Standing Balance Test Research Articles

Effects of a 12-Week Aerobic Exercise Program Combined with Music Therapy and Memory Exercises on Cognitive and Functional Ability in People with Middle Type of Alzheimer's Disease

Background: The Alzheimer's disease is the most common form of dementia and represents 60% of its cases. The disease is characterized by cognitive, non-cognitive and functional deficits and it’s incurable. The main of this study was to examine the effects of the aerobic exercise in combination with the music therapy and memory exercises in functional and cognitive ability on a patient with that have been affected by middle type (Second stage) of Alzheimer's disease.Methods: Thirty patients from Chronic Diseases Center, with Alzheimer's disease, divided between an intervention and a control group, participated in this randomized controlled study. (Thirty patients with Alzheimer's were chosen from chronic disease center, and are divided into an intervention and a control group). The intervention requires 30 minutes of aerobic exercise, 10 minutes of memory games and music therapy, three times a week, for the duration of 12 weeks. The outcome measures the “Mini Mental State Examination” (MMSE) scale and the “Alzheimer's Disease Assessment Scale cognitive test” (ADAS) for the cognitive ability, “Katz Index Independence in Activities of Daily Living” (ADL), “Get up and Go test” and “One leg standing balance test” (OLST) for the functionality. A three-way analysis of variance designs was applied to compare changes in each outcome measure before and after the intervention between the groups.Results: The MMSE score decrease significantly for the control group (males: 16.00 ± 4.04 to 15.14 ± 4.01 and for females: 16.00 ± 1.85 to 15.25 ± 1.98 before and after intervention) but not for the intervention group (p > 0.05) (males: 16.25 ± 2.71 to 16.12 ± 2.94 and females: 12.85 ± 2.67 to 12.57 ± 2.93). The ADAS score on intervention experimental therapy group was significantly low (males: 39.00 ± 7.98 to 37.50 ± 8.12 and females: 49.85 ± 6.54 to 48.28 ± 6.79). In the Get up and Go test (males: 18.87 ± 5.24 to 17.87 ± 4.15 and females: 19.85 ± 4.94 to 18.57 ± 4.64) and in the OLST(males: 4.57 ± 3.10 to 6.00 ± 2.77 and females: 4.00 ± 3.26 to 5.28 ± 3.40) there was a sign of progress in the results, while in the ADL no difference was observed in any group. (experimental group males: 3.50 ± 1.19 to 3.50 ± 1.19 and females: 2.57 ± 1.13 to 2.57 ± 1.13, control group males: 3.57 ± 1.51 to 3.57 ± 1.51 and females: 3.50 ± 0.75 to 3.50 ± 0.75).Conclusion: The aerobic exercise combined with the music therapy and the memory tests offer some improvement in cognitive and functional ability and contribute to the deteriorating delay of the symptoms of patients that suffer from Alzheimer and are hospitalized.

Prognostic value of physical function tests and muscle mass in elderly hospitalized patients. A prospective observational study.

To determine the prognostic value for mortality of physical function tests, muscle mass loss, disability and frailty in elderly hospitalized patients. We prospectively included 298 hospitalized patients aged >60 years (152 men and 146 women). We assessed comorbidity using the Charlson Comorbidity Index; nutrition by body mass index, midarm muscle area and subjective nutritional score; physical muscle function by handgrip strength, gait speed, standing balance and stand up test; disability using the Barthel test and activities of daily living; frailty by the clinical frailty scale and Fried frailty index; and cognitive impairment by the Pfeiffer test. We assessed 100-day and long-term mortality. We found a high prevalence of malnutrition, comorbidity, cognitive impairment, physical function impairment, disability and frailty. Mortality at 100 days was 15.1%, with a long-term median survival of 989 days. Mortality was significantly related to age, comorbidity, nutritional status, physical function, disability and frailty. Serum vitamin D3 levels were not related to mortality. Independent prognostic value for long-term mortality was shown by: (i) incapacity to carry out any of the walking, stand up and standing balance tests; (ii) male sex; (iii) aged >80 years; (iv) impaired handgrip strength or gait speed; (v) Charlson Comorbidity Index ≥1; and (6) impaired muscle mass of subjective nutritional score. In elderly hospitalized patients, there is an important role of muscle regarding prognosis, mainly related to physical function, but also and independently regarding muscle mass. Geriatr Gerontol Int 2018; 18: 57-64.

