Jane Freund

A rehabilitative ultrasound imaging investigation of lateral abdominal muscle thickness in healthy aging adults.

Purpose: Rehabilitative ultrasound imaging (RUSI) is used to evaluate lateral abdominal muscle size and function during the abdominal drawing‐in maneuver (ADIM), an exercise used to improve lumbar spine stability. Little is known about the size and performance of these muscles in healthy aging adults. The purpose of this study was to investigate, using RUSI, the size and symmetry of the lateral abdominal muscles bilaterally at rest and during the ADIM in healthy older adults and the reliability of these measurements. Methods: Three ultrasound images of the right and left lateral abdominal muscles were taken at rest and during the ADIM in 12 healthy older adults. Thickness of the transversus abdominis muscles (TrA), internal oblique (IO), and external oblique (EO) were measured for all images. Intraclass correlation coefficients were computed using model 3, form 1 (ICC3,1). Two ratios of the abdominal muscles were calculated in the relaxed and contracted states. Paired t‐tests were used to compare relaxed muscle thickness to contracted muscle thickness for all 3 muscles for each side. To test further for interactions of side and contractile state, 2 × 2 repeated measures ANOVAs were performed. Side‐to‐side differences in absolute and relative thickness were assessed with paired t‐tests for the TrA and IO muscles. Absolute and relative side‐to‐side muscle symmetry indices were computed for each muscle at rest. Results: There was a signi⊠cant difference in muscle thickness between the contracted and relaxed states for both the TrA and IO. There was no signi⊠cant difference between left/right muscle thickness for the TrA or IO at rest or during the ADIM. The TrA nearly doubled in size while thickness of the IO + EO stayed relatively constant during the ADIM. Reliability for absolute muscle thickness was generally excellent: ICCs3,1 ranged from 0.95 to 1.00 for intra‐image reliability; 0.77 to 0.97 for inter‐image reliability. Conclusions: These ⊠ndings support symmetrical and preferential activation of the TrA during the ADIM in healthy older adults. Continued research on the use of RUSI as a tool for both assessment and intervention in older adults is needed.

Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design

The purpose of this study is to describe the effects of trunk stabilization training and locomotor training (LT) using body-weight support on a treadmill (BWST) and overground walking on balance, gait, self-reported function, and trunk muscle performance in an adult with severe ataxia secondary to brain injury. There are no studies on the effectiveness of these combined interventions in persons with ataxia. The subject was a 23-year-old male who had a traumatic brain injury 13 months prior. An A-B-A withdrawal single-system design was used. Outcome measures were Berg Balance Test (BBT), timed unsupported stance, Functional Ambulation Category (FAC), 10-meter walk test (10-MWT), Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL), transverse abdominis (TrA) thickness, and isometric trunk endurance tests. Performance on the BBT, timed unsupported stance, FAC, 10-MWT, and OPTIMAL each improved after 10 weeks of intervention. In additions, TrA symmetry at rest improved as did right side-bridge endurance time. LT, using BWST and overground walking, and trunk stabilization training may be effective in improving balance, gait, function, and trunk performance in individuals with severe ataxia. Further research with additional subjects is indicated.

Continued recovery in an adult with cerebellar ataxia

Background and purpose: The authors previously reported on the functional recovery of an adult with chronic, severe ataxia secondary to traumatic brain injury (TBI) after 28 sessions of trunk stabilization and locomotor training (LT). The purpose of this case report is to describe this individuals functional abilities 3.5 years after the intervention. Case description: Thirteen months post-TBI and not expected to be a functional ambulator, an adult male participated in a trunk stabilization and LT intervention. After the intervention, he continued to exercise in a hospital-based fitness program and received additional physical therapy. Evaluation of balance, gait, trunk performance, self-reported function, and quality of life was performed at 6 weeks (baseline), 1 year, and 3.5 years after completing the intervention. Outcomes: Balance, gait, and function improved. Resting left transverse abdominis thickness, measured using ultrasound imaging, increased as did left-side bridge and trunk flexion endurance. He increased community participation and expressed general satisfaction with his overall quality of life. Discussion and conclusion: In the 3.5 years after participation in an intervention of trunk stabilization and LT this adult became an independent limited community ambulator. Persons with severe ataxia secondary to TBI may continue to improve many years after injury.

