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Morone G, Martino Cinnera A, Paolucci T, Beatriz HDR, Paolucci S, Iosa M. Clinical features of fallers among inpatient subacute stroke: an observational cohort study. Neurol Sci 2020; 41:2599-2604. [PMID: 32253635 DOI: 10.1007/s10072-020-04352-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to observe the differences between fallers, common fallers, and non-fallers in stroke patients compared with the global ability in a rehabilitation setting. MATERIALS AND METHODS An observational and prospective study has been carried out. A total of 476 subacute stroke patients have been observed. The main outcome measures were assessed using the Canadian Neurological Scale (CNS), Barthel Index (BI), Functional Ambulatory Category (FAC), and Trunk Control Test (TCT) at admission to the rehabilitation unit and after 90 days of the rehabilitation treatment (nearly 3 h for day for 5 days for week) at the discharge with intermediate evaluations after the first and second months. RESULTS Out of 397 patients, 109 reported 1 or more falls (27.5%), of whom 67 fell 1 time (fallers) in the hospital (16.9%) and 42 fell 2 or more times (common fallers) (10.6%). For fallers, BI and FAC scores had a significant effect (p = 0.003 for both). Common fallers had statistically significant differences in BI (p = 0.002), FAC (p = 0.012), and TCT scores (0.023) compared with non-fallers. CONCLUSIONS The severity of stroke may directly increase the risk of fall, and also indirectly, lengthening the hospitalization. Our study seems to suggest that patients with BI scores of between 21 and 30 on admission are more prone to fall in the first period of hospitalization, whereas in the second month, those with scores of between 11 and 20 on admission have a higher risk of falls. In the third month, patients with BI scores below 10 on admission are more susceptible to falls.
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[Postural regulation and stability with acoustic input in normal hearing subjects. German version]. HNO 2020; 68:344-351. [PMID: 32219489 DOI: 10.1007/s00106-020-00845-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Postural regulation is based on complex interactions among postural subsystems. The auditory system too appears to have an influence on postural control. OBJECTIVE The aim of this study was to measure the influence of auditory input on postural control and to gain a deeper understanding of the interactions between auditory input and postural subsystems including subjective aspects. MATERIALS AND METHODS In 30 healthy normal-hearing subjects, postural regulation and stability was measured with the Interactive Balance System (IBS; Inc. neurodata GmbH, Wien, Österreich) in 8 test positions with noise (frontal presentation) and plugged without noise. The IBS is an electrophysiological measurement device that measures postural control at the product level (e.g., stability, weight distribution) and the mechanisms of postural subsystems at the process level based on frequency-oriented fast-Fourier analysis of force-time relation. RESULTS At the process level, we found a relevant reduction (ηp2 ≥ 0.10) of postural regulation with noise in the frequency bands F1 (visual and nigrostriatal system ηp2 = 0.122) and F2-4 (peripheral vestibular system ηp2 = 0.125). At the product level, the weight distribution index (WDI) parameter showed a relevant increase with noise (ηp2 = 0.159). No difference between the auditory conditions was found for postural stability (parameter: stability indicator, ST). Substantial interindividual variations in the subjective estimation of the influence of auditory inputs on stability were observed. CONCLUSION In this study, a shift in the activity of postural subsystems was observed with auditory input, while no difference was seen in ST. This leads to new insights into mechanisms of audiovestibular interaction.
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[The Bárány Classification of vestibular disorders, its clinical implementation and future prospects]. HNO 2020; 68:304-312. [PMID: 32193582 DOI: 10.1007/s00106-020-00847-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Vestibular diseases often have no or only nonspecific biomarkers. It is therefore necessary to define these disorders using operational criteria based on patterns of symptoms, i.e., the presence of inclusion and exclusion criteria, similar to the situation with headaches or psychiatric diseases. Ten years ago, the Bárány Society embarked upon development of the International Classification of Vestibular Disorders (ICVD). This entails producing the different definitions iteratively according to a structured procedure with an internal review process, resulting in an open-access publication on the diagnostic criteria in each case. It is a multidisciplinary effort, and depending on the topic, cooperation with other scientific societies is sought. The classification encompasses primary vestibular disorders and non-vestibular disorders that may manifest with prominent vestibular symptoms. The following paper describes the procedure and briefly presents definitions which have already been published as well as those presently in elaboration.
