151
|
Nestico J, Novak A, Perry SD, Mansfield A. Does increased gait variability improve stability when faced with an expected balance perturbation during treadmill walking? Gait Posture 2021; 86:94-100. [PMID: 33711616 DOI: 10.1016/j.gaitpost.2021.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/04/2021] [Accepted: 03/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Currently, there is uncertainty as to whether movement variability is errorful or exploratory. RESEARCH QUESTION This study aimed to determine if gait variability represents exploration to improve stability. We hypothesized that 1) spatiotemporal gait features will be more variable prior to an expected perturbation than during unperturbed walking, and 2) increased spatiotemporal gait variability pre-perturbation will correlate with improved stability post-perturbation. METHODS Sixteen healthy young adults completed 15 treadmill walking trials within a motion simulator under two conditions: unperturbed and expecting a perturbation. Participants were instructed not to expect a perturbation for unperturbed trials, and to expect a single transient medio-lateral balance perturbation for perturbed trials. Kinematic data were collected during the trials. Twenty steps were recorded post-perturbation. Unperturbed and pre-perturbation gait variabilities were defined by the short- and long-term variabilities of step length, width, and time, using 100 steps from pre-perturbation and unperturbed trials. Paired t-tests identified between-condition differences in variabilities. Stability was defined as the number of steps to centre of mass restabilization post-perturbation. Multiple regression analyses determined the effect of pre-perturbation variability on stability. RESULTS Long-term step width variability was significantly higher pre-perturbation compared to unperturbed walking (mean difference = 0.28 cm, p = 0.0073), with no significant differences between conditions for step length or time variabilities. There was no significant relationship between pre-perturbation variability and post-perturbation restabilization. SIGNIFICANCE Increased pre-perturbation step width variability was neither beneficial nor detrimental to stability. However, the increased variability in medio-lateral foot placement suggests that participants adopted an exploratory strategy in anticipation of a perturbation.
Collapse
Affiliation(s)
- Jacqueline Nestico
- University of Toronto, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alison Novak
- University of Toronto, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Stephen D Perry
- University of Toronto, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - Avril Mansfield
- University of Toronto, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| |
Collapse
|
152
|
Kuo KT, Hunter BC, Obayashi M, Lider J, Teramoto M, Cortez M, Hansen C. Novice vs expert inter-rater reliability of the balance error scoring system in children between the ages of 5 and 14. Gait Posture 2021; 86:13-16. [PMID: 33668005 DOI: 10.1016/j.gaitpost.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Balance Error Scoring System (BESS) is a tool to measure balance, however, no studies have shown its reliability between novice and expert raters. RESEARCH QUESTION What is the inter-rater reliability of BESS measurements when performed by novice raters compared to experts, and does completion of a focused, online training module increase the inter-rater reliability among novice raters? METHODS In this reliability study, 5 novice volunteers were asked to independently rate BESS tests from 50 random prerecorded BESS videos of normal healthy subjects aged 5-14. Novice raters regraded the same 50 videos after receiving a formal training. The novices' scores before and after the formal training were compared to one another and then the scores were compared to 4 expert scores. Intraclass correlation (ICC) with 95 % confidence intervals or percent agreements were calculated and compared across groups. RESULTS For the total BESS score, novice raters showed good reliability (ICC 0.845) which did not change with a formal training (ICC 0.846). Expert raters showed excellent reliability (ICC 0.929). Poor to moderate reliability was noted in the foam stance-single leg in the untrained novice and trained novice group (ICCs 0.452 and 0.64 L respectively). SIGNIFICANCE BESS testing by novice raters with only written instruction and no formal training yields good inter-rater reliability. In contrast, BESS testing by expert raters yields excellent reliability. A focused training for novice raters conferred a small improvement in the reliability of the scoring of the single leg stance on foam condition but not a significant difference to the overall BESS score. While novices demonstrated promising reliability for overall BESS scores, optimizing clinical research using the BESS with expert raters show the highest reliability.
Collapse
Affiliation(s)
- Keith T Kuo
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA.
| | | | - Mizuho Obayashi
- Johns Hopkins University Krieger School of Arts & Science, Baltimore, MD, USA
| | - Joshua Lider
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Melissa Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Colby Hansen
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
153
|
da Silva de Jesus LA, Pinheiro BV, Koufaki P, Lucinda LMF, Gravina EPL, Barros FS, Garcia RSA, Oliveira CC, Reboredo MM. Factors associated with fear of falling in hemodialysis patients. Int Urol Nephrol 2021. [PMID: 33881702 DOI: 10.1007/s11255-021-02856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Fear of falling (FOF) has important clinical and psychological consequences. This study evaluated the factors associated with FOF in hemodialysis patients and compared with the FOF reported by age-gender matched individuals without chronic kidney disease. METHODS This cross sectional study included hemodialysis group (n = 60, 55.4 ± 7.6 years, 55.0% male) and control group (n = 40, 55.1 ± 7.5 years, 52.5% male). FOF was assessed by the Falls Efficacy Scale International (FES-I). Physical function was evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test, 4-m gait speed, isometric handgrip force and 10-repetition sit-to-stand test. The physical and mental components of quality of life was evaluated by 36-Item Short Form Health Survey. RESULTS The FES-I score was higher in the hemodialysis group compared to the control group (28.2 ± 9.7 vs. 23.3 ± 5.1, p = 0.020). In addition, the prevalence of individuals with a higher concern about falling was greater in the hemodialysis group (41.7 vs. 17.5%, p = 0.033). Multiple linear regression showed that the FES-I score was associated with the Mini-BESTest score and the physical component summary of quality of life (coefficient of determination of 0.51 and an adjusted coefficient of determination of 0.46). CONCLUSION FOF was associated with poor postural balance and reduced physical component of quality of life in patients on hemodialysis and these patients showed higher FOF compared to individuals without chronic kidney disease.
Collapse
|
154
|
Moraes AG, Neri SGR, Motl RW, Tauil CB, von Glehn F, Corrêa ÉC, de David AC. Effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with relapsing-remitting multiple sclerosis: Secondary results of an exploratory clinical trial. Mult Scler Relat Disord 2021; 52:102948. [PMID: 33940496 DOI: 10.1016/j.msard.2021.102948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) results in worsening of postural balance, functional mobility, and self-perceived fatigue as influences of quality of life. OBJECTIVE To examine the effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with MS. METHODS Participants were assigned into a hippotherapy intervention group (n= 17) or a control group (n= 16). The intervention included 16 sessions of 30-minutes of hippotherapy conducted twice a week whereas the control group was maintained their therapeutic routine. Postural balance was evaluated as CoP speed (cm/s) and CoP 95% elliptical area (cm2) using a force platform under 4 experimental conditions: stable surface/ eyes open, stable surface/ eyes closed, foam surface/ eyes open, and foam surface/ eyes closed. Functional mobility was evaluated by the Timed Up and Go (TUG) test. The Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) measured perceived fatigue, and the Functional Assessment of Multiple Sclerosis (FAMS) measured quality of life. The data were examined using mixed model ANOVA with Bonferroni post hoc. RESULTS CoP speed and CoP 95% elliptical area (p < .05) significantly decreased across all testing conditions for the intervention group compared with control. The TUG improved over time in the intervention group (p = .001) as did the FSS (p < .001). In addition, there was also an improvement for the score and all the MFIS domains (p < .005) for the intervention group compared with control and for FAMS improved over time in the intervention group (p < .05). CONCLUSION Hippotherapy improved postural balance, functional mobility, fatigue, and quality of life in people with relapsing-remitting MS. This suggests that hippotherapy may be a useful approach for complimentary treatment among people with MS.
Collapse
|
155
|
Jassi FJ, Del Antônio TT, Azevedo BO, Moraes R, George SZ, Chaves TC. Star-Shape Kinesio Taping Is Not Better Than a Minimal Intervention or Sham Kinesio Taping for Pain Intensity and Postural Control in Chronic Low Back Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1352-1360.e3. [PMID: 33819489 DOI: 10.1016/j.apmr.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study investigated the effects of star-shape Kinesio taping (KT) compared with both sham KT and minimal intervention (MI) on pain intensity and postural control. DESIGN Randomized controlled trial. SETTING Outpatient physical therapy. PARTICIPANTS A total of 120 people with chronic low back pain (CLBP) aged 18-60 years (N=120). INTERVENTIONS Star-shape KT, sham KT (no tension), and MI (educational booklet for self-management counseling). MAIN OUTCOME MEASURES The primary outcome measures were pain intensity and center of pressure (COP) mean sway speed, and disability score (Oswestry Disability Index) was a secondary outcome. The outcomes were obtained immediately after initial KT application, on the seventh day of intervention and at the 1-month follow-up. Linear mixed-model analyses using Bonferroni post hoc analyses were applied to investigate between-group differences. The model included treatment, time, and treatment×time interaction as fixed effects. RESULTS Pain intensity was significantly lower for the star-shape KT group than for the MI group (mean difference [MD], -1.35; 95% confidence interval [CI], -2.63 to -0.07) immediately after the intervention and on the seventh day of intervention (MD, -1.32; 95% CI, -2.56 to -0.07). No difference in pain intensity between star-shape KT vs sham-KT groups was observed. In addition, no significant between-group differences were observed for the COP mean sway speed and disability score at any of the follow-up times. CONCLUSIONS Our results showed no meaningful effect of star-shape KT intervention on pain intensity and postural control in people with CLBP compared with MI or sham KT. The observed reduction of 1.3 units between star-shape KT and MI groups was statistically different, but it could not be considered clinically relevant. The results of this trial suggest that benefits from KT are more likely attributable to contextual factors rather than specific taping parameters.
Collapse
Affiliation(s)
- Fabrício José Jassi
- Centre of Health Sciences, University of North Paraná, Jacarezinho, Paraná, Brazil; Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Tiago Tsunoda Del Antônio
- Centre of Health Sciences, University of North Paraná, Jacarezinho, Paraná, Brazil; Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Beatriz Oliveira Azevedo
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Renato Moraes
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Steven Z George
- Department of Orthopaedic Surgery and Therapeutic Area Lead for Musculoskeletal and Surgical Sciences, Duke University, Durham, NC
| | - Thais Cristina Chaves
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| |
Collapse
|
156
|
Lin CL, Hsieh YW, Chen HY. Age-related differences in alpha and beta band activity in sensory association brain areas during challenging sensory tasks. Behav Brain Res 2021; 408:113279. [PMID: 33812990 DOI: 10.1016/j.bbr.2021.113279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
Sensory challenges to postural balance are daily threats for elderly individuals. This study examined electroencephalography (EEG) in alpha and beta bands in sensory association areas during the Sensory Organization Test, involving withdrawal of visual or presenting misleading somatosensory inputs, in twelve young and twelve elderly participants. The results showed stepwise deterioration in behavioral performance in four conditions, with group effects that were amplified with combined sensory challenges. With eye closure, alpha and beta activities increased in all sensory association areas. Fast beta activity increased in the bilateral parietal-temporal-occipital areas. Misleading somatosensory information effects on EEG activity were of smaller amplitude than eye closure effects and in a different direction. Decreased alpha activity in left parietal-temporal-occipital areas and decreased beta and fast beta activities in bilateral parietal-temporal-occipital areas were significant. Elderly participants had increased fast beta activity in the left temporal-occipital and bilateral occipital areas, indicative of sustained efforts that they made in all sensory conditions. Similar to the young participants, elderly participants with eyes closed showed increased alpha activity, although to a smaller degree, in bilateral temporal-occipital and left occipital areas. This might indicate a lack of efficacy in redistributing relative sensory weights when elderly participants dealt with eye closure. In summary, EEG power changes did not match the stepwise deterioration in behavioral data, but reflected different sensory strategies adopted by young and elderly participants to cope with eye closure or misleading somatosensory information based on the efficacy of these different strategies.
Collapse
Affiliation(s)
- Chun-Ling Lin
- Department of Electrical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Ya-Wen Hsieh
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Hui-Ya Chen
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan; Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
157
|
Feliciano JS, Rodrigues SMA, de Carvalho Lana R, Polese JC. Predictors of physical activity levels in individuals with Parkinson's disease: a cross-sectional study. Neurol Sci 2021; 42:1499-1505. [PMID: 32870459 DOI: 10.1007/s10072-020-04701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To investigate whether modifiable predictors (depressive symptoms, impairment in behavior and mood, balance impairments, and knee extensor muscle strength) are determinants of the physical activity level in Parkinson's disease. MATERIALS AND METHODS A cross-sectional study with individuals diagnosed with idiopathic Parkinson's disease. Regression analysis of the data was used to investigate whether depressive symptoms, impairments in behavior and mood, balance impairments, or dominant knee extensor muscle strength are predictors of physical activity levels in Parkinson's disease. RESULTS A total of 50 individuals with mild to moderate Parkinson's disease participated in this study, with a mean age of 67 ± 8 years and 68% male. Balance impairments explained 29% of the variation in the physical activity levels. The explained variance increased to 34% when depressive symptoms were included in the model. CONCLUSION Among the predictor variables investigated in our study, only balance impairments and depressive symptoms explained the variance in physical activity levels in individuals with Parkinson's disease.
