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1 Database f Knwledge Translatin Tls Assessment Summary Mini-Balance Evaluatin Systems Test (Mini-BESTest) Summary Authrs: Anna Apelman, Marie Berg, Kjetil Bjerke, Elisabeth Trøyen Gundersen, Egil Hvland, Lene Kristiansen, Julia Mbalilaki, Jennifer Mre, Jan Nrdvik, Grethe Tveit Pettersen, Siri Slberg Date Published: December Instrument Descriptin and Administratin Instructins Purpse f the assessment: Multi-task balance assessment that identifies the fllwing pstural cntrl prblems: External perturbatins Anticipatry pstural adjustments Sensry rientatin Dynamic balance during gait Type f assessment: Perfrmance based, clinician rated measure Predicts fall risk, assesses balance impairment, measures change ver time Administratin instructins: Full testing instructins are lcated Patient perfrms 14 tasks Each task is rated n an rdinal scale f 0 t 2 Maximum scre is 28, minimum scre is 0 Standing n ne leg (item 3) and Cmpensatry stepping crrectin in lateral directin (item 6) were assessed n bth sides. The lwer scre f the tw shuld be used in the ttal scre calculatin. Standardizatin prcedures: Fllw the instructins n the testing frm. English standardizatin vides are available at: The Nrwegian translatin and standardizatin prcedures are available at: ICF Dmain: Bdy Functin Measurement Area: Balance Several articles cited in this summary were riginally extracted frm Di Carl et al, Cnsideratins fr Clinical Use Indicatins fr use: Can be used in many patient ppulatins as a measure t assess: balance impairment predict falls (with cautin) assess a patient s change in balance functin ver time Page 1 f 10

2 Cnsideratins: Has been tested in many patient ppulatins and perfrms cnsistently well acrss the diagnses The cut-ff fr fall risk is generally between 16 and 20, indicating patients wh scre less than this scre shuld be cnsidered at risk fr falls. Hwever, the sensitivity f the measure varies between 52% and 88%, indicating that it is crrectly identifying 52% 88% f fallers. Because sme fallers may be missed, it is imprtant t als use yur clinical judgment t determine fall risk when a patient scres abve the cut-ff scre. Pr reliability was nted n items 5 (cmpensatry stepping backward), 6 (cmpensatry stepping lateral), and 8 (fam eyes clsed), additinal standardizatin may be needed n these items (Tsang et al, 2013) During a pilt f the Mini-BESTest in practice in Nrway, many clinicians reprted discmfrt with administering the reactive pstural cntrl items (4, 5, 6; cmpensatry stepping frward, backward, lateral). Therefre, additinal training and experience with these items may be needed befre using the Mini-BESTest in rutine practice. The Knwledge Experts pilted the Mini-BESTest in clinical practice fr 6 mnths at 3 rehabilitatin facilities (n= 134). Sample: Parkinsn Disease (n=88), Strke (n=27), and ther diagnses (degenerative disease, plyneurpathy, ther neurlgic cnditins, and musculskeletal cnditins, n=19). Mean Admissin scres = 20.5 pints Mean discharge scre = 23.2 pints Mean change = 2.7 pints Mean time between test administratins = 2.75 weeks 62% demnstrated a meaningful change (scre change f > 3), including 44% f patients with Parkinsn disease and 63% f patients with strke A cmparisn with utcmes achieved in research studies in Parkinsn disease patients revealed that despite a shrt amunt f time between testing perids, changes seen were similar t thse seen in much lnger research studies. Fr example, in a study that cmpared intensive cycle ergmeter t treadmill fr 2, 30-minute sessins per day, 5 days per week, fr 3 weeks resulted in mean changes f 2.3 pints (ergmeter grup) and 3.3 pints (treadmill grup).