Software Application for Balance Assessment: Difference between revisions

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</ref><ref name=":0">Duncan PW, Studenski S, Chandler J, Prescott B. [https://academic.oup.com/geronj/article-abstract/47/3/M93/556518?redirectedFrom=fulltext Functional reach: predictive validity in a sample of elderly male veterans]. J Gerontol 1992; 47: M93–M98.</ref><ref>Weiner DK, Bongiorni DR, Studenski SA, Duncan PW, Kochers berger GG. [https://www.sciencedirect.com/science/article/abs/pii/000399939390003S Does functional reach improve with rehabilitation?] Arch Phys Med Rehabil 1993; 74: 796–800.</ref><ref>Weiner DK, Duncan PW, Chandler J, Studenski SA. [https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.1992.tb02068.x Functional reach: a marker of physical frailty]. J Am Geriatr Soc 1992; 40: 203 207.</ref>, but clinicians should consider other factors that can affect the results, such as decreased trunk mobility, decreased calf muscle flexibility, trunk rotation, and center of pressure displacement. So, it is recommended that clinicians use multiple assessment tools for balance assessment, as no one test can measure all factors affecting balance<ref>Jonsson E, Henriksson M, Hirschfeld H. [https://medicaljournals.se/jrm/content/abstract/10.1080/16501970306099 Does the functional reach test reflect stability limits in elderly people?]. Journal of rehabilitation medicine. 2003 Jan 1;35(1):26-30.</ref>.
</ref><ref name=":0">Duncan PW, Studenski S, Chandler J, Prescott B. [https://academic.oup.com/geronj/article-abstract/47/3/M93/556518?redirectedFrom=fulltext Functional reach: predictive validity in a sample of elderly male veterans]. J Gerontol 1992; 47: M93–M98.</ref><ref>Weiner DK, Bongiorni DR, Studenski SA, Duncan PW, Kochers berger GG. [https://www.sciencedirect.com/science/article/abs/pii/000399939390003S Does functional reach improve with rehabilitation?] Arch Phys Med Rehabil 1993; 74: 796–800.</ref><ref>Weiner DK, Duncan PW, Chandler J, Studenski SA. [https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.1992.tb02068.x Functional reach: a marker of physical frailty]. J Am Geriatr Soc 1992; 40: 203 207.</ref>, but clinicians should consider other factors that can affect the results, such as decreased trunk mobility, decreased calf muscle flexibility, trunk rotation, and center of pressure displacement. So, it is recommended that clinicians use multiple assessment tools for balance assessment, as no one test can measure all factors affecting balance<ref>Jonsson E, Henriksson M, Hirschfeld H. [https://medicaljournals.se/jrm/content/abstract/10.1080/16501970306099 Does the functional reach test reflect stability limits in elderly people?]. Journal of rehabilitation medicine. 2003 Jan 1;35(1):26-30.</ref>.


==== '''Berg balance scale:''' ====
==== '''Berg balance Scale (BBS) and Balance Evaluation Systems Test (BESTest):''' ====
The validity of (BBS, BESTest, Mini-BESTest, and brief BESTest) was studied in several studies and it was found that all four tests have almost the same validity in balance with slightly increased accuracy in mini-BESTest when compared only with BBS and suggestions for usage of brief BESTest due to its simplicity and quickness in usage<ref>Godi M, Franchignoni F, Caligari M, Giordano A, Turcato AM, Nardone A. [https://academic.oup.com/ptj/article/93/2/158/2735496 Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders.] Physical therapy. 2013 Feb 1;93(2):158-67.
 
BibTeXEndNoteRefManRefWorks</ref><ref>Viveiro LA, Gomes GC, Bacha JM, Junior NC, Kallas ME, Reis M, Jacob Filho W, Pompeu JE. [https://journals.lww.com/jgpt/fulltext/2019/10000/reliability,_validity,_and_ability_to_identity.21.aspx Reliability, validity, and ability to identity fall status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in older adults who live in nursing homes]. Journal of geriatric physical therapy. 2019 Oct 1;42(4):E45-54.</ref>.


