Rehabilitation for balance impairment in patients after stroke: a single-blind randomized controlled study
Abstract
Background/Aim. Balance problems in post-stroke patients should be recognized and treated with the most effective rehabilitation approaches. The aim of this study was to assess a group exercise program with chairs for improving balance and walking ability in post-stroke patients. Methods. This single-blind, randomized, controlled study included 86 post-stroke patients recruited from the only inpatient rehabilitation facility in the country. Patients were randomly assigned to one of the two groups: a group that had conventional rehabilitation only (control group) or a group that had a group exercise program with chairs, along with the conventional rehabilitation (treatment group). The methodology encompassed examination of demographics, history, clinical (balance was assessed using a Berg Balance Scale – BBS), and functional characteristics (walking ability and ability to use stairs). The assessments were made at baseline and after three weeks of rehabilitation. Results. All participants completed the exercise program. According to BBS, the balance improved in both examined groups: by 3.16 ± 2.16 (t = -4.989; p = 0.001) in the control group and by 8.33 ± 5.85 (t = -9.326; p = 0.001) in the treatment group. Significant improvement in balance and walking ability was registered in the treatment group compared to the control group. Conclusion. Group exercises with chairs appear to be effective in improving balance and stroke rehabilitation in post-stroke patients.
References
Kuriakose D, Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci 2020; 21(20): 7609.
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20(10): 795–820.
Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry 2020; 91(4): 411–7.
Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics and prevention. Circ Res 2017; 120(3): 472–95.
Wist S, Clivaz J, Sattelmayer M. Muscle strengthening for hemi-paresis after stroke: A meta-analysis. Ann Phys Rehabil Med 2016; 59(2): 114–24.
Rafsten L, Meirelles C, Danielsson A, Sunnerhagen KS. Impaired motor function in the affected arm predicts impaired postural balance after stroke: a cross-sectional study. Front Neurol 2019; 10: 912.
Norvang OP, Askim T, Egerton T, Dahl AE, Thingstad P. Associ-ations between changes in gait parameters, balance and walk-ing capacity during the first 3 months after stroke: a prospec-tive observational study. Physiother Theory Pract 2020; 38(4): 534–42.
Shumway-Cook A, Woollacott MH. Motor Control. Translating Research into Clinical Practice. 4th ed. Baltimore: Lippincott Williams &Wilkins; 2012. p. 641.
Li J, Zhong D, Ye J, He M, Liu X, Zheng H, et al. Rehabilita-tion for balance impairment in patients after stroke. A proto-col of a systematic review and network meta-analysis. BMJ Open 2019; 9(7): e026844.
Wang CY, Miyoshi S, Chen CH, Lee KC, Chang LC, Chung JH, et al. Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a pro-spective study based on propensity score matching. Aging (Al-bany, NY) 2020; 12(11): 10704–14.
Handelzalts S, Kenner-Furman M, Gray G, Soroker N, Shani G, Melzer I. Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2019; 33(3): 213–24.
Park GD, Choi JU, Kim YM. The effects of multidirectional stepping training on balance, gait ability, and falls efficacy fol-lowing stroke. J Phys Ther Sci 2016; 28(1): 82–6.
Ravichandran H, Sharma HR, Haile TG, Gelaw AY, Gebremeskel BF, Janakiraman B. Effects of trunk exercise with physioball to improve trunk balance among subjects with stroke: a sys-tematic review and meta-analysis. J Exerc Rehabil 2020; 16(4): 313–24.
In T, Lee K, Song C. Virtual Reality Reflection Therapy Im-proves Balance and Gait in Patients with Chronic Stroke: Randomized Controlled Trials. Med Sci Monit 2016; 22: 4046–53.
Cabanas-Valdés R, Bagur-Calafat C, Girabent-Farrés M, Caballe-ro-Gómez FM, Hernández-Valiño M, Urrútia Cuchí G. The effect of additional core stability exercises on improving dynamic sit-ting balance and trunk control for subacute stroke patients: a randomized controlled trial. Clin Rehabil 2016; 30(10): 1024–33.
Zheng QX, Ge L, Wang CC, Ma QS, Liao YT, Huang PP, et al. Robot-assisted therapy for balance function rehabilitation af-ter stroke: A systematic review and meta-analysis. Int J Nurs Stud 2019; 95: 7–18.
Ordahan B, Karahan AY, Basaran A, Turkoglu G, Kucuksarac S, Cubucku M, et al. Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a ran-domized controlled study. Hippokratia 2015; 19(2): 125–30.
Morris J. Commentary: NIHR Signal: Exercise therapy may still improve balance when started a long time after stroke. Frontline: Physiotherapy Magazine for CSP Members 2018; 24(9): 21.
