Sitting Balance Research Articles

An Intensive Combination of Bobath Therapy and Core Stability Exercises Is More Effective In Improving the Sitting Balance of Cerebral Palsy Children

This research is an experimental study with a pretest – post one group design which aims to analyze the effectiveness of intensive bobath therapy and core stability exercises on sitting balance in children with Cerebral Palsy. A total of 17 Cerebral Palsy children were given bobath therapy and core stability exercises for 10 weeks, with a dose: 1 time/day, 4 times a week with a treatment time of 60 minutes for each child. The research subjects were children suffering from Cerebral Palsy with the age criteria of 1 year sitting unbalanced. Carried out from February to July 2023. Sitting balance is measured using a sitting flat scale. The research subjects consisted of 13 men (76.47%) and 4 women (23.53%) with GMFCS categories III and IV. Average age of research subjects: 36.5758 ± 15.02504. The results of the statistical test using Wilcoxon obtained a p value = 0.001. Conclusion: Bobath therapy and core stability exercises are more effective in increasing sitting level scale scores in Cerebral Palsy children.

High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit.

Considering that malnutrition (undernutrition) is common in stroke patients and may negatively impact body function, the aim of this study was to determine the relationship between nutritional risk and functional status in stroke patients at admission to a rehabilitation unit. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score. Functional status was assessed using the Barthel Index, the modified Rankin Scale, the Trunk Control Test and the Sitting Balance Scale, and cognitive function was assessed using the Short Portable Mental Status Questionnaire. C-reactive protein, fibrinogen and D-dimer were also evaluated as established prognostic biomarkers. Stroke patients (n = 245; age 69.7 ± 12.8 years; 47%, women; 82% ischemic stroke) at admission to a rehabilitation unit were included in this study. A high prevalence of nutritional risk was detected with each tool and was found to be greater using the GNRI and in patients aged ≥75 years. Multiple logistic regression analysis showed that age and dysphagia were independent predictors of high nutritional risk. High risk groups performed worse on all functional tests compared to the low-risk groups (p < 0.05). Nutritional risk with each tool was associated with functional and cognitive statuses (with the highest correlation being with the Trunk Control Test). Significant associations were also found with C-reactive protein, fibrinogen and D-dimer. In conclusion, a high nutritional risk, as evaluated with the GNRI, the PNI and the CONUT score, was detected in stroke patients at admission to a rehabilitation unit. High nutritional risk was associated with functional status and with predictors of clinical outcomes (and specifically in older patients).

Investigation of the reliability and validity of the Turkish version of the Sitting Balance Scale in individuals with stroke.

The purpose of the study was to investigate the reliability and validity of the Turkish version of the Sitting Balance Scale (SBS-T). SBS-T was tested with 60 individuals with stroke. Test-retest reliability was calculated with the Intraclass Correlation Coefficient (ICC). The Trunk Impairment Scale (TIS), Function in Sitting Test (FIST), The Berg Balance Scale (BBS), and Barthel Index (BI) were used to test the validity of SBS-T. The internal consistency of the SBS-T items was calculated with the Cronbach Alpha Analysis. Factor analysis and hypothesis testing were used for construct validity. Ceiling and floor effects were calculated for reliability. The intra-observer ICC was found to be 0.970 and the inter-observer ICC value was 0.999. The Cronbach's Alpha Coefficient was detected to be 0.955. A high correlation was detected between SBS-T and TIS, BBS, FIST, and BI (r = 0.861, p = 0.001; r = 0.849, p = 0.001; r = 0.906, p = 0.001; r = 0.848, p = 0.001, respectively). As a result of the factor analysis, it was found that the scale was determined by one single factor. No ceiling and floor effects were detected. The Turkish version of the SBS is a valid and reliable scale for predicting mobility and functionality in stroke for use in clinical and scientific studies. NCT04801927.

