Effect of Dry Needling on Spinal Reflex Excitability and Postural Control in Individuals With Chronic Ankle Instability

ObjectiveThe purpose of this study was to compare postural control and neurophysiologic components of balance after dry needling of the fibularis longus between individuals with chronic ankle instability (CAI) and a healthy control group.MethodsThis quasi-experimental university-laboratory study included 50 adult volunteers—25 with CAI (16 female, 9 male; age: 26 ± 9.42 years; height: 173.12 ± 9.85 cm; weight: 79.27 ± 18 kg) and 25 healthy controls (15 female, 10 male; age: 25.8 ± 5.45 years; height: 169.47 ± 9.43 cm; weight: 68.47 ± 13 kg). Participants completed the Star Excursion Balance Test (SEBT), single-leg balance, and assessment of spinal reflex excitability before and after a single treatment of dry needling to the fibularis longus. The anterior, posterolateral, and posteromedial directions of the SEBT were randomized, and reach distances were normalized to a percentage of leg length. A composite SEBT score was calculated by averaging the normalized scores. Postural control was assessed in single-limb stance on a force plate through time-to-boundary measurements in eyes-open and eyes-closed conditions. Fibularis longus and soleus spinal reflexes were obtained by providing electrical stimulation to the common fibular and tibial nerves with participants lying prone. A Group × Time analysis examined changes in performance, and effect sizes were calculated to assess significance.ResultsSignificant group × time interactions were identified for composite (P = .006) and posteromedial (P = .017) SEBT scores. Significant time effects for all directions of the SEBT, time to boundary with eyes open, and the mediolateral direction with eyes closed indicate improved postural control following treatment (P < .008). Within-group effect sizes for significant time effects ranged from small to large, indicating potential clinical utility.ConclusionDry needling demonstrated immediate short-term improvement in measures of static and postural control in individuals with CAI as well as healthy controls.     

Test of Intrarater and Interrater Reliability for the Star Excursion Balance Test

[Purpose] The aim of this study was to examine the intrarater and interrater reliability of the Star Excursion Balance Test (SEBT), thereby increasing understanding of its efficient utilization. [Subjects and Methods] There were 67 subjects (49 female; 18 male). For the SEBT, eight lines were made using tape at 45-degree angles from the center of a circle. The experiment was conducted in the following order: the anterior, anterior-medial, medial, posterior-medial, posterior, posterior-lateral, lateral, and anterior-lateral directions. Intraclass correlation coefficients (ICC) (3,1) were used to evaluate the intrarater and interrater reliability (2,1) for each reach distance, while the standard error of measurement (SEM) and smallest detectable distance (SDD) were employed to assess absolute reliability. [Results] For intraratar reliability, the ICC values for all directions ranged from 0.88 to 0.96, SEM values ranged from 2.41 to 3.30, and SDD values ranged from 6.68 to 9.15. For interrater reliability, the ICC values for all directions ranged from 0.83 to 0.93, SEM values ranged from 3.19 to 4.26, and SDD values ranged from 8.85 to 11.82 [Conclusion] The SEBT is a highly reliable tool for measuring dynamic balance. Measurements for intrarater reliability are more reliable than measurements for interrater reliability. When measurement for eight directions was difficult, the SEBT was used. While the anterior, posteromedial, and posterolateral directions employed in the Y Balance Test Kit^TM can be utilized, this study recommends using the reverse Y Balance Test Kit^TM method with the posterior direction, not the anterior direction.Key words: Star excursion balance test (SEBT), Dynamic balance, Reliability     

Postural adjustment of children with spastic diplegic cerebral palsy during seated hand reaching in different directions

