the canoe or kayak and the paddle in the water [8]. Currently, canoe paddling training can be conducted using an ergometer to provide a training opportunity that is independent of outdoor conditions and to better control training progression [9]. A paddling ergometer has also been studied for rehabilitation training of patients with paraplegia and has been shown to be effective in improving postural control, balance, motor performance, and upper extremity strength [8,9].

Game-based virtual reality (VR) using gaming consoles is now used as a therapeutic approach for the rehabilitation of patients with stroke and provides an opportunity for patients to perform activities that are difficult in a clinical setting. Furthermore, VR programs are often designed to be more entertaining and enjoyable than traditional physical therapy tasks, thereby encouraging patients to participate in the rehabilitation program.

The use of VR equipment specifically designed for physical rehabilitation is not yet commonly available in clinical settings. Therefore, VR rehabilitation programs using a game-based, motion-controlled console that can be used in clinical settings and at low cost that can utilize a variety of gaming software are needed.

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.[…]

 

Continue —>  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

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Figure 2
Game-based virtual reality (VR) canoe paddling training.

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[ARTICLE] Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study – Full Text HTML

 

Abstract

Objective: To investigate the efficacy of Nintendo Wii Fit®-based balance rehabilitation as an adjunctive therapy to conventional rehabilitation in stroke patients.

Methods: During the study period, 70 stroke patients were evaluated. Of these, 23 who met the study criteria were randomly assigned to either the experimental group (n = 12) or the control group (n = 11) by block randomization. Primary outcome measures were Berg Balance Scale, Functional Reach Test, Postural Assessment Scale for Stroke Patients, Timed Up and Go Test and Static Balance Index. Secondary outcome measures were postural sway, as assessed with Emed-X, Functional Independence Measure Transfer and Ambulation Scores. An evaluator who was blinded to the groups made assessments immediately before (baseline), immediately after (post-treatment), and 4 weeks after completion of the study (follow-up).

Results: Group-time interaction was significant in the Berg Balance Scale, Functional Reach Test, anteroposterior and mediolateral centre of pressure displacement with eyes open, anteroposterior centre of pressure displacement with eyes closed, centre of pressure displacement during weight shifting to affected side, to unaffected side and total centre of pressure displacement during weight shifting. Demonstrating significant group-time interaction in those parameters suggests that, while both groups exhibited significant improvement, the experimental group showed greater improvement than the control group.

Conclusion: Virtual reality exercises with the Nintendo Wii system could represent a useful adjunctive therapy to traditional treatment to improve static and dynamic balance in stroke patients.

Introduction

Stroke is one of the leading causes of disability (1). In stroke patients, balance can be affected by various factors, such as muscular weakness, abnormal muscle tone, deficits in visual and sensory function or disturbances in vestibular mechanisms (2). Since balance dysfunction is associated with increased risk of falling, balance exercises are a critical component of the rehabilitation of stroke patients.

Recent years have seen growing interest in the use of new technologies, such as virtual reality (VR), in stroke rehabilitation. Clinical results indicate that the use of VR technologies improves motor functioning (3–5). VR can be used to improve upper limb function, gait and balance, global motor function and cognitive function in stroke patients (6). However, VR equipment is usually complex and expensive, and may be available only in specialist centres with the help of experienced therapists. As a consequence, there has been an increase in the number of studies on the efficacy of commercial gaming programs in stroke rehabilitation. PlayStation, Wii, and Xbox, along with Kinect, are the game consoles most commonly used in stroke rehabilitation. Wii (Nintendo, Kyoto, Japan) is a game console used to improve balance, strength, flexibility and fitness. It provides a relatively simple and inexpensive opportunity for VR treatment (7).

Several randomized controlled studies have evaluated the effect of Wii-based balance rehabilitation programmes in stroke patients. Cho et al. (8) investigated the effects of VR balance training using Wii in chronic stroke patients. They reported that Wii-based VR exercises resulted in a significant improvement in dynamic balance (8). In another study, chronic stroke patients were randomly assigned to 2 groups. In the first group patients played console games for 5 weeks, and in the control group patients maintained their usual daily activities. A slight improvement was measured in the first group (9).

