Balance

[Guest guest]

From Biomechanics Magazine April 2005

(Note: This is about Balance studies in general. Some of you might be

interested; it is not only those of us with CMT that can have balance

issues - G)

By the Numbers: Balance

For some time, the question of balance in injury cause and

prevention, and in overall health, was overlooked by the biomechanics

mainstream. Now, with an increased awareness of the role it plays in

preventing injuries and maintaining the ability to live

independently, its importance is being recognized. What follows are

snapshots of relevant studies published in peer reviewed journals

during the last year. Sources are provided.

---

3.5 Improvement in Tinetti body balance score for nursing home

residents after six weeks of physical therapy and controlled whole-

body vibration training. After training, the intervention group

improved by 3.5 plus/minus 2.1 out of 16 on the body balance score.

The scores of a control group of nursing home residents decreased by

0.3 plus/minus 1.2 points.

Bruyere O, Wuidart MA, Di Palma E. Controlled whole body vibration to

decrease fall risk and improve health-related quality of life of

nursing home residents. Arch Phys Med Rehabil 2005;86(2):303-307.

6 Number of months duration of hemiparesis during which an ankle foot

orthosis can help with balance issues, including body sway and weight-

bearing distribution, according to a study from Taiwan. Improved

balance, speed, and cadence were associated with AFO wear in 42

patients with hemiparesis of less than six months. Patients whose

hemiparesis was of 12 months or longer duration were not helped as

much by the AFO.

Wang RY, Yen L, Lee CC, et al. Effects of an ankle-foot orthosis on

balance performance in patients with hemiparesis of different

durations. Clin Rehabil 2005;19(1):37-44.

7 The number of weeks it took for children with Down syndrome who

wore a supramalleolar orthosis (designed to reduce pronation

associated with hypotonia) to show improvement on the balance subtest

of the Bruininks-Oseretsky Test of Motor Proficiency. Seventeen

children with Down syndrome (mean age 5 years, 10 months) were tested

three times during a 10-week period.

K. Effects of supramalleolar orthoses on postural stability in

children with Down syndrome. Dev Med Child Neurol 2004;46(6):406-411.

8 Number of items on the Dynamic Gait Index, whose inverse

correlation with 6.1-m walk time in patients with multiple sclerosis

suggests its validity for assessing balance in such patients. The DGI

measures the ability to modify gait in response to changing task

demands. Eleven physical therapists were shown a videotape of 10 MS

patients walking and scored the patients' gait using the DGI. They

viewed the same tape twice, two weeks apart, to ascertain interrater

reliability. Results showed a high interrater reliability on DGI

scores (a perfect score is 24) and an inverse relationship between

total DGI scores and the 6.1-m walk time.

McConvey J, SE. Reliability of the Dynamic Gait Index in

individuals with multiple sclerosis. Arch Phys Med Rehabil 2005;86

(1):130-133.

9 Percent of variance in quality of life score attributed to dynamic

balance in a Finnish study of 153 healthy postmenopausal, home-

dwelling women (mean age 72). Quality of life was measured using the

Rand 36-item Health Survey; dynamic balance was measured using a

figure-8 running test. Researchers also found a positive correlation

between dynamic balance and dynamic strength, as measured using sit-

to-stand and step-up tests.

Karinkanta S, Heinonen A, Sievanen H. Factors predicting dynamic

balance and quality of life in home-dwelling elderly women.

Gerontology 2005;51(2):116-121.

11.27 Odds (relative to 1.0) of a future fall in elderly women

meeting at least five of the following predictive criteria: previous

falls, conditions affecting balance, tendency to fall, intake of

psychosocial medication, inability to stand on one leg, and high

biologic age.

Gerdhem P, Ringsberg KA, Akesson K, Obrant KJ. Clinical history and

biologic age predicted falls better than objective functional tests.

J Clin Epidemiol 2005;58(3):226-232.

13.8 The percentage of 256 balance-impaired patients who had diabetes

mellitus in a Thai study on the etiologies of balance disorder and

how to prevent them. Besides diabetes mellitus, the other underlying

causes were hypertension (32.4%), arthritis (8.1%), and heart disease

(4.4%). Audiometric testing showed impaired hearing in 90%. The

participants were divided into two groups, one who did head balance

exercises and a control group. Posturography showed slightly less

balance abnormality in the exercise group.

Prasansuk S, Siriyananda C, Nakorn AN, et al. Balance disorders in

the elderly and the benefit of balance exercise. J Med Assoc Thai

2004;87(10):1225-1233.

