Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Sit-to-stand as home exercise for mobility-limited adults over 80 years of age--GrandStand System may keep you standing? Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Visual Biofeedback Balance Training Using Wii Fit after Stroke: A Randomized Controlled Trial A Randomized Trial to Measure the Impact of a Community-Based Cognitive Training Intervention on Balance and Gait in Cognitively Intact Black Older Adults The Effect of a Four-Week Balance Training Program on Anticipatory Postural Adjustments in Older Adults: A Pilot Feasibility Study. Wearable Sensor-Based Biofeedback Training for Balance and Gait in Parkinson Disease: A Pilot Randomized Controlled Trial. A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems. Effects of Core Instability Strength Training on Trunk Muscle Strength, Spinal Mobility, Dynamic Balance and Functional Mobility in Older Adults Which impairments are most associated with high mobility performance in older adults? Implications for a rehabilitation prescription. Effect of 24 weeks strength training on unstable surfaces on mobility, balance and concern about falling in older adults. Arch support use for improving balance and reducing pain in older adults. Should physical activity programs be tailored when older adults have compromised function? The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial. [Interest of visual biofeedback training in rehabilitation of balance after stroke]. Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. A 12-week Iyengar yoga program improved balance and mobility in older community-dwelling people: a pilot randomized controlled trial. EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement. Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson’s disease and patients stable post stroke
OBJECTIVE To determine the short-term effectiveness of a biofeedback-based , computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling . PARTICIPANTS Forty-five older adults ( X = 78.5 years ) with a history of falls were assigned to either a control ( n = 21 ) or intervention group ( n = 24 ) . DESIGN A 2 x 2 ( Group x Time ) mixed factorial design with repeated measures on the second factor . SETTING A motor control research laboratory in a university setting . MEASUREMENT Impairments in multiple dimensions of balance ( i.e. , dynamic postural control and sensory organization ) were measured before and after an 8-week balance intervention using the 100 % Limits of Stability Test and Sensory Organization Test . More functional limitations in balance and /or mobility were measured using two clinical tests : Berg Balance Scale and Timed Up and Go test . MAIN RESULTS Repeated measures multivariate analyses and follow-up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only ( P < .03 ) . Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only . CONCLUSIONS Theory-driven rehabilitation programs that focus on manipulating individual , task , and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments . Moreover , the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task-specific practice are not the only means by which an older adult 's ability to perform daily activities requiring postural control can be improved PURPOSE To compare the effects of functional home exercise of repeated sit-to-st and s with low-intensity progressive resistance training , on performance measures in mobility-limited adults over 80 years of age . SETTING Participants ' homes . DESIGN Community-dwelling older adults > or = 80 years of age were invited to participate in a r and omised controlled clinical trial . Baseline and outcome measures were : comfortable gait velocity , 30-s chair-st and test , 15-s step test , Berg Balance Scale , Modified Falls Efficacy Scale and the Late-Life Function and Disability Instrument-function component . Participants r and omised to the intervention group performed repeated sit-to-st and s using a Gr and St and System ; a biofeedback device that recorded and displayed the number of repetitions performed . Participants r and omised to the control group performed knee extensions using ankle cuff weights . Both groups performed the exercises daily for 6 weeks . RESULTS Sixty-six older adults took part . The intervention group had a statistically significant improvement in Berg Balance Scale mean score , 1.67 + /- 2.64 points , P = 0.001 ( control group 0.73 + /- 3.63 points , P = 0.258 ) , indicating an improvement in balance over the 6-week exercise period . There was no statistically significant effect of either intervention on the other outcome measures . CONCLUSIONS In a highly variable population of older adults with mobility limitations , low-intensity functional home exercise of repeated sit-to-st and s using the Gr and St and System improved Berg Balance Scale score while low-intensity progressive resistance training did not . While statistically significant , the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinical ly significant in this population BACKGROUND Older adults show increased risk of falling and major risk factors include impaired lower extremity muscle strength