Assessment Of Balance In Patients Research Articles

Reliability and Validity of the Spanish Version of the Brief-BESTest in Stroke Patients.

Background: Balance disorders and postural control treatments play an important role in fall prevention. The Brief-BESTest is a short-scale employed to evaluate balance and fall risk in different populations. Balance assessment is a fundamental element in patients with Acquired Brain Injury rehabilitation since postural alteration is one of the most frequent sequelae. The objective was to validate the Spanish version of the Brief-BESTest questionnaire in the stroke population. Methods: Subjects of both sexes aged over 18 years with a diagnosis of acute/chronic stroke were included. The BESTest, Mini-BESTest, Brief-BESTest, Berg Balance Scale, and Timed Up & Go Test were used to assess balance. The scales were implemented once. Cronbach's alpha coefficient was used to assess the internal consistency and confirmatory factorial analysis was employed to assess validity. Results: A total of 44 patients with a mean age of 65.35 years (SD = 10.665) participated. Cronbach's alpha coefficient showed a high internal consistency with a value of 0.839. In the criterion validity, there was a high positive correlation between the Brief-BESTest and BESTest (r = 0.879), Mini-BESTest (r = 0.808), and Berg Balance Scale (r = 0.711). Conclusion: The Spanish version of the Brief-BESTest scale is valid and reliable, showing adequate psychometric properties for balance assessment in patients with acute or chronic stroke.

Individual acute-phase bleeding and thrombotic risk balance assessment in patients undergoing percutaneous coronary intervention for acute myocardial infarction

BackgroundIndividualized treatment approach based on pre-procedural precise risk balance assessment between bleeding and thrombosis would be desirable for patients with myocardial infarction (MI) undergoing emergent percutaneous coronary intervention (PCI) in this ultra-short dual antiplatelet therapy era. We aimed to develop and validate a quick thrombosis/bleeding risk-balance assessment tool. MethodsWe developed and validated a novel thrombosis/bleeding risk-balance assessment tool using individual patient data from the prospective multicenter MI registry. Individual risks of thrombosis and bleeding within 7 days of the index PCI were estimated using a multinomial logistic regression model. The model was developed in the derivation cohort (4554 patients enrolled during 2003–2009) and validated in the validation cohort (2215 patients during 2010–2014). ResultsA total of 6769 patients (66 ± 12 years, 5175 men) were eligible in this analysis. Predictive performance of the multinomial logistic regression models for bleeding and thrombosis assessed by calibration plots was good both in the derivation and validation cohorts. The net predicted probability (NPP) was defined as predicted probability of bleeding event (%) – predicted probability of thrombotic event (%). The NPP successfully stratified patients into those with a higher risk of bleeding than thrombosis and those with a higher risk of thrombosis than bleeding. This finding was consistent between the derivation and validation cohorts. ConclusionsWe have established the risk balance assessment model for bleeding and thrombosis. Pre-procedural quick and precise assessment of the risk balance may help a decision making of procedural strategy and antithrombotic regimens in STEMI/non-STEMI patients undergoing PCI.

Posture stability and risk of fall test in the objective assessment of balance in patients with ectopic bone tissue after total hip replacement

Introduction. Total hip replacement is an operative treatment method for end-stage osteoarthritis, considered the most effective nowadays. One of the typical complications after the procedure is heterotopic ossification which may influence patient posture stability and increase the risk of falls. Aim. The study aimed to assess whether patients developing heterotopic ossifications after total hip replacement have a higher risk of falls in comparison to the matched-cohort group without them. Materials and methods. 46 out of 312 patients undergoing a total hip replacement in 2020 who developed heterotopic ossifications were observed. For these patients, a propensity score based on age, sex, and BMI was generated, and a matched-cohort control group consisting of 39 patients was selected. Each patient was operated on via an anterolateral approach, and an uncemented total hip prosthesis was implanted. Patients from both cohorts underwent postoperative radiological and biomechanical assessment and fulfilled WOMA C and Oxford questionnaires pre-and postoperatively. Statistical analyses of the results were performed. Results. There were statistically significant differences between cohorts in the postural stability test (4.9±1.1 vs 2.0±1.0 p<0.05), antero-posterior stability index (3.6±1.2 vs 1.6±0.9, p<0.05), medio-lateral stability index (3.0±1.3 vs 1.0±0.7, p<0.05) and risk of fall test (9.8±1.0 vs 7.8±1.0, p<0.05). No statistically significant differences were observed in the WOMA C and Oxford questionnaires. Conclusions. Our study proved that heterotopic ossifications, which appear in hip abductor muscles, could have an impact on balance and the risk of falls in patients after total hip replacement. In the elderly population, this can result in serious consequences such as a periprosthetic fracture or head trauma after total hip replacement.

