Self-reported Balance Research Articles

Associations of frailty, self-reported balance problems, hearing abilities, and posturography in a sample of older adults

Objective The aim of this study was to identify risk factors for self-reported balance problems, and to analyse associations between hearing and balance. Design A battery of tests was administered to assess hearing and balance performance, as well as additional health-related factors indicative of frailty and fall risk. In a retrospective analysis, logistic regression was used to identify risk factors for self-reported balance problems and linear regression was used to identify associations between hearing ability and functional balance. Study sample For the risk factor analysis, 199 volunteers aged 55–81 years (mean:67) were divided into two groups according to their self-reported balance problems. Only participants lacking self-reported balance problems (n = 157) were included in the second analysis. Results Female gender, frailty, and fine-motor skills were statistically significant predictors of self-reported balance problems. Functional balance performance was related to hearing impairment for dynamic, but not for static, balance tasks. Conclusion For a holistic approach to healthcare and regardless of age, individuals with multiple comorbidities and/or phenotypic signs of frailty should be considered at risk for falls. For further research, it was shown that dynamic, rather than static, balance tasks may be needed to gain deeper insights into the relationship between hearing and balance.

Association between screen time and self-reported balance disorders in middle-aged and older adults: national health and nutrition examination survey

BackgroundBalance disorders can give rise to sensations of instability, lightheadedness, vertigo, disequilibrium, or syncope, ultimately leading to grave medical, physical, emotional, and societal ramifications. These conditions are highly prevalent among individuals aged 40 and above. Screen time encompasses activities associated with television viewing, video game playing, and non-work-related computer usage. Prolonged screen exposure may engender a spectrum of health issues and even elevate overall mortality rates. However, the available evidence on the potential link between excessive screen time and balance dysfunction remains limited.AimsThe primary aim of this study was to explore the possible association between prolonged screen exposure and impaired balance function.MethodsThis cross-sectional study utilized data from participants who completed a comprehensive questionnaire in the NHANES database between 1999 and 2002, all of whom were aged over 40 and under 85 years. Participants’ screen time was categorized into two groups (< 4 h/d and ≥4 h/d) for subsequent data analysis. Logistic regression, combined with propensity score matching (PSM), was employed to investigate the correlation between screen time and balance disorders.ResultsA total of 5176 participants were enrolled in this study, comprising 2,586 men and 2,590 women, with a prevalence rate of balance disorders at 25.7% (1331/5176). The incidence of balance disorders was found to be significantly higher among individuals who spent 4 hours or more per day on screen time compared to those with less screen time (P<0.001). Multivariate logistic analysis conducted on the unmatched cohort revealed a significant association between screen time and balance disorders, with an odds ratio (OR) 1.8 (95%CI 1.57 ∼ 2.05). These findings remained consistent even after adjusting for confounding factors, yielding an OR 1.43 (95%CI 1.24 ∼ 1.66). Moreover, the association persisted when employing various multivariate analyses such as propensity score matching adjusted model, standardized mortality ratio weighting model and pairwise algorithmic model; all resulting in ORs ranging from 1.38 to 1.43 and p-values < 0.001.ConclusionsAfter controlling for all covariates, screen time (watching TV, playing video games, and using computers outside of work) was associated with balance dysfunction among middle-aged and older adults. This finding may offer a possible idea for the prevention of dizziness and balance disorders. Nevertheless, additional research is imperative to further validate these results.

Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis

BackgroundChronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. MethodsIn a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures – Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test – were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. ResultsAmong 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88–0.97) and moderate convergent validity (r = 0.34–0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. ConclusionThough all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.

Telerehabilitation by Videoconferencing for Balance and Gait in People with Parkinson's Disease: A Scoping Review.

