Activities Balance Confidence Scale Research Articles

On-line pilates program as an alternative to conventional rehabilitation therapy for people with multiple sclerosis, pilot study

IntroductionRestrictions in physical activity during Covid-19 pandemic had an impact on exercise activities on people with chronic diseases such as multiple sclerosis, for whom regular exercise is important for managing the disease. Therefore, alternative forms of exercise and rehabilitation were in high demand. The aim of pilot study was to verify the feasibility and potential effect of an online Pilates exercise programme for people with mild to moderate disability due to multiple sclerosis. MethodsThe exercise programme was scheduled for 12 weeks (2 times a week for 45 minutes of Pilates exercise combined with 30 minutes of aerobic activity based on participants preferences).The participants' adherence and the anthropometric parameters (weight, BMI, waist circumference) and the functional tests (Single-Leg Stance Test, Sit to Stand Test) were measured together with the patient reported outcomes to monitor patient's psychological well-being and exercise effect (General Self-efficacy Scale and Activity Balance Confidence Scale). ResultsThe total number of 22 women with multiple sclerosis completed the pilot programme. The exercise program proved to be feasible. After 12 weeks of the online Pilates exercise programme significant improvements were found only in the parameter waist circumference (p = 0.03) and in the functional test Sit to Stance (p = 0.01). For the other tests, despite some improvement (self-efficacy and subjective perceived balance performance), there was no significant statistical difference. ConclusionThe online Pilates exercise programme supervised by a physiotherapist is feasible for people with mild to moderate neurological disability. It seems to have a positive impact on the anthropometric parameters, but this result needs to be evaluated on larger sample of patients.

Living with dizziness impacts health-related quality of life among older adults.

This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health-related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC-scale), and Euro-QoL-5D-3L questionnaires. A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non-dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non-dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. 2b.

Neuromotor and functional assessment of the non-progressive to progressive transition in multiple sclerosis: a multiple case study

Background The search for sensitive outcome measures that discriminate among subtypes of multiple sclerosis (MS) is important for targeting appropriate treatment and assessing the efficacy of intervention. Even more elusive are measures that can identify and track disease progression. Longitudinal studies targeted at assessing functional and neuromotor measures over time may enable us to characterize the natural history of the transition from non-progressive to progressive forms. Methods In this multiple case study, we examined functional and neuromotor measures from three individuals who were part of a large-scale longitudinal study (N=93), and for whom we captured the transition to progressive MS. All participants were tested at 3 timepoints (approximately every 12 months) across 5 domains: patient-reported (Fatigue Severity Score, Visual Analog Fatigue Scale, Activities Balance Confidence Scale, Godin Leisure Time Questionnaire), mobility function (Timed 25 Foot Walk, Timed Up and Go), sensation (vibration sensitivity thresholds of foot and hand), proprioception (ankle- and elbow- position matching, and a multi-joint finger matching task) and motor (rapid foot and hand tapping). Only descriptive data will be reported. Results One participant transitioned between the first and second visits, while two transitioned between the second and third. Across most outcome measures there was rarely a linear change identified. Particularly for the participants for which transition occurred between visits 2 and 3, the second visit (just prior to their diagnosis of progressive MS) often demonstrated an inflection point of either worsening or improvement of neuromotor measures followed by a reversal towards their baseline levels. Foot vibration sensitivity demonstrated worsening that appeared to mirror means of the larger cohort, although there was a ceiling effect. Discussion These data underscore the need for robust longitudinal studies with frequent assessments to characterize how neuromotor and functional measures change prior to, during and following the transition from non-progressive to progressive MS. The search for sensitive outcome measures that discriminate among subtypes of multiple sclerosis (MS) is important for targeting appropriate treatment and assessing the efficacy of intervention. Even more elusive are measures that can identify and track disease progression. Longitudinal studies targeted at assessing functional and neuromotor measures over time may enable us to characterize the natural history of the transition from non-progressive to progressive forms. In this multiple case study, we examined functional and neuromotor measures from three individuals who were part of a large-scale longitudinal study (N=93), and for whom we captured the transition to progressive MS. All participants were tested at 3 timepoints (approximately every 12 months) across 5 domains: patient-reported (Fatigue Severity Score, Visual Analog Fatigue Scale, Activities Balance Confidence Scale, Godin Leisure Time Questionnaire), mobility function (Timed 25 Foot Walk, Timed Up and Go), sensation (vibration sensitivity thresholds of foot and hand), proprioception (ankle- and elbow- position matching, and a multi-joint finger matching task) and motor (rapid foot and hand tapping). Only descriptive data will be reported. One participant transitioned between the first and second visits, while two transitioned between the second and third. Across most outcome measures there was rarely a linear change identified. Particularly for the participants for which transition occurred between visits 2 and 3, the second visit (just prior to their diagnosis of progressive MS) often demonstrated an inflection point of either worsening or improvement of neuromotor measures followed by a reversal towards their baseline levels. Foot vibration sensitivity demonstrated worsening that appeared to mirror means of the larger cohort, although there was a ceiling effect. These data underscore the need for robust longitudinal studies with frequent assessments to characterize how neuromotor and functional measures change prior to, during and following the transition from non-progressive to progressive MS.

