Timed Up & Go Research Articles

P.5.4 Clinical outcome measures for dysferlinopathy: An exploration of reliability and suitability of novel functional rating scales

As part of an international study assessing a wide range of outcome measures in dysferlinopathy a subset was taken from one site (Newcastle, UK) to assess the reliability of several functional measures. The 6 min walk distance (6MWD) and functional timed tests – Timed Up & Go (TUG), 10 m run/walk, timed four stair climb and descend, timed rise from floor and a motor performance measure adapted for use in dysferlinopathy, the Northstar Ambulatory Assessment for Dysferlinopathy (NSAA for dysferlinopathy). Data on 24 individuals were examined for the above items on two time points, screen and baseline assessment. Individuals were aged between 20–65 years of age. Male to female = 16:16. Ambulant: non-ambulant = 16:8. The maximum time difference between the two assessments was less than 8 weeks in all but four individuals due to MRI unavailability. Times, distances and grades were compared and an exploratory Rasch analysis was conducted on 35 (screen and baseline +3 seen once) NSAA assessments to examine the item fit, person fit, ordering of categories for each item, targeting and reliability (PSI). Results showed good reliability between the two time points for the timed tests and 6MWD. The exploratory Rasch analysis showed the NSAA worked reasonably well in measuring ambulatory motor performance in dysferlinopathy however analysis needs to be repeated on a larger cohort to confirm the findings. Alteration in the items and their scoring scheme would benefit the measurement capabilities of the scale making it more robust for use in clinical trials. We would like to acknowledge the support of the Jain Foundation in this project.

Walking Ability and Quality of Life in Subjects With Transfemoral Amputation: A Comparison of Osseointegration With Socket Prostheses

ObjectiveTo investigate walking ability and quality of life of osseointegrated leg prostheses compared with socket prostheses. DesignProspective case-control study. SettingUniversity medical center. ParticipantsSubjects (N=22) with transfemoral amputation (1 bilateral) referred to our center because of socket-related skin and residual limb problems resulting in limited prosthesis use. Their mean age was 46.5 years (range, 23–67y) and mean time since amputation was 16.4 years (range, 2–45y). Causes of amputation were trauma (n=20) and tumor (n=2). InterventionImplantation of an osseointegration prosthesis (OIP). Main Outcome MeasuresGlobal score of the Questionnaire for Persons With a Transfemoral Amputation (Q-TFA), prosthesis use, 6-minute walk test (6MWT), Timed Up & Go (TUG) test, and oxygen consumption during treadmill walking. ResultsWith the socket prosthesis, the mean ± SD Q-TFA global score, prosthesis use, 6MWT, TUG, and oxygen consumption were 39±4.7 points, 56±7.9h/wk, 321±28m, 15.1±2.1 seconds, and 1330±310mL/min, respectively, and significantly improved with OIP to 63±5.3 points, 101±2.4h/wk, 423±21m, 8.1±0.7 seconds, and 1093±361mL/min, respectively. ConclusionsOsseointegration is a suitable intervention for persons whose prosthesis use is reduced because of socket-related problems. Subjects with OIP significantly increased their walking ability and prosthesis-related quality of life.

Validation of the Lower Extremity Functional Scale in community-dwelling elderly people (LEFS-Greek); determination of functional status cut-off points using TUG test

PurposeThe aim of this study was to evaluate structural and validity properties of the Greek version of the Lower Extremity Functional Scale (LEFS-Greek) in elderly individuals. Furthermore, to explore the ability of Timed Up & Go (TUG) test as an additional validation criterion. MethodsTwo hundred and two individuals were randomly selected from a large cohort of community-dwelling elderly people with lower extremity musculoskeletal disorders. The structural properties of LEFS-Greek were examined using exploratory and confirmatory factor analysis. The concurrent validity of the instrument was tested against the subscales of the physical functioning and role physical SF-36® Health Survey-Greek version and the TUG test. Known-groups validity was examined to assess questionnaire's ability to discriminate participants into subgroups according to their use of a cane. The cut-off points of the LEFS-Greek were obtained by ROC analysis using the TUG test as external criterion. ResultsFactor analysis demonstrated that the scale has a single-factor structure. LEFS-Greek was strongly correlated with SF36-PF, SF36-RP and TUG test (0.93, 0.62, and −0.72, respectively; P<0.001). The questionnaire was able to distinguish between the subgroups (LEFS-Greek subgroup scores 19.70±14.43 vs. 51.03±20.39, respectively; P<0.001). In ROC analysis the area under the curve for LEFS-Greek was 0.978 (95%CI 0.94–1.02, P<0.001), with cut-off points at 53, and sensitivity and specificity of 92% and 96% respectively. ConclusionLEFS-Greek is a valid assessment tool that can be used to measure functional ability in individuals with lower extremity musculoskeletal disorders. This is the first study in which specific cut-off points were determined.

