Balance In Stroke Survivors Research Articles

High-Intensity Exercise Training Impact on Cardiorespiratory Fitness, Gait Ability, and Balance in Stroke Survivors: A Systematic Review and Meta-Analysis.

Stroke survivors commonly face challenges such as reduced physical activity and cardiorespiratory fitness (CRF) as well as balance and gait impairments, exacerbating their disability. While high-intensity exercise interventions have demonstrated some potential, their effects on these items remain uncertain. Therefore, our study aimed to investigate the impact of high-intensity training protocols on CRF, gait ability, and balance in stroke survivor populations. Two independent investigators systematically searched five databases for relevant RCTs following the PICO model. Through a systematic review of 25 RCTs published up to 31 May 2023, including adult first-stroke survivors, comparing high-intensity exercise training versus low-to-mild or no exercises, we evaluated outcomes such as the Six-Minute Walking Test (6 MWT), peak oxygen uptake (VO2peak), Ten-Meter Walk Test (10 MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG). The protocol was registered in PROSPERO (registration number CRD42023456773). Meta-analyses indicated significant enhancements in CRF, as measured by 6 MWT and VO2peak, following high-intensity exercise interventions. However, no significant differences were observed in BBS, 10 MWT, and TUG. Our findings underscore the potential of high-intensity exercise interventions in ameliorating CRF among stroke survivors, although further research involving standardized protocols and long-term follow-ups is imperative to optimize rehabilitation outcomes.

The effects of visual information deprivation and feedback balance training on balance in patients with stroke.

Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.

Interrelationship Among Fear of Falling, Gait Characteristics and Dynamic Balance in Stroke Survivors – A Case-control Study

Interrelationship Among Fear of Falling, Gait Characteristics and Dynamic Balance in Stroke Survivors – A Case-control Study

Effectiveness of a Virtual Reality-Based Rehabilitation Program versus Conventional Physical Therapy in Improving Motor Function and Balance in Stroke Survivors: A Randomized Controlled Trial.

Background: Stroke is a leading cause of mortality and functional impairment worldwide, often resulting in balance and motor function deficits. Conventional stroke therapy, primarily consisting of aerobic exercise and physical training, does not fully address neuroplasticity-related motor improvements in stroke survivors. Recent advancements in technology have enabled the development of virtual reality-based rehabilitation (VRBR), which offers immersive, intensive therapy that may be more effective than traditional methods. Objective: This study aims to evaluate the efficacy of VRBR compared to conventional physical therapy (CPT) in enhancing motor function and balance in individuals who have experienced a stroke. Methods: A randomized controlled trial was conducted at Johar Poly Clinic, Lahore, over a 9-month period, with 56 participants who had recent stroke diagnoses. Participants were randomly assigned to either the VRBR or CPT group. Balance was measured using the Berg Balance Scale, and functional abilities were assessed with the Barthel Index Scale. Statistical analysis included descriptive and inferential methods to identify within-group and between-group differences. Results: In the study, both the Virtual Reality-Based Rehabilitation (VRBR) and Conventional Physical Therapy (CPT) groups showed improvements, but the VRBR group exhibited statistically significant increases in both balance and functional abilities. Specifically, Berg Balance Scale scores improved more in the VRBR group (from 20 ± 3.5 at baseline to 30 ± 6 at 9 months) compared to the CPT group (from 19 ± 4 to 25 ± 5). Similarly, Barthel Index Scale scores, which measure functional abilities, increased substantially in the VRBR group (from 40 ± 6 to 55 ± 9), outperforming the CPT group (from 39 ± 5.5 to 48 ± 8) over the 9-month study period. These results indicate a potential advantage of VRBR in enhancing balance and functional independence among stroke survivors. Conclusion: Virtual Reality-Based Rehabilitation demonstrates significant potential in improving balance and functional abilities among stroke survivors compared to conventional physical therapy. The immersive nature and intensity of VRBR may contribute to its effectiveness, suggesting its incorporation into stroke rehabilitation protocols.

Current Trends in Balance Rehabilitation for Stroke Survivors: A Scoping Review of Experimental Studies.

