Activities-specific Balance Confidence Scale Scores Research Articles

Application of clinical indicators in evaluating vestibular compensation efficacy in benign recurrent vestibular vertigo patients with short-term personalized vestibular rehabilitation.

Short-term personalized vestibular rehabilitation (ST-PVR) can establish stable vestibular compensation. However, there is a lack of a clear definition for clinical indicators that can dynamically reflect the progress of vestibular rehabilitation (VR). To explore the clinical indicators suitable for evaluating the effectiveness of ST-PVR in treating benign recurrent vertigo (BRV). In total, 50 patients diagnosed with BRV were enrolled. All patients received the ST-PVR treatment program. At 2 and 4weeks after rehabilitation, subjective scales, including the visual analogue scale (VAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence scale (ABC) and generalized anxiety disorder (GAD-7) were assessed. Objective vestibular function tests were performed. VR grading was determined. At 2 weeks after rehabilitation, significant enhancements were observed in VAS, DHI, ABC, GAD-7, UW, vHIT results, and VR grading scores (p < 0.05). The sensory organization test (SOT) results demonstrated statistically significant improvements at 2 weeks and 4 weeks after rehabilitation (p < 0.05). Both subjective scales and partial examination results in objective assessment can serve as indicators to dynamically monitor the compensatory process of vestibular function in patients with BRV. The VR efficacy grading score, which incorporates the above indicators, allows for quantification of the changes that occur during the vestibular rehabilitation process.

The Relationship between Balance Confidence and Center of Pressure in Lower-Limb Prosthesis Users

Background: Agreement between the activities-specific balance confidence scale (ABC) and center of pressure (CoP) in prosthesis users is still very much unknown. The purpose of this study was to investigate the agreement between ABC and CoP in lower-limb prosthesis users. Methods: Twenty-one individuals with lower-limb prostheses were recruited. Participants were provided with the ABC scale and performed static balance tasks during eyes opened (EO) and eyes closed (EC) conditions whilst standing on a force platform. Pearson product moment coefficients between CoP displacements and ABC scores were performed. Participants were also stratified by those who had better (≥80 on ABC scale) and less (&lt;80 on ABC scale) perceived balance confidence. Displacement was compared using an independent t-test with Cohen’s d to estimate effect size with alpha set at 0.05 for these tests. Results: There was a significant inverse moderate relationship between eyes opened displacement (EOD) (18.3 ± 12.5 cm) and ABC (75.1 ± 18.3%), r = (19)−0.58, p = 0.006, as well as eyes closed displacement (ECD) (37.7 ± 22.1 cm) and ABC, r = (19)−0.56, p = 0.008. No significant difference in EOD (t(19) = 1.36, p = 0.189, d = 0.61) and ECD (t(19) = 1.47, p = 0.156, d = 0.66) was seen between those with greater and less balance confidence. Conclusions: Self-report and performance-based balance outcome measures are recommended when assessing lower-limb prostheses users.

Mobility Rehab visual feedback system for gait rehabilitation in older adults

BackgroundGait and balance impairments are among the main causes of falls in older adults. The feasibility and effectiveness of adding sensor-based feedback to physical therapy (PT) in an outpatient PT setting is unknown. We evaluated the feasibility and effectiveness of PT intervention combined with a therapist-assisted visual feedback system, called Mobility Rehab, (PT + MR) in older adults.MethodsTwenty-eight older adults with and without neurological diseases were assigned either PT + MR (n = 22) or PT alone (n = 6). Both groups performed 8 sessions (individualized) of 45 min long (30 min for gait training and 15 min for endurance, strength, and balance exercises) in an outpatient clinic. Mobility Rehab uses unobtrusive, inertial sensors on both wrists and feet, and at the sternum level with real-time algorithms to provide real-time feedback on five gait metrics (step duration, stride length, elevation at mid-swing, arm swing range-of-motion [ROM], and trunk coronal ROM), which are displayed on a tablet. The primary outcome was the Activities-specific Balance Confidence scale (ABC). The secondary outcome was gait speed measured with wearable inertial sensors during 2 min of walking.ResultsThere were no between-group differences at baseline for any variable (P > 0.05). Neither PT + MR nor PT alone showed significant changes on the ABC scores. PT + MR, but not PT alone, showed significant improvements in gait speed and arm swing ROM. The system was evaluated as ‘easy to use’ by the PT.ConclusionsOur preliminary results show that PT + MR improves gait speed in older adults with and without neurological diseases in an outpatient clinic.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03869879.

