Performance Oriented Mobility Assessment Research Articles

Consistency in the assessment of postural balance using static stabilometry and scale techniques in older individuals: An observational study

BACKGROUND: In clinical practice, both clinical scales and instrumental methods are used in parallel to assess postural stability and the risk of falls. Literature data on the comparability of postural balance estimates obtained using scale techniques and stabilometry, particularly in older patients, are conflicting.
 AIM: to analyze the consistency in the assessment of postural balance by static stabilometry and scale techniques in older patients.
 MATERIALS AND METHODS: A pilot observational, nonrandomized, single-center study was conducted. The study participants were 39 women aged 60–75 years who did not have diseases or conditions that significantly affected the postural control system. Postural balance was assessed using clinical scales and tests (timed up and go test, classic and a double task; Berg balance scale; Mini-BESTest, balance evaluation systems test; performance-oriented mobility assessment; and falls efficacy scale) and basic spatial, spatiotemporal, and spectral parameters of static stabilometry. A stabilometric study was conducted at the posturological complex Biokinect. Correlation analysis of the data of the scale techniques and stabilometry was performed.
 RESULTS: The correlation analysis showed both the correlation between some parameters of stabilogram and scale techniques and the complete absence of a significant correlation between others. However, even in the presence of a statistically significant correlation, the relationship between the parameters did not exceed the moderate or average level (maximum value of the correlation coefficient, 0.685, p 0.01). The largest correlation was found between the stabilometric parameters and the timed up and go test (correlated with 11 out of 21 parameters) and the falls efficacy scale (10 parameters), and the smallest was found with the Mini-BESTest (5 parameters). The values of the stabilometric parameter (speed of movement of the center of pressure) demonstrated a statistically significant correlation with most of the clinical instruments (4 out of 6).
 CONCLUSION: This study showed low consistency between the basic parameters of static stabilometry and scale techniques in older people. The results of simpler scale techniques for the assessment of postural balance correlated better with stabilometry data than with more complex and multicomponent ones because the total indicator of the latter is a generalized assessment of postural stability and other elements of complex motor behavior associated with postural balance. Therefore, simple scale techniques and tasks should be preferred when assessing the basic postural stability and risk of falls in older people.

The Dubousset Functional Test: a reliable and valid test in early stage Parkinson's disease patients.

Dubousset Functional Test (DFT) is an assessment test evaluating the functional capacity and dynamic balance. The study aimed to examine the reliability, validity, and responsiveness of the DFT in early stage Parkinson's disease (PD) patients. This was a cross-sectional study. Thirty-three early stage PD patients were recruited. The DFT was performed along with the Timed Up and Go (TUG) test, dual-task TUG, Functional Reach Test (FRT), 3-m backward walk test (3MBWT), Tinetti Performance-Oriented Mobility Assessment (POMA), and Berg Balance Scale (BBS). The test-retest reliability of the subcomponents of the DFT was excellent. The ICCs were as follows: 0.952, 0.955, 0.917, and 0.919, respectively. The correlation with subcomponents of DFT and TUG, dual-task TUG, FRT, 3MBWT, BBS, and POMA was found to be statistically significant (p < 0.05). The standard measurement errors of the subcomponents of the DFT were 1.45, 1.39, 1.70, and 1.57, respectively. The minimal clinically important difference (MCID) of the subcomponents was 2.05, 1.97, 2.41, and 2.22, respectively. The DFT is a reliable, valid, and easy-to-administer tool in assessing the balance and physical function of early stage PD patients.

