A PROJECT REPORT

“COMPARISON OF SPECIALY DESIGNED BALANCE EXERCISES AND

CONVENTIONAL BALANCE EXERCISES IN ELDERLY POPULATIONS
SUFFERING FROM ATAXIA”

SUBMITTED TO
SCHOOL OF MEDICAL AND ALLIED SCIENCES

In Partial Fulfillment of the Requirements for the award of the Degree of

MASTER OF PHYSIOTHERAPY
IN
(NEUROLOGY)
Submitted By
ANSHULI SEN
Univ. Enrollment No: .2308201108

MAJOR SUPERVISOR
Dr.
(Assistant Professor)
DEPARTMENT OF PHYSIOTHERAPY
SCHOOL OF MEDICAL AND ALLIED SCIENCE
SANSKRITI UNIVERSITY, MATHURA
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 2023-2025

PLAIGARISM REPORT (Less than 10% of Urkund/ Turnitin only)

I hereby declare that this project report entitled “Comparison of Specialy

Designed Balance Exercises and Conventional Balance Exercises in Elderly
Populations Suffering From ATAXIA” is less than 10% plagiarized as per
University guidelines, I have check the plagiarism for my project though
plagiarism checker x pro software.

If plagiarized content found more than 10% I will be responsible for that
and may lead to any action against me for the plagiarized content in my
report.

Date:- (ANSHULI SEN)

Enrollment No.: 2308201108

21
 CERTIFICATE

This is to certify that the work embodies in this dissertation entitled “Comparison
of Specialy Designed Balance Exercises and Conventional Balance Exercises in
Elderly Populations Suffering From ATAXIA” being submitted by Anshuli Sen,
Enrollment No. 2308201108 for partial fulfillment of the requirement for the
award of Master of Physiotherapy in (NEUROLOGY) to Sanskriti University,
Mathura during the academic year 2022-24 is a record of bonafide piece of work,
undertaken by her the supervision of the undersigned.

Approved and Supervised by

Signature

(Dr. ……………………)

Programme Coordinator

Department of Physiotherapy

22
 SANSKRITI UNIVERSITY, CHHATA, MATHURA, U.P

Department of Physiotherapy

DECLARATION

I ‘ANSHULI SEN’ Enrollment No. 2308201108’, a student of ‘Master of

Physiotherapy in (Neurology), Session-2023-25, Sanskriti University, Chhata,
Mathura hereby declare that the work presented in this dissertation entitled
“Comparison of Specialy Designed Balance Exercises and Conventional
Balance Exercises in Elderly Populations Suffering From ATAXIA” is the
outcome of my own bonafide work and is correct to the best of my knowledge and
this work has been undertaken taking care of research Ethics. It contains no
material previously published or written by another person nor material which has
been accepted for the award of any other degree or diploma of the university or
other institute of higher learning, except where due acknowledgment has been
made in the text.

Date: (ANSHULI SEN )

Enrollment No.:2308201108

23
 Acknowledgement

I express my sincere gratitude to Chancellor Sir for the constant inspiration and valuable
guidance to undertake the project.

I also thank Vice-Chancellor Sir for providing us with the best opportunities and keen interest
shown in the project.

I also express my gratitude to Registrar of the University for the support and guidance to
accomplish the Project.

I express my earnest thanks to the Dean, School of Medical and Allied Sciences,Sanskriti
University, for the guidance and motivation for completion of the project.

I thank Dr. …………, Major Supervisor for the constant guidance and critical analysis for the
compilation of the work.

No words can express the moral support and help extended by …………………….

From here, add the other persons who have contributed in the guidance during this project
work and have encouraged us to complete this work.

Last but not the least, my parents who have stood by me.

Date: (ANSHULI SEN)

Enrollment No.:2308201108

24
 TABLES OF CONTENTS

Heading Page No.

CERTIFICATE (GUIDE) i

CERTIFICATE (COLLEGE) ii

CERTIFICATE (STUDENT) iii

DEDICATION iv

ACKNOWLEDGEMENT v

LIST OF TABLES viii

LIST OF GRAPHS ix

CHAPTERS

1. INTRODUCTION 1

2. OBJECTIVES 6

3. HYPOTHESIS 8

4. OPERATIONAL DEFINITIONS 10

5. REVIEW OF LITERATURE 12

6. METHODS 37

7. DATA ANALYSIS 51

8. RESULTS 53

9. DISCUSSION 64

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 - Discussion of results

- Future Research

- Relevance to clinical practice

10. CONCLUSION 70

11. LIMITATIONS 72

12. BIBLIOGRAPHY 74

13. APPENDIX 85

- Consent Form

- Screening Form

- Data Collection Form

- Scales Used

- Master Chart

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 LIST OF TABLES

Table No. Topic of Table Page No

8.1: Demographic Data: Comparison between Group 1 and 2 (Unpaired t-test) 43

8 2: Comparison of Timed up and go (TUGT) and Berg balance scale (BBS) pre-intervention
scores between group 1 and 2.(unpaired t-test) 43

