title: Fall Incidence in Frail Older Women after Individualized Visual Feedback-Based Balance Training Direction-Induced Effects of Visually Guided Weight-Shifting Training on Standing Balance in the Elderly A randomised controlled trial investigating motor skill training as a function of attentional focus in old age Effects of visual feedback rhythmic weight-shift training on hemiplegic stroke patients Biofeedback versus physiotherapy in patients with partial weight-bearing. Audio-biofeedback improves balance in patients with bilateral vestibular loss. Electromyographic biofeedback for gait training after stroke Electromyographic feedback in the remobilization of stroke patients: a controlled trial. Aging and selective sensorimotor strategies in the regulation of upright balance Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism Balance and strength training in older adults: intervention gains and Tai Chi maintenance. The effects of balance training on gait late after stroke: a randomized controlled trial Use of visual feedback in retraining balance following acute stroke. Visual feedback training improves postural adjustments associated with moving obstacle avoidance in elderly women. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bo bath and feedback training approaches The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. Improving balance by improving motor
  skills The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial. Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Base of support feedback in gait rehabilitation Control of sway using vibrotactile feedback of body tilt in patients with moderate and severe postural control deficits. Reliability of the PEDro scale for rating quality of randomized controlled trials. Vertical ground reaction force feedback to enhance stroke patients' symmetrical body-weight distribution while rising/sitting down. Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training. Changes in Postural Balance in Frail Elderly Women during a 4-Week Visual Feedback Training: A Randomized Controlled Trial Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function. Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. Real-time feedback of body center of gravity for postural training of elderly patients with peripheral neuropathy.
abstract: Background : The knowledge concerning balance training actually lowering fall rates among frail older persons is limited . Objective : The aim of this study was to examine the effects of a 4-week individualized visual feedback-based balance training on the fall incidence during 1-year follow-up among frail older women living in residential care . Methods : Twenty-seven older women from 2 residential care homes were r and omized into  exercise ( n = 20 ) and  control ( n = 7 ) groups . Balance measurements were carried out before and after a 4-week training period and falls were monitored by monthly diaries for 1 year . An interview about fear of falling and physical activity was completed before and after the intervention and after the 1-year follow-up . Results : A positive effect of  balance training on fall incidence was found . A dynamic Poisson regression model showed that during the follow-up the monthly risk of falling was decreased in the exercise group compared to controls ( risk ratio 0.398 , 95 % CI 0.174–0.911 , p = 0.029 ) . In addition , the exercise group reported a reduced fear of falling and increased physical activity after a training period but these changes declined during the follow-up period . Conclusion : Individualized visual feedback-based balance training was shown to be a promising method for fall prevention among frail older women . High compliance ( 97.5 % ) with the training program showed that carefully targeted training programs can be carried out among older people with health limitations Background : Controversial findings exist in the literature with respect to the efficacy of visually guided weight-shifting ( WS ) training as a means of improving balance in healthy older adults . Objective : The purpose of this study was to investigate the impact of two direction-specific , visually guided WS training protocol s on st and ing balance of healthy elderly women . Methods : Forty-eight community-dwelling elderly women , all free of any neurological or musculoskeletal impairment , were r and omly assigned into : a group that practice d WS in the anterior/posterior direction ( A/P group , n = 19 ) , a group that practice d WS in the medio/lateral direction ( M/L group , n = 15 ) and a control group ( n = 14 ) . Participants performed 12 training sessions of visually guided WS ( 3 sessions a week for 25 minutes per session ) . Static balance was measured before and after training in normal ( bipedal ) quiet stance ( NQS ) and sharpened-Romberg stance ( SRS ) by recording center of pressure ( CoP ) variations and angular segment kinematics . Results : In NQS , neither of the two training protocol s had a significant impact on postural sway measures , although a significant decrease in interlimb asymmetry of CoP displacement was noted for the A/P group . In SRS , A/P training induced a significant reduction of CoP displacement , lower limb pitch and upper trunk roll rotation . Conclusion : The results of the study stress the importance of using direction-specific WS tasks in balance training , particularly in the A/P direction , in order to improve control of static balance in elderly women Background Motor learning research has had little impact on clinical applications and rarely extended to research about how older adults learn motor skills . There is consistent evidence that motor skill performance and learning can be enhanced by giving learners instructions that direct their attention . The aim of this study was to test whether elderly individuals that receive an external focus instruction during training of dynamic balance skills would learn in a different manner compared to individuals that received an internal focus instruction . Methods This r and omised trial included 26 older persons ( 81 ± 6 years ) that were training functional balance twice a week for the duration of 5 weeks .  