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Use of Visual Feedback in Retraining Balance Following Acute Stroke

C Walker, MSc, is Lecturer, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
BJ Brouwer, PhD, is Associate Professor and Chair, Graduate Program, School of Rehabilitation Therapy, Queen's University, LD Acton Bldg, 13 George St, Kingston, Ontario, Canada K7L 3N6 (brouwerb{at}post.queensu.ca) Address all correspondence to Dr Brouwer
EG Culham, PhD, is Associate Professor and Chair, Physical Therapy Program, School of Rehabilitation Therapy, Queen's University

Background and Purpose. Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke, although it is not clear whether functional balance ability also improves. This study compared the relative effectiveness of visual feedback training of center-of-gravity (CoG) positioning with conventional physical therapy following acute stroke. Subjects. Forty-six people who had strokes within 80 days before the study, resulting in unilateral hemiparesis, and who were in need of balance retraining participated. Methods and Materials. Initially, subjects were randomly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited. The next 14 subjects were assigned to a control group. All subjects received physical therapy and occupational therapy (regular therapy) 2 hours a day, and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge. The visual feedback group received information about their CoG position as they shifted their weight during various activities. The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting. Static (postural sway) and activity-based measures of balance (Berg Balance Scale, gait speed, and the Timed "Up & Go" Test) were contrasted across the 3 groups at baseline, at discharge, and at 1 month following discharge using an analysis of variance for repeated measures. Results. All groups demonstrated marked improvement over time for all measures of balance ability, with the greatest improvements occurring in the period from baseline to discharge. No between-group differences were detected in any of the outcome measures. Conclusion and Discussion. Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke.

Key Words: Outcomes • Posture • Rehabilitation • Treatment

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