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1.
Front Med (Lausanne) ; 11: 1392429, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38975052

RESUMO

Background: It has been reported that both aerobic exercise and resistance exercise can improve cognitive function in older people with mild cognitive impairment (MCI), but it is unclear which type of exercise has a higher impact on cognitive function. Additionally, low-intensity exercise is considered safe for the elderly and can be done at home. This study aimed to compare the effects of 3-month low-intensity home-based exercises, aerobic versus resistance exercises, on cognitive function in people with MCI. Methods: This study was a single-blind randomized controlled trial conducted in a suburban community. Ninety eligible participants aged 60-80 years were randomly assigned into aerobic exercise, resistance exercise or control group (30 in each group). The aerobic and resistance exercise groups underwent 3 months of low-intensity exercise at home (35 min/day, 5 days/week). The control group performed their usual daily activities. The Montreal Cognitive Assessment Thai version (MoCA), Trail Making Test Part A and B (TMT-A, TMT-B), Stroop Color and Word Test (SCWT), forward and backward Digit Span Test (DST-F, DST-B) and Stick Design Test (SDT) were administered before training, 3-month after training and 3-month follow-up. Results: All participants completed a 3-month exercise program, but during the follow-up, data were gathered from 28, 27, and 26 participants in the aerobic, resistance, and control groups, respectively. Both aerobic and resistance groups showed significant improvements in all outcome measures during posttraining and follow-up, except SDT, while there was no cognitive improvement in control group at posttraining and follow-up. Compared to those in the control group, the aerobic group had significant improvements in MoCA, TMT-A, TMT-B, and SCWT, while resistance group had significant improvements in MoCA and TMT-B at posttraining and follow-up. There were no differences in any outcome measures between aerobic and resistance groups, except SCWT, which was significantly greater in the aerobic group than in the resistance group posttraining. Conclusion: Low-intensity exercise, whether aerobic or resistance training, was effective at improving cognitive function in older people with MCI, and the effects were sustained at the 3-month follow-up.Clinical trial registration:thaiclinicaltrials.org, TCTR20231110003.

2.
Front Med (Lausanne) ; 11: 1324375, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38384408

RESUMO

Background: Chronic neck pain (CNP) can lead to altered gait which is worse when combined with head movement. Gait parameters for indicating speed and symmetry have not been thoroughly investigated in older adults with CNP. This study aimed to compare gait performance in term of speed and symmetry in older adults with and without CNP during walking with head movement. Methods: Fifty young older adults, consisting of 36 healthy controls without neck pain (OLDs) and 14 older adults with CNP, participated in the study. Participants completed the Neck Disability Index and Activities-specific Balance Confidence Scale. The 10-Meter Walk Test (10MWT) was used to assess gait performance. Participants were instructed to walk at preferred speed under three different head movement patterns: no head movement (NM), horizontal head movement (HM), and vertical head movement (VM). The Inertial Measurement Unit was used to capture gait performance, and its software was used to analyze gait variables; gait speed, Locomotor Rehabilitation Index (LRI), gait asymmetry index, Phase Coordination Index (PCI). Results: The CNP group reported moderate neck pain with mild disability in activities of daily living, and less balance confidence than the OLD group (p < 0.05). The CNP group showed significantly slower gait speed and lower LRI during walking with both the HM and VM (p < 0.05), which corresponded to lower stride length and cadence. The gait asymmetry index in the CNP group was significantly higher than the OLD group during walking with VM (p < 0.05), whereas the PCI was significantly higher than the OLD group during walking with both HM and VM (p < 0.05). Conclusion: Chronic neck pain affects both speed and symmetry when walking with head movement. Gait parameters in this study could be implemented to identify changes in speed and symmetry of gait in older adults with CNP who have mild disability and high physical functioning.

