Perturbation-based balance training after stroke.

Rationale:

In the Netherlands, an estimated 41.000 people sustain a first ever stroke every year. Falls are a common complication after stroke, with balance and gait disorders as its main risk factors. This can be explained by the fact that people after stroke have an impaired capacity to execute quick stepping reactions after a balance perturbation, particularly when de paretic leg is involved. There is some evidence that these stepping reactions can be improved after stroke by a perturbation based training program.



Objective:

The aim of the proposed explorative “proof-of-principle” study is to assess the feasibility and (preliminary) effectiveness of a 5-week perturbation-based training program using the Radboud Falls Simulator (RFS) on dynamic balance capacity in community-dwelling persons in the chronic phase after stroke.



Study design:

This study is designed as a randomized controlled cross over trial. Participants will be randomly allocated to an experimental group receiving the 5-week training program after one week, or to a (waiting list) control group receiving no specific intervention (“usual care”). After a waiting period of 6 weeks, the control group will also receive the experimental training.



Study population:

In this study, twenty participants in the chronic phase after stroke, aged 18 till 75 years, will be included. They will have to have a FAC (Functional Ambulation Categories) score of 4 or more (being able to independently walk on even terrain).



Intervention:

A 5-week perturbation-based training program on the Radboud Falls Simulator (RFS). This program will train sustaining single translations in eight different directions and at increasing intensities (accelerations) necessitating step reactions. In addition, stepping with both the paretic and the nonparetic leg will be stimulated. Participants will receive the training in pairs during training sessions of 90 minutes, two times a week, 5 weeks in a row, under supervision of a trained physiotherapist. The level of difficulty will be increased each session based on a fixed individualized protocol.



Main study parameters/endpoints:

Because this study has an explorative design and aims toprovide “proof of principle”, the primary outcome measure is related to the efficacy of the stepping responses. Centre of mass (CoM) displacement and step length during perturbations on the Radboud Falls Simulator will be compared between the intervention group and the usual care group.

The hypothesis is that a 5-week perturbation-based training program using the Radboud Falls Simulator (RFS) will improve the mechanical efficiency of stepping to recover balance in community-dwelling persons in the chronic phase after stroke.

Experimental group:

T0: Intake;

T1: Pre intervention;

T2: Post intervention (6 weeks);

T3: Follow up (6 weeks);

T4: Follow up (6 weeks).



Control group:

T0: Intake;

T1: Baseline;

T2: Pre intervention (6 weeks);

T3: Post intervention (6 weeks);

T4: Follow up (6 weeks).

A 5-week perturbation-based training program on the Radboud Falls Simulator (RFS). This program will train sustaining single translations in eight different directions and at increasing intensities (accelerations) necessitating step reactions. In addition, stepping with both the paretic and the nonparetic leg will be stimulated. Participants will receive the training in pairs during training sessions of 90 minutes, two times a week, 5 weeks in a row, under supervision of a trained physiotherapist. The level of difficulty will be increased each session based on a fixed individualized protocol.



The control group will be put on a waitinglist.