Immediate effects of bilateral grade III mobilization of the talocrural joint on the balance of elderly women

Talus mobilization-based manual therapy is effective for restoring range of motion and enhancing balance in older adults with limited ankle mobility: A randomized controlled trial

BACKGROUND

The ankle plays a key role in balance, but ankle range of motion decreases with ageing.

RESEARCH QUESTION

To establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process.

METHODS

Randomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions.

RESULTS

Forty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p < 0.001). Both groups presented similar performance in post-treatment static balance measures (p > 0.05).

SIGNIFICANCE

An anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility.

Measurement of Results of Functional Reach Test with Sensors: A Systematic Review

The test of physical conditions is important to treat and presents several diseases related to the movement. These diseases are mainly related to the physiotherapy and orthopedy, but it can be applied in a wide range of medical specialties. The Functional Reach Test is one of the most common physical tests used to measure the limit of stability that is highly important for older adults because their stability is reduced with aging. Thus, older adults are part of the population more exposed to stroke. This test may help in the measurement of the conditions related to post-stroke and stroke treatment. The movements related to this test may be recorded and recognized with the inertial sensors available in off-the-shelf mobile devices. This systematic review aims to determine how to determine the conditions related to this test, which can be detected, and which of the sensors are used for this purpose. The main contribution of this paper is to present the research on the state-of-the-art use of sensors available on off-the-shelf mobile devices to measure Functional Reach Test results. This research shows that the sensors that are used in the literature studies are inertial sensors and force sensors. The features extracted from the different studies are categorized as dynamic balance, quantitative, and raw statistics. These features are mainly used to recognize the different parameters of the test, and several accidents, including falling. The execution of this test may allow the early detection of different diseases.

A Randomized Controlled Trial Assessing the Evolution of the Weight-Bearing Ankle Dorsiflexion Range of Motion Over 6 Sessions of Talus Mobilizations in Older Adults

BACKGROUND

Ankle range of motion declines with age, affecting mobility and postural control.

OBJECTIVE

The objective of this study was to investigate the effects of a talus mobilization-based intervention among healthy community-dwelling older adults presenting with limited weight-bearing ankle dorsiflexion range of motion and determine how ankle mobility evolved over the treatment.

DESIGN

This was a randomized clinical trial.

SETTING

This study was conducted in an outpatient clinic.

PARTICIPANTS

Community-dwelling, older adults over 60 years of age who had limited ankle mobility participated in this study.

INTERVENTIONS

The experimental intervention consisted of 6 sessions of manual therapy applied in the ankle joint. The control group received the same volume of sham treatment.

MEASUREMENTS

The primary outcome was the weight-bearing ankle dorsiflexion range of motion as measured using the lunge test. Data were collected at 9 time points: baseline, after each session, and follow-up.

RESULTS

A total of 36 participants were analyzed. A single session of mobilization increased ankle range of motion by 8 degrees (95% confidence interval = 6 to 11). At the end of the sixth session, this effect had increased slightly to 11 degrees (95% confidence interval = 9 to 13). Significant between-group differences were found throughout the intervention.

LIMITATIONS

Optimal dose and effects from follow-up evaluations for treatment volumes of fewer than 6 sessions remain unknown.

CONCLUSIONS

Six sessions of a talus mobilization-based intervention in healthy community-dwelling older adults found that the greatest mobility gain in terms of the weight-bearing ankle dorsiflexion range of motion is produced after the first session. Additional sessions produce smaller improvements with a slight upward trend. Importantly, the restoration of joint mobility is enhanced over time after the end of the intervention.

