Effects of balance training with and without gaze stabilization exercises on clinical outcomes in elderly patients with chronic dizziness: A randomized controlled trial.

OBJECTIVE: To compare the effects of balance training with and without Gaze Stabilization exercises on clinical outcomes in elderly patient with chronic dizziness. METHOD: Total 64 participants after referral from neurologist at Lahore General Hospital were recruited in this study. These participants were randomly assigned into two groups i.e. Group A (Gaze group) and Group B (control group) with 32 participants in each group by sealed envelope method. Gaze group performed balance exercises with gaze stability exercise whereas, group B performed balance exercises with saccade eye exercises. Berg Balance Scale, Disability Handicapped Inventory, and Activity Specific Balance Confidence Scale were used to measure outcome variables. RESULTS: Demographic variables were represented by mean, standard deviation and frequency distribution. Results showed that there was no baseline difference between gaze and control group (p > 0.05). Both groups showed improved results with the gaze group showing significantly more improvement as compare to the control group on balance (p < 0.05, Mean Group A = 44.1, Mean group B = 40.91), perceived disability (p < 0.05, Mean Group A = 52.84, Group B = 56.09), and risk of fall (p < 0.05, Mean Group A = 53.84, Mean Group B = 50.72) respectively. CONCLUSION: This study concluded that gaze stability exercises with balance training are effective in improving balance, level of perceived disability, and risk of fall prevention among elderly patients with chronic dizziness.

Effect of Action Observation Therapy in the Rehabilitation of Neurologic and Musculoskeletal Conditions: A Systematic Review.

OBJECTIVE: To investigate the effect of action observation therapy (AOT) in the rehabilitation of neurologic and musculoskeletal conditions. DATA SOURCES: Searches were completed until July 2020 from the electronic databases Allied and Complementary Medicine Database (via OVID SP), Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, MEDLINE, and the Physiotherapy Evidence Database. STUDY SELECTION: Randomized controlled trials comparing AOT with standard care were assessed. Musculoskeletal (amputee, orthopedic) and neurologic (dementia, cerebral palsy, multiple sclerosis, Parkinson disease, stroke) conditions were included. There were no age limitations. Articles had to be available in English. DATA EXTRACTION: Two reviewers independently screened titles, abstracts and full extracts of studies for eligibility and assessed the risk of bias of each study using the Cochrane Risk of Bias Tool. Data extraction included participant characteristics and intervention duration, frequency, and type. RESULTS: The effect of AOT in different outcome measures (OMs) was referenced in terms of body structures and functions, activities and participation, and environmental factors as outlined by the International Classification of Functioning, Disability, and Health (ICF). Of the 3448 articles identified, 36 articles with 1405 patients met the inclusion criteria. Seven of the 11 meta-analyses revealed a significant effect of intervention, with results presented using the mean difference and 95% CI. A best evidence synthesis was used across all OMs. Strong evidence supports the use of AOT in the rehabilitation of individuals with stroke and Parkinson disease; moderate evidence supports AOT in the rehabilitation of populations with orthopedic and multiple sclerosis diagnoses. However, moderate evidence is provided for and against the effect of AOT in persons with Parkinson disease and cerebral palsy. CONCLUSIONS: This review suggests that AOT is advantageous in the rehabilitation of certain conditions in improving ICF domains. No conclusions can be drawn regarding treatment parameters because of the heterogeneity of the intervention. AOT has been considerably less explored in musculoskeletal conditions.

Augmented reality-assisted training with selected Tai-Chi movements improves balance control and increases lower limb muscle strength in older adults: A prospective randomized trial.