3.
Front Med (Lausanne) ; 10: 1076963, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36817771

RESUMO

Introduction: The TUG can be used to distinguish between people who fall and people who don't fall. To evaluate cognitive dual-task performance while walking for fall prediction, TUG-dual was frequently employed. A recent study has created a mobile application that enables simple interaction to provide greater convenience for monitoring the duration of TUG, TUG-subtraction, and reaction time. Objective: The research aim was to ascertain the concurrent validity of the mobile application that was developed for the clinical assessment of TUG, TUG-subtraction, and reaction time. Methods: Twenty-nine older persons participated in this study. The testing protocol involved the TUG, TUG-subtraction, and reaction time assessment. For TUG and TUG-subtraction, the duration to complete the task was recorded by the APDM Mobility Lab system and the mobile application. For the reaction time tests, the reaction times (msec) were recorded by the Multi Choice Reaction timer and the Mobile application. The TUG durations recorded by the APDM Mobility Lab system were correlated with those recorded by the mobile application to verify the concurrent validity using Pearson's product moment correlation coefficient. Also, the reaction time by the Multi Choice Reaction timer was correlated with the mobile application. Bland-Altman plots were used to explore the existence of any systematic differences between the measurements. Results: Our results showed very strong correlations between the TUG and TUG-subtraction duration derived from the APDM Mobility Lab system and the mobile application (r = 0.96 and 0.96, respectively). For the reaction time, the results showed a moderate correlation between the reaction time derived from the mobile application and the Multi Choice Reaction Timer (r = 0.67). Conclusion: The mobile application, which allows measurement in TUG and TUG-subtraction, is a highly valid tool for TUG duration assessment. However, this application is capable for assess the reaction time with moderate validity for reaction time assessment.

4.
Front Med (Lausanne) ; 9: 1012880, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388898

RESUMO

Background: Older adults with chronic neck pain (CNP) demonstrate impaired postural control. The Balance Evaluation Systems Test (BESTest) is used to assess systems underlying postural control impairments, but its use in CNP has not been reported. This study assessed whether the BESTest can identify postural control impairments in CNP as well as the level of BESTest item difficulty by Rasch analysis. Materials and methods: This cross-sectional study recruited thirty young adults (YOUNG) aged 20-40 years and eighty older adults aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were administered to collect demographic data, intensity of neck pain (VAS), patient's self-rated neck pain and disability (NDI), and balance confidence in daily activities (ABC). The BESTest was used to assess postural control. Results: The CNP group showed the lowest ABC scores. Compared to the YOUNG group, the BESTest score was significantly lower in the OLD group, while the CNP group showed the lowest score, suggesting that balance control deteriorated from the normal aging process and further declined in the CNP group, especially in biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response (p < 0.05). Using scores from these three sections, the BESTest was accurate at the cutoff score of 48.5 out of 51 for differentiating the older adults whose daily life are affected by neck problems (using the NDI as a reference) with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Rasch analysis revealed that the Timed Up and Go with dual task test was the most difficult BESTest item for all groups, whereas 14 items showed more difficulty for the CNP group. Conclusion: The BESTest can be used to identify postural control impairments in CNP patients, even those with moderate pain and mild disability with a high level of physical functioning. The combined score of biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response domains was suggested for the detection of older adults whose daily lives are affected by neck problems. This will also help clinicians consider the management of neck pain to prevent falls in CNP.

5.
Front Psychol ; 13: 906898, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35967690

RESUMO

It is unclear whether the decline in executive function (EF) and perceptual-motor function (PMF) found in older adults with mild cognitive impairment (MCI) is the result of a normal aging process or due to MCI. This study aimed to determine age-related and MCI-related cognitive impairments of the EF and PMF. The EF and PMF were investigated across four groups of 240 participants, 60 in each group, including early adult, middle adult, older adult, and older adult with probable MCI. The EF, working memory, inhibition, and cognitive flexibility were evaluated using digit span backward tasks, the Stroop color-word test, and the modified switching verbal fluency test, respectively. The PMF, visual perception, visuoconstructional reasoning, and perceptual-motor coordination were evaluated using the clock reading test, stick design test, and stick catching test, respectively. Group differences were found for all subdomains of EF and PMF (p < 0.05), except for perceptual-motor coordination, indicating that this subdomain could be maintained in older adults and was not affected by MCI. For the age difference, working memory, cognitive flexibility, visual perception, and visuoconstructional reasoning remained stable across middle adults and started to decline in older adults, while cognitive inhibition began to decrease in middle adults and it further declined in older adults. To control the confounding effect of education level, the results showed that only cognitive flexibility was further decreased in older adults with probable MCI compared to those without MCI (p < 0.05). In conclusion, cognitive inhibition decreased earlier in middle adults, whereas EF and PMF started to decline in older adults. Cognitive flexibility was the only MCI-sensitive cognitive function.

