Validating the Berg Balance Scale for patients with Parkinson's disease: A key to rehabilitation evaluation

Southeastern Parkinson's Disease Research, Education, and Clinical Center, McGuire Veterans Medical Center, Richmond, VA 23249, USA.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 05/2005; 86(4):789-92. DOI: 10.1016/j.apmr.2004.11.005
Source: PubMed


To assess the criterion-related validity of the Berg Balance Scale (BBS) in subjects with Parkinson's disease (PD).
Prospective, correlational analysis between the BBS and accepted measures of PD motor and functional impairment.
The federally funded PD research center, an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center.
Thirty-eight men (average +/- standard deviation, 71.1+/-10.5 y) with confirmed PD. Their initial diagnosis had been made on average 5.8+/-3.6 years earlier. All could stand or walk unassisted and had mild to moderate disability. Patients who could not ambulate without assistive devices were excluded.
Not applicable.
Correlational analyses between the BBS and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale, Modified Hoehn and Yahr Staging (Hoehn and Yahr) Scale, and the Modified Schwab and England Capacity for Daily Living Scale (S&E ADL Scale).
BBS score showed significant correlations with indicators of motor functioning, stage of disease, and daily living capacity. BBS score was inversely associated with the UPDRS motor score (-.58, P <.005), Hoehn and Yahr Scale staging (-.45, P <.005), and S&E ADL Scale rating (.55, P <.005). In all 3 correlations, lower scores on the BBS (indicating greater balance deficits) correlated with higher UPDRS scores (indicating greater motoric or functional impairment).
Results support the criterion-related validity of the BBS. Its utility in other balance conditions of older adults has been established. Rehabilitation interventions have been shown to improve the balance deficits associated with PD. Early referral and periodic reassessment is vital to achieving and maintaining improvements. Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD.