and postural balance . However , the potential positive effect of biofeedback-based Nintendo Wii training on muscle strength and postural balance in older adults is unknown . METHODS This r and omized controlled trial examined postural balance and muscle strength in community-dwelling older adults ( 75±6 years ) pre- and post-10 weeks of biofeedback-based Nintendo Wii training ( WII , n = 28 ) or daily use of ethylene vinyl acetate copolymer insoles ( controls [ CON ] , n = 30 ) . Primary end points were maximal muscle strength ( maximal voluntary contraction ) and center of pressure velocity moment during bilateral static stance . RESULTS Intention-to-treat analysis with adjustment for age , sex , and baseline level showed that the WII group had higher maximal voluntary contraction strength ( 18 % ) than the control group at follow up ( between-group difference = 269 N , 95 % CI = 122 ; 416 , and p = .001 ) . In contrast , the center of pressure velocity moment did not differ ( 1 % ) between WII and CON at follow-up ( between-group difference = 0.23 mm(2)/s , 95 % CI = -4.1 ; 4.6 , and p = .92 ) . For secondary end points , pre-to-post changes favoring the WII group were evident in the rate of force development ( p = .03 ) , Timed Up and Go test ( p = .01 ) , short Falls Efficacy Scale-International ( p = .03 ) , and 30-second repeated Chair St and Test ( p = .01 ) . Finally , participants rated the Wii training highly motivating at 5 and 10 weeks into the intervention . CONCLUSIONS Biofeedback-based Wii training led to marked improvements in maximal leg muscle strength ( maximal voluntary contraction ; rate of force development ) and overall functional performance in community-dwelling older adults . Unexpectedly , static bilateral postural balance remained unaltered with Wii training . The high level of participant motivation suggests that biofeedback-based Wii exercise may ensure a high degree of compliance to home- and /or community-based training in community-dwelling older adults BACKGROUND AND PURPOSE Visual biofeedback/forceplate systems are often used for treatment of balance disorders . In this study , the research ers investigated whether the addition of visual biofeedback/forceplate training could enhance the effects of other physical therapy interventions on balance and mobility following stroke . SUBJECTS The study included a sample of convenience of 13 out patients with hemiplegia who ranged in age from 30 to 77 years ( mean=60.4 , SD=15.4 ) and were 15 to 538 days poststroke . METHODS Subjects were assigned r and omly to either an experimental group or a control group when the study began , and their cognitive and visual-perceptual skills were tested by a psychologist . Subjects were also assessed using the Berg Balance Scale and the Timed " Up & Go " Test before and after 4 weeks of physical therapy . Both groups received physical therapy interventions design ed to improve balance and mobility 2 to 3 times per week . The experimental group trained on the NeuroCom Balance Master for 15 minutes of each 50-minute treatment session . The control group received other physical therapy for 50 minutes . RESULTS Following intervention , both groups scored higher on the Berg Balance Scale and required less time to perform the Timed " Up & Go " Test . These improvements corresponded to increased independence of balance and mobility in the study population . However , a comparison of mean changes revealed no differences between groups . DISCUSSION AND CONCLUSION Although both groups demonstrated improvement following 4 weeks of physical therapy interventions , no additional effects were found in the group that received visual biofeedback/forceplate training combined with other physical therapy [ Purpose ] The aim of the present study was to investigate the effect of balance training with visual biofeedback on balance , body symmetry , and function among individuals with hemiplegia following a stroke . [ Subjects and Methods ] The present study was performed using a r and omized controlled clinical trial with a blinded evaluator . The subjects were twenty adults with hemiplegia following a stroke . The experimental group performed balance training with visual biofeedback using Wii Fit ® together with conventional physical therapy . The control group underwent conventional physical therapy alone . The intervention lasted five weeks , with two sessions per week . Body symmetry ( baropodometry ) , static balance ( stabilometry ) , functional balance ( Berg Balance Scale ) , functional mobility ( Timed Up and Go test ) , and independence in activities of daily living ( Functional Independence Measure ) were assessed before and after the intervention . [ Results ] No statistically significant differences were found between the experimental and control groups . In the intragroup analysis , both groups demonstrated a significant improvement in all variables studied . [ Conclusion ] The physical therapy program combined with balance training involving visual biofeedback ( Wii Fit ® ) led to an improvement in body symmetry , balance , and function among stroke victims . However , the improvement was similar to that achieved with conventional physical therapy alone Introduction . Fall prevention is important for maintaining mobility and independence into old age . Approaches for reducing falls include exercise , tai chi , and home modifications ; however , causes of falling are multifactorial and include not just physical but cognitive factors . Cognitive decline occurs with age , but older adults with the greatest declines in executive function experience more falls . The purpose of this study was twofold : to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population . Method . This pilot study used a pretest/posttest r and omized trial design with assignment to an intervention or control group . Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks . Classes were held at senior/community centers . Primary outcomes included balance as measured by the Berg Balance Scale ( BBS ) , 10-meter gait speed , and 10-meter gait speed under visuospatial dual-task condition . All measures were assessed at baseline and immediately post-intervention . Results . Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls ( N = 45 ) . Compared to controls , intervention participants experienced statistically significant improvements in BBS and gait speed . Mean performance on distracted gait speed also improved more for intervention participants compared to controls . Conclusion . Findings from this pilot r and omized trial demonstrate the feasibility of a community-based cognitive training intervention . They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls BACKGROUND Balance deterioration in older adults limits their activities of daily living , community participation , and is a significant risk factor for falls . One contributory element to this functional decline is impairment of anticipatory postural adjustments ( APAs ) . OBJECTIVES To evaluate the role and feasibility of a novel training program in improving APAs for balance control of older adults . METHOD Six older adults ( 73.3±5.0 years ) were r and omly assigned into the Experimental ( EG ) and Control groups ( CG ) . The EG participated in four weeks of APA-focused training involving catching a medicine ball while st and ing . All subjects were exposed to predictable external and self-initiated perturbations before and after training . EMG activity of eight trunk and leg muscles was recorded bilaterally and muscle onsets were analyzed during the anticipatory phase of postural control . Clinical tests of balance ( Timed-Up and Go , Single limb stance , and Activities-specific Balance Confidence scale ) were implemented . RESULTS Early onsets of APA activity prior to the external perturbations were seen in the EG following training . Moreover , early APA activity was observed in the EG prior to bilateral arm flexion , a task that was not a part of training , indicating a transfer of the learning effect of training . The improvement of APAs in the EG also result ed in improved performance on clinical outcome measures . There were no improvements seen in the CG for both the APA activity and the clinical balance tests . CONCLUSION The study outcome suggests that a four-week APA-based training program is feasible and could be effective in improving postural control , functional balance , mobility , and quality of life in older adults OBJECTIVES To analyze the feasibility and efficacy of a novel system ( Gamepad [ GAMing Experience in PArkinson 's Disease ] ) for biofeedback rehabilitation of balance and gait in Parkinson disease ( PD ) . DESIGN R and omized controlled trial . SETTING Clinical rehabilitation gym . PARTICIPANTS Subjects with PD ( N=42 ) were r and omized into experimental and physiotherapy without biofeedback groups . INTERVENTIONS Both groups underwent 20 sessions of training for balance and gait . The experimental group performed tailored functional tasks using Gamepad . The system , based on wearable inertial sensors , provided users with real-time visual and acoustic feedback about their movement during the exercises . The physiotherapy group underwent individually structured physiotherapy without feedback . MAIN OUTCOME MEASURES Assessment s were performed by a blinded examiner preintervention , postintervention , and at 1-month follow-up . Primary outcomes were the Berg Balance Scale ( BBS ) and 10-m walk test ( 10MWT ) . Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Question naire . RESULTS Gamepad was well accepted by participants . Statistically significant between-group differences in BBS scores suggested better balance performances of the experimental group compared with the physiotherapy without biofeedback group both posttraining ( experimental group-physiotherapy without biofeedback group : mean , 2.3±3.4 points ; P=.047 ) and at follow-up ( experimental group-physiotherapy without biofeedback group : mean , 2.7±3.3 points ; P=.018 ) . Posttraining stabilometric indexes showed that mediolateral body sway during upright stance was significantly reduced in the experimental group compared with the physiotherapy without biofeedback group ( experimental group-physiotherapy without biofeedback group : -1.6±1.5 mm ; P=.003 ) . No significant between-group differences were found in the other outcomes . CONCLUSIONS Gamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for 1 month . After training , 10MWT data were comparable between groups . Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical setting s , to enhance gait improvements , and to increase transfer of training effects to real-life context OBJECTIVES To examine the effects of a community-based group exercise program for older individuals with chronic stroke . DESIGN Prospect i ve , single-blind , r and omized , controlled intervention trial . SETTING Intervention was community-based . Data collection was performed in a research laboratory located in a rehabilitation hospital . PARTICIPANTS Sixty-three older individuals ( aged > or = 50 ) with chronic stroke ( poststroke duration > or = 1 year ) who were living in the community . INTERVENTION Participants were r and omized into intervention group ( n=32 ) or control group ( n=31 ) . The intervention group underwent a fitness and mobility exercise ( FAME ) program design ed to improve cardiorespiratory fitness , mobility , leg muscle strength , balance , and hip bone mineral density ( BMD ) ( 1-hour sessions , three sessions/week , for 19 weeks ) . The control group underwent a seated upper extremity program . MEASUREMENTS Cardiorespiratory fitness ( maximal oxygen consumption ) , mobility ( 6-minute walk test ) , leg muscle strength ( isometric knee extension ) , balance ( Berg Balance Scale ) , activity and participation ( Physical Activity Scale for Individuals with Physical Disabilities ) , and femoral neck BMD ( using dual-energy x-ray absorptiometry ) . RESULTS The intervention group had significantly more gains in cardiorespiratory fitness , mobility , and paretic leg muscle strength than controls . Femoral neck BMD of the paretic leg was maintained in the intervention group , whereas a significant decline of the same occurred in controls . There was no significant time-by-group interaction for balance , activity and participation , nonparetic leg muscle strength , or nonparetic femoral neck BMD . CONCLUSION The FAME program is feasible and beneficial for improving some of the secondary complications result ing from physical inactivity in older adults living with stroke . It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions OBJECTIVE To determine whether trunk extension endurance changes with training are associated with clinical ly meaningful improvements in balance among mobility-limited older adults . DESIGN Longitudinal data from a r and omized controlled trial . SETTING Outpatient rehabilitation research center . PARTICIPANTS Community-dwelling older adults ( N=64 ; mean age , 75.9y ) with mobility limitations as defined by a score of 4 to 10 on the Short Physical Performance Battery . INTERVENTIONS Sixteen weeks of progressive resistance training . MAIN OUTCOME MEASURES Outcomes were the Berg Balance Scale ( BBS ) and the Unipedal Stance Time ( UST ) . Predictors included leg strength , leg power , trunk extension endurance , and the product of heart rate and blood pressure ( RPP ) at the final stage of an exercise tolerance test . We performed an analysis of data from participants who completed 16 weeks of training by using binary outcomes defined by a clinical ly meaningful change ( CMC ) from baseline to completion of the intervention ( BBS=4 units ; UST=5s ) . The association of predictor variables with balance outcomes was examined separately and together in multivariate adjusted logistic regression models . RESULTS Trunk extension endurance in seconds ( 1.04 [ 1.00 - 1.09 ] ) was independently associated with CMC on the BBS . Trunk extension endurance ( 1.02 [ 1.00 - 1.03 ] ) was independently associated with CMC on the UST . Other physical attributes were not associated with meaningful change in balance . CONCLUSIONS Improvements in trunk extension endurance were independently associated with CMCs in balance in older adults . Leg strength , leg power , and RPP were not associated with CMC in balance . Poor trunk extension endurance may be a rehabilitative impairment worthy of further study as a modifiable factor linked to balance among older adults Background : Age-related postural misalignment , balance deficits and strength/power losses are associated with impaired functional mobility and an increased risk of falling in seniors .  Core instability strength training ( CIT ) involves exercises that are challenging for both trunk muscles and postural control and may thus have the potential to induce benefits in trunk muscle strength , spinal mobility and balance performance . Objective : The objective was to investigate the effects of CIT on measures of trunk muscle strength , spinal mobility , dynamic balance and functional mobility in seniors . Methods : Thirty-two older adults were r and omly assigned to an intervention group ( INT ; n = 16 , aged 70.8 ± 4.1 years ) that conducted a 9-week progressive CIT or to a control group ( n = 16 , aged 70.2 ± 4.5 years ) . Maximal isometric strength of the trunk flexors/extensors/lateral flexors ( right , left)/rotators ( right , left ) as well as of spinal mobility in the sagittal