Validity and intra- and inter-rater reliability of the Tinetti performance-oriented mobility assessment balance subscale using different tele-assessment methods in patients with chronic stroke

ABSTRACT Introduction Balance assessments are an important component of rehabilitation. Considering the increasing use of telemedicine to meet rehabilitation needs, it is important to examine the feasibility of such assessments. This study aimed to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment Balance Subscale (POMA-B) when applied via synchronous and asynchronous tele-assessment. Methods Twenty-five patients with chronic stroke were included in the study. The first physiotherapist assessed the patients on the first day in a face-to-face clinical setting. Synchronous or asynchronous tele-assessment was applied the next day. The assessments were performed in the same time zone, with an interval of one day. The synchronous tele-assessment was done online in real time by the first and second physiotherapists. A reference assessment video was sent to the patients for asynchronous tele-assessment. They were asked to make a video recording while performing the evaluation activities according to the reference video. Then the first and second physiotherapists assessed these video recordings separately. All the tests were repeated 10 days later to determine the intra-rater reliability of the tele-assessment methods. Results The intra-class correlation coefficients ranged from 0.96 to 0.98 for inter-rater reliability and from 0.97 to 0.98 for intra-rater reliability for both tele-assessment methods. Both asynchronous and asynchronous tele-assessment methods were medium correlated with the face-to-face versions. Conclusions We demonstrated the validity and reliability of the POMA-B in chronic stroke patients with different tele-assessment methods, typically using the internet and available devices.

Comparing the effects of augmented virtual reality treadmill training versus conventional treadmill training in patients with stage II-III Parkinson's disease: the VIRTREAD-PD randomized controlled trial protocol.

Intensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson's Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients' performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient's satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles. Single-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial-temporal gait parameters at T1 and T2, patients' satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α < 0.05), raised to 24 per group to compensate for potential drop-outs. Both interventions will be customized and progressive, based on the participant's performance, according to a predefined protocol. This study will provide data on the possible superiority of AVR-associated TT over conventional TT in improving gait and other motor and non-motor symptoms in persons with PD and gait disturbances. Results of the exploratory analysis could add information in the field of biomarker research in PD rehabilitation.

Associations of Gait and Cognitive Impairment and Dementia in Individuals with Down Syndrome

AbstractBackgroundLife expectancy of individuals with Down syndrome (DS) has increased considerably over the years. Atypical aging in Down syndrome (DS) is associated with neuropathological characteristics consistent with Alzheimer disease (AD). Significant gait alterations are associated with an increased risk of dementia for the general population. The aim of this study was to determine whether gait performance is associated with cognitive performance and dementia in adults with DS.MethodThis study included 66 individuals with DS over 20 years of age, divided into three diagnostic groups: stable cognition, prodromal dementia, and dementia. They were evaluated with the Performance‐Oriented Mobility Assessment (POMA), Timed Up and Go test, and Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS), which includes the Cambridge Cognitive Examination (CAMCOG). Logistic regression model was used to assess the effects of gait and balance on the diagnosis (prodromal dementia and dementia versus stable cognition) adjusting for age, sex, body mass index (BMI), degree of intellectual disability and physical inactivity.ResultThe score on the POMA‐Gait subscale score and body mass index (BMI) were found to be independent predictors of prodromal dementia and dementia (Poma‐Gait OR = 0.67, 0.53‐0.85 CI, p&lt;0.001; and BMI OR = 1.12, 1.021.24 CI, p&lt;0.001). A lower POMA‐Total score indicates a higher fall risk. With the exception of perception, all cognitive domains correlated with the POMA total score (P&lt;0.05).ConclusionThese data indicate that poor gait performance, as assessed by the POMA, as well as a high BMI, were associated with a diagnosis of prodromal dementia or dementia. In those individuals, applying the POMA could facilitate the early diagnosis of dementia, help identify fall risks, and promote the adoption of geriatric interventions focused on improving functional mobility. There is a need for longitudinal studies to characterize the true nature of the associations found, to validate gait instruments specifics to this population, and for future analyses in order to clarify the role that gait and balance play in cognitive decline and the development of dementia.