Instrumented balance and walking assessments in persons with multiple sclerosis show strong test-retest reliability

BackgroundThere is a need for objective movement assessment for clinical research trials aimed at improving gait and balance in persons with multiple sclerosis (PwMS). Wireless inertial sensors can accurately measure numerous walking and balance parameters but these measures require evaluation of reliability in PwMS. The current study determined the test-retest reliability of wireless inertial sensor measures obtained during an instrumented standing balance test and an instrumented Timed Up and Go test in PwMS.MethodsFifteen PwMS and 15 healthy control subjects (HC) performed an instrumented standing balance and instrumented Timed Up and Go (TUG) test on two separate days. Ten instrumented standing balance measures and 18 instrumented TUG measures were computed from the wireless sensor data. Intraclass correlation coefficients (ICC) were calculated to determine test-retest reliability of all instrumented standing balance and instrumented TUG measures. Correlations were evaluated between the instrumented standing balance and instrumented TUG measures and self-reported walking and balance performance, fall history, and clinical disability.ResultsFor both groups, ICCs for instrumented standing balance measures were best for spatio-temporal measures, while frequency measures were less reliable. All instrumented TUG measures exhibited good to excellent (ICCs > 0.60) test-retest reliability in PwMS and in HC. There were no correlations between self-report walking and balance scores and instrumented TUG or instrumented standing balance metrics, but there were correlations between instrumented TUG and instrumented standing balance metrics and fall history and clinical disability status.ConclusionsMeasures from the instrumented standing balance and instrumented TUG tests exhibit good to excellent reliability, demonstrating their potential as objective assessments for clinical trials. A subset of the most reliable measures is recommended for measuring walking and balance in clinical settings.

Participation Restriction in People With Multiple Sclerosis: Prevalence and Correlations With Cognitive, Walking, Balance, and Upper Limb Impairments

ObjectivesTo calculate the percentage of participation restrictions according to disability level in multiple sclerosis (MS), and to assess the relationship between participation restrictions and cognitive, gait, balance, and upper limb deficits. DesignCross-sectional study. SettingRehabilitation unit. ParticipantsParticipants (N=125) consisted of people with MS (n=105) and healthy subjects (HS; n=20). InterventionsNot applicable. Main Outcome MeasuresThe Community integration Questionnaire was used to assess participation in home, social, and productive activities. Percentages of people with MS having Community Integration Questionnaire scores lower than the 10th percentile of those of HS were calculated for each subscale to categorize the persons with participation restrictions. Cognitive deficits (Symbol Digit Modalities Test), walking disability (25-ft walking test/Expanded Disability Status Scale [EDSS]), balance disorders (Bohannon Standing Balance Test), and manual dexterity (Nine Hole Peg Test) were recorded. ResultsSeventy-seven percent of participants showed participation restrictions, which increased with higher EDSS scores from 40% (EDSS<4) to 82% (EDSS>5.5). Social participation was more restricted than home integration, with <20% of participants shopping for groceries alone. Cognitive deficits were more highly associated (r=.60) with participation restrictions than balance (r=.47), gait (r=−.45), and hand dexterity (r=.45) limitations. ConclusionsParticipation restrictions are present in MS and increase with disability level. However, the results also show that MS does not restrict participation in all domains. Participation restrictions at home are less restricted compared with social participation. Cognitive disorders are more associated with participation restrictions than physical limitations.

