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Kohle F, Stark C, Klünter HD, Wernicke D, Wunderlich G, Fink GR, Klussmann JP, Schroeter M, Lehmann HC. Peripheral neuropathy, an independent risk factor for falls in the elderly, impairs stepping as a postural control mechanism: A case-cohort study. J Peripher Nerv Syst 2024. [PMID: 39219364 DOI: 10.1111/jns.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND/AIMS Peripheral neuropathies perturbate the sensorimotor system, causing difficulties in walking-related motor tasks and, eventually, falls. Falls result in functional dependency and reliance on healthcare, especially in older persons. We investigated if peripheral neuropathy is a genuine risk factor for falls in the elderly and if quantification of postural control via posturography is helpful in identifying subjects at risk of falls. METHODS Seventeen older persons with a clinical polyneuropathic syndrome of the lower limbs and converging electrophysiology were compared with 14 older persons without polyneuropathy. All participants were characterized via quantitative motor and sensory testing, neuropsychological assessment, and self-questionnaires. Video-nystagmography and caloric test excluded vestibulocochlear dysfunction. For further analysis, all subjects were stratified into fallers and non-fallers. Overall, 28 patients underwent computerized dynamic posturography for individual fall risk assessment. Regression analyses were performed to identify risk factors and predictive posturography parameters. RESULTS Neuropathy is an independent risk factor for falls in the elderly, while no differences were observed for age, gender, weight, frailty, DemTect test, timed "Up & Go" test, and dizziness-related handicap score. In computerized dynamic posturography, fallers stepped more often to regain postural control in challenging conditions, while the Rhythmic Weight Shift test showed a lack of anterior-posterior bidirectional voluntary control. INTERPRETATION Our study confirms peripheral neuropathy as a risk factor for older persons' falls. Fallers frequently used stepping to regain postural control. The voluntary control of this coping movement was impaired. Further investigations into these parameters' value in predicting the risk of falls in the elderly are warranted.
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Affiliation(s)
- Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Christopher Stark
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Heinz-Dieter Klünter
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Daniel Wernicke
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Michael Schroeter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Helmar C Lehmann
- Department of Neurology, Hospital Leverkusen, Leverkusen, Germany
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Young SN, Norris ES, Shifflett TB, Nisbet DB, Saunders BE, Driver CZ. Reliability of the Instrumented Modified Clinical Test of Sensory Interaction on Balance Using a Virtual Balance Device. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:1183-1192. [PMID: 39257646 PMCID: PMC11385286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
The purpose of this study was to evaluate the test-retest reliability of the instrumented version of the modified Clinical Test of Sensory Interaction on Balance (i-mCTSIB) using the VirtuSense VirtuBalance System™ (VSTBalance), a virtual balance device, in healthy young adults. Fifty-four subjects aged 20-27 years (Mean age 23.07, SD ± 1.6), participated in the study. A one-group design was utilized. Three trials of the i-mCTSIB were performed on two separate days to measure the mean sway velocity of the trunk under four conditions. Within-day reliability of trials 1-3 was estimated with intraclass correlation coefficients (ICC3,1) and between-day reliability was estimated using the averages of trials 1-3 on day 1 and day 2 (ICC3,3). Within-day reliability was moderate on day 1 (ICC = 0.511-0.672) and day 2 (ICC = 0.539 -0.677). Between-day reliability was moderate to good (ICC = 0.705-0.810). The lower bounds of the confidence intervals of within-day reliability estimates were 0.341-0.548, while the lower bounds of the confidence interval for the between-day reliability estimates were 0.390-0.671. Reliability of the VSTBalance for balance assessment using the i-mCTSIB test is moderate to good. Between-day reliability was higher than within-day reliability. When using the VSTBalance to assess balance with the i-mCTSIB, clinicians should provide practice of each condition contained in the test to improve reliability. The higher between-day reliability as compared to within-day reliability suggests that clinicians should use the averages of three trials when assessing balance performance change across time for each condition of the i-mCTSIB test when assessing balance using the VSTBalance.
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Affiliation(s)
- Sonia N Young
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Elizabeth S Norris
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Thomas B Shifflett
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Daniel B Nisbet
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Brady E Saunders
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Caleb Z Driver
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
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Allum JHJ, Candreia C, Honegger F. Trunk Instability in the Pitch, Yaw, and Roll Planes during Clinical Balance Tests: Axis Differences and Correlations to vHIT Asymmetries Following Acute Unilateral Vestibular Loss. Brain Sci 2024; 14:664. [PMID: 39061407 PMCID: PMC11274631 DOI: 10.3390/brainsci14070664] [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: 04/17/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Clinical dynamic posturography concentrates on the pitch and roll but not on the yaw plane instability measures. This emphasis may not represent the axis instability observed in clinical stance and gait tasks for patients with balance deficits in comparison to healthy control (HC) subjects, nor the expected instability based on correlations with vestibulo-ocular reflex (VOR) deficits. To examine the axis stability changes with vestibular loss, we measured trunk sway in all three directions (pitch, roll, and yaw) during the stance and gait tasks of patients with acute unilateral vestibular neuritis (aUVN) and compared the results with those of HC. Concurrent changes in VORs were also examined and correlated with trunk balance deficits. METHODS The results of 11 patients (mean age of 61 years) recorded within 6 days of aUVN onset were compared within those of 8 age-matched healthy controls (HCs). All subjects performed a two-legged stance task-standing with eyes closed on foam (s2ecf), a semi-gait task-walking eight tandem steps (tan8), and four gait tasks-walking 3 m with head rotating laterally, pitching, or eyes closed (w3hr, w3hp, w3ec), and walking over four barriers 24 cm high, spaced 1 m apart (barr). The tasks' peak-to-peak yaw, pitch and roll angles, and angular velocities were measured with a gyroscope system (SwayStarTM) mounted at L1-3 and combined into three, axis-specific, balance control indexes (BCI), using angles (a) for the tandem gait and barriers task, and angular velocities (v) for all other tasks, as follows: axis BCI = (2 × 2ecf)v + 1.5 × (w3hr + w3hp + w3ec)v + (tan8 + 12 × barr)a. RESULTS Yaw and pitch BCIs were significantly (p ≤ 0.004) greater (88 and 30%, respectively) than roll BCIs for aUVN patients. For HCs, only yaw but not pitch BCIs were greater (p = 0.002) than those of roll (72%). The order of BCI aUVN vs. HC differences was pitch, yaw, and roll at 55, 44, and 31%, respectively (p ≤ 0.002). This difference with respect to roll corresponded to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN based on VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses did not correspond with the pitch plane instability observed in the balance control tests. The increases in pitch plane instability in UVL subjects were, however, highly correlated with those of roll and yaw. CONCLUSIONS These results indicate that greater yaw than pitch and roll trunk motion during clinical balance tasks is common for aUVN patients and HCs. However, aUVN leads to a larger increase in pitch than yaw plane instability and a smaller increase in roll plane instability. This difference with respect to roll corresponds to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN observed in VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses does not correspond with the enhanced movements in the pitch plane, observed in balance control tasks. Whether asymmetries in vestibular-evoked myogenic potentials (Vemps) are better correlated with the deficits in pitch plane balance control remains to be investigated. The current results provide a strong rationale for the clinical testing of directional specific balance responses, especially yaw and pitch, and the linking of balance results for yaw and roll to VOR asymmetries.
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Affiliation(s)
- John H. J. Allum
- Departments of ORL, University of Basel Hospital, 4031 Basel, Switzerland;
| | | | - Flurin Honegger
- Departments of ORL, University of Basel Hospital, 4031 Basel, Switzerland;
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Dumke BR, Theilen LH, Shaw JM, Foreman KB, Dibble LE, Fino PC. Sensory integration and segmental control of posture during pregnancy. Clin Biomech (Bristol, Avon) 2024; 115:106264. [PMID: 38744223 DOI: 10.1016/j.clinbiomech.2024.106264] [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: 03/08/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Approximately 25% of pregnant people fall, yet the underlying mechanisms of this increased fall-risk remain unclear. Prior studies examining pregnancy and balance have utilized center of pressure analyses and reported mixed results. The purpose of this study was to examine sensory and segmental contributions to postural control throughout pregnancy using accelerometer-based measures of sway. METHODS Thirty pregnant people (first trimester: n = 10, second trimester: n = 10, third trimester: n = 10) and 10 healthy, nonpregnant control people stood quietly for one minute in four conditions: eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam pad, and eyes closed on foam. Postural sway was quantified using the root mean square accelerations in the anterior-posterior and medial-lateral directions from an inertial sensor at the lumbar region. Sensory sway ratios, segmental coherence and co-phase, were calculated to assess sensory contributions and segmental control, respectively. FINDINGS Pregnant people did not display greater sway compared to healthy, nonpregnant controls. There were no group differences in vestibular, visual, or somatosensory sway ratios, and no significant differences in balance control strategies between pregnant and nonpregnant participants across sensory conditions. INTERPRETATION The small effects observed here contrast prior studies and suggest larger, definitive studies are needed to assess the effect of pregnancy on postural control. This study serves as a preliminary exploration of pregnant sensory and segmental postural control and highlights the need for future to hone the role of balance in fall risk during pregnancy.
