Ann Medley

Predicting the probability of falls in community dwelling persons with brain injury: a pilot study.

Primary objectives: To determine the usefulness of select balance and functional mobility measures in predicting fall risk in community dwelling persons with brain injury (BI) and to develop a model to quantify fall risk. Research design: An exploratory pilot study to predict fall risk in persons with BI. Non-manipulated independent variable was fall status with two levels, non-faller and faller. Dependent variables were scores on the Berg Balance Scale (BBS), the Dynamic Gait Index (DGI) and the Falls Efficacy Scale (FES); age, gender, supervision required and assistive device use. Methods and procedures: Twenty-six participants recruited from support groups and community re-entry programmes were divided into two groups, fallers and non-fallers. The FES, BBS and DGI were administered. Main outcomes and results: T-tests and chi-square tests revealed between group differences for age, FES, BBS, DGI and assistive device use. Spearmans rho statistic showed moderate relationships among the variables, FES, BBS, DGI and assistive device use. Logistic regression determined the DGI to best predict fall risk. Conclusions: This study developed a predictive model that could be used by therapists to determine an individuals fall risk in the home or outpatient settings. Assessing risk allows therapists to identify individuals who would benefit from intervention designed to improve balance and gait ability, possibly preventing future falls and a second head injury.

Forward and lateral sitting functional reach in younger, middle-aged, and older adults.

Purpose: We adapted the original Functional Reach so that sitting balance could be quantifiably measured in 2 directions. Purposes of the study were to determine if sitting forward or lateral reach: (1) are reliable among younger, middle‐aged, and older adults without balance problems; (2) provide reference values for clinicians; and (3) examine factors (age and anthropometrics) that may influence such measures. Methods: This descriptive study involved 146 apparently healthy adults in 3 age groups: 62 younger (21 to 39 yr), 41 middle‐aged (40 to 59 yr), and 43 older (60 to 97 yr). After anthropometric measurements were obtained, participants reached forward and laterally (shoulder elevated 90°) with a closed fist while sitting in a chair. Intrarater reliability was calculated on a subset of 84 participants. Results: Intrarater reliability of sitting forward and lateral reach measured with a yardstick was excellent (ICC3,1 = .98 and .96 respectively). Means and standard deviations by age group and sex are reported. Regression analysis showed that body segment anthropometrics did not affect performance. Differences between age groups for both the sitting reaches were found. Post hoc analysis revealed that older participants differed from both younger and middle‐aged participants. Conclusions: Forward and lateral reach from the seated position can be reliably measured and offer therapists a way to quantify sitting balance. This study provides reference values for younger, middle‐aged, and older adults for clinical use. While anthropometrics do not affect performance, older adults perform differently from younger and middle‐aged adults.

Aerobic Exercise in People with Multiple Sclerosis: Its Feasibility and Secondary Benefits

The aims of this study were to explore the feasibility of structured aerobic exercise followed by a period of unstructured physical activity and determine the impact of such exercise on cognition, mood, and quality of life in people with multiple sclerosis (MS). A convenience sample of 9 individuals with relapsing-remitting MS performed 30 minutes of aerobic exercise (upper- and lower-extremity ergometry and treadmill ambulation) twice weekly for 8 weeks, followed by 3 months of unstructured physical activity. Eight participants completed the intervention and posttest; 6 returned for the 3-month follow-up. Cardiovascular fitness, cognition, mood (measured with the Beck Depression Inventory-II; BDI-II), and quality of life (measured with the Multiple Sclerosis Quality of Life-54; MSQOL-54) were assessed. Participants completed 27.9 minutes of exercise per session, with an 85.1% attendance rate. Evaluation using the Wilcoxon signed rank test revealed no deleterious effects and improved results on the BDI-II and MSQOL-54 mental subscale. Analysis of change scores using the one-sample t test revealed that the BDI-II and MSQOL-54 were changed from zero after structured exercise, but only the BDI-II maintained improvement after unstructured physical activity. Further analysis of BDI-II subscales revealed that improvement occurred only in the Somato-Affective subscale. In this study, program feasibility was demonstrated in several ways. There were no declines in cognitive function over the 5-month period. Despite unchanged cognitive function, participants may value the improved mood enough to continue both the structured and unstructured physical activity. The role of unstructured physical activity in concert with periodic structured exercise programs merits further investigation.

Development, reliability, and validity of the Sitting Balance Scale

The Sitting Balance Scale (SBS) measures sitting balance for frail older adults who are primarily nonambulatory. Purposes were to generate items representing different functional abilities of sitting balance, reduce the number of items to make a clinically useful tool, refine the assessment, and establish reliability and validity. The study was conducted in multiple phases, with qualitative and quantitative methodologies. Content development used nominal group process, expert narratives, and literature review. After consensus was reached on content and scoring, item reduction began. Item retention and deletion decisions were based on a combination of practical considerations during field testing, expert and experienced clinician opinion of clinical relevance, and statistical information. Item retention or deletion decisions were based in part on the internal consistency analysis of the 19-item SBS based on 256 scores, which included participants who were apparently healthy and those with pathology. We applied a decision matrix to yield the final 11-item version. The 11-item SBS demonstrated good internal consistency (α = 0.762), intrarater rater reliability (ICC3,1 = 0.96 to 0.99), and interrater reliability (ICC2,1 = 0.87). On the basis of analysis of 156 scores, construct and concurrent validity were established. The SBS appears to meet the criteria required to make it a useful tool. The SBS can be used to assess sitting balance in frail individuals who are primarily nonambulatory who might exhibit floor effects for traditionally used balance measures. The SBS is the first attempt to assess lower balance abilities. Further assessment of the tools validity with larger and varied samples is necessary.

