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At least 811 records · Page 45Linked to original sources
PubMed1993

Test-retest reliability of two tiltboard tests in children.

BACKGROUND AND PURPOSE: Most clinical evaluations of postural control in children are relatively subjective and have not been tested for reliability of scoring. The purpose of this study was to investigate the test-retest reliability of measurements obtained with two tiltboard tests. SUBJECTS: Subjects were 18 children, aged 53 to 81 months (mean = 64.4, SD = 8.3), who were typically developing (TD group) and 18 children, aged 50 to 79 months (mean = 63.3, SD = 8.4), with developmental delays (DD group). METHODS: Each child was tested using the two tilt-board tests and was then retested using the same tests approximately 1 week later. The maximum angle of tiltboard tilt prior to any postural adjustment by the child was recorded. RESULTS: Intraclass correlation coefficients for test-retest reliability (two-way, random-effects, repeated-measures model) ranged from .49 to .54 for the TD group and from .52 to .82 for the DD group. Angles were higher for both groups for the second test. CONCLUSION AND DISCUSSION: The results suggest that these tiltboard tests do not give stable and reliable measurements across test sessions. Before these tests can be used to document change in postural control abilities across time, further research is warranted.

Child↗
PubMed1994

An impairment and disability assessment and treatment protocol for community-living elderly persons.

BACKGROUND AND PURPOSE: Falls and immobility are common among community-living elderly persons and result from the accumulated effect of multiple impairments and disabilities as well as environmental hazards. We developed and tested a simple assessment and intervention protocol for use in prevention and treatment programs among community-living elderly persons. This article presents the components of the assessment; the criteria for intervening on diagnosed impairments contributing to falls and immobility; and the recommended treatments, environmental adaptations, training, and exercise programs targeting the diagnosed problems. SUBJECTS: A convenience sample of 11 residents of a senior housing complex who were cognitively intact and ambulatory were chosen for reliability testing of the assessment protocol. A random sample of 20 of the 153 elderly subjects involved in a multiple risk factor trial for fall prevention then were chosen to test the reliability of the intervention recommendations. METHODS: The assessment and intervention protocol was developed by a consensus approach among a group consisting of a geriatric physician, two nurses, and three physical therapists. The interrater reliability of both the assessment and the intervention components of the protocol was determined by comparing the results of two of the study physical therapists. RESULTS: There was excellent agreement in assessment and intervention results by the two physical therapists. The assessment required approximately 45 minutes to complete, suggesting it is feasible for use in clinical practice. CONCLUSION AND DISCUSSION: A simple, standardized assessment and intervention protocol, such as the one described, could aid physical therapists in evaluating and treating community-living elderly persons by improving communication among care providers, providing better documentation for reimbursers, and ensuring a direct linkage between assessment and intervention, thus simplifying the development of a treatment plan for elderly persons with complicated or multiple impairments. The ultimate test of this assessment and intervention protocol will be ascertainment of the goal of the protocol, namely a reduction in falls and improvement in mobility among multiply and chronically ill elderly persons.

Accidental Falls↗
PubMed1995

Reliability of measurements of body center-of-mass momentum during sit-to-stand in healthy adults.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the reliability of measurements of momentum of the body's center of mass (CM) during a sit-to-stand (STS) transfer in healthy adults. SUBJECTS: Nineteen healthy adults aged 25 to 38 years (mean = 31.7, SD = 4.2) participated. METHODS: Horizontal and vertical components of CM momentum were computed for STS transfers made at three movement speeds (fast, natural, and slow) with the aid of a motion analysis system. Two force platforms detected the time when the subject lost contact with the chair and the propulsive and braking impulses in the horizontal and vertical directions. Separate intraclass correlation coefficients (ICCs) were calculated for three temporal variables (time to peak horizontal and vertical momentum and time to when the subject lost contact with the chair) and two magnitude variables (peak horizontal and vertical momentum). RESULTS: The ICCs for magnitude variables were > or = .81 for all speeds of movement. The ICCs for temporal variables ranged from .28 for fast movements to .75 for slow movements. CONCLUSION AND DISCUSSION: Measurement of peak vertical and horizontal momentum magnitudes is highly reproducible during STS transfers. Measurement of temporal variables exhibits a range of reliability estimates. Implications include consideration of the speed at which STS transfer is performed and its effect on reliability estimates and the potential differences between reliability estimates for magnitude measurements versus temporal measurements.

