Balance Performance In Patients Research Articles

Validity and reliability of the Balance Error Score System (BESS) Thai version in patients with chronic non-specific neck pain.

Neck pain has been found to affect the somatosensory system, which can lead to impaired balance control. To assess the balance of patients with neck pain and other conditions, the balance error scoring system (BESS) is commonly used as a static balance measurement tool. However, this tool is seldom used in Thailand due to its English language format. To translate and determine the content, convergent validity, and reliability of a Thai version of the BESS tool. A process of cross-cultural adaptation was utilized to translate BESS into a Thai version, called BESS-TH. To assess content validity, five physical therapy lecturers specializing in the musculoskeletal field used BESS to measure balance in participants with neck pain. For the convergent validity process, 130 patients diagnosed with chronic non-specific neck pain (CNSNP) were randomly assessed using four static balance tests (BESS, Single-leg balance test (SLBT), Romberg test, and Tandem stance test). For reliability, two assessors with varying years of work experience independently assessed videos of the participants twice using the BESS-TH, with a minimum 7-day interval between assessments. The BESS-TH used to assess balance of patients with neck pain demonstrated acceptable content validity (index of item objective congruence (IOC) = 0.87). The Spearman's Rank Correlation Coefficient was calculated between the BESS-TH and three other measures: the SLBT with eyes open and eyes closed, the Romberg test with eyes open and eyes closed, and the Tandem stance test with eyes open and Tandem stance test with eyes closed. The values obtained were as follows: -0.672, -0.712, -0.367, -0.529, -0.570, and -0.738, respectively. The inter-rater and intra-rater reliability were 0.922 (95% CI = 0.864-0.956) and 0.971 (95% CI = 0.950-0.983), respectively. Minimum detectable change (MDC) for the total BESS score of inter-rater and intra-rater reliability were 7.16 and 4.34 points, respectively. The BESS-Thai version was acceptable, reliable, and valid for evaluating balance performance in patients with CNSNP. This tool can be used and applied to clinically evaluate postural control in Thailand.

The effect of increased listening effort on the balance performance of patients with compensated vestibular lesion

ObjectivesThis study investigated the effects of listening effort (LE) on balance in patients with compensated vestibular deficits compared to healthy peers. MethodsThe subjects included two main groups: a control group of 15 healthy subjects and a study group of 19 patients with compensated vestibular pathology. The computerized dynamic posturography test (CDP) was conducted without the speech-in-noise task as a baseline, then the participant was subjected to a dual task in which the auditory task (speech-in-noise sentences) was given as the primary task, and the balance function test was the secondary task. Results: within-group analysisThe study group showed statistically significantly worse values of all body balance parameters under dual-task than the baseline in all conditions. These differences were much higher under the compliant platform conditions. However, these findings were not statistically significant in the control group. Between-group analysisThe study group showed a statistically significant decline in body balance reactions compared to the control group under dual-task with increased listening effort and the compliant platform. Study subgroup analysis revealed statistically significant differences between patients with unilateral vestibular loss (UVL) and those with bilateral vestibular loss (BVL) in the unstable platform condition. ConclusionOur study regarding implementing a dual-tasking paradigm as a measure of LE during the evaluation of chronic vestibular patients with CDP demonstrated how dual-tasking with increased LE affects postural stability. Because of this, patients will probably be more prone to tripping and falling in multitasking situations, as found in real-world settings. This fact should be taken into consideration while testing patients with chronic vertigo and compensated states at VNG. A dual-task paradigm helps uncover the unrevealed pathology.

