Effect of Leg Selection on the Berg Balance Scale Scores of Hemiparetic Stroke Survivors: A Cross-Sectional Study

Item distribution of the Berg Balance Scale in older adults with Hip fracture: a Rasch analysis

INTRODUCTION

Balance impairment occurs after a hip fracture, but the characteristics of the impairment are not clear.

OBJECTIVE

To investigate the uni-dimensionality, fit statistics, and item difficulty of the Berg Balance Scale (BBS) in older adults with hip fracture by conducting a Rasch analysis.

METHODS

This was an observational cross-sectional study. The 254 participants were all ≥ 65 years old and had been hospitalized for rehabilitation after a unilateral hip fracture incurred during a fall. We collected their BBS scores at the time of hospital discharge and conducted a Rasch analysis to examine the uni-dimensionality, fit statistics, and item difficulty.

RESULTS

The principal component analysis (PCA) of the Rasch model demonstrated that the BBS is uni-dimensional. The information-weighted mean square (MnSq) fit statistic was within the range of fit criteria for all items. The underfit item of the outlier-sensitive MnSq fit statistics was "Standing unsupported eyes closed" with the MnSq of 2.06. The difficult items were in order of logits: "Standing on one leg" (logits = 4.01); "Step tool" (logits = 2.74); and "Turn 360°" (logits = 2.61).

CONCLUSION

The BBS is uni-dimensional and conforms with the Rasch model. The BBS most difficult items for older adults with a hip fracture required one-legged support and dynamic balance.

Development of a convolutional neural network (CNN) based assessment exercise recommendation system for individuals with chronic stroke: a feasibility study

BACKGROUND

The use of artificial intelligence (AI) is revolutionizing nearly every aspect of healthcare, but the application of AI in rehabilitation is lagging behind. Clinically, gait parameters and patterns are used to evaluate stroke-specific impairment. We hypothesized that gait kinematics of individuals with stroke provide rich information for the deep-learning to predict the clinical decisions made by physiotherapist.

OBJECTIVE

To investigate whether the results of clinical assessments and exercise recommendations by physiotherapists can be accurately predicted using a deep-learning algorithm with gait kinematics data.

METHOD

In this cross-sectional study, 40 individuals with stroke were assessed by a physiotherapist using the lower-extremity subscale of the Fugl-Meyer Assessment (FMA-LE) and Berg Balance Scale (BBS). The physiotherapist also decided whether or not the single-leg-stance was an appropriate balance training for each participant. The participants were classified as having good mobility and a low fall risk based on the cutoff scores of the two clinical scales. A convolutional neural network (CNN) was trained using gait kinematics to predict the assessment results and exercise recommendations.

RESULTS

The trained model accurately predicted the results of the clinical assessments and decisions with an average prediction accuracy of 0.84 for the FMA-LE, 0.66 for the BBS, and 0.78 for the recommendation of the single-leg-stance exercise.

CONCLUSIONS

This CNN deep-learning model provided time-effective and accurate prediction of clinical assessment results and exercise recommendations. This study provides preliminary evidence to support the use of biomechanical data and AI to assist treatment planning and shorten the decision-making process in rehabilitation.

Application of a virtual reality tracker-based system to measure seated postural stability in stroke patients

Background

Postural stability while sitting is an important indicator of balance and an early predictor for future functional improvement in neurorehabilitation, but the evaluation is usually dependent on clinical balance function measures. Meanwhile, instrumental posturography has been used widely to obtain quantitative data and characterize balance abilities and underlying control mechanisms, but not as often for sitting balance. Moreover, traditional kinetic methods using a force platform to test sitting stability often require modification and are costly. We proposed a tracker-based posturography with a commercial virtual reality system, the VIVE Pro system (HTC, Inc. Taiwan), to record the trunk displacement (TD) path with a lumbar tracker for evaluation of sitting stability. The goals were to test the reliability and validity of the TD parameters among stroke patients.

Methods

Twenty-one stroke individuals and 21 healthy adults had their postural sway measured with this system under four sitting conditions, i.e., sitting on a solid surface or a soft surface, with eyes open or closed. The test–retest reliability of the TD parameters was evaluated with intraclass correlation coefficients in 22 participants. We also tested the discriminative validity of these parameters to discriminate between stroke and healthy controls, and among four sitting conditions. Furthermore, the TD parameters were correlated with the three balance function tests: the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS) and the Function in Sitting Test (FIST).

