Clinical Balance Tests Research Articles

Quantitative Assessment of the Effect of Instability Levels on Reactive Human Postural Control Using Different Sensory Organization Strategies

Reactive postural control (RPC), essential for maintaining balance during daily activities, relies on a complex sensory system integrating visual, vestibular, and proprioceptive inputs. Deficits in RPC can lead to falls, especially in unpredictable environments where sensory inputs are challenged. Traditional rehabilitation often fails to prepare patients adequately for real-world conditions. This study aims to explore the effects of varying instability levels (ILs) and sensory integration strategies (SIS) on RPC by evaluating balance disturbances without applying additional external force. Twenty-five healthy participants (12 men, 13 women, 24.5 ± 6.1 years) performed balance tasks on Abili® platforms with adjustable ILs (0, 1, 2, 3) while altering sensory strategies (Basic, Visual, Proprioception, Vestibular) using the Modified Clinical Test of Sensory Integration and Balance (mCTSIB). RPC efficiency was measured using the 95th percentile confidence interval for chest movement’s ellipsoid volume and average velocity, analyzed with Wilcoxon signed-rank tests and Cliff’s delta effect size. Results showed significant increases in chest movement velocity and volume, particularly with the Vestibular strategy at higher ILs, with a 7176% increase in chest volume from Basic strategy at 0IL to Vestibular strategy at 3IL. Additionally, removing visual input (Visual and Vestibular strategies) had a greater impact on chest movement than increasing instability levels. These findings underscore the significant role of combined platform instability and reduced sensory input on postural control. This study presents a novel method for challenging balance and suggests that sensory integration with variable instability could be valuable in training and rehabilitation, even for healthy individuals.

Long-term effects of mild and moderate COVID-19 on static and dynamic balance

IntroductionCOVID-19 affects both musculoskeletal and central nervous systems. However, there is no research on its impact on balance in mild to moderate cases. This study aims to compare static and dynamic balance, as well as fall risk, between individuals with mild to moderate COVID-19 and those without the disease.Methods: in this case control study 30 subjects (25–45 years old) with mild to moderate severity of covid-19 and 30 healthy subjects were compared. Outcome measures of Timed Up & Go, Timed Unipedal Stance Test and the overall sway & stability index via Biodex balance device were used to evaluate static and dynamic balance and risk of fall. ResultsSignificant differences between groups were observed in most Biodex indexes: Modified Clinical Test of Sensory Interaction and Balance (mCTSIB): modes 1, 3, and 4 (p ≤ 0.001). Fall Risk Test (FRT): with eyes open/closed, on normal/narrow surfaces (p < 0.05). Unipedal Stance Test (UPST): with eyes open (p = 0.023) and closed (p = 0.00). DiscussionAll indicators of balance and fall risk were different in covid-19 patients than healthy people except the mCTSIB test mode 2 (p = 0.11) and TUG test (p = 0.33). In simple activities, balance disorder due to Covid-19 is not evident, but in more detailed tests, it is effective even with moderate and mild severity. ConclusionEven after 3–6 months of the recovery, there were significant differences in overall sway & stability index between people with covid-19 and healthy subjects.

Does multifactorial inspiratory muscle training improve postural stability and quality of life of patients with diabetes in Pakistan? A randomised controlled trial

ObjectiveTo determine the effects of multifactorial inspiratory muscle training (IMT) combined with Otago Exercise Programme (OEP) on balance and quality of life (QoL) in patients with diabetes.MethodsPretest–post-test randomised controlled trial.SettingRehabilitation...

Gait and Balance Assessments with Augmented Reality Glasses in People with Parkinson's Disease: Concurrent Validity and Test-Retest Reliability.

