Objective Measures Of Balance Research Articles

PREDICTING FALLS IN OLDER ADULTS

Abstract Falls are detrimental to older adults causing injury and mortality. Although clinical assessments of balance deficits exist, it is not well understood how well they predict falls. Longitudinal analysis utilized data from 688 men and women aged 60-97 enrolled in the Baltimore Longitudinal Study of Aging with index and subsequent visits approximately 1.7 years apart. Inclusion criteria included objective balance assessment at index visit and answering the question “Have you fallen in the past 12 months?” at both visits. Predictors of interest included thigh muscle strength, progressive static balance test performance, narrow walk, and sway reference with eyes closed/feet together. Tests were parameterized using validated methods. Adjusted logistic regression was modeled to estimate the association between objective measures of balance and fall risk. Adjustment variables included age, sex, race, height, and weight. Results reported those who failed the eyes closed/feet together position had 3.6 (95% CI 1.03, 12.81) times the odds of future falls compared with those who passed. Those who failed the semi-tandem, tandem, and single leg stance, had respectively 3.1 (1.44, 6.75), 3.6 (1.59, 8.06) and 4.8 (1.93, 12.09) times greater odds of history of falls compared with those who did not fail. Progressive standing balance performance did not predict future falls. The eyes closed/feet together test is easily administered, requires no equipment, and takes less than 30 seconds to complete. Failure of eyes closed/feet together may predict future falls, which is clinically relevant as this may suggest shifting the momentum towards proactively preventing an initial fall.

A-16 Self-reported balance disturbance and performance-based balance measures in varsity level athletes with and without concussion history

Abstract [Outstanding Trainee Award Winner] Purpose Assessment of postural balance in varsity athletes is essential to managing sport-related concussion. The current study characterizes the relationship between subjective and objective measures of balance in varsity athletes. Methods A total of 208 varsity athletes across 12 sports participated in pre-season testing from June 2019 to January 2020 (no history of concussion= 117; 1+ past concussion= 91). Measures included the Sport Concussion Assessment Tool (SCAT-5) and the AccuGait force plate. Relationships between objective and subjective balance measures were assessed using correlations, parametric, and non-parametric tests. Results Of the total sample, 9.6% (n=20) endorsed subjective balance issues and 5.3% (n=11) reported subjective dizziness. Those with a history of concussion, endorsed greater total number of symptoms at baseline (M=2.95, SD=4.03) than those without (M=1.90, SD=3.07; p=.04; Cohen’s d=.30). However, there were no differences on subjective or objective balance measures (i.e., total balance error on the MBESS or force plate measures; ps>0.05) between athletes with and without a history of concussion. For those with no history of concussion, total balance errors from the Modified Balance Error Scoring system were significantly associated with force plate metrics in the eyes closed condition (ps<0.05) but not the eyes open condition. These associations were not observed in athletes with history of concussion (ps>0.05). Similarly, no associations were found between subjective balance issues and objective balance metrics. Conclusions Overall, findings suggest poor alignment between subjective and objective balance measures in varsity athletes, regardless of concussion history. Associations were observed across the objective balance measures in those with no history of injury, but not in athletes with a history of concussion.

The Instrumented Stand and Walk (ISAW) test to predict falls in older men

Objective measures of balance and gait have the potential to improve prediction of future fallers because balance and gait impairments are common precursors. We used the Instrumented Stand and Walk Test (ISAW) with wearable, inertial sensors to maximize the domains of balance and gait evaluated in a short test. We hypothesized that ISAW objective measures across a variety of gait and balance domains would improve fall prediction beyond history of falls and better than gait speed or dual-task cost on gait-speed. We recruited 214 high-functioning older men (mean 82 years), of whom 91 participants (42.5%) had one or more falls in the 12 months following the ISAW test. The ISAW test involved 30 s of stance followed by a 7-m walk, turn, and return. We examined regression models for falling using 17 ISAW metrics, with and without age and fall history, and characterize top-performing models by AUC and metrics included. The ISAW test improved distinguishing between future fallers and non-fallers compared to age and history of falls, alone (AUC improved from 0.69 to 0.75). Models with 1 ISAW metric usually included a postural sway measure, models with 2 ISAW measures included a turning measure, models with 3 ISAW measures included a gait variability measure, and models with 4 or 5 measures added a gait initiation measure. Gait speed and dual-task cost did not distinguish between fallers and non-fallers in this high-functioning cohort. The best fall-prediction models support the notion that older people may fall due to a variety of balance and gait impairments.

