Mini-BESTest Scores Research Articles

AVALIAÇÃO DO EQUILÍBRIO DE MULHERES COM CÂNCER DE MAMA

The objective of this study was to verify the balance of women with breast cancer. This cross-sectional study, tested balance of 15women, eight women with cancer and seven without cancer. The evaluation was performed through the Mini Balance Evaluation Systems (MiniBESTest), TUG with simple and dual-task. The mean of age was 59.2 ± 5 years for cancer group and 60.2 ± 5 years for thecontrol group. Student's t-test for independent samples showed that there was no statistical differencebetween the groups for: MiniBESTest score, TUG with simple and dual-task. Women with cancer did not present balance impairments compared to control group according to MiniBESTest, and TUG with simple and dual-task.

A study of the discriminative properties of the Six-Spot Step Test in people with Parkinson's disease at risk of falling.

Clinical tests that can discriminate between people at risk of falling and those not at risk are warranted. The discriminative properties of the Six-Spot Step Test was investigated in people with Parkinson's disease at risk of falling. Eighty-one participants with a median age of 69 years (Q1-Q3:63-74) and a median Hoehn and Yahr score of 2.5 (Q1-Q3:2-3) completed the Six-Spot Step Test and the Timed "Up and Go" test. A mini-BESTest score of 19 or below was used as a cut-off for defining risk of falling, and a receiver operating characteristics curve was generated to determine clinical relevant cut-off scores. A cut-off score of 7.0 and 6.8 seconds identified people not at risk of falling, while 11.1 and 9.4 seconds identified people at risk of falling for the Six-Spot Step Test and the Timed "Up and Go" test, respectively. When maximizing the sensitivity and specificity a cut-off score of 9.2 (accuracy of 84%) and 8.1 seconds (accuracy of 70%) was found for the Six-Spot Step Test and the Timed "Up and Go" test, respectively. The Six-Spot Step Test discriminates accurately between people with Parkinson's disease at risk of falling and people not at risk.

Perception of whole-body motion during balance perturbations is impaired in Parkinson's disease and is associated with balance impairment

BackgroundIn addition to motor deficits, Parkinson's disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions. Research questionWe hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group. MethodsParticipants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°–44°. Participants reported whether the perturbations in each pair were in the “same” or “different” direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to “just-noticeable differences” in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score. Results20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40). SignificancePerception of whole-body motion is impaired in PD and may contribute to impaired balance and falls.

Quantifying balance control after spinal cord injury: Reliability and validity of the mini-BESTest

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.Design: Cross-sectional study.Setting: Rehabilitation hospital.Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).Interventions: None.Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants performed tests of lower extremity muscle strength and quiet standing on a force platform with eyes opened (EO) and eyes closed (EC). Intraclass correlation coefficients (ICC) evaluated test-retest reliability. To evaluate concurrent and convergent validity, Pearson’s correlation coefficient (r) quantified relationships between mini-BESTest scores and measures of center of pressure (COP) velocity during EO and EC standing, and lower extremity muscle strength, respectively.Results: Test-retest reliability of the mini-BESTest total score and sub-scale scores were high (ICC = 0.94–0.98). Mini-BESTest scores were inversely correlated with COP velocity when standing with EO (r = 0.54–0.71, P < 0.05), but not with EC. Lower extremity strength correlated strongly with mini-BESTest total scores (r = 0.73, P < 0.001).Conclusion: The mini-BESTest has high test-retest reliability, and concurrent and convergent validity in individuals with chronic iSCI.

The importance of physical function in patients with multiple myeloma for improving quality of life.

