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Moshal T, Lasky S, Roohani I, Jolibois MI, Manasyan A, Munabi NCO, Fahradyan A, Lee JA, Hammoudeh JA. The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction-A Systematic Review. J Reconstr Microsurg 2024. [PMID: 38917840 DOI: 10.1055/s-0044-1787741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction. METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted. RESULTS A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years. CONCLUSION This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.
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Affiliation(s)
- Tayla Moshal
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sasha Lasky
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Idean Roohani
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marah I Jolibois
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Artur Manasyan
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Naikhoba C O Munabi
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Artur Fahradyan
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Jessica A Lee
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
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Gonçalves AK, Silva PCD, Griebler EM, Silva WAD, Sant Helena DP, Possamai VD, Martins VF. Multicomponent Physical Program: Effects on Physical Fitness of Older Women of Different Age Groups. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024:1-7. [PMID: 38324771 DOI: 10.1080/02701367.2024.2306285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Abstract
Purpose: Experimental studies investigating the outcomes of physical exercise among age-stratified groups of older women are still incipient. This study aimed to investigate the effects of a ten-month multicomponent physical program on the physical fitness of older women in three age-stratified groups (60-69 years, 70-79 years, and ≥80 years). Method: Participants (n = 141) were divided into three age groups: GR1 60-69 years (n = 45; 65.2 ± 2.3 years); GR2 70-79 years (n = 67; 72.9 ± 2.9 years), GR3 ≥80 years (n = 29; 83.5 ± 4.5 years). The participants performed the multicomponent physical program and were evaluated before and after the intervention with Senior Fitness Test. Data were analyzed using generalized estimating equations, Bonferroni test (p ≤.05) and effect size (Cohen's d). Results: For the group factor, there were significant differences in lower limb strength (p = .003), upper limb strength (p < .001), upper limb flexibility (p < .001), balance/agility (p < .001), and cardiorespiratory fitness (p < .001). For the time factor, significant differences were observed in lower limb strength (GR2, p = .014, small effect size), upper limb strength (GR1, p = .003; GR2, p < .001; GR3, p = .017; small effect sizes), lower limb flexibility (GR1, p = .025, non-significant effect size), cardiorespiratory fitness (GR1, p < .001, medium effect size; GR2, p = .002; small effect size). Conclusion: Physical fitness improved with training, but effects differed between age groups. Positive effects were observed for GR1 and GR2, whereas GR3 showed maintenance of physical fitness. Aging interferes more strongly in women aged 80 years and older and it is necessary for specific training programs for this age group. .
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Sadeh S, Shen KH, Foroughi F, Hsiao HY. Leading limb biomechanical response following compelled forward and descending body shift in old versus young adults. Clin Biomech (Bristol, Avon) 2024; 112:106169. [PMID: 38211422 DOI: 10.1016/j.clinbiomech.2024.106169] [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: 04/19/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Falls pose a significant health risk in older adults, with stair descent falls carrying particularly severe consequences. Reduced balance control and limb support due to aging-related physiological and neuromuscular decline are critical components in increased falling risk in older adults. Understanding the age-associated abnormalities in balance control and limb support strategies during sudden forward and downward body shift could reveal potential biomechanical deficits responsible for increased falling risks in older adults. This study investigates balance regulatory responses following first-time exposure to compelled forward and downward body shift in young and older adults. METHODS Thirteen healthy old and thirteen healthy young adults participated in this study. Participants stood on two adjacent perturbation platforms in modified tandem stance. The leading limb support surface dropped 3 in. vertically at an unknown time. The anterior margin of stability and center of mass velocity, peak vertical ground reaction forces, and leading limb ankle and knee joint angular displacement, torque, and power during the initial response phase were compared between age groups. FINDINGS Compared to young adults, older adults showed higher center of mass velocity, lower margin of stability, peak vertical ground reaction force, peak ankle and knee joint power, and peak knee joint torque during the initial response phase. INTERPRETATIONS The abnormalities potentially identified in our study, particularly in dynamic stability regulation, limb support force generation, and shock absorption may affect the ability to arrest the body's forward and downward motion. These deficits may contribute to an increased risk of forward falls in aging.