Inter-Rater and Intra-Rater Reliability of the Kansas University Sitting Balance Scale

Kluding et al., created The Kansas University Sitting and Standing Balance Scales (KUSSBS) in 2006 to meet the need for objective documentation of balance and for a tool without a floor effect. Rater reliabilities were established by Kluding for the standing scale, but not for the sitting balance scale (KUSitBS). The aim of this study was to establish inter- and intra-rater reliability for the KUSitBS. Four occupational therapists were recruited to rate a videotaped performance of a simulated patient. Resulting inter-rater reliability inter-class coefficients (ICC) are good, ICC = .877, p < .01, suggesting that sitting balance on the KUSitBS was rated similarly across coders. Intra-rater reliability ICC are excellent, ICC = .914, indicating that each occupational therapist rated sitting balance on the KUSitBS similarly at initial assessment and then again two weeks later. In order to have confidence in using any assessment tool, intra- and inter-rater reliability must be established. This study’s results advance the use of the KUSitBS with adult populations.

Development and validation of the sitting balance assessment for spinal cord injury (SitBASCI).

Multicentric psychometric study. The aim of this study is to introduce the development of the Sitting Balance Assessment for Spinal Cord Injury (SitBASCI) and assess its inter-rater reliability and internal consistency. The study was developed among the three Spinal Units of San Bortolo Hospital in Vicenza, Niguarda Hospital in Milan and AOU Careggi in Florence. SitBASCI is a 13-item scale developed to evaluate trunk control in individuals with SCI. Subjects were filmed while performing the 13 items of the scale. The videotapes were submitted to 25 examiners who evaluated patients' performances with the scale. The power of the study was estimated. The interclass correlational coefficient (ICC) was used to assess the inter-rater reliability of the examiner's evaluations regarding each item and the total. Cronbach's alpha was used to assess internal consistency of the scale and internal consistency of the scale on the eliminated item. The study showed to have a significant power. The inter-rater reliability for the total score was ptot = 0.997 (item's values were p = 0.876-0.998). The internal consistency of the scale was alpha = 0.925, while the internal consistency of the scale on the eliminated item was alpha = 0.912-0.930. SitBASCI had a high inter-rater reliability and internal consistency. Items had also good inter-rater reliability and item-total correlation. Therefore, SitBASCI could be proposed as a good and reliable instrument for Italian clinicians to evaluate sitting balance and trunk control in patient with SCI despite of aetiology and level of injury.

The Effect of Virtual Reality Exercise Program on Sitting Balance Ability of Spinal Cord Injury Patients.

(1) Background: Virtual reality (VR) is a useful device for rehabilitation therapy. The purpose of this study was to examine the effect of virtual reality exercise program on sitting balance with spinal cord injury; (2) Methods: 20 subjects who selected on the basis of the screening criteria were divided into the experimental group (n = 10) who underwent the virtual reality exercise program and rehabilitation therapy and the control group (n = 10) who underwent a regular sitting balance training program and a regular rehabilitation therapy. Each intervention consisted of a 30-min session a day, three times a week, for eight weeks. In order to measure functions of the sitting balance, FSA (force sensitive application) and LOS (limit of stability) were used before and after the treatment intervention; (3) Results: We found significant differences for the FSA, LOS between pre-test and post-test in the 2 groups; (4) Conclusions: The findings of this study suggest that virtual reality exercise program can be applied as a useful approach for spinal cord injury patients.

The Partial Immersion Aquatic Approach Using Adjustable Weight Bearing to Improve Posture and Sitting Balance Adaptation for Children with Severe Cerebral Palsy

The Partial Immersion Aquatic Approach Using Adjustable Weight Bearing to Improve Posture and Sitting Balance Adaptation for Children with Severe Cerebral Palsy

Validity of the Sock Test for Sitting Balance: A Functional Sitting Balance Assessment.

There is a relationship between sitting balance and self-care functioning, but no occupation-based sitting balance assessment. The objective of this study was to determine whether the Sock Test for Sitting Balance (STSB) is a valid balance assessment for use by therapists in acute care. Results of the STSB were compared with those of the Adapted Functional Reach (AFR), the Functional Independence Measure (FIM™) chair transfer, and the Kansas University Sitting Balance Scale (KUSBS), in both hospitalized and healthy participants. There is a significant relationship between STSB results and AFR results for all participants (rs = -.382, p = .012). Relationships between STSB results and score on the FIM™ Chair Transfer subscale (p = .001), and score on the KUSBS (p = .003) are significant. The STSB can differentiate between a hospitalized population and healthy population (p = .017). Criterion and known-groups validity are demonstrated, but should be confirmed with further testing.

