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PubMed2000

What is balance?

Balance is a term frequently used by health professionals working in a wide variety of clinical specialities. There is no universally accepted definition of human balance, or related terms. This article identifies mechanical definitions of balance and introduces clinical definitions of balance and postural control. Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity. Postural control strategies may be either predictive or reactive, and may involve either a fixed-support or a change-in-support response. Clinical tests of balance assess different components of balance ability. Health professionals should select clinical assessments based on a sound knowledge and understanding of the classification of balance and postural control strategies.

Gravity Sensing↗

PubMed2005

Foot and ankle characteristics associated with impaired balance and functional ability in older people.

BACKGROUND: Ageing is associated with changes to the structure and function of the foot and ankle, and there is preliminary evidence that foot problems impair balance and increase the risk of falls. To explore this in more detail, we conducted a study to determine the relative contribution of several foot and ankle characteristics to performance on a range of balance and functional tests. METHODS: One hundred seventy-six people (56 men and 120 women, mean age 80.1 years, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity), sensorimotor function (including vision, sensation, strength, and reaction time), and balance and functional ability (including tests of standing balance, leaning balance, stepping, sit-to-stand, and walking speed). RESULTS: Many foot and ankle characteristics and sensorimotor measures were associated with performance on the balance and functional tests in univariate analyses. Multiple regression analysis consistently revealed that ankle flexibility, plantar tactile sensitivity, and toe plantarflexor strength were significant and independent predictors of balance and functional test performance, explaining up to 59% of the variance in these test scores. CONCLUSIONS: Foot and ankle characteristics, particularly ankle flexibility, plantar tactile sensation, and strength of toe plantarflexor muscles, are significant independent predictors of balance and functional ability in older people. Programs to improve the strength and flexibility of the foot and interventions to augment plantar sensation may be beneficial in improving mobility and reducing the risk of falls.

Aged↗

PubMed1989

Objective assessment of the quality of response during two equilibrium tasks.

Therapists typically evaluate the balance abilities of children as part of developmental or diagnostic assessments. While the pattern or quality of a child's balance reaction is considered to be an important indicator of developmental delay or disability, no criteria for objectively scoring the qualitative aspects of balance reactions have been developed. As a result, the evaluation of the quality of a balance reaction has remained subjective. The purpose of this investigation was to develop a qualitative grading scale for scoring the overall pattern of balance reactions on two clinical tests of balance: Tilt Board Reach and Flat Board Reach. Six patterns of response were identified in an initial sample of 66 normal children and 25 children with learning disabilities. Two trained assistants, unaware of age and group membership, then graded the responses of an independent sample of 263 normal children between 2 and 13 years of age, and 26 boys with learning disability and sensory integrative dysfunction between 7 and 14 years of age. Descriptive analysis of patterns of response by age for the normal children resulted in the identification of three normal patterns and three atypical patterns. Although boys with identified learning disabilities associated with sensory integrative dysfunction often used normal patterns, they were more likely than normal children to use either abnormal patterns or patterns commonly used by very young children.

Journal Article↗

PubMed1997

Influence of visual control, conduction, and central integration on static and dynamic balance in healthy older adults.

Aging is associated with decreased balance abilities, resulting in an increased risk of fall. In order to appreciate the visual, somatosensory, and central signals involved in balance control, sophisticated methods of posturography assessment have been developed, using static and dynamic tests, eventually associated with electromyographic measurements. We applied such methods to a population of healthy older adults in order to appreciate the respective importance of each of these sensorial inputs in aging individuals. Posture control parameters were recorded on a force-measuring platform in 41 healthy young (age 28.5 +/- 5.9 years) and 50 older (age 69.8 +/- 5.9 years) adults, using a static test and two dynamic tests performed by all individuals first with eyes open, then with eyes closed. The distance covered by the center of foot pressure, sway area, and anteroposterior oscillations were significantly higher, with eyes open or closed, in older people than in young subjects. Significant differences were noted in dynamic tests with longer latency responses in the group of old people. Dynamic recordings in a sinusoidal test had a more regular pattern when performed eyes open in both groups and evidenced significantly greater instability in old people. These data suggest that vision remains important in maintaining postural control while conduction and central integration become less efficient with age.

