Visual Feedback Intervention Techniques to Improve Balance Within the Post-Stroke Population

Visual Feedback Intervention Techniques to Improve Balance Within the Post-Stroke Population

 By : Cara Hehn

           During my last clinical rotation in the acute setting, working in the neurological ward, I had the opportunity to use a treatment technique I was quite intrigued by and did not have prior experience with. This technique involved the use of a long standing mirror in which the patient viewed themselves during balance intervention, and was one that my CI and I used several times with post-stroke patients. During the fall semester, I had the chance to further research this area through the class Evidenced Based Practice II, where I created a Critically Appraised Topic (CAT) focusing on this intervention tool. My topic specifically investigated if a long standing mirror was more effective in improving long-term standing vertical alignment than tactile and verbal cueing during dynamic and static balance exercises. While the results from this systematic search and research appraisal did not indicate any additional benefits from the use of the longstanding mirror, it did further intrigue me to look at the broader topic of visual feedback intervention to improve balance within the post-stroke population. Since this topic was one of much interest to me, and is not extensively covered in the current UNC DPT curriculum, I decided to tailor my project as an educational presentation that could accompany the neurological studies of UNC DPT students.

        When expanding my current systematic search, which focused solely on the use of a mirror for visual feedback, I found sufficient evidence on Virtual Reality Feedback, Wii Fit Gaming, and Visual Feedback based on Force Platforms, which is highlighted in my evidence based table. While the research is vital in understanding what evidence supports or refutes visual feedback intervention in the post-stroke population, I was also looking to present the information in a way that would be clinically relevant and applicable. Therefore, I spent some time observing at Spaulding Rehabilitation Hospital, where I was able to witness several treatment sessions for post-stroke patients which incorporated visual feedback. There was one patient in particular, who had decreased proprioception in his right lower extremity, that demonstrated immediate improvements in his gait quality with the use of a long standing mirror. I was able to tape part of his initial treatment session, and included this video in my Voicethread Presentation.

     Since this project was tailored for DPT students, I wanted to make sure the information and research I had gathered had clinical relevance and would be applicable. Therefore, I included a section on outcome measures most appropriate for this patient population, as well as motor control concepts to apply and a guideline to using clinical judgement when determining the most beneficial visual feedback intervention for particular patients. After reviewing materials regarding health literacy and the importance of incorporating this concept with every patient to ensure effective communication and treatment, I decided to specifically address this issue in a short paper in the context of visual feedback interventions.

        The evaluation of my project is in an online survey format composed of ten questions. The link to this survey is included on a final slide of the presentation, and thus can be taken by any viewer. Although the results and responses from the survey are not all in yet, the website allows me to view overall responses to every question; thus allowing for a detailed review. Additionally, throughout the entire process I sought feedback and evaluation from my committee members and advisor.

    Finally, I would like to thank those who were an integral part of my project. To my committee members, Marie Lucey PT, Miranda Bunge PT, DPT, CMTPT, and Vicki Mercer PT, PhD,  who offered truly invaluable feedback and guidance throughout the entire process, I cannot thank you enough for your time or wisdom. To my advisor Karen McCulloch PT, PhD, NCS, thank you so much for your keen eye, and assistance in making this presentation most suitable for the intended audience. I would also like to thank all of my 2015 DPT classmates for guidance and assistance throughout various parts of this process, as well as their support through viewing my presentation.