Effect of eye movements on dynamic equilibrium

The purpose of this study was to determine whether visual improvement of balance varies depending on the movement of the eye. Three movements were compared: static visual fixations, saccadic eye movements, and smooth pursuit eye movements. The subjects in this study were 35 healthy female volunteers. Balance was defined as the subjects' ability to maintain their equilibrium while keeping the unstable platform on which they stood within 5 degrees of the horizontal plane. The testing protocol consisted of five recorded practice trials, during which the subjects tried to maintain their balance without any visual instructions, and nine experimental trials, during which they tried to maintain their balance while visually following a videotaped target light projected onto a screen. The target light was sequenced randomly to remain stationary, move in a continuous horizontal path, or alternately jump between right and left. Data were analyzed using a one-way multivariate analysis of variance for repeated measures. A significant effect of vision on balance was found. The t tests for correlated samples revealed that time in balance during visual fixations and saccades was significantly longer than during tracking eye movements. We, therefore, concluded that tracking eye movements have a negative effect on balance. This information can be useful in treating patients with balance problems. For example, instructing patients to fixate visually on an object may aid their stability. Visual tracking of a moving limb, however, may impair a patient's stability.     

Interobserver reproducibility of the Berg Balance Scale by novice and experienced physiotherapists

This study aimed to assess the interobserver reliability of the Brazilian–Portuguese version of the Berg Balance Scale (BBS), which consists of 14 items that evaluate body balance during daily activities. The assessment was made by physiotherapists with extensive or little clinical experience in noninstitutionalized elderly individuals. Participants comprised 12 elderly subjects (10 women and 2 men) with mean ages of 75.8±8.4 years (range=63–87) and 18 physiotherapists with varying clinical experience. Interexaminer reliability obtained for each scale item yielded weighted kappa value >0.75 in 11 of the 14 items (varying from 0.37 to 1.0). The intraclass correlation coefficient (ICC) for the total sum of BBS scores between the two groups of physiotherapists was 0.996 (95% confidence interval, 0.987–0.999) with a Cronbach alpha coefficient of 0.996. We found no statistically significant difference between the rater groups when we compared the sum score means obtained with Student's t-test (p=0.86). Although some items had low reliability values, in general our results suggest that the Brazilian–Portuguese version of the BBS showed acceptable levels of interrater reliability and agreement when used by physiotherapists with different clinical practice levels and without previous training on noninstitutionalized elderly patients.     

Development of a framework for the evidence-based choice of outcome measures in neurological physiotherapy

BACKGROUND: Neurological physiotherapists recognize the need to include standardized outcome measures (OMs) in clinical practice but lack of information about the OMs available hampers utilization. This paper reports on the first stage of a project to identify the most robust OMs for use in neurological physiotherapy. OBJECTIVE: To identify what physiotherapists perceive that they need to measure during a neurological assessment. METHODS: Three separate workshops were held using patient vignettes to represent the acute, rehabilitation and community settings. Thirty senior neurological physiotherapists participated and were asked: 'What would you observe, test or measure if assessing this patient?' Data were analysed using thematic content analysis performed independently by each of the authors. Internal and external member checking ensured validity. In addition, the authors produced definitions of the items and domains identified in the data collection and subsequent content analysis. RESULTS: Items from the data collection were classified into 16 domains that physiotherapists need to measure: Weakness; range of movement/contracture; pain; muscle tone/spasticity; sensation; ataxia/co-ordination; personal fatigue; oedema; subluxation; postural and balance impairment; walking impairment; upper limb; balance disability; walking disability; mobility disability and falls. CONCLUSIONS: The domains that physiotherapists need to measure during clinical assessment were identified. In the second stage of the project these domains will inform systematic reviews to identify the most robust outcome measures for use in clinical practice.     

Balance problems after unilateral lateral ankle sprains

Abstract-Ankle ligament injury is the most common injury in athletic activities. This study examined balance problems in athletes with acute lateral ankle sprains. Thirty male athletes aged 20 to 35 years with right dominant side and traumatic ankle sprain were recruited through simple nonprobability sampling. We measured the sway index and limits of stability with the Biodex Balance System under different conditions. Functional balance was evaluated with two clinical tests: the Functional Reach Test and the Star-Excursion Balance Test. The results showed that balance ability in patients with acute lateral ankle sprain was significantly weaker under closed- versus open-eye conditions. Symmetry of weight-bearing on involved and sound limb in bilateral standing was not significantly different, but weight-bearing on the nondominant limb was significantly higher than on the dominant limb. We can conclude that balance problems occur after acute ankle sprains because of proprioception deficits and that the unconscious (reflexive) aspect of proprioception is more severely affected than the conscious (voluntary) aspect.     