Association of impaired cognitive function with balance confidence, static balance, dynamic balance, functional mobility, and risk of falls in older adults with depression

AbstractObjectivesIncreased depression severity has been linked to cognitive impairment (CI). Importantly, CI is a known risk factor for impaired balance and falls. Therefore, this study aims to explore the relationship between CI and neuromuscular functions and secondarily it aims to find out if CI is a potential predictor for neuromuscular functions deficits in depressed elderly.MethodsEighty‐four depressed elderly participated in the study. Assessment for CI symptoms were done using Mini Mental Status Examination (MMSE) in subjects having confirmed depression. Neuromuscular functions such as balance confidence, static and dynamic balance, functional mobility, and fall risk were subjectively assessed using Activities‐specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Performance Oriented Mobility Assessment (POMA), respectively.ResultsPearson's analysis revealed that there was moderate positive linear‐correlation between MMSE and BBS (R = 0.382, p = &lt;0.001) and between MMSE and ABC (R = 0.229, p = 0.036*). Further, regression analysis (R2) revealed that MMSE significantly predicted the neuromuscular functions using BBS [F(1, 82) = 14.013, p &lt; 0.001, with an R2 of 0.146] and ABC [F(1, 82) = 4.545, p= 0.036*, with an R2 of 0.053].ConclusionResults of this study points to an impaired CI as a possible factor in development of neuromuscular function impairment in depressed elderly.

Validation of the Performance Oriented Mobility Assessment (Tinetti Test) Scale in Russia for Stroke Patients

INTRODUCTION. Balance disturbances are frequent syndromes after a cerebral stroke (CS). The availability of a validated tool for balance and walking functions comprehensive assessments is very important part of real clinical practice, for rehabilitation diagnosis and individual medical rehabilitation plan.&#x0D; AIM. To determine the psychometric properties of the Motor Activity Performance Assessment Scale (Tinetti Test, TT) for measuring balance and walking in patients with ischemic stroke (IS).&#x0D; MATERIALS AND METHODS. 200 patients were included, 100 in the early (ERP) and 100 in the late (LRP) recovery periods of IS. The average age of patients was 55 [51; 57] years. The average of IS-duration were 99.3 ± 30.9 days (ERP) and 267.7 ± 27.8 days (LRP). Clinical and demographic characteristics of patients in two groups were comparable. The median and interquartile interval of TT were 20 [14; 24] points out of 28 possible. Content validity and intra-rater reliability were assessed by 10 clinicians. The test-retesting method was used to determine the intra-rater reliability. The Berg Balance Scale (BBS), the Stand Up and Go for Time (TUG), and the 10-meter walk test (10MWT) were used for concurrent validation.&#x0D; RESULTS. Two-stage linguistic and cultural adaptation made it possible to construct a Russian-language version of TT that was tested in a pilot study of 30 patients. The subsequent study of the psychometric properties of TT demonstrated high level of content validity and internal consistency of TT (α-Kronbach: 0.74 for TT-Balance and 0.72 for TT-Gait). BBS data significantly correlated with TT-Balance scores (r = 0.73, p = 0.001), TUG showed a negative correlation with TT-Gait (r = −0.69, p = 0.02). Retest reliability ranged from 0.72 to 0.86. The Bland-Altman plot showed the loss of one data point for TT-total beyond 95 % CI.&#x0D; DISCUSSION. The Tinetti test indicates high substantive validity and internal consistency of the scales (the α-Kronbach for the balance and walking sections are 0.74 and 0.72, respectively), which is consistent with the data of foreign authors.&#x0D; CONCLUSION. The linguistic and cultural adaptation and psychometric testing of the Russian version of the Motor Activity Performance Assessment Scale demonstrated the validity and reliability of this test as a tool for balance and walking assessment in patients with IS.

Impact of Mild Level Exercise Program on Incidence of Falls, Gait and Balance Among Elderly People at Selected Rural Areas of Belagavi District.

