Four Square Step Test Research Articles

Manual Dexterity, Balance, and Trunk Control in Patients with Alzheimer's Disease: A Cross-Sectional Study

Aim: The study's objectives were to assess manual dexterity in those with Alzheimer's Disease (AD) and healthy older adults, as well as to look into the relationships between manual dexterity and balance and trunk control in patients with AD. Material and Methods: The study involved 32 patients with AD and 32 healthy older adults matched for gender and age. Manual dexterity was assessed with the Nine Hole Peg Test (NHPT); balance with The Berg Balance Scale (BBS), The Four Square Step Test (FSST) and The One Leg Standing Test (OLST); trunk control with the Trunk Impairment Scale (TIS). Results: The dominant and nondominant NHPT times were higher in patients with AD compared to healthy older adults (p

Effect of Comprehensive Balance Modulating Strategies on Physical Performance Among the Elderly in Care Home Settings in Southern India.

Purpose Globally, the proportion of the elderly population is rising. Age-related physical performance impairments are more common and affect quality of life. This study aimed to investigate the impact of a new exercise regimen called Comprehensive Balance-Modulating Strategies (CBMS) on the physical performance of older adults living in care home settings. Methods Forty-eight functionally independent elderly individuals were randomized into two groups: group A received the CBMS programme for eight weeks, and group B received routine medical care. The Short Physical Performance Battery (SPPB) and the Four Square Step Test (FSST) were outcome measures. Outcomes were measured at baseline, immediately after the intervention, and eight weeks after the intervention. Results The mean and standard deviation of subjects' ages in both groups were 72.46 (8.28) and 68.12 (6.95), respectively. The CBMS programme significantly improved physical performance among the intervention group (p = <0.0001). Conclusion The present study found that CBMS was effective in improving physical performance among institutionalized elderly. Large-scale clinical trials and research exploring the effect of CBMS among community-dwelling elderly individuals are recommended.

Physical Functioning, Physical Activity, and Variability in Gait Performance during the Six-Minute Walk Test.

Instrumenting the six-minute walk test (6MWT) adds information about gait quality and insight into fall risk. Being physically active and preserving multi-directional stepping abilities are also important for fall risk reduction. This analysis investigated the relationship of gait quality during the 6MWT with physical functioning and physical activity. Twenty-one veterans (62.2 ± 6.4 years) completed the four square step test (FSST) multi-directional stepping assessment, a gait speed assessment, health questionnaires, and the accelerometer-instrumented 6MWT. An activity monitor worn at home captured free-living physical activity. Gait measures were not significantly different between minutes of the 6MWT. However, participants with greater increases in stride time (ρ = -0.594, p < 0.01) and stance time (ρ = -0.679, p < 0.01) during the 6MWT reported lower physical functioning. Neither physical activity nor sedentary time were related to 6MWT gait quality. Participants exploring a larger range in stride time variability (ρ = 0.614, p < 0.01) and stance time variability (ρ = 0.498, p < 0.05) during the 6MWT required more time to complete the FSST. Participants needing at least 15 s to complete the FSST meaningfully differed from those completing the FSST more quickly on all gait measures studied. Instrumenting the 6MWT helps detect ranges of gait performance and provides insight into functional limitations missed with uninstrumented administration. Established FSST cut points identify aging adults with poorer gait quality.

Assessment of balance and risk of falls in people over 60 years old

Introduction: Falls of the elderly are a significant problem for public health and healthcare. They are also included in the geriatric giants, and the assessment of balance and risk of falls is an important part of the comprehensive geriatric assessment (CGA). It is estimated that almost one in three people over the age of 65 living independently in a community suffers one fall per year. These estimates increase with age, and in people older than 80 years, every second senior may experience at least one fall. The aim of the study was to assess the balance and risk of falls in people over 60 years of age living independently in society. Materials and methods: The study enrolled 40 seniors over the age of 60 who agreed to participate in the study and met the inclusion criteria. Three functional tests were used to assess balance and the risk of falls among seniors: the Timed Up and Go (TUG), the Four Square Step Test (FSST) and One-leg standing (OLS). Result: The study shows that as age increases, subjects perform worse on the Timed Up and Go rho = 0.38 test; p &lt; 0.05 and in the Four Square Step Test rho = 0.53; p &lt; 0.01. No statistically significant differences were observed between genders or age groups in the One Leg Standing test (OLS), although older people scored worse than younger age groups. There were no statistically significant associations between performance test results and BMI. The average results of the clinical tests show that the seniors in the study had good balance and a low risk of falling.

