Stroke, Postural Balance
Conditions
Keywords
Chronic stroke, Balance training, Posturography, Biofeedback, Berg Balance Scale, Fall risk
Brief summary
Stroke frequently leads to long-term balance impairments, increased fall risk, and reduced independence in daily activities. In chronic stroke patients, deficits in sensory integration and postural control may persist despite conventional rehabilitation programs. Additional targeted balance interventions may enhance recovery by improving multisensory processing and motor control. This study investigates whether adding biofeedback-based interactive posturographic balance training to conventional rehabilitation improves balance performance, fall risk, functional independence, and psychological well-being in individuals with chronic stroke. Participants were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation combined with interactive balance training for eight weeks. Outcomes were assessed using validated clinical scales measuring balance, fall risk, daily functioning, and emotional status.
Detailed description
Stroke is a major cause of long-term disability and frequently results in persistent impairments in postural control and balance. In individuals with chronic stroke, altered sensory integration and impaired motor coordination contribute to increased fall risk and reduced functional independence. Although conventional rehabilitation programs address strength, mobility, and functional training, balance deficits may remain due to insufficient multisensory challenge and limited task-specific feedback. Biofeedback-based interactive posturographic systems provide real-time visual and sensory feedback during standing tasks and systematically challenge postural control under varying sensory conditions. Such interventions may enhance motor learning and promote adaptive sensory reweighting mechanisms by exposing individuals to controlled visual deprivation and head-position alterations. This prospective, single-blind randomized controlled study was conducted in individuals with chronic stroke (\>6 months post-event). Participants were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation combined with interactive posturographic balance training. The intervention period lasted eight weeks, with sessions conducted five days per week. The primary objective of the study was to determine whether adding biofeedback-based interactive posturographic balance training improves clinical balance performance. Secondary objectives included evaluating effects on fall risk, functional independence, and psychological status.
Interventions
DEVICEBiofeedback-Based Interactive Posturographic Balance Training
Intervention Description (Experimental Arm) Participants received biofeedback-based interactive posturographic balance training using a multisensory platform that provides real-time visual feedback based on vertical pressure fluctuations detected from four force plates under the heels and forefeet. The system systematically challenges postural control under different sensory conditions, including eyes open, eyes closed, unstable surface, and head-position variations. Training sessions lasted 25 minutes, five days per week, for eight weeks and were conducted in addition to a standardized conventional rehabilitation program.
BEHAVIORALConventional Rehabilitation Program
Participants received a standardized conventional rehabilitation program consisting of neurophysiological facilitation techniques, range of motion exercises, muscle strengthening exercises, postural control training, weight-shifting exercises, and gait training. Sessions lasted 45 minutes per day, five days per week, for eight weeks.
Sponsors
Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessor was blinded to group allocation throughout the study. Participants and treating therapists were not blinded due to the nature of the intervention. Participants were instructed not to disclose their group assignment during outcome assessments.
Intervention model description
Participants were randomly assigned in a 1:1 ratio to one of two parallel groups. One group received conventional rehabilitation combined with biofeedback-based interactive posturographic balance training, while the control group received conventional rehabilitation alone. Both groups underwent intervention for eight weeks without crossover between groups.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* At least 6 months had elapsed since stroke onset * They were ambulatory prior to stroke * They were able to stand independently for at least 2 minutes * Mini-Mental State Examination (MMSE) score ≥22
Exclusion criteria
* Medical conditions contraindicating participation in an exercise program * Additional disorders affecting balance assessment (vertebrobasilar or peripheral vestibular insufficiency, significant visual impairment, neglect, cognitive impairment, major lower extremity contracture, neuromuscular disease, other neurological pathology, impaired joint position sense) * Previous history of stroke * Cerebellar involvement (dysmetria, dysdiadochokinesia, ataxia)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Berg Balance Scale (BBS) | Baseline and 8 weeks | The Berg Balance Scale is a 14-item clinical measure of balance performance scored from 0 to 56, with higher scores indicating better balance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Barthel Index score from baseline to 8 weeks | Baseline and 8 weeks | The Barthel Index assesses functional independence in activities of daily living and ranges from 0 to 100. Higher scores indicate greater independence. |
| Change in Fall Risk Index from baseline to 8 weeks | Baseline and 8 weeks | The Fall Risk Index is derived from computerized posturographic assessment and reflects the estimated percentage risk of falling. Scores range from 0 to 100, with higher scores indicating greater fall risk. |
| Change in Hospital Anxiety and Depression Scale (HADS) total score from baseline to 8 weeks | Baseline and 8 weeks | The HADS is a 14-item questionnaire assessing anxiety and depression symptoms. Total scores range from 0 to 42, with higher scores indicating greater psychological distress. |
Countries
Turkey (Türkiye)
Outcome results
None listed