Tongue-Based Biofeedback for Balance in Stroke: Results of an 8-Week Pilot Study

Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Arch Phys Med Rehabil 2011; 92:1364-70. Objective: To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. Design: Prospective multicenter research design. Setting: Outpatient rehabilitation clinics. Participants: Patients (N=29) with chronic stroke. Interventions: Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. Main Outcome Measures: The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. Results: There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. Conclusions: Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.