Collapse
Affiliation(s)
- Jéssica Soares Feliciano
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte, MG, 30120-010, Brazil
| | - Samara Maria Alves Rodrigues
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte, MG, 30120-010, Brazil
| | - Raquel de Carvalho Lana
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte, MG, 30120-010, Brazil
| | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte, MG, 30120-010, Brazil.
| |
Collapse
|
158
|
Varedi M, Lu L, Phillips NS, Partin RE, Brinkman TM, Armstrong GT, Chase E, Khan RB, Powell D, McKenna RF, Robison LL, Hudson MM, Ness KK. Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations. J Cancer Surviv 2021; 15:311-324. [PMID: 32895869 PMCID: PMC7936993 DOI: 10.1007/s11764-020-00932-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/30/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE The study aims were to determine the prevalence of balance impairments in adult survivors of pediatric central nervous system (CNS) tumors, and to identify predictors of and limitations associated with balance impairments. METHODS Participants were adult survivors (N = 329) of pediatric CNS tumors. Balance was considered impaired among those with composite scores < 70 on the sensory organization test. Potential predictors of impaired balance were evaluated with generalized linear regression. Multivariable logistic regression was used to evaluate associations between balance impairment and function. RESULTS Balance impairment was observed in 48% of survivors, and associated with infratentorial tumor location (OR = 4.0, 95% CI, 2.0-7.6), shunt placement (OR = 3.5, 95% CI, 1.8-6.7), increased body fat percentage (OR = 1.1, 95% CI, 1.0-1.1), hearing loss (OR = 11.1, 95% CI, 5.6-22.2), flexibility limitations (OR = 2.0, 95% CI, 1.0-3.9), peripheral neuropathy (OR = 2.4, 95% CI, 1.2-4.5), and cognitive deficits (OR = 2.2, 95% CI, 1.1-4.7). In adjusted models, impaired balance was associated with limitations in overall physical performance (OR = 3.6, 95% CI, 2.0-6.3), mobility (OR = 2.6, 95% CI, 1.5-4.4), diminished walking endurance (OR = 2.9, 95% CI, 1.7-5.0), and non-independent living (OR = 2.0, 95% CI, 1.0-4.3). CONCLUSIONS Nearly half of adult survivors of pediatric CNS tumors have impaired balance, which is associated with mobility and physical performance limitations. Interventions to address the complex needs of this population should be prioritized. IMPLICATIONS FOR CANCER SURVIVORS Survivors with identified risk factors should be closely evaluated for presence of balance impairment. Interventions tailored to improve balance also can positively affect function and mobility in survivors.
Collapse
Affiliation(s)
- Mitra Varedi
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
| | - Lu Lu
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Nicholas S Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Emma Chase
- School of Health Studies, The University of Memphis, Memphis, TN, USA
| | - Raja B Khan
- Division of Neurology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Douglas Powell
- School of Health Studies, The University of Memphis, Memphis, TN, USA
| | - Raymond F McKenna
- Department of Physical Therapy, Stony Brook University, Stony Brook, NY, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| |
Collapse
|
159
|
Ayvat F, Özçakar L, Ayvat E, Aksu Yıldırım S, Kılınç M. Effects of low vs. high frequency local vibration on mild-moderate muscle spasticity: Ultrasonographical and functional evaluation in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 51:102930. [PMID: 33836458 DOI: 10.1016/j.msard.2021.102930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Local vibration (LV) is a physiotherapy application that aims to reduce spasticity. The study aimed to compare the effects of 50 Hz vs. 100 Hz LV on mild-moderate spasticity, functional performance and muscle architecture. METHODS Thirty-three patients were randomly divided into three groups: 50 Hz LV group, 100 Hz LV group and the control group. Physical therapy was applied for one hour a day, three days a week, for a total of eight weeks. LV was applied to the right and left medial gastrocnemius muscles for five minutes. Clinical (spasticity, ankle joint position sense, balance, gait) and ultrasonographic (gastrocnemius fascicle length and pennation angle) measurements were performed before and after treatment. RESULTS The study was completed with 27 patients. The decrease in spasticity and the increase in fascicle length were found to be statistically significant in the 50 Hz group (both p<0.05). Ankle joint position sense, single-leg stance time, limits of stability/postural sway range in the medio-lateral direction significantly improved in the vibration treatment groups (all p<0.05). The antero-posterior limits of stability and postural sway showed significant improvement in all groups (all p<0.05). While the 50 Hz group showed significant improvement for all walking parameters; velocity, step length and base of support values improved in the 100 Hz group (all p<0.05). The exercise group showed significant improvement only for single support and stance phase percentages of the gait cycle (both p<0.05). According to between group comparisons, significant difference was found only in medio-lateral limits of stabillity (p<0.05). Medio-lateral limits of stabillity scores were better for the 50 Hz group than the 100 Hz and exercise group. CONCLUSION Our findings show that LV does not have any substantial effect except for medio-lateral limits of stability. CLINICAL TRIAL NUMBER NCT04192786.
Collapse
Affiliation(s)
- Fatma Ayvat
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
| | - Ender Ayvat
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| | - Sibel Aksu Yıldırım
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| | - Muhammed Kılınç
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| |
Collapse
|
160
|
Rogan S, Taeymans J, Eggertswyler B, Zuber S, Eichelberger P. Effect of finding-oriented manual therapy techniques on muscle activity and postural control in patients with chronic ankle instability - A randomized controlled feasibility study. J Bodyw Mov Ther 2021; 27:402-409. [PMID: 34391263 DOI: 10.1016/j.jbmt.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/19/2020] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Previous studies have analyzed the effects of manual therapy techniques (MTT) in patients with chronic ankle instability (CAI). Clinicians treat patients according the finding-oriented MTT approach. This approach is seldom pursued in research. The purpose of this study was to evaluate the feasibility and efficacy of finding-oriented MTT applications in patients with CAI. METHOD In this randomized controlled, blinded assessor crossover feasibility trial, participants were randomized to receive nine finding-oriented MTT treatments or no treatment during a three-week period, followed by a six-day washout period after which participants were crossed-over. Criteria under evaluation were adherence and attrition rates, safety (adverse events (AEs)) and acceptability and preliminary effects of finding-oriented MTT on muscular activity (measured by surface Electromyography (sEMG)) and on dynamic balance (measured by time to stabilization (TTS) and the modified Star Excursion Balance Test (modified STBT)). RESULTS Seven women and two men (mean age: 26 ± 6.1 years) with CAI enrolled in this feasibility study. Success criteria showed a high adherence (90%) and low attrition rate (10%). All data could be used for analysis. AEs such as tingling in the foot during a short time frame were reported after four finding-oriented MTT interventions. Preliminary effect sizes showed divergence and few statistically significant results for sEMG. CONCLUSION The participants were adherent to the finding-oriented MTT intervention. The acceptability of data recording and data analysis was good. In addition, the study protocol should be adapted by adding a 10-min warm up period, a participant familiarization to TTS and modified STBT, and test repetitions.
Collapse
Affiliation(s)
- Slavko Rogan
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland; Akademie für Integrative Physiotherapie und Trainingslehre, Grenzach-Wyhlen, Germany; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Jan Taeymans
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Beatrice Eggertswyler
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| | - Stefan Zuber
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| | - Patric Eichelberger
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| |
Collapse
|
161
|
Lima Rebêlo F, de Souza Silva LF, Doná F, Sales Barreto A, de Souza Siqueira Quintans J. Immersive virtual reality is effective in the rehabilitation of older adults with balance disorders: A randomized clinical trial. Exp Gerontol 2021; 149:111308. [PMID: 33744393 DOI: 10.1016/j.exger.2021.111308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
QUESTION What are the effects of immersive virtual reality (IVR) training compared to conventional physiotherapy on body balance and risk of falls in older adults with balance disorders? DESIGN A randomized controlled trial with two intervention arms, concealed allocation, per-protocol analysis, and blinded assessment. PARTICIPANTS Thirty-seven older adults with balance disorders and risk of falling. INTERVENTION Participants were randomized into two groups: a control group, which received balance training with conventional physiotherapy using multimodal circuit exercises, and an experimental group, which received balance training using immersive virtual reality. Both groups received 16 individual sessions, twice a week. OUTCOME MEASURES The primary outcome was functional balance. Secondary outcomes were static balance, gait speed, functional range, dizziness symptoms, and fear of falling. Safety was ensured by assessing any adverse events during the intervention. RESULTS After 16 sessions, in the intragroup analysis, the functional balance score in the experimental group increased by 3.00 (95% CI 1.42 to 4.57) and in the control group by 3.88 (95% CI 2.16 to 5.59). Both groups improved in assessments of sensory interaction and anterior reach. Only the experimental group presented increased mobility and reduced dizziness. After two months, there was a maintenance of gains in functional balance and a reduction of the gains in functional reach for both groups. In the intergroup comparison, there was no significant difference. CONCLUSION Immersive Virtual Reality training proved to be effective for balance-related outcomes, although it was not superior to conventional therapy. TRIAL REGISTRATION RBR-3tk7fw.
Collapse
Affiliation(s)
- Felipe Lima Rebêlo
- Health Sciences from the Federal University of Alagoas, Physiotherapy Department, State University of Health Sciences of Alagoas and Cesmac University Center, Maceió, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil; State University of Health Sciences of Alagoas, Maceió, Brazil; Department of Physiotherapy, Cesmac University Center, Maceió, Brazil.
| | | | - Flávia Doná
- Health Sciences, Ibirapuera University, Physiotherapy Department, São Paulo, Brazil
| | - André Sales Barreto
- Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil; Health Sciences, Federal University of Sergipe, Health Education Department, Aracaju, Brazil
| | | |
Collapse
|
162
|
Queiroz Dos Santos AN, Lemos T, Duarte Carvalho PH, Ferreira AS, Silva JG. Immediate effects of myofascial release maneuver applied in different lower limb muscle chains on postural sway. J Bodyw Mov Ther 2021; 25:151-156. [PMID: 33714487 DOI: 10.1016/j.jbmt.2020.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is little evidence about the myofascial release maneuver (MLM) targeting the fascial tissue and its effect on postural balance. This study investigated the immediate effects of the MLM in different lower limb muscle chains on the postural sway of healthy men. METHODS Sixty-three healthy men (27.2 ± 4.7 years) were randomly assigned to 7 groups (n = 9 each) to receive MLM applied to the lower limb muscle chains (anterior, posterior, medial, lateral, anterior/posterior, and medial/lateral) or placebo intervention. Skin pressure during the 3-min MLM was determined by the visual analog scale between 5 and 7 as previously assessed on participants. Posturography analysis of the elliptical area (Area) and average velocity (Vavg) of the center-of-pressure displacement was performed before and immediately after the MLM in single-leg support and with eyes closed. RESULTS A two-way repeated measures analysis of variance showed no interaction effect of factors group and time (Area: p = 0.210, ω2 = 0.004; Vavg: p = 0.358, ω2 < 0.001). Within-factor main effect of time was observed for both Area (p < 0.001, ω2 = 0.038) and Vavg (p < 0.001, ω2 = 0.028), with decreased Area and Vavg after all interventions. No between-factor main effect of group was observed for Area or Vavg (MLM or placebo, p = 0.188 or higher). CONCLUSION MLM applied to the lower limb muscle chains showed no immediate specific effects on postural sway in healthy men. Pre-post effects of MLM were not different from those elicited by a superficial massage. MLM in lower limb muscle chains is not advocated for an immediate improvement of postural balance in this population.