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Affiliation(s)
- Breanna R Dumke
- University of Utah, Department of Health & Kinesiology, Salt Lake City, UT, USA.
| | - Lauren H Theilen
- University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, UT, USA
| | - Janet M Shaw
- University of Utah, Department of Health & Kinesiology, Salt Lake City, UT, USA
| | - K Bo Foreman
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Leland E Dibble
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Peter C Fino
- University of Utah, Department of Health & Kinesiology, Salt Lake City, UT, USA
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Nassajpour M, Shuqair M, Rosenfeld A, Tolea MI, Galvin JE, Ghoraani B. Objective estimation of m-CTSIB balance test scores using wearable sensors and machine learning. Front Digit Health 2024; 6:1366176. [PMID: 38707195 PMCID: PMC11066210 DOI: 10.3389/fdgth.2024.1366176] [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: 01/05/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Accurate balance assessment is important in healthcare for identifying and managing conditions affecting stability and coordination. It plays a key role in preventing falls, understanding movement disorders, and designing appropriate therapeutic interventions across various age groups and medical conditions. However, traditional balance assessment methods often suffer from subjectivity, lack of comprehensive balance assessments and remote assessment capabilities, and reliance on specialized equipment and expert analysis. In response to these challenges, our study introduces an innovative approach for estimating scores on the Modified Clinical Test of Sensory Interaction on Balance (m-CTSIB). Utilizing wearable sensors and advanced machine learning algorithms, we offer an objective, accessible, and efficient method for balance assessment. We collected comprehensive movement data from 34 participants under four different sensory conditions using an array of inertial measurement unit (IMU) sensors coupled with a specialized system to evaluate ground truth m-CTSIB balance scores for our analysis. This data was then preprocessed, and an extensive array of features was extracted for analysis. To estimate the m-CTSIB scores, we applied Multiple Linear Regression (MLR), Support Vector Regression (SVR), and XGBOOST algorithms. Our subject-wise Leave-One-Out and 5-Fold cross-validation analysis demonstrated high accuracy and a strong correlation with ground truth balance scores, validating the effectiveness and reliability of our approach. Key insights were gained regarding the significance of specific movements, feature selection, and sensor placement in balance estimation. Notably, the XGBOOST model, utilizing the lumbar sensor data, achieved outstanding results in both methods, with Leave-One-Out cross-validation showing a correlation of 0.96 and a Mean Absolute Error (MAE) of 0.23 and 5-fold cross-validation showing comparable results with a correlation of 0.92 and an MAE of 0.23, confirming the model's consistent performance. This finding underlines the potential of our method to revolutionize balance assessment practices, particularly in settings where traditional methods are impractical or inaccessible.
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Affiliation(s)
- Marjan Nassajpour
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, United States
| | - Mustafa Shuqair
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, United States
| | - Amie Rosenfeld
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Boca Raton, FL, United States
| | - Magdalena I. Tolea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Boca Raton, FL, United States
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Boca Raton, FL, United States
| | - Behnaz Ghoraani
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, United States
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Mitsutake T, Sonobe M. Noisy galvanic vestibular stimulation influences head stability in young healthy adults while standing on a moving platform. Gait Posture 2024; 107:177-181. [PMID: 37840004 DOI: 10.1016/j.gaitpost.2023.09.014] [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: 04/02/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The ability to stand with eyes closed on a sinusoidal translational moving platform may be affected by spatial orientation owing to vestibular input information. Moreover, changes in the frequency of the moving platform may affect the sensory reweighting through somatosensory and vestibular sensations. However, it is unclear whether noisy galvanic vestibular stimulation (nGVS), which activates vestibular-related brain regions, affects the stability of individuals standing on a platform moving at different frequencies. RESEARCH QUESTION Do vestibular stimulation by nGVS and changes in the frequency of translationally moving platforms affect the standing stability of individuals? METHODS Thirty-one healthy young adult participants were provided both sham and nGVS interventions while they maintained a static standing position, with their eyes closed, on an anterior-posterior sinusoidal translation platform. The nGVS was adapted to an optimal intensity below the perceptual threshold (frequency band: 100-640 Hz), and the sham stimulus was adapted to 0 µA. The participants were randomly assessed for postural stability at 0.2, 0.6, and 1.2 Hz moving platform frequencies for 80 s each under both stimulus conditions. Postural stability was calculated as the root mean square (RMS) sway from head accelerations in the anteroposterior (AP) and mediolateral (ML) directions for 50 s between 20 and 70 s during the 80 s period, measured using an inertial sensor placed on the external occipital ridge. RESULTS nGVS significantly reduced the RMS sway of head acceleration in the AP direction compared with sham stimulation. Furthermore, nGVS significantly reduced RMS sway in the ML direction compared with sham stimulation at a 1.2 Hz moving platform oscillation. SIGNIFICANCE These findings suggest that postural adjustment by the vestibular system influences head stability on a moving platform at specific sinusoidal translation frequencies, suggesting that nGVS may reduce head sway.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan.
| | - Motomichi Sonobe
- Department of Intelligent Mechanical Systems Engineering, Kochi University of Technology, Kochi, Japan
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Landers MR, Haller AM, Aldaco A, La B, Babarinde AA, Rider JV, Longhurst JK. The psychometric properties of the modified fear of falling avoidance behavior questionnaire in Parkinson's disease and older adults. Arch Physiother 2024; 14:11-19. [PMID: 38707914 PMCID: PMC11067869 DOI: 10.33393/aop.2024.2702] [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: 10/27/2023] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The Fear of Falling Avoidance Behavior Questionnaire (FFABQ) has good psychometric properties. However, we have recently modified the FFABQ (mFFABQ) to improve the clarity of the questions and Likert responses. This study aimed to examine the reliability and validity of this modified version in older adults and people with Parkinson's disease (PD). Methods A total of 88 participants, 39 with PD (age = 72.2 ± 9.5; 29 males, 10 females) and 49 older adults (age = 72.8 ± 5.0; 13 males, 36 females), answered the mFFABQ twice, separated by 1 week, for test-retest reliability. Construct validity was evaluated through correlational analyses with fall history, Activities-Specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Timed Up and Go, 30-Second Sit to Stand, Sensory Organization Test, Zung Anxiety Scale, Beck Depression Inventory, Consequences of Falling Questionnaire (CoFQ), and average daily activity levels using an activity monitor. Results The mFFABQ had good overall test-retest reliability (intraclass correlational coefficient [ICC] = 0.822; older adult ICC = 0.781, PD ICC = 0.806). The mFFABQ correlated with fall history (r = -0.430) and exhibited high correlation with the ABC (rho = -0.804) and moderate correlations with CoFQ (rho = 0.582) and BBS (rho = -0.595). The mFFABQ also correlated with time stepping (rho = -0.298) and number of steps (rho = -0.358). Conclusion These results provide supportive evidence for the reliability and validity of the mFFABQ in older adults and people with PD, which supports its suitability as a clinical and research tool for the assessment of fear of falling avoidance behavior.
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Affiliation(s)
- Merrill R. Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada - USA
| | - Ash M. Haller
- Sequoia Hospital, Dignity Health, Redwood City, California - USA
| | - Arturo Aldaco
- Sunrise Hospital and Medical Center, Las Vegas, Nevada - USA
| | - Billy La
- FYZICAL Balance and Therapy Centers – Buffalo, Las Vegas, Nevada - USA
| | - Adetayo A. Babarinde
- School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada - USA
| | - John V. Rider
- School of Occupational Therapy, Touro University Nevada, Henderson, Nevada - USA
| | - Jason K. Longhurst
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri - USA
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Campbell KR, Wilhelm JL, Antonellis P, Scanlan KT, Pettigrew NC, Martini DN, Chesnutt JC, King LA. Assessing the Effects of Mild Traumatic Brain Injury on Vestibular Home Exercise Performance with Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2023; 23:9860. [PMID: 38139706 PMCID: PMC10748190 DOI: 10.3390/s23249860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
After a mild traumatic brain injury (mTBI), dizziness and balance problems are frequently reported, affecting individuals' daily lives and functioning. Vestibular rehabilitation is a standard treatment approach for addressing these issues, but its efficacy in this population remains inconclusive. A potential reason for suboptimal outcomes is the lack of objective monitoring of exercise performance, which is crucial for therapeutic success. This study utilized wearable inertial measurement units (IMUs) to quantify exercise performance in individuals with mTBI during home-based vestibular rehabilitation exercises. Seventy-three people with mTBI and fifty healthy controls were enrolled. Vestibular exercises were performed, and IMUs measured forehead and sternum velocities and range of motions. The mTBI group demonstrated a slower forehead peak angular velocity in all exercises, which may be a compensatory strategy to manage balance issues or symptom exacerbation. Additionally, the mTBI group exhibited a larger forehead range of motion during specific exercises, potentially linked to proprioceptive deficits. These findings emphasize the usefulness of utilizing IMUs to monitor the quality of home-based vestibular exercises for individuals with mTBI and the potential for IMUs improving rehabilitation outcomes.
