The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults

The effect of Tai Chi lower extremity exercise on the balance control of older adults in assistant living communities

BACKGROUND

Although Tai Chi (TC) is an evidence-based fall prevention training for older adults, its effective movements remain unclear, which may limit the practice of TC. The purpose of this study was to compare the effectiveness of TC lower extremity exercise (TC LEE), the 8-form Tai Chi (8-form TC), and a stretching control intervention for improving balance and functional mobility among older adults.

METHODS

This was a randomized controlled trial. A total of 102 participants (79 ± 6 years old) were recruited from assisted living facilities. All participants were randomly assigned to the TC LEE (n = 40), 8-form TC (n = 31), and stretching (n = 31) groups in which they received the respective interventions for 16 weeks. The Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and center of pressure (COP) measurements during quiet stance were collected prior to and following the 16-week interventions. Comparisons on all measurements were conducted among all groups.

RESULTS

Significant improvements were found in BBS (P = 0.002), TUG test (P = 0.001), root mean square amplitude of COP displacement in the anterior-posterior (P = 0.001) and medial-lateral (P = 0.001) directions, and average COP speed in the anterior-posterior (P = 0.001) and medial-lateral (P = 0.001) directions after training in the TC intervention groups compared with the stretching group. The upper limit of the 95% confidence interval (CI) of differences in change scores on the BBS (-0.8 - 1.3 points) between the TC LEE group and the 8-form TC group was within equivalence margins (1.8 points), while the upper limit of the 95% CI of differences in change scores on the TUG test (0.1 - 2.1 s) exceeded the equivalence margin (0.7 s) with the TC LEE group having the larger change scores.

CONCLUSION

TC LEE can improve balance and functional mobility in older adults, and may have greater effect than the 8-form TC on improving functional mobility as measured by the TUG test.

TRIAL REGISTRATION

ChiCTR2300070600 retrospectively registered.

Effectiveness of non-immersive virtual reality exercises for balance and gait improvement in older adults: A meta-analysis

BACKGROUND

Virtual reality (VR)-based physical exercise is an innovative and effective intervention strategy for healthcare in older adults.

OBJECTIVE

This meta-analysis aimed to clarify the effects of VR-based balance exercise programs on various balancing abilities of older adults. In addition, the effect size of each variable was computed by total exercise time, sensor type, avatar presence, and feedback type to determine influencing factors that lead to the success of VR-based rehabilitation programs.

METHODS

The databases searched were PubMed/Medline, CINAHL, NDSL, and Google Scholar. Inclusion criteria were: (1) independent older adults; (2) non-immersive VR exercise; (3) randomized controlled design; (4) both balance and gait data; and (5) written in English and Korean. The studies without information to compute effect sizes were excluded. Standardized mean difference was used to analyze the effect size (d).

RESULTS

Twenty-five studies were finally included in this study. The main findings of this meta-analysis were as follows: (1) Non-immersive VR-based balance exercises are moderately and largely effective for improving overall balance function, (2) VR balance exercise was more effective for static balance than for gait, (3) VR exercise is more effective when avatars are presented and KP is provided as feedback.

CONCLUSION

Total exercise time and mode of feedback are influencing factors that affect the effectiveness of VR-based balance exercises.

A study of the discriminative properties of the Six-Spot Step Test in older adults at risk of falling and those not at risk

OBJECTIVE

To investigate the discriminative properties of the Six-Spot Step Test in older adults with self-reported balance problems.

METHODS

Seventy-five older adults aged ≥65 years completed the Six-Spot Step Test and the Timed "Up and Go" test. A Mini-BESTest score of ≤19 was used as a cutoff for defining the risk of falling, and a receiver operating characteristics curve was generated to determine relevant cutoff scores.

RESULTS

An overall accuracy of 85% for the Six-Spot Step Test and 88% for the Timed "Up and Go" test were found. The probability of ruling out people at risk of falling increased with a test score shorter than 8.0 and 7.3 seconds on the Six-Spot Step Test and the Timed "Up and Go" test, respectively. Maximizing the total true positive and true negative test results generated a cutoff score of 8.8 seconds (accuracy 79%) and 8.3 seconds (accuracy 80%) for the Six-Spot Step Test and the Timed "Up and Go" test, respectively.

CONCLUSIONS

The Six-Spot Step Test, which challenges the ability to adapt to more complex tasks during walking, discriminates accurately between older adults at risk of falling and those not at risk. Results as low as eight seconds qualify for fall-preventive interventions.

Feasibility and Safety of Sequential Transcranial Direct Current Stimulation and Physical Therapy in Older Adults at Risk of Falling: A Randomized Pilot Study

Objective

To establish the feasibility and safety of administering transcranial direct current stimulation (tDCS) immediately prior to physical therapy (PT) sessions in older adults at risk of falls.

Design

A pilot randomized controlled study.

Setting

Outpatient geriatric physical therapy clinic.

Participants

Ten older adults living within supportive housing facilities (86.8±7.9 y/o, 8F) were enrolled in the study.

Interventions

Participants received tDCS or sham stimulation targeting the left dorsal lateral prefrontal cortex for 20 minutes, immediately prior to up to 10 of their PT visits.

Main Outcome Measures

Feasibility, safety, and functional outcomes were reported to inform the design of a larger and more definitive trial.

Results

Six fallers (88.8±5.0 y/o, 5F) completed the study and received 82.3% of the possible stimulation sessions, suggesting adding a 20-minute session of stimulation immediately prior to PT training sessions, along with pre- and post-assessments is feasible. The blinding strategy was successful and all reported side effects were expected and transient. While feasible and safe, the trial was met with numerous challenges, including selection bias, time and energy commitment, and large variation in functional performance, that must be considered when designing and implementing larger more definitive trials.

Conclusion

This study provides preliminary evidence about the feasibility, safety, and challenges to combine PT and tDCS in very frail older adults.

Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer's disease

INTRODUCTION

Optimal trunk control relies on adequate musculoskeletal, motor, and somatosensory systems that are often affected in people with Alzheimer's disease (AD). Therefore, the aim of this study was to compare trunk control between people with AD and healthy older adults, and investigate the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with AD.

