Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. The effects of transcutaneous electrical nerve stimulation on strength, proprioception, balance and mobility in people with stroke: a randomized controlled cross-over trial The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial Virtual Reality Exercise Improves Mobility After Stroke: An Inpatient Randomized Controlled Trial Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training Trunk Muscle Strength in Relation to Balance and Functional Disability in Unihemispheric Stroke Patients The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. [Effects of Acupuncture Intervention Combined with Rehabilitation on Standing-balance-walking Ability in Stroke Patients]. Effect of treadmill training based real-world video recording on balance and gait in chronic stroke patients: a randomized controlled trial. Long-Term Effects of Individually Tailored Physical Training and Activity on Physical Function, Well-Being and Cognition in Scandinavian Nursing Home Residents: A Randomized Controlled Trial Rehabilitation of sensorimotor integration deficits in balance impairment of patients with stroke hemiparesis: a before/after pilot study Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control) Virtual Walking Training Program Using a Real-world Video Recording for Patients with Chronic Stroke: A Pilot Study Active Video-Gaming Effects on Balance and Mobility in Individuals with Chronic Stroke: A Randomized Controlled Trial Use of Virtual Reality to Enhance Balance and Ambulation in Chronic Stroke: A Double-Blind, Randomized Controlled Study
Objective : To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke . Design : R and omized controlled trial . Setting : Outpatient neurorehabilitation unit . Participants : A total of 20 individuals with chronic stroke . Interventions : The intervention consisted of 20 one-hour sessions , five sessions per week . The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training . The control group underwent one hour conventional therapy . Main measures : Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale , the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment , the Brunel Balance Assessment , and the 10-m Walking Test . Subjective data of the virtual reality-based intervention were collected from the experimental group , with a feedback question naire at the end of the trial . Results : The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale ( p < 0.05 ) and in the 10-m Walking Test ( p < 0.05 ) . Post-hoc analyses showed greater improvement in the experimental group : 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale , –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test , and also in the number of participants who increased level in the Brunel Balance Assessment ( χ2 = 2.5 , p < 0.01 ) . Conclusions : Virtual reality interventions can be an effective re source to enhance the improvement of balance in individuals with chronic stroke BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Trunk instability is one of main problems in survivors following stroke . We investigated the effects of weight-shift training ( WST ) on an unstable surface in sitting position on trunk control , proprioception , and balance in individuals with chronic hemiparetic stroke . Eighteen participants with chronic hemiparetic stroke were recruited and were allocated to either WST or control group . The WST group received a weight-shift training program for 30 min and then received a conventional exercise program for 30 min , while the control group received conventional exercise program for 60 min , five times a week for four weeks for both groups . In this r and omized control study , we used three outcome measures : trunk reposition error ( TRE ) , Trunk Impairment Scale ( TIS ) , and Timed Up and Go ( TUG ) test . TRE was measured by each participant 's reposition error to the target angle during his/her active trunk movement . TIS and TUG were examined for trunk control abilities and dynamic balance abilities , respectively . After training , TRE showed significantly greater improvement in the WST group ( mean change , 1.67 ± 1.45˚ ) than the control group ( mean change , 0.08 ± 1.05˚ ) . The TIS score was significantly higher in the WST group ( mean change , 2.33 ± 1.50 ) than the control group ( mean change , 0.13 ± 0.83 ) . The TUG test also showed a significant improvement in the WST group ( mean change , 5.03 ± 1.88 sec ) than the control group ( mean change , 2.59 ± 1.86 sec ) . Our findings indicate that weight-shift training is beneficial for improving trunk control and proprioception in patients with chronic hemiparetic stroke Objective : To investigate the feasibility and potential efficacy of ‘ activeTENS ’ ( that is transcutaneous electrical nerve stimulation ( TENS ) during everyday activities ) by assessing the immediate effects on strength , proprioception , balance/falls risk and mobility after stroke . Design : A paired- sample r and omized cross-over trial . Subjects : Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS . Setting : University clinical research facility . Intervention : A single session of ‘ activeTENS ’ delivered via a ‘ sock electrode ’ ( 70–130 Hz , five second cycle ) plus a session of control treatment ( wearing the sock electrode with no stimulation ) , lasting approximately two hours in total . Main Outcomes : Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer , balance and falls risk ( St and ing Forward Reach Test ) and gait speed ( 10-m walk test ) . Results : All participants tolerated ‘ active TENS ’  . Most parameters improved during stimulation with activeTENS ; balance ( p = 0.009 ) , gait speed ( p = 0.002 ) , plantarflexor strength ( p = 0.008 ) and proprioception of plantarflexion ( p = 0.029 ) , except dorsiflexor strength ( p = 0.194 ) and dorsiflexion proprioception ( p = 0.078 ) . Conclusions : The results provide initial evidence of the potential of ‘ active TENS ’ to benefit physical function after stroke which warrants further phase II trials to develop the intervention . Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported Objective . Gait performance is an indicator of mobility impairment after stroke . This study evaluated changes in balance , lower extremity motor function , and spatiotemporal gait parameters after receiving body weight supported treadmill training ( BWSTT ) and conventional overground walking training ( CT ) in patients with subacute stroke using 3D motion analysis . Setting . Inpatient department of rehabilitation medicine at a university-affiliated hospital . Participants . 24 subjects with unilateral hemiplegia in the subacute stage were r and omized to the BWSTT ( n = 12 ) and CT ( n = 12 ) groups . Parameters were compared between the two groups . Data from twelve age matched healthy subjects were recorded as reference . Interventions . Patients received gait training with BWSTT or CT for an average of 30 minutes/day , 5 days/week , for 3 weeks . Main Outcome Measures . Balance was measured by the Brunel balance assessment . Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale . Kinematic data were collected and analyzed using a gait capture system before and after the interventions . Results . Both groups improved on balance and lower extremity motor function measures ( P < 0.05 ) , with no significant difference between the two groups after intervention . However , kinematic data were significantly improved ( P < 0.05 ) after BWSTT but not after CT .  Maximum hip extension and flexion angles were significantly improved ( P < 0.05 ) for the BWSTT group during the stance and swing phases compared to baseline . Conclusion . In subacute patients with stroke , BWSTT can lead to improved gait quality when compared with conventional gait training . Both methods can improve balance and motor function The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results , whereas little information is available regarding the use of this therapy in subacute stroke patients . The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase . Fifty adult stroke patients participated to the study : 25 subjects were r and omly assigned to balance training with Wii Fit , and the other 25 subjects were assigned to usual balance therapy . Both groups were also treated with conventional physical therapy ( 40 min 2 times/day ) . The main outcome was functional balance ( Berg Balance Scale-BBS ) , and secondary outcomes were disability ( Barthel Index-BI ) , walking ability ( Functional Ambulation Category ) , and walking speed ( 10-meters walking test ) .  Wii Fit training was more effective than usual balance therapy in improving balance ( BBS : 53 versus 48 , P = 0.004 ) and independency in activity of daily living ( BI : 98 versus 93 , P = 0.021 ) . A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did . VR treadmill training also improved balance skill during sit-to-st and transfers and the involvement of paretic limb in level walking more than the traditional one did Karatas M , Çetin N , Bayramoglu M , Dilek A : Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients . Am J Phys Med Rehabil 2004;83:81–87 . Objective To evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group . Design This prospect i ve case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers .  The Berg balance scale was used to assess balance and stability , and the  FIM ™ instrument was used to evaluate functional disability in the patient group . Patients were evaluated as soon as they were able to st and long enough for testing . Results Peak torque values for trunk flexion and extension were lower in the stroke patients than in the controls . The differences were significant for trunk flexion and for trunk extension . In both groups , peak torque values for trunk flexors were greater than peak torque values for trunk extensors . There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge . Trunk muscle strength was not correlated with FIM total score or FIM motor score , but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values , except for isometric extension . Conclusion The findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients , which can interfere with balance , stability , and functional disability OBJECTIVE To compare body weight-supported exercise on a gait trainer with walking exercise overground . DESIGN R and omized controlled trial . SETTING Rehabilitation hospital . PARTICIPANTS Forty-five ambulatory patients with chronic stroke . INTERVENTIONS Patients were r and omized to 3 groups : ( 1 ) gait trainer exercise with functional electric stimulation ( GTstim ) , ( 2 ) gait trainer exercise without stimulation ( GT ) , and ( 3 ) walking overground ( WALK ) . All patients practice d gait for 15 sessions during 3 weeks ( each session , 20 min ) , and they received additional physiotherapy 55 minutes daily . MAIN OUTCOME MEASURES Ten-meter walk test ( 10MWT ) , six-minute walk test ( 6MWT ) , lower-limb spasticity and muscle force , postural sway tests , Modified Motor Assessment Scale ( MMAS ) , and FIM instrument scores were recorded before , during , and after the rehabilitation and at 6 months follow-up . RESULTS The mean walking distance using the gait trainer was 6900+/-1200 m in the GTstim group and 6500+/-1700 m in GT group . In the WALK group , the distance was 4800+/-2800 m , which was less than the walking distance obtained in the GTstim group ( P=.027 ) . The body-weight support was individually reduced from 30 % to 9 % of the body weight over the course of the program . In the pooled 45 patients , the 10MWT ( P<.001 ) , 6MWT ( P<.001 ) , MMAS ( P<.001 ) , dynamic balance test time ( P<.001 ) , and test trip ( P=.005 ) scores improved ; however , no differences were found between the groups . CONCLUSIONS Both the body weight-supported training and walking exercise training programs result ed in faster gait after the intensive rehabilitation program . Patients ' motor performance remained improved at the follow-up Stroke is one of the most serious healthcare problems and a major cause of impairment of cognition and physical functions . Virtual rehabilitation approaches to postural control have been used for enhancing functional recovery that may lead to a decrease in the risk of falling . In the present study , we investigated the effects of virtual reality balance training ( VRBT ) with a balance board game system on balance of chronic stroke patients . Participants were r and omly assigned to 2 groups : VRBT group ( 11 subjects including 3 women , 65.26 years old ) and control group ( 11 subjects including 5 women , 63.13 years old ) . Both groups participated in a st and ard rehabilitation program ( physical and occupational therapy ) for 60 min a day , 5 times a week for 6 weeks . In addition , the VRBT group participated in VRBT for 30 min a day , 3 times a week for 6 weeks . Static balance ( postural sway velocity with eyes open or closed ) was evaluated with the posturography . Dynamic balance was evaluated with the Berg Balance Scale ( BBS ) and Timed Up and Go test ( TUG ) that measures balance and mobility in dynamic balance . There was greater improvement on BBS ( 4.00 vs. 2.81 scores ) and TUG ( -1.33 vs. -0.52 sec ) in the VRBT group compared with the control group ( P < 0.05 ) , but not on static balance in both groups . In conclusion , we demonstrate a significant improvement in dynamic balance in chronic stroke patients with VRBT . VRBT is feasible and suitable for chronic stroke patients with balance deficit in clinical setting OBJECTIVE To observe the influence of acupuncture stimulation of lateral side of Tianzhu ( para-BL 10 ) , electroacupuncture ( EA ) stimulation of scalp-point Balance Area ( MS 14 ) , Motor Area ( MS 6 ) and body acupoints combined with rehabilitation training on st and ing-balance and walking ability in stroke patients . METHODS A total of 145 stroke in patients were r and omly assigned to rehabilitation group ( n=48 ) , routine acupuncture group ( n=49 ) and para-BL10 group ( n = 48 ) . Patients of the rehabilitation group received balance training and routine rehabilitation training treatment , those of the routine acupuncture group received acupuncture stimulation of scalp-points ( MS 14 , MS 6 ) , body acupoints , balance training and routine rehabilitation training , and those of the para-BL10 group received acupuncture stimulation of lateral side of BL 10 combined with scalp-points of MS 14 and MS 6 and body acupoints , and balance training and routine rehabilitation training . The treatment was conducted once daily , 5 times per week , 8 weeks altogether . The patients ' balancing function , lower-limb motor function and walking ability were assessed using Berg Balance Scale ( BBS ) , Sheikh Trunk Control Ability Scale(STCAS ) , Fugl-Meyer Assessment Scale ( FMAS ) , and Holden Functional Ambulation Classification ( FAC ) , respectively . RESULTS After 4 and 8 weeks ' treatment , the scores of BBS , STCAS , FMAS and FAC in patients of the rehabilitation , routine acupuncture and para-BL10 groups were significantly increased and 10 meters-walking time obviously reduced in comparison with pre-treatment in the same one group ( P<0.01 ) . The effects of acupuncture stimulation of para-BL 10 were considerably better than both rehabilitation and routine acupuncture groups in raising BBS , STCAS , FMAS and FAC scores and in reducing 10 m-walking time ( P<0.05 ) . CONCLUSION Acupuncture stimulation of lateral side of BL 10 combined with scalp-points has a significant benefit for stroke patients in st and ing-balance ability and walking ability OBJECTIVE The purpose of this study was to determine the role of treadmill training based real-world video recording ( TRWVR ) for balance and gait ability in chronic stroke patients . DESIGN Thirty chronic stroke patients were r and omly assigned to either the  TRWVR group ( n=15 ) or the  control group ( n=15 ) . Both groups participated in a st and ard rehabilitation program ; in addition , the TRWVR group participated in TRWVR for 30 min per day , three times per week , for 6 weeks , and the control group participated in treadmill walking training for 30 min per day , three times per week , for 6 weeks . Balance ability was measured using the Berg Balance Scale ( BBS ) , Timed Up and Go test ( TUG ) and the postural sway by force platform system . Gait performance was measured using a pressure sensitive walkway . RESULTS Significant differences in the time factor for dynamic balance and gait ( P<0.05 ) were observed in the TRWVR and control group , with the exception of static balance . For the group × time interaction , significant improvements in dynamic balance