Validation of the BESTest for Measuring Balance in People with Multiple Sclerosis

Background: Evaluation of balance disorders is necessary for treatment and rehabilitation. The Balance Evaluation Systems Test (BESTest) has been shown to distinguish between different neurological populations. So far, no study has examined the validity of the subsystems of this test in comparison with objective evaluation. Objectives: This study aimed to investigate the validity of the BESTest in measuring balance through using the force plate in people with multiple sclerosis (MS). Methods: In this cross-sectional study, BESTest was performed. Then, objective measures of balance, including anticipatory postural adjustments (APAs) and sensory orientation were assessed using a force plate. Moreover, we calculated the sway, velocity, and area of sway outcomes. Results: This study included 17 MS patients (42.64 ± 7.8 years old; score 1 - 5 on the Expanded Disability Status Scale) and 17 healthy controls (42.33 ± 8.65 years old). All the BESTest subsystems, except subsystem stability limits/verticality, showed a significant difference between the two groups (P < 0.005). Significant correlations were found between the BESTest scores with anterior-posterior and medio-lateral sway, sway velocity in anterior-posterior direction, and the area of displacement in anterior-posterior direction (P < 0.005). Conclusions: The results of this study showed a good correlation between BESTest test and objective tests. Also, according to the correlation between each subsystem and the information extracted from the force plate, the subsystems had a good sensitivity for measuring balance disorders.

Varenicline for the Treatment of Postural and Gait Dysfunction in Parkinson Disease.

To determine whether varenicline is effective for the balance in Parkinson disease (PD). This was an investigator-initiated, double-blind, placebo-controlled study. Participants with a clinical diagnosis of PD were randomized to receive varenicline or placebo for 8 weeks. After dose escalation, participants took 1 mg of drug twice daily until the end of the study. Patients with severe tremor were excluded. Primary outcome was a change on the Berg Balance Scale (BBS) from baseline to 8 weeks. The BBS is a 14-item measure consisting of basic balance tasks. The study had a secondary, exploratory outcome of a change in cognition, measured with the Frontal Assessment Battery (FAB) and the Mini-Mental State Exam (MMSE) from baseline to 8 weeks. The FAB is a 6-item measure of executive functioning. Thirty-six participants were randomized (82% men, 100% White). Average age was 71.0 years (± 8.1). Average baseline motor Movement Disorder Society Unified Parkinson's Disease Rating Scale was 34.7 (± 11.6). There were no differences between treatment groups on the BBS (F[1,28] = 2.85, p = 0.10) or FAB (d = 0.16, 95% confidence interval [CI] = [-1.39 to 1.53]) or MMSE (d = 0.81, 95% CI = [-0.40 to 1.40]). The results did not suggest that varenicline had an effect on balance in patients with PD. Furthermore, varenicline did not seem to affect cognition. Perhaps, if an objective measure of balance had been used in place of the BBS, the analysis would show a difference between the groups. However, the authors do not recommend further study. This study provides Class III evidence that in patients with PD with Hoehn and Yahr stages 2, 3, or 4, varenicline does not improve balance as assessed by the BBS.

THE DAILY BALANCE PROJECT: AN INQUIRY INTO THE INTRAINDIVIDUAL DYNAMICS OF PERCEIVED AND ACTUAL FALL RISK

An accurate understanding of one’s abilities and limitations allows adaptive response to the challenges that are faced in daily life. However, older adults may over or under estimate their actual abilities. The Daily Balance Project examined the intraindividual dynamics of older adults’ perceived balance with objective measures of balance and physical activity. For 30 consecutive days, following a comprehensive fall risk assessment, 20 older adults rated their balance confidence (Activities Balance Confidence scale) at that moment and then performed five standardized balance assessments measured via smartphone accelerometer held to their chest. Physical activity was measured with an activity monitor. Baseline measurements of fall risk differentiated the extent of intraindividual variation and co-variation of balance and physical activity. For some participants, actual and perceived balance became more closely aligned as the study progressed. The implications of the findings for life-span perspectives on aging and fall prevention are discussed.

