Unbalanced walking is increasingly common among older adults; therefore, routinely assessing the balance of older adults is crucial. The traditional method of assessing balance uses scales, requires ...the supervision of a physical therapist (PT), and is time-consuming. The present study, therefore, proposes a deep learning (DL) model architecture that combines a convolutional neural network (CNN) and a long short-term memory (LSTM) network model to predict the scores of three scales, namely the Berg balance scale (BBS), timed up and go (TUG), and single-leg stance (SLS). The gait data of 15 m of walking were collected from seven inertial measurement units (IMUs) and input into the CNN-LSTM model for evaluation. The BBS and TUG only require the participants to wear two IMUs on the left and right thighs, respectively, for accurate predictions. The mean absolute errors (MAEs) of predicting the scores of the BBS and TUG are 1.2562 and 1.4016 s, respectively; however, the MAE of score predictions of SLS is higher than that of the BBS and TUG, indicating that gait data cannot be used for assessing SLS; moreover, participants only wear one IMU on the right calf for BBS and TUG evaluations, which yield MAEs of 1.4334 and 1.5229 s, respectively. The proposed system can quickly and accurately predict the scores of the BBS and TUG. The proposed model can assist PTs with making clinical decisions.
Introduction: Patients who have had a stroke often experience issues with static balance while sitting and standing. Additionally, they may encounter problems with dynamic balance, particularly when ...transitioning between sitting and standing positions, leading to reduced postural stability in both static and dynamic standing. This also contributes to weakness in the affected lower limb and decreased engagement in Activities of Daily Living (ADL). Nevertheless, few studies have investigated the impact of sit-to-stand training on balance, muscle strength, and ADL in stroke patients. Aim: To assess the impact of sit-to-stand training on balance, muscle strength, and ADL in patients who have had a stroke. Materials and Methods: This trial was an experimental, parallel, and assessor-blinded allocation with a computer-generated randomisation sequence. Sixty-six stroke patients (33 in each group) were enrolled from the inpatient Department of Medicine and the neurosurgery ward of Justice KS Hegde Charitable Hospital in Deralakatte, Mangaluru, Karnataka, India based on specific selection criteria. The trial was conducted from March 2022 to March 2023. Inclusion criteria included patients who had experienced a stroke involving the Anterior Cerebral Artery (ACA) and Middle Cerebral Artery (MCA), encompassing both ischaemic and haemorrhagic types of stroke, aged between 35-60 years, and including both male and female stroke patients who were able to effectively communicate and comprehend instructions. Other criteria included a Mini-Mental State Examination (MMSE) score greater than or equal to 23, the ability to independently have a transition from a supine position to a seated position, and a minimum score on the trunk impairment scale. In the experimental group, participants received sit-to-stand training for 45 minutes over five days, while the control group received conventional physical therapy, including tandem walking, single leg stance, double leg stance, early mobilisation, position and balance training exercises for 45 minutes over five days. The primary outcomes used for balance assessment were the Berg Balance Scale (BBS), and for ADL, the Barthel Index (BI) Scale was used, with muscle strength being measured using a push and pull dynamometer. The independent sample t-test was used to compare between groups, and within-group comparisons were conducted using the paired t-test. A p-value <0.05 was considered significant. Results: Significant differences (p-value=0.044) were observed in BBS score and muscle strength between the groups during both the pretest (Day-1) and post-test (Week-1). The BI exhibited a significant difference (p-value=0.016) during the post-test (Week-1) only. Additionally, a significant difference (p-value<0.001) was found in muscle strength, specifically in the Hip Extensors (HE) between the groups. Conclusion: The results of the current study showed a statistically significant difference in muscle strength of the HE. However, no significant difference was observed in BI and BBS between the groups. No side-effects or harms were reported, indicating that the approach is safe and feasible for stroke patients.
To translate the Berg Balance Scale (BBS) to Hungarian and to evaluate the psychometric characteristics of the Hungarian version (HU-BBS).
In total, 150 institutionalised older adults were recruited ...for the study. Eighty-one participants completed the retesting. Internal consistency, intra- and inter-rater reliability, and 95% limits of agreement of the HU-BBS were examined. Construct validity was assessed through convergent, discriminant, and known-group validity.
The overall Cronbach's alpha was 0.943. The intra- and inter-rater reliability was excellent (intraclass correlation coefficient > 0.92). The Bland-Altman analysis revealed a mean inter-rater difference of 0.284 −2.193-2.744 and a mean intra-rater difference of 0.259 −2.657-3.162. Regarding convergent validity, the HU-BBS was correlated with the functional status (r = 0.833), Timed Up and Go test (r= −0.824), and age (r= −0.606). The HU-BBS scores of women were similar to those of men (p = 0.104), showing discriminant validity. Additionally, the HU-BBS scores were lower among faller than among non-faller participants (p ˂ 0.0001), establishing known-group validity.
Translation and cultural adaptation of the original scale was successful. The HU-BBS proved to be a reliable, valid tool confirming that it can be used in future clinical and scientific work on Hungarian older adults.
Implications for rehabilitation
Institutionalised older adults are vulnerable and at a high risk of developing further decline in postural control, contributing to an increase in limited functional mobility and risk for falls.
The Berg Balance Scale is a widely used tool originally developed to measure postural control in older adults.
The Hungarian version of the Berg Balance Scale tested on institutionalised older adults shows excellent test-retest reliability, good internal consistency, and acceptable convergent construct validity.