Idiopatska skolioza i balans

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and the trunk, of unknown etiology. Balance or postural control can be defined as the ability to maintain the body's line of gravity above the base of support and thus to avoid falling. Adequate balance control is not only important for maintaining postural stability, but also for safe mobility during activities of daily life. This requires efficient central processing of information coming from the visual, vestibular and somatosensory (proprioceptive) systems. The aim of this article was to review the literature about postural stability and balance performance in patients with idiopathic scoliosis. Some studies showed that people with idiopathic scoliosis have reduced postural stability, assessed with posturography, as well as proprioceptive and vestibular deficits. Two hypotheses in the literature, biomechanical and sensory integration hypotheses, tried to explain this from different points of view. The biomechanical hypothesis emphasizes biomechanical and morphological changes in IS as responsible for poorer postural stability, while the hypothesis of sensory integration points out that certain people with idiopathic scoliosis have impaired dynamic regulation of sensorimotor integration due to an inaccurate evaluation of sensory inputs. Studies that used clinical balance tests showed difficulties in mediolateral stability and dynamic proprioception in IS. Further studies on balance in this population are needed to deepen knowledge in this area.

The effects of Q angle and Hamstring Length on Balance Performance in Patients with Lumbar Disc Hernia

Aim: Patellafemoral angle (Q angle) and Hamstring length are important measurements to evaluate balance. This study aims to examine the effects of Q angle and Hamstring length on balance performance in patients with lumbar intervertebral disc herniation (LDH). Material and Methods: LDH (n=32) and control group (CG)(n=30) were included in the study. Q angles and hamstring muscle lengths of the participants were measured. Balance was evaluated with Y balance test. Results: As a result of our study, no difference was found between LDH patients and CG groups in terms of hamstring muscle length; Q angle decreased in LDH patients and there was a negative high correlation between Q angle and R -Anterior, R-Posteromedial, R-Posterolateral values on the right and between Q angle and L-Anterior, L-Posteriolmedial, L-Posterolateral values on the left. Conclusion: It was found that Q angle measurements decreased in LDH patients, causing genu varum and leading to impairment in balance, especially in the left anterior, anteromedial and anterolateral.

Balance alterations are associated with neck pain and neck muscle endurance in migraine

BackgroundMigraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored. ObjectivesThis study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine. MethodsSixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored. ResultsPatients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = −0.33; p = 0.007), migraine frequency (r = −0.29; p = 0.021), neck pain intensity (r = −0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability. ConclusionNeck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

Immediate Effect of an Intervention Using a Head-mounted Display with a Modified Pitch Angle on Spatial Awareness and Standing Balance in Stroke Hemiparesis.

This study aimed to clarify the effect of an intervention using a head-mounted display with a web camera set at a modified pitch angle on spatial awareness, sit-to-stand movement, and standing balance in patients with left and right hemisphere damage. The participants were 12 patients with right hemisphere damage and 12 patients with left hemisphere damage. The line bisection test, a sit-to-stand movement, and balance assessment were performed before and after the intervention. The intervention task involved pointing at targets 48 times in an upward bias condition. Significant upward deviation on the line bisection test was noted in patients with right hemisphere damage. The load on the forefoot during the sit-to-stand movement was significantly increased. The range of anterior-posterior sway during forward movement in the balance assessment was reduced. An adaptation task performed in an upward bias condition may produce an immediate effect on upward localization, sit-to-stand movement, and balance performance in patients with right hemisphere stroke.

Effect of therapeutic exercise on the balance of patients with progressive supranuclear palsy: A pilot study.

BackgroundProgressive supranuclear palsy (PSP) is a parkinsonian-like progressive neurodegenerative syndrome. Key clinical features include ocular motor dysfunction, postural instability, and cognitive dysfunction. Maintaining and improving balance function and gait function are very important for patients with PSP with severe postural dysfunction and repeated falls. In addition, patients with PSP have a poor response to pharmacological treatment; hence, rehabilitation is a key approach in dealing with this syndrome. However, no conclusion on the beneficial effects of rehabilitation for patients with PSP have been established in the literature.ObjectivesThe effectiveness of multiple therapeutic exercise program with probable or possible PSP according to the Movement Disorder Society criteria for the clinical diagnosis of PSP was validated.MethodsParticipants underwent multiple therapeutic exercise program customized for each participant, including resistance training, balance training, and walking exercises that were performed for 60–80 minutes a day, 5 days a week for 4 weeks. The outcomes measured were as follows: pull test, Berg Balance Scale (BBS), timed up and go test (TUG), and gait speed test.ResultsA total of 117 patients with PSP were enrolled and the analysis was performed on 20 patients with probable PSP. Four-week rehabilitation significantly improved pull test (p = 0.034) and BBS scores (p = 0.001). There were no significant differences both TUG (p = 0.502) and gait speed (p = 0.813).ConclusionThe multiple therapeutic exercise program had beneficial effects on balance performance in patients with PSP in 4 weeks and could be an essential element in their rehabilitation. Although this pilot study was conducted without a control group, it provided valuable information for future prospective randomized controlled trials.

