Effect of active over-ground body weight-support walking system on balance and gait ability in stroke: A randomized controlled trial

The effect of robot-assisted gait training has been demonstrated to improve gait recovery in patients with stroke. The aim of this study was to determine effects of robot-assisted gait training with various training modes in patients post stroke. Forty-seven patients post stroke were randomly assigned to one of 4 groups: Healbot T with pelvic off mode (pelvic off group; n = 11); Healbot T with pelvic control mode (pelvic on group; n = 12); Healbot T with constraint-induced movement therapy (CIMT) mode (CIMT group; n = 10); and conventional physiotherapy (control group; n = 10). All patients received a 30-minute session 10 times for 4 weeks. The primary outcomes were the 10-meter walk test (10MWT) and Berg Balance Scale (BBS). The secondary outcomes were functional ambulation category, timed up and go (TUG), and motricity index of the lower extremities (MI-Lower). The pelvic off group showed significant improvements in BBS, TUG, and MI-Lower (P < .05). The pelvic on and CIMT groups showed significant improvement in 10MWT, BBS, TUG, and MI-Lower (P < .05). Compared with control group, the pelvic on group showed greater improvement in the TUG and BBS scores; the CIMT group showed greater improvement in 10MWT and MI-Lower (P < .05). This study suggested that Healbot T-assisted gait training benefited patients with stroke. The Healbot T with pelvic motion and CIMT modes were more helpful in improving balance and walking ability and lower limb strength, respectively, compared with conventional physiotherapy.

The current study aimed to evaluate the effects of whole-body vibration combined with task-oriented training on muscle strength, balance, and gait in stroke patients with hemiplegia. In total, 24 stroke patients were included in this study. All participants were randomly assigned to either the whole-body vibration combined with task-oriented training group (n=12) or the whole-body vibration group (n=12). The WBVMT group underwent training (8 sets) for 30 min a day, 5 times per week for 4 weeks. Meanwhile, the WBV group underwent training (8 sets) for 30 min a day, 5 times per week for 4 weeks. Both groups received standard rehabilitation physical therapy for 60 min a day, 5 times a week for 4 weeks. In all participants, the scores for the hip extensor (HE) and knee extensor (KE) muscle strength, Five Times Sit-to-Stand (FTSTS) Test, limit of stability (LOS), Timed Up and Go (TUG) Test, Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), and 6-Min Walk Test (6MWT) were evaluated before and after the intervention. The WBVMT and WBV groups had a significant increase in the scores for HE and KE strength, FTSTS test, LOS, TUG test, BBS, 10MWT, and 6MWT (p&lt;0.05). In particular, the WBVMT group had a significantly greater improvement than the WBV group in terms of KE muscle strength and TUG test, BBS, 10MWT, and 6MWT scores (p&lt;0.05). WBVMT improved muscle strength, balance, and gait in stroke patients with hemiplegia.

