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Kohle F, Stark C, Klünter H, Wernicke D, Wunderlich G, Fink GR, Klussmann JP, Schroeter M, Lehmann HC. Peripheral neuropathy, an independent risk factor for falls in the elderly, impairs stepping as a postural control mechanism: A case-cohort study. J Peripher Nerv Syst 2024; 29:453-463. [PMID: 39219364 PMCID: PMC11625983 DOI: 10.1111/jns.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND/AIMS Peripheral neuropathies perturbate the sensorimotor system, causing difficulties in walking-related motor tasks and, eventually, falls. Falls result in functional dependency and reliance on healthcare, especially in older persons. We investigated if peripheral neuropathy is a genuine risk factor for falls in the elderly and if quantification of postural control via posturography is helpful in identifying subjects at risk of falls. METHODS Seventeen older persons with a clinical polyneuropathic syndrome of the lower limbs and converging electrophysiology were compared with 14 older persons without polyneuropathy. All participants were characterized via quantitative motor and sensory testing, neuropsychological assessment, and self-questionnaires. Video-nystagmography and caloric test excluded vestibulocochlear dysfunction. For further analysis, all subjects were stratified into fallers and non-fallers. Overall, 28 patients underwent computerized dynamic posturography for individual fall risk assessment. Regression analyses were performed to identify risk factors and predictive posturography parameters. RESULTS Neuropathy is an independent risk factor for falls in the elderly, while no differences were observed for age, gender, weight, frailty, DemTect test, timed "Up & Go" test, and dizziness-related handicap score. In computerized dynamic posturography, fallers stepped more often to regain postural control in challenging conditions, while the Rhythmic Weight Shift test showed a lack of anterior-posterior bidirectional voluntary control. INTERPRETATION Our study confirms peripheral neuropathy as a risk factor for older persons' falls. Fallers frequently used stepping to regain postural control. The voluntary control of this coping movement was impaired. Further investigations into these parameters' value in predicting the risk of falls in the elderly are warranted.
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Affiliation(s)
- Felix Kohle
- Department of Neurology, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
| | - Christopher Stark
- Department of Neurology, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
| | - Heinz‐Dieter Klünter
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
| | - Daniel Wernicke
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
| | - Gilbert Wunderlich
- Department of Neurology, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
| | - Gereon R. Fink
- Department of Neurology, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
- Cognitive Neuroscience, Research Center JuelichInstitute of Neuroscience and Medicine (INM‐3)JuelichGermany
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
| | - Michael Schroeter
- Department of Neurology, Faculty of MedicineUniversity of Cologne and University Hospital CologneCologneGermany
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Nolff MR, Kapur S, Kendall BJ, Doumas M, Conner NO, Chander H, Haworth JL, Goble DJ. An initial set of reference values for the Balance Tracking System (BTrackS) Limits of Stability protocol. Gait Posture 2024; 107:67-71. [PMID: 37757595 DOI: 10.1016/j.gaitpost.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The Balance Tracking System (BTrackS) Limits of Stability (LOS) protocol is a relatively new means of evaluating unconstrained dynamic postural control ability. While the reliability of this protocol has previously been established, reference data is currently unavailable to assist in the interpretation of results. RESEARCH QUESTION What are typical reference values for the BTrackS LOS protocol with respect to sex, height, and BMI? METHODS A cross= -section of 800 healthy, young adults (aged 18-29 years; 368 men, 432 women) were administered the BTrackS LOS protocol. Sex, height and weight variables were also captured for the participants. RESULTS Results of a stepwise linear regression showed that the outcome measure for BTrackS LOS testing (i.e. LOS Area) was larger in taller individuals and in men. Based on these findings, four percentile ranking categories were established and associated look-up tables created. SIGNIFICANCE The reference values provided by this study offer much needed guidance to clinicians and researchers for the determination of dynamic balance abnormalities based on BTrackS LOS testing.
