Software Application for Balance Assessment

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Original Editors - Aya Alhindi

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

Balance, also known as postural control, is the ability to maintain, attain, or correct the center of mass in relation to the base of support1 and it is necessary for successful daily life tasks. Maintaining normal balance requires multiple systems (somatosensory, vestibular, visual, musculoskeletal system, and cognition) working in integrative fashion, and the disorders affecting one or more of these systems may lead to impaired balance.

History taking[edit | edit source]

should include self -perceived balance impairment and falls. History taking can be framed for both patient’s complaints of specific system issues (e.g. foot pain) and description of overall balance impairment (feeling unsteady).[10]

Static balance assessment:[edit | edit source]

Functional reach test:[edit | edit source]

It is a quick and single task that is used to predicting falls in older adults. This test measures the margin of stability along with the ability to measure balance during a functional task.

  • The patient is instructed to stand next to, but not touching, a wall and position the arm that is closer to the wall at 90 degrees of shoulder flexion with a closed fist.
  • The assessor records the starting position at the 3rd metacarpal head on the yardstick. Instruct the patient to “Reach as far as you can forward without taking a step.”
  • The location of the 3rd metacarpal is recorded.
  • Scores are determined by assessing the difference between the start and end position is the reach distance, usually measured in inches.
  • Three trials are done and the average of the last two is noted.

Measurement:

  • 10”/25 cm or greater: Low risk of falls .
  • 6”/15cm to 10”/25cm Risk of falling is 2x greater than normal.
  • 6”/15cm or less Risk of falling is 4x greater than normal.
  • Unwilling to reach: Risk of falling is 8x greater than normal.[11]

Static and Dynamic Balance assessment:[edit | edit source]

The Berg Balance Scale:[edit | edit source]

It is a testing tool with high validity and reliability used to measure balance. It evaluates both dynamic and static balance through 14 tasks regarding mobility. The tasks varying in degrees of difficulty. The tasks are divided into 3 domains: sitting balance, standing balance, and dynamic balance.

  1. In the sitting balance the task is the evaluation of sitting unsupported. Standing balance consist of standing unsupported, standing with eyes closed, standing with feet together, standing on one foot, turning to look behind, grabbing an object from the floor, reaching forward with outstretched arms, and placing one foot in front of the other. In the last domain
  2. the dynamic balance is evaluated with the individual going from sitting to standing, standing to sitting, transferring, turning 360 degrees, placing one foot on a step.

Each task is graded on a 5-point ordinal scale that ranges from 0 to 4 for a maximum score of 56. In general, a score of 0 is given when the individual is unable to perform the task, and a score of 4 is given when able to complete the given task independently. Other factors that affect the points given are the time it takes to complete the task, the time a position can be maintained, and the amount of supervision or assistance required. The more time or supervision required or the need to use assistive devices affects the points given.

Total score after performing the test determines the predicted risk of falls. Overall, total scores below 45 are associated with a higher risk of falls. An individual with a history of falls and a total score below 51 is highly predictive of falls. A score of less than 40 is associated almost with a 100% fall risk.[12]

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

The Fullerton Test is mainly intended to identify highly active older adults who are at an increased risk to experience fall-related injuries due to sensory impairments. The test consists of 10 activities that challenge different aspects of balance, such as standing with eyes closed, reaching forward, turning, stepping, and standing on one leg. Each activity is scored on a 5-point scale from 0 to 4, where higher scores indicate better performance. The total score ranges from 0 to 40, with a score of 25 or lower indicating a high risk of falls.[13]

Balance Evaluation Systems Test (BESTest):[edit | edit source]

The Balance Evaluation Systems Test (BESTest) serves as a 36-item clinical balance assessment tool, developed to assess balance impairments across six contexts of postural control: mechanical constraints, limits of stability, APAs, postural response to induced loss of balance, sensory orientation, and gait. [14]

Dynamic Balance tests (gait activities)[edit | edit source]

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

It is a validated measure recommended to screen individuals for fall risk. It is based on the persons ability to hold four progressively more challenging positions

Directions – There are four standing positions that get progressively harder to maintain.

