The Figure-of-Eight Walk test: reliability and associations with stroke-specific impairments

Abstract

Objectives: To investigate (1) the intra-rater, inter-rater and test–retest reliabilities of the Figure-of-Eight Walk (F8W) test times; (2) its correlation with other stroke-specific impairments; and (3) the cut-off scores best discriminating patients with stroke from the healthy elderly. Design: Cross-sectional study. Setting: University-based rehabilitation centre. Participants: A convenience sample of 64 subjects: 35 subjects with chronic stroke and 29 healthy elderly. Main Outcome Measures: F8W test times, Fugl–Meyer Motor Assessment for the lower extremities (FMA-LE), hand-held dynamometer measurements of bilateral hip abductor and knee extensor isometric muscle strength, Five times Sit to Stand Test (FTSTST) times, 10-Meter Walk Test (10MWT), Timed Up and Go Test (TUGT) times, Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC) scores. Results: Excellent intra-rater, inter-rater and test–retest reliabilities (intra-class correlation coefficient (ICC) range 0.944–0.999) of F8W test times were found. The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT. No significant correlation was found between F8W test times and either leg strength or ABC results. A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%. Conclusions: The F8W test time is a reliable measurement tool, which is able to differentiate the patients with stroke and healthy elderly subjects and correlated well with stroke-specific impairments and walking tests. The F8W is a reliable measurement tool for assessing the advanced walking performance of subjects with chronic stroke.

• Implication for Rehabilitation

• The F8W test times have excellent intra-rater, inter-rater and test–retest reliabilities in patients with chronic stroke.

• The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT.

• A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%.

• The F8W test time is a reliable and valid measure in assessing the advanced walking skill in patients with stroke.

     

Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients

[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.Key words: Balance training, Visual feedback, Acute stroke patients     

Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone

Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up &; Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone.ObjectiveTo determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC₉₅) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone.DesignTest-retest study. Data were collected on 2 occasions, about 6 days apart.SettingOutpatient physical therapy clinics.ParticipantsVolunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17).InterventionNot applicable.Main Outcome MeasuresReliability and absolute and relative MDC₉₅ of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed “Up &; Go” test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT).ResultsExcellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC₉₅ in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC₉₅ of the subgroups were varied based on ankle plantarflexor tone.ConclusionsThe BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC₉₅ of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC₉₅ seems more useful than the absolute MDC₉₅ because the relative value can be used for a single individual.     

触觉振动反馈训练对脑卒中后偏瘫患者平衡及行走功能的影响

目的 观察自行研发的触觉振动反馈训练系统对脑卒中后偏瘫患者平衡与步行能力的影响。 方法 将符合入选标准的恢复期偏瘫患者50例,随机分为对照组和观察组,每组25例,2组患者均接受常规的运动训练、神经肌肉电刺激疗法、生物反馈疗法。在此基础上,观察组每日配合人体步态增加1 h的触觉振动反馈训练,每周5 d;对照组每日增加自行步行训练1 h,每周5 d。分别于治疗前和治疗6周后(治疗后),采用Berg平衡量表（BBS）、Time up and go（TUG）行走测试、下肢Fugl-Meyer评定量表（FMA-LE）评定下肢运动功能,使用美国产Gaitrite步态分析仪获取2组患者的步态参数,选取健侧步长、患侧单支撑相时长/健侧单支撑相时长进行统计学比较和分析。 结果 治疗前,2组患者的健侧步长、患侧单支撑相时长/健侧单支撑相时长、BBS评分、TUG测试时长、FMA-LE评分组间差异均无统计学意义（P>0.05)。治疗后,2组患者的健侧步长、患侧单支撑相时长/健侧单支撑相时长、BBS评分、TUG测试时长、FMA-LE评分均较组内治疗前明显改善（P<0.05）。治疗后,观察组的健侧步长［(60.2±8.2)cm］、患侧单支撑相时长/健侧单支撑相时长［(0.92±0.03)］、BBS评分［(42.9±5.5)分］、FMA-LE评分［(31.4±2.0)分］均显著优于对照组（P<0.05）,TUG测试时长［(15.3±5.4)s］显著短于对照组（P<0.05）。 结论 触觉振动反馈训练能显著提高脑卒中后恢复期偏瘫患者的平衡与步行功能,降低跌倒风险。     

Reliability,Concurrent Validity,and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke

ObjectiveThe aims of this study were to investigate the psychometric property of the timed Up and Go Obstacle (TUGO) test in people with stroke.DesignCross-sectional design.SettingUniversity based neurorehabilitation laboratory.ParticipantsTwenty-eight people with stroke and 30 healthy older adults.InterventionNot Applicable.Outcome MeasuresThe TUGO (obstacle heights: 0, 5, 17 cm) test completion times, Fugl-Meyer Assessment (FMA) score, ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS) score, Narrow Corridor Walking Test (NCWT) completion time, timed Up and Go (TUG) test completion time, and Community Integrated Measure.ResultsExcellent inter-rater (intraclass correlation coefficient [ICC]=0.999-1.000) and test-retest reliabilities (ICC=0.917-0.975) were found for TUGO test completion times for all obstacle heights. The TUGO test completion times for all obstacle heights were significantly correlated with NCWT and TUG test completion times (r=0.817-0.912). Only TUGO test completion times for 0 and 5 cm obstacle heights showed significant correlations with BBS scores (r=-0.518 to -0.534), while the TUGO test completion time for the 17 cm obstacle height correlated significantly with FMA scores. The minimal detectable change and optimal cut-off values for TUGO test completion times for the 0, 5, and 17 cm obstacle heights were 2.54, 3.60, and 3.07 s, and 14.69, 14.76, and 16.10 s, respectively.ConclusionThe TUGO test is a reliable, valid, and easy-to-administer clinical measure to discriminate between people with stroke and healthy older adults.     

Relationship between the Berg Balance Scale and Static Balance Test in Hemiplegic Patients with Stroke

[Purpose] The purpose of this study was to analyze the relationship between results of the Berg Balance Scale (BBS) and Static Balance Test (SBT) in hemiplegic patients with stroke. [Subjects] The subjects were 39 hemiplegic patients (25 men, 14 women; mean age, 69.4 ± 11.0 years) with stroke that had occurred within the preceding 6 months and who had good understanding of verbal instructions. [Methods] The SBT consists of five posture-holding tasks (sitting, stride standing, close standing, one-foot standing on the unparalyzed leg, and one-foot standing on the paralyzed leg). Four grades, 1–4, are used to judge the ability of patients to hold these postures. The SBT and BBS were each implemented, and the relationship between test results was analyzed using correlation coefficients. [Results] The correlation coefficient for the BBS score and SBT score was 0.87. Thus, a strong correlation was seen between the BBS and SBT. [Conclusion] The SBT is thought to be an assessment index that can predict overall balance ability.Key words: Stroke, Balance, Assessment     

Contribution of subjective balance confidence on functional mobility in subjects with chronic stroke

Purpose.?To examine the contribution of subjective balance confidence, balance ability, motor impairments and muscle strength to the timed ‘Up & Go’ (TUG) scores of 78 subjects with chronic stroke using cross-sectional design.

Methods.?Functional mobility was measured in terms of TUG scores. Balance ability and subjective balance confidence were assessed with the Berg Balance Scale (BBS) and the activities-specific balance confidence (ABC) scale, respectively. Stroke-specific motor impairment and muscle strength of lower extremity were measured using the Fugl-Meyer Motor Assessment lower extremity (FMA-LE) scores and hand-held dynamometer.

Results.?We found that the TUG scores had the highest negative correlation with subjective balance confidence. After controlling for use of walking aids, significant partial correlations were identified between the TUG scores and subjective balance confidence and balance ability. Applying linear regression model, the TUG scores showed association with subjective balance confidence and balance ability, independently. The motor impairments and muscle strength, however, were not significant predictors of TUG scores. The whole model could explain 63.0%% of the variance in the TUG scores.

Conclusions.?Our results support that improving both subjective balance confidence, in addition to functional balance training could be crucial in promoting functional mobility of community-dwelling stroke survivors.     

The effects of stair gait training using proprioceptive neuromuscular facilitation on stroke patients’ dynamic balance ability

[Purpose] This study aims to examine stroke patients’ changes in dynamic balance ability through stair gait training where in proprioceptive neuromuscular facilitation (PNF) was applied. [Subjects and Methods] In total 30 stroke patients participated in this experiment and were randomly and equally allocated to an experimental group and a control group. The experimental group received exercise treatment for 30 min and stair gait training where in PNF was applied for 30 min and the control group received exercise treatment for 30 min and ground gait training where in PNF was applied for 30 min. For the four weeks of the experiment, each group received training three times per week, for 30 min each time. Berg Balance Scale (BBS) values were measured and a time up and go (TUG) test and a functional reach test (FRT) were performed for a comparison before and after the experiment. [Results] According to the result of the stroke patients’ balance performance through stair gait training, the BBS and FRT results significantly increased and the TUG test result significantly decreased in the experimental group. On the contrary, BBS and FRT results did not significantly increase and the TUG test result did not significantly decrease in the control group. According to the result of comparing differences between before and after training in each group, there was a significant change in the BBS result of the experimental group only. [Conclusions] In conclusion, the gait training group to which PNF was applied saw improvements in their balance ability, and a good result is expected when neurological disease patients receive stair gait training applying PNF.Key words: Proprioceptive neuromuscular facilitation, Stroke, Balance ability     