Collapse
Affiliation(s)
| | - Thiago Lemos
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil
| | | | - Arthur Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
| | - Julio Guilherme Silva
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil; Department of Physiotherapy, Universidade Federal Do Rio de Janeiro/UFRJ, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
163
|
Lee DH, Han SK. Dynamic balance measurements: Reliability of smartphone attachment sites. J Bodyw Mov Ther 2021; 27:222-226. [PMID: 34391237 DOI: 10.1016/j.jbmt.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Dynamic balance devices are costly and uncommon, requiring dedicated space for use. Thus, studies often utilize smartphones to measure dynamic balance by attaching them to body parts, as they are inexpensive, small, and readily available. However, little consideration has been given to determine which body part would yield the most reliable measurements. METHOD ː A total of 25 healthy college students consented to stand on a balance pad on their dominant leg for 30 s. The test and retests were performed at a one-week interval. RESULTS ː Agreement between the test and retest values was moderate for those obtained from the sternum and waist (0.50 ≤ ICC ≤ 0.74) and was good for those obtained from the shin (0.75 ≤ ICC ≤ 0.89). There were significant moderate positive correlations between the test and retest results for all the attachment sites (0.40 < r < 0.69, p < 0.05). DISCUSSION Based on a review of related literature and the experiment's results, this study determined the pros and cons of using a smartphone as a measuring tool and the various measurement locations in the body. Despite the smartphone being a low-cost measuring tool, greater care must be taken to ensure the validity of the interpreted data. CONCLUSION ː Although quantifying balance is necessary for evidence-based medicine, clinics seldom use existing modern devices due to their costliness. This study's results suggest that a smartphone, which is a cheaper alternative, produces the most reliable results when attached to the shin.
Collapse
Affiliation(s)
- Dae-Hee Lee
- Department of Physical Therapy, U1 University, 310, Daehak-ro, Yeongdong-eup, Yeongdong-gun, Chungbuk, 29131, Republic of Korea
| | - Seul-Ki Han
- Department of Physical Therapy, Daejeon Health Institute of Technology, 21, Chungjeong-ro, Dong-gu, Daejeon, 34504, Republic of Korea.
| |
Collapse
|
164
|
Zhao J, Chau JPC, Zang Y, Choi KC, He R, Zhao Y, Xiang X, Li Q, Thompson DR. Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke. Health Qual Life Outcomes 2021; 19:85. [PMID: 33691738 PMCID: PMC7948338 DOI: 10.1186/s12955-021-01730-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke. Methods A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test–retest reliability, internal consistency, equivalence, and content, criterion, and construct validity. Results Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs = 0.81, p < 0.001) or Modified Barthel Index (rs = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke. Conclusions The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.
Collapse
Affiliation(s)
- Jie Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong.,School of Nursing, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong.
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong
| | - Rong He
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Yali Zhao
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Xiaoqi Xiang
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Qin Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| |
Collapse
|
165
|
Lorenzo-García P, Cavero-Redondo I, Torres-Costoso AI, Guzmán-Pavón MJ, Núñez de Arenas-Arroyo S, Álvarez-Bueno C. Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses. Arch Phys Med Rehabil 2021; 102:2012-2021. [PMID: 33684361 DOI: 10.1016/j.apmr.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD). DATA SOURCES A literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION Randomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD. DATA EXTRACTION The methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS). DATA SYNTHESIS Twelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was -0.35 (95% CI, -0.57 to -0.12; I2=1.9%, P=.418), whereas for UPDRS III it was -0.35 (95% CI, -0.68 to -0.01; I2=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, -0.07 to 1.18; I2=77.1%, P=.002), for gait velocity was 0.37 (95% CI, -0.10 to 0.84); I2=78.9%, P<.001), for cadence was 0.03 (95% CI, -0.25 to 0.30; I2=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I2=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I2=51.8%, P=.042). CONCLUSIONS Interventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.
Collapse
Affiliation(s)
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Rehabilitation and Health Research Center (CIRES), Universidad de las Amércias, Santiago, Chile.
| | - Ana Isabel Torres-Costoso
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - María José Guzmán-Pavón
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | | | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| |
Collapse
|
166
|
Rezaee Z, Ranjan S, Solanki D, Bhattacharya M, Srivastava MVP, Lahiri U, Dutta A. Feasibility of combining functional near-infrared spectroscopy with electroencephalography to identify chronic stroke responders to cerebellar transcranial direct current stimulation-a computational modeling and portable neuroimaging methodological study. Cerebellum 2021. [PMID: 33675516 DOI: 10.1007/s12311-021-01249-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Feasibility of portable neuroimaging of cerebellar transcranial direct current stimulation (ctDCS) effects on the cerebral cortex has not been investigated vis-à-vis cerebellar lobular electric field strength. We studied functional near-infrared spectroscopy (fNIRS) in conjunction with electroencephalography (EEG) to measure changes in the brain activation at the prefrontal cortex (PFC) and the sensorimotor cortex (SMC) following ctDCS as well as virtual reality-based balance training (VBaT) before and after ctDCS treatment in 12 hemiparetic chronic stroke survivors. We performed general linear modeling (GLM) that putatively associated the lobular electric field strength with the changes in the fNIRS-EEG measures at the ipsilesional and contra-lesional PFC and SMC. Here, fNIRS-EEG measures were found in the latent space from canonical correlation analysis (CCA) between the changes in total hemoglobin (tHb) concentrations (0.01-0.07Hz and 0.07-0.13Hz bands) and log10-transformed EEG bandpower within 1-45 Hz where significant (Wilks' lambda>0.95) canonical correlations were found only for the 0.07-0.13-Hz band. Also, the first principal component (97.5% variance accounted for) of the mean lobular electric field strength was a good predictor of the latent variables of oxy-hemoglobin (O2Hb) concentrations and log10-transformed EEG bandpower. GLM also provided insights into non-responders to ctDCS who also performed poorly in the VBaT due to ideomotor apraxia. Future studies should investigate fNIRS-EEG joint-imaging in a larger cohort to identify non-responders based on GLM fitting to the fNIRS-EEG data.
Collapse
|
167
|
Ramaswamy S, Rosso M, Levine SR. Body Lateropulsion in Stroke: Case Report and Systematic Review of Stroke Topography and Outcome. J Stroke Cerebrovasc Dis 2021; 30:105680. [PMID: 33652344 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Body lateropulsion (BLP) is seen in neurological lesions involving the pathways responsible for body position and verticality. We report a case of isolated body lateropulsion (iBLP) as the presentation of lateral medullary infarction and conducted a systematic literature review. METHODS MEDLINE and EMBASE databases were searched up to December 3, 2020. INCLUSION CRITERIA age ≥ 18, presence of BLP, confirmed stroke on imaging. EXCLUSION CRITERIA age < 18, qualitative reviews, studies with inadequate patient data. Statistical analysis was performed using IBM® SPSS® Statistics 20. RESULTS A 64-year-old man presented with acute-onset iBLP. Brain MRI demonstrated acute infarction in the right caudolateral medulla. His symptoms progressed with ipsilateral Horner syndrome over the next 24 hours and contralateral hemisensory loss 10 days later. Repeat MRI showed an increase in infarct size. BLP resolved partially at discharge. Systematic review: 418 abstracts were screened; 59 studies were selected reporting 103 patients. Thirty-three patients had iBLP (32%). BLP was ipsilateral to stroke in 70 (68%) and contralateral in 32 (32%). The most common stroke locations were medulla (n = 63, 59%), pons (n = 16, 15%), and cerebellum (n = 16, 15%). Four strokes were cortical, 3 frontal and 1 temporoparietal (3%). The most common etiology was large-artery atherosclerosis (LAA) in 20 patients (32%), followed by small-vessel occlusion in 12 (19%). Seventeen (27%) had large-vessel occlusion (LVO), 12 involving the vertebral artery. Sixty (98%) had some degree of resolution of BLP; complete in 41 (70%). Median time-to-resolution was 14 days (IQR 10-21). There was no relationship between time-to-resolution and age, sex, side of BLP or side of stroke. CONCLUSION BLP was commonly seen with medullary infarction and was the isolated finding in one-third. LAA and LVO were the most common etiologies. Recovery of BLP was early and complete in most cases.
Collapse
Affiliation(s)
- Srinath Ramaswamy
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
| | - Michela Rosso
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
| | - Steven R Levine
- Departments of Neurology and Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; Jaffe Stroke Center, Maimonides Medical Center, Brooklyn, NY 11219, USA; Department of Neurology, King's County Hospital Center, Brooklyn, NY 11203, USA.
| |
Collapse
|
168
|
Domínguez-Navarro F, Silvestre-Muñoz A, Igual-Camacho C, Díaz-Díaz B, Torrella JV, Rodrigo J, Payá-Rubio A, Roig-Casasús S, Blasco JM. A randomized controlled trial assessing the effects of preoperative strengthening plus balance training on balance and functional outcome up to 1 year following total knee replacement. Knee Surg Sports Traumatol Arthrosc 2021; 29:838-48. [PMID: 32342139 DOI: 10.1007/s00167-020-06029-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the effects of including balance training in a preoperative strengthening intervention on balance and functional outcomes in patients undergoing total knee replacement (TKR) and compare these effects to those induced by preoperative strengthening and no intervention. METHODS Eighty-two subjects scheduled for TKR were randomly allocated into the strengthening (ST, n = 28) group: a preoperative lower limb strengthening intervention; the strengthening + balance (ST + B, n = 28) group: same intervention augmented with balance training; and the control group (n = 26). The Berg Balance Scale (BBS) and the function in daily living subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL) were the primary outcomes. The secondary measures included balance and mobility, self-reported status, and knee function. The outcomes were assessed at baseline, 1 week before surgery, and 2, (primary endpoint), 6 and 52 weeks after surgery. RESULTS Compared with the controls, the participants in the ST and ST + B groups presented significant improvements from baseline to the end of the preoperative intervention in BBS (p = 0.005) and KOOS-ADL (p < 0.001). At 6 weeks post-surgery, the knee extensor strength values were similar in the two treatment groups and significantly higher than that in the controls. Overall, the participant outcomes in all groups stabilized at 1 year after surgery. CONCLUSION A preoperative strengthening intervention, regardless of whether it is complemented with balance training, enhances strength but not balance or functional outcomes at 6 weeks after surgery. Patients are expected to present similar performance at 1 year postoperatively, but adequately statistically powered trials are needed to confirm the findings. LEVEL OF EVIDENCE II. TRIAL REGISTRATION NCT02995668.
Collapse
|
169
|
Yi L, Houwei L, Lin W, Lihua Z, Mengjie C, Sun W, Zejiang R, Qichao M. Evaluation of correlation between sagittal balance and plantar pressure distributions in adolescent idiopathic scoliosis: A pilot study. Clin Biomech (Bristol, Avon) 2021; 83:105308. [PMID: 33662651 DOI: 10.1016/j.clinbiomech.2021.105308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate the correlation between baropodometric parameters and sagittal parameters for adolescent idiopathic scoliosis. METHODS 44 volunteers (7 males and 37 females) were recruited. All participants were diagnosed as adolescent idiopathic scoliosis by X-ray before baropodometric study. Sagittal parameters included thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence. A static baropodometry was performed for each patient. The foot area was divided into four quadrants. The contact surface and weight percentage were measured. FINDINGS Lumbar lordosis was positively correlated to pelvic incidence, sacral slope and (P < 0.001, P < 0.001, respectively). On the major curve side, pelvic tilt showed a positive correlation with all baropodometric parameters (P < 0.05) except forefoot weight percentage. Thoracic kyphosis showed negative correlations with contact surface and weight percentage of the forefoot (P = 0.04, 0.02 respectively) but no correlation with any rearfoot feature. Lumbar lordosis, sagittal vertical axis, pelvic incidence and sacral slope were not in correlation with plantar pressure. On the opposite side, sagittal profile showed no obvious correlation with any baropodometric parameter. INTERPRETATION In scoliosis, sagittal balance is closely correlated to plantar pressure distributions. Baropodometry is a feasible method to assess sagittal balance.
