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Background Falls are the leading cause of injuries among older adults. Perturbation-based balance training (PBT) is an innovative approach to fall prevention that aims to improve the reactive balance response following perturbations such as slipping and tripping. Many of these PBT studies have targeted reactive balance after slipping or tripping, despite both contributing to a large proportion of older adult falls. The goal of this randomized controlled trial was to evaluate the effects of PBT targeting slipping and tripping on laboratory-induced slips and trips. To build upon prior work, the present study included: 1) a control group; 2) separate training and assessment sessions; 3) PBT methods potentially more amenable for use outside the lab compared to methods employed elsewhere, and 4) individualized training for older adult participants. Methods Thirty-four community-dwelling, healthy older adults (61–75 years) were assigned to PBT or a control intervention using minimization. Using a parallel design, reactive balance (primary outcome) and fall incidence were assessed before and after four sessions of BRT or a control intervention involving general balance exercises. Assessments involved exposing participants to an unexpected laboratory-induced slip or trip. Reactive balance and fall incidence were compared between three mutually-exclusive groups: 1) baseline participants who experienced a slip (or trip) before either intervention, 2) post-control participants who experienced a slip (or trip) after the control intervention, and 3) post-PBT participants who experienced a slip (or trip) after PBT. Neither the participants nor investigators were blinded to group assignment. Results All 34 participants completed all four sessions of their assigned intervention, and all 34 participants were analyzed. Regarding slips, several measures of reactive balance were improved among post-PBT participants when compared to baseline participants or post-control participants, and fall incidence among post-PBT participants (18%) was lower than among baseline participants (80%). Regarding trips, neither reactive balance nor fall incidence differed between groups. Conclusions PBT targeting slipping and tripping improved reactive balance and fall incidence after laboratory-induced slips. Improvements were not observed after laboratory-induced trips. The disparity in efficacy between slips and trip may have resulted from differences in dosage and specificity between slip and trip training. Trial registration Name of Clinical Trial Registry: clinicaltrials.gov Trial Registration number: NCT04308239 . Date of Registration: March 13, 2020 (retrospectively registered).

Objective To explore and compare the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability (CAI). Methods The PubMed, Embase, Web of Science, Medline, and Cochrane databases were searched up to December 2023. Quality assessment was carried out using the risk-of-bias guidelines of the Cochrane Collaboration, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were compute. Results Among 20 eligible studies, including 682 participants were analyzed in this meta-analysis. The results of the meta-analysis demonstrated that balance training was effective in enhancing ankle function with self-functional scores (SMD = 1.02; 95% CI, 0.61 to 1.43; p  < 0.00001; I 2  = 72%) and variables associated with the ability of dynamic balance such as SEBT-A (MD = 5.88; 95% CI, 3.37 to 8.40; p  < 0.00001; I 2  = 84%), SEBT-PM (MD = 5.47; 95% CI, 3.40 to 7.54; p  < 0.00001; I 2  = 61%), and SEBT-PL (MD = 6.04; 95% CI, 3.30 to 8.79; p  < 0.0001; I 2  = 79%) of CAI patients. Meta-regression indicated that the intervention time might be the principal cause of heterogeneity ( p  = 0.046) in self-functional scores. In subgroup analyses of self-functional score across intervention types, among the intervention time, more than 20 min and less than 30 min had the most favorable effect (MD = 1.21, 95% CI: 0.96 to 1.46, p  < 0.00001, I 2  = 55%); among the intervention period, 4 weeks (MD = 0.84, 95% CI: 0.50 to 1.19, p  < 0.00001, I 2  = 78%) and 6 weeks (MD = 1.21, 95% CI: 0.91 to 1.51, p  < 0.00001, I 2  = 71%) had significant effects; among the intervention frequency, 3 times (MD = 1.14, 95% CI: 0.89 to 1.38), p  < 0.00001, I 2  = 57%) had significant effects. Secondly, in subgroup analyses of SEBT across intervention types, a 4-week and 6-week intervention with balance training 3 times a week for 20–30 min is the optimal combination of interventions to improve SEBT (dynamic balance) in patients with chronic ankle instability. Conclusion Balance training proves beneficial for ankle function in patients with CAI. Intervention time constitutes a major factor influencing self-function in patients with CAI. It is recommended that the optimal dosage of balance training for CAI involves intervention three times a week, lasting for 20 to 30 min over a period of 4 to 6 weeks for superior rehabilitation.