Balance impairment is a common consequence of a stroke, which can significantly hinder individuals' participation in daily activities, social interactions, and leisure pursuits and their ability to return to work. Rehabilitation is vital for minimizing post-stroke sequelae and facilitating the recovery of patients. This review aims to identify current trends in balance rehabilitation of stroke survivors. This Scoping review followed Arksey and O'Malley's methodological framework. The literature search was conducted in electronic databases, including CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection. The search was performed in March 2023, and the inclusion criteria were articles published in English or Portuguese between 2013 and 2023. A total of 446 articles were identified. After selecting and analyzing the reports, fourteen publications were included in this review. Seven distinct categories of balance rehabilitation interventions were identified, covering various approaches. These categories included conventional rehabilitation exercises, gym-based interventions, vibration therapy, rhythmic auditory stimulation training, boxing therapy, dual-task training, and technology-based rehabilitation interventions. Each of these methods presents unique benefits and can significantly impact the recovery of balance in stroke survivors, enhancing their overall well-being and functional capacity.

Ankle stiffness asymmetry is associated with balance function in individuals with chronic stroke

Ankle joint is one of important contributors on balance in stroke survivors. This study aimed to investigate the relationships of ankle stiffness symmetry ratios along the talocrural and subtalar axes with clinical balance measures and weight distribution during quiet standing in ambulatory chronic post-stroke survivors. The clinical trials involved 15 ambulatory elderly with chronic post-stroke hemiparesis and 15 healthy controls. Ankle stiffness was evaluated during non-weight-bearing isokinetic passive biaxial ankle movements, and ankle stiffness symmetry ratios between paretic and non-paretic ankle stiffness (SR: Inversion/Eversion SRIE & Dorsi-/Plantarflexion SRDP) were measured. A certified physiotherapist evaluated the Berg Balance Scale (BBS) and weight-distribution ratio (WDR) on bilateral force plates during quiet standing. Correlation coefficients, the factor analysis, and Pearson linear multiple regression were assessed with measured parameters. Correlation coefficients showed significances in-betweens; BBS and SRDP (r = −0.543, p = 0.022), WDR and SRIE (r = −0.667, p = 0.004), SRIE and SRDP (r = −0.604, p = 0.011). The exploratory factor analysis suggested four extracted factors; (1) Balance & Gait, (2) Stroke, (3) Symmetry and (4) Dimension. The first and second factors include general and pathological characteristics in stoke participants respectively. The third factor is associated with symmetrical characteristics explaining up to 99.9% of the variance. Multiple regression analysis showed ankle stiffness ratios predict BBS up to 60% of variance. The biaxial ankle stiffness ratio is a useful clinical variable that assesses balance function, in ambulatory chronic stroke survivors.

Impaired Upper Limb Motor Function in Post-stroke Patients and Its Impact on Trunk Control and Mobility: A Cross-sectional Study

Objectives: This study aims to investigate the impact of impaired upper limb motor function on trunk control and mobility in chronic post-stroke survivors so that the upper limb function should be enhanced as a core component of rehabilitation. Methods: This analytical cross-sectional study was conducted from March 2021 to August 2021 at the Rehabilitation Center for the Physically Disabled in Peshawar, Pakistan. A total of 166 chronic stroke patients in the age range of 35 to 70 years and greater than 6 months post-stroke were included. To assess the impaired upper extremity, the Fugl-Meyer assessment upper extremity scale was used, and the trunk control and mobility were checked through functional reach test and timed up and go test, respectively. Results: Among 166 stroke survivors having upper extremity impairment, 109(65.7%) participants’ upper extremity was severely affected. Mobility levels measured through the timed up and go test were categorized and scored; accordingly, the participants showed a low risk of 22(13.3%), moderate 32(19.3%), high 72(43.4%), and very high risk of falls of 40(24%). Among 166 patients, 147(88.6%) had no trunk control which resulted in 8 times greater fall risk in 65(39.2%) participants. Thus, upper limb impairment is significantly associated with impaired trunk control and mobility (P=0.001). Discussion: This study found about one-third of stroke survivors have a risk of falling, two-thirds have upper extremity impairment, and two-thirds have no trunk control. This study showed a significant reduction in mobility level, balance, and posture balance in stroke survivors having upper extremity impairment. These findings suggest that stroke survivors with upper extremity impairment may use therapeutic intervention to minimize falls and enhance postural balance and trunk control.

The effect of a modified elastic band orthosis on gait and balance in stroke survivors.

Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability. The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs. Experimental study design. The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire. The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5. EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.

Effects of Task-related Trunk Training with Sensory Electrical Stimulation on Sitting Balance in Stroke Survivors: A Randomized Controlled Trial.

