Balance performance and step width in noninstitutionalized, elderly, female fallers and nonfallers

The purposes of this study were to compare age, static balance performance, and step-width variables between elderly noninstitutionalized women with and without a history of falls and to determine the relationship between balance performance and step width. Each subject performed a maximum of three timed trials on the sharpened Romberg and one-legged stance tests with eyes open and with eyes closed. The first and best trial measurements were used for analysis. Each subject walked on paper walkways making ink prints for step-width measurements. The mean and the variability of each subject's step-width measurements were used for analysis. Data from 110 women, aged 60 to 89 years, were analyzed. The fallers (n = 26) had significantly lower values than the nonfallers (n = 84) on the best trial of the sharpened Romberg test in the eyes-open condition (t = 1.98, df = 108, p less than .05). No significant differences between fallers and nonfallers were revealed in age, the mean and variability of step width, the first trials of the balance tests, and the best trials on the other balance tests. For the total group, the mean measurements on the first trials were significantly lower than those on the best trials for each balance test. Small, but statistically significant (p less than .05), negative relationships existed between balance performance and the mean and variability of step width. The results of this study indicate that the methods of measuring balance and step width are clinically applicable, and the data of patients from a similar population sample may be compared with the data established in this study.     

Balance performance, force production, and activity levels in noninstitutionalized men 60 to 90 years of age

The purpose of this study was to collect and analyze balance and muscle performance data obtained from 54 men aged 60 to 90 years. Balance was tested using the sharpened Romberg test (SR) and the one-legged stance test (OLST) on each foot with eyes open and eyes closed. A strain-gauge-based quantitative muscle tester (QMT) was used to measure force production. All torque values were normalized as a percentage of body weight. A self-report of activity level also was recorded. The results indicated that OLST scores and normalized torques of the hip flexors, extensors, and abductors had a positive correlation and that SR scores and normalized torques of the hip extensors and right hip abductors had a positive correlation. Subjects who considered themselves to be very active had a significantly higher SR eyes-closed balance time as compared with those who rated themselves as less active. Subjects who considered themselves to be very active also had significantly higher normalized torque values for most muscle groups tested. Negative relationships were shown between age and balance time and between age and force production.     

Steadiness in one-legged stance: development of a reliable force-platform testing procedure.

Postural steadiness in one-legged stance has potential for evaluation of unilateral injuries and disorders, but any test protocol must be demonstrated to be both feasible and reliable. A testing protocol for using a force platform to measure steadiness in one-legged stance with eyes opened and eyes closed was successfully developed, and its within-session retest reliability was investigated in a group of 24 young, healthy subjects. Strategies were used to minimize the loss of data for trials in which the subjects incurred significant loss of balance from the one-legged position. The performance scores examined were the standard deviation of the three orthogonal force components and the two horizontal center of pressure (CP) coordinates averaged over four consecutive five-second trials. The retest coefficients for all test conditions were substantially improved compared with testing protocols reported earlier. Retest reliability was higher for performance scores based on force measures than for performance scores based on CP measures. The difference was statistically significant in two of the stances, with a similar trend in the other two stances. Further, factor analysis showed that force measures were the best predictors of steadiness in one-legged stance. Analysis of variance failed to detect any systematic effect for leg preference or laterality on steadiness in one-legged stance with eyes opened or eyes closed in the healthy subjects with no history of injury (p greater than .05). The test protocol described enables the development of clinical or experimental trials with repeated-measures design using the subject's nonaffected leg as a control.     

闭眼单脚站立方法在体质测试中的应用

背景：闭眼单脚站立是反应肌力与平衡能力的测试方法,在中国被作为评价成年人和老年人平衡能力的重要素质指标, 以往有大量的测试工作,但深入的研究报道较少。目的：总结闭眼单脚站立方法的国内外研究现状,分析闭眼单脚站立在体质测试中存在的问题,并展望研究方向。方法：通过计算机检索 CNKI 和 Elsevier 数据库中相关文献,关键词为＂闭眼单脚站立,平衡能力,体质测试＂。对资料进行初审,选取符合研究要求的文献。结果与结论：中国男性闭眼单脚站立评分标准高于女性;测试中出现部分老年人站立时间很短,很难评定其平衡能力;老年人平衡能力明显低于中、青年人,成年人与老年人采用相同的测试方法是否具有科学性;在简单平衡能力测试方法中,闭眼单脚站立的各项指标相关系数较低。鉴于以上原因,闭眼单脚站立作为国民体质平衡能力评价的测试方法尚待进一步研究。     

