Laboratory Measures Of Balance Research Articles

Clinical and laboratory measures of balance and comparison of balance performances according to postural instability and gait disorders in individuals with Parkinson’s disease

Purpose/aim Primary aim was to investigate the association between laboratory measures of balance and clinical balance tests in individuals with Parkinson’s disease (PD). The secondary aim was to compare the balance performances according to postural instability and gait disorders (PIGD). Materials and methods Sixty-four individuals with PD were included in the study. Clinical data were investigated using modified Hoehn and Yahr Scale and Unified Parkinson's Disease Rating Scale (UPDRS). Berg Balance Scale (BBS), Timed Up&Go Test (TUG), Five Times Sit-to-Stand Test (FTSST) were used for clinical measures of balance. Laboratory measures of balance were evaluated by Balance Master System including the modified Clinical Test of Sensory Interaction of Balance (mCTSIB), Limits of Stability Test (LOS), Sit to Stand Test (STS), and Tandem Walk Test (TW). The relationship between clinical and laboratory measures of balance was determined. After participants were divided into two groups based on UPDRS: patients with and without PIGD, their balance performance was compared. Results There were significant correlations between BBS and mCTSIB, LOS-Movement Velocity, and LOS-Endpoint Excursion. FTSST was correlated with STS-Weight Transfer and STS-Rising Index, and TUG was correlated with TW-Speed. Patients with PIGD had worse scores of balance assessments including FTSST, LOS-Movement Velocity, STS-Rising Index. Conclusion Laboratory measures are associated with clinical balance tests and they may reflect clinical balance outcome measures. Furthermore, PIGD may negatively affect balance performance in patients with PD.

Effects of foot and ankle devices on balance, gait and falls in adults with sensory perception loss: a systematic review.

EXECUTIVE SUMMARYBackgroundFoot and ankle devices are being developed as a method of preventing people with sensory perception loss sustaining a fall. Such devices are believed to work by reducing the likelihood of a fall by improving the balance and gait of the user.ObjectivesThe objective of the review was to evaluate the effectiveness of foot and ankle devices for the prevention of falls and the improvement of balance and gait in adults with sensory perception loss.Inclusion criteria Types of participantsParticipants were community-dwelling adults with bilateral pathological sensory perception loss.Types of intervention(s)/phenomena of interestThe current review evaluated any foot or ankle device, including but not restricted to, all types of footwear (therapeutic and retail), insoles (customized and prefabricated) and ankle-foot orthoses (AFOs).Types of studiesIn the absence of randomized controlled trials (RCT), the review considered experimental and epidemiological study designs, except case series, individual case reports and descriptive cross-sectional studies.OutcomesThe primary outcome was number of falls. Secondary outcome measures were clinical or laboratory measures of balance or gait.Search strategyA search for published and unpublished literature from inception to March 2015 written in the English language was conducted across a number of major electronic databases. A three-step search strategy was developed using MeSH terminology and keywords to ensure all that relevant materials are captured.Methodological qualityMethodological quality of included studies was assessed by two reviewers, who appraised each study independently, using standardized Joanna Briggs Institute (JBI) critical appraisal tools.Data extractionQuantitative data were extracted from the studies that were identified as meeting the criteria for methodological quality using the standardized JBI data extraction tools.Data synthesisDue to the heterogeneity of populations, interventions and outcome measures, meta-analyses were not possible and results are presented in narrative form.ResultsNine trials (from 10 papers) involving 238 participants, (14 with multiple sclerosis and 16 with idiopathic peripheral neuropathy, 150 with diabetic neuropathy) and 58 controls were included in the review. No study reported falls as an outcome measure. The results of the included studies found that in people with sensory perception loss, postural sway improved with vibrating insoles and AFO, altering the softness and texture of the top cover had no effect on postural sway, wearing footwear over long distances or AFOs improved step-to-step consistency, and no foot and ankle device was reported to have a negative effect on the balance or gait of people with sensory perception loss. The methodological quality of the included studies was poor. No study used a randomized controlled trial (RCT) methodology. No study incorporated a follow-up period or tested the intervention within the context of the intended clinical environment.ConclusionThere is limited evidence to suggest that footwear and insole devices can artificially alter postural stability and may reduce the step-to-step variability in adults with sensory perception loss. Varying the material properties of an insole does not notably affect static balance or gait.

