Conventional Balance Training Research Articles

Effects of VR task-oriented training combined with rTMS on balance function and brain plasticity in stroke patients: a randomized controlled trial study protocol

BackgroundBalance dysfunction affects 70% of stroke patients. Emerging neurophysiological approaches, such as virtual reality therapy (VRT) and repetitive transcranial magnetic stimulation (rTMS), have been proven by clinical studies that the balance function of stroke patients can be improved when applied alone, but there are relatively few studies on the combined treatment of balance dysfunction after stroke. This study aimed to evaluate the impact of a 4-week intensive intervention combining VRT and rTMS on both balance function and brain plasticity among stroke patients.MethodsThis single-blind, randomized controlled trial was conducted at the Rehabilitation Medical Center of the Rehabilitation General Hospital of Ningxia Medical University. A cohort of 136 stroke patients, with durations of 2 to 24 weeks post-stroke, were enrolled in the study. Participants were randomly allocated in a 1:1:1:1 ratio to four groups: the VR group (n = 34), the rTMS group (n = 34), the combined treatment group receiving both VR and rTMS (n = 34), and the control group undergoing traditional balance training (n = 34). All patients underwent a standardized inpatient rehabilitation program over 4 weeks. The VR group received daily 30-min sessions of VR therapy for 20 days. The rTMS group underwent daily sessions of rTMS stimulation for 20 min, targeting the motor imagery region in the affected hemisphere. The combination group received VR therapy after completing their rTMS treatment. The control group received conventional balance training, with each session lasting 30 min. Additionally, all patients received an extra 60 min of standard rehabilitation therapy twice daily. Assessments were conducted at baseline, 2 weeks, and 4 weeks post-treatment, using the Berg Balance Scale (BBS) as the primary measure, and secondary measures including the Timed Up-and-Go Test (TUGT), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), and 6-m walking test (6MWT), as well as assessments for brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VGEF), tyrosine receptor kinase (TrκB), motor-evoked potential latency (PL), central motor conduction time (CMCT), and amplitude.DiscussionThe widespread application of VR technology and rTMS in clinical settings is well-established. However, the potential synergistic effects of combining these modalities on balance function and neuroplasticity in stroke patients remain uncertain. Our hypothesis suggests that the integration of VR with rTMS may result in more pronounced improvements in both balance function and neuroplasticity among stroke patients, surpassing the outcomes achievable with VR alone, rTMS alone, or traditional therapy. The possible mechanism is that VR-based training combined with rTMS plays a superimposed effect, promoting better repair of damaged neurons and ultimately improving balance function in stroke patients. The positive results anticipated from this trial could provide objective evidence advocating for the concurrent use of VR and rTMS in clinical interventions.Trial registrationThe study protocol underwent review and approval by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 26, 2024 (No. KYLL-2024–0162). Subsequently, it was registered in the Chinese Clinical Trial Registry on March 11, 2024 (registration number: ChiCTR2400081775). Currently, the study is still ongoing.

Efficacy and safety of using a unilateral lower limb exoskeleton combined with conventional treatment in post-stroke rehabilitation: a randomized controlled trial.

The incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population. To assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia. This multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21days. The CG underwent a standard daily rehabilitation routine for 21days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21days of rehabilitative training. The BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy's safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population. The LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.

The Effect of Motor Dual -Task Balance Training on Balance and Gait of Elderly Women