Chronic stroke often results in balance and gait impairments, significantly impacting patients’ quality of life. The purpose of this study was to investigate whether the combined effect of unstable surface balance training and visual feedback, based on proprioceptive neuromuscular stimulation in patients with chronic stroke, is effective in restoring balance and gait ability. A total of 39 chronic stroke patients were randomly assigned to a visual feedback combined with unstable surface balance training group (VUSBG), an unstable surface balance training group (USBG), or a conventional physical therapy group (CG). This study was conducted with the Trunk Impairment Scale, the Bug Balance Scale, the Timed Get Up and Go Test, and Gait Analysis. VUSBG and USBG improved function and gait (stride length and hip/knee flexion angle), but there was no significant difference in the CG group. Specific results showed that the stride length in the VUSBG improved by 25% (p < 0.05), and the hip/knee flexion angle improved by 18% (p < 0.05). The post-hoc analysis revealed that VUSBG had a greater impact on the hip/knee flexion angle relative to the other two groups, as well as gait velocity and stride length relative to CG. Visual feedback complex exercise based on the principle of proprioceptive neuromuscular facilitation could be an intervention strategy to improve gait speed, trunk stability, and mobility in chronic stroke patients.

Study aim: To investigate the effects of 6-month sensorimotor training on postural control of 5-6-year-old preschool children born with ‘biological risk factors’ (BRF). Material and methods: Sixty-four Hungarian preschoolers participated in this study, and were assigned to an experimental group (n = 17), control group 1 (n = 23) and control group 2 (n = 24). The experimental group (born with BRF) attended a 6-month balance intervention based on Ayres’ therapy, while control group 1 (born with BRF) and control group 2 (born with no BRF) fol­lowed the regular preschool schedule. Birth weight, gestational age at birth, Apgar score and other abnormalities during pregnancy and birth were considered to be BRF. A moveable platform (stabilometer) was used to examine the distance of center of pressure movements of all participants prior to the start and after the end of the intervention. The testing procedure was performed with four enjoyable tests in the same sequence (‘Mouse in the hole’, ‘Center’, ‘Christmas tree’, ‘Square painting’). Results: The balance intervention program resulted in significant improvements in postural control of the experimental group. In three of six variables the balance index scores of the intervention group approached the scores of their peers born without BRF, and they even had better performance in three of six variables. Conclusions: Balance training with instability training devices could help children born with BRF attain a higher level of inte­gration through the stimulation of tactile and balancing senses.

To investigate the effects of total resistance exercise (TRX), suspension training on the specialized balance ability of surfing athletes. A total of 32 Chinese National Surfing Team athletes were randomly assigned to TRX suspension training group (TRX group) and traditional balance training group (TB group), both undergoing an 8-week intervention training program consisting of three sessions per week lasting approximately 30 minutes each to improve balance ability. The balance board lateral squat specialized balance ability test was administered at different intervention phases to examine changes in participants' specialized balance ability. Following the 8-week intervention, both training modalities demonstrated significant improvements in surfing specialized balance metrics relative to baseline (  < 0.01 for all comparisons). Inter-group comparisons revealed statistically superior outcomes for TRX suspension training, with marked divergence emerging at the 5-week assessment (  = 0.005 < 0.01, |d| = 1.062 > 0.8) that intensified through intervention completion (  = 0.000 < 0.01, |d| = 1.417 > 0.8). Both 8 weeks of TRX suspension training and traditional balance training were effective in enhancing the specialized balance of surfers, but TRX suspension training was superior to traditional training in terms of enhancement, and this advantage was significantly demonstrated after 5 weeks and continued until the end of the training. TRX suspension training aligns with the balance demands of surfing, making it an effective training method. It is feasible for coaches to formulate customized TRX suspension training regimens tailored to surfers' proficiency levels and core stability, integrating sport-specific movement patterns to enhance athletes' neuromuscular adaptations for improved biomechanical control during dynamic wave navigation.

Deficits in the propioceptive system of the ankle contribute to chronic ankle instability (CAI). Recently, whole-body-vibration (WBV) training has been introduced as a preventive and rehabilitative tool.   To evaluate how a 6-week WBV training program on an unstable surface affected balance and body composition in recreational athletes with CAI.   Randomized controlled clinical trial.   Research laboratory.   Fifty recreational athletes with self-reported CAI were randomly assigned to a vibration (VIB), nonvibration (NVIB), or control group.   The VIB and NVIB groups performed unilateral balance training on a BOSU 3 times weekly for 6 weeks. The VIB group trained on a vibration platform, and the NVIB group trained on the floor.   We assessed balance using the Biodex Balance System and the Star Excursion Balance Test (SEBT). Body composition was measured by dual-energy x-ray absorptiometry.   After 6 weeks of training, improvements on the Biodex Balance System occurred only on the Overall Stability Index ( P = .01) and Anterior-Posterior Stability Index ( P = .03) in the VIB group. We observed better performance in the medial ( P = .008) and posterolateral ( P = .04) directions and composite score of the SEBT in the VIB group ( P = .01) and in the medial ( P < .001), posteromedial ( P = .002), and posterolateral ( P = .03) directions and composite score of the SEBT in the NVIB group ( P < .001). No changes in body composition were found for any of the groups.   Only the VIB group showed improvements on the Biodex Balance System, whereas the VIB and NVIB groups displayed better performance on the SEBT.

