Stroke is one of the most common disabilities experienced by the elderly in the community. However, stroke progresses to a chronic level, patients are discharged from medical institutions and eventually no longer receive therapeutic interventions at home. In this systematic review, we compared home-based rehabilitation (HBR) with comparison for patients with stroke. Literature published in Cumulative Index for Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro), PubMed, and Google Scholar were reviewed. A total of 1,158 studies were initially retrieved. After reading the full texts, 11 articles were included in the systematic review. Quality assessment of the included studies was conducted using Risk of Bias (RoB) 2.0, and Egger’s regression test was used to evaluate publication bias. Data analysis was performed using the R studio software (R Studio). According to the quality assessment using RoB 2.0, three studies were evaluated as low risk, two as of some concern, and three as high risk. The overall effect size was moderate (0.309). The value of the balance function was a small effect size (0.201), while the value of the gait function was a moderate effect size (0.353). The values were small and moderate effect (0.154, 0.411) for the chronic and subacute conditions, respectively. According to the Egger’s regression test, no publication bias was observed. The findings of this study indicate that HBR resulted in the greatest improvement in gait function in patients with subacute stroke compared to those with chronic stroke. Therefore, the application of this intervention to patients with stroke in the community is recommended.

Background: Some patients may not fully recover their daily activity capabilities even after the total hip replacement (THR), and may continue to experience functional limitations for up to a year after the procedure, according to reports. Objectives: The purpose of this study was to examine the effects of machine squat on muscle strength, balance and gait in patients after THR. Design: A randomized controlled trial. Methods: Thirty-three patients after THR were randomly allocated into slide (n=11), reformer (n=11), and control groups (n=11). Each group underwent their respective squat regimens for thirty minutes, seven times a week, for two weeks. Muscle strength changes were assessed using the manual muscle test (MMT), balance was evaluated using the Berg Balance Scale (BBS), and gait analysis was performed using the 10-meter walk test (10MWT). Results: Significant changes in hip flexor and abductor strength were observed in the slide and reformer groups within each group (P<.05). The reformer group showed significant changes in hip extensor strength (P<.05). Significant improvements in BBS were observed in all three groups (P<.05). There were significant changes in 10MWT in the slide and reformer groups (P<.05). A significant difference in hip extensor strength was found between the reformer and control groups after the intervention (P<.0167). Significant differences in BBS were observed between the slide and reformer groups and between the reformer and control groups after the intervention (P<.0167). Conclusion: Our findings suggest that machine squat regimens can be effective for early rehabilitation after THR, improving muscle strength, balance, and gait.

Background: Stroke is one of the causes affecting gait and balance. Taping is considered an effective method for improving balance and gait in stroke patients. Numerous studies have confirmed the functional effects of taping in stroke patients. However, there is still no consensus regarding the use of taping to improve gait and balance. Objects: The purpose of this review was to investigate the effects of taping on the balance and gait of patients with stroke through meta-analysis of studies. Methods: PubMed, Medline, Embase, Web of Science, Cochrane Review, RISS, DBPia, and Science on were used to collect articles on Kinesio and non-elastic taping. The key terms were “Stroke”, “Hemiplegia”, “Taping”, “Tape”, “Balance”, and “Gait” with cut-off of October, 2022. Taping group was compared with control groups with sham, placebo, and no taping. The outcome measures included the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and gait speed (cm/s). Eighteen studies (524 patients) were selected for the meta-analysis. Results: Overall, taping improved balance and gait in stroke patients, and Kinesio and nonelastic taping had similar effect sizes. Taping improved the BBS and TUG, and was most effective on gait speed. Contrary to the expectation that a longer duration of taping would be more affective, taping was most effective when the total taping duration was shorter than 500 minutes. In addition, the effect size of taping was greater when it was simultaneously attached to multiple locations. Conclusion: This meta-analysis supports the use of taping to improve gait and balance in stroke patients, and provides guidelines for the location, duration, and type of tape to increase taping efficiency.