Effectiveness of Static and Dynamic Weight Shift Balance Strategies to Improve Balance Performance in patients With Stroke-

Aim: To enhance the balance in post stroke patients by the implementation of static and dynamic weight shift balance strategies. Methods: Data from 32 patients who complete selection criteria were included to this study. Study design was Randomized controlled trial (RCT). Written informed consent were taken from every individual participating in this study before performing any physical examination. Patients were allocated into two equal groups. On 1st day balance was assessed by Brunel Balance Assessment (BBA), re-accessed by the end of 3rd week and at 6th week. There were two groups, one is Experimental (Group A) receiving static and dynamic weight shift balance training strategies along with conventional physiotherapy treatment while control group (Group B) receiving only conventional rehabilitation program. Results: The results of the BBA (Brunel Balance Assessment) scale showed statistically significant variations in the pre-post analysis for the experimental group with the p-value less than 0.05. By comparing the BBA scale score of group A and B has shown that there was significant difference between post treatment scores, post treatment mean BBA score was 7.000±1.4142 in group A while 3.6250±1.85742 in group B, with the value of p 0.00, showing that group A is better in improving balance of stroke patients. Conclusion: Implementation of static and dynamic balance strategies has a significant effect on improvement of balance in the patients suffering from stroke. Keywords: BBA (brunel balance assessment), CVA (cerebrovascular accident) and RCT (randomized controlled trial)

Balance performance in patients with post-acute COVID-19 compared to patients with an acute exacerbation of chronic obstructive pulmonary disease and healthy subjects.

COVID-19 leaves important sequelae in patients, not only in those who had the experience of a critical illness but also in patients with severe form. Understanding the impairments allows us to target rehabilitation to patients’ real needs; balance impairments are an assumed sequela of COVID-19, but no study has specifically evaluated balance performance in these patients. Their performance was compared to that of patients with a pulmonary disease that leads to systemic diseases, such as patients with an acute exacerbation of chronic obstructive pulmonary disease (PwAECOPD), and of healthy subjects. A total of 75 subjects were assessed: 25 patients with COVID-19 (PwCOVID) with a severe form in the acute phase, 25 PwAECOPD and 25 healthy subjects sex- and age-matched. A stabilometric platform was used to evaluate static balance, both with eyes open and closed, while the dynamic balance was assessed with the Mini-BESTest and the Timed Up and Go test. When compared to healthy subjects, results showed that PwCOVID had worse performance in both static (P < 0.005) and dynamic (P < 0.0001) balance, with a large effect size in all measures (>0.8). Moreover, PwCOVID showed similar results to those of PwAECOPD. In conclusion, PwCOVID showed a balance deficit in both dynamic and static conditions. Therefore, as for PwAECOPD, they should require not only respiratory rehabilitation but also balance and mobility physiotherapy to prevent today’s PwCOVID from becoming tomorrow’s fallers.

