Tandem Stance Test Research Articles

The Relationship Between Physical Performance and Obesity in Elderly African-American Women

ABSTRACTObjective. To examine the relationship between physical performance and obesity in older African-American women. Methods. Obese (n = 45) and nonobese (n = 88) women were assessed using instrumental activities of daily living, physical function subscale of the Medical Outcomes Short Form-36, and the physical activity scale for the elderly. Physical performance was assessed by Berg Balance Scale, Tandem Stance and Single Test Stance Tests, Multidirectional Reach Test, Timed Up and Go Limb, Six-Minute Walk Test, gait stability ratio, and self-report of daily walking. Results. The obese group had significantly lower self-reported daily activities and poorer scores on several physical performance measures than nonobese older African-American women. Conclusions. Our findings substantiate a relationship between obesity and physical performance in African-American women. Although urban obese women have poorer physical performance, their impairments may be counterbalanced by their daily walking. Clinicians should consider this finding when developing rehabilitative and preventive strategies for older obese African-American women.

Peripheral arterial disease, diabetes and postural balance among elderly Finns: a population-based study

Little is known about the role of peripheral arterial disease (PAD) in the development of balance impairment. The aim of this study was to assess postural balance among people having PAD or PAD combined with diabetes. As part of the comprehensive health examination of the Health 2000 survey (two-stage stratified cluster sampling), 1323 people aged 65 years or older took part in balance assessments using a force platform system. The presence of PAD was confirmed with data from the National Hospital Discharge Registry. Individuals with hospitalization due to PAD were regarded as having severe disease, whereas those with solely self-reported diagnosis were considered possible cases. Diabetes was ascertained on the basis of self-reported physicians' diagnoses subsequently confirmed in a clinical examination. Forty-five (3.4%) individuals had previously been hospitalized due to PAD, and 32 (2.4%) reported that they had been diagnosed with the disease. 413 (31%) participants had diabetes. Compared with people without PAD, those with confirmed diagnoses exhibited significantly increased movement of the center of pressure while standing, indicating deteriorated balance. Those with possible PAD formed an intermediate group. Diabetes exacerbated the deterioration in balance, but the interaction term between PAD and diabetes did not reach statistical significance. The risk of failing tandem stance tests was over three-fold (OR 3.20, 95% CI 1.09-9.37) among those with confirmed PAD and almost one and a half-fold (OR 1.44, 95% CI 1.07-1.93) among those with diabetes, in comparison to those without these diseases. Individuals over 65 years of age with severe PAD showed increased balance impairment, a known risk factor for falls and disability in aged people. Diabetes affected balance somewhat less than PAD, but there was no formal evidence of the synergetic effect of the two diseases. Additional studies are indicated to reveal the possible effect of proper treatment of PAD and diabetes, combined with suitable training interventions on slowing down the progression of balance impairment.

Evaluation of postural stability in patients wit unilateral vestibular hypofunction: effect of feet orientation

ObjectiveTo investigate effect of feet orientation on the evaluation of the postural stability in patients with unilateral vestibular hypofunction (UVH) by timed standing tests and static posturography (SPG). Methods65 subjects with UVH and 92 healthy subjects regarded as control group took the postural stability tests in four different stances including(1) standard Romberg test, (2) feet–apart stance test, (3) tandem and (4) unilateral standing tests. In each stance, the postural stability was measured in both eyes open (EO) and eyes closed (EC) conditions. The average time that subjects kept balance before falling in each test conditions was recorded by stopwatch as the timed result. In addition, the sway velocity (SV) of center of foot pressure in the upright stance during standard Romberg test and feet apart stance, regarded as postural stability, was also recorded as SPG. Results(1) The balance–maintaining time of the UVH group in tandem and unilateral standing with EO and EC was decreased(P<0.001) compared with the control group. (2) The SVs during standard Romberg test and foot–apart stance with EO were not different between the UVH group and control group (P = 0.118 and 0.110 respectively), but significant with EC condition (P < 0.001). (3) For both groups, the SV during foot–apart standing was shorter than standard Romberg test both with EO and EC(P<0.05 and P < 0.001). (4) There was no correlation between the balance time and SV for either groups (P >0.05). ConclusionsThe results suggest that the tandem and unilateral stance tests may provide additional information about the upright stance to the SPG measurement in patients with UVH. The effect of feet orientation on SPG measurements should be considered.