키넥트 센서를 이용한 고령자 대상의 선자세 균형능력 평가

Portable low-cost Kinect sensor was used to analyze standing balance ability of the elderly. Eighty subjects who can walk alone and have a normal cognitive level participated in this experiment. Based on Berg Balance scale (BBS) test with 52 points, subjects were divided into Healthy older (HO: 46 persons, BBS: 53.80 ± 1.19) and Impaired older (IO: 34 persons, BBS: 49.06 ± 2.03) group. Each subject performed 30 seconds four different standing balance tests (EO: Eyes Open, EC: Eyes Close, EOf: Eyes Open on foam, ECf: Eyes Close on foam). Five variables (Mean distance, Range of distance, Root mean square, Mean velocity, 95% ellipse area) were calculated from the hip joint center movement of Kinect sensor. Results showed that there were significant differences between groups for four different standing tests. Calculated variables from kinect sensor showed significant correlation with BBS score. Especially, mediolateral mean distance, mediolateral root mean square, mediolateral range of distance and 95% ellipse area showed discriminative ability for all tests. Mean values of variables of IO were higher than those of HO, which means the decreased balance ability in IO compared with HO. Therefore, it was possible to estimate simple balance assessment of the elderly using portable low-cost Kinect sensor.

Effect of Trunk Extensor Muscle Fatigue on Postural Stability in Healthy Young Adults

Objective: To determine the effect of trunk extensor muscle fatigue on postural stability in healthy young adults using clinical measures Design: Prospective, experimental, within subject, repeated measures design Setting: Tertiary care hospital and research centre Participants: 70 healthy adults in the age group of 20 to 25 years, volunteer sample Intervention: Fatigue of trunk extensor muscles was induced by repeated dynamic contractions performed to maximum exhaustion. Postural stability was assessed under three different conditions viz. No fatigue, Fatigue and Recovery. Main Outcome Measures: One-leg standing balance test and Functional reach test were used to assess static and dynamic postural stability respectively. Results: Wilcoxon matched-paired signed ranked test was used for comparison of postural stability in No fatigue and Fatigue condition with p-value<0.001. One-leg standing balance test showed a significant decrease from No fatigue (15.16+8.47 seconds) to Fatigue (5.89+5.7 seconds) condition. Functional reach test values showed a significant decrease from No fatigue condition (12.34+2.61 inches) to fatigue condition (12.27+2.6 inches). Mean recovery time was 12.5+3.27 minutes for One-leg standing balance test and 11.93+3.22 minutes for the Functional reach test. Further analysis using Mann Whitney test showed no significant difference (P=0.288) between the recovery time of one-leg standing balance test and functional reach test. Conclusions: Trunk extensor fatigue significantly affects static and dynamic postural stability in healthy young adults. Complete recovery takes 12.5+3.27 minutes for static and 11.93+3.22 minutes for dynamic postural stability. Results of this study stress the importance of intact trunk extensor muscle function on the regulation of static and dynamic postural stability in healthy young adults. However, more studies are required to determine the effect of trunk extensor muscle fatigue using other clinical measures and in individuals with neuromuscular disorders.

Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores.

OBJECTIVE:Stress is a condition caused by various factors and characterized by imbalance in body functioning, impair in nervous system, and tension. The purpose of this study was to examine the effects of cortisol level, which increases in healthy young individuals due to stress, on dynamic and static balance scores as well as to present the results caused by high levels of stress.METHODS:In this study, 107 healthy medicine faculty students in their second year (who will take the same committee exam) aged between 19 and 23 years were included. The first balance measurements and saliva samples were taken 40 days before the committee exam, and this period was acknowledged as the relaxed period. The same students were considered for balance measurements again on the day of committee exam; saliva samples were collected, and cortisol concentration was determined. This period was acknowledged as the stressful period. The State-Trait Anxiety Inventory (STAI) was given to the participants in their relaxed and stressful periods. Dynamic balance scores were measured with Star Excursion Balance Test (SEBT). Static balance scores were measured with One Leg Standing Balance Test (OLSBT).RESULTS:The mean cortisol level was found to increase approximately 9 times in stressful periods compared with that in relaxed periods. STAI, which shows state anxiety, showed an increase supporting this increase. In stressful periods, dynamic balance scores showed obvious decrease in all directions. In addition, in stressful periods, an obvious decrease was observed in static balance scores compared with those in relaxed periods.CONCLUSION:This study showed that stress negatively affected dynamic and static balance, even for short periods of time. We believe that our study will form a positive source and basis when correlated with long terms stress and balance measurements.

