scholarly journals The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits

2009 ◽  
Vol 89 (5) ◽  
pp. 484-498 ◽  
Author(s):  
Fay B Horak ◽  
Diane M Wrisley ◽  
James Frank
Keyword(s):  
Control Systems ◽  
Concurrent Validity ◽  
Interrater Reliability ◽  
Balance Control ◽  
Balance Assessment ◽  
Evaluation Systems ◽  
Balance Confidence ◽  
Balance Deficits ◽  
Abc Scale ◽  
Balance Problems

BackgroundCurrent clinical balance assessment tools do not aim to help therapists identify the underlying postural control systems responsible for poor functional balance. By identifying the disordered systems underlying balance control, therapists can direct specific types of intervention for different types of balance problems.ObjectiveThe goal of this study was to develop a clinical balance assessment tool that aims to target 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits. This article presents the theoretical framework, interrater reliability, and preliminary concurrent validity for this new instrument, the Balance Evaluation Systems Test (BESTest).DesignThe BESTest consists of 36 items, grouped into 6 systems: “Biomechanical Constraints,” “Stability Limits/Verticality,” “Anticipatory Postural Adjustments,” “Postural Responses,” “Sensory Orientation,” and “Stability in Gait.”MethodsIn 2 interrater trials, 22 subjects with and without balance disorders, ranging in age from 50 to 88 years, were rated concurrently on the BESTest by 19 therapists, students, and balance researchers. Concurrent validity was measured by correlation between the BESTest and balance confidence, as assessed with the Activities-specific Balance Confidence (ABC) Scale.ResultsConsistent with our theoretical framework, subjects with different diagnoses scored poorly on different sections of the BESTest. The intraclass correlation coefficient (ICC) for interrater reliability for the test as a whole was .91, with the 6 section ICCs ranging from .79 to .96. The Kendall coefficient of concordance among raters ranged from .46 to 1.00 for the 36 individual items. Concurrent validity of the correlation between the BESTest and the ABC Scale was r=.636, P<.01.LimitationsFurther testing is needed to determine whether: (1) the sections of the BESTest actually detect independent balance deficits, (2) other systems important for balance control should be added, and (3) a shorter version of the test is possible by eliminating redundant or insensitive items.ConclusionsThe BESTest is easy to learn to administer, with excellent reliability and very good validity. It is unique in allowing clinicians to determine the type of balance problems to direct specific treatments for their patients. By organizing clinical balance test items already in use, combined with new items not currently available, the BESTest is the most comprehensive clinical balance tool available and warrants further development.

scholarly journals Concurrent and Discriminative Validity of the Mini Balance Evaluation Systems Test (miniBESTest) in People with Parkinson's Disease

2015 ◽  
Vol 26 (2) ◽  
pp. 43-48
Author(s):  
Margaret KY Mak
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Healthy Subjects ◽  
Balance Performance ◽  
Discriminative Validity ◽  
Evaluation Systems ◽  
Balance Confidence ◽  
Analysis Laboratory ◽  
Abc Scale ◽  
The University

Abstract Purpose To examine the concurrent and discriminative validity of the miniBESTest in individuals with Parkinson's disease (PD). Method Thirty-four individuals with PD participated in study 1. Thirty-one healthy subjects and 127 individuals with PD completed study 2. All participants were assessed at the University Balance and motion analysis laboratory. Balance performance was assessed using the miniBESTest and Berg's balance scale (BBS). Self-perceived balance confidence level of subjects was measured by the activities-specific balance confidence (ABC) scale. Results In study 1, results of Pearson's correlation showed that the scores of the miniBESTest correlated well with BBS (r=0.765; p<0.001) and moderately well with ABC scores (r=0.587; p<0.001). For study 2, results of one-way analysis of variance demonstrated significant differences in miniBESTest scores among healthy subjects, PD non-fallers (PD-NF) and PD fallers (PD-F). Healthy subjects obtained the highest mini-BESTest score of 88.2 ± 8.9%, followed by PD-NF (73.6 ± 14.7%) and PDF (57.1 ± 17.0%) (all p<0.001). Significant differences were also observed among healthy subjects, PD-NF and PD-F for each miniBESTest domain score (all p<0.05). Conclusion The miniBESTest is a valid method to document balance performance in individuals with PD. Both total and domain miniBESTest scores could differentiate between healthy subjects, PD-NF and PD-F.

