Functional Balance Performance Research Articles

Functional Task and Balance Performance in Bed Rest Subjects and Astronauts.

The purpose of this study was to determine how short- and long-duration spaceflight affects astronauts' performance on functional tests that challenge the balance control system (Seated Egress and Walk; Object Translation; Recovery from Fall/Stand; and Jump Down) and on clinical tests of balance function (Computerized Dynamic Posturography and Tandem Walk). In addition, we examined how exercise affects functional performance after long-term axial body unloading during 70 d of bed rest at 6° head-down tilt. Data were collected twice during the 2-mo period before spaceflight or during the 2-wk period before bed rest, and four times after flight or bed rest: on the day of landing or the day bed rest ended, 1 d and 6 d later, and a final session 12 d after bed rest or 30 d after spaceflight. For bed rest subjects, long-term axial unloading alone caused functional performance deficits immediately after bed rest. However, the addition of an exercise regimen did not significantly improve median functional performance immediately after this axial unloading. For spaceflight subjects, the length of the space mission was directly related to the severity of functional performance deficits within 1 d of landing and during the subsequent recovery period after flight. The performance data suggest that an additional sensorimotor-based countermeasure may be necessary to maintain functional performance at preflight levels immediately after spaceflight.Miller CA, Kofman IS, Brady RR, May-Phillips TR, Batson CD, Lawrence EL, Taylor LC, Peters BT, Mulavara AP, Feiveson AH, Reschke MF, Bloomberg JJ. Functional task and balance performance in bed rest subjects and astronauts. Aerosp Med Hum Perform. 2018; 89(9):805-815.

Peripheral sensory information and postural control in children with strabismus

BackgroundSensory feedback from the visual system along with the vestibular and somatosensory systems is essential for the regulation of normal postural control. Children with strabismus and, therefore, with abnormal binocular vision, may have an altered perception of space and use different sets of cues to determine depth perception when compared with children without strabismus. ObjectiveTo explore the postural control of children with and without strabismus, when the three sensory systems are challenged. MethodForty-six children (21 with strabismus and 25 age-matched controls) aged between 5 and 10 years completed ophthalmic screening and then underwent assessment for postural control, which included Paediatric Balance Scale (PBS) and six conditions of the Sensory Organization Test (SOT). Four primary outcome measures were: PBS summary score, Equilibrium Score (ES), Strategy Score (SS) and Sensory Analysis Score of the SOT. ResultsA significant difference (P < 0.05) was observed between the strabismus and non-strabismus group in the PBS and, ES and SS of SOT condition 1. The Sensory Analysis scores were significantly different (P = 0.03) between the groups for ‘Somatosensory’. Simple linear regression analysis suggested that the strabismus condition was significantly (P ≤ 0.02) associated with the PBS and, the ES and SS of condition 1, with a variance of 14.6%, 16.1% and 12.8%, respectively. Subgroup analysis suggested that age was a significant (P ≤ 0.001) correlate for balance scores in non-strabismus group (R2 ranged from 32% to 58.4%), but not for the strabismus group. SignificancePostural control in children with strabismus is not equivalent to that of children without strabismus, when their somatosensory system is challenged. Additionally, the functional balance performance of children with strabismus is lower than their counterparts without strabismus. Collectively, the results suggest that the usual improvement in balance performance with increasing age is observed in children without strabismus but not in children with strabismus.

The Influence of Age and Adiposity on Functional Balance Performance in Career Firefighters