Predicting mobility outcome in lower limb amputees with motor ability tests used in early rehabilitation.

Retrospective cohort study. Persons with a lower limb amputation can regain mobility using a prosthetic device. For fast and adequate prescription of prosthetic components, it is necessary to predict the mobility outcome early in rehabilitation. Currently, prosthetic prescription is primarily based on empirical knowledge of rehabilitation professionals. In this study, we explored motor ability tests, to be completed without a prosthetic device, which have predictive value for mobility outcome at the end of rehabilitation. For this study, data of 82 patients with a lower limb amputation were included. The Single-limb standing balance test (Balance test), the Lower-Extremity Motor Coordination Test and the Amputee Mobility Predictor Assessment Tool (AMPnoPRO) were used as measures for motor ability. Mobility outcome was measured using the Timed Up and Go Test, the Two-Minute Walking Test and K levels were used. The explained variance of the Balance test, the Lower-Extremity Motor Coordination Test and the AMPnoPRO was, respectively, 0.603, 0.534 and 0.649 on the Two-Minute Walking Test (linear regression); 0.597, 0.431 and 0.624 on the Timed Up and Go Test (linear regression); and 0.432, 0.420 and 0.526 on the K levels (logistic regression). The AMPnoPRO predicted mobility outcome statistically (largest amount of explained variance). Clinical relevance This study explored the possibility of statistically predicting mobility outcome in lower limb amputees at the end of rehabilitation, using motor ability tests conducted in early rehabilitation. This study suggests the use of the AMPnoPRO to predict mobility outcome in lower limb amputees.

A pilot study to evaluate multi-dimensional effects of dance for people with Parkinson's disease

Parkinson's disease (PD) is a progressive neurodegenerative disease associated with deficits in motor, cognitive, and emotion/quality of life (QOL) domains, yet most pharmacologic and behavioral interventions focus only on motor function. Our goal was to perform a pilot study of Dance for Parkinson's—a community-based program that is growing in popularity—in order to compare effect sizes across multiple outcomes and to inform selection of primary and secondary outcomes for a larger trial. Study participants were people with PD who self-enrolled in either Dance for Parkinson's classes (intervention group, N=8) or PD support groups (control group, N=7). Assessments of motor function (Timed-Up-and-Go, Gait Speed, Standing Balance Test), cognitive function (Test of Everyday Attention, Verbal Fluency, Alternate Uses, Digit Span Forward and Backward), and emotion/QOL (Geriatric Depression Scale, Falls Efficacy Scale-International, Parkinson's Disease Questionnaire-39 (total score and Activities of Daily Living subscale)) were performed in both groups at baseline and follow-up. Standardized effect sizes were calculated within each group and between groups for all 12 measures. Effect sizes were positive (suggesting improvement) for all 12 measures within the intervention group and 7 of 12 measures within the control group. The largest between-group differences were observed for the Test of Everyday Attention (a measure of cognitive switching), gait speed and falls efficacy. Our findings suggest that dance has potential to improve multiple outcomes in people with PD. Future trials should consider co-primary outcomes given potential benefits in motor, cognitive and emotion/QOL domains.

