Background Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161

Introduction: Impaired balance-regulation after stroke put patients and therapists at risk for injury during rehabilitation. Body-weight-support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill based balance perturbation systems with BWSSs are known to improve balance in patients with age or disease related impairments. However, these stationary systems are unable accommodate complex exercises requiring more freedom of movement. Objective: To evaluate the impact of a new balance perturbation module, which is directly integrated to a track-mounted BWSS, has on patient balance after acute stroke. Design: Unblinded quasi-randomized controlled pilot study. Setting: Rehabilitation centered long-term acute care hospital. Participants: Stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) assessment score of 21/56 or greater. Interventions: BWSS and BWSS with perturbation (BWSS-P) training was incorporated into participants regular treatment. While both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral and anterior/posterior resistive or assistive balance perturbations. Main outcome measures: BBS and Activities-Specific Balance-Confidence (ABC) assessments were the main outcome measure collected. Institutional BBS data from fiscal-year 2018, prior to installation of the track mounted BWSS, was used as a historical standard-of-care (SOC) baseline. Results: Improved post-intervention BBS and ABC assessment scores showed all participants benefited from therapy (p≤0.0438). The BBS percent-change of the BWSS-P [mean(SD)n] [66.95%(43.78%)14] and BWSS control [53.29%(24.13%)15] were greater than the SOC group [28.31%(17.25%)30] (p≤0.0178), with no difference between BWSS groups (p=0.6669); ABC percent score-changes were also similar (p≥0.8036). Conclusions: BWSS groups demonstrated similar BBS and ABC score improvements, indicating balance perturbations are not detrimental to post-acute stroke rehabilitation and are safe to use. This data provides strong rationale for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to stroke patient balance during rehabilitation. Clinical Trial Registration: NCT04919161

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BACKGROUND Impaired balance-regulation after stroke put patients and therapists at risk for injury during rehabilitation. Body-weight-support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill based balance perturbation systems with BWSSs are known to improve balance in patients with age or disease related impairments. However, these stationary systems are unable accommodate complex exercises requiring more freedom of movement. OBJECTIVE To evaluate the effect of a new balance perturbation module, which is directly integrated to a track-mounted BWSS, has on impaired balance secondary to acute stroke. METHODS This unblinded quasi-randomized controlled pilot study took place in a rehabilitation focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21/56 or greater. Over a two-week period, consented participants completed eight BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment so as to not disrupt their care. While both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral and anterior/posterior resistive or assistive balance perturbations. Pre- and post-intervention BBS and Activities-Specific Balance-Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from fiscal-year 2018, prior to installation of the track mounted BWSS, was used as a historical standard-of-care (SOC) baseline. RESULTS Improved post-intervention BBS and ABC assessment scores showed all participants benefited from therapy (p<0.05). The BBS percent-change of the BWSS-P [mean(SD)n] [66.95%(43.78%)14] and BWSS control [53.29%(24.13%)15] were greater than the SOC group [28.31%(17.25%)30] (p<0.05), with no difference between BWSS groups (p=0.6669); ABC percent score-changes were also similar (p>0.800). CONCLUSIONS Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating balance perturbations are not detrimental to post-acute stroke rehabilitation and are safe to use. This data provides strong rationale for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. CLINICALTRIAL ClinicalTrials.gov [NCT04919161]