Balance Training on Vestibular Function and Proprioception Feedback in Stroke Patient
Condition: Stroke, Ischemic
MeSH terms: Stroke; Ischemic Stroke
Study type: Interventional

Summary: 
      The aim of this study was to find out the role of balance training on vestibular function and
      proprioception feedback in stroke patients. It was a randomized control trial and was
      conducted in civil hospital Gujranwala. Current study was completed within the time duration
      of 6 month. Sample size of twenty four patient consists of both male and female aged between
      50 years to 75 years. Each group contain 12 patient .Group A was experimental group which
      received balance exercise in two phases and group B (n=12) was control group received
      conventional therapy. Each of exercise program begun with 10 mints warm up consisting of
      walking ad light stretching of hip flexor. The balance training group received the balance
      training exercise twice a week for 6 week each session comprise of 60 minutes. Each set
      consisted of 4 periods of 11 exercises and rest of 40 seconds. Many exercises over time was
      turned into circuit training. Data was analyzed by using SPSS version 23.
    

Detailed description: 
      Stroke is a global health-care problem that is common, serious, and disabling in most
      countries, the 2nd or 3rd most common cause of death and one of the main causes of acquired
      adult disability. Patients with stroke have number of impairments but usually present with
      difficulty maintaining balance. Balance is described as the ability to maintain equilibrium
      in a gravitational field by keeping or returning the center of body mass over its base of
      support. Body balance is the result of a harmonious interaction between the afferents from
      sensory systems (vestibular, proprioceptive and visual). The somatosensory system organizes
      proprioceptive information, while the visual system provides information about the position
      of the body in relation to the external environment. When the functions of the sensory triad
      are disrupted, unpleasant sensations occur, e.g. dizziness, nausea, feeling of imbalance and,
      sometimes, nystagmus, Balance is a complex process in which the maintenance of a position is
      regulated by postural adjustments to voluntary activity and in response to external
      perturbation. Impairments of postural control result in increased rates of unintentional
      falls. In fact, falls are the leading cause of injuries and subsequent deaths among people 65
      years and older, and generate a fundamental financial burden to the healthcare system.Stroke
      survivors present with deficits in different systems, including sensory, musculoskeletal,
      perceptual, and cognitive, which decrease postural stability. The lack of postural stability
      can lead to falls during hospitalization, both in the acute care and rehabilitation stages,
      and after discharge. Because of the importance of postural instability in this population, a
      systematic evaluation of balance is needed to identify specific problems.The measures most
      commonly used with stroke patients are different parameters extracted from the center of
      pressure (COP) and weight distribution of the vertical reaction force. After a stroke,
      patients have demonstrated a significant increase in sway and weight-bearing asymmetry. The
      relearning of postural control through external visual and auditory biofeedback is believed
      to be an effective therapy for improving balance control. In a Cochrane review, the results
      of seven randomized clinical trials and indicated that providing feedback from a force
      platform resulted in improved stance symmetry after stroke but did not improve balance during
      active functional activities, nor did it improve overall independence. A study conducted on
      elderly population was concluded that Balance training reduced elderly subjects' overactive
      proprioceptive feedback and enhanced vestibular orientation Previous studies only assess the
      effect of balance training on elderly population or stroke population. But the role of these
      trainings on vestibular and proprioception function were not assessed among stoke population
      while in the current study we aimed to assess the effect of balance training of simple
      physical therapy exercises on sensory channel (vestibular function, proprioception feedback
      mainly). In 2011 on Stroke rehabilitation was concluded by Ongoing trials of repetitive task
      training, early mobilization, treadmill training, physical fitness training, and speech and
      language training for aphasia and dysarthria are high-quality, multicenter, multidisciplinary
      studies of complex interventions, which meet many of the above recommendations.

