The relationship between trunk position sense and postural control in ataxic individuals

Effect of a Home-Base Core Stability Exercises in Hereditary Ataxia. A Randomized Controlled Trial. A Pilot Randomized Controlled Trial

BACKGROUND

Core stability exercises (CSE) have been shown to be effective in improving trunk function in several neurological diseases, but the evidence is scarce on Hereditary Ataxias (HA).

OBJECTIVE

To evaluate the effectiveness of a 5-week home-based CSE program in terms of ataxia severity, trunk function, balance confidence, gait speed, lower limb motor function, quality of life, health status and falls rate in HA individuals at short- and long-term.

METHODS

This is an assessor-blind randomized controlled clinical trial parallel group 1:1. The individuals were divided in experimental group (EG) performed standard care in addition to CSE, and control group (CG) performed standard care alone. The CSE home-program was conducted 1-h/day, 5-day/week for 5-week. The assessment was performed at baseline, endpoint (5-week), and follow-up (10-week). The primary outcomes were ataxia severity assessed by the Scale for the Assessment and Rating of Ataxia and trunk function assessed by Spanish-version of Trunk Impairment Scale 2.0. The secondary outcomes were balance confidence assessed by Activities-specific Balance Confidence (ABC), gait speed by 4-meter walk test (4-MWT), the lower limb motor function by 30-s sit-to-stand, quality of life by EuroQol 5-dimension 5-level (EQ-5D-5L), health-status by EQ-5D and falls rate.

RESULTS

Twenty-three HA individuals were recruited (51.8 ± 11.10 years). Statistically significant group-time interaction was shown in ABC (F:5.539; P = 0.007), EQ-5D-5L Total (F:4.836; P = 0.013), EQ 5D (F:7.207; P = 0.006).

CONCLUSIONS

No statistical differences between groups for ataxia severity and trunk function were observed. However, were differences for balance confidence, gait speed, quality of life, and falls rate in HA individuals.

Effect of sit-stand workstation position and computer task on head and trunk postural sway and discomfort

Adjustable-height desks may provide musculoskeletal health benefits to offset the effects of prolonged sitting. One mechanism may be increased postural variability, here characterized by head and trunk postural sway. Linear acceleration of the head and trunk were measured while participants used computer workstations in seated and standing positions during keyboard and mouse tasks; secondary measures were discomfort and proprioception (head and neck repositioning error). Median accelerations of the head and trunk were 20-26% lower in mouse tasks compared to keyboard tasks (p < 0.01). There were no significant differences in sway parameters between seated and standing positions. Discomfort and proprioception were correlated; subjects who experienced increased neck discomfort after 1.5 h of computer work had almost twice the head and neck repositioning error. The results suggest that postural sway is more affected by different tasks (keyboard vs. mouse) than by different workstation configurations and that low proprioception acuity may relate to the development of discomfort.

Investigation of the relationship between trunk position sense and balance, functional mobility, fear of falling, and disease stage in Parkinson's disease

INTRODUCTION

Parameters related to trunk control such as balance disorders, mobility problems, and falling are frequently observed in patients with Parkinson's disease (PD). However, to provide a stable foundation for movement, trunk stability requires appropriate adequate position sense. The aim of the study was to examine the relationship between trunk position sense, balance, functional mobility, fear of falling, and disease stage in patients with PD.

METHODS

The study was conducted in 41 patients with PD (16 female and 25 male). Trunk position sense was assessed with a digital inclinometer, balance with functional reach test, Berg balance scale and one-leg stand test, functional mobility with timed up and go test, fear of falling with activity-specific balance confidence scale, and disease stage with Modified Hoehn and Yahr Scale (MHYS). All patients were tested during the "on" phase following drug therapy.

RESULTS

Repositioning error degree was related with MHYS, Berg balance scale, right and left one-leg stand test, forward functional reach test, timed up and go test, timed up and go test-cognitive and activity-specific balance confidence scale results in patients with PD (r =  - 0.363/ - 0.609, p < 0.05 for all).

CONCLUSION

It was shown in the study that trunk position sense was associated with disease stage, balance level, functional mobility, and fear of falling in patients with PD. These results suggest that trunk position sense is more important to plan effective rehabilitation program for development and protection of disease stage, balance level, functional mobility, and fear of falling in patients with PD.