BackgroundIn the last few years, virtual reality (VR) has been increasingly used to strengthen the effect of balance training (BT) in Parkinson’s disease (PD).ObjectiveWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effects of VR-BT relative to BT alone for improving balance and mobility PD subjects with balance/mobility difficulties.MethodsFour electronic databases were searched: two reviewers independently selected RCTs, extracted data, and applied the Cochrane risk-of-bias tool for randomized trials (version 2) and the GRADE framework for assessing the certainty of evidence. Primary outcomes were balanced (Berg Balance Scale-BBS), mobility (Timed Up and Go-TUG) and walking speed. Secondary outcomes were falls, walking distance and stability, spatial gait parameters, balance confidence, sensory integration ability, motor signs and quality of life.ResultsWe included 22 studies (901 patients). Meta-analysis on fourteen trials (430 patients) showed a mean difference (MD) of 2.09 points (95% confidence interval [CI] 0.86–3.33) on BBS favoring VR-BT compared to BT (low certainty evidence). Subgroup analyses showed higher balance improvement in most affected subjects (moderate certainty evidence) and using VR rehabilitation-specific systems vs. VR non-specific systems. Eight trials (236 patients) assessing mobility showed a MD of 1.55 s (95% CI 0.04–3.06) on TUG favoring VR-BT (very low certainty evidence). No differences were observed in walking speed. Estimated effects were not maintained for any outcome at follow-up.ConclusionsThis review suggests that VR-BT is more effective than BT to improve balance in PD subjects immediately after training, particularly in individuals with higher postural instability at baseline.

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children’s experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant’s experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

The study aimed to investigate the effect of combined balance and plyometric training on dynamic balance and quickness performance of elite badminton athletes. Sixteen elite male badminton players volunteered to participate and were randomly assigned to a balance-plyometric group (PB: n = 8) and plyometric group (PT: n = 8). The PB group performed balance combined with plyometric training three times a week over 6 weeks (40 min of plyometrics and 20 min of balance training); while the PT group undertook only plyometric training for the same period (3–4 sets × 8–12 reps for each exercise). Both groups were given the same technical training (badminton techniques for 6 days a week). The dynamic stability and quick movement ability were assessed at baseline and after the intervention by measuring the performance of dynamic posture stability test (DPSI and COP), T-running test and hexagon jump test. The results showed that compared to PT, PB induced significantly greater improvements in F-DPSI, L-DPSI (p = 0.003, 0.025, respectively), F-COPAP, F-COPML, F-COPPL, L-COPPL (p = 0.024, 0.002, 0.029, 0.043, respectively), T-running test and hexagon jump test (p < 0.001). The change in L-DPSI, L-COPAP, L-COPML did not differ between PB and PT (p > 0.907). The findings suggest that combined training holds great promise of improving the dynamic balance and quickness performance in elite badminton athletes.

The purpose of this study was to examine the effect of an 8-week combined balance and plyometric training on the Change of Direction (COD) performance of young badminton players. The study hypothesized that 8 weeks of combined training would improve COD performance in young badminton players. A total of 48 young male badminton players were recruited and randomly assigned to two groups: balance + plyometric training (BP; n  = 24) and plyometric training alone (PL; n  = 24). All the participants completed a 2-week familiarization process before the intervention. Both groups underwent their respective training sessions three times per week. Performance was assessed using the modified Southeast Missouri (SEMO) Test, modified T-Test, Hexagon Test, and Lower Extremity Injury Risk Test. The results showed significant improvements in COD performance for both groups, with the BP group showing superior performance in the modified T-test and Hexagon Test compared with that shown by the PL group. Specifically, the BP group had significant time and interaction effects on the T-Test ( p  < 0.001, partial η 2 = 0.18) and Hexagon Test ( p  < 0.001, partial η 2 = 0.15) scores. No significant time effect ( p  = 0.345) and interaction ( p  = 0.551) were observed for the SEMO test. Additionally, the BP group showed greater improvements in dynamic postural stability index (DPSI)-DF ( p  < 0.01, partial η 2 = 0.69), DPSI-NF ( p  < 0.01, partial η 2 = 0.27), and DPSI-NL ( p  < 0.01, partial η 2 = 0.30). Significant time and interaction effects were also observed for LSI (Limb symmetry index)-3 ( p  < 0.01, partial η 2 = 0.18) and LSI-6 ( p  < 0.01, partial η 2 = 0.54). The 8-week BP program compared with PL significantly enhanced the COD performance and reduced the lower limb injury risk in young badminton players. The BP regimen proved more effective than the PL in improving dynamic balance, neuromuscular control, and stability, suggesting that integrating balance training with plyometric exercises is superior for optimizing performance and preventing injuries in this athletic population.