Balance Outcome Measures Research Articles

Amplify Gait to Improve Locomotor Engagement in Spinal Cord Injury (AGILE SCI) trial: study protocol for an assessor blinded randomized controlled trial

BackgroundAmong ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.g., error augmentation) can accelerate motor learning by intensifying sensorimotor feedback and facilitating exploration of motor control strategies. These features may be beneficial for retraining walking balance after iSCI. We have developed a cable-driven robot that creates a movement amplification environment during treadmill walking. The robot applies a continuous, laterally-directed, force to the pelvis that is proportional in magnitude to real-time lateral velocity. Our purpose is to investigate the effects of locomotor training in this movement amplification environment on walking balance. We hypothesize that for ambulatory people with iSCI, locomotor training in a movement amplification environment will be more effective for improving walking balance and participation in walking activities than locomotor training in a natural environment (no applied external forces).MethodsWe are conducting a two-arm parallel-assignment intervention. We will enroll 36 ambulatory participants with chronic iSCI. Participants will be randomized into either a control or experimental group. Each group will receive 20 locomotor training sessions. Training will be performed in either a traditional treadmill environment (control) or in a movement amplification environment (experimental). We will assess changes using measures that span the International Classification of Functioning, Disability and Health (ICF) framework including 1) clinical outcome measures of gait, balance, and quality of life, 2) biomechanical assessments of walking balance, and 3) participation in walking activities quantified by number of steps taken per day.DiscussionTraining walking balance in people with iSCI by amplifying the individual’s own movement during walking is a radical departure from current practice and may result in new strategies for addressing balance impairments. Knowledge gained from this study will expand our understanding of how people with iSCI improve walking balance and how an intervention targeting walking balance affects participation in walking activities. Successful outcomes could motivate development of clinically feasible tools to replicate the movement amplification environment within clinical settings.Trial registrationNCT04340063.

Balance and strength measures are associated with incident dementia in older men

BackgroundAs people age the risk of dementia increases. Balance and strength deteriorate with ageing, but their associations with dementia are not clear. We aimed to determine relationships of balance and strength performance with incident dementia in the Health in Men Study (HIMS) cohort. MethodsWe used wave 4 of the HIMS as baseline for analyses (2011–2013), following 1261 men until December 2017 via data linkage to determine incident dementia. Balance was measured using a modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) Score and strength with the knee extension test. Cox proportional hazards regression was used, adjusting for sociodemographic and health data. Strength and balance scores were analysed non-linearly using restricted cubic splines. Results13.7% of men were diagnosed with dementia over a mean period of 4.7 (SD 1.5) years. Higher baseline mBOOMER scores were associated with a reduced risk of incident dementia, with greater changes in risk at higher mBOOMER scores (9 vs 8: HR 0.80, 95% CI 0.73–0.88; 12 vs 11: 0.49, 95% HR 0.36–0.68). Higher baseline lower limb strength was associated with a reduced risk of incident dementia, with greater changes occurring at lower scores, plateauing at around 25 kg (5 vs 4: HR 0.93, 95% CI 0.89–0.98; 25 vs 24: HR 0.99, 95% CI 0.95–1.03). ConclusionsThis study demonstrated a non-linear association of better performance in both strength and balance with reduced likelihood of incident dementia. These results raise the hypothesis that strategies to improve strength and balance could reduce the incidence of dementia in older men.

Relationship of Arm Length, Foot Length and Dynamic Balance in 9-12 Years Old Children