and the coronal plane was measured before and after the intervention program . Dynamic balance ( i.e. walking 10 m on an optoelectric walkway , the Functional Reach test ) and functional mobility ( Timed Up and Go test ) were additionally tested . Results : Program compliance was excellent with participants of the INT group completing 92 % of the training sessions . Significant group × test interactions were found for the maximal isometric strength of the trunk flexors ( 34 % , p < 0.001 ) , extensors ( 21 % , p < 0.001 ) , lateral flexors ( right : 48 % , p < 0.001 ; left : 53 % , p < 0.001 ) and left rotators ( 42 % , p < 0.001 ) in favor of the INT group . Further , training-related improvements were found for spinal mobility in the sagittal ( 11 % , p < 0.001 ) and coronal plane ( 11 % , p = 0.06 ) directions , for stride velocity ( 9 % , p < 0.05 ) , the coefficient of variation in stride velocity ( 31 % , p < 0.05 ) , the Functional Reach test ( 20 % , p < 0.05 ) and the Timed Up and Go test ( 4 % , p < 0.05 ) in favor of the INT group . Conclusion : CIT proved to be a feasible exercise program for seniors with a high adherence rate . Age-related deficits in measures of trunk muscle strength , spinal mobility , dynamic balance and functional mobility can be mitigated by CIT . This training regimen could be used as an adjunct or even alternative to traditional balance and /or resistance training OBJECTIVE To test which rehabilitative impairments are associated with higher mobility performance among community-dwelling , mobility-limited older adults . DESIGN Cross-sectional analysis of baseline data from participants within a r and omized controlled trial . SETTING Outpatient rehabilitation research center . PARTICIPANTS Community-dwelling older adults ( N=138 ; mean age , 75.4 y ) with mobility limitations as defined by the Short Physical Performance Battery ( SPPB ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance measured via the Berg Balance Scale , leg strength , leg velocity , submaximal aerobic capacity , body mass index ( BMI ) , and mobility performance as measured by the SPPB . RESULTS Each of the 5 physiologic attributes ( unipedal balance , leg strength , leg velocity , submaximal aerobic capacity , BMI ) was categorized into tertiles by using lower values as reference for impairment status . Within an adjusted model , measures associated with higher SPPB performance ( > 9 ) included a BBS score greater than or equal to 54 ( odds ratio [OR]=4.54 ; 95 % confidence interval [ CI ] , 1.11 - 18.60 ) , leg strength greater than or equal to 21.5 N/kg ( OR=30.35 ; 95 % CI , 5.48 - 168.09 ) , leg velocity .0101 to .0129 m.s(-1).kg(-1 ) ( OR=5.31 ; 95 % CI , 1.25 - 22.57 ) , and leg velocity greater than or equal to .0130 m.s(-1).kg(-1 ) ( OR=22.86 ; 95 % CI , 3.88 - 134.75 ) . CONCLUSIONS Our investigation highlights the importance of rehabilitative impairments in leg strength , leg velocity , and balance as being associated with mobility status as measured by the SPPB . In our sample of participants within an exercise trial , submaximal aerobic capacity and BMI status were not associated with mobility performance . These findings suggest that the augmentation of not only leg strength and balance but also leg velocity may be important in the rehabilitative care of mobility-limited older adults OBJECTIVE To evaluate the effects of 24-weeks of strength training on stable ( ST ) and unstable surfaces ( UST ) on the functional mobility , balance and concern about falling in healthy older adults , younger than 70 . DESIGN A single-center , r and omized clinical trial . PARTICIPANTS Sixty-four older adults ( 58 females and 6 males ; 68 years ) were r and omized into control , ST or UST groups . INTERVENTIONS Both ST and UST intervention groups received a core muscles , upper and lower limbs , moderate-intensity strength exercises using stable and unstable surfaces . The classes were performed three times per week over a 24-week period . The control group did not receive any type of active intervention . MEASUREMENTS The primary outcomes measure were the dynamic balance ( Berg Balance Scale ( BBS ) ) and functional mobility ( timed up and go test ( TUG ) ) . The secondary outcomes included the sitting and rising test ( SRT ) and Falls Efficacy Scale International ( FESI ) scores . RESULTS There was a significant improvement in balance performance ( BBS= + 4 points ) after 24-weeks of both ST ( + 1.22 ; 95 % CI- .19 to 2.63 ) and UST ( + 2.26 ; 95 % CI , .83 to 3.70 ) compared with the control group . Additionally , compared with the control , only UST experienced functional mobility gains ( TUG= -2.44 ; 95 % CI , -4.41 to - .48 ; SRT= + 1.12 ; 95 % CI , .08 to 2.17 ) and decreased concern about falling ( FESI= -4.41 ; 95 % CI , -9.30 to -.27 ) . CONCLUSION Long-term ST with and without unstable devices were effective to improve dynamic balance in older adults . Furthermore , the effects of UST were extended to functional mobility gains , and reduced concern about falling . This article is protected by copyright . All rights reserved PURPOSE The purpose of this study was to examine the effects of arch supports on balance , functional mobility , and pain in the back and lower extremity joints  among older adults . DESIGN A single-factor within-subjects design was used . METHOD A convenience sample of older adults formed a single group for fitting with arch supports .  