Dynamic Balance In Individuals Research Articles

Reliability of the Star Excursion Balance Test with End-Stage Knee Osteoarthritis Patients and Its Responsiveness Following Total Knee Arthroplasty.

Background/Objectives: The Star Excursion Balance Test (SEBT) is a simple and feasible tool for assessing dynamic balance in individuals with knee osteoarthritis (KOA). It has an advantage as it replicates dynamic balance better than other static balance tools. This study aims to determine how reliable SEBT is among people with end-stage KOA, as well as how responsive it is and how well it correlates with performance-based outcome measures after TKA. Methods: Patients on the waiting list for TKA performed SEBT in the anterior, posteromedial and posteriorlateral directions twice within 7 days. The measurements were repeated 6 and 12 months after TKA. The participants completed performance-based outcome measurements (PBOMs) and the Oxford Knee Score (OKS) before and after TKA to estimate correlation. Results: In all directions, the intraclass correlation coefficient range (ICC) was 0.998-0.993, and there were no significant differences between the test and re-test mean SEBT scores. The standard error of measurement (SEM) ranged from 0.37% to 0.68%, and the minimum detectable change (MDC) ranged from 1.02% to 1.89%. The post TKA SEBT results show significant improvement, with a large effect size. There were large-to-medium correlations between SEBT and PBOMs before and after TKA, while OKS correlated only before surgery. The magnitude of change in SEBT, PBOMs and OKS did not correlate. Conclusions: SEBT is an extremely reliable tool for assessing dynamic balance in all three directions of severe KOA patients. It is sensitive enough to detect balance changes at 6 and 12 months post TKA. SEBT cannot be used to reflect the change in functional outcome improvement after TKA.

Balancing the prescription of virtual reality balance training for Parkinson disease: a critically appraised topic

Clinical Scenario Individuals with Parkinson Disease (PD) often present with impaired balance, resulting in increased fall risk. Evidence suggests that balance can be improved with physical therapy balance training interventions applied through video game play, or ‘exergaming’. However, best practices regarding the prescription of exergaming for persons with PD are unknown. The goal of this appraisal was to identify the Nintendo Wii exergame (NWE) parameters that have been shown to improve dynamic balance in individuals with PD, specifically Hoehn and Yahr (HY) stages 1-3, and make recommendations for the prescription of NWE balance interventions for this population. Methods The literature was searched to identify randomized controlled trials (RCT) that utilized NWE as a balance intervention for individuals with PD within HY stages 1-3. The search was limited to articles published within the last 10 years that assessed dynamic balance outcomes via the Dynamic Gait Index (DGI) or Functional Gait Assessment (FGA). Participants had no other known comorbidities that would impact dynamic balance and were on a stable dopaminergic prescription. 3 RCTs were identified and included in this appraisal. Conclusion and Implications for Practice NWE may improve dynamic balance in individuals with PD, HY stages 1-3. Recommended parameters include a variety of NWE modes, performed for 45-50 min per session, at a frequency of 2-3 times a week for 6-8 weeks. Clinicians should utilize a skilled approach when prescribing NWE including ongoing assessment to determine progress and to maintain safety. Future research is needed to determine the necessary intensity of NWE to improve dynamic balance in individuals with PD.

Effects of Rehabilitative Exercise and Neuromuscular Electrical Stimulation on Muscle Morphology and Dynamic Balance in Individuals with Chronic Ankle Instability.

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals.

Effect of Verbal Encouragement on Postural Balance in Individuals with Intellectual Disabilities.

This study investigated the effect of verbal encouragement (VE) on static and dynamic balance in individuals with intellectual disabilities (IDs). A total of 13 mild IDs and 12 moderate IDs participants underwent static balance tests (bipedal stance on firm surface, under open eyes (OEs) and closed eyes (CEs), and foam surface, unipedal stance on firm surface) and dynamic balance assessments (Y Balance Test (YBT) and Expanded Timed Up-and-Go Test (ETUGT)) under VE and no VE (NO/VE) conditions. VE significantly reduced center of pressure mean velocity (CoPVm) values for mild IDs in firm bipedal CEs conditions. The mild IDs group exhibited improved YBT scores and enhanced ETUGT performances for both groups under VE. Incorporating VE as a motivational strategy in balance training interventions can positively impact static and dynamic balance in individuals with mild IDs, especially in challenging conditions like unipedal stances on firm surfaces.

Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study

Plantar fasciitis is generally described as an inflammation of the plantar fascia and adjacent tissues around calcaneus tuberosity. Plantar fasciitis onset has been proposed to have an internal mechanical cause, even though this is inadequately recognized. Studies related to alternation in lower-extremity biomechanics that leads to reduced domes of the foot are hypothesized to cause tension in the underlying fascia. Similarly, despite a wealth of anecdotal data suggesting a direct connection between foot mechanism and disability. This condition typically leads to calf muscular stiffness, soreness in the bottom of the feet, decreased range and foot function, strength, and balance impairment. These results interfere with the normal biomechanics of ambulation. A total of (n=66) individuals with plantar fasciitis will be selected for the trial. Subjects will be allocated to Groups A and B at equal allocation with randomization. Group A will undergo foot core exercises, while Group B will undergo ankle proprioceptive neuromuscular facilitation, with both groups receiving conventional treatment. The regimen lasts for 40 minutes, 5 days, for 6 weeks. Foot core exercises are exercises to strengthen the intrinsic and extrinsic muscles of the foot, which results in the improvement in the alignment of the foot. Proprioceptive neuromuscular facilitation exercises are the facilitatory technique to improve the range and strength of the muscles, which results in the improvement in balance. Ultrasound and stretching techniques were added as the conventional therapy to reduce the pain. The outcome measures will be assessed on the Foot Functional Index, modified Star Excursion Balance Test (mSEBT), Visual Analogue Scale (VAS), and Weight Bearing Lunge Test (WBLT) will be assessed at the initiation and completion of the entire treatment protocol. Results will be analyzed prior to and after therapeutic intervention. Based on the comparison of the two treatments' effects on measuring outcomes in individuals with plantar fasciitis, an analysis will be conducted.

Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis

AimTo identify the effects of strength and balance training on dynamic balance and patient reported outcomes in people with chronic ankle instability(CAI).MethodFive databases(CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched in September 2022. The search was conducted on randomized controlled trials(RCTs) that the effects of strength training, balance training and combination of strength and balance training in people with chronic ankle instability compared to a control group. Using Review Manager 5.3 and Stata-SE 15 to conduct Meta-analysis on the included literature. methodological quality and risk of bias were assessed by using the PEDro scale.ResultsA total of 33 Chinese and English RCTs document were screened and 1154 patients with CAI were included in the study. Compared with control group, strength training, balance training and combination of strength and balance training demonstrated to be more effective in terms of improving patient reported outcomes(strength training: SMD = 0.80, 95%CI = 0.39–1.22; balance training: SMD = 0.79, 95%CI = 0.41–1.17; combination of strength and balance training: SMD = 1.28, 95%CI = 0.57, 1.99). Subgroup analysis: Intervention for 6 weeks, more than 3 times a week and more than 30 min each time were the best rehabilitation programs to improve CAI patientreported outcomes. Compared with control group, balance training demonstrated to be more effective in terms of improving Star Excursion Balance Test (SEBT)((anterior: SMD = 0.71, 95%CI = 0.03–1.40; posterolateral: SMD = 0.84, 95%CI = 0.22–1.46; posteromedial: SMD = 0.88, 95%CI = 0.45–1.32). However, strength training and combination of strength and balance training had no improvement effects on SEBT.ConclusionsAvailable evidence showed that, results of the comparison between balance training versus strength training suggest that the combination of strength and balance training achieves greater benefits for patient reported outcomes and balance training could bring greater benefits to dynamic balance. Strength training should be used cautiously in clinic to improve the dynamic balance in individuals with CAI.Trial registration(http://www.crd.york.ac.uk/PROSPERO, Registration No. CRD42022371396).

