Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2016; 7(8): 513-518
Published online Aug 18, 2016. doi: 10.5312/wjo.v7.i8.513
Slacklining and stroke: A rehabilitation case study considering balance and lower limb weakness
Charles P Gabel, Natalie Rando, Markus Melloh
Charles P Gabel, Coolum Physiotherapy Sunshine Coast, Queensland 4573, Australia
Natalie Rando, Physiotherapy Program, Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland 4226, Australia
Markus Melloh, Centre for Health Sciences, School of Health Professions, Zurich University of Applied, Sciences, 8400 Winterthur, Switzerland
Markus Melloh, Centre for Medical Research, University of Western Australia, Nedlands 6909, Australia
Author contributions: Charles PG performed the rehabilitation exercises with the case study patient in the clinical setting; Markus M provided vital input for the manuscript content, references and editing of the manuscript; Natalie R provided specific vital input regarding neurological rehabilitation, referencing and editing of the manuscrip; all authors contributed to writing the manuscript.
Institutional review board statement: This case study was approved by the Coolum Physiotherapy Clinic through a clinical directors meeting to approve the study as part of a research initiative.
Informed consent statement: The patient has provided her informed consent.
Conflict-of-interest statement: No author has a conflict of interest for this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Charles P Gabel, MDT, PHD, Private Researcher, Coolum Physiotherapy Sunshine Coast, PO Box 760, Coolum Beach, Queensland 4573, Australia.
Telephone: +61-7-54461022 Fax: +61-7-54717022
Received: January 23, 2016
Peer-review started: January 24, 2016
First decision: March 24, 2016
Revised: April 4, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 18, 2016

To ascertain the effectiveness of slacklining as a supplementary therapy for elderly stroke patients who are functionally non-progressing. This case study involved an 18-mo prospective observation of the management of an 87-year-old female stroke-patient of the left hemisphere with reduced balance, reduced lower limb muscular activation, hypertonia, and concurrent postural deficits. This entailed the initial acute care phase through to discharge to home and 18-mo final status in her original independent living setting. The introduction of slacklining as an adjunct therapy was made 12 mo post incident. Slacklining involves balance retention on a tightened band where external environmental changes cause a whole-body dynamic response to retain equilibrium. It is a complex neuromechanical task enabling individualized self-developed response strategies to be learned and adapted. This facilitates the innate process of balance retention, lower-limb and core muscle activation, and stable posture through a combination of learned motor skills and neurological system down regulation. Individuals adopt and follow established sequential motor learning stages where the acquired balance skills are achieved in a challenging composite-chain activity. Slacklining could be considered an adjunct therapy for lower limb stroke rehabilitation where function is compromised due to decreased muscle recruitment, decreased postural control and compromised balance. Initial inpatient rehabilitation involved one-month acute-care, one-month rehabilitation, and one-month transitional care prior to home discharge. A further six months of intensive outpatient rehabilitation was provided with five hourly sessions per week including:supervised and self-managed hydrotherapy, plus one individual and two group falls’ prevention sessions. These were supported by daily home exercises. At 12 mo post incident, recovery plateaued, then regressed following three falls. Rehabilitation was subsequently modified with the hydrotherapy retained and the group sessions replaced with an additional individual session supplemented with slacklining. The slacklining followed stages one and two of a standardized five-stage protocol. Self-reported functional progression resumed with improvement by 14 mo which further increased and was sustained 18 mo (Students’t test P < 0.05). Slacklining’s external stimulations activate global-body responses through innate balance, optimal postural and potentially down-regulated reflex control. Incorporated into stroke rehabilitation programs, slacklining can provide measurable functional gains.

Keywords: Stroke, Rehabilitation, Lower limbs, Balance, Slacklining

Core tip: Slacklining may supplement stroke rehabilitation where lower limb function is compromised. This case study considers an 87-year-old female with reduced balance, reduced lower limb activation, and hypertonia. Rehabilitation from acute care to home discharge and subsequent six-month intensive outpatient therapy showed progression then plateaued at nine months. Three falls resulted in regression and rehabilitation was modified by supplementing slacklining. Functional progression improved by 14 mo and was sustained at 18 mo. Slacklining’s external stimulations activate global-body responses through innate balance, optimal postural response and potentially down-regulated reflex control that can provide quantifiable functional gains. Further prospective cohort studies are required.