Objective Assessment of Postural Control.pptx

presentation on in depth assessment of posture and balance

1. Objective Assessment of Postural Control Maya Prabhu

2. Activity specific balance confidence scale (ABC) The original English-language version of the ABC scale was developed and tested in ambulatory, community-dwelling older adults living in Canada

3. Author, yr Population Reliability Validity Botner EM, 2005 Stroke test – retest reliability was ICC=0.85 Salbach NM, 2006 Stroke a= .94 Spearman ρ values ranged between .30 and .60 Nilsagard Y, 2012 MS α=0.95 The cc validity was moderate to good (0.50 to−0.75)

4. Botner conducted the study with patients beyond 1 year of stroke, however Salbach included stroke pts within 1 yr, but got consistent results as the former which suggests that the homogeneity of ABC scale items, generated by clinicians and older adults living in the community, is unaffected by the time interval poststroke

5. All 3 studies agree that ABC items (not all) have ceiling and flooring effect ; however the summary score of ABC does not have either of the effects The lack of floor or ceiling effects for the summary score ranging between 20% and 80% on the scale indicates that the ABC scale covers a range of walking-related tasks that are relevant to community life in the first year post stroke ( Salbach , 2006)

6. According to the study by Nilsagard , a s ignificant difference was found between non-fallers and the multiple fallers and a statistically significant difference was also found in ABC scoring between those reporting using assistive device outdoors or not

7. Berg balance scale

8. The purposes of this study were to conduct a systematic review of the psychometric properties of the BBS specific to stroke and to identify strengths and weaknesses in its usefulness for stroke rehabilitation 1966 - July 2007 Total 21 studies included: 4 examined reliability, 16 studied validity, and 8 examined responsiveness

9. The results suggest that the BBS has strong reliability, validity, and responsiveness to change, and the test is useful and easy to administer without the need for expensive equipment or prolonged assessment time

10. Flooring effect: least demanding item - sitting independently Severely impaired patients - unable to sit independently and perform other items . Although these patients may experience some meaningful clinical improvements, the BBS will not capture these changes. Ceiling effect for patients with mild stroke impairments when administered at 90 and 180 days, it may miss significant gains in balance that are critical for community reintegration and leisure participation

11. The PASS has been reported to have slightly better psychometric proper-ties than the BBS and it does not demonstrate the significant floor or ceiling effects reported with the other measures

12. Honey I shrunk BBS. . . .  Suzuki M, 2013 (J Phy Ther Sci) analyze the relationship between results of the Berg Balance Scale (BBS) and Static Balance Test (SBT) in hemiplegic patients with stroke SBT: 5 postural holding tasks- sitting, stride standing, close standing, one-foot standing on the unparalyzed leg, and one-foot standing on the paralyzed leg

13. Stroke within the preceding 6 months Brunnstrom: III-VI The correlation coefficient for the BBS score and SBT score was 0.87 (p<0.01)

14. The reason behind this finding may be the influence of assessing static balance ability near the limit of stability Subjects who obtained the maximum score of 56 on the BBS, further differences in balance ability could be detected using the SBT

15. Chou CY et al, 2006 (Physical Therapy) Aim : to develop a short form of the BBS (SFBBS ) that was psychometrically similar to the original BBS for people with stroke Prospective study Outcome measures done 14 days and 90 days after stroke (BBS, BI. FM)

16. Original BBS: 14 items- Short form ( 4 items, 5 items, 6 items, 7 items) Grading ( 3 points) 4 items (5 level); 4 items (3 level) 5 items (5 level); 5 items (3 level) total 8 short 6 items (5 level); 6 items (3 level) forms 7 items (5 level); 7 items (3 level)

17. Results: Only the 7-item BBS-3P demonstrated both satisfactory and psychometric properties similar to those of the original BBS All other short forms - variable psychometric properties

18. Discussion: The Bland-Altman plot revealed that there was no notable trend between the difference and the average scores of the 7-item BBS-3P and the original BBS Advantages of 7-item BBS-3P : No. of items reduced to half Scoring from 5 to 3 Lesser assessment tools “So use it when ur case presentation is on and u wanna make susu very badly. . . . Hahaha ”

19. The Balance Evaluation Systems Test ( BESTest ) Horak FB in 2009 (Physical Therapy) Goal : To develop a clinical balance assessment tool that aims to target 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits. presents psychometric properties of The Balance Evaluation Systems Test ( BESTest )

20. The BESTest consists of 36 items, grouped into 6 systems

21. 22 subjects: with and without balance disorders Raters were given training Total time for each patient: 20 – 30 min Results: (ICC) for interrater reliability for the test as a whole was .91 The Kendall coefficient of concordance among raters ranged from .46 to 1.00 for the 36 individual items. Concurrent validity of the correlation between the BESTest and the ABC Scale was r = .636, P < .01

22. stop conceptualizing balance as a single system so that treatment can be more specific than generalized “balance training” for a generalized “balance problem” Whether or not the sections of the BESTest accurately detect dissociable balance deficits remains to be investigated to establish its construct validity

23. Timed Up and Go Test TUG test was described by Podsiadlo and Richardson (1991) Modifications of TUG in children: A concrete task was used in that children were asked to touch a target on a wall, compared to the more abstract instructions of the standard TUG. Abstract instructions have been shown to limit performance in children with CP.

