Effect of constraint standing training on balance and gait in hemiparetic stroke patients: a single-blind randomized controlled trial protocol.

Background: Stroke is one of the causes affecting gait and balance. Taping is considered an effective method for improving balance and gait in stroke patients. Numerous studies have confirmed the functional effects of taping in stroke patients. However, there is still no consensus regarding the use of taping to improve gait and balance. Objects: The purpose of this review was to investigate the effects of taping on the balance and gait of patients with stroke through meta-analysis of studies. Methods: PubMed, Medline, Embase, Web of Science, Cochrane Review, RISS, DBPia, and Science on were used to collect articles on Kinesio and non-elastic taping. The key terms were “Stroke”, “Hemiplegia”, “Taping”, “Tape”, “Balance”, and “Gait” with cut-off of October, 2022. Taping group was compared with control groups with sham, placebo, and no taping. The outcome measures included the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and gait speed (cm/s). Eighteen studies (524 patients) were selected for the meta-analysis. Results: Overall, taping improved balance and gait in stroke patients, and Kinesio and nonelastic taping had similar effect sizes. Taping improved the BBS and TUG, and was most effective on gait speed. Contrary to the expectation that a longer duration of taping would be more affective, taping was most effective when the total taping duration was shorter than 500 minutes. In addition, the effect size of taping was greater when it was simultaneously attached to multiple locations. Conclusion: This meta-analysis supports the use of taping to improve gait and balance in stroke patients, and provides guidelines for the location, duration, and type of tape to increase taping efficiency.

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<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<0.05). WBVMT improved muscle strength, balance, and gait in stroke patients with hemiplegia.

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 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.

Background Restoring gait is essential for stroke rehabilitation to support patients’ return to independent living. Objective To examine the effects of gait training using an active over-ground body weight-support walking system (GT-AOGBWSWS) on balance and gait in stroke patients. Methods In this RCT, 26 chronic stroke patients were randomized to either the GT-AOGBWSWS ( n = 13) or conventional gait training (CGT) ( n = 13) groups. Both groups underwent gait training—GT-AOGBWSWS with Andago ® and CGT—alongside a standard rehabilitation program, totaling 105 minutes daily, 5 days per week, for 4 weeks. Balance was assessed using the Berg Balance Scale (BBS) and Timed Up and Go (TUG), and gait was assessed using the Dynamic Gait Index (DGI) and 10-meter walk test (10MWT). Results Both groups showed significant post-intervention improvements in balance and gait ( p &lt;0.05), though the GT-AOGBWSWS group had significantly greater improvements in BBS (18.82% vs 6.8%), TUG (13.61% vs 5.27%), DGI (15.18% vs 7.61%), and 10MWT (19.55% vs 3.71%) compared to the CGT group. Conclusions GT-AOGBWSWS shows promise for enhancing balance and gait in stroke patients. These findings highlight the potential of active over-ground body weight-supported walking systems as an effective intervention for stroke rehabilitation. Future large-scale RCTs are warranted to further validate these results and to explore the mechanisms and patient characteristics that optimize treatment outcomes.

Background and Objectives: Forward head posture (FHP) is associated with reduced stability limits, impaired balance performance, and compromised cervical proprioception. This study investigated the effects of capital flexion exercise (CFE) on the craniovertebral angle (CVA), trunk control, balance, and gait in chronic stroke patients with forward head posture. Materials and Methods: Twenty-six subjects were randomly assigned to the CFE group or the control group (n = 13 each). The CFE group underwent a familiarization process and performed CFE for 9 min per session, 3 times a week for 6 weeks, as well as the existing neurodevelopmental treatment (NDT). The control group received only the existing NDT. Results: The CVA, the Korean version of the Postural Assessment Scale for Stroke (K-PASS), the Berg Balance Scale (BBS), and the Timed Up and Go test (TUG) improved after the intervention in the CFE group (p < 0.05). In the control group, CVA and TUG improved after the intervention (p < 0.05). The CVA (d = 1.34, p = 0.002), K-PASS (d = 1.36, p = 0.000), and BBS (d = 1.68, p = 0.000) values of the CFE group showed statistically significant improvement compared to the control group. Although TUG improved in the CFE group, the between-group difference was not statistically significant (d = -0.28, p = 0.467). Conclusions: This study suggests that capital flexion exercises effectively improve craniovertebral angle, trunk control, and balance in chronic stroke patients with forward head posture.

Objectives: This study investigated the effects of trunk extension-based inspiratory muscle strengthening on respiratory function, balance, and gait in patients with stroke. Methods: Thirty stroke patients were randomly assigned to the study group (n = 15) or control group (n = 15). The study group performed inspiratory muscle strengthening exercises in a trunk extension posture, while the control group received conventional inspiratory muscle training. Both groups trained five times per week for six weeks. Outcome measures included maximal inspiratory pressure (MIP), maximal inspiratory flow rate (MIFR), maximal inspiratory volume (MIV), peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV1), Berg Balance Scale (BBS), weight distribution ratio (WDR), limits of stability (LOSs), Timed Up and Go (TUG), gait velocity, cadence, and stride length. Results: The study group showed significantly greater improvements in respiratory parameters (MIP, MIFR, MIV, PEF, FEV1) and functional outcomes (WDR, LOS, BBS, TUG, gait velocity, cadence, stride length) compared to the control group. Conclusions: Trunk extension-based inspiratory muscle strengthening effectively improves respiratory function, balance, and gait in stroke patients, and may serve as a valuable addition to stroke rehabilitation programs.

