Clinical Balance Research Articles

Postural balance in COPD with obstructive sleep apnoea: a cross-sectional study.

The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population. Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months via phone calls. COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm versus 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm versus 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s-1 versus 1.30 (1.02-1.76) cm·s-1) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function. Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.

Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke

BackgroundMany people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. Research questionAre biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? MethodsIn this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. ResultsOnly ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SignificanceWhile the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.

Balance Impairment in the Burn Population: A Burn Model System National Database Study.

Balance is an important component of daily function and impairments can lead to injury and quality-of-life limitations. Balance is not well studied in the burn population. This study examines the frequency of long-term balance impairments and associated factors after a burn injury. The Burn Model System National Database was analyzed. Trouble with balance was self-reported at discharge, 6, 12, 24, and 60 months after injury. Regression analyses examined the associations between demographic and clinical characteristics and balance impairments at 12 months. Of 572 participants, balance impairments were most reported at discharge (40.3%), continuing over 60 months (26.8-36.0%). Those reporting balance impairments (n = 153) were more likely to be older, unemployed, have Medicaid or Medicare, receive inpatient rehabilitation, receive outpatient physical or occupational therapy, have vision problems, have leg or feet burns and swelling, and have foot numbness compared to those without (p ≤ 0.001). Regression analysis demonstrated a 4% increased odds of balance impairment for every increase in year of age (p < 0.001), 71% lower odds if employed at time of injury (p < 0.001), and 140% higher odds if receiving outpatient physical or occupational therapy at 12 months (p = 0.008). Common reports of balance impairments highlight the need for routine screenings to identify burn survivors that may benefit from targeted interventions.

Validity and Reliability of an Integrated Smartphone Measurement Approach for Balance

Context: Clinical balance assessments vary in reliability due to subjectivity in their scoring. A valid and objective accelerometer-based smartphone evaluation could benefit patients, clinicians, and researchers. Objective: Our objective was to assess the validity and reliability of smartphone-based standing balance. Design: A repeated-measures study was conducted with 23 healthy young adult participants across 2 sessions ∼7 days apart. Methods: Participants completed 30-second standing trials during tandem-stance eyes-open, tandem-stance eyes-closed, single-leg eyes-open, and single-leg eyes-closed conditions. Android and iOS smartphones were placed vertically on the lower back via a belt with 3 retroreflective markers attached and tracked by an 8-camera motion capture system. Sway path, range, and area were calculated from smartphone accelerometer and marker data. We assessed reliability using intraclass correlation coefficients (ICC[2,k]) and validity using Pearson r correlations between the marker and smartphones from visit 1. Results: Across eyes-open conditions, Android (ICC = .84–.96), iOS (ICC = .82–.98), and marker-based (ICC = .84–.95) assessments demonstrated good to excellent reliability. Across eyes-closed conditions, Android (ICC = .41–.87), iOS (ICC = .34–.79), and marker-based (ICC = .31–.87) assessments demonstrated poor to good reliability. Correlations between smartphones and the marker data were moderate to very high (r = .56–.97). Conclusions: The smartphone-based assessment was valid and reliable, indicating that clinicians and researchers can implement this method to measure balance with the opportunity for remote administration and increased patient tracking across various recovery timepoints.

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.

The decline in postural balance has a negative impact on the performance of functional tasks in individuals with Parkinson's Disease

IntroductionAn accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as Computerized Dynamic Posturography (CDP) are not feasible for the clinical setting. Therefore, the present study's aim was to assess the correlation between the clinical Balance Evaluation Systems Test (BESTest) and CDP. Methods20 male older adults with Parkinson's Disease (PD) were included in this study. Participants first executed the Sit-To-Stand (STS), Step/Quick turn (SQT), and Step Up and Over (SUO) tests on a Balance Master® force platform, followed by a clinical balance evaluation using the BESTest. ResultsFour outcomes of the CDP were negatively correlated with one or more BESTest domains or total BESTest score: STS sway velocity was negatively correlated with the anticipatory postural adjustment (p = 0.02) and sensory orientation (p = 0.01) domains. SQT turn time was negatively correlated with biomechanical restriction (for turns to the left, p = 0.01, and right, p = 0.03, respectively), postural response (p = 0.01, p = 0.01), dynamic balance during gait (p = 0.007, p = 0.001), and total score (p = 0.02, p = 0.01). Step over time to the right in SUP was negatively correlated with the limits of the stability domain (p = 0.002) and total BESTest score (p = 0.020). SUO impact index was negatively correlated with the anticipatory postural adjustment domain (p = 0.01). ConclusionThis study shows that several BESTest domains are significantly correlated with CDP outcomes, demonstrating that the BESTest can be used as a more clinically feasible alternative for computerized posturography, without loss of information.