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Pressure and Traction Technique Improves Postural Control More Than Tactile Stimulation in Foot Plantar Fascia: A Randomized Single-Blind Trial. Arch Phys Med Rehabil 2020; 101:978-984. [PMID: 32113972 DOI: 10.1016/j.apmr.2020.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To check the acute effects of manual pressure and traction technique on balance and plantar footprint variables. DESIGN A single-blind clinical study with 2 groups. SETTING Private practice. PARTICIPANTS Healthy participants (N=40; 28 female and 12 male) were recruited to carry out a single-blind study. INTERVENTIONS Experimental group performed a bilateral plantar fascia manual pressure and traction technique. Control group performed a tactile stimulation. The position of the participant, the therapist, and the time of application of the techniques (5min) were the same for both interventions. MAIN OUTCOME MEASURES We measured stabilometry variables and static footprint. The footprint variables were divided in rear, middle, and front foot areas. RESULTS Significant differences were found in stabilometry variables. There was an improvement in experimental group at X displacement with eyes open (P=.014) and surface eyes closed (P=.046) variables. CONCLUSIONS After technique the experimental group improved the stabilometry variables, specifically surface with eyes closed and X displacement with eyes open. The static footprint variables have not shown differences after the technique compared with the control group.
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Baker N, Gough C, Gordon S. Classification of Balance Assessment Technology: A Scoping Review of Systematic Reviews. Stud Health Technol Inform 2020; 268:45-59. [PMID: 32141878 DOI: 10.3233/shti200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Accurate assessment of postural balance is necessary to identify and measure falls risk, inform clinical practice, determine efficacy of treatment and ultimately falls prevention. The aim of this scoping review was to identify gaps and inform practice, research and policy. There are a multitude of technologies available for assessing balance and no one that meets the requirements of every situation. Force plates had provided the gold standard technology for measuring centre of pressure variables as the cornerstone of balance assessment. Inertial measurements units are now considered as valid and reliable, however inertial sensors in smartphone require further refinement to measure with the same degree of accuracy. Fusion systems combine wearable and non-wearable technology in formal gait labs but also gaming. The flexibility provided choice of wearable, non-wearable and fusion systems meets most clinical and research requirements.
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Neri SGR, Harvey LA, Tiedemann A, Gadelha AB, Lima RM. Obesity and falls in older women: Mediating effects of muscle quality, foot loads and postural control. Gait Posture 2020; 77:138-143. [PMID: 32036318 DOI: 10.1016/j.gaitpost.2020.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/12/2019] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk. RESEARCH QUESTION Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older? METHODS At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05. RESULTS 204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39-3.27). Using the counterfactual approach, only specific torque (NIE: 1.11, 95 % CI: 1.01-1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01-1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively. SIGNIFICANCE Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population.
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Postural control in karate practitioners: Does practice make perfect? Gait Posture 2020; 77:218-224. [PMID: 32059140 DOI: 10.1016/j.gaitpost.2020.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Karate training likely leads to enhanced postural control, however, previous studies did not always include a healthy, physically active comparison group and the findings are inconsistent. RESEARCH QUESTION Will the postural control of experienced karate practitioners be better than that of experienced swimmers, i.e., athletes with similar characteristics who do not practice under conditions that require upright postural control? METHODS In this cross-sectional study, 20 experienced, male karate practitioners and 20 experienced, male swimmers, ages 20-50, performed four standing postural control tasks of increasing difficulty: (a) two-legged stance with eyes open; (b) one-legged stance with eyes open; (c) one-legged stance with eyes closed, and (d) a dual-task, one-legged stance with eyes closed and a verbal fluency challenge. The primary outcome measure was a functional, behavioral measure that reflects the loss of balance. Specifically, in tasks that included one-legged stance, every touch of the raised foot to the floor was counted. Center-of-gravity movements were measured using a wearable sensor. RESULTS Task-related differences were seen in all of the postural control measures. In the OneLegEyesClosed task, the median number of touches was 0.00 in the karate group and 6.50 in the swimming group (p < 0.001). In the OneLegEyesClosedWords task, the median number of touches was 0.00 in the karate group and 5.00 in the swimming group (p < 0.001). Shannon entropy, a measure of the complexity of the sway of the center-of-gravity, was lower in the karate group (p = 0.002), compared to the swimmers. SIGNIFICANCE Karate training is associated with a higher level of postural control, even when compared to a physically active age-matched comparison group. In addition to supporting the specificity of exercise training principle, these findings raise the intriguing possibility that karate may be useful as a form of pre-habilitation, potentially aiding in the prevention of age-associated declines in balance control.