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Affiliation(s)
- Michael R Nolff
- Department of Human Movement Science, Oakland University, 433 Meadow Brook Road, Rochester, MI 48309, USA
| | - Shweta Kapur
- Department of Human Movement Science, Oakland University, 433 Meadow Brook Road, Rochester, MI 48309, USA
| | | | - Mihalis Doumas
- Department of Psychology, Queen's University Belfast, Belfast BT, UK
| | - Nathan O Conner
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
| | - Harish Chander
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
| | - Joshua L Haworth
- Department of Human Movement Science, Oakland University, 433 Meadow Brook Road, Rochester, MI 48309, USA
| | - Daniel J Goble
- Department of Human Movement Science, Oakland University, 433 Meadow Brook Road, Rochester, MI 48309, USA.
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Darbandi SM, Zarei M, Mohammadi H, Hosseinzadeh M. Investigating the value of balance and proprioception scores to predict lower limb injuries in professional judokas. Sci Rep 2023; 13:21726. [PMID: 38066336 PMCID: PMC10709458 DOI: 10.1038/s41598-023-49114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
We investigated the ability of balance and proprioception screening tests to predict lower limb injuries in professional male judokas. Fifty-three male judokas of the national teams (Mean ± SD, age 18.68 ± 3.08 years, weight 75.34 ± 11.62 kg, height 175.28 ± 7.24 cm) participated in this study. Limits of stability (LOS), single leg stability (SLS), and knee joint position sense (JPS) was recorded as the screening tests before starting the 10 month follow up. Lower limb injury was recorded all through the follow up. Fifteen lower limb sport injuries were recorded for 53 judokas during the follow-up recordings. Significant accuracy of SLS, overall bilateral ratio (AUC 0.646, 95% CI 0.452-0.839, p = 0.046), as well as JPS 60° bilateral ratio (AUC 0.657, 95% CI 0.480-0.834, p = 0.044), and LOS overall (AUC 0.696, 95% CI 0.551-0.840, p = 0.031) were revealed discriminating between injured and uninjured judokas. The optimum cut-off of SLS, overall bilateral ratio, JPS 60° bilateral ratio, and LOS overall associated with belonging to uninjured judokas group was ≤ 1.15%, ≤ 1.09%, and ≤ 1.09 respectively (sensitivity, 0.763, 0.711, 0.789 respectively; specificity, 0.600). Although the absolute unilateral balance and proprioception scores were almost the same between injured and non-injured judokas, the bilateral ratio of both these indices were different between the two groups. Lower limbs bilateral balance and proprioception asymmetries is a more important risk factor than the absolute unilateral balance and proprioception scores for sustaining lower limb injuries in professional male judokas. Medical professionals and coaches are suggested to use these findings as pre-participation screening tools identify injury-prone athletes.
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Affiliation(s)
- Shirzad Mian Darbandi
- Department of Sport Rehabilitation and Health, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Mostafa Zarei
- Department of Sport Rehabilitation and Health, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Haniyeh Mohammadi
- Department of Sport Injuries and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Shomal University, Amol, Iran
| | - Mahdi Hosseinzadeh
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, No. 3, 5th Alley, Miremad Street, Motahhari Street, PO Box: 1587958711, Tehran, Iran.
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Dunne LAM, Cole MH, Cormack SJ, Howell DR, Johnston RD. Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:76. [PMID: 37578611 PMCID: PMC10425315 DOI: 10.1186/s40798-023-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. OBJECTIVES This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. METHODS A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. RESULTS A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. CONCLUSION These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. TRAIL REGISTRATION This systematic review was registered on PROSPERO (reg no. CRD42021256298).
