Dataset Information

Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4.

ABSTRACT: OBJECTIVE:For individuals with lower-limb loss, functional mobility (ie, K-level) classification can be subjective. Performance-based outcome measures improve the objectivity of K-level assignment; therefore, this study aimed to determine differences in functional strength- and dynamic balance-based outcome measures performance between K3- and K4-classified adults with lower-limb loss. DESIGN:Prosthetists used subjective information and prosthetic componentry to determine K-levels before outcome measures testing for adults with a unilateral transtibial (n = 50) or transfemoral amputation (n = 17). Outcome measures (ie, 5-Times Sit-to-Stand Test, Figure-of-8 Walk Test, 360-degree Turn Test, and modified Four-Square Step Test) were administered by a blinded examiner. Univariate analyses of variance were used to evaluate between-subgroup differences. RESULTS:K4-classified participants with a unilateral transfemoral amputation performed better on all outcome measures when compared with K3-classified peers, whereas K4-classified individuals with a transtibial amputation performed better on the modified Four-Square Step Test compared with K3-classified peers (P < 0.050). CONCLUSIONS:K4-classified individuals demonstrated greater lower-limb functional strength and better dynamic balance compared with K3-classified peers. To assist with K-level classification, clinicians should consider selecting outcome measures that objectively differentiate between K-levels (ie, modified Four-Square Step Test for those with a unilateral transtibial or transfemoral amputation; 5-Times Sit-to-Stand Test, Figure-of-8 Walk Test, and 360-degree Turn Test for those with a transfemoral amputation).

SUBMITTER: Beisheim EH

PROVIDER: S-EPMC7309599 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4.

Beisheim Emma Haldane EH Horne John Robert JR Pohlig Ryan Todd RT Sions Jaclyn Megan JM

American journal of physical medicine & rehabilitation 20190901 9

<h4>Objective</h4>For individuals with lower-limb loss, functional mobility (ie, K-level) classification can be subjective. Performance-based outcome measures improve the objectivity of K-level assignment; therefore, this study aimed to determine differences in functional strength- and dynamic balance-based outcome measures performance between K3- and K4-classified adults with lower-limb loss.<h4>Design</h4>Prosthetists used subjective information and prosthetic componentry to determine K-levels ...[more]

PMID: 30950838

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Project description:Background: According to dynamical systems theory, an increase in movement variability leads to greater adaptability, which may be related to the number of feedforward and feedback mechanisms associated with movement and postural control. Using Higuchi dimension (HDf) to measure complexity of the signal and Singular Value Decomposition Entropy (SvdEn) to measure the number of attributes required to describe the biosignal, the purpose of this study was to determine the effect of kinesiology and strapping tape on center of pressure dynamics, myoelectric muscle activity, and joint angle during the Y balance test. Method: Forty-one participants between 18 and 34 years of age completed five trials of the Y balance test without tape, with strapping tape (ST), and with kinesiology tape (KT) in a cross-sectional study. The mean and standard errors were calculated for the center of pressure, joint angles, and muscle activities with no tape, ST, and KT. The results were analyzed with a repeated measures ANOVA model (P A < 0.05) fit and followed by Tukey post hoc analysis from the R package with probability set at P < 0.05. Results: SvdEn indicated significantly decreased complexity in the anterior-posterior (p < 0.05) and internal-external rotation (p < 0.001) direction of the ankle, whilst HDf for both ST and KT identified a significant increase in ankle dynamics when compared to no tape (p < 0.0001) in the mediolateral direction. Taping also resulted in a significant difference in gastrocnemius muscle myoelectric muscle activity between ST and KT (p = 0.047). Conclusion: Complexity of ankle joint dynamics increased in the sagittal plane of movement with no significant changes in the possible number of physiological attributes. In contrast, the number of possible physiological attributes contributing to ankle movement was significantly lower in the frontal and transverse planes. Simply adhering tape to the skin is sufficient to influence neurological control and adaptability of movement. In addition, adaptation of ankle joint dynamics to retain postural stability during a Y Balance test is achieved differently depending on the direction of movement.

