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Faria JO, Favretto MEC, Bezerra IS, Santos TF, Lemos TW, Junqueira EB, Santiago PRP, Moraes R. Effect of a Perturbation-Based Balance Training Session on Adaptive Locomotor Response in Older Adults With a History of Falls. Motor Control 2024:1-16. [PMID: 39179222 DOI: 10.1123/mc.2023-0147] [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: 12/17/2023] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 08/26/2024]
Abstract
AIM To assess the adaptive response of older adults with a history of falls in a single Perturbation-Based Balance Training (PBT) session by examining the margin of stability (MoS) and the number of falls. METHODS Thirty-two older adults with a history of falls underwent a treadmill walking session lasting 20-25 min. During the PBT protocol, participants experienced 24 unexpected perturbations delivered in two ways: acceleration or deceleration of the treadmill belt, with 12 perturbations in each direction. The MoS in the anteroposterior direction was assessed for the first and last perturbations of the session, during the perturbation step (N) and the recovery step (REC), along with the number of falls during the training session. RESULTS There was no statistically significant difference in MoS between the first and last perturbations (acceleration and deceleration) for steps N and REC. Regarding the number of falls, a significant reduction was found when comparing the first half with the second half of the training session (p = .033). There were 13 falls in the first half and only three in the second half of the PBT session. CONCLUSION Older adults with a history of falls exhibited an adaptive response with a reduction in the number of falls during a single session of PBT despite not showing changes in the MoS.
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Affiliation(s)
- Júlia O Faria
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria E C Favretto
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Isadora S Bezerra
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Thiago F Santos
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Tenysson W Lemos
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Eduardo B Junqueira
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo R P Santiago
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Renato Moraes
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Handelzalts S, Soroker N, Melzer I. Characteristics of unsuccessful reactive responses to lateral loss of balance in people with stroke. Neurol Res 2024:1-10. [PMID: 39168452 DOI: 10.1080/01616412.2024.2394327] [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: 01/22/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE The effectiveness of reactive responses to a sudden loss of balance is a critical factor that determines whether a fall will occur. We examined the strategies and kinematics associated with successful and unsuccessful balance recovery following lateral loss of balance in people with stroke (PwS). METHODS Eleven PwS were included in the analysis. They were exposed to unannounced right and left horizontal surface translations and demonstrated both successful and unsuccessful balance responses at the same perturbation magnitude. Reactive step strategies and kinematics were investigated comparatively in successful and unsuccessful recovery tests. RESULTS The crossover strategy was used in most of the unsuccessful tests (7/11) while the unloaded-leg side-step in the successful tests (6/11). There were no significant differences in the reactive step initiation time in unsuccessful vs. successful tests. However, the step execution time, step length and center of mass displacement were significantly higher during the first recovery step in unsuccessful tests. CONCLUSIONS PwS have difficulties in controlling and decelerating the moving center of mass following a lateral loss of balance. The increased step time and step length of the first reactive step in unsuccessful vs. successful tests suggest the crossover step strategy may be ineffective for PwS.
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Affiliation(s)
- Shirley Handelzalts
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Physical Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Nachum Soroker
- Neurological Rehabilitation Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Benn NL, Jervis-Rademeyer H, Souza WH, Pakosh M, Inness EL, Musselman KE. Balance Interventions to Improve Upright Balance Control and Balance Confidence in People With Motor-Incomplete Spinal Cord Injury or Disease: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01162-6. [PMID: 39111646 DOI: 10.1016/j.apmr.2024.07.013] [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: 02/09/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES To assist with clinical decision making, evidence syntheses are needed to demonstrate the efficacy of available interventions and examine the intervention components and dosage parameters. This systematic review and meta-analysis described the efficacy, components and dosage of interventions targeting upright balance control, balance confidence, and/or falls in adults with motor-incomplete spinal cord injury/disease (SCI/D). DATA SOURCES A search strategy following the population, intervention, control, outcome framework was developed. Six databases were searched: APA PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Embase, Emcare Nursing, Web of Science CC, and Medline. STUDY SELECTION Title, abstract, and full-text screening were conducted by 2 researchers independently. Inclusion criteria included the following: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls. DATA EXTRACTION Participant characteristics, balance intervention details, adverse events, and study results were extracted. The Downs and Black Checklist was used to assess methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to evaluate the quality of the evidence. DATA SYNTHESIS The search returned 1664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Minor adverse events were reported in 8 studies (eg, muscle soreness and fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls. CONCLUSIONS Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.
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Affiliation(s)
- Natasha L Benn
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | | | - Wagner H Souza
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Maureen Pakosh
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Elizabeth L Inness
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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4
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Arnal-Gómez A, Iosa M, Pérez-Alenda S, Cortés-Amador S. Validity of an android device for assessing mobility in people with chronic stroke and hemiparesis: a cross-sectional study. J Neuroeng Rehabil 2024; 21:54. [PMID: 38616288 PMCID: PMC11017601 DOI: 10.1186/s12984-024-01346-5] [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: 08/03/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Incorporating instrument measurements into clinical assessments can improve the accuracy of results when assessing mobility related to activities of daily living. This can assist clinicians in making evidence-based decisions. In this context, kinematic measures are considered essential for the assessment of sensorimotor recovery after stroke. The aim of this study was to assess the validity of using an Android device to evaluate kinematic data during the performance of a standardized mobility test in people with chronic stroke and hemiparesis. METHODS This is a cross-sectional study including 36 individuals with chronic stroke and hemiparesis and 33 age-matched healthy subjects. A simple smartphone attached to the lumbar spine with an elastic band was used to measure participants' kinematics during a standardized mobility test by using the inertial sensor embedded in it. This test includes postural control, walking, turning and sitting down, and standing up. Differences between stroke and non-stroke participants in the kinematic parameters obtained after data sensor processing were studied, as well as in the total execution and reaction times. Also, the relationship between the kinematic parameters and the community ambulation ability, degree of disability and functional mobility of individuals with stroke was studied. RESULTS Compared to controls, participants with chronic stroke showed a larger medial-lateral displacement (p = 0.022) in bipedal stance, a higher medial-lateral range (p < 0.001) and a lower cranio-caudal range (p = 0.024) when walking, and lower turn-to-sit power (p = 0.001), turn-to-sit jerk (p = 0.026) and sit-to-stand jerk (p = 0.001) when assessing turn-to-sit-to-stand. Medial-lateral range and total execution time significantly correlated with all the clinical tests (p < 0.005), and resulted significantly different between independent and limited community ambulation patients (p = 0.042 and p = 0.006, respectively) as well as stroke participants with significant disability or slight/moderate disability (p = 0.024 and p = 0.041, respectively). CONCLUSION This study reports a valid, single, quick and easy-to-use test for assessing kinematic parameters in chronic stroke survivors by using a standardized mobility test with a smartphone. This measurement could provide valid clinical information on reaction time and kinematic parameters of postural control and gait, which can help in planning better intervention approaches.
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Affiliation(s)
- M Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain.
| | - Anna Arnal-Gómez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
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Brough LG, Neptune RR. A comparison of the effects of mediolateral surface and foot placement perturbations on balance control and response strategies during walking. Gait Posture 2024; 108:313-319. [PMID: 38199090 DOI: 10.1016/j.gaitpost.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Balance perturbation studies during walking have improved our understanding of balance control in various destabilizing conditions. However, it is unknown to what extent balance recovery strategies can be generalized across different types of mediolateral balance perturbations. RESEARCH QUESTION Do similar mediolateral perturbations (foot placement versus surface translation) have similar effects on balance control and corresponding balance response strategies? METHODS Kinetic and kinematic data were previously collected during two separate studies, each with 15 young, healthy participants walking on an instrumented treadmill. In both studies, medial and lateral balance perturbations were applied at 80% of the gait cycle either by a treadmill surface translation or a pneumatic force applied to the swing foot. Differences in balance control (frontal plane whole body angular momentum) and balance response strategies (hip abduction moment, ankle inversion moment, center of pressure excursion and frontal plane trunk moment) between perturbed and unperturbed gait cycles were evaluated using statistical parametric mapping. RESULTS Balance disruptions after foot placement perturbations were larger and sustained longer compared to surface translations. Changes in joint moment responses were also larger for the foot placement perturbations compared to the surface translation perturbations. Lateral hip, ankle, and trunk strategies were used to maintain balance after medial foot placement perturbations, while a trunk strategy was primarily used after surface translations. SIGNIFICANCE Surface and foot placement perturbations influence balance control and corresponding response strategies differently. These results can help inform the development of perturbation-based balance training interventions aimed at reducing fall risk in clinical populations.
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Affiliation(s)
- Lydia G Brough
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA.
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Roelofs JMB, Zandvliet SB, Schut IM, Huisinga ACM, Schouten AC, Hendricks HT, de Kam D, Aerden LAM, Bussmann JBJ, Geurts ACH, Weerdesteyn V. Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity. Neurorehabil Neural Repair 2023; 37:786-798. [PMID: 37877724 PMCID: PMC10685695 DOI: 10.1177/15459683231207360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. Objective. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls. METHODS An observational case-control study was performed. Main outcomes included the Mini-Balance Evaluation Systems Test (mini-BEST), Timed Up and Go (TUG), 10-m Walking Test (10-MWT), and 6-item version Activity-specific Balance Confidence (6-ABC) scale which were measured in 1 session. Objectively measured daily physical activity was measured for 7 consecutive days. Fall rate in daily life was recorded for 12 months. Individuals after a mild stroke were considered eligible when they: (1) sustained a transient ischemic attack or stroke longer than 6 months ago, resulting in motor and/or sensory loss in the contralesional leg at the time of stroke, (2) showed (near-) complete motor function, that is, ≥24 points on the Fugl-Meyer Assessment-Lower Extremity (range: 0-28). RESULTS Forty-seven healthy controls and 70 participants after mild stroke were included. Participants with stroke fell more than twice as often as healthy controls, had a 2 point lower median score on the mini-BEST, were 1.7 second slower on TUG, 0.6 km/h slower on the 10-MWT, and had a 12% lower 6-ABC score. Intensity for both total activity (8%) as well as walking activity (6%) was lower in the participants with stroke, while no differences were found in terms of duration. CONCLUSIONS Individuals in the chronic phase after a mild stroke demonstrate persistent balance limitations and have an increased fall risk. Our results point at an unmet clinical need in this population.
