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Abstracts Neurology Section POSTER Presentations Found 155 Abstracts TITLE: The reliability and validity of the ‘Sway Sled’®: a new clinical measure of stability limits. AUTHORS/INSTITUTIONS: L.K. Allison, R. Shoaf, M. van der Linde, Physical Therapy, East Carolina Univ, Greenville, NC| ABSTRACT BODY: Purpose/Hypothesis : Decreased stability limits are a major risk factor for falls in older adults. Computerized forceplate testing (LOS) is the gold standard stability limits test, but is costly. The Multi-Directional Functional Reach (MDFR) test costs less, but may not be a valid measure. The new Sway Sled® (SS) is an inexpensive, easy clinical measure of stability limits that may offer better measures than the MDFR. The purpose(s) of this study are to test the reliability and validity of the Sway Sled® in young and older healthy adults, and compare these to the MDFR. Number of Subjects : Subjects were healthy young (N=22; 12 F, mean age = 24.9 yrs, +7) and older adults (N=9; 2 F, mean age= 77.1 yrs, +26). Materials/Methods : The SS is a lightweight, low-friction device placed on parallel bars with a height adjustable bar at the ASIS. Subjects slide the SS by weight-shifting. The distance between start and stop positions is measured. Subjects performed the SS first, then the LOS and MDFR in random order. For each group, maximum volitional sway excursion (ME) scores in all trials (3) in each direction (4; anterior, posterior, left, right) for each test (3) were compared using a RM-ANOVA (p=0.05) with post-hoc Paired t-tests (p=0.0167). Between-test comparisons included RM-ANOVA (p= 0.05) with post-hoc Paired t-tests (p=0.0167), and Pearson correlations (p=0.05). Results : Reliability: For both groups, for all 3 tests in all 4 directions there was no significant difference in ME scores for Trials 2 & 3, with one exception for young adults [LOS; anterior]. In young adults, for Trials 1 & 2, SS ME scores were significantly different in only one direction (anterior), MDFR in 3 directions (anterior, right, left), and LOS in all 4 directions. In older adults, for Trials 1 & 2, ME scores for all tests in all directions were not significantly different, with one exception [LOS; left]. Validity: For both groups, SS ME scores were significantly highly correlated with the LOS in all 4 directions, with one exception for young adults (posterior). For both groups, the MDFR ME scores were significantly mildly correlated with the LOS in only one direction (young-right; older-anterior). In both groups, the SS ME scores were not significantly correlated with the MDFR in any direction, with one exception for young adults (right). Conclusions : All 3 tests had good inter-trial reliability for both groups. First trial SS scores are accurate in both groups. First trial LOS and MDFR scores are accurate in healthy older adults; second trial scores should be used for young adults. SS scores are more reliable than MDFR scores laterally. This is important as medial-lateral COP control is a strong predictor of falls, and hip fractures occur most often with lateral falls. The SS had more frequent and higher correlations with the LOS for both age groups than the MDFR. Clinical Relevance : The SS is a new clinical measure of stability limits with high inter-trial reliability and greater validity than the MDFR. It is useful in settings with parallel bars. TITLE: Minimum Clinically Important Difference of the Functional Gait Assessment in Older Adults Based on Survey of Patients and Therapists AUTHORS/INSTITUTIONS: M. Beninato, L. Plummer, Department of Physical Therapy, MGH Institute of Health Professions , Boston, MA|A. Fernandes, Physical Therapy, Brookline Heath Care Center, Brookline, MA| ABSTRACT BODY: Purpose/Hypothesis : The purpose of this study was to determine the Minimal Clinically Important Difference (MCID) for the Functional Gait Assessment (FGA) in older community dwelling adults relative to patient and therapist estimates of change after physical therapy treatment of balance impairment and to determine the extent of agreement between patient and therapist (PT) estimates of change. Number of Subjects : 94 community dwelling older adults undergoing physical therapy for balance retraining. Materials/Methods : Patient demographics collected at the beginning of the episode of care. Estimates of change in “balance while walking” were solicited from patients and their PTs using a 15 point (-7 to +7 including a 0 point) Global Rating of Change (GROC) scale at the end of the episode of care. The FGA scores were collected at initial assessment and discharge. Descriptive statistics were generated for demographic variables. The extent of agreement between patient and PT estimates of change was determined using weighted Kappa and Chi-square statistics. For agreement analysis, scores from the GROC were categorized as no change (scores of 0, 1, 2) minimal change (3 and 4) and moderate change (5, 6, 7). To determine the MCID for the FGA, we generated receiver operating characteristic (ROC) curves plotting the FGA