Reference value for the TUGT in healthy older people: A systematic review and meta-analysis

The timed up and go test (TUGT) was recently proposed as a strong predictor of adverse outcomes. Few reviews have been conducted to identify a standard for the TUGT in healthy older people, and the aims of this study were to explore the source of heterogeneity and evaluate the range of reference values for the TUGT in healthy people over 60 years old stratified by age and sex. The VIP, EMBASE, Web of Science and PubMed databases were searched from January 1, 2000, to December 31, 2018. A subgroup analysis and meta-regression were used to assess heterogeneity. Thirty-four eligible studies were included. The mean TUGT results for the total population, males and females in the sample were 9.21 s [95% CI (9.11, 9.31)], 9.33 s [95% CI (7.82, 11.08)] and 8.87 s [95% CI (8.40, 9.38)], respectively. The mean TUGT results for older people in their 60 s, 70 s, and 80 s were 7.91 s [95% CI (6.62, 9.20)], 8.67 s [95% CI (7.23, 10.12)] and 11.68 s [95% CI (8.11, 15.26)], respectively. The meta-regression analysis results showed that the heterogeneity was related to age (P < 0.01). Age affects the results of the TUGT, and it is necessary to take age into consideration when conducting stratified physical evaluations for the evaluation of older people individuals' physical fitness.

Balance training versus balance training and foot and ankle mobilization: a pilot randomized trial in community-dwelling older adults

Background: Balance limitations and foot and ankle problems are common in older adults. Objective: To determine the impact of augmented balance training with foot and ankle mobilizations (FAMs) on balance in older adults. Methods: Two-arm pilot randomized trial. Both groups underwent a 4-week conventional balance training. Additionally, the experimental group received four sessions of FAM. Balance measurement, as assessed by the Berg Balance Scale, was the primary outcome. The secondary outcome was the ankle range of movement (ROM). Outcomes were evaluated 1 day before and after intervention, and at 3 months' post-intervention (midterm). Results: Twenty-eight participants completed the study (14 control, 14 experimental). No between-group differences were observed in terms of balance. Similarly, both groups significantly improved the ankle ROM, but the effects persisted at 3 months only in the FAM group. Conclusion: Augmented balance training with FAM does not improve balance of older adults over conventional methods, but may help to correct ankle mobility limitations at midterm. As this was a pilot study, further studies with adequate sample size are warranted to validate our findings, and elucidate the dose-response relationship of FAM with improvement of balance and ROM in older adults.

Analysis of peak plantar pressure and center of pressure oscillation in individuals with chronic neck pain: A cross-sectional study

BACKGROUND

Baropodometric evaluation has been used in research and clinical environments by professionals who are working on the physical rehabilitation of patients. However, to date, there is no published data on the use of baropodometry in patients with chronic neck pain.

OBJECTIVE

To analyze peak plantar pressure and center of pressure oscillation in individuals with chronic neck pain compared to a control group.

METHODS

This was a blind cross-sectional study. It included 44 participants of both genders, between 18 and 45 years old, distributed into a chronic neck pain group (n= 22) and a control group (n= 22). Participants were assessed by means of baropodometry, the Numeric Rating Scale, the Neck Disability Index, and the Pain-Related Self Statement Scale. The Mann-Whitney test was used for comparison of baropodometric variables between the two groups, and the Spearman correlation coefficient was used to check possible associations between the variables.

RESULTS

No significant differences (p> 0.05) in peak plantar pressure or center of pressure oscillation were detected in the comparisons between the chronic neck pain and control groups. In addition, no significant correlation was observed (p> 0.05) between baropodometric variables and neck pain.

CONCLUSION

Individuals with chronic neck pain with mild disability did not differ from a control group in terms of peak plantar pressure or center of pressure oscillation.

Effects of thai foot massage on balance performance in diabetic patients with peripheral neuropathy: a randomized parallel-controlled trial

BACKGROUND Peripheral neuropathy is the most common complications of diabetic patients and leads to loss of plantar cutaneous sensation, movement perception, and body balance. Thai foot massage is an alternative therapy to improve balance. Therefore, the purpose of this study was to investigate the effects of Thai foot massage on balance performance in diabetic patients with peripheral neuropathy. MATERIAL AND METHODS Sixty patients with type-2 diabetes were recruited and randomly assigned into either the Thai foot massage or control groups. The Thai foot massage group received a modified Thai traditional foot massage for 30 min, 3 days per week for 2 weeks. We measured timed up and go (TUG), one leg stance: OLS), the range of motion (ROM) of the foot, and foot sensation (SWMT) before treatment, after the first single session, and after the 2-week treatment. RESULTS After the single treatment session, only the Thai foot massage group showed a significant improvement in TUG. After the 2-week treatment, both Thai foot massage and control groups showed a significant improvement of TUG and OLS (P<0.05); however, when comparing between 2 groups, the Thai foot massage group showed better improvement in TUG than the control group (p<0.05). The Thai foot massage group also showed significant improvements in ROM and SWMT after the 2-week treatment. CONCLUSIONS The results of this study suggest that Thai foot massage is a viable alternative treatment for balance performance, ROM of the foot, and the foot sensation in diabetic patients with peripheral neuropathy.

Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women

[Purpose] The purpose of this study was to correlate the talocrural range of motion (ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects (57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also assessed. [Results] No significant differences were found between the groups by comparing talocrural ROM and arterial blood velocity. However, a significant association was found in G2 only between the following variables: plantar flexion and blood flow velocity of the dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a decrease in the arterial blood flow velocity in diabetic women.

Acute effects of rearfoot manipulation on dynamic standing balance in healthy individuals

Dynamic standing balance is essential to perform functional activities and is included in the treatment of many lower extremity injuries. Physiotherapists utilize many methods to restore standing balance including stability exercises, functional retraining, and manual therapy. The purpose of this study was to investigate the effects of a rearfoot distraction manipulation on dynamic standing balance. Twenty healthy participants (age: 24.4 ± 2.8 years; height: 162.9 ± 37.7 cm; mass: 68.0 ± 4.8 kg; right leg dominant = 20) completed this study. Following familiarization, dynamic standing balance was assessed during: (1) an experimental condition immediately following a rearfoot distraction manipulation, and (2) a control condition. Dominant leg balance was quantified using the Y-balance test which measures lower extremity reach distances. Reach distances were normalized to leg length and measured in the anterior, posteromedial and posterolateral directions. Overall balance was calculated through the summing of all normalized directions. Paired t-tests and Wilcoxon rank tests were used to compare balance scores for parametric and non-parametric data as appropriate. Significance was set at 0.05 a priori. Effect size (ES) was calculated to determine the clinical impact of the manipulation. Increased reach distances (indicating improved balance) were noted following manipulation for overall balance (p = 0.03, ES = 0.26) and in the posteromedial direction (p = 0.01, ES = 0.42). Reach distances did not differ for the anterior (p = 0.11, ES = 0.16) or posterolateral (p = 0.11, ES = 0.25) components. Dynamic standing balance improved after a rearfoot distraction manipulation in healthy participants. It is hypothesized that manual therapy applied to the foot and ankle may be beneficial to augment other therapeutic modalities when working with patients to improve dynamic standing balance.

Effect of mandibular mobilization on electromyographic signals in muscles of mastication and static balance in individuals with temporomandibular disorder: study protocol for a randomized controlled trial

BACKGROUND

The stomatognathic system and dysfunction in this system may be related to postural control. The proposal of the present study is to assess the effect of mandibular mobilization in individuals with temporomandibular disorder using surface electromyography of the muscles of mastication and stabilometric variables.

METHODS/DESIGN

A randomized, controlled, blind, clinical trial will be carried out, with the participants divided into three groups: 1) facial massage therapy (control group), 2) nonspecific mandibular mobilization and 3) specific mandibular mobilization. All groups will be assessed before and after treatment using the Research Diagnostic Criteria for Temporomandibular Disorders, surface electromyography of the masseter and temporal muscles and stabilometry. This study is registered with the Brazilian Registry of Clinical Trials (RBR9x8ssz).

DISCUSSION

A large number of studies have employed surface electromyography to investigate the function/dysfunction of the muscles of mastication and associations with signs and symptoms of temporomandibular disorders. However, it has not yet been determined whether stabilometric variables offer adequate reliability in patients with this disorder. The results of the proposed study will help determine whether specific and/or nonspecific mandibular mobilization exerts an effect on the muscles of mastication and postural control. Moreover, if an effect is detected, the methodology defined in the proposed study will allow identifying whether the effect is local (found only in the muscles of mastication), global (found only in postural control) or generalized.