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Affiliation(s)
- Jolanda M. B. Roelofs
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sarah B. Zandvliet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid M. Schut
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Alfred C. Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Henk T. Hendricks
- Department of Rehabilitation Medicine, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Digna de Kam
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo A. M. Aerden
- Department of Neurology, Reinier de Graafgasthuis, Delft, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research, Nijmegen, The Netherlands
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7
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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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Margalit N, Kurz I, Wacht O, Mansfield A, Melzer I. A survey of Israeli physical therapists regarding reactive balance training. BMC Geriatr 2023; 23:656. [PMID: 37833653 PMCID: PMC10571354 DOI: 10.1186/s12877-023-04356-5] [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: 09/24/2022] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND 'Reactive balance training' (RBT) was developed to improve balance reactions to unexpected losses of balance. Although this training method is effective, its practical usage in the field of physical-therapy in Israel and world-wide is still unclear. AIMS This study aimed to evaluate the extent of RBT use in physical-therapy clinics in Israel, to identify the significant barriers to/facilitators for implementing RBT in clinical practice among physical therapists, and to determine which aspects of RBT most interest physical therapists in Israel. METHODS Physical therapists in Israel completed a survey using a questionnaire regarding their knowledge and use of RBT in their clinical practices. We compared the specific use of RBT among users; non-users; and open-to-use physical therapists. The odds ratios of the facilitators and barriers were calculated using univariate and multivariate logistic regression models. RESULTS Four-hundred and two physical therapists responded to a yes/no question regarding their use of RBT. Three-quarters (75.4%) of physical therapists reported using RBT in their practices. The most prevalent barrier cited was insufficient space for setting up equipment and most prevalent facilitator was having a colleague who uses RBT. Most of the respondents wanted to learn more about RBT, and most of the non-users wanted to expand their knowledge and mastery of RBT principles. CONCLUSIONS There are misconceptions and insufficient knowledge about RBT among physical therapists in Israel, indicating that they may falsely believe that RBT requires large and expensive equipment, suggesting they categorize RBT as external perturbation training only. Reliable information may help to improve general knowledge regarding RBT, and to facilitate the more widespread implementation of RBT as an effective fall-prevention intervention method.
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Affiliation(s)
- Noam Margalit
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Ilan Kurz
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion University, Beer-Sheva, Israel
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Itshak Melzer
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel.
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9
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Brown D, Simpkins C, Yang F. A systematic review of perturbation-based balance training on reducing fall risk among individuals with stroke. Clin Biomech (Bristol, Avon) 2023; 109:106078. [PMID: 37647717 DOI: 10.1016/j.clinbiomech.2023.106078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Perturbation-based balance training has been proven effective to reduce falls in older adults. However, it remains inconclusive if this training paradigm reduces falls in the stroke population. This review sought to summarize the existing literature to assess the effects of perturbation-based balance training on falls and some common fall risk factors in people with stroke. METHODS Seven databases were searched for studies, which included at least one perturbation-based balance training group and a control group. The primary outcome was the proportion of fallers, and the secondary outcomes encompassed commonly used fall risk factors: balance, balance confidence, reactive stepping characteristics, functional mobility, and muscle strength. FINDINGS This review included nine studies that enrolled 364 participants. The training protocols were significantly heterogeneous among studies, with variations in the training duration, number of sessions, session length, and type of devices used. The results indicated insufficient evidence supporting that perturbation-based balance training reduces falls in the laboratory and everyday living conditions for people with stroke. Furthermore, the effects of perturbation-based balance training on fall risk factors are also inconsistent between studies. INTERPRETATION The existing evidence does not conclusively support the reduction in falls and improvements in fall risk factors resulting from perturbation-based balance training among people with stroke. Such an inconsistent finding could be due to the small sample sizes and variations in perturbation-based balance training protocols across studies. More high-quality studies are needed to further determine the effects of perturbation-based balance training on reducing fall risk in people with stroke.
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Affiliation(s)
- Diané Brown
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA.
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10
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Lutonsky C, Peham C, Mucha M, Reicher B, Gaspar R, Tichy A, Bockstahler B. External mechanical perturbations challenge postural stability in dogs. Front Vet Sci 2023; 10:1249951. [PMID: 37789869 PMCID: PMC10544342 DOI: 10.3389/fvets.2023.1249951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
This study aimed to explore the effect of external mechanical perturbations on postural stability (PS) in dogs using the body center of pressure (COP). Thirteen sound adult dogs were included in this study. PS was tested during quiet standing on a pressure measurement plate. The conditions included a standard standing measurement and external mechanical perturbations conducted using six settings on a motorized training platform with different intensities of speed and amplitude. Measurement conditions were compared using linear mixed-effects models, followed by multiple comparisons using Sidak's alpha correction procedure. Compared with the standing measurement, external mechanical perturbations resulted in a significant increase in almost all COP parameters, indicating a challenge for the PS. Furthermore, an increase in amplitude had a greater effect than an increase in speed, whereas the combination of the highest intensities of amplitude and speed was not well tolerated by the dogs. The mediolateral COP displacement was significantly greater than the craniocaudal COP displacement during standing measurement and conditions with a small amplitude, whereas no significant difference was observed during settings with an increased amplitude. To the best of our knowledge, this is the first study to demonstrate the effects of a balance training device in dogs. Therefore, the intensity of the training programs on motorized platforms or similar devices can be controlled by the wobbling amplitude of the platform.
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Affiliation(s)
- Christiane Lutonsky
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
| | - Christian Peham
- Department of Companion Animals and Horses, University Clinic for Horses, Movement Science Group, University of Veterinary Medicine, Vienna, Austria
| | - Marion Mucha
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
| | - Bianca Reicher
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
| | - Rita Gaspar
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, Bioinformatics and Biostatistics Platform, University of Veterinary Medicine, Vienna, Austria
| | - Barbara Bockstahler
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
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Bhatt T, Dusane S, Gangwani R, Wang S, Kannan L. Motor adaptation and immediate retention to overground gait-slip perturbation training in people with chronic stroke: an experimental trial with a comparison group. Front Sports Act Living 2023; 5:1195773. [PMID: 37780126 PMCID: PMC10533933 DOI: 10.3389/fspor.2023.1195773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Perturbation-based training has shown to be effective in reducing fall-risk in people with chronic stroke (PwCS). However, most evidence comes from treadmill-based stance studies, with a lack of research focusing on training overground perturbed walking and exploring the relative contributions of the paretic and non-paretic limbs. This study thus examined whether PwCS could acquire motor adaptation and demonstrate immediate retention of fall-resisting skills following bilateral overground gait-slip perturbation training. Methods 65 PwCS were randomly assigned to either (i) a training group, that received blocks of eight non-paretic (NP-S1 to NP-S8) and paretic (P-S1 to P-S8) overground slips during walking followed by a mixed block (seven non-paretic and paretic slips each interspersed with unperturbed walking trials) (NP-S9/P-S9 to NP-S15/P-S15) or (ii) a control group, that received a single non-paretic and paretic slip in random order. The assessor and training personnel were not blinded. Immediate retention was tested for the training group after a 30-minute rest break. Primary outcomes included laboratory-induced slip outcomes (falls and balance loss) and center of mass (CoM) state stability. Secondary outcomes to understand kinematic contributors to stability included recovery strategies, limb kinematics, slipping kinematics, and recovery stride length. Results PwCS within the training group showed reduced falls (p < 0.01) and improved post-slip stability (p < 0.01) from the first trial to the last trial of both paretic and non-paretic slip blocks (S1 vs. S8). During the mixed block training, there was no further improvement in stability and slipping kinematics (S9 vs. S15) (p > 0.01). On comparing the first and last training trial (S1 vs. S15), post-slip stability improved on both non-paretic and paretic slips, however, pre-slip stability improved only on the non-paretic slip (p < 0.01). On the retention trials, the training group had fewer falls and greater post-slip stability than the control group on both non-paretic and paretic slips (p < 0.01). Post-slip stability on the paretic slip was lower than that on the non-paretic slip for both groups on retention trials (p < 0.01). Conclusion PwCS can reduce laboratory-induced slip falls and backward balance loss outcomes by adapting their post-slip CoM state stability after bilateral overground gait-slip perturbation training. Such reactive adaptations were better acquired and retained post-training in PwCS especially on the non-paretic slips than paretic slips, suggesting a need for higher dosage for paretic slips. Clinical registry number NCT03205527.
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Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Rachana Gangwani
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- MS program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shuaijie Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Lakshmi Kannan
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
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Hu J, Jin L, Wang Y, Shen X. Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial. Front Neurol 2023; 14:1167261. [PMID: 37528855 PMCID: PMC10389716 DOI: 10.3389/fneur.2023.1167261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Background Treadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients. Objective To investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability. Methods For this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures. Results All participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05). Conclusion Challenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability.