Falls, Transfers, Wheelchair Skills And Sitting Balance Among Wheelchair and Scooter Users With Multiple Sclerosis

To investigate the correlation between fall incidence and transfer quality, wheelchair skills, and sitting balance among people with multiple sclerosis who are full-time wheelchair and scooter users by using Spearman rank correlation analysis.

Inter-Rater and Intra-Rater Reliability of the Kansas University Sitting Balance Scale

Abstract Date Presented 04/06/19 This poster summarizes the results of a study of the inter-rater and intra-rater reliability of the Kansas University Sitting Balance Scale, a tool for describing balance in an objective and measurable manner. Results of the study indicate that the tool can reliably be used by OTs to describe the sitting balance of their adult patients. Primary Author and Speaker: Ingrid Franc Additional Authors and Speakers: Magdalea Roberts Contributing Authors: Samantha Mauldin, Gregoria Rosa-Distefano

Effect of Swiss Ball Exercises on Sitting Balance and Trunk Coordination in Stroke Patients

Effect of Swiss Ball Exercises on Sitting Balance and Trunk Coordination in Stroke Patients

Abstract T P281: Facilitating Best Practices in Rehabilitation for Persons With Stroke: Use of a Triage Tool in Toronto

Background: Best practice indicates all stroke patients (including severely affected) benefit from timely and intensive rehabilitation care. Currently in Toronto 27% of patients with stroke are discharged to inpatient rehabilitation from acute care (Canadian Institute for Health Information (CIHI) 11/12). Sixty percent of admissions to rehabilitation were patients with moderate stroke, 17% mild and 22% severe CIHI (FY12-13 Q1-3). Access to rehabilitation in Toronto is not equitable as admission criteria and rehabilitation programming are not standardized for stroke. Purpose: Develop a triage tool to support clinical decision making, equitable access to care and early referral to appropriate rehabilitation based on best practice Methods Acute and rehabilitation leaders collaboratively developed the triage tool. Provincial expert panel recommendations and existing referral frameworks were considered. The AlphaFIM® tool was used as the basis for categorizing stroke severity. Agreement was reached to support automatic acceptance of patients referred to rehab with AlphaFIM® score of 60-80. The tool was implemented Feb 1, 2013. All rehabilitation organizations agreed to standardized admission criteria and are working toward best practice for stroke inpatient rehabilitation care. Results: Baseline data (January to August 2012) for patients referred with an early AlphaFIM® of 60-80 indicated only 66% were accepted to rehab, 15% were declined and 8.5% had a decision pending. For those declined, 10% were identified as having special needs that could not be met, 29% were considered more appropriate for slow stream rehab, and 14% because of limited sitting tolerance and balance. An analysis of data following implementation will be presented. Conclusion: The triage tool creates a standard of best practice for the system. Agreement on common admission criteria and standard of practice for rehabilitation referral management for patients with AlphaFIM® 60-80 have been established between referrers and rehab providers. It is expected that transition barriers for this group should be minimal unless special needs are identified.

Resource-efficient mobilization programs in the intensive care unit: who stands to win?

BackgroundFunctional outcomes can improve with early intensive care unit (ICU) mobilization programs but require additional resources. Details regarding resource allotment and methods to deliver therapy are lacking. We describe an effective team-based, resource-efficient mobility program (REMP). MethodsConsecutive admissions (November 2009 to March 2010) underwent an evaluation by a physical therapist and participation in the REMP. Sitting balance (SB), transfer from bed to chair, and ambulation were assessed on the initial evaluation and compared with ICU and hospital discharge using the Functional Independence Measure scale. ResultsTwenty-eight patients entered the REMP, and 31 patients served as controls. There were no differences in baseline characteristics or initial Functional Independence Measure scores for ambulation or SB. Bed-to-chair evaluation was higher in the controls (P < .024). Both groups improved across the 3 time periods on all measures; however, more REMP patients had a significantly improved SB at ICU and hospital discharge. ConclusionsA team-based, resource-efficient approach to early mobilization is feasible and effective in the ICU.