What is balance?

Balance is a term frequently used by health professionals working in a wide variety of clinical specialities. There is no universally accepted definition of human balance, or related terms. This article identifies mechanical definitions of balance and introduces clinical definitions of balance and postural control. Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity. Postural control strategies may be either predictive or reactive, and may involve either a fixed-support or a change-in-support response. Clinical tests of balance assess different components of balance ability. Health professionals should select clinical assessments based on a sound knowledge and understanding of the classification of balance and postural control strategies.     

The difficult patient in private practice physiotherapy: a qualitative study

This qualitative study utilised the nominal group technique to identify a typology of the difficult patient in private practice physiotherapy and to determine strategies physiotherapists use, and would like to improve, when dealing with such patients. The two areas physiotherapists found most difficult to manage were behavioural problems of patients and patient expectations. Few differences were evident regarding ranking of difficult patient attributes between the experienced (n = 19) and less experienced (n = 18) physiotherapists except for the categories of pain and diagnosed psychological problems. While less experienced physiotherapists ranked the pain category highly, experienced physiotherapists did not identify this category. Further, more experienced physiotherapists specifically distinguished between patients with diagnosed psychological problems and patients with psychosocial concerns, while less experienced physiotherapists did not, and placed both these issues into one category. To assist in their interaction with difficult patients, physiotherapists (n = 37) identified that communication skills and behaviour modification techniques were strategies that they would like to learn more about. The results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy.     

A clinical model for the assessment of posture and balance in people with stroke

Purpose : The lack of models to define and describe rehabilitation processes have often been identified as limiting research and the development of clinical practice. This study describes the development of a clinical model to address a key aspect of stroke physiotherapy--the assessment of posture and balance.

Method : Twenty seven experienced neurological physiotherapists (PT) in six focus groups were used. Participants were shown photographs of a typical stroke patient in sitting and standing positions and were asked 'What would you note if you were assessing the posture and balance of this patient?' Answers were displayed on flip charts to allow immediate feedback about the accuracy and completeness of data. Thematic content analysis was then used.

Results : A complex reasoning process emerged to answer three main questions: What can the patient do? How does s/he do it? Why does s/he do it that way? To answer these questions physiotherapists established balance disability (by observing the patient's ability to perform a series of increasingly demanding balance tasks), identified postural and movement impairments (by observing alignment and movement of body segments relative to each other and to the expected norm for that patient) and assessed muscle activity (by observation and palpation).

Conclusions : Focus groups have been used to elicit a clinical model for the assessment of posture and balance, the content of which will be used to inform a new outcome measure.     

Professional roles in physiotherapy practice: Educating for self-management,relational matching,and coaching for everyday life

The patient’s active participation in treatment and rehabilitation represents a cultural change in clinical practice as well as a major change in physiotherapist and patient roles. This article presents findings from a study aimed at gaining a better understanding of how physiotherapists in actual practice understand their interactions with patients during the treatment process. This article reports on the findings from focus-group interviews with physiotherapists working in three different settings. Analyses of the interview data identified three modes of physiotherapy practice. In one, physiotherapists educate their patients to be self-managing in conducting exercise programs based on sound evidence. Educational films available on the Internet are included in these efforts to teach patients. In another, physiotherapists emphasize the importance of a close relationship to the patient. A good personal chemistry is believed to improve the treatment process. And finally, what physiotherapists learn about the living conditions and the biographies of their patients was shown to be very important. Understanding the importance of the life-world and taking this into consideration in the treatment process were factors considered to be central to good practice. The article concludes with a discussion linking these findings to those of other studies identifying those factors contributing to our knowledge of what is involved in biopsychosocial practice in physiotherapy.     

