Tandem Stance Research Articles

Ab. No. 67 Comparative Analysis of Postural Stability in School-Aged Children With Hearing Loss Versus Typical Hearing: A Cross-Sectional Study

Introduction: To compare postural stability between children with hearing loss and age & gender matched children with typical hearing. Postural control is described as the ability of an individual to remain comfortably in a standing position, keeping his/her body stable and aligned against any external force. As the vestibular system is one of the sensory system responsible for regulating the postural control, these children may have reduced/poor postural control when compared to children with normal hearing. Methods: The study enrolled a convenient sample of 100 children (aged 7-18 years) into two groups: 50 with hearing loss and 50 with normal hearing. Children in the hearing-impaired group were included if they had sign language proficiency. Children with any musculoskeletal deformity of lower limb were excluded from both groups. A cross sectional observational study was conducted among two groups of children (a) hearing loss (b) normal hearing using Balance Error Scoring System. The subjects were instructed about all the six tasks (i) Double support (ii) One leg standing (iii)Tandem stance and each task was performed with closed eyes on ground and foam respectively. Statistical analysis was done using SPSS 20. For between group analysis Mann-Whitney U Test was applied. Result: Statistical significant difference was noted in all the components of BESS scale with the p<0.05 except double support (on ground) component with p>0.05. Conclusion: Children with hearing loss presented with more instability in postural control than children with normal hearing of same age and gender. Implication: The study suggests that children with hearing loss have postural instability but their daily activities are not hampered because of masking of vestibular deficits, thus training the other two sensory systems (visual & somatosensory) should be focused on to avoid any anticipatory falls.

Immediate Effect of Wearable Balance Training Device on Muscle Co-Contraction and Postural Control During Standing.

Postural control is one of the primary body functions for fall prevention. Unexpected perturbation-based balance training is effective for improving postural control. However, the effect of perturbation-based training using assistive devices on muscle activity and co-contraction for standing balance is still unclear. This training is also difficult to perform easily because it requires large instruments or expert guidance. The purpose of this study is to demonstrate the effect of perturbation-based balance training using a wearable balance training device (WBTD) on postural control. In this study, fourteen healthy young adult males were assigned to either a WBTD group or a sham group. In the intervention session, participants in the WBTD group were perturbed either left or right direction at random timing by the WBTD during tandem stance balance training. Participants in the Sham group did not receive external perturbation during tandem stance balance training. Before and after the intervention session, participants of both groups underwent unexpected lateral perturbation postural control testing (pre- and post-test). The normalized integral of electromyography (IEMG), co-contraction index (CCI), and center of pressure (COP) parameters were measured in the pre- and post-test. Experimental results showed that the WBTD group in the post-test significantly decreased left Gluteus Medius IEMG, CCI of both Gluteus Medius, and peak [Formula: see text] velocity, compared to those of the pre-test ( [Formula: see text], p =0.024 , p =0.031 , respectively). We conclude that balance training using WBTD could improve flexible postural control adjustment via cooperative muscle activation.

EFFECT OF MANIPULATION OF BASE OF SUPPORT ON CENTER OF PRESSURE: COMPARISON OF CHILDREN WITH AND WITHOUT INTELLECTUAL DISABILITY

The postural control (PC) of children with intellectual disabilities (ID) have been extensively studied; however, there is limited information available on the role of PC strategies during manipulated balance conditions. The aim of this study is to investigate the effect of manipulation of the base of support on the center of pressure in the children with and without intellectual disabilities. This study included 34 girls with mild intellectual disabilities and 30 typically developing children of the same sex and age (7-13 years old). The participants as stood as still on a platform and completed four tasks: feet-together on a firm surface, feet-together on a foam surface, tandem stance on a firm surface, and tandem stance on a foam surface. The displacement, sway, amplitude, root mean square (RMS), velocity, and acceleration of the center of pressure (CoP) were calculated. The results indicate significant differences between the two groups in spatial variables of CoP movement (p < 0.05). Moreover, sway and amplitude were found to be sensitive to changes in surface factors (p < 0.05) and all variables to be sensitive to changes in stance position. There was significant interaction of stance*group in CoP velocity (p < 0.05). Based on the results, children with intellectual disabilities demonstrated poorer postural control than the control group, particularly in more demanding PC tasks. However, the quantitative variables of CoP were less impacted by ID characteristics compared to spatial variables. Accordingly, it is suggested that the role of effective balance training on improving postural control strategies in ID children be investigated in future studies.

