Exercise and dehydration: A possible role of inner ear in balance control disorder

Postural control in Chiari I malformation: protocol for a paediatric prospective, observational cohort - potential role of posturography for surgical indication

INTRODUCTION

Chiari I malformation (CM1) is an anatomical abnormality characterised by the cerebellar tonsils descending at least 5 mm below the foramen magnum. CM1 causes obstruction of cerebrospinal fluid (CSF) circulation as well as direct compression on the brainstem, thus causing typical consequences (syringomyelia), and typical clinical features (characteristic headaches and neurological impairment). Surgery is the only available treatment, indicated when symptomatology is present. However, sometimes patients have atypical complaints, which are often suggestive of otolaryngological (ears, nose and throat, ENT) involvement. This may be difficult for a neurosurgeon to explain. Our study aims to investigate the relationship between one of these atypical symptoms, for example, postural instability, in a paediatric population using a Computerised Dynamic Posturography (Equitest, NeuroCom, Clackamas, OR). To our knowledge, there are no previously published studies carried out on children with CM1, using dynamic posturography.

METHODS AND ANALYSIS

Forty-five children aged 6-18 years old presenting with radiologically confirmed CM1 and presenting ENT clinical complaints will be included in the study for a duration of 3 years. As primary endpoint, posturographic results will be described in the population study. Second, posturographic results will be compared between patients with and without indication for surgery. Finally, preoperative and postoperative posturographic results, as well as CSF circulation quality at foramen magnum level, syringomyelia, sleep apnoea syndrome, scoliosis and behaviour will be compared in the operated patient group.

ETHICS AND DISSEMINATION

This protocol received ethical approval from the Clinical Research Delegation of Nancy University Hospital, in accordance with the National Commission on Informatics and Liberties (Commission Nationale de l'Informatique et des Libertés) (protocol number 2019PI256-107). Our data treatment was in accordance with the Methodology of reference Methodology Reference-004 specification for data policy. The study findings will be disseminated via peer-reviewed publications and conference presentations, especially to the Neurosphynx's rare disease healthcare network.

TRIAL REGISTRATION NUMBER

NCT04679792; Pre-results.

Effects of a Multicomponent Exercise Training Program on Balance Following Bariatric Surgery

Patients who undergo bariatric surgery (BS) have an increased risk of falls. Our aim was to determine if a multicomponent exercise intervention after BS improves balance. Eighty-four patients with obesity enrolled for BS were recruited and 1 month after BS randomly allocated to a control (CG; standard medical care) or exercise group (EG; exercise plus standard medical care) consisting of a supervised multicomponent training program (3d/week; 75 min/session; 5 months). Anthropometry, lower limb muscle strength (isokinetic dynamometer), vitamin D (ELISA) and balance in bipedal stance (force platform) were assessed pre-BS, 1 month and 6 months post-BS. One month post-BS, significant balance improvements were observed, namely in antero-posterior center of gravity (CoG) displacement and velocity, and medio-lateral and total CoG velocity. Between 1- and 6-months post-BS, improvements in balance were observed only in the EG, with a significant treatment effect on CoG displacement area and antero-posterior CoG displacement. No significant differences were observed between EG and CG over time in any of the anthropometric, muscle strength, and vitamin D variables assayed. In conclusion, a multicomponent exercise intervention program improves some balance parameters in patients with severe obesity following BS and therefore should be part of post-BS follow-up care as a potential strategy to reduce falls and associated injuries.

Physiological Mechanisms of Exercise and Its Effects on Postural Sway: Does Sport Make a Difference?