Ju Y-H, Hwang I-S, Cherng R-J. Postural adjustment of children with spastic diplegic cerebral palsy during seated hand reaching in different directions.ObjectivesTo examine the effect of reaching in different directions on postural adjustment in children with diplegic cerebral palsy (CP), and to examine the relationship between hand reach performance and postural adjustment, and between postural control ability and postural adjustment.DesignCross-sectional study.SettingA movement science laboratory at a medical university.ParticipantsChildren with CP (n=12) and typically developing (TD) children (n=16).InterventionsNot applicable.Main Outcome MeasuresTwo force platforms were used to measure the ground reaction force (GRF) and center of pressure (COP) data. Absolute peak COP velocity, COP sway ratio (SR), and mean GRF in the anterior posterior direction during the acceleration and deceleration segments of a reaching task were the main outcome measures.ResultsChildren with CP showed a greater absolute peak COP velocity in the medial lateral direction, a smaller SR (wider COP pattern), and greater amplitude of force modulation (exaggerated postural adjustments) than TD children in lateral or medial reaches. There was a moderate correlation between SR and total Pediatric Reach Test score. The chair SR was also negatively correlated with the hand movement units.ConclusionsChildren with CP showed wider, more crooked, and less efficient COP patterns than TD children, especially on medial or lateral reaches. Reaching medially or laterally involves trunk rotation, which produces more postural challenges than reaching anteriorly to children with CP. The patterns of postural adjustments in children with CP were correlated with their postural control ability and hand-reach smoothness.     

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

ObjectivesThe purpose of this study was to investigate the effects of arms position (arms free or hands on the hips) and shoe-wear (with or without athletic shoe) on star excursion balance test (SEBT) scores in healthy physically active individuals.DesignCross-sectional study.MethodsFifty-one participants [Age: 22.74 ± 1.93 years; Body Mass Index: 22.52 ± 2.29 kg/m²] were included in the study. The anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions of the SEBT were performed under four conditions in a randomized order. Within session reliability analysis was performed for each test condition. The composite (COMP) score was calculated as the average of the normalized scores of anterior, posteromedial and posterolateral reach distances. Repeated measures of ANOVA was used for statistical analysis.ResultsThe ANT and PM reach distances and the composite (COMP) score were found greater with shoes (ANT p = 0.004; PM p < 0.001; COMP p < 0.001). However, the difference in the scores with shoes conditions did not exceed the measurement error. On the other hand, PM and PL reach distances and the COMP score were greater with arms free conditions and the difference in the scores exceeded the measurement error.ConclusionsThe results of the study suggest that the differences in the SEBT procedure should be taken into account when comparing the outcomes of different studies. In addition, measurement error values should be considered while interpreting the change in repeated measures of SEBT scores.     

Stance foot alignment and hand positioning alter star excursion balance test scores in those with chronic ankle instability: What are we really assessing?

Objective: The literature has consistently shown that the Star Excursion Balance Test (SEBT) is a reliable and valid tool to anticipate the risk of lower extremity injury, assess dynamic postural control differences among groups, and assess the effectiveness of balance training programs in both healthy individuals and people with lower extremity injuries. However, there is no standard administration technique for the SEBT in research, clinical practice, or performance settings. Therefore, the purpose of this investigation was to compare six different combinations (3 different foot alignments × 2 hand positions) on the SEBT performance in those with chronic ankle instability (CAI). Design: Repeated Measures Design. Setting: University Research Laboratory. Participants: Twenty-five university students with CAI (12 males, 13 females; age: 20.3 ± 2.4 years, height: 172.7 ± 7.4 cm, weight: 77.5 ± 15.3 kg., BMI: 25.9 ± 4.0 kg/m²) voluntarily participated in the study. Methods: Six different SEBT positions were used to assess dynamic postural control. Three foot positions: 1) Foot centered; 2) Toe fixed; and 3) Toe-heel changing and two hand placements: 1) Hands free and 2) Hands on the hips were used in this study. After 6familiarization trials for each condition, three Star Excursion Balance Test scores were recorded. Main outcome measures: Normalized reach distance (% of leg length) in the anterior, posteromedial, and posterolateral directions as well as a composite reach score quantified dynamic postural control. Results: Both foot alignment and hand position significantly altered normalized SEBT reach distance in the anterior (p < 0.003), posteromedial (p < 0.001), posterolateral (p < 0.001), and composite reach scores (p < 0.001). Conclusion: Different foot alignments and hand constraints significantly altered normalized reach distances and the composite score in individuals with CAI. These results do not suggest that any combination of foot alignments and/or hand constraints is superior. However, changing the toe/heel position, while maintaining hands on the hips, may provide the best standardization for clinicians and researchers.     

