Short-form Berg Balance Scale Research Articles

Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data.

Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.

Stroke impairment, balance, and cognitive status on admission predict walking independence up to 90 days post-stroke but their contributions change over time.

This study aimed to identify predictors of gait independence in three successive patient cohorts that received inpatient rehabilitation for at least 30 days, 60 days, or 90 days post-stroke. A total of 26 independent variables were collected within 3 days of stroke onset, including basic information (age, sex, stroke type), sensorimotor function (Stroke Impairment Assessment Set), gait function, balance function, and cognitive function. The dependent variable was walking independence (without assistance from another person) at 30, 60, or 90 days post-stroke. A decision tree was developed for predicting gait independence at each assessment time point. The predictors of walking independence differed among the cohorts that received inpatient rehabilitation for at least 30, 60, and 90 days post-stroke. Specifically, the Short Form Berg Balance Scale score was in the higher layer and was a strong predictor of gait at all time points. The cognitive Functional Independence Measure progressed to the higher layer at later time points. The lower extremity motor function was an additional predictor in the 30-day cohort. For later cohorts, the predictive value of balance and cognitive function declined whereas the contribution of the paralyzed grip strength and trunk function increased. These results suggest that sensorimotor and cognitive function within 3 days of stroke can predict walking independence between 1 and 3 months post-stroke; however, the prognostic value of predictors varies among the patients who receive inpatient rehabilitation for shorter versus longer time.

Random Forest for Automatic Feature Importance Estimation and Selection for Explainable Postural Stability of a Multi-Factor Clinical Test.

Falling is a common incident that affects the health of elder adults worldwide. Postural instability is one of the major contributors to this problem. In this study, we propose a supplementary method for measuring postural stability that reduces doctor intervention. We used simple clinical tests, including the timed-up and go test (TUG), short form berg balance scale (SFBBS), and short portable mental status questionnaire (SPMSQ) to measure different factors related to postural stability that have been found to increase the risk of falling. We attached an inertial sensor to the lower back of a group of elderly subjects while they performed the TUG test, providing us with a tri-axial acceleration signal, which we used to extract a set of features, including multi-scale entropy (MSE), permutation entropy (PE), and statistical features. Using the score for each clinical test, we classified our participants into fallers or non-fallers in order to (1) compare the features calculated from the inertial sensor data, and (2) compare the screening capabilities of the multifactor clinical test against each individual test. We use random forest to select features and classify subjects across all scenarios. The results show that the combination of MSE and statistic features overall provide the best classification results. Meanwhile, PE is not an important feature in any scenario in our study. In addition, a t-test shows that the multifactor test of TUG and BBS is a better classifier of subjects in this study.

Assessing elderly\u2019s functional balance and mobility via analyzing data from waist-mounted tri-axial wearable accelerometers in timed up and go tests

BackgroundPoor balance has been cited as one of the key causal factors of falls. Timely detection of balance impairment can help identify the elderly prone to falls and also trigger early interventions to prevent them. The goal of this study was to develop a surrogate approach for assessing elderly’s functional balance based on Short Form Berg Balance Scale (SFBBS) score.MethodsData were collected from a waist-mounted tri-axial accelerometer while participants performed a timed up and go test. Clinically relevant variables were extracted from the segmented accelerometer signals for fitting SFBBS predictive models. Regularized regression together with random-shuffle-split cross-validation was used to facilitate the development of the predictive models for automatic balance estimation.ResultsEighty-five community-dwelling older adults (72.12 ± 6.99 year) participated in our study. Our results demonstrated that combined clinical and sensor-based variables, together with regularized regression and cross-validation, achieved moderate-high predictive accuracy of SFBBS scores (mean MAE = 2.01 and mean RMSE = 2.55). Step length, gender, gait speed and linear acceleration variables describe the motor coordination were identified as significantly contributed variables of balance estimation. The predictive model also showed moderate-high discriminations in classifying the risk levels in the performance of three balance assessment motions in terms of AUC values of 0.72, 0.79 and 0.76 respectively.ConclusionsThe study presented a feasible option for quantitatively accurate, objectively measured, and unobtrusively collected functional balance assessment at the point-of-care or home environment. It also provided clinicians and elderly with stable and sensitive biomarkers for long-term monitoring of functional balance.

