Validation of the Wii Balance Board to assess balance modifications induced by increased respiratory loads in healthy subjects

BackgroundThere is a link between breathing and balance and posture. When the inspiratory loads are increased by pathologies, there is a decrease of postural control. The increase of the inspiratory load on respiratory muscles is a common feature in various chronic pulmonary pathologies. Consequently, the balance of those patients is likely affected.Research questionThe aim of this study is to validate the use of the Nintendo Wii Balance Board (WBB) to assess balance modifications induced by increased respiratory loads in healthy subjects.MethodsThirty-seven healthy young participants (25 ± 4 years old, 17 women) participated in this study. Five different conditions were tested: without anything (control), throughout a mouthpiece, and throughout three inspiratory threshold loads (ITL) at 10% (low), 40% (mid) and 60% (high) of the maximal inspiratory pressure. Each trial lasted for 60 s. Nine parameters were extracted based on center of pressure displacement based on a previously-validated method. ANOVA tests were used to compare the different conditions followed by Bonferroni’s corrections.ResultsHighly statistically significant differences (all p < 0.01) and large effect sizes (all ω² > 0.24) were obtained for all parameters between the different loads and the mouthpiece condition. There is a linear relationship between the load and balance perturbation.SignificanceIn this study, we demonstrated the validity of the WBB to detect the effect of the inspiratory load on balance in young healthy subjects. Further studies are needed to determine if such a kind of evaluation can be used in clinics with patients suffering from chronic respiratory disease.     

Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards

Weight bearing asymmetry (WBA) during dynamic tasks is prevalent in a variety of clinical populations. However, accurate measurement has previously been out of reach of the clinician due to the costly equipment and technical expertise required. The aim of this study was to assess the test-retest reliability of WBA data obtained using an inexpensive and simple to use dual force plate system incorporating unmodified Nintendo Wii Balance Boards (NWBB) and customized software. A secondary outcome measure, individual limb COP path velocity, which represents the postural sway under each limb was also examined. Twenty-three participants performed squats both with and without visual WBA feedback on two separate occasions. Weight-bearing asymmetry as a percentage of body mass and individual limb center of pressure (COP) path velocity were recorded during these trials, with intraclass correlation coefficient (ICC_2,1) analysis performed to assess test-retest reliability. This system provided reliable values for both outcome measures when performed with and without real-time visual feedback of WBA (ICC_2,1 range = 0.75-0.91). In conclusion, recording WBA and COP path velocity data using NWBB is reliable. Given that tens of millions of NWBB have been sold worldwide, and that reprogramming them for clinical purposes is within the reach of most software developers, similar systems may soon become commonplace in the clinical setting.     

Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance

Impaired standing balance has a detrimental effect on a person's functional ability and increases their risk of falling. There is currently no validated system which can precisely quantify center of pressure (COP), an important component of standing balance, while being inexpensive, portable and widely available. The Wii Balance Board (WBB) fits these criteria, and we examined its validity in comparison with the ‘gold standard’—a laboratory-grade force platform (FP). Thirty subjects without lower limb pathology performed a combination of single and double leg standing balance tests with eyes open or closed on two separate occasions. Data from the WBB were acquired using a laptop computer. The test–retest reliability for COP path length for each of the testing devices, including a comparison of the WBB and FP data, was examined using intraclass correlation coefficients (ICC), Bland–Altman plots (BAP) and minimum detectable change (MDC). Both devices exhibited good to excellent COP path length test–retest reliability within-device (ICC = 0.66–0.94) and between-device (ICC = 0.77–0.89) on all testing protocols. Examination of the BAP revealed no relationship between the difference and the mean in any test, however the MDC values for the WBB did exceed those of the FP in three of the four tests. These findings suggest that the WBB is a valid tool for assessing standing balance. Given that the WBB is portable, widely available and a fraction of the cost of a FP, it could provide the average clinician with a standing balance assessment tool suitable for the clinical setting.     