The effects of visual information deprivation and feedback balance training on balance in patients with stroke.

Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.

Mechanical loading of bone-anchored implants during functional performance tests in service members with transfemoral limb loss.

For individuals with limb loss, bone-anchored implants create a direct structural and functional connection to a terminal prosthesis. Here, we characterized the mechanical loads distal to the abutment during several functional performance tests in Service members with transfemoral (TF) limb loss, to expand on prior work evaluating more steady-state ambulation on level ground or slopes/stairs. Two males with unilateral TF limb loss and two males with bilateral TF limb loss participated after two-stage osseointegration (24 and 12 months, respectively). Tri-directional forces and moments were wirelessly recorded through a sensor, fit distal to the abutment, during six functional tests: Timed Up and Go (TUG), Four Square Step Test (FSST), Six Minute Walk Test (6MWT), Edgren Side-Step Test (SST), T-Test (TTEST), and Illinois Agility Test (IAT). Additionally, participants performed a straight-line gait evaluation on a 15 m level walkway at a self-selected speed (0.93-1.24 m/s). Peak values for each component of force and moment were extracted from all six functional tests; percent differences compared each peak with respect to the corresponding mean peak in straight-line walking. Peak mechanical loads were largest during non-steady state components of the functional tests (e.g., side-stepping during SST or TTEST, standing up from the ground during IAT). Relative to walking, peak forces during functional tests were larger by up to 143% (anterior-posterior), 181% (medial-lateral), and 110% (axial); peak moments were larger by up to 108% (flexion-extension), 50% (ab/adduction), and 211% (internal/external rotation). A more comprehensive understanding of the mechanical loads applied to bone-anchored implants during a variety of activities is critical to maximize implant survivability and long-term outcomes, particularly for Service members who are generally young at time of injury and return to active lifestyles.

Impact of mobile phone usage on dynamic postural control among South Indian college students.

Smartphones are a technical marvel that rapidly evolved to play an important role in our lives. One downside to smartphone use is that it significantly worsens posture. It is believed that using a smartphone while walking increases the risk of cognitive decline and the loss of dynamic balance needed to perform functional tasks. The objective of the study was to determine the impact of smartphone usage on dynamic postural control among South Indian college students. The study was carried out in a private college with 400 invited students through online social media platforms. The four-square step test and SAS-SV were used to determine the impact of smartphone usage on dynamic postural control. The students were informed about the study process. A total of 250 participants were included based on the inclusion criteria. There was a high percentage of agreement on smartphone usage on dynamic postural control measured with SAS-SV, revealing statistical significance with a mean value of 41.532 and SD of 10.010886. The four-square step test with a mean value of 22.5 and SD of 1.8995878 also proved significant impact. A positive correlation was found between smartphone usage and dynamic postural control, which was analysed using Pearson's correlation coefficient of 0.90130. A significant correlation was noted between mobile usage and dynamic balance. Smartphones can have a negative impact on dynamic balance by distracting users from their surroundings and increase the risk of falls.