Slips, trips, and falls (STF) are one of the primary causes of non-fatal injuries in firefighters, incurring a large economic burden. Laboratory based measures of functional balance may help identify key risk factors for STF injuries. PURPOSE: The purpose of the current investigation is to examine the impact of age and adiposity [body mass index (BMI) and percent fat (%BF)] on a functional balance assessment in career firefighters. METHODS: Forty-nine healthy career firefighters (mean ± SD age = 35 ± 8 yrs; stature = 178.72 ± 7.99 cm; mass = 93.76 ± 21.85 kg; BMI = 29.11 ± 5.34 kg/m2; %BF = 25.22 ± 5.34%) volunteered to participate in this study. Data were collected over two separate visits. The first visit required participants to arrive to the laboratory following a four-hour fast prior to a dual energy x-ray absorptiometry scan to estimate %BF and be familiarized with the functional balance assessment. On the subsequent visit, participants completed the assessment for time while wearing their personal protective equipment and a self-contained breathing apparatus. The task required firefighters to step down from a raised platform, walk across a narrow beam, pass beneath an overhead obstacle (at 75% of their height), and step up to a final raised platform. The task was repeated while walking backwards as fast as possible. Each participant performed five trials that were digitally recorded to account for minor (i.e. foot contact with the ground) and major errors (i.e. overhead obstacle falls) with a minute rest between each to create a performance index (PI). Pearson product-moment correlation coefficients were used to examine the relationship between PI and age, BMI, and %BF with an a priori alpha level set a P ≤ 0.05. RESULTS: There was a significant relationship between PI and age (r = 0.406; P = 0.004) and %BF (r = 0.401; P = 0.004), but not BMI (r = 0.242; P = 0.093). CONCLUSION: The results from the present study demonstrated that increased age and %BF were associated with poorer functional balance performance. These findings may highlight key risk factors that may contribute to an increased risk of STF injuries. Lastly, %BF may be a more sensitive measure of adiposity than BMI when identifying STF risk factors. GRANT FUNDING: National Institute of Occupational Safety and Health (T42OH008673)

Chapter 15 - Balance, gait, and falls in multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) and the most widespread nontraumatic cause of disability in young adults around the world. MS occurs in people of all ages, races, and ethnicities. MS is characterized by clinical symptoms resulting from lesions in the brain, spinal cord, or optic nerves that can affect balance, gait, and fall risk. Lesions accumulate over time and occur in different areas of the CNS causing symptoms that include weakness, spasticity, and fatigue, as well as changes in sensation, coordination, vision, cognition, and bladder function. Thus, it is not surprising that imbalance, gait dysfunction, and falls are common in people with MS. The overwhelming majority have abnormalities of postural control and gait even early in the disease course. In all, 50-80% have balance and gait dysfunction and over 50% fall at least once each year. Balance dysfunction in MS is conceptualized as three interrelated problems: decreased ability to maintain position, limited and slowed movement towards limits of stability, and delayed responses to postural displacements and perturbations. In addition, functional balance performance may be affected by impaired dual-task integration. Walking changes in MS include reduced gait speed, impaired walking balance, and reduced walking-related physical activity. Falls in people with MS are associated with injuries, reduced participation, and increased fear of falling. A wide and growing range of rehabilitation and medical interventions are available to address the changes in balance, gait, and fall risk associated with MS.

Adapted taekwondo training for skeletal development and motor proficiency in prepubertal children with developmental coordination disorder: a randomised controlled trial

BackgroundDevelopmental coordination disorder (DCD) is a chronic neurodevelopmental movement disorder that affects 5–8% of primary school-aged children in Hong Kong Special Administrative Region, China. These children have a delay in skeletal development associated with reduced activity level. Taekwondo training has been acknowledged to improve bone health in young individuals. We aimed to assess the effectiveness of a novel, adapted taekwondo training regime on skeletal development and motor proficiency in children with DCD. MethodsIn this single-blinded, randomised controlled trial, prepubertal children with DCD were recruited from schools and non-governmental organisations in Hong Kong. They were randomly allocated to either taekwondo or control groups using computer-generated random codes. Children in the taekwondo group participated in a weekly 1 h adapted taekwondo training programme and daily taekwondo home exercises for 12 weeks. The control group participated in a daily jogging intervention. Data were collected at baseline, post-test, and 3 months after the intervention was initiated (follow-up test). The primary outcome was the ultrasonic bone age, and the secondary outcomes were the Movement Assessment Battery for Children (MABC) total motor impairment score and balance impairment subscore. Data analysis was based on intention to treat. The trial was registered with ClinicalTrials.gov (NCT02635711). Ethics approval was obtained from the Human Research Ethics Committee of the University of Hong Kong. Written informed consent was obtained from both children and parents. Findings145 children with DCD were recruited and randomly assigned to the taekwondo group (n=51; mean age 7·4 years, SD 1·2 years; 45 boys and 6 girls) and the control groups (n=94; mean age 7·5 years, SD 1·2 years; 76 boys and 18 girls). The demographics were well balanced between the two groups, but children in the control group had an older mean ultrasonic bone age at baseline (treated as a covariate). Two-way repeated measures analysis of covariance results revealed that ultrasonic bone age increased similarly (F1.6,220.6=5·806, 95% CI 7·34–7·61; p=0·006; ηp2 =0·04), and MABC total motor impairment score decreased similarly (F2,286=25·430, 95% CI 16·61–19·42; p<0·0001; ηp2 = 0·15) from baseline to follow-up in both groups. The MABC balance impairment subscore fell differentially by 0·95 points (22·1%) in the taekwondo group from baseline to follow-up test (p=0·019; 95% CI 0·16–1·74). No adverse events were reported. InterpretationThe 3 month adapted taekwondo programme improved functional balance performance in children with DCD. However, with respect to skeletal development and general motor proficiency, the effect of maturation might be more profound than that of taekwondo. Further studies could increase the taekwondo training duration and use bone growth as a biomarker instead of ultrasonic bone age. FundingHealth and Medical Research Fund (13142081), Food and Health Bureau of Hong Kong Government.

