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PubMed2001

Foot pain impairs balance and functional ability in community-dwelling older people.

Foot problem assessments were performed on 135 community-dwelling older people in conjunction with clinical tests of balance and functional ability. Eighty-seven percent of the sample had at least one foot problem, and women had a higher prevalence than men of foot pain, hallux valgus, plantar hyperkeratosis, lesser digital deformity, and digital lesions. Postural sway did not differ between older people with and without each of these foot conditions. However, the presence of specific foot conditions impaired performance in a more challenging balance test and in some functional tests. In particular, older people with foot pain performed worse in a leaning balance test, stair ascent and descent, an alternate step-up test, and a timed six-meter walk. Furthermore, multiple regression analyses revealed that foot pain was a significant independent predictor of performance in each of these tests. These results show that the presence of foot problems, particularly foot pain, impairs balance and functional ability. As foot pain is amenable to treatment, podiatric intervention has the potential to improve mobility and independence in older people.

Aged↗

PubMed2002

The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial.

OBJECTIVE: To investigate the effect of independent practice of sitting balance as an addition to standard physiotherapy treatment for patients with stroke. DESIGN: Randomized controlled trial, using blocked randomization procedure with 2:1 ratio. SUBJECTS: Inpatients with diagnosis of stroke, having achieved one minute of independent sitting balance but not yet achieved 10 independent steps, and with no known previous disabilities, pathology or neurological deficit affecting mobility prior to stroke. INTERVENTION: A four-week regime of independent practice aimed at improving aspects of balance, as an addition to standard physiotherapy treatment based on the Bobath Approach. MAIN OUTCOME MEASURE: Proportion of patients achieving 'normal' symmetry of weight distribution during sitting, standing, rising to stand, sitting down, and reaching. RESULTS: Nineteen subjects were randomized to the control group; nine to the intervention group. There were no clinically significant differences in measured outcome between the groups. CONCLUSIONS: The regime of independent practice had no measured beneficial effect on the balance ability of patients with recently acquired stroke.

Aged↗

PubMed2001

Development of lower extremity kinetics for balance control in infants and young children.

Developmental changes in the kinematics and kinetics underlying balance control were studied in 61 children, 9 months to 10 years of age. The children were classified according to developmental milestones as standers; new, intermediate, and advanced walkers; runners-jumpers; hoppers; gallopers; and skippers. The children experienced support-surface translations of varying size and speed. Children with greater locomotor experience withstood larger balance threats without collapsing or stepping. Analyses of scaled trials (perturbations normalized in size to foot length and center of gravity height) revealed that improvement in balance was not related to initial configuration parameters surrounding the task (degree of crouch or lean). Children with advanced locomotor skills had faster recovery times and relatively larger muscle torques than children with less experience. Relative torque-time histories of the more experienced children began to match the adult response to similar perturbations. With increased experience and changing muscle torque regulatory abilities, balance skills became more robust.

Child↗

PubMed2005

Proficiency of balance in children and youth who have had acute lymphoblastic leukemia.

BACKGROUND AND PURPOSE: As the survival rate for acute lymphoblastic leukemia (ALL) in childhood increases, long-term sequelae are a growing concern. This cross-sectional, descriptive study compared the balance skills of children and youth who have had ALL with those of comparable subjects and explored associations with demographics, therapy, physical activity, and health-related quality of life (HRQL). SUBJECTS: Ninety-nine subjects treated previously for ALL and 89 comparison subjects were examined. METHODS: Measures included the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) balance subtest, the Children's Self-perceptions of Adequacy in and Predilection for Physical Activity Scale (CSAPPA), and the Health Utilities Index (HUI), a measure of HRQL. RESULTS: The children and youth who had ALL had poorer balance than the comparison subjects (BOTMP = 10.55 and 16.30, respectively) and lower CSAPPA scores (57.72 and 63.72, respectively) and HUI scores (0.86 and 0.97, respectively). Regression analyses identified exposure to cranial irradiation, being overweight, lower CSAPPA scores for adequacy, and lower HUI single-attribute scores for cognition as predictors of lower balance scores in subjects who had ALL. DISCUSSION AND CONCLUSION: Balance abilities in subjects treated for ALL were compromised, and several factors were associated with this deficit.

Adolescent↗

PubMed2001

Elderly subjects' ability to recover balance with a single backward step associates with body configuration at step contact.