The Reliability and Validity of the Modified Four Square Step Test in Individuals with Anterior Cruciate Ligament Reconstruction.

The modified four square step test (mFSST) is frequently used in the evaluation of dynamic balance in individuals with balance problems. However, the reliability of the mFSST has not been examined in individuals undergoing anterior cruciate ligament reconstruction (ACLR) surgery. The aim of this study was to examine the test-retest reliability of the mFSST in individuals undergoing ACLR surgery. Forty-eight patients who had ACLR surgery were included in this study. Patients performed a total of four mFSSTs, two times each, by two different raters over seven days. In the current study, the mFSST demonstrated excellent test-retest and inter-rater reliability. The intraclass correlation coefficient for mFSST was 0.92. The standard error of measurement and minimal detectable change for mFSST were 0.15 and 0.41, respectively. The mFSST has excellent test-retest and inter-rater reliability in patients with ACLR. It is a valid and reliable tool for evaluating dynamic balance in patients with ACLR. We think that mFSST, which is a clinical evaluation test, can be preferred because it is easy to score and does not require special equipment.

Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study

Plantar fasciitis is generally described as an inflammation of the plantar fascia and adjacent tissues around calcaneus tuberosity. Plantar fasciitis onset has been proposed to have an internal mechanical cause, even though this is inadequately recognized. Studies related to alternation in lower-extremity biomechanics that leads to reduced domes of the foot are hypothesized to cause tension in the underlying fascia. Similarly, despite a wealth of anecdotal data suggesting a direct connection between foot mechanism and disability. This condition typically leads to calf muscular stiffness, soreness in the bottom of the feet, decreased range and foot function, strength, and balance impairment. These results in interference with the normal biomechanics of ambulation. A total of (n=66) individuals with plantar fasciitis will be selected for the trial. Subjects will be allocated to Groups A and B at equal allocation with randomization. Group A will undergo foot core exercises, while Group B will undergo ankle proprioceptive neuromuscular facilitation, with both groups receiving conventional treatment. The regimen lasts for 40 minutes, 5 days, for 6 weeks. The outcome measures will be assessed on Foot Functional Index, modified Star Excursion Balance Test (mSEBT), Visual Analogue Scale (VAS), and Weight Bearing Lunge Test (WBLT) be assessed at the initiation and completion of the entire treatment protocol. Prior and after therapeutic intervention results will be analyzed. Based on the comparison of the two treatments' effects on measuring outcomes in individuals with plantar fasciitis, an analysis will be conducted.

Effect of Kinesio Tape on Proprioception, Static and Dynamic Balance in Individuals with Chronic Ankle Instability

Effect of Kinesio Tape on Proprioception, Static and Dynamic Balance in Individuals with Chronic Ankle Instability

The Effect of Corrective Exercises on the Foot Posture and Balance in Female Karate Athletes With Flat Foot

Background and Aims Karate is one of the most popular martial arts worldwide, and flat foot deformity is one of the most common disorders in people participating in this sport. This disorder can negatively affect the static and dynamic balance in individuals. Therefore, this study aimed to investigate the effect of corrective exercises on foot posture and balance in female karate athletes with flat foot. Methods This research was a quasi-experimental study performed in two phases: pre-test and post-test. Forty female karatekas with flexible flat foot postures entered the study as subjects. They were randomly divided into exercise group (Mean±SD age: Mean±SD 20.00±1.81 y, Mean±SD height: 161.4±6.49 cm, and Mean±SD weight: 55.27±6.56 kg) and control (Mean±SD age: 21.02±2.19 y, Mean±SD height cm: 160.4±4.23, and Mean±SD weight: 55.75±3.90 kg). As one of the inclusion criteria, a navicular drop test was performed for all subjects to assess the condition of the foot posture. Also, the balance error scoring system and Y balance tests were used for all subjects to check the static and dynamic balance. Then, the exercise group performed 6 weeks of corrective exercises, but the control group did not perform any specific exercises during this period. After 6 weeks, the tests were repeated. Statistical analysis was performed in SPSS software version 26. A covariance analysis test was used to evaluate the between-group differences, and paired sample t test was used to evaluate the within-group changes. Results This study’s findings showed that the corrective exercise group in thepost-test had a better performance than the pre-test in the navicular drop test, in all three directions of the Y balance test, and in the balance error scoring system (P=0.0001). But in the control group, no significant difference was observed between the two stages of the test (P>0.05). It was also observed in the comparison between groups that in thepost-test in the variables of the navicular drop test and also in all three directions of the Y balance test and the test of the scoring system, the balance error scoring system of the experimental group achieved better results than the control group (P>0.05). Conclusion This study showed that 6 weeks of corrective exercises has significantly improved foot posture and static and dynamic balance in karate women with flexible flat feet. According to the results obtained in this study, it seems that comprehensive corrective exercises can be used in this group to improve balance and posture.

