Modified Berg Balance Scale Research Articles

Two Physiotherapy Methods to Improve the Physical Condition of Children with Autism Spectrum Disorder.

This study presents two simple physiotherapy programs that were implemented for five weeks and showed positive changes in balance, coordination, and motor skills in kindergarteners with ASD. Physiotherapy programs in a gym and games on a smart board with balance plates and an unstable base were applied to improve the physical condition of children with ASD. Thirty children with ASD (4-6 years old) attending special needs kindergarten were enrolled in the study. Three tests were used to assess participants' physical condition before and after the study: the modified Berg Balance Scale, the Imbalance Coordination Sample, and the Bruininks-Oseretsky Motor Proficiency Test (BOTMP). The resulting mean change, calculated from each group's scores, shows that the participants who received physical therapy sessions at the smart board had the greatest change of 1.58 points. It shows that the opportunity to play games on a smart board motivates children with ASD to work harder; therefore, it is a simple and easy way to engage children in different types of physical exercise. A slightly smaller change of 1.51 was obtained in the group that received gym sessions. However, working in the gym was more psychologically challenging for the children with ASD due to their lack of desire and motivation. Both methods are relatively simple and easy to apply at home; therefore, parents can make a significant contribution to improving children's physical condition and that can be an effective tool to assist these individuals with activities in daily life.

Effect of Whole-Body Vibration Training on Physical Fitness and Postural Control in Working-Age Patients on Haemodialysis.

ObjectiveTo evaluate the effect of whole-body vibration training on working-age people on haemodialysis.DesignConsecutive case series study.SubjectsSeventeen working-age participants on maintenance haemodialysis were enrolled.MethodsA 12-week whole-body vibration training programme, including different postures, was designed. The study evaluated and compared physical fitness, including a list of tests such as the 5-repetition sit-to-stand test, hand grip test, 2-min step test, and 8-foot up-and-go test; modified Berg balance scale; static and dynamic balance function; and quality of life, using a quality of life questionnaire before and after the training.ResultsAll physical fitness parameters, except grip strength on the left side, improved after whole-body vibration training. For balance, the modified Berg balance scale demonstrated enhanced scores for equilibrium, with eyes closed on a stable surface and eyes open on an unstable surface, and movement velocity under the fast condition along the left and right directions (p=0.011). No significant improvements in quality of life were found.ConclusionWhole-body vibration exercise training enhanced physical fitness and static and dynamic balance control in working-age participants on haemodialysis.LAY ABSTRACTThis study designed a series of exercises in different postures on a whole-body vibration machine for individuals on maintenance haemodialysis and evaluated the changes in their physical fitness, postural control and quality of life before and after a 12-week programme. Seventeen working-age participants on maintenance haemodialysis were enrolled and completed the whole-body vibration training programme. There were no significant changes in the scores on the quality of life questionnaire for multifactorial aspects. However, the physical fitness parameters, including a list of tests, such as the 5-repetition sit-to-stand test, hand grip test of right side, 2-min step test and 8-foot up-and-go test, improved after the whole-body vibration training. Their postural control also demonstrated improvements in the modified Berg balance scale, equilibrium scores with eyes closed on a stable surface and eyes open on an unstable surface, and movement velocity under the fast condition along the left and right directions.

Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls

ABSTRACT Objectives To investigate predictors of fear of falling (FOF) among older people with or without hip fracture. Methods The FOF was assessed by the Visual Analogue Scale (VAS-FOF), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). The modified Berg Balance Scale (mBBS) to evaluate functional balance was used. All people were asked to complete the dizziness Handicap Inventory (DHI) and the 36-item Short Form Health Survey (SF-36) for evaluating quality of life. Results Eighty-eight older adults (44 cases; 44 controls) took part in this study. The case group had received surgical intervention for femoral neck or trochanteric fracture resulting from a fall. The results showed significantly more intensity of FOF in hip fracture patients than controls (p < .001). The FOF was significantly correlated with anxiety, DHI, mBBS, and SF-36. The results of the multiple linear regression showed that four predictors explained about 44% of the variance of the FOF. It was found that mBBS and DHI significantly predicted FOF (p < .001 and < .001, respectively). Conclusions The hip fracture patients had a high degree of the fear of falling, low quality of life and low functional capacity. The mBBS and DHI were significant predictors of the FOF in older adults. Clinical implications It may be useful to employ an inter-disciplinary approach to addressing fear of falling to best understand physiological and psychological contributions.