Relationship between self-reported function and disability and balance performance measures in the elderly

This study evaluated the reliability and validity of the Hebrew version of the Late-Life Function and Disability Instrument (LLFDI). Fifty-five older adults (mean age 79.7 +/- 5.2) participated. We calculated test-retest reliability with intraclass correlation coefficients (ICCs). Partial correlations determined the construct validity with a balance measure (Berg Balance Scale [BBS]) and a mobility measure (Timed Up and Go [TUG] test). We examined known-group validity by comparing the scores of cane and noncane users. Test-retest ICCs ranged from good to excellent (0.77-0.90) for the function component and fair to good for the disability component (0.63-0.83), except for the disability management role subscale (0.46). BBS and TUG were associated with LLFDI overall function (r = 0.48, p < 0.001 and r = -0.52, p < 0.001, respectively). TUG and BBS were weakly associated with disability limitations (r = -0.26 and 0.32, respectively) and disability frequency (r = -0.16 and 0.24, respectively). Cane users showed significantly lower function scores than noncane users. We demonstrated that the Hebrew version of the LLFDI reliably and validly assesses older adults' function and disability. The LLFDI is recommended as an outcome instrument in studies in which older adults' function and disability are outcomes of interest.     

The intra- and inter-rater reliabilities of the Short Form Berg Balance Scale in institutionalized elderly people

[Purpose] The purpose of this study was to examine the intra- and inter-rater reliabilities of the Short Form Berg Balance Scale in institutionalized elderly people. [Subjects and Methods] A total of 30 elderly people in a nursing facility in Y city, South Korea, participated in this study. Two examiners administered the Short Form Berg Balance Scale to one subject to investigate inter-rater reliability. After a week, the same examiners administered the Short Form Berg Balance Scale once more to investigate intra-rater reliability. [Results] The intra-rater reliability was 0.83. The inter-rater reliability was 0.79. Both reliabilities were high (more than 0.7). [Conclusion] The Short Form Berg Balance Scale is a version of the Berg Balance Scale shortened by reducing the number of items, but its reliabilities were not lower than those of the Berg Balance Scale. The Short Form Berg Balance Scale can be useful clinically due to its short measurement time.Key words: Balance, Elderly, Reliability     

The Persian version of the Berg Balance Scale: inter and intra-rater reliability and construct validity in elderly adults

Purpose: As a well-known measure for quantifying functional mobility in elderly persons, Berg Balance Scale (BBS) was used in the present study to evaluate its psychometric properties among a sample of 106 elderly individuals speaking Persian language. Method: After forward-backward translation process, videotapes were recorded from all participants while performing 14 tasks of the BBS. The volunteers were also asked to perform the Timed Up and Go (TUG) test at the same session. To determine inter and intra-rater reliability, the videotapes were viewed by two experienced therapists while one of the raters assessed the videotaped performance of the subjects on a second occasion. Results: Intraclass correlation coefficients (95% confidence interval) of 0.93 (0.87 0.96) and 0.95 (0.92 0.97) were obtained for inter and intra-rater reliability, respectively. Cronbach’s alpha was 0.62 which is marginally lower than the cut-off point of 0.70. Furthermore, there were no ceiling and floor effects for the Persian version. In terms of construct validity, the BBS had a negative and strong correlation with the TUG (r?=??0.74, p < 0.001). Conclusions: Acceptable levels of intra and inter-rater reliability with a moderate internal consistency and high validity were demonstrated for the Persian version of BBS.

Implications for Rehabilitation

• The results on psychometric properties of the Persian BBS are comparable with the Italian, Brazilian, Norwegian, Turkish and Taiwanese versions of BBS.

• The Persian BBS seems to be a reproducible and standardized clinical instrument for use in community-dwelling elderly population.

• The Persian BBS can be used in geriatrics clinical settings and future outcome researches to assess balance abilities of Iranian older adults.