and gait ( P<0.05 ) . In the correlation coefficient , no significant correlation was observed between changes in postural sway and other dependent variables . CONCLUSIONS Findings of this study demonstrated that the real-world video recording has an effect on dynamic balance and gait in chronic stroke patients when added to treadmill walking Background : The preservation of physical functions such as muscle strength , balance and mobility is fundamental to maintaining independence in activities of daily living ( ADL ) . The physical activity level of most nursing home residents is very low , which implies that they are often subject to a decline in health , mobility , autonomy and social contacts and are also at risk of suffering a decline in mental well-being . In a previous study , we demonstrated that transfers , balance and physical activity level improved after 3 months of individually tailored intervention in nursing home residents . Objective : To evaluate the long-term effects on ADL , balance function , physical activity level , physical performance , falls-related self-efficacy , well-being and cognitive function 3 months after the completion of our intervention in nursing home residents . Methods : The study was a multicenter r and omized , controlled clinical trial with a parallel-group design . It was conducted in nursing homes in Sweden , Norway and Denmark , with an intervention period lasting 3 months and a follow-up at 6 months . Initially , 322 nursing home residents with a mean age of 85 years were included ; 85 from Sweden , 171 from Norway and 66 from Denmark . Of these , 241 [ 129 intervention group ( IG ) , 112 control group ( CG ) ] were eligible for the 6-month follow-up tests . The level of dependence in ADL , physical activity level , several dimensions of physical function , well-being , falls-related self-efficacy and cognitive function were assessed with reliable and valid instruments at baseline , immediately after 3 months of intervention and 3 months later at the 6-month follow-up . Results : After 3 months of intervention and an additional period of 3 months without intervention , only the following 2 variables demonstrated significant group differences : social and cognitive function , measured by the Functional Independence Measure n-r , where the IG deteriorated while the CG was almost stable . However , regarding transfers , the IG deteriorated significantly less than the CG . Conclusion : Without supervised physical exercise that challenged the individuals ' capability , gains in ADL function , balance and transfer ability deteriorated during the 3 months following the intervention period . Thus , continuous , individually adjusted and supported physical activity seems crucial for the maintenance of physical functions in these vulnerable elderly persons Balance impairment in patients with stroke hemiparesis is frequently related to deficits of central integration of afferent inputs ( somatosensory , visual , vestibular ) . Our aim was to evaluate whether balance exercises performed under various sensory input manipulations can improve postural stability and /or walking ability in patients with stroke . Seven chronic hemiparetic subjects were recruited . Patient performance was assessed before , immediately after and one week after treatment ( consisting of 20 one-hour daily sessions of several balance exercises ) by means of the  Sensory Organization Balance Test  and the  Ten Metre Walking Test .  Before treatment , all patients showed balance impairment with difficulty integrating somatosensory information from the lower extremities and excessive reliance upon visual input in st and ing balance control . After treatment , balance and walking speed significantly increased and this improvement was maintained for one week . These findings indicate that rehabilitation of sensorimotor integration deficits can improve balance in patients with stroke hemiparesis Objective To compare the effects on balance and walking of three models of stroke rehabilitation : early supported discharge with rehabilitation in a day unit or at home , and traditional uncoordinated treatment ( control ) . Design Group comparison study within a r and omised controlled trial . Setting Hospital stroke unit and primary healthcare . Participants Inclusion criteria : a score of 2–26 on National Institutes of Health Stroke Scale , assessed with Postural Assessment Scale for Stroke ( PASS ) , and discharge directly home from the hospital stroke unit . Interventions Two intervention groups were given early supported discharge with treatment in either a day unit or the patient 's own home . The controls were offered traditional , uncoordinated treatment . Outcome measures Primary : PASS . Secondary : Trunk Impairment Scale — modified Norwegian version ; timed Up- and -Go ; 5 m timed walk ; self-reports on problems with walking , balance , ADL , physical activity , pain and tiredness . The patients were tested before r and omisation and 3 months after inclusion . Results From a total of 306 r and omised patients , 167 were tested with PASS at baseline and discharged directly home . 