Comparison of postural control in older adults under different dual-task conditions: A cross-sectional study

Backgroundand purpose: Performing a cognitive task while maintaining postural stability, known as “dual-task” condition, can increase the cognitive demand and reduce the postural control capacity. The inability to allocate attention to postural control under dual-task conditions may lead to balance impairments, particularly in older adults. The present study aimed to compare the effects of different dual-task conditions of backward counting (BC) and visual attention (VA) on older adults’ postural balance performance.MethodsTwenty asymptomatic volunteers (mean age: 70.4 ± 4.1 years) were recruited. Participants stood on a foam surface placed over a force plate, and displacement and sway velocity of their center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions were recorded under three conditions: BC dual-task, VA dual-task (control of center of mass with a laser pointer), and quiet stance as the control task (CT).ResultsRepeated measures ANOVA showed a significant difference in AP and ML sway velocities between conditions with p-values of 0.039 and 0.042, respectively. The LSD post-hoc test revealed that the BC task significantly increased AP sway velocity compared to the CT (p = 0.013), and the VA task significantly increased ML sway velocity compared to the CT (p = 0.034) and the BC tasks (p = 0.026). There were no statistically significant differences between conditions for ML (p = 0.058) and AP (p = 0.350) displacements and total sway velocity (p = 0.051).ConclusionOlder adults’ postural stability can be impaired under dual-task conditions and the present study revealed that various dual tasks increase postural sway in different directions.     

Development of an objective balance assessment method for purposes of telemonitoring and telerehabilitation in elderly population

Purpose.?Reliable assessment of balance abilities and determination of the likelihood of falling in the elderly requires a skilled clinician to guide and assist the individual throughout the scoring of a suitable balance assessment method. The most widely used clinical instrument is the Berg Balance Scale (BBS). The aim of this study was to develop an objective balance assessment measure that would correlate well with BBS and could thus be used to test balancing abilities remotely.

Methods.?Twenty elderly individuals were divided into two groups: fallers and non-fallers based on their falling records. Balance abilities were assessed by means of BBS as well as through analysis of peak amplitude of center-of-pressure (COP) responses that followed induced-sway, provoked by a moveable standing frame in the medio-lateral plane. An independent t-test was used to compare BBS scores and COP based measures between both groups. Additionally, correlation between both tests was determined by use of the Pearson correlation coefficient.

Results.?Fallers exhibited significantly lower BBS scores as well as significantly lower peak values of COP responses. The coefficient of correlation between both tests was relatively high (0.68) and statistically significant.

Conclusion.?The high degree of correlation between both tests implies that the proposed objective balance testing apparatus and methods could be used for remote assessment of balance abilities in the elderly, which has implications for the development of home-based mobility training programs.     

Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs

Pluchino A, Lee SY, Asfour S, Roos BA, Signorile JF. Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs.ObjectiveTo compare the impacts of Tai Chi, a standard balance exercise program, and a video game balance board program on postural control and perceived falls risk.DesignRandomized controlled trial.SettingResearch laboratory.ParticipantsIndependent seniors (N=40; 72.5±8.40) began the training, 27 completed.InterventionsTai Chi, a standard balance exercise program, and a video game balance board program.Main Outcome MeasuresThe following were used as measures: Timed Up &; Go, One-Leg Stance, functional reach, Tinetti Performance Oriented Mobility Assessment, force plate center of pressure (COP) and time to boundary, dynamic posturography (DP), Falls Risk for Older People–Community Setting, and Falls Efficacy Scale.ResultsNo significant differences were seen between groups for any outcome measures at baseline, nor were significant time or group × time differences for any field test or questionnaire. No group × time differences were seen for any COP measures; however, significant time differences were seen for total COP, 3 of 4 anterior/posterior displacement and both velocity, and 1 displacement and 1 velocity medial/lateral measure across time for the entire sample. For DP, significant improvements in the overall score (dynamic movement analysis score), and in 2 of the 3 linear and angular measures were seen for the sample.ConclusionsThe video game balance board program, which can be performed at home, was as effective as Tai Chi and the standard balance exercise program in improving postural control and balance dictated by the force plate postural sway and DP measures. This finding may have implications for exercise adherence because the at-home nature of the intervention eliminates many obstacles to exercise training.     

