Berg Balance Test Research Articles

Keep it simple: comparing functional assessments in individuals with Down syndrome.

A number of assessments exist that evaluate function in ambulatory adults. However, these assessments take for granted the cognitive abilities required for the participant to understand what is being asked of them in order to demonstrate their functional abilities. It has been shown that individuals with Down syndrome (DS) demonstrate lower functional levels when asked to perform additional tasks while walking. Therefore, measurements of function may not be reflective of actual function if the assessment requires additional tasks in those with DS. It is for these reasons the current investigation sought to evaluate four common functional assessments, two with [modified Berg balance test (mBERG) and Functional Gait Assessment (FGA)] and two without [Timed Up and Go (TUG) and Established Populations for Epidemiologic Study in the Elderly (EPESE)] complex tasks. Adults with DS (n=19) completed four functional assessments, which were later compared using bivariate Pearson correlation coefficients. There were large associations between simple assessments (TUG-EPESE: r=-0.525, P=0.021) and complex assessments (FGA-mBERG: r=0.612, P=0.005), respectively. The TUG also inversely correlated with the FGA (r=-0.476, P=0.039), and the EPESE had a large association with mBERG (r=0.508, P=0.027). The mBERG may be the best test to replicate real-world scenarios through its tasks, although it may also be confounded by the cognitive load required to perform the movements as asked. The TUG and EPESE may be more appropriate as mobility assessments because they require very little cognitive attention when completing the tasks. True assessments of mobility ought to err on the side of simple so to not confuse the outcomes with executive functionality.

Rehabilitation of patients with progressive forms of multiple sclerosis

Rehabilitation has an important place in the treatment and management of patients with multiple sclerosis (MS). Currently, active research is being carried out in the field of telerehabilitation, extended rehabilitation and staged rehabilitation.Objective: to study the results of staged motor rehabilitation, which is a combination of methods of inpatient rehabilitation, telerehabilitation and home rehabilitation, as links in a chain to maintain rehabilitation potential for a longer period and, if possible, maintain the level of physical activity and quality of life of patients.Patients and methods. The study included 53 patients with progressive forms of MS, who were divided into the main (n=28) and control (n=25) groups. Intensive rehabilitation was carried out, supplemented by telerehabilitation and home rehabilitation. The condition of all patients was assessed using validated scales: the Beck questionnaire, the suicide scale, the Multiple Sclerosis Quality of Life-54 Questionnaire (MsQol-54), the Rankin scale, the Rivermead mobility index, the Barthel index. Physical activity tests were performed – Berg's balance test, 25-foot and 6-minute walk test, five squats, nine-hole peg tests. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA test), Symbol Digit Modalities Test (SDMT).Results and discussion. Statistically significant improvement 12 weeks after the end of intensive rehabilitation was noted in the nine-hole peg test, the five squats test, the Berg balance test, the Rivermead mobility index, and the pain level on the visual analog scale. Conclusion. The obtained results suggest that the staged rehabilitation of patients with progressive forms of MS helps to maintain the rehabilitation potential for a long time.

Somatosensory impairment of the feet is associated with higher activation of prefrontal cortex during walking in older adults.

Over-activation of prefrontal cortex during walking has been reported in older adults versus young adults. Heighted activity in prefrontal cortex suggests a shift toward an executive control strategy to control walking. A potential contributing factor is degraded functioning of pattern-generating locomotor circuits in the central nervous system that are important to walking coordination. Somatosensory information is a crucial input to these circuits, so age-related impairment of somatosensation would be expected to compromise the neural control of walking. The present study tested the hypothesis that poorer somatosensation in the feet of older adults will be associated with greater recruitment of the prefrontal cortex during walking. This study also examines the extent to which somatosensory function and prefrontal activity are associated with performance on walking and balance assessments. Forty seven older adults (age 74.6±6.8years; 32 female) participated in walking assessments (typical walking and obstacle negotiation) and Berg Balance Test. During walking, prefrontal activity was measured with functional near infrared spectroscopy (fNIRS). Participants also underwent somatosensory testing with Semmes-Weinstein monofilaments. The primary findings is that worse somatosensory monofilament level was associated with greater prefrontal cortical activity during typical walking (r=0.38, p=0.008) and obstacle negotiation (r=0.40, p=0.006). For the obstacle negotiation task, greater prefrontal activity was associated with faster walking speed (p=0.004). Poorer somatosensation was associated with slower typical walking speed (p=0.07) and obstacles walking speed (p<0.001), as well as poorer balance scores (p=0.03). The study findings are consistent with a compensation strategy of recruiting prefrontal/executive control resources to overcome loss of somatosensory input to the central nervous system. Future research should further establish the mechanisms by which somatosensory impairments are linked to the neural control and performance of walking tasks, as well as develop intervention approaches.

