Age dependency of neuromuscular function and dynamic balance control

Acute short term effects of endurance and resistance training on balance control in patients with diabetic peripheral neuropathy

PURPOSE

Exercise training have numerous beneficial effects on the complications of diabetic peripheral neuropathy. Exercise training may cause immediate effects on balance control in DPN patients. This study aims to assess the Acute Short Term effects of endurance and resistance exercise training on balance control in DPN patients.

METHODS

In this study, 11 patients with DPN and 11 healthy subjects participated. Patients and healthy subjects did endurance and resistance training in two separate exercise sessions. Dynamic balance and functional balance test were assessed before and after the interventions. Independent t-test was used to compare balance indices before and after training, the intervention effects were examined using ANOVA repeated measure test. The statistical significance level was set at p < 0.05.

RESULTS

The results showed that dynamic and functional balance in DPN patients were significantly lower than in healthy subjects. Anterior-posterior stability and total stability indices and functional balance test deteriorated significantly after training.

CONCLUSION

Endurance or resistance training may lead to acute disturbance of dynamic and functional balance in DPN patients. Hence, immediately after exercise, patients with diabetes are at an increased risk of falling, therefore, preventive considerations are necessary.

Effects of H-Reflex Onset Latency on Gait in Elderly and Hemiplegic Individuals

Background and Objectives: The Hoffmann’s reflex (H-reflex) is important in electrodiagnostic testing because it improves sensitivity and specificity in diagnosing radiculopathies. Although quantitative electromyography (EMG) measurements for H-reflex amplitudes during the gait cycle have been performed in both hemiplegic and healthy individuals, research on the H-wave latency in these individuals during the gait cycle is lacking. Materials and Methods: The H-reflex latency of the soleus muscle was investigated in hemiplegic stroke patients and healthy elderly persons in this observational analytical study. Two groups of individuals participated in this study: healthy adults (n = 25) and stroke patients with hemiplegia (n = 25) were compared. An MP150 with Ag-Ag/Cl electrodes was utilized to record and analyse electromyography measurements. All individuals could walk independently indoors. Stimuli were administered to elicit the H-reflex in the four gait phases as the participant walked. Results: Stroke patients had a significantly shorter latency than did healthy patients in the mid-swing, mid-stance, and toe-off phases of the gait cycle; heel-strike latency did not significantly differ. Conclusions: These results can be used as diagnostic data to help account for patient characteristics or measure the recovery extent for treatment planning and gait training in hemiplegic individuals.

Associations Between Lower Limb Isometric Torque, Isokinetic Torque, and Explosive Force With Phases of Reactive Stepping in Young, Healthy Adults

This study aimed to determine the relationship between lower limb muscle strength and explosive force with force plate-derived timing measures of reactive stepping. Nineteen young, healthy adults responded to 6 perturbations using an anterior lean-and-release system. Foot-off, swing, and restabilization times were estimated from force plates. Peak isokinetic torque, isometric torque, and explosive force of the knee extensors/flexors and plantar/dorsiflexors were measured using isokinetic dynamometry. Correlations were run based on a priori hypotheses and corrected for the number of comparisons (Bonferroni) for each variable. Knee extensor explosive force was negatively correlated with swing time (r = -.582, P = .009). Knee flexor peak isometric torque also showed a negative association with restabilization time (r = -.459, P = .048); however, this was not statistically significant after correcting for multiple comparisons. There was no significant relationship between foot-off time and knee or plantar flexor explosive force (P > .025). These findings suggest that there may be utility to identifying specific aspects of reactive step timing when studying the relationship between muscle strength and reactive balance control. Exercise training aimed at improving falls risk should consider targeting specific aspects of muscle strength depending on specific deficits in reactive stepping.

Comparison of the effects of visual feedback training and unstable surface training on static and dynamic balance in patients with stroke

[Purpose] This study compared the effects of visual feedback training and unstable surface training on the static and dynamic balance of stroke patients. [Subjects and Methods] The study enrolled 20 stroke patients and randomly assigned them to visual feedback training and unstable surface training groups. Both groups performed 30 minutes of conventional exercise therapy twice a week for 4 weeks. In addition, the subjects in the visual feedback training group completed a visual feedback training regimen and the subjects in the unstable surface training group completed training on an unstable surface (30-minute session three times a week for 4 weeks in both groups). Static and dynamic balance parameters were recorded immediately before and after the 4 weeks of training. For data analysis, the paired and independent t-test was used to compare the two groups. [Results] In the visual feedback training group, the sway line at the postural sway of the center of pressure and trace length decreased significantly after training. In both groups, the sway range at the limits of stability in the anteroposterior and mediolateral directions increased significantly after training. [Conclusion] Visual feedback training was better at improving static and dynamic balance than unstable surface training in stroke patients.

Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis

BACKGROUND

It has frequently been reported that balance and lower-extremity muscle strength/power are associated with sports-related and everyday activities. Knowledge about the relationship between balance, strength, and power are important for the identification of at-risk individuals because deficits in these neuromuscular components are associated with an increased risk of sustaining injuries and falls. In addition, this knowledge is of high relevance for the development of specifically tailored health and skill-related exercise programs.

OBJECTIVES

The objectives of this systematic literature review and meta-analysis were to characterize and, if possible, quantify associations between variables of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan.

DATA SOURCES

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus up to March 2015 to capture all relevant articles.

STUDY ELIGIBILITY CRITERIA

A systematic approach was used to evaluate the 996 articles identified for initial review. Studies were included only if they investigated healthy individuals aged ≥6 years and tested at least one measure of static steady-state balance (e.g., center of pressure [CoP] displacement during one-legged stance), dynamic steady-state balance (e.g., gait speed), proactive balance (e.g., distance in the functional-reach-test), or reactive balance (e.g., CoP displacement during perturbed one-legged stance), and one measure of maximal strength (e.g., maximum voluntary contraction), explosive force (e.g., rate of force development), or muscle power (e.g., jump height). In total, 37 studies met the inclusionary criteria for review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The included studies were coded for the following criteria: age (i.e., children: 6-12 years, adolescents: 13-18 years, young adults: 19-44 years, middle-aged adults: 45-64 years, old adults: ≥65 years), sex (i.e., female, male), and test modality/outcome (i.e., test for the assessment of balance, strength, and power). Studies with athletes, patients, and/or people with diseases were excluded. Pearson's correlation coefficients were extracted, transformed (i.e., Fisher's z-transformed r z value), aggregated (i.e., weighted mean r z value), back-transformed to r values, classified according to their magnitude (i.e., small: r ≤ 0.69, medium: r ≤ 0.89, large: r ≥ 0.90), and, if possible, statistically compared. Heterogeneity between studies was assessed using I2 and Chi-squared (χ2) statistics.

RESULTS

Three studies examined associations between balance and lower-extremity muscle strength/power in children, one study in adolescents, nine studies in young adults, three studies in middle-aged adults, and 23 studies in old adults. Overall, small-sized associations were found between variables of balance and lower-extremity muscle strength/power, irrespective of the age group considered. In addition, small-sized but significantly larger correlation coefficients were found between measures of dynamic steady-state balance and maximal strength in children (r = 0.57) compared with young (r = 0.09, z = 3.30, p = 0.001) and old adults (r = 0.35, z = 2.94, p = 0.002) as well as in old compared with young adults (z = 1.95, p = 0.03).

LIMITATIONS

Even though the reported results provided further insight into the associations between measures of balance and lower-extremity muscle strength/power, they did not allow us to deduce cause and effect relations. Further, the investigated associations could be biased by other variables such as joint flexibility, muscle mass, and/or auditory/visual acuity.

CONCLUSIONS

Our systematic review and meta-analysis showed predominately small-sized correlations between measures of balance and lower-extremity muscle strength/power in children, adolescents, and young, middle-aged, and old adults. This indicates that these neuromuscular components are independent of each other and should therefore be tested and trained complementarily across the lifespan. Significantly larger but still small-sized associations were found between measures of dynamic steady-state balance and maximal strength in children compared with young and old adults as well as in old compared with young adults. These findings imply that age/maturation may have an impact on the association of selected components of balance and lower-extremity muscle strength.

Which muscles compromise human locomotor performance with age?

Ageing leads to a progressive decline in human locomotor performance. However, it is not known whether this decline results from reduced joint moment and power generation of all lower limb muscle groups or just some of them. To further our understanding of age-related locomotor decline, we compare the amounts of joint moments and powers generated by lower limb muscles during walking (self-selected), running (4 m s(-1)) and sprinting (maximal speed) among young, middle-aged and old adults. We find that age-related deficit in ankle plantarflexor moment and power generation becomes more severe as locomotion change from walking to running to sprinting. As a result, old adults generate more power at the knee and hip extensors than their younger counterparts when walking and running at the same speed. During maximal sprinting, young adults with faster top speeds demonstrate greater moments and powers from the ankle and hip joints, but interestingly, not from the knee joint when compared with the middle-aged and old adults. These findings indicate that propulsive deficit of ankle contributes most to the age-related locomotor decline. In addition, reduced muscular output from the hip rather than from knee limits the sprinting performance in older age.

