Effects of oculomotor and gaze stability exercises on balance after stroke: Clinical trial protocol

Influence of Subjective Postural Vertical with Closed and Open Eyes in Patients with Hemiplegic and Pusher Behavior with Unilateral Spatial Neglect After Stroke: A Cross-Sectional Study

BACKGROUND

When integrating visual and somatosensory processing into the subjective postural vertical using the Romberg test, patients with hemiplegic can be sorted into either post-stroke or pushers with unilateral spatial neglect (USN). This study aimed to clarify the characteristics of the integrated processing of the integrated subjective postural vertical (ISPV) with open or closed eyes in patients with hemiplegic and/or pusher with USN.

METHODS

This cross-sectional study included 91 patients with hemiplegic and 45 with pusher and USN. The outcomes included the ratio and sum of SPV with the eyes closed and open. Statistical analyses were performed using the parametric and/or non-parametric Wilcoxon rank-sum test, Mann-Whitney U test, or chi-square test after the Shapiro-Wilk test.

RESULTS

The outcomes in the 91 patients with hemiplegic were as follows: moderate-to-severe ISPV with ratio, 1.64°; ISPV sum (ISPVS), 9.41°. The outcomes in the 45 patients with pusher and USN were as follows: moderate-to-severe, ISPV: 1.35°, and ISPVS: 13.96°. No significant differences were observed between the two groups in terms of demographic data or ISPV. However, the number of patients with pusher syndrome was significantly higher in the ISPVS group than in stroke patients with hemiplegic.

CONCLUSIONS

Adaptation occurs by integrating sensory modalities, and the pusher behavior in patients with USN is characterized by the specific pathophysiology of a two-modality disorder with visual and somatosensory deficits. This study provides key insights into the pathophysiological characteristics of patients with pusher syndrome and USN.

The effects of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke: A 2-week follow-up from a randomized controlled trial

BACKGROUND

This study aimed to examine the effect of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke, as well as to investigate whether any observed effects were maintained 2 weeks later.

METHODS

In this experiment, 30 chronic stroke patients were selected. The patients were randomly divided into 3 groups (10 patients in each group). All patients in the 3 groups performed basic neurodevelopmental treatment. Group 1 performed balance exercises accompanied by gaze stability exercises. Group 2 performed gaze stability exercises, and group 3 performed balance exercises. Each exercise program for 40 minutes 3 times a week for 4 weeks. After the intervention period, the patient's balance, gait ability, and fall efficacy were measured again. In order to know whether the training effect is maintained, a 2-week follow-up test was conducted after the training.

RESULTS

The results of this study showed that there was a significant improve in balance (overall stability index, limit of stability test, and Berg Balance Scale), gait ability (gait velocity, cadence, step time and step length, Timed Up and Go [TUG] test), and fall efficacy over the different time within the 3 groups. The effect was observed to be maintained in follow-up tests after 2 weeks. In the comparison among 3 groups, the overall stability index, limit of stability test in the balance test and the gait velocity, cadence, step time, step length and Timed Up and Go test in the gait test all showed statistically significant differences, and the other items did not have significant differences. In most of the assessments, group 1 that used balance exercise combined with gaze stability exercise showed a better improvement than the other 2 groups.

CONCLUSION

As a result, for stroke patients, gaze stability exercise is an effective arbitration method to improve balance and gait ability and fall efficacy. With balance exercise combined with gaze stability exercise, a greater effect can be seen than with gaze stability exercise or balance exercise alone. Thus, this combination exercise program can be recommended as effective.

Do Combined Oculomotor and Bimanual Coordination Exercises Instantly Stabilize Balance in Athletes?

Purpose

This study examined the immediate effects of oculomotor and bimanual coordination exercises, as well as a combination of the two, on stability of balance in athletes.

Patients and Methods

Changes in center-of-gravity sway were measured in 30 college student athletes before and after the following three exercise conditions: 1) oculomotor exercises, 2) bimanual coordination exercises, and 3) a combination of oculomotor and bimanual coordination exercises (1+2). The order of these exercises was counterbalanced.

Results

The combination of exercises (condition 3) reduced large swaying during balancing and immediately increased postural stability. Moreover, the oculomotor and bimanual coordination exercises (conditions 1 and 2) immediately reduced large sway during balancing when performed independently. Thus, the present study revealed that the combination of oculomotor and bimanual coordination exercises immediately reduced accidental swaying during balancing and also improved postural stability.

Conclusion

This combination could be effective as an immediate balance adjustment method for athletes.

A Study on the Effects of a Self-Administered Eye Exercise Program on the Balance and Gait Ability of Chronic Stroke Patients: A Randomized Controlled Trial

This study investigates the effects of a self-administered eye exercise (SEE) program on the balance and gait ability of chronic stroke patients hospitalized due to hemiplegia. This study includes 42 patients diagnosed with stroke-related hemiplegia and hospitalized at D Rehabilitation Hospital. The researcher randomly allocated 42 patients into two groups: the experimental group (EG, n = 21, mean age = 58.14 ± 7.69 years, mean BMI = 22.83 ± 2.19 kg/m2) and the control group (CG, n = 21, mean age = 58.57 ± 6.53 years, mean BMI = 22.81 ± 2.36 kg/m2). The SEE program was applied to the EG and the general self-administered exercise (SE) program was applied to the CG. After 4 weeks of intervention, weight distribution of the affected side, the Timed Up and Go test (TUG), step length of the affected side, step length of the unaffected side, gait speed, and cadence were analyzed and compared. In the within-group comparison, both groups showed significant differences in weight distribution (p < 0.05), TUG (p < 0.05), step length of the affected side (p < 0.05), step length of the unaffected side (p < 0.05), gait speed (p < 0.05), and cadence (p < 0.05). In the between-group comparison, a significant difference in the TUG (p < 0.05) was observed. The SEE program had an overall similar effect to the SE program in improving the balance and gait ability of chronic stroke patients, and had a greater effect on dynamic balance ability. Therefore, the SEE program can be proposed as a self-administered exercise program to improve balance and gait ability in stroke patients who are too weak to perform the SE program in a clinical environment or have a high risk of falling.