Correlations of clinical and laboratory measures of balance in older men and women

It is known that impaired balance is associated with falls in older adults; however, there is no accepted gold standard on how balance should be measured. Few studies have examined measures of postural sway and clinical balance concurrently in large samples of community-dwelling older adults. We examined the associations among 4 types of measures of laboratory- and clinic-based balance in a large population-based cohort of older adults. We evaluated balance measures in the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly Boston Study (276 men and 489 women ages 64-97 years). The measures included laboratory-based anteroposterior (AP) path length and mean sway speed, mediolateral (ML) mean sway and root mean square, and area of ellipse postural sway; the Short Physical Performance Battery (SPPB); the Berg Balance Scale; and the one-leg stand test. Spearman's rank correlation coefficients were assessed among the balance measures. The area of ellipse sway was highly correlated with the ML sway measures (r = >0.91, P < 0.0001) and sway speed was highly correlated with AP sway (r = 0.97, P < 0.0001). The Berg Balance Scale was highly correlated with the SPPB (r = 0.74, P < 0.001) and the one-leg stand test (r = 0.82, P < 0.001). Correlations between the laboratory- and clinic-based balance measures were low but statistically significant (-0.29 ≤ r ≤ -0.16, P < 0.0001). Clinic-based balance measures, and laboratory-based measures comparing area of ellipse with ML sways or sway speed with AP sway, are highly correlated. There is less correlation between the clinic- and laboratory-based measures. Since both laboratory- and clinic-based measures inform balance in older adults, but are not highly correlated with each other, future work should investigate the differences.

Task-Oriented Intervention in Chronic Stroke

The objective of this study was to evaluate whether, after a task-oriented exercise program, the changes in clinical measures of balance and mobility were paralleled by changes in biomechanical parameters in subjects with chronic stroke. Ten stroke subjects took part in an 8-wk exercise program aimed at improving balance and mobility through various functional tasks. Subjects were evaluated before and after the exercise intervention. Clinical measures included the Berg Balance Scale and the Timed-Up-and-Go and laboratory measures included ground reaction forces and center of pressure displacement during four functional tasks. Stroke subjects showed significant improvements (P < 0.05) in the clinical measures after completing the exercise program. Significant improvements (P < 0.05) were also found in postural steadiness during tandem stance and stool touch and in force production through the paretic lower limb during sit-to-stand. This last result was strongly correlated (r = -0.93) with the improvements on the Timed-Up-and-Go after exercise intervention. In contrast, the increase in postural steadiness was poorly correlated with the improvements on the Berg Balance Scale. A task-oriented exercise program might improve both clinical and laboratory measures of balance and mobility in stroke subjects. However, several correlations between the changes in clinical and laboratory measures after exercise intervention were generally weak, indicating that these outcome measures assessed different components of improvements.

Standing balance during internally produced perturbations in subjects with hemiplegia: validation of the balance scale.

To examine the concurrent validity of the Berg Balance Scale (BBS) in subjects with hemiparesis after stroke by correlating functional balance performance on the BBS with laboratory measures of balance (center of pressure [CP] and electromyographic [EMG] activity of leg musculature during rapid arm flexion and during quiet stance). Concurrent validation study. Consistency of performance was determined through repeat measures obtained from 13 subjects. Laboratory. Twenty-four volunteers with longstanding hemiparesis from cerebrovascular accident (CVA) were tested. BBS scores were compared with CP excursion speed during (1) self-initiated rapid unilateral arm flexion with the nonhemiplegic arm and (2) quiet stance. The peak tangential arm acceleration and the sequence of EMG events in the posterior leg muscles were monitored during the arm flexion movement. In the arm flexion condition, BBS performance was significantly correlated with arm acceleration and CP excursion speed (multiple regression R = .81). BBS performance was also related to the presence of anticipatory activation of ipsilateral hamstrings during the rapid arm flexion movement. BBS performance and CP excursion speed during quiet stance were also significantly related (r = .76). The initial and repeat measures were not significantly different in magnitude (paired tests of difference, p < .01). The BBS appears to reflect differing abilities to tolerate the internally produced perturbation to standing balance associated with forward arm flexion in individuals with hemiparesis from CVA.