Context: Exercises that are low-intensity can aid with balance and gait. Regular low-intensity exercise is a beneficial substitute for treating balance and gait issues brought on by ageing. Objective: To assess incidence of falls, gait and balance of elderly people before and after low intensity exercise program and to assess effectiveness of low intensity exercise program on incidence of falls, gait and balance of elderly people.&#x0D; Setting and design: The study was conducted in selected rural areas of Belgaum district and pre experimental one group pretest post test study design was used.&#x0D; Materials and Methods: Population was comprised of elderly people aged 60 years and above. The sample size was 30 and non probability purposive sampling technique was used to select the samples. Berg balance scale and Performance oriented mobility assessment scale for gait was used to assess gait and balance..&#x0D; Statistical Analysis used:Descriptiveand inferential statistics were used with the helpof SPSSversion 20.&#x0D; Results: In pretest12 (40%) of elders had incidence of fall during the one month prior to pre test and is reduced in post test as 7(23.3%) were had incidence of fall after one month to interventional program. The obtained value of ‘ t’ (29) = 6.97 for gait and ‘ t’ (29) = 2.65 for balance are found significant at 0.05 level of significance, indicating that the low intensity exercise program has helped elderly to improve their gait and balance.&#x0D; Conclusions: Low intensity exercise program helped elderly people to improve their gait and balance. So, such programs need to be implemented in community area to prevent incidence of fall and improve gait and balance among the elderly population.

Effectiveness of Vestibular Rehabilitation for Patients with Degenerative Cerebellar Ataxia: A Retrospective Cohort Study.

Many patients with cerebellar ataxia have dizziness caused by oculomotor or peripheral vestibular deficits; however, there is little evidence supporting the use of vestibular rehabilitation for this population. The purpose of this study was to determine whether patients with degenerative cerebellar diseases improve following rehabilitation including vestibular exercises. A secondary aim was to identify variables associated with the outcomes. A retrospective chart review identified 42 ambulatory patients (23 men and 19 women; mean age = 54.5 ± 14.4 years) with cerebellar degeneration. Fourteen patients had ataxia only, twenty had ataxia and oculomotor abnormalities, and eight had ataxia with oculomotor and peripheral vestibular deficits. Patients received customized physical therapy including balance and gait training, as well as gaze stabilization and habituation exercises for vestibular hypofunction and motion-provoked dizziness. Primary outcome measures (Activities-specific Balance Confidence Scale, Tinetti Performance Oriented Mobility Assessment, Dynamic Gait index, and Sensory Organization Test) were evaluated at baseline and discharge. Patients improved (p < 0.05) on all outcome measures. Patients with vestibular deficits were seen for more visits compared to those with gait ataxia only (7.1 vs. 4.8 visits). This study provides evidence that patients with degenerative cerebellar disease improve in balance confidence, fall risk and sensory integration with therapy that includes vestibular rehabilitation.

Balance and Gait: Associations With Cognitive Impairment and Dementia in Individuals With Down Syndrome.

Atypical aging in Down syndrome (DS) is associated with neuropathological characteristics consistent with Alzheimer disease. Gait abnormalities have been shown to be associated with an increased risk of dementia for the general population. The aim of this study was to determine whether gait disorders are associated with worse cognitive performance and dementia in adults with DS. We evaluated 66 individuals with DS (≥20y of age), divided into 3 groups: stable cognition, prodromal dementia, and dementia (presumed Alzheimer disease). Each individual was evaluated with the Performance-Oriented Mobility Assessment (POMA), Timed Up and Go test, and Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), in addition to a comprehensive clinical protocol to ascertain the occurrence of medical or psychiatric comorbidities. The score on the POMA-Gait subscale score and body mass index were found to be independent predictors of prodromal dementia and dementia ( P <0.001 for both). With the exception of perception, all cognitive domains correlated with the POMA-Total score ( P <0.05). A lower POMA-Gait score increases the chance of prodromal dementia and dementia in adults with DS. Unlike other research, in this study higher body mass index was also found to increase the chance of prodromal dementia and dementia. In those individuals, applying the POMA could facilitate the early diagnosis of dementia, help identify fall risks, and promote the adoption of geriatric interventions focused on improving functional mobility.

