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PubMed2006

Physical capacity and walking ability after lower limb amputation: a systematic review.

OBJECTIVE: To review the influence of physical capacity on regaining walking ability and the development of walking ability after lower limb amputation. DESIGN: A systematic search of literature was performed. The quality of all relevant studies was evaluated according to a checklist for statistical review of general papers. SUBJECTS: Lower limb amputees. MAIN MEASURES: Physical capacity (expressed by aerobic capacity, anaerobic capacity, muscle force, flexibility and balance) and walking ability (expressed by the walking velocity and symmetry). RESULTS: A total of 48 studies that complied with the inclusion criteria were selected. From these studies there is strong evidence for deterioration of two aspects of physical capacity (muscle strength and balance) and of two aspects of walking ability (walking velocity and symmetry) after lower limb amputation. Strong evidence was found for a relation between balance and walking ability. CONCLUSION: Strong evidence was only found for a relation between balance and walking ability. Evidence about a relation between other elements of physical capacity and walking ability was insufficient. Training of physical capacity as well as walking ability during rehabilitation following lower limb amputation should not be discouraged since several parameters have been shown to be reduced after amputation, although their relation to regaining walking ability and to the development of walking ability remains unclear.

Amputation, Surgical↗
PubMed2005

Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance?

In this review we explore studies related to constraints on balance and walking in children with cerebral palsy (CP) and the efficacy of training reactive balance (recovering from a slip induced by a platform displacement) in children with both spastic hemiplegic and diplegic CP. Children with CP show (a) crouched posture, contributing to decreased ability to recover balance (longer time/increased sway); (b) delayed responses in ankle muscles; (c) inappropriate muscle response sequencing; (d) increased coactivation of agonists/antagonists. Constraints on gait include (a) crouched gait; (b) increased co-activation of agonists/antagonists; (c) decreased muscle activation; (d) spasticity. The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.

Cerebral Palsy↗
PubMed2001

Phylogenetically conditioned possibilities of the realization and of the development of complex movements at the age of 7 years.

Upon entering a school the seven-year olds (+/- 2 months) underwent a systematic, experimental, specially programmed, eighteen-month-long transformational procedure. The objective of the procedure was to develop the abilities and to observe the growth and the development of children, both girls and boys. The data were processed by means of discriminant analyses in each of the three control points. There was a total sample of 487 children. With regard to the phylogenetic characteristics of a human, it may be said that the basic abilities connected with phylogenetic development may be clearly recognized, precisely in such a way that children replicate this development throughout their earliest childhood. Most probably, the basic ability was the ability to maintain a postural balance, followed by the ability of movement control. Then came object manipulation by upper extremities, followed by the significance of resistance to inertial forces while moving, and ultimately the control of complex movements of the whole body.

Child↗
PubMed2000

Pattern of motor and cognitive deficits in detoxified alcoholic men.

BACKGROUND: Chronic excessive consumption of alcohol produces marked deficits in cognitive and motor abilities, although not all functions are affected to the same extent. Furthermore, although the occurrence of neuropsychological deficits in recently detoxified alcoholics is firmly established, the relative severity of these deficits, the specific neural systems that underlie the deficits, and their relationship to age and alcohol consumption variables either are less established or have proven elusive altogether. METHODS: We administered an extensive battery of neuropsychological tests, chosen for their known sensitivity to brain lesions in specific locations, to 71 recently (1 month) detoxified alcoholic men and 74 healthy controls who spanned the adult age range. Test scores were standardized to the controls for age and grouped a priori into composites that reflected performance in six functional domains: executive functions, short-term memory, upper limb motor ability, declarative memory, visuospatial abilities, and gait and balance. Analogous verbal and nonverbal materials and left- and right-hand upper limb motor tasks were used to test whether alcohol-related deficits were greater for left or right hemisphere. RESULTS: Compared with controls, the alcoholics were impaired on executive functions, visuospatial abilities, and gait and balance even after we accounted for group differences in estimated premorbid IQ and education. Within the alcoholic group, the most salient deficits were in gait and balance and visuospatial abilities. No consistent lateralized deficit was observed across the four domains tested. Unlike the cognitive composites, the upper limb motor ability and gait and balance composites both showed increasing vulnerability to age, with an independent contribution to the gait and balance dysfunction from the amount of alcohol consumed over a lifetime. CONCLUSIONS: The pattern of functional deficits implicates at least two principal neural systems: the cerebellar-frontal system and the corticocortical system between the prefrontal and parietal cortices. In addition, age and amount of alcohol consumption were better predictors of motor than cognitive impairments.