Effect of a physical therapeutic intervention on locomotive syndrome in the elderly patients with Parkinson’s disease and sarcopenia

Purpose: to evaluate the effectiveness of the effect of physical therapy on the indicators and severity of locomotive syndrome in elderly patients with Parkinson’s disease and sarcopenia.
 Material and methods: 57 elderly people with Parkinson’s disease in combination with sarcopenia were examined. They were divided into two groups: group 1 (followed the principles of standard protocols of outpatient rehabilitation) and group 2 (followed the physical therapy program, which was developed in terms of patient-centered model of rehabilitation taking into account the specifics of each comorbid condition with the use of functional training on the «Prosedos» platform, therapeutic exercises, massage, occupational therapy, nutrition correction, and patient education). The control group consisted of 24 elderly people without signs of sarcopenia and Parkinson’s disease. The effectiveness of the program was evaluated by the dynamics of 25-question Geriatric Locomotive Function Scale, Dynamic Gait Index, Functional Gait Assessment, Activities Balance Confidence Scale, Modified Parkinson Activity Scale.
 Results: Elderly patients with Parkinson’s disease and sarcopenia were diagnosed with locomotive syndrome stage 2 (according to the 25-question Geriatric Locomotive Function Scale), which manifested itself as a high risk of falling and deteriorating dynamic balance (according to Dynamic Gait Index, Functional Gait Assessment), decreased confidence in maintaining balance during activities (according to Activities Balance Confidence Scale), violation of activities of daily living (according to Modified Parkinson Activity Scale); it was statistically significantly worse than in their peers (p<0.05). The developed program of physical therapy led to a statistically significant (p<0.05) improvement of all studied parameters of locomotive syndrome in comparison with baseline and the condition of patients who received standard restorative correction.
 Conclusions: Elderly patients with comorbid pathology (Parkinson’s disease and sarcopenia) need new physical therapy programs considering the specifics of each disease and its correcting, the presence of locomotive syndrome to improve social and domestic activity of patients and reduce health risks associated with geriatric syndromes – falls and frailty.

Modifying the five-time sit-to-stand test to allow use of the upper limbs: Assessing initial evidence of construct validity among lower limb prosthesis users.