While the effect of a variety of exercises on postural balance control has been extensively studied, less attention has been paid to those requiring sport-specific skills. Therefore there is a need to analyze the literature and elucidate changes in postural balance control after exercises performed in conditions close to a particular sport. This scoping review aims (i) To map the literature that addresses postural sway aspects of acute responses to general and sport-specific exercises and their underlying physiological mechanisms, and (ii) To identify gaps in the existing literature and propose future research on this topic. The main literature search conducted on MEDLINE, Web of Science, Scopus, PubMed, and Cochrane Library databases was completed by SpringerLink, Elsevier, and Google Scholar. A total of 60 articles met the inclusion criteria. Findings identified that among a variety of studies evaluating the effects of exercise on postural balance control, only few of them were conducted under sport-specific conditions (i.e., while shooting in biathlon or pentathlon, and after simulated or match-induced protocols in combat and team sports). Therefore, more research is still needed to address this gap in the literature and aim research at investigation of postural sway response to sport-specific exercises. Further analysis of the literature showed that the type, intensity and duration of exercise play a key role in increased postural sway. Whole body and localized muscular fatigue of the trunk, neck and lower limbs is considered to be a main factor responsible for the magnitude of balance impairment in an initial phase of recovery and speed of its readjustment to a pre-exercise level. Other likely factors affecting postural stability are hyperventilation and deterioration of sensorimotor functions, though some contribution of muscle damage, dehydration, hyperthermia or dizziness cannot be excluded. A better understanding of the physiological mechanisms of balance impairment after exercises performed under simulated fatigue induced protocol, close to conditions specific to a particular sport, has implications for designing smart exercise programs tailored to individual needs to improve athlete performance with high demands on postural stability and/or decrease their risk of injuries.

Heat Exposure and Occupational Injuries: Review of the Literature and Implications

PURPOSE OF REVIEW

The burden of heat-related adverse occupational health effects, as well as traumatic injuries, is already substantial. Projected increases in mean temperatures and extreme events may increase the risk of adverse heat health effects and enhance disparities among exposed workers. This article reviews the emerging literature on the relationship between heat exposure and occupational traumatic injuries and discusses implications of this work.

RECENT FINDINGS

A recent meta-analysis of three case-crossover and five time series studies in industrialized settings reported an association of increasing occupational injuries with increasing heat exposure, with increased effect estimates for male gender and age less than 25 years, although heterogeneity in exposure metrics and sources of bias were demonstrated to varying degrees across studies. A subsequent case-crossover study in outdoor construction workers reported a 0.5% increase in the odds of traumatic injuries per 1 °C increase in maximum daily humidex (odds ratio 1.005 [95% CI 1.003-1.007]). While some studies have demonstrated reversed U-shaped associations between heat exposure and occupational injuries, different risk profiles have been reported in different industries and settings. Studies conducted primarily in industrialized settings suggest an increased risk of traumatic injury with increasing heat exposure, though the exact mechanisms of heat exposure's effects on traumatic injuries are still under investigation. The effectiveness of heat-related injury prevention approaches has not yet been established. To enhance the effectiveness of prevention efforts, prioritization of approaches should take into account not only the hierarchy of controls, social-ecological models, community and stakeholder participation, and tailoring of approaches to specific local work settings, but also methods that reduce local and global disparities and better address the source of heat exposure, including conservation-informed land-use planning, built environment, and prevention through design approaches. Participation of occupational health experts in transdisciplinary development and integration of these approaches is needed.

Effects of Rapid Weight Loss on Balance and Reaction Time in Elite Judo Athletes

Balance, reaction time, and strength are key factors affecting judo performance. Although ample research has been done examining potential strength changes caused by weight loss prior to competition, changes in balance and reaction time have been overlooked.

PURPOSE

To examine the effects of rapid and progressive weight loss (RWL and PWL) on balance, reaction time, and strength in a group of elite judo athletes.

METHODS

A total of 38 female and male judo athletes (age = 20.6 [2.6] y) completed balance, reaction-time, and strength assessments 1 wk prior to an official weigh-in (pretest) and immediately after the weigh-in (posttest). The athletes were divided into 3 groups, 1 control group who maintained regular training and eating habits, 1 experimental group who engaged in PWL (<3% reductions in body mass), and a second experimental group who used RWL techniques (>3% reductions in body mass).