Although supervised and real-time telerehabilitation by videoconferencing is now becoming common for people with Parkinson's disease (PD), its efficacy for balance and gait is still unclear. This paper uses a scoping approach to review the current evidence on the effects of telerehabilitation by videoconferencing on balance and gait for patients with PD. We also explored whether studies have used wearable technology during telerehabilitation to assess and treat balance and gait via videoconferencing. Literature searches were conducted using PubMed, ISI's Web of Knowledge, Cochrane's Library, and Embase. The data were extracted for study design, treatment, and outcomes. Fourteen studies were included in this review. Of these, seven studies investigated the effects of telerehabilitation (e.g., tele-yoga and adapted physiotherapy exercises) on balance and gait measures (e.g., self-reported balance, balance scale, walking speed, mobility, and motor symptoms) using videoconferencing in both assessment and treatment. The telerehabilitation programs by videoconferencing were feasible and safe for people with PD; however, the efficacy still needs to be determined, as only four studies had a parallel group. In addition, no study used wearable technology. Robust evidence of the effects of telerehabilitation by videoconferencing on balance and gait for patients with PD was not found, suggesting that future powered, prospective, and robust clinical trials are needed.

Global Cognition, Gender, and Level of Education Predict Dual-Task Gait Speed Variability Metrics in Older Adults

Introduction: The purpose of this study was to determine if demographic variables and measures of cognitive function, functional mobility, self-reported balance self-efficacy, and self-reported physical activity can predict gait speed variability during single-task walking (STGSCV), during cognitive-motor dual-tasking (DTGSCV), and dual-task effect on gait speed variability (DTEGSCV) in older adults. Methods: In 62 older adults, demographics were recorded and cognitive function (including the Montreal Cognitive Assessment, MoCA), functional mobility, balance self-efficacy (Activities-specific Balance Confidence Scale, ABC), and self-reported physical activity (Physical Activity Scale for the Elderly, PASE) were assessed. Three linear regression models were used to determine whether the functional mobility tests, PASE score, ABC score, and tests of cognitive function predicted gait speed variability outcomes (STGSCV, DTGSCV, DTEGSCV), with demographics included as covariates. Results: MoCA score (p = 0.003), gender (p = 0.040), and years of education (p = 0.010) significantly predicted DTGSCV (R2 = 0.297, p = 0.002). MoCA score (p = 0.008) and years of education (p < 0.001) also significantly predicted DTEGSCV. Despite a significant regression model (R2 = 0.316, p = 0.001), there were no significant individual predictors of STGSCV. Conclusion: Older adults with lower cognitive function scores, according to the MoCA, and higher levels of education demonstrate larger gait speed variability during dual-tasking and may be at increased risk of real-world mobility issues or falling.

Collegiate Athletes With Diabetes: Baseline Medical Comorbidities and Preseason Concussion Testing Performance.

People with diabetes mellitus (DM) are at increased risk for adverse health events and complications throughout their lifetime. Whether DM significantly affects collegiate athletes' concussion baseline testing performance remains unclear. To (1) describe the prevalence of DM and associated comorbidities and (2) compare concussion baseline testing performance between student-athletes with DM and student-athletes without DM (NoDM). Retrospective, cross-sectional study. University. Using the Concussion, Assessment, Research and Education (CARE) Consortium research database, we matched athletes with self-reported DM (N = 229) by institution, sex, age, sport, position, testing year, and concussion history to athletes with NoDM (N = 229; total sample mean age = 19.6 ± 1.4 years, women = 42%). Descriptive statistics and χ2 tests of independence with subsequent odds ratios were calculated. Independent-samples t tests compared baseline symptoms, neurocognitive testing, and balance performance between athletes with DM and athletes with NoDM. Effect sizes were determined for significant group differences. At baseline, athletes with DM had higher rates of self-reported pre-existing balance disorders, sleep disorders, seizure disorders, motion sickness, learning disorders, vision and hearing problems, psychiatric disorders, depression, bipolar disorder, nonmigraine headaches, and meningitis than athletes with NoDM (P values < .05). We found balance differences between groups (P = .032, Cohen d = 0.17) such that, on average, athletes with DM had 1 additional error on the Balance Error Scoring System (DM = 13.4 ± 6.5; NoDM = 12.1 ± 5.9). No other comparisons yielded significant results. Although athletes with DM had high rates of self-reported balance disorders, sleep disorders, seizures, and meningitis, their baseline neurocognitive testing results were largely identical to those of athletes with NoDM. Our findings suggested that nonclinically meaningful differences were present in concussion baseline balance testing but no significant differences were noted in cognitive testing; however, the effect of DM on concussion recovery remains unknown.

