Author(s): David Guerrero Ramos, Francisca Peydro de Moya, María José Vivas Broseta, Ignacio Bermejo Bosch.
Instituto de Biomecánica (IBV)
Balance is a person's ability to maintain their center of gravity within their base of support with minimal sway. In clinical practice, a comprehensive clinical assessment of postural control is important for both diagnostic and therapeutic reasons, as balance disorders can have serious consequences for physical and psychological performance.
NedSVE/IBV is a software application that not only quantifies a patient's functional status in relation to their postural balance but also provides a rehabilitation program. A major update has recently been carried out to add new functions and improve usability for clinical practice.
Balance is a person's ability to maintain their center of gravity within their base of support with minimal sway. The complexity surrounding postural control can lead to many different types of stability problems that require clinical assessment.
Controlling balance involves such tasks as maintaining, achieving or restoring a person's center of gravity within his or her limits of stability. This control is a complex process that hinges on the integration of visual, vestibular and somatosensory inputs to the central nervous system and on its responses.
Balance disorders can be the result of such pathologies as neurological diseases, sensory deficits or muscle weakness. An intact postural balance not only serves to maintain postural stability, but also to ensure mobility-related activities of everyday life, such as standing while performing manual tasks, getting up from a chair, walking and turning.
In clinical practice, a comprehensive clinical assessment is important for both diagnostic and therapeutic reasons, as balance disorders can have serious consequences for a person’s physical functionality (fall-related injuries) as well as for their social interaction (fear of falling may lead them to restrict their activity and isolate themselves socially).
In this context, the NedSVE/IBV software application is an extremely useful tool, given that it uses data recorded by a dynamometric platform to obtain an assessment of balance function. This application combines a set of tests that provide healthcare professionals with a global index of balance or postural control. Based on the assessment data, and if and when the scores are below 90% of the normal range, the software creates an assisted rehabilitation program.
This tool assesses balance by comparing the parameters that best discriminate the normal from the pathological population, using data obtained from normality patterns segmented by age and height.
WHAT IS NedSVE/IBV?
NedSVE/IBV is a software application that quantifies a patient's functional status in relation to their postural balance. This tool studies and records the behavior of a subject in a standing position with stable support, under destabilized conditions, as well as dynamically (i.e., voluntarily shifting his or her center of gravity or walking). The same system also includes a module to work on balance rehabilitation.
This rehabilitation module creates two assisted subprograms designed to improve postural control. These contain a set of recommended exercises depending on the assessment of each of the indexes obtained by the patient. Once selected, a screen appears (Figure 1) with active boxes corresponding to the systems that the patient should strengthen and the levels of difficulty to be applied.
Figure 1: Set of exercises recommended by the sensory rehabilitation subprogram.
Hundreds of users are already benefitting from the NedSVE/IBV application. The first version was developed in 2000 and, since then, the IBV has developed new versions that improve its features. The latest 2022 update adds greater flexibility in test selection, a more streamlined approach to assessment protocol application and decision making, and easier interpretation of results.
The software can be used to perform a sensory assessment of stability limits, the rhythmic and directional control of the center of gravity, and gait assessment (Figure 2).
Four Romberg tests are used to perform the sensory assessment. In these, the patient stands on a dynamometric platform with their arms relaxed. They have to remain in a standing position with their eyes open and then with their eyes closed. Subsequently, both tests are performed during a proprioceptive perturbation using a 9 cm foam cushion. These data are used to obtain a normality index for the somatosensory system, the visual system and the vestibular system.
The assessment of the stability limits corresponds to the mean of the final result of the displacement of the center of pressures in each direction. A total of eight directions (frontal, right frontal, right, right rear, rear, left rear, left, left frontal) are evaluated to obtain a normality index.
The assessment of rhythmic and directional control is the mean of the result of the voluntary and rhythmic movement control of the center of gravity in the anterior-posterior axis and in the medial-lateral axis, performed at three different speeds.
The functional gait assessment is calculated by using the normality database to analyze the most relevant kinetic parameters.
Figure 2: Example of sensory assessment tests (left) and stability limits (right)
IMPROVEMENTS INTRODUCED IN THE CURRENT VERSION
Improvements to the interface
NedSVE/IBV is now a more user-friendly software and has new features related to the recording of tests and the visualization of their results. The improved usability of the new version compared to the previous one can be seen in the layout of the data. Previously, data and test recordings were displayed on a single screen. This made it more difficult and time-consuming to consult specific results of the same test (Figure 3).
In the new version (Figure 4), the results are displayed for each test, depending on where you are in the assessment process, and independently for each test, which means it is a much more intuitive tool than its predecessor.
Figure 3: Graphical interface of the previous version of the NedSVE/IBV software, with no differentiation between data, test recordings and test results.
Figure 4: Graphical interface of the new version of NedSVE/IBV during the recording of the Romberg eyes-closed (ROC) test, containing the sensory analysis.
Flexibility in the selection of the assesment test
The new version has a much more flexible assessment protocol. Previously, in order to obtain a final result and a complete assessment report, NedSVE/IBV required the user to perform all the tests, and it was not possible to choose the tests on the basis of the patient's pathology.
This new version now allows the user to select the type of test they wish to perform and to obtain a final result and a report. For example, if all you want to do is perform an analysis of a person's stability limits, you can do so knowing that you will obtain a final test result accompanied by a detailed test report.
Streamlined and clear analysis and interpretation of results
Unlike the previous version, the results are displayed in a much more visual and comprehensive way (Figure 5). This makes them easier to understand and explain.
Figure 5: Graphical representation of the results of a sensory analysis test using the new NedSVE/IBV update.
One of the most important improvements that help to streamline result interpretation is the homogenization of the cut-off points to determine when a result is considered to be within normality. In the previous version, each test had its own cut-off point. Now, values equal to or greater than 90% in all percentages of normality are considered functionally normal (Figure 6). The application uses these results to recommend a specific sensory rehabilitation or stability cut-off program.
Figure 6: Overall display of the parameters with the results in percentage of normality obtained in the different tests, with their corresponding percentage of normality. The thickness of the red band in the overall results per test indicates how far it deviates from the cut-off point used as a delimiter of normality (90%).
Possibility of more comprehensive reports
Regarding the reports generated after testing, the new version of this software includes one for each test performed and a full report for those cases in which the assessment protocol has been performed in its entirety. They also include more graphs and results to make it easier to understand the patient's situation. In addition, to make it easier to draw conclusions, the reports contain a pre-designed report template with common terminology, which is automatically filled in according to the functional capacity of the subject.
This generates reports that are much more complete, detailed and faster than in the old version. Finally, it is also worth mentioning changes in the content of the comparative report (a document containing two sessions performed on the same subject) and the evolutionary report (a graphic display of three or more sessions showing the variation of the parameters obtained over time), which make it possible to control the care process more effectively.
Guided rehabilitation programs according to objective deficits
The NedSVE/IBV rehabilitation module has been improved in this new version: it is now much easier to access it from the results parameters window, making it a much better guided process to create a rehabilitation program or to let oneself be guided by the recommendations offered by the system itself (Figure 6).
The new update of NedSVE/IBV has completely renewed all the aspects of this software. It is an application that has been operational for more than 20 years and that currently offers a new concept of postural balance assessment and rehabilitation, streamlining its use and interpretation of results for different professionals in the healthcare sector.