Adult↗
PubMed1988

Effect of the dietary alpha-linolenate/linoleate balance on lipid compositions and learning ability of rats. II. Discrimination process, extinction process, and glycolipid compositions.

Donryu strain rats through two generations were fed semi-purified diets supplemented with safflower seed oil (rich in linoleic acid) or with perilla seed oil (rich in alpha-linolenic acid), or a conventional laboratory chow (normal control diet). Brightness-discrimination learning ability was determined to be the highest in the perilla oil-fed group, followed by the normal group, and then by the safflower group, extending our earlier observation in a different strain of rat that alpha-linolenic acid is a factor in maintaining high learning ability (Yamamoto, N., M. Saitoh, A. Moriuchi, M. Nomura, and H. Okuyama. 1987. J. Lipid Res. 28: 144-151). After the brightness-discrimination learning test was administered, extinction of learning was measured. The time required for extinction was significantly longer in the safflower group than in either the perilla group or the normal diet group. Thus, the dietary alpha-linolenate/linoleate balance affected both the learning and the extinction of learning. The glycolipids of the cerebrum, cerebellum, and olfactory lobe were analyzed. Although the fatty acid compositions of the sulfatide and gangliosides were significantly different in the three parts of the brain, relatively little difference was observed in the fatty acids of glycolipids between the safflower group and the perilla group, suggesting that gross changes in brain glycolipids are not responsible for the differences in learning abilities between these dietary groups.

Animals↗
PubMed1996

Sitting balance: its relation to function in individuals with hemiparesis.

OBJECTIVES: To evaluate test-retest reliability of sitting balance measures in healthy subjects and individuals with hemiparesis secondary to stroke, to evaluate the ability of the balance measures and Functional Independence Measure (FIM) to document changes over time, and to compare changes in the balance measures and FIM to each other. METHOD: Six nonpatient subjects were evaluated for test-retest reliability. Fourteen subjects with hemiparesis were tested every 2 weeks during their hospitalization on their ability to lean to either side, lean forward, and maintain a symmetrical posture. Maximum displacement was recorded using the Balance System. FIM scores were obtained for each testing session. RESULTS: Test-retest reliability for nonpatient subjects was high and for patients was moderate to high. Leaning forward and to the paretic side showed the greatest number of correlations with the FIM scores. All of the FIM scales and the forward lean measure documented progress. CONCLUSIONS: The protocol developed to test sitting balance, using the Balance System, seems appropriate for use with patient populations. The ability to lean maximally to either side or forward or sit symmetrically is not strongly related to function.

Adult↗
PubMed2005

Assistive devices for balance and mobility: benefits, demands, and adverse consequences.

OBJECTIVES: To provide information on the advantages and possible disadvantages of using canes and walkers. DATA SOURCES: English-language articles were identified by searching MEDLINE and PubMed (1966-May 2003) for key words cane or walker , excluding articles unrelated to mobility aids. Bibliographies were reviewed and ISI Web of Science citation searches were run to identify additional references. Over 1000 articles were selected for further evaluation. STUDY SELECTION: We extracted all studies of single-tip canes or pickup walkers addressing: (1) functional, biomechanic, or neuromotor benefits; (2) biomechanic, attentional, neuromotor, metabolic, or physiologic demands; and (3) falls, injuries, or other problems. We included approximately 10% of the articles originally identified. DATA EXTRACTION: The methodology of each selected article, and findings relevant to the benefits, demands, or adverse effects of cane or walker use were summarized. DATA SYNTHESIS: Findings were synthesized by considering their relation to basic biomechanic principles. Some biomechanic findings appear to support the clinical view that canes and walkers can improve balance and mobility for older adults and people with other clinical conditions. However, a large proportion of users experience difficulties, and the use of such devices is associated with increased risk of falling. A small number of studies have characterized some of the specific demands and problems associated with using mobility aids. CONCLUSIONS: Clinical and biomechanic evaluations of canes and walkers confirm that these devices can improve balance and mobility. However, they can also interfere with ones ability to maintain balance in certain situations, and the strength and metabolic demands can be excessive. More research is needed to identify and solve specific problems. Such research may lead to improved designs and guidelines for safer use of canes and walkers.

