Balance rehabilitation by moving platform and exercises in patients with neuropathy or vestibular deficit.

Objective: To assess the efficacy of a balance rehabilitation treatment by using both a powered platform on which subjects stand and specific physical exercises (EXs). Design: Crossover trial. Setting: Physical and rehabilitation medicine department in Italy. Participants: Patients (N33) with balance disorders (14 vestibular origin, 19 peripheral neuropathy origin). Interventions: Patients underwent powered platform then EX treatment (n17); the other 16 received the same treatments in reverse order. powered platform consisted of balancing on a sinusoidally oscillating powered platform (in anteroposterior and laterolateral directions in separate trials) with eyes open and closed. A physical therapist administered Cawthorne- Cooksey EXs for patients with vestibular disorders and modified Frenkel EXs for patients with neuropathy. Treatment lasted 1 hour a day for 10 consecutive days, except for the weekend. Main Outcome Measures: Body sway area, subjective score of stability, balance and gait scores, and amplitude of head displacement while balancing on the oscillating powered platform were recorded before, (t0) after the first (t1), and after the second treatment (t2), regardless of the powered platform or EX order. Results: On average, all participants improved balance regardless of the order of treatments, and more so at t2 than t1. Improvement was observed by using instrumental evaluations and balance and gait scales. In both patient groups, powered platform treatment proved to be as effective as EX in improving balance. This effect was stronger in patients with vestibular disorders, independently of order of treatment. Conclusions: Balance rehabilitation with either EX or powered platform is effective in patients with balance disorders of vestibular or neuropathic origin. These findings point to the value of either or both physical EXs and powered platform in increasing stability and potentially decrease the risk of falling in patients with neuropathy, for whom few results are documented in the literature