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Badke MB, Boissonnault WG. Changes in disability following physical therapy intervention for patients with low back pain: dependence on symptom duration. Objectives To assess the impact of symptom duration on functional outcome, functional improvement, pain, and patient perception of recovery after a physical therapy (PT) program for low back pain (LBP) and to determine what variables are significantly associated with improved function. Design Retrospective case series. Setting Outpatient setting at a tertiary care facility. Participants Patients (N=130) who were seen for PT between June 2003 and November 2004. Interventions A customized rehabilitation program was developed for each patient based on examination findings and included a combination of the following interventions: mobilization/manipulation, flexibility exercises, strengthening exercises, endurance exercises, massage techniques, and heat and cold modalities. Main Outcome Measures Functional outcome, functional improvement, perceived pain, and perceived improvement scores in the CareConnections Outcomes System (formerly TAOS) database. Results Persons whose symptom duration was greater than 6 months had significantly less functional improvement than persons whose symptom duration was less than 1 month. The median percentage improvement score for perceived recovery was also significantly lower for the chronic group than for the acute group. There was no significant difference in the percentage decrease in pain among the acute, subacute, and chronic groups. In regression analyses, a model with age ( P =.001), symptom duration ( P =.002), and inclusion of strengthening, flexibility, and mobilization and manipulation exercises ( P =.001) fit the data well and explained 55.5% of the variance in functional improvement score for all 3 groups combined. Conclusions Patients showed improvements in function following a rehabilitation program for LBP. The functional improvement score is influenced by age, symptom duration, and inclusion of mobilization/manipulation and strengthening and flexibility exercises.

Badke MB, Shea TA, Miedaner JA, Grove CR. Outcomes after rehabilitation for adults with balance dysfunction. Arch Phys Med Rehabil 2004;85:227–33. Objectives To assess balance, dynamic gait, and dynamic visual acuity outcomes after a vestibular and balance rehabilitation program and to determine which variables were significantly associated with improved balance and ambulation. Design Retrospective case series. Setting Outpatient setting at a tertiary care facility. Participants Twenty patients who were seen for vestibular and balance therapy between July 1999 and June 2000. Interventions A customized exercise program was developed for each patient according to the results of the assessment and included the following interventions, as indicated: gaze stabilization, balance and gait training, and habituation exercises. Main outcome measures The Dynamic Gait Index (DGI), Berg Balance Scale (BBS), Dynamic Visual Acuity Test (DVAT), and computerized posturography (Sensory Organization Test [SOT]). Results The mean change scores for the DGI showed significant improvement for both patients with peripheral vestibular dysfunction and patients with central balance disorders. For the central balance disorders group, the BBS score also showed significant improvement. No difference was noted for pretherapy and posttherapy SOT scores between groups. The total group appeared to show an average improvement of more than 2 lines on the visual acuity chart on the clinical DVAT. Patients who were 66 years or older were 1.5 times more likely to score less than 20 on the DGI, and those whose pretherapy vertical dynamic visual acuity was 20/80 or worse were 1.3 times more likely to score less than 20 on the DGI. Conclusions Patients showed functional improvements in balance, visual acuity, and gait stability after balance and vestibular physical therapy. Age and pretherapy vertical dynamic visual acuity score influenced dynamic gait outcome after a balance rehabilitation program.

Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Objective To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. Design Prospective multicenter research design. Setting Outpatient rehabilitation clinics. Participants Patients (N=29) with chronic stroke. Interventions Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. Main Outcome Measures The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. Results There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 ( P P P =.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. Conclusions Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.

Boissonnault WG, Badke MB. Influence of acuity on physical therapy outcomes for patients with cervical disorders. Objectives To assess the influence of symptom acuity on functional outcomes, pain, and patient perception of recovery after a physical therapy (PT) program for cervical disorders and to determine what variables are associated with patient function at discharge. Design Retrospective case series. Setting Outpatient settings at a tertiary care facility. Participants Patients (N=220) who were seen for PT between June 2003 and November 2005. Interventions A customized rehabilitation program was developed for each patient based on examination findings and included a combination of the following interventions: mobilization or manipulation, flexibility exercises, strengthening exercises, endurance exercises, massage techniques, and heat and cold modalities. Main Outcome Measures Functional outcome, functional improvement, perceived pain, and perceived improvement scores in the CareConnections Outcomes System (formerly TAOS) database. Results Persons whose symptom duration was greater than 6 months (chronic group) had significantly less functional improvement than persons whose symptom duration was less than 1 month (acute group). The median percentage improvement score for patient perceived recovery was also significantly lower for the chronic group than for the acute group. There was no significant difference in the percentage decrease in pain among the acute, subacute (symptom duration, 1−6mo), and chronic groups. In regression analyses, a model with age ( P =.001), symptom duration ( P =.05), and inclusion of mobilization and manipulation interventions ( P =.02) fit the data well and explained 35.6% of the variance in functional outcome score for all 3 groups combined. Conclusions Patients showed improvements in function after a rehabilitation program for cervical disorders. Patient functional score at discharge is influenced by age, symptom duration, and inclusion of mobilization or manipulation treatments.

Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed.

The locus of postural stability during dynamic, visually cued weight redistribution was studied in six hemiplegic and five able-bodied subjects. After a verbal warning with a variable foreperiod, a visual trace appeared on an oscilloscope to indicate a sway magnitude equaling half the subject's maximal voluntary sway. Body movement was cued in three directions--forward, and toward the paretic and nonparetic lower extremities. In order to assess extraneous postural patterns, all three directions of sway were analyzed for each trial. The results showed that with cued lateral sway (right or left) there was a tendency for hemiplegic subjects to reduce the dispersion (or variability) of the sway path. Clustering of the active lateral postural response near the geometric center of the sway path indicated a restricted balance response in this plane of motion. During cued forward sway the variability of the sway path was not statistically different from the able-bodied, but three-dimensional visualization of the sway pattern illustrated a qualitatively different postural response with extraneous, nonfocused balance activity biased toward the nonparetic lower extremity. Short-term practice did not alter the dispersion of the sway path for hemiplegic or able-bodied subjects in any direction. Hemiplegic extraneous movement in one case (forward sway) and restricted movement in another (lateral sway) emphasize the level of specificity which needs to be addressed during rehabilitation of balance.