Will balance training improve balance performance as well as confidence in order to prevent falls in individuals with chronic acoustic neuroma? A multiple single subject pilot study.

Research Report
Population: Adult

Joni G Barry, PT, PDT, NCS, Associate Professor, Maryville University jbarry@maryville.edu

Tanya Tepen, SPT, Student PT, Maryville University ttepen@live.maryville.edu

Kristy Frey, SPT, Student Physical Therapist, Maryville University kfrey1@live.maryville.edu

Serena Beffa, SPT, Student Physical Therapist, Maryville University sbeffa@live.maryville.edu

Shannon Hasselhorst, SPT, Student Physical Therapist, Maryville University shaselhorst@live.maryville.edu

Keywords: Prevention, Balance, Acoustic neuroma, Falls

Purpose: Individuals living with acoustic neuromas (AN) have a unilateral vestibular hypofunction. Life expectancy is good and as these individuals age they may have increased risk of falls. While research has focused on improving balance in people with acoustic neuroma close to the time of diagnosis or surgery, research on improving balance as people enter the chronic phase of their recovery has been limited. The primary purpose of this pilot study was to determine if six-weeks of a group-based balance intervention program along with a home exercise program was effective in improving balance performance along with balance confidence in persons living long-term with acoustic neuroma. A secondary purpose was to analyze if change scores for any individuals led to a decreased fall risk based on established cut-off scores. Subjects: Four individuals living with a chronic, unilateral AN took part in this study; one man and three women that were a range of 4.5-15 years post diagnosis or the treatment of an AN. Methods: This was a multiple single subject design. Outcome measures were the Mini Balance Evaluation Systems Test (Mini-BESTest) and the Activities-Specific Balance Confidence Scale (ABC Scale). Pre-tests were collected two days a week apart. The intervention program consisted of attending 8-12 sessions of a group class focusing on balance exercises that met twice a week along with home exercise instructions. Post-testing was then performed a week following the completion of the intervention program. The means and standard deviations (SD) were calculated after the two days of pre-testing and statistical significance was set as a change of greater than two standard deviations in the post-test score compared to the pre-test mean. Results: All participants improved a significantly and clinically important amount on the Mini-BESTest scores. In addition 3 of the 4 participants started below the cut-off score for frequent fallers and they all finished above that score. Two of the four participants had a significant improvement in self-reported balance confidence on the ABC Scale with the most dramatic improvement in participant 2 from a pre-test mean of 54.3 (SD=5.1) to a post-test score of 78.1. This signifies an improvement beyond the cut-off score for fallers of 75. The other 3 started with ABC Scale scores above 90 which can cause ceiling effects of this measure. Conclusions: The findings of this study suggested balance classes along with a home exercise program may be effective in helping to prevent falls in people with chronic AN. In this small pilot study after 6 weeks of intervention all 4 participants showed significantly improved scores on the Mini-BESTest and half reported improved confidence in their balance. Further research is needed with a larger sample size and possibly with a longer or more intense intervention. Clinical Relevance: The Mini-BESTest is an appropriate tool in the clinic when treating balance in individuals with chronic AN.  In addition, those with chronic AN can improve balance performance which can help prevent future falls.

Barry, Joni G, PT, PDT, NCS; Tepen, Tanya , SPT; Frey, Kristy , SPT; Beffa, Serena , SPT; Hasselhorst, Shannon , SPT. Will balance training improve balance performance as well as confidence in order to prevent falls in individuals with chronic acoustic neuroma? A multiple single subject pilot study.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/099_barry-et-al/