The construct and concurrent validity of brief standing sway assessments in children with and without cerebral palsy

BackgroundStanding postural sway is often quantified from center of pressure trajectories. During assessments of longer durations, children may fidget, thus limiting the feasibility and validity of sway recordings.Research questionDo postural sway sample durations less than 30 s maintain construct and concurrent validity?MethodsIn this case-control, observational study, we measured postural sway in 41 children (age 5–12 years, 23 typically developing (TD); 18 with spastic cerebral palsy (CP), 13 diplegic and 5 hemiplegic, 11 GMFCS level I and 7 level II) for 30-second eyes-opened and eyes-closed conditions. From a single recording, 5-second incremental durations of 5−30 s were considered in this analysis. We quantified anteroposterior, mediolateral, and transverse-plane sway using seven time-domain variables: root-mean-square error, total excursion, mean frequency, mean distance, sway area, and 95 % confidence circle and ellipse areas. Variables were calculated in eyes-opened and eyes-closed conditions, as well as the ratio of the two. Construct validity was evaluated by the persistence of large effect sizes (Glass’s Δ ≥ 0.80) between CP and TD participants at shorter durations than 30 s. Concurrent validity was evaluated by the correlations of shorter duration measures to the 30 s measure.ResultsSeven sway measures had large between-group effects (Glass’s Δ ≥ 1.02) for the 30 s measure that persisted (Glass’s Δ ≥ 0.81) at shorter durations (5−25 s) and also maintained concurrent validity (r ≥ 0.83). Six of these seven measures were taken in the eyes-closed condition, and all seven measures were in the mediolateral direction or transverse plane.SignificanceOur analysis suggests that sway durations less than 30 s can uphold construct and concurrent validity. These measures were primarily in the eyes-closed conditions and mediolateral direction. These results are a promising indicator that shorter-duration sway measures may be of utility when fidgeting prevents longer recordings.     

Postural control measured as the center of pressure excursion in young female gymnasts with low back pain or lower extremity injury

Gymnasts are known to practice and compete although suffering from injuries and pain. Pain may change strategies for postural control. The primary aim of the present study was to investigate how center of pressure (COP) measurements are influenced by low back pain and lower extremity injury in top-level female gymnasts. A secondary aim was to study the reliability of these measurements using a test-retest design, and how this depends on the duration of the test. Fifty-seven top-level gymnasts were included in four groups: non-injured (NI, n=18), low back pain (LBP, n=11), lower extremity injury (LEI, n=17) and a multiple injury group (MI, n=11). COP excursion during quiet stance was measured on a force platform, during 120s: (1) hard surface/eyes open, (2) hard surface/eyes closed, (3) foam surface/eyes open and (4) foam surface/eyes closed. The COP excursion increased, for all groups, during the foam surface/eyes closed measurement compared to the other three tests. Furthermore, the LBP group showed a 49% (p=0.01) larger COP area compared to the LEI group in the foam surface/eyes closed condition. Measurements on foam surface were in general more reliable than tests on hard surface and tests with eyes closed were more reliable than tests with eyes open. Tests during 120s were in most cases more reliable than tests during 60s. In conclusion the COP excursion is influenced by injury location. Quiet stance measurements on foam surface with eyes closed seems to be reliable and sensitive in young female gymnasts.     

Reliability and validity of the Turkish version of Fullerton Advanced Balance Scale in cerebral palsy

BackgroundThe Fullerton Advanced Balance Scale (FAB) is a multi-item balance assessment test designed to measure balance in relatively higher functioning individuals. The aim of this study was to examine the reliability and validity of the Turkish version of the FAB (FAB-T) in children with cerebral palsy (CP).Research questionIs the Turkish version of the Fullerton Advance Balance Scale valid and reliable in determining balance problems in children with cerebral palsy and determining the underlying cause of this condition?MethodsForty-six children with CP participated in this study. Rasch analysis was used to investigate item adherence. Internal consistency of the FAB-T was established using Cronbach's alpha coefficient. Test-retest reliability was also evaluated. In addition, to assess concurrent validity, FAB-T scores were compared with the Pediatric Balance Scale (PBS) using the Spearman correlation coefficient.ResultsThe FAB-T showed satisfactory internal consistency (Cronbach's alpha value=0.94) and excellent test-retest reliability (ICC=0.99). The FAB and the PBS exhibited concurrent positive validity (r = 0.913; p < 0.001). All items of the FAB-T were found to fit the Rasch Model (Chi-square 16.01(df=20), p = 0.716).SignificanceThe FAB-T is a reliable and valid tool that can be used to measure balance skills and to identify the source of the problem in children with CP.     

Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis

BackgroundAlthough it is recognized that the majority of children with developmental coordination disorder (DCD) have balance deficits, comprehensive insights into which balance domains are affected, are still lacking in literature.Research questionTo what extent is balance control deficient in individuals with DCD compared to controls?MethodsPubmed, Scopus and Web of Science were systematically searched. Risk of bias was assessed with the Scottish Intercollegiate Guidelines Network checklist for case-control studies. Mean and standard deviations characterizing balance control were extracted to calculate standardized mean differences (SMD) and pooled, if possible, using Review Manager.ResultsThe results of 31 studies (1152 individuals with DCD, 1103 typically developing (TD) peers, mean age 10.4 years old) were extracted of which 17 were used for meta-analysis. The mean SMD for the balance subscale of the Movement Assessment Battery for Children was 1.63 (pooled 95 %CI =[1.30;1.97]), indicating children with DCD to perform significantly poorer than their TD peers. Force plate studies also revealed that children with DCD present with a larger sway path during bipedal stance with eyes closed (pooled mean SMD = 0.55; 95 %CI=[0.32;0.78]). Children with DCD tend to have direction-specific limited stability limits and task-independent delayed onset of anticipatory postural adjustments.InterpretationChildren with DCD perform poorer on different domains of balance compared to TD peers. Future research should focus on comprehensive balance assessment in these children, preferably using a longitudinal design.     

Validation of the stabilometer balance test: Bridging the gap between clinical and research based balance control assessments for stroke patients

BackgroundA pronounced discrepancy exists between balance assessments for stroke survivors that are used for clinical purposes and those used for research. Clinical assessments like the Berg Balance Scale generally have stronger ecological validity, whereas research-based assessments like posturography are generally more reliable and precise. We developed a stabilometer balance test (SBT) that aims to couple measurement reliability and precision to clinical meaningfulness by means of a personalized and adaptive test procedure.Research questionTo examine the validity, reliability, and measurement error of the stabilometer balance test in inpatient stroke patients.MethodsIn this cross-sectional study, inpatient stroke patients (FAC > 2) were tested on a stabilometer with adjustable resistance to mediolateral movement. A modified staircase procedure was used to adapt task difficulty (i.e., rotational stiffness) on a trial-by-trial basis. The main outcome was the threshold stiffness at which a patient could just stay balanced. Threshold stiffness was correlated with the Berg Balance Scale and posturography measurements to determine concurrent validity (N = 86). Test-retest reliability (N = 23) was analyzed with the Intraclass Correlation Coefficient (ICC). Floor and ceiling effects were assessed. The minimal detectable change was determined at individual and group level.ResultsThreshold rotational stiffness moderately correlated with the Berg Balance Scale (r=−0.559, p < 0.001), and the absolute path length of the center of pressure during posturography (r=0.348, p = 0.006). Test-retest reliability was good to excellent (ICC=0.869; 95%CI=0.696–0.944). There were no floor or ceiling effects. The minimal detectable change was sufficiently small to detect relevant changes in balance control both on individual and group level.RelevanceThe SBT is both a valid and reliable balance assessment in stroke patients. It is at least as precise as current clinically preferred measures and does not suffer from ceiling effects. Therefore, it is suitable for use in clinical practice as well as research.     

Reproducibility of the Balance Evaluation Systems Test (BESTest) and the Mini-BESTest in school-aged children

