Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study.

OBJECTIVE: To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. DESIGN: Prospective multicenter research design. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: Patients (N=29) with chronic stroke. INTERVENTIONS: Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. MAIN OUTCOME MEASURES: The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. RESULTS: There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. CONCLUSIONS: Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.

Orthotic functional electrical stimulation following botulinum toxin for a young adult with severe hand impairment due to childhood stroke.

ABSTRACT This case report describes the outcomes of a task-specific training protocol using functional electrical stimulation for a young adult with severe hand impairment from a childhood stroke who had a history of tendon transfer and a recent botulinum toxin injection. A 22-year-old female who had a hemorrhagic stroke at age 5, a tendon transfer at 18, and a botulinum toxin injection 6 weeks before study entry, participated in a home- and clinic-based task-specific training program using a functional electrical stimulation orthosis. Training was 30-90 minutes per day, 4 days per week, for 4 weeks. Stroke-specific outcomes were measured before and after intervention. Increases occurred in the following scores: Action Research Arm Test, Stroke Impact Scale Hand Function Domain, and Canadian Occupational Performance Measure. A task-specific training protocol using orthotic functional electrical stimulation appears to have increased hand function and quality of life for an adult with chronic, childhood-onset stroke. To our knowledge, this is the first study to investigate the efficacy of functional electrical stimulation for such an individual.