WALKING DIFFICULTY IS THE MAIN CONTRIBUTOR TO FEAR OF FALLING IN PEOPLE WITH PARKINSON’S DISEASE

Fear of falling is more common and pronounced in people with Parkinson’s disease than in controls. We conducted a series of studies that used multivariable regression analyses to identify explanatory factors of fear of falling in people with Parkinson’s disease. Three independent samples were used. The first study (n=154) was a postal survey study that used well-established self-rating scales. The second study replicated the first one by using a clinical sample (n=104) and added unexplored motor aspects (e.g., gait speed, functional balance performance) as well as global cognition. The third clinical study (n=241) included independent variables that focused on personal (e.g. general self-efficacy) and environmental factors as well as Parkinson-related disabilities. In all three studies, walking difficulties was the strongest explanatory (60–68%) factor. The results imply that walking difficulties in daily life should be the primary target in order to reduce fear of falling in people with Parkinson’s disease. (Less)

The Immediate Effects of Inhibitive Gastrocnemius Kinesio Taping on Static and Functional Balance Performance in Subjects With Chronic Stroke Disorders

سکته مغزی یک ضایعه عصبی-عروقی در مغز است و عوارض حسی حرکتی ومخصوصا تعادل از علامت های شاخص این بیماری است.، کاهش کنترل تعادل بیشترین تاثیر را بر افتادن مکرر،اختلال در راه رفتن، ناتوانی در انجام فعالیت های مستقل روزانه دارد. ممکن است کینزیوتیپ بااثرات حسی و مکانیکی خود منجر به بهبود توانایی های کنترل وضعیتی در این بیماران شود. این مطالعه با هدف بررسی اثرکوتاه مدت کینزیوتیپینگ مهاری عضله گاستروکنمیوس برکنترل وضعیتی بیماران مبتلا به سکته مغزی مزمن انجام شد.روش هاو مواد بکار رفته: این مطالعه به صورت مداخله ای نیمه تجربی (بدون شاهد و به صورت قبل ازآزمون- بعد از آزمون) در مرکز تحقیقات اسکلتی عضلانی دانشکده توانبخشی دانشگاه علوم پزشکی اصفهان در بازه زمانی اردیبهشت تا شهریور93 انجام شد. مطالعه شامل 22 بیمار30تا65 ساله مبتلا به سکته مغزی شامل12زن(5/54درصد)، 10مرد(5/45درصد)، 11 نفر همی پلژی راست، 11 نفر همی پلژی چپ بامیاگین سنی04/12±04/52بود. در ابتدا ازصفحه نیرو(جهت بررسی کنترل وضعیتی ایستا)، ازآزمونTimed up and go test(TUG)(جهت بررسی کنترل وضعیتیپویا) و ازمقیاسModified modified ashworth scale(MMAS)(جهت اندازه گیری نمره اسپاستیسیته) استفاده گردید. برای بررسی کنترل وضعیتی ایستا، از شخص خواسته شد با پاهای باز و به عرض لگن، بطوری که نگاه وسر مستقیم باشد و اندام های فوقانی در وضعیت راحتی کنار بدن قرار گیرند، 5مرتبه یک دقیقه ای روی صفحه نیرو بایستد. برای بررسی کنترل وضعیتی پویا، از بیمار تقاضا شداز وضعیت نشسته روی صندلی بلند شده، بایستد، 3متر با سرعت دلخواه راه برود، سپس تغییر جهت داده و به عقب برگردد و دوباره روی صندلی بنشیند.بعد از اتمام اولین ارزیابی ها توسط محقق، Kinesiotape (KT)مهاری عضله گاستروکنمیوس(به روش کشش در قاعده) که توسط خود محقق انجام شد، به مدت 1 ساعت روی پوست ناحیه دریافت شد. تمامارزیابی هادر زمان های پیش از مداخله، بلافاصلهو یک ساعت پس از مداخله تکرار شدند.برای مقایسه تفاوت های درون گروهی و بین گروهی پارامترهای تعادلی ایستا و پویا بین زمان های قبل و بعد از درمان، از آزمون Repeatedmeasure ANOVA(RM)استفاده شد. همچنین برای مقایسه تفاوت های درون گروهی و بین گروهی نمره اسپاستیسیته بین زمان های قبل و بعد از درمان از آزمون(GEE)Generalized estimating equationاستفاده گردید تجزیهوتحلیلآمارییافته هاتوسطنرمافزار PASW statistics 18, release 18.0.0انجامشد.