Effects of incorporating dual task into repeated 6-min walk test on balance and walking functions in patients with subacute stroke: A randomized controlled trial.

To explore the effects of incorporating dual task into a repeated 6-min walk test (6MWT) on balance and walking functions in patients with subacute stroke. Twenty-eight subacute stroke survivors were randomized into experimental group (EG) and control group (CG). EG and CG participated in dual task during the repeated 6MWT and the repeated 6-min test, respectively, for twice a day, three times weekly over 4weeks. Outcome assessments were measured pre- and post-test using the 10-m walk test (10MWT), timed up and go test (TUG), 6MWT, Berg balance scale (BBS), and the activities specific balance confidence scale (ABC). In the between-group comparison, change values in the 6MWT and ABC values between pre- and post-test appeared to be significantly different (p<0.05). In within-group comparisons, the 10MWT, 6MWT, TUG, and ABC scores showed significant differences between pre- and post-test values in two groups (p<0.05). Repeated 6MWT may be beneficial to enhance balance and walking functions in patients with subacute stroke, with more favorable effects when performing dual tasks.

Tai chi as an adjunctive therapy for individuals who plateau after vestibular rehabilitation.

This study aimed to evaluate the effectiveness of tai chi on balance in patients with improved but persistent dizziness and imbalance following completion of traditional vestibular rehabilitation therapy. Patients who completed vestibular rehabilitation therapy with persistent imbalance were prospectively enrolled in a tai chi programme comprising eight weekly classes. Balance was assessed before the first and after the eighth session using the Dynamic Gait Index, Activities-Specific Balance Confidence scale and Dizziness Handicap Inventory. A total of 37 participants (34 females, 3 males) completed the programme with balance testing. Mean age was 76.8 years (range, 56-91 years). Mean Dynamic Gait Index significantly increased after completion of tai chi (p < 0.00001). Mean Activities-Specific Balance Confidence scale score increased from 63.6 to 67.9 per cent (p = 0.046). A subset (n = 18) of patients completed a Dizziness Handicap Inventory without significant post-therapeutic change (p = 0.62). Most (36 of 37; 97.3 per cent) patients demonstrated post-therapy improvement on one or more assessments. Tai chi is a viable adjunct to improve balance in patients who complete a vestibular rehabilitation therapy programme.

Self-perceived balance confidence is independently associated with any subsequent falls and injurious falls among community-dwelling older fallers: A prospective cohort study

IntroductionBalance confidence contributes to activity restriction, decline in physical function, and falls, potentially. This study aimed at examining whether balance confidence is a significant fall predictor independent of physical function measures in community-dwelling older adults. MethodsThis was an observational cohort study. Self-perceived balance confidence was measured by the Activities-specific Balance Confidence scale (ABC) and the short form of it, ABC-6. Other potential predictors included gait speed, Five Times Sit-to-Stand Test, Physiological Profile Assessment (PPA), age, sex, cognition, depression, arthritis, body mass index, recurrent fall history, number of comorbidities, number of prescribed medications, and the use of walking aids. Fall occurrence and subsequent injuries were followed up trimonthly for 12 months. The association of the potential predictors with falls was examined with multivariable logistic regression analyses. Sensitivity analysis for their association with injurious falls in a year was performed. Results461 community-dwelling older adults with a fall history in the past year completed the 12-month follow-up (mean age 70.6±7.1 years, range 60–92 years; 81% females). Participants with high balance confidence (ABC score ≥76 and ABC-6 score ≥64) were less likely to fall in the subsequent year, independently of the physical function measures and other covariates (adjusted OR 0.51-0.57, 95%CI 0.30-0.97, p<0.05). ConclusionBalance confidence is a significant fall predictor independent of physical function measures and other covariates in community-dwelling older adults with a history of falls. Future studies might investigate the causal effects of balance confidence on the risk of falling with randomized controlled trials.