State-of-the-art augmented reality (AR) glasses record their 3D pose in space, enabling measurements and analyses of clinical gait and balance tests. This study's objective was to evaluate concurrent validity and test-retest reliability for common clinical gait and balance tests in people with Parkinson's disease: Five Times Sit To Stand (FTSTS) and Timed Up and Go (TUG) tests. Position and orientation data were collected in 22 participants with Parkinson's disease using HoloLens 2 and Magic Leap 2 AR glasses, from which test completion durations and durations of distinct sub-parts (e.g., sit to stand, turning) were derived and compared to reference systems and over test repetitions. Regarding concurrent validity, for both tests, an excellent between-systems agreement was found for position and orientation time series (ICC(C,1) > 0.933) and test completion durations (ICC(A,1) > 0.984). Between-systems agreement for FTSTS (sub-)durations were all excellent (ICC(A,1) > 0.921). TUG turning sub-durations were excellent (turn 1, ICC(A,1) = 0.913) and moderate (turn 2, ICC(A,1) = 0.589). Regarding test-retest reliability, the within-system test-retest variation in test completion times and sub-durations was always much greater than the between-systems variation, implying that (sub-)durations may be derived interchangeably from AR and reference system data. In conclusion, AR data are of sufficient quality to evaluate gait and balance aspects in people with Parkinson's disease, with valid quantification of test completion durations and sub-durations of distinct FTSTS and TUG sub-parts.

Are Clinical Balance Measures Linked to Cycling Performance?

Balance is paramount to safe and successful cycling, both in competition and recreation. Balance has been investigated in the return-to-cycling context, but its relationship to cycling performance is unknown. Our study aimed to analyse the relationship between balance, measured by common clinical balance tests, and cycling performance. Seven competitive cyclists participated in this cross-sectional correlational study. We collected field-based measures of cycling performance, including mean velocity, minimum and maximum velocity, mean corner speed, average lap time, and lean angle. Also, we measured balance via the balance error scoring system, the star excursion balance test, the lateral reach test, and the modified Bass test of dynamic balance. Strong correlations between cornering performance and cycling performance (r = 0.65–0.87, p &lt; 0.01) were detected. Weak correlations between clinical balance tests and cycling performance (r = 0.33–0.53, p &lt; 0.05) were observed. In conclusion, our study showed that improving cornering performance has the potential to improve overall cycling performance. We also found no clear correlations between our clinical balance tests and cycling performance. These weak correlations between postural control in standing and cycling performance suggest that standing balance and balancing during cycling are distinct motor control processes.

Trunk Instability in the Pitch, Yaw, and Roll Planes during Clinical Balance Tests: Axis Differences and Correlations to vHIT Asymmetries Following Acute Unilateral Vestibular Loss.

Clinical dynamic posturography concentrates on the pitch and roll but not on the yaw plane instability measures. This emphasis may not represent the axis instability observed in clinical stance and gait tasks for patients with balance deficits in comparison to healthy control (HC) subjects, nor the expected instability based on correlations with vestibulo-ocular reflex (VOR) deficits. To examine the axis stability changes with vestibular loss, we measured trunk sway in all three directions (pitch, roll, and yaw) during the stance and gait tasks of patients with acute unilateral vestibular neuritis (aUVN) and compared the results with those of HC. Concurrent changes in VORs were also examined and correlated with trunk balance deficits. The results of 11 patients (mean age of 61 years) recorded within 6 days of aUVN onset were compared within those of 8 age-matched healthy controls (HCs). All subjects performed a two-legged stance task-standing with eyes closed on foam (s2ecf), a semi-gait task-walking eight tandem steps (tan8), and four gait tasks-walking 3 m with head rotating laterally, pitching, or eyes closed (w3hr, w3hp, w3ec), and walking over four barriers 24 cm high, spaced 1 m apart (barr). The tasks' peak-to-peak yaw, pitch and roll angles, and angular velocities were measured with a gyroscope system (SwayStarTM) mounted at L1-3 and combined into three, axis-specific, balance control indexes (BCI), using angles (a) for the tandem gait and barriers task, and angular velocities (v) for all other tasks, as follows: axis BCI = (2 × 2ecf)v + 1.5 × (w3hr + w3hp + w3ec)v + (tan8 + 12 × barr)a. Yaw and pitch BCIs were significantly (p ≤ 0.004) greater (88 and 30%, respectively) than roll BCIs for aUVN patients. For HCs, only yaw but not pitch BCIs were greater (p = 0.002) than those of roll (72%). The order of BCI aUVN vs. HC differences was pitch, yaw, and roll at 55, 44, and 31%, respectively (p ≤ 0.002). This difference with respect to roll corresponded to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN based on VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses did not correspond with the pitch plane instability observed in the balance control tests. The increases in pitch plane instability in UVL subjects were, however, highly correlated with those of roll and yaw. These results indicate that greater yaw than pitch and roll trunk motion during clinical balance tasks is common for aUVN patients and HCs. However, aUVN leads to a larger increase in pitch than yaw plane instability and a smaller increase in roll plane instability. This difference with respect to roll corresponds to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN observed in VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses does not correspond with the enhanced movements in the pitch plane, observed in balance control tasks. Whether asymmetries in vestibular-evoked myogenic potentials (Vemps) are better correlated with the deficits in pitch plane balance control remains to be investigated. The current results provide a strong rationale for the clinical testing of directional specific balance responses, especially yaw and pitch, and the linking of balance results for yaw and roll to VOR asymmetries.