Background: Total hip replacement (THR) is performed in patients with femur fractures and osteoarthritis. THR patients have balance problems even after surgery. There is a lack of research on vibration stimulation interventions for balance in THR patients. Objectives: To investigated the effect of vibration stimulation intervention on the balance and gait of THR patients. Design: Randomized controlled trials. Methods: 44 subjects were randomly assigned to a vibration stimulation group (VSG) and a non-vibration stimulation group (N-VSG). Seven study subjects dropped out, and 37 completed the study. Timed up and go (TUG) and Berg balance scale (BBS) were used for balance assessment, and 10-meter walk (10MW) was used for gait assessment. The intervention program was conducted three times a week for 4 weeks. Results: Significant differences within the groups in balance (BBS, TUG) and gait (10MW) between the VSG and the N-VSG. There was no difference between the two groups in any variable. Conclusion: The VSG improved the balance and gait of THR patients without any difference from the N-VSG. However, VSG showed a higher effect size than N-VSG.

Background: Although several studies have reported functional improvements after forward walking training on a treadmill and after backward walking training on a treadmill, there is a lack of immediate effects data, investigating spatiotemporal parameter, neuromuscular recruitment. Objectives: To compare the immediate effects between forward and backward walking on treadmill training, present study measured muscle activities of the lower extremity, gait parameters, and dynamic balance. Design: Cross-sectional study. Methods: The twenty-four asymptomatic young male subjects were participated in this study. Subjects have performed 15-min of forward and backward walking on treadmill. Before and after treadmill walking, the gait parameters were measured with the GAITRite. The dynamic balance abilities were assessed with the Y-balance test. Muscular activities were collected from the tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris during forward and backward walking. Results: Muscular activities of the biceps femoris and tibialis anterior were significantly different between forward and backward walking conditions, which were higher with the backward walking (P<.05). Compared to the pre-measurement, the normalized dynamic balance composite score of the post-measurement was significantly higher with the backward walking (P<.05). Regardless of the treadmill training method, there were no significant differences between pre and post measurement, both the stride length and step length (P>.05). Conclusion: The performing backward walking training has positive effects for dynamic balance.

Background: Foot drop is a common symptom in stroke patients. Tape applications are widely used to manage foot drop symptoms. Previous studies have evaluated the effects of static and dynamic balance and gait on foot drop using kinesiology tape; however, only few studies have used dynamic tape application in stroke patients with foot drop. Objects: The purpose of this study was to investigate the immediate effects of dynamic taping, which facilitates the dorsiflexor muscle, on static and dynamic balance and gait speed in stroke patients with foot drop. Methods: The study included 34 voluntary patients (17 men, 17 women) with stroke. The patients were randomly assigned to the experimental group (n = 17), wherein dynamic taping was used to facilitate the dorsiflexor muscle, or the control group (n = 17), wherein kinesiology taping was used. Before the taping application, velocity average, path-length average, Berg balance scale, and timed up and go test (TUG) were recorded to measure static and dynamic balance, whereas the 10-meter walk test (10MWT) was used to measure gait speed. After the taping application, these parameters were re-evaluated in both groups. Repeated measure analysis of variance was used. Statistical significance levels were set to α = 0.05. Results: Except for the 10MWT scores in the control group, significant differences were noted in all the parameters measured for static and dynamic balance and gait speed between the pre and post-test (p < 0.05). However, the parameters showed significant interaction effects between group and time in the TUG and 10MWT (p < 0.01). Conclusion: These results indicate that compared with kinesiology taping, dynamic taping used in chronic stroke patients with foot drop had a more significant effect on dynamic balance and gait speed.

Background: Stroke patients have dosiflexor weakness. Functional electrical stimulation (FES) for motor and sensory threshold stimulation has been applied to patients with stroke. Objectives: To investigate effects of FES intervention for motor and sensory threshold on balance and gait in subacute patients with stroke. Design: A randomized controlled trial. Methods: In all, 34 patients with subacute stroke were recruited and randomly assigned to the motor threshold (MTG, n=17) and sensory threshold group (STG, n=17). The measured variables were static balance (BioRescue), dynamic balance (BBS), and gait (TUG test). The study period was 5 weeks, twice a day, 5 days a week. Results: There was a significant difference in all variables except the speed variable (open eye Romberg test) after the intervention; MTG improved more significantly except for the speed variable of the Romberg test (open eye). BBS score increased significantly only in the MTG group after the intervention, and the increase was more significant in the MTG group than in the STG group. The TUG test significantly decreased in both groups after the intervention, and the decrease was more significant in the MTG group than in the STG group. Conclusion: FES for motor threshold applied to patients with subacute stroke appears to be more effective in improving balance and gait ability than FES for sensory threshold.

