Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke: a pilot randomized controlled trial

Abstract

Background Technology development for sitting balance therapy and trunk rehabilitation is scarce. Hence, intensive one-to-one therapist-patient training is still required. We have developed a novel rehabilitation prototype, specifically aimed at providing sitting balance therapy. We investigated whether technology-supported sitting balance training was feasible and safe in chronic stroke patients and we determined whether clinical outcomes improved after a four-week programme, compared with usual care. Methods In this parallel-group, assessor-blinded, randomized controlled pilot trial, we divided first-event chronic stroke participants into two groups. The experimental group received usual care plus additional therapy supported by rehabilitation technology, consisting of 12 sessions of 50 min of therapy over four weeks. The control group received usual care only. We assessed all participants twice pre-intervention and once post-intervention. Feasibility and safety were descriptively analysed. Between-group analysis evaluated the pre-to-post differences in changes in motor and functional outcomes. Results In total, 30 participants were recruited and 29 completed the trial (experimental group: n = 14; control group: n = 15). There were no between-group differences at baseline. Therapy was evaluated as feasible by participants and therapist. There were no serious adverse events during sitting balance therapy. Changes in clinical outcomes from pre- to post-intervention demonstrated increases in the experimental than in the control group for: sitting balance and trunk function, evaluated by the Trunk Impairment Scale (mean points score (SD) 7.07 (1.69) versus 0.33 (2.35); p < 0.000); maximum gait speed, assessed with the 10 Metre Walk Test (mean gait speed 0.16 (0.16) m/s versus 0.06 (0.06) m/s; p = 0.003); and functional balance, measured using the Berg balance scale (median points score (IQR) 4.5 (5) versus 0 (4); p = 0.014). Conclusions Technology-supported sitting balance training in persons with chronic stroke is feasible and safe. A four-week, 12-session programme on top of usual care suggests beneficial effects for trunk function, maximum gait speed and functional balance. Trial Registration:ClinicalTrials.gov identifier: NCT04467554, https://clinicaltrials.gov/ct2/show/NCT04467554, date of Registration: 13 July 2020.

Therapists and patients perceptions of a mixed reality system designed to improve trunk control and upper extremity function

“…The assistive therapy chair has been described in detail elsewhere and, therefore, is summarized only briefly here 22 , 23 , 27 – 29 . The seat was designed for the rehabilitation of trunk control in patients after stroke and has shown good usability and effectiveness as an adjunct to conventional trunk control rehabilitation 22 , 23 . Patients training on the device improved beyond the clinically minimal important difference for trunk control and gait speed 23 .…”

“…The seat was designed for the rehabilitation of trunk control in patients after stroke and has shown good usability and effectiveness as an adjunct to conventional trunk control rehabilitation 22 , 23 . Patients training on the device improved beyond the clinically minimal important difference for trunk control and gait speed 23 .…”

“…Mindful of this gap, we developed a prototype of an assisted therapy chair that produces exercise stimuli for trunk control training, standing, and walking in early post stroke 22 . This device has shown good usability and effectiveness as an adjunct to conventional trunk control rehabilitation 22 , 23 . In this study, the chair is enhanced with a Mixed Reality (MR) application (smart glasses) to train reaching beyond the participant’s arm length (Holoreach).…”

Effectiveness of cerebellar vermis intermittent theta-burst stimulation in improving trunk control and balance function for patients with subacute stroke: a randomised controlled trial protocol

“… 37 It is a 17-item scale used to evaluate static and dynamic sitting balance and trunk coordination for patients with stroke, with a total score ranging from 0 to 23 points. 38 A higher score indicates better trunk control.…”

Surface electromyographic activity of trunk muscles during trunk control exercises for people after stroke; effect of a mobile and stable seat for rehabilitation

“…The movable seat is described in detail in separate publications and is therefore described only briefly here [24,26]. The seat was designed for the rehabilitation of PAT to support the following therapy goals of the International Classification of Health Intervention (ICHI)-Interventions on Body Systems and Functions-10 Interventions on the Musculoskeletal System-Movement (ICHI 1-10-MV) domain [27]: The movable seat possesses either one or two degrees of freedom i.e.…”