Berg Balance Scale Scores Research Articles

Multimodal biofeedback for Parkinson’s disease motor and nonmotor symptoms

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor retardation, myotonia, quiescent tremor, and postural gait abnormality, as well as nonmotor symptoms such as anxiety and depression. Biofeedback improves motor and nonmotor functions of patients by regulating abnormal electroencephalogram (EEG), electrocardiogram (ECG), photoplethysmography (PPG), electromyography (EMG), respiration (RSP), or other physiological signals. Given that multimodal signals are closely related to PD states, the clinical effect of multimodal biofeedback on patients with PD is worth exploring. Twenty-one patients with PD in Beijing Rehabilitation Hospital were enrolled and divided into three groups: multimodal (EEG, ECG, PPG, and RSP feedback signal), EEG (EEG feedback signal), and sham (random feedback signal), and they received biofeedback training five times in two weeks. The combined clinical scale and multimodal signal analysis results revealed that the EEG group significantly improved motor symptoms and increased Berg balance scale scores by regulating β band activity; the multimodal group significantly improved nonmotor symptoms and reduced Hamilton rating scale for depression scores by improving θ band activity. Our preliminary results revealed that multimodal biofeedback can improve the clinical symptoms of PD, but the regulation effect on motor symptoms is weaker than that of EEG biofeedback.

Yaşlı Bireyler İçin X16 Denge Test Testinin Türkçe Versiyonunun Geçerlilik Ve Güvenilirliği

Objective: This study aimed to determine the validity and reliability of the Turkish version of the X16 Balance Testing Scale for older people. Materials and Method: Three hundred and forty five older people were included in the study. The test-retest process was completed with all individuals for intra-rater agreement. For validity, the correlation with Berg Balance Scale (BBS) and Performance-Oriented Mobility Assessment (POMA) were applied. Results: For intra-rater agreement of the X16 Balance Testing Scale obtained as a result of the initial testing and retesting, results were found to be highly reliable (Cronbach's alpha coefficient = 0.904, 0.902, respectively). Test-retest reliability was found to be at a quite high or excellent level in all domains. A high correlation was found between the X16 Balance Testing Scale total score and the total scores of BBS and POMA (r=0.710, 0.706 respectively). Conclusion: The Turkish version of the X16 Balance Testing Scale was found to be valid and reliable in older people. Due to its simplicity and quickness to use, it is practical to be used for balance evaluation.

Wii Fit-Based Biofeedback Rehabilitation Among Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial.

Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors. We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted. To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors. 22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used. Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.

Effect of 5-week training session on balance in elderly with medium risk of fall: a comparative study

Background: Ageing is a process through which slow, spontaneous, and progressive changes occur in the body structure over time. Healthy ageing is also characterized by reduction in muscle mass, maximal strength, rate of force development and changes in the architectural and mechanical properties of the muscle-tendon unit, thus affecting balance in the elderly. Here, we sought to compare the effectiveness of Frenkel’s and Cawthorne-Cooksey exercises on the balance in elderly within age group 60-70 years. Methods: A comparative study was conducted on 32 geriatric people of age group 60-70 years with medium risk of fall. The risk of fall was considered using Berg Balance Scale (BBS: 21-40 score). The sample size (n=32) was divided into 16 subjects each in Group A and Group B respectively. Informed consent was taken and the procedure was explained to all the participants. Results: The effectiveness of both the interventions on BBS was compared before and after 5 weeks of training. After 5 weeks of balance training sessions of both the groups, improvement in Berg Balance Scale (BBS) scores of the elderly group was seen. Conclusions: The current study, conducted on Frenkel’s exercises and Cawthorne- Cooksey exercises (Group A and Group B, respectively) used for the elderly with medium risk of fall of the age group 60-70 years for 5 weeks using Berg Balance Scale (BBS) shows that both the groups are equally effective in improving the balance.

Effect of the Educational Intervention on the Balance of Diabetic Foot Amputees: A Randomized Controlled Study.