یافته هاتفاوت معناداری در آزمون های TUG وMMASبین زمان های های پیش از مداخله، بلافاصله و یک ساعت پس از مداخله برای بیماران بدست آمد. بطوریکه نمرات TUG و MMASدر زمان های بلافاصله و یک ساعت پس از مداخلهدر مقایسه با زمان صفر، کاهش یافت(Pلازم به ذکر است که تاثیر مداخله در زمان های مختلف بر آزمونTUGدر بیماران همی پلژی راست و چپ از لحاظ آماری متفاوت است(P=0/013)و تاثیر مداخله در زمان های مختلف بر متغیرهای تعادل ایستا و نمره اسپاستیسیته در بیماران همی پلژی راست و چپ از لحاظ آماری یکسان است(05/0نتیجه گیریKTعضله گاستروکنمیوس منجر به کاهش اسپاستیسیته عضله گاستروکنمیوس، بهبود کنترل وضعیتی ایستا و پویای بیماران شد.KTعضله گاستروکنمیوس دارای تاثیر بیشتری در بهبودی کنترل وضعیتی پویای بیماران همی پلژی چپ در مقایسه با بیماران همی پلژی راست بود.

Cerebellar transcranial direct current stimulation in children with ataxic cerebral palsy: A sham-controlled, crossover, pilot study

ABSTRACTObjective: The aim of the present study was to analyze the use of anodal tDCS of the cerebellar region combined with treadmill training to improve balance and functional performance in children with ataxic cerebral palsy. Design: Single-blind, sham-controlled, crossover, pilot study. Setting: Rehabilitation center and research motion analysis laboratory. Participants: Children (N = 6) with ataxic cerebral palsy and balance deficit. Main Outcome Measures: Static balance (oscillations of the center of pressure), functional balance (Pediatric Balance Scale) and functional performance (Pediatric Evaluation of Disability Inventory) were evaluated. Results: Significant reductions occurred in oscillations of the center of pressure with eyes closed after active anodal tDCS only. The effects of treadmill training on functional balance and functional performance in mobility were maintained in the active tDCS group only. Conclusion: These preliminary data support the notion that anodal tDCS of the cerebellar region combined with treadmill training improves balance in children with ataxic cerebral palsy.

Balance and ankle muscle strength predict spatiotemporal gait parameters in individuals with diabetic peripheral neuropathy

AimsThe aims of this study were to evaluate aspects of balance, ankle muscle strength and spatiotemporal gait parameters in individuals with diabetic peripheral neuropathy (DPN) and verify whether deficits in spatiotemporal gait parameters were associated with ankle muscle strength and balance performance. Materials and methodsThirty individuals with DPN and 30 control individuals have participated. Spatiotemporal gait parameters were evaluated by measuring the time to walk a set distance during self-selected and maximal walking speeds. Functional mobility and balance performance were assessed using the Functional Reach and the Time Up and Go tests. Ankle isometric muscle strength was assessed with a handheld digital dynamometer. Analyses of variance were employed to verify possible differences between groups and conditions. Multiple linear regression analysis was employed to uncover possible predictors of gait deficits. ResultsGait spatiotemporal, functional mobility, balance performance and ankle muscle strength were affected in individuals with DPN. The Time Up and Go test performance and ankle muscle isometric strength were associated to spatiotemporal gait changes, especially during maximal walking speed condition. ConclusionFunctional mobility and balance performance are damaged in DPN and balance performance and ankle muscle strength can be used to predict spatiotemporal gait parameters in individuals with DPN.