BACKGROUND: Aging in its broadest sense is the continuous and irreversible decline in the efficiency of various physiological processes. India has second largest number of elderly (60+) in the world. One of the most common problems of elderly is fall. They are the cause of accidental death among people over 65 years of age and account for significant mortality and morbidity, including fractures, impaired mobility and decreased quality of life due to fear of falling and death. Balance is dynamic phenomenon that requires stability and mobility to be a good harmony and in order to properly maintain body balance, the ability to integrate the neurological and musculoskeletal system is important. Balance control is a necessary component of stable walking. Dual-task training is defined as the ability to perform two or more cognitive and motor activities simultaneously while maintaining postural control. AIMS AND OBJECTIVES: To study the effect of motor dual-task balance training on balance and gait of elderly women. METHODOLOGY: Thirty females were randomly selected according to inclusion and exclusion criteria and was divided into two groups – Group 1: Experimental group and Group 2: Control group. Both the groups were assessed for the berg balance scale and dynamic gait index. These parameters were assessed before the start of the program as pre-test values and at the end of 6 week as post-test values. Group 1 received motor dual task balance training and Group 2 conventional balance and gait training. RESULT: The mean age of group 1 was 67.4 years and group 2 was 67.07 years. The statistical analysis correlates the study by proposing that groups taken for study either group1 treated motor dual task balance training and Group 2 conventional balance and gait training.and also showed that group 1 treated with motor dual task balance training had higher significance when compared to group 2 treated with conventional balance and gait training. The mean improvement in BBS was 13.74 in group 1 and 10.66 in group 2. The mean improvement in DGI scores was 6.47 in group 1 and 3.73 in group 2. It was resulted that group 1 received motor dual task balance training had a superior effect over group 2 received conventional balance and gait training. CONCLUSION: This study concluded that motor dual task balance training had effective tool in improving balance and gait control and decreases tendency of falls in elderly women. KEY WORDS: Fall, Elderly, Balance, gait, BBS, DGI, motor dual task balance training, conventional balance and gait training.

Improving trunk posture control in children with CP through a cable-driven robotic hippotherapy: A randomized controlled feasibility study

BackgroundMany children with cerebral palsy (CP) show impairments in trunk posture control, one crucial factor contributing to impairments in gait and arm manipulation. Research questionThe goal of this study was to test the feasibility of the cable-driven hippotherapy system on improving trunk posture control and walking function in children with CP. MethodTen children were recruited in this study with average age 6.4 ± 3.0 years old, and were randomly assigned to the robotic group and the conventional balance training group. A custom designed cable-driven robotic hippotherapy system was used to deliver controlled pelvis perturbations while children were sitting astride. Participants from both groups underwent intensive robotic hippotherapy training or conventional balance training, depending on their group assignment, for 6 weeks (3 time/week). Outcome measures were assessed pre and post 6 weeks of robotic or conventional balance training, and 8 weeks after the end of training (follow-up test). The primary outcome measure was trunk control, which was measured using the Trunk Control Measurement Scale (TCMS). In addition, the Gross Motor Function Measure (GMFM-66), self-selected overground walking speed, and 6-minute walking distance were also assessed. ResultsThe change in TCMS score from baseline to the post intervention was significantly greater for the robotic group than that for the conventional group (i.e., 6 ± 3 vs. −1 ± 5, p = 0.048, Mann-Whitney test). GMFM scores, self-selected overground walking speed, and 6-minute walking distance showed no significant improvement after robotic hippotherapy and after conventional balance training (p > 0.05). SignificanceResults from this study indicated that it was feasible to improve trunk posture control in children with CP using a cable-driven robotic hippotherapy system. Knowledge obtained from this study may provide an insight for the development of new perturbation-based intervention approaches for improving trunk posture control in children with CP.

Effects of Head and Neck pattern of PNF combined with conventional balance training in older adults with balance impairment – A Randomized control Trial

BackgroundFalls are a prevalent and serious concern among individuals in their older life. Residual impairments, such as balance and gait deficiencies, reduced sensory processing, and diminished strength, are the common causes of falls. Balance and mobility deficits can last for years and are linked to a high rate of falls (>6 months). Proprioceptive Neuromuscular Facilitation is neuromuscular re-education in which sensory receptors are stimulated to provide information regarding body posture and movement. ObjectiveTo identify the effects of Head and Neck Pattern of PNF combined with Conventional Balance training in elderly. MethodsA total of 40 subjects were randomly assigned to the Experimental Group (Group A) and the Control Group (Group B) (Group B). The following were the criteria for inclusion: Subjects aged 60–80 years old, of both genders, who had experienced one or more episodes of loss of balance in the previous 12 months, were ambulating independently, had a Mini-mental scale score of 24 or higher, and were ready to participate. Subjects with heart or lung disease, chronic neurological diseases, mental illness, an acute orthopaedic ailment, or a head injury were excluded. ResultsGroup A showed greater improvement when compared to Group B (p < 0.05) Comparison of Pre and Post values of FAB and CBMS showed significant difference (p < 0.05). ConclusionsThe study provides evidence that PNF Pattern based Exercises when combined with Conventional Balance Training is effective in training individuals with balance impairment.

