Tehran University Medical Journal

Background: Impaired balance is one of the most common symptoms that occur after stroke. There are several tests for evaluating balance in neurological disorders. Brief-balance evaluation systems test (Brief-BESTest) is the short version of BESTest that assess the systems contributing to postural control. The purpose of this study was to investigate the inter- and intra-rater reliability of the Persian version of Brief-BESTest for balance evaluation in patients with stroke.
Methods: Patients with stroke recruited from the Tehran University of Medical Sciences Physiotherapy Clinics in Tehran participated in this cross-sectional study. Patients were included in the study with first ever stroke, able to follow instructions, able to walk without aid, and willingness to participate in the study. The study was conducted from August to December 2016. Two physiotherapists independently scored the videotaped performance of patients on Persian Brief-BESTest in one session for inter-rater reliability. The first physiotherapist recorded the patients’ performance on Persian Brief-BESTest after 1 week for intra-rater reliability. The physiotherapists were blinded to each other’s scores. Intraclass correlation coefficient (ICC) was used to assess the reliability. SPSS statistical software, version 18 (IBM, Armonk, NY, USA) was used for all analyses.
Results: Thirty patients with stroke (10 males, 20 females, mean age 57.3±13.5 years, duration 40.7±47.3 months) participated in this study. The ICC values for inter-rater reliability and intra-rater reliability of total scores were 0.98 (95% CI: (0.95-0.99)) and 0.99 (95% CI: (0.98-0.99)), respectively. The ICC values for inter- and intra-rater reliability of each item score were 0.72-1.0, and 0.87-1.0 respectively.
Conclusion: The Persian version of Brief-BESTest has high inter- and intra-rater reliability for evaluation of balance in patients with stroke. Therefore, it is recommended for use by clinicians in the clinic and for research purposes in the clinical trials.

Background: The previous studies showed that the odor can improve balance in the elderly. The purpose of the current study was to determine the effect of olfactory stimulus and its gender specific effect on the balance of young healthy people.
Methods: This is a pretest-posttest semi experimental study comprised 40 healthy volunteers (age range 18-73 years) from February 2016 through May 2017. The static balance test with one-leg standing time (OLST) and dynamic balance test using Biodex balance system to measure overall stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) and overall limit of stability index (OLOSI) randomly were performed before and after application of lavender scant as the olfactory stimuli. A two-way repeated measurement ANOVA was used to assess the effect of olfactory stimulus conditions and gender on dynamic balance indexes (OSI, APSI, MLSI, and OLOSI). Since the distribution of the OLST was not normal, the generalized estimating equations (GEE) method was used. Significance level of P<0.05 was adopted for all comparisons. Means are reported±SD unless otherwise stated. SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) was used to carry out all statistical analyses.
Results: The results showed that in comparison of the two different conditions (no odor/with odor), there was no significant difference in any of static and dynamic balance indexes (P>0.05). There were significant differences in relation to the interaction of the gender and odor in OSI (P=0.026), APSI (P=0.019). For gender, there were statistically significant differences in OSI (P=0.002, F (1,38) =11.649), APSI (P=0.001, F (1,38) =12.057), and MLSI (P=0.007, F (1,38) =8.228) for females.
Conclusion: Although there was no effect of odor on balance control of young healthy people, we found that the odor has gender specific effect. This is probably due to the more sensitivity of females to the odor.

Background: With aging, muscles strength decrease. Balance disorder is one of the common aging problems which can cause falls and serious injuries. The purpose of this study was to present a model along with the determinants of balance status in the elderly.
Methods: This cross-sectional study is part of a cohort study, "investigation of the health status of elderly in Amirkola City", which was performed on 1616 old people aged≥ 60 years, (response rate 72 %). The baseline data of this study were collected in the Center for Social Determinants of Health (SDH) Research Centre of the Babol University of Medical Sciences during March 2011 to July 2012. We considered the age, sex, physical activity, quadriceps muscle strength, daily activity, serum level of vitamin D, BMI, number of comorbidities and orthostatic hypotension as independent variables. Using the results of Berg balance test, the balance status of participants (as dependent variable) was categorized into two groups: score between 41-56 as normal (low risk of fall) and score < 41 as balance disorder (medium or high risk of fall). Then, the association of independent variables with balance status were evaluated in the logistic regression model.
Results: The mean and standard deviation of participants' age was 69.37±7.6 years, 54.7% of them were men and 7.5% of them had balance disorder. The odds ratio of medium or high falls in women to men, the number of comorbidities, having strong quadriceps to weak muscles, seniors aged 80 years and over, to 60-69, seniors with high physical activity to low physical activity, daily activities were (OR=2.1, 95%CI: 1.0-4.1), (OR=1.7, 95%CI: 1.0-2.9), (OR=0.05, 95%CI: 0.0-0.4), (OR=5.0, 95%CI: 2.3-10.6), (OR=0.3, 95%CI: 0.1-0.6), (OR=14.4, 95%CI: 3.4-60.4), respectively and statistically significant. The odds ratio of fall for vitamin D, orthostatic blood pressure and BMI variables did not show any statistically significant differences. The results of the analysis showed that the balance in all age groups in men was better than women.
Conclusion: Weak quadriceps, aging, being a woman and having comorbidities are the most important risk factors of balance disorder in the elderly.