Adolescent↗
PubMedDate not supplied

Decreasing mental frailty in at-risk elders.

Frailty may be used to describe those older adults who are in precarious balance between their abilities to maintain health and function and their deficits that threaten the balance. Frailty often is described in purely physical terms, omitting the mental and psychologic aspects. When the term is applied to the mental abilities of older adults, frailty is associated with memory vulnerability in the cognitive domain and depression in the psychologic domain. Compromised thinking, anxiety, and decreased confidence in memory are symptoms of mental frailty. This article examines the effects of aging on memory and the intertwining factors of depression and self-efficacy as treatable antecedents of mental frailty in older adults. The article also describes simple assessment techniques, explores memory improvement strategies, and considers nursing implications.

Aged↗
PubMed2005

The effect of time to peak ankle torque on balance stability boundary: experimental validation of a biomechanical model.

Pai and Patton (1997), using a biomechanical model, determined a set of feasible center of mass (CM) velocity-position combinations (balance stability boundary) that guarantee upright stability. In their study, the magnitude of the restoring ankle torque was used to study the subject's ability to recover balance. Recent studies have suggested that the ability to maintain a stable posture depends not only on the magnitude of the restoring torque but also on the time to generate this torque. The objectives of the present study were: (1) to build a biomechanical model that predicts the balance stability boundary which includes time to peak ankle torque, (2) to determine the capability of the model to predict successful and failed experimental balance recovery trials, and (3) to compare the predictive capability of the biomechanical model with that of a statistical model (logistic regression). A single-link-plus-foot biomechanical model was used to determine a set of balance stability boundaries, computed from the combination of maximum CM velocity and related CM position, for various times to peak ankle torque. An experiment was conducted to validate the biomechanical model. The participants self-initiated a forward destabilization and were asked to regain balance using an ankle feet-in-place strategy. Also, a forward stepwise logistic regression (predictors: CM position and velocity and time to peak ankle torque) was used to discriminate between successful and failed experimental trials. (1) The outcomes of the biomechanical model confirmed that the time to peak ankle torque drastically constrained the stability boundaries. (2) The biomechanical model predicted 79.9% of the failed experimental trials and 74.5% of the successful experimental trials. (3) The stepwise logistic regression included all independent variables and predicted 57.2% of the failed and 93.7% of the successful experimental trials. Hence, the biomechanical model showed better predictive capability than the statistical model for identifying unsuccessful balance recovery. It is noteworthy that the balance stability boundaries constrained by the speed of ankle torque development predicted the outcome of the experimental trial earlier in the time series than balance stability boundary constrained by constant ankle torque. Overall, the present biomechanical model may serve as an assessment tool to develop specific interventions towards improving a patient's speed of ankle torque development and to possibly reduce falling frequency.

Accidental Falls↗
PubMed1979

Bilateral writing ability, cerebral organization, and hand posture.

Among a group of 12 persons selected for the ability to write with ease with either hand, none were found to write using a hooked hand posture with either the right or left hand. Tests of verbal and manipulospatial ability indicated a normal balance of these two types of abilities, usually associated with the left and right hemispheres. Findings are discussed in terms of implications for cerebral organization and hand position in writing.

Dominance, Cerebral↗
PubMedDate not supplied

Lessons in leadership. Keys to success from some of corporate America's best-known leaders.

With the rapidity of change in the healthcare field, effective leadership is becoming increasingly important--for both the organizations and the people they serve. For insight on what makes a leader effective, Healthcare Executive looked to five well-known business leaders who have learned what it takes to lead and succeed in today's increasingly intricate business world. All agreed that good leadership is not the ability to analyze a balance sheet. Rather, it's the ability to manage the people side of the equation that makes a leader great and an enterprise successful.

Administrative Personnel↗
PubMed2003

Balance in single-limb stance in healthy subjects--reliability of testing procedure and the effect of short-duration sub-maximal cycling.

