Postural stability decreases with increasing age after middle age. The consequences of falls or disequilibrium have a tremendous impact on the health and quality of life in the elderly. Recent trend in fall-related studies emphasized the concept of early prevention to falls. Thus physical therapists not only have to treat the patients with fall-related injuries but also have to properly evaluate the stability in preventing falls. To evaluate the ability of the elderly to maintain balance under altered sensory feedback conditions, Drs. Shumway-Cook and Horak, both are physical therapists in the United States, developed a set of simple tests of balance, ie., the Clinical Test of Sensory Interaction and Balance (CTSIB). The purposes of this study were to investigate quantitatively the range of normal responses to the CTSIB and to the one-leg stance test in Chinese living in Taipei. Sixty-three subjects (40 males, 23 females) completed this study. There were 19 young-age (mean age=24 years), 23 middle-age (mean age=47 years), and 21 old-age (mean age=65 years) subjects. Subjects were healthy volunteers without any known orthopedic or neurological disorders that may influence their balance. The CTSIB used a special visual dome around the head of the subject to alter the visual feedback during standing. The somatosense was altered in three of the six sensory conditions by asking the subject to stand on a medium-density foam pad. The duration for each sensory condition was 20 seconds in this study. Postural stability was recorded by the forceplate of the Balance Master system (Neurocomm International Inc.) during each condition. The six conditions were: (1) eyes open, no foam, ie., both vision and somatosense were normal; (2) eyes closed, no foam, ie., the visual feedback was deprived; (3) visual dome, no foam, ie., the visual feedback was altered; (4) eyes open with foam, ie., the somatosense alone was altered; (5) eyes closed with foam, ie., vision was deprived and the somatosense was altered; (6) visual dome with foam, ie., both vision and somatosense were altered. A stop watch was used to record the length of time a subject was able to maintain balance on one leg during the one-leg stance test. The results revealed that all subjects were able to complete the entire duration (20 seconds under each condition) of the CTSIB successfully. The postural stability was affected by both feedback condition and age. When sensory feedback was altered or deprived during quiet standing, the postural stability decreased. This phenomenon was more prominent under Test Conditions 5 and 6, ie., when two sensory feedback systems were simultaneously altered. Age had an significant effect on postural stability during Test Conditions 1, 3, 4, and 5 (p<.05). The older-aged group swayed significantly more than young-and middle-aged groups under normal condition, when standing on a firm surface with the visual dome, or when standing on a foam pad with eyes open or closed. There were no significant difference between male and female during the CTSIB when height and weight were controlled by the ANCOVA procedure. Significant age effect was found for the one-leg stance test. The standing duration of the older-age group was shorter that that of the young-and middle-age groups (p<.05). It was concluded that standing balance was affected by altered sensory feedback and by age. The ability of sensory integration to maintain balance was decreased in older adults. The one-leg stance test and the CTSIB are effective clinical tools to evaluate the balance ability under altered or deprived sensory conditions. It is recommended that both tests be used as standard screening tests in the community or clinics.
Postural stability decreases with increasing age after middle age. The consequences of falls or disequilibrium have a tremendous impact on the health and quality of life in the elderly. Recent trend in fall-related studies emphasized the concept of early prevention to falls. Thus physical therapists not only have to treat the patients with fall-related injuries but also have to properly evaluate the stability in preventing falls. To evaluate the ability of the elderly to maintain balance under altered sensory feedback conditions, Drs. Shumway-Cook and Horak, both are physical therapists in the United States, developed a set of simple tests of balance, ie., the Clinical Test of Sensory Interaction and Balance (CTSIB). The purposes of this study were to investigate quantitatively the range of normal responses to the CTSIB and to the one-leg stance test in Chinese living in Taipei. Sixty-three subjects (40 males, 23 females) completed this study. There were 19 young-age (mean age=24 years), 23 middle-age (mean age=47 years), and 21 old-age (mean age=65 years) subjects. Subjects were healthy volunteers without any known orthopedic or neurological disorders that may influence their balance. The CTSIB used a special visual dome around the head of the subject to alter the visual feedback during standing. The somatosense was altered in three of the six sensory conditions by asking the subject to stand on a medium-density foam pad. The duration for each sensory condition was 20 seconds in this study. Postural stability was recorded by the forceplate of the Balance Master system (Neurocomm International Inc.) during each condition. The six conditions were: (1) eyes open, no foam, ie., both vision and somatosense were normal; (2) eyes closed, no foam, ie., the visual feedback was deprived; (3) visual dome, no foam, ie., the visual feedback was altered; (4) eyes open with foam, ie., the somatosense alone was altered; (5) eyes closed with foam, ie., vision was deprived and the somatosense was altered; (6) visual dome with foam, ie., both vision and somatosense were altered. A stop watch was used to record the length of time a subject was able to maintain balance on one leg during the one-leg stance test. The results revealed that all subjects were able to complete the entire duration (20 seconds under each condition) of the CTSIB successfully. The postural stability was affected by both feedback condition and age. When sensory feedback was altered or deprived during quiet standing, the postural stability decreased. This phenomenon was more prominent under Test Conditions 5 and 6, ie., when two sensory feedback systems were simultaneously altered. Age had an significant effect on postural stability during Test Conditions 1, 3, 4, and 5 (p<.05). The older-aged group swayed significantly more than young-and middle-aged groups under normal condition, when standing on a firm surface with the visual dome, or when standing on a foam pad with eyes open or closed. There were no significant difference between male and female during the CTSIB when height and weight were controlled by the ANCOVA procedure. Significant age effect was found for the one-leg stance test. The standing duration of the older-age group was shorter that that of the young-and middle-age groups (p<.05). It was concluded that standing balance was affected by altered sensory feedback and by age. The ability of sensory integration to maintain balance was decreased in older adults. The one-leg stance test and the CTSIB are effective clinical tools to evaluate the balance ability under altered or deprived sensory conditions. It is recommended that both tests be used as standard screening tests in the community or clinics.
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