PREDICTING FALLS IN OLDER ADULTS

Abstract Falls are detrimental to older adults causing injury and mortality. Although clinical assessments of balance deficits exist, it is not well understood how well they predict falls. Longitudinal analysis utilized data from 688 men and women aged 60-97 enrolled in the Baltimore Longitudinal Study of Aging with index and subsequent visits approximately 1.7 years apart. Inclusion criteria included objective balance assessment at index visit and answering the question “Have you fallen in the past 12 months?” at both visits. Predictors of interest included thigh muscle strength, progressive static balance test performance, narrow walk, and sway reference with eyes closed/feet together. Tests were parameterized using validated methods. Adjusted logistic regression was modeled to estimate the association between objective measures of balance and fall risk. Adjustment variables included age, sex, race, height, and weight. Results reported those who failed the eyes closed/feet together position had 3.6 (95% CI 1.03, 12.81) times the odds of future falls compared with those who passed. Those who failed the semi-tandem, tandem, and single leg stance, had respectively 3.1 (1.44, 6.75), 3.6 (1.59, 8.06) and 4.8 (1.93, 12.09) times greater odds of history of falls compared with those who did not fail. Progressive standing balance performance did not predict future falls. The eyes closed/feet together test is easily administered, requires no equipment, and takes less than 30 seconds to complete. Failure of eyes closed/feet together may predict future falls, which is clinically relevant as this may suggest shifting the momentum towards proactively preventing an initial fall.

Comparison of different methods used in balance evaluation in children with diparetic cerebral palsy

ABSTRACTPurposeIn this study, we aimed to investigate the validity and reliability of Single Leg Stance (SLS), Tandem Stance (TS) and Pediatric Reach Tests (PRT) in children with Cerebral Palsy (CP).MethodsFifty-three children (31 boys, 22 girls, age:3-15 years, Gross Motor Function Classification System (GMFCS) Level I- II with diparetic CP were included the study. SLS, TS, PRT test used for balance evaluations. SLS test was made by standing on dominant (D) and non-dominant (ND) extremity both eyes opened (EO) and closed (EC).ResultsThe mean age of childrens were 7.88±3.43 years. The Cronbach’s - coefficients of all tests used to evaluate the internal consistency were found to excellent to acceptable level. SLS-D with EO/ EC, SLS-ND with EO/ EC and TS with EO had strong correlation, TS with EC and PRT-Forward moderate correlation, PRT-Right and eft low correlation with GMFCS. All tests except PRT-Right and PRT-Left were discriminate balance ability between GMFCS level I and level II (AUC>0.800).ConclusionIn this study, we used SLS, TS, PRT for balance evaluations and we investigated reliability and validity (construct and predictive) of each balance tests in childeren with diparetic CP. All tests were sensitive in distinguishing between GMFCS levels I and II, except PRT-Right and PRT-Left. As a result of the study, it was determined that the tests were valid and reliable, suggesting that physiotherapists will provide clinical advantage in order to quickly learn about the balance of children with CP.

Impact of Preparticipation Hypohydration on Cognitive Performance and Concussion-like Symptoms in Recreational Athletes.

Sports-related concussion is a relevant risk of contact sports, with several million cases per year worldwide. Prompt identification is crucial to prevent complications and late effects but may be impeded by an overlap with dehydration-associated impairment of cognitive function. Researchers have extensively studied the effects of pronounced dehydration in endurance sports, especially in the heat. However, little is known about the effects of isolated and mild dehydration. Healthy recreational athletes underwent a standardized fluid deprivation test. Hypohydration was assessed by bioelectrical impedance analysis (BIA) and laboratory testing of electrolytes and retention parameters. Participants underwent cardiopulmonary exercise testing (CPET) with a cycle ramp protocol. Each participant served as their own control undergoing CPET in a hypohydrated [HYH] and a euhydrated [EUH] state. Effects were assessed using a shortened version of Sport Concussion Assessment Tool 3 (SCAT3). Fluid deprivation caused a mild (2%) reduction in body water, resulting in a calculated body mass loss of 0.8% without alterations of electrolytes, serum-osmolality, or hematocrit. Athletes reported significantly more (1.8 ± 2.2 vs. 0.4 ± 0.7; p < 0.01) and more severe (4.4 ± 6.2 vs. 1.0 ± 1.9; p < 0.01) concussion-like symptoms in a hypohydrated state. Balance was worse in HYH by trend with a significant difference for tandem stance (1.1 ± 1.3 vs. 0.6 ± 1.1; p = 0.02). No relevant differences were presented for items of memory and concentration. Mild dehydration caused relevant alterations of concussion-like symptoms and balance in healthy recreational athletes in the absence of endurance exercise or heat. Further research is needed to clarify the real-life relevance of these findings and to strengthen the differential diagnosis of concussion.