Results

The results indicated that the TD parameters obtained by tracker-based posturography had mostly moderate to good reliability across the four conditions, with a few exceptions in the solid surface and eyes open tasks. The TD parameters could discriminate the postural stability between sitting on solid and soft surfaces. The stroke group had more seated postural sway than the control group, especially while sitting on a soft surface. In addition, velocity measures in the sagittal and frontal planes had moderate to high correlations with the PASS and BBS scores.

Conclusions

This tracker-based system is a cost-effective option for the clinical assessment of body stability for stroke patients in a seated position and shows acceptable reliability and validity.

Optimal frequency of whole body vibration training for improving balance and physical performance in the older people with chronic stroke: A randomized controlled trial

OBJECTIVE

To explore the optimal frequency of whole-body vibration training for improving the balance and physical performance in older people with chronic stroke.

DESIGN

a single-blind randomized controlled trial.

SETTING

Two rehabilitation units in the Wuhan Brain Hospital in China.

PARTICIPANTS

A total of 78 seniors with chronic stroke.

INTERVENTIONS

Low-frequency group (13 Hz), high-frequency group (26 Hz), and zero-frequency group (Standing on the vibration platform with 0 Hz) for 10 sessions of side-alternating WBV training.

MAIN MEASURES

The timed-up-and-go test, five-repetition sit-to-stand test, 10-metre walking test, and Berg balance scale were assessed pre- and post-intervention.

RESULTS

Significant time × group interaction effects in five-repetition sit-to-stand test (p = 0.014) and timed-up-and-go test at self-preferred speed (p = 0.028) were observed. The high-frequency group outperformed the zero-frequency group in both five-repetition sit-to-stand test (p = 0.039) and timed-up-and-go test at self-preferred speed (p = 0.024) after 10-sessions training. The low-frequency group displayed only a significant improvement in five-repetition sit-to-stand test after training (p = 0.028). No significant within- or between-group changes were observed in the Berg balance scale and walking speed (p > 0.05). No significant group-difference were found between low-frequency and high-frequency groups. No adverse events were reported during study.

CONCLUSIONS

Compared with 13 Hz, 26 Hz had no more benefits on balance and physical performance in older people with chronic stroke.

Distance-limited walk tests post-stroke: A systematic review of measurement properties

BACKGROUND

Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation.

OBJECTIVE

To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke.

METHODS

Electronic database searches were completed in 2017. Records were screened and appraised for quality.

RESULTS

Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05).

CONCLUSIONS

The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.

Use of Reaction Force to Evaluate Older Adults' Gait Patterns While Using a Walker to Walk

Walking is the most common activity in daily life. As people age, however, they begin to become imbalanced and need the assistance of mobility devices for walking, such as walkers. However, clinical gait measurement requires a lot of equipment to be worn; as walker users are seniors or disabled, this may cause them to be troubled in the assessment. Thus, this study used four load cells on the walker to estimate gait status. To understand the difference between the three groups of the Berg Balance Scale (BBS), 60 volunteers, who served as the subjects, were divided into three groups according to BBS scores, 20 volunteers for each group. Data were obtained from four load cells; walker users were divided per the BBS to observe their stance, swing phases, and support force while walking. The results of the study found that participants in the study were able to walk smoothly with the walker, and differences between the three groups in stance, swing phases, and support force were observed. The main findings of this study were: (1) While walking, the stance and swing phases could be stabilized by the evaluated gait; and (2) even if the user can walk stably, body function can be evaluated by the support force. We hope that our method will be widely applied in the design of mobility devices and in the evaluation of seniors’ care; we also hope our study will contribute to increasing knowledge, generally, in this field.

Reliability of the Maximal Step Length Test and Its Correlation with Motor Function in Chronic Stroke Survivors

OBJECTIVE

This study aimed to (1) investigate the interrater, intrarater, and test-retest reliabilities, as well as the minimal detectable change, of the Maximal Step Length test (MSL) in stroke survivors, (2) examine the concurrent validity of MSL with other stroke-specific impairment measurements in stroke survivors, and (3) compare the MSL performances of stroke survivors and those of age-matched healthy older adults in different directions.

DESIGN

Cross-sessional study.

SETTING

University-based research laboratory.

PARTICIPANTS

Stroke survivors (n = 48) and age-matched healthy older adults (n = 39).

