Balance Outcome Measures Research Articles

Reliability of the Kinematic Steadiness Index during one-leg standing in subjects with recurrent low back pain.

To assess the reliability of standing time and the Kinematic Steadiness Index (KSI) in one-leg standing compared with the Timed Up and Go (TUG) test while considering anthropometric factors in subjects with recurrent low back pain (LBP). Sixty-six individuals participated in the study. The data were collected on two different days, 1week apart. The KSI of the core spine, using video motion-capture techniques, was based on the relative standing time and relative standstill time. The intraclass correlation coefficient (ICC2,1) was compared for the reliability between measures. The covariates, such as age, Body Mass Index, and the Oswestry Disability Index (ODI), were analyzed for any interactions based on these measures. The standing time (t=-1.01, p=0.32) and the KSI (t=-1.70, p=0.09) were not significantly different between measures. The TUG results were not different between measures (t=1.01, p=0.32). The Cronbach's alpha for the standing time was 0.84, for KSI was 0.89, and for TUG was 0.76. The standing time and KSI demonstrated an interaction with age, while the TUG demonstrated an interaction with the ODI score. The KSI during one-leg standing could help to develop a practical tool to justify quantity and quality of balance outcome measures, which identify balance deficits and core spine rehabilitation strategies in subjects with recurrent LBP.

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients

ObjectivesTo examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P. DesignData were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS. SettingMedical center. ParticipantsPatients (N=212) with first onset of stroke within 14 days before hospitalization. InterventionsNot applicable. Main Outcome MeasuresGroup-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using the bootstrap approach. ResultsThe BBS-3P and PASS-3P had good group-level (SRM, .60 and SRM, .56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual change. ConclusionsThe responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke.

The walking speed reserve in low disabled people with multiple sclerosis: Does it provide greater insight in detecting mobility deficits and risk of falling than preferred and fast walking speeds?

The extent of an increase from a preferred walking speed (PWS) to a fast walking speed (FWS) is defined as the walking speed reserve (WSR). The WSR is unique as it reflects an individual's ability to increase their walking speed on demand. The primary objective of this study was to examine whether the WSR was more advantageous than the PWS and FWS in terms of reflecting mobility deficits and risk of falling associated with multiple sclerosis (MS). The patient group included 235 people with MS (PwMS) (139 women) with a mean age of 43.6 (SD = 13.6) years. The WSR, PWS and FWS (m/s) were: 0.47 (SD = 0.29), 0.98 (SD = 0.28) and 1.45 (SD = 0.47), respectively. Significant correlation scores were found between the WSR and all clinical walking and balance outcome measures; Pearson's rho ranged from 0.240 to 0.517. However, stronger correlation scores were found between the PWS, FWS and all clinical walking and balance outcome measures with the Pearson's rho ranging from 0.415 to 0.797. In terms of fall status, non-significant differences were observed between the fallers (n = 133) and non-fallers’ (n = 102) groups with respect to the WSR scores. We found that the PWS and FWS were more instructive measures for assessing mobility deficits and fall status in PwMS than the WSR. Nevertheless, we do not rule out the possibility that the WSR score may be a preferred predictor of other adverse events related to MS, such as lower limb muscle weakness, spasticity and aerobic capacity.

Balance Assessment using Microsoft Xbox Kinect

Reduction in balance has been identified as an indicator of risk of fall, and thus, an accurate and cost effective balance assessment tool is essential for prescribing effective postural control strategies. PURPOSE: To establish the validity of the Microsoft Xbox Kinect (Kinect v2) in assessing the whole body center of mass (CoM) excursion and velocity during single leg balance and voluntary ankle sway tasks among young and elderly subjects. METHODS: Twenty subjects (10 young: age = 20.5±2.3 years, Height = 171.8±7.2 cm, Weight = 70.7±11.6 kg; 10 elderly: age = 70.6±9.5 years, Height = 169.1±8.7 cm, Weight = 74.0±17.8 kg), with no history of lower extremity injury, participated in this study. Subjects performed a total of six randomized trials; four single leg stand (SLS) and two ankle sway trials. A comparison between the balance outcome measures (anteroposterior (AP) and mediolateral (ML) CoM excursion and velocity and average sway length) from the Kinect v2 and a traditional three-dimensional motion analysis (3DMA) system was performed. RESULTS: Results from the SLS and voluntary ankle sway trials showed that consistency, agreement, and correlation between systems was excellent (ICC > 0.75) for all CoM related variables when all subjects were considered a single group as well as when the elderly and young groups were analyzed. Concordance between systems ranged from poor to almost perfect depending on the group, task, and variable assessed. CONCLUSION: This new technique, using a low cost motion analysis technology, may enable real time, objective assessments of balance parameters in the clinical and research environments, which represents a clear advancement in clinical balance assessment and home-based rehabilitation programs.

