Berg Balance Scale Assessment Research Articles

Association of Balance with Somatosensory Loss of Lower Limb in Diabetic Patients

Background: Diabetes, a prevalent global health issue, notably in Pakistan, poses significant challenges in healthcare management due to its complications, including impaired balance and increased fall risk. Objective: This study aimed to investigate the association between balance impairment and somatosensory loss in diabetic patients, focusing on the impact of aging and gender differences. Methods: A cross-sectional study was conducted over six months at Akhtar Seed Trust Teaching Hospital, Lahore, involving 600 participants. The Berg Balance Scale (BBS) and Rivermead assessments were used to evaluate balance and somatosensory loss. Participants included males and females aged above 25, with stratification into positive and negative cases based on their balance and somatosensory status. Results: Of the 600 participants (224 males, 376 females), 150 were categorized as positive cases, showing significant balance impairment. The BBS assessment revealed that two-point discrimination was more affected compared to vibratory sense and proprioception. The study found a statistically significant association between somatosensory loss and balance impairment, irrespective of age and gender. Conclusion: The study concludes that there is a significant correlation between somatosensory loss and balance impairment in diabetic patients, with aging and gender playing a lesser role. These findings underscore the need for targeted balance and sensory training in diabetic care to reduce fall risks.

Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function.

Background: A variety of functional disorders can be caused after stroke, among which impairment of respiratory function is a frequent and serious complication of stroke patients. The aim of this study was to examine diaphragmatic function after stroke by diaphragm ultrasonography and then to apply to explore its correlation with extremity motor function and balance function of the hemiplegia patients. Methods: This cross-sectional observational study recruited 48 hemiplegic patients after stroke and 20 matched healthy participants. The data of demographic and ultrasonographic assessment of all healthy subjects were recorded, and 45 patients successfully underwent baseline data assessment in the first 48 h following admission, including post-stroke duration, stroke type, hemiplegia side, pipeline feeding, pulmonary infection, ultrasonographic assessment for diaphragm, Fugl–Meyer Motor Function Assessment Scale (FMA Scale), and Berg Balance Scale assessment. Ultrasonographic assessment parameters included diaphragm mobility under quiet and deep breathing, diaphragm thickness at end-inspiratory and end-expiratory, and calculated thickening fraction of the diaphragm. The aim was to analyze the diaphragm function of hemiplegic patients after stroke and to explore its correlation with extremity motor function and balance function. Results: The incidence of diaphragmatic dysfunction under deep breath was 46.67% in 45 hemiplegia patients after stroke at the convalescent phase. The paralyzed hemidiaphragm had major impairments, and the mobility of the hemiplegic diaphragm was significantly reduced during deep breathing (p < 0.05). Moreover, the thickness fraction of hemiplegic side was extremely diminished when contrasted with the healthy control and non-hemiplegic side (p < 0.05). We respectively compared the diaphragm mobility under deep breath on the hemiplegic and non-hemiplegic side of patients with left and right hemiplegia and found there was no significant difference between the hemiplegic side of right and left hemiplegia (p > 0.05), but the non-hemiplegic side of right hemiplegia was significantly weaker than that of left hemiplegia patients (p < 0.05). The diaphragm mobility of stroke patients under quiet breath was positively correlated with age and FMA Scale score (R2 = 0.296, p < 0.05), and significant positive correlations were found between the diaphragm mobility under deep breath and Berg Balance Scale score (R2 = 0.11, p < 0.05), diaphragm thickness at end-inspiratory and FMA Scale score (R2 = 0.152, p < 0.05), and end-expiratory thickness and FMA Scale score (R2 = 0.204, p < 0.05). Conclusions: The mobility and thickness fraction of the hemiplegic diaphragm after stroke by diaphragm ultrasonography were significantly reduced during deep breathing. Diaphragm mobility on bilateral sides of the right hemiplegia patients were reduced during deep breathing. Moreover, the hemiplegic diaphragmatic function was positively correlated with extremity motor and balance function of the hemiplegia patients.

Automatic and Efficient Fall Risk Assessment Based on Machine Learning.

Automating fall risk assessment, in an efficient, non-invasive manner, specifically in the elderly population, serves as an efficient means for implementing wide screening of individuals for fall risk and determining their need for participation in fall prevention programs. We present an automated and efficient system for fall risk assessment based on a multi-depth camera human motion tracking system, which captures patients performing the well-known and validated Berg Balance Scale (BBS). Trained machine learning classifiers predict the patient’s 14 scores of the BBS by extracting spatio-temporal features from the captured human motion records. Additionally, we used machine learning tools to develop fall risk predictors that enable reducing the number of BBS tasks required to assess fall risk, from 14 to 4–6 tasks, without compromising the quality and accuracy of the BBS assessment. The reduced battery, termed Efficient-BBS (E-BBS), can be performed by physiotherapists in a traditional setting or deployed using our automated system, allowing an efficient and effective BBS evaluation. We report on a pilot study, run in a major hospital, including accuracy and statistical evaluations. We show the accuracy and confidence levels of the E-BBS, as well as the average number of BBS tasks required to reach the accuracy thresholds. The trained E-BBS system was shown to reduce the number of tasks in the BBS test by approximately 50% while maintaining 97% accuracy. The presented approach enables a wide screening of individuals for fall risk in a manner that does not require significant time or resources from the medical community. Furthermore, the technology and machine learning algorithms can be implemented on other batteries of medical tests and evaluations.