This study evaluated the intra-rater, inter-rater and test-retest reproducibility of the Full-BESTest and Mini-BESTest when assessing postural control in children. Thirty-four children aged 7–17 years participated in intra-rater and inter-rater evaluation, and 22 children repeated assessment six weeks later for evaluation of test-retest reliability. Postural control was assessed using the Full Balance Evaluation Systems Test (Full-BESTest) and the short-form Mini-BESTest. Intra-rater, inter-rater and test-retest reproducibility were examined using video assessment. Test-retest reproducibility was also assessed in real-time. Reproducibility was examined by agreement and reliability statistics. Agreement was calculated using percentage of agreement, Limits of Agreement and Smallest Detectable Change. Reliability was calculated using Intra-class Correlation Coefficients. Results showed that the reliability of Total Scores was excellent for the Full-BESTest for all conditions (all ICCs > 0.82), whereas the Mini-BESTest ranged from fair to excellent (ICC = 0.56–0.86). Percentage of Domain Scores with good-excellent reliability (ICCs > 0.60) was slightly higher for the Full-BESTest (66%) compared to the Mini-BESTest (59%). Smallest Detectable Change scores were good to excellent for the Full-BESTest (2%–6%) and for the Mini-BESTest (5%–10%) relative to total test scores. Both the Full-BESTest and Mini-BESTest can discriminate postural control abilities within and between days in school-aged children. The Full-BESTest has slightly better reproducibility and a broader range of items, which could be the most useful version for treatment planning. We propose minor modifications to improve reproducibility for children, and indicate the modified version by the title Kids-BESTest. Future psychometric research is recommended for specific paediatric clinical populations.     

Interrater reliability of the cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain

ObjectiveExamine the interrater reliability of cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain.DesignSingle-group repeated-measures design for interrater reliability.SettingOrthopaedic physical therapy clinics.ParticipantsTwenty-one patients with a primary complaint of shoulder pain underwent a standardized examination by a physical therapist (PT). A PT conducted the first examination and one of two additional PTs conducted the 2nd examination.Main outcome measuresThe Cohen κ and weighted κ were used to calculate the interrater reliability of ordinal level data. Intraclass correlation coefficients model 2,1 (ICC2,1) and the 95% confidence intervals were calculated to determine the interrater reliability.ResultsThe kappa coefficients ranged from −.24 to .83 for the mobility assessment of the glenohumeral, acromioclavicular and sternoclavicular joints. The kappa coefficients ranged from −.20 to .58 for joint mobility assessment of the cervical and thoracic spine. The kappa coefficients ranged from .23 to 1.0 for special tests of the shoulder and cervical spine.ConclusionsThe present study reported the reliability of a comprehensive upper quarter physical examination for a group of patients with a primary report of shoulder pain. The reliability varied considerably for the cervical and shoulder examination and was significantly higher for the examination of muscle length and cervical range of motion.     

Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans

Background: Balance challenges are associated with not only the aging process but also a wide variety of psychiatric and neurological disorders. However, relatively little is known regarding the neural basis of balance and the effects of balance interventions on the brain.Research question: This review synthesizes the existing literature to answer the question: What are the key brain structures associated with balance?Methods: This review examined 37 studies that assessed brain structures in relation to balance assessment or intervention. These studies provided 234 findings implicating 71 brain structures. The frequency of implication for each structure was examined based upon specific methodological parameters, including study design (assessment/intervention), type of balance measured (static/dynamic), population (clinical/non-clinical), and imaging analysis technique (region of interest [ROI]/voxel-based morphometry [VBM]).Results: Although a number of structures were associated with balance across the brain, the most frequently implicated structures included the cerebellum, basal ganglia, thalamus, hippocampus, inferior parietal cortex, and frontal lobe regions. Findings in the cerebellum and brainstem were most common in studies with clinical populations, studies that used an ROI approach, and studies that measured dynamic balance. Findings in the frontal, occipital, and parietal regions were also more common in studies that measured dynamic compared to static balance.Significance: While balance appears to be a whole-brain phenomenon, a subset of structures appear to play a key role in balance and are likely implicated in balance disorders. Some of these structures (i.e., the cerebellum, basal ganglia and thalamus) have a well-appreciated role in balance, whereas other regions (i.e., hippocampus and inferior parietal cortex) are not commonly thought to be associated with balance and therefore may provide alternative explanations for the neural basis of balance. Key avenues for future research include understanding the roles of all regions involved in balance across the lifespan and in different clinical populations.     