Balance And Cognitive Recovery Following Concussion Injury Is Associated With Initial Symptom Severity

INTRODUCTION: Symptoms remain a primary way to monitor recovery from concussion injury. However, the association between subjective symptoms and objective measures of balance and cognition is not entirely understood. PURPOSE: To examine the association between objective and subjective measures during recovery from concussion injury. The primary hypothesis is to describe changes in cognition, balance, and symptom severity over a one month timeframe following concussion injury. A secondary hypothesis is that symptom severity at time of injury will be associated with objective measures during the recovery period. METHODS: Fifty-one young adults (18.01±5.96 years old) who recently sustained a concussion completed a battery of four cognitive tests, eight balance tests, and a 22 item symptom report using a commercially available assessment tool (ClearEdge, Quadrant Biosciences Inc; Syracuse, NY). All subjects completed test 1, on average, 5.45 ± 3.53 days after injury, and test 2, 23.06 ± 10.92 days following test 1. Group comparisons (repeated measures ANOVA or T-Test) and effect sizes (Cohen’s d) were used to compare recovery across time. To address the secondary hypothesis, those within the group reporting low symptom severity (symptoms <10; n=18) and high symptom severity (symptoms > 40; n=14) were compared. RESULTS: Across the sample, symptom severity at initial testing ranged from 0-89. Statistically significant differences between test 1 and 2 were seen for all cognitive tests (p<0.001) and 1 of the 8 balance tests (p=0.028). When comparing symptom severity groups, significant differences (p<0.05) at the first testing session were seen on 3 cognitive tests and 2 balance tests. No differences were seen between groups at test 2. The low symptom severity group had no changes in cognitive or balance scores between test 1 and 2. The high symptom group had large effects sizes towards improvement on Tandem Stance Eyes Closed (d=1.16), and Simple Reaction Time 2 (d=1.36). CONCLUSION: Symptom severity is associated with objective measures of balance and cognition during the recovery period. The low symptom group appears to have reached full recovery prior to initial testing. The high symptom group showed signs of injury at initial testing with large changes in cognitive and balance performance at re-test.

Correlation of falls in patients with Amyotrophic Lateral Sclerosis with objective measures of balance, strength, and spasticity.

BACKGROUND:Persons diagnosed with Amyotrophic Lateral Sclerosis (ALS) often demonstrate neurological deficits that predispose them to repeated falls and associated adverse consequences. Determining contributing factors to falls in this population is critical to improve safety and patient outcomes.OBJECTIVE:The purpose of this study was to correlate clinical measures of gait speed, balance, strength, spasticity, and a self-reported rating scale of function with fall incidence in individuals with ALS.METHODS:Thirty-one participants with a confirmed ALS diagnosis were recruited from an outpatient clinic. Each participant performed the following tests: timed gait speed, Berg Balance Scale (BBS), manual muscle testing (MMT) for lower extremity (LE) strength, Modified Ashworth Scale (MAS) for LE spasticity, and the ALS Functional Rating Scale-Revised (ALSFRS-R). Each participant reported number of falls that occurred in the past three months. Pearson correlation coefficients were calculated to determine correlations between variables.RESULTS:Significant correlation was found between fall incidence and composite LE strength score (rp = 0.385, p = 0.032).CONCLUSIONS:There is a relationship between LE weakness and number of falls in the ALS population. Preventing disuse-related LE muscle weakness and education of need for external support may decrease the number of falls experienced by individuals with ALS.

K-D Balance: An objective measure of balance in tandem and double leg stances.