Comparison between six-week exergaming, conventional balance and no exercise training program on older adults’ balance and gait speed

Abstract We evaluated differences between a six-week exergame-training and a conventional balance training program on the balance and gait speed of older adults’ (&gt;65 years). Forty-two healthy participants were recruited from independent living and community centers and randomized to one of three groups: exergaming balance training (EBT), conventional balance training (CBT), or control (no training). The participants completed two balance measurements (Fullerton Advanced Balance Scale (FAB) and center of pressure (COP) excursion), and gait speed at pre, post-intervention, and after a three-week follow-up. Both EBT and CBT groups improved their scores on the FAB, COP displacement, and gait speed post-intervention (p&lt;0.05) and these changes were maintained and did not return to pre-training values after three weeks of detraining. The control group scores for FAB and gait velocity values declined (p&lt;0.001) but not COP excursions during the study. This six-week exergame training program improved balance control and gait speed in community-dwelling seniors in a similar fashion to conventional training. Participants’ physical abilities scores improved and were maintained following three weeks of detraining. Exergame-based training therefore may be considered as an intervention that can address balance control and gait speed in older adults. As well improved scores can be maintained with transient or sporadic activity.

Ab. No. 15 Efficacy of ADL-Based Dynamic Postural Stability Exercises After Canalith Repositioning Maneuver in Benign Paroxysmal Positional Vertigo Patients

Introduction: CRP produces short-term effects, not sufficient to reactivate postural control in BPPV. Most studies prescribe balance training which is not well incorporated with ADL activities. Hence, this study aimed to find out the effectiveness of ADL-based dynamic postural stability exercises. Benign paroxysmal positional vertigo is a common peripheral vestibular disorder. Canalith repositioning manoeuvre is considered to be the gold standard method of treatment. Even after CRP 2/3rd of patients has postural instabilities, especially in dynamic conditions such as walking, sitting to standing, and in performing daily activities, which was not given attention in studies and treatment programs. Methods: 100 BPPV patients (50 each in interventional and control group) aged between‹18–60 years, positive for Dix Hallpike test/supine roll test confirmed by an ENT specialist and treated with CRP by random sampling. All patients were evaluated by the Berg balance scale, POMA (gait scale), and Dizziness Handicap Inventory on the third day of CRP. The control group received CRP with conventional balance training whereas the interventional group received ADL-based dynamic postural stability exercises (with more challenging environments involving various sensory inputs with postural strategies) along with CRP for 2 weeks. Data was analyzed using SPSS version 23; the Mann-Whitney U test (between group analysis) and Wilcoxon Signed Rank test (within group analysis) were used. Result: In the interventional group, there was greater improvement in balance in dynamic conditions, functional ability, and reduction in dizziness (p value‹0.05) in ADL activities. Conclusion: ADL-based exercises are beneficial for the improvement of balance, reduction in dizziness, and improving functional activities after CRP in BPPV patients. As this postural instability/residual dizziness has an impact on ADL in BPPV patients even after CRP, if untreated may lead to compensatory strategies that delay functional recovery. Hence, this instability period should be managed with ADL-based dynamic postural stability exercises.

Ab. No. 69 Comparative Study on Effect of Square Stepping Exercises With Conventional Balance Exercises on Balance in Community Dwelling Elderly Population: A Randomized Control Trial

Introduction: Determining &amp; comparing the effects of Square Stepping Exercises (SSE) versus Conventional balance exercises after 4 weeks training in the older adults. To tackle age-related decline in balance performance in elderly, physical interventions are essential. SSE is a novel intervention that can enhance balance and reduce the risk of falls. Methods: 40 healthy community dwelling older individuals of age 60 years &amp; more with ability to walk backwards for 3 meters were included in the study. Participants were randomly allocated into two groups of 20 each using sealed envelope method. Limits of Stability (LOS) and Mini-BES Test were assessed as outcome measures prior to and after the 4 weeks of training. Non-Parametric test were used to analyze the data of Mini BESTest as the data was not normally distributed. Whereas the rest of the data (LOS) were normally distributed, hence parametric tests were used to analyze. Results: Both the groups showed statistically significant results when compared to their pre-intervention scores (p&lt;0.0001) The between group comparison did not show any statistically significant difference on balance components (p&gt;0.05). Conclusions: Both Conventional balance training exercises and Square stepping exercises were found to be equally effective in improving balance in elderly. Implications: SSE does not have an advantage over the conventional balance exercises, however it can be used as an adjunct to the conventional balance training to introduce variety in training of community dwelling elderly with adequate safety measures in place.