Validity and reliability of the Dynamic Gait Index in children with hemiplegic cerebral palsy

BackgroundDynamic Gait Index (DGI) is a performance-based tool can be applied in a short time and evaluates dynamic balance and gait ability.Research questionIs the DGI valid and reliable for assessing gait and balance disorders in children with hemiplegic cerebral palsy (CP)?MethodsSixteen children with hemiplegic CP (5 females, 11 males; mean age 10y 3mo, SD 2y 7mo; range 6–14y; Gross Motor Function Classification System (GMFCS) levels I [n = 9], II [n = 7]) and 16 age-matched typically developing (TD) (8 females, 8 males; mean age 9y 9mo, SD 2y 6mo; range 6–14y) participated. The relationship between the DGI, Four-Square Step Test (FSST), Timed Up and Go Test (TUG) and Pediatric Berg Balance Scale (PBS) was analyzed. To determine the test-retest reliability, the DGI was performed twice and; for the inter-rater reliability, only DGI was reapplied by a different rater on the same day. Internal consistency was obtained by Cronbach-α value. Validity was tested by Spearman correlation coefficient and reliability was calculated by Intraclass correlation coefficient (ICC).ResultsThere was a significant difference between hemiplegic CP and TD and between the children with GMFCS level I and II in the comparison of results of the DGI and other tests. All items on the DGI had appropriate internal consistency (Cronbach-α = 0.969). The test-retest (ICC = 0.970 CI(0.915- 0.990)) and inter-rater (ICC = 0.983 CI(0.882- 0.998)) reliabilities were found to be excellent. A negative, moderate correlation between FSST and DGI (rs = −0.673, p = 0.004); a positive, high correlation between PBS (rs = 0.724, p = 0.002) and DGI and a negative, high correlation between TUG and DGI (rs = −0.828, p < 0.001) was detected.SignificanceDGI with features such as its feasibility in a short time, being simple but distinctive and not requiring heavy equipment is a valid and reliable method in children with hemiplegic CP.     

干部亚健康状态评价量表的编制与信效度检验

目的研制符合工作特点且能较准确评价干部亚健康状态评价量表。方法根据量表设计原理,运用文献研究和专家咨询的方法,结合工作特点和文化背景,通过亚健康概念的确定、问题与答案的产生、卷首语、填写说明的确定、量表编码、预调查、信度和效度检验以及修订过程,设计评价量表。结果经过核心组的多次讨论和几轮Delphi专家咨询,形成一个条目池,包括由工作特点决定的生理功能削弱的生理亚健康状态、情绪情感困扰的心理亚健康状态、社会适应能力下降的社会交往亚健康状态3个方面,躯体状况（躯体不适）、精力状况（精力不足）、情志状况（情绪失调、情志不畅）、外界交流协调状况（待人处事、环境适应能力下降）4个维度,50个问题条目,以自填与封闭式为主的调查评价量表。结论量表的研制,能够在一定程度上对干部的健康状态作出判断,为干部亚健康状态的研究提供方法和应用工具。     

Model-based assessments of the effects of age and ankle fatigue on the control of upright posture in humans

The aim of this study was to investigate how and why age and localized muscle fatigue affect postural control using model-based simulations. A balance control model, based on an optimal control strategy, was used to simulate trials of quiet upright stance both pre-fatigue and following induced ankle plantarflexor fatigue. Empirical data were obtained from an earlier study that included both younger and older participants. Effects of age and ankle fatigue were determined from center-of-pressure (COP) measures and fitted model parameters. Though some discrepancies existed, the simulated effects of age and ankle fatigue were consistent with experimental findings in terms of trends in COP-based measures with age and ankle fatigue. Changes in both COP-based measures and model parameters were used to infer potential underlying causal mechanisms for the observed effects of age and ankle fatigue. For example, the model-based simulations indicated that sensory delay time increased with age and ankle fatigue by 31.1% and 2.9%, respectively, suggesting a potentially important role for such delay in postural control and fall risks.     

Reproducibility and discriminant validity of the Posterior Shoulder Endurance Test in healthy and painful populations