6.
J Neurol Phys Ther ; 46(2): 96-102, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34775436

RESUMO

BACKGROUND AND PURPOSE: Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM. METHODS: Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation. RESULTS: Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items "flexes hip and knee in supine" and "rolls onto side" were the easiest items, whereas the "dorsiflexes affected ankle with knee extended" item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment. DISCUSSION AND CONCLUSIONS: Findings can be used in the assessment and treatment planning of persons with stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Avaliação da Deficiência , Humanos , Extremidade Inferior , Movimento , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações
7.
Disabil Rehabil ; 44(3): 420-427, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32475182

RESUMO

PURPOSE: To compare the immediate effects of voluntary-induced stepping response training (VSR) and DynSTABLE perturbation training (DST) on protective stepping in patients with stroke. METHODS: A randomized controlled trial (registration number: TCTR20170827001) was conducted in 34 patients with chronic stroke who were randomly allocated to the VSR (n = 17) or DST (n = 17) group. The VSR group was instructed to lean forward to induce protective stepping, while the DST group experienced support surface translation. All participants received one session of training (3 set, 10 min for each set with 10-minute rest in between). Step length, step width, number of steps and center of mass (CoM) position during protective stepping were assessed using a computer-assisted rehabilitation environment (CAREN) system prior to and immediately after training. Two-way ANOVA was used to compare between groups and times. RESULTS: Both types of training resulted in an increase in step width, but step length increased and there was a more positive COM position exhibited following DST (p < .05) than following VSR. Single-step incidence increased, whereas multiple-step incidence decreased significantly in both groups. Only participants in the VSR group generated protective stepping with the affected leg in a larger percentage of trials (27%) after training than before training. CONCLUSION: Both DST and VSR led to changes in protective stepping parameters after a single session of training. VSR may be a feasible alternative to equipment-based training but requires further study.Implication for RehabilitationVSR and DST trainings improved protective stepping in stroke.Step length and CoM control at foot touchdown increased after DST training.VSR training for 50 minutes led to increase affected stepping and reduce grasping.Step width, affected step length, and single step increased after both trainings.Without instrument, VSR increased steps execution and performance similar to DST.


Assuntos
Equilíbrio Postural , Acidente Vascular Cerebral , Acidentes por Quedas , Humanos , Equilíbrio Postural/fisiologia
8.
Top Stroke Rehabil ; 29(7): 465-472, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-34170215

RESUMO

BACKGROUND: Postural control impairments following a stroke have an impact on mobility, reduce independence, and increase the risk of falls. Assessing these impairments during tasks representative of real-life situations, such as quiet standing (QS) and voluntary stepping response (VSR), will enhance our understanding of how the postural control system is impaired in individuals post-stroke (IPS). It will also inform the development of a more targeted and effective rehabilitation to prevent falls in IPS. OBJECTIVES: Identify the postural control impairments encountered by IPS during QS and VSR. METHODS: Twenty IPS and 16 healthy controls were recruited to perform QS and VSR tasks, while ground reaction forces and whole-body motion were measured. Displacement and speed variation of the COM, center of pressure (COP) displacement and spatiotemporal data were calculated and compared between groups. RESULTS: During QS, IPS exhibited greater maximal COP displacement in mediolateral direction, COM displacement in vertical direction and COM speed excursions compared to controls. During VSR, IPS exhibited smaller step length, braking force, posterior foot placement in relation to the pelvis and COM anteroposterior excursion compared to controls. IPS presented less static and dynamic postural stability compared to controls. CONCLUSIONS: Greater postural sway during QS, smaller anteroposterior COM displacement before losing balance and altered voluntary recovering steps during VSR could place IPS at more risk of falling when they face a postural challenge in the community. These novel results will improve the current knowledge base and should be considered in IPS rehabilitation.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estudos de Casos e Controles , Humanos , Equilíbrio Postural/fisiologia , Posição Ortostática , Acidente Vascular Cerebral/complicações
9.
Curr Aging Sci ; 14(3): 235-241, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34269671