Standing Data Disproves Biomechanical Mechanism for Balance-Based Torso-Weighting

Objective

To test a proposed mechanism for the effect of balance-based torso-weighting (BBTW) in people with multiple sclerosis (MS) and healthy controls. The mechanism to be tested is that application of light weights to the trunk may result in a biomechanical shift of postural sway in the direction of weighting, mechanically facilitating maintenance of the center of mass over the base of support.

Design

Nonrandomized controlled trial.

Setting

Motion analysis laboratory.

Participants

Participants with MS (n=20; average Expanded Disability Status Scale score, 4.1) and controls matched for sex, age, height, and weight (n=18).

Intervention

Light weights strategically placed according to the BBTW protocol were applied to all participants after at least 3 walking trials and 10 seconds of quiet standing with feet together and eyes open and then eyes closed. Measures were repeated after weighting.

Main Outcome Measure

Forceplate center of pressure (COP) changes >1 standard error of measurement.

Results

With BBTW, people with MS had larger maximum changes in COP than healthy controls in the left-right direction but not in the anterior-posterior direction. COP changes >1 standard error of measurement occurred in the same direction of weighting 20% of the time (95% confidence interval, 5–34), ranging from 10% to 28% across conditions and directions of postural sway. Direction of greatest weight placement did not match the direction of change in the average COP in most participants with MS or the healthy controls in eyes open or eyes closed conditions (P<.001).

Conclusions

If BBTW worked via a biomechanical shift of the center of mass, COP changes should match the direction of greatest weighting with BBTW. Our data allowed us to reject this hypothesis. Future research may explore alternative mechanisms of action underlying this intervention.     

Relationship between Lower Extremity Tightness and Star Excursion Balance Test Performance in Junior High School Baseball Players

[Purpose] The purpose of this study was to examine the relationship between lower extremity tightness and lower extremity balance, measured by the Star Excursion Balance Test (SEBT), in junior high school baseball players. [Subjects] Thirty-three male students belonging to baseball clubs in 2 junior high schools participated in this study. [Methods] For the SEBT, we chose to examine the anterior (ANT), posterior (POS), lateral (LAT), and medial (MED) directions. Regarding muscle tightness measurement, the angle of each joint of the bilateral iliopsoas, quadriceps, hamstring, gastrocnemius, hip internal rotator, and hip external rotator was measured. [Results] The ANT direction of the SEBT was significantly negatively correlated with gastrocnemius tightness. The MED direction of the SEBT was significantly positively correlated with hip internal rotator tightness and hamstrings tightness and significantly negatively correlated with gastrocnemius tightness. The LAT direction of the SEBT was significantly negatively correlated with iliopsoas tightness and gastrocnemius tightness. [Conclusion] Since the rate of upper extremity injury is high in these subjects and this could be due to tightness and instability of the lower extremity from a kinetic viewpoint, the SEBT could be used as a standard evaluation test when examining upper extremity injuries in young baseball players.Key words: Growth phase, Standing balance, Flexibility     

COMPARISON OF THE IMMEDIATE EFFECT OF DIFFERENT TYPES OF TRUNK EXERCISE ON THE STAR EXCURSION BALANCE TEST IN MALE ADOLESCENT SOCCER PLAYERS

Purpose/Background:

Trunk exercises, such as trunk stabilization exercises (SE) and conventional trunk exercises (CE), are performed to improve static or dynamic balance. Recently, trunk exercises have also been often used as part of warm‐up programs. A few studies have demonstrated the immediate effects of SE and CE on static balance. However, immediate effects on dynamic balance are not yet known. Therefore, the purpose of this study was to compare the immediate effect of SE with that of CE on the Star Excursion Balance Test (SEBT).