8.3: Comparison of Timed up and go (TUGT) and Berg balance scale (BBS) post-intervention
scores between group 1 and 2. 44

8.4: Intra-group comparison of TUGT and BBS scores (Paired t-test) 44

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 LIST OF GRAPHS

Graphs No Topic of Graphs Page No

8.1 Ratio of Males and Females in Group 1 and 2 45

8.2 Comparison between Pre- and Post-intervention scores of TUGT for Group 1 46
8.3 Comparison between Pre- and Post-intervention scores of BBS Scores for Group 1 47
8.4 Comparison between Pre- and Post- intervention scores of TUGT scores for Group2 48
8.5 Comparison between Pre- and Post-intervention scores of BBS scores for Group 2 49
8.6 Comparison of Pre-intervention TUGT Scores between Group 1 and 2 50
8.7 Comparison of Post-intervention TUGT Scores between Group 1 and 2 51
8.8 Comparison of Pre-intervention BBS Scores between Group 1 and 2 52
8.9 Comparison of Post-intervention BBS Scores between Group 1 and 2 53

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 INTRODUCTION

Biological functions decline with age. Deterioration of balance is a well- documented hallmark

of the ageing process(1). Poor balance is initially detectable in the sixth decade of life but then

accelerates so that it becomes the rule rather than the exception by one’s late eighties(2). Balance

disturbances frequently cause elderly people to seek medical advice and admission to hospitals

and residential homes (3). Impaired balance has been correlated with an increased risk for falls

and a resulting increase in the mortality rate of elder people. Approximately 35% to 40% of

generally healthy, community-dwelling persons aged 65 or older fall annually (4). Regardless of

severity of injury, squeal from even a benign fall can be devastating. A single fall often results in

a fear of falling, which leads to a loss of confidence in one’s ability to perform routine tasks,

restriction in activities, social isolation, and increased dependence on others (5). The ensuing

reconditioning, joint stiffness, and muscle weakness that result from immobility can lead to more

falls and further mobility restriction(6).

Identification of significant risk factors is an important step towards fall prevention. Several

studies have been performed among both home-living and institutionalized populations to define

risk factors associated with falls. These risk factors have included both patient-related or

“intrinsic” factors (e.g. advanced age, specific diseases, muscle weakness, gait disorders, mental

status alterations, medications) (7-11)

and environment- related or “extrinsic” factors (e.g.

hazardous activities, time of day, environmental hazards) (12, 13).

(14,15)
A number of reviews have described balance performance as a highly complex set of

overlapping sensor motor, musculoskeletal psycho emotional, and perceptual functions.

Abnormalities in any or, typically, several of the links of this system render some elderly prone

29
to falls (15). Because balance is an ill-defined and non-unitary entity, it is not surprising that

endeavors to improve it have met with mixed success. Several fall prevention strategies have

shown effectiveness in preventing falls and decreasing the risk of falling (4, 17) , although less is

known about their effectiveness in preventing fall-related injuries. Exercise has been a key

feature in reducing the risk for falls (18,19) .

(16)
About 10%-25% of falls are associated with poor balance and gait abnormalities . Thus,

balance training interventions have an important place in fall prevention. Literature on geriatric

balance training is a medley of non-specific interventions characterized by conventional

callisthenic (coordination) exercises, which often include aerobic or muscle-strengthening

components (15). Many of these interventions have focused too heavily on simple maneuvers that

are easier to quantify but that may not address adequately the varied needs of different

individuals. Programs that are successful at improving balance took a more intensive approach to

training.

However, because many different types of exercise programs were studied, it was impossible to

determine which type was most effective.

Keeping this in mind this study was designed with the purpose of identifying the most

appropriate balance training program for community dwelling elders with active lifestyle.

Two balance scales were used to assess the outcomes of both the interventions. They were the

Timed Up and Go Test (20) and the Berg Balance Scale (21). These scales have good reliability and

validity which will be discussed in detail in the literature review chapter.

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These scales have been selected for the study because:

1. They are very simple to administer.

2. They are quick and practical.

3. They are easy to be conducted in an Indian clinical setting.

4. The contents of these scales closely mimic the day to day activities and are easy for the

patient to understand.

Statement of Question

Is a Specific Balance Training program better than a General Balance and Mobility exercise

program for improvement of balance in community dwelling elderly population?

