scholarly journals Proposing Development and Utility of a Mobility Composite Measure in Patients with a Neurologic Disorder

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Chad Swank ◽  
Sattam Almutairi ◽  
Ann Medley
Keyword(s):  
Outcome Measures ◽  
Walk Test ◽  
Composite Measure ◽  
Balance Confidence ◽  
Sit To Stand ◽  
Neurologic Disorders ◽  
The Individual ◽  
Abc Scale ◽  
A Prospective Study ◽  
10 Meter Walk Test

Background. Outcome measures typically assess single domains making holistic assessment difficult. Our purpose was to develop a mobility composite measure (MCM) based on four commonly used outcome measures and compare this composite score to the individual measures in patients with neurologic disorders.Methods. We retrospectively reviewed 148 medical records for inclusion of primary neurologic diagnosis and scoring for 5 times sit-to-stand test (5TSST), 10-meter walk test (10MWT), 2-minute walk test (2MWT), and activities-specific balance confidence (ABC) scale.Results. After establishing that a single concept was being assessed with interitem correlations, raw scores were converted to percentage of normal and combined into the MCM for analysis from admission to discharge. Scores on each measure significantly improved after intervention (5TSST,p<.001; 10MWT,p<.001; 2MWT,p<.001; ABC,p=.02). Mean MCM (n=93) admission scores were67.55±31.88% and discharge scores were74.81±34.39% (p=.002). On average, patients improved 7.26% on the MCM exceeding the threshold of expected error (MDC95= 3.59%).Conclusions. MCM detected change in patient outcomes statistically and clinically and appears to capture a holistic picture of functional status. We recommend a prospective study to further investigate a “composite measure” incorporating measures from several functional domains.

scholarly journals Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial

2019 ◽  
Vol 33 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Shirley Handelzalts ◽  
Michal Kenner-Furman ◽  
Ganit Gray ◽  
Nachum Soroker ◽  
Guy Shani ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Balance Training ◽  
Treadmill Walking ◽  
Secondary Outcome ◽  
Walk Test ◽  
Balance Confidence ◽  
Abc Scale ◽  
Reactive Balance ◽  
Weight Shifting ◽  
Multiple Step

Background: Reactive balance responses are critical for fall prevention. Perturbation-based balance training (PBBT) has shown a positive effect in reducing the risk of falls among older adults and persons with Parkinson’s disease. Objective: To explore the effect of a short-term PBBT on reactive balance responses, performance-based measures of balance and gait and balance confidence. Methods: Thirty-four moderate-high functioning, subacute persons with stroke (PwS) (lower extremity Fugl-Meyer score 29.2 ± 4.3; Berg Balance Scale [BBS] score 43.8 ± 9.5, 42.0 ± 18.7 days after stroke onset) hospitalized in a rehabilitation setting were randomly allocated to PBBT (n = 18) and weight shifting and gait training (WS&GT) (n = 16). Both groups received 12 training sessions, 30 minutes each, for a period of 2.5 weeks. PBBT included unexpected balance perturbations during standing and treadmill walking, WS&GT included weight shifting in standing and treadmill walking without perturbations. The main outcome measures, that is, multiple step-threshold and fall-threshold were examined at baseline, immediately postintervention, and about 5 weeks postintervention. The secondary outcome measures, that is, BBS, 6-minute walk test (6MWT), 10-meter walk test (10MWT), and Activity-specific Balance Confidence (ABC) scale were examined at baseline and immediately postintervention. Results: Compared with the WS&GT group, immediately postintervention participants in the PBBT group showed higher multiple-step thresholds in response to forward and backward surface translations (effect size [ES] = 1.07 and ES = 1.10, respectively) and moderate ES in the ABC scale (ES = 0.74). No significant differences were found in fall-threshold, BBS, 6MWT, and 10MWT between the groups. Conclusions: Inclusion of perturbation training during rehabilitation of PwS improved reactive balance and balance confidence.