Background: Recent clinical guidelines for adults with neurological disabilities suggest the need to assess measures of static and dynamic balance using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) as core outcome measures. Given that the BBS measures both static and dynamic balance, it was unclear as to whether either of these instruments was superior in terms of its convergent and concurrent validity, and whether there was value in complementing the BBS with the DGI. Objective: The objective was to evaluate the concurrent and convergent validity of the BBS and DGI by comparing the performance of these two functional balance tests in people with multiple sclerosis (MS). Methods: Baseline cross-sectional data on 75 people with MS were collected for use in this study from 14 physical therapy clinics participating in a large pragmatic cluster-randomized trial. Convergent validity estimates between the DGI and BBS were examined by comparing the partial Spearman correlations of each test to objective lower extremity functional measures (Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Timed 25-Foot Walk (T25FW) test) and the self-reported outcomes of physical functioning and general health using the 36-Item Short Form Health Survey (SF-36). Concurrent validity was assessed by applying logistic regression with gait disability as the binary outcome (Patient Determined Disease Steps (PDDS) as the criterion measure). The predictive ability of two models, a reduced/parsimonious model including the BBS only and a second model including both the BBS and DGI, were compared using the adjusted coefficient of determinations. Results: Both the DGI and BBS were strongly correlated with lower extremity measures overall as well as across the two PDSS strata with correlations. In PDDS ≤ 2, the difference in the convergence of BBS with TUG and DGI with TUG was −0.123 (95% CI: −0.280, −0.012). While this finding was statistically significant at a type 1 error rate of 0.05, it was not significant (Hommel’s adjusted p-value = 0.465) after accounting for multiple testing corrections to control for the family-wise error rate. The BBS–SF-36 physical functioning correlation was at least moderate and significant overall and across both PDDS strata. However, the DGI–physical functioning score did not have a statistically significant correlation within PDDS ≤ 2. None of the differences in convergent and concurrent validity between the BBS and DGI were significant. The additional variation in 6MWT explained by the DGI when added to a model with the BBS was 7.78% (95% CI: 0.6%, 15%). Conclusions: These exploratory analyses on data collected in pragmatic real-world settings suggest that neither of these measures of balance is profoundly superior to the other in terms of its concurrent and convergent validity. The DGI may not have any utility for people with PDDS ≤ 2, especially if the focus is on mobility, but may be useful if the goal is to provide insight on lower extremity endurance. Further research leveraging longitudinal data from pragmatic trials and quasi-experimental designs may provide more information about the clinical usefulness of the DGI in terms of its predictive validity when compared to the BBS.

Introduction: Balance and gait issues significantly contribute to fall-related injuries in older adults. Aquatic therapy interventions, such as Clinical Ai Chi (CAC), Water-Specific Therapy (WST) and the Bad Ragaz Ring Method (BRRM), have shown shortterm benefits in enhancing balance and gait. Nevertheless, it is uncertain whether these improvements can be maintained over a longer duration. Aim: To assess the long-term effectiveness of CAC, WST and BRRM in preserving balance and gait improvements 12 months after the intervention, with an emphasis on functional outcomes and the reduction of falls. Materials and Methods: This randomised clinical study was conducted at Bangalore, Karnataka, India which involved 69 participants who completed an initial eight weeks of intervention. The sustainability of the eight-week intervention’s impact on balance and gait was evaluated over 12 months, with periodic assessments using the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), Timed Up and Go (TUG) test and Balance Confidence Scale (BCS). Data were gathered through clinical assessments, self-reported fall records and mobility diaries. Statistical analysis involved repeated measures Analysis of Variance (ANOVA) and post-hoc comparisons to investigate temporal trends and differences between groups. Results: A 12-month follow-up revealed that the CAC group maintained clinically significant improvements in BBS (p-value &lt;0.01) and DGI (p-value &lt;0.012) scores. The WST group exhibited a delayed but progressive improvement in FRT and TUG scores, indicating sustained long-term benefits. However, the BRRM group showed only marginal improvements, which diminished over time. Furthermore, the CAC group reported significantly fewer self-reported falls compared to both the WST and BRRM groups (p-value &lt;0.05), and participants in the CAC group also expressed increased confidence and improved mobility in their daily activities. Conclusion: The study confirms the long-term efficacy of CAC in sustaining balance and gait improvements, reducing fall risk and enhancing confidence among older adults. WST showed delayed but beneficial effects, while BRRM exhibited limited long-term impact. Future research should explore tailored aquatic therapy protocols to maximise long-term benefits for diverse populations.