Methods:

Eleven adolescent male soccer players (17.9 ± 0.3 years, 168.5 ± 5.4 cm, and 60.1 ± 5.1 kg) participated in this study. A crossover design was used, and each participant completed three kinds of testing sessions: SE, CE, and non‐exercise (NE). Experiments took place for three weeks with three testing sessions, and a 1‐week interval was provided between different conditions. Each testing session consisted of three steps: pretest, intervention, and posttest. To assess dynamic balance, the SEBT score in the anterior, posteromedial, and posterolateral directions was measured before and 5 minutes after each intervention program. The data of reach distance were normalized with the leg length to exclude the influence of the leg length on the analysis.

Results:

The SEBT composite score was significantly improved after the SE (p < 0.05) but did not change after the CE and NE (p > 0.05). Furthermore, in the SE condition, SEBT scores of the posterolateral and posteromedial directions were significantly improved at the posttest, compared with those at the pretest (p < 0.05).

Conclusions:

This study demonstrated the immediate improvements in the posteromedial and posterolateral directions of the SEBT only after the SE. This result suggests that the SE used in this study is effective in immediately improving dynamic balance.

Levels of Evidence:

3b     

Does verbal encouragement change dynamic balance? The effect of verbal encouragement on Star Excursion Balance Test performance in chronic ankle Instability

BackgroundThe Star Excursion Balance Test (SEBT) is commonly used for testing dynamic balance in chronic ankle instability (CAI) in both clinical and research settings. However, the effect of verbal encouragement (VE) on the SEBT performance is not known.ObjectiveTo investigate the effects of VE on maximum reach distance performance between CAI and healthy participants on the SEBT.MethodThirty-four college-aged adults, 17 with CAI and 17 healthy controls, performed the SEBT in the anterior, posteromedial, and posterolateral reach directions. Independent variables (VE versus No-VE) and group (CAI versus healthy) were analyzed using Analysis of Variance (ANOVA) to determine whether VE and group affected reach performance.ResultsThere was a significant group-by-condition interaction (p = 0.02) for the anterior as well as for the posteromedial reach (p = 0.04). There was no statistically significant interaction (p = 0.48) for the posterolateral reach. There were moderate to large effect sizes in the reach distances found in the No-VE condition between the CAI and healthy controls, but with VE, the range of effect sizes from No-VE to VE were diminished.ConclusionThere was a significant group by condition interaction for anterior and posteromedial reaches which shows that providing VE resulted in a greater increase in performance for participants with CAI compared to healthy controls. Psychological constraints need to be considered while performing and interpreting the results of the SEBT.     

Effects of foot position of the nonparetic side during sit-to-stand training on postural balance in patients with stroke

[Purpose] We aimed to investigate postural balance after sit-to-stand (STS) training with different nonparetic foot positions in stroke patients. [Subjects] Thirty-six subjects who experienced a stroke (21 males, 15 females) participated and were divided into the symmetric foot position (SYMM), asymmetric foot position (ASYM), and step foot (STEP) groups. [Methods] Each group performed repetitive sit-to-stand training 5 times a week for 6 weeks. The timed up-and-go test (TUG), functional reach test (FRT), and F-mat system correcting the anterior/posterior (A-P) and medial/lateral (M-L) distance of the center of pressure (COP) were used to measure the static and dynamic postural balance pre- and postintervention. ANCOVA was used to analyze differences among groups, and preintervention variables were used as covariates. [Results] The TUG, FRT, and A-P and M-L distance of the COP in the ASYM and STEP groups were significantly decreased after intervention compared with the SYMM group. All parameters in the STEP group were lower than those in the ASYM group, without a significant difference. [Conclusion] The asymmetric foot position during STS is a good intervention to improve the static and dynamic postural balance in stroke patients. Especially, using a step to change the foot position is effective in improving STS performance.Key words: Foot position, Sit-to-stand, Postural balance     