Lower Quarter Y-Balance Test in healthy women 50–79 years old

ABSTRACT The Lower Quarter Y-Balance Test (LQ-YBT), a measure of dynamic balance used in young adults, has not been adequately studied in older women. We determined the reliability, normative values, and relationships to other balance measures for LQ-YBT in women aged 50–79 years. Interrater reliability was strong, and test-retest reliability was moderate to strong. Results by decade showed women 50–59 years had significantly better scores than both older groups. There were moderate positive correlations between single leg stance, gait speed, and LQ-YBT composite score. LQ-YBT may be used as a dynamic balance assessment in healthy older women.

P7 Relationship between function, quality of life and balance in persons with chronic ankle instability

Study Design Cross-sectional. Objectives To investigate the relationship between subjective measures of function and quality of life, and objective measures of balance in individuals with Chronic Ankle Instability (CAI). Background CAI results due to an inadequately healed ankle sprain, and may impact the individual’s balance and quality of life. However, it is unknown how they are related. Methods and Measures Participants: 1) CAI group (n=18; age 22.4±2.8 years) had a history of at least 1 significant ankle sprain with feelings of instability and/or recurrent sprain, 2) Copers (n=15; age 22.4±3.2 years) also sustained 1 significant ankle sprain, but are able to return to their pre-injury levels without residual symptoms and 3) Control (n=18; 22.2±3.0 years), who never had ankle injury. Static balance was tested using single leg standing on the Biodex Balance System platform set to levels of varying stability. Dynamic balance was tested using Y-balance system. Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) surveys were administered. Results For CAI group, the FAOS quality of life subscale was negatively correlated with sway index and area when the platform was stable (both r>=−0.52; p<0.026). Also the FAOS activities of daily living and pain subscales negatively correlated with maximum reach in the posteromedial direction of the Y-balance test (both r>=−0.49; p<0.037). For Copers, the FAOS symptoms subscale negatively correlated with sway index when the platform was stable (r=−0.54; p=0.037). For Controls the FAOS symptoms subscale showed negative moderate significant correlation with sway index and area on the very unstable platform level. Conclusions For those with a history of ankle sprain, subjective measures seemed to be related to performance on the least challenging static balance and dynamic balance test. Subjective measures of quality of life and function do not seem to be related to more challenging static balance tests.

P47 Accuracy of athlete single leg test on biodex balance system and y-balance for distinguising individuals with chronic ankle instability

Study Design Cross-sectional. Objectives To determine the accuracy of athlete single leg test on the Biodex balance system (BBS) and Y-balance test in distinguishing individuals with chronic ankle instability (CAI) from healthy controls. Background Lateral ankle sprains are common orthopaedic injuries that often result in chronic ankle instability characterised by many residual symptoms. Single leg standing test and Y-balance are commonly used to assess postural control in individuals with CAI. However, the accuracy of these tests for distinguishing individuals with CAI from healthy controls are unknown. Methods and Measures Eighteen individuals with unilateral CAI (age=22.4±2.8 years; IdFAI=21.3±8.3), 15 individuals with unilateral injury who are copers (age=22.4±3.2 years; IdFAI=7.3±2.5), and 18 healthy controls (age=22.2±3.0 years; IdFAI=2.9±3.1) participated. Everyone completed two 20 s trials of athlete single leg testing without visual feedback at Levels 4, 8 ,12, and static levels on the BBS. Each level corresponded to the degree of tilt of the platform surface with a lower number corresponding to lesser stability. Overall stability index (OSI) and sway area was calculated for each level. Maximum reach values of three trials for 3 directions (Anterior, postero-medial and postero-lateral) were recorded and used to calculate the composite score for the Y-balance test. Accuracy was quantified using area under curve from ROC curve analysis. Results Comparing CAI and controls, the accuracy ranged from 0.213 for Y-balance composite score (indicating failure to accurately distinguish CAI from Controls) to 0.62 for sway area at Level 8 (indicating poor accuracy). Comparing CAI and Copers, the accuracy ranged from 0.389 for OSI at Level 12 (indicating failure to accurately distinguish CAI from Copers) to 0.60 for sway area at Level 8 (indicating poor accuracy). Conclusion Athlete single leg testing on BBS and Y-balance test seem to have poor diagnostic accuracy in distinguishing individuals with CAI from healthy controls.