Effects of Customized Biomechanical Footwear on Gait and Balance in Individuals with Polio: A Randomized Controlled Trial

Background Evidence suggests that the factors behind the increased risk of falls among polio survivors are mainly categorized into intrinsic and extrinsic domains. The intrinsic category involves factors like muscle weaknesses, fear of falls and self-reported balance problem. In contrast, extrinsic factors include poor environmental circumstances and ambulatory issues that cause reduced ability to adapt to walking conditions in polio patients. Therefore, the present study aimed to investigate biomechanical footwear’s effects on gait and balance in individuals with polio. Methods A total of 30 participants were randomly divided into two groups of 15 each. The experimental group received customized shoe footwear with features such as medial arch support, metatarsal pad, rear foot control, fibreglass lateral counter, and a rocker sole. The control group did not receive specialized footwear. Results The intervention group showed significant improvements in several gait parameters compared to the control group, including step length (p=0.008), stride length (p=&lt;0.001), step width (p=0.002), cadence (p&lt;0.001) and speed (p=0.0009). The intervention group also showed significant improvements in Berg Balance Scale scores (p=0.07) compared to the control group. Conclusion Biomechanical footwear with medial arch support, metatarsal pad, and rear foot control can improve gait and balance in individuals with polio. Keywords Disability, Gait, Foot Orthosis, Poliovirus.

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&amp;gt;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&amp;lt;0.05) but not the eyes open condition. These associations were not observed in athletes with history of concussion (ps&amp;gt;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.

Modifying the five-time sit-to-stand test to allow use of the upper limbs: Assessing initial evidence of construct validity among lower limb prosthesis users.

The Five-time Sit-to-Stand (5xSTS) Test is a performance-based measure used by clinicians and researchers to assess the body functions needed to accomplish sit-to-stand transitions (e.g., lower limb strength, balance, and trunk control). The current requirements for performance of the 5xSTS Test (i.e., crossing arms over the chest) may not be appropriate for many, if not most lower limb prosthesis (LLP) users. The study aims were to (1) develop a modified five-time sit-to-stand (m5xSTS) Test protocol; (2) to examine initial evidence of known-groups construct validity among LLP users by comparing differences in performance by amputation level, amputation etiology, and functional level; and (3) to assess initial evidence of convergent construct validity by examining the correlations between m5xSTS performance with self-reported mobility (Prosthetic Limb Users Survey of Mobility (PLUS-M)), self-reported balance confidence (Activities-balance Confidence Scale (ABC)) and functional capability (comfortable walking speed). Three-hundred sixty-one LLP users participated in this cross-sectional study. The investigators developed a m5xSTS Test protocol that allows tested individuals to use different assistance strategies (i.e., use of upper limbs to push off thighs, push up from the armrests, or use a walker) when needed to perform the test. The investigators recorded m5xSTS Test times and assistance strategies. Significant differences in m5xSTS Test times were found between those who did and did not use an assistance strategy, as well as between participants grouped by different amputation level, etiology, and functional level. Significant moderate negative correlations were found between m5xSTS Test times and PLUS-M T-score (ρ = -0.42, p<0.001), ABC score (ρ = -0.42, p<0.001), and comfortable walking speed (ρ = -0.64, p<0.001), respectively. The m5xSTS Test allows LLP users to perform sit-to-stand transitions in a manner that accounts for their functional impairments, is consistent with post-amputation training, and is safe for the tested individual. Results from this study provide preliminary evidence of known groups and convergent construct validity for the m5xSTS Test with a large national sample of LLP users.

Network segregation in aging females and evaluation of the impact of sex steroid hormones.