Tai Chi improves balance and mobility in people with Parkinson disease

This pilot study examines the effects of Tai Chi on balance, gait and mobility in people with Parkinson disease (PD). Thirty-three people with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi group participated in 20 1-h long training sessions completed within 10–13 weeks; whereas, the control group had two testing sessions between 10 and 13 weeks apart without interposed training. The Tai Chi group improved more than the control group on the Berg Balance Scale, UPDRS, Timed Up and Go, tandem stance test, six-minute walk, and backward walking. Neither group improved in forward walking or the one leg stance test. All Tai Chi participants reported satisfaction with the program and improvements in well-being. Tai Chi appears to be an appropriate, safe and effective form of exercise for some individuals with mild–moderately severe PD.

Temporal Changes in Postural Sway Caused by Ultrashort-Acting Hypnotics: Triazolam and Zolpidem

Two ultrashort-acting hypnotics, triazolam 0.25 mg and zolpidem 10 mg, were studied for their effects on equilibrium function in humans. Eight healthy male subjects participated in a double-blind, placebo-controlled study after informed consent. They subjected to static equilibrium tests, oculomotor tests and an assay of drug concentrations in the blood. Zolpidem was statistically significant in postural sway in tandem stance test, as defined by parametric values of tracing sum length and polygonal area of foot pressure center measured by a gait analysis system. In the tandem stance test, triazolam was statistically significant in postural sway only as defined by the polygonal area. However, in the Romberg test, the only statistically significant difference in zolpidem use was observed in polygonal area values. Blood concentrations of triazolam and zolpidem were found to closely correlate with the extent of postural sway in both tandem stance and Romberg tests. In this study, zolpidem with minimal muscle-relaxant effect incurred imbalance more extensively than triazolam, which is known for its effect of muscle relaxation. In addition, gaze deviation nystagmus was observed only in zolpidem use in 5 of 8 subjects (62.5%). From these results, it is suggested that in the use of hypnotics, sway derives from the suppression of the central nervous system relevant to awakening rather than from muscle relaxation. The prior reference to blood concentrations of hypnotics should help improve safety care in minimizing loss of balance control and possible fall.

Standing balance in persistent whiplash: a comparison between subjects with and without dizziness

Dizziness and unsteadiness, associated with altered balance, are frequent complaints in subjects suffering persistent whiplash associated disorders. Research has been inconclusive with respect to possible aetiology. This study assessed balance responses in subjects with whiplash associated disorders, taking into account several possible causes. A prospective, 3 group, observational design. 100 subjects with persistent whiplash associated disorders, 50 complaining of dizziness, 50 not complaining of dizziness and 50 healthy controls. The Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance. The sway trace was analysed using wavelet analysis. The results indicated that the energy of the sway signal for comfortable stance tests was significantly greater in the group with dizziness compared with the group without dizziness. In the group without dizziness the energy was greater than controls for all tests, but significantly different on selected tests. In selected tandem stance tests, subjects with dizziness were significantly less able to complete the test than subjects without dizziness and controls. These deficits could not be attributed to medications, compensation, anxiety or age and are likely to be due to disturbances to the postural control system possibly originating from abnormal cervical afferent input.

Is the method of signal analysis and test selection important for measuring standing balance in subjects with persistent whiplash?

