I personally think the Bosu is by far the best balance training there is, but since I'm not medically trained, you can't listen to stroke-addled me. You won't get any ankle exercises on the Swiss ball unless you are really advanced and can stand on it. I used to kneel on one for practicing balance in a whitewater canoe
Comparing the effects of Swiss-ball training and virtual reality training on balance, mobility, and cortical activation in individuals with chronic stroke: study protocol for a multi-center randomized controlled trial
Trials volume 25, Article number: 677 (2024)
Abstract
Background
Balance and mobility deficits are major concerns in stroke rehabilitation. Virtual reality (VR) training and Swiss-ball training are commonly used approaches to improve balance and mobility. However, no study has compared the efficacy of VR training, Swiss-ball training, and their combination in improving balance and mobility function or investigated cortical activation and connectivity in individuals with stroke.
Methods
A prospective, single-blinded, parallel-armed, multi-center randomized controlled trial with factorial design will be conducted. Seventy-six participants aged 30–80 years with stroke will be recruited. Participants will be allocated to one of the four groups: (A) the VR training + Swiss-ball training + conventional physical therapy group; (B) the Swiss-ball training + conventional physical therapy group; (C) the VR training + conventional physical therapy group; or (D) the conventional physical therapy group. All participants will receive 50 min of training per day, 5 times per week, for a total of 4 weeks. The primary outcomes will be balance and mobility measures. Secondary outcomes will include the 10-min walk test, dynamic gait index, and cortical activation. Outcomes will be measured on three occasions: at baseline, after the training, and at the 4-week follow-up.
Discussion
This trial will provide evidence to determine whether there are differences in clinical outcomes and cortical activation following two different types of exercise programs and their combination, and to elucidate the recovery mechanisms of balance and mobility function in individuals with stroke.
Trial registration
Chinese Clinical Trial Registry reference: www.chictr.org.cn (No. ChiCTR2400082135). Registered on May 24, 2024.
Introduction
Background and rationale {6a}
Balance and mobility deficits are always major concerns in stroke rehabilitation [1]. The common balance- and mobility-related problems observed in individuals with stroke are slower gait speed, abnormal posture, poorer walking adaptability (e.g., obstacle avoidance), and greater susceptibility to falls [2]. Impaired balance and mobility function after stroke inevitably lead to restrictions in active participation in daily activities, thereby triggering a vicious cycle of social isolation and compromised quality of life [3].
A range of rehabilitation approaches have been used to improve balance and mobility in individuals with stroke [4]. Among them, virtual reality (VR) and Swiss-ball training are commonly used methods [5, 6]. Mounting evidence has shown that VR training combined with conventional physiotherapy could improve balance and mobility in individuals with stroke, especially in the chronic stage [7,8,9,10,11]. On the other hand, the liable surface of a Swiss ball poses more challenges for dynamic balance, coordination, and trunk control [12, 13]. Compared to regular physiotherapy, core stability exercises on both stable and unstable support surfaces are similarly useful in increasing patients’ trunk control, strength, standing weight-bearing symmetry, and balancing confidence [14]. A systematic review and meta-analysis also showed that Swiss-ball exercise can enhance trunk control and balance function for individuals with stroke in acute and sub-acute stages [15].
Balance is maintained through the complex integration and coordination of multiple body systems, including the vestibular, visual, auditory, and motor systems, whereas little is known about the function and connection of neural structures during balance and mobility rehabilitation [16]. The activation of higher cortical processes in regulating balance and mobility is still poorly understood [17]. A few studies have shown positive correlations between neural plasticity changes and balance function recovery induced by VR training, which are mainly attributed to improved interhemispheric balance [18]. However, whether VR training could increase cortical activation and/or enhance cortical connectivity was not identified in these studies. Furthermore, no study has investigated the cortical activation induced by Swiss-ball training. Considering the compromised quality of life induced by balance and mobility deficits and the threat imposed by falls on individuals with stroke, identifying changes in cortical activity and connectivity during balance and mobility rehabilitation could provide a foundation for deciphering the mechanisms of interventions, thus contributing to the ongoing innovation of rehabilitation approaches [19, 20].
To the best of our knowledge, no study has compared the efficacy of VR training, Swiss-ball training, and their combination in improving balance and mobility function or investigated cortical activation and connectivity in individuals with stroke. Moreover, as proposed by previous studies, VR training and Swiss-ball training improve balance and mobility function may be due to different mechanisms [21,22,23], but whether the combination of these two training approaches could increase the cortical activation and connectivity in individuals with stroke, thus augment the recovery of balance and mobility function is still unknown.
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