24. Instructions were repeated during the test. A seat with a backrest but without arms was selected from the children’s environment. The seat height was acceptable if the child’s knee angle was 90˚(SD 10) flexion with feet flat on the floor Children were allowed to behave spontaneously, so no qualitative instructions (e.g. ‘walk as fast as you can’) were given to ensure a naturalistic performance for ecological validity Timing was started as the child left the seat, rather than on the instruction ‘go’, and stopped as the child’s bottom touched the seat, in order to measure movement time only

25. Author, year Population Reliability Validity Williams EN, 2005 (DMCN) Children without dis. And with CP/SB Test –retest (time 1 and time 2): ICC = 0.99 Not assessed Ng SS, 2005 (APMR) Chronic stroke Test- retest: 0 .95 Not assessed Reis JD, 2009 (Physical Therapy) Alzheimer’s Test – retest : 0.973 MDC: 4.09 sec Not assessed Morris S, 2001 (Physical Therapy) Parkinson’s Inter rater : ICCs > .87 (during ‘ON’ and ‘OFF’ phase) T-R rel : high Not assessed

26. Muscle weakness and spasticity are characterized by difficulty in generating appropriately timed and sufficient muscle force to accomplish a given functional task, which could explain the lengthened time score of TUG in subjects with stroke (Ng SS) The mean TUG time for the PD group in the “on” phase was 13.72 seconds and “off” phase was 17.54 seconds TUG can differentiate between pts in the ‘ON’ phase and ‘OFF’ phase because performance was slower (Morris S)

27. Participants in the moderately severe to severe AD group had comparable MMSE scores (10.2 [8.8]) and were able to perform the test with excellent relative reliability results (Reis JD) The moderate negative correlation (rho=–0.52) of TUG scores with the Standing and Walking dimensions of GMFM indicates the potential for TUG to be administered between GMFM testing sessions to provide an indication of progress or deterioration with regard to functional mobility. However, a larger group of young people with disability may provide stronger evidence of the validity of TUG as a functional measure compared with GMFM (Williams)

28. Functional Reach Test The Modified Functional Reach Test (MFRT) was developed by Duncan

29. In spinal cord injury: Modified FRT was used (consider ulnar styloid process instead of 3 rd MC) Lynch SM in 1998 revealed that mFRT could differentiate between group 1 and 3; and between group 2 and 3 Reason for no diff between group 1 and 2 – further trials required

30. In patients with PD: (Behrman AL, 2002, APMR) Mean FRT scores differentiated subjects with PD and a known history of falls from subjects with PD and no history of falls and from control subjects (P<.001). Validity for the FRT as a screening tool: (reference score for FRT is 25.4) sensitivity as 30%, specificity as 92%, PPV as 90%, and NPV as 36% Better to consider using only 1 trial to evaluate effectively the functional reach performance of a person with PD (as his results of analysing 1 trial or mean of 3 trials were almost same )

31. Aim: - to assess reliability in sitting within session - to document changes over time - to compare mFRT with Balance Master and motor and function assessments Stroke patients in acute phase Assessments on 2 occasions: 2-3 weeks post stroke and 6 weeks post stroke Motor function assessments used : SAS and FIM

32. 3 trials in 3 directions: forward and either sides However, 1 st trial- practice session; 2 nd and 3 rd trials considered for analysis Results: Reliability: ICC( 0.90 – 0.97) for all directions. Validity: A significant moderate correlation was found between MFRT and BM on both occasions

33. At follow up, difference in the sideways lean between stroke subjects and healthy controls still existed ; however no difference was seen in forward lean, this was may be due to treatment strategy where most functional activities are trained using forward lean

34. Smith P,2004 (Clinical Rehab) – post stroke As motor impairment increased, balance ability declined and both the Functional Reach and Berg Balance Scale proved sensitive to this decline. Hence subjects’ performance on the Berg Balance Scale was closely associated with performance on the Functional Reach. Therefore, the clinician may elect to use the shorter Functional Reach as a measure of balance where efficient use of time is the primary goal

35. Thank you

36. Use of force plates/ posturography Winter DA, Prince F, Frank JS, Powell C, Zabjek KF. Unified theory regarding A/P and M/L balance in quiet stance. J Neurophysiol 1996;75:2334–43. [33] Dickstein R, Abulaffio N. Postural sway of the affected and non-affected pelvis and leg in stance of hemiparetic patients. Arch Phys Med Rehabil 2000;81:364–7. [34] Paillex R, So A. Posture debout chez sujet adultes : spe ´ cificite´sde l’he ´ miple´gie . Ann Readapt Med Phys 2003;46:71–8. [35] Karlsson A, Frykberg G. Correlations between force plate measures for assessment of balance. Clin Biomech 2000;15:365–9.

37. 36] Niam S, Cheung W, Sullivan PE, Kent S, Gu X. Balance and physical impairments after stroke. Arch Phys Med Rehabil 1999; 80:1227–33. [37] Pyoria O, Era P, Talvitie U. Relationships between standing balance and symmetry measurements in patients following recent strokes (3 weeks or less) or older strokes (6 months or more). Phys Ther 2004; 84:128–36. [38] Stevenson TJ, Garland SJ. Standing balance during internally pro- duced perturbations in subjects with hemiplegia : validation of the balance scale. Arch Phys Med Rehabil 1996;77:656–62. [39] Corriveau H, Hebert R, Raiche M, Prince F. Evaluation of postural stability in the elderly with stroke. Arch Phys Med Rehabil 2004;85:1095–101.