Collapse
Affiliation(s)
- Luo Yi
- Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Lin Houwei
- Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, PR China
| | - Wang Lin
- Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhao Lihua
- Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Chen Mengjie
- Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Wang Sun
- Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Rao Zejiang
- Shanghai JunCheng Orthopaedic Rehabilitation Center, Shanghai, PR China
| | - Ma Qichao
- Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China.
| |
Collapse
|
170
|
Keklicek H, Sermenli Aydin N, Can HB, Dönmez Aydin D, Yilmazer Kayatekin AZ, Uluçam E. Primary dysmenorrhea and postural control: Is it a problem only during menstruation? Gait Posture 2021; 85:88-95. [PMID: 33517042 DOI: 10.1016/j.gaitpost.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effects of the menstrual cycle and primary dysmenorrhea (PD) on phase-related cognitive and physical functions are controversial. This study was carried out to examine whether women with PD showed a different physical function or dual-tasking response than women without PD at times other than menstruation. METHODS Women with or without PD were recruited for the study. Individuals assessed on the first day of the menstruation and the day they reported themselves as well being (feeling good day-FGD). Zebris © FDM Type Force Platform was used to evaluate postural stability. Individuals have were asked to perform to a 3-step balance test protocol; the first session: comfortable upright standing; the second session: standing with a motor task; the third session: standing with a cognitive task (counting backward). Correctly calculated numbers were also recorded. RESULTS The number of correct answers given by individuals during the cognitive dual-task was similar on the first day of menstruation and FGD (p > 0.05). In the control group, no difference was observed between the first days of menstruation and the evaluations on FGD days with dual-task (p > 0.05). In individuals with PD, there was no difference between the measurements at different times (p > 0.05). However, in the assessment with the motor dual-task on the first day of menstruation; postural sway increased (p < 0,05). In FDG measurement; distortion in postural stability was observed with the cognitive task (p < 0,05). In the assessments performed on the first day of menstruation, there was no difference in any parameters between the groups (p > 0.05). In the measurements made on FGD day with the cognitive task; there was a difference between the groups (p < 0,05). Individuals with PD had higher postural sway. SIGNIFICANCE This study showed that the primary dysmenorrhea is not only a problem for females during menstruation, primary dysmenorrhea causes impaired ability of the individual to perform dual-tasking and continuously affects postural stability.
Collapse
Affiliation(s)
- Hilal Keklicek
- Department of Physical Therapy and Rehabilitation, Trakya University, Faculty of Health Science, 22030 Edirne, Turkey.
| | - Nimet Sermenli Aydin
- Department of Physical Therapy and Rehabilitation, Trakya University, Faculty of Health Science, 22030 Edirne, Turkey; Department of Physical Therapy and Rehabilitation, Marmara University, Faculty of Health Science, 34854 İstanbul, Turkey.
| | - Hilal Başak Can
- Department of Physical Therapy and Rehabilitation, Trakya University, Faculty of Health Science, 22030 Edirne, Turkey; Department of Physical Therapy and Rehabilitation, Marmara University, Faculty of Health Science, 34854 İstanbul, Turkey.
| | - Didem Dönmez Aydin
- Department of Anatomy, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey.
| | - Ayşe Zeynep Yilmazer Kayatekin
- Department of Anatomy, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey; Department of Anatomy, Zonguldak Bülent Ecevit University Faculty of Medicine, 67600 Zonguldak, Turkey.
| | - Enis Uluçam
- Department of Anatomy, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey.
| |
Collapse
|
171
|
Habib Perez O, Chan K, Unger J, Lee JW, Masani K, Musselman KE. Characterizing inter-limb synchronization after incomplete spinal cord injury: A cross-sectional study. Gait Posture 2021; 85:191-197. [PMID: 33610130 DOI: 10.1016/j.gaitpost.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury (iSCI) demonstrate greater postural sway and increased dependency on vision to maintain balance compared to able-bodied individuals. Research on standing balance after iSCI has focused on the joint contribution of the lower limbs; however, inter-limb synchrony in quiet standing is a sensitive measure of individual limb contributions to standing balance control in other neurological populations. It is unknown if and how reduced inter-limb synchrony contributes to the poor standing balance of individuals with iSCI. RESEARCH QUESTION How does an iSCI affect inter-limb synchrony and weight-bearing symmetry in standing? METHODS Eighteen individuals with non-progressive motor iSCI and 15 age- and sex-matched able-bodied individuals (M-AB) were included in the study. Participants stood in a standardized position on two adjacent force plates in eyes open and closed conditions for 70 s per condition. Net centre-of-pressure (COP) root mean square (RMS), net COP velocity, COP inter-limb synchrony (i.e. cross-correlation between left and right COP), and weight-bearing asymmetry (i.e. vertical force from each limb over total vertical force) were calculated. Muscle strength of the lower limbs was assessed with manual muscle testing. RESULTS Individuals with iSCI demonstrated reduced inter-limb synchrony when standing with eyes open and eyes closed, but did not differ to M-AB with respect to weight-bearing asymmetry. They also produced greater net COP RMS and velocity when compared to M-AB. Muscle strength of the two lower limbs demonstrated an overall asymmetry in individuals with iSCI. SIGNIFICANCE Individuals with iSCI demonstrated impaired balance control as evidenced by reduced inter-limb synchrony and greater COP RMS and velocity compared to M-AB individuals. This increased understanding of how balance control is impaired following iSCI may inform balance assessment and intervention for this population. Future work examining the association between inter-limb synchrony and the occurrence of falls in iSCI is warranted.
Collapse
Affiliation(s)
- Olinda Habib Perez
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada
| | - Katherine Chan
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada
| | - Janelle Unger
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Jae W Lee
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Institute of Biomaterials & Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Kei Masani
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Institute of Biomaterials & Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
| |
Collapse
|
172
|
Maden T, Bayramlar K, Maden C, Yakut Y. Investigating the effects of appropriate fitting footwear on functional performance level, balance and fear of falling in older adults: A comparative-observational study. Geriatr Nurs 2021; 42:331-335. [PMID: 33561615 DOI: 10.1016/j.gerinurse.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
The aim of the study was to assess the characteristics of footwear altogether and to compare the effect of appropriate-fitting and ill-fitting footwear on functional performance, balance, and fear of falling (FoF) in older adults. Individuals who wore appropriate-fitting (n = 61) or ill-fitting footwear (n = 92) were enrolled in the study. Footwear was evaluated using the Footwear Assessment Scale (FAS). The participants were assessed using the Berg Balance Scale (BBS) for balance, the Timed Up and Go test for functional performance and the Activities-specific Balance Confidence scale for FoF. Tests were conducted twice for each individual with or without footwear. Differences between the groups were analyzed using the MANOVA for scores of balance, performance and fear of falling and Chi-squared test for homogeneity. The Paired t-test was used to compare test scores with or without footwear. It was concluded that appropriate-fitting footwear improves balance, reduces fear of falling and may affect functional performance positively. ClinicalTrials.gov No: NCT04151654.
Collapse
Affiliation(s)
- Tuba Maden
- Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey.
| | - Kezban Bayramlar
- Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey.
| | - Cagtay Maden
- Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey.
| | - Yavuz Yakut
- Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey.
| |
Collapse
|
173
|
Steinberg N, Tenenbaum S, Zeev A, Pantanowitz M, Waddington G, Dar G, Siev-Ner I. Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers. BMC Musculoskelet Disord 2021; 22:161. [PMID: 33563260 PMCID: PMC7874653 DOI: 10.1186/s12891-021-04023-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Many young girls with generalized joint hypermobility (GJH) choose to participate in dance because their bodies are suited for this activity. Scoliosis tends to occur often in thin girls, who also are more likely to choose dance. Both anomalies (GJH and scoliosis) may be related to reduced abilities such as diminished strength and insufficient postural balance, with increased risk for musculoskeletal conditions. The main objectives of the present study were to determine the prevalence of dancers with GJH, the prevalence of dancers with scoliosis, and the prevalence of dancers with these two anomalies; and, to determine differences in physical abilities and the presence of patellofemoral pain (PFP) between young female dancers with and without such anomalies. Methods One hundred thirty-two female dancers, aged 12–14 years, were assessed for anthropometric parameters, GJH, scoliosis, knee muscle strength, postural balance, proprioception ability, and PFP. Results GJH was identified in 54 dancers (40.9%) and scoliosis in 38 dancers (28.8%). Significant differences were found in the proportion of dancers with no anomalies (74 dancers, 56.1%) and dancers with both anomalies (34 dancers, 25.8%) (p < .001). Dancers with both anomalies had reduced dynamic postural balance in the anterior direction (p = .023), reduced proprioception ability (p < .001), and weaker knee extensors (p = .036) and flexors (p = .040) compared with dancers with no anomalies. Among dancers with both anomalies, 73.5% suffered bilateral PFP, 17.6% suffered unilateral PFP, and 8.8% had no PFP (p < .001). Conclusions A high prevalence of young girls participating in dance classes had GJH, as the increased joint flexibility probably provides them with some esthetic advantages. The high prevalence of scoliosis found in these young dancers might be attributed to their relatively low body mass, their delayed maturation, and the selection process of dancers. Dancers with both GJH and scoliosis had decreased muscle strength, reduced postural balance, reduced proprioception, with higher risk of PFP. The main clinical implications are the need to reduce the risk of PFP among dancers by developing appropriate strength and stabilizing exercises combined with proprioceptive and postural balance training, to improve the correct alignment of the hyperextended and hypermobile joints, and to improve their supporting muscle strength.
Collapse
Affiliation(s)
- Nili Steinberg
- Anatomy Laboratory, The Academic College at Wingate, Wingate Institute, Netanya, Israel.
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Zeev
- Anatomy Laboratory, The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | - Michal Pantanowitz
- Anatomy Laboratory, The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | | | - Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare & Health Studies, University of Haifa, Haifa, Israel
| | - Itzhak Siev-Ner
- Orthopedic Rehabilitation Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|
174
|
Van Ooteghem K, Mansfield A, Inness EL, Killingbeck J, Sibley KM. Integrating Technology Into Clinical Practice for the Assessment of Balance and Mobility: Perspectives of Exercise Professionals Practicing in Retirement and Long-term Care. Arch Rehabil Res Clin Transl 2020; 2:100041. [PMID: 33543070 DOI: 10.1016/j.arrct.2020.100041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To explore exercise professionals’ perspectives on technology integration for balance and mobility assessment practices in retirement and long-term care. Setting A private residential care organization in Ontario, Canada, with 18 sites providing accommodation and services for older adults. Design A qualitative descriptive approach was used including semistructured focus group interviews. Open-ended questions explored perceptions of technology integration along with factors influencing its adoption. Analysis involved preliminary coding based on research questions, review and discussion of emerging themes, and final, resultant coding for each category. Participants Exercise professionals (kinesiologists and exercise therapists) (N=18). Interventions Not applicable. Main Outcome Measures Not applicable. Results All participants felt that technology could enhance their practice by supporting programming, communication, and/or information management. Potential barriers to technology integration related primarily to the need to accommodate the broad range of complex health conditions present among clients, which would impact (1) their ability to engage with the technology and (2) relevance of technology-derived outcomes. Specific concerns related to individuals with significant cognitive and/or functional impairment. Solutions to these barriers emphasized the need for flexible technology and appropriate normative data to maximize the potential for uptake. Conclusions The participating exercise professionals working in a retirement and long-term care setting saw technology as a potentially effective addition to current clinical practice. To increase the likelihood for clinical uptake, technology must be maximize flexibility in order to accommodate a wide range of physical and cognitive abilities and meet specific needs related to setting and job responsibilities. The findings emphasize the need for continuous dialogue between technology producers and end users for successful development and implementation.
Collapse
|
175
|
Shao S, Maruyama H. Testing the Validity of the Diamond Steps Test for Balance in Healthy Adults. Arch Rehabil Res Clin Transl 2021; 2:100091. [PMID: 33543113 PMCID: PMC7853401 DOI: 10.1016/j.arrct.2020.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives To test the validity of the Diamond Steps Test (DST), a new test to assess balance. Design This cross-sectional study evaluated the validity of the DST, a brief new balance assessment tool. Setting The implementation site was the rehabilitation center of a hospital. Data collection was conducted from February to June 2017. Participants Healthy adults (N=65) between the ages of 40 and 72 years who volunteered to participate. Interventions Not applicable. Main Outcome Measures Two measures were used to assess DST: the time required to step around the diamond 5 times (5-DS) and the time required to step around the diamond twice, once using the dominant foot and the other using the non-dominant foot (LRDS). Results Multiple regression analysis was performed for each of the 2 methods for measuring DST. Five variables were predictive of DST as measured by the 5-DS test: the 10-Second Open Close Stepping Test, timed Up and Go (TUG) test, Y Balance Test (YBT) posterolateral reach for the left leg, Standing on One Leg with Eyes Closed (SOLEC) test for the right leg, and sex. The coefficient of determination was 0.54. For DST measured by the LRDS, 4 variables were found to be predictive: the 30-Second Chair Stand Test, YBT posterolateral reach for the left leg, TUG, and SOLEC for the right leg. The coefficient of determination was 0.49. Conclusion The DST was shown to assess 7 of the 9 components of balance (static stability, functional stability limits, underlying motor systems, anticipatory posture control, dynamic stability, reactive postural control, and sensory integration), suggesting that it is a valid test to use for balance assessment. We evaluated the validity of a new balance assessment tool, the Diamond Steps Test (DST). The DST was found to assess 7 of the 9 components of balance. Most components of balance can be quickly assessed using the DST. Time to step around the diamond 5 times is a valid method to assess the DST.