Idiopatska skolioza i balans

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and the trunk, of unknown etiology. Balance or postural control can be defined as the ability to maintain the body's line of gravity above the base of support and thus to avoid falling. Adequate balance control is not only important for maintaining postural stability, but also for safe mobility during activities of daily life. This requires efficient central processing of information coming from the visual, vestibular and somatosensory (proprioceptive) systems. The aim of this article was to review the literature about postural stability and balance performance in patients with idiopathic scoliosis. Some studies showed that people with idiopathic scoliosis have reduced postural stability, assessed with posturography, as well as proprioceptive and vestibular deficits. Two hypotheses in the literature, biomechanical and sensory integration hypotheses, tried to explain this from different points of view. The biomechanical hypothesis emphasizes biomechanical and morphological changes in IS as responsible for poorer postural stability, while the hypothesis of sensory integration points out that certain people with idiopathic scoliosis have impaired dynamic regulation of sensorimotor integration due to an inaccurate evaluation of sensory inputs. Studies that used clinical balance tests showed difficulties in mediolateral stability and dynamic proprioception in IS. Further studies on balance in this population are needed to deepen knowledge in this area.

Position statement on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies, part 3: precautions in situations of surgery, fever, and opportunistic infections

The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient’s previous situation as well as the current infectious disease, in addition to experience.What is Known:• Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases.• Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults.What is New:• In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.

Clinical study of Tuina combined with functional training to improve the clinical symptoms and balance function in patients with meniscus injury

ObjectiveTo observe the effect of Tuina (Chinese therapeutic massage) combined with functional training in improving clinical symptoms and balance function in patients with meniscus injury.MethodsA total of 93 patients with grade I-II meniscus injury were randomly divided into a functional training group, a Tuina group, and a combination group, with 31 cases in each group. The Tuina group received Tuina manipulation. The functional training group underwent functional training under the supervision of physicians. The combination group received Tuina manipulation in addition to the functional training. The treatment course of all three groups was 8 weeks. The clinical symptoms were observed before the intervention and after 4 and 8 weeks of interventions, and the changes in knee injury and osteoarthritis outcome score (KOOS) and Y-balance test (YBT) were compared.ResultsThere was no statistically significant difference in the total response rate among the three groups after treatment (P>0.05). The total and subscale KOOS in the three groups were significantly higher than those before treatment after 4 and 8 weeks of interventions (P<0.05). There was a statistically significant difference in the total KOOS between the combination group and the functional training group after 4 and 8 weeks of interventions (P<0.05); there was a statistically significant difference in the score of daily living ability and sports and recreation function between the two groups after 8 weeks of interventions (P<0.05). The YBT balance coefficients of the affected and non-affected knees of the three groups were significantly improved after 4 and 8 weeks of interventions (P<0.05), and there was no statistically significant difference among the groups (P>0.05).ConclusionTuina, functional training, and their combination can improve clinical symptoms and balance function in patients with grade I-II meniscus injury. Tuina combined with functional training is significantly effective in improving daily living ability and sports and recreation function.

PP44 Time Is Now: Advancing Value Assessment Of Cancer Therapies To Help Eliminate Cancer As The Cause Of Death

IntroductionEarlier cancer diagnosis and advances in science are resulting in improved patient and societal outcomes. However, payer frameworks and methods can find it difficult to keep pace with scientific progress, evolution of endpoints, and assess the wider value of these advances.MethodsA multidisciplinary, international group of experts working in the cancer field was brought together to reach consensus on key principles of defining and assessing of cancer treatment value. A Delphi-based approach including surveys, virtual panels, interviews and structured online discussions was used to reach consensus. This work was initiated and funded by AstraZeneca.ResultsTwenty-four experts from across the world (including patient advocates, oncologists, health economists, regulators, members of payer and health technology assessment (HTA) bodies) reached consensus on seven key principles across two themes, oncology relevant endpoints and dimensions of value. Three of the seven principles were found to be of particular relevance to HTA bodies and payers: assessing broad economic impact of new medicines (including socio-economic and caregiver impact), where early-stage cancer treatments can enhance patients’ ability to lead productive lives and contribute to economic activity; consider other value aspects of relevance to patients and society; use of Managed Entry Agreements (MEAs) supported by ongoing evidence collection to help address decision-maker evidence needs and address clinical uncertainty.ConclusionsIncentivizing access to early-stage treatments can promote cancer control, improved outcomes and generate long-term societal benefit. Furthermore, early diagnosis and treatment at earlier stages of cancer can be cost-effective, and sometimes cost-saving, as well as provide opportunities for cure. Expanding value components in therapy assessments to include, for example, insurance value, the value of choice, scientific spillovers, and wider societal perspectives, along with structured MEAs to manage clinical uncertainty and balance budgets will help realize the potential to eliminate cancer as the cause of death.

