Effects of Balance Training on Different Support Surface on Balance and Gait in Patients with Chronic Stroke



Kong, Hae-na;Bang, Dae-hyouk;Shin, Won-seob

  • 투고 : 2015.07.10
  • 심사 : 2015.08.06
  • 발행 : 2015.08.31


PURPOSE: The purpose of this study was to investigate the effect of balance training on different support surface (affected and non-affected sides) on the balance and gait function of chronic stroke patients. METHODS: The patients were randomly assigned to 1 of 4 groups. Group 1 received balance training on the stable surface, group 2 received balance training on the unstable surface, group 3 received balance training on different support surface (affected side: stable surface, non-affected side: unstable surface), and group 4 received balance training on different support surface (affected side: unstable, non-affected side: stable). Twelve sessions (30 min/d, 3 times/wk for 4 wk) were applied. There were assessed before and after the intervention with Balancia, functional reach test (FRT), lateral reach test (LRT), timed up-and-go (TUG), and 10-meter walking test (10MWT). RESULTS: After the training, all of the groups improved significantly than before training in Balancia, FRT, LRT, TUG, and 10MWT. There were significantly variable in sway distance, FRT, LRT, TUG, and 10MWT among the 4 groups. Post hoc analysis revealed that the group 3 had significantly higher results than other 3 groups in sway distance, and FRT, LRT, TUG, and 10MWT. CONCLUSION: Balance training on different support surface (affected side: stable surface, non-affected side: unstable surface) could facilitate a stronger beneficial effect on balance and walking ability than other balance trainings on different support surface in patients with stroke.


