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Background and Aim: Balance is an essential part of motor development. Assessment of balance in children with neurological disorders is necessary before any treatment. There are various versions of balance tests for adult assessment however, little has been done with regard to a reliable test for evaluating the balance in children with spastic cerebral palsy.      

The purpose of this study was to investigate inter and intra rater reliability of Berg balance scale in children with spastic hemieplegia.

Material & Methods: 20 Spastic hemieplegia children were participated in this study (cross sectional).  Children were in the range of 6-12 Yrs (Mean & SD, 7/10 &1/58 yrs, correspondingly). Parents were asked to sign the informed consent. Berg Balance Scale tested in one session by two therapist for inter rater and repeated tests by the same therapist for intra rater reliability after a week.

Results: Intraclass correlation coefficient (ICC) test was used for inter rater (between two therapists, ICC= 0.966, p<001 and intra rater reliability (repeated test by the same therapist, ICC= 0.988 , p<001 ).

Conclusion: The result of this study suggests that inter rater and intra rater reliability of Berg balance scale is acceptable. Therefore, it could be used in clinic for the assessment of children with spastic hemieplegia as a reliable scale.

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Background and aim: The elderly people are one of the most vulnerable people in any society. Falling in this group is accompanied with decrease of daily living activities. With regard of improvement of balance in perevention of falling, the aim of this study is survey about the effect of Cawthorne and Cooksey exercises on improvement of balance.
Material and Methods:36 elder men with age above 60 years old put in two groups (control group= 19 and exercise group= 17) who lived in the elderly center in city of Mashhad. The subjects in exercise group participated in the Cawthorne and Cooksey exercises during three months, three times a week, during sixty minutes. Balance status of subjects evaluated with Berg Balance Scale(BBS) in 4 stages ( befor exercise and one month, two months and three months) after exercises.
Result: Results showed that improvement of the balance in the different evaluation stages of BBS was significantly increased particularly in the first and second months (p< 0.05). The effects of exercise group were significantly different from control group(p=0.000).
Conclusion: Cawthorne and Cooksey exercises were effective on the balance improvement of elderly men in center of Mashhad and two months of these exercises were enough to improve balance in this group.

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Background and Aim: in hemiplegic children Postural tone of the two sides of body is different. Once, asymmetric stance is a typical state in individuals' with unilateral pain and/or paresis and standing is with weight bearing on the stronger side. Obviously, an asymmetric stance with majority of weight bearing on the affected side can counter faces individual with the falling risk and causes instability. It seems coordinating of the two sides of body is the most vitally important therapeutic exercises in hemiplegic patients. Although stable stance is a simple postural task but it's controlled semi-automatically by cortical and spinal centers. It is established that stable standing, also demands cognition resources. So, postural control demands the interaction between musculoskeletal and nervous systems.
Material and method: In this clinical trial (before-after) 17 children 5-12 years old with spastic hemiplegia were participated. The subjects stayed in the center of force plate with the most stable standing position while using /not-using lateral wedge and in each state with/without doing cognition task. Short- memory test of digit span used as dual task condition. The mean range of fore-after and mediolateral sway and velocity and area as postural control independent variables and error measures in recalling of randomized digit chain as cognition task independent variables were registered.
Results: The wedge affected Rsw (P=0.015), Area (P=0.007) and Vm (P=0.005) significantly. Dual task also had significant effect on Rfa (P=0.014), Rsw (P=0.014), Area (P=0.002) and Vm (P=0.002). But the wedge declines its effect properly.
Conclusion: The results represent that a 5º lateral wedge applied to the unaffected limb, can improve factors of postural control even in Dual tasking thus The wedge can be used with a good effect on the posture of hemiplegic children.

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Background and Aim: Few studies have assessed the reliability of postural balance measures during dynamic balance performance that introduce additional challenging to postural control system. In addition sometimes in the static conditions some deficiencies of the postural control system may not be revealed obviously therefore the aim of this study was to assess the reliability of postural control parameters during functional performance on force plate in healthy subjects.
Materials and Methods:  Ten healthy male subjects (mean age: 25.4 years, weight: 68.2 kg height:176.9cm) participated  in this study. None of the subjects were involved in sport activities. Every subject performed three 15seconds trials of eyes open single leg stance on a force plate during dynamic balance task. Participants grasped object with hand at their waist level and release it at above shoulder level.  The reproducibility of the center of pressure (COP) deviations (average speed &length of path) was assessed. All participants were tested on 2 sessions with an inter-measurement interval of 7 days. COP data was collected for each trial. The intraclass correlation coefficient (ICC) was used as parameter of intra-session and inter-session (Test-Retest) reliability.
Results: The ICCs for intra-session reliability of average speed and length of COP path were  0.89 and 0.91  respectively. The ICCs for inter-session reliability were 0.95 and 0.96 respectively.
Conclusion: The study showed high and very high reliability for center of pressure measures during dynamic balance task. Therefore this dynamic performance can be used as a balance pattern in postural control assessment. These can be used as reliable parameters in dynamic postural control assessment due to high reliability of average speed and length of COP path