The Impact of Betahistine versus Dimenhydrinate in the Resolution of Residual Dizziness in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial

The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver. In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0. In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD (P = .05). The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.

An automated, electronic assessment tool can accurately classify older adult postural stability

Current methods of balance assessment in the clinical environment are often subjective, time-consuming and lack clinical relevance for non-ambulatory older adults. The objective of this study was to develop a novel method of balance assessment that utilizes data collected using the Microsoft Kinect 2 to create a Berg Balance Scale score, which is completely determined by statistical methods rather than by human evaluators. 74 older adults, both healthy and balance impaired, were recruited for this trial. All participants completed the Berg Balance Scale (BBS) which was scored independently by trained physical therapists. Participants then completed the items of the “Modified Berg Balance Scale” in front of the Microsoft Kinect camera. Kinematic data collected during this measurement was used to train a feed-forward neural network that was used to assign a Berg Balance Scale score. The neural network model estimated the clinician-assigned BBS score to within a median of 0.93 points for the participants in our sample population (range: 0.02–5.69). Using low-cost depth sensing camera technology and a clinical protocol that takes less than 5 min to complete in both ambulatory and non-ambulatory older adults, the method outlined in this manuscript can accurately predict a participant’s BBS score and thereby identify whether they are deemed a high fall risk or not. If implemented correctly, this could enable fall prevention services to be deployed in a timely fashion using low-cost, accessible technology, resulting in improved safety of older adults.

Validity of the modified Berg Balance Scale in adults with intellectual and visual disabilities

BackgroundA modified version of the Berg Balance Scale (mBBS) was developed for individuals with intellectual and visual disabilities (IVD). However, the concurrent and predictive validity has not yet been determined. AimThe purpose of the current study was to evaluate the concurrent and predictive validity of the mBBS for individuals with IVD. MethodFifty-four individuals with IVD and Gross Motor Functioning Classification System (GMFCS) Levels I and II participated in this study. The mBBS, the Centre of Gravity (COG), the Comfortable Walking Speed (CWS), and the Barthel Index (BI) were assessed during one session in order to determine the concurrent validity. The percentage of explained variance was determined by analyzing the squared multiple correlation between the mBBS and the BI, COG, CWS, GMFCS, and age, gender, level of intellectual disability, presence of epilepsy, level of visual impairment, and presence of hearing impairment. Furthermore, an overview of the degree of dependence between the mBBS, BI, CWS, and COG was obtained by graphic modelling. Predictive validity of mBBS was determined with respect to the number of falling incidents during 26 weeks and evaluated with Zero-inflated regression models using the explanatory variables of mBBS, BI, COG, CWS, and GMFCS. ResultsThe results demonstrated that two significant explanatory variables, the GMFCS Level and the BI, and one non-significant variable, the CWS, explained approximately 60% of the mBBS variance. Graphical modelling revealed that BI was the most important explanatory variable for mBBS moreso than COG and CWS. Zero-inflated regression on the frequency of falling incidents demonstrated that the mBBS was not predictive, however, COG and CWS were. ConclusionsThe results indicated that the concurrent validity as well as the predictive validity of mBBS were low for persons with IVD.

Exergames for Patients in Acute Care Settings: Systematic Review of the Reporting of Methodological Quality, FITT Components, and Program Intervention Details.

