The effect of foot somatosensory loss in postural control during Functional reach test in patients with diabetic polyneuropathy: A controlled study

BACKGROUND

In patients with diabetic polyneuropathy (DPN), differences in postural control due to losing the lower limb somatosensory information were reported. However, it is still unclear by which mechanisms the dynamic postural instability is caused.

OBJECTIVES

This study aimed to investigate postural control differences and neuromuscular adaptations resulting from foot somatosensory loss due to DPN.

METHODS

In this controlled cross-sectional study, fourteen DPN patients and fourteen healthy controls performed the Functional Reach Test (FRT) as a dynamic task. The postural control metrics were simultaneously measured using force plate, motion capture system, and surface electromyography (sEMG). The main metrics including reach length (FR), FR to height ratio (FR/H), displacement of CoM and CoP, moment arm (MA), and arch height ratio. Also, kinematic (range of motion of ankle, knee, and hip joints), and sEMG metrics (latencies and root mean square amplitudes of ankle and hallux muscles) were measured. To compare variables between groups, the independent sample T-test for (normally distributed) and the Mann-Whitney U test (non-normally distributed) were used.

RESULTS

The subjects' reach length (FR), FR to height ratio, absolute MA, and displacement of CoM were significantly shorter than controls, while displacement of CoP was not significant. Arch height ratio was found significantly lower in DPN patients. We observed that CoM was lagging CoP in patients (MA = + 0.89) while leading in controls (MA = -1.60). Although, the muscles of patients showed significantly earlier activation, root mean square sEMG amplitudes were found similar. Also, DPN patients showed significantly less hip flexion, knee extension, and ankle plantar flexion.

CONCLUSIONS

This study presented that decreasing range of motion at lower limbs' joints and deterioration in foot function caused poor performance at motor execution during FRT in DPN patients.

Effect of controlled start position on the reach distance distribution range in the functional reach test among community-dwelling older adults

[Purpose] This study investigated the effect of controlled start position (CSP) on the reach distance distribution range (RDDR) in the functional reach test (FRT) in community-dwelling older adults. [Participants and Methods] The participants were 34 community-dwelling older adults. We compared the RDDR in CSP and non-CSP and analyzed the relationship between the mean reach distance (MRD) and the length of movement of the center of pressure (LMCOP). [Results] The RDDR in CSP condition was significantly lower than non-CSP condition. A significant positive correlation was observed only for CSP condition. In the non-CSP condition, MRD was not reflected in the LMCOP. [Conclusion] The FRT in the CSP effectively reflects the standing balance ability of community-dwelling older adults.

Effects of noisy galvanic vestibular stimulation on functional reach test

Balance disorders are a risk factor for falls in older individuals, and an increased center of pressure (COP) sway path length during standing and decreased reach distance in the functional reach test (FRT) predispose them to falls. Reportedly, noisy galvanic vestibular stimulation (nGVS) reduces COP sway path length during standing in young and community-dwelling older individuals and suggested to be a promising approach to improve balance function. However, the effect of nGVS on FRT remains unclear. Therefore, this study aimed to clarify the effect of nGVS on the FRT reach distance. This study has a cross-over design and included 20 healthy young adults. Interventions under nGVS (stimulation intensity: 0.2 mA) and sham (stimulation intensity: 0 mA) conditions were randomly administered to each participant. The participants underwent COP sway during standing measurements and FRT pre-intervention and post-intervention under each condition, and COP sway path length and the FRT reach distance were calculated. Statistical analysis revealed a significant decrease in post-intervention COP sway path length compared with pre-intervention COP sway path length under the nGVS condition. Conversely, the FRT reach distance remained the same under both nGVS and sham conditions. Thus, nGVS may improve the standing balance function but cannot change the FRT reach distance in healthy young individuals.

Chest and pelvis coordination during functional reach test: A possible indication of balance deficiency in older adults