Comparisons of clinically based outcome measures and laboratory-based outcome measure for balance in patients following total hip and knee arthroplasty.

BackgroundInformation available in the literature on clinically based and laboratory-based outcome measures of balance is limited. How much information is provided by clinically based outcome measures compared to laboratory-based measure in patients with total hip (THA) and knee arthroplasty (TKA) is not known.AimThe purpose of this study was to determine the relationship between selected clinically based outcome measures and laboratory-based force platform measure in patients following THA and TKA.MethodsPatients who underwent THA (n = 26) and TKA (n = 28) were evaluated at about 5–7 weeks following surgery. Participants were assessed using four clinically based outcome measures – 1) the Berg Balance Scale (BBS), 2) the Timed Up and Go test (TUG), 3) the Activities-specific Balance Confidence Scale (ABC), and 4) the Western Ontario McMaster Universities Osteoarthritis Index-function subscale (WOMAC-function) – and one laboratory-based force plate measure (95% ellipse area).ResultsModerate correlations were observed between the BBS and the 95% ellipse area of force plate (r = 0.46–0.51) for the two-legged stance, the anterior lean stance, and the posterior lean stance. Fair correlations were observed between TUG and the 95% ellipse area of force plate (r = 0.31–0.37) for all the three test conditions. Low correlations were observed for the ABC and the WOMAC-function with the 95% ellipse area of force plate (r = 0.11–0.25) for all the three test conditions.ConclusionThe BBS demonstrated the greatest correlations with the 95% ellipse area of the force plate measure and should be preferred by physical therapists over the TUG, the ABC, and the WOMAC-function to assess balance in patients with THA and TKA.

Validation of Static and Dynamic Balance Assessment Using Microsoft Kinect for Young and Elderly Populations

Reduction in balance is an indicator of fall risk, and therefore, an accurate and cost-effective balance assessment tool is essential for prescribing effective postural control strategies. This study established the validity of the Kinect v2 sensor in assessing center of mass (CoM) excursion and velocity during single-leg balance and voluntary ankle sway tasks among young and elderly subjects. We compared balance outcome measures (anteroposterior (AP) and mediolateral (ML) CoM excursion and velocity and average sway length) to a traditional three-dimensional motion analysis system. Twenty subjects (10 young: age = y, height cm, weight kg; 10 elderly: age y, height cm, weight kg), with no history of lower extremity injury, participated in this study. Subjects performed six randomized trials; four single-leg stand (SLS) and two ankle sway trials. SLS and voluntary ankle sway trials showed that consistency (ICC(2, k)) and agreement (ICC(3, k)) for all variables when all subjects were considered, as well as when the elderly and young groups were analyzed separately. Concordance between systems ranged from poor to nearly perfect depending on the group, task, and variable assessed.

The Romberg ratio in people with multiple sclerosis

Postural control relies on the integration of inputs from the visual, somatosensory and vestibular systems which are frequently impaired in people with Multiple Sclerosis (PwMS). In this situation, examining the Romberg ratio can be useful. This parameter can be interpreted as a gross indicator of a vestibular and proprioceptive contribution to postural control. Therefore, the primary objective of the current study was to examine whether the Romberg ratio differs between MS fallers, non-fallers and neurological disability levels. In addition, we clarified the association between the Romberg ratio values with validated gait and the balance tests in PwMS. Romberg ratio values were calculated according to the sway rate, total sway area and center of pressure (CoP) path length. The patient group included 542 PwMS (337 women) with a mean age of 42.3 (S.D=13.8). In terms of fall status, significant differences were observed between the faller (n=287) and non-faller (n=255) groups solely in terms of the Romberg ratio-ellipse sway area: 2.76 (S.D=2.46) vs. 2.24 (S.D=2.01), P-value=0.01. A significant increase in the Romberg ratio was found between the severe group (n=50), the very mild (n=245), mild (n=186) and moderate (n=61) groups for each of the three Romberg ratio quotients. Significant weak correlation scores were found between the Romberg ratio-ellipse sway area and all walking and balance outcome measures; the Pearson’s rho ranged from 0.172 to 0.270. The present data suggest that an elevated Romberg ratio quotient, especially according to the sway area, is an indicator of poor walking and balance capabilities in PwMS.

