Changes In Balance Performance Research Articles

Age-related decline in GABAergic intracortical inhibition can be counteracted by long-term learning of balance skills.

Ageing induces a decline in GABAergic intracortical inhibition, which seems to be associated not only with decremental changes in well-being, sleep quality, cognition and pain management but also with impaired motor control. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. Therefore, the present study investigated whether age-related cortical dis-inhibition could be reversed after 6months of balance learning and whether improvements in postural control correlated with the extent of reversed dis-inhibition. The results demonstrated that intracortical inhibition can be upregulated in elderly subjects after long-term balance learning and revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition and may therefore be seminal for many pathologies in which the equilibrium between inhibitory and excitatory neurotransmitters is disturbed. KEY POINTS: Ageing induces a decline in GABAergic intracortical inhibition. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. After 6months of balance learning, intracortical inhibition can be upregulated in elderly subjects. The results of this study also revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition.

Examining the joint coordination during dynamic balance learning using vector coding and statistical parametric mapping analyses

We aimed to examine the changes in balance performance, kinematic variables, and joint coordination of the lower extremities during the Y-balance learning task. Twenty female university students completed five consecutive blocks of Y-balance learning from days 3 to 7 (135 trials). Pre-tests and tests were performed on days 1 and 9. Maximum reach distance, peak joint angle, and joint coordination in the anterior (AL), posterolateral (PL), and posteromedial (PM) directions were measured to determine the efficacy of Y-balance performance. A repeated measures ANOVA was performed for the maximum reach distance across learning blocks to confirm whether learning had occurred. Our results indicated that the maximum reach distance on day 5 was longer than that on other learning days. The maximum reach distance significantly increased in the PL and PM directions after learning. The hip flexion (PL/PM), abduction (PM), internal rotation (PM), and external rotation (PL) angles increased after learning. The knee joint flexion angle increased in both AL and PL directions. Only the ankle dorsiflexion angle increased in the AL direction. Joint coordination indicated that the knee and hip joints performed simultaneously during internal rotation. Ankle-knee joint coordination was performed using dorsiflexion and flexion strategies. Statistical parametric mapping analysis indicated significant differences in the ankle sagittal plane in the AL direction, hip horizontal and hip/knee sagittal planes in the PL direction, and hip/knee sagittal and hip frontal/horizontal planes in the PM direction. These data suggest that the dynamic balance ability of the novice participants improved in relation to changes in coordination patterns after learning. The results of this study can be applied to other populations to improve their dynamic balance and prevent fall injuries.

Increased roll tilt thresholds are associated with subclinical postural instability in asymptomatic adults aged 21 to 84 years.

Balance assessments that intentionally alter the reliability of visual and proprioceptive feedback (e.g., standing on foam with eyes closed) have become a standard approach for identifying vestibular mediated balance dysfunction in older adults. However, such assessments cannot discern which specific element of the vestibular system (e.g., semicircular canal, otolith, or combined canal-otolith) underlies the observed age-related changes in balance performance. The present study was designed to determine the associations between specific sources of vestibular noise and quantitative measures of quiet stance postural control measured during standard "vestibular" balance conditions. A group of 52 asymptomatic adults (53.21 ± 19.7, 21 to 84 years) without a history of vestibular or neurologic disorders volunteered for this study. We measured a battery of five vestibular perceptual thresholds that assay vestibular noise with predominant contributions from the vertical canals, lateral canals, utricles, saccules, and the centrally integrated canal-otolith signal. In addition, participants completed two standard balance assessments that were each designed to prioritize the use of vestibular cues for quiet stance postural control-eyes closed on foam (Condition 4 of the Modified Romberg Balance Test) and eyes closed, on a sway referenced support surface (Condition 5 of the Sensory Organization Test). In age adjusted models, we found strong positive associations between roll tilt vestibular thresholds, a measure of noise in the centrally integrated canal-otolith signal, and the root mean square distance (RMSD) of the anteroposterior and mediolateral center of pressure (CoP) captured during eyes closed stance on a sway referenced support surface. The strength of the association between roll tilt thresholds and the RMSD of the CoP was between 3-times and 30-times larger than the association between postural sway and each of the other vestibular thresholds measured. We posit that noise in the centrally estimated canal-otolith "tilt" signal may be the primary driver of the subclinical postural instability experienced by older adults during the "vestibular" conditions of balance assessments. Additional testing in adults with clinical balance impairment are needed to identify if roll tilt thresholds may also serve as a surrogate metric by which to detect vestibular mediated balance dysfunction and/or fall risk.

