Article

Balance and fear of falling in Parkinson's disease

December 2005
Parkinsonism & Related Disorders 11(7):427-33

DOI:10.1016/j.parkreldis.2005.05.005

Source
PubMed

Authors:

To assess internal consistency and validity of measures of balance (Berg balance scale, BBS), postural changes (postural changes scale, PCS) and fear of falling (fear of fall measure, FFM) in 70 ambulant Parkinson's disease (PD) persons, these instruments were matched with performance-based balance and mobility tests, and other clinical, functional and quality of life PD-specific measures. The BBS, PCS and FFM showed a good internal consistency, moderate to good inter-correlation, and a significant correlation with measures of both disability (UPDRS-ADL, Schwab and England scale) and--to a lesser extent--impairment/severity of symptoms (UPDRS-ME, Hoehn and Yahr Scale). Tandem Romberg, Single-Limb Stance, Functional Reach, and the Timed Up & Go test correlated slightly better with BBS than with PCS and FFM. This study shows that problems of balance and postural control in PD patients result from complex interactions between motor impairment, functional abilities and fear of falling.

The Association of Balance, Fear of Falling, and Daily Activities With Drug Phases and Severity of Disease in Patients With Parkinson

Article

Full-text available

Jul 2024

Parvane Bazipoor

A new postural stability-indicator to predict the level of fear of falling in Parkinson’s disease patients

Article

Full-text available

Aug 2020
BIOMED ENG ONLINE

Background: Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. Seventy percent of Parkinson's disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error. Objectives: In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods: Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRis; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF-related behavior(s). Results: FTR1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = - 0.63, p < 0.001), Pull test (r = - 0.65, p < 0.001), Timed Up and Go test (r = - 0.57, p < 0.001), and Berg Balance Scale (r = 0.62, p < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions: Using the proposed assessment technique, we can accurately predict the intensity of FoF in PD patients. Also, the FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

A New Postural Stability-Indicator to Predict the Level of Fear of Falling in Parkinson’s Disease Patients

Preprint

Full-text available

Jun 2020

Background: Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. Seventy percent of Parkinson’s disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error. Objectives: In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods: Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRi’s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF related behavior(s). Results: FTR1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = −0.63, P < 0.001), Pull Test (r = −0.65, p < 0.001), Timed Up and Go test (r = −0.57, p < 0.001), and Berg Balance Scale (r = 0.62, p < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions: Using the proposed assessment technique we can accurately predict the intensity of FoF in PD patients. Also, The FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

A New Postural Stability-Indicator to Predict the Level of Fear of Falling in Parkinson’s Disease Patients

Preprint

Full-text available

Jun 2020

Background: Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. Seventy percent of Parkinson’s disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error. Objectives: In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods: Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRi’s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF related behavior(s). Results: FTR1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = −0.63, P < 0.001), Pull Test (r = −0.65, P < 0.001), Timed Up and Go test (r = −0.57, P < 0.001), and Berg Balance Scale (r = 0.62, P < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions: Using the proposed assessment technique we can accurately predict the intensity of FoF in PD patients. Also, The FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

A New Postural Stability-Indicator to Predict the Level of Fear of Falling In Parkinson’s Disease Patients

Preprint

Full-text available

Jun 2020

Background Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. 70% of Parkinson’s disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error. Objectives In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRi’s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF related behavior(s). Results FTR 1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = − 0.63, P < 0.001), Pull Test (r = − 0.65, P < 0.001), Timed Up and Go test (r = − 0.57, P < 0.001), and Berg Balance Scale (r = 0.62, P < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions Using the proposed assessment technique we can accurately predict the intensity of FoF in PD patients. Also, The FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

Measures of balance and falls risk prediction in people with Parkinson’s disease: a systematic review of psychometric properties

Article

Full-text available

Oct 2019

Objective To investigate the psychometric properties of measures of balance and falls risk prediction in people with Parkinson’s disease (PD). Data sources PubMed, Embase, CINAHL, Ovid Medline, Scopus, and Web of Science were searched from inception to August 2019. Review method Studies testing psychometric properties of measures of balance and falls risk prediction in PD were included. The four-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) assessed quality. Results Eighty studies testing 68 outcome measures were reviewed; 43 measures assessed balance, 9 assessed falls risk prediction, and 16 assessed both. The measures with robust psychometric estimation with acceptable properties were the (1) Mini-Balance Evaluation Systems Test (Mini-BEST), (2) Berg Balance Scale, (3) Timed Up and Go test, (4) Falls Efficacy Scale International, and (5) Activities-Specific Balance Confidence scale. These measures assess balance and falls risk prediction at the body, structure and function level, falls risk and balance, and falls risk at the activity level. The motor examination of the Unified Parkinson’s Disease Rating Scale (UPDRS-ME) with robust psychometric analysis is a condition-specific measure with acceptable properties. Except the UPDRS-ME and Mini-BESTest, the responsiveness of the other four measures has yet to be established. Conclusion Six of the 68 outcome measures have strong psychometric properties for the assessment of balance and falls risk prediction in PD. Measures assessing balance and falls risk prediction at the participatory level are limited in number with a lack of psychometric validation.

The Association Between Balance, Fear of Falling and Daily Activities in Drug Phases and Different Levels of Disease Severity in Patients With Parkinson's Disease

Article

Full-text available

Jul 2019

Introduction: In the elderly, functional balance, fear of falling, and independence in daily living activities are interrelated; however, this relationship may change under the influence of drug phase and the severity of disease in individuals with idiopathic Parkinson disease. This study aimed to investigate the association of functional balance, fear of falling, and independence in the Activities of Daily Living (ADL) with the drug on- and drug off-phases. Methods: A total of 140 patients with Parkinson disease (age: Mean±SD; 60.51±12.32 y) were evaluated in terms of their functional balance, fear of falling, and independence in their daily activities by the Berg Balance Scale (BBS), Fall Efficacy Scale-International (FES-I), and Unified Parkinson Disease Rating Scale-ADL (UPDRS-ADL), respectively, in drug on- and drug off-phases. The Hoehn and Yahr scale recorded global disease rating. The Spearman coefficient, Kruskal-Wallis, and Mann-Whitney tests were used to find out whether the distribution of scale scores differs with regard to functional balance or disease severity. Results: A strong correlation was found between the functional balance, fear of falling, and independence in ADL with both drug phases. The results also showed the significant difference in the distribution of the FES-I and UPDRS-ADL scores with regard to functional balance (except independence in ADL in drug off-phase). Also, the distribution of the scores of BBS, FES-I, and UPDRS-ADL showed significant differences with regard to disease severity. Conclusion: The study showed a strong correlation between functional balance, fear of falling, and independence in ADL that can be affected by the drug phase and severity of the disease. However, more studies are needed to understand this relationship precisely.

Fear of falling impairs spatiotemporal gait parameters, mobility, and quality of life in Parkinson's disease: a cross-sectional study

Article

Jan 2025
NEUROL SCI

Fear of Falling (FOF) significantly affects Parkinson's Disease (PD) patients by limiting daily activities and reducing quality of life (QoL). Though common in PD, the relation between FOF, mobility, and QoL remains unclear. This study examines the connections between FOF, gait, daily motor activity, and QoL in PD patients. Fifty PD patients on stable levodopa therapy were enrolled, excluding those with dementia or walking impairments. Assessments included UPDRS-III, Hoehn and Yahr, MoCA, Berg Balance scale, Geriatric Depression Scale and Fall Efficacy Scale International (FES-I). QoL was evaluated using PDQ39. The Timed-Up-and-Go (TUG) test was performed at regular and fast paces, with data collected via smartphone apps for TUG gait parameters and for 24-h quantity of movement monitoring (Activity Index, AIX). A subgroup of 10 patients also underwent 24-h gait monitoring. FOF was found in 38% of patients, correlating with worse motor scores and QoL (UPDRS-III, 26 vs 17, p < 0.0001; PDQ39 36 vs 14, p < 0.0001). FOF patients showed slower walking (0.73 m/s vs 1.13 m/s, p < 0.001), reduced step length (0.151 vs 0.220 m, p < 0.001), and poorer adaptation to fast walking and environment (being unable to vary their speed and frequency). FOF and sex were both associated with a reduced mobility QoL, with a significant contribution of AIX only in women (r -0.648, p = 0.012). This study supports the existence of a significant correlation between FOF, motor activity and QoL in PD, especially in women, emphasize the need for targeted interventions, early rehabilitation and prospective studies focusing on gender.

A neuromechanical model characterizing the motor planning and posture control in the voluntary lean in Parkinson’s disease

Article

Full-text available

Feb 2024
J NEUROENG REHABIL

Parkinson’s disease targets patients’ cognitive and motor abilities, including postural control. Many studies have been carried out to introduce mathematical models for a better understanding of postural control in such patients and the relation between the model parameters and the clinical assessments. So far, these studies have addressed this connection merely in static tests, such as quiet stance. The aim of this study is to develop a model for voluntary lean, and as such, identify the model parameters for both PD patients and healthy subjects from experimental data. The proposed model comprises planning and control sections. The model parameters for the planning section were extracted from the time response characteristics. Parameters for the control section were identified based on the spatial characteristics of the center-of-pressure (COP) response using an optimization process. 24 PD patients along with 24 matched healthy subjects participated in the study. The results showed a significant difference between the two groups in terms of temporal parameters for the planning section. This difference emphasizes bradykinesia as an essential symptom of PD. Also, differences were found for the postural control section. In all directions, the proportional gain of the feedback controller was significantly larger in PD patients; however, the gain of the feedforward controller was significantly smaller in PD patients. Furthermore, the control gains were strongly correlated with the clinical scales (Functional Reach Test and Unified Parkinson's Disease Rating Scale) in certain directions. In conclusion, the new model helps to better understand and quantify some PD symptoms in voluntary lean tasks.

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson’s Disease

Article

Full-text available

Jan 2023
SENSORS-BASEL

Background: Fear of falling (FOF) is common in Parkinson’s disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. Methods: In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. Results: According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Conclusion: Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

Comparison of the DiagnosticAccuracy of Common Balance Measurement Tools in Community-Dwelling OlderAdults

Article

Full-text available

Dec 2022

Introduction: Balance screening has been identified as a major predictor of falls in the elderly. The current study compares the diagnostic accuracy of various balance instruments in community-dwelling older adults. Materials and Methods: In this cross-sectional study, 145 older adults were recruited. The Berg balance scale (BBS), Fullerton advanced balance (FAB) scale, dynamic gait index (DGI), performance-oriented mobility assessment (POMA), timed up and go (TUG) test, gait speed, step length, step test, and single item question were administered. The receiver operating characteristics curve analysis was used to calculate diagnostic accuracy. Results: All single-item tools had moderate diagnostic accuracy (area under the curve [AUC]=0.76-0.89) and all multi-item tools had high diagnostic accuracy (AUC=0.91-0.95) when using the recommended cut-off point of 45 for BBS. All multi-item tools maintained high to moderate diagnostic accuracy (AUC=0.85-1.00) in all thresholds while using BBS severity cut-off points. The FAB scale showed the highest diagnostic accuracy (AUC=0.95) among all assessment tools. Single-item question scores (Wald=22.61, df=1, P=0.0001, Exp(B)=8.82) were significant as covariates in the regression model. Conclusion: For older adults with or without a history of falling, the FAB scale demonstrated the highest diagnostic accuracy. Along with single-item tools, the FAB scale may be a preferred multi-item tool.