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Ilha J, Abou L, Romanini F, Dall Pai AC, Mochizuki L. Postural control and the influence of the extent of thigh support on dynamic sitting balance among individuals with thoracic spinal cord injury. Clin Biomech (Bristol, Avon) 2020; 73:108-114. [PMID: 31981887 DOI: 10.1016/j.clinbiomech.2020.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unsupported sitting balance with reduced thigh support is necessary during several daily living activities among individuals with spinal cord injury. This study proposed to compare dynamic unsupported sitting postural control under reduced thigh support conditions in individuals with motor-complete thoracic spinal cord injury and able-bodied individuals. METHODS Thirteen individuals with spinal cord injury and thirteen able-bodied individuals were asked to put on a t-shirt and reach forward while sitting on a force platform using maximum, medium or minimum thigh support extent. Postural control was measured by the center of pressure parameters. FINDINGS Individuals with spinal cord injury presented larger postural sway parameters and mean velocity of the center of pressure displacement in anterior-posterior direction during the t-shirt wearing task. On the other hand, these parameters were lower in the medial-lateral direction. These results are more expressive when the task was performed in reduced thigh support conditions [F(1,76) = 5.05-18.70; p < 0.05]. Lower postural sway parameters and mean velocity of the center of pressure displacement in anterior-posterior, and postural sway in medial-lateral direction in the three thigh support conditions were observed when individuals with spinal cord injury performed the forward reaching task [F(1,76) = 9.81-185.46; p < 0.01]. INTERPRETATION The results confirm that individuals with motor-complete thoracic spinal cord injury have poor postural stability and show a trunk postural sway constraint to maintain the suboptimal unsupported sitting balance. Reduced thigh support extent can challenge the dynamic sitting balance in individuals with thoracic spinal cord injury and should be indicated to train new and diversified postural control strategies.
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Kirkwood RN, Batista NCL, Marques LBF, de Melo Ocarino J, Neves LLA, de Souza Moreira B. Cross-cultural adaptation and reliability of the Functional Gait Assessment in older Brazilian adults. Braz J Phys Ther 2020; 25:78-85. [PMID: 32143957 DOI: 10.1016/j.bjpt.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The Functional Gait Assessment (FGA) is a standardized instrument for assessing postural stability during various walking tasks. It was developed to increase the reliability and to decrease the potential ceiling effect observed with the Dynamic Gait Index (DGI). OBJECTIVE To translate and cross-culturally adapt the FGA into Portuguese-Brazilian, and to evaluate its reliability in community-dwelling Brazilian older adults. METHODS The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. The pre-final version was applied to a sample of 55 older adults of both sexes living independently in the community. For the assessment of reliability (i.e. inter- and intra-rater reliability, standard error of measurement (SEM), and internal consistency), 70 older adults aged 60-87 years were evaluated. RESULTS There was a conceptual equivalence between the original and the translated versions. All FGA items that used measurements in inches and feet were modified to use matching values in centimeters to reflect the measurement unit used in Brazil. The FGA-Brazil showed excellent inter- and intra-rater reliability (ICC2,1 > 0.90), low SEM (ranging from 1.03 to 1.52), and good internal consistency (Cronbach's alpha = 0.858). CONCLUSION The FGA-Brazil is a semantically and linguistically valid and reliable instrument to assess walking balance among community-dwelling older adults.
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Acute effects of myofascial induction technique in plantar fascia complex in patients with myofascial pain syndrome on postural sway and plantar pressures: A quasi-experimental study. Phys Ther Sport 2020; 43:70-76. [PMID: 32114316 DOI: 10.1016/j.ptsp.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The prevalence of myofascial pain syndrome varies from 21% 93%. Several studies have shown that myofascial induction is effective in treating myofascial pain syndrome. Although these techniques have shown some effectiveness in clinical practice, there have been little study into their effects, and have deep effects. The purpose of this study was to investigate if the application of a single myofascial induction technique for each foot, targeted to the plantar fascia resulted in changes in balance and footprint variables. DESIGN A quasi-experimental study. SETTING An outpatient clinic. SUBJECTS 20 healthy participants (12 females and 8 males) were evaluated pre and post Myofascial induction technique for each foot in plantar fascia during 5 min. METHODS We measured static footprint and stabilometry variables in asymptomatic subjects. The footprint surface area was divided: bilateral rear foot, bilateral midfoot, bilateral fore foot. RESULTS We found differences in the footprint variables: maximun pressure in forefoot (p = 0.025), surface in forefoot (p = 0.03). The myofascial induction has no effects on stabilometry variables. CONCLUSIONS The immediate effects of the longitudinal technique of myofascial induction of the plantar fascia are the increase of surface and maximum pressure in fore foot.
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de Castro LA, Felcar JM, de Carvalho DR, Vidotto LS, da Silva RA, Pitta F, Probst VS. Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial. Physiotherapy 2020; 107:58-65. [PMID: 32026836 DOI: 10.1016/j.physio.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 04/07/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN Randomised clinical trial. SETTING University-based, outpatient, physical therapy clinic. SUBJECTS Fifty individuals with COPD. INTERVENTIONS Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions: standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS Seventeen subjects completed the intervention in the LG {nine males, mean age 64 [standard deviation (SD) 8] years, mean forced expiratory volume in 1 second (FEV1) 48 (SD 17) %predicted} compared with 14 subjects in the WG [nine males, mean age 65 (SD 8) years, FEV1 51 (SD 15) %predicted]. Water-based exercise training had a positive effect on functional balance [TUG: mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; P=0.006], whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; P<0.001). CONCLUSION Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. CLINICAL TRIAL REGISTRATION NUMBER clinicalTrials.gov NCT01691131.