Stroke;Unstable surface;Support surface;Balance;Sensorimotor training


  1. Bang DH, Shin WS, Kim SY, et al. The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial. Clin Rehabil. 2013;27(12):1118-25. https://doi.org/10.1177/0269215513501528
  2. Bang DH, Shin WS, Noh HJ, et al. Effect of Unstable Surface Training on Walking Ability in Stroke Patients. J Phys Ther Sci. 2014;26(11):1689. https://doi.org/10.1589/jpts.26.1689
  3. Bayouk JF, Boucher J, PLeroux A. Balance training following stroke: effects of task-oriented exercises with and without altered sensory input. Int J Rehabil Res. 2006;29(1):51-9. https://doi.org/10.1097/01.mrr.0000192100.67425.84
  4. Borreani S, Calatayud J, Martin J, et al. Exercise intensity progression for exercises performed on unstable and stable platforms based on ankle muscle activation. Gait Posture. 2014;39(1):404-09. https://doi.org/10.1016/j.gaitpost.2013.08.006
  5. Brauer S, Burns Y, Galley P. Lateral reach: a clinical measure of medio-lateral postural stability. Physiother Res Int. 1999;4(2):81-8. https://doi.org/10.1002/pri.155
  6. Brunnstrom S, Dickinson R. Clinical kinesiology. FA Davis Company. 1972.
  7. Cameron DM, Bohannon RW, Garrett GE, et al. Physical impairments related to kinetic energy during sit-to-stand and curb-climbing following stroke. Clin Biomech (Bristol, Avon). 2003;18(4):332-40. https://doi.org/10.1016/S0268-0033(03)00023-8
  8. Carter JM, Beam WC, McMahan SG, et al. The effects of stability ball training on spinal stability in sedentary individuals. J Strength Cond Res. 2006;20(2):429-35.
  9. Chaudhuri S, Aruin AS. The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis. Arch Phys Med Rehabil. 2000;81(11): 1498-503. https://doi.org/10.1053/apmr.2000.17827
  10. Cheng PT, Wang CM, Chung CY, et al. Effects of visual feedback rhythmic weight-shift training on hemiplegic stroke patients. Clin Rehabil. 2004;18(7):747-53. https://doi.org/10.1191/0269215504cr778oa
  11. Chiang JH, Wu G. The influence of foam surfaces on biomechanical variables contributing to postural control. Gait Posture. 1997;5(3):239-45. https://doi.org/10.1016/S0966-6362(96)01091-0
  12. Clark RA, Bryant AL, Pua Y, et al. Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture. 2010;31(3):307-10. https://doi.org/10.1016/j.gaitpost.2009.11.012
  13. Conforto AB, Cohen LG, dos Santos RL, et al. Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes. J Neurol. 2007; 254(3):333-9. https://doi.org/10.1007/s00415-006-0364-z
  14. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81(4):409-17. https://doi.org/10.1053/mr.2000.3839
  15. Dickstein R, Nissan M, Pillar T, et al. Foot-ground pressure pattern of standing hemiplegic patients major characteristics and patterns of improvement. Phys Ther. 1984;64(1):19-23. https://doi.org/10.1093/ptj/64.1.19
  16. Duncan PW, Weiner DK, Chandler J, et al. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45(6):M192-M97. https://doi.org/10.1093/geronj/45.6.M192
  17. Green J, Forster A, Bogle S, et al. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial. Lancet. 2002;359 (9302):199-203. https://doi.org/10.1016/S0140-6736(02)07443-3
  18. Seo HG, Kim MC. Study on the Correlation between Muscle Activity of Lower Extremity and Sway Speed of Chronic Stroke Patients according to Unstable Surface Training. J Korean Soc Int Med. 2013;1(4):75-83. https://doi.org/10.15268/ksim.2013.1.4.075
  19. Smania N, Piceli A, Gandolfi M, et al. Rehabilitation of sensorimotor integration deficit in balance impairment of patients with storke hemiparesis: a before/after pilot study. Neurol Sci. 2008;29(5):313-9. https://doi.org/10.1007/s10072-008-0988-0
  20. Hughes MA, Duncan PW, Rose DK, et al. The relationship of postural sway to sensorimotor function, functional performance, and disability in the elderly. Arch Phys Med Rehabil. 1996;77(6):567-72. https://doi.org/10.1016/S0003-9993(96)90296-8
  21. Hunt SM, McKenna S, Williams J. Reliability of a population survey tool for measuring perceived health problems: a study of patients with osteoarthrosis. J Epidemiol Community Health. 1981;35(4):297-300. https://doi.org/10.1136/jech.35.4.297
  22. Irion J. Use of the gym ball in rehabilitation of spinal dysfunction. Orthop Phys Ther Clin North Am. 1992;1(2):375-99.
  23. Ju S-k, Yoo W-g. The Effect of Somatosensory and Cognitivemotor Tasks on the Paretic Leg of Chronic Stroke Patients in the Standing Posture. J Phys Ther Sci.2014;26(12):1869. https://doi.org/10.1589/jpts.26.1869
  24. Kawanabe K, Kawashima A, Sashimoto I, et al. Effect of whole-body vibration exercise and muscle strengthening, balance, and walking exercises on walking ability in the elderly. Keio J Med. 2007;56(1):28-33. https://doi.org/10.2302/kjm.56.28
  25. Lundy-Ekman L. Neuroscience: fundamentals for rehabilitation. Elsevier Health Sciences. 2013.
  26. Nyberg L, Gustafson Y. Patient Falls in Stroke Rehabilitation A Challenge to Rehabilitation Strategies. Stroke. 1995;26(5):838-42. https://doi.org/10.1161/01.STR.26.5.838
  27. Park DS, Lee DY, Choi, et al. Reliability and Validity of the Balancia using Wii Balance Board for Assessment of Balance with Stroke Patients. Kor Aca-Ind Coop Soc. 2013;14(6): 2767-72.
  28. Podsiadlo D, Richardson S. The timed" Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  29. Pollock AS, Durward BR, Rowe PJ, et al. What is balance? Clin Rehabil. 2000;14(4):402-06. https://doi.org/10.1191/0269215500cr342oa
  30. Sackley CM. The relationships between weight-bearing asymmetry after stroke, motor function and activities of daily living. Physiother Theory Pract. 1990;6(4): 179-85. https://doi.org/10.3109/09593989009048293
  31. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Lippincott. Williams & Wilkins. 2007.
  32. Taube W, Gruber M, Beck S, et al. Cortical and spinal adaptations induced by balance training: correlation between stance stability and corticospinal activation. Acta Physiol (Oxf). 2007;189(4):347-58. https://doi.org/10.1111/j.1748-1716.2007.01665.x
  33. Verhagen E, Bobbert M, Inklaar M, et al. The effect of a balance training programme on centre of pressure excursion in one-leg stance. Clin Biomech (Bristol, Avon). 2005;20(10):1094-100. https://doi.org/10.1016/j.clinbiomech.2005.07.001
  34. Warlow C, Sudlow C, Dennis M, et al. Stroke. Lancet. 2003;362(9391):1211-24. https://doi.org/10.1016/S0140-6736(03)14544-8
  35. Yang YP, Roh JS. The Effect of Types of Weight-Bearing Surfaces on Muscle Activities of Lower Limbs and Weight Distribution During Semi-Squat Movement of Patients With Hemiplegia. Phys Ther Korea. 2012;19(1):28-36. https://doi.org/10.12674/ptk.2012.19.1.028
  36. Yavuzer G, Eser F, Karakus D, et al. The effects of balance training on gait late after stroke: a randomized controlled trial. Clin Rehabil. 2006;20(11):960-9. https://doi.org/10.1177/0269215506070315
  37. Yoo J, Jeong J, Lee W. The Effect of Trunk Stabilization Exercise Using an Unstable Surface on the Abdominal Muscle Structure and Balance of Stroke Patients. J Phys Ther Sci. 2014;26(6):857. https://doi.org/10.1589/jpts.26.857

피인용 문헌

  1. 1. The Effects of Trunk Exercise on Mobility, Balance and Trunk Control of Stroke Patients vol.12, pp.1, 2017, doi:10.13066/kspm.2015.10.3.57