平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响

目的：探讨平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响。方法：将符合试验条件的住院卒中患者分层随机分为试验组（20例）和对照组（20例）,两组对象在试验开始前Berg平衡得分（BBS）、“起立-走”计时试验（Up＆Go）比较差异无显著性意义。试验组的平衡训练使用平衡仪视觉反馈法,对照组平衡训练使用Bobath平衡训练法,测试指标采用BBS和Up＆Go,在试验开始前和训练6周后各评定1次。结果：训练6周后试验组的BBS、Up＆Go均优于对照组比较差异具有显著性意义。结论：使用平衡仪训练对改善脑卒中患者的平衡和行走功能比单纯的Bobath平衡训练法更有效。     

Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients

[Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.Key words: Coordination movement using the PNF pattern, Balance, Gait     

Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients

[Purpose] This study aimed to assess the effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. [Subjects] Twenty stroke patients were randomly assigned to two groups 10 to an experimental group that performed a virtual reality exercise program accompanied by cognitive tasks and 10 to a control group. The control group performed a proprioceptive neuromuscular facilitation exercise program. Balance was measured with the Berg Balance Scale. Gait was assessed using the Timed Up and Go Test. The paired t-test was used to compare groups before and after the experiment. The independent t-test was conducted to assess differences in the degree of change between the two groups before and after the experiment. [Results] Within-group comparison in the experimental group showed significant differences in the Berg Balance Scale and Timed Up and Go Test. In a comparison between groups, the differences in the Berg Balance Scale and Timed Up and Go Test in the experimental group appeared significant compared with the control group. [Conclusion] The results of the experiment indicate that a virtual reality exercise program accompanied by cognitive tasks has a positive effect on the balance and gait of stroke patients.Key words: Virtual reality exercise program accompanied by cognitive tasks, Balance, Gait     

An efficacy study on improving balance and gait in subacute stroke patients by balance training with additional motor imagery: a pilot study

[Purpose] The few studies conducted on subacute stroke patients have focused only on gait function improvement. This study therefore aimed to confirm the effect of balance training with additional motor imagery on balance and gait improvement in subacute stroke patients. [Subjects and Methods] Participants were divided into an experimental or control group. The experimental group received balance training for 20 minutes/day with mental imagery for 10 minutes/day, three days/week, for four weeks. The control group received only balance training for 30 minutes. Before and after the 12 sessions, balance and gait ability were assessed by the researcher and a physical therapist. [Results] After completion of the 4-week intervention, Berg Balance Scale, Timed Up and Go test, Functional Reach Test, and Four Square Step test scores significantly increased in the experimental group. In the control group, Berg Balance Scale and Functional Reach Test scores significantly improved. Changes in the Timed Up and Go test, Functional Reach Test, and Four Square Step Test scores after intervention were significantly higher in the experimental than in the control group. [Conclusion] Specific balance training with additional motor imagery may result in better rehabilitation outcomes of gait and balance ability than balance training alone.Key words: Balance, Gait, Motor imagery     

Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients

[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.Key words: Balance training, Visual feedback, Acute stroke patients     

Berg平衡量表在脑卒中患者中的内在信度和同时效度

目的：探讨Berg平衡量表在脑卒中患者中的内在信度和同时效度。方法：40例符合入选标准的脑卒中偏瘫患者参与本研究。对患者进行Berg平衡量表、计时起立-步行测验和Barthel指数的评价。结果：Berg平衡量表的Cronbach α系数为0.864,14项目的Cronbach α系数范围为0.844—0.869,Berg平衡量表折半信度系数为0.915。Berg平衡量表与效标工具计时起立-步行测验和Barthel指数之间显著相关。结论：Berg平衡量表在脑卒中患者中具有良好的内在信度和同时效度。     

Visual Biofeedback Balance Training Using Wii Fit after Stroke: A Randomized Controlled Trial

[Purpose] The aim of the present study was to investigate the effect of balance training with visual biofeedback on balance, body symmetry, and function among individuals with hemiplegia following a stroke. [Subjects and Methods] The present study was performed using a randomized controlled clinical trial with a blinded evaluator. The subjects were twenty adults with hemiplegia following a stroke. The experimental group performed balance training with visual biofeedback using Wii Fit^® together with conventional physical therapy. The control group underwent conventional physical therapy alone. The intervention lasted five weeks, with two sessions per week. Body symmetry (baropodometry), static balance (stabilometry), functional balance (Berg Balance Scale), functional mobility (Timed Up and Go test), and independence in activities of daily living (Functional Independence Measure) were assessed before and after the intervention. [Results] No statistically significant differences were found between the experimental and control groups. In the intragroup analysis, both groups demonstrated a significant improvement in all variables studied. [Conclusion] The physical therapy program combined with balance training involving visual biofeedback (Wii Fit^®) led to an improvement in body symmetry, balance, and function among stroke victims. However, the improvement was similar to that achieved with conventional physical therapy alone.Key words: Postural balance, Stroke, Visual biofeedback     

