Retraining sitting balance after stroke: a feasibility study

Abstract

Introduction Half of people with stroke present with reduced sitting balance. Currently systematic retraining has only been tested on people with some control of their balance. This study aimed to test the feasibility of providing and evaluating sitting balance retraining early post-stroke in people with more significant difficulties. Method A mixed methods study using a longitudinal case series plus qualitative interviews. People on a stroke unit with reduced sitting balance were recruited. The retraining involved practise of reaching activities from a sitting position for ten sessions up to 30 minutes each over two weeks. Fidelity was recorded in practise diaries. Five participants and two staff were interviewed about their experiences. Outcomes at baseline, two weeks and two months included Trunk Impairment Scale, functional reach, Functional Ambulatory Category, Modified Rankin Scale, and level of seating support. Analysis focused on acceptability and feasibility. Results Eleven participants were recruited with only seven starting the intervention. They completed a mean (SD) of 156 (94) minutes from a potential 300 minutes of training. Some participants said they found the intervention gave them structure to their day and provided opportunities for social interaction, although they found repeated practice boring. The intervention was adapted to involve two people working together, which participants found more motivating but reduced the potential for variation of tasks. Staff found supervising those with most severe problems time-consuming. Trunk Impairment Scale, functional reach and degree of support all demonstrated change. Conclusion It appears feasible to recruit people with more significant problems post-stroke and to offer sitting balance training. However the described intervention cannot be considered feasible or acceptable at this stage as no participants were able to complete the protocol. Further work is required to develop interventions that enable repeated practice in a way that is motivating for people with stroke.