Background and objectiveSubjective grade-based scoring balance assessments tend to be lengthy and have demonstrated poor repeatability and reliability. This study examined the reliability of a mobile balance assessment tool and differences in balance measurements between individuals at risk for a balance deficit secondary to a diagnosed neurological or musculoskeletal condition and a control group of healthy individuals. MethodsObjective balance testing was measured using K-D Balance on a compatible iPhone. Seventy-seven participants were enrolled (control group, n = 44; group at risk for balance deficits, n = 33). Mean and standard deviation of K-D Balance were recorded for each stance. Intra-rater reliability was calculated by repeating the trial.ResultsOverall balance scores were superior for the control group compared with the group at risk for balance deficits in double leg stance (mean (SD): 0.15 (0.12) versus 0.18 (0.13), p = 0.260), tandem stance right leg (mean (SD): 0.27 (0.17) versus 0.45 (0.49), p = 0.028), and tandem stance left leg (mean (SD): 0.26 (0.17) versus 0.35 (0.35), p = 0.136). Intra-rater reliability was good to excellent for K-D Balance double leg stance (intra-class correlation coefficient (ICC) = 0.80, 95% confidence interval (CI) 0.58–1.03), tandem stance right leg (ICC = 0.96, 95% CI 0.86–1.06) and tandem stance left leg (ICC = 0.98, 95% CI 0.95–1.0).ConclusionsK-D Balance revealed differences in balance performance between healthy individuals compared with individuals with neurological or musculoskeletal impairment. Objective balance measures may improve the accuracy and reliability of clinical balance assessment by detecting subtle differences in balance and aid in early detection of diseases that impair balance.

Validity and Reliability of a Portable Balance Tracking System, BTrackS, in Older Adults.

Falls are the leading cause of disability, injury, hospital admission, and injury-related death among older adults. Balance limitations have consistently been identified as predictors of falls and increased fall risk. Field measures of balance are limited by issues of subjectivity, ceiling effects, and low sensitivity to change. The gold standard for measuring balance is the force plate; however, its field use is untenable due to high cost and lack of portability. Thus, a critical need is observed for valid objective field measures of balance to accurately assess balance and identify limitations over time. The purpose of this study was to examine the concurrent validity and 3-day test-retest reliability of Balance Tracking System (BTrackS) in community-dwelling older adults. Minimal detectable change values were also calculated to reflect changes in balance beyond measurement error. Postural sway data were collected from community-dwelling older adults (N = 49, mean [SD] age = 71.3 [7.3] years) with a force plate and BTrackS in multitrial eyes open (EO) and eyes closed (EC) static balance conditions. Force sensors transmitted BTrackS data via a USB to a computer running custom software. Three approaches to concurrent validity were taken including calculation of Pearson product moment correlation coefficients, repeated-measures ANOVAs, and Bland-Altman plots. Three-day test-retest reliability of BTrackS was examined in a second sample of 47 community-dwelling older adults (mean [SD] age = 75.8 [7.7] years) using intraclass correlation coefficients and MDC values at 95% CI (MDC95) were calculated. BTrackS demonstrated good validity using Pearson product moment correlations (r > 0.90). Repeated-measures ANOVA and Bland-Altman plots indicated some BTrackS bias with center of pressure (COP) values higher than FP COP values in the EO (mean [SD] bias = 4.0 [6.8]) and EC (mean [SD] bias = 9.6 [12.3]) conditions. Test-retest reliability using intraclass correlation coefficients (ICC2.1 was excellent (0.83) and calculated MDC95 for EO (9.6 cm) and EC (19.4 cm) and suggested that postural sway changes of these amounts are meaningful. BTrackS showed some bias with values exceeding force plate values in both EO and EC conditions. Excellent test-retest reliability and resulting MDC95 values indicated that BTrackS has the potential to identify meaningful changes in balance that may warrant intervention. BTrackS is an objective measure of balance that can be used to monitor balance in community-dwelling older adults over time. It can reliably identify changes that may require further attention (eg, fall-prevention strategies, declines in physical function) and shows promise for assessing intervention efficacy in this growing segment of the population.

Association Between the Functional Independence and Difficulty Scale and Physical Functions in Community-Dwelling Japanese Older Adults Using Long-term Care Services.