1. Stand with your feet side-by-side

2. Place the instep of one foot so it is touching the big toe of the other foot.

3. Tandem stance Place one foot in front of the other, heel touching toes.

4. Stand on one foot.

You should describe and demonstrate each position to the patient. Then, stand next to the patient, hold their arm, and help them assume the correct position.

When the patient is steady, let go, and time how long they can maintain the position, but remain ready to assist the patient if they should lose their balance.

If the patient can hold a position for 10 seconds without moving their feet or needing support, go on to the next position. If not, STOP the test. Patients should not use an assistive device (cane or walker) and they should keep their eyes open.

Outcomes Not being able to hold the tandem stance (task number 3) for 10 seconds is an indication of increased risk of fall.[15]

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

It is a modification of the Dynamic Gait Index (DGI) that uses higher-level tasks to increase the applicability of the test to people with vestibular disorders and to eliminate the ceiling effect of the original test. Three items were added to the DGI because these were noted to be difficult in people with vestibular disorders.

Number of Test Items: 10

Scoring: Each item is scored on an ordinal scale from 0 – 3, with

0 = severe impairment, 1 = moderate impairment, 2 = mild impairment, 3 = normal ambulation

Thus, the highest score is 30/30.[16]

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

In recent years, the Biodex Balance System (BBS) has been used to evaluate postural balance. The BBS is a multiaxial device that objectively measures and records an individual’s ability to stabilize the involved joint under dynamic stress. It uses a circular platform that is free to move in the anterior-posterior and medial-lateral axes simultaneously. It can also be used for the purpose of balance training.

The BBS allows up to 20° of foot platform tilt, which permits the ankle joint mechanoreceptors to be stimulated maximally. The BBS measures, in degrees, the tilt about each axis during dynamic conditions and calculates a medial-lateral stability index (MLSI), anterior-posterior stability index (APSI), and an overall stability index (OSI). These indexes represent fluctuations around a zero point established prior to testing when the platform is stable.[17]

Software Application Assessment[edit | edit source]

Control of balance is complex and involves maintaining postures, facilitating movement, and recovering equilibrium. Balance control consists of controlling the body center of mass over its limits of stability. Clinical balance assessment can help assess fall risk and/or determine the underlying reasons for balance disorders.[18]

Most of the traditional ways to assist balance are merely subjective, that's why more research, effort and time were put into the investigation of more accurate ways, and many ways were proven effective and easier for both parts.

There are many forms of evaluating body movements and balance, including observational assessments performed by experts, self-reporting of fall history, measurements collected from sensors and devices, and machine learning applications. Such sensor-based methods include laboratory force plates, accelerometers worn on the body, and, more recently, 3D motion capture devices and RGB-D sensors.[19]

An RGB-D sensor-based instrument for sitting balance assessment[edit | edit source]

Sitting balance is an important aspect of overall motor control, particularly for individuals who are not able to stand. Typical clinical assessment methods for sitting balance rely on human observation, making them subjective, imprecise, and sometimes time-consuming.[19]

Sitting balance is assessed almost entirely by observational methods with potentially imprecise and/or subjective mechanisms, particularly in the fields of physical and occupational therapy.[20]

Sensor-based methods of balance assessment have multiple advantages over methods that rely on human observation, including that they are based on objective data, they avoid the problem of bias associated with inter-operator variability, and participants may act more naturally than they would while under human observation. Another advantage offered by sensor-based methods is their ability to capture data from multiple parts of the body at once. A human observer is only able to direct attention to one area of the subject’s body at a time, meaning the subject will need to perform multiple tasks which isolate different areas of the body in order to receive a comprehensive assessment. 3D motion capture devices are more precise, objective, and capable of assessing multiple parts of the subject’s body simultaneously, which can significantly reduce data collection times.[19]

Red-Green-Blue-Depth (RGB-D) sensors have been widely used in many applications including rehabilitation[21][22], evaluation of patients with Parkinson’s disease[23], assessments of workplace ergonomics[24], and assessments of balance and postural control[25].