(arclin, Pisan et al. 2015) A highly challenging balance prgram delivered in 60- minute sessins, 3 x week, fr 10 weeks resulted in a change f 3 pints.(cnradssn, Lfgren et al. 2015) These are just tw f many studies that tested patients with similar levels f balance impairment and achieved similar results with a much higher dse f therapy than in the Nrwegian clinics. Knwledge Expert grup recmmendatin: The Mini-BESTest can be used in inpatient and utpatient rehabilitatin t assess: Fall risk Change in balance ver time Administratin instructins: Fall risk: Administer nce, at any pint in patient s care when falls need t be assessed Change ver time: Need a minimum f 2 administratins t assess change ver time, but > 2 pints wuld be better when rehabilitatin episde is > 4 weeks. Within 2 days (r sessins) f admissin and discharge Fllw Nrwegian standardizatin (see clinical utility sectin) Apprpriate patients include: Page 2 f 10

3 Adult patients with neurlgic cnditins and lung disease; als apprpriate fr cmmunity dwelling lder adults Ambulatry patients (with r withut assistive device) Ptential facilitatrs Assessment results can mtivate patients, therefre it may help t educate patient n the reasn fr testing and the test results Dedicated equipment and testing area fr the Mini-BESTest Weekly reprting f results in team meetings If pssible, create a frm in the electrnic medical recrd fr dcumentatin See Mini-BESTest Implementatin package Sustainability strategies: Ensure clinicians understand hw t use the results t guide decisin-making Discuss test results ften with each ther, and when with patients (Fr example, the patient btained an 18 n the test, what interventins might be best?) Reprting f Mini-BESTest data in clinical practice Jurnal club n Mini-BEST studies Add Mini-BESTest r measurement educatin, training, and administratin as a part f the Medarbeidersamtale Clinical Utility Cst: Free Equipment required: standard height chair Number f items: 14 items Time t administer: 10 minutes 15 minutes Training required: Free training available in English available at: Nrwegian translatin and standardizatin prcedures are available at: 5. Interpretatin f the Results Standard Errr f Measurement (SEM): Chrnic Strke: 1.08 pints (Tsang et al, 2013) Mixed Neurlgic: 1.26 pints (Gdi et al, 2013) Older Cancer Survivrs:.86 pints (Huang et al, 2015) Cmmunity Dwelling Older Adults: 1.4 pints (Marques et al, 2016) Minimum Detectable Change (MDC): Chrnic Strke: MDC 95 = 3.0 pints (Tsang et al, 2013) Mixed Neurlgic: MDC 95 = 3.5 pints (Gdi et al, 2013) Parkinsn Disease: MDC 95 = 3.4 t 4.1 pints (Lfgren et al, 2014) Older Cancer Survivrs: Page 3 f 10