Interventions to Promote the Development of Motor Performance Skills in Primary School Aged Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Controlled Trials

Background: The development of proficiency in motor performance skills (MPS) builds the foundation for the complex movement skills required to participate in a range of sports and physical activities throughout the lifespan. Objective: To assess the efficacy of different intervention approaches on developing MPS proficiency in children with autism spectrum disorder (ASD) and examine the intervention factors that influence change. Method: Searches were completed in three databases (PubMed/MEDLINE, Scopus, Web of Science) up to March 2022. Only randomised controlled trials (RCTs) or controlled trials (CTs), that evaluated the effectiveness of interventions on overall MPS proficiency or specific MPS such as balance, running speed and agility, bilateral coordination, jumping, ball skills and push-ups in children (4–13 years old) were included. The DerSimonian and Laird random-effects model was used to compute the meta-analyses. The effect sizes were reported as Hedges’ g. Using a random-effects model, potential sources of heterogeneity were identified, including subgroup analyses (type of intervention), and single training factor analysis (total number of weeks, session frequency, total intervention time, total number of training sessions). In addition, a multivariate meta-regression calculation was performed for balance. The GRADE framework was applied to assess certainty of evidence. Results: Seventeen interventions (13 RCTs and 4 CTs) revealed significant differences among groups favouring the intervention group with moderate to very large effects. Significant (p 0.05) small-to-large effects of interventions were evident on overall motor performance skills (ES = 2.43), ball skills (ES = 2.95), jumping (ES = 1.89), bilateral coordination (ES = 2.21), push-ups (ES = 1.92), balance (ES = 1.56), running speed and agility (ES = 1.31). Multivariate meta-regression for balance revealed that total sessions, total intervention time and session frequency predicted (p = 0.009, p0.001, p = 0.036, respectively) the effects of interventions on change in balance performance. Conclusion: Structured interventions that explicitly teach traditional FMS or promote the development and learning of movement skills specifically associated with a type of physical activity or sport, effectively improve MPS in children with ASD. Education settings should implement ‘planned’ movement experiences or interventions as a strategy to promote MPS proficiency in children with ASD.

The impact of anxiety on postural control: CO2 challenge model.

Anxiety and balance and postural control are linked via common neural pathways, such as the parabrachial nucleus network. A laboratory-based model of general anxiety disorder (GAD) using the CO2 challenge, has potential to be used to observe this relationship, potentially mimicking subjective, autonomic, and neuropsychological features of GAD. The current feasibility study used the CO2 challenge to explore postural control changes in healthy adults. It was predicted that during the CO2 condition, participants would show increased postural sway path length and decreased sway stability, compared with a normal air breathing condition. To assess this, heart and breathing rate, quiet standing postural sway path length, sway dynamic stability, and subjective measures of emotion were measured either before and after or during and after the inhalation conditions. Results demonstrated that CO2 inhalation led to both an increase in sway path length and reduced sway stability compared to the air breathing conditions; the effect on sway path lasted after the inhalation of CO2 had ceased. Additionally, replication of HR and subjective measures of emotion were observed when comparing air and CO2 conditions. This provides experimental evidence that CO2 inhalation can affect balance, suggestive of shared mechanisms between anxiety and balance performance, as well as indicating that the CO2 model of GAD is suitable to look at changes in balance performance in healthy adults. Future use of this model to explore factors that can reduce the influence of GAD on balance would be beneficial as would a more detailed exploration of the neural pathways associated with the associated comorbidity.

