Feasibility of early functional rehabilitation in acute stroke survivors using the Balance-Bed-a technology that emulates microgravity.

Lars I E Oddsson,Sarah Meissner,Marsha J Finkelstein

doi:10.3389/fnsys.2015.00083

Abstract

Evidence-based guidelines recommend early functional rehabilitation of stroke patients when risk of patient harm can be managed. Current tools do not allow balance training under load conditions sufficiently low for acute stroke patients. This single-arm pilot study tested feasibility and safety for acute stroke survivors to use “Balance-Bed”, a technology for balance exercises in supine initially developed to emulate microgravity effects on balance. Nine acute stroke patients (50–79 years) participated in 3–10 sessions over 16–46 days as part of their rehabilitation in a hospital inpatient setting. Standard inpatient measures of outcome were monitored where lack of progress from admission to discharge might indicate possible harm. Total FIM scores at admission (median 40, range 22–53) changed to (74, 50–96), Motor FIM scores from (23, 13–32) to (50, 32–68) and Berg Balance scores from (3, 0–6) to (19, 7–43) at discharge. Changes reached Minimal Clinical Important Difference for a sufficient proportion (>0.6) of the patients to indicate no harm to the patients. In addition, therapists reported the technology was safe, provided a positive experience for the patient and fit within the rehabilitation program. They reported the device should be easier to set up and exit. We conclude acute stroke patients tolerated Balance-Bed exercises such as standing on one or two legs, squats, stepping in place as well as balance perturbations provided by the therapist. We believe this is the first time it has been demonstrated that acute stroke patients can safely perform whole body balance training including balance perturbations as part of their rehabilitation program. Future studies should include a control group and compare outcomes from best practices to interventions using the Balance-Bed. In addition, the technology is relevant for countermeasure development for spaceflight and as a test-bed of balance function under microgravity-like conditions.

Highlights

Evidence-based clinical practice guidelines for stroke survivors strongly recommend balance training as a key component of the rehabilitation program (Ottawa et al, 2006) based on evidence that balance training improves outcomes (Sackley and Lincoln, 1997; Walker et al, 2000; Chen et al, 2002)
Exercises using the Balance-Bed replaced similar exercises and equipment commonly used in the rehabilitation program
Other circumstances included patients being discharged to outpatient rehabilitation, which made ineligible to participate in the current study

Summary

Introduction

Evidence-based clinical practice guidelines for stroke survivors strongly recommend balance training as a key component of the rehabilitation program (Ottawa et al, 2006) based on evidence that balance training improves outcomes (Sackley and Lincoln, 1997; Walker et al, 2000; Chen et al, 2002). In spite of growing evidence of clear benefits to outcomes and patient’s quality of life, a recent systematic review found only three randomized controlled trials (RCTs) that initiated interventions early It is commonly not part of standard clinical practice (Bernhardt et al, 2004; Veerbeek et al, 2014), there is growing agreement that rehabilitation therapy should be provided as soon as the patient’s medical status is stable (Ottenbacher and Jannell, 1993; Cifu and Stewart, 1999). It would be reasonable to assume that functional and task-oriented training early after stroke is beneficial to the patient (Veerbeek et al, 2014) and it may even be cost-effective (Tay-Teo et al, 2008) For such rehabilitation to be provided to patients early after stroke, clinicians must have access to equipment and tools that can safely deliver relevant challenges that are specific to the patient’s rehabilitation needs

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Discussion

Conclusion