The Functional Independence and Difficulty Scale (FIDS), a newly developed basic activities of daily living (BADL) assessment tool, assesses both independence and subjective difficulty of BADL performance. This patient-reported outcome measure has been shown to have acceptable internal consistency, concurrent validity, and reliability. However, little is known about the relationship between FIDS and objective measures of physical function among older Japanese adults using long-term care insurance services. This study aimed to reveal the relationship between FIDS and physical functions and to examine the concurrent validity of FIDS against physical functions. Participants of this cross-sectional, correlational research study included community-dwelling Japanese adults aged 65 years or older and certified as long-term care insurance service users with musculoskeletal disease, internal disease, cerebrovascular diseases without observable motor paralysis, and others. Data on physical functions, including muscle strength (grip strength and isometric knee extension muscle strength [IKEMS]), flexibility (range of motion [ROM] of hip flexion and knee flexion), balance (Modified Functional Reach Test [M-FRT]) and gait performance (timed 2.4-m walk), and BADL performance assessed by FIDS, were obtained. Associations between FIDS scores and physical functions were determined by Spearman correlation coefficient and partial correlations after controlling for subject age and sex. Data were collected on 53 participants (mean age = 81.9 years; 62.3% women). Spearman partial correlation coefficients controlled for sex and age between FIDS score and grip strength, IKEMS, ROM of hip flexion, ROM of knee flexion, M-FRT, and timed 2.4-m walk were 0.47 (P = .001), 0.44 (P = .001), 0.29 (P = .04), -0.05 (P = .73), 0.51 (P < .001), and -0.64 (P < .001), respectively. The strength of association was moderate for the M-FRT and 2.4-m walk and was low for grip strength and IKEMS. However, ROM of the knee showed no significant association and hip flexion had negligible association with FIDS. The FIDS, a patient-reported BADL assessment tool, mainly reflected balance and gait performance and had concurrent validity as an objective measure of balance and gait performance.

The efficacy of treadmill training on balance dysfunction in individuals with chronic stroke: a systematic review

Background: Physical activity and exercise interventions are useful in facilitating the functional recovery of those with chronic stroke and, routinely, are gait-specific. While treadmill training has proven useful in gait performance recovery post-stroke, its efficacy on balance dysfunction has not been systematically reviewed.Objectives: The purpose of this systematic review was to determine the effect of treadmill training (TT) interventions on balance dysfunction in individuals with chronic stroke.Methods: A systematic literature search of PubMed, EMBASE, and CINAHL was performed. Eligible randomized controlled trials were published between 2007 and 2016. Selected trials investigated TT interventions in persons with chronic stroke and implemented at least one objective balance measure. Methodological quality was assessed using PEDro criteria.Results: Eight studies met eligibility criteria and were included in the qualitative analysis. Studies differed in TT implementation and use of adjunctive treatments; however, all trials demonstrated improvements in balance measures that were as effective, if not more so, than conventional physical therapy treatments, including targeted balance training.Conclusions: This review recognized moderate evidence in favor of TT interventions in balance and stroke rehabilitation programs. With TT, intensity may be a more critical factor than specificity and may offer additional carryover to recovery parameters of postural control and balance, beyond gait performance. It is recommended that clinicians utilizing TT incorporate objective measures of balance to assess the potential for skill transference and improvements in balance. Higher quality studies and additional research are needed to denote critical parameters by which improvements in balance may be optimized.

Objective Gait and Balance Impairments Relate to Balance Confidence and Perceived Mobility in People With Parkinson Disease

Body-worn, inertial sensors can provide many objective measures of balance and gait. However, the objective measures that best reflect patient perception of mobility disability and clinician assessment of Parkinson disease (PD) are unknown. The purposes of this study were: (1) to determine which objective measures of balance and gait are most related to patient perception of mobility disability and disease severity in people with PD and (2) to examine the effect of levodopa therapy on these correlates. This was an experimental correlation study. One hundred four people with idiopathic PD performed 3 trials of the Instrumented Stand and Walk Test (ISAW) in the "on" and "off" medication states. The ISAW consists of quiet standing (30 seconds), gait initiation, straight walking (7 m), and turning (180°), yielding 34 objective measures of mobility from body-worn inertial sensors. Patient perception of mobility disability was assessed with the Activities-specific Balance Confidence (ABC) scale and the mobility subscale of the Parkinson's Disease Questionnaire (PDQ-39). Disease severity was assessed with the Unified Parkinson's Disease Rating Scale, part III (motor UPDRS). Spearman correlations were used to relate objective measures of mobility to patient perception and disease severity. Turning speed, gait speed, and stride length were most highly correlated to severity of disease and patient perception of mobility disability. The objective measures of mobility in the off-medication state were more indicative of patient perception of mobility disability and balance confidence compared with on-medication state measures. Causation is an inherent problem of correlation studies. Physical therapists should evaluate mobility in people with PD in the off-medication state because the off-medication state is more related to disease severity and patient perception of mobility disability than the on-medication state mobility. Assessment and treatment of mobility in people with PD should target specific measures (ie, turning, gait speed, and stride length) because these measures best reflect patients' quality of life and balance confidence.