BACKGROUND: In the event of a slip or trip, one's ability to recover a stable upright stance by stepping should depend on (a) the configuration of the body at the instant of step contact and (b) the forces generated between the foot and ground during step contact. In this study, we tested whether these two variables associate with elderly subjects' ability to recover balance by taking a single backward step after sudden release from an inclined position. METHODS: Twenty-six community-dwelling subjects (12 women, 14 men) of mean age 75+/-4 (SD) years each underwent five trials in which they were suddenly released from a backward inclination of 7 degrees and instructed to "recover balance with a single step." Body segment motions and foot contact forces were analyzed to determine step contact times, stepping angles, body lean angles at step contact, and the magnitudes and times (after step contact) of peak foot-floor contact forces and peak sagittal-plane torques at the ankle, knee, and hip of the stepping leg. RESULTS: Fifty percent of subjects were predominantly single steppers (successful at recovering with a single step in greater than three of five trials), 27% were multiple steppers (successful in less than two of five trials), and 23% were mixed response steppers (successful in two of five or three of five trials). Recovery style associated with the ratio of stepping angle divided by body lean angle at step contact (p = .003), which averaged 1.4+/-0.5 for single steppers and 0.6+/-0.5 for multiple steppers, but not with step contact time, stepping angle, or contact forces and joint torques during step contact. CONCLUSIONS: These results suggest that elderly subjects' ability to recover balance with a single backward step depends primarily on the configuration of the body (in particular, the ratio of stepping angle to body lean angle) at step contact.

Aged↗

PubMed1995

Postural control after propofol anaesthesia in minor surgery.

There is, not only from an economic perspective, a continuous search for surgical and anaesthetic procedures that allow out-patient surgery to be conducted. Reliable estimators of the patient's street fitness are of the utmost importance. Balancing capacity is one aspect that should be considered. Clinical methods like Romberg's are subjective and imprecise. Dynamic posturography comprises a movable support surface and visual surround that are either stable or referenced to the patient's sway, with eyes open or closed. In this study the recovery from propofol anaesthesia was studied in 8 patients who underwent surgery for minor microlaryngoscopic procedures. Dynamic posturography who performed before, and 2 and 4 h after cessation of anaesthesia. All patients who were awake had normal balancing ability already at 2 h after anaesthesia. Further studies may supply additional information of other aspects of discharge after anaesthesia.

Adult↗

PubMed2001

Relationship between change in balance and self-reported handicap after vestibular rehabilitation therapy.

BACKGROUND AND PURPOSE: Dizziness and balance problems are two commonly reported symptoms of vestibular system disease, with subsequent alterations in lifestyle and reports of physical, functional and emotional handicap. Vestibular rehabilitation therapy (VRT) was developed to improve the functional status of patients with vestibular dysfunction. The aim of the present study was to investigate the relationship between change in balance performance and change in self-rated handicap after a four-week home exercise programme in 16 subjects with chronic vestibular disease. METHOD: Before and after the treatment intervention, balance was tested by use of a Smart Balance Master (SBM) system (Neurocom International, Clackamas, OR, USA) and self-rated handicap was measured by use of the Dizziness Handicap Inventory (DHI). RESULTS: Significant improvement was observed in both the SBM (p < 0.001) and DHI (p = 0.003) scores over the testing period. A moderately strong negative correlation existed between change in SBM and DHI scores (Spearman's r = -0.6). Further analysis using the DHI subscales indicated, however, that the emotional component showed no significant change over time, and a poor correlation with change in balance scores (Spearman's r = -0.39). CONCLUSIONS: These results indicate that a home-based exercise programme can significantly improve balance abilities in people with chronic vestibular dysfunction, but that outcomes may be enhanced by addressing the emotional issues associated with their disability.

Adult↗

PubMed1997

Comparison of upper-extremity balance tasks and force platform testing in persons with hemiparesis.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the relationship between clinically accessible functional balance tools and sophisticated force platform measures in a standing position. SUBJECTS: Twenty persons who had hemiparesis secondary to a stroke and were ambulatory (mean age = 57.9 years, SD = 13.6, range = 35-79) were evaluated during a single testing session. METHODS: Performances on self-generated upper-extremity balance tasks using the nonparetic side (Functional Reach Test [FRT], arm raise and arm reach tasks) were compared with responses to external perturbations on the Balance System (postural sway, symmetry of weight distribution). RESULTS: No relationship was found between the upper-extremity balance tests and the force platform measures of postural sway. After suppressing the effect of age by means of partial correlation coefficients, the FRT was correlated with measures of postural symmetry in parallel stance on the Balance System (r = .66-.78). The FRT was only moderately correlated with the arm raise and arm reach tasks (r = .43 and .44). CONCLUSION AND DISCUSSION: Postural sway in response to force platform perturbations may have little relation to the postural control necessary for self-generated upper-extremity balance tasks. In contrast, the FRT and the force platform measures of postural symmetry appear to be evaluating comparable standing-balance abilities in persons with hemiparesis. The modest relationship between the FRT and the arm raise and arm reach tasks limits the finding's clinical relevance.