Learning outcomes were recorded after every training session . Weight shifting score and dynamic balance parameters ( Biodex Balance System ) , components of the Extended Timed-Get-Up- and -Go test , five chair rises , and falls efficacy ( FES-I )  was assessed at baseline and post-intervention . Results Participation for training sessions was 94 % . No differences between groups were found following 5 weeks of training for weight shifting score , dynamic balance index and dynamic balance time ( p < 0.95 , p = 0.16 , p < 0.50 ) , implying no learning differences between training groups . Extended Timed-Get-Up- and -Go components Sit-to-st and , p = .036 ; Gait initiation , p = .039 ; Slow down , stop , turnaround , and sit down , p = 0.011 and the Fes-I ( p = 0.014 ) showed improvements for the total group , indicating that function improved compared to baseline . Conclusion A 5-week balance training improved weight shifting scores and dynamic balance parameters as well as functional abilities . The observed improvements were independent from the type of attentional focus instructions . The findings provide support for the proposition of different motor learning principles in older adults compared to younger adults . Trial Registration IS RCT Objective : To assess the balance function of hemiplegic stroke patients and to investigate whether visual feedback rhythmic weight-shift training following acute stroke can decrease falls among patients with hemiplegic stroke . Design : A prospect i ve study , using a Balance Master . Setting : Hospital-based rehabilitation units . Subjects : Fifty-two hemiplegic stroke patients ( 28 in the training group and 24 in the control group ) . Interventions : Conventional stroke rehabilitation programme plus visual feedback rhythmic weight-shift training . Training effect was evaluated by assessing the static and dynamic balance performance as well as comparing the occurrence of falls in the training and control groups at six-month follow-up . Main measures : Occurrence of falls ; static balance in different sensory conditions ; and dynamic balance performance , including on-axis velocity and directional control during rhythmic weight-shift . Results : Significant improvement in dynamic balance performance was found in hemiplegic patients in the training group . The improvement was sustained for six months . With regarding to static balance function , no significant improvement was found . At six-month follow-up , 5 of 28 patients ( 17.8 % ) in the training group had fallen , compared with 10 of 24 patients ( 41.7 % ) in the control group . The occurrence of falls decreased , although not statistically significantly ( p = 0.059 ) . Conclusions : Visual feedback rhythmic weight-shift training may improve dynamic balance function for hemiplegic stroke patients . The effects of training may be sustained for six months . The occurrence of falls decreased in the training group , but not statistically significantly Medical instructions for partial weight-bearing after lower limb surgery and fractures are commonly given . The techniques for instruction are mainly verbal cues . Our aim was to evaluate the efficiency of a new biofeedback device  compared with traditional intervention for gait rehabilitation .  After orthopedic surgery , 33 patients , r and omly divided into a study group ( n = 15 ) and a control group ( n = 18 ) , completed 10 days of a rehabilitation protocol . A significant difference ( P<.05 ) was found between the groups . Study subjects were able to follow weight-bearing instructions better . We suggest that gait rehabilitation is more efficient when biofeedback is used to instruct patients regarding partial weight-bearing OBJECTIVE To evaluate the effectiveness of an audio-biofeedback ( ABF ) system for improving balance in patients with bilateral vestibular loss ( BVL ) . DESIGN Before-after trial . SETTING University balance disorders laboratory . PARTICIPANTS Nine subjects with BVL and 9 unaffected subjects as controls . INTERVENTION Trunk acceleration ABF while st and ing on foam with eyes closed . MAIN OUTCOME MEASURE Balance stability was evaluated according to the following parameters : the root mean square of ( 1 ) the center of pressure ( COP ) displacements and of ( 2 ) the trunk accelerations ; the COP b and width ; the time spent by the participant within + /-1 degrees threshold from their baseline COP position ; and the mean accelerations of the trunk while the participant was swaying outside this + /-1 degrees threshold . RESULTS Participants with BVL had significantly larger postural sway than did unaffected participants . Those with BVL , while using ABF , decreased sway area by 23%+/-4.9 % , decreased trunk accelerations by 46%+/-9.9 % , and increased time spent within + /-1 degrees sway threshold by 195%+/-34.6 % . CONCLUSIONS ABF improved stance stability of participants with BVL by increasing the amount of postural corrections Objective : To examine the effects of electromyographic ( EMG ) biofeedback training on the recovery of gait in the acute phase post stroke . Design : Patients were r and omly assigned to EMG biofeedback or control groups . They received treatment three times a week for six weeks . All patients were assessed prior to treatment , after 18 treatment sessions , and at three months follow-up . Setting : The study was carried out at Scunthorpe General Hospital in North Lincolnshire . The