To investigate the relationship between physical function and quality of life in multiple myeloma patients. In this retrospective cross-sectional study, data from patients with multiple myeloma (N = 63), who were referred to the department of Rehabilitation Medicine from October 2017 to May 2018, were reviewed. Patients were excluded based on the following criteria: acute illness, unstable medical conditions, impaired cognition or communication, refusal, or inability to perform the assessment. Physical function was evaluated with the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-MY20 were used for the evaluation of quality of life. To evaluate fatigue and psychotic status, the Fatigue Severity Scale and Beck Depression Inventory were used. Patients were divided into two groups ("good-function group" and "poor-function group"), based on previously studied normative values of the Mini-BESTest. Clinical data was reviewed to interrogate the contributing factors of physical function. Positive correlations were observed between Mini-BESTest scores and all domains of the QLQ-C30. The Mini-BESTest score was lower in patients with lower serum hemoglobin (r = 0.396, p = 0.001) and albumin levels (r = 0.440, p < 0.001), severe disease-related symptoms (r = - 0.39, p = 0.02), and depression (r = - 0.538, p < 0.001). Further, the poor-function group showed lower hemoglobin (p = 0.024) and albumin levels (p = 0.004). In patients with multiple myeloma, physical function had a significant relationship with quality of life. Low hemoglobin and albumin levels, severe disease- or treatment-related symptoms, and depression were related to decreased physical function, and thus consequentially exert an effect on quality of life in multiple myeloma patients.

Do Upper and Lower Camptocormias Affect Gait and Postural Control in Patients with Parkinson's Disease? An Observational Cross-Sectional Study.

Gait impairments and camptocormia (CC) are common and debilitating in patients with Parkinson's disease (PD). Two types of CC affect patients with PD, but no studies investigated their relative contribution in worsening gait and postural control. Therefore, we investigated spatiotemporal gait parameters, gait variability, and asymmetry and postural control in PD patients (Hoehn & Yahr ≤4) with upper CC and lower CC and patients without CC. This observational cross-sectional study involving patients with PD and upper CC (n=16) and lower CC (n=14) and without CC (n=16). The primary outcome measure was gait speed assessed by the GAITRite System. The secondary outcome measures were other spatiotemporal parameters, gait variability, and asymmetry. Postural control and balance were assessed with posturography and the Mini-BESTest. Patients with lower CC showed a higher H&Y stage (p=0.003), a worse PDQ8 (p=0.042), and a lower Mini-BESTest score (p=0.006) than patients with PD without CC. Patients with lower CC showed a reduced gait speed (p=0.012), stride length, and velocity than patients with PD without CC. Upper CC patients showed a higher stride length than lower CC ones (p=0.007). In the eyes open and closed condition, patients with lower CC showed a higher (worse) velocity of CoP displacement in mediolateral direction and length of CoP than patients with PD without CC. No significant between-group differences were measured in gait variability and asymmetry. In conclusion, lower CC was associated with more severe gait and postural control impairment than patients with upper CC and without CC. Categorizing CC based on the bending fulcrum is compulsory to identify patients with the worst performance and to implement specific rehabilitation programs.

Functional Performance and Balance in the Oldest-Old.

The group of individuals 85 years and over (termed oldest-old) is the fastest-growing population in the Western world. Although daily functional abilities and balance capabilities are known to decrease as an individual grows older, little is known about the balance and functional characteristics of the oldest-old population. The aims of this study were to characterize balance control, functional abilities, and balance self-efficacy in the oldest-old, to test the correlations between these constructs, and to explore differences between fallers and nonfallers in this age group. Forty-five individuals living in an assisted living facility who ambulated independently participated in the study. The mean age was 90.3 (3.7) years. Function was tested using the Late-Life Function and Disability Instrument (LLFDI). Balance was tested with the mini-Balance Evaluation System Test (mini-BESTest) and the Timed Up and Go (TUG) test. Balance self-efficacy was tested with the Activities-Specific Balance Confidence (ABC) scale. The mean total function LLFDI score was 63.2 (11.4). The mean mini-BESTest score was 69.8% (18.6%) and the mean TUG time was 12.6 (6.9) seconds. The mean ABC score was 80.2% (14.2%). Good correlation (r > 0.7) was observed between the ABC and the function component of the LLFDI, as well as with the lower extremity domains. Correlations between the mini-BESTest scores and the LLFDI were fair to moderate (r's range: 0.38-0.62). Age and ABC scores were significant independent explanators of LLFDI score (P = .0141 and P = .0009, respectively). Fallers and nonfallers differed significantly across all outcome measures scores, except for TUG and for the "Reactive Postural Control" and "Sensory Orientation" domains of the mini-BESTest. The results of this study provide normative data regarding the balance and functional abilities of the oldest-old, and indicate a strong association between self-efficacy and function. These results emphasize the importance of incorporating strategies that maintain and improve balance self-efficacy in interventions aimed at enhancing the functional level of this cohort.