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Affiliation(s)
- Jia Hu
- Medical Education Department, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Medical Education Department, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yubing Wang
- Rehabilitation Medicine Research Center, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Xia Shen
- Rehabilitation Medicine Research Center, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
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13
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Jagroop D, Aryan R, Schinkel-Ivy A, Mansfield A. Reliability of unconventional centre of pressure measures of quiet standing balance in people with chronic stroke. Gait Posture 2023; 102:159-163. [PMID: 37023563 DOI: 10.1016/j.gaitpost.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND People with stroke often have asymmetric motor impairment. Investigating asymmetries in, and dynamic properties of, centre of pressure movement during quiet standing can inform how balance is controlled. RESEARCH QUESTION What are the test-retest reliabilities of unconventional measures of quiet standing balance control in people with chronic stroke? METHODS Twenty people with chronic stroke (>6 months post-stroke), who were able to stand for at least 30 s without support, were recruited. Participants completed two 30-second quiet standing trials in a standardized position. Unconventional measures of quiet standing balance control included: symmetry of variability in centre of pressure displacement and velocity, between-limb synchronization, and sample entropy. Root mean square of centre of pressure displacement and velocity in the antero-posterior and medio-lateral directions were also calculated. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability, and Bland-Altman plots were created to examine proportional biases. RESULTS ICC3,2 were between 0.79 and 0.95 for all variables, indicating 'good' to 'excellent' reliability (>0.75). However, ICC3,1 for symmetry indices and between-limb synchronization were < 0.75. Bland-Altman plots revealed possible proportional biases for root mean square of medio-lateral centre of pressure displacement and velocity and between-limb synchronization, with larger between-trial differences for participants with worse values. SIGNIFICANCE These findings suggest that centre of pressure measures extracted from a single 30-second quiet standing trial may have sufficient reliability for some research studies in chronic stroke. However, for clinical applications, the average of at least two trials may be required.
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Affiliation(s)
- David Jagroop
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Raabeae Aryan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alison Schinkel-Ivy
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
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14
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Devasahayam AJ, Farwell K, Lim B, Morton A, Fleming N, Jagroop D, Aryan R, Saumur TM, Mansfield A. The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. Phys Ther 2022; 103:pzac154. [PMID: 37651698 DOI: 10.1093/ptj/pzac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/11/2022] [Accepted: 08/19/2022] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of RBT on falls in daily life among individuals at increased risk of falls and to document associated adverse events. METHODS Databases searched were Ovid MEDLINE (1946 to March 2022), Embase Classic and Embase (1947 to March 2022), Cochrane Central Register of Controlled Trials (2014 to March 2022), and Physiotherapy Evidence Database (PEDro; searched on 22 March 2022). Randomized controlled trials of RBT were included. The literature search was limited to the English language. Records were screened by 2 investigators separately. Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information. RESULTS Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events. Participants assigned to RBT groups were less likely to fall compared with control groups (fall risk ratio = 0.76; 95% CI = 0.63-0.92; I2 = 32%) and reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45-0.83; I2 = 81%). Prevalence of adverse events was higher in RBT (29%) compared with control groups (20%). CONCLUSION RBT reduced the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported in RBT than control groups. IMPACT Balance training that evokes balance reactions can reduce falls among people at increased risk of falls. Older adults and individuals with balance problems were less likely to fall in daily life after participating in RBT compared with traditional balance training. LAY SUMMARY If you are an older adult and/or have balance problems, your physical therapist may prescribe reactive balance training rather than traditional balance training in order to reduce your likelihood of falling in daily life.
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Affiliation(s)
| | - Kyle Farwell
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Bohyung Lim
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Abigail Morton
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Fleming
- École de Readaptation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- École de Kinésiologie et de Loisir, Université de Moncton, Moncton, New Brunswick, Canada
| | - David Jagroop
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Raabeae Aryan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Tyler Mitchell Saumur
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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15
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Jagroop D, Houvardas S, Danells CJ, Kochanowski J, French E, Salbach NM, Musselman K, Inness EL, Mansfield A. Rehabilitation clinicians' perspectives of reactive balance training. Disabil Rehabil 2022; 44:7967-7973. [PMID: 34812700 DOI: 10.1080/09638288.2021.2004246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Reactive balance training (RBT) aims to improve reactive balance control. However, because RBT involves clients losing balance, clinicians may view that it is unsafe or not feasible for some clients. We aimed to explore how clinicians implement RBT to treat balance and mobility issues. MATERIALS AND METHODS Physiotherapists and kinesiologists across Canada who reported that they include RBT in their practices were invited to complete telephone interviews about their experiences with RBT. Interviews were transcribed verbatim, and analysed using a deductive thematic analysis. RESULTS Ten participants completed telephone interviews, which lasted between 30-60 min. Participants primarily worked in a hospital setting (inpatient rehabilitation (n = 3); outpatient rehabilitation (n = 2)), and were treated clients with neurological conditions (n = 5). Four main themes were identified: 1) there is variability in RBT approaches; 2) knowledge can be a barrier and facilitator to RBT; 3) reactive balance control is viewed as an advanced skill; and 4) RBT experience builds confidence. CONCLUSIONS Our findings suggest a need for resources to make clinical implementation of RBT more feasible.Implications for rehabilitationTrust between the therapist and client improves self-efficacy and feelings of apprehension/fear when conducting reactive balance training.Being creative and improvising with equipment that is readily available in clinics enables reactive balance training, without the need for high-tech equipment.Clinicians should consider using standardized tools with reactive balance control components, such as the Balance Evaluation Systems Test or Performance Oriented Mobility Assessment, to assess balance control.
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Affiliation(s)
- David Jagroop
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Esmé French
- Northwestern Ontario Regional Stroke Network, Thunder Bay, Canada
| | - Nancy M Salbach
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Faculty of Kinesiology, University of Toronto, Toronto, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada.,Evaluative Clinical Sciences, Hurvtiz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
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Staring WHA, van Duijnhoven HJR, Roelofs JMB, Zandvliet S, den Boer J, Lem FC, Geurts ACH, Weerdesteyn V. Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke. Front Sports Act Living 2022; 4:1008236. [DOI: 10.3389/fspor.2022.1008236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
IntroductionPeople with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people with chronic stroke after PBT on the level of recruitment of automatic postural responses (APR), step parameters and step quality. In addition, we provide insight into possible correlations across these outcomes and their changes after PBT.MethodsWe performed a complementary analysis of a recent PBT study. Participants received a 5-week PBT on the Radboud Fall simulator. During pre- and post-intervention assessments participants were exposed to platform translations in forward and backward directions. We performed electromyography of lower leg muscles to identify changes in APR recruitment. In addition, 3D kinematic data of stepping behavior was collected. We determined pre-post changes in muscle onset, magnitude and modulation of recruitment, step characteristics, and step quality. Subsequently, we determined whether improvements in step or muscle characteristics were correlated with improved step quality.ResultsWe observed a faster gastrocnemius muscle onset in the stance and stepping leg during backward stepping. During forward stepping we found a trend toward a faster tibialis anterior muscle onset in the stepping leg. We observed no changes in modulation or magnitude of muscle recruitment. Leg angles improved by 2.3° in forward stepping and 2.5° in backward stepping. The improvement in leg angle during forward stepping was accompanied by a −4.1°change in trunk angle, indicating a more upright position. Step length, duration and velocity improved in both directions. Changes in spatiotemporal characteristics were strongly correlated with improvements in leg angle, but no significant correlations were observed of muscle onset or recruitment with leg or trunk angle.ConclusionPBT leads to a multi-factorial improvement in onset of APR, spatiotemporal characteristics of stepping, and reactive step quality in people with chronic stroke. However, current changes in APR onset were not correlated with improvement in step quality. Therefore, we suggest that, in addition to spatiotemporal outcomes, other characteristics of muscle recruitment or behavioral substitution may induce step quality improvement after PBT.
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McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR, Okubo Y. Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front Sports Act Living 2022; 4:1015394. [PMID: 36275443 PMCID: PMC9583884 DOI: 10.3389/fspor.2022.1015394] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tanvi S. Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Marissa H. G. Gerards
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Mark W. Rogers
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Taylor Z, Walsh GS, Hawkins H, Inacio M, Esser P. Perturbations during Gait: A Systematic Review of Methodologies and Outcomes. SENSORS (BASEL, SWITZERLAND) 2022; 22:5927. [PMID: 35957484 PMCID: PMC9371403 DOI: 10.3390/s22155927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite extensive literature regarding laboratory-based balance perturbations, there is no up-to-date systematic review of methods. This systematic review aimed to assess current perturbation methods and outcome variables used to report participant biomechanical responses during walking. METHODS Web of Science, CINAHL, and PubMed online databases were searched, for records from 2015, the last search was on 30th of May 2022. Studies were included where participants were 18+ years, with or without clinical conditions, conducted in non-hospital settings. Reviews were excluded. Participant descriptive, perturbation method, outcome variables and results were extracted and summarised. Bias was assessed using the Appraisal tool for Cross-sectional Studies risk of bias assessment tool. Qualitative analysis was performed as the review aimed to investigate methods used to apply perturbations. RESULTS 644 records were identified and 33 studies were included, totaling 779 participants. The most frequent method of balance perturbation during gait was by means of a treadmill translation. The most frequent outcome variable collected was participant step width, closely followed by step length. Most studies reported at least one spatiotemporal outcome variable. All included studies showed some risk of bias, generally related to reporting of sampling approaches. Large variations in perturbation type, duration and intensity and outcome variables were reported. CONCLUSIONS This review shows the wide variety of published laboratory perturbation methods. Moreover, it demonstrates the significant impact on outcome measures of a study based on the type of perturbation used. REGISTRATION PROSPERO ID: CRD42020211876.