Factors Affecting Static and Dynamic Balance in Individuals with Pes Planus: A 45 Case Clinical Study

Factors Affecting Static and Dynamic Balance in Individuals with Pes Planus: A 45 Case Clinical Study

Reliability of the Modified Star Excursion Balance Test in individuals with Down Syndrome

Neuromotor problems such as hypotonia, incoordination, impaired sensory-motor integration lead to significant delays in motor skills and balance development in individuals with Down Syndrome (DS). Balance control is essential for performing many motor skills independently and safely. Standardised testing of balance control can contribute significantly to the rehabilitation of individuals with DS. The purpose of this study was to determine intrarater and interrater reliability of the Modified Star Excursion Balance Test (SEBT) for individuals with DS. Thirteen individuals with DS were recruited in this study. Intraclass correlation coefficients (ICC [3,1]) with 95% confidence intervals, standard error of measurement (SEM), the smallest detectable difference (SDD) and the Spearman rank correlation coefficient were calculated. In all directions of the Modified SEBT, no statistically significant difference was found between two raters’ first and second measurements (p > 0.05). Interrater reliability for all reach directions of the Modified SEBT was high, with ICC ranging from 0.990 to 0.998.95% confidence intervals, SEM and SDD ranged from 0.924 to 0.999, 0.180–2.434 and 3.270–6.747, respectively. The Modified SEBT are reliable for evaluating dynamic balance in individuals with DS aged between 6 and 24 years.

Effects of Instrument Assisted Soft-Tissue Mobilization on Dynamic Balance in Those with Chronic Ankle Instability

Our objective was to examine the effectiveness of IASTM application to the FL on dynamic balance in individuals with CAI. Fifteen individuals (seven females, eight males, age = 26.07 ± 9.18 years, mass = 87.33 ± 24.07 kg, height = 178.83 ± 12.83 cm) with CAI, as determined by the Ankle Instability Instrument (AII) volunteered to participate. Participants completed two counterbalanced sessions (experimental and control), and we recorded measurements at two time points (pre- and post-). The application of IASTM to the FL muscle was carried out using Técnica Gavilán® instruments for 90 s during the intervention, and participants sat for 2 min during the control session. Dynamic balance was assessed using the Y-balance test (YBT). The interaction between session and time for anterior reach was significant (F1,14 = 5.26, p = 0.04, η2 = 0.27). Post-hoc tests revealed farther reach distances at post-test (71.02 ± 9.45 cm) compared to pre-test (66.57 ± 10.87 cm) when IASTM was applied (p = 0.02, Mean Difference = 4.45 cm, CI95 = 0.71–8.19 cm, Cohen’s d = 0.44). The interaction between session and time was not significant for posteromedial (F1,14 = 0.25, p = 0.62, η2 = 0.02, 1 − β = 0.08) or posterolateral reaches (F1,14 = 1.17, p = 0.30, η2 = 0.08, 1 − β = 0.17). The application of IASTM to the FL improved anterior reach of the YBT, but not posterolateral or posteromedial reaches in individuals with CAI. However, the 4.45 cm increase in anterior reach could have clinical implications for improved function.

