The Influence of Feedback on Balance in Stroke Patients

Abstract

Stroke has been recognized as one of the basic reasons what concerns illness, death-rate and long-term disability all over the world. Balance disorder is one of the most common disorders and one of the basic factors limiting the routine of cerebral stroke patients. Therefore the feedback is especially important to train balance in patients with the disorder to perceive their body position. The use of feedback provides patients with sensormotoric disorders ability to evaluate different physiological reactions better and to improve simetricity of their body position. There are expensive and complicated feedback-based platforms used to train balance, however, there was no evidence, whether a mirror – a simple and cheap means of feedback – equally influences the balance of stroke patients. Objectives: to assess the feedback influence on the balance of stroke patients. To evaluate the mobility of stroke patients before and after the physical therapy. To evaluate the static balance of stroke patients before and after the physical therapy To evaluate the dynamic balance of stroke patients before and after the physical therapy Methods and measures: The research was carried out from 2008–02–01 to 2009–02–02, in the 2nd Department of In-patient Rehabilitation (Centre of Physical Medicine and Rehabilitation, Vilnius University Hospital Santariškių Klinikos). There were 40 cerebral stroke patients in the survey examined, who were selected according to the following criteria: • the first cerebral stroke, • ability to understand the tasks of the survey, • ability to stand 2 minutes without assistance, • ability to stand 30 seconds without assistance ant with eyes closed, • ability to step on and step off a stair individually or with observation, • stable state of the cardiovascular system The patients were divided into two groups randomly: group 1 (n = 20) consisted of the patients whose balance was trained using platform „MTD-balance“; group 2 (n = 20) consisted of the patients whose balance was trained using a mirror. During the survey all the patients underwent a specially created program of both general and special, aimed physical exercises. The program lasted 4 weeks (5 days a week, twice a day) and consisted of basic and functional procedures of physical therapy The functional state was evaluated at the time of patients’ arrival at the department of rehabilitation and 4 weeks later. The power of muscles was evaluated according to the 5 grade system of Lovett; sensations (surface and deep), muscular tone according the spastic scale of Ashworth; general mobility (5 classes according to the scale suggested by the European Federation for Research in Rehabilitation (EFRR), legs mobility (5 classes according to the scale suggested by the EFRR), dynamic balance was evaluated using the tests of Berg and „Stand and go“, static balance (sitting and standing, with eyes closed and eyes opened) was evaluated using the „MTD-balance“ system. Conclusions: 1. During the application of the 4-week program of physical exercises the mobility of the patients surveyed were improving. It was found, that the improvement of mobility was the same when using both „MTD-balance“platform and a mirror 2. The static balance improved using both „MTD-balance“platform and a mirror. However, using both „MTD-balance“platform as more effective in improving static balance when standing with closed eyes (p < 0.05). 3. Better results of dynamic balance are achieved when balance is trained using the „MTD-balance“platform (p < 0.05).

Keywords: the stroke, balance, feedback