Physiotherapists' perceptions and use of medical imaging information in practice

Background and Purpose . Physiotherapists must take responsibility for all aspects of patient care. Information from medical imaging studies can influence clinical decisions. The purpose of the present study was to gather information about physiotherapists' perceptions and use of medical imaging information in clinical practice. Method . A survey questionnaire was developed, validated and pilot tested. Subjects were randomly selected from a pool of licensed physiotherapists practising in four California Physical Therapy Association Districts. The survey was sent to 500 physiotherapists. Data gathered from the survey were transcribed to spreadsheets for analysis. Results . One hundred and twenty participants completed and returned the survey. Information from radiographs was most frequently available, followed by MRI and CT scan information, respectively. Respondents reported more use of information from reports than from images. Respondents also indicated that it was important to be able to review medical imaging information (70%), that they use medical imaging information in their practice when it is available (83.4%), that physiotherapists have the necessary knowledge and skills to use this type of information (77.3%), and that medical imaging should be covered in entry‐level educational programmes (84.2%). Respondents additionally indicated that medical imaging information could be used to understand a patient's disease process (85%), improve communication about patient care (90%), improve diagnosis, prognosis and interventions for patients (81.6%), and identify contraindications to examination and interventions (87.5%). Conclusions . Physiotherapists have access to some medical imaging information and perceive that this information could be valuable in patient care; however, not all therapists are confident in their ability to interpret this information. Curricula in entry‐level physiotherapist educational programmes should include information about medical imaging. Copyright © 2006 John Wiley & Sons, Ltd.     

Assessment of the importance of glenohumeral peripheral mechanics by practicing physiotherapists

Background and Purpose. Physiotherapists develop clinical reasoning theories and applied manual therapy skills through a variety of educational exposures. No studies have assessed the importance of selected theories such as the convex–concave rule, capsular pattern and scapulohumeral rhythm during clinical decision‐making by physiotherapists. The present study investigated which variables physiotherapists considered were associated with the importance of these theories during practice and investigated physiotherapists' perception of translational motion biomechanics of the glenohumeral (GH) joint. Method. Six hundred and sixty physiotherapists in the USA volunteered to participate in this study. Using ologit regression analyses, the identifier themes and clinical background characteristics were associated with importance of peripheral biomechanics in manual therapy application and reliability/validity of the scapulohumeral rhythm theory in predicting pathological sequences of the shoulder complex. An intraclass correlation coefficient (ICC) was used to determine agreement regarding necessary translation of the GH joint for normal movement. Results. The majority of physiotherapists indicated that all theories were important or very important during treatment decision‐making and reported frequent utilization. Regression models identified that the importance placed on peripheral biomechanics was negatively influenced by academic qualification (bachelors and masters degrees) and gender (men were less likely to report that scapulohumeral rhythm was a reliable/valid predictor of shoulder pathology). ICC values identified excellent agreement among clinicians regarding translational motion. Conclusions. The importance of biomechanics of the periphery for use, validation and frequency was based heavily on adoption of selected theories of glenohumeral movements despite evidence that suggests the theories lack validity. Copyright © 2007 John Wiley & Sons, Ltd.     

The Correlation between Dynamic Balance Measures and Stance Sub-phase COP Displacement Time in Older Adults during Obstacle Crossing

[Purpose] This study examined the relationship between the center of pressure (COP) displacement time during the stance subphases and dynamic balance ability when elderly cross obstacles 0, 10, and 40 cm in height. [Subjects] Fifteen older adults were enrolled in this study (≥65 years of age). [Methods] An F-Scan System was used to measure the COP displacement time when subjects crossed obstacles 0, 10, and 40 cm in height, and the Dynamic Gait Index, Berg Balance Scale, and Four Square Step Test were used to measure dynamic balance ability. [Results] The Dynamic Gait Index, Berg Balance Scale, and Four Square Step Test were correlated with each other. Dynamic balance tests were correlated with the COP displacement time during the stance phase. At obstacle heights of 10 and 40 cm during loading response and at all heights during pre-swing, there were correlations with dynamic balance ability. However, dynamic balance ability did not affect the COP displacement time during mid-stance and terminal stance. [Conclusion] People with a lower dynamic balance ability show a larger COP displacement time during loading response and pre-swing. Therefore, dynamic balance ability can be predicted by measuring the COP displacement time.Key words: Dynamic balance, Obstacle crossing, Center of pressure     