Evaluation of the psychometric properties and clinical applications of the Timed Up and Go test in Parkinson disease: a systematic review

Article

Full-text available

Aug 2020

To review and systematically summarize the psychometric and clinical properties (reliability, validity, responsiveness) of the Timed Up and Go test applied to persons diagnosed with Parkinson disease. A systematic review was performed by screening four scientific databases (MED-LINE, CINAHL, and PubMed). Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change, and/or clinical properties of the Timed Up and Go test in persons with Parkinson disease. Twenty-four studies were selected. Nine analyzed reliability and yielded "good" to "moderate" scores. Seventeen used a range of different contrast tests to assess validity of the Timed Up and Go test and found "good" quality scores in those that assessed balance. Only two studies analyzed sensitivity to change and they reported "poor" quality scores. The use of Timed Up and Go in Parkinson disease patients presents good reliability and validity (when compared to tests that assess balance).

Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates

Article

Full-text available

Jul 2020
PLOS ONE

Background Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. Methods We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. Results There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes ‘excessive.’ The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. Conclusions The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.

Design and validation of a new instrument to assess fear of falling in Parkinson's disease

Article

Aug 2019

Background: Fear of falling may be significantly associated with falls in Parkinson's disease (PD) and may have a negative impact on quality of life. Nevertheless, there are no valid and reliable tools to examine this condition in PD. The objective of this study was to design and determine the psychometric attributes of an instrument to assess fear of falling in PD. Methods: A prospective 1-year, 2-phase study was conducted to validate the Fear of Falling Scale, a self-assessed instrument for assessing fear of falling in PD. During phase 1, we designed a scale to measure the severity of fear of falling and determine its baseline psychometric characteristics, whereas phase 2 was a 1-year follow-up study to assess the frequency of falls and other clinical factors linked to fear of falling. Convergent and discriminant validity were assessed against the Fear of Falling Measure and the Starkstein Apathy Scale, respectively. Results: The Fear of Falling Scale showed high internal consistency, test-retest reliability, and strong convergent and discriminant validity. There was a significant association between fear of falling score and the presence of both generalized anxiety disorder and major depression, poor balance-related motor ability, increased nonmotor symptoms of PD, more severe impairments in activities of daily living, and increased motor fluctuations. Finally, generalized anxiety disorder was a significant predictor of number of falls during a 12-month follow-up period. Conclusions: The Fear of Falling Scale is a valid and reliable instrument to assess fear of falling in PD. Fear of falling in PD is associated with specific psychiatric and motor disorders and is significantly related to the performance of balance-related motor functions. © 2019 International Parkinson and Movement Disorder Society.

Postural Control in Individuals with Parkinson’s Disease

Chapter

Full-text available

Nov 2018

Evaluation of Balance Disorders in Parkinson's Disease Using Simple Diagnostic Tests—Not So Simple to Choose

Article

Full-text available

Oct 2018

Background: Balance disorders are one of the main symptoms in parkinson's Disease (PD)—patients have a tendency to fall, related traumas and also a significant restriction of mobility. Numerous tools may be used to evaluate the balance, but it is difficult to choose the proper one. The aim of this review was to compare simple diagnostic tools for PD and emphasize those characterized by a high reliability and sensitivity. Methods: The global literature search was conducted in PubMED, Scopus, Science Direct, Web of Science, Cochrane, and Google Scholar for publications in English and Polish. Results: According to the literature some scales and functional tests in which clinimetric properties had been assessed in PD population were selected and described. Conclusion: Basing on current knowledge, psychometric properties, and clinical experience, the authors suggest the BESTest with its shortened versions and the Fullerton Advanced Balance Scale to be used for comprehensive balance assessment of parkinson's disease patients. These tests are easy in administration, not time-consuming and provide a professional diagnosis allowing to plan individual therapy for the patient being examined.

Effectiveness of aerobic exercise interventions on balance, gait, functional mobility and quality of life in Parkinson’s disease: an umbrella review

Article

Full-text available

Dec 2024

Introduction Parkinson’s disease (PD) is a neurodegenerative disorder with increasing prevalence into older age. Aerobic exercise (AE) is the most commonly prescribed exercise for PD, although an optimal protocol is undefined. This umbrella review aimed to summarise and synthesize existent evidence regarding the effectiveness of AE on balance, gait, functional mobility, and QoL in people with PD. Content Six databases were searched for systematic reviews reporting the effects of AE on balance, gait, functional mobility, and QoL in people with PD from inception to June 2024. Quality of evidence was assessed using the AMSTAR-2 tool. From 4182 records, 17 systematic reviews were included for qualitative analysis. Most (n=12) were rated as critically low for methodological quality, with four rated low and one high. Moderate intensity was the most commonly investigated AE intensity (n=4), although almost half of the reviews (n=8) did not report intensity. AE protocols lasted from 1 to 64 weeks and 1 to 7 days per week. Session length was between 20 and 120 minutes. Reported outcomes included gait (n=15), QoL (n=14), balance (n=12), and functional mobility (n=7). AE does improve aspects of gait, balance, and functional mobility in PD; however it does not appear to improve QoL. Summary and Outlook AE is recommended as part of rehabilitation for people with PD. However, research exploring the efficacy of AE assesses multiple modalities with varied protocols. Further research is needed to identify AE protocols that will best alleviate the symptoms of PD, providing an evidence base for effective clinical translation.

Evaluating plantar biomechanics while descending a single step with different heights

Article

Full-text available

Aug 2024

Objective This study aims to investigate the plantar biomechanics of healthy young males as they descend a single transition step from varying heights. Methods Thirty healthy young males participated the experiment using the F-scan insole plantar pressure system in which participants made single transition steps descent from four step heights (5, 15, 25, and 35 cm), leading with their dominant or non-dominant foot. Plantar pressure data were collected for 5 s during the period between landing touchdown and standing on the ground. Landing at each step height was repeated three times, with a five-minute rest between different height trials. Results At 5 cm and 15 cm steps, participants demonstrated a rearfoot landing strategy on both sides. However, forefoot contact was observed at heights of 25 cm and 35 cm. Parameters related to center of plantar pressure (COP) of the leading foot were significantly larger compared to the trailing foot (P < 0.001), increased with higher step heights. Vertical ground reaction forces for the biped, leading and trailing feet decreased with increasing step height (all P < 0.05). The leading foot had a higher proportion of overall and forefoot loads, and a lower proportion of rearfoot load compared to the trailing foot (P < 0.001). The overall load on the dominant side was lower than that on the non-dominant side for both the leading and trailing feet (P < 0.001). For the trailing foot, forefoot load on the dominant side was lower than that on the non-dominant side, however, the opposite result appeared in rearfoot load (P < 0.001). Upon the leading foot landing, forefoot load exceeded the rearfoot load for the dominant (P < 0.001) and non-dominant sides (P < 0.001). Upon the trailing foot landing, forefoot load was lower than the rearfoot load for the dominant (P < 0.001) and non-dominant sides (P = 0.019). Conclusion When the characteristics of biomechanical stability are compromised by step height, landing foot, and footedness factors — due to altered foot landing strategies, changing COP, or uneven force distribution — ability to control motion efficiently and respond adaptively to the forces experienced during movement is challenged, increasing the likelihood of loss of dynamic balance, with a consequent increased risk of ankle sprains and falls.

Dance-Based Exergaming To Improve Physical Function In Aging and Stroke

Article

Aug 2024

Savitha Subramaniam

The Effects of Lumbar Muscle Myofascial Release Technique in Parkinson’s Disease with Chronic Pain: A Pilot Experimental Study

Article

Dec 2023

THE EFFECT OF DISABILITY AND SELF-CARE AGENCY ON ACTIVITIES OF DAILY LIVING IN PATIENTS WITH PARKINSON’S DISEASE

Article

Full-text available

Aug 2023

Do visual and step height factors cause imbalance during bipedal and unipedal stances? A plantar pressure perspective

Article

Full-text available

Aug 2023

Objective: The plantar pressure analysis technique was used to explore the static balance ability and stability of healthy adult males under the influence of visual and step height factors during bipedal and unipedal stances. Methods: Thirty healthy adult males volunteered for the study. Experiments used the F-scan plantar pressure analysis insoles to carry out with eyes open (EO) and eyes closed (EC) at four different step heights. The plantar pressure data were recorded for 10 s and pre-processed to derive kinematic and dynamic parameters. Results: For unipedal stance, most of kinematic parameters of the subjects’ right and left feet were significantly greater when the eyes were closed compared to the EO condition and increased with step height. The differences in toe load between right and left feet, open and closed eyes were extremely statistically significant (p < 0.001). The differences in midfoot load between the EO and EC conditions were statistically significant (p = 0.024) and extremely statistically significant between the right and left feet (p < 0.001). The difference in rearfoot load between EO and EC conditions was extremely statistically significant (p < 0.001) and statistically significant (p = 0.002) between the right and left feet. For bipedal stance, most of kinematic parameters of the subjects’ EO and EC conditions were statistically significant between the right and left feet and increased with step height. The overall load’s difference between EO and EC states was statistically significant (p = 0.003) for both feet. The overall load’s difference between the right and left feet was extremely statistically significant (p < 0.001) in the EC state. The differences between the right and left feet of the forefoot and rearfoot load with EO and EC suggested that the right foot had a smaller forefoot load, but a larger rearfoot load than the left foot (p < 0.001). The differences between the forefoot and rearfoot load of the subjects’ both feet with EO and EC were extremely statistically significant (p < 0.001). Conclusion: Both visual input and step height factors, even the dominant foot, act on kinematic and dynamic parameters that affect the maintenance of static balance ability.

Rasch Validation of the Mini-BESTest in People With Parkinson Disease

Article

Apr 2022
J Neurol Phys Ther

Background and purpose: The Mini-BESTest is a balance measure with robust psychometric properties widely used in people with Parkinson disease. The aim of this study was to examine-with advanced psychometric techniques-some key properties of the Mini-BESTest (including unidimensionality, functioning of rating categories, internal construct validity, reliability indexes) in a consecutive sample of individuals with Parkinson disease admitted for balance rehabilitation. Methods: Confirmatory factor analysis and Rasch analysis (partial credit model) were performed on 193 individual raw scores of the Mini-BESTest items. Results: Confirmatory factor analysis fit indices and principal component analysis of the residuals confirmed the scale's unidimensionality. At Rasch analysis, the 3-level rating scale demonstrated appropriate functioning. All items fitted the Rasch model. Item response dependence was negligible. No differential item functioning was found across gender and age groups. Discussion and conclusions: We confirmed and extended the evidence (demonstrated in different populations) on the general psychometric soundness of the Mini-BESTest, even when tested with rigorous statistical methods. In addition, 2 forms were created: (i) to transform raw scores into linear estimates of dynamic balance; and (ii) to compare the individual's item responses with those expected by the Rasch model (thus providing an aid for tailored interventions) and manage missing responses. Further independent studies using advanced psychometric techniques are warranted, also in people with balance disturbances of different etiology. Our study further increases the confidence in using the Mini-BESTest to assess dynamic balance in people with Parkinson disease and provides some useful additional clinical aids for interpreting the results and calculating more precise change scores.See the Supplementary Video, available at: http://links.lww.com/JNPT/A384.

Fear of Falling Does Not Influence Dual-Task Gait Costs in People with Parkinson’s Disease: A Cross-Sectional Study

Article

Full-text available

Mar 2022
SENSORS-BASEL

Cognitive deficits and fear of falling (FOF) can both influence gait patterns in Parkinson’s disease (PD). While cognitive deficits contribute to gait changes under dual-task (DT) conditions, it is unclear if FOF also influences changes to gait while performing a cognitive task. Here, we aimed to explore the association between FOF and DT costs in PD, we additionally describe associations between FOF, cognition, and gait parameters under single-task and DT. In 40 PD patients, motor symptoms (MDS-revised version of the Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr), FOF (Falls Efficacy Scale International), and Montreal Cognitive Assessment (MoCA) were assessed. Spatiotemporal gait parameters were recorded with a validated mobile gait analysis system with inertial measurement units at each foot while patients walked in a 50 m hallway at their preferred speed under single-task and DT conditions. Under single-task conditions, stride length (β = 0.798) and spatial variability (β = 0.202) were associated with FOF (adjusted R² = 0.19, p < 0.001) while the MoCA was only weakly associated with temporal variability (adjusted R² = 0.05, p < 0.001). Under DT conditions, speed, stride length, and cadence decreased, while spatial variability, temporal variability, and stride duration increased with the largest effect size for speed. DT costs of stride length (β = 0.42) and age (β = 0.58) explained 18% of the MoCA variance. However, FOF was not associated with the DT costs of gait parameters. Gait difficulties in PD may exacerbate when cognitive tasks are added during walking. However, FOF does not appear to have a relevant effect on dual-task costs of gait.