Standing balance post total knee arthroplasty: sensitivity to change analysis from four to twelve weeks in 466 patients

Little is known about how static standing balance changes post total knee arthroplasty (TKA). The primary aim of this study was to examine the sensitivity to change and redundancy of center of pressure (COP) variables post-TKA. The secondary aim was to compare the sensitivity of these measures to standard clinical assessments of one repetition maximum knee extension strength and fast pace gait speed. 466 participants performed instrumented double-limb standing balance tests with eyes open at 4 and 12 weeks post-TKA. Measures of COP standard deviation, amplitude, root mean square (RMS), path length, detrended fluctuation analysis (DFA) and signal frequency content for the medial-lateral (ML) and anterior-posterior (AP) axes were examined. Significant decreases in total path length, ML variables related to sway velocity and AP signal complexity and frequency were observed. Inter-session Cohen's d effect size (ES) revealed the strongest effect was for high velocity ML path length, with a 12% decrease in this rapid sway. This variable, along with AP mean instantaneous frequency and AP DFA, were the only ones significantly different with effect sizes >0.20 and non-redundant (Spearman's rho <0.75). The ES of COP-derived variables (maximum=0.45) were lower than gait speed (1.40) and knee extensor strength (1.54). Increased high velocity ML sway is present at four compared to 12 weeks post-TKA. This augmented rapid sway may provide increased challenges to the postural control system at a time coinciding with reduced strength levels, which could have implications for physical function during activities of daily living.

Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing.

Backgroundfalls are a major cause of disability and death in older people. Women are more likely to fall than men, but little is known about whether risk factors for falls differ between the sexes. We used data from the English Longitudinal Study of Ageing to investigate the prevalence of falls by sex and to examine cross-sectionally sex-specific associations between a range of potential risk factors and likelihood of falling.Methodsparticipants were 4,301 men and women aged 60 and over who had taken part in the 2012–13 survey of the English Longitudinal Study of Ageing. They provided information about sociodemographic, lifestyle and behavioural and medical factors, had their physical and cognitive function assessed and responded to a question about whether they had fallen down in the last two years.Resultsin multivariable logistic regression models, severe pain and diagnosis of at least one chronic disease were independently associated with falls in both sexes. Sex-specific risk factors were incontinence (odds ratio (OR), 1.48; 95% CI, 1.19, 1.85) and frailty (OR 1.69, 95% CI 1.06, 2.69) in women, and older age (OR 1.02, 95% CI 1.04, 1.07), high levels of depressive symptoms (OR 1.33, 95% CI 1.05, 1.68), and being unable to perform a standing balance test (OR 3.32, 95% CI 2.09, 5.29) in men.Conclusionalthough we found some homogeneity between the sexes in the risk factors that were associated with falls, the existence of several sex-specific risk factors suggests that gender should be taken into account in designing fall-prevention strategies.

Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients.

BackgroundLittle is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients.Materials and methodsTwenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects’ balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group.ResultsThe COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (P<0.001), five-times sit-to-stand times (P=0.002), daily steps (P=0.003), and MV-PA (P=0.022) compared to the controls; the exception was the standing balance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (P<0.001) and between OLST times and MV-PA (P=0.014) in the COPD group after adjusting for possible confounding factors.ConclusionImpairments in balance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical inactivity.

Reliability and sensitivity to change of the timed standing balance test in children with down syndrome.

Objective:To estimate the reliability and sensitivity to change of the timed standing balance test in children with Down syndrome (DS).Methods:It was a nonblinded, comparison study with a convenience sample of subjects consisting of children with DS (n = 9) aged 8–17 years. The main outcome measure was standing balance which was assessed using timed standing balance test, the time required to maintain in four conditions, eyes open static, eyes closed static, eyes open dynamic, and eyes closed dynamic.Results:Relative reliability was excellent for all four conditions with an Interclass Correlation Coefficient (ICC) ranging from 0.91 to 0.93. The variation between repeated measurements for each condition was minimal with standard error of measurement (SEM) of 0.21–0.59 s, suggestive of excellent absolute reliability. The sensitivity to change as measured by smallest real change (SRC) was 1.27 s for eyes open static, 1.63 s for eyes closed static, 0.58 s for eyes open dynamic, and 0.61 s for eyes closed static.Conclusions:Timed standing balance test is an easy to administer test and sensitive to change with strong absolute and relative reliabilities, an important first step in establishing its utility as a clinical balance measure in children with DS.