Normative data of Modified Functional Reach Test in younger and middle-aged North Eastern Indian population

Background and Purpose: The modified functional reach test (MFRT) is the objective measure for dynamic sitting balance. It quantifies sitting balance in two directions: Forward and lateral reach. So, the purpose of the study was to 1) provide clinical reference value and 2) examine the factors that may influence the anthropometrics measures. Materials and Methods: A total of 200 apparently healthy subjects participated in this descriptive study. All subjects were divided in two groups: Younger (20-39 yr) and middle-aged (40-59 yr). After anthropometric measurement, all subjects performed test by reaching forward and lateral with a closed fist while sitting. MFRT was taken with 3 trials with 15 sec break in between. Results: The mean score of the forward and lateral reach of right and left in group 1 was higher compared to group 2. The normative value of forward reach in group 1 was 34.05 ± 9.03 cm; for lateral reach right and left, it was 18.2 ± 5.26 cm and 17.32 ± 5.21 cm, respectively. For group 2, normative values for forward reach, lateral right and left were 25.18 ± 5.71 cm, 14.02 ± 3.98 cm and 13.53 ± 4.25 cm, respectively. There was no significant correlation of forward and lateral reach measures with the anthropometric characteristics in both the groups, except trunk length and BMI in group 1, which was significantly correlated ( P < 0.001). Conclusion: This study provides clinical reference value for younger and middle age group subjects while anthropometrics do not affect performance except trunk length and BMI in younger age group.

Effects on Cerebral Activation of Electrical Stimulation Delivered to the Posterior Neck during a Sitting Balance Task

Effects on Cerebral Activation of Electrical Stimulation Delivered to the Posterior Neck during a Sitting Balance Task

Validity of the Sitting Balance Scale in older adults who are non-ambulatory or have limited functional mobility

Objective: To determine whether the Sitting Balance Scale is an acceptable alternative to the Trunk Impairment Scale for measuring the construct of sitting balance, to examine relationships with other clinical outcomes and to establish discriminative validity. Design: Prospective descriptive methodological study. Setting: Acute care, inpatient rehabilitation, skilled nursing facility and home health. Participants: Patients receiving physical therapy (N = 98; n = 20 acute care, n = 18 inpatient rehabilitation, n = 30 skilled nursing facility, n = 30 home setting) mean (SD) age, 80.5 (7.9) years. Nineteen were non-ambulatory and 79 had limited functional mobility with Timed Up and Go scores ≥20 seconds. Main measures: Sitting Balance Scale, Trunk Impairment Scale, Timed Up and Go, length of stay and setting specific clinical measures of sitting balance (OASIS-C M1850; MDS G-3b). Results: Moderate association between ambulatory status and sitting balance measures (Sitting Balance Scale r = 0.67, Trunk Impairment Scale r = 0.61; P = 0.0001). Moderate to strong relationships between Sitting Balance Scale, Trunk Impairment Scale and clinical outcomes varying by setting. MANOVA results revealed differences between ambulators and non-ambulators and among diagnostic categories for both instruments (P < 0.001). Conclusions: The Sitting Balance Scale is comparable to the Trunk Impairment Scale for measuring sitting balance in older adults who are non-ambulatory or have limited mobility.

Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours

Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer. Despite the high incidence of neurological and functional deficits in patients affected by brain tumours (BTs), rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions. To assess functional outcome in brain tumour inpatients who underwent early rehabilitation after surgery. 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study. All patients were evaluated by means of a core set of clinical scales (Functional Independence Measure, Sitting Balance score, Standing Balance score, Hauser Index, Massachusetts General Hospital Functional Ambulation Classification). Patients were evaluated before the beginning (T0) and at the end (T1) of rehabilitation treatment. The neurorehabilitation programme consisted of individual 60-min sessions of treatment, administered once a day, six days a week, for four consecutive weeks. Speech therapy was included when aphasia was diagnosed. All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients (P = 0.000). Analysis of subgroups showed that patients affected by meningioma achieved better results (in efficiency terms) as regards independence in activities of daily living (P = 0.02) and mobility (P = 0.04) compared with patients affected by glioblastoma or stroke. Rehabilitation after surgery can improve functional outcome, justifying the delivery of rehabilitation services, even during the acute phase, to BTs inpatients, irrespective of tumour type.