Effects of visual feedback balance system combined with weight loss training system on balance and walking ability in the early rehabilitation stage of stroke: a randomized controlled exploratory study.

Previous studies have suggested that the Pro-Kin visual feedback balance system can promote the recovery of balance function in stroke patients. However, this system has not been used effectively in the early stages of stroke rehabilitation. This study aimed to investigate the effect of Pro-Kin system combined with weight loss system for the early recovery of balance and walking ability following a stroke. A total of 62 patients who underwent radiological diagnosis of stroke were randomly divided into two groups: a control group (n = 31) and a treatment group (n = 31). Both groups received conventional balance training. The treatment group also received training on the Pro-Kin system in conjunction with a weight loss system. Balance was measured using the Berg Balance Scale (BBS), Timed 'Up & Go' (TUG) test and Pro-Kin system. Walking ability was assessed using the Functional Ambulation Classification (FAC). The tests were performed before the start of treatment and on the 4th week following the training. There was no statistically significant difference between the groups before training. After 4 weeks of training in both groups, there were significant improvements in balance and walking ability. BBS values and FAC were significantly higher (p < 0.01), TUG times, ellipse area and motion trajectory length were significantly reduced (p < 0.01, p < 0.05) after training. The treatment group outperformed the control group (p < 0.05). In addition, there was a positive correlation between balance function and walking ability (p < 0.01). The Pro-Kin system combined with weight loss system is a viable method that promotes early reconstruction of balance and walking ability following a stroke. Clinical trial number ChiCTR1900026370. https://www.chictr.org.cn/showprojEN.html?proj=43736.

Is Balance Training Using Biofeedback Effective in the Prophylaxis of Falls in Women over the Age of 65?

The paper aims to investigate the usefulness of training in improving mobility and reducing the risk of falls of patients with osteoarthritis by using a force plate and virtual reality as rehabilitation tools. The study involved 72 women randomly divided into two equal groups: the force plate training group, which underwent virtual balance training with visual motor feedback, and the gym training group, which received conventional balance training only. The functional balance assessment was performed before and after the rehabilitation by computerized posturography in a relaxed upright position with open and closed eyes, with visual motor feedback. In the FPT group in the feedback measurement, the mean radius of sways was 30% smaller after rehabilitation (p < 0.00002); the feedback coordination coefficient was more than 10% bigger after rehabilitation (p < 0.001) and reached 92%, which is excellent for elderly people. Total stagnation and stumbling reported by patients decreased after rehabilitation compared to the first examination. Both tested forms of training can contribute to reducing the risk of falls. However, a more significant improvement was obtained in the force plate training group perhaps because the physical effort on a force plate trains the precise movements needed to reposition the centre of gravity without generating excessive inertia forces responsible for loss of balance and falls. Perhaps the most desirable method of intervention is to train a person's ability to perform slow but definite body movements.

Effect of Hemibridge with Ball and Balloon Exercise on Balance, Gait Speed, Fear of Fall, and Quality of Life in Elderly – A Randomized Controlled Trial

Context: Hemibridge with ball and balloon exercise causes co-contraction of the core, pelvic floor muscles, and lower limb muscles. However, limited data exist about the efficacy of these exercises in elderly individuals. Aim: The aim of this study was to determine the effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of falls, and quality of life in elderly individuals. Settings and Design: A randomized controlled trial was conducted at a tertiary care center and old age homes. Subjects and Methods: Thirty-six (n = 36) elderly individuals were randomly allocated to the control and experimental groups. The control group received conventional balance training, while the experimental group received hemibridge with ball and balloon exercises with conventional balance training exercises. The outcome measures were the Timed-Up and Go test (TUG), 4-m gait speed (4MGS) test, Short Falls-Efficacy Scale (SFES), and RAND 36-Item Short-Form Survey (SF-36). Both groups received treatment for 3 weeks with three sessions a week. Statistical Analysis: The test used for between-group analysis was the Mann–Whitney U-test and for within-group analysis was the Wilcoxon matched-pair test. Results: The between-group results for TUG, 4MGS test, and SFES for the experimental group showed a statistical significance compared to the control group. However, the results of the RAND SF-36 health survey for the experimental group were not statistically significant compared to the control group. Conclusion: Hemibridge with ball and balloon exercise with conventional balance exercises showed beneficial effects on balance, gait speed, fear of falls, and quality of life for the elderly.

