Roberta A. Newton

Test-retest reliability of the sensory organization test in noninstitutionalized older adults

The purpose of this study was to determine the 1-week test-retest reliability of the Sensory Organization Test (SOT), using computer-generated scores and loss of balance (LOB) episodes in noninstitutionalized older adults. The SOT was administered to each subject on two separate days 1 week apart in an out-patient clinic. A volunteer sample of 40 individuals who were at least 65 years of age participated in this study. The main outcome measures were computer-generated scores for the first trial and the average of the three trials in each of the six sensory conditions of the SOT; computer-generated composite score of the six conditions; LOB on the first trial and any of three trials in each condition. The intraclass correlation coefficients (ICC) for the SOT first trial data ranged from .15 in Condition 3 to 0.70 in Condition 5. The ICCs for the SOT average of three trials ranged from 0.26 in Condition 3 to 0.68 and 0.64 in Conditions 5 and 6. Percent agreement was 77% to 100% for LOB on the first trial, as well as LOB on any of three trials of Conditions 1 through 6. As the conditions became more difficult, an increasing number of subjects experienced LOB. Analysis revealed fair to good test-retest reliability for computer-generated scores and good reliability for LOB across some conditions of the SOT. A modification to the current scoring system is suggested which would improve the reliability of the computer-generated scores of the SOT.

Horizontal plane head stabilization during locomotor tasks.

Abstract Frequency characteristics of head stabilization were examined during locomotor tasks in healthy young adults (N = 8) who performed normal walking and 3 walking tasks designed to produce perturbations primarily in the horizontal plane. In the 3 walking tasks, the arms moved in phase with leg movement, with abnormally large amplitude, and at twice the frequency of leg movement. Head-in-space angular velocity was examined at the predominant frequencies of trunk motion. Head movements in space occurred at low frequencies (< 4.0 Hz) in all conditions and at higher frequencies (> 4.0 Hz) when the arms moved at twice the frequency of the legs. Head stabilization strategies were determined from head-on-trunk with respect to trunk frequency profiles derived from angular velocity data. During natural walking at low frequencies (< 3.0 Hz), head-on-trunk movement was less than trunk movement. At frequencies 3.0 Hz or greater, equal and opposite compensatory movement ensured head stability. When arm swing was altered, compensatory movement guaranteed head stability at all frequencies. Head stabilization was successful for frequencies up to 10.0 Hz during locomotor tasks Maintaining head stability at high frequencies during voluntary tasks suggests that participants used feedforward mechanisms to coordinate head and trunk movements. Maintenance of head stability during dynamic tasks allows optimal conditions for vestibulo-ocular reflex function.

Usefulness of the Berg balance scale to predict falls in the elderly

Objective:The purpose of this systematic review was to complete a comprehensive search and review of the literature to determine the ability of the Berg Balance Scale (BBS) to predict falls in the elderly with and without pathology. Specifically, the cutoff score that is most predictive of falls in the older adults and the sensitivity and specificity of the BBS in predicting falls. Methods:A search of English-language–based literature with relevant search terms using the OVID, CINAHL, PubMed, and MEDLINE search engines from 1985 to March 2009. Results:Nine studies warranted inclusion in this systematic review after evaluation for article objectives, inclusion criteria, and scoring 5 or more out of 10 on the Physiotherapy Evidence Database scale. Five studies addressed the elderly population ( = 65 years) without pathology. The remaining 4 studies addressed elderly participants with neurological disorders. All 9 studies reported sensitivity and specificity of the BBS in predicting falls. Sensitivity and specificity results varied greatly depending on the cutoff score and the authors objectives. Eight of the 9 studies recommended specific cutoff scores. Discussion and Conclusion:The BBS alone is not useful for predicting falls in the older adults with and without pathological conditions. Given the varied recommended cutoff scores and psychometric values, clinicians should use the BBS in conjunction with other tests/measures considering unique patient factors to quantify the chances of falls in the older adults. This study recommends research to formulate a scoring algorithm that can further enhance the clinicians ability to predict falls in the older adults.

ASSOCIATION OF BALANCE MEASURES AND PERCEPTION OF FALL RISK ON GAIT SPEED: A MULTIPLE REGRESSION ANALYSIS

ABSTRACT Gait speed, commonly modified to adapt to the balance and stability challenges of aging, is related to measures of balance and mobility. This study investigated associations between age, Berg Balance Scale, Activities-Specific Balance Confidence (ABC) Scale, One Question Fear of Falling (1QFOF), and gait speed in adults using regression analysis. Results suggested an interaction between 1QFOF and ABC scores. An expanded five-variable model explained 49% of gait speed variance. Age, ABC, and 1QFOF-ABC interactions were significantly associated with gait speed. Regression analysis is useful in investigating associations between performance variables and function. Continued research needs to identify optimal variable combinations and improve prediction of function.