==== '''Fullerton Advanced Balance Scale (FAB):''' ====
==== '''Fullerton Advanced Balance Scale (FAB):''' ====


==== '''Balance Evaluation Systems Test (BESTest):''' ====
==== '''The Four-Stage Balance Test:''' ====
 
==== '''The Four Stage Balance Test:''' ====


==== '''The Functional Gait Assessment (FGA) :''' ====
==== '''The Functional Gait Assessment (FGA) :''' ====

Revision as of 23:53, 24 February 2024

Welcome to PTCU Excellence and Innovation Unit Project. This space was created by and for the students at Cairo University. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editors - Aya Alhindi

Top Contributors - Shrouk Ashraf Rekaby, Kim Jackson, Shahd Mohammed Abdelhafeez Hamed, Adham Abdelhady, Mohamed A Hassanin, Mariam Eldaly, Aya Alhindi and Esraa Elsaeed Mohamed  

Introduction[edit | edit source]

Balance is the ability to evenly distribute body weight in static positions e.g. standing or during movement so person doesn’t fall or can recover from any external disturbances to this state and it is closely related to the position of body’s center of gravity. Due to its dependence on neuromusculoskeletal system, Balance deficits can occur due to many disorders or diseases in your body. Imbalance symptoms like dizziness and vertigo are common in world-wide community (dizziness 17 - 30%, and for vertigo 3 - 10%)[1]. That’s why Physiotherapists and other health care professions pay special attention to balance deficits among patients they deal with.

The three-level nervous system deficits model based on the level of neuronal processing involved[2]:

Level 1: Low level deficits depict gait disorders due to peripheral sensory (peripheral neuropathy, vestibular, hearing[3] or visual dysfunction) or peripheral motor impairment (myopathy, focal muscle weakness e.g. peroneus paresis). Low level impairments can be compensated, if central nervous functions are intact.

Level 2: Intermediate level deficits are caused by dysfunction of postural or motor responses, and sensory and motor modulation as in spastic hemiplegia, spastic paraplegia, extrapyramidal (e.g. Parkinsonian) gait disorders, and cerebellar movement disorders.

Level 3: Higher level disorders are characterized by cognition deficits in planning, intention, and executive functions, as well as gait apraxia. As in dementia and depression.

Patients with diseases of other body systems can complain from imbalance like patients with chronic obstructive pulmonary disease[4], Obesity[5], Hip arthroplasties (Surgical and post-operative risk factors)[6]and knee osteoarthritis[7].

Types of Balance[edit | edit source]

  1. Static balance: can be defined as the maintenance of a steady position on a fixed ,firm stable support base [8]. Static balance can be also defined as the ability to maintain support with minimum movement of one or both legs.

2.Dynamic balance : it is the ability to perform activities while maintaining a stable position.[9]

Traditional Assessment[edit | edit source]

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Software Application Assessment[edit | edit source]

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Reliability[edit | edit source]

Functional Reach Test[edit | edit source]

Functional Reach Test is a reliable and valid measure of balance that is also sensitive to clinically significant changes.[10]

  • The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability.
  • Intra-class correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r=0.32-0.74 p≤0.05)
  • Test-retest reliability r = 0.89
  • Inter-rater agreement on reach measurement = 0.98.[10] [11]

Berg balance scale:[edit | edit source]

  • A total of 33 articles were included. The BBS was found to have excellent reliability and validity. The scores were predictive of factors contributing to patient function and performance. Fall risk was unable to be strongly predicted from scores.[12]
  • Studies of various elderly populations (N = 31–101, 60–90 + years of age) have shown high intra-rater and inter-rater reliability (ICC =.98,14,15 ratio of variability among subjects to total = .96–1.0,16 rs =.8817). Test-retest reliability in 22 people with hemiparesis is also high (ICC [2,1]=.98).[13]

Fullerton Test:[edit | edit source]

  • Excellent test-retest reliability (ICC=0.98).
  • Older Adults: Excellent test re-test reliability (r = 0.96) for total score.
  • Older adults: Excellent internal consistency (H coefficients >0.75) for all 10 items.[14]
  • Excellent internal consistency (Cronbach’s alpha=0.805).[15]

The BESTest[edit | edit source]