The Immediate Effect of Kinesio Taping on the Balance Performance of Patients with Chronic Ankle Sprains: A Randomized Controlled Trial

Background: Lateral ankle sprain is a common injury resulting from a rapid supination moment that damages the lateral ligaments and cartilaginous surfaces and contributes to the deterioration of functional ankle stability and balance among individuals. Objectives: This study aimed to investigate the immediate effect of Kinesio Taping (KT) on the balance performance of patients with chronic ankle sprains. Methods: This randomized, single-blind, parallel-group study was performed using the allocation concealment method. Sixty individuals (27 males and 33 females) with a history of ankle sprain were recruited and randomly assigned to one of the experimental (KT; n = 30) or control (non-KT; n = 30) groups. The intervention continued for two consecutive days, including four assessment sessions before and after taping on the first day and before and after removing KT on the second day. The mean and standard deviation (SD) of the center of pressure (COP) displacement and the velocity and SD of COP displacement were measured in the ant-post and med-lat directions following inversion and anterior perturbations. For data analysis, analysis of variance (ANOVA) test was performed using SPSS software version 22. This study was registered in the Iranian Registry of Clinical Trials (IRCT2013110415262N1). Results: The results of repeated measures ANOVA revealed an increase in the mean changes of COP displacement, velocity of COP displacement, and SD of COP displacement in the med-lat direction during inversion perturbation immediately after KT (P = 0.031, P = 0.005, and P = 0.011, respectively) and 24 hours after KT (P = 0.019, P = 0.002, and P = 0.009, respectively), compared to the control group. Moreover, during anterior perturbation, a significant increase was observed in the SD of COP displacement immediately and 24 hours after applying KT in the med-lat direction, compared to the control group (P = 0.022 and P = 0.016, respectively). Conclusions: Our findings revealed that KT might not improve the COP sway during perturbation in individuals with ankle sprains.

O-TS003. The combined effect of Repetitive Transcranial Magnetic Stimulation (RTMS) and treadmill training on walking endurance and balance in people with Parkinson’s Disease (PD) – A randomised PLACEBO-CONTROLLED trial

Introduction. Reduced walking endurance and balance is common among patients with PD. Treadmill training and rTMS have been shown to be effective in improving walking performance in patients with PD, but effects were modest and short-lived. Long-term effect of combined rTMS and treadmill training on walking endurance and balance performance in patients with PD is not known. Methods. 34 participants with PD were randomised into 2 groups. Participants received 12 sessions of either 25 Hz rTMS and treadmill training (25 Hz-TT) or sham rTMS and treadmill training (1 Hz-TT) conducted over 3 weeks. For 25 Hz-TT group, 600 TMS stimuli at 80% resting motor threshold were delivered to leg area of motor cortex of each hemisphere. Two- minute walk test (2MWT) and mini-Balance Evaluation System Test (mini-BEST) were used to evaluate the efficacy of interventions on walking tolerance and balance performance. Participants were tested before, after, 1 month and 3 months after intervention ended. Two- way repeated measure ANOVA was used to evaluate the outcome data. SPSS 23.0 was used for all statistical analysis. Results. Significant interaction effect was found in mini-BEST (F (3,32) = 3.247, p = 0.041). Post-hoc analysis shows that only 25-Hz group improved mini-BEST at Post (p = 0.001), 1-month (p = 0.006) and 3-month post intervention (p = 0.036). Between-group analysis of change from baseline showed that 25 Hz-TT had a greater change than sham-TT (by 1.96, p = 0.01) in improving mini-BEST. Both 25 Hz-TT and sham-TT groups improved 2MWT at all measurement time points (p < 0.001). Conclusion. Our results showed that combining 25-Hz rTMS with treadmill training improved walking endurance and balance performance in people with PD in both short-and long-term.

Clinical and laboratory measures of balance and comparison of balance performances according to postural instability and gait disorders in individuals with Parkinson’s disease

