Dataset Information

Instrumented static and dynamic balance assessment after stroke using Wii Balance Boards: reliability and association with clinical tests.

ABSTRACT:

Background and objectives

The Wii Balance Board (WBB) is a globally accessible device that shows promise as a clinically useful balance assessment tool. Although the WBB has been found to be comparable to a laboratory-grade force platform for obtaining centre of pressure data, it has not been comprehensively studied in clinical populations. The aim of this study was to investigate the measurement properties of tests utilising the WBB in people after stroke.

Methods

Thirty individuals who were more than three months post-stroke and able to stand unsupported were recruited from a single outpatient rehabilitation facility. Participants performed standardised assessments incorporating the WBB and customised software (static stance with eyes open and closed, static weight-bearing asymmetry, dynamic mediolateral weight shifting and dynamic sit-to-stand) in addition to commonly employed clinical tests (10 Metre Walk Test, Timed Up and Go, Step Test and Functional Reach) on two testing occasions one week apart. Test-retest reliability and construct validity of the WBB tests were investigated.

Results

All WBB-based outcomes were found to be highly reliable between testing occasions (ICC ?= 0.82 to 0.98). Correlations were poor to moderate between WBB variables and clinical tests, with the strongest associations observed between task-related activities, such as WBB mediolateral weight shifting and the Step Test.

Conclusions

The WBB, used with customised software, is a reliable and potentially useful tool for the assessment of balance and weight-bearing asymmetry following stroke. Future research is recommended to further investigate validity and responsiveness.

SUBMITTER: Bower KJ

PROVIDER: S-EPMC4277284 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Instrumented static and dynamic balance assessment after stroke using Wii Balance Boards: reliability and association with clinical tests.

Bower Kelly J KJ McGinley Jennifer L JL Miller Kimberly J KJ Clark Ross A RA

PloS one 20141226 12

<h4>Background and objectives</h4>The Wii Balance Board (WBB) is a globally accessible device that shows promise as a clinically useful balance assessment tool. Although the WBB has been found to be comparable to a laboratory-grade force platform for obtaining centre of pressure data, it has not been comprehensively studied in clinical populations. The aim of this study was to investigate the measurement properties of tests utilising the WBB in people after stroke.<h4>Methods</h4>Thirty individu ...[more]

PMID: 25541939

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Project description:BackgroundFalls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12?months following rehabilitation discharge.MethodsA prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63?years; median 24?days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars.ResultsOver 12?months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P?<?0.001-0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P?<?0.040; IQR-odds ratio(OR)?=?1.37-7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P?=?0.001-0.018; IQR-OR?=?5.28-10.29).ConclusionsReduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.

Project description:ContextTraditional assessments of reactive balance require sophisticated instrumentation to ensure objective, highly repeatable paradigms. This instrumentation is clinically impractical. The Push and Release test (P&R) is a well-validated clinical test that examines reactive balance, and the application of wearable inertial measurement units (IMU) enables sensitive and objective assessment of this clinically feasible test. The P&R relies on administrator experience and may be susceptible to interadministration reliability concerns. The purpose of this study was to evaluate the interadministrator reliability of objective outcomes from an instrumented, modified version of the P&R test.DesignCrossover interadministrator design.MethodsTwenty healthy adults (20-35 y) completed the P&R in 4 directions with 2 different administrators. Measures quantified using IMUs included step latency, step length, and time to stability. Lean angle (LA) at release was used as a measure of administration consistency. The intraclass correlation coefficient (ICC) estimate was used to assess interadministrator reliability in each direction. To determine consistency of LA within and across administrators, we calculated the SDs for each rater by direction and the interadministrator reliability of LA using ICC.ResultsAcross individual directions, the ICC for agreement between raters ranged from .16 to .39 for step latency, from .52 to .62 for time to stability, and from .48 to .84 for step length. Summary metrics across all 4 directions produced higher ICC values. There was poor to moderate consistency in administration based on LA, but LA did not significantly affect any of the outcomes.ConclusionThe modified P&R yields moderate interadministrator reliability and high validity. Summary metrics over all 4 directions (the maximum step latency, the median time to stability, and the median step length) are likely more reliable than direction-specific scores. Variations in body size should also be considered when comparing populations.

