Distal Versus Proximal Balance Training in Chronic Stroke

August 31, 2026 updated by: Naziye Ş CEYHAN, PhD, Istanbul University - Cerrahpasa

Comparison of the Effects of Distal Versus Proximal Balance Training on Postural Stability and Functional Outcomes in Chronic Stroke: a Randomized Controlled Trial

Study will include two different intervention groups. Both groups will receive a standardized 50-minute multimodal rehabilitation program consisting of 30 minutes of Bobath-based exercises, 10 minutes of neuromuscular electrical stimulation (NMES) applied to the hemiparetic limb, and 10 minutes of bicycle ergometer training. In addition, both groups will receive 15 minutes of technology-assisted balance training, 5 days per week for 4 weeks.

Group 1 will receive distal (ankle-strategy) balance training (DBT) using the Technobody Prokin system, including interactive "Game Pong" tasks with controlled anteroposterior and mediolateral platform displacement.

Group 2 will receive proximal (hip-strategy) balance training (PBT) using the TheraTrainer Balo device.

Study Aim: To investigate and compare the effects of technology-assisted distal (ankle-strategy) versus proximal (hip-strategy) balance training, each added to a standardized multimodal rehabilitation program, on balance, posture and functional outcomes in individuals with chronic stroke.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This prospective, participant- and assessor-blinded, two-group parallel randomized controlled trial included 46 participants aged 65-85 years with chronic stroke. Participants were randomly assigned in a 1:1 ratio to distal balance training (DBT) or proximal balance training (PBT), with 23 participants allocated to each group.

All participants received a standardized 50-minute multimodal rehabilitation program consisting of 30 minutes of Bobath-based therapeutic exercises, 10 minutes of neuromuscular electrical stimulation (NMES), and 10 minutes of bicycle ergometer training. In addition, participants received 15 minutes of technology-assisted balance training, 5 days per week for 4 weeks.

Participants in the DBT group received ankle-strategy-based balance training using the Technobody Prokin system. Training included interactive "Game Pong" tasks requiring controlled anteroposterior and mediolateral platform displacement. Participants in the PBT group received hip-strategy-based balance training using the TheraTrainer Balo device, which provided visual feedback during multidirectional trunk and pelvic control tasks.

Functional outcomes were assessed using the Timed Up and Go Test (TUG), 5-Repetition Sit-to-Stand Test (SST), and Functional Independence Measure (FIM). Balance was assessed using the Berg Balance Scale (BBS), Functional Reach Test (FRT), Trunk Impairment Scale (TIS), and Single-Leg Stance Test (SLST). Postural sway was assessed using the Technobody force platform, and postural alignment was assessed using the PostureScreen Mobile application. Cognitive status was assessed using the Standardized Mini-Mental Test (SMMT), which was administered once before treatment. All other outcome assessments were performed at baseline and after 4 weeks of rehabilitation.

Study Type

Interventional

Enrollment (Actual)

46

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Merdivenkoy-Kadıköy
      • Istanbul, Merdivenkoy-Kadıköy, Turkey (Türkiye), 34732
        • Erenköy Physical Therapy and Rehabilitation Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

65 years to 85 years (Older Adult)

Accepts Healthy Volunteers

No

Description

nclusion Criteria:

Hemiparesis secondary to a prior stroke At least 6 months post-stroke Standardized Mini-Mental Test (SMMT) score between 18 and 23 Absence of visual impairment Ability to walk independently or with an assistive device Age between 65 and 85 years

Exclusion Criteria:

Contractures in joints of the hemiparetic extremity Peripheral nerve lesions or lower motor neuron disease Other neurological conditions such as ataxia, dyskinesia, or dystonia Uncontrolled hypertension Cardiac instability Any condition that could pose a risk during physical rehabilitation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Distal Balance Training (DBT) Group
Distal (ankle-strategy) balance training using the Technobody Prokin system.
Device: TechnoBody intervention
Participants will receive distal (ankle-strategy) balance training using the Technobody Prokin system for 15 minutes per session, 5 days per week for 4 weeks. In addition, participants will receive the standardized multimodal rehabilitation program consisting of 30 minutes of Bobath-based exercises, 10 minutes of neuromuscular electrical stimulation (NMES) applied to the hemiparetic limb, and 10 minutes of bicycle ergometer training.
Experimental: Proximal Balance Training (PBT) Group
Proximal (hip-strategy) balance training using the TheraTrainer Balo device.
Device: Thera-Trainer intervention
Participants will receive proximal (hip-strategy) balance training using the TheraTrainer Balo device for 15 minutes per session, 5 days per week for 4 weeks. In addition, participants will receive the standardized multimodal rehabilitation program consisting of 30 minutes of Bobath-based exercises, 10 minutes of neuromuscular electrical stimulation (NMES) applied to the hemiparetic limb, and 10 minutes of bicycle ergometer training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
"Single Leg Stance Test (SLST)"
Time Frame: Baseline and after 4 weeks of rehabilitation
For the test, volunteers were asked to lift one foot without touching the support leg, look steadily across, and maintain their balance for 30 seconds. The time they focused on the paretic limb for hemiparetic individuals and the time they focused on the dominant limbs for healthy individuals were recorded.
Baseline and after 4 weeks of rehabilitation