Prediction of falls and/or near falls in people with mild Parkinson's disease.

ObjectiveTo determine factors associated with future falls and/or near falls in people with mild PD.MethodsThe study included 141 participants with PD. Mean (SD) age and PD-duration were 68 (9.7) and 4 years (3.9), respectively. Their median (q1–q3) UPDRS III score was 13 (8-18). Those >80 years of age, requiring support in standing or unable to understand instructions were excluded. Self-administered questionnaires targeted freezing of gait, turning hesitations, walking difficulties in daily life, fatigue, fear of falling, independence in activities of daily living, dyskinesia, demographics, falls/near falls history, balance problems while dual tasking and pain. Clinical assessments addressed functional balance performance, retropulsion, comfortable gait speed, motor symptoms and cognition. All falls and near falls were subsequently registered in a diary during a six-month period. Risk factors for prospective falls and/or near falls were determined using logistic regression.ResultsSixty-three participants (45%) experienced ≥1 fall and/or near fall. Three factors were independent predictors of falls and/or near falls: fear of falling (OR = 1.032, p<0.001) history of near falls (OR = 3.475, p = 0.009) and retropulsion (OR = 2.813, p = 0.035). The strongest contributing factor was fear of falling, followed by a history of near falls and retropulsion.ConclusionsFear of falling seems to be an important issue to address already in mild PD as well as asking about prior near falls.

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

ObjectiveTo investigate whether a home-based rehabilitation program for community-dwelling older people with recent hip fracture is more effective than standard care in improving mobility recovery and reducing disability. DesignRandomized, controlled, parallel-group trial. SettingRehabilitation in participants' homes; measurements in university-based laboratory and local hospital. ParticipantsClinical population of community-dwelling men and women (aged 60+) recovering from hip fracture. Participants were randomly assigned into control (n = 41) or intervention (n = 40) groups on average 42 ± 23 days after discharge home. InterventionA yearlong multicomponent home-based rehabilitation aimed at promoting mobility recovery and physical functional capacity after hip fracture. The intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, a progressive home exercise program, physical activity counseling, and standard care. MeasurementsMeasurements were outlined according to the tiers of the disablement process, with the ability to negotiate stairs as the main outcome. Prefracture ability to negotiate stairs was enquired at the hospital on average 10 ± 5 days after fracture. Subsequently, current perceived ability to negotiate stairs was reported immediately before the intervention (on average 9 weeks after surgery) and 3, 6, and 12 months thereafter. Other measurements included leg extension power deficit (LEP), functional balance (Berg Balance Scale) and lower extremity performance (Short Physical Performance Battery). Effects of the intervention were analyzed with generalized estimation equations and longitudinal repeated measures mixture path models. ResultsThe intervention reduced perceived difficulties in negotiating stairs (interaction, group × time P = .001) from prefracture to 12 months compared with the control condition. The mixture path model revealed that less difficulty in negotiating stairs at 6 and 12 months correlated with better functional balance at 3 and 6 months in the intervention group but not controls (group difference P = .007 and P < .001, respectively). ConclusionThe individualized home-based rehabilitation program improved mobility recovery after hip fracture over standard care. To be efficacious in reducing or reversing disability after hip fracture, rehabilitation needs to be individualized, include many components, be progressive, and span a sufficiently long period. Current Controlled Trials (ISRCTN53680197).

