Acceptability and feasibility of a vestibular nerve stimulation headset protocol in children with cerebral palsy

Background Research suggests electrical Vestibular Nerve Stimulation (VeNS) may improve balance for people with neurological impairments. This study aimed to assess the feasibility and acceptability of a VeNS headset protocol in children with cerebral palsy (CP). Methods Children aged 5–18 years with ambulant CP, their parents, and healthcare professionals were recruited via social media. Children completed a battery of balance tests and wore a sham VeNS headset one hour per day for four weeks. Perspectives on the balance tests and headset were ascertained from children, parents and healthcare professionals using semi-structured interviews. Interview data were analysed thematically. Results Two families and four healthcare professionals participated. Balance outcome measures were fully completed and deemed acceptable. Adherence with wearing the headset was 89–100% but discomfort with self-adhesive electrodes was reported. Four themes emerged from interview data: headset issues, perceptions about VeNS, the importance of balance, and modifications for future study. Conclusions Although the VeNS headset had high acceptability, the volunteer sample was small, potentially suggesting limited interest in VeNS as a treatment for children with CP, or reluctance to trial a ‘non-active’ headset. Recruitment via clinicians known to the family and use of an ‘active’ headset may increase participation in future research.

How increased cognitive load affects the dual-task cost in healthy young adults? A randomized, double-blind sham-controlled study

Our ability to interact flexibly with the surrounding environment and achieve an adaptive goal-directed response is one of the necessities of balance control. This study aimed to examine the interaction between cognitive demand and the necessity for keeping balance in unstable conditions. We examined the effects of performing two cognitive tasks, namely the Stroop test and Wisconsin Card Sorting Test (WCST), on postural balance in healthy young adults. Stroop and the WCST test assess selective attention and cognitive flexibility in shifting between rules, respectively. Thirty-two healthy adults were included in two experimental conditions (control and treatment) in random order, separated by at least seven days. Standing balance was evaluated by the Sway Medical Mobile application in eyes open (EO) and eyes closed (EC) in different stance positions: feet apart, feet together, semi-tandem, tandem, and single-leg stance (SLS). Balance was evaluated before and after the cognitive test in each experimental condition. Our findings indicate that performing cognitively demanding tasks adversely affected the balance ability in more demanding balance tests such as the SLS with EC (P ˂ 0.05). However, no significant changes were seen in other balance tests (P ˃ 0.05). Additionally, no significant changes were seen in balance ability after the Stroop or Wisconsin card sorting test alone. These results confirm that performing cognitively demanding tasks significantly reduced the ability to keep balance in less stable conditions. These findings have significant implications in understanding and preventing falls and incidents resulting from an impaired balance in complex and cognitively demanding conditions.

Anteroposterior and mediolateral postural adaptations during single and duals tasks in healthy young adults

Dual tasks are fundamental and standard for daily walking and balance movements. However, further research is required to determine the comprehensive postural profile during challenging dual cognitive tasks. To distinguish the influence of dual cognitive tasks on anterior-posterior (AP) and mediolateral (ML) jerk (direction of sway), velocity, and distance in young adults with normal balance systems. Nineteen subjects took part in this inquiry (2 males and 17 females), with a mean age of 23.9+\- 2.3 years. The participants were instrumented using a lumbar accelerometer and a dynamometer designed to capture sway. All subjects completed eight balance tests comprising four single and four dual-cognitive tasks involving counting backward by three, starting at the number 100 (dual-task). Postural modifications were prominent in the AP direction, with a faster jerk, velocity, and considerable distance than in the ML direction. The introduction to challenging balance situations, including dual tasks, provoke AP direction adaptations to preserve balance through variations in AP parameters, indicating the engagement of the sensory reweighting system.