change scores with the dichotomous outcome as having achieved important change (GROC score 3-7) or not (GROC score 0-2). Area under the curve (AUC), cutoff (CO) scores, sensitivity (SN), specificity (SP) and likelihood ratios (LR) were calculated. Separate analysis was performed based on therapists’ ratings of change. Results : The patients were 37.2% male with average age of 78.1+/- 6.9 and received on average 7.6 +/- 3.91 weeks of therapy. Median initial, discharge and change FGA scores were 18 (range 5-29), 23 (range 10-30) and 4 (range - 2-4), respectively. Based on GROC scores, 90.4% of the patients reported important change had taken place versus 68.1% of the PTs. Poor agreement (weighted Kappa = 0.182; Chi Square = 17.89) was observed between PTs’ and patients’ estimates of change. Using PTs’ ratings of change as the anchor, the MCID for the FGA was 5 points (AUC=.83; SN=.59; SP=.90; LR+=5.9; LR-=.46). The MCID for the FGA using patients’ rating of change was also 5 points but this CO rendered lower accuracy (AUC=.59; SN=.46; SP=.78; LR+=2.09; LR-=.69). Conclusions : A change score of 5 points may be used as an indicator of the MCID on the FGA. Poor agreement was found between patients’ and PTs’ estimates of change. Clinical Relevance : PTs and their patients may be using different reference points for estimating important change in balance while walking implying a need for more explicit communication with patients relative to treatment goals consistent with patient centered care. PT ratings of change were more closely related to actual FGA change scores suggesting that PTs likely used observed performance as their anchor for rating change while patents may be using some other reference point for estimating change in balance. TITLE: Use of the Wii Fit for Balance Rehabilitation: Establishing Parameters for Healthy Individuals, Preliminary Results AUTHORS/INSTITUTIONS: M. Burns, K. Andeway, K. Ruroede, P. Eppenstein, Physical Therapy, Marianjoy Rehabilitation Hospital, Wheaton, IL| ABSTRACT BODY: Purpose/Hypothesis : The purpose of this study is to establish balance parameters for the Wii Fit in a sample of healthy adults, for evaluation of balance measurement reproducibility. Number of Subjects : The Wii Fit has been introduced as a cost-effective adjunct to balance training used in rehabilitation. There is scant literature on how to incorporate this technology into rehabilitation protocols using valid and reliable measurements. An IRB approved this prospective study of a healthy subject sample for analysis; 75 healthy subjects were approved for recruitment and planned to be evenly distributed across ages 21-65. The initial 73 participants’ measurements are discussed here. Participants’ had no history of neurological conditions or orthopedic injury that would limit study participation; body mass index below 35; self-reported to be physically active for moderate physical exertion and able to walk one mile; no self-reported history of seizures; normal blood pressure or under control with medication; female volunteers cannot be pregnant; normal or corrected to normal vision; and no previous experience with the Wii Fit. Materials/Methods : All participants completed three trials of three balance activities on the Wii Fit, during a single session. The three activities, randomly ordered by the investigators, included: 1) Balance Bubble; 2) Body Fit/Center of Balance; and 3) Tight Rope Walking. All data were analyzed with the IBM SPSS Statistics 19. Results : The 73 participants’ age distribution were grouped into ranges; 21-35 (n = 24), 36-50 (n = 22), and 51-65 (n = 27). Descriptive statistics for distance and duration for the Bubble Balance and Tight Rope Walking were measured. Right and left Center of Balance distribution percentages were also measured across three trials. Bar graphs, line charts, and boxplots were generated to evaluate the distribution appearance and range of scores for each parameter. Detailed mean parameters are not reported given the partial sample; however, several general observations can be provided. Participants increased Balance Bubble distance and duration from the first trial to subsequent trials within the youngest and oldest group, while the middle age group did not demonstrate consistent performance across trials. Participants increased performance overall for the Tight Rope distance across trials and duration decreased from the first to subsequent trials across all age groups. Center of Balance distributed weight percentages were equal across trials on right and left sides. Conclusions : More subjects need to complete the Wii Fit activities to evaluate a sample of healthy participants’ parameters. Preliminary analysis suggests that the Wii Fit demonstrates promise as a potential tool to measure balance performance in healthy adults. Final results will be reported when testing is completed. Clinical Relevance : To establish whether the cost effective Wii Fit can be used as a tool to measure and treat balance dysfunction in the clinical setting.
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