METHODS

The study was completed with 35 people with AD and 33 healthy older adults with matching age and gender. Trunk control was evaluated with Trunk Impairment Scale (TIS); balance with Berg Balance Scale (BBS), Functional Reach Test (FRT), One-Leg Standing Test (OLST) and Five-Repeat Sit-and-Stand Test (5STS); gait with Dynamic Gait Index (DGI); functional mobility with Timed Up and Go (TUG) Test; fear of falling with Falls Efficacy Scale-International (FES-I).

RESULTS

BBS, FRT, OLST, and DGI scores were lower and 5STS and TUG Test scores were higher in people with AD compared to healthy older adults (p < 0.05). There was no difference in FES-I score between people with AD and healthy older adults (p > 0.05). TIS was associated with BBS, FRT, OLST, 5STS, DGI, TUG Test, and FES-I (r between - 0.341 and 0.738; p < 0.05 for all).

CONCLUSION

Trunk control is affected and related with balance, gait, functional mobility, and fear of falling in people with AD. For this reason, we think that trunk control should be evaluated in the early period, and applications for trunk control should be included in rehabilitation approaches in order to improve balance, gait, functional mobility, and reduce fear of falling.

Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists.

OBJECTIVE

Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs.

METHODS

Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses.

RESULTS

3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence.

CONCLUSIONS

Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.

A Hybrid Assessment of Clinical Mobility Test Items for Evaluating Individuals With Mild Traumatic Brain Injury

BACKGROUND AND PURPOSE

The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls.

METHODS

Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data.

RESULTS

The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring.

DISCUSSION AND CONCLUSIONS

The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409 ).

The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups

Whole-body vibration (WBV) is a novel exercise training measure that promotes the muscle strength, flexibility, and balance abilities of elderly groups. The feasibility and applicability of 20-30 min (lowering a heat pack at 73 °C by wrapping it in multiple layers of towels to 40-43 °C before it touched the skin) thermotherapy are increasingly being demonstrated by applications and clinical trials. Studies show that it increases the flexibility of macules and ligament. However, no studies have examined the interactions between the pre-exercise and post-exercise application of heat therapy (duration a training course). Therefore, this study investigates the effects of WBV and heat therapy on the muscle strength, flexibility, and balance abilities of elderly groups. Eighty middle-age and elderly participants with no regular exercise habits were enrolled in this study. They were randomly assigned to a WBV group, a WBV plus heat therapy group, a heat therapy alone group, and a control group. The WBV groups underwent 5-min, fixed-amplitude (4 mm), thrice-weekly WBV training sessions for 3 consecutive months on a WBV training machine. Participants' balance was measured using the limits of stability (LOS) test on a balance system. The pretest and posttest knee extensor and flexor strength were tested using an isokinetic lower extremity dynamometer. Pretest and posttest flexibility changes were measured using the sit-and-reach test. Significantly larger pretest and posttest differences in flexibility and muscle strength were observed in the WBV and WBV plus heat therapy groups. The addition of heat therapy to WBV resulted in the largest flexibility improvements.

Extended effects of a wearable sensory prosthesis on gait, balance function and falls after 26 weeks of use in persons with peripheral neuropathy and high fall risk—The walk2Wellness trial

Background

We recently reported that individuals with impaired plantar sensation and high fall risk due to sensory peripheral neuropathy (PN) improved gait and balance function following 10 weeks of use of Walkasins^®, a wearable lower limb sensory prosthesis that provides directional specific mechanical tactile stimuli related to plantar pressure measurements during standing and walking (RxFunction Inc., Eden Prairie, MN, United States). Here, we report 26-week outcomes and compare pre- and in-study fall rates. We expected improvements in outcomes and reduced fall rates reported after 10 weeks of use to be sustained.

Materials and methods

Participants had clinically diagnosed PN with impaired plantar sensation, high fall risk (Functional Gait Assessment, FGA score < 23) and ability to sense tactile stimuli above the ankle at the location of the device. Additional outcomes included 10 m Gait Speed, Timed Up and Go (TUG), Four-Stage Balance Test, and self-reported outcomes, including Activities-Specific Balance Confidence scale and Vestibular Disorders Activities of Daily Living Scale. Participants tracked falls using a calendar.

Results

We assessed falls and self-reported outcomes from 44 individuals after 26 weeks of device use; 30 of them conducted in-person testing of clinical outcomes. Overall, improvements in clinical outcomes seen at 10 weeks of use remained sustained at 26 weeks with statistically significant increases compared to baseline seen in FGA scores (from 15.0 to 19.2), self-selected gait speed (from 0.89 to 0.97 m/s), and 4-Stage Balance Test (from 25.6 to 28.4 s), indicating a decrease in fall risk. Non-significant improvements were observed in TUG and fast gait speed. Overall, 39 falls were reported; 31 of them did not require medical treatment and four caused severe injury. Participants who reported falls over 6 months prior to the study had a 43% decrease in fall rate during the study as compared to self-report 6-month pre-study (11.8 vs. 6.7 falls/1000 patient days, respectively, p < 0.004), similar to the 46% decrease reported after 10 weeks of use.

Conclusion

A wearable sensory prosthesis can improve outcomes of gait and balance function and substantially decreases incidence of falls during long-term use. The sustained long-term benefits in clinical outcomes reported here lessen the likelihood that improvements are placebo effects.

Clinical trial registration

ClinicalTrials.gov, identifier #NCT03538756.

Reliability and Validity of the Turkish Version of the Modified Dynamic Gait Index in the Elderly

The modified Dynamic Gait Index (mDGI) is one of the valid instruments used in the evaluation of gait disorders. This study aimed to translate the mDGI into Turkish and evaluate the evidence for its reliability and validity for use in an elderly population. For test-retest reliability, the mDGI was administered twice, and for inter-rater reliability, the mDGI was administered alone on the same day by two raters. Concurrent validity of the mDGI was assessed using Pearson’s correlation analysis between the Turkish version of the mDGI score and the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-m Walk Test (10-MWT), respectively. The internal consistency of the mDGI was found to be excellent (Cronbach’s alpha = 0.97) and test-retest (ICC = 0.95; 95% Cl (0.84–0.95)) and inter-rater reliability (ICC = 0.95; 95% Cl (0.85–0.95)) were excellent. A negative, moderate correlation was found between mDGI and TUG (r = −0.73, p < .0001), and a positive, moderate correlation with BBS (r = 0.71, p < .0001) and 10-MWT (r = 0.72, p < .0001). The Turkish version of the mDGI was found to be a valid and reliable assessment instrument for gait and balance in the elderly.