Passive stretching decreases muscle efficiency in balance tasks

The current study aimed to verify whether or not passive static stretching affects balance control capacity. Thirty-eight participants (19 women and 19 men) underwent a passive static stretching session, involving the knee extensor/flexor and dorsi/plantarflexor muscles, and a control session (no stretching, CTRL). Before (PRE), immediately after (POST), after 15 (POST15) and 30 min (POST30) from stretching (or rest in CTRL), balance control was evaluated under static and dynamic conditions, with open/closed eyes, and with/without somatosensory perturbation (foam under the feet). During tests, centre of pressure (CoP) sway area and perimeter and antero-posterior and medio-lateral sway mean speed were computed. Surface electromyography root mean square (sEMG RMS) was calculated from the vastus lateralis, biceps femoris, gastrocnemius medialis, and tibialis anterior muscles during MVC and during the balance tests. Hip flexion/extension and dorsi/plantarflexion range of motion (ROM), maximum voluntary contraction (MVC) and sEMG RMS during MVC were measured at the same time points. After stretching, ROM increased (≈6.5%; P<0.05), while MVC and sEMG RMS decreased (≈9% and ≈7.5%, respectively; P<0.05). Regardless of the testing condition, CoP sway area and the perimeter remained similar, while antero-posterior and medio-lateral sway mean speed decreased by ≈8% and ≈12%, respectively (P<0.05). sEMG RMS during the balance tests increased in all muscles in POST (≈7%, P<0.05). All variables recovered in POST30. No changes occurred in CTRL. Passive static stretching did not affect the overall balance control ability. However, greater muscle activation was required to maintain similar CoP sway, thus suggesting a decrease in muscle efficiency.

A Comparison of Postural Responses in a Virtual and a Real Environment, a Randomised Controlled Study.

BackgroundImmersive virtual reality solutions are seeing increasing usage in functional rehabilitation programmes. However, there is no reference that allows us to confirm that these environments present the same characteristics and therefore the same degree of safety and training in postural responses for balance.QuestionThe aim of the study was to compare displacements from centre of gravity (distance covered and surface used) in balance tests, comparing the real situation to an identical virtual situation. Participants 70 healthy subjects aged between 18 and 65 were recruited in two centres. DesignThe study used a one-way repeated-measures design with randomisation of the order in which the two test conditions were performed. Intervention: .The first test condition was "real", taking place in a bedroom of a treatment centre apartment, and the second was virtual, with the room reproduced and seen through a HMD. For each condition, two static tests (left leg, right leg) and two dynamic tests (left and right) were performed. Each test included three attempts. Outcome measuresThe displacement from the centre of gravity was recorded on a force plate.Result69 participants completed all of the tests and were analysed. None of the tests resulted in confirmation that the virtual was equivalent to the real (Two One-Sided Tests for left static, right static, left dynamic, right dynamic; surface respectively p = 0.592, p = 0.151, p = 0.238, p = 0.503; distance respectively p = 1.00, p = 0.91, p = 0.0742, p = 1.00). Furthermore 6 tests of out 8 showed a significant and considerable difference (surface respectively p = 0.00249, p = 0.0664, p = 0.0318, p = 0.00483; distance respectively p = 1.12 x 10-8, p = 5.27 x 10-5, p = 0.153, p = 2.55 x 10-9). ConclusionPostural responses were poorer in the immersive virtual environment, both on the static and dynamic balance tests. The offer of balance rehabilitation in immersive VR raises safety issues and consequently ethical issues that are as yet unresolved. Researchers must test solutions to correct this serious problem. Trial registration: The study is registered at the US National Institutes of Health (ClinicalTrials.gov) NCT04574726

Comparison of Two Electronic Physical Performance Batteries by Measurement Time and Sarcopenia Classification

