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de Aquino Costa Sousa T, Gagnon IJ, Li KZH, McFadyen BJ, Lamontagne A. Exploring the challenges of avoiding collisions with virtual pedestrians using a dual-task paradigm in individuals with chronic moderate to severe traumatic brain injury. J Neuroeng Rehabil 2024; 21:80. [PMID: 38755606 PMCID: PMC11097498 DOI: 10.1186/s12984-024-01378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Individuals with a moderate-to-severe traumatic brain injury (m/sTBI), despite experiencing good locomotor recovery six months post-injury, face challenges in adapting their locomotion to the environment. They also present with altered cognitive functions, which may impact dual-task walking abilities. Whether they present collision avoidance strategies with moving pedestrians that are altered under dual-task conditions, however, remains unclear. This study aimed to compare between individuals with m/sTBI and age-matched control individuals: (1), the locomotor and cognitive costs associated with the concurrent performance of circumventing approaching virtual pedestrians (VRPs) while attending to an auditory-based cognitive task and; (2) gaze behaviour associated with the VRP circumvention task in single and dual-task conditions. METHODOLOGY Twelve individuals with m/sTBI (age = 43.3 ± 9.5 yrs; >6 mo. post injury) and 12 healthy controls (CTLs) (age = 41.8 ± 8.3 yrs) were assessed while walking in a virtual subway station viewed in a head-mounted display. They performed a collision avoidance task with VRPs, as well as auditory-based cognitive tasks (pitch discrimination and auditory Stroop), both under single and dual-task conditions. Dual-task cost (DTC) for onset distance of trajectory deviation, minimum distance from the VRP, maximum lateral deviation, walking speed, gaze fixations and cognitive task accuracy were contrasted between groups using generalized estimating equations. RESULTS In contrast to CTLs who showed locomotor DTCs only, individuals with m/sTBI displayed both locomotor and cognitive DTCs. While both groups walked slower under dual-task conditions, only individuals with m/sTBI failed to modify their onset distance of trajectory deviation and maintained smaller minimum distances and smaller maximum lateral deviation compared to single-task walking. Both groups showed shorter gaze fixations on the approaching VRP under dual-task conditions, but this reduction was less pronounced in the individuals with m/sTBI. A reduction in cognitive task accuracy under dual-task conditions was found in the m/sTBI group only. CONCLUSION Individuals with m/sTBI present altered locomotor and gaze behaviours, as well as altered cognitive performances, when executing a collision avoidance task involving moving pedestrians in dual-task conditions. Potential mechanisms explaining those alterations are discussed. Present findings highlight the compromised complex walking abilities in individuals with m/sTBI who otherwise present a good locomotor recovery.
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Affiliation(s)
- Thiago de Aquino Costa Sousa
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital - CISSS Laval, Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, H7V 1R2, Canada.
| | - Isabelle J Gagnon
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Trauma/Child Development, Montreal Children's Hospital, Montreal, QC, Canada
| | - Karen Z H Li
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Bradford J McFadyen
- School of Rehabilitation Sciences, Université Laval, Quebec City, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS Capitale Nationale, Quebec City, QC, Canada
| | - Anouk Lamontagne
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital - CISSS Laval, Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, H7V 1R2, Canada
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Elnaggar RK, Ramirez-Campillo R, Azab AR, Alrawaili SM, Alghadier M, Alotaibi MA, Alhowimel AS, Abdrabo MS, Elbanna MF, Aboeleneen AM, Morsy WE. Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics. CHILDREN (BASEL, SWITZERLAND) 2024; 11:243. [PMID: 38397355 PMCID: PMC10887404 DOI: 10.3390/children11020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Alshimaa R. Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mazyad A. Alotaibi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ahmed S. Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohamed S. Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Mohammed F. Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed M. Aboeleneen
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Walaa E. Morsy
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
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Böttinger MJ, Litz E, Gordt-Oesterwind K, Jansen CP, Memmer N, Mychajliw C, Radeck L, Bauer JM, Becker C. Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study. JMIR Aging 2023; 6:e46738. [PMID: 37751274 PMCID: PMC10565622 DOI: 10.2196/46738] [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: 02/28/2023] [Revised: 07/10/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. OBJECTIVE This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. METHODS A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. RESULTS The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. CONCLUSIONS The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment.