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Affiliation(s)
- Laura A M Dunne
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Stuart J Cormack
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rich D Johnston
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Carnegie Applied Rugby Research Centre, School of Sport, Leeds Beckett University, Leeds, UK
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Milne SC, Kim SH, Murphy A, Larkindale J, Farmer J, Malapira R, Danoudis M, Shaw J, Ramakrishnan T, Rasouli F, Yiu EM, Georgiou-Karistianis N, Tai G, Zesiewicz T, Delatycki MB, Corben LA. The Responsiveness of Gait and Balance Outcomes to Disease Progression in Friedreich Ataxia. CEREBELLUM (LONDON, ENGLAND) 2022; 21:963-975. [PMID: 34855135 DOI: 10.1007/s12311-021-01348-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
To identify gait and balance measures that are responsive to change during the timeline of a clinical trial in Friedreich ataxia (FRDA), we administered a battery of potential measures three times over a 12-month period. Sixty-one ambulant individuals with FRDA underwent assessment of gait and balance at baseline, 6 months and 12 months. Outcomes included GAITRite® spatiotemporal gait parameters; Biodex Balance System Postural Stability Test (PST) and Limits of Stability; Berg Balance Scale (BBS); Timed 25-Foot Walk Test; Dynamic Gait Index (DGI); SenseWear MF Armband step and energy activity; and the Friedreich Ataxia Rating Scale Upright Stability Subscale (FARS USS). The standardised response mean (SRM) or correlation coefficients were reported as effect size indices for comparison of internal responsiveness. Internal responsiveness was also analysed in subgroups. SenseWear Armband daily step count had the largest effect size of all the variables over 6 months (SRM = -0.615), while the PST medial-lateral index had the largest effect size (SRM = 0.829) over 12 months. The FARS USS (SRM = 0.824) and BBS (SRM = -0.720) were the only outcomes able to detect change over 12 months in all subgroups. The DGI was the most responsive outcome in children, detecting a mean change of -2.59 (95% CI -3.52 to -1.66, p < 0.001, SRM = -1.429). In conclusion, the FARS USS and BBS are highly responsive and can detect change in a wide range of ambulant individuals with FRDA. However, therapeutic effects in children may be best measured by the DGI.
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Affiliation(s)
- Sarah C Milne
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia.
- Physiotherapy Department, Monash Health, Melbourne, Australia.
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | | | - Anna Murphy
- MonARC, Monash Health, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Mary Danoudis
- MonARC, Monash Health, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Eppie M Yiu
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Geneieve Tai
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
| | | | - Martin B Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Clinical Genetics Services, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Elnaggar RK, Alqahtani BA, Alsubaie SF, Mohamed RR, Elbanna MF. Stretch-shortening cycle exercises can efficiently optimize gait-symmetry and balance capabilities in children with unilateral cerebral palsy: A randomized controlled trial. NeuroRehabilitation 2021; 49:139-149. [PMID: 34180425 DOI: 10.3233/nre-210063] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with unilateral cerebral palsy (UCP) experience an asymmetrical gait pattern and poor balance capabilities. Effective interventions, therefore, are needed to facilitate remediation of these functional issues. OBJECTIVE This study was set out to investigate the emerging role of stretch-shortening cycle (SSC) exercises on gait-symmetry and balance in children with UCP. METHODS In this randomized controlled trial, 42 children with UCP (age; 8 -12 years) were enrolled and received either standard physical rehabilitation (control group; n = 21) or the SSC exercise program plus physical rehabilitation (SSC group; n = 21). Spatial- and temporal-gait symmetry index (GSI) and specific balance capabilities [reactive balance, directional control, movement synchronization, and sensory organization] were assessed before and after 16 sessions that were carried out twice/week over non-sequential days in an 8-week program. RESULTS Using the pre-treatment scores as covariates, the post-treatment spatial- (P = 0.006; ηp2= 0.17) and temporal- GSI (P < .001; ηp2= 0.46) scores reduced significantly in the SSC group as compared to the control group, suggesting favorable improvement of gait symmetry. Also, all measures of balance (P < 0.05; ηp2 ranged between 0.10 and 0.29) improved remarkably, post-treatment, in SSC group in comparison with the control group. CONCLUSION The evidence from this study suggests that SSC exercises besides standard physical rehabilitation appear to be effective for improving gait symmetry and boosting balance capabilities in children with UCP.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Bader A Alqahtani
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Saud F Alsubaie
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Rania R Mohamed