4 MDC 95 = 2.39 pints (Huang et al, 2015) Cmmunity Dwelling Older Adults: 3.8 pints r 16.3% (Marques et al, 2016) Minimal Clinical Imprtant Difference (MCID): Mixed Neurlgic: 4 pints (Gdi et al, 2013) Nrmative Values: Nt established Cut-ff scres: Elderly: < 16/28 indicates patient is at risk fr falling (Adequate area under the curve =.84; sensitivity 85%, specificity 75%; Yingyngyudha et al, 2015) <19.5 / 32 indicates patient is at risk fr falls (Adequate area under the curve =.76; sensitivity 74%; specificity 71%; psitive likelihd rati 2.49; negative likelihd rati.38; Marques et al, 2016) Parkinsn Disease: < 20/32 indicates patient is at risk fr falling (Adequate area under the curve =.86; sensitivity 88%, specificity 78%; Leddy et al, 2011) < 20/32 indicates patient is at risk fr falling ( Adequate area under the curve =.87; sensitivity 86%, specificity 78%; Duncan et al, 2012) < 16/32 indicates patient is at risk fr falling (Adequate area under the curve =.80; sensitivity 75%, specificity 79%; Duncan and Earhart et al, 2012) < 20/32 indicates patient is at risk fr falling (Adequate area under the curve =.77/.87; sensitivity 62%/82%, specificity 74%/78%; Duncan et al, 2013) < 19/32 indicates patient is at risk fr falling (Adequate area under the curve =.75; sensitivity 79%, specificity 67%; Mak and Auyeung et al, 2013) <19/28* indicates patient is at risk fr falling (Adequate area under the curve =.65, specificity 70 %, sensitivity 52 %; Schlenstedt et al, 2015; used riginal scring f 28) Strke: Chrnic Strke (Tsang et al, 2013): Limited assciatin between scre and fall histry Area under the curve =.64,.7 t.8 is acceptable), <17.5 indicates a patient is at risk fr falls (Area under the curve =.64; sensitivity 64%, specificity 64.2%; likelihd ratis were 1.8 and 1.6, respectively) Significantly smaller area under then curve than the Berg Balance Scale, but nt significantly different than the Timed Up and G, r One Leg Stance) Subacute Strke: Scre f > 9/28 indicates a patient has a high level f functinal ability (Area under the curve =.85; Chinsngkram et al, 2014) Multiple Sclersis (Rss et al, 2016): <19.5/28 indicates patient requires mbility aid (Adequate area under the curve =.88; LR+4.53; LR- 0.18) < 22.5/28 assciated with a histry f near falls (adequate area under the curve = 0.77; LR ; LR-= 0.19) Assciatin with histry f falls is pr (area under the curve = 0.65) 6. Applicatin t specific patient diagnses Ppulatins reviewed in this summary: Subacute strke, chrnic strke, mixed neurlgic ppulatins, Parkinsn Disease, Cancer survivrs, Knee Arthrplasty, Elderly, Multiple Sclersis Page 4 f 10

5 7. Psychmetric Prperties: Reliability: Test-Retest Reliability Parkinsn Disease: Excellent test-retest reliability (ICC =.92; Leddy et al, 2011) Excellent test-retest reliability (ICC =.98; Schlenstedt et al, 2015) Excellent inter-rater reliability (ICC =.80; Lfgren et al, 2014) Mixed Neurlgic: Excellent test-retest reliability (ICC =.96; Gdi et al, 2013) Older Cancer Survivrs: Excellent test-retest reliability (ICC =.90; Huang et al, 2015) Knee arthrplasty: Excellent test-retest reliability (ICC >.90; Chan and Pang, 2015) Cmmunity dwelling lder adults: Adequate test-retest reliability (ICC =.73) Inter-rater Reliability Chrnic Strke (Tsang et al, 2013): Excellent inter-rater reliability (ICC =.96, p <.001) When each item was analyzed fr reliability separately, adequate t excellent inter-rater reliability was nted fr each item EXCEPT items 5 (cmpensatry stepping backward), 6 (cmpensatry stepping lateral), and 8 (fam eyes clsed) Parkinsn Disease: Excellent inter-rater reliability (ICC =.91; Leddy