A study of the validity of the Six-Spot Step Test in ambulatory people with Parkinson’s disease

Objective: The aim of this study was to evaluate the concurrent and divergent validity of the Six-Spot Step Test in mild to moderately impaired people with Parkinson’s disease. Design: Cross-sectional cohort study. Setting: Outpatient clinics. Subjects: Fifty-eight people with Parkinson’s disease. Main measure: The Six-Spot Step Test, the Timed “Up and Go” test, the mini-Balance Evaluation Systems Test (mini-BESTest), and postural sway were tested on the same day, and the Spearman’s Rank Correlation Coefficient (ρ) was used for data analysis. Results: Subjects had a median age of 68 years (Q1–Q3: 62–73), a median Hoehn and Yahr score of 2.5 (Q1–Q3: 2–3), a median Six-Spot Step Test score of 7.9 seconds (Q1–Q3: 6.5–9.2), a median Timed “Up and Go” test score of 7.0 seconds (Q1–Q3: 5.6–7.9), a median mini-BESTest score of 22.5 (Q1–Q3: 19.8–25.0), and a median postural sway score of 27.9 mm2 (Q1–Q3: 15.0–53.5) and 22.5 mm/s (Q1–Q3: 14.6–39.8). Statistical significant correlations were found between the Six-Spot Step Test and the Timed “Up and Go” test (ρ = 0.81) and the mini-BESTest (ρ = –0.64), whereas no significant relations were identified between the Six-Spot Step Test and postural sway (ρ = 0.18, P > 0.05). Conclusion: In patients with Parkinson’s disease, the Six-Spot Step Test showed promising concurrent validity to other recommended clinical tests for encompassing balance capacity and capacity of functional mobility, making it a reasonable and easily administered alternative to existing assessment tools when measuring walking agility. As expected, weak correlates to postural sway revealed that the Six-Spot Step test is not a valid measure of standing balance.

Long-term effects of highly challenging balance training in Parkinson’s disease—a randomized controlled trial

Objectives: To determine long-term effects of a highly challenging training program in people with Parkinson’s disease, as well as describe how initially observed improvements of the program deteriorated over time. Design: Long-term follow-up of previously reported outcomes at 10 weeks of a randomized controlled trial. Setting: University hospital setting. Participants: One-hundred elderly with mild-to-moderate (Hoehn and Yahr 2–3) Parkinson’s disease. Interventions: Participants in the training group (n = 51) received 10 weeks (three times/week) of balance and gait exercises, incorporating dual-tasks, while the control group (n = 49) received care as usual. Main Outcome Measures: Balance control (Mini-Balance Evaluation System Test (Mini-BESTest)) and gait velocity. Mixed-design analyses of variance were used to determine potential training effects at 6- and 12-month follow-up, and piecewise regression models predicted the rate of deterioration. Results: Seventy-six participants were included at final follow-up. No significant (P > .05) between-group differences remained at either 6 or 12 months following the intervention. The mean Mini-BESTest scores of the training and control group were 19.9 (SD 4.4) and 18.6 (SD 4.3), respectively, at the 12-month follow-up. Gait speed was 1.2 (SD 0.2) m/s in both groups at 12 months. The training group showed a larger deterioration rate per month in balance performance (0.21 point) and gait velocity (0.65 cm/s) than controls (P < .05). Conclusion: These results suggest that training effects diminish within 6 months after balance training, implying that the program may need to be repeated regularly.

The effect of Balance Exercise Assist Robot (BEAR) to patient after allogenetic hematopoietic stem cell transplantation (allo-HSCT): Preliminary study