Functional strength training in child with cerebral palsy GMFCS IV: Case report

Objective: To evaluate the effectiveness of a functional strength training.Case report: A nine-year-old child with Cerebral Palsy (CP) classified as level IV according to Gross Motor Function Classification System participated in the study. Assessments were at baseline, five weeks and 10 weeks post-intervention. Lower-extremity muscles strength was evaluated with an isokinetic dynamometer. Also, Gross Motor Function Measure (GMFM-88) and Timed up & Go (TUG) tests were assessed. A functional strength training protocol, four sessions a week, for 10 weeks was applied.Results: Following functional strength training, it improvements were found in hip, knee and ankle muscles strength, as well as increase in GMFM-88 score and decrease in time for TUG test performance. Positives outcomes from functional strength training were obtained beyond improvements in strength, since improvements in functional motor performance were also achieved.Conclusion: Therefore, individualized, specific and functional strength training seems to be an alternative to rehabilitation of children with CP with high level of functional disability.

Within-Day Test-Retest Reliability of the Timed Up & Go Test in Patients With Advanced Chronic Organ Failure

ObjectiveTo investigate the within-day test-retest reliability of the Timed Up & Go (TUG) test in patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and chronic renal failure (CRF). DesignCross-sectional. SettingPatients' home environment. ParticipantsSubjects (N=235, 64% men; median age, 70y [interquartile range, 61–77y]; median body mass index, 25.6kg/m2 [interquartile range, 22.8–29.4kg/m2]) with advanced COPD (n=95), CHF (n=68), or CRF (n=72). InterventionsNot applicable. Main Outcome MeasureTime to complete the TUG test. Three trials were performed on the same day and by the same assessors. The intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement, and absolute and relative minimal detectable change (MDC) values were calculated. ResultsGood agreement was observed, in general, for both the total sample and subgroups (COPD, CHF, CRF), with ICC values ranging from .85 to .98, and kappa coefficients from .49 to 1.00. However, statistical improvement occurred in the total sample from the first to the second trial with large limits of agreement (mean difference, −.97s; 95% confidence interval, 3.00 to −4.94s; P<.01). The third trial added little or no information to the first 2 trials. For the total sample, a standard error of measurement value of approximately 1.6 seconds, an absolute value of MDC at the 95% confidence level (MDC95%) of approximately 4.5 seconds, and a relative value of MDC at the 95% confidence level (MDC95%%) of approximately 35% were found between the first 2 trials, with similar values found for the subgroups. ConclusionsThe TUG test is reliable in patients with advanced COPD, CHF, or CRF after 2 trials. Values of standard error of measurement and MDC may be used in daily clinical practice with these populations to define what is expected and what represents true change in repeated measures.

Effectiveness of in-patient rehabilitation in obesity-related orthopedic conditions.

The aim of the present paper is to provide initial evidence that in-patient multidisciplinary rehabilitation is effective in minimizing the obesity-related disability and enhancing functional capacities in obese patients with motor disability. Four hundred and sixty-four obese patients with orthopedic conditions admitted to our Rehabilitation Unit for multidisciplinary rehabilitation were enrolled in this study. At admission and discharge (after 4 weeks), the following outcome measures were computed: body weight (BW) (kg), body mass index (BMI) (kg/m2), Functional Independence Measure (FIM) motor and cognitive, Obesity-related disability test (TSD-OC), Visual Analogue Score (VAS) for functioning, Timed-Up-Go (TUG). Intensive rehabilitation addressed to obese patients with orthopedic conditions and motor difficulties consisted of a 4-week and 3-h daily multidisciplinary program covering nutritional, motor and psychological aspects. All of the outcomes measured, except the FIM cognitive score, improved significantly after in-patient rehabilitation. The obesity-specific disability scale appears sensitive to changes among groups with different grades of disability and the percentage of change does not differ among groups. Younger obese individuals generally showed to benefit more from rehabilitation interventions than the older ones. In-patient rehabilitation interventions appear effective in reducing both mild and severe disabilities related to obesity with orthopedic co-morbidities. This paper provides initial evidence that in-patient multidisciplinary intensive rehabilitation is effective in minimizing the obesity-related disability and initial support to the indications of the Italian Ministry of Health for such rehabilitation pathway. The disability grading could help the decision making of allocating patients to appropriate rehabilitation settings.

Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. ObjectiveTo observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. MethodThis is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. Resultsmost subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). ConclusionClinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.

Reliability and Concurrent Validity of Four Square Step Test Scores in Subjects With Chronic Stroke: A Pilot Study

ObjectivesTo establish (1) the intrarater and interrater reliability of Four Square Step Test (FSST) times in persons with chronic stroke; (2) the concurrent validity of FSST times with standing balance and functional mobility measures; and (3) the FSST cutoff score for distinguishing the differences in dynamic balance performance of persons with chronic stroke from healthy control adults. DesignCross-sectional study. SettingUniversity-based rehabilitation center. ParticipantsConvenience sample of subjects (N=30) consisting of community-dwelling persons with chronic stroke (n=15) and healthy control adults (n=15). InterventionsNot applicable. Main Outcome MeasuresFSST scores; balance and functional mobility measured using Berg Balance Scale (BBS) scores; Timed Up & Go (TUG) test scores; and limits of stability (LOS) measured by dynamic posturography. ResultsFSST times showed good intrarater reliability, with intraclass correlation coefficients ranging from .82 to .83 and an interrater reliability >.99. An FSST cutoff score of 11 seconds was able to discriminate between healthy adults older than 50 years and persons with stroke (sensitivity, 73.3%; specificity, 93.3%). FSST times were correlated with LOS scores for directional control in the backward direction (r=.64; P=.01). FSST was approaching a significant correlation with TUG scores (r=.59; P=.02) and LOS scores for endpoint excursion in the forward direction (r=−.58; P=.02). However, there was no correlation with BBS scores. ConclusionFSST is an easy-to-administer clinical test with good intrarater and interrater reliability in persons with chronic stroke to assess dynamic standing balance. FSST times of 11 seconds are able to differentiate between persons with chronic stroke and healthy adults older than 50 years. The correlation of FSST times with standing balance and functional mobility measures requires further research with a larger sample size.

Feasibility of Rehabilitation Training With a Newly Developed Wearable Robot for Patients With Limited Mobility

ObjectiveTo investigate the feasibility of rehabilitation training with a new wearable robot. DesignBefore-after clinical intervention. SettingUniversity hospital and private rehabilitation facilities. ParticipantsA convenience sample of patients (N=38) with limited mobility. The underlying diseases were stroke (n=12), spinal cord injuries (n=8), musculoskeletal diseases (n=4), and other diseases (n=14). InterventionsThe patients received 90-minute training with a wearable robot twice per week for 8 weeks (16 sessions). Main Outcome MeasuresFunctional ambulation was assessed with the 10-m walk test (10MWT) and the Timed Up & Go (TUG) test, and balance ability was assessed with the Berg Balance Scale (BBS). Both assessments were performed at baseline and after rehabilitation. ResultsThirty-two patients completed 16 sessions of training with the wearable robot. The results of the 10MWT included significant improvements in gait speed, number of steps, and cadence. Although improvements were observed, as measured with the TUG test and BBS, the results were not statistically significant. No serious adverse events were observed during the training. ConclusionsEight weeks of rehabilitative training with the wearable robot (16 sessions of 90min) could be performed safely and effectively, even many years after the subjects received their diagnosis.

Effects of a Multifactorial Fall Prevention Program on Fall Incidence and Physical Function in Community-Dwelling Older Adults With Risk of Falls

ObjectiveTo evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults. DesignMulticenter randomized controlled trial. SettingThree medical centers and adjacent community health centers. ParticipantsCommunity-dwelling older adults (N=616) who have fallen in the previous year or are at risk of falling. InterventionsAfter baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or the control group (CG), stratified by the Physiological Profile Assessment (PPA) fall risk level. The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consults. The CG received health education brochures, referrals, and recommendations without direct exercise intervention. Main Outcome MeasuresPrimary outcome was fall incidence within 1 year. Secondary outcomes were PPA battery (overall fall risk index, vision, muscular strength, reaction time, balance, and proprioception), Timed Up & Go (TUG) test, Taiwan version of the International Physical Activity Questionnaire, EuroQol-5D, Geriatric Depression Scale (GDS), and the Falls Efficacy Scale-International at 3 months after randomization. ResultsParticipants were 76±7 years old and included low risk 25.6%, moderate risk 25.6%, and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in the IG and 27.6% in the CG (hazard ratio=.90; 95% confidence interval, .66–1.23). The IG improved more favorably than the CG on overall PPA fall risk index, reaction time, postural sway with eyes open, TUG test, and GDS, especially for those with marked fall risk. ConclusionsThe multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls, but did not reduce falls at 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

