Abstract
Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.Design: Randomized clinical trial.Setting: Tertiary SCI/D rehabilitation center.Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.Methods: Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations.Main Outcome Measures: Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes.Results: Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups [median (interquartile range): PBT 0.08 (0.68); CIBT 0.00 (0.22)]. One participant in the PBT group experienced a non-injurious fall during training.Conclusions: Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (i.e., PBT) did not prove advantageous for performance on a measure of reactive stepping ability.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02960178.
Highlights
Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease
Impaired balance is a leading cause of falls in this population [4] the current time in physical therapy allocated to balance training is limited [5]. This is despite the fact that time spent on balance training during inpatient rehabilitation increases the odds of being ambulatory at discharge in people with motor incomplete SCI/D [5]
Perturbation-based Balance Training (PBT) does not appear to be more effective than CIBT to improve reactive stepping ability, balance, strength, gait, or self-reported balance confidence or fall concern for individuals with chronic incomplete spinal cord injury or disease (iSCI/D); participants showed improvement over time by participating in intensive and challenging balance training programs, regardless of exposure to external balance perturbations
Summary
Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Impaired balance is a leading cause of falls in this population [4] the current time in physical therapy allocated to balance training is limited [5] This is despite the fact that time spent on balance training during inpatient rehabilitation increases the odds of being ambulatory at discharge in people with motor incomplete SCI/D (iSCI/D) [5]. Studies that do use a balance-focused intervention typically only include outcomes that measure standing balance [14, 15, 18], even though most falls experienced by ambulatory individuals with iSCI/D occur during walking [4]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call