ObjectiveThis investigation measured the reproducibility and discriminant validity of the Posterior Shoulder Endurance Test (PSET) on painful and non-painful populations.DesignReliability and validity study.SettingLaboratory setting.ParticipantsThirty subjects (male = 11; female = 19).Main outcome measuresTime to failure (TTF) was the primary outcome measure to determine reliability of the PSET. Discriminant validity identified with receiver operator characteristic (ROC) curves utilized TTF separately in men and women since they used different loads.ResultsThere were 25/30 subjects (painful = 12; non-painful = 13) tested a second time. ICC, SEM, and MDC90 ranged respectively from 0.77, 13.1 s, 30.6 s in the painful group to 0.85, 7.3 s, 17 s in the non-painful group. The male ROC curve AUC was 0.833 with 47 s resulting in the best combination of sensitivity = 0.833, and specificity = 0.80. The female ROC curve AUC was 0.633 with 46 s resulting in the best combination of sensitivity = 0.600 and specificity = 0.889 at 46 s.ConclusionThe PSET is a reliable way to measure shoulder girdle muscular endurance. These data suggest that the PSET discriminates painful and non-painful individuals better in men compared to women.     

The validity of the sphygmomanometer for shoulder strength assessment in amateur rugby union players

ObjectivesTo determine the concurrent validity of a sphygmomanometer for assessing shoulder strength in the I, Y and T positions during the athletic shoulder test (ASH test). Force platforms were used as the gold standard measurement tool for this purpose.DesignShoulder strength was assessed using force platforms and a sphygmomanometer, both placed on the floor and the participant positioned prone. One rater assessed strength, taking three measurements in each of the I, Y and T positions, using the sphygmomanometer and force platforms. Concurrent validity was calculated using the force platforms as the gold standard device.SettingData was collected within the treatment room of an amateur rugby club.ParticipantsTwenty male amateur rugby players (25.15 years old ± 3.27 years) were recruited for this study.Main outcome measuresPeak force across the shoulder girdle was assessed using the force platforms and sphygmomanometer which provided values in Newtons (N) and millimetres of mercury (mmHg) respectively.ResultsResults showed high concurrent validity (Pearsons r = 0.76–0.81) between the sphygmomanometer and the force platform. Coefficient of determination (r² = 0.59–0.67) showed the sphygmomanometer to have a valid predictive model in the I, Y and T positions.ConclusionsThe sphygmomanometer is suitable for monitoring force transfer across the shoulder during the ASH test, and is able to quantify peak force in mmHg. The sphygmomanometer enables coaches and clinicians to accurately quantify force production across the shoulder girdle in order to screen and monitor players at a low cost.     

Effectiveness of interactive computer play on balance and postural control for children with cerebral palsy: A systematic review

BackgroundInteractive computer play (ICP) becomes popular in rehabilitation for children with cerebral palsy (CP). With the nature of ICP, it could be an effective intervention specifically to improve balance and postural control for children with CP. The present paper aimed to review the effectiveness of ICP on postural control and balance for children with CP.MethodsElectronic databases including Medline, AMED, EBSCOhost, PsycINFO, Embase, the Cochrane Library and the DARE were searched up to September 2018. Studies were included if (1) participants were aged under 18 and had CP, (2) ICP intervention was performed, (3) an explicit objective was postural control and balance of the participants, and (4) results were fully published in English-language peer-reviewed journals. Characteristics of study participants, ICP protocols and study results were extracted. Level of evidence of each studies was graded using the guidelines from the American Academy of Cerebral Palsy and Developmental Medicine. Methodological quality was graded using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes were calculated on available data.ResultsTwenty studies were included, with nine of level I or II evidence. Most studies had fair methodological rigor. Huge variations in the study designs and protocols of ICP were found among the studies.ConclusionsICP seemed to be more effective than conventional therapy in improving postural control and balance, with medium to large effect sizes for children with mild to moderate severity of CP. Future studies of high methodological rigour are required to verify the role of on-site guidance of the children during ICP and the effect on children with more severe CP.     

Advanced characterization of static postural control dysfunction in persons with multiple sclerosis and associated neural mechanisms

