Neuroathletic Training in Stroke Rehabilitation? A Single-blind Randomized Controlled Pilot Study on the Potentials of Neuroathletic Training on Balance Ability in Stroke Outpatient Rehabilitation

Neuroathletic Training in Stroke Rehabilitation - A Pilot Study

Based on anecdotal evidence, neuroathletic training is described as effective for target groups in performance sports, leisure sports and movement therapy. Neuroathletic training is being integrated more and more into practical fields of training, coaching education and therapy. In addition to athletic objectives, it emphasizes to address central nervous system movement control and specific perception exercises, which are included in specific training sessions. It is gaining attention through literature and an increasing number of workshops for practitioners, yet scientific evidence to support effectiveness of therapeutic approaches is lacking. Only few research findings show positive effects in the context of specific neuroathletic exercises. With respect to patients in stroke rehabilitation, exercises to stimulate the visual and vestibular systems were found to be effective for movement rehabilitation. Exploring neuroathletic perceptual exercises to improve balance seems to be promising for the target group. Stroke patients experience deficits in balance and losses in motor function during activities of daily living, therefore temporal precision activity-related stimuli could provide a useful complement of movement therapy to provide targeted support of neuronal plasticity, in order to restore functions over time. Outpatient rehabilitation movement therapy aims to promote physical functions that are important in everyday life, including coordination and balance tasks, in order to enable independent and safe movement. To explore neuroathletic training potentials on balance ability in stroke rehabilitation, a single-blinded controlled pilot study was conducted in a stroke outpatient rehabilitation program.

Study Overview

• Status: Completed
• Conditions: Stroke; Balance Postural
• Intervention / Treatment: Behavioral: Neuroathletic training; Behavioral: Traditional movement therapy in outpatient rehabilitation

Detailed Description

Study design The study design was a monocentric single-blinded randomized controlled pilot study (N=19). Aim of the study was to investigate potential effects of a 4-week outpatient rehabilitation program including 15 minutes of daily neuroathletic training compared to 15 minutes treatment as usual (traditional movement therapy). The primary endpoint was balance ability in stroke outpatient rehabilitation, measured via the German Version of the Berg Balance Scale (BBS) during a pre and post measurement, conducted by one blinded therapist in the years 2021-2022. The pretest of BBS was assessed in all participants on the first day of their rehabilitation program before the start of therapeutic measures. The second and final assessment of BBS was carried out on the last day after completion of all rehabilitation measures. Sample size calculation was based on an initial power analysis.

Population Participants were randomly assigned to the control and intervention groups by a coordinating therapist of the study site via a simple concealed randomization. Participant selection took place ad hoc. Inclusion criteria for the study participation were the main clinical diagnosis of stroke and indication for outpatient rehabilitation including movement therapy as well as adequate fitness to participate in a 4-week movement therapy program. All subjects agreed to participate voluntarily and gave written informed consent. The study was approved by Ethics Committee of the German Sports University Cologne in accordance with the Declaration of Helsinki (Seventh revision, 2013).

Study procedure The neuroathletic training included a structured exercise catalog prepared in advance and performed in a standardized manner for all patients of the intervention group. The conducting therapists received an introduction to carry out neuroathletic training and received all materials necessary for the intervention as well as the standardized training program with the exercise catalogue to perform almost identical training (table 1, Appendix A). All other therapeutic contents were the same for the intervention and control groups. More frequent short training sessions are to be preferred over a few longer ones. Therefore, training was conducted daily for 15 minutes with each patient. The total time of neuroathletic training in the intervention period was ten hours per patient of the intervention group.

Measures and statistical analyses As in the original English version, the German version of the Berg balance scale comprises 14 test items, which can be rated on a 5-point Likert scale from 0 to 4 points. It represents a well-established and valid measure and is considered as the gold standard to assess balance [12]. The total score is calculated by adding the values of each item and is a maximum of 56 points. According to Berg, Wood-Dauphinee, Williams & Maki [1992], persons with a total score of less than 45 points are considered to have impaired balance and are at increased risk of falling. The data analysis was carried out via IBM SPSS Statistics Version 28 (190). Demographic data were analyzed via descriptive statistics. The change in the subjects' ability to balance was analyzed in both groups using the Wilcoxon test. The examination of the values between the control and intervention group were analyzed using the Mann Whitney-U test (significance level α = 5 %) due to the small sample size. Effect sizes were calculated via Cohens d.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Northrhine Westphalia
    • Gummersbach, Northrhine Westphalia, Germany, 51643
      • Clinic Oberberg - Healthcare facility

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• main clinical diagnosis of stroke and indication for outpatient rehabilitation including movement therapy as well as adequate fitness to participate in a 4-week movement therapy program

Exclusion Criteria:

• No adequate fitness for participationg in the 4 week intervention time
• no adequate diagnosis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; Daily 15 Minutes of Neuroathletic training additional to traditional movement therapy in outpatient rehabilitation	Behavioral: Neuroathletic training; Specific Neuroathletic training exercises were performed to improve balance ability of post stroke patients
Active Comparator: Control group; Traditional movement therapy in outpatient rehabilitation	Behavioral: Traditional movement therapy in outpatient rehabilitation; Traditional movement therapy in outpatient rehabilitation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berg Balance Scale	The BBS comprises 14 activities that the therapist observes and evaluates in relation to balance. A maximum of four points can be awarded for each activity. A maximum score of 56 points can be achieved. The therapist conducts the various activities according to an instructions (manual) and demonstrates them if necessary. Due to the very good reliability and responsiveness the scale can therefore be recommended for follow-up measurements	4 weeks

Collaborators and Investigators

• Sponsor: German Sport University, Cologne

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): December 31, 2022
• Study Completion (Actual): December 31, 2022

Study Registration Dates

• First Submitted: April 25, 2024
• First Submitted That Met QC Criteria: April 25, 2024
• First Posted (Actual): April 30, 2024

Study Record Updates

• Last Update Posted (Actual): May 1, 2024
• Last Update Submitted That Met QC Criteria: April 30, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: Neuroathletic in Stroke Rehab; 124/22 (Registry Identifier: Pilot study of specific neuroathletic training on the balance ability of stroke patients in outpatient rehabilitation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The participants in this study did not give written consent for their personal data to be shared publicly; therefore, so due to the sensitive nature of the research, supporting data is unavailable.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No