RESUMO

BACKGROUND: Age is related to a decline in muscle mass and physical function in both respiratory and peripheral muscle strength, which could lead to mobility and mortality. In addition, older people have suffered from one or multiple chronic conditions in particular in type 2 Diabetes Mellitus (type 2 DM). However, a few studies have reported the relationship between sarcopenic elderly and respiratory and peripheral muscle strengths in type 2DM. OBJECTIVE: To explore the prevalence of sarcopenia in type 2 DM elderly people among community- dwelling patients and the relationships with peripheral and respiratory muscle loss in sarcopenic type 2 DM older patients. METHODS: A total of 330 older individuals were recruited from community-dwelling centers. Respiratory muscle and quadriceps muscle were assessed. According to the defined criteria for sarcopenia (defined by Asian Working Group for Sarcopenia), muscle mass, gait speed (six-meter walk test), and handgrip strength were examined. RESULTS: Of 330 elderly people, 82 volunteers had a history of type 2 DM. Participants with type 2DM had a risk for sarcopenia (odds ratio= 2.324, 95% CI=1.251-4.317). The prevalence of sarcopenia was 25.61% among older participants with type 2 DM. In addition, decreased respiratory muscle strength and quadriceps muscle strength were observed in type 2 DM with sarcopenia compared to type 2 DM with non-sarcopenia. These relationships also remained after controlling for age and sex. CONCLUSION: Sarcopenia in type 2 DM leads to a decrease in respiratory muscle and peripheral muscle strength.


Assuntos
Diabetes Mellitus Tipo 2 , Sarcopenia , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Força da Mão , Humanos , Força Muscular , Músculos Respiratórios , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Tailândia/epidemiologia
10.
Hong Kong Physiother J ; 40(2): 133-143, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33005077

RESUMO

BACKGROUND: The type of foam pad used in the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) influences the accuracy with which elderly fallers are identified. Two types of foam are commonly used in practice: Airex and Neurocom foam. OBJECTIVE: The aim of this study was to assess the accuracy with which elderly fallers can be identified when the Airex foam and Neurocom foam are used in the mCTSIB. METHODS: One hundred eighty-four elderly participants with a mean age of 69 years were classified into faller and nonfaller groups based on their 12-month fall history. Balance stability was measured under four conditions of the mCTSIB for 120 s each: standing on a floor or a foam pad with their eyes open or eyes closed. The time needed to maintain stability was measured by a stopwatch, and postural sway characteristics were measured using an acceleration-based system. Comparisons between groups were performed by two-way mixed ANOVA. The accuracy of differentiating elderly fallers from nonfallers with different foam types was evaluated using receiver operating characteristic curve (ROC) analysis. The time to maintain stability under four conditions of the mCTSIB (composite score) and under two conditions on the foam (foam score) were used for the ROC analysis. RESULTS: The results showed that the nonfallers required more time to maintain stability and had a smaller sway area than the fallers ( p < 0 . 001 ). The foam led to a larger difference between groups, suggesting the use of foam in examining the risk of falls. The Airex and the Neurocom foam pads led to a large area under the curve (0.93 to 0.95) in identifying elderly fallers and nonfallers when the composite and foam scores were used. A cutoff score of 447/480 s for the composite score and 223/240 s for the foam score yielded a posttest accuracy of 88% to 89%, with a sensitivity of 0.80-0.92 and specificity of 0.88-0.95. CONCLUSION: In conclusion, Airex and Neurocom foam can be used interchangeably with guidance in the mCTSIB, as they led to the accurate identification of elderly fallers among older persons who could walk and live independently in the community.

11.
Gait Posture ; 82: 75-82, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32906006

RESUMO

BACKGROUND: Impairment of protective steps to recover balance from external perturbation is evident after stroke. Voluntary-induced stepping response (VSR) can be used to practice protective steps by instructing an individual to voluntarily lean their whole body forward until they perceive a loss of balance and automatically induce a step. However, to improve protective stepping performance, detailed characteristics of VSR in healthy persons are required. RESEARCH QUESTION: What is the difference in VSR between healthy and persons with stroke? METHODS: An observational study was conducted in 30 participants, (10 young, 10 older, and 10 persons with stroke). All participants performed VSR for 10 trials. Step length, step width, step duration, CoM position, CoM velocity, trunk-hip displacement, and strategies of response were recorded using a motion capture system and analysed using Matlab software. Statistical analysis was performed using One-way ANOVA and Chi-square. RESULTS: On average, participants with stroke had shorter step lengths and step durations than young and older adults. Step width of older adults and participants with stroke was wider than that of young adults (p < 0.05). While multiple steps and losing balance were reported more frequently in participants with stroke than the others, the percentage of trials in which participants grasped the handrails was not significantly different between older adults and participants with stroke. CoM position, CoM velocity, and trunk-hip displacement at foot liftoff were significantly smaller in older adults and participants with stroke than young adults (p < 0.05). Participants with stroke tended to use trunk bending rather than trunk leaning strategies to generate VSR in contrast to healthy participant. The prevalence of the trunk bending strategy was also greater in older adults than young adults. SIGNIFICANCE: Values obtained from healthy groups can be used as guidelines to set realistic goals during VSR training to improve protective steps in patients with stroke.