Background: Spasticity is one of the most important symptoms of stroke, which leads to movement constraints and disability. The presence of spasticity in the ankle and toe plantar flexor muscles disturbs the balance and gait of patients with stroke. Dry needling has been introduced as a new method for the treatment of spasticity. The aim of this study was to investigate the immediate effects of the ankle and toe plantar flexors dry needling on spasticity and balance in patients with stroke.
Methods: This study was a clinical pretest-posttest study. Twenty patients with stroke (12 males and 8 females), the mean age of 56.5±13 years were included. The assessments were performed before dry needling, immediately after dry needling and 15 minutes after that. Dry needling was used to treat gastrocnemius (ankle plantar flexor) muscles, flexor digitorum longus, and flexor digitorum brevis of the affected lower limb of the patients, for one session. Each muscle was needled for one minute with fast in-fast out technique. The outcome measures of the study were modified modified Ashworth scale (MMAS) for the assessment of the severity of muscle spasticity, timed up and go test and one leg stance test, for balance evaluation. The study was conducted in neurological physical therapy, Clinic of Rehabilitation School, Tehran University of Medical Sciences in Iran, from April 2017 to April 2018.
Results: The results showed a significant decrease in the ankle and toe plantar flexor muscles spasticity both immediately after dry needling and at 15 minutes follow-up (P=0.001). The duration of timed up and go test (P=0.001) and one leg stance test (P=0.001) improved significantly after dry needling and this improvement persisted for 15 minutes after dry needling. The effect size for timed up and go test and one leg stance test was small (Cohen'sd=0.33 and 0.32 respectively).
Conclusion: This study suggests that dry needling is effective in improving spasticity of ankle and toe plantar flexor muscles and the balance of patients with stroke. Further research with larger sample size and control group is necessary.

Background: Posturography is a method in which the postural stability of adults is evaluated by measuring the center of pressure sway. This study aims to evaluate the reproducibility of measuring the center of pressure oscillation in standing position with internal perturbation in healthy young women with and without hyperkyphosis.
Methods: Ten women with dorsal hyperkyphosis with the mean age of 23.5±2.65 years and 10 healthy women with the mean age of 21.9±1.3 years (October 2018 to February 2019) were recruited for the study. Subjects were asked to perform rapid bilateral arm elevation while standing on a force plate. Standard deviation of the amplitude and The standard deviation of the velocity of the center of pressure sway in anterior-posterior, Medio-lateral directions and the area of sway were used for statistical analysis. Measurements were carried out by one examiner with a 1-day interval in The Biomechanics laboratory of The School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences. The relative reproducibility of the measurements was calculated by Intra-class Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC).

Background: Most hemiplegic children experience disorders related to lower limbs such as balance. Considering the importance of balance, in order to participate in activities of daily living, it is very important to use modern neuro-rehabilitation methods such as mirror therapy to improve balance. The purpose of the present study was to determine the effectiveness of mirror therapy on the static and dynamic balance of children with hemiplegic CP aged 5 to 12 years.
Methods: This study was conducted as a double-blind, randomized clinical trial on 20 children with spastic hemiplegia aged between 5-12 years old, from June 2021 to August 2022 in Tehran, Iran. Participating children were randomly allocated into test (n=10) and control (n=10) groups. The children in the treatment group underwent 20 treatment sessions during four weeks. Each session consisted of 30 minutes of routine treatment and 15 minutes of mirror therapy for lower limbs. In the control group, sham therapy was performed instead of mirror therapy. The exercises performed in a seated position were: (1) active flexion of hip, knee, and ankle joints, (2) active knee extension plus ankle dorsiflexion, and (3) knee flexion (> 90°). Both groups were measured by the Pediatric Balance Scale to assess static balance and the Timed Up and Go test to assess dynamic balance at entry and the end of the study. SPSS version 26 software was used for statistical analysis.

Results: Examining the results of the evaluations showed that before the treatment, the static and dynamic balance of the two groups did not differ significantly (p> 0/05), but the static and dynamic balance scores of the children in the treatment group after the four weeks mirror therapy period (five days per week) were statistically significant different from the control group (p<0/05). Conclusion: According to the present study, it seems that mirror therapy as a complementary treatment can have a positive effect on improving balance (static and dynamic) in children with hemiplegic CP.