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Affiliation(s)
- Soroosh Sadeh
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Keng-Hung Shen
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Forouzan Foroughi
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
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Borrelli J, Creath RA, Rogers MW. A method for simulating forward falls and controlling impact velocity. MethodsX 2023; 11:102399. [PMID: 37830002 PMCID: PMC10565865 DOI: 10.1016/j.mex.2023.102399] [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: 05/11/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
Assessment of protective arm reactions associated with forward falls are typically performed by dropping research participants from a height onto a landing surface. The impact velocity is generally modulated by controlling the total height of the fall. This contrasts with an actual fall where the fall velocity is dependent on several factors in addition to fall height and not likely predictable at the onset of the fall. A counterweight and pulley system can be used to modulate the fall velocity in simulated forward falls in a manner that is not predictable to study participants, enhancing experimental validity. However, predicting the fall velocity based on participant height and weight and counterweight mass is not straightforward. In this article, the design of the FALL simulator For Injury prevention Training and assessment (FALL FIT) system is described. A dynamic model of the FALL FIT and counterweight system is developed and model parameters are fit using nonlinear optimization and experimental data. The fitted model enables prediction of fall velocity as a function of participant height and weight and counterweight load. The method can be used to provide controllable perturbations thereby elucidating the control strategy used when protecting the body from injury in a forward fall, how the control strategy changes because of aging or dysfunction or as a method for progressive protective arm reaction training.•Construction of device to simulate forward falls with controllable impact velocity using material that are commercially available is described•A dynamic model of the FALL FIT is developed to estimate the impact velocity of a simulated forward fall using participant height and counterweight load•The dynamic model is validated using data from 3 previous studies.
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Affiliation(s)
| | | | - Mark W. Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland
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Hatami M, Torkaman G, Ashtiani MN, Mohebi S. Different muscle strategy during head/knee level of functional reaching-transporting task to decrease falling probability in postmenopausal women with osteoporosis. Arch Physiother 2023; 13:10. [PMID: 37161595 PMCID: PMC10170822 DOI: 10.1186/s40945-023-00165-6] [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: 12/25/2022] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND The reaching-transporting task as an essential daily activity impacts balance control and falling in older women. This study investigated the different muscle strategies during the head/knee level of the functional reaching-transporting task in postmenopausal women with osteoporosis. METHODS 24 postmenopausal volunteers were classified into two groups based on the lumbar T-score: osteoporosis (≤ -2.5, n = 12) and non-osteoporosis (> -1, n = 12). Using a custom-designed device, participants randomly performed 12 reaching-transporting tasks at the head and knee levels. Electromyography signals were collected while reaching and transporting phases with a wireless system. The peak of the root means square (PRMS) and time to PRMS (TPRMS) were measured. In addition, the isometric muscle strength and the fear of falling were assessed. RESULTS The isometric muscle strength in the osteoporotic group was significantly lower than in the non-osteoporotic group (P < 0.05), except for vastus lateralis (VL). The PRMS of VL, (P = 0.010) during the reaching phase and VL (P = 0.002) and gastrocnemius lateralis (GL) (P < 0.001) during transporting phase was greater than the non-osteoporotic group. The PRMS value of the muscles was greater for reaching-transporting at the knee level than the head level; this increase was significant just for VL and biceps femoris during the transporting phase (P = 0.036 and P = 0.004, respectively). CONCLUSION Osteoporotic women have more muscle activities during the reaching-transporting task, especially at the knee level, compared to the head level. Their muscle weakness may lead to insufficient stability during the task and cause disturbance and falling, which requires further investigation.