Screening for balance in children and adults in a community science education setting: Normative data, influence of age, sex, and body mass index, and feasibility.

BackgroundScreening standing and walking balance is useful for people suspected of having vestibular disorders, a variety of neurologic and musculoskeletal disorders, and for screening astronauts returning after exposure to microgravity. Visitors to a community science education center children and adults, aged 4 to 85, were tested on tandem walking with eyes closed and the modified Romberg test on compliant foam. They were then asked about their experience participating in research, many people for the first time.MethodsSubjects performed 10 steps of tandem walking with eyes closed, and three trials of the modified Romberg, or Clinical Test of Sensory Integration and Balance, with eyes closed, standing on compliant memory foam, with a) head still, b) head shaking in yaw, and c) head nodding in pitch. Afterward, staff queried subjects about the experience of participating in science.ResultsAge-related changes across the life span occurred in both sets of tests. Therefore, look-up tables by age are provided. Body mass index significantly affected tandem walking. Some sex differences were found. The tests were easy to administer in a community setting. Most participants enjoyed the experience and reported that they learned about the process of scientific research.DiscussionThese data support and extend the evidence for age-related changes in balance performance across the lifespan and for an influence of body mass index on some balance skills. Clinicians and sports educators should be cognizant of these differences when they use these tests for screening. The community science education environment provided a useful laboratory in which to collect valid and reliable data, while simultaneously educating participants about the process of science.

Psychometric Properties of the Urdu Translation of Berg Balance Scale in People with Parkinson's Disease.

Background: The most common assessment tool used in clinical settings to detect changes in balance performance is the Berg Balance Scale (BBS). Thus, the purpose of this study was to translate the BBS into Urdu and investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) for individuals with Parkinson’s disease (PD). Methods: Eighty patients of either gender with idiopathic Parkinson’s disease, stages I–III on the modified Hoehn–Yahr (H&Y) scale, with intact cognition according to the Mini Mental Score Examination (MMSE) score (greater than or equal to 24) and independent of transfers, were included in this study. The BBS was translated according to international guidelines based on forward and backward translation processes. The test-retest reliability as well as intra- and inter-observer reliability was assessed by calculating the intra-class correlation coefficient (ICC). The internal consistency of the entire BBS score was assessed by calculating Cronbach’s α. The convergent validity was assessed by correlating the scale with the Unified Parkinson Disease Rating Scale (UPDRS) parts II and III and the Activity-specific Balance Confidence Scale (ABCS). The construct validity was assessed using a factor analysis. Results: The mean age of the subjects was 62.35 ± 5.74 in years (range: 60–87 years). The ICC for intra- and inter-observer reliability was 0.95 (p < 0.0001) and 0.99 (p < 0.001), respectively. Cronbach’s α was calculated as 0.81, which showed acceptable internal consistency of the Urdu version of the BBS. The test-retest reliability (ICC) of the Urdu version of the BBS was determined as 0.97 for the total score, and ranged from 0.66–0.95 for individual items. In terms of validity, the Urdu version of the BBS was correlated with the ABCS (in the positive direction) and UPDRS-II and III (in the negative direction) (r = 0.53, p < 0.001; r = −0.68, p < 0.001, r = −0.78, p < 0.0001), respectively. Conclusion: The Urdu version of the BBS is a reliable and valid scale to be used in balance assessment of population diagnosed with PD with excellent psychometric properties.