Exploration of Fall-Evaluation Scores Using Clinical Tools with the Short-Form Berg Balance Scale and Timed Up and Go and Motion Detection Sensors

The results obtained by medical experts and inertial sensors via clinical tests to determine fall risks are compared. A clinical test is used to perform the whole timed up and go (TUG) test and segment-based TUG (sTUG) tests, considering various cutoff points. In this paper, (a) t-tests are used to verify fall-risk categorization; and (b) a logistic regression with 100 stepwise iterations is used to divide features into training (80%) and testing sets (20%). The features of (a) and (b) are compared, measuring the similarity of each approach’s decisive features to those of the clinical-test results. In (a), the most significant features are the Y and Z axes, regardless of the segmentation, whereas sTUG outperforms TUG in (b). Comparing the results of (a) and (b) based on the overall TUG test, the Z axis multiscale entropy (MSE) features show significance regardless of the approach: expert opinion or logistic prediction. Among various clinical test combinations, the only commonalities between (a) and (b) are the Y-axis MSE features when walking. Thus, machine learning should be based on both expert domain knowledge and a preliminary analysis with objective screening. Finally, the clinical test results are compared with the inertial sensor results, prompting the proposal for multi-oriented data analysis to objectively verify the sensor results.

Estimating Postural Stability Using Improved Permutation Entropy via TUG Accelerometer Data for Community-Dwelling Elderly People.

To develop an effective fall prevention program, clinicians must first identify the elderly people at risk of falling and then take the most appropriate interventions to reduce or eliminate preventable falls. Employing feature selection to establish effective decision making can thus assist in the identification of a patient’s fall risk from limited data. This work therefore aims to supplement professional timed up and go assessment methods using sensor technology, entropy analysis, and statistical analysis. The results showed the different approach of applying logistic regression analysis to the inertial data on a fall-risk scale to allow medical practitioners to predict for high-risk patients. Logistic regression was also used to automatically select feature values and clinical judgment methods to explore the differences in decision making. We also calculate the area under the receiver-operating characteristic curve (AUC). Results indicated that permutation entropy and statistical features provided the best AUC values (all above 0.9), and false positives were avoided. Additionally, the weighted-permutation entropy/statistical features test has a relatively good agreement rate with the short-form Berg balance scale when classifying patients as being at risk. Therefore, the proposed methodology can provide decision-makers with a more accurate way to classify fall risk in elderly people.

A Novel Approach for Fall Risk Prediction Using the Inertial Sensor Data From the Timed-Up-and-Go Test in a Community Setting

Post-stroke patients usually suffer from a higher fall risk. Identifying potential fallers and giving them proper attention could reduce their chance of a fall that results in severe injuries and decreased quality of life. In this study, we introduced a novel approach for fall risk prediction that evaluates Short-form Berg Balance Scale scores via inertial measurement unit data measured from a 3-meter timed-up-and-go test. This approach used sensor technology and was thus easy to implement, and allowed a quantitative analysis of both gait and balance. The results showed that elastic net logistic regression achieved the best performance with 85% accuracy and 88% area under the curve compared with support vector machine, least absolute shrinkage and selection operator (LASSO), and stepwise logistic regression. This paper provides a framework for using sensor-based features together with a feature-selection strategy for screening and predicting the fall risk of post-stroke patients in a convenient setup with high accuracy. The findings of this study will not only enable the assessment of fall risk among post-stroke patients in a cost-effective manner but also provide decision-making support for community care providers and medical professionals in the form of sensor-based data on gait performance.