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Affiliation(s)
- Zoe Taylor
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford OX3 0BP, UK
- Department of Sport Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 0BP, UK
| | - Gregory S. Walsh
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford OX3 0BP, UK
- Department of Sport Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 0BP, UK
| | - Hannah Hawkins
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford OX3 0BP, UK
- Department of Sport Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 0BP, UK
| | - Mario Inacio
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford OX3 0BP, UK
- Research Centre in Sport Sciences, Health Sciences and Human Development, University Institute of Maia, 4475-690 Maia, Portugal
| | - Patrick Esser
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford OX3 0BP, UK
- Department of Sport Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 0BP, UK
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Okubo Y, Duran L, Delbaere K, Sturnieks DL, Richardson JK, Pijnappels M, Lord SR. Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study. J Geriatr Phys Ther 2022; 45:160-166. [PMID: 34320534 DOI: 10.1519/jpt.0000000000000312] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips. METHODS Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls. RESULTS Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls. CONCLUSION Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
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Affiliation(s)
- Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
| | - Lionne Duran
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
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Wang Y, Wang S, Liu X, Lee A, Pai YC, Bhatt T. Can a single session of treadmill-based slip training reduce daily life falls in community-dwelling older adults? A randomized controlled trial. Aging Clin Exp Res 2022; 34:1593-1602. [PMID: 35237948 DOI: 10.1007/s40520-022-02090-3] [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: 01/15/2022] [Accepted: 02/01/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Task-specific training with single-session overground slip simulation has shown to reduce real-life falls in older adults. AIMS The purpose of this study was to determine if fall-resisting behavior acquired from a single-session treadmill-based gait slip training could be retained to reduce older adults' falls in everyday living over a 6-month follow-up period. METHODS 143 community-dwelling older adults (≥ 65 years old) were randomly assigned to either the treadmill-based gait slip training group (N = 73), in which participants were exposed to 40 unpredictable treadmill slips, or the control group (N = 70), in which participants walked on a treadmill at their comfortable speed. Participants reported their falls from the preceding year (through self-report history) and over the following 6 months (through fall diaries and monitored with phone calls). RESULTS There was no main effect of time (retrospective vs. prospective fall) and training (treadmill training vs. control) on fall reduction (p > 0.05 for both). The survival distributions of event of all-cause falls or slip falls were comparable between groups (p > 0.05 for both). DISCUSSION Unlike overground slip training where a single training session could significantly reduce everyday falls in a 6-month follow-up period, the results indicated that one treadmill-based gait slip training session by itself was unable to produce similar effects. CONCLUSION Further modification of the training protocol by increasing training dosage (e.g., number of sessions or perturbation intensity) may be necessary to enhance transfer to daily living. This study (NCT02126488) was registered on April 30, 2014.
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Boerger TF, McGinn L, Wang MC, Schmit BD, Hyngstrom AS. Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability. J Neurophysiol 2022; 127:673-688. [PMID: 35080466 PMCID: PMC8897012 DOI: 10.1152/jn.00159.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to quantify balance impairments in standing in people with degenerative cervical myelopathy (PwDCM) in response to external perturbations. PwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. Balance was quantified by capturing kinetics, kinematic, and electromyographic data during standing in response to lateral waist pulls. Participants received pulls during predictable and unpredictable contexts in three stance widths at two magnitudes. In response to lateral waist pulls, PwDCM had larger center of mass excursion (P < 0.001) and delayed gluteus medius electromyography onset (P < 0.001) and peak (P < 0.001) timing. These main effects of history of myelopathy were consistent across predictability, stance width, and magnitude. A multilinear regression determined that gluteus medius peak timing + tibialis anterior peak timing most strongly predicted center of mass excursion (R2 = 0.50, P < 0.001). These data suggest that PwDCM have delays in generating voluntary and reactive motor commands, contributing to balance impairments. Future rehabilitation strategies should focus on generating rapid muscular contractions. Additionally, frontal plane postural control is regulated by the gluteus medius and the tibialis anterior, whereas other muscles (e.g. gluteus minimus, ankle invertors/evertors) not studied here may also contribute.NEW & NOTEWORTHY Frontal plane reactive postural control is impaired in persons with degenerative cervical myelopathy because of delayed muscle responses. Additionally, postural control varies across stance width, predictability, and perturbation magnitude.
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Affiliation(s)
- T. F. Boerger
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L. McGinn
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - M. C. Wang
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B. D. Schmit
- 3Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - A. S. Hyngstrom
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
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22
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Nevisipour M, Honeycutt CF. Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke. Gait Posture 2022; 92:144-152. [PMID: 34847412 PMCID: PMC8900662 DOI: 10.1016/j.gaitpost.2021.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle-foot-orthoses (AFOs) and functional electrical stimulators (FES) are commonly prescribed to treat foot-drop in individuals with stroke. Despite well-established positive impacts of AFO and FES devices on balance and gait, AFO and FES-users still fall at a high rate. OBJECTIVE The objective of this study was to investigate 1) the underlying biomechanical mechanisms leading to a fall in long-term AFO and FES-users with chronic stroke and 2) the impacts of AFOs and FES devices on fall outcomes and compensatory stepping response of long-term users with chronic stroke. METHODS Fall outcomes as well as kinematics and kinetics of compensatory stepping response of 42 individuals with chronic stroke (14 AFO-users, 10 FES-users, 18 Non-users) were evaluated during trip-like treadmill perturbations. AFO and FES-users were evaluated with and without their device. RESULTS Chronic AFO and FES-users fell 2.50 and 2.77 times more than Non-users. The most robust differences between AFO/FES-users and Non-users were 1) Reduced capacity to stabilize the trunk through reduction in forward whole-body angular momentum and 2) diminished capability to prepare and generate a second step using the paretic leg. Provocatively, the removal of AFO and FES devices did not decease/increase falls or change kinematics. SIGNIFICANCE It is well-established that AFOs/FES devices have a positive impact on static balance and decrease community falls by increasing toe clearance thus preventing trips/stumbles. However, our results suggest that once a trip occurs, these devices do not adequately assist recovery of balance. Specifically, current AFO and FES devices do not assist with second step generation or trunk control. Future studies should explore new devices or training paradigms that target enhancing trunk control and paretic compensatory stepping to decrease falls in this population.
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Affiliation(s)
- Masood Nevisipour
- School for Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Claire F. Honeycutt
- School of Biological and Health System Engineering, Arizona State University, Tempe, AZ, USA
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Meyer A, Hrdlicka HC, Cutler E, Hellstrand J, Meise E, Rudolf K, Grevelding P, Nankin M. Preliminary Evaluation of a Novel Body-Weight Supported Postural Perturbation Module for Gait and Balance Rehabilitation after Stroke. JMIR Rehabil Assist Technol 2022; 9:e31504. [PMID: 35080495 PMCID: PMC8924779 DOI: 10.2196/31504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/30/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161
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Affiliation(s)
- Amanda Meyer
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Henry Charles Hrdlicka
- Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Erica Cutler
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Jill Hellstrand
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Emily Meise
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Kaitlyn Rudolf
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Pete Grevelding
- Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Matthew Nankin
- Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, US
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Moghadas Tabrizi Y, Mansori MH, Karimizadeh Ardakani M. Postural control and risk of falling in people who are blind: The effect and durability of perturbation and vestibular exercises. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/02646196211067355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare the effect and durability of perturbation and vestibular exercises on balance and the risk of falling in people with visual impairment (VI). Thirty-six men with VI were divided into three groups, including a control and two experimental (perturbation and vestibular) groups. The experimental groups performed perturbation and vestibular exercises for 4 weeks and three sessions per week. Biodex balance system was used to assess balance and falling risk before and after training interventions. To evaluate the effects within and between groups at three levels of measurement: pre-test, post-test, and durability effect between three groups, repeated measures analysis of variance (ANOVA) and one-way ANOVA were used. Repeated measures ANOVA test showed that both experimental groups showed significant improvements in static balance, dynamic balance, and falling risk. In comparison between the groups, the results showed that in the post-test and durability stages, there was a significant difference between the groups and the perturbation exercise group had a greater effect on the dependent variables. Due to the effectiveness of exercises, it is recommended that people with VI pay attention to balance-based perturbation exercises to strengthen the somatosensory system and vestibular exercises to strengthen the vestibular system.
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Phu S, Sturnieks DL, Lord SR, Okubo Y. Impact of ageing, fall history and exercise on postural reflexes following unpredictable perturbations: A systematic review and meta-analyses. Mech Ageing Dev 2022; 203:111634. [DOI: 10.1016/j.mad.2022.111634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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Alayat MSM, Almatrafi NA, El Fiky AAR, Elsodany AM, Shousha TM, Basuodan R. The Effectiveness of Perturbation-Based Training in the Treatment of Patients With Stroke: A Systematic Review and Meta-Analysis. Neurosci Insights 2022; 17:26331055221114818. [PMID: 35910084 PMCID: PMC9329815 DOI: 10.1177/26331055221114818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To investigate the effectiveness of perturbation-based training (PBT) on balance and balance confidence in patients with stroke. Methods: Systematic searching was performed from inception to November 2021. The inclusion criteria were RCTs assessed the effectiveness of PBT in patients with stroke. Data regarding participants, intervention parameters, outcome measures, follow-up, and main results were extracted. The outcomes were balance and balance confidence. Methodological quality and quality of evidence were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system; respectively. Data analysis: A total of 7 articles )271 patients) were included. A meta-analysis using a random-effect model was performed on 6 studies. Standardized mean difference (SMD) with a 95% confidence interval was calculated for balance and balance confidence. Results: PEDro scale revealed 5 good-quality and 2 fair-quality studies. The currently available evidence showed significant effect of PBT in improving balance (SMD 0.60 [95% CI 0.15-1.06]; P = .01; very low-quality evidence) and non-significant in improving balance confidence (SMD 0.11 [95% CI −0.24 to 0.45]; P = .55; low-quality evidence). Conclusion: PBT may improve balance in patients with stroke, however its effect on balance confidence was limited. The quality of the evidence was low or very low with little confidence in the effect estimate, which suggests further high-quality trials are required. Registration: PROSPERO registration number (CRD42021291474).
