Gait analysis with cognitive-motor dual tasks to distinguish fallers from nonfallers among rehabilitating stroke patients.

OBJECTIVES: To evaluate fall risk in stroke patients based on single- and dual-task gait analyses, and to investigate the difference between 2 cognitive tasks in the dual-task paradigm. DESIGN: Prospective cohort study. SETTING: Rehabilitation hospitals. PARTICIPANTS: Subacute stroke patients (N=32), able to walk without physical/manual help with or without walking aids, while performing a verbal task. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional gait measures were Functional Ambulation Categories (FAC) and use of a walking aid. Gait measures were evaluated by an electronic walkway system under single- and dual-task (DT) conditions. For the single-task, subjects were instructed to walk at their usual speed. One of the DTs was a verbal fluency dual task, whereby subjects had to walk while simultaneously enumerating as many different animals as possible. For the other DT (counting dual task), participants had to walk while performing serial subtractions. After inclusion, participants kept a 6-month falls diary. RESULTS: Eighteen (56.3%) of the 32 included patients fell. Ten (31.3%) were single fallers (SFs), and 8 (25%) were multiple fallers (MFs). Fallers (Fs) more frequently used a walking aid and more frequently needed an observatory person for walking safely (FAC score of 3) than nonfallers (NFs). Two gait decrement parameters in counting dual task could distinguish potential Fs from NFs: decrement in stride length percentage (P=.043) and nonparetic step length percentage (P=.047). Regarding the division in 3 groups (NFs, SFs, and MFs), only MFs had a significantly higher percentage of decrement for paretic step length (P=.023) than SFs. CONCLUSIONS: Examining the decrement of spatial gait characteristics (stride length and paretic and nonparetic step length) during a DT addressing working memory can identify fall-prone subacute stroke patients.

A 12-week multicomponent therapy in fibromyalgia improves health but not in concomitant moderate depression, an exploratory pilot study.

Objectives: Literature suggests that graded and multicomponent therapy improves outcomes in fibromyalgia, but there is no conclusive evidence in which combination to be used. This study focused on the effect of a multicomponent therapy in fibromyalgia when a combination of exercise therapy and cognitive behavioural therapy was applied. Additionally, predictors for dropping out were explored as research reports high dropout rates.Methods: Participants received graded multicomponent therapy for 12 weeks, twice a week during two hours every session by an occupational therapist, a physiotherapist, and a psychologist. Following outcome measures were assessed at baseline, weeks 6 and 12: Fibromyalgia Impact Questionnaire, Tampa scale for kinesiophobia, the Beck Depression Index, the Pain Coping Inventory (PCI), pain at the tenderpoints, grip strength, the 6-min walking test (6MWT), and cycling test.Results: In total, 64 fibromyalgia patients were screened and included. The dropout rate was 28%. A per-protocol analysis revealed significant improvement at week 6 for the Beck Depression Index, pain at the tenderpoints and the 6MWT. At week 12, the Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Index (BDI), Pain PCI, pain at the tenderpoints, grip strength, and 6MWT improved significantly. The dropout analysis showed an association in participants with a moderate BDI score at baseline.Conclusions: A 12-week multicomponent therapy for fibromyalgia, well described and gradually applied, showed improvement in health-related outcome. According to our results, we recommend to exclude patients with a moderate-to-severe depression at onset before starting a multicomponent therapy protocol.Implications for rehabilitationMulticomponent therapy for fibromyalgia is beneficial on different health outcomes.Moderate depression at onset should be exclusion criteria for starting with multicomponent therapy in patients with fibromyalgia.This multicomponent therapy protocol is ready to be implemented at daily practice.

Ghent developmental balance test: a new tool to evaluate balance performance in toddlers and preschool children.

BACKGROUND: Balance is a fundamental component of movement. Early identification of balance problems is important to plan early intervention. The Ghent Developmental Balance Test (GDBT) is a new assessment tool designed to monitor balance from the initiation of independent walking to 5 years of age. OBJECTIVE: The purpose of this study was to establish the psychometric characteristics of the GDBT. METHODS: To evaluate test-retest reliability, 144 children were tested twice on the GDBT by the same examiner, and to evaluate interrater reliability, videotaped GDBT sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT scores, z scores on the GDBT were compared between a clinical group (n = 20) and a matched control group (n = 20). Concurrent validity of GDBT scores with the subscale standardized scores of the Movement Assessment Battery for Children-Second Edition (M-ABC-2), the Peabody Developmental Motor Scales-Second Edition (PDMS-2), and the balance subscale of the Bruininks-Oseretsky Test-Second Edition (BOT-2) was evaluated in a combined group of the 20 children from the clinical group and 74 children who were developing typically. RESULTS: Test-retest and interrater reliability were excellent for the GDBT total scores, with intraclass correlation coefficients of .99 and .98, standard error of measurement values of 0.21 and 0.78, and small minimal detectable differences of 0.58 and 2.08, respectively. The GDBT was able to distinguish between the clinical group and the control group (t(38) = 5.456, P<.001). Pearson correlations between the z scores on GDBT and the standardized scores of specific balance subscales of the M-ABC-2, PDMS-2, and BOT-2 were moderate to high, whereas correlations with subscales measuring constructs other than balance were low. CONCLUSIONS: The GDBT is a reliable and valid clinical assessment tool for the evaluation of balance in toddlers and preschool-aged children.