Multiscale Entropy Analysis of Postural Stability for Estimating Fall Risk via Domain Knowledge of Timed-Up-And-Go Accelerometer Data for Elderly People Living in a Community

As people in developed countries live longer, assessing the fall risk becomes more important. A major contributor to the risk of elderly people falling is postural instability. This study aimed to use the multiscale entropy (MSE) analysis to evaluate postural stability during a timed-up-and-go (TUG) test. This test was deemed a promising method for evaluating fall risk among the elderly in a community. The MSE analysis of postural instability can identify the elderly prone to falling, whereupon early medical rehabilitation can prevent falls. Herein, an objective approach is developed for assessing the postural stability of 85 community-dwelling elderly people (aged 76.12 ± 6.99 years) using the short-form Berg balance scale. Signals were collected from the TUG test using a triaxial accelerometer. A segment-based TUG (sTUG) test was designed, which can be obtained according to domain knowledge, including “Sit-to-Walk (STW),” “Walk,” “Turning,” and “Walk-to-Sit (WTS)” segments. Employing the complexity index (CI) of sTUG can reveal information about the physiological dynamics’ signal for postural stability assessment. Logistic regression was used to assess the fall risk based on significant features of CI related to sTUG. MSE curves for subjects at risk of falling (n = 19) exhibited different trends from those not at risk of falling (n = 66). Additionally, the CI values were lower for subjects at risk of falling than those not at risk of falling. Results show that the area under the curve for predicting fall risk among the elderly subjects with complexity index features from the overall TUG test is 0.797, which improves to 0.853 with the sTUG test. For the elderly living in a community, early assessment of the CI for sTUG using MSE can help predict the fall risk.

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients

ObjectivesTo examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P. DesignData were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS. SettingMedical center. ParticipantsPatients (N=212) with first onset of stroke within 14 days before hospitalization. InterventionsNot applicable. Main Outcome MeasuresGroup-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using the bootstrap approach. ResultsThe BBS-3P and PASS-3P had good group-level (SRM, .60 and SRM, .56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual change. ConclusionsThe responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke.

Interactive visualization to assist fall-risk assessment of community-dwelling elderly people

In fall-risk assessment, clinical experts have to provide accurate assessment of high-risk individuals using vast amounts of collected data. In this article, we propose an interactive visualization approach for clinical experts to improve their interpretation of assessment scores and facilitate the decision-making process. Fall-risk assessment data on a total of 356 community-dwelling elders were collated. The Short-Form Berg Balance Scale and 3-Meter Timed Up and Go test were used to screen elderly people with high fall risks. A series of interactive visualization techniques were conducted. After grouping by the literature and a statistical 5% outlier method, some disputed elderly people were examined through interactive visualization. Finally, receiver operating characteristic analysis was conducted using previous fall experience (faller or non-faller) and the three methods. Receiver operating characteristic analysis revealed that the area under the curve was the highest (0.87, 95% confidence interval: 0.80–0.94) for the interactive visualization process compared to the other methods (literature, 0.81 (95% confidence interval: 0.71–0.90); statistical 5% outlier, 0.80 (95% confidence interval: 0.70–0.90)). Through the interactive visualization approach, the clinical experts were able to determine the screening results and their relationship with the decision boundary more rapidly and accurately, demonstrating that this approach is useful for risk assessment in the medical domain.

The effects of horse-riding simulator exercise on balance in elderly with knee osteoarthritis.

[Purpose] The aim of this study was to examine the effects of horse-riding simulator exercise on balance in elderly with knee osteoarthritis. [Subjects and Methods] Fifty elderly patients with knee osteoarthritis were recruited, a horse-riding simulator group performed exercise three times a week for eight weeks. And each exercise was performed for 30 minutes. [Results] The horse-riding simulator group showed significant differences after the intervention in Short Form Berg Balance Scale, Functional reaching test. [Conclusion] The results of this study indicate that horse-riding simulator exercise is effective on knee osteoarthritis. Therefore, horse-riding simulator exercise can be used balance training for knee osteoarthritis.