HYPOTHESIS

Specific Balance-strategy Training program is more effective in improving balance in elderly

population as compared to the General Balance and Mobility exercise program.

OPERATIONAL DEFINITIONS

Balance

Balance is a complex process involving the reception and integration of sensory inputs, and the

planning and execution of movement, to achieve a goal requiring an upright posture. It is the

ability to control the center of gravity (COG) over the base of support in a given sensory

environment (22).

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 Fall

A fall is defined as a sudden unintentional change in position, with or without loss of

consciousness, causing the victim to land on the ground (23).

Timed Up And Go Test

Podsiadlo and Richardson (1991)(20), modified the original Up and Go test, by timing the task of

getting up from the chair, walking a distance of 3m, turning around and walking back to the

chair. They proposed its use as a short test of basic mobility skills for frail community- dwelling

elderly.

Berg Balance Scale

The Berg Balance Scale is an easy to administer, safe, simple and reasonably brief measure of

balance for elderly people developed as a performance-oriented measure of balance in elderly

individuals (67).

Balance Training Intervention

It is a set of exercises or training maneuvers that are administered to improve balance in the

elderly. They are simple, easy to administer and affordable as well as effective (15).

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 METHODS

This chapter deals with the methods used for this study. These include information on the
subjects, instrumentation used and the interventions given.

Sample

A sample of convenience of 70 older adults took part in this study. The subjects were collected
through visiting various old age homes of Bangalore & Those were coming to Paras Hospital,
Darbhanga, Bhiar India. Subjects who fulfilled the inclusion criteria and were ready to attend the
exercise program regularly were selected.

Inclusion Criteria

1. Age above 65 years.

2. Elderly who are community dwellers and not institutionalized or hospitalized.
3. Mini-mental status examination (MMSE) scores above 24.
4. No history of orthopedic surgery in the lower limbs.
5. Not dependent on the assistance of another person.

Exclusion Criteria

1. An acute illness that may interfere in the participation for the study.
2. Unstable cardiac condition.
3. No other orthopedic or neurological illness.
4. Permanent history of dizziness
5. Severe visual deficit.
Design

An experimental design was used in this study.

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 Instrumentation

1. Chair of 46cm of seating height.

2. Plinths and exercise mats.
3. Standard measuring tape
4. Markers
5. Weighing machine
6. Stopwatch
7. Wooden blocks of various heights.
8. Chairs of different heights with and without armrests.
9. Cup and saucer
10. Balls of various size and weight.
11. Foam
12. Shelves of various heights.
13. Mirror
14. Weights (0.5,1,2 kg)
15. Bedsheets

Protocol

A sample of convenience of 70 older adults took part in this study. These subjects were then
randomly divided into two groups which received different balance training interventions. Group
1 consisting of 35 subjects received General balance and mobility exercise while Group 2 also
consisting of 35 subjects received Specific balance-strategy training. Demographic data of the
subjects was collected in the demographic data collection form. This included the sex, age,
height and the weight. Following this the subjects were assessed on the two balance scales: The
Timed Up and Go (TUGT) – Appendix B (2) and the Berg Balance Scale (BBS) - Appendix
B(3). After assessing the initial balance scores, the specific intervention programme was applied
for each group for a period of four weeks with five sessions per week. Each session lasted for
25-30 minutes. The same subjects were assessed on the above mentioned balance scales after 4
weeks of training.

34
 Procedure

The subjects were invited to participate in the study. A detailed explanation of the procedure was
given after which the subjects signed an informed consent. the subjects were assessed on the two
balance scales: The Timed Up and Go (TUGT)– Appendix B (2) and the Berg Balance Scale
(BBS)- Appendix B(3). Subjects of Group 1 received the General Balance and mobility exercise
program (Appendix D-1) which consists of active stretching and strengthening of the lower limb
muscles, postural control exercises, endurance walking and repetitive muscle coordination
exercises. This programme initially started with a low level of intensity (low frequency and
repetitions) of individual exercises and was progressive over the weeks. The resistance applied,
rest period, etc was adjusted individually so that participants could exercise at a subjectively
moderate intensity.

Data Analysis

Statistics were performed using SPSS software.

A student’s t-test was used to analyze the difference between the balance improvements in group
1 and group 2. Intragroup analysis between pre-intervention and post-intervention scores was
also done for both the groups. A significance level of p<0.05 was fixed.

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 REFERNCES

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2. Wolfson, L., Whipple, R., Derby, C.A., Amerman, P., Murphy, T., Tobin, J.N. &

Nashner, L. (1992). A dynamic posturography study of balance in healthy elderly.

Neurology, 42, 2069-2075.

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American Geriatric Soc, 49, 664-672.

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performance in the elderly. Journal of Gerontology, 46, M123-M131.

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