IMPAIRED GAIT AND BALANCE DISORDERS AS RISK MARKERS FOR FALLS IN CHRONIC CEREBRAL ISCHEMIA

The main clinical syndromes of chronic cerebral ischemia (CCI) are impaired gait and balance disorders, which increase risks for falls. The objective of the study is to analyze correlation between impaired gait and postural instability to determine risk markers for falls in CCI patients. Materials and Methods. We examined 104 CCI patients (15 men and 89 women, median age 70 (63; 76) years). The patients did not have significant functional limitations in daily life (modified Rankin scale, 0–2 points). Thirteen patients (13 %) had a history of acute cerebrovascular accidents, thirty-seven patients (36 %) had a history of falls. Moderate cognitive impairment was detected in 53 patients (51 %). Impaired gait and balance disorders were assessed according to Tinetti test, Berg balance scale, and stabilometric platform. Statistica 13.0, SPSS 22 was used for statistical data processing. Results. According to the Tinetti test, impaired gait was detected in 101 patients (97 %), balance disorders were found in 32 patients (31 %). According to the Berg balance scale, most patients had a low risk for falls. Stabilometry showed a decrease in the limits of stability, mainly forward. Discriminant analysis revealed that significant predictors of falls in CCI patients are the “forward” limit of stability (&lt;59 points), female gender, age (&gt;67 y.o.), depression (&gt;9 points, HADS), sway index (eyes closed) in the clinical test for sensory integration and balance (&gt;0.855), balance score for the Tinetti test (&lt;15 points), and a history of acute cerebrovascular accident. Conclusion. Stabilometry along with clinical assessment can improve the effectiveness of determining the risk group for falls in CCI patients.

Physical Therapy and Aminopyridine for Downbeat Nystagmus Syndrome: A Case Report.

Individuals with downbeat nystagmus (DBN) syndrome present with DBN, dizziness, blurred vision, and unsteady gait. Pharmacological intervention with 4-aminopyridine (4-AP) may be effective in improving oculomotor function, but there is minimal evidence to date that it improves gait. This suggests the possible benefit of combining pharmacotherapy with physical therapy to maximize outcomes. This case report documents improvements in gait and balance after physical therapy and aminopyridine (AP) in an individual with DBN syndrome. The patient was a 70-year-old man with a 4-year history of worsening dizziness and imbalance, diagnosed with DBN syndrome. He demonstrated impaired oculomotor function, dizziness, and imbalance, which resulted in falls and limited community ambulation. The patient completed a customized, tapered course of physical therapy over 6months. Outcome measures included the 10-meter walk test, the Timed Up and Go (TUG), the Dynamic Gait Index (DGI), and the modified clinical test of sensory integration and balance. Improvements exceeding minimal detectable change were demonstrated on the TUG and the DGI. Gait speed on the 10-meter walk test did not change significantly, but the patient was able to use a cane to ambulate in the community and reported no further falls. Controlled studies are needed to explore the potential for AP to augment physical therapy in people with DBN syndrome. Physical therapists are encouraged to communicate with referring medical providers about the use of AP as pharmacotherapy along with physical therapy for individuals with DBN syndrome.