Males and females show differential patterns in connectivity in resting-state networks (RSNs) during normal aging, from early adulthood to late middle age. Age-related differences in network integration (effectiveness of specialized communication at the global network level) and segregation (functional specialization at the local level of specific brain regions) may also differ by sex. These differences may be due at least in part to endogenous hormonal fluctuation, such as that which occurs in females during midlife with the transition to menopause when levels of estrogens and progesterone drop markedly. A limited number of studies that have investigated sex differences in the action of steroid hormones in brain networks. Here we investigated how sex steroid hormones relate to age-network relationships in both males and females, with a focus on network segregation. Females displayed a significant quadratic relationship between age and network segregation for the cerebellar-basal ganglia and salience networks. In both cases, segregation was still increasing through adulthood, highest in midlife, and with a downturn thereafter. However, there were no significant relationships between sex steroid hormone levels and network segregation levels in females, and they did not exhibit significant associations between progesterone or 17β-estradiol and network segregation. Patterns of connectivity between the cerebellum and basal ganglia have been associated with cognitive performance and self-reported balance confidence in older adults. Together, these findings suggest that network segregation patterns with age in females vary by network, and that sex steroid hormones are not associated with this measure of connectivity in this cross-sectional analysis. Though this is a null effect, it remains critical for understanding the extent to which hormones relate to brain network architecture.

Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool?

The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in community-living older men and women, who may be targets for primary preventive interventions. The FIF tool consists of 3 self-reported questions and 1 physical test (1-leg standing balance). The purpose of this study was to examine the predictive ability of the FIF tool and a modified FIF tool (in which 1-leg standing is replaced by self-reported balance) for first-time injurious falls. A cohort of 1194 community-living people 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden, was followed longitudinally for 5 years. Data on injurious falls were collected from registered data and were defined as receipt of care after a fall. The predictive ability of the FIF tool and the m-FIF tool was explored using Harrell's C statistic, stratified by sex. The injurious fall rate per 1000 person-years was 54.9 (95% CI: 47.22-63.78) for women and 36.3 (95% CI: 28.84-45.78) for men. The predictive ability for women and men according to Harrell's C statistic was 0.70 and 0.71 for the FIF tool and the m-FIF tool. The predictive ability was 0.70 and 0.69 for 1-leg standing, and 0.65 and 0.60 for self-reported balance problems. The m-FIF tool presented similar predictive ability as the FIF tool regarding first-time injurious falls. This finding could extend the usefulness of the tool to other settings, such as to electronic health (eHealth). A quickly and easily administered screening tool can help physical therapists to identify people with a high risk of falling who may need to undergo a more comprehensive fall risk assessment.

The Effect of Different Physiotherapy Programs on Pain, Balance and Trunk Functional Capacity in Adolescents with Low Back Pain

Background. Low back pain is a common problem, adversely affecting balance and strategy for controlling the trunk muscles. There are various methods to treat low back pain, therefore, studies comparing the effectiveness of different programs can help improve the rehabilitation program for patients with low back pain.&#x0D; The aim. To evaluate the effect of trunk stabilization and balance exercises performed with different devices on pain, balance and trunk functional capacity in adolescents with low back pain.&#x0D; Methods. 12 adolescents with low back pain participated in this study. They were divided into two groups. The first group received 20 minutes of stabilization exercises and 10 minutes of balance training using the Biodex balance system. The second group received 20 minutes of stabilization exercises and 10 minutes of balance training using a vibration platform. All subjects were evaluated before and after 10 physiotherapy procedures. Self-reported pain, balance and static endurance of trunk muscles were assessed before and after the interventions.&#x0D; Results. Both programs significantly reduced pain, improved control of the center of gravity within the base of support, reduced the time required to shift weight in different paths, reduced sway index in conditions of eyes open or eyes closed on a firm or foam surface, improved dynamic and static overall postural stability and increased static endurance of trunk muscles. Improvement in control of the center of gravity within the base of support, and reduction in the time required to shift weight in different paths, were more significant in the group that received balance training using the Biodex balance system compared with that in the group that received balance training using a vibration platform.&#x0D; Conclusions. Balance training using the Biodex balance system was more effective in improving control of the center of gravity within the base of support and reducing the time required to shift weight in different paths than balance training using a vibration platform.&#x0D; Keywords: low back pain, balance, trunk stability, Biodex balance system, vibration platform.&#x0D; &#x0D;

Free-living gait does not differentiate chronic mTBI patients compared to healthy controls