Difficulties encountered in testing, scoring, and interpreting balance performance in older adults using clinical evaluation tools: a cross-sectional study

Abstract Background: Balance impairment is one of the primary intrinsic risk factors contributing to falls in older adults. Prior research has consolidated the prevalent clinical tools for detecting balance issues in this demographic. Nevertheless, only a few studies have recognized the constraints associated with current balance assessment methods. Materials and Methods: The current research was initiated due to a shortage of comprehensive knowledge concerning the hurdles clinicians faced when interpreting balance test results and the obstacles older adults encountered while undertaking these assessments. The methodology involved assessing the static and dynamic balance capabilities of 661 older individuals through tests including the four stage balance test (FSBT), star excursion balance test (SEBT), Four Square step test (FSST), timed up and go (TUG) test, and Tinetti performance-oriented mobility assessment (TPOMA). Results: All older adults were able to complete the TUG and TPOMA tests. . Fifteen percent encountered difficulty completing the entire FSBT; however, they managed to execute the initial two stages of this test. Additionally, 5% of older adults who utilized walking aids could not complete the FSST. Thirty four percent of young-old individuals and 56.3% of old-old individuals were unable to execute the SEBT in posterior directions. Moreover, 1% of 60-64-year-old and 2% of &gt;/75-year-old individuals were unable to perform SET in all 8 directions. Conclusion: TPOMA and TUG emerged as the most suitable clinical assessment tool for older adults. Within the FSBT, maintaining tandem and one-leg stance positions posed challenges, whereas the SEBT proved to be the most demanding dynamic balance test for older adults. These current findings will aid clinicians in selecting the most suitable balance assessment tool for routine clinical evaluations of older adults.

Effects of the BalanCI on Working Memory and Balance in Children and Young Adults With Cochleovestibular Dysfunction.

This study aimed to: (1) determine the interaction between cognitive load and balance in children and young adults with bilateral cochleovestibular dysfunction who use bilateral cochlear implants (CIs) and (2) determine the effect of an auditory balance prosthesis (the BalanCI) on this interaction. Many (20 to 70%) children with sensorineural hearing loss experience some degree of vestibular loss, leading to poorer balance. Poor balance could have effects on cognitive resource allocation which might be alleviated by the BalanCI as it translates head-referenced cues into electrical pulses delivered through the CI. It is hypothesized that children and young adults with cochleovestibular dysfunction will demonstrate greater dual-task costs than typically-developing children during dual balance-cognition tasks, and that BalanCI use will improve performance on these tasks. Study participants were 15 typically-developing children (control group: mean age ± SD = 13.6 ± 2.75 years, 6 females) and 10 children and young adults who use bilateral CIs and have vestibular dysfunction (CI-V group: mean age ± SD=20.6 ± 5.36 years, 7 females). Participants completed two working memory tasks (backward auditory verbal digit span task and backward visuospatial dot matrix task) during three balance conditions: seated, standing in tandem stance with the BalanCI off, and standing in tandem stance with the BalanCI on. Working memory performance was quantified as total number of correct trials achieved. Postural stability was quantified as translational and rotational path length of motion capture markers worn on the head, upper body, pelvis, and feet, normalized by trial time. Relative to the control group, children and young adults in the CI-V group exhibited poorer overall working memory across all balance conditions ( p = 0.03), poorer translational postural stability (larger translational path length) during both verbal and visuospatial working memory tasks ( p < 0.001), and poorer rotational stability (larger rotational path length) during the verbal working memory task ( p = 0.026). The CI-V group also exhibited poorer translational ( p = 0.004) and rotational ( p < 0.001) postural stability during the backward verbal digit span task than backward visuospatial dot matrix task; BalanCI use reduced this stability difference between verbal and visuospatial working memory tasks for translational stability overall ( p > 0.9), as well as for rotational stability during the maximum working memory span (highest load) participants achieved in each task ( p = 0.91). Balance and working memory were impaired in the CI-V group compared with the control group. The BalanCI offered subtle improvements in stability in the CI-V group during a backward verbal working memory task, without producing a negative effect on working memory outcomes. This study supports the feasibility of the BalanCI as a balance prosthesis for individuals with cochleovestibular impairments.