Therapeutic effects of reaching with forward bending of trunk on postural stability,dynamic balance,and gait in individuals with chronic hemiparetic stroke

[Purpose] The objective of this study was to perform forward bending of the trunk and reaching training in chronic stroke patients and to investigate subsequent changes in trunk control, dynamic balance, and gait. [Subject] Twenty-three chronic stroke patients were randomly divided into two groups, with 10 patients in the forward bending of the trunk and reaching group and 13 patients in the control group. [Methods] Both groups underwent 30 minutes of rehabilitation therapy, five days a week, for four weeks. The forward bending of the trunk and reaching group additionally performed forward bending of the trunk and reaching training five times a week for four weeks, which involved four sets of pressing buttons 35 times, for a total of 140 button presses per session. The subjects were tested before and after training using the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test, and 10-Meter Walking Test. Trunk control, dynamic balance, and walking ability were compared between the two groups. [Result] The results of the study showed that the results of the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test improved significantly in the FBR group, while there were no significant differences in the control group. [Conclusion] This study results suggest that forward bending of the trunk and reaching training can be an effective exercise method for chronic stroke patients.Key words: Postural control, Stroke, Trunk     

Concurrent and construct validity of scores on the Timed Movement Battery

BACKGROUND AND PURPOSE: The Timed Movement Battery (TMB) is a new assessment tool designed to measure mobility in elderly individuals. "Mobility" was defined as a person's ability to maneuver his or her body independently in order to accomplish everyday tasks. The purpose of this study was to assess the concurrent and construct validity of scores obtained with the TMB as a measure of mobility in a group of elderly individuals who reported moderate or no difficulty in performing either basic or instrumental activities of daily living (BADL or IADL). SUBJECTS: Thirty community-dwelling elderly people, with a mean age of 77.5 years (SD=7.0, range=65-92), participated in this study. METHODS: Subjects responded to 2 questionnaires regarding their activities of daily living (ADL) (ie, Barthel Index and an 18-item ADL/IADL scale) and completed 3 assessments of mobility (ie, Berg Balance Scale, Timed "Up & Go" Test, and the TMB). Subjects were asked to perform the items on the TMB at a "self-selected" speed (their normal speed) and at a "maximum-movement" speed (as quickly as they could safely perform the items). Subjects' scores on the TMB were cross-correlated with data for 4 criterion tests (ie, Berg Balance Scale, Timed "Up & Go" Test, Barthel Index, and the 18-item ADL/IADL scale) using Spearman rank correlations and Pearson product moment correlations. RESULTS: Composite scores of the TMB performed at self-selected speeds correlated highly with data for the criterion tests and differentiated between those subjects reporting difficulty with ADL and those reporting no difficulty. CONCLUSION AND DISCUSSION: These results support the validity of scores obtained with the TMB as a measure of mobility in this sample of elderly individuals with moderate or no reported difficulty with ADL.     

Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis

Purpose: The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients.

Methods: Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n?=?26) or a control group (resistance-endurance training only, n?=?23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale.

Results: All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group.

Conclusions: In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only.

• Implications for rehabilitation

• Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities.

• Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.

     

Effects of Resistance Exercise Using Thera-band on Balance of Elderly Adults: A Randomized Controlled Trial

[Purpose] This study investigated the effects of resistance exercise using Thera-band on balance of elderly adults. [Methods] Subjects (age range, 60–70 years) were randomly assigned to an experimental (n=12) or control group (n=12). The experimental group performed stretching and resistance exercises, and the control group performed stretching exercises only. Before and after the 5-week intervention, the participants’ static and dynamic balance were evaluated using the Berg Balance Scale, the Timed Up & Go Test, and the Tetrax Portable Multiple System (Tetrax Ltd., Ramat Gan, Israel) after 5 weeks. [Results] After the intervention, the values of the Tetrax in the weight distribution index with eyes open and that with eyes closed and the stability test index with eyes open were significantly lower in the resistance exercise group than in the control group, and the pre-test values were was significantly higher than the post-test values. However, there were no significant differences between groups in the values of the Berg Balance Scale, the Timed Up & Go Test, and the Tetrax stability test index with the eyes closed. [Conclusion] The findings of this study indicate that resistance exercise using the Thera-band is possible to improve the static and dynamic balance of elderly adults.Key words: Stretching, Resistance exercise, Balance     