This study aimed to evaluate the effect of educational intervention on the balance of diabetic foot amputees. There were 2 groups and 60 patients (30 in each group) in the study. The patients were divided into 2 groups using block randomization to provide equal distribution of the minor and major amputations in groups. An education program was prepared in line with Bandura's Social Cognitive Learning theory. Education was administered to the intervention group before the amputation. Three days after the education, the patients' balance was examined using Berg Balance Scale (BBS). There were not any statistically significant differences between the groups regarding the sociodemographic and disease-related characteristics except for marital status (P = .038). The mean BBS scores were 31.4 ± 17.6 for the intervention group and 20.3 ± 17.8 for the control group. We demonstrated that the intervention lowered fall risk after minor (P = .045) but not major amputation (P = .067). We recommend using education for the patients who will undergo amputation and further studies in larger and different populations.

Effectiveness of Epley-Canalith Repositioning Procedure versus Vestibular Rehabilitation Therapy in Diabetic Patients with Posterior Benign Paroxysmal Positional Vertigo: A Randomized Trial.

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder, characterized by brief episodes of vertigo caused by changes in head position. The condition can cause significant functional impairment and reduced quality of life. BPPV is especially common among diabetic patients. The Epley-canalith repositioning procedure (CRP) and vestibular rehabilitation therapy (VRT) are two commonly used interventions for the treatment of BPPV. The objective of this study is to compare the effectiveness of Epley-canalith repositioning procedure (ECRP) and Vestibular Rehabilitation (VR) therapy in the management of vertigo among Type 2 Diabetes Mellitus patients. A total of 30 subjects with Type 2 diabetes mellitus, aged between 40 and 65 years, were randomly allocated to either the ECRP or VR therapy groups using a lottery method, and then underwent Epley-canalith repositioning procedure or vestibular rehabilitation therapy, respectively. The outcomes measured by the study were Vertigo Symptom Scale-Short Form (VSS-sf) score and Berg Balance Scale (BBS) score, assessed pre-treatment (pre) and 4 weeks post-treatment (post). The results demonstrated that both ECRP and VR therapy led to improvements in VSS-sf and BBS scores. However, VR therapy was found to be more effective, resulting in a 13.6% higher improvement in VSS-sf scores (p = 0.03) and a 5.1% higher improvement in BBS scores (p = 0.51) compared to ECRP. Both Epley-canalith repositioning procedure and vestibular rehabilitation therapy are effective in managing BPPV in diabetic patients. Although the differences in BBS scores are not statistically significant, VRT demonstrated a trend towards greater improvement. Vestibular rehabilitation therapy can be used by clinicians as another rehabilitation technique for improving vertigo, postural stability, and activity of daily living in diabetic patients with BPPV.

Examination of factors affecting pain-related self-efficacy in patients with chronic neck pain

Objective: Chronic neck pain (CNP) is a musculoskeletal disorder and has psychosocial characteristics. Our study aimed to identify demographic and clinical descriptives for pain-related self-efficacy in patients with CNP. Material and Methods: Two hundred patients (100 women, 100 men) with CNP included to the study were divided into 2 groups according to gender. Of the groups, pain-related self-efficacy, pain severity, balance skills, and physical activity level were evaluated with the Pain Self-Efficacy Questionnaire (PSEQ), the Visual Analogue Scale (VAS), the Berg Balance Scale (BBS), the Timed Up and Go Test (TUG), and the International Physical Activity Questionnaire-Long Form (IPAQ-LF). Multiple linear regression analysis was used to determine whether the models created with the variables that were determined as a result of Spearman's correlation analysis were descriptive of pain-related self-efficacy. Results: As a result of the correlation analysis, the model, created to determine the contribution of age, BMI, BBS, TUG and total IPAQ-LF scores, which were found to be associated with the pain-related self-efficacy levels, explained 62% of the total variance in women with CNP (F= 22.276; p=0.001; R2= 0.629). In men with CNP, it was revealed that the model created with the scores of VAS, BBS and TUG, which were found to be associated with the level of pain-related self-efficacy, explained 73% of the variance (F= 70.138, p&lt;0.001, R2= 0.736). While the main variables affecting the PSEQ results in women were VAS (p=0.000) and total IPEQ-LF scores (p=0.003), only VAS scores significantly contributed to PSEQ results in men. Conclusion: Primarily, reducing the severity of CNP contributes to increasing pain-related self-efficacy, regardless of gender. Moreover, increasing the level of physical activity in women may increase their belief in pain-related self-efficacy.