Balance abilities in individuals with moderate and severe traumatic brain injury

Balance characteristics, latency, amplitude, and symmetry were measured in 23 moderate and 23 severe traumatic brain-injured (TBI) patients. Patients received two graded forward and two graded backward linear perturbations. Although within normal limits, latency was high. Patients were able to appropriately grade force in relation to the size of the perturbation. Standing posture prior to and during perturbation was recorded by the amount of force generation through each lower extremity. Some individuals used an asymmetrical balance response following perturbations, whereas others shifted to a more symmetrical weight-bearing balance response. TBI patients may be prone to instability due to a combination of long latency of onset of the balance response coupled with asymmetrical stance patterns during recovery from an unexpected linear perturbation.

Gait Variability Detects Women in Early Postmenopause With Low Bone Mineral Density

Background Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. Objective The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. Design This study was an observational cohort design with participants assigned to groups on the basis of BMD status. Methods Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. Results Significant between-group differences were found for step time and stance time variability. Limitations The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. Conclusions Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Effect of guided relaxation and imagery on falls self-efficacy: a randomized controlled trial.

To examine the effects of guided relaxation and imagery (GRI) on improvement in falls self‐efficacy in older adults who report having a fear of falling.

The effects of aging on the attentional demands of walking toward and stepping up onto a curb

Community ambulation requires the capacity to alter gait in response to obstacles within the path of travel that appear at a known location. Acquiring information from the environment to safely negotiate a curb may increase the cognitive demands of walking. The purpose of this study was to examine the attentional demands of walking toward and stepping up onto a curb in young, middle-age and older adults. Single and dual-task voice reaction time (VRT) was measured in community-dwelling young (n = 24), middle-age (n = 24), and older adults (n = 24) across 5 conditions: sitting in a chair, standing, level walking, and walking toward and while stepping up onto a curb. A 3 (group) by 5 (task condition) ANOVA was used to examine VRT. The interaction of group with task revealed statistically significant within group increases in VRT when comparing either sitting and/or standing to walking on a level surface and walking toward the curb and stepping up onto the curb. When compared to the other groups, older adults had significantly longer VRT for all walking tasks. Stepping onto the curb significantly increased the attentional requirements of walking for all of the groups when compared to level walking. The pattern of statistically significant between group and within group differences during the walking tasks indicate the effects of a curb located at a predictable place in the environment on attentional allocation.

Balance Abilities of Homebound Older Adults Classified as Fallers and Nonfallers

Purpose: Balance instability and falling are not well documented in homebound older adults.This study examined balance, falls, and related variables in older adults primarily confined to their homes. Subjects: Thirty older adults between the ages of 66 and 99 years participated. Fifteen were classified as fallers and 15 classified as nonfallers. Methods: Subjects were assessed on the Berg Balance Test (BBT) and measures of fear of falling and activity levels. The number of environmental hazards in their homes that could contribute to falls was recorded. Results: Mean scores for the fallers and nonfallers were similar on the BBT (36.5 vs 35.7), Falls Efficacy Scale (16.8 vs 14.7), and Tinetti Activity Index (4.5 vs 4.9). A cut‐off score on the BBT of ≤ 45 yielded a sensitivity of 60%, a specificity of 40%, and a predictive value of 50% for determining fall risk. Conclusion: On the basis of BBT scores, homebound older adults receiving therapy services should be considered at risk of falling regardless of 6‐month fall history. These homebound individuals may be at higher risk of falling because their current health and medical condition precipitated the need for home care physical therapy.The BBT and screening for environmental hazards should be a standard part of all assessments for older adults using home care services.

The Relationship Between Physical Performance and Obesity in Elderly African-American Women

ABSTRACT Objective. To examine the relationship between physical performance and obesity in older African-American women. Methods. Obese (n = 45) and nonobese (n = 88) women were assessed using instrumental activities of daily living, physical function subscale of the Medical Outcomes Short Form-36, and the physical activity scale for the elderly. Physical performance was assessed by Berg Balance Scale, Tandem Stance and Single Test Stance Tests, Multidirectional Reach Test, Timed Up and Go Limb, Six-Minute Walk Test, gait stability ratio, and self-report of daily walking. Results. The obese group had significantly lower self-reported daily activities and poorer scores on several physical performance measures than nonobese older African-American women. Conclusions. Our findings substantiate a relationship between obesity and physical performance in African-American women. Although urban obese women have poorer physical performance, their impairments may be counterbalanced by their daily walking. Clinicians should consider this finding when developing rehabilitative and preventive strategies for older obese African-American women.