Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews (original) (raw)
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Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis
PLOS ONE
Background Stroke results in balance disorders and these directly affect autonomy and quality of life. The purpose of this systematic review and meta-analysis was to determine the efficacy of physical therapy (PT) on balance and postural control after stroke. Methods We included all randomized controlled trials assessing the efficacy of PT on balance and postural control in adult patients after stroke without language restriction. Medline, Embase/ Scopus, Cochrane Central Register of Controlled Trials, PEDro, Pascal, and Francis databases were searched until January 2019. Primary outcomes were balance (Berg Balance scale and Postural Assessment Scale for Stroke) and postural control with postural deviation or stability measurement in sitting or standing static evaluation. A pair of independent
BMJ open, 2017
Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective. We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the 'weight-bearing asymmetry' (WBA), the 'centre of pressure' (COP) and the 'limit of stability' (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and ...
Effects of Exercise Therapy on Balance Capacity in Chronic Stroke
Stroke, 2016
A fter stroke, a main goal of rehabilitation is to promote independence in activities of daily living. An important determinant of activities of daily living performance is standing balance, which is a strong predictor of functional recovery 1,2 and walking capacity 3,4 and an important risk factor for falls 5 after stroke. Although the vast majority (75%) of people after stroke regain independent standing-balance capacity, 6 weightbearing asymmetry and increased postural sway often persist, as well as a diminished capacity to voluntarily shift body weight or to withstand external perturbations. 7 Hence, a key Background and Purpose-The purpose of this systematic review and meta-analysis was to investigate the effects of exercise training on balance capacity in people in the chronic phase after stroke. Furthermore, we aimed to identify which training regimen was most effective. Methods-Electronic databases were searched for randomized controlled trials evaluating the effects of exercise therapy on balance capacity in the chronic phase after stroke. Studies were included if they were of moderate or high methodological quality (PEDro score ≥4). Data were pooled if a specific outcome measure was reported in at least 3 randomized controlled trials. A sensitivity analysis and consequent subgroup analyses were performed for the different types of experimental training (balance and/or weight-shifting training, gait training, multisensory training, high-intensity aerobic exercise training, and other training programs).
RECENT ADVANCEMENT TO IMPROVE BALANCE IN STROKE REHABILITATION.
International Journal of Advanced Research (IJAR), 2019
After stroke, a main goal of rehabilitation is promote independent in activity of daily living. An important determinant of activities of daily living performance is standing and balance, which is a strong predictor of functional recovery and walking capacity in post stroke rehabilitation. Purpose of this study was to investigate the effects of different balance Techniques/Approaches on post stroke rehabilitation. Furthermore, the study was aimed to identify which training regimen was most effective. Electronic databases were searched to evaluate the effects of exercise therapy on balance capacity in stroke rehabilitation. 63 articles were studied and 42 were selected after inclusion and exclusion criteria strategies. After going through all the articles, it was concluded that both the three approaches (Mental Practice/Mental Imagery MP/MI, Visual Reality VR, and Mirror Therapy MT) were effective, but MP/MI is more effective according to my studies, it was observed that mental imagery is a safe and low-cost technique that can be performed even without supervision once the patient has completed appropriate training.
Brain Sciences
Background: Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors. Methods: PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used. Results: A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of −0.62 (95%CI − ...
2013
Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson's correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training. Contents
Life
The present study aims to determine the potential benefits of PNF on balance and gait function in patients with chronic stroke by using a systematic review and meta-analysis. Systematic review in the following databases: MEDLINE/PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Google Scholar. Studies up to September 2020 are included. A systematic database search was conducted for randomized control trials (RCTs) that investigated the effects of PNF intervention in patients with chronic stroke using balance and gait parameters as outcome measures. The primary outcomes of interest were Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUG) and 10-Meter Walking Test (10MWT). Nineteen studies with 532 participants were included, of which twelve studies with 327 participants were included for meta-analysis. When the data were pooled, PNF made statistically significant improvements in balance with BBS, FRT and TUG (p < 0.05) or gait velo...
Pakistan biomedical journal, 2022
The mortality rate is higher in underdeveloped countries. In Pakistan, however, there is no speci c stroke estimate. The annual occurrence rate is likely to be 250 per 100,000, with 350 expected in the near future [1]. The most wellknown cause of death in the world is stroke. For the rst time, Hippocrates (the father of medicine) coined the term 'apoplexia' to describe the sudden blackout and loss of function caused by a cerebrovascular accident [2]. Stroke has a negative in uence on families due to poor dietary habits [3]. Imbalance is a signi cant aspect of stroke; this attribute demonstrates impairment in both ne and di cult activities; balance incoordination is the most accurate predictor of falls, which also causes panic in stroke patients. The risk of fall con nes the patient from daily activities. That's why balance training needs to be done in post-stroke patients [4,5]. The bene ts of training include developments in functional consequences such as activities of daily living and instrumental activities of daily living [6]. There are a lot of people who have had both acute and chronic strokes. If a person survives a stroke, he will
Rehabilitation interventions for improving balance in Parkinson’s disease: a narrative review
American Journal of Physical Medicine & Rehabilitation
Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a "low or critically low" quality, 23% "moderate" quality and 22% "high" quality.
An intensive massed practice approach to retraining balance post-stroke
Gait & Posture, 2005
Background and Purpose: Falls are highly prevalent and a significant source of complications post-stroke. This study tested the efficacy of standard physical therapy (based on the task-oriented approach) delivered in a massed practice paradigm. The purpose of this study was to test if the intensive massed practice intervention (6 h/day for 2 consecutive weeks) could significantly improve balance function post-stroke. Methods: A single-subject multiple baseline design across subjects with probes was utilized with ten subjects with chronic stroke disability. Clinical tests and time to stabilization (TTS) of the center of pressure in response to a platform perturbation were calculated during baseline, intervention, and the maintenance phases. Results: The ability of the subjects to recover from a balance threat improved, with mean TTS decreasing from 2.35 AE .51 s during baseline, to 1.58 AE .23 s during training, and further still to 1.45 AE .29 s during the maintenance phase, ending 3 months post-intervention. Clinical findings demonstrated improvements in anticipatory and steady-state balance control. In addition weight-bearing symmetry improved and the number of falls sustained reduced. Conclusions: Intensive massed practice of standard physical therapy produced significant results in balance retraining with patients poststroke. Our finding support the need to offer additional practice to maximize the efficacy of physical therapy sessions.