Falls in older adults represent the most common cause of injuries and a major cause of mortality in this vulnerable population. The morbidity and mortality rate of falls among older people makes balance analysis in older adults very important. Therefore, this study aims to explore different metrics that can potentially be used to identify early indications of balance loss and fall risk. To that end, the motion strategies and chest and pelvis coordination of a group of younger, a group of older non-faller and a group of older faller participants while conducting the functional reach test were investigated. To analyse the motion strategies of the different participant groups, four metrics of maximum angular rotation of chest, maximum angular rotation of pelvis, time warped chest and pelvis angular rotation difference, and the mean continuous relative phase of the chest and pelvis were assessed. In this study younger participants are found to have larger maximum chest rotation, maximum pelvis rotation, and time warped chest and pelvis angular rotation difference compared to older participants. However, these metrics were not significantly different in older non-fallers compared to older fallers. Meanwhile, the mean continuous relative phase of the chest and pelvis was the only metric found to be significantly different among all three participant groups. This metric is indicative of the chest and pelvis coordination which is associated with the ability to construct proper coordination and maintain balance. The mean continuous relative phase yielded the sensitivity of 92.3% and specificity of 73.7% in recognizing older fallers from older non-fallers. The results suggest that this metric might be useful in identifying the risk of falling in older population, thus, it should be further studied in a prospective study.

Correlation between community balance and mobility scale (CB&M) with a battery of outcome measures to assess balance in Parkinson's disease - a cross-sectional study

BACKGROUND

Evaluating balance in a functional context that integrates challenging tasks frequently performed in the community is essential to identify community-dwelling individuals who are at risk of falls in early Parkinson Disease (PD) than a simple balance measure. Community Balance and Mobility (CB&M) scale is one such measure that evaluates severe deficits in gait, balance, and mobility. The risk of falling and fear of fall is common among PD individuals and this affects the day to day functioning as well as the quality of life. Early identification of individuals who may be at risk to fall will lead to intervention strategies that can help to with balance issues. The aim of this study was to correlate between Community Balance and Mobility with a battery of outcome measures commonly used to assess balance in Parkinson's disease.

METHODS

A cross sectional study design; with individuals referred to Outpatient physiotherapy department, diagnosed with idiopathic Parkinson's disease, independently mobile and on a stable drug regimen referred by the neurologist; were screened and recruited by convenience sampling. With written informed consent, demographic data gathered and scales such as Berg Balance scale, Community balance & mobility scale, Functional Reach test and Timed up and go test were administered with an ample amount of rest.

RESULTS

The results obtained were documented and analysed using Karl Pearson's correlation coefficient. Significant correlation between CB&M and BBS (r = 0.795) was found, CB&M and TUG (r = - 0.755), CB&M and FRT (r = 0.772).

CONCLUSION

CB&M is a useful measure which integrates items that challenge balance in the community context. It has been used to assess high functioning community dwelling individuals and hence may be apt for individuals with early Parkinson's, since the tasks to be performed in CB&M are challenging and these simulate community level activities where the risk of falls is higher. It may well be a good tool to assess early Parkinson's; their level of balance, community level activity and without need for sophisticated & expensive equipment.

The functional reach test in people with multiple sclerosis: a reliability and validity study

Background: Limits of stability (LOS) is a major component of balance dysfunction in people with multiple sclerosis (MS). The functional reach test (FRT) is a clinical LOS assessment; however, its psychometric properties have not been investigated in people with MS yet. Objectives: To investigate: (1) the intrarater, interrater, and test-retest reliability of the FRT in people with MS; (2) the minimum detectable change (MDC) in the FRT distances; (3) the concurrent and discriminant validity of the FRT; and (4) the cutoff distance that best discriminates people with MS from healthy people and fallers from non-fallers with MS.Methods: Forty-three people with MS and 36 healthy people participated in this study. The FRT was administered along with the instrumented LOS test, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, and Expanded Disability Status Scale. The FRT was repeated by the same rater after 2 min from the first test session to determine the intrarater reliability and was simultaneously conducted by two independent raters to determine the interrater reliability. The FRT was also repeated after 7-10 days to determine the test-retest reliability. The reliability was quantified using intraclass correlation coefficients (ICC), Bland-Altman plots, and the MDC. The validity was assessed by correlating the FRT distances with the scores of other measures and by comparing the FRT distances between the MS group and healthy people, and between the fallers and non-fallers in the MS group.Results: The FRT demonstrated good to excellent intrarater, interrater, and test-retest reliability with an ICC (3,1) of 0.80-0.88 (p < .001), an ICC (3,2) of 0.94-0.97 (p < .001), an ICC (2,3) of 0.84-0.86 (p < .001), respectively. Bland-Altman analyses showed no systematic bias between the assessments. The MDC was 8.28 centimeters. The FRT was correlated with the other outcome measures (correlation coefficients ranged from 0.31 to 0.79, p < .05 for all). Significant differences in the FRT distances were found between people with MS and healthy people; however, no significant difference was found between the fallers and non-fallers with MS (p < .001 and p = .09, respectively). The cutoff distance of 35.5 centimeters best discriminates healthy people from people with MS while of 28.5 centimeters did not discriminate between the fallers and non-fallers with MS.Conclusions: The FRT is a reliable, valid, and easy-to-administer tool for assessing LOS in people with MS.

