Medicine and Health Sciences Commons^™

The Psychometric Properties Of The Modified Fear Of Falling Avoidance Behavior Questionnaire In Parkinson’S Disease And Older Adults, Billy La, Arturo Aldaco, Ashley Haller

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background/purpose: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ), developed in 2011 to measure fear of falling avoidance behavior, has good evidence for reliability and validity. However, a recently modified version (mFFABQ) is theorized to be easier to understand for those completing the questionnaire because the Likert responses are more logical in completing the item stem. The purpose of this study was to examine the test-retest reliability and construct validity of the mFFABQ in adults with Parkinson’s Disease (PD) and older adults aged 60-90 years. Methods: Thirty-nine participants (age 72.21 ± 9.5; 29 men, 10 women) diagnosed with PD (diagnosis …

Spatial Characteristics Of Reactive Stepping Among People Living With Chronic Incomplete Spinal Cord Injury, Matthew G Heffernan, Jae Woung Lee, Katherine Chan, Janelle Unger, Susan Marzolini, Timothy N Welsh, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.

Design: Cross sectional.

Setting: Lyndhurst Centre.

Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).

Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and …

Neuromotor Changes In Participants With A Concussion History Can Be Detected With A Custom Smartphone App, Christopher K. Rhea, Masahiro Yamada, Nikita A. Kuznetsov, Jason T. Jakiela, Chanel T. Lojacono, Scott E. Ross, F. J. Haran, Jason M. Bailie, W. Geoffrey Wright

Moss-Magee Rehabilitation Papers

Neuromotor dysfunction after a concussion is common, but balance tests used to assess neuromotor dysfunction are typically subjective. Current objective balance tests are either cost- or space-prohibitive, or utilize a static balance protocol, which may mask neuromotor dysfunction due to the simplicity of the task. To address this gap, our team developed an Android-based smartphone app (portable and cost-effective) that uses the sensors in the device (objective) to record movement profiles during a stepping-in-place task (dynamic movement). The purpose of this study was to examine the extent to which our custom smartphone app and protocol could discriminate neuromotor behavior between …

The Effect Of Dual-Task Testing On The Balance And Gait Of People With Lower Limb Amputations: A Systematic Review, Humberto Omana, Edward Madou, Manuel Montero-Odasso, Michael W. Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

OBJECTIVE: To systematically review the literature on the effect of dual-task testing on the balance and gait of people with lower limb amputations (PLLA).

LITERATURE SURVEY: Databases MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus were searched in duplicate (inception to December 1, 2020).

METHODOLOGY: Inclusion criteria: participants were adults with transtibial, knee-disarticulation, transfemoral, or bilateral lower limb amputations; balance or gait was paired with a secondary task; and studies were peer-reviewed and published in English. Two authors independently reviewed articles and consensus was required. A standardized data extraction sheet was used to gather study relevant information in duplicate. …

Co-Contraction Of Ankle Muscle Activity During Quiet Standing In Individuals With Incomplete Spinal Cord Injury Is Associated With Postural Instability, Kai Lon Fok, Jae W Lee, Janelle Unger, Katherine Chan, Kristin E Musselman, Kei Masani

Physical Therapy Publications

Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), …

Functional Reach Test, Single-Leg Stance Test, And Tinetti Performance-Oriented Mobility Assessment For The Prediction Of Falls In Older Adults: A Systematic Review, Humberto Omaña, Kari Bezaire, Kyla Brady, Jayme Davies, Nancy Louwagie, Sean Power, Sydney Santin, Susan W. Hunter

Physical Therapy Publications

OBJECTIVE: The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations.

METHODS: The PubMed, EMBASE, and CINAHL databases were searched (inception-July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale.

RESULTS: Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 …

Perspectives Of Individuals With Chronic Spinal Cord Injury Following Novel Balance Training Involving Functional Electrical Stimulation With Visual Feedback: A Qualitative Exploratory Study, David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.

METHODS: Five individuals with a motor …

The Effect Of Dual-Task Testing On Balance And Gait Performance In Adults With Type 1 Or Type 2 Diabetes Mellitus: A Systematic Review, Humberto Omana, Edward Madou, Manuel Montero-Odasso, Michael Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

BACKGROUND: Individuals with diabetes mellitus (DM) are susceptible to balance, gait and cognitive impairments. Importantly, diabetes affects executive function, a set of cognitive processes critical to everyday cortical function and mobility. Reduced executive function is a risk factor for falls in people with DM. Dual-task testing, the completion of two tasks at once, enables the examination of the cognitive-mobility relationship. A synthesis of the literature on the effects of dual- task testing on the balance and gait of individuals with DM has not been performed.