Dizziness and or unsteadiness, associated with episodes of loss of balance, are frequent complaints in those suffering from persistent problems following a whiplash injury. Research has been inconclusive with respect to possible aetiology, discriminative tests and analyses used. The aim of this pilot research was to identify the test conditions and the most appropriate method for the analysis of sway that may differentiate subjects with persistent whiplash associated disorders (WAD) from healthy controls. The six conditions of the Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance in 20 subjects with persistent WAD compared to 20 control subjects. The analyses were carried out using a traditional method of measurement, total sway distance, to results obtained from the use of wavelet analysis. Subjects with WAD were significantly less able to complete the tandem stance tests on a firm surface than controls. In comfortable stance, using wavelet analysis, significant differences between subjects with WAD and the control group were evident in total energy of the trace for all test conditions apart from eyes open on the firm surface. In contrast, the results of the analysis using total sway distance revealed no significant differences between groups across all six conditions. Wavelet analysis may be more appropriate for detecting disturbances in balance in whiplash subjects because the technique allows separation of the noise from the underlying systematic effect of sway. These findings will be used to direct future studies on the aeitiology of balance disturbances in WAD.

Performance on clinical tests of balance in Parkinson's disease.

Due to the high incidence of falls in people with idiopathic Parkinson's disease (PD), the assessment of standing balance is a key component of physical therapist evaluation. This study investigated performance on clinical tests of standing balance in subjects with and without PD. The subjects were 10 persons with PD who had a history of falls (age range = 60-80 years), 10 persons with PD who had no history of falls (age range = 63-79 years), and 10 persons with no known neurological impairment (age range = 60-78 years) who served as a comparison group. Subjects were tested on their ability to maintain stability in 3 conditions: (1) steady standing (feet apart, feet together, tandem stance, step stance, and single-limb stance), (2) in response to perturbations generated by self-initiated movements (arm raise, functional reach, bend-reach, and step tests), and (3) in response to an external perturbation to upright stance (shoulder tug). Balance was measured at peak dosage in the levodopa medication cycle (in the morning) and 7 days later. The mean Hoehn and Yahr Disability Scale score was 3.0 for the fallers with PD and 2.5 for the nonfallers with PD. Performance on the tandem stance, single-limb stance, functional reach, and shoulder tug tests demonstrated differences between the subjects with PD and the comparison group and between the fallers and nonfallers with PD. The results of these tests were highly repeatable over 7 days (ICC = .61-.94). Although there was a small sample size, performance was highly consistent across 7 days when testing occurred during peak dosage of levodopa. A small battery of tests were sensitive enough to discriminate between people with PD who fall and those with no history of falls.

Evaluation of relaxation states by brain mapping

Dual tasking is frequently impaired in Multiple Sclerosis (MS), substantially impairing quality of life (QoL). We aimed to examine the effects of motor-motor and motor-cognitive tasks on balance in highly mobile patients with relapsing-remitting MS (RRMS), with mild disability.Thirty-eight patients and 34 controls were included. Steady Stance Test (SST), Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC) were used to evaluate the balance. Expanded Disability Status Scale (EDSS), Mini-mental State Examination (MMSE), Beck Depression Inventory (BDI) and Fatigue Impact Scale (FIS) were used to evaluate disability, cognitive impairment, depression and fatigue, respectively.BBS and ABC scores were significantly different between the groups. Also, balance was significantly impaired in patients. Eyes-open left single stance test was the most efficient test to reveal the balance impairment in RRMS patients independent of dual-task. Physical component of FIS affected this test independent of age and BMI. Visual input significantly increased the stance durations in majority of SST, especially in tough stance positions with reduced balance area. However, visual input during dual-tasking impaired the balance. In addition, eyes-closed left tandem stance test with MM dual task significantly improved the balance in patients. BBS was significantly correlated with EDSS(r: −0.336), ABC(r: 0.688), FIS physical subgroup(r: −0.614) and FIS social subgroup(r: −0.475).Dual-tasking improves balance and increases QoL in patients with RRMS. Eyes closed balance treatment with motor-dual task could be beneficial.