scholarly journals 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

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.

scholarly journals The Effect of Pilates Training on the Balance of Elderly

2019 ◽  
Vol 1 (16) ◽  
Author(s):  
Kristina Zaičenkovienė ◽  
Renata Rakovaitė
Keyword(s):  
Dynamic Balance ◽  
Step Test ◽  
Control Group ◽  
Static Balance ◽  
Study Group ◽  
Timed Up And Go ◽  
Physically Active ◽  
Before And After ◽  
Four Square ◽  
And Control

Research background. Falling is one of the most important problems in the elderly’s mobility disorder, which is most often affected by the loss of balance. It is known that Pilates exercises could help to increase the deep muscle strength, improve posture and proprioception, which affects the improvement of the balance. Objective – to evaluate the effects of Pilates exercises on the elderly’s static and dynamic balance. Methodology. The study population consisted of 20 volunteers, men and women, who were divided into Pilates exercises (n = 10, age 65.1 ± 2.6) and control (n = 10, age 68.6 ± 4.9) groups. The study group participated in Pilates classes 2 times per week for six weeks (session duration 60 minutes). The control group did not participate in any physical activity, but they were physically active as usually in their daily life. The main outcome measures were assessed before and after the intervention. The static balance was assessed by measuring posturographic parameters using the force platform, dynamic balance was measured with the Timed up and Go Test (TUG) and the Four Square Step Test (FSST). Results. The results showed signifcant improvement in static balance of the experimental group after the Pilates exercises during standing tests when the feet were apart, eyes opened and closed and when the feet together with eyes opened, and when the foot was in front of the other foot. The results of the control group did not differ during both tests. The results of both groups did not differ in the static balance tests before and after the study, but after the Pilates exercises, the results of the Pilates group signifcantly differed from the control group test results when the feet were in shoulder line with open eyes. The results of the dynamic balance after Pilates exercises signifcantly improved in both tests in the study group. Before the study, there were not statistically signifcant differences in the dynamic balance results between the groups. Conclusions. Six-week Pilates exercises had a positive effect on the elderly’s static and dynamic balance.Keywords: Pilates training, static balance, dynamic balance.

scholarly journals Activities-Specific Balance Confidence in People with Multiple Sclerosis

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ylva Nilsagård ◽  
Anna Carling ◽  
Anette Forsberg
Keyword(s):  
Multiple Sclerosis ◽  
Convergent Validity ◽  
Ecological Validity ◽  
Cross Sectional Study ◽  
Step Test ◽  
Timed Up And Go ◽  
Cross Sectional ◽  
Balance Confidence ◽  
Rural And Urban ◽  
Four Square

Objective. To evaluate the validity of the Activities-specific Balance Confidence scale (ABC) in people with multiple sclerosis (PwMS).Design. A multicentre, cross-sectional study.Setting. Six rural and urban Swedish sites, including specialized units at hospitals and primary care centers.Participants. A sample of 84 PwMS with subjective gait and balance impairment but still able to walk 100 m (comparable with EDSS 1–6).Outcome Measures. Timed Up and Go, Timed Up and Gocog, 25-foot Timed Walk Test, Four Square Step Test, Dynamic Gait Index, Chair Stand Test, 12-item MS Walking Scale, self-reported falls, and use of assistive walking device were used for validation.Results. The concurrent convergent validity was moderate to good (0.50 to −0.75) with the highest correlation found for the 12-item MS Walking Scale. The ABC discriminated between multiple fallers and nonfallers but not between men and women. Ecological validity is suggested since ABC discriminated between users of assistive walking device and nonusers. The internal consistency was high atα=0.95,and interitem correlations were between 0.30 and 0.83.Conclusion. This study supports the validity of the ABC for persons with mild-to-moderate MS. The participants lacked balance confidence in many everyday activities, likely restricting their participation in society.

