The 13 subjects were broken up into 2 groups. The groups were referred to as the experimental group and the control group respectively. The experimental group underwent biofeedback/forceplate training combined with a normal physical therapy program to improve balance and mobility. The control group received a normal physical therapy program to improve balance and mobility only. The authors of the article don’t specify how many members were in each group. Both groups were similar in age, number of days following a stroke, visual-perceptual and cognitive test results, and educational level. There was also no difference found in subjects that suffered a right CVA compared to those that had a left CVA. The number of patient’s with either a right or left CVA isn’t specified.
The equipment used in the experimental group included a machine called the Balance Master. This machine has “a dual forceplate system composed of 4 load cells that detect pressure, connected to a 486 DX IBM- compatible computer and monitor.” How it works is by picturing the patient’s center of gravity on the computer screen. The patient can move their center of gravity by weight shifting on the forceplates. Random targets appear on the screen and the patient is instructed to hit the targets by moving their center of gravity. The speed of the targets movement is controlled by the treating physical therapist. The Balance Master was intended to be used as an assessment tool to measure the ability of the patient to maintain a proper balance. However in this study it is being used as an intervention in treating balance disorders. Other equipment used in the study include a 4 inch wide balance beam, rocker boards, firm and compliant floor mats, a swiss ball, stairs, chair with an armrest, a stool, gait belts, AFO’s, a tape measurer, and assistive devices.
The study lasted for 4 weeks. The administrators of the study tested each subject at the beginning of the study and after the 4 weeks of treatment had ended using the timed “up and go” test and the berg balance scale. The timed “up and go” test involves a patient who begins in a seated armchair then rises to stand with no assistance, walks a distance of 3m, turns around and walks back to the chair and sits unassisted. This test was used to measure mobility. If a patient performs this test in 10 seconds or less it means that they have no mobility issues and are independent in ADL’s. A time of 30 seconds or longer indicates severe mobility issues and these patient’s tend to be very dependent.
The Berg Balance Scale measures a patient’s ability to perform 14 different balance activities. The balance activities include sit and stand unsupported, sit to stand and stand to sit, chair to mat, stand unsupported with eyes closed, stand unsupported with feet together, reach with outstretched arm, squat and pick up an object from the floor, stand and turn to look over each shoulder, stand and turn 360 degrees toward the right and left, stand and alternately place one foot up on a step, maintain static standing, and stand on one LE. The subjects were not allowed to use any assistive device to perform this test. However they were allowed the use of an AFO if needed. The scores from this test range from 0 to 56. The higher the score means the better the balance. These two tests were used due to their proven accuracy and compatibility. The authors of the article note that there are many tests that could have been used but these two, in their opinion, compliment each other the best.
There were seven physical therapists and one PTA who implemented treatment for the 13 subjects during the study. Physical therapy interventions for both groups included muscle strengthening, range of motion, balance and mobility training. The therapists used stretching to improve ROM, weight shifting and bearing activities in the parallel bars, unilateral stance activities and balancing on rocker boards. Functional training was also incorporated in the treatments. Such activities as bed mobility, standing, reaching, stair climbing, transfers, and walking on even and uneven surfaces were performed. The therapists didn’t use the same treatment for every subject. Each subject’s treatment plan was individualized for that person. The control groups’ treatment took place 2 to 3 times per week for 50 minute sessions.
The physical therapy clinicians had to be trained to operate the balance master to be used on the experimental group. Treatment for experimental group subjects took place 2 to 3 times per week for 50 minute sessions. Thirty five minutes were used to implement normal physical therapy interventions and 15 minutes was used for training on the balance master. Each subject was instructed to wear shoes and was allowed to use their assistive devices while on the machine if needed. The assistive devices were the only support allowed while on the Balance Master. There was no physical assistance given to those treated on the machine. Treatment that took place on the Balance master was individualized to meet the needs of every subject. Normal training sessions included a brief warm-up of static standing with eyes closed and open, and the actual testing which required the subjects to hit 8 targets that made the shape of an eclipse. Most subjects required no rest periods during training on the balance master.
At the conclusion of the 4 week study each subject was tested using the timed “up and go” test and the berg balance scale to measure progress. Test result showed that both groups made progress. After comparing the progress made by the two groups it was determined that they both progressed at around the same rate proving that the addition of biofeedback/forceplate training to a normal physical therapy program for balance and mobility had no increased impact on balance and mobility training. After determining that there was no difference between the two groups’ progress the administrators combined the results of both groups and measured overall improvement. The average pre-treatment score for the Berg Balance Scale for all subjects was 45.69. Post-treatment scores for the Berg Balance Scale for all subjects were 51.54 showing a significant improvement. The average pre-treatment time for the timed “up and go” test for all subjects was 23.08 seconds. Post-treatment for the timed “up and go” test for all subjects was 14.62 seconds also showing a significant improvement.
I chose this article because we discussed balance issues and interventions in class and I believe that subject of balance training is an essential part of physical therapy. I liked this article because it gives insight on different strategies that can be used in treating poor balance. I believe that the administrators of the study’s choice of using the Berg Balance Scale and timed “up and go” test as assessment tools were good. I have to admit though that this study was very limited. It was limited in the fact that they only had a total of 13 subjects that took part in the study and they only had patients with hemiparesis. I think that the study would have been more beneficial if it had a larger group of subjects and have treated patients with many different balance issues. In the discussion portion of this article they admit that due to the size of their sample group the findings of this study may not be significant and I agree.
The findings of the study that proved that the addition of biofeedback/forceplate training to a normal physical therapy program for balance and mobility added no increased effect to the outcome of treatment wasn’t surprising to me. The Balance Master used in this study was used as just another intervention in treating poor balance. I don’t believe that this intervention provides better results than the other ones used in this study. I admit that the use of the Balance Master as an intervention was a very good idea and is an idea that can be taken out of this article and used in the clinic. The idea behind the study was a rational one and made a lot of sense. Overall I think the article was good and I would recommend it to others.