Previous studies have shown that patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) frequently complicate balance dysfunction, with at least 50% experiencing one or more falls during hospitalization. We investigated the effect of Balance Exercise Assist Robot (BEAR) on patients after allo-HSCT, and the correlation between the effect of BEAR and the severity of balance dysfunction before intervention. Fifteen patients, who were allowed to leave the sterile room after allo-HSCT during hospitalization, participated. Mini-Balance Evaluation Systems Test (mini-BESTest), grip power, knee extension strength, 10-m walk test, Timed Up and Go test (TUG), dual-task TUG, functional reach test, Berg balance scale, sub-items of the mini-BESTest, and single-leg standing time were evaluated before and after intervention using BEAR. The participants performed 15 BEAR sessions, 20 minutes per session. The difficulty level of training task was automatically adjusted for each participants by BEAR. We divided into two groups based on pre-intervention Mini-BESTest scores: less than 70% (low group) and 70% or more (high group) and analyzed. Statistical analyses were performed to compare the groups; P < 0.05 indicated statistically significant differences. Informed consent was obtained from all participants before the intervention. There was no significant difference in pre- and post-intervention mini-BESTest in the low group (52.4 ± 15.9 vs. 70.8 ± 18.5) and high group (86.9 ± 12.0 vs. 88.5 ± 13.0). However, change between pre- and post-intervention scores in the low group was greater than the minimally important change of the mini-BESTest. Furthermore, significant improvement was observed between pre- and post-intervention scores for postural response (18.5 ± 22.7 vs. 51.9 ± 32.8), a mini-BESTest sub-item, in the low group. The other pre- and post-intervention outcomes were not significantly different in either group. BEAR was an effective and safe balance training, especially for postural response, in allo-HSCT patients with pre-intervention scores of less than 70% in the mini-BESTest.

Dynamic balance in patients with degenerative lumbar spinal stenosis; a cross-sectional study

BackgroundDegenerative lumbar spinal stenosis (LSS) is a prevalent condition in adults over the age of 55 years. The condition is associated with activity limitations that are related to increased pain when engaging in weight-bearing activities, such as walking and standing, and release of pain while sitting down or bending forward. The limitation on ambulation is also associated with impaired balance although the types of balance problems are sparsely described in this patient group. The purpose of this study was to assess dynamic balance in persons with LSS by the Mini-BESTest and explore the associations with self-reported balance and functional disability.MethodsSixty two participants were included in this cross-sectional study. The main outcome measure was the Mini-BESTest, providing a total score and sub-scores for 4 balance control systems (Anticipatory Adjustment, Reactive Response, Sensory Orientation, Stability of Gait). The Swiss Spinal Stenosis Questionnaire provided sub-scores for self-reported balance problems and walking function (FUNC).ResultsThe participants showed large inter-individual variation in all measures of balance. The Mini-BESTest score ranged from very good to poor and the mean value was 22.8 (SD 3.5). Nineteen participants (31%) reported having frequent balance problems. Logistic regression analyses showed that both the total Mini-BESTest score (OR (95% CI) 1.6 (1.2, 2.0)(P = .001) and 3 of the 4 balance control systems (Anticipatory Adjustment, Sensory Orientation, Stability in Gait) were significantly associated with self-reported balance problems (.001 ≤ P ≤ .01). The strongest association was seen between Sensory Orientation and balance problems, implying that it is 4.4 times more likely that persons would have no or occasional balance problems with each unit of increase in Sensory Orientation. The total score for the Mini-BESTest was significantly associated with FUNC (P = .042).ConclusionsThe dynamic balance of persons with LSS showed a large heterogeneity with a large fraction of the participants displaying no balance impairments. The test results were associated with the participants’ self-reported balance problems and walking function. The Mini-BESTest thus appears to provide additional information to self-reported disability, and by identifying different kind of balance control impairments, the Mini-BESTest could be useful for physiotherapists working with person-centered rehabilitation in persons with LSS.

A dance program to improve gait and balance in individuals with chronic stroke: a feasibility study

