Timed Balance Test Research Articles

Clinical efficacy of vestibular assessment and rehabilitation training in peripheral vestibular vertigo.

To evaluate the clinical efficacy of vestibular assessment and rehabilitation training in patients with peripheral vestibular vertigo. This was a retrospective study. A total of 169 patients diagnosed with peripheral vestibular vertigo, admitted to Cangzhou People's Hospital between January 2020 and January 2023 were divided into control group (83 cases) and observation group (86 cases). The control group received medication-based treatment, while the observation group was provided with combined treatment of medication and vestibular rehabilitation training. Assessment of recovery included the Dizziness Handicap Inventory (DHI), Vestibular Symptom Index (VSI), and Activities-specific Balance Confidence (ABC) scale before and at two, four, and eight weeks post-treatment. Psychological status, sleep quality, and life quality were evaluated. Both groups underwent the Fukuda stepping test and timed balance test. At two, four, and eight weeks post-treatment, both groups exhibited significantly lower DHI-P, DHI-F, DHI-E, VSI, and ABC scores compared to pre-treatment (p<0.05). The observation group showed significantly lower DHI-P, DHI-F, DHI-E, VSI, and ABC scores than the control group at two and four weeks post-treatment (p<0.05). After treatment, both groups demonstrated reduced body deviation angles and increased time without falling in the Fukuda stepping test (p<0.05). Notably, the observation group had significantly better outcomes (p<0.05). In comparison to medication-based treatment alone, a combined approach involving medication treatment and vestibular rehabilitation training may demonstrate early improvements in vertigo symptoms, enhance balance capabilities, and ameliorate psychological well-being, sleep quality, and overall quality of life for patients.

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study

ObjectiveTo investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. DesignIntervention study. SettingCommunity-based older adult–specific exercise clinic. ParticipantsOlder adults (N=245) with complex care needs who were receiving government-funded aged care support. InterventionsTwenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. Main Outcome MeasuresThe primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. ResultsAt baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=−.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (−11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. ConclusionsThis study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults.

Effect of 6 weeks wobble board exercises on static and dynamic balance of stroke survivors

Balance is a complex motor skill and it is frequently disturbed among stroke survivors. Rehabilitation experts are still facing challenges in achieving good stability. The primary aim of this study was to determine the effect of a wobble board exercise program on static and dynamic balance of hemiplegic subjects. Seventeen (17) stroke survivors were randomly selected into two groups. The subjects in the experimental group were trained on wobble board for six weeks while the control group received only the baseline treatment programs. The modified version of the timed balance test was used to assess balance while the foursquare step test was used to assess dynamic balance. Descriptive statistics and Analysis of variance (ANOVA) were used to analyze the data obtained. The result showed that there was significant difference in the static balance (eye closed) (F=7.49, P< 0.05) and dynamic balance (F3.20, P< 0.05) between the groups but there was no significant difference in static balance (eye opened) (F= 1.75, P> 0.05). The study concluded that wobble board exercise improved both static (eye closed) and dynamic balance of stroke survivor used in this study.

Ankle-foot orthoses in stroke: Effects on functional balance, weight-bearing asymmetry and the contribution of each lower limb to balance control

Background Ankle-foot orthoses are often provided to improve walking in stroke patients, although the evidence of effects on walking and balance control is still inconsistent. This could be caused by a lack of insight into the influence of orthoses on the underlying impairments. These impairments can be assessed with dual plate posturography to determine the relative contribution of each lower limb to balance control and weight-bearing. This study examined the effects of ankle-foot orthoses on functional balance, static and dynamic weight-bearing asymmetry and dynamic balance control of the paretic and non-paretic lower limbs. Methods Twenty stroke subjects (time since stroke 5–127 months) completed the study. Subjects were assessed with and without ankle-foot orthosis. Functional balance was assessed using the Berg Balance Scale, Timed Up & Go test, Timed Balance Test, 10-m walking test and Functional Ambulation Categories. Weight-bearing asymmetry and dynamic balance control were assessed with force plates on a movable platform. Findings No significant effects of ankle-foot orthoses were found for weight-bearing asymmetry and dynamic balance control, but significant differences in favour of ankle-foot orthosis use were found for most functional tests. Interpretation Although ankle-foot orthoses had no effect on weight-bearing asymmetry or dynamic balance contribution of the paretic lower limb, functional tests were performed significantly better with orthoses. Apparently, improvements at functional level cannot be readily attributed to a greater contribution of the paretic lower limb to weight-bearing or balance control. This finding suggests that ankle-foot orthoses influence compensatory mechanisms.

Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial

Objectives: Gait and mobility problems are difficult to treat in people with Parkinson’s disease. The Rehabilitation in Parkinson’s Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home...

Cueing training in the home improves mobility in Parkinson's disease

Does a 3-week, home-based cueing program improve gait, gait-related activity, and health-related quality of life in people with Parkinson's disease (PD)? A multicentre, single-blinded randomised crossover trial. University medical centres in the UK, Belgium, and The Netherlands. 153 patients with PD aged between 41 and 80 years and in Hoehn and Yahr stage II–IV were randomly allocated to an ‘early’ or ‘late’ intervention group. Subjects in the late group were put on a 3-week waiting list, without intervention, followed immediately by three weeks of cueing training. The order of the 3-week periods was reversed in the early group. Both groups underwent a follow-up period of 6 weeks without training. The cueing program was delivered at home and consisted of nine treatment sessions of 30 minutes. Patients were trained with their preferred cueing modality: auditory, visual (light flashes), or somatic-sensory (vibrations). Cueing strategies were trained during a variety of tasks and environmental situations (indoor and outdoor), aiming to improve step length and walking speed, prevent freezing episodes and improve balance, by correcting the temporal aspects of gait. Posture and gait scores (PG scores) measured at 3, 6, and 12 weeks were the primary outcomes. The PG scores consisted of a composite score of gait and balance based on items of the Unified Parkinson's Disease Rating Scale. Secondary outcomes included specific measures of gait, freezing and balance, functional activities, quality of life, and carer strain. Small but significant ( p < 0.05) improvements were found after intervention of 4.2% on the PG scores, gait speed (5 cm/sec), step length (4 cm), timed balance tests, and the confidence to carry out functional activities as measured with the Falls Efficacy Scale (3.7%). Severity of freezing was reduced by 5.5% in freezers only. Cueing training in the home improves mobility in patients with PD.

Predicting Improvement in Gait After Stroke

To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability. A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population. Prospective cohort study based on 18 repeated measurements over time during the first poststroke year. Baseline characteristics as well as longitudinal information from functional ambulation categories (FAC), Fugl-Meyer leg score (FM-leg), Motricity index leg score (MI-leg), letter cancellation task (LCT), Fugl-Meyer balance (FM-balance), and timed balance test (TBT) were obtained. Intervention consisted of a basic rehabilitation program with additional arm, leg, or air splint therapy. Main outcome measure constituted change scores on FAC over time. In total, 1532 of the 1717 change scores were available for regression analysis. The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC (beta=0.094; P<0.001) followed by changes scores on FM-leg (beta=0.014; P<0.001) and reduction in LCT omissions (beta=-0.010; P<0.001) and MI leg test (beta=0.001; P<0.001). In addition, time itself was significantly negatively associated with improvement (beta=-0.002; P<0.001). Improvement in standing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability, whereas reduction in visuospatial inattention is independently related to improvement of gait. Finally, time itself is an independent covariate that is negatively associated with change on FAC, suggesting that most pronounced improvements occur earlier after stroke.

The Measurement of Balance and Walking Post-Stroke. Part 2: Functional Performance Tests

The rehabilitation of balance and walking is a primary goal of stroke physiotherapy and our main interest is to assess the effectiveness of physiotherapy interventions. The literature was reviewed to seek functional performance tests (ratio and interval tests which require the subject to perform a balance or walking task) that would be suitable for such a purpose. CINAHL, Medline and Embase databases were searched for tests which measured balance and/or walking post-stroke and could be used in clinical settings. They were assessed for reliability, validity, sensitivity to change, suitability for use in clinical settings and with a wide range of stroke severity. Fourteen tests were identified. All had some information about their psychometric properties. They were generally reliable, valid, and sensitive to change, easy to use and suitable for community and hospital settings. An exception was timed balance tests, which showed poor reliability and validity. The main disadvantage is that any test is only suitable for a narrow range of ability, there is also insufficient information about the measurement error to be able to judge whether they could be used to assess the effects of specific interventions.

