The Use of a Balance Performance Monitor in the Treatment of Weight-bearing and Weight-transference Problems after Stroke

Ankle Proprioception Deficit Is the Strongest Factor Predicting Balance Impairment in Patients With Chronic Stroke

OBJECTIVE

To determine the main factor that predicts balance impairment in patients with chronic stroke.

DESIGN

Cross-sectional study.

SETTING

Inpatient rehabilitation hospital and research laboratory.

PARTICIPANTS

A total of 57 patients (42 men, 15 women; mean age 55.7±12.2 years) with chronic symptoms after stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Primary outcomes were ankle functions, including strength, range of motion, and proprioception, and balance, including Berg Balance Scale score and Timed Up and Go test values. Secondary outcomes included gait kinematics, Fugl-Meyer Scale score, and Fall Efficacy Scale score.

RESULTS

According to the cutoff score <46 on the Berg Balance Scale and the Timed Up and Go test ≥13.5 seconds, 21 patients were classified as having a balance impairment (36.8%). Multivariable logistic regressions showed that ankle proprioception (odds ratio = 3.49; 95% confidence interval, 1.17-10.42) was a significant predictor when coupled with step length (odds ratio = 0.00; 95% confidence interval, 0.00-0.22). A cutoff score of 2.59 for the ankle proprioception value predicts balance impairment in patients with stroke (area under the curve 0.784).

CONCLUSION

Ankle proprioception can be used to predict balance impairment in patients with stroke.

Trunk alignment in different standing positions in healthy subjects and stroke patients -a comparative study with a simple method for the everyday practice.: Trunk alignment in healthy and stroke subjects

OBJECTIVES

Weight-bearing (WB) on the lower extremities is an important outcome parameter in the rehabilitation of poststroke hemiparesis. However, the patients often regain this ability by compensatory movement patterns.

METHODS

Our goal was to characterize with a simple method the trunk alignment of healthy subjects and stroke patients (n = 17 for both groups) during standing and following lateral weight shift (WS). To describe trunk alignment, five markers were placed on the subjects' back, and the angles of the trunk at both sides were defined by the lines drawn from the posterior angle of the acromion and the iliac crest on the same body side to the seventh thoracic spinal process. Weight distributions on the lower extremities during standing and lateral WS were determined with a force platform.

RESULTS

The patients had significantly limited WB capacity on their paretic limb, which was accompanied with significant asymmetry in the trunk alignment during standing and following WS to the paretic side.

DISCUSSION

Our results show that this patient population tends to use abnormal compensatory movement patterns to optimize weight shifting, and changes of trunk alignment play a key role in this. This should be taken into consideration during rehabilitation.

Rhythmic arm swing integrated into treadmill training in patients with chronic stroke: A single-subject experimental study

Normal walking includes coordinated and controlled movement of the legs and arms. However, patients following stroke often present with inappropriate motor control which limits coordinated movement patterns of the affected limbs. This study aimed to compare the effects of rhythmic arm swing and arm fixation during treadmill walking in patients with poststroke hemiparesis. We used an alternating study design with multiple baselines across subjects. Three patients with chronic stroke participated in this study. During treadmill walking, rhythmic arm swing and arm fixation conditions were alternately applied. Outcome measures included the 10-meter walk test (10MWT) and energy expenditure index (EEI). In the intervention phase, all subjects showed significantly greater improvements in the 10MWT and EEI scores for rhythmic arm swing condition compared to those for arm fixation condition (p < 0.05). 10MWT improvement rates: Subject 1-34.81% vs. 15.75%; Subject 2-40.00% vs. 17.95%; and Subject 3-38.08% vs. 21.85%; and EEI improvements: Subject 1-23.19% vs. 14.08%; Subject 2-26.15% vs. 20.43%; and Subject 3-22.99% vs. 14.49%. These findings suggest that rhythmic arm swing is clinically feasible as a more favorable option to enhance the effects of treadmill walking training. However, larger studies with a different study design are needed to be able to make any judgment about the usefulness of the treatment.

