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Phu S, Sturnieks DL, Song PYH, Lord SR, Okubo Y. Neuromuscular adaptations to perturbation-based balance training using treadmill belt accelerations do not transfer to an obstacle trip in older people: A cross-over randomised controlled trial. Hum Mov Sci 2024; 97:103273. [PMID: 39217920 DOI: 10.1016/j.humov.2024.103273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/08/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND This study examined (i) adaptations in muscle activity following perturbation-based balance training (PBT) using treadmill belt-accelerations or PBT using walkway trips and (ii) whether adaptations during treadmill PBT transfer to a walkway trip. METHODS Thirty-eight older people (65+ years) undertook two PBT sessions, including 11 treadmill belt-accelerations and 11 walkway trips. Surface electromyography (EMG) was measured bilaterally on the rectus femoris (RF), tibialis anterior (TA), semitendinosus (ST) and gastrocnemius medial head (GM) during the first (T1) and eleventh (T11) perturbations. Adaptations (within-subjects - 1st vs 11th perturbations for treadmill and walkway PBT) and their transfer (between-subjects - 1st walkway trip after treadmill PBT vs 1st walkway trip with no prior training) effects were examined for the EMG parameters. RESULTS Treadmill PBT reduced post-perturbation peak muscle activation magnitude (left RF, TA, ST, right RF, ST, GM), onset latency (right TA), time to peak (right RF) and co-contraction index (knee muscles) (P < 0.05). Walkway PBT reduced post-trip onset latencies (right TA, ST), peak magnitude (left ST, right GM), time to peak (right RF, ST) and pre-perturbation muscle activity (right TA) (P < 0.05). Those who undertook treadmill PBT were not different to those without prior training during the first walkway trip (P > 0.05). CONCLUSIONS Both treadmill and walkway PBT induced earlier initiation and peak activation of right limb muscles responsible for the first recovery step. Treadmill PBT also reduced co-contraction of the knee muscles. Adaptations in muscle activity following treadmill PBT did not transfer to a walkway trip.
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Affiliation(s)
- Steven Phu
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Randwick, NSW, Australia; Department of Medicine, Western Health, The University of Melbourne, St Albans, VIC, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Biomedical Sciences - Faculty of Medicine and Health, The University of New South Wales, Randwick, NSW, Australia
| | - Patrick Y H Song
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Randwick, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Randwick, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Randwick, NSW, Australia.
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MacKenzie EG, Snow NJ, Chaves AR, Reza SZ, Ploughman M. Weak grip strength among persons with multiple sclerosis having minimal disability is not related to agility or integrity of the corticospinal tract. Mult Scler Relat Disord 2024; 88:105741. [PMID: 38936325 DOI: 10.1016/j.msard.2024.105741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Mobility impairment is common in multiple sclerosis (MS); however, agility has received less attention. Agility requires strength and neuromuscular coordination to elicit controlled propulsive rapid whole-body movement. Grip strength is a common method to assess whole body force production, but also reflects neuromuscular integrity and global brain health. Impaired agility may be linked to loss of neuromuscular integrity (reflected by grip strength or corticospinal excitability). OBJECTIVES We aimed to determine whether grip strength would be associated with agility and transcranial magnetic stimulation (TMS)-based indices of corticospinal excitability and inhibition in persons with MS having low disability. We hypothesized that low grip strength would predict impaired agility and reflect low corticospinal excitability. METHODS We recruited 34 persons with relapsing MS (27 females; median [range] age 45.5 [21.0-65.0] years) and mild disability (median [range] Expanded Disability Status Scale 2.0 [0-3.0]), as well as a convenience sample of age- and sex-matched apparently healthy controls. Agility was tested by measuring hop length during bipedal hopping on an instrumented walkway. Grip strength was measured using a calibrated dynamometer. Corticospinal excitability and inhibition were examined using TMS-based motor evoked potential (MEP) and corticospinal silent period (CSP) recruitment curves, respectively. RESULTS MS participants had significantly lower grip strength than controls independent of sex. Females with and without MS had weaker grip strength than males. There were no statistically significant sex or group differences in agility. After controlling for sex, weaker grip strength was associated with shorter hop length in controls only (r = 0.645, p < .05). Grip strength did not significantly predict agility in persons with MS, nor was grip strength predicted by corticospinal excitability or inhibition. CONCLUSIONS In persons with MS having low disability, grip strength (normalized to body mass) was reduced despite having intact agility and walking performance. Grip strength was not associated with corticospinal excitability or inhibition, suggesting peripheral neuromuscular function, low physical activity or fitness, or other psychosocial factors may be related to weakness. Low grip strength is a putative indicator of early neuromuscular aging in persons with MS having mild disability and normal mobility.