The cerebellum is a key structure involved in balance and motor control, and has become a new stimulation target in brain regulation technology. Interference theta-burst simulation (iTBS) is a novel simulation mode of repetitive transcranial magnetic simulation. However, the impact of cerebellar iTBS on balance function and gait in stroke patients is still unknown. The aim of this study was to determine whether cerebellar iTBS can improve function, particularly balance and gait, in patients with post-stroke hemiplegia. This study is a randomized, double-blind, sham controlled clinical trial. The study was carried out at the Department of Rehabilitation Medicine in a general hospital. Patients with stroke with first unilateral lesions were enrolled in the study. Thirty-six patients were randomly assigned to the cerebellar iTBS group or sham stimulation group. The cerebellar iTBS or pseudo stimulation site is the ipsilateral cerebellum on the paralyzed side, which is completed just before daily physical therapy. The study was conducted five times a week for two consecutive weeks. All patients were assessed before the intervention (T0) and at the end of 2 weeks of treatment (T1), respectively. The primary outcome was the Berg Balance Scale (BBS), while secondary outcome measures included the Fugl Meyer Lower Limb Assessment Scale (FMA-LE), timed up and go (TUG), Barthel Index (BI), and gait analysis. After 2 weeks of intervention, the BBS, FMA-LE, TUG, and BI score in both the iTBS group and the sham group were significantly improved compared to the baseline (all P<0.05). Also, there was a significant gait parameter improvement including the cadence, stride length, velocity, step length compared to the baseline (P<0.05) in the iTBS group, but only significant improvement in cadence was identified in the sham group (P<0.05). Intergroup comparison showed that the BBS (P<0.001), FMA-LE (P<0.001), and BI (P=0.002) in the iTBS group were significantly higher than those in the sham group, and the TUG in the iTBS was significantly lower than that in the sham group (P=0.002). In addition, there were significant differences in cadence (P=0.029), strip length (P=0.046), gain velocity (P=0.002), and step length of affected lower limb (P=0.024) between the iTBS group and the sham iTBS group. Physical therapy is able to improve the functional recovery in hemiplegic patients after stroke, but the cerebellar iTBS can facilitate and accelerate the recovery, particularly the balance function and gait. Cerebellar iTBS could be an efficient and facilitative treatment for patients with stroke. Cerebellar iTBS provides a convenient and efficient treatment modality for functional recovery of patients with stroke, especially balance function and gait.

The Potential Of Accelerometry-Derived Gait Features For Assessing The Risk Of Falls In Older Adults

A stroke patient with hemiplegic gait is generally described as being slow and asymmetric. Body weight-supported treadmill training and backward gait training are recent additions to therapeutic gait trainings that may help improve gait in stroke patient with hemiplegic gait. Therefore, we examined the effect of progressive backward body weight-supported treadmill training on gait in chronic stroke patients with hemiplegic gait. Thirty subjects were divided to the experimental and control groups. The experimental group consisted of 15 patients and underwent progressive backward body weight-supported treadmill training. The control group consisted of 15 patients and underwent general treadmill gait training five times per week, for a total of four weeks. The OptoGait was used to analyze gait kinematics, and the dynamic gait index (DGI) and results of the 6-minute walk test were used as the clinical evaluation indicators. A follow-up test was carried out four weeks later to examine persistence of exercise effects. The experimental group showed statistically significant results in all dependent variables week four compared to the control group. However, until the eighth week, only the dependent variables, of affected step length (ASL), stride length (SL), and DGI differed significantly between the two groups. This study verified that progressive bodyweight-supported treadmill training had a positive influence on the temporospatial characteristics of gait and clinical gait evaluation index in chronic stroke patients.

Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study

Introduction: Knee Osteoarthritis (OA) affects 30-40% of the population worldwide by the age of 65 years and is associated with proprioception loss, postural instability, and fall risk. Strengthening and balance exercises at home can prevent these issues. The Otago home exercise program is commonly used for fall prevention in the elderly. Aim: To compare the effects of home-based and clinic-based exercise training on balance and function in geriatric individuals with knee OA. Materials and Methods: A non randomised controlled trial (NRCT) was conducted from October 2017 to December 2017 at an old age home and residential zone of Ahmedabad city. Nineteen participants were divided into two groups: group A (home-based exercise) with nine participants, and group B (clinicbased exercise) with ten participants. The exercises were based on the Otago program. The study duration was eight weeks, and outcome measures included the Berg Balance Scale (BBS) for static and dynamic balance, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for physical function, the Timed Up and Go (TUG) test for dynamic balance, and the Visual Analog Scale (VAS) for knee pain. Data analysis was performed using Statistical Package for the Social Science (SPSS) version 22.0, employing the Wilcoxon and Mann-Whitney tests for within group and between group comparisons, respectively. Results: Group A (home-based exercise) showed significant improvements in BBS (p-value=0.007), WOMAC (p-value=0.007), and TUG (p-value=0.027). Group B (clinic-based exercise) also showed significant improvements in BBS (p=0.005), WOMAC (p=0.005), and TUG (p=0.041). When comparing the two groups, significant differences were found in BBS (p=0.013) and WOMAC (p=0.039), but not in TUG (p=0.864) and VAS (p=0.908). The clinic-based exercise group demonstrated greater improvement, as indicated by higher pre and postintervention readings. Conclusion: This study concludes that both home-based and clinic-based exercises are effective in improving balance and physical function in geriatric individuals with knee OA. However, clinic-based exercise interventions showed greater improvement, as evidenced by higher pre and postintervention readings in the clinic-based exercise group.