The effects of a single bout of high-intense strength exercise on cognitive function and postural dual-task control in older adults

ABSTRACT In this study we aimed to test if acute strength exercise would induce cognitive improvements. Secondarily, we examined the relationship between exercise-induced changes in cognitive function and postural dual-task control. Thirty-seven cognitively intact, non-faller older adults (≥60 years) were nonrandomly allocated to strength exercise or control. Strength exercise consisted of Smith machine squats (one session, 3 × 3reps at 90%, 95%, and 100% one-repetition maximum). Control participants held seated rest for 45 min. Cognitive functions, recognition (memory search), working memory (mathematical processing), processing speed (2-choice reaction time), and postural dual-task control were tested before and immediately after exercise or control using the Automated Neuropsychological Assessment Metrics-4 (ANAM4) battery and a mathematical counting task while maintaining a tandem Romberg stance with eyes open on a force plate. Outcome measures were response time and performance index (100 × [accuracy/response time]) on the ANAM4 tests and sway activity and entropy during the postural dual-task. We found a non-significant improvement with moderate effect size in performance index on the mathematical processing task of experimental participants compared to control participants (p = 0.145, = 0.060). Improvements in the mathematical processing task over time in the control group were associated with increased sway activity during the postural dual-task. No significant associations were found between changes in cognitive function and changes in postural control in the experimental group. Ultimately, our results may direct researchers and healthcare professionals in designing the optimal exercise treatment to improve cognitive function and postural control in older adults.

Effects of flooring on static and dynamic balance in young and older adults

BackgroundReducing fall-related injuries is difficult due to the multi-factorial nature of falls, and challenges in implementing injury-preventative strategies. While safety floors are effective at absorbing energy and reducing fall-related impact forces, the low stiffness component of these floors may impair an individual’s balance and mobility, thereby increasing fall risk. Research question: Therefore, the objective of this study was to investigate the influence of compliant flooring (i.e., safety flooring) on balance and mobility in young and older adults. Methods: Kinematics were measured with inertial measurement units from 20 young and 10 older adults. Static balance was evaluated during quiet stance on three flooring surfaces (traditional, safety, foam) with three stance positions (regular, tandem, one-legged). Mobility was evaluated using the 3 m timed-up-and-go test on two flooring surfaces (traditional, safety). Results: All participants were able to complete quiet standing trials on normal and safety flooring surfaces; however, most older adults could not complete one-legged stance trials or standing on foam. Significant age-related effects were observed for several balance and mobility tasks, particularly during the more challenging tandem stance condition, and the dynamic timed-up-and-go mobility test. In contrast, the introduction of safety flooring (compared to traditional flooring) had limited effects on balance/mobility (1 of 16 outcome variables showed negative effects). Significance: Overall, the findings demonstrate minimal effects of a novel safety floor compared to the age-related differences, and provide insights to assist researchers, consumers, and industry stakeholders in the development of environments that support safe movement and maintained independence for older adults.

Practice walking on a treadmill-mounted balance beam modifies beam walking sacral movement and alters performance in other balance tasks.