Project description:In this case-control study, we concluded that women with distal radial fractures who were surgically treated showed lower grip strength and dynamic body balancing than those of controls. These results suggest that measurements of grip strength and dynamic body balance may be useful screening tools to assess future fracture risk.IntroductionPatients with distal radial fractures (DRFs) are at risk of future fragility fractures. However, their physical characteristics and tendencies for falls remain unclear. We aimed to compare the physical characteristics of women with and without distal radial fractures.MethodsWe included 128 women with a DRF as their first fragility fracture (fracture group) who underwent surgical treatment. Concurrently, 128 age- and sex-matched participants without a history of fragility fractures were selected as controls (control group). The participants underwent assessments of grip strength and the body balancing ability test. Measurements were taken twice in the fracture group, at 2 weeks and 6 months postoperatively, and once in the control group. The body balancing ability test included the Functional Reach Test, Timed Up and Go test (TUG), 2-Step test (2ST), and Timed Uni-pedal Stance test. The participants also completed questionnaires about their health.ResultsThere were no significant differences (p > 0.05) in patient characteristics between the groups. The fracture group showed lower grip strength across all age groups. In the DRF group, prolonged TUG time was observed at 2 weeks postoperatively in all age groups and at 6 months in participants aged 55-74 years; the 2ST score was significantly lower in participants aged between 65 and 74 years.ConclusionsWomen with DRF demonstrated lower grip strength and dynamic body balancing ability. Lower grip strength and dynamic body balancing ability were identified as significant risk factors in women with DRF, suggesting that these may be useful screening tools to assess fracture risk.

Project description:BackgroundDistal radius fractures are common fractures in older adults and associated with increased risk of future functional decline and hip fracture. Whether lower limb muscle strength and balance are impaired in this patient population is uncertain. To help inform rehabilitation requirements, this systematic review aimed to compare lower limb muscle strength and balance between older adults with a distal radius fracture with matched controls, and to synthesise lower limb muscle strength and balance outcomes in older adults with a distal radius fracture.MethodsWe searched Embase, MEDLINE, and CINAHL (1990 to 25 May 2022) for randomised and non-randomised controlled clinical trials and observational studies that measured lower limb muscle strength and/or balance using instrumented measurements or validated tests, in adults aged ≥ 50 years enrolled within one year after distal radius fracture. We appraised included observational studies using a modified Newcastle-Ottawa Scale and included randomised controlled trials using the Cochrane risk-of-bias tool. Due to the clinical and methodological heterogeneity in included studies, we synthesised results narratively in tables and text.ResultsNineteen studies (10 case-control studies, five case series, and four randomised controlled trials) of variable methodological quality and including 1835 participants (96% women, mean age 55-73 years, median sample size 82) were included. Twelve included studies (63%) assessed strength using 10 different methods with knee extension strength most commonly assessed (6/12 (50%) studies). Five included case-control studies (50%) assessed lower limb strength. Cases demonstrated impaired strength during functional tests (two studies), but knee extension strength assessment findings were conflicting (three studies). Eighteen included studies (95%) assessed balance using 14 different methods. Single leg balance was most commonly assessed (6/18 (33%) studies). All case-control studies assessed balance with inconsistent findings.ConclusionCompared to controls, there is some evidence that older adults with a distal radius fracture have impaired lower limb muscle strength and balance. A cautious interpretation is required due to inconsistent findings across studies and/or outcome measures. Heterogeneity in control participants' characteristics, study design, study quality, and assessment methods limited synthesis of results. Robust case-control and/or prospective observational studies are needed.RegistrationInternational prospective register of systematic reviews (date of registration: 02 July 2020, registration identifier: CRD42020196274).