Balancing sensory inputs: somatosensory reweighting from proprioception to tactile sensation in maintaining postural stability among older adults with sensory deficits.

Sensory deficits increase the risk of falls among older adults. The purpose of this study was to investigate the correlations of lower extremity muscle strength, proprioception, and tactile sensation to postural stability among older adults with and without sensory deficits, to understand the contribution of each factor to postural stability, and to explore sensory reweighting among the two populations. A total of 103 participants were recruited and divided into two older adult groups with (female = 24, male = 26, age = 69.1 ± 3.15 years, height = 162.72 ± 6.94 cm, body mass = 64.05 ± 9.82 kg) and without sensory deficits (female = 26, male = 27, age = 70.02 ± 4.9 years, height = 163.76 ± 7.60 cm, body mass = 65.83 ± 10.31 kg), based on whether a 5.07 Semmes-Weinstein monofilament could be detected at foot soles. Their Berg Balance Scale (BBS), lower extremity muscle strength, proprioception, and tactile sensation were tested and compared between the two groups. Pearson's or Spearman's correlations were used to explore the relationships between the BBS and each variable. Factor analysis and multivariate linear regression were used to verify the degrees of correlation between the generated factors and the postural stability. Low BBS (p = 0.003, η2 = 0.088) scores and higher proprioception thresholds (knee flexion: p = 0.015, η2 = 0.059; knee extension: p = 0.011, η2 = 0.065; ankle plantarflexion: p = 0.006, η2 = 0.075; ankle dorsiflexion: p = 0.001, η2 = 0.106) were detected among older adults with sensory deficits compared with those without sensory deficits. Lower extremity muscle strength (ankle plantarflexion: r = 0.342, p = 0.002; hip abduction: r = 0.303, p = 0.041) and proprioception (knee flexion: r = -0.419, p = 0.004; knee extension: r = -0.292, p = 0.049; ankle plantarflexion: r = -0.450, p = 0.002; ankle dorsiflexion: r = -0.441, p = 0.002) were correlated with BBS among older adults without sensory deficits, while lower extremity muscle strength (ankle plantarflexion: r = 0.501, p<0.001; hip abduction: r = 0.302, p = 0.041) and tactile sensation (great toe: r = -0.388, p = 0.008; 5th metatarsal: r = -0.301, p = 0.042) were correlated with BBS among older adults with sensory deficits. Older adults with sensory deficits have poorer proprioception and postural stability. Somatosensory reweighting occurs from proprioception to tactile sensation among older adults with sensory deficits in maintaining postural stability.

Utility of the items of the paediatric balance scale to assess postural control in children from 3 to 10 years of age

Purpose: The purpose of the study was to find out the utility of the items of Paediatric Balance Scale to assess the development of postural control in children from the age group of 3 to 10 years of age.Relevance: Despite the importance of Postural Control Development we don’t have established measures for evaluating postural control for school- aged children in our country.Participants: This study included 160 school-aged children from the age of 3 to 10 years. The children were divided in 7 groups each of 20 children, 10 Male and 10 Female.Methods: The above study was an experimental design and correlational study for school children of age group of 3 to 10 years of age who were able to walk and stand independently without support. The children below 3 years and above 10 years and all the children who cannot maintain standing independently and have any abnormal disease process were excluded from the study.Analysis: The data was analysed using the Mann- Whitney Test and Ordinal Regression Analysis Results: Mann- Whitney Test and showed a significant progressive increase in Paediatric Berg Balance Scale Scores as age advances from 3 to 10 years of age. Ordinal Regression Analysis revealed that Item no 6,7,8,9,11,14 were found to be more sensitive out of the 14 items. There was a significant difference in males and females in 8 and 9 years of age.Conclusion: There was a positive correlation between Paediatric Balance Scores and Age. Six items were found to sensitive in evaluating development of postural control in childrenImplications: For assessing the postural control development, introduction of Paediatric Balance Scale in our school settings which are less time consumable and easy to administer is a must.

Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls.

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

Psychometric properties of Upper-body Dressing Scale in people with stroke.

To investigate the psychometric properties of the Upper-Body Dressing Scale (UBDS), a tool for evaluating upper-body dressing performance in stroke patients. Cross-sectional study. Seventy-six chronic stroke patients and 49 healthy older adults. UBDS, Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), Limit of Stability (LOS) test, Motor Activity Log (MAL-30), Arm Activity Measure (AAM), 12-item Short Form Health Survey, and Community Integration Measure - Cantonese version were assessed Results: UBDS time and UBDS score demonstrated good to excellent inter-rater and test-retest reliabilities for chronic stroke patients (intraclass correlation coefficient 0.759-1.000). UBDS time correlated significantly with FMA Upper and Lower Extremity, WMFT, and BBS scores, TUGT time, LOS Movement Velocity (affected side), LOS Maximal Excursion (composite), MAL-30 Amount of Use and Quality of Movement (affected side), and AAM (section B) scores (r = -0.61 to 0.63). The minimal detectable changes in UBDS time and UBDS score were 28.67 s and 0, respectively. The cut-off UBDS time and UBDS score were 37.67 s and 7.50, respectively. UBDS time is a reliable, sensitive, and specific measurement for assessing upper-body dressing performance in chronic stroke patients.

Adapting Geriatric Day Hospital Care From an In-House to Outreach Process

Outpatient programs have been challenged to find ways to deliver services while adhering to coronavirus disease protocols. Our Geriatric Day Hospital (GDH) Falls Clinic changed from a 6-week in-house program to an outreach program incorporating telephone assessments and home visits. We evaluated whether the outreach program was effective in improving patient outcomes in 23 serially enrolled clients. Statistically significant gains were achieved with falls, Berg Balance Scale scores, functional reach measurements, and pain management scores. Access to social support from family or friends led to higher implementation of recommendations. There was an inability to predict which clients would improve from an outreach program, but it was evident that the program benefited some clients and provided a viable alternative to an in-person program. [Journal of Gerontological Nursing, 49(4), 33-38.].

Fall risk is related to cognitive functioning in ambulatory multiple sclerosis patients.

Patients with multiple sclerosis (PwMS) may suffer severely from falling and gait disturbance. Cognitive dysfunction, a common condition in MS patients, may also increase falling rates, regardless of physical disability. We planned this study to determine the fall rate and risk factors in MS patients, follow patients for falls, and reveal the relationship between falls and cognitive dysfunction. The study was conducted on 124 patients who have RRMS diagnoses. Patients' gait speed, simultaneous gait speed during other tasks, functions of the upper extremity, balance rating, and fear of falling were evaluated with dual-task Timed-Up-and-Go-3 versions (TUG, TUG-C, TUG-M), Timed 25 Foot Walk (T25WFT), Nine Hole Peg Test (9HPT), Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I) tests. Cognitive functions, fatigue levels, and quality of life were measured with the Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and Multiple Sclerosis Quality of Life (MSQoL) test. Two groups were formed as "fallers" and "non-faller patients". We monitored the patients in six months period. Forty-six patients fell at least once in the last one year before the study began. Fallers were older, less educated, had lower SDMT scores and higher disability scores. Non-faller patients scored lower in FES-I, TUG, and FSS tests. SDMT scores showed statistically significant, linear, positive, and moderate correlation with BBS and 9HPT scores (r = 0.307, p = 0.038, and r = 0.320, p = 0.030, respectively). We determined that advanced age, lower education level, and cognitive dysfunction adversely affect gait speed and balance. Among the fallers, those with lower SDMT and MoCA scores had higher falling rates. We determined that EDSS and BBS scores are predictive factors for falls in patients with MS. In conclusion, patients with cognitive impairment should be closely monitored for the risk of falling. Consideration of falls during follow-up examinations might be predictive of cognitive deterioration in patients with MS.

Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined with Visual Feedback Training in Improving Neuroplasticity and Lower Limb Function after Chronic Stroke: A Pilot Study.

After a stroke, sustained gait impairment can restrict participation in the activities listed in the International Classification of Functioning, Disability, and Health model and cause poor quality of life. The present study investigated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and visual feedback training (VF) training in improving lower limb motor performance, gait, and corticospinal excitability in patients with chronic stroke. Thirty patients were randomized into three groups that received either rTMS or sham stimulation over the contralesional leg region accompanied by VF training groups in addition to the conventional rehabilitation group. All participants underwent intervention sessions three times per week for four weeks. Outcome measures included the motor-evoked potential (MEP) of the anterior tibialis muscle, Berg Balance Scale (BBS) scores, Timed Up and Go (TUG) test scores, and Fugl-Meyer Assessment of Lower Extremity scores. After the intervention, the rTMS and VF group had significantly improved in MEP latency (p = 0.011), TUG scores (p = 0.008), and BBS scores (p = 0.011). The sham rTMS and VF group had improved MEP latency (p = 0.027). The rTMS and VF training may enhance the cortical excitability and walking ability of individuals with chronic stroke. The potential benefits encourage a larger trial to determine the efficacy in stroke patients.

The factors associated with the deterioration of activities of daily life in stroke patients: A retrospective cohort study

ABSTRACT Background The activities of daily life (ADL) of stroke patients generally improves after rehabilitation. However, some patients remain at risk of ADL deterioration in the future. So far, there have been few studies on the factors related to ADL deterioration in stroke patients. Objective To identify the factors related to ADL deterioration in stroke patients with independent mobility after discharge. Methods We assessed 336 stroke patients with independent mobility who were discharged from the rehabilitation center between January 2016 and December 2018. The primary outcome was ADL deterioration, defined as that ADL assessed at 2 years after discharge decreased more than 15 points compared with that assessed at discharge. Univariate and multivariate statistical analyses were conducted to screen for factors related to ADL deterioration. Results Overall, 62 (18.4%) patients exhibited ADL deterioration at 2 years after discharge. Age (OR = 1.114, 95%CI = 1.045–1.188, p = 0.001), vascular risk factors>3 (OR = 3.269, 95%CI = 1.189–8.986, p = 0.022) and with post-stroke depression (OR = 2.486, 95%CI = 1.011–6.114, p = 0.047) were risk factors for ADL deterioration in stroke patients. In contrast, elevated Berg Balance Scale (BBS) scores at discharge was a protective factor for ADL deterioration (OR = 0.484, 95%CI = 0.386–0.606, p < 0.001). Conclusions Nearly 1 in 5 stroke patients with independent mobility experienced ADL deterioration at 2 years after discharge. Aging, vascular risk factors>3, BBS at discharge, and post-stroke depression (PSD) were identified as factors associated with ADL deterioration

Reliability, Concurrent Validity, and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke

ObjectiveThe aims of this study were to investigate the psychometric property of the timed Up and Go Obstacle (TUGO) test in people with stroke. DesignCross-sectional design. SettingUniversity based neurorehabilitation laboratory. ParticipantsTwenty-eight people with stroke and 30 healthy older adults. InterventionNot Applicable. Outcome MeasuresThe TUGO (obstacle heights: 0, 5, 17 cm) test completion times, Fugl-Meyer Assessment (FMA) score, ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS) score, Narrow Corridor Walking Test (NCWT) completion time, timed Up and Go (TUG) test completion time, and Community Integrated Measure. ResultsExcellent inter-rater (intraclass correlation coefficient [ICC]=0.999-1.000) and test-retest reliabilities (ICC=0.917-0.975) were found for TUGO test completion times for all obstacle heights. The TUGO test completion times for all obstacle heights were significantly correlated with NCWT and TUG test completion times (r=0.817-0.912). Only TUGO test completion times for 0 and 5 cm obstacle heights showed significant correlations with BBS scores (r=-0.518 to -0.534), while the TUGO test completion time for the 17 cm obstacle height correlated significantly with FMA scores. The minimal detectable change and optimal cut-off values for TUGO test completion times for the 0, 5, and 17 cm obstacle heights were 2.54, 3.60, and 3.07 s, and 14.69, 14.76, and 16.10 s, respectively. ConclusionThe TUGO test is a reliable, valid, and easy-to-administer clinical measure to discriminate between people with stroke and healthy older adults.

