Effects of continuous visual feedback during sitting balance training in chronic stroke survivors

Introduction Homework-based rehabilitation programs can help stroke survivors restore upper extremity function. However, compensatory motions can develop without therapist supervision, leading to sub-optimal recovery. We developed a visual feedback system using a live video feed or an avatar reflecting users' movements so users are aware of compensations. This pilot study aimed to evaluate validity (how well the avatar characterizes different types of compensations) and acceptability of the system. Methods Ten participants with chronic stroke performed upper-extremity exercises under three feedback conditions: none, video, and avatar. Validity was evaluated by comparing agreement on compensations annotated using video and avatar images. A usability survey was administered to participants after the experiment to obtain information on acceptability. Results There was substantial agreement between video and avatar images for shoulder elevation and hip extension (Cohen's κ: 0.6–0.8) and almost perfect agreement for trunk rotation and flexion (κ: 0.80–1). Acceptability was low due to lack of corrective prompts and occasional noise with the avatar display. Most participants suggested that an automatic compensation detection feature with visual and auditory cuing would improve the system. Conclusion The avatar characterized four types of compensations well. Future work will involve increasing sensitivity for shoulder elevation and implementing a method to detect compensations.

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Training the Unimpaired Arm Improves the Motion of the Impaired Arm and the Sitting Balance in Chronic Stroke Survivors

IEEE Transactions on Neural Systems and Rehabilitation Engineering ◽

10.1109/tnsre.2016.2635806 ◽

2017 ◽

Vol 25 (7) ◽

pp. 873-882 ◽

Cited By ~ 8

Author(s):

Alice De Luca ◽

Psiche Giannoni ◽

Honore Vernetti ◽

Cristina Capra ◽

Carmelo Lentino ◽

...

Keyword(s):

Chronic Stroke ◽

Stroke Survivors ◽

Sitting Balance

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The Effects of Visual Feedback Training on Sitting Balance Ability and Visual Perception of Patients with Chronic Stroke

Journal of Physical Therapy Science ◽

10.1589/jpts.25.635 ◽

2013 ◽

Vol 25 (5) ◽

pp. 635-639 ◽

Cited By ~ 18

Author(s):

Seok Won Lee ◽

Doo Chul Shin ◽

Chang Ho Song

Keyword(s):

Visual Perception ◽

Visual Feedback ◽

Chronic Stroke ◽

Feedback Training ◽

Sitting Balance ◽

Balance Ability

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Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke: A pilot randomized controlled trial

10.21203/rs.3.rs-326548/v1 ◽

2021 ◽

Author(s):

Liselot Thijs ◽

Eline Voets ◽

Evelien Wiskerke ◽

Thomas Nauwelaerts ◽

Yves Arys ◽

...

Keyword(s):

Usual Care ◽

Balance Training ◽

Group Versus ◽

Chronic Stroke ◽

Control Group ◽

Post Intervention ◽

Functional Balance ◽

Randomized Controlled ◽

Sitting Balance ◽

Experimental Group

Abstract Insights in evidence on sitting balance and trunk rehabilitation have not resulted in specific device development. Hence, intensive one-by-one therapist-patient guidance is still required. We developed a novel rehabilitation prototype, specifically aimed at providing sitting balance therapy. In this study, we investigated if technology-supported sitting balance training was feasible and safe in chronic stroke patients and we evaluated whether clinical outcomes improved after a four-week programme when compared with usual care. Methods. In this parallel-group, assessor-blinded, randomized controlled pilot trial, we divided first event chronic stroke participants randomly into two groups. The experimental group received usual care plus additional therapy supported by rehabilitation technology consisting of 12 sessions of 50 minutes of therapy in four weeks. The control group received usual care only. We assessed all participants twice pre-intervention and once post-intervention. Feasibility and safety were descriptively analysed. Between-group analysis evaluated the differences in changes in motor and functional outcomes. Results. In total, 30 participants were recruited and 29 completed the trial (experimental group, n=14; control group, n=15). There were no between-group differences at baseline. Therapy was evaluated feasible by participants and therapist. There were no serious adverse events during sitting balance therapy. Changes in clinical outcomes from pre- to post-intervention demonstrated an increase in the experimental compared to the control group for trunk function; mean (standard deviation [SD]): 7.07 (1.69) versus 0.33 (2.35) points on trunk impairment scale (p<.000), maximum walking speed on 10-meter walk test (0.16 (0.16) m/s in the experimental group versus 0.06 (0.06) m/s in the control group; p=.003), and functional balance measured using Berg balance scale (median [interquartile range] 4.5 (5) points in the experimental group versus 0 (4) points in the control group (p=.014). Conclusions. Technology-supported sitting balance training in persons with chronic stroke is feasible and safe. A four-week, 12-hour programme on top of usual care suggests beneficial effects for trunk function, maximum gait speed and functional balance.Trial Registration: ClinicalTrials.gov identifier: NCT04467554, https://clinicaltrials.gov/ct2/show/NCT04467554, date of Registration: 13 July 2020.