Adult↗

PubMed2005

Sensory organization determinants of postural stability in trained ballet dancers.

Trained ballet dancers and nondancer controls completed six balance tests using computerized dynamic posturography. The tests facilitated assessment of the type of sensory organization used to maintain postural control under conditions ranging from quiet standing to a situation in which visual and/or somatosensory information was systematically removed or made unreliable. Results indicated that ballet dancers and controls have comparable balance ability during eyes open and eyes closed conditions. However, when somatosensory information alone or in combination with visual information was made unreliable, dancers were significantly less stable than controls and utilized a hip strategy to maintain postural control.

Adult↗

PubMed1998

Balance in the cat: role of the tail and effects of sacrocaudal transection.

To determine whether the tail of the domestic cat plays a role in balance during locomotion, four cats were trained to traverse a narrow beam. To challenge balancing ability, a sudden lateral displacement was imparted to the beam as the subject was crossing. Freeze-frame videotape analysis revealed that cats responded to beam movement by rapidly moving the tail in the opposite direction. Adjustment of the tail contributed to realignment of the hips over the beam and enabled the animal to remain aboard the beam. Following complete sacrocaudal spinal transection, that eliminated supraspinal control to only the tail, cats fell significantly more often in response to movements of the beam. The importance of the cat's tail for balance, and the utility of this system for modeling functional consequences of spinal cord injury and therapeutic interventions, are discussed.

Animals↗

PubMed1991

The impact of daily exercise on the mobility, balance and urine control of cognitively impaired nursing home residents.

The purpose of this intervention study was to examine the impact of a daily exercise regimen on the mobility, balance, and urine control of a sample of cognitively impaired elderly nursing home residents. A quasi-experimental pretest-posttest design was used with 15 elderly, cognitively impaired, incontinent nursing home residents. Data were collected regarding walking distance, speed of walking, balance ability, ability to rise from a chair unassisted, ability to walk unassisted, and incidence of urinary incontinence before and after a month of daily assisted walking. Subjects were able to walk significantly greater distances before tiring after the exercise regimen. In addition, the incidence of urinary incontinence was significantly decreased.

Aged↗

PubMed1995

Influence of cerebrospinal fluid tapping on dynamic equilibrium in suspected hydrocephalus.

Thirty-nine patients aged 21-82 years (mean 62 years) under investigation for suspected acquired hydrocephalus were investigated by dynamic posturography before and 6-8 h after a cerebrospinal fluid tap of 20-40 ml. Dynamic posturography comprises a sensory organization (SO) part in which the platform and visual surround are either stable or referenced to the patient's sway. The eyes are closed or open. In a movement coordination (MC) part the platform makes active movements, thus introducing external disturbances in the procedure. The patients improved their balancing ability in all tests on the sway referenced platform in SO, while MC remained unaffected. It is concluded that dynamic posturography is valuable for dysequilibrium assessment in clinical evaluation of suitable candidates for ventricular shunts in acquired hydrocephalus.

Adult↗

PubMed2006

Effect of occlusion status on the time required for initiation of recovery in response to external disturbances in the standing position.

BACKGROUND: To examine whether occlusion status contributes to improvement of postural balance. METHODS: Thirty healthy adolescents (15 males and 15 females; mean age, 20.3; standard deviation (SD) 1.6 years) with no equilibrium or stomatognathic function abnormalities were examined. Occlusion is a term meaning "jaw clenching." Occlusion status was evaluated by measuring masseter activity using the EMG system. Balancing ability was evaluated using the EquiTest system, which measures sway of the center of gravity produced by rapid movement of force plates as an external disturbance (three intensity levels). The time required for initiation of recovery after application of the disturbance was calculated by measuring displacement of the center of foot pressure. Data were compared according to occlusion status. FINDINGS: Little difference in latency was observed following a small disturbances; however, the greater the disturbance the shorter the latency with occlusion, while without occlusion, latency increased with increasing disturbance. A statistically significant interaction (P<0.001) between occlusion and external disturbance was also found. INTERPRETATION: This study suggested that occlusion contributes to maintenance of postural balance and improvement of stability when unexpected sway occurs in the standing position.