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Affiliation(s)
- Kody R. Campbell
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Jennifer L. Wilhelm
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Prokopios Antonellis
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Kathleen T. Scanlan
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Natalie C. Pettigrew
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Douglas N. Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01060, USA
| | - James C. Chesnutt
- Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Laurie A. King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
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Martini DN, Gera G, Brumbach BH, Campbell KR, Parrington L, Chesnutt J, King LA. Symptoms and Central Sensory Integration in People With Chronic mTBI: Clinical Implications. Mil Med 2023; 188:3553-3560. [PMID: 35657326 PMCID: PMC10629982 DOI: 10.1093/milmed/usac157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/27/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Balance deficits in people with chronic mild traumatic brain injury (mTBI; ≥3 months post-mTBI), thought to relate to central sensory integration deficits, are subtle and often difficult to detect. The purpose of this study was to determine the sensitivity of the instrumented modified clinical test of sensory integration for balance (mCTSIB) in identifying such balance deficits in people with symptomatic, chronic mTBI and to establish the associations between balance and mTBI symptom scores in the chronic mTBI group. METHODS The Institutional Review Board approved these study methods. Forty-one people with chronic mTBI and balance complaints and 53 healthy controls performed the mCTSIB (eyes open/closed on firm/foam surfaces; EoFi, EcFi, EoFo, and EcFo) with a wearable sensor on their waist to quantify sway area (m2/s4). Sensory reweighting variables were calculated for the firm and foam stance conditions. A stopwatch provided the clinical outcome for the mCTSIB (time). Each participant completed the Neurobehavioral Symptom Inventory (NSI), which quantifies mTBI-related symptoms and provides a total score, as well as sub-scores on affective, cognitive, somatic, and vestibular domains. RESULTS The mTBI group reported significantly higher symptom scores across each NSI sub-score (all Ps < .001). The mTBI group had a significantly larger sway area than the control group across all mCTSIB conditions and the mTBI group had significantly higher sensory reweighting scores compared to the control group on both the firm (P = .01) and foam (P = .04) surfaces. Within the mTBI group, the NSI vestibular score significantly related to the mCTSIB sway area EcFi (r = 0.38; P = .02), sway area EcFo (r = 0.43; P = .006), sensory reweighting firm (r = 0.33; P = .04), and sensory reweighting foam (r = 0.38; P = .02). The average sway area across the 4 mCTSIB conditions was significantly (area under the curve: 0.77; P < .001) better at differentiating groups than the mCTSIB clinical total score. The average sway area across the 4 mCTSIB conditions had a sensitivity of 73% and a specificity of 71%. The clinical mCTSIB outcome scores were not different between groups. CONCLUSION People with chronic mTBI appear to have central sensory integration deficits detectable by instrumented measures of postural assessment. These findings suggest that central sensory integration should be targeted in rehabilitation for people with chronic mTBI.
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Affiliation(s)
- Douglas N Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Geetanjali Gera
- Department of Physical Therapy, University of Kentucky, Lexington, KY 40536, USA
| | - Barbara H Brumbach
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kody R Campbell
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - James Chesnutt
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Family Medicine and Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, OR 97239, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
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Butowicz C, Yoder AJ, Hendershot BD, Gunterstockman B, Farrokhi S. Principal components analysis of postural sway in persons with unilateral lower limb amputation: A wearable sensor approach. J Biomech 2023; 158:111768. [PMID: 37625201 DOI: 10.1016/j.jbiomech.2023.111768] [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: 12/16/2022] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Standing sway assessments can detect sensory imbalances which compromise postural control. Persons with lower limb amputation (LLA) often demonstrate impaired postural control, increasing fall risk. Here, principal features of postural sway were identified in persons with unilateral LLA using a single, commercially available wearable sensor. Sixty-one persons with LLA (n = 44 transtibial; n = 17 transfemoral) stood on a firm surface with eyes open/closed while wearing a single accelerometer mounted over the sacrum. Common parameters quantified spatiotemporal and spectral features of sway in anterior-posterior (AP) and mediolateral (ML) directions. Principal component (PC) dimensionality reduction was applied and loadings inspected to identify a reduced, non-redundant set among 14 original variables capturing 90 % variance. Six PCs described ≥ 90 % variance, with the first 3 explaining 75 %. With eyes open and closed, PC1 was loaded by variables characterizing trajectory planar size: area, jerk (i.e., sway smoothness), AP/ML RMS path distance, and AP/ML path range. With eyes open, PC2 was loaded by variables characterizing direction and spectral features: ellipse rotation, AP centroidal frequency, and ML jerk. With eyes closed, PC2 spectral loadings increased: ML centroidal frequency, ML frequency dispersion, and AP centroidal frequency. With eyes open, PC3 was loaded by ellipse rotation, jerk, ML velocity, ML centroidal frequency. With eyes closed, PC3 was loaded by ellipse rotation, ML centroidal frequency, ML frequency dispersion, and AP path velocity, characterizing off-axis error/corrections. RMS of path distance, ellipse rotation, centroidal frequency, frequency dispersion, path velocity, and jerk are a concise parameter set, derived from an accelerometer, to capture principal sway features in persons with LLA during standing balance with visual perturbations.
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Affiliation(s)
- Courtney Butowicz
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
| | - Adam J Yoder
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Physical & Occupational Therapy, Naval Medical Center, San Diego, CA 92134, United States
| | - Brad D Hendershot
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
| | - Brittney Gunterstockman
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Physical & Occupational Therapy, Naval Medical Center, San Diego, CA 92134, United States; Department of Physical Therapy, Lincoln Memorial University, Knoxville, TN 37932, United States
| | - Shawn Farrokhi
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States; Department of Physical & Occupational Therapy, Naval Medical Center, San Diego, CA 92134, United States
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11
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Özkan E, Özler C, Akar K, Youssef H, Özmen K, Şen ZD, Vural A, Gürsoy-Özdemir Y. Individual-based predominance of visual input in multisensorial integration for balance is correlated with proprioceptive drift in rubber hand illusion. Sci Rep 2023; 13:11905. [PMID: 37488214 PMCID: PMC10366093 DOI: 10.1038/s41598-023-39253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/22/2023] [Indexed: 07/26/2023] Open
Abstract
Rubber hand illusion (RHI) is a traditional task that examines multisensory integration. The visual capture of tactile stimulus given to the seen rubber hand was considered to predominate the sensory processing and interfere with the bottom-up proprioceptive and tactile inputs received from the unseen real hand that results in mislocalization of participants hand towards rubber hand, namely proprioceptive drift (PD). Another task that requires multisensorial integration and shows a predominance of visual input is the maintenance of body posture. However, if the predominance of visual input in one task is generalizable to another task is yet to be elucidated. We aimed to examine if individual dependency on visual inputs in multisensorial integration in balance correlated with PD in RHI. Twenty healthy participants were recruited for the study and completed the RHI task. The contribution of visual inputs to the static body balance was measured with the instrumented clinical test of sensory interaction for balance and indexed with Romberg Quotient (RQ). We found a moderate positive correlation between PD and RQ. Individuals with more dependence on visual information in maintaining body posture had higher PD in RHI. Our results indicate that there can be an individual-based dependence on particular domains of sensory input preserved during different tasks of multisensorial integration. Future studies must clarify whether this tendency relates to certain physical or physiological traits.
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Affiliation(s)
- Esra Özkan
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey.
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Ceyda Özler
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Kardelen Akar
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Hussein Youssef
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Kaan Özmen
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Zümrüt Duygu Şen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health, DZP, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Atay Vural
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Yasemin Gürsoy-Özdemir
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
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12
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Boolani A, Gruber AH, Torad AA, Stamatis A. Identifying Current Feelings of Mild and Moderate to High Depression in Young, Healthy Individuals Using Gait and Balance: An Exploratory Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6624. [PMID: 37514917 PMCID: PMC10384769 DOI: 10.3390/s23146624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Depressive mood states in healthy populations are prevalent but often under-reported. Biases exist in self-reporting of depression in otherwise healthy individuals. Gait and balance control can serve as objective markers for identifying those individuals, particularly in real-world settings. We utilized inertial measurement units (IMU) to measure gait and balance control. An exploratory, cross-sectional design was used to compare individuals who reported feeling depressed at the moment (n = 49) with those who did not (n = 84). The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was employed to ensure internal validity. We recruited 133 participants aged between 18-36 years from the university community. Various instruments were used to evaluate participants' present depressive symptoms, sleep, gait, and balance. Gait and balance variables were used to detect depression, and participants were categorized into three groups: not depressed, mild depression, and moderate-high depression. Participant characteristics were analyzed using ANOVA and Kruskal-Wallis tests, and no significant differences were found in age, height, weight, BMI, and prior night's sleep between the three groups. Classification models were utilized for depression detection. The most accurate model incorporated both gait and balance variables, yielding an accuracy rate of 84.91% for identifying individuals with moderate-high depression compared to non-depressed individuals.
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Affiliation(s)
- Ali Boolani
- Honors Department, Clarkson University, Potsdam, NY 13699, USA
| | - Allison H Gruber
- Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA
| | - Ahmed Ali Torad
- Faculty of Physical Therapy, Kafrelsheik University, Kafr El Sheik 33516, Egypt
| | - Andreas Stamatis
- Department of Health and Sport Sciences, University of Louisville, Louisville, KY 40292, USA
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13
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Zur O, Ben-Rubi Shimron H, Deutsch L, Carmeli E. Reliability, validity and normal ranges of the Zur Balance Scale for detecting mild postural control differences: introducing the modified, short version mZBS. Front Hum Neurosci 2023; 17:1131478. [PMID: 37305365 PMCID: PMC10250721 DOI: 10.3389/fnhum.2023.1131478] [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: 12/25/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Balance is achieved through interactions between the vestibular, somatosensory, and visual systems. There are several clinical tests to measure postural stability. However, most of them do not assess postural stability with head movements, which is the main function of the vestibular system, and those that do, require the use of sizeable, expensive equipment. Therefore, an applicable, easy-to-perform test that challenges the function of the visual, somatosensory and vestibular systems, using head movements, is needed. The Zur Balance Scale (ZBS) contains ten conditions, which are a combination of surfaces (floor or Styrofoam with subject standing on its width in Romberg position or its length in tandem position), stances (Romberg or tandem), tasks (no head movement with eyes open or closed and horizontal or vertical head movements with eyes open). The purpose of this study was to determine the validity, inter- and intra-examiner reliability, and normal performance values of the ZBS among individuals 29-70-years of age and to introduce the modified version: the mZBS, using kinetic measurements. Methods Healthy participants ages 29-70 years were evaluated for inter- and intra-tester reliability (n = 65), kinetic measurements on a force plate, and validity compared to the modified clinical test of sensory interaction and balance (mCTSIB) (n = 44) and characterization of normal values (n = 251). Results Zur Balance Scale head movements, duration of each condition (up to 10 s) and the total ZBS score agreed across examiners (ICC > 0.8). Normal ZBS scores were negatively correlated with age (r = -0.34; P < 0.0001). Older subjects (60-70 years) had a median score of 95.5 compared with younger subjects, where medians ranged from 97.6 to 98.9. Kinetic parameters showed positive correlations between ZBS and the mCTSIB scores, with the highest correlation between the five Romberg tasks (modified ZBS). Conclusion Zur Balance Scale is a valid and reliable test. Its advantages include using head movements and the ability to detect minimal differences in postural control, even in healthy populations. Kinetic evaluation of the ZBS enables the use of a modified, shorter version of the ZBS (mZBS).