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Perception of verticality is altered in people with severe chronic low back pain compared to healthy controls: A cross-sectional study. Musculoskelet Sci Pract 2020; 45:102074. [PMID: 31672595 DOI: 10.1016/j.msksp.2019.102074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/14/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND People with chronic low back pain (CLBP) have abnormal lumbar proprioception, which increases their reliance on visual input to maintain body verticality. Maintaining verticality is important for spatial orientation, balance and movement coordination. It is unknown if these patients also have altered perception of verticality. OBJECTIVE To compare whether the perception of verticality is different between people with and without CLBP. DESIGN Cross-sectional. METHODS Two comparisons of perception of verticality were done between a group of people with CLBP (n = 25) and healthy people (n = 25); and between a subgroup of people with severe CLBP (n = 14) and healthy people (n = 25). In a dark room, the subjective visual vertical test was performed under 3 conditions: rod, rod-and-frame, and rod-and-disc. In each condition, the rod was tilted 40° clockwise and counterclockwise, and the participants were asked to bring it back to vertical 0° position. The rod deviation from verticality was recorded in degrees. RESULTS When considering the CLBP group, analysis of variance showed that deviation from verticality had no significant group interaction with condition (p = 0.2), or group main effect (p = 0.2). However, deviation from verticality was significantly different between the conditions (p < 0.001). When considering the severe CLBP subgroup, the interaction effect was significant (p = 0.046). Simple main effects showed that the severe CLBP subgroup had larger deviations from verticality (7.5 ± 0.9 deg) compared to the healthy group (4.2 ± 0.7 deg) specifically on the rod-and-frame condition (p = 0.007). CONCLUSION People with severe CLBP appear to have larger deviations in judging verticality compared to the healthy group.
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Zanotto T, Gobbo S, Bullo V, Vendramin B, Roma E, Duregon F, Bocalini DS, Di Blasio A, Cugusi L, Furian L, Di Bella C, Neunhaeuserer D, Battista F, Bergamin M, Ermolao A. Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: A cross-sectional study. Gait Posture 2020; 76:358-363. [PMID: 31901763 DOI: 10.1016/j.gaitpost.2019.12.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND End-stage renal disease patients living with a kidney transplant (KT) often present with frailty, functional disability, and mobility impairments that may result in a high risk of falls. Postural balance and muscle strength are implicated in the etiology of falls in the geriatric population, and both may be impaired in KT patients. RESEARCH QUESTION We conducted a cross-sectional investigation to estimate the prevalence of falls, as well as to explore the association between postural balance, muscle strength and history of falls in end-stage renal disease patients living with a KT. METHODS Fifty-nine prevalent KT patients (age = 53.2 ± 11 years) were enrolled in this cross-sectional study. Participants were classified as fallers/non-fallers and underwent an objectively-measured assessment of postural balance on a stabilometric platform in eyes open (EO), eyes closed (EC), and dual-task (DT) conditions. Center of pressure (CoP) variables were taken for the analysis. In addition, participants underwent isometric (IM) and isokinetic (IK) assessments of lower limb muscle strength on a multi-joint evaluation system. RESULTS Thirty-four percent of the study participants reported at least one fall in the previous 12 months. In logistic regression analysis, CoP velocity in EO (OR: 1.23, 95 % CI: 1.06-1.43, p = .007), and IK ankle dorsiflexion strength (OR: 0.87, 95 % CI: 0.77-0.99, p = .034) were independently associated with increased odds of falling. SIGNIFICANCE This cross-sectional study indicates that patients living with a KT presented with a prevalence of falls indicative of a high risk of falling. Postural balance and muscle strength are exercise-modifiable factors and further research is warranted to establish to what extent these measures may be implicated in the etiology of falling in this patient group.