The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review.

Background: Improving balance remains a challenge in stroke rehabilitation. The technological development has allowed the design of more accessible and user-friendly systems for assessing postural control. Objectives: The aim of this review was to analyze portable devices for the instrumental assessment of balance in patients with chronic stroke. Methods: PRISMA guidelines were used to carry out the systematic review. The literature search was restricted to articles written in English or Spanish published from 2013 to December 2022 in Pubmed, Web of Science, Scopus, PEDro, and CINAHL. Of the 309 search results, 229 unique references were reviewed after duplicates were removed. The PEDro scale was applied to evaluate the methodological quality of the included papers, and the degree of evidence and level of recommendation were determined through the Oxford Centre for Evidence-Based Medicine. Results: A total of seven articles reporting on five different balance testing devices were included in this systematic review; they regarded BIORescue, a smartphone application, and the Biodex-BioSway Balance System for the evaluation of standing balance, and SwayStar Balance and Xsens ForceShoes™ for the evaluation of dynamic balance during walking. Conclusions: The use of portable devices that assess balance in adult patients with chronic stroke is scarce.

Reliability and minimal detectable change of the Step Test in patients with knee osteoarthritis

IntroductionThe study aim was to evaluate the test-retest reliability and minimal detectable change of the Step Test in patients with knee osteoarthritis.MethodsThe intraclass correlation coefficient was used to assess the test-retest reliability of the Step Test. The minimal detectable change with 95% confidence interval (MDC95) was calculated to determine the true change. The inclusion criteria involved a diagnosis of knee osteoarthritis and age of ≥ 40 years.ResultsThirty-eight participants who met the inclusion criteria were investigated. Seven were male and the mean age equalled 61.23 ± 9.31 years. Three patients had radiographic findings indicative of Kellgren-Lawrence grade II, 10 of grade III, and 25 of grade IV. The Step Test presented excellent test-retest reliability. The intraclass correlation coefficient was 0.97, standard error of the mean was 0.46, and the MDC95 was 1.27.ConclusionsThe Step Test is a reliable outcome measurement for the assessment of balance in patients with knee osteoarthritis, and it showed excellent test-retest reliability in these patients. The test may assist clinicians and researchers in evaluating balance and planning rehabilitation in patients with knee osteoarthritis.

Results of assessment of oral acid-base balance in patients with mandibular fractures combined with periodontal pathology

Aim. To estimate the condition of acid-main balance of oral cavity in patients with fracture of the mandible in combination with parodontal pathology.Material and methods. 40 patients with fractures of the mandible in combination with parodontal pathology were observed in the study. They were divided into three groups. Patients of the first group had a fracture of the mandible in combination with chronic periodontitis. Patients of the second group had fractures of the mandible and chronic gingivitis. Patients of the third group had no bone-traumatic damages and parodontal pathology.Results and discussion. The activity of the parodontal microflora of the oral cavity in patients with the bone trauma of the mandible in combination with periodontitis is higher and characterizes the quick response component of the acid-main balance regulation in the oral cavity.Conclusion. Lingual raid is the main reservoir of oral microflora and its role under existing bone-traumatic damage on the background of parodontal pathology in maintaining microbiocenosis not only increases but also becomes the factor of destabilization regenerators processes at fracture of the mandible.

Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus.

Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance and other factors affecting balance impairment and fear of falling in patients with type 2 DM. Sixty-three patients with DM aged >50 years were categorized as having normal vibration sense (NVS; n = 34) or impaired vibration sense (IVS; n = 29) according to a VPT value of 8.9 μm. The following parameters were evaluated for all patients: postural steadiness through the fall index using posturography, functional balance through the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and fear of falling through the Falls Efficacy Scale-International (FES-I). The IVS group showed a significantly greater balance impairment in fall index, BBS, and TUG, as well as greater fear of falling on the FES-I than the NVS group. The linear regression analysis showed that the fall index was associated only with the VPT, whereas BBS, TUG, and FES-I were associated with the VPT, age, and/or lower extremity muscle strength. VPT, age, and/or muscle strength were identified as predictors of balance and fear of falling in patients with type 2 DM. Therefore, along with age and lower extremity strength, the VPT can be useful for balance assessment in patients with type 2 DM.

Static balance assessment in patients with severe osteoarthritis of the knee

BackgroundPain related to severe knee osteoarthritis may lead to static balance disorders. Patients with severe knee arthrosis with arthroplasty indication should be aware of the postoperative rehabilitation menu because their balance ability has decreased. MethodsThe study involved 33 patients with unilateral severe osteoarthritis (the study group) and 33 healthy subjects (the control group). We conducted the measurements of static balance with the CQStab2P platform. Functional disability was assessed using the Knee Society Score (KSS). ResultsIn the study group, balance distribution asymmetry between lower limbs was higher. Patients unloaded the painful joints due to pain and knee instability. We observed statistically significant differences both with eyes open and with eyes closed only for balance symmetry. The study group had mean results of 53.9 (±19.1 SD) points in the KSS scales and 52.1 (±24.1) in the KSS function. There were statistically significant positive correlations regarding KSS and body height (0.270; P < 0.05), and negative correlations for body mass index (0.329; P < 0.01). In measurements with open eyes, patients' KSS correlated with mean amplitude of sways (−0,227; P < 0.01) and max anteroposterior (−0.279; P < 0.01). In measurements with eyes closed, KSS function correlated with number of sways in the sagittal plane (0.331; P < 0.01). ConclusionsPatients with severe osteoarthritis suffered from balance disorders regarding limbs' asymmetrical loading both under visual control and without visual control.

Impaired Standing Balance in Individuals with Cervicogenic Headache and Migraine.

To determine whether a difference in standing balance exists among individuals with cervicogenic headache, those with migraine, and asymptomatic controls. A total of 24 participants with cervicogenic headache, 24 with migraine, and 24 asymptomatic controls of similar age, gender, and body mass index were included. Standing balance was assessed with a swaymeter under the conditions of eyes open and closed; on firm and soft surfaces; and in comfortable and narrow stances (for a total of eight testing conditions). Each condition was tested for 30 seconds. The outcome measures were sway area and displacement. Multivariate analysis of variance with Bonferroni post hoc test were used to analyze between-group differences in the postural sway variables. Both headache groups had significantly larger sway areas than the control group during comfortable stance with eyes open and with eyes closed on a soft surface (P < .05) and during narrow stance with eyes closed on firm and soft surfaces (P < .05). The overall results demonstrated significantly greater sway in the anterior-posterior direction and less sway in the medial-lateral direction in selected tests in the cervicogenic headache group compared to the migraine group. Individuals with cervicogenic headache and those with migraine have impaired balance during standing, but possibly to a different extent and pattern. Assessment of balance in patients with cervicogenic headache and migraine should be considered in clinical practice.