scholarly journals Capturing Change in Balance Confidence over 30 Days: Insights Gained from a Micro-Longitudinal Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 789-790
Author(s):  
Tai-Te Su ◽  
Aileen Griffin ◽  
Faith-Christina Washington ◽  
Jacob Sosnoff ◽  
Shannon Meija
Keyword(s):  
Fall Risk ◽  
Functional Limitations ◽  
Later Life ◽  
Individual Characteristics ◽  
Repeated Measurements ◽  
Extensive Literature ◽  
Linear Change ◽  
Balance Confidence ◽  
The Individual ◽  
Abc Scale

Abstract Balance confidence reflects one’s estimate of their ability to maintain balance and avoid falls. Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life. However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research. In this study, we aimed to investigate how older adults’ balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change. We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month. Twenty-one participants (age=78.6±5.8, 48%female) were enrolled, and individual characteristics were measured upon recruitment. Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale. We performed growth modeling techniques to examine change within a multilevel framework. Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was non-significant (b=0.03, SE=0.21, p=.89) on average. However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37, SE=0.13, p&lt;.01) and decreased among those with greater physical fall risk (b=-0.18, SE=0.07, p&lt;.01) and accurate understanding of fall risk at baseline (b=-0.24, SE= 0.12, p=.04). Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal. We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.

scholarly journals Performance-based outcome measures are associated with cadence variability during community ambulation among individuals with a transtibial amputation

2020 ◽  
Vol 44 (4) ◽  
pp. 215-224
Author(s):  
Emma Haldane Beisheim ◽  
Elisa Sarah Arch ◽  
John Robert Horne ◽  
Jaclyn Megan Sions
Keyword(s):  
Physical Performance ◽  
Outcome Measures ◽  
Gait Speed ◽  
The United States ◽  
Clinical Settings ◽  
Walk Test ◽  
Community Based ◽  
Transtibial Amputation ◽  
Community Ambulation ◽  
10 Meter Walk Test

Background: In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation. Objectives: Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation. Study design: Cross-sectional. Methods: Forty-nine participants, aged 18–85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® OneTM minute-by-minute step counts), while controlling for sex, age, and time since amputation ( p ⩽ .013). Results: Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%, p < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1–17.1%, p = .001–.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively ( p < .013). Conclusions: In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation. Clinical relevance The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.

Abstract 46: A New Rehabilitation Strategy to Improve Gait Speed and Balance Self-Efficacy Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dorian K Rose ◽  
Lou DeMark ◽  
Christy Conroy ◽  
Emily Fox ◽  
David Clark
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Fall Risk ◽  
Step Length ◽  
Walk Test ◽  
Post Intervention ◽  
Backward Walking ◽  
Balance Confidence ◽  
Post Stroke ◽  
Abc Scale

Introduction: Impaired balance and decreased balance confidence contribute to slow gait speed and increased fall risk post-stroke. Standard balance exercises and gait training do not adequately address these impairments. Backward Walking Training (BWT), incorporating the unique postural and lower extremity motor control demands of walking backward, may reduce these gait impairments. This study compared the effects of BWT to Forward Walking Training (FWT) on forward and backward gait speed, dynamic balance and balance confidence. Methods: Thirty adults with first time stroke (18 male; 15 right hemisphere lesion; mean time post-stroke 12.7±6.6 months; mean age 58.8±10.1 yrs; mean Lower Extremity Fugl-Meyer Motor Score 22.7±1.4) were randomized to receive eighteen exercise sessions (3x/week for 6 weeks) of BWT (n=15) or FWT (n=15) consisting of 20 minutes training on a treadmill with Body Weight Support followed by 20 minutes overground. Gait was facilitated by a physical therapist-led team. Speed, limb loading and bout duration were progressed across sessions. The Ten Meter Walk Test (10MWT), Activities-Specific Balance Confidence (ABC) Scale, 3-meter Backward Walk Test (3MBWT), Functional Gait Assessment (FGA) and spatial-temporal gait characteristics were assessed pre- and post-intervention. Results: Pre- to post-intervention increases in the 3MBWT (BWT: 0.23±0.4 to 0.32±0.06 m/s ; FWT 0.21±0.4 to 0.23±0.04 m/s: ), ABC (BWT: 55.2±5.2% to 61.8±7.1% ; FWT: 52.9±6.5% to 53.5±6.2%: ), 10MWT (BWT: 0.42±0.07 to 0.51±0.08 m/s ; FWT: 0.44±0.08 to 0.47±0.07 m/s ) and backward paretic step length (BWT: 0.19±0.04 to 0.34±0.03 cm ; FWT: 0.21±0.03 to 0.20±0.04 cm were greater for the BWT than the FWT group. These gains were all statistically significant (p < 0.01). Group differences in FGA did not reach statistical significance. Conclusions: The greater increase in backward paretic step length, backward walking speed and balance confidence observed in the BWT group are all known contributors to reduced fall risk. BWT may be an important addition to the rehabilitation plan for individuals post-stroke. A longitudinal examination of fall incidence following BWT is the next important step in determining the overall utility of this novel rehabilitation approach.