BACKGROUND: Tai-Chi benefits older adults by enhancing balance control and increasing the muscle strength of the lower limbs. However, a complete set of traditional Tai-Chi exercises is sometimes too difficult for beginners. We investigated whether practicing augmented reality-assisted training with selected Tai-Chi movements tailored to the practitioner's ability (selected Tai-Chi, or sTC) is as effective as performing a complete set of Tai-Chi sequences (complete traditional Tai-Chi, or tTC). METHODS: In this prospective randomized trial carried out in the Beitou District of Taipei City, Taiwan, community-dwelling adults aged ≥65 and without any debilitating diseases (n = 28) were included. Participants were randomly assigned to the sTC group (n = 14) or the tTC group (n = 14). Participants in the sTC group practiced selected Tai-Chi movements using the augmented reality Tai-Chi training system. Participants of the tTC group were asked to complete the 24-form Yang-style Tai-Chi following the instructions of Tai-Chi masters. Each training session lasted 30 min, with 3 sessions per week for 8 weeks. Pre- and post-intervention evaluations included functional balance tests, comprising the Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Functional Reach Test (FRT), as well as muscle strength measurements of the lower extremities. RESULTS: Pre-intervention evaluations showed significant differences in FRT (p = 0.034) and left hip abductor muscle strength (p = 0.046) between the sTC and tTC groups. After 8 weeks of training, the BBS, TUG, and FRT scores in the sTC group showed significant improvement overall. Although all three functional balance test scores improved in the tTC group, only the improvement in BBS was statistically significant (p = 0.001). After 8 weeks, all muscle strength measurements increased by an average of 3.1 ± 1.0 kgw in the sTC group and 1.6 ± 0.8 kgw in the tTC group. CONCLUSIONS: The augmented reality-assisted training with selected Tai-Chi movements, designed based on objective measurements of the practitioner's capability, improved balance control and muscle strength of lower limbs at least as effectively as the complete sequence of traditional Tai-Chi exercises. TRIAL REGISTRATION: This study was approved by the Institutional Review Board of National Yang-Ming University (IRB number: 1000087). Written informed consent was obtained from all participants.

Studying the correlation between balance assessment by Biodex Stability System and Berg Scale in stroke individuals.

INTRODUCTION: Balance disorders are considered to be a serious clinical manifestation after stroke. Therefore, to assess stroke patients' balance performance, use of a quantitative method appears essential. A fundamental step would be the approval of the efficiency of the measurement instruments. The current study aimed to investigate correlations between balance assessment as examined by Biodex Stability System (BSS) and the clinical Berg Balance Scale (BBS) in post-stroke hemiparesis. METHODS: Twenty-five stroke survivors and 25 healthy age-sex matched subjects were recruited. The subjects were assessed using BSS during 3 days, with a 24-h interval. The high interclass correlation coefficient (ICC) values showed that the system was reliable enough to continue the study. The clinical evaluation was performed by the standard BBS. RESULTS: There was a significant moderate negative correlation between the Biodex overall indices and BBS scores in the stroke groups (ravg = -0.68) and in the healthy cohort (ravg = -0.55). Also, a significant moderate negative correlation was found between the Biodex antero-posterior stability indices and BBS scores in the stroke groups (ravg = -0.67) and in healthy cohort (ravg = -0.55). The correlation between the Biodex mediolateral stability indices and BBS scores was moderate to low in the stroke and healthy groups (ravg = -0.67 and -0.39 respectively). DISCUSSION AND CONCLUSION: Moderate negative correlation between the stability indices of the Biodex Stability System and BBS scores indicates that dynamic balance status of the participants partially reflects their functional balance status.

Walking meditation promotes ankle proprioception and balance performance among elderly women.

