Efficacy of treatment with a kinaesthetic ability training device on balance and mobility after stroke: a randomized controlled study

Abstract

Objective: To investigate whether the addition of a kinaesthetic ability training device could enhance the effect of a conventional rehabilitation programme on balance and mobility in hemiparetic patients late after stroke.

Design: Randomized, controlled, assessor-blinded trial.

Setting: The rehabilitation ward of a university hospital. Thirty hemiparetic patients (mean age (SD) of 57.4 (8.1) years) late after stroke (mean time since stroke (SD) 545.2 (99.9) days) were assigned randomly to an experimental or a control group.

Interventions: The control group (n = 15) participated in a conventional rehabilitation programme. The experimental group (n = 15) participated in balance training with a kinaesthetic ability training device in addition to a conventional rehabilitation programme for four weeks, five days a week.

Outcome measures: Kinaesthetic ability training static and dynamic balance indices, balance and lower extremity subscores of the Fugl-Meyer Stroke Assessment Instrument (FMA), total motor and locomotor subitem scores of the Functional Independence Measure (FIM) were evaluated at baseline and after treatment.

Results: The experimental group had greater improvement in measures of balance including static (P = 0.045) and dynamic balance index (P = 0.001) and FMA balance score (P = 0.001) than the control group. No between-group differences were detected in subscore of FMA, total motor and locomotor subscores of FIM. There were significant improvements in balance subscores of FMA, static and dynamic balance indexes in the experimental group and in sub-item scores of FIM and lower extremity scores of FMA in both groups.

Conclusion: Kinaesthetic ability training in addition to a conventional rehabilitation programme is effective in improving balance late after stroke. However, this improvement is not reflected in individual functional status.

Get full access to this article

View all access options for this article.

References

Liston RA , Brouwer BJ Reliability and validity of measure obtained from stroke patients using the balance master. Arch Phys Med Rehabil 1996 ; 77: 425-30.

Pollock AS , Durward BR , Rowe PJ What is balance? Clin Rehabil 2000; 14: 402-06.

Yavuzer G. , Eser F. , Karakus D. , Karaoglan B. , Stam HJ The effects of balance training on gait late after stroke: a randomized controlled trial. Clin Rehabil 2006; 20: 960-69.

Shumway-Cook A. , Anson D. , Haller S. Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. Arch Phys Med Rehabil 1988; 69: 395-400.

Dickstein R. , Abulaffio N. Postural sway of the affected and nonaffected pelvis and leg in stance of hemiparetic patients. Arch Phys Med Rehabil 2000; 81: 364-67.

Haart de M. , Geurts ACH , Dault MC , Nienhuis B. , Duysen J. Restoration of weight-shifting capacity in patients with postacute stroke: a rehabilitation cohort study. Arch Phys Med Rehabil 2005; 86: 755-62.

Laufer Y. , Dickstein R. , Resnik S. , Marcovitz E. Weight bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights. Clin Rehabil 2000; 14: 125-29.

Sackley CM Falls, sway, and symmetry of weight bearing after stroke. Int Disabil Stud 1991; 13: 1-4.

Mackintosh SFH , Hill K. , Dodd KJ , Goldie P. , Culham E. Falls and injury prevention should be part of every stroke rehabilitation program. Clin Rehabil 2005; 19: 441-51.

10.

Pollock A. , Baer G. , Pomeroy V. , Langhorne P. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. Cochrane Database Syst Rev 2003; 2: CD001920.

11.

Bohannon RW Gait performance of hemiparetic stroke patients: selected variables. Arch Phys Med Rehabil 1987; 68: 777-81.

12.

Hocherman S. Dickstein R. Platform training and postural stability in hemiplegia. Arch Phys Med Rehabil 1984; 65: 588-92.

13.

Wade DT , Heller WA , Maggs J. , Hewer RL Walking after stroke. Scand J Rehabil Med 1987; 19: 25-30.

14.

Barclay-Goddard R. , Stevenson T. , Poluha W. , Moffatt ME , Taback SP Forceplatform feedback for standing balance training after stroke. Cochrane Database Syst Rev 2004; 18: CD004129.

15.

Van Peppen RPS , Kortsmit M. , Lindeman E. , Kwakkel G. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. J Rehabil Med 2006; 38: 3-9.

16.

Geiger RA , Allen JB , O'Keefe J. Hicks RR Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Phys Ther 2001; 81: 995-1005.

17.

Winstein CJ , Gardner ER , Mcneal DR , Barto PS , Nicholson DE Standing balance training: effect on balance and locomotion in hemiparetic adults. Arch Phys Med Rehabil 1989; 70: 755-62.

18.

Walker C. , Brouwer BJ , Culham EC Use of visual feedback in retraining balance following acute stroke . Phys Ther 2000; 80: 886-95.

19.

Hansen MS , Dieckmann B. , Jensen K. , Jakobsen BW The reliability of balance tests performed on the kinesthetic ability trainer (KAT 2000). Knee Surg Sports Traumatol Arthrosc 2000; 8: 180-85.

20.

Crawford C. , Fleming K. , Karabatsos P. , Volkmann C. , Williams K. , Newton R. Normative values for healthy young and elderly adult populations on the KAT balance system . Issues Aging 1995; 18: 10-14.

21.

Johnston RB , Howard ME , Cawley PW , Losse GM Effects of lower extremity muscular fatique on motor control performance. Med Sci Sports Exerc 1998; 30: 1703-707.

22.

Vrbanic TS , Ravlic-Gulan J. , Gulan G. , Matovinović D. Balance index score as a predictive factor for lower sports results or anterior cruciate ligament knee injuries in Croatian female athletes - preliminary study. Coll Antropol 2007; 31: 253-58.

23.

Holm I. , Fosdahl MA , Friis A. , Risberg MA , Myklebust G. , Steen H. Effect of neuromuscular training on proprioception, balance, muscle strength, and lower limb function in female team handball players. Clin J Sport Med 2004; 14: 88-94.

24.

Richards CL , Malouin F. , Dumas F. , Tardif D. Gait velocity as an outcome measure of locomotor recovery after stroke . In: Craig R , Oatis C eds. Gait analysis: theory and applications. Mosby, 1995: 355-64.

25.

Granger CV , Gresham GE New developments in functional assessment. Phys Med Rehabil Clin N Am 1993; 4: 417-99.

26.

Kucukdeveci AA , Yavuzer G. , Elhan AH , Sonel B. , Tennant BA Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil 2000 ; 15: 311-19.

27.

Dettman MA , Linder MT , Sepic SB Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med 1987; 66: 77-90.

28.

Fugl-Meyer AR , Jääskö L. , Leyman I. , Olsson S. , Steglind S. The post stroke hemiplegic patient. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7: 13-31.

29.

Malouin F. , Richard L. , Bonneau C. , Durand D. , Corriveau D. Evaluating motor recovery after stroke: comparison of the Fugl-Meyer assessment and the Motor Assessment Scale. Arch Phys Med Rehabil 1994; 74: 1200-12.

30.

France P. , Derscheid G. , Irrgang J. et al. Preliminary clinical evaluation of the Breg KAT: effects of training in normals. Isokinet Exerc Sci 1992 ; 2: 133-39.

31.

Ashburn A. Physical recovery following stroke. Physiotherapy 1997; 83: 480-90.

32.

Sackley CM , Baguly BI Visual feedback after stroke with balance performance monitor: two single case studies. Clin Rehabil 1993; 7: 189-95.

33.

Sackley CM , Lincoln NB Single blind randomised controlled trial of visual feedback after stroke: effects on stance symmetry and function. Disabil Rehabil 1997; 19: 536-46.