Effect of robot-assisted gait training on gait automaticity in Parkinson disease: A prospective, open-label, single-arm, pilot study

Article

Full-text available

Feb 2021
MEDICINE

Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD. This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2). Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ± 5.66 years, and disease duration was 112.91 ± 50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively). In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.

Beauty That Moves: Dance for Parkinson’s Effects on Affect, Self-Efficacy, Gait Symmetry, and Dual Task Performance

Article

Full-text available

Feb 2021

Background: Previous studies have investigated the effects of dance interventions on Parkinson’s motor and non-motor symptoms in an effort to develop an integrated view of dance as a therapeutic intervention. This within-subject study questions whether dance can be simply considered a form of exercise by comparing a Dance for Parkinson’s class with a matched-intensity exercise session lacking dance elements like music, metaphorical language, and social reality of art-partaking. Methods: In this repeated-measure design, 7 adults with Parkinson’s were tested four times; (i) before and (ii) after a Dance for Parkinson’s class, as well as (iii) before and (iv) after a matched-intensity exercise session. Physiological measures included heart rate and electrodermal activity. Self-reported affect and body self-efficacy were collected. Gait symmetry and dual task cost were analyzed using the 6 min walking test (6MWT) and Timed-Up-and-Go test (TUG), respectively. Results: Average heart rate was the same for both conditions, while electrodermal activity was higher during Dance for Parkinson’s. Significant differences were found in body self-efficacy, beauty subscale, symmetry of gait, and dual task performance. Conclusion: Dance, compared to an exercise intervention of matched intensity, yields different outcomes through the means of intrinsic artistic elements, which may influence affective responses, the experience of beauty, self-efficacy, and gait performance.

A Walker Designed for Parkinson’s Disease Patients Based on a Survey in Dhaka, Bangladesh

Article

Full-text available

Dec 2020

A neurodegenerative disorder like Parkinson's disease (PD) causes tremor, rigidity, postural instability and gait problems in early stages and thus poses an undetermined threat to the social and personal lives of the elderly in developing countries due to insufficient survey and research activities. However, several types of assistive devices (AD) are available in the market and the real patients' requirements are often overlooked in their design. This paper presents the process of design and fabrication of an innovative walker for PD patients. This walker has a non-modular foldable design which incentivizes patients to stand up straight and walk without the help of others. A survey on patients battling parkinsonism and practicing doctors was performed in public hospitals in Dhaka, Bangladesh and relevant engineering data was derived from it using Quality Function Deployment (QFD) which can also help visualize further market research opportunities. A finite element analysis (FEA) was performed before the walker was constructed for safety. It was handed to several volunteers for use and their responses were satisfactory. The designed walker may serve as a low-cost AD which is likely to improve a patient's posture and overall lifestyle and therefore, it can act as a means of rehabilitation.

Beauty That Moves: Dance for Parkinson’s Effects on Affect, Self-Efficacy, Gait Symmetry and Dual Task Performance

Preprint

Full-text available

Nov 2020

Background Previous studies have investigated the effects of dance interventions on Parkinson’s motor and non-motor symptoms in an effort to develop an integrated view of dance as a therapeutic intervention. This within-subject study questions whether dance can be simply considered a form of exercise by comparing a Dance for Parkinson’s class with a matched-intensity exercise session lacking dance elements like music, metaphorical language, and social reality of grace and beauty. Methods In this repeated-measure design, 7 adults with Parkinson’s were tested four times; (i) before and (ii) after a Dance for Parkinson’s class, as well as (iii) before and (iv) after a matched-intensity exercise session. Physiological measures included heart rate and electrodermal activity. Self-reported affect and body self-efficacy were collected. Gait symmetry and dual task cost were analyzed using the 6-minutes walking test (6MWT) and Timed-Up-and-Go test (TUG), respectively. Results Average heart rate was the same for both conditions, while electrodermal activity was higher during Dance for Parkinson’s. Significant differences were found in body self-efficacy, beauty subscale, symmetry of gait, and dual task performance. Conclusions Dance, compared to an exercise intervention of matched intensity, yields different outcomes through the means of intrinsic artistic elements, which may influence affective responses, the experience of beauty, self-efficacy, and gait performance.

The Augmented Movement Platform For Embodied Learning (AMPEL): development and reliability

Article

Nov 2020

Balance and gait impairments are highly prevalent in the neurological population. Although current rehabilitation strategies focus on motor learning principles, it is of interest to expand into embodied sensori-motor learning; that is learning through a continuous interaction between cognitive and motor systems, within an enriched sensory environment. Current developments in engineering allow for the development of enriched sensory environments through interactive feedback. The Augmented Movement Platform for Embodied Learning (AMPEL) was developed, both in terms of hardware and software by an inter-disciplinary circular participatory design strategy. The developed device was then tested for in-between session reliability for the outcome measures inter-step interval and total onset time. Ten healthy participants walked in four experimental paths on the device in two different sessions, and between session correlations were calculated. AMPEL was developed both in terms of software and hardware, with three Plug-In systems (auditory, visual, auditory + visual). The auditory Plug-In allows for flexible application of augmented feedback. The in-between session reliability of the outcomes measured by the system were between high and very high on all 4 walked paths, tested on ten healthy participants [mean age 41.8 ± 18.5; BMI 24.8 ± 6.1]. AMPEL shows full functionality, and has shown between session reliability for the measures of inter-step-intervals and total-onset-time in healthy controls during walking on different paths.

Effects of water-based exercise on functioning and quality of life in people with Parkinson’s disease: a systematic review and meta-analysis

Article

Full-text available

Jul 2020

Aim To investigate the effects of the water-based exercise on balance, mobility, mobility and functional independence, functional performance, fear of falling and quality of life in people with Parkinson’s disease. Methods We searched pubmed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base and SciELO to June 2020 for randomised controlled trials that investigated the effects of water-based exercise in people with Parkinson’s disease. Two comparisons were made: water-based exercise versus usual care and water-based exercise versus land-exercise. The main outcomes were Balance, Confidence, Mobility, Unified Parkinson’s Disease Rating Scale and quality of life. Mean differences (MD) with 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I² test. Results Fifteen randomised controlled trials were found (435 people). Compared to usual care, water-based exercise resulted in improvement in balance MD (9.1, 95% CI: 6.5, 11.8, N = 45). Water-based exercise resulted in improvement in balance MD (3.1, 95% CI: 1.2, 5.0, N = 179), mobility MD (−2.2, 95% CI: −3.3, −1.0, N = 197) and quality of life MD (−5.5, 95% CI: −11, −0.07, N = 98) compared to land-based exercise, but without significant difference in functional performance MD (0.01, 95% CI: −2.6 to 2.7, N = 69). Land-based exercise resulted in improvement in fear of falling MD (−3.5, 95% CI: −5.6, −1.3, N = 58) compared to water-based exercise. Conclusion Water-based exercise was more efficient than land-based exercise and/or usual care in improving balance, mobility and quality of life in people with Parkinson’s disease.

Usability of the Experience Sampling Method in Parkinson's Disease on a Group and Individual Level

Article

Full-text available

May 2020

Background Around 50% of PD patients experience motor fluctuations, which are often accompanied by mood fluctuations. The nature of the relationship between motor and mood fluctuations remains unknown. It is suggested that the experience sampling method can reveal such associations on both a group and individual level. Revealing group patterns may enhance our understanding of symptom interactions and lead to more general treatment recommendations, whereas analyses in individual patients can be used to establish a personalized treatment plan. Objectives To explore the usability of routinely collected experience sampling method data over a brief period of time to detect associations between motor fluctuations, affective state, and contextual factors in PD patients with motor fluctuations on a group level and on an individual level. Methods Eleven patients with motor fluctuations collected data at 10 semirandom moments over the day for 5 consecutive days. Results On a group level, multilevel analyses showed significant associations between all motor symptoms and positive affect. Being at home was associated with increased balance problems and rigidity. Analyses on an individual level revealed much less significant associations that mostly, but not always, were in line with the results on a group level. Conclusion This exploratory study showed significant associations between affective state, motor symptoms, and contextual factors in a group of PD patients with motor fluctuations, but less so in individual patients. Given that the ultimate aim is to use the experience sampling method as an aid to personalize treatments, the sensitivity of the approach needs to be increased. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Brain Body Cognition Volume 8, Issue 1

Book

Jan 2018

Gerry Leisman

Power vs strength training to improve muscular strength, power, balance and functional movement in individuals diagnosed with Parkinson's disease

Article

Oct 2019
EXP GERONTOL

Fear among patients with Parkinson's disease and repeated falls: Analysis of skin conductance responses during simulated accidents

Article

Nov 2024
PARKINSONISM RELAT D

Balance training in individuals with Parkinson's disease: Biodex Stability System versus supervised exercise program

Article

Jul 2022

OBJECTIVE The objective of this study was to evaluate the effect of balance training, using the Biodex Stability System (BSS) or supervised exercises, on balance and gait in individuals with Parkinson's disease (PD). DESIGN This was a prospective, pilot interventional cohort study. PARTICIPANTS Twenty individuals with PD at Hoehn and Yahr stages I–III were included in the study. INTERVENTIONS Ten subjects in the BSS group and 10 subjects in the non-BSS group (supervised balance exercise training without BSS) participated in 55-min exercise sessions 3 times a week for 4 weeks. OUTCOME MEASUREMENTS Postural sway measures-sway area, anterior-posterior (AP) and medial-lateral (ML) center of pressure path length, and root mean square velocity in AP and ML directions were collected at baseline and postintervention. Secondary outcome measures of the Berg Balance Scale (BBS), spatiotemporal gait measures-gait velocity, step length, and stride length, Timed Up and Go, and 6-min walk test data were also collected at baseline and postexercise intervention for both the groups. RESULTS Improvements in postural sway were seen in the BSS group postintervention (sway area mean change = −435.3 mm ² ; 95% confidence interval = −818.5, −52.2). Postural sway data from the non-BSS group were unavailable, due to a technical failure. All secondary outcome measures improved in both the groups; however, we did not find any significant between-group differences in any of the secondary measures. CONCLUSIONS A 4-week exercise training using BSS improved measures of balance and gait in individuals with PD. However, improvements were also seen after an exercise program that did not use BSS. This suggests that at least for the measures used in this study, there were no differences between BSS training and supervised exercise balance training.

Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson’s Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation

Article

Full-text available

Dec 2023
BSRCCS

Objective: To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. Methods: Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. Results: Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. Conclusions: PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.

Implementation and the effects of a Parkinson Network Therapy (PaNTher) on activities of daily living and health-related quality of life in Parkinson’s disease patients: study protocol of an mixed-method observational cohort study in outpatient care

Article

Full-text available

Nov 2023

Introduction Parkinson’s disease (PD) represents the fastest growing neurodegenerative disease with an increasing prevalence worldwide. It is characterised by complex motor and non-motor symptoms that lead to considerable disability. Specialised physiotherapy has been shown to benefit patients with PD. The Parkinson Netzwerk Therapie (PaNTher) was created to improve access to specialised physiotherapy tailored to care priorities of PD patients. This study aims to evaluate the effectiveness, acceptability and needs of the PaNTher network by neurologists and physiotherapists involved in the network in outpatient care. Methods and analysis This is a mixed-method, prospective, pragmatic non-randomised cohort study of parallel groups, with data collection taking place in Bavaria, Germany, between 2020 and 2024. Patients with PD insured by the Allgemeine Ortskrankenkasse Bayern (AOK Bayern) living in Bavaria will be recruited for study participation by network partners. Patients in the intervention group must reside in Munich or the surrounding area to ensure provision of specialised physiotherapy in close proximity to their place of residence. Controls receive care as usual. Six and 12 months after baseline, all patients receive a follow-up questionnaire. Mixed-effect regression models will be used to examine changes in impairment of activities of daily living and quality of life of patients with PD enrolled in the programme over time compared with usual care. Qualitative interviews will investigate the implementation processes and acceptability of the PaNTher network among neurologists and physiotherapists. The study is expected to show that the PaNTher network with an integrative care approach will improve the quality and effectiveness of the management and treatment of patients with PD. Ethics and dissemination The study has been approved by the ethics committee at the medical faculty of the Ludwig-Maximilians-University Munich (20-318). Results will be published in scientific, peer-reviewed journals and presented at national and international conferences.