Analysis of Movement Entropy during Community Dance Programs for People with Parkinson's Disease and Older Adults: A Cohort Study

Dance therapy can improve motor skills, balance, posture, and gait in people diagnosed with Parkinson’s disease (PD) and healthy older adults (OA). It is not clear how specific movement patterns during dance promote these benefits. The purpose of this cohort study was to identify differences and complexity in dance movement patterns among different dance styles for PD and OA participants in community dance programs using approximate entropy (ApEn) analysis. The hypothesis was that PD participants will show greater ApEn during dance than OA participants and that the unique dance style of tango with more pronounced foot technique and sharp direction changes will show greater ApEn than smoother dance types such as foxtrot and waltz characterized by gradual changes in direction and gliding movement with rise and fall. Individuals participated in one-hour community dance classes. Movement data were captured using porTable 3D motion capture sensors attached to the arms, torso and legs. Classes were also video recorded to assist in analyzing the dance steps. Movement patterns were captured and ApEn was calculated to quantify the complexity of movements. Participants with PD had greater ApEn in right knee flexion during dance movements than left knee flexion (p = 0.02), greater ApEn of right than left hip flexion (p = 0.05), and greater left hip rotation than right (p = 0.03). There was no significant difference in ApEn of body movements (p > 0.4) or mean body movements (p > 0.3) at any body-segment in OA. ApEn analysis is valuable for quantifying the degree of control and predictability of dance movements and could be used as another tool to assess the movement control of dancers and aid in the development of dance therapies.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association

Background:

Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises.

Methods:

These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence.

Results:

Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes.

Discussion:

Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction.

Limitations:

The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction.

Disclaimer:

These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).

Self-Monitoring of Balance Performance can Reduce the Rate of Falls Among Older Adults

Background: 29% of older adults fall annually, resulting in the leading cause of accidental death. Fall prevention programs typically include exercise training and self-monitoring of physical activity has a positive effect on the self-efficacy and self-regulation of exercise behaviors. We assessed if self-monitoring of fall risk, without an intervention, impacts fall rates. Methods: Fifty-three older adults had open access to a balance measuring platform which allowed them to self-monitor their postural stability and fall risk using a simple 1-min standing balance test. 12-month retrospective fall history was collected and a monthly/bimonthly fall log captured prospective falls. Participants had access to self-monitoring for up to 2.2 years. Fall history and fall incidence rate ratios and their confidence intervals were compared between the periods of time with and without access to self-monitoring. Results: A 54% reduction in the number of people who fell and a 74% reduction in the number of falls was observed when participants were able to self-monitor their postural stability and fall risk, after normalizing for participation length. Further, 42.9% of individuals identified as having high fall risk at baseline shifted to a lower risk category at a median 34 days and voluntarily measured themselves for a longer period of time. Discussion: We attribute this reduction in falls to changes in health behaviors achieved through empowerment from improved self-efficacy and self-regulation. Providing older adults with the ability to self-monitor their postural stability and intuit their risk of falling appears to have modified their health behaviors to successfully reduce fall rates.

Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls

Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual’s perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.

Effects of customized vestibular rehabilitation plus canalith repositioning maneuver on gait and balance in adults with Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial

BACKGROUND

Adults with unilateral posterior canal benign paroxysmal positional vertigo (BPPV) may continue to present with residual dizziness and balance impairments after the canalith repositioning maneuver (CRM). Customized Vestibular rehabilitation (VR) in addition to the standard CRM may improve postural control in adults with BPPV. However, the effectiveness of this intervention for improving dyanmic gait measures in adults with BPPV is unknown.

OBJECTIVE

We aimed to determine the effectiveness of customized VR in addition to the standard CRM on dynamic gait measures among adults with unilateral posterior canal BPPV.

METHODS

In this double blind, randomized controlled trial, 28 adults with BPPV were randomized to either control (n = 14, age: 54.36±8.55) or experimental (n = 14, age: 50.71±9.88) groups. The experimental and control groups received customized VR plus standard CRM for six weeks and standard CRM for two weeks respectively. Dynamic gait measures (duration of a complete gait cycle, stride velocity, turning duration and number of steps while turning) were recorded using a portable mobility sensor (iTUG) at baseline, week 4 and 6. A mixed model ANOVA was used to estimate the main effects of the interventions.

RESULTS

During walking, a group effect was demonstrated on gait duration, stride velocity, turning duration and number of steps while turning (p <  0.05).

CONCLUSIONS

Six weeks of customized VR performed in addition to the standard CRM was more effective than the standard CRM alone in improving balance and gait in adults with posterior canal BPPV. (252 words).

Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems

OBJECTIVE

To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults.

DESIGN

Cross-sectional study.

SETTING

Outpatient clinics.

SUBJECTS

Sixty-six adults aged ⩾65 years with self-reported balance problems.

MAIN MEASURE

The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed "Up and Go" test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman's rank correlation coefficient (ρ).

RESULTS

Participants had a mean (SD) age of 75.5 (6.6) years, a median (Q1-Q3) Montreal Cognitive Assessment test score of 26 (24-27), and a median (Q1-Q3) Falls Efficacy Scale International score of 22 (20-26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92-0.98) and 0.94 (CI: 0.86-0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = -0.62), Dynamic Gait Index (ρ = -0.55), and the Timed "Up and Go" test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38).

CONCLUSION

The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.

Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review

Aging is associated with progressive declines in both the vestibular and human balance systems. While vestibular lesions certainly contribute to imbalance, the specific contributions of age-related vestibular declines to age-related balance impairment is poorly understood. This gap in knowledge results from the absence of a standardized method for measuring age-related changes to the vestibular balance pathways. The purpose of this manuscript is to provide an overview of the existing body of literature as it pertains to the methods currently used to infer vestibular contributions to age-related imbalance.

Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community-Dwelling Older Adults: A Blinded Randomized Controlled Trial

BACKGROUND

This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults.

METHODS

Community-dwelling older adults were randomized to 4 training groups. Induced step training (IST, n = 25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n = 25) utilized progressive resistance exercises. Combined training (CMB, n = 25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n = 27). The training involved 36 sessions for a period of 12 weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined.

RESULTS

Overall, the number of recovery steps was reduced by 31% and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre- and post-training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were CMB 0.26 [0.07-0.90], IST 0.44 [0.18-1.08], and HST 0.30 (0.10-0.91).

