Balance Dimensions-Based Rehabilitation Program in People With Acquired Brain Injury

Acquired brain injury (ABI) is a major cause of disability in adults. It can affect balance, walking, mobility, independence in daily activities, and quality of life. Balance problems are common after ABI and may increase the risk of falls.

This study will evaluate a rehabilitation program based on different dimensions of balance in people with ABI. The program is designed to work on proprioception, biomechanical constraints, limits of stability, anticipatory postural adjustments, reactive postural responses, sensory orientation, and dynamic gait stability.

This is a prospective, longitudinal, randomized controlled trial with assessor blinding. The study will include 68 adults with ABI who are receiving active rehabilitation at the State Reference Centre for Brain Injury Care (CEADAC) in Madrid, Spain. Participants will be randomly assigned to one of two groups.

The experimental group will receive a structured multimodal balance rehabilitation program. The control group will receive conventional physiotherapy according to the usual clinical protocols at CEADAC. Both groups will receive treatment for 12 weeks, with five 60-minute sessions per week.

The main outcome will be balance performance, assessed with the Balance Evaluation Systems Test adapted for Acquired Brain Injury (BESTest_DCA). Secondary outcomes will include mobility, walking speed, fall risk, and quality of life, assessed with the Timed Up and Go Test, the 10-Meter Walk Test, and the CAVIDACE questionnaire (Spanish Quality of Life Questionnaire for People with Acquired Brain Injury).

Assessments will be performed at baseline, after 6 weeks of treatment, after 12 weeks of treatment, and at 6 and 12 weeks after the end of the intervention. Data will be analyzed to compare changes between the experimental and control groups over time.

This study may help determine whether a balance-specific rehabilitation program provides additional benefits compared with conventional physiotherapy in people with acquired brain injury.

Inclusion criteria

• Adults aged 18 to 65 years.
• Diagnosis of acquired brain injury (stroke, traumatic brain injury, anoxic brain injury, brain tumor, or encephalitis).
• At least 2 months since the brain injury.
• Mini-Mental State Examination (MMSE) score greater than 24.
• Modified Rankin Scale (mRS) score of 3 or lower.
• Ability to walk independently or with an assistive device.
• Clinical stability and ability to participate in a rehabilitation program.
• Written informed consent signed by the participant.

Exclusion criteria

• Severe cognitive impairment (MMSE score of 24 or lower).
• Severe functional dependence (mRS score greater than 3).
• Unstable medical conditions that may interfere with participation.
• Severe musculoskeletal, cardiovascular, or other conditions that prevent safe participation in the intervention.
• Severe communication disorders that prevent understanding of study procedures.
• Participation in another clinical trial that may interfere with the study results.