Dynamic Balance Evaluation: Reliability and Validity of a Computerized Wobble Board

Informing wobble-board training and assessment through an investigation of the effect of biological-sex, anthropometrics, footwear and dual-tasking in young adults

BACKGROUND

Despite wobble board use being common in physiotherapy the effect of certain factors, essential to clinical reasoning, have not been investigated.

OBJECTIVE

To determine the effect of biological sex, anthropometrics, footwear and dual tasking (DT) on wobble board balance performance.

METHODS

Eighty-six healthy participants (44 females) had their wobble board performance measured during double-leg-stance (DLS) with eyes open (DLSEO), closed (DLSEC) and single-leg-stance (SLS) tasks, with and without footwear and a DT added. Anthropometrics were also measured.

RESULTS

Females outperformed males during most tasks, with some large effect sizes (ES). Performance was moderately related to weight and shoulder, waist and hip circumference. Overall, there were no differences between footwear and no footwear, except for males during SLS. DT made little difference, except during DLSEO and SLS, where single task was better than DT, though only females had a large ES.

CONCLUSION

During wobble board tasks, biological sex differences were observed and a modest correlation between anthropometrics and performance noted. DT and footwear had minimal effect.

Validity and reliability of an unstable board for dynamic balance assessment in young adults

Scientific literature is giving greater importance to dynamic balance in fall prevention. Recently, the validity and reliability of the most employed functional tests for dynamic balance assessment has been investigated. Although these functional tests are practical and require minimal equipment, they are inherently subjective, as most do not use instrumented measurement data in the scoring process. Therefore, this study aimed to assess the validity and reliability of an instrumented unstable board for dynamic balance objective assessment in young adults through double-leg standing trials. A test-retest design was outlined with the unstable board positioned over a force platform to collect objective Center of Pressure (CoP) related and kinematic parameters. Fifteen young adults participated in two evaluation sessions (7-day apart) that comprised ten trials per two dynamic conditions (anterior-posterior and medio-lateral oscillations) aiming to maintain the board parallel to the ground. Pearson's correlation coefficient (r) was employed to assess the validity of the kinematic parameters with those derived from the CoP. The test-retest reliability was investigated through Intraclass Correlation Coefficient (ICC), Standard Error of the measurement, Minimal Detectable Change, and Bland-Altman plots. Statistically significant correlations between the CoP and kinematic parameters were found, with r values ranging from 0.66 to 0.95. Good to excellent intrasession (0.89≤ICCs≤0.95) and intersession (0.66≤ICCs≤0.95) ICCs were found for the kinematics parameters. The Bland-Altman plots showed no significant systematic bias. The kinematics parameters derived from the unstable board resulted valid and reliable. The small size of the board makes it a suitable tool for the on-site dynamic balance assessment and a complement of computerized dynamic posturography.

The Effect of a Combined Exercise Program on Postural Control and Fine Motor Skills in Parkinson's Disease: Study Design

Parkinson's disease (PD) is a progressive and neurodegenerative disorder defined by physical symptoms such as hand disability and postural instability. To counteract the detrimental effects of PD, physical activity programs showed improvements in overall aspects of physical functioning. Therefore, this protocol will aim to evaluate the effect a of postural and fine motor skills training program in older adults with PD. PD individuals, with mild to moderate stage PD, aged between 65 to 80 years, will be voluntary selected from the Nursing Home Residences and Rehabilitation Centers. Subsequently, they will be randomly assigned to intervention group (PD) to receive a combined training program (postural control and fine motor skills exercises) or to the Control group (CON) to receive a stretching program. Before (PRE) and after (POST) a 12-week program both groups will perform wobble board (WB) and grooved pegboard (GPT) tests. Different performances between groups will be expected: (1) no significant differences between PD and CON group for WB and GPT test values before the beginning of the training intervention (PRE); (2) significantly better WB and GPT test values in PD subjects after the training intervention (POST) when compared to the base values (PRE); and (3) no significant differences in WB and GPT test values in CON subjects after the training intervention (POST) when compared to the base values (PRE). The findings of the present study protocol could be used for future studies investigating clinical populations, such as PD, and the effects of different rehabilitative interventions aiming to improve postural control and fine motor skills performances assessed by WB and GPT tests.