Collapse
Key Words
- 5-DS, time required to step around the diamond 5 times
- BESTest, Balance Evaluation Systems Test
- CS-30, 30-second Chair Stand Test
- DS, diamond steps
- DST, Diamond Steps Test
- Healthy aging
- LRDS, the time it takes to walk the diamond twice, one time starting with the dominant foot (right) and the other time starting with the non-dominant foot (left)
- OCS-10, 10-second Open-Close Stepping Test
- Postural balance
- Rehabilitation
- SOLEC, Standing on One Leg with Eyes Closed
- TUG, timed Up and Go test
- YBT, Y Balance Test
- YPLL, Y Balance Test, posterolateral Left
Collapse
Affiliation(s)
- Shuangyan Shao
- Tochigi Medical Association Shiobara Onsen Hospital Rehabilitation Center, 1333 Nasushiobara Japan
| | - Hitoshi Maruyama
- Fukuoka International University of Health and Welfare, Fukuoka, Japan
| |
Collapse
|
176
|
Olsson K, Franzén E, Johansson A. A Pilot Study of the Feasibility and Effects of Table Tennis Training in Parkinson Disease. Arch Rehabil Res Clin Transl 2021; 2:100064. [PMID: 33543090 PMCID: PMC7853352 DOI: 10.1016/j.arrct.2020.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective To investigate feasibility and effects of table tennis training on balance control and physical function in individuals with Parkinson disease. Design Single group, observational, before-after trial. Setting Table tennis training in a gymnasium. Participants Community-dwelling individuals with Parkinson disease (N=9; 5 men, 4 women) with an average age of 66.9 years, average time since diagnosis of 8.6 years, and a modified Hoehn and Yahr score between 2 and 2.5 participated in this study. Participants were recruited via newspaper advertisement, at the patient organization, and at the university hospital outpatient clinic. Eight participants completed the study. One participant withdrew for logistical reasons. Interventions Group training program consisting of 2 table tennis training sessions per week (120min each) for 10 weeks. Main Outcome Measures The primary outcome was feasibility, including attendance rate, drop-out rate, a final questionnaire assessing the participants' experience during the intervention, and any adverse events. The primary effect outcome was the Mini Balance Evaluation Systems Test (Mini-BESTest). Secondary effect outcomes were Parkinson's disease questionnaire-8, European quality of life questionnaire, Montgomery Åsberg Depression Rating Scale (MADRS), Unified Parkinson's Disease Rating Scale, 10-meter walk test, generic walking scale, activities-specific balance confidence scale, and physical activity measured with an accelerometer and the Frändin-Grimby scale. Results The average attendance rate was 84%. There were no adverse events reported. The participants reported that the training improved well-being. The mean total score on the Mini-BESTest before and after intervention was 21.2 versus 23.3 (P=.093). Statistically significant positive effects without adjustment for multiple comparisons were found for MADRS and the Frändin-Grimby scale. Conclusions This study demonstrates that table tennis training is safe and feasible, and may have the potential to improve balance control, mental well-being, and self-reported physical activity level. Further studies are required before table tennis can be considered an evidence-based recommendation for individuals with Parkinson disease.
Collapse
Affiliation(s)
- Karin Olsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Johansson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
177
|
Malaya CA, Haworth J, Pohlman KA, Smith DL. Immediate impact of extremity manipulation on dual task performance: a randomized, crossover clinical trial. Chiropr Man Therap 2021; 29:6. [PMID: 33541378 PMCID: PMC7863424 DOI: 10.1186/s12998-021-00366-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research demonstrated that manipulation of the extremities was associated with changes in multisegmental postural sway as well as improvement in a lower extremity balancing task. We were interested if these effects would extend to an upper extremity task. Our aim in this study was to investigate whether extremity manipulation could influence dual task performance where the explicit suprapostural task was balancing a water filled tube in the frontal plane. METHODS Participants were healthy volunteers (aged 21-32 years). Upper- or lower-extremity manipulations were delivered in a participant and assessor blinded, randomized crossover, clinical trial. Postural (center of pressure) and suprapostural (tube motion) measurements in the frontal plane were made pre-post manipulation under eyes open and eyes closed conditions using a BTrackS™ force plate and a Shimmer inertial measurement unit, respectively. Pathlength, range, root mean square and sample entropy were calculated to describe each signal during the dual task performance. RESULTS There was no main effect of manipulation or vision for the suprapostural task (tube motion). However, follow-up to interaction effects indicates that roll pathlength, range and root means square of tube motion all decreased (improvement) following lower extremity manipulation with eyes open. Regarding the postural task, there was a main effect of manipulation on mediolateral center of pressure such that pathlength reduced with both upper and lower extremity manipulation with larger decreases in pathlength values following upper extremity manipulation. CONCLUSION Our findings show that manipulation of the extremities enhanced stability (e.g. tube stabilization and standing balance) on performance of a dual task. This furthers the argument that site-specific manipulations influence context specific motor behavior/coordination. However, as this study focused only on the immediate effects of extremity manipulation, caution is urged in generalizing these results to longer time frames until more work has been done examining the length of time these effects last. TRIAL REGISTRATION Clinicaltrials.gov , NCT03877367 , Registered 15 March 2019. Data collection took place July 2019.
Collapse
Affiliation(s)
- Christopher A Malaya
- Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA. .,Research Center, Parker University, Dallas, TX, USA.
| | - Joshua Haworth
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | | | - Dean L Smith
- Department of Kinesiology and Health, Miami University, Oxford, Ohio, USA.,Essence of Wellness Chiropractic Center, Eaton, OH, USA
| |
Collapse
|
178
|
Landers MR, Jacobson KM, Matsunami NE, McCarl HE, Regis MT, Longhurst JK. A vicious cycle of fear of falling avoidance behavior in Parkinson's disease: A path analysis. Clin Park Relat Disord 2021; 4:100089. [PMID: 34316667 PMCID: PMC8299987 DOI: 10.1016/j.prdoa.2021.100089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postural instability (PI) in Parkinson's disease (PD) is associated with several negative downstream consequences. OBJECTIVE The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance confidence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. METHODS A path analysis of cross-sectional data from 55 participants with PD was conducted. The four constructs in the model connected in succession were: 1. PI (principal components analysis (PCA) composite of the Unified Parkinson's Disease Rating Scale PI and Gait Difficulty score, Timed Up and Go test, and Berg Balance Scale); 2. balance confidence (Activities-Specific Balance Confidence Scale); 3. FOF avoidance behavior (PCA composite of the FOF Avoidance Behavior Questionnaire and average number of steps per day); and, 4. physical conditioning (2-Minute Step Test). RESULTS The path model was an excellent fit to the data, χ2 (7) = 7.910, p = .341, CFI = 0.985, TLI = 0.968, RMSEA = 0.049 (90% CI: 0.000 to 0.179). The moderate to strong and uniformly significant parameter estimates were -0.519, -0.651, -0.653, and -0.570, respectively (ps < 0.01). CONCLUSIONS PI directly and inversely predicted balance confidence, which in turn directly and inversely predicted FOF avoidance behavior. Furthermore, FOF avoidance behavior directly and inversely predicted physical conditioning, which directly and inversely predicted PI, thereby closing the cycle. These findings highlight the downstream consequences of PI in PD and support the notion of a vicious cycle of FOF avoidance behavior.
Collapse
Affiliation(s)
| | | | | | | | | | - Jason K. Longhurst
- University of Nevada, Las Vegas, United States
- Cleveland Clinic Lou Ruvo Center for Brain Health
| |
Collapse
|
179
|
Mansano Pletsch AH, de Souza Borges NC, Villar DM, Franzini Sutilo AL, de Oliveira Guirro EC, de Paula FJA, de Jesus Guirro RR. Does sensorimotor training influence neuromuscular responses, balance, and quality of life in diabetics without a history of diabetic distal polyneuropathy? J Bodyw Mov Ther 2021; 27:148-56. [PMID: 34391226 DOI: 10.1016/j.jbmt.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/31/2020] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effect of supervised and home sensorimotor training on static postural balance (SPB), quality of life (QL), and neuromuscular responses of Type 2 Diabetics (DM-2). DESIGN Randomized controlled blind study with DM-2 patients, between 45 and 64 years old, of both sexes, divided into 3 groups: Control Group - CG (n = 27), Home Training Group - HTG (n = 27), and Supervised Training Group - STG (n = 26). The subjects were evaluated before and at the end of 3 months of treatment, with a four-week follow-up. The intervention was held twice a week, for 45 min, divided into three phases: warm-up, sensorimotor training, and cool-down. The primary outcome was SPB, using the force platform. Secondary outcome: questionnaires and clinical measures related to diabetic foot and knee flexor-extensors using isokinetic dynamometry. RESULTS In the baseline, the characteristics were similar between groups and between times. Tactile and vibratory sensitivity demonstrated the absence of symptoms of peripheral neuropathy in diabetic patients. In the intra-group comparison, there was a significant increase in the classification without symptoms of diabetic distal polyneuropathy in the HTG and STG groups (p < 0.05) and there were no significant effects on other clinical outcomes and QL and SPB, muscle strength, and sense of knee joint position. CONCLUSION The intervention showed no improvement in SPB, QL, and other clinical outcomes of DM-2 patients. Thus, no differences were found between the groups, considering that the patients did not present clinical characteristics of diabetic distal polyneuropathy.
Collapse
|
180
|
Park JH, Kia K, Srinivasan D, Kim JH. Postural balance effects from exposure to multi-axial whole-body vibration in mining vehicle operation. Appl Ergon 2021; 91:103307. [PMID: 33202332 DOI: 10.1016/j.apergo.2020.103307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Twenty participants (18 males and 2 females) completed postural stability assessments before and after 4-h exposure to whole body vibration (WBV) in four experimental conditions: (a) vertical-dominant WBV with vertical passive air suspension, (b) multi-axial WBV with vertical passive air suspension, (c) multi-axial WBV with multi-axial active suspension, and (d) no WBV condition. Center of pressure (COP)-based postural sway measures significantly increased following multi-axial WBV exposure. Increase in COP velocity and displacement following multi-axial WBV was significantly higher than the increase in all the other exposure conditions. However, no significant differences between the WBV conditions were observed in functional limits of stability and anticipatory postural adjustments. While our results show standing balance to be impaired following the multi-axial WBV exposure of off-road mining vehicles, dynamic stability across a broader range of conditions needs to be understood to causally link postural stability decrements to increased fall-risks associated with off-road vehicle operators.
Collapse
Affiliation(s)
- Jang-Ho Park
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Kiana Kia
- School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, OR, USA
| | - Divya Srinivasan
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Jeong Ho Kim
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA.
| |
Collapse
|
181
|
Bertolini GN, de Alencar Silva BS, Dos Santos VR, de Anchieta Messias I, Ribeiro JPJ, Marini E, Gobbo LA. Are bioelectrical parameters and functionality associated with postural control in the elderly? Clin Biomech (Bristol, Avon) 2021; 82:105258. [PMID: 33454457 DOI: 10.1016/j.clinbiomech.2020.105258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/07/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alterations in bioimpedance parameters and postural control occur with aging and contribute to the increased risk of falls. The aim of this study was to evaluate the balance behavior in relation to bioimpedance and functionality. METHODS We evaluated 21 elderly (men: 77.3 ± 9.5 years; women: 74.2 ± 9.6 years). The balance in standing posture was measured by the movement of the pressure center in seven positions. Bioimpedance was defined by its parameters resistance, reactance and phase angle, and functionality through the Timed Up and Go Test and Short Physical Performance Battery. FINDINGS In the analysis of the mediolateral velocity at the positions feet separated with open and closed eyes, feet together with eyes closed and semi-tandem with eyes open on the platform, an inverse correlation between balance and bioimpedance variables were verified for all models, with a coefficient of determination varying between 20% and 74%. Inverse and significant correlations between reactance and phase angle in the one-legged-support position were verified, in all adjustment models, with coefficient of determination varying between 62% and 91%. In the analysis of mediolateral velocity for the semi-tandem eyes closed position, positive correlation with TUG and an inverse correlation with bioimpedance parameters and pennation angle were observed, with coefficient of determination varying between 21% and 67%. INTERPRETATION The postural control is linearly related to bioimpedance parameters and functionality in the elderly. The assessment of balance can provide important information and furnishes useful insights for prevention and treatment strategies in elderly.
