Investigating the Relationship of the Functional Gait Assessment to Spatiotemporal Parameters of Gait and Quality of Life in Individuals With Stroke.

BACKGROUND AND PURPOSE: Walking in the community is an important aspect of independence and quality of life (QOL) that poses challenges for individuals with stroke. This study investigated whether performance on the Functional Gait Assessment (FGA) differentiated spatiotemporal gait parameters, QOL, and fall history of community-ambulating individuals with stroke. We hypothesized that those scoring higher on the FGA would present with better gait speed and cadence, stride width and length, and improved load time on the paretic limb, report a higher QOL, and be less likely to have a fall history than those who scored lower on the FGA. METHODS: Participants were screened for cognitive impairment and the ability to walk independently. Participant demographics and stroke characteristics were recorded. The Falls Risk for Older People in the Community (FROP-Com) screening tool determined whether the participant had incurred 1 or more falls within the preceding 12 months. The FGA provided a composite measure of gait with varied walking tasks challenging different aspects of walking. The total score was recorded. The GAITRite instrumented-walkway was used to acquire high-resolution footfall data during performance of the first 9 FGA walking tasks. The Assessment of Quality of Life-6D (AQoL-6D) was used to measure health-related QOL across the domains of independent living, mental health, coping, relationships, pain, and senses. Pearson and Spearman correlations were used to check for correlations between FGA score and the demographic characteristics, AQoL-6D scores, and 12-month fall history. Pearson correlations were used to check for correlations between FGA score and multiple spatiotemporal gait parameters for each FGA item. RESULTS AND DISCUSSION: A sample of 29 volunteers who were community-ambulating individuals with stroke was recruited. Participants had a mean age of 62.31 (10.89) years, mean time since stroke of 3.78 (4.10) years, and included both males and females (52% male). Individuals presented with both left- and right-sided strokes. FGA score correlated positively with velocity, cadence, and step length, and negatively with stride width, double-support percent, and single-support variability (P = .001 to P = .031). FGA score correlated positively with the AQoL-6D dimension of independent living. FGA score correlated significantly with the FROP-Com screening tool predicted fall risk, but not with fall history. CONCLUSIONS: The FGA is a clinical measure of functional gait performance that reflected spatiotemporal gait parameters and ability of individuals with chronic stroke to live independently. The FGA could be used to target interventions to improve functional gait performance of individuals with chronic stroke.

A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo.

OBJECTIVES: To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time. DATA SOURCES: Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016. STUDY SELECTION: Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics. DATA EXTRACTION: Data comprising demographics, diagnostic cases, and the total number of cases were recorded and independently tested, followed by a risk of bias analysis. DATA SYNTHESIS: Sample size weighted proportions expressed as percentages with confidence intervals were calculated and compared using χ analysis and a reference proportion formed by the combination of Ear Nose and Throat and Neurotology case series published between 2010 and 2016. Analysis of diagnostic trends over time used Poisson regression with consideration for overdispersion. CONCLUSIONS: This systematic review of case series demonstrated significant differences in the proportions of diagnoses for patients presenting with dizziness or vertigo, depending on the specialty making the diagnosis. ENT proportions were dominated by BPPV, Psychogenic and Menière's disease diagnostic categories, whereas emergency proportions were dominated by Other, Cardiac, and Neurological categories. Analysis of case series proportions over time revealed increases in diagnoses such as Benign Paroxysmal Positional Vertigo and Vestibular Migraine, and a corresponding decrease in the diagnoses of Menière's disease.

Child obesity service provision: a cross-sectional survey of physiotherapy practice trends and professional needs.

This study explored current physiotherapy practice trends for management of children who are overweight or obese. The professional needs of physiotherapists working with this population were also assessed, including the perceived need for physiotherapy clinical guidelines for prevention and management of children with obesity. A cross-sectional survey design was used, with questionnaires purposefully distributed through 13 key physiotherapy services throughout Australia. Snowball sampling resulted in completed questionnaires from 64 physiotherapists who provided services to children. Half (n=33, 52%) of respondents provided services specifically to overweight or obese children. Of those providing services, one-quarter had prior training specific to working with this population. Most used multi-disciplinary models (n=16, 76%) and provided under 5h of obesity-related services each week (n=29, 88%). Half (n=16, 49%) used body mass index as an outcome measure but more (n=25, 76%) used bodyweight. Only 14 (42%) assessed motor skills. The majority of respondents (n=57, 89%) indicated a need for physiotherapy guidelines to best manage overweight and obese children. Professional development priorities included: 'Educating children and families', 'Assessment methods' and 'Exercise prescription' for overweight and obese children. This data provides workforce intelligence to guide future professional training and inform development of clinical guidelines for physiotherapists in prevention and management of children with obesity and related chronic disease.

