Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial

Abstract

Background: Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions.

Objective: To evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors' overall balance and balance recovery reaction.

Methods: In this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a "lean-and-release" perturbation system.

Results: Thirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg's rectus femoris reacted significantly faster post-training (P = .036).

Conclusion: The RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors' overall balance, motor function and improving balance recovery with faster muscle response.

Trial registration: The study was registered at Clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03183635 , NCT03183635) on 12 June 2017.

Keywords: Balance; Falls; Posture; Slip and fall; Stroke rehabilitation; Telerehabilitation.

Fig. 1

CONSORT flowchart of the randomized controlled trial. RMT rapid movement training, CBT conventional balance training

Fig. 2

RMT training effects from sessions 1, 10 and 20 on A Range-of-motion and B Movement Completion Time. The grey colored areas are the target region for the arms and legs for the range-of-motion and the movement completion time. The figure shows the Range-of-motion for both non-paretic and paretic legs increased. Non-paretic and paretic arms and legs became faster in their Movement Completion Time. C The RMT system setup. D The user needed to stand in an upright position with arms rest on side and feet were placed at shoulder width. The system was real-time show the arms and feet position. The users need to place all of them in the initial positions [Green boxes] E This is a sample screen to indicate which limb and which direction need to respond, and this case is Right Foot-Anterior direction

Fig. 3

EMG Activation Sequences of A Stepping Legs and B Supporting Legs. MG medial gastrocnemius, TA tibialis anterior, BF biceps femoris, RF rectus femoris

Fig. 4

Image showing muscle reaction time for stepping and support leg during “lean-and-release” fall assessment. RMT, Rapid Movement Training; CBT, Conventional Balance Training; MG, medial gastrocnemius; TA, tibialis anterior; BF, biceps femoris; RF, rectus femoris (*P < 0.05; ✤Time effects)