Investigating Balance Perception and Balance Performance in Neurological Disorders for Targeted Rehabilitation
Rebecca Cardini1, Alessandro Torchio2, Irene Aprile3
1Department of Pathophysiology and Transplantation, University of Milan, 20100 Milan, Italy.
Importance:
Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their activities of daily living (ADLs). However, the relationship between balance deficits and ADLs measured by patient-reported outcomes is poorly understood, thus limiting the selection of specific static and dynamic tasks to be used to train for a given activity.
Objective:
The aim of the study was to provide a clinical framework linking ADLs, balance tasks, and balance resources to support clinicians' decision-making when planning task-oriented balance rehabilitation for PwND.
Design:
This was an observational study with a cross-sectional design.
Setting:
This study examined clinical contexts involving PwND.
Participants:
This study involved people with Parkinson disease, stroke, or multiple sclerosis (MS).
Exposure:
The study used the Activities-Specific Balance Confidence (ABC) Scale for patient-reported outcomes to assess perceived balance during ADLs, and the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) to evaluate static and dynamic balance.
Main Outcomes And Measures:
Kendall tau correlations (τ) were used to identify meaningful associations between ABC and BBS-DGI items, matching ADLs with specific balance tasks.
Results:
The study sample comprised 299 people with Parkinson disease (n = 94), stroke (n = 94), and MS (n = 111) with a median (interquartile range) age of 63 (52.0-71.5) years, all exhibiting moderate to severe balance impairments. Moderate correlations (τ ≥ 0.39) were found between dynamic and semi-dynamic challenging outdoor ADLs with static and dynamic tasks involving sensory orientation and the use of vestibular and proprioceptive systems. Moreover, stability limits-verticality, anticipatory postural adjustments, and stability in gait are the primary balance resources to consider when designing ad hoc rehabilitation interventions.
Conclusions:
This study establishes associations between specific ADLs and balance tasks, offering a clinical framework to identify relevant balance resources for rehabilitation. It provides clinicians with a structured approach for planning task-oriented, needs-based balance rehabilitation for PwND, focusing on the training of specific balance resources to enhance ADLs.
Relevance:
This study provides a clinical framework to help clinicians in planning task-oriented and needs-based balance rehabilitation for PwND, suggesting which balance resources should be trained to improve specific ADLs.