Effects of orthopedic footwear on postural stability and walking in individuals with Hereditary Motor Sensory Neuropathy

BackgroundOrthopedic footwear is often prescribed to improve postural stability during standing and walking in individuals with Hereditary Motor Sensory Neuropathy. However, supporting evidence in literature is scarce. The aim of this study was to investigate the effect of orthopedic footwear on quiet standing balance, gait speed, spatiotemporal parameters, kinematics, kinetics and dynamic balance in individuals with Hereditary Motor Sensory Neuropathy. MethodsFifteen individuals with Hereditary Motor Sensory Neuropathy performed a quiet standing task and 2-min walk test on customized orthopedic footwear and standardized footwear. Primary outcome measures were the mean velocity of the center of pressure during quiet standing and gait speed during walking. Secondary outcome measures included center of pressure amplitude and frequency during quiet standing, and spatiotemporal parameters, kinematics, kinetics, and dynamic balance during walking. Two-way repeated measures ANOVA and paired t-tests were performed to identify differences between footwear conditions. FindingsNeither quiet standing balance nor dynamic balance differed between orthopedic and standardized footwear, but orthopedic footwear improved spatiotemporal parameters (higher gait speed, longer step length, shorter step time and smaller step width) during walking. Moreover, less sagittal shank-footwear range of motion, more frontal shank-footwear range of motion, more dorsiflexion of the footwear-to-horizontal angle at initial contact and more hip adduction during the stance phase were found. InterpretationOrthopedic footwear improved walking in individuals with Hereditary Motor Sensory Neuropathy, whereas it did not affect postural stability during quiet standing or dynamic balance. Especially gait speed and spatiotemporal parameters improved. An improved heel landing at initial contact for all footwear and reduced foot drop during swing for mid and high orthopedic footwear contributed to the gait improvements wearing orthopedic footwear.

Effects of Mobilization With Movement Using Posterior Talus Glide Taping Added Myofascial Release on Kinematic Data of Dynamic Balance in Individuals With Calf Shortening

Effects of Mobilization With Movement Using Posterior Talus Glide Taping Added Myofascial Release on Kinematic Data of Dynamic Balance in Individuals With Calf Shortening

Is kinesiophobia associated with disturbances in dynamic balance in individuals with chronic non-specific low back pain?

Is kinesiophobia associated with disturbances in dynamic balance in individuals with chronic non-specific low back pain?

Effect of Flat Feet on Static and Dynamic Balance in Adults

Background: The foot is the most distal segment in the lower extremity chain and represents a smallBOS upon which the body maintains balance. Minor biomechanical alterations in the support surfacecan influence postural-control strategies. However, the implications of a flat foot on balance havereceived little attention to date.Aimof the present study was to Evaluate the static and dynamic balancein individuals with flat feet.Method: A total of 40 subjects were recruited. Participants were assigned to 2 groups case groupand control group depending on foot type, as defined by the foot ink print method. Subjects weredivided into case groups and control groups. The static and dynamic balance were measured throughthe Unipedal stance test and star excursion balance test respectively.There was a significant correlation between single-leg stance time (with eyes opened and closed) andflat feet (p-value = < .01). There was a significant correlation between reach distance in some direction(AM, MR, PM, P, AL, LL) with a flat foot (p-value <0 .05).Conclusion: This study suggests that both static (single leg stance test) and dynamic (SEBT) balanceare affected in individuals with flat feet.

Dynamic Balance Measures in Healthy and Chronic Ankle Instability Participants While Wearing Ankle Braces: Systematic Review With Meta-Analysis.