The aim of this study was to investigate the immediate effect of sensory electrical stimulation (SES) and task-related trunk training (TRTT) interventions on sitting postural control in stroke survivors. Acute to subacute stroke survivors were screened and recruited for this study. Patients were randomly assigned to the SES group, receiving TRTT combined with simultaneous SES of the neck and lumbar muscles, or to the sham group, receiving TRTT combined with sham stimulation. The primary outcome of the sitting task assessment was the joint angles of the neck and trunk. The outcome was measured at three time points (baseline; online effect: 10 min after the intervention started while the intervention continued; and after-effect: immediately after the intervention). In total, 26 patients were divided into the SES (n=13) and sham (n=13) groups. The SES group showed a significant increase in the trunk joint angle for the online effect (P=0.03) and the after-effect (P=0.01) when compared with those measured at baseline. TRTT combined with simultaneous SES of the neck and lumbar muscles can immediately change the trunk angle during a sitting balancing task.

Efficacy of Overground Robotic Gait Training on Balance in Stroke Survivors: A Systematic Review and Meta-Analysis.

Strokes often lead to a deficit in motor control that contributes to a reduced balance function. Impairments in the balance function severely limit the activities of daily living (ADL) in stroke survivors. The present systematic review and meta-analysis primarily aims to explore the efficacy of overground robot-assisted gait training (o-RAGT) on balance recovery in individuals with stroke. In addition, the efficacy on ADL is also investigated. This systematic review identified nine articles investigating the effects of o-RAGT on balance, four of which also assessed ADL. The results of the meta-analysis suggest that o-RAGT does not increase balance and ADL outcomes more than conventional therapy in individuals after stroke. The data should not be overestimated due to the low number of studies included in the meta-analysis and the wide confidence intervals. Subgroup analyses to investigate the influence of participant’s characteristics and training dosage were not performed due to lack of data availability. Further well-designed randomized controlled trials are needed to investigate the efficacy of o-RAGT on balance in individuals with stroke.

Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta-analysis of randomised controlled studies.

Stroke is one of the most common causes of disability worldwide. In recent years, diverse telehealth programmes for stroke survivors have suggested that this mode of rehabilitation could improve stroke survivors' abilities to perform activities of daily living (ADLs) and maintain balance. Although increasingly utilised in clinical and community settings, the effectiveness of telehealth interventions in stroke survivors remains inconclusive. This warrants investigation so that telehealth interventions are evidence-based and are not merely modalities of convenience. To identify the effects of telehealth interventions on the ability to perform ADLs and maintain balance in stroke survivors. A systematic literature review and meta-analysis were conducted in accordance with PRISMA guidelines. A systematic literature search was performed using seven databases for literature dated up to April 25, 2021. The revised Cochrane risk of bias tool for randomised trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth interventions. Stata 16.0 was used for the statistical analyses. A total of 14studies with 1,367 participants were included in the analysis. Overall, telehealth interventions were effective in improving stroke survivors' abilities to carry out their ADLs (standardised mean difference: .45; 95% confidence interval: .12 to .78); however, no significant effects were found on balance. Telehealth interventions are beneficial for improving stroke survivors' performance of their ADLs. Future telehealth intervention trials should focus on identifying essential intervention delivery components that facilitate intervention adoption by clinicians and stroke survivors and sustain the positive effects on stroke survivors' performance of their ADLs in different settings. It is essential to build flexibility in the telehealth-based intervention delivery protocol to meet individual stroke survivors' needs to motivate and enhance their ADL performance.

Smartphone Applications to Assess Gait and Balance Among Stroke Survivors

<h3>Objective(s)</h3> To summarize the viability of smartphone applications for determining gait dysfunctions and balance disorders in stroke survivors (SS). <h3>Data Sources</h3> A database search of peer-reviewed articles published in English through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss was conducted in January 2021. The search strategy included a combination of the terms: smartphone, stroke, gait, balance, and postural control. <h3>Study Selection</h3> Studies that explored the use of smartphone-based applications in laboratory and/or home-based settings for assessing gait and balance among SS. <h3>Data Extraction</h3> Two independent reviewers screened potential articles to determine their eligibility for inclusion in the review. Eligible studies were summarized for participant and study characteristics, validity, reliability, sensitivity, and specificity of smartphone assessments. Methodological quality assessment of all studies was performed. <h3>Data Synthesis</h3> Seven cross-sectional studies were included in this review. Quality assessment revealed all studies had a low risk of bias. In total, 43% of the included studies examined the validity, 57% examined the reliability, and 29% examined the specificity and sensitivity of smartphone-based application assessments of gait and balance in SS. All those studies revealed that smartphones were valid, reliable, specific and sensitive to evaluate gait and balance in SS. Six of the 7 included studies intended their use for SS and one study for clinicians. <h3>Conclusions</h3> Gait and balance impairments are key fall risk factors among SS. Effective methods to assess these impairments may help reduce fall risks, while also improving functional outcomes. The results provide evidence that smartphone-based gait and balance assessments are a viable option in SS in laboratory settings. Future research is needed to test smartphone-based gait and balance assessments in home settings and determine optimal wear sites for assessments. <h3>Author(s) Disclosures</h3> JJS is principal owner of Sosnoff Technologies LLC.

Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study

BackgroundStroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation.MethodsIn this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category.ResultsComparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70).ConclusionThe Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke.Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

The Impact of Diabetic Peripheral Neuropathy on Spatiotemporal Gait Parameters in Stroke Survivors: A Case-Control Study

The deterioration of gait performance following stroke is related to the impairment of sensorimotor function on the paretic side. Improper gait performance in post-stroke with additional diabetic peripheral neuropathy (DPN) on paretic and non-paretic legs may create destabilizing effects, including serious injuries and falls. Therefore, this study aimed to investigate the effect of DPN on spatiotemporal gait parameters in stroke survivors and determine the correlation of movement functioning and functional balance post-stroke with gait parameters. Ten stroke survivors with DPN, 10 stroke survivors without DPN and 10 healthy controls participated in this case-control study. Movement functioning and functional balance were assessed before the actual testing. Spatiotemporal gait parameters were recorded using the Nexus Vicon motion analysis system. Kruskal-Wallis test was used to analyze the gait parameters and Spearman’s rank-order correlation coefficient was used to identify the correlation between variables. Results showed that stroke survivors with DPN had longer stride time (temporal gait parameter, p = 0.001), lower cadence (p = 0.001) and greater gait variability than those without DPN and the healthy controls. The gait parameters were significantly correlated with movement functioning and functional balance in stroke survivors with DPN (p &lt; 0.05). These findings suggested that DPN possibly affected the gait parameters in stroke survivors. DPN could also play a role in movement functioning and functional balance in stroke survivors.

Effects of inspiratory muscle training on respiratory function and balance in stroke survivors: a randomized controlled trial

After a stroke, patients with hemiparesis and / or hemiplegia will present a notable asymmetry of the trunk and pelvis, and decreased postural stability and balance, affecting, consequently, respiratory function. The objective of this study is to analyze the effects of inspiratory muscle training (IMT) on lung function, inspiratory muscle strength, postural and trunk control and balance in stroke survivors in the subacute phase. 16 survivors of stroke in the subacute phase participated in RCT (experimental = 8; placebo = 8). The experimental group received IMT program, 5 days a week, once a day, for 8 weeks, with a progressive intensity from 15% to 60% of the PImax. The placebo group performed the same program, but with a fixed load of 7cmH20. Inspiratory muscle strength (PImax), lung function (FVC, FEV1, PEF, VMV), trunk control (TCT), and postural control and balance (PASS and Berg Scale) were evaluated. Experimental and placebo groups showed significant increases in PImax, with a difference between groups. There was a moderate and negative correlation between the initial PImax value and the percentage change (?PImax) (r = -0.572; p = 0.021). Significant increases in VMV (l/m) were observed in the experimental group, and increases in PASS in both groups, but without significant differences between groups. Inspiratory muscle training, although low intensity, is effective in improving inspiratory muscle strength in stroke survivors. However, the effects on postural control and balance remain uncertain.

Effects of Tai Chi Yunshou on upper limb function and balance in stroke survivors: A protocol for systematic review and meta analysis.

Background:Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors.Methods:This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes.Results:This systematic review results will be carried out after the completion of the protocol.Conclusions:This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training.PROSPERO registration number:CRD42020169549.

Visceral Mobilization and Functional Constipation in Stroke Survivors: A Randomized, Controlled, Double-Blind, Clinical Trial