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Affiliation(s)
- Oz Zur
- The Israeli Center for Dizziness and Balance Disorders, Ra’anana, Israel
- Department of Physical Therapy, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Lisa Deutsch
- BioStats Statistical Consulting, Ltd., Modi’in-Maccabim-Re’ut, Israel
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa, Israel
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14
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Vargas Matamala M, Tapia C, Salvador Sagüez F, Guerrero-Henriquez J. Postural performance assessment in aging people with diabetes and diabetic peripheral neuropathy using a Wii balance board. Disabil Rehabil 2023; 45:1202-1207. [PMID: 35369833 DOI: 10.1080/09638288.2022.2055168] [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] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the effect of sensory perturbations on static postural control in older people with type 2 diabetes mellitus by comparing postural outcomes of people with and without diabetic neuropathy using a Wii Balance Board (WBB). MATERIALS AND METHODS Static postural balance assessments were performed in 31 participants: nine with type 2 diabetes mellitus; 12 with diabetic neuropathy; and 10 non-diabetic controls. Participants stood on the WBB under sensory perturbations (visual and proprioceptive). Body balance was analysed using centre of pressure ellipse area, mean velocity, and sample entropy. The effects of within-participant factors, sensory perturbations and the between-participants factor 'group' on outcomes were analysed using a multivariate analysis of variance model. RESULTS Type 2 diabetes mellitus participants with and without neuropathy showed altered postural performance under sensory perturbations compared to non-diabetic participants. Moreover, participants with diabetic neuropathy showed impaired postural performance when one perceptual system was disturbed. Finally, participants with type 2 diabetes mellitus without neuropathy decreased their postural performance when both sensory disturbances were present. CONCLUSIONS The Wii Balance Board can be a useful alternative for balance impairment screening related to diabetic neuropathy and contribute as an affordable source of insight in early interventions in integral diabetes care.Implications to rehabilitationOlder people with diabetic peripheral neuropathy depend on visual and somatosensory cues to keep their static postural balance.Static balance assessment using the Wii Balance Board allows the identification of alterations in postural performance in participants with diabetes.This low-cost method used can be considered as a complement to integral diabetes care.
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Affiliation(s)
- Martin Vargas Matamala
- Department of Rehabilitation Sciences and Human Movement, University of Antofagasta, Antofagasta, Chile
| | - Claudio Tapia
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Juan Guerrero-Henriquez
- Department of Rehabilitation Sciences and Human Movement, University of Antofagasta, Antofagasta, Chile
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15
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Lai MH, Xu HC, Huang MC, Lu Y, Yang K, Jiang LM, Yu XM. Transcranial direct current stimulation combined with bodyweight support-tai chi footwork for motor function of stroke survivors: a study protocol of randomised controlled trial. BMJ Open 2023; 13:e065338. [PMID: 36882241 PMCID: PMC10008177 DOI: 10.1136/bmjopen-2022-065338] [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] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Our previous studies have proposed the bodyweight support-t'ai chi (BWS-TC) footwork training for stroke survivors with severe motor dysfunction and fear of falling, and have proven its positive effects for motor function. Transcranial direct current stimulation (tDCS) provides a non-invasive and safe way to modulate neuronal activity and provoke neuroplastic changes and to improve the motor function of stroke survivors. However, it is unclear whether the integration of BWS-TC and tDCS has synergistic effects on improving motor function of the stroke survivors. METHODS AND ANALYSIS This study will be an assessor-blinded randomised controlled trial involving 12-week intervention and 6-month follow-up. One hundred and thirty-five individuals with stroke will be randomly divided in a ratio of 1:1:1 into three groups. Control group A, control group B and intervention group C will receive tDCS and conventional rehabilitation programmes (CRPs), BWS-TC and CRP, tDCS-BWS-TC and CRP for 12 weeks, respectively. The primary outcome measures will include the efficacy (Fugl-Meyer Assessment), acceptability and safety of these interventions. The secondary outcome measures will include balance ability (ie, limits of stability and modified clinical test of sensory integration), walking function, brain structure and function, risk of falling, Barthel Index and 36-Item Short Form Survey. All outcomes will be assessed at baseline, 6 and 12 weeks during intervention, and 1, 3 and 6 months during the follow-up period. Two-way analysis of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committee of the Shanghai Seventh People's Hospital (2021-7th-HIRB-017). The results of the study will be published in a peer-reviewed journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059329.
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Affiliation(s)
- Ming-Hui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hai-Chen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Meng-Cui Huang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Lu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li-Ming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Ming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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16
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Villegas CM, Curinao JL, Aqueveque DC, Guerrero-Henríquez J, Matamala MV. Identifying neuropathies through time series analysis of postural tests. Gait Posture 2023; 99:24-34. [PMID: 36327535 DOI: 10.1016/j.gaitpost.2022.09.090] [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: 05/31/2022] [Revised: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In physical therapy, postural tests are frequently used to diagnose neuropathies, particularly in diabetic individuals. This study aims to develop a method based on the analysis of time series that allows discriminating between healthy and diabetic subjects with or without a neuropathic condition. RESEARCH QUESTION Do features obtained from time series corresponding to postural tests allow us to reliably discriminate between healthy, diabetic and neuropathic patients? METHODS In this study, 32 people participated in the healthy, diabetic, and neuropathic categories (11, 9, and 12, respectively). The data was collected by positioning each participant on a Wii Balanced Board platform, under 8 different conditions. The analyzed time series are sensed by devices that capture variations in the subject's center of pressure when subjected to a test on different conditions over a short period of time. The method proposed considers statistical techniques used for characterizing the time series combined with machine learning techniques to classify the individual's profile into one of the three categories mentioned. The classification is supported by an underlying probabilistic model, based on the characteristics of the time series, generating average curves for each class, which are then used by the classification methods. RESULTS The empirical results include classification models for each class, obtaining a performance (F-score) over 98%. In addition, other models considering the particular conditions to which the subject is exposed during the test are developed, revealing that the conditions of eyes open and eyes closed show the highest levels of discrimination to classify participants into one of the three class categories. SIGNIFICANCE These results suggest a test protocol simplification and, at the same time, that the proposed method based on the analysis of the time series associated with the test used is highly predictive and may reliably complement or substitute a questionnaire-based diagnosis.
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Affiliation(s)
- Claudio Meneses Villegas
- Department of Computing and Systems Engineering, Universidad Católica del Norte, Antofagasta, Chile.
| | | | - David Coo Aqueveque
- Department of Computing and Systems Engineering, Universidad Católica del Norte, Antofagasta, Chile.
| | - Juan Guerrero-Henríquez
- Department of Rehabilitation Sciences and Human Movement, Universidad de Antofagasta, Antofagasta, Chile.
| | - Martín Vargas Matamala
- Department of Rehabilitation Sciences and Human Movement, Universidad de Antofagasta, Antofagasta, Chile.
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17
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Denizoglu Kulli H, Gurses HN. Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol 2022; 279:40-44. [DOI: 10.1016/j.ejogrb.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/11/2022] [Accepted: 10/01/2022] [Indexed: 11/28/2022]
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Whittier TT, Weller ZD, Fling BW. I Can Step Clearly Now, the TENS Is On: Transcutaneous Electric Nerve Stimulation Decreases Sensorimotor Uncertainty during Stepping Movements. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22145442. [PMID: 35891122 PMCID: PMC9317326 DOI: 10.3390/s22145442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 06/01/2023]
Abstract
Transcutaneous electric nerve stimulation (TENS) is a method of electrical stimulation that elicits activity in sensory nerves and leads to improvements in the clinical metrics of mobility. However, the underlying perceptual mechanisms leading to this improvement are unknown. The aim of this study was to apply a Bayesian inference model to understand how TENS impacts sensorimotor uncertainty during full body stepping movements. Thirty healthy adults visited the lab on two occasions and completed a motor learning protocol in virtual reality (VR) on both visits. Participants were randomly assigned to one of three groups: TENS on first visit only (TN), TENS on second visit only (NT), or a control group where TENS was not applied on either visit (NN). Using methods of Bayesian inference, we calculated the amount of uncertainty in the participants' center of mass (CoM) position estimates on each visit. We found that groups TN and NT decreased the amount of uncertainty in the CoM position estimates in their second visit while group NN showed no difference. The least amount of uncertainty was seen in the TN group. These results suggest that TENS reduces the amount of uncertainty in sensory information, which may be a cause for the observed benefits with TENS.