(1) Introduction: This study aimed to investigate the effects of curved-path stride gait training on the gait ability of patients with stroke. (2) Materials and Methods: Thirty patients with stroke were randomly assigned to curved-path stride gait training (n = 15) and general gait training groups (n = 15). Both groups underwent training for 30 min five times a week for 8 weeks. The gait ability of each was assessed using the Dynamic Gait Index (DGI), Timed-Up-and-Go (TUG) test, 10-meter walk test, and Figure-of-8 walk test (F8WT). (3) Results: The curved-path gait training group showed significant differences in the DGI, TUG test, 10-m walk test, and F8WT pre- versus post- intervention (p < 0.05). The general gait training group showed no significant difference in F8WT pre- versus post-intervention (p > 0.05). Additionally, there was a statistically significant intergroup difference in gait ability (p < 0.05). (4) Conclusions: Curved-path gait training resulted in greater improvement in gait ability than general gait training. Therefore, curved-path gait training can be a meaningful intervention for improving the gait ability of patients with stroke.

Objective: Stroke is a predominant cause of adult disability and ranks as the third leading cause of mortality in the Western Hemisphere. Approximately half of stroke survivors endure severe long-term disabilities, often characterized by balance impairments that hinder mobility, daily activities, and increase fall risk. Consequently, restoring mobility through effective gait training is a crucial rehabilitation goal. Recent studies have investigated the utility of auditory cues, such as metronome timing, to enhance hemiparetic gait, while core strengthening has gained recognition for its role in stabilizing the spine and body during movement. Methods: This study involved 40 participants divided into two groups. Group a, comprising 20 subjects, participated in a regimen of core strengthening exercises designed to enhance dynamic balance and gait, supplemented by general dynamic balance and gait training, and metronome-based balance and gait training. Group B, also consisting of 20 subjects, engaged solely in core strengthening exercises. The study was conducted over an eight-week period with assessments on days 1, 15, 40, and 60. Outcome measures included the tinetti gait and balance score and the Timed Up and Go (TUG) test. Results: The analysis demonstrated significant improvements in both balance and gait among stroke patients in Group A, as evidenced by higher Tinetti scores and lower TUG times (p = 0.00). These results indicate that the integration of metronome training with core strengthening exercises yields superior outcomes compared to core strengthening exercises alone. Conclusion: The study concludes that combining metronome training with core strengthening exercises significantly enhances balance and gait in stroke patients. This combined approach proves to be more effective than core strengthening alone, offering a robust strategy for improving gait and balance in stroke rehabilitation.

Electrical stimulation (ES) is commonly used in stroke rehabilitation to enhance balance and walking, but its effectiveness remains unclear. This systematic review evaluated randomized controlled trials (RCTs) on the effects of various ES types including transcranial direct current stimulation (tDCS), functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS), and neuromuscular electrical stimulation (NMES) on balance and gait in stroke patients. A literature search was conducted in PubMed, Web of Science, and Scopus. RCTs comparing ES with sham or conventional therapies were included. Methodological quality was assessed Via the PEDro scale. Meta analyses were performed for the Berg Balance Scale (BBS), Timed Up and Go (TUG) test and Trunk Impairment Scale (TIS), with qualitative analysis for other outcomes. A meta-analysis of 20 randomized controlled trials (1,366 participants) examined tDCS, FES, TENS, and NMES effects on balance using BBS, TUG, and TIS. Meta-regression analyses within the FES subgroup revealed that stimulation intensity, frequency, and electrode location did not significantly influence treatment outcomes (all P > 0.05). However, outcome type was a significant moderator (QM = 13.59, P = 0.0011), accounting for approximately 56% of between-study heterogeneity. FES showed larger effect sizes for balance outcomes (BBS) compared to mobility (TUG) or trunk control (TIS) measures. Balance improvements were greatest in the acute stroke phase, suggesting that timing may influence ES effectiveness. Electrical stimulation significantly improves balance and trunk control in stroke survivors with consistent effects across studies, however functional mobility benefits remain unclear due to high degree of study variability. Early intervention during acute stroke phases appears most effective, supporting the integration of electrical stimulation into post stroke rehabilitation protocols.