Effets d''un entraînement physique sur l''équilibre statique et dynamique chez des sujets âgés chuteurs et non-chuteurs

OBJECTIVE: To evaluate the effects of a physical training program on static and dynamic balance during single and dual task conditions in elderly subjects who have had a fall or not. PATIENTS: Two groups, comprising a total of 33 elderly subjects, were trained: 16 who had a fall were 69.2 +/- 5.0 years old and 17 who had not had a fall were 67.3 +/- 3.8 years. METHODS: All subjects underwent an unipedal test with eyes open and eyes closed, followed by gait assessment during single and dual motor task conditions, before and after a physical training program. RESULTS: All subjects showed a significant decrease, by six times for subjects who had fallen and four times by those who had not, in the number of touch-downs in the unipedal test with eyes open (P < 0.05), and by 2.5 and 2 times, respectively, with eyes closed (P < 0.05) after the training program. All subjects showed a significant increase in speed (P < 0.05), cadence (P < 0.05) and stride length (P < 0.05) and a significant decrease in the single support time (P < 0.05) and stride time (P < 0.05) in gait assessment during single and dual task conditions after the training program. During the training program, no subjects fell. CONCLUSION: The physical training program improved static balance and quality of gait in elderly subjects who had had a fall and those who had not, which could contribute to minimizing and/or retarding the effects of aging and maintaining physical independence.     

The relation between previous fractures and physical performance in elderly women

OBJECTIVE: To examine the association between previous fracture and different aspects of physical performance. DESIGN: Population-based retrospective study. SETTING: Orthopaedic research department. PARTICIPANTS: Randomly selected women (N = 1044), all 75 years old and participants of the Malm? Osteoporosis Prospective Risk Assessment study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Type of and time since any previous fracture event were compared with results of tests on physical performance function (Romberg test, computerized sway test, gait speed, questionnaire) at the age of 75. RESULTS: Women with no previous fractures (n = 505) had a better median Romberg balance of 94 seconds (interquartile range [IQR], 75-118s) than women with 1, 2, or 3 or more fractures, who had a median balance of 88 seconds (IQR, 71-111s), 85 seconds (IQR, 68-107s), and 81 seconds (IQR, 65-109s), respectively (Kruskal-Wallis analysis of variance, P = .002). Balance was inferior in women who had sustained a previous fracture between the ages of 65 and 75 years compared with women with no previous fractures or fractures before the age of 65 years. Gait speed and questions on tendency to fall followed the same pattern. The computerized sway test could not differ between women with and without previous fractures. CONCLUSIONS: Poor physical performance is associated with previous fractures. Inferior physical performance may exist up to 10 years after a fracture.     

Unilateral lower-limb musculoskeletal injury: its long-term effect on balance

OBJECTIVE: To assess if any long-term decrements in balance occur after unilateral musculoskeletal injury. The relation between the size of decrement and the dominance, the type, and the time since injury were also considered. DESIGN: With eyes open and closed, postural sway in one-legged standing was recorded for 10 seconds in 48 subjects who sustained a unilateral musculoskeletal injury 6 months to 42 years earlier. Comparative data were also collected in 108 healthy subjects with no previous injury. SETTING: A university physiologic laboratory. PATIENTS: Injured subjects were recruited locally via the district general hospital, sports injury clinic, and the university, and had not received any treatment within the past 6 months. MAIN OUTCOME MEASURE: Postural sway of the injured and uninjured limb (or dominant and nondominant limb in the uninjured subjects). RESULTS: Postural sway was significantly greater in the injured limb compared with the uninjured limb (p = .0118). The ratio of the postural sway of the injured limb compared with the uninjured limb (I/UI%) was significantly lower in the group with nondominant injuries (p = .0085). Subjects with nondominant injuries performed significantly better than those with dominant injuries (p = .0085). No relation was found between the decrements in balance performance and the type of injury and time since injury. CONCLUSIONS: Full recovery is frequently not achieved and perhaps recovery does not continue to improve once the formal rehabilitation period is over.     

Dual Task Timed Up-and-Go for Older Adults With and Without Balance Deficits

Abstract

Aims: Dual task conditions of the Timed Up-and-Go (TUG) add a cognitive (C-TUG) and a manual (M-TUG) task. The purpose of this study was to determine if balance ability differentially affected performance on the three TUG conditions. Methods: One hundred community-dwelling older adults participated. They performed the sharpened Romberg (SR) eyes open test as a measure of balance and the three TUG conditions. Results: Participants were 71.8?±?7.8?years old. Across TUG conditions, those who completed the SR had faster TUG times than those who could not. Across groups, TUG times were faster than C-TUG and M-TUG times. Trends indicated that the C-TUG was challenging for those with the poorest balance, with an automaticity index twice that of the other groups and the lack of a correlation between the C-TUG and the TUG. Conclusions: As part of clinical assessment, the C-TUG may provide important information about balance, mobility, and cognition.     

Influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss

OBJECTIVE: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss. DESIGN: Prospective study. SETTING: Ear, nose and throat departments in three hospitals. SUBJECTS: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss participating in a randomized controlled training study were included. MAIN MEASURES: Electronystagmography testing was performed within one week after onset of symptoms and after 10 weeks. The outcome measures clinical static balance tests (sharpened Romberg's test with eyes closed, standing on foam with eyes closed, and standing on one leg with eyes open and closed) and subjective symptom ratings on a visual analogue scale were done after one week, 10 weeks and six months. The correlation between age and asymmetry of vestibular caloric response, respectively, and the outcome measures were analysed. RESULTS: Greater caloric asymmetry correlated with poorer performance at the sharpened Romberg's test and standing on one leg with eyes closed at all three follow-ups (rho = -0.31 to -0.54), and with higher symptom ratings at the 10-week and six-month follow-ups (rho = 0.30-0.60). Higher age was associated with poorer performance on the sharpened Romberg's test and standing on one leg at all three follow-ups (rho = 0.31-0.64), but did not change over time. Higher age was also associated with higher ratings of vertigo at the six-month follow-up, and less reduction of vertigo between the 10-week and six-month follow-ups (rho = 0.29-0.48). CONCLUSIONS: A higher degree of asymmetry of vestibular caloric response and high age seem to be associated with poor outcome in balance and perceived symptoms after acute unilateral vestibular loss.     

Stance duration under sensory conflict conditions in patients with hemiplegia

Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed.     

Change in static standing balance ability of community-residing elderly females after the onset of COVID-19 pandemic in Japan

[Purpose] This study aimed to examine the changes in the balance ability of community-residing elderly females between 2017 and 2020. [Participants and Methods] The participants included 202 females with ≥65 years of age (average age, 78.3 ± 5.88 years), living independently in the community and attending the salon. The balance ability was measured through a one-legged standing test by keeping the participants’ eyes open. The measurement duration was a maximum of 120 s while standing still. Each participant underwent the measurement twice, and the best attempt was recorded. The survey period was from 2017 to 2020, and the measurements were conducted once a year. [Results] The 2020 records showed a statistically significant difference compared to those of the other 3 years. The degree of decline was higher in the old-old than that in the young-old. [Conclusion] The balance ability of the elderly females was found to reduce significantly during the COVID-19 pandemic. Specifically, supporting physical activities in the old-old females is necessary to improve their balance ability.     

People with chronic low back pain have poorer balance than controls in challenging tasks

Purpose: To compare the balance of individuals with and without chronic low back pain during five tasks.

Method: The participants were 20 volunteers, 10 with and 10 without nonspecific chronic low back pain, mean age 34?years, 50% females. The participants completed the following balance tasks on a force platform in random order: (1) two-legged stance with eyes open, (2) two-legged stance with eyes closed, (3) semi-tandem with eyes open, (4) semi-tandem with eyes closed and (5) one-legged stance with eyes open. The participants completed three 60-s trials of tasks 1–4, and three 30-s trials of task 5 with 30-s rests between trials. The center of pressure area, velocity and frequency in the antero-posterior and medio-lateral directions were computed during each task, and compared between groups and tasks.

Results: Participants with chronic low back pain presented significantly larger center of pressure area and higher velocity than the healthy controls (p?p?1.37 vs. effect size <0.64). There were no significant interactions between groups and tasks.

Conclusions: Individuals with chronic low back pain presented poorer postural control using center of pressure measurements than the healthy controls, mainly during more challenging balance tasks such as semi-tandem and one-legged stance conditions.

• Implications for Rehabilitation

• People with chronic low back had poorer balance than those without it.

• Balance tasks need to be sensitive to capture impairments.

• Balance assessments during semi-tandem and one-legged stance were the most sensitive tasks to determine postural control deficit in people with chronic low back.

• Balance assessment should be included during rehabilitation programs for individuals with chronic low back pain for better clinical decision making related to balance re-training as necessary.