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Berg Balance Scale (BBS)
Time Frame: Baseline and after 4 weeks of rehabilitation
The Berg Balance Scale (BBS) was used to assess functional balance. The scale consists of 14 items assessing balance during functional tasks. Each item is scored from 0 to 4, resulting in a total score ranging from 0 to 56. Higher scores indicate better balance performance.
Baseline and after 4 weeks of rehabilitation
TechnoBody Balance Test
Time Frame: Baseline and after 4 weeks of rehabilitation
The TechnoBody balance platform was used to assess postural balance. The system measures center-of-pressure displacement over time. Parameters including anteroposterior and mediolateral displacement, sway area, oscillation velocity, and total displacement distance were evaluated.
Baseline and after 4 weeks of rehabilitation
Functional Reach Test (FRT)
Time Frame: Baseline and after 4 weeks of rehabilitation
The Functional Reach Test (FRT) was used to assess dynamic balance. Functional reach distance was measured in centimeters. Distances of ≥25 cm indicate good balance, 16-24 cm indicate moderate impairment, and ≤15 cm indicate a high risk of instability.
Baseline and after 4 weeks of rehabilitation
Trunk Impairment Scale (TIS)
Time Frame: Baseline and after 4 weeks of rehabilitation
The Trunk Impairment Scale (TIS) was used to assess trunk control in participants with stroke. The total score ranges from 0 to 23, with higher scores indicating better trunk control.
Baseline and after 4 weeks of rehabilitation
5-Repetition Sit-to-Stand Test (SST)
Time Frame: Baseline and after 4 weeks of rehabilitation
The 5-Repetition Sit-to-Stand Test (SST) was used to assess functional lower-extremity performance. Participants were instructed to stand up from and sit down on a chair five times as quickly as possible. The time required to complete five repetitions was recorded in seconds. A shorter completion time indicates better functional performance.
Baseline and after 4 weeks of rehabilitation

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
"PostureScreen Mobile"
Time Frame: Baseline and after 4 weeks of rehabilitation
Patients photography with apple telephone and, Pictures of subjects were taken in three standing positions. Two raters independently digitized the static standing posture image twice. The app calculated posture variables, including sagittal and coronal plane translations and angulations.
Baseline and after 4 weeks of rehabilitation
Timed Up and Go Test (TUG)
Time Frame: Baseline and after 4 weeks of rehabilitation
The Timed Up and Go Test (TUG) was used to assess functional mobility and balance. Participants were instructed to stand up from a chair, walk 3 meters, turn around, walk back to the chair, and sit down. The test was repeated three times, and performance time was measured with a stopwatch and recorded in seconds. A shorter completion time indicates better functional mobility.
Baseline and after 4 weeks of rehabilitation
Functional Independence Measure (FIM)
Time Frame: Baseline and after 4 weeks of rehabilitation
The Functional Independence Measure (FIM) was used to assess functional independence in activities of daily living. It consists of 18 items, including 13 motor and 5 cognitive items. Each item is scored from 1 to 7, resulting in a total score ranging from 18 to 126. Higher scores indicate greater functional independence.
Baseline and after 4 weeks of rehabilitation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Istanbul University - Cerrahpasa

Investigators

  • Principal Investigator: Naziye Şenyuva Ceyhan, Istanbul University Cerrapasa

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 1, 2019

Primary Completion (Actual)

July 20, 2021

Study Completion (Actual)

July 20, 2021

Study Registration Dates

First Submitted

December 4, 2021

First Submitted That Met QC Criteria

December 24, 2021

First Posted (Actual)

December 29, 2021

Study Record Updates

Last Update Posted (Actual)

September 2, 2026

Last Update Submitted That Met QC Criteria

August 31, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ıstanbulıucnazıye

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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