Comparison of Objective Measures for Predicting Perceptual Balance and Visual Aesthetic Preference.

The aesthetic appreciation of a picture largely depends on the perceptual balance of its elements. The underlying mental mechanisms of this relation, however, are still poorly understood. For investigating these mechanisms, objective measures of balance have been constructed, such as the Assessment of Preference for Balance (APB) score of Wilson and Chatterjee (2005). In the present study we examined the APB measure and compared it to an alternative measure (DCM; Deviation of the Center of “Mass”) that represents the center of perceptual “mass” in a picture and its deviation from the geometric center. Additionally, we applied measures of homogeneity and of mirror symmetry. In a first experiment participants had to rate the balance and symmetry of simple pictures, whereas in a second experiment different participants rated their preference (liking) for these pictures. In a third experiment participants rated the balance as well as the preference of new pictures. Altogether, the results show that DCM scores accounted better for balance ratings than APB scores, whereas the opposite held with respect to preference. Detailed analyses revealed that these results were due to the fact that aesthetic preference does not only depend on balance but also on homogeneity, and that the APB measure takes this feature into account.

Effects of a Novel Therapeutic Intervention in Patients With Diabetic Peripheral Neuropathy

ObjectiveTo determine the effect of a novel therapeutic intervention called intraneural facilitation on balance measures and a neuropathy scale in patients with diabetic peripheral neuropathy. DesignProspective pre- and posttest, single group clinical trial. SettingOutpatient physical therapy clinic. ParticipantsPatients with diabetic peripheral neuropathy (N=13). InterventionSubjects received 10 sessions of intraneural facilitation. Main Outcome MeasuresThe modified Total Neuropathy Scale, the NeuroCom SMART Balance Master system computerized dynamic posturography (CDP) that includes the Sensory Organization Test (SOT) and the limits of stability (LOS), and the Activities-specific Balance and Confidence (ABC) scale. ResultsSubjects in this study showed significant improvement in the modified Total Neuropathy Scale, SOT, and 1 component in the LOS test (movement velocity). There were no significant differences in the ABC scale or in 4 components of the LOS test, which were reaction time, end point excursion, maximum excursion, and directional control. ConclusionsIntraneural facilitation improved objective balance measures and neuropathy symptoms in patients with diabetic peripheral neuropathy. Further study is needed to determine long-term benefits of this intervention.

Center of pressure velocity and its fast alternating deviations as an objective measure of balance – Normal values and their sensitivity investigated in SCA patients

Center of pressure velocity and its fast alternating deviations as an objective measure of balance – Normal values and their sensitivity investigated in SCA patients

Center of pressure velocity and its fast alternating deviations as an objective measure of balance – Normal values and their sensitivity investigated in SCA patients

Center of pressure velocity and its fast alternating deviations as an objective measure of balance – Normal values and their sensitivity investigated in SCA patients

Variability of the modified Balance Error Scoring System at baseline using objective and subjective balance measures.

Aim:To investigate preseason modified Balance Error Scoring System (mBESS) performance in a collegiate football cohort; to compare scores to an objective mobile balance measurement tool.Materials & methods:Eighty-two athletes completed simultaneous balance testing using mBESS and the King–Devick Balance Test, an objective balance measurement tool. Errors on mBESS and objective measurements in the double-leg, single-leg (SS) and tandem stances were compared.Results:Mean mBESS error score was 7.23 ± 4.65. The SS accounted for 74% of errors and 21% of athletes demonstrated the maximum error score. There was no significant correlation between mBESS score and objective balance score.Conclusion:The high variability and large number of errors in the SS raises concerns over the utility of the SS in identifying suspected concussion.

