Advances in balance training to prevent falls in stroke patients: a scoping review

 But you FUCKING FAILED TO CREATE PROTOCOLS ON THIS!

Research should actually help survivors; this did nothing of the sort.  You're all fired!

Advances in balance training to prevent falls in stroke patients: a scoping review

Kehan Chen^1,2,3†Siyi Zhu^1†Yidan Tang¹Fuxia Lan²Zuoyan Liu^1,3*

• ¹Department of Rehabilitation Medicine, Rehabilitation Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
• ²Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
• ³West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Objective: To summarize the status and characteristics of the available evidence, research gaps, and future research priorities for preventing falls in stroke patients through balance training.

Methods: We used a scoping review framework. A systematic search of PUBMED, Embase, and Cochrane databases for main articles was conducted. Our study only included articles that on balance training and fall-related indicators in stroke patients. Two researchers independently screened the literature according to the inclusion and exclusion criteria. The data of demographic, clinical characteristics, intervention, sample, and outcome indicators were extracted. The characteristics and limitations of the included literature were comprehensively analyzed.

Results: Of the 1,058 studies, 31 were included. The methods of balance training include regular balance training, Tai Chi, Yoga, task balance training, visual balance training, multisensory training, aquatic balance training, perturbation-based balance training, cognitive balance training, system-based balance training, and robot-assisted balance training. The commonly used outcome measures include clinical balance test, such as Berg balance scale (BBS), Timed Up-and-Go Test (TUG), Fall Risk Index assessment (FRI), Fall Efficacy Scale score (FES), and instrumented balance tests.

Conclusion: This scoping review summarizes the existing primary research on preventing falls in stroke patients by balance training. Based on the summary of the existing evidence, the characteristics of balance training and their relation to falls in stroke patients were found.(But you did nothing with the knowledge you gained!) The future researches should explore how to develop personalized training program, the sound combination of various balance training, to more effectively prevent falls.

1 Introduction

Stroke is the second leading cause of death and the third leading cause of disability in the world (1). According to statistics, the global cost of stroke is more than US $721 billion (0.66% of global GDP), and the incidence of stroke (70%), mortality (43%), morbidity (102%) and disability (143%) are also on the rise (1990–2019) (1). The most common physical dysfunction in stroke patients is impaired balance, which has been shown in studies to have an incidence as high as 61–83%, and even in the chronic stage, the incidence is as high as 22–43% (2, 3).

Balance refers to the ability to keep the body in a state of balance, which can be divided into static and dynamic. Static balance is defined as the ability to keep balance in a position without moving, while dynamic balance is defined as the ability to keep certain positions during movement (4). The increased risks of falls, social isolation, and reduced physical activity were common in stroke patients with balance dysfunction (5, 6). Early identification and appropriate intervention can prevent balance dysfunction from becoming worse (5, 7, 8). A good balance is likely to be a rapid synergy between various physiological and cognitive factors to respond quickly and accurately to disturbances. This very complex system that can respond rapidly and accurately to prevent falls.

According to the World Health Organization, fall is sudden, involuntary and unintentional change of position, falling to the ground or a lower plane. Falling is a common complication after a stroke. Studies have shown that the incidence of falls in stroke patients is as high as 25–40%, and the injury rate is as high as 90, 32–83% of stroke patients are afraid of falling, and the risk of falling increased with the severity of stroke (9, 10). Falls lead to injuries, fractures, reduced quality of life, prolonged length of hospital stays (LOS) for stroke patients, and a heavy financial burden.

There have been many studies on balance training in stroke patients. Conventional balance training including sitting to stand, standing on one leg, using paralyzed and nonparalyzed limbs across stools of varying heights, standing on the bottom of foam or rocker, walking sideways, posture training on a therapy ball, reaching forward and side, standing with eyes closed, tandem standing, progression to tandem walking, lateral stepping, step forward and backward, walk forward, stomp up and down, throw and catch plastic balls (using soft volleyball) or small beanbags (11). Tai Chi and Yoga were ancient exercise, Tai Chi is effective in improving the balance function of stroke patients (12). In addition, water-based balance training, which is similar to land, is more efficacious (13). Reactive balance training (RBT) is a novel exercise designed to improve reactive balance control, its effect in reducing falls has been demonstrated in multiple studies. Perturbation-based balance training (PBT/PBBT) focuses on practicing responses to instability and aims to improve reactive balance control, reduce the risk of falls (14). PBT includes tasks that induce external perturbations, which are applied by external forces (e.g., pushing or pulling by a physical therapist), and internal perturbations include rapid movements that may cause loss of balance (e.g., balance disturbances during football playing, standing, and treadmill walking) (14). In recent years, balance training is also carried out through Wii Fit games, virtual reality (VR) (15), etc.

However, only a few studies included fall-related indicators in the outcome measures. To outline the scope and characteristics of any existing evidence on balance training for fall prevention, research gaps, and future research priorities, we conducted a scoping review to summarize and critically analyze the findings of all published articles.

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