Effects of contrast strength training with elastic band program on sprint, jump, strength, balance and repeated change of direction in young female handball players

Maximal strength, power and his derivates (sprint, change of direction repeatedly and jump) are considered as major determinants of success in elite handball players. Contrast strength training with elastic band (CSTEB) program is form of resistance training, and may play an important method of training to improve this quality. This study examined the effects of 10-week contrast strength training with elastic band (CSTEB) program on physical performance in young female handball players. Thirty participants (age: 15.7 ± 0.3 years; body mass: 63.7 ± 3.7 kg; body height: 166.8 ± 3.8 cm; body fat: 26.9 ± 3.4; and Maturity-offset: 2.9 ± 0.3 years) were randomly assigned between experimental group (EG; n = 15) and control group (CG; n = 15). Two-way analyses of variance (group × time) were assessed for handgrip; back extensor; medicine ball throw; 30-m sprint times; Modified Illinois change-of-direction (Illinois-MT); four jump tests [(squat jump (SJ), countermovement jump (CMJ), countermovement jump with arms (CMJA) and five jump test (5JT)]; static (stork) and dynamic (Y balance) balance tests; and repeated sprint T-test (RSTT). The EG enhanced all strength performance [handgrip right, handgrip left, back extensor strength and medicine ball throw (p &lt; 0.001)] compared to CG. The EG enhanced all sprint performance. The EG also improved performance in the Illinois-MT. All jump performance improved significantly [SJ (p = 0.007), CMJ (p = 0.001) and CMJA (p = 0.001)] except 5JT in the EG. Of the same, 3 of 4 repeated sprint T-test scores [RSTT-Best-Time, RSTT-Mean-Time and RSTT-Total-Time] increased significantly in the EG relative to the CG. Conversely, there were no significant changes in balance performance between groups. It is concluded that 10-weeks of CSTEB improved physical performance (strength, sprint, change of direction, jump, and repeated change of direction) measures in young female handball players.

Whole-body vibration training versus conventional balance training in patients with severe COPD\u2014a randomized, controlled trial

BackgroundWhole-body vibration training (WBV) performed on a vibration platform can significantly improve physical performance in patients with chronic obstructive pulmonary disease. It has been suggested that an important mechanism of this improvement is based on an improvement in balance. Therefore, the aim of this study was to investigate the effects of WBV compared to conventional balance training.Methods48 patients with severe COPD (FEV1: 37 ± 7%predicted) and low exercise performance (6 min walk distance (6MWD): 55 ± 10%predicted) were included in this randomized controlled trial during a 3 week inpatient pulmonary rehabilitation. All patients completed a standardized endurance and strength training program. Additionally, patients performed 4 different balance exercises 3x/week for 2 sets of 1 min each, either on a vibration platform (Galileo) at varying frequencies (5–26 Hz) (WBV) or on a conventional balance board (BAL). The primary outcome parameter was the change in balance performance during a semi tandem stance with closed eyes assessed on a force measurement platform. Muscular power during a countermovement jump, the 6MWD, and 4 m gait speed test (4MGST) were secondary outcomes. Non-parametric tests were used for statistical analyses.ResultsStatic balance performance improved significantly more (p = 0.032) in favor of WBV (path length during semi-tandem stand: − 168 ± 231 mm vs. + 1 ± 234 mm). Muscular power also increased significantly more (p = 0.001) in the WBV group (+ 2.3 ± 2.5 W/kg vs. − 0.1 ± 2.0 W/kg). 6MWD improved to a similar extent in both groups (WBV: 48 ± 46 m, p < 0.001 vs. BAL: 38 ± 32 m; p < 0.001) whereas the 4MGST increased significantly only in the WBV-group (0.08 ± 0.14 m/s2, p = 0.018 vs. 0.01 ± 0.11 m/s2, p = 0.71).ConclusionsWBV can improve balance performance and muscular power significantly more compared to conventional balance training.Trial registration: Clinical-Trials registration number: NCT03157986; date of registration: May 17, 2017. https://clinicaltrials.gov/ct2/results?cond=&term=NCT03157986&cntry=&state=&city=&dist =

Effects of six weeks of stable versus unstable multi-dimensional surfaces balance training on passing skills and balance performance in young male basketball players