et al, 2011 ) Excellent inter-rater reliability (ICC =.98; Schlenstedt et al, 2015) Adequate inter-rater reliability (ICC =.72; Lfgren et al, 2014) Mixed Neurlgic: Excellent inter-rater reliability (ICC =.98; Gdi et al, 2013) Older Cancer Survivrs: Excellent inter-rater reliability (ICC =.86; Huang et al, 2015) Knee arthrplasty: Excellent inter-rater reliability (ICC >.90; Chan and Pang, 2015) Cmmunity dwelling lder adults: Adequate inter-rater reliability (ICC =.71; Marques et al, 2016) Intra-rater Reliability Chrnic Strke: Excellent intra-rater reliability (ICC =.97, p <.001; Tsang et al, 2013) Internal Cnsistency Chrnic strke: Excellent internal cnsistency (Crnbach s alpha ranged frm.89 t.94 depending n rater; Tsang et al, 2013) Mixed Neurlgic: Excellent internal cnsistency (Crnbach s alpha =.90; Gdi et al, 2013) Knee arthrplasty: Excellent internal cnsistency (Crnbach s alpha >.95; Chan and Pang, 2015) Rasch Reliability Persn reliability Mixed Neurlgic Ppulatins (Franchignni et al, 2010): Excellent persn reliability (.86) Elderly and Parkinsn Disease (Maia et al, 2013): Excellent persn reliability (.91) Mixed Neurlgic Ppulatins (Franchignni et al, 2015): Excellent persn reliability (.91) Page 5 f 10

6 Persn separatin index Mixed Neurlgic Ppulatins (Franchignni et al, 2010): 2.5 Elderly and Parkinsn Disease (Maia et al, 2013): 3.16 Mixed Neurlgic Ppulatins (Franchignni et al, 2015): 3.24 Item reliability Mixed Neurlgic Ppulatins (Franchignni et al, 2010): Excellent item reliability (.98) Elderly and Parkinsn Disease (Maia et al, 2013): Excellent item reliability (.98) Mixed Neurlgic Ppulatins (Franchignni et al, 2015): Excellent item reliability (.99) Item separatin index Mixed Neurlgic Ppulatins (Franchignni et al, 2010): 7.4 Elderly and Parkinsn Disease (Maia et al, 2013): 6.41 Mixed Neurlgic Ppulatins (Franchignni et al, 2015): 1.2 Validity: Enter the results frm each type f validity study, if available. Include the actual validity cefficient and the descriptin f the strength f the statistics (excellent >.6; adequate is.31 t.59; pr <.30) Criterin Validity: Predictive Validity (see cut-ff scres abve) Cncurrent Validity: Parkinsn Disease: Excellent crrelatin with the BesTest (r =.96; Leddy et al, 2011) Excellent crrelatin with the Berg Balance Scale (r=.79; King et al, 2012) Excellent crrelatin with the Brief BesTest (r=.94; Duncan et al, 2013) Excellent crrelatin with the Berg Balance Scale (rh =.85; Schlenstedt et al, 2015) Excellent crrelatin with the Functinal Activity Balance Scale (rh =.87; Schlenstedt et al, 2015) Parkinsn Disease and Strke: Excellent crrelatin with the Berg Balance Scale (r=.94; Bergstrm et al, 2012) Mixed Neurlgical: Excellent crrelatin with the Berg Balance Scale (r=.85; Gdi et al, 2014) Subacute Strke: Excellent crrelatin with the BesTest (rh =.96; Chinsngkram et al, 2014) Chrnic Strke (Tsang et al, 2013): Excellent crrelatin with the BBS (rh=.83, p <.001) Adequate crrelatin with the Functin Reach Test (rh=.55, p <.001) Excellent crrelatin with ne leg standing n paretic side (rh=.83, p <.001) Adequate crrelatin with ne leg standing n the nnparetic side (rh =.54, p <.001) Excellent crrelatin with the Timed Up and G (rh=-.82, p <.001) Multiple Sclersis (Rss et al, 2016): Excellent crrelatin with the Berg Balance Scale (Rh =.788) Excellent crrelatin with MSIS-29 Phys (Rh =.643) Excellent crrelatin with MSWS-12 (Rh =.766) Excellent crrelatin with 6MWT (Rh =.810) Page 6 f 10