OBJECTIVE: Dynamic balance (DB) is defined as abilities that are operating during performance of a functional task such as reaching, walking, or running, irrespective of changing support surface (i.e. BOS). Functional Reach Test (FRT), which was developed by Duncan et al. in 1990. FRT is defined as the maximal distance one can reach forward beyond arm’s length while maintaining a fixed Base of Support (BOS) in standing. The outcome measures of dynamic balance (DB) are important elements of examination, which measures correlate with specific age but how anthropometric variables (e.g.: arm length, foot length, height, weight) which might influence balance is still unclear. The influence of arm length, foot length on dynamic balance in children is not well understood. Hence there is a need to investigate the relationship between arm length, foot length on dynamic balance in children. The objective of this study is to investigate the relationship of arm length, foot length on dynamic balance in 9-12 years old children. METHODOLOGY: This descriptive study (correlational study) was conducted among 41 children with typical development of age 9-12 years old (50% male and 50% females). Arm length (males 58.6 + 4.0; females 58.7 + 3.6), foot length (males 20.8 + 1.4; females 20.6 + 1.6). Dynamic balance was assessed using FRT, the participants were asked to reach three times and the scores were recorded. STATISTICAL ANALYSIS: The collected data was summarized using the descriptive statistics such mean +S.D. (standard deviation) to find the relationship between the arm length, foot length with dynamic balance in 9-12-years-old children. Pearson correlation coefficient is used, p value <0.05 was considered as significant. The data was analyzed using Microsoft Excel and SPSS 21. RESULTS: The mean distance reached by the children aged 9-12 years old were (males 22.2 + 5.1; females 22.9 + 6.6). The obtained p value for Pearson correlation coefficient is >0.05 and hence there is between arm length, foot length and dynamic balance in children of 9-12 years old. CONCLUSION: Dynamic balance has correlation with arm length and foot length. Hence it suggests that the arm length and foot length does influence the score of dynamic balance on FRT in children. Keywords: Arm length, foot length, dynamic balance, children, 9-12-year-olds

Effectiveness of Multidirectional Stepping Training on Balance among Geriatric Population

Background: In order to perform an activity that requires an upright posture, balance is a complex process that involves receiving and integrating the sensory inputs as well as planning and carrying out movements. Falls are frequent among elderly people. An example of home based aerobic activity is multidirectional stepping training.Purpose: To find out the effectiveness of multidirectional stepping training on balance among geriatric population.Materials and Methods: From November 2022 to April 2023, 200 participants were recruited from the Sai Chai Physio Centre, with only 82 participants selected based on inclusion and exclusion criteria.The subjects were separated into two groups: Group A (n=41) and Group B (n=41).Group A received multidirectional stepping training, whereas Group B received conventional exercise.Both the interventions were given for four weeks, three times a week for 40 minutes.Results: The findings indicated that both the groups showed statistically significant improvement after the interventions in scores of fall efficacy scale and Balance outcome measure for elderly rehabilitation(p<0.005). Multidirectional stepping training showed statistically significant improvement in both the measures.Conclusion: When compared to conventional exercise, multidirectional stepping training is more effective at improving balance.

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 (<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.

Associations between balance, strength and incident dementia in older men: the Health in Men Study

AbstractBackgroundIncreased amount of physical activity has been associated with reduced incidence of dementia. It is less clear whether the discrete physical performance measures of balance and strength are associated with dementia incidence. We investigated whether baseline measures of balance and strength were associated with incident dementia.MethodA cohort of 1,314 men with no recorded history of dementia, aged 79‐97 underwent physical performance assessments between 2011 and 2013. These assessments were performed during wave 4 of the Health in Men Study, initially recruiting participants 1996‐9 in Perth, Australia. Balance was assessed with a modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) score: a combination of three tests, the Timed Up and Go, Step and Functional Reach Tests. Strength was tested using knee extension with a spring dynamometer, measured in kilograms. Incident dementia was identified up to December 2017 from the Western Australian Data Linkage System and the national Aged Care Assessment Program. Data were analysed using Cox proportional hazards models. Balance and strength measures were entered as restricted cubic splines to allow for non‐linear relationships. Models were adjusted for sociodemographic, lifestyle and health variables, including hours of physical activity.ResultA total of 187 (14.2%) incident cases of dementia were identified. Higher (better) mBOOMER scores were associated with decreased risk of incident dementia, with greater changes in risk occurring at higher scores (1 vs 0: HR 0.91, 95% CI 0.81‐1.01, 6 vs 5: HR 0.91, 95% CI 0.81‐1.01, 9 vs 8: HR 0.77, 95% CI 0.70‐0.84, 12 vs 11: HR 0.51, 95% CI 0.37‐0.69). Higher knee extension strength was associated with a decreased risk of incident dementia, with greater changes occurring at lower levels then plateauing at around 25 kilograms (5kg vs 4kg: HR 0.93, 95% CI 0.89‐0.97, 15kg vs 14kg: HR 0.93, 95% CI 0.89‐0.97, 25kg vs 24kg: HR 0.99, 95% CI 0.95‐1.02, 35kg to 34kg: HR 1.00, 95% CI 0.95‐1.06). Relationships remained after excluding those with a dementia diagnosis within two years of baseline physical performance assessment.ConclusionBetter balance and strength are both associated with decreased risk of developing dementia, thus representing potentially modifiable risk factors.