Examining the Influence of Different Physical Activity Training on the Postural Stability of University Students

Static balance ability has a critical role in the execution of complex motor patterns as well as normal daily activities, and its efficiency could be improved by means of a regular and specific training program. In this study we investigated the relation between postural stability and different types of physical activities (PA) training among university students. Thirty-six students were enrolled and grouped into two PA categories: the Exergames category included subjects who use Nintendo Wii Balance Board gaming at least twice a week, and the Sport category included subjects who practiced sport activities at least twice a week. Subjects who did not practice structured sports or physical activities were enrolled as Control. Postural control was assessed by means of a normal standing balance test with open eyes (OE) and closed eyes (CE), respectively; a force plate was used to acquire data of the center of pressure (CoP) sway. From the CoP sway we were able to select two variables: the total displacement of sway (DOT) and the mean velocity. The mean velocity was estimated for antero-posterior (MVAP) and medio-lateral (MVML) directions, respectively. ANOVA revealed significant differences among groups for the three variables. We found that the mean of DOT and MVAP was significantly decreased in the Exergame's category compared with the others groups. Furthermore, the differences were higher for the CE than the OE test. The training programs based on the use of exergames seems to improve the postural control level of the aforementioned ability more than conventional sport training.

ABSOLUTE VARIABILITY AND RELATIVE RELIABILITY OF THE TIMED STANDING BALANCE TEST IN CHILDREN WITH DOWN SYNDROME

Background: Reliability of an instrument or clinical test should be known in the field of rehabilitation medicine. But the reliability of most of clinical test to be used among pediatric population with disabilities is yet to be known. One among them is the timed standing balance test. Aim: To determine the minimal detectable change at 95% confidence (MDC 95 )for the static and dynamic standing balance test in children with Down syndrome (DS). Methods: A sample of nine (09) children with DS, aged between 8 and 17 years were recruited randomly from the recognized special school. Children with DS who were able to understand and obey simple commands were selected and noted their anthropometric measurements. Standing balance was assessed using timed unipedal stance on a hard floor for static and on foam with uniform density for dynamic balance. Standing balance was assessed thrice with an interval of minimum two (02) days in four conditions, Eyes Open Static (EOS), Eyes Closed Static (ECS), Eyes Open Dynamic (EOD) and Eyes Closed Dynamic (ECD) to estimate test retest reliability, Intraclass correlation coefficient (ICC). Then standard error of measure (SEM) and minimal detectable change (MDC 95 ) was calculated. Results: Test retest reliability in four conditions, EOS, ECS, EOD and ECD are ICC = 0.93, 0.91, 0.92 and 0.91 respectively while 1.27 s, 1.63 s, 0.58 s and 0.61 s are the MDC 95 required in four conditions. Conclusion: Absolute variability and relative reliability of the timed standing balance test in children with DS have been established.

Reliability and concurrent validity of the Microsoft Xbox One Kinect for assessment of standing balance and postural control

The Microsoft Kinect V2 for Windows™, also known as the Xbox One Kinect, includes new and potentially far improved depth and image sensors which may increase its accuracy for assessing postural control and balance. The aim of this study was to assess the concurrent validity and reliability of kinematic data recorded using a marker-based three dimensional motion analysis (3DMA) system and the Kinect V2 during a variety of static and dynamic balance assessments. Thirty healthy adults performed two sessions, separated by one week, consisting of static standing balance tests under different visual (eyes open vs. closed) and supportive (single limb vs. double limb) conditions, and dynamic balance tests consisting of forward and lateral reach and an assessment of limits of stability. Marker coordinate and joint angle data were concurrently recorded using the Kinect V2 skeletal tracking algorithm and the 3DMA system. Task-specific outcome measures from each system on Day 1 and 2 were compared. Concurrent validity of trunk angle data during the dynamic tasks and anterior–posterior range and path length in the static balance tasks was excellent (Pearson's r>0.75). In contrast, concurrent validity for medial–lateral range and path length was poor to modest for all trials except single leg eyes closed balance. Within device test–retest reliability was variable; however, the results were generally comparable between devices. In conclusion, the Kinect V2 has the potential to be used as a reliable and valid tool for the assessment of some aspects of balance performance.