Factors associated with fear of falling in people with Parkinson’s disease

BackgroundThis study aimed to comprehensibly investigate potential contributing factors to fear of falling (FOF) among people with idiopathic Parkinson’s disease (PD).MethodsThe study included 104 people with PD. Mean (SD) age and PD-duration were 68 (9.4) and 5 (4.2) years, respectively, and the participants’ PD-symptoms were relatively mild. FOF (the dependent variable) was investigated with the Swedish version of the Falls Efficacy Scale, i.e. FES(S). The first multiple linear regression model replicated a previous study and independent variables targeted: walking difficulties in daily life; freezing of gait; dyskinesia; fatigue; need of help in daily activities; age; PD-duration; history of falls/near falls and pain. Model II included also the following clinically assessed variables: motor symptoms, cognitive functions, gait speed, dual-task difficulties and functional balance performance as well as reactive postural responses.ResultsBoth regression models showed that the strongest contributing factor to FOF was walking difficulties, i.e. explaining 60% and 64% of the variance in FOF-scores, respectively. Other significant independent variables in both models were needing help from others in daily activities and fatigue. Functional balance was the only clinical variable contributing additional significant information to model I, increasing the explained variance from 66% to 73%.ConclusionsThe results imply that one should primarily target walking difficulties in daily life in order to reduce FOF in people mildly affected by PD. This finding applies even when considering a broad variety of aspects not previously considered in PD-studies targeting FOF. Functional balance performance, dependence in daily activities, and fatigue were also independently associated with FOF, but to a lesser extent. Longitudinal studies are warranted to gain an increased understanding of predictors of FOF in PD and who is at risk of developing a FOF.

Musculoskeletal strength, balance performance, and self-efficacy in elderly ving tsun chinese martial art practitioners: implications for fall prevention.

Objectives. To (1) compare the bone strength, lower limb muscular strength, functional balance performance, and balance self-efficacy between Ving Tsun (VT) martial art practitioners and nonpractitioners and (2) identify the associations between lower limb muscular strength, functional balance performance, and balance self-efficacy among the VT-trained participants. Methods. Thirty-five VT practitioners (mean age ± SD = 62.7 ± 13.3 years) and 49 nonpractitioners (mean age ± SD = 65.9 ± 10.5 years) participated in the study. The bone strength of the distal radius, lower limb muscular strength, functional balance performance, and balance self-efficacy were assessed using an ultrasound bone sonometer, the five times sit-to-stand test (FTSTS), the Berg balance scale (BBS), and the Chinese version of the activities-specific balance confidence scale, respectively. A multivariate analysis of covariance was performed to compare all the outcome variables between the two groups. Results. Elderly VT practitioners had higher radial bone strength on the dominant side (P < 0.05), greater lower limb muscular strength (P = 0.001), better functional balance performance (P = 0.003), and greater balance confidence (P < 0.001) than the nonpractitioners. Additionally, only the FTSTS time revealed a significant association with the BBS score (r = −0.575, P = 0.013). Conclusions. VT may be a suitable health-maintenance exercise for the elderly. Our findings may inspire the development of VT fall-prevention exercises for the community-dwelling healthy elderly.

Balance Performance in Irradiated Survivors of Nasopharyngeal Cancer with and without Tai Chi Qigong Training.

This cross-sectional exploratory study aimed to compare the one-leg-stance time and the six-minute walk distance among TC Qigong-trained NPC survivors, untrained NPC survivors, and healthy individuals. Twenty-five survivors of NPC with TC Qigong experience, 27 survivors of NPC without TC Qigong experience, and 68 healthy individuals formed the NPC-TC Qigong group, NPC-control group, and healthy-control group, respectively. The one-leg-stance (OLS) timed test was conducted to assess the single-leg standing balance performance of the participants in four conditions: (1) standing on a stable surface with eyes open, (2) standing on a compliant surface with eyes open, (3) standing on a stable surface with eyes closed, and (4) standing on a compliant surface with eyes closed. The six-minute walk test (6MWT) was used to determine the functional balance performance of the participants. Results showed that the NPC-control group had a shorter OLS time in all of the visual and supporting surface conditions than the healthy control group (P < 0.05). The OLS time of the TC Qigong-NPC group was comparable to that of the healthy control group in the somatosensory-challenging condition (condition 3) (P = 0.168) only. Additionally, there was no significant difference in the 6MWT distance among the three groups (P > 0.05). TC Qigong may be a rehabilitation exercise that improves somatosensory function and OLS balance performance among survivors of NPC.