scholarly journals Avaliação do Tempo Atribuído à Travessia de Peões: Contributo para uma Lisboa Mais Inclusiva

2020 ◽  
Vol 33 (6) ◽  
pp. 401
Author(s):  
Sílvia Boaventura ◽  
Jorge Rodrigues ◽  
Teresa Plancha ◽  
Mariana Martins ◽  
Marta Silva ◽  
...  
Keyword(s):  
Public Transport ◽  
Gait Speed ◽  
Walk Test ◽  
Physical Medicine ◽  
Portuguese Population ◽  
Balance Confidence ◽  
The Disabled ◽  
Pedestrian Crossing ◽  
10 Meter Walk Test ◽  
Confidence Scale

Introduction: With progressive ageing of the Portuguese population, it is paramount that the conditions of outdoor accessibility and safety are adapted to this age group. The aim of this study was to assess whether the time allocated to pedestrian crossing in the crosswalks with pedestrian crossing lights between Curry Cabral Hospital and local public transport is enough to allow safe passage of the elderly.Material and Methods: We evaluated 100 ambulatory care patients from the Physical Medicine and Rehabilitation department. All of them answered a questionnaire, the Activities-Specific Balance Confidence Scale (Portuguese version) and performed a 10-meter walk test. All crosswalks with pedestrian crossing lights between the hospital and local public transport were analyzed, in a total of 26, and the gait speed required to perform a safe crossing was calculated.Results: Mean age of patients was 75 years and the majority (73%) were female. The study showed that all patients could safely cross 17 (65%) crosswalks. The nine remaining crosswalks (35%) represented an obstacle to our sample.Discussion: If the required gait speed as currently set in legislation for the disabled was implemented, 99% of the patients would have been able to cross the crosswalks safely.Conclusion: It is essential to apply the gait speed set in legislation, since non-compliance endangers elderly patients in Curry Cabral Hospital, increasing the likelihood of accidents and the feeling of insecurity on the streets.

scholarly journals The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sarah Uno ◽  
Elizabeth Jusko ◽  
Breanna Roderos ◽  
Jennifer D. Hastings
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Tilt Angle ◽  
Head Tilt ◽  
Balance Confidence ◽  
Postural Alignment ◽  
Abc Scale ◽  
Heel Lift

This study expands upon the Hastings et al (2018) study on the use of heel lifts to change static postural alignment in persons with Parkinson's Disease (PD) and further explores whether the use of heel lifts provide improvements in dynamic gait parameters, Timed Up and Go (TUG) scores, and balance confidence. Outcome measures were taken with and without the heel lifts in place, at two data collection dates. Photographs were analyzed for postural alignment measures using ImageJ software and video was analyzed for gait and turning parameters utilizing the Dite and Temple scale. The Activities-specific Balance Confidence (ABC) scale was collected at baseline and after two weeks of heel lift use, otherwise outcome measures were performed in the reverse order on the first and second session to account for ordering, practice, and fatigue effects. Statistical analysis included paired t-tests for outcome measures and Pearson product correlation between the degree of plantarflexion contracture and ABC scale and overall balance confidence and fall history. We found that head tilt angle and turn time significantly improved (p = .037) (p = .002) with use of heel lifts. Turn time correlated to overall balance confidence (r = -.802, p = .000) and overall balance confidence correlated to fall history (r = -.501, p = .041). This study showed that accommodating a lack of ankle dorsiflexion range of motion with heel lifts significantly improves head tilt angle and decreases turn time as compared to without heel lifts, but has no significant effect on step length, gait speed, or overall TUG score in individuals with PD. Because our work shows that limited range of motion at the ankle contributes to real and perceived balance difficulties healthcare providers working with any population of patients exhibiting balance problems should include this measurement in their assessment and consider intervention with a heel lift when limitations are found.