     

正常人动态平衡能力测试的信度及效度分析

目的　对正常人平衡功能进行动态姿势图重复检测 ,分析各参数间的内在一致性、重测信度及不同测试者间的信度 ;并与Berg平衡量表、功能性前伸测量、起立行走计时测定结果比较 ,检验其效标效度。方法　 2名测试者应用BiodexBalanceSystem (BBS)分别对 40名正常受试者 ( 18～ 67岁 )进行 2次 8级平台稳定性动态姿势图测试及稳定性测试 ;同时还应用Berg平衡量表、功能性前伸距离及起立行走计时等方法进行检测。结果　研究结果发现年龄因素对所有检测参数均有影响 ,体重指数对稳定指数及平均方向控制能力有影响。各参数间内部存在一致性 (r =0 .2 2～ 0 .93 ,均P <0 .0 1) ,其重测信度 (r =0 .70～ 0 .99)及不同测试者间信度 (r =0 .71～ 0 .98)较佳 (ICC =0 .88～ 0 .99)。在测试过程中 ,发现不同跌下次数的受试者其年龄差异和测试结果间差异显著相关 (P <0 .0 0 1)。BBS测试数据与Berg平衡量表、功能性前伸测量、起立行走计时测评结果有较高的相关性 (r =0 .72～ 0 .86)。结论　BBS能反映受试者平衡能力的年龄变化趋势 ,具有较高的内在一致性、重测信度及不同测试者间的信度 ,与Berg平衡量表、起立行走计时及功能性前伸测量结果具有一致性 ,可用于平衡功能的定量评定。     

中文版躯干损伤量表评定脑卒中患者躯干功能的信度及效度研究

目的:探讨中文版躯干损伤量表(TIS)评定脑卒中患者躯干功能的信度及效度,为该量表的临床应用提供客观依据。方法:病例组和对照组各50例参加了本研究,病例组进行TIS、Fugl-Meyer中的平衡部分(FM-B)和Berg平衡量表(BBS)评定,并在2天内完成TIS第二次评定;对照组进行1次的TIS和FM-B评定。将两次TIS的结果做相关性分析测试其信度;将TIS结果与FM-B、BBS作相关性分析检验其效度。结果:TIS两次测试结果高度相关,重测信度组内相关系数(ICC)为0.899-0.971,测量者间ICC为0.843-0.973;TIS与FM-B、BBS总分高度相关(r=0.891,r=0.858);病例组和对照组的TIS总分分别为21.7±1.3分和13.5±4.3分,两者间差异具有显著性(P<0.01)。结论:中文版TIS具有良好的效度、信度和区分度,可用于脑卒中患者躯干功能的评价。     

Treadmill Sideways Gait Training with Visual Blocking for Patients with Brain Lesions

[Purpose] The aim of this study was to verify the effect of sideways treadmill training with and without visual blocking on the balance and gait function of patients with brain lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in this study. They were divided into two groups: an experimental group (12 subjects) and a control group (12 subjects). [Methods] Each group executed a treadmill training session for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the treadmill was performed with visual blocking by the experimental group and with normal vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function. It was used to measure walking speed, walking distance, step length, and stance time on each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were used as balance measures. [Results] The sideways gait training with visual blocking group showed significantly improved walking speed, walking distance, step length, and stance time on each foot after training; FTSST and TUG times also significantly improved after training in the experimental group. Compared to the control group, the experimental group showed significant increases in stance time on each foot. [Conclusion] Sideways gait training on a treadmill with visual blocking performed by patients with brain lesions significantly improved their balance and gait function.Key words: Brain lesions, Treadmill training, Visual block     

Effects of Robot-assisted Gait Training Combined with Functional Electrical Stimulation on Recovery of Locomotor Mobility in Chronic Stroke Patients: A Randomized Controlled Trial

[Purpose] The purpose of the present study was to investigate the effects of robot-assisted gait training combined with functional electrical stimulation on locomotor recovery in patients with chronic stroke. [Subjects] The 20 subjects were randomly assigned into either an experimental group (n = 10) that received a combination of robot-assisted gait training and functional electrical stimulation on the ankle dorsiflexor of the affected side or a control group (n = 10) that received robot-assisted gait training only. [Methods] Both groups received the respective therapies for 30 min/day, 3 days/week for 5 weeks. The outcome was measured using the Modified Motor Assessment Scale (MMAS), Timed Up-and-Go Test (TUG), Berg Balance Scale (BBS), and gait parameters through gait analysis (Vicon 370 motion analysis system, Oxford Metrics Ltd., Oxford, UK). All the variables were measured before and after training. [Results] Step length and maximal knee extension were significantly greater than those before training in the experimental group only. Maximal Knee flexion showed a significant difference between the experimental and control groups. The MMAS, BBS, and TUG scores improved significantly after training compared with before training in both groups. [Conclusion] We suggest that the combination of robot-assisted gait training and functional electrical stimulation encourages patients to actively participate in training because it facilitates locomotor recovery without the risk of adverse effects.Key words: Robot-assisted gait training, Functional electrical stimulation, Chronic stroke     

