Improving impaired balance function: real-time versus carry-over effects of prosthetic feedback

This study investigated whether training with realtime prosthetic biofeedback (BF) of trunk sway induces a carry-over improvement in balance control once BF is removed. 12 healthy older adults and 7 uncompensated unilateral vestibular loss patients were tested. All participants performed a battery of 14 balance and gait tasks (pre-test) upon their initial lab visit during which trunk angular sway was measured at L1-3. They then received balance BF training on a subset of 7 tasks, three times per week, for two consecutive weeks. BF was provided using a multi-modal biofeedback system with graded vibrotactile, auditory, and visual cues in relation to subject-specific angular displacement thresholds. Performance on the battery of the 14 balance and gait tasks (without BF) was re-assessed immediately after the 2 week training period, as well as 1 week later to examine BF carry-over effects. Significant reductions in trunk angular displacement were observed with the real-time BF, compared to the pre-test trials. The effects of BF persisted when BF was removed immediately after the final training session. BF carry-over effects were less evident at one week post-training. This evidence supports the potential short-term effects of BF training in a limited number of tasks after the BF is removed in healthy elderly subjects and those with vestibular loss. However, the prospect for longer term (>1 week) effects of prosthetic training on balance control remains currently unknown.