subjects were acute stroke patients who had been admitted on to the medical and elderly wards . Interventions : The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy . The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles . The control group were treated using the same techniques , electrodes were used with this group of patients , but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect . Outcome measures : A large battery of outcome measures was used for physical and psychological assessment . The physical measures consisted of active movement , muscle tone , sensation , proprioception , mobility and activities of daily living ( ADL ) . The psychological measures included orientation , memory , spatial performance , language and IQ . Results : Twenty-one patients were included in the study . Scores were combined into four groups : mild EMG , severe EMG , mild control and severe control . Results showed that there was an improvement in physical scores for active movement , mobility and ADL over time , but there was no significant difference between the EMG and control groups . Scores on the psychological tests were within normal limits , and there was no difference in performance between the EMG and control groups . Conclusions : This study showed no significant differences in the rate of improvement after stroke between the two groups . Although EMG biofeed-back was used as an adjunct to physiotherapy and represented clinical practice , the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke Electromyographic biofeedback was compared with simple exercise therapy as to its effectiveness in improving  foot-drop in 22 stroke patients . The study was design ed to be a rigorous trial of biofeedback and the patients tested were aged and had stroke of long duration . One group of 11 patients underwent 6 weeks of exercise therapy 2 sessions per week for 15 minutes per session ; the 2nd group of 11 patients underwent similar therapy with EMG feedback . All therapy was conducted by a research assistant who was not a trained therapist . The groups were assessed blind before treatment , after treatment and a 6-week follow-up . The significantly greater improvements in the biofeedback group in terms of muscle strength at the end of treatment were maintained at follow-up . On the range of movement and gait analysis measures , both groups showed some improvement after treatment . However , at follow-up this improvement had relapsed for the exercise group while for the biofeedback group it had been maintained . It is argued that controlled trials are possible in biofeedback and that using patients as their own controls is not justified in view of the present findings and the previously reported literature Background The maintenance of upright equilibrium is essentially a sensorimotor integration task . The central nervous system ( CNS ) has to generate appropriate and complex motor responses based on the selective and rapid integration of sensory information from multiple sources . Since each sensory system has its own coordinate framework , specific time delay and reliability , sensory conflicts may arise and represent situations in which the CNS has to recalibrate the weight attributed to each particular sensory input . The resolution of sensory conflicts may represent a particular challenge for older adults given the age-related decline in the integrity of many postural regulating systems , including musculoskeletal and sensory systems , as well as neural processing and conduction of information . The effects of aging and adaptation ( by repeated exposures ) on the capability of the CNS to select pertinent sensory information and resolve sensory conflicts were thus investigated with virtual reality ( VR ) in the present study . Methods Healthy young and older adults maintained quiet stance while immersed in a virtual environment ( VE ) for 1 hour during which transient visual and /or surface perturbations were r and omly presented . Visual perturbations were induced by sudden pitch or roll plane tilts of the VE viewed through a helmet-mounted display , and combined with or without surface perturbations presented in a direction that was either identical or opposite to the visual perturbations . Results Results showed a profound influence of aging on postural adjustments measured by electromyographic ( EMG ) responses and displacements of the center of pressure ( COP ) and body 's center of mass ( COM ) in the recovery of upright stance , especially in the presence of sensory conflicts . Older adults relied more on vision as compared to young adults . Aging affects the interaction of the somatosensory and visual systems on the control of equilibrium during st and ing and the ability of CNS to resolve sensory conflicts . However , even with a one-hour immersion in VE and exposure to sensory conflicts , it is possible for the CNS to recalibrate and adapt to the changes , while improving balance capability in older adults . Conclusion Preventive and rehabilitation programs targeting postural control in older adults should take into account the possible impairment of sensory organization or sensorimotor integration and include VE training under conditions of sensory conflicts Background and Purpose : Distinguishing between a clinical ly significant change and change due to measurement error can be difficult . The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale ( BBS ) , forward and backward functional reach , the  Romberg Test and the Sharpened Romberg Test ( SRT ) with eyes open and closed , the Activities-specific Balance Confidence ( ABC ) Scale , the  Six-Minute Walk Test ( 6MWT ) , comfortable and fast gait speed , the  Timed “ Up & Go ” Test ( TUG ) , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , and the Unified