BACKGROUND: To assess balance in single-limb stance, center of pressure movements can be registered by stabilometry with force platforms. This can be used for evaluation of injuries to the lower extremities. It is important to ensure that the assessment tools we use in the clinical setting and in research have minimal measurement error. Previous studies have shown that the ability to maintain standing balance is decreased by fatiguing exercise. There is, however, a need for further studies regarding possible effects of general exercise on balance in single-limb stance. The aims of this study were: 1) to assess the test-retest reliability of balance variables measured in single-limb stance on a force platform, and 2) to study the effect of exercise on balance in single-limb stance, in healthy subjects. METHODS: Forty-two individuals were examined for test-retest reliability, and 24 individuals were tested before (pre-exercise) and after (post-exercise) short-duration, sub-maximal cycling. Amplitude and average speed of center of pressure movements were registered in the frontal and sagittal planes. Mean difference between test and retest with 95% confidence interval, the intraclass correlation coefficient, and the Bland and Altman graphs with limits of agreement, were used as statistical methods for assessing test-retest reliability. The paired t-test was used for comparisons between pre- and post-exercise measurements. RESULTS: No difference was found between test and retest. The intraclass correlation coefficients ranged from 0.79 to 0.95 in all stabilometric variables except one. The limits of agreement revealed that small changes in an individual's performance cannot be detected. Higher values were found after cycling in three of the eight stabilometric variables. CONCLUSIONS: The absence of systematic variation and the high ICC values, indicate that the test is reliable for distinguishing among groups of subjects. However, relatively large differences in an individual's balance performance would be required to confidently state that a change is real. The higher values found after cycling, indicate compensatory mechanisms intended to maintain balance, or a decreased ability to maintain balance. It is recommended that average speed and DEV 10; the variables showing the best reliability and effects of exercise, be used in future studies.

Adult↗
PubMed2002

Effects of age, step direction, and reaction condition on the ability to step quickly.

BACKGROUND: The ability to take a step quickly is important for balance maintenance during activities of daily living. The purpose of this study was to investigate the effects of age, reaction condition, and step direction on the ability to take a volitional step as fast as possible. METHODS: The performance of a voluntary step task was measured in young adult (mean age 20, SD 0.9 years), young-old adult (mean age 67, SD 3.7 years), and old adult (mean age 78, SD 2.3 years) healthy female participants. Each participant stepped as fast as possible in eight directions in response to a visual cue in a simple or choice reaction time condition. The effects of age, reaction condition, and step direction and their interactions on the primary outcome variables of response time, step liftoff, and step landing time were examined. RESULTS: The normal aging process progressively increased the response, liftoff, and landing times. The choice reaction time condition, compared to the simple, had significantly increased response, liftoff, and landing times. Step direction significantly affected the liftoff and landing times, with lateral, diagonal, and anterior and posterioir (A-P) times increasing, respectively. CONCLUSIONS: We found substantial declines in the ability to step rapidly in healthy adults as age increased. When a decision was required regarding the step direction, the step performance also declined. Step direction also significantly affected step performance. The assessment of voluntary step performance, which may be an indicator of balance ability, should include dimensions of both direction and the choice condition.

Adult↗
PubMed2002

Standing balance evaluation using a triaxial accelerometer.

This paper presents a new inherently triaxial accelerometer-based system for determining the ability to maintain balance while standing. In this study, the accelerometer was placed at the back of the subject at the approximate height of the centre of mass. The data were processed to obtain five performance parameters. Paired t-tests indicated that the accelerometer measurements were able to distinguish between the different test conditions as well as or better than simultaneous AMTI force platform measurements (P < or = 0.05). The accelerometer system is fully portable, independent of inclination in space, low-cost and allows long term measurements of standing balance.

Electrophysiology↗
PubMed2005

Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations.