The Influence of Maturity Status on Dynamic Balance Following 6 Weeks of Eccentric Hamstring Training in Youth Male Handball Players

Information about when to apply an appropriate eccentric hamstring strength training stimulus during long-term athlete development is essential for effective programming and improving balance performance. This study examined the effects of six-week eccentric hamstring training on dynamic balance performance in youth handball players of different maturity statuses (pre- or post-peak height velocity (PHV)). A randomized controlled design with 45 young male handball players (14.6 ± 0.3 years) from a local national handball club were randomly allocated to a 6 week, twice weekly eccentric hamstring training in two experimental groups: a pre-PHV (maturation offset: −2.13 ± 0.63, n = 10) and post-PHV (maturation offset: 0.79 ± 0.34, n = 12) group and two control groups: maturation offset: −2.09 ± 0.61, n = 10 and maturation offset: 0.55 ± 0.67, n = 13. Dynamic balance performance was evaluated by using the composite score during the lower quarter Y-balance test from pre- and post-intervention. A significant effect on balance scores was found from pre to post (F = 11.4; p = 0.002; η2p = 0.22), intervention (F = 5.4; p = 0.025; η2p = 0.12), and maturation (F = 369; p < 0.001; η2p = 0.9), but no significant interaction effects were found (F ≥ 3.3; p ≥ 0.077; η2p ≤ 0.07). Post hoc analysis revealed that the post-PHV group had a higher score than the pre-PHV group. Furthermore, that dynamic balance increased in the post-PHV group after intervention much more in the control post-PHV group. It was concluded that somatic maturation influences dynamic balance performance and that eccentric hamstring training results in greater improvement in balance performance in young male handball players for the post-pubertal group.

Influence of Rehabilitation Aid with Biofeedback on the Rehabilitation Process during Remote Home-Based Rehabilitation

Ensuring the regularity and correctness of rehabilitation exercises in the home environment is a prerequisite for successful treatment. This clinical study compares balance therapy in the home environment on a conventional balance mat and an instrumented wobble board, with biofeedback supported by a rehabilitation scheme realized as web-based software that controls the course of rehabilitation remotely. The study included 55 patients with knee injuries. The control group consisted of 25 patients (12 females and 13 males, mean age 39 ± 12 years) and the study group of 30 patients (19 females and 11 males, mean age 40 ± 12 years). Treatment effects were compared using the ICS Balance Platform measurement system. Measurements showed significant differences in the change in ICS Balance platform parameters representing the dynamic stability of the patients. The dynamic stability improved more with the instrumented wobble board. The study did not show an influence of different methods of communication with patients during home-based rehabilitation.

Association between Anthropometric Variables, Sex, and Visual Biofeedback in Dynamic Postural Control Assessed on a Computerized Wobble Board

Anthropometrics and sex influence balance performances, and visual information can change anthropometrics’ relation and the postural sway. Therefore, the aim of the present study was to evaluate the effect of anthropometric characteristics, sex, and visual biofeedback and/or their interaction on a computerized wobble board. Twenty-seven (14 females, 13 males) young adults performed three 30-s double leg stance trials on a wobble board during two conditions: with visual and without visual biofeedback. Visual biofeedback improved (p = 0.010) balance on a wobble board with respect to the condition without visual biofeedback. Regardless of sex, no differences between conditions were found (p = 0.088). When investigating the effect of anthropometrics variables, sex, and their interactions on conditions, a significant main effect of the lower limb/height ratio, sex, and their interaction on the condition without visual biofeedback was found (p = 0.0008; R2 = 0.57). For the visual biofeedback condition, significant effects for sex and body mass (p = 0.0012; R2 = 0.43) and sex and whole-body moment of inertia (p = 0.0030; R2 = 0.39) were found. Results from the present study showed (1) visual biofeedback improved wobble board balance performance; (2) a significant main effect of lower limb/height ratio, sex, and their interaction on the wobble board performances without visual biofeedback emerged; (3) significant effects were found for sex and body mass and sex and moment of inertia in the visual biofeedback condition. Findings from the present study could have an impact on training and evaluations protocols, especially when several populations such as children, athletes, older adults and people with balance disorders are involved.

