scholarly journals Effects of application of texture insoles on the balance of subjects with Multiple Sclerosis

2017 ◽  
Vol 16 (1) ◽  
pp. 9-16
Author(s):  
Wildja De Lima Gomes ◽  
Thais Botossi Scalha ◽  
Lucas Brino Mota ◽  
Viviane Almeida Kuroda ◽  
Juliana Cintra Garrafa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Dynamic Balance ◽  
Step Length ◽  
Berg Balance Scale ◽  
Measuring Instruments ◽  
Balance Scale ◽  
Functional Gait ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Objective: The aim of this study was to evaluate the effects on static and dynamic balance after the use of textured insoles. Method: Fifteen subjects with multiple sclerosis were evaluated before using the insoles, after using them for 1 month, and after 2 months without using, them using the following measuring instruments: the Berg Balance Scale, Dynamic Gait Index, and 10-meter Walk Test, a means of functional gait assessment. Results: Improvement was observed in the Berg Balance Scale and Dynamic Gait Index scores, walking time, number of steps and step length after using the insoles for 1 month. The improvement in Berg Balance Scale score remained after two months without the insoles and there were no changes in gait speed. Conclusion: The use of textured insoles was effective as an intervention to improve static and dynamic balance in patients with multiple sclerosis.

Dynamische Posturografie zur Quantifizierung der posturalen Kontrolle

2018 ◽  
Vol 45 (10) ◽  
pp. 714-725
Author(s):  
Heinz Reichmann ◽  
Martin Gerber ◽  
Markus Reckhardt ◽  
Fritjof Reinhardt
Keyword(s):  
Morbus Parkinson ◽  
Berg Balance Scale ◽  
Eine Hohe ◽  
Balance Scale ◽  
Stadium I ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

ZusammenfassungDie erfolgreiche Haltungskontrolle setzt eine effektive und effiziente Interaktion aller posturalen Systeme voraus, die sowohl aktiv als auch reaktiv mittels muskulärer Kräfte den Körper im Gleichgewicht halten. Eine Störung dieses komplexen Posturalsystems auf sensorischer, zentraler oder motorischer Ebene führt in der Folge zu einer zunehmenden Instabilität und zu einer erhöhten Sturzneigung. Insofern scheinen die zuverlässige Erhebung der posturalen Kontrolle und die damit verbundene Sturzprävalenz ein wichtiges Element der ambulanten und stationären Versorgung zu sein. Die motorisch-funktionellen Assessments, die sich aus verschiedenen Gleichgewichts- und Stabilitätsaufgaben ergeben, stellen noch immer den Goldstandard zur Quantifizierung der posturalen Kontrolle dar. Diese Verfahren sind jedoch oftmals nicht in der Lage, die Gleichgewichtsfähigkeit eines Patienten vollumfänglich abzubilden, oder sind aufgrund der subjektiven Bewertung oder unzureichender Standardisierung nur bedingt vergleichbar. Das Ziel der vorliegenden Studie war daher die Entwicklung eines quantitativen Messverfahrens zur Überprüfung der posturalen Kontrolle, basierend auf dem neuroorthopädischen Therapiegerät Posturomed®. Das Messsystem wurde in Form eines reaktiven Screeningverfahrens ausgeführt. Bei diesem werden mechanische Perturbationen erzeugt mittels Elektromagneten, die an der Unterstützungsfläche des Probanden appliziert werden. Der Eignungsnachweis dieses Systems für eine Quantifizierung der posturalen Kontrolle erfolgte durch eine zweiarmige Querschnittsstudie mit 115 gesunden Probanden (Referenzgruppe) und 149 neurologischen Patienten.Die Gruppe der neurologischen Patienten setzte sich zusammen aus– 69 Patienten mit zerebraler Mikroangiopathie (ZMA) mit in den letzten 12 Monaten klinisch eher leichter, aber chronisch progredienter Symptomatik,– 31 Patienten mit Morbus Parkinson Stadium I bis III nach Hoehn & Yahr als chronisch progrediente, multilokuläre Netzwerkerkrankung und – 49 Patienten mit klinisch vordergründig restierender Hemiparese bei Zustand nach zerebraler Embolie (Kraftgrad des betroffenen Beins 4/5 oder latente Parese) außerhalb der Subakutphase. Die Ergebnisse der Studie belegen, dass Perturbationsversuche zur Quantifizierung der posturalen Kontrolle für ein breites Spektrum neurologischer Patienten geeignet sind. Die Validität des Verfahrens konnte durch eine hohe inhaltliche Übereinstimmung zwischen der dynamischen Posturografie und den konvergenten Maßen der Motorik (Berg Balance Scale; Dynamic Gait Index) nachgewiesen werden. Das vorgestellte System erscheint folglich geeignet, das reaktive Gleichgewicht als eine Eigenschaft der motorischen Standkontrolle zu bestimmen. Die dynamische Posturografie auf Basis eines Perturbationsversuchs kann im klinischen und therapeutischen Umfeld zur Quantifizierung der posturalen Kontrolle eingesetzt werden. Zielgruppenlimitationen und damit verbundene Einschränkungen der Generalisierbarkeit von motorisch-funktionellen Testverfahren werden mit ihm überwunden. Darüber hinaus können auf der Basis der reaktiven posturalen Kompetenz individuelle Rückschlüsse auf das Sturzrisiko gezogen werden. Die Prognosegüte dieser Sturzrisikobewertung entspricht denen der motorisch-funktionellen Testverfahren und ist je nach Zielgruppe teilweise sogar besser. Für Patienten mit Morbus Parkinson konnte für den Dämpfungskoeffizienten bei einem Grenzwert von Δτ = − 0,45 s die höchste Güte ermittelt werden. Eine Sensitivität von 79 % und Spezifität von 78 % lassen eine gute Verwendung als sturzbezogenes Assessment erkennen. Der routinemäßige klinische Einsatz zur Quantifizierung der Sturzgefährdung, z. B. im Rahmen einer Krankenhausaufnahme, erscheint auf Grundlage der Ergebnisse empfehlenswert. Eine Grundvoraussetzung dafür, dass sich ein Assessment für eine Verlaufsbestimmung im Rahmen von Behandlungen einer Erkrankung eignet, ist seine ausreichende Reliabilität. Die laterale Perturbation und dann die Wertung von mittlerer Schwingungsgeschwindigkeit und Schwingungsdistanz sind geeignet für die Beurteilung der posturalen Stabilität im Verlauf neurologischer Erkrankungen und damit auch für eine quantitative Erfassung auftretender Therapieeffekte.