The Five-time Sit-to-Stand (5xSTS) Test is a performance-based measure used by clinicians and researchers to assess the body functions needed to accomplish sit-to-stand transitions (e.g., lower limb strength, balance, and trunk control). The current requirements for performance of the 5xSTS Test (i.e., crossing arms over the chest) may not be appropriate for many, if not most lower limb prosthesis (LLP) users. The study aims were to (1) develop a modified five-time sit-to-stand (m5xSTS) Test protocol; (2) to examine initial evidence of known-groups construct validity among LLP users by comparing differences in performance by amputation level, amputation etiology, and functional level; and (3) to assess initial evidence of convergent construct validity by examining the correlations between m5xSTS performance with self-reported mobility (Prosthetic Limb Users Survey of Mobility (PLUS-M)), self-reported balance confidence (Activities-balance Confidence Scale (ABC)) and functional capability (comfortable walking speed). Three-hundred sixty-one LLP users participated in this cross-sectional study. The investigators developed a m5xSTS Test protocol that allows tested individuals to use different assistance strategies (i.e., use of upper limbs to push off thighs, push up from the armrests, or use a walker) when needed to perform the test. The investigators recorded m5xSTS Test times and assistance strategies. Significant differences in m5xSTS Test times were found between those who did and did not use an assistance strategy, as well as between participants grouped by different amputation level, etiology, and functional level. Significant moderate negative correlations were found between m5xSTS Test times and PLUS-M T-score (ρ = -0.42, p<0.001), ABC score (ρ = -0.42, p<0.001), and comfortable walking speed (ρ = -0.64, p<0.001), respectively. The m5xSTS Test allows LLP users to perform sit-to-stand transitions in a manner that accounts for their functional impairments, is consistent with post-amputation training, and is safe for the tested individual. Results from this study provide preliminary evidence of known groups and convergent construct validity for the m5xSTS Test with a large national sample of LLP users.

A new paradigm for assessing postural stability

BackgroundThe sensory organization test (SOT) is an established and effective method for assessing postural stability and determining fall risk. SOT equilibrium scores are derived from the relationship between an individual’s peak sway amplitude and a standard, theoretically-derived normal limits of stability (tLOS). Determining an individual’s postural stability and fall risk based on this one-size-fits-all tLOS may overestimate functional equilibrium scores and underestimate fall risk when personal stability limits (pLOS) are reduced. Research questionThe purpose of this study is to investigate whether LOS measured from a group of healthy adults is different from the tLOS, and whether SOT equilibrium scores are significantly different when calculated using pLOS versus the standard tLOS. MethodsSixty healthy volunteers were recruited into three age-groups: young (18−39), middle-aged (40−64), and elderly (65−80), with 10 males and 10 females in each age-group. Outcome measures included SOT and LOS. Additional measures o balance perception and functional mobility were obtained including the Activities Balance Confidence (ABC) scale and the timed-up-and-go test (TUG). The tLOS and pLOS were used to calculate standard (tSOT) and personalized (pSOT) equilibrium scores. ResultsThe mean pLOS from the group of healthy adults was significantly lower than the tLOS. Consequently, the pSOT equilibrium scores were significantly lower than the standard SOT scores derived using the tLOS. SignificanceIndividual measures of LOS are significantly lower than theoretical estimates of the LOS in healthy adults. This suggests that use of tLOS in the calculation of SOT equilibrium scores often overestimates postural stability and may have implications for the determination of fall risk.

The minimal clinically important difference for gait speed in significant unilateral vestibular hypofunction after vestibular rehabilitation

Gait speed is a valid measure of both physical function and vestibular health. Vestibular rehabilitation is useful to improve gait speed for patients with vestibular hypofunction, yet there is little data to indicate how changes in gait speed reflect changes in patient-reported health outcomes. We determined the minimal clinically important difference in the gait speed of patients with unilateral vestibular hypofunction, mostly due to deafferentation surgery, as anchored to the Dizziness Handicap Index and the Activities Balance Confidence scale, validated using regression analysis, change difference, receiver-operator characteristic curve, and average change methods. After six weeks of vestibular rehabilitation, a change in gait speed from 0.20 to 0.34 m/s with 95% confidence was required for the patients to perceive a significant reduction in perception of dizziness and improved balance confidence.

Minimal clinically important difference of modified dynamic gait index in people with neurological disorders.