RESULTS

The RWL group showed significant decreases (P < .05) in balance performance (ellipse area: 4.83 [0.87] vs 6.31 [1.39] mm2 with eyes closed; mean mediolateral velocity: 2.07 [0.2] vs 2.52 [0.45] mm·s-1 with eyes closed; and mean anteroposterior velocity: 2.25 [0.20] vs 2.51 [0.32] mm·s-1 with eyes open and 2.44 [0.26] vs 3.06 [0.56] mm·s-1 with eyes closed) and reaction time (0.38 [0.04] vs 0.42 [0.06] s) with no changes in strength from pretesting to posttesting. The athletes in the PWL and control groups maintained performance in all variables.

CONCLUSION

These findings demonstrate negative effects on perceptual motor-skill performance in judo athletes engaging in RWL strategies prior to competition.

Associations between heat exposure, vigilance, and balance performance in summer tree fruit harvesters

BACKGROUND

We sought to evaluate potential mediators of the relationship between heat exposure and traumatic injuries in outdoor agricultural workers.

METHODS

Linear mixed models were used to estimate associations between maximum work-shift Wet Bulb Globe Temperature (WBGT_max) and post-shift vigilance (reaction time) and postural sway (total path length) in a cross-sectional sample of 46 Washington State tree fruit harvesters in August-September 2015.

RESULTS

The mean (SD) WBGT_max was 27.4 (3.2)°C in August and 21.2 (2.0)°C in September. The mean pre-work-shift participant urine specific gravity indicated minimal dehydration. Twenty-four percent of participants exhibited possible excessive sleepiness. There was no association between WBGT_max and post-shift reaction time or total path length.

CONCLUSIONS

Heat exposure was not associated with impaired vigilance or balance in this study, in which the overall mean (SD) WBGT_max was 25.9 (4.2)°C. However, the study identified opportunities to ensure adequate pre-work-shift hydration and to optimize sleep and work-shift timing in order to reduce occupational injury and heat-related illness risk.

Comparison of an Innovative Rehabilitation, Combining Reduced Conventional Rehabilitation with Balneotherapy, and a Conventional Rehabilitation after Anterior Cruciate Ligament Reconstruction in Athletes

Background

Instability of the knee, related to anterior cruciate ligament injury, is treated by surgical reconstruction. During recovery, a loss of proprioceptive input can have a significant impact. Few studies have evaluated the benefits of rehabilitation of the knee in aquatic environment on functional outcomes.

Objective

This study aimed to compare an innovative rehabilitation protocol combining reduced conventional rehabilitation with aquatic rehabilitation, with a conventional rehabilitation, according to the National French Health Authority, in terms of kinetics, development of proprioceptive skills, and functional improvement of the knee.

Methods

67 patients, who were amateur or professional athletes, were randomized into two groups: 35 patients followed the conventional rehabilitation protocol (Gr1) and 32 patients followed the innovative rehabilitation protocol (Gr2). Patients were evaluated before surgery, and at 2 weeks, 1, 2, and 6 months after surgery using posturography, and evaluation of muscular strength, walking performance and proprioception. This study is multicenter, prospective, randomized, and controlled with a group of patients following conventional rehabilitation (level of evidence I).

Results

For the same quality of postural control, Gr2 relied more on somesthesia than Gr1 at 6 months. The affected side had an impact on postural control and in particular on the preoperative lateralization, at 2 weeks and at 1 month. Lateralization depended on the affected knee, with less important lateralization in Gr2 preoperatively and at 1 month. The quadriceps muscular strength was higher in Gr2 than in Gr1 at 2 and 6 months and muscle strength of the external hamstring was greater in Gr2 than in Gr1 at 6 months. The isokinetic test showed a greater quadriceps muscular strength in Gr2. Gr2 showed a greater walking distance than Gr1 at one month. Gr2 showed an improvement in the proprioceptive capacities of the operated limb in flexion for the first 2 months.

Conclusion

The effectiveness of the innovative rehabilitation program permits faster recovery, allowing for an earlier return to social, sporting, and professional activities. Faster retrieval of knee function following aquatic rehabilitation would prevent both short-term risk of lesions of the contralateral limb due to overcompensation and long-term risk of surgery due to osteoarthritis.

Registration of clinical trials

NCT02225613.