Effects of trunk stabilization exercises using laser pointer visual feedback in patients with chronic stroke: A randomized controlled study.

Many previous studies have cited the importance of trunk stabilization exercises in patients with stroke. However, the evidence for optimal trunk stabilization exercises for patients with stroke is still lacking. To investigate the effects of laser pointer visual feedback in trunk stabilization exercises that are important for improving trunk dysfunction in patients with stroke. In total, 30 patients with chronic stroke were randomly assigned to experimental and control groups. The experimental group underwent a traditional stroke rehabilitation program and trunk stabilization exercises using laser pointer visual feedback. The control group underwent a traditional stroke rehabilitation program and trunk stabilization exercises without visual feedback. Pre- and postintervention results after 6weeks were evaluated using the Berg Balance Scale, static and dynamic plantar pressure, 10-m walk test, and the Korean version of the Fall Efficacy Scale. The results were analyzed using a general linear repeated measurement model. Both groups showed significant improvements in BBS scores, static plantar pressure, dynamic plantar pressure, 10 MWT, and K-FES scores after 6weeks of intervention (P< 0.05). Compared to the control group, significant improvements were observed in the experimental group in the Berg Balance Scale scores, dynamic paretic posterior plantar pressure, 10-m walk test, and Korean version of the Fall Efficacy Scale scores (P< 0.025). Our results demonstrated the effectiveness of visual feedback during trunk stabilization exercises for resolving trunk dysfunction in patients with stroke. Trunk stabilization exercises using laser pointer visual feedback have been found to be more effective in balance, walking, and fall efficacy in patients with stroke.

Interventions to Improve Standing Balance in Individuals With Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis.

Incomplete spinal cord injury (iSCI) often results in impaired balance leading to functional impairments. Recovery of standing balance ability is an important aim of rehabilitative programs. However, limited information is available on effective balance training protocols for individuals with iSCI. To assess the methodological quality and effectiveness of various rehabilitation interventions for improving standing balance in individuals with iSCI. A systematic search was performed in SCOPUS, PEDro, PubMed, and Web of Science from inception until March 2021. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. PEDro Scale was used to assess the quality of randomized controlled trials (RCT) and crossover studies while pre-post trials were assessed using the modified Downs and Black tool. A meta-analysis was performed to quantitatively describe the results. The random effects model was applied to present the pooled effect. Ten RCTs with a total of 222 participants and 15 pre-post trials with 967 participants were analyzed. The mean PEDro score and modified Downs and Black score was 7/10 and 6/9, respectively. The pooled standardized mean difference (SMD) for controlled and uncontrolled trials of body weight-supported training (BWST) interventions was -0.26 (95% CI, -0.70 to 0.18; p = .25) and 0.46 (95% CI, 0.33 to 0.59; p < .001), respectively. The pooled effect size of -0.98 (95% CI, -1.93 to -0.03; p = .04) indicated significant improvements in balance after a combination of BWST and stimulation. Pre-post studies analyzing the effect of virtual reality (VR) training interventions on Berg Balance Scale (BBS) scores in individuals with iSCI reported a mean difference (MD) of 4.22 (95% CI, 1.78 to 6.66; p = .0007). Small effect sizes were seen in pre-post studies of VR+stimulation and aerobic exercise training interventions indicating no significant improvements after training on standing balance measures. This study demonstrated weak evidence to support the use of BWST interventions for overground training for balance rehabilitation in individuals with iSCI. A combination of BWST with stimulation however showed promising results. There is a need for further RCTs in this field to generalize findings. Virtual reality-based balance training has shown significant improvement in standing balance post iSCI. However, these results are based on single group pre-post trials and lack appropriately powered RCTs involving a larger sample size to support this intervention. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further well-designed and appropriately powered RCTs to evaluate specific features of training interventions to improve standing balance function in iSCI.