Adult↗

PubMed1997

One-leg balance is an important predictor of injurious falls in older persons.

OBJECTIVE: To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls. DESIGN: Analysis of data from a longitudinal cohort study. SUBJECTS: Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years). MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month. INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg). RESULTS: At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03). CONCLUSION: One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.

Accidental Falls↗

PubMed2004

The relationship between balance and pitching error in college baseball pitchers.

The objective of the study was to examine the relationship between balance and pitching error in college baseball pitchers. Sixteen college baseball pitchers, 9 National Association of Intercollegiate Athletics (NAIA) and 7 National Collegiate Athletic Association (NCAA) Division III, participated in the study. Balance ability, expressed as average sway velocity (deg.s(-1)), during dominant leg unilateral stance with eyes open and eyes closed was quantified for each subject utilizing the Balance Master System 7.04 (long force plate). Additionally, each subject underwent sensory organization testing on the SMART EquiTest System providing information regarding the effective use of the somatosensory, visual, and vestibular inputs. Pitching error was assessed with a high-speed video camera recorder during spring practice. A JUGS radar gun measured pitch velocity. The mean pitching error was 37.50 cm with a mean pitch velocity of 78 miles.h(-1) (35 m.s(-1)). No significant correlation was demonstrated between unilateral stance eyes open and pitching error (r = -0.24; p = 0.36) or unilateral stance eyes closed and pitching error (r = -0.29; p = 0.27). A significant negative correlation was demonstrated between sensory organization test 5 and pitching error (r = -0.50; p = 0.05) and between sensory organization test 5/1 and pitching error (r = -0.50; p = 0.05). Additionally, unilateral stance eyes closed demonstrated a positive correlation with pitch velocity (r = 0.52; p = 0.04). The results reveal that low levels of vestibular input utilization may lead to high levels of pitching error in college baseball pitchers.

Adolescent↗

PubMed2003

BalanceReTrainer: a new standing-balance training apparatus and methods applied to a chronic hemiparetic subject with a neglect syndrome.

In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-balance training in neurologically impaired individuals. BalanceReTrainer provides an impaired individual with a fall-safe balancing environment, where the balancing efforts of a standing individual are augmented by stabilizing forces acting at the level of pelvis in the sagittal and frontal planes of motion, assisting the balancing activity ankle and hip muscles and at the level of shanks, assisting the knee extensor muscles. A range of different levels of supporting forces is generated by passive, compliant means. Additionally, movement in the sagittal and frontal planes, acquired by transducers is fed to an electronic interface which transforms the current inclinations into a computer mouse signals, which are interfaced to a personal computer (PC) where balance training and evaluation program is running. The level of stiffness support and level of difficulty of computer task can be selected according to current balancing abilities of the impaired individual. We further present results of a case study where an ambulatory chronic hemiparetic subject with neglect syndrome received ten days of balance training on BalanceReTrainer. Biomechanical evaluation of weight-shifting activity before and after treatment shows a substantial functional improvement.

Adult↗

PubMed1995

Postural stability following mild head or whiplash injuries.

Studies of the sequelae of head injury suggest that cochlear and vestibular dysfunctions, comprise some of the most frequently reported delayed complications following head trauma. To date, little attention has been given to the relation between post-traumatic subjective symptoms of dizziness and the objective measures of postural stability or balance. The purpose of this study was to quantify the balance deficits in individuals who had developed symptoms of dizziness following mild head and whiplash injuries. The balance abilities of 29 patients, who developed dizziness following some type of mild head or whiplash injury, were compared to those of 51 healthy symptom-free subjects. Balance was assessed by examining the center-of-pressure movements, in the anterior-posterior and medial-lateral directions, and the total movement displacement. The isolated contributions of visual and somatosensory inputs were estimated by comparing the magnitudes of the center-of-pressure movements for the various sensory conditions. Data were collected from three 30-second trials of each combination of three visual conditions (accurate, absent, and inaccurate) and two somatosensory conditions (accurate and inaccurate), with the patient standing on a fixed-force platform. Univariate analyses of variance indicated that the group with head injury, compared to the control group, exhibited significantly greater anterior-posterior movements in four of the six sensory conditions and greater total movement displacement during the inaccurate vision/inaccurate somatosensation condition. These data suggest that patients who have sustained head or neck trauma exhibit increased reliance on accurate visual input and are unable to utilize vestibular orienting information to resolve conflicting information from the visual and somatosensory systems.