Background and objective: Adolescence is a period when balance and coordination decrease as a result of rapid musculoskeletal growth. These changes may affect various sports-specific skills, including balance. This study aimed to examine the changes in balance performance and basketball passing speed in male youth basketball players following six weeks of balance training performed on unstable versus stable surfaces. Methods: Twenty-five male basketball players, mean age 15.53 ± 0.57 years, participated in balance training on different surfaces (unstable surface (US, n = 13); stable surface (SS, n = 12)) for six weeks (2 days/week; 35 to 50 min/day, incrementally). Their physical characteristics, passing skills (passing accuracy and speed test) and balance performance (Y-Balance Test and The Closed Kinetic Chain Upper Extremity Stability Test) were measured. Results: The improvement rates for passing accuracy (effect size (ES) = 0.86, moderate, P &lt; 0.001), lower extremity (ES right = 0.94, moderate, P &lt; 0.001; ES left = 0.88, moderate, P &lt; 0.001) and upper extremity (ES right = 1.01, moderate, P &lt; 0.001; ES left = 0.94, moderate, P &lt; 0.001) balance scores, upper extremity stability test power (ES = 0.89, P ≤ 0.001) and the normalized scores (ES = 1.20, moderate, P &lt; 0.001) of the US group were higher than those of the SS group. Passing speed significantly increased only in the US group (P &lt; 0.028). Conclusion: A multi-dimensional surface training model improved balance performance and passing accuracy skills compared to a stable surface training model for male basketball players. US balance training may be used as a complementary training model to increase dynamic balance and passing accuracy skills for male basketball players.

Effect Of Practice And Game-Related Impacts On Common Indicators Of Concussion: A Pilot Study

Previous studies have suggested that football players not clinically diagnosed with concussion may still demonstrate differences in balance and neurocognitive performance by end of season. Clinically this is important as it indicates the athlete with sub-clinical injuries that may contribute to long-term deficits. PURPOSE: A pilot study to determine if non-concussive impacts sustained during normal play at NCAA Division I football practices and spring season scrimmage are sufficient to elicit detectable changes in oculomotor (OM) and balance performance. METHODS: 23 NCAA Division I football players were recruited to this pilot study during the 2019 spring football season. Questionnaires were used to collect demographic information. Portable virtual reality equipment was utilized to measure OM performance of smooth pursuit, saccade, and vestibular ocular reflex (VOR). BESS was utilized to measure balance performance. Assessments were administered at baseline, 24-48 hours after 3 practices, and the spring season scrimmage. Shapiro-Wilkes analysis was used to assess changes in balance and OM skills in subjects across the pilot project. RESULTS: Of the 23 recruited subjects, 7 (30%) completed all assessments; however, there were missing data observations for the 7 subjects who completed all 5 assessment points. There was no significant change in balance performance (p = 0.375); one variable of smooth pursuit testing (mean phase error of left eye) demonstrated near significant changes (p = 0.0625). There was no significant change in any variables for horizontal or vertical VOR, while, one variable of horizontal and vertical saccade testing (accuracy x of left eye) demonstrated near significant changes (p = 0.0625). CONCLUSION: We found no significant detectable changes in balance and OM performance in this pilot study.

Effect of a Spinomed orthosis on balance performance, spinal alignment, joint position sense and back muscle endurance in elderly people with hyperkyphotic posture: A randomized controlled trial.