The influence of a vestibular dysfunction on the motor development of hearing-impaired children.

OBJECTIVES/HYPOTHESIS: To identify the predictive ability of vestibular function test results on motor performance among hearing-impaired children. STUDY DESIGN: Cross-sectional study. METHODS: Fifty-one typically developing children and 48 children with a unilateral (n = 9) or bilateral hearing impairment (n = 39) of more than 40 dB HL between 3 and 12 years were tested by the Movement Assessment Battery for Children-Second Edition (M ABC-2), clinical balance tests, posturography, rotatory chair testing, and vestibular evoked myogenic potential (VEMP). From the group of hearing-impaired children, 23 had cochlear implants. RESULTS: Balance performance on M ABC-2, clinical balance tests, as well as the sway velocity assessed by posturography in bipedal stance on a cushion with eyes closed and in unilateral stance differed significantly between both groups. Presence of a VEMP response is an important clinical parameter because comparison of the motor performance among hearing-impaired children between those with present and absent VEMPs showed significant differences in balance performance. The three most important predictor variables on motor performance by bivariate regression analyses are the vestibular-ocular reflex (VOR) gain value of the rotatory chair test at 0.01 and 0.05 Hz frequency, as well as the VEMP asymmetry ratio. Multivariate regression analyses suggest that the VOR asymmetry value of the rotatory chair test at 0.05 Hz and the etiology of the hearing loss seem to have additional predictive value. CONCLUSIONS: Hearing-impaired children are at risk for balance deficits. A combination of rotatory chair testing and VEMP testing can predict the balance performance.

Prediction of falling among stroke patients in rehabilitation.

OBJECTIVE: To identify risk factors and predict falling in stroke patients. To determine the strength of general vs mobility screening for this prediction. DESIGN: Prospective study. SUBJECTS: Patients in the first 6 months after stroke. METHODS: The following assessments were carried out: an interview concerning civil state and fall history, Mini-Mental State Examination, Geriatric Depression Scale, Falls Efficacy Scale (FES), Star Cancellation Task (SCT), Stroop test, Berg Balance Scale, Functional Ambulation Categories (FAC), Motricity Index, grip and quadriceps strength, Modified Ashworth Scale, Katz scale, and a 6-month fall follow-up. RESULTS: Sixty-five patients were included for analysis. Thirty -eight (58.5%) reported falling. Risk factors were: being single (odds ratio (OR) 4.7; 95% confidence interval (95% CI) 1.2-18.3), SCT-time (OR 1.2; 95% CI 1.0-1.3), grip strength on unaffected side (US) (OR 0.1; 95% CI 0.0-0.8), FAC 3 vs FAC 4-5 (OR 8.1; 95% CI 1.5-43.2), and walking aid vs none (OR 5.1; 95% CI 1.4-17.8). These parameters were included in predictive models, which finally implied a general model (I) with inclusion of SCT-time, FAC category and use of walking aid. A mobility model (II) included: FAC category and strength (US). These models showed a sensitivity of 94.1% and 76.3%, respectively. CONCLUSION: Several assessments and both prediction models showed acceptable accuracy in identifying fall-prone patients. A purely physical model can be used; however, looking beyond mobility aspects adds value. Further validation of these results is required.

Construct validity of the assessment of balance in children who are developing typically and in children with hearing impairments.

BACKGROUND: Children with hearing impairments have a higher risk for deficits in balance and gross motor skills compared with children who are developing typically. As balance is a fundamental ability for the motor development of children, a valid and reliable assessment to identify weaknesses in balance is crucial. OBJECTIVE: The purpose of this study was to investigate the construct validity of posturography and clinical balance tests in children with hearing impairments and in children who are developing typically. METHODS: The study involved 53 children with typical development and 23 children with hearing impairments who were between 6 and 12 years of age and without neuromotor or orthopedic disorders. All participants completed 3 posturography tests (modified Clinical Test of Sensory Interaction of Balance [mCTSIB], unilateral stance, and tandem stance) and 4 clinical balance tests (one-leg stance with eyes open and with eyes closed, balance beam walking, and one-leg hopping). RESULTS: Three conditions of the mCTSIB, unilateral stance, and 2 clinical balance tests were able to distinguish significantly between the 2 groups. Children with hearing impairments showed more difficulties in balance tasks compared with children who were developing typically when 1 or 2 types of sensory information were eliminated or disturbed. The study showed only low to moderate correlations among the different methods of evaluating balance. CONCLUSIONS: Clinical balance tests and posturography offer different but complementary information. An assessment protocol for balance consisting of posturography and clinical balance tasks is proposed. Static and dynamic balance abilities could not be differentiated and seem not to be a valid dichotomy.