Effect of Mechanical Horse Practice as New Postural Training in Patients With Neurological Disorders: A Pilot Study

Importance of core stability for coordinated movement of the human body in stroke rehabilitation

OBJECTIVES

To examine the effect of core stability on parameters of coordinated movement of the trunk and lower extremities in post-stroke rehabilitation.

METHODS

A total of 55 subjects (mean age, 58 years) were included in the study: 33 patients after stroke (17 with ischemic cerebral stroke and 16 with cerebellar) and 22 neurologically healthy subjects with lower back pain. Participation was voluntary. All subjects were asked to complete two exercises: a dynamic movement in the seated position (leaning forward and back) and a march-in-place exercise with a high elevation of the knees. The two exercises were performed with and without contraction of the abdominal muscles. The frontal and sagittal inclination of the trunk during movement, gait speed, elevation of the feet, and muscle tension was recorded. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04886466.

RESULTS

Core stability (abdominal contraction) was associated with more precise trunk movement in the frontal and sagittal plane, as well as higher elevation of the feet and a faster gait. This occurred in both post-stroke patients and neurologically healthy subjects with lower back pain.

DISCUSSION

Muscle tensions were generally lower in post-stroke patients compared to those with lower back pain syndrome but active abdominal tension muscles caused the increase of core stability and alter the trunk movement path, and improves gait and range of movement. Core stability training during stroke rehabilitation may help patients to achieve a higher level of coordinated movement.

[Physical factors in the rehabilitation of patients after brain injury: a scientometric analysis of evidence-based studies]

OBJECTIVE

Scientometric analysis of evidence-based studies of the physical and rehabilitation medicine (PRM) technologies' effectiveness in the rehabilitation of patients with traumatic brain injury (TBI).

MATERIAL AND METHODS

The search for the material was carried out in electronic databases (PEDro, eLIBRARY, PubMed), as well as databases of systematic reviews (SR) (Cochrane Library) using the keywords: «brain injury», «brain», «physical therapy». RCTs were assessed on the PEDro scale from 1 to 10 points. For the final analysis the results of foreign SRs and RCTs published in the period from January 2014 to December 2019 were selected.

RESULTS

The analysis of studies devoted to the use of therapeutic physical factors in the rehabilitation of patients with TBI from the standpoint of evidence-based medicine is carried out. The basic trends in evidence-based studies on the use of various forms of physical exercise, neuromuscular stimulation, and robot-assisted training in the rehabilitation of patients with TBI are highlighted. PRM technologies have been identified which usage led to positive results in patients with TBI for a number of physiological indicators but the number of evidence-based studies on this topic was insufficient. Based on the scientometric analysis of benign studies the promising directions in the study of the influence of therapeutic physical factors in the rehabilitation of patients with TBI have been identified.

CONCLUSION

The presented data demonstrate the studies' results conducted over the past 5 years on the use of PRM technologies in patients with previous TBI. A significant part of the methods considered in the article is actively used in domestic rehabilitation that reflects the ubiquitous process of integrating information obtained in the course of evidence-based research. In order to improve the quality of rehabilitation care for patients with TBI the practice of analyzing and conducting evidence-based studies on this nosology should be continued.

Effects of practice on a mechanical horse with an online feedback on performing a sitting postural coordination

The present research aims at quantifying the impact of practicing a new coordination pattern with an online visual feedback on the postural coordination performed on a mechanical horse. Forty-four voluntary participants were recruited in this study. They were randomly assigned to four practice groups based on i) with or without feedback (i.e., group 1, control, did not receive the feedback; group 2, 3 and 4 received an online feedback during practice) and ii) the specific trunk/horse coordination to target during practice (group 1, target coordination = 180° (without feedback); group 2, target coordination = 0°; group 3, target coordination = 90°; group 4, target coordination = 180°). All participants performed pre-, practice, post- and retention sessions. The pre-, post- and retention sessions consisted of four trials, with one trial corresponding to one specific target coordination to maintain between their own oscillations and the horse oscillations (spontaneous, 0°, 90°, and 180°). The practice phase was composed of three different sessions during which participants received an online feedback about the coordination between their own oscillations and the horse oscillations. Results showed a significant change with practice in the trunk/horse coordination patterns which persisted even after one month (retention-test). However, all the groups did not show the same nature of change, evidenced by a high postural variability during post-test for 0° and 90° target coordination groups, in opposition to the 180° and spontaneous groups who showed a decrease in coordination variability for the 180° group. The coordination in anti-phase was characterized as spontaneously adopted by participants on the mechanical horse, explaining the ease of performing this coordination (compared to the 0° and 90° target coordination). The effect of online visual feedback appeared not only on the coordination pattern itself, but most importantly on its variability during practice, including concerning initially stable coordination patterns.