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Affiliation(s)
- Marzie Hatami
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Ale-Ahmad Ave, P. O. Box: 1411713116, Tehran, Iran
| | - Giti Torkaman
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Ale-Ahmad Ave, P. O. Box: 1411713116, Tehran, Iran.
| | - Mohammad Najafi Ashtiani
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Ale-Ahmad Ave, P. O. Box: 1411713116, Tehran, Iran
| | - Sanaz Mohebi
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Ale-Ahmad Ave, P. O. Box: 1411713116, Tehran, Iran
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Borrelli J, Creath R, Rogers MW. The timing and amplitude of the muscular activity of the arms preceding impact in a forward fall is modulated with fall velocity. J Biomech 2023; 150:111515. [PMID: 36867953 PMCID: PMC10257944 DOI: 10.1016/j.jbiomech.2023.111515] [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] [Received: 10/20/2022] [Revised: 01/16/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
Protective arm reactions have been shown to be an important injury avoidance mechanism in unavoidable falls. Protective arm reactions have been shown to be modulated with fall height, however it is not clear if they are modulated with impact velocity. The aim of this study was to determine if protective arm reactions are modulated in response to a forward fall with an initially unpredictable impact velocity. Forward falls were evoked via sudden release of a standing pendulum support frame with adjustable counterweight to control fall acceleration and impact velocity. Thirteen younger adults (1 female) participated in this study. Counterweight load explained more than 89% of the variation of impact velocity. Angular velocity at impact decreased (p < 0.001), drop duration increased from 601 ms to 816 ms (p < 0.001), and the maximum vertical ground reaction force decreased from 64%BW to 46%BW (p < 0.001) between the small and large counterweight. Elbow angle at impact (129 degrees extension), triceps (119 ms) and biceps (98 ms) pre-impact time, and co-activation (57%) were not significantly affected by counterweight load (p-values > 0.08). Average triceps and biceps EMG amplitude decreased from 0.26 V/V to 0.19 V/V (p = 0.004) and 0.24 V/V to 0.11 V/V (p = 0.002) with increasing counterweight respectively. Protective arm reactions were modulated with fall velocity by reducing EMG amplitude with decreasing impact velocity. This demonstrates a neuromotor control strategy for managing evolving fall conditions. Future work is needed to further understand how the CNS deals with additional unpredictability (e.g., fall direction, perturbation magnitude, etc.) when deploying protective arm reactions.
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Affiliation(s)
- James Borrelli
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA.
| | - Robert Creath
- Lebanon Valley College, Exercise Science Department, Annville, PA, USA
| | - Mark W Rogers
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA
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Martins VF, Tesio L, Simone A, Gonçalves AK, Peyré-Tartaruga LA. Determinants of age-related decline in walking speed in older women. PeerJ 2023; 11:e14728. [PMID: 36915651 PMCID: PMC10007973 DOI: 10.7717/peerj.14728] [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: 06/21/2022] [Accepted: 12/20/2022] [Indexed: 03/09/2023] Open
Abstract
Background Walking speed is reduced with aging. However, it is not certain whether the reduced walking speed is associated with physical and coordination fitness. This study explores the physical and coordination determinants of the walking speed decline in older women. Methods One-hundred-eighty-seven active older women (72.2 ± 6.8 years) were asked to perform a 10-m walk test (self-selected and maximal walking speed) and a battery of the Senior fitness test: lower body strength, lower body flexibility, agility/dynamic balance, and aerobic endurance. Two parameters characterized the walking performance: closeness to the modeled speed minimizing the energetic cost per unit distance (locomotor rehabilitation index, LRI), and the ratio of step length to step cadence (walk ratio, WR). For dependent variables (self-selected and maximal walking speeds), a recursive partitioning algorithm (classification and regression tree) was adopted, highlighting interactions across all the independent variables. Results Participants were aged from 60 to 88 years, and their self-selected and maximal speeds declined by 22% and 26% (p < 0.05), respectively. Similarly, all physical fitness variables worsened with aging (muscle strength: 33%; flexibility: 0 to -8 cm; balance: 22%; aerobic endurance: 12%; all p < 0.050). The predictors of maximal walking speed were only WR and balance. No meaningful predictions could be made using LRI and WR as dependent variables. Discussion The results suggest that at self-selected speed, the decrease in speed itself is sufficient to compensate for the age-related decline in the motor functions tested; by contrast, lowering the WR is required at maximal speed, presumably to prevent imbalance. Therefore, any excessive lowering of LRI and WR indicates loss of homeostasis of walking mechanics and invites diagnostic investigation.