OBJECTIVE: To systematically review the literature on the effect of dual-task testing on balance and …

Executive Function As A Mediating Factor Between Visual Acuity And Postural Stability In Cognitively Healthy Adults And Adults With Alzheimer's Dementia, Susan W. Hunter, Alison Divine, Edward Madou, Humberto Omana, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes, Walter Wittich

Physical Therapy Publications

BACKGROUND: Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability.

METHODS: We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and …

Reactive Stepping After A Forward Fall In People Living With Incomplete Spinal Cord Injury Or Disease, Katherine Chan, Jae Woung Lee, Janelle Unger, Jaeeun Yoo, Kei Masani, Kristin E Musselman

Physical Therapy Publications

STUDY DESIGN: Cross sectional.

OBJECTIVES: To compare the reactive stepping ability of individuals living with incomplete spinal cord injury or disease (SCI/D) to that of sex- and age-matched able-bodied adults.

SETTING: A tertiary SCI/D rehabilitation center in Canada.

METHODS: Thirty-three individuals (20 with incomplete SCI/D) participated. Participants assumed a forward lean position in standing whilst 8-12% of their body weight was supported by a horizontal cable at waist height affixed to a rigid structure. The cable was released unexpectedly, simulating a forward fall and eliciting one or more reactive steps. Behavioral responses (i.e., single step versus non-single step) were compared …

The Effect Of Aquatic Interventions In Combination With Early Start Physical Therapy Services On Gross Motor Development In A Male Child With Down Syndrome, Roxanne Mueller

San Marcos, Fall 2019

Introduction: Aquatic therapy has been used in various patient populations as a modality to facilitate motor control and manage tonicity.^1-3 Despite the variety of literature addressing individuals with Down syndrome (DS) and aquatic therapy, there has been little described about the effects of aquatic therapy on early gross motor development in children with DS.

Purpose: The purpose of this case study is to examine whether aquatic physical therapy interventions combined with early start physical therapy influence gross motor developmental delay in a child with DS.

Case Description: The patient is a 31-month-old boy with diagnosis of …

Quantifying Balance Control After Spinal Cord Injury: Reliability And Validity Of The Mini-Bestest, Katherine Chan, Janelle Unger, Jae Woung Lee, Gillian Johnston, Marissa Constand, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.

Design: Cross-sectional study.

Setting: Rehabilitation hospital.

Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).

Interventions: None.

Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants …

Intensive Balance Training For Adults With Incomplete Spinal Cord Injuries: Protocol For An Assessor-Blinded Randomized Clinical Trial., Janelle Unger, Katherine Chan, Carol Y Scovil, B Catharine Craven, Avril Mansfield, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke.

OBJECTIVE: The objective is to investigate whether PBT or conventional intensive balance training (CIBT) results in greater improvements in reactive stepping ability in individuals with chronic incomplete spinal cord injury (iSCI).

DESIGN: The design consists of an assessor-blind randomized clinical trial comparing the efficacy of 2 balance training programs (PBT and CIBT) matched for training duration …

Hip And Trunk Muscle Activity During The Star Excursion Balance Test In Healthy Adults, Kunal Bhanot, Navpreet Kaur, Lori Thein Brody, Jennifer Bridges, David C. Berry, Joshua J. Ode

Physical Therapy Collection

CONTEXT: Dynamic balance is a measure of core stability. Deficits in the dynamic balance have been related to injuries in the athletic populations. The Star Excursion Balance Test (SEBT) is suggested to measure and improve dynamic balance when used as a rehabilitative tool.

OBJECTIVE: To determine the electromyographic activity of the hip and the trunk muscles during the SEBT.

DESIGN: Descriptive.

SETTING: University campus.

PARTICIPANTS: Twenty-two healthy adults (11 males and 11 females; 23.3 [3.8] y, 170.3 [7.6] cm, 67.8 [10.3] kg, and 15.1% [5.0%] body fat).

INTERVENTION: Surface electromyographic data were collected on …

Reliability, Validity, And Agreement Of The Short-Form Activities-Specific Balance Confidence Scale In People With Lower Extremity Amputations., Katherine Fuller, Humberto Adolfo Omaña Moreno, Courtney Frengopoulos, Michael W Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

BACKGROUND: Clinicians use the Activities-specific Balance Confidence Scale to understand balance confidence. A short-form Activities-specific Balance Confidence scale, was developed using the six most difficult tasks from the original Activities-specific Balance Confidence scale; however, short-form the short-form scale psychometrics and agreement with the original scale have yet to be explored in people with lower extremity amputations.

OBJECTIVE: To determine the relative and absolute reliability, construct validity, and agreement of the short-form Activities-specific Balance Confidence scale.

STUDY DESIGN: Test-retest with a 2-week interval.