Collapse
Affiliation(s)
- Giovana Navarro Bertolini
- Skeletal Muscle Assessment Laboratory, Department of Physcial Education, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil; Post-Graduation Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil.
| | - Bruna Spolador de Alencar Silva
- Skeletal Muscle Assessment Laboratory, Department of Physcial Education, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil; Post-Graduation Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Vanessa Ribeiro Dos Santos
- Skeletal Muscle Assessment Laboratory, Department of Physcial Education, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Iracimara de Anchieta Messias
- Department of Planning, Urban Planning and Environment, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | | | - Elisabetta Marini
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Luís Alberto Gobbo
- Skeletal Muscle Assessment Laboratory, Department of Physcial Education, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil; Post-Graduation Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil; Post-Graduation Program in Physical Therapy, School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| |
Collapse
|
182
|
Heidt C, Vrankovic M, Mendoza A, Hollander K, Dreher T, Rueger M. Simplified digital balance assessment in typically developing school children. Gait Posture 2021; 84:389-394. [PMID: 33485024 DOI: 10.1016/j.gaitpost.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/25/2020] [Accepted: 01/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural balance can be considered a conjoined parameter of gross motor performance. It is acquired in early childhood and honed until adolescence, but may also be influenced by various conditions. A simplified clinical assessment of balance and posture could be helpful in monitoring motor development or therapy particularly in pediatric patients. While analogue scales are considered unprecise and lab-based force-plate posturography lacks accessibility, we propose a novel kinematic balance assessment based on markerless 3D sensor technology. RESEARCH QUESTION Can balance and posture be assessed by tracking kinematic data using a single 3D motion tracking camera and are the results representative of normal motor development in a healthy pediatric cohort? METHODS A proprietary algorithm was developed and tested that uses skeletal data from the Microsoft Kinect™ V2 3D motion capture camera to calculate and track the center of mass in real time during a set of balance tasks. The algorithm tracks the distance of the COM traveled over time to calculate a balance score (COM speed). For this study, 432 school children aged 4-18 years performed 5 balance tasks and the resulting balance scores were analyzed and correlated with demographic data. RESULTS Preliminary experiments demonstrated that the system was able to reliably detect differences in COM speed during different balance tasks. The method showed moderate correlation with age and sex. Athletic activity positively correlated with balance skill in the age group < 8 years, but not in older children. Body mass appeared not to be correlated with balance ability. SIGNIFICANCE This study demonstrates that markerless 3D motion analysis can be used for the clinical assessment of coordination and balance and could potentially be used to monitor gross motor performance at the point-of-care.
Collapse
Affiliation(s)
- Christoph Heidt
- Department of Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland; Department of Pediatric Orthopaedics, University Children's Hospital Basel, Basel, Switzerland.
| | - Matia Vrankovic
- Department of Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | | | - Thomas Dreher
- Department of Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Matthias Rueger
- Department of Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Technical University of Munich, Munich, Germany
| |
Collapse
|
183
|
Dewar RM, Tucker K, Claus AP, Ware RS, Johnston LM. Postural Control Performance on the Functional Reach Test: Validity of the Kids-Balance Evaluation Systems Test (Kids-BESTest) Criteria. Arch Phys Med Rehabil 2021; 102:1170-9. [PMID: 33508337 DOI: 10.1016/j.apmr.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Evaluate the validity of the Kids-Balance Evaluation Systems Test (Kids-BESTest) clinical criteria for the Functional Reach Test (FRT) forward and lateral with laboratory measures of postural control in children with cerebral palsy (CP). DESIGN Psychometric study of face, concurrent, and content validity. SETTING Clinical laboratory. PARTICIPANTS Children (N=58) aged 7-18 years (ambulant CP n=17, typically developing [TD] n=41). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Stability limits in standing were assessed using the Kids-BESTest items for FRT forwards (FRTFORWARD), FRT lateral preferred (FRTLATERAL(P)), and FRT lateral nonpreferred (FRTLATERAL(NP)). Force platforms and kinematic markers were used to collect information on center of pressure (CoP) and joint movement during reach. Analyses included face validity (Kids-BESTest scores compared between CP and TD groups), concurrent validity (agreement between Kids-BESTest scores and digitally derived scores), and content validity (relations between Kids-BESTest scores with kinematic and CoP data). RESULTS Face validity of Kids-BESTest criteria was demonstrated with lower scores for CP compared to TD groups for FRTFORWARD (P<.001) and FRTLATERAL(NP) (P=.03) and equal scores for FRTLATERAL(P) (P=.12). For concurrent validity, agreement between Kids-BESTest scores and digitally derived scores was good to excellent for FRTLATERAL(both P/NP) (88%-100%) and good for FRTFORWARD (86%-88%) for both groups. For content validity, the CP group Kids-BESTest scores were correlated with CoP-RangeFORWARD during FRTFORWARD (ρ=0.68) and CoP-RangeLATERAL during FRTLATERAL(NP) (ρ=0.57). For kinematic data, correlations were moderate-high between Kids-BESTest scores and range of hip flexion (ρ=0.51) and ankle plantar flexion (ρ=0.75) during FRTFORWARD, and trunk lateral flexion (ρ=0.66) during FRTLATERAL(NP). CONCLUSION The FRTFORWARD demonstrated face, concurrent, and content validity. The FRTLATERAL(P/NP) demonstrated concurrent validity, but partial face and content validity. To improve validity of Kids-BESTest FRT criteria, additional descriptors have been added under the scoring criteria to enable clinicians to quantify observed reach strategies.
Collapse
|
184
|
Catalán Edo P, Serrano Ostariz E, Sánchez Latorre M, Villarroya Aparicio A. [Postural control in adults. Influence of age and aerobic training.]. Rev Esp Salud Publica 2021; 95:e202101025. [PMID: 33501924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The ability to control postural balance is essential to perform most of the activities of daily life, allowing you to maintain an active lifestyle, avoiding falls. However, aging-related changes in sensory systems, neural processing, information conduction, and musculoskeletal mechanics make postural control difficult in older adults. In the evaluation of posturo-graphic parameters, alterations are observed after physical exercise. The objective of this study focused on analyzing the possible influence of age on postural control in an adult population and comparing the differences in postural control due to the regular practice of aerobic physical activity. METHODS A cross-sectional study was carried out in 116 healthy adults, differentiating them between sedentary and sportsmen (cyclists and runners) and in two age groups (< and ≥ 65 years). Data were collected on the RMS amplitude (root-mean-square) in AP (antero-posterior) and ML (medio-lateral) and the RMS velocity obtained through a force platform in different support and vision conditions. SPSS 15.0 Software was used for the statistical treatment with a significance level of 5%. To compare the dependent variables between the different activity gropus, the t-test and the Mann-Witney were applied (p<0,05), while correlation análisys was applied to study the relationship of age in the postural parameters using p Pearson and Spearman test depending on the distribution of the data. RESULTS The results reaffirmed the negative influence of physiological aging on postural control mechanisms in the sedentary group, as well as a positive influence of the practice of aerobic exercise regardless of age, with an improvement in balance. More than half of the posturagraphic parameters (PP) were altered in sedentary subjects compared to athletes, who did not show alterations (p<0,05). The RMS-Velocity (mm/s) or distribution of displacement in standing over time, is the parameter with the greatest alteration in all the conditions analyzed (p<0,01), among sedentary subjects regardless of age, not suffering variations among athletes. In relation to the type of sport, we observed better results in cyclists compared to the sedentary group, with less alterations in all PP (RMS-ROM in AP, ML and RMS-Velocity) mainly for single-leg support on a hard surface and with eyes open as well as closed. CONCLUSIONS We can conclude that the practice of regular aerial exercise is a beneficial activity to improve postural control, preserve the deterioration of balance and prevent falls.
Collapse
Affiliation(s)
- Pilar Catalán Edo
- Hospital Obispo Polanco. Teruel. España
- Grupo de Investigación UNEVAF de la Universidad de Zaragoza. Zaragoza. España
| | - Enrique Serrano Ostariz
- Universidad de Zaragoza. Zaragoza. España
- Grupo de Investigación UNEVAF de la Universidad de Zaragoza. Zaragoza. España
| | | | | |
Collapse
|
185
|
Debenham MIB, Smuin JN, Grantham TDA, Ainslie PN, Dalton BH. Hypoxia and standing balance. Eur J Appl Physiol 2021; 121:993-1008. [PMID: 33484334 DOI: 10.1007/s00421-020-04581-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Standing balance control is important for everyday function and often goes unnoticed until impairments appear. Presently, more than 200 million people live at altitudes > 2500 m above sea level, and many others work at or travel to these elevations. Thus, it is important to understand how hypoxia alters balance owing to implications for occupations and travelers. Herein, the influence of normobaric and hypobaric hypoxia on standing balance control is reviewed and summarized. As postural control relies on the integration of sensorimotor signals, the potential hypoxic-sensitive neurophysiological factors that contribute to balance impairments are also reviewed. Specifically, we examine how hypoxia impairs visual, vestibular, and proprioceptive cues, and their integration within subcortical or cortical areas. METHODS This systematic review included a literature search conducted via multiple databases with keywords related to postural balance, hypoxia, and altitude. Articles (n = 13) were included if they met distinct criteria. RESULTS Compared to normoxia, normobaric hypoxia worsened parameters of standing balance by 2-10% and up to 83 and 240% in hypobaric hypoxia (high-altitude and lab-based, respectively). Although balance was only disrupted during normobaric hypoxia at FIO2 < ~ 0.15, impairments consistently occurred during hypobaric hypoxia at altitudes > 1524 m (~ FIO2 < 0.18). CONCLUSION Hypoxia, especially hypobaric, impairs standing balance. The mechanisms underpinning postural decrements likely involve alterations to processing and integration of sensorimotor signals within subcortical or cortical structures involving visual, vestibular, and proprioceptive pathways and subsequent motor commands that direct postural adjustments. Future studies are required to determine the sensorimotor factors that may influence balance control in hypoxia.
Collapse
Affiliation(s)
- Mathew I B Debenham
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, Canada
| | - Janelle N Smuin
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, Canada
| | - Tess D A Grantham
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, Canada
| | - Philip N Ainslie
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, Canada
| | - Brian H Dalton
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, Canada.
| |
Collapse
|
186
|
Strandkvist V, Larsson A, Pauelsen M, Nyberg L, Vikman I, Lindberg A, Gustafsson T, Röijezon U. Hand grip strength is strongly associated with lower limb strength but only weakly with postural control in community-dwelling older adults. Arch Gerontol Geriatr 2021; 94:104345. [PMID: 33497911 DOI: 10.1016/j.archger.2021.104345] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hand grip strength is frequently used as a measurement of muscle strength, especially among older adults. Muscle strength is only one of the many components in postural control and it is currently unclear to what extent hand grip strength is associated with postural control. The aim was to analyze the association between hand grip strength and lower limb muscle strength, and postural control among older adults. METHODS Forty-five community-dwelling individuals over 70 years of age provided isometric hand grip strength and lower limb strength (including hip extension and abduction, knee flexion and extension, and ankle dorsiflexion and plantarflexion), as well as postural control measurements. In the latter, center of pressure excursions were recorded for quiet stance and limits of stability tests on a force plate. Orthogonal projection of latent structures regression models were used to analyze associations between hand grip strength and lower limb strength as well as postural control, respectively. RESULTS Lower limb strength explained 74.4% of the variance in hand grip strength. All lower limb muscle groups were significantly associated with hand grip strength. In a corresponding model, postural control measured with center of pressure excursions explained 20.7% of the variance in a statistically significant, albeit weak, model. CONCLUSIONS These results support that hand grip strength is a valid method to estimate lower limb strength among older adults on a group level. However, strength measurements seem insufficient as a substitute for measuring postural control, and therefore specific balance tests are necessary.
