Elsevier

Gait & Posture

Volume 52, February 2017, Pages 153-158
Gait & Posture

Full length article
Unique approach to sensorimotor training with a new device combining air cushion with stochastic translations—A prospective randomized controlled clinical trial

https://doi.org/10.1016/j.gaitpost.2016.11.038Get rights and content

Abstract

Sensorimotor training with a wide variety of available devices represents an important component in rehabilitation and prevention of different sports injuries and chronic diseases. The purpose of this study was to evaluate the effects of a sensorimotor training with a newly developed device, which consists of an instable platform moving on an air cushion, providing dynamic balance training by tilting and unanticipated stochastic translations on postural control. Seventy-two healthy young subjects were included in this prospective, randomized, controlled, and observer-blinded study. Balance was objectively assessed by posturography and Functional Reach Test (FRT). Additionally we evaluated the subjective rating of balance. After randomization the sensorimotor training group performed a training program on the new device over a 5–6 week study period. After this time improvement in objective and subjective measurements as a result of training became evident. A significant difference in challenging posturographic parameters (Sensory Organization Test 5: training group 5.32 ± 5.25 vs. control group 1.78 ± 5.05, p = 0.006 and Head Shake Sensory Organization Test 5: training group 11.94 ± 8.97 vs. control group 5.41 ± 10.17, p = 0.01) as well as a significant difference in the FRT (training group 3.34 ± 3.35 cm vs. control group 0.01 ± 2.97 cm, p = 0.0001) was found. Subjective assessment revealed a significant improvement in the participants’ rating of balance and alteration of balance. Subjects showed a high satisfaction with the new training device. Our findings suggest that the newly developed device could be a promising option for sensorimotor training to improve postural control.

Introduction

Balance describes the ability to maintain an upright bipedal stance and requires multisensory information like visual, vestibular and somatosensory inputs and motor mechanisms [1], [2]. In specific conditions, when information provided by these modalities is inconsistent, a selection or adapted weighting of the information – called sensory weighting – is necessary [3]. The loss of balance is important especially to the elderly with a high impact on public health and general economy as deficits in mobility, gait and balance are the most important determinants of functional dependency [4]. Physical training, especially sensorimotor training, can improve the bipedal equilibrium control and reduce body oscillations during stance and therefore plays a significant role in the rehabilitation of elderly people and the prevention of falls [5]. Furthermore, sensorimotor training represents an important component in the rehabilitation and prevention of different sports injuries such as ankle sprains [6] and ruptures of the anterior cruciate ligament [7].

For sensorimotor training different devices are currently available. Amongst many other alternatives, foam pads, wobble boards, trampolines, moving platforms (e.g. Posturomed) and recently the Wii balance board [8] are utilized in prevention, therapy and rehabilitation. Different recommendations of variation in exercise duration, repetitions and the level of task- and exercise difficulty are available [9], [10]. In this randomized, controlled and observer-blinded study we used a newly developed device for sensorimotor training. The tool consists of an instable platform moving on an air cushion, thus providing dynamic balance training by tilting on the one hand and by unanticipated translations on the other. The combination of these mechanisms is a major difference to other devices currently in widespread use for sensorimotor training.

In previous studies balance was often evaluated by means of clinical tests such as the Timed Up and Go Test, Berg Balance Scale [8] and the Functional Reach Test [11]. Alternatively, different types of force plates and platforms [12], [13] were used for analyses. These methods, however, seem to lack exact, objective baseline and post-treatment information regarding the mechanism which underlies the control of balance. Only Cone et al. [8] and Haslinger et al. [14] performed balance testing with computerized dynamic posturography in healthy people to evaluate the effects of new devices for sensorimotor training. In comparison to our study, both used different procedures, Cone et al. [8] did not use clinical tests in combination to objective data, while Haslinger et al. [14] evaluated healthy older subjects.

The aim of the study was to find subjectively and objectively evaluated effects on balance after a sensorimotor training on this new device combining air cushion and stochastic translations in healthy young people. We hypothesized that, especially in the most demanding conditions, postural stability will improve after training in this population.

Section snippets

Participants

Seventy-two healthy young subjects (37 female, 35 male, mean age: 23.8 ± 2.4, range: 19–31 years) were included in this prospective, randomized, controlled, and observer-blinded study (Fig. 1). Inclusion criteria consisted of age between 18 and 35 years, good health, ability to understand the German language and a Dizziness Handicap Inventory (DHI) score smaller than 5 points [15]. Exclusion criteria included pregnancy or lack of contraception use (because of uncertain effects of pregnancy on

Results

Overall compliance of participants was excellent and all training sessions were performed. No serious adverse event was observed during the study period. No drop outs occurred.

Discussion

The main objective of this prospective, randomized, controlled and observer-blinded study was to evaluate the alteration of balance generated by sensorimotor training on a newly developed device combining air cushion and unanticipated translations in healthy young people. We indicated improvements in objective and subjective measurements as a result of training. A significant increase in posturographic parameters (composite score of the SOT, SOT 5, HS-SOT 5) as well as a significant improvement

Contributors

Christian Mittermaier contributed to the conception and design of the study and the acquisition of data. He revised the article and approved the final version. Maximilian Schindler contributed to the acquisition of data, revised the article and approved the final version. Benjamin Loader contributed to the conception and design of the study, revised the article and approved the final version. Thomas Waldhoer and Clemens Ambrozy contributed to the analysis and interpretation of data, revised the

Conflict of interest statement

None of the authors has any conflict of interest to declare.

Financial disclosure

The Austrian Workers’ Compensation Board (AUVA) provided financial support, but had no role in the study concept, design, data collection, data analysis, data interpretation or the writing of the report.

We thank Robert Atzmüller, Bernd Hiller and Florian Waigl (Medical University of Vienna) for their assistance with the conduction of this study.

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