Both the FGA and the BESTest have reliability and validity for assessing balance in individuals with PD. The BESTest is most sensitive for identifying fallers.

Background and Purpose The Balance Evaluation Systems Test (BESTest) has been shown to be a reliable and valid measure of balance in individuals with Parkinson disease (PD). A less time-consuming assessment may increase clinical utility. We compared the discriminative fall risk ability of the Mini-BESTest to that of the BESTest, and determined the reliability and normal distribution of scores for each section of the BESTest and the Mini-BESTest in individuals with PD. Methods Eighty individuals with idiopathic PD were assessed using the BESTest and Mini-BESTest. A faller was defined as an individual with 2 or more falls in the prior 6-months. Subsets of individuals were used to determine inter-rater (n=15) and test-retest reliability (n=24). Results The Mini-BESTest, total BESTest score, and all sections of the BESTest, showed a significant difference between the average scores of fallers and non-fallers. For both the Mini-BESTest and BESTest, inter-rater (intraclass correlation ICC≥0.91) and test-retest (ICC≥0.88) reliability was high. The Mini-BESTest and BESTest were highly correlated (r=0.955). Accuracy of identifying a faller was comparable for the Mini-BESTest and BESTest (area under the ROC plots =0.86 and =0.84, respectively). Discussion No specific section of the BESTest captured the primary balance deficit for individuals with PD. The post-test probabilities for discriminating fallers versus non-fallers were comparable-to-slightly stronger when using the Mini-BESTest. Conclusion Although the Mini-BESTest has fewer than half of the items in the BESTest and takes only 15 minutes to complete, it is as reliable as the BESTest and has comparable-to-slightly greater discriminative properties for identifying fallers in individuals with Parkinson Disease.

Objectives Our objectives were to: 1) determine intra-rater and test-retest reliability of the FTSTS in Parkinson disease (PD), 2) characterize Five Time Sit to Stand (FTSTS) performance in PD at different disease stages, 3) determine predictors of FTSTS performance in PD, and 4) determine utility of the FTSTS for discriminating between fallers and non-fallers with PD, identifying an appropriate cutoff score to delineate between these groups. Design Measurement study of community-dwelling individuals with idiopathic PD. Setting Participants were examined in a medical school laboratory. Participants Eighty-two participants were recruited via population-based sampling. The final sample included eighty participants. Two were excluded per exclusion criteria and unrelated illness, respectively. Interventions Not applicable. Main Outcome Measure(s) Five Times Sit to Stand Test (FTSTS) time (seconds). Secondary outcome measures included: Mini-Balance Evaluation Systems Test (Mini-BEST), Maximal Voluntary Isometric Contraction – Quadriceps (MVIC), nine hole peg test (9HPT), six minute walk, freezing of gait questionnaire, Activities-specific Balance Confidence Scale, Physical Activity Scale for the Elderly, Parkinson Disease Questionnaire-39, and Movement Disorders Society-Unified Parkinson Disease Rating Scale. Results Interrater and test-retest reliability for the FTSTS were high (Intraclass correlation coefficients of 0.99 and 0.76, respectively). Mean FTSTS performance was 20.25 ± 14.12 (seconds). All mobility measures were significantly correlated with FTSTS (p<0.01). The Mini-BEST and 9HPT together explained 53% of the variance in FTSTS. Receiver Operating Characteristic (ROC) analysis determined a cutoff of 16.0 seconds (sensitivity = 0.75, specificity = 0.68) for discriminating between fallers and non-fallers, with an area under the curve (AUC) of 0.77. Conclusion The FTSTS is a quick, easily administered measure useful for gross determination of fall risk in individuals with PD.

Background Previous data suggest the amount and aerobic intensity of stepping training may improve walking post-stroke. Recent animal and human studies suggest training in challenging and variable contexts can also improve locomotor function. Such practice may elicit substantial stepping errors, although alterations in locomotor strategies to correct these errors could lead to improved walking ability. Objective This un-blinded, pretest-posttest pilot study was designed to evaluate the feasibility and preliminary efficacy of providing stepping practice in variable, challenging contexts (tasks and environments) at high aerobic intensities in participants with chronic (< 6 months) and subacute (1–6 months) stroke. Methods Twenty-five participants with stroke (gait speeds < 0.9 m/s with no more than moderate assistance) participated in ≤ 40 1-hr training sessions within 10 weeks. Stepping training in variable, challenging contexts was performed at 70–80% heart rate reserve, with feasibility measures of total steps/session, ability to achieve targeted intensities, patient tolerance, dropouts, and adverse events. Measures of daily stepping, gait speed, symmetry, and 6-min walk were performed every 4–5 weeks or 20 sessions with a 3 month follow-up. Results Twenty-two participants completed ≥ 4 weeks of training, averaging 2887±780 steps/session over 36±5.8 sessions. Self-selected and fastest speed, paretic single limb stance, and 6-min walk improved significantly at post-training and follow-up. Conclusions This preliminary study suggests stepping training at high aerobic intensity in variable contexts was tolerated by participants post-stroke, with significant locomotor improvements. Future trials should delineate the relative contributions of amount, intensity and variability of stepping training to maximize outcomes.

The present study examined the efficacy of high-intensity, variable stepping training on walking and nonwalking outcomes in individuals 1 to 6 months poststroke as compared with conventional interventions. Methods Individuals with unilateral stroke (mean duration = 101 days) were randomized to receive ≤40, 1-hour experimental or control training sessions over 10 weeks. Experimental interventions consisted only of stepping practice at high cardiovascular intensity (70%-80% heart rate reserve) in variable contexts (tasks or environments). Control interventions were determined by clinical physical therapists and supplemented using standardized conventional strategies. Blinded assessments were obtained at baseline, midtraining, and posttraining with a 2-month follow-up. Results A total of 32 individuals (15 experimental) received different training paradigms that varied in the amount, intensity, and types of tasks performed. Primary outcomes of walking speed (experimental, 0.27 ± 0.22 m/s vs control, 0.09 ± 0.09 m/s) and distances (119 ± 113 m vs 30 ± 32 m) were different between groups, with stepping amount and intensity related to these differences. Gains in temporal gait symmetry and self-reported participation scores were greater following experimental training, without differences in balance or sit-to-stand performance. Conclusion Variable intensive stepping training resulted in greater improvements in walking ability than conventional interventions early poststroke. Future studies should evaluate the relative contributions of these training parameters.