Normative Reference Value of Four Square Step Test among School-going Children

Introduction: Dynamic Balance (DB) is the ability to maintain balance while the body is moving. The Four-Square Step Test (FSST) is a reliable and valid tool to assess DB in older populations. Previous research demonstrated the normative score of FSST for the community-dwelling older population. Aim: To estimate the reference score of FSST among 8 to 15-yearolds. Materials and Methods: FSST is a test that can be used for both therapeutic and diagnostic purposes to evaluate an individual’s dynamic standing balance. A total of 90 School goers were recruited for this research. Participants had to cross the four sticks in a predetermined order. The sticks were each 90 cm long and were positioned in a cross pattern on the ground. They were instructed Shiwangi, BPT Intern UG Student, Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India. Sunanda Bhowmik, Assistant Professor, Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India. Normative Reference Value of Four Square Step Test among School-going Children Abstract ID-UG 10 not to touch any sticks when they were crossing them. The amount of time it took to complete the test was recorded. Results: The normative value of FSST was (mean±SD 11.43±1.24) Geometric mean (11.37), skewness (0.30), kurtosis (0.65), median (25, 75 IQR) 11.25 (11.25,12.07), range (8.00-15.00). Conclusion: The total time taken by the participants to finish the test was 9 to 12 seconds. Analysing these results against findings to previous research, children between the ages of 8 and 15 were found to finish the FSST faster than average adults. In clinical practice, the standard reference score may be employed to rule out abnormalities related to children’s DB.

Relationship between Gait Speed and Balance Among Older Adults Residing in Long Term Care Settings

Introduction: Studies have documented that a decrease in gait speed is linked to an increased risk of falling among older adults residing in the community. However, there is a lack of research examining the correlation between gait speed and balance in older adults who reside in long-term care settings (LTCS). Objective: To determine the relationship between balance using a four-square step test (FSST) and gait speed using a 10-m walk test among older adults residing in LTCS in and around Udupi-Manipal. Methods: A cross-sectional study was conducted among older adults residing in six LTCS. The residents above 60 years, either gender, able to follow commands, with functional vision and duration of stay &gt; 6 months were included, and those who were bed or wheelchair-bound, use assistive devices for mobility, any acute cardiovascular events in the past 3 months, any orthopaedic or neurological conditions that affect mobility, and with benign paroxysmal positional vertigo were excluded. The participants were asked to perform the FSST and gait speed test. The demographic characteristics were summarized using descriptive statistics. Linear regression analysis was carried out keeping balance as the outcome variable and gait speed as the independent variable. Results: A total of ninety-four residents were screened, and thirty-five (n=35) were included in the study. The mean age of participants was 74.94 ± 7.54 years, with an average duration of stay in LTCS being 5.37 years. The participant's average gait speed was 0.994 ± 0.325 m/s, and the average time taken to complete the balance test was 12.75 ± 4.41 sec. The regression analysis revealed that for every second decline in gait speed, the dynamic balance assessed by the FSST reduced by 0.036 seconds (r2 =0.443; p = 0.008; 95% CI: -.062, -.010). Conclusion: This study showed that with an increase in gait speed, the time taken to complete the balance test decreased. This suggests older adults have better balance abilities when they can walk at a faster speed.

Efeito agudo da terapia por ondas de choque na pressão plantar e equilíbrio de indivíduos hemiparéticos

Abstract Introduction: Cerebral vascular accident (CVA) is the second leading cause of death and is one of the diseases that most generate disability Hemiparesis is the most common motor deficit, and one of its characteristics is asymmetry in weight bearing and in the plantar sup-port area, leading to balance deficits. extracorporeal shock-wave therapy (ESWT) has been shown to be effective in reducing post-stroke spasticity. Objective: To evaluate the effect of a ESWT session on the distribution of plantar pressure and on the static and dynamic balance of hemiparetic individuals after stroke. Methods: Twelve individuals with hemiparesis as a result of stroke in the chronic stage participated in the study. Data collection was divided into two days. On the first day, anamnesis and tests were performed: timed up and go (TUG), four square step test (FSST), and short physical performance battery (SPPB). After carrying out the tests, the distribution of plantar pressure was evaluated using baropodometry. Also on the first day, participants received ESWT in the muscle belly of the gastrocnemius muscle on the hemiparetic side. At the end of the ESWT session and after 7 days, the individuals were reassessed. Results: The results referring to the static and dynamic balance and baropodometry evaluations performed before, immediately after and one week after the application of ESWT did not show a significant difference between the three evaluations in any of the tests and in any of the moments performed. Conclusion: One ESWT session did not affect plantar pressure distribution and static and dynamic balance of hemiparetic individuals after stroke.

Postural Balance in Boys With Intellectual Disabilities Who Participate in Soccer Training.