The goals of this study were to determine if a single 30-minute session of practice walking on a treadmill mounted balance beam: 1) altered sacral marker movement kinematics during beam walking, and 2) affected measures of balance during treadmill walking and standing balance. Two groups of young, healthy human subjects practiced walking on a treadmill mounted balance beam for thirty minutes. One group trained with intermittent visual occlusions and the other group trained with unperturbed vision. We hypothesized that the subjects would show changes in sacrum movement kinematics after training and that there would be group differences due to larger improvements in beam walking performance by the visual occlusions group. We also investigated if there was any balance transfer from training on the beam to treadmill walking (margin of stability) and to standing static balance (center of pressure excursion). We found significant differences in sacral marker maximal velocity after training for both groups, but no significant differences between the two groups from training. There was limited evidence of balance transfer from beam-walking practice to gait margin of stability for treadmill walking and for single leg standing balance, but not for tandem stance balance. The number of step-offs while walking on a narrow beam had the largest change with training (partial η2 = 0.7), in accord with task specificity. Other balance metrics indicative of transfer had lower effect sizes (partial η2<0.5). Given the limited transfer across balance training tasks, future work should examine how intermittent visual occlusions during multi-task training improve real world functional outcomes.

Effects of arm movement strategies on emotional state and balance control during height-induced postural threat in young adults

BackgroundIt is firmly established that postural threat seems to lead to an increased reliance on an ankle control (‘stiffening’) strategy. However, little is known about how postural threat affects performance in challenging tasks that require the use of upper body postural control strategies for stability. It is logical to assume that in such conditions, being able to utilise an upper body strategy may reduce the reliance on such ankle stiffening strategy. Research questionThe objective of this study was to determine how arm movement influences balance control during a challenging balance task performed under conditions of postural threat. MethodsThirty young adults (mean ± SD age; 22.0 ± 4.0 years) balanced in tandem stance whilst standing at both ground-level (no threat) and 0.8 m above ground (threat). In both conditions, participants performed the task under two different arm positions: restricted arm movements and free arm movements. Postural sway amplitude and frequency were calculated to infer postural stiffening response. Self-reported emotional responses were quantified by assessing balance confidence, fear of falling, perceived stability, and conscious balance processing. ResultsIndependent of arm movements, postural threat evoked an increase in fear of falling and conscious balance processing, and reductions in balance confidence and perceived stability. These threat-related changes in emotional state were further amplified when arm movements were restricted. Whilst significant increases in sway frequency during threat were observed in both arm conditions, reductions in sway amplitude were only observed during the restricted arm movement condition. SignificanceWe propose that these responses likely reflect a fear-related cautious strategy intended to reduce the postural destabilisation associated with individuals being unable to use their arms to counter any destabilisation, as would normally be the case in daily life.

The relationship of multifidus and gastrocnemius muscle thickness with postural stability in patients with ankylosing spondylitis.

This study aimed to investigate potential changes in the thickness of the multifidus and gastrocnemius muscles and to demonstrate the association of muscle thickness with postural stability in ankylosing spondylitis (AS) patients. The cross-sectional observational study enrolled 32 AS patients (23 males, 9 females; mean age: 39.4±7.2 years; range, 18 to 65 years) diagnosed according to the modified New York criteria and 32 healthy controls (22 males, 10 females; mean age: 36.6±7.5 years; range, 18 to 65 years) between April 2017 and October 2018. Plantar center of pressure (CoP) excursions were recorded using a pressure platform to evaluate postural stability. The thickness of the lumbar multifidus and gastrocnemius muscles was measured using ultrasound. Patients with AS showed reduced muscle thickness at the multifidus (p<0.05) muscle and medial gastrocnemius (p=0.002) and lateral gastrocnemius (p=0.002) muscles compared to controls. Increased CoP excursions were observed only in the anteroposterior direction in the double-leg (standard) stance with the eyes closed (p=0.003) and in both anteroposterior and mediolateral directions in tandem and single-leg stances (all p<0.05). Center of pressure excursions in standard stance with the eyes closed were negatively correlated with all muscle thickness values (all p<0.05). In the single-leg stance, CoP excursions were negatively correlated with muscle thickness of medial gastrocnemius (p=0.008) and lateral G (p=0.016) muscles. Early planning of exercise programs taking muscle loss into account can help improve balance and thereby prevent falls and fractures in AS patients.

