Identification of the period of stability in a balance test after stepping up using a simplified cumulative sum.

Falls are a major cause of death in older people. One method used to predict falls is analysis of Centre of Pressure (CoP) displacement, which provides a measure of balance quality. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that calculates instantaneous values of vertical ground reaction force (Fz) as well as the CoP in both anteroposterior (AP) and mediolateral (ML) directions. The entire testing process needs to take no longer than 12 s to ensure subject compliance, making it vital that calculations related to balance are only calculated for the period when the subject is static. In the present study, a method is presented to detect the stabilization period after a subject has stepped onto the BQT. Four different phases of the test are identified (stepping-on, stabilization, balancing, stepping-off), ensuring that subjects are static when parameters from the balancing phase are calculated. The method, based on a simplified cumulative sum (CUSUM) algorithm, could detect the change between unstable and stable stance. The time taken to stabilize significantly affected the static balance variables of surface area and trajectory velocity, and was also related to Timed-up-and-Go performance. Such a finding suggests that the time to stabilize could be a worthwhile parameter to explore as a potential indicator of balance problems and fall risk in older people.

Balance quality assessment as an early indicator of physical frailty in older people.

Frailty is an increasingly common geriatric condition that results in an increased risk of adverse health outcomes such as falls. The most widely-used means of detecting frailty is the Fried phenotype, which includes several objective measures such as grip strength and gait velocity. One method of screening for falls is to measure balance, which can be done by a range of techniques including the assessment of the Centre of Pressure (CoP) during a balance assessment. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that can evaluate balance quality. The BQT provides instantaneously the position of the CoP (stabilogram) in both anteroposterior (AP) and mediolateral (ML) directions and can estimate the vertical ground reaction force. The purpose of this study was to examine the relationship between balance quality assessment and physical frailty. Balance quality was compared to physical frailty in 186 older subjects. Rising rate (RR) was slower and trajectory velocity (TV) was higher in subjects classified as frail for both grip strength and gait velocity (p<;0.05). Balance assessment could be used in conjunction with functional tests of grip strength and gait velocity as a means of screening for frailty.