Effectiveness of vestibular rehabilitation on postural balance in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Postural balance impairment can affect the quality of life of patients with Parkinson's disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson's disease. METHODS: A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. RESULTS: From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P < 0.001), regardless of the stage of Parkinson's disease. Although the effect size was suggested as a useful functional gain, the analysis was done with caution, as it only included 3 randomized controlled trials. The risk of bias using the RoB-2 was considered as being of "some concern" in all studies. Furthermore, the quality of the evidence based on the Grading of Recommendations Assessment Development and Evaluation system, produced by pooling the included studies was considered very low. CONCLUSION: Compared to other interventions, vestibular rehabilitation has potential to assist the postural balance of patients with Parkinson's disease. However, the very low quality of the evidence demonstrates uncertainty about the impact of this clinical practice. More robust studies are needed to confirm the benefits of this therapy in patients with Parkinson's disease. This study was prospectively registered in PROSPERO: CRD42020210185.

Altered neuroimaging patterns of cerebellum and cognition underlying the gait and balance dysfunction in cerebral small vessel disease.

Background: The mechanism of gait and balance dysfunction (GBD) in cerebral small vessel disease (CSVD) remains unclear. Evidence supports cognition engages in GBD of CSVD. The cerebellum is important in motor and cognition, while little is known about the influence of the cerebellum on GBD in CSVD. Methods: This study is a retrospective cohort study. All participants of this study were enrolled from the CSVD individuals in Nanjing Drum Tower Hospital from 2017 to 2021. The GBD of CSVD patients was defined as Tinetti Test score ≤ 23. Cerebral cortical thickness, cerebellar gray matter volume, the amplitude of low-frequency fluctuation, functional connectivity, and modular interaction were calculated to determine the cortical atrophy and activity patterns of CSVD patients with GBD. The effect of cognitive domains during GBD in CSVD patients was explored by correlation analyses. Results: A total of 25 CSVD patients were recruited in CSVD patients with GBD group (Tinetti Test score ≤ 23, mean age ± standard deviation: 70.000 ± 6.976 years), and 34 CSVD patients were recruited in CSVD patients without GBD group (Tinetti Test score > 23, mean age ± standard deviation: 64.029 ± 9.453 years). CSVD patients with GBD displayed worse cognitive performance and cortical atrophy in the right cerebellum VIIIa and bilateral superior temporal gyrus than those without GBD. The right postcentral gyrus, left inferior temporal gyrus, right angular gyrus, right supramarginal gyrus and right middle frontal gyrus were functionally overactivated and showed decreased modular interaction with the right cerebellum. Tinetti Test scores were negatively related to the volume of the right cerebellum VIIIa in CSVD patients with GBD. Notably, memory, especially visuospatial memory, was greatly associated with GBD in CSVD. Conclusion: The cortical atrophy and altered functional activity in sensorimotor area and ventral attention network in the cerebellum and cerebrum may underlying the GBD in CSVD. Memory might be critically cognitively responsible for GBD in CSVD.

Innovative System for Evaluation and Rehabilitation of Human Imbalance.

<b>Introduction:</b> Mobile posturography is based on wearable inertial sensors; it allows to test static stability (static posturography) and gait disturbances. </br> </br> <b>Aim:</b> The aim of this work was to present the results of research on the innovative MEDIPOST system used for diagnosis and rehabilitation of balance disorders. </br> </br> <b>Material and methods:</b> Fourteen articles published in influenced foreign journals were presented and discussed. The deve-lopment and construction of the device was preceded by a literature review and methodological work. The Dizziness Handi-cap Inventory (DHI) questionnaire was translated and validated. The methodology of posturography with head movements with a frequency of 0.3 Hz was also developed in the group with chronic vestibular disorders. Simultaneous measurements were performed (static posturogrphy vs. MEDIPOST) in the CTSIB-M (Modified Clinical Test of Sensory Interaction in Balance) test in healthy subjects and patients with unilateral peripheral dysfunction.</br> </br> <b>Results:</b> In the posturography with head movements the improvement of sensitivity (67 to 74%) and specificity (65 to 71%) was noted. In the CTSIB-M test the intraclass correlation coefficients for both methods were 0.9. The greatest differences between examinations were observed for the mean angular velocity in the tests on the foam (trials no. 3 and 4), in particular on the foam with eyes closed (trial no. 4 - sensitivity 86.4%, specificity 87.7%). Two functional tests were analyzed: the Swap Seats test and the 360 degree turn test. In the former, the results are studied from 6 sensors - 86% of the true positives and 73% of the true negatives for the fall/ no-fall group classification. The second test differentiates people with vestibular impairment and healthy people. It can be analyzed with 1 (sensitivity 80%) and 6 sensors (sensitivity 86%, specificity 84%). Currently, the MEDIPOST device is in the development and certification phase.