Comparison of the effects of visual feedback training and unstable surface training on static and dynamic balance in patients with stroke

[Purpose] This study compared the effects of visual feedback training and unstable surface training on the static and dynamic balance of stroke patients. [Subjects and Methods] The study enrolled 20 stroke patients and randomly assigned them to visual feedback training and unstable surface training groups. Both groups performed 30 minutes of conventional exercise therapy twice a week for 4 weeks. In addition, the subjects in the visual feedback training group completed a visual feedback training regimen and the subjects in the unstable surface training group completed training on an unstable surface (30-minute session three times a week for 4 weeks in both groups). Static and dynamic balance parameters were recorded immediately before and after the 4 weeks of training. For data analysis, the paired and independent t-test was used to compare the two groups. [Results] In the visual feedback training group, the sway line at the postural sway of the center of pressure and trace length decreased significantly after training. In both groups, the sway range at the limits of stability in the anteroposterior and mediolateral directions increased significantly after training. [Conclusion] Visual feedback training was better at improving static and dynamic balance than unstable surface training in stroke patients.

Lateral weight transference exercises following acute stroke: a preliminary study of clinical effectiveness

Objectives: To evaluate a training programme aimed at improving lateral weight transference in patients following acute stroke to determine main treatment effects, if any, to inform the design of future studies.

Design: A single-blind randomized controlled trial.

Setting: The Stroke Unit at The James Cook University Hospital, Middlesbrough, UK.

Subjects: Thirty-five patients with an acute stroke.

Interventions: All subjects received their usual care, including physiotherapy. The treatment group (n / 17) received 12 additional therapy sessions (over four weeks) comprising exercises aimed at improving lateral weight transference in sitting delivered by trained physiotherapy assistants.

Main outcome measures: Measures of dynamic reaching, sitting and standing, and static standing balance were undertaken by a blind independent observer.

Results: Specific measures of weight displacement in standing and reaching, and timed standing up and sitting down did not detect any differences over time regardless of group. Neither were there any significant changes over time, except for sway during static standing (p B=0.01) and time to return to their original position during dynamic reaching (p / 0.01).

Conclusions: A training programme aimed at improving lateral weight transference did not appear to enhance the rehabilitation of acute stroke patients. Improvements observed in postural control in standing and sitting may be attributable to usual care or natural recovery.

Visual feedback after stroke with the balance performance monitor: two single-case studies

Research over the past decade had indicated the effectiveness of visual feedback as a method of training stance symmetry and weight-transference after stroke. This study was carried out to assess the efficacy of the Balance Performance Monitor (BPM) in providing feedback. A reversal ABAB single-case experimental design was used with two patients at different stages poststroke. Assessments of motor function and independence in functional tasks (ADL) were made, as well as the measures of stance symmetry. The results indicated large improvements in symmetry, with both patients achieving levels within the normal range after five treatments. Functional skills also improved. Although the limitations of single-case studies are recognized, such dramatic improvements suggest that the BPM is an effective method of providing feedback and that this approach to treatment enhances the effects of physiotherapy and could be used more frequently after stroke.

Effect of Task Specific Exercises, Gait Training, and Visual Biofeedback on Equinovarus Gait among Individuals with Stroke: Randomized Controlled Study

Background and Purpose. Equinovarus foot is a common sign after stroke. The aim of this study is to investigate the effect of task specific exercises, gait training, and visual biofeedback on correcting equinovarus gait among individuals with stroke. Subjects and Methods. Sixteen subjects with ischemic stroke were randomly assigned to two equal groups (G1 and G2). All the patients were at stage 4 of motor recovery of foot according to Chedoke-McMaster Stroke Assessment without any cognitive dysfunction. E-med pedography was used to measure contact time, as well as force underneath hind and forefoot during walking. Outcome measures were collected before randomization, one week after the last session, and four weeks later. Participants in G1 received task specific exercises, gait training, and visual biofeedback and a traditional physical therapy program was applied for participants in G2 for 8 weeks. Results. Significant improvement was observed among G1 patients (P ≤ 0.05) which lasts one month after therapy termination. On the other hand, there were no significant differences between measurements of the participants in G2. Between groups comparison also revealed a significant improvement in G1 with long lasting effect. Conclusion. The results of this study showed a positive long lasting effect of the task specific exercises, gait training, and visual biofeedback on equinovarus gait pattern among individuals with stroke.