Hyperkyphosis may cause balance impairment in elderly people. Although the effectiveness of orthoses for improving balance in hyperkyphotic elderly people has received much attention, the mechanisms by which devices affect balance remain unknown. The objective of this study was to evaluate changes in balance performance, thoracic kyphosis angle, craniovertebral angle, back muscle endurance and joint position sense after 3 months of wearing a Spinomed orthosis. The study also included a secondary exploratory analysis to determine whether changes in any of the above-mentioned outcome measures can predict balance performance improvement in elderly people with hyperkyphosis. Parallel group randomized controlled trial. In total, 44 hyperkyphotic elderly people were randomly allocated to an experimental group, who wore a Spinomed orthosis and a control group, who did not. No other treatment or change in physical activity was permitted during the study. A blinded assessor evaluated thoracic kyphosis angle, joint position sense, craniovertebral angle, back muscle endurance, Timed Up and Go Test time and Berg Balance Scale score at baseline and after 5, 9 and 13 weeks. All dependent variables were measured without the orthosis and analyzed separately using a 2 × 4 (time × group) mixed model analysis of variance. Based on the results of correlation analysis, thoracic kyphosis angle, back muscle endurance and joint position sense were selected as independent variables in a stepwise multiple regression model. The two-way (group × time) interactions were significant in terms of Berg Balance Scale (F = 11.6, P ⩽ 0.001, ), Timed Up and Go Test (F = 3.74, P = 0.013, ), thoracic kyphosis angle (F = 43.39, P ⩽ 0.001, ), craniovertebral angle (F = 5.245, P = 0.002, ) and joint position sense (F = 4.44, P = 0.005, [Formula: see text]). The two-way interaction was not significant in terms of back muscle endurance; however, the main effect of group was significant for this variable (F = 3.85, P = 0.025). Stepwise multiple regression showed that thoracic kyphosis angle and joint position sense were significant determinants of Timed Up and Go Test time (R2 = 0.155, P = 0.037 and R2 = 0.292, P = 0.012, respectively). Wearing a Spinomed orthosis for 3 months improved the posture, position sense and muscle performance of hyperkyphotic elderly people. Orthoses may improve balance performance by correcting spinal alignment and increasing proprioceptive information.

Change in Balance Performance Predicts Neurocognitive Dysfunction and Symptom Endorsement in Concussed College Athletes.

Following concussion, there is an array of sequelae including symptom burden, neurocognitive dysfunction, and balance impairment. However, the magnitude of change in balance performance has yet to be explored fully regarding its relationship with neurocognitive functioning or symptom endorsement. The present study hypothesized that the magnitude of change in balance performance from baseline to post-trauma would have unique predictive power in identifying acute clinical outcomes. Sixty-eight college athletes completed annual preparticipation baseline testing and were later diagnosed with a concussion. Linear regressions determined that the magnitude of change in balance performance was a better predictor of neurocognitive dysfunction and endorsement of "balance problems" than post-trauma balance performance alone. These findings highlight the importance of incorporating balance measurements during preparticipation baseline assessment.

Assessing balance in non-disabled subjects with multiple sclerosis: Validation of the Fullerton Advanced Balance Scale

ObjectiveTo validate the Fullerton Advanced Balance (FAB) scale for high-functioning non-disabled people with multiple sclerosis (PwMS). DesignCross-sectional study. ParticipantsA convenience sample of early-diagnosed PwMS (N = 82; Expanded Disability Status Scale score ≤ 2.5) with disease duration ≤ 5 years and a control group of healthy volunteers (N = 45). Main Outcome MeasuresFAB scale, Timed Up and Go test (TUG), 6 Min Walk Test (6MWT) and 25 Foot Walk Test (25FWT). ResultsSix of the ten original FAB scale items were selected to represent a unidimensional construct. Only one factor with eigenvalues > 1.0 (1.90) was found. The new version of the scale reported a Cronbach alpha value of 0.65, and it was also statistically significantly correlated with TUG (r = -0.48). The new six-item scale, dubbed the FAB-short scale (FAB-s), discriminated between healthy volunteers and PwMS; moreover, both the FAB-s and the TUG test discriminated between the two PwMS subgroups: EDSS=0–1.5 (no disability) and EDSS=2–2.5 (minimal disability). ConclusionsFAB-s is a unidimensional clinical tool for assessing balance. The scale is a promising instrument for detecting subtle changes in balance performance in high-functioning PwMS.