Adult↗
PubMed1997

Evaluation of postural stability in children: current theories and assessment tools.

Children with many types of motor dysfunction have problems maintaining postural stability. Because maintenance of postural stability is an integral part of all movements, therapists evaluate and treat to improve postural stability in these children. This article reviews current pediatric assessment tools for postural stability and issues affecting testing this construct in children. The tests and measurements are classified according to their testing purpose and the National Center for Medical Rehabilitation Research disablement framework, focusing on the impairment and functional limitation dimensions. Postural stability is defined from a systems perspective with tests related to the sensory, motor, and biomechanical systems described. Reliability and validity information on the measurements is discussed. Relatively few measurements of postural stability in children are available that have acceptable reliability and validity documentation. Suggestions for research on test development in this area are discussed.

Activities of Daily Living↗
PubMed1995

Trunk and head stabilization during the first months of independent walking.

This study measured the rate of acquisition of head and trunk postural control during the two early developmental periods of independent walking, as defined by global gait parameters. Gait parameters were observed longitudinally in four children. The maximum angular deviations of the trunk and head oscillations were computed in the frontal and sagittal planes. These decreased most dramatically during the first 10-15 weeks of independent walking, during the same period when global gait parameters changed rapidly. This head and trunk stabilization may be a fundamental process that help to maintain equilibrium during walking, and may be a necessary step prior to the development of fine posturo-motor control.

Analysis of Variance↗
PubMed2002

Cutaneous afferents from human plantar sole contribute to body posture awareness.

We investigated whether the tactile information from the main supporting areas of the foot are used by the brain for perceptual purposes, namely body posture awareness and body representation in space. We applied various patterns of tactile stimulation to one or both soles of unmoving and blindfolded subjects by a 60 micro-vibrator tactile matrix set in a force platform. The perceptual effects of the stimulation were assessed through a 3D joystick handled by the subjects. All subjects reported illusory perceptions of whole-body leaning. Both orientation and amplitude of these perceptions depended on the stimulation pattern. Additional kinesthetic illusions sometimes occurred along the longitudinal axis of the body. We conclude that foot sole input contributes to the coding and the spatial representation of body posture.

Adult↗
PubMedDate not supplied

Ankle, knee, and hip moments during standing with and without joint contractures: simulation study for functional electrical stimulation.

Joint contractures have been one of the contraindications for use of functional electrical stimulation for standing in paraplegic patients. A simulation study using a three-segment link mechanical model of the human body was performed to calculate the muscle moments at the ankles, knees, and hips during standing with and without having joint contractures. The knee and hip angles were varied in 5 degrees increments, whereas the ankle angles were varied in 1 degree increments. It was assumed that energy efficient posture was obtained with the least sum of the squared moments of the ankles, knees, and hips joints by the muscles. Ankles at 5 degrees of dorsiflexion, knees at 0 degrees, and hips at 15 degrees of extension resulted in the most energy efficient posture without joint contractures. The muscle moments increased with the increase in angle of contractures. The joint contractures at ankle angles > or = 6 degrees of plantar flexion, knee angles > or = 20 degrees of flexion, and/or hip angles > or = 20 degrees of flexion produce a potentially unstable posture. These findings suggest that some degree of joint contractures can be tolerated in paraplegic patients using functional electrical stimulation for standing.

Algorithms↗
PubMed2003

Postural control during sit-to stand and gait in stroke patients.