[Scalp acupuncture combined with suspension training for balance dysfunction in patients with stroke: a randomized controlled trial].

OBJECTIVE: To explore the effect of scalp acupuncture combined with suspension training on balance ability and motor function in stroke patients with balance dysfunction. METHODS: A total of 105 stroke patients with balance dysfunction were randomly divided into a combined group (35 cases, 2 cases dropped off), a scalp acupuncture group (35 cases, 3 cases dropped off) and a suspension training group (35 cases, 2 cases dropped off). The scalp acupuncture group was treated with scalp acupuncture at bilateral suboccipital lateral line, parietal midline, upper 1/5 line of anterior oblique line of parietal and temporal and line 1 of the parietal lateral line on the opposite side of hemiplegia. The suspension training group was treated with suspension training. The combined group was treated with suspension training at the same time of scalp acupuncture. All the treatment was given once a day, 30 min each time, 5 days a week, for a total of 6 weeks. The Berg balance scale (BBS) score, balance tester and Fugl-Meyer assessment (FMA) score were used to evaluate the motor function and balance ability before treatment, 3 and 6 weeks into treatment. The clinical efficacy was evaluated in the 3 groups. RESULTS: The scores of BBS and FMA in each group at 3 and 6 weeks into treatment were higher than those before treatment (P<0.05); the scores of BBS and FMA in the combined group were higher than those in the scalp acupuncture group and the suspension training group (P<0.05). At 3 and 6 weeks into treatment, the length and area of centroid locus of balance tester in each group were lower than those before treatment (P<0.05); the length and area of centroid locus of balance tester in the combined group were lower than those in the scalp acupuncture group and the suspension training group (P<0.05). The total effective rate of the combined group was 97.0% (32/33), which was higher than 87.5% (28/32) in the scalp acupuncture group and 90.9% (30/33) in the suspension training group (P<0.05). CONCLUSION: Scalp acupuncture combined with suspension training could improve the balance ability and motor function in stroke patients with balance dysfunction, and the curative effect is better than simple scalp acupuncture and simple suspension training.

Kohonen Neural Network Investigation of the Effects of the Visual, Proprioceptive and Vestibular Systems to Balance in Young Healthy Adult Subjects.

Kohonen neural network (KNN) was used to investigate the effects of the visual, proprioceptive and vestibular systems using the sway information in the mediolateral (ML) and anterior-posterior (AP) directions, obtained from an inertial measurement unit, placed at the lower backs of 23 healthy adult subjects (10 males, 13 females, mean (standard deviation) age: 24.5 (4.0) years, height: 173.6 (6.8) centimeter, weight: 72.7 (9.9) kg). The measurements were based on the modified Clinical Test of Sensory Interaction and Balance (mCTSIB). KNN clustered the subjects' time-domain sway measures by processing their sway's root mean square position, velocity, and acceleration. Clustering effectiveness was established using external performance indicators such as purity, precision-recall, and F-measure. Differences in these measures, from the clustering of each mCTSIB condition with its condition, were used to extract information about the balance-related sensory systems, where smaller values indicated reduced sway differences. The results for the parameters of purity, precision, recall, and F-measure were higher in the AP direction as compared to the ML direction by 7.12%, 11.64%, 7.12%, and 9.50% respectively, with their differences statistically significant (p < 0.05) thus suggesting the related sensory systems affect majorly the AP direction sway as compared to the ML direction sway. Sway differences in the ML direction were lowest in the presence of the visual system. It was concluded that the effect of the visual system on the balance can be examined mostly by the ML sway while the proprioceptive and vestibular systems can be examined mostly by the AP direction sway.

Evaluation of balance in children with sensorineural hearing loss according to age.