Correlation between balance and gait according to pelvic displacement in stroke patients

[Purpose] The purpose of this study was to investigate the correlations of balance and gait according to pelvic displacement in stroke patients. [Subjects] The subjects of this study were 58 stroke patients who had been admitted to a hospital. [Methods] A Global Postural System was used to measure pelvic displacement. To measure the balance ability, a Tetrax balance system was used to measure the weight distribution index and stability index. Gait ability was measured during the 10-Meter Walking Test and Figure-of-8 Walk Test. [Results] The results of this study showed that was significant positive correlation between the anterior superior iliac spine height difference in pelvic displacement and the weight distribution index and significant positive correlation between the posterior superior iliac spine height difference and the stability index in the normal position with the eyes closed. Statistically significant positive correlation also was found between the anterior superior iliac spine height difference and the straight and curved gait ability. [Conclusion] The increased pelvic displacement in stroke patients results in a decrease in balance ability and gait speed. This suggests that control of pelvic displacement is necessary before functional training for patients with stroke.Key words: Balance, Pelvic displacement, Stroke     

Applying self-determination theory for improved understanding of physiotherapists’ rationale for using research in clinical practice: a qualitative study in Sweden

Abstract

Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists’ use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.     

Effects of spiral taping applied to the neck and ankle on the body balance index

[Purpose] This study was performed to investigate the changes in the body balance index when spiral taping is applied to the neck and ankle. The findings are expected to serve as evidence of the usefulness of taping the neck instead of the ankle when ankle taping is not feasible in clinical practice. [Subjects and Methods] Twenty healthy male students at A university were enrolled in this study. Balance measurements were made under three conditions: no intervention, ankle intervention and neck intervention. Static balance was measured with subjects’ eyes open and closed, and dynamic balance was measured with subjects’ eyes closed. [Results] There were significant differences in dynamic balance assessed by the Overall Balance Index (OBI), and the Anteroposterior Balance Index (ABI) with subjects’ eyes open when ankle or neck taping was applied compared to no intervention. The static balance (OBI) of subjects with eyes open showed significant differences from the no intervention condition in both the ankle and neck intervention. The static balance (OBI) with subjects’ eyes closed also showed significant differences in both the ankle and neck interventions compared to the no intervention condition. [Conclusion] Our results indicate that neck taping stimulates the somatic senses around the neck and increase proprioception, resulting in balance improvement similar to that elicited by ankle taping. Further studies with larger sample sizes various experimental conditions should be performed to more systematically and objectively elucidate the effects of neck taping.Key words: Spiral taping, Balance, Balance index     

Does balance or motor impairment of limbs discriminate the ambulatory status of stroke survivors?

OBJECTIVE: This study was performed to determine if ambulatory function is governed by motor impairment of limbs or balance ability in subjects with hemiplegia caused by stroke. DESIGN: Seven patients who walked with physical assistance (FIM 4) after stroke and 13 who walked independently with assistive devices (FIM 6) were compared with 13 healthy subjects. Motor impairment of limbs was evaluated with the Fugl-Meyer Assessment. The Berg Balance Scale and limit of stability test of the Smart Balance Master were used to evaluate balance ability. RESULTS: The FIM 6 group and the controls were best differentiated by motor impairment of the paretic limbs and limit of stability in the backward direction. Motor impairment of the upper limb and limit of stability in direction toward the paretic side separated the FIM 4 from the FIM 6 group. Upper limb motor impairment and the Berg Balance Scale consistently separated the three subject groups. CONCLUSIONS: Motor impairment in the paretic upper limb and balance dysfunction should be addressed in treatments working toward independent ambulation.     

全膝关节置换术后的康复治疗要点与相关研究

康复治疗对人工膝关节置换术后的临床效果至关重要，是术后膝关节功能能够达到预期效果的重要措施。肌力训练、关节活动度训练、本体觉训练及行走步态训练是术后康复治疗最重要的内容。为最大限度地恢复膝关节功能，综合康复训练必不可少，包括各种主动肌力训练增加膝关节伸、屈肌力；早期持续被动膝关节活动度训练增加关节活动度；本体感觉训练改善膝关节的运动控制能力、姿势校正及平衡维持能力；行走步态训练矫正异常行走步态等。