Lee DK, Kim EK. Effects of Active Vibration Exercise on Trunk Muscle Activity, Balance, and activities of daily living in patients with chronic stroke. J Kor Phys Ther 2018; 30(4): 146–50.
Teasell R, Salbach NM, Foley N, Mountain A, Cameron JI, de Jong A, et al. Canadian stroke best practice recommendations: re-habilitation, recovery and community participation following stroke. Part one: Rehabilitation and recovery following stroke; 6th edition update 2019. Int J Stroke 2020; 15(7): 763–88.
Patterson KK, Inness E, McIlroy WE, Mansfield A. A Retrospec-tive Analysis of Post-Stroke Berg Balance Scale Scores: How Should Normal and At-Risk Scores Be Interpreted? Physiother Can 2017; 69(2); 142–9.
Finnegan S, Bruce J, Skelton DA, Withers EJ, Lamb SE; PreFIT Study Group. Development and delivery of an exercise pro-gramme for falls prevention: the Prevention of Falls Injury Trial (PreFIT). Physiotherapy 2018; 104(1): 72–9.
Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke 2016; 11(4): 459–84.
Sadaqa M, Németh Z, Makai A, Prémusz V, Hock M. Effective-ness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis. Front Public Health 2023; 11: 1209319.
American Stroke Association. HOPE: A stroke recovery guide: Rehabilitation, Prevention, Self-Advocacy, Recovery, Rela-tionships, Movement, Resources, Exercise [Internet]. Dallas: ASA; 2020 [accessed on 2025, March 28]. Available from: https://www.stroke.org/-/media/Stroke-Files/life-after-stroke/ASA_HOPE_Stroke_Recovery_Guide_122020. pdf
Alghadir AH, Al-Eisa ES, Anwer S, Sarkar B. Reliability, valid-ity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurol 2018; 18(1): 141.
Cho K, Yu J, Rhee H. Risk factors related to falling in stroke patients: a cross-sectional study. J Phys Ther Sci 2015; 27(6): 1751–3.
Rafsten L, Danielsson A, Sunnerhagen KS. Self-perceived postur-al balance correlates with postural balance and anxiety during the first year after stroke: a part of the randomized controlled GOTVED study. BMC Neurol 2020; 20(1): 410.
Chang KV, Chen KH, Chen YH, Lien WC, Chang WH, Lai CL, et al. A multicenter study to compare the effectiveness of the inpatient post acute care program versus traditional rehabilita-tion for stroke survivors. Sci Rep 2022; 12(1): 12811. Erra-tum in: Sci Rep 2022; 12(1): 14025.
Van Duijnhoven HJ, Heeren A, Peters MA, Veerbeek JM, Kwakkel G, Geurts AC, et al. Effects of exercise therapy on balance capacity in chronic stroke. Stroke 2016; 47(10): 2603–10.
English C, Hiller SL, Lynch EA. Circuit class therapy for im-proving mobility after stroke. Cochrane Database Syst Rev 2017; 6(6): CD007513.
Westerlind E, Persson HC, Sunnerhagen KS. Return to work after a stroke in working age persons; A six-year follow up. PLoS One 2017; 12(1): e01697759.
Mohd Nordin NA, Yusoff NAH, Ajit Singh DK. Facilitating exercise engagement among community dwelling stroke survivors: is a once per week group session sufficient? Int J Environ Res Public Health 2019; 16(23): 4746.
Shrestha R, Sandesh TS, Jalal Z, Nuhmani S, Alghadir AH, Khan M. Effects of multi-directional step exercise with weight-shifting as an adjunct to conventional exercises on balance and gait in stroke patients. Sci Rep 2022; 12(1): 17053.
Logan A, Freeman J, Kent B, Pooler J, Creanor S, Vickery J, et al. Standing Practice In Rehabilitation Early after Stroke (SPIRES): a functional standing frame program (prolonged standing and repeated sit-to-stand) to improve function and quality of life and reduce neuromuscular impairment in people with the severe sub-acute stroke-a protocol for a feasibility randomized controlled trial. Pilot Feasibility Stud 2018; 4: 66.
Madhuranga PVH, Mathangasinghe Y, Anthony DJ. Improving balance with wobble board exercises in stroke patients: single-blind, randomized clinical trial. Top Stroke Rehabil 2019; 26(8): 595–601.
Ahmed U, Karimi H, Amir S, Ahmed A. Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a ran-domized controlled trial. J Int Med Res 2021; 49(11): 3000605211059413.
Obembe AO, Eng JJ. Rehabilitation Interventions for Improv-ing Social Participation After Stroke: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair 2016; 30(4): 384–92.