Correlation of postural stability with pain, disability and quality of life among patients with sacroiliac joint dysfunction- A cross-sectional study

Context-Sacroiliac (SI) joint dysfunction accounts for altered postural stability which can cause a continuously intense pain level and range of disabilities. AimTo investigate the correlation of postural stability with pain, disability & QOL among sufferers of sacroiliac joint dysfunction. SettingThis cross-sectional research was undertaken at Rehabilitation Centre, Jamia Hamdard University. MethodA total of fifty participants were recruited using sample of convenience according to inclusion and exclusion criteria. After obtaining informed consent, three pain provocative tests and one motion palpation test were used to determine sacroiliac joint dysfunction. Humac balance master system (CSMi USB powered, Stoughton, USA), Visual analogue scale (VAS), modified Oswestry Disability Index (ODI) & WHO QOL-BREF (US version) were used to assess postural stability, pain, disability & Quality of life (QOL) respectively. Data analysis was done for correlation by SPSS version 24.0. ResultStrong positive correlations were found between reaction time, VAS (r = 0.791) and modified ODI score (r = 0.576) and weak positive correlations between eyes closed solid surface (ECSS) component of modified clinical test of sensory interaction & balance with VAS (r = 0.333) and with modified ODI score (r = 0.304) and eyes open foam surface (EOFS) component with environmental component of QOL (r = 0.287). There were negative correlations between reaction time, physical health (r = −0.413), psychological health (r = −0.375), social relations (r = −0.305), and environment (r = −0.379) parameters of QOL. ConclusionAccording to the findings of the study, there were positive correlations of reaction time with pain and disability and negative correlations with QOL. Awareness of clinicians regarding the altered postural stability can help in improvising the assessment and treatment protocols for patients of SI dysfunction.

Biomechanical Balance Measures During Timed Up and Go Test Improve Prediction of Prospective Falls in Older Adults

ObjectiveTo assess the feasibility of using biomechanical gait balance measures, the frontal and sagittal plane center of mass (COM)-Ankle angles, to prospectively predict recurrent falls in community-dwelling older adults. DesignA cohort study with a 1-year longitudinal follow-up. Logistic regression was used to test the ability of the COM-Ankle angles to predict prospective falls. SettingGeneral community. ParticipantsSixty older adults over the age of 70 years were recruited using a volunteer sample. InterventionsNot applicable. Main Outcome Measure(s)Biomechanical balance parameters: the sagittal and frontal plane COM-Ankle angles during the sit-to-walk and turning phases of the timed Up and Go test. The COM-Ankle angles are the inclination angles of the line formed by the COM and lateral ankle (malleolus) marker of the stance foot in the sagittal and frontal planes. We also included the following clinical balance tests in the analysis: Activity-Specific Balance Confidence, Berg Balance Scale, Fullerton Advanced Balance scale, and timed Up and Go test. Their abilities to predict falls served as a reference for the biomechanical balance parameters. ResultsWhen the biomechanical gait balance measures were added to all the confounders, the explained variance was increased from 25.3% to 50.2%. Older adults who have a smaller sagittal plane COM-Ankle angle at seat-off, a greater frontal plane COM range of motion during STW and a smaller frontal plane angle during turning were more likely to become recurrent fallers. Conclusion(s)Our results indicated that dynamic biomechanical balance parameters could provide valuable information about a participant's future fall risks beyond what can be explained by demographics, cognition, depression, strength, and past fall history. Among all biomechanical parameters investigated, frontal plane COM motion measures during STW and turning appear to be the most significant predictors for future falls.

Postural Control and Sensory Processing in Preschool Children with Autistic Spectrum Disorder: A Cross-Sectional Study.

The role of sensory processing in maintaining postural control (PC) among preschool-aged children with autism spectrum disorder (ASD) remains underexplored despite its potential implications for their developmental trajectory. This study aimed to assess the utilization of sensory information for PC maintenance while standing in preschool-aged children with ASD and to examine its correlation with PC during functional tasks using a standardized tool. The cross-sectional study recruited 27 children, aged between 3 and 6 years, diagnosed with ASD. Participation indexes for somatosensory, vestibular, visual, and visual preference were computed during a modified Clinical Test of Sensory Integration and Balance (m-CTSIB), based on sagittal plane body sway analyzed via video with Kinovea® software (version 0.9.4). Additionally, scores from the Pediatric Balance Scale (PBS) were analyzed. Statistical analysis of data derived from lateral malleolus and mastoid process sway using the Friedman test revealed significant differences in the utilization of various sensory systems involved in PC during the m-CTSIB (p < 0.001). There was a pronounced reliance on somatosensory information, coupled with increased instability in the absence or with the variability of visual information. The mean PBS score was 50.44 ± 2.74, exhibiting a significant negative correlation with the vestibular index (p < 0.05). Preschool-aged children with ASD demonstrated challenges in maintaining PC while standing under different sensory conditions, indicating a heightened dependence on somatosensory cues, particularly in the absence or with the variability of visual stimuli. While these challenges were not reflected in PBS scores, they were negatively correlated with the vestibular index.