This study was designed to summarize (1) the evidence from studies investigating the use of exergames in acute care settings, (2) the methodological quality of these studies, (3) the reporting of frequency, intensity, time, and type (FITT) of exergaming components and adherence, and (4) reporting of intervention details enabling study replication. Medline-Ovid, EMBASE, CINAHL, PsychInfo, and the Cochrane Library were consulted. Two authors independently selected and systematically reviewed the included reports. Study quality was scored for each study. Of the nine reports representing five randomized clinical trials, one controlled clinical trial, and three single-group studies, the methodological quality was rather low, and the majority of the reports appeared to have a high risk of bias. Altogether, 365 patients were included in the selected articles. Energy expenditure, 6-Minute Walking Test, Timed Up and Go Test, Modified Berg Balance Scale, level of enjoyment, Transitional Dyspnea Index, upper limb activity, cognitive performance, and length of hospital stay favored exergaming. Three studies considered 70 percent or more of methodological quality items. Two studies reported all four FITT components. No studies reported adherence. Three studies each included descriptions of six intervention details. The included studies suggest that patients in acute care settings may benefit from exergaming. The relationship between exergaming and patient outcomes requires, however, further exploration. Future adequately powered studies with low risk of bias and with acute care populations that are followed over extended time periods should be performed to substantiate or refute the advantageous effect of exergaming in acute care settings. Future studies should pay attention to the description of FITT components and adherence to the intervention. Attention to include details of the used exergaming intervention is important for replication purposes.

Modified Berg Balance Scale: making assessment appropriate for people with aphasia

Objective:Modifying assessments for people with aphasia has the potential to increase the validity of healthcare assessments across professional domains. This pilot study addressed the challenges of giving people with aphasia the power to fully participate in the assessment process. The study aimed to investigate the feasibility of using an aphasia-modified version of the Berg Balance Scale (BBS), a physical therapy assessment tool to quantify dynamic sitting and standing balance.Method:The study compared how people with aphasia performed on the original BBS to an aphasia-modified version (MBBS), created for this study. We examined the relationship between auditory comprehension scores and balance performance of 15 participants with chronic aphasia and three control participants. We tested the hypothesis that individuals with aphasia would perform higher on the MBBS rather than the BBS, thus more closely approaching a score reflective of their true physical abilities.Results:Overall people with aphasia performed significantly better on the MBBS than the BBS, indicating that at least some portion of their performance difficulty was likely due to poor auditory comprehension of test instructions rather than true balance difficulty.Conclusion:Implications of this study suggest that modifying assessments, such as the BBS, by reducing linguistic complexity and adding visual and written cues along with modeling and repetition has the potential to increase the validity of healthcare assessments for individuals with aphasia.

Poster 120 Modified Berg Balance Scale for Use in Fall Prediction Among Patients with Lumbar Spine Precautions

Poster 120 Modified Berg Balance Scale for Use in Fall Prediction Among Patients with Lumbar Spine Precautions

EFFECT OF BALANCE TRAINING ON DYNAMIC STABILITY AND FUNCTIONAL INDEPENDENCE IN VISUALLY DISABLED CHILDREN - A RANDOMIZED CONTROLLED TRIAL

Abstract Aim and Objective: Visual disability is the one of the prevalent type of handicap worldwide and motor ability is affected due to poor balance. Important components of motor performance are dynamic stability and functional independence, studies on which are lacking in visually disabled children. However effect of balance training on motor performance in visually impaired children has not been studied enough. Hence the purpose of this study was to determine the effect of balance training on dynamic stability and functional independence in children with visual disability. Methods: It was a randomized controlled trial conducted on 40 subjects with visual disability in the age group of 6- 16 years, allocated into control group (A) n = 20 and experimental group (B) n = 20. Balance training was given for 4 weeks, thrice a week. Before and after training the subjects were evaluated using modified Berg Balance Scale and Wee FIM and the scores were analyzed. Results: There was no significant difference in Wee FIM scores within and between groups. Comparison of Wee FIM scores was found not to be significant. Comparison of within group m BBS scores was found to be highly significant with a p

Functional Mobility Limitations and Falls in Assisted Living Residents With Dementia