Comprehensive, blinded assessment of balance in orthostatic tremor

IntroductionOrthostatic Tremor (OT) is a movement disorder characterized by a sensation of unsteadiness and tremors in the 13–18 Hz range present upon standing. The pathophysiology of OT is not well understood but there is a relationship between the sensation of instability and leg tremors. Despite the sensation of unsteadiness, OT patients do not fall often and balance in OT has not been formally assessed. We present a prospective blinded study comparing balance assessment in patients with OT versus healthy controls. MethodsWe prospectively enrolled 34 surface Electromyography (EMG)-confirmed primary OT subjects and 21 healthy controls. Participants underwent evaluations of balance by blinded physical therapists (PT) with standardized, validated, commonly used balance scales and tasks. ResultsOT subjects were mostly female (30/34, 88%) and controls were majority males (13/20, 65%). The average age of OT subjects was 68.5 years (range 54–87) and for controls was 69.4 (range 32–86). The average duration of OT symptoms was 18 years.OT subjects did significantly worse on all the balance scales and on most balance tasks including Berg Balance Scale, Functional Gait Assessment, Dynamic Gait Index, Unipedal Stance Test, Functional Reach Test and pull test. Gait speed and five times sit to stand were normal in OT. ConclusionsCommon validated balance scales are significantly abnormal in primary OT. Despite the objective finding of impaired balance, OT patients do not commonly have falls. The reported sensation of unsteadiness in this patient population seems to be out of proportion to the number of actual falls. Further studies are needed to determine which components of commonly used balance scales are affected by a sensation of unsteadiness and fear of falling.

A blinded assessment of balance in patients with orthostatic tremor (P3.010)

A blinded assessment of balance in patients with orthostatic tremor (P3.010)

Assessment of calcium balance in patients on hemodialysis, based on ionized calcium and parathyroid hormone responses

Identification of the underlying causes of secondary hyperparathyroidism (SHPT) in individual patients on hemodialysis (HD) is hampered by the lack of clinically reliable information on calcium balance. The aim of this study was to assess calcium balance during HD sessions with a method that is applicable in day-to-day practice. Plasma ionized calcium (pCa2+) and parathyroid hormone (PTH) were measured at the beginning and end of HD to evaluate calcium fluxes in 23 patients on a dialysate calcium (DCa) concentration of 1.25 mmol/L. HD with a DCa of 1.25 mmol/L caused a decrease in pCa2+ from 1.15 ± 0.01 mmol/L to 1.09 ± 0.01 mmol/L (p<0.0001) and increased plasma PTH from 26.7 ± 1.8 pmol/L to 37.0 ± 2.9 pmol/L (p<0.0001). The changes in pCa2+ were inversely related to the predialysis pCa2+ levels (R2 = 0.86, p<0.001). Patients with a predialysis pCa2+ >1.06 mmol/L had a calcium efflux, whereas those with a predialysis pCa2+ <1.06 mmol/L had a calcium influx during HD. The results suggest that measurement of pCa2+ and PTH at the beginning and the end of HD provides useful information about calcium fluxes in individual patients. Further validation of this approach is warranted.

Computerized Dynamic Posturography in the Objective Assessment of Balance in Patients With Intermittent Claudication

One-third of all elderly patients fall each year and impaired balance has been recognized as a specific risk factor. Intermittent claudication is common among the elderly population, affecting approximately 5% of the population over the age of 50. The aim of this proof-of-concept study was to assess the prevalence of impaired balance among elderly claudicants and to assess each patient's insight into their own risk of falling. A total of 58 claudicants (45 men), median age of 70 (interquartile range = 65-73) years, underwent objective balance assessment by using computerized dynamic posturography. As compared with 195 (5%) historic controls, 24 (41%) of the claudicants demonstrated abnormal balance when the Sensory Organization Test (SOT) was used. Vestibular dysfunction occurred in 52% of the claudicants. Abnormalities including somatosensory (22%), visual function (17%), and preferential reliance on inaccurate visual cues (17%) occurred less often. Prolonged Motor Control Test latency times were uncommon (n = 13) and were in most cases evenly distributed between those with normal (n= 7) and abnormal (n = 6) composite SOT scores. There was a significant difference in history of falling between claudicants with abnormal and normal SOT scores (p = 0.003), with a higher number of patients with abnormal SOT having experienced falling in the past year. However, no correlation between fear of falling and composite SOT score was found (Spearman rank correlation, r= 0.124; p = 0.381). Impaired balance, particularly secondary to vestibular problems, is very common among claudicants and may predispose to a high incidence of falls. Claudicants with abnormal balance are more likely to have a history of falls but not a fear of falling, thus potentially rendering these patients to be at a greater risk.

Assessment of Balance in Patients with Stroke

Assessment of Balance in Patients with Stroke