Intracortical Inhibition Increases during Postural Task Execution in Response to Balance Training

Intracortical inhibitory modulation seems crucial for an intact motor control and motor learning. However, the influence of long(er) term training on short-interval intracortical inhibition (SICI) is scarcely investigated. With respect to balance, it was previously shown that with increasing postural task difficulty, SICI decreased but the effect of balance training (BT) is unknown. The present study tested whether improvements in postural control due to BT are accompanied by changes in SICI. SICI was measured in the tibialis anterior by applying paired-pulse magnetic stimuli to the motor cortex in a BT group (n = 13) training 2 weeks on an unstable platform and a control (CON) group (n = 13) while performing three progressively demanding postural tasks: stable stance (‘Stable’), standing on a movable platform partly secured with elastic straps (‘Straps’) or freely moving (‘Free’). The BT group improved postural control significantly more than the CON-group (‘Free’ condition: +80% vs. + 21%; p < 0.001). For SICI, there was a main effect of POSTURAL TASK (F2, 48 = 24.6; p < 0.001) with decreasing SICI when task difficulty increased and a TIME × GROUP interaction (F1, 24 = 5.9; p = 0.02) caused by significantly enhanced SICI in the BT group in all three postural tasks after the training. The increases in SICI were significantly correlated with improvements in balance performance (r = 0.56; p = 0.047). The present study confirms previous findings of task-specific modulation of SICI when balancing. More importantly, training was shown to increase SICI and this increase was correlated with changes in balance performance. Thus, changes in SICI seem to be involved not only for the control but also when adapting upright posture with training.

Factors Associated With Responsiveness to Gait and Balance Training in People With Parkinson Disease.

Although increasing evidence supports the benefit- of exercise among people with Parkinson disease (PwPD), it is unclear whether a given exercise modality suits all PwPD, given the heterogeneity of the disease. The purpose of this study was to explore factors associated with responsiveness to a highly challenging training intervention that incorporated dual-task exercises. Forty-seven PwPD (mean age: 73 years; 19 females, Hoehn and Yahr stages 2-3) who had participated in 10 weeks of highly challenging gait and balance training were included. Baseline demographics, disease-related factors, physical and cognitive ability, and perceived health were used for the prediction of percent change in balance performance (the Mini-BESTest) and comfortable gait speed between the pre- and postassessments, using multiple linear regression analyses. Thirty-five percent of the variance of change in balance performance was explained by General Health Perceptions (β = -0.36), the Timed Up and Go test (β = -0.33), and the single-task performance of a cognitive task (β = -0.24). Forty-nine percent of change in gait speed was explained by gait speed while performing a dual task (β = -0.46), dual-task interference while walking (β = 0.43), time to complete the Timed Up and Go test (β = -0.29), and percent error on a cognitive task (β = -0.25). The results may suggest that the PwPD with overall lower perceived health, functional mobility, and cognitive functions are the ones most likely to benefit from highly challenging and attention-demanding gait and balance training.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A240).

Implementation of the HiBalance training program for Parkinson's disease in clinical settings: A feasibility study.

BackgroundTranslating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson’s disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings.MethodFeasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild–moderate PD were enrolled in this pre–post feasibility study. The dose of the original program was adapted by reducing therapist‐led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health‐related quality of life) were also evaluated.ResultsRegarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD.ConclusionThe findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long‐term effects as the original program.

