Robotic balance assessment in community-dwelling older people with different grades of impairment of physical performance

Abstract

Background Impaired physical performance is common in older adults and has been identified as a major risk factor for falls. To date, there are no conclusive data on the impairment of balance parameters in older subjects with different levels of physical performance. Aims The aim of this study was to investigate the relationship between different grades of physical performance, as assessed by the Short Physical Performance Battery (SPPB), and the multidimensional balance control parameters, as measured by means of a robotic system, in community-dwelling older adults. Methods This study enrolled subjects aged ≥ 65 years. Balance parameters were assessed by the hunova robot in static and dynamic (unstable and perturbating) conditions, in both standing and seated positions and with the eyes open/closed. Results The study population consisted of 96 subjects (62 females, mean age 77.2 ± 6.5 years). According to their SPPB scores, subjects were separated into poor performers (SPPB < 8, n = 29), intermediate performers (SPPB = 8-9, n = 29) and good performers (SPPB > 9, n = 38). Poor performers displayed significantly worse balance control, showing impaired trunk control in most of the standing and sitting balance tests, especially in dynamic (both with unstable and perturbating platform/seat) conditions. Conclusions For the first time, multidimensional balance parameters, as detected by the hunova robotic system, were significantly correlated with SPPB functional performances in community-dwelling older subjects. In addition, balance parameters in dynamic conditions proved to be more sensitive in detecting balance impairments than static tests.

Development and validation of a robotic multifactorial fall-risk predictive model: A one-year prospective study in community-dwelling older adults

“…In the balance tests (Exercises 2-6) the following indicators, usually computed in standard posturography [30][31][32] and already validated for hunova for elderly subjects [13], for the trunk sensor and the platform (base or seat) were considered:…”

“…• First, we identified a minimal set of clinical parameters by using a fixed dataset of robotic variables and comparing different configurations of clinical assessments. Specifically, the subset of robotic variables was selected on the basis of the results of a previous study [13], in which we investigated the correlation between hunova parameters during standing and sitting balance tasks and the Short Physical Performance Battery test (SPPB) in communitydwelling older adults; in that study, we found the strongest correlation with trunk control parameters in standing conditions (see the selected subset in S2 Table).…”

“…Robotic parameters. On the basis of the literature [45,46], previous results and baseline comparison between fallers and non-fallers (see S3 Table), we tested the following sets of parameters: 1) all robotic parameters; 2) a subset of robotic variables based on the results of a previous study [13] (see the selected subset in S2 Table); 3) only dynamic variables (all variables included in exercises 3-7); 4) only static variables (all variables included in exercises 1-2); 5) a selection of variables (see S4 Table) based on significant differences between fallers and non-fallers (S3 Table) and on a detailed analysis of the appropriate literature [47].…”

“…hunova is a new robotic device that allows the evaluation of traditional stabilometric parameters and the implementation of various dynamic environments that stimulate postural responses. Owing to its accuracy, reproducibility and thoroughness in analyzing movement and postural control, which have already been shown in subjects with Parkinson's disease [12] and elderly subjects [13], this robotic device could constitute an objective fall-risk assessment tool that may find clinical application in identifying and targeting individuals at high risk and in implementing specific training to rectify balance deficits.…”

SWalker: a robotic platform for hip fracture rehabilitation

“…We have not found robotic rehabilitation platforms explicitly designed for HF rehabilitation. Some of the general purpose robotic platforms have been tested in HF patients for balance control exercises and monitoring [38]. However, given that they are not designed speci cally for HF rehabilitation, they are not optimized for gait speeds or sway adequate for these patients, nor they provide weight support for early post-operative mobilization [39].…”