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Affiliation(s)
- Valéria Feijó Martins
- LaBiodin Biodynamics Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luigi Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anna Simone
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andréa Kruger Gonçalves
- LaBiodin Biodynamics Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leonardo A Peyré-Tartaruga
- LaBiodin Biodynamics Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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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: 24] [Impact Index Per Article: 12.0] [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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Borrelli J, Creath R, Westlake K, Rogers MW. Test-retest reliability of the FALL FIT system for assessing and training protective arm reactions in response to a forward fall. MethodsX 2022; 9:101702. [PMID: 35518921 PMCID: PMC9062354 DOI: 10.1016/j.mex.2022.101702] [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: 01/03/2022] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
The use of the hands and arms is an important protective mechanism in avoiding fall-related injury. The aim of this study was to evaluate the test-retest reliability of fall dynamics and evokd protective arm response kinematics and kinetics in forward falls simulated using the FALL simulator For Injury prevention Training and assessment system (FALL FIT). Fall FIT allows experimental control of the fall height and acceleration of the body during a forward fall. Two falls were simulated starting from 4 initial lean angles in Experiment 1 and with 4 different fall accelerations in Experiment 2. Fourteen younger adults (25.1±3.5 years) and 13 older adults (71.3±3.7 years) participated in Experiment 1 and 13 younger adults (31.8±5.7 years) participated in Experiment 2. Intraclass correlation coefficients (ICC) were used to the evaluate absolute agreement of single measures at each condition and averages across conditions. Average measures of fall dynamics and evoked kinematics and kinetics exhibited excellent reliability (ICC(A,4)>0.86). The reliability of single measures (ICC(A,1) > 0.59) was good to excellent, although 18% of single measures had a reliability (ICC(A,1)) between 0.00 and 0.57. The FALL FIT was shown to have good to excellent reliability for most measures. FALL FIT can produce a wide range of fall dynamics through modulation of initial lean angle and body acceleration. Additionally, the range of fall velocities and evoked kinematics and kinetics are consistent with previous fall research.The FALL FIT can be used to gain further insight into the control of protective arm reactions and may provide a therapeutic tool to assess and train protective arm reactions.
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Khizhnikova AE, Klochkov AS, Fuks AA, Kotov-Smolenskiy AM, Suponeva NA, Piradov MA. Effects of virtual reality exergame on psychophysiological and postural disorders in elderly patients. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Balance impairment at advanced age is a serious medical problem that often has significant implications and affects the quality of the patient’s life. Among the underlying causes are overall slowness of motor response and vestibular syndrome. Virtual reality exergames, including reaction and balance training, hold promise for managing balance dysfunction. The aim of this study was to investigate the effects of a combination rehabilitation program containing elements of virtual reality exergame on the postural and psychophysiological parameters of elderly patients with small vascular disease The study was conducted in 24 patients with small vascular disease (median age: 66 years). All patients underwent a virtual reality rehabilitation program. Psychophysiological, postural and clinical evaluations were performed at baseline and after the program was completed. Balance function measured on the Berg scale improved significantly and was 53 [52; 55] after the training program vs 50 [45; 54] at baseline (p < 0.05). The strategy of balance control also changed: the Romberg ratio was 266 [199.5; 478.5] before rehabilitation and 221 [149.25; 404] after the program was completed (p < 0.05). The most pronounced changes in the measured psychophysiological parameters occurred in the simple audiomotor reaction, which improved from 210 [174.25; 245.5] at baseline to 180.5 [170.5; 208] after rehabilitation (p < 0.05). Thus, the combination balance and reaction virtual reality training is an effective rehabilitation method for advanced-age patients with balance impairment.
