Star excursion balance test scores under different conditions: Effects of arms position and shoe-wear

Help! - you need your hands: Contribution of arm movements on balance performance in healthy individuals: A systematic review with meta-analysis

BACKGROUND

Emerging evidence highlights that arm movements exert a substantial and functionally relevant contribution on postural control in healthy individuals. However, performance differences between free versus restricted arm movement for different balance categories with varying levels of task difficulty have not been systematically investigated yet.

OBJECTIVE

The objective of this systematic review and meta-analysis was to characterise, aggregate, and quantify performance discrepancies between free and restricted arm movement conditions for diverging balance categories with varying levels of task difficulty in healthy individuals.

METHODS

A systematic search of the literature according to the PRISMA guidelines was performed on the electronic databases PubMed, Web of Science, and SPORTDiscus from their inception date till 1st September 2024. To be applicable for analysis, studies had to report at least one measure of balance performance in healthy individuals. The included studies were coded according to the following criteria: age, sex, status, arm movement conditions, balance test, and test modality. Methodological study quality was assessed using the Appraisal tool for Cross-Sectional Studies. Weighted standardized mean differences (SMD) were calculated and classified according to their magnitude.

RESULTS

The literature search identified a total of N = 941 records, 25 of which met the inclusion criteria and were analysed in this review. A total of 725 participants (n = 331 females) participated in the studies. The free use of arm movement resulted in moderate (static: SMD = 0.51, dynamic: SMD = 0.66, proactive: SMD = 0.52, reactive: SMD = 0.50) improvements of balance performance. In addition, the performance enhancements were more pronounced for balance tasks with a high (static: SMD = 0.89, dynamic: SMD = 1.04) compared to a low (static: SMD = 0.20, dynamic: SMD = 0.76) difficulty level. Due to a lack of studies, no analysis for measures of proactive and reactive balance was performed.

CONCLUSIONS

The findings revealed that the free use of arm movement positively affects several measures of balance performance, and this is effect is more pronounced for balance tasks with a high difficulty level.

Effect of Lower Limb Muscle Fatigue on Dynamic Balance Performance in Healthy Young Adults: Role of Arm Movement

There is evidence that balance performance deteriorates due to exercise-induced muscle fatigue. However, it is unknown if free arm movement during balance testing can compensate for, or restricted arm movement can amplify these performance degradations. Thus, the objective of this study was to compare the effects of free versus restricted arm movement on balance performance under non-fatigued and fatigued conditions. Fifty-two healthy participants (men=31, women=21; age=22.6±1.6 years) were assessed for their dynamic balance (reach distances for the Y Balance Test - Lower Quarter) under non-fatigued and fatigued (repetitive vertical bipedal box jumps until failure) conditions using two different arm positions: free (move the arms freely) and restricted (keep the arms akimbo) arm movement. Restriction of arm movement (all p< 0.001; 0.48≤ η p 2 ≤0.79) and application of fatigue ( p≤ 0.003; 0.16≤ η p 2 ≤0.28) independently, but not the interaction between the two (except for the posteromedial reach direction: p= 0.046; η p 2 =0.08) , resulted in significantly deteriorated lower limb reach distances. These findings suggest that free arm movement and thus the use of an 'upper body strategy' has no compensatory effect on muscle fatigue-induced balance deteriorations.

Influence of protocol variables on outcomes of the star excursion balance test group (SEBT, mSEBT, YBT-LQ) in healthy individuals: a systematic review

Background

The "SEBT group," which includes the Star Excursion Balance Test (SEBT), its modified version (mSEBT), and the Lower Quarter Y-Balance Test (YBT-LQ), is used to assess the limits of stability. Interestingly, the testing protocol allows users a considerable degree of flexibility, which can affect the obtained results. Therefore, the objective of this systematic review was to analyze the impact of different protocol variants within the "SEBT group" on outcomes.

Methods

Data were acquired by searching 4 databases (MEDLINE, ScienceDirect, Wiley, Springer Link) focusing on studies published in English in peer-reviewed journals, empirical in nature, conducted on healthy individuals, and examining the effects of various protocol variants on test outcomes. Study quality was assessed with the NHLBI quality assessment tool for pre-post studies with no control group.