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Affiliation(s)
- Mohamed Salaheldien Mohamed Alayat
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
| | - Nahla Ahmad Almatrafi
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amir Abdel Raouf El Fiky
- Department of Physical Therapy for Neurological Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Tamer Mohamed Shousha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Reem Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University Riyadh, Saudi Arabia
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27
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Munoz-Martel V, Santuz A, Bohm S, Arampatzis A. Proactive Modulation in the Spatiotemporal Structure of Muscle Synergies Minimizes Reactive Responses in Perturbed Landings. Front Bioeng Biotechnol 2021; 9:761766. [PMID: 34976964 PMCID: PMC8716881 DOI: 10.3389/fbioe.2021.761766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Stability training in the presence of perturbations is an effective means of increasing muscle strength, improving reactive balance performance, and reducing fall risk. We investigated the effects of perturbations induced by an unstable surface during single-leg landings on the mechanical loading and modular organization of the leg muscles. We hypothesized a modulation of neuromotor control when landing on the unstable surface, resulting in an increase of leg muscle loading. Fourteen healthy adults performed 50 single-leg landings from a 30 cm height onto two ground configurations: stable solid ground (SG) and unstable foam pads (UG). Ground reaction force, joint kinematics, and electromyographic activity of 13 muscles of the landing leg were measured. Resultant joint moments were calculated using inverse dynamics and muscle synergies with their time-dependent (motor primitives) and time-independent (motor modules) components were extracted via non-negative matrix factorization. Three synergies related to the touchdown, weight acceptance, and stabilization phase of landing were found for both SG and UG. When compared with SG, the motor primitive of the touchdown synergy was wider in UG (p < 0.001). Furthermore, in UG the contribution of gluteus medius increased (p = 0.015) and of gastrocnemius lateralis decreased (p < 0.001) in the touchdown synergy. Weight acceptance and stabilization did not show any statistically significant differences between the two landing conditions. The maximum ankle and hip joint moment as well as the rate of ankle, knee, and hip joint moment development were significantly lower (p < 0.05) in the UG condition. The spatiotemporal modifications of the touchdown synergy in the UG condition highlight proactive adjustments in the neuromotor control of landings, which preserve reactive adjustments during the weight acceptance and stabilization synergies. Furthermore, the performed proactive control in combination with the viscoelastic properties of the soft surface resulted in a reduction of the mechanical loading in the lower leg muscles. We conclude that the use of unstable surfaces does not necessarily challenge reactive motor control nor increase muscle loading per se. Thus, the characteristics of the unstable surface and the dynamics of the target task must be considered when designing perturbation-based interventions.
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Affiliation(s)
- Victor Munoz-Martel
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Adamantios Arampatzis,
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28
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Mang CS, Peters S. Advancing motor rehabilitation for adults with chronic neurological conditions through increased involvement of kinesiologists: a perspective review. BMC Sports Sci Med Rehabil 2021; 13:132. [PMID: 34689800 PMCID: PMC8542408 DOI: 10.1186/s13102-021-00361-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022]
Abstract
Many people with neurological conditions experience challenges with movement. Although rehabilitation is often provided acutely and sub-acutely following the onset of a condition, motor deficits commonly persist in the long-term and are exacerbated by disuse and inactivity. Notably, motor rehabilitation approaches that incorporate exercise and physical activity can support gains in motor function even in the chronic stages of many neurological conditions. However, delivering motor rehabilitation on a long-term basis to people with chronic neurological conditions is a challenge within health care systems, and the onus is often placed on patients to find and pay for services. While neurological motor rehabilitation is largely the domain of physical and occupational therapists, kinesiologists may be able to complement existing care and support delivery of long-term neurological motor rehabilitation, specifically through provision of supported exercise and physical activity programs. In this perspective style review article, we discuss potential contributions of kinesiologists to advancing the field through exercise programming, focusing on community-based interventions that increase physical activity levels. We conclude with recommendations on how kinesiologists' role might be further optimized towards improving long-term outcomes for people with chronic neurological conditions, considering issues related to professional regulation and models of care.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - Sue Peters
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada
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29
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Song PYH, Sturnieks DL, Davis MK, Lord SR, Okubo Y. Perturbation-Based Balance Training Using Repeated Trips on a Walkway vs. Belt Accelerations on a Treadmill: A Cross-Over Randomised Controlled Trial in Community-Dwelling Older Adults. Front Sports Act Living 2021; 3:702320. [PMID: 34490425 PMCID: PMC8417700 DOI: 10.3389/fspor.2021.702320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Walkway and treadmill induced trips have contrasting advantages, for instance walkway trips have high-ecological validity whereas belt accelerations on a treadmill have high-clinical feasibility for perturbation-based balance training (PBT). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway. Method: Thirty-eight healthy community-dwelling older adults underwent one session each of walkway and treadmill PBT in a randomised crossover design on a single day. For both conditions, 11 trips were induced to either leg in pseudo-random locations interspersed with 20 normal walking trials. Dynamic balance (e.g., margin of stability) and gait (e.g., step length) parameters from 3D motion capture were used to examine adaptations in the walkway and treadmill PBT and transfer of adaptation from treadmill PBT to a walkway trip. Results: No changes were observed in normal (no-trip) gait parameters in both training conditions, except for a small (0.9 cm) increase in minimum toe elevation during walkway walks (P < 0.01). An increase in the margin of stability and recovery step length was observed during walkway PBT (P < 0.05). During treadmill PBT, an increased MoS, step length and decreased trunk sway range were observed (P < 0.05). These adaptations to treadmill PBT did not transfer to a walkway trip. Conclusions: This study demonstrated that older adults could learn to improve dynamic stability by repeated exposure to walkway trips as well as treadmill belt accelerations. However, the adaptations to treadmill belt accelerations did not transfer to an actual trip. To enhance the utility of treadmill PBT for overground trip recovery performance, further development of treadmill PBT protocols is recommended to improve ecological authenticity.
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Affiliation(s)
- Patrick Y H Song
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Michael K Davis
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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30
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Zadravec M, Olenšek A, Rudolf M, Bizovičar N, Goljar N, Matjačić Z. Toward improving the specificity of perturbation-based training through assessment of dynamic balancing responses: a series of N-of-1 studies in subacute stroke. Int J Rehabil Res 2021; 44:276-281. [PMID: 34138802 DOI: 10.1097/mrr.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perturbation-based balance training (PBT) has been shown to improve reactive balancing abilities in chronic stroke. To inform future investigations in the subacute phase of stroke, the objective of this series of N-of-1 studies was to investigate the range of balancing responses to unexpected mechanical perturbations applied to the pelvis during walking on an instrumented treadmill before and after PBT training. Three subacute stroke subjects were assessed on each occasion with clinical tests and biomechanical measurements following perturbations applied in forward, backward, inward and outward directions. After 15 daily sessions of PBT, most clinical mobility outcomes showed improvements in all three subjects. Assessment of reactive balancing also showed improvements in all subjects when responding to perturbations in backward and inward directions whereas the changes following perturbations in forward and outward directions were subject-specific. The results suggest that PBT should be individually tailored to target balance deficiencies identified through a serial biomechanical assessment.
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Affiliation(s)
- Matjaž Zadravec
- Research and Development Unit, University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia
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31
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Dusane S, Bhatt T. Effect of Multisession Progressive Gait-Slip Training on Fall-Resisting Skills of People with Chronic Stroke: Examining Motor Adaptation in Reactive Stability. Brain Sci 2021; 11:brainsci11070894. [PMID: 34356128 PMCID: PMC8303184 DOI: 10.3390/brainsci11070894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 01/28/2023] Open
Abstract
Background: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). Methods: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed on six intensities of gait-slips (levels 1–6). Training consisted of 10 blocks of each progressively increasing intensity (four trials per block) until participants fell at >2 trials per block (fall threshold). In the next session, training began at a sub-fall threshold and progressed further. Fall outcome and threshold, number of compensatory steps, multiple stepping threshold, progression to higher intensities, pre- and post-slip center of mass (CoM), state stability, clinical measures, and treadmill walking speed were analyzed. Results: Post-training, PwCS demonstrated a reduction in falls and compensatory steps on levels 5 and 6 (p < 0.05) compared to pre-training. While an increase in pre-slip stability was limited to level 6 (p < 0.05), improvement in post-slip stability at lift-off was noted on levels 2, 3, and 5 (p < 0.05) along with improved post-slip minimum stability on levels 5 and 6 (p < 0.05). Post-training demonstrated improved fall (p < 0.05) and multiple stepping thresholds (p = 0.05). While most participants could progress to level 4 between the first and last training sessions, more participants progressed to level 6 (p < 0.05). Participants’ treadmill walking speed increased (p < 0.05); however, clinical measures remained unchanged (p > 0.05). Conclusions: Multisession, progressively increasing intensity of treadmill-based gait-slip training appears to induce significant adaptive improvement in falls, compensatory stepping, and postural stability among PwCS.
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Affiliation(s)
- Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA;
- Ph.D. Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA;
- Correspondence: ; Tel.: +1-312-355-4443; Fax: +1-312-996-4583
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Gregor S, Saumur TM, Crosby LD, Powers J, Patterson KK. Study Paradigms and Principles Investigated in Motor Learning Research After Stroke: A Scoping Review. Arch Rehabil Res Clin Transl 2021; 3:100111. [PMID: 34179749 PMCID: PMC8211998 DOI: 10.1016/j.arrct.2021.100111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To (1) characterize study paradigms used to investigate motor learning (ML) poststroke and (2) summarize the effects of different ML principles in promoting skill acquisition and retention. Our secondary objective is to evaluate the clinical utility of ML principles on stroke rehabilitation. DATA SOURCES Medline, Excerpta Medica Database, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception on October 24, 2018 and repeated on June 23, 2020. Scopus was searched on January 24, 2019 and July 22, 2020 to identify additional studies. STUDY SELECTION Our search included keywords and concepts to represent stroke and "motor learning. An iterative process was used to generate study selection criteria. Three authors independently completed title, abstract, and full-text screening. DATA EXTRACTION Three reviewers independently completed data extraction. DATA SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews were used to guide our synthesis. Thirty-nine studies were included. Study designs were heterogeneous, including variability in tasks practiced, acquisition parameters, and retention intervals. ML principles investigated included practice complexity, feedback, motor imagery, mental practice, action observation, implicit and explicit information, aerobic exercise, and neurostimulation. An additional 2 patient-related factors that influence ML were included: stroke characteristics and sleep. Practice complexity, feedback, and mental practice/action observation most consistently promoted ML, while provision of explicit information and more severe strokes were detrimental to ML. Other factors (ie, sleep, practice structure, aerobic exercise, neurostimulation) had a less clear influence on learning. CONCLUSIONS Improved consistency of reporting in ML studies is needed to improve study comparability and facilitate meta-analyses to better understand the influence of ML principles on learning poststroke. Knowledge of ML principles and patient-related factors that influence ML, with clinical judgment can guide neurologic rehabilitation delivery to improve patient motor outcomes.