Oblique, forward, and lateral directions reach test distances in young adults, and concurrent validity of these tests with the center of pressure excursion in assessing the limits of stability

BackgroundLimits of stability is required to perform functional activities and other advanced tasks of life without losing balance, and assessment of limits of stability is essential in clinical practice. Forward, Lateral, and Oblique direction reach tests are clinical balance tests that assess limits of stability, and these reach distances in various directions may be symmetrical or asymmetrical. The aim was to establish the symmetry between various reach distances on three reach tests and to establish the concurrent validity of oblique, forward, and lateral direction reach test distances with limits of stability measured by the Iso Free machine of TecnoBody company. Methods: The measurements of oblique, forward, and lateral reach tests and limits of stability excursions of center of pressure were taken in eight directions on Iso Free machine of Techno Body in fifty typical college-going young adults who were recruited through convenience sampling. Pearson correlation test was used to find the relationship between forward, lateral, and oblique direction reaches and limits of stability in forward, lateral, and oblique directions. Regression analysis was used to find the factors influencing the forward, lateral, and oblique reach tests. Results: The reach distances were symmetrical, and out of the three tests, the lateral and oblique direction reach tests have a moderate positive correlation with limits of stability test in lateral and oblique directions with an r-value of 0.569 (p < 0.001) and 0.50 (p < 0.001) respectively. A Significant standardized beta value of 0.49 (p < 0.05) for the oblique direction reach test with total stability limits. Conclusions: The oblique and lateral direction reach tests are correlated with their respective center of pressure excursion. However, the oblique direction reach test moderately correlated with the total limits of stability scores. Forward reach distances were more in number followed by oblique and lateral reach distances among young Saudi adults.

Zinc Deficiency: A Harbinger of Vestibular Dysfunction?

Background: Role of zinc in the maintenance of redox homeostasis have been explored &amp; is established to have antioxidant effects in the body. Presence of zinc in auditory system &amp; its role in deafness &amp; tinnitus is well established. Zinc supplementation has shown to not only improve tinnitus but also dizziness associated with it which marks the presence of zinc in vestibular system 4. The possible role of zinc in modulating neurotransmission across the glutaminergic synapses in vestibulo cerebellar, vestibulo-occular pathways are established. So, this study aims to assess serum zinc levels in vestibular disorder patients &amp; correlate with severity of the vestibular dysfunction Methodology: This was Cross sectional comparative study, 40 patients with vestibular disorders &amp; 40 subjects without vestibular dysfunction were included in the study. After thorough history taking, these patients were subjected to Dix Hallpike test, Head Impulse test Romberg test on foam with eyes closed /The Clinical Test of Sensory Interaction and Balance (CTSIB) to confirm vestibular dysfunction. After that, Dizziness handicap inventory (DHI) to assess the severity of the vestibular dysfunction. Serum zinc levels along with other, micronutrients like magnesium, calcium &amp; Serum vitamin B12 &amp; vitamin D were also assessed. Serum zinc levels were compared with age matched controls. Results: Out of 40 patients, 24 had mild &amp; 16 had moderate scores according to DHI. Serum zinc levels in study group was 60.63±10.10 which was significantly (p&lt;0.005) lower than compared control group 70.50±19.1. Also, Serum zinc levels were corelated with the severity of the vestibular dysfunction, (r=0.89, p&lt;0.00) which shows that more severe the dysfunction lesser the serum zinc levels. Conclusion: Role of zinc as an antioxidant is well established and deficiency of zinc is linked with the pathogenesis of various diseases. Since evidences suggest involvement of zinc in vestibular system, zinc supplementation in vestibular disorder patients can be considered as add on therapy, which might have a beneficial role with respect to cognitive function as well.