Hip Fracture−Related Pain Strongly Influences Functional Performance of Patients With an Intertrochanteric Fracture Upon Discharge From the Hospital

To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. Prospective observational study. A 20-bed orthopedic hip fracture unit. Fifty-five cognitively intact patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery. All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days after surgery. The Timed Up & Go (TUG) test, supervised by a physical therapist, was used to evaluate functional performance, and a 5-point verbal ranking scale (0 = no pain to 4 = intolerable pain) was used to evaluate pain. Patients took an average of 22.7 ± 11.7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during testing (P < .001), with associated poorer performances on the TUG test (29.4 ± 12.8 seconds versus 18.3 ± 8.5 seconds). Univariate analysis showed that TUG scores were associated with age, prefracture function evaluated by the New Mobility Score, fracture type, day of TUG performance, and pain intensity. Multivariate linear regression analyses (fracture type not included) showed that only greater age (B = 0.34), low prefracture function (B = 7.9), and experiencing moderate to severe pain (B = 8.7) were independently associated with having a poorer TUG score. Hip fracture-related pain primarily compromises the functional performance of patients with an intertrochanteric hip fracture upon discharge from hospital. Physical therapists should be involved in new and optimized fracture-type stratified pain management strategies.

Global brain atrophy is associated with physical performance and the risk of falls in older adults with cognitive impairment

Falls are common in patients with cognitive disorder. The purpose of this study was to determine whether global brain atrophy is associated with cognitive function, physical performance and fall incidents in older adults with mild cognitive disorder. A total of 31 older adults with mild cognitive disorders (mean age 78.9 ± 7.3 years) were studied, and 10 of them had experienced falls and the others had not in the past 1 year. Cognitive function and physical performance were measured in these patients. Global brain atrophy was determined by the Voxel-Based Specific Regional Analysis System for Alzheimer's Disease software. Fallers showed significantly worse scores than the non-fallers in the Global Brain Atrophy Index, Clock Drawing Test (CDT), Verbal Fluency Test (animal), maximum walking time and Timed Up & Go (TUG) Test. The Global Brain Atrophy Index was correlated with the Verbal Fluency Test (animal; r = -0.522), the Verbal Fluency Test with letter (ka; r = -0.337), CDT (r = -0.547), TUG (r = 0.276) and Five Chair Stands Test (r = 0.303) by age-adjusted correlation analyses. Stepwise regression analysis showed that the Global Brain Atrophy Index (β = 1.265, 95% CI 1.022-1.567) was a significant and independent determinant of falls (R(2) = 0.356, P = 0.003). Global brain atrophy might be indicated as one of the risk factors for falls in older adults with mild cognitive disorders.

ATUG: technical apparatus for gait and balance analysis within component-based Timed Up &amp; Go using mutual ambient sensors

A novel approach to instrumenting the Timed Up & Go (TUG) assessment test and to performing a detailed mobility analysis during the test in professional and domestic environments is presented. The approach, called aTUG, is based on the usage of ambient sensor technologies i.e. a light barrier, four force sensors, and a laser range scanner built into a single apparatus. aTUG supports execution and documentation of traditional TUG and enhanced component-based TUG and computes several spatio-temporal parameters of gait and balance. aTUG defines five components: Standing up, walking there, turning, walking back, and sitting down. Algorithms for detection of those components, for computation of their durations and the duration of the whole TUG, and for detailed gait and balance analysis based on available sensor data are presented. An experiment with five elderly patients aged 74–91 years has been conducted in a residential care facility in Oldenburg, Germany. Results of the experiment show that aTUG can reliably and precisely measure total duration of TUG and durations of the single components with a mean error of only 0.05 s and mean standard deviation of 0.59 s using especially its force and range measurements. Initial results of gait and balance analysis are presented and challenges regarding application of the approach is domestic environments are outlined.

Frailty and its prediction of disability and health care utilization: The added value of interviews and physical measures following a self-report questionnaire

AimsTo establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty. Materials and methodsA representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care. ResultsAfter controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization. ConclusionsAssessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes.