THE INFLUENCE OF PHYSICAL THERAPY ON INDICATORS OF LOCOMOTIVE SYNDROME IN ELDERLY PERSONS WITH OSTEOARTHRITIS OF THE KNEE AND OBESITY

Aim: to assess the effectiveness of the developed physical therapy program on locomotive syndrome parameters in elderly people with osteoarthritis of the knee and obesity.&#x0D; Material and methods. 93 elderly people were examined. The control group consisted of 31 people without osteoarthritis of the joints, with no obesity. The main group 1 consisted of 33 people who received rehabilitation according to the general principles of osteoarthritis correction. Representatives of the main group 2 (31 people) were engaged in a physical therapy program using functional training on the «Prosedos» platform, therapeutic exercises, Proprioceptive Neuromuscular Facilitation; massage, kinesiological taping, nutritional correction, patient education. The effectiveness of the program was evaluated according to the dynamics of the Short Physical Performance Battery, Functional Gait Assessment, Tinetti-test (Performance-Oriented Mobility Assessment), 25-question Geriatric Locomotive Function Scale.&#x0D; Results. Elderly patients with osteoarthritis of the knee and obesity were found to have impaired balance (Short Physical Performance Battery), altered gait stereotype (Functional Gait Assessment), risk of falling when performing activities of daily living (Tinetti-test) at the level of locomotive syndrome II degree (25- question Geriatric Locomotive Function Scale). The developed program of physical therapy in persons of the main group 2 revealed a statistically significantly better effect on the components of the locomotive syndrome compared to the initial examination in all studied parameters (p&lt;0.05). Elderly patients who underwent rehabilitation according to the standard program for the correction of osteoarthritis achieved a statistically significant improvement compared to the initial state according to the studied parameters (p&lt;0.05), but less pronounced compared to the tested program.&#x0D; Conclusions. Elderly patients with osteoarthritis of the knee joints and obesity need to develop physical therapy programs taking into account and correcting the specifics of each condition, the presence of static and dynamic balance disorders and the risk of falling, which will increase the overall effectiveness of rehabilitation measures.

A new instrument to assess physical function in stroke patients: the Dubousset function test and its validity, reliability, responsiveness

ABSTRACT Aim The Dubousset Functional Test (DFT) ia a practical four-component assessment test to assess the physical function and balance capacities. The study aimed to examine the reliability, validity, responsiveness of the DFT in stroke survivors. Methods This study included a total of 57 post-stroke patients (age 60.16 ± 15.08 years). The participants were divided into two groups according to the duration of stroke (6–12 months, 12 months and more). Reliability of DFT test was evaluated with Intraclass Correlation Coefficient (ICC). The correlation between the DFT and The Timed Up and Go test (TUG), dual-task TUG, Functional Reach Test (FRT), 3-meter backward walk test (3MBWT), Tinetti Performance Oriented Mobility Assessment (POMA) was used for the validity. Results For total post-stroke patients, ICC values were between 0.899 and 0.984 (excellent agreement). For stroke patients have 6–12 months stroke duration ICC values were between 0.831 and 0.988 (excellent agreement). For post-stroke patients have 6–12 months stroke duration ICC values were between 0.858 and 0.992 (excellent agreement). For total stroke post-patients the correlation with four component of DFT and TUG, dual-task TUG, FRT, 3MBWT and POMA was found to be statistically significant (p < 0.001). Conclusion The DFT has excellent reliability and validity in post-stroke patients. Therefore, it may be a clinically suitable test for detecting balance and physical function.