There are conflicting results in the literature about the efficacy of Wii-based balance exercises compared with other balance rehabilitation programmes, such as progressive balance training and task-specific programmes.

A number of studies have investigated whether the addition of Wii exercises or other exercise options to balance rehabilitation programmes makes a difference in stroke patients. The results are controversial. Lee et al. (10) reported better results in the Wii group. In contrast, Yatar et al. (11) indicated that there were no differences between Wii Fit balance training and progressive balance exercises.

Adequate postural control and good balance performance are prerequisites for independence in daily activities; therefore, these should be important goals of stroke rehabilitation (8). The aim of this study was to investigate the efficacy of Wii Fit-based balance rehabilitation as an adjunctive therapy to conventional rehabilitation in stroke patients.[…]

Continue —>  Journal of Rehabilitation Medicine – Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study – HTML

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[ARTICLE] Use of visual feedback for balance training in hemiparetic Stroke patients – Full Text PDF

Abstract

Introduction: Hemiparetic Stroke patients have their daily activities affected by the balance impairment. Techniques that used visual information for training this impairment it seems to be effective.

Objective: To analyze the effects of the unstable balance board training and compare two ways of visual feedback: the biomechanical instrumentation and the mirror.

Materials and methods: Eight chronic hemiparetic Stroke patients participated in the research, randomized in two groups. The first group (G1) accomplished the training with biomechanical instrumentation, and the second group (G2) trained in front of the mirror. Sixteen training sessions were done with feet together, and feet apart. The evaluation instruments that were used before and after the period of training were the Time Up and Go Test (TUGT), Berg Balance Scale (BBS) and the Instrumented Balance Board (IBB), that quantified the functional mobility, the balance and the posture control respectively.

Results: The TUGT showed significant results (p < 0.05) favorable to G1. Despite the results of BBS were significant for G2, the intergroup comparison did not reveal statistical significance. Both groups obtained decrease in levels of IBB oscillation, what can indicate a higher stability, however the results did not indicate statistical significance (p > 0.05). A strong correlation between all the applied tests was observed in this research.

Conclusion: Although the advantages found were different between the groups, in both it could be observed that the training brought benefits, with the transference to the functional mobility.

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[ARTICLE] Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review – Full Text PDF

Abstract

Question: In people after stroke, does virtual reality based rehabilitation (VRBR) improve walking speed, balance and mobility more than the same duration of standard rehabilitation? In people after stroke, does adding extra VRBR to standard rehabilitation improve the effects on gait, balance and mobility?

Design: Systematic review with meta-analysis of randomised trials.

Participants: Adults with a clinical diagnosis of stroke.

Intervention: Eligible trials had to include one these comparisons: VRBR replacing some or all of standard rehabilitation or VRBR used as extra rehabilitation time added to a standard rehabilitation regimen. Outcome measures: Walking speed, balance, mobility and adverse events.

Results: In total, 15 trials involving 341 participants were included. When VRBR replaced some or all of the standard rehabilitation, there were statistically significant benefits in walking speed (MD 0.15 m/s, 95% CI 0.10 to 0.19), balance (MD 2.1 points on the Berg Balance Scale, 95% CI 1.8 to 2.5) and mobility (MD 2.3 seconds on the Timed Up and Go test, 95% CI 1.2 to 3.4). When VRBR was added to standard rehabilitation, mobility showed a significant benefit (0.7 seconds on the Timed Up and Go test, 95% CI 0.4 to 1.1), but insufficient evidence was found to comment about walking speed (one trial) and balance (high heterogeneity).

Conclusion: Substituting some or all of a standard rehabilitation regimen with VRBR elicits greater benefits in walking speed, balance and mobility in people with stroke. Although the benefits are small, the extra cost of applying virtual reality to standard rehabilitation is also small, especially when spread over many patients in a clinic. Adding extra VRBR time to standard rehabilitation also has some benefits; further research is needed to determine if these benefits are clinically worthwhile. [Corbetta D, Imeri F, Gatti R (2015) Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. Journal of Physiotherapy XX: XX-XX]

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via Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review – Journal of Physiotherapy.

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