Lift and Shift: Shoe Insole Helps Stroke Patients Relearn Balance

A stroke can weaken one side of the body, raising the dangerous possibility of unstable walking and debilitating falls. Physical therapy can help patients learn to shift their body weight slightly to the weaker, stroke-affected side to help regain balance, but for some patients, the weakness returns after their therapy ends.

University of Illinois at Chicago physical therapy professor Alexander Aruin has developed an inexpensive, simple way to deal with the problem, training the brain to rebalance body weight using a simple shoe insole he calls a “compelled body weight shift.” It slightly lifts and tilts the body toward the stroke-affected side, restoring balance without the patient having to think about it.

Aruin along with colleagues at UIC and Marianjoy Rehabilitation Hospital in Wheaton, Ill., studied two patient groups: one group at UIC who just had strokes, and one at Marianjoy who had strokes over a year ago.

“We tried a purely biomechanical approach,” Aruin said. “We mechanically lifted the healthy side so the patient cannot resist. The mechanics force body weight to where it is distributed almost 50/50. When patients ambulate in such a condition, they learn how to bear weight equally through both extremities. It’s quite simple.”

The two test groups followed slightly different protocols and were tested for various lengths of time. Their results were measured against those of control groups, who did not get the small therapeutic shoe insole, which measures less than half an inch thick. patients in all groups also received standard post-stroke physical therapy.

After the testing period ended, patients stopped using the insole. About three months afterward they were tested again to see if they retained the ability to keep their balance. Aruin and his colleagues found that physical therapy helped both the insole-user and control groups, but the insole group got an added boost.

“They showed more symmetrical body weight distribution and bore more weight on their affected side, and their gait velocity improved,” he said. “The outcome looks promising. The technique is very simple and inexpensive and has potential, which is exciting.”

Aruin hopes other physical therapists use the simple devices on stroke patients to see if they too benefit from it. His associates are also considering ways to use the insole to improve posture in post-stroke patients.

Results are published in two journals: ISRN Rehabilitation and in a forthcoming issue of Topics in Stroke Rehabilitation.

The research was supported by a grant from the National Institutes of Health.

Co-authors of the ISRN Rehabilitation article include Sambit Mohapatra, Aileen Eviota, Keir Ringquist and Sri Ranjini Muthukrishnan of UIC. Co-authors of the Topics in Stroke Rehabilitation article include Noel Rao, Asha Sharma and Gouri Chaudhuri of Marianjoy Rehabilitation Hospital.

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