The effect of vibratory stimulation on the timed-up-and-go mobility test: a pilot study for sensory-related fall risk assessment

A Systematic Review of the Effect of Physical Rehabilitation on Balance in People with Diabetic Peripheral Neuropathy Who are at Risk of Falling

Background

Falls are a significant issue in people with diabetic peripheral neuropathy. Balance interventions have been broadly administered in individuals with diabetic peripheral neuropathy, but the effects on static and dynamic balance in those who are at risk of falling have not yet been comprehensively reviewed.

Objective

To provide a synthesis of the literature regarding the effectiveness of physical rehabilitation interventions to improve balance in people with diabetic peripheral neuropathy who are at risk of falling.

Methods

Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Cumulated Index in Nursing and Allied Health Literature) were systematically searched from inception to July 2022. Articles meeting the eligibility criteria (ie, participants with diabetic peripheral neuropathy and at risk of falling based on validated fall balance outcome risk cut off scores; inclusion of physical rehabilitation intervention) underwent a quality assessment using the Physiotherapy Evidence Database scale. Data regarding fall risk was extracted.

Results

Sixteen studies met the eligibility criteria. Participants in six studies improved balance such that their fall risk was reduced from a moderate-high risk of falls to no or low risk of falls from pre- to post-intervention. Interventions within these six studies were variable and included balance exercise, gait training, endurance, tai-chi with mental imagery, proprioceptive training, aerobic training, and yoga. Participants in seven of the remaining studies showed no improvement and participants in three studies showed mixed results regarding improved balance and reduced fall risk status by post-intervention.

Conclusion

While physical rehabilitation is sufficient to improve balance in individuals with diabetic peripheral neuropathy who are at risk of falling, few interventions led to improved balance and reduced fall risk. Interventions involving intentional weight shifting, manipulation of the base of support, and displacement of the center of mass such as tai-chi and yoga appear to provide the most consistent results in terms of decreasing fall risk. To better understand the effectiveness of rehabilitation on balance and fall risk, future studies should examine the impact of physical interventions on prospective fall rates.

What are the temporal and physical characteristics of locally applied vibration that modulate balance in older adults? - A systematic review of the literature

BACKGROUND

Compromised balance is known to contribute to falls, which are associated with increased morbidity and mortality for older adults. Evidence suggests that the application of local vibration to the lower limbs of older adults has the potential to modulate balance.

RESEARCH QUESTION

To identify the temporal and mechanical parameters of vibration applied locally to the lower limbs of older adults that modulate measures of balance, and to define the short- and long-term effects of vibration on balance in this population.

METHODS

The PRISMA 2020 guidelines were used to conduct a systematic search including the PUBMED, EMBASE, and Scopus databases to identify peer-reviewed literature where vibration was applied to the lower limbs of older adults to modulate balance. Data was extracted using a study-specific data extraction form and risk of bias assessed. Where possible, effect sizes were calculated.

RESULTS

Of 7777 records screened, ten randomised controlled trials and 43 prospective laboratory-based studies met the inclusion criteria. Vibration frequencies ranged from 1 to 272 Hz, most studies (n=41) used ≤100 Hz. Amplitude ranged from 0.2 to 3.0 mm, most studies (n=28) used ≤1 mm. Effects of short-term vibration (applied for seconds to hours) were measured during and/or immediately after application. Short-term suprathreshold perceived muscle/tendon vibration had a 'large' destabilising effect size on balance in healthy older adults, but little or no effect on older fallers. Short-term subthreshold vibration to the soles of the feet had a 'small' stabilising effect size. Suprathreshold muscle, tendon or sole vibration applied for 10-30 min over days to weeks improved balance measures, but most (8 of 10) had increased risk of bias.

SIGNIFICANCE

The heterogeneity of methodology, populations, and vibration and balance parameters precluded conclusions about the relative effects of lower limb vibration in older adults. However, these results suggest that the application of local vibration to the lower limbs of older adults can modulate balance in the short- and long-term.

