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      Effect of balance training with Pro-kin System on balance in patients with white matter lesions

      research-article
      , MD , , MD, , MD, , MD, , MD, , MD, , MD
      Medicine
      Wolters Kluwer Health
      balance training, visual feedback, white matter lesions

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          Abstract

          Patients with white matter lesions (WMLs) often present with problems of balance. The aim of this study was to verify the effects of combined Pro-kin system and conventional balance training to improve balance ability in WMLs patients.

          This is a randomized controlled study, and 40 participants were divided into 2 groups: the intervention group (n=18) received Pro-kin system with additional conventional balance training for 20 minutes per session, 5 times a week, for 2 weeks. The control group (n = 19) received only conventional balance training. Outcome measures were examined before and after the 2 weeks intervention using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Pro-kin system.

          After completion of the 2 weeks intervention, BBS, TUG, and Pro-kin system results significantly improved in the intervention group ( P < .05). In the control group, BBS and Pro-kin system results significantly improved ( P < .05). Changes in all outcomes but the ellipse area with eye closed ( P < .05) were significantly higher in the intervention group than in the control group.

          The combination of Pro-kin system and conventional balance training is a potentially valuable treatment for patients with WMLs.

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          Most cited references14

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          A new rating scale for age-related white matter changes applicable to MRI and CT.

          MRI is more sensitive than CT for detection of age-related white matter changes (ARWMC). Most rating scales estimate the degree and distribution of ARWMC either on CT or on MRI, and they differ in many aspects. This makes it difficult to compare CT and MRI studies. To be able to study the evolution and possible effect of drug treatment on ARWMC in large patient samples, it is necessary to have a rating scale constructed for both MRI and CT. We have developed and evaluated a new scale and studied ARWMC in a large number of patients examined with both MRI and CT. Seventy-seven patients with ARWMC on either CT or MRI were recruited and a complementary examination (MRI or CT) performed. The patients came from 4 centers in Europe, and the scans were rated by 4 raters on 1 occasion with the new ARWMC rating scale. The interrater reliability was evaluated by using kappa statistics. The degree and distribution of ARWMC in CT and MRI scans were compared in different brain areas. Interrater reliability was good for MRI (kappa=0.67) and moderate for CT (kappa=0.48). MRI was superior in detection of small ARWMC, whereas larger lesions were detected equally well with both CT and MRI. In the parieto-occipital and infratentorial areas, MRI detected significantly more ARWMC than did CT. In the frontal area and basal ganglia, no differences between modalities were found. When a fluid-attenuated inversion recovery sequence was used, MRI detected significantly more lesions than CT in frontal and parieto-occipital areas. No differences were found in basal ganglia and infratentorial areas. We present a new ARWMC scale applicable to both CT and MRI that has almost equal sensitivity, except for certain regions. The interrater reliability was slightly better for MRI, as was the detectability of small lesions.
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            Balance retraining after stroke using force platform biofeedback.

            Balance is a somewhat ambiguous term used to describe the ability to maintain or move within a weight-bearing posture without falling. Balance can further be broken down into three aspects: steadiness, symmetry, and dynamic stability. Steadiness refers to the ability to maintain a given posture with minimal extraneous movement (sway). The term symmetry is used to describe equal weight distribution between the weight-bearing components (eg, the feet in a standing position, the buttocks in a sitting position), and dynamic stability is the ability to move within a given posture without loss of balance. All of these components of balance (steadiness, symmetry, and dynamic stability) have been found to be disturbed following stroke. Balance testing of patients with hemiparesis secondary to stroke has revealed a greater amount of postural sway during static stance, asymmetry with greater weight on the nonparetic leg, and a decreased ability to move within a weight-bearing posture without loss of balance. Furthermore, research has demonstrated moderate relationships between balance function and gait speed (r = -.67 and .42, respectively), independence (r = .62), appearance (defined as "significantly abnormal," "slightly abnormal," and "nearly normal") (r = .50), dressing (r.55-.69), wheelchair mobility (r = .51), and reaching (r = .49-.78). Thus, a principal construct within physical therapy practice is the reestablishment of balance function in patients following stroke. Recent advances in technology have resulted in the commercial availability of numerous force platform systems for the retraining of balance function in patient populations, including patients with stroke. These systems are designed to provide visual or auditory biofeedback to patients regarding the locus of their center of force (COF) or center of pressure (COP), as well as training protocols to enhance stance symmetry, steadiness, and dynamic stability. Typical force platform biofeedback systems consist of at least two force plates to allow the weight on each foot to be determined, a computer and monitor to allow visualization of the COF or COP, and software that provides training protocols and data analysis capabilities. Some units allow auditory feedback in addition to the visual feedback in response to errors in performance.
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              Changes in postural balance in frail elderly women during a 4-week visual feedback training: a randomized controlled trial.

              Balance training programs have not shown consistent results among older adults, and it remains unclear how different training methods can be adapted to frail elderly people. The purpose of this study was to investigate the effects of a 4-week visual feedback-based balance training on the postural control of frail elderly women living in residential care homes. Elderly women of two residential care facilities were randomized to an exercise group (EG, n = 20) and to a control group (CG, n = 7). The EG participated in training sessions three times/week for 4 weeks. The exercises were carried out with a computerized force platform with visual feedback screen. The dimensions of balance function studied were standing body sway, dynamic weight shifting, and Berg Balance Scale performance. The EG showed significant improvement in balance functions. The performance time in dynamic balance tests improved on average by 35.9% compared with a 0.6% increase in the CG (p = 0.025-0.193). The performance distance in these tests decreased on average by 28.2% in the EG as compared with a 9.8% decrease seen in the CG. The Berg Balance Scale performance improved by 6.9% compared with a 0.7% increase in the CG (p = 0.003). The standing balance tests in the more demanding standing positions showed improvements in the EG, whereas similar changes in the CG were not found. Our findings suggest that balance training based on visual feedback improves the balance control in frail elderly women living in residential care, also enhancing the performance of functional balancing tasks relevant to daily living. The subjects were motivated to participate in the training, as indicated by the high compliance (97.5%) with the program. Copyright 2004 S. Karger AG, Basel
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                December 2017
                22 December 2017
                : 96
                : 51
                : e9057
                Affiliations
                Sino-French Department of Neurological Rehabilitation, Gansu Provincial Hospital, Lanzhou, P.R. China.
                Author notes
                []Correspondence: Hong You, Sino-French Department of Neurological Rehabilitation, Gansu Provincial Hospital, Lanzhou, P.R. China (e-mail: lzyouhonginedin@ 123456163.com ).
                Article
                MD-D-16-05362 09057
                10.1097/MD.0000000000009057
                5758135
                29390433
                7d8b8048-81d8-4943-8220-b61599e67d3e
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 23 August 2016
                : 27 August 2017
                : 12 November 2017
                Categories
                5300
                Research Article
                Observational Study
                Custom metadata
                TRUE

                balance training,visual feedback,white matter lesions

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