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.

Lung ultrasound scores are not associated with subcutaneous oedema or fluid balance in infants after cardiac surgery

BackgroundLung ultrasound may help to estimate extravascular lung water (EVLW). However, after paediatric cardiac surgery, the relationship of a lung ultrasound score (LUS) with subcutaneous oedema, fluid balance, or body weight is unknown.MethodsA prospective, observational study was performed in mechanically ventilated infants following cardiac surgery. A clinical oedema score (COS), fluid balance (FB), body weight (BW) and LUS (based on a B-line scoring tool) were performed.ResultsWe studied 53 infants with a median age of 8 days [IQR, 0–14]. EVLW, as estimated by the mean LUS, was 8.7 (SD 3.7) at baseline, 9.2 (SD 4.2) at 24 h, and 9.1 (SD 3.4) at 48 h, out of a maximum score of 24. However, LUS changes over time were small and infero-lateral lung zones had higher mean LUS compared to supero-anterior lung zones. Moreover, subcutaneous body oedema, as measured by a COS, change in BW, or FB, were not associated with the LUS. On multivariable, linear, mixed-effects modelling, accounting for repeated measures within children over time, there was no significant association between the COS and LUS (0.2 points [95% CI − 0.01–0.3]. Finally, in similar regression analyses, there was no significant association between each 100 gm increase in BW or 100 ml increase in FB and changes in LUS (BW, 0.3 [− 0.1–0.7] and FB, 0.1 [− 0.2–0.4]).ConclusionsIn infants following cardiac surgery, the lung ultrasound score was higher in infero-lateral lung zones compared to supero-anterior zones. However, it had no association with a subcutaneous oedema score or changes in fluid balance or body weight.

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.

Effectiveness of a multicomponent rehabilitation protocol on outcomes following post-acute care

BackgroundThe purpose of this study was to determine the effect of a multicomponent rehabilitation protocol on functional outcomes in a post-acute care facility. MethodsEleven older, medically complex patients (80.3 ± 7.3 yrs) completed a multicomponent rehabilitation protocol during a stay at a post-acute care facility. Gait speed, Berg Balance scores, and sit-to-stand velocity were examined upon admission and discharge. Bayesian paired sample t-tests were used to determine changes from PRE to POST and linear regression analyses were used to determine the influence of length of stay. FindingsGait speed increased by 0.26 m/s (49% increase) from PRE (0.65 ± 0.38 m/s) to POST (0.90 ± 0.42 m/s) exercise intervention (p = 0.013). Berg Balance Scores significantly increased by 26% from PRE (38.27 ± 8.33) to POST (45.73 ± 3.32) exercise intervention (p = 0.009). A 45% increase in STS velocity from PRE (0.37 ± 0.14 m/s) to POST (0.51 ± 0.13 m/s; p ≤ 0.001) was observed following the multicomponent rehabilitation protocol. Length of stay did not influence improvements in gait speed, Berg Balance Scores, nor Sit-to-stand velocity (p = 0.176–0.811). InterpretationsThe multicomponent rehabilitation protocol with movement velocity biofeedback is feasible in a post-acute care facility in medically complex older patients and demonstrates improvements in clinical mobility and balance outcomes.

Clinical Static Balance Assessment: A Narrative Review of Traditional and IMU-Based Posturography in Older Adults and Individuals with Incomplete Spinal Cord Injury.

Maintaining a stable upright posture is essential for performing activities of daily living, and impaired standing balance may impact an individual's quality of life. Therefore, accurate and sensitive methods for assessing static balance are crucial for identifying balance impairments, understanding the underlying mechanisms of the balance deficiencies, and developing targeted interventions to improve standing balance and prevent falls. This review paper first explores the methods to quantify standing balance. Then, it reviews traditional posturography and recent advancements in using wearable inertial measurement units (IMUs) to assess static balance in two populations: older adults and those with incomplete spinal cord injury (iSCI). The inclusion of these two groups is supported by their large representation among individuals with balance impairments. Also, each group exhibits distinct aspects in balance assessment due to diverse underlying causes associated with aging and neurological impairment. Given the high vulnerability of both demographics to balance impairments and falls, the significance of targeted interventions to improve standing balance and mitigate fall risk becomes apparent. Overall, this review highlights the importance of static balance assessment and the potential of emerging methods and technologies to improve our understanding of postural control in different populations.