OBJECTIVE: To investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patients. DESIGN: A total of 40 chronic stroke patients with hemiplegia and 22 age-matched healthy subjects were included in this study. Data of a motion analysis system and three force platforms were collected in a rehabilitation unit of a medical center. RESULTS: Laboratory sit-to-stand measurement and gait analysis were evaluated in both groups via three AMTI (Advanced Mechanical Technology Inc.) force platforms and a Vicon 370 system (six high-resolution cameras and one AMTI force plate), respectively. The sit-to-stand and gait parameters of hemiplegic patients were correlated significantly, especially in rising speed and the maximal vertical force of both legs during rising. CONCLUSIONS: Hemiplegic stroke patients, who could stand up within 4.5 sec or who had a maximal vertical force difference of less than 30% of body weight between both legs, had better gait performance than the others did.

Activities of Daily Living↗
PubMed1997

Postural and gait disturbance correlated with decreased frontal cerebral blood flow in Alzheimer disease.

In a group of 45 patients with Alzheimer disease (AD) and 15 control subjects, we studied the relationship between parameters showing postural and gait disturbance and regional cerebral blood flow (rCBF) measured with N-isopropyl-p-[123I]iodoam-phetamine single photon emission computed tomography at different clinical stages. Patients with AD with mild dementia exhibited only increased postural sway associated with a reduced mean value of rCBF in the cortex. At a moderate stage, the reduced mean values of rCBF in the cortex and in the frontal lobe were associated with increased postural sway and stride length variability and with decreased stride length. At a severe stage, reduced rCBF in the basal ganglia and in the frontal lobe additionally were associated with increased postural sway, double support time, and stride length variability, and with decreased walking speed and stride length. In multiple regression analysis, there was a high contribution by rCBF in the frontal lobe to account for postural and gait disturbance in AD. We propose that impaired frontal lobe circulation is an important factor causing postural and gait disturbance as AD progresses.

Aged↗
PubMed1997

A new clinical tool for gait evaluation in Parkinson's disease.

This study was devised to check the feasibility and validity of a rating scale specifically designed to evaluate gait impairment in Parkinson's disease (RSGE). Demographic data, a brief questionnaire on general aspects influencing gait and mobility, a battery of scales (Barthel Index; Hoehn and Yahr staging; and Northwestern University Disability, Schwab and England, and Unified Parkinson's Disease Rating Scale [UPDRS]), and timed tests ("Up and Go" and "Steps x Seconds" tests) were recorded under protocol, as was the RSGE-Version 1.0 (23 items in four subscales). Fifty patients enrolled at two centers were included. Twenty-five (50%) were simultaneously (though independently) evaluated by three examiners, in order to determine the interrater reliability. The mean age of the patients was 67.6 +/- 11.16 years, with a mean 8.18 +/- 5.58 years of disease duration. Motor fluctuations were present in 48% of patients. The RSGE Cronbach's alpha was 0.94. Only the item "Dyskinesias" was not correlated with the RSGE total sum. The item "Axial rigidity" showed a fair interrater reliability (kappa = 0.30). However, most of the RSGE items (16/23, 70%) had kappa > or = 0.65. The convergent validity with the applied scales was very high (Spearman r = 0.74-0.90, p < 0.001). The highest correlation (0.90) was obtained with the UPDRS. Also, the RSGE correlation with timed tests was very satisfactory ("Up and Go" = 0.81; "Steps x Seconds" = 0.70; both, p < 0.001). Factor analysis of the RSGE disclosed four dimensions explaining 68% of the variance. The RSGE-Version 1.0 proved to be a valid instrument. The reliability of some items has to be improved, however.

Adult↗
PubMed2003

Movement termination and stability in standing.

This brief review develops a new conceptual framework for describing the influence of center-of-mass position and velocity on ability to terminate movement. Limitations of this dynamic conceptual framework and its applications in physical rehabilitation are explored.

Accidental Falls↗
PubMed1988

Rehabilitation treatment for vertigo.