Predictors of Falls with Injuries in People with Parkinson's Disease

Article

Dec 2022

Background: Falls are frequent in Parkinson's disease (PD), but there is lack of information about predictors of injurious falls. Objectives: To determine predictors of falls with injuries in people with PD; to compare circumstances and consequences of falls in single and recurrent fallers. Methods: Participants (n = 225) were assessed by disease-specific, self-report, and balance measures, and followed-up for 12 months with a diary to record falls, their circumstances, and injuries. Univariate and multivariate analyses were performed. Circumstances and consequences of falls presented by single and recurrent fallers were compared. Results: A total of 805 falls were analyzed, 107 (13%) were falls with injuries. Multivariate logistic regression model revealed that greater PD duration and higher balance confidence were protective factors; better balance during gait, outdoor falls, and falls related to extrinsic factors were risk factors for falls with injuries, when compared to falls with no injuries. Multivariate multinomial regression model revealed that, when compared to zero fall, past falls and daily levodopa equivalent dose were predictors of falls with injuries; these predictors together with disability were predictors of falls with no injuries. Single falls (n = 27; 3%) were more common outdoors because of extrinsic factors, whereas recurrent falls (n = 778; 97%) were more common indoors because of intrinsic factors. Single falls led to more injuries than recurrent falls (P < 0.05). Conclusions: Different predictors of falls with injuries were obtained when different outcomes were compared. It should be noted that falls with injuries might be influenced by fall-related activities and environmental factors. Single and recurrent falls differed on circumstances and consequences.

Computer-vision based method for quantifying rising from chair in Parkinson's disease patients

Article

Full-text available

Dec 2021

Background The ability to arise from a sitting to a standing position is often impaired in Parkinson's disease (PD). This impairment is associated with an increased risk of falling, and higher risk of dementia. We propose a novel approach to estimate Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) ratings for “item 3.9” (arising from chair) using a computer vision-based method, whereby we use clinically informed reasoning to engineer a small number of informative features from high dimensional markerless pose estimation data. Methods We analysed 447 videos collected via the KELVIN-PD™ platform, recorded in clinical settings at multiple sites, using commercially available mobile smart devices. Each video showed an examination for item 3.9 of the MDS-UPDRS and had an associated severity rating from a trained clinician on the 5-point scale (0, 1, 2, 3 or 4). The deep learning library OpenPose was used to extract pose estimation key points from each frame of the videos, resulting in time-series signals for each key point. From these signals, features were extracted which capture relevant characteristics of the movement; velocity variation, smoothness, whether the patient used their hands to push themselves up, how stooped the patient was while sitting and how upright the patient was when fully standing. These features were used to train an ordinal classification system (with one class for each of the possible ratings on the UPDRS), based on a series of random forest classifiers. Results The UPDRS ratings estimated by this system, using leave-one-out cross validation, corresponded exactly to the ratings made by clinicians in 79% of videos, and were within one of those made by clinicians in 100% of cases. The system was able to distinguish normal from Parkinsonian movement with a sensitivity of 62.8% and a specificity of 90.3%. Analysis of misclassified examples highlighted the potential of the system to detect potentially mislabelled data. Conclusion We show that our computer-vision based method can accurately quantify PD patients’ ability to perform the arising from chair action. As far as we are aware this is the first study estimating scores for item 3.9 of the MDS-UPDRS from singular monocular video. This approach can help prevent human error by identifying unusual clinician ratings, and provides promise for such a system being used routinely for clinical assessments, either locally or remotely, with potential for use as stratification and outcome measures in clinical trials.

How does perceived fall risk influence decisions about whether to undertake activities in people with Parkinson’s disease and their care partners? A qualitative study

Article

Jul 2021

Purpose To explore how perceptions of fall risk influence decisions to undertake activities in people with Parkinson’s disease who have fallen, along with their care-partners. Materials and methods This qualitative study used semi-structured interviews to collect data from eight people with moderate to severe Parkinson’s Disease and freezing of gait (including those with cognitive impairments) and their care-partners. An inductive approach to thematic analysis was used to analyse the data. Results Four main, interconnected themes emerged, and a framework was developed to illustrate these connections. Weighing up the risks and benefits reflected the constant tension between assessing the likelihood of falling and potential benefit of any activity; Being fearful heightened the perceived risk resulting in a tendency to avoid or modify activities; Desire to lead a normal life heightened the perceived benefit of any activity, leading towards risk taking behaviour; It’s a part of Parkinson’s provided the context in which the decision-making process took place, with the reality of a progressive disorder influencing choices and contributing to a belief that falls were inevitable. Conclusions There is a complex interaction between perceptions of fall risk and behaviour. An understanding of these interactions will assist therapists to tailor individualised fall prevention interventions. • IMPLICATIONS FOR REHABILITATION • People are constantly weighing up the risks and benefits of activities while balancing fear of falling and a desire to lead a normal life in the context of Parkinson’s disease. • The resulting activity choices vary along a continuum from avoiding activities to taking risks, with a common approach to minimise the risk and then embrace the activity. • Therapists can help people with Parkinson’s and their care-partners to determine what level of risk is acceptable for them when balancing risk with quality of life. • Understanding how people decide if they will undertake an activity that poses a risk of falling will allow therapists and patients to co-design fall prevention and management interventions based on the patient’s values and priorities.

Nº 1 (Págs. 1-14)

Article

Mar 2021

Javier Martín Núñez

Associations between kinesiophobia, performance and functionality in patients with freezing of gait and Parkinson

Article

Full-text available

Jan 2021

Javier Martín Núñez

Parkinson´s Disease is the second most common neurodegenerative movement disorder worldwide and the first one in Europe, with a prevalence increasing with age. Freezing of gait is a motor disorder which fundamentally causes a block of lower limb, during this espisode patients can not generate a step. Furthermore, freezing of gait is one of the most motor disabling motor disorder in Parkinson´s Disease, being related to the progression of the disease and sometimes with the appearance of complications. Those complications can include increase fall risk, impairment of activities of daily life and reduction of quality of life; due to the related decrease in movement and physical activity in patients with Parkinson´s Disease and freezing of gait. Despite others studies have shown a relationship between kinesiophobia, physical activity and functionality in patients with Parkinson´s Disease, there are no evidences of this link in patients with Parkinson´s Disease and freezing of gait in ``On´´ state.

Validation of the Activities-Specific Balance Confidence Scale With 5-Option Response Format in Slovene Lower-Limb Prosthetic Users

Article

Nov 2020
ARCH PHYS MED REHAB

Objective To examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale administered in the Slovene version with a simplified 5-option response format (ABC-5/SLO) using Rasch analysis. Design Methodological research on data gathered in a cross-sectional study. Setting Outpatient university rehabilitation clinic. Participants A convenience sample of adults with unilateral lower-limb amputation (N=138; 75% men) longer than 6 months who regularly wear a prosthesis. Intervention Not applicable. Main Outcome Measures We evaluated functioning of rating scale categories, internal construct validity, reliability indices, and dimensionality using the ABC-5/SLO (0=no confidence to 4=complete confidence). Results The ABC-5/SLO rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct (balance confidence) except item 8 (“walk outside the house to a car parked in the driveway”), which was overfitting. The person abilities-item difficulty matching (targeting) was good. The person separation reliability was .92, and the item separation reliability was .99. Analysis of the standardized Rasch residuals showed the scale’s unidimensionality and absence of high item dependency (residual correlations, <.30). The correlation between the ABC-5/SLO and the Prosthetic Mobility Questionnaire (Rasch measures) was high (ρ=.84), as expected. Minor signs of item redundancy were found. Conclusions The simplified ABC-5/SLO scale is a valid and reliable measure of balance confidence for individuals with lower-limb amputation. It is possible to transform the ordinal summed raw scores of the ABC-5/SLO into interval-level measurements using a nomogram.

Effects of contemporary dance and physiotherapy intervention on balance and postural control in Parkinson’s disease

Article

Nov 2020

Purpose To describe the effects of a contemporary dance program, combined with conventional physiotherapy, on postural control, satisfaction and adherence in mild-moderate Parkinson’s disease (PD) patients. Methods A withdrawal/reversion test with three intervention periods. Each period lasts for two months: physiotherapy, physiotherapy + dance and withdrawing dance and continuing with the physiotherapy sessions. Berg Balance Scale (BBS), Timed Up & Go test (TUG), Sensory Organization Test (SOT), Motor Control Test (MCT) and Rhythmic Weigh Shift (RWS) were assessed at T1 (baseline), T2 (post-physiotherapy treatment), T3 (post-physiotherapy and dance) and T4 (post-physiotherapy). A satisfaction questionnaire and adherence were registered. Results 27 patients (67.32 ± 6.14 yrs) completed the study. Statistical analysis revealed differences between T2-T3 (p = 0.027), T2-T4 (p = 0.029), T1-T3 (p = 0.010) and T1-T4 (p = 0.008) for BBS; and between T1-T2 (p = 0.037), T1-T3 (p = 0.005), T1-T4 (p = 0.004), T2-T3 (p = 0.022) and T2-T4 (p = 0.041) for TUG. Significant differences for CES (p < 0.001), VEST (p = 0.024) and strategy (p = 0.011) were observed, but not for MCT. Lateromedial velocity (p = 0.003) and anteroposterior velocity (p < 0.001) were significant for RWT. Patients showed a high level of satisfaction and adherence. Conclusions A short 8-weeks contemporary dance program plus combined physiotherapy shows benefits in functional mobility and balance, with a high degree of satisfaction and adherence in PD. • IMPLICATIONS FOR REHABILITATION • Contemporary dance, combined with physiotherapy, is a useful therapeutic tool to treat balance disorders and postural control in people with PD. • A short 8-weeks contemporary dance program plus combined physiotherapy shows high satisfaction in people with PD. • Contemporary dance, combined with physiotherapy, shows high adherence in people with mild-moderate PD to treat postural control.

Comparison of the effect of whole-body vibration therapy versus conventional therapy on functional balance of patients with Parkinson’s disease: adding a mixed group

Article

Full-text available

Jul 2020

Objective Assess the effect of Whole-Body Vibration (WBV) therapy in functional balance status of Parkinson’s disease (PD) patients and compare this to conventional and combined therapy.IntroductionPD patients experience a decreased mobility, inactivity, and loss of independence as consequence of disturbances in gait, posture, and balance. Rehabilitation therapy is a non-pharmacological way of improving functionality. One of the most studied modalities is WBV, with multiple studies showing improvement in motor function. However, results in this manner are inconsistent.Methods Forty-five patients were enrolled in a non-randomized controlled trial and divided into three groups. Group 1 received conventional therapy (thermotherapy, stretching, strengthening, coordination and balance). Group 2 received WBV therapy, and group 3 patients underwent a combined therapy protocol. A total of 20 sessions (3 per week) were conducted, assessing Berg Balance Scale (BBS) before initial and after final session.ResultsThe 3 intervention groups showed significant improvement in BBS scores after concluding the 20-session trial compared to initial assessment. When comparing mean change in BBS score from initial to final assessment, the combined therapy group had a greater increase compared to conventional therapy, but no significant differences were observed comparing to WBV group. Mean change in BBS score showed no significant difference between conventional therapy and WBV therapy group.ConclusionsWBV therapy is a useful tool as co-adjuvant in conventional therapy. The combination of both therapies is a significant therapeutic alternative for the improvement of functional balance status in PD patients compared to conventional therapy alone.