시각 차단을 사용한 수행-기반 트레드밀 보행 훈련이 만성 뇌졸중 환자의 균형과 보행 능력에 미치는 영향 : 단일 사례 연구

This study aimed to examine the effects of performance-based treadmill walking training with visual deprivation on balance and walking functions in patients with chronic stroke. We performed this study with a single-subject experimental research design (A-B-C). One patient with chronic stroke participated in this study. Experimental sessions consisted of three phases (a total of 20 sessions): (1) baseline phase, (2) 1st intervention phase, and (3) 2nd intervention phase. During the two intervention phases, performance-based treadmill walking training was performed, and visual deprivation was added in the 2nd intervention phase only. Intervention was performed for an average of 60 min, twice per day for two weeks. Outcome measures included Berg Balance Scale (BBS), Timed Up-and-Go test (TUGT), 10-meter walk test (10MWT), and Dynamic Gait Index (DGI). The BBS and DGI scores improved by 11 and 6 points, respectively. Furthermore, TUGT (36.91 sec) and 10MWT (18.74 sec) improved in the 1st intervention phase, and more improvement (TUGT: 56.45 sec, and 10MWT: 45.18 sec) was observed during the 2nd intervention phase. These results indicates that the performance-based treadmill walking training might improve balance and walking functions, with more favorable outcomes when visual deprivation was added. Further studies are required to support these results.

Effectiveness of Home Based Telerehabilitation for Forward Versus Backward Stepping Strategy in Ground Walking Training on Functional Mobility and Balance Among Spastic Diplegic Cerebral Palsy-- A Simple Experimental Study

Background: The primary focus of physiotherapy interventions for children with CP is to improve locomotor function and functional activities. It is suggested that walking training activates neural circuits that mediate central pattern generators to activate limb muscles repetitively and produced rhythmic movements. Additionally, it adjusts control between agonist and antagonist muscles, leading to enhanced walking speed, and static and functional balance. The purpose of the study is to find out the effectiveness of home based telerehabilitation for forward stepping vs backward stepping strategy in ground walking training on functional mobility and balance among spastic diplegic cerebral palsy. Methodology: A simple experimental study was conducted on 24 spastic diplegic cerebral palsy who fulfill the selection criteria were selected for this study at the telerehabilitation Unit. A clear explanation was given to every subject and parents/guardian about the procedures and a written consent was obtained from them. Twenty spastic diplegic children were evaluated in person in the department for pre-training and post-training were used as a study design with total study duration was six weeks. (from April 2021 to May 2021). The subjects in group A&amp;B were consisting of 12 subjects and they were treated with home based telerehabilitation for forward and backward ground walking training. Along with that both the group children received routine physiotherapy. Both the groups were received intervention for 15-30 minutes per session, 5 days in a week for a period of 6 weeks. The pre and post score values of balance and functional mobility were measured by using, GMFM walking dimension, modified timed get up and go test and Pediatric Berg balance scale. The values were recorded and documented. Result: In the statistical analysis of pretest values of both group A and group B were calculated. The pre mean values of PBS for both groups were 33.33 and 33.38. The T-value was 0.3721 the obtained t-value is lesser than the table value and the P-value showed there were no significant in pretest comparison. The posttest mean values of PBS for both groups were 46.08 and 46.33.The T-value was 2.38967,the obtained t-value is greater than the table value. and the P-value showed there were significant in posttest comparison. Alternative hypothesis was accepted. Hence the statistical report states that there were statistically significant differences in posttest comparison. The post score values of the Gross Motor Function Meaure-88, Pediatric Berg Balance Scale and TUG test score in all the variables showed significant difference. Conclusion: The study concluded that the 6 weeks of backward stepping strategy in ground walking home based telerehabilitation training program along with regular physiotherapy treatment showed statistically significant improvement in balance and functional mobility among spastic diplegic children when compared to forward stepping strategy in ground walking home based telerehabilitation training program.