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Affiliation(s)
- Tyler T. Whittier
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA;
| | - Zachary D. Weller
- Department of Statistics, Colorado State University, Fort Collins, CO 80523, USA;
| | - Brett W. Fling
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA;
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO 80523, USA
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Carvalho GF, Luedtke K, Pinheiro CF, Moraes R, Lemos TW, Carneiro CG, Bigal ME, Dach F, Bevilaqua-Grossi D. Migraine and balance impairment: Influence of subdiagnosis, otoneurological function, falls, and psychosocial factors. Headache 2022; 62:548-557. [PMID: 35593785 DOI: 10.1111/head.14309] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/24/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors. BACKGROUND Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far. METHODS Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross-sectional study (30 patients per group). Thirty headache-free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. RESULTS All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5-85.3], MWoA: 76.5 [95% CI: 73.6-79.3], MWA: 66.5 [95% CI: 63.6-69.3], CM: 69.1 [95% CI: 66.3-72.0]; p < 0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3-80.4], MWoA: 67.3 [95% CI: 62.7-71.8], MWA: 55.7 [95% CI: 51.2-60.3], CM: 58.4 [95% CI: 53.8-63.0]; p < 0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2-94.9], MWoA: 83.2 [95% CI: 77.9-88.6], MWA: 68.6 [95% CI: 63.3-74.0], CM: 71.9 [95% CI: 66.5-77.2], p < 0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p = 0.001). The SOT scores correlated with fear of falls (r = -0.44), dizziness disability (r = -0.37), kinesiophobia (r = -0.38), and migraine frequency (r = -0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F = 3.33, p = 0.070], visual score [F = 2.11, p = 0.149], vestibular score [F = 1.88, p = 0.172], somatosensory score [F = 0.00, p = 0.993]). CONCLUSIONS Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.
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Affiliation(s)
- Gabriela F Carvalho
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany
| | - Kerstin Luedtke
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany.,Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Carina F Pinheiro
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Renato Moraes
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Tenysson W Lemos
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Camila G Carneiro
- Department of Ophthalmology, Otolaryngology and Head & Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Debora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Stark M, Huang H, Yu LF, Martin R, McCarthy R, Locke E, Yager C, Torad AA, Kadry AM, Elwan MA, Smith ML, Bradley D, Boolani A. Identifying Individuals Who Currently Report Feelings of Anxiety Using Walking Gait and Quiet Balance: An Exploratory Study Using Machine Learning. SENSORS 2022; 22:s22093163. [PMID: 35590853 PMCID: PMC9105708 DOI: 10.3390/s22093163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 12/10/2022]
Abstract
Literature suggests that anxiety affects gait and balance among young adults. However, previous studies using machine learning (ML) have only used gait to identify individuals who report feeling anxious. Therefore, the purpose of this study was to identify individuals who report feeling anxious at that time using a combination of gait and quiet balance ML. Using a cross-sectional design, participants (n = 88) completed the Profile of Mood Survey-Short Form (POMS-SF) to measure current feelings of anxiety and were then asked to complete a modified Clinical Test for Sensory Interaction in Balance (mCTSIB) and a two-minute walk around a 6 m track while wearing nine APDM mobility sensors. Results from our study finds that Random Forest classifiers had the highest median accuracy rate (75%) and the five top features for identifying anxious individuals were all gait parameters (turn angles, variance in neck, lumbar rotation, lumbar movement in the sagittal plane, and arm movement). Post-hoc analyses suggest that individuals who reported feeling anxious also walked using gait patterns most similar to older individuals who are fearful of falling. Additionally, we find that individuals who are anxious also had less postural stability when they had visual input; however, these individuals had less movement during postural sway when visual input was removed.
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Affiliation(s)
- Maggie Stark
- Department of Medicine, Lake Erie Osteopathic College of Medicine, Elmira, NY 14901, USA;
| | - Haikun Huang
- Department of Computer Science, George Mason University, Fairfax, VA 22030, USA; (H.H.); (L.-F.Y.)
| | - Lap-Fai Yu
- Department of Computer Science, George Mason University, Fairfax, VA 22030, USA; (H.H.); (L.-F.Y.)
| | - Rebecca Martin
- Department of Physical Therapy, Hanover College, Hanover, IN 47243, USA;
| | - Ryan McCarthy
- Department of Biology, Clarkson University, Potsdam, NY 13699, USA;
- Department of Psychology, Clarkson University, Potsdam, NY 13699, USA
| | - Emily Locke
- Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699, USA;
| | - Chelsea Yager
- Department of Neurology, St. Joseph’s Hospital Health Center, Syracuse, NY 13203, USA;
| | - Ahmed Ali Torad
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Faculty of Physical Therapy, Kafrelsheik University, Kafr El Sheik 33516, Egypt
| | - Ahmed Mahmoud Kadry
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Faculty of Physical Therapy, Kafrelsheik University, Kafr El Sheik 33516, Egypt
| | - Mostafa Ali Elwan
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Faculty of Physical Therapy, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Matthew Lee Smith
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA;
| | - Dylan Bradley
- Canino School of Engineering Technology, State University of New York, Canton, NY 13617, USA;
| | - Ali Boolani
- Department of Biology, Clarkson University, Potsdam, NY 13699, USA;
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Correspondence:
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21
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Use of Wearable Sensors to Assess the Effects of Performing a Cognitive Task on Sensory Integration of Balance in Healthy Individuals. SENSORS 2022; 22:s22072776. [PMID: 35408390 PMCID: PMC9003408 DOI: 10.3390/s22072776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023]
Abstract
This study investigated the effects of performing a cognitive task on the sensory integration of balance in healthy individuals. Ten subjects (five F/five M; 21.5 ± 2.17 years; 69.9 ± 3.4 inches; 155.6 ± 26.1 lbs; Caucasian), without known balance issues, performed the modified Clinical Test of Sensory Interaction of Balance (mCTSIB) with and without a cognitive task. The cognitive task involved counting down in threes from a randomly assigned number between 95 and 100. Postural sway area and postural sway jerk were assessed through the use of inertial sensors placed around the subjects’ lower lumbar region. Each subject performed four trials for the four conditions of the mCTSIB: eyes open firm (EOFirm), eyes closed firm (ECFirm), eyes open foam (EOFoam), and eyes closed foam (ECFoam). We tested the effect of performing a cognitive task on the sensory integration of balance. We hypothesized that sensory cognitive interaction would be more apparent for more complex conditions and would be better assessed with postural sway jerk compared to postural sway area measure. With the addition of a cognitive task for the mCTSIB: (1) postural sway area increased in the baseline condition, i.e., EOFirm (p < 0.05), but did not increase in the most difficult condition, i.e., ECFoam; (2) postural sway jerk increased in all conditions of the mCTSIB (p < 0.05); (3) cognitive performance did not deteriorate across conditions of the mCTSIB. Postural sway jerk was shown to be a more sensitive measure in detecting the effect of a cognitive task on sensory integration for postural control. Overall, inertial sensors can be used to reliably assess postural sway differences related to sensory−cognitive integration.
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Utility of the Novel MediPost Mobile Posturography Device in the Assessment of Patients with a Unilateral Vestibular Disorder. SENSORS 2022; 22:s22062208. [PMID: 35336379 PMCID: PMC8953915 DOI: 10.3390/s22062208] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/28/2022]
Abstract
Balance disorders are a growing problem worldwide. Thus, there is an increasing need to provide an inexpensive and feasible alternative to standard posturographic platforms (SP) used for the assessment of balance and to provide a possible solution for telemonitoring of patients. A novel mobile posturography (MP) MediPost device was developed to address these issues. This prospective study used a Modified Clinical Test of Sensory Interaction on Balance to evaluate healthy individuals and patients with a unilateral vestibular disorder through SP and MP simultaneously. The control group included 65 healthy volunteers, while the study group included 38 patients diagnosed with a unilateral vestibular deficit. The angular velocity values obtained from both methods were compared by intraclass correlation coefficients (ICC) and Bland−Altman plot analysis. Diagnostic capabilities were measured in terms of sensitivity and specificity. The ICC between the two methods for conditions 2−4 was indicative of excellent reliability, with the ICC > 0.9 (p < 0.001), except for Condition 1 (standing stance, eyes open) ICC = 0.685, p < 0.001, which is indicative of moderate reliability. ROC curve analysis of angular velocity for condition 4 represents the most accurate differentiating factor with AUC values of 0.939 for SP and 0.953 for MP. This condition also reported the highest sensitivity, specificity, PPV, and NPV values with 86.4%, 87.7%, 80%, and 90.5% for SP, and 92.1%, 84.6%, 77.8%, and 94.8% for MP, respectively. The newly developed MediPost device has high sensitivity and specificity in distinguishing between healthy individuals and patients with a unilateral vestibular deficit.
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23
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Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7959830. [PMID: 35281607 PMCID: PMC8906973 DOI: 10.1155/2022/7959830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/10/2022] [Indexed: 11/20/2022]
Abstract
Background Recent protocols for posturographic assessment of postural control and balance have included head shake test conditions to challenge the vestibular contributions of postural control in an effort to increase the diagnostic accuracy of identifying individuals with impaired balance. However, evidence is limited regarding the test-retest reliability of such assessment protocols. Purpose The purpose of this study was twofold: to determine the test-retest reliability of postural control assessment on the Biodex Biosway™, an accessible and field expedient tool for posturographic assessment, and to determine the test-retest reliability of the Head Shake Sensory Interaction and Balance Test (HS-SIB), an adaptation of the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) which adds two head shake conditions to challenge the vestibular contributions to postural control. Study Design. This was a correlational time series cohort study completed in a biomechanics laboratory. Methods The sample consisted of nineteen healthy adults (10 females, 9 males). Sway Index, Equilibrium Score, and the area of the ellipse enclosing 95% of the anterior-posterior (AP) and medial-lateral (ML) center of gravity (COG) displacement (AREA95) are the 3 summary variables. Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) are also reported. Results Test-retest reliability was generally poor with limited exceptions. Moderate to good reliability was observed for the more challenging stance conditions (ICC range 0.58-0.81), including those with head shake. Conclusions Field-expedient systems, such as the Biodex BioSway™, may offer reliable posturographic testing where gold-standard methods are not available. Clinicians should be aware that less demanding test conditions have limited reliability; however, test-retest reliability of this assessment tool is improved with more challenged stance conditions and the inclusion of a head shake task.