scholarly journals Are Gait and Balance Problems in Neurological Patients Interdependent? Enhanced Analysis Using Gait Indices, Cyclograms, Balance Parameters and Entropy

Entropy ◽  
2021 ◽  
Vol 23 (3) ◽  
pp. 359
Author(s):  
Malgorzata Syczewska ◽  
Ewa Szczerbik ◽  
Malgorzata Kalinowska ◽  
Anna Swiecicka ◽  
Grazyna Graff
Keyword(s):  
Sensory Integration ◽  
Neurological Diseases ◽  
Force Plate ◽  
Balance Assessment ◽  
Complex Functions ◽  
Neurological Patients ◽  
Balance Deficits ◽  
Integration Problems ◽  
Analytical Tools ◽  
Balance Problems

Background: Balance and locomotion are two main complex functions, which require intact and efficient neuromuscular and sensory systems, and their proper integration. In many studies the assumption of their dependence is present, and some rehabilitation approaches are based on it. Other papers undermine this assumption. Therefore the aim of this study was to examine the possible dependence between gait and balance in patients with neurological or sensory integration problems, which affected their balance. Methods: 75 patients (52 with neurological diseases, 23 with sensory integration problems) participated in the study. They underwent balance assessment on Kistler force plate in two conditions, six tests on a Balance Biodex System and instrumented gait analysis with VICON. The gait and balances parameters and indices, together with entropy and cyclograms were used for the analysis. Spearman correlation, multiple regression, cluster analysis, and discriminant analysis were used as analytical tools. Results: The analysis divided patients into 2 groups with 100 % correctly classified cases. Some balance and gait measures are better in the first group, but some others in the second. Conclusions: This finding confirms the hypothesis that there is no direct link between gait and balance deficits.

scholarly journals Association between Statin Use and Balance in Older Adults

2020 ◽  
Vol 17 (13) ◽  
pp. 4662
Author(s):  
Antoine Langeard ◽  
Kathia Saillant ◽  
Elisabeth Charlebois Cloutier ◽  
Mathieu Gayda ◽  
Frédéric Lesage ◽  
...  
Keyword(s):  
Older Adults ◽  
Center Of Pressure ◽  
Balance Control ◽  
Balance Assessment ◽  
Pressure Sensing ◽  
Heart Attacks ◽  
Eyes Closed ◽  
Increased Risk ◽  
Balance Deficits ◽  
Statin Use

Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing a large health and economic issue. Statins are regularly prescribed to prevent strokes and heart attacks, but their impact on balance is unknown. The aim of this paper was to determine whether statin use is associated with poorer balance performances in older adults. Methods: All participants, one group taking statins (n = 34), and the other group not taking statins (n = 31), completed a balance assessment with their eyes closed and their eyes opened on a MatScan Pressure Sensing Mat. Center of Pressure (CoP) velocity, peak-to-peak distance, and standard deviation were collected in both anteroposterior (AP) and mediolateral (ML) directions. Multiple linear regression analyses were performed for each balance outcome, testing the statin use status as a predictor and controlling for appropriate factors including participants characteristics, lipid profile, and cardiovascular disease. Results: After controlling for confounding factors, statin use significantly predicted both CoP ML-Amplitude (β = 0.638, p = 0.004) and ML-Velocity (β = 0.653, p = 0.002) in the eyes-opened condition. Conclusions: The present study detected a negative association between statin use and balance control in the ML direction, suggesting that caution should be taken when prescribing statins in older adults, as this could decrease ML stability and ultimately increase fall and fracture risks.

scholarly journals Deficits in postural control in individuals with COPD - emerging evidence for an important secondary impairment