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Affiliation(s)
- Sarah Gregor
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Tyler M. Saumur
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Lucas D. Crosby
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Jessica Powers
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Kara K. Patterson
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Osman HE, van den Bogert AJ, Reinthal A, Slane S, Espy D. A progressive-individualized midstance gait perturbation protocol for reactive balance assessment in stroke survivors. J Biomech 2021; 123:110477. [PMID: 34020123 DOI: 10.1016/j.jbiomech.2021.110477] [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: 02/25/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Restoration of balance control is a primary focus of rehabilitation after a stroke. The study developed a gait perturbation, treadmill-based, balance assessment protocol and demonstrated that it can be used to quantify improvements in reactive balance responses among individuals post-stroke. The protocol consists of a sequence of fifteen 90-second treadmill walking trials, with a single perturbation applied during the middle third of each trial. Gait was perturbed by rapid acceleration-deceleration of the treadmill belt at mid-stance of the unaffected leg during a randomly selected gait cycle. The initial perturbation magnitude was based on the participant's maximum walking speed and increased or decreased in each trial, based on success or failure of recovery, as determined from an instrumented harness. The protocol was used before and after a 10-week period of therapy in twenty-four stroke survivors. Outcomes included maximum recoverable perturbation (MRP), self-selected gait speed, levels progressed through the algorithm, and falls versus recoveries.Participants were able to take recovery steps in response to the perturbation. Twelve participants completed the full assessment protocol before and after the therapeutic intervention. After the intervention, they had fewer falls and more recoveries (p < 0.001), progressed through more algorithm levels (p = 0.043), had a higher MRP (p = 0.005), and had higher gait speeds. The protocol was found to be feasible in stroke survivors with moderate gait deficits. The data supports the conclusion that this protocol can be used in clinical research to quantify improvements in balance during walking.
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Affiliation(s)
- Hala E Osman
- Cleveland State University, Department of Biomedical Engineering, Cleveland, OH, USA
| | | | - Ann Reinthal
- Cleveland State University, School of Health Sciences, Cleveland, OH, USA
| | - Steve Slane
- Cleveland State University, Professor Emeritus, Cleveland, OH, USA
| | - Debbie Espy
- Cleveland State University, School of Health Sciences, Cleveland, OH, USA.
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Harper SA, Beethe AZ, Dakin CJ, Bolton DAE. Promoting Generalized Learning in Balance Recovery Interventions. Brain Sci 2021; 11:402. [PMID: 33810159 PMCID: PMC8004641 DOI: 10.3390/brainsci11030402] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
Recent studies have shown balance recovery can be enhanced via task-specific training, referred to as perturbation-based balance training (PBT). These interventions rely on principles of motor learning where repeated exposure to task-relevant postural perturbations results in more effective compensatory balance responses. Evidence indicates that compensatory responses trained using PBT can be retained for many months and can lead to a reduction in falls in community-dwelling older adults. A notable shortcoming with PBT is that it does not transfer well to similar but contextually different scenarios (e.g., falling sideways versus a forward trip). Given that it is not feasible to train all conditions in which someone could fall, this limited transfer presents a conundrum; namely, how do we best use PBT to appropriately equip people to deal with the enormous variety of fall-inducing scenarios encountered in daily life? In this perspective article, we draw from fields of research that explore how general learning can be promoted. From this, we propose a series of methods, gleaned from parallel streams of research, to inform and hopefully optimize this emerging field where people receive training to specifically improve their balance reactions.
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Affiliation(s)
- Sara A. Harper
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Anne Z. Beethe
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Christopher J. Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - David A. E. Bolton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
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Unger J, Chan K, Lee JW, Craven BC, Mansfield A, Alavinia M, Masani K, Musselman KE. The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial. Front Neurol 2021; 12:620367. [PMID: 33603710 PMCID: PMC7884853 DOI: 10.3389/fneur.2021.620367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability. Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D. Design: Randomized clinical trial. Setting: Tertiary SCI/D rehabilitation center. Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study. Methods: Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations. Main Outcome Measures: Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes. Results: Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups [median (interquartile range): PBT 0.08 (0.68); CIBT 0.00 (0.22)]. One participant in the PBT group experienced a non-injurious fall during training. Conclusions: Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (i.e., PBT) did not prove advantageous for performance on a measure of reactive stepping ability. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02960178.
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Affiliation(s)
- Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Katherine Chan
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - B Catharine Craven
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Avril Mansfield
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alavinia
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Kei Masani
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Pigman J, Reisman DS, Pohlig RT, Jeka JJ, Wright TR, Conner BC, Petersen DA, Christensen MS, Crenshaw JR. Posterior fall-recovery training applied to individuals with chronic stroke: A single-group intervention study. Clin Biomech (Bristol, Avon) 2021; 82:105249. [PMID: 33421756 PMCID: PMC7940569 DOI: 10.1016/j.clinbiomech.2020.105249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the effects of the initial stepping limb on posterior fall recovery in individuals with chronic stroke, as well as to determine the benefits of fall-recovery training on these outcomes. METHODS This was a single-group intervention study of 13 individuals with chronic stroke. Participants performed up to six training sessions, each including progressively challenging, treadmill-induced perturbations from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. The highest perturbation level achieved, the proportion of successful recoveries, step and trunk kinematics, as well as stance-limb muscle activation about the ankle were compared between the initial stepping limbs in the first session. Limb-specific outcomes were also compared between the first and last training sessions. FINDINGS In the first session, initial steps with the non-paretic limb were associated with a higher proportion of success and larger perturbations than steps with the paretic limb (p = 0.02, Cohen's d = 0.8). Paretic-limb steps were wider relative to the center of mass (CoM; p = 0.01, d = 1.3), likely due to an initial standing position with the CoM closer to the non-paretic limb (p = 0.01, d = 1.4). In the last training session, participants recovered from a higher proportion of perturbations and advanced to larger perturbations (p < 0.05, d > 0.6). There were no notable changes in kinematic or electromyography variables with training (p > 0.07, d < 0.5). INTERPRETATION The skill of posterior stepping in response to a perturbation can be improved with practice in those with chronic stroke, we were not able to identify consistent underlying kinematic mechanisms behind this adaptation.
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Affiliation(s)
- Jamie Pigman
- Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA; Department of Health and Physical Education, Monmouth University, West, Long Branch, NJ, USA.
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE, USA.
| | - John J Jeka
- Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA.
| | - Tamara R Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - Benjamin C Conner
- Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA; College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA.
| | - Drew A Petersen
- Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.
| | - Michael S Christensen
- Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA.
| | - Jeremy R Crenshaw
- Department of Kinesiology, Applied Physiology University of Delaware, Newark, DE, USA.
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Munoz-Martel V, Santuz A, Bohm S, Arampatzis A. Neuromechanics of Dynamic Balance Tasks in the Presence of Perturbations. Front Hum Neurosci 2021; 14:560630. [PMID: 33584219 PMCID: PMC7874030 DOI: 10.3389/fnhum.2020.560630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/18/2020] [Indexed: 01/13/2023] Open
Abstract
Understanding the neuromechanical responses to perturbations in humans may help to explain the reported improvements in stability performance and muscle strength after perturbation-based training. In this study, we investigated the effects of perturbations, induced by unstable surfaces, on the mechanical loading and the modular organization of motor control in the lower limb muscles during lunging forward and backward. Fifteen healthy adults performed 50 forward and 50 backward lunges on stable and unstable ground. Ground reaction forces, joint kinematics, and the electromyogram (EMG) of 13 lower limb muscles were recorded. We calculated the resultant joint moments and extracted muscle synergies from the stepping limb. We found sparse alterations in the resultant joint moments and EMG activity, indicating a little if any effect of perturbations on muscle mechanical loading. The time-dependent structure of the muscle synergy responsible for the stabilization of the body was modified in the perturbed lunges by a shift in the center of activity (later in the forward and earlier in the backward lunge) and a widening (in the backward lunge). Moreover, in the perturbed backward lunge, the synergy related to the body weight acceptance was not present. The found modulation of the modular organization of motor control in the unstable condition and related minor alteration in joint kinetics indicates increased control robustness that allowed the participants to maintain functionality in postural challenging settings. Triggering specific modulations in motor control to regulate robustness in the presence of perturbations may be associated with the reported benefits of perturbation-based training.
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Affiliation(s)
- Victor Munoz-Martel
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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39
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Elkarif V, Kandel L, Rand D, Schwartz I, Greenberg A, Portnoy S. Kinematics following gait perturbation in adults with knee osteoarthritis: Scheduled versus not scheduled for knee arthroplasty. Gait Posture 2020; 81:144-152. [PMID: 32888553 DOI: 10.1016/j.gaitpost.2020.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare recovery kinematics following trip-simulated perturbation during gait between three groups: adults without knee Osteoarthritis (OA) and adults with OA, scheduled and not scheduled for Total Knee Replacement (TKR). METHODS People with OA scheduled for TKR (TKR group; N = 19) and not scheduled (NTKR group; N = 17) were age-matched with People without OA (N = 19). Outcome measures included: joint range of motion (ROM), Timed Up and Go (TUG), joint pain levels, Oxford score, Instrumental Activities of Daily Living Questionnaire, and the Activities-specific Balance Confidence Scale. Also, spatiotemporal gait parameters and joint kinematics were recorded during perturbed and unperturbed gait. The perturbed gait data were normalized by unperturbed gait data. RESULTS There were no differences between the two OA groups in the four questionnaire scores and joint ROM. The TUG score of the TKR group was higher than that of the NTKR group. There were no statistically significant between-group differences in the normalized spatiotemporal parameters. The OA groups showed statistically significant lower anterior pelvic tilt ranges and higher maximal hip adduction of the contralateral limb compared to the Non-OA group. When the contralateral limb was perturbed, the TKR group showed significantly lower pelvic rotation range compared to the NTKR and Non-OA groups. When the OA limb was perturbed, the maximal hip flexion of the injured limb was significantly lower and the maximal knee flexion higher in the OA groups compared with the Non-OA group. CONCLUSION The recovery strategy from trip-simulated perturbation of individuals with OA differs from that of individuals without OA. This may emphasize the importance of devising a treatment plan that focuses on improving balance and reactions to gait perturbation.
