Reliability of dynamic sitting balance tests and their correlations with functional mobility for wheelchair users with chronic spinal cord injury

Kelly L Gao, K M Chan, Sheila Purves, William W N Tsang, Kelly L Gao, K M Chan, Sheila Purves, William W N Tsang

Abstract

The purpose of this study is to develop a reliable and valid tool for measuring the dynamic sitting balance of wheelchair users with spinal cord injury. The balance tests were performed in nine patients with chronic spinal cord injury (average of 17.2 years postinjury) between levels C6 and L1, while they were sitting in their wheelchairs and on a standardized stool (unsupported sitting), twice, 7 days apart. Limits of stability (LOS) and sequential weight shifting (SWS) were designed in this study. The balance tests measured participants' volitional weight shifting in multiple directions within their base of support. Their mobility scores on the Spinal Cord Independence Measure III were correlated with the balance test results. The LOS results showed moderate to excellent test-retest reliability (intraclass correlation coefficients ranged from 0.673 to 0.990) for both the wheelchair and the unsupported sitting. The SWS results showed moderate to excellent reliability (intraclass correlation coefficients ranged from 0.688 to 0.952). The LOS results correlated significantly with the Spinal Cord Independence Measure III mobility scores only in case of unsupported sitting, but the SWS test results showed significant correlations in both sitting conditions. To sum up, the sitting LOS and SWS tests are reliable and valid tools for assessing the dynamic sitting balance control of patients with spinal cord injury.

Keywords: mobility; reliability; sitting balance; spinal cord injury; validity.

Figures

Fig. 1
Fig. 1
Trajectory of the targets in SWS. The filled yellow circle denotes the centre, filled red circles denote the target locations and the arrows denote the trajectory. SWS = sequential weight shifting.

References

    1. Post M.W.M., vanAsbeck F.W.A., vanDijk A.J., Schrijvers A.J.P. Services for spinal cord injured: availability and satisfaction. Spinal Cord. 1997;35:109–115.
    1. Sisto S.A., Druin E., Sliwinski M.M. Mosby; St Louis, MO: 2009. Spinal cord injuries management and rehabilitation; pp. 351–379.
    1. Bolin I., Bodin P., Kreuter M. Sitting position: posture and performance in C5–C6 tetraplegia. Spinal Cord. 2000;38:425–434.
    1. Nelson A.L., Groer S., Palacios P., Mitchell D., Sabharwal S., Kirby R.L. Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study. Arch Phys Med Rehabil. 2010;91:1166–1173.
    1. Nelson A.L., Ahmed S., Harrow J., Fitzger S., Sanchez-Anguiano A., Gavin-Dreschnack D. Fall-related fractures in persons with spinal cord impairment: a descriptive analysis. SCI Nurs. 2003;20:30–37.
    1. Bernard P.L., Peruchon E., Micallef J.P., Hertog C., Rabischong P. Balance and stabilization capability of paraplegic wheelchair athletes. J Rehabil Res Dev. 1994;31:287–296.
    1. Gagnon D., Nadeau S., Noreau L., Eng J., Gravel D. Trunk and upper extremity kinematics during sitting pivot transfers performed by individuals with spinal cord injury. Clin Biomech. 2008;23:279–290.
    1. Burns A.S., Ditunno J.F. Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management. Spine. 2001;26:S137–S145.
    1. Tsang W.W.N., Hui-Chan C.W.Y. Effects of Tai Chi on joint proprioception and stability limits in elderly subjects. Med Sci Sports Exerc. 2003;35:1962–1971.
    1. Lynch S.M., Leahy P., Barker S.P. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther. 1998;78:128–133.
    1. Catz A., Itzkovich M. Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient. J Rehabil Res Dev. 2007;44:65–68.
    1. Itzkovich M., Gelernter I., Biering-Sorensen F., Weeks C., Laramee M.T., Craven B. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil. 2007;29:1926–1933.
    1. Zhang X., Wang C.H., Liang Q. Comparison of sensitivity of SCIM vs FIM in patient with spinal cord injury. Chin J Rehabil. 2009;24:315–317.
    1. Wang Y.L., Liang Q., Huang D.F. Reliability and validity of the Chinese version of Spinal Cord Independence Measure II. Chin J Rehabil Med. 2007;22:714–717.
    1. Portney L.G., Watkins M.P. Foundations of clinical research. 3rd ed. Pearson Education Inc; Upper Saddle River, New Jersey: 2009. Validity in experimental design.
    1. Shrout P., Fleiss J. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.
    1. Curtis K.A., Roach K.E., Applegate E.B., Amar T., Benbow C.S., Genecco T.D. Reliability and validity of the wheelchair user's Shoulder Pain Index (SUSPI) Paraplegia. 1995;33:595–601.
    1. Chen C.L., Yeung K.T., Bih L.I., Wang C.H., Chen M.I., Chien J.C. The relationship between sitting stability and functional performance in patients with paraplegia. Arch Phys Med Rehabil. 2003;84:1276–1281.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する