Using Wearable Accelerometers in a Community Service Context to Categorize Falling Behavior

In this paper, the Multiscale Entropy (MSE) analysis of acceleration data collected from a wearable inertial sensor was compared with other features reported in the literature to observe falling behavior from the acceleration data, and traditional clinical scales to evaluate falling behavior. We use a fall risk assessment over a four-month period to examine >65 year old participants in a community service context using simple clinical tests, including the Short Form Berg Balance Scale (SFBBS), Timed Up and Go test (TUG), and the Short Portable Mental Status Questionnaire (SPMSQ), with wearable accelerometers for the TUG test. We classified participants into fallers and non-fallers to (1) compare the features extracted from the accelerometers and (2) categorize fall risk using statistics from TUG test results. Combined, TUG and SFBBS results revealed defining features were test time, Slope(A) and slope(B) in Sit(A)-to-stand(B), and range(A) and slope(B) in Stand(B)-to-sit(A). Of (1) SPMSQ; (2) TUG and SPMSQ; and (3) BBS and SPMSQ results, only range(A) in Stand(B)-to-sit(A) was a defining feature. From MSE indicators, we found that whether in the X, Y or Z direction, TUG, BBS, and the combined TUG and SFBBS are all distinguishable, showing that MSE can effectively classify participants in these clinical tests using behavioral actions. This study highlights the advantages of body-worn sensors as ordinary and low cost tools available outside the laboratory. The results indicated that MSE analysis of acceleration data can be used as an effective metric to categorize falling behavior of community-dwelling elderly. In addition to clinical application, (1) our approach requires no expert physical therapist, nurse, or doctor for evaluations and (2) fallers can be categorized irrespective of the critical value from clinical tests.

急性期脳血管障害症例におけるShort Form Berg Balance Scaleの信頼性，妥当性の検討

急性期脳血管障害症例におけるShort Form Berg Balance Scaleの信頼性，妥当性の検討

The intra- and inter-rater reliabilities of the Short Form Berg Balance Scale in institutionalized elderly people.

[Purpose] The purpose of this study was to examine the intra- and inter-rater reliabilities of the Short Form Berg Balance Scale in institutionalized elderly people. [Subjects and Methods] A total of 30 elderly people in a nursing facility in Y city, South Korea, participated in this study. Two examiners administered the Short Form Berg Balance Scale to one subject to investigate inter-rater reliability. After a week, the same examiners administered the Short Form Berg Balance Scale once more to investigate intra-rater reliability. [Results] The intra-rater reliability was 0.83. The inter-rater reliability was 0.79. Both reliabilities were high (more than 0.7). [Conclusion] The Short Form Berg Balance Scale is a version of the Berg Balance Scale shortened by reducing the number of items, but its reliabilities were not lower than those of the Berg Balance Scale. The Short Form Berg Balance Scale can be useful clinically due to its short measurement time.

A prospective study of the responsiveness of the original and the short form Berg Balance Scale in people with stroke

Objective: The study aim was to examine the responsiveness of the Berg Balance Scale (BBS) and that of its short form (SFBBS) at both the individual person level and the group level. Design: A repeated-measurements design. Setting: Hospital and home setting. Participants: Patients with stroke. Results: Totals of 226, 202, and 168 patients with stroke were assessed with the BBS at 14, 30, and 90 days after stroke, respectively. The SFBBS data were extracted from the patients’ responses on the BBS. At the group level, the BBS and the SFBBS had sufficient and similar responsiveness. For the Rasch scores, the effect sizes of the three change scores for the BBS and the SFBBS, respectively, had similar ranges between 0.38 and 0.88 and between 0.39 and 0.85, respectively. The standardized response means of the three change scores for the BBS and the SFBBS ranged from 0.74 to 1.33 and from 0.72 to 1.13, respectively. At the individual person level, the BBS detected significant balance improvement in about twice as many patients as the SFBBS detected. Conclusion: The responsiveness of the BBS at the individual person level was better than that of the SFBBS in patients with stroke. The BBS is recommended as an outcome measure to better detect changes in individual patients.

