A Novel Body Weight–Supported Postural Perturbation Module for Gait and Balance Rehabilitation After Stroke: Preliminary Evaluation Study

Abstract

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

Utilizing mobile robotics for pelvic perturbations to improve balance and cognitive performance in older adults: a randomized controlled trial

“…The methods of PBT implementation vary and include standing on a surface, like a thick foam, balance board, or slip board, or experiencing external forces applied by a physical therapist (PT), occupational therapist (OT), or a robotic platform [13][14][15] . One benefit of robotic platform PBT is the application of precise, measurable forces…”

“…PBT is a form of rehabilitation that intentionally introduces minor, unpredictable disruptions to an individual's gait cycle, allowing them to react and build motor skills safely. Through PBT, individuals can become more physically adept at recovering from real-life disruptive situations where they must control abrupt shifts in body weight or unexpected trips on external barriers 6,12 .The methods of PBT implementation vary and include standing on a surface, like a thick foam, balance board, or slip board, or experiencing external forces applied by a physical therapist (PT), occupational therapist (OT), or a robotic platform [13][14][15] . One benefit of robotic platform PBT is the application of precise, measurable forces…”

Utilizing Mobile Robotics for Pelvic Perturbations to Improve Balance and Cognitive Performance in Older Adults: A Randomized Controlled Trial

“…The methods of PBT implementation vary and include standing on a surface, like a thick foam, balance board, or slip board, or experiencing external forces applied by a physical therapist (PT), occupational therapist (OT), or a robotic platform [13], [14], [15]. One bene t of robotic platform PBT is the application of precise, measurable forces for speci c time intervals.…”