CONCLUSIONS

Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56%-74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.

The Effects of a Wearable Sensory Prosthesis on Gait and Balance Function After 10 Weeks of Use in Persons With Peripheral Neuropathy and High Fall Risk - The walk2Wellness Trial

BACKGROUND

Sensory peripheral neuropathy (PN) is associated with gait, balance problems and high fall risk. The walk2Wellness trial investigates effects of long-term, home-based daily use of a wearable sensory prosthesis on gait function, balance, quality of life and fall rates in PN patients. The device (Walkasins®, RxFunction Inc., MN, United States) partially substitutes lost nerve function related to plantar sensation providing directional tactile cues reflecting plantar pressure measurements during standing and walking. We tested the null hypothesis that the Functional Gait Assessment (FGA) score would remain unchanged after 10 weeks of use.

METHODS

Participants had PN with lost plantar sensation, gait and balance problems, an FGA score < 23 (high fall risk), and ability to sense tactile stimuli above the ankle. Clinical outcomes included FGA, Gait Speed, Timed Up&Go (TUG) and 4-Stage Balance Test. Patient-reported outcomes included Activities-Specific Balance Confidence (ABC) scale, Vestibular Disorders Activities of Daily Living Scale, PROMIS participation and satisfaction scores, pain rating, and falls. Evaluations were performed at baseline and after 2, 6, and 10 weeks. Subjects were not made aware of changes in outcomes. No additional balance interventions were allowed.

RESULTS

Forty-five participants of 52 enrolled across four sites completed in-clinic assessments. FGA scores improved from 15.0 to 19.1 (p < 0.0001), normal and fast gait speed from 0.86 m/s to 0.95 m/s (p < 0.0001) and 1.24 m/s to 1.33 m/s (p = 0.002), respectively, and TUG from 13.8 s to 12.5 s (p = 0.012). Four-Stage Balance Test did not improve. Several patient-reported outcomes were normal at baseline and remained largely unchanged. Interestingly, subjects with baseline ABC scores lower than 67% (high fall risk cut-off) increased their ABC scores (49.9% to 59.3%, p = 0.01), whereas subjects with ABC scores above 67% showed a decrease (76.6% to 71.8%, p = 0.019). Subjects who reported falls in the prior 6 months (n = 25) showed a decrease in the number of fall-risk factors (5.1 to 4.3, p = 0.023) and a decrease in fall rate (13.8 to 7.4 falls/1000 days, p = 0.014). Four pre-study non-fallers (n = 20) fell during the 10 weeks.

CONCLUSION

A wearable sensory prosthesis presents a new way to treat gait and balance problems and manage falls in high fall-risk patients with PN.

TRIAL REGISTRATION

ClinicalTrials.gov (#NCT03538756).

Reliability, internal consistency, and concurrent validity of a modified version of the dynamic gait index in people with vestibular disorders

BACKGROUND

People with vestibular disorders often have abnormalities in gait and balance. The Dynamic Gait Index (DGI) is a relatively effective clinical gait measure that has been validated for use in patients with vestibular disorders. The modified version of the DGI (M-DGI) is based on the original DGI.

RESEARCH QUESTION

The objective of this study was to refine and test the clinical application of the M-DGI, and to investigate whether it is an effective indicator of dynamic gait in patients with vestibular disorders.

METHODS

A reliability and validity study. All raters reviewed the instructions and scoring criteria for each M-DGI item prior to the initial test. The raters simultaneously scored two M-DGI tasks for the 75 subjects, and the two tasks were completed with an interval of two hours in-between. Reliability of total M-DGI scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the M-DGI was evaluated using Cronbach's alpha. Concurrent validity of the M-DGI with Dizziness Handicap Inventory (DHI) and Timed "Up & Go" Test (TUG) was assessed using Spearman's rank order correlation coefficient.

RESULTS AND SIGNIFICANCE

Interrater and intrarater reliability of the total M-DGI scores were reflected by ICCs of 0.99 and 0.97. Internal consistency of the M-DGI score was 0.9975. Spearman's rank order correlation coefficient of the M-DGI score with the Dizziness Handicap Inventory (DHI) and the Timed "Up & Go" Test (TUG) was 0.72 and 0.65, respectively.The M-DGI demonstrates acceptable reliability, internal consistency, and concurrent validity for use as a clinical gait measurement for patients with vestibular disorders.

Effect of Community-Based Group Exercise Interventions on Standing Balance and Strength in Independent Living Older Adults

BACKGROUND AND PURPOSE

Many interventions to improve mobility in older adults often include exercises to address underlying impairments such as strength deficits. Task-oriented exercise interventions that focus more on walking and stepping tasks that may be encountered in the community have been considered for improving mobility in older adults. The main purpose was to examine the effect of task-oriented and impairment-based group exercise interventions on standing balance and lower extremity muscle strength.

METHODS

This is an ancillary study to a cluster-randomized clinical trial. Participants included 107 older adults. Participants were randomized by facility to 1 of 2 different interventions, or a waitlist control group. The On the Move (OTM) task-oriented intervention consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The standard of care impairment-based exercise intervention (STD) consisted of warm-up, strength, endurance, and stretching exercises. Postural sway and balance measures were recorded before and after the 12-week interventions. An accelerometer was used to collect postural sway for 6 different standing balance conditions. A portable load cell was used to assess lower extremity muscle strength for 3 muscle groups.

RESULTS AND DISCUSSION

The OTM group had a significant reduction in sway acceleration during most of the balance conditions over the 12-week period, whereas the STD had smaller, nonsignificant reductions. Both exercise interventions had a significant reduction in sway compared with the waitlist control group in at least 1 balance condition. The OTM and STD groups had significant increases in hip abduction strength during the intervention and the STD group also had an increase in knee extension strength. The waitlist group had a significant reduction in strength in all muscle groups during the 12-week period. Strength changes in both exercise groups were significantly different from the waitlist group but not from each other.

CONCLUSION

Both exercise intervention groups had an improvement in standing balance and lower extremity strength when compared with a waitlist group that did not receive exercise. Although the exercise groups did not significantly differ from each other, the OTM exercise group showed a trend toward improvement in static standing balance conditions.