Construction and Validation of the Vestibular Screening Tool for Use in the Emergency Department and Acute Hospital Setting.

OBJECTIVES: To construct a new vestibular screening tool to identify likely vestibular disorders and guide referral of dizzy patients presenting to hospital and to test the vestibular screening tool for construct and discriminative validity and reliability of physiotherapy assessors. DESIGN: Methodologic study. SETTING: Emergency and acute hospital wards of a metropolitan hospital. PARTICIPANTS: Adults (N=114) presenting to hospital with dizziness (mean age, 67.36±14.88y; 57% women). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Three vestibular screening tools (3, 4, and 5 items) were investigated. Physiotherapy vestibular diagnostic tests categorized patients as vestibular or nonvestibular patients. Subsets of patients were assessed twice by 2 physiotherapists (n=20) and twice by the same physiotherapist (n=30). RESULTS: Each of the vestibular screening tools had a good fit to the Rasch measurement model. Factor analysis demonstrated individual items loaded across 1 factor, confirming unidimensionality of the 3 vestibular screening tools, and Cronbach α determined internal consistency. The 4-item vestibular screening tool had the greatest area under the curve using receiver operator curve analysis (.894), with highest sensitivity (83%) and specificity (84%) for identifying vestibular disorders (cutoff value ≥4/8). Sensitivity of the 3- and 5-item versions was lower than the 4-item vestibular screening tool (80%). The 4-item vestibular screening tool scores showed high intrarater (κ item scores, .831-1; intraclass correlation coefficient [ICC] total, .988) and interrater (κ item scores, .578-.921; ICC total, .878) reliability. CONCLUSIONS: The 4-item vestibular screening tool is a reliable, valid tool for screening dizzy patients presenting to hospital, with unidimensional construct validity, high sensitivity, and specificity for identifying likely vestibular disorders. The vestibular screening tool could be used clinically to streamline referrals of dizzy patients to vestibular clinics.

Age-related changes in musculoskeletal function, balance and mobility measures in men aged 30-80 years.

OBJECTIVES: This study aimed to establish age-related changes in musculoskeletal function, balance and mobility measures in men. DESIGN: An observational, cross-sectional cohort study was undertaken. METHODS: One hundred six healthy, community-ambulant men (30-80 years) participated in this study. Recruitment of a convenience sample continued until a minimum of 20 men represented each decade between 30 and 80 years. Demographics (age, height, weight), health and current activity level were recorded. Balance and mobility were measured using the timed up and go test, the step test, functional and lateral reach. Reaction time was determined from limits of stability test. Leg muscle strength was measured with a spring gauge (kg), and ankle flexibility was measured using goniometry. RESULTS: Balance, mobility and most strength measures were reduced by the 60s while ankle flexibility declined by the 70s (p < 0.01). Reaction times increased by the 60s (p < 0.01). CONCLUSION: This study of men demonstrated reduced musculoskeletal function, balance and mobility generally by the 60s. These results provide health professionals with normal performance levels to use as therapeutic goals as well as identify musculoskeletal factors associated with reducing balance and mobility. Hence, these results inform clinicians and policy makers for the establishment of pre-emptive interventions to promote healthier ageing.

Sensory system function and postural stability in men aged 30-80 years.

OBJECTIVE: To examine age-related changes in postural stability and sensory system functioning in men aged 30-80 years. DESIGN: Observational, cross-sectional study. METHODS: One hundred six healthy men aged 30-80 years participated. Personal characteristics were recorded and outcome measures included: velocity of sway during bilateral stance on a firm and foam surface (eyes open (EO) and eyes closed (EC)), balancing on one leg (EO and EC), lower limb somatosensation (tactile acuity, vibration threshold and joint position error), high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA), edge contrast sensitivity and vestibular-ocular reflex (VOR) control. RESULTS: Men in their 60s and 70s were found to be less stable than the younger age decades when standing on a firm or foam surface. Reduced stability was evident from the 40s to 50s for one-leg-stance (EC). Lower limb somatosensation and HCVA and LCVA were significantly reduced by the 60s but edge contrast sensitivity reduced by the 50s. Age-related changes in VOR control did not emerge until the 70s in this study cohort. CONCLUSIONS: The results show reduction in postural stability and sensory system functioning in men by the 60s supporting pre-emptive assessment of workers in industries where falls are frequent.

Balance, mobility and gaze stability deficits remain following surgical removal of vestibular schwannoma (acoustic neuroma): an observational study.