Teleassessment of Balance and Gait Outcome Measures in Older Adults

Introduction: This article systematically reviews the reliability and validity of balance and gait outcome measures obtained by teleassessment in older adults. Methods: Two reviewers searched electronic databases for articles published from 2010 to 2022. Included studies were appraised for quality. Results: Six articles were reviewed. Reliability was found to be low to good, and validity was acceptable, with some concerns with bias during testing. Discussion: There is evidence to support the use of certain balance and gait outcome measures in teleassessment of the older adult population if the individuals have appropriate electronic devices for telecommunication, good Internet connectivity, and adequate technological knowledge.

Balance and Strength Measures Are Associated With Mortality in Older Men.

As people age, rates of morbidity and mortality are heterogenous. Balance and strength performance may contribute to this, offering modifiable risk factors for mortality. We aimed to compare relationships of balance and strength performance with all-cause and cause-specific mortality. The Health in Men Study, a cohort study, using wave 4 as baseline for analyses (2011-2013). 1335 older men (>65years old), initially recruited April 1996-January 1999 in Western Australia, were included. Physical tests included a strength (knee extension test) and balance measure (modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) Score), derived from baseline physical assessments. Outcome measures included all-cause, cardiovascular, and cancer mortality, ascertained via the WADLS death registry. Data were analyzed using Cox proportional hazards regression models (age as analysis time, adjusted for sociodemographic data, health behaviors, and conditions). Four hundred seventy-three participants died before the end of follow-up (December 17, 2017). Better performance on both the mBOOMER score and knee extension test was associated with lower likelihood of all-cause [hazard ratio (HR) 0.83, 95% CI 0.80-0.87, and HR 0.96, 95% CI 0.95-0.98, respectively] and cardiovascular mortality (HR 0.82, 95% CI 0.77-0.87, and HR 0.96, 95% CI 0.94-0.98, respectively). Better mBOOMER score performance was associated with lower likelihood of cancer mortality (HR 0.90, 95% CI 0.83-0.98) only when including participants with prior cancer. In summary, this study demonstrates an association of poorer performance in both strength and balance with future all-cause and cardiovascular mortality. Notably, these results clarify the relationship of balance with cause-specific mortality, with balance equaling strength as a modifiable risk factor for mortality.

Executive function is associated with balance and falls in older cancer survivors treated with chemotherapy: A cross-sectional study

IntroductionBalance decrements and increased fall risk in older cancer survivors have been attributed to chemotherapy-induced peripheral neuropathy (CIPN). Cognition is also affected by chemotherapy and may be an additional contributing factor to poor balance through changes in executive functioning. We examined the association of executive function with balance and falls in older cancer survivors who had been treated with chemotherapy. Materials and MethodsFifty cancer survivors (aged 65.6 ± 11.5 years; 88% female) who were all treated with chemotherapy were included in this cross-sectional study at a tertiary medical center. Executive function was measured by Trails-B, Stroop, and rapid reaction accuracy, a measure emphasizing rapid inhibitory function. Balance was measured by five sit-to-stand time (5STS), repetitions of sit-to-stand in thirty seconds (STS30), and unipedal stance time (UST), which was the primary balance outcome measure. Self-reported falls in the past year were also recorded and was a secondary outcome. Bivariate analyses were conducted between executive function measures and balance variables. Multivariable models were constructed for UST and falls outcomes and included covariates of age and chemotherapy induced peripheral neuropathy status. ResultsPearson correlations demonstrated significant relationships between two executive function measures (rapid reaction accuracy, Trails-B) and all the balance measures assessed (UST, STS30, and 5STS). Rapid reaction accuracy correlations were stronger than Trails-B. The Stroop measure correlated solely with UST. In multivariable models, rapid reaction accuracy was associated with better UST (standardized regression coefficient: 64.1, p < 0.01), decreased any fall (odds ratio = 0.000901, p = 0.04), and decreased recurrent falls (odds ratio = 0.0000044, p = 0.01). The interaction of CIPN with the inhibitory measures in the prediction of balance was not significant. DiscussionMeasures of executive function were associated with balance, but among the executive function tests, rapid reaction accuracy had the strongest correlations to balance and was independently associated with falls. The findings suggest that executive function should be considered when assessing fall risk and developing interventions intended to reduce fall risk in older chemotherapy-treated cancer survivors.