Risk Factors for Falls in Patients with Alzheimer Disease: A Retrospective Study of Balance, Cognition, and Visuospatial Ability

Aim

This study aimed to determine the main risk factors for falls in patients with Alzheimer disease (AD) by comparing balance, cognition, and visuospatial ability between those who have experienced a fall and those who have not.

Methods

Forty-seven AD patients were admitted to a ward for patients with dementia (22 men and 25 women). The balance of patients was evaluated using the Functional Reach Test (FRT), the one-leg standing duration, and the Timed Up and Go (TUG) test. The Mini-Mental State Examination-Japanese (MMSE-J) was used to evaluate cognition. For visuospatial ability assessment, the Clock-Drawing Test (CDT) as well as overlapping figure identification and shape discrimination in the Visual Perception Test for Agnosia (VPTA) were used. The patients were allocated to either the fall group or the nonfall group based on their history of falls in the past year. The relationships between patients' characteristics and evaluation outcomes were compared and examined. Logistic regression analysis was performed using a fall as the objective variable. The area under the curve (AUC) and the cutoff value were calculated.

Results

Of the 47 participants, 22 had experienced falls within the past year (46.8%). The results of the FRT, one-leg standing duration, the TUG, the CDT, and the VPTA were significantly lower in the fall group. No significant difference between the MMSE-J scores of the fall group and those of the nonfall group was observed. The results of the logistic regression analysis indicated that falls in AD patients were significantly associated with the FRT. It was found that a shorter FRT distance (cm) had a significant impact on falls. For the FRT, the fall-related AUC was 0.755. At a cutoff value of 24.5 cm, the level of sensitivity was 68.0%, and the level of specificity was 77.3%.

Conclusions

The findings of this study indicate that balance and visuospatial abilities are risks factors for falls in AD patients. In contrast, cognitive impairment was not a risk factor for falls. It was demonstrated that the FRT could be an appropriate risk predictor for falls in AD patients. In particular, falls in AD patients were strongly affected by a reduced dynamic balance.

Reliability of measurement using Image J for reach distance and movement angles in the functional reach test

[Purpose] The purpose of this study was to examine the test-retest reliability and minimal detectable change (MDC) of reach distance and movement angle analyses using Image J. [Participants and Methods] Thirty-eight healthy young males performed the functional reach test (FRT) twice, and their reach movements were recorded using a digital video camera. Image J was used to combine the digital photographs taken at the start position and maximum reach and to measure each movement. The measurements recorded were the movement distance of the third metacarpal bone (reach distance), anterior-superior iliac spine, and trochanter major, and the angles recorded were the acromion-malleolus lateralis, acromion-trochanter major, and trochanter major-malleolus lateralis. The reliability of all the measurements was analyzed using intraclass correlation coefficients (ICCs), Bland-Altman plots, and MDCs. [Results] The ICCs (1, 1) were >0.80 for all the outcomes. The Bland-Altman analysis revealed no systematic bias in any outcome. The MDC of reach distance was 18.3 mm. [Conclusion] Measurement using Image J for reach distance and movement angles in the FRT showed acceptable high test-retest reliability. Measurement of the FRT and the MDC calculated in this study could be used as a reference for further research.

Analysis of the muscular activities of the tibialis anterior and gastrocnemius muscles in functional reach

[Purpose] This study aimed to examine the changes in the muscle activities of each section of the tibialis anterior and gastrocnemius muscles in the functional reach test. [Subjects and Methods] This study selected those who can walk independently, can reach out their arm up to over 25 cm, can show over 90° shoulder joint bending, have not undergone an operation in the lower limb joint, and are not taking any medication affecting their ability to keep their balance from among 24 elderly males and 24 elderly females. The muscular activities of the tibialis anterior and gastrocnemius muscles were measured using the functional reach test and electromyogram. The functional reach test was conducted at a total of four sections: 0, 15, 20, and 25 cm. [Results] Gender and age affected the muscular activity by section in the functional reach test. It was also found that the gastrocnemius muscle was used more than the tibialis anterior muscle to keep the balance, and the aged subjects with good balance ability showed no great change in muscular activity on both stable and unstable ground. [Conclusion] It was found that the subjects used the tibialis anterior muscle more, and the lower limbs of the frequently used part, to keep their balance. As the aged subjects had good balance ability, they showed no great change in muscular activity on both stable and unstable ground.