Parkinson Disease Rating Scale ( UPDRS ) in people with parkinsonism . Subjects : Thirty-seven community-dwelling adults with parkinsonism ( mean age=71 years ) participated . The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale ; however , the scores ranged from 1 to 4 . Methods : Subjects were tested twice by the same raters , with 1 week between tests . Test-retest reliability was calculated using intraclass correlation coefficients ( ICCs ) . Minimal detectable change was calculated using a 95 % confidence interval ( MDC95 ) . Results : The ICCs for test-retest reliability were above .90 for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and comfortable and fast gait speeds . The MDC95 values for those functional tests were : BBS=5/56 , ABC Scale=13 % , SRT with eyes closed=19 seconds , 6MWT=82 m , comfortable gait speed=0.18 m/s , and fast gait speed=0.25 m/s . The ICCs for test-retest reliability of SF-36 scores were above .80 , with the exception of the social functioning subscale . The MDC95 values for the SF-36 ranged between 19 % and 45 % . The MDC95 values for the UPDRS Activities of Daily Living section , Motor Examination section , and total scores were 4/52 , 11/108 , and 13/176 , respectively . Discussion and Conclusion : Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinical ly significant . High test-retest reliability of scores for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and gait speed make them trustworthy functional assessment s in people with parkinsonism . The SF-36 and UPDRS provide quality -of-life and disease severity rating values in the ongoing assessment of people with parkinsonism OBJECTIVE To determine the effect on balance and strength of 3 months of intensive balance and /or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains . DESIGN R and omized control intervention . Four groups in 2 x 2 design : Control , Balance , Strength , Balance + Strength , using blinded testers . SETTING Exercise and balance laboratory at University of Connecticut Health Center . PARTICIPANTS Subjects were 110 healthy community dwellers ( mean age 80 ) who were free of dementia , neurological disease , and serious cardiovascular or musculoskeletal conditions . INTERVENTIONS Short-term training ( 3 months ) occurred 3 times/week ( 45 minutes Balance and Strength , 90 minutes Balance + Strength ) . Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback . Strengthening consisted of lower extremity weight-lifting . All subjects than received long-term group Tai Chi instruction ( 6 months , 1 hour , 1 time/week ) . MEASUREMENTS Losses of balance during Sensory Organization Testing ( LOB ) , single stance time ( SST ) , voluntary limits of stability ( FBOS ) , summed isokinetic torque of eight lower extremity movements ( ISOK ) , and usual gait velocity ( GVU ) . RESULTS AND CONCLUSIONS Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger : LOB = -2.0 + /- 0.3 ( adjusted paired differences , P < .005 ANOVA ) ; SST = 7.0 + /- 1.2 sec ; and FBOS = 9.0 + /- 2.0 % of foot length ( P < .05 ) . Strengthening increased ISOK by 1.1 + /- 0.1 Nm kg-1 ( P < .005 ) . There was no interaction between balance and strength training . Significant gains persisted after 6 months of Tai Chi , although there was some decrement Objective : To investigate the effects of balance training , using force platform biofeedback , on quantitative gait characteristics of hemiparetic patients late after stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation ward and gait laboratory of a university hospital . Subjects : Forty-one patients ( mean ( st and ard deviation ; SD ) age of 60.9 ( 11.7 ) years ) with hemiparesis late after stroke ( median time since stroke six months ) were r and omly assigned to an experimental or a control group . Interventions : The control group ( n = 19 ) participated in a conventional stroke inpatient rehabilitation programme , whereas the experimental group ( n = 22 ) received 15 sessions of balance training ( using force platform biofeedback ) in addition to the conventional programme . Main outcome measures : Selected paretic side time-distance , kinematic and kinetic gait parameters in sagittal , frontal and transverse planes were measured using a three-dimensional computerized gait analysis system , one week before and after the experimental treatment programme . Results : The control group did not show any statistically significant difference regarding gait characteristics . Pelvic excursion in frontal plane improved significantly ( P = 0.021 ) in the experimental group . The difference between before-after change scores of the groups was significant for pelvic excursion in frontal plane ( P = 0.039 ) and vertical ground reaction force ( P = 0.030 ) in favour of experimental group . Conclusion : Balance training using force platform biofeedback in addition to a conventional inpatient stroke rehabilitation programme is beneficial in improving postural control and weight-bearing on the paretic side while walking late after stroke BACKGROUND AND PURPOSE Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke , although it is not clear whether functional balance ability also improves . This study compared the relative effectiveness of visual feedback training of center-of-gravity ( CoG ) positioning with conventional physical therapy following acute stroke . SUBJECTS Forty-six people who had strokes within 80 days before the study , result ing in unilateral hemiparesis , and who were in need of balance retraining participated . METHODS AND MATERIAL S Initially , subjects were r and omly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited . The next 14 subjects were assigned to a control group . All subjects received physical therapy and occupational therapy ( regular therapy ) 2 hours a day , and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge . The visual feedback group received information about their CoG position as they shifted their weight during various activities . The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting . Static ( postural sway ) and activity-based measures of balance ( Berg Balance Scale , gait speed , and the Timed " Up & Go " Test ) were contrasted across the 3 groups at baseline , at discharge , and at 1 month following discharge using an analysis of variance for repeated measures . RESULTS All groups demonstrated marked improvement over time for all measures of balance ability , with the greatest improvements occurring in the period from baseline to discharge . No between-group differences were detected in any of the outcome measures . CONCLUSION AND DISCUSSION Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke The study examined the impact of visually guided weight shifting ( WS ) practice on the postural adjustments evoked by elderly women when avoiding collision with a moving obstacle while st and ing . Fifty-six healthy elderly women ( 70.9+/-5.7 years , 87.5+/-9.6 kg ) were r and omly assigned into one of three groups : a group that completed 12 sessions ( 25 min , 3s/week ) of WS practice in the Anterior/Posterior direction ( A/P group , n=20 ) , a group that performed the same practice in the medio/lateral direction ( M/L group , n=20 ) and a control group ( n=16 ) . Pre- and post-training , participants were tested in a  moving obstacle avoidance task .  As a result of practice , postural response onset shifted closer to the time of collision with the obstacle . Side-to-side WS result ed in a reduction of the M/L sway amplitude and an increase of the trunk 's velocity during avoidance . It is concluded that visually guided WS practice enhances elderly 's ability for on-line visuo-motor processing when avoiding collision eliminating reliance on anticipatory scaling . Specifying the direction of WS seems to be critical for optimizing the transfer of training adaptations Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Objective : To determine ( 1 ) the most effective of three treatment approaches to retrain seated weight distribution long-term after stroke and ( 2 ) whether improvements could be generalized to weight distribution in st and ing . Setting : Inpatient rehabilitation unit . Design : Forty asymmetrical acute stroke subjects were r and omly allocated to one of four groups in this pilot study . Changes in weight distribution were compared between the 10 subjects of each of three treatment groups ( task-specific reach , Bobath , or Balance Performance Monitor [ BPM ] feedback training ) and a no specific treatment control group . One week of measurement only was followed by two weeks of daily training sessions with the treatment to which the subject was r and omly allocated . Measurements were performed using the BPM daily before treatment sessions , two weeks after cessation of treatment and 12 weeks post study . Weight distribution was calculated in terms of mean balance ( percentage of total body weight ) or the mean of 300 balance points over a 30-s data run . Results : In the short term , the Bobath approach was the most effective treatment for retraining sitting symmetry after stroke ( p = 0.004 ) . Training with the BPM and no training were also significant ( p = 0.038 and p = 0.035 respectively ) and task-specific reach training failed to reach significance ( p = 0.26 ) . At 12 weeks post study 83 % of the BPM training group , 38 % of the task-specific reach group , 29 % of the Bobath group and 0 % of the untrained group were found to be distributing their weight to both sides . Some generalization of symmetry training in sitting to st and ing was noted in the BPM training group which appeared to persist long term . Conclusions : Results should be treated with caution due to the small group sizes . However , these preliminary endings suggest that it might be possible to restore postural symmetry in sitting in the early stages of rehabilitation with therapy that focuses on creating an awareness of body position BACKGROUND AND PURPOSE This study explored whether two exercise programs would affect the ability to minimize postural sway of 72 relatively inactive , older subjects who participated in the Atlanta FICSIT trial . SUBJECTS Subjects were r and omly assigned to ( 1 ) a computerized balance training group , ( 2 ) a tai chi group , or ( 3 ) an educational group serving as a control for exercise .  Each group consisted of 24 members . METHODS All subjects were evaluated under four postural conditions before , immediately after , and 4 months following their respective interventions , each of which was given over 15 weeks . RESULTS Platform balance measures revealed greater stability after training among subjects in the balance training group but little change in stability among subjects in the tai chi and educational group . Subjects in the tai chi group were less afraid of falling after training compared with subjects in other groups with similar covariates . CONCLUSION AND DISCUSSION Unlike computerized balance training , tai chi does not improve measures of postural stability . Because tai chi delayed onset to first or multiple falls in older individuals , this effect does not appear to be associated with measures of enhanced postural stability .  