The Hungarian version of the Berg Balance Scale is a valid and reliable tool for measuring postural control among Hungarian-speaking institutionalised older adults both in clinical practice and scientific studies.
Balance dysfunction is common in stroke patients. The Berg Balance Scale (BBS) is useful for evaluating the balance function of stroke patients, and it can estimate the minimal clinically important ...difference (MCID) in balance. BBS scores differ among stroke patients depending on whether they require walking assistance. The MCID should thus be estimated separately for patients who require assistance and those who do not.
To estimate the MCID of individuals who have had an early subacute stroke and require a walking aid and those who do not, to assist the clinical determination of the effectiveness of therapy.
This was a retrospective clinical analysis of 80 early subacute stroke patients. We estimated the MCID by using the Functional Ambulation Categories (FAC) as anchors for changes in BBS scores during a 1-month period. The MCID was estimated based on a cutoff score for separating the patients who achieved a FAC change ≥1 point on receiver operator characteristic curves. The area under the curve (AUC) was used to measure the discrimination accuracy. The MCID was estimated for the patients who needed walking assistance and those who did not.
The estimated MCID of BBS scores in the assisted-walking group was 5 points and the AUC was 0.84 (p < .01); the corresponding values in the unassisted-walking group were 4 points and 0.62 (p = .26).
For early subacute stroke patients who require assistance to walk, a 5-point improvement in the BBS score is a useful indicator for reducing the amount of assistance.
The number of studies investigating the role of physical activity and exercise in hypertension (HT) patients is insufficient in the literature, and reports evaluating the relationship between HT, ...physical activity, and balance are lacking. This study aims to examine the relationship between physical activity levels and balance parameters, muscle strength, and fear of falling in patients with HT. 78 subjects with HT participated in this study. Demographic and clinical characteristics of all participants were recorded. Blood pressure was evaluated using a sphygmomanometer, physical activity level was assessed using a SenseWear Armband, fear of falling was assessed using the Fall Efficacy Scale, balance was assessed using the Fullerton Advanced Balance Scale, and muscle strength was evaluated using a digital handheld dynamometer. All 78 subjects completed the study as planned. The average age of participants was 57.75 ± 5.82, the mean systolic blood pressure was 133 ± 5.73, and the diastolic blood pressure was 84 ± 6.78. 34.2% of participants used angiotensin-converting enzyme inhibitors, 38% used beta blockers, and 26% used diuretic drugs. A positive correlation between physical activity and balance scores of individuals with HT was found (
P
< .005). It was also found that low muscle strength was associated with balance and risk of falling (
P
< .005). There is a positive correlation between decreased physical activity levels and balance in participants with HT. The results suggest that people with HT who have poor balance also have decreased muscle strength against gravity, such as in the quadriceps femoris and gluteus maximus. Overall, we recommend that patients with HT should improve their physical activity levels.
Purpose: People with Multiple Sclerosis (PwMS) have a high incidence of accidental falls that have a potentially detrimental effect on their daily life participation. The effect of balance specific ...rehabilitation on clinical balance measures and frequency of falls in PwMS was studied.
Method: A bi-centre randomised rater-blinded controlled trial. Participants in both groups received 20 treatment sessions. Participants in the intervention group received treatment aimed at improving balance and mobility. Participants in the control group received treatments to reduce limitations at activity and body function level.
Primary measures were frequency of fallers (>1 fall in two months) and responders (>3 points improvement) at the Berg Balance Scale (BBS). Data was analysed according to an intention to treat approach.
Results: One hundred and nineteen participants were randomised. Following treatment frequency of fallers was 22% in the intervention group and 23% in the control group, odds ratio (OR) and (confidence limits): 1.05 (0.41 to 2.77). Responders on the BBS were 28% in the intervention group and 33% in the control group, OR = 0.75 (0.30 to 1.91). At follow up ORs for fallers and responders at BBS were 0.98 (0.48 to 2.01) and 0.79 (0.26 to 2.42), respectively.
Conclusions: Twenty sessions 2-3 times/week of balance specific rehabilitation did not reduce fall frequency nor improve balance suggesting the need for more frequent and challenging interventions.
Implications for Rehabilitation
Programs for balance rehabilitation can improve balance but their effects in fall prevention are unclear.
Twenty treatments sessions 2/3 times per week did not reduced frequency of falls in MS.
The comparison with similar studies suggests that higher intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness.
Purpose The purpose of this study was to investigate and compare the predictive properties of Berg Balance Scale and Fullerton Advanced Balance Scales, in a group of independently-functioning ...community dwelling older adults. Subjects and Methods Ninety-seven community-dwelling older adults (male=39, female=58) who were capable of walking independently on assessment were included in this study. A binary logistic regression analysis of the Berg Balance Scale and Fullerton Advanced Balance Scale scores was used to investigate a predictive model for fall risk. A receiver operating characteristic analysis was conducted for each, to determine the cut-off for optimal levels of sensitivity and specificity. Results The overall prediction success rate was 89.7%; the total Berg Balance Scale and Fullerton Advanced Balance Scale scores were significant in predicting fall risk. Receiver operating characteristic analysis determined that a cut-off score of 40 out of 56 on the Berg Balance Scale produced the highest sensitivity (0.82) and specificity (0.67), and a cut-off score of 22 out of 40 on the Fullerton Advanced Balance Scale produced the highest sensitivity (0.85) and specificity (0.65) in predicting faller status. Conclusion The Berg Balance Scale and Fullerton Advanced Balance Scales can predict fall risk, when used for independently-functioning community-dwelling older adults.
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