BackgroundPhysical function remains a crucial component of mild traumatic brain injury (mTBI) assessment and recovery. Traditional approaches to assess mTBI lack sensitivity to detect subtle deficits post-injury, which can impact a patient’s quality of life, daily function and can lead to chronic issues. Inertial measurement units (IMU) provide an opportunity for objective assessment of physical function and can be used in any environment. A single waist worn IMU has the potential to provide broad/macro quantity characteristics to estimate gait mobility, as well as more high-resolution micro spatial or temporal gait characteristics (herein, we refer to these as measures of quality). Our recent work showed that quantity measures of mobility were less sensitive than measures of turning quality when comparing the free-living physical function of chronic mTBI patients and healthy controls. However, no studies have examined whether measures of gait quality in free-living conditions can differentiate chronic mTBI patients and healthy controls. This study aimed to determine whether measures of free-living gait quality can differentiate chronic mTBI patients from controls.MethodsThirty-two patients with chronic self-reported balance symptoms after mTBI (age: 40.88 ± 11.78 years, median days post-injury: 440.68 days) and 23 healthy controls (age: 48.56 ± 22.56 years) were assessed for ~ 7 days using a single IMU at the waist on a belt. Free-living gait quality metrics were evaluated for chronic mTBI patients and controls using multi-variate analysis. Receiver operating characteristics (ROC) and Area Under the Curve (AUC) analysis were used to determine outcome sensitivity to chronic mTBI.ResultsFree-living gait quality metrics were not different between chronic mTBI patients and controls (all p > 0.05) whilst controlling for age and sex. ROC and AUC analysis showed stride length (0.63) was the most sensitive measure for differentiating chronic mTBI patients from controls.ConclusionsOur results show that gait quality metrics determined through a free-living assessment were not significantly different between chronic mTBI patients and controls. These results suggest that measures of free-living gait quality were not impaired in our chronic mTBI patients, and/or, that the metrics chosen were not sensitive enough to detect subtle impairments in our sample.

Military status as an effect modifier of the association of chlorpyrifos exposure with self-reported balance problems

BACKGROUND AND AIM: Chlorpyrifos has been widely used within the US military; however, it is unclear whether exposure poses a specific concern for military personnel. Our aim is to determine the association between urinary 3,5,6-trichloropyridinol with self-reported balance problems stratified by military affiliation. METHODS: This is a cross-sectional analysis of the United States Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) 1999-2002 data, including adults ≥40 years, N=1279. 3,5,6-trichloropyridinol, a metabolite of chlorpyrifos, was measured in urine. Military affiliation (ever/never), balance problems in the past year, and other variables were obtained via questionnaire. Statistical analyses accounted for the complex survey design and utilized the pesticide subsample weights. Adjusted regression models included age, sex, race/ethnicity, body mass index, and urinary creatinine as covariates. The adjusted associations between 3,5,6-trichloropyridinol with balance were determined; this was stratified by military affiliation. RESULTS:Geometric mean urinary 3,5,6-trichloropyridinol was 15.31 µg/g creatinine (95% confidence interval (CI): 11.17, 20.98) and was slightly, but not significantly, higher among those with a military affiliation (15.92; 95% CI: 7.48, 33.88) versus not (15.19; 95% CI: 10.68, 21.57). There was also no association of 3,5,6-trichloropyridinol with balance problems within the past year among the full population (odds ratio (OR)= 1.01; 95% CI: 0.98, 1.04) or those with no military affiliation (OR= 1.04; 95% CI: 0.88, 1.23). However, the association of 3,5,6-trichloropyridinol among those with a military affiliation (OR=1.40; 95% CI: 1.08, 1.81) was statistically significant. CONCLUSIONS:We identified a significant association of urinary 3,5,6-trichloropyridinol with self-reported balance problems among US adults with a military affiliation, suggesting military affiliation may be an effect modifier this association. More extensive studies are recommended to confirm and expand upon these results. KEYWORDS: chlorpyrifos, postural balance, military personnel, NHANES

\u201cFear of falling serves as protection and signifies potential danger\u201d: a qualitative study to conceptualise the phrase \u201cfear of falling\u201d in women with osteoporosis