The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study

Background The likelihood of regaining independent walking after stroke influences rehabilitation and hospital discharge planning. Objective This study aimed to develop and internally validate a tool to predict whether and when a patient will walk independently in the first 6 months post-stroke. Methods Adults with stroke were recruited if they had new lower limb weakness and were unable to walk independently. Clinical assessments were completed one week post-stroke. The primary outcome was time post-stroke by which independent walking (Functional Ambulation Category score ≥ 4) was achieved. Cox hazard regression identified predictors for achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. The cut-off and weighting for each predictor was determined using β-coefficients. Predictors were assigned a score and summed for a final TWIST score. The probability of achieving independent walking at each time point for each TWIST score was calculated. Results We included 93 participants (36 women, median age 71 years). Age < 80 years, knee extension strength Medical Research Council grade ≥ 3/5, and Berg Balance Test < 6, 6 to 15, or ≥ 16/56, predicted independent walking and were combined to form the TWIST prediction tool. The TWIST prediction tool was at least 83% accurate for all time points. Conclusions The TWIST tool combines routine bedside tests at one week post-stroke to accurately predict the probability of an individual patient achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. If externally validated, the TWIST prediction tool may benefit patients and clinicians by informing rehabilitation decisions and discharge planning.

Falls in older adults: a practical approach.

Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive interventions may be a challenging task. The objectives of this study are to summarize the most relevant information on the topic "falls in the elderly" and to give a critical view and practical clinical approach on this topic. In March 2022, a search of Pubmed database was performed, using the terms "fall elderly", fall prevention", "fall risk", with the following parameters: five years, review, systematic review, meta-analysis, practice guidelines. There are several risk factors for falls that can be grouped in different areas (psychosocial, demographic, medical, medication, behavioral, environmental). The clinical evaluation of an older adult prone to falls must include identification of risk factors through history and examination and identification of risk of falls through an assessment tool such as gait velocity, functional reach test, timed up and go, Berg balance test, and miniBEST test. Fall prevention strategies can be single or multiple, and physical activity is the most cited. Technology can be used to detect and prevent falls. A systematic approach to the older patient in risk of falls is feasible and may impact fall prevention.

The impact of a multicomponent-functional training with postural correction on functional balance in the elderly with a history of falling

PurposeGood posture plays a significant role for the elderly in achieving optimal quality of life. This study aimed to evaluate the impact of multicomponent functional training with postural correction on functional balance in the elderly with a history of falling.MethodsThis study was a randomized controlled, single-blind study. Subjects (n = 28, mean age = 70 years) with a history of falling were selected and randomly allocated to either a multicomponent functional training (n = 14) or a control group (n = 14). The experimental group exercised for 8 weeks, three days per week for 60 min per day. The training program with strength, endurance, and balance parts was conducted in the multi-task conditions to stimulate the physical and cognitive abilities focusing on the attentional-correct posture. The control group received conventional care. The Berg balance and short physical performance battery tests were used in the pre-test and post-test. The adjusted post-test means of experimental and control groups were analyzed using the ANCOVA test to eliminate any pretest effects.ResultsThis study found a significant effect of training on Berg balance test (P = 0.001), Timed Up and Go with D-T (P = 0.01), Timed Up and Go (P = 0.002), and Short Physical Performance Battery (P = 0.001).ConclusionsEight weeks of multicomponent exercise training has beneficial effects on balance and physical function and results in improved equilibrium and a decreasing probability of falling. Therefore, practitioners can use this 8-week training program for older adults.