Project description:BackgroundFalls and fall-related injuries are not uncommon among older adults and may lead to serious health deterioration and decreased quality of life. Numerous types of physical activity have been proposed to improve balance and strength in older adults with varying degrees of success. Nintendo's Wii Fit video exergame uses body movement as a game controller and provides real-time feedback for games designed to enhance balance and muscle strength. However, whether Wii Fit exercise improves the balance and lower limb muscle strength of older adults remains uncertain.ObjectiveTo evaluate the current literature by using meta-analyses to assess whether Wii Fit exercise is associated with improved balance and lower limb muscle strength in older adults.MethodsWe searched PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data from inception to February 16, 2022, for relevant studies and conducted a manual search of the literature. Data extraction of the included studies were independently performed by two authors. The methodologic quality of each included study was assessed using the Physical Therapy Evidence Database (PEDro) scale. Meta-analyses were conducted using Review Manager 5.3.ResultsOf 991 articles initially identified, 10 articles (379 participants; aged ≥65 years, range 65-92 years; 188 participants in Wii Fit exercise groups, and 191 participants in control groups), including 8 randomized controlled trials, were assessed in this meta-analysis. The methodologic quality of the included studies evaluated with the PEDro average score was 6.4 and ranged from 5 to 8 points, indicating moderate quality. Compared with no exercise, Wii Fit exercise was associated with significant improved scores on the Berg Balance Scale, which evaluates functional balance (mean difference, 1.38; 95% CI, 0.61-2.16; I 2 = 31%; P = 0.0005) and on the Timed Up and Go test, which evaluates static and dynamic balance (standardized mean difference, -0.51; 95% CI,-0.88 to -0.14; I 2 = 52%; P = 0.007). However, for the three studies assessed, Wii Fit exercise did not significantly improve scores on the 30-s chair stand test, which evaluates the functional strength and endurance of the lower limb muscles (mean difference, 0.82; 95% CI, -0.14 to 1.77; z = 1.68; P = 0.09).ConclusionsOur findings indicated that Wii Fit exercise is an effective approach to improve functional, static, and dynamic balance among older adults. Additional meta-analyzes with higher numbers of randomized controlled trials are suggested to confirm the benefits of Wii Fit exercise on balance in older adults, to establish whether functional strength and endurance of lower limb muscles are improved, and to explore the relationship between improved balance and fall prevention in this population.

Project description:BackgroundGeneralized Joint hypermobility (GJH) is predominantly non-symptomatic. In fact, individuals with joint flexibility usually perform better than their non-hypermobile counterparts during physical activities. Notwithstanding, strength and balance are essential to maintain the control of the extra range of motion during activities and to prevent musculoskeletal complications. There are limited and conflicting pieces of evidence in literature regarding the association between strength and balance in children with GJH.ObjectivesThe purpose of this study was to examine differences in functional strength, dynamic balance, proprioception, and isometric strength in children with and without joint hypermobility and determine the association between strength outcomes and dynamic balance.MethodA cross-sectional study was conducted among children aged 6 to 11. Hypermobility was determined using the Beighton Score, with scores ≥6 representing hypermobility. Functional strength was assessed with the Functional Strength Measure (FSM), isometric strength was determined with a handheld dynamometer (HHD), the Y-Balance Test (YBT) was used to assess dynamic balance and the Wedges test to measure proprioception.ResultsThis study included 588 participants (age: 7.97 ± 1.3 years; height: 128±10.1 cm; mass: 27.18 ± 7.98 kg). 402 children were classified as having normal mobility and 186 as being hypermobile. Hypermobile children had better functional strength in the lower extremities than children with normal range mobility but lower reach distance in the YBT. No differences in proprioception, functional strength of the upper extremity or isometric strength in the hands were found. However, isometric lower extremity force was less in hypermobile children than children with normal range mobility. Irrespective of their joint mobility, a fair significant correlation existed between total Y-balance distance and FSM items r = 0.16-0.37, p = 0.01. Correlations between total Y-balance distance and isometric strength of knee and ankle muscles ranged between r = 0.26-0.42, p = 0.001.ConclusionHypermobile joints seem to co-occur with lower extremity isometric strength, more functional strength in the lower extremities and less reaching distance in dynamic balance. The opposing direction of the results on functional and isometric strength tests highlights the importance of the type of outcome measures used to describe the association of strength and the range of motion.