Effects of Resistance Exercise Using Theraband with Weighted Cuff Resistance on Fall Risk and Balance among the Geriatric Population: A Randomised Controlled Trial

Introduction: Balance impairments and an increased fall risk are common concerns among individuals with various health conditions. Resistance exercise has shown potential in improving balance and reducing fall risk. Aim: To determine the effects of home-based Thera-Band resistance training in reducing the risk of falls among the geriatric population and to compare it with weight-cuff resistance training. Materials and Methods: A Randomised Controlled Trial (RCT) was conducted at the Amity Institute of Health and Applied Science, Noida, India, from November 2022 to April 2023. The intervention period spanned four weeks, and a total of thirtythree subjects were enrolled in the study. The participants were divided into three groups: Group A, Group B, and Group C. Group A performed resistance exercises using weight cuffs combined with standard balance training, Group B performed resistance training with Thera-Band combined with standard balance training, and Group C received standard balance exercises alone. The effects of the interventions on fall risk reduction were assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG), and Fall Efficacy Scale (FES) among the geriatric population. Paired t-tests were employed to compare pre- and post-intervention data within each group, determining significant changes within each group over the intervention period. Analysis of variance (ANOVA) was utilised to assess between-group effects of the different interventions. Results: The FES scores were assessed pre- and postintervention for each group. Group B (Thera-Band) demonstrated significantly better outcomes in fall efficacy compared to Group A (Weight-cuff) (p&lt;0.01) and Group C (p&lt;0.01). For balance assessment using the BBS, both Group A and Group B showed better results compared to Group C (p&lt;0.01). In terms of mobility assessed through the TUG test, Group B exhibited substantial improvement compared to both Group A and Group C (p&lt;0.05). Improvements in fall efficacy, balance, and mobility were seen in Group B (Thera-Band). Conclusion: Home-based resistance training using TheraBand was found to be the most effective method for reducing the risk of falls in the geriatric population, followed by weightcuff resistance training in combination with conventional balance training. Thera-Band is not only effective but also more convenient, hassle-free, and cost-effective. The geriatric population should be provided with more multi-mode exercises that are easy to perform and have been found to be effective and helpful at their advanced age.

DOES PERTURBATION-BASED BALANCE TRAINING ON COMMERCIAL TREADMILLS IMPROVE BALANCE RECOVERY IN OLDER ADULTS?

Abstract Background Perturbation-based training (PBT) is a balance training method that causes a trip like event requiring a rapid step response to regain balance. There are numerous examples in the literature demonstrating the effectiveness of PBT but the need to use an expensive treadmill in a scientific laboratory limits the general applicability of PBT as a community-based intervention. A possible solution is to rapidly stop the treadmill belt during walking using the e-brake as the perturbation event. Importantly this could be performed on a commercially available, lower cost treadmill. Therefore, the purpose of this study was to evaluate the effectiveness of a commercial treadmill during PBT. Methods Seventeen participants completed either 9 weeks of PBT or conventional balance training based on ACSM guidelines. During an initial and final testing session participants balance recovery performance was evaluated. Participants were released from a forward static lean angle and asked to recover with a single step, during this test their movement was recorded and subsequently used to determine the Margin or Stability pre- and post-training. Participants were tracked for 6 months following the intervention and falls were recorded on a weekly basis. Results and Summary: There was no difference in balance recovery performance between groups following the training intervention and there was no difference in fall rate between groups in the 6-month follow-up period. We conclude that overall using the e-brake of a commercial treadmill is ineffective as a PBT strategy as it elicits no greater benefit than conventional exercise training.

Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial

Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR). The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes. We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters. We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p≤0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p=0.022): post-hoc analysis revealed within-group differences in the EG (p=0.002) but not CG (p=0.834). We found no significant between-group differences in other outcomes. Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG. GOV: NCT03454256.

Perturbation-based Balance Training to improve postural responses and falls in people with multiple sclerosis: a randomized controlled trial

Purpose To determine the effects of Perturbation-based Balance Training (PBT) on postural responses and falls in people with multiple sclerosis (PwMS) and compare the results with conventional balance training (CBT). Materials and methods Thirty-four PwMS were randomized to receive 4 weeks of PBT or CBT. Latency of postural responses to external perturbations, Timed-Up-and-Go (TUG), 10-meter-walk (10MW), Berg Balance Scale (BBS), and Activities-specific Balance Confidence Scale (ABC) were measured at baseline and post-training. Also, the proportion of fallers and fall rate were assessed at a 3-month follow-up. Results The latency of postural responses significantly decreased in PBT compared to CBT. TUG, 10MW, BBS, and ABC, at post-training, and relative risk of falls and fall rate at 3-month follow-up had no statistically significant between-group differences. Conclusions The results show that PBT is at least as effective as CBT in improving balance and decreasing falls, while it has superiority over CBT whenever the clinicians mainly aim to improve reactive balance strategies. Future studies with a larger sample size are warranted to complement the results of this study. Implication for rehabilitation Perturbation-based Balance Training is at least as effective as conventional balance training (CBT) in improving proactive postural control in people with multiple sclerosis (PwMS). Perturbation-based Balance Training has superiority over CBT in improving reactive postural control in PwMS. Perturbation-based Balance Training has no superiority over CBT in improving fall-related outcomes.

Effects of 12 weeks of Tai Chi Chuan intervention on the postural stability and self-reported instability in subjects with functional ankle instability: Study protocol for a randomized controlled trial.

BackgroundTai Chi Chuan (TCC) is a physical activity modality that originated in China and is now widely popular around the world. Although there are a series of articles reporting that TCC can improve balance and other functional symptoms in a variety of populations, including the elderly, patients with stroke, and patients with Parkinson's disease, its efficiency has not been scientifically and methodically evaluated in subjects with functional ankle instability (FAI). Moreover, there is no literature directly comparing TCC and conventional balance training (CBT) interventions for FAI. The objective of this study is to investigate the comparative effects of TCC intervention and CBT protocols in improving postural balance and subjective instability feelings in patients with FAI.MethodsThis study will be a single-center, parallel group, randomized controlled trial. Sixty-eight patients with FAI will be included and randomly assigned in a 1:1 ratio to either an intervention group (n =34) or a control group (n = 34). The participants in the intervention group will complete 12 weeks of TCC intervention (40 min/time, 3 times/week for 12 weeks) on the basis of health education treatment. The control group will receive health education and 36 CBT sessions during a 12-week period. Outcome measures include postural stability and self-reported feelings of instability at baseline, after the end of the intervention, and 3-month follow-up. The postural stability assessment of patients with FAI will be detected by performing static and dynamic postural tests, which will be carried out through a specific balance platform (TecnoBody ProKin). Self-reported feelings of instability will be assessed by Cumberland Ankle Instability Tool (CAIT), American Orthopedics Foot and Ankle Society's Ankle–Hindfoot Evaluation Scale (AOFAS-AHES), and the MOS item Short Form Health Survey (SF-36).DiscussionThis trial will demonstrate whether a 12-week TCC intervention positively affects postural stability and self-reported outcomes in patients with FAI. At the same time, the superiority of its clinical efficacy will also be compared with that of CBT. This study may also help to redefine the value of traditional Chinese exercises in the treatment of chronic ankle instability.Clinical trial registrationChinese Clinical Trial Registry: ChiCTR2100041790. Registration date: 22 March 2021. http://www.chictr.org.cn/edit.aspx?pid=119501&htm=4.

Effects of Balance Training Using a Virtual Reality Program in Hemiplegic Patients.