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Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke: a pilot randomized controlled trial

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00910-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Liselot Thijs ◽

Eline Voets ◽

Evelien Wiskerke ◽

Thomas Nauwelaerts ◽

Yves Arys ◽

...

Keyword(s):

Usual Care ◽

Gait Speed ◽

Balance Training ◽

Chronic Stroke ◽

Control Group ◽

Post Intervention ◽

Functional Balance ◽

Randomized Controlled ◽

Sitting Balance ◽

Experimental Group

Abstract Background Technology development for sitting balance therapy and trunk rehabilitation is scarce. Hence, intensive one-to-one therapist-patient training is still required. We have developed a novel rehabilitation prototype, specifically aimed at providing sitting balance therapy. We investigated whether technology-supported sitting balance training was feasible and safe in chronic stroke patients and we determined whether clinical outcomes improved after a four-week programme, compared with usual care. Methods In this parallel-group, assessor-blinded, randomized controlled pilot trial, we divided first-event chronic stroke participants into two groups. The experimental group received usual care plus additional therapy supported by rehabilitation technology, consisting of 12 sessions of 50 min of therapy over four weeks. The control group received usual care only. We assessed all participants twice pre-intervention and once post-intervention. Feasibility and safety were descriptively analysed. Between-group analysis evaluated the pre-to-post differences in changes in motor and functional outcomes. Results In total, 30 participants were recruited and 29 completed the trial (experimental group: n = 14; control group: n = 15). There were no between-group differences at baseline. Therapy was evaluated as feasible by participants and therapist. There were no serious adverse events during sitting balance therapy. Changes in clinical outcomes from pre- to post-intervention demonstrated increases in the experimental than in the control group for: sitting balance and trunk function, evaluated by the Trunk Impairment Scale (mean points score (SD) 7.07 (1.69) versus 0.33 (2.35); p < 0.000); maximum gait speed, assessed with the 10 Metre Walk Test (mean gait speed 0.16 (0.16) m/s versus 0.06 (0.06) m/s; p = 0.003); and functional balance, measured using the Berg balance scale (median points score (IQR) 4.5 (5) versus 0 (4); p = 0.014). Conclusions Technology-supported sitting balance training in persons with chronic stroke is feasible and safe. A four-week, 12-session programme on top of usual care suggests beneficial effects for trunk function, maximum gait speed and functional balance. Trial Registration:ClinicalTrials.gov identifier: NCT04467554, https://clinicaltrials.gov/ct2/show/NCT04467554, date of Registration: 13 July 2020.

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Effects of a High Intensity Tapering Conventional Balance Training for Improving Balance Control Among Chronic Stroke Survivors

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2016.08.376 ◽

2016 ◽

Vol 97 (10) ◽

pp. e120-e121

Author(s):

Jinal Vora ◽

Lakshmi Kannan ◽

Rini Varghese ◽

Prakruti Patel ◽

Tanvi Bhatt

Keyword(s):

High Intensity ◽

Balance Control ◽

Balance Training ◽

Chronic Stroke ◽

Stroke Survivors

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Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00922-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Melisa Junata ◽

Kenneth Chik-Chi Cheng ◽

Hok Sum Man ◽

Charles Wai-Kin Lai ◽

Yannie Oi-Yan Soo ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Balance Control ◽

Controlled Trial ◽

Balance Training ◽

Chronic Stroke ◽

Stroke Survivors ◽

Balance Recovery ◽

Rapid Movement ◽

Randomized Controlled ◽

Movement Training

Abstract Background Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions. Objective To evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors’ overall balance and balance recovery reaction. Methods In this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a “lean-and-release” perturbation system. Results Thirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg’s rectus femoris reacted significantly faster post-training (P = .036). Conclusion The RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors’ overall balance, motor function and improving balance recovery with faster muscle response. Trial registration: The study was registered at Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT03183635, NCT03183635) on 12 June 2017.

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