The Effects of Taping Prior to PNF Treatment on Lower Extremity Proprioception of Hemiplegic Patients

[Purpose] The purpose of this study was to compare the effects of taping on the articular angle of the knee joint and on the functioning of patients with hemiplegia resulting from stroke. [Subjects] The subjects of this study were 30 patients who were diagnosed with hemiplegia due to stroke. The subjects were randomly assigned to either an experimental group which received proprioceptive neuromuscular facilitation combination patterns and kinesio taping were applied, or a control group which received neurodevelopmental treatment. [Methods] Joint angle was measured at the hip and the ankle for both the paretic and non-paretic sides using a goniometer. Dynamic balance ability was assessed using the Berg Balance Scale. Gait velocity was measured as the 10-m walking time using a stopwatch. [Results] Comparative analysis of the experimental group's pre-test and post-test results showed statistically significant differences in the BBS and 10-m walking test. There were significant differences between the groups in ankle dorsiflexion, BBS, and 10-m walking times. [Conclusion] We judge the application of taping on the knee joint prior to rehabilitation treatment for patients in accordance with nervous system damage positively influences their functional improvement.

Balance is associated with quality of life in chronic stroke

OBJECTIVE

To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment.

METHODS

This is a secondary analysis of a cross-sectional study. People who had a stroke more than 6 months earlier from 3 Midwest states were included in the study if they met the following criteria: were referred to occupational or physical therapy for poststroke physical deficits; had self-reported stroke-related physical deficits; completed all stroke-related rehabilitation; had residual functional disability; had a score of ≥4 out of 6 on the short 6-item Mini-Mental State Examination; and were between 50 and 85 years old (n = 59). The main outcome measures included the Berg Balance Scale (BBS) to assess balance and the Stroke Specific Quality of Life Scale (SS-QOL) to assess QOL. Number of falls since stroke was self-reported.

RESULTS

Mean BBS score was 44 ± 8 and mean SS-QOL score was 46 ± 8; these scores were significantly correlated (r = .394, P = .002). Seventy-six percent of the sample reported a fall since stroke. Persons with balance impairment (BBS score ≤46; n = 29; 49%) had an average BBS score of 39 ± 7 and significantly worse SS-QOL scores than those without balance impairment (42 ± 8 vs 49 ± 7; P = .001).

CONCLUSION

In the chronic stroke population, balance impairment and fall risk are associated with lower QOL scores. If balance can be improved and maintained into the chronic phases of stroke, it is likely that individuals will benefit with improved QOL.

Acupuncture stimulation improves balance function in stroke patients: a single-blinded controlled, randomized study

The disturbance of balance function is one of main etiology resulting in falling down in stroke patients. A number of studies report that acupuncture may improve the motor function of stroke patients. Therefore, the aim of the present study was to investigate the effect of acupuncture on balance function. We designed a single-blinded, controlled, randomized study. A total of 30 stroke patients were randomized into experimental and control groups. Experimental groups received acupuncture treatment accompanied by the manual twisting of needles and obtaining of qi (the subjects experienced sensations of soreness, numbness, swelling and heaviness, while the acupuncturist experienced a sensation of needle resistance), whereas the control group did not receive manual twisting of needles and without obtaining of qi. All of the subjects were first-time stroke patients; infarction location was limited to either the left or right hemisphere, and all subjects were able to walk for at least 6 meters. Acupuncture stimulation (AS) was applied to Baihui (GV 20) acupoint as well as to 4 spirit acupoints (1.5 cun anterior, posterior, left and right laterals from Baihui acupoint, respectively) for 20 min. Balance function outcome measures were: (1) the displacement area of the patient's center of gravity; (2) the time taken for a patient to stand vertically from a seated position; (3) the time taken for a patient to walk a distance of 6 meters; (4) muscle strength of both lower extremities. Results indicated that the displacement area from the center of gravity decreased in the experimental group, but not in the control group. There was greater reduction in the displacement area in the experimental group than in the control group. Following AS, the time taken to reach a standing position from a seated position, as well as the time taken to walk 6 meters was decreased equally in both the experimental and control groups. The muscle strength of the hip flexor and knee extensor were increased in the paralyzed and non-paralyzed sides of patients in the experimental group, but not in the control group. The results of the present study suggest that acupuncture stimulation may induce an immediate effect that improves balance function in stroke patients.

Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review

BACKGROUND

In a recent study of 655 physical therapists working with a stroke population, the Berg Balance Scale (BBS) was identified as the most commonly used assessment tool across the continuum of stroke rehabilitation. Given the widespread popularity of the BBS, it is important to critically appraise the BBS for its use with a stroke population.

OBJECTIVE

The purposes of this study were to conduct a systematic review of the psychometric properties of the BBS specific to stroke and to identify strengths and weaknesses in its usefulness for stroke rehabilitation.

RESULTS

Twenty-one studies examining the psychometric properties of the BBS with a stroke population were retrieved. Internal consistency was excellent (Cronbach alpha=.92-.98) as was interrater reliability (intraclass correlation coefficients [ICCs]=.95-.98), intrarater reliability (ICC=.97), and test-retest reliability (ICC=.98). Sixteen studies focused on validity and generally found excellent correlations with the Barthel Index, the Postural Assessment Scale for Stroke Patients, Functional Reach Test, the balance subscale of Fugl-Meyer Assessment, the Functional Independence Measure, the Rivermead Mobility Index (except for weight shift and step-up items), and gait speed. Berg Balance Scale scores predicted length of stay, discharge destination, motor ability at 180 days poststroke, and disability level at 90 days, but these scores were not predictive of falls. Eight studies focused on responsiveness; all reported moderate to excellent sensitivity. Three studies found floor or ceiling effects.

DISCUSSION AND CONCLUSION

The BBS is a psychometrically sound measure of balance impairment for use in poststroke assessment. Given the floor and ceiling effects, clinicians may want to use the BBS in conjunction with other balance measures.

Weight distribution in standing and sitting positions, and weight transfer during reaching tasks, in seated stroke subjects and healthy subjects

BACKGROUND AND PURPOSE

The recovery of sitting balance after a stroke is assumed to be essential to obtain independence in other vital functions. The purpose of the present study was to investigate weight distribution while sitting and standing still, and weight transfer during seated reaching tasks performed by stroke subjects and healthy subjects.

METHOD

The study was cross-sectional. Twenty-one stroke subjects and 21 healthy subjects, matched by age and gender, participated. Main measures were weight distribution while standing and sitting still, and displacements of centre ofpressure (COP) during seated reaching tasks. Data were collected using a balance performance monitor (BPM), including software.

RESULTS

Stroke subjects had less symmetrical weight distribution in standing than that of healthy subjects (p < 0.001). No significant differences between the groups were found while sitting still, and no associations between asymmetries in standing still and sitting positions within individual stroke subjects were found. Neither did the degree of weight distribution in sitting correspond to COP displacements in seated reaching tasks. However, COP displacement patterns in reaching tasks in the seated position were different in stroke subjects from those of healthy subjects. Stroke subjects showed more lateral displacement when reaching forwards (p < 0.001), and less lateral displacement when reaching sideways to the unaffected side (p = 0.01).

CONCLUSION

COP displacement patterns in stroke subjects deviate more than those of healthy subjects in seated reaching tasks. The deviating COP displacement patterns are discussed as a possible dysfunction in the ability to make postural adjustments and learn an efficient movement pattern.

The mobility capabilities of persons with adolescent idiopathic scoliosis

STUDY DESIGN

An analysis of differences among healthy elementary school children and those with adolescent idiopathic scoliosis (AIS), and between groups of individuals with AIS with different Cobb angles.

OBJECTIVES

To research the differences in dynamic balance among adolescents with a variety of postural statuses and verify the sensitivity value of the Cobb angle.

SUMMARY OF BACKGROUND DATA

Assuming the biomechanical and functional particularities of the children with AIS, there is a need for an earlier diagnosis.

METHODS

The participants' balance (left and right step test) was estimated using electromyography and the reaction of base power on the platform.

RESULTS

Discriminant analysis confirmed a significant difference between the participants with AIS and healthy persons on the left step test. The values of the lumbal erector muscles, right gluteus, and side-to-side reaction of the force platform are more pronounced than the other variables. There is no significant difference among the participants with various Cobb angles.

