Single-Limb Balance Evaluation Using SEBT

Each subject completed a modified SEBT modeled after the methodology described by Plisky et al^{27 (link)} on 2 occasions, 8 weeks apart. Subjects received verbal instruction and visual demonstration of the SEBT from the same examiner, who was not blinded to group assignment. The subjects stood on 1 lower extremity, with the most distal aspect of their great toe on the center of the grid. The subjects were then asked to reach in the anterior, posteromedial, and posterolateral direction, while maintaining their single-limb stance (FIGURE 1). Six practice trials were performed on each limb for each of the 3 reach directions prior to official testing.^{14 (link)} On the seventh trial, the examiner visually recorded the most distal location of the reach foot as it contacted the grid in the 3 directions. The trial was discarded and the subject repeated the testing trial if (1) the subject was unable to maintain single-limb stance, (2) the heel of the stance foot did not remain in contact with the floor, (3) weight was shifted onto the reach foot in any of the 3 directions, or (4) the reach foot did not return to the starting position prior to reaching in another direction. The process was then repeated while standing on the other lower extremity. The order of limb testing was counterbalance randomized by the tester. The subject’s limb length measurements, from the most distal end of the anterior superior iliac spine to the most distal end of the lateral malleolus on each limb, were taken and recorded. In previous work, the SEBT has demonstrated good intratester reliability, with an intraclass correlation coefficient (ICC) of 0.67 to 0.96.^{8 ,14 (link)} Intratester reliability for this study on the SEBT composite score and all 3 individual reach directions was good to excellent (TABLE 2). The SEBT composite score was calculated by dividing the sum of the maximum reach distance in the anterior (A), posteromedial (PM), and posterolateral (PL) directions by 3 times the limb length (LL) of the individual, then multiplied by 100 {[(A + PM + PL)/(LL × 3)] × 100}.