Quantitative Romberg on a Force Plate: Objective Assessment Before and After Surgery for Cervical Spondylotic Myelopathy.

Longitudinal observational cohort. The purpose of this study was to evaluate the utility of Quantitative Romberg measurements as pre-op and post-op balance outcome measures. Cervical spondylotic myelopathy (CSM) is characterized by balance deficiencies produced by impaired proprioception. Evaluation is subjective, and binary physical exam findings lack the precision to assess postoperative outcome improvement. CSM patients were prospectively enrolled to undergo preoperative and postoperative Quantitative Romberg tests on a force plate to record center of pressure (COP) motion for 30 seconds with eyes open followed by eyes closed. Revision cases were excluded. Kinematics of COP movement parameters were compared between preoperative and postoperative state for each patient. Twenty-seven CSM patients were enrolled and completed both pre/post-testing. The mean age was 60.0 years, with 13 (48%) males and 9 (33%) smokers. Mean number of surgical levels was 2.48. The minimum mean follow-up was six months. There was a statistically significant improvement in eyes closed after surgery compared with preoperative for total COP motion (523.44 vs. 387.00cm, P <0.001), average sway speed (17.41 vs. 13.00cm/s, P <0.001), and total lateral COP motion (253.44 vs. 186.70cm, P <0.001). There was no statistically significant improvement in the modified Japanese Orthopaedic Association (13.29 vs. 14.29, P =0.28). CSM balance findings on Quantitative Romberg testing significantly improve postoperatively in patients with CSM. These findings support this testing as representative of proprioceptive balance deficiencies seen in CSM. Quantitative Romberg may be used as an objective measure of clinical outcome and assist in stratification of surgical interventions, surgery timing, and technique.

Useful outcome measures in INPH patients evaluation.

Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients. The second aim is to verify the most important spatio-temporal parameters in INPH assessment and their possible correlations with clinical outcome measures. Between January 2019 and June 2022, we evaluated 70 INPH subjects. We assessed balance performances with the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), and TUG, both single (ST) and dual task (DT). We also performed an instrumental gait assessment with the GAITRite electronic walkway system, asking the patients to walk on the carpet for one minute at normal speed, fast speed, and while performing a dual task. We compared the results with those of 20 age-matched healthy subjects (HS). INPH patients obtained statistically significant lower scores at the BBS, SPPB, and TUG DT but not at the TUG ST, likely because the DT involves cognitive factors altered in these subjects. Concerning instrumental gait evaluation, we found significant differences between HS and INPH patients in almost all spatio-temporal parameters except cadence, which is considered a relevant factor in INPH guidelines. We also found significant correlations between balance outcome measures and gait parameters. Our results confirm the usefulness of BBS and suggest improving the assessment with SPPB. Although the TUG ST is the most commonly used test in the literature to evaluate INPH performances, it does not identify INPH; the TUG DT, instead, might be more useful. The GAITRite system is recognized as a quick and reliable tool to assess walking abilities and spatio-temporal parameters in INPH patients, and the most useful parameters are stride length, stride width, speed, and the percentage of double support. Both clinical and instrumental evaluation may be useful in recognizing subjects at risk for falls.