Utilizing the ZeroG TRiP Module During Inpatient Rehabilitation: Balance Recovery in Acute Stroke Patients – A Pilot Study

<h3>Research Objectives</h3> To determine if inducing safe postural-perturbations with the TRiP-module during standing and ambulation exercises in the ZeroG body-weight support system, more effectively improves patient balance than ZeroG without these perturbations. <h3>Design</h3> Study was an unblinded randomized control pilot study. <h3>Setting</h3> Study was conducted at Gaylord Specialty Healthcare, a long-term acute care rehabilitation hospital located in Wallingford, Connecticut, USA. <h3>Participants</h3> Inpatient stroke rehabilitation patients were considered for the study if their Berg Balance Scale score was ≥ 21/56. Consented participants were randomly assigned to either the ZeroG or ZeroG+TRiP group. <h3>Interventions</h3> ZeroG interventions consisted of balance activities including ambulation, marching, side-stepping, retro-ambulation, step-taps, and step-ups. ZeroG+TRiP interventions included these same activities, with the addition of a sudden and brief assistive or resistive force in the lateral, anterior, or posterior direction. Participants completed eight-sessions over two-weeks, starting at TRiP level-one and progressing to level-ten based on the participant's progress and therapist's discretion. <h3>Main Outcome Measures</h3> The main study outcomes were the Activities-Specific Balance Confidence (ABC) and Berg Balance Scale assessments. <h3>Results</h3> Institutional Berg Balance data from 2018 served as a historical Standard of Care (SOC) baseline. SOC, ZeroG, and ZeroG+TRiP groups displayed improved post-intervention Berg Balance scores (p≤0.0025), however, the post-intervention scores were not different between groups. Calculating the Berg Balance score percent change [mean(SD)n], the ZeroG+TRiP [66.95%(43.78%)14] and ZeroG groups [53.29%(24.13%)15] were significantly greater than the SOC group [28.31%(17.25%)30] (p≤0.0178), with no difference between the ZeroG groups (p=0.6669). The post intervention ABC assessment scores were similarly improved (p≤0.0438), with no difference between ZeroG groups. <h3>Conclusions</h3> Participants in both ZeroG groups demonstrated similar Berg Balance Scale and ABC score improvements, indicating the TRiP Module is not detrimental to post-acute stroke rehabilitation and can be safely used. This pilot-study then provides the rationale for conducting a larger study to better assess if the TRiP protocol provides an additional benefit to stroke patients during inpatient rehabilitation. <h3>Author(s) Disclosures</h3> Aretech, LLC provided financial assistance for protected time to complete the administrative work associated with this pilot study. Authors have no other disclosures.

The BAND Test: Improving Reliability and Balance Testing for People with Neurocognitive Impairments: A Pilot Study

People with neurocognitive impairments have a higher risk of falls compared to other older adults and require specific cues for evaluation. Additional options for balance testing is necessary to improve reliability and assessment of fall risk. This study established the efficacy of the novel Balance Assessment for Neurocognitive Deficits (BAND) in order to improve measurement of fall risk for people with neurocognitive impairments. The BAND was analyzed for construct validity and reliability through comparison with the Berg Balance Scale (BBS). Older adults with neurocognitive impairments (n=15) in subacute and long-term settings performed BAND and BBS assessments during therapy. Clinicians determined ambulation assistance, fall risk, and time. Calculation of intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC95) values was completed. Corresponding ICC values were 0.985 (95% confidence interval (95% CI), 0.956-0.995) for test-retest reliability and 0.995 (95% CI, 0.985-0.998) for inter-rater reliability. Other values included SEM=0.79 and MDC95=2.18. A linear-regression graph including Pearson’s coefficient (r) demonstrated validity through comparing BAND and BBS and showed a strong correlation (r=0.94, 95% CI, 0.825-0.98). A Bland-Altman plot was created to assess agreement between clinicians, and the mean difference was 0.2667 with 95% limits of agreement (-0.897 to 1.430). The BAND demonstrated excellent reliability and agreement for clinicians providing the test. Further research is necessary to compare the BAND with additional assessments and to demonstrate the utility in expanded populations including the community.

