Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

Abstract

Background: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods: Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 min were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over 3 weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre-and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed.

The Effectiveness of Perturbation-Based Training in the Treatment of Patients With Stroke: A Systematic Review and Meta-Analysis

“…Seven studies with a total of 271 participants were included in this review, 134 participants were in experimental groups and 137 in control groups. All these studies were published during the period from 2005 to 2020 and included both genders, 20 , 39 - 43 only one study did not mention sample’s gender. 44 Two studies investigated the effect of PBT in patients with subacute stroke 40 , 43 4 studies in patients with chronic stroke, 20 , 39 , 41 , 42 however Kumar et al 44 did not report the participants’ stage of stoke.…”

Inducing Body-Weight Supported Postural Perturbations during Gait and Balance Exercises to Improve Balance after Stroke – A Pilot Study

“…Conventional balance perturbation training, including modified treadmills, [11][12][13][14] tilttables, 14,15 or external force provided by the therapist directly, 16 pose an injury risk to the therapist and the patient. Additionally, if the patient were to experience an injurious fall during treatment, it may further contribute to their fear of falling after stroke.…”

“…Training Responses in Postural rehabilitation or TRiP, is directly integrated to the ZeroG BWSS. This perturbation module is different than other systems as the balance perturbations are elicited directly through the BWSS and do not require a treadmill, [11][12][13][14] tilt-table/shaking platform, 14,15 or manual exertion by a therapist. 16 Further, they can be induced during normal gait and balance exercises during therapy.…”

“…In addition to BWSSs, balance perturbation systems, which purposefully unbalance a patient so they can rehabilitate their postural control, have been used to improve gait and balance-control after stroke, or other age and disease related balance impairments. [11][12][13][14][15][16] The goal of this study was to evaluate the efficacy of a recently developed, not yet reported, balance perturbation module for the ZeroG BWSS. This new balance perturbation training module is directly integrated into the BWSS and allows therapists to induce safe lateral, anterior, or posterior perturbations via a Wi-Fi-enabled handheld device.…”

Rehabilitation Supported by Technology: Protocol for an International Cocreation and User Experience Study

“…Patients are satisfied with telerehabilitation provided that it is appropriate and some social interaction occurs, whereas clinicians prefer face-to-face interactions and will only use telerehabilitation when face-to-face interactions are not feasible [ 16 ]. Another example of a promising technology for physical rehabilitation is the use of a split-belt treadmill for balance and gait training in patients with stroke [ 17 , 18 ]. Finally, gravity therapy by means of a SAHC, an integrated multisystem countermeasure to provide artificial gravity training for rehabilitation purposes, has been proposed to have beneficial effects for individuals with neuromuscular disorders, balance disorders, stroke, and sports injuries.…”