Background: Stroke patients have multiple disorders, but most have problems with balance and gait. Post-stroke rehabilitation exercise has been shown to be very important for functional recovery. Objectives: To systematically review and meta-analyze the effects of sling exercise (SE) on patients with stroke in studies published in Korea. Design: Meta-analysis. Methods: Five databases, namely, RISS, KISS, NDSL, DBpia and Earticle, were used to collect articles on vibration. Keywords such as “Stroke,” “Hemiplegia,” “Sling,” and “Sling Exercise” were used in the search for published articles. Interventions and comparisons were SE and other exercise (OE). Outcome measures were berg balance scale (BBS) and timed up and go (TUG). Consequently, eight studies were selected in the second screening using meta-analyses. Results: Based on the results of the meta-analysis, SE was effective for BBS in the comparison of SE and OE [2.71, 95% CI (1.42, 4.01)]. It was effective for TUG in the comparison of SE and OE [-1.89, 95% CI (-3.01, -0.77)]. Conclusion: Based on eight limited studies, SE improved BBS and TUG over OE, suggesting improved stroke balance and gait. Therefore, more studies and large-scale sample randomized controlled trials are needed to confirm clinical application.

Background: Therapeutic climbing training, which originated in Germany, is a wall-hanging rock climbing-based therapy to increase the body's coordination through movement of the upper and lower limbs against gravity. However, there are no studies examining the effectiveness of therapeutic climbing training to treat balance and gait ability in patients with chronic stroke. Objectives: To investigate therapeutic climbing training program on balance and gait in patients with chronic stroke. Design: Pretest-posttest control group design. Methods: Fourteen patients with chronic hemiplegic stroke participated. Participants were randomized into the therapeutic climbing training group (TCTG, n=7) and the standard rehabilitation program group (SRPG, n=7) group. All subjects participated in the same standard rehabilitation program consisting of 60 minutes 5 times a week for 6 weeks. TCTG participated additionally in the therapeutic climbing program consisting of 30 minutes sessions 3 times a week for the same 6 weeks. Berg balance scale (BBS), Gaitview Measure, Timed up and go test (TUG) were measured. Results: In the TCTG, revealed a statistical difference in BBS between the groups; in the difference of plantar pressure ratio in the static standing position revealed a statistical difference between the groups after training; the balance ability in the one-leg standing tests increased significantly; the time in TUG decreased significantly after training in both groups; The changes in the difference of dynamic plantar pressure ratio were reduced significantly in the TCTG. Conclusion: Therapeutic climbing training contribute to improve balance and walking function in patients with chronic stroke.

Background: Stroke patients have reduced trunk control compared to normal people. The ability to control the trunk of a stroke patient is important for gait and balance. However, there is still a lack of research methods for the characteristics of stroke control in stroke patients. Objects: The aim of this research was to determine whether trunk position sense has any relation with balance and gait. Methods: This study assessed trunk performance by measuring position sense. Trunk position sense was assessed using the David back concept to determine trunk repositioning error in 20 stroke patients and 20 healthy subjects. Four trunk movements (flexion, extension, lateral flexion, rotation) were tested for repositioning error and the measurement was carried out 6 times per move; these parameters were used to compare the mean values obtained. Subjects with stroke were also evaluated with clinical measures of balance and gait. Results: There were significant differences in trunk repositioning error between the stroke group and the control group in flexion, lateral flexion to the affected side, lateral flexion to the unaffected side, rotation to the affected side, and rotation to the unaffected side. Mean flexion error: post-stroke: 7.95 ± 6.76 degrees, control: 3.32 ± 2.27; mean lateral flexion error to the affected side: 6.13 ± 3.79, to the unaffected side: 5.32 ± 3.15, control: 3.57 ± 1.92; mean rotation error to the affected side: 8.25 ± 3.09, to the unaffected side: 9.24 ± 3.94, control: 5.41 ± 1.82. There was an only significant negative correlation between the repositioning error of lateral flexion and the Berg balance scale score to the affected side (–0.483) and to the unaffected side (–0.497). A strong correlation between balance and gait was found. Conclusion: The results of this study indicate that stroke patients exhibit greater trunk repositioning error than age-matched controls on all planes of movement except for extension. And lateral flexion has correlation with balance and gait.