Project description:BackgroundStroke patients have impaired postural balance that increases the risk of falls and impairs their mobility. Assessment of postural balance is commonly carried out by recording centre of pressure (CoP) displacements, but the lack of data concerning reliability of these measures compromises their interpretation. The purpose of this study was to investigate the between-day reliability of six CoP-based variables, in order to provide i) reliability data for monitoring postural sway and weight-bearing asymmetry of stroke patients in clinical practice and ii) consistent assessment method of measurement error for applications in physical medicine and rehabilitation.MethodsPostural balance of 20 stroke patients was assessed in quiet standing on a force platform, in two sessions, 7 days apart. Six CoP-based variables were collected in eyes open and eyes closed conditions: postural sway was assessed with mean and standart deviation of CoP-velocity, CoP-velocity along the mediolateral and anteroposterior axes, and confidence ellipse area (CE(AREA)); weight-bearing asymmetry was assessed with mean CoP position along the mediolateral axis (CoP(ML)). The intraclass correlation coefficient (ICC) was used to determine the level of agreement between test-retest. Small real difference (SRD), corresponding to the smallest change that indicates a real improvement for a single individual, was used to determine the extent of measurement error.ResultsICCs were satisfactory (>0.9) for all CoP-based variables, except for CE(AREA) in eyes open condition and CoP(ML) (<0.8). The SRDs (eyes open/closed conditions) were: 6.1/9.5 mm.s(-1) for mean velocity; 12.3/12.2 mm.s(-1) for standard deviation of CoP-velocity; 3.6/5.5 mm.s(-1) and 4.9/7.3 mm.s(-1) for CoP-velocity in mediolateral and anteroposterior axes, respectively; 17.4/21.4 mm for CoP(ML). Because CE(AREA) showed heteroscedasticity of measurement error distribution, SRD (eyes open/closed conditions) was expressed as a percentage (121/75%) and a ratio (3.68/2.16) obtained after log-antilog procedure.ConclusionsIn clinical practice, the CoP-based velocity variables should be prefer to CE(AREA) to assess and monitor postural sway over time in hemiplegic stroke patients. The poor reliability of CoP(ML) compromises its use to assess weight-bearing asymmetry. The procedure we used could be applied in reliability studies concerning other CoP-based variables or other biological variables in the field of physical medicine and rehabilitation.

Project description:CONTEXT:? Without a true criterion standard assessment, the sport-related concussion (SRC) diagnosis remains subjective. Inertial balance sensors have been proposed to improve acute SRC assessment, but few researchers have studied their clinical utility. OBJECTIVE:? To determine if group differences exist when using objective measures of balance in a sample of collegiate athletes with recent SRCs and participants serving as the control group and to calculate sensitivity and specificity to determine the diagnostic utility of the inertial balance sensor for acute SRC injuries. DESIGN:? Cross-sectional cohort study. SETTING:? Multicenter clinical trial. PATIENTS OR OTHER PARTICIPANTS:? We enrolled 48 participants with SRC (age = 20.62 ± 1.52 years, height = 179.76 ± 10.00 cm, mass = 83.92 ± 23.22 kg) and 45 control participants (age = 20.85 ± 1.42 years, height = 177.02 ± 9.59 cm, mass = 74.61 ± 14.92 kg) at 7 clinical sites in the United States. All were varsity or club collegiate athletes, and all participants with SRC were tested within 72 hours of SRC. MAIN OUTCOME MEASURE(S):? Balance performance was assessed using an inertial balance sensor. Two measures (root mean square sway and 95% ellipse sway area) were analyzed to represent a range of general balance measures. Balance assessments were conducted in double-legged, single-legged, and tandem stances. RESULTS:? A main effect for group was associated with the root mean square sway measure ( F1,91 = 11.75, P = .001), with the SRC group demonstrating balance deficits compared with the control group. We observed group differences in the 95% ellipse sway area measure for the double-legged ( F1,91 = 11.59, P = .001), single-legged ( F1,91 = 6.91, P = .01), and tandem ( F1,91 = 7.54, P = .007) stances. Sensitivity was greatest using a cutoff value of 0.5 standard deviations (54% [specificity = 71%]), whereas specificity was greatest using a cutoff value of 2 standard deviations (98% [sensitivity = 33%]). CONCLUSIONS:? Inertial balance sensors may be useful tools for objectively measuring balance during acute SRC evaluation. However, low sensitivity suggests that they may be best used in conjunction with other assessments to form a comprehensive screening that may improve sensitivity.

Project description:Falls are the second most frequent cause of injury in the elderly. Physiological processes associated with aging affect the elderly's ability to respond to unexpected balance perturbations, leading to increased fall risk. Every year, approximately 30% of adults, 65 years and older, experiences at least one fall. Investigating the neurophysiological mechanisms underlying the control of static and dynamic balance in the elderly is an emerging research area. The study aimed to identify cortical and muscular correlates during static and dynamic balance tests in a cohort of young and old healthy adults. We recorded cortical and muscular activity in nine elderly and eight younger healthy participants during an upright stance task in static and dynamic (core board) conditions. To simulate real-life dual-task postural control conditions, the second set of experiments incorporated an oddball visual task. We observed higher electroencephalographic (EEG) delta rhythm over the anterior cortex in the elderly and more diffused fast rhythms (i.e., alpha, beta, gamma) in younger participants during the static balance tests. When adding a visual oddball, the elderly displayed an increase in theta activation over the sensorimotor and occipital cortices. During the dynamic balance tests, the elderly showed the recruitment of sensorimotor areas and increased muscle activity level, suggesting a preferential motor strategy for postural control. This strategy was even more prominent during the oddball task. Younger participants showed reduced cortical and muscular activity compared to the elderly, with the noteworthy difference of a preferential activation of occipital areas that increased during the oddball task. These results support the hypothesis that different strategies are used by the elderly compared to younger adults during postural tasks, particularly when postural and cognitive tasks are combined. The knowledge gained in this study could inform the development of age-specific rehabilitative and assistive interventions.

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Dataset Information

Instrumented static and dynamic balance assessment after stroke using Wii Balance Boards: reliability and association with clinical tests.

Background and objectives

Methods

Results

Conclusions

Publications

Instrumented static and dynamic balance assessment after stroke using Wii Balance Boards: reliability and association with clinical tests.

Similar Datasets

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