Ankle braces have been theorized to augment dynamic balance. To complete a systematic review with meta-analysis of the available literature assessing the effect of ankle braces on dynamic balance in individuals with and without chronic ankle instability (CAI). Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to October 2019 using combinations of keywords related to dynamic balance, ankle braces, Star Excursion Balance Test (SEBT), Y-Balance Test (YBT), and Time to Stabilization. Inclusion criteria required that studies examined the effects of ankle braces on dynamic balance. Studies were excluded if they evaluated other conditions besides CAI, did not access dynamic balance, or did not use an ankle brace. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The level of evidence was assessed using the Strength of Recommendation Taxonomy. The magnitude of brace effects on dynamic balance was examined using Hedges g effect sizes (ESs) and 95% confidence intervals (CIs). Random-effects meta-analysis was performed to synthesize SEBT/YBT and Time to Stabilization data separately. Seven studies were included with a median Physiotherapy Evidence Database score of 60% (range 50%-60%), and 4 were classified as high quality. Overall meta-analysis indicated a weak to no effect of braces on SEBT/YBT (ES = 0.117; 95% CI, -0.080 to 0.433; P = .177) and Time to Stabilization (ES = -0.064; 95% CI, -0.211 to 0.083, P = .083). Subanalysis of SEBT/YBT measures indicated a weak negative effect in healthy participants (ES = -0.116; 95% CI, -0.209 to -0.022, P = .015) and a strong positive effect in individuals with CAI (ES = 0.777; 95% CI, 0.418 to 1.136; P < .001). The current literature supports a strong effect of ankle braces on the SEBT/YBT in those with CAI. However, little to no dynamic balance changes were noted in healthy participants. Future research should include consistent ankle brace types, pathologic populations, and the examination of dynamic balance changes contribution to injury risk reduction.

Effectiveness of Short Foot Exercises Versus Towel Curl Exercises to Improve Balance and Foot Posture in Individuals with Flexible Flat Foot

Background: Flexible flat foot is a condition of foot in which the medial longitudinal arch is lowered which is visible in weight bearing foot. This condition may be asymptomatic and needs to be treated to prevent further overuse injuries. Many of the literature suggest that individuals with flexible flat foot shows imbalances in the strength of IFM like abductor hallucis, flexor hallucis brevis, flexor digitorum brevis and interosseous muscles which plays major role in maintaining stability. The dynamic balance is found to be more affected in flexible flat foot which needs to be treated by strengthening the IFM. Strengthening IFM with greater efficacy can improve the dynamic balance and also have impact on foot posture of individuals with flexible flat foot. Objective: to find the effect of 2 different types of IFM strengthening on dynamic balance Material and Method: In this pre-post intervention study 40 individuals with flexible flat foot were included. They were randomly divided into 2 groups with 20 individuals in each group. Group A was instructed to perform short foot exercises and Group B was instructed to perform towel curl exercise for four weeks. After pre-post assessment, data was analysed with help of appropriate statistical methods. Results: According to result the in Group A and Group B there is significant increase in both right and left anterior, posteromedial and posterolateral directions with p value < 0.0001. Conclusion: Both short foot exercise and towel curl exercise are found to be equally effective in improving the dynamic balance in individuals with flexible flat foot. The impact of these exercises on foot posture needs to be taken into consideration.

EFEITO DA TERAPIA COM REALIDADE VIRTUAL NO EQUILÍBRIO DINÂMICO DE INDIVÍDUOS PÓS-ACIDENTE VASCULAR ENCEFÁLICO

The aim of this study was to analyze the effect of virtual reality-based (VR) therapy on balance training of patients after stroke. 10 hemiparetic participants received twelve individual physical therapy sessions using the VR therapeutic, through Nintendo Wii® Fit Plus and Wii Sports Resort™. The analysis revealed that the Dynamic Gait Index (DGI) instrument, responsible for evaluating the dynamic balance, obtained significant difference (p=0.0085) between the basal (17.30±3.59) and final (20.30±2.94) evaluation. The Penguin Slide game had no significance between the scores (p=0.918), but there was a moderate correlation between the DGI instrument (r=0.662; p=0.037). This study obtained favorable results related to dynamic balance and also suggests that VR therapy as in general influenced the improvement of dynamic balance in individuals with hemiparesis after stroke.