BackgroundMultiple sclerosis (MS) is an autoimmune-based chronic inflammatory disease characterized by the neurodegeneration of the central nervous system and produces postural dysfunction. Quiet or static standing is a complex task carried out through afferent sensory inputs and efferent postural corrective outputs. Currently the mechanisms underlying these outputs remain largely unknown.Research questionAssess the relationship between multi-dimensional measures of postural control and microstructural integrity of the cortical sensorimotor pathway (CSP) in persons with MS (PwMS) and neurotypical adults.MethodsPostural control performance was assessed by both overall and directional time-to-boundary measures across four manipulated sensory stance conditions (eyes open/closed; stance firm/foam) in twenty-nine neurotypical and twenty-seven PwMS. These postural outcomes were evaluated with mixed-model repeated measures analysis of variance across group (MS and control) and stance condition. Postural performance was also correlated with magnetic resonance imaging diffusion tensor-derived measures of microstructural integrity of the CSP.ResultsPwMS displayed significantly (p = 0.026) worse anterior-posterior postural control compared to their neurotypical counterparts across sensory testing conditions and poorer CSP microstructural integrity in comparison to neurotypical adults (p = 0.008). Additionally, PwMS displayed a significant association (2D (rho = -0.384, p = 0.048), AP (rho = -0.355, p = 0.035), and ML (rho = -0.365, p = 0.030) between integrity of the CSP and postural control performance during proprioceptive-based balance, such that those with worse cortical structure had poorer balance control.SignificanceThis is the first study to establish connections between the microstructural integrity of the CSP and multi-dimensional postural control performance. Results indicate that a reduction in the CSP microstructural integrity is associated with poorer postural control in PwMS. These outcomes identify neural underpinnings of postural control dysfunction in PwMS and provide new avenues for evaluating the efficacy of postural rehabilitation strategies in PwMS that express proprioceptive-based postural deficits.     

Intra-rater reliability,inter-rater reliability and minimal detectable change of the posterior shoulder endurance test in elite athletes

ObjectiveInvestigate intra-rater and inter-rater reliability of the posterior shoulder endurance test (PSET) and calculate minimal detectable change (MDC) to establish measurement properties and inform use of the PSET in practice.Study designTest-retest reliability. Setting: British Canoe Slalom National Training Centre.ParticipantsTwelve participants (7 male, 5 female; 22.5 ± 4.48 years; 73.4 ± 6.36 kg) were investigated by two physiotherapists with >10 years’ experience.Main outcome measureIntraclass correlation coefficients (ICC) were calculated for intra-rater reliability (ICC 3,1) and inter-rater reliability (ICC 2,1) and used to calculate MDC.ResultsIntra-rater reliability scores were 0.84 and 0.85 for rater A and B, respectively, with 95% confidence interval (CI) crossing moderate to excellent reliability for both raters (0.5–0.75 and > 0.9). Inter-rater reliability scores were 0.74 and 0.63 at baseline and follow-up, respectively, with 95% CI crossing poor to good reliability in both time points (<0.5 and >0.75). MDC95% for intra-rater scores was 6 repetitions, MDC95% for inter-rater scores was 8 repetitions at baseline and 9 repetitions at follow-up.ConclusionThe PSET has acceptable intra-rater reliability but further work is needed to narrow the CI to an appropriate level for inter-rater reliability. The MDC calculated helps clinicians interpret changes in tests scores.     

Calculations of mechanisms for balance control during narrow and single-leg standing in fit older adults: A reliability study

For older people balance control in standing is critical for performance of activities of daily living without falling. The aims were to investigate reliability of quantification of the usage of the two balance mechanisms M₁ ‘moving the centre of pressure’ and M₂ ‘segment acceleration’ and also to compare calculation methods based on a combination of kinetic (K) and kinematic (Km) data, (K–Km), or Km data only concerning M₂. For this purpose nine physically fit persons aged 70–78 years were tested in narrow and single-leg standing. Data were collected by a 7-camera motion capture system and two force plates. Repeated measure ANOVA and Tukey's post hoc tests were used to detect differences between the standing tasks. Reliability was estimated by ICCs, standard error of measurement including its 95% CI, and minimal detectable change, whereas Pearson's correlation coefficient was used to investigate agreement between the two calculation methods. The results indicated that for the tasks investigated, M₁ and M₂ can be measured with acceptable inter- and intrasession reliability, and that both Km and K–Km based calculations may be useful for M₂, although Km data may give slightly lower values. The proportional M₁:M₂ usage was approximately 9:1, in both anterio-posterior (AP) and medio-lateral (ML) directions for narrow standing, and about 2:1 in the AP and of 1:2 in the ML direction in single-leg standing, respectively. In conclusion, the tested measurements and calculations appear to constitute a reliable way of quantifying one important aspect of balance capacity in fit older people.