CONCLUSIONS

The dynamic balance tests contribute to the AIS screening process. The pathologic form of AIS and lateralization highly affect dynamic balance. The study confirmed the neurophysicians' claims of the neuroplasticity of the central nervous system. In addition, the research illustrated the compensational functioning of mobility, especially when there is a lack of normal mobility forms, and there are weak postural control mechanisms and proprioception. There was no proof of the value of the Cobb angle as a clinical method and a measurement of the functional capabilities of the participants in the screening process.

Stepping onto a single step: a kinematic study

BACKGROUND AND PURPOSE

To describe the timings and ranges of linear displacements of the pelvis and feet occurring in a healthy older population when stepping up onto a step, and to describe variations noted in a small sample of subjects with hemiplegia.

METHOD

An observational case series study design was used and the study took place in a gait laboratory in a general hospital. A convenience sample of 54 healthy volunteers (mean age 57.6 years, range 40-90 years; 26 males, 28 females) and six subjects with chronic hemiplegia (mean age 61.7 years, range 47-70 years; five males, one female) was recruited. Participants stepped up onto an 18 cm step. The following outcome measures were made: kinematic measures of stepping up cycle time; pelvic lateral displacement; width of foot base; and height of heel clearance by use of CODA (a three-dimensional movement analysis system).

RESULTS

The mean (standard deviation, SD) stepping up cycle of healthy subjects was 1.68 seconds (+/- 0.22 seconds). The total range of pelvic lateral displacement during one stepping up cycle was 70 mm. Pelvic lateral displacement was asymmetrical, being significantly greater towards the initial weightbearing leg (p<0.0001). Older subjects (aged 60+ years) had less heel clearance (p<0.03) than younger subjects (aged <60 years). Stepping up performance by subjects with hemiplegia showed wide inter-subject variability, and was observed to be as much as three times slower to use as much as four times the range of pelvic lateral displacement and twice the foot base, and to be asymmetrical in timing of the stepping up cycle.

CONCLUSIONS

This kinematic study describes a healthy stepping up pattern not previously reported. Age and hemiplegia influenced the amount and speed of movement adopted during the task. Information about the movement strategies used by the elderly and those with hemiplegia should guide physiotherapists in their management of physical function.

The reliability, distribution, and responsiveness of the Postural Control and Balance for Stroke Test

OBJECTIVES

To determine the inter- and intrarater reliability of the Postural Control and Balance for Stroke (PCBS) test and to assess its distribution and responsiveness to changes during 1-year follow-up.

DESIGN

Intrarater reliability of the PCBS test was assessed by comparing the repeat ratings of videotaped test performances by each of the 5 raters. Interrater reliability was assessed by comparing the ratings of the videotaped test performances between the raters.

SETTING

Hospital neurologic ward and outpatient department of physiotherapy as well as health centers in Finland.

PARTICIPANTS

Fifty stroke patients (age range, 42-89 y) were measured 7, 120, and 360 days poststroke for the study of distribution and responsiveness and 19 patients (age range, 55-85 y) were measured during a period between 7 and 60 days poststroke for the reliability study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The distributions of the scores of the PCBS test, intraclass correlation coefficient (ICC) and weighted kappa values, and Wilcoxon matched-pairs tests.

RESULTS

The PCBS test had limited floor and ceiling effects at 7, 120, and 360 days poststroke. The differences between scores 7 and 120 days poststroke were significant (P<.001). The differences between scores 120 and 360 days poststroke were not significant (P>.05). The Cronbach alpha for all the items combined was .96. The ICC values for the interrater and intrarater reliability of the PCBS test were .94 and .96, respectively.

CONCLUSIONS

The PCBS test showed an acceptable level of reliability and the responsiveness results indicated a good level before 120 days but not between 120 and 360 days after stroke.

Force platform feedback for standing balance training after stroke

BACKGROUND

Standing balance deficits are common in individuals after stroke. One way to address these deficits is to provide the individual with feedback from a force platform while balance activities are performed. The feedback can take visual and/or auditory form.

