Investigating Balance Perception and Balance Performance in Neurological Disorders for Targeted Rehabilitation Strategies.

Abstract

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 (Horak, 2009) 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.

Exposure: The study used the Activities-Specific Balance Confidence Scale (ABC) 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 multiple sclerosis (n = 111) with a median (IQR) 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.