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Affiliation(s)
- Melissa J Böttinger
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Elena Litz
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Katharina Gordt-Oesterwind
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Carl-Philipp Jansen
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Nicole Memmer
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Christian Mychajliw
- Geriatric Center, University Hospital of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Leon Radeck
- Institute for Computer Science, Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Becker
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
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Siedlecki P, Ivanova TD, Garland SJ. Cardiovascular response to anticipatory and reactionary postural perturbations in young adults. Exp Physiol 2023; 108:1144-1153. [PMID: 37458232 PMCID: PMC10988459 DOI: 10.1113/ep091173] [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: 02/08/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023]
Abstract
NEW FINDINGS What is the central question of this study? It has been suggested that the cardiovascular responses to a postural perturbation are centrally mediated and reflex mediated. We wanted to know the extent to which the cardiovascular responses to external perturbations could be executed in a feedforward manner, in anticipation of the perturbation. What is the main finding and its importance? We found no anticipatory component driving heart rate and systolic blood pressure responses, suggesting that reflexive mechanisms dominate cardiovascular regulation after a postural perturbation in young adults. ABSTRACT Cardiovascular responses to postural perturbations have been reported, but whether the cardiovascular responses to external perturbations could be executed in anticipation of the perturbation is unknown. The purpose of this study was to determine the effect of anticipated and reactionary perturbations on heart rate (HR) and systolic blood pressure (SBP) responses in healthy young adults. A secondary aim was to determine whether perceived state anxiety scores were correlated with the change in HR response during postural perturbation. Twenty healthy young adults stood on a treadmill and experienced two perturbation conditions (anticipatory vs. reactionary), each with two intensity levels (Step vs. No Step). The HR and SBP were collected continuously. Two-way repeated-measures statistical non-parametric mapping tests were used to compare HR and SBP responses to the perturbations over time (from -3 to +8 s). The results indicated that HR was significantly elevated in the higher intensity perturbations [Step vs. No Step, at 0.56-1.32 s (P < 0.0001) and 1.92-3.44 s (P < 0.0001) post-perturbation], while there were no differences in HR between perturbation types (anticipatory vs. reactionary) or in SBP between perturbation types and intensity levels. The perceived state anxiety scores did not differ between perturbation types and intensity levels but were correlated with the change in HR post-perturbation (P = 0.013). We suggest that reflexive mechanisms dominate cardiovascular regulation after anticipatory and reactionary perturbations. The data highlight the cardiovascular mechanism(s) associated with perturbations that should be considered when assessing postural stability in populations with poor balance performance.
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Affiliation(s)
| | | | - S. Jayne Garland
- Faculty of Health SciencesWestern UniversityLondonOntarioCanada
- Department of Physiology & PharmacologyWestern UniversityLondonOntarioCanada
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5
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Lyon MF, Mitchell K, Roddey T, Medley A, Gleeson P. Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes. Disabil Rehabil 2023; 45:3099-3107. [PMID: 36083016 DOI: 10.1080/09638288.2022.2118872] [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: 09/21/2021] [Revised: 07/20/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. MATERIALS AND METHODS This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. RESULTS Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making. CONCLUSIONS In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.Implications For RehabilitationBalance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury.Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury.In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.
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Affiliation(s)
- Marissa F Lyon
- Physical Therapy, University of New England, Portland, ME, USA
| | - Katy Mitchell
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Toni Roddey
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Ann Medley
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Peggy Gleeson
- Physical Therapy, Texas Woman's University, Houston, TX, USA
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O’Neil J, Egan M, Marshall S, Bilodeau M, Pelletier L, Sveistrup H. The Impact of Two Telerehabilitation Supervision Schedules on Physical Activity, Mobility, and Balance Among People with Moderate to Severe Traumatic Brain Injury: A Mixed-Method Single-Subject Design. Physiother Can 2023; 75:118-131. [PMID: 37736373 PMCID: PMC10510551 DOI: 10.3138/ptc-2021-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/26/2021] [Accepted: 10/08/2021] [Indexed: 09/23/2023]
Abstract
Background Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery. Objective We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life. Methods A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured. Results Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule. Conclusion Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.