The minimal clinically important difference (MCID) of modified Dynamic Gait Index (mDGI) has not yet been determined for People with Neurological Disorders (PwND). To establish the MCID of the mDGI to determine clinically meaningful improvement in balance and gait in PwND. In this longitudinal study from a randomised clinical trial, 55 participants both in and outpatients with neurological disorders, received fifteen 40-minute rehabilitation sessions. Inpatients received daily treatments over a period of three weeks while outpatients received three treatments/week over a period of five weeks. An anchor-based method using percentage rating of improvement in balance (Activities Balance Confidence scale, ABC) was used to determine the MCID of mDGI. The MCID was defined as the minimum change in mDGI total score (post - pre intervention) that was needed to perceive at least a 10 % improvement on the ABC scale. A Receiver Operating Characteristic curve was used to define the cut-off for the optimal MCID of the mDGI discriminating between improved and not improved participants. The MCID of the mDGI total score was 6 points and Area under the Curve was 0.64. For the mDGI time sub-scores the MCID was 2 points and Area under the Curve was 0.6. The MCID of balance and gait improvement measured by mDGI was prudently establish at ≥7 points, meaning that this is the minimum improvement score PwND need to get to perceive a clinically relevant change in their balance and gait confidence. These reference values can be a tool incorporated into clinicians daily practice to interpret mDGI change scores helping to determine whether the intervention is effective; to develop clinical tailored intervention goals and to establish meaningful perceived change in PwND.

The effects of hallux extension on plantar pressure behavior and foot posture

The minimal clinically important difference (MCID) of modified Dynamic Gait Index (mDGI) has not yet been determined for People with Neurological Disorders (PwND).To establish the MCID of the mDGI to determine clinically meaningful improvement in balance and gait in PwND.In this longitudinal study from a randomised clinical trial, 55 participants both in and outpatients with neurological disorders, received fifteen 40-minute rehabilitation sessions. Inpatients received daily treatments over a period of three weeks while outpatients received three treatments/week over a period of five weeks. An anchor-based method using percentage rating of improvement in balance (Activities Balance Confidence scale, ABC) was used to determine the MCID of mDGI. The MCID was defined as the minimum change in mDGI total score (post – pre intervention) that was needed to perceive at least a 10 % improvement on the ABC scale. A Receiver Operating Characteristic curve was used to define the cut-off for the optimal MCID of the mDGI discriminating between improved and not improved participants.The MCID of the mDGI total score was 6 points and Area under the Curve was 0.64. For the mDGI time sub-scores the MCID was 2 points and Area under the Curve was 0.6.The MCID of balance and gait improvement measured by mDGI was prudently establish at ≥7 points, meaning that this is the minimum improvement score PwND need to get to perceive a clinically relevant change in their balance and gait confidence. These reference values can be a tool incorporated into clinicians daily practice to interpret mDGI change scores helping to determine whether the intervention is effective; to develop clinical tailored intervention goals and to establish meaningful perceived change in PwND.

Examining the Relationship Between Conventional Outcomes and Immersive Balance Task Performance in Service Members With Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) is associated with significant financial cost and reduced military readiness and impacts quality of life for active duty service members (SMs). Post-concussive symptoms can include vestibular impairments, such as chronic dizziness and postural instability, which can be compounded by psychological comorbidities like PTSD. Comprehensive vestibular evaluations are required to assess symptoms and guide clinical decision-making. At the National Intrepid Center of Excellence (NICoE), in addition to traditional vestibular assessments, clinicians can also leverage virtual environments (VEs) in the Computer-Assisted Rehabilitation Environment (CAREN) to further evaluate balance. The objective of this study was to examine the relationship between conventional outcomes and VE performance on immersive balance tasks in the CAREN, determine whether VE performance could predict conventional outcomes, and explore the impact of PTSD. This retrospective analysis included 112 SMs from the NICoE Intensive Outpatient Program who provided informed consent for their clinical data to be used for research purposes. All had a history of mTBI, underwent vestibular evaluations, and completed immersive balance tasks on the CAREN. Conventional outcomes included the Sensory Organization Test (SOT), Functional Gait Assessment (FGA), Activities Balance Confidence (ABC) Scale, and Dizziness Handicap Inventory (DHI). The PTSD Checklist-Military Version was added to account for behavioral symptoms. Computer-Assisted Rehabilitation Environment outcomes included total time to complete the Balance Cubes VE, with the platform static (BC-Static) and with random platform motion (BC-PM) as well as composite scores for the Shark Hunt VE, with (SH-Recall) and without a recall task (SH-Standard). Statistical analyses included independent t-tests to determine group differences, Pearson's correlations to examine relationships between conventional outcomes and VE performance, and binary logistic regressions to determine if VE performance predicted conventional outcomes based on clinically relevant cutoffs. SMs who took less time to complete BC-Static had better overall balance, indicated by higher ABC, SOT, and FGA scores (P <.001). Those with greater self-reported dizziness, higher DHI scores, took longer to complete BC-Static (P < .05). FGA and SOT, objective gait and balance, were similarly correlated to BC-PM performance (P <.001). SMs with higher SOT scores, better balance, also tended to have higher SH-Standard scores (P <.1). SMs, who were above normative SOT, FGA, and ABC cutoffs, completed BC-Static significantly faster than those below (P <.05). This remained true for BC-PM but was only significant for SOT (P = .004). Performance on BC-Static, BC-PM, and SH-Standard was significant predictors of SOT score. For SMs with comorbid mTBI and PTSD, increased functional disability was observed in conventional outcomes and diminished VE performance was noted. Objective balance and gait, SOT and FGA, demonstrated the strongest relationships to immersive VE performance in the CAREN. Our findings suggest that these immersive balance tasks may be effective as an adjunct assessment to examine balance. Future work will focus on moving these VEs from the CAREN to a portable system, which could be more readily utilized in a variety of clinical settings, increasing accessibility.