Control of center of mass motion during walking correlates with gait and balance in people with incomplete spinal cord injury.

There is evidence that ambulatory people with incomplete spinal cord injury (iSCI) have an impaired ability to control lateral motion of their whole-body center of mass (COM) during walking. This impairment is believed to contribute to functional deficits in gait and balance, however that relationship is unclear. Thus, this cross-sectional study examines the relationship between the ability to control lateral COM motion during walking and functional measures of gait and balance in people with iSCI. We assessed the ability to control lateral COM motion during walking and conducted clinical gait and balance outcome measures on 20 ambulatory adults with chronic iSCI (C1-T10 injury, American Spinal Injury Association Impairment Scale C or D). To assess their ability to control lateral COM motion, participants performed three treadmill walking trials. During each trial, real-time lateral COM position and a target lane were projected on the treadmill. Participants were instructed to keep their lateral COM position within the lane. If successful, an automated control algorithm progressively reduced the lane width, making the task more challenging. If unsuccessful, the lane width increased. The adaptive lane width was designed to challenge each participant's maximum capacity to control lateral COM motion during walking. To quantify control of lateral COM motion, we calculated lateral COM excursion during each gait cycle and then identified the minimum lateral COM excursion occurring during five consecutive gait cycles. Our clinical outcome measures were Berg Balance Scale (BBS), Timed Up and Go test (TUG), 10-Meter Walk Test (10MWT) and Functional Gait Assessment (FGA). We used a Spearman correlation analysis (ρ) to examine the relationship between minimum lateral COM excursion and clinical measures. Minimum lateral COM excursion had significant moderate correlations with BBS (ρ = -0.54, p = 0.014), TUG (ρ = 0.59, p = 0.007), FGA (ρ = -0.59, p = 0.007), 10MWT-preferred (ρ = -0.59, p = 0.006) and 10MWT-fast (ρ = -0.68, p = 0.001). Control of lateral COM motion during walking is associated with a wide range of clinical gait and balance measures in people with iSCI. This finding suggests the ability to control lateral COM motion during walking could be a contributing factor to gait and balance in people with iSCI.

Bespoke Exergames for Balance Improvement and Fall Risk Reduction in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Bespoke exergames have been designed for balance improvement and fall risk reduction in community-dwelling older adults. However, the overall effectiveness of bespoke exergames and their compliance with exercise prescription principles is unclear. This systematic review aims to critique the technology and effectiveness of bespoke balance exergames prescribed for older adults. A literature search was performed for randomized controlled trials that implemented bespoke exergame interventions among community-dwelling older adults. The standardized mean difference was obtained for each study, and the pooled effect size was calculated based on the random effects inverse variance model. This review had 870 participants, and 12 of the 15 studies were classified with a low risk of bias. Bespoke exergames have an effect size of 0.75 (95% CI: 0.57 – 0.93; I <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> = 7.92%), 0.62 (95% CI: 0.48 – 0.77; I <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> = 11.7%), 0.52 (95% CI: 0.24 – 0.80; I <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> = 0%), and 0.54 (95% CI: 0.23 – 0.86; I <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> = 9.9%) on balance functional tests, static balance, dynamic balance, and psychological outcome measure, respectively. Bespoke balance exergames have a moderate and consistent effect on fall risk factors. Several recommendations were offered to improve future exergame programs for balance improvement and future research on the topic.

Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes

Purpose The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. Materials and methods This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. Results Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists’ decision-making. Conclusions In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes. Implications For Rehabilitation Balance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury. Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury. In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.

Validity of balance measures in cerebellar ataxia: A prospective study with 12-month follow-up.