The aim of this study is to investigate the postural balance in children with intellectual disabilities who participate in soccer training compared with their sedentary peers. Two groups of boys with intellectual disabilities aged 8-10years participated in this study: a soccer group (n = 12) and a sedentary group (n = 12). Postural balance was assessed using a force platform under 4 different conditions: open eyes, and closed eyes, on firm and foam surfaces. The Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test were also conducted. The soccer group had significantly lower (P < .05) center of pressure values compared with the sedentary group, on both firm and foam surfaces, but only under the open eyes condition. They were significantly faster (P < .05) in the Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test compared with their sedentary peers. However, there were no significant differences between the 2 groups on the sit-to-stand and turn-to-sit phases of the Timed Up and Go Test. Soccer participation may have a positive effect on postural balance in boys with intellectual disabilities. These findings may have implications for the development of exercise programs to improve postural balance and reduce the risk of falls in this population.

Correlation of Foot Posture, Dynamic Balance and Gait Speed in Community-dwelling Older Individuals

Introduction: Foot posture is crucial in maintaining stability and balance during movement. It encompasses the position and alignment of the feet and ankles, significantly impacting overall body stability and reducing the risk of falls. Dynamic balance refers to maintaining balance while in motion, encompassing walking, running, and jumping. Aim: To find a correlation between foot posture, dynamic balance and gait speed in community-dwelling older individuals. Materials and Methods: The correlational study included 100 community-dwelling older individuals who met the specified inclusion and exclusion criteria. The Foot Posture Index was utilised as the outcome measure for foot posture, the Modified Four-Square Step Test (MFSST) for dynamic balance, and the Gait Speed Test for gait speed assessment. Results: The results revealed a weak positive correlation between gait speed and foot posture, with a statistically significant weak positive correlation observed in individuals with normal foot posture. In contrast, a statistically significant moderate positive correlation was found between gait speed, dynamic balance, and pronated foot posture (r= 0.63, P &lt; 0.05). Furthermore, a weak negative correlation was observed between gait speed and supinated foot posture, with a statistically significant moderate negative correlation between dynamic balance and supinated foot posture. Conclusion: Pronated foot posture demonstrated a stronger association with gait speed and dynamic balance than supinated and normal foot posture. These findings suggest that older adults with pronated foot posture experience greater effects on gait speed and dynamic balance. Keywords: Foot posture, Gait, Balance, Elderly

Difficulties encountered in testing, scoring, and interpreting balance performance in older adults using clinical evaluation tools: a cross-sectional study

Abstract Background: Balance impairment is one of the primary intrinsic risk factors contributing to falls in older adults. Prior research has consolidated the prevalent clinical tools for detecting balance issues in this demographic. Nevertheless, only a few studies have recognized the constraints associated with current balance assessment methods. Materials and Methods: The current research was initiated due to a shortage of comprehensive knowledge concerning the hurdles clinicians faced when interpreting balance test results and the obstacles older adults encountered while undertaking these assessments. The methodology involved assessing the static and dynamic balance capabilities of 661 older individuals through tests including the four stage balance test (FSBT), star excursion balance test (SEBT), Four Square step test (FSST), timed up and go (TUG) test, and Tinetti performance-oriented mobility assessment (TPOMA). Results: All older adults were able to complete the TUG and TPOMA tests. . Fifteen percent encountered difficulty completing the entire FSBT; however, they managed to execute the initial two stages of this test. Additionally, 5% of older adults who utilized walking aids could not complete the FSST. Thirty four percent of young-old individuals and 56.3% of old-old individuals were unable to execute the SEBT in posterior directions. Moreover, 1% of 60-64-year-old and 2% of &gt;/75-year-old individuals were unable to perform SET in all 8 directions. Conclusion: TPOMA and TUG emerged as the most suitable clinical assessment tool for older adults. Within the FSBT, maintaining tandem and one-leg stance positions posed challenges, whereas the SEBT proved to be the most demanding dynamic balance test for older adults. These current findings will aid clinicians in selecting the most suitable balance assessment tool for routine clinical evaluations of older adults.