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Background and Aim: Multiple sclerosis (MS) is a demylinating disease that due to the involvement of multiple areas in central nervous system, including sensorimotor system can impair the patients' balance. The aim of the present study was to determine the balance, extremities muscular strength and disability rate in Iranian patients with MS and to investigate the relationship between these parameters. 

Materials and Methods: Sixty eight patients with MS participated voluntarily in this study. The berg balance scale (BBS), Motricity index (MI) and self report patient determined disease steps (PDDS) were used for assessing the balance, extremities muscular strength and patients' disability rate, respectively 

Results: Fifty six of patients showed balance impairment. Balance values were significantly correlated with muscular strength of upper (p=0.011) and lower (p<0.001) extremities in patients with balance impairment. But, the relation between balance and muscular strength in patients without balance impairment was not significant (p>0.05).There was a negative correlation between balance and disability rate (p<0.001).

Conclusion: The results of this study showed that more than 50% of patients have balance impairment. Furthermore, the importance of evaluating muscle strength in order to predict the falling risk in MS patients were identified.

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Background and Aim: The effect of rocker soles on improvement of foot plantar pressure distribution is well documented. Rockers are commonly prescribed for diabetic patients with neuropathy in order to offloading the particular area of the foot sole thereby decreasing the chance of the foot ulcers. On the other hand, these patients may experience balance problems because of the somatosensory defects due to peripheral neuropathy. There is an evidence of postural destabilizing effect of rocker soles in healthy adults. The purpose of the current study was to investigate the postural responses to the rocker sole in diabetic patients with neuropathy. 

Materials and Methods: Seventeen diabetic patients with neuropathy participated in this study. Canvas shoes were modified by addition of toe only rocker soles made of EVA (Ethyl Vinyl Acetate). The motor control test was conducted by the use of Neurocom system to evaluate postural stability with and without rocker sole. The Center of force displacement, response latency and response strength were measured.

Results: No significant difference was observed between the toe only rocker sole and without it in center of force displacement and response latency of the patients (P› 0.05). The results also indicated a significant increase in the response strength of patients by the rocker shoe, only in medium perturbations (P‹ 0.05).

Conclusion: The results of this study demonstrated that the postural stability of diabetic patients with neuropathy in response to the toe only rocker shoe is the same as the shoe without any rocker profiles. However, rocker shoes increase the need for generating active force during the automatic postural response of these patients which may indicate a training effect on diabetic patients with neuropathy.

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Background and Aim: Rehabilitation interventions have significant role in reducing the disabilities of Down syndrome. Due to great role of balance in the function of individuals particularly in Activity of Daily Living and the effect of strength on balance, the aim of this study was to investigate the effects of Progressive Resistive Exercise on functional balance in children with Down syndrome.
Material and Methods: Fifteen girls children aged between 8 and 12 years, with Down syndrome participated in this study by available sampling method. The subjects participated three times per week in a six-week progressive strengthening program. During intervention, 3 of them excluded. Balance were measured by Berg Balance Scale and right/left hip abductor and flexor, knee extensor and flexor muscles isometric strengths were measured by Nickolas hand-held dynamometer. Paired-sampled T-Test was used for data analysis.
Results: The results of this study showed that the mean of functional balance and muscles isometric strengths were significantly increased after intervention (P<0.001).
Conclusion: It seems that the results of this study confirm the effect of progressive resistance training on progressing functional balance, and 8-12 years old children with Down syndrome can benefit from these exercises.

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Background and Aim: With regard to importance of the role of balance in performance of daily activity especially in exercise activity and necessary to identify the factors that influence the balance, the purpose of this study was to survey the effect of lower limb muscle fatigue on balance in elite young athletes.
Materials and Methods: For this purpose, 15 young elite swimmers with a mean age and body mass index 17±0.7 and 21.62±0.5 during the two test phase, were studied. All participants performed the postural Stability and limit of stability tests in six for each test (three repetitions before and three repetitions after fatigue protocol by Wingate test)on the balance Biodex system. Values obtained by the system of the total , anterior - posterior, medial - lateral, anterior, anterior - right, anterior- left, posterior, posterior - right and posterior left index, were analyzed using paired sample t-test(P0.05).
Results: Results showed that fatigue caused a significantly influence the anterior - posterior, medial - lateral, posterior, left and posterior –left index.
Conclusion: With considering the specificity of training principle, the results can be helpful in the design of exercises involving the lower limb muscles in the specific direction. Keyword: Balance, Limit of stability, Fatigue, Athlete.