Dual-task training using virtual reality: Influence on walking and balance in three post stroke survivors

Objective: To investigate the feasibility of using a virtual reality (VR)-based dual task of upper extremity tracking while treadmill walking, to improve gait and functional balance performance of stroke survivors. Materials and Methods: Three individuals (two males and one female), 66, 64, and 54 years old, respectively, participated in the study. The participants were trained in eight sessions of dual-task walking (DTW) on a treadmill while performing virtual tasks, and eight sessions of single-task treadmill walking (TMW), in a cross-over design. Their walking speed, balance performances, and perceived confidence were measured four times along different stages of the study. Results: Two participants demonstrated improvements in each of the outcome measures after the DTW intervention and no change after the TMW intervention. Conclusion: The improvements that were observed in the study demonstrate the potential benefit of DTW using VR while treadmill walking on gait and balance performances of stroke survivors.

Medication improves balance and complex gait performance in Parkinson disease

Gait and balance impairments in people with Parkinson disease (PD) may lead to falls and serious injuries. Therefore, it is critical to improve our understanding of the nature of these impairments, including how they respond to prescribed anti-Parkinson medication. This is particularly important for complex balance and gait tasks that may be associated with falls. We evaluated motor function, functional balance, and gait performance during various gait tasks in 22 people with PD OFF and ON medication (PD OFF, PD ON) and 20 healthy older adults. Although MDS-UPDRS-III score, Berg Balance Scale, Mini-Balance Evaluations Systems test, and Timed-Up-and-Go improved in PD with medication, impairments persisted in all measures on medication, compared to controls. Dual task Timed-Up-and-Go did not improve with medication, and PD ON required more time than controls. Gait velocity and stride length improved similarly with medication in PD across forward, fast, backward, dual task forward, and dual task backward gait tasks. Cadence did not change with medication, nor did it differ between PD ON and controls. Velocity and stride length were reduced in PD ON compared to controls. Velocity reductions in PD ON during fast gait were cadence-mediated, while velocity reductions in backward gait were stride length-mediated. Our results suggest functional balance improves with medication in PD and gait performance improves with medication, regardless of task complexity. Remaining impairments on medication highlight the need to examine additional therapeutic options for individuals with PD to reduce the risk of falls.

Factors Associated With Balance Confidence in Older Adults With Health Conditions Affecting the Balance and Vestibular System

Marchetti GF, Whitney SL, Redfern MS, Furman JM. Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system. Objective To determine the functional, clinical, and comorbid health condition factors that contribute to balance confidence in persons with balance or vestibular disorders, or both. Design Cross-sectional descriptive. Setting Tertiary care center for balance disorders. Participants Older adults (N=95) with signs and symptoms of vestibular dysfunction. Interventions Not applicable. Main Outcome Measures Activity-specific Balance Confidence Scale (ABC) was administered on examination for complaints of balance, postural instability, or both. Results Balance confidence as measured by the ABC was associated with functional balance performance on the Timed Up & Go test and the Dynamic Gait Index. Duration of symptoms and general health-related quality of life (as measured by the Medical Outcomes Study 36-Item Short-Form Health Survey) were significant covariates of balance confidence. Self-reported treatment for anxiety, depression, or both, significantly reduced balance confidence. Conclusions Balance confidence is a complex construct in older adults with signs and symptoms of balance or vestibular dysfunction, or both. Decreased balance confidence in performing functional activities is associated with actual balance performance, duration of vestibular symptoms, general health-related quality of life, and the presence of comorbid psychological and visual impairments. Understanding these relationships can potentially improve management of older adults who present with balance or vestibular disease, or both.

The Influence of Unilateral Saccular Impairment on Functional Balance Performance and Self-Report Dizziness