Pilot trial of physical and cognitive changes related to fall risk in enzalutamide patients with castration-resistant prostate cancer (CRPC).

e17018 Background: Advanced prostate cancer disproportionally affects older men (age ≥ 75 years). Despite representing only 26% of diagnoses, older men represent half of those diagnosed with metastatic disease and half of all prostate cancer deaths. Treatment options for CRPC include enzalutamide (enza), a competitive inhibitor of the androgen receptor, which shows improved overall survival and other cancer-specific responses in older men. However, enza is also reportedly associated with increased fall frequency of unclear pathophysiology. This pilot study examines strength, balance, and cognition in men before and 12 weeks after starting enza therapy for CRPC. Methods: This prospective single-arm study included men about to begin enza for CRPC, ≥ 65 years, able to ambulate independently. The following tests were administered at baseline and 12 weeks after initiation of enza: Sit-to-stand test (STS), Timed-Up-and-Go test, proprioception assessment, computerized dynamic posturography including sensory organization test (SOT), motor control test (MCT), and limits of stability; Functional Assessment of Cancer Therapy-Prostate, BPI-SF, Activities-specific Balance Confidence (ABC), Montreal Cognitive Assessment (MoCA), International Physical Activity Questionnaire (IPAQ), and the Godin leisure-time exercise questionnaire (GLTEQ). Falls were assessed with self-report fall diaries and calls from study team to participants over the course of 12 months. Results: Twenty-five participants enrolled. Median age was 75 years. There were 23 (92%) with both baseline and 12-week assessments, and 21 (84%) participants had complete falls data. From baseline to the 12-week follow up, ABC scale scores decreased (median 90.4 to 85.2), GLTEQ scale scores decreased (median 31.4 to 28.0), and time sitting per day from IPAQ increased (4 hours to 5 hours). Of those evaluable for falls, 15 (71%) did not fall during the 12 months and 6 (29%) fell at least once. The fallers and non-fallers did not differ with respect to age or MoCA scores at baseline and on re-assessment. Those who fell performed more poorly on the STS test, the ABC and the dynamic posturography evaluations. Those who fell also had a higher level of activity by GLTEQ. Conclusions: This pilot study does not clearly elucidate the pathophysiology of falls in older men with CRPC taking enza but does provide useful and important guidance for the design of future studies in this area. Baseline and 12-week testing should be repeated at the 24-week time-point to allow for sufficient exposure to enza. To avoid confounding by practice effects, physical tests, particularly dynamic posturography, should be performed at least once prior to baseline assessment. Further research is needed to understand the mechanisms underlying the increased risk of falls previously observed in older men with CPRC taking enza.

Efficacy of supervised vestibular rehabilitation on functional mobility in patients with chronic vestibular hypofunction.

[Purpose] This study aimed to compare the effects of different intervention frequencies on walking ability and balance in patients with chronic unilateral vestibular hypofunction. [Participants and Methods] Participants included in this case-control study were assigned to one of two groups: the multiple-intervention (once a week) and single-intervention groups. Results for the Timed Up and Go test, Dynamic Gait Index, Functional Gait Assessment, and Activities-specific Balance Confidence scale were determined at baseline and four weeks after initiating the vestibular rehabilitation program. Thereafter, intra- and inter-group differences in the rates of change of these parameters were determined. [Results] The Timed Up and Go test values, Dynamic Gait Index, and Functional Gait Assessment scores improved significantly after four weeks in the multiple-intervention group. The improvement rate in the Timed Up and Go test differed significantly between the two groups. The Activities-specific Balance Confidence scale scores did not significantly change in either group after four weeks. [Conclusion] Compared to a single intervention, multiple interventions by a physical therapist produced significantly greater benefits in a relatively shorter period of time in patients with chronic unilateral vestibular hypofunction.

Walking while talking: validation in older adults with lower-limb amputation.