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Postural Control and Adaptation Strategy of Young Adults on Unstable Surface. Motor Control 2022; 27:179-193. [PMID: 36216337 DOI: 10.1123/mc.2021-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/06/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Abstract
Balance control is essential for postural adjustment in physical activities. This study investigates the behavior of human postural control and the coordination and adaptation strategy of hip, knee, and ankle when standing on an unstable surface. Twenty participants were recruited. Four different conditions were investigated: a quiet bipedal stance with eyes open and eyes closed, and standing on an unstable surface with eyes open and eyes closed. Other than the joint angle, the standard body sway measures, such as sway area and sway velocity, were computed. A nonlinear time series measure, that is, sample entropy, was used to determine the regularity of the time series and body adaptability to change and perturbation. The results show that the body sway increases as the difficulty increases. This study also confirms the coordination of the hip, knee, and ankle to maintain body balance on the unstable surface by decreasing the joint angle and adopting a lower posture. Even though the individual joint has lower sample entropy value and is deemed to be rigid and less adaptive to perturbation, the postural control exhibits higher sample entropy value, particularly in the anterior–posterior direction, and has the ability to stabilize the body by manipulating the joints simultaneously. These outcomes suggest that an unstable surface not only challenges the human postural control, but also reduces the hip, knee, and ankle adaptability to perturbation, thus making it a great tool to train body balance.
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Blais AA, Tremblay C, Guarnaccia L, Tremblay L, Laflamme-Thibault S, Côté S, Tremblay P, Bouchard J, da Silva RA. The Importance of Adapting Functional Test Instructions for Older Adults with Neurocognitive Disorders. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1920654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Audrey-Ann Blais
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Cynthia Tremblay
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Laury Guarnaccia
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Léane Tremblay
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Sandrine Laflamme-Thibault
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Sharlene Côté
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
| | - Patrice Tremblay
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
| | - Julie Bouchard
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
| | - Rubens A. da Silva
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
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Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy. Sci Rep 2021; 11:17212. [PMID: 34446786 PMCID: PMC8390502 DOI: 10.1038/s41598-021-96725-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/10/2021] [Indexed: 01/28/2023] Open
Abstract
Tandem gait is considered one of the most useful screening tools for gait impairment. The aim of this study is to evaluate diagnostic usefulness of 10-step tandem gait test for the patients with degenerative cervical myelopathy (DCM). Sixty-two DCM patients were compared to 55 persons without gait abnormalities as control. We counted the number of consecutive steps and graded into five according the number of steps and stability. Five grades of tandem gait were investigated for association with clinical parameters including qualitative Japanese orthopedic association (JOA) sub-score for lower extremities and Nurick scale and quantitative balance and gait assessments. The number of tandem steps were reduced and the grades of tandem gait were differently distributed in the DCM patients compared to controls (steps, 7.1 ± 3.6 versus 9.9 ± 0.4, p < 0.001; grades of 0/1/2/3/4/5, 1/13/14/15/19 versus 0/0/2/15/38, p < 0.001 in patients with DCM and control respectively). Patients with DCM showed more unstable balance and abnormal gait features including slower velocity, shorter strides, wider bases with increased stance phase of a gait cycle compared to the control group. The grades of tandem gait were correlated with JOA sub-score (r = 0.553, p < 0.001) and the Nurick scale (r = - 0.652, p < 0.001) as well as both balance and gait parameters. In DCM patients, tandem gait was impaired and correlated with severity of gait abnormality. The authors believe that 10-step tandem gait test is an objective and useful screening test for evaluating gait disturbance in patients with DCM.
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27
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Cochrane GD, Christy JB, Almutairi A, Busettini C, van Heyningen HKK, Weise KK, Swanson MW, Gould SJ. Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion. J Head Trauma Rehabil 2021; 36:264-273. [PMID: 33656474 PMCID: PMC8249322 DOI: 10.1097/htr.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The main objective of this study was to assess whether objective vestibular, oculomotor, and balance functions were impaired in children with a current diagnosis of concussion with vestibular and/or ocular symptoms. SETTING Data were collected in a vestibular/ocular clinical laboratory. Patient participants were recruited from a concussion clinic in a children's hospital. PARTICIPANTS Thirty-three children aged 8 to 17 years with a current diagnosis of concussion and vestibular and/or ocular symptoms and 30 children without concussion. DESIGN Cross-sectional single-visit study. MAIN OUTCOME MEASURES Eye-tracking rotary chair oculomotor and vestibular measures, vestibular evoked potentials, and static posturography. RESULTS There were no statistically significant differences on any clinical measure between children with concussion and children without concussion. Younger children without concussion performed significantly worse on several rotary chair and balance measures compared with older children without concussion. CONCLUSIONS No vestibular, oculomotor, or balance measures were significantly different between children with concussion and children without concussion, suggesting these measures may not be useful in the evaluation of a child with concussion and vestibular and/or oculomotor symptoms. Future research should investigate age effects and other vestibular and oculomotor tests to identify objective findings that better relate to vestibular and/or ocular symptoms in children with concussion.
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Affiliation(s)
- Graham D. Cochrane
- Medical Scientist Training Program, School of Medicine, University of Alabama at Birmingham
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham
| | - Jennifer B. Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham
| | - Anwar Almutairi
- Department of Physical Therapy, Allied Health Sciences Center, Kuwait University
| | | | | | | | | | - Sara J. Gould
- Concussion Clinic, Children’s of Alabama
- Division of Orthopedics, Department of Surgery, University of Alabama at Birmingham
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Monaghan AS, Monaghan PG, Richmond SB, Roper JA, Fling BW. The effect of shoe cushioning on gait and balance in females with multiple sclerosis. Exp Brain Res 2021; 239:2593-2603. [PMID: 34212220 DOI: 10.1007/s00221-021-06161-1] [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: 02/07/2021] [Accepted: 06/22/2021] [Indexed: 01/28/2023]
Abstract
Gait and balance deficits are significant concerns for people with multiple sclerosis (MS). Shoe cushioning can influence mobility and balance, but its effect on walking and balance remains unknown in MS. This study aimed to determine how shoe cushioning affects gait and balance in females with MS (FwMS). We hypothesized that extra cushioning would improve gait but reduce balance performance. FwMS performed gait (n = 18) and balance (n = 17) assessments instrumented using inertial sensors in two different shoe conditions: a standard-cushioned and an extra-cushioned shoe. Care was taken to ensure minimal differences between shoe types other than midsole cushioning, but shoe construction was not identical between conditions. Spatiotemporal gait parameters were assessed during a 2-min walk test, while postural sway measures were evaluated using the modified Clinical Test of Sensory Interaction and Balance. In the extra-cushioned shoe, FwMS spent less time in the double support and stance phase with more time in the single support and swing phase. No differences in stride length, gait speed, or elevation at midswing were observed between shoe conditions. Decreased path length, RMS sway, and sway velocity were observed in the extra-cushioned shoe. No differences were observed in the gait cycle's spatial composition between shoe conditions, but FwMS demonstrated improvements in the gait cycle's temporal parameters and postural sway in the extra-cushioned shoe. This may suggest a less cautious walking strategy and improved balance when wearing a shoe with extra cushioning.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | | | - Sutton B Richmond
- Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Jamie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Room 220 Moby Complex, 951 Plum Street, Fort Collins, CO, 80523-1582, USA. .,Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO, USA.
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29
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State and Trait Fatigue and Energy Predictors of Postural Control and Gait. Motor Control 2021; 25:519-536. [PMID: 34117130 DOI: 10.1123/mc.2020-0106] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
Compromised attentional resources during perceived fatigue has been suggested to alter motor control. The authors determined if measures of postural control and gait are predicted by state and trait physical and mental fatigue and energy, and how these relationships are modified by sex, sleep quality, and physical activity. Young adults (n = 119) completed the Modified Clinical Test of Sensory Integration, overground walking, and questionnaires to quantify fatigue and energy, sleep quality, and physical activity. Regression models indicated that trait fatigue, trait energy, and sleep quality were predictors of postural control (p ≤ .02, R2 ≥ .04). State fatigue, state energy, and sex were predictors of gait (p ≤ .05, R2 ≥ .03). While the variance explained was low (3-13%), the results demonstrate perceptions of fatigue and energy may influence posture and gait.