EFFECTIVENESS OF CORRECTION OF GERIATRIC STATUS OF ELDERLY PATIENTS WITH MOVEMENT CONSEQUENCES OF TOTAL KNEE ARTHROPLASTY USING PHYSICAL THERAPY

The aim of the study was to evaluate the effectiveness of the influence of the developed program of physical therapy on the parameters of the geriatric status of elderly patients with motor consequences of total knee arthroplasty in the long-term period after surgery. &#x0D; Material and methods. 80 elderly people were examined. The control group consisted of 24 people without joint endoprostheses with no signs of geriatric syndromes. The comparison group consisted of persons with a knee joint endoprosthesis and sarcopenia with low rehabilitation compliance with respect to rehabilitation intervention. Representatives of the main group with a knee joint replacement and sarcopenia were engaged in a physical therapy program using functional training on the Prosedos platform, therapeutic exercises, massage, kinesiology taping, nutrition correction, and patient education. The effectiveness of the program was evaluated by the dynamics of the Senior Fitness Test, Tinetti-test (Performance-Oriented Mobility Assessment), Geriatric Depression Scale, Tampa Kinesiophobia Scale. &#x0D; Results. The geriatric status of the examined patients was characterized by muscle weakness (statistically significant lag in parameters of physical status - coordination, static and dynamic balance, strength, flexibility, endurance, dexterity compared to their peers according to the Senior Fitness Test, Tinetti-test), high risk of falling, kinesiophobia and psycho-emotional depression, which increases the risk of loss of autonomy and death. The developed program of physical therapy revealed an improvement in the condition of the patients of the main group due to the influence on the links of the pathogenesis of geriatric syndromes due to the improvement of balance and gait parameters, reduction of the risk of falling and fear of movements, improvement of the psycho-emotional status in comparison with the initial indicators in all studied parameters (р&lt;0.05). The low rehabilitation compliance of patients in the comparison group, despite the awareness of the risks of poly morbidity, was associated with the lack of improvement in the condition after a similar observation period. &#x0D; Conclusions. Elderly patients with the consequences of total knee arthroplasty and signs of geriatric syndromes need to develop physical therapy programs that take into account and correct the specifics of each condition, which will increase the overall effectiveness of rehabilitation measures.

Reliability and validity of the Tinetti performance oriented mobility assessment in Chinese community-dwelling older adults

ObjectiveThe Tinetti Performance Oriented Mobility Assessment (POMA) has been used for assessing mobility limitations and predicting falling risk among older adults. This study aimed to evaluate the reliability and validity of the POMA in Chinese community-dwelling older adults. MethodsWe used data from a cross-sectional study in which a sample of 627 older adults completed the POMA. Reliability was tested using internal consistencies and test-retest reliability analyses, while validity was assessed using confirmatory factor analysis and known-group approach. Floor and ceiling effects were also tested. ResultsThe POMA and its two subscales had good internal consistency reliability and interrater reliability. Confirmatory factor analysis indicated the POMA had a two-factor structure. The POMA and its subscales exhibited moderate-to-good discriminant validity. A high ceiling effect was detected. ConclusionsThe POMA had satisfactory reliability and validity among Chinese older adults. Nevertheless, a high ceiling effect may limit its use in community settings.