QUESTION: Are there residual deficits in balance, mobility, and gaze stability after surgical removal of vestibular schwannoma? DESIGN: Observational study. PARTICIPANTS: Twelve people with a mean age of 52 years who had undergone surgical removal of vestibular schwannoma at least three months previously and had not undergone vestibular rehabilitation. Twelve age- and gender-matched healthy people who acted as controls. OUTCOME MEASURES: Handicap due to dizziness, balance, mobility, and gaze stability was measured. RESULTS: Handicap due to dizziness was moderate for the clinical group. They swayed significantly more than the controls in comfortable stance: firm surface eyes open and visual conflict (p < 0.05); foam surface eyes closed (p < 0.05) and visual conflict (p < 0.05); and feet together: firm surface, eyes closed (p < 0.05), foam surface, eyes open (p < 0.05) and eyes closed (p < 0.01). They displayed a higher rate of failure for timed stance and gaze stability (p < 0.05) than the controls. Step Test (p < 0.01), Tandem Walk Test (p < 0.05) and Dynamic Gait Index (p < 0.01) scores were also significantly reduced compared with controls. There was a significant correlation between handicap due to dizziness and the inability to maintain balance in single limb and tandem stance (r = 0.68, p = 0.02) and the ability to maintain gaze stability during passive head movement (r = 0.78; p = 0.02). CONCLUSION: A prospective study is required to evaluate vestibular rehabilitation to ameliorate dizziness and to improve balance, mobility, and gaze stability for this clinical group.

The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial.

BACKGROUND: older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups. OBJECTIVE: to determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls. DESIGN: a randomised controlled trial model. SETTING: Neurological Disorders, Ageing and Balance Clinic, Department of Physiotherapy, The University of Queensland. SUBJECTS: 73 males and females over 60 years, living independently in the community and who had fallen in the previous year were recruited. METHODS: all subjects received a falls risk education booklet and completed an incident calendar for the duration of the study. Treatment sessions were once a week for 10 weeks. Subject assessment before and after intervention and at 3 months follow-up included number of falls, co-morbidities, medications, community services and activity level, functional motor ability, clinical and laboratory balance measures and fear of falling. RESULTS: all participants significantly reduced the number of falls (P < 0.000). The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group (P = 0.034). Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group (P < 0.04). The control group only improved in TUG and TUGcog. CONCLUSIONS: the results provide evidence that all participants achieved a significant reduction in falls. Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance.

Shoulder pain, range of motion, and functional motor skills after acute tetraplegia.

OBJECTIVES: To investigate (1) the prevalence and course of shoulder pain in acute tetraplegia and (2) its relationship with range of motion (ROM) and function and any associated risk factors. DESIGN: A longitudinal prospective study. SETTING: Spinal injury unit in an Australian hospital. PARTICIPANTS: Inpatients with acute tetraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, pain intensity, shoulder ROM, and functional motor skills. RESULTS: The prevalence of pain during rehabilitation was 85%. Risk factors associated with pain during rehabilitation included age less than 30 years or more than 50 years (F=8.892, P=.064), admission motor level at C2-5 (F=5.833, P=.016), admission sensory level at C2-5 (F=7.543, P=.006), lower left upper limb (P=.005; 95% confidence interval [CI], -14.74 to -2.86) and total American Spinal Injury Association motor scores (P=.009; 95% CI, -29.53 to -4.67), and a shorter duration of bedrest (F=5.794, P=.055). Subjects with pain lost ROM in left abduction (P=.038; 95% CI, -25.9 to -0.9) and right abduction (P=.05; 95% CI, -30 to 9.3). No relationship existed between shoulder pain and functional motor skills on discharge. CONCLUSION: Shoulder pain is common in acute tetraplegia and is associated with loss of shoulder ROM. Risk factors identified include age, injury level, and duration of bedrest. Areas for further study are identified.

Changes in postural stability in women aged 20 to 80 years.

BACKGROUND: A study of postural stability was undertaken to identify the relationship between vision and support surface across age decades. Understanding when reliance on vision for postural stability emerges and the support conditions contributing to this instability may provide the evidence required to introduce falls-prevention strategies in younger age decades. METHODS: We measured postural stability in 453 women aged 20 to 80 years using the Balance Master force-plate system while the women performed the modified Clinical Test for the Sensory Interaction and Balance (firm and foam surfaces, eyes open and closed) and the Single-Limb Stance Test (eyes open and closed). RESULTS: Women in their 60s and 70s were more unstable than younger women in bilateral stance on a firm surface with the eyes closed. This instability was evident from the 50s when a foam surface was introduced and from the 40s when single-limb stance was tested with eyes closed. A further decline in stability was demonstrated for each subsequent decade when the eyes were closed in single-limb stance. CONCLUSIONS: Age, visual condition, and support surface were significant variables influencing postural stability in women. Reliance on vision for postural stability was evident for women from the 40s when single-limb stance was tested, from the 50s when bilateral stance on foam was tested, and from the 60s when a firm surface was used. The cause(s) of this decline in stability requires further investigation, and screening for postural instability between the ages of 40 and 60 is advocated.