7 Adequate crrelatin with MFIS (Rh =.495) Adequate crrelatin with MSIS-29 Psyc (Rh =.390) Cmmunity Dwelling Older Adults: excellent crrelatin with the BBS, BESTest and Mini-BESTest (rh =.83 t.96; Marques et al, 2016) Cnstruct validity: Discriminant Validity Chrnic Strke: Pr crrelatin with the Mdified Ashwrth Scale (rh=-.22, p=.02; Tsang et al, 2013) Pr crrelatin with Abbreviated Mental Test (rh =.08, p=.42; Tsang et al, 2013) Pr crrelatin with the Geriatric Depressin Scale (rh=-.17, p=.08; Tsang et al, 2013) Cnvergent Validity: Parkinsn Disease: Excellent crrelatin with the Timed Up and G (r = -.81; Bergstrm et al, 2012) Adequate crrelatin with the Activities Specific Balance Cnfidence Scale (r=.53; Cmbs et al, 2014) Excellent crrelatin with the Timed Up and G (rh = -.76; Schlenstedt et al, 2015) Parkinsn Disease and Elderly: Excellent crrelatin with the Activities Specific Balance Cnfidence Scale (r =.66; McNeely et al, 2012) Parkinsn Disease and Strke: Pr crrelatin with the Falls Efficacy Scale (r = -.89; Bergstrm et al, 2012) Pr crrelatin with the Activities Specific Balance Cnfidence Scale (r =.26; Bergstrm et al, 2012) Chrnic Strke: Excellent crrelatin with the Timed Up and G (r = -.81; Bergstrm et al, 2012) Adequate crrelatin with the Chedke-McMaster Strke Assessment leg scre (rh=.53, p <.001; Tsang et al, 2013) Excellent crrelatin with the Chedke-McMaster Strke Assessment ft scre (rh=.64, p <.001; Tsang et al, 2013) Adequate crrelatin with Activities Specific Balance Cnfidence (rh=.50, p <.001; Tsang et al, 2013) Older Cancer Survivrs: Adequate crrelatin with the Activities Specific Balance Cnfidence Scale (rh =.52; Huang et al, 2015) Cmmunity Dwelling Older Adults: adequate crrelatin with the Activities Specific Balance Cnfidence (Rh =.61; Marques et al, 2016) Adults and elderly: Excellent crrelatin with the ne leg stance (r =.68; O Hlski et al, 2015) Excellent crrelatin with the Timed up and g (r = -.66; O Hlski et al, 2015) Excellent crrelatin with the Activities Specific Balance Cnfidence Scale (r =.62; O Hlski et al, 2015) COPD: Adequate crrelatin with the Mini-BesTest (r=.55; Jacme et al, 2016) Knwn grups validity: Chrnic Strke: Page 7 f 10

8 Significant difference between the strke and cntrl grups (median scre 19 vs. 27; p<.001; Tsang et al, 2013) Significant difference between fallers and nnfallers (median scre 16 vs. 19; p =.03; Tsang et al, 2013) Flr and ceiling effects: Chrnic Strke: Flr effects: Excellent, n flr effects (0%; Tsang et al, 2013) Ceiling effects: Excellent, minimal ceiling effects (.9%; Tsang et al, 2013) Subacute strke: Ceiling effects: excellent, minimal ceiling effects (4.3%; Chinsngkram et al, 2014) Flr effects: pr flr effects (34.3%; Chinsngkram et al, 2014) Flr effects: pr, flr effects befre rehab (32,7%; Chinsngkram et al, 2016) Adequate, flr effects in less than 20% f ppulatin after rehab (10,2%, Chinsngkram et al, 2016) Multiple Sclersis: Excellent, n ceiling effects (0%; Rss et al, 2016) Internal respnsiveness: The standardized respnse mean (SRM) was used t indicate the internal respnsiveness; large change >0.8, mderate change 0.5 > 0.8, small change < 0.2. SRM Imprvements in balance after