ORIGINAL ARTICLE Balance Rehabilitation by Moving Platform and Exercises in Patients With Neuropathy or Vestibular Deficit Antonio Nardone, MD, PhD, Marco Godi, PT, Alessia Artuso, MD, Marco Schieppati, MD ABSTRACT. Nardone A, Godi M, Artuso A, Schieppati M. Balance rehabilitation by moving platform and exercises in patients with neuropathy or vestibular deficit. Arch Phys Med Rehabil 2010;91:1869-77. 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 (N=33) with balance disorders (14 vestibular origin, 19 peripheral neuropathy origin). Interventions: Patients underwent powered platform then EX treatment (n=17); the other 16 received the same treat- ments in reverse order. powered platform consisted of balanc- ing on a sinusoidally oscillating powered platform (in antero- posterior and laterolateral directions in separate trials) with eyes open and closed. A physical therapist administered Caw- thorne-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 re- gardless 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 improv- ing balance. This effect was stronger in patients with vestibular disorders, independently of order of treatment. Conclusions: Balance rehabilitation with either EX or pow- ered 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 docu- mented in the literature. Key Words: Balance rehabilitation; Dynamic equilibrium; Neuropathy; Quiet stance; Rehabilitation; Vestibular disorders. © 2010 by the American Congress of Rehabilitation Medicine B ALANCE IS AN IMPERATIVE skill for daily life. It requires the integration of sensory information regarding orientation of the body relative to gravity and environment. Altered sensory function leads to impaired control of stance. 1,2 In turn, unsteadiness decreases functional gait performance in patients with vestibular disorders 3 and those with peripheral neuropathy. 4,5 Rehabilitation training successfully manages symptoms and balance problems that result from central and/or peripheral vestibular lesions 6-13 (see 14 ). We and others have shown that balance improvement in patients with vestibular disorders can be obtained through instrumental rehabilitation consisting of standing on a continuously and predictably moving powered platform 15,16 and ad hoc therapeutic EXs. Both interventions improved patients’ control of balance, although patients with vestibular disorders treated by using the powered platform showed the largest improvement. 15 The greater efficacy of powered platform treatment was attributed to the continuous and predictable perturbations, thereby compelling patients to rely not only on feedback mechanisms (from residual vestibu- lar function) for control of posture, but also on feed-forward mechanisms. 17 Patients acquired knowledge of cyclic powered platform displacement by using multiple sensory inputs and anticipated the appropriate muscle activation to counteract the impending balance perturbations. On the other hand, rehabilitation treatment of patients with sensorimotor disturbances caused by neuropathy has received little attention despite the considerable risk for falling in these From the Posture and Movement Laboratory, Dept of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Fondazione Salvatore Maugeri (IRCCS), Veruno (Nardone, Godi, Artuso); Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara (Nardone); Unit of Physical Medicine and Rehabilitation, University of Pavia, Pavia (Artuso); Centro Studi Attività Motorie, Fondazione Salvatore Maugeri (IRCCS), Scientific Institute of Pavia, Pavia (Schieppati); and Department of Experimental Medicine, University of Pavia, Pavia, Italy (Schieppati). Supported by a Ricerca Finalizzata 2008 grant from the Italian Ministry of Health and a PRIN 2007 grant from the Italian Ministry of University and Research. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated. Correspondence to Marco Godi, PT, Posture and Movement Laboratory, Fondazi- one Salvatore Maugeri (IRCCS), Scientific Institute of Veruno (NO), 28010, Veruno, Italy, e-mail: marco.godi@fsm.it. Reprints are not available from the author. 0003-9993/10/9112-00372$36.00/0 doi:10.1016/j.apmr.2010.09.011 List of Abbreviations ADL activity of daily living ANOVA analysis of variance BPOMA Tinetti Performance-Oriented Mobility Assessment, testing balance CFP center of foot pressure EC eyes closed EO eyes open EX exercise GPOMA Tinetti Performance-Oriented Mobility Assessment, testing gait POMA Performance-Oriented Mobility Assessment SA sway area SMD standardized mean difference t0 before the first treatment t1 after the first treatment t2 after the second treatment 1869 Arch Phys Med Rehabil Vol 91, December 2010