PURPOSE: Hearing is an important sensory skill for psychomotor development. As the cochlea and vestibule share the membranous labyrinth of the inner ear, children with sensorineural hearing loss (SNHL) may have vestibular dysfunction. This study aimed to evaluate static, dynamic, functional balance, and mobility as a whole in children with SNHL. MATERIAL AND METHODS: Eighty children, 40 with bilateral severe-to-profound SNHL (20 children between the ages of 6-10 were included in the Group 1, and 20 children between the ages of 11-15 were included in the Group 2) and 40 with normal-hearing (the Group 3 included 20 children between the ages of 6-10 and the Group 4 of 20 children between the ages of 11-15) were included in the study. The Single-Leg Stance (SLS) Test, Functional Reach Test (FRT), Time Up and Go (TUG) Test, and Pediatric Balance Scale (PBS) were used to evaluate the balance skills of children. RESULTS: The present study found out that children with SNHL in both age groups performed worse than those with normal-hearing in FRT, SLS, and PBS. In the TUG test, children with SNHL in the younger age group had lower performance compared to their peers with normal-hearing while the TUG performance of children with SNHL in the older age group was similar to their normal-hearing peers. CONCLUSION: It was concluded that the static, dynamic and functional balance skills of children with SNHL were impaired compared to their normal-hearing peers. Including balance assessment in the routine test battery in children with SNHL may be decisive for early diagnosis and rehabilitation of balance disorders. It may be beneficial to add static, dynamic and functional balance tests to the test battery in addition to mobility assessment, especially in children with SNHL in the older age groups.

Static Balance Function in Stroke Patients: A Plantar Pressure Analysis / 中国康复理论与实践

Objective:To explore the mechanism of balance control after stroke by plantar pressure analysis. Methods:From July to December, 2019, twelve stroke subjects (stroke group) and 30 normal subjects (control group) were recruited in the rehabilitation department of our hospital. Both groups were measured plantar pressure in eyes open and closed conditions. The kinematic parameters, dynamic parameters, plantar pressure center (CoP), symmetry index (SI), symmetry angle (SA) and Romberg quotient (RQ) were calculated. Results:Compared with eyes open condition, the average Y and maximum swing of the control group increased significantly in eyes closed condition (P < 0.01); moreover, the ball length, average speed and maximum swing increased significantly in the stroke group (P <0.05). Compared with the control group, the area of the ellipse (|t| > 3.509, P < 0.001) and the average X (|Z|> 2.311, P < 0.05) significantly increased both in eyes open and closed condition, whereas the maximum swing (Z = -3.118, P < 0.01) increased significantly in eyes closed condition in the stroke group. The RQ of ball length was significantly more in the stroke group than in the control group (t = -3.570, P < 0.01). There was no significant difference in SI and SA of all parameters between the eyes open and closed condition in two groups (P > 0.05). Compared with the control group, load SI, overall load SI, forefoot load SI, area SI and forefoot area SI increased in both the eyes open and closed conditions in the stroke group (t > 2.344, P < 0.05), whereas load SA, overall load SA, forefoot load SA, area SA, forefoot area SA increased (|t|> 2.297, P < 0.05), hindfoot load SA increased only in eyes open condition (t = -2.485, P < 0.05), and hindfoot area SA increased only in eyes closed condition (t = -2.132, P < 0.05). In the control group, CoP was mainly distributed in the negative direction of Y axis when the eyes were open and closed, while CoP in the stroke group was relatively discrete, and the distribution on X axis was more obvious than that of the control group. Conclusion:The balance control of stroke patients might depend on visual compensation, and the plantar pressure analysis system could be used to evaluate the balance function in stroke patients.

Scalp acupuncture combined with suspension training for balance dysfunction in patients with stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To explore the effect of scalp acupuncture combined with suspension training on balance ability and motor function in stroke patients with balance dysfunction.@*METHODS@#A total of 105 stroke patients with balance dysfunction were randomly divided into a combined group (35 cases, 2 cases dropped off), a scalp acupuncture group (35 cases, 3 cases dropped off) and a suspension training group (35 cases, 2 cases dropped off). The scalp acupuncture group was treated with scalp acupuncture at bilateral suboccipital lateral line, parietal midline, upper 1/5 line of anterior oblique line of parietal and temporal and line 1 of the parietal lateral line on the opposite side of hemiplegia. The suspension training group was treated with suspension training. The combined group was treated with suspension training at the same time of scalp acupuncture. All the treatment was given once a day, 30 min each time, 5 days a week, for a total of 6 weeks. The Berg balance scale (BBS) score, balance tester and Fugl-Meyer assessment (FMA) score were used to evaluate the motor function and balance ability before treatment, 3 and 6 weeks into treatment. The clinical efficacy was evaluated in the 3 groups.@*RESULTS@#The scores of BBS and FMA in each group at 3 and 6 weeks into treatment were higher than those before treatment (@*CONCLUSION@#Scalp acupuncture combined with suspension training could improve the balance ability and motor function in stroke patients with balance dysfunction, and the curative effect is better than simple scalp acupuncture and simple suspension training.