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Affiliation(s)
| | - AS Klochkov
- Research Center of Neurology, Moscow, Russia
| | - AA Fuks
- Research Center of Neurology, Moscow, Russia
| | | | - NA Suponeva
- Research Center of Neurology, Moscow, Russia
| | - MA Piradov
- Research Center of Neurology, Moscow, Russia
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Age Differences in Motor Recruitment Patterns of the Shoulder in Dynamic and Isometric Contractions. A Cross-Sectional Study. J Clin Med 2021; 10:jcm10030525. [PMID: 33540507 PMCID: PMC7867168 DOI: 10.3390/jcm10030525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022] Open
Abstract
Aging processes in the musculoskeletal system lead to functional impairments that restrict participation. Purpose: To assess differences in the force and motor recruitment patterns of shoulder muscles between age groups to understand functional disorders. A cross-sectional study comparing 30 adults (20–64) and 30 older adults (>65). Surface electromyography (sEMG) of the middle deltoid, upper and lower trapezius, infraspinatus, and serratus anterior muscles was recorded. Maximum isometric voluntary contraction (MIVC) was determined at 45° glenohumeral abduction. For the sEMG signal registration, concentric and eccentric contraction with and without 1 kg and isometric contraction were requested. Participants abducted the arm from 0° up to an abduction angle of 135° for concentric and eccentric contraction, and from 0° to 45°, and remained there at 80% of the MIVC level while isometrically pushing against a handheld dynamometer. Differences in sEMG amplitudes (root mean square, RMS) of all contractions, but also onset latencies during concentric contraction of each muscle between age groups, were analyzed. Statistical differences in strength (Adults > Older adults; 0.05) existed between groups. No significant differences in RMS values of dynamic contractions were detected, except for the serratus anterior, but there were for isometric contractions of all muscles analyzed (Adults > Older adults; 0.05). The recruitment order varied between age groups, showing a general tendency towards delayed onset times in older adults, except for the upper trapezius muscle. Age differences in muscle recruitment patterns were found, which underscores the importance of developing musculoskeletal data to prevent and guide geriatric shoulder pathologies.
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Hsiao H, Creath RA, Sanders O, Inacio M, Beamer BA, Rogers MW. Acoustic pre-stimulation modulates startle and postural reactions during sudden release of standing support surface in aging. Hum Mov Sci 2020; 74:102715. [PMID: 33227568 DOI: 10.1016/j.humov.2020.102715] [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: 06/26/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Falls contribute to injuries and reduced level of physical activity in older adults. During falls, the abrupt sensation of moving downward triggers a startle-like reaction that may interfere with protective response movements necessary to maintain balance. Startle reaction could be dampened by sensory pre-stimulation delivered immediately before a startling stimulus. This study investigated the neuromodulatory effects of pre-stimulation on postural/startle responses to drop perturbations of the standing support surface in relation to age. Ten younger and 10 older adults stood quietly on an elevated computer-controlled moveable platform. At an unpredictable time, participants were dropped vertically to elicit a startle-like response. Reactive drop perturbation trials without a pre-stimulus (control) were alternated with trials with acoustic pre-stimulus tone (PSI). A two-way mixed design analysis of variance comparing condition (control vs. PSI) X group (younger vs. older) was performed to analyze changes in muscle activation patterns, ground reaction force, and joint angular displacements. Compared to younger adults, older adults showed lower neck muscle electromyography amplitude reduction rate and incidence of response. Peak muscle activation in neck, upper arm, and hamstring muscles were reduced during PSI trials compared to control trials in both groups (p < 0.05). In addition, knee and hip joint flexion prior to ground contact was reduced in PSI trials compared to control (p < 0.05). During post-landing balance recovery, increased knee and hip flexion displacement and time to peak impact force were observed in PSI trials compared to control condition (p < 0.05). PSI reduced startle-induced muscle activation at proximal body segments and likely decreased joint flexion during abrupt downward vertical displacement perturbations of the body. Older adults retained the ability to modulate startle and postural responses but their neuromodulatory capacity was reduced compared with younger adults. Further research on the potential of applying PSI as a possible therapeutic tool to reduce the risk of fall-related injury is needed.
