Neurological diseases affect the brain and nerves found in the spinal cord and peripheral nervous system in many people. Moreover, aging is an unavoidable part of life that comes with health issues. These facets of the human condition often leave a negative impact on sensorimotor and neuromuscular systems, leading to a significant decrease in postural and physical control [1]. This decrease is associated with a two- to threefold increase in falls; fall-related injuries include mobility limitations, functional decline, and dependent care, all which lead to reduced quality of life and increased risk of early death [1]. Balance training is one strategy to prevent or reduce the risk of falls.
To prevent falls in those with conditions affecting balance or strength and in healthy older adults, studies over the last few decades have focused on balance training, which aims to restore postural control through understanding the body’s center of gravity and physical support system. In recent years, balance training has developed a virtual version; virtual reality-based balance training has shown positive results in treatment for patients with neuromuscular diseases [2]. Home-based balance training for mobile patients or healthy older adults has also been proven feasible [3].
Advanced age is often associated with unique neuromuscular deficits, such as a decrease in the number and size of Type II muscle fibers and loss of sensory and motor neurons. Balance training for older adults was carefully examined in a 2015 meta-analysis of 23 studies. Training protocols included steady-state, proactive, and reactive exercises on stable or unstable surfaces (for example: tilt board, trampoline, wobble board, foam mat, obstacle walking, etc.) with eyes open or closed [1]. Analyses on effectiveness across these randomized studies showed high standardized mean differences on assessments of postural control between participants receiving balance training and the control group. Statistics of effect size and heterogeneity demonstrate that while the effect found is not due to chance, the studies had a high degree of heterogeneity, or difference in methodology. The systematic review concluded that an effective balance training protocol for older adults includes a training period of 11-12 weeks, a training frequency of 3+ sessions per week, a total number of 36+ training sessions, a duration of 30-45 minutes per session, and a total duration of 90-120 minutes per week [1].
Balance training is important for improving the physical and mental performance of patients suffering from multiple sclerosis (MS). MS is a chronic progressive autoimmune disease of the central nervous system and patients often report a high prevalence of falls or balance/mobility impairments. As a result, virtual reality-based balance training protocols have been implemented in treatment for these individuals. In a 2015 randomized clinical trial, 30 MS patients were assessed with conventional tests of mobility such as the Manual Muscle Test, the Timed Up-and-Go test, and others to calculate the Fall Risk Index and Overall Stability Index. Patients in the intervention group (n=15) used the Biodex Balance System SD to train postural stability. Test scores before the intervention showed no substantial differences between the groups; however, after the 12-week training period, patients in the intervention group scored significantly lower on the Timed Up-and-Go test and had decreased Fall Risk Index and Overall Stability Index scores [2]. The literature suggests virtual reality-based tbalance training can be safe, enjoyable, and accessible alternatives to more traditional, on-site balance regimens and can still help prevent falls [3].
Two German hospitals recruited 11 older stroke survivors with low functional impairment for a 2018 study employing a home-based balance training protocol using the Nintendo WiiTM Balance Board. While results are largely inconclusive due to ceiling effects and the biased recruitment of participants, overall, the participants rated the intervention positively. The physical strain was rated low to moderate and the intervention itself was perceived to be relatively self-applicable [4]. Although no reliable change was detected between balance scores taken at the beginning and end of the intervention, this pilot study offers a look at potential outcomes and challenges associated with home-based balance interventions [4].
Over the past few years, studies on balance training to prevent falls have observed individuals with motor deficits, due to either neurological disease or age. Currently, there are no evidence-based recommendations for balance training protocols; therefore, the studies available have a high degree of heterogeneity [1]. Further research is needed to identify a standardized training protocol which offers the highest degree of efficacy, enhancing clinical care on a global scale.
References
- Lesinski, M., Hortobágyi, T., Muehlbauer, T., Gollhofer, A., & Granacher, U. (2015). Effects of balance training on balance performance in healthy older adults: A systematic review and meta-analysis. Sports Medicine, 45(12), 1721–1738. https://doi.org/10.1007/s40279-015-0375-y
- Eftekharsadat, B., Babaei-Ghazani, A., Mohammadzadeh, M., Talebi, M., Eslamian, F., & Azari, E. (2015). Effect of virtual reality-based balance training in multiple sclerosis. Neurological Research, 37(6), 539–544. https://doi.org/10.1179/1743132815Y.0000000013
- Yousefi Babadi, S., & Daneshmandi, H. (2021). Effects of virtual reality versus conventional balance training on balance of the elderly. Experimental Gerontology, 153, 111498. https://doi.org/10.1016/j.exger.2021.111498
- Golla, A., Müller, T., Wohlfarth, K., Jahn, P., Mattukat, K., & Mau, W. (2018). Home-based balance training using Wii FitTM: A pilot randomised controlled trial with mobile older stroke survivors. Pilot and Feasibility Studies, 4(1), 143. https://doi.org/10.1186/s40814-018-0334-0