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohammed F Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Young S, Wallmann HW, Quiambao KL, Grimes BM. The Effects of Whole Body Vibration on the Limits of Stability in Adults With Subacute Ankle Injury. Int J Sports Phys Ther 2021; 16:749-755. [PMID: 34123528 PMCID: PMC8168983 DOI: 10.26603/001c.24250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited research exists on the effects of both high and low frequency whole body vibration (WBV) on individuals with subacute lateral ankle sprains. HYPOTHESIS/PURPOSE To examine the difference in the effects of high and low frequency WBV on limits of stability (LOS) in adults with a subacute ankle sprain. It was hypothesized that WBV would improve effects on outcome variables for LOS as a component of dynamic balance. STUDY DESIGN Quasi-experimental, pretest-posttest design. METHODS Fifteen participants ages 19-27 years (Mean age 22±2.36) with either a Grade I or Grade II lateral ankle sprain received WBV in bilateral stance under three randomized conditions (high frequency-25 Hz, low frequency-6 Hz, and control, which consisted of bilateral stance with machine off) for six minutes over three sessions (one time per week). The LOS test, consisting of 5 variables, were assessed using the NeuroCom® Balance Manager-SMART EquiTest® (Natus Medical Incorporated, Pleasanton, CA) at baseline and after the intervention period. The participants completed a practice LOS test and then had a six-minute standing rest break. After the rest break, they completed the pre-LOS (baseline) test. Intervention was administered using the Galileo® Med L Chip Research (Novotec Medical GmbH, Pforzheim, Germany) for six minutes for the appropriate condition of either high or low frequency WBV or control. Data analysis was performed using 2-Way (2x3) Repeated Measures ANOVAs with additional post hoc testing as needed. RESULTS Significant interactions were found for reaction time (RT), movement velocity (MVL), and maximal excursion (MXE) composite scores with a decrease in RT of 0.117 seconds (p=0.022) between control and high frequency conditions during the post LOS. For composite MVL, an increase of 0.547 degrees/second (p=0.002) between pre- and post-high frequency WBV occurred. For composite MXE, an increase of 2.13% p=0.031 (when comparing pre- and post-high frequency WBV. CONCLUSION Findings suggest that a single session of high frequency WBV in individuals with a subacute lateral ankle sprain may result in improvement in several components of postural stability. WBV is a quick intervention that could be implemented in physical therapy clinics, athletic training rooms, and workout facilities to improve an individual's LOS as a component of dynamic balance one to eight weeks post lateral ankle sprain. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Sonia Young
- Western Kentucky University, Bowling Green, KY, USA
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Abstract
The aim of this study was to determine whether young adolescent female artistic gymnasts demonstrate better functional stability than age- and sex-matched non-athletes. Different characteristics of the gymnasts’ postural control were expected to be observed. Twenty-two 10- to 13-year-old healthy females (ten national-level artistic gymnasts and twelve non-athletes) participated in the study. To assess their forward functional stability, the 30-s limit of stability test was performed on a force plate. The test consisted of three phases: quiet standing, transition to maximal forward leaning, and standing in the maximal forward leaning position. Between-group comparisons of the directional subcomponents of the root mean squares and mean velocities of the center of pressure and rambling-trembling displacements in two phases (quiet standing and standing in maximal leaning) were conducted. Moreover, anterior stability limits were compared. During standing in maximal forward leaning, there were no differences in the center of pressure and rambling measures between gymnasts and non-athletes (p > 0.05). The values of trembling measures in both anterior-posterior and medial-lateral directions were significantly lower in gymnasts (p < 0.05). Both groups presented similar values for anterior stability limits (p > 0.05). The comparisons of rambling components may suggest a similar supraspinal control of standing in the maximal leaning position between gymnasts and healthy non-athletes. However, decreased trembling in gymnasts may indicate reduced noise in their postural control system possibly due to superior control processes at the spinal level. The anterior stability limit was not influenced by gymnastics training in female adolescents.
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Tamplain P, Sherrod GM, Fuchs C, Miller HL. Preliminary Improvements in Dynamic Postural Control after A Group-based Intervention Program for Children with Developmental Coordination Disorder: A Brief Report. Dev Neurorehabil 2021; 24:63-67. [PMID: 32945221 PMCID: PMC7769962 DOI: 10.1080/17518423.2020.1819463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the value of a traditional (easy to implement) group-based intervention program on both static and dynamic postural control in children with Developmental Coordination Disorder (DCD). METHODS Sway and stability indices were measured with the Clinical Test of Sensory Integration in Balance (CTSIB) and efficiency of goal-directed movement was measured during a Limits-of-Stability (LoS) task, before and after the intervention program. The intervention involved a total of 10 one-hour group sessions, administered once per week for 10 weeks. RESULTS Results indicated significant group increases in dynamic postural control (p <.05). These results suggest it is possible to improve dynamic postural control in this population. This type of intervention does not require any expensive materials, it is feasible, and easy-to-implement to a group of children. CONCLUSION We conclude that this simple form of intervention involving fun group activities can significantly improve dynamic postural control in children with DCD.