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Vérité F, Soria S, Reynolds R, Bachta W. Perception of haptic motion is enhanced during conditions of increased postural stability. Gait Posture 2020; 76:334-338. [PMID: 31896536 DOI: 10.1016/j.gaitpost.2019.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Coupling between postural sway and fingertip displacement has been observed in individuals lightly touching a moving surface. This can be attributed to the central nervous system (CNS) misinterpreting surface motion as self-motion, evoking a compensatory sway response. RESEARCH QUESTION Does baseline postural state influence the correct perception of haptic object motion? METHODS Motion perception detection thresholds of index finger displacement at 1 mm s-1 velocity during light touch were determined for three postural conditions: standing with eyes open (EO) and closed (EC), and sitting with eyes closed. For the standing condition with eyes shut, displacement thresholds were measured using three velocities (1, 2 and 4 mm s-1). RESULTS Postural condition had a large influence on motion perception, with a reduction in displacement threshold from 12 → 6 → 2 mm during the transition from standing EC → standing EO → sitting EC. A systematic decrease in displacement perception threshold was observed with increasing velocity. This tends to suggest that the increase of the touched object velocity may help overcoming the misinterpretation. SIGNIFICANCE These results suggest that the ability to disambiguate self motion from haptic motion is enhanced during stable postures, and when stimulus velocity is high. Our findings may help to understand the mechanisms underlying the coupling between surface movements and postural sway, reported in the literature.
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Riis J, Eika F, Blomkvist AW, Rahbek MT, Eikhof KD, Hansen MD, Søndergaard M, Ryg J, Andersen S, Jorgensen MG. Lifespan data on postural balance in multiple standing positions. Gait Posture 2020; 76:68-73. [PMID: 31734637 DOI: 10.1016/j.gaitpost.2019.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/06/2019] [Accepted: 11/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Maintaining balance is important throughout life. The Nintendo Wii Balance Board (WBB) can give reliable quantitative measures of postural balance, but reference data are lacking. Furthermore, one-leg standing balance across the adult lifespan is not fully described. The aim of the study was (1) to provide reference data on postural balance in multiple standing positions using a WBB, (2) to determine an age cut-off for the ability to stand on one-leg in men and women. METHODS This was a cross-sectional study and data was collected in two cities in Denmark (Aalborg and Odense) and Norway (Oslo and Ålesund) during spring and summer of 2016. Postural balance was assessed in individuals across the adult lifespan in three different bases of support positions (hip-wide and narrow two-legged stance, and one-legged stance) using a WBB. Reference data were analyzed and presented in 10-year intervals. RESULTS A total of 354 individuals aged 20-99 years were recruited. Reference data were presented in percentiles stratified by gender for the following age categories: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80+. Data showed that the difference between men and women's balance was larger at older age with men performing worst. The cut-off ability to stand on one-leg was 72.5 years without statistical evidence of gender difference. CONCLUSION This study reports reference data for postural balance across the entire adult lifespan using a WBB. More than half of the individuals over 72.5 years of age were unable to stand balanced on one-leg.
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Cersonsky TE, Kellner S, Chapman S, Huey ED, Louis ED, Cosentino S. Profiles of Normal Cognition in Essential Tremor. J Int Neuropsychol Soc 2020; 26:197-209. [PMID: 31581969 PMCID: PMC7015784 DOI: 10.1017/s1355617719001140] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Patients with essential tremor exhibit heterogeneous cognitive functioning. Although the majority of patients fall under the broad classification of cognitively "normal," essential tremor is associated with increased risk for mild cognitive impairment and dementia. It is possible that patterns of cognitive performance within the wide range of normal functioning have predictive utility for mild cognitive impairment or dementia. These cross-sectional analyses sought to determine whether cognitive patterns, or "clusters," could be identified among individuals with essential tremor diagnosed as cognitively normal. We also determined whether such clusters, if identified, were associated with demographic or clinical characteristics of patients. METHODS Elderly subjects with essential tremor (age >55 years) underwent comprehensive neuropsychological testing. Domain means (memory, executive function, attention, visuospatial abilities, and language) from 148 individuals diagnosed as cognitively normal were partitioned using k-means cluster analysis. Individuals in each cluster were compared according to cognitive functioning (domain means and test scores), demographic factors, and clinical variables. RESULTS There were three clusters. Cluster 1 (n = 64) was characterized by comparatively low memory scores (p < .001), Cluster 2 (n = 39) had relatively low attention and visuospatial scores (p < .001), and Cluster 3 (n = 45) exhibited consistently high performance across all domains. Cluster 1 had lower Montreal Cognitive Assessment scores and reported more prescription medication use and lower balance confidence. CONCLUSIONS Three patterns of cognitive functioning within the normal range were evident and tracked with certain clinical features. Future work will examine the extent to which such patterns predict conversion to mild cognitive impairment and/or dementia.
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Lim YH, Lee HC, Falkmer T, Allison GT, Tan T, Lee WL, Morris SL. Effect of Visual Information on Postural Control in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4731-4739. [PMID: 29882108 DOI: 10.1007/s10803-018-3634-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sensory processing difficulties affect the development of sensorimotor skills in individuals with autism spectrum disorder (ASD). However, the effect of sensory information on postural control is unclear in the ASD adult population. The present study examined the effect of visual information on postural control as well as the attentional demands associated with postural control in fourteen adults with ASD and seventeen typically developed adults. The results showed that postural sway and attention demands of postural control were larger in adults with ASD than in typically developed adults. These findings indicate that visual processing used for postural control may be different in adults with ASD. Further research in visual field processing and visual motion processing may elucidate these sensorimotor differences.
