University of Phoenix
RES – 320 Foundations of Research
September 16th, 2013
The Balance Evaluation Systems Test to Differentiate Balance Deficits Experimentation Critique. The article viewed presents the framework, preliminary concurrent validity and interrater credibility for the specific tool. The Balance Evaluation Systems Test, also known as BESTest. The overall goal of this particular study was the development of a clinical balance tool for assessment which focus’ on six separate systems of balance control, so that isolated rehabilitation mapping can be put into place for different balance deficiencies. Sampling subjects and healthy subjects with different balance deficits make up the independent variable. The balance assessment tools use currently do not assist therapist in identifying underlying postural control systems that are responsible for low functional balance. They do however help identify if there is a risk of falling or what and where the balance deficits are such as visual function, reaction time delays or impaired proprioception. Although the risk is identified, what is not identified is what is causing them. Another problem with current methods is that treatment seems to be standard balance training for a standard balance problem. By identifying the cause of the balance deficits of each individual patient the therapist will then be able to direct specific individualized types of intervention for different types of problems. BESTest is made up of thirty six items that are grouped into six systems: • Biomechanical constraints for standing balance that include ankle and hip strength, postural alignment, the quality of base for the foot support, and the ability to get up off the floor to a standing position. • Stability limits/verticality includes how far the body can travel over its support base before changing the support of losing balance, the ability to realign the head and the trunk back to normal vertical, lateral limits such as leaning as far as possible in a sitting position with eyes closed, and in standing to reach as far as possible to the front and out to the side, • Anticipatory postural adjustments includes anticipating the need to adjust the bodies postural position, • Postural responses includes being able to adjust the body by stepping in response to someone pushing from front, back, or either side, • Sensory orientation identifies an increase in the sway of the body associated with changing visual or surface information, • Stability in gait includes evaluating balance during gait and balance when it is challenged during gait by speed, rotation of the head, pivot turns, or stepping over objects, it also includes a test called “Get up and GO” which is timed and assesses the speed a patient can do a task in sequence by rising from a chair, walking 3 meters, turning around, and sitting back down again without assistance. This also has a secondary cognitive task to challenge a patients attention. The development of the BESTest has been in the works since 1990. Horak and Shumway-Cook came up with the framework of this test to initially detect underlying balance function in their continuing medical education courses. During these courses they were provided with feedback about the different aspects of the test such as clarity, sensitivity, and practically of some of the items in the test. Some of the tasks of balance in the test have been taken from from current balance test already being used but are now placed in a theoretical framework. This test also has modified patient and therapist instructions along with rating scales to improve reliability and consistency. There had been two interrater trials performed, 22 subjects either having or not having balance disorders. The subjects ranged in age from 50 to 88 years old. These subjects were rated on the BESTest by 19 balance...
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