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Affiliation(s)
- Jennifer O’Neil
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Egan
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shawn Marshall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin Bilodeau
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Luc Pelletier
- Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Fino PC, Michielutti PG, Pelo R, Parrington L, Dibble LE, Hoppes CW, Lester ME, Weightman MM, King LA. A Hybrid Assessment of Clinical Mobility Test Items for Evaluating Individuals With Mild Traumatic Brain Injury. J Neurol Phys Ther 2023; 47:84-90. [PMID: 36538333 PMCID: PMC10033306 DOI: 10.1097/npt.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls. METHODS Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data. RESULTS The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring. DISCUSSION AND CONCLUSIONS The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409 ).
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Affiliation(s)
- Peter C Fino
- Departments of Health & Kinesiology (P.C.F.) and Physical Therapy & Athletic Training (R.P., L.E.D.), The University of Utah, Salt Lake City, Utah; Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (P.G.M., M.M.W.); Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia (L.P.); Department of Neurology, Oregon Health & Science University, Portland, Oregon (L.P., L.A.K.); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (C.W.H., M.E.L.); and Department of Physical Therapy, Texas State University, Round Rock, Texas (M.E.L.)
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8
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Roberts HJ, Johnson KM, Sullivan JE, Hoppes CW. Balance Confidence and Balance Performance, But Not Fall History Are Associated With Quality of Life in Community-Dwelling Older Adults: A Cross Sectional Study. J Geriatr Phys Ther 2023; 46:82-89. [PMID: 35471965 DOI: 10.1519/jpt.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Fear of falling (FoF) is highly prevalent in community-dwelling older adults and is associated with low health-related quality of life (QoL). Low QoL is associated with increased health care utilization and is a predictor of future falls, but few studies have examined the relationship between high-level balance and dynamic gait performance and QoL in community-dwelling older adults. The purpose of this cross-sectional study was to determine whether there is a relationship between FoF avoidance behaviors, balance confidence, performance on measures of high-level mobility, and QoL in community-dwelling older adults. The secondary purpose was to determine whether older adults who fall have a different QoL than older adults who have not fallen in the past year. METHODS Eighty-nine community-dwelling older adults (76.33 ± 6.84 years, 54 female, 34 fallers) completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF), Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance and Mobility Scale (CB&M). Correlation and multiple regression analyses were calculated to determine the relationship between the outcome measures and domains on the WHOQOL-BREF. RESULTS AND DISCUSSION Significant correlations were observed between the WHOQOL-BREF physical health domain and the ABC, FFABQ, FGA, and CB&M (ρ= 0.524, -0.509, 0.348, and r = 0.423, respectively), the WHOQOL-BREF psychological domain and the ABC (ρ= 0.284) and FFABQ (ρ=-0.384), and the WHOQOL-BREF environment domain and the ABC (ρ= 0.343) and FFABQ (ρ=-0.406). No correlations were found between WHOQOL-BREF domain scores and a history of falls. CONCLUSIONS Performance-based outcome measures that measure high-level mobility such as the CB&M and FGA, and patient-reported outcome measures for balance confidence and FoF avoidance behavior such as the ABC and FFABQ, are correlated with the physical health QoL domain on the WHOQOL-BREF. The ABC and FFABQ are correlated with psychological and environment QoL. Fall history was not correlated with QoL. Interventions to decrease FoF or improve high-level mobility may improve QoL in community-dwelling older adults.
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Affiliation(s)
- Holly J Roberts
- Rocky Mountain University of Health Professions, Provo, Utah
- University of Puget Sound School of Physical Therapy, Tacoma, Washington
| | - Kristen M Johnson
- Rocky Mountain University of Health Professions, Provo, Utah
- Hawaii Pacific University, Honolulu, Hawaii
| | - Jane E Sullivan
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carrie W Hoppes
- Army-Baylor Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, Texas
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9
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Tanel MR, Gupta C, Wilson KE, Murphy J, Wright FV, Reed N. The Concussion Challenge Assessment: Development and reliability of a novel gross motor assessment tool for paediatric concussion. Front Sports Act Living 2022; 4:1027339. [PMID: 36589783 PMCID: PMC9795185 DOI: 10.3389/fspor.2022.1027339] [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: 08/24/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Aims The aim of this study was to develop a gross motor performance clinical assessment tool, the Concussion Challenge Assessment (CCA), for paediatric concussion populations. Methods An expert panel evaluated tasks from the Acquired Brain Injury Challenge Assessment to determine relevant tasks for a paediatric concussion population. These tasks were administered to a convenience sample of 854 healthy youth. An analysis of the response options for each task, considering task difficulty, was performed. The test-retest reliability of each task was considered to finalise the tool. Results The Acquired Brain Injury Challenge Assessment was reduced to six tasks (three coordination, two speed and agility, and one strength) to create the CCA. Population-specific 4-point response options were generated, which, upon examination of task difficulty, were revised as 5-point response sets to better capture performance differences. The test-retest reliability results led to acceptance of all six: three performance tasks and three exertion tasks. Conclusion This development of the CCA is an important step in creating a gross motor performance assessment tool that can assist in the determination of when youth are able to safely return to activity following a concussion.