Horn Clause Techniques in Rehabilitation Clinic for Return to Work

Rehabilitation therapy aims to enable disabled patients to maintain optimal functioning upon achieving returnto-work (RTW) approval. The Berg Balance Scale (BBS) is a benchmark for activity accomplishment featured in the International Classification of Functioning, Disability and Health Framework (ICF). The ICF is used by physiotherapist (PT) and occupational therapist (OT) to determine the functional mobility of disabled patient. Conventionally, practitioners measure, record, and analyze assessment results manually which resulting in difficulty in predicting patient progression. The large data volume involved in the RTW process requires synthesize and reasoning for decision making purposes. Thus, there is a need to identify an efficient reasoning technique to facilitate the decision making process. This study highlights the use of Horn Clause in decision tree to assist medical doctor in assessing improvement of RTW approved patient based on the BBS assessment. The Horn Clause is one of the fundamental reasoning techniques applied in various domains including healthcare. The next phase of this study is to test the efficiency of the Horn Clause reasoning based on patient’s stroke recovery and spinal cord injury.

Inertial data-based gait metrics correspondence to Tinetti Test and Berg Balance Scale assessments

Abstract The analysis of selected gait metrics and their correspondence to human gait and balance abilities is presented in this paper. Accelerometric and gyroscopic data have been acquired from 42 older patients for the entire Berg Balance Scale examination along with expert assessments and additional gait segments of a ca. 1 min duration evaluated by means of the Tinetti Test. The inertial data is analyzed for gait and step detection and subjected to a detailed gait analysis using four metrics for both legs separately: pitch angle change, average duration of step swing and stance phase, and the average phase duration ratio. The analysis is performed offline. The results are compared to expert assessments using Spearman's rank correlation coefficient with p

Correlation between accelerometry and clinical balance testing in stroke.

[Purpose] The purpose of this study was to determine the correlation between the Berg Balance Scale (BBS) and acceleration of postural sway in the Clinical Test of Sensory Interaction and Balance (CTSIB) by using a triaxial accelerometer for quantitative assessment. [Subjects and Methods] Twenty-seven stroke patients participated in this study. Balance ability was evaluated with the BBS, and postural sway was evaluated with a triaxial accelerometer. The data were then analyzed for frequency and correlation by using statistical software (SPSS 18.0). [Result] Acceleration in left-right and forward-backward directions in all conditions of the CTSIB assessment showed a significant correlation with BBS assessment. Acceleration in Signal Vector Magnitude values in condition 3 of the CTSIB assessment showed a significant correlation with BBS assessment. [Conclusion] This study revealed that postural sway represented balance ability as acceleration in the quantitative measurement of kinematic analysis. This finding suggests that the triaxial accelerometer could be used as a measurement tool in clinical conditions.

Interrater Reliability of the Berg Balance Scale When Used by Clinicians of Various Experience Levels to Assess People With Lower Limb Amputations

People with lower limb amputations frequently have impaired balance ability. The Berg Balance Scale (BBS) has excellent psychometric properties for people with neurologic disorders and elderly people dwelling in the community. A Rasch analysis demonstrated the validity of the BBS for people with lower limb amputations of all ability strata, but rater reliability has not been tested. The study objective was to determine the interrater reliability and intrarater reliability of BBS scores and the differences in scores assigned by testers with various levels of experience when assessing people with lower limb amputations. This reliability study of video-recorded single-session BBS assessments had a cross-sectional design. From a larger study of people with lower limb amputations, 5 consecutively recruited participants using prostheses were video recorded during an in-person BBS assessment. Sixteen testers independently rated the video-recorded assessments. Testers were 3 physical therapists, 1 occupational therapist, 3 third-year and 4 second-year doctor of physical therapy (DPT) students, and 5 first-year DPT students without clinical training. Rater reliability was calculated using intraclass correlation coefficients (ICC [2,k]). Differences in scores assigned by testers with various levels of experience were determined by use of an analysis of variance with Tukey post hoc tests. The average age of the participants was 53.0 years (SD=15.7). Amputations had occurred at the ankle disarticulation, transtibial, and transfemoral levels because of vascular, trauma, and medical etiologies an average of 8.2 years earlier (SD=7.9). Berg Balance Scale scores spanned all ability strata. Interrater reliability (ICC [2,k]=.99) and intrarater reliability of scores determined in person and through video-recorded assessments by the same testers (ICC [2,k]=.99) were excellent. For participants with the lowest levels of ability, licensed professionals assigned lower scores than did DPT students without clinical training. Intrarater reliability calculations were based on 2 testers. Berg Balance Scale scores assigned to people using prostheses by testers with various levels of clinical experience had excellent interrater reliability and intrarater reliability.

How the tobacco industry continues to keep the home fires burning

<h3><b>Background</b></h3> People with lower limb amputations frequently have impaired balance ability. The Berg Balance Scale (BBS) has excellent psychometric properties for people with neurologic disorders and elderly people dwelling in...