Development of Modified Step Test as Dynamic Balance Assessment: Reliability and Validity

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.

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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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Dynamic balance assessment during gait in children with Down and Prader-Willi syndromes using inertial sensors

Human Movement Science ◽

10.1016/j.humov.2018.11.010 ◽

2019 ◽

Vol 63 ◽

pp. 53-61 ◽

Cited By ~ 6

Author(s):

V. Belluscio ◽

E. Bergamini ◽

G. Salatino ◽

T. Marro ◽

P. Gentili ◽

...

Keyword(s):

Inertial Sensors ◽

Dynamic Balance ◽

Balance Assessment

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Balance a few years after total hip replacement

10.21203/rs.2.11747/v1 ◽

2019 ◽

Author(s):

Agnieszka Wareńczak ◽

Przemysław Lisiński

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Dynamic Balance ◽

Berg Balance Scale ◽

Step Test ◽

Control Group ◽

Timed Up And Go ◽

Total Hip ◽

Functional Reach ◽

Functional Reach Test

Abstract Background: The aim of the study was to conduct a long-term evaluation of whether total hip replacement permanently affects the quality of postural reactions and body balance. Material and methods: The unilateral Total Hip Replacement (THR) group consisted of 30 subjects (mean age: 69.4). The control group consisted of 30 healthy subjects (mean age: 68.8). The force platform and functional tests such as Timed Up and Go, 3m walk test, Functional Reach Test, 30s Chair Stand Test, Step Test and Berg Balance Scale were used to assess dynamic balance. Results: Subjects from the study group exhibited significantly increased time (p=0.002) and distance (p=0.012) in the tests performed on the force platform compared to the control group. We also observed worse balance and functional test scores in the THR group: Timed Up and Go test (p<0.001), 3m walk test (p<0.001), Functional Reach Test (p=0.003), 30s Chair Stand Test (p=0.002) and Step Test (operated leg: p<0.001, non-operated leg: p=0.002). The results obtained in the Berg Balance Scale tests were not significantly different between the groups (p=0.597). Conclusions: Our research shows that total hip replacement permanently impairs patients’ dynamic balance and functionality in certain lower-extremity activities. Keywords: balance, total hip replacement, gait, muscle strength

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The Effect of Pilates Training on the Balance of Elderly

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i16.745 ◽

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.

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Differences between Tempos of Step Error and Postural Sway in the Stipulated Tempo Step Test for Children and Their Relationships

World Journal of Education ◽

10.5430/wje.v11n6p31 ◽

2021 ◽

Vol 11 (6) ◽

pp. 31

Author(s):

Hiroki Aoki ◽

Shin-ichi Demura ◽

Kenji Takahashi ◽

Hiroshi Hirai

Keyword(s):

Repeated Measures ◽

Path Length ◽

Postural Sway ◽

Dynamic Balance ◽

Step Test ◽

Total Path Length ◽

Fast Tempo ◽

Balance Ability ◽

Path Lengths ◽

Slow Tempo

Recently, to evaluate dynamic balance ability, a stipulated tempo step test has been developed, and a step error between tempo and contact time of feet has been used as an evaluation variable. The step error, postural sway, and their relationships may differ between the slow tempo (40 bpm) and fast tempo (120 bpm). This study aimed to examine the aforementioned problem with 62 participant children (30 boys and 32 girls). The step error and postural sway variables (X-axis path length, Y-axis path length, total path length, peripheral area, and rectangular area) during stepping while matching both tempos were measured. Means of one minute and three intervals (0–20 sec, 20–40 sec, and 40–60 sec) for each variable were calculated in both tempos. The results of the paired t-test showed that means of all variables were larger in the 40 bpm tempo than in the 120 bpm tempo. In the multiple comparison tests after the results of the two-way repeated measures ANOVA, the means of three intervals in all variables were larger in the 40 bpm tempo than in the 120 bpm tempo; the means of the sway variables, excluding that of the X-axis path length, in the 40 bpm tempo were larger in the 0–20 sec interval than in the 20–40 sec interval or the 40–60 sec interval. Correlations between step errors and those between the step error and sway variables of both tempos were insignificant or under moderation. The correlations between the step error and sway variables in both tempos were insignificant or significant but low, and those among sway variables were high, except between the X- and Y-axis path lengths. The relationship between both axis path lengths differed according to the tempo. In conclusion, in the case of the stipulated tempo step test targeting children, the slow tempo has a greater step error and postural sway than the fast tempo, and the sway in the early step stage is greater in the slow tempo. The relationships between step errors and between the step error and sway variables of both tempos are low; hence, the ability related to the test may differ in both tempos. The relationships among sway variables in both tempos are high, except between the X- and Y-axis path lengths.