Tongue-Based Biofeedback for Balance in Stroke: Results of an 8-Week Pilot Study

Virtual reality (VR) therapy has gained attention as a promising intervention in stroke rehabilitation, particularly for its potential to enhance motor function and promote neuroplasticity. However, its specific effects on balance, mobility, and gait remain underexplored. This review aims to provide a comprehensive evaluation of the effectiveness of VR therapy on the recovery of lower limb function in stroke survivors. Randomized controlled trials comparing VR therapy with conventional therapy were eligible for inclusion. All studies were identified through databases, such as MEDLINE, Embase, PubMed, Cochrane Library, Web of Science, and PsycINFO (up to July 2024). The primary outcomes included balance, assessed using the Berg Balance Scale (BBS), and mobility, measured with the Timed Up and Go Test (TUG) and 10-Meter Walk Test (10-MWT). Secondary outcomes included gait parameters (stride length and step length), the Functional Reach Test (FRT), the Dynamic Gait Index (DGI), and the Falls Efficacy Scale-International (FES-I). RevMan version 5.4 (The Cochrane Collaboration) software was used for the meta-analysis. A total of 2145 studies were screened, and 24 randomized controlled trials that met the inclusion criteria were included, involving 768 participants. Meta-analysis results showed that VR therapy, compared to conventional therapy, significantly improved BBS (mean difference [MD] 3.29, 95% CI 0.52-6.06; P=.02), TUG (MD -1.67, 95% CI -2.89 to -0.46; P=.007), and step length (MD 3.59, 95% CI 0.50-6.69; P=.02). However, no significant difference was observed between the 2 groups in 10-MWT (MD -0.91, 95% CI -3.33 to 1.50; P=.46), stride length (MD 5.63, 95% CI -0.73 to 11.99; P=.08), FRT (MD 2.68, 95% CI -0.30 to 5.67; P=.08), DGI (MD 1.08, 95% CI -0.41 to 2.58; P=.16), and FES-I (MD 0.16, 95% CI -2.92 to 3.24; P=.92). In the subgroup analyses, significant improvements in balance and mobility were observed in patients receiving greater than or equal to 20 sessions, with BBS improved by 5.14 points (95% CI 0.43-9.85; P=.03) and TUG reduced by 1.98 seconds (95% CI -3.33 to -0.63; P=.004). In addition, patients who received VR therapy more than 6 months after stroke showed greater improvements in BBS (MD 1.64, 95% CI 0.14-3.14; P=.03), compared to those who received VR therapy between 7 days and 6 months after stroke. Long-term VR-based therapies are more effective in improving functional ability after stroke. VR therapy has demonstrated significant potential for enhancing lower limb recovery, especially when applied with frequencies of ≥20 sessions.

The aim of this study is investigate the effect of arm swing exercise on balance and gait in stroke patients. Group A (n=8): 0.5kg strap was applied during arm swing exercise in experimental group for 30 minutes a day, 3 times a week for 4 weeks. Group B (n=8): Subjects in control group performed neurodevelopmental treatment for 30 minutes a day, 3 times a week for 4 weeks. Subjects were measured for balance and gait on Berg Balance scale, 10meter walking test and Six-minute walk test. There were significant changed of 10Meter Walking Test and 6-Minute Walk Test after experimental group performed the reinforced arm swing exercise of upper extremities and control group was provided with neurodevelopment treatment(p 0.05). The application reinforced arm swing exercise can be said to be effective intervention for the gait training in hemiplegic stroke patient.