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268
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Wong CK, Chihuri ST, Santo EG, White RA. Relevance of medical comorbidities for functional mobility in people with limb loss: retrospective explanatory models for a clinical walking measure and a patient-reported functional outcome. Physiotherapy 2020; 107:133-141. [PMID: 32026813 DOI: 10.1016/j.physio.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Various modifiable and non-modifiable factors affect functional mobility, but subjective patient-reported and objective performance-based measures are rarely combined in explanatory analyses of functional mobility in people with limb loss. This study determined separate explanatory models for patient-reported function using the Prosthetic Evaluation Questionnaire Mobility Subscale (PEQ-MS), and performance-based 2-Minute Walk Test (2MWT). DESIGN Retrospective cross-sectional observational analysis. SETTING Wellness-walking program. PARTICIPANTS Three hundred five volunteers with lower limb loss participated. Sixty nine percent were men, mean age 56 (15) years. Fifty two percent had vascular amputation causes, 42% had surgical levels above the knee, and 82% had medical comorbidities. Walking levels included limited-household (21%), limited-community (30%), and independent-community (49%). Outcome measures included patient-reported PEQ-MS, Activities-specific Balance Confidence (ABC) and Houghton scales; and performance-based balance and walking. MAIN OUTCOMES Separate PEQ-MS and 2MWT multiple regression models fit using backward deletion. RESULTS Modifiable (balance ability, ABC, Houghton score; P<0.05) and non-modifiable factors (sex, amputation cause, surgical level; P<0.05) explained the variance in 2MWT (adjusted R2=0.685). Patient-reported and performance-based modifiable factors (Houghton score, 2MWT; P<0.001) explained PEQ-MS variance (adjusted R2=0.660). Integumentary (P=0.022) and cardiopulmonary (P<0.001) comorbidities explained an additional 4% of PEQ-MS variance, while surgical level was insignificant. CONCLUSIONS Both modifiable and non-modifiable factors explained prosthetic functional mobility. Performance-based walking was explained by modifiable factors including balance ability and confidence, prosthesis and walking aid use. Patient-reported function was also explained by prosthesis and walking aid use, walking speed and medical comorbidities. Modifiable factors for objective and subjective prosthetic mobility may provide a clinical roadmap for rehabilitation.
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269
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Bouchaala F, Laatar R, Lahiani M, Zouabi A, Borji R, Rebai H, Sahli S. Time of day effect on balance performance, functional capacities and risk of fall in women with rheumatoid arthritis. Chronobiol Int 2020; 37:227-235. [PMID: 31913721 DOI: 10.1080/07420528.2019.1700997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This study explored the time of day effect of balance performance, functional capacities and risk of fall in three different times in patients with rheumatoid arthritis (RA) and the association between these variations and those of RA symptoms.Methods: A "discontinual" protocol, composed of three test sessions, carried out at 6 am, 2 pm and 10 pm was set up, in order to investigate the time of day effect of balance performance, functional capacities, risk of fall, stiffness, range of motion, swollen and painful joints in women with RA.Results: Time Up and Go Test (TUGT), Functional Reach Test (FRT) and tinetti test scores were significantly higher (p < .01) at 6 am and at 10 pm compared to 2 pm. Stiffness, range of motion, swollen and painful joints values were significantly higher (p < .01) at 6 am and at 10 pm compared to 2 pm. A significant difference was observed on the stiffness, range of motion and swollen joints values between 6 am and 10 pm that were higher at 6 am (p < .05).Using Pearson's coefficient, correlations were found between RA symptom values; and TUGT, FRT and Tinetti test scores.Conclusion: Results showed a time of day effect of balance performance, functional capacities and risk of falls in women with RA. This variation indicates an alteration of performance at 6 am and 10 pm. Fluctuations of stiffness, limited range of motion, swollen and painful joints noted are concomitant to those of balance performance, functional capacities, and risk of fall.Abbreviations: RA: rheumatoid arthritis; H&O questionnaire: Horne and Ostberg questionnaire; PSQI: Pittsburgh sleep quality index; HAQ: health assessment questionnaire; SF-36: the short form-36; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; TUGT: Time Up and Go Test; FRT: Functional Reach Test.
