Modified Baduanjin improves balance function in subacute stroke survivors: a randomized controlled study.

BackgroundPrevious studies have reported that movement-based computer gaming is more effective than conventional intervention in enhancing upper limb rehabilitation.ObjectiveTo evaluate whether the use of bilateral movement-based computer games could augment the effects of conventional intervention in improving the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors.MethodsA total of 93 subjects with subacute stroke were randomized into 2 groups receiving one of two 3.5-h interventions for 2 days per week over 8 weeks: (i) “bilateral movement-based computer games + conventional rehabilitation”; and (ii) “video-directed exercise + conventional rehabilitation” (control group).ResultsA total of 83 subjects completed the interventions and follow-up assessments. Compared with video-directed exercise + conventional rehabilitation, bilateral movement-based computer games + conventional rehabilitation produced greater improvements in upper limb motor impairment from mid-treatment to follow-up 1 month post-intervention, greater improvements in upper limb function from post-intervention to 1 month follow-up, and earlier improvements in grip strength (paretic) from mid-intervention to follow-up 1 month post-intervention. Subjects who received bilateral movement-based computer games + conventional rehabilitation also continued to improve in motor function from post-intervention to 1 month post-intervention.ConclusionBilateral movement-based computer games may serve as an adjuvant therapy to conventional rehabilitation programmes for improving upper limb recovery among stroke survivors.LAY ABSTRACTUpper limb sensorimotor impairment is a common and serious post-stroke sequel, affecting up to two-thirds of stroke survivors. Simultaneous bilateral training is a rehabilitative method that requires the use of both paretic and non-paretic sides completing identical tasks at the same time. Previous findings suggested that bilateral upper limb training was superior to unilateral upper limb training in improving upper limb motor impairment. Given that virtual reality-based therapy can be advantageous for engaging and encouraging participation in repetitive rehabilitative training tasks, this study aimed to investigate whether bilateral movement-based computer gaming (BMCG) using custom-made handlebars could better improve the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors than a conventional rehabilitation programme. After 16 sessions of bilateral BMCG, it was found that subacute stroke survivors had greater improvements in upper limb motor control, functional use of paretic upper limb and health-related quality of life than after a conventional rehabilitation programme. Thus, the combined use of computer gaming and bilateral movement-based training could be an adjunct therapy to conventional physiotherapy and occupational therapy in cognitively intact subacute stroke survivors.

This study aimed to comprehensively summarize assistive technology devices for postural control and gait performance in stroke patients. In the study, we searched for randomized controlled trials (RCTs) published until 31 December 2022 in four electrical databases. The most frequently applied assistive technology devices involving postural stability and gait function for stroke patients were robot-assistive technology devices. Out of 1065 initially retrieved citations that met the inclusion criteria, 30 RCTs (12 studies for subacute patients and 18 studies for chronic patients) were included in this review based on eligibility criteria. The meta-analysis included ten RCTs (five studies for subacute patients and five for chronic patients) based on the inclusion criteria of the data analysis. After analyzing, the variables, only two parameters, the Berg balance scale (BBS) and the functional ambulation category (FAC), which had relevant data from at least three studies measuring postural control and gait function, were selected for the meta-analysis. The meta-analysis revealed significant differences in the experimental group compared to the control group for BBS in both subacute and chronic stroke patients and for the FAC in chronic stroke patients. Robot-assistive training was found to be superior to regular therapy in improving postural stability for subacute and chronic stroke patients but not gait function. This review suggests that robot-assistive technology devices should be considered in rehabilitative approaches for postural stability and gait function for subacute and chronic stroke patients.

Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial.