Microsoft Kinect™ to assess standing balance.[edit | edit source]

Many researchers have used inexpensive RGB-D sensors like the Microsoft Kinect™ to assess standing balance during clinical tests of postural control. The Kinect device incorporates a color video camera and a depth camera to create a 3D map of the area in front of the sensor and uses a randomized decision forest algorithm in close to real time to determine the location of the subject’s body joints. The sensor can recognize 25 body joints representing the positions of the major joints of the human body and estimations of the positions of the major limbs.

The Kinect offers some advantages over other 3D camera body tracking systems in that it is both portable and affordable, and minimally intrusive, as it does not require the subject to wear markers on the body. In their review of Kinect-based applications to elderly care and stroke rehabilitation, authors Webster & Celik [26] acknowledged the Kinect’s potential as a component of financially accessible and medically beneficial therapy and alert systems. However, they also identified the following limitations: difficulty in capturing fine movements, fixed location and limited range of capture, lack of biomechanical accuracy in the shoulder joint, and limitations in fall risk reduction methodologies. A number of studies have evaluated the efficacy of using the Kinect for postural assessment in comparison to more expensive 3D motion capture devices, and 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 [19].

The Kinect was more spatially accurate for large body movements than small body movements and suggested that it could be valuable for tracking relative changes in body movements over time.[27]

The Kinect was found to be slightly less accurate in identifying sitting body movements than standing body movements.[28]

Wearable Inertial Sensors.[edit | edit source]

A wearable inertial sensing unit typically includes accelerometers, gyroscopes, and magnetometers. A triaxial accelerometer measures the proper linear acceleration of movements in a sensor-fixed three-dimensional (3D) frame; measured data include both motion and gravity components.[29]

From the beginning of the new millennium, technology advances in the field of motion measurement techniques allowed to measure kinematics of body segments without the need of camera-based systems using wearable inertial sensors. Some of the potential benefits of using wearable inertial devices to assess movements in clinical settings include the low cost, small dimensions and light weight of these devices, and the absence of any limitation of the testing environment to a laboratory.

The most common and promising areas of application of IMUs are gait analysis, instrumented clinical tests; daily-life activities, and tremor. Gait analysis performed by using IMUs may allow for suitably assessing upright gait stability.

One of the most important advantages of wearable IMU is the possibility of collecting data without laboratory restrictions: it allows for a continuous and objective assessment of activities of daily living. IMUs also allow the possibility of a quantitative assessment of tremor in terms of amplitude and frequency. The interest for wearable inertial systems will probably even increase in the next years, becoming a common tool for clinical motor assessment. In the next future, these devices will also be combined with other machines, for example embedded in video-game based therapy and in neuro-robots for rehabilitation.[30]

Mobile phone applications[edit | edit source]

There is a need for portable, valid, and reliable methods to facilitate the easy collection of real-world data, as mobile phones.[31]

There are many attempts for several mobile phone applications to assess balance, including MyAnkle, Sway, sensor kinetics pro and many others.

The number of smartphone apps for self-managed or professional health assessment is rapidly developing. Furthermore, the use of mobile devices for mHealth continues growing in all groups of population[32]. Thus, due to the situation described, apps targeted to assess the body balance need to be validated in order to offer an adequate service. The assessment accuracy of these kind of apps will support an adequate training program, through the same app or leads by a therapist, so the app reports are useful. However, the apps development in relation to health assessment or promotion needs to be regulated. There are several commercial software developers that offer mHealth solutions without evidence in their results. As it is reflected in the scientific literature, the risks to patient safety and professional reputation are real, and some considerations should be taken into account. [33]

MyAnkle application[edit | edit source]

"MyAnkle” is a smartphone application that was developed to assess standing balance in healthy volunteers. This application was validated against subjective experts’ rating rather than using objective methods.