ABSTRACTBackground and Objective Despite gains made with rehabilitation, gait and balance remain limited post-stroke. Dance is a fun and motivating activity which has shown benefits in individuals with Parkinson’s disease. The purpose of this article is to investigate the feasibility of a dance program for individuals with chronic stroke.Methods Pre-post intervention feasibility study where twenty individuals with chronic stroke participated in a dance class twice a week for 10 weeks. Feasibility measures included interest, enrollment, attendance, adverse events, and participant satisfaction. Outcomes of interest were spatiotemporal gait parameters and balance assessed with the MiniBESTest before and after the dance program. Pre and post measures were compared with paired t-tests.Results Of the 33 individuals approached, 30 (90.9%) were interested in participating; however, scheduling conflicts were a common barrier. Ultimately, 22 individuals consented and 20 individuals completed the dance program without adverse events. The mean age was 62.3 (10.4) years, time post-stroke was 6.4 (6.0) years and National Institutes of Health Stroke Scale score was 3.1 (2.0). Average attendance was 92.5% with 10 classes missed across 8 participants and satisfaction ratings were high (e.g. 17/20 strongly agreed they enjoyed the program). No significant differences in spatiotemporal gait parameters were found; however, MiniBESTest scores significantly increased from 16.5 (6.0) to 18.6 (4.9) (p = 0.0005).Discussion and Conclusions A dance program is safe and feasible post-stroke. Attendance and satisfaction were high and participants perceived walking and balance benefits. Future work will include a randomized controlled trial.

Recovery of balance function among individuals with total knee arthroplasty: Comparison of responsiveness among four balance tests

Background and aimBalance deficits are common after total knee arthroplasty (TKA); however the responsiveness of commonly used balance measurement tools has not been well defined. The objective of this prospective study was to compare the internal and external responsiveness of four measurement tools in assessing recovery of balance function following TKA. MethodsA total of 134 individuals with TKA (95 women; age: 66.3±6.6years) completed the Balance Evaluation Systems Test (BESTest), Mini-BESTest, Brief-BESTest, and Berg Balance Scale (BBS) at 2, 4, 8, 12, and 24 weeks post-TKA. The Functional Gait Assessment (FGA) served as the anchor measure, and was also measured across these time points. Internal responsiveness was indicated by the standardized response mean (SRM), while external responsiveness was reflected by the degree of association of the changes of balance scores with those of FGA. ResultsThe SRM ranged from 0.60–1.14 for the BESTest, 0.40–0.94 for the Mini-BESTest, 0.27–0.91 for the Brief-BESTest, and 0.19–0.70 for the BBS, over time. The change in BESTest and Mini-BESTest scores predicted the change in the FGA scores across all time periods, except for the Mini-BESTest between weeks 12–24, accounting for 13–27%, and 12–24% of the variance, respectively. The Brief-BESTest scores only predicted FGA scores between the weeks 2–4 (R2=20%). The changes in BBS scores were not associated with the FGA. ConclusionThe BESTest is the most responsive in measuring recovery of balance among individuals with TKA. The Mini-BESTest is a reasonable option during time constraints.

Gait abnormalities of COPD are not directly related to respiratory function

To assess whether gait abnormalities in COPD depend on mere impairment of respiratory function. In 40 patients with COPD at different GOLD stages and 28 controls, we evaluated: forced expiratory volume in 1s (FEV1); partial pressure of oxygen; Mini-Mental State Examination (MMSE); dynamic balance through the Mini-BESTest (MBT); Timed Up and Go (TUG) test without and with dual task counting aloud back by three; 6-min walk test (6MWT); body sway during quiet stance (stabilometry); spatial-temporal variables of gait by a 4-m long sensorized walkway (baropodometry). Lower-limb muscle strength, tendon reflexes, and sensation were also clinically evaluated. Muscle strength of proximal but not distal muscles was slightly reduced in patients, whereas reflexes and sensation were unaffected. FEV1, partial pressure of oxygen, MMSE, MBT, stabilometry, as well as baropodometry, were abnormal and unrelated to muscle weakness. The time taken to perform the TUG test was increased, and to a larger extent with than without dual task. At baropodometry, variability of step length was increased; abnormalities of gait variables were associated with larger body sway but not with FEV1 or hypoxemia. Gait speed at 6MWT was correlated with MBT score and with FEV1 as well as hypoxemia. 6MWT findings give a measure of gait disability linked to endurance-related respiratory failure. Gait at baropodometry is associated with impairment of balance, cognitive status and abnormal dual task performance. We suggest that central nervous lesions, presumably of vascular origin, are detrimental to balance and gait in COPD.

Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism.