Questioning the Impact of Vestibular Rehabilitation in Mal de Debarquement Syndrome

Introduction: Mal de debarquement syndrome (MdDS) is a rare and poorly understood clinical entity defined as a persistent sensation of rocking and swaying that can severely affect the quality of life. To date, the treatment options are very limited. Even though vestibular rehabilitation (VR) efficacy following peripheral vestibular lesion is well-documented, little is known about its influence on MdDS. The objective of the study was to explore the influence of traditional VR program on postural control in a patient diagnosed with MdDS. Methods: We assessed 3 different participants: 1 healthy control; 1 participant with identified peripheral vestibular impairment (VI); 1 participant diagnosed with MdDS. Postural control was assessed using a force plate (AMTI, Accusway). Participants were assessed following the modified Clinical Test Sensory Integration Balance protocol (mCTSIB, eyes open on firm surface/eyes closed on firm surface/eyes open on foam/eyes closed on foam). The raw data were exported and analyzed in a custom-made Matlab script (Matlab R2020a). We retrieved the center of pressure velocity in both anterior-posterior and mediolateral directions and performed an analysis of the frequency content using Daubechies wavelet of order 4 with 6 levels of decomposition. Protocol VI and MdDS patients performed a 4-week VR program. Postural control, using a force plate, and Dizziness Handicap Inventory (DHI) were assessed before and after the VR program. Healthy control was assessed twice separated by 1 week without any specific intervention. Results: VI participant showed clear improvement on DHI and sway velocity on condition eyes closed with foam. Accordingly, a reduction of energy content within frequency bands (0.39–0.78 Hz and 0.78–1.56 Hz) was observed post-rehabilitation for VI participant in both conditions with foam. Interestingly, MdDS participant demonstrated a reduction in sway velocity in most of the conditions but the frequency content was not modified by VR and was comparable to healthy control. Accordingly, the DHI of the MdDS participant failed to demonstrate any difference following VR. Conclusion: The results of the present study question the use of VR as an efficient treatment option for MdDS. Future studies must recruit a larger sample size and focus on the relationship between illusion of movement and postural characteristics such as sway velocity.

Do lower limb motor-evoked potentials predict walking outcomes post-stroke?

BackgroundThis observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and...

Ankle stiffness asymmetry is associated with balance function in individuals with chronic stroke

Ankle joint is one of important contributors on balance in stroke survivors. This study aimed to investigate the relationships of ankle stiffness symmetry ratios along the talocrural and subtalar axes with clinical balance measures and weight distribution during quiet standing in ambulatory chronic post-stroke survivors. The clinical trials involved 15 ambulatory elderly with chronic post-stroke hemiparesis and 15 healthy controls. Ankle stiffness was evaluated during non-weight-bearing isokinetic passive biaxial ankle movements, and ankle stiffness symmetry ratios between paretic and non-paretic ankle stiffness (SR: Inversion/Eversion SRIE & Dorsi-/Plantarflexion SRDP) were measured. A certified physiotherapist evaluated the Berg Balance Scale (BBS) and weight-distribution ratio (WDR) on bilateral force plates during quiet standing. Correlation coefficients, the factor analysis, and Pearson linear multiple regression were assessed with measured parameters. Correlation coefficients showed significances in-betweens; BBS and SRDP (r = −0.543, p = 0.022), WDR and SRIE (r = −0.667, p = 0.004), SRIE and SRDP (r = −0.604, p = 0.011). The exploratory factor analysis suggested four extracted factors; (1) Balance & Gait, (2) Stroke, (3) Symmetry and (4) Dimension. The first and second factors include general and pathological characteristics in stoke participants respectively. The third factor is associated with symmetrical characteristics explaining up to 99.9% of the variance. Multiple regression analysis showed ankle stiffness ratios predict BBS up to 60% of variance. The biaxial ankle stiffness ratio is a useful clinical variable that assesses balance function, in ambulatory chronic stroke survivors.

Technology-based balance performance assessment can eliminate floor and ceiling effects

Many clinical measurement tools for balance have ceiling effects. Technology-based assessments using virtual reality systems such as the Computer-Assisted Rehabilitation Environment (CAREN) may provide a way to develop objective, quantitative measures that scale from low to high levels of difficulty. Our objective was to: (1) develop a performance assessment tool (PAT) for the CAREN; (2) quantify the reliability of the tool; (3) validate the scores against clinical balance measures; and (4) compare the scores from a population with balance impairments to those from able-bodied individuals in a cross-sectional validation study. Three games were developed on the CAREN and tested on 49 participants (36 able-bodied and 13 with impaired mobility). For each module, the corresponding measures were transformed into scores using a series of functions such that ceiling and flooring effects would be minimized. The results showed an association between scores and age, an overlap in scores from impaired high-performance individuals and able-bodied low performance individuals, and a correlation of PAT scores with other clinical tests. Several of the limitations of current clinical tools, including floor and ceiling effects, were overcome by the PAT, suggesting that the PAT can be used to monitor the effect of rehabilitation and training.

The importance of the functional base-of-support for clinical biomechanical balance analysis

The importance of the functional base-of-support for clinical biomechanical balance analysis