FEAR IS AN IMPORTANT PUBLIC HEALTH ISSUE

Book

Full-text available

Apr 2020

Liubov Ben-Noun (Nun)

Fear is an important public health issue. What is the neurobiological basis for fear? What are the types? What are the characteristics of fear? What are the coping strategies? Biblical verses related to these issues are studied from a contemporary viewpoint.

Effect of Virtual Reality on Balance in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Article

Full-text available

Mar 2020
PHYS THER

Background: Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. Purpose: The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). Data sources: Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. Study selection: All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. Data extraction: Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. Data synthesis: Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. (However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly. Limitations: Publication bias and diversity in the interventions were the main limitations. Conclusions: Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to the active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.

People in early stages of Parkinson’s disease are able to intentionally reweight the use of visual information for postural control

Article

Full-text available

Feb 2020

Background Parkinson’s disease (PD) leads to several changes in motor control, many of them related to informational or cognitive overload. The aim of this study was to investigate the influence of knowledge and intention on the postural control performance and on the coupling between visual information and body sway in people with and without PD standing upright. Methods Participants were 21 people with PD (62.1 ± 7.2 years), stages 1 and 2 (Hoehn & Yahr scale), under dopaminergic medication, and 21 people in the control group (62.3 ± 7.1 years). Participants stood upright inside a moving room, performing seven trials of 60 s. In the first trial, the room remained motionless. In the others, the room oscillated at 0.2 Hz in the anterior-posterior direction: in the first block of three trials, the participants were not informed about the visual manipulation; in the second block of three trials, participants were informed about the room movement and asked to resist the visual influence. An OPTOTRAK system recorded the moving room displacement and the participants’ sway. The variables mean sway amplitude (MSA), coherence and gain were calculated. Results With no visual manipulation, no difference occurred between groups for MSA. Under visual manipulation conditions, people with PD presented higher MSA than control, and both groups reduced the sway magnitude in the resisting condition. Control group reduced sway magnitude by 6.1%, while PD group reduced by 11.5%. No difference was found between groups and between conditions for the coupling strength (coherence). For the coupling structure (gain), there was no group difference, but both groups showed reduced gain in the resisting condition. Control group reduced gain by 12.0%, while PD group reduced by 9.3%. Conclusions People with PD, under visual manipulation, were more influenced than controls, but they presented the same coupling structure between visual information and body sway as controls. People in early stages of PD are able to intentionally alter the influence of visual information.

The Effect of Virtual Reality-Based Exercise Program on Balance, Gait, and Falls Efficacy in Patients with Parkinson’s Disease

Article

Full-text available

Nov 2019

Characteristics that affect score reliability in the Berg Balance Scale: A meta-analytic reliability generalization study

Article

Full-text available

May 2019
Eur J Phys Rehabil Med

Abstract INTRODUCTION: The Berg Balance Scale is the most widely used clinical scale used to assess balance performance in neurological conditions. Reliability is not an unalterable value of a scale across different applications, but is a property referring to the results obtained with the scale, not the instrument in itself. The results of a scale can vary depending on the context where it is applied and the characteristics of the participants, therefore the reliability coefficient should be reported in each study. A systematic review and meta-analysis of the reliability coefficients obtained in different applications of the test with the data at hand is the best method to examine how the reliability of a test scores varies. The objectives of this systematic revision are: To determine the mean of internal consistency, intra and interrater reliability of the Berg balance scale in the clinical, nonclinical and mixed populations, to determine the methodological and substantive characteristics and to propose a predictive model enabling researchers and clinicians to use it in the future to estimate the expected reliability based on the characteristics of the most relevant studies. EVIDENCE ACQUISITION: The MEDLINE (Pubmed), EMBASE and CINAHL databases were searched from 1989 to 2015. Two reviewers independently selected empirical studies published in English or in Spanish that applied the Berg Balance Scale and reported any reliability coefficient. EVIDENCE SYNTHESIS: The 80 samples in the 65 studies reported any the Berg Balance Scale reliability estimate. Coefficient alpha ranged from .62 to .98, with a mean of .92. For intra-rater agreement, the mean intraclass correlation was ICC+ = .957, and for inter-rater agreement ICC+ = .97. The SD of the Berg Balance Scale scores presented statistically significant relationships with the coefficient alpha and with ICC (intra-rater). In addition, the clinical population and the institutionalized population presented statistically significant relationships with the coefficient alpha. The sample size and mean scale results were also statistically related to ICCs (intra-rater). CONCLUSIONS: The alpha coefficient and intra- and inter-rater agreement for Berg Balance Scale scores was very satisfactory. Several characteristics of the studies were statistically associated to the alpha coefficient and with intra-rater reliability.

Measuring balance in the elderly: Validation of an instrument

Article

Full-text available

Nov 1991

This study assessed the validity of the Balance Scale by examining: how Scale scores related to clinical judgements and self-perceptions of balance, laboratory measures of postural sway and external criteria reflecting balancing ability; if scores could predict falls in the elderly; and how they related to motor and functional performance in stroke patients. Elderly residents (N = 113) were assessed for functional performance and balance regularly over a nine-month period. Occurrence of falls was monitored for a year. Acute stroke patients (N = 70) were periodically rated for functional independence, motor performance and balance for over three months. Thirty-one elderly subjects were assessed by clinical and laboratory indicators reflecting balancing ability. The Scale correlated moderately with caregiver ratings, self-ratings and laboratory measures of sway. Differences in mean Scale scores were consistent with the use of mobility aids by elderly residents and differentiated stroke patients by location of follow-up. Balance scores predicted the occurrence of multiple falls among elderly residents and were strongly correlated with functional and motor performance in stroke patients. Reproduced with permission of the Canadian Public Health Association.

The Balance Scale: Reliability assessment with elderly residents and patients with an acute stroke

Article

Full-text available

Apr 1995
Scand J Rehabil Med

The objective of this study was to assess the reliability of the Balance Scale. Subjects were chosen from a larger group of 113 elderly residents and 70 stroke patients participating in a psychometric study. Elderly residents were examined at baseline, and at 3, 6 and 9 months, and the stroke patients were evaluated at 2, 4, 6 and 12 weeks post onset. The Cronbach's alphas at each evaluation were greater than 0.83 and 0.97 for the elderly residents and stroke patients respectively, showing strong internal consistency. To assess inter-rater reliability, therapists treating 35 stroke patients were asked to administer the Balance Scale within 24 hours of the independent evaluator. Similarly, caregivers at the Residence were asked to test the elderly residents within one week of the independent evaluator. To assess intra-rater reliability, 18 residents and 6 stroke patients were assessed one week apart by the same rater. The agreement between raters was excellent (ICC = 0.98) as was the consistency within the same rater at two points in time (ICC = 0.97). The results support the use of the Balance Scale in these groups.

Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females

Article

Full-text available

Mar 1998
Aging Clin Exp Res

Four common tests of balance and mobility were administered to 45 healthy women, aged 55-71 years: Sharpened Romberg (also defined as tandem stance), eyes open and closed; One-Legged Stance Test, eyes open and closed; Functional Reach; and Sit-To-Stand test. Two independent observers scored the tests, which were performed on two successive days. Inter-rater (IRR) and test-retest reliability (TRR) were good. Across the six different tests, Intraclass Correlation Coefficients ranged from 0.95 to 0.99 for scoring consistency between rates, and from 0.73 to 0.93 within raters. This is in line with previous findings based on similar subjects and similar, though not identical, testing procedures. Intercorrelations between the scores were moderate: r coefficients ranged 0.40-0.66. The results suggest that this simple test battery provides reliable scores, and that the different tests relate to a homogeneous construct, while not being redundant. It thus seems worthwhile to further investigate whether they represent and measure a unidimensional domain, rather than conceptually different dimensions, in view of achieving a unique measure of balance performance.

PDQ-39: A review of the development, validation and application of a Parkinson's Disease quality of life questionnaire and its associated measures

Article

Full-text available

Jun 1998

Parkinson's disease is a common degenerative neurological condition. A number of general instruments exist to measure quality of life, but these were not designed to address areas salient to a specific disease. This contribution reviews the development and validation of the PDQ-39, a short 39-item quality of life questionnaire for Parkinson's disease. PDQ-39 data can be presented either in profile form or as a single index. This report also reviews the development and validation of a briefer measure (PDQ-8) derived from the PDQ-39, and of two summary indices (PDQ-39SI and PDQ-8SI.

Prospective Study of the Impact of Fear of Falling on Activities of Daily Living, SF-36 Scores, and Nursing Home Admission

Article

Full-text available

Jun 2000

The aim of this study was to assess the impact of fear of falling on the health of older people. A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.

Reliability of Measurements Obtained With the Timed “Up & Go” Test in People With Parkinson Disease

Article

Full-text available

Feb 2001

The Timed "Up & Go" Test (TUG) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning. This study investigated the retest reliability, interrater reliability, and sensitivity of scores obtained with the TUG in detecting changes in mobility in subjects with idiopathic Parkinson disease (PD). The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD. The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours ("off" phase of the medication cycle) as well as an additional 5 trials 1 hour after levodopa was administered ("on" phase of the medication cycle). They were scored on the Modified Webster Scale at both sessions. The comparison subjects also performed 5 TUG trials. All trials were videotaped and timed by 2 experienced raters. The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians. For the subjects with PD, within-session performance was highly consistent, with correlations (r) ranging from.80 to.98 for the "off" phase and from.73 to.99 for the "on" phase. The performance of the comparison subjects across the 5 trials was also highly consistent (r=.90-.97). Comparisons showed differences between trials 1 and 2 on the TUG for both groups. Removal of data for trial 1 (the practice trial) further enhanced retest reliability. There was close agreement in TUG scores among raters despite different levels of experience (intraclass correlation coefficient [3,1]=.87-.99). Mean TUG scores were different between the "on" and "off" phases of the levodopa cycle and between subjects with PD and comparison subjects during the "on" phase. Retest reliability and interrater reliability of the TUG measurements were high, and the measurements reflected changes in performance according to levodopa use. The TUG can also be used to detect differences in performance between people with PD and elderly people without PD.

Incidence and Prediction of Falls in Parkinson's Disease: A Prospective Multidisciplinary Study

Article

Full-text available

Jul 2002

To accurately establish the incidence of falls in Parkinson's disease (PD) and to investigate predictive risk factors for fallers from baseline data. 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data, disease specific rating scales, physiotherapy assessment, tests of visual, cardiovascular and autonomic function, and bone densitometry. Patients were then prospectively followed up for one year using weekly prepaid postcards along with telephone follow up. Falls occurred in 68.3% of the subjects. Previous falls, disease duration, dementia, and loss of arm swing were independent predictors of falling. There were also significant associations between disease severity, balance impairment, depression, and falling. Falls are a common problem in PD and some of the major risk factors are potentially modifiable. There is a need for future studies to look at interventions to prevent falls in PD.

The Falls-Efficacy Scale, Swedish version: Does it reflect clinically meaningful changes after stroke?

Article

Full-text available

Jul 2002

The overall aim of this prospective investigation was to evaluate the ability of the Falls Efficacy Scale (Swedish version) (FES(S)) to reflect clinically meaningful changes over time. Changes on the FES(S) scale were compared with changes in two different standardized measures of observer-assessed balance, the Berg Balance Scale (BBS), the Fugl-Meyer balance subscale (FMB), and of motor function and ambulation in 62 stroke patients. Assessments took place on admission for rehabilitation, at discharge and 10 months after the stroke. Indices of effect size were used to evaluate responsiveness of the instruments. Three time periods were studied: admission to discharge (early response), discharge to 10 month follow-up (late response) and admission to follow-up (overall response). The main findings are that the FES(S) is as responsive as BBS and FMB in detecting changes during the early and overall response periods. Changes in FES(S) scores between admission and discharge correlated significantly with changes in observer-assessed balance, motor function and ambulation scores. The present results suggest that measurement of perceived confidence in task performance using the FES(S) scale is responsive to improvement in patients with hemiparesis at an early stage after stroke.