Mobility Matters: A Pilot Study on Increasing Health Literacy Among Fall-Risk Elders

Mobility is important to sustain for older adults to live independently. The purpose of this project was to evaluate teach back and ask me 3 interventions with a health education program that included Otago strength and balance exercise and a walking program The pilot program, Mobility Matters, was completed with 16 older adults (mean age =76, range 63-87, SD = 8.6), 69% African American, 94% female. Older adults with moderate fall risk were recruited from community centers and participated in a 3-month program where they were paired with physical therapy students for pre- and post-intervention assessment. Participants were randomly assigned to a health literacy intervention group (HLG) (n=9) and received teach back and ask me 3 intervention twice a month for three months. The control group (n=7) received the same program of balance exercises/ walking program and after 3 months was given the health literacy intervention. Groups were not significantly different on age, gender and REALM scores. Assessment measures included: timed up and go, 30 second chair rise, 4 stage step test, 6 minute walk test, and activity balance confidence scale (ABC). Paired t-test analysis revealed mean significant differences on the measures of four stage balance test (p =.008), six-minute walk test (p=.026) and approached significance on ABC (p=.054). No significant differences were found for the non-health literacy group on all measures. The results suggest that health literacy intervention may improve outcomes for health education interventions with balance and aerobic exercise.

The effects of vestibular rehabilitation training on the symptoms of vertigo and disability in patients with vestibular peripheral vertigo

Objective: To compare the effects of vestibular rehabilitation training and drug therapy on the symptoms of vertigo and disability in patients with vestibular peripheral vertigo. Methods: This prospective study was enrolled 43 patients with vestibular peripheral vertigo who admitted to the outpatient department of Eye & ENT Hospital of Fudan University from January 2018 to December 2018. They were randomly divided into two groups: control group (drug treatment group) and experimental group (drug treatment combined rehabilitation training group). All patients filled in the first vertigo disability rating scale (DHI), specific activity balance confidence scale (ABC) and anxiety self-rating scale (SAS) on the day of treatment and at two, four and eight weeks after treatment intervention, and the data were statistically analyzed. Results: There was no significant difference in gender, age and body weight between the two groups (P>0.05). After treatment (Control group (4w) : DHI (45.5±30.6) , ABC (86.9±12.4) , SAS (37.9±8.2) Experimental group (8w) : DHI (34.8±28.5) , SAS (35.7±7.9) ) , the three scales of the two groups were better than before treatment (Control group: DHI (59.2±25.9) , ABC (79.7±16.7) ,SAS (41.1±6.8) ; Experimental group: DHI (55.2±20.5) , ABC (80.3±18.3) , SAS (41.9±9.1) ) . The comparison of data before and after treatment in each group according to treatment time indicated that DHI and ABC scores in the experimental group showed that the DHI and ABC scores of the experimental group changed significantly at 2 weeks after treatment, and the SAS scores changed at 4 weeks after treatment. The difference was statistically significant (P<0.05). However, there was a statistically significant difference between the control group DHI score 4 weeks after treatment and SAS score 8 weeks after treatment (P<0.05). ABC score did not show statistical difference (P>0.05). Conclusion: The subjective symptoms and anxiety of vertigo and disability in the two groups improved obviously after treatment. Compared with drug therapy alone, drug therapy combined with vestibular rehabilitation training can significantly improve patients' subjective symptoms of vertigo and disability, as well as their anxiety and depression, so as to improve their overall quality of life.