Background: Weakness of the trunk muscles decreases the trunk control ability of stroke patients, which is significantly related to balance and gait. Objectives: To compare the impact of diagonal pattern self-exercise on an unstable surface and a stable surface for trunk rehabilitation on trunk control, balance, and gait ability in stroke patients. Design: Nonequivalent control group design. Methods: Twenty four participants were randomized into the experimental group (diagonal pattern self-exercise while sitting on an unstable surface, n=12) and the control group (diagonal pattern self-exercise while sitting on a stable surface, n=12). All interventions were conducted for 30 minutes, three times a week for four weeks, and the trunk impairment scale (TIS), berg balance scale (BBS), functional gait assessment (FGA), and G-walk were measured. Results: All groups indicated significant increases in all variables (TIS, BBS, FGA, cadence, speed, stride length) after four weeks. The TIS, BBS, FGA, cadence, gait speed, and stride length group-by-time were significantly different between the two groups. Conclusion: We found that, in stroke patients, diagonal pattern self-exercise on an unstable surface is a more effective method for improving trunk control, balance, and gait ability than diagonal pattern self-exercise on a stable surface.

Background: Self-checked monitoring home exercises are recommended for preventing falls among people with Parkinson’s disease. However, as these home exercises are performed autonomously by patients without professional management, their accuracy and efficiency can be compromised. Objective: To investigate the effects of providing regular training sessions to patients and caregivers and of patient self-monitoring of exercise performance following the implementation of a self-checked monitoring exercise program for people with Parkinson’s disease. Design: Randomized Pretest-Posttest Control Group Design. Methods: We provided regular self-checked monitoring home exercise and general home exercise programs to 30 participants for 12 weeks. Once a month at the first, fifth, and ninth-week sessions, a rehabilitation team attended the Parkinson’s group education. In addition to the subject in the experimental group perform the home exercises program to provide feedback regarding the home exercises program and to carry out a self-monitoring checklist performance for 12 weeks. Results: The 10 m walk test, functional reach test, and sit to stand test and the modified Barthel index significantly improved in the self-checked monitoring home exercise group. Conclusion: These results suggest that self-checked home exercise programs, which facilitate safety and consistent performance of exercises at home, are beneficial for people with Parkinson’s disease.

Background:Children with cerebral palsy (CP) have impaired postural control, but critically require the control of stability. Consequently, therapeutic interventions for enhancing postural control in children with CP have undergone extensive research. One intervention is sensorimotor training (SMT) using a Flexi-bar, but this has not previously been studied with respect to targeting trunk control in children with CP.Objects:This study was conducted to determine the effect of SMT using a Flexi-bar on postural balance and gait performance in children with CP.Methods:Three children with ambulatory spastic diplegia (SD) participated in the SMT program by using a Flexi-bar for forty minutes per day, three times a week, for six weeks. Outcome variables included the pediatric balance scale (PBS), trunk control movement scale (TCMS), 10 meter walking test (10MWT), and 3-dimensional movement coordination measurement.Results:The SMT provided no statistically significant improvement in PBS, TCMS, 10MWT, or 3-dimensional movement coordination measurement. However, positive changes were observed in individual outcomes, as balance and trunk control movement were improved.Conclusion:SMT using a Flexi-bar may be considered by clinicians as a potential intervention for increasing postural balance and performance in children with SD. Future studies are necessary to confirm the efficacy of Flexi-bar exercise in improving the functional activity of subjects with SD.