Reliability of the Star Excursion Balance Test and Two New Similar Protocols to Measure Trunk Postural Control

Background

Although the Star Excursion Balance test (SEBT) has shown a good intrasession reliability, the intersession reliability of this test has not been deeply studied. Furthermore, there is an evident high influence of the lower limbs in the performance of the SEBT, so even if it has been used to measure core stability, it is possibly not the most suitable measurement.

Comparative effect of walking meditation and rubber-band exercise on ankle proprioception and balance performance among persons with chronic ankle instability: A randomized controlled trial

BackgroundAnkle proprioception and balance impairments are usual consequences of chronic ankle instability (CAI). The impairments affect functional and sport activities and can lead to recurrent ankle sprain. Mind-body practice is claimed to improve ankle proprioception and balance.ObjectiveTo investigate the effects of walking meditation, a mind-body practice, and compare it with the rubber-band exercise on ankle proprioception and balance among individuals with CAI.Study designA randomized controlled trial.MethodsThirty-two participants with CAI aged 20.3 ± 1.8 years were randomized into three groups; 1) walking meditation (WM, n = 10), 2) Rubber-band exercise (RE, n = 11) and 3) control (n = 11). WM and RE were enrolled on a 4-week training regimen (30 min/day, 3 days/week). Before and after the training, ankle proprioception was evaluated by angular error of the ankle reposition test (AEA) at three positions, randomly, i.e., plantarflexion-5°, plantarflexion-10° and dorsiflexion-5°. Balance performance was assessed by the star excursion balance test (SEBT).ResultsAs adjusted by pre-training baseline, no significant difference in AEA and SEBT was found among three groups. However, after training, only the WM group revealed a significant decrease in AEA at plantarflexion-5° (p = 0.007) and plantarflexion-10° (p = 0.04) compared to the baseline. For SEBT, the WM and RE groups showed significant improvements compared to the baseline in 4 directions each (p < 0.05), while the control group improved only 2 directions (p < 0.05).ConclusionsWM and RE groups significantly improved SEBT after 4-week training when compared to before training. Additionally, WM group also improved ankle proprioception. Therefore, WM demonstrates feasibility as a promising intervention that could be applied for balance and ankle proprioceptive rehabilitations in persons with CAI.     

Postural control and the influence of the extent of thigh support on dynamic sitting balance among individuals with thoracic spinal cord injury

BackgroundUnsupported sitting balance with reduced thigh support is necessary during several daily living activities among individuals with spinal cord injury. This study proposed to compare dynamic unsupported sitting postural control under reduced thigh support conditions in individuals with motor-complete thoracic spinal cord injury and able-bodied individuals.MethodsThirteen individuals with spinal cord injury and thirteen able-bodied individuals were asked to put on a t-shirt and reach forward while sitting on a force platform using maximum, medium or minimum thigh support extent. Postural control was measured by the center of pressure parameters.FindingsIndividuals with spinal cord injury presented larger postural sway parameters and mean velocity of the center of pressure displacement in anterior-posterior direction during the t-shirt wearing task. On the other hand, these parameters were lower in the medial-lateral direction. These results are more expressive when the task was performed in reduced thigh support conditions [F(1,76) = 5.05–18.70; p < 0.05]. Lower postural sway parameters and mean velocity of the center of pressure displacement in anterior-posterior, and postural sway in medial-lateral direction in the three thigh support conditions were observed when individuals with spinal cord injury performed the forward reaching task [F(1,76) = 9.81–185.46; p < 0.01].InterpretationThe results confirm that individuals with motor-complete thoracic spinal cord injury have poor postural stability and show a trunk postural sway constraint to maintain the suboptimal unsupported sitting balance. Reduced thigh support extent can challenge the dynamic sitting balance in individuals with thoracic spinal cord injury and should be indicated to train new and diversified postural control strategies.     