2010 ◽  
Vol 5 ◽  
Author(s):  
Maria K. Beauchamp ◽  
Dina Brooks ◽  
Roger Goldstein
Keyword(s):  
Postural Control ◽  
Pulmonary Rehabilitation ◽  
Fall Risk ◽  
Balance Control ◽  
Relevant Literature ◽  
Future Research ◽  
Balance Assessment ◽  
Balance Deficits ◽  
The Impact ◽  
And Training

Emerging evidence suggests that individuals with COPD demonstrate reductions in balance control that may be associated with an increased fall risk. The purpose of this review is to: 1) provide a brief overview of balance control and its assessment; 2) review relevant literature describing balance impairment in individuals with COPD; and 3) highlight impor- tant areas for future research. The observation of balance deficits and an increased fall risk in patients with COPD suggests the need for including balance assessment and training for patients enrolled in pulmonary rehabilitation who may be vulnerable. Further studies are needed to determine which aspects of balance are affected and to examine the impact of interventions.

Cultural and Linguistic Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Into Hindi

2020 ◽  
Vol 63 (12) ◽  
pp. 3974-3981
Author(s):  
Ashwini Joshi ◽  
Isha Baheti ◽  
Vrushali Angadi
Keyword(s):  
Strong Correlation ◽  
Concurrent Validity ◽  
Interrater Reliability ◽  
Voice Quality ◽  
Weak Correlation ◽  
Voice Assessment ◽  
Perceptual Evaluation ◽  
Severity Grade ◽  
Normal Voice ◽  
Group A

Aim The purpose of this study was to develop and assess the reliability of a Hindi version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Reliability was assessed by comparing Hindi CAPE-V ratings with English CAPE-V ratings and by the Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Method Hindi sentences were created to match the phonemic load of the corresponding English CAPE-V sentences. The Hindi sentences were adapted for linguistic content. The original English and adapted Hindi CAPE-V and GRBAS were completed for 33 bilingual individuals with normal voice quality. Additionally, the Hindi CAPE-V and GRBAS were completed for 13 Hindi speakers with disordered voice quality. The agreement of CAPE-V ratings was assessed between language versions, GRBAS ratings, and two rater pairs (three raters in total). Pearson product–moment correlation was completed for all comparisons. Results A strong correlation ( r > .8, p < .01) was found between the Hindi CAPE-V scores and the English CAPE-V scores for most variables in normal voice participants. A weak correlation was found for the variable of strain ( r < .2, p = .400) in the normative group. A strong correlation ( r > .6, p < .01) was found between the overall severity/grade, roughness, and breathiness scores in the GRBAS scale and the CAPE-V scale in normal and disordered voice samples. Significant interrater reliability ( r > .75) was present in overall severity and breathiness. Conclusions The Hindi version of the CAPE-V demonstrates good interrater reliability and concurrent validity with the English CAPE-V and the GRBAS. The Hindi CAPE-V can be used for the auditory-perceptual voice assessment of Hindi speakers.

scholarly journals Multidirectional Overground Robotic Training Leads to Improvements in Balance in Older Adults

Robotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 101
Author(s):  
Lara A. Thompson ◽  
Mehdi Badache ◽  
Joao Augusto Renno Brusamolin ◽  
Marzieh Savadkoohi ◽  
Jelani Guise ◽  
...  
Keyword(s):  
Older Adults ◽  
Healthy Aging ◽  
Robotic System ◽  
Control Group ◽  
Support Surface ◽  
Training Methods ◽  
Robotic Training ◽  
Balance Confidence ◽  
Balance Ability ◽  
Abc Scale

For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.

scholarly journals Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

Sensors ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 1343
Author(s):  
Sebastian Fudickar ◽  
Jörn Kiselev ◽  
Christian Stolle ◽  
Thomas Frenken ◽  
Elisabeth Steinhagen-Thiessen ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Measurement Accuracy ◽  
Dynamic Balance ◽  
Step Length ◽  
Berg Balance Scale ◽  
Walking Ability ◽  
Functional Requirements ◽  
Balance Confidence ◽  
Gait Parameters ◽  
Abc Scale

This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG’s gait parameters demonstrate a strong correlation coefficient with the GAITRite, indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.