Purpose/aim Primary aim was to investigate the association between laboratory measures of balance and clinical balance tests in individuals with Parkinson’s disease (PD). The secondary aim was to compare the balance performances according to postural instability and gait disorders (PIGD). Materials and methods Sixty-four individuals with PD were included in the study. Clinical data were investigated using modified Hoehn and Yahr Scale and Unified Parkinson's Disease Rating Scale (UPDRS). Berg Balance Scale (BBS), Timed Up&Go Test (TUG), Five Times Sit-to-Stand Test (FTSST) were used for clinical measures of balance. Laboratory measures of balance were evaluated by Balance Master System including the modified Clinical Test of Sensory Interaction of Balance (mCTSIB), Limits of Stability Test (LOS), Sit to Stand Test (STS), and Tandem Walk Test (TW). The relationship between clinical and laboratory measures of balance was determined. After participants were divided into two groups based on UPDRS: patients with and without PIGD, their balance performance was compared. Results There were significant correlations between BBS and mCTSIB, LOS-Movement Velocity, and LOS-Endpoint Excursion. FTSST was correlated with STS-Weight Transfer and STS-Rising Index, and TUG was correlated with TW-Speed. Patients with PIGD had worse scores of balance assessments including FTSST, LOS-Movement Velocity, STS-Rising Index. Conclusion Laboratory measures are associated with clinical balance tests and they may reflect clinical balance outcome measures. Furthermore, PIGD may negatively affect balance performance in patients with PD.

Combined effect of repetitive transcranial magnetic stimulation and treadmill training on walking endurance and balance in people with Parkinson's disease

Objective: Reduced walking endurance and balance is common among patients with Parkinson's disease (PD). Treadmill training and transcranial magnetic stimulation (rTMS) have been shown to be effective in improving walking performance in patients with PD, but effects were modest and short-lived. This study aimed to examine the long-term effect of combined rTMS and treadmill training on walking endurance and balance performance in patients with PD.

Balance performance in patients with heart failure

BackgroundIt has been suggested that patients with heart failure (HF) have an increased fall rate. Although balance is one of the most important risk factors for fall, there is not sufficient information about balance in HF. ObjectiveTo compare static, dynamic and functional balance between patients with HF and healthy controls. MethodsTwenty-seven patients with HF and 22 healthy controls were recruited in this study. The Unilateral Stance (US) and Limits of Stability (LOS) tests were used to measure static and dynamic balance, respectively. Functional balance was assessed with Berg Balance Scale. ResultsThere was no significant difference in age, gender and body mass index between the groups (p > 0.05). There was a significant difference in US with open eyes between the groups (p < 0.05). Reaction time (backward and left), endpoint excursion (backward), maximum excursion (forward and backward) and directional control (forward and right) variables of LOS were significantly different between the groups (p < 0.05). ConclusionsPatients with HF have impaired static, dynamic and functional balance. Considering the balance impairment, a comprehensive balance assessment performed and balance training should be included in the management of HF as a part of the cardiac rehabilitation program.

A Systematic Review on Balance Performance in Patients With Bilateral Vestibulopathy.

Patients with bilateral vestibulopathy (BVP) have severe balance deficits, but it is unclear which balance measures are best suited to quantify their deficits and approximate the diversity of their self-reports. The purpose of this study was to explore measures of balance control for quantifying the performance of patients with BVP related to different balance domains, allowing targeted assessment of response to intervention. MEDLINE, Web of Science, and Embase were systematically searched on October 9, 2019. The Scottish Intercollegiate Guidelines Network checklist for case-control studies was applied to assess each individual study's risk of bias. Standardized mean differences (SMD) were calculated based on the extracted numeric data and reported according to the type of sensory perturbation in the balance tasks. Twelve studies (1.3%) met the eligibility criteria and were analyzed, including data of 176 patients with BVP, 196 patients with unilateral vestibulopathy, and 205 healthy controls between 18 and 92years old. In general, patients with BVP were either unable to maintain (or had reduced) balance during tasks with multisensory perturbations compared with healthy controls (range of mean SMD=1.52-6.92) and patients with unilateral vestibulopathy (range of absolute mean SMD=0.86-1.66). During clinical assessment to quantify balance control in patients with BVP, tasks involving multisensory perturbations should be implemented in the test protocol. As patients with BVP show difficulties with movement strategies, control of dynamics, orientation in space, and cognitive processing, clinicians should implement these aspects of balance control in their assessment protocol to fully comprehend the balance deficits in these patients.