Test–retest reproducibility of two short-form balance measures used in individuals with stroke

The aim of this study is to determine the test-retest reproducibility of the seven-item Short-Form Berg Balance Scale (SFBBS) and the five-item Short-Form Postural Assessment Scale for Stroke Patients (SFPASS) in individuals with chronic stroke. Fifty-two chronic stroke patients from two rehabilitation departments were included in the study. Both balance measures were administered twice 7 days apart. Test-retest reliability was analysed using the weighted κ (κ(w)) statistic for each item and intraclass correlation coefficients (ICC(2,1)) for the total scores of both measures. Agreement was expressed as the SEM, minimal detectable change and limits of agreement by Bland and Altman analysis. Test-retest agreements were good to very good for SFBBS and SFPASS, with weighted κ values ranging from 0.75 to 0.89 and 0.66 to 0.84, respectively. The ICCs for the total SFBBS and SFPASS scores were excellent (ICC(2,1): SFBBS=0.99; SFPASS=0.93). The SEMs for both measures were less than 10% of the score range; the minimal detectable changes of the SFBBS and SFPASS were 2.83 and 2.16, respectively, indicating that both measures had a small and acceptable measurement error. Both measures showed good reproducibility. These results indicate that the SFBBS and SFPASS are useful for clinicians and researchers for the evaluation of balance performance and to determine whether the change score of an individual with stroke is real.

Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, preexperimental, feasibility study

Objective This feasibility study was conducted to further the development of a line of investigation into the potential effects of spinal manipulation/manual therapy on cervicogenic dizziness, balance, and neck pain in adults. Methods A single-group, preexperimental, feasibility study was conducted at a chiropractic college health center and a senior fitness center with a target sample size of 20 patients (40 years or older). Patients were treated by either a clinician or a chiropractic student intern for 8 weeks. The Dizziness Handicap Inventory was the primary outcome measurement, with the Short Form Berg Balance Scale (SF-BBS) and the Neck Disability Index used as secondary outcome measurements. Results Twenty-seven patients were recruited over a period of 13 months. Twenty-one patients enrolled in the study; but because of 2 dropouts, 19 patients completed the treatment. A median Dizziness Handicap Inventory change score of +7 points was calculated for those dizziness patients, with 3 patients improving by at least 18 points, indicating a clinically meaningful change. Seven of the 15 patients who performed the SF-BBS attained at least a 4-point improvement with an effect size of 1.2. A median Neck Disability Index change score of +1 was calculated for those patients with neck pain. Twelve minor adverse reactions were reported by 8 patients, with 3 of those reactions lasting longer than 24 hours. Conclusion A large effect size was calculated for the SF-BBS. Most patients demonstrated improved balance, and some showed reduced dizziness and neck pain. Involving interns in care proved feasible. Further studies with comparison groups and larger samples are needed to explore the promising results of this study before any cause and effect relationship can be determined.

Chiropractic Care for Older Adults: Effects on Balance, Dizziness, and Chronic Pain

Objective This study is part of an avenue of research exploring the effect of chiropractic care on balance in older adults. The purpose of this study was to (1) assess the use of the 7-item version of the Berg Balance Scale, (2) explore possible effects of an 8-week course of chiropractic care on balance as measured by the 7-item Short-Form Berg Balance Scale (SF-BBS) in adults 65 years or older with impaired balance, and (3) collect preliminary information on the possible relationships of dizziness and/or chronic pain to poor balance. Methods This was a single-group, pretest/posttest design intervention study. Patients 65 years and older who could stand on one leg for less than 5 seconds were eligible. They received pragmatic chiropractic care for 16 visits for an 8-week period. Outcomes were assessed at baseline, visit 8 and visit 16 in terms of balance SF-BBS, dizziness (Dizziness Handicap Inventory [DHI]), chronic pain (Pain Disability Index), and depression (Geriatric Depression Scale). Results Sixteen patients were enrolled; 14 completed the study. There was one mild and transient adverse effect, muscle soreness, which self-resolved. One patient was depressed, and his Geriatric Depression Scale score improved significantly during the study. Of the 6 patients with significant dizziness at baseline, 3 had scores of 0 (no dizziness) on the DHI at visit 16. Patients with dizziness tended to have greater chronic pain and show greater reductions in that pain than nondizzy patients. No clinically important effects on balance as measured by the SF-BBS were apparent for the group as a whole, although 3 individual patients improved by 4 to 6 points. Conclusion The Short-Form Berg Balance Scale (SF-BBS) did not show a great deal of clinical responsiveness in this study population. The outcome measures used for chronic pain (Pain Disability Index) and dizziness (DHI) appear to be appropriate for assessing patients in future larger studies for longer periods.