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30
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Teare-Ketter A, LaForme Fiss A, Ebert J. The Utility of Neuromotor Retraining to Augment Manual Therapy and Vestibular Rehabilitation in a Patient with Post-Concussion Syndrome: A Case Report. Int J Sports Phys Ther 2021; 16:248-258. [PMID: 33604153 PMCID: PMC7872469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/24/2020] [Indexed: 11/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Less than half of patients discharged from the emergency department post-concussion receive patient education or follow-up care, and 10-20% of individuals will develop symptoms that last longer than six months. Current research on interventions for post-concussion syndrome (PCS) shows inconsistent results, and recommendations for effective physical therapy treatment for patients with chronic PCS are lacking. The purpose of this case report is to highlight a successful, multi-system approach to physical therapy examination and treatment of a patient with chronic PCS. CASE DESCRIPTION This case describes a 21-year-old male who sustained a concussion 356 days prior to evaluation. He received no follow-up treatment and reported periods of worsening symptoms since the injury. Impairments in cervical range of motion and accessory mobility, vestibular and vestibulo-ocular function, and postural stability were identified. Both cognitive and emotional symptoms were also present. The patient attended eight, sixty-minute sessions over a five-week period in an outpatient setting. Comprehensive physical therapy interventions included manual therapy, vestibular rehabilitation, and neuromotor retraining aimed at restoring proper sensory integration and midline postural orientation. OUTCOMES Outcomes included cervical spine goniometric measurements and accessory mobility assessments. Objective measures of postural stability included the Modified Clinical Test of Sensory Interaction in Balance (m-CTSIB) and the Fukuda Step Test. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) was used to subjectively assess symptom severity. At discharge, goniometric measurements returned to within normal limits except left cervical rotation active range of motion (ROM), and both the m-CTSIB and Fukuda Step Test were within normal ranges. The RPQ score reduced from 20 to 2 demonstrating symptom resolution in all items but "headache." DISCUSSION PCS can affect multiple systems, necessitating a comprehensive approach to examination and intervention. Manual therapy was used to restore cervical spine ROM, vestibular rehabilitation was utilized to improve gaze stability and visual motion sensitivity, and neuromotor retraining was implemented to improve postural stability and sensory integration. Physical therapists have the ability to treat multiple systems impacted with PCS, with the potential to reduce the longevity and severity of impairments for patients. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Andrew Teare-Ketter
- Department of Physical Therapy, Mercer University, Atlanta, GA, USA; Division of Sports Medicine, Department of Physical Therapy and Rehabilitation, Floyd Medical Center, Rome, GA, USA
| | | | - Jeffrey Ebert
- Department of Physical Therapy, Mercer University, Atlanta, GA, USA
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31
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Croarkin E, Zampieri C. On the EDGE of Task Force Recommendations: Computerized Balance Assessment. REHABILITATION ONCOLOGY 2021; 39:64-67. [PMID: 38404645 PMCID: PMC10888498 DOI: 10.1097/01.reo.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Earllaine Croarkin
- Board Certified Neurological Clinical Specialist, Physical Therapist, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Research Physical Therapist, Functional and Applied Biomechanics Laboratory, Clinical Research Center, National Institutes of Health, Bethesda, MD
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Zouita S, Zouhal H, Ferchichi H, Paillard T, Dziri C, Hackney AC, Laher I, Granacher U, Ben Moussa Zouita A. Effects of Combined Balance and Strength Training on Measures of Balance and Muscle Strength in Older Women With a History of Falls. Front Physiol 2020; 11:619016. [PMID: 33424642 PMCID: PMC7786296 DOI: 10.3389/fphys.2020.619016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We investigated the effects of combined balance and strength training on measures of balance and muscle strength in older women with a history of falls. METHODS Twenty-seven older women aged 70.4 ± 4.1 years (age range: 65 to 75 years) were randomly allocated to either an intervention (IG, n = 12) or an active control (CG, n = 15) group. The IG completed 8 weeks combined balance and strength training program with three sessions per week including visual biofeedback using force plates. The CG received physical therapy and gait training at a rehabilitation center. Training volumes were similar between the groups. Pre and post training, tests were applied for the assessment of muscle strength (weight-bearing squat [WBS] by measuring the percentage of body mass borne by each leg at different knee flexions [0°, 30°, 60°, and 90°], sit-to-stand test [STS]), and balance. Balance tests used the modified clinical test of sensory interaction (mCTSIB) with eyes closed (EC) and opened (EO), on stable (firm) and unstable (foam) surfaces as well as spatial parameters of gait such as step width and length (cm) and walking speed (cm/s). RESULTS Significant group × time interactions were found for different degrees of knee flexion during WBS (0.0001 < p < 0.013, 0.441 < d < 0.762). Post hoc tests revealed significant pre-to-post improvements for both legs and for all degrees of flexion (0.0001 < p < 0.002, 0.697 < d < 1.875) for IG compared to CG. Significant group × time interactions were found for firm EO, foam EO, firm EC, and foam EC (0.006 < p < 0.029; 0.302 < d < 0.518). Post hoc tests showed significant pre-to-post improvements for both legs and for all degrees of oscillations (0.0001 < p < 0.004, 0.753 < d < 2.097) for IG compared to CG. This study indicates that combined balance and strength training improved percentage distribution of body weight between legs at different conditions of knee flexion (0°, 30°, 60°, and 90°) and also decreased the sway oscillation on a firm surface with eyes closed, and on foam surface (with eyes opened or closed) in the IG. CONCLUSION The higher positive effects of training seen in standing balance tests, compared with dynamic tests, suggests that balance training exercises including lateral, forward, and backward exercises improved static balance to a greater extent in older women.
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Affiliation(s)
- Sghaier Zouita
- Higher Institute of Sport and Physical Education, Ksar-said, University of Manouba, Manouba, Tunisia
| | - Hassane Zouhal
- M2S (Laboratoire Mouvement, Sport, Santé), University of Rennes, Rennes, France
| | - Habiba Ferchichi
- Department of Medicine Physical and Functional Rehabilitation of the National Institute of Orthopedics “M.T. Kassab”, Tunis, Tunisia
| | - Thierry Paillard
- Movement, Balance, Performance and Health Laboratory, Tarbes, E2S/University of Pau and Pays de l’Adour, Pau, France
| | - Catherine Dziri
- Department of Medicine Physical and Functional Rehabilitation of the National Institute of Orthopedics “M.T. Kassab”, Tunis, Tunisia
| | - Anthony C. Hackney
- Department of Exercise and Sport Science, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Amira Ben Moussa Zouita
- Higher Institute of Sport and Physical Education, Ksar-said, University of Manouba, Manouba, Tunisia
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Fino PC, Raffegeau TE, Parrington L, Peterka RJ, King LA. Head stabilization during standing in people with persisting symptoms after mild traumatic brain injury. J Biomech 2020; 112:110045. [PMID: 33011672 DOI: 10.1016/j.jbiomech.2020.110045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 01/28/2023]
Abstract
Increased postural sway is often observed in people with mild traumatic brain injury (mTBI), but our understanding of how individuals with mTBI control their head during stance is limited. The purpose of this study was to determine if people with mTBI exhibit increased sway at the head compared with healthy controls. People with persisting symptoms after mTBI (n = 59, 41 women) and control participants (n = 63, 38 women) stood quietly for one minute in four conditions: eyes open on a firm surface (EO-firm), eyes closed on a firm surface (EC-firm), eyes open on a foam pad (EO-foam), and eyes closed on foam (EC-foam). Inertial sensors at the head, sternum, and lumbar region collected tri-axial accelerations. Root-mean-square (RMS) accelerations in anteroposterior (AP) and mediolateral (ML) directions and sway ratios between the head and sternum, head and lumbar, and sternum and lumbar region were compared between groups. Temporal coupling of anti-phase motion between the upper and lower body angular accelerations was assessed with magnitude squared coherence and cross-spectral phase angles. People with mTBI demonstrated greater sway than controls across conditions and directions. During foam-surface conditions, the control group, but not the mTBI group, reduced ML sway at their head and trunk relative to their lumbar by increasing the expression of an anti-phase hip strategy within the frontal plane. These results are consistent with suggestions of inflexible or inappropriate postural control in people with mTBI.
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Affiliation(s)
- Peter C Fino
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA.
| | - Tiphanie E Raffegeau
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA
| | - Lucy Parrington
- Oregon Health Sciences University, Department of Neurology, Portland, OR, USA
| | - Robert J Peterka
- Oregon Health Sciences University, Department of Neurology, Portland, OR, USA; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA
| | - Laurie A King
- Oregon Health Sciences University, Department of Neurology, Portland, OR, USA; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA
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Boonsinsukh R, Khumnonchai B, Saengsirisuwan V, Chaikeeree N. The effect of the type of foam pad used in the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) on the accuracy in identifying older adults with fall history. Hong Kong Physiother J 2020; 40:133-143. [PMID: 33005077 PMCID: PMC7526061 DOI: 10.1142/s1013702520500134] [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: 02/15/2020] [Accepted: 06/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background The type of foam pad used in the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) influences the accuracy with which elderly fallers are identified. Two types of foam are commonly used in practice: Airex and Neurocom foam. Objective The aim of this study was to assess the accuracy with which elderly fallers can be identified when the Airex foam and Neurocom foam are used in the mCTSIB. Methods One hundred eighty-four elderly participants with a mean age of 69 years were classified into faller and nonfaller groups based on their 12-month fall history. Balance stability was measured under four conditions of the mCTSIB for 120 s each: standing on a floor or a foam pad with their eyes open or eyes closed. The time needed to maintain stability was measured by a stopwatch, and postural sway characteristics were measured using an acceleration-based system. Comparisons between groups were performed by two-way mixed ANOVA. The accuracy of differentiating elderly fallers from nonfallers with different foam types was evaluated using receiver operating characteristic curve (ROC) analysis. The time to maintain stability under four conditions of the mCTSIB (composite score) and under two conditions on the foam (foam score) were used for the ROC analysis. Results The results showed that the nonfallers required more time to maintain stability and had a smaller sway area than the fallers ( p < 0 . 001 ). The foam led to a larger difference between groups, suggesting the use of foam in examining the risk of falls. The Airex and the Neurocom foam pads led to a large area under the curve (0.93 to 0.95) in identifying elderly fallers and nonfallers when the composite and foam scores were used. A cutoff score of 447/480 s for the composite score and 223/240 s for the foam score yielded a posttest accuracy of 88% to 89%, with a sensitivity of 0.80-0.92 and specificity of 0.88-0.95. Conclusion In conclusion, Airex and Neurocom foam can be used interchangeably with guidance in the mCTSIB, as they led to the accurate identification of elderly fallers among older persons who could walk and live independently in the community.