The One-Leg Stance (OLS) test is a widely adopted tool for the clinical assessment of balance in the elderly and in subjects with neurological disorders. It was previously showed that the ability to control anticipatory postural adjustments (APAs) prior to lifting one leg is significantly impaired by idiopathic Parkinson’s disease (iPD). However, it is not known how APAs are affected by other types of parkinsonism, such as frontal gait disorders (FGD). In this study, an instrumented OLS test based on wearable inertial sensors is proposed to investigate both the initial anticipatory phase and the subsequent unipedal balance. The sensitivity and the validity of the test have been evaluated. Twenty-five subjects with iPD presenting freezing of gait (FOG), 33 with iPD without FOG, 13 with FGD, and 32 healthy elderly controls were recruited. All subjects wore three inertial sensors positioned on the posterior trunk (L4–L5), and on the left and right frontal face of the tibias. Participants were asked to lift a foot and stand on a single leg as long as possible with eyes open, as proposed by the mini-BESTest. Temporal parameters and trunk acceleration were extracted from sensors and compared among groups. The results showed that, regarding the anticipatory phase, the peak of mediolateral trunk acceleration was significantly reduced compared to healthy controls (p < 0.05) in subjects with iPD with and without FOG, but not in FGD group (p = 0.151). Regarding the balance phase duration, a significant shortening was found in the three parkinsonian groups compared to controls (p < 0.001). Moreover, balance was significantly longer (p < 0.001) in iPD subjects without FOG compared to subjects with FGD and iPD subjects presenting FOG. Strong correlations between balance duration extracted by sensors and clinical mini-BESTest scores were found (ρ > 0.74), demonstrating the method’s validity. Our findings support the validity of the proposed method for assessing the OLS test and its sensitivity in distinguishing among the tested groups. The instrumented test discriminated between healthy controls and people with parkinsonism and among the three groups with parkinsonism. The objective characterization of the initial anticipatory phase represents an interesting improvement compared to most clinical OLS tests.

A clinical single blind study to investigate the immediate effects of plantar vibration on balance in patients after stroke

SummaryBalance disorder is a very common cause of disability in patients after a stroke. Vibration therapy is one of the physiotherapeutic modalities used to improve balance. ObjectiveTo investigate the immediate effects of plantar vibration on balance in patients with stroke. MethodsIn this single blind comparative study, 22 patients with stroke (8 females, 14 males; age 55.82 ± 11.87 years old) participated. Patients underwent treatment, first with the placebo vibration and 1 week later with active vibration (frequency 100 HZ, 5 min). Mini-BESTest score, Modified Modified Ashworth Scale for plantar flexor spasticity, and ankle dorsiflexion passive range of motion (PROM) were evaluated before and immediately after the placebo or active vibration. ResultsA significant clinical improvement in balance, ankle plantar flexor spasticity, and the ankle dorsiflexion PROM was observed following either placebo or active vibration. The improvements after active vibration were significantly greater for all outcome measures compared with placebo vibration. There was a large effect size (Cohen's d = 0.85) for balance after active vibration. ConclusionThe vibration applied to the sole of the affected foot of patients after stroke was effective for improving balance, reducing ankle plantar flexor spasticity, and increasing ankle dorsiflexion PROM.

Improvements in Gait With Hearing Aids and Cochlear Implants.

To evaluate whether wearing auditory assistive devices can improve gait and dynamic balance. Three adult users of bilateral hearing assistive devices: one with cytomegalovirus exposure wearing cochlear implants, one with Ménière's disease wearing hearing aids, and one with presbystasis wearing hearing aids. Rehabilitative intervention involved participants performing gait and dynamic posture tasks with and without their hearing assistive devices. Gait velocity and Mini-BESTest score. The participant with Ménière's disease showed a clinically significant improvement in gait in the aided versus the unaided condition (20.5 cm/s higher velocity and five point better Mini-BESTest score). The other two participants also improved with augmented audition, but to a lesser degree. Bilateral hearing augmentation may promote clinically significant improvements in gait, although the effects are not uniform among patients. Hearing aids or cochlear implants may be important interventions for improving stability during walking in some people with hearing loss.