SummaryFear of falling (FoF) was described as a dichotomy, whereby FoF on one hand posed a threat to the sense of security but on the other hand provided protection against harm through increased awareness and cautious behaviour. These findings contribute to a deeper understanding of FoF for women with osteoporosis.IntroductionFear of falling is a major problem for many individuals in society and it increases with age; it is more common among women, especially women with a diagnosis of osteoporosis. It is important to gain a deeper understanding of the concept of fear of falling among women with osteoporosis to be able to devise fall prevention programmes to address fear of falling in the most appropriate way. Therefore, we aimed to explore and describe how older women with osteoporosis and self-reported balance deficits conceptualise their fear of fallingMethodsA qualitative study with individual interviews was carried out, using a semi-structured interview guide. The interviews were recorded, transcribed verbatim, and analysed with inductive qualitative content analysis. The study includes 25 informants, all women with osteoporosis aged 66–85 years.ResultsThe analysis resulted in one overarching theme, “Fear of falling is a protection and danger”, and three main themes: “Fear of falling is a sense of unease”, “Fear of falling is to be vulnerable”, and “Fear of falling is a call for help”.ConclusionThe concept of fear of falling was perceived in terms of emotional states as well as cognitive and active strategies and was described in the context of being able to protect oneself in order to stay safe and secure. The concept was described as a dichotomy, whereby fear of falling on the one hand posed a threat to the sense of security but on the other hand provided protection against harm through increased awareness and cautious behaviour. These findings contribute to a deeper understanding of the phenomenon of fear of falling and how it could be seen from both a positive and negative perspective.

Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems

Objective: To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults. Design: Cross-sectional study. Setting: Outpatient clinics. Subjects: Sixty-six adults aged ⩾65 years with self-reported balance problems. Main measure: The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed “Up and Go” test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman’s rank correlation coefficient (ρ). Results: Participants had a mean (SD) age of 75.5 (6.6) years, a median (Q1–Q3) Montreal Cognitive Assessment test score of 26 (24–27), and a median (Q1–Q3) Falls Efficacy Scale International score of 22 (20–26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92–0.98) and 0.94 (CI: 0.86–0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = −0.62), Dynamic Gait Index (ρ = −0.55), and the Timed “Up and Go” test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38). Conclusion: The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.

The Toronto concussion study: a cross-sectional analysis of balance deficits following acute concussion in community-dwelling adults

ABSTRACT Objective: To characterize balance deficits in community-dwelling adults following acute concussion. Design: Cross-sectional observational study. Methods: Individuals with acute concussion (n=100) and healthy controls (n=20) completed the BESS (Balance Error Scoring System) and quiet standing trials on forceplates with the eyes open, closed, or during a cognitive dual task. BESS score and centre-of-pressure root mean square and high-frequency power (0.4-3Hz) were used to characterize group differences. In a secondary analysis, participants were subdivided based on self-reported symptoms of balance problems and dizziness using the SCAT-3 (Sport Concussion Assessment Tool – Third Edition) Symptom Checklist. Results: In comparing individuals with concussion and controls, BESS score (16.0 ± 6.0 vs 12.6 ± 3.8; F(1,116) = 5.814, p = .017) and anteroposterior [F(1.78, 204.2) = 11.93, p < .001] and mediolateral [F(1, 114) = 10.05, p = .002] high-frequency power revealed significant group differences. Dividing individuals based on self-reported symptoms revealed significant differences in mediolateral high frequency power, such that participants reporting balance and dizziness problems as well as those participants not reporting balance or dizziness symptoms following concussion were less stable than controls. Conclusions: Deficits in clinical and posturographic measures of balance occur in community-dwelling adults with concussion. These measures do not align with self-reported balance symptoms. Future research and clinical practice aimed at careful selection of optimized balance assessment is recommended.