METHODS: Analysis for relative reliability and internal consistency was intraclass correlation coefficient and Cronbach's

RESULTS: The short-form Activities-specific …

Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz

Physical Therapy Scholarly Projects

Background/Purpose: The Four Square Step Test (FSST) measures dynamic standing balance and agility and was developed to identify older adults at risk for falls. It has a cognitive component for remembering the stepping sequence but has never been tested with an additional cognitive task. The purpose of this study was to collect normative data for the FSST and Cognitive FSST in community dwelling adults for various age groups.

Materials/Methods: Eighty-seven community-dwelling adults (55 females, 32 males) between the age 21 and 86 (48.22 years) were included in the study. Participants completed a fall risk checklist and a cognitive screen prior …

Collaboration Of Music And Physical Therapy: A Case Study For Treatment Of Balance And Coordination Impairments Following Radiation Necrosis, Micah Hale, Paige Slemmons

Physical Therapy Scholarly Projects

Background and Purpose: Medulloblastomas are a form of cancer most commonly found in children. They are normally treated through surgery, radiation therapy, and chemotherapy. Radiation necrosis is a possible side effect of radiation therapy which can have devastating effects on a patient's function. Research on the effects of physical therapy interventions in treating the functional impairments which can result from medulloblastomas and radiation necrosis is limited. The purpose of this case study is to examine the effects of collaborative treatment between two student physical therapists and a student music therapist on a· patient with functional limitations due to a medulloblastoma …

Effects Of Weight Shifting And Heel Lift On Gait, Posture, And Balance In An Elderly Female With Backward Disequilibrium: A Case Report, Gilissa T. Schjang, Evan M. Pucillo

St. Augustine, Fall 2018

The purpose of this case report is to investigate how weight shifts and a heel lift affects a patient's center of mass in respect to their base of support to improve posture, balance, and gait which will aid in decreasing falls.

The patient demonstrated functional improvements by reducing the amount of assistance required from a caregiver for transfers and gait. Improvements in balance will allow the patient to sit on the toilet and edge of bed for toileting and dressing more independently.

Older adults with BD or other similar balance disorders are at risk for increased falls.⁵ This case …

Shall We Dance: A Parkinson’S Dance-Based Program, Rebecca Zawodny, Anne H. Boddy

St. Augustine, Fall 2018

This poster presents the implementation of a community-based dance program for individuals diagnosed with Parkinson’s disease.

Dance interventions for individuals with PD are shown to be superior to exercise for improving balance and mobility^5,6,7 thus, effectively addressing both motor as well non-motor symptoms such as depression, fear, anxiety, and declined self-efficacy.^8,9,10 Further positive effects include improved flexibility and coordination7^,11 and forced-use of the senses of sight, sound, and touch to assist with movement and balance.¹² The use of choreography further allows for the rehearsal of movement sequences, new motor skill learning, and improved cognitive functions.^{13 …}

Sara Plus And Task Specific Training In A Patient With Anoxic Encephalopathy, Olivia Levi, Erica Kiernan

St. Augustine, Fall 2018

The purpose of this case report is to describe the benefits of using a task-specific approach and the SARA plus to improve balance and gait in a patient with anoxic encephalopathy.

This case demonstrated the positive results of incorporating repetitive, task-specific, and early use of the SARA plus for gait training. With these interventions, the patient was able to ambulate 25 ft and transfer from sit to stand with the use of a rolling walker and minimum assistance. He was also able to maintain static sitting balance for 32 seconds independently and reach 17 inches outside of his base of …

The Modified Dynamic Gait Index And Limits Of Stability In Myotonic Dystrophy Type 1, Evan M. Pucillo, Melissa M. Mcintyre, Mary Pautler, Man Hung, Jerry Bounsanga, Maren W. Voss, Heather Hayes, Deanna Dibella, Caren Trujillo, Melissa Dixon, Russell Butterfield, Nicholas E. Johnson

Physical Therapy Collection

INTRODUCTION:

The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1).

METHODS:

Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests.

RESULTS:

Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those …

Canalith-Repositioning Maneuvers And Balance Interventions On A Patient With Multiple-Canal Bppv: A Case Study, Nicole Knights, Kerry C. Mallini

St. Augustine, Summer 2018

The purpose of this case report is to demonstrate using canalith-repositioning maneuvers and balance training as interventions to reduce vertigo and improve balance and gait in a patient with multiple-canal BPPV.

Trunk Motion Visual Feedback During Walking Improves Dynamic Balance In Older Adults: Assessor Blinded Randomized Controlled Trial., Eric Anson, Lei Ma, Tippawan Meetam, Elizabeth Thompson, Roshita Rathore, Victoria Dean, John Jeka

Department of Physical Therapy Faculty Papers

BACKGROUND: Virtual reality and augmented feedback have become more prevalent as training methods to improve balance. Few reports exist on the benefits of providing trunk motion visual feedback (VFB) during treadmill walking, and most of those reports only describe within session changes.