Trunk and foot acceleration variability during walking relates to fall history and clinical disability in persons with multiple sclerosis

BackgroundPersons with multiple sclerosis are often at higher risk for falling, but clinical disability scales and fall risk questionnaires are subjective and don't provide specific feedback about why an individual is unstable. The purpose of this study was to determine how relationships between trunk and foot acceleration variability relate to physiological impairments, clinical disability scales, and mobility questionnaires in persons with multiple sclerosis. Methods15 fallers and 25 non-fallers with multiple sclerosis walked on a treadmill at normal walking speed while trunk and foot accelerations were recorded with wireless accelerometers and variability measures were extracted and used to calculate the gait stability index metrics as a ratio of trunk acceleration variability divided foot acceleration variability. Subjects' sensorimotor delays and lower extremity vibration sensitivity were tested. Subjects also completed clinical disability scales (Guy's Neurological Disability Scale and Patient Reported Expanded Disability Status Scale) and mobility questionnaires (Falls Efficacy Scale, Activities Balance Confidence Scale, 12 Item Multiple Sclerosis Walk Scale). FindingsMultiple gait stability index metrics were significantly correlated with clinical measures of disability and mobility in multiple sclerosis subjects (r = 0.354–0.528), but no correlations were found for sensorimotor delays or lower extremity sensation. Multiple gait stability indices performed at least as well as clinical questionnaires for separating fallers from non-fallers. InterpretationThe gait stability indices can potentially be used outside of a laboratory setting to measure walking characteristics related to fall history and disability level in people with multiple sclerosis.

Dance improves symptoms, functional mobility and fine manual dexterity in people with Parkinson disease: a quasi-experimental controlled efficacy study.

Clinically, individuals diagnosed with Parkinson disease (PD) present several symptoms that impact on their functional independence and quality of life. While there is accumulating evidence supporting dance as an effective symptom management option, few studies have objectively assessed these benefits, particularly related to the Dance for Parkinson's Disease® (DfPD®) program. The aim of this study was to explore the effects of DfPD®-based dance classes on disease-related symptoms, fine-manual dexterity and functional mobility in people with PD. A quasi-experimental controlled efficacy study, with pre and post testing of two parallel groups (dance versus control). Community. Thirty-three participants with PD allocated to one of two groups: dance group (DG; N.=17; age=65.8±11.7 years) or control group (CG: N.=16; age=67.0±7.7 years). They were cognitively intact (Addenbrooke's Score: DG=93.2±3.6, CG=92.6±4.3) and in early-stage of disease (Hoehn & Yahr: DG=1.6±0.7, CG=1.5±0.8). The DG undertook a one-hour DfPD®-based class, twice weekly for 12 weeks. The CG had treatment as usual. Both groups were assessed at baseline and after 12 weeks on disease-related symptom severity (MDS-Unified Parkinson Disease Rating Scale: MDS-UPDRS), fine-manual dexterity (Perdue Peg Board), measures of functional mobility (Timed Up & Go: single & dual task, Tinetti, Berg, Mini-BESTest) and self-rated balance and gait questionnaires (Activities Balance Confidence Scale: ABC-S; Gait and Falls: G&F-Q; Freezing of Gait: FOG). Compared to the CG, there was significantly greater improvement in the DG pre-post change scores on measures of symptom severity MDS-UPDRS, dexterity, six measures of functional mobility, and the ABC-S, G&F-Q, FOG questionnaires. DfPD®-based dance classes improved disease-related symptom severity, fine-manual dexterity, and functional mobility. Feasibility of the approach for a large scale RCT was also confirmed. DfPD® could be an effective supportive therapy for the management of symptoms and functional abilities in PD.