Development, reliability, and validity of the Sitting Balance Scale

The Sitting Balance Scale (SBS) measures sitting balance for frail older adults who are primarily nonambulatory. Purposes were to generate items representing different functional abilities of sitting balance, reduce the number of items to make a clinically useful tool, refine the assessment, and establish reliability and validity. The study was conducted in multiple phases, with qualitative and quantitative methodologies. Content development used nominal group process, expert narratives, and literature review. After consensus was reached on content and scoring, item reduction began. Item retention and deletion decisions were based on a combination of practical considerations during field testing, expert and experienced clinician opinion of clinical relevance, and statistical information. Item retention or deletion decisions were based in part on the internal consistency analysis of the 19-item SBS based on 256 scores, which included participants who were apparently healthy and those with pathology. We applied a decision matrix to yield the final 11-item version. The 11-item SBS demonstrated good internal consistency (α = 0.762), intrarater rater reliability (ICC3,1 = 0.96 to 0.99), and interrater reliability (ICC2,1 = 0.87). On the basis of analysis of 156 scores, construct and concurrent validity were established. The SBS appears to meet the criteria required to make it a useful tool. The SBS can be used to assess sitting balance in frail individuals who are primarily nonambulatory who might exhibit floor effects for traditionally used balance measures. The SBS is the first attempt to assess lower balance abilities. Further assessment of the tool's validity with larger and varied samples is necessary.

Assessment of unsupported sitting in patients with spinal cord injury

Cross-sectional study using a consecutive sample. To modify the Motor Assessment Scale (MAS) item 3 'balanced sitting' and the Sitting Balance Score (SBS) to ensure suitability for patients with spinal cord injury (SCI), and to assess the inter-rater reliability and validity of these instruments. Spinal Care Unit, clinical setting. Unsupported sitting was tested by three physiotherapists using MAS and SBS in 48 in-patients with SCI. The validity of the scales was tested using neurological level and extent of injury according to the International Standards for Neurological Classification of Spinal Cord Injury, time since injury and the patients' function, as measured by Functional Independence Measure (FIM) item 9-13 and Five Additional Mobility and Locomotor Items (5AML). The inter-rater reliability was for MAS (k(w)=0.83-0.91) and for SBS (k(w)=0.69-0.96). The correlation between the balance scales were in relation to; neurological injury level (r(s)=0.19-0.51), extent of injury (r(s)=0.57-0.68) and the functional tests as measured by FIM items 9-13 (r(s)=0.13-0.68, highest for going up and down stairs) and 5AML (r(s)=0.10-0.49). The spread of data on the scales was poor. The inter-rater reliability of MAS and SBS was very good. The validity was little to moderate, probably because the chosen functional tests measured complex functional tasks and not only unsupported sitting. Both tests appear to be feasible in clinical settings, but will need major revisions. These results can therefore be used as a base for constructing new, better tests of unsupported sitting.

Kyphectomy Improves Sitting and Skin Problems in Patients with Myelomeningocele

Progressive kyphosis occurs in up to 20% of patients with myelomeningocele. Severely affected patients can develop recurrent skin breakdown, osteomyelitis, sitting imbalance, and poor cosmetic appearance. We (1) assessed the ability of kyphectomy to restore an intact skin envelope and allow comfortable seating in a wheelchair; (2) reviewed the complications of kyphectomy and spinal fusion in myelomeningocele; and (3) determined whether patients requiring unexpected reoperation had worse correction or more ulceration compared with those patients treated with a single surgery. We retrospectively reviewed the records of 23 children with thoracic-level myelomeningocele who were treated with kyphectomy and spinal fusion since 1980. Indications for surgery included recurrent skin breakdown (15 patients) and poor sitting balance or unacceptable cosmetic deformity (three patients). We evaluated operative technique, type of sacropelvic fixation, surgical complications, radiographic correction, and skin condition at followup. The minimum followup was 2 years (median, 4.1 years; range, 2.1-10 years); 18 of the 23 children had greater than 2 years followup and are reported here. Kyphectomy achieved a sitting balance and resolved in skin ulceration in 17 of 18 patients. Seven patients had complications requiring reoperation. Three patients had multiple reoperations for early deep infection and one patient each had reoperation for late infection, pseudarthrosis, implant-related sacral pressure sore, and planned extension of proximal fusion after growth. Patients requiring multiple operations had similar correction and relief of ulceration to those treated with a single procedure. Complications after kyphectomy are frequent and many children with myelomeningocele and severe hyperkyphosis require multiple procedures and lengthy hospital stays. Nonetheless, improved seating balance and resolution of skin problems was achieved in 17 of 18 patients.