How to Select Balance Measures Sensitive to Parkinson's Disease from Body-Worn Inertial Sensors-Separating the Trees from the Forest.

This study aimed to determine the most sensitive objective measures of balance dysfunction that differ between people with Parkinson's Disease (PD) and healthy controls. One-hundred and forty-four people with PD and 79 age-matched healthy controls wore eight inertial sensors while performing tasks to measure five domains of balance: standing posture (Sway), anticipatory postural adjustments (APAs), automatic postural responses (APRs), dynamic posture (Gait) and limits of stability (LOS). To reduce the initial 93 measures, we selected uncorrelated measures that were most sensitive to PD. After applying a threshold on the Standardized Mean Difference between PD and healthy controls, 44 measures remained; and after reducing highly correlated measures, 24 measures remained. The four most sensitive measures were from APAs and Gait domains. The random forest with 10-fold cross-validation on the remaining measures (n = 24) showed an accuracy to separate PD from healthy controls of 82.4%-identical to result for all measures. Measures from the most sensitive domains, APAs and Gait, were significantly correlated with the severity of disease and with patient-related outcomes. This method greatly reduced the objective measures of balance to the most sensitive for PD, while still capturing four of the five domains of balance.

Effects of Tai Chi Yunshou exercise on community-based stroke patients: a cluster randomized controlled trial.

BACKGROUD: Tai Chi Chuan was used for stroke survivors with balance impairments. However, even a short-form of Tai Chi Chuan includes forms that make the exercise challenging for the stroke survivors. Tai Chi Yunshou (wave hands in the cloud) is the "mother" form and the fundamental form of all Tai Chi Chuan styles, which is considered more suitable and feasible for stroke survivors with balance impairments. So this study was designed to evaluate the effects of Tai Chi Yunshou exercise on community-based stroke patients with balance dysfunctions. METHODS: A total of 250 participants from 10 community health centers (5 per arm) were selected and randomly allocated into Tai Chi Yunshou exercise group (TC group) or a balance rehabilitation training group (control group) in an equal ratio. Participants in the TC group were received Tai Chi Yunshou exercise training five times per week for 12 weeks and those in control group were received balance rehabilitation training five times per week for 12 weeks. Outcome assessments including Berg Balance Scale (BBS), Time up to go test (TUGT), Modified Barthel Index (MBI) were measured at baseline, 4 weeks, 8 weeks, 12 weeks and followed-up 6 weeks (18 weeks), 12 weeks (24 weeks). Intention-to-treat analysis was performed. Analysis of variance of repeated measures was used to assess between-group differences. RESULTS: A total of 244 participants, 120 in the TC group and 124 in the rehabilitation group, were included in final analysis. There was no siginificant difference in Tai Chi Yunshou and balance rehabilitation training on the improvement of balance ability and mobility (P = 0.531 and P = 0.839, respectively) after adjustment for baseline. However, there was significant difference between two groups on improvement of motor funtion (P = 0.022), fear of falling (P < 0.001) and depression (P = 0.035) for the post stroke patients. No adverse events were reported during the study. CONCLUSION: Tai Chi Yunshou and balance rehabilitation training led to improved balance ability and functional mobility, and both are suitable community-based programs that may benefit for stroke recovery and community reintegration. Our data demonstrated that a 12-week Tai Chi Yunshou intervention was more effective in motor function, fear of falling and depression than balance rehabilitation training. Future studies examining the effectiveness of Tai Chi Yunahou as a balance ability improvement strategy for community-dwelling survivors of stroke are recommended. TRIAL REGISTRATION: Chinese Clinical Trail Registry: ChiCRT-TRC-13003641. Registration date: 22 August, 2013.

Effects of a 12-month task-specific balance training on the balance status of stroke survivors with and without cognitive impairments in Selected Hospitals in Nnewi, Anambra State, Nigeria.

