Reliability and feasibility of gait initiation centre-of-pressure excursions using a Wii\xae Balance Board in older adults at risk of falling

James Lee,Adam P Shortland,Graham Webb,Rebecca Edwards,Charlotte Wilce,Gareth D Jones

doi:10.1007/s40520-018-0945-6

Abstract

BackgroundImpairments in dynamic balance have a detrimental effect in older adults at risk of falls (OARF). Gait initiation (GI) is a challenging transitional movement. Centre of pressure (COP) excursions using force plates have been used to measure GI performance. The Nintendo Wii Balance Board (WBB) offers an alternative to a standard force plate for the measurement of CoP excursion.AimsTo determine the reliability of COP excursions using the WBB, and its feasibility within a 4-week strength and balance intervention (SBI) treating OARF.MethodsTen OARF subjects attending SBI and ten young healthy adults, each performed three GI trials after 10 s of quiet stance from a standardised foot position (shoulder width) before walking forward 3 m to pick up an object. Averaged COP mediolateral (ML) and anteroposterior (AP) excursions (distance) and path-length time (GI-onset to first toe-off) were analysed.ResultsWBB ML (0.866) and AP COP excursion (0.895) reliability (ICC3,1) was excellent, and COP path-length reliability was fair (0.517). Compared to OARF, healthy subjects presented with larger COP excursion in both directions and shorter COP path length. OARF subjects meaningfully improved their timed-up-and-go and ML COP excursion between weeks 1–4, while AP COP excursions, path length, and confidence-in-balance remained stable.DiscussionCOP path length and excursion directions probably measure different GI postural control attributes. Limitations in WBB accuracy and precision in transition tasks needs to be established before it can be used clinically to measure postural aspects of GI viably.ConclusionsThe WBB could provide valuable clinical evaluation of balance function in OARF.

Highlights

There is a significant association between ageing and fall prevalence [1, 2] with concomitant economic impact costing the UK National Health Service (NHS) £2 billion per year [3]
COPnet excursion data were reduced to three parameters (Fig. 2); (1) mean maximum mediolateral (ML) horizontal distance (COPx), (2) mean maximum anteroposterior (AP) horizontal distance (COPy), and (3) the C OPnet path time (GI-onset to second toe-off time)
To establish initial C OPnet position prior to Gait initiation (GI), the mean (SD) position of the ML (COPx) and AP ( COPy) coordinates during 10 s of quiet stance were calculated per trial enabling starting position coordinates in the Wii Balance Board (WBB) reference frame to be established

Summary

Introduction

There is a significant association between ageing and fall prevalence [1, 2] with concomitant economic impact costing the UK National Health Service (NHS) £2 billion per year [3]. Aging Clinical and Experimental Research (2019) 31:257–263 flexibility, muscle weakness, poor mobility and balance confidence are modifiable if systematic exercise-based interventions are employed [1, 2]. These are often physiotherapistled prevention programmes for older adults who have fallen or are at risk of falling [4]. They include strength and balance (S + B) exercises monitored by reliable and valid clinical measures of balance and mobility limitations [5]. Conclusions The WBB could provide valuable clinical evaluation of balance function in OARF

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