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Affiliation(s)
- HaoYuan Hsiao
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Exercise Science, Lebanon Valley College, Annville, PA, USA
| | - Ozell Sanders
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA; Division of Neurological and Physical Medicine Devices, Office of Device Evaluation, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Mario Inacio
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA; Research Center in Sports Sciences, Health Sciences and Human Development, University Institute of Maia, Portugal
| | - Brock A Beamer
- Gerontology Research, Education and Clinical Center (GRECC) at Baltimore Veterans Affairs Medical Center, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.
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13
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Alissa N, Akinlosotu RY, Shipper AG, Wheeler LA, Westlake KP. A systematic review of upper extremity responses during reactive balance perturbations in aging. Gait Posture 2020; 82:138-146. [PMID: 32927220 DOI: 10.1016/j.gaitpost.2020.08.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/30/2020] [Accepted: 08/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balance responses to perturbations often involve the arms in an attempt to either restore balance or protect against impact. Although a majority of research has been dedicated to understanding age-related changes in lower limb balance responses, there is a growing body of evidence supporting age-related changes in arm responses. This systematic review aimed to summarize differences in arm responses between older and younger adults under conditions requiring counterbalancing, reaching to grasping, and protection against impact. METHODS Following a systematic review and critical appraisal of the literature, data regarding the arm response in studies comparing young and older adults was extracted. The resulting articles were also assessed for quality to determine risk of bias. RESULTS Fifteen high quality studies were identified. The majority of these studies reported delayed onsets in muscle activation, differences in arm movement strategies, delayed movement timing, increased impact forces, and greater grasp errors in older compared to young adults. These differences were also identified under varied visual and cognitive conditions. CONCLUSIONS The studies included in this review demonstrate age-related differences in arm responses regardless of the direction and nature of the perturbation. These differences could provide insight into developing more targeted rehabilitation and fall prevention strategies. More research is needed to assess whether the identified age-related differences are a necessary compensation or a contributory factor to balance impairments and fall risk in older adults.
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Affiliation(s)
- Nesreen Alissa
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD, 20201, United States
| | - Ruth Y Akinlosotu
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD, 20201, United States
| | - Andrea G Shipper
- University of Maryland School of Medicine, Health Sciences and Human Services Library, 601 W Lombard Street, Baltimore, MD, 21201, United States
| | - Lauren A Wheeler
- University of Maryland School of Medicine, Health Sciences and Human Services Library, 601 W Lombard Street, Baltimore, MD, 21201, United States
| | - Kelly P Westlake
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD, 20201, United States.
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14
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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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15
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Dominguez L. Postural control and perturbation response in aging populations: fall risk implications. J Neurophysiol 2020; 124:1309-1311. [PMID: 32816613 DOI: 10.1152/jn.00767.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Falls are an increasing cause of mortality in an ever-growing aging population. The main factors to consider in reducing mortality rates due to falls are postural control, consisting of the vestibular, visual, and proprioceptive system, and perturbation response. This Neuro Forum article reviews recent literature highlighting the developmental changes that occur in aging populations and the possible avenues for interventions and training to mitigate fall risk.
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Affiliation(s)
- Luis Dominguez
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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16
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Age-Related Differences in Arm and Trunk Responses to First and Repeated Exposure to Laterally Induced Imbalances. Brain Sci 2020; 10:brainsci10090574. [PMID: 32825342 PMCID: PMC7564542 DOI: 10.3390/brainsci10090574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to examine age-related differences in arm and trunk responses during first and repeated step induced balance perturbations. Young and older adults received 10 trials of unpredictable lateral platform translations. Outcomes included maximum arm and trunk displacement within 1 s of perturbation and at first foot lift off (FFLO), arm and neck muscle activity as recorded using electromyography (EMG), initial step type, balance confidence, and percentage of harness-assisted trials. Compared to young adults, older adults demonstrated greater arm and trunk angular displacements during the first trial, which were present at FFLO and negatively associated with balance confidence. Unlike young adults, recovery steps in older adults were directed towards the fall with a narrowed base of support. Over repeated trials, rapid habituation of first-trial responses of bilateral arm and trunk displacement and EMG amplitude was demonstrated in young adults, but was absent or limited in older adults. Older adults also relied more on harness assistance during balance recovery. Exaggerated arm and trunk responses to sudden lateral balance perturbations in older adults appear to influence step type and balance recovery. Associations of these persistently amplified movements with an increased reliance on harness assistance suggest that training to reduce these deficits could have positive effects in older adults with and without neurological disorders.