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Background and Aim: Improving the affecting factors of balance could be a critical procedure in managing the elderly's balance dysfunction. The goal of this study is to find out how and to which amount a prolonged period of stretch and massage impact on elderly's balance. Materials and Methods: In this RCT study with a simple randomized case selection, 205 normal subjects screened and after that, 18 subject (74.6 5.45 Years) for intervention group and 17 (75.8± 4.27 Years) subjects for control group contributed for the study. The procedure was 15 sessions in 5 weeks (3 sessions per week). Each session last about 1 hour. Berg Balance Scale (BBS) and Timed Up and Go (TUG) were used for evaluation of balance.

Results: Using by SPSS-19 software and after independent T-test, significant differences in balance scales were found between the intervention and the control groups (p<0.05).

Conclusion: According to present evidence, stretch and massage are significantly effective on elderly's balance function. 

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Background and Aim: Reading disorder is a neurodevelopmental disorder with deficits in cognition and motor skills. According to available studies, the brain structure in thesechildren is intact, but the brain function is abnormal. So, neurofeedback as a new treatment, can improve brain function in this disorder through regulating abnormalities of electroencephalogram (EEG). The purpose of this study was to investigate the effectiveness of neurofeedback balance protocol (to inhibit 4-7 Hz while reinforcing 15-18 Hz at electrode sites O1 and O2) on EEG and balance performance in children with reading disorder.

Materials and Methods: The study was conducted in a single subject design in 20 sessions. Participants were 4 children (1girl and 3 boys) aged between 8-12 years old who completed twelve 30-min neurofeedback sessions. Repeated measurements were performed during the baseline, treatment and follow-up by means of 2nd subtest of BOTMP for balance performance and EEG for brain waves changes.

Results: The results showed that the effect of treatment on balance performance was high (Cohen’d > 0.8) in all subjects but there were no significant changes in absolute power of brain waves.

Conclusion: The results of this study indicated that neurofeedback balance protocol can improve balance in children with reading disorder and may be more treatment sessions are needed for significant brain waves changes.

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Background and Aim: One of the most common defects after stroke is deficit in trunk control and balance which can lead to disability or dependency in many functional activities in life. Many therapeutic approacheswere used in the stroke rehabilitation, but there is not any unique accepted approach in this field yet. However there are many evidences that show task-oriented practice for neuro-movement rehabilitation can be efficient. The purpose of this study was to examine the effect of intensive task-oriented balance practices on functional balance and mobility in patients with chronic stroke.

Materials and Methods: This was an interventional - quasi-experimental study on 13 patients (4 women, 9 men, mean age 55.07 ± 8.41) with chronic stroke which were selected according to inclusion criteria. The intervention included 10 days of intensive practice during 2 weeks ,5 days per week and 3 hours a day. The assessments (Berg Balance Scale, Time Up-Go) were performed before and after the intervention.

Results: Intensive task-oriented balance training in patients with chronic stroke significantly increased the functional balance (p=0.005) and reduced the time of functional mobility (p=0.001)

Conclusion: The results showed that intensive task-oriented balance training can improve functional balance and functional mobility. Because this study was done only in one group, conducting more studies with appropriate control group is suggested.it is recommended to follow up the long lasting effects of training.

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Abstract

 Background and Aim: Regard with the importance of balance in daily activities especially in sport activities and understanding the important factor affecting it, the purpose of this study was to compare the role of vision system on dynamic postural stability of young women with men elite athletes.

Materials and Methods: Twenty six young women and men elite swimmer were chosen from the available society. They were divided in two groups according to body mass index. Each subject performed postural stability tests for 6 trials with open and close eyes (3 trials with open and 3 trial with close eyes) that each trial was taken for 30 seconds and with 10 seconds rest between each of them. Balance index in anterior- posterior and medial- lateral directions were calculated and independent t test was used to compare between groups.

Result: Results show that men swimmer are more depended to vision than women swimmer in maintaining retrieval postural stability (p= 0.001), while most impairment in maintaining postural stability in both groups occur in lack of vision status in anterior- posterior direction (p= 0.001).

 Conclusion: The findings of this study can be used to design training programs to prepare athletes.

Key words: balance, vision, athlete, control

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Background and Aim: The aim of present study was to examine effect of attentional focus on balance performance and EMG activity of athletes.