Cervical mobility and cervical proprioception in relation to fall risk among older adults: a prospective cohort study

PURPOSE

Age-related decreases in cervical mobility and proprioception have previously been demonstrated. Potential associations of these deteriorations with fall risk have not been investigated so far. This study aims to compare cervical mobility and proprioception between fallers and non-fallers and prospectively assess the contribution of these parameters in fall risk identification among healthy older adults.

METHODS

95 community-dwelling older adults underwent a cervical screening. Active cervical range of motion (aCROM) was measured using a digital inclinometer and cervical proprioception was assessed by determining joint position error (JPE). Fear of falling was identified through the Iconographical Falls Efficacy Scale (iconFES). Falls were prospectively recorded during a 1-year follow-up period using monthly calendars. Univariate and multivariate logistic regression analyses were conducted to examine the association between these parameters and falls occurrence.

RESULTS

Baseline measurements revealed reduced cervical performance (i.e., smaller aCROM and larger JPE) among individuals who reported at least one fall during the following year ("fallers"). The multivariate logistic regression model contained eight independent variables (age, sex, walking aid, fall history, iconFES, aCROM F, aCROM E and JPE) and correctly classified 77.8% of cases.

CONCLUSION

Although the contribution of cervical parameters to fall risk identification seems to be rather small compared to well-known (though often unmodifiable) major risk factors, further research is needed to elucidate underlying mechanisms of cervical functions in relation to falls. Second, it would be interesting to develop a targeted fall preventive cervical exercise program and assess its effectiveness in terms of falls occurrence.

Effects of Gaze Stabilization Exercises on Gait, Plantar Pressure, and Balance Function in Post-Stroke Patients: A Randomized Controlled Trial

This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group performed GSEs combined with physical therapy, while the control group only performed physical therapy, once a day, 5 days a week, for 4 weeks. The Berg Balance Scale (BBS) was used to test the balance function and the risk of falling, which was the primary outcome. The Timed Up and Go test (TUGT) evaluated the walking ability and the fall risk. The envelope ellipse area and the plantar pressure proportion of the affected side were used to measure the patient’s supporting capacity and stability in static standing. The anterior−posterior center of pressure displacement velocity was used to test the weight-shifting capacity. Compared to the control group, the swing phase of the affected side, swing phase’s absolute symmetric index, envelope ellipse area when eyes closed, and TUGT of the experimental group had significantly decreased after GSEs (p < 0.05); the BBS scores, TUGT, the anterior−posterior COP displacement velocity, and the plantar pressure proportion of the affected side had significantly increased after 4 weeks of training (p < 0.05). In conclusion, GSEs combined with physical therapy can improve the gait and balance function of people following stroke. Furthermore, it can enhance the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falling.

[Advances in vestibular rehabilitation in the treatment of peripheral vestibular vertigo]

The attack of vertigo and balance disorder affects individual quality of life among all age, while brings high medical burden. Vestibular rehabilitation plays an important role in the treatment for balance disorder. Early active and systematic rehabilitation treatment will be more conducive to symptom relief, functional recovery, and prevent the occurrence of chronic vestibular syndrome. There were no criteria for the methods, influencing factors and evaluation of vestibular rehabilitation in the treatment of peripheral vestibular vertigo yet, and the clinical application is diversified. This paper reviewed and summarized the related studies of vestibular rehabilitation in peripheral vestibular vertigo in recent years.

Sustainable Intervention for Health Promotion and Postural Control Improvement: Effects of Home-Based Oculomotor Training

Currently, it is crucial to propose daily sustainable interventions that elicit healthy lifestyles and the promotion of favorable health outcomes beyond the usual medical prescriptions. Home confinement and pandemic limitations reduced physical activity and augmented sedentary behaviors that potentially also reflect on posture. Health-related quality of life includes an effective postural control which is affected by visual performance. Therefore, the aim of the study was to analyze the effects of a single session of eye exercises and also of a home-based oculomotor training on postural control. Thirty active adults (mean age: 42.9 ± 14.4 years) were randomly assigned to three experimental conditions: subjects were evaluated on a stabilometric platform before (T0) and immediately after (T1) a training session consisting in clockwise ocular movements (C1), counterclockwise (C2) and mixed condition (C3). All subjects repeated, at home, the same ocular training and were re-evaluated after 5 weeks (T2). All measured variables tended to improve after 5-week home training, but significative differences were found, especially in acute measurement. C1 and C2 conditions showed better results than C3. Thus, a specific oculomotor training, a cost free and self-administered training, can represent a practical tool to improve postural control and health-related quality of life in active adults.