Determinants of balance confidence in community-dwelling elderly people

BACKGROUND AND PURPOSE: The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study. SUBJECTS: The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (mean=81.7, SD=6.7). METHODS: Balance was measured using the Berg Balance Scale. Functional mobility was measured using the Timed Up Go Test. The Activities-specific Balance Scale was used to assess balance confidence. Data were analyzed using Pearson correlation, multiple regression analysis, and t tests. RESULTS: Fifty-seven percent of the variance in balance confidence could be explained by balance performance. Functional mobility and subject characteristics examined in this study did not contribute to balance confidence. DISCUSSION AND CONCLUSION: Balance performance alone is a strong determinant of balance confidence in community-dwelling elderly people.     

视觉反馈平衡训练对髋部骨折术后患者平衡和行走功能的影响

目的:观察视觉反馈平衡功能训练对髋部骨折术后患者平衡和行走功能的影响。方法:髋部骨折术后患者120例,随机分为观察组和对照组各60例,均配合常规康复训练,观察组于术后2～12周时利用MTD平衡仪进行视觉反馈法静、动态平衡功能训练。训练1周和12周时2组分别采用MTD平衡测定训练仪进行站立平衡功能评定,采用Tinetti步态及平衡试验和"起立-走"计时试验评定步态和静动态平衡、行走能力。结果:治疗1周时2组各项评定指标比较差异无统计学意义。治疗12周时2组MTD平衡测定,其平均压力峰值差和百分比差均较1周时明显缩小;Tinetti步态及平衡试验评分明显提高;"起立-走"计时试验所需时间明显减少(均P0.05),且观察组较对照组表现更显著(P0.05)。结论:在常规康复训练的基础上加MTD平衡仪进行视觉反馈平衡功能训练对改善髋部骨折术后患者的平衡和行走功能有明显促进作用。     

平衡评价量表在临床中的应用

临床评定平衡障碍的方法很多,其中最常用的是量表评定法.本文介绍Berg平衡量表((BBS)、Tinetti平衡与步态量表(Tinetti POMA)、计时起立一步行测验(TUGT)、特异性活动平衡自信量表(ABC),Brunei平衡量表(BRA)、动态步态指数(DGI)、功能性步态评价(FGA)、平衡评价系统测试(BEST)等国内外常用的平衡评价量表及其信度、效度分析结果.并为临床推荐较好的平衡及步态障碍评价工具.     

Use of visual feedback in retraining balance following acute stroke

BACKGROUND AND PURPOSE: Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke, although it is not clear whether functional balance ability also improves. This study compared the relative effectiveness of visual feedback training of center-of-gravity (CoG) positioning with conventional physical therapy following acute stroke. SUBJECTS: Forty-six people who had strokes within 80 days before the study, resulting in unilateral hemiparesis, and who were in need of balance retraining participated. METHODS AND MATERIALS: Initially, subjects were randomly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited. The next 14 subjects were assigned to a control group. All subjects received physical therapy and occupational therapy (regular therapy) 2 hours a day, and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge. The visual feedback group received information about their CoG position as they shifted their weight during various activities. The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting. Static (postural sway) and activity-based measures of balance (Berg Balance Scale, gait speed, and the Timed "Up & Go" Test) were contrasted across the 3 groups at baseline, at discharge, and at 1 month following discharge using an analysis of variance for repeated measures. RESULTS: All groups demonstrated marked improvement over time for all measures of balance ability, with the greatest improvements occurring in the period from baseline to discharge. No between-group differences were detected in any of the outcome measures. CONCLUSION AND DISCUSSION: Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke.     