rehabilitatin Subacute strke: Large effect (0,9 (0.6, 1,2): The BESTest shwed a significantly higher SRM than the Mini- BESTest (p<.001) Chinsngkram et al, 2016) Number f participants with n change 13 (26): The percentage f participants with n change was significantly higher with the Mini-BESTest cmpared t the BESTest (Chinsngkram et al, 2016) External respnsiveness: Area under the curve (AUC) > 0.9 Excellent Subacute strke: : Mini-BESTest 0.89 (0.79,0.99) (nt significantly different than the BESTest with an AUC f 0.92 Chinsngkram et al, 2016) The cut-ff scre fr the Mini-BESTest (> 3 pints) was clinically meaningful, LR (2.3, 19.8) and LR- 0.2 (0.1, 0.8) Chinsngkram et al, 2016) 8. Dcumentatin and Clinical Decisin-Making Tips: Cmpnents t include in dcumentatin: Assistive device used during the test 9. Links t ther relevant resurces: Websites: Online presentatins: Cpy f the instrument: Prvide a link t the instrument whenever it is available. 10. References and sample: Arclin, I., F. Pisan, C. Delcnte, M. Gdi, M. Schieppati, A. Mezzani, D. Picc, M. Grass and A. Nardne (2015). "Intensive cycle ergmeter training imprves gait speed and endurance in patients Page 8 f 10

9 with Parkinsn's disease: A cmparisn with treadmill training." Restr Neurl Neursci 34(1): Chan A & Pang M. Assessing Balance Functin in Patients With Ttal Knee Arthrplasty. Phys Ther. 2015; 95(10) Chinsngkram B, Chaikeeree N, Saengsirisuwan V, Viriyatharakij N, Hrak FB, & Bnsinsukh R. Reliability and validity f the Balance Evaluatin Systems Test (BESTest) in peple with subacute strke. Phys Ther. 2014; 94(11) Chinsngkram B, Chaikeeree N, Saengsirisuwan V, Hrak FB, and Bnsinsukh R. Respnsiveness f the Balance Evaluatin Systems Test (BESTest) in Peple with Subacute Strke. Am Phys Ther 2016, Vl 96 (x). Study sample: Subacute strke, mean age 57.8 (11.8), male/female 29/20, Time since strke 38,7 (36,7) days (range 2 120), Type f strke Ischemia 36, Hemrrhage 13, Affected side right 27, left 22, MMSE scre (/30) 28.4 (2.3), BI (/100) 49,8 (21.9), FM-Mtr scre (/100) 38 (27.4), Time between 2 assessments 13.7 (9,3) days. Cnradssn, D., N. Lfgren, H. Ner, M. Hagstrmer, A. Stahle, J. Lkk and E. Franzen (2015). "The Effects f Highly Challenging Balance Training in Elderly With Parkinsn's Disease: A Randmized Cntrlled Trial." Neurrehabil Neural Repair 29(9): Di Carl S, Bravini E, Vercelli S, Massazza G, & Ferrier G. The Mini-BESTest: a review f psychmetric prperties. Internatinal Jurnal f Rehabilitatin Research (in press) Study sample: Systematic review f all studies and ppulatins that assessed psychmetric prperties f the Mini-BesTest. Duncan R, Leddy A, Cavanaugh J, et al. Cmparative utility f the BESTest, mini-bestest, and brief-bestest fr predicting falls in individuals with Parkinsn disease: a chrt study. Phys Ther. 2013; 93(4) Franchignni F, Hrak F, Gdi M, Nardne A, Girdan A. Using psychmetric techniques t imprve the Balance Evaluatin Systems Test: the mini-bestest. J Rehabil Med. 2010; 42(4) Gdi M, Franchignni F, Caligari M, Girdan A, Turcat A, & Nardne A. Cmparisn f reliability, validity, and respnsiveness f the mini-bestest and Berg Balance Scale in patients with balance disrders. Phys Ther. 2013; 93(2) Leddy A, Crwner, B, & Earhart, G. Utility f the Mini-BESTest, BESTest, and BESTest sectins fr balance assessments in