Effect of Balance Training on Health Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Objective: There is a need to find the effect of balance training with pulmonary rehabilitation in subjectswith COPD. The Purpose of this study is to find the effectiveness of balance training with pulmonaryrehabilitation on improvement of balance, exercise tolerance, health related quality of life and risk of falls.Method: A 20 moderate COPD subjects randomised into experimental group and control group. Theexperimental group with 10 subjects were treated with balance training along with pulmonary rehabilitationand control group with 10 subjects were treated with pulmonary rehabilitation for eight weeks. The outcomemeasurements such as Berg Balance Scale, Timed Up and Go Test, Activities Balance Confidence (ABC)scale, 6 minutes walk test and St George Respiratory Questionnaire was measured before and after 8 weeksof intervention in both the groups’ subjects.Results: There is a statistically significant difference (p&lt;0.05) in means of balance measures, Six minuteswalk test, and St. George respiratory questionnaire between the groups. There is no statistically significantdifference in St. George respiratory questionnaire components- Symptoms, and Activity score between thegroups.Conclusion: The subjects with moderate COPD shown greater improvement in balance, exercise tolerance,health related quality of life and reduced risk of falls in pulmonary rehabilitation with balance training.

THE DAILY BALANCE PROJECT: AN INQUIRY INTO THE INTRAINDIVIDUAL DYNAMICS OF PERCEIVED AND ACTUAL FALL RISK

An accurate understanding of one’s abilities and limitations allows adaptive response to the challenges that are faced in daily life. However, older adults may over or under estimate their actual abilities. The Daily Balance Project examined the intraindividual dynamics of older adults’ perceived balance with objective measures of balance and physical activity. For 30 consecutive days, following a comprehensive fall risk assessment, 20 older adults rated their balance confidence (Activities Balance Confidence scale) at that moment and then performed five standardized balance assessments measured via smartphone accelerometer held to their chest. Physical activity was measured with an activity monitor. Baseline measurements of fall risk differentiated the extent of intraindividual variation and co-variation of balance and physical activity. For some participants, actual and perceived balance became more closely aligned as the study progressed. The implications of the findings for life-span perspectives on aging and fall prevention are discussed.

A Novel Approach to Fall Risk Reduction: Combining Education and Therapeutic Yoga

Falls have negative consequences for older adults, but falls can be reduced through interventions that target the reduction of fall risk factors. Cognitive behavioral education programs and therapeutic yoga are two interventions that have independently been used as a means to reduce the risk of falls. The purpose of this study was to determine if adding therapeutic yoga following an education intervention improved well known fall risk factors. Potential participants were recruited through a senior center for a 12-week fall prevention program that consisted of four weeks of an evidence-informed educational program and eight weeks of therapeutic yoga. Physical performance measures and psychosocial constructs were tested at baseline (T1), between the education intervention and yoga (T2), and after yoga (T3). Physical performance measures included the chair stand test to assess lower-body strength, the Timed Up-and-Go to assess agility and dynamic balance, and the Fullerton Advanced Balance Scale to assess static and dynamic balance. Psychosocial surveys included the University of Illinois at Chicago Fear of Falling to assess fear of falling, the Leisure Constraints Scale to assess constraints to physical activity, and the Activities Balance Confidence Scale, to assess perceived balance ability. A repeated measures test was used to determine if any significant changes in fall risk factors occurred. There were significant improvements in balance confidence after education, in agility and dynamic balance after yoga, and in fear of falling across the full 12-week intervention. Adding therapeutic yoga following education improved more outcomes than education alone and this combined intervention warrants further exploration as a fall risk reduction strategy.

Retrospective Balance Study for Individuals With Chronic Obstructive Pulmonary Disease: Evaluating the Effect of a 1-Month Physical Therapy Program