Validity and Reliability of Two-Dimensional Motion Analysis for Quantifying Postural Deficits in Adults With and Without Neurological Impairment.

Frequently, clinical balance outcome measures are limited by floor or ceiling effects and provide insufficient resolution to determine subtle deficits. Detailed assessment of postural control obtained through posturography may be cost-prohibitive or logistically infeasible in some clinical settings. Two-dimensional (2D) motion analysis may provide a clinically feasible means of obtaining detailed quantification of balance deficits. Forty-five participants aged 18-80 years, with and without Parkinson disease, performed the Push and Release (PR) test, sit-to-stand (STS), and timed single leg stance (SLS). Performance was captured simultaneously using a three-dimensional (3D) (10-camera laboratory-based 3D motion capture system and 3D motion analysis software) and 2D (two commercially available video cameras and 2D motion analysis software) system. Agreement was excellent between 2D and 3D systems for all outcomes of the PR and SLS (intraclass correlation coefficients [ICC2,1 ] 0.96-0.99, 95% CIs 0.92-0.98 to 0.99-1.0), and ranged from fair to excellent for STS outcomes (ICC2,1 0.59-0.93, 95% CIs 0.36-0.75 to 0.87-0.96). Test-retest reliability (ICC3,1 0.89-1.0, 95% CIs 0.76-0.96 to 1.0-1.0) and inter-rater reliability (ICC2,1 0.77-1.0, 95% CIs 0.61-0.87 to 1.0-1.0) of the 2D obtained outcomes were excellent. A technology package of commonly available video cameras and 2D motion analysis software was a valid and reliable method for quantifying outcomes of postural control tasks in people with a range of balance abilities. Two-dimensional analysis can be used in clinical practice to provide balance assessments as a cost-effective alternative to 3D motion capture. Anat Rec, 299:1165-1173, 2016. © 2016 Wiley Periodicals, Inc.

A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients.

Introduction: Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions.Materials and Methods: An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks.Results: Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events.Discussion and Conclusion: This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia.

Balance self-efficacy in older adults following inpatient rehabilitation.

Older adults discharging from inpatient rehabilitation were investigated to determine change in self-efficacy at 1 month after discharge, the relationship with discharge balance performance and physical function, and the influence of diagnosis. A prospective cohort of 101 adults older than 50 years of age, 43% men, average age 75.84 (SD 9.8) years, were recruited at discharge from inpatient rehabilitation. Balance self-efficacy was assessed using Activities-specific Balance Confidence (ABC) scale at discharge and 1 month following discharge. Balance and physical function were measured at discharge using the Functional Independence Measure, Balance Outcome Measure for Elder Rehabilitation, Modified Elderly Mobility Scale and gait speed. At discharge, balance self-efficacy was moderate (ABC score 62, SD 23) and did not change at follow-up. When grouped by discharge self-efficacy (ABC scores: low<50; moderate 51-80; high>80), significant between-group differences were found for balance (P=0.005) and physical function (P=0.035). At the 1-month follow-up, those with low discharge balance self-efficacy showed improvement (mean-change ABC score 12, 95% confidence interval 2-22) and those with high discharge balance self-efficacy had lower scores (mean-change ABC score 18, 95% confidence interval -8 to -28). Differences in ABC change scores were also found between diagnostic groups (F=3.740, P=0.03), with the orthopaedic group improving (ABC mean change=8) and the general frailty group showing a decrease in confidence (ABC mean change=10). The differences in balance self-efficacy change at 1 month following discharge were related to self-efficacy level at discharge and clinical group requiring rehabilitation. Clinicians need to be aware of these changes as patients are prepared for discharge.

Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review.

Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke. Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation. VR-based therapy thus has the potential to be a useful tool for balance and gait training for stroke rehabilitation. Utilization of motor learning principles related to task-related training may have been an important factor leading to positive results. Other principles such as repetition, feedback etc. were used in studies but were not explored explicitly and may need to be investigated to further improve the strength of results. Lastly, robust study designs with appropriate attention towards the intensity and dose-response aspects of VR training, clear study objectives and suitable outcomes would further aid in determining evidence-based efficacy for VR game-based interventions in the future.

Developing a mouse model of chronic ankle instability.

Ankle sprains are the most common orthopedic pathology experienced during sport and physical activity and often result in chronic ankle instability (CAI). Understanding how to prevent CAI is difficult because of the costs and logistics associated with clinical trials aimed at preventing the heterogeneous symptoms associated with CAI. Thus, a need exists to develop an animal model that presents similar long-term consequences as CAI to assess preclinical data. Thus, the purpose was to determine whether surgically transecting the lateral ligaments of a mouse hind limb results in the development of CAI-like symptoms 12 months after injury. Thirty male mice (CBA/J) were randomly placed into a SHAM (control), CFL (calcaneofibular ligament; mild ankle sprain), or ATFL/CFL (anterior talofibular ligament/CFL; severe) ankle sprain group and housed individually. Three days after surgically transecting the respective lateral ligaments, mice were given a solid surface running wheel and daily running wheel measurements were recorded. Outcome measures of balance and gait were obtained before and at 4, 48, 54, and 60 wk after injury. The ATFL/CFL group had significantly more hind foot slips than the CFL and SHAM groups (P < 0.05). The CFL also had more hind foot slips relative to the SHAM group (P < 0.05). The ATFL/CFL group was significantly less physically active relative to the SHAM and CFL groups (P < 0.05). A cut score of 4.75 foot slips had a sensitivity of 0.68 and specificity of 1.00 and indicates that 70% (14/20) of mice with an ankle sprain had developed CAI. The results of this study indicate that an acute ankle sprain in mice can result in the development of CAI-like symptoms 12 months after injury.

Exercises Including Weight Vests and a Patient Education Program for Women With Osteopenia: A Feasibility Study of the OsteoACTIVE Rehabilitation Program

Prospective case series with 1-year follow-up. The primary aim was to describe the OsteoACTIVE rehabilitation program and evaluate its feasibility in terms of progression, adherence, and adverse events in patients with low bone mineral density (BMD) and a healed forearm fracture. The secondary aim was to assess changes in measures of function and quality of life. Previous studies have shown benefits of weight-bearing activities, resistance exercises, and balance and coordination training for women with low BMD and older adults. However, no studies, to our knowledge, have described or examined a rehabilitation program combining the use of weight vests and patient education in patients with low BMD. Forty-two postmenopausal women with osteopenia and a healed forearm fracture attended the OsteoACTIVE program for 6 months (3 sessions of 60 minutes per week). Feasibility was assessed by documenting training progression (load and exercises), program adherence (aiming for greater than 80%), and adverse events (joint pain, muscle soreness, and falls). Secondary measures included quadriceps strength, BMD, dynamic balance, walking ability, and self-report functional outcome measures. All outcome measures were recorded preintervention (baseline), postintervention, and at 1-year follow-up. Thirty-five women (83%) completed the 6-month program and 31 women (74%) attended all the follow-up measurement sessions. All participants progressed during the rehabilitation program for both load and type of exercises. Furthermore, 87% of the participants met the a priori goal of 80% adherence, and no participants reported adverse events. Improvements in quadriceps strength and BMD of the femoral trochanter were noted at the end of the 6-month training period (P<.05). At 1-year follow-up, there were significant improvements in quadriceps strength and dynamic balance compared to baseline (P<.05). The OsteoACTIVE rehabilitation program was feasible and achieved progression of training level, had high adherence, and had no adverse events. Positive improvements were established in lower extremity function and femoral trochanter BMD. Clinical trial registered at ClinicalTrials.gov (NCT01357278). Therapy, level 4.

The effects of foot and ankle devices on balance, gait and falls in adults with sensory perception loss: a systematic review protocol

The effects of foot and ankle devices on balance, gait and falls in adults with sensory perception loss: a systematic review protocol

A cognitive-balance control training paradigm using wii fit to reduce fall risk in chronic stroke survivors.