Impaired Lower Limb Proprioception in Spinocerebellar Ataxia Type 3 and Its Affected Factors

Background

Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases. Postural control dysfunction is the main symptom of SCA3, and the proprioceptive system is a critical sensory component of postural control. Accordingly, proprioception quantification assessment is necessary in monitoring the progression of SCA3.

Objective

We aimed to quantitatively assess lower limb proprioception and investigate the relationship between proprioception and clinical characteristics in patients with SCA3.

Methods

A total of 80 patients with SCA3 and 62 health controls were recruited, and their lower limb proprioception was measured using the Pro-kin system. Clinical characteristics of the SCA3 patients were collected. Multivariable linear regression was used to investigate potential affected factors for lower limb proprioception.

Results

We found that the patients with SCA3 experience poorer lower limb proprioception characterized by significant impairment in the average trace error (ATE) and time to carry out the test time execution (TTE) compared to controls (P < 0.05). Moreover, there were significant differences in TTE between the right and left lower limbs (P < 0.05) of the patients. Regression analyses revealed that increasing age at onset (AAO) predicts poorer lower limb proprioception for both ATE (β = 2.006, P = 0.027) and TTE (β = 1.712, P = 0.043) and increasing disease duration predicts poorer lower limb proprioception for ATE (β = 0.874, P = 0.044). AAO (β = 0.328, P = 0.019) along with the expanded alleles (β = 0.565, P = 0.000) could affect the severity of ataxia. By contrast, ATE (β = 0.036, P = 0.800) and TTE (β = −0.025, P = 0.862) showed no significant predictors.

Conclusions

Lower limb proprioception in patients with SCA3 is significantly impaired when compared to healthy controls. Increasing AAO and disease duration are related to impaired lower limb proprioception.

Relationship between Trunk Position Sense and Trunk Control in Children with Spastic Cerebral Palsy: A Cross-Sectional Study

METHODS

In this study, 24 children with spastic CP aged between 8 and 15 years were recruited. They were classified based on their functional performance using Gross Motor Function Classification System (GMFCS). Trunk control and trunk position sense were assessed using the trunk control measurement scale (TCMS) and digital goniometer, respectively. The correlation between these variables was tested using Spearman's correlation coefficient.

RESULTS

Significant negative correlation was found between trunk position sense and TCMS score. Similarly, a significant moderate correlation was found between trunk position sense and GMFCS. A strong negative correlation was also found between GMFCS and TCMS.

CONCLUSION

Children with spastic CP with better trunk position sense had better trunk control. Similarly, children with higher functional performance had better trunk control and lesser error in trunk position sense. The current findings imply the relevance of proprioceptive training of the trunk for enhancing trunk motor control in children with spastic CP.

Quantitative assessment of postural instability in spinocerebellar ataxia type 3 patients

Objective

Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases, with balance instability as main symptom. Balance quantification is crucial for evaluating the efficacy of therapeutic interventions. However, balance evaluation in SCA3 is often subject to bias. Here, we aimed to quantitatively evaluate postural instability and investigate the relationship between postural instability and clinical characteristics in SCA3 patients.

Methods

Sixty‐two SCA3 patients and 62 normal controls were recruited, and their postural balance was measured using a posturographic platform. Principal component analysis was performed as data reduction to identify postural instability factors. Multivariable linear regression was used to investigate potential risk factors for postural instability and to explore whether postural instability predicts the severity and progression of ataxia in SCA3 patients.

Results

We found SCA3 patients experience postural instability characterized by significant impairment in static and dynamic stability. The condition without visual feedback was the most sensitive measure in differentiating SCA3 from controls. Regression analyses revealed that ataxia severity predicted both static (P = 0.014) and dynamic stability (P = 0.001). Likewise, along with expanded CAG repeats (P < 0.001), both static (P < 0.001) and dynamic stability (P < 0.001) predicted ataxia severity, but not ataxia progression.

Interpretation

Our findings demonstrate the validity of using the Pro‐kin system for assessing postural instability in SCA3 patients. This type of quantitative assessment of balance dysfunction can contribute to clinical trials and balance rehabilitation in SCA3 patients.