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270
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Gray M, Wilson JC, Potter M, Provance AJ, Howell DR. Female adolescents demonstrate greater oculomotor and vestibular dysfunction than male adolescents following concussion. Phys Ther Sport 2020; 42:68-74. [PMID: 31935640 DOI: 10.1016/j.ptsp.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine differences between male and female adolescents on measures of balance, vestibular and oculomotor function within 3 weeks of concussion among a group of pediatric patients presenting to a sports medicine clinic. DESIGN Medical record review. SETTING Sports medicine clinic. PARTICIPANTS 197 female (median age = 15.2 years) and 381 male (median age = 14.6 years) pediatric patients seen for a concussion, evaluated 9.3 ± 5.2 (mean ± SD) days post-concussion. MAIN OUTCOME MEASURES Patients completed Balance Error Scoring System (BESS), tandem gait, gaze stability, and near point of convergence (NPC) tests. RESULTS A higher proportion of female patients exhibited abnormal NPC (22% vs. 14%; p = 0.017), gaze stability (53% vs. 43%; p = 0.028), and tandem gait tests (20% vs. 13%; p = 0.026) compared to male patients. Multivariable analysis indicated an independent association between female sex and increased odds of abnormal NPC (adjusted odds ratio [aOR] = 1.79, 95% CI = 1.07-3.00), and tandem gait tests (aOR = 1.96, 95% CI = 1.12-3.41) following concussion. CONCLUSIONS Our results indicate that within the first three weeks of a concussion, female pediatric patients demonstrated increased odds of exhibiting abnormal near point of convergence, and tandem gait test performance compared to male patients.
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271
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Dreneva AA, Skvortsov DV. Postural balance in pediatric posterior fossa tumor survivors: Through impairments to rehabilitation possibilities. Clin Biomech (Bristol, Avon) 2020; 71:53-58. [PMID: 31704535 DOI: 10.1016/j.clinbiomech.2019.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/20/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rehabilitation after pediatric brain tumors is a pressing issue in current neuro-oncology. The purpose of this study was to reveal the peculiarities of postural stability in pediatric posterior fossa tumor survivors as compared to the healthy controls. Additionally, we aimed to determine the feasibility of the balance biofeedback training for these patients. METHODS We measured 6 postural stability parameters with the eyes opened and closed in 35 patients and 25 healthy controls aged 7-17. Further, the patients were divided into two groups: the intervention and waitlist. The intervention group was the first to undergo a 2-week biofeedback training designed to enhance balance control, while the waitlist group performed only the usual exercises. Then the groups were interchanged. Pre- and post-stability scores were measured in each condition. FINDINGS The current results suggest the pronounced deficiency of stability in the patients. Their results in both opened and closed eyes conditions were similar. The post-training measurements revealed that some stability parameters were improved: ellipse square and mean root square oscillations in the frontal and sagittal planes. INTERPRETATION The patients predictably demonstrated the significantly worse stability measurements as compared to the healthy controls. Moreover, they were shown not to use visual information to correct postural balance thus prompting us to assume severe deficits of the eye movements control due to the cerebellar pathology. This specificity, as well as the post-training significant improvement, emphasizes the clinical necessity to consider them when designing the rehabilitation protocols for posterior fossa tumor survivors.
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272
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Correlation between spinal coronal balance and static baropodometry in children with adolescent idiopathic scoliosis. Gait Posture 2020; 75:93-97. [PMID: 31639614 DOI: 10.1016/j.gaitpost.2019.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Scoliosis is accepted as a 3-dimensional deformity involving axial, sagittal and frontal planes. RESEARCH QUESTION To evaluate the correlation between baropodometric parameters and coronal balance status for idiopathic scoliosis. METHODS 44 patients (7 males and 37 females) of Adolescent Idiopathic Scoliosis (AIS) were recruited. All participants should have scoliosis confirmed by a spine X-ray performed less than one month ahead of the baropodometric study. Radiographic studies including Cobb angle, offset between Central Sacral Vertical Line (CSVL) and C7 Vertebra Plumb Line (C7PL) (considered as global coronal balance, GCB), Apical Translation of the major curve (AT, considered as regional coronal balance) as well as Lateral Pelvic Tilt (LPT) were examined. A static baropodometry was performed for each patient. The contact surface and load ratio (to the entire load of both feet) were measured. RESULTS On both sides, the surface of the forefoot was significantly larger than that of the rearfoot (P < 0.001) and the load ratio of the forefoot was significantly smaller than that of the rearfoot (P < 0.001). On the major curve side, GCB showed a positive correlation with the contact surface of the forefoot (r = 0.36, P = 0.019), as well as the load ratio (r = 0.40, P = 0.008). AT also showed a positive correlation with the load ratio of the forefoot (r = 0.331, P = 0.03) but no correlation with contact surface. SIGNIFICANCE In scoliosis, coronal balance is correlated to plantar pressure distribution. Apical translation of the major curve and offset between CSVL and C7PL are the best describers of coronal balance.
