scholarly journals Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

2020 ◽  
Author(s):  
Vahid Esmaeili ◽  
Andréanne Juneau ◽  
Joseph-Omer Dyer ◽  
Anouk Lamontagne ◽  
Dahlia Kairy ◽  
...  
Keyword(s):  
Dynamic Balance ◽  
Community Integration ◽  
Pilot Trial ◽  
Gait Training ◽  
External Support ◽  
Balance Confidence ◽  
Perturbation Training ◽  
Control Intervention ◽  
Training Evaluations ◽  
History Of

Abstract Background: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods: Twenty-one stroke individuals with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 minute were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over three weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results: With no baseline differences between groups (p>0.075), perturbation training yielded large improvements in most variables in the Perturb (p<0.05, Effect Size: ES>.46) group (n=10) and the NonPerturb (p≤.089, ES>.45) group (n=7 post-crossing), except for maximal strength (p>.23) in the NonPerturb group. Walking-only training in the NonPerturb group (n=8, pre-crossing) mostly had no effect (p>.292, ES<.26), except on balance confidence (p=.063, ES=.46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in chronic stroke individuals. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830 (https://clinicaltrials.gov/ct2/show/NCT04314830?term=NCT04314830&draw=2&rank=1).

scholarly journals Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

2020 ◽  
Author(s):  
Vahid Esmaeili ◽  
Andréanne Juneau ◽  
Joseph-Omer Dyer ◽  
Anouk Lamontagne ◽  
Dahlia Kairy ◽  
...  
Keyword(s):  
Dynamic Balance ◽  
Community Integration ◽  
Pilot Trial ◽  
Gait Training ◽  
External Support ◽  
Balance Confidence ◽  
Post Stroke ◽  
Perturbation Training ◽  
Control Intervention ◽  
Training Evaluations

Abstract Background: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods: Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 minute were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over three weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results: With no baseline differences between groups (p>0.075), perturbation training yielded large improvements in most variables in the Perturb (p<0.05, Effect Size: ES>.46) group (n=10) and the NonPerturb (p≤.089, ES>.45) group (n=7 post-crossing), except for maximal strength (p>.23) in the NonPerturb group. Walking-only training in the NonPerturb group (n=8, pre-crossing) mostly had no effect (p>.292, ES<.26), except on balance confidence (p=.063, ES=.46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830 (https://clinicaltrials.gov/ct2/show/NCT04314830?term=NCT04314830&draw=2&rank=1).

Physical, cognitive and psychosocial effects of telerehabilitation-based motor imagery training in people with multiple sclerosis: A randomized controlled pilot trial

2019 ◽  
Vol 26 (5) ◽  
pp. 251-260 ◽  
Author(s):  
Turhan Kahraman ◽  
Sema Savci ◽  
Asiye Tuba Ozdogar ◽  
Zumrut Gedik ◽  
Egemen Idiman
Keyword(s):  
Quality Of Life ◽  
Motor Imagery ◽  
Cognitive Functions ◽  
Walking Speed ◽  
Dynamic Balance ◽  
Pilot Trial ◽  
Control Group ◽  
Walking Ability ◽  
Balance Confidence

Introduction Motor imagery training delivered at home via telerehabilitation is a novel rehabilitation concept. The aim was to investigate the effects of telerehabilitation-based motor imaging training (Tele-MIT) on gait, balance and cognitive and psychosocial outcomes in people with multiple sclerosis (pwMS). Methods This randomized, controlled pilot trial included pwMS and healthy individuals. pwMS were randomly divided into two groups, intervention and control. The intervention group received Tele-MIT twice a week for 8 weeks. The control group was a wait-list group without any additional specific treatment. Healthy participants served as a baseline comparison. The Dynamic Gait Index, used to assess dynamic balance during walking, was the primary outcome. Secondary outcomes included assessments of walking speed, endurance and perceived ability, balance performance assessed by a computerized posturography device, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life. Results Baseline comparisons with healthy individuals revealed that motor imagery abilities were preserved in pwMS ( p > 0.05). The intervention group exhibited significant improvements in dynamic balance during walking ( p = 0.002), walking speed ( p = 0.007), perceived walking ability ( p = 0.008), balance confidence ( p = 0.002), most cognitive functions ( p = 0.001–0.008), fatigue ( p = 0.001), anxiety ( p = 0.001), depression ( p = 0.005) and quality of life ( p = 0.002). No significant changes were observed in the control group in any of the outcome measures ( p > 0.05). Discussion Tele-MIT is a novel method that proved feasible and effective in improving dynamic balance during walking, walking speed and perceived walking ability, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life in pwMS.

The Relationship Between Fear of Falling and Functional Fitness among Older Adults Living in Rest Home

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
H Tuna ◽  
Ö Bozan ◽  
B Gürpınar ◽  
N İlçin
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Dynamic Balance ◽  
Upper Body ◽  
Functional Fitness ◽  
Fall Risk Factors ◽  
Rest Home ◽  
History Of

Objective: This study aimed to report the fear of falling and assess its associations with several fall-related characteristics and functional fitness parameters among older adults living in the rest home. Methods: Seventy-eight older adults aged between 65-94 years were included in the study. History of falling and the number of risk factors for falling were recorded. Fear of falling was evaluated with The Falls Efficacy ScaleInternational. Functional fitness was assessed with Senior Fitness Test, including tests for the functional measurement of strength, flexibility, aerobic endurance and dynamic balance. Result: The mean age of participants was 78.46±7.16 years. There were correlations exist between fear of falling and number of fall risk factors, dynamic balance, upper body flexibility and aerobic endurance (p<0.05). Multiple linear regression analysis showed that the parameters with the highest determinants of fear of falling were the dynamic balance and history of falling (p<0.05). Conclusions: In our study, history of falling, number of fall risk factors, flexibility for the upper body, aerobic endurance and dynamic balance were parameters related to fear of falling among older adults, but the most influential factors in fear of falling were dynamic balance and history of falling.