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Available from: Rashelle B Hayes, May 07, 2014
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    • "After providing informed consent, participants completed falls diaries over a period of 4 weeks, at the end of which they underwent a battery of assessments, including objective and self-reported measures of both motor and non-motor impairment. Relevant to the present analysis, the following data on measures of PD severity, motor function and mobility were extracted from the GABI database, and utilized for the assessment of construct validity of the ACM/PIGD: Items 13, 14, 15, 29, and 30 of the UPDRS [13] to calculate the ACM/PIGD; Hoehn and Yahr state while ON (HYS) as a measure of disease severity [14]; number of falls in the preceding 4 weeks (NOF); Activities Based Confidence Scale (ABC) [15] as a measure of the subjects' confidence in their own ability to ambulate safely; Freezing of Gait Questionnaire (FOG) [16] as a measure of freezing; Five Times Sit-to-Stand (FTSS) [17] [18], Timed Upand Go (TUG) [19] [20], Gait Velocity (GV) [21], as global measures of bradykinesia and overall mobility; and, Berg Balance Scale (BBS) [22] [23] as a measure of balance. Briefly, all objective assessments took place in the ON state, according to standardized protocols. "
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    ABSTRACT: Background: A construct calculated as the sum of items 13-15, 29, 30 of the Unified Parkinson's Disease Rating Scale (UPDRS) has been used as an "Ambulatory Capacity Measure" (ACM in Parkinson disease (PD). Its construct validity has never been examined. A similar construct, consisting of the mean value of the same UPDRS items has been used under the acronym PIGD as a measure of postural instability and gait disorder in PD. Objective: To examine the construct validity of the ACM and PIGD in PD. Methods: We analyzed data in an existing database of 340 PD patients, Hoehn and Yahr stages (HYS) 1-5 who participated in a study of falls. Number of falls (NOF) was recorded over 4 weeks, and UPDRS (mental, ADL, and motor subscales), HYS, Activities Based Confidence Scale (ABC), Freezing of Gait Questionnaire (FOG), Five Times Sit-to-Stand (FTSS), Timed Up-and Go (TUG), Gait Velocity (GV), and Berg Balance Scale (BBS) evaluations were performed. Internal consistency was assessed by Cronbach's alpha. Construct validity was assessed through correlations of the ACM and PIGD to these measures and to their summed-ranks. A coefficient of determination was calculated through linear regression. Results: Mean age was 71.4, mean age at diagnosis 61.4 years; 46% were women; mean UPDRS subscale scores were: Mental 3.7; ADL 15.7; motor: 27.1; mean ACM was 6.51, and mean PIGD 1.30. Cronbach's alpha was 0.78 for both ACM and PIGD. Spearman correlation coefficients between the ACM/PIGD and ABC, FOG, TUG, GV and BBS were 0.69, 0.72, 0.67, 0.58, and 0.70 respectively. Correlation between the ACM/PIGD and summed-ranks of HYS, NOF, ABC, FOG, FTSS, TUG, GV and BBS was high (Spearman r = 0.823, p < 0.0001); 68% of the variability in the summed-ranks was explained by ACM/PIGD. Conclusion: The ACM and the PIGD are valid global measures and accurately reflect the combined effects of the various components of ambulatory capacity in PD patients with HY stages 1-4.
    Journal of Parkinson's Disease 10/2014; 5(1). DOI:10.3233/JPD-140405 · 1.91 Impact Factor
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    • "The exceptionally strong relationship between changes in STV and changes in scores on the Berg Balance Scale and Sit-Stand Test both resulting from the exercise program supports the construct validity of STV as a measure of gait performance and postural stability. In clinical populations with PD, BBS, and SST are valid and reliable measures of postural stability and gait performance, respectively [21], [22]. Further, it could be reasoned that because significant changes were noted in the STV and not in BBS and SST, that perhaps the STV is a more sensitive tool for detecting improvements in gait and stability changes than these other clinical measures. "
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    ABSTRACT: There is a growing interest in the use of Inertial Measurement Unit (IMU)-based systems that employ gyroscopes for gait analysis. We describe an improved IMU-based gait analysis processing method that uses gyroscope angular rate reversal to identify the start of each gait cycle during walking. In validation tests with six subjects with Parkinson disease (PD), including those with severe shuffling gait patterns, and seven controls, the probability of True-Positive event detection and False-Positive event detection was 100% and 0%, respectively. Stride time validation tests using high-speed cameras yielded a standard deviation of 6.6 ms for controls and 11.8 ms for those with PD. These data demonstrate that the use of our angular rate reversal algorithm leads to improvements over previous gyroscope-based gait analysis systems. Highly accurate and reliable stride time measurements enabled us to detect subtle changes in stride time variability following a Parkinson's exercise class. We found unacceptable measurement accuracy for stride length when using Aminian and colleague's gyro-based biomechanical algorithm, with errors as high as 30% in PD subjects. An alternative method, using synchronized infrared timing gates to measure velocity, combined with accurate mean stride time from our angular rate reversal algorithm, more accurately calculates mean stride length.
    IEEE transactions on neural systems and rehabilitation engineering: a publication of the IEEE Engineering in Medicine and Biology Society 10/2013; 22(1). DOI:10.1109/TNSRE.2013.2282080 · 3.19 Impact Factor
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    • "Each task is scored between 0 and 4 and indicates the capacity of an individual to execute tasks independently. A total score of 56 is possible and higher scores point to better balance status (Qutubuddin et al., 2005; Scalzo et al., 2009) -Cognitive screening (Mini Mental Exam Examination - MMSE): a brief 30-point questionnaire to evaluate spatial and temporal orientation, memory, language, attention, ability to do calculations and constructive visual capacity. Scores under 24 means that the subject has its mental capacity impaired. "
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    ABSTRACT: The severity of Parkinson's disease (PD) and PD's motor subtypes influence the components of physical capacity. The aim of this study was to investigate the impact of both PD severity and motor subtype in the performance of these components. Thirty-six PD patients were assigned into four groups: Tremor (TD) initial and TD mild, akinetic-rigid (AR) initial, and AR mild. Patients' strength, balance, coordination, mobility and aerobic capacity were evaluated and groups were compared using a two-way ANOVA (severity and subtype as factors). AR presents a poorer performance than TD in almost all tests. Also this performance was worsened with the advance of the disease in AR, contrary to TD. We conclude that AR and TD subgroups are different about their performance on physical capacity components, moreover, this performance worsens with the advance of the disease of the AR group, but not for TD.
    Motriz. Revista de Educação Física 09/2013; 19(3):605-613. DOI:10.1590/S1980-65742013000300011 · 0.09 Impact Factor
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