Purpose: To determine whether a 1-month physical therapy (PT) program that includes a balance component improves balance impairments and fear of falling in individuals with chronic obstructive pulmonary disease (COPD), and to evaluate the utility of the Four Square Step Test (FSST) and Functional Reach Test (FRT) in this population. Methods: A retrospective analysis of participants with COPD in a PT program between May 2015 and December 2015. Assessments performed before and after therapy were the Berg Balance Scale (BBS), FRT, FSST, and Activities Balance Confidence Scale (ABC) questionnaire. Statistical analysis used Pearson product–moment coefficient of correlation, 1-tailed T test, and Independent T test. Results: Twenty-five individuals with COPD completed the PT program. Individuals at high risk of falls experienced significant improvements on the BBS (6.6 points, P = .0097), FSST (6.75 seconds, P = .001), and FRT (5.63 cm, P = .01333). The BBS and FSST were correlated with each other (r = 0.70) at baseline. Improvements in the ABC were not statistically significant (P = .071). Use of supplemental oxygen was not correlated with any assessment tool. Conclusions: People with greater balance deficits had significant improvements in balance after a 1-month PT program. The FSST should be investigated further in patients with COPD.

Changes in Nonmotor Symptoms Following an 8-Week Yoga Intervention for People with Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative disorder marked by progressive degenerative motor symptoms (e.g., tremors, impaired balance and gait) and nonmotor symptoms (e.g., fatigue, sleep disturbances, pain) that can negatively influence health-related quality of life (HRQoL). Previous studies have shown that yoga for individuals with PD improves balance, strength, and mobility. However, little research has been conducted to determine the effect of yoga on nonmotor symptoms of PD. The purpose of this study was to examine changes in nonmotor symptoms among individuals with PD following an 8-week yoga intervention. Data used for analyses were part of a larger study that researched improvements in motor function for individuals with PD. Participants (N = 27) were randomly assigned to experimental (n = 15) and control (n = 12) groups and completed pre- and postintervention quantitative measures. Within-group improvements were statistically significant for fatigue measured by the Parkinson's Fatigue Scale, balance confidence measured by the Activities Balance Confidence Scale, the belief in one's ability to manage falls measured by the Falls Management Scale, activity constraints measured by the Activities Constraint Questionnaire, and PD-specific quality of life measured by the Parkinson's Disease Questionnaire-8. Across-group changes were statistically significant for activity constraints. Findings indicate yoga may be an efficacious intervention for improving nonmotor symptoms as well as HRQoL for individuals with PD.

Abstract TP166: The Six Minute Walk Test as a Predictor for Fall Risk in Persons With Stroke

Introduction: Persons with stroke have increased risk for recurrent stroke, other chronic health conditions and falls. One option to reduce the risk of worsening health conditions is to increase physical activity by engaging in group medical fitness programs like cardiac rehabilitation (CR). CR programs utilize clinical measures for functional capacity, commonly exercise stress testing or the six-minute-walk test (6MWT). Absent is measurement and focus on balance or balance confidence. Supervising staff may be unaware of fall risk which is an important safety factor for persons with stroke. The purpose of this study was to determine the degree to which the 6MWT is associated with fall risk in community-dwelling persons with stroke. Methods: A cross-sectional analysis measured association between the 6MWT and fall risk in 66 persons with stroke. Fall risk is defined as a score on the Activities Balance Confidence Scale (ABC) of &lt; 81.1 based on a study by Beninato et al. (2009) which found significant accuracy of fall prediction with this cutoff (Sensitivity = 1.00, Specificity = 0.72(0.51-0.93)). The 6MWT and the 6MWT combined with other data differing between fall risk groups (e.g. walking speed, Berg Balance Scale and time since stroke) were evaluated using univariate logistic regression to determine influence on fall risk. The best fit model was used in Receiver Operating Characteristic (ROC) analysis to determine the area under the curve (AUC) to detect an increased risk of falls. Likelihood ratios and post-test probabilities were calculated. Results: The 6MWT was associated with fall risk in logistic regression (p=0.002) with an odds ratio (OR) of 0.995 (0.991,0.999), p=0.007). The AUC for the univariate 6MWT ROC model (best fit) was 0.701 (p=0.006). The cutoff for increased fall risk was 6MWT &lt; 331.65 meters. The post-test probability of fall risk was 74.3%, increased from a pre-test probability of 59.1%. Conclusion: The association between fall risk and 6MWT suggests that in addition to aerobic capacity and motor components, the 6MWT includes a fall risk/balance confidence component. In conclusion, utilizing the 6MWT to screen fall risk in CR and other community exercise programs can enhance safety for persons with stroke without additional testing burden.