RESEARCH QUESTION: To determine whether trunk motion VFB treadmill walking would improve over-ground balance for older adults with self-reported balance problems.

METHODS: 40 adults (75.8 years (SD 6.5)) with self-reported balance difficulties or a history of falling were randomized to a control or experimental group. Everyone walked on a treadmill at a comfortable speed 3×/week for 4 weeks …

Walk It Like You Talk It, Like A Champ With Some Amp, Sam Chukwuma, Anne H. Boddy

St. Augustine, Spring 2018

The purpose of this case report is to measure the effectiveness of amplified movement therapy to improve functional balance and gait in a post-stroke patient.

Effectiveness Of The Stepping On Program In Fall Prevention Measured By The Four Stage Balance Test (Fsbt), Jenna Goecke

Physical Therapy Scholarly Projects

Introduction: Falls are a leading cause of injury for older adults. Stepping On is one of many fall prevention programs in which individuals who have a fear of falling can participate. Stepping On is a 7 week multifactorial fall prevention program for community-dwelling adults age 65 and older. The program implements an exercise program and addresses education on mobility safety in the community and home. The program addresses how different fall risk factors impact function including diet, medication, vision, balance, and strength.

Purpose: The purpose of this study is to measure pre- and post-program fall risk with the …

The Effectiveness Of The "Stepping On" Program For Reducing The Incidence Of Falls In The Elderly: Measured By Four Stage Balance Test, Julia Nelson

Physical Therapy Scholarly Projects

Introduction: The Stepping On program encompasses both a balance and strengthening exercise regimen that is targeted towards reducing falls in community-dwelling individuals over the age of 65, who have experienced a fall or are fearful of falling.

Purpose: The purpose of this study was to determine if the Four Stage Balance Test (FSBT) is an appropriate measure of fall risk in the Stepping On program and to determine if the Stepping On program is effective at reducing fall risk, measured by improved time performance.

Methods: Eight participants, all female, ages ranging from 80-94 years old (M=87.2) completed …

The Activities-Specific Balance Confidence Scale And Its Use In Assessing Confidence In Elderly Community-Dwellers Attending The Stepping On Program, Sierra Heeren

Physical Therapy Scholarly Projects

Introduction: Stepping On is a 7-week comprehensive fall program aimed at reducing falls for the community-dwelling elderly. Participants are educated on balance and strengthening exercises, and the influence medications, visions, inclement weather, etc. has on safety and falls.

Purpose: The main purpose of this study is to utilize the Activities-specific Balance Confidence scale (ABC) and survey results to determine if attendance of Stepping On improves balance confidence. Secondly, this research sought out to discover if increased balance confidence relates to decreased fall risk.

Methods: Participants of this were included 13 individuals initially (with one participant joining the …

Timed Up And Go (Tug) Test And Its Effectiveness In Fall Risk Screening And Assessing The Success Of The Stepping On Program In Fall Prevention, Eric Estes

Physical Therapy Scholarly Projects

Background: The Timed Up and Go (TUG) test is a functional assessment that has been proven effective at identifying individuals at a risk for falls. The Stepping On program aims toward fall prevention through education, exercise, and shared experiences among participants. With previous evidence displaying positive, significant results for Stepping On and the TUG, a utilization of this assessment to track participants' progress in the course is indicated.

Objective: The purpose of this study was 1) to determine if the Stepping On program displays a decrease in fall risk through the application of the TUG and 2) if …

Effectiveness Of Cognitive Timed Up And Go Test In Assessing Fall Risk In The Older Adult, Cory Sailer

Physical Therapy Scholarly Projects

Introduction: Falls are a common and devastating injury for the older adult. Fall programs, such as the Stepping On program, are used to educate, strengthen, and sequentially reduce the number of falls its participant's endure. The Stepping On program is a multifactorial fall prevention program that addresses: balance and strength exercises, visual impairments, home modifications, pharmacologic effects, and even assistive devices. One aspect that has been found to be influential on fall risk is cognition, in particular executive functioning during ambulation.

Purpose: The purpose of this study was to screen participants of the Stepping On program for unknown …

Stepping On: Gait Velocity And Fall Risk Assessment, Brittney Herbst

Physical Therapy Scholarly Projects

Purpose: To identify fall risk and determine if the Stepping On program is effective at reducing the risk of falls in participants by increasing gait speed to greater than or equal to 1 m/s. Step and stride length were also compared to age related norms to determine if they correlated to fall risk. Gait speed of less than I m/s has been shown to increase the risk for falls in elderly.

Methods: Fourteen female participants over the age of 65 (mean age of 87) were recruited from a local Stepping On class conducted at an assisted living facility …