Post-fatigue recovery of power, postural control and physical function in older women

Low muscle power, particularly at high velocities, has been linked to poor physical function in older adults. Any loss in muscle power following fatiguing exercise or daily activities could impact physical function and postural control until power has fully recovered. To test the overall hypothesis that a common task such as walking can result in prolonged power loss and decreased physical function and balance, 17 healthy older (66–81 years) women completed a 32-min walking test (32MWT) designed to induce neuromuscular fatigue, followed by 60min of recovery (60R). Fatigue and recovery of knee extensor muscle power (3 velocities) were quantified by dynamometry. Function was quantified by chair rise time and postural control by measures of center of pressure (COP) range (mm) and velocity (mm·s^-1) during quiet stance. Power declined at all velocities by 8–13% 2min following the 32MWT (p≤0.02) and remained depressed by 8–26% at 60R (p≤0.04). Postural control decreased following the 32MWT, indicated by increased COP range in the anterior-posterior (AP, p<0.01) direction and a trend in the medial-lateral (ML) direction (p = 0.09), and returned to baseline by 60R (p≥0.10). COP velocity was unchanged immediately following the 32MWT, but at 60R was lower in ML (p = 0.03) and tended to be reduced in AP (p = 0.07). Changes in high-velocity power (270°·s^-1) were associated with altered postural control (p = 0.02) and chair rise performance (p≤0.03). These results provide evidence of long-duration neuromuscular changes following fatigue in healthy older women that may place them at increased risk for functional deficits during everyday mobility tasks.

Advanced Materials for Health Monitoring with Skin-Based Wearable Devices

Skin-based wearable devices have a great potential that could result in a revolutionary approach to health monitoring and diagnosing disease. With continued innovation and intensive attention to the materials and fabrication technologies, development of these healthcare devices is progressively encouraged. This article gives a concise, although admittedly non-exhaustive, didactic review of some of the main concepts and approaches related to recent advances and developments in the scope of skin-based wearable devices (e.g. temperature, strain, biomarker-analysis werable devices, etc.), with an emphasis on emerging materials and fabrication techniques in the relevant fields. To give a comprehensive statement, part of the review presents and discusses different aspects of these advanced materials, such as the sensitivity, biocompatibility and durability as well as the major approaches proposed for enhancing their chemical and physical properties. A complementary section of the review linking these advanced materials with wearable device technologies is particularly specified. Some of the strong and weak points in development of each wearable material/device are highlighted and criticized. Several ideas regarding further improvement of skin-based wearable devices are also discussed.

Vertigo in downhill mountain biking and road cycling

Vertigo has been described after the practice of mountain bike. This study aimed to investigate the prevalence of vertigo following competitions or training sessions of downhill mountain biking (DMB) or road cycling (RC). One hundred and two DMB riders, 79 road cyclists and 73 control participants filled in a survey intended to evaluate the prevalence of vertigo in daily living activities and following competitions or training sessions. Vertigo causal factors (crashes, head trauma, fatigue, characteristics of the path/road ridden) were recorded. DMB riders and road cyclists did not report more vertigo during daily living activities than controls. But DMB riders older than 30 had more risk to report vertigo than age-matched road cyclists (OR: 5.06, 95% CI: 1.23-20.62). Road cyclists aged between 20 and 29 were 2.59-fold (95% CI: 1.06-6.27) more likely to report vertigo than controls. After competitions and training sessions, DMB riders were 2.33-fold (95% CI: 1.22-4.41) more likely to report vertigo than road cyclists. Vertigo causal factors were crash with head trauma in DMB riders and fatigue in road cyclists. Vertigo during daily living activities may be of concern for cyclists, particularly older DMB riders. The accumulation of impacts (crashes, vibrations) during the career of a DMB rider may generate micro-traumatisms of the central nervous system and/or peripheral vestibular structures, particularly the otolith organs. In RC, the pathophysiological mechanisms generating vertigo might be effort-related disturbance of homeostasis. To avoid injuries, DMB riders should be aware that vertigo may occur at the end of training sessions or competitions.