Balance & Mobility Following

Stroke: Effects of Physical

Therapy Interventions With &
Without
Biofeedback/Forceplate
Training
Prepared by:
CALINGA, Marivic
CHIN, Eunice
ESTRADA, Ernest Michael
LUZON, Geelyn
PASSILAN, Jennylyn
Introduction
Definition of terms:
Balance Master – a dual forceplate system
composed of 4 load cells that detect
PRESSURE, connected to a 486 DX IBM-
compatible computer

 Biofeedback – form of alternative medicine

that involves measuring a subject’s quantifiable
bodily functions, conveying the info to the
patient
 NeuroCom Balance Master – a device
that provides a visual representation of a
person’s center of gravity
 Timed “Up & Go” Test – a test wherein
the examiner times the pt as he/she
performs the ff. activities:
> from a sitting position, the pt
independently stands up, walks 3m. (w/
assistive device, as needed), turns
around, walks back, turns around & sits
down again.
 Berg Balance Scale – a performance-
based assessment tool that is used to
evaluate standing balance during
functional activities. The pt is scored on
14 different tasks.
PURPOSE:
*The purpose of this study was to
COMPARE outcomes (using Berg
Balance Scale & Timed “Up & Go” Test)
following BALANCE and MOBILITY
retraining by physical therapy w/ or w/o
the addition of NeuroCom Balance
Master training in 2 groups of patients
who had hemiplegia 2˚ to stroke
SUBJECTS:

 13 outpatients
- (+) Hemiplegia
- Age ranges from 30-77 years old
- 15-538 days poststroke
METHODS (overview):

 Subjects were assigned RANDOMLY to

either Experimental or Control Group

 Cognitive & Visual-Perceptual Skills were

tested by a psychologist

 Assessed using the Berg Balance Scale

& the Timed “Up & Go” Test before and
after 4 weeks of physical therapy
 Both groups received physical therapy
interventions designed to improve
BALANCE & MOBILITY
(2-3 times per week)
 Experimental Group
- trained on NeuroCom Balance
Master (15 mins. of each 50-min. tx
session)

 Control Group
- received other physical therapy
interventions for 50-min tx session
RESULTS (overview):
 Both groups
-scored HIGHER on the Berg Balance
Scale
- required less time to perform Timed
“Up & Go” Test
DISCUSSION & CONCLUSION
(overview):

*although both groups demonstrated

improvement following 4 weeks of
physical therapy interventions, NO
additional effects were found in the group
that received visual
biofeedback/forceplate training..
Stroke – (aka CVA) is a sudden
loss of neurological function
caused by an interruption of the
blood flow to the brain
In a STROKE..
*balance is diminished in pt’s (+)
hemiplegia & hemiparesis
*postural sway can be TWICE than that
to people in their same age
* symmetry of weight bearing is impaired.
(61%-80% of their body weight is beared in
their nonparetic LE)
*pt’s limits of stability is reduced
*MOST prevalent dx among adults who
FALL
Meth ods
SUBJECT S
 13 patients (9 male and 4 female)
 Hemiplegic 2° stroke
 Currently undergoing PT eval & interventions
 Age bet. 30-77 y/o
 Poststroke days: 15-538 days
1° criteria inclusion:
Pt. able to maintain stationary position for
about 2 consecutive minutes with or without
assist. (7 Pt. required assistance)
SU BJ EC TS

 They agreed to participate and signed an

approved consent.
 They were randomly assigned to either an
experimental or a control group via coin
toss.
PSY CHO LOG IC AL
TES T
 Testing was performed by a psychologist
initially to determine whether the
experimental and control groups were
equal with respect to the cognitive skills
tested.
PSY CHO LOG IC AL
TES T
• Basic cognitive screening

 Orientation
 Attention
 Comprehension
 Repetition
 Naming
 Constructional ability
 Calculation and reasoning
 Sequencing
PSY CHO LOG IC AL
TES T
 comprehensive testing of visual
discrimination, concentration, sequencing,
and set shifting was also performed using:

 Benton’s test for visual discrimination

 Neurobehavioral Cognitive Status Exam
 Mental control subtest of the Wechsler Memory
Scale
 Trail-Making Test from the Halstead-Reitan
Battery
PSY CHO LOG IC AL
TES T
 both groups were similar with respect to
age, number of days poststroke, and
educational level

 no differences were identified between

groups with respect to the cognitive and
visual-perceptual tests performed

 subjects with right vs. left hemiplegia also

revealed no statistically significant
differences
EQ UI PM ENT
 Balance Master

 a dual forceplate system composed of 4

load cells that detect pressure, connected
to a 486 DX IBM-compatible computer
and monitor.
EQ UI PM ENT
NEUROCOM
BALANCE
MASTER
EQ UI PM ENT
The subjects were instructed to maintain
or shift their weight, as appropriate, to
make the representation of their center of
gravity reach the target presented visually

If calibration errors occur during initial

computer power-up or during training, an
error message is displayed.
EQ UI PM (4-in-wide)
 10.16-cm-wide ENT balance beam
 small and large rocker boards
 a Swiss ball
 firm and compliant floor mats
 a 48.26-cm high (19-in-high) treatment mat
 a 16.51-cm-high (6.5-in-high) stool
 a chair with armrests (seat-to-floor height544.45
cm [17.5 in], armrest height566.04 cm [26 in]
 Stairs
 gait belts
 a tape measure
 Appropriate assistive devices
 Ankle-foot orthoses
RES UL TS
RES UL TS

 TIMED “UP & GO” TEST

-NO DIFFERENCE BETWEEN

CONTROL AND EXPERIMENTAL
GROUP
RES UL TS

 BERG BALANCE SCALE

-DID NOT IDENTIFY A DIFFERENCE

BETWEEN THE CONTROL AND
EXPERIMENTAL GROUP
RES UL TS

 BOTH GROUP OF SUBJECTS

COMBINED DEMONSTRATED
IMPROVEMENT AFTER PHYSICAL
THERAPY INTERVENTIONS WITH
RESPECT TO BOTH BERG
BALANCE SCALE & TIMED “UP &
GO” TEST
Dis cu ssi on
 The research indicates that the use of
visual biofeedback/ forceplate training
improves stance symmetry in subjects
with hemiplegia following stroke.
 However the research’s major findings:
- visual biofeedback/ forceplate training
combined with conventional physical
therapy did not enhance the effects of the
intervention on balance and functional
mobility in outpatients with hemiplegia
secondary stroke
 Limitations:
- Balance retraining is very context or task
specific. Although biofeedback did showed
improvement on stance symmetry, it lacks
effect on gait speed or functional abilities.
- The smallness of the sample size may
have contributed to statistical error.
 Strengths:
- Consistent masking and assessment of
the evaluators ability to accurately perform
test.
- Specific therapist influence can be ruled
out because each of the 9 therapists
involved in physical therapy delivery and
measure assessment had equal
opportunity to work with both groups.
 Correlation analysis was performed
between the cognitive and visual-
perceptual data and the 2 measures, it
was a positive correlation, meaning both
variables increased together.
Co nclu si on
 The results indicate that there was no
benefit of Balance Master training when
administered in combination with other
physical therapy interventions compared
to physical therapy alone.