scholarly journals Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 27 ◽  
Author(s):  
Tapan Mehta ◽  
Hui-Ju Young ◽  
Byron Lai ◽  
Fuchenchu Wang ◽  
Yumi Kim ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lower Extremity ◽  
Physical Functioning ◽  
Concurrent Validity ◽  
Convergent Validity ◽  
Dynamic Balance ◽  
Berg Balance Scale ◽  
Sf 36 ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Background: Recent clinical guidelines for adults with neurological disabilities suggest the need to assess measures of static and dynamic balance using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) as core outcome measures. Given that the BBS measures both static and dynamic balance, it was unclear as to whether either of these instruments was superior in terms of its convergent and concurrent validity, and whether there was value in complementing the BBS with the DGI. Objective: The objective was to evaluate the concurrent and convergent validity of the BBS and DGI by comparing the performance of these two functional balance tests in people with multiple sclerosis (MS). Methods: Baseline cross-sectional data on 75 people with MS were collected for use in this study from 14 physical therapy clinics participating in a large pragmatic cluster-randomized trial. Convergent validity estimates between the DGI and BBS were examined by comparing the partial Spearman correlations of each test to objective lower extremity functional measures (Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Timed 25-Foot Walk (T25FW) test) and the self-reported outcomes of physical functioning and general health using the 36-Item Short Form Health Survey (SF-36). Concurrent validity was assessed by applying logistic regression with gait disability as the binary outcome (Patient Determined Disease Steps (PDDS) as the criterion measure). The predictive ability of two models, a reduced/parsimonious model including the BBS only and a second model including both the BBS and DGI, were compared using the adjusted coefficient of determinations. Results: Both the DGI and BBS were strongly correlated with lower extremity measures overall as well as across the two PDSS strata with correlations. In PDDS ≤ 2, the difference in the convergence of BBS with TUG and DGI with TUG was −0.123 (95% CI: −0.280, −0.012). While this finding was statistically significant at a type 1 error rate of 0.05, it was not significant (Hommel’s adjusted p-value = 0.465) after accounting for multiple testing corrections to control for the family-wise error rate. The BBS–SF-36 physical functioning correlation was at least moderate and significant overall and across both PDDS strata. However, the DGI–physical functioning score did not have a statistically significant correlation within PDDS ≤ 2. None of the differences in convergent and concurrent validity between the BBS and DGI were significant. The additional variation in 6MWT explained by the DGI when added to a model with the BBS was 7.78% (95% CI: 0.6%, 15%). Conclusions: These exploratory analyses on data collected in pragmatic real-world settings suggest that neither of these measures of balance is profoundly superior to the other in terms of its concurrent and convergent validity. The DGI may not have any utility for people with PDDS ≤ 2, especially if the focus is on mobility, but may be useful if the goal is to provide insight on lower extremity endurance. Further research leveraging longitudinal data from pragmatic trials and quasi-experimental designs may provide more information about the clinical usefulness of the DGI in terms of its predictive validity when compared to the BBS.