Fear of Falling in Elderly Persons: Association With Falls, Functional Ability, and Quality of Life

Article

Full-text available

Oct 2003

This study examined heterogeneity in response patterns of the participants of the Survey of Activities and Fear of Falling in the Elderly (SAFFE) and their relationships to falls, functional ability, quality of life, and activity restriction measures in a cohort of 256 older people (mean age = 77.5 years). Participants recruited from local primary care clinics were administered the SAFFE instrument, an activity restriction measure, a combination of self-reported and performance-based functional ability tests, and quality-of-life measures. Latent class analyses identified two classes: Class 1 (n = 209), which had a low SAFFE fear of falling, and Class 2 (n = 47), which had a high SAFFE fear of falling. Subsequent analyses of variance indicated that the two-class (low fear and high fear) SAFFE fear of falling profiles discriminated fallers from nonfallers, and low and high levels of functional ability, activity restriction, and quality of life. The findings from this study suggest that variations in the SAFFE response patterns on a single dimension of fear of falling and that high levels of fear of falling measured by the SAFFE are linked to a range of adverse health consequences.

A cultural-historical approach to distributed cognition

Chapter

Jan 1991

Projection technique for evaluating surgery in Parkinson's disease

Article

Jan 1969

Projection technique for evaluating surgery in Parkinson's disease

Article

Jan 1969

Accuracy of clinical diagnosis of idiopathic Parkinson's disease: A clinico-pathological study of 100 cases

Article

Mar 1992

Few detailed clinico-pathological correlations of Parkinson's disease have been published. The pathological findings in 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic Parkinson's disease are reported. Seventy six had nigral Lewy bodies, and in all of these Lewy bodies were also found in the cerebral cortex. In 24 cases without Lewy bodies, diagnoses included progressive supranuclear palsy, multiple system atrophy, Alzheimer's disease, Alzheimer-type pathology, and basal ganglia vascular disease. The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82%. These observations call into question current concepts of Parkinson's disease as a single distinct morbid entity.

A cultural-historical approach to distributed cognition', in Salomon, G. (ed), Distributed Cognitions: Psychological and Educational Considerations

Article

Jan 1993

Unified Parkinson's Disease Rating Scale; Fahn S, Marsden C, Goldstein M, Calne D, editors

Article

Rating scale analysis of the Berg Balance Scale

Conference Paper

Jul 2004
ARCH PHYS MED REHAB

Objectives: To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms. Design: Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data. Setting: Outpatient Veterans Affairs medical center. Participants: One hundred (99 men, I woman) community-dwelling veterans referred for balance deficits (age range, 64-88y). Interventions: Not applicable. Main Outcome Measure: The BBS. Results: Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item "tandem stance," as well as passing 2 of the following 3 items: "alternating foot," "standing on one leg," and "look behind." Conclusions: Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.

The Basal Ganglia and Posture

Book

Jan 1967

J. Purdon Martin

Best Test Design. Rasch Measurement

Article

Jan 1979

This handbook explains how to do Rasch measurement. The emphasis is on practice, but theoretical explanations are also provided. The Forward contains an introduction to the topic of Rasch measurement. Chapters 2, 4, 5, and 7 use a small problem to illustrate the application of Rasch measurement in detail, and methodological issues are considered in chapters 1, 5, and 6. Users of this book might approach the problem first and then explore the theory, or they might familiarize themselves with the theory before considering the practical aspects of Rasch measurement. The following chapters are included: (1) "The Measurement Model"; (2) "Item Calibration by Hand"; (3) "Item Calibration by Computer"; (4) "The Analysis of Fit"; (5) "Constructing a Variable"; (6) "Designing Tests"; (7)"Making Measures"; and (8) "Choosing a Scale." Appendixes contain three supporting tables. (Contains 45 figures, 81 tables, and 61 references.) (SLD)

Task‐Specific Resistance Training to Improve the Ability of Activities of Daily Living–Impaired Older Adults to Rise from a Bed and from a Chair

Article

Nov 2001
J AM GERIATR SOC

OBJECTIVES: To determine the effect of a 12-week intervention to improve the ability of disabled older adults to rise from a bed and from a chair. DESIGN: Subjects were randomly allocated to either a 12-week task-specific resistance-training intervention (training in bed- and chair-rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention. SETTING: Seven congregate housing facilities. PARTICIPANTS: Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. MEASUREMENTS: At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed- and chair-rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed- and chair-rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise-time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance. CONCLUSIONS: Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.

Fear of falling and postural control in Parkinson's disease

Article

May 2003
MOVEMENT DISORD

This study investigated the relationship between fear of falling (FOF) and qualitative and quantitative postural control in Parkinson's disease (PD). Fifty-eight nondemented PD patients were studied along with age-matched healthy controls. The degree of FOF was estimated using the Activities-specific Balance Confidence scale. Qualitative postural control was evaluated using a component of the Unified Parkinson Disease Rating Scale. Postural control was quantified, using centre of pressure measures obtained from a force plate, for eight standing balance tests of different challenges. The results showed that FOF was more evident for PD patients when compared with healthy individuals of similar age. Furthermore, FOF was significantly associated with a qualitative estimate of postural control in PD; individuals with PD who had a greater degree of posture impairment reported greater FOF. The results also showed that an estimate of FOF may help to explain quantitative postural instability in PD. FOF, when coupled with a qualitative estimate of postural control, was able to explain a greater amount of variation in quantitative balance performance for five of the eight balance tests. When considered independently, the qualitative measure of postural control, in general, could not well predict quantitative balance performance. The greater degree of FOF and its possible association with altered postural control suggests that FOF should be considered as an important, independent risk factor in the assessment and treatment of postural instability in patients with PD. © 2003 Movement Disorder Society

Chapter 3 Interaction of the basal ganglia and supplementary motor area in the elaboration of movement

Article

Dec 1995

This chapter reviews basal ganglia (BG) function and concentrates on the BG and supplementary motor area (SMA) interaction. A framework for this interaction is described based on four general areas of research: extrinsic anatomical connections of the BG; cerebral blood flow studies of the motor cortical regions during movement performance in human subjects; single cell recordings from the BG and SMA in animals and studies of movement performance in subjects with Parkinson's disease. This review suggests that the motor function of the BG is twofold and that both of these functions are expressed via the motor cortical regions. Firstly the BG provide internal motor cues that enable the release of submovements from the SMA for execution by the motor cortex. The cue (phasic neuronal activity) interacts with the SMA (sustained neuronal activity) to string submovements together in the correct timing sequence. The second function is to contribute to cortical motor set (sustained neuronal activity) which maintains whole movement sequences in readiness for running and execution. This contribution may be to the SMA, premotor area or to both. The BG is only utilized in these two functions when the movements or sequences are skilled and require few attentional resources for their performance. In Parkinson's disease a defective cue leads to slowing of skilled movement sequences and associated instability of submovements (each submovement cumulatively decreases in amplitude and velocity). This is the phenomenon of hypokinesia. A defect in the contribution to motor set leads to an inability to initiate whole skilled movement sequences (akinesia).

The Unified Parkinson's Disease Rating Scale

Chapter

Jan 1997

A cultural-historical approach to distributed cognition

Article

Jan 1993

Hughes AJ, Daniel SE, Kilford L, Lees AJAccuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinicopathologic study of 100 cases. J Neurol Neurosurg Psychiatry 55:181-184

Article

Apr 1992

Fear of Falling and Postural Performance in the Elderly

Article

Aug 1991
J Gerontol

A cross-sectional study was performed to investigate the association between fear of falling and postural performance in the elderly. One hundred ambulatory and independent volunteers (aged 62-96) were subjected to five types of balance tests: (a) spontaneous postural sway, (b) induced anterior-posterior sway, (c) induced medial-lateral sway, (d) one-leg stance, and (e) a clinical balance assessment scale. Pseudorandom platform motions were used in the induced-sway tests. The subjects were classified into both "faller"/"nonfaller" and "fear"/"no-fear" categories, to allow the influence of fear of falling and falling history to be separated in the analyses. Subjects who expressed a fear of falling were found to exhibit significantly poorer performance in blindfolded spontaneous-sway tests and in eyes-open, one-leg stance tests. The clinical scale was the only balance measure that showed a significant association with retrospective, self-reported falling history. We could not ascertain whether the fear of falling affected balance-test performance in an artifactual manner, or whether the fear and poorer performance were related to a true deterioration in postural control. Until this issue can be resolved, balance-test performance should be interpreted with caution when testing apprehensive individuals. Furthermore, studies of postural control and falling should allow for the potentially confounding influence of fear of falling.

Abnormalities in postural reflexes and voluntary induced automatic movements in Parkinson's patients

Article

Feb 1982
CLIN NEUROL NEUROSUR

Postural abnormalities were systematically studied in 41 Parkinson patients in relation with the other Parkinson symptomatology. Evidence was collected that kinetic postural mechanisms, including turning in recumbant position, rising from the floor and walking, to be considered as volitional automatic movements, reacted differently on Levodopa therapy compared with static postural reflexes and the classical Parkinson symptoms. This suggests that the neuro-biochemical substrate of these postural movements may involve other than dopaminergic pathways as well.

The mysterious motor function of the basal ganglia: The Robert Wartenberg Lecture

Article

Jun 1982

C D Marsden

Taching tape for the motor section of the Unified Parkinson's Disease Rating Scale

Article

May 1995

We developed a teaching tape of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) to provide investigators with a visual document of three raters' interpretations of the scoring system for each item except rigidity. The rate of agreement for the selected samples was always significant, with Kendall's coefficient of concordance W ranging between 0.97 and 0.62. We also provided full UPDRS ratings on sample patients that may be used for training and for multicenter studies to assure uniformity of rating. The study identified several items of the UPDRS motor examination for which written instructions were vague, including speech, action tremor, finger taps, rapid alternating movements, and postural stability. Future versions of the scale should address these problems and correct ambiguities. This project offers the first attempt to provide a visual analog for the UPDRS.

Fear of Falling and Fall-Related Efficacy in Relationship to Functioning Among Community-Living Elders

Article

May 1994
J Gerontol

The relationships of fear of falling and fall-related efficacy with measures of basic and instrumental activities of daily living (ADL-IADL) and physical and social functioning were evaluated in a cohort of community-living elderly persons. Sociodemographic, medical, psychological, and physical performance (e.g., gait speed, timed hand function) measures were administered, during an in-home assessment, to a probability sample of 1,103 residents of New Haven, Connecticut, who were > or = 72 years of age. Falls and injuries in the past year, fear of falling, and responses to the Falls Efficacy Scale were also ascertained. The three dependent variables included a 10-item ADL-IADL scale, an 8-item social activity scale, and a scale of relative physical activity level. Among cohort members, 57% denied fear of falling whereas 24% acknowledged fear but denied effect on activity; 19% acknowledged avoiding activities because of fear of falling. Twenty-four percent of recent fallers vs 15% of nonfallers acknowledged this activity restriction (chi 2 = 13.1; p < .001). Mean fall-related efficacy score among the cohort was 84.9 (SD 20.5), 79.8 (SD 23.4), and 88.1 (SD 17.9) among fallers and nonfallers, respectively (p < or = .0001). Fall-related efficacy proved a potent independent correlate of ADL-IADL (partial correlation = .265, p < .001); physical (partial correlation = .234, p < .001); and social (partial correlation = .088, p < .01), functioning in multiple regression models after adjusting for sociodemographic, medical, psychological, and physical performance covariates as well as history of recent falls and injuries. Fear of falling was only marginally related (p = .05) with ADL-IADL functioning and was not associated with higher level physical or social functioning. The strong independent association between self-efficacy and function found in this study suggests that clinical programs in areas such as prevention, geriatric evaluation and management, and rehabilitation should attempt simultaneously to improve physical skills and confidence. Available knowledge of the factors influencing efficacy should guide the development of these efficacy-building programs.