Postural sway changes in genu recurvatum deformity during standing with manipulation of visual and proprioceptive systems

ObjectivesGenu recurvatum deformity shifts the mechanical axis of lower extremity posteriorly which may disturb the balance and lead to injury. The aim of this research was to compare postural sways in genu recurvatum subjects with healthy controls while manipulating visual and proprioceptive systems.Methods10 female subjects with genu recurvatum (20.04 ± 4.64 years) and 11 female healthy controls (20.11 ± 4.64 years) participated in the study. The back knee angle was measured using a goniometer. Dynamic BIODEX balance system was used to measure the total, anteroposterior, and mediolateral postural sways while manipulating the stability of the base of support (stable versus unstable) and visual system (open versus closed eyes).ResultDuring standing on the stable level, in both visual conditions, genu recurvatum subjects demonstrated greater total and anteroposterior postural sways than controls in both standing on the right and left foot (p<0.05). Similarly, when standing on the unstable base of support, in all conditions, the postural sways of genu recurvatum subjects were significantly greater than controls in both right and left foot (p<0.05). The vision had a main effect on postural control of genu recurvatum group (p=0.0001). There was a significant interaction between vision, the stability of the base of support and group factors (p=0.003).ConclusionThe results indicated that genu recurvatum subjects have a proprioceptive deficiency and they mainly rely on visual system inputs to control and maintain their balance. Thus, the proprioceptive system and balance control should be considered in assessment and designing an appropriate treatment regimen for genu recurvatum.     

Reliability and Validity of the Y-balance Test in Young Adults with Chronic Low Back Pain

BackgroundIndividuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined.PurposeTo determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group.Study DesignReliability and validity study.MethodsFifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant’s dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis.ResultsThe YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001).ConclusionsThe results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP.Level of Evidence2b.     

Evaluation of postural stability in the elderly with stroke

OBJECTIVE: To compare clinical and biomechanical measures of balance in elderly stroke patients with those of healthy elderly people. DESIGN: Two-group comparison design. SETTING: Laboratory environment. PARTICIPANTS: Fifteen poststroke patients and 15 healthy age-matched older adults (N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The biomechanical variable COP-COM, which represents the distance between the center of pressure (COP) and the center of mass (COM) in terms of root mean square. The mean of 4 trials of the COP-COM variable for each test condition was used for statistical analysis. Furthermore, the different systems (sensory, motor, central processor) related to postural stability were evaluated. RESULTS: Statistical significance of the COP-COM variable was larger in the stroke group than in healthy subjects, in both the anteroposterior (AP) and mediolateral (ML) directions. Furthermore, statistically, stroke subjects showed amplitudes of the COP-COM variable that were significantly larger in the eyes-closed condition. The significant negative correlation demonstrated between COP-COM amplitude and the balance scales (Berg, Tinetti) indicated that the patients with larger COP-COM amplitudes had lower clinical balance score. Furthermore, correlation coefficient scores between COP-COM variables in both AP and ML directions and motor performance using Fugl-Meyer Assessment (rho=-.53, rho=-.51, respectively) and reaction time (rho=-.53, rho=-.44, respectively) were significant. Vibration (rho=.41) and touch-pressure (rho=.42) perception thresholds correlated significantly only in the AP direction. CONCLUSIONS: Evaluating postural stability with COP-COM variable provided an accurate measure of postural stability in poststroke elderly people. Furthermore, postural stability in quiet stance, as measured by COP-COM amplitude, was related to functional measures of balance as well as physiologic factors relating to balance, such as visual conditions, lower-extremity peripheral sensibility, motor recovery, and simple reaction time.