Association of vertebral compression fractures with physical performance measures among community-dwelling Japanese women aged 40 years and older

BACKGROUND

Numerous reported studies have shown that vertebral compression fractures are associated with impaired function or disability; however, few examined their association with objective measures of physical performance or functioning.

METHODS

We examined the association of vertebral compression fractures with physical performance measures in 556 Japanese women aged 40-89 years. Lateral spine radiographs were obtained and radiographic vertebral compression fractures were assessed by quantitative morphometry, defined as vertebral heights more than 3 SD below the normal mean. Measures of physical performance included walking speed, chair stand time and functional reach. Adjusted means of performance-based measures according to the number and severity of vertebral compression fractures were calculated using general linear modeling methods.

RESULTS

After adjusting for age, body mass index, back pain, number of painful joints, number of comorbidities and regular physical activities, the walking speed of women with two or more compression fractures (1.17 m/s) was significantly slower than that of women without compression fracture (1.24 m/s) (p = 0.03). Compared with women without compression fracture, chair stand time was longer in women with two or more compression fractures (p = 0.01), and functional reach was shorter (p = 0.01). No significant differences were observed in walking speed, chair stand time, or functional reach between women with one compression fracture and those without compression fracture.

CONCLUSIONS

Having multiple vertebral compression fractures affects physical performance in community-dwelling Japanese women. Poor physical functioning may lead to functional dependence, accelerated bone loss, and increased risk for falls, injuries, and fractures. Preventing vertebral compression fracture is considered important for preserving the independence of older adults.

Reliability and comparison of trunk and pelvis angles, arm distance and center of pressure in the seated functional reach test with and without foot support in children

This study determined test-retest reliability of trunk and pelvis joint angles, arm distance and center of pressure (COP) excursion for the seated functional reach test (FRT) and compared these variables during the seated FRT with and without foot support. Fifteen typically developing children (age 9.3±4.1years) participated. Trunk and pelvis joint angles, arm distance, and COP excursion were collected on two days using three-dimensional motion analysis and a force plate while subjects reached maximally with and without foot support in the anterior, anterior/lateral, lateral, posterior/lateral directions. Age, weight, height, trunk and arm lengths were correlated (p<0.01) with maximum arm distance reached. Maximum arm distance, trunk and pelvis joint angles, and COP with and without foot support were not significant (p<0.05) for the two test periods. Excellent reliability (ICCs>0.75) was found for maximum arm distance reached in all four directions in the seated FRT with and without foot support. Most trunk and pelvis joint angles and COP excursions during maximum reach in all four directions showed excellent to fair reliability (ICCs>0.40-0.75). Reaching with foot support in all directions was significantly greater (p<0.05) than without foot support; however, most COP excursions and trunk and pelvic angles were not significantly different. Findings support the addition of anterior/lateral and posterior/lateral reaching directions in the seated FRT. Trunk and pelvis movement analysis is important to examine in the seated FRT to determine the specific movement strategies needed for maximum reaching without loss of balance.

Computerized Functional Reach Test to Measure Balance Stability in Elderly Patients With Neurological Disorders

Background

The ability to maintain static and dynamic balance is a prerequisite for safe walking and for obtaining functional mobility. For this reason, a reliable and valid means of screening for risk of falls is needed. The functional reach test (FRT) is used in many countries, yet it does not provide some kinematic parameters such as shoulder or pelvic girdles translation. The purpose was to analyze video records measuring of distance, velocity, time length, arm direction and girdles translation while doing FRT.

Methods

A cross-sectional, descriptive study was conducted where the above variables were correlated to the mini-mental state examination (MMSE) for mental status and the Tinetti balance assessment test, which have been validated, in order to computerize the FRT (cFRT) for elderly patients with neurological disorders. Eighty patients were tested and 54 were eligible to serve as experimental group. The patients underwent the MMSE, the Tinetti test and the FRT. LAB view software was used to record the FRT performances and to process the videos. The control group consisted of 51 healthy subjects who had been previously tested.

Results

The experimental group was not able to perform the tests as well as the healthy control subjects. The video camera provided valuable kinematic results such as bending down while performing the forward reach test.

Conclusions

Instead of manual measurement, we proposed to use a cheap with fair resolution web camera to accurately estimate the FRT. The kinematic parameters were correlated with Tinetti and MMSE scores. The performance values established in this study indicate that the cFRT is a reliable and valid assessment, which provides more accurate data than “manual” test about functional reach.