OBJECTIVE: To examine the effects of an ankle-foot orthosis (AFO) on balance performance in patients with hemiparesis of short and long duration. DESIGN: Within-subject random order of intervention, cross-sectional study design. SETTINGS: Medical centres and district hospitals. SUBJECTS: Forty-two subjects with hemiparesis of short duration (< six months) and 61 subjects of long duration ( > 12 months). MEASUREMENTS: The balance and gait ability of subjects were evaluated both with an AFO and without. The static and dynamic balance activities were evaluated by the Balance Master System, whereas the functional balance was assessed with the Berg Balance Scale. The speed and cadence were also measured during a 10-metre walk. Paired t-test was used to determine the effect of the AFO. RESULTS: In subjects with hemiparesis of short duration, we found that subjects wearing an AFO showed significant improvements in (1) weight-bearing distribution during quiet standing (p = 0.042, 95% confidence interval (CI) 0.521, 7.325), (2) body sway during standing on foam surface with eyes open (p = 0.020, 95% CI 0.020, 0.680) and eyes closed (p = 0.041, 95% CI 0.023, 0.921), (3) movement velocity during limit of stability test (LOS)--toward the affected side (p = 0.037, 95% CI - 0.978, - 0.042) and nonaffected side (p = 0.008, 95% CI -2.223, - 0.377), (4) maximal excursion toward the affected side (p= 0.042, 95% CI -19.546, -0.071), and (5) speed (p=0.028, 95% CI -0.204, -0.017) and cadence (p= 0.021, 95% CI - 22.983, - 1.864). Such effects were not observed in subjects with hemiparesis of long duration. CONCLUSIONS: For the subjects with hemiparesis of short duration, the AFO improves the symmetry in quiet and dynamic standing balances. It also increases speed and cadence. However, its effectiveness is minimal for patients of long duration.

Ankle↗
PubMed1999

The relation between admission balance and functional outcomes following stroke rehabilitation: a medical center based study.

This prospective study evaluated the clinical use of the Fugl-Meyer Balance Scale (FMBS) on stroke patients during hospitalization and assessed the relationship between balance score at admission to the rehabilitation program and functional outcome at discharge. One hundred and sixty-three stroke patients admitted to the in-patient rehabilitation department of a university-based medical center between January 1 and December 31, 1997 were recruited for this investigation. Functional ability was evaluated with the Functional Independence Measure (FIM) instrument, and balance was measured using the 7-item Fugl-Meyer Balance Scale. These measures were assessed both at admission to and discharge from the inpatient rehabilitation program. Pearson correlation and multiple regression analyses were used to determine the relationship between balance and functional ability scores at admission and rehabilitation outcomes at discharge, including length of stay, functional gain, and efficiency. The results demonstrated that the balance score at admission accounted for 6% of the variation in length of stay, once demographic influences were controlled. The FIM efficiency score could possibly be predicted by the balance ability at admission, which accounted for 3% of the variance. However, the balance score could not provide predictive information about the FIM gain beyond that already provided by the FIM score at admission, which accounted for 4% of the variance with demographic factors controlled. Overall, balance ability at admission, assessed by the Fugl-Meyer Balance Scale, had no or at least only little, contribution to account for the variance in rehabilitation outcomes. These findings suggest that the use of Fugl-Meyer Balance Scale at admission to stroke inpatient rehabilitation seemed not to enhance the ability to predict rehabilitation outcomes.

Adult↗
PubMed2005

Age-related differences in peak joint torques during the support phase of single-step recovery from a forward fall.

BACKGROUND: Previous studies have reported that older adults have a reduced ability to recover balance with a single step after a forward-induced fall. To better understand the reasons for this reduced ability, this study investigated any age-related differences in peak joint torques during the support phase of a single-step balance recovery from a forward fall. METHODS: Ten young (19-23 years old) and 10 older (65-83 years old) men were released from forward-leaning positions and attempted to recover their balance with a single step. Lean was increased until they failed to recover their balance with a single step. Peak extensor torques were calculated for the support phase of balance recovery and were compared across age groups. RESULTS: A consistent pattern of joint torques emerged during the support phase of balance recovery, suggesting a similar strategy across young and older participants. Despite this similarity, older participants exhibited smaller peak knee extensor torques during the support phase of single-step balance recoveries, and trends toward larger peak extensor torques at the hip and ankle. CONCLUSIONS: The age-related differences found are believed to be the combined result of an age-related reduction in muscle strength and an age-related neuromuscular adaptation to mitigate the effects of muscle strength loss on physical performance capabilities.

Accidental Falls↗