Measurements of Trunk Sway for Stance and Gait Tasks 2 Years after Vestibular Neurectomy

2018 ◽  
Vol 23 (5) ◽  
pp. 298-308 ◽  
Author(s):  
Dominique Vibert ◽  
John H.J. Allum ◽  
Martin Kompis ◽  
Simona Wiedmer ◽  
Christof Stieger ◽  
...  
Keyword(s):  
Balance Control ◽  
Recovery Period ◽  
Subjective Assessment ◽  
Vestibular Neurectomy ◽  
Eyes Closed ◽  
Before And After ◽  
Task Durations ◽  
Trunk Sway ◽  
Central Compensation ◽  
Balance Problems

The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere’s disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients’ subjective assessment of disability using the AAO-HNS scale. For patients with low AAO-HNS scores 0–2 (n = 14), trunk roll and pitch sway velocities, standing eyes closed on foam, increased 2 years post VN compared to HC values (p < 0.01). Trunk sway amplitudes remained at levels of HC for simple gait tasks, but task durations were longer and therefore gait slower. For complex gait tasks (stairs), balance control remained impaired at 2 years. In patients with AAO-HNS high scores level 6 (n = 5), balance control remained abnormal, compared to HC, 2 years postoperatively for all stance, several simple and all complex gait tasks. Trunk sway in the pitch and roll directions for stance tasks was correlated with clinical (AAO-HNS) scores (p ≤ 0.05). These results indicate that VN leads to chronic balance problems for stance and complex gait tasks. The problems are greater for patients with high compared to low AAO-HNS scores, thereby explaining the different symptoms reported by these patients. The lack of balance recovery in VN patients to levels of HCs after 2 years contrasts with the 3 months average recovery period for acute vestibular neuritis patients and is indicative of the effects of neurectomy on central compensation processes.

Incorporating Voluntary Knee Flexion Into Nonanticipatory Balance Corrections

2007 ◽  
Vol 98 (5) ◽  
pp. 3047-3059 ◽  
Author(s):  
Lars B. Oude Nijhuis ◽  
Bastiaan R. Bloem ◽  
Mark G. Carpenter ◽  
John H. J. Allum
Keyword(s):  
Knee Flexion ◽  
Balance Control ◽  
Critical Role ◽  
Support Surface ◽  
Trunk Flexion ◽  
Postural Perturbation ◽  
Automatic Balance ◽  
Human Balance ◽  
Balance Deficits ◽  
Balance Corrections

Knee movements play a critical role in most balance corrections. Loss of knee flexibility may cause postural instability. Conversely, trained voluntary knee flexions executed during balance corrections might help to overcome balance deficits. We examined whether bilateral knee flexion could be added to automatic balance corrections generated by sudden balance perturbations. We investigated how this could be achieved and whether it improved or worsened balance control. Twenty-four healthy subjects participated in three different test conditions, in which they had to flex their knees following an auditory cue (VOLUNTARY condition), had to restore their balance in response to multidirectional rotations of a support surface (REACTIVE condition), or the combination of these two (COMBINED condition). A new variable set (PREDICTED), calculated as the mathematical sum of VOLUNTARY and REACTIVE, was compared with the COMBINED variable set. COMBINED responses following forward rotations were close to PREDICTED, or greater, suggesting adequate integration of knee flexion into the automatic balance reactions. For backward rotations, the COMBINED condition resulted in several near-falls, and this was generally associated with smaller knee flexion and smaller EMG responses. Subjects compensated by using greater trunk flexion and arm movements. Activity in several muscles displayed earlier onsets for the COMBINED condition following backward rotations. We conclude that healthy adults can incorporate voluntary knee flexion into their automatic balance corrections and that this depends on the direction of the postural perturbation. These findings highlight the flexibility of the human balance repertoire and underscore both the advantages and limitations of using trained voluntary movements to aid balance corrections in man.

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