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Affiliation(s)
- Vicktoria Elkarif
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Kandel
- Department of Orthopaedics Department, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isabella Schwartz
- Department of Physical and Medicine Rehabilitation, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Alexander Greenberg
- Department of Orthopaedics Department, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Zhang Q, Schwade M, Smith Y, Wood R, Young L. Exercise-based interventions for post-stroke social participation: A systematic review and network meta-analysis. Int J Nurs Stud 2020; 111:103738. [PMID: 32858433 DOI: 10.1016/j.ijnurstu.2020.103738] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Resuming participation in society is an important goal of post-stroke rehabilitation. Exercise-based interventions have been shown to be effective non-pharmacological methods for improving social participation in post-stroke survivors, however it is unclear what the most effective types of exercise interventions are. OBJECTIVE To assess the comparative effects and ranks of all exercise-based interventions in improving social participations in patients after a stroke. METHODS A random-effects network meta-analysis was performed to identify evidence from relevant randomized control trials. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, CINHAL, Cochrane Library, AMED, SPORTDiscus, Web of Science and Clinical Trials.gov from their earliest records to January 2020. Included trials must include at least one types of exercise for patients with stroke. The primary e was social participation. Bias will be assessed according to the revised Cochrane risk of bias tool. Data were analysed using Stata v14.0. Registration number of this study is CRD42020152523. RESULTS A total of 16 randomized control trials involving 1704 patients and 12 intervention arms were included in our study. We performed three subgroup analyses divided based on follow up time (1 to <6 months post-treatment, and ≥6 months post-treatment), and intervention adherence. Based on the ranking probabilities, motor relearning programme was ranked as the most effective among all exercise interventions (surface under cumulative ranking curve values [SUCRCV]: 95.6%, standardized mean difference [SMD]: 2.72, 95% confidence interval [CI]: 1.76 to 3.69) in overall and short-term treatment efficacy. In the long-term subgroup, home-based combined exercise ranked the best for the efficacy of social participation improvements among stroke survivors (SUCRCV: 71.8%, SMD: -0.23, 95% CI: -0.61 to 0.15). In the analysis of all interventions with adherence of >90%, cognitive-based exercise ranked the best (SUCRCV: 100%, SMD: 2.64, 95% CI: 1.62 to 3.66). CONCLUSIONS Interventions that emerged with the highest ranks in our analysis might be considered in practice when resources allow. More large, well-designed multicentre trials are needed to support the conclusion of this study.
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Affiliation(s)
- Qi Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Mark Schwade
- Medical College of Georgia, Augusta University, Augusta, USA
| | - Yvonne Smith
- Abraham Baldwin Agricultural College, Tifton, USA
| | - Racheal Wood
- College of Nursing, Augusta University, Augusta, USA
| | - Lufei Young
- College of Nursing, Augusta University, Augusta, USA
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Mansfield A, Inness EL, Danells CJ, Jagroop D, Bhatt T, Huntley AH. Determining the optimal dose of reactive balance training after stroke: study protocol for a pilot randomised controlled trial. BMJ Open 2020; 10:e038073. [PMID: 32847916 PMCID: PMC7451480 DOI: 10.1136/bmjopen-2020-038073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Falls risk poststroke is highest soon after discharge from rehabilitation. Reactive balance training (RBT) aims to improve control of reactions to prevent falling after a loss of balance. In healthy older adults, a single RBT session can lead to lasting improvements in reactive balance control and prevent falls in daily life. While increasing the dose of RBT does not appear to lead to additional benefit for healthy older adults, stroke survivors, who have more severely impaired balance control, may benefit from a higher RBT dose. Our long-term goal is to determine the optimal dose of RBT in people with subacute stroke. This assessor-blinded pilot randomised controlled trial aims to inform the design of a larger trial to address this long-term goal. METHODS AND ANALYSIS Participants (n=36) will be attending out-patient stroke rehabilitation, and will be randomly allocated to one of three groups: one, three or six RBT sessions. RBT will replace a portion of participants' regular physiotherapy so that the total physical rehabilitation time will be the same for the three groups. Balance and balance confidence will be assessed at: (1) study enrolment; (2) out-patient rehabilitation discharge; and (3) 6 months postdischarge. Participants will report falls and physical activity for 6 months postdischarge. Pilot data will be used to plan the larger trial (ie, sample size estimate using fall rates, and which groups should be included based on between-group trends in pre-to-post training effect sizes for reactive balance control measures). Pilot data will also be used to assess the feasibility of the larger trial (ie, based on the accrual rate, outcome completion rate and feasibility of prescribing specific training doses). ETHICS AND DISSEMINATION Institutional research ethics approval has been received. Study participants will receive a lay summary of results. We will also publish our findings in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04219696; Pre results.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia J Danells
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - David Jagroop
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois, Chicago, Illinois, USA
| | - Andrew H Huntley
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
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Guimarães M, Monteiro MM, Matos RT, Furtado MC, Maia HF, Almeida LRS, Filho JO, Pinto EB. External validation of the recurrent falls risk scale in community-dwelling stroke individuals. J Stroke Cerebrovasc Dis 2020; 29:104985. [PMID: 32807417 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To externally validate the Recurrent Fall Risk Scale (ReFR) in community-dwelling stroke survivors. METHODS Cohort of stroke survivors with independent gait ability recruited from a reference outpatient stroke clinic. Besides sociodemographic and clinical data, the following scales were used: Modified Barthel Index (mBI), ReFR scale and National Institutes of Health Stroke Scale (NIHSS). Participants were followed up for 12 months to record the incidence of falls. Accuracy of the ReFR scale was measured by the area under the ROC curve. RESULTS One hundred and thirteen individuals were recruited between April 2016 and November 2016: mean age 54 years (± 14), 55% women, median time since the last stroke 24 months (range 12 -48 months), posterior vascular territory affected in 35% of the sample. Median NIHSS was 3 (range 1 to 6), median mBI 49 (range 46-50), median ReFR 3 (range 2 to 5). During the follow-up period, 32 (33%) subjects had at least one fall and 18 (19%) were recurrent fallers (two or more falls). The accuracy of ReFR scale was 0.67 (95% CI = 0.54-0.79), p = 0.026. CONCLUSION This study externally validated the ReFR as a tool to predict recurrent falls in individuals after stroke.
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Affiliation(s)
- Moema Guimarães
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
| | - Ms Maiana Monteiro
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Rafael Tito Matos
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ms Cláudia Furtado
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Helena Fraga Maia
- Public Health Universidade do Estado da Bahia - UNEB, Salvador, Bahia, Brazil
| | - Lorena R S Almeida
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
| | | | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Stroke Clinic of the Federal University of Bahia, Brazil
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Abou L, Alluri A, Fliflet A, Du Y, Rice LA. Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 102:132-154. [PMID: 32745544 DOI: 10.1016/j.apmr.2020.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases. DATA SOURCES PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019. STUDY SELECTION Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected. DATA EXTRACTION Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence. RESULTS Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach. CONCLUSIONS Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yiting Du
- Department of Interdisciplinary Health Sciences, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
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De Luca A, Squeri V, Barone LM, Vernetti Mansin H, Ricci S, Pisu I, Cassiano C, Capra C, Lentino C, De Michieli L, Sanfilippo CA, Saglia JA, Checchia GA. Dynamic Stability and Trunk Control Improvements Following Robotic Balance and Core Stability Training in Chronic Stroke Survivors: A Pilot Study. Front Neurol 2020; 11:494. [PMID: 32625162 PMCID: PMC7311757 DOI: 10.3389/fneur.2020.00494] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/05/2020] [Indexed: 01/25/2023] Open
Abstract
Stroke survivors show greater postural oscillations and altered muscular activation compared to healthy controls. This results in difficulties in walking and standing, and in an increased risk of falls. A proper control of the trunk is related to a stable walk and to a lower falling risk; to this extent, rehabilitative protocols are currently working on core stability. The main objective of this work was to evaluate the effectiveness of trunk and balance training performed with a new robotic device designed for evaluation and training of balance and core stability, in improving the recovery of chronic stroke patients compared with a traditional physical therapy program. Thirty chronic stroke patients, randomly divided in two groups, either underwent a traditional rehabilitative protocol, or a robot-based program. Each patient was assessed before and after the rehabilitation and at 3-months follow-up with clinical and robot-based evaluation exercises focused on static and dynamic balance and trunk control. Results from clinical scores showed an improvement in both groups in balance and trunk control. Robot-based indices analysis indicated that the experimental group showed greater improvements in proprioceptive control, reactive balance and postural control in unstable conditions, compared to the control group, showing an improved trunk control with reduced compensatory strategies at the end of the training. Moreover, the experimental group had an increased retention of the benefits obtained with training at 3 months follow up. These results support the idea that such robotic device is a promising tool for stroke rehabilitation.
