Objective: The purposes of this study were to conduct a systematic review of the psychometric properties of the BBS specific to stroke and to identify strengths and weaknesses in its usefulness for stroke rehabilitation.

Results: Twenty-one studies examining the psychometric properties of the BBS with a stroke population were retrieved. Internal consistency was excellent (Cronbach alpha=.92–.98) as was interrater reliability (intraclass correlation coefficients [ICCs]=.95–.98), intrarater reliability (ICC=.97), and test-retest reliability (ICC=.98). Sixteen studies focused on validity and generally found excellent correlations with the Barthel Index, the Postural Assessment Scale for Stroke Patients, Functional Reach Test, the balance subscale of Fugl-Meyer Assessment, the Functional Independence Measure, the Rivermead Mobility Index (except for weight shift and step-up items), and gait speed. Berg Balance Scale scores predicted length of stay, discharge destination, motor ability at 180 days poststroke, and disability level at 90 days, but these scores were not predictive of falls. Eight studies focused on responsiveness; all reported moderate to excellent sensitivity. Three studies found floor or ceiling effects.

Discussion and Conclusion: The BBS is a psychometrically sound measure of balance impairment for use in poststroke assessment. Given the floor and ceiling effects, clinicians may want to use the BBS in conjunction with other balance measures.

Subjects and Methods: Twenty-four subjects (12 subjects with unilateral TKA and 12 control subjects) were recruited; those with TKA were tested 3 months and 1 year following surgery. Motion analysis of an STS task was synchronized with 2 force platforms and electromyography. Outcome measures included joint angles and moments, electromyography, vertical ground reaction forces, muscle strength, and functional performance tests.

Results: Subjects with TKA showed improvements in symmetry of motion, strength, and functional performance from 3 months to 1 year following TKA. Compared with control subjects, subjects with TKA relied on increased hip flexion and a larger hip extensor moment to perform the STS task.

Discussion and Conclusion: The increased hip extensor moment demonstrated that subjects adopted a strategy to avoid the use of the quadriceps femoris muscle, yet this strategy persisted as quadriceps femoris muscle strength improved. This pattern may be a learned movement pattern that may not resolve without retraining.

Subject: The subject was a nonambulatory 41/2-year-old boy with an American Spinal Injury Association Impairment Scale (AIS) C Lower Extremity Motor Score (LEMS) of 4/50 who was deemed permanently wheelchair-dependent and was enrolled in an LT program 16 months after a severe cervical SCI.

Methods: A pretest-posttest design was used in the study. Over 16 weeks, the child received 76 LT sessions using both treadmill and over-ground settings in which graded sensory cues were provided. The outcome measures were ASIA Impairment Scale score, gait speed, walking independence, and number of steps.

Result: One month into LT, voluntary stepping began, and the child progressed from having no ability to use his legs to community ambulation with a rolling walker. By the end of LT, his walking independence score had increased from 0 to 13/20, despite no change in LEMS. The child's final self-selected gait speed was 0.29 m/s, with an average of 2,488 community-based steps per day and a maximum speed of 0.48 m/s. He then attended kindergarten using a walker full-time.

Discussion and Conclusion: A simple, context-dependent stepping pattern sufficient for community ambulation was recovered in the absence of substantial voluntary isolated lower-extremity movement in a child with chronic, severe SCI. These novel data suggest that some children with severe, incomplete SCI may recover community ambulation after undergoing LT and that the LEMS cannot identify this subpopulation.

Subjects and Methods: A total of 1,940 motor measurements from 650 children with CP were used to develop percentiles. These observations were taken from a subsample, stratified by age and GMFCS, of those in a longitudinal cohort study reported in 2002. A standard LMS (skewness-median-coefficient of variation) method was used to develop cross-sectional reference percentiles.

Results: Reference curves were created for the GMFM-66 by age and GMFCS level, plotted at the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles. The variability of change in children's percentiles over a 1-year interval also was investigated.

Discussion and Conclusion. The reference percentiles extend the clinical utility of the GMFM-66 and GMFCS by providing for appropriate normative interpretation of GMFM-66 scores within GMFCS levels. When interpreting change in percentiles over time, therapists must carefully consider the large variability in change that is typical among children with CP. The use of percentiles should be supplemented by interpretation of the raw scores to understand change in function as well as relative standing.

Objectives: The objectives of this study were: (1) to determine the 1-year incidence rate of WMSDs in physical therapists and (2) to determine the effects of specific risk factors.

Design: This was a prospective cohort study with 1-year follow-up.

Methods: Subjects were randomly selected American Physical Therapy Association members (N=882). Exposure assessment included demographic data, physical risk factors, job strain, and specific physical therapy tasks. The primary outcome was WMSDs, with a severity rating of at least 4/10 and present at least once a month or lasting longer than a week.

Results: The response rate to the baseline questionnaire was 67%. Ninety-three percent of the subjects who responded to the baseline questionnaire responded to the follow-up questionnaire. The 1-year incidence rate of WMSDs was 20.7%. Factors that increased the risk for WMSDs included patient transfers, patient repositioning, bent or twisted postures, joint mobilization, soft tissue work, and job strain.

Limitations: The primary limitation of this study was the number of therapists who had a change in their job situation during the follow-up year.

Conclusions: Work-related musculoskeletal disorders are prevalent in physical therapists. Physical therapy exposures, patient handling, and manual therapy, in particular, increase the risk for WMSDs.

Subjects: Twenty-five recreational runners who had ≥6 degrees of foot pronation participated in the study.

Methods: An insole sensor was used to register the plantar force of the subjects before and after running 1.5 km in different shoe conditions.