Tai chi may gain its success , in part , from promoting confidence without reducing sway rather than primarily facilitating a reduction in sway-based measures Summary .The effectiveness of a computer-assisted balance training was compared with a homebased exercise program in healthy elderly subjects . Twenty-four physically active community dwelling elderly ( median age 71 years ) participated in the study . Balance was assessed by a summary performance score , measuring postural stability while st and ing , reaching , stepping and walking . Subjects of the  computer-assisted balance training group  could considerably improve their performance on the training device ( p = 0.0078 ) as well as in the summary balance score ( p = 0.0176 ) . No improvement of balance was documented in the home-based exercise group . A superiority of the computer-assisted balance training exercise protocol over the home-based exercise group could not be documented ( p = 0.3934 ) . The study indicates that a computer-assisted balance training , focussing on one motor skill , can improve balance . It is suggested that a home-based exercise program is ineffective to improve balance in elderly persons , if there is no direct supervision . Zusammenfassung . Es wurde das Balancetraining mit gesunden Älteren an einem  computer-gesteuerten Trainingsgerät mit einem zu Hause durchgeführten Trainingsprogramm verglichen . Es nahmen 24 gesunde , aktive Senioren ( Median 71 Jahre ) an der Studie teil . Untersuchungen der Balance i m ruhigen St and , beim Setzen eines großen Schrittes , beim Gehen und die funktionelle Reichweite wurden mit Hilfe eines Summen-Scores beurteilt . Die Teilnehmer , die auf dem computer-gesteuerten Trainingsgerät trainierten , konnten sich sowohl auf dem Gerät ( p = 0,0078 ) , als auch i m Balance-Summen-Score ( p = 0,0176 ) erheblich verbessern . In der Gruppe der zu Hause trainierenden wurden keine Veränderungen i m Balance-Summen-Score gemessen . Eine Überlegenheit des computer-gesteuerten Trainings konnte allerdings statistisch nicht belegt werden ( p = 0,3934 ) . Die Studie zeigt , dass das Training einer motorischen Fertigkeit auf einem computer-gesteuerten Trainingsgerät zu Verbesserungen der Balance führen kann . Es wird vermutet , dass ein Heimtraining ohne direkte Anleitung bei älterenMenschen nicht zur Verbesserung der Balance führt AIM To investigate the effects of balance training , using force platform biofeedback , on motor recovery , mobility and activity level of hemiparetic patients with stroke . METHODS In this r and omized , controlled , assessor-blinded trial 41 in patients [ mean ( + /-SD ) age of 60.9 ( + /-11.7 ) years ] with hemiparesis after stroke ( median time since stroke 6 months ) were r and omly assigned to an experimental or a control group . The control group ( n=19 ) participated in a conventional stroke inpatient rehabilitation program , whereas the experimental group ( n=22 ) received 15 sessions of balance training ( using force platform biofeedback ) in addition to the conventional program . Main outcome measures were motor recovery of the lower extremity ( Brunnstrom staging ) , mobility ( Rivermead Mobility Index , RMI ) and activity level ( Functional Independence Measure , FIM ) that performed one week before and after the experimental treatment program . RESULTS Both groups were similar in terms of baseline clinical characteristics . Motor recovery , mobility and activity level improved significantly in both groups ( P<0.05 ) . Between-group difference of mean change score was not significant for the Brunnstrom stages ( 0.23 vs 0.26 ) , RMI ( 2.9 vs 2.2 ) and FIM score ( 10.7 vs 11.5 ) . CONCLUSION In our group of stroke patients , balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery , mobility and activity level OBJECTIVE To determine the short-term effectiveness of a biofeedback-based , computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling . PARTICIPANTS Forty-five older adults ( X = 78.5 years ) with a history of falls were assigned to either a control ( n = 21 ) or intervention group ( n = 24 ) . DESIGN A 2 x 2 ( Group x Time ) mixed factorial design with repeated measures on the second factor . SETTING A motor control research laboratory in a university setting . MEASUREMENT Impairments in multiple dimensions of balance ( i.e. , dynamic postural control and sensory organization ) were measured before and after an 8-week balance intervention using the 100 % Limits of Stability Test and Sensory Organization Test . More functional limitations in balance and /or mobility were measured using two clinical tests : Berg Balance Scale and Timed Up and Go test . MAIN RESULTS Repeated measures multivariate analyses and follow-up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only ( P < .03 ) . Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only . CONCLUSIONS Theory-driven rehabilitation programs that focus on manipulating individual , task , and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments . Moreover , the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task-specific practice are not the only means by which an older adult 's ability to perform daily activities requiring postural control can be improved The purpose of this study was to investigate the effect of feedback information about base of support in gait rehabilitation . Sixteen individuals with hemiparesis result ing in narrow base of support , were r and omly placed into two equal groups , experimental and control . The experimental group was provided with a portable device that provided extrinsic auditory feedback information about base of support incorporated in the functional context of conventional gait therapy , whereas the control group received a conventional gait therapy only .  Changes in step width with treatment were assessed with step print technique . The experimental group of subjects improved their step width with treatment from 0.09±0.003 m to 0.16±0.006 m while individuals assigned to the control group showed smaller improvement from 0.099±0.004 m to 0.13±0.003 m. While both groups demonstrated statistically significant improvement ( p<0.05 ) , the level of recovery of step width seen in the experimental group was greater We evaluated the effect of the vibrotactile display of body tilt upon the postural stability of vestibulopathic subjects during st and ing . Two groups were studied : those with moderate and with severe deficits as defined by postural stability test scores . They were studied under conditions of distorted sensory input , and during anterior-posterior perturbations .  