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Affiliation(s)
- Priscila Tamplain
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Dr., Arlington, TX, 76019, USA
| | - Gabriela M. Sherrod
- Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Chadwick Fuchs
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Dr., Arlington, TX, 76019, USA
| | - Haylie L. Miller
- Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
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Molina-Rueda F, Cuesta-Gómez A, Carratalá-Tejada M, Koutsou A, Fernández-González P, Alguacil-Diego IM. Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability. Phys Ther Sport 2020; 47:134-139. [PMID: 33278784 DOI: 10.1016/j.ptsp.2020.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study postural control and muscle activity during the limit of stability test (LOS) in subjects with chronic ankle instability. DESIGN Observational study. SETTING University laboratory. PARTICIPANTS 10 healthy subjects were included in the control group and 10 subjects in the CAI group (age between 18 and 30 years, with history of the multiple ankle "giving way" episodes in the last six months and score ≤24 in the Cumberland Ankle Instability Tool). MAIN OUTCOME MEASURES A computerized dynamic posturography equipment was used for assessing the LOS. The electromyography activity of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG) and peroneus longus (PL) was registered. RESULTS Subjects with CAI had a greater activation in TA to forward (p < .01), forward affected (p = .001), backward affected (p = .007) and backward directions (p < .01); in PL to forward affected (p < .01) and affected directions (p = .001); in MG to forward (p = .023) and affected directions (p < .01) and in SOL to the affected direction (p = .009). We observed restricted excursions and less directional control in subjects with CAI. CONCLUSIONS Subjects with CAI exhibited poorer ability to move their center of gravity within stability limits. In addition, they have an altered ankle muscle activity during LOS test toward the affected ankle joint.
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Affiliation(s)
- Francisco Molina-Rueda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Alicia Cuesta-Gómez
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
| | - María Carratalá-Tejada
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Aikaterini Koutsou
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Pilar Fernández-González
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Isabel María Alguacil-Diego
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Bertrand-Charette M, Dambreville C, Bouyer LJ, Roy JS. Systematic review of motor control and somatosensation assessment tests for the ankle. BMJ Open Sport Exerc Med 2020; 6:e000685. [PMID: 32655878 PMCID: PMC7342858 DOI: 10.1136/bmjsem-2019-000685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background/Aim Ankle sprains are frequent musculoskeletal injuries that can lead to sensorimotor deficits provoking long-term instability at the ankle joint. A broad variety of clinical tests currently exist to assess sensorimotor processing, and are commonly clinically referred to as proprioceptive tests. However, there is a discrepancy in the use of the term proprioception when looking at the main outcome of these tests. As identifying specific deficits is important for motor recovery, it is critical for clinicians to select the most appropriate tests. Methods A systematic review of four databases was performed to provide an up-to-date review of the psychometric properties of available tests referred to as proprioceptive tests. Seventy-nine articles on eight ankle proprioceptive tests were included and critically appraised. Data on validity, reliability and responsiveness were extracted from the included articles and synthesised. The tests reviewed were then divided into two categories based on their main outcome: motor control or somatosensation. Results Strong evidence showed that the Star Excursion Balance Test, a motor control test, is capable of differentiating between stable and unstable ankles. Moderate evidence suggests that somatosensation tests, such as Joint Position Sense, are also valid and reliable, but their responsiveness has yet to be evaluated. Conclusions Together, these findings indicate that the Star Excursion Balance Test can be used in the clinic to assess motor control based on its excellent psychometric properties. However, as ankle stability control involves complex sensorimotor interactions, care has to be taken regarding the use of this test as a specific tool for proprioception assessment.
