Efficacy of the structured balance awareness program on perceived balance confidence and fear-related maladaptive behaviour in post-stroke survivors

BACKGROUND: The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE: To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS: A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS: A paired t-test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t-test exhibited a statistically significant improvement on ABC (t = 2.57, p = 0.012 *), BBS (t = 3.32, p = 0.001 *) and FESI (t = 3.38, p = 0.001 *) in the SBAP group. CONCLUSION: The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors.

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Reliability of the Maximal Step Length Test and Its Correlation with Motor Function in Chronic Stroke Survivors

BioMed Research International ◽

10.1155/2018/6985963 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Shamay S. M. Ng ◽

Mimi M. Y. Tse ◽

Patrick W. H. Kwong ◽

Isaac C. K. Fong ◽

Sun H. Chan ◽

...

Keyword(s):

Older Adults ◽

Intraclass Correlation ◽

Step Length ◽

Berg Balance Scale ◽

Minimal Detectable Change ◽

Stroke Survivors ◽

Healthy Older Adults ◽

Abc Scale ◽

Walking Speeds ◽

Test Retest Reliability

Objective. This study aimed to (1) investigate the interrater, intrarater, and test-retest reliabilities, as well as the minimal detectable change, of the Maximal Step Length test (MSL) in stroke survivors, (2) examine the concurrent validity of MSL with other stroke-specific impairment measurements in stroke survivors, and (3) compare the MSL performances of stroke survivors and those of age-matched healthy older adults in different directions. Design. Cross-sessional study. Setting. University-based research laboratory. Participants. Stroke survivors (n = 48) and age-matched healthy older adults (n = 39). Methods. Stroke survivors were assessed with MSL, lower limb muscle strength, Limits of Stability (LOS) Test, Berg Balance Scale (BBS), 5-meter walk test, and Activities-specific Balance Confidence (ABC) scale by two trained assessors in 1 session. Their performance on MSL was reassessed 1 week later to establish the test-retest reliability. Healthy older adults were assessed with MSL only. Intraclass correlation coefficient (ICC) was used to assess the reliability of MSL and Spearman’s rho was used to quantify the strength of correlations between MSL and secondary outcomes. Between-group differences of MSL were assessed with the independent t-test. Results. The MSL exhibited excellent intrarater, interrater, and test-retest reliabilities [ICC: 0.885–1.000]. Significant correlations (ρ: 0.447–0.723) were demonstrated between MSLs in most directions and muscle strengths of the affected legs, BBS scores, and walking speeds. The step lengths differed significantly between stroke survivors and healthy older adults in the forward, backward, and sideways directions on both the affected and less affected sides. Conclusions. The MSL is a reliable, valid, and easily administered test of the stepping capabilities of stroke survivors. Stroke survivors had significant shorter MSLs in all directions than the age-matched healthy older adults.

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

Sensors ◽

10.3390/s21041343 ◽

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.

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

Stroke ◽

10.1161/str.51.suppl_1.46 ◽

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.

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Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers

Archives of Gerontology and Geriatrics ◽

10.1016/s0167-4943(03)00082-7 ◽

2004 ◽

Vol 38 (1) ◽

pp. 11-26 ◽

Cited By ~ 467

Author(s):

Y Lajoie ◽

S.P Gallagher

Keyword(s):

Reaction Time ◽

Postural Sway ◽

The Elderly ◽

Berg Balance Scale ◽

Balance Confidence ◽

Balance Scale ◽

Abc Scale

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Virtual reality in vestibular rehabilitation: a pilot study

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2018.0056 ◽

2019 ◽

Vol 26 (7) ◽

pp. 1-13 ◽

Cited By ~ 1

Author(s):

Otávio Corrêa Miziara ◽

Vanessa Rossato de Oliveira ◽

Andréa Licre Pessina Gasparini ◽

Beatriz Coelho Souza ◽

Angela Santos ◽

...