BACKGROUND: Age-related change of proprioception affects body balance among the elderly. Walking meditation (WM)-a mindfulness practice-involves focusing on leg movements while walking slowly, possibly improving brain processes for perception and balance adjustments. This study investigates the WM's effects on ankle proprioception and balance among the elderly. METHODS: Fifty-eight women aged 69.25 ±â€¯6.06 were randomized into control (n = 29) and WM (n = 29) groups. The WM group engaged in 8 weeks of WM practice (30 min/day, 3 days/week). The absolute angular error of the ankle reposition test (AAE) was measured by an electrogoniometer. The balance performance was evaluated using the Berg Balance Scale (BBS), Functional Reach Test (FRT), and Timed Up and Go test (TUG). Data were analyzed using two-way ANOVA and Bonferroni post hoc test and BBS with nonparametric statistics. RESULTS: At baseline, the WM group's AAE, BBS, FRT, and TUG were 4.2 ±â€¯1.6°, 51.3 ±â€¯4.1 points, 21.7 ±â€¯5.7 cm, and 11.1 ±â€¯2.5 s, respectively, whereas those of the control group were 3.6 ±â€¯2.0°, 51.0 ±â€¯5.0 points, 21.6 ±â€¯5.2 cm, and 10.2 ±â€¯3.1 s, respectively. Post-training, WM group showed significant decrease in AAE (2.4 ±â€¯0.9°) and displayed improvements in BBS, FRT, and TUG (55.4 ±â€¯0.9 points, 29.1 ±â€¯5.8 cm, and 8.1 ±â€¯1.1 s, respectively) (p < 0.01). Conversely, the control group presented no change in AAE, significant decreases in BBS and FRT, and slower TUG (p < 0.01). No difference was found between WM and control groups at the baseline. However, post-training, WM group demonstrated significant improvements in AAE, BBS, FRT, and TUG as compared to the control group (p < 0.001). CONCLUSIONS: WM practice improved the balance and ankle reposition sense among the elderly. It can be used as an alternative form of training to promote balance and ankle proprioception. The results supported that balance performance worsens among the elders who do not engage in physical training.

Hippotherapy for patients with multiple sclerosis: A multicenter randomized controlled trial (MS-HIPPO).

BACKGROUND: Evidence-based complementary treatment options for multiple sclerosis (MS) are limited. OBJECTIVE: To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients. METHODS: A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity. RESULTS: Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03-4.63, p = 0.047) between intervention ( n = 32) and control ( n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (-6.8, p = 0.02) and spasticity (-0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 ( p < 0.001) in physical health score and 14.4 ( p < 0.001) in mental health score of Multiple Sclerosis Quality of Life-54 (MSQoL-54). CONCLUSION: Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.

Balance Assessment in Deaf Children and Teenagers Prior to and Post Capoeira Practice through the Berg Balance Scale.

INTRODUCTION: Hearing loss changes the functionality and body structure a disability that limits activity and restricts the participation of the individual in situations of daily life. It is believed that capoeira can help people with visual disabilities to minimize these deficits. BSE is a low specificity scale that evaluates objectively and functionally aspects of balance and risk of falls in the elderly and children, including the effect of environment on balance function. OBJECTIVE: The objective of the research is to analyze deaf children and adolescents prior to and post-practice of capoeira using the Berg Balance Scale (BBS). METHODS: Quantitative, clinical and observational studies. Twenty five deaf children between 10 and 16 years old of both genders were assessed. BBS was applied in two stages: before starting capoeira and after 6 months of training. The one-hour classes were held once a week for quantitative evaluation purposes. The subjects were divided and evaluated in two groups (10-13 years old and 14-16 years old). RESULTS: There was a significant statistical difference in BBS scores. The general group and the group of 10-13 years old (p = 0.0251) showed an increase in scores after practicing capoeira (p = 0.0039). There were no statistically significant differences in the group from 14 to 16 years of age (p = 0.0504). CONCLUSION: Using the Berg Balance Scale, it was possible to observe an improvement in the balance of the group of children and adolescents who practiced capoeira, and consequently, a decrease in the risk of falling.

Effect of Early-stage Acupuncture Intervention on Activities of Daily Living in Patients with Hemiplegic Balance Disturbance / 上海针灸杂志

Objective To observe the clinical efficacy of balance acupuncture predominantly by puncturing Jiaji points (EX-B2) from C4 to T1and from T12 to L1in treating hemiplegic balance disturbance after cerebral stroke. Method A total of 180 hemiplegia patients were randomized into 3 groups, 60 cases in balance acupuncture group, 60 cases in ordinary acupuncture group, and 60 cases in basic control group. After 1-month treatment and 3 months after the treatment, the motor function (Fugl-Meyer Assessment, FMA), balance function (Berg Balance Scale, BBS; Timed Up and Go Test, TUGT), and activities of daily living (ADL) (Barthel Index, BI) were observed.Result After 1-month treatment and 3 months after the treatment, limb function, balance ability and ADL were significantly different from those before the treatment in balance acupuncture group (P<0.01); after 1-month treatment, limb function in balance acupuncture group was significantly different from that in basic control group (P<0.05), and the differences were more statistically significant in comparing the rest indexes between the two groups (P<0.01); there were significant differences between ordinary acupuncture group and basic control group (P<0.05). Three months after the treatment, there was a significant difference in comparing balance function between balance acupuncture group and basic control group (P<0.05), and the differences were more statistically significant in comparing the rest indexes between the two groups (P<0.01), there was no significant difference in comparing balance function between ordinary acupuncture group and basic control group (P>0.05).Conclusion In combination with basic treatment, balance acupuncture works better than ordinary acupuncture and basic control in improving limb function, ADL and balance function of hemiplegia patients.