Concurrent validity of clinical balance tests for older adults with cognitive impairment

Older adults with cognitive impairment frequently have reduced balance and are at high risk for falling. We investigated the concurrent validity of the Physiological Profile Assessment (PPA) and the Timed Up and Go (TUG) test with computerised posturography in 13 older adults (mean (SD) age 80 (8) years) with mild-to-moderate cognitive impairment (mean (SD) Mini-Mental State Examination score, 19 (9)). Spearman’s rho demonstrated: moderately good positive correlation between PPA (muscle strength) and posturography rising index (rs = 0.699, p = 0.01) and posturography mediolateral sway during eyes open standing on a foam surface (rs = 0.604, p = 0.04); good negative correlations between PPA anteroposterior sway (eyes closed) and posturography sway velocity (eyes open) standing on foam (rs = –0.745, p = 0.01) and Romberg ratios of PPA and posturography (rs = –0.698, p = 0.02); moderately good positive correlations between TUG and posturography (left step quick turn time; left turn sway; rs = 0.548, p = 0.04; 0.646, p = 0.02) and good-to-excellent negative correlation between TUG and posturography (rising index rs = –0.719, p = 0.01). Both tests appear valid measures of balance in older adults with mild-to-moderate cognitive impairment; however, we suggest both are used.

A non-expensive bidimensional kinematic balance assessment can detect early postural instability in people with Parkinson's disease.

BackgroundPostural instability is a debilitating cardinal symptom of Parkinson’s disease (PD). Its onset marks a pivotal milestone in PD when balance impairment results in disability in many activities of daily living. Early detection of postural instability by non-expensive tools that can be widely used in clinical practice is a key factor in the prevention of falls in widespread population and their negative consequences.ObjectiveThis study aimed to investigate the effectiveness of a two-dimensional balance assessment to identify the decline in postural control associated with PD progression.MethodsThis study recruited 55 people with PD, of which 37 were men. Eleven participants were in stage I, twenty-three in stage II, and twenty-one in stage III. According to the Hoehn and Yahr (H&amp;amp;Y) rating scale, three clinical balance tests (Timed Up and Go test, Balance Evaluation Systems Test, and Push and Release test) were carried out in addition to a static stance test recorded by a two-dimensional movement analysis software. Based on kinematic variables generated by the software, a Postural Instability Index (PII) was created, allowing a comparison between its results and those obtained by clinical tests.ResultsThere were differences between sociodemographic variables directly related to PD evolution. Although all tests were correlated with H&amp;amp;Y stages, only the PII was able to differentiate the first three stages of disease evolution (H&amp;amp;Y I and II: p = 0.03; H&amp;amp;Y I and III: p = 0.00001; H&amp;amp;Y II and III: p = 0.02). Other clinical tests were able to differentiate only people in the moderate PD stage (H&amp;amp;Y III).ConclusionBased on the PII index, it was possible to differentiate the postural control decline among the first three stages of PD evolution. This study offers a promising possibility of a low-cost, early identification of subtle changes in postural control in people with PD in clinical practice.

Predictors of static and dynamic balance control in kidney transplant recipients.

We aimed to evaluate balance control and lower extremity muscle strength in kidney transplant recipients (KTRs) including acomparison to ahealthy control group and determine the predictors of static and dynamic balance control after kidney transplantation. In this study 40 KTRs and 40healthy controls were included. Balance control was assessed using the Biodex balance system. The static postural stability test (SPST) and clinical test of sensory integration and balance (CTSIB) were used to assess static balance control whereas the dynamic postural stability test (DPST) and limits of stability test (LOST) were used for dynamic balance control. Lower extremity muscle strength was measured with ahand-held dynamometer. Renal functions and laboratory findings of KTRs were recorded. All the stability index scores of SPST and sway index in CTSIB were significantly higher in KTRs compared to healthy controls. The right anteroposterior stability index score in DPST and the reaction time in LOST were significantly higher whereas overall score in LOST and lower extremity muscle strength were significantly lower in KTRs. The linear regression analysis revealed that hemoglobin was the predictor of static balance control accounting for 11% of the variance and body weight was the predictor of dynamic balance control accounting for 34% of the variance. Balance control, both static and dynamic, are impaired in KTRs as well as lower extremity muscle strength. Hemoglobin level is apredictor of static balance control whereas body weight is apredictor of dynamic balance control after kidney transplantation.