Adolescent↗

PubMed2007

Apparatus for dynamic balance training during treadmill walking.

OBJECTIVE: A presentation of a novel apparatus for dynamic balance training during treadmill walking, which was tested in a case study. SUBJECT: The subject was a man with incomplete chronic spinal cord injury (C5), graded D on the American Spinal Injury Association Impairment Scale. METHODS: Following a 6-month baseline period, 4 weeks of control treatment (treadmill walking) and a subsequent 4 weeks of experimental treatment (treadmill walking assisted by the apparatus) were compared. Outcome measures were Lower Extremities Motor Score, Berg Balance Scale, 10-metre walking test and 9-minute walking test. RESULTS: During the baseline period the changes in the outcome measures were small. After the control treatment the balance score remained unchanged, while walking speed and walking endurance increased moderately. Experimental treatment resulted in further substantial changes in balance and walking endurance scores, while further increase in walking speed was moderate. At follow-up these values were maintained. Lower Extremities Motor Scores were almost identical in all study phases. CONCLUSION: The subject's walking and balancing abilities improved moderately after the control treatment, while greater improvement occurred during experimental treatment. This indicates that the apparatus developed might be an important tool for facilitating dynamic balancing training during treadmill walking.

Adult↗

PubMed2002

Postural balance in elderly people: changes over a five-year follow-up and its predictive value for survival.

Postural balance in three test conditions (normal standing with eyes open, normal standing with eyes closed, and tandem standing with eyes open) was measured in samples of 75-year-old men and women (N=757) living in three Nordic localities (Glostrup in Denmark, Göteborg in Sweden, and Jyväskylä in Finland). The subjects were re-tested five years later when they had reached the age of 80 years (N=434). The results showed a highly significant longitudinal decline in balancing abilities in all localities and in both sexes. The longitudinal change was larger than suggested by cross-sectional comparisons. On both occasions women showed better results in the balance tests than men in all three localities. Inter-locality differences observed at baseline (somewhat poorer performance among the subjects from Göteborg) largely remained during the follow-up. The simplest balance test, normal standing with eyes open, was also a significant predictor for survival over the 5-year follow-up: the results at baseline were poorer in those subjects who died during the follow-up than in the survivors. It is concluded that postural balance deteriorates markedly from 75 to 80 years of age; at high ages a poor performance in balance tests may also indicate below-average survival.

Aged↗

PubMed2000

The genetics of acute functional tolerance and initial sensitivity to ethanol for an ataxia test in the LSxSS RI strains.

BACKGROUND: It has been proposed that development of tolerance to the behavioral effects of ethanol depends on the degree of impairment produced by the drug; that is, more sensitive individuals should develop greater tolerance. Tests of this hypothesis with respect to acute functional tolerance have produced contradictory results. We tested the hypothesis by examining the genetic relationship between initial sensitivity and acute functional tolerance in the LSXSS recombinant inbred mice. METHODS: We tested mice for initial sensitivity to the ataxic effects of 1.75 g/kg of ethanol in a stationary dowel balance test by determining blood and brain ethanol concentrations at fall. Acute tolerance to the ataxic effects of ethanol was determined by measuring blood ethanol concentration (BEC) at regain of dowel balance ability after the first injection (BEC1RB) and after a second ethanol injection of 2.0 g/kg (BEC2RB). Acute tolerance was quantified by the difference in ethanol concentration at the two regains of balance (BEC2RB - BEC1RB) or by the difference between the second regain and one of the initial sensitivity measures (BEC2RB - initial sensitivity). RESULTS: Four different measures of initial sensitivity were taken: two that used BEC values and two that used forebrain or hindbrain ethanol concentrations. We calculated acute tolerance values by using each of these initial sensitivity measures plus BEC2RB. No evidence of a genetic relationship between initial sensitivity and acute tolerance was found, which suggests that these are two independent phenomena with respect to stationary dowel balance. CONCLUSIONS: Three conclusions can be drawn from this work: (1) Orbital sinus BEC at early time points (<5 min postinjection) may or may not accurately reflect brain EC in mice, dependent on genotype; (2) there is no genetic relationship between initial sensitivity and acute tolerance to stationary dowel ataxia in the LSXSS RIs; and (3) sex-specific factors affect low-dose ethanol responses on the stationary dowel.