Seventeen subjects , with uni- or bilateral vestibular deficits , as determined by electronystagmography and vertical axis rotation , were tested using  Equitest computerized dynamic posturography ( CDP ) . Based on their performance on the CDP they were divided into two groups having either moderate ( nine subjects ) or severe ( eight subjects ) postural control deficits . Their anterior-posterior ( A/P ) body motion at the waist was measured with a micromechanical rate gyroscope and a linear accelerometer . The result ing tilt estimate was displayed by a vibrotactile array attached to the torso . The vibration served as a tilt feedback to the subject . The subject 's performance was evaluated using the root-mean-square ( RMS ) of both the A/P body motion and center-of-pressure ( CoP ) estimates . Sensory distortions were introduced using the Equitest Sensory Organization Tests ( SOT ) . These tests are design ed to distort A/P sensory inputs while st and ing . The SOT 5 distorts proprioceptive information about ankle joint movement , while the subject st and s eyes-closed on a moving support platform that measures foot pressure . The SOT 6 adds distorted visual information about body movement instead of testing with eyes closed . Perturbations were introduced using the Equitest Motor Control Tests ( MCT ) . These move the support platform forward or backward with small , medium and large displacements in the horizontal plane while measuring subjects ' foot pressure responses . We used the medium and large backward tests . Vibrotactile display of body tilt reduced the subjects ' A/P sway and improved their balance . The finding was more evident for those subjects with severe deficits than those moderate ones . This trend was found for both SOT 5 and 6 , as well as the medium and large MCT . Additionally , during the MCT , the peak deflection and mean recovery time also decreased significantly BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . A force platform with an auditory output consisting of two electronic balances was used to reinforce symmetrical body-weight distribution in stroke patients . Forty patients r and omly assigned to an experimental group or a control group practised rising and sitting down for 15 min , thrice daily , 5 days a week for 6 weeks . The experimental group but not the control group received ground reaction force feedback through the auditory output .  Vertical ground reaction forces under each foot were measured with two force plates . Mean difference in improvement of body weight distribution on the paretic leg was 13.2 + /- 10.7 ( M , SD ) per cent total body weight in the experimental group and 5.1 + /- 6.7 per cent in the control group in rising ( p < 0.01 ) and 12.7 + /- 7.5 per cent total body weight and 4.6 + /- 6.6 per cent in sitting down tests ( p < 0.001 ) . The patients in the experimental group achieved in average close to a symmetrical body-weight distribution while rising and sitting down . Improvements in physical performance and sit-st and tests were greater in the experimental group ( p < 0.05 and p < 0.01 , respectively ) . No differences were seen in improvement in performance of activities of daily living . Symmetry in body-weight distribution in rising and sitting down correlated with high scores in physical performance , motor function in rising , and with functional ability OBJECTIVES To evaluate the effects of two exercise approaches , tai chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrences of fall ) . DESIGN The Atlanta Frailty and Injuries : Cooperative Studies and Intervention Techniques , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education ( ED ) ) . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional instrumental activities of daily living ( IADL ) , and psychosocial well-being ( Center for Epidemiological Studies for Depression scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P=.046 and P=.058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSION A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  TC warrants further study as an exercise treatment to improve the health of older people Background : 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 . Objective : 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 . Methods : Elderly women of two residential care facilities were r and omized 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 st and ing body sway , dynamic weight shifting , and Berg Balance Scale performance . Results : 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 st and ing balance tests in the more dem and ing st and ing positions showed improvements in the EG , whereas similar changes in the CG were not found . Conclusions : 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 OBJECTIVE To determine the role of symmetrical body-weight distribution training in preventing falls among patients with hemiplegic stroke . DESIGN A prospect i ve study using a st and ing biofeedback trainer . SETTING Hospital-based rehabilitation units . PATIENTS Fifty-four patients with hemiplegic stroke ( 30 in the training group , 24 in the control group ) . INTERVENTIONS Conventional stroke rehabilitation program , plus symmetrical st and ing training and repetitive sit-to-st and training , with a st and ing biofeedback trainer . Training effect was evaluated by assessing the sit-to-st and performance and comparing the occurrence