Effect of a Community-Based Argentine Tango Dance Program on Functional Balance and Confidence in Older Adults

2008 ◽  
Vol 16 (4) ◽  
pp. 435-453 ◽  
Author(s):  
Patricia McKinley ◽  
Allison Jacobson ◽  
Alain Leroux ◽  
Victoria Bednarczyk ◽  
Michel Rossignol ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Fear Of Falling ◽  
The Elderly ◽  
Epidemiologic Studies ◽  
Argentine Tango ◽  
Balance Confidence ◽  
Functional Balance ◽  
Sit To Stand ◽  
Walking Programs ◽  
Abc Scale

Tango-dancing and walking programs are compared in nondemented seniors at risk for falls. Fallers (N= 30) age 62–91 were randomly assigned to a 10-wk (40 hr, 2 hr 2×/wk) tango class or walk group. The Activities-specific Balance Confidence (ABC) scale, sit-to-stand scores, and normal and fast walk were measured pre-, post-, and 1 month postintervention. Two-way repeated-measures ANOVAs indicated a significant main effect (p< .01) for time on all measures. Group and interaction effects for ABC led to improvement only in tango because of high baseline mean for the walk group. Clinical improvements measured using Established Populations for Epidemiologic Studies of the Elderly scoring were greater for the tango group. From these preliminary results it is suggested that although both interventions are effective activities for increasing strength and walk speed, tango might result in greater improvements than walking in balance skills and in walking speed in the 10-wk intervention. The study needs to be repeated with a greater sample size to determine the effectiveness of walking on fear of falling.

scholarly journals Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation

2017 ◽  
Vol 42 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Sara Agueda Fuenzalida Squella ◽  
Andreas Kannenberg ◽  
Ângelo Brandão Benetti
Keyword(s):  
Outcome Measures ◽  
Gait Speed ◽  
Standard Of Care ◽  
Walking Distance ◽  
Walk Test ◽  
Transfemoral Amputation ◽  
Prosthetic Knee ◽  
Balance Confidence ◽  
Highly Active ◽  
Prosthetic Knees

Background:Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes.Objectives:To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees.Study design:Comparative within-subject clinical study.Methods:A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor–enhanced knee.Results:Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions.Conclusion:The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects’ satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees.Clinical relevanceThis study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.

University Dropout

2008 ◽  
Vol 29 (3) ◽  
pp. 134-147 ◽  
Author(s):  
Manuel C. Voelkle ◽  
Nicolas Sander
Keyword(s):  
Grade Point Average ◽  
Structural Equation ◽  
Unobserved Heterogeneity ◽  
School Grade ◽  
Grade Point ◽  
High School Grade ◽  
Hands On ◽  
University Dropout ◽  
The Individual ◽  
A Prospective Study

University dropout is a politically and economically important factor. While a number of studies address this issue cross-sectionally by analyzing different cohorts, or retrospectively via questionnaires, few of them are truly longitudinal and focus on the individual as the unit of interest. In contrast to these studies, an individual differences perspective is adopted in the present paper. For this purpose, a hands-on introduction to a recently proposed structural equation (SEM) approach to discrete-time survival analysis is provided ( Muthén & Masyn, 2005 ). In a next step, a prospective study with N = 1096 students, observed across four semesters, is introduced. As expected, average university grade proved to be an important predictor of future dropout, while high-school grade-point average (GPA) yielded no incremental predictive validity but was completely mediated by university grade. Accounting for unobserved heterogeneity, three latent classes could be identified with differential predictor-criterion relations, suggesting the need to pay closer attention to the composition of the student population.

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