Progression of postural control and gait deficits in Parkinson's disease and freezing of gait: A longitudinal study

Background and aimsThe relationship between impaired postural control and freezing of gait (FOG) in Parkinson's disease (PD) is still unclear. Our aim was to identify if postural control deficits and gait dysfunction progress differently in freezers compared to non-freezers and whether this relates to FOG development. Methods76 PD patients, classified as freezer (n = 17) or non-freezer (n = 59), and 24 controls underwent a gait and postural control assessments at baseline and after 12 months follow-up. Non-freezers who developed FOG during the study period were categorized as FOG converters (n = 5). Gait was analyzed during walking at self-preferred pace. Postural control was assessed using the Mini-BESTest and its sub-categories: sensory orientation, anticipatory, reactive and dynamic postural control. ResultsMini-BESTest scores were lower in PD compared to controls (p < 0.001), and in freezers compared to non-freezers (p = 0.02). PD has worse anticipatory (p = 0.01), reactive (p = 0.02) and dynamic postural control (p = 0.003) compared to controls. Freezers scored lower on dynamic postural control compared to non-freezers (p = 0.02). There were no baseline differences between converters and non-converters. Decline in postural control was worse in PD compared to controls (p = 0.02) as shown by a greater decrease in the total Mini-BESTest score. Similar patterns were found in freezers (p = 0.006), who also showed more decline in anticipatory (p < 0.001) and dynamic postural control (p = 0.02) compared to non-freezers. FOG converters had a greater decline in the total Mini-BESTest (p = 0.005) and dynamic postural control scores (p = 0.04) compared to non-converters. Gait outcomes showed no significant differences in any of the analyses. ConclusionFOG is associated with more severe decline in postural control, which can be detected by the clinical Mini-BESTest.

Unexplained physical complaints in everyday physical therapy practice in The Netherlands

of such patients: 0–5%); 12 patients (20%, 95% CI 11–32%) and 20 patients (33%, CI 22–47%) reached the maximum score on the BBS (56 points) at admission and after 4 weeks, respectively. Conversely, there were 7 patients at admission and 3 after 4 weeks who achieved 0 points on the mini-BESTest yet scored above 0 on the BBS. Spearman rank-correlations between the mini-BESTest and BBS scores (0.942 at admission, 0.931 after 4 weeks) were higher than Pearson correlations (0.883 at admission, 0.848 after 4 weeks), which confirms the nonlinearity of the association. There was no significant correlation between the progress scores (i.e., the differences between the score at admission and after 4 weeks) on the two tests (Pearson r= 0.203, p= 0.120; Spearman rho = 0.125, p= 0.341), which indicates that the tests are sensitive over a different ability range. Conclusion(s): The mini-BESTest is highly correlated with the BBS, but in a nonlinear way in the sense of being more sensitive for assessing balance in persons who had reached the maximum score when assessed using the BBS, whereas the BBS is more sensitive for assessing the patients with severely impaired balance. Implications:Mini-BESTest is suitable for assessing balance in stroke patients, especially those with mild balance disorders.

Distal motor deficit contributions to postural instability and gait disorder in Parkinson's disease

Clinical subtypes in Parkinson's disease (PD) are often based on the presence of clustered motor symptoms. In contrast to the tremor dominant (TD) subtype, the postural instability and gait disorder (PIGD) subtype is characterized by predominantly axial motor involvement and increased cognitive impairment. It is, however, unclear if subtypes represent distinct underlying neuropathological mechanisms or reflect more severe disease progression. We aimed to clarify the validity of PD subtypes by investigating behavioral outcomes at multiple levels. Therefore, spatiotemporal kinematics of gait, upper and lower limb repetitive movements in combination with a balance and cognitive assessment were recorded in 73 patients with PD. We classified patients as PIGD (n=43), TD (n=22) or indeterminate (n=8) while ‘off’ medication and recruited 20 age-matched controls. Surprisingly, differences between PIGD and TD were more prominent during repetitive distal motor tasks than during gait. Gait impairment in PIGD was only shown by reduced step length and gait speed. However, motor scaling and coordination of distal movements were more affected in PIGD than in TD patients. PIGD patients also had impaired postural control compared to TD patients as shown by lower mini-BESTest scores. There were no cognitive differences between patient subgroups. Distal movement was not significantly different in TD patients from controls, except for greater movement asymmetry. The results indicate a widespread impairment within PIGD with more pronounced distal than axial motor deficits. This suggests involvement of different neurotransmitter systems in the neuropathology of PD subtypes, which are at least partially independent of disease progression.