IntroductionChronic functional constipation is common among stroke survivors. Osteopathy is an effective form of treatment as it acts on the structures surrounding the bowels that may have lost their normal capacity of resilience. The aim of the present study was to evaluate the effect of visceral mobilization on symptoms of functional constipation and static balance in stroke survivors.Materials and methodsThirty stroke survivors met the eligibility criteria and were randomly allocated to a group physical therapy and visceral manipulation or a group physical therapy. Both groups were submitted to conventional physical therapy. The group physical therapy and visceral manipulation was also submitted to visceral mobilization (sphincter inhibition and mobilization of the large intestine), whereas the group physical therapy was submitted to a sham procedure (superficial touching over the intestines). Evaluations were conducted prior to the intervention, immediately after the first intervention session and one week after the end of the five sessions. At each evaluation, the static balance was analyzed using a computerized plantar pressure sensor. Moreover, an intestinal symptoms rating scale was administered during the pre-intervention evaluation, and one week after the end of the intervention.ResultsSignificant improvements were found in intestinal symptoms (frequency of bowel movements, abdominal pain/discomfort, difficulty eliminating stools, sensation of intestinal swelling or distention, difficulty eliminating gas, sensation of incomplete bowel movement and, anal pain during bowel movement) and static balance (anteroposterior sway: F = 82.06, p = 0.0001; velocity of anteroposterior sway: F = 17.6, p = 0.001; and velocity of mediolateral sway: F = 4.41, p = 0.01).ConclusionVisceral mobilization can be part of a neurologic rehabilitation program to improve symptoms of constipation and static balance in stroke survivors.

Effects of Transcranial Direct Current Stimulation and Peripheral Stimulation on Electrical Activity of the Tibialis Anterior Muscle and Balance in Stroke Survivors with Hemiparesis – Randomized, Sham-Controlled, Double-Blind, Clinical Trial

Lower limb motor dysfunction and lack of balance is one of the most common and disabling sequelae affecting stroke. Objectives: Analyze the effects of the combination of Transcranial Direct Stimulation (tDCS) with peripheral stimulation (PES) on the activity of the tibialis anterior (TA) paretic and balance of hemiparetic post stroke.

Motor module generalization across balance and walking is impaired after stroke.

Muscle coordination is often impaired after stroke, leading to deficits in the control of walking and balance. In this study, we examined features of muscle coordination associated with reduced walking performance in chronic stroke survivors using motor module (a.k.a. muscle synergy) analysis. We identified differences between stroke survivors and age-similar neurotypical controls in the modular control of both overground walking and standing reactive balance. In contrast to previous studies that demonstrated reduced motor module number poststroke, our cohort of stroke survivors did not exhibit a reduction in motor module number compared with controls during either walking or reactive balance. Instead, the pool of motor modules common to walking and reactive balance was smaller, suggesting reduced generalizability of motor module function across behaviors. The motor modules common to walking and reactive balance tended to be less variable and more distinct, suggesting more reliable output compared with motor modules specific to either behavior. Greater motor module generalization in stroke survivors was associated with faster walking speed, more normal step length asymmetry, and narrower step widths. Our work is the first to show that motor module generalization across walking and balance may help to distinguish important and clinically relevant differences in walking performance across stroke survivors that would have been overlooked by examining only a single behavior. Finally, because similar relationships between motor module generalization and walking performance have been demonstrated in healthy young adults and individuals with Parkinson's disease, this suggests that motor module generalization across walking and balance may be important for well-coordinated walking. NEW & NOTEWORTHY This is the first work to simultaneously examine neuromuscular control of walking and standing reactive balance in stroke survivors. We show that motor module generalization across these behaviors (i.e., recruiting common motor modules) is reduced compared with controls and is associated with slower walking speeds, asymmetric step lengths, and larger step widths. This is true despite no between-group differences in module number, suggesting that motor module generalization across walking and balance is important for well-coordinated walking.

Effect of Eye Movement Training on Balance in Post Stroke Patients with Unilateral Spatial Neglect. First Preliminary report

Background: Unilateral Spatial Neglect (USN) is a complex disorder associated with stroke and is more severe and persistent following right hemisphere damage. Stroke patients have mobility limitations, muscle weakness, and behaviors disorders. The problem with USN is lack of orientation and information from affected side that may cause balance problems specially in elderly survivors. Training eye movements are aimed at improving visual function by training patients to navigate the blind hemifield and increase their overall sensitivity. Accurate reliable knowledge of balance in stroke survivors is important for prognosis and to predict falls. Aim of the study: This study was designed to find out the effect of training eye movements on balance in elderly post stroke survivors with USN. Subjects and Methods: The study included 15 of both sexes with post stroke USN (11 males and 4 females) their mean age was 69.1 ± 1.9 years. Patients received sequentially in same session training for eye movement program and a traditional gait training program 4 days/week for 6 weeks. Balance assessment was measured by Berg Balance Scale (BBS), Time Up and go test (TUG), 10 meters Talking Test (10mWT), and 6 Minutes Walking Test (6MWT). Results: there were significant changes in between pre and post-study as the analysis of mean values of BBS, TUG, 10mW, and 6MWT.Conclusion: eye movement training had a significant effect on improving balance in post stroke survivors with USN. Eye movement training improved patients with USN ability to explorer the blind hemispace and to improve balance.