Results: There was no change in the magnitude and distribution pattern of plantar force with the motion control shoes after the 1.5-km run. With the neutral shoes, however, there was an increase in mean peak force under the medial midfoot (364–418 N, 15% increase) and first metatarsal head (524–565 N, 8% increase) toward the end of the running bout.

Discussion and Conclusion: The plantar force on the medial foot structures increased with mileage of running with neutral shoes but not with motion control shoes. This finding has implications for injury prevention with footwear selection for recreational runners who have more than 6 degrees of foot pronation.

Subjects and Methods: Three hundred eighty pediatric physical therapists responded to a survey questionnaire mailed to a random sample of members of the Section on Pediatrics of the American Physical Therapy Association. The survey was used to determine training needs of therapists in the area of AT, their confidence in delivering AT services, preferred methods of training, and challenges in becoming trained.

Results: The therapists reported having less-than-adequate training in AT and a lack of confidence in delivering AT services. They also reported that they would like accessible and affordable training that focuses on funding technology and services, knowledge of specific devices, and assessment and evaluation methods.

Discussion and Conclusion: The findings underscore the need to develop pre-service, in-service, and continuing education training opportunities in AT for providers working with children who have disabilities.

Subjects and Methods: Forty-seven subjects (mean age=59.2 years, SD=8.5, range=24–90) participated in the study; 26 were control subjects, and 21 were subjects with balance or vestibular dysfunction. Three trials of each level gait item were administered to subjects as they ambulated on an instrumented walkway. Test-retest reliability was determined by use of an intraclass correlation coefficient (3,1) 2-way random-effects model for gait parameters associated with continuous walking and the item requiring turning and stopping quickly. Mean gait parameter differences between control subjects and subjects with balance or vestibular disorders were compared by use of a multivariate analysis of variance for each gait task.

Results: The reliability of most gait parameters during DGI performance were fair to excellent between trials. Subjects with balance or vestibular disorders demonstrated differences in gait characteristics compared with control subjects. The heterogeneity of the group of subjects with balance or vestibular disorders does not permit inferences to be drawn regarding the relationship between gait and any specific balance or vestibular diagnosis. The results are most pertinent to people with chronic balance or vestibular disorders.

Discussion and Conclusion: Gait parameters underlying dynamic walking appeared to be relatively reliable across multiple trials and distinguished subjects with balance or vestibular disorders. Evaluating a person's performance on items of the DGI may be useful in identifying gait deviations and in evaluating gait improvements as a result of interventions.

Subjects and Methods: Fourteen participants with hemiparesis after stroke performed forward reaching tasks on 2 occasions 37.3 (SD=9.8) days apart. At each session, participants performed 4 forward reaching tasks produced by the combination of 2 target heights (low and high [109 and 153 cm from the floor, respectively]) and 2 instructed movement speeds (self-selected and as fast as possible). Two analytical methods were used to calculate kinematic parameters.

Results: Relative reliability (intraclass correlation coefficient) ranged from .04 to .99, and absolute reliability (standard error of measurement) ranged from 2.7% to 76.8%, depending on the kinematic variable, the demands of the motor task (target height and movement speed), and the analytical method. Bland-Altman analysis, a statistical method used to assess the repeatability of a method, revealed few systematic errors between sessions. The minimal detectable change ranged from 7.4% to 98.9%.

Discussion and Conclusion: Depending on the demands of the motor task and the analytical method, most kinematic outcome measures (such as peak hand velocity, endpoint error, reach extent, maximum shoulder flexion range of motion, and minimum elbow extension range of motion) are reliable measures of motor performance in people after stroke. However, because of the magnitude of within-subject measurement error, some variables (such as peak hand velocity, time to peak hand velocity, and movement time) must change considerably (>50%) to indicate a real change in individual participants. The results of our reliability analysis, which are based on our cohort of participants with hemiparesis after stroke and our specific paradigm, may not be generalizable to different subpopulations of people with hemiparesis after stroke or to the myriad movement tasks and kinematic variables used for the assessment of reaching performance in people after stroke.

Methods: Translation of the KFT was performed according to international recommendations, and the translated version was tested twice by 2 observers for intraobserver and interobserver reliability, with a 1-week interval between assessments, in 20 patients with RA with stable disease activity. Validity was investigated by studying 2 patient groups: (1) 15 patients with long-lasting (median=6 years) active RA, tested before and after 2, 6, and 14 weeks of anti-tumor necrosis factor alpha (TNF-) inhibitor therapy, and (2) 35 patients with early (median=0.25 year) RA, tested at years 0, 0.5, 1, and 2. Twenty-three patients in the early RA group also were tested at year 7. KFT, conventional clinical and biochemical markers of disease activity, and Health Assessment Questionnaire (HAQ) were used.

Results: The translated KFT showed good intraobserver reliability (intraclass correlation coefficients [ICC]=.90 and .95, coefficient of variation [CV]=3.5%) and interobserver reliability (ICC=.99 and .92, CV=3.5%), and the KFT correlated with several measures of disease activity and, most closely, with the HAQ. The KFT was, in contrast to clinical disease activity measures, not sensitive to changes over time. Only baseline KFT data were significantly related to functional changes over a long period of time as measured by the KFT, and only in the early RA group.

Discussion and Conclusion: The Danish translation of the KFT showed good reliability, acceptable concurrent validity, very poor responsiveness, and inconclusive results concerning predictive validity. The results of this study do not support the use of the KFT for monitoring function in clinical practice, as an outcome measure in clinical trials, or as a predictor of functional changes.