METHODS

Stroke survivors were assessed with MSL, lower limb muscle strength, Limits of Stability (LOS) Test, Berg Balance Scale (BBS), 5-meter walk test, and Activities-specific Balance Confidence (ABC) scale by two trained assessors in 1 session. Their performance on MSL was reassessed 1 week later to establish the test-retest reliability. Healthy older adults were assessed with MSL only. Intraclass correlation coefficient (ICC) was used to assess the reliability of MSL and Spearman's rho was used to quantify the strength of correlations between MSL and secondary outcomes. Between-group differences of MSL were assessed with the independent t-test.

RESULTS

The MSL exhibited excellent intrarater, interrater, and test-retest reliabilities [ICC: 0.885-1.000]. Significant correlations (ρ: 0.447-0.723) were demonstrated between MSLs in most directions and muscle strengths of the affected legs, BBS scores, and walking speeds. The step lengths differed significantly between stroke survivors and healthy older adults in the forward, backward, and sideways directions on both the affected and less affected sides.

CONCLUSIONS

The MSL is a reliable, valid, and easily administered test of the stepping capabilities of stroke survivors. Stroke survivors had significant shorter MSLs in all directions than the age-matched healthy older adults.

Nine-hole Peg Test and Ten-meter Walk Test for Evaluating Functional Loss in Chinese Charcot-Marie-Tooth Disease

Background:

The 9-hole peg test (9-HPT) and 10-meter walk test (10-MWT) are commonly used to test finger motor function and walking ability. The aim of this present study was to investigate the efficacy of these tests for evaluating functional loss in Chinese Charcot-Marie-Tooth (CMT) disease.

Methods:

Thirty-four Chinese CMT patients (CMT group) from August 2015 to December 2016 were evaluated with 9-HPT, 10-MWT, CMT disease examination score, overall neuropathy limitation scale (ONLS), functional disability score, and Berg Balance Scale (BBS). Thirty-five age- and gender-matched healthy controls (control group) were also included in the study. Student's nonpaired or paired t-test were performed to compare data between two independent or related groups, respectively. The Pearson test was used to examine the correlations between recorded parameters.

Results:

The mean 9-HPT completion time in the dominant hand of CMT patients was significantly slower than that in the healthy controls (29.60 ± 11.89 s vs. 19.58 ± 3.45 s; t = −4.728, P < 0.001). Women with CMT completed the 9-HPT significantly faster than men with CMT (dominant hand: 24.74 ± 7.93 s vs. 33.01 ± 13.14 s, t = 2.097, P = 0.044). The gait speed of the average self-selected velocity and the average fast-velocity assessed using 10-MWT for CMT patients were significantly slower than those in the control group (1.03 ± 0.18 m/s vs. 1.44 ± 0.17 m/s, t = 9.333, P < 0.001; 1.31 ± 0.30 m/s vs. 1.91 ± 0.25 m/s, t = 8.853, P < 0.001, respectively). There was no difference in gait speed between men and women. Both 9-HPT and 10-MWT were significantly correlated with the ONLS, functional disability score, and BBS (P < 0.05 for all).

Conclusion:

The 9-HPT and 10-MWT might be useful for functional assessment in Chinese patients with CMT.

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower-Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) has been used to augment the efficacy of task-oriented training (TOT) after stroke. Bilateral intervention approaches have also been shown to be effective in augmenting motor function after stroke. The purpose of this study was to compare the efficacy of bilateral TENS combined with TOT versus unilateral TENS combined with TOT in improving lower-limb motor function in subjects with chronic stroke.

METHODS AND RESULTS

Eighty subjects were randomly assigned to bilateral TENS+TOT or to unilateral TENS+TOT and underwent 20 sessions of training over a 10-week period. The outcome measures included the maximal strength of the lower-limb muscles and the results of the Lower Extremity Motor Coordination Test, Berg Balance Scale, Step Test, and Timed Up and Go test. Each participant was assessed at baseline, after 10 and 20 sessions of training and 3 months after the cessation of training. The subjects in the bilateral TENS+TOT group showed greater improvement in paretic ankle dorsiflexion strength (β=1.32; P=0.032) and in the completion time for the Timed Up and Go test (β=-1.54; P=0.004) than those in the unilateral TENS+TOT group. However, there were no significant between-group differences for other outcome measures.

CONCLUSIONS

The application of bilateral TENS over the common peroneal nerve combined with TOT was superior to the application of unilateral TENS combined with TOT in improving paretic ankle dorsiflexion strength after 10 sessions of training and in improving the completion time for the Timed Up and Go test after 20 sessions of training.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02152813.