Falling, an epidemic most prevalently seen in the elderly population, accounts for the majority of injury-related cases seen by emergency departments across the United States. Unfortunately, with no large-scale institutionalization of a solution, the problem is only expected to exacerbate as our planet’s population approaches the 7 billion mark. In the wake of the recent surge of falls among the elderly, Japan has implemented a program to include unicycling in the physical education curriculum for elementary schools across the country. The goal for this program is to encourage children to establish strong fundamental balancing skills, which could potentially alleviate the pain—physical, emotional, and financial—incurred from falls in the elderly. This senior thesis study builds off Japan’s unicycling program by investigating ways to improve wobble board balancing, a more practical alternative to unicycling. In previous research, the skill of stick balancing, a motor task that has been shown to behave with the same power laws as wobble board balancing, has been improved with the use of vibrations. Here, we show that learning to wobble board balance is not expedited and wobble board balancing skill is not improved with the employment of vibrations, unlike stick balancing. Nonetheless, those who learned to wobble board balance with background vibrations went on to later outperform those who learned to wobble board balance without vibrations. These results suggest that vibrations (50 Hz, 0.18 mm amplitude) have a beneficial effect on the development of skill for wobble board balancing that is not related to the direct physical effects of the vibration. The observations also suggest that in the presence of vibrations, the nervous system develops more robust strategies for controlling balance.

Bakgrund: Tio till tjugo procent av akuta skador på ligamenten kring fotleden resulterar ikronisk fotledsinstabilitet, vilket innebär en instabilitetskänsla, stukningstendens, smärta ochsvullnad i fotleden. Det är värdefullt att som fysioterapeut ha kunskap om vilkenrehabiliteringsmetod som förbättrar balans i syfte att öka stabiliteten i foten. Syfte: Sammanställa litteraturen och bedöma det vetenskapliga underlaget gällande effektenpå balansen hos individer med kronisk fotledsinstabilitet genom träning med balansbräda.Detta ställs upp i två sammanvägningar: balansbräda jämfört med styrketräning, ochbalansbräda jämfört med ingen behandling. Metod: En systematisk litteratursökning efter randomiserade kontrollerade studier utfördes idatabaserna PubMed, Uppsala universitetsbibliotek, samt Cochrane Library. Totaltinkluderades åtta studier med sammanlagt 286 deltagare. Samtliga studier kvalitetsgranskadesenligt PEDro-skalan, och GRADEstud användes för bedömning av det sammanvägdaresultatets tillförlitlighet. Resultat: Signifikant förbättring av balans kopplat till styrketräning samt balansträning medbalansbräda, men liten fördel för en kombination för de båda kopplat till statisk balans. Kvalitetsgranskning enligt PEDro visade på att sex studier hade en måttlig kvalité och tvåstudier hade hög kvalité. Utifrån evidensbedömningen anses det föreligga en lågtillförlitlighet till det vetenskapliga underlaget för styrketräning med motståndsband förfotleden samt balansträning med balansbräda. Konklusion: Både styrketräning för relevant muskulatur och balansträning med balansbrädaförbättrar balansen efter ett ≥4 veckor långt protokoll med ≥3 träningssessioner/vecka.Evidensen talar för att båda rehabiliteringsmetoder ger liknande utfall, men fler studierbehövs för att bekräfta resultatet då de sammanvägda resultaten har låg tillförlitlighet. / Background: Ten to twenty percent of acute ankle injuries result in chronic ankle instability,which results in instability in the foot, distorsion tendency, and pain and swelling around theankle. Thus it´s valuable for physiotherapists to have knowledge regarding whichrehabilitation methods yield the most positive effect on balance in order to increase stabilityin the foot. Purpose: To compile the literature and assess the evidence regarding the effects on balanceof people diagnosed with chronic ankle instability through rehabilitation with awobble-board. This is set up in two comparisons: wobble-board compared tostrength-training, and wobble-board compared to no treatment. Method: A systematic literature search for randomized controlled trials was done inPubMed, Uppsala University Library, and CochraneLibrary. A total of eight studies wereincluded in this review, with a total of 286 participants. Study quality was judged by using the PEDro-scale, and GRADEstud was used to assess the reliability of the combined results. Results: Significant improvement in balance related to resistance training and balancetraining with wobble-board, with a small advantage to training with a combination of the twowhen measuring static balance. Quality according to PEDro showed six studies of moderatequality and two studies of high quality. Grading of the evidence is deemed insufficient whenit comes to training with resistance bands and training with a wobble-board. Conclusion: Both strength-training for the relevant muscles and balance-training using thewobble-board improves the balance after a ≥4 week-long protocol with ≥3 sessions/week.The evidence shows that both methods give similar results, however further research isrequired to confirm the results because the reliability of the combined results was deemedinsufficient.