Background: The Short Physical Performance Battery (SPPB) is a widely accepted test for measuring lower extremity function in older adults. However, there are concerns regarding the examination time required to conduct a complete SPPB consisting of three components (walking speed, chair rise, and standing balance tests) in clinical settings. We aimed to assess specific examination times for each component of the electronic Short Physical Performance Battery (eSPPB) and compare the ability of the original three-component examinations (eSPPB) and a faster, two-component examination without a balance test (electronic Quick Physical Performance Battery, eQPPB) to classify sarcopenia. Methods: The study was a retrospective, cross-sectional study which included 124 ambulatory outpatients who underwent physical performance examination at a geriatric clinic of a tertiary, academic hospital in Seoul, Korea, between December 2020 and March 2021. For eSPPB, we used a toolkit containing sensors and software (Dyphi, Daejeon, Korea) developed to measure standing balance, walking speed, and chair rise test results. Component-specific time stamps were used to log the raw data. Duration of balance examination, 5 times sit-to-stand test (5XSST), and walking speed examination were calculated. Sarcopenia was determined using the 2019 Asian Working Group for Sarcopenia (AWGS) guideline. Results: The median age was 78 years (interquartile range, IQR: 73,82) and 77 subjects (62.1%) were female. The total mean eSPPB test time was 124.8 ± 29.0 s (balance test time 61.8 ± 12.3 s, 49.5%; gait speed test time 34.3 ± 11.9 s, 27.5%; and 5XSST time 28.7 ± 19.1 s, 23.0%). The total mean eQPPB test time was 63.0 ± 25.4 s. Based on the AWGS criteria, 34 (27.4%) patient’s results were consistent with sarcopenia. C-statistics for classifying sarcopenia were 0.83 for eSPPB and 0.85 for eQPPB (p = 0.264), while eQPPB took 49.5% less measurement time compared with eSPPB. Conclusion: Breakdowns of eSPPB test times were identified. Omitting balance tests may reduce test time without significantly affecting the classifying ability of eSPPB for sarcopenia.

TEST–RETEST RELIABILITY OF STATIC POSTURAL BALANCE VARIABLES IN NATURAL AND FEET-TOGETHER STANCE CONDITIONS

It is important to confirm the reliability of postural balance variables because the results of balance tests would be different with different balance test protocols, i.e., stance conditions such as natural and feet-together stances. The aim of this study was to investigate the test–retest reliability of postural balance variables during the natural and feet-together stance conditions. Sixteen young healthy adults were instructed to sustain their center of body mass as stably as possible on the force plate. As balance standing conditions, natural (a comfortable self-selected stance width) and feet-together stances (placing the feet [Formula: see text] apart) were selected. The mean distance, mean velocity, mean frequency, and 95% confidence ellipse area were derived from the center of pressure (COP) time series in the overall, anteroposterior (AP), and mediolateral (ML) directions. To evaluate the test–retest reliability of the postural balance variables, Cronbach’s alpha coefficient was calculated in each stance condition. Mean velocity was the most reliable variable particularly in three repeated balances within both the natural and feet together stances ([Formula: see text]–0.921). The reliability of all variables of the three balance test was greater than that of the two balance tests, mainly in the natural stance. In contrast, the mean ML distance of the feet-together stance had poor reliability despite three balance tests ([Formula: see text]). These results suggest that the balance test protocol should consider the appropriate stance conditions as well as the number of balance trials to select the reliable postural balance variables.

Cortical correlates in upright dynamic and static balance in the elderly

Falls are the second most frequent cause of injury in the elderly. Physiological processes associated with aging affect the elderly’s ability to respond to unexpected balance perturbations, leading to increased fall risk. Every year, approximately 30% of adults, 65 years and older, experiences at least one fall. Investigating the neurophysiological mechanisms underlying the control of static and dynamic balance in the elderly is an emerging research area. The study aimed to identify cortical and muscular correlates during static and dynamic balance tests in a cohort of young and old healthy adults. We recorded cortical and muscular activity in nine elderly and eight younger healthy participants during an upright stance task in static and dynamic (core board) conditions. To simulate real-life dual-task postural control conditions, the second set of experiments incorporated an oddball visual task. We observed higher electroencephalographic (EEG) delta rhythm over the anterior cortex in the elderly and more diffused fast rhythms (i.e., alpha, beta, gamma) in younger participants during the static balance tests. When adding a visual oddball, the elderly displayed an increase in theta activation over the sensorimotor and occipital cortices. During the dynamic balance tests, the elderly showed the recruitment of sensorimotor areas and increased muscle activity level, suggesting a preferential motor strategy for postural control. This strategy was even more prominent during the oddball task. Younger participants showed reduced cortical and muscular activity compared to the elderly, with the noteworthy difference of a preferential activation of occipital areas that increased during the oddball task. These results support the hypothesis that different strategies are used by the elderly compared to younger adults during postural tasks, particularly when postural and cognitive tasks are combined. The knowledge gained in this study could inform the development of age-specific rehabilitative and assistive interventions.