Postural stability in humans is largely maintained by vestibular, visual, and somatosensory inputs to the central nervous system. Recent clinical advances in the assessment of otolith function (e.g., cervical and ocular vestibular evoked myogenic potentials [cVEMPs and oVEMPs], subjective visual vertical [SVV] during eccentric rotation) have enabled investigators to identify patients with unilateral otolith impairments. This research has suggested that patients with unilateral otolith impairments perform worse than normal healthy controls on measures of postural stability. It is not yet known if patients with unilateral impairments of the saccule and/or inferior vestibular nerve (i.e., unilaterally abnormal cVEMP) perform differently on measures of postural stability than patients with unilateral impairments of the horizontal SCC (semicircular canal) and/or superior vestibular nerve (i.e., unilateral caloric weakness). Further, it is not known what relationship exists, if any, between otolith system impairment and self-report dizziness handicap. The purpose of this investigation was to determine the extent to which saccular impairments (defined by a unilaterally absent cVEMP) and impairments of the horizontal semicircular canal (as measured by the results of caloric testing) affect vestibulospinal function as measured through the Sensory Organization Test (SOT) of the computerized dynamic posturography (CDP). A secondary objective of this investigation was to measure the effects, if any, that saccular impairment has on a modality-specific measure of health-related quality of life. A retrospective cohort study. Subjects were assigned to one of four groups based on results from balance function testing: Group 1 (abnormal cVEMP response only), Group 2 (abnormal caloric response only), Group 3 (abnormal cVEMP and abnormal caloric response), and Group 4 (normal control group). Subjects were 92 adult patients: 62 were seen for balance function testing due to complaints of dizziness, vertigo, or unsteadiness, and 30 served as controls. All subjects underwent videonystagmography or electronystagmography (VNG/ENG), vestibular evoked myogenic potentials (VEMPs), self-report measures of self-perceived dizziness disability/handicap (Dizziness Handicap Inventory), and tests of postural control (Neurocom Equitest). Subjects were categorized into one of four groups based on balance function test results. All variables were subjected to a multifactor analysis of variance (ANOVA). The Dizziness Handicap Inventory (DHI) total scores and equilibrium scores served as the dependent variables. Results showed that patients with abnormal unilateral saccular or inferior vestibular nerve function (i.e., abnormal cVEMP) demonstrated significantly impaired postural control when compared to normal participants. However, this group demonstrated significantly better postural stability when compared to the group with abnormal caloric responses alone and the group with abnormal caloric responses and abnormal cVEMP results. Patients with an abnormal cVEMP did not differ significantly on the DHI compared to the other two impaired groups. We interpret these findings as evidence that a significantly asymmetrical cVEMP in isolation negatively impacts performance on measures of postural control compared to normal subjects but not compared to patients with significant caloric weaknesses. However, patients with a unilaterally abnormal cVEMP do not differ from patients with significant caloric weaknesses in regard to self-perceived dizziness handicap.

Sensory organization of balance control in children with developmental coordination disorder

This study aimed to (1) compare functional balance performance and sensory organization of postural control between children with and without developmental coordination disorder (DCD) and (2) determine the association between postural control and participation diversity among children with DCD. We recruited 81 children with DCD and 67 typically developing children. Balance was evaluated with the Sensory Organization Test (SOT) and the Movement Assessment Battery for Children-2 (Movement ABC-2). Participation patterns were evaluated using the Children Assessment of Participation and Enjoyment assessment. Analysis of variance was used to compare outcome variables between the two groups. A multiple regression analysis was performed to examine the relationship between participation diversity and balance performance in children with DCD. The DCD group had significantly lower Movement ABC-2 balance scores, SOT-derived equilibrium scores, and sensory ratios than the control group (p<0.05). However, only the Movement ABC-2 balance score was significantly associated with participation diversity in children with DCD. After accounting for the effects of age and gender, Movement ABC-2 balance score remained significantly associated with participation diversity, explaining 10.9% of the variance (F(change1,77) = 9.494, p = 0.003). Children with DCD demonstrate deficits in sensory organization of balance control. This suboptimal balance ability contributes to limited participation in activities.

Comparing stabilization training with balance training in recreationally active individuals

Aims The present study was undertaken to compare the efficacy of lumbar core stability training with that of balance training, at improving the balance performance in the recreationally active individuals. Most of the studies to date have been conducted on sporting professionals, whose activity demands are higher than the norm. The present study focuses on the recreationally active population, for which the activity demands are comparatively lesser. Methods Thirty recreationally active subjects (15 males and 15 females) were selected for this study. Subjects were randomly divided into three groups: core stability training group (CSTG), balance training group (BTG), and the control group. All subjects were assessed at baseline, and after six weeks, for balance performance, including static, dynamic and functional balance tests. Data were analyzed by paired t-test, ANOVA, Wilcoxon signed-rank test and Kruksal Wallis test. Findings Both training groups (BTG and CSTG) showed significant (P &lt; 0.05) improvement in balance performance compared to the control group, however the improvement in the mean value for the CSTG was greater than that of the BTG. Conclusions Balance training as well as core stabilization training leads to improvement in static and dynamic balance. However none of these training leads to improvement in the functional balance performance.