Falls among stroke survivors : an online survey on perceptions and approaches among physiotherapists in Flanders

Objective. To describe physiotherapists' perceptions of fall risk and appropriate fall prevention interventions in rehabilitating stroke patients. Method. A web-based survey addressed to physiotherapy units on a stroke unit, general neurology department or rehabilitation ward/centre in Flanders. Results. Hospital response rate was 66.3%,. Sixty-five physiotherapy units were taken into account. About 84.6% recognised falls among stroke patients as an essential problem and 73.8% thought falls interfered with the outcome. About 56.9% agreed with the need of a standardised fall assessment at the beginning of the treatment and only 36.9% reported that on their department stroke patients are screened on risk of falling. The most used fall risk assessments are: Berg Balance scale and Tinetti-test. The most popular fall prevention measures are: specific exercises for balance, gait and functional abilities (100%), informative education (92.3%,) and adapting or intensifying the treatment after a fall (81.5%). Conclusions. Physiotherapy units acknowledge falls as an essential threat, implying a need for risk screening and prevention. However, results reveal that perception of the necessity of such screening is lower and that the performance is even less. This discrepancy underlines the necessity of guidelines and education of therapists working with stroke patients

Prediction of falling among stroke patients in rehabilitation

Objective: To identify risk factors and predict falling in stroke patients. To determine the strength of general vs mobility screening for this prediction. Design: Prospective study. Subjects: Patients in the first 6 months after stroke. Methods: The following assessments were carried out: an interview concerning civil state and fall history, Mini-Mental State Examination, Geriatric Depression Scale, Falls Efficacy Scale (FES), Star Cancellation Task (SCT), Stroop test, Berg Balance Scale, Functional Ambulation Categories (FAC), Motricity Index, grip and quadriceps strength, Modified Ashworth Scale, Katz scale, and a 6-month fall follow-up. Results: Sixty-five patients were included for analysis. Thirty -eight (58.5%) reported falling. Risk factors were: being single (odds ratio (OR) 4.7; 95% confidence interval (95% CI) 1.2–18.3), SCT–time (OR 1.2; 95% CI 1.0–1.3), grip strength on unaffected side (US) (OR 0.1; 95% CI 0.0–0.8), FAC 3 vs FAC 4–5 (OR 8.1; 95% CI 1.5–43.2), and walking aid vs none (OR 5.1; 95% CI 1.4–17.8). These parameters were included in predictive models, which finally implied a general model (I) with inclusion of SCT–time, FAC category and use of walking aid. A mobility model (II) included: FAC category and strength (US). These models showed a sensitivity of 94.1% and 76.3%, respectively. Conclusion: Several assessments and both prediction models showed acceptable accuracy in identifying fall-prone patients. A purely physical model can be used; however, looking beyond mobility aspects adds value. Further validation of these results is required

The influence of a vestibular dysfunction on the motor development of hearing-impaired children

Objectives/Hypothesis: To identify the predictive ability of vestibular function test results on motor performance among hearing-impaired children. Study Design: Cross-sectional study. Methods: Fifty-one typically developing children and 48 children with a unilateral (n ¼ 9) or bilateral hearing impairment (n ¼ 39) of more than 40 dB HL between 3 and 12 years were tested by the Movement Assessment Battery for Children–Second Edition (M ABC-2), clinical balance tests, posturography, rotatory chair testing, and vestibular evoked myogenic potential (VEMP). From the group of hearing-impaired children, 23 had cochlear implants. Results: Balance performance on M ABC-2, clinical balance tests, as well as the sway velocity assessed by posturography in bipedal stance on a cushion with eyes closed and in unilateral stance differed significantly between both groups. Presence of a VEMP response is an important clinical parameter because comparison of the motor performance among hearingimpaired children between those with present and absent VEMPs showed significant differences in balance performance. The three most important predictor variables on motor performance by bivariate regression analyses are the vestibular-ocular reflex (VOR) gain value of the rotatory chair test at 0.01 and 0.05 Hz frequency, as well as the VEMP asymmetry ratio. Multivariate regression analyses suggest that the VOR asymmetry value of the rotatory chair test at 0.05 Hz and the etiology of the hearing loss seem to have additional predictive value. Conclusions: Hearing-impaired children are at risk for balance deficits. A combination of rotatory chair testing and VEMP testing can predict the balance performance

Ghent Developmental Balance Test : a new tool to evaluate the balance performance in toddlers and preschool children

Background: Balance is a fundamental component of movement. Early identification of balance problems is important to plan early intervention. The Ghent Developmental Balance Test (GDBT) is a new assessment tool to monitor balance from the moment of independent walking to 5 years of age. Objective: The purpose of this study was to establish the psychometric characteristics of the GDBT. Methods: To evaluate test-retest reliability, 144 children were tested twice on GDBT by the same examiner, and to evaluate inter-rater reliability, videotaped GDBT test sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT, z-scores on GDBT were compared between a clinical group (n=20) and a matched control group (n=20). Concurrent validity of GDBT scores with the subscale standardized scores of Movement Assessment Battery for Children-Second edition (M ABC-2), the Peabody Developmental Motor Scales–Second Edition (PDMS-2), and the balance subscale of Bruininks Oseretsky Test-Second Edition (BOT-2) was evaluated in a combined group of the 20 children from the clinical group and 74 children who are developing typically. Results: Test-retest and inter-rater reliability was excellent for the GDBT total score, with intra class correlation coefficients of 0.99 and 0.98, standard error of measurement values of 0.21 and 0.78, and small minimal detectable differences of 0.58 and 2.08 respectively. The GDBT was able to distinguish between the clinical group and the control group (t(38)=5.456, p<0.01). Pearson correlations between the z-scores on GDBT and the standardized scores of specific balance subscales of the M ABC-2, PDMS-2 and BOT-2 were moderate to high, whereas correlations with subscales measuring constructs other than balance were low. Conclusion: The GDBT is a reliable and valid clinical assessment tool for the evaluation of balance in toddlers and preschool-aged children

New reference values must be established for the Alberta Infant Motor Scales for accurate identification of infants at risk for motor developmental delay in Flanders

Background: The Alberta Infant Motor Scales (AIMS) is a reliable and valid assessment tool to evaluate the motor performance from birth to independent walking. This study aimed to determine whether the Canadian reference values on the AIMS from 1990 - 1992 are still useful tor Flemish infants, assessed in 2007-2010. Additionally, the association between motor performance and sleep and play positioning will be determined. Methods: 270 Flemish infants between 0 and 18 months, recruited by formal day care services, were assessed with the AIMS by 4 trained physiotherapists. Information about sleep and play positioning was collected by mean of a questionnaire. Results: Flemish infants perform significantly lower on the AIMS compared to the reference values (p6m: p=0.013). Infants who are placed often to frequently in a sitting device in the first 6 months of life (p=0.010) and in supine after 6 months (p=0.001) performed significantly lower than those who are placed less in it. Conclusion: Flemish infants recruited by formal day care services, show significantly lower motor scores than the Canadian norm population. New reference values should be established for the AIMS for accurate identification of infants at risk. Prevention of sudden infant death syndrome by promoting supine sleep position should go together with promotion of tummy time when awake and avoiding to spent too much time in sitting devices when awake