Parkinson's disease (PD) is the second most common neurodegenerative disease. Patients often present with balance dysfunction. Several studies have applied visual feedback training to stroke patients and demonstrated significant improvement. However, the application of visual feedback balance training in PD patients has not been reported. To observe the effects of visual feedback balance training combined with conventional rehabilitation training on the balance function of patients with early PD. Fifty patients with early PD were randomly divided into control group and observation group. The control group received conventional rehabilitation training, including body position transfer, weight shifting, movement in all directions and gait training. The observation group were added with visual feedback balance training on the basis of the training above. All patients were trained 5 times per week for 4 weeks. Berg Balance Scale (BBS), Time Up-and-Go test (TUG) and Pro-Kin balance training instrument were used to evaluate the balance function of patients before and after treatment, and the balance function were compared between the two groups. The BBS and TUG scores of the observation group and the control group were improved significantly (P<0.01), and the BBS and TUG scores of the observation group were improved more obviously than control group (P<0.01). The length and area of eye open and closed condition in the observation group and the control group were significantly reduced compared with those before training (P<0.01), and the degree of reduction in the observation group was more obvious (P<0.01). The length and area of the observation group and the control group before and after training when eye open were smaller than those when eye closed (P<0.01). The conventional rehabilitation therapy can improve the balance function of PD patients, but the combination of visual feedback balance training and conventional rehabilitation therapy can improve the balance function more significantly.

[Purpose] The aim of this study was to investigate the effects of the task-orientedcircuit training on balance and gait ability in subacute patients with stroke. [Subjectsand Methods] Participants were randomly allocated to two groups: group 1 (subjects whoperformed task-oriented circuit training) and group 2 (subjects who underwent conventionalphysical therapy). Berg balance scale, timed up and go test, functional ambulationcategory, 6-minute walk test were assessed before and after four weeks of training.[Results] There were significant differences between groups for the 6-minute walk test.[Conclusion] The result of this study showed that task-oriented circuit training couldimprove the gait ability in patients with subacute stroke.

Although the Mini-Balance Evaluation Systems Test (Mini-BESTest) is known to be a reliable and valid measure of balance in individuals with stroke, the utility of this tool in relation to subacute stroke walking speed and the recovery of gait ability has not been explored. Here, we compared the measurement properties and their relationship to gait speed on the Mini-BESTest and the Berg Balance Scale (BBS) in middle and older ambulatory individuals with subacute stroke, and we investigated which balance assessment tool is more likely to capture the status of the recovery of gait speed. We retrospectively analyzed the cases of 88 individuals 50 years or older with stroke who had been evaluated using the Mini-BESTest by using the BBS and by assessing their comfortable walking speed (CWS). The proportion of subjects who showed improvement was calculated for 34 stroke survivors from data obtained at admission to and discharge from the hospital. Compared with the BBS, the Mini-BESTest showed a better distribution of total scores without a ceiling effect. The two scales showed correlations with gait speed (Mini-BESTest: r=0.702; BBS: r=0.592) and discrimination between fast and slow walkers. The responsiveness of the Mini-BESTest was excellent, with an area under the curve of 0.894, thus discriminating between gait speed improvement versus non-improvement. These results indicate that the Mini-BESTest is more useful than the BBS in terms of its measurement properties and ability to measure gait recovery in middle and older ambulatory individuals with subacute stroke.

Objectives: The Berg Balance Scale (BBS) is a core measure of balance function in patients with stroke. Latent rank theory (LRT) is a statistical method that enables the degree of functional impairment to be ranked from the sub-items of a rating scale; each rank can then be characterized. Identification of the characteristics of balance function by rank would be beneficial for interventions to improve balance function in patients with stroke. This study aims to use LRT to rank and characterize patients with stroke balance impairment. Methods: This was a multicenter retrospective analysis of 293 patients with subacute stroke. We used LRT and the BBS to estimate the optimal rankings based on the goodness-of-fit index and the information criterion. We compared the obtained ranks with the level of walking independence for each rank. Results: The evaluation of the patient’s BBS scores revealed that balance impairment could be divided into six ranks. The average BBS score for each rank rose from 27.1 for rank 1 to 53.9 for rank 6. The scores of the BBS sub-items for each rank also differed. The level of walking independence by rank ranged from rank 1 for assisted walking to rank 6 for independent outdoor walking. Conclusions: Balance function in patients with subacute stroke was ranked sixth in the BBS, with varying characteristics identified for different ranks. This result helped to determine the therapy to improve the balance function of patients with stroke.