The prevalence of functional mobility limitations and falls is higher in people with dementia compared with cognitively healthy older adults, and both are associated with gait and motor impairments. The aims of this study were to examine concurrent validity of physical performance assessments and spatiotemporal gait measures in older adults with advanced dementia and to prospectively examine their relationship to functional mobility limitations and falls over a 4-month period. Thirty-one older adults living in dementia-specific assisted living residences participated. Correlations were examined between a modified Berg Balance Scale (mod-Berg), the Short Physical Performance Battery (SPPB), and spatiotemporal gait measures using the GAITRite Walkway system. Over 4-months, functional mobility limitations were rated, and falls were recorded by nursing supervisors. Differences in functional mobility limitations and falls were examined in relation to baseline balance and gait measures. Partial correlations between spatiotemporal gait measures and the mod-Berg as well as the SPPB were statistically significant (P < .05) after adjusting for age and Mini-Mental State Examination scores. Participants with low functional mobility ratings had significantly lower scores on the mod-Berg (P ≤ .001) and SPPB (P ≤ .001). They also demonstrated slower gait speed, lower cadence, higher stride time variability, and a greater percentage of gait cycle in double support (P ≤ .01). Participants with at least 1 fall, compared with those who did not fall, had lower scores on the mod-Berg (P = .02), lower cadence (P = .048), and greater stride length variability (P = .035). The mod-Berg and SPPB were strongly correlated with reliable gait measures associated with instability and increased fall risk. The modified Berg Balance Scale demonstrates potential as a predictor of falls in older adults living in dementia-specific assisted living. The results of this study provide support for the application of brief physical performance assessments by physical therapists to identify functional mobility limitations and fall risk in older adults with advanced dementia.

Feasibility and reliability of the modified Berg Balance Scale in persons with severe intellectual and visual disabilities

The purpose of this study was to determine the feasibility and reliability of the modified Berg Balance Scale (mBBS) in persons with severe intellectual and visual disabilities (severe multiple disabilities, SMD) assigned Gross Motor Function Classification System (GMFCS) grades I and II. Thirty-nine participants with SMD and GMFCS grades I and II performed the mBBS twice with 1-week interval. Feasibility was assessed by the percentage of successful measurements per task and of the total score. First, test-retest reliability was determined by intraclass correlation coefficients (ICC) for each task and for the total score of all tasks combined. Second, level of agreement between test-retest scores was assessed with the proportion of equal scores for each task. Finally, internal consistency of the distinct tasks was assessed by Cronbach's alpha. The results indicated that 92% of the measurements by the mBBS for all selected tasks were successful, indicating that the mBBS is a feasible instrument for the tested target group. ICC for the test-retest of the total score was 0.95. The proportion of equal scores for test-retest of the tasks was 0.80 or more, except for tasks 9 and 10. Cronbach's alpha of distinct tasks was 0.84. Test-retest reliability of tasks 9 and 10 was not acceptable. Feasibility of all tasks and test-retest reliability of 10 out of 12 mBBS tasks is acceptable. The mBBS is a both feasible and reliable test for evaluating the functional balance of persons with SMD and GMFCS grades I and II.

Factors Associated With Skilled Nursing Facility Transfers in Dementia-specific Assisted Living

Medical, functional, and behavioral problems are associated with transitions from assisted living (AL), but limited information is available on those at highest risk for transition. We conducted a multidisciplinary geriatric team assessment of individuals newly admitted to 2 dementia-specific AL communities from January 2000 to March 2002. Transitions of individuals to permanent skilled nursing facilities (SNF) was assessed for 9 months. Multidisciplinary assessment on admission included medical and cognitive evaluations, physical function, nutritional status, and psychosocial adjustment. Twenty-four men and 24 women with a mean age of 83+/-6 years were assessed. Mental status score was 15+/-6. Residents had 2.1+/-1.7 comorbidities and were prescribed 1.7+/-1.2 medications. During follow-up, 23 (47.9%) transitioned to SNF and 9 (18.8%) individuals died (censored events). Significant predictors of transfer to nursing home from AL by one-predictor Cox proportional hazards model included depression score [hazard ratio (HR) 1.19; P=0.008], dependent activities of daily living (HR 1.18; P=0.014), gait speed (HR 1.15; P=0.004), modified Berg Balance Score (HR 0.88; P=0.004), and mental status score (HR 0.924, P=0.034). Our multivariate model selected by the forward procedure indicates that the modified Berg Balance Scale score predicted transfer to permanent nursing home with a interquartile HR of 0.91 (95% CI 0.8264, 0.989). A significant number of new residents of dementia-specific AL transitioned to SNF over 9 months. In univariate analysis, depression score, walking speed, balance, and mental status score were significantly associated with transition and in multivariate analysis, balance performance predicted transfer. These results suggest that fall risk should receive attention on admission to AL to potentially mitigate the high transfer rate.