A novel approach to measuring wobble board performance in individuals with chronic ankle instability

Computerized wobble boards (WB) are used to objectively assess balance in healthy and chronic ankle instability individuals. As in field setting health professionals might not own WB, objective evaluations are not always feasible. Therefore, the aim of this tudy was to investigate the contribution of sagittal plane joints angular-displacement and anthropometrics to predict equations to estimate WB performance by portable two-dimensional motion analysis (2D-MA) and cross-validate the developed equations in chronic ankle instability individuals. Thirty-nine healthy and twenty chronic ankle instability individuals stood on a WB in single stance position. The balance test consisted of three 30s trials per limb keeping the platform flat at 0°. Trials were video recorded, and three time-segments joints angular-displacement analyzed with 2D-MA: segment 1 (T1) including 30s data, segment 2 (T2) from second 0 to 10, segment 3 (T3) only the first 5s. Mixed regression for multilevel models was used to estimate WB performance for each time-segment and to examine limb differences for the predicted WB performance in chronic ankle instability sample. The accuracy of the equations to detect injured limbs was calculated via area under the curve for receiver operating characteristic. Ankle and knee angular-displacement parameters, body height and lower limb length were the major predictors of WB performance for the extrapolated models (p < 0.05; R² = 0.83-0.56). The measured WB performance and T1 model showed significant (p < 0.05) performance differences between the injured and uninjured limbs. Receiver operating characteristic analysis showed an asymptotic significance of 0.03 for T1 equation with area under the curve of 0.70. The proposed models provide different methods to quantify the performance and accurately detect the injured limb in individuals with unilateral chronic ankle instability, when measuring balance via WB might not be feasible. App-makers may use the equations to provide an automatic all-in-one system to monitor the performance status and progress.

Effects of Differential Jump Training on Balance Performance in Female Volleyball Players

The purpose of this study was to determine whether coordinative jump training that induces neuromuscular stimuli can affect balance performance, associated with injury risk, in elite-level female volleyball players. During the competitive season, the balance performance of 12 elite female players (highest Austrian division) was obtained via a wobble board (WB; 200 Hz) placed on an AMTI force plate (1000 Hz). Three identically repeated measurements defined two intervals (control and intervention phases), both comparable in duration and regular training. The intervention included 6 weeks of differential training (8 sessions of 15–20 min) that delivered variations in dynamics around the ankle joints. Multilevel mixed models were used to assess the effect on postural control. WB performance decreased from 27.0 ± 13.2% to 19.6 ± 11.3% during the control phase and increased to 54.5 ± 16.2% during the intervention (β = 49.1 ± 3.5; p < 0.001). Decreased sway area [cm²] (β = −7.5 ± 1.6; p < 0.001), anterior–posterior (β = −4.1 ± 0.4; p < 0.001) and mediolateral sway [mm] (β = −2.7 ± 0.6; p = 0.12), and mean velocity [mm∙s−1] (β = −9.0 ± 3.6; p < 0.05) were observed during the intervention compared with the control phase. Inter-limb asymmetry was reduced (β = −41.8 ± 14.4; p < 0.05). The applied training concept enhanced balance performance and postural control in elite female volleyball players. Due to the low additional physiological loads of the program and increased injury risk during the competitive season, we recommend this intervention for supporting injury prevention during this period.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Utility and Advantages of the Eccentric Training through the Isoinertial System

We are glad to introduce the first Journal Club of volume five, the first issue. This edition is focused on relevant studies published in the last years in the field of eccentric training, chosen by our editorial board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport, seen also from a scientific point of view. The editorial board members wish you an inspiring lecture.