Objectives: 1) to characterize balance reactions to unexpected perturbations during standing and walking in post-stroke individuals in comparison to healthy individuals. 2) to explore the effect of lesion characteristics (location, size) on the patients' balance reactions.3)To examine the effect of a training program on postural stability and gait parameters in post-stroke individuals.
Study design: Two stage study. Stage 1 - examination, stage 2 - intervention. stage 1: 60 post-stroke subjects will be recruited from rehabilitation units at Loewenstein hospital, Raanana, Israel. 60 healthy age-matched controls will be recruited by snowball sampling method from the physical therapy department and will be matched as close as possible for gender and BMI.The following measurements will be administered:
1)Compensatory balance reaction measurement:
Compensatory balance reactions will be measured using the BalanceTutor (MediTouch). The BalanceTutor is a mechatronic device consisting of a computerized treadmill with a horizontal movable platform and an operator station. Measurements will be taken in two conditions:
Standing. Subjects will be instructed to stand and will be exposed to random unexpected platform translations. The platform translations will be increased systematically and controlled. The increases in platform translation will be adjusted by the examiner to the subject's ability to recover from perturbations. Participants will be asked to respond in a "natural" manner to perturbations.
Walking. Subjects will be instructed to walk comfortably (self-paced) on the treadmill, and will be exposed to random unexpected platform translations. The platform translations will be increased systematically and controlled and will be adjusted by the examiner to the subject's ability to recover from perturbations. Compensatory balance reaction characteristics (reaction time, swing time, compensatory step time, step length etc.) will be collected through a three-dimensional motion analysis system. Stage 2 - 60 post stroke patients will be recruited from rehabilitation units at Loewenstein hospital. Measurements as in stage 1 will be conducted before and after intervention.
Intervention program will consist of 8-12 sessions, 2-4 times a week. Each session will last 20-30 minutes. The intervention consists of 2 conditions: Standing. Subjects will be exposed to random unexpected perturbations by the BalanceTutor. The training program will be performed at different levels of difficulty where each level reflects increasing amplitudes of perturbations (i.e., increase in the displacement and accelerations of the horizontal translations of the treadmill). The difficulty level will be adjusted by the examiner according to the subject's abilities.
Walking. Subjects will be exposed to random unexpected perturbations as in the standing condition.
During examination subjects will wear a loose safety harness that will prevent a fall and yet allow the execution of balance recovery reactions.
In addition, clinical measures will be used: Berg Balance Scale, 6 minute walk test, 10 meter walk test, the Fugl-Meyer test for motor recovery after stroke and the Fall Efficacy Scale-International (FES-I) . Normalized lesion data will be computed using the ABLE module within MEDx software (Medical Numerics).
- BalanceTutor Device
ARM 1: Kind: Experimental Label: BalanceTutor
- Masking: Open Label
- Purpose: Treatment
- Intervention: Single Group Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||compensatory step execution time pre intervention||1-5 days before the first session of intervention||No|
|Primary||compensatory step execution time post intervention||1-5 days after the last session of intervention||No|
|Secondary||Berg Balance Scale score pre intervention||1-5 days before the first session of intervention||No|
|Secondary||Berg Balance Scale score post intervention||1-5 days after the last session of intervention||No|