Force platform feedback for standing balance training after stroke

Article type
Authors
Barclay Goddard R, Stevenson T, Poluha W, Moffatt M, Taback S
Abstract
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 providing feedback from a force platform during performance of standing balance exercises improves the standing balance of individuals after stroke.

Methods: The following databases were searched: the Cochrane Stroke Group trials register, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, PEDro, CIRRIE, and REHABDATA databases. Reference lists of articles were reviewed and manufacturers of force platform devices were contacted. Randomised controlled trials comparing force platform visual feedback and /or auditory feedback to other balance treatments were included. 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.

Results: 7 trials (246 participants) were included. Force platform feedback did not improve clinical measures of balance during active functional activities (Berg Balance Scale and Timed Up and Go). Significant improvements in force platform indicators of stance symmetry were found for regimens using visual feedback (SMD -0.68, 95% CI -1.31, -0.04) and concurrent visual and auditory feedback (WMD-4.02, 95% CI -5.99, -2.04). There were no significant effects on postural sway indicators, clinical outcomes or measures of function at follow-up assessment.

Conclusions: Force platform feedback (visual or auditory) improved stance symmetry but not sway, clinical balance outcomes or measures of independence. Further study is required to evaluate the association between improvement in force platform outcomes and improvement in the clinical outcomes of balance and functional activities. A larger sample size is needed to determine if significant clinical, functional change may occur with force platform feedback compared to a control.