Accidental Falls↗

PubMed1995

Driving ability in cancer patients receiving long-term morphine analgesia.

When given in single doses to healthy volunteers, opioid analgesics impair reaction time, muscle coordination, attention, and short-term memory sufficiently to affect driving and other skilled activities. Despite the increasing use of oral morphine daily, little is known about the effect of long-term opioid therapy on psychomotor performance. To examine the effects of continuous morphine medication, psychological and neurological tests originally designed for professional motor vehicle drivers were conducted in two groups of cancer patients who were similar apart from experience of pain. 24 were on continuous morphine (mean 209 mg oral morphine daily) for cancer pain; and 25 were pain-free without regular analgesics. Though the results were a little worse in the patients taking morphine, there were no significant differences between the groups in intelligence, vigilance, concentration, fluency of motor reactions, or division of attention. Of the neural function tests, reaction times (auditory, visual, associative), thermal discrimination, and body sway with eyes open were similar in the two groups; only balancing ability with closed eyes was worse in the morphine group. These results indicate that, in cancer patients receiving long-term morphine treatment with stable doses, morphine has only a slight and selective effect on functions related to driving.

Administration, Oral↗

PubMed2006

Age-associated decrease of type IIA/B human skeletal muscle fibers.

Elderly individuals often fall because of poor muscle strength and reduced balancing ability related to muscle aging. However, it is unclear whether changes in muscle fiber types contribute to poor strength or imbalance. We studied age- associated changes in human skeletal muscle fibers using muscle biopsy specimens taken from 65 male and female Chinese patients aged 17-96 years. The muscle specimens were cryosectioned with alkaline triphosphatase staining at pH 4.4, followed by image analysis. We analyzed morphologic observations and performed quantitative analyses of the number, size, and area percentage of different types of skeletal muscle fibers and connective tissues. Types IIA and IIB muscle fibers decreased with age in the area percentage, fiber number percentage, and mean fiber area, whereas Type I fibers increased in area and number but not in size. Morphologically, Type II fibers appeared smaller and flatter. Our findings suggest deterioration in muscle quality and balancing coordination in elderly patients. We provide data to help determine treatments for reversing muscle fiber changes and reducing the number of falls and related fractures in patients.

Accidental Falls↗

PubMedDate not supplied

Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players.

Anterior cruciate ligament injuries are occurring at a higher rate in female athletes compared with their male counterparts. Research in the area of anterior cruciate ligament injury has increasingly focused on the role of joint proprioception and muscle activity in promoting knee joint stability. We measured knee joint laxity, joint kinesthesia, lower extremity balance, the amount of time required to generate peak torque of the knee flexor and extensor musculature, and electromyographically assessed muscle activity in 34 healthy, collegiate-level athletes (average age, 19.6 +/- 1.5 years) who played soccer or basketball or both. Independent t-tests were used to determine significant sex differences. Results revealed that women inherently possess significantly greater knee joint laxity values, demonstrate a significantly longer time to detect the knee joint motion moving into extension, possess significantly superior single-legged balance ability, and produce significantly greater electromyographic peak amplitude and area of the lateral hamstring muscle subsequent to landing a jump. The excessive joint laxity of women appears to contribute to diminished joint proprioception, rendering the knee less sensitive to potentially damaging forces and possibly at risk for injury. Unable to rely on ligamentous structures, healthy female athletes appear to have adopted compensatory mechanisms of increased hamstring activity to achieve functional joint stabilization.

Adult↗

PubMed2003

A model of neuro-musculo-skeletal system for human locomotion under position constraint condition.

The human locomotion was studied on the basis of the interaction of the musculo-skeletal system, the neural system and the environment. A mathematical model of human locomotion under position constraint condition was established. Besides the neural rhythm generator, the posture controller and the sensory system, the environment feedback controller and the stability controller were taken into account in the model. The environment feedback controller was proposed for two purposes, obstacle avoidance and target position control of the swing foot. The stability controller was proposed to imitate the self-balancing ability of a human body and improve the stability of the model. In the stability controller, the ankle torque was used to control the velocity of the body gravity center. A prediction control algorithm was applied to calculate the torque magnitude of the stability controller. As an example, human stairs climbing movement was simulated and the results were given. The simulation result proved that the mathematical modeling of the task was successful.

Adaptation, Physiological↗

PubMed1994

A multifactorial intervention to reduce the risk of falling among elderly people living in the community.

BACKGROUND: Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. METHODS: We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). RESULTS: During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. CONCLUSIONS: The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.

Accidental Falls↗