The relationship between visual function and physical performance in the Study of Muscle, Mobility and Aging (SOMMA).

The relationship of types of visual function to different aspects of physical function, especially strength and coordination, has been understudied, but delineation of these relationships could suggest potentially modifiable targets prior to the onset of disability. Cross-sectional analysis of visual function (self-reported eyesight and eye disease, visual acuity, contrast sensitivity) and physical function tests in 877 older adults (mean age 76.36±5.01 years, 59.2% women, and 13.3% Black race). Separate linear regression models were constructed for short physical performance battery (SPPB), expanded SPPB (eSPPB), their components (gait speed, chair stand, balance, narrow walk), stair climb, four-square step, leg extension peak power and strength, and grip strength. In adjusted models, worse acuity, worse contrast sensitivity, and self-reported poor vision were significantly associated with worse performance on the eSPPB and four-square step test. Worse contrast sensitivity, but not acuity, was significantly associated with shorter balance times, slower chair stand pace, longer stair climb time, and worse SPPB score. Associations of worse acuity and contrast sensitivity with weaker leg extension power, leg strength, and grip strength were attenuated by covariate adjustment. Self-reported macular degeneration, but not cataract or glaucoma, was associated with worse performance on SPPB, eSPPB, balance, stair climb, and four-square step tests in adjusted models. Worse contrast sensitivity and macular degeneration remained associated with worse SPPB and balance after controlling for visual acuity and self-reported eyesight. Poor contrast sensitivity was more strongly associated with worse physical performance than acuity, especially for complex tasks that dynamically challenge coordination and balance. Future studies should examine if older adults with contrast sensitivity impairment would benefit from targeted intervention to decrease their risk of disability.

Skeletal Muscle Health, Physical Performance, and Lower Urinary Tract Symptoms in Older Adults: The Study of Muscle, Mobility, and Aging.

Lower urinary tract symptoms (LUTS) and mobility limitations are bidirectionally associated among older adults, but the role of skeletal muscle remains unknown. We evaluated cross-sectional associations of muscle health and physical performance with LUTS. We used data from 377 women and 264 men aged >70 years in the Study of Muscle, Mobility and Aging (SOMMA). LUTS and urinary bother were assessed using the LURN Symptom Index-10 (SI-10; higher = worse symptoms). Muscle mass and volume were assessed using D3-creatine dilution (D3Cr) and magnetic resonance imaging. Grip strength and peak leg power assessed upper/lower extremity physical performance. 400-m walk, Short Physical Performance Battery (SPPB), and Four Square Step Test (FSST) assessed global physical performance. Mobility Assessment Tool-short form (MAT-sf) assessed self-reported mobility. We calculated Spearman correlation coefficients adjusted for age, body mass index, multimorbidity, and polypharmacy, chi-square tests, and Fisher's Z-test to compare correlations. Among women, LURN SI-10 total scores were inversely correlated with FSST (rs = 0.11, p = .045), grip strength (rs = -0.15, p = .006), and MAT-sf (rs = -0.18, p = .001), but not other muscle and physical performance measures in multivariable models. LURN SI-10 was not associated with any of these measures among men. Forty-four percent of women in the lowest tertile of 400-m walk speed versus 24% in the highest tertile reported they were at least "somewhat bothered" by urinary symptoms (p < .001), whereas differences among men were not significant. Balance and grip strength were associated with LUTS severity in older women but not men. Associations with other muscle and physical performance measures varied by LUTS subtype but remained strongest among women.