Effect of Early-stage Acupuncture Intervention on Activities of Daily Living in Patients with Hemiplegic Balance Disturbance / 上海针灸杂志

Objective To observe the clinical efficacy of balance acupuncture predominantly by puncturing Jiaji points (EX-B2) from C4 to T1and from T12 to L1in treating hemiplegic balance disturbance after cerebral stroke. Method A total of 180 hemiplegia patients were randomized into 3 groups, 60 cases in balance acupuncture group, 60 cases in ordinary acupuncture group, and 60 cases in basic control group. After 1-month treatment and 3 months after the treatment, the motor function (Fugl-Meyer Assessment, FMA), balance function (Berg Balance Scale, BBS; Timed Up and Go Test, TUGT), and activities of daily living (ADL) (Barthel Index, BI) were observed.Result After 1-month treatment and 3 months after the treatment, limb function, balance ability and ADL were significantly different from those before the treatment in balance acupuncture group (P<0.01); after 1-month treatment, limb function in balance acupuncture group was significantly different from that in basic control group (P<0.05), and the differences were more statistically significant in comparing the rest indexes between the two groups (P<0.01); there were significant differences between ordinary acupuncture group and basic control group (P<0.05). Three months after the treatment, there was a significant difference in comparing balance function between balance acupuncture group and basic control group (P<0.05), and the differences were more statistically significant in comparing the rest indexes between the two groups (P<0.01), there was no significant difference in comparing balance function between ordinary acupuncture group and basic control group (P>0.05).Conclusion In combination with basic treatment, balance acupuncture works better than ordinary acupuncture and basic control in improving limb function, ADL and balance function of hemiplegia patients.

Clinical Observation of JIN's Three-needle Acupuncture plus Modern Nerve Facilitation Technique for Infantile Cerebral Palsy / 上海针灸杂志

Objective To observe the clinical efficacy of JIN'sthree needle acupuncture plus modern nerve facilitation technique in treating infantile cerebral palsy.Method Fifty-two patients were randomized into a treatment group of 26 cases and a control group of 26 cases. The treatment group was intervened by JIN'sthree-needle acupuncture plus modern nerve facilitation technique, while the control group was by bionic electrical stimulation. After 2 treatment courses, the treatment group and control group were compared with each other by the Gross Motor Function Measure (GMFM), time taken for 10 m walk, Berg Balance Scale (BBS), modified Barthel Index (MBI) and therapeutic efficacy.Result After the treatment, the GMFM, time taken for 10 m walk, BBS, and MBI scores were significantly improved in the two groups (P<0.05). There were significant differences in comparing the GMFM, time for 10 m walk, BBS, and MBI scores between the two groups (P<0.05). The total effective rates were respectively 92.3% and 76.9%in the treatment group and control group, and the difference was statistically significant (P<0.05).Conclusion JIN's three-needle acupuncture plus modern nerve facilitation technique can significantly boost the efficacy in treating cerebral palsy.