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Affiliation(s)
- Michaël Bertrand-Charette
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
| | - Charline Dambreville
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
| | - Laurent J Bouyer
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
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Elnaggar RK. Pulsed Nd:YAG laser: effects on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy. Lasers Med Sci 2020; 35:1075-1083. [PMID: 31628558 DOI: 10.1007/s10103-019-02889-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
Hemophilic ankle arthropathy features joint pain, impaired postural control, and abnormal weight-bearing pattern. This study was designed to investigate the effects of pulsed Nd:YAG laser on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy. Forty children diagnosed with hemophilia type A (age, 8-16 years) were randomly allocated to either the treatment group (n = 20) who received a three-phase active therapy with pulsed Nd:YAG laser thrice/week (total energy was 1500 J) plus a physical exercise program for four consecutive weeks, or the placebo group (n = 20) who received placebo laser plus the physical exercise program. Pain, postural control (i.e., directional control [DC], endpoint excursion [EE], center-of-gravity movement velocity [CoG-MV], and maximum excursion [MXE]), and weight-bearing pattern (i.e., pressure peaks of the hindfoot [PP-HF] and forefoot [PP-FF], and the foot contact area [FCA]) were assessed pre- and post-treatment. The treatment group showed greater improvement in pain (P = .004), DC (P = .02), EE (P = .003), and CoG-MV (P = .003) compared to the placebo group. However, there was no statistically significant difference between both groups regarding the MXE (P = .15). In addition, the treatment group achieved favorable improvements in PP-HF (P = .003), PP-FF (P = .027), and FCA (P = .002) relative to the placebo group. Pulsed Nd:YAG laser is a potentially effective therapy for pain relief, postural control enhancement, and weight-bearing pattern adjustment in children with hemophilic ankle arthropathy.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.
- , Giza, Egypt.
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13
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Training With Wii Balance Board for Dynamic Balance in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Impairments in Postural Control and Retest Reliability of Dynamic Posturographic Measures After Lung Transplantation. Am J Phys Med Rehabil 2018; 98:353-359. [PMID: 30422827 DOI: 10.1097/phm.0000000000001095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to classify impairments in postural control using computerized posturography in lung transplant recipients undergoing subacute rehabilitation and to examine the retest reliability of these measures. METHODS In a prospective repeated-measures study, 50 lung transplant recipients underwent clinical and quantitative posturographic testing (SMART EquiTest), which included the sensory organization test, motor control test, and limits of stability test. Testing was repeated after 1 to 2 days and upon completion of rehabilitation, 2 mos later. Main outcome measures were the following: sensory organization test-composite score, motor control test-latency and amplitude scaling, limits of stability test-movement velocity, and endpoint excursion/maximum excursion. RESULTS At the beginning of rehabilitation, the mean sensory organization test-composite score and limits of stability test, but not the motor control test scores, were below normative reference values and and did not return to normal after rehabilitation. Intraclass correlation coefficients(2,1) yielded excellent relative reliability for all posturographic tests. The smallest detectable differences observed for the sensory organization test and limits of stability test exceeded the mean changes observed upon completion of rehabilitation. CONCLUSIONS Impairments in sensory and anticipatory postural control were insufficiently restored after subacute lung transplantation rehabilitation. The little sensitivity of the sensory organization test-composite score or limits of stability test scores to detect a minimal change in performance due to rehabilitation limits the clinical applicability of these tests as objective outcome measures in lung transplantation rehabilitation.
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Pucillo EM, Mcintyre MM, Pautler M, Hung M, Bounsanga J, Voss MW, Hayes H, Dibella DL, Trujillo C, Dixon M, Butterfield RJ, Johnson NE. Modified dynamic gait index and limits of stability in myotonic dystrophy type 1. Muscle Nerve 2018; 58:694-699. [PMID: 30160307 DOI: 10.1002/mus.26331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). METHODS Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. RESULTS Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as "fallers" and those who had been classified as "nonfallers." Significant correlations were found between mDGI scores and 10-m walking time. DISCUSSION Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1. Muscle Nerve 58: 694-699, 2018.