105 were retested at 3 months : mean age 69 years , 63 men , 27 patients in day unit rehabilitation , 43 in home rehabilitation and 35 in a control group . There were no group differences , either at baseline for demographic and test data or for length of stroke unit stay . At 3 months , there was no group difference in change on PASS ( p>0.05 ) . Some secondary measures tended to show better outcome for the intervention groups , that is , trunk control , median ( 95 % CI ) : day unit , 2 ( 0.28 to 2.31 ) ; home rehabilitation , 4 ( 1.80 to 3.78 ) ; control , 1 ( 0.56 to 2.53 ) , p=0.044 ; and for self-report on walking , p=0.021 and ADL , p=0.016 . Conclusions There was no difference in change between the groups for postural balance , but the secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group . Trial registration This study is part of the Early Supported Discharge after Stroke in Bergen , Clinical Trials.gov ( NCT00771771 ) Objective The purpose of this study was to investigate the effectiveness of the virtual walking training program using a real-world video recording on walking balance and spatiotemporal gait parameters in patients with chronic stroke . Design Fourteen patients with chronic stroke were r and omly assigned to either the experimental group ( n = 7 ) or the control group ( n = 7 ) . The subjects in both groups underwent a st and ard rehabilitation program ; in addition , the experimental group participated in the virtual walking training program using a real-world video recording for 30 mins a day , three times a week , for 6 wks , and the control group participated in treadmill gait training for 30 mins a day , three times a week , for 6 wks . Walking balance was measured using the Berg Balance Scale ( BBS ) and the Timed Up and Go test . Gait performance was measured using an electrical walkway system . Results In walking balance , greater improvement on the Berg Balance Scale ( experimental group : 4.14 vs. control group : 1.85 ) and the Timed Up and Go test ( −2.25 vs. −0.94 ) was observed in the experimental group compared with the control group ( P < ; 0.05 ) . In the spatiotemporal gait parameters , greater improvement on velocity ( 25.40 vs. 9.74 ) and cadence ( 26.71 vs. 11.11 ) was observed in the experimental group compared with the control group ( P < ; 0.05 ) . Conclusions This study demonstrated the positive effects of the virtual walking training program using a real-world video recording on gait performance . These findings suggest that the virtual walking training program using a real-world video recording may be a valid approach to enhance gait performance in patients with chronic stroke Abstract Background : Treatments that provide feedback , increase practice with multiple repetitions , and motivate patients are essential to rehabilitation post stroke . Objective : To determine whether playing active video games results in improved balance and mobility post stroke . Methods : Thirty participants with chronic ( time since stroke = 3.0 [ 2.9 ] years ) hemiparesis post stroke were r and omly assigned to a gaming group or normal activity control group . Gaming systems provided participants with an interactive interface of real-time movement of either themselves or an avatar on the screen . Participants played games 50–60 minutes/day , 4 days/week , for 5 weeks . The intervention was strictly game-play , in st and ing position , without physical therapy . The control group received no special intervention and continued with normal activity . Both groups were tested prior to , following the 5 weeks ( post test ) , and 3 months following the completion of the study . Outcome measures included the Fugl-Meyer Assessment , Berg Balance Scale , Dynamic Gait Index , Timed Up & Go , 6-minute walk test , 3-meter walk ( self-selected and fast ) , and perception of recovery . Results : No statistically significant differences between or within groups were found through analysis of covariance ( covaried for side of hemiparesis ) at post test or follow-up . Although the within-group effect sizes were primarily indexed as “ small ” ( < .36 ) , the gaming group exhibited higher within-group effect sizes before and after testing than did the control group on all 7 dependent variables analyzed . Conclusions : Even though the only intervention was game-play , there were small positive effects . Therapist assistance in making more optimum movement choices may be needed before significant improvements are seen with commercially available , general purpose games Kim JH , Jang SH , Kim CS , Jung JH , You JH : Use of virtual reality to enhance balance and ambulation in chronic stroke : A double-blind , r and omized controlled study . Objective : To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke . Design : Twenty-four adults with hemiparetic stroke were r and omly assigned to either an experimental group ( n = 12 ) or a control group . Both groups underwent conventional physical therapy , 40 mins a day , 4 days a week for 4 wks . The experimental group received an additional 30 mins of virtual reality therapy each session . Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests . Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale , and spatiotemporal parameters were obtained using GAITRite . Analysis of variance and correlation statistics were performed at P < 0.05 . Results : In the balance test , the experimental group had improved Berg Balance Scale scores , balance and dynamic balance angles ( ability to control weight shifting ) compared with the controls ( P < 0.05 ) . In the gait performance test , the experimental group showed significant improvements in velocity , Modified Motor Assessment Scale scores , cadence , step time , step length , and stride length ( P < 0.05 ) . Improvement in dynamic balance angles was correlated with velocity and cadence ( P < 0.01 ) . Conclusions : This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy
To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population .