The efficacy of treadmill training on balance dysfunction in individuals with chronic stroke: a systematic review

Tally, Zachary; Boetefuer, Laura; Kauk, Courtney; Pérez, Gabriela; Schrand, Lorraine; Hoder, Jeffrey

doi:10.1080/10749357.2017.1345445

Cited by 32 publications

(29 citation statements)

References 29 publications

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“…In that way, vestibular rehabilitation [14], vibration [15], and multimodal exercise show benefits on balance in the elderly. Innovative methods such as virtual reality [16], complementary therapies such as mind-body movements [17], treadmill training [18], and peripheral somatosensory stimulation [19] have been shown to have different benefits on balance after stroke. For cerebral palsy, different techniques have been used to improve postural balance: whole-body vibration [20], exercise-based interventions [21], therapeutic horseback riding, and hippotherapy [22].…”

Section: Instructionmentioning

confidence: 99%

Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Dominguez-Romero¹,

Molina-Aroca²,

Moral-Muñoz

et al. 2019

IJERPH

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Mechanical horse-riding simulators consist of a device that mimics the movement of a real horse, generating between 50 and 100 three-dimensional physical movements (forward and back, left and right, up and down). The main objective of this study is to analyze the effectiveness of mechanical horse-riding simulators to improve postural balance in subjects with neurological disorders. The search was conducted during January–March 2019 in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane, Web of Science, CINAHL, and Scopus. The methodological quality of the studies was evaluated through the PEDro scale. A total of seven articles were included in this systematic review, of which four contributed information to the meta-analysis. Statistical analysis showed favorable results for balance in stroke patients, measured by the Berg Balance Scale (standardized mean difference (SMD) = 3.24; 95%; confidence interval (CI): 1.66–4.83). Not conclusive results were found in sitting postural balance, measured using the Gross Motor Function Measure-66 (GMFM-66) Sitting Dimension, in patients with cerebral palsy. Most studies have shown beneficial effects on postural balance compared with conventional physical therapy. However, due to the limited number of articles and their low methodological quality, no solid conclusions can be drawn about the effectiveness of this therapy.

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Section: Instructionmentioning

confidence: 99%

Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Dominguez-Romero¹,

Molina-Aroca²,

Moral-Muñoz

et al. 2019

IJERPH

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show abstract

“…(20) Lastly, gradual increases in treadmill speed of walking during the training sessions may be a confounder in these studies, (20,21) given that treadmill gait training is known to improve gait abilities (23) and possibly balance. (24,25) To determine whether gait perturbations are effective in clinically improving dynamic balance, it is necessary to control for the effect of gait training on gait and balance abilities. In addition, perturbations that occur in daily life vary in intensity and require specific adaptations in stepping reactions or gait pattern.…”

Section: Introductionmentioning

confidence: 99%

“…(20) The control group (NonPerturb), which would walk on the treadmill without perturbation, would only improve in walking speed, and possibly dynamic balance, but to a lower extent due to the lower-level challenge of the steady treadmill speed throughout the training program. (21,25) The participants in this group who would cross over to perturbation training once the no-perturbation training was finished, would demonstrate greater improvements in balance and gait abilities during this second training period.…”

Section: Introductionmentioning

confidence: 99%

Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

Esmaeili

Juneau

Dyer

et al. 2020

Preprint

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Background: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods: Twenty-one stroke individuals with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 minute were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over three weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results: With no baseline differences between groups (p>0.075), perturbation training yielded large improvements in most variables in the Perturb (p<0.05, Effect Size: ES>.46) group (n=10) and the NonPerturb (p≤.089, ES>.45) group (n=7 post-crossing), except for maximal strength (p>.23) in the NonPerturb group. Walking-only training in the NonPerturb group (n=8, pre-crossing) mostly had no effect (p>.292, ES<.26), except on balance confidence (p=.063, ES=.46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in chronic stroke individuals. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830 (https://clinicaltrials.gov/ct2/show/NCT04314830?term=NCT04314830&draw=2&rank=1).

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“…(20) Lastly, gradual increases in treadmill speed of walking during the training sessions may be a confounder in these studies, (20,21) given that treadmill gait training is known to improve gait abilities (23) and possibly balance. (24,25) To determine whether gait perturbations are effective in clinically improving dynamic balance, it is necessary to control for the effect of gait training on gait and balance abilities. In addition, perturbations that occur in daily life vary in intensity and require speci c adaptations in stepping reactions or gait pattern.…”

mentioning

confidence: 99%

“…(20) The control group (NonPerturb), which would walk on the treadmill without perturbation, would only improve in walking speed, and possibly dynamic balance, but to a lower extent due to the lower-level challenge of the steady treadmill speed throughout the training program. (21,25) The participants in this group who would cross over to perturbation training once the no-perturbation training was nished, would demonstrate greater improvements in balance and gait abilities during this second training period.…”

mentioning

confidence: 99%

Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

Esmaeili

Juneau

Dyer

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods: Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 minute were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over three weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results: With no baseline differences between groups (p>0.075), perturbation training yielded large improvements in most variables in the Perturb (p<0.05, Effect Size: ES>.46) group (n=10) and the NonPerturb (p≤.089, ES>.45) group (n=7 post-crossing), except for maximal strength (p>.23) in the NonPerturb group. Walking-only training in the NonPerturb group (n=8, pre-crossing) mostly had no effect (p>.292, ES<.26), except on balance confidence (p=.063, ES=.46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830 (https://clinicaltrials.gov/ct2/show/NCT04314830?term=NCT04314830&draw=2&rank=1).

show abstract

The efficacy of treadmill training on balance dysfunction in individuals with chronic stroke: a systematic review

Cited by 32 publications

References 29 publications

Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

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