scholarly journals Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Moshe M. H. Aharoni ◽  
Anat V. Lubetzky ◽  
Liraz Arie ◽  
Tal Krasovsky
Keyword(s):  
Virtual Reality ◽  
Trait Anxiety ◽  
Dynamic Balance ◽  
Step Test ◽  
Simulator Sickness ◽  
Balance Confidence ◽  
Task Duration ◽  
Head Kinematics ◽  
Perceived Disability ◽  
Four Square

Abstract Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and  high perceived disability were associated with reduced AP-ROM (|r| =  0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.

scholarly journals Concussion History and Balance Performance in Adolescent Rugby Union Players

2021 ◽  
pp. 036354652199870
Author(s):  
Mark Matthews ◽  
William Johnston ◽  
Chris M. Bleakley ◽  
Richard J. Davies ◽  
Alan T. Rankin ◽  
...  
Keyword(s):  
Dual Task ◽  
Inertial Sensor ◽  
Dynamic Balance ◽  
Rugby Union ◽  
Static Balance ◽  
Balance Performance ◽  
Eyes Closed ◽  
History Of ◽  
Concussion History ◽  
Rugby Players

Background: Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. Hypothesis: Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes ( x, y, and z). Results: Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- ( P = .47) and dual-task ( P = .67) conditions. Conclusion: Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.

scholarly journals Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

Sensors ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 1343
Author(s):  
Sebastian Fudickar ◽  
Jörn Kiselev ◽  
Christian Stolle ◽  
Thomas Frenken ◽  
Elisabeth Steinhagen-Thiessen ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Measurement Accuracy ◽  
Dynamic Balance ◽  
Step Length ◽  
Berg Balance Scale ◽  
Walking Ability ◽  
Functional Requirements ◽  
Balance Confidence ◽  
Gait Parameters ◽  
Abc Scale

This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG’s gait parameters demonstrate a strong correlation coefficient with the GAITRite, indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.

scholarly journals Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

2018 ◽  
Vol 20 (5) ◽  
pp. 238-243
Author(s):  
Prudence Plummer ◽  
Corinne J. Bohling ◽  
L. Ellese Nickles ◽  
Alexis A. Williams ◽  
Amy Thomas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Dual Task ◽  
Gait Speed ◽  
Gait Training ◽  
Important Change ◽  
Relapsing Remitting ◽  
History Of ◽  
Task Conditions ◽  
Clinically Important Change

Abstract Background: Dalfampridine extended release (D-ER) improves gait speed in some people with multiple sclerosis (MS), but many patients who take D-ER demonstrate only small improvements of questionable clinical significance. Physical therapy (PT) may augment the treatment effects of D-ER on the nervous system and improve clinical outcomes. This case report describes the successful use of D-ER combined with multicomponent PT in a patient who did not have a clinically important change in gait speed with D-ER alone. Methods: A 59-year-old woman with a 6-year history of relapsing-remitting MS was prescribed D-ER by her neurologist. After 3 weeks of D-ER therapy (10 mg twice daily), she demonstrated only a 7.1% improvement in the Timed 25-Foot Walk test. She then commenced PT consisting of two 40-minute sessions per week for 6 weeks while continuing D-ER therapy. Training focused on gait, balance, coordination, functional strengthening, and dual-task performance. Results: After 6 weeks of D-ER + PT, she had a further 14.6% improvement in Timed 25-Foot Walk gait speed, for a total improvement of 20.7%, which elevated her above the clinically meaningful threshold of 20%. Similar patterns of improvement were also observed for self-selected gait speed in single- and dual-task conditions. Improvements in fast and dual-task gait speed were retained 3 weeks later. Conclusions: For this patient, combining PT with D-ER therapy improved gait speed more than the use of D-ER alone. Further investigation of D-ER + PT or PT as an alternative to D-ER in patients with submeaningful medication response is warranted.

scholarly journals Evolutional neurologic evaluation of seven year-old children born prematurely

1996 ◽  
Vol 54 (3) ◽  
pp. 369-374 ◽  
Author(s):  
Lygia Ohiweiler ◽  
Ligia Alfano ◽  
Newra T. Rotta
Keyword(s):  
Cerebral Palsy ◽  
Neurological Examination ◽  
Gestational Age ◽  
Dynamic Balance ◽  
Evaluation Criteria ◽  
Control Group ◽  
Developmental Disturbances ◽  
Limb Coordination ◽  
History Of ◽  
Trunk Limb

A sample of 51 children aged 7 with a history of prematurity was compared to 44 age-matched children who were born at term at the HCPA. The premature children had had gestational ages up to 37 weeks and 6 days and were born weighing less than 2500g. The control group consisted of children born with gestational age between 38 and 42 weeks and weights above 2S00g. The evaluation criteria were clinical examination, neurological examination and the evolutional neurological evaluation (ENE). The results pointed out that impulsiveness, aggressiveness, disorganization and enuresis were prevalent symptoms of developmental disturbances in the sample of prematures. Alterations at neurological examination did not discriminate between the two groups, although cerebral palsy occurred only in the proup of prematures. The ENE functions which differentiated the two groups studied were dynamic balance, appendicular and trunk-limb coordination and motor persistence.

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