老年人下肢肌力和功能性活动测试与步速的相关性

目的了解老年人下肢特殊肌群肌力和几种功能性活动测试与步速的相关性。方法341 名居家老年人(65~94 岁),按步速<0.8 m/s 为肌少症的筛查标准,分为可疑肌少症组(n=137)和正常组(n=204)。比较两组人群的基本特征,下肢肌群(包括髂腰肌、股四头肌、腘绳肌、胫前肌)肌力,单腿站立测试、Berg 平衡量表、功能性步态测试、功能性伸展测试、计时起立-走测试评分,及其与步速的相关性。结果两组间体重、身高无显著性差异(P>0.05),可疑肌少症组年龄较大(P<0.05)。双侧下肢肌群肌力两组间无显著性差异(P>0.05);髂腰肌、股四头肌、腘绳肌肌力与步速呈弱相关(r=0.121~0.227, P<0.05),胫前肌肌力与步速无显著相关性(P>0.05)。步速与单腿站立试验呈弱相关(r=0.121~0.236, P<0.05),与Berg 平衡量表、功能性步态测试、功能性伸展试验评分呈中度相关(r=0.479~0.584, P<0.001),与计时起立-走测试评分呈中度负相关(r=-0.502, P<0.001);除功能性伸展测试(P=0.28)外,其他测试两组间均有非常高度显著性差异(P<0.001)。结论诊断肌少症不能仅依靠肌力,还应结合功能性活动。     

Effects of mechanical horseback riding on the balance ability of the elderly

[Purpose] This study was conducted to evaluate the effect of mechanical horseback riding exercise on the balance ability of the elderly. [Subjects and Methods] Ten elderly patients were assigned to an experimental group, and they performed 15 min of horseback riding. Another 10 elderly patients were assigned to a control group, and they performed 15 min of one-leg standing exercise. Both exercises were repeated five times a week for a total of six weeks. The participants’ balance ability was evaluated. [Results] The horseback-riding group showed significant differences between the pre-and post-test balance abilities as assessed by the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. [Conclusion] Horseback riding effectively improves the balance ability of the elderly. Horseback riding should be considered as a therapeutic method for the physical therapy of the elderly.Key words: Balance ability, Elderly, Mechanical horseback riding     

Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients

[Purpose] This study investigated the effect of aquatic proprioceptive neuromuscular facilitation (PNF) patterns in the lower extremity on balance and activities of daily living (ADL) in stroke patients. [Subjects] Twenty poststroke participants were randomly assigned to an experimental group (n = 10) or a control group (n = 10). The experimental group performed lower extremity patterns in an aquatic environment, and the control group performed lower extremity patterns on the ground. Both exercises were conducted for 30 minutes/day, 5 days/week for 6 weeks. Balance was measured with the Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), Functional Reach Test (FRT), and One Leg Stand Test (OLST). Activities of daily living were measured with the Functional Independence Measure (FIM). A paired t-test was used to measure pre- and post-experiment differences, and an independent t-test was used to measure between-group differences. [Results] The experimental and control groups showed significant differences for all pre- and post-experiment variables. In the between-group comparison, the experimental group was significantly difference from the control group. [Conclusion] These results indicate that performing aquatic proprioceptive neuromuscular facilitation patterns in the lower extremity enhances balance and ADL in stroke patients.Key words: Proprioceptive neuromuscular facilitation, Balance, Activities of daily living     

正常人动态平衡能力测试的信度及效度分析

目的　对正常人平衡功能进行动态姿势图重复检测 ,分析各参数间的内在一致性、重测信度及不同测试者间的信度 ;并与Berg平衡量表、功能性前伸测量、起立行走计时测定结果比较 ,检验其效标效度。方法　 2名测试者应用BiodexBalanceSystem (BBS)分别对 40名正常受试者 ( 18～ 67岁 )进行 2次 8级平台稳定性动态姿势图测试及稳定性测试 ;同时还应用Berg平衡量表、功能性前伸距离及起立行走计时等方法进行检测。结果　研究结果发现年龄因素对所有检测参数均有影响 ,体重指数对稳定指数及平均方向控制能力有影响。各参数间内部存在一致性 (r =0 .2 2～ 0 .93 ,均P <0 .0 1) ,其重测信度 (r =0 .70～ 0 .99)及不同测试者间信度 (r =0 .71～ 0 .98)较佳 (ICC =0 .88～ 0 .99)。在测试过程中 ,发现不同跌下次数的受试者其年龄差异和测试结果间差异显著相关 (P <0 .0 0 1)。BBS测试数据与Berg平衡量表、功能性前伸测量、起立行走计时测评结果有较高的相关性 (r =0 .72～ 0 .86)。结论　BBS能反映受试者平衡能力的年龄变化趋势 ,具有较高的内在一致性、重测信度及不同测试者间的信度 ,与Berg平衡量表、起立行走计时及功能性前伸测量结果具有一致性 ,可用于平衡功能的定量评定。