Postural transitions detection and characterization in healthy and patient populations using a single waist sensor

Background

Sit-to-stand and stand-to-sit transitions are frequent daily functional tasks indicative of muscle power and balance performance. Monitoring these postural transitions with inertial sensors provides an objective tool to assess mobility in both the laboratory and home environment. While the measurement depends on the sensor location, the clinical and everyday use requires high compliance and subject adherence. The objective of this study was to propose a sit-to-stand and stand-to-sit transition detection algorithm that works independently of the sensor location.

Methods

For a location-independent algorithm, the vertical acceleration of the lower back in the global frame was used to detect the postural transitions in daily activities. The detection performance of the algorithm was validated against video observations. To investigate the effect of the location on the kinematic parameters, these parameters were extracted during a five-time sit-to-stand test and were compared for different locations of the sensor on the trunk and lower back.

Results

The proposed detection method demonstrates high accuracy in different populations with a mean positive predictive value (and mean sensitivity) of 98% (95%) for healthy individuals and 89% (89%) for participants with diseases.

Conclusions

The sensor location around the waist did not affect the performance of the algorithm in detecting the sit-to-stand and stand-to-sit transitions. However, regarding the accuracy of the kinematic parameters, the sensors located on the sternum and L5 vertebrae demonstrated the highest reliability.

Examining the Feasibility of a Mindfulness Intervention for the Prevention of Falls: A Pilot Study

This pilot study was designed to assess the feasibility of implementing a mindfulness intervention in the prevention of falls. We employed a quasi-experimental design consisting of 22 participants from two retirement homes in Ontario partaking in the regional falls prevention class. Participants were assigned to either an eight-week intervention, comprising mindfulness exercises incorporated into the standard falls prevention class, or to the standard falls prevention class. Participants were assessed using the Tinetti Balance and Gait Scale and the Timed Up and Go (TUG) test. The mindfulness intervention showed no significant effect on TUG or balance scores; however, there was a significant effect on assessments of gait. Given the ease of implementation of mindfulness-based interventions, further research may be warranted in mindfulness as a potential modality for falls prevention.

Varied movement errors drive learning of dynamic balance control during walking in people with incomplete spinal cord injury: a pilot study

The purpose of this study was to determine whether the application of a varied pelvis perturbation force would improve dynamic balance control and gait stability of people with incomplete spinal cord injury (iSCI). Fourteen participants with iSCI completed the test in two conditions, i.e., walking paired with pelvis perturbation force and treadmill walking only, with 1-week interval in between. The order of the testing condition was randomized across participants. For the pelvis pertubation condition, subjects walked on a treadmill with no force for 1 min, with a varied pelvis perturbation force that was bilaterally applied in the medial-lateral direction for 10 min, without force for 1 min, and then with the perturbation for another 10 min after a sitting break. For the treadmill only condition, a protocol that was similar to the perturbation condition was used but no force was applied. Margin of stability (MoS), weight shifting, and other spatiotemporal gait parameters were calculated. Compared to treadmill training only, participants showed significant smaller MoS and double-leg support time after treadmill walking with pelvis perturbation. In addition, participants showed significantly greater improvements in overground walking speed after treadmill walking with pelvis perturbation than treadmill only (p = 0.021). Results from this study suggest that applying a varied pelvis perturbation force during treadmill walking could improve dynamic balance control in people with iSCI, which could be transferred to overground walking. These findings may be used to develop a new intervention to improve balance and walking function in people with iSCI.

Effects of training with a custom-made visual feedback device on balance and functional lower-extremity strength in older adults: A randomized controlled trial

INTRODUCTION

Training with a slow and sustained mechanical load, such as standing on one leg, is an effective method for improving balance and increasing lower-extremity strength. Also, visual feedback during motor learning is important in facilitating efficient postural responses and balance skills. In this study, a custom-made visual feedback device was invented to provide the training modality and program based on single-leg standing combined with augmented visual feedback training. This study aimed to investigate the effects of visual feedback training using the custom-made visual feedback device on balance and functional lower-extremity strength in older adults.

METHODS

Thirty-four independent older adults were randomly allocated to a training group (TG) and a control group (CG). The participants in the TG received training with the custom-made visual feedback device. The training duration was three sessions per week, for four weeks. The participants in the CG continued their routine activities. Balance (static and dynamic balances, and balance confidence) and functional lower-extremity strength were assessed pre- and post-training.

RESULTS

Improvements in static balance (sway velocity and limit of balance during one-leg standing with eyes open) and dynamic balance (directional control of limits of stability in the backward direction) were found after training in the TG compared with the CG. No significant differences in balance confidence or functional lower-extremity strength were found between groups after training.

CONCLUSION

In older adults, training with a custom-made visual feedback device could be used to improve both static and dynamic balances, but not balance confidence and functional lower-extremity strength.

Case Report on Fear of Falling Syndrome: A Debilitating but Curable Gait Disorder

Patient: Male, 70

Final Diagnosis: Fear of falling syndrome

Symptoms: Inability to get up from a chair and ambulate independently

Medication: —

Clinical Procedure: Lumbar puncture

Specialty: Neurology

Walking meditation promotes ankle proprioception and balance performance among elderly women

BACKGROUND

Age-related change of proprioception affects body balance among the elderly. Walking meditation (WM)-a mindfulness practice-involves focusing on leg movements while walking slowly, possibly improving brain processes for perception and balance adjustments. This study investigates the WM's effects on ankle proprioception and balance among the elderly.

METHODS

Fifty-eight women aged 69.25 ± 6.06 were randomized into control (n = 29) and WM (n = 29) groups. The WM group engaged in 8 weeks of WM practice (30 min/day, 3 days/week). The absolute angular error of the ankle reposition test (AAE) was measured by an electrogoniometer. The balance performance was evaluated using the Berg Balance Scale (BBS), Functional Reach Test (FRT), and Timed Up and Go test (TUG). Data were analyzed using two-way ANOVA and Bonferroni post hoc test and BBS with nonparametric statistics.

RESULTS

At baseline, the WM group's AAE, BBS, FRT, and TUG were 4.2 ± 1.6°, 51.3 ± 4.1 points, 21.7 ± 5.7 cm, and 11.1 ± 2.5 s, respectively, whereas those of the control group were 3.6 ± 2.0°, 51.0 ± 5.0 points, 21.6 ± 5.2 cm, and 10.2 ± 3.1 s, respectively. Post-training, WM group showed significant decrease in AAE (2.4 ± 0.9°) and displayed improvements in BBS, FRT, and TUG (55.4 ± 0.9 points, 29.1 ± 5.8 cm, and 8.1 ± 1.1 s, respectively) (p < 0.01). Conversely, the control group presented no change in AAE, significant decreases in BBS and FRT, and slower TUG (p < 0.01). No difference was found between WM and control groups at the baseline. However, post-training, WM group demonstrated significant improvements in AAE, BBS, FRT, and TUG as compared to the control group (p < 0.001).