Assuntos
Fenômenos Biomecânicos/fisiologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Caminhada , Adulto Jovem
12.
Front Neurol ; 11: 262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32390925

RESUMO

Background: The Timed Up and Go Test (TUG) with serial subtraction is commonly used to assess cognitive-dual task performance during walking for fall prediction. Some stroke patients cannot perform number subtraction and it is unclear which cognitive task can be used to substitute for the subtraction task in the TUG test. The aim of this study was to determine the type of cognitive task that produced the highest decrease on both motor and cognitive performances during TUG-dual in stroke patients. Methods: A total of 23 persons with stroke but capable of completing subtraction (ST) and 19 persons with subtraction operation difficulties (SOD) participated. Both groups have a similar age range (ST: 59.3 ± 10.4 years and SOD: 62.0 ± 6.8 years) and stroke onset duration (ST: 44.13 ± 62.29 months and SOD: 42.34 ± 39.69 months). The participants performed TUG without a cognitive task (TUG-single) followed by a cognitive task when seated (cognitive-single). In addition, TUG with a cognitive task (TUG-dual) was performed, with the activity randomly selected from four cognitive tasks, including alternate reciting, auditory working memory, clock task, and phonologic fluency. The main outcome variables-TUG duration measured by OPAL accelerometer and cognitive-dual task effect (DTE)-were analyzed using repeated-measures analyses of variance (ANOVA). Results: The number of correct responses when seated were significantly lower in the SOD as compared to the ST (p < 0.05) during all cognitive tasks, except the phonologic fluency. During TUG-cognitive, TUG duration in the ST was significantly longer for all cognitive tasks compared with TUG-single (p < 0.0001), whereas TUG duration in the SOD was significantly increased only during the phonologic fluency task (p < 0.01). In the ST, there was a significant difference in cognitive DTE between the subtraction and the phonologic fluency tasks (p < 0.01). The highest cognitive cost was found in the subtraction task, whereas the highest cognitive benefit was shown in the phonologic fluency task. No significant cognitive DTE was found among the cognitive tasks in the SOD. Conclusion: For stroke persons with SOD, phonologic fluency is suitable to be used in the TUG-cognitive assessment. In contrast, subtraction (by 3s) is recommended for the assessment of TUG-cognitive in stroke persons who can perform subtraction.

13.
Curr Gerontol Geriatr Res ; 2020: 8041489, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33424964

RESUMO

BACKGROUND: Age-related sarcopenia is associated with physical decline, including poor functional capacity, lack of physical activity, problems with activities of daily living, and disability. However, little is known about the association between mental health problems and cognitive function in older adults with sarcopenia. Therefore, this study explored community-dwelling older adults' sarcopenia prevalence and related associations with depression, cognitive performance, and physical activity. METHODS: This cross-sectional study included 330 community-dwelling older adults (66.85 ± 5.54 years, 76.06% female). Based on the Asian Working Group for Sarcopenia guidelines, gait speed, muscle mass, and handgrip were assessed. All participants responded to a set of questionnaires (e.g., Global Physical Activity Questionnaire, cognitive assessment, and depression scale). Logistic regression analysis and multivariate logistic regression were used to determine independent predictors for sarcopenia. RESULTS: Overall, 16.1% of the participants were identified as having sarcopenia. Further, advanced age (i.e., mean age ≥ 70 years; odds ratio: 4.67), high depression scores (odds ratio: 2.09), mild cognitive impairment (odds ratio: 0.22), and low physical activity levels (odds ratio: 1.96) were significant associated risk factors for sarcopenia after adjusting for age, sex, and educational level. CONCLUSIONS: Sarcopenia can lead to adverse health outcomes (i.e., depressive symptoms, cognitive decline, and low physical activity) in older adults.