Quantitative assessments of static and dynamic balance performance in patients with chronic ankle instability.

Patients with chronic ankle instability (CAI) have postural-control deficits during center-of-pressure excursions than do healthy individuals. While an external analysis of center-of-pressure excursions in CAI has been performed, a quantitative analysis of center-of-gravity movements, to detect the balance deficits associated with CAI, has yet to be performed. Therefore, the aim of the study is to quantify the balance deficits in patients with unilateral CAI.Forty-four patients with unilateral CAI (24 men; age, 31.7 ± 5.5 years) and 26 uninjured volunteers (12 men; age, 28.6 ± 5.9 years) underwent Neurocom Balance Manager assessments of dynamic and static balance responses in limits of stability, unilateral stance, and forward lunge tests.In the limits of stability test, there were no significant group differences in the forward direction; however, reaction times were longer in the CAI group than in the control group in the backward (P = .037, effect size [ES] = 0.49) and rightward directions (P = .032, ES = 0.47). Furthermore, the CAI group showed more excursions in the rightward (P = .046, ES = 0.50) and leftward directions (P = .002, ES = 0.80), and less directional control in the leftward direction (P = .036, ES = 0.59). In the unilateral stance test, the center of gravity sway velocity was faster in the CAI group than in the control group, whether eyes were opened or closed (P < .05). There were no significant group differences in forward lunge-test outcomes.Patients with CAI have poor static and dynamic balance performance compared to that in healthy counterparts. Thus, balance retraining should be an essential component of rehabilitation programs for patients with CAI.

The immediate effect of lumbopelvic manipulation on knee pain, knee position sense, and balance in patients with patellofemoral pain: A randomized controlled trial

BackgroundPatellofemoral pain (PFP) is a common musculoskeletal disorder. Quadriceps and core muscle neuromuscular control impairments are frequently associated with PFP. Lumbopelvic manipulation (LPM) has been shown to improve quadriceps and core muscle activation and decrease their inhibition, but changes in balance and knee joint position sense (JPS) after this intervention remain unknown. ObjectiveTo determine whether LPM decreases knee pain and JPS error and increases balance performance in patients with PFP. DesignRandomized controlled trial. SettingBiomechanics laboratory at a rehabilitation science research center. MethodsForty-four patients with PFP participated in this study that randomly divided into two equal groups. One group received LPM and the other received sham LPM (positioning with no thrust) in a single session. At baseline and immediately after the intervention, the outcomes of pain using a visual analog scale, balance using the modified star excursion balance test (mSEBT), and JPS at 20° and 60° of knee flexion using a Biodex dynamometer. ResultsThere was a statistically significant improvement in pain, balance control (anterior direction) and JPS in the LPM group immediately after the intervention. In addition, we observed significant differences between groups in pain, balance control (anterior direction) and JPS at 60° of knee flexion immediately after the intervention. ConclusionA single session of LPM immediately improved balance control, knee JPS, and pain in patients diagnosed with PFP. Clinical rehabilitation impactFindings suggest that LPM may be used as a therapeutic tool for immediate improvement of symptoms of PFP. However, more research is needed to determine long term results.

Can fibular reposition taping improve balance performance in individuals with chronic ankle instability? A randomized controlled trial

BackgroundLateral ankle sprain results in positional faults in the fibula which are thought to limit accessory motion in the ankle, leading to hypomobility and negatively influencing sensorimotor function and postural control. Although it has been shown that fibular reposition taping (FRT) is effective in the prevention of recurrent lateral ankle sprain, its ability to produce significant changes in balance measures in patients with chronic ankle instability is inconclusive. ObjectiveThis study aimed to determine whether a FRT intervention affects balance performance in patients with chronic ankle instability. DesignRandomized controlled trial. MethodsSixty individuals with chronic ankle instability were randomly allocated to three groups: FRT, sham taping, or no intervention (control group). Kinesiotape was applied and then re-applied on 3 occasions per week for 2 weeks. Static and dynamic balance were measured with three functional tests before and 1 day after the last session of intervention with the tape removed: single-leg stance test, single-leg hop test for distance, and modified Star Excursion Balance Test (mSEBT). ResultsThe results of ANCOVA showed that there were no significant differences between the three groups except for mSEBT reach distance in the posterolateral direction, which was significantly greater in the FRT group than the control group (p = 0.03). ConclusionApplying FRT for 2 weeks did not significantly affect static or dynamic balance measures in individuals with chronic ankle instability, hence its clinical efficacy to influence balance remains uncertain in this population. Clinical trial registration numberIRCT20171122037576N2