      In 2004 a comparative study to compare clinical and biomechanical measures of balance in
      elderly stroke patients with those of healthy elderly people. This study concluded as
      postural stability in quiet stance, as measured by COP-COM amplitude, was related to
      functional measures of balance as well as physiologic factors relating to balance, such as
      visual conditions, lower-extremity peripheral sensibility, motor recovery, and simple
      reaction time Another study on dynamic balance ability through stair gait training where in
      proprioceptive neuromuscular facilitation (PNF) was applied and for the four weeks of the
      experiment, each group received training three times per week, for 30 min each time. Berg
      Balance Scale (BBS) values were measured and a time up and go (TUG) test and a functional
      reach test (FRT) were performed for a comparison before and after the experiment which is
      concluded that gait training group to which PNF was applied saw improvements in their balance
      ability, and a good result is expected when neurological disease patients receive stair gait
      training applying PNF.(10) A systematic review evaluated recent evidence related to the
      effect of balance training on balance performance among individuals post stroke across the
      continuum of recovery. On the basis of this evidence, we also provide recommendations for
      exercise prescription in such programs. Review evaluated recent evidence related to the
      effect of balance training on balance performance among individuals post stroke across the
      continuum of recovery. On the basis of this evidence, we also provide recommendations for
      exercise prescription in such programs.

      In 2o18 on to investigate the effect of customized vestibular rehabilitation training on gait
      stability of patients with sub-acute stroke. An instrumented 10- Meter Walk Test together
      with traditional clinical scales were used to assess VR effects. Which is concluded by VR
      could be included into a rehabilitation program for patients with stroke for improving their
      gait and dynamic balance acting on their vestibular system as facilitator of recovery.

      Another study in 2014 virtual reality (VR) proprioception rehabilitation system was developed
      for stroke patients to use proprioception feedback in upper limb rehabilitation by blocking
      visual feedback. To evaluate its therapeutic effect, 10 stroke patients (onset > 3 month)
      trained proprioception feedback rehabilitation for one week and visual feedback
      rehabilitation for another week in random order. Proprioception functions were checked
      before, a week after, and at the end of training.it was concluded that effectiveness and
      possible use of the VR to recover the proprioception of stroke patients In 2020 A pilot study
      to find out the effects of COP (center of pressure) movement tracking training conducted
      using the Biodex Balance System SD in static and dynamic modes on balance ability in stroke
      patients. The result of study concluded that COP movement tracking training in dynamic mode
      was found to be a more effective intervention for improving the static balancing abilities of
      stroke patients than training in static mode.

      In 2000 A comparative study was done by walker et al to compared the relative effectiveness
      of visual feedback training of center-of-gravity (COG) positioning with conventional physical
      therapy following acute stroke result show that Visual feedback or conventional balance
      training in addition to regular therapy affords no added benefit when offered in the early
      stages of rehabilitation following stroke
    

Intervention name(s): Traditional physical therapy balance exercise; proprioception based balance training
Intervention type(s): Other; Other
Intervention description(s): first phase : stepping forward, backward, and sideways on the exercise step stepping over blocks of various heights standing up from a chair, walking four steps forward,)A performing a range of motion and balance exercises (forward and backward rolling of the arms; bending the trunk forward and side to side);on a swiss ball. performed In a normal condition In first 20 m of each session 2nd phase Performing double-legged stance tandem walking forward and backward
• Dosage of exercise was twice a week for 6 week each session comprise of 60 mints. Each set consisted of 4 periods of 11 exercises and rest of 40 sec .many exercise over time will turn into circuit training; first phase : stepping forward, backward, and sideways on the exercise step stepping over blocks of various heights standing up from a chair, walking four steps forward,)A performing a range of motion and balance exercises (forward and backward rolling of the arms; bending the trunk forward and side to side);on a swiss ball. performed In a normal condition In first 20 m of each session 2nd phase Performing double-legged stance tandem walking forward and backward all exercise done under following condition.
eyes open firm surfaces
Eyes open soft surfaces
Eyes closed firm surfaces
Eyes closed soft surfaces (the soft surfaces will be a foam mate with 2.5 cm thick )
These exercise will perform with turning the head side to side ad up and down
Dosage of exercise was twice a week for 6 week each session comprise of 60 mints. Each set consisted of 4 periods of 11 exercises and rest of 40 sec .many exercise over time will turn into circuit training
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: parallel assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Balance training; Stroke; Proprioceptive feedback; Vestibular function