"TiC-TUG": technology in clinical practice using the instrumented timed up and go test-a scoping review

Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has been long established for assessment in geriatric medicine and instrumented versions (iTUG) have been developed and validated. This scoping review includes studies that applied the iTUG and aims to identify use cases to show where and how iTUG assessment could guide interventions and clinical management. The literature search was limited to peer-reviewed studies that performed pre- and post-intervention measurements with a 3-meter TUG instrumented with body-worn technology in samples of at least 20 subjects aged 60+ years. Of 3018 identified articles 20 were included. Four clinical use cases were identified: stratification for subsequent therapy, monitoring of disease or treatment-associated changes and evaluation of interventions in patients with idiopathic normal pressure hydrocephalus (1), and patients with Parkinson's disease (2); monitoring after joint replacement surgery (3), and evaluation after different exercise and rehabilitation interventions (4). The included studies show diversity in terms of iTUG technology and procedures. The identified use cases highlight clinical relevance and high potential for the clinical application of the iTUG. A consensual approach as well as comprehensive reporting would help to further exploit the potential of the iTUG to support clinical management. Future studies should investigate the benefits of segmental iTUG analysis, responsiveness and participants' perspectives on clinically meaningful changes in iTUG.

Assessing the role of ankle and hip joint proprioceptive information in balance recovery using vibratory stimulation

Background

Previous work suggests that proprioceptive information from ankle and hip are crucial in maintaining balance during upright standing; however, the contribution of these proprioceptive information during stepping balance recovery in not clear. The goal of the current study was to assess the role of ankle and hip proprioceptive information on balance recovery performance by manipulating type 1a afferent in muscle spindles using vibratory stimulation.

Methods

Twenty healthy young participants were recruited (age = 22.2 ± 2.7 years) and were randomly assigned to balance recovery sessions with either ankle or hip stimulation. Trip-like perturbations were imposed using a modified treadmill setup with a protecting harness. Vibratory stimulation was imposed bilaterally on ankle and hip muscles to expose participants to three condition of no-vibration, 40Hz vibration, and 80Hz vibration. Kinematics of the trunk and lower-extremities were measured using wearable sensors to characterize balance recovery performance. Outcomes were response time, recovery step length, trunk angle during toe-off and heel-strike of recovery stepping, and required time for full recovery.

Findings

Ankle vibratory stimulation elicited main effects on reaction time and recovery step length (p < 0.002); reaction time and recovery step length increased by 23.0% and 21.2%, respectively, on average across the conditions. Hip vibratory stimulation elicited significant increase in the full recovery time (p = 0.019), with 55.3% increase on average across the conditions.

Interpretation

Current findings provided evidence that vibratory stimulation can affect the balance recovery performance, causing a delayed recovery initiation and an impaired balance refinement after the recovery stepping when applied to ankle and hip muscles, respectively.

The effect of mechanical vibration-based stimulation on dynamic balance control and gait characteristics in healthy young and older adults: A systematic review of cross-sectional study

BACKGROUND

A good dynamic balance control and stable gait played an important role in the daily ambulation, especially for older adults with sensorimotor degeneration. This study aimed to systematically review the effects and potential mechanisms of mechanical vibration-based stimulation (MVBS) on dynamic balance control and gait characteristics in healthy young and older adults.

METHOD

Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until September 4th, 2022. Studies published between 2000 and 2022 in English and Chinese involving mechanical vibration related to gait and dynamic balance were included. The procedure was followed via the preferred reporting items for systematic reviews and meta-analysis method. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies.

RESULTS

A total of 41 cross-sectional studies met the inclusion criteria and were included in this study. Eight studies were good-quality while 26 were moderate-quality and 7 were poor-quality. There were six categories of MVBS at various frequencies and amplitudes utilized in included studies, including plantar vibration, focal muscle vibration, Achilles tendon vibration, vestibular vibration, cervical vibration, and vibration on nail of hallux.

SIGNIFICANCE

Different types of MVBS targeting different sensory systems affected the dynamic balance control and gait characteristics differently. MVBS could be used to provide improvement or perturbation to specific sensory systems, to induce different sensory reweight strategies during gait.