We created a new approach to balance assessment: Total Balance Pro
The motive behind
As we explained before in one of our articles (What is Balance?), balance is the ability to maintain the body’s center of mass over its base of support. Balance is achieved and maintained by a complex set of sensorimotor control systems that include sensory input from vision (sight), proprioception (touch), and the vestibular system (motion, equilibrium, spatial orientation); integration of that sensory input; and motor output to the eye and body muscles.
There are different protocols/tests to measure different aspects of the balance system, such as the well-known Clinical Test of Sensory Interaction in Balance, the Limits of Stability, or the One Leg Standing test.
Although these protocols allow to gather important information about the patient’s sway, postural stability, or movement control, we felt it was important to create a new feature that could present all the parameters at once in one chart, so as to quickly analyze several characteristics of the balance. Thus, we combine three protocols – the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), the Limits of Stability (LOS) and the Sit-to-Stand (STS), to analyze the patient balance through six categories:
proprioception,
vestibular & visual input,
postural stability,
lower limb strength,
reflexes & reaction time
motor control.
We named this combination Total Balance Pro (Figure 1). This new protocol can be done in about seven minutes!
Fig.1 Total Balance Pro protocol – combination of mCTSIB, LOS and STS.
Why those protocols?
The mCTSIB protocol is a postural sway test to measure the influence of sensory input in balance. It has four conditions: (1) stand on firm surface with eyes open; (2) stand on firm surface with eyes closed; (3) stand on unstable surface (foam) with eyes open; and (4) stand on unstable surface (foam) with eyes closed. This test indicates if the patient has difficulty incorporating visual, somatosensory or vestibular information in balance control, depending on the condition(s) with higher values of sway velocity.
The LOS protocol quantifies the patent ability to intentionally displace its centre of gravity (CoG), without losing balance, to eight directions: front, front/right, right, back/right, back, back/left, left and front/left. This allows the measure of reaction time, movement velocity, first distance reached (endpoint excursion), maximum excursion and directional control. Those parameters are important as limited capacity for CoG displacement can be correlated with lower extremities strength, range of motion, or other musculoskeletal impairments. Moreover, poor directional control is an indicator of motor control abnormalities.
At last, the STS protocol measures the ability of the patient to lift from a sitting position to a standing position as quickly as possible on three 15-seconds trials. Rising from a seated to a standing position is influenced by a number of musculoskeletal, movement control, and balance factors. The rising maneuver also depends on adequate lower extremity and trunk strength, and range of motion. Thus, the percentage of body weight used (rising index), weight time transfer and left/right symmetry are measured during this movement.
In this way it is possible to analyze the different parameters of the three protocols, compare them with their age normative values and combine them in one radar chart with the six categories mentioned.
Results obtained
Figure 2 – Example of the radar chart result.
After performing the three protocols, a radar chart (Figure 2) is displayed with the six categories – proprioception, vestibular & visual input, postural stability, lower limb strength, reflexes & reaction time and motor control. The value of each category corresponds to the weighted average of the parameters results in relation to their normative values. In which a value of 100% indicates that all the parameter results in this category are within the normative values. The scale of the chart is inverted (100% in middle) so as to quickly present the categories that need intervention. The parameters used for each category are listed in the following table:
In addition, the software has the option to export the radar chart and a detailed result section with all the parameters calculated to a clinical report (Figure 3), in which a description of each category and some clinical considerations are presented for the health professional.
Figure 3 – Example of the detailed results section for two categories – Postural stability and Lower limb strength, and the respective descriptions and clinical considerations.
This protocol is available in the new version of PhysioSensing Balance 21 with the pressure plate- check here the difference between pressure and force plate.
You may also like check: 12 Protocols for Balance Assessment with force/pressure plate.
Sources:
The parameters selection was based in the following articles:
Ø Melzer I, Benjuya N, Kaplanski J, Alexander N. (2009) Association between ankle muscle strength and limit of stability in older adults. Age Ageing, 38(1):119-23. doi:10.1093/ageing/afn249.
Ø Frykberg, G. and C. Häger (2015) Movement analysis of sit-to-stand – research informing clinical practice. Physical Therapy Reviews, 20: 156 – 167. doi:10.1179/1743288X15Y.0000000005.
Ø Tony Szturm, Aimee L. Betker, Zahra Moussavi, Ankur Desai, Valerie Goodman (2011) Effects of an Interactive Computer Game Exercise Regimen on Balance Impairment in Frail Community-Dwelling Older Adults: A Randomized Controlled Trial. Phys Ther., 91(10):1449-62. doi:10.2522/ptj.20090205.
Ø Brandon, L. J., Boyette, L. W., Gaasch, D. A., Lloyd, A. (2000) Effects of Lower Extremity Strength Training on Functional Mobility in Older Adults. Journal of Aging and Physical Activity, 8(3), 214-227. doi:10.1123/japa.8.3.214.
Ø Bandy, William D. and Sanders, Barbara (2007) Therapeutic exercise for physical therapist assistants (2nd Ed.). Lippincott Williams & Wilkins.
Ø O'Sullivan, S. B. and Schmitz, T. J. (2007) Physical rehabilitation (5th Ed.). FA Davis.
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