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Affiliation(s)
| | | | - Laura M Barone
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Honorè Vernetti Mansin
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Serena Ricci
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Ivano Pisu
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Cinzia Cassiano
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Cristina Capra
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | - Carmelo Lentino
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy
| | | | | | | | - Giovanni A Checchia
- Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure, Italy.,Department of Rehabilitation, Local Health Agency EUGANEA, Padua, Italy
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Zadravec M, Olenšek A, Rudolf M, Bizovičar N, Goljar N, Matjačić Z. Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects. J Neuroeng Rehabil 2020; 17:85. [PMID: 32615990 PMCID: PMC7330998 DOI: 10.1186/s12984-020-00710-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/23/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. METHODS Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. RESULTS The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions. CONCLUSIONS Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Timed-Up-and-Go and Functional Independence Measure tests may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.
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Affiliation(s)
- Matjaž Zadravec
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Andrej Olenšek
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Marko Rudolf
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Nataša Bizovičar
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Nika Goljar
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Zlatko Matjačić
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia.
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Barzideh A, Marzolini S, Danells C, Jagroop D, Huntley AH, Inness EL, Mathur S, Mochizuki G, Oh P, Mansfield A. Effect of reactive balance training on physical fitness poststroke: study protocol for a randomised non-inferiority trial. BMJ Open 2020; 10:e035740. [PMID: 32606059 PMCID: PMC7328813 DOI: 10.1136/bmjopen-2019-035740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Regular exercise is essential in the chronic phase of stroke recovery for improving or maintaining function, and reducing the risk of a second stroke. To achieve these goals, multiple components of fitness should be targeted with poststroke exercise, including aerobic capacity, strength and balance. However, following the recommended frequency and duration of each component separately can take a long time and lead to fatigue in people with stroke. Therefore, finding types of exercise that target multiple components of fitness all together is valuable.Reactive balance training (RBT) is a novel type of exercise where individuals repeatedly lose their balance in order to practise balance reactions. When people do RBT, they increase their heart rate and exert forces with their leg muscles which could improve aerobic fitness and muscle strength, respectively. This means that RBT could have the potential to improve multiple components of fitness, simultaneously. METHODS AND ANALYSIS This is a randomised controlled non-inferiority trial with internal pilot study. Participants with chronic stroke will be randomly assigned to one of two groups: (1) RBT or (2) aerobic and strength training (AST). Participants in both groups will complete 1 hour of exercise, three times/week for 12 weeks. The primary objective is to determine the effect of RBT on aerobic capacity and knee muscles' strength. The secondary objective is to determine the effects of RBT and AST on balance control and balance confidence. We expect to find that RBT is superior to AST in terms of improving balance control and balance confidence, yet not inferior to AST in terms of its effects on aerobic capacity and strength. ETHICS AND DISSEMINATION Research ethics approval has been received. Results will be disseminated directly to study participants at the end of the trial, and to other stakeholders via publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04042961.
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Affiliation(s)
- Azadeh Barzideh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - David Jagroop
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew H Huntley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Evaulative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Lemus D, Berry A, Jabeen S, Jayaraman C, Hohl K, van der Helm FCT, Jayaraman A, Vallery H. Controller synthesis and clinical exploration of wearable gyroscopic actuators to support human balance. Sci Rep 2020; 10:10412. [PMID: 32591577 PMCID: PMC7320159 DOI: 10.1038/s41598-020-66760-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
Gyroscopic actuators are appealing for wearable applications due to their ability to provide overground balance support without obstructing the legs. Multiple wearable robots using this actuation principle have been proposed, but none has yet been evaluated with humans. Here we use the GyBAR, a backpack-like prototype portable robot, to investigate the hypothesis that the balance of both healthy and chronic stroke subjects can be augmented through moments applied to the upper body. We quantified balance performance in terms of each participant's ability to walk or remain standing on a narrow support surface oriented to challenge stability in either the frontal or the sagittal plane. By comparing candidate balance controllers, it was found that effective assistance did not require regulation to a reference posture. A rotational viscous field increased the distance healthy participants could walk along a 30mm-wide beam by a factor of 2.0, compared to when the GyBAR was worn but inactive. The same controller enabled individuals with chronic stroke to remain standing for a factor of 2.5 longer on a narrow block. Due to its wearability and versatility of control, the GyBAR could enable new therapy interventions for training and rehabilitation.
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Affiliation(s)
- Daniel Lemus
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Andrew Berry
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Chandrasekaran Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Frans C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Heike Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands.
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Esmaeili V, Juneau A, Dyer JO, Lamontagne A, Kairy D, Bouyer L, Duclos C. Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial. J Neuroeng Rehabil 2020; 17:79. [PMID: 32552850 PMCID: PMC7298869 DOI: 10.1186/s12984-020-00707-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 min were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over 3 weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results With no baseline differences between groups (p > 0.075), perturbation training yielded large improvements in most variables in the Perturb (p < 0.05, Effect Size: ES > .46) group (n = 10) and the NonPerturb (p ≤ .089, ES > .45) group (n = 7 post-crossing), except for maximal strength (p > .23) in the NonPerturb group. Walking-only training in the NonPerturb group (n = 8, pre-crossing) mostly had no effect (p > .292, ES < .26), except on balance confidence (p = .063, ES = .46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830.
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Affiliation(s)
- Vahid Esmaeili
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada
| | - Andréanne Juneau
- Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada.,Lethbridge-Layton-MacKay Rehabilitation Centre, Montréal, Canada
| | - Joseph-Omer Dyer
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada
| | - Anouk Lamontagne
- Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada.,School of Physical and Occupationnal Therapy, McGill University, Montréal, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada
| | - Laurent Bouyer
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Canada
| | - Cyril Duclos
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada.
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Interindividual Balance Adaptations in Response to Perturbation Treadmill Training in Persons With Parkinson Disease. J Neurol Phys Ther 2020; 43:224-232. [PMID: 31517749 DOI: 10.1097/npt.0000000000000291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Perturbation training is a promising approach to reduce fall incidence in persons with Parkinson disease (PwPD). This study aimed to evaluate interindividual differences in balance adaptations in response to perturbation treadmill training (PTT) and identify potential outcome predictors. METHODS PwPD (n = 43, Hoehn & Yahr stage 1-3.5) were randomly assigned to either 8 weeks of PTT or conventional treadmill training (CTT) without perturbations. At baseline and following intervention, data from 4 domains of balance function (reactive, anticipatory, dynamic postural control, and quiet stance) were collected. Using responder analysis we investigated interindividual differences (responder rates and magnitude of change) and potential predictive factors. RESULTS PTT showed a significantly higher responder rate in the Mini Balance Evaluation Systems Test (Mini-BESTest) subscore reactive postural control, compared with CTT (PTT = 44%; CTT = 10%; risk ratio = 4.22, confidence interval = 1.03-17.28). Additionally, while between-groups differences were not significant, the proportion of responders in the measures of dynamic postural control was higher for PTT compared with CTT (PTT: 22%-39%; CTT: 5%-10%). The magnitude of change in responders and nonresponders was similar in both groups. PTT responders showed significantly lower initial balance performance (4/8 measures) and cognitive function (3/8 measures), and were older and at a more advanced disease stage, based on descriptive evaluation. DISCUSSION AND CONCLUSIONS Our findings suggest that PTT is beneficial to improve reactive balance in PwPD. Further, PTT appeared to be effective only for a part of PwPD, especially for those with lower balance and cognitive function, which needs further attention.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A1).
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CRENSHAW JEREMYR, PETERSEN DREWA, CONNER BENJAMINC, TRACY JAMESB, PIGMAN JAMIE, WRIGHT HENRYG, MILLER FREEMAN, JOHNSON CURTISL, MODLESKY CHRISTOPHERM. Anteroposterior balance reactions in children with spastic cerebral palsy. Dev Med Child Neurol 2020; 62:700-708. [PMID: 32124436 PMCID: PMC7916524 DOI: 10.1111/dmcn.14500] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare anterior and posterior standing balance reactions, as measured by single-stepping thresholds, in children with and without spastic cerebral palsy (CP). METHOD Seventeen ambulatory children with spastic CP (eight males, nine females) and 28 typically developing children (13 males, 15 females; age range 5-12y, mean [SD] 9y 2mo [2y 3mo]), were included in this cross-sectional, observational study. Balance reaction skill was quantified as anterior and posterior single-stepping thresholds, or the treadmill-induced perturbations that consistently elicited a step in that direction. In order to understand the underlying mechanisms of between-group differences in stepping thresholds, dynamic stability was quantified using the minimum margin of stability. Ankle muscle activation latency, magnitude, and co-contraction were assessed with surface electromyography. RESULTS We observed an age and group interaction for anterior thresholds (p=0.001, partial η2 =0.24). At older (≈11y; p<0.001, partial η2 =0.48), but not younger (≈7y; p=0.33, partial η2 =0.02) ages, typically developing children had larger anterior thresholds than those with CP. In response to near-threshold anterior perturbations, older typically developing children recovered from more instability than their peers with CP (p=0.004, partial η2 =0.18). Older children had no between-group differences in ankle muscle activity. No between-group differences were observed in posterior thresholds. INTERPRETATION The effects of CP on balance reactions are age- and direction-specific. Older typically developing children are more able or willing to withhold a step when unstable. WHAT THIS PAPER ADDS Children with spastic cerebral palsy have age- and direction-specific balance-reaction impairments. Lower anterior stepping thresholds were observed in older, but not younger children. Older typically developing children withheld a forward step at higher levels of instability. No between-group differences were seen in posterior stepping thresholds.
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Affiliation(s)
- JEREMY R CRENSHAW
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - DREW A PETERSEN
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE;,Department of Physical Therapy, Drexel University, Philadelphia, PA
| | - BENJAMIN C CONNER
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE;,College of Medicine -Phoenix, University of Arizona, Phoenix, AZ
| | - JAMES B TRACY
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - JAMIE PIGMAN
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE;,Department of Health and Physical Education, Monmouth University, West Long Beach, NJ
| | - HENRY G WRIGHT
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - FREEMAN MILLER
- Department of Orthopedics, Nemours A.I. duPont Hospital for Children, Wilmington, DE
| | - CURTIS L JOHNSON
- Department of Biomedical Engineering, University of Delaware, Newark, DE
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