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Clinical assessment of balance using BBS and SARAbal in cerebellar ataxia: Synthesis of findings of a psychometric property analysis

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702518500063 ◽

2018 ◽

Vol 38 (01) ◽

pp. 53-61 ◽

Cited By ~ 3

Author(s):

Stanley John Winser ◽

Catherine M Smith ◽

Leigh A Hale ◽

Leica S Claydon ◽

Susan L Whitney

Keyword(s):

Multiple Sclerosis ◽

Cerebellar Ataxia ◽

Psychometric Property ◽

Reliability And Validity ◽

Berg Balance Scale ◽

Psychometric Analysis ◽

Balance Assessment ◽

Good Reliability ◽

The Core ◽

Core Set

Background: In the previous psychometric analysis paper in our series for identifying the core set of balance measures for the assessment of balance, we recommended the Berg Balance Scale (BBS) and balance sub-components of the Scale for the assessment and rating of ataxia (SARAbal) as psychometrically sound measures of balance for people with cerebellar ataxia (CA) secondary to multiple sclerosis. Objective: The present study further examined the suitability of BBS and SARAbal for the assessment of balance in CA with regard to psychometric property strength, appropriateness, interpretability, precision, acceptability and feasibility. Methods: Criteria to fulfill each factor was defined according to the framework of Fitzpatrick et al. (1998). Based on the findings of our previous psychometric analysis, each criterion was further analyzed. Results: The psychometric analysis reported good reliability and validity estimates for the BBS and SARAbal recommending them as psychometrically sound measures; they fulfilled both criteria for appropriateness and interpretability, the measures showed evidence for precision and acceptability, and they were found to be feasible in terms of the time and cost involved for the balance assessment. Conclusion: We have provided evidence for the use of the BBS and SARAbal for the assessment of balance among people with CA.

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Reliability and validity of Six-Spot Step Test (SSST) in stroke survivors

European Journal of Physical and Rehabilitation Medicine ◽

10.23736/s1973-9087.21.06799-x ◽

2021 ◽

Vol 57 (6) ◽

Author(s):

Tai-Wa LIU ◽

Shamay S. NG ◽

Ka-Yuen CHEUNG ◽

Ming-Yeung CHEUNG ◽

Ryan N. HUNG ◽

...

Keyword(s):

Reliability And Validity ◽

Step Test ◽

Stroke Survivors

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Reliability and Validity of the Ladder Agility Test Among Children

Pediatric Exercise Science ◽

10.1123/pes.2018-0117 ◽

2019 ◽

Vol 31 (3) ◽

pp. 370-378 ◽

Cited By ~ 2

Author(s):

Bouwien Smits-Engelsman ◽

Wendy Aertssen ◽

Emmanuel Bonney

Keyword(s):

Body Mass Index ◽

Confidence Interval ◽

Motor Coordination ◽

Dynamic Balance ◽

Intraclass Correlation ◽

Reliability And Validity ◽

Test Items ◽

Explosive Power ◽

Explained Variance ◽

Test Retest Reliability

Purpose: This study aimed (1) to evaluate the test–retest reliability of a new agility test among children and (2) to determine the physical performance and anthropometric variables that may influence agility performance in this population. Methods: For aim 1, participants (n = 34) completed the Ladder Agility Test (LAT) twice, with a 2-week interval between the first and second test occasions. For aim 2, participants (n = 125) were assessed on the LAT as well as other measures thought to be necessary for agility such as motor coordination, explosive power of the lower extremity, dynamic balance, age, and body mass index. Results: Intraclass correlation coefficient of the LAT total score was .94 (95% confidence interval, .88–.97). Cronbach alpha of .85 was found between the 4 test items. An R2 of .466 was found to represent the explained variance of the LAT total score by the predicting variables. Dynamic balance (2-legged side jumps) (P < .001), motor coordination (P < .01), and age (P < .06) were found to be the major predictors of the LAT total score. Conclusions: This study shows that the LAT is a reliable and valid field-based test that can be used to evaluate agility performance in children. Factors such as dynamic balance, motor coordination, and age may influence agility performance.

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Development of a Smartphone-Based Balance Assessment System for Subjects with Stroke

Sensors ◽

10.3390/s20010088 ◽

2019 ◽

Vol 20 (1) ◽

pp. 88 ◽

Cited By ~ 6

Author(s):

You-Ruei Hou ◽

Ya-Lan Chiu ◽

Shang-Lin Chiang ◽

Hui-Ya Chen ◽

Wen-Hsu Sung

Keyword(s):

Intraclass Correlation ◽

Reliability And Validity ◽

Smartphone Application ◽

Chronic Stroke ◽

Healthy Adults ◽

Assessment System ◽

Balance Performance ◽

Balance Assessment ◽

Artery Disease ◽

Validity Tests

Stroke is a cerebral artery disease that negatively affects activities of daily living (ADLs) and quality of life (QoL). Smartphones have demonstrated strong potential in assessing balance performance. However, such smartphone-based tools have thus far not been applied to stroke survivors. The purpose of this study was to develop a smartphone-based balance assessment system for subjects who have experienced strokes and evaluate the system feasibility. The smartphone-based balance assessment application was developed with Android Studio, and reliability and validity tests were conducted. The smartphone was used to record data using a built-in accelerometer and gyroscope, and increased changes represented greater instability. Six postures were tested for 30 s each. Ten healthy adults were recruited in the reliability test, and the intraclass correlation coefficient (ICC) was used to analyze the within-day and between-day reliabilities. Eight subjects with chronic stroke and eight healthy adults were recruited for the validity test, in which balance performance was compared to represent the application validity. The ICC values of the reliability tests were at least 0.76 (p = 0.00). The acceleration data exhibited no difference between individuals who have experienced stroke and healthy subjects; however, all six postures were found to differ significantly between the two groups in the gyroscope data. The study demonstrates that the smartphone application provides a convenient, reliable, and valid tool for the balance assessments of subjects who have experienced chronic stroke.

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