Principal component analysis of whole-body kinematics using markerless motion capture during static balance tasks

Balance tests have clinical utility in identifying balance deficits and supporting recommendations for appropriate treatments. Motion capture technology can be used to measure whole-body kinematics during balance tasks, but to date the high technical and financial costs have limited uptake of traditional marker-based motion capture systems for clinical applications. Markerless motion capture technology using standard video cameras has the potential to provide whole-body kinematic assessments with clinically accessible technology. Our aim was to quantify poses and movement strategies during static balance tasks (tandem stance, single limb stance, standing hip abduction, and quiet standing on foam with eyes closed) using video-based markerless motion capture software (Theia3D) and principal component analysis to examine the associations with age, body mass index (BMI) and sex. In 30 healthy adults, the mean poses for all balance tasks had at least one principal component (PC) that differed significantly by sex. Age was significantly associated with the PC describing leg height for the hip abduction task and erect posture for the quiet standing task. BMI was significantly associated with the PC capturing knee flexion in the single leg stance task. The movement strategies used to maintain balance showed significant differences by sex for the tandem stance pose. BMI was correlated with PCs for movement strategies for hip abduction and quiet standing tasks. Results from this study demonstrate how markerless motion capture technology could be used to augment analyses of balance both in the clinic and in the field.

Clinical Measures of Balance and Walking Ability in People with Stroke for Assessment via Videoconferencing

Purpose: This study modified established clinical balance and walking measures and estimated the reliability, validity, and feasibility of using these measures to assess people post-stroke via videoconferencing. Method: Twenty-eight people with chronic stroke were recruited and completed the in-person balance and mobility tests. Five clinical measures were modified as virtual assessments over videoconferencing. Feasibility was evaluated by task completion rate, occurrence of adverse events, and technical difficulties. Test–retest reliability and agreement were examined by intra-class correlations and standard error of measurement between two testing days. Convergent validity was examined by the magnitude of associations between in-person and virtual assessments using Pearson or Spearman rank correlation. Results: Twenty-one participants (52% female) participated in both in-person and virtual assessments. No adverse events occurred. Technical challenges were experienced by eight participants. Test–retest reliability for timed up and go test, 30-seconds sit-to-stand, five-times sit-to-stand, functional reach test, and tandem stance resulted in intra-class coefficients of 0.97, 0.90, 0.77, 0.54, and 0.50 respectively. The standard error of measurement was low across all virtual assessments. The timed up and go test, five-times sit-to-stand, and 30-seconds sit-to-stand showed relationship with in-person assessments ( r = −0.55 to −0.81). Conclusion: Virtual assessment of walking and balance function in ambulatory people post-stroke is feasible; however, technical challenges were experienced. The test–retest reliability of virtual assessments of timed up and go test and sit-to-stand tasks for people with stroke, together with strong convergent validity of the measures compared to in-person assessments is promising.

Lifespan changes in postural control

Lifespan development of postural control shows as an inverted U-shaped function with optimal performance in young adults and similar levels of underperformance in children and older adults. However, similarities in children and older adults might conceal differences in underlying control processes. We mapped out age-related differences in postural control using center-of-pressure trajectories of 299 participants ranging from 7 to 81 years old in three tasks: stable stance, compromised vision, and narrowed base of support. Summary statistics (path length, ellipse area) replicated the well-known U-shape function also showing that compromising vision and narrowing the base of support affected older adults more than children. Stabilogram diffusion analysis (SDA) allows to assess postural control performance in terms of diffusion at short (< 1 s) and longer timescales. SDA parameters showed the strongest short-term drift in older adults, especially under compromised vision or narrowed base of support conditions. However, older adults accommodated their poor short-term control by corrective adjustments as reflected in long-term diffusion under eyes closed conditions and initiating anti-persistent behavior earlier compared with children and young adults in tandem stance. We argue that these results highlight the adaptability of the postural control system and warrant a reinterpretation of previous postural control frameworks.

Inertial Sensor-Based Assessment of Static Balance in Athletes with Chronic Ankle Instability.