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Affiliation(s)
- Evan M Pucillo
- Department of Physical Therapy, University of Saint Augustine Health Sciences, 1 University Boulevard, Room D129, Saint Augustine, Florida, 32086, USA
| | | | - Mary Pautler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Division of Public Health, University of Utah, Salt Lake City, Utah, USA
| | - Jerry Bounsanga
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Maren W Voss
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Heather Hayes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Deanna L Dibella
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Caren Trujillo
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Melissa Dixon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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Rusaw DF, Rudholmer E, Barnett CT. Development of a limits of stability protocol for use in transtibial prosthesis users: Learning effects and reliability of outcome variables. Gait Posture 2017; 58:539-545. [PMID: 28968587 DOI: 10.1016/j.gaitpost.2017.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/31/2017] [Accepted: 08/14/2017] [Indexed: 02/02/2023]
Abstract
The aims of this study were to empirically quantify reliability and learning effects of a Limits of Stability protocol for transtibial prosthesis users. Outcome variables from center of pressure and center of mass were tested on: 1) multiple test repetitions within a single test occasion; and 2) between multiple test occasions. Trantibial prosthesis users (n=7) and matched controls (n=7) executed five trials of the Limits of Stability protocol on two occasions per day, on two consecutive days. Inter-trial learning effects and reliability of outcomes extracted via center of mass and center of pressure were evaluated utilizing standard biomechanics laboratory equipment. Reliability was good to excellent except the reaction time variable which was poor (Pooled 95%CI of ICC=0.248-0.484). An inter-trial learning effect was present in directional control for prosthesis users when the first trial was included in analysis (center of mass: 95%CI of r=0.065-0.239; center of pressure: 95%CI of r=0.076-0.249). The use of standard biomechanics lab equipment can produce reliable results for the Limits of Stability protocol. Researchers should be aware of low reliability of reaction time variable in the protocol assessed and should execute at least one practice trial prior to that which is used in subsequent analysis.
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Affiliation(s)
- David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Elin Rudholmer
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study. Int J Rehabil Res 2017; 40:227-231. [DOI: 10.1097/mrr.0000000000000240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Components of Standing Postural Control Evaluated in Pediatric Balance Measures: A Scoping Review. Arch Phys Med Rehabil 2017; 98:2066-2078.e4. [PMID: 28438514 DOI: 10.1016/j.apmr.2017.02.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/24/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify measures of standing balance validated in pediatric populations, and to determine the components of postural control captured in each tool. DATA SOURCES Electronic searches of MEDLINE, Embase, and CINAHL databases using key word combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests, and child/pediatrics; gray literature; and hand searches. STUDY SELECTION Inclusion criteria were measures with a stated objective to assess balance, with pediatric (≤18y) populations, with at least 1 psychometric evaluation, with at least 1 standing task, with a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. There were 21 measures included. DATA EXTRACTION Two reviewers extracted descriptive characteristics, and 2 investigators independently coded components of balance in each measure using a systems perspective for postural control, an established framework for balance in pediatric populations. DATA SYNTHESIS Components of balance evaluated in measures were underlying motor systems (100% of measures), anticipatory postural control (72%), static stability (62%), sensory integration (52%), dynamic stability (48%), functional stability limits (24%), cognitive influences (24%), verticality (9%), and reactive postural control (0%). CONCLUSIONS Assessing children's balance with valid and comprehensive measures is important for ensuring development of safe mobility and independence with functional tasks. Balance measures validated in pediatric populations to date do not comprehensively assess standing postural control and omit some key components for safe mobility and independence. Existing balance measures, that have been validated in adult populations and address some of the existing gaps in pediatric measures, warrant consideration for validation in children.
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Alsalaheen B, Haines J, Yorke A, Diebold J. King-Devick Test reference values and associations with balance measures in high school American football players. Scand J Med Sci Sports 2015; 26:235-9. [PMID: 26648587 DOI: 10.1111/sms.12628] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/30/2022]
Abstract
The King-Devick test appears to be a promising tool in screening for concussions. However, limited evidence exists on the baseline associations between the K-D test and age and baseline screening tools used after concussion. Additionally, there are no published reference values for the K-D test in high school football players. The K-D test, the Balance Error Scoring System, and the Limits of Stability (LOS) test were administered to 157 high school football players. Additionally, a subsample of 62 participants completed the test twice to examine the reliability of K-D test. There was no relationship between the K-D test and the BESS, or the reaction time and directional control of LOS test. Students aged between 16 and 18 years demonstrated faster K-D test performance compared to students between 13 and 15 years of age. However, there was no association between K-D test and history of concussion. The reliability of the K-D test was (ICC2,1 = 0.89), and the minimal detectable change was 6.10 s. Normative reference values for high school football players are presented in this study.
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Affiliation(s)
- B. Alsalaheen
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
| | - J. Haines
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
| | - A. Yorke
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
| | - J. Diebold
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
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