Balance , functional mobility , and self-reported pain in the back and lower extremities were measured without the arch supports , immediately after the insertion of the supports in the subjects ' shoes , and after 6 weeks of arch support use . FINDINGS Sixty-seven older adults completed the study . The measures used indicated statistically significant improvements in scores for the Berg Balance Scale [ Berg , K. , Williams-Dauphinee , S. , & Williams , J. I. , ( 1995 ) . The Balance Scale : Reliability assessment for elderly residents and patients with an acute stroke . Sc and inavian Journal of Rehabilitation Medicine , 27 , 27 - 31 ] and functional mobility [ Timed Up and Go test ; Podsiadlo , D. , & Richardson , S. ( 1991 ) . The Timed " Up and Go " : A test of basic functional mobility for frail elderly persons . Journal of the American Geriatrics Society , 39 , 142 - 148 ] as well as reduced back , foot , knee , and hip pain ( p < .05 ) . There was no statistically significant change in ankle pain ( p > .05 ) . IMPLICATION S Knowledge of interventions that enhance health and well-being is essential for nurses . Arch supports may provide improved balance and functional mobility while reducing back and lower extremity joint pains . Further research is needed to support evidence -based practice The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function AIM To investigate the effects of balance training , using force platform biofeedback , on motor recovery , mobility and activity level of hemiparetic patients with stroke . METHODS In this r and omized , controlled , assessor-blinded trial 41 in patients [ mean ( + /-SD ) age of 60.9 ( + /-11.7 ) years ] with hemiparesis after stroke ( median time since stroke 6 months ) were r and omly assigned to an experimental or a control group . The control group ( n=19 ) participated in a conventional stroke inpatient rehabilitation program , whereas the experimental group ( n=22 ) received 15 sessions of balance training ( using force platform biofeedback ) in addition to the conventional program . Main outcome measures were motor recovery of the lower extremity ( Brunnstrom staging ) , mobility ( Rivermead Mobility Index , RMI ) and activity level ( Functional Independence Measure , FIM ) that performed one week before and after the experimental treatment program . RESULTS Both groups were similar in terms of baseline clinical characteristics . Motor recovery , mobility and activity level improved significantly in both groups ( P<0.05 ) . Between-group difference of mean change score was not significant for the Brunnstrom stages ( 0.23 vs 0.26 ) , RMI ( 2.9 vs 2.2 ) and FIM score ( 10.7 vs 11.5 ) . CONCLUSION In our group of stroke patients , balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery , mobility and activity level OBJECTIVE The aim of this study was the assessment of visual biofeedback  in the management of  balance disorders after stroke . MATERIAL AND METHODS This is a prospect i ve r and omised trial , which compares visual biofeedback training and traditional balance training .  Twenty-seven patients took part in this study : 13 in the first group and 14 in the second group . The rehabilitation program in the first group consists in an association of visual biofeedback and traditional training during 3 weeks . For the second group traditional training was used alone . Clinical , functional and forceplate assessment s were performed before and after the program of rehabilitation . RESULTS All the patients had a clinical and functional improvement . However , patients who have benefited from biofeedback training had a significant improvement of the forceplate parameters with closed eyes . DISCUSSION AND CONCLUSION Those results confirm the interest of rehabilitation in balance disorders after stroke . The use of biofeedback training incorporated into functional physiotherapy affords added benefits probably by a best integration of proprioceptive informations BACKGROUND : Physical activity ( PA ) reduces the rate of mobility disability , compared with health education ( HE ) , in at risk older adults . It is important to underst and aspects of performance contributing to this benefit . OBJECTIVE : To evaluate intervention effects on tertiary physical performance outcomes . DESIGN : The Lifestyle Interventions and Independence for Elders ( LIFE ) was a multi‐centered , single‐blind r and omized trial of older adults . SETTING : Eight field centers throughout the United States . PARTICIPANTS : 1635 adults aged 78.9 ± 5.2 years , 67.2 % women at risk for mobility disability ( Short Physical Performance Battery [ SPPB ] < 10 ) . INTERVENTIONS : Moderate PA including walking , resistance and balance training compared with HE consisting of topics relevant to older adults . OUTCOMES : Grip strength , SPPB score and its components ( balance , 4 m gait speed , and chair‐st and s ) , as well as 