Walking while talking (WWT) is a dual-task (cognitive and motor) performance test that has not yet been validated in older adults with lower-limb amputation (LLA). WWT is composed of two sections: WWT-simple (walking while reciting every letter of the alphabet) and WWT-complex (walking while reciting every other letter of the alphabet). To determine the validity, and provide normative data and a new scoring system for the WWT test in older adults with LLA. Baseline cross-sectional data were collected from 56 community-living older adults (≥50 years old) with LLA at rehabilitation hospitals in Vancouver, BC, London, ON, and Edmonton, AB, Canada. Time and number of recited letters and errors during both sections were recorded. A new score was developed based on all these variables. Correlations of the recorded times with the Activities-specific Balance Confidence (ABC) scale and the 2-Minute Walk Test (2MWT) score were used to evaluate the validity of the WWT test. As hypothesized, the times for both sections of the WWT were negatively correlated with both the ABC and 2MWT scores. Positive correlations were observed between the scores developed for both WWT sections with the 2MWT score. Times taken to complete each section of the WWT test were correlated with the 2MWT and the ABC scale scores, providing evidence for the validity of the WWT test. We also provided a scoring method that is more objective and in line with the dual-task nature of the test.

Trekking Poles to Aid Multiple Sclerosis Walking Impairment: An Exploratory Comparison of the Effects of Assistive Devices on Psychosocial Impact and Walking.

Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making. Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices-a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)-at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F). The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores. Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration.

Beyond Physical Capacity: Factors Associated With Real-world Walking Activity After Stroke

ObjectiveTo identify homogeneous subsets of survivors of chronic stroke who share similar characteristics across several domains and test if these groups differ in real-world walking activity. We hypothesized that variables representing the domains of walking ability, psychosocial, environment, and cognition would be important contributors in differentiating real-world walking activity in survivors of chronic stroke. DesignCross-sectional, secondary data analysis. SettingUniversity/laboratory. ParticipantsA total of 283 individuals with chronic (≥6mo) stroke (N=238). InterventionsNot applicable. Main Outcome MeasuresThirteen variables representing 5 domains were included: (1) walking ability: 6-minute walk test (6MWT), self-selected speed (SSS) of gait; (2) psychosocial: Patient Health Questionnaire-9, Activities-specific Balance Confidence (ABC) scale; (3) physical health: low-density lipoprotein cholesterol, body mass index, Charlson Comorbidity Index (CCI); (4) cognition: Montreal Cognitive Assessment (MoCA); and (5) environment: living situation and marital status, work status, Area Deprivation Index (ADI), Walk Score. Mixture modeling was used to identify latent classes of survivors of stroke. After identifying the latent classes, walking activity, measured as steps per day (SPD), was included as a distal outcome to understand if classes were meaningfully different in their real-world walking ResultsA model with 3 latent classes was selected. The 6MWT, SSS, ABC scale, and Walk Score were significantly different among all 3 classes. Differences were also seen for the MoCA, ADI, and CCI between 2 of the 3 classes. Importantly, the distal outcome of SPD was significantly different in all classes, indicating that real-world walking activity differs among the groups identified by the mixture model. ConclusionsSurvivors of stroke with lower walking ability, lower self-efficacy, lower cognitive abilities, and greater area deprivation had lower SPD. These results demonstrate that the physical and social environment (including socioeconomic factors) and cognitive function should also be considered when developing interventions to improve real-world walking activity after stroke.

Association of polypharmacy with postural instability and impaired balance in community-dwelling older adults in Turkey

Objective: Polypharmacy, an important geriatric syndrome, has been shown to be an independent risk factor for falling. However, the data about effects of polypharmacy on balance is lacking. We aimed to evaluate the effects of polypharmacy and inappropriate drug use on balance in older adults. Patients and Methods: Fifty-one patients using ≥ 5 drugs and 50 patients using &amp;lt; 5 drugs were included in the study. Inappropriate drug usage of the patients was evaluated by Beers criteria. Postural stability and risk of falling was investigated by using Biosway Portable Balance System (BPBS). Activities and functional status of the patients were assessed by using Short Physical Performance Battery (SPPB) and Activities Specific Balance Confidence Scale (ABC). All patients underwent comprehensive geriatric assessment. Results: Age, gender, hand grip strength, SPPB scores of the patients were similar between polypharmacy and control groups (all had p&amp;gt;0.05). ABC score was higher in polypharmacy group than control (p&amp;lt;0.01). Overall, anterior-posterior, medial-lateral stability index and eyes closed firm surface scores detected in BPBS were higher, indicating worse stability in the polypharmacy group than control (p&amp;lt;0.05). Limit of stability score was lower in the polypharmacy group than control (p=0.03). Rates of polypharmacy and inappropriate drug usage were higher in patients with a history of falling than without (p&amp;lt;0.01, p&amp;lt;0.01, respectively). In multivariate analysis model, polypharmacy was found to be an independently correlated parameter for impaired balance (OR 24.31; 95%CI 3.05- 193.91; p&amp;lt;0.01). Conclusion: This study has demonstrated that polypharmacy might be a related factor for impaired balance. Struggling with polypharmacy should be one of the most important part of comprehensive geriatric assessment.

