# Real-Time Feedback Training to Improve Postural Control in a Patient With Femoral Neck Fracture and Severe Dementia: A Case Study

## TL;DR

A 97-year-old woman with severe dementia and a hip fracture improved her balance using a real-time feedback system that doesn't require complex instructions.

## Contribution

A real-time feedback balance training method is shown to be feasible and effective for patients with severe dementia.

## Key findings

- Functional balance and COP parameters improved during BASYS-based training.
- Spectral analysis showed reduced power in mid- and low-frequency bands of COP movement.
- Static standing balance training is viable for patients with severe cognitive impairments.

## Abstract

Older adults with Alzheimer’s disease have a higher risk of falling compared to cognitively healthy individuals, partly due to the combined presence of cognitive decline and motor impairments. In older adults with severe dementia, conventional balance training is often difficult to implement because of reduced comprehension and difficulty following complex instructions. To address these challenges, there is increasing interest in balance interventions that are cognitively accessible, feasible under static conditions, and do not rely heavily on active motor learning or verbal instruction. Balance training using the Balance Adjustment System (BASYS) (Tec Gihan Co., Ltd., Kyoto, Japan) can be performed in a static standing position and is expected to offer clinical benefits. This case study examined the changes observed following BASYS-based balance training, which reduces body sway in real-time, on balance improvement. The subject was a 97-year-old female patient with severe Alzheimer’s disease and a femoral neck fracture. Conventional balance training was used initially, followed by an intervention phase of balance training with BASYS. The observed changes following the intervention were assessed based on changes in functional balance and center of pressure (COP) parameters during static standing. Improvements in both functional balance and COP parameters were observed during the period in which balance training with BASYS was implemented. Furthermore, spectral analysis of the anterior-posterior (AP) component of the COP revealed a reduction in the relative power of the mid- and low-frequency bands of the AP spectral density, which may suggest potential alterations in balance control mechanisms. These findings suggest that a static standing approach could support balance training in patients with severe dementia.