The Balance Error Scoring System (BESS), a subjective examiner-based assessment, is often employed to assess postural balance in individuals with chronic ankle instability (CAI); however, inertial sensors may enhance the detection of balance deficits. This study aimed to compare the BESS results between the CAI and healthy groups using conventional BESS scores and inertial sensor data. The BESS test (six conditions: double-leg, single-leg, and tandem stances on firm and foam surfaces, respectively) was performed for the CAI (n = 16) and healthy control (n = 16) groups with inertial sensors mounted on the sacrum and anterior shank. The BESS score was calculated visually by the examiner by counting postural sway as an error based on the recorded video. The root mean square for resultant acceleration (RMSacc) in the anteroposterior, mediolateral, and vertical directions was calculated from each inertial sensor affixed to the sacral and shank surfaces during the BESS test. The mixed-effects analysis of variance and unpaired t-test were used to assess the effects of group and condition on the BESS scores and RMSacc. No significant between-group differences were found in the RMSacc of the sacral and shank surfaces, and the BESS scores (P > 0.05), except for the total BESS score in the foam condition (CAI: 14.4 ± 3.7, control: 11.7 ± 3.4; P = 0.039). Significant main effects of the conditions were found with respect to the BESS scores and RMSacc for the sacral and anterior shank (P < 0.05). The BESS test with inertial sensors can detect differences in the BESS conditions for athletes with CAI. However, our method could not detect any differences between the CAI and healthy groups.

Tremor, Gait, and Balance Disorders in Essential Tremor and the Efficacy of Atenolol

ABSTRACT Background: To assess gait and balance in patients with essential tremor (ET), which is the most common tremor disorder characterized by bilateral action tremor of the hands with possible involvement of further tremor locations and to test the efficacy of atenolol on tremor and gait and balance. Methods: In this prospective study, gait and balance were evaluated by static posturography in addition to International Cooperative Ataxia Rating Scale (ICARS) in 22 ET patients without any additional neurologic signs on examination. Tremor severity was assessed by The Essential Tremor Rating Assessment Scale (TETRAS). The efficacy of atenolol 100 mg/day both on tremor and gait and balance was investigated. Posturographic recordings were performed in gender, age-, and height-matched healthy volunteers who constituted the control group. Results: The mean center of gravity sway velocity of the ET patients recorded on firm and foam surfaces with eyes open and closed was not significantly different from the healthy controls but sway velocity on tandem stance was significantly increased (P = 0.032). Gait speed (P = 0.015) was decreased and step width was increased (P = 0.001). An improvement in TETRAS scores was recorded with atenolol treatment (P = 0.046). An improvement not reaching statistical significance was present in ICARS scores (P = 0.059). However, posturographic parameters did not change significantly (P &gt; 0.05). Conclusion: Increased sway velocity on tandem stance, decreased gait speed and increased step width are consistent with midline cerebellar dysfunction in ET patients with no obvious gait and balance deficits on clinical examination. Atenolol seems to be effective on tremor but does not cause a significant improvement in gait and balance deficits.

Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes.

Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. Cross-sectional. In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94]y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.

Comparative Assessment of Gait and Balance in Patients with Parkinson's Disease and Normal Pressure Hydrocephalus.

We aim to compare balance and gait parameters in patients diagnosed with Parkinson's disease (PD) and normal pressure hydrocephalus (NPH). A total of 13 patients with NPH, 20 with PD, and 13 healthy controls (HC) recruited in the study. Three IMU sensors (Ambulatory PD Monitoring Inc., OR, USA) were placed on the lumbar area and the feet of the participants. The balance evaluations comprised eight successive standing tasks; the modified clinical test of sensory interaction on balance test. These tasks involved standing with feet apart and eyes open as well as eyes closed on a firm and foam surface, standing with feet together and eyes open as well as eyes closed, and tandem stance with the right foot front and the left foot front. Functional evaluations of gait were conducted using the 10-M Walk Test (10 MWT), the 2 min-Walk Test (2 MWT), and the timed-up and go (TUG). Parameters of the gait and balance were analyzed and then compared. NPH patients displayed a notable decrease in both stride length and gait speed as compared with both PD patients and healthy participants. The balance tests revealed that the NPH group demonstrated significantly poorer performance, specifically in the feet-apart eyes-closed foam-surface test, and the tandem stance test. During the tasks while eyes were open on firm and foam surfaces, PD and NPH groups showed an increase in root mean square sway, range, and mean velocity (p<0.05) of sway in the anteroposterior plane. In addition, during the TUG test, the NPH group exhibited a significant prolongation in the time needed to complete the task and a decline in turning velocity as compared to PD, but no notable difference was seen in comparison to the HC group. Our study indicated that the patients with NPH exhibited notably worse gait and balance measurements in comparison to both the PD patients and HC groups. These findings emphasize the significance of monitoring and managing gait and balance impairments in NPH patients. Sensor-based technologies may offer objective parameters for a more precise and efficient follow-up of these patients in terms of gait and balance.