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.

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.

Circumduction gait in stroke patients, a compensatory movement involving pelvic hike and femoral abduction, increases energy cost. However, longitudinal studies on its mechanism during the acute phase are lacking. This study longitudinally investigated changes in the paretic femoral abduction angle during gait in acute stroke patients and identified related factors. Twenty-two stroke patients were assessed twice: at gait initiation and 10-14 days later. Gait kinematics during a 3 m walk were measured using a depth sensor, and physical functions (SIAS) were evaluated. Changes were analyzed using paired t-tests and correlation analyses. Spatiotemporal parameters improved significantly. Kinematically, paretic femoral abduction (p = 0.049) and paretic pelvic hike (p = 0.025) significantly decreased, while maximum paretic knee flexion during swing (p = 0.026) increased. The decrease in femoral abduction correlated positively with the decrease in pelvic hike (r = 0.55) and negatively with the improvement in paretic ankle motor function (SIAS) (ρ = -0.49). The decrease in pelvic hike correlated negatively with the improvement in paretic knee motor function (SIAS) (ρ = -0.43). These results suggest that in acute stroke patients, the recovery of paretic ankle and knee motor functions leads to a reduction in compensatory femoral abduction and pelvic hike, respectively. This study provides insights for re-evaluating compensatory movements as an adaptive phenomenon during recovery, not merely as abnormal movements.

Purpose This study aimed to investigate the impact of wearable robotassisted gait training with maximum step length on improving the respiratory function, balance and gait in hemiplegia with CVA (stroke) patients. Methods 36 participants were consisted of patients who had experienced a stroke within the past year and agreed to participate in this study. The study group (n1 = 18), in addition to receiving standard neurological treatment, underwent wearable robotassisted gait training with maximum step length. The intervention was conducted for four weeks, three times a week, 30 minutes per day. The control group (n2 = 18) received treadmill gait training with traditional neurological treatment. Both groups were evaluated using the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), postural stability test (PST), berg balance scale (BBS), trunk impairment scale (TIS), timed up &amp; go test (TUG) and 10 meter walk test (10MWT) pre and post the intervention. Results The results showed a significant improvement in FEV1/FVC(%), TIS, TUG, 10MWT in the study group. Conclusion Based on the study's findings, wearable robotassisted gait training with maximum step length can be considered effective in enhancing the respiratory function, balance and gait in stroke patients.

Fresnel prism shifts the field of view and converts object position in space, but its effect on stroke patients without unilateral neglect has not been examined. We aimed to investigate the effect of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia. This study included 17 stroke patients with hemiplegia without unilateral neglect. Balance and gait training were applied in the control group (n= 9), and Fresnel prism glasses were applied with balance and gait training in the experimental group (n= 8). In all groups, interventions were done for 30 min/day for 5 times/week for 4 weeks. Motor-free visual perception test for visual perception (MVPT), Berg Balance Scale (BBS), and functional reach test (FRT) for dynamic balance ability, and gait were performed. Measurements were done before and after interventions. MVPT showed no significant difference between the groups (p> 0.05). A significant increase in BBS and FRT results was found before and after interventions in the experimental group (p< 0.05). Gait variables showed significant difference in the experimental group (p< 0.05). Fresnel prism glasses may effectively improve dynamic balance and gait functions by shifting body weight to the affected side of stroke patients with hemiplegia without vision loss.

[Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.

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.

ObjectivesTo compare the effects of deep transcranial magnetic stimulation (dTMS) and repetitive transcranial magnetic stimulation (rTMS) on balance function and gait of stroke patients.MethodsThis randomized, single-blind trial enrolled 66 eligible stroke patients with hemiplegia. These participants were randomly assigned to either the deep transcranial magnetic stimulation (dTMS) group (n = 33) or the repetitive transcranial magnetic stimulation (rTMS) group (n = 33). All patients received conventional rehabilitation therapy. Moreover, the dTMS group received dTMS treatment, while the rTMS group received rTMS treatment. The stimulation was administered to the M1 region for a period of 4 weeks. Outcome evaluations were conducted both before and after the intervention. The balance function was assessed using the Berg Balance Scale (BBS) and the Pro-kin balance tester. For evaluating lower limb function and walking ability, the Timed Up and Go (TUG) test was employed. Additionally, a gait analyzer was utilized to perform gait analysis.ResultsFollowing 4 weeks of treatment, both groups showed significant improvements in BBS scores, gait velocity, stride rate, step length, and limits of stability (LOS) compared with the baseline values (all P < 0.001). Notably, the dTMS group exhibited significantly greater improvements in BBS scores (P < 0.01) and gait velocity (P < 0.05) than the rTMS group. However, there were no significant between-group differences in stride rate, step length, or LOS (all P > 0.05).Similarly, both groups demonstrated significant reductions in TUG test time, center of pressure (COP) path length, and COP displacement area compared with the baseline (all P < 0.01). Moreover, the dTMS group exhibited more pronounced decreases in TUG test time (P < 0.01), COP path length (P < 0.05), and COP displacement area (P < 0.05) than the rTMS group.ConclusionBoth dTMS and rTMS effectively improved balance and gait functions in stroke patients. Notably, dTMS demonstrated superior efficacy compared to rTMS in enhancing these parameters, providing evidence to support its clinical utility.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03268-x.