Effects of backward walking training on balance, gait, and functional mobility in people with multiple sclerosis: A randomized controlled study

BackgroundBackward walking training (BWT) can have a positive effect on balance, gait, and functional mobility in neurological diseases; however, the effectiveness of BWT has not been examined in multiple sclerosis (MS). Therefore, the study aimed to investigate the effects of BWT on balance, gait, and functional mobility in people with MS (PwMS). MethodNineteen PwMS were randomly allocated to either the experimental group (n=10) and the control group (n=9). The experimental group received BWT in addition to conventional walking training (CWT) while the control group only received CWT. Both groups performed training three times a week for 8 weeks. Participants were assessed with the Berg Balance Scale (BBS), four square step test (FSST), activities-specific balance confidence scale (ABC), timed 25-foot walk test (T25FW), dynamic gait index (DGI), 3-meter backward walk test (3MBWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), and timed up and go test (TUG) before and after training. ResultsAfter training, both groups showed significant improvements on the T25FW, and TUG (p<0.05) while only the experimental group showed significant improvements on the BBS, FSST, ABC, DGI, 3MBWT, and MSWS-12 (p<0.05). The experimental group significantly improved more than the control group in all outcomes (p<0.05) except for the T25FW (p=0.202). ConclusionBWT in addition to CWT is an effective way to improve balance, gait, and functional mobility for PwMS. These results suggest that BWT may be a potentially useful treatment approach when added to CWT in the rehabilitation of MS.

Contextual sensory integration training vs. traditional vestibular rehabilitation: a pilot randomized controlled trial

BackgroundWe created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (e.g., turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation.MethodsThirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic + home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the covid-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis.ResultsFollowing intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference − 18.703, 95% CI [-28.235, -9.172], p = 0.0002), ABC (8.556, [0.938, 16.174], p = 0.028), VVAS, (-13.603, [-25.634, -1.573], p = 0.027) and the FGA (6.405, [4.474, 8.335], p < 0.0001). No changes were observed for TUG and FSST.ConclusionPatients’ symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation.Trial registrationThis study (NCT04268745) was registered on clincaltrials.gov and can be found at https://clinicaltrials.gov/ct2/show/NCT04268745.

Comparative study of young-old and old-old people using functional evaluation, gait characteristics, and cardiopulmonary metabolic energy consumption

BackgroundWalking is an important factor in daily life. Among older adults, gait function declines with age. In contrast to the many studies revealing gait differences between young adults and older adults, few studies have further divided older adults into groups. The purpose of this study was to subdivide an older adult population by age to identify age-related differences in functional evaluation, gait characteristics and cardiopulmonary metabolic energy consumption while walking.MethodsThis was a cross-sectional study of 62 old adult participants who were classified into two age groups of 31 participants each as follows: young-old (65–74 years) and old-old (75–84 years) group. Physical functions, activities of daily living, mood state, cognitive function, quality of life, and fall efficacy were evaluated using the Short Physical Performance Battery (SPPB), Four-square Step Test (FSST), Timed Up and Go Test (TUG), Korean Version of the Modified Barthel Index, Geriatric Depression Scale (GDS), Korean Mini-mental State Examination, EuroQol-5 Dimensions (EQ-5D) questionnaire, and the Korean version of the Fall Efficacy Scale. A three-dimensional motion capture system (Kestrel Digital RealTime System®; Motion Analysis Corporation, Santa Rosa, CA, USA) and two force plates (TF-4060-B; Tec Gihan, Kyoto, Japan) were used to investigate spatiotemporal gait parameters (velocity, cadence, stride length, stride width, step length, single support, stance phase, and swing phase), kinematic variables (hip, knee, and ankle joint angles), and kinetic variables (hip, knee, and ankle joint moment and power) of gait. A portable cardiopulmonary metabolic system (K5; Cosmed, Rome, Italy) was used to measure cardiopulmonary energy consumption.ResultsThe old-old group showed significantly lower SPPB, FSST, TUG, GDS-SF, and EQ-5D scores (p < 0.05). Among spatiotemporal gait parameters, velocity, stride length, and step length were significantly lower in the old-old group than in the young-old group (p < 0.05). Among the kinematic variables, the knee joint flexion angles during initial contact and terminal swing phase were significantly higher in the old-old than the young-old group (P < 0.05). The old-old group also showed a significantly lower ankle joint plantarflexion angle during the pre- and initial swing phases (P < 0.05). Among the kinetic variables, the hip joint flexion moment and knee joint absorption power in the pre-swing phase were significantly lower in the old-old than the young-old group (P < 0.05).ConclusionThis study demonstrated that participants 75–84 years of age had less functional gaits than their young-old counterparts (65–74 years old). As the walking pace of old-old people diminishes, driving strength to move ahead and pressure on the knee joint also tend to decrease together with stride length. These differences in gait characteristics according to age among older adults could improve our understanding of how aging causes variations in gait that increase the risk of falls. Older adults of different ages may require customized intervention plans, such as gait training methods, to prevent age-related falls.Trial registrationClinical trials registration information: ClinicalTrials.gov Identifier: NCT04723927 (26/01/2021).

