View Full Version : Summary: Clinical balance impairment

Warrick Mckinon
07-01-2003, 06:25 PM
Thanks for all the responses.

Hereafter follows the original query:

While looking at the literature on the biomechanics of balance control
in humans (especially in the gerontology and clinical gait literature), I
have come across the term "clinical balance impairment" in a few
published papers. If I understand the methods of assessing balance
impairment correctly, in order to asses the level of balance impairment,
one would need to measure variables such as centre of gravity minus
centre of pressure (COG-COP), as well as ground support/contact area. I
have however been unable to find the criteria regarding these or other
variables that would justify "clinical impairment". My question to the
list therefore is: does anyone know where I could find any recognised
quantitative criteria for "clinical balance impairment"?


All the responses that I have received indicate that functional testing of falling (the frequency of falling or other measures of stability, such as the time till falling, sway, use a supporting limb, etc) are the standard methods used for the clinical assessment of balance, rather than biomechanical assessment of the physical mechanisms that underlie falling. This was well described by two of the responses:

Firstly from Ellen Freiberger :

>to my knowledge the term clinical balance impairements are coming
>from field tests not really ground reaction or COM measures.
>If you look at the literature and tests done by Shumway-Cook and
>Woollacott, as well as the Berg BAlance test tool you will find the
>term clinical impaired balance very often because it refers to field
>tested balance impairments.

as well as Keith Hill :

>There are many simple clinical measures of balance performance that have
>been reported that assess an individuals performance on one or more tasks
>that require specific aspects of balance ability. In some ways, I consider
>some of these to be of more utility than some of the force platform
>measures reported, particularly those which are static in nature.

In particular the specific tests that were cited as being able to quantify the functional risk of falling included:

The Romberg Test
The Berg Balance Scale
The Tinetti Balance Scale
Functional reach test - Duncan, P., K. Weiner, J. Chandler and S. Studenski
(1990). "Functional Reach: A new clinical measure of balance." Journal of
Gerontology 45: M192-7.
Timed Up and Go test - Podsiadlo, D. and S. Richardson (1991). "The timed
"Up & Go": A test of basic functional mobility for frail elderly persons."
Journal of the American Geriatrics Society 39: 142-8.
Step test - Hill, K., J. Bernhardt, A. McGann, D. Maltese and D. Berkovits
(1996). "A new test of dynamic standing balance for stroke patients:
Reliability, validity, and comparison with healthy elderly." Physiotherapy
Canada 48: 257-62.
Clinical test of sensory integration of balance - Shumway-Cook, A. and F.
Horak (1986). "Assessing the influence of Sensory Interaction on Balance:
suggestion from the field." Physical Therapy 66: 1548-50.
Four square step test - Dite, W. and V. Temple (2002). "A clinical test of
stepping and change of direction to identify multiple falling older
adults." Archives of Physical Medicine and Rehabilitation 83: 1566-71.

Thanks to Keith Hill, Jenny Baird, Hamish Wolfenden and Ellen Freiberger for your valuable responses.


Warrick Mckinon

Warrick McKinon
Exercise Laboratory
School of Physiology
University of the Witwatersrand
e-mail: mckinonw@physiology.wits.ac.za

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