Can balance and balance self-efficacy predict levels of community ambulation in individuals with chronic stroke?

Background: Community ambulation is a key goal for a majority of stroke survivors (Lord et al., 2004). Restriction in communitywalking is a consequence ofmulti-system impairments following stroke. Community ambulation has been evaluated with measures particularly focusing on gait speed and endurance. However, an individual’s perception about his/her ability to maintain balance can play an important role for participation in the community. Purpose:Several researchers have concludedgait speed to be a valid predictor of community ambulation (Perry et al., 1995; Hill et al., 1997). An observational study conducted by Lord et al (2004), concluded that gait speed is not sufficient as a single measure of community ambulation and should be augmented by self-report and the use of measures of social integration and community participation. Recently, Robinson et al (2011) in a case–control study investigated the role physical impairments in participation in the communitywalking after stroke. They found that underlying physical impairments explained very little of the variance in participation related to community walking and further recommended a need to investigate the role of self efficacy in community walking. This study aims to identify the role of subjective and objective balancemeasures in predicting levels of community ambulation in individuals with chronic stroke. Participants: 28 ambulatory adults with chronic stroke. Methods: Participants were recruited by convenient sampling from Neuro-rehabilitation OPD and categorized into Functional Ambulatory Category (FAC) levels. Balance was evaluated using Berg Balance Scale. To assess subjects self perceived level of confidence, Balance Confidence Scale (BCS) (a 22-item scale for assessing balance confidence in Indian community dwelling older adults) was administered. Detailed history and other demographic data were collected. Analysis: Correlation statistics (Pearson’s correlation coefficient) & Regression analysis was applied. Results: In a sample of 28, 18 were males and 10 were females. Mean age was 46.7 and mean post-stroke duration was 26.3 months. BBS correlated strongly (r= 0.841) with Functional Ambulatory Category (FAC) (p= 0.01). Balance Confidence score had a strong positive correlation (r= 0.766) with Functional Ambulatory Category (FAC) with significance of p= 0.01. Regression analysis revealed predictability of BBS for FAC is 71% and for Balance Confidence score, it is 59%. Components like ‘crossing the roads’, going to public places had highest correlation with FAC scores (r= 0.837 and 0.781, respectively). Conclusion(s): Subjective (balance self efficacy on BCS) & objective measurements (BBS) correlated positively with community ambulation. Confidence in activities like crossing the road (r= 0.837) plays a major role for walking in the community. Implications: Psychological aspects such as self efficacy for balance need to be addressed when designing rehabilitation protocols for individuals with chronic stroke. Further research into the areas of environmental factors affecting level of confidence and physical impairments for balance would contribute to our understanding of community ambulation in individuals with Chronic Stroke.

Objective biomarkers of balance and gait for Parkinson's disease using body‐worn sensors

Balance and gait impairments characterize the progression of Parkinson's disease (PD), predict the risk of falling, and are important contributors to reduced quality of life. Advances in technology of small, body-worn, inertial sensors have made it possible to develop quick, objective measures of balance and gait impairments in the clinic for research trials and clinical practice. Objective balance and gait metrics may eventually provide useful biomarkers for PD. In fact, objective balance and gait measures are already being used as surrogate endpoints for demonstrating clinical efficacy of new treatments, in place of counting falls from diaries, using stop-watch measures of gait speed, or clinical balance rating scales. This review summarizes the types of objective measures available from body-worn sensors. The metrics are organized based on the neural control system for mobility affected by PD: postural stability in stance, postural responses, gait initiation, gait (temporal-spatial lower and upper body coordination and dynamic equilibrium), postural transitions, and freezing of gait. However, the explosion of metrics derived by wearable sensors during prescribed balance and gait tasks, which are abnormal in individuals with PD, do not yet qualify as behavioral biomarkers, because many balance and gait impairments observed in PD are not specific to the disease, nor have they been related to specific pathophysiologic biomarkers. In the future, the most useful balance and gait biomarkers for PD will be those that are sensitive and specific for early PD and are related to the underlying disease process.