14.
J Rehabil Med ; 51(9): 683-691, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31448806

RESUMO

OBJECTIVES: To examine the reliability, validity and responsiveness of 3 different short versions of the Balance Evaluation Systems Test (BESTest: S--BESTest, Brief-BESTest and Mini-BESTest) in patients with subacute stroke. DESIGN: A prospective cohort study. PARTICIPANTS: Patients with subacute stroke. METHODS: Patients were assessed using the full BESTest. Scores of 3 short-form BESTests were later extracted. The intra-rater and inter-rater reliability (n = 12) were gathered from 5 raters. Concurrent validity was assessed with the Berg Balance Scale (BBS). Floor/ceiling effect, internal responsiveness and external responsiveness with the BBS (n = 70) were assessed at baseline, 2 weeks and 4 weeks post-rehabilitation. RESULTS AND CONCLUSION: All short-form BESTests demonstrated excellent intra-rater and inter-rater reliability (intraclass correlation coefficient (ICC) = 0.95-0.99) and excellent concurrent validity (r = 0.93-0.96). Unlike the Brief-BESTest and Mini-BESTest, the S-BESTest and BESTest had no significant floor/ceiling effects (< 20%). The standardized response mean of all 4 BESTest versions were large, ranging between 1.19 and 1.57, indicating sufficient internal responsiveness. The area under the curve of the S-BESTest and BESTest were significantly higher than the Brief-BESTest and Mini-BESTest, reflecting better accuracy of the S-BESTest and BESTest in identifying patients with subacute stroke who had balance improvement using the minimal clinically important difference of 6 and 16 points, respectively. These findings suggest that the S-BESTest is a short-form BESTest that is appropriate for assessing balance impairments in patients with subacute stroke.


Assuntos
Avaliação da Deficiência , Modalidades de Fisioterapia/normas , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/patologia
15.
Phys Ther ; 96(10): 1638-1647, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27103226

RESUMO

BACKGROUND: The reliability and convergent validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke have been established, but its responsiveness to rehabilitation has not been examined. OBJECTIVE: The study objective was to compare the responsiveness of the BESTest with those of other clinical balance tools in people with subacute stroke. DESIGN: This was a prospective cohort study. METHODS: Forty-nine people with subacute stroke (mean age=57.8 years, SD=11.8) participated in this study. Five balance measures-the BESTest, the Mini-BESTest, the Berg Balance Scale, the Postural Assessment Scale for Stroke Patients, and the Community Balance and Mobility Scale (CB&M)-were used to measure balance performance before and after rehabilitation or before discharge from the hospital, whichever came first. The internal responsiveness of each balance measure was classified with the standardized response mean (SRM); changes in Berg Balance Scale scores of greater than 7 were used as the external standard for determining the external responsiveness. Analysis of the receiver operating characteristic curve was used to determine the accuracy and cutoff scores for identifying participants with balance improvement. RESULTS: Participants received 13.7 days (SD=9.3, range=5-44) of physical therapy rehabilitation. The internal responsiveness of all balance measures, except for the CB&M, was high (SRM=0.9-1.2). The BESTest had a higher SRM than the Mini-BESTest and the CB&M, indicating that the BESTest was more sensitive for detecting balance changes than the Mini-BESTest and the CB&M. In addition, compared with other balance measures, the BESTest had no floor, ceiling, or responsive ceiling effects. The results also indicated that the percentage of participants with no change in scores after rehabilitation was smaller with the BESTest than with the Mini-BESTest and the CB&M. With regard to the external responsiveness, the BESTest had higher accuracy, sensitivity, specificity, and posttest accuracy than the Postural Assessment Scale for Stroke Patients and the CB&M for identifying participants with balance improvement. Changes in BESTest scores of 10% or more indicated changes in balance performance. LIMITATIONS: A limitation of this study was the difference in the time periods between the first and the second assessments across participants. CONCLUSIONS: The BESTest was the most sensitive scale for assessing balance recovery in participants with subacute stroke because of its high internal and external responsiveness and lack of floor and ceiling effects.