  

Materials and Methods: The semi-dynamic balance task of 10 gymnasts (22.2±2.09 years old) with 3-5 years of experience in two periods, one in internal focus (focus on leg) and one in external focus (focus on stabilometer plate) was assessed. Postural sways were measuredby Biodexstabilometer and muscular activity of tibialis anterior and soleus muscles were recorded using ME6000electromygram device. Data were analyzed using paired t- test.

  

Results : muscular activity for controlling posture was reduced in external focus condition than internal focus. Postural sways is more in internal focus condition than internal focus.

  

Conclusion: Research findings (enhanced performance and reduced EMG) showed that antinational focus conditions (internal or external) have significant effect on athletes balance performance. In conditions that attention is focused on external feedback and information (rather than focus on body itself) balance is enhanced and requirement to muscular activity will reduce.

  

Key words: Attentional focus, Electromyography, Semi-dynamic balance

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 Background and Aim: Total Hip Replacement (THR) is done comprehensively all over the world. Despite the effects of braces on control of THR complications , few studies have been performed on this subject. The purpose of this study was to evaluate immediate effect of hip abduction brace on mobility and functional balance of patients with THR.

  

 Materials and Methods: Eight men and nine women with THR participated in this study. Mobility and functional balance were assessed and compared with and without brace conditions by means of TUG, FR and Berg tests.

  

  Results : A significantly higher TUG, FR and Berg scores were seen in brace condition compared to without brace situation (P < 0.05).

  

  Conclusion: Hip abduction brace can increase mobility and functional balance in patients with THR.

  

  Keywords: Total Hip Replacement, Functional balance, Functional Mobility, Hip Abduction Brace

  

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Background and Aim: The number of elderly population in the world and also in Iran has increased due to health improvements and therefore, the quality of life has been focused in this group of population. Physical disabilities and particularly balance disturbances are among the consequences of the ageing process and hence, would affect the quality of life in elderly population. Mental practice is in fact the cognitive review of a physical skill without performing obvious bodily movements. The purpose of this study was to investigate the effect of mental practice of a movement skill on improvement of the quality of life in elderly men (60-80 yrs).

  

Materials and Methods: This was a Single blind Randomized controlled trial (RCT) study. The study was approved by the research ethics committee of the Tehran university of medical science (Irct ID: IRCT201107041722N3). The elderly population was 44 elderly men (60-80 yrs.) who were living in Kahrizak Nursing Home. They were randomly assigned in two groups and entered the study based on inclusion criteria. After baseline assessment, the quality of life of all of participants were assessed by SF36 test and also at 3 various stages (i.e. respectively, before the beginning of ,baseline assessment two weeks after intervention ,short term follow up and 3 months after intervention, long term follow up). Elderly population in the intervention group did mental practice of one movement skill for 4 weeks and during this periods, the control group did no mental practice.

  

Results: The results of our study showed the scores of SF36 in physical component, after the intervention of mental practice, have had a significant difference between the control and intervention groups. Although test scores in mental component and the whole test score showed no significant difference between the case and control groups at 3 stages of assessments.

  

Conclusion: The results of this study showed the significant effects of mental practices on physical component of SF36 in elderly population. However, these results also showed that this type of mental practice had no significant effects on mental component and total score of SF36.

  

Key Word: Quality of life, Balance, Mental practice, Elderly men

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Background and Aim : One of the most common defects observed after stroke is deficit in trunk control and balance which can lead to disability or dependency in many functional activities in life. Many therapeutic approaches are used in the rehabilitation of stroke patients, but there is no any unique accepted approach in this field yet. However there are many evidences that show task-oriented practice for neuro-movement rehabilitation can be efficient. The purpose of this study was to examine the effect of intensive task-oriented balance practices on functional balance and mobility in patients with chronic stroke.

  

Materials and Methods: This study was an intervention - quasi-experimental with chronic stroke on 13 patients (study on 4 women, 9 men, mean age 55/07 ± 8/41)which were selected according to inclusion criteria. The intervention included 10 days of intensive practice during 2 weeks , 5 days per week for 3 hours a day. The assessments (Berg Balance Scale, Time Up and Go) were performed before and after the intervention.

  

Results: Intensive task-oriented balance training in patients with chronic stroke significantly increased the functional balance (p=0/005) and reduced the time of functional mobility (p=0/001)

  

Conclusion: The results showed that intensive task-oriented balance training can improve functional balance and functional mobility. Because this study was done only in one group, conducting more studies with appropriate control group is suggested. Follow up were recommended in order to show durability effect for future researches.