Prevalence and determinants of falls in persons with multiple sclerosis without a clinical disability

BackgroundFalls are common in persons with Multiple Sclerosis (pwMS) and lead to destructive results, specifically with increasing disability. However, there is only scarce data investigating prevalence and determinants of falls in pwMS without a clinical disability. Therefore, this study aimed to investigate proportion of fallers and related factors in pwMS without a clinical disability. MethodsOne hundred and four pwMS with no clinical disability (EDSS≤1.5) were recruited in this cross-sectional study. The outcome measures comprised of the Timed 25-Foot Walk (T25FW), Six Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Multiple Sclerosis Walking Scale (MSWS-12), Single Leg Stance Test (SLS), Activities-Specific Balance Confidence Scale (ABC), Symbol Digit Modalities Test (SDMT), Modified Fatigue Impact Scale (MFIS), and Beck Depression Inventory-II (BDI-II). The number of falls during the last three months was recorded. Results: Twenty-five percent of the pwMS reported at least one fall in the last three months. The TUG and MSWS-12 scores were significantly greater in the fallers compared to non-fallers (p<0.05). Whereas the fallers had significantly less ABC scores (p<0.05). Increasing TUG and MSWS-12 score and decreasing ABC score was related with increased risk of being classified as a faller adjusting for EDSS score. ConclusionThe present findings highlight that falls are frequent problem for pwMS, even if they do not have a clinical disability. Therefore, falls prevention strategies are also required in the early stages of the disease in clinical practice. The ABC scale, MSWS-12, and TUG test can be used by the clinicians and researchers to predict potential fallers of the pwMS without a clinical disability.

Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study.

The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.

Is The Physical Activity Vital Sign Associated With Fall Risk In Older Adults?

PURPOSE: ACSM Exercise Is Medicine (EIM) initiative recommends the use of Physical Activity Vital Signs (PAVS) as an objective measure to assess compliance with the Physical Activity Guidelines for Americans. While physical activity is important for overall health, it may not necessarily improve balance and reduce risk of falls. The purpose of this study is to determine the associations between PAVS and measures of fall risk. METHODS: 65 seniors (age=81.2+8.0) participated. The PAVS was calculated in accordance with ACSM Exercise is Medicine. Fall risk was assessed using the Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG), and BTrackS™ Balance Plate. A less than 68-point ABC score suggested less balance confidence and a fall risk. A greater than 12-second TUG time and greater postural sway on the balance plate (based on BTrackS normative data) suggested a fall risk. Dependent measures were dichotomized as fall risk or no fall risk. Separate point biserial correlations were conducted to determine associations between the PAVS and fall risk category for the ABC, TUG, and postural sway. RESULTS: No signficant associations existed between PAVS and ABC (r = .23; p = .06), TUG (r = .20; p = .12), or postural sway (r = -.01; p = .94). CONCLUSIONS: Increasing physical activity levels based on the PAVS was not strongly associated with scores from commonly used fall risk assessments. This finding suggests that meeting physical activity guidelines alone may not be sufficient to reduce fall risk. While the PAVS can provide benefical information regarding other health factors, clinicians should utilize established balance screening tools and incorporate balance exercises into physical activity prescription to reduce fall risk in older adults.

Reliability, Validity, and Responsiveness of the Mini-Balance Evaluation Systems Test in Ambulatory Individuals with Multiple Sclerosis.