Vestibular Habituation Training (VHT), an exercise treatment for vertigo, has become an accepted therapeutic approach. However, a good insight into the basic mechanisms as well as into the indications is required in order to treat it correctly. Only vertigo of the provoked type and produced by a stable peripheral vestibular dysfunctional state can be influenced. The basic mechanism of VHT is the stimulation of the development of adaptation by a repeatedly eliciting positional vertigo. In this way, exercises are selected individually and have to elicit vertigo. The procedure for selection of exercises is described. The results obtained by this treatment show a net favourable effect. It develops progressively, as might be expected from the assumed action of habituation. Typical vertigo is more easily influenced than atypical forms, and fewer cases with unilateral canal deficiency have a complete result.

Adaptation, Physiological↗
PubMed1994

Restoration of standing, weight-shift and gait by multichannel electrical stimulation in hemiparetic patients.

The effects of multichannel electrical stimulation of standing, weight-shift and gait were studied in hemiparetic patients. The ground reaction forces under both feet were assessed by two force plates during standing and weight-shift of 11 patients with and without three-channel stimulation of the pelvic and knee muscles. Stance symmetry and rate of the weight-shift significantly improved (p = 0.05) for 11.4% and 50.8% respectively during the stimulation. The gait of three hemiparetic patients was treated by adaptable, individually fitted four-channel stimulation. Besides peroneal nerve, knee extensor and flexor, hip extensor and abductor muscles, a shoulder-arm stimulation was introduced to elevate a depressed shoulder, initiate arm swing and erect the trunk. Gait parameters including symmetry improved consistently after the 25 stimulation sessions: velocity 33%, cadence 5%, stride length 26%, stance symmetry ratio from 0.62 to 0.97. Moreover the gait pattern was restored in all patients. The study investigated a possibility of neurophysiologically based treatment by the stimulation of standing, weight-shift and gait.

Adult↗
PubMed2002

Frontal plane knee angle affects dynamic postural control strategy during unilateral stance.

PURPOSE: Center of plantar pressure (COPP) location moves toward the forefoot as ankle plantar flexor muscles attempt to maintain postural control during single leg stance. This study evaluated relationships between frontal plane tibiofemoral joint angulation during relaxed bilateral stance and mean COPP locations during vision-denied single leg stance at 20 degrees knee flexion. METHODS: Fifty-six nonimpaired athletes (29 female, 27 male) were evaluated for frontal plane tibiofemoral joint angulation and standing foot angle by using two-dimensional videography (30 Hz). Mean anterior-posterior and mediolateral COPP locations were assessed during single leg stance on a mat (25 Hz, 15 s). One-way ANOVA and Tukey HSD tests evaluated group differences (P < or = 0.05) based on frontal plane tibiofemoral joint angulation. RESULTS: Group 1 (genu varus or genu valgus < 5 degrees ) displayed a mean anterior-posterior COPP location of 54.2 +/- 6% from the (0,0) coordinate starting point at the anterolateral foot (10.3 +/- 2 cm from the posterior sensor edge). Group 2 (genu varus angulation > or = 5 degrees ) and group 3 subjects (genu valgus angulation > or = 5 degrees ) displayed mean anterior-posterior COPP locations of 60.6 +/- 8% and 60.7 +/- 7% (8.8 +/- 2 cm and 8.7 +/- 2 cm from the posterior sensor edges), respectively. Group 2 (12.5 +/- 3 N x kg(-1)) and group 3 (12.4 +/- 3.1 N x kg(-1)) subjects also displayed greater mean plantar force magnitude/body weight than group 1 (10.3 +/- 2 N x kg(-1)) subjects. Mean ankle plantar flexor moment magnitudes did not differ between groups. CONCLUSIONS: Rearfoot directed mean anterior-posterior COPP locations and greater plantar force magnitudes/body weight suggests that subjects with genu varus or genu valgus relied more on the subtalar and midtarsal joint control function of the ankle plantar flexor muscle group for lower extremity dynamic postural control.