“MyAnkle” smartphone application is an alternative to the BBS in assessing overall balance among patients and healthy volunteers when the eyes are closed, regardless of limb dominance. However, there is no evidence to support application’s validity in assessing balance when the eyes are opened, regardless of limb side and participants’ grouping.[31]

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.[32]

  • 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.[32] [34]

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.[35]
  • 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).[36]

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.[37]
  • Excellent internal consistency (Cronbach’s alpha=0.805).[38]

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 [39]

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). [40]

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.[41]

  • 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 [42]
  • The FGA has been found to maintain reliability when translated into different languages and from standard to metric scale.[43]

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. [44]

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.[45]

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) .[46]

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. [47]

In assessing standing balance Microsoft Kinect™ may reliably and validly evaluate standing balance when its measured COM parameters are calibrated by linear equations.[48]

Slight body movements may not be detected accurately by the Kinect, which would result in an unchanged COM. [48]

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[49]

Validity[edit | edit source]

Functional reach test:[edit | edit source]

functional reach test has been proven to be a valid method for balance assessment[34][32][50][51], 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[52].

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[53][54].

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

Schlenstedt et al., tested the validity of FAB scale in postural control assessment in Parkinson's disease and Özbaş et al., also tested the validity of the same test in patients with multiple sclerosis. Both studies revealed that FAB scale is a valid method, does not need an experienced physiotherapist, and suitable for online use[55][56].

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

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

The convergent validity of FGA was compared with 10 minutes walk test (10MWT), Walking Index for Spinal Cord Injury II (WISCI-II), and Spinal Cord Injury Functional Ambulation Profile (SCI-FAP). This comparison resulted in the FGA is an excellent valid method for assessing balance in spinal cord injury population as the other tests have limitation in clinical application[57].

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[58].

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[45][48].

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[49].

Resources[edit | edit source]

References[edit | edit source]