scholarly journals Fatores associados ao equilíbrio funcional em idosos com disfunção vestibular crônica

2006 ◽  
Vol 72 (5) ◽  
pp. 683-690 ◽  
Author(s):  
Juliana Maria Gazzola ◽  
Monica Rodrigues Perracini ◽  
Maurício Malavasi Ganança ◽  
Fernando Freitas Ganança
Keyword(s):  
Berg Balance Scale ◽  
Timed Up And Go ◽  
Balance Scale ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Tarefas do dia-a-dia podem ser muito desafiadoras para o equilíbrio do idoso. OBJETIVO: Verificar a associação entre equilíbrio funcional, avaliado pela Berg Balance Scale (BBS) e os dados sociodemográficos, clínicos e de mobilidade (Timed up and go test - TUGT, Dynamic Gait Index - DGI) em idosos vestibulopatas crônicos. MATERIAL E MÉTODO: Estudo de casos com 120 idosos com diagnóstico de disfunção vestibular crônica. Foram utilizados os testes de Mann-Whitney, Kruskal-Wallis seguido do teste de Dunn e Coeficiente de Correlação de Spearman. RESULTADOS: Ocorreram associações =-0,354; e correlações significantes entre a pontuação total da BBS e idade (p<0,001), faixa etária (p<0,001), número de doenças (p=0,030), número de =-0,287; p=0,001), número de medicamentos (p=0,014), número de doenças (=-0,274; p=0,002), quedas recorrentes (p=0,010), tendência a medicamentos (quedas (p=0,002), diagnóstico topográfico de vestibulopatia central (p<0,001) =-0,709; periodicidade da tontura (p=0,039), TUGT (<0,001) e DGI =-0,748; p(<0,001). CONCLUSÕES: O equilíbrio funcional de idosos vestibulopatas crônicos avaliados à BBS é mais comprometido quando associado ao avançar da idade, faixa etária mais idosa (80 anos ou mais), aumento do número de doenças, presença de cinco ou mais doenças, polifarmacoterapia, quedas recorrentes, tendência a quedas, vestibulopatia central, tontura diária, comprometimento da mobilidade e marcha.

Effect of Virtual Reality on Balance in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 100 (6) ◽  
pp. 933-945 ◽  
Author(s):  
Yi Chen ◽  
Qiang Gao ◽  
Cheng-Qi He ◽  
Rong Bian
Keyword(s):  
Virtual Reality ◽  
Parkinson Disease ◽  
Randomized Controlled Trials ◽  
Berg Balance Scale ◽  
Controlled Trials ◽  
Balance Scale ◽  
Randomized Controlled ◽  
Functional Gait ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Abstract Background Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. Purpose The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). Data Sources Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. Study Selection All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. Data Extraction Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. Data Synthesis Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed “Up & Go” Test and the Activities-Specific Balance Confidence Scale did not differ significantly. Limitations Publication bias and diversity in the interventions were the main limitations. Conclusions Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.

scholarly journals Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke

2021 ◽  
pp. 154596832110193
Author(s):  
Sungwoo Park ◽  
Chang Liu ◽  
Natalia Sánchez ◽  
Julie K. Tilson ◽  
Sara J. Mulroy ◽  
...  
Keyword(s):  
Angular Momentum ◽  
Sagittal Plane ◽  
Dynamic Balance ◽  
Objective Measure ◽  
Frontal Plane ◽  
Step Length ◽  
Berg Balance Scale ◽  
Whole Body ◽  
Functional Gait ◽  
Full Body

Background People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. Results When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased. Conclusions Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.

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