Balance deficits are common in cerebellar ataxia. Determining which balance outcome measures are psychometrically strong for this population remains an unmet need. To evaluate the validity and responsiveness of two clinic-based balance measures (Berg Balance Scale [BBS] and balance sub-component of the Scale for the Assessment and Rating of Ataxia [SARA-bal]) and two laboratory-based balance measures (Sensory Organization Test [SOT] and Limits of Stability [LOS]) in cerebellar ataxia. Prospective cohort study. Institutional study assessing 40 participants with cerebellar ataxia at baseline, and 6 and 12 months. Balance was assessed using the BBS, SARA-bal, SOT, and LOS; disease severity was assessed using the SARA; and Patients' Global Impression of Change (PGIC) was used to estimate responsiveness to disease progress at 6 and 12 months. BBS and SARA-bal (Spearman's correlation coefficient, ρS=-0.89, p < .01) demonstrated strong criterion validity. Convergent validity was moderate to high (ρS range: -0.75 to 0.92) and external validity was low (ρS range: -0.75 to 0.11). Composite SOT scores (SOT-COM; ρS=0.29, p < .01) and maximal excursion (MXE-LOS) in the forward (F) and right (R) directions of the LOS (ρS=0.18, p < .01) demonstrated moderate to low criterion and convergent validity. The area under the receiver-operating characteristic curve (AUCROC ) and its effect size (standard response mean [SRM]) for categorizing "stable" and "worsened" patients at 6 and 12 months were satisfactory for the BBS (AUCROC : 0.75; SRM-Stable: 1.06; SRM-Worsened: 1.16), SARA-bal (AUCROC : 0.76; SRM-Stable: 0.86; SRM-Worsened: 0.85), and MXE-LOS(R) (AUCROC : 0.29; SRM-Stable: 0.41; SRM-Worsened: 1.39). BBS and SARA-bal have moderate to strong criterion and convergent validity and adequate responsiveness to balance changes. Both laboratory-based measures (SOT and LOS) demonstrated a high floor effect. The SOT-COM and MXE-LOS(R) demonstrated moderate to low criterion validity, with only the MXE-LOS(R) displaying adequate responsiveness to balance changes after 6 and 12 months.

Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study

BackgroundThe first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility.MethodsA prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.ResultsA total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group.After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively.ConclusionsImplementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.

Estimating the minimal clinically important difference for balance and gait outcome measures in individuals with vestibular disorders.

Vestibular Rehabilitation Therapists (VRT) utilize outcome measures to quantify gait and balance abilities in individuals with vestibular disorders (IVD). The minimal clinically important difference (MCID) in gait and balance outcome measures for IVD is unknown. The purpose of this study is to estimate the MCID of the Activities-specific Balance Confidence Scale (ABC), Functional Gait Assessment (FGA), and Gait Speed (GS) using distribution and anchor-based methods relative to the Dizziness Handicap Inventory (DHI) in IVD. Data were collected using a retrospective chart review from two outpatient Vestibular Rehabilitation (VR) clinics. Data included demographic characteristics, diagnosis, VR course, and pre and post outcome measures including DHI, ABC, FGA, and GS. The DHI was used to classify subjects as "responders" or "non-responders" in order to calculate MCID values. The total number of subjects analyzed for each outcome measure was 222 for the ABC, 220 for FGA, and 237 for GS. Subjects made statistically significant improvements in ABC, DHI, FGA, and GS (p < 0.001) from pre to post VR. The MCID calculated for ABC, FGA, and GS using the anchor-based approach was 18.1%, 4 points, and 0.09 m/s respectively. The MCIDs calculated using distribution-based approach for the ABC ranged between 7.5-23.5%, FGA ranged between 1.31-4.15 points, and GS ranged between 0.07 m/s-0.22 m/s. The anchor-based calculations of the MCID of 18.1%, 4 points, and 0.09 m/s for ABC, FGA, and GS respectively for IVD should be used over distribution-based calculations. This is due to strength of DHI as the anchor and statistical analysis. VRT and researches can use these values to indicate meaningful changes in gait and balance function in IVD.