  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.
  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].
  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. ↑ Oh-Park, M., & Mehta, N. (2016). Assessment and Treatment Of Balance Impairments. American Academy Of Physical and Medical Rehablitation.
  11. ↑ Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance.J Gerontol. 1990;45(6):M192-197.
  12. ↑ Miranda-Cantellops, N., & Tiu, T. K. (2021). Berg balance testing.
  13. ↑ Klein, P. J., Fiedler, R. C., et al. (2011). "Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale." Physiother Can 63(1): 115-125
  14. ↑ Balance Evaluation Systems Test. Shirley Ryan AbilityLab.
  15. ↑ The 4-Stage Balance Test - Physiopedia (physio-pedia.com)
  16. ↑ Functional gait assessment. Shirley Ryan AbilityLab.
  17. ↑ Biodex Balance System - Physiopedia (physio-pedia.com)
  18. ↑ Mancini, M., & Horak, F. B. (2010). The relevance of clinical balance assessment tools to differentiate balance deficits. European Journal of Physical and Rehabilitation Medicine, 46(2), 239.
  19. ↑ 19.0 19.1 19.2 19.3 Bartlett, K. A., & Camba, J. D. (2023). An RGB-D sensor-based instrument for sitting balance assessment. Multimedia Tools and Applications, 82(18), 27245–27268.
  20. ↑ Arora T, Oates A, Lynd K, Musselman KE (2020) Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: a systematic review. J Spinal Cord Med 43(1):10–23.
  21. ↑ Bo APL, Hayashibe M, Poignet P (2011) Joint angle estimation in rehabilitation with inertial sensors and its integration with Kinect. In: Engineering in medicine and biology society, EMBC, 2011 annual international conference of the IEEE. IEEE, pp 3479-3483
  22. ↑ Kitsunezaki N, Adachi E, Masuda T, Mizusawa JI (2013) KINECT applications for the physical rehabil�itation. In: Medical measurements and applications proceedings (MeMeA), 2013 IEEE international symposium on. IEEE, pp 294-299
  23. ↑ Galna B, Barry G, Jackson D, Mhiripiri D, Olivier P, Rochester L (2014) Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson’s disease. Gait Posture 39(4):1062–1068
  24. ↑ Diego-Mas JA, Alcaide-Marzal J (2014) Using Kinect™ sensor in observational methods for assessing postures at work. Appl Ergon 45(4):976–985
  25. ↑ Clark RA, Pua YH, Fortin K, Ritchie C, Webster KE, Denehy L, Bryant AL (2012) Validity of the Microsoft Kinect for assessment of postural control. Gait Posture 36(3):372–377
  26. ↑ Webster D, Celik O (2014) Systematic review of Kinect applications in elderly care and stroke rehabilitation. J Neuroeng Rehabil 11(1):108
  27. ↑ Galna B, Barry G, Jackson D, Mhiripiri D, Olivier P, Rochester L (2014) Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson’s disease. Gait Posture 39(4):1062–1068
  28. ↑ Xu X, McGorry RW (2015) The validity of the first and second generation Microsoft Kinect™ for identifying joint center locations during static postures. Appl Ergon 49:47–54
  29. ↑ Ghislieri, M., Gastaldi, L., Pastorelli, S., Tadano, S., & Agostini, V. (2019). Wearable inertial sensors to assess standing balance: A systematic review. Sensors (Basel, Switzerland), 19(19), 4075.
  30. ↑ Iosa, Marco; Picerno, Pietro; Paolucci, Stefano; Morone, Giovanni (2016). Wearable inertial sensors for human movement analysis. Expert Review of Medical Devices, (), 1–19. doi:10.1080/17434440.2016.1198694
  31. ↑ 31.0 31.1 Abdo, N., ALSaadawy, B., Embaby, E., & Rehan Youssef, A. (2020). Validity and reliability of smartphone use in assessing balance in patients with chronic ankle instability and healthy volunteers: A cross-sectional study. Gait & Posture, 82, 26–32.
  32. ↑ 32.0 32.1 32.2 32.3 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.
  33. ↑ Morera, E. P., De la Torre Díez, I., Garcia-Zapirain, B., López-Coronado, M., and Arambarri, J., Security recommendations for mHealth apps: Elaboration of a developer’s guide. J. Med. Syst. 40(6):152, 2016.
  34. ↑ 34.0 34.1 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.
  35. ↑ 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.
  36. ↑ 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.
  37. ↑ 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.
  38. ↑ Klein, P. J., Fiedler, R. C., et al. (2011). "Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale." Physiother Can 63(1): 115-125
  39. ↑ 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.
  40. ↑ 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.
  41. ↑ 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.
  42. ↑ 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.
  43. ↑ 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.
  44. ↑ 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.
  45. ↑ 45.0 45.1 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.
  46. ↑ 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.
  47. ↑ 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.
  48. ↑ 48.0 48.1 48.2 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.
  49. ↑ 49.0 49.1 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.
  50. ↑ 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.
  51. ↑ Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: a marker of physical frailty. J Am Geriatr Soc 1992; 40: 203 207.
  52. ↑ 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.
  53. ↑ 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
  54. ↑ 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.
  55. ↑ Schlenstedt C, Brombacher S, Hartwigsen G, Weisser B, Möller B, Deuschl G. Comparison of the fullerton advanced balance scale, mini-BESTest, and berg balance scale to predict falls in Parkinson disease. Physical therapy. 2016 Apr 1;96(4):494-501.
  56. ↑ Özbaş E, Balkan AF, Salcı Y, Tuncer A. Reliability and Validity of The Fullerton Advanced Balance Scale in People with Multiple Sclerosis. Multiple Sclerosis and Related Disorders. 2023 Nov 1;79:104980.
  57. ↑ Kahn JH, Ohlendorf A, Olsen A, Gordon KE. Reliability and validity of the functional gait assessment in incomplete spinal cord injury. Topics in spinal cord injury rehabilitation. 2020 Dec 1;26(4):268-74.
  58. ↑ 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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