OBJECTIVES

To determine if visual or auditory force platform feedback improves the clinical and force platform standing balance outcomes in clients with stroke.

SEARCH STRATEGY

We searched the Cochrane Stroke Group trials register (last searched December 2003), and the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to May 2003), EMBASE (1974 to May 2003), CINAHL (1982 to May 2003), PEDro (May 2003), CIRRIE (May 2003) and REHABDATA (May 2003). Reference lists of articles were reviewed and manufacturers of equipment were contacted.

SELECTION CRITERIA

Randomized controlled trials comparing force platform with visual feedback and/or auditory feedback to other balance treatments.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trials for inclusion, methodological quality, and data extraction. Trials were combined for meta-analysis according to outcome and type of feedback.

MAIN RESULTS

We included seven trials (246 participants). Force platform feedback did not improve clinical measures of balance when moving or walking (Berg Balance Scale and Timed Up and Go). Significant improvements in laboratory force platform indicators of stance symmetry were found for regimens using visual feedback (standardised mean difference (SMD) -0.68, 95% confidence interval (CI) -1.31 to -0.04, p = 0.04) and the concurrent visual and auditory feedback (weighted mean difference (WMD) -4.02, 95% CI -5.99 to -2.04, p = 0.00007). There were no significant effects on laboratory postural sway indicators, clinical outcomes or measures of function at follow-up assessment.

REVIEWERS' CONCLUSIONS

Force platform feedback (visual or auditory) improved stance symmetry but not sway in standing, clinical balance outcomes or measures of independence.

The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals

OBJECTIVE

To determine the effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals.

DESIGN

Weight bearing on the paretic side was measured in patients with hemiparesis during quiet standing and in conditions of compelled weight shift.

SETTING

Free-standing acute inpatient rehabilitation hospital.

PARTICIPANTS

Nine individuals with hemiparesis as a result of unilateral stroke who were able to stand for 3 to 5 minutes without assistance or rest, and satisfied other inclusion criteria.

INTERVENTIONS

Compelled shift of the body weight was induced with different shoe wedges (5 degrees, 7.5 degrees, 12.5 degrees) or shoe lifts (0.6, 0.9, 1.2cm), which extended under the entire shoe of the unaffected limb. Weight-bearing symmetry scores were used to characterize the symmetry of stance.

MAIN OUTCOME MEASURES

Weight-bearing symmetry scores.

RESULTS

Without a shoe wedge or a shoe lift, weight-bearing symmetry was characterized by underloading of the paretic limb (39.90% +/-.80% of body weight). Weight shift induced by shoe wedges or shoe lifts applied to the unaffected limb promoted improved symmetry of weight bearing and stance. A shoe wedge of 5 degrees provided the most symmetrical weight distribution (51.44% +/- 1.88% of body weight).

CONCLUSION

Shoe wedges and shoe lifts under the unaffected limb induced compelled weight shift toward the paretic limb, resulting in improved symmetry of stance of individuals with mild hemiparesis. We suggest that improved symmetry of bipedal standing obtained with a shoe wedge or a shoe lift applied to the unaffected limb can help overcome the learned disuse of the affected limb. We further suggest that weight distribution induced by shoe wedges or shoe lifts may help in the treatment of ambulatory hemiparetic individuals with asymmetrical stance caused by unilateral stroke.

Fear of falling in patients with stroke: a reliability study

OBJECTIVE

To examine the scaling properties and test-retest reliability of an expanded version of the Falls Efficacy Scale (FES) and to compare group differences in the scores. The expanded version focuses on more basic, primary activities of daily living (ADL), which makes the scale more suitable for subjects with moderate to low functional ability, e.g. patients with stroke.

DESIGN

A test-retest reliability study with one group convenience sample.

SETTING

Two day-care units: a rehabilitation unit and a geriatric rehabilitation unit.

SUBJECTS

A volunteer sample of 30 patients (mean age 65 years, SD 11 years) who had sustained stroke between 5 and 84 months prior to the investigation.

MAIN OUTCOME MEASURE

A 13-activity questionnaire (the Swedish modification of the Falls Efficacy Scale (FES(S)) comprising the 10 activities of the original FES and three additional activities was used. Falls efficacy was rated on a 10-point visual analogue scale for each activity on two occasions, 5-22 (mean 10, Md 7) days apart.

