Force platform feedback for standing balance training after stroke

Feedback from a force platform improves standing balance but the impact on independence is unclear. People who have had a stroke often experience problems with standing balance. Impaired standing balance is often treated with balance exercises suggested by a physiotherapist. Exercises are sometimes given with feedback from a force platform to indicate the person's standing position. The results of seven clinical trials indicated that providing feedback from a force platform resulted in patients standing more evenly but did not improve balance during active functional activities, nor did it improve overall independence.

Authors' conclusions: 

Force platform feedback (visual or auditory) improved stance symmetry but not sway in standing, clinical balance outcomes or measures of independence.

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Background: 

Standing balance deficits are common in individuals after stroke. One way to address these deficits is to provide the individual with feedback from a force platform while balance activities are performed. The feedback can take visual and/or auditory form.

Objectives: 

To determine if visual or auditory force platform feedback improves the clinical and force platform standing balance outcomes in clients with stroke.

Search strategy: 

We searched the Cochrane Stroke Group trials register (last searched December 2003), and the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to May 2003), EMBASE (1974 to May 2003), CINAHL (1982 to May 2003), PEDro (May 2003), CIRRIE (May 2003) and REHABDATA (May 2003). Reference lists of articles were reviewed and manufacturers of equipment were contacted.

Selection criteria: 

Randomized controlled trials comparing force platform with visual feedback and/or auditory feedback to other balance treatments.

Data collection and analysis: 

Two reviewers independently assessed trials for inclusion, methodological quality, and data extraction. Trials were combined for meta-analysis according to outcome and type of feedback.

Main results: 

We included seven trials (246 participants). Force platform feedback did not improve clinical measures of balance when moving or walking (Berg Balance Scale and Timed Up and Go). Significant improvements in laboratory force platform indicators of stance symmetry were found for regimens using visual feedback (standardised mean difference (SMD) -0.68, 95% confidence interval (CI) -1.31 to -0.04, p = 0.04) and the concurrent visual and auditory feedback (weighted mean difference (WMD) -4.02, 95% CI -5.99 to -2.04, p = 0.00007). There were no significant effects on laboratory postural sway indicators, clinical outcomes or measures of function at follow-up assessment.

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