A Study to Associate the Flamingo Test and the Stork Test in Measuring

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The Foot and Ankle Online Journal Official Publication of the International Foot & Ankle Foundation faoj.com / ISSN 1941-6806

A study to associate the Flamingo Test and the Stork Test in measuring static balance on healthy adults by Kranti Panta, BPT1, Watson Arulsingh D.R.², Joseph Oliver Raj³, Mukesh Sinha⁴, Mansoor Rahman4

The Foot and Ankle Online Journal 8 (3): 4

The Flamingo and Stork tests are frequently used clinical tests to measure static balance. However, the association between these tests has not been explored to date. This study is focused on finding association between these two clinical tools in measuring static balance on healthy adults. Twenty- four healthy collegiate students were chosen on convenient sampling method. The Flamingo Static Balance Test and the Standing Stork Balance Test were carried out on all participants. Each subject was instructed on the test procedure and performed three trails on each leg, and the average was taken. Statistical Package for the Social Sciences (IBM SPSS) version 16 was used for data analysis. Test of normality was done. Based on this, Pearson’s R Correlation Test was used. When corelated, the Stork test values of right leg stance against the Flamingo test values of the right leg stance exhibited positive correlation r=0.646 with p= 0.001. Similarly, the Stork test values of the left leg stance against the Flamingo test values of the left leg stance exhibited positive correlation r= 0.5666, p=0.004. Hence, this study concludes that the Flamingo test and the Stork test have revealed high association to each other as a clinical tool to measure static balance with statistical significance.

Keywords single stance balance test, BMI, base of support, center of gravity

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alance is an important aspect that helps to Frequently used for research purposes are functional maintain a stable posture for performing daily reach test, multidirectional reach test, standing stork B activities while counteracting external or test and the Flamingo test. Among these, the flamingo internal conflicts [1]. In terms of biomechanics, balance test is a total body balance test in order to test balance is the process that maintains the center of static balance [2]. It achieves the requirements of gravity (COG) or center of mass (COM) within the simplicity, low cost, and is capable for mass body’s base of support [2]. When the body is at rest it investigations [2]. This test assesses the strength of the is called static balance, and when the body is at steady leg, pelvic, and trunk muscle, as well as dynamic state motion then it is called dynamic balance [1]. The balance [5]. Limitations are that equipment is required factors affecting balance are breathing, vision, to conduct the test. The stork test is used to monitor vestibular function, and musculoskeletal alignment the development of the individual’s ability to maintain and proprioception [3]. Tests to measure static balance a state of equilibrium (balance) in a static position [6]. are FICSIT (Frailty and Injuries: Cooperative Studies Advantages of the test is that no equipment required, of Intervention Techniques) which includes parallel, it is simple to set up and conduct and it can be semi-tandem, tandem, and one-legged stance test [4]. conducted almost anywhere. The disadvantage is that Address correspondence to: Watson Arulsingh DR an assistant is required to conduct this test [7]. Despite [email protected] the fact that both these tests are widely practiced and [1] Alva’s college of physiotherapy and research centre, Moodbidri [2] Associate professor, Alva’s college of physiotherapy and research centre, used for research purposes, these two tools have not Moodbidri been correlated to each other previously. Hence, the [3] Professor, Alva’s college of physiotherapy and research centre, Moodbidri [4] Lecturer, Alva’s college of physiotherapy and research centre, Moodbidri purpose of this study was to correlate both of these tools to look for any significance.

ISSN 1941-6806 doi: 10.3827/faoj.2015.0803.0004 The Foot and Ankle Online Journal 8 (3): 4

Figure 1 Materials; stadiometer, weighing machine, calculator, stopwatch, wooden beam.

Methodology this position as long as they can. Stopwatch was used to note each time the person loses balance either by Twenty-four collegiate students from Dakshina falling off the beam or letting go of the foot being Kannada were taken on convenient sampling method held or hands removed off the body [5]. To within the age group of 18-25 of either gender for this administer the Stork test (Figure 2), the subject was study. Candidates were excluded if he or she had any made to stand comfortably on both feet with hands disease or functional impairments of the auditory, on the hip and instructed to lift one leg and place the visual, vestibular and proprioceptive systems, history toes of that foot against the knee of the other leg. The of injury to or surgery on the lower limbs and trunk, subject was then asked to raise the heel and stand on congenital deformities, current use of any medications their toes on command. The stopwatch was started as that might alter postural balance, presence of knee or the heel was raised from the floor. The stopwatch was ankle clinical instability, and presence of neurological, stopped if the hand(s) came off the hips or the cardiovascular, metabolic, rheumatic diseases and supporting foot swiveled or moved in any direction, underweight and obese subjects. Materials used or the non-supporting foot lost contact with the knee, included weighing machine, calculator, stadiometer, or the heel of the supporting foot touched the floor and a wooden beam (Figure 1). [6]. Every student was made to perform three attempts for each of the test and the average was Procedure recorded for statistical analysis of this study. The tests were demonstrated to all participants and the students were allowed to practice three times to avoid all possible errors. Tests were practiced with eyes open without shoes for both the right and left leg. To administer the flamingo test (Figure 2), the subject was asked to stand on the wooden beam (50 cm long, 5 cm high, 3 cm wide) with shoes removed on the tested leg and bend the free leg at the knee, and the foot of this leg was held close to the buttocks with both hands on the iliac crests, standing like a Flamingo. Participants were instructed to maintain

N=24 Min Max Mean ± S.D AGE 18.00 25.00 21.83±2.16 WEIGH 45.00 85.00 59.45±10.62 T HEIGHT 150.00 164.00 157.27±4.13 BMI 18.87 32.07 24.02±4.17

Table 1 Participant’s demographic data.

Stork Flamingo Stork Flamingo N=24 test test right test test left right left Pearson 1 .646** Stork Corr. test Sig. .001 right (2-tailed)

Pearson 1 .566** Figure 2 Flamingo test (left) and Stork test (right). Stork Corr.

test Sig. Results .004 Left (2-tailed)

SPSS 16 version was used for data analysis. Test of normality was also done. Based on this, the Pearson’s **. Correlation is significant at the 0.01 level (2tailed) R Correlation Test was used to correlate the measurements. Table 1 describes the demographic Table 2 Correlation analysis between stork test and flamingo in right and left leg stance. data of particpants of this study. Table 2 illustrates the correlation analysis between the stork test and the flamingo test in the right and left leg stance. Table 3 Mean Std. N provides mean values of the stork test values of the Deviation Stork test right leg stance. Table 4 provides mean values of the .0508 .06737 24 stork test values of the left leg stance. right Flamingo .0571 .05312 24 Discussion test right

This study resulted in showing a good association Table 3 Mean values of stork test values right leg between the flamingo test and the stork test measured stance. on 24 healthy collegiate students. This result has shown high significance in all correlation values as r Mean Std. N values were 0.64 and 0.56 for the right leg and left leg Deviation respectively. Hence, one can understand these two Stork test .0513 .05511 24 tests are highly valid in measuring static balance on left the young adult, provided considering all advantages Flamingo .0383 .02014 24 and disadvantages [7] for these tests discussed test left previously. Stork tests normative values and its reliability is already provided for 16-19 age groups. Table 4 Mean values of stork test values left leg stance. Out of this study’s result, one can practice both the tests interchangeably to assess static balance in healthy adults. Copyright © 2015 The Foot and Ankle Online Journal The Foot and Ankle Online Journal 8 (3): 4 Conclusion References

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