RESULTS

The overall test-retest reliability of the FES(S) was high (intraclass correlation coefficient (ICC) = 0.97). The ICC for the personal ADL (items 1-6) scores was 0.93 and for the instrumental ADL (items 8-13) 0.97. ICC for the individual items ranged from 0.76 to 0.97.

CONCLUSIONS

On the basis of these preliminary findings, the FES(S) appears to have acceptable test-retest reliability. The test may be a reasonable addition for assessing stroke patients with balance disturbances and risk for falls.

Inter- and intra-tester reliability of the Balance Performance Monitor in a non-patient population

BACKGROUND AND PURPOSE

There is a growing interest in the measurement and evaluation of balance deficits and a number of instruments for measurement are now available. However, few data exist that accurately describe the reliability when using these measurement tools. This study was designed to evaluate the inter- and intra-tester reliability of using the Balance Performance Monitor (BPM) (SMS Healthcare) in a non-patient population.

METHODS

A total of 58 subjects (mean age 29.83 years (+/- 9.44 years)) and three testers participated in two separate experiments. Intra Class Correlation Coefficients (ICCs) and coefficients of variation were used to describe the reliability of two different protocols for positioning subjects on the footplates of the BPM.

RESULTS

Measurements of weight distribution showed high and significant inter- and intra-tester reliability for both protocols (ICCs ranging from 0.720 to 0.868). Sway measurements showed more limited reliability (ICCs ranging from 0.183 to 0.775). Coefficients of variation were low for weight distribution measurements and high for sway measurements.

CONCLUSIONS

Taking the mean of three measurements is recommended for both the weight distribution and the sway measurements as it has shown to produce acceptable measurement results.

Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function

A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke, an associated improvement in function has been demonstrated. This study examines this promising technique further using a single-blind controlled trial. Twenty-six patients were recruited from a register of consecutive admissions and randomized into treatment and control groups. Both groups received additional therapy, only the treatment group received visual feedback. Assessments were carried out independently. Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function. Between group differences had disappeared at three months. The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway. Transfer of training was indicated by improvements in ADL and gross motor function. Three months later the improvement was maintained, but did not automatically continue without treatment.

Reliability and validity of measures obtained from stroke patients using the Balance Master

OBJECTIVE

To determine the test-retest reliability and validity of data obtained using the Balance Master (BM), a computerized balance assessment and training tool.

DESIGN

Data were collected on three occasions, 1 week apart. Intraclass correlation coefficients (ICCs) were calculated if significant (p < .05) between-subject variance was found using a univariate analysis of variance for repeated measures. Concurrent validity of the BM data was determined using the Berg Balance Scale and gait velocity as criterion standards.

PARTICIPANTS

Twenty ambulatory hemiparetic subjects who had no history of lower extremity orthopedic problems, no neurological deficits apart from stroke, and had not trained using the BM.

MAIN OUTCOME MEASURES

BM data relating to static and dynamic balance performance, gait velocity, and the total score from the Berg Balance Scale.

RESULTS

ICCs indicated that only the BM test requiring subjects to shift their center of gravity to randomly highlighted targets (positioned in a circle representing 75% of the individual's limits of stability) was reliable, both in terms of movement path (ICC = .84) and movement time (ICC = .88). Concurrent validity of the BM data was established for the dynamic measures of balance only, which correlated with both the Berg Balance Scale and gait velocity outcomes (r > or = .48, p < .05).

CONCLUSIONS

These findings suggest that in stroke patients the test-retest reliability of data obtained using the BM is greatest for complex tests of balance and that dynamic rather than static balance measures are valid indicators of functional balance performance.

Outcomes-based research in neurorehabilitation: the need for multidisciplinary team involvement

There is a need for the evaluation of neurorehabilitation to reflect the integrated multidisciplinary input which is fundamental to the intervention process. The importance of multidisciplinary involvement in achieving this is discussed with particular reference to multiple sclerosis, which exemplifies the many problems inherent in chronic neurological disease that must be addressed in the evaluation of the rehabilitation programme. Some of the current difficulties of research in this specialty are raised, and suggestions made for the future.