Background: Assessments of Sit-to-Stand (STS) and gait functions are essential procedures in evaluating level of independence for the patients after stroke. In a previous study, we developed the software to analyze center of pressure (COP) in standing position on Wii Balance Board (WBB). Objects: This purpose of this study is to measure test-retest reliability of ground reaction forces, COP and time using WBB on STS and gait in healthy adults. Methods: Fifteen healthy participants performed three trials of STS and gait on WBB. The time (s), vertical peak (%) and COP path-length (㎝) were measured on both tasks. Additionally, counter (%), different peak (%), symmetry ratio, COP x-range and COP y-range were analyzed on STS, 1st peak (%), 2nd peak (%) of weight were analyzed on gait. Intra-class correlation coefficient (ICC), standard error measurement (SEM) and smallest real difference (SRD) were analyzed for test-retest reliability. Results: ICC of all variables except COP path-length appeared to .676∼.946 on STS, and to .723∼.901 on gait. SEM and SRD of all variables excepting COP path-length appeared .227∼8.886, .033∼24.575 on STS. SEM and SRD excepting COP path-length appeared about .019∼3.933, .054∼11.879 on gait. Conclusion: WBB is not only cheaper than force plate, but also easier to use clinically. WBB is considered as an adequate equipment for measuring changes of weight bearing during balance, STS and gait test which are normally used for functional assessment in patients with neurological problems and elderly. The further study is needed concurrent validity on neurological patients, elderly patients using force plate and WBB.

The purpose of this study was to compare the effects of underwater treadmill gait training (UTGT) and overground treadmill gait training (OTGT) on the gait, balance ability and pulmonary function of stroke patients. Twenty subjects were recruited for this study. The subjects were randomly assigned to two groups: UTGT (n1=10) and OTGT (n2=10). The 10 m walk test (10 MWT), Berg Balance Scale, Timed Up and Go (TUG) test, center of pressure, pulmonary function of forced vital capacity (FVC), forced expiratory volume after 1 sec (FEV1) and FEV1/FVC were measured before and after 4 weeks of training. Both groups undertook the gait training for 30 min a day, 3 times a week, for 4 weeks, and rating of perceived exertion of the groups were measured and compared. All the studied variables were significantly improved in both groups (p<.05) at the end of the study, except in the FEV1 of OTGT (p>.05). There was significant between-group difference in all of the variables, except in the 10 MWT (p>.05). These findings suggest that UTGT is more effective than OTGT in improving the balance and pulmonary functions of stroke patients.

The aim of this study was to evaluate the effects of walking on a treadmill while using dynamic functional electrical stimulation (Dynamic FES) on functional ability and gait in chronic stroke patients. This was a prospective, randomized controlled study. Twelve patients with chronic stroke (＞;24 months) who were under grade 3 in dorsiflexor strength with manual muscle test were included and randomized into intervention (Dynamic FES) (n1=7) and control (FES) (n2=5). Both the Dynamic FES group and FES group were given a neuromuscular development treatment. The Dynamic FES group has implemented a total of 60 minutes of exercise treatment and gait training with Dynamic FES application. The FES group, with the addition of applying FES while sitting, has also implemented a total of 90 minutes of gait training on treadmill after the exercise treatment. Both two groups accomplished the program, twice a week, for a total of 24 times in a 12-week period. Exercise treatment, gait training on treadmill, and both Dynamic FES and FES were implemented for 30 minutes each. Korean version activities-specific balance confidence scale (K-ABC) was measured to determine self-efficacy in balance function. Timed up and go (TUG) test was performed to evaluate the physical performance. K-ABC, TUG, Berg balance scale (BBS), modified physical performance test (mPPT) and G-walk were evaluated at baseline and at 12 weeks. After 12 weeks, statistically significant differences (p＜.05) were apparent in the Dynamic FES group in the changes in K-ABC and BBS. mPPT, TUG, gait speed, stride length and stance phase duration (%) were compared with the FES group. K-ABC had higher correlation to BBS, along with mPPT to TUG. Our results suggest that walking with Dynamic FES in chronic stroke patients may be beneficial for improving their balance confidence, functional ability and gait.

The purpose of this study was to examine the effects of dual-task training (cognitive and exercise tasks) on the balance and gait performance of chronic stroke patients. Eighteen subjects with chronic stroke were divided equally into two groups, an experimental group and a control group. Subjects in both groups participated in an exercise program, performing the same tasks, for 45 minutes per day, three times per week for four weeks. The experimental group also performed additional cognitive task. The experimental group showed a more significant improvement than the control group on the Berg Balance Scale, the Timed Up and Go Test, the Korean Activities-Specific Balance Confidence Scale, and the Functional Gait Assessment (p<.05). The cognitive task error rates in the final week were significantly less than in the first week in the experimental group (p<.01). These results suggest that dual-task training for chronic stroke patients is effective in improving balance, gait, and cognitive abilities.

