The effects of ankle joint strategy exercises with and without visual feedback on the dynamic balance of stroke patients

BACKGROUND Lower limb spasticity, as is common following a cerebrovascular attack (CVA) or stroke, can affect the balance and gait of patients. This then not only affects independence, and quality of life, but also increases the risk for other concerns, such as falling and an increased sedentariness, which could further affect health outcomes. OBJECTIVE We aimed to evaluate the effect of ankle plantar flexor spasticity severity on balance and to determine the relationship between the spasticity severity with ankle proprioception, passive range of motion (ROM), and balance confidence in post-stroke patients. METHODS Twenty-eight post-stroke patients were divided into two groups based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS) as a High Spasticity Group (HSG) (MMAS>2) (n=14) or a Low Spasticity Group (LSG) (MMAS≤2) (n=14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway in the open and closed eyes conditions, timed up and go (TUG) test, ankle dorsiflexion passive range of motion (ROM), and ankle joint proprioception were measured. RESULTS No significant (p>0.05) differences were found between the LSG and HSG in terms of balance confidence, dynamic balance, and ankle dorsiflexion ROM. In addition, postural sway in the open and closed eye conditions was not significantly different in both the LSG and HSG for both the less affected and affected limbs. Similarly, posturography indicators in the open and closed eye conditions were not significantly different in both the LSG and HSG for both the less affected and affected limbs. However, ankle joint proprioception in terms of repositioning error angle was significantly (p≤0.05) better in the LSG compared to the HSG (p=0.01). There was also a significant relationship between TUG scores and balance confidence in the HSG(r=-0.55, p=0.04) CONCLUSIONS Our data suggests that several aspects of balance needs to be considered in the assessment and rehabilitation of post-stroke patients and there is a need to monitor entire patterns of activities to support wider engagement in rehabilitation activities. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16045

Download Full-text

Effectiveness of Virtual Reality and Visual Feedback on Balance and Leg Function in Children with Cerebral Palsy

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i18.748 ◽

2019 ◽

Vol 1 (18) ◽

Author(s):

Arūnė Dūdaitė ◽

Vilma Juodžbalienė

Keyword(s):

Virtual Reality ◽

Cerebral Palsy ◽

Postural Control ◽

Range Of Motion ◽

Visual Feedback ◽

Lower Limb ◽

Dynamic Balance ◽

Control Group ◽

Children With Cerebral Palsy ◽

Stretching Exercises

Research background. Virtual reality and visual feedback improve motor performance, motor function and balance, so we want to fnd if it aﬀects the function of legs and balance of children with spastic hemiplegia. Research aim was to establish if the use of virtual reality and visual feedback with traditional physiotherapy improve the function of legs and balance of children with cerebral palsy. Methods. Nine children with cerebral palsy participated in the research. Participants were randomly divided into two groups – virtual reality group (n = 6) and control (n = 3). Virtual reality group practised exergaming and stretching exercises for 10 weeks, twice a week. Control group practiced conventional physiotherapy and stretching exercises for 6 weeks, twice a week. We measured the range of motion of the lower limb, spasticity of the lower limb using Modifed Ashworth’o Scale, static, dynamic balance, trunk coordination using Trunk Impairment Scale at the start and the end of the research, and balance using Pediatric Balance Scale. Results. Virtual reality and visual feedback reduced the spasticity of the lower limb, improved balance and postural control for children with cerebral palsy, but it did not improve the range of motion of the lower limb of children with cerebral palsy. Conclusions. Virtual reality and visual feedback did not improve the range of motion of the lower limb of children with cerebral palsy. Virtual reality and visual feedback reduced spasticity of the lower limb, improved balance and postural control for children with cerebral palsy.Keywords. Cerebral palsy, virtual reality, visual feedback, postural control, muscle architecture.

Download Full-text

Use of visual feedback for balance training in hemiparetic Stroke patients

Fisioterapia em Movimento ◽

10.1590/0103-5150.028.002.ao04 ◽

2015 ◽

Vol 28 (2) ◽

pp. 241-249

Author(s):

Fabiane Maria Klitzke dos Santos ◽

Franciely Voltolini Mendes ◽

Simone Suzuki Woellner ◽

Noé Gomes Borges Júnior ◽

Antonio Vinicius Soares

Keyword(s):

Visual Feedback ◽

Visual Information ◽

Statistical Significance ◽

Balance Training ◽

Berg Balance Scale ◽

Functional Mobility ◽

Stroke Patients ◽

Intergroup Comparison ◽

Hemiparetic Stroke ◽

Balance Board

Introduction Hemiparetic Stroke patients have their daily activities affected by the balance impairment. Techniques that used visual information for training this impairment it seems to be effective. Objective To analyze the effects of the unstable balance board training and compare two ways of visual feedback: the biomechanical instrumentation and the mirror. Materials and methods Eight chronic hemiparetic Stroke patients participated in the research, randomized in two groups. The first group (G1) accomplished the training with biomechanical instrumentation, and the second group (G2) trained in front of the mirror. Sixteen training sessions were done with feet together, and feet apart. The evaluation instruments that were used before and after the period of training were the Time Up and Go Test (TUGT), Berg Balance Scale (BBS) and the Instrumented Balance Board (IBB), that quantified the functional mobility, the balance and the posture control respectively. Results The TUGT showed significant results (p < 0.05) favorable to G1. Despite the results of BBS were significant for G2, the intergroup comparison did not reveal statistical significance. Both groups obtained decrease in levels of IBB oscillation, what can indicate a higher stability, however the results did not indicate statistical significance (p > 0.05). A strong correlation between all the applied tests was observed in this research. Conclusion Although the advantages found were different between the groups, in both it could be observed that the training brought benefits, with the transference to the functional mobility.

Download Full-text