Recalibrating disparities in perceived and actual balance abilities in older adults: a mixed-methods evaluation of a novel exergaming intervention

BackgroundPublished reports suggest a disparity between perceived and actual balance abilities, a trait associated with increased fall-risk in older adults. We investigate whether it is possible to ‘recalibrate’ these disparities using a novel gaming intervention.MethodsWe recruited 26 older adults for a 4-week intervention in which they participated in 8-sessions using a novel gaming intervention designed to provide explicit, augmented feedback related to postural control. Measures of perceived balance abilities (Falls Efficacy Scale-International) and actual postural control (limits of stability) were assessed pre- and post-intervention. We used focus groups to elicit the opinions of participants about how the game may have influenced balance abilities and confidence.ResultsA stronger alignment was observed between postural control and perceived balance capabilities post-intervention (i.e., significant correlations between Falls Efficacy Scale-International scores and limits of stability which were not present pre-intervention). Also, significant improvements in measures of postural control were observed, with these improvements confined to the aspects of postural control for which the exergame provided explicit, augmented feedback. Qualitative data revealed that the intervention made participants more “aware” of their balance abilities.ConclusionsOur results demonstrate that it is possible to recalibrate the perceptions of older adults relating to their balance abilities through a targeted, short-term intervention. We propose that the post-intervention improvements in postural control may have been, in part, the result of this recalibration; with altered perceptions leading to changes in balance performance. Findings support the application of novel interventions aimed at addressing the psychological factors associated with elderly falls.

Test-Retest Reliability, Validity, and Minimal Detectable Change of the Balance Evaluation Systems Test to Assess Balance in Persons with Multiple Sclerosis.

Individuals with multiple sclerosis (MS) have balance deficits that result in falls. Balance tests developed for older adults do not discriminate between fallers and nonfallers with MS. The Balance Evaluation Systems Test (BESTest) identifies body systems contributing to imbalance/fall risk. This study evaluated the test-retest reliability and construct validity of the BESTest to assess balance in individuals with MS, compared the diagnostic accuracy of the BESTest and Berg Balance Scale (BBS), and investigated the minimal detectable change of the BESTest in this population. Twenty individuals with MS were recruited. Age, onset of disease, and fall history were obtained. The following measures were used: Expanded Disability Status Scale, University of Illinois at Chicago Fear of Falling Measure, BESTest, and BBS. Twelve participants were retested to determine test-retest reliability of the BESTest. The BESTest demonstrated strong test-retest reliability (intraclass correlation coefficient [3,1] = 0.98 [95% CI, 0.91-0.99], P = .01) and was highly correlated with the BBS (r = 0.94, P = .01). The BBS had poor accuracy to identify fallers. Using a score of 81%, the BESTest had moderate sensitivity (0.89) to identify fallers. The standard error of the measurement for the BESTest was 4.16 points, which translates into a minimal detectable change of 9.7% [90% CI] to 11.5% [95% CI]. The BESTest demonstrates excellent test-retest reliability and diagnostic utility as a measure of functional balance in persons with moderate MS. A change in BESTest score of at least 10% may indicate a true change in balance performance in this population.

Age related changes in balance performance during self-selected and narrow stance testing

BackgroundVarious balance tests have been considered as fall risk screening tools however there is a lot of variability in the methods and outcome measures reported. Based on previous research examining age-related changes in balance and differences between fallers and nonfallers, the purpose of this investigation was to examine age-related balance changes, as reflected in medial-lateral center of pressure (CP) velocity, in community-dwelling/independently living adults (≥60years) during self-selected and narrow stance testing with eyes opened and closed. MethodsTwo hundred and thirty adults aged 60yrs or older completed one 45s trial under two stances (self-selected, narrow) and two visual conditions (eyes opened, eyes closed). Average medial-lateral CP velocity was computed from the CP data, with preliminary analysis demonstrating positive skewness and association with body height. A sway velocity index (SVI) was created by a natural logarithm transformation and dividing by body height. Multiple linear regression was used to determine the association between age, visual condition, stance, and sex with SVI. ResultsAge, visual condition, stance and sex were all demonstrated to be significant predictors of SVI, with the combination of the predictors explaining 25% of the variance in the SVI. ConclusionsThese results confirm the balance testing protocol and SVI to be sensitive to age-related changes in balance performance. The results of this study should help future research aimed towards establishing a quick, easy to administer, and readily interpretable instrumented test for assisting with identifying potential balance impairments in older adults who have yet to demonstrate outward deficits.