scholarly journals AB0883 RELIABILITY OF THE MODIFIED FOUR SQUARE STEP TEST IN PATIENTS WITH REVISION TOTAL KNEE ARTHROPLASTY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1746.3-1747
Author(s):  
B. Unver ◽  
K. Sevik ◽  
V. Karatosun
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Fall Risk ◽  
Dynamic Balance ◽  
Primary Total Knee Arthroplasty ◽  
Step Test ◽  
Retest Reliability ◽  
Total Knee ◽  
Four Square ◽  
Test Retest Reliability

Background:Patients with total knee arthroplasty (TKA) often experience pain and reduced balance control, which may predispose them to greater fall risk. The patients with revision total knee arthrooplasty (rTKA), have more pain, stiffness and physical dysfunction and less postoperative improvement compared to the patients with TKA [1]. Falls in people with gait or balance disorders have significant consequences. Fear of falling can also predispose people to inactivity, which can lead to problems of debilitation, increased handicap, and disability by itself. Most of the falls take place in the course of movement, and the trips and slips were determined as the most common cause of elderly falls. Trips are responsible of falls between 40% to 60% and slips between 10% to 15%, showing that the capability to take a quick step would prevent many falls [2]. Literature has found stepping speed to the different directions declines with aging and are lesser for fallers than for nonfallers [3].Modified four square step test (mFSST) was developed to assessing fall risk and dynamic balance by scoring time while participants stepping in multiple directions but its reliability has not been investigated in patients undergoing rTKA.Objectives:The aims of this study were to determine the test-retest reliability and the minimal clinically important change (MCID) of the mFSST in patients with rTKAMethods:mFSST administered on 22 patients undergoing rTKA. mFSST is performed by using tapes to make one horizontal and one vertical line like a cross to create 4 quadrants. Patients’ performances were timed as patients were successfully stepping clockwise and counter-clockwise while avoid touching on tapes, turning their body or losing balance. Two trials performed and patients rested between trials and were encouraged to rest as often as they required to prevent fatigue.Results:ICC(2.1)for mFSST was 0.83. The standard error of measurement and MCID were 0.67 and 1.85 respectively (95 %. confidence level).Conclusion:The mFSST has a good test-retest reliability in patients with rTKA. It is a reliable and responsive tool for measuring fall risk, dynamic balance and mobility. The mFSST is an excellent measure of gait variability, stepping in multipl directions and dynamic balance, also can easily identify real clinically important changes in patients with rTKA in simple environments and minimal equipment.References:[1]Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. International Orthopaedics 2010; 34: 649-653.[2]Cumming RG, Klineberg RJ. Fall frequency and characteristics and the risk of hip fractures. Journal of the American Geriatrics Society 1994; 42: 774-778.[3]Medell JL, Alexander NB. A clinical measure of maximal and rapid stepping in older women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2000; 55: M429-M433.Disclosure of Interests:None declared

Cardio-kickboxing and dynamic balance in adults with developmental disabilities

2017 ◽  
Vol 16 (1) ◽  
pp. 33
Author(s):  
Tyler Tapps, PhD, CPRP ◽  
Alysha A. Walter, MS, CTRS ◽  
Mary Tapps, MS, CTRS
Keyword(s):  
Developmental Disabilities ◽  
Martial Arts ◽  
Dynamic Balance ◽  
Intervention Group ◽  
Step Test ◽  
Control Group ◽  
Development Disabilities ◽  
Four Square ◽  
The Relationship ◽  
Adults With Developmental Disabilities

This study examined the relationship between cardio-kickboxing and balance in individuals with developmental disabilities (DDs). Cardio-kickboxing is a combination of aerobics, boxing, and martial arts. In general, cardio-kickboxing has shown to improve balance in participants. To our knowledge, this is the first adult cardio-kickboxing program for participants with a DD. Twenty-one adults with development disabilities were randomly assigned to either an intervention group or a control group. Participants were tested at baseline, week four, and postintervention using the Four Square Step Test. Improvements were shown in balance (p < 0.0125) at postintervention testing. Results indicate that cardio-kickboxing may be a promising intervention to improve balance for individuals with DDs.