The impaired ability to maintain balance while performing higher-level cognitive tasks (cognitive-motor interference) significantly predisposes stroke survivors to risk of falls. We investigated adherence and intervention-related effects of gaming to improve balance control and decrease cognitive-motor interference in stroke survivors. Community-dwelling individuals with hemiparetic stroke (N = 8) received balance control training using Wii Fit in conjunction with cognitive training for approximately 110 min/d for 5 consecutive days. Changes in balance and cognitive performance were evaluated by the limits of stability test performed under single-task (ST) and dual-task (DT) conditions. The outcome measures from the limits of stability test included reaction time and movement velocity of the center of pressure. The cognitive performance was quantified by the number of errors. The DT cost was computed for the balance and cognitive outcome measures using [(ST - DT)/ST × 100]. Adherence was assessed by change on the Intrinsic Motivation Inventory scores postintervention. No commercial party having a direct financial interest in the research findings reported here has conferred orwill confer. Posttraining, reaction time cost in the forward direction improved from 31 ± 8.02 to ±8.7 ± 6.6. Similarly, movement velocity cost improved from 33.7 ± 12.3 to 11 ± 1. Cognitive cost also decreased from 47.9 ± 13.9 to 20 ± 18.8. There were similar improvements in the backward direction for all the outcome measures. Scores on the Intrinsic Motivation Inventory improved from 16.6 ± 1.3 to 23.5 ± 1.5. The results demonstrate good adherence and evidence of clinical value of this high-intensity, short-duration protocol for reducing cognitive-motor interference and improving balance control in stroke survivors. Future studies should examine the dose-response effects and long-term changes of such DT training paradigm applied to improve fall efficacy.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A80) for more insights from the authors.

Quantification of postural stability in older adults using mobile technology.

Traditional biomechanical systems used to capture kinematic data have shown that declines in postural stability are frequently present in older adults and neurological populations. Recent advances in processor speed and measuring capabilities of on-board electronics within mobile devices present an opportunity to gather kinematic data and apply biomechanical analyses to potentially quantify postural stability. The aim of this project was to determine if the kinematic data gathered using a mobile device were of sufficient quantity and quality to characterize postural stability in older adults. Twelve healthy older adults completed six different balance conditions under altered surface, stance and vision. Simultaneous kinematic measurements were gathered from a three-dimensional motion analysis system and iPad during balance conditions. Correlation between the two systems was significant across balance conditions and outcome measures: peak-to-peak (r = 0.70-0.99), normalized path length (r = 0.64-0.98), root mean square (r = 0.73-0.99) of linear acceleration, 95 % volume (r = 0.96-0.99) of linear and angular acceleration and total power across different frequencies (r = 0.79-0.92). The mean absolute percentage error metric, used to evaluate time-series measurements point-by-point, indicated that when measuring linear and angular acceleration, the iPad tracked the motion analysis system with average error between 6 and 10 % of motion analysis measurements across all balance conditions. Collectively, similar accuracy with the iPad compared to motion capture suggests the sensors provide sufficient accuracy and quality for the quantification of postural stability in older adults. The objectivity, portability, and ease of use of this device make it ideal for use in clinical environments, which often lack biomechanical systems.

Suitability of Kinect for measuring whole body movement patterns during exergaming

Exergames provide a challenging opportunity for home-based training and evaluation of postural control in the elderly population, but affordable sensor technology and algorithms for assessment of whole body movement patterns in the home environment are yet to be developed. The aim of the present study was to evaluate the use of Kinect, a commonly available video game sensor, for capturing and analyzing whole body movement patterns. Healthy adults (n=20) played a weight shifting exergame under five different conditions with varying amplitudes and speed of sway movement, while 3D positions of ten body segments were recorded in the frontal plane using Kinect and a Vicon 3D camera system. Principal Component Analysis (PCA) was used to extract and compare movement patterns and the variance in individual body segment positions explained by these patterns. Using the identified patterns, balance outcome measures based on spatiotemporal sway characteristics were computed. The results showed that both Vicon and Kinect capture >90% variance of all body segment movements within three PCs. Kinect-derived movement patterns were found to explain variance in trunk movements accurately, yet explained variance in hand and foot segments was underestimated and overestimated respectively by as much as 30%. Differences between both systems with respect to balance outcome measures range 0.3–64.3%. The results imply that Kinect provides the unique possibility of quantifying balance ability while performing complex tasks in an exergame environment.