Preoperative Home-Based Physical Therapy Versus Usual Care to Improve Functional Health of Frail Older Adults Scheduled for Elective Total Hip Arthroplasty: A Pilot Randomized Controlled Trial

Oosting E, Jans MP, Dronkers JJ, Naber RH, Dronkers-Landman CM, Appelman-de Vries SM, van Meeteren NL. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. ObjectiveTo investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty (THA). DesignSingle-blind pilot randomized controlled trial. SettingPatients' homes and a general hospital in The Netherlands. ParticipantsFrail patients (N=30) older than 65 years. InterventionA preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions. Main Outcome MeasuresFeasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary pre- and postoperative effectiveness was determined by the Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Chair Rise Time, and self-reported measures of functions, activities, and participation. ResultsPatient satisfaction and adherence to the training were good (median=5 on a 5-point Likert scale) and no serious adverse events occurred. The Borg score during training was 14 (range, 13–16). Preoperative clinical relevant differences on the TUG test (2.9s; 95% confidence interval [CI], −0.9 to 6.6) and significant differences on the 6MWT (41m; 95% CI, 8 to 74) were found between groups. ConclusionsIntensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training.

Both conventional indices of cognitive function and frailty predict levels of care required in a long‐term care insurance program for memory clinic patients in Japan

To delineate relationships among cognitive function, frailty and level of care required in the Japanese long-term care insurance program (LTCIP) in outpatient memory clinic patients. This was a cross-sectional study carried out at an outpatient memory clinic. Participants were 201 cognitively impaired patients. Cognitive function was measured by the Mini-Mental State Examination (MMSE). Frailty was measured by Timed Up & Go (TUG) and grip strength. Waist circumference, body mass index, living arrangement and level of care required in the LTCIP (rank 1 minor disability to rank 7 severe disability) were also assessed. Mean age, MMSE score, TUG score and grip strength were 78.8 ± 6.9 years, 19.6 ± 6.1, 14.6 ± 6.7 s and 16.9 ± 7.5 kg, respectively. A total of 70 patients (34.8%) had not applied for the certification, at least in part because of their younger age and existence of family caregivers. LTCIP rank was correlated both with MMSE score (β: -0.49, P = 0.001), grip strength (β: -0.27, P = 0.005) and living alone (β: -0.18, P = 0.03), but not with TUG score (β: 0.14, P = 0.105). In outpatients of a memory clinic, care ranks, which define the upper limit of monthly benefit in the Japanese LTCIP, were influenced by age, cognitive function, frailty and living arrangements. Understanding the relationship among these parameters would be useful in predicting the needs of cognitively impaired patients and important when comparing the possible services provided by long-term care systems for them worldwide.

뇌졸중환자의 반웅크리기 동안에 하지근활성도와 BBS, TUG와의 상관관계

Purpose : We studied the correlation between reference voluntary contraction (% RVC) of vastus lateralis (VL) and vastus medialis (VM), Berg balance scale (BBS), and timed-up & go (TUG) test. Methods : We recruited 30 stroke patients from a rehabilitation center at a hospital.? All subjects could walk with or without an assisting device. Subjects were evaluated with % RVC of VL and VM, BBS, and TUG. The data were analyzed using a Pearson correlation coefficient. Results : The % RVC of VL and VM and BBS (p<0.01) showed a significant positive correlation. TUG negatively correlated with % RVC of VL and VM and BBS (p<0.01). Conclusion : Lower extremity muscle activity increases balance and walking ability. We recommend the implementation of lower extremity strength exercises in the rehabilitation of stroke patient.

Telerehabilitation using virtual reality task can improve balance in patients with stroke

Purpose: The objective of the telerehabilitation is a continuation of the rehabilitation process on patients’ home. The study also compares the balance training in clinical environment with the telerehabilitation approach when the physiotherapists and physicians can follow the progress remotely. Method: In this paper, the preliminary study of the pilot project with virtual reality (VR)-based tasks for dynamic standing frame supported balance training is presented. Six patients with stroke participated in the study. The patients performed the balance training 3 weeks, 2 weeks in the clinical settings and 1 week in the home environment, five times a week, and each time for up to 20 minutes. Objective effectiveness was demonstrated by parameters as track time, number of collisions and the clinical instruments Berg Balance Scale (BBS), Timed Up & Go (TUG), 10-m walk test and standing on the unaffected and affected extremity. The outcomes were compared to the balance training group without VR and telerehabilitation support. A 2-way ANOVA was used to explore the differences between the both stroke groups. Results: In patients who were subject to VR supported balance training, the BBS demonstrated improvement for 15%, the TUG for 29%, the 10-m walk for 26%, stance time on the affected and unaffected extremity for 200 and 67%, respectively. The follow-up demonstrated that the patients preserved the gained functional improvement. The VR task performance time and number of collisions decreased to 45 and 68%, respectively. Besides, no statistical differences were found between the telerehabilitation approach with VR supported balance training and conventional balance training in clinical settings either regarding the overall mean level or regarding the mean improvement. Conclusions: The telerehabilitation approach in VR supported balance training improved balance in stroke patients and had similar effect on patients’ postural functional improvement as conventional balance training in clinical settings. However, when balance training is continued on patient’s home instead of the hospital, it would eventually decrease the number of outpatients’ visits, reduce related costs and enable treatment of larger number of patients.Implications for RehabilitationPeople suffering from stroke have severe problems with posture and balance.This study demonstrates that using target based tasks in a virtual environment can improve balance in stroke population.Telerehabilitation offers continuation of balance training in the remote centres or at home.The longer rehabilitation period improves functionality and therefore the quality of life.

Sensors vs. experts - A performance comparison of sensor-based fall risk assessment vs. conventional assessment in a sample of geriatric patients

BackgroundFall events contribute significantly to mortality, morbidity and costs in our ageing population. In order to identify persons at risk and to target preventive measures, many scores and assessment tools have been developed. These often require expertise and are costly to implement. Recent research investigates the use of wearable inertial sensors to provide objective data on motion features which can be used to assess individual fall risk automatically. So far it is unknown how well this new method performs in comparison with conventional fall risk assessment tools. The aim of our research is to compare the predictive performance of our new sensor-based method with conventional and established methods, based on prospective data.MethodsIn a first study phase, 119 inpatients of a geriatric clinic took part in motion measurements using a wireless triaxial accelerometer during a Timed Up&Go (TUG) test and a 20 m walk. Furthermore, the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) was performed, and the multidisciplinary geriatric care team estimated the patients' fall risk. In a second follow-up phase of the study, 46 of the participants were interviewed after one year, including a fall and activity assessment. The predictive performances of the TUG, the STRATIFY and team scores are compared. Furthermore, two automatically induced logistic regression models based on conventional clinical and assessment data (CONV) as well as sensor data (SENSOR) are matched.ResultsAmong the risk assessment scores, the geriatric team score (sensitivity 56%, specificity 80%) outperforms STRATIFY and TUG. The induced logistic regression models CONV and SENSOR achieve similar performance values (sensitivity 68%/58%, specificity 74%/78%, AUC 0.74/0.72, +LR 2.64/2.61). Both models are able to identify more persons at risk than the simple scores.ConclusionsSensor-based objective measurements of motion parameters in geriatric patients can be used to assess individual fall risk, and our prediction model's performance matches that of a model based on conventional clinical and assessment data. Sensor-based measurements using a small wearable device may contribute significant information to conventional methods and are feasible in an unsupervised setting. More prospective research is needed to assess the cost-benefit relation of our approach.

Dynamic Gait Stability, Clinical Correlates, and Prognosis of Falls Among Community-Dwelling Older Adults

Bhatt T, Espy D, Yang F, Pai Y-C. Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults. Objective To establish an accurate measure for prognostic assessment of fall risk in community-dwelling older adults, this study examined the prediction accuracy of a dynamic gait stability measure and common clinical tests for slip-related falls among these adults. Design Participants were tested for their fall-risk likelihood on a slip-test. Setting Biomechanics research laboratory. Participants Community-dwelling older adults (N=119; ≥65y). Interventions Not applicable. Main Outcome Measures Participants performed a battery of clinical tests, including Berg Balance Scale, Timed Up & Go (TUG) test, static posturography, isometric muscle strength, and bone density. They were then exposed to an unannounced slip during gait. The dynamic stability during unperturbed gait was measured based on the center of mass position and velocity relative to the limits of stability against backward falling. Accuracy of each measure was examined for prediction of slip outcome (fall or recovery). Results On the slip, 59 participants fell, 56 recovered their balance, and 4 were harness-assisted. Dynamic stability predicted fall outcome with 69% accuracy. Except for TUG and bone density, no other measure could differentiate fallers from nonfallers; TUG predicted 56% of fall outcomes. Conclusions Reproduction of actual falls provides a new benchmark for evaluating the prognostic power of different performance-based assessment tools. The TUG was able to better predict fall outcome than other clinical measures; however, the new dynamic gait stability measure was more sensitive than TUG in its prediction of falls. Ultrasound bone scan could be used to screen older adults for fall risk.