ICap: Instrumented assessment of physical capability

ObjectivesThe aims of this study were to (i) investigate instrumented physical capability (iCap) as a valid method during a large study and (ii) determine whether iCap can provide important additional features of postural control and gait to categorise cohorts not previously possible with manual recordings. Study designCross-sectional analysis involving instrumented testing on 74 adults who were recruited as part of a pilot intervention study; LiveWell. Participants wore a single accelerometer-based monitor (lower back) during standardised physical capability tests so that outcomes could be compared directly with manual recordings (stopwatch and measurement tape) made concurrently. Main outcome measuresTime, distance, postural control and gait characteristics. ResultsAgreement between manual and iCap ranged from moderate to excellent (0.649–0.983) with mean differences between methods low and deemed acceptable. Additionally, iCap successfully quantified (i) postural control characteristics which showed sensitivity to distinguish between 5 variations of the standing balance test and (ii) 14 gait characteristics known to be sensitive to age/pathology. ConclusionsOur findings show that iCap can provide robust quantitative data about physical capability during standardised tests while also providing sensitive (age/pathology) postural control and gait characteristics not previously quantifiable with manual recordings. The methodology which we propose may have practical utility in a wide range of clinical and public health surveys and studies, including intervention studies, where assessment could be undertaken within diverse settings. This will need to be tested in further validation studies in a wider range of settings.

Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness.

To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness. Case controlled. Otolaryngology clinic of a tertiary referral hospital center. Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo. Symptoms description, Dizziness Handicap Inventory-short form (DHI), Trait anxiety score, cervical joint position error, the smooth pursuit neck torsion and cervical torsion tests on videonystagmography, and standing balance test (timed 10-meter walk with head turns). The results showed differences in reported symptoms, in mean cervical joint position error (p = 0.001), and cervical torsion test (p = 0.001) between the two groups. There was no between-group difference for DHI scores (p = 0.137), trait anxiety scores (p = 0.240), and walking test: time (p = 0.797), steps (p = 0.963). The Youden index is 0.60 for the predictive value of the cervical joint position error, and the smooth pursuit and the cervical torsion tests. This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.

High heels on human stability and plantar pressure distribution

Many women wear high heeled shoes (HHS) on a daily basis to increase the femininity and attractiveness, making these shoes remain popular despite the negative effects surrounding HHS. This study aimed to investigate the effects of HHS wearing experience and heel height on human stability and foot plantar pressure distribution. Thirty young healthy women consisted of two groups, inexperienced and experienced high-heel wearers, participated in a standing balance test to measure their foot plantar pressures and stability limits when they wore shoes of four different heel heights: 0cm (flat), 4cm (low), 7cm (medium), and 10cm (high). Experimental results showed that the increased heel height shifted the force and peak pressure from the rear foot and mid foot regions to the forefoot and toe regions and the center-of-pressure location moved towards medial anterior side of the foot. Human stability limits were worsened significantly with the increased heel height, especially when it reached 7cm. HHS wearing experience provided certain advantages to the wearers on plantar pressure distributions and the limits of stability, shown by more appropriate pressure distributions and larger excursions and better directional controls in the forward and back directions.

Clinical assessment of balance in adults with concussion.

Balance is a key component to the assessment of concussion injury; however, the efficacies of clinical tests used are currently under debate. It is questionable whether currently accepted methods of standing balance assessment quantify balance disturbances sufficiently to support decisions on recovery and return to play. Recent evidence of balance abnormalities postconcussion that linger beyond the typical 3- to 5-day recovery period support arguments that currently available standing balance tests are not sensitive enough to determine recovery of function. This article discusses the current clinical tests used in the assessment of concussion in adults and their limitations and the evidence supporting continued balance dysfunction. Implications for the future of balance assessment in concussed adults and recommendations to clinicians for best practices are presented.