A Multidimensional Inpatient Balance Training Class to Improve Functional Outcomes in Rehabilitation Inpatients With ABI

Not Applicable

• Conditions: Brain Injuries, Traumatic; Cerebrovascular Trauma; Acute Brain Injuries
• Interventions: Other: Fallproof Balance Training (BT) class; Other: Control Balance Training (BT) class

• Registration Number: NCT03110237
• Lead Sponsor: University of British Columbia

Brief Summary

Many survivors of acquired brain injury (ABI) suffer from decreased balance and increased risks of falls. Previous studies indicate that balance training improves balance, reduces falls, and increases walking speed and balance confidence. The purpose of this study is to determine if a multidimensional balance training based on the FallProof(TM) approach achieves better improvements in balance and walking performance than the current practice . Participants will be assigned to: 1)a task-oriented circuit training balance class (current practice), or 2) balance training class based on the FallProof(TM) approach. Standardized tests will determine if participating in balance training helps improve balance, walking speed and balance confidence.

Detailed Description

The purpose of this pilot research study is to determine if a balance training (BT) class based on the FallProof(TM) approach achieves better balance and mobility outcomes than the current practice. The FallProof's approach focuses on multiple components of balance impairment including multisensory, postural strategy and centre of gravity control training. Current practice is a task-oriented circuit training balance class.

ABI survivors may have muscle weakness, decreased coordination and sensory loss, which contribute to reduced balance, difficulty with functional mobility and activities of daily living. Balance control provides the foundation for a person's ability to stand, walk and function independently. Previous studies indicate that balance training (BT) improves balance, reduces falls, increases walking speed and balance self-efficacy for ABI patients .The Ottawa Panel Evidence-Based Clinical Practice Guidelines for ABI Rehabilitation supported the use of BT based on the research evidence. Interventions such as task-oriented training, multisensory training, trunk control training and perceptual exercises demonstrate positive effect on balance and mobility outcomes. To our knowledge, there are few studies that have examined a multidimensional approach to BT.

A systematic review concluded that exercises performed for 20-60 minutes, 3-4 times a week for 6-12 weeks can improve balance in ABI patients. However, Treacy et al demonstrated that inpatient BT for just 2 weeks can improve balance compared to a control group who received traditional exercise interventions.

At GF Strong Rehabilitation Center (GFS), the usual care provided to the ambulatory ABI patients consists of individualized one to one physiotherapy treatment, as well as a high level BT class. Currently, this BT class is a circuit training class that focuses on task-oriented gait exercises. FallProof balance training is a group- based approach that includes multisensory, postural strategy, centre of gravity control and gait pattern training. It was originally developed for older adults with impaired balance; but there is no research on the effectiveness of this approach for ABI patients. The FallProof approach has been introduced to the low level and intermediate level BT class at GFS, for ABI patients with sever and moderate balance impairments. These classes received positive feedback from patients and therapists. Patients reported improved functional mobility and confidence after attending the class. However, there was no functional outcome measurements collected to compare the effectiveness of the previous class and the new FallProof class. We plan to modify the current circuit training high level balance class with the FallProof approach in the spring of 2017. Before introducing the FallProof class, we would like to collect outcome measures with the current BT class for three months, and then collect collect data with the new class for comparison. We would like to determine if a multidimensional group based BT treatment approach is more effective at improving functional outcomes compared to the current practice.

Study Timeline

• Study First Submitted: 2017-03-31
• Status Verified: 2017-04
• Study Start: 2017-04-10
• Study First Submitted QC: 2017-04-11
• Last Update Submitted: 2017-04-11
• Study First Posted: 2017-04-12
• Last Update Posted: 2017-04-12
• Primary Completion: 2017-11-30
• Study Completion: 2017-12-30

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

1. inpatients admitted to GFS with a diagnosis of ABI;
2. medical stability
3. has the cognitive ability to understand and follow instructions and participate in a class setting
4. a Berg Balance Score of ≥52;
5. able to walk independently with or without a mobility aid.

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Exclusion Criteria

1. unable to attend class in a group setting and/or unable to follow instructions.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Fallproof Balance Training (BT) class	Fallproof Balance Training (BT) class	Group based balance training class based on the FallProof(TM) approach, 30 minute session , twice a week for three weeks
Control Balance Training (BT) class	Control Balance Training (BT) class	Group based circuit training class, 30 minute session, twice a week for three weeks

Primary Outcome Measures

Name	Time	Method
Community Balance and Mobility Scale (CB & M)	after attending balance class for 3 weeks	A performance measure composed of 13 challenging tasks. Item scores range from 0 to 5 and reflect progressive task difficulty. All tasks performed without ambulation aides.

Secondary Outcome Measures

Name	Time	Method
Timed Up and Go Test (TUG)	after attending balance class for 3 weeks	Timing how long it takes for patient to rise from a chair, walks 3 meters at a comfortable and safe pace, turns, walks back to the chair and sits down.
Falls Efficacy Scale (FES)	after attending balance class for 3 weeks	A 10-item questionnaire for patients to rate their confidence in their ability to perform 10 daily tasks without falling as an indicator of how one's fear of falling impacts physical performance. Each item is rated from 1 ("very confident") to 10 ("not confident at all").
4 meters Gait Speed Test (GST)	after attending balance class for 3 weeks	Measure time (in seconds) that it takes the patient to walk 4 meters. The patient should be at their usual speed during the entire 4 meter timed area. Use a 6 meter path, with the central 4 meters as the timed area. Patient may use any walking aid.

Trial Locations

Locations (1)

GF Strong Rehabilitation Center; 🇨🇦 Vancouver, British Columbia, Canada