CONCLUSIONS

WM practice improved the balance and ankle reposition sense among the elderly. It can be used as an alternative form of training to promote balance and ankle proprioception. The results supported that balance performance worsens among the elders who do not engage in physical training.

The Effectiveness of Driving Game on Trunk Control and Gait Ability in Stroke

Patients who require neurological rehabilitation often do not comply with conventional programs because they find the therapy uninteresting. As a result, specialized interactive video games have been designed to be more enjoyable than conventional therapy (CT) tasks. This study aimed to assess the trunk control and gait ability of patients with chronic stroke after participation in driving-based interactive video games (DBIVG). Participants included 24 chronic stroke patients allocated to an experimental group (n = 13, CT + DBIVG) or a control group (n = 11, CT + treadmill walking training). Both groups received CT five days/week; the experimental and control groups participated in DBIVG and treadmill walking training, respectively, three days/week for four weeks. The primary outcome of trunk control was measured by the trunk impairment scale (TISall) and TIS subscales, including static sitting balance (TISssb), dynamic sitting balance (TISdsb), and trunk co-ordination (TISco). Gait ability was measured by the dynamic gait index (DGI), timed walking test (TWT), and time up and go test (TUGT). Both groups demonstrated significant improvements in TISall, TISdsb, and TUGT results. The experimental group showed significantly greater improvement in TISssb, TISco, and DGI than the control group. Our findings indicate that DBIVG can improve trunk control and gait ability in patients with chronic stroke.

Effect of Selected Balance Exercises on the Dynamic Balance of Children with Visual Impairments

Introduction

Maintaining balance while walking is of utmost importance for individuals with visual impairments because deficits in dynamic balance have been associated with a high risk of falling. Thus, the primary aim of the study presented here was to determine whether balance training effects the dynamic balance of children with visual impairments.

Methods

The study included 19 children with visual impairments (aged 8 to 14) from the school for students with visual impairments in Isfahan, Iran, who were randomly assigned to a balance-training (n = 9) or control (n = 10) group. The balance-training group was required to participate in an eight-week balance-training program, while the control group did not participate in any organized balance-training program. The Modified Bass Test of Dynamic Balance was used to measure the dynamic balance of the participants. Both groups performed a pretest prior to the experimental period and performed a posttest immediately after the experimental period.

Results

The scores on the pretest showed no significant difference between the balance-training group and the control group. However, after the balance-training group completed the balance-training program, a between-group difference was found in the participants’ task scores, t (18) = 4.095, p < .05.

Discussion

The findings indicate that involvement in a balance-training program will significantly improve the dynamic balance of individuals with visual impairments relative to a control group.

Implications for practitioners

The study showed that if instructors require individuals with visual impairments to perform balance-improving exercises, the result can be an outstanding improvement in their dynamic balance. With improved balance, individuals with visual impairments may encounter fewer falls and experience a healthier lifestyle.

The Effect of Intensive Abductor Strengthening on Postoperative Muscle Efficiency and Functional Ability of Hip-Fractured Patients: A Randomized Controlled Trial

BACKGROUND

Hip fractures are common in the elderly and many patients fail to regain prefracture hip abductor strength or functional status. The purpose of this clinical trial was to compare the effects of an intensive abductor muscle exercise program versus a standard physiotherapy intervention in hip-fractured patients.

MATERIALS AND METHODS

Ninety six femoral neck-fractured patients were randomized into equal-sized groups. A 12-week standard physiotherapy program was implemented in the control group(S-PT) whereas an intensive exercise program, emphasizing on abductors' strengthening, was implemented in the research group(I-PT). Abductors' isometric strength of the fractured hip, abductor ratio% in the fractured compared to contralateral hip, and functional level were assessed at the 3^rd (postintervention) and 6^th (followup) months.

RESULTS

Postintervention, abductors' isometric strength was 35.7% greater (P < 0.0005) and abductor ratio% was 2.5% higher (P < 0.0005) in I-PT group, compared to S-PT group. With regard to functional assessments, I-PT group was 29.1% faster during Timed Up and Go (TUG) test and achieved a 26.7% higher Lower Extremity Functional Scale Greek version's (LEFS-Greek) total score, compared to S-PT group (P < 0.0005). At followup, abductors' isometric strength was 37.0% greater (P < 0.0005) and abductor ratio% was 7.1% higher (P < 0.0005) in I-PT group, compared to S-PT group. In addition, I-PT group was 45.9% faster during TUG test (P < 0.0005) and achieved an 11.2% higher LEFS-Greek total score, compared to S-PT group (P = 0.013).

CONCLUSIONS

Compared to the standard physiotherapy intervention, the intensive abductor-strengthening program significantly increased both abductors' isometric strength of the fractured hip and abductor ratio% and resulted in patients' enhanced functional level.

CLINICAL TRIAL IDENTIFIER

ISRCTN30713542.

Housebound patients' experiences of a falls service provided by a team of community physiotherapists

Background/Aims:

To explore the experiences of patients of a falls service provided by a community physiotherapy team to elderly, housebound people who have fallen.

Methods:

Six housebound elderly patients who had been referred to the service were interviewed in their own homes. The interviews were transcribed and a thematic analysis framework was used to analyse the data. Codes were identified and developed into key themes that addressed the overall research question.

Results:

The analysis revealed that the participants presented with multiple risk factors including recurrent falls and comorbidities and were at high risk of falls. Exercise was understood to increase their mobility and the majority expressed a fear of falling. The participants appeared to have a limited understanding of the referral process, the cause of their falls and the interventions that may reduce their risk of falling.

Conclusions:

A multidisciplinary falls team, established and recognised as a central point of referral for the care of people who have fallen, could enhance the care of elderly, housebound people who have fallen. The team, with their specialist knowledge and understanding of the multifactorial nature of falls and appropriate interventions, could coordinate and monitor the assessments and interventions needed with the relevant professionals and services.

