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Rehabilitation of Balance After Stroke With Multisensorial Training: A Single-Blind Randomized Controlled Study

Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris, alain.yelnik{at}lrb.aphp.fr

Frederique Le Breton, MD

Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris

Florence M. Colle, MD

Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris

Isabelle V. Bonan, MD, PhD

Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris

Caroline Hugeron, MD

Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches

Véronique Egal

Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris

Elizabeth Lebomin

Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches

Jean-Philippe Regnaux, PhD

Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches

Dominic Pérennou, MD, PhD

Physical Medicine and Rehabilitation Department, CHU, Dijon

Eric Vicaut, MD, PhD

Unité de Recherche Clinique, G.H. Lariboisière-E.Widal, Université Paris 7, Paris France

Objective. To compare 2 rehabilitation strategies to improve balance after stroke: (1) a multisensorial approach based on higher intensity of balance tasks and exercise during visual deprivation and (2) a conventional neurodevelopmentaltheory-based treatment (NDT) that used a general approach for sensorimotor rehabilitation. Methods . This prospective, multicenter, randomized, parallel-group study measured outcomes with blinded assessors. Sixty-eight patients able to walk without human assistance were entered from 3 to 15 months (mean, 7 months) after a first hemispheric stroke. They received 20 sessions in 4 weeks of NDT or multisensorial rehabilitation. On day 0, day 30, and day 90, assessment included the Berg Balance Scale (BBS), posturography, gait (velocity, double stance phase, climbing 10 steps, amount of walking per day), the Functional Independence Measure, and the Nottingham Health Profile. Results. All subjects improved significantly in balance and walking parameters. Regarding the main dependent variable (BBS on day 30), no difference between groups was found. Analysis of secondary outcomes suggested small differences in favor of the experimental group, but the differences are not likely to be clinically relevant. Conclusion. No evidence was found for the superiority of a multisensorial rehabilitation program in ambulatory patients with impairments beyond the time of inpatient therapy. Additional studies are recommended.

Key Words: Stroke • Balance • Rehabilitation • Functional independence • Sensory plasticity.

Neurorehabilitation and Neural Repair, Vol. 22, No. 5, 468-476 (2008)
DOI: 10.1177/1545968308315996


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