The BESTest showed excellent inter- reliability of the total score with inter-class correlation (ICC) of 0.91 and subsection ICC ranged from 0.79 to 0.95:

  • Bio-mechanical constraints: 0.80
  • Stability limits/verticality: 0.79
  • Anticipatory Postural Adjustments: 0.92
  • Postural Reactions: 0.92
  • Sensory Orientation: 0.96
  • Stability of Gait: 0.88 [16]

Four stage balance test :[edit | edit source]

Interclass (Pearson) correlations, with time between test and re-test of 3-4 months, 187 subjects from the community) is reported as moderate (0.66). [17]

Functional Gait Assessment Test :[edit | edit source]

Eight studies have shown that The FGA has a high inter-rater reliability across the patient populations studied.[18]

  • Intrarater reliability of the total FGA: ICC = 0.83
  • Interrater reliability of the total FGA: ICC = 0.84
  • ⁠Internal Consistency: Cronbach alpha value 0.79 across both trials [19]
  • The FGA has been found to maintain reliability when translated into different languages and from standard to metric scale.[20]

Biodex Balance System (BBS) :[edit | edit source]

Biodex balance measures have been found to be reliable. Biodex Balance may be useful for the measurement of the risk of falls and for demonstrating the progress patients in exercise programs oriented to the improve of balance for falls prevention. [21]

Microsoft Kinect™:[edit | edit source]

A number of studies have evaluated the efficacy of using the Kinect for postural assessment in comparison to 3D motion analysis system have concluded that although slightly less accurate, the data collected with the Kinect was reliable enough to use for the assessment of body movements and postural control during common clinical tests.[22]

In a study by Clark et al. (2015) comparing the inter-trial reliability and concurrent validity of the Microsoft Kinect™ and 3D motion analysis systems; The Microsoft Kinect™ and 3D motion analysis systems had comparable inter-trial reliability (ICC difference = 0.06 ± 0.05; range, 0.00–0.16) and excellent concurrent validity, with Pearson's r-values >0.90 for the majority of measurements (r = 0.96 ± 0.04; range, 0.84–0.99) .[23]

Microsoft Kinect™ system provides comparable data to a video-based 3D motion analysis system when assessing step length and less accurate but still clinically acceptable for step times during balance recovery when balance is lost and fall is initiated. [24]

In assessing standing balance Microsoft Kinect™ may reliably and validly evaluate standing balance when its measured COM parameters are calibrated by linear equations.[25]

Slight body movements may not be detected accurately by the Kinect, which would result in an unchanged COM. [25]

MyAnkle software application[edit | edit source]

The application showed a significant poor to good inter-session correlations for all the measured variables in the two groups (ICC:0.34-0.81, p < 0.05), except for healthy volunteers' tested during dominant limb standing while eyes were opened in the D6 level[26]

Validity[edit | edit source]

Functional reach test:[edit | edit source]

functional reach test has been proven to be a valid method for balance assessment[11][10][27][28], but clinicians should consider other factors that can affect the results, such as decreased trunk mobility, decreased calf muscle flexibility, trunk rotation, and center of pressure displacement. So, it is recommended that clinicians use multiple assessment tools for balance assessment, as no one test can measure all factors affecting balance[29].

Berg balance Scale (BBS) and Balance Evaluation Systems Test (BESTest):[edit | edit source]

The validity of (BBS, BESTest, Mini-BESTest, and brief BESTest) was studied in several studies and it was found that all four tests have almost the same validity in balance with slightly increased accuracy in mini-BESTest when compared only with BBS and suggestions for usage of brief BESTest due to its simplicity and quickness in usage[30][31].

Fullerton Advanced Balance Scale (FAB):[edit | edit source]

The Four-Stage Balance Test:[edit | edit source]

The Functional Gait Assessment (FGA) :[edit | edit source]

Biodex Balance System (BBS):[edit | edit source]

Dawson et al., examined the validity of commonly used assessment tools to measure balance (i.e., four‐square step test, timed‐up‐and‐go test, and Biodex balance system) and found that all these tools have poor construct validity, and each of them is focused on a particular aspect of balance factors[32].