Animals↗

PubMed1981

Standing balance in healthy boys and in children with Duchenne muscular dystrophy.

Balance in double stance was measured on a force platform with an X-Y Plotter (stabilograph) in 57 healthy boys aged 5 to 10 years and in 13 children with Duchenne muscular dystrophy (DMD), aged 6 to 15 years. Horizontal excursions of the center of gravity were measured in the anteroposterior (AP) and right-left (RL) planes. Measurements superimposed upon foot position tracings were compared with a potential excursion defined by the outer margin of foot position. Balancing ability was expressed as a ratio of measured excursion to potential maximal excursion. The objective was to determine whether a quantitative functional measure relating to muscle weakness and standing could be obtained. The mean ratio of AP excursions for healthy children was 0.5 (range 0.29 to 0.7); for dystrophic children 0.29 (range 0.07 to 0.57). The mean ratio of RL excursions for healthy children was 0.57 (range 0.23 to 0.77); for dystrophic children 0.36 (range 0.1 to 0.63). These ratios tended to increase with age in healthy children but decreased in those with dystrophy. DMD children have less ability to move the horizontal center of gravity within the base of support on double stance than their healthy peers of comparable age. Stabilography may be useful not only for assessing balance and documenting its deterioration but also for evaluating the effectiveness of treatment in DMD.

Adolescent↗

PubMed2005

Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance.

STUDY DESIGN: One-group, prospective, cross-sectional study. OBJECTIVES: To determine how sensorimotor function, balance, and physical performance are associated with disability and walking capacity in patients with lumbar spinal stenosis. BACKGROUND: Disability and limited walking capacity are often reported by patients with lumbar spinal stenosis. Identification of associated factors could provide information for future investigations leading to better prevention and intervention strategies. METHODS AND MEASURES: Fifty patients with lumbar spinal stenosis answered questions regarding symptom intensity, disability, and walking capacity. Muscle strength and vibration sense were assessed to represent sensorimotor function. Balance ability was measured by single-leg stance time and basic physical performance was tested by the up-and-go (UG) test. Regression analyses, entering demographics and symptom intensity as control variables, and sensory, strength, balance, and physical performance as additional independent variables, were conducted separately for disability and walking capacity. RESULTS: Symptom intensity, vibration sense at the big toe, and UG test time were significantly correlated with disability. The final regression model showed that the control variables explained 20% of the variance, while vibration sense and UG test time explained an additional 20% of the variance. Walking capacity was significantly correlated with vibration sense at the big toe and UG test time. No significant regression model emerged for walking capacity. CONCLUSIONS: A moderate amount of variance in disability could be explained by sensory function at the big toe and physical performance. These factors should be considered in future research.

Aged↗

PubMedDate not supplied

Fear of falling, balance, and gait velocity in patients with stroke.

After a stroke balance can be impaired, that may influence the physical activities which can be undertaken. A person's confidence in performing activities without falling could be as important as the real balance ability in situations of daily living. The aims of the study were to evaluate the relationship between perceived self-confidence in task performance without falling, using the Falls Efficacy Scale, Swedish version, (FES(S)) and observer-assessed balance, measured by the BDL Balance Scale (BDL BS) and also between the FES(S) and gait velocity. Thirty-one subjects with stroke, 32-62 years of age, time since onset between 3 and 104 months, participated The FES(S) was significantly correlated with the BDL BS (r = 0.49, p = 0.008). Furthermore there were significant correlations between the FES(S) and self-selected (r = 0.53, p = 0.003) as well as for maximum (r = 0.55, p = 0.002) gait velocity. The results indicate that the use of the FES(S) can be recommended in subjects with stroke and balance deficit in order to map out the dimension of self-confidence in balance problems. However, in more highly functioning subjects with stroke other fall-efficacy assessments with major demands on balance performance may be preferable due to partly ceiling effect in the study population.