Assuntos
Avaliação da Deficiência , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
16.
J Geriatr Phys Ther ; 39(2): 64-70, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25794308

RESUMO

BACKGROUND AND PURPOSE: Balance deficits a significant predictor of falls in older adults. The Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) are tools that may predict the likelihood of a fall, but their capabilities and accuracies have not been adequately addressed. Therefore, this study aimed at examining the capabilities of the BESTest and Mini-BESTest for identifying older adult with history of falls and comparing the participants with history of falls identification accuracy of the BESTest, Mini-BESTest, Berg Balance Scale (BBS), and the Timed Up and Go Test (TUG) for identifying participants with a history of falls. METHODS: Two hundred healthy older adults with a mean age of 70 years were classified into participants with and without history of fall groups on the basis of their 12-month fall history. Their balance abilities were assessed using the BESTest, Mini-BESTest, BBS, and TUG. An analysis of the resulting receiver operating characteristic curves was performed to calculate the area under the curve (AUC), sensitivity, specificity, cutoff score, and posttest accuracy of each. RESULTS: The Mini-BESTest showed the highest AUC (0.84) compared with the BESTest (0.74), BBS (0.69), and TUG (0.35), suggesting that the Mini-BESTest had the highest accuracy in identifying older adult with history of falls. At the cutoff score of 16 (out of 28), the Mini-BESTest demonstrated a posttest accuracy of 85% with a sensitivity of 85% and specificity of 75%. The Mini-BESTest had the highest posttest accuracy, with the others having results of 76% (BESTest), 60% (BBS), and 65% (TUG). CONCLUSION: The Mini-BESTest is the most accurate tool for identifying older adult with history of falls compared with the BESTest, BBS, and TUG.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação da Deficiência , Avaliação Geriátrica/métodos , Modalidades de Fisioterapia , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Curva ROC , Reprodutibilidade dos Testes
17.
Gait Posture ; 41(1): 313-5, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25300239

RESUMO

Clinical Test for Sensory Interaction and Balance (CTSIB) is a simplified method for investigating the organization of multiple sensory inputs in postural control. The accuracy of the test is based partly on the foam types. Several types of foam are available, but the validity of these foams on CTSIB and the interaction of age and foam types have not been addressed. In this study, postural sway of young (21.6 ± 3.3 years) and older (53.2 ± 4.9 years) participants were assessed while standing on four types of foam: NeuroCom(®), sponge, Ethylene Vinyl Acetate (EVA), and memory foams. Postural sway during stance on solid floor and foams with eyes open and eyes closed were quantified by root-mean-square (RMS) of center of body mass acceleration in the mediolateral (ML) and anteroposterior (AP) directions using the acceleration-based OPAL system. Physical properties of foams including density, Young's modulus, and indentation force deflection (IFD) were determined. Results demonstrated that RMS-ML in older subjects was larger than younger subjects (p ≤ 0.001), especially when standing on the NeuroCom(®) foam with eyes closed (p = 0.001). There was an interaction of age and foam types as larger differences in RMS-ML were observed between young and older subjects on the NeuroCom(®) and EVA foams, but not the other foams. The sway characteristics were largest when standing on the NeuroCom(®) foam which demonstrated high density and high compliance. Our findings suggested the importance of foam selection in CTSIB on accurate postural sway analysis and balance assessment.


Assuntos
Equilíbrio Postural , Aceleração , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico/instrumentação , Propriedades de Superfície , Adulto Jovem
18.
Phys Ther ; 94(11): 1632-43, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24925073

RESUMO

BACKGROUND: The Balance Evaluation Systems Test (BESTest) is a new clinical balance assessment tool, but it has never been validated in patients with subacute stroke. OBJECTIVE: The purpose of this study was to examine the reliability and validity of the BESTest in patients with subacute stroke. DESIGN: This was an observational reliability and validity study. METHODS: Twelve patients participated in the interrater and intrarater reliability study. Convergent validity was investigated in 70 patients using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), Community Balance and Mobility Scale (CB&M), and Mini-BESTest. The receiver operating characteristic curve was used to calculate the sensitivity, specificity, and accuracy of the BESTest, Mini-BESTest, and BBS in classifying participants into low functional ability (LFA) and high functional ability (HFA) groups based on Fugl-Meyer Assessment motor subscale scores. RESULTS: The BESTest showed excellent intrarater reliability and interrater reliability (intraclass correlation coefficient=.99) and was highly correlated with the BBS (Spearman r=.96), PASS (r=.96), CB&M (r=.91), and Mini-BESTest (r=.96), indicating excellent convergent validity. No floor or ceiling effects were observed with the BESTest. In contrast, the Mini-BESTest and CB&M had a floor effect in the LFA group, and the BBS and PASS demonstrated responsive ceiling effects in the HFA group. In addition, the BESTest showed high accuracy as the BBS and Mini-BESTest in separating participants into HFA and LFA groups. LIMITATION: Whether the results are generalizable to patients with chronic stroke is unknown. CONCLUSION: The BESTest is reliable, valid, sensitive, and specific in assessing balance in people with subacute stroke across all levels of functional disability.