Microsoft Kinect™:[edit | edit source]

Several studies assessed the validity of using Microsoft Kinect™ for standing balance assessment using positional variability of center of mass (COM) and revealed that it is a valid method for this assessment[22][25].

MyAnkle software application:[edit | edit source]

Abdo et al., tested the validity of MyAnkle smartphone application using BBS as a gold standard and supported usage of MyAnkle for balance assessment while closing eyes but the validity of the application to evaluate balance with eyes open is unsupported by any evidence, irrespective of the participant's grouping or limb side. Also, the application failed to discriminate between patients and healthy people so clinicians should be cautious while using this application in follow-up[26].

Resources[edit | edit source]

References[edit | edit source]

see adding references tutorial.

  1. ↑ Murdin L, Schilder AGM. Epidemiology of Balance Symptoms and Disorders in the Community. Otology & Neurotology. 2015 Mar;36(3):387–92.
  2. ↑ Axer H, Axer M, Sauer H, Witte OW, Hagemann G. Falls and gait disorders in geriatric neurology. Clinical Neurology and Neurosurgery. 2010 May;112(4):265–74.
  3. ↑ Carpenter MG, Campos JL. The Effects of Hearing Loss on Balance: A Critical Review. Ear & Hearing [Internet]. 2020 Oct 26;41(Supplement 1):107S119S. Available from: https://journals.lww.com/ear-hearing/fulltext/2020/11001/the_effects_of_hearing_loss_on_balance__a_critical.12.aspx
  4. ↑ beauchamp MK, Hill K, Goldstein RS. Impairments in balance discriminate fallers from non-fallers in COPD [Internet]. Respiratory Medicine ; 2009 [cited 2024 Feb 16]. Available from: https://www.resmedjournal.com/article/S0954-6111(09)00209-1/fulltext
  5. ↑ Alice A, Yadav M, Verma R, Kumari M, Arora S. Effect of obesity on balance. International journal of health sciences. 2022 Jun 17;3261–79.
  6. ↑ Di Laura Frattura G, Bordoni V, Feltri P, Fusco A, Candrian C, Filardo G. Balance Remains Impaired after Hip Arthroplasty: A Systematic Review and Best Evidence Synthesis. Diagnostics. 2022 Mar 11;12(3):684.
  7. ↑ Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, et al. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis & Rheumatism. 2006;55(4):610–5.
  8. ↑ Gonçalves C, Vila-Chã C, Bezerra P, Clemente F, Leão C, Brandão A, et al. The connection between dynamic and static balance in young people who are active. 2022;23(2):65–75; Human Movement. Reference: 10.5114/hm.2021.106165.
  9. ↑ 1. Mahmoudi F, Rahnama N, Daneshjoo A, Behm DG. Comparison of dynamic and static balance among professional male soccer players by position. Journal of Bodywork and Movement Therapies [Internet]. 2023 Oct 1 [cited 2023 Oct 6];36:307–12. Available from: https://www.sciencedirect.com/science/article/pii/S1360859223001705 ‌
  10. ↑ 10.0 10.1 10.2 Duncan PW, Studenski S, Chandler J, Prescott B. Functional reach: predictive validity in a sample of elderly male veterans. J Gerontol 1992; 47: M93–M98.
  11. ↑ 11.0 11.1 Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. Journal of gerontology. 1990 Nov 1;45(6):M192-7.
  12. ↑ Kudlac M, Sabol J, Kaiser K, Kane C, Phillips RS. Reliability and validity of the Berg balance scale in the stroke population: a systematic review. Physical & Occupational Therapy in Geriatrics. 2019 Jul 3;37(3):196-221.
  13. ↑ Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scandinavian journal of rehabilitation medicine. 1995 Mar 1;27(1):27-36.
  14. ↑ Rose, D. J., Lucchese, N., et al. (2006). "Development of a multidimensional balance scale for use with functionally independent older adults." Archives of Physical Medicine and Rehabilitation 87(11): 1478-1485.