Results

The calculation method based on the maximum repetition yields statistically significantly higher results compared to other calculation methods. Allowing unrestricted arm movements during the test results in statistically significantly higher scores compared to the procedure that restricts arm movements. The impact of a warm-up, wearing footwear during testing, and using a dedicated kit remains ambiguous. To obtain reliable results, 4-6 familiarization trials are necessary, though fewer may suffice for athletes experienced in performing the test.

Conclusion

This systematic review highlights the significant impact of the calculation method and arm movement restrictions on the outcomes of the "SEBT group." The effects of wearing footwear during testing, warm-up, and using a dedicated test kit remain unclear. The required number of familiarization repetitions may varies depending on biological maturity level of the person being tested. Future research should develop a warm-up protocol tailored to the needs of the "SEBT group," and investigate the impact of heel elevation during testing on outcomes.

Systematic review registration

The protocol for this systematic review was prospectively registered in the OSF Registries (https://doi.org/10.17605/OSF.IO/JSKH2).

A systematic review and meta-analysis of balance training in patients with chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) is a common yet serious problem for elder patients. This meta-analysis aimed to evaluate the effects of balance training for CAI, to provide evidence for the clinical treatment, and care of CAI patients.

METHODS

Two investigators searched PubMed, EMBASE, Science Direct, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Weipu Databases up to May 20, 2023, for randomized controlled trials (RCTs) on the effects of balance training for CAI. The mean difference (MD) with 95% confidence intervals (95%CIs) was calculated for each outcome with a fixed or random effect model. Review Manager 5.3 software was used for meta-analysis.

RESULTS

Nine RCTs involving 341 patients were included. Meta-analysis results showed that compared with blank controls, balanced training treatment of CAI could significantly improve the score of CAI [MD = 3.95, 95% CI (3.26, 4.64), P < 0.00001], SEBT-PM [MD = 4.94, 95% CI (1.88, 8.00), P = 0.002], SEBT-PL [MD = 5.19, 95% CI (1.57, 8.81), P = 0.005], and FAAM Sports [MD = 17.74, 95% CI (14.36, 21.11), P < 0.00001]. Compared with strength training, balance training treatment of CAI improved the score of CAIT [MD = 2.36, 95% CI (0.29, 4.44), P = 0.03], FAAM-ADL [MD = 4.06, 95% CI (1.30, 6.83), P = 0.004].

CONCLUSION

The analysis outcomes indicate that balance training enhances daily activity capability, motor function, and dynamic balance to different extents. Additionally, when comparing the results of balance training and strength training, no significant difference was observed between the two methods in improving the dynamic stability of CAI patients. However, it is noteworthy that balance training exhibits a more pronounced impact on enhancing functional scale scores.

Effect of Arm Movement and Task Difficulty on Balance Performance in Children, Adolescents, and Young Adults

Background

Studies have shown that restricted compared to free arm movement negatively affects balance performance during balance assessment and this is reinforced when the level of task difficulty (e.g., varying stance/walk conditions, sensory manipulations) is increased. However, it remains unclear whether these findings apply to individuals with differences in the development of the postural control system. Thus, we examined the influence of arm movement and task difficulty on balance performance in children, adolescents, and young adults.

Methods

Static, dynamic, and proactive balance performance were assessed in 40 children (11.5 ± 0.6 years), 30 adolescents (14.0 ± 1.1 years), and 41 young adults (24.7 ± 3.0 years) using the same standardized balance tests [i.e., one-legged stance (OLS) time with eyes opened/closed and/or on firm/foam ground, 3-m beam (width: 6, 4.5, or 3 cm) walking backward step number, Lower Quarter Y-Balance test (YBT-LQ) reach distance] with various difficulty levels under free vs. restricted arm movement conditions.

Results

In all but one test, balance performance was significantly better during free compared to restricted arm movement. Arm by age interactions were only observed for the YBT-LQ and post hoc analyses revealed significantly greater performance differences between free and restricted arm movement, especially, in young adults. Arm by age by task difficulty interactions were found for the OLS and the 3-m beam walking backward test. Post hoc analyses showed significantly greater performance differences between free and restricted arm movement during high vs. low levels of task difficulty and this was more pronounced in children and adolescents.

Conclusions

Regardless of age, static, dynamic, and proactive balance performance benefited from arm movements and this was especially noted for youth performing difficult balance tasks.