Relative and absolute reliability of functional performance measures for adults with dementia living in residential aged care.

This pilot investigation aimed to assess the relative and absolute test-retest reliability of commonly used functional performance measures in older adults with dementia residing in residential aged care facilities. A total of 12 participants were tested on the Short Physical Performance Battery (SPPB), the Balance Outcome Measure for Elder Rehab (BOOMER), hand grip strength, anthropometric measures and Bio-electric Impedance Analysis (BIA). This study utilized a seven-day test-retest evaluation. Intra-class Correlation Coefficients (ICC) were used to assess relative reliability, Typical Error of Measurement (TEM) was used to assess the absolute reliability, and Bland-Altman plots were used to assess group and individual levels of agreement. With the exception of Standing Balance (ICC = 0.49), 2.4-m walk (ICC = 0.68), functional reach (ICC = 0.38), and static timed standing (ICC = 0.47), all measures demonstrated acceptable (>0.71) ICCs. However, only the anthropometric measures demonstrated acceptable levels of absolute reliability (>10% TEM). Bland-Altman analysis showed non-significant (p > 0.05) mean differences, and eight out of the 17 measures showing wide Limits of Agreement (LoA). Current measures of functional performance are demonstrably inappropriate for use with a population of older adults with dementia. Authors suggest aligning current measurement strategies with Item Response Theory as a way forward.

Acute exercise effects on balance outcome measures in healthy older adults: Preliminary results

Approximately one third of Canadian seniors experience a fall each year and one quarter suffer serious injuries as a result. Preventative exercise programs are commonly recommended; however, the current methods used to assess the risk associated with these programs do not include the effects of exercise on fall risk. The purpose of this study was to determine the effects of acute exercise on balance in elderly individuals. We hypothesized that acute exercise in healthy seniors would negatively affect balance outcome measures in those seniors who had a prior history of at least one fall in the past year. During the study participants were separated into two groups: those who had experienced a fall in the last year (fallers) and those who had not (non-fallers). All participants underwent static and dynamic tests to determine balance outcome measures under fatigued and control (non-fatigued) conditions. To represent the fatigued condition, the Naughton treadmill protocol was used to safely increase heart rate to 60-69% HRmax. Although it was expected that performance in the balance outcome measures would be adversely affected by the acute exercise bout in patients at a high risk of falling, conclusive results could not be drawn as the data collected were all from participants who had not experienced a fall within the past year. However, preliminary results are presented for data collected from six participants classified as non-fallers.&#x0D; &#x0D; Keywords: acute exercise; balance; fall risk; older adults

Transfemoral interfaces with vacuum assisted suspension comparison of gait, balance, and subjective analysis: Ischial containment versus brimless

ObjectiveInvestigate the effect of a brimless interface design compared with ischial ramus containment (IRC) of interfaces when using vacuum-assisted suspension (VAS) on transfemoral amputees (TFAs). DesignRandomized experimental crossover. SettingHousehold, community, and clinic. ParticipantsUnilateral TFAs (N=12 enrolled, N=10 analyzed). Mean age: 42.9 years. Mean residual limb length: 60.3% of the sound side femur length. Participants’ mean time as an amputee: 8.3 years and median AMP score: 43. Interventions(1) IRC VAS interface, and (2) brimless VAS interface. Average medial wall height for IRC interfaces was 0.7cm proximal to the distal-most aspect of the ischial tuberosity (IT). The medial wall on the brimless design was an average of 3.3cm distal to the distal-most aspect of the IT. Main outcome measuresSpatiotemporal gait parameters, limits of stability, four square step test, and subjective perception using the prosthetic evaluation questionnaire (PEQ). ResultsStep length was significantly improved towards the IRC (p=0.04), when calculating degree of asymmetry. Base of support was significantly narrowed toward the brimless (p=0.03). All subjective measures reached statistical significance in favor of improvement with the brimless design, compared to the IRC. ConclusionsThe brimless design was equivalent to IRC in most gait and balance outcome measures. However, step length was more symmetrical toward the IRC while base of support was narrowed toward the brimless demonstrating mixed inconsistent performance changes. Further, the PEQ demonstrated significant subjective improvements in prosthetic related function and quality of life when participants used the brimless design. Brimless interface design may be a clinically viable choice.