Therapeutic goals for hemiplegic patients with neurological impairments are mainly focused on improving their independent lives. Based on the previously reported effectiveness of Wii Fit balance training, this study investigated the most influential outcomes after long-term intensive training (including balance and functional factors) on quality of life in hemiplegic patients. The intervention group (n = 21) received Nintendo Wii Fit balance training under supervision, and control group (n = 20) received conventional balance training by an occupational therapist. Two groups were matched based on age and onset duration. Both groups received a total of 15 treatments for 30 min per session, twice a week for 8 weeks. There were significant improvements not only in balance confidence and activities of daily living, but also in body composition, such as fat proportion and metabolic rate, in the intervention group compared to the control group (p < 0.05). In particular, balance confidence significantly affected EuroQoL Visual Analogue Scale according to stepwise multiple regression analyses in this study. These results demonstrated that Wii Fit balance training using virtual reality improved the quality of life of hemiplegic patients while overcoming the asymmetrical weight distribution of the affected side via the self-modulating biofeedback exercises.

Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial.

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children’s experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant’s experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

Dual-Task Balance Training for Motor Skill Development among Children with Intelligence Quotient Discrepancy.

The motor skills of people with mental disabilities are reportedly reduced compared with those of their peers. Therefore, any task incorporating both motor and cognitive skills was hypothesized to provide better motor recovery. The aim of this study is to find the effect of dual-task balance training (DTBT) on motor skill development in children of 6–13 years with intelligence quotient discrepancy (IQD) (score: 50–79). Overall, 30 individuals with mental disabilities aged 6–13 years having an IQ score of 50–79 were included. The participants were randomly divided into two groups that received dual-task training and standard balance training, respectively. IQ was measured with the Wechsler Intelligence Scale for Children-Revised, motor proficiency with the Bruininks–Oseretsky test, reaction time with COGNIBOARD, and balance with Functional Reach Test scores. Intervention was provided twice a week for 12 consecutive weeks. Participants in both groups showed higher test scores in all tests after the training program. Both training programs positively affected the motor performance of the participants. The DTBT was more effective in improving balance performance than the standard balance training. DTBT is a better tool than conventional balance training for improving motor skills and balance in children of 6–13 years with IQD (score: 50–79).

Balance Training With Vibrotactile Neurofeedback and Ginkgo Biloba Extract in Age-Related Vertigo.

Background: Balance training with vibrotactile neurofeedback (VNF) can improve balance and subjective impairment in age-related vertigo and dizziness. Ginkgo biloba dry extract EGb 761 has been shown to improve subjective impairment in chronic vertigo and the efficacy of conventional balance training. The combination was expected to work synergistically in this difficult-to-treat population.Objectives: To demonstrate the efficacy of VNF added to EGb 761 for age-related vertigo and dizziness.Design: Multicenter, prospective, controlled, randomized, single-blind, two-arm trial (German Clinical Trials Register https://www.drks.de No. DRKS00007633).Setting: Specialist offices and tertiary care outpatient department.Participants: One hundred and twenty subjects aged 60+ years with chronic dizziness for over 3 months, a Dizziness Handicap Inventory (DHI) Sum Score >25 and fall risk in balance-related situations as measured by the geriatric Standard Balance Deficit Test Composite Score (gSBDT-CS)>40. Patients with other distinct vestibular pathology (e.g., Meniére's disease, stroke, BPPV) were excluded.Intervention: EGb 761 (80 mg twice daily for 12 weeks) plus 10 days of individually adapted balance training with VNF, randomized 1:1 to sensitive (active) or non-sensitive (sham) neurofeedback.Measurements: The change in gSBDT-CS after 6 weeks (primary), other gSBDT outcomes, DHI, cognition, hearing, and safety.Results: One hundred nine of 120 enrolled subjects received both treatments at least once. Over 12 weeks, the gSBDT-CS improved by 6.7 (active) vs. 4.5 (sham). There was a difference in favor of the active treatment of −2.4 (95% CI −5.4; 0.6) after 6 weeks. Under active treatment, more pronounced effects occurred in all secondary analyses and in nearly all secondary endpoints. The DHI sum score decreased from 44.1 to 31.1 in the total sample with a treatment group difference after 6 weeks of −3.1, 95% CI (−7.1; 0.9). No safety issues were reported.Conclusion: Over 12 weeks, the combination of balance training with VNF and Ginkgo biloba dry extract EGb 761 reached a clinically relevant improvement of age-related vertigo and dizziness with a good pharmacological safety profile.