Accidental Falls↗

PubMed1990

Early sensory determinants of locomotor speed in adult cats: II. Effects of strobe rearing on vestibular functions.

Cats raised under stroboscopic illumination are known to exhibit oculomotor and visuomotor deficits, but little is known about their locomotor abilities. Four strobe-reared cats with intact labyrinths were tested in a locomotor test involving various walking surfaces and various illumination conditions. Apart from their general slowness under all the experimental conditions, these strobe cats showed no special deficit on narrow rails, which indicates that their dynamic balancing abilities were normal. In these subjects, the decrease in the use of kinetic visual cues was roughly compensated for by an increase in the use of position cues. When tested after chronic bilateral labyrinthectomy, the strobe-reared cats' locomotor speeds were identical to those of control labyrinthectomized cats, except on wide platforms involving orientation towards a visual goal. These results show that in the absence of motion-vision, vestibular control of dynamic balance can mature normally, but they suggest that other aspects of locomotion involving the processing of vestibular and kinesthetic inputs may be impaired.

Aging↗

PubMed1984

Dynamic balance of learning disabled and nondisabled children.

This investigation assessed a difference in the dynamic balance abilities of 30 learning disabled and 30 nondisabled children of elementary-school age. Only distance traveled across the beam, a novel task, was significantly different between groups; no other effects were significant. Nondisabled subjects traveled further across the beam before losing balance than learning disabled children.

Child↗

PubMed2006

[Relationship between activity of daily living and motor function in the community-dwelling elderly after hip fracture].

AIM: To clarify the relationship between ADL and motor functions in 44 community-dwelling elderly patients with hip fracture. METHODS: The questionnaire comprised items on BADL, IADL, ability to walk, and certification for long-term care. The assessment of motor functions included grip strength, knee extension strength, 10 m walking time, TUG, FRT, and Romberg rate and shift length of the center of gravity measured by a stabilometer. Based on these tests, relationships between the motor functions and ADL were evaluated in elderly patients after hip fracture. RESULTS: Significant correlations were found between BADL and grip strength, knee extension strength, and FRT. As for IADL, significant correlations were found with grip strength, knee extension strength, 10-m walking speed, TUG, FRT, and MMSE items. Similarly, regarding ability to walk and the certification of long-term care, significant correlations were shown with grip strength, knee extension strength, 10 m walking speed, and MMSE items. CONCLUSION: The relationships between ADL and motor functions were confirmed in community-dwelling elderly patients with hip fracture. The parameters related to muscle strength and balance ability that were assessed in this study are those that can be improved through constant training after discharge from hospital. The validity of these parameters as the indices for future intervention studies to assess the maintenance and improvement of ADL after discharge and prognosis was indicated.

Activities of Daily Living↗

PubMed2003

Retest reliability of dynamic balance during standing in older people after surgical treatment of hip fracture.

BACKGROUND AND PURPOSE: Computerized force platform systems are becoming more widely used in clinical practice to measure balance control; however, their retest reliability has not been documented in people with hip fracture. The present study examined the retest reliability of dynamic weight shift during standing in older people after surgical treatment of hip fractures. METHOD: This single group test-retest research design employed a computerized force platform system (the Neurocom Pro-Balance Master; PBM) to measure the amplitude and symmetry of weight shift in 14 patients with unilateral hip fracture on three test occasions held one hour and 24 hours apart. Subjects performed six trials of a forward-backward and side-to-side weight shift task at each test session. RESULTS: The results showed that reliability was, at best, moderate for forward-backward and side-to-side weight shift measures taken over an hour and over a day. CONCLUSIONS: Clinicians should be cautious when using the computerized balance assessment procedures investigated in this study to assess change in dynamic balance ability in older people during the early stages of rehabilitation after surgical treatment of hip fractures.

Aged↗