Perception and use of balance measures for stroke patients among physical therapists in South Korea

[Purpose] The purpose of this study looked into physical therapists’ perception and use of balance measures for stroke patients. [Subjects and Methods] Three hundred eighty two physical therapists who understood the purpose of this study, agreed on their participation in this study, were treating or treated stroke patients. A Cross-sectional study based on self-administered questionnaire that had a total of 41 questions was performed in South Korea. 382 questionnaires were used for analysis. [Results] Regarding the questions about their perception and of personal measures, 287 persons (75.1%) replied that Single Leg Stance test was the most useful. According to the data analysis on their use of balance measures, Single Leg Stance Test was used by 254 persons (66.5%, the highest percentage), Functional Reach Test by 199 (52.1%). Also, stepwise multiple regression analysis was conducted. As a result, the most influential factor was physical therapists’ perception of personal measures, and their use was also influenced by their comprehensive perception of measurement and their perception of balance factors. [Conclusion] This study revealed physical therapists’ perception and use of balance measures for stroke patients and showed that their perception of balance measures for stroke patients affected their use of personal measures.

Development of the Brunel Balance Assessment: a new measure of balance disability post stroke

Objective: To report the psychometric properties of the Brunel Balance Assessment (BBA), a new test of balance disability post stroke.

Design: Data from 92 subjects were collected and cohorts used to test hierarchical scaling, reliability and validity. Data from 80 people were used to test the hierarchical scaling using an inter-item correlation for redundancy, coefficient of reproducibility (CR) and scalability (CS) for the hierarchy and Cronbach's alpha coefficient for the internal consistency. Thirty-seven people participated in the reliability testing. Test / retest and inter-tester reliability were tested using the kappa coefficient. The testing was repeated on consecutive days to assess test / retest reliability and was scored simultaneously by two physiotherapists for inter-tester reliability. Fifty-five people participated in validity testing. The BBA was compared with the sitting Motor Assessment Scale (MAS), Berg Balance Test (Berg), Rivermead Mobility Index (RMI) using Spearman's rho.

Setting: Physiotherapy stroke services of six UK NHS trusts.

Participants: Hemiplegic stroke patients were recruited from physiotherapy services and the BBA used to assess their balance.

Results: The order of the items was revised and the original 14-point scale reduced to 12 points in the scale development. The revised scale formed a hierarchical scale. Inter-item correlations were < 0.9, coefficients of reproducibility and scalability were 0.99 and 0.69 respectively and Cronbach's alpha was 0.92. Reliability was high (100% agreement) for both aspects of reliability. Correlations with other balance measures were significant (0.83 / 0.97, p<0.01) indicating validity as measure of balance disability.

Conclusion: The BBA is a reliable, valid, hierarchical measure of balance disability post stroke that is suitable for use in the clinical setting.

Assessing the balance capabilities of people with profound intellectual disabilities who have experienced a fall

BACKGROUND

Although it is common for people with intellectual disability (ID) to fall, the reasons for this have not yet been identified. This pilot study aimed to explore the balance capabilities of a sample of adults with profound ID who had experienced a fall, in order to identify possible reasons for falling and to identify potential tests that could be used to quantify balance capabilities in this population group.

METHODS

The neuromuscular systems and balance capabilities of 20 adults with profound ID were comprehensively assessed with a battery of tests, including computerized posturography.

RESULTS

Of the 20 participants, 15 described themselves as frequent fallers, and 10 participants reported serious injuries as a result of falling. Formalized assessment of the neuromuscular and balance capabilities proved to be challenging, with many participants unable to comprehend what was required of them in the performance of a number of the tests. All participants were observed to have an abnormal pattern of walking. Nine participants completed posturography testing, the main finding of which was that low motor control composite scores indicated a slowing of motor responses to postural perturbations. Other potential risk factors identified were concurrent medical problems, medication, the context and environment of falling, movement impulsiveness and distractibility, and visual deficits.

CONCLUSION

The reason why people with ID frequently fall appears complex and multifactorial. Larger studies are required to verify the potential risk factors identified in this pilot study. Many of the standardized outcome measures commonly used in physiotherapy practice to quantify balance capabilities are not suitable for use in this population group, as participants found it difficult to comprehend what was required of them. Allowing the person to become familiarized with both the test and the tester may help to alleviate this problem. Videotaping and quantifying observations of strategies people use to perform common movements such as walking or turning maybe a more appropriate measurement tool of balance capabilities of people with ID than current standardized measures. This method would require rigorous development.

Balance disability after stroke

BACKGROUND AND PURPOSE

Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability.

SUBJECTS

The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia.

METHODS

Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects' stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke.

RESULTS

A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability.

DISCUSSION AND CONCLUSION

Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability.

Reliability and validity of functional balance tests post stroke

OBJECTIVE

To contribute to the reliability and validity of a series of functional balance tests for use post stroke.

DESIGN

Within-session, test-retest and intertester reliability was tested using the kappa coefficient and intraclass correlations. The tests were performed three times and the first and third attempts compared to test the within-session reliability. The tests were repeated a few days later to assess test-retest reliability and were scored simultaneously by two physiotherapists to assess the intertester reliability. To test criterion-related validity the tests were compared with the sitting section of the Motor Assessment Scale, Berg Balance Scale and Rivermead Mobility Index using Spearman's rho.

SETTING

Stroke physiotherapy services of six National Health Service hospitals.

PARTICIPANTS

People with a post stroke hemiplegia attending physiotherapy who had no other pathology affecting their balance took part. Thirty-five people participated in the reliability testing and 48 people took part in the validity testing.

MAIN OUTCOME MEASURES

The following functional balance tests were used: supported sitting balance, sitting arm raise, sitting forward reach, supported standing balance, standing arm raise, standing forward reach, static tandem standing, weight shift, timed 5-m walk with and without an aid, tap and step-up tests.

RESULTS

The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability. Intraclass correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r = 0.32-0.74 p < 0.05), except the weight shift test and step-up tests which did not form significant relationship with Berg Balance Scale (r = 0.26 and 0.19 respectively).

CONCLUSION

These functional balance tests are reliable and valid measures of balance disability post stroke.