Background. Balance dysfunction and high dual-task costs are eminent features in multiple sclerosis (MS). Vestibular rehabilitation therapy (VRT) proved to promote functional outcomes; yet, its influence on dynamic balance and dual-task cost of walking (DTCW) in MS needs further research. Objective. To investigate the effect of adding VRT to aerobic training on dynamic balance and DTCW in people with MS. Design. Single blinded, parallel randomized controlled trial. Settings. Out-Patient Clinic at Faculty of Physical Therapy and Kasr Al-Ainy Multiple Sclerosis Unit, Cairo University, Egypt. Participants. 40 patients with remitting-relapsing multiple sclerosis. Intervention. Patients were randomized to a control (n = 20) and intervention (n = 20) groups. Over four successive weeks, all patients received stationary bicycle aerobic training. Intervention group received an additional VRT program. Outcomes measures. Berg Balance Scale (BBS), walking speed tested by the 10 meters timed walk test (10 m-TWT), (DTCW), and overall stability index (SI). Results. Intervention group showed a remarkable improvement in BBS (p = 0.02), SI at levels four (p = 0.002) and seven (p = 0.03), and DTCW (p = 0.03) compared with control group. Walking speed did not show significant changes post-treatment within or between groups comparison (P &gt; 0.05). Conclusion. Adding VRT to aerobic training has a positive effect on dynamic balance and dual-task cost of walking in MS.

Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke.

Hearing loss, gait and balance impairments and falls among individuals with sub-acute stroke: A comparative cross-sectional study

Prediction of functional ambulation with sitting posturography in patients with subacute hemiplegic stroke

Balance assessment is crucial for predicting community ambulation outcomes in subacute stroke patients undergoing rehabilitation. This study aims to compare the accuracy of the Postural Assessment Scale for Stroke Patients (PASS) and the Berg Balance Scale (BBS) in predicting community walking ability at discharge from rehabilitation. This prospective cohort study included 47 stroke patients admitted to a 4-week inpatient rehabilitation program. Patients were assessed with PASS and BBS at admission. Discharge assessments included the Functional Ambulation Categories and 6-Min Walk Distance tests. Statistical analysis involved calculating the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and cut-off scores. PASS and BBS demonstrated excellent predictive accuracy, with AUC values of 0.955 (95% CI [0.850-0.994]) for PASS and 0.991 (95% CI [0.906-1.000]) for BBS. Cut-off scores were >28 for PASS and >46 for BBS. Sensitivity was high for both (94.44%, 95% CI [72.7-99.9]), while BBS had superior specificity (96.43%, 95% CI [81.7-99.9]) compared to PASS (85.71%, 95% CI [67.3-96.0]). BBS also had a higher positive likelihood ratio (26.44 vs. 6.61). The difference in AUC values was non-significant (p = 0.093). PASS and BBS assessed at admission are highly accurate tools for predicting community ambulation at discharge in subacute stroke patients, with BBS demonstrating a slight advantage, particularly in its positive predictive value. These findings support the use of both scales to guide rehabilitative clinical decision-making.