The effect of context and age on functional reach performance in healthy adults aged 21 to 94 years.

Background:Activities of daily living require an individual to exhibit dynamic standing balance, while reaching beyond arms length under varying contexts that involve an object to reach toward or grasp. Research shows that object context impacts the kinematics of reaching; however, there has been less research regarding the effect of context on functional reach (FR) ability. The purpose of the present study was to assess FR ability under 3 conditions between 3 age groups: (1) traditional FR, (2) reaching to an object (object present FR), and reaching to grasp an object (FR to grasp). Methods:Reach distance was measured as 142 apparently healthy participants performed the 3 contexts in random order. A 2-way repeated-measures analysis of variance (age group × reach context) determined the effect of age and context on reach ability. Results:For all age groups, both object-present contexts resulted in greater reach ability than the traditional FR condition. The task goal, touching or grasping, however, impacted reach ability differently in each age group. For the young and older age groups, there was no difference between reaching to touch an object or to grasp an object. Reach distance was less, however, for the middle-age group when grasping an object compared with touching an object. Conclusion:These results suggest that the presence of an object enhances dynamic standing balance as indicated by greater reach distances compared with traditional FR when an object is absent. Applications of these findings might extend to balance testing and balance training.

The Effect of Balance Confidence and Context on Functional Reach Ability in Healthy Older Adults

To assess functional reach (FR) ability in 4 contexts in older adults (≥ 60 years) with high balance confidence (HBC) and low balance confidence (LBC).

Proposing Development and Utility of a Mobility Composite Measure in Patients with a Neurologic Disorder

Background Outcome measures typically assess single domains making holistic assessment difficult. Our purpose was to develop a mobility composite measure (MCM) based on four commonly used outcome measures and compare this composite score to the individual measures in patients with neurologic disorders. Methods We retrospectively reviewed 148 medical records for inclusion of primary neurologic diagnosis and scoring for 5 times sit-to-stand test (5TSST), 10-meter walk test (10MWT), 2-minute walk test (2MWT), and activities-specific balance confidence (ABC) scale. Results After establishing that a single concept was being assessed with interitem correlations, raw scores were converted to percentage of normal and combined into the MCM for analysis from admission to discharge. Scores on each measure significantly improved after intervention (5TSST, p < .001; 10MWT, p < .001; 2MWT, p < .001; ABC, p = .02). Mean MCM (n = 93) admission scores were 67.55 ± 31.88% and discharge scores were 74.81 ± 34.39% (p = .002). On average, patients improved 7.26% on the MCM exceeding the threshold of expected error (MDC95 = 3.59%). Conclusions MCM detected change in patient outcomes statistically and clinically and appears to capture a holistic picture of functional status. We recommend a prospective study to further investigate a “composite measure” incorporating measures from several functional domains.

A Comparison of Physical Activity and Dual Task Gait Among Persons with Parkinson's Disease and Healthy Older Adults

ABSTRACT Aims: To identify if dual task gait differed between persons with PD (high versus low physical activity levels) and healthy peers. Methods: Persons with PD (n = 19) and matched healthy controls (HC) (n = 19) completed Timed Up and Go single (TUGalone) and dual task conditions (TUGmotor/TUGcognitive), Beck Depression Inventory-II (BDI-II), and step activity monitoring. Participants with PD were classified low active (LAPD; n = 11) or high active (HAPD; n = 8) using HC mean steps/day cut-point (M = 4,658). Results: PD groups were equivalent for mental status, disease severity, and PD duration. LAPD steps/day (M = 2,482.00 ± 1,466.33) differed from HAPD (M = 5,675.13 ± 1,198.93) and HC (M = 4,657.74 ± 1,604.99) (p = 0.001). LAPD completed the TUG slower than HAPD and HC (MANOVA, p < 0.02; post-hoc analysis, p < 0.04). BDI-II scores were greater in LAPD than HC (p = 0.013). Conclusions: Physical activity impacted mobility and depression. HAPD were similar to HC in walking activities and affect but LAPD walked slower with higher levels of depression.

Validity of the Sitting Balance Scale in older adults who are non-ambulatory or have limited functional mobility

Objective: To determine whether the Sitting Balance Scale is an acceptable alternative to the Trunk Impairment Scale for measuring the construct of sitting balance, to examine relationships with other clinical outcomes and to establish discriminative validity. Design: Prospective descriptive methodological study. Setting: Acute care, inpatient rehabilitation, skilled nursing facility and home health. Participants: Patients receiving physical therapy (N = 98; n = 20 acute care, n = 18 inpatient rehabilitation, n = 30 skilled nursing facility, n = 30 home setting) mean (SD) age, 80.5 (7.9) years. Nineteen were non-ambulatory and 79 had limited functional mobility with Timed Up and Go scores ≥20 seconds. Main measures: Sitting Balance Scale, Trunk Impairment Scale, Timed Up and Go, length of stay and setting specific clinical measures of sitting balance (OASIS-C M1850; MDS G-3b). Results: Moderate association between ambulatory status and sitting balance measures (Sitting Balance Scale r = 0.67, Trunk Impairment Scale r = 0.61; P = 0.0001). Moderate to strong relationships between Sitting Balance Scale, Trunk Impairment Scale and clinical outcomes varying by setting. MANOVA results revealed differences between ambulators and non-ambulators and among diagnostic categories for both instruments (P < 0.001). Conclusions: The Sitting Balance Scale is comparable to the Trunk Impairment Scale for measuring sitting balance in older adults who are non-ambulatory or have limited mobility.