Ordinal and timed balance measurements: reliability and validity in patients with stroke

The aim of this study of 38 patients with stroke was to describe the intrasession and intersession reliability and validity of ordinally graded and timed balance tests. Patients had a mean age and time since stroke of 67 years and 21 days respectively. Balance and gait were both timed with a stop-watch and given an ordinal score. Balance was timed for four different task levels: feet apart, feet together and unilateral stance (either limb first). Subjects who demonstrated the ability to complete the task for 60 seconds proceeded to the next, more difficult, task level. Most subjects remained within an ordinal balance category during a session; 81.6% for session 1 and 86.8% for session 2. The distribution of ordinal balance scores between sessions revealed that 31 of the 38 subjects remained within the same ordinal balance score, with the remainder of subjects scoring higher during session 2. The weighted Kappa coefficient for these scores was 0.858, indicating excellent reliability. The magnitude of the intrasession and intersession intraclass correlation coefficients for unilateral balance times indicated acceptable reliability. The Spearman correlations showed that balance measurements were a valid indicator of walking performance regardless of whether timed or ordinal measurements were used to characterize balance and gait. Given the findings of this study relevant to reliability and validity, the use of the more precise timed balance times cannot be advocated.

Stance duration under sensory conflict conditions in patients with hemiplegia.

Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed.

Relationship of Sensory Organization to Balance Function in Patients with Hemiplegia

Standing balance and dynamic weight shifting were evaluated in 10 subjects with hemiplegia using a sensory organization balance test (SOT) and the Fugl-Meyer sensorimotor assessment (FMSA). The SOT is a timed balance test that evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. In contrast, the FMSA is a functional status assessment that indicates the amount of assistance needed during various balance tasks and the tolerated duration of the task. The results of both clinical tests were compared to determine whether the SOT correlated with functional ability. The SOT scores were significantly correlated with the FMSA balance subscores and the FMSA total lower extremity scores. Based on the results of this preliminary study, the authors concluded that the SOT may be useful for evaluating a patient's functional status. Further implications for the evaluation and treatment of balance dysfunction in persons with hemiplegia are discussed.

Balance performance among noninstitutionalized elderly women.

Descriptive data were collected regarding static standing balance of 71 noninstitutionalized elderly women as they performed two timed balance tests. All subjects performed the sharpened Romberg test and the one-legged stance test on each foot in four test conditions: 1) eyes open, 2) eyes closed, 3) shoes on, and 4) shoes off. Subjects were grouped and analyzed according to the following age ranges: 1) 60 to 64 years, 2) 65 to 69 years, 3) 70 to 74 years, 4) 75 to 79 years, and 5) 80 to 86 years. The best time of three trials was used for data analysis. The maximum balance time for the sharpened Romberg test was 60 seconds. For the one-legged stance test, a maximum balance time was 30 seconds. No significant difference was found between right and left or dominant and nondominant limbs while performing the one-legged stance test. No significant difference was found in mean balance time between subjects who had fallen versus those who had not fallen, nor between shoes-on and shoes-off test performance. Subjects' performance on the eyes-open test was consistently superior to their eyes-closed test performance (p less than .0001). The one-legged stance test mean balance time decreased significantly as age increased. More subjects reached the maximum balance time on the sharpened Romberg test than on the one-legged stance test. The results of this study indicate that additional research is needed in the area of balance maintenance among the elderly population.

Decrease in timed balance test scores with aging.

This study investigated whether 184 volunteers from 20 to 79 years of age could perform eight timed balance tests and examined the relationship between test performance and age. All subjects were able to balance with their feet together and eyes closed for 30 seconds. The ability to balance on the right and left legs did not differ significantly. Subjects over 60 years of age were unable to balance on one leg, particularly when their eyes were closed, for as long a period as younger subjects. The Pearson product-moment and Spearman correlations of age and duration of one-legged balance were -.65 and -.71 (eyes opened) and -.79 and -.75 (eyes closed). The findings suggest that when timed balance tests are performed as a part of a patient's neurologic examination, the results should be interpreted in light of the patient's age. Information is provided to assist in this interpretation.