The Test–Retest Reproducibility, Standard Error Measurement, and Smallest Real Difference of Dynamic Balance Tests in Chronic Stroke Survivors

Background: A dynamic balance assessment of stroke patients is a very important factor in their rehabilitation process. The aim of this study was to investigate the test–retest reproducibility and smallest real differences in the dynamic balance tests of chronic stroke survivors. Methods: This was a methodological study that fifty-three chronic stroke survivors participated in. Dynamic balance tests were performed using the figure of eight walk test, four square step test, and step test. These tests and measurements were performed twice with 1-week intervals and intra-class correlation coefficients (ICC) were used to investigate their test–retest reliability. To determine the size of the measurement error, the standard error of measurement (SEM) and smallest real difference (SRD) were used. The SEM was used to compare the test–retest reproducibility. Results: The test–retest reliability of the figure of eight walk test, four square step test, and step test was confirmed to be high, with an ICC = 0.93~0.99. The SEMs were 2.21 and 2.25 for the figure of eight walk test and four-square step test, respectively. As for the step test (paretic and non-paretic side), the SEMs were 0.68 and 0.70, respectively, which were &lt;10% of the average score. The SRDs of the figure of eight walk test, four square step test, and step test (paretic and non-paretic side) were 6.10, 6.21, and 1.87 and 1.93, respectively. This showed a reliability of &lt;20% of the highest score. The SRDs (%) of the figure of eight walk test, four square step test, and step test (paretic and non-paretic sides) were 28.9%, 21.9%, and 27.32% and 24.43%, respectively. The SEM for all the tests was &lt;30% and the level of measurement error was acceptable. The ICCs of the test–retest reliability of the figure of eight walk test, four square step test, and step test were identified as high, and the test–retest reproducibility was verified by the low values of the SEM and SRD. Conclusions: The figure of eight walk test, four square step test, and step test might be useful tools for clinicians to examine the changes in dynamic balance over time in the rehabilitation of chronic stroke survivors.

Effects of backward walking exercise using lower body positive pressure treadmill on knee symptoms and physical function in individuals with knee osteoarthritis: a protocol for RCT

ObjectivesThe primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength in individuals with mild to moderate knee osteoarthritis using lower body positive pressure, in addition to mobility functions, balance, and self-reported health status.MethodsThe study is a single blind randomized clinical trial with two independent groups. This study will enroll 26 participants with mild to moderate knee osteoarthritis. The participants will be randomized into either experimental group (backward walking exercise) or control group (forward walking exercise). Both groups will use lower body positive pressure treadmill for walking exercise. Both groups will perform regular conventional exercise and worm-up exercise before walking exercise. The treatment will be three times a week for six weeks. Walking session will be up to 30 min each session. Data collection will be collected during pre- and post- intervention including primary outcomes including numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), and thigh muscle strength test. The secondary outcomes include five times sit to stand test (FTSTS), 3-meter backward walk test (3MBWT), timed up and go test (TUG), four square step test (FSST), functional reach test (FRT), 10-meter walk test (10-MWT), six minute walk test (6MWT), medical outcomes study short form 12 (SF-12), patient health questionnaire -9 (PHQ-9), and rapid assessment of physical activity (RAPA). An independent t-test will be used to evaluate the effect of treatment on the outcome measures.ResultsNot applicable.ConclusionUsing lower body positive pressure may have promising results against knee osteoarthritis. Moreover, walking backward exercise using lower body positive pressure might add more benefits to individuals with knee osteoarthritis and help clinicians in decision making.Trial registration: This study was registered in ClinicalTrails.gov (ID: NCT05585099).