Janelle Unger1, Katherine Chan2, Carol Y Scovil3, B Catharine Craven4, Avril Mansfield5, Kei Masani6, Kristin E Musselman7. 1. Rehabilitation Sciences Institute, University of Toronto; and Toronto Rehabilitation Institute, University Health Network, Toronto, Canada. 2. Rehabilitation Sciences Institute, University of Toronto; and Toronto Rehabilitation Institute, University Health Network. 3. Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network; and Department of Occupational Science and Occupational Therapy, University of Toronto. 4. Rehabilitation Sciences Institute, University of Toronto; Toronto Rehabilitation Institute, University Health Network; Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto. 5. Toronto Rehabilitation Institute, University Health Network; Sunnybrook Research Institute, Toronto; and Department of Physical Therapy, Faculty of Medicine, University of Toronto. 6. Toronto Rehabilitation Institute, University Health Network; and Institute of Biomaterials and Biomedical Engineering, University of Toronto. 7. Rehabilitation Sciences Institute, University of Toronto; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada M4G 3V9; and Department of Physical Therapy, Faculty of Medicine, University of Toronto.
Abstract
BACKGROUND: Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke. OBJECTIVE: The objective is to investigate whether PBT or conventional intensive balance training (CIBT) results in greater improvements in reactive stepping ability in individuals with chronic incomplete spinal cord injury (iSCI). DESIGN: The design consists of an assessor-blind randomized clinical trial comparing the efficacy of 2 balance training programs (PBT and CIBT) matched for training duration (thrice weekly for 8 weeks). SETTING: A tertiary spinal cord injury rehabilitation center is used as the setting. PARTICIPANTS: Participants include 24 adults with iSCI classified as a C or D on the American Spinal Association Impairment Scale, who are able to stand independently and exhibit moderate trunk control. INTERVENTION: Both PBT and CIBT involve 24 sessions, each 1 hour long, of individualized static and dynamic balance tasks. However, PBT includes external, unexpected balance perturbations provided manually by the trainer at a frequency of roughly 1 per training minute. MEASUREMENTS: The primary outcome is the ability to recover balance using a single step during the Lean-and-Release test, a novel method of assessing reactive balance. Secondary outcomes include a number of clinical balance and gait assessments, and the number of falls experienced in a 6-month follow-up period. Semi-structured interviews are conducted 3 months after training completion to gain insight into the participants' perceptions of the impact of the interventions. LIMITATIONS: A control group receiving "standard care" for balance training is not included. CONCLUSIONS: This trial will provide physical therapists with insight into the efficacy of 2 forms of balance training for individuals with iSCI.
RCT Entities:
BACKGROUND: Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke. OBJECTIVE: The objective is to investigate whether PBT or conventional intensive balance training (CIBT) results in greater improvements in reactive stepping ability in individuals with chronic incomplete spinal cord injury (iSCI). DESIGN: The design consists of an assessor-blind randomized clinical trial comparing the efficacy of 2 balance training programs (PBT and CIBT) matched for training duration (thrice weekly for 8 weeks). SETTING: A tertiary spinal cord injury rehabilitation center is used as the setting. PARTICIPANTS: Participants include 24 adults with iSCI classified as a C or D on the American Spinal Association Impairment Scale, who are able to stand independently and exhibit moderate trunk control. INTERVENTION: Both PBT and CIBT involve 24 sessions, each 1 hour long, of individualized static and dynamic balance tasks. However, PBT includes external, unexpected balance perturbations provided manually by the trainer at a frequency of roughly 1 per training minute. MEASUREMENTS: The primary outcome is the ability to recover balance using a single step during the Lean-and-Release test, a novel method of assessing reactive balance. Secondary outcomes include a number of clinical balance and gait assessments, and the number of falls experienced in a 6-month follow-up period. Semi-structured interviews are conducted 3 months after training completion to gain insight into the participants' perceptions of the impact of the interventions. LIMITATIONS: A control group receiving "standard care" for balance training is not included. CONCLUSIONS: This trial will provide physical therapists with insight into the efficacy of 2 forms of balance training for individuals with iSCI.
Authors: An-Wen Chan; Jennifer M Tetzlaff; Peter C Gøtzsche; Douglas G Altman; Howard Mann; Jesse A Berlin; Kay Dickersin; Asbjørn Hróbjartsson; Kenneth F Schulz; Wendy R Parulekar; Karmela Krleza-Jeric; Andreas Laupacis; David Moher Journal: BMJ Date: 2013-01-08
Authors: Elizabeth L Inness; Avril Mansfield; Louis Biasin; Karen Brunton; Mark Bayley; William E McIlroy Journal: Gait Posture Date: 2014-12-10 Impact factor: 2.840
Authors: M Jöbges; G Heuschkel; C Pretzel; C Illhardt; C Renner; H Hummelsheim Journal: J Neurol Neurosurg Psychiatry Date: 2004-12 Impact factor: 10.154
Authors: Janelle Unger; Katherine Chan; Jae W Lee; B Catharine Craven; Avril Mansfield; Mohammad Alavinia; Kei Masani; Kristin E Musselman Journal: Front Neurol Date: 2021-02-02 Impact factor: 4.003