Psychometric Properties of 2 Simplified 3-Level Balance Scales Used for Patients With Stroke

To determine if the 3-level scales yield data as reliable and valid as data obtained for the original scales, 2 simplified 3-level measures of balance--a modified Berg Balance Scale (BBS-3P) and a modified Postural Assessment Scale for Stroke Patients (PASS-3P)--were proposed by the researchers, and psychometric properties of each were compared with those of the original measures (the Berg Balance Scale [BBS] and the Postural Assessment Scale for Stroke Patients [PASS], respectively) in patients with stroke. The study consisted of 2 parts. The first part examined the reliability and concurrent and convergent validity of measurements obtained with these instruments. A total of 77 patients participated in this part of the study. The 3 levels in the center of the BBS were collapsed to a single level (ie, 0-2-4) to form the BBS-3P. Similarly, the 2 middle scores of the center of the PASS were averaged (ie, 0-1.5-3) to form the PASS-3P. In the second part of the study, the predictive validity and responsiveness of these measures were examined. The BBS and PASS scores of 226 patients were retrieved from the records of participants in the Quality of Life After Stroke Study, and these scores were converted into the proposed BBS-3P and PASS-3P scores. The BBS-3P and PASS-3P showed high concurrent validity with the BBS and PASS, good predictive validity for disability, and moderate to high responsiveness. Importantly, the psychometric properties of the BBS-3P and PASS-3P were essentially identical to those of the original BBS and PASS. The psychometric properties of both simplified 3-level balance measures were comparable to those of the full, nontruncated scales. Future study is needed to investigate how much meaningful utility can be gained from the scheme of simplification of scaling.

Systematic home-based physical and functional therapy for older persons after hip fracture

Objective: To describe the development, implementation, and results of a home-based rehabilitation protocol for older persons after hip fracture. Design: Demonstration study. Setting: Community. Participants: One hundred forty-eight community-living, nondemented participants at least 65 years of age who underwent repair of a fractured hip at two local hospitals. Intervention: A linked assessment-intervention, home-based rehabilitation strategy. The physical therapy (PT) component of the intervention was designed to identify and ameliorate impairments in balance, strength, transfers, gait, and stair climbing; the functional therapy (FT) component was designed to identify and improve unsafe and/or inefficient performance of specific activities of daily living (ADL). Main Outcome Measures: The percentage of participants able to complete each component and the extent of progress noted in strength, balance, transfers, gait, and daily functioning. Results: A total of 104 of the 148 participants (70%) completed the 6-month PT and FT program; 4 completed only PT and 6 refused both PT and FT. The remaining 32 participants (22%) received partial PT and FT that was terminated by death, hospitalization, or institutionalization. Seventy-seven percent of participants reported performing at least half of the recommended daily exercise sessions. Ninety-four percent and 96% of participants progressed in upper and lower extremity conditioning respectively; 33% progressed to the highest level in the graduated resisted exercise program. All participants progressed in the competency-based graded balance program, with 55% progressing to the fifth (most difficult) level. Similarly, the majority progressed in transfer maneuvers, stair climbing, and outdoor gait. One repetition maximum (RM) elbow extension increased from a mean of 5.8 (SD 4.6) pounds at baseline to 7.2 (SD 3.8) pounds at 6mo ( t 2.22; p < .02). One RM knee extension increased from 5.8 (SD 5.8) pounds to 10.8 (SD 5.4) pounds ( t = 8.06; p < .0001). The number of gait deviations decreased from 2.1 (SD 1.3) to 0.6 (SD 0.9) ( p < .0001), while the mean modified Berg Balance Scale Score increased from 13.0 (SD 4.8) to 20.5 (SD 6.8) ( t = 16.6; p < .0001). Finally, the Total ADL Score increased from a mean of 48.2 (SD 15.0) to 77.7 (SD 18.8) ( t = 17.03; p = .0001). Conclusions: This systematic assessment and intervention protocol, targeting impairments and ADL, was feasible, safe, and effective. Protocols such as the one presented should enhance the ability to implement rehabilitation programs for the increasing number of multiply impaired older persons receiving home-based therapy and to document the process and outcomes of this care.