Assuntos
Atividades Cotidianas , Avaliação da Deficiência , Atividade Motora/fisiologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Estudos de Coortes , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Reabilitação do Acidente Vascular Cerebral
19.
Phys Ther ; 92(9): 1117-29, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22628583

RESUMO

BACKGROUND: Little is known about the effects of use of a cane on balance during perturbed gait or whether people with Parkinson disease (PD) benefit from using a cane. OBJECTIVES: The purpose of this study was to evaluate the effects of cane use on postural recovery from a slip due to repeated surface perturbations in individuals with PD compared with age- and sex-matched individuals who were healthy. DESIGN: This was a prospective study with 2 groups of participants. METHODS: Fourteen individuals with PD (PD group) and 11 individuals without PD (control group) walked across a platform that translated 15 cm rightward at 30 cm/s during the single-limb support phase of the right foot. Data from 15 trials in 2 conditions (ie, with and without an instrumented cane in the right hand) were collected in random order. Outcome measures included lateral displacement of body center of mass (COM) due to the slip and compensatory step width and length after the perturbation. RESULTS: Cane use improved postural recovery from the first untrained slip, characterized by smaller lateral COM displacement, in the PD group but not in the control group. The beneficial effect of cane use, however, occurred only during the first perturbation, and those individuals in the PD group who demonstrated the largest COM displacement without a cane benefited the most from use of a cane. Both PD and control groups gradually decreased lateral COM displacement across slip exposures, but a slower learning rate was evident in the PD group participants, who required 6, rather than 3, trials for adapting balance recovery. LIMITATIONS: Future studies are needed to examine the long-term effects of repeated slip training in people with PD. CONCLUSIONS: Use of a cane improved postural recovery from an unpracticed slip in individuals with PD. Balance in people with PD can be improved by training with repeated exposures to perturbations.


Assuntos
Bengala , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Caminhada/fisiologia , Acidentes por Quedas/prevenção & controle , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Prospectivos
20.
Top Stroke Rehabil ; 18 Suppl 1: 633-42, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22120032

RESUMO

OBJECTIVES: To determine clinical characteristics that can be used to identify patients with stroke who can perform light touch contact with a cane during walking, and to determine whether these patients benefit from TC. METHODS: A prediction and randomized experimental study was conducted of 62 patients (mean onset time, 43.8 days) who were 59.4 ± 11.2 years. There were 3 conditions of cane usage: force contact (FC), touch contact (TC), and no contact (NC). Clinical characteristics included age, stroke onset duration, gait speed, and Chedoke-McMaster and Fugl-Meyer (FM) Assessment scores. We studied trunk acceleration and activation of tensor fascia latae (TFL), and vastus medialis (VM) muscles during walking using 3 cane conditions. RESULTS: Out of 62 patients, 36 were able to perform TC during walking. These patients benefited from TC as demonstrated by higher trunk stability (compared to NC) and larger paretic VM and TFL activations (compared to FC). FM scale was the only variable that differed between patients who could perform TC and those who could not (P < .00). Analysis of receiver operating characteristics (ROC) revealed that FM scores for balance and lower extremity motor domains (area under ROC = 0.93 and 0.96, respectively) are able to predict the TC group with high accuracy. Calculations using cutoff scores for balance (6.5) or lower extremity (14.5) FM subscales correctly predicted patients who benefited from TC 89% of the time. CONCLUSION: Balance and lower extremity FM subscales can be used to identify suitable candidates among patients with stroke for implementation of TC in gait rehabilitation.


Assuntos
Bengala , Sinais (Psicologia) , Transtornos Neurológicos da Marcha/reabilitação , Reabilitação do Acidente Vascular Cerebral , Tato/fisiologia , Idoso , Área Sob a Curva , Interpretação Estatística de Dados , Eletromiografia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Testes Neuropsicológicos , Dor/etiologia , Dor/reabilitação , Equilíbrio Postural/fisiologia , Prognóstico , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
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