400 m walking speed . RESULTS : Total SPPB score was higher in PA versus HE across all follow‐up times ( overall P = .04 ) as was the chair‐st and component ( overall P < .001 ) . No intervention effects were observed for balance ( overall P = .12 ) , 4 m gait speed ( overall P = .78 ) , or grip strength ( overall P = .62 ) . However , 400 m walking speed was faster in PA versus HE group ( overall P = < .001 ) . In separate models , 29 % of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score , while 39 % was explained by change in the chair st and component . CONCLUSION : Lower extremity performance ( SPPB ) was significantly higher in the PA compared with HE group . Changes in chair‐st and score explained a considerable portion of the effect of PA on the reduction of major mobility disability‐consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability BACKGROUND Falls and fall-related injuries are a major public health concern , a financial challenge for health care providers , and critical issues for older adults . Poor balance and limited mobility are major risk factors for falls . OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance , mobility , and balance confidence in older adults . METHODS Participants ( N = 47 , mean age 75.6 ) were r and omly assigned to a Feldenkrais group ( FG , n = 25 ) or to a control group ( CG , n = 22 ) . The FG group attended a 5-week Feldenkrais program , 60 minutes three times per week , while the CG group was a waitlist control . The outcome measures were balance ( t and em stance ) , mobility ( Timed Up and Go ) , gait characteristics ( GAITRite Walkway System ) , balance confidence ( Balance Confidence Scale ; ABC ) , and fear of falling ( Falls Efficacy Scale ) . Pre- and post-tests were conducted . RESULTS After completion of the program , balance ( p = 0.030 ) and mobility ( p = 0.042 ) increased while fear of falling ( p = 0.042 ) decreased significantly for the FG group . No other significant changes were observed . However , participants of the FG group showed improvements in balance confidence ( p = 0.054 ) and mobility while performing concurrently a cognitive task ( p = 0.067 ) . CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility , and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults . A long-term follow-up study of balance and mobility is warranted . Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes OBJECTIVES To determine the effect of two different community-based group exercise programs on functional balance , mobility , postural reflexes , and falls in older adults with chronic stroke . DESIGN A r and omized , clinical trial . SETTING Community center . PARTICIPANTS Sixty-one community-dwelling older adults with chronic stroke . INTERVENTION Participants were r and omly assigned to an agility ( n=30 ) or stretching/weight-shifting ( n=31 ) exercise group . Both groups exercised three times a week for 10 weeks . MEASUREMENTS Participants were assessed before , immediately after , and 1 month after the intervention for Berg Balance , Timed Up and Go , step reaction time , Activities-specific Balance Confidence , and Nottingham Health Profile . Testing of st and ing postural reflexes and induced falls evoked by a translating platform was also performed . In addition , falls in the community were tracked for 1 year from the start of the interventions . RESULTS Although exercise led to improvements in all clinical outcome measures for both groups , the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group . In addition , the agility group experienced fewer induced falls on the platform . CONCLUSION Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes , functional balance , and mobility and may lead to a reduction of falls in older adults with stroke BACKGROUND Exercise that challenges balance can improve mobility and prevent falls in older adults .  Yoga as a physical activity option for older adults is not well studied . This trial evaluated the feasibility and effect of a 12-week Iyengar yoga program on balance and mobility in older people . METHODS We conducted a blinded , pilot r and omized controlled trial with intention-to-treat analysis . Participants were 54 community dwellers ( mean age 68 years , SD 7.1 ) not currently participating in yoga or tai chi . The intervention group ( n = 27 ) participated in a 12-week , twice-weekly yoga program focused on st and ing postures and received a fall prevention education booklet . The control group ( n = 27 ) received the education booklet only . Primary outcome was st and ing balance component of the short physical performance battery with addition of one-legged stance time ( st and ing balance ) . Secondary outcomes were the timed sit-to-st and test , timed 4-m walk , one-legged st and with eyes closed , and Short Falls Efficacy Scale-International . Feasibility was measured by recording class attendance and adverse events . RESULTS Fifty-two participants completed follow-up assessment s. The intervention group significantly improved compared with control group on st and ing balance ( mean difference = 1.52 seconds , 95 % CI 0.10 - 2.96 , p = .04 ) , sit-to-st and test ( mean difference = -3.43 seconds , 95 % CI -5.23 to -1.64 , p < .001 ) , 4-m walk ( mean difference = -0.50 seconds , 95 % CI -0.72 to -0.28 , p < .001 ) , and one-legged st and with eyes closed ( mean difference = 1.93 seconds , 95 % CI 0.40 - 3.46 , p = .02 ) . Average class attendance was 20 of 24 classes ( 83 % ) . No serious adverse events occurred . CONCLUSIONS This trial demonstrates the balance and mobility-related benefits and feasibility of Iyengar yoga for older people . The fall prevention effect of Iyengar yoga warrants further investigation BACKGROUND Muscle imbalance between serratus anterior ( SA ) , upper trapezius ( UA ) , middle trapezius ( MT ) , and lower trapezius ( LT ) muscles has been observed in subjects with subacromial impingement syndrome ( SAIS ) . OBJECTIVE ( 1 ) To investigate the effect of electromyography ( EMG ) biofeedback training on muscle balance ratios and scapular kinematics in healthy adults and subjects with SAIS . ( 2 ) To investigate whether the effects of EMG biofeedback on muscle balance ratios are different between groups . DESIGN Twelve healthy adults and 13 subjects with SAIS were recruited in this study .  EMG  was used to record the activity of scapular muscles . The ratios ( UT/SA , UT/MT , and UT/LT ) during exercises with/without EMG biofeedback were calculated . Scapular kinematics were recorded before and after exercises with/without EMG biofeedback . RESULTS For the subjects with SAIS , muscle balance ratios were lower during forward flexion with EMG biofeedback than during exercise only ( UT/SA : 70.3 - 45.2 ; UT/LT : 124.8 - 94.6 ) . Additionally , similar results were found during side-lying external rotation ( UT/MT : 58.5 - 36.4 ) . For the scapular upward rotation and tipping in both groups , there were no significant differences with and without EMG biofeedback . CONCLUSION EMG biofeedback improved the scapular muscular balance during training exercises in both groups . Further clinical trials should investigate the long-term effects of EMG biofeedback As the world 's population ages , falls , physical inactivity , decreased attention and impairments in balance and gait arise as a consequence of decreased sensation , weakness , trauma and degenerative disease . Progressive balance and gait training can facilitate postural righting , safe ambulation and community participation . This small r and omized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility , endurance , balance , strength and flexibility in older individuals greater than one year post stroke ( Gobbi et al. , 2009 ) or Parkinson 's disease ( PD ) ( Gobbi et al. , 2009 ) . Twenty-four individuals consented to participate . The participants were stratified by diagnosis and r and omly assigned to a control ( usual gait training ( Gobbi et al. , 2009 ) ) or an experimental group ( usual gait training plus kinematic feedback ( Gobbi et al. , 2009 ) ) . At baseline and 6 weeks post training ( 18 h ) , subjects completed st and ardized tests ( mobility , balance , strength , range of motion ) . Gains were described across all subjects , by treatment group and by diagnosis . Then they were compared for significance using nonparametric statistics . Twenty-three subjects completed the study with no adverse events . Across all subjects , by diagnosis ( stroke and PD ) and by training group ( control and experimental ) , there were significant gains in mobility ( gait speed , step length , endurance , and quality ) , balance ( Berg Balance ) , range of motion and strength . There were no significant differences in the gain scores between the control and experimental groups . Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences . In summary , during supervised gait training , dynamic visual kinematic feedback from wireless pressure and motion sensors had similar , positive effects as verbal , therapist feedback . A wireless kinematic feedback system could be used at home , to provide feedback and motivation for self correction of gait while simultaneously providing data to the therapist ( at a distance )
Results and Conclusions Although most available studies did not systematic ally evaluate feasibility aspects , reports of high participation rates , low drop-out rates , absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults .
An indication for effectiveness of visual feedback-based training of balance in ( frail ) older adults was identified for postural sway , weight-shifting and reaction time in st and ing , and for the Berg Balance Scale .
Indications for added effectiveness of applying biofeedback during training of balance , gait , or sit-to-st and transfers in older patients post-stroke were identified for training-specific aspects .
The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery .
Implication sFurther appropriate studies are needed in different population s of older adults to be able to make definitive statements regarding the ( long-term ) added effectiveness , particularly on measures of functioning
Context An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity .
Objective To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and /or mobility in older adults .