A speed-based approach to vestibular rehabilitation for peripheral vestibular hypofunction: A retrospective chart review

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke

Background

Various outcome measures are used for the assessment of balance and mobility in patients with stroke. The purpose of the present study was to examine test-retest reliability, construct validity, and responsiveness of the Timed Up and Go Test (TUG), Berg Balance Scale (BBS), and Dynamic Gait Index (DGI) for measuring balance in patients with chronic stroke.

Methods

Fifty-six patients (39 male and 17 female) with chronic stroke participated in this study. A senior physical therapist assessed the test-retest reliability and validity of three scales, including the DGI, TUG, and BBS over two testing sessions. In addition, the third assessment of each scale was taken at the time of discharge to determine the responsiveness of the three outcome measures.

Results

The reliability of the TUG (intraclass correlation coefficient [ICC_2,1] = 0.98), DGI (ICC_2,1 = 0.98) and BBS (ICC_2,1 = 0.99) were excellent. The standard error of measurement (SEM) of the TUG, DGI, and BBS were 1.16, 0.71, and 0.98, respectively. The minimal detectable change (MDC) of the TUG, DGI, and BBS were 3.2, 1.9, and 2.7, respectively. There was a significant correlation found between the DGI and BBS (first reading [r] = 0.75; second reading [r] = 0.77), TUG and BBS (first reading [r] = −.52; second reading [r] = −.53), and the TUG and DGI (first reading [r] = 0.45; second reading [r] = 0.48), respectively.

Conclusions

The test-retest reliability of the TUG, BBS, and DGI was excellent. The DGI demonstrated slightly better responsiveness than TUG and BBS. However, the small sample size of this study limits the validity of the results.

Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects

INTRODUCTION

This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman's ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = -13, CI 95% -16 to -9 points), lower dynamic postural stability (MD = -14, CI 95% -19 to -8 points), and increased fear of falling (MD = 14, CI 95% 10-18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738-0.351), risk of falling (ρ = -0.746), and fear of falling (ρ = -0.432). Dynamic postural stability was correlated with risk of falling (ρ = -0.841), fear of falling (ρ = -0.277), and static postural stability (ρ = -0.869 to -0.435; ρ = -0.361 to -0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.

Effects of Vestibular Rehabilitation in the Management of a Vestibular Migraine: A Review

Vestibular rehabilitation (VR) has been shown to be effective for many vestibular disorders. This review focuses on the current evidence on the effects of physical therapy in the management of vestibular symptoms in individuals with a vestibular migraine (VM). The individuals with a history of a migraine tend to have a high incidence of vestibular symptoms with some or all of their headaches. A total of six included studies investigated the effects of VR in the management of VM. The critical review form for quantitative studies was used to appraise quality assessment and risk of bias in the selected studies. Previous studies validated the use of VR in the treatment of vestibular symptoms for individuals with a VM to include improved headache and migraine-related disability in patients with a VM. From the current evidence, it is difficult to provide conclusive evidence regarding the efficacy of VR to minimize vestibular symptoms in patients with VM. Therefore, more randomized controlled studies are required to make firm evidence on the effect of VR in reducing vestibular symptoms in patients with VM. The future prospective, blinded, randomized controlled studies may help to isolate possible therapeutic effects of VR and other general effects.

Fall Risk Assessment Metrics for Elderly Patients With Hip Fractures

The most common surgery performed by orthopedic surgeons likely involves that for hip fractures. The incidence of hip fractures is anticipated to rise in the coming decades. Hip fractures most commonly occur in elderly women with osteoporosis after a fall from standing position. In an effort to reduce the incidence, improve the postoperative care, and accelerate the rehabilitation of hip fractures, it is important to evaluate the fall risk of these patients, as it is an objective indication of their level of physical activity. Metrics currently available for the evaluation of fall risk in the elderly vary widely, with each having been designed to assess a specific patient population. However, their applicability has often proved to be much broader than expected. This review summarizes the metrics available for fall risk assessment of elderly patients with hip fractures, describes their individual features and efficacy, and highlights those that seem to be more reliable for the assessment of rehabilitation of these patients after hip fracture surgery. [Orthopedics. 2018; 41(3):142-156.].

The effects of a fatiguing lifting task on postural sway among males and females

Lifting and falls comprise a large proportion of work related injuries. Repetitive lifting to the point of fatigue can affect postural sway, which is associated with fall risk. To investigate the effects of lifting and fatigue on postural sway in males and females, 35 participants (18 male, 17 female) were asked to lift a weighted box in sets of 25 lifts at 5 different incremental weights (10, 15, 20, 25, and 30 kg) until fatigue. Before and after each lifting set, participants performed a single leg balance test on a force platform to assess postural sway by means of center of pressure mean velocity. Analysis of pre-fatigue to post-fatigue postural sway measurements indicated that there were no significant differences in mean velocity when males and females were grouped together. However, when analyzed as separate groups, mean postural sway center of pressure velocity increased for males but did not for females, indicating that males and females use different strategies to maintain balance when fatigued.

Movements of older adults during exergaming interventions that are associated with the Systems Framework for Postural Control: A systematic review

One in three older adults fall annually, in part due to impairments in the physiological systems that make up the postural control (PC) system. Exercise, particularly balance training, helps to prevent deterioration and even to improve outcomes in the PC system. Exergaming (exercise-gaming) is interactive computer gaming whereby an individual moves the body in response to onscreen cues in a playful format. Exergaming is an alternative method to standard practice for improving PC outcomes, which has been shown to reduce the risk of falling. Exergaming has received research attention, yet the intervention is still in its infancy. There could be benefit in exploring the movements trained with respect to a framework known for identifying underlying deficits in the PC system, the Systems Framework for Postural Control (SFPC). This may help target areas for improvement in balance training using exergames and shed light on the impact for fall prevention. A literature search was therefore conducted across six databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Movements were rated by two reviewers based on the 9 operational definitions of the SFPC. Eighteen publications were included in the analysis, with a mean PEDro score of 5.6 (1.5). Overall, 4.99 (1.27) of the 9 operational definitions of the SFPC are trained in exergaming interventions. Exergaming does encourage individuals to stand up (3), lean while standing (4), move upper limbs and turn heads (6) and dual-task while standing (9), to some extent move the body forwards, backwards and sideways (1), and coordinate movements (2) but hardly at all to kick, hop, jump or walk (7), or to force a postural reaction from a physical force to the individual (5) and it does not mimic actual changes in sensory context (8). This is the first review, to our knowledge, that synthesises the literature on movements trained in exergaming interventions with respect to an established theoretical framework for PC. This review could provide useful information for designing exergames with PC outcomes in mind, which could help target specific exergames for multi-factorial training to overcome balance deficits. Some elements of PC are too unsafe to be trained using exergames, such as restricting sensory inputs or applying physical perturbations to an individual to elicit postural responses.

The effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness: A systematic review

Background: Dizziness is a non-specific term used by patients to describe several symptoms ranging from true vertigo, light headedness, disorientation or sense of imbalance. Vestibular rehabilitation (VR) is a specific form of exercise-based therapy programme aimed at alleviating the primary and secondary problems of a vestibular pathology. The aim of this study was to investigate the effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness.

Methods: The following five databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, PubMed, the Physiotherapy Evidence Database (PEDro) and Scopus (Elsevier). Two investigators independently reviewed all articles and a systematic review of literature was performed using the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles were included if they met the following inclusion criteria: (1) randomised controlled trial, (2) people with chronic dizziness, (3) adults aged 18 or over, (4) exercise-based VR, (5) VR exercises compared with sham or usual care, non-treatment or placebo and (6) only studies published full text in English.

Results: The initial search identified 304 articles, four of which met the criteria for analysis. All studies involved some form of vestibular rehabilitation, including vestibular compensation, vestibular adaptation and substitution exercises. These exercises were compared with usual medical care (three studies) or placebo eye exercise (one study). The Vertigo Symptom Scale was the most commonly used outcome measure to assess subjective perception of symptoms of dizziness (three studies). According to the PEDro scale, three studies were considered to be of high quality, and one was rated as fair. 

Conclusions: This review suggests that exercise-based vestibular rehabilitation shows benefits for adult patients with chronic dizziness with regard to improvement in the vertigo symptom scale, fall risk, balance and emotional status.

Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study

Background

Sensory augmentation has been shown to improve postural stability during real-time balance applications. Limited long-term controlled studies have examined retention of balance improvements in healthy older adults after training with sensory augmentation has ceased. This pilot study aimed to assess the efficacy of long-term balance training with and without sensory augmentation among community-dwelling healthy older adults.

Methods

Twelve participants (four males, eight females; 75.6 ± 4.9 yrs) were randomly assigned to the experimental group (n = 6) or control group (n = 6). Participants trained in their homes for eight weeks, completing three 45-min exercise sessions per week using smart phone balance trainers that provided written, graphic, and video guidance, and monitored trunk sway. During each session, participants performed six repetitions of six exercises selected from five categories (static standing, compliant surface standing, weight shifting, modified center of gravity, and gait). The experimental group received vibrotactile sensory augmentation for four of the six repetitions per exercise via the smart phone balance trainers, while the control group performed exercises without sensory augmentation. The smart phone balance trainers sent exercise performance data to a physical therapist, who recommended exercises on a weekly basis. Balance performance was assessed using a battery of clinical balance tests (Activity Balance Confidence Scale, Sensory Organization Test, Mini Balance Evaluation Systems Test, Five Times Sit to Stand Test, Four Square Step Test, Functional Reach Test, Gait Speed Test, Timed Up and Go, and Timed Up and Go with Cognitive Task) before training, after four weeks of training, and after eight weeks of training.

Results

Participants in the experimental group were able to use vibrotactile sensory augmentation independently in their homes. After training, the experimental group had significantly greater improvements in Sensory Organization Test and Mini Balance Evaluation Systems Test scores than the control group. Significant improvement was also observed for Five Times Sit to Stand Test duration within the experimental group, but not in the control group. No significant improvements between the two groups were observed in the remaining clinical outcome measures.

Conclusion

The findings of this study support the use of sensory augmentation devices by community-dwelling healthy older adults as balance rehabilitation tools, and indicate feasibility of telerehabilitation therapy with reduced input from clinicians.

A plea for minimally biased naturalistic philosophy

Naturalistic philosophers rely on literature search and review in a number of ways and for different purposes. Yet this article shows how processes of literature search and review are likely to be affected by widespread and systematic biases. A solution to this problem is offered here. Whilst the tradition of systematic reviews of literature from scientific disciplines has been neglected in philosophy, systematic reviews are important tools that minimize bias in literature search and review and allow for greater reproducibility and transparency. If naturalistic philosophers wish to reduce bias in their research, they should then supplement their traditional tools for literature search and review by including systematic methodologies.

Pilates Reformer exercises for fall risk reduction in older adults: A randomized controlled trial

OBJECTIVE

To investigate the effects of Pilates exercises using a Reformer on measures of fall risk, balance and mobility, self-efficacy, and active range of motion in adults age 65 and over at risk for falls compared to a control group.

DESIGN

Randomized Controlled Trial.

METHODS

Fifty-five subjects (27 Pilates intervention, 28 control; 38 females, 17 males; mean age 77.6 years, range 65-95) were randomly assigned to either a Pilates Reformer intervention group or a control group (no intervention). Subjects in the intervention group attended a Pilates Reformer exercise program in a group format once a week over a 10-week period. The primary outcome measures were the Sensory Organization Test (SOT) composite scores on the NeuroCom^® system, Timed Up-and-Go (TUG), and Activities-specific Balance Confidence (ABC) scale. The secondary outcome measures were the Adaptation Test (ADT), straight leg raise (SLR), hip extension, and ankle dorsiflexion active range of motion (AROM), Berg Balance Scale (BBS), and 10 Meter Walk Test (10MWT).

RESULTS

There was a significant interaction between group and time on the TUG, BBS, 10MWT, and SLR, hip extension, and ankle dorsiflexion AROM measurements. Over time, subjects in the Pilates intervention group improved their scores significantly on all mentioned measures, whereas subjects in the control group did not (P ≤ 0.05). Significantly improved AROM was found between groups following the Pilates intervention for hip extension, left SLR, and right ankle dorsiflexion.

CONCLUSION

Pilates Reformer exercises performed once per week for 10 weeks resulted in reduced fall risk and significant improvements in static and dynamic balance, functional mobility, balance self-efficacy, and lower extremity AROM in adults age 65 and older at risk for falling, whereas the control group did not significantly improve in any measures. Pilates Reformer exercises are more effective compared to no exercise intervention at improving hip and ankle AROM.