Effect of postural training using a whole-body tilt apparatus in subacute stroke patients with lateropulsion: A single-blinded randomized controlled trial - 15/10/20

Doi : 10.1016/j.rehab.2020.05.001

Chang-Man An ^a,^{^{1
Co-first author.}}, Myoung-Hwan Ko ^a,^b,^c,^{^{1
Co-first author.}}, Dae-hyun Kim ^a, Gi-Wook Kim ^a,^b,^c,⁎
^a Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, 20, Geonjiro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Republic of Korea
^b Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea
^c Translational Research & Clinical Trial Center for Medical Device, Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea

^⁎Corresponding author.

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Highlights

•	Whole-body tilt apparatus varies angles and directions in 3-D space to train posture.
•	Whole-body tilting postural training is effective in individuals with subacute stroke.
•	Whole-body tilting postural training could effectively lessen the lateropulsion in individuals with subacute stroke.
•	The training improved postural control, activities of daily living, and lower-extremity motor function.
•	The training is effective for functional recovery in individuals with subacute stroke.

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Abstract

Background

Lateropulsion after stroke is defined as a postural bias toward the paretic side and push away from the non-paretic side. New rehabilitation techniques and programs should be designed to attenuate lateropulsion and improve functions of balance and gait.

Objective

This study aimed to determine the effects of whole-body tilting postural training (WTPT) using a Spine Balance 3D on lateropulsion and postural control as compared with general postural training (GPT). Postural training was performed and involved a whole-body tilt apparatus that enables postural training in the tilted position, in multiple directions.

Methods

This was a pragmatic, single-blind, randomized controlled trial conducted between June 2018 and May 2019. We randomly allocated 30 patients with subacute stroke and lateropulsion based on the Scale of Contraversive Pushing (SCP score>0) to experimental (n=15) and control (n=15) groups. The experimental group received WTPT with a whole-body tilt apparatus, and the control group GPT. WTPT was performed with the Spine Balance 3D and GPT with postural training commonly applied in the clinic. All participants received treatment for 30min/session, 2 times/day, 5 days/week for 3 weeks. The primary outcome measure was lateropulsion assessed with the Burke Lateropulsion Scale (BLS). Secondary outcome measures were postural control ability, activities of daily living, Postural Assessment Scale for Stroke (PASS) score, Berg Balance Scale (BBS) score, Korea-modified Barthel index (K-MBI), and Fugl-Meyer Motor Assessment-Lower Extremity (FMA-L) score.

Results

For the primary outcome, after training, BLS scores were decreased more for the experimental than control group (Δ=–5.8 vs. Δ=–4.2, P=0.002). For secondary outcomes, scores were improved more for the experimental than control group: PASS (Δ=13.8 vs. Δ=8.5, P<0.001), BBS (Δ=20.1 vs. Δ=11.1, P=0.001), K-MBI (Δ=27.0 vs. Δ=20.1, P=0.005), and FMA-L (Δ=10.2 vs. Δ=6.3, P=0.002).

Conclusions

WTPT is a potentially effective therapeutic intervention for lateropulsion recovery in patients with subacute stroke. It may be useful for improving postural control and activities of daily living.

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Keywords : Stroke, Posture, Behaviour, Therapeutics