Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Use of visual feedback in retraining balance following acute stroke. The development and clinical evaluation of a standing biofeedback trainer. Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function. Effects of balance training on hemiplegic stroke patients.
Visual biofeedback/forceplate systems are often used for treatment of balance disorders. In this study, the researchers investigated whether the addition of visual biofeedback/forceplate training could enhance the effects of other physical therapy interventions on balance and mobility following stroke.
                The study included a sample of convenience of 13 outpatients with hemiplegia who ranged in age from 30 to 77 years (mean=60.4, SD=15.4) and were 15 to 538 days poststroke.
                Subjects were assigned randomly to either an experimental group or a control group when the study began, and their cognitive and visual-perceptual skills were tested by a psychologist. Subjects were also assessed using the Berg Balance Scale and the Timed "Up & Go" Test before and after 4 weeks of physical therapy. Both groups received physical therapy interventions designed to improve balance and mobility 2 to 3 times per week. The experimental group trained on the NeuroCom Balance Master for 15 minutes of each 50-minute treatment session. The control group received other physical therapy for 50 minutes.
                Following intervention, both groups scored higher on the Berg Balance Scale and required less time to perform the Timed "Up & Go" Test. These improvements corresponded to increased independence of balance and mobility in the study population. However, a comparison of mean changes revealed no differences between groups.
                Although both groups demonstrated improvement following 4 weeks of physical therapy interventions, no additional effects were found in the group that received visual biofeedback/forceplate training combined with other physical therapy. Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke, although it is not clear whether functional balance ability also improves. This study compared the relative effectiveness of visual feedback training of center-of-gravity (CoG) positioning with conventional physical therapy following acute stroke.
                Forty-six people who had strokes within 80 days before the study, resulting in unilateral hemiparesis, and who were in need of balance retraining participated.
                Initially, subjects were randomly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited. The next 14 subjects were assigned to a control group. All subjects received physical therapy and occupational therapy (regular therapy) 2 hours a day, and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge. The visual feedback group received information about their CoG position as they shifted their weight during various activities. The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting. Static (postural sway) and activity-based measures of balance (Berg Balance Scale, gait speed, and the Timed "Up & Go" Test) were contrasted across the 3 groups at baseline, at discharge, and at 1 month following discharge using an analysis of variance for repeated measures.
                All groups demonstrated marked improvement over time for all measures of balance ability, with the greatest improvements occurring in the period from baseline to discharge. No between-group differences were detected in any of the outcome measures.
                Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke. A new standing biofeedback training device, which includes a height-adjustable work table, weight-bearing sensors, and a real-time visual and auditory feedback system, has been developed for postural training. Sixty persons with hemiplegia after acute stroke or traumatic brain injury were randomly divided into Group A (experimental) and Group B (control). After a training period of 4 weeks, the percentage of postural asymmetry in Group A and Group B was reduced from 17.2 +/- 10.8% and 17.0 +/- 10.0% to 3.5 +/- 2.2% and 10.1 +/- 6.4 percent, respectively (p = 0.003). There was no significant difference between subjects with right or left hemiplegia. The results indicated that this device had a positive training effect on stance symmetry in hemiplegic subjects. A static force plate system was used to examine postural sway characteristics in 16 hemiplegic patients and in 34 normal elderly subjects. The effectiveness of postural sway (center of pressure) biofeedback was compared to conventional physical therapy practices in reestablishing stance stability in hemiplegic patients. Postural sway abnormalities in hemiplegic patients included significant mean lateral displacement of sway towards the nonaffected leg and increased total sway area. Postural sway biofeedback was more effective than conventional physical therapy practices in reducing mean lateral displacement of sway. This was associated with increased loading of the affected leg. Posttreatment changes in total sway area were not significantly different between experimental and control groups. A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke, an associated improvement in function has been demonstrated. This study examines this promising technique further using a single-blind controlled trial. Twenty-six patients were recruited from a register of consecutive admissions and randomized into treatment and control groups. Both groups received additional therapy, only the treatment group received visual feedback. Assessments were carried out independently. Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function. Between group differences had disappeared at three months. The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway. Transfer of training was indicated by improvements in ADL and gross motor function. Three months later the improvement was maintained, but did not automatically continue without treatment. The purpose of this study was to evaluate the delayed effects of balance training program on hemiplegic stroke patients.
                A total of 41 ambulatory hemiplegic stroke patients were recruited into this study and randomly assigned into two groups, the control group and trained group. Visual feedback balance training with the SMART Balance Master was used in the trained group. Bruunstrom staging of affected limb scores and Functional Independent Measure (FIM) scores of each patient were recorded. Quantitative balance function was evaluated using the SMART Balance Master. Data were collected before training and 6 months after completing the training program.
                Significant improvements in dynamic balance function measurements were found for patients in the trained group at 6 months after completing the training program. The ability of self-care and sphincter control also improved for patients in the trained group. On the other hand, no significant differences were found in static balance functions between the trained group and control group at 6 months of follow up. The locomotion and mobility scoring of FIM also revealed no differences between the groups.
                Dynamic balance function of patients in the visual feedback training group had significant improvements when compared with the control group. Activities of daily living (ADL) function in self-care also had significant improvements at 6 months of follow up in the trained group. The results showed that balance training was beneficial for patients after hemiplegic stroke.
Force platform feedback (visual or auditory) improved stance symmetry but not sway in standing, clinical balance outcomes or measures of independence.