of falls in the 2 groups at a 6-month follow-up . MAIN OUTCOME MEASURES Occurrence of falls , sit-to-st and performance , including body-weight distribution , rate of rise in force , and sway in center of pressure ( COP ) . RESULTS Significant improvement in sit-to-st and performance was found in patients in the training group . Body weight was distributed more symmetrically in both legs , with less mediolateral sway in the COP when rising and sitting down . The mean difference in body-weight distribution between the left and right legs while subjects were rising from a chair significantly decreased , from 49.5 % + /- 18.9 % to 38.6 % + /- 15.8 % of body weight ( BW ) ( p < .005 ) . The rate of rise in force while rising from a chair significantly increased , from 28.3 % + /- 13.5%BW/s to 53.6 % + /- 20.5%BW/s ( p < .001 ) . At the 6-month follow-up , 10 of 24 patients ( 41.7 % ) in the control group had fallen , compared with only 5 of 30 patients ( 16.7 % ) in the training group ( p < .05 ) . CONCLUSIONS Symmetrical body-weight distribution training may improve sit-to-st and performance and , consequently , decrease the number of falls by stroke patients A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke , an associated improvement in function has been demonstrated . This study examines this promising technique further using a single-blind controlled trial . Twenty-six patients were recruited from a register of consecutive admissions and r and omized into treatment and control groups . Both groups received additional therapy , only the treatment group received visual feedback . Assessment s were carried out independently . Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function . Between group differences had disappeared at three months . The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway . Transfer of training was indicated by improvements in ADL and gross motor function . Three months later the improvement was maintained , but did not automatically continue without treatment AIM Gait rehabilitation programs often require either partial weight-bearing ( PWB ) or encourage full weight-bearing ( FWB ) on the affected limb . Until recently , there was no objective and practical way to measure correct weight-bearing during ambulation . The present study evaluates a new in-shoe device ( SmartStep , And ante Medical Devices Ltd. ) for measuring the amount of weight on the affected limb and for biofeedback gait training . METHODS The first part of the study aim ed to establish the validity of the SmartStep by comparing the results obtained from this device with the results obtained from a force plate . The second part aim ed to evaluate the effectiveness of the SmartStep  as a biofeedback method in patients who have been referred for FWB gait rehabilitation . Analysis was based on independent sample s t-test and chi squared test for evaluating statistically significant differences between the 2 gait rehabilitation modes . RESULTS The SmartStep could repeat the same results with 0.53 kg error of mean . Statistically significant correlation was found between results obtained from the SmartStep and from the force plate ( R2=0.9067 and P=0.004 ) . The use of the SmartStep auditory biofeedback , significantly ( P=0.00031 ) improved patients ' weight-bearing over the affected limb in the experimental group ( 7.9 kg + /-5.28 ) as compared to the control group ( 0.7+/-2.41 kg ) . CONCLUSIONS The SmartStep proved to be very reliable since it generated significant repeatable results which correlated significantly with those obtained from a force plate . Patients recommended for FWB gait can significantly improve body weight loading over the affected limb by the use of the SmartStep auditory biofeedback A system that estimates and displays , in real-time , the location of the center of gravity of the human body relative to the feet was developed and then used in a biofeedback training program for improving the postural instability caused by deterioration of the proprioceptive system in elderly patients with significant diabetic sensory neuropathy during perturbations of a support platform . Training sessions were scheduled three times a week for four weeks and consisted of continuous perturbations of the support platform for the st and ing subject  . Postural stability of each subject was evaluated before , during and after training on a weekly basis . After twelve sessions of training , subjects who received visual feedback showed greater reduction in total number of falls and in fall magnitude defined by force in the body suspension cord , and longer delay in time between perturbation and fall than NFB group
target: Results and Conclusions Although most available studies did not systematic ally evaluate feasibility aspects , reports of high participation rates , low drop-out rates , absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults .
  An indication for effectiveness of visual feedback-based training of balance in ( frail ) older adults was identified for postural sway , weight-shifting and reaction time in st and ing , and for the Berg Balance Scale .
  Indications for added effectiveness of applying biofeedback during training of balance , gait , or sit-to-st and transfers in older patients post-stroke were identified for training-specific aspects .
  The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery .
  Implication sFurther appropriate studies are needed in different population s of older adults to be able to make definitive statements regarding the ( long-term ) added effectiveness , particularly on measures of functioning
background: Context An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity .
  Objective To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and /or mobility in older adults .