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Affiliation(s)
- Michelle R. Tanel
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christopher Gupta
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Katherine E. Wilson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Murphy
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Correspondence: Nick Reed
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10
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Tramontano M, Belluscio V, Bergamini E, Allevi G, De Angelis S, Verdecchia G, Formisano R, Vannozzi G, Buzzi MG. Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial. SENSORS (BASEL, SWITZERLAND) 2022; 22:8553. [PMID: 36366250 PMCID: PMC9657265 DOI: 10.3390/s22218553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Neurorehabilitation research in patients with traumatic brain injury (TBI) showed how vestibular rehabilitation (VR) treatments positively affect concussion-related symptoms, but no studies have been carried out in patients with severe TBI (sTBI) during post-acute intensive neurorehabilitation. We aimed at testing this effect by combining sensor-based gait analysis and clinical scales assessment. We hypothesized that integrating VR in post-acute neurorehabilitation training might improve gait quality and activity of daily living (ADL) in sTBI patients. A two-arm, single-blind randomized controlled trial with 8 weeks of follow-up was performed including thirty sTBI inpatients that underwent an 8-week rehabilitation program including either a VR or a conventional program. Gait quality parameters were obtained using body-mounted magneto-inertial sensors during instrumented linear and curvilinear walking tests. A 4X2 mixed model ANOVA was used to investigate session−group interactions and main effects. Patients undergoing VR exhibited improvements in ADL, showing early improvements in clinical scores. Sensor-based assessment of curvilinear pathways highlighted significant VR-related improvements in gait smoothness over time (p < 0.05), whereas both treatments exhibited distinct improvements in gait quality. Integrating VR in conventional neurorehabilitation is a suitable strategy to improve gait smoothness and ADL in sTBI patients. Instrumented protocols are further promoted as an additional measure to quantify the efficacy of neurorehabilitation treatments.
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Affiliation(s)
- Marco Tramontano
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
| | - Valeria Belluscio
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy
| | - Elena Bergamini
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy
| | - Giulia Allevi
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
| | - Sara De Angelis
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
| | | | - Rita Formisano
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
| | - Giuseppe Vannozzi
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy
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11
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The effects of slow breathing on postural muscles during standing perturbations in young adults. Exp Brain Res 2022; 240:2623-2631. [PMID: 35962803 DOI: 10.1007/s00221-022-06437-0] [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: 05/09/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
Maintaining standing balance is vital to completing activities in daily living. Recent findings suggest an interaction between cardiovascular and postural control systems. Volitional slow breathing can modulate the cardiovascular response and affect postural control during quiet standing. However, the effects of slow breathing during threats to standing balance have not been studied. The study examined the effect of slow breathing on the latency and amplitude of postural muscle responses to perturbations of the base of support in healthy, young adults. Twenty-seven participants completed two balance perturbation tasks in standing on an instrumented split-belt treadmill while breathing spontaneously and breathing at 6 breaths per minute. Each perturbation task consisted of 25 posteriorly directed translations of the treadmill belts every 8-12 s. Muscle latency and muscle burst amplitude were measured using surface electromyography from the right limb for the quadriceps (QUADS), medial hamstring (MH), gastrocnemii (GASTROC), soleus (SOL), and tibialis anterior (TA) muscle groups, while a respiratory belt was used to record respiratory rate. Results indicated that during the slow breathing task both muscle latency (p = 0.022) and muscle burst amplitude (p = 0.011) decreased compared to spontaneous breathing. The EMG pre-perturbation activation was not significantly different in any muscle group between conditions (p > 0.167). The study found that reducing respiratory rate to approximately 6 breaths per minute affects the neuromuscular responses in the lower limb muscles to perturbations.