Psychological Indicators of Balance Confidence: Relationship to Actual and Perceived Abilities

Article

Feb 1996

This study compares several psychological indicators of balance confidence in relation to physical performance, past and current experience, gender bias, and other perceptions of daily functioning. Sixty community-dwelling ambulatory elders (aged 65-95) were administered the Falls Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC), and three dichotomous questions on fear of falling, activity avoidance, and perceived need for personal assistance to ambulate outdoors. Performance measures on walking (average speed) and balance (static posturography) were obtained on a subsample of 21 subjects. Balance confidence assessed by the ABC and self-perceived need for personal assistance with outdoor ambulation were the only indicators significantly associated with the performance measures. As expected, perceived balance capabilities were more strongly related to current behavior (frequency of doing specific activities) than to past experience (fall history). Gender differences in self-report emerged for the global fear-of-falling indicator but not for the two efficacy ratings. Psychological indicators of balance confidence are important to measure both in conjunction with balance test performance and as a legitimate focus of rehabilitation. Of the various indicators assessed here, the dichotomous fear-of-falling question appears to have the least utility. Perceived need for personal assistance to ambulate outdoors has merit as an initial clinical screening question for discriminating persons on the basis of both physical ability and confidence. The ABC scale appears to have the greatest utility as an evaluative index for older persons at a moderate to high level of functioning.

Fear of Falling and Activity Restriction: The Survey of Activities and Fear of Falling in the Elderly (SAFE)

Article

Feb 1998

A new instrument was developed to assess the role of fear of falling in activity restriction. The instrument assesses fear of falling during performance of 11 activities, and gathers information about participation in these activities as well as the extent to which fear is a source of activity restriction. The instrument demonstrated good internal consistency reliability and showed convergent validity with other fear of falling measures. Concurrent (empirical) validity was demonstrated in that the scale was effective in differentiating among those who were expected to be afraid vs. not afraid of falling. Criterion validity was examined in relation to quality of life variables. Fear of falling was shown to be related to lower quality of life, even when controlling for related background factors. One advantage of this measure over existing measures is the possibility for differentiating fear of falling that leads to activity restriction from fear of falling that accompanies activity. This may provide useful information for those interested in treating fear of falling or promoting activity among the elderly.

Performance on clinical tests balance in Parkinson’s disease

Article

Jul 1998

Due to the high incidence of falls in people with idiopathic Parkinson's disease (PD), the assessment of standing balance is a key component of physical therapist evaluation. This study investigated performance on clinical tests of standing balance in subjects with and without PD. The subjects were 10 persons with PD who had a history of falls (age range = 60-80 years), 10 persons with PD who had no history of falls (age range = 63-79 years), and 10 persons with no known neurological impairment (age range = 60-78 years) who served as a comparison group. Subjects were tested on their ability to maintain stability in 3 conditions: (1) steady standing (feet apart, feet together, tandem stance, step stance, and single-limb stance), (2) in response to perturbations generated by self-initiated movements (arm raise, functional reach, bend-reach, and step tests), and (3) in response to an external perturbation to upright stance (shoulder tug). Balance was measured at peak dosage in the levodopa medication cycle (in the morning) and 7 days later. The mean Hoehn and Yahr Disability Scale score was 3.0 for the fallers with PD and 2.5 for the nonfallers with PD. Performance on the tandem stance, single-limb stance, functional reach, and shoulder tug tests demonstrated differences between the subjects with PD and the comparison group and between the fallers and nonfallers with PD. The results of these tests were highly repeatable over 7 days (ICC = .61-.94). Although there was a small sample size, performance was highly consistent across 7 days when testing occurred during peak dosage of levodopa. A small battery of tests were sensitive enough to discriminate between people with PD who fall and those with no history of falls.

Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease: A Randomized, Controlled Trial

Article

Nov 1998

The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described. Fifty-one men and women, aged 55-84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.e., no specific exercise). Of the original 51 participants, 46 completed the randomized, controlled trial. Participants in the exercise arm (n = 23) received individual instruction three times per week for 10 weeks. Participants in the usual care arm (n = 23) were "wait listed" for intervention. Changes over 10 weeks in spinal flexibility (i.e., functional axial rotation) and physical performance (i.e., functional reach, timed supine to stand) were the primary outcome measures. MANOVA conducted for the three primary outcome variables demonstrated significant differences (P < or = .05) between the two groups. Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group. There was no significant difference in supine to sit time. Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD.

Effects of physical training on straightening-up processes in patients with Parkinson's disease

Article

Mar 1999

The aim of this study was to evaluate whether motor training could improve the straightening-up sequences in patients with Parkinson's disease and, consequently, could ease the capacity of the patients to change body's position. Twenty out-patients with idiopathic Parkinson's disease (12 males, 8 females; mean age 72.9; H-Y, 1. 5-3) were enrolled in a rehabilitation programme which included exercises for the mobility of the trunk, of upper and lower limbs and of each segment of the spine, in order to improve the coordination of movement and to avoid postural disturbances. They received 1 hour of group treatment twice a week for a 5 week consecutive period. No changes were made in the pharmacological treatment received by each patient. The patients were evaluated at the beginning and at the end of the rehabilitation training. The statistical evaluation was made using the Wilcoxon test. Statistically significant differences were observed in all the motor parameters that were evaluated (supine to sitting and sitting to supine, supine rolling, standing from a chair). The observations demonstrate that physical training can be effective in improving motor performance related to changes in position which affects the simple daily activities of the patients.

Movement Disorders in People With Parkinson Disease: A Model for Physical Therapy

Article

Jul 2000

Meg E Morris

People who are diagnosed with idiopathic Parkinson disease (PD) experience movement disorders that, if not managed, can lead to considerable disability. The premise of this perspective is that physical therapy for people with PD relies on clinicians having: (1) up-to-date knowledge of the pathogenesis of movement disorders, (2) the ability to recognize common movement disorders in people with PD, (3) the ability to implement a basic management plan according to a person's stage of disability, and (4) problem-solving skills that enable treatment plans to be tailored to individual needs. This article will present a model of physical therapy management for people with idiopathic PD based on contemporary knowledge of the pathogenesis of movement disorders in basal ganglia disease as well as a review of the evidence for physical therapy interventions. The model advocates a task-specific approach to training, with emphasis on treating people with PD-related movement disorders such as hypokinesia and postural instability within the context of functional tasks of everyday living such as walking, turning over in bed, and manipulating objects. The effects of medication, cognitive impairment, the environment, and coexisting medical conditions are also taken into consideration. An argument is put forward that clinicians need to identify core elements of physical therapy training that apply to all people with PD as well as elements specific to the needs of each individual. A case history is used to illustrate how physical therapy treatment is regularly reviewed and adjusted according to the changing constellation of movement disorders that present as the disease progresses.

Development of an Activity Scale for Individuals With Advanced Parkinson Disease: Reliability and “On-Off” Variability

Article

Dec 2000

Functional mobility in people with advanced Parkinson disease, some of whom have a variable response to drug treatment, is often difficult to evaluate. The objectives of this study were to investigate the interrater reliability of measurements obtained with a scale designed to measure mobility and to determine the impact of self-rated dyskinesias and fluctuations on the measure. SSUBJECTS: Twenty-nine people with Parkinson disease and with disability and considerable disease duration (mean=11.7 years, SD=4.9, range=6-22) took part in the study. The subjects' performance on a 10-item scale was videotaped. The videotapes were then scored by 2 independent raters, and the scores were used to determine interrater reliability. The stability of 6 repeated measurements was examined in the home situation, taking into account self-rated fluctuations of motor performance. Weighted Kappa values of agreement (.86-.98) confirmed the reliability between testers. Measurement during the "on" phase (when medication was working optimally) and the "off" phase (when the action of medication was strongly decreased or absent) led to different measurements. Measuring frequently within "on" and "off" phases gave relatively stable measurements for total function, bed transfers, and gait akinesia, the latter during the "off" phase only (intraclass correlation coefficients [ICCs]=.70-.93). However, more modest repeatability applied to transfers from a chair (ICC=.65-.67). To ensure valid results in future effect studies, clinical differentiation between "on" and "off" phase measurements is proposed on the basis of patients' own perception of their medication status.

Postural instability in Parkinson's disease: A comparison with and without a concurrent task

Article

Jan 2001
GAIT POSTURE

The purpose of this investigation was to determine the effects of dual task performance on postural instability in subjects with idiopathic Parkinson's disease (PD) compared with healthy elderly people. In particular, we aimed to divert attention to a secondary task so the full extent of balance disturbance could be revealed without compensation by attentional mechanisms. Forty-five subjects were tested: 15 PD subjects with a past history of falls; 15 PD subjects with no history of falls; and 15 unimpaired individuals. Groups were matched for age and sex and subjects with PD were tested at peak dose in the levodopa medication cycle. Each subject was tested on their ability to maintain stability in three conditions: (1) steady standing (feet apart, feet together, step stance, tandem stance, single leg stance); (2) in response to perturbations generated by self-initiated movements (arm raise test, step test); and (3) in response to an unexpected external perturbation in upright stance, the shoulder tug test. The concurrent task was verbal-cognitive and required subjects to recite the days of the week backwards. The concurrent task produced a significant deterioration in performance for the arm raise test in all groups, the step test for the PD fallers and controls and for tandem stance in the PD fallers. Ceiling effects were evident for timed tests with feet apart and feet together resulting in poor discriminative validity for these tests. The external perturbation test showed differences between the three groups for both unitask and concurrent task conditions, yet similar rates of change from unitask to dual task conditions. Because PD fallers had a more severe initial deficit than controls, deterioration placed them in that part of the balance continuum at high risk of losing equilibrium.

Postural instability and falls in Parkinson’s disease

Article

Feb 2001
Adv Neurol

Developing Meaningful Fear of Falling Measures for Community Dwelling Elderly

Article

Oct 2001

The objective of this study is to demonstrate how a Rasch analytic approach can be used to create fear of falling measures that remain connected to the meaningful descriptions provided by the instrument items. The University of Illinois at Chicago Fear of Falling Measure was developed using focus groups and consists of 19 common activities designed to represent an increasing level of concern about falling among older adults. Rasch analysis of responses from 106 community dwelling elderly revealed that the two middle rating scale categories (a little worried and moderately worried) were not being used in the expected fashion. After modification of the rating scale, Rasch analysis showed that the three items causing the least worry (get dressed, get on/off toilet, and get in/out of bed) were statistically erratic. Final analysis demonstrated that the remaining 16 items represented a unidimensional construct that, in general, supported the original expected item difficulty hierarchy. Because person and item measures were calibrated on the same linear scale person measures are translatable to item descriptions. This connection provides meaning to the numeric values obtained from the instrument and provides a basis for setting clinically relevant criteria for interventions.

Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients

Article

May 2002
STROKE

This study compared the psychometric properties of 3 clinical balance measures, the Berg Balance Scale (BBS), the Balance subscale of the Fugl-Meyer test (FM-B), and the Postural Assessment Scale for Stroke Patients (PASS), in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset. One hundred twenty-three stroke patients were followed up prospectively with the 3 balance measures 14, 30, 90, and 180 days after stroke onset (DAS). Reliability (interrater reliability and internal consistency) and validity (concurrent validity, convergent validity, and predictive validity) of each measure were examined. A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity. The FM-B and BBS showed a significant floor or ceiling effect at some DAS points, whereas the PASS did not show these effects. The BBS, FM-B, and PASS all had good reliability and validity for patients at different recovery stages after stroke. The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but, as expected, only a low level of responsiveness at 90 to 180 DAS. The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset, 14 to 30 DAS. All 3 measures tested showed very acceptable levels of reliability, validity, and responsiveness for both clinicians and researchers. The PASS showed slightly better psychometric characteristics than the other 2 measures.