Gait and Balance Outcome Measures Are Responsive in Severely Impaired Individuals Undergoing Inpatient Stroke Rehabilitation

ObjectiveTo investigate whether gait and balance outcome measures in patients with severe gait and balance impairments at admission to inpatient rehabilitation provided additional and meaningful information beyond customary measures. Specifically, this study investigated whether individuals who obtained low scores at admission exhibited improvements that exceeded the established minimal detectable change during inpatient rehabilitation. We also investigated whether gait outcomes would capture changes in function not identified by customary measures. DesignSecondary analysis of a knowledge translation project aimed at increasing the systematic collection of these outcome measures in a poststroke cohort. SettingSubacute inpatient rehabilitation facility. ParticipantsIndividuals<2 months poststroke (N=157) with 34-43 with severe deficits including Berg Balance Scale≤5, 10-meter walk test=0 m/s, or 6-minute walk test=0 m. InterventionNot applicable. Main outcome measuresBerg Balance Scale, 10-meter walk test, 6-minute walk test. ResultsAfter 1 week of rehabilitation, 41%-53% of severely impaired individuals had changes above minimal detectable changes in gait and balance outcomes, which increased to 68%-84% at discharge. Across the entire cohort, FIM locomotion scores failed to identify changes in gait function for 35% of participants after 1 week of rehabilitation. ConclusionsRoutine assessment of gait and balance outcome measures in patients with severe deficits early poststroke may be beneficial. These measures were responsive after 1 week of rehabilitation and detected changes not captured by customary measures. Routine use of a standardized gait and balance assessments may provide clinicians with important information to guide clinical decision making.

Acceptability and feasibility of a vestibular nerve stimulation headset protocol in children with cerebral palsy

BackgroundResearch suggests electrical Vestibular Nerve Stimulation (VeNS) may improve balance for people with neurological impairments. This study aimed to assess the feasibility and acceptability of a VeNS headset protocol in children with cerebral palsy (CP).MethodsChildren aged 5–18 years with ambulant CP, their parents, and healthcare professionals were recruited via social media. Children completed a battery of balance tests and wore a sham VeNS headset one hour per day for four weeks. Perspectives on the balance tests and headset were ascertained from children, parents and healthcare professionals using semi-structured interviews. Interview data were analysed thematically.ResultsTwo families and four healthcare professionals participated. Balance outcome measures were fully completed and deemed acceptable. Adherence with wearing the headset was 89–100% but discomfort with self-adhesive electrodes was reported. Four themes emerged from interview data: headset issues, perceptions about VeNS, the importance of balance, and modifications for future study.ConclusionsAlthough the VeNS headset had high acceptability, the volunteer sample was small, potentially suggesting limited interest in VeNS as a treatment for children with CP, or reluctance to trial a ‘non-active’ headset. Recruitment via clinicians known to the family and use of an ‘active’ headset may increase participation in future research.

THE EFFECT OF TAI CHI ON BALANCE IN WOMEN WITH OR AT RISK OF OSTEOPOROSIS: A SYSTEMATIC REVIEW

Background: As women age, hormone levels change and put them at increased risk for osteoporosis. Tai Chi is a weight bearing exercise intervention that incorporates balance. Balance training and weight bearing exercises have both been shown to be beneficial to those with or at risk of osteoporosis by benefiting bone mineral density and decreasing fall risk. Objective: The purpose of this systematic review is to determine whether Tai Chi is an effective intervention for improving balance in women with or at risk for osteoporosis. Methods: A search of PubMED and EMBASE databases was completed using search terms related to osteoporosis, Tai Chi, and balance, and was limited to randomized control trials, clinical trials, and research articles. The authors screened the resultant studies by title, abstract, and full text. In order to qualify for inclusion in this study, articles must have had a measure for balance before and after intervention, Tai Chi as an intervention, and women 45 or older as study subjects. Five studies were assessed for quality using the PEDro Scale and one study was assessed using the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Results: Six articles remained for inclusion in the review after screenings. Four out of six studies reported significant differences in at least one balance outcome measure post-intervention. Studies that had longer intervention periods resulted in more significant findings in the outcome measures of interest. Conclusion: Results from this systematic review suggest that Tai Chi may have positive effects on balance in women with or at risk of osteoporosis. Further research is recommended due to the heterogeneity of balance outcome measures, as well as length of intervention, with some studies indicating that longer intervention periods may increase benefits of Tai Chi.