Age-related neuromuscular function and dynamic balance control during slow and fast balance perturbations

This study investigated age-related differences in dynamic balance control and its connection to reflexes and explosive isometric plantar flexor torque in 19 males (9 Young aged 20–33 yr, 10 Elderly aged 61–72 yr). Dynamic balance was measured during Slow (15 cm/s) and Fast (25 cm/s) anterior and posterior perturbations. H/M-ratio was measured at 20% of maximal M-wave (H/M20%) 10, 30, and 90 ms after perturbations. Stretch reflexes were measured from tibialis anterior and soleus during anterior and posterior perturbations, respectively. In Slow, Elderly exhibited larger peak center-of-pressure (COP) displacement (15%; P < 0.05) during anterior perturbations. In Fast, Young showed a trend for faster recovery (37%; P = 0.086) after anterior perturbations. M-wave latency was similar between groups (6.2 ± 0.7 vs. 6.9 ± 1.2 ms), whereas Elderly showed a longer H-reflex latency (33.7 ± 2.3 vs. 36.4 ± 1.7 ms; P < 0.01). H/M20% was higher in Young 30 ms after Fast anterior (50%; P < 0.05) and posterior (51%; P < 0.05) perturbations. Plantar flexor rapid torque was also higher in Young (26%; P < 0.05). After combining both groups' data, H/M20% correlated negatively with Slow peak COP displacement ( r = −0.510, P < 0.05) and positively with Fast recovery time ( r = 0.580, P < 0.05) for anterior perturbations. Age-related differences in balance control seem to be more evident in anterior than posterior perturbations, and rapid sensory feedback is generally important for balance perturbation recovery.

Motor unit firing behaviour of soleus muscle in isometric and dynamic contractions

INTRODUCTION

Understanding the detailed control of human locomotion and balance can be improved, when individual motor units can be isolated and their firing rates followed in natural movement of large, fuctionally important muscles. For this reason the present study investigated the motor unit discharge rate (MUDR) in isometric and dynamic contractions of the soleus muscle.

METHODS

Eleven males performed isometric (10-100% MVC) and dynamic (10-40% MVC) plantar flexions. Intramuscular EMG was measured from Soleus with bipolar wire-electrodes and decomposed with custom built "Daisy" software.

RESULTS

The Soleus MUDR was significantly higher in concentric compared to isometric or eccentric contractions at all submaximal force levels (P<0.05). In isometric contractions MUDR increased up to 100% MVC.

CONCLUSION

Motor unit discharge properties of a large plantarflexor can be measured in dynamic and maximal contractions. For a given torque output, MUDR is dependent upon contraction type, as set by the major mechanical differences between concentric and eccentric actions.

Test-retest reliability of the Sensory Organization Test in older persons with a transtibial amputation

OBJECTIVE

To determine the test-retest reliability of the Sensory Organization Test (SOT) in older persons with a unilateral transtibial amputation.

DESIGN

Cross-sectional observational study with repeated measures.

SETTING

A University balance laboratory.

PARTICIPANTS

Fifteen participants (12 men and 3 women) who had undergone a unilateral transtibial amputation that was performed as a result of either trauma or complications of diabetes or peripheral vascular disease were recruited from a patient database. The mean age of the participants was 69.53 years (SD, 6.60), with 11.94 mean years of prosthetic use.

INTERVENTION

All participants completed 3 trials of the 6 balance testing conditions in the standard SOT protocol with use of the NeuroCom SMART Equitest system on 2 occasions approximately 2 weeks apart.

MAIN OUTCOME MEASURES

Reliability of the mean equilibrium and strategy scores for the 6 SOT conditions and the overall composite score was evaluated using intraclass correlation coefficients.

RESULTS

The test-retest reliability coefficients (intraclass correlation coefficient model 2,1) for the equilibrium scores ranged from 0.67-0.90 for conditions 1 to 4 and 6, indicating fair-to-good reliability. The coefficients obtained for the strategy scores of all the conditions and the composite score showed excellent reliability (intraclass correlation coefficients >0.75).

CONCLUSIONS

This study suggests that the majority of outcome measurements associated with the SOT protocol on the SMART Equitest provide a reliable measure of dynamic balance performance in older persons with a unilateral transtibial amputation, even in the presence of comorbidities. The equilibrium, strategy, and composite scores obtained from the testing protocol with the exception of condition 5, can be used reliably in clinical practice to monitor for changes in balance with rehabilitation or to monitor the effects of a specific intervention and/or in patients with comorbidities that could potentially affect their balance capacities.