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17
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Wood TA, Hernandez ME, Sosnoff JJ. Age-related differences to neck muscle activation latency as a potential risk factor to fall-related traumatic brain injuries. J Electromyogr Kinesiol 2020; 51:102405. [PMID: 32088582 DOI: 10.1016/j.jelekin.2020.102405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/24/2020] [Accepted: 02/12/2020] [Indexed: 11/29/2022] Open
Abstract
This investigation examined age-related differences in neck muscle activation latency in response to anterior and posterior postural perturbations to understand the potential implications in fall-related traumatic brain injuries. 57 adults were recruited and categorized into 3 groups based on age: Young (18-30 years old), Young-Old (60-74 years) and Old-Old (75-89 years) group. Study participants underwent six anterior and posterior postural perturbations while bilateral sternocleidomastoid, upper trapezius, and splenius capitis electromyography was collected. Muscle activation latency time was calculated with established procedures. During anterior translations, a significant group effect for muscle activation latency of the right SCM (F(2,43) = 8.786, p < 0.001), right (F(2,34) = 4.838, p = 0.014) and left (F(2,34) = 5.015, p = 0.012) upper trapezius, and right (F(2,45) = 3.195, p = 0.050) and left (F(2,45) = 3.819, p = 0.029) splenius capitis was observed. During posterior translations, a significant group effect for muscle activation latency was observed in the right (F(2,34) = 6.419, p = 0.004) and left (F(2,41) = 5.275, p = 0.009) SCM, and the right (F(2,34) = 4.925, p = 0.013) and left (F(2,32) = 4.055, p = 0.027) upper trapezius. Both older groups displayed longer muscle activation latencies than the young group. The age-related differences in neck muscle activation latency may be placing older adults at a greater risk of fall-related traumatic brain injuries.
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Affiliation(s)
- Tyler A Wood
- Department of Kinesiology and Physical Education, College of Education, Northern Illinois University, DeKalb, IL 60115, USA.
| | - Manuel E Hernandez
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; Illini Fall Prevention Clinic, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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18
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E Kızıltan M, Gündüz A. Late component of trigemino-cervical reflex: changes according to age and gender. Neurol Sci 2020; 41:1759-1764. [PMID: 32006124 DOI: 10.1007/s10072-020-04242-7] [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: 08/01/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trigemino-cervical reflex (TCR) is a protective reflex which is elicited by the stimulation of any branch of the trigeminal nerve. After infraorbital stimulation, an early and late components have been described. The aim of this study was to find out whether there are age- or gender-related changes in the long-latency (RII) component of TCR. METHOD We included consecutive 53 healthy subjects (20 men, 37.7%) who had normal neurological examination. The mean age was 45.1 ± 14.3 years (age range 18-75 years). TCR was recorded simultaneously from bilateral sternocleidomastoid (SCM) and splenius capitis (SC) muscles with surface electrodes after stimulating right or left infraorbital branch of the trigeminal nerve, separately. We compared latency, amplitude, and duration according to gender and age. RESULTS The amplitudes of SC responses were significantly higher in women compared to men. The duration of SCM response was significantly longer in subjects above the age of 50 years compared to younger patients. The latency of the SC response was significantly delayed above the age of 40 years. CONCLUSION There are age- and gender-related changes in TCRs probably due to changes in the motoneurons of the SC and SCM muscles.
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Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, IUC, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, IUC, Istanbul, Turkey.
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