individuals with Parkinsn disease. J Neurl Phys Ther. 2011; 35(2)90-7. Lfgren N, Lenhlm E, Cnradssn D, Stahle A, & Franzen E. The Mini-BESTest--a clinically reprducible tl fr balance evaluatins in mild t mderate Parkinsn's disease? BMC Neurl (14) 235. Marques A, Almeida S, Carvalh J, Cruz J, Oliveira A, Jácme C. Balance tests in healthy lder peple Reliability, validity and ability t identify fall status f the BESTest, Mini-BESTest and Brief- BESTest in lder peple living in the cmmunity. Arch Phys Med Rehabil Dec;97(12): Page 9 f 10

10 Study sample: 122 lder adults, cmmunity dwelling, mean age yrs; 70.5% wmen; 13 participants used walking aids (11 used a cane, and 2 used a walker); average Mini-BESTest scre ; average BBS scre O'Hski S, Sibley K, Brks D, & Beauchamp M. Cnstruct validity f the BESTest, mini-bestest and briefbestest in adults aged 50 years and lder. Gait Psture. 2015;42(3): O'Hski S, Winship B, Herridge L, Agha T, Brks D, Beauchamp M, & Sibley K. Increasing the clinical utility f the BESTest, mini-bestest, and brief-bestest: nrmative values in Canadian adults wh are healthy and aged 50 years r lder. Phys Ther. 2014; 94(3): Rss E, purtill H, Uszynski M, Hayes S, Casey B, Brwne C, Cte S; Chrt study cmparing the Berg Balance Scale and the Mini Bestest in peple wh have multiple sclersis and are ambulatry. American Physical Therapy Assciatin 2016 Sep;96(9): Study Sample: Patients with Multiple Sclerris wh are ambulatry, with r withut a mbility aid, n= 52 (nne walking aid used =32(61,5%)), mean age 45,73, male/female 15/37,mean age since diagnsis 10,87. Schlenstedt C, Brmbacher S, Hartwigsen G, Weisser B, Mller B, & Deuschl G. Cmparisn f the Fullertn Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale t Predict Falls in Parkinsn Disease. Phys Ther. 2016; 96(4) Study sample: Parkinsns disease, n=66 (fallers n=33, nn-fallers n=33). Mean age fallers 68.1 (7.5), mean age nn-fallers 66.0 (11.6). Fallers: male/female 20/13, nn-fallers: male/female 25/8. H&Y stage 1-4: fallers 2.5(0.8), nn-fallers 2.8 (0.7). Tested in the n-state f medicatin. Tsang CS, Lia LR, Chung R, & Pang M. Psychmetric prperties f the Mini-Balance Evaluatin Systems Test (Mini-BESTest) in Cmmunity-Dwelling Individuals with Chrnic Strke. Physical Therapy Jurnal. 2013;93: Study sample: Chrnic strke, mean age 57.1 (11.0), male/female 73/33, Pststrke duratin 2.9 years, hemiplegic side left (n=46) right (n=60), median Chedke McMaster Strke Assessment Scre Leg = 4, Ft = 3; Arm = 3; Hand = 3 Yingyngyudha A, Saengsirisuwan V, Panichaprn W, & Bnsinsukh, R. The Mini-Balance Evaluatin Systems Test (Mini-BESTest) Demnstrates Higher Accuracy in Identifying Older Adult Participants With Histry f Falls Than D the BESTest, Berg Balance Scale, r Timed Up and G Test. J Geriatr Phys Ther. 2016; 39(2): Arclin, I., F. Pisan, C. Delcnte, M. Gdi, M. Schieppati, A. Mezzani, D. Picc, M. Grass and A. Nardne (2015). "Intensive cycle ergmeter training imprves gait speed and endurance in patients with Parkinsn's disease: A cmparisn with treadmill training." Restr Neurl Neursci 34(1): Cnradssn, D., N. Lfgren, H. Ner, M. Hagstrmer, A. Stahle, J. Lkk and E. Franzen (2015). "The Effects f Highly Challenging Balance Training in Elderly With Parkinsn's Disease: A Randmized Cntrlled Trial." Neurrehabil Neural Repair 29(9): Page 10 f 10