The Effects of Core Stabilization Exercises on Respiratory Muscle Strength, Respiratory Functions, and Postural Control in Children With Hearing Loss: A Randomized Controlled Trial.

To evaluate the effects of core stabilization training on respiratory muscle strength, respiratory functions, and postural control in children with hearing loss. We conducted a randomized controlled trial at Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation. Thirty children with hearing loss who were diagnosed with prelingual sensorineural hearing loss were randomly allocated to the study (n = 15, 12.20 ± 1.69 years) and control (n = 15, 11.87 ± 2.20 years) groups. Core stabilization training protocol was performed by the study group for 8 weeks, 5 days/week, whereas the control group received no training. The primary outcome measure was respiratory muscle strength. The secondary outcome measures were: spirometry, postural control tests on Biodex Balance System, and Balance Error Scoring System (BESS). Exercise adherence was recorded via a diary for home sessions. Outcomes were assessed at baseline and the end of the 8 weeks. In the study group, a significant improvement was observed in force vital capacity, peak expiratory flow of the spirometry test, maximum inspiratory pressure/expiratory pressure (MEP) of the respiratory muscle strength test; postural stability test except "anterior/posterior stability index", limits of stability test except "backward" and "forward/right", all parameters of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) test except "eyes closed firm surface" of the Biodex Balance System, and total score of BESS. Group × time interaction was found in MEP, "overall" stability index in postural stability test, "overall," "left," and "backward left" of limits of stability test, all parameters of the mCTSIB, and BESS total. Core stabilization exercises were effective in improving respiratory muscle strength, spirometry, and postural control in children with hearing loss.

Screening People on Standing Balance with Romberg Testing and Walking Balance with Tandem Walking.

The goal of this protocol is to inform readers about the exact procedures to use to perform two screening tests for vestibular disorders: tandem walking (TW) with eyes closed, also known as heel-toe walking, and the Clinical Test of Sensory Integration and Balance (CTSIB), which is also known as the modified Romberg. The study describes the steps for performing each test and each of the three CTSIB subtests so that the reader will be able to replicate the test conditions for use in the clinic, in the clinical laboratory, or in any other situation needing valid and reliable screening for balance skill which might be affected by changes in vestibular system function. The procedures detailed here can be easily administered and take less than 1 min per trial. References to published papers with normative data are provided. The representative results section includes examples of data collected with these screening tests.

Time of day and athlete status effects on the modified clinical test of sensory integration and balance (mCTSIB) and stability evaluation test (SET)

BackgroundConcussions or musculoskeletal injuries may impair postural control, which is one diagnostic to help determine return-to-activity decisions. Postural control may be affected by diurnal rhythm. Research questionDoes time of day influence postural control as measured by two Neurocom Balance Master diagnostic protocols, the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) and the Stability Evaluation Test (SET)? MethodsFollowing Institutional Review Board (IRB) approval, consented participants completed the SET and mCTSIB twice: between 0700 and 1000; and between 1600 and 1900. We randomized and balanced testing order. Familiarization trials were completed for the mCTSIB and SET. Assessments were completed in a controlled laboratory environment. We instructed participants to get a normal night’s sleep prior to testing and refrain from caffeine use and exhaustive exercise on the day of testing. Sixty-nine participants (48 female, 21 male: age = 21.42±2.56 years, height = 168.20±7.53 cm, mass = 72.05±16.60 kg) completed the study. Thirty-one of the participants were National Association of Intercollegiate Athletes (NAIA) student-athletes from the sports of baseball, soccer and softball. Average postural sway velocity was measured and compared by time of day for each of the balance conditions in the mCTSIB and SET protocols. ResultsAccording to repeated measures ANOVA, there were no significant postural sway velocity main effects by time of day for any of the balance conditions. We found significant postural sway main effects by foam, stance and eyes. We also noted significant ANOVA between participants’ differences for athlete status, but not for sex. SignificanceThese results inform practitioners about the importance of controlling time-of-day between baseline and post-injury testing, which may allow for more flexible, accurate and reliable diagnosis and return-to-activity decisions. Athletes displayed better static postural control, possibly warranting different normative values for diagnostic comparison.

A Comparison of Walking Behavior during the Instrumented TUG and Habitual Gait.

The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.