scholarly journals Reliability and Validity of the Six Spot Step Test in People with Intellectual Disability

2021 ◽  
Vol 11 (2) ◽  
pp. 201
Author(s):  
María Mercedes Reguera-García ◽  
Raquel Leirós-Rodríguez ◽  
Eva Fernández-Baro ◽  
Lorena Álvarez-Barrio
Keyword(s):  
Intellectual Disability ◽  
Dynamic Balance ◽  
Subjective Evaluation ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Step Test ◽  
Linear Regression Models ◽  
Clinical Tests ◽  
Cross Sectional ◽  
Four Square

Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been developed, such as the Six Spot Step Test. The aim of this study was to determine the validity and within-day and day-to-day test–retest reliability of the Six Spot Step Test in people with intellectual disability. A descriptive cross-sectional study was conducted with 18 people with intellectual disability. The participants conducted the Six Spot Step Test three times and a set of five clinical tests for the balance assessment. The relative reliability was excellent (Intraclass Correlation Coefficient (ICC) = 0.86 − 0.97), and the absolute reliability ranged between 4.7% and 7.3% for coefficient variation and between 0.6 and 1.2 for the standard error of measurement. Linear regression models showed that that test can explain the results of the Timed Up & Go, Four Square Step Test and the Berg Balance Scale. The Six Spot Step Test proved to be as valid and reliable for the evaluation of dynamic balance in people with intellectual disability as the most frequently used tests for the clinical evaluation of postural control.

The assessment of dynamic balance using four square step test in COPD

2017 ◽  
Author(s):  
Ali Yalman ◽  
Ugur Yanbal ◽  
Suleyman Gursoy ◽  
Orcin Telli Atalay ◽  
Harun Taskin ◽  
...  
Keyword(s):  
Dynamic Balance ◽  
Step Test ◽  
Four Square

scholarly journals Reliability and Feasibility of the Four Square Step Test for Use in Children with Cerebral Palsy: A Pilot Study

2014 ◽  
Author(s):  
Edward James Gorgon ◽  
Gilbert Madriaga ◽  
Minerva Gomez-Cailao ◽  
Levin Abdon ◽  
Mary Boniquit
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Interrater Reliability ◽  
Dynamic Balance ◽  
Standing Balance ◽  
Step Test ◽  
Retest Reliability ◽  
Children With Cerebral Palsy ◽  
Four Square ◽  
Test Retest Reliability

Purpose: The ability to maintain standing balance with a moving base of support and while making rapid postural adjustments is important for independence in various functional activities. Clinical tests and measures have not addressed this ability in children with disability. This pilot study examined the feasibility and reliability of the Four Square Step Test (FSST) as a test of dynamic balance in children with cerebral palsy (CP). Method: Four children with CP (Gross Motor Function Classification Scale levels I-II) were tested on the FSST by 3 assessors on the first occasion (interrater reliability) and repeat-tested by 1 assessor after 2 weeks (test-retest reliability). Six children with typical development (TD) were tested on a separate occasion to explore any between-group difference in performance. Results: The FSST was easy to setup, required no specialized equipment, could be completed in 5 minutes, and might be carried out by clinicians with limited experience in pediatric therapy. It demonstrated excellent interrater reliability (ICC = 0.832) and test-retest reliability (ICC = 0.979) in children with CP. Compared with FSST times for children with TD (mean = 9.12 ± 2.67 seconds), times for children with CP (mean = 18.38 ± 9.02 seconds) were significantly slower (p = 0.019, Mann-Whitney U = -2.345). Conclusions and Recommendations: The pilot study provides initial evidence on the potential usefulness of the FSST as a test of dynamic standing balance in children with CP. This warrants further investigation of the clinimetric properties of the FSST using an adequate sample size.

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