Clinical Observation of Acupuncture plus Rehabilitation for Lower-limb Dysfunction Due to Different Types of Ataxia After Stroke / 上海针灸杂志

Objective To observe the clinical efficacy ofXing Nao Kai Qiao(brain-awakening orifice-opening) needling method plus Frenkel's balance rehabilitation exercise in treating lower-limb dysfunction due to different types of ataxia after stroke.MethodA total of 115 eligible patients were randomized into two groups. Fifty-seven cases in the treatment group were intervened by Xing Nao Kai Qiaoneedling plus rehabilitation training; 58 cases in the control group were intervened byXing Nao Kai Qiaoneedling method alone. Berg Balance Scale (BBS) was adopted to evaluate the symptoms, balance function, and therapeutic efficacy before and after the treatment.Result In the treatment group, the markedly effective rate was respectively 72.2%, 83.3% and 61.1% in the cerebella subtype, brainstem subtype and basal ganglia subtype, and the total effectiverate was respectively 100.0%, 94.4% and 94.4%; in the control group, the markedly effective rate was respectively 21.1%, 35.0% and 58.8%, and the total effective rate was respectively 94.7%, 85.0% and 82.4%, and the between-group differences were statistically significant (P<0.05). After the treatment, the BBS score showed significant intra-group differences in both groups (P<0.01); the between-group comparisons showed that there were significant differences in comparing the scores of cerebella and brainstem subtypes after the treatment (P<0.05).ConclusionXing Nao Kai Qiaoneedling method plus Frenkel's rehabilitation exercise can effectively improve the symptoms of poststroke lower-limb ataxia, especially for cerebella and brainstem subtypes.

Study of the effectiveness of hippotherapy on the symptoms of multiple sclerosis - Outline of a randomised controlled multicentre study (MS-HIPPO).

BACKGROUND: Hippotherapy is a form of therapeutic riding which is used in the treatment of neurological and muscular disorders. Until now there has not been any high-quality randomised study that has proven its effectiveness. OBJECTIVE: The aims of this study are to evaluate whether hippotherapy (as add-on to physiotherapy and/or pharmacotherapy) is superior to the standard treatment (physiotherapy and/or pharmacotherapy as prior to the study) in terms of balance function and other patient relevant outcomes in patients with multiple sclerosis. METHODS: The MS-HIPPO study is a prospective, randomised, examiner-blinded, controlled multicentre study. Patients were randomised to one of two groups: 12 weeks of hippotherapy accompanied by physiotherapy and/or pharmacotherapy (intervention) or 12 weeks of physiotherapy and/or pharmacotherapy as prior to the study (control). The primary endpoint is the change in balance function, as measured by the Berg Balance Scale (BBS). The treatment comparison is evaluated using a covariance analysis with baseline BBS, centre, age, gender and EDSS as covariates. Secondary endpoints include fatigue, quality of life, pain intensity and spasticity. RESULTS AND CONCLUSIONS: The described study is the first randomised study evaluating the benefits of hippotherapy for patients with multiple sclerosis. In 5 national centres ten study physicians will screen potential participants. The expected results will help to improve the knowledge on non-pharmaceutical therapeutic options in this field.

Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: a randomized controlled trial.

OBJECTIVE: To investigate the effects of hydrotherapy on walking ability and balance in patients with chronic stroke. DESIGN: Single-blind, randomized controlled pilot trial. SETTING: Outpatient rehabilitation clinic at a tertiary neurological hospital in China. SUBJECTS: A total of 28 participants with impairments in walking and controlling balance more than six months post-stroke. INTERVENTION: After baseline evaluations, participants were randomly assigned to a land-based therapy (control group, n = 14) or hydrotherapy (study group, n = 14). Participants underwent individual sessions for four weeks, five days a week, for 45 minutes per session. MAIN MEASURES: After four weeks of rehabilitation, all participants were evaluated by a blinded assessor. Functional assessments included the Functional Reach Test, Berg Balance Scale, 2-minute walk test, and Timed Up and Go Test. RESULTS: After four weeks of treatment, the Berg Balance Scale, functional reach test, 2-minute walk test, and the Timed Up and Go Test scores had improved significantly in each group (P < 0.05). The mean improvement of the functional reach test and 2-minute walk test were significantly higher in the aquatic group than in the control group (P < 0.01). The differences in the mean values of the improvements in the Berg Balance Scale and the Timed Up and Go Test were not statistically significant. CONCLUSION: The results of this study suggest that a relatively short programme (four weeks) of hydrotherapy exercise resulted in a large improvement in a small group (n = 14) of individuals with relatively high balance and walking function following a stroke.

Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia.

Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia.