Targeted ankle proprioceptive training improves balance, gait, and functional mobility in chronic stroke survivors: a multicenter randomized controlled trial with longitudinal follow-up

 

Did your competent? doctor give you ANYTHING TO RECOVER PROPRIOCEPTION? NO?  So, fucking incompetent then!

You need to create EXACT PROTOCOLS FOR THIS! And completely failed at that! NO protocol and no delivery to all stroke hospitals!

Targeted ankle proprioceptive training improves balance, gait, and functional mobility in chronic stroke survivors: a multicenter randomized controlled trial with longitudinal follow-up

• Muslim Khan,
• Ayman Abdullah Alhammad,
• Mshari Alghadier,
• Saeed Mufleh Alnasser,
• Abdullah Basheer Alanazi,
• Hasan Ali Abdullah AlAidarous,
• Engy BadrEldin S Moustafa,
• Mohammad Ahmad Sharahily,
• Mohammed Ibrahim Amri &
• Edward Muteesasira 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

One of the most common predictors of post-stroke balance and gait problems is ankle proprioceptive impairment. Previous cross-sectional studies have shown strong links, especially with inversion proprioception, but causality, progression over time, and effectiveness in severe cases has not been proven.

Objective

To determine the causal effects of ankle proprioceptive training on balance, gait, and mobility in moderate-to-severe and non-ambulatory chronic stroke survivors, and to examine the long-term impact of proprioception training across different stroke stages.

Methods

A total of 132 participants (mean age 58.4 ± 11.2 years; 18 to 72 months post stroke) completed the 12 weeks of intervention and immediate post-intervention assessments, (68 were randomly assigned to the intervention group(proprioceptive ankle training) while 64 to the control group(standard rehabilitation)).The primary outcome was weight-bearing ankle proprioception, assessed with the Active Movement Extent Discrimination Apparatus (AMEDA) while the secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go Test (TUG), 10-meter walk test (10-MWT), Fugl-Meyer Lower Extremity Test (FM-LE), and Functional Ambulation Category(FAC). An assessment from acute to chronic stages was conducted on a longitudinal subsample (n = 42).

Results

The intervention led to significant and clinically meaningful improvements in proprioception (inversion Δ = 0.21), balance(BBS + 12.4 points), gait speed (+ 0.32 m/s)(TUG), and mobility(10-MWT, FM-LE, FAC), which were sustained at 6-month follow-up (all p < 0.001). Benefits were evenly observed in severe/non-ambulatory individuals who experienced a stroke. This was supported by mediation analysis showing that 72% of the functional gains in severe/non-ambulatory chronic stroke participants were influenced by improved inversion proprioception. Longitudinal data indicated a progressive bilateral decline, with the earliest and steepest drop occurring in inversion.

Conclusion

Targeted proprioceptive exercises are causally efficacious in enhancing functional recovery across all levels of severity in post stroke populations and it therefore compliments routine clinical practice.

Trial registration This study was retrospectively registered at Clinical Trials.gov (Registration Number NCT07420608) on 18th February,2026.

New device promises reliable rehabilitation for balance disorders

 This just seems like a version of the Bosu ball with monitoring thrown in.  I always preferred the round side down, although harder to get on it, it had less chance of rolling an ankle

New device promises reliable rehabilitation for balance disorders

The University of the Basque Country (UPV/EHU) has presented a promising device designed to conduct measurements reliably and repeatably when treating the after-effects of stroke, vertigo, etc.

The UPV/EHU's COMPMECH research group has patented a mechatronic instrument that uses a mobile platform to stimulate the patient's balance in a controlled manner and measures his/her response. This prototype, which enables rehabilitation work to be systematized while monitoring the patient's evolution over time, is the result of close collaboration with professionals from different departments at Gorliz Hospital.

One of the main sequelae of stroke is partial loss of strength or partial paralysis. This condition means that patients who have suffered a stroke must undergo long rehabilitation processes to recover their balance and gait. The traditional techniques used in exercise-based assessments are not entirely objective, as they largely depend on the person carrying them out. So professionals from Gorliz Hospital suggested a need to objectify this assessment and systematize the evolution of patients during the rehabilitation process.

So the UPV/EHU's COMPMECH research group, which has expertise in mechatronics (a multidisciplinary branch of engineering that develops devices and technologies combining the branches of systems, electronics, mechanics, control and robotics), has developed a new prototype to "assess, exercise and rehabilitate a person's balance when standing on a surface by measuring his or her centre of pressure," explained Francisco Campa, a researcher in the group.

"Let's imagine we are standing while travelling on a bus," explained Campa. "When the bus moves off or brakes, the body, in order to balance itself, distributes its weight forwards and backwards supported by the soles of the feet against the floor. The resultant point of this force is known as the centre of pressure, and the study of its movement enables a person's balance to be assessed."

Control over balance stimulation

The prototype recently patented by the COMPMECH group has a platform on which the person with balance problems stands, and has two functions. The first is to stimulate the patient's balance, in other words, to provoke a reaction in order to see how he or she responds. "The mechanism we have designed raises the platform vertically or tilts it forward, from side to side or in any direction, with a certain amplitude and speed that is determined by the physiotherapist who is programming the machine," he pointed out. And the second function is to measure the patient's response: "The platform rests on four sensors that enable the force the patient is exerting on the platform to be measured. And on the basis of that force, the movement of the centre of pressure is determined," he added.

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

 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

• Alisha Noreen,
• Jiani Lu,
• Xuan Xu,
• Huihui Jiang,
• Yuanyuan Hua,
• Xiaoyu Shi,
• Xin Tang,
• Zhongfei Bai,
• Qihui Liang,
• Yuan Tian,
• Tao Han,
• Yi Lu,
• Lijuan Ao &
• Lei Yang 

Trials volume 25, Article number: 677 (2024) Cite this article

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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.

Peer Review reports

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.

Exoskeleton rehabilitation robot training for balance and lower limb function in sub-acute stroke patients: a pilot, randomized controlled trial

 Unless this gets you 100% recovered while doing rehab in the hospital, no one will be able to afford this after leaving the hospital.

Exoskeleton rehabilitation robot training for balance and lower limb function in sub-acute stroke patients: a pilot, randomized controlled trial

• Yuting Zhang,
• Weiwei Zhao,
• Chunli Wan,
• Xixi Wu,
• Junhao Huang,
• Xue Wang,
• Guilan Huang,
• Wenjuan Ding,
• Yating Chen,
• Jinyu Yang,
• Bin Su,
• Yi Xu,
• Zhengguo Zhou,
• Xuting Zhang,
• Fengdong Miao,
• Jianan Li &
• Yongqiang LI 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 98 (2024) Cite this article

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Abstract

Purpose

This pilot study aimed to investigate the effects of REX exoskeleton rehabilitation robot training on the balance and lower limb function in patients with sub-acute stroke.

Methods

This was a pilot, single-blind, randomized controlled trial. Twenty-four patients with sub-acute stroke (with the course of disease ranging from 3 weeks to 3 months) were randomized into two groups, including a robot group and a control group. Patients in control group received upright bed rehabilitation (n = 12) and those in robot group received exoskeleton rehabilitation robot training (n = 12). The frequency of training in both groups was once a day (60 min each) for 5 days a week for a total of 4 weeks. Besides, the two groups were evaluated before, 2 weeks after and 4 weeks after the intervention, respectively. The primary assessment index was the Berg Balance Scale (BBS), whereas the secondary assessment indexes included the Fugl-Meyer Lower Extremity Motor Function Scale (FMA-LE), the Posture Assessment Scale for Stroke Patients (PASS), the Activities of Daily Living Scale (Modified Barthel Index, MBI), the Tecnobody Balance Tester, and lower extremity muscle surface electromyography (sEMG).

Results

The robot group showed significant improvements (P < 0.05) in the primary efficacy index BBS, as well as the secondary efficacy indexes PASS, FMA-LE, MBI, Tecnobody Balance Tester, and sEMG of the lower limb muscles. Besides, there were a significant differences in BBS, PASS, static eye-opening area or dynamic stability limit evaluation indexes between the robotic and control groups (P < 0.05).

Conclusions

This is the first study to investigate the effectiveness of the REX exoskeleton rehabilitation robot in the rehabilitation of patients with stroke. According to our results, the REX exoskeleton rehabilitation robot demonstrated superior potential efficacy in promoting the early recovery of balance and motor functions in patients with sub-acute stroke. Future large-scale randomized controlled studies and follow-up assessments are needed to validate the current findings.

Clinical trials registration

URL: https://www.chictr.org.cn/index.html.Unique identifier: ChiCTR2300068398.

Introduction

Stroke is the second leading cause of mortality and the third leading cause of disability worldwide [1]. During the recent decades, owing to rapid advancement in stroke treatment, global stroke mortality showed a significant decline [2]. Therefore, the total population of stroke survivors has increased and large population of stroke survivors would live with persistent dysfunctions. According to relevant statistics, more than 70% of stroke survivors will be left with motor, sensory, cognitive, and speech dysfunctions to varying degrees, which have resulted in the loss of personal labor force and posed a heavy burden on both the families and the society [3].

Balance, defined as the ability to maintain stable posture across diverse environments and conditions, is fundamental to all human static and dynamic activities [4]. Balance dysfunction may occur in more than 80% of stroke survivors, and is characterized by poor trunk control, insufficient muscle strength in the lower limbs, poor weight bearing in the affected lower limbs and slower walking speed [5, 6]. Such dysfunction can adversely affect mobility and quality of life [7]. Compromised balance is associated with an increased risk of falls [8], which may lead to restricted activities, physiological deconditioning, diminished independence, heightened fear of falling, and a higher incidence of subsequent falls [9]. In addition, balance is considered as an important factor for the walking ability of patients and is an important predictor of whether a patient will be able to walk independently [10]. Therefore, improving balance function and balance response strategies are the important goals in stroke rehabilitation programs [11].