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12
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Tefertiller C, Ketchum JM, Bartelt P, Peckham M, Hays K. Feasibility of virtual reality and treadmill training in traumatic brain injury: a randomized controlled pilot trial. Brain Inj 2022; 36:898-908. [PMID: 35834738 DOI: 10.1080/02699052.2022.2096258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of treadmill training with virtual reality compared to treadmill training alone and standard of care balance and mobility treatment in chronic traumatic brain injury (TBI). PARTICIPANTS AND DESIGN Thirty-one individuals with chronic TBI with self-reported and objective balance deficits participated in a 4-week 12 session intervention of treadmill training with virtual reality, treadmill training alone, or standard of care overground therapy. OUTCOME MEASURES Primary measures included recruitment and enrollment rates, retention, tolerance to intervention, completeness of outcome measures, and adverse events. Secondary measures included the Community Balance and Mobility Scale, 10 Meter Walk Test, 6 Minute Walk Test, and Timed Up and Go. RESULTS No serious adverse events were reported. All participants completed all training sessions and assessments at all time points. Recruitment, enrollment, and retention rates were high. All groups showed a trend toward improvement in all balance and mobility measures following treatment. CONCLUSION Virtual reality and treadmill training are safe and feasibile for individuals with TBI. Participants show improvements on balance and mobility measures following a 4-week intervention. Future research is needed to evaluate the efficacy of this intervention compared to other modes of balance and mobility training.
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Affiliation(s)
| | | | | | | | - Kaitlin Hays
- Research Department, Craig Hospital, Englewood, Colorado, USA
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13
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Khanna M, Selvaraj P, Jeyaraman M, Muthu S, Khanna V. Degenerative Joint Scoring System - An Ortho-Rheumatological assessment tool. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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14
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Siedlecki P, Shoemaker JK, Ivanova TD, Garland SJ. Cardiovascular response to postural perturbations of different intensities in healthy young adults. Physiol Rep 2022; 10:e15299. [PMID: 35531916 PMCID: PMC9082380 DOI: 10.14814/phy2.15299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 04/15/2023] Open
Abstract
The ability to regain control of balance is vital in limiting falls and injuries. Little is known regarding how the autonomic nervous system responds during recovery from balance perturbations of different intensities. The purpose of this study was to examine the cardiovascular response following a standing balance perturbation of varying intensities, quantify cardiac baroreflex sensitivity (cBRS) during standing perturbations, and to establish the stability of the cardiac baroreflex during quiet standing before and after balance disturbances. Twenty healthy participants experienced three different perturbation intensity conditions that each included 25 brief posteriorly-directed perturbations, 8-10 s apart. Three perturbation intensity conditions (low, medium, high) were given in random order. Physiological data were collected in quiet stance for 5 min before testing (Baseline) and again after the perturbation conditions (Recovery) to examine baroreflex stability. Beat-to-beat heart rate (HR) and systolic blood pressure (SBP) analysis post-perturbation indicated an immediate acceleration of the HR for 1-2 s, with elevated SBP 4-5 s post-perturbation. Heart rate changes were greatest in the medium (p = 0.035) and high (p = 0.012) intensities compared to low, while there were no intensity-dependent changes in SBP. The cBRS was not intensity-dependent (p = 0.402) but when perturbation conditions were combined, cBRS was elevated compared to Baseline (p = 0.046). The stability of baseline cBRS was excellent (ICC = 0.896) between quiet standing conditions. In summary, HR, but not SBP or cBRS were intensity-specific during postural perturbations. This was the first study to examine cardiovascular response and cBRS to postural perturbations.
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Affiliation(s)
| | | | | | - S. Jayne Garland
- Faculty of Health SciencesWestern UniversityLondonOntarioCanada
- Department of Physiology & PharmacologyWestern UniversityLondonOntarioCanada
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15
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Lai AKM, Wakeling JM, Garland SJ, Hunt MA, Ivanova TD, Pollock CL. Does the stimulus provoking a stepping reaction correlate with step characteristics and clinical measures of balance and mobility post-stroke? Clin Biomech (Bristol, Avon) 2022; 93:105595. [PMID