Short-Term Effects of Cerebellar tDCS on Standing Balance Performance in Patients with Chronic Stroke and Healthy Age-Matched Elderly

Transcranial direct current stimulation (tDCS) may serve as an adjunct approach in stroke rehabilitation. The cerebellum could be a target during standing balance training due to its role in motor adaptation. We tested whether cerebellar tDCS can lead to short-term effects on standing balance performance in patients with chronic stroke. Fifteen patients with a chronic stroke were stimulated with anodal stimulation on the contra-lesional cerebellar hemisphere, ipsi-lesional cerebellar hemisphere, or sham stimulation, for 20 min with 1.5 mA in three sessions in randomized order. Ten healthy controls participated in two sessions with cerebellar stimulation ipsi-lateral to their dominant leg or sham stimulation. During stimulation, subjects performed a medio-lateral postural tracking task on a force platform. Standing balance performance was measured directly before and after each training session in several standing positions. Outcomes were center of pressure (CoP) amplitude and its standard deviation, and velocity and its standard deviation and range, subsequently combined into a CoP composite score (comp-score) as a qualitative outcome parameter. In the patient group, a decrease in comp-score in the tandem position was found after contra-lesional tDCS: β = − 0.25, CI = − 0.48 to − 0.03, p = 0.03. No significant differences in demographics and clinical characteristics were found between patients who responded (N = 10) and patients who did not respond (N = 5) to the stimulation. Contra-lesional cerebellar tDCS shows promise for improving standing balance performance. Exploration of optimal timing, dose, and the relation between qualitative parameters and clinical improvements are needed to establish whether tDCS can augment standing balance performance after stroke.

Noisy vestibular stimulation improves vestibulospinal function in patients with bilateral vestibulopathy.

To examine the mechanism underlying previously reported ameliorating effects of noisy galvanic vestibular stimulation (GVS) on balance performance in patients with bilateral vestibulopathy (BVP) and determine those patients (incomplete versus complete vestibular loss) that might benefit from this intervention. Vestibulospinal reflex thresholds were determined in 12 patients with BVP [2 with complete loss (cBVP) and 10 with residual function (rBVP)]. Patients were stimulated with 1Hz sinusoidal GVS of increasing amplitudes (0-1.9mA). Coherence between GVS input and stimulation-induced body motion was determined and psychometric function fits were subsequently used to determine individual vestibulospinal reflex thresholds. The procedure was repeated with an additional application of imperceptible white noise GVS (nGVS). All patients with rBVP but none with cBVP exhibited stimulation-induced vestibulospinal reflex responses with a mean threshold level of 1.26 ± 0.08mA. Additional nGVS resulted in improved processing of weak subthreshold vestibular stimuli (p = 0.015) and thereby effectively decreased the vestibulospinal threshold in 90% of patients with rBVP (mean reduction 17.3 ± 3.9%; p < 0.001). The present findings allow to identify the mechanism by which nGVS appears to stabilize stance and gait performance in patients with BVP. Accordingly, nGVS effectively lowers the vestibular threshold to elicit balance-related reflexes that are required to adequately regulate postural equilibrium. This intervention is only effective in the presence of a residual vestibular functionality, which, however, applies for the majority of patients with BVP. Low-intensity noise stimulation thereby provides a non-invasive treatment option to optimize residual vestibular resources in BVP.