Comparing the effects of Swiss-ball training and virtual reality training on balance, mobility, and cortical activation in individuals with chronic stroke: study protocol for a multi-center randomized controlled trial

Abstract Background: Balance and mobility deficits are major concerns in stroke rehabilitation. virtual reality (VR) training and Swiss-ball training are commonly used approaches to improve balance and mobility. However, no study has compared the efficacy of VR training and Swiss-ball training in improving balance and mobility function or investigated cortical activation and connectivity in individuals with stroke. Methods: A prospective, single-blinded, parallel-armed, multi-center randomized controlled trial with 4 weeks of training will be conducted. Seventy-six participants aged 30–80 years with stroke will be recruited.Participants will be allocated to one of four groups: A) the VR + Swiss-ball training + conventional physical therapy group; B) the Swiss-ball training + conventional physical therapy group; C) the VR training + conventional physical therapy group; or D) the conventional physical therapy group. All participants will receive 50 min of training per day, 5 times per week, for a total of 4 weeks. The primary outcomes will be balance and mobility measures. Secondary outcomes will include the 10-minute walk test,dynamic gait index and cortical activation. Outcomes will be measured on three occasions: at baseline, after the training, and at the 4-week follow-up. Discussion: This trial will provide evidence to determinewhether there are differences in clinical outcomes and cortical activation following two different types of exercise programs and/or their combination and to elucidate the recovery mechanisms of balance and mobility function in individuals with stroke. Trial registration: Chinese Clinical Trial Registry reference: www.chictr.org.cn (No. ChiCTR2400082135)