BACKGROUND: Stroke results in varying levels of physical disabilities that may adversely impact balance with increased tendency to falls. This may intensify with cognitive impairments (CI), and impede functional recovery. Therefore, task-specific balance training (TSBT), which presents versatile task-specific training options that matches varied individual needs, was explored as a beneficial rehabilitation regime for stroke survivors with and without CI. It was hypothesized that there will be no significant difference in the balance control measures in stroke survivors with and without CI after a 12-month TSBT. OBJECTIVE: To determine if TSBT will have comparable beneficial effects on the balance control status of sub-acute ischemic stroke survivors with CI and without CI. METHODS: One hundred of 143 available sub-acute first ever ischemic stroke survivors were recruited using convenience sampling technique in a quasi-experimental study. They were later assigned into the cognitive impaired group (CIG) and non-cognitive impaired group (NCIG), respectively, based on the baseline presence or absence of CI, after screening with the mini-mental examination (MMSE) tool. With the help of four trained research assistants, TSBT was applied to each group, thrice times a week, 60 mins per session, for 12 months. Their balance was measured as Bergs Balance scores (BBS) at baseline, 4th, 8th, and 12th month intervals. Data were analyzed statistically using Kruskal Wallis test, and repeated measure ANOVA, at p < 0.05. RESULTS: There was significant improvement across time points in the balance control of CIG with large effect size of 0.69 after 12 months of TSBT. There was also significant improvement across time points in the balance control of NCIG with large effect size of 0.544 after 12 months of TSBT. There was no significant difference between the improvement in CIG and NCIG after 8th and 12th months of TSBT. CONCLUSIONS: Within the groups, a 12-month TSBT intervention significantly improved balance control, respectively, but with broader effects in the CIG than NCIG. Importantly, though between-group comparison at baseline revealed significantly impaired balance control in the CIG than NCIG, these differences were not significant at the 8th month and non-existent at the 12th month of TSBT intervention. These results underscore the robustness of TSBT to evenly address specific balance deficits of stroke survivors with and without CI within a long-term rehabilitation plan as was hypothesized.

The effectiveness of physiotherapy treatment on balance dysfunction and postural instability in persons with Parkinson's disease: a systematic review and meta-analysis.

BACKGROUND: Balance dysfunction and postural instability in Parkinson's disease are among the most relevant determinants of an impaired quality of life. Physiotherapy interventions are essential to reduce the level of disability by treating balance dysfunction and postural instability. The aim of this systematic review with meta-analysis was to test the effectiveness of conventional physiotherapy interventions in the management of balance dysfunction and postural instability in Persons with idiopathic Parkinson's disease. METHOD: A systematic literature search of the Cochrane Library, PubMed/Medline, PEDro, Rehadat, and Rehab Trials were performed by 2 reviewers (AY and AT) independently. Eligible randomised controlled trials published from September 2005 to June 2015 were included. The selected RCTs, which investigated the effects of conventional physiotherapy treatments in the management of postural instability and balance dysfunction in Persons with Parkinson's disease, were assessed on a methodological quality rating scale. Included studies differed clearly from each other with regard to patient characteristics, intervention protocol, and outcome measures. Important characteristics and outcomes were extracted, summarized and analyzed. RESULTS: Eight trials with a total of 483 participants were eligible for inclusion of which 5 trials provide data for meta-analysis. Benefits from conventional physiotherapy treatment were reported for all of the outcomes assessed. The pooled estimates of effects showed significantly improved berg balance scale (SMD, 0.23; 95 % CI, 0.10-0.36; P < 0.001) after exercise therapy, in comparison with no exercise or sham treatment. Exercise interventions specifically addressing components of balance dysfunction demonstrated the largest efficacy with moderate effect size (SMD, 5.98; 95 % CI, 2.29-9.66; P < 0.001). Little effects were observed for interventions that specifically targeted Falls efficacy scale. The pooled data indicated that physiotherapy exercises decreased the incidence of falling by 6.73 (95 % CI: -14.00, 0.54, p = 0.07) with the overall effect of Z = 1.81. CONCLUSION: Physiotherapy interventions like balance training combined with muscle strengthening, the range of movement and walking training exercise is effective in improving balance in patients with Parkinson's disease and more effective than balance exercises alone. Highly challenging balance training and incremental speed-dependent treadmill training can also be part of a rehabilitation program for management of balance dysfunction and Postural instability in patients with idiopathic Parkinson's disease.

Virtual reality training improves balance function.

Virtual reality is a new technology that simulates a three-dimensional virtual world on a computer and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can activate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.