Purpose: The purpose of this study was to determine the reliability, validity, and responsiveness of the Mini-Balance Evaluation Systems Test (MBT) in persons with multiple sclerosis (pwMS). Method: A total of 32 pwMS completed a questionnaire on disease severity, the Activities-specific Balance Confidence Scale (ABC), and the MBT. The MBT was re-administered 1 week later. Results: The interrater and test-retest reliability of the total MBT and subscales were excellent. The standard error of measurement for the total MBT, calculated from test-retest and interrater reliability, respectively, was 1.32 and 1.07. The minimal detectable change (MDC) for the total MBT was 3.74; the MDC for the subscales ranged from 0.98 (sensory) to 2.38 (gait). The correlations between individual subscale scores and the total MBT, among subscales, and between the total MBT and disease severity and ABC were excellent. Correlations between the total MBT and age, MS type, and fall and imbalance histories were moderate. Disease severity and ABC scores were the strongest predictors of MBT score. No floor effects were found. Ceiling effects were found for two subscales, but not for the total MBT. Conclusions: The MBT is reliable and valid in pwMS. MDC values will facilitate assessing the effectiveness of treatment. Because ceiling effects were found for two subscales, but not the total MBT, it is recommended that clinicians administer the MBT in its entirety.

An Investigation of the Predictors of Comfortable and Fast Gait Speed in Community-Dwelling Older Adults.

To identify the unique predictors of comfortable and fast gait speed in community-dwelling older adults using measures of physical performance (eg, lower extremity strength and balance), self-reported balance confidence, and global cognitive function. Demographic information was collected from 60 healthy, community-dwelling older adults older than 60 years. Participants completed the following assessments: Mini-Mental State Examination; Activities-Specific Balance Confidence Scale; 30-second Chair Stand (30-SCS); Functional Reach (FR); and gait speed (comfortable and fast) using the GAITRite system. Hierarchical linear regression was used to examine the relationship of both fast and comfortable gait speeds with functional performance (CST and FR), cognition (Mini-Mental State Examination), Activities-Specific Balance Confidence Scale, and demographic information (age, gender, and body mass index). Functional performance measures (30-SCS and FR) explained 55.4% and 64.7%, respectively, of the variance in comfortable and fast gait speed. Unique predictors for comfortable gait speed included 30-SCS, FR, and body mass index. Unique predictors of fast gait speed included 30-SCS, FR, gender, body mass index, and Activities-Specific Balance Confidence Scale score. These predictors explained 68.5% and 80.4% of the total variance in comfortable and fast gait speed, respectively. Global cognition was not a unique predictor of gait speed when performance measures were statistically controlled. However, the current study measured global cognitive status rather than the specific cognitive constructs, such as processing speed or executive function. Further research is needed to determine the role of cognition in the composition of gait speed. Gait speed is an important indicator for many outcomes such as fall risk, mortality, and functional status. Understanding that key variables of strength and balance comprise a large portion of gait speed allows clinicians to better direct their care and optimize rehabilitation outcomes. This study specifically used functional measures of strength and balance that can be easily implemented in the clinical setting.

Variables that Influence Basic Prosthetic Mobility in People With Non‐Vascular Lower Limb Amputation

There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals. To determine the influence of modifiable and non-modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model. Secondarily, to determine if personal factors and self-reported balance and mobility are predictive of Component timed-up-and-go (cTUG) performance. Cross-sectional study of a convenience sample. National conference. People (N=68) with non-vascular causes of unilateral LLA. Assessment of anthropometrics, mobility, bilateral hip extensor strength, hip range of motion, single limb balance, and self report measures. Lasso linear regression and extreme gradient boosting analyses were used to determine influence of variables on prosthetic mobility. Timed performance of the cTUG. The following five variables were found to influence basic prosthetic mobility (P ≤ .05) in people with transtibial amputation: hip extensor strength, hip range of motion, single limb balance, waist circumference, and age. In the transfemoral cohort, number of comorbidities and waist circumference primarily influenced prosthetic mobility. Additionally, 66% of the variance in cTUG total time for the entire sample could be explained by simply regressing on level of amputation, number of comorbidities, age and Activities-specific Balance Confidence scale score, all variables easily collected in a waiting room. Variables that are modifiable with physical therapy intervention including hip extensor strength, hip range of motion, single limb balance, and waist circumference significantly influenced basic prosthetic mobility. These variables can be affected by targeted rehabilitation interventions and lifestyle changes. II.