Assessment of postural balance in patients with stroke

The Cerebral Vascular Accident (CVA) results in disabilities of paretic limbs, but few studies have investigated the impacts of CVA on perception deficits as well as related functional changes. Motor function alterations caused by CVA, such as the presence of associated reactions, loss of postural control mechanisms, and tone disorders, shift the body's center of gravity, generating a risk of falls. The aim of the present study was to evaluate postural balance changes in patients affected by CVA using the POMA-Brazil Scale (Performance Oriented Mobility Assessment). A cross-sectional study was conducted to assess postural balance changes in patients diagnosed with CVA undergoing rehabilitation at the UNIT Health Center, CEMISE Physiotherapy Service, and Maria Virgínia Leite Franco Rehabilitation Center in Aracaju, Sergipe. The B-POMA subscale consists of 13 tasks (sitting balance, rising from a chair, immediate standing balance, standing balance, eyes closed balance, 360-degree turning balance, resistance to displacement (Nudge Test), neck turning, unipedal stance balance, spinal extension, reaching upward, leaning forward, and sitting), aimed at detecting fall risk factors in elderly individuals with disabilities or chronic illnesses. Descriptive statistics were used for numerical variables, frequency distribution for demographic and clinical variables, and individuals per task, with the application of the chi-square test and the Student's t-test. Among the tasks measured according to the B-POMA subscale, sitting balance was the most frequent qualitative response (97.5%), followed by immediate standing, eyes closed, and leaning forward. Unipedal stance balance was the least common normal task (25%), and 360-degree turning was the most adaptive (62.5%). Balance changes are associated with cerebral vascular accidents in terms of dynamic equilibrium. This study demonstrated that unipedal stance balance was the most affected task, 360-degree turning balance was the most adaptive, and sitting balance was the least affected. There were no significant differences in balance scores based on sex, age, and time of injury.

Validity, Reliability, and Responsiveness of the Dubousset Functional Test in Older Adults

Objective: The aim of our study was to examine the test-retest reliability and validity of the Dubousset Functional Test (DFT) in older adults. Methods: The DFT, 3-m Backward Walk Test (3MBWT), Timed Up and Go (TUG) test, and Tinetti Performance-Oriented Mobility Assessment (POMA) were administered to 80 older adults. Results: Intraclass correlation coefficient (ICC) values were between 0.819 and 0.965 (excellent agreement). A correlation was found between DFT parameters and the TUG test, 3MBWT, and POMA scores. A low correlation was found between the TUG test and 3MBWT with the dual-task test; no correlation was determined between the POMA scores with the dual-task test. Conclusion: It was concluded that the DFT is a valid and reliable test for older adults.

Yaşlı Bireyler İçin X16 Denge Test Testinin Türkçe Versiyonunun Geçerlilik Ve Güvenilirliği

Objective: This study aimed to determine the validity and reliability of the Turkish version of the X16 Balance Testing Scale for older people. Materials and Method: Three hundred and forty five older people were included in the study. The test-retest process was completed with all individuals for intra-rater agreement. For validity, the correlation with Berg Balance Scale (BBS) and Performance-Oriented Mobility Assessment (POMA) were applied. Results: For intra-rater agreement of the X16 Balance Testing Scale obtained as a result of the initial testing and retesting, results were found to be highly reliable (Cronbach's alpha coefficient = 0.904, 0.902, respectively). Test-retest reliability was found to be at a quite high or excellent level in all domains. A high correlation was found between the X16 Balance Testing Scale total score and the total scores of BBS and POMA (r=0.710, 0.706 respectively). Conclusion: The Turkish version of the X16 Balance Testing Scale was found to be valid and reliable in older people. Due to its simplicity and quickness to use, it is practical to be used for balance evaluation.

Walking Stability and Risk of Falls.

Walking stability is considered a necessary physical performance for preserving independence and preventing falls. The current study investigated the correlation between walking stability and two clinical markers for falling risk. Principal component analysis (PCA) was applied to extract the three-dimensional (3D) lower-limb kinematic data of 43 healthy older adults (69.8 ± 8.5 years, 36 females) into a set of principal movements (PMs), showing different movement components/synergies working together to accomplish the walking task goal. Then, the largest Lyapunov exponent (LyE) was applied to the first five PMs as a measure of stability, with the interpretation that the higher the LyE, the lower the stability of individual movement components. Next, the fall risk was determined using two functional motor tests-a Short Physical Performance Battery (SPPB) and a Gait Subscale of Performance-Oriented Mobility Assessment (POMA-G)-of which the higher the test score, the better the performance. The main results show that SPPB and POMA-G scores negatively correlate with the LyE seen in specific PMs (p ≤ 0.009), indicating that increasing walking instability increases the fall risk. The current findings suggest that inherent walking instability should be considered when assessing and training the lower limbs to reduce the risk of falling.