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Affiliation(s)
- Evan G MacKenzie
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Nicholas J Snow
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Arthur R Chaves
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, ON, Canada; Neuromodulation Research Clinic, The Royal's Institute of Mental Health Research, ON, Canada; Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, QC, Canada
| | - Syed Z Reza
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada.
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Qu X, Yang B, Wang W, Hu X. Balance recovery after trips is affected by the type of tripping obstacles. ERGONOMICS 2024:1-7. [PMID: 39017622 DOI: 10.1080/00140139.2024.2375749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/28/2024] [Indexed: 07/18/2024]
Abstract
Occupational falls are often initiated by trips. Mechanical perturbations applied onto the tripped foot are different for different types of tripping obstacles. The present study aimed to determine how different types of tripping obstacles affect balance recovery after trips. Sixty-four healthy adults participated in an experimental study. They were instructed to perform several walking trials, during which two trips were randomly induced, one by a pole-like obstacle and the other by a board-like obstacle. Balance recovery after trips was measured and compared between the two obstacles. Results showed that the board-like obstacle led to longer step-off time, shorter recovery step duration, and smaller minimum hip height, suggesting that the risk of trip-initiated falls could be higher with the board-like obstacle vs. the pole-like obstacle. This finding presents the need for future research to consider the influence of obstacle type when exploring mechanisms for trips and falls.
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Affiliation(s)
- Xingda Qu
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Baozhan Yang
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Weiliang Wang
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Xinyao Hu
- Institute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
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Phu S, Sturnieks DL, Song PYH, Lord SR, Okubo Y. Treadmill induced belt-accelerations may not accurately evoke the muscle responses to obstacle trips in older people. J Electromyogr Kinesiol 2024; 75:102857. [PMID: 38330509 DOI: 10.1016/j.jelekin.2024.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Treadmill belt-accelerations are a commonly utilised surrogate for tripping, but their physiological validity is unknown. This study examined if a treadmill belt-acceleration induces lower limb muscle activation responses similar to a trip on a walkway. METHODS 38 older people (65+ years) experienced one treadmill belt-acceleration and one walkway obstacle trip in random order. Muscle responses were assessed bilaterally using surface electromyography on the rectus femoris (RF), tibialis anterior (TA), semitendinosus (ST) and gastrocnemius medial head (GM). Unperturbed muscle activity, post-perturbation onset latency, peak magnitude, time to peak and co-contraction index (CCI) were examined. RESULTS Muscle activity in the right ST was greater during unperturbed walking on the treadmill compared to walkway (P=0.011). Compared to a treadmill belt-acceleration, a walkway trip elicited faster onset latencies in all muscles; greater peak magnitudes in the left RF, TA, GM and right GM; faster time to peaks in the left TA and right GM; and lower knee and ankle muscle CCI (P<0.05). CONCLUSIONS Walkway trips and treadmill belt-accelerations elicit distinct muscle activation patterns. While walkway trips induced faster and larger muscle responses, treadmill belt-accelerations involved greater co-contraction. Therefore, treadmill belt-accelerations may not accurately simulate the muscle responses to trips.
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Affiliation(s)
- Steven Phu
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia; Department of Medicine, Western Health, The University of Melbourne, St Albans, VIC, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Biomedical Sciences - Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Patrick Y H Song
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health - Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia.
