The first aim of this study was to evaluate the within-session reliability of sitting balance measures by assessing forward and lateral reach while sitting in both healthy subjects and patients post- stroke. The second aim was to evaluate the ability to document change in reaching while sitting over time in patients post-stroke. The third aim was to compare sitting balance results by the modified functional reach test (MFRT) to the Balance Master (BM), motor and function assessments. Data were collected on two occasions: Two to three weeks post-event and again six weeks later. On each occasion within-session reliability was tested using the intra-class correlations (ICC). The tests were performed three times; the second and third attempts were compared in order to test the within-session reliability. For assessing the concurrent validity, the MFRT results were compared with the BM results, Stroke Assessment Scale (SAS) and the Functional Independence Measure (FIM) score using Pearson correlations. In-patient rehabilitation department. Patients after a first ischemic stroke 14 - 21 days post-event were recruited from the inpatient rehabilitation department at Hadassah University Hospital, Jerusalem, Israel. Excluded were patients with brain stem lesions and/or bilateral signs or hemorrhagic events as diagnosed by Computerized Tomography, patients with Mini-Mental State Examination < 20, those who were not able to sit unsupported for 10 sec and those who could stand without support for more than 30 sec. The MFRT, performed while sitting in forward and sideward directions. The MFRT in all directions on both occasions exhibited high reliability (intra-class correlation coefficient range, 0.90 - 0.97). The responsiveness to the paretic side was high (effect size 0.80) and moderate for the forward and non-paretic side (effect size 0.57 - 0.60). A significant moderate correlation was found between MFRT and BM on both occasions. The MFRT while sitting can be reliably measured and may serve as a useful outcome measure in individuals with stroke 2 - 8 weeks post-event.

Objective: To assess the effect of aerobic walking training as compared to active training, which includes muscle strengthening, on functional abilities among patients with chronic low back pain. Design: Randomized controlled clinical trial with blind assessors. Setting: Outpatient clinic. Subjects: Fifty-two sedentary patients, aged 18–65 years with chronic low back pain. Patients who were post surgery, post trauma, with cardiovascular problems, and with oncological disease were excluded. Intervention: Experimental ‘walking’ group: moderate intense treadmill walking; control ‘exercise’ group: specific low back exercise; both, twice a week for six weeks. Main measures: Six-minute walking test, Fear-Avoidance Belief Questionnaire, back and abdomen muscle endurance tests, Oswestry Disability Questionnaire, Low Back Pain Functional Scale (LBPFS). Results: Significant improvements were noted in all outcome measures in both groups with non-significant difference between groups. The mean distance in metres covered during 6 minutes increased by 70.7 (95% confidence interval (CI) 12.3–127.7) in the ‘walking’ group and by 43.8 (95% CI 19.6–68.0) in the ‘exercise’ group. The trunk flexor endurance test showed significant improvement in both groups, increasing by 0.6 (95% CI 0.0–1.1) in the ‘walking’ group and by 1.1 (95% CI 0.3–1.8) in the ‘exercise’ group. Conclusions: A six-week walk training programme was as effective as six weeks of specific strengthening exercises programme for the low back.

Objective: To investigate the effect of early cycling training on balance and motor abilities of stroke patients in their subacute stage. Design: Randomized clinical trial. Setting: Inpatient rehabilitation. Subjects: Twenty-four patients who had had a first stroke were randomly assigned to a cycling training group ( n = 10) or to a control ( n = 14) group. Intervention: All subjects received their usual rehabilitation programme; the cycling training group received in addition a daily session of leg cycle ergometer, lasting three weeks. Both groups were followed for six weeks. Main outcome measurements: Balance was assessed using the Postural Assessment Scale for Stroke Patients (PASS) and the standing balance test. The motor function of the lower extremity was also assessed by the Fugl-Meyer Assessment (FMA). Results: In the within-group comparison, both the exercise group and the control group had improved significantly (P B=0.01) with time with respect to PASS total (exercise group 18.79=2.8 to 31.19=2.2, control group 18.19=3.2 to 26.49=3.8) and PASS subscores, as well as the FMA score (exercise group 17.29=7.5 to 29.19=5.9, control group 16.69=6.4 to 22.19=6.8). In addition there was a significant group=time interaction effect, with exercise group patients demonstrating better performance in both the total PASS score and PASS subscores and FMA score relative to the control patients (P B=0.01). Conclusions: These preliminary findings suggest that stroke patients in the subacute stage can improve their motor and balance abilities after an early short duration of cycling training.

Objectives: To evaluate the feasibility and the ability to recruit and retain children with severe traumatic brain injury or cerebral palsy, and their families, to a simple home-based exercise programme and to assess the immediate and short-term effects of such intervention on reducing impairment and improving function. Study design: Randomized clinical trial. Participants: Twenty children aged 7—13 years, with traumatic brain injury (N = 10) or cerebral palsy (N = 10) who were independent ambulators. Five children from each group were randomly assigned to a control group — regular daily activities, or to an experimental group — regular daily activities plus a home-based task-oriented exercise programme of sit-to-stand and step-up exercise, for six weeks. Outcome measures: Feasibility: The number of participants who completed the programme protocol. Efficacy: Timed Up and Go Test and Functional Reach Test were used as functional balance tests. Maximal isometric strength was assessed by using a hand-held dynamometer; walking performance was assessed by the 10 m walk test, 2-minute walk test and Energy Expenditure Index. Results: Nine children completed all parts of the training programme. At the end of the intervention period an increase of 3—4 cm in the mean Functional Reach Test and a reduction of 1.6 ± 2.1 seconds in the Timed Up and Go Test were noted (P<0.01) in the experimental group while no changes were noted in the control group. In all other outcomes assessed no significant differences were noted between groups. The positive change in balance performance in the experimental group was maintained during a six-week follow-up period. Conclusions: A home-based task-oriented exercise programme can improve balance performance in children with spastic cerebral palsy or severe traumatic brain injury.

To quantify the differences in gait variability and balance performance between children with cerebral palsy (CP), children with post-traumatic brain injury (TBI) and typically developed (TD) children and to determine the association between gait variability and functional balance in these groups. Cross-sectional study. Physical therapy department of a paediatric and adolescent rehabilitation hospital. A convenience sample of 15 children post-TBI, 15 children with CP and 30 TD age- and sex-matched controls. Not applicable. Step length and step time variability measured by an electronic walkway; timed up and go (TUG) test and functional reach test (FRT) were used as functional balance tests. The functional balance abilities of children post-TBI and children with CP were significantly limited compared to TD children. Children post-TBI had significantly greater variability in step length in comparison to healthy controls. A significant linear inverse correlation between balance performance and step length variability was found only among children with TBI. Brain damage is associated with restricted balance performance and increased step variability. It might be that in a child born with brain damage, as opposed to acquired damage, the developmental process has a restraining effect on gait variability.