Balance assessment in Multiple Sclerosis and cerebellar ataxia: rationale, protocol and demographic data

A core set of standardized balance measures are required for use in rehabilitation among people with multiple sclerosis (MS) and cerebellar ataxia. An earlier systematic review and Delphi survey identified the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), Posture and Gait sub-component of the International Co-operative Ataxia Rating Scale (PG of ICARS) and the gait, sitting and stance sub-components of the Scale for the Assessment and Rating of Ataxia (SARA Bal) as suitable balance measures. This study aims to estimate the reliability, validity and interpretability of these measures. This study will recruit 60 participants with multiple sclerosis with secondary cerebellar involvement across four centres in New Zealand and the United States of America. Participants will be assessed and videotaped performing the BBS, TUG, SARA Bal and PG of ICARS by trained physiotherapists. Barthel Index, Expanded Disability Status Scale (EDSS), Disease duration, ICARS and SARA will also be assessed to determine validity. A second assessment to determine reliability will be conducted by assessors watching the video-recording. Data collection is in progress, 44 samples have been collected and the demographic data are presented. The findings of this study will recommend a core set of reliable, valid and interpretable measures that are suitable for clinical practice and research for the assessment of balance among adults with MS and cerebellar ataxia. Minimal Clinically Important Difference (MCID) and cut-off scores to predict the use of assistive walking device will be established

Vestibular perceptual testing from lab to clinic: a review

Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research

Allopreening in birds is associated with parental cooperation over offspring care and stable pair bonds across years

Individuals of many species form bonds with their breeding partners, yet the mechanisms maintaining these bonds are poorly understood. In birds, allopreening is a conspicuous feature of interactions between breeding partners and has been hypothesized to play a role in strengthening and maintaining pair bonds within and across breeding attempts. Many avian species, however, do not allopreen and the relationship between allopreening and pair bonding across species remains unexplored. In a comparative analysis of allopreening and pair bond behavior, we found that allopreening between breeding partners was more common among species where parents cooperate to rear offspring. The occurrence of allopreening was also associated with an increased likelihood that partners would remain together over successive breeding seasons. However, there was no strong evidence for an association between allopreening and sexual fidelity within seasons or time spent together outside the breeding season. Allopreening between partners was also no more common in colonial or cooperatively breeding species than in solitary species. Analyses of evolutionary transitions indicated that allopreening evolved from an ancestral state of either high parental cooperation or high partner retention, and we discuss possible explanations for this. Overall, our results are consistent with an important role for allopreening in the maintenance of avian pair bonds

THE EFFECT OF VIBROTACTILE FEEDBACK DURING BALANCE AND VESTIBULAR REHABILITATION ON FUNCTIONAL BALANCE OUTCOMES

Purpose: Postural stability improvements have been observed using vibrotactile feedback (VTF), but the long-term functional benefits of training with VTF is unknown. The purpose of this study was to investigate the effects of VTF on functional outcomes in people with chronic balance disorders immediately following balance training and at 6-months post-training. We also aimed to determine the amount of agreement between participant and physical therapist ratings of participant balance performance. Participants: Twenty participants with chronic balance disorders between the ages of 21 to 80 years old (70% female, mean age 67 ± 10 years) were enrolled in the study. Three participants were diagnosed with bilateral vestibular hypofunction, nine with unilateral vestibular hypofunction, five with peripheral neuropathy, and three were older adults with balance disorders. Methods: Eighteen participants completed a 6-week balance training program. Participants were randomized into either the control group (balance training alone) or the experimental group (balance training plus VTF). Group differences in functional balance outcome measures were analyzed using a repeated measures analysis of variance. Postural sway and balance performance ratings from the participant and the physical therapist were collected during training sessions. A quadratic weighted kappa analysis was conducted to investigate the agreement between the participant and physical therapist balance ratings. Regression was used to examine the association between postural sway and balance rating. Results: The entire sample demonstrated significant improvements in the majority of the functional clinical outcomes following the balance training program, but there were not significant differences between the experimental and control groups. The repeated measures analysis did not indicate that the experimental group had faster improvements compared to the control group, and they did not maintain the improvements longer. Participant and physical therapist ratings had good agreement with quadratic weighted kappa correlation analysis. Conclusion: The use of VTF during balance training did not improve functional outcomes compared to balance training alone in our small sample. Retention of improvements in functional outcomes following training were not maintained differently between the control and experimental groups at the six-month post-training assessment. Balance rating scales may be useful in determining balance exercise progression

Measurement tools for activity and participation in older adults: a scoping review

This proposed scoping review aims to identify the activity and participation measurement tools that have been used in scientific investigations and clinical practice for older adults. Themes arising from a synthesis of the findings of this research will be used to consider: I. The identified self-report and performance-based activity and participation measures will inform rehabilitation clinicians and scientists who work with older adults with impaired balance on most appropriate tools to use based on the available psychometric properties. II. Recommendations for when and how tools might be used will be included in the synthesis as well as suggestions for future work based on the extraction results of the scoping review The broad research questions for this review are: I. What are the tools that have been used to measure activity and participation in older adults; and II. Do gaps in the literature exist that future scientific inquiries should address to fully appreciate and understand activity and participation limitations in older adults with impaired balance

Reliability and Validity of Ratings of Perceived Difficulty During Performance of Static Standing Balance Exercises

BACKGROUND: Standardized instruments for measuring the intensity of balance exercises in clinical environments are lacking. OBJECTIVE: The objective of this study was to develop a method for quantifying the perceived intensity of standing balance exercises. DESIGN: A test-retest study design was used, with repeated evaluations within the same visit and between visits 1 week later. METHODS: Sixty-two participants who were healthy and 18 to 85 years old (with a mean age of 55 years [SD = 20 years]; 50% women) were enrolled. On each of 2 visits, they performed 2 sets of 24 randomized static standing exercises consisting of combinations of the following factors: surface, vision, stance, and head movement. Postural sway was measured with an inertial measurement unit, and ratings of perceived difficulty (RPD) were recorded using numerical and qualitative scales. The RPD scales were validated against the quantitative sway measures using a general linear model approach. The test-retest reliability of the RPD scales was examined using a weighted kappa coefficient. RESULTS: Both RPD scales were associated with postural sway measures with correlation coefficients \u3e 0.6 for the whole sample. The test-retest reliability of the ratings varied considerably across the different balance exercises, and the highest weighted kappa values occurred for RPD scores on the numerical scale within the second visit, as moderate agreement was achieved in 18 of the 24 exercises. LIMITATIONS: The limitations are that the RPD scales need to be validated for other types of balance exercises and in individuals with balance disorders. CONCLUSIONS: The RPD scores correlated with the magnitude of postural sway, suggesting that they can be used as a proxy measure of perceived intensity of balance exercises