Adolescent↗
PubMed1999

Subthalamic nucleus stimulation for gait disturbance in Parkinson's disease.

OBJECTIVE: A preliminary study of subthalamic nucleus (STN) stimulation was performed to determine its applicability for the treatment of gait and postural disturbances in Parkinson's disease. METHODS: Five Parkinson's disease patients with freezing gait and postural instability were selected for this study. Their ages ranged from 60 to 73 years (mean+/-standard deviation, 65.6+/-4.8 years). Semi-microelectrode recording was used to identify the STN and to place a chronic electrical stimulation electrode within the right STN in all patients. The Unified Parkinson's Disease Rating Scale and the modified Hoehn and Yahr Staging Scale were used to assess patients in on- and off-drug conditions before surgery and 3 months after surgery. RESULTS: The scores on the Hoehn and Yahr Staging Scale and the total Unified Parkinson's Disease Rating Scale for akinesia (P < 0.05), gait (P < 0.05), and gait and posture (P < 0.01) in off-drug on-stimulation conditions significantly improved over the preoperative and postoperative off-drug off-stimulation conditions (analysis of variance [ANOVA], P < 0.01). Improvement over the preoperative scores was 24% on the Hoehn and Yahr Staging Scale, 43.6% on the total Unified Parkinson's Disease Rating Scale, 33.4% for akinesia, 36.6% for gait, and 38.7% for gait and posture. However, stimulation in the on-drug phase did not show a significant difference compared with pre- and postoperative conditions (ANOVA, P > 0.05). Comparisons between preoperative on-drug and postoperative off-drug on-stimulation conditions revealed that there were no significant differences in the scores, except for gait (ANOVA, P < 0.05). The scores on subscales for falling, freezing, walking, and gait in off-drug on-stimulation conditions were significantly improved over the scores for preoperative and postoperative off-stimulation (ANOVA, P < 0.05), but the score for postural stability remained unchanged. CONCLUSION: Our findings showed that STN stimulation effectively alleviates freezing gait and improves walking to its status during the preoperative on-drug phase and can be applied for treatment of Parkinson's disease patients with these symptoms.

Aged↗
PubMed1994

Visual stabilization of posture in the elderly: fallers vs. nonfallers.

BACKGROUND: Postural instability is one of the important contributors to falling in observers aged 65 years and older. In this study we examine the role of vision in the relation between postural stability and falling, as well as in the relation between postural stability and the fear of falling. METHODS: Community-dwelling adults 65 years and older were administered a questionnaire about their history of falls and fear of falling (N = 185). Postural sway was measured in the same subjects with eyes open and eyes closed. Visual function was assessed by measures of visual acuity and contrast sensitivity. RESULTS: The 29 subjects who reported falling in the last year showed less of a visual contribution to posture stabilization than those who reported no falls. Controlling for age and gender, there is a 2.13-fold increase in the likelihood of reporting falling for a 0.1 decrement in the visual stabilization index when it is measured within the context of reliable somatosensory feedback. Those who reported a fear of falling and those who reported no fear showed similar visual stabilization. Contrast sensitivity was significantly associated with visual stabilization when it was measured within the context of reliable somatosensory feedback. CONCLUSIONS: The visual contribution to postural stabilization is significantly greater in nonfallers compared to fallers, and it is significantly associated with contrast sensitivity.

Accidental Falls↗
PubMedDate not supplied

Equilibrium analysis for the forces in the human spinal column and its musculature.

The equations of equilibrium are set up for the thoracic and lumbar spine and involve body weight, external load, muscle forces, and intervertebral reactions. These equations are solved using a linear programming technique that minimizes the total force in the system. The solution gives numeric values for the muscle forces and intervertebral reactions. The results for a subject in progressive forward flexion and in lateral bend are presented. Also examined are the effects of three different orthotic devices on the muscle forces of a patient with a scoliotic spine.

Biomechanical Phenomena↗