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Affiliation(s)
- Rumpa Boonsinsukh
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Bodin Khumnonchai
- Faculty of Physical Therapy and Sport Medicine, Rangsit University, Pathum Thani, Thailand
| | | | - Nithinun Chaikeeree
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok, Thailand
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Shieh V, Sansare A, Jain M, Bulea T, Mancini M, Zampieri C. Body-Worn Sensors Are a Valid Alternative to Forceplates for Measuring Balance in Children. JOURNAL FOR THE MEASUREMENT OF PHYSICAL BEHAVIOUR 2020; 3:228-233. [PMID: 37476708 PMCID: PMC10358862 DOI: 10.1123/jmpb.2019-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Aims Clinical evaluation of balance has relied on forceplate systems as the gold standard for postural sway measures. Recently, systems based on wireless inertial sensors have been explored, mostly in the adult population, as an alternative given their practicality and lower cost. Our goal was to validate body-worn sensors against forceplate balance measures in typically developing children during tests of quiet stance. Methods 18 participants (8 males) 7 to 17 years old performed a quiet stance test standing on a forceplate while wearing 3 inertial sensors. Three 30-second trials were performed under 4 conditions: firm surface with eyes open and closed, and foam surface with eyes open and closed. Sway area, path length, and sway velocity were calculated. Results We found 20 significant and 8 non-significant correlations. Variables found to be significant were represented across all conditions, except for the foam eyes closed condition. Conclusions These results support the validity of wearable sensors in measuring postural sway in children. Inertial sensors may represent a viable alternative to the gold standard forceplate to test static balance in children.
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Affiliation(s)
- Vincent Shieh
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Ashwini Sansare
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Minal Jain
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Thomas Bulea
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
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Porciuncula F, Wasserman P, Marder KS, Rao AK. Quantifying Postural Control in Premanifest and Manifest Huntington Disease Using Wearable Sensors. Neurorehabil Neural Repair 2020; 34:771-783. [PMID: 32672492 DOI: 10.1177/1545968320939560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Impairments in postural control in Huntington disease (HD) have important consequences for daily functioning. This observational study systematically examined baseline postural control and the effect of sensory attenuation and sensory enhancement on postural control across the spectrum of HD. Methods. Participants (n = 39) included healthy controls and individuals in premanifest (pHD) and manifest stages (mHD) of HD. Using wearable sensors, postural control was assessed according to (1) postural set (sit vs stand), (2) sensory attenuation using clinical test of sensory integration, and (3) sensory enhancement with gaze fixation. Outcomes included sway smoothness, amplitude, and frequency. Results. Based on postural set, pHD reduced postural sway in sitting relative to standing, whereas mHD had pronounced sway in standing and sitting, highlighting a baseline postural deficit. During sensory attenuation, postural control in pHD deteriorated relative to controls when proprioceptive demands were high (eyes closed on foam), whereas mHD had significant deterioration of postural control when proprioception was attenuated (eyes open and closed on foam). Finally, gaze fixation improved sway smoothness, amplitude, and frequency in pHD; however, no benefit was observed in mHD. Conclusions. Systematic examination of postural control revealed a fundamental postural deficit in mHD, which further deteriorates when proprioception is challenged. Meanwhile, postural deficits in pHD are detectable when proprioceptive challenge is high. Sensory enhancing strategies using gaze fixation to benefit posture may be useful when introduced well before motor diagnosis. These findings encourage further examination of wearable sensors as part of routine clinical assessments in HD.
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Affiliation(s)
- Franchino Porciuncula
- Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | - Paula Wasserman
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Karen S Marder
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Neurology, Psychiatry, G.H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ashwini K Rao
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine (Program in Physical Therapy), G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Winser SJ, Kannan P, Bello UM, Whitney SL. Measures of balance and falls risk prediction in people with Parkinson's disease: a systematic review of psychometric properties. Clin Rehabil 2019; 33:1949-1962. [PMID: 31571503 PMCID: PMC6826874 DOI: 10.1177/0269215519877498] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the psychometric properties of measures of balance and falls risk prediction in people with Parkinson's disease (PD). DATA SOURCES PubMed, Embase, CINAHL, Ovid Medline, Scopus, and Web of Science were searched from inception to August 2019. REVIEW METHOD Studies testing psychometric properties of measures of balance and falls risk prediction in PD were included. The four-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) assessed quality. RESULTS Eighty studies testing 68 outcome measures were reviewed; 43 measures assessed balance, 9 assessed falls risk prediction, and 16 assessed both. The measures with robust psychometric estimation with acceptable properties were the (1) Mini-Balance Evaluation Systems Test (Mini-BEST), (2) Berg Balance Scale, (3) Timed Up and Go test, (4) Falls Efficacy Scale International, and (5) Activities-Specific Balance Confidence scale. These measures assess balance and falls risk prediction at the body, structure and function level, falls risk and balance, and falls risk at the activity level. The motor examination of the Unified Parkinson's Disease Rating Scale (UPDRS-ME) with robust psychometric analysis is a condition-specific measure with acceptable properties. Except the UPDRS-ME and Mini-BESTest, the responsiveness of the other four measures has yet to be established. CONCLUSION Six of the 68 outcome measures have strong psychometric properties for the assessment of balance and falls risk prediction in PD. Measures assessing balance and falls risk prediction at the participatory level are limited in number with a lack of psychometric validation.
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Affiliation(s)
- Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Umar Muhhamad Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Susan L Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Huang S, Yu X, Lu Y, Qiao J, Wang H, Jiang LM, Wu X, Niu W. Body weight support-Tai Chi footwork for balance of stroke survivors with fear of falling: A pilot randomized controlled trial. Complement Ther Clin Pract 2019; 37:140-147. [PMID: 31570211 DOI: 10.1016/j.ctcp.2019.101061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Balance impairment is the predominant risk factor for falls in stroke survivors. This study examined the effects of body weight support-Tai Chi (BWS-TC) footwork on balance control among stroke survivors with fear of falling (FOF). MATERIALS AND METHODS Twenty-eight stroke survivors with FOF were randomly allocated to either control or BWS-TC groups. Those in BWS-TC underwent Tai Chi training for 12 weeks. Outcomes were assessed in all participants by evaluation of the limits of stability test, modified clinical test of sensory integration of balance, fall risk index, and Fugl-Meyer assessment of lower limbs at baseline and 12 weeks. RESULTS The BWS-TC group displayed significant enhancement in dynamic control and vestibular and somatosensory integration. CONCLUSION BWS-TC may enhance dynamic control and sensory integration of balance and reduce the risk of fall in stroke survivors with FOF.
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Affiliation(s)
- ShangJun Huang
- Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai, 200092, China; Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - XiaoMing Yu
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Yan Lu
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Jun Qiao
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, 200441, China
| | - HongLin Wang
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Li-Ming Jiang
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - XuBo Wu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - WenXin Niu
- YangZhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, 201619, China.
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Gera G, Chesnutt J, Mancini M, Horak FB, King LA. Inertial Sensor-Based Assessment of Central Sensory Integration for Balance After Mild Traumatic Brain Injury. Mil Med 2019; 183:327-332. [PMID: 29635623 DOI: 10.1093/milmed/usx162] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Optimal balance control requires a complex integration of sensory information from the visual, vestibular, and proprioceptive systems. The goal of this study is to determine if the instrumented modified Clinical Test of Sensory Integration and Balance (mCTSIB) was impaired acutely after mild traumatic brain injury (mTBI) when postural sway under varying sensory conditions was measured with a wearable inertial sensor. Materials and Methods Postural sway was assessed in athletes who had sustained a mTBI within the past 2-3 d (n = 38) and control athletes (n = 81). Postural sway was quantified with a wearable inertial sensor (Opal; APDM, Inc.) during four varying sensory conditions of quiet stance: (1) eyes open (EO) firm surface, (2) eyes closed (EC) firm surface, (3) eyes open (EO) foam surface, and (4) eyes closed (EC) foam surface. Sensory reweighting deficits were computed by comparing the postural sway area in eyes closed versus eyes open conditions for firm and foam condition. Results Postural sway was higher for mTBI compared with the control group during three of the four conditions of instrumented mCTSIB (EO firm, EC firm, and EC foam; p < 0.05). Sensory reweighting deficits were evident for mTBI individuals compared with control group on foam surface (EC firm vs EO firm; p < 0.05) and not on firm surface (EC firm vs EO firm; p = 0.63). Conclusions The results from this study highlight the importance of detecting postural sway deficits during sensorimotor integration in mild TBI individuals.
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Affiliation(s)
- Geetanjali Gera
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Jim Chesnutt
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Martina Mancini
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Fay B Horak
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536.,Veterans Affairs Portland Healthcare System, 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - Laurie A King
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536
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McGough EL, Hsu LY, Thompson H, Teri L. Concurrent Validity of Postural Sway Measures in Older Adults with Cognitive Impairment. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019; 36:399-410. [PMID: 31598029 DOI: 10.1080/02703181.2018.1556231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aims To examine concurrent validity of inertial sensor (APDM ISway) versus force plate center of pressure (COP) measures of postural sway in cognitively impaired older adults. Methods Participants, mean age 85.6 (SD 4.8), were tested in 4 static standing conditions: (1) eyes open/normal base, (2) eyes open/narrow base, (3) eyes closed/normal base, and (4) eyes closed/narrow base. ISway and COP measures were collected. Results Strong correlations between ISway trunk sway smoothness [ISway JERK, (m 2 /s 5 )] and COP path length (r = 0.67-0.85) and COP mean velocity (r = 0.77-0.87); also ISway total sway acceleration path length/trail duration [ISway PATH, (m2/s2)] and COP path length (r = 0.77-0.87) and COP mean velocity (r = 0.77-0.91). Increased sway was detected in narrow versus normal base and eyes closed versus open conditions (P = .001). Conclusions APDM ISway demonstrated concurrent validity to force-plate COP and changes in postural sway were detected between conditions.
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Affiliation(s)
- Ellen L McGough
- Department of Rehabilitation Medicine, University of Washington
| | - Lin-Ya Hsu
- Department of Rehabilitation Medicine, University of Washington
| | | | - Linda Teri
- School of Nursing, University of Washington
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Normative data for static balance testing in healthy individuals using open source computerized posturography. Eur Arch Otorhinolaryngol 2018; 276:41-48. [PMID: 30327905 DOI: 10.1007/s00405-018-5170-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software. METHODS A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis. RESULTS Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05). CONCLUSIONS With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.
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