An intensive massed practice approach to retraining balance post-stroke

Background and Purpose: Falls are highly prevalent and a significant source of complications post-stroke. This study tested the efficacy of standard physical therapy (based on the task-oriented approach) delivered in a massed practice paradigm. The purpose of this study was to test if the intensive massed practice intervention (6 h/day for 2 consecutive weeks) could significantly improve balance function post-stroke. Methods: A single-subject multiple baseline design across subjects with probes was utilized with ten subjects with chronic stroke disability. Clinical tests and time to stabilization (TTS) of the center of pressure in response to a platform perturbation were calculated during baseline, intervention, and the maintenance phases. Results: The ability of the subjects to recover from a balance threat improved, with mean TTS decreasing from 2.35 ± .51 s during baseline, to 1.58 ± .23 s during training, and further still to 1.45 ± .29 s during the maintenance phase, ending 3 months post-intervention. Clinical findings demonstrated improvements in anticipatory and steady-state balance control. In addition weight-bearing symmetry improved and the number of falls sustained reduced. Conclusions: Intensive massed practice of standard physical therapy produced significant results in balance retraining with patients post-stroke. Our finding support the need to offer additional practice to maximize the efficacy of physical therapy sessions.