  15. ↑ Klein, P. J., Fiedler, R. C., et al. (2011). "Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale." Physiother Can 63(1): 115-125
  16. ↑ Horak FB, Wrisley DM, Frank J. The balance evaluation systems test (BESTest) to differentiate balance deficits. Physical therapy. 2009 May 1;89(5):484-98.
  17. ↑ Rossiter-Fornoff JE, Wolf SL, Wolfson LI, Buchner DM, FICSIT Group. A cross-sectional validation study of the FICSIT common data base static balance measures. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1995 Nov 1;50(6):M291-7.
  18. ↑ Weber C, Schwieterman M, Fier K, Berni J, Swartz N, Phillips RS, Reneker JC. Reliability and validity of the functional gait assessment: A systematic review. Physical & Occupational Therapy in Geriatrics. 2016 Jan 2;34(1):88-103.
  19. ↑ Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, Internal Consistency and Validity of Data Obtained with the Functional Gait Assessment. Physical Therapy. 2004; 84(10): 906-918.
  20. ↑ Kirkwood RN, Batista NC, Marques LB, de Melo Ocarino J, Neves LL, de Souza Moreira B. Cross-cultural adaptation and reliability of the functional gait assessment in older Brazilian adults. Brazilian Journal of Physical Therapy. 2021 Jan 1;25(1):78-85.
  21. ↑ Cachupe WJ, Shifflett B, Kahanov L, Wughalter EH. Reliability of biodex balance system measures. Measurement in physical education and exercise science. 2001 Jun 1;5(2):97-108.
  22. ↑ 22.0 22.1 Clark RA, Pua YH, Fortin K, Ritchie C, Webster KE, Denehy L, Bryant AL. Validity of the Microsoft Kinect for assessment of postural control. Gait & posture. 2012 Jul 1;36(3):372-7.
  23. ↑ Clark RA, Pua YH, Oliveira CC, Bower KJ, Thilarajah S, McGaw R, Hasanki K, Mentiplay BF. Reliability and concurrent validity of the Microsoft Xbox One Kinect for assessment of standing balance and postural control. Gait & posture. 2015 Jul 1;42(2):210-3.
  24. ↑ Shani G, Shapiro A, Oded G, Dima K, Melzer I. Validity of the microsoft kinect system in assessment of compensatory stepping behavior during standing and treadmill walking. European Review of Aging and Physical Activity. 2017 Dec;14(1):1-1.
  25. ↑ 25.0 25.1 25.2 Yang Y, Pu F, Li Y, Li S, Fan Y, Li D. Reliability and validity of Kinect RGB-D sensor for assessing standing balance. IEEE Sensors Journal. 2014 Jan 2;14(5):1633-8.
  26. ↑ 26.0 26.1 Abdo N, ALSaadawy B, Embaby E, Youssef AR. Validity and reliability of smartphone use in assessing balance in patients with chronic ankle instability and healthy volunteers: A cross-sectional study. Gait & Posture. 2020 Oct 1;82:26-32.
  27. ↑ Weiner DK, Bongiorni DR, Studenski SA, Duncan PW, Kochers berger GG. Does functional reach improve with rehabilitation? Arch Phys Med Rehabil 1993; 74: 796–800.
  28. ↑ Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: a marker of physical frailty. J Am Geriatr Soc 1992; 40: 203 207.
  29. ↑ Jonsson E, Henriksson M, Hirschfeld H. Does the functional reach test reflect stability limits in elderly people?. Journal of rehabilitation medicine. 2003 Jan 1;35(1):26-30.
  30. ↑ Godi M, Franchignoni F, Caligari M, Giordano A, Turcato AM, Nardone A. Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders. Physical therapy. 2013 Feb 1;93(2):158-67. BibTeXEndNoteRefManRefWorks
  31. ↑ Viveiro LA, Gomes GC, Bacha JM, Junior NC, Kallas ME, Reis M, Jacob Filho W, Pompeu JE. Reliability, validity, and ability to identity fall status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in older adults who live in nursing homes. Journal of geriatric physical therapy. 2019 Oct 1;42(4):E45-54.
  32. ↑ Dawson N, Dzurino D, Karleskint M, Tucker J. Examining the reliability, correlation, and validity of commonly used assessment tools to measure balance. Health science reports. 2018 Dec;1(12):e98.
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