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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.

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Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00852-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Moshe M. H. Aharoni ◽

Anat V. Lubetzky ◽

Liraz Arie ◽

Tal Krasovsky

Keyword(s):

Virtual Reality ◽

Trait Anxiety ◽

Dynamic Balance ◽

Step Test ◽

Simulator Sickness ◽

Balance Confidence ◽

Task Duration ◽

Head Kinematics ◽

Perceived Disability ◽

Four Square

Abstract Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and high perceived disability were associated with reduced AP-ROM (|r| = 0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.

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Measurement Precision and Efficiency of Computerized Adaptive Testing for the Activities-specific Balance Confidence Scale in People With Stroke

Physical Therapy ◽

10.1093/ptj/pzab020 ◽

2021 ◽

Author(s):

Bryant A Seamon ◽

Steven A Kautz ◽

Craig A Velozo

Keyword(s):

Rasch Model ◽

Computerized Adaptive Testing ◽

Adaptive Testing ◽

Measurement Precision ◽

Strongly Correlated ◽

Computerized Adaptive Test ◽

Balance Confidence ◽

Adaptive Test ◽

The Rasch Model ◽

Confidence Scale

Abstract Objective Administrative burden often prevents clinical assessment of balance confidence in people with stroke. A computerized adaptive test (CAT) version of the Activities-specific Balance Confidence Scale (ABC CAT) can dramatically reduce this burden. The objective of this study was to test balance confidence measurement precision and efficiency in people with stroke with an ABC CAT. Methods We conducted a retrospective cross-sectional simulation study with data from 406 adults approximately 2-months post-stroke in the Locomotor-Experience Applied Post-Stroke (LEAPS) trial. Item parameters for CAT calibration were estimated with the Rasch model using a random sample of participants (n = 203). Computer simulation was used with response data from remaining 203 participants to evaluate the ABC CAT algorithm under varying stopping criteria. We compared estimated levels of balance confidence from each simulation to actual levels predicted from the Rasch model (Pearson correlations and mean standard error (SE)). Results Results from simulations with number of items as a stopping criterion strongly correlated with actual ABC scores (full item, r = 1, 12-item, r = 0.994; 8-item, r = 0.98; 4-item, r = 0.929). Mean SE increased with decreasing number of items administered (full item, SE = 0.31; 12-item, SE = 0.33; 8-item, SE = 0.38; 4-item, SE = 0.49). A precision-based stopping rule (mean SE = 0.5) also strongly correlated with actual ABC scores (r = .941) and optimized the relationship between number of items administrated with precision (mean number of items 4.37, range [4–9]). Conclusions An ABC CAT can determine accurate and precise measures of balance confidence in people with stroke with as few as 4 items. Individuals with lower balance confidence may require a greater number of items (up to 9) and attributed to the LEAPS trial excluding more functionally impaired persons. Impact Statement Computerized adaptive testing can drastically reduce the ABC’s test administration time while maintaining accuracy and precision. This should greatly enhance clinical utility, facilitating adoption of clinical practice guidelines in stroke rehabilitation. Lay Summary If you have had a stroke, your physical therapist will likely test your balance confidence. A computerized adaptive test version of the ABC scale can accurately identify balance with as few as 4 questions, which takes much less time.

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Psychometric Properties of the Activities-Specific Balance Confidence Scale and the Survey of Activities and Fear of Falling in Older Women

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2007.01550.x ◽

2008 ◽

Vol 56 (2) ◽

pp. 328-333 ◽

Cited By ~ 72

Author(s):

Kristine M.C. Talley ◽

Jean F. Wyman ◽

Cynthia R. Gross

Keyword(s):

Psychometric Properties ◽

Older Women ◽

Fear Of Falling ◽

Balance Confidence ◽

Confidence Scale

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Patient-Centered Integrated Motor Imagery Delivered in the Home With Telerehabilitation to Improve Walking After Stroke

Physical Therapy ◽

10.2522/ptj.20110277 ◽

2012 ◽

Vol 92 (8) ◽

pp. 1065-1077 ◽

Cited By ~ 15

Author(s):

Judith E. Deutsch ◽

Inbal Maidan ◽

Ruth Dickstein

Keyword(s):

Motor Imagery ◽

Assisted Living ◽

Chronic Phase ◽

Patient Centered ◽

Balance Confidence ◽

Obstacle Clearance ◽

Gait Parameters ◽

Walking Recovery ◽

Therapy Sessions

Background and Purpose This case report describes the clinical reasoning process used to examine a person after stroke and intervene with a novel integrated motor imagery treatment designed for the rehabilitation of walking and delivered in the home through telerehabilitation. The integrated motor imagery treatment consisted of patient-centered goal setting and physical practice combined with motor and motivational imagery. Case Description The patient was a 38-year-old woman who had had a diffuse left subarachnoid hemorrhagic stroke 10 years earlier. She lived independently in an assisted living complex and carried a straight cane during long walks or in unfamiliar environments. Examination revealed a slow gait speed, reduced walking endurance, and decreased balance confidence. Although she was in the chronic phase, patient-centered integrated motor imagery was predicted to improve her community mobility. Treatment sessions of 45 to 60 minutes were held 3 times per week for 4 weeks. The practiced tasks included transitioning from sitting to standing, obstacle clearance, and navigation in interior and exterior environments; these tasks were first executed and then imagined at ratios of 1:5. Task execution allowed the creation of a scene based on movement observation. Imagery scenarios were customized to address the patient's goals and observed movement problems. Motivational elements of arousal, problem solving, and reward were embedded in the imagery scenarios. Half of the sessions were provided on site, and the remaining sessions were delivered remotely. Seven sessions were delivered by the clinician in the home, and 5 sessions were delivered using telerehabilitation. Outcomes Improvements in motor imagery ability, gait parameters, and balance were observed after training. Most gains were retained at the 3-month follow-up. Compared with on-site delivery, the telerehabilitation sessions resulted in less therapist travel time and cost, as well as shorter therapy sessions. Discussion The delivery of integrated motor imagery practice for walking recovery was feasible both on site and remotely.

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