  

Key word s: Stroke, Functional balance, Functional mobility, Task- oriented approach, Intensive practice

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Background and Aim: The aim of this research was to study spinal abnormalities ( kyphosis, lordosis and scoliosis ) and dynamic and static balance in mentally retardation with and without Down syndrome (DS) and relation between them in DS.

  

Materials and Methods: Thirty mentally retardation with DS (age 13.96 ± 1.77 yr) and 30 mentally retardation without DS (age 14.30±1.96 yr) that selected randomly participated in this study. Modified single balance test for the evaluation static balance and heel-to-toe test for evaluation dynamic balance were used. Continued spinal abnormalities included kyphosis, lordosis and thoracic & lumbar scoliosis were measured by spinal mouse.

  

Result: The results showed a significant difference between static and dynamic balance, kyphosis and thoracic & lumbar scoliosis in mentally retarded with and without DS . There was a significant relationship between static balance and kyphosis and thoracic and lumbar scoliosis and dynamic balance with kyphosis and thoracic and lumbar scoliosis in DS . There was not a significant relationship between balance and lordosis.

  

Conclusion: Due to relationship between postural and balance and special needs in mentally retardation particularly Down syndrome, for optimal performance of their daily activities, it should emphasis to recognize the structural profile and prescribe postural corrective programs and improving balance.

  

Key words : Down syndrome, Spinal deformities, Static balance, Dynamic balance  

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Background and Aim: According to the further tendency of osteoporotic people to use the hip strategy to maintain stability, in present study, the relationship between hip, ankle and back extensor muscles strength and functional balance in healthy and osteoporotic postmenopausal women were evaluated.

  

Materials and Methods: Forty-five volunteer postmenopausal women were divided into two normal and osteoporosis groups according to their bone mineral density. Maximal isometric strength of hip, ankle, and back extensor muscles were assessed by a hand-held digital dynamometer. Functional balance was assessed by Near Tandem Stand (NTS), Star excursion (SE) and Figure of 8 walking (F8W) tests.

  

Results: In osteoporosis group, all muscle groups were significantly weaker than the normal group (P<0.05), and the time of F8W test was significantly more than normal group (P=0.031). Also, in osteoporosis group, hip adductors and extensors showed a significant correlation with three functional balance tests (P<0.05).

  

Conclusion: Regarding to decrease of muscle strength in osteoporotic women and its relationship to declining of functional balance in ADL, strengthening of hip and ankle muscle groups should be considered in their rehabilitation programs.

 

Keywords: Muscle strength, Functional balance, Postmenopausal women, Osteoporosis.

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Background and Aim: Anterior Cruciate Ligament (ACL) is responsible for physical and somatosensory function. It is expected that additional sensory information improves dynamic balance of ACL reconstruction patients. This study is aimed to determine the effect of sensory information on knee dynamic balance after ACL reconstruction in comparison with normal people.

 

Materials and Methods: The study was designed as a randomized clinical trial. Thirty two men (16 men with unilateral ACL reconstruction and 16 healthy men), assigned in three groups: ACLR, reconstructed knee ACLR, non-reconstructed knee and normal. All participants received tactile information during functional tests. Dynamic postural stability was assessed by two functional tests including: Star Excursion Balance test and Cross over Hop for distance. The functional tests scores were conducted both pre and post applying sensory information in ACLR and normal people.

  

Results: The data showed that tactile information improves functional performance of ACLR patients. There were significant difference in reconstructed knee’s SEBT scores in medial (p=0.005) and posteromedial (p=0.034) directions by adding touch information. Significant difference in dynamic balance by addition of touch sense, in COH scores of ACLR people and normal population was found.

  

Conclusion: The findings of this study showed that additional sensory information improves dynamic balance in ACLR patients. The positive effect of tactile information supports to apply additional sensory information as a new method for increasing dynamic balance.

  

Key words: Anterior cruciate ligament, Sensory information, Dynamic balance.

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Background and Aim : Vision plays an important role in maintaining balance in the body so that the visual defects produce some disturbances in the body balance. In order to establish balance, the first afferent signals to the brain are provided through the visual system. Therefor, diagnosis and treatment of visual disturbances are so most effective and important. This paper reviews the importance of the visual system in body balance control and visual disorders which affecting on balance.

  

Materials and Methods : In this study, the articles from 1989 to 2012 with issues of vision and body balance were reviewed. The research with medical subject heading terms and key words of “vision” and “balance” in Pub-med, Science Direct, Scopus, Iran Doc, Scholar Google, Iran Medex, Magiran were done.

  

Conclusion: Correction of visual disorders and improving vision in patients with balance disorders can hasten the healing process.

  

Keywords: Vision, Balance, Visual Disorders