The purpose of this study was to examine the effects of hip joint mobilization (HJM) on walking ability, balance ability, and the joint range of motion in stroke patients to minimize the problems of the musculoskeletal system in patients with central nervous system diseases. All volunteers were randomly assigned to the HJM group (n1=14) and the general neurodevelopment therapy (NDT) group (n2=16). The HJM procedure involved applying Maitland mobilization techniques (distraction, lateral gliding, inferior gliding, and anterior gliding) by grade 3 to both hip joint. The mobilization process included mobilization and NDT for 15 min/day, 3 days a week for 4 weeks. The outcome measures were evaluated, including the hip joint passive range of motion (ROM) test and femur head anterior glide test (FHAG) using prone figure four test, dynamic and static balance abilities [timed up and go (TUG) test and center of pressure (COP) analysis], and walking ability [10-meter walking test (10MWT) and 6-min walking test (6MWT)]. Both the groups showed significant post-training differences in the hip joint ROM (FHAG and degree of hip extension) and 10MWT. The post-training improvements in the TUG test were significantly greater in patients of the HJM group than in the NDT group; however, there were no post-training improvements in COP in both groups. Patients in the HJM group showed post-training improvement in the 6MWT; however, statistically significant differences were not observed. Patients in the NDT group showed post-training improvements in the 6MWT. These results suggest that HJM improves hip joint ROM, dynamic balance ability, and walking speed in stroke patients. However, further studies are required to evaluate the long-term therapeutic efficacy of HJM in stroke patients.

The purpose of this study was to determine the effects of weight shift training with joint mobilization on the ankle joint passive range of motion (PROM), balance capacity and gait velocity in hemiplegic patients. Fourteen subjects were randomly assigned to either the experimental group (EG) or the control group (CG), with seven subjects in each group. The EG received weight shift training with joint mobilization in the paretic leg's subtalar joint in order to increase ankle dorsiflexion. The CG received general physical therapy training. Both groups received training five times a week over a period of two consecutive weeks. The figures for PROM of ankle dorsiflexion on the paretic leg, the functional reach test (FRT), the timed up and go (TUG) test, and gait velocity were recorded both before and after the training sessions for both groups. The EG's results in gait velocity, the FRT and the TUG test improved after training (p<.05). The PROM of ankle dorsiflexion improved both in the EG and the CG (p<.05), the EG demonstrated a significantly higher increase (p<.05) than that of the CG. The results of this study suggest that increased joint mobilization positively affects balance and gait velocity of hemiplegic patients. Further studies with a greater sample size are necessary in order further prove the accuracy of the results of this study.

The purpose of this study is to examine the effects of gait training using functional electrical stimulation on the improvement of hemiplegic patients' functions for balance and gait velocity. The subjects of the experiment were determined to be 10 each hemiplegic patients who had been diagnosed with stroke or brain damage six months or longer earlier assigned to an experimental group and a control group respectively. The subjects were evaluated before the experiment using Tetrax and 10M gait tests, received gait training five times a week for four weeks using functional electrical stimulation and were evaluated after the experiment in the same method as used in the evaluation before the experiment. In order to examine differences between the experimental group that received gait training using functional electrical stimulation and the control group that was treated by functional electrical stimulation and received gait training thereafter, differences between before and after the experiment were analyzed using paired sample t-tests and differences in changes after the experiment between the experimental group and the control group were analyzed using independent sample t-tests in order to compare the two groups with each other. Experimental results showed significant differences in weight bearing, balance and gait velocity between before and after the experiment in the experimental group(p<.05). In the control group, whereas weight bearing and gait velocity did not show any significant difference between before and after the experiment(p>.05), balance showed significant differences(p<.05). Weight bearing, balance and gait velocity change rates showed significant differences between the experimental group and the control group(p<.05). In conclusion, it was indicated that gait training using functional electrical stimulation is effective for enhancing stroke patients' weight bearing rates, balance abilities and gait velocity.