Collapse
Affiliation(s)
- Viktor Strandkvist
- Department of Health Sciences, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden; Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine, Umeå University, Robertsviksgatan 9, 971 89 Luleå, Sweden.
| | - Agneta Larsson
- Department of Health Sciences, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden
| | - Mascha Pauelsen
- Department of Health Sciences, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden
| | - Lars Nyberg
- Department of Health Sciences, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden
| | - Irene Vikman
- Department of Health Sciences, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, division of Medicine, Umeå University, Robertsviksgatan 9, 971 89, Luleå, Sweden
| | - Thomas Gustafsson
- Department of Computer Science, Electrical and Space Engineering, Divison of Signals and Systems, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden
| | - Ulrik Röijezon
- Department of Health Sciences, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Laboratorievägen 14, 971 87 Luleå, Sweden
| |
Collapse
|
187
|
Brech GC, Machado-Lima A, Bastos MF, de Jesus Bonifácio W, Peterson MD, Takayama L, Pereira RMR, D'Andréa Greve JM, Alonso AC. Vitamin D supplementation associated with 12-weeks multimodal training in older women with low bone mineral density: A randomized double-blind placebo-controlled trial. Exp Gerontol 2021; 146:111211. [PMID: 33421538 DOI: 10.1016/j.exger.2020.111211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the influence of vitamin D supplementation with a multimodal exercise program on postural balance and muscle strength in older women with low bone mineral density (BMD) and vitamin D insufficiency. METHODS 12-week, randomized, double-blind, placebo-controlled clinical trial. Total of 422 subjects were screened for participation, and 46 met the inclusion criteria. Those were randomized into an experimental group (EG; n = 23) and control group (CG; n = 23). At the time of enrollment, all subjects had low BMD, vitamin D insufficiency, and were not practicing resistance exercise. Muscle strength assessments were performed by the 30-s sit to stand test; 15-steps climbing test; handgrip dynamometer and knee muscle strength using an isokinetic dynamometer at 60°/sec. Postural balance was clinically evaluated by the MiniBESTest and by a force platform. Dynamic balance was assessed by standing up from a chair and walk over a step, using also a force platform. RESULTS In the EG, vitamin D levels increased in the post-treatment period (P < 0.001) whereas in CG levels remained unchanged (P = 0.86). Both groups improved muscular strength in the dynamometry isokinetic test: flexors PT/BW - right (P < 0.02) and left side (P < 0.04). In the dynamic postural balance during the task to step up over: the Lift Up Left was better in the CG (P = 0.01); the Moment Time left was better in the CG (P = 0.01); the Impact index left was better in the EG (P = 0.01). The Mini-BESTest - both groups improved the postural balance test (P < 0.001). CONCLUSION Vitamin D supplementation associated with multimodal exercise program did not augment muscle strength adaptation or postural balance in older women with low bone mineral density and vitamin D insufficiency.
Collapse
|
188
|
Verbecque E, Johnson C, Rameckers E, Thijs A, van der Veer I, Meyns P, Smits-Engelsman B, Klingels K. Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis. Gait Posture 2021; 83:268-279. [PMID: 33227605 DOI: 10.1016/j.gaitpost.2020.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although it is recognized that the majority of children with developmental coordination disorder (DCD) have balance deficits, comprehensive insights into which balance domains are affected, are still lacking in literature. RESEARCH QUESTION To what extent is balance control deficient in individuals with DCD compared to controls? METHODS Pubmed, Scopus and Web of Science were systematically searched. Risk of bias was assessed with the Scottish Intercollegiate Guidelines Network checklist for case-control studies. Mean and standard deviations characterizing balance control were extracted to calculate standardized mean differences (SMD) and pooled, if possible, using Review Manager. RESULTS The results of 31 studies (1152 individuals with DCD, 1103 typically developing (TD) peers, mean age 10.4 years old) were extracted of which 17 were used for meta-analysis. The mean SMD for the balance subscale of the Movement Assessment Battery for Children was 1.63 (pooled 95 %CI =[1.30;1.97]), indicating children with DCD to perform significantly poorer than their TD peers. Force plate studies also revealed that children with DCD present with a larger sway path during bipedal stance with eyes closed (pooled mean SMD = 0.55; 95 %CI=[0.32;0.78]). Children with DCD tend to have direction-specific limited stability limits and task-independent delayed onset of anticipatory postural adjustments. INTERPRETATION Children with DCD perform poorer on different domains of balance compared to TD peers. Future research should focus on comprehensive balance assessment in these children, preferably using a longitudinal design.
Collapse
Affiliation(s)
- Evi Verbecque
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - Charlotte Johnson
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Eugène Rameckers
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; Department of Rehabilitation Medicine Maastricht University, Maastricht, the Netherlands; Center of Expertise Adelante Rehabilitation, Valkenburg, the Netherlands; AVANSplus, University for Professionals, Breda, the Netherlands
| | - Angelina Thijs
- Center of Development Advancement and Pediatric Neurorehabilitation of the Wildermeth Foundation, Biel/Bienne, Switzerland
| | - Ingrid van der Veer
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; AVANSplus, University for Professionals, Breda, the Netherlands
| | - Pieter Meyns
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University, Cape Town, South Africa
| | - Katrijn Klingels
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| |
Collapse
|
189
|
Latorre-Román PA, Martínez-Redondo M, Párraga-Montilla JA, Lucena-Zurita M, Manjón-Pozas D, González PJC, Robles-Fuentes A, Cardona-Linares AJ, Keating CJ, Salas-Sánchez J. Analysis of dynamic balance in preschool children through the balance beam test: A cross-sectional study providing reference values. Gait Posture 2021; 83:294-9. [PMID: 33246259 DOI: 10.1016/j.gaitpost.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND dynamic balance (DB) is a complex ability at an early age and balance deficits are related to numerous disorders. There are several balance measures but wide variation in their use has restricted the capacity to synthesise references values. The main purpose of this study was to analyse the performance of the Balance beam test (BBT) in preschool children, according to age and sex providing BBT reference values, and also to analyse its reliability and validity. RESEARCH QUESTION could the BBT be a reliable test for measuring dynamic balance in preschool children? METHODS 593 preschool children (3-6 years) participated in this study. The BBT was used to evaluate DB by measuring distance reached, time spent, and number of steps. Differences between sex and age groups were analysed using the Mann-Whitney U and Kruskal-Wallis tests. Test-retest reliability analysis was performed using intraclass correlation coefficients and the Bland-Altman graphic. Convergent validity was investigated with the Stork Balance stand test (SBST). RESULTS no significant differences were found for sex in any components of the BBT. Age had positive effects on BBT performance in distance (χ2 = 63.474, p < 0.001), time (χ2 = 46.441, p < 0.001), and step numbers (χ2 = 40.967, p < 0.001). Younger children performed more poorly than older children. No significant interactions between age groups and sex were found. The BBT showed adequate validity and reliability. SIGNIFICANCE the reference values established for Spanish preschool children in the current study could be used to monitor DB development. It is necessary to take into account distance reached, time spent, and the steps taken to obtain a more precise measure of DB in this population.
Collapse
|
190
|
Saumur TM, Mathur S, Nestico J, Perry SD, Mochizuki G, Mansfield A. Test-retest reliability of force plate-derived measures of reactive stepping. J Biomech 2021; 115:110185. [PMID: 33385871 DOI: 10.1016/j.jbiomech.2020.110185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/11/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022]
Abstract
Characterizing reactive stepping is important to describe the response's effectiveness. Timing of reactive step initiation, execution, and termination have been frequently reported to characterize reactive balance control. However, the test-retest reliabilities of these measures are unknown. Accordingly, the purpose of this study was to determine the between- and within-session test-retest reliabilities of various force plate-derived measures of reactive stepping. Nineteen young, healthy adults responded to 6 small (~8-10% of body weight) and 6 large perturbations (~13-15% of body weight) using an anterior lean-and-release system. Tests were conducted during two visits separated by at least two days. Participants were instructed to recover balance in as few steps as possible. Step onset, foot-off, swing, and restabilization times were extracted from force plates. Relative test-retest reliability was determined through intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs). Absolute test-retest reliability was assessed using the standard error of the measurement (SEM). Foot-off and swing times had the highest between- and within-session test-retest reliabilities regardless of perturbation size (between-session ICC = 0.898-0.942; within-session ICC = 0.455-0.753). Conversely, step onset and restabilization times had lower ICCs and wider CIs (between-session ICC = 0.495-0.825; within-session ICC = -0.040-0.174). Between-session test-retest reliability was higher (ICC = 0.495-0.942) for all measures than within-session test-retest reliability (ICC = -0.040-0.753). Time to restabilization had the highest SEM, indicating the worst absolute reliability of the measures. These findings suggest multiple baseline sessions are needed for measuring restabilization and step onset times. The minimal detectable changes reported provide an index for measuring meaningful change due to an intervention.
Collapse
|
191
|
Tramontano M, Consorti G, Morone G, Lunghi C. Vertigo and Balance Disorders - The Role of Osteopathic Manipulative Treatment: A Systematic Review. Complement Med Res 2020; 28:368-377. [PMID: 33361695 DOI: 10.1159/000512673] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Balance disorders are among the most frequent reasons for consultation and referral to specialist care. Osteopathic Manipulative Treatment (OMT) can influence the proprioceptive system by inducing alterations in the proprioceptive stimuli, hence affecting postural control. OBJECTIVE The present systematic review aimed to explore the effects of OMT in managing patients with vertigo and balance disorders. METHODS MEDLINE (PubMed), ScienceDirect, and Google Scholar were searched. Clinical trials and prospective observational studies were considered. Only studies that considered OMT as the main intervention, provided alone or combined with other interventions, were included. The methodological quality of the evidence was assessed with a modified version of the Newcastle-Ottawa Scale. RESULTS Five studies that enrolled a total of 114 subjects met our inclusion criteria. Overall, it has been observed that there is a positive effect on balance disorders through different outcomes in all of the included studies. Only two studies (9 subjects) mentioned low to moderate adverse events after OMT. CONCLUSIONS OMT showed weak positive effects on balance function, encouraging the connection of conventional medicine and evidence-based complementary medicine for integrative clinical practice and interprofessional work. However, full-sized adequately powered randomized trials are required to determine the effectiveness of OMT for vertigo and balance disorders.
Collapse
Affiliation(s)
| | - Giacomo Consorti
- Clinical-Based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy.,Educational Department of Osteopathy, Istituto Superiore Osteopatia, Milan, Italy
| | | | - Christian Lunghi
- Clinical-Based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy
| |
Collapse
|
192
|
Motealleh A, Sinaei E, Nouraddinifard E, Rezaei I. Comparison of postural control in older adults under different dual-task conditions: A cross-sectional study. J Bodyw Mov Ther 2020; 26:443-447. [PMID: 33992281 DOI: 10.1016/j.jbmt.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND and purpose: Performing a cognitive task while maintaining postural stability, known as "dual-task" condition, can increase the cognitive demand and reduce the postural control capacity. The inability to allocate attention to postural control under dual-task conditions may lead to balance impairments, particularly in older adults. The present study aimed to compare the effects of different dual-task conditions of backward counting (BC) and visual attention (VA) on older adults' postural balance performance. METHODS Twenty asymptomatic volunteers (mean age: 70.4 ± 4.1 years) were recruited. Participants stood on a foam surface placed over a force plate, and displacement and sway velocity of their center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions were recorded under three conditions: BC dual-task, VA dual-task (control of center of mass with a laser pointer), and quiet stance as the control task (CT). RESULTS Repeated measures ANOVA showed a significant difference in AP and ML sway velocities between conditions with p-values of 0.039 and 0.042, respectively. The LSD post-hoc test revealed that the BC task significantly increased AP sway velocity compared to the CT (p = 0.013), and the VA task significantly increased ML sway velocity compared to the CT (p = 0.034) and the BC tasks (p = 0.026). There were no statistically significant differences between conditions for ML (p = 0.058) and AP (p = 0.350) displacements and total sway velocity (p = 0.051). CONCLUSION Older adults' postural stability can be impaired under dual-task conditions and the present study revealed that various dual tasks increase postural sway in different directions.