     

Factors related to falls among the community-dwelling elderly

The purpose of this study was to investigate falls among community elderly and the factors related thereto. The cross-sectional method was utilized in this study. A sample of 118 subjects aged 65 and over completed structured questionnaires and balance tests. Forty participants (34%) had fallen once or more in the past. Multivariate logistic regression showed that incidents of falls were significantly related to general perceived health status (OR=0.938, 95% confidence interval [CI]=0.900-0.997), one legged stance with eyes closed (OR=0.788, 95% CI=0.626-0.933), and mobility (OR=1.184, 95% CI=1.026-1.367). Falling is a major health risk for older adults. Health professionals can therefore develop fall preventive programs with a focus on monitoring perceived health status, dynamic balance, and mobility ability, and interventions that are associated with these factors.     

Postural steadiness and weight distribution during tandem stance in healthy young and elderly adults

BACKGROUND: Tandem stance is a clinical measure of standing balance considered to assess postural steadiness in a heel-to-toe position by a temporal measurement. To our knowledge, no studies have evaluated the change of postural steadiness, expressed as force variability, over time. The objective of this paper is to investigate postural steadiness during 30 s of tandem stance in healthy elderly and young adults, and to explore the weight distribution between legs during tandem stance. METHODS: A cross-sectional analysis comparing ground reaction forces and muscle activity in 26 healthy elderly adults (mean age 70.6 years) and 27 healthy young adults (mean age 30.0 years). Ground reaction forces beneath both feet and muscle activity of ankle muscles were recorded while the subjects performed 30 s of tandem stance during two conditions. FINDINGS: Two phases were identified in both groups: First a dynamic phase, a decrease in force variability during the first 3-4 s after foot placement, and thereafter a static phase, maintaining a certain level of force variability. Age-related changes were seen in the decrease in force variability (P<0.001) and ankle muscle activity (P<0.001). However, both groups placed more weight on the rear leg (P<0.001). INTERPRETATION: The first few seconds of tandem stance pose the greatest challenge to postural steadiness and influence the static phase. We suggest that the dynamic phase is the most crucial period of time for assessing balance requirements. Independent of age, tandem stance is not a task for equal weight bearing.     

Quantitative evaluation of sway as an indicator of functional balance in post-traumatic brain injury

The test of sway, using different conditions of stance with measurements of the average radial deviation of the center of pressure and its path length of sway per unit of time, has been shown to be a useful clinical tool in determining balance problems in traumatic brain injury (TBI) patients. Normative values were established to determine if an individual patient's sway values fell within the normal range (mean +/- 2SD). The tests have shown good test-retest reliability for TBI patients. In addition, it has been shown that the sensitivity of the test is sufficient to identify changes in patients' performances as their clinical conditions change. It has been demonstrated that the different stance conditions of the battery of tests become progressively more difficult to perform (from comfortable stance, eyes open and eyes closed, through narrow stance, eyes open and eyes closed, to tandem stance with right or left foot forward, eyes open and eyes closed). By using these subtests, it is easy to distinguish between the performances of able-bodied patients and TBI patients with very mild balance problems. The validity of the measure has been documented by correlating the sway performance with clinical functional performance tests. The test performance also correlates with the patient's own assessment of his or her gait difficulties. The limited data available suggest that the test of sway relates difficulties in static balance to the frequency of falls. Finally, subtests permit identification of specific problems in maintaining balance as a basis for therapeutic intervention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Standing balance after vestibular stimulation in Tai Chi-practicing and nonpracticing healthy older adults

OBJECTIVE: To compare the effects of vestibular stimulation on standing balance control between Tai Chi practitioners and older subjects. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center. PARTICIPANTS: Tai Chi practitioners (n=24; age +/- standard deviation, 69.3+/-5.0y) and control subjects (n=24; age, 71.6+/-6.1y) were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects stood on a force platform with eyes closed before and after stimulation of their horizontal semicircular canals, applied by means of whole head-and-body rotation at 80 degrees /s for 60 seconds, with subjects seated in a rotational chair. Body sway during stance was measured as total sway path, peak amplitudes, and mean velocities of sway in both anteroposterior (AP) and mediolateral (ML) directions. RESULTS: After head-and-body rotation, significant within-group increases were found in all measures in both AP and ML directions during stance with eyes closed in older control subjects but not in Tai Chi practitioners along the AP direction. In fact, significantly smaller increases in total sway path, peak amplitude, and mean velocity of body sway in the AP direction were found in the Tai Chi practitioners when compared with those of control subjects. CONCLUSIONS: Our results show that long-term Tai Chi practitioners had better AP standing balance control after vestibular stimulation than older control subjects.     