BackgroundWalking recovery post stroke can be slow and incomplete. Determining effective stroke rehabilitation frequency requires the assessment of neuroplasticity changes. Neurobiological signals from electroencephalogram (EEG) can measure neuroplasticity through incremental changes of these signals after rehabilitation. However, changes seen with a different frequency of rehabilitation require further investigation. It is hypothesized that the association between the incremental changes from EEG signals and the improved functional outcome measure scores are greater in higher rehabilitation frequency, implying enhanced neuroplasticity changes.ObjectiveThe purpose of this study is to identify the changes in the neurobiological signals from EEG, to associate these with functional outcome measures scores, and to compare their associations in different therapy frequency for gait rehabilitation among subacute stroke individuals.MethodsA randomized, single-blinded, controlled study among patients with subacute stroke will be conducted with two groups: an intervention group (IG) and a control group (CG). Each participant in the IG and CG will receive therapy sessions three times a week (high frequency) and once a week (low frequency), respectively, for a total of 12 consecutive weeks. Each session will last for an hour with strengthening, balance, and gait training. The main variables to be assessed are the 6-Minute Walk Test (6MWT), Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and quantitative EEG indices in the form of delta to alpha ratio (DAR) and delta-plus-theta to alpha-plus-beta ratio (DTABR). These will be measured at preintervention (R0) and postintervention (R1). Key analyses are to determine the changes in the 6MWT, MAS, BBS, MBI, DAR, and DTABR at R0 and R1 for the CG and IG. The changes in the DAR and DTABR will be analyzed for association with the changes in the 6MWT, MAS, BBS, and MBI to measure neuroplasticity changes for both the CG and IG.ResultsWe have recruited 18 participants so far. We expect to publish our results in early 2023.ConclusionsThese associations are expected to be positive in both groups, with a higher correlation in the IG compared to the CG, reflecting enhanced neuroplasticity changes and objective evaluation on the dose-response relationship.International Registered Report Identifier (IRRID)DERR1-10.2196/27935

Robot-assisted gait training (RAGT) constitutes a modern neurorehabilitation approach. However, limited data are available regarding the efficacy of RAGT when combined with conventional rehabilitation in the early subacute phase of stroke. This pilot study assessed the additive impact of protocol-defined RAGT on functional ambulation categories (FACs), walking abilities, and balance. This randomized controlled trial used a 1:1 Prospective Randomized Open Blinded End-point design (NCT04910217), comparing two groups: conventional rehabilitation and the RAGT group. All participants received protocol-defined conventional rehabilitation (15 sessions over 3 weeks). The RAGT group underwent additional sessions using the Lokomat Pro FreeD (15 sessions over 3 weeks). FAC, 10-meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS) were assessed at 3 weeks and 3 months after randomization. In addition, the modified Rankin Scale was evaluated. Among 184 patients screened between June 1, 2020, and November 30, 2023, 42 were included (19 in the RAGT group and 23 in the conventional group). The median time from stroke to randomization was 13 days (interquartile range [IQR]: 11-16), and the median age was 67 years (IQR: 58-71). Both groups demonstrated improvements in FACs. Significantly, patients in the RAGT group showed better results in the endpoint of FAC improvement by 2 or more points ( P = 0.044). Progress in TUG ( P = 0.034) and BBS ( P = 0.049) during the study period was significantly more favorable in the RAGT group. The addition of RAGT to conventional rehabilitation in the subacute phase of stroke exhibited positive effects on improving gait, walking, and balance.Trial registration number: NCT04910217.

Foot drop is common gait impairment after stroke. Functional electrical stimulation (FES) of the ankle dorsiflexor muscles during the swing phase of gait can help correcting foot drop. To evaluate efficacy of additional novel FES system to conventional therapy in facilitating motor recovery in the lower extremities and improving walking ability after stroke. Sixteen stroke patients were randomly allocated to the FES group (FES therapy plus conventional rehabilitation program) (n = 8), and control group (conventional rehabilitation program) n = 8. FES was delivered for 30 min during gait to induce ankle plantar and dorsiflexion. gait speed using 10 Meter Walk Test (10 MWT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI). Results showed a significant increase in gait speed in FES group (p < 0.001), higher than the minimal detected change. The FES group showed improvement in functional independence in the activities of daily living, motor recovery and gait performance. The findings suggest that novel FES therapy combined with conventional rehabilitation is more effective on walking speed, mobility of the lower extremity, balance disability and activities of daily living compared to a conventional rehabilitation program only.