Collapse
Affiliation(s)
- Alireza Motealleh
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ehsan Sinaei
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Iman Rezaei
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
193
|
Roostaei M, Raji P, Morone G, Razi B, Khademi-Kalantari K. The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies. J Bodyw Mov Ther 2020; 26:448-462. [PMID: 33992282 DOI: 10.1016/j.jbmt.2020.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 10/29/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
Dual-task conditions are commonly experienced in daily routines. The aim of the present systematic review is to investigate the effect of dual-task conditions on gait and balance performance in children with cerebral palsy (CP) and to perform meta-analyses where applicable. Five databases, "ProQuest", "PubMed", "OTSeeker", "Scopus", and "PEDro" from the incipient date of databases up to Aug 24, 2020 were searched for studies focusing on the effects of dual-task conditions on gait and balance performance in children with CP. After removing irrelevant articles and applying inclusion and exclusion criteria, nine articles were included in the present systematic review and meta-analysis. The results of the meta-analysis showed that walking speed was slower during dual-task conditions compared to single-task conditions in children with CP (WMD = -0.29 m/s, 95% CI = -0.34, -0.24, P ≤ 0.001) and walking speed decreased in children with CP during dual-task conditions in comparison with the typical development (TD) control group (WMD = -0.19 m/s, 95% CI = -0.23 to -0.15, P ≤ 0.001). The results of subgroup analysis based on the type of task indicated that adding concurrent tasks to walking degrades walking speed under varied dual-task conditions. Additionally, theoretical synthesis of the literature demonstrated that other gait and balance variables are changed by performing cognitive and motor secondary tasks differently. Although these changes may be compensatory strategies to retain their stability, there was not sufficient evidence to reach a firm conclusion. Research gaps and recommendations for future studies are discussed.
Collapse
Affiliation(s)
- Meysam Roostaei
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Bahman Razi
- Department of Hematology, School of Medicine, Tarbiat Modares University, Tehran, Iran.
| | - Khosro Khademi-Kalantari
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
194
|
Molina-Rueda F, Cuesta-Gómez A, Carratalá-Tejada M, Koutsou A, Fernández-González P, Alguacil-Diego IM. Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability. Phys Ther Sport 2020; 47:134-139. [PMID: 33278784 DOI: 10.1016/j.ptsp.2020.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study postural control and muscle activity during the limit of stability test (LOS) in subjects with chronic ankle instability. DESIGN Observational study. SETTING University laboratory. PARTICIPANTS 10 healthy subjects were included in the control group and 10 subjects in the CAI group (age between 18 and 30 years, with history of the multiple ankle "giving way" episodes in the last six months and score ≤24 in the Cumberland Ankle Instability Tool). MAIN OUTCOME MEASURES A computerized dynamic posturography equipment was used for assessing the LOS. The electromyography activity of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG) and peroneus longus (PL) was registered. RESULTS Subjects with CAI had a greater activation in TA to forward (p < .01), forward affected (p = .001), backward affected (p = .007) and backward directions (p < .01); in PL to forward affected (p < .01) and affected directions (p = .001); in MG to forward (p = .023) and affected directions (p < .01) and in SOL to the affected direction (p = .009). We observed restricted excursions and less directional control in subjects with CAI. CONCLUSIONS Subjects with CAI exhibited poorer ability to move their center of gravity within stability limits. In addition, they have an altered ankle muscle activity during LOS test toward the affected ankle joint.
Collapse
Affiliation(s)
- Francisco Molina-Rueda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Alicia Cuesta-Gómez
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
| | - María Carratalá-Tejada
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Aikaterini Koutsou
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Pilar Fernández-González
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Isabel María Alguacil-Diego
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Madrid, Spain; Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
195
|
Zéronian S, Noé F, Paillard T. Effect of the application of somatosensory and excitomotor electrical stimulation during quiet upright standing balance. Med Eng Phys 2020; 87:82-86. [PMID: 33461677 DOI: 10.1016/j.medengphy.2020.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 11/25/2022]
Abstract
Somatosensory (which activates sensory neurons only) and excitomotor (which activates both motoneurons and sensory neurons) electrical stimulations applied on the musculature of the lower-limb are likely to facilitate and disturb balance control respectively. The aim of this study was to compare the possible balance control modifications induced by somatosensory (SS) and excitomotor (EX) electrical stimulations applied on the quadriceps femoris in quiet standing condition. Kinetics and kinematics parameters were recorded with a force platform (displacements of center of foot pressure) and a 3D analysis system (hip, knee and ankle angles) respectively during a postural task. Twenty healthy young male participants carried out a monopedal postural task (i.e., unilateral stance) in three conditions: SS stimulation (1ms; 10Hz; 7±2 mA i.e., twice the intensity corresponding to the sensory threshold), EX stimulation (400 µs; 50 Hz; 20 ± 5 mA i.e., twice the intensity corresponding to the motor threshold), and a control (CONT) condition without stimulation. The results showed no significant differences between the three conditions except for the knee' angle which was higher in the EX condition (167.3±11.6 vs 164.3±5.8 and 163.9±8) (p < 0.005) than in the two other conditions (SS stimulation and CONT). This means that the EX stimulation induced a postural position change (i.e., a slight knee extension) during the monopedal postural task without altering balance control. Overall, on the basis of the stimulation parameters used in the present work, neither the SS stimulation, nor the EX stimulation facilitated or disturbed postural balance.
Collapse
Affiliation(s)
- Sacha Zéronian
- Université de Pau et des Pays de l'Adour, E2S UPPA, MEPS, Tarbes, France
| | - Frédéric Noé
- Université de Pau et des Pays de l'Adour, E2S UPPA, MEPS, Tarbes, France
| | - Thierry Paillard
- Université de Pau et des Pays de l'Adour, E2S UPPA, MEPS, Tarbes, France.
| |
Collapse
|
196
|
Pettersson B, Nordin E, Ramnemark A, Lundin-Olsson L. Proposals for continued research to determine older adults' falls risk. J Frailty Sarcopenia Falls 2020; 5:89-91. [PMID: 33283074 PMCID: PMC7711736 DOI: 10.22540/jfsf-05-089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves.
Collapse
Affiliation(s)
- Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Ellinor Nordin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Ramnemark
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
197
|
Picardi M, Redaelli V, Antoniotti P, Pintavalle G, Aristidou E, Sterpi I, Meloni M, Corbo M, Caronni A. Turning and sit-to-walk measures from the instrumented Timed Up and Go test return valid and responsive measures of dynamic balance in Parkinson's disease. Clin Biomech (Bristol, Avon) 2020; 80:105177. [PMID: 32979787 DOI: 10.1016/j.clinbiomech.2020.105177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/28/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Balance impairment is a hallmark of Parkinson's disease with dramatic effects for patients (e.g. falls). Its assessment is thus of paramount importance. The aim of this work is to assess which measures from the instrumented Timed Up and Go test (recorded with inertial sensors) are valid balance measures in Parkinson's disease and evaluate their responsiveness to rehabilitation. METHODS The Mini-BESTest (a criterion-standard balance measure) and the instrumented Timed Up and Go test (with inertial sensors secured to the trunk) were administered to 20 Parkinson's disease patients before and after inpatient rehabilitation (median [IQR]; 76.5 [8.25] years; 5 females; Hoehn and Yahr stage: 2.5 [0.5]). 81 parameters from the instrumented Timed Up and Go test were evaluated. Multiple factor analysis (a variant of principal component analysis for repeated measurements) and effect sizes were used to assess validity and responsiveness, respectively. FINDINGS Only the first component of the multiple factor analysis correlated with the Mini-BESTest, and 21 measures from the instrumented Timed Up and Go test had large loadings on this component. However, only three of these 21 measures also directly correlated with the Mini-BESTest (trunk angular velocities from sit-to-walk and turning; r = 0.46 to 0.50, P = 0.021 to 0.038). Sit-to-walk angular velocity showed greater responsiveness than the Mini-BESTest, while turning showed slightly less. INTERPRETATION Angular velocities from the turning and sit-to-walk phases of the Timed Up and Go test are valid balance measures in Parkinson's disease and are also responsive to rehabilitation.
Collapse
Affiliation(s)
- Michela Picardi
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Valentina Redaelli
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Paola Antoniotti
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Giuseppe Pintavalle
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Evdoxia Aristidou
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Irma Sterpi
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, Milano 20148, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Dezza 48, Milano 20144, Italy
| | - Antonio Caronni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, Milano 20148, Italy.
| |
Collapse
|
198
|
Molouki A, Roostayi MM, Abedi M, Fakharian A, Akbarzadeh Baghban A. Postural Balance Evaluation in Patients with Chronic Obstructive Pulmonary Disease. Tanaffos 2020; 19:392-400. [PMID: 33959178 PMCID: PMC8088140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The risk of falling in patients with chronic obstructive pulmonary disease (COPD) is higher than healthy people, imposing a great financial burden on patients due to clinical diagnosis and treatment. This study aimed to compare static balance between two groups of healthy people and COPD patients, based on cognitive tasks and vision tests, using linear and non-linear analyses. MATERIALS AND METHODS A total of 15 patients with COPD and 14 age- and gender-matched healthy individuals were recruited in this study. Variations in the center of pressure were recorded in both medial-lateral (ML) and anterior-posterior (AP) directions by implementing visual feedback and cognitive tasks, with the subject standing on a force plate. Data related to the center of pressure were analyzed in the AP and ML directions by linear methods (i.e., standard deviation of displacement, standard deviation of maximum velocity, average velocity, and phase plane). Also, the nonlinear method (Lyapunov exponents) was used in both directions. RESULTS The cognitive tasks improved the center of pressure variables in both groups. In association with the vision tests, only lack of vision had a significant effect on the patients. The results of the linear analysis in the ML direction were significantly higher in the COPD group as compared to the healthy group; however, the results were not significant in the AP direction. Also, the non-linear analysis showed significant differences between the groups. CONCLUSION Use of both linear and non-linear analyses is necessary for evaluating the balance of patients with breathing difficulties. Balance disorders in COPD patients were mostly in the ML direction; therefore, postural deformities might be one of the reasons for balance problems in the AP direction.
Collapse
Affiliation(s)
- Ali Molouki
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Roostayi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Roostayi MM Address: Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran Email address:
| | - Mohsen Abedi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
199
|
Meyer M, Constancias F, Vogel T, Kaltenbach G, Schmitt E. Gait Disorder among Elderly People, Psychomotor Disadaptation Syndrome: Post-Fall Syndrome, Risk Factors and Follow-Up - A Cohort Study of 70 Patients. Gerontology 2020; 67:17-24. [PMID: 33254165 DOI: 10.1159/000511356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Falls among older people are a major health issue and the first cause of accidental death after 75 years of age. Post-fall syndrome (PFS) is commonly known and yet poorly studied. OBJECTIVE Identify risk factors for PFS and do a follow-up 1 year later. METHODS We included all patients over 70 years of age hospitalized after suffering a fall in a case-control study, and then followed them in a cohort study. PFS was retained in case of functional mobility decline (transferring, walking) occurring following a fall in the absence of an acute neurological, orthopedic or rheumatic pathology directly responsible for the decline. The data initially collected were: clinical (anamnestic, emergency and departmental/ward evolution, medical history, lifestyle, treatments, clinical examination items); and imaging if the patient had been subjected to brain imaging in the last 3 years prior to inclusion. Regarding the follow-up at 1 year, we collected from the general physician the occurrence and the characteristics of new falls, functional mobility assessment, hospitalization and death. RESULTS Inclusion took place from March 29, 2016 to June 7, 2016 and follow-up until June 30, 2017. We included 70 patients. A total of 29 patients exhibited a PFS (41.4 %). Risk factors for PFS included age, walking disorder prior to the fall, the use of a walking aid prior to the fall, no unaccompanied outdoor walk in the week before the fall, visual impairment making close reading impossible, stiffness in ankle dorsiflexion, grip strength and the fear of falling. Among patients with PFS, 52.9% could still perform a transfer at 1 year and 64.7% could still walk against 80.7% and 85.2%, respectively, for patients without PFS. CONCLUSION The study showed the existence of body functions/structure impairments and activity limitations prior to the fall among patients exhibiting a PFS. This suggests the existence of a pre-fall syndrome, i.e., a psychomotor disadaptation syndrome existing prior to the fall. Among the 8 risk factors, fear of falling, vision impairment and muscle strength could be targeted for improvement. The diagnosis of PFS could be a marker of loss of functional mobility at 1 year.
Collapse
Affiliation(s)
- Maxence Meyer
- Geriatric Department, CHU Strasbourg, Strasbourg, France,
| | | | - Thomas Vogel
- Geriatric Department, CHU Strasbourg, Strasbourg, France
| | | | - Elise Schmitt
- Geriatric Department, CHU Strasbourg, Strasbourg, France
| |
Collapse
|
200
|
Regauer V, Seckler E, Müller M, Bauer P. Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review. BMC Geriatr 2020; 20:494. [PMID: 33228601 PMCID: PMC7684969 DOI: 10.1186/s12877-020-01899-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. METHODS A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. RESULTS A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. CONCLUSION To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making. TRIAL REGISTRATION PROSPERO 2017 CRD42017080291 .
Collapse
Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany.
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences and Centre for Research, Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences and Centre for Research, Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| |
Collapse
|