Characteristics Associated with Fear of Falling and Activity Restriction in Community-Living Older Persons

Article

Apr 2002

To identify the characteristics associated with restricting activity because of fear of falling (activity restriction) and to determine which characteristics distinguish older persons who restrict activity from those who have fear of falling but do not restrict their activities (fear of falling alone). Population-based cross-sectional study. General community. One thousand sixty-four community-living persons aged 72 and older. Candidate predictors were identified from the following domains: demographic, health status, physical, psychosocial, and fall-related. The outcome measure was the report of no fear of falling, fear of falling alone,or activity restriction. Fifty-seven percent of the cohort reported no fear of falling, 24% reported fear of falling alone, and 19% reported restricting activity. The proportion of participants with poor health status, slow timed physical performance, activities of daily living disability, and poor psychosocial function was highest in those with activity restriction, intermediate in those with fear of falling alone, and lowest in those with no fear of falling. Of participants with fear of falling, characteristics independently associated with activity restriction were history of an injurious fall, slow timed physical performance, two or more chronic conditions, and depressive symptoms. Older persons who restrict activity are more physically frail and have a greater burden of chronic conditions and depressive symptoms than those who have fear of falling alone. These differences between persons with fear of falling may guide the refinement of clinical interventions and preventative programs.

Floor-Rise Strategy Training in Older Adults

Article

Oct 2002

To determine the effect of a 2-week (six-session) training intervention to improve the ability of disabled older adults to rise from the floor. Prospective intervention trial. Congregate housing in Michigan. Subjects aged 65 and older who admitted to requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. Participants were randomly allocated to individual training (n = 17, mean age 81) in strategies to rise from the floor (using for example, certain key intermediate body positions) or a control chair-based flexibility intervention (n = 18, mean age 80). At baseline and postintervention, residents were queried regarding their rise difficulty (difficulty scale) and symptoms (symptoms scale) associated with the rise and were tested in their ability to perform timed floor-rise tasks. These tasks varied in starting position (supine vs all fours) and in use of a support to assist in rising (no support, use of an end table, use of a chair). Using baseline performance as the covariate, by analysis of covariance (ANCOVA), the training group showed a significant (P <.05) improvement in mean number of rise tasks completed (baseline mean 6.6, postintervention mean 7.3) versus essentially no improvement in the controls. Similarly, by ANCOVA, the training group (compared with controls) showed a significant (P <.05) improvement on the difficulty and symptoms scales. There was no intervention effect for rise time. A short-term, strategy-based intervention improved floor-rise ability and perceived difficulty and symptoms associated with the rise. This approach, focusing on key intermediate body positions, may be useful in training floor-rise skills, particularly in older adults at risk for falls.

Predicting falls within the elderly community: Comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers

Article

Feb 2004
ARCH GERONTOL GERIAT

Simple reaction time, the Berg balance scale, the Activities-specific Balance Confidence (ABC) scale and postural sway were studied in order to determine cut-off scores as well as develop a model used in the prevention of fallers within the elderly community. One hundred and twenty-five subjects, 45 fallers and 80 non-fallers were evaluated throughout the study and results indicated that non-fallers have significantly faster reaction times, have higher scores on the Berg balance scale and the ABC scale as well as sway at slower frequencies when compared to fallers. Furthermore, all risk factors were subsequently entered into a logistic regression analysis and results showed that reaction time, the total Berg score and the total ABC score contributed significantly to the prediction of falls with 89% sensitivity and 96% specificity. A second logistic regression was carried out with the same previous variables as well as all questions of the Berg and ABC scales. Results from the logistic analysis revealed that three variables were associated with fall status with 91% sensitivity and 97% specificity. Results from the following study would seem rather valuable as an assessment tool for health care professionals in the identification and monitoring of potential fallers within nursing homes and throughout the community.

Clinical gait and balance scale (GABS): Validation and utilization

Article

Jan 2004
J NEUROL SCI

Gait and Balance Scale (GABS) consists of historical information and examination of 14 different gait and balance parameters designed to assess the severity of these functional domains. Thirty-five patients with Parkinson's disease (PD), Hoehn and Yahr stages 1-3, were tested during their "off" period. GABS items were compared to quantitative data from two computerized gait analysis instruments, GAITRite and Pro Balance Master. Intra-class correlation coefficients were calculated to establish reliability. Intra-rater test-retest reliability was determined using Cohen's Kappa statistic. Concurrent validity was derived using the Spearman's rho test with the items from GABS, GAITRite and Balance Master. Intra-rater reliability was high with k>0.41 (k=kappa statistic) for 17 items, 6 had k>0.61. When performing validity measurements, a number of items on the GABS had a correlation coefficient significant at p<0.01 (2-tailed). Posture, pull test, balance during stance, single limb stance, tandem stance, turning, toe walking and functional reach had significant correlation with Balance Master data (R=0.46-1). Gait, arm swing, gait speed, steps/5 m, 'up-and-go test', modified performance oriented assessment of gait scale and provocative testing had significant correlation with the GAITRite items (R=0.51-0.83). GABS is an easy-to-use comprehensive clinical scale with high intra-rater and internal item reliability. We have shown concurrent validity with two computerized gait analysis instruments. We expect GABS to have a particular utility in clinical trials designed to modify functional impairment associated with abnormalities in gait and balance.

Determinants of Balance Confidence in Community-Dwelling Elderly People

Article

Jan 2004

The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study. The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (mean=81.7, SD=6.7). Balance was measured using the Berg Balance Scale. Functional mobility was measured using the Timed Up Go Test. The Activities-specific Balance Scale was used to assess balance confidence. Data were analyzed using Pearson correlation, multiple regression analysis, and t tests. Fifty-seven percent of the variance in balance confidence could be explained by balance performance. Functional mobility and subject characteristics examined in this study did not contribute to balance confidence. Balance performance alone is a strong determinant of balance confidence in community-dwelling elderly people.

The effect of physical therapy on balance of patients with Parkinson??s disease

Article

Apr 2004
INT J REHABIL RES

Ivona Stankovic

Physical therapy can improve performance of balance tests in patients with Parkinson's disease. Parkinson's disease is a chronic progressive neurological disturbance with significant effect on movements, cognitive functions, autonomous systems and psychosocial activities. The effects of physical therapy are rarely reported and not sufficiently studied. This prospective study comprised 40 persons with stage III Parkinson's disease, according to aged over 50 years and 20 healthy controls of the same age. Patients were medically stable and had no other neurological deficits, postural hypotensia, visual disturbances or musculo-skeletal deficits. Balance tests before and after physical therapy were analysed according to. Balance tests in patients with Parkinson's disease resulted in significant differences of values for tandem stance, one leg stance, step test and external perturbation when compared to the controls, and between groups with and without falling tendency. Tandem stance, one leg stance, step test and external perturbation can be used for differentiation between groups with and without a tendency to fall. Physical therapy resulted in significant improvement of these tests in both the groups analysed. Systematic application of physical therapy, as part of team treatment, improves the balance of patients with Parkinson's disease.

Developing methods to evaluate how people with Parkinson's Disease turn 180°: An activity frequently associated with falls

Article

Apr 2004

To develop a test that identified fallers from their turning strategies, as people with Parkinson's Disease (PD) commonly fall turning. We compared (1) Turn Types demonstrated when turning 180 degrees during the Timed Up and Go Test (TUG Test) by 19 non-fallers and 29 fallers (median age 71) and (2) Turn Types, Turning Steps, Heelstrike, Stability and the Use of Space and Support demonstrated when turning 180 degrees during an everyday activity by 15 non-fallers and 26 fallers (median age 75). Turns were rated from video by observers blinded to group. Inter-observer agreement was tested. Similar proportions of fallers and non-fallers demonstrated multiple-step Turn Types during the TUG Test (69% v 58%; p=0.433) and the everyday activity (66% vs. 46%; p=0.241). When turning, similar proportions of each group lacked Heelstrike, lost Stability and used the available Space and Support (p>0.7); Turning Step counts were also similar (p=0.891). Inter-observer agreement proved acceptable except for Turn Type during everyday activity (Kappa=0.46). The anticipated differences between fallers and non-fallers were not identified, perhaps obscured by insufficiently or overly challenging protocols and/or the compensations deployed by fallers. Further methodological development is needed in the analysis of fall-related activities with high-risk groups.

Tests of Stepping as Indicators of Mobility, Balance, and Fall Risk in Balance-Impaired Older Adults

Article

Jul 2004

To determine the relationships between two tests of stepping ability (the maximal step length (MSL) and rapid step test (RST)) and standard tests of standing balance, gait, mobility, and functional impairment in a group of at-risk older adults. Cross-sectional study. University-based laboratory. One hundred sixty-seven mildly balance-impaired older adults recruited for a balance-training and fall-reduction program (mean age 78, range 65-90). Measures of stepping maximally (MSL, the ability to maximally step out and return to the initial position) and rapidly (RST, the time taken to step out and return in multiple directions as fast as possible); standard measures of balance, gait, and mobility including timed tandem stance (TS), tandem walk (TW, both timing and errors), timed unipedal stance (US), timed up and go (TUG), performance oriented mobility assessment (POMA), and 6-minute walk (SMW); measures of leg strength (peak knee and ankle torque and power at slow and fast speeds); self-report measures of frequent falls (>2 per 12 months), disability (Established Population for Epidemiologic Studies of the Elderly (EPESE) physical function), and confidence to avoid falls (Activity-specific Balance Confidence (ABC) Scale). Spearman and Pearson correlation, intraclass correlation coefficient, logistic regression, and linear regression were used for data analysis. MSL consistently predicted a number of self-report and performance measures at least as well as other standard balance measures. MSL correlations with EPESE physical function, ABC, TUG, and POMA scores; SMW; and peak maximum knee and ankle torque and power were at least as high as those correlations seen with TS, TW, or US. MSL score was associated with the risk of being a frequent faller. In addition, the six MSL directions were highly correlated (up to 0.96), and any one of the leg directions yielded similar relationships with functional measures and a history of falls. Relationships between RST and these measures were relatively modest. MSL is as good a predictor of mobility performance, frequent falls, self-reported function, and balance confidence as standard stance tests such as US. MSL simplified to one direction may be a useful clinical indicator of mobility, balance, and fall risk in older adults.

Comorbid disorders and hospitalisation in Parkinson's disease: a prospective study

Article

Jul 2004

Parkinson's disease (PD) is often associated with other disorders, typical of the disease or of the age of PD patients, that can lead to hospitalisation, sometimes as emergencies. In this one-year prospective, longitudinal study, we investigated the comorbid events prompting the hospitalisation, or occurring during the planned hospitalisation, of an unselected group of 180 PD patients, admitted to 9 general hospitals in the course of the study. The most frequent acute comorbid events were trauma (30.5%), mostly due to falls, and vascular disorders (29.3%). Comorbidities were closely related to PD in 50% of cases. More than 50% of patients did not require (in addition to PD therapy) specific treatment for the acute comorbid event. Older age was associated with increased risk of complications. The setting up of multidisciplinary networks covering entire territories could help to improve the way in which we tackle the clinical and social problems generated by PD and its comorbidities.

Rating scale analysis of the Berg Balance Scale

Article

Aug 2004
ARCH PHYS MED REHAB

To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms. Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data. Outpatient Veterans Affairs medical center. One hundred (99 men, 1 woman) community-dwelling veterans referred for balance deficits (age range, 64-88y). Not applicable. The BBS. Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item "tandem stance," as well as passing 2 of the following 3 items: "alternating foot," "standing on one leg," and "look behind." Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.