Changes in balance strategy in the third trimester

[Purpose] The purpose of this study was to elucidate changes in balance strategy during pregnancy from a kinematics perspective. [Subjects] Eight pregnant women and eight non-pregnant women participated. [Methods] A 3D motion analysis system, two force plates, and 10 infrared cameras were used to measure the kinematics of the balance strategy. The 3D motion analysis system was used to analyze performance of the functional reach test (FRT). Parameters were compared between non-pregnant women and pregnant women during each trimester, and between pregnant women in the second and third trimesters. [Results] The FRT of pregnant women was shorter than that of non-pregnant women. Bilateral hip joint extension moments were smaller in pregnant women in the second and third trimesters compared to non-pregnant women. Bilateral ankle plantar flexion moments were larger in pregnant women in their third trimester compared to non-pregnant women. In pregnant women, the right ankle plantar flexion moment was larger in the third trimester than in the second trimester. [Conclusion] These results suggest that forward reach distance is reduced, and that the ankle joint strategy takes precedence over the hip joint strategy in maintaining balance during pregnancy compared to non-pregnancy.

Self-perceived and actual ability in the functional reach test in patients with Parkinson's disease

Falls frequently occur during daily activities such as reaching for an object in patients with Parkinson's disease (PD). Misjudgment is also reported to be one of the circumstances that lead to falls. The functional reach test is an indicator of dynamic balance. The primary objective was to establish whether there is a difference between self-perceived and actual ability to perform the functional reach test in patients with PD who have never fallen. Three groups of participants (all with no history of falls) were studied: young adults, elderly adults and PD patients. The participants first estimated their maximum reaching distance (but without performing the action, i.e. as a motor imagery task) and then actually performed the functional reach test (i.e. as a motor task). No significant overestimation or underestimation was observed. The reaching distance was lower in PD than in the two other groups. There were no differences between PD patients and elderly adults in terms of the forward centre of pressure displacement. Seven PD patients reported a fall in the year following the experiment. The fallers had a longer history of disease. Finally, PD patients adequately estimated their ability in the functional reach test and did not adopt an "at risk" strategy and appeared to be quite conservative (as were healthy elderly adults) in their postural control behavior. Ability to estimate self-performance is preserved in PD patients with no clinical impairments of postural control although they are at risk of future falls.

Multi-directional Reach Test: An Investigation of the Limits of Stability of People Aged between 20-79 Years

[Purpose] The multi-directional reach test (MDRT) is a simple, inexpensive, reliable and valid screening tool for assessing the limits of stability in the anterorposterior and mediolateral directions. The aim of this study was to quantify the limits of stability of people aged between 20 and 79 years using the MDRT. [Subjects] One hundred and eighty subjects were divided into the following 6 age groups: 20–29, 30–39, 40–49, 50–59, 60–69 and 70–79 years (n=30 per group). [Methods] The MDRT was used to measure the limits of stability in four directions: forward, backward, leftward and rightward. Subjects performed maximal outstretched arm reach in each direction with their feet flat on the floor. [Results] All age groups performed the greatest values of the limit of stability in the forward direction. The 60–79 year group demonstrated significantly lower limits of stability in the forward, leftward and rightward directions compared to the 20–39 year group. [Conclusion] The limits of stability declined with age mainly in the forward, leftward and rightward directions. The MDRT appears to be a useful assessment tool for postural control and balance of those aged 60 years and over.

The immediate effect of lumbar spine patterns of neuromuscular joint facilitation in young amateur baseball players

[Purpose] The aim of the study was to investigate the changes in baseball pitching velocity, the functional reach test (FR) and the simple reaction times (SRT) in young amateur baseball players after lumbar spine patterns of neuromuscular joint facilitation (NJF) treatment. [Subjects] The subjects were 11 young amateur baseball players. An NJF intervention and a proprioceptive neuromuscular facilitation (PNF) intervention were performed. The interventions were performed one after the other with one week between them. The order of the interventions was completely randomized. [Methods] The baseball pitching velocity, the FR and the SRT were evaluated before and after treatment. [Results] In the NJF group, there were significant differences in baseball pitching velocity, FR and SRT after treatment. In the PNF group, there was a significant difference in SRT after treatment. [Conclusion] NJF intervention shortens the SRT, increases the baseball pitching velocity and FR, and may be recommended to improve performance in baseball players.