Unipedal stance testing as an indicator of fall risk among older outpatients

OBJECTIVE: To test the hypothesis that a decreased unipedal stance time (UST) is associated with a history of falling among older persons. DESIGN: Fifty-three subjects underwent a standardized history and physical examination and three trials of timed unipedal stance. SETTING: The electroneuromyography laboratories of tertiary care Veterans Administration and university hospitals. SUBJECTS: Ambulatory outpatients 50 years and older referred for electrodiagnostic studies. OUTCOME MEASURES: UST and fall histories during the previous year. RESULTS: Twenty subjects (38%) reported falling. Compared with the subjects who had not fallen, those who fell had a significantly shorter UST (9.6 [SD 11.6] vs 31.3 [SD 16.3] seconds, using the longest of the three trials, p < .00001). An abnormal UST (<30sec) was associated with an increased risk of having fallen on univariate analysis and in a regression model (odds ratio 108; 95% confidence interval 3.8, >100; p < .007). The sensitivity of an abnormal UST in the regression model was 91% and the specificity 75%. When UST was considered age was not a predictor of a history of falls. CONCLUSIONS: UST of <30sec in an older ambulatory outpatient population is associated with a history of falling, while a UST of > or = 30sec is associated with a low risk of falling.     

Evaluating the short term effects of kinesiology taping and stretching of gastrocnemius on postural control: A randomized clinical trial

IntroductionThe ability to maintain balance is essential for both remaining in the standing position and preventing falls. Physical therapy techniques such as kinesiology taping (KT) and stretching are considered to be effective measures in ameliorating balance issues. However, there is no available study comparing the effects of these two methods on postural control. Thus, the current study aims to investigate and compare the efficacy of interventions accomplished through these methods on young and elderly subjects.MethodIn a single-blind randomized clinical trial, 40 young subjects (<30 years) and 40 elderly subjects (>60 years) were randomly assigned to two groups of KT and stretching. In the first group, inhibitory tape was applied to the gastrocnemius muscle. In the second group, 60 s of stretch was repeated 4 times. The static balance was evaluated before and after the interventions using the single-leg standing (SLS) test along with measurements of the velocity and displacement of the center of pressure by the force plate.ResultsBased on the Mann-Whitney test, there were no significant differences between the tape and stretching techniques in the study variables of either group of participants, before and after the interventions (p > 0.05). However, the results of the Wilcoxon test showed a significant increase in single-leg stance time in the stretching group in the elderly subjects (p = 0.03). MANOVA results demonstrated significant group and time effects only in the SLS parameter (p < 0.05).ConclusionStretching the gastrocnemius seems to be more efficacious than KT for improving balance problems in older adults.Level of evidenceII.     

绝经妇女下肢肌力与平衡功能的相关性研究

目的:研究绝经后妇女膝关节肌力与静态平衡之间的相关性。方法:60例绝经后妇女,分别用PJ-I型电脑平衡功能检测仪测定静态平衡功能,Cybex-330等速肌力测试仪测试膝关节肌力,将所测定的平衡功能参数与肌力参数做相关性分析,按年龄分为65岁以下(含65岁)以及65岁以上年龄组,每组组内进行肌力与平衡功能相关性分析。结果:总体上静态平衡功能与下肢肌力之间无直线相关,按年龄分组后,65岁以上年龄组平衡功能与下肢肌力间存在相关性。结论:年龄相关的平衡功能减退涉及的因素繁杂,单纯膝关节肌力下降一般不至于引起显著的静态平衡功能低下。     

Halo vest effect on balance

OBJECTIVE: To determine the effect of a halo vest, a cervical orthosis, on clinically relevant balance parameters. DESIGN: Subjects performed unipedal stance (with eyes open and closed, on both firm and soft surfaces) and functional reach, with and without the application of a halo vest. SUBJECTS: A convenience sample of 12 healthy young subjects, with an equal number of men and women. OUTCOME MEASURES: Seconds for unipedal stance (maximum 45); inches for functional reach. RESULTS: Both unipedal stance times and functional reach (mean +/- standard deviation) were significantly decreased with the halo vest as compared to without it (29.1+/-5.8 vs. 32.8+/-6.4 seconds, p = .002; 12.9+/-1.4 vs. 15.1+/-2.1 inches, p<.01). CONCLUSION: A halo vest causes an acute impairment in balance in the healthy young. It is likely that the impairment would be greater in older or injured patients, thus increasing their risk for a fall, which could have devastating consequences.