Keyword(s):

Virtual Reality ◽

Benign Paroxysmal Positional Vertigo ◽

Berg Balance Scale ◽

T Test ◽

Dizziness Handicap Inventory ◽

Balance Confidence ◽

Balance Scale ◽

Positional Vertigo ◽

Confidence Scale ◽

Paroxysmal Positional Vertigo

Background/AimsWe evaluated the efficacy of using virtual reality with specific games for vestibular rehabilitation to treat patients with benign paroxysmal positional vertigo.MethodsThe Activity-Specific Balance Confidence Scale (ABC Scale), Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Berg Balance Scale, Balancim, Romberg and Dix-Hallpike tests were used to evaluate 10 participants (5 males and 5 females; mean age 38.5 ± 14.7 years) with benign paroxysmal positional vertigo, who played 3 specific games of Nintendo Wii console (Snowboard Slalom, Tightrope Walk, Rhythm Parade) for 10 minutes twice a week for 4 weeks.ResultsThe intervention resulted in significant increases in Activity-Specific Balance Confidence Scale score (d de Cohen >0.50), decreases in Dizziness Handicap Inventory (P<0.05 in t test for all dimensions and total score) and Tinnitus Handicap Inventory (P<0.05 in Wilcoxon test for all dimensions and total score), and improvement in balance shown on Romberg test, Berg Balance Scale (P<0.05 in t test for all dimensions and total score) and Balancim (d de Cohen >0.80).ConclusionsVirtual reality with the selected games seemed to be effective on benign paroxysmal positional vertigo treatment, improving scores of tests and scales used in the assessment.

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Fibromyalgia: is there association between balance and pain? a pilot study

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/341210114 ◽

2014 ◽

Vol 21 (1) ◽

pp. 27-33

Author(s):

Adriana de Sousa do Espírito Santo ◽

Pamela Cristina Mango ◽

Ana Assumpção ◽

Juliana Ferreira Sauer ◽

Amélia Pasqual Marques

Keyword(s):

Self Efficacy ◽

The Elderly ◽

Berg Balance Scale ◽

Interquartile Range ◽

Control Group ◽

Intrinsic Factors ◽

Balance Confidence ◽

Balance Scale ◽

Abc Scale ◽

And Control

Studies of balance and risk factors for falling typically focus on the elderly population or on individuals with musculoskeletal pain. Although fibromyalgia is associated with intrinsic factors that predispose to falls (pain, depression, fatigue), few studies have researched balance and falls in this syndrome. The aim of this study was to verify the association between balance, balance self-efficacy and pain in women with and without fibromyalgia, and verify the association between Berg Balance Scale and Activities-specific Balance Confidence Scale (ABC Scale). The sample consisted of 48 women aged between 40 and 59 years, divided into two groups: Fibromyalgia group (n=22) and Control group (n=26) with asymptomatic people. Balance was assessed by Berg Balance Scale, balance self-efficacy by the ABC Scale and pain by the visual analog scale. Mean scores for pain, Berg and ABC Scale were 5.4 cm (SD 2.6), 55 (interquartile range 54-56), and 54.6 (SD 26.6) respectively for Fibromyalgia group, and 0 cm, 56 (interquartile range 55-56), and 89.4 (SD 14.4) respectively for Control group. Statistically significant differences were found in balance on comparing both groups (p=0.000 for Berg Balance Scale and 0.009 for ABC Scale) with lower values for Fibromyalgia group. In Fibromyalgia group, pain was negatively correlated with balance (r=-0.48, p=0.020) and balance self-efficacy (rs=-0.56, p=0.006). Correlation between Berg Balance Scale and ABC Scale was found only in the Fibromyalgia group (rs =0.55, p=0.007). There are associations between poor balance and pain, and poor balance and decreased balance self-efficacy in women with fibromyalgia. There is an association between scales in the Fibromyalgia group.

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Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00307-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Ingrid Johansen Skogestad ◽

Marit Kirkevold ◽

Petra Larsson ◽

Christine Råheim Borge ◽

Bent Indredavik ◽

...

Keyword(s):

Future Development ◽

Health Professionals ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Stroke Survivors ◽

Structured Interviews ◽

Post Stroke ◽

Patient Reported Outcome Measure ◽

Patient Reported ◽

Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

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‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Clinical Rehabilitation ◽

10.1177/02692155211000740 ◽

2021 ◽

pp. 026921552110007

Author(s):

Hannah Stott ◽

Mary Cramp ◽

Stuart McClean ◽

Ailie Turton

Keyword(s):

Support Groups ◽

Phenomenological Study ◽

Community Support ◽

Phenomenological Approach ◽

The Body ◽

Stroke Survivors ◽

Post Stroke ◽

Personal Perceptions ◽

Psychological Sense ◽

Qualitative Phenomenological

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

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

Robotics ◽

10.3390/robotics10030101 ◽

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.

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