Robotic training, characterized by high repetition, dosage, and intensity, has emerged as a cost-effective intervention in recent years [12]. Currently, exoskeleton rehabilitation robots ahave gained remarkable attention in recent years lower limb rehabilitation in stroke survivors [13]. While definitive evidence remains elusive regarding the superiority of exoskeleton-assisted training over conventional therapy, various studies have suggested it may enhance gait, ambulatory capabilities, balance, reduce muscle spasticity in the lower limbs, and improve cardiorespiratory fitness in individuals post-stroke [14, 15]. A meta-analysis has indicated that exoskeleton-assisted gait training is either beneficial or comparable to traditional rehabilitation methods for recovering gait and balance in stroke patients [16].

In this study, we utilized the REX robotic exoskeleton (REX Bionics PLC, London, UK), a self-stabilizing device that allows for the performance of upper body exercises in an upright position without the need for additional upper body support or balance aids, such as crutches or walking frames. This represents a significant deviation from other rehabilitation robot paradigms [17, 18]. Currently, there is only one study demonstrating the good feasibility, safety, and acceptability of the REX rehabilitation robot for the physical activity and upper body movement training in patients with spinal cord injury [19]. Therefore, the objective of this study is to investigate the effectiveness of REX exoskeleton rehabilitation robot training on the balance and lower limb function in patients with stroke in the sub-acute rehabilitation phase. Notably, we focused on determining whether REX exoskeleton rehabilitation robot training was superior to dose-matched conventional training with regard to the balance and lower limb function in patients with sub-acute stroke.

Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review

 

For me body weight supported treadmill training was worthless. I needed the weight of my body to counteract the spasticity of my legs. And since spasticity never goes away, even now as I'm chronic this would do no good. Overground training is much better in my opinion since it normally gives you perturbations you need to deal with, giving you better balance and preventing falls. 

And of course my doctor and therapists DID NOTHING to cure my leg spasticity.

Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review

• Sanne Ettema,
• Geertje H. Pennink,
• Tom J.W. Buurke,
• Sina David,
• Coen A.M. van Bennekom &
• Han Houdijk 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 97 (2024) Cite this article

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Abstract

Background

Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses.

Method

A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles.

Results

Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies.

Conclusion

Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.

Background

Over the last decades, gait rehabilitation technology has seized a firm spot in the rehabilitation of individuals with neurological gait disorders, such as stroke, spinal cord injury, cerebral palsy and multiple sclerosis [1, 2]. Rehabilitation technology is widely used to assess gait quality and behavior [3], and to improve gait function through the use of supportive training devices [1]. Many of these training devices have found their way into clinical practice and have been implemented within rehabilitation centers. Amongst these rapid innovative developments, there has been great interest in body weight support (BWS) devices. These devices have emerged as an appealing option to clinicians as they stimulate early gait training and reduce the physical burden on a therapist [4].

The use of BWS devices has shown promise in improving walking ability and avoiding the development of malfunctional compensatory movement patterns in various patient groups [4,5,6]. Generally, BWS is provided by an overhead suspension mechanism and a harness that apply vertical forces on a person’s pelvis or trunk causing partial weight reduction [7]. Initially, BWS training was mainly offered to individuals with a spinal cord injury, as its working mechanism was primarily associated with neuroplasticity [8, 9] and functional re-organization of neuronal networks [10]. Then, BWS devices were also used for other diagnoses, as they reduce the load on the lower limbs [11], improve vertical alignment and trunk stability [12], enhance gait initiation [13] and improve physical fitness [14]. It is also thought that BWS reduces the fear of falling through prevention mechanisms that ensure a safe walking environment [4].

Recently, BWS devices have developed from stationary, treadmill-coupled devices to more elaborate mobile and ceiling-mounted systems with multiple degrees of freedom that can be used during overground walking [15]. The current developments in BWS devices accompany the trend towards promoting active participation in training and providing assist-as-needed based on patient-specific requirements [16]. Roughly, four main categories of BWS devices can be distinguished: frame-based constructions (either stationary or mobile) and ceiling mounted devices (either unidirectional or multidirectional). Well-known examples of frame-based constructions are the Woodway Loko system (stationary, Woodway USA Inc., USA) and the LiteGait (mobile, Mobility Research, USA), whereas examples of ceiling-mounted devices are the ZeroG (unidirectional, Aretech, USA) and the RYSEN (multidirectional, Motek Medical, The Netherlands).

Although all different types of BWS devices are frequently used in rehabilitation programs, guidance in selecting an appropriate support level is limited. In literature, providing BWS up to 30% is generally recommended as this is shown to allow walking with close to normal kinematics [17, 18]. However, gait rehabilitation depends on more factors than solely normal gait kinematics and therapists may consider different reasons to select BWS levels, such as patient-specific characteristics or training goals. Guidelines on clinically relevant and feasible BWS selection are currently lacking and therapists often subjectively determine BWS levels based on visual inspection and patient’s feedback.

This systematic review aims to describe the initial BWS levels used during gait training, the rationale for this selection, the clinical goals that are aligned with the use of BWS and whether these differ between diagnoses. Moreover, the study aims to describe whether pursued training goals are more likely to be achieved at particular BWS levels and within a particular diagnosis. Insights from this study can serve as a first step towards developing clinical guidelines.

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.

More at link.