Project description:BackgroundTo evaluate the relationship between measures of neuromuscular impairment and limb accelerations (LA) collected during sleep among individuals with chronic spinal cord injury (SCI) to provide evidence of construct and concurrent validity for LA as a clinically meaningful measure.MethodsThe strength (lower extremity motor score), sensation (summed lower limb light touch scores), and spasticity (categorized lower limb Modified Ashworth Scale) were measured from 40 adults with chronic (≥ 1 year) SCI. Demographics, pain, sleep quality, and other covariate or confounding factors were measured using self-report questionnaires. Each participant then wore ActiGraph GT9X Link accelerometers on their ankles and wrist continuously for 1-5 days to measure LA from movements during sleep. Regression models with built-in feature selection were used to determine the most relevant LA features and the association to each measure of impairment.ResultsLA features were related to measures of impairment with models explaining 69% and 73% of the variance (R²) in strength and sensation, respectively, and correctly classifying 81.6% (F1-score = 0.814) of the participants into spasticity categories. The most commonly selected LA features included measures of power and frequency (frequency domain), movement direction (correlation between axes), consistency between movements (relation to recent movements), and wavelet energy (signal characteristics). Rolling speed (change in angle of inclination) and movement smoothness (median crossings) were uniquely associated with strength. When LA features were included, an increase of 72% and 222% of the variance was explained for strength and sensation scores, respectively, and there was a 34% increase in spasticity classification accuracy compared to models containing only covariate features such as demographics, sleep quality, and pain.ConclusionLA features have shown evidence of having construct and concurrent validity, thus demonstrating that LA are a clinically-relevant measure related to lower limb strength, sensation, and spasticity after SCI. LA may be useful as a more detailed measure of impairment for applications such as clinical prediction models for ambulation.

Project description:Key factors positively influencing rehabilitation and functional recovery after spinal cord injury (SCI) include training variety, intensive movement repetition, and motivating training tasks. Systems supporting these aspects may provide profound gains in rehabilitation, independent of the subject's treatment location. In the present study, we test the hypotheses that virtual reality (VR)-augmented training at home (i.e., unsupervised) is feasible with subjects with an incomplete SCI (iSCI) and that it improves motor functions such as lower limb muscle strength, balance, and functional mobility. In the study, 12 chronic iSCI subjects used a home-based, mobile version of a lower limb VR training system. The system included motivating training scenarios and combined action observation and execution. Virtual representations of the legs and feet were controlled via movement sensors. The subjects performed home-based training over 4?weeks, with 16-20 sessions of 30-45?min each. The outcome measures assessed were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), Timed Up and Go (TUG), Spinal Cord Independence Measure mobility, Walking Index for Spinal Cord Injury II, and 10?m and 6?min walking tests. Two pre-treatment assessment time points were chosen for outcome stability: 4?weeks before treatment and immediately before treatment. At post-assessment (i.e., immediately after treatment), high motivation and positive changes were reported by the subjects (adapted Patients' Global Impression of Change). Significant improvements were shown in lower limb muscle strength (LEMS, P?=?0.008), balance (BBS, P?=?0.008), and functional mobility (TUG, P?=?0.007). At follow-up assessment (i.e., 2-3?months after treatment), functional mobility (TUG) remained significantly improved (P?=?0.005) in contrast to the other outcome measures. In summary, unsupervised exercises at home with the VR training system led to beneficial functional training effects in subjects with chronic iSCI, suggesting that it may be useful as a neurorehabilitation tool. Trial registration:Canton of Zurich ethics committee (EK-24/2009, PB_2016-00545), ClinicalTrials.gov: NCT02149186. Registered 24 April 2014.

Dataset Information

Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4.

Publications

Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4.

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