INPH and parkinsonism: A positive shunt response with a negative tap test.

The aim of this study was to compare clinical and functional performances of idiopathic normal pressure hydrocephalus (INPH) patients with and without parkinsonism at the initial evaluation, 72 h after the cerebrospinal fluid tap test (CSF TT), and 6 months after ventriculoperitoneal shunt (VPS) surgery. This is an observational prospective study on patients with INPH who underwent VPS. Patients were classified into INPH with parkinsonism (INPH-P+) and without parkinsonism (INPH-P-). We used the time up and go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA) test, INPH grading scale (INHPGS), and modified Rankin scale (mRS) at baseline, 72 h after CSF TT, and 6 months after VPS surgery. A total of 64 patients with probable INPH were included, 12 patients with INPH-P+ and 52 controls with INPH-P-. Patients with INPH showed significant improvement in all clinical and neurological parameters after VPS including TUG, Tinetti POMA, INPHGS, and mRS (p < 0.001) with the exception of mRS where there was no significant change 72 h after CSF TT compared to baseline for patients with INPH (p = 0.182). Patients with INPH-P+ performed significantly worse than patients with INPH-P- on Tinetti POMA and mRS at baseline, at 72 h post-CSF TT, and at 6 months post-VPS with INPHGS being worst at 72 h post-CSF TT. There was no difference between patients with INPH-P+ and patients with INPH-P- for TUG at baseline (p = 0.270), at 72 h post-CSF TT (p = 0.487), and at 6 months post-VPS (p = 0.182). Patients with INPH-P+ did not show any change in any of the parameters at 72 h post-CSF TT compared to baseline; however, there was a trend toward improvement on TUG (p = 0.058), Tinetti gait (p = 0.062), and Tinetti total (p = 0.067). INPH-P+ significantly improved in all parameters 6 months post-VPS compared to baseline except for mRS (p = 0.124). Patients with INPH-P- significantly improved in all parameters at 72 h post-CSF TT and at 6 months post-VPS compared to baseline, respectively, except on mRS 72 h after CSF TT (p = 0.299). Patients with INPH and parkinsonism overall do worse than patients without parkinsonism. An unsatisfying response to the CSF tap test in INPH patients with parkinsonism should not be used as an exclusion criterion from VPS surgery since patients with and without parkinsonism showed significant improvement post-VPS.

Pain and Motor Function in Myotonic Dystrophy Type 1: A Cross-Sectional Study

Pain is an underestimated finding in myotonic dystrophy type 1 (DM1). We provide a characterization of pain in terms of functional implications through a multidimensional assessment in patients with DM1, focusing on gender differences. We assessed pain through the Brief Pain Inventory (BPI) and its indexes (the Severity Index (SI) and the Interference Index (II)), balance/gait (the Tinetti Performance-Oriented Mobility Assessment (POMA)), functional abilities (the Functional Independence Measure (FIM)), and fatigue (the Fatigue Severity Scale (FSS)). We divided our sample into a mild (<4) and a moderate-severe group (≥4) based on BPI indexes. A between-group analysis was performed. We recruited 23 males and 22 females with DM1. A statistically significant difference was found for the FSS and the BPI-SI ≥ 4, and for all outcomes in the BPI-II ≥ 4 (p ≤ 0.003). In the female group, all outcomes except for the FIM were statistically significantly worse (p ≤ 0.004). Dividing our sample into four groups based on gender and the BPI, a statistically significant difference was found for FSS between the two groups with BPI-II ≥ 4 (with worsen score in the female one) (p < 0.002). Pain in DM1 patients is highly reported and gender related, with increased fatigue and poor balance/gait in the female group.