Interpreting Prefrontal Recruitment During Walking After Stroke: Influence of Individual Differences in Mobility and Cognitive Function.

Background: Functional near-infrared spectroscopy (fNIRS) is a valuable neuroimaging approach for studying cortical contributions to walking function. Recruitment of prefrontal cortex during walking has been a particular area of focus in the literature. The present study investigated whether task-related change in prefrontal recruitment measured by fNIRS is affected by individual differences in people post-stroke. The primary hypotheses were that poor mobility function would contribute to prefrontal over-recruitment during typical walking, and that poor cognitive function would contribute to a ceiling in prefrontal recruitment during dual-task walking (i.e., walking with a cognitive task).Methods: Thirty-three adults with chronic post-stroke hemiparesis performed three tasks: typical walking at preferred speed (Walk), serial-7 subtraction (Serial7), and walking combined with serial-7 subtraction (Dual-Task). Prefrontal recruitment was measured with fNIRS and quantified as the change in oxygenated hemoglobin concentration (ΔO2Hb) between resting and active periods for each task. Spatiotemporal gait parameters were measured on an electronic walkway. Stepwise regression was used to assess how prefrontal recruitment was affected by individual differences including age, sex, stroke region, injured hemisphere, stroke chronicity, 10-meter walking speed, balance confidence measured by Activities-specific Balance Confidence (ABC) Scale, sensorimotor impairment measured by Fugl-Meyer Assessment, and cognitive function measured by Mini-Mental State Examination (MMSE).Results: For Walk, poor balance confidence (ABC Scale score) significantly predicted greater prefrontal recruitment (ΔO2Hb; R2 = 0.25, p = 0.003). For Dual-Task, poor cognitive function (MMSE score) significantly predicted lower prefrontal recruitment (ΔO2Hb; R2 = 0.25, p = 0.002).Conclusions: Poor mobility function predicted higher prefrontal recruitment during typical walking, consistent with compensatory over-recruitment. Poor cognitive function predicted lower prefrontal recruitment during dual-task walking, consistent with a recruitment ceiling effect. These findings indicate that interpretation of prefrontal recruitment should carefully consider the characteristics of the person and demands of the task.

The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma.

Vestibular schwannoma removal causes unilateral vestibular deafferentation, which results in dizziness and postural unsteadiness. Vertigo and balance problems together are among the most important aspects affecting quality of life. Intensive vestibular rehabilitation, which starts before surgery, with following postsurgical supervised rehabilitation, using visual biofeedback propose an instrument to accelerate a recovery process. Another option how to accelerate the vestibular compensation, is employment of presurgical gentamicin ablation together with vestibular rehabilitation (prehabilitation) of vestibular function. Purpose of present study was to examine the dynamics of vestibular compensation process using supervised intensive vestibular rehabilitation with visual biofeedback in the short-term postsurgical period. The second aim was to compare both studied groups mainly to evaluate if prehabilitation has potential to accelerate the compensation process in the early postoperative course. The study included 52 patients who underwent the retrosigmoid vestibular schwannoma removal. They were divided into two groups. The first group was prehabilitated with intratympanic application of gentamicin before surgery to cause unilateral vestibular loss (14 patients), the second group (38 patients) was treated in standard protocol without prehabilitation. All patients underwent at home vestibular training before surgery to learn new movement patterns. Following the surgery supervised intensive vestibular rehabilitation including visual biofeedback was employed daily in both groups between the 5th and 14th postoperative day. Outcome measurements included an evaluation of subjective visual vertical (SVV), posturography and the Activities-Specific Balance Confidence Scale (ABC). ANOVA for repeated measurements was used for statistical analysis. We observed significant improvement in SVV (p < 0.05), posturography parameters (p < 0.05) and ABC scores (p < 0.05) with postoperative rehabilitation program following surgery in both groups. There was no statistically significant difference between group treated by prehabilitation and group without prehabilitation. Results of this study showed that intensive postsurgical rehabilitation represents key factor in compensation process following retrosigmoid vestibular schwannoma surgery. Prehabilitation did not speed up recovery process.