30 The number of seconds of unsupported sitting needed for a score of

2 on the first question of the Berg Functional Balance Scale. For a

3, the patient must be able to sit for two minutes with supervision,

and for a 4 to sit unsupervised for two minutes safely and securely.

Berg K, Wood-Dauphinee S, J, Gayton D. Measuring balance in

the elderly: preliminary development of an instrument. Physiother Can

1989;41:304-311.

61 The percentage of 86 patients with vestibular hypofunction who,

after vestibular rehabilitation, achieved greater stability while

walking. The group of patients who had six weeks of VR significantly

increased their gait velocity and stability at 12 weeks compared with

a group who had six weeks of strengthening exercises; there were no

differences between groups at one year.

Krebs DE, Gill-Body KM, SW. Vestibular rehabilitation: useful

but not universally so. Otolaryngol Head Neck Surg 2003;128(2):240-

250.

68 The mean score on the 16-item activity-specific Balance Confidence

scale for 245 community-living patients with lower limb amputation

(both BK and AK) after two-year follow-up. As the baseline score for

these amputees was 67.7, their final score of 68 shows that balance

confidence remains an ongoing problem.

WC, Deathe AB. A prospective study examining balance

confidence among individuals with lower limb amputation. Disabil

Rehabil 2004;26(14-15):875-881.

69 The percentage of amputees whose functional outcome at one year

after amputation was predicted at two weeks by the 15-word test, one-

leg balance, age, and comorbidity on the Sickness Impact Profile.

Single-leg balance was the only significant predictor of prosthesis

use at one year.

Schoppen T, Boonstra A, Groothoff JW, et al. Physical, mental, and

social predictors of functional outcome in unilateral lower-limb

amputees. Arch Phys Med Rehabil 2003;84(6):803-811.

219 The height, in millimeters, of one of two steps used in a study

to determine the effect of stepping direction (up or down) on the

balance and postural control of gait initiation in patients with

recent unilateral, lower limb amputations. Researchers found

statistically significant differences between the amputee (five BK,

five AK) and control groups (eight participants) in phase duration,

center of pressure displacement, and center of mass velocity. The

authors concluded that balance is not managed by a fixed motor

program, meaning a patient will need some time to adapt to the

changes in balance and gait initiation required by a prosthesis.

SF, Twigg PC, Scally AJ, Buckley JG. The gait initiation

process in unilateral lower-limb amputees when stepping up and

stepping down to a new level. Clin Biomech (Bristol, Avon) 2005;20

(4):405-413.

256 The number of physically inactive older adults in a six-month

study to determine the effects of a tai chi exercise program on

functional balance. The participants were randomized to either a tai

chi group or a stretching group. Functional measurements using the

Berg Balance Scale and the dynamic gait index found the tai chi group

showed greater improvement in balance scores and in fall reduction

than the stretching group.

Li F, Harmer P, Fisher KJ, McAuley E. Tai Chi: improving functional

balance and predicting subsequent falls in older persons. Med Sci

Sports Exerc 2004;36(12):2046-2052.

778 The average balance index score in 35 elite female team handball

players after eight weeks of neuromuscular training to improve

balance, muscle strength, and proprioception. The athletes performed

three different sets of exercises, three times a week for five to

seven weeks. Dynamic balance scores improved significantly (from 924

to 778) after training.

Holm I, Fosdahl MA, Friis A, et al. Effect of neuromuscular training

on proprioception, balance, muscle strength, and lower limb function

in female team handball players. Clin J Sport Med 2004;14(2):88-94.

4 The number of weeks of single-leg balance training associated with

improved stability in individuals with multiple inversion ankle

sprains and control subjects. Both groups showed statistically

significant improvements in stability indices: from 5.93 before

testing to 2.63 after testing for the impaired subjects and from 4.67

to 2.69 for the controls (a lower stability index indicates better

stability). Both groups completed three-days-a-week balance training

on the Biodex Stability System.

Rozzi SL, Lephart SM, Sterner R, Kuligowski L. Balance training for

persons with functionally unstable ankles. J Orthop Sports Phys Ther

1999;29(8):478-486.

14 The number of items on the Berg Functional Balance Scale. Each of

the items is scored 0 to 4, for a possible total of 56 points. A

final score of 0 to 20 points can mean the patient is wheelchair

bound. Twenty-one to 40 is walking with assistance; and 41 to 56 is

independent walking.

Berg K, Wood-Dauphinee S, J, Gayton D. Measuring balance in

the elderly: preliminary development of an instrument. Physiother Can

1989;41:304-311.

Copyright © 2005 CMP Media LLC. All rights reserved.

4/1/05, Issue # 1204, page 37.