Proprioceptive Training to Improve Static and Dynamic Balance in Elderly

Background: The risk of falls is a major cause of disability in older adults. A single fall, for the elderly, increases the risk of frequent falls and often causes an increased fear of falling again, which can become debilitating.&#x0D; Objectives: The purpose of the present study was to test the effects of 12 weeks of proprioceptive training on the static and dynamic balance of older adults who have experienced at least one fall without compromising consequences.&#x0D; Method: The sample consisted of older adults, aged 60 to 80 years, randomly divided into two groups: an experimental group, which followed a proprioceptive training protocol at a physiotherapy studio, and a control group, which did not observe any treatment. Static and dynamic balance assessment was performed pre-and post-intervention. The tests administered were the Berg Balance Test for the evaluation of static balance, and the Four-Square Step Test, for dynamic balance. A questionnaire to assess confidence and fear of falling was administered at the end of the protocol. Independent sample t-test was performed to analyze differences between groups and two-way ANOVA to test the null hypothesis of no change different over time between groups (interaction intervention × time). A Chi-Square was performed to analyze perceptions.&#x0D; Conclusions: The results showed that 12 weeks of proprioceptive training effectively improved dynamic and static balance in older adults. The perceptions of the experimental group were more positive than the other one, in terms of the importance of physical activity to prevent the risk of falls, fear of falling again, and experience of falls during the last 12 weeks.

Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome.

Objectives In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up

ObjectivesTo investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. MethodsIn this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n=16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n=16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. ResultsStatistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p<0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p<0.05). ConclusionThe application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness.

Effects of Robot-Assisted Gait Training in Patients With Multiple Sclerosis: A Single-Blinded Randomized Controlled Study.

This study aims to evaluate and compare the effects of conventional and robot-assisted gait training (RAGT) programs on fatigue, mood, and quality of life in patients with multiple sclerosis who have fatigue. In this single-blinded, randomized controlled study, 37 patients with multiple sclerosis were randomized into two groups: RAGT ( n = 18) and conventional gait training ( n = 19). The RAGT group had gait training with RoboGait, whereas the conventional gait training group received conventional physiotherapist-assisted gait training. Outcome measures were the Fatigue Severity Scale, Hospital Anxiety Depression Scale, Multiple Sclerosis Quality of Life-54, Extended Disability Status Scale, Functional Ambulation Category, Berg Balance Test, and 6-min walk test. Baseline demographic, clinic, and functional data were similar. Both groups showed improvements in the Fatigue Severity Scale, Hospital Anxiety Depression Scale-Depression, Multiple Sclerosis Quality of Life, Berg Balance Test, and 6-min walk test scores after treatment. Only the RAGT group showed an improvement in Hospital Anxiety Depression Scale-Anxiety score. The RAGT group had better Fatigue Severity Scale, and Hospital Anxiety Depression Scale scores. In combination with the standard rehabilitation program, both RAGT and conventional gait training are effective for multiple sclerosis. However, RAGT has superior effects in terms of fatigue, depression, and anxiety. Therefore, it may be preferred in multiple sclerosis patients who exhibit prominent symptoms of fatigue, depression, or anxiety.

The Comparison and Interpretation of Machine-Learning Models in Post-Stroke Functional Outcome Prediction.

Prediction of post-stroke functional outcomes is crucial for allocating medical resources. In this study, a total of 577 patients were enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) program, and 77 predictors were collected at admission. The outcome was whether a patient could achieve a Barthel Index (BI) score of >60 upon discharge. Eight machine-learning (ML) methods were applied, and their results were integrated by stacking method. The area under the curve (AUC) of the eight ML models ranged from 0.83 to 0.887, with random forest, stacking, logistic regression, and support vector machine demonstrating superior performance. The feature importance analysis indicated that the initial Berg Balance Test (BBS-I), initial BI (BI-I), and initial Concise Chinese Aphasia Test (CCAT-I) were the top three predictors of BI scores at discharge. The partial dependence plot (PDP) and individual conditional expectation (ICE) plot indicated that the predictors’ ability to predict outcomes was the most pronounced within a specific value range (e.g., BBS-I < 40 and BI-I < 60). BI at discharge could be predicted by information collected at admission with the aid of various ML models, and the PDP and ICE plots indicated that the predictors could predict outcomes at a certain value range.

Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study.

Understanding and assessing patients' body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed "Up & Go," Berg Balance Test, ankle range of motion, shoulder range of motion) as the "challenge" for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers' family members and clinical experience. Kubi, which allowed the clinician to remotely control the patient's device, was useful for repositioning the tablet camera to gain a better view of the patient's body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient's clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.

The effect of vitamin D and exercise on balance and fall risk in postmenopausal women: A randomised controlled study.

To evaluate the effects of vitamin D and exercise on balance, fall risk and quality of life (QoL) in postmenopausal women. In this prospective, randomised, controlled, single-blind study postmenopausal women aged 50-70years were included. Participants with <25nmol/L 25(OH) vitamin D were randomised to three groups: group-I (vitamin D replacement) (n=21), group-II (core and balance exercises) (n=18), and group-III (vitamin D replacement plus core and balance exercises) (n=20). The participants with >75nmol/L 25(OH) vitamin D (group-IV) (n=40) were designated as control group and received the core and balance exercises. The participants were evaluated before and after 8weeks with Berg balance test and Biodex balance system (postural stability and fall risk tests) for balance and Nottingham Health Profile (NHP) for QoL. Group IV had better baseline BBT, NHP pain, NHP emotional reactions, NHP social isolation subdomain and total score. After treatment, all groups showed significant improvement in balance (except group I, mediolateral stability index) and QoL (except group II). There was no significant difference between groups (I, II and III) after intervention. Vitamin D replacement therapy has positive effects on balance and QoL. Core strengthening and balance exercises are essential for better balance and fall prevention in postmenopausal women. Any superior effect of vitamin D or exercise on each other was not determined.

The relationship between serum hydroxyvitamin D levels and fall risks in young adults.

Serum hydroxyvitamin D [25(OH)D] has a role in several aspects of physical performance. Our aim was to determine the possible association between serum 25(OH)D deficiency on the fall risk in young adults by using an objective computerized technique. This cross-sectional study included 80 adults aged 18-40 years with 25(OH)D deficiency and 40 age-matched controls. The participants were devided into three groups according to serum 25(OH)D levels: Group 1; deficient, Group 2; insufficient and Group 3; sufficient (serum 25(OH)D level <20, 20 to <30 and 30-100ng/mL, respectively). The age, gender, height and weight were recorded. To evaluate the fall risk, the Berg Balance test as a clinical assessment and a computerised posturography devise as an objective technique were used. Serum 25(OH)D levels were analyzed by ELISA. Pearson Chi-square, the Kruskal Wallis and Spearman correlation tests were used for statistical analysis. 42 male and 78 female participants were evaluated. In posturographic evaluation, although fall risk score was the highest in group 1 and the lowest in group 3, these differences could not reach statistical significance. However, statistically significant higher fall risk was found in participants with 25(OH)D deficiency (25(OH)D<30) than in controls (25(OH)D>30) (p=0.036). Also a statistically significant correlation was determined between serum 25(OH)D levels and the posturography fall risk scores (p=0.016, r=-0, 219). By using an objective computerized technique, fall risk was found to be higher in young adults with 25(OH)D deficiency than in the controls. Vitamin D deficiency, even when clinically occult, seems to affect balance negatively.

Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

Post-acute care (PAC) is a type of transitional care for poststroke patients after the acute medical stage; it offers a relatively intensive rehabilitative program. Under Taiwan's National Health Insurance guidelines, the only patients who can transfer to PAC institutions are those who have had an acute stroke in the previous month, are in a relatively stable medical condition, and have the potential for improvement after aggressive rehabilitation. Poststroke patients receive physical, occupational, and speech therapy in PAC facility. However, few studies have evaluated the effects of PAC in poststroke patients since PAC's initiation in Taiwan. Thus, this study aims to investigate whether the length of stay in a PAC institution correlates with patients’ improvements.This retrospective and single-center study in Taiwan enrolled 193 poststroke patients who had received acute care at Chi-Mei Medical Center, Taiwan, at any period between 2014 and 2017. Data on their length of stay in the PAC institution were collected. Poststroke patients’ functional ability—such as activities of daily living (ADL) function and swallowing ability—as well as their corresponding scales were assessed on the first and last day of PAC stay. Statistical analysis was conducted by SPSS version 21.0.The average duration of PAC stay was 35.01 ± 16.373 days. Duration of PAC stay was significantly positively correlated with the Barthel index (P < .001), Berg balance test score (P < .001), gait speed (P = .002), and upper sensory function and upper motor function within the Fugl–Meyer Assessment (both P < .001).Poststroke patients with longer stay in a PAC institution had superior ADL function, balance and coordination, walking speed, and upper-limb dexterity and sensory function.

The Effect of Eight Weeks of Selected Exercises in Water on Pain and Balance of Female Nurses With Chronic Back Pain

Objective: The purpose of this study was to investigate the effect of eight weeks of selected exercises in water on pain and balance of nurses with chronic back pain. Methods: This semi-experimental study was carried out on 30 nurses working in Sanandaj city hospitals. Selected exercises in water for eight weeks, three sessions per week, which was carried out progressively and with the practice of central stability exercises on the experimental group. To assess the pain and balance of the patients in the pre and post test tests, both groups used the standard questionnaire of Quebec, FBT test, berg balance test. Independent and dependent t-test was used to analyze the data. The significance level was considered as P&lt;0.05. Results: There was a significant difference between the mean scores of pain and the static and dynamic balance in the experimental and control groups, respectively, with a significant decrease and significant increase in the pain (P=0.001) and static (P=0.001) and dynamic (P=0.001) balance variables in the experimental group. Conclusion: Regarding the effectiveness of selected exercises in water on the pain and balance of nurses with non-specific chronic low back pain, it is recommended to design the training protocols for patients with Special attention should be given to the chronic pain, to the practice of water therapy (and to the importance of taking core stability of the workout in these exercises).

Exo-rehabilitation of patients with spastic hemiparesis: high technology

AIM: Walking disorders are a frequent consequence of stroke. New technologies, such as the use of robotic exoskeletons, can help with recovery, but their effectiveness has not yet been sufficiently proven.&#x0D; MATERIALS AND METHODS: Forty-two patients with spasticity and walking disorders (stroke duration from 1.5 to 4 years) were included in the study. The Tardieu Scale, Modified Ashworth scale, Medical Research Council Scale, 10 Meter Walk Test, Rivermead Mobility Index, Berg Balance Test, Rankin scale, and a Visual Analog Scale (to assess patient satisfaction with treatment) were used in assessments. The patients were randomized into 2 groups (n = 22 20): the first group received exoskeleton walk training with the powered exoskeleton, ExoAtlet, and the second group received physical therapy sessions, each for 1 hour daily over 10 days. Clinical evaluations of patients were performed at 3 timepoints: baseline (Day 1), and 12.&#x0D; RESULTS: Comparison of both groups at the second timepoint showed significantly better results (p 0.05) in the first group vs the second group. Walking speed increased due to balance training, correction of postural disorders, spastic muscle stretching, and stretch reflex suppression.&#x0D; CONCLUSION: The wearable powered ExoAtlet exoskeleton is a promising technology for improving walking (2 tables, bibliography: 13 refs).