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Min TJ, Cho J, Ha YC, Lim JY, Kang SH, Kim DK, Seo KM, Beom J. Correlation Between Mechanography and Clinical Parameters at Six Months After Hip Fracture Surgery. Ann Rehabil Med 2019; 43:642-649. [PMID: 31918527 PMCID: PMC6960088 DOI: 10.5535/arm.2019.43.6.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/04/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the correlation between mechanography and clinical parameters in older people at 3 and 6 months after hip fracture surgery. METHODS A longitudinal follow-up study was conducted in university hospitals with 38 patients at 3 months and 29 patients at 6 months after hip fracture surgery. Subjects 65 years and older completed measurements on the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), walking ability by Koval, Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale, and hand grip strength. The Romberg test with center of foot pressure (COP), chair rise test (CRT), and maximal power (W/kg) were conducted using the Leonardo Mechanograph. RESULTS COP area and pathway length were correlated with BBS at 3 and 6 months. Change in BBS was correlated with change in COP area, but not with change in COP length. COP area and pathway length were correlated with K-FRAIL at 3 months after hip fracture surgery. The same COP variables showed correlations with FAC and walking ability by Koval at 6 months after surgery. Maximal power during CRT had correlation with chair rise time but not with other clinical parameters. CONCLUSION The study revealed correlations between mechanography and clinical parameters in older people at 3 and 6 months after hip fracture surgery. Both the clinical assessment and objective test with mechanography may be required for the quantitative and sensitive measurement of postural balance and lower limb muscle power.
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Individuals with peripheral vestibulopathy and poor quality of sleep are at a higher risk for falls. Braz J Otorhinolaryngol 2019; 87:440-446. [PMID: 31882378 PMCID: PMC9422609 DOI: 10.1016/j.bjorl.2019.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/16/2019] [Accepted: 10/27/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction There is a lack of scientific studies on the assessment of patients with vestibular disorders associated with sleep quality disorders and its impact on the balance and overall quality of life. Objectives to assess the impact of the sleep quality on the balance and quality of life of individuals with peripheral vestibulopathies. Methods 52 individuals with peripheral vestibulopathies underwent sleep quality assessment through the Pittsburgh sleep quality index, neurotological examination through dizziness handicap inventory and Tetrax posturography (Sunlight Medical Ltd.) in eight sensory conditions. Thirty-two healthy individuals (G3) participated as the control group. Results Fourteen individuals with vestibulopathy had good quality of sleep (G1) and 38 showed poor quality of sleep (G2) as demonstrated by the Pittsburgh sleep quality index global scores (p = 0.001). The dizziness handicap inventory showed worse impact of the dizziness on the quality of life in G2 when compared to G1 (p = 0.045). The G2 showed higher risk of falling in posturography when compared to G3 (p = 0.012) and higher index of postural instability in five sensory conditions in comparison with G3. In the vestibulopathy groups, the worse the sleep quality, the higher the risk of falling (r = 0.352) and the worse the quality of life (r = 0.327). Conclusion Individuals with peripheral vestibulopathies and poor quality of sleep demonstrate worse balance evidenced by increased postural instability, higher risk of falls and worse perceived quality of life. The quality of sleep is a predictive factor for worse perceived quality of life and for higher risk of falls in individuals with peripheral vestibulopathies.
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Carvalho GF, Schwarz A, Szikszay TM, Adamczyk WM, Bevilaqua-Grossi D, Luedtke K. Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Braz J Phys Ther 2019; 24:306-317. [PMID: 31813696 DOI: 10.1016/j.bjpt.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Migraine is a primary headache with high levels of associated disability that can be related to a variety of symptoms and comorbidities. The role of physical therapy in the management of migraine is largely unknown. Therefore, the aim of this review is to highlight and critically discuss the current literature and evidence for physical therapy interventions in individuals with migraines. METHODS A narrative review of the literature was performed. RESULTS Physical therapists assessing and treating patients with migraine should focus on two primary aspects: (1) musculoskeletal dysfunctions, and (2) vestibular symptoms/postural control impairment. Signs and symptoms of musculoskeletal and/or vestibular dysfunctions are prevalent among individuals with migraines and different disability levels can be observed depending on the presence of aura or increment of the migraine attacks. CONCLUSION A proper physical examination and interview of the patients will lead to a tailored treatment plan. The primary aim regarding musculoskeletal dysfunctions is to reduce pain and sensitization, and physical therapy interventions may include a combination of manual therapy, exercise therapy, and education. The aim regarding postural control impairment is to optimize function and reduce vestibular symptoms, and interventions should include balance exercises and vestibular rehabilitation. However, consistent evidence of benefits is still lacking due to the lack of and therefore need for tailored and pragmatic clinical trials with high methodological quality.
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