Interactive Posturographic Balance Training Added to Conventional Rehabilitation in Chronic Stroke

Effect of Interactive Biofeedback-Based Posturographic Balance Training Added to Conventional Rehabilitation in Chronic Stroke: A Randomized Controlled Trial

Stroke frequently leads to long-term balance impairments, increased fall risk, and reduced independence in daily activities. In chronic stroke patients, deficits in sensory integration and postural control may persist despite conventional rehabilitation programs. Additional targeted balance interventions may enhance recovery by improving multisensory processing and motor control.

This study investigates whether adding biofeedback-based interactive posturographic balance training to conventional rehabilitation improves balance performance, fall risk, functional independence, and psychological well-being in individuals with chronic stroke. Participants were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation combined with interactive balance training for eight weeks. Outcomes were assessed using validated clinical scales measuring balance, fall risk, daily functioning, and emotional status.

Study Overview

• Status: Completed
• Conditions: Stroke; Postural Balance
• Intervention / Treatment: Device: Biofeedback-Based Interactive Posturographic Balance Training; Behavioral: Conventional Rehabilitation Program

Detailed Description

Stroke is a major cause of long-term disability and frequently results in persistent impairments in postural control and balance. In individuals with chronic stroke, altered sensory integration and impaired motor coordination contribute to increased fall risk and reduced functional independence. Although conventional rehabilitation programs address strength, mobility, and functional training, balance deficits may remain due to insufficient multisensory challenge and limited task-specific feedback.

Biofeedback-based interactive posturographic systems provide real-time visual and sensory feedback during standing tasks and systematically challenge postural control under varying sensory conditions. Such interventions may enhance motor learning and promote adaptive sensory reweighting mechanisms by exposing individuals to controlled visual deprivation and head-position alterations.

This prospective, single-blind randomized controlled study was conducted in individuals with chronic stroke (>6 months post-event). Participants were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation combined with interactive posturographic balance training. The intervention period lasted eight weeks, with sessions conducted five days per week.

The primary objective of the study was to determine whether adding biofeedback-based interactive posturographic balance training improves clinical balance performance. Secondary objectives included evaluating effects on fall risk, functional independence, and psychological status.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye), 34147
      • University of Health Sciences, Istanbul, Turkey

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• At least 6 months had elapsed since stroke onset
• They were ambulatory prior to stroke
• They were able to stand independently for at least 2 minutes
• Mini-Mental State Examination (MMSE) score ≥22

Exclusion Criteria:

• Medical conditions contraindicating participation in an exercise program
• Additional disorders affecting balance assessment (vertebrobasilar or peripheral vestibular insufficiency, significant visual impairment, neglect, cognitive impairment, major lower extremity contracture, neuromuscular disease, other neurological pathology, impaired joint position sense)
• Previous history of stroke
• Cerebellar involvement (dysmetria, dysdiadochokinesia, ataxia)

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: Interactive Posturographic Balance Training + Conventional Rehabilitation; Participants received conventional rehabilitation (45 minutes per session, 5 sessions per week) combined with biofeedback-based interactive posturographic balance training (25 minutes per session) for 8 weeks. The balance training was conducted using a multisensory posturographic system providing real-time visual feedback under varying sensory conditions. The conventional rehabilitation program included neurophysiological facilitation techniques, range of motion exercises, strengthening exercises, postural control training, weight-shifting exercises, and gait training.	Device: Biofeedback-Based Interactive Posturographic Balance Training; Intervention Description (Experimental Arm) Participants received biofeedback-based interactive posturographic balance training using a multisensory platform that provides real-time visual feedback based on vertical pressure fluctuations detected from four force plates under the heels and forefeet. The system systematically challenges postural control under different sensory conditions, including eyes open, eyes closed, unstable surface, and head-position variations. Training sessions lasted 25 minutes, five days per week, for eight weeks and were conducted in addition to a standardized conventional rehabilitation program.
Active Comparator: Conventional Rehabilitation; Participants received conventional rehabilitation only (45 minutes per session, 5 sessions per week) for 8 weeks. The program consisted of neurophysiological facilitation techniques, range of motion exercises, strengthening exercises, postural control training, weight-shifting exercises, and gait training.	Behavioral: Conventional Rehabilitation Program; Participants received a standardized conventional rehabilitation program consisting of neurophysiological facilitation techniques, range of motion exercises, muscle strengthening exercises, postural control training, weight-shifting exercises, and gait training. Sessions lasted 45 minutes per day, five days per week, for eight weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berg Balance Scale (BBS)	The Berg Balance Scale is a 14-item clinical measure of balance performance scored from 0 to 56, with higher scores indicating better balance.	Baseline and 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Barthel Index score from baseline to 8 weeks	The Barthel Index assesses functional independence in activities of daily living and ranges from 0 to 100. Higher scores indicate greater independence.	Baseline and 8 weeks
Change in Fall Risk Index from baseline to 8 weeks	The Fall Risk Index is derived from computerized posturographic assessment and reflects the estimated percentage risk of falling. Scores range from 0 to 100, with higher scores indicating greater fall risk.	Baseline and 8 weeks
Change in Hospital Anxiety and Depression Scale (HADS) total score from baseline to 8 weeks	The HADS is a 14-item questionnaire assessing anxiety and depression symptoms. Total scores range from 0 to 42, with higher scores indicating greater psychological distress.	Baseline and 8 weeks

Collaborators and Investigators

• Sponsor: Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2021
• Primary Completion (Actual): October 15, 2021
• Study Completion (Actual): October 15, 2021

Study Registration Dates

• First Submitted: February 26, 2026
• First Submitted That Met QC Criteria: February 26, 2026
• First Posted (Actual): March 4, 2026

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: February 26, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Balance training; Biofeedback; Chronic stroke; Fall risk; Berg Balance Scale; Posturography
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: CRS-TETRAX-2021

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to institutional data protection regulations and ethical considerations.

Drug and device information, study documents

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