Gait and balance impairments in patients with subcortical vascular cognitive impairment

BackgroundSubcortical vascular cognitive impairment (SVCI) is a subtype of vascular cognitive impairment associated with extensive cerebral small vessel diseases (CSVDs) imaging biomarkers. The objectives of this work were to study the existence and patterns of gait and balance impairments in patients with SVCI due to CSVDs.MethodsThe study was conducted on 28 newly diagnosed SVCI patients and 22 healthy control subjects (HCS) submitted to the advanced activity of daily living scale (AADLs), Berg balance test (BBT), Montreal Cognitive Assessment Scale (MoCA), computerized dynamic posturography (CDP), vision-based 3-D skeletal data gait analysis, and brain MRI volumetric assessment.ResultsSVCI patients showed a significant decrease in AADLs as well as total cerebral white matter volume, total cerebral cortical volume, and mean cortical thickness which were proportional to the degree of cognitive impairment as measured by the MoCA score. Regarding CDP analysis, patients with SVCI revealed prolongation of cancelation time and spectral power for mid- and high frequencies in dynamic positions. In respect to gait analysis, there were significant decreases in mean stride length and mean cadence as well as increases in mean step width and left to right step length difference in the SVCI group compared to HCS while doing a single task. These variables get highly significant during the dual-task performance with a p value < 0.001 for each one.ConclusionPatients with SVCI suffer from gait and balance impairments that are proportional to the severity of their cognitive decline and greatly impair their ADLs.

Effects of Onabotulinum Toxin A on Gait in Parkinson's Disease Patients with Foot Dystonia.

We investigated the effects of botulinum toxin on gait in Parkinson's disease (PD) patients with foot dystonia. Six patients underwent onabotulinum toxin A injection and were assessed by Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), visual analog scale (VAS) of pain, Timed Up and Go (TUG), Berg Balance Test (BBT), and 3D gait analysis at baseline, 1 month, and 3 months. BFMDRS (p = 0.002), VAS (p = 0.024), TUG (p = 0.028), and BBT (p = 0.034) were improved. Foot pressures at Toe 1 (p = 0.028) and Midfoot (p = 0.018) were reduced, indicating botulinum toxin's effects in alleviating the dystonia severity and pain and improving foot pressures during walking in PD.

Examining Different Motor Learning Paradigms for Improving Balance Recovery Abilities Among Older Adults, Random vs. Block Training—Study Protocol of a Randomized Non-inferiority Controlled Trial

Introduction: Falls are the leading cause of fatal and nonfatal injuries among older adults. Studies showed that older adults can reduce the risk of falls after participation in an unexpected perturbation-based balance training (PBBT), a relatively novel approach that challenged reactive balance control. This study aims to investigate the effect of the practice schedule (i.e., contextual interference) on reactive balance function and its transfer to proactive balance function (i.e., voluntary step execution test and Berg balance test). Our primary hypothesis is that improvements in reactive balance control following block PBBT will be not inferior to the improvements following random PBBT.Methods and Analysis: This is a double-blind randomized controlled trial. Fifty community-dwelling older adults (over 70 years) will be recruited and randomly allocated to a random PBBT group (n = 25) or a block PBBT group (n = 25). The random PBBT group will receive eight training sessions over 4 weeks that include unexpected machine-induced perturbations of balance during hands-free treadmill walking. The block PBBT group will be trained by the same perturbation treadmill system, but only one direction will be trained in each training session, and the direction of the external perturbations will be announced. Both PBBT groups (random PBBT and block PBBT) will receive a similar perturbation intensity during training (which will be customized to participant’s abilities), the same training period, and the same concurrent cognitive tasks during training. The generalization and transfer of learning effects will be measured by assessing the reactive and proactive balance control during standing and walking before and after 1 month of PBBT, for example, step and multiple steps and fall thresholds, Berg balance test, and fear of falls. The dependent variable will be rank transformed prior to conducting the analysis of covariance (ANCOVA) to allow for nonparametric analysis.Discussion: This research will explore which of the balance retraining paradigms is more effective to improve reactive balance and proactive balance control in older adults (random PBBT vs. block PBBT) over 1 month. The research will address key issues concerning balance retraining: older adults’ neuromotor capacities to optimize training responses and their applicability to real-life challenges.Clinical Trial Registration: Helsinki research ethics approval has been received (Soroka Medical Center approval #0396-16-SOR; MOH_2018-07-22_003536; www.ClinicalTrials.gov, NCT04455607).