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Monjezi S, Molhemi F, Shaterzadeh-Yazdi MJ, Salehi R, Mehravar M, Kashipazha D, Hesam S. Perturbation-based Balance Training to improve postural responses and falls in people with multiple sclerosis: a randomized controlled trial. Disabil Rehabil 2023; 45:3649-3655. [PMID: 36322558 DOI: 10.1080/09638288.2022.2138570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To determine the effects of Perturbation-based Balance Training (PBT) on postural responses and falls in people with multiple sclerosis (PwMS) and compare the results with conventional balance training (CBT). MATERIALS AND METHODS Thirty-four PwMS were randomized to receive 4 weeks of PBT or CBT. Latency of postural responses to external perturbations, Timed-Up-and-Go (TUG), 10-meter-walk (10MW), Berg Balance Scale (BBS), and Activities-specific Balance Confidence Scale (ABC) were measured at baseline and post-training. Also, the proportion of fallers and fall rate were assessed at a 3-month follow-up. RESULTS The latency of postural responses significantly decreased in PBT compared to CBT. TUG, 10MW, BBS, and ABC, at post-training, and relative risk of falls and fall rate at 3-month follow-up had no statistically significant between-group differences. CONCLUSIONS The results show that PBT is at least as effective as CBT in improving balance and decreasing falls, while it has superiority over CBT whenever the clinicians mainly aim to improve reactive balance strategies. Future studies with a larger sample size are warranted to complement the results of this study.Implication for rehabilitationPerturbation-based Balance Training is at least as effective as conventional balance training (CBT) in improving proactive postural control in people with multiple sclerosis (PwMS).Perturbation-based Balance Training has superiority over CBT in improving reactive postural control in PwMS.Perturbation-based Balance Training has no superiority over CBT in improving fall-related outcomes.
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Affiliation(s)
- Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farshad Molhemi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad-Jafar Shaterzadeh-Yazdi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Davood Kashipazha
- Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Okubo Y, Mohamed Suhaimy MSB, Hoang P, Chaplin C, Hicks C, Sturnieks D, Lord S. Training reactive balance using trips and slips in people with multiple sclerosis: a blinded randomised controlled trial. Mult Scler Relat Disord 2023; 73:104607. [PMID: 37004274 DOI: 10.1016/j.msard.2023.104607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/26/2023] [Accepted: 03/04/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND This study examined the feasibility and efficacy of reactive balance training for improving stepping performance and reducing laboratory-induced falls in people with multiple sclerosis (MS). METHODS Thirty people diagnosed with MS (18-70 years) participated in a blinded randomized controlled trial (ACTRN12618001436268). The intervention group (n = 14) underwent two 50-minute sessions (total 100 min) that exposed them to a total of 24 trips and 24 slips in mixed order, over one week. The control group (n = 16) received sham training (stepping over foam obstacles) with equivalent dosage. The primary outcome was falls into the harness (defined as >30% body weight) when exposed to trips and slips that were unpredictable in timing, location and type at post-assessment. Physical and psychological measures were also assessed at baseline and post assessments. RESULTS The intervention and control groups completed 86% and 95% of the training protocols respectively. Incidence rate ratios (95% confidence intervals) of the intervention group relative to the control group were 0.57 (0.25, 1.26) for all falls, 0.80 (0.30, 2.11) for slip falls and 0.20 (0.04, 0.96) for trip falls in the laboratory. Kinematic analyses indicated the intervention participants improved dynamic stability, with higher centre of mass position and reduced trunk sway during recovery steps following a trip, compared to control. There were no significant differences between the intervention and control participants at post-assessment for other secondary outcome measures. CONCLUSIONS Reactive balance training improved trip-induced dynamic stability, limb support, trunk control and reduced falls in people with MS. More research is required to optimise the training protocol and determine whether the beneficial effects of reactive balance training can be retained long term and generalize to fewer daily-life falls.
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