A block randomised controlled trial investigating changes in postural control following a personalised 12-week exercise programme for individuals with lower limb amputation

BackgroundIndividuals with a lower limb amputation (LLA) have an increased risk of falls and often report lower balance confidence. They must compensate for altered mechanics and prosthetic limitations in order to execute appropriate motor responses to postural perturbations. Personalised exercise could be an effective strategy to enhance balance and reduce falls. Research questionIn this study, we investigated whether a personalised exercise programme could improve postural control and self-reported balance confidence in individuals with an LLA. MethodsParticipants were block randomised into two groups (exercise, n = 7; control, n = 7) based on age and level of amputation. The exercise group completed a 12-week personalised exercise programme, including home-based exercise sessions, consisting of balance, endurance, strength, and flexibility training. The control group continued with their normal daily activities. All participants performed the Sensory Organization Test (SOT) and Motor Control Test (MCT) on the NeuroCom SMART Equitest, and completed the Activities-specific Balance Confidence-UK (ABC) self-report questionnaire, at baseline and post-intervention. Results and significanceExercise group equilibrium scores improved significantly when standing on an unstable support surface with no visual input and inaccurate somatosensory feedback (SOT condition 5, P < 0.012, d = 1.45). There were significant group*time interactions for medium (P = 0.029) and large (P = 0.048) support surface forward translations, which were associated with a trend towards increased weight-bearing on the intact limb in the control group (medium: P = 0.055; large: P = 0.087). No significant changes in ABC score were observed. These results indicate reduced reliance on visual input, and/or enhanced interpretation of somatosensory input, following an exercise programme. However, objective improvements in aspects of postural control were not associated with subjective improvements in self-reported balance confidence. More weight-bearing asymmetry in the control group suggests that a lack of targeted exercise training may have detrimental effects, with potential adverse long-term musculoskeletal consequences, that were quantifiable within a short timeframe.

Role of the newly designed Ankle Foot Orthosis on balance related parametersin drop foot post stroke patients

BackgroundPassive and hybrid passive ankle foot orthoses (AFOs) are often prescribed in post stroke drop foot; however, the effects of these AFOs on balance related parameters in these patients seem unclear. Accordingly, the aim of current study was to evaluate the role of the newly designed hybrid passive and Posterior Leaf Spring (PLS) AFOs on balance related parameters including: self-reported balance confidence (ABC), Timed Up and Go Test (TUG) and Berg Balance Scale (BBS) in post stroke drop foot patients. MethodsFifteen post stroke drop foot patients were recruited in current study. Then, ABC, TUG and BBS were assessed with newly designed AFO and PLS AFO. ResultsThe results of this study were shown a significant improvement in ABC, TUG and BBS scores with the newly designed AFO than PLS AFO (p < 0.05). ConclusionThis study suggested that the newly designed AFO was improved the balance related parameters than PLS AFO.

Relating Self-Reported Balance Problems to Sensory Organization and Dual-Tasking in Chronic Traumatic Brain Injury.

Individuals who have experienced a traumatic brain injury (TBI) often have residual balance problems. It remains unclear whether these balance problems are driven by vestibular dysfunction or gait automaticity deficits, particularly in the chronic stages of TBI recovery, because most studies include only acute/subacute cases. Compare performance on the Sensory Organization Test vestibular score and Dual-Task test in individuals with and without subjective balance problems at least 1 year after a TBI. Investigate the ability of each test to predict perceived balance problems. Prospective cohort study. Rehabilitation department within a single institution. Fifty adults (21-71 years) with a history of mild, moderate, or severe TBI 1 to 5 years following nonpenetrating TBI. N/A. Measures included the Dual-Task test, Sensory Organization Test, Neurobehavioral Symptom Inventory, Dizziness Handicap Inventory, and assessments of four cognitive domains and depression. Participants who endorsed "feeling dizzy" and "loss of balance" on the Neurobehavioral Symptom Inventory were classified as symptomatic (n = 26) and others as asymptomatic (n = 24). T-tests, chi-square, and regression analyses predicting the Dizziness Handicap Inventory total score were performed. Dual-task gait cost was negatively associated with the Dizziness Handicap Inventory (P = .044), controlling for depression and gender, whereas vestibular scores failed to predict balance-related disability. Symptomatic individuals endorsed more balance problems (P < .001) and depression symptoms (P = .007), had poorer dual-task cognitive output (P = .036), and slower dual-task gait velocity (P = .036) than asymptomatic participants. Groups did not differ on Sensory Organization Test scores. The nature of balance problems in chronic TBI may be related to automaticity of gait. These findings suggest that patients in the chronic stages of TBI may benefit from dual-task assessments and interventions. Balance rehabilitation should be tailored to patient needs and assess cognition and affect.