Proactive and Reactive Balance Training Effects on Balance and Functional Performance Among Chronic Stroke Survivors

Primary outcomes

1. International Physical Activity Questionnaire

   Time frame: 1 minute

   This measure assesses the types of intensity of physical activity and sitting time that people do as part of their daily lives are considered to estimate total physical activity in min-hours/week and time spent sitting. The short form consists of 7 questions, the questions ask about the time that patients spent being physically active in the last 7 days. The sequence of questions is from vigorous to moderate activities to walking then to sitting. And it is a valid and reliable questionnaire

2. Time Up and Go (TUG)

   Time frame: 1 minute

   Is a reliable and valid outcome measure.and it's a sensitive and specific test to measure balance and risk of fall among elderly. The patient will be sitting on chair with arm rest then will stand up and walk in straight line 3 m then will turns around and back to the chair and sit down, the timing will start when patient stand up from chair and ends when back to the chair and sit down.[33]

   The score of the TUG:

   • ≤10s → completely independent
   • ≤ 2s → Independent for main transfers

3. 10 Meters walking test (MWT)

   Time frame: 5 minutes

   It is a reliable and vailed outcome measure, it is evaluated by measuring speed and counting the steps and time. The steps and time will be measured when patient start to walk from beginning point. Individual walks without assistance 10 meters (32.8 feet) and the time is measured for the intermediate 6 meters (19.7 feet) to allow for acceleration and deceleration.

4. The Falls Efficacy Scale (FES)

   Time frame: 2 minutes

   The FES was developed through a series of meetings between members of the Prevention of Falls. FES IS A confidence measure in performing a range of activities of daily living without falling. This scale has excellent reliability, is correlated with measures of balance and gait, and predicts future falls and decline in functional capacity. Most importantly, the FES has proven sensitive to change in fears following clinical interventions

5. Tinetti Balance Assessment tool or Tinetti Performance-Oriented Mobility Assessment (POMA)

   Time frame: 10 minutes

   It is a balancing tool with both a balance and a gait component that was created for the elderly. The balance component of the test evaluates the patient's ability to maintain postural control while standing, sitting statically, rising from a chair, immediately after standing, standing with eyes open and closed, turning 360 degrees, and during perturbation. The gait component evaluates the following during gait: symmetry, initiation, continuation, path, base of support, and postural sway. measures reactive balance by asking the patient to react to a perturbation.

   The test comprises 16 items:

   • 9 balance-related items and
   • 7 gait-related items

6. Mini-BESTest Balance Evaluation System Test (BEST)

   Time frame: 5 minutes

   The Mini-BESTest, the shorter version of the BESTest, was developed to reduce the assessment time. - 14-item Mini-BESTest is scored on a 3-level ordinal scale:

   • 0 : poor balance performance
   • 2: no balance impairment. Several studies have shown that the Mini-BESTest also was reliable and valid and useful for fall prediction. The use of the Mini-BESTest in community-dwelling people with chronic stroke has recently been reported, with excellent interrater and intrarater reliability and validity.

7. 2 Minutes Walking test

   Time frame: 2 minutes

   There are 5 versions of walking tests available in the stroke population, the 12-, 6-, 5-, 3-, and 2-Minute Walk Tests.

   Will use 2 MWT:

   • To assess exercise tolerance in chronic airflow limitation.
   • Highly correlated with the 6 and 12 MWTs. A valid measure of self-selected walking speed.
   • The most time efficient.