The reliability,validity and correlation of two observational gait scales assessed by video tape for Chinese subjects with hemiplegia

To test the reliability of the Wisconsin Gait Scale (WGS) and the Gait Abnormality Rating Scale (GARS) for hemiplegic Chinese subjects, as well as to establish the concurrent validity of these two scales with clinical measurements. [Subjects] Twenty hemiplegic stroke subjects were recruited for this study. [Methods] The subjects walked along a 10-meter walkway and their gait was videotaped from 4 directions. Two physical therapists assessed the subjects’ gait using the aforementioned scales by watching the video tape. The Intraclass Correlation Coefficient (ICC) was calculated for the two physiotherapists’ scores for each category and the total scores to assess the reliability. Concurrent validity was tested by comparing the total scores to subjects’ walking speed, the Fugl-Meyer assessment, the Motricity Index of the lower limb, and the Composite Spasticity Index of the lower limb. [Results] The ICC of WGS was 0.961 for intra-rater reliability, and 0.945 for inter-rater reliability. The ICC of GARS was 0.708 for intra-rater reliability and 0.875 for inter-rater reliability. The correlations of the two scales with walking speed, the Fugl-Meyer assessment and the Motricity Index were statistically significant. [Conclusion] Both the Wisconsin Gait Scale and the Gait Abnormality Rating Scale are reliable and valid protocols for measuring the hemiplegic gait of stroke patients.Key words: Reliability, Validity, Observational scales     

The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance

[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients’ dynamic balance ability. [Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared. [Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant. [Conclusion] In conclusion, ramp gait training with PNF improved stroke patients’ dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.Key words: Stroke, Proprioception, Ramp gait     

The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke

OBJECTIVES: To examine test-retest reliability of the Timed Up & Go (TUG) test, its ability to differentiate subjects with chronic stroke from healthy elderly subjects, and its associations with ankle plantarflexor spasticity, ankle muscle strength, gait performance, and distance walked in 6 minutes in subjects with chronic stroke. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center in Hong Kong, China. PARTICIPANTS: Ten healthy elderly subjects and 11 subjects with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time taken to complete the TUG test was recorded. Plantarflexor spasticity and ankle muscle strength were assessed, respectively, by the Composite Spasticity Scale and a load-cell together with electromyography. Gait parameters and walking endurance were measured respectively by walkway system (GAITRite II) and 6-minute walk test. Intraclass correlation coefficients (ICCs) were calculated as measures of reliability, and all correlation analyses were conducted using Spearman correlation coefficients. RESULTS: The TUG test showed excellent reliability (ICC>.95). Subjects with chronic stroke had significantly more spastic and weaker plantarflexors, slower walking speeds, and poorer walking endurance when compared with healthy elderly subjects (all P<.003). The strength of the affected ankle plantarflexors (rho=-.860, P<.01), gait parameters (rho range, .620-.900; P<.05), and walking endurance (rho=-.960, P<.01) correlated with TUG scores. CONCLUSIONS: The TUG scores were reliable, were able to differentiate the patients from the healthy elderly subjects, and correlated well with plantarflexor strength, gait performance, and walking endurance in subjects with chronic stroke.     

Translation and validation of the Swedish version of the mini-BESTest in subjects with Parkinson's disease or stroke: A pilot study

Recently, a comprehensive clinical balance test, the balance evaluation systems test (BESTest), was developed to identify the postural control systems causing balance impairments. A short version, the mini-BESTest, was thereafter developed by eliminating redundant and insensitive items. This study aimed to translate the mini-BESTest to Swedish, adapt it and investigate its validity in subjects with Parkinson's disease (PD) or stroke. The Mini-BESTest was translated and back-translated in accordance with Guillemin's guidelines. Discrepancies were discussed and solved by a panel and the test was culturally adapted. Concurrent validity of the final version was explored by correlating well-known clinical tests - the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES(s)) - with the new mini-BESTest in nine subjects with mild-to-moderate PD (60 years, range 46-85) and nine with chronic stroke (78 years, range 66-90). A high-to-very-high correlation was shown between the mini-BESTest and the BBS (PD: r(s)?=?0.94, stroke: r(s)?=?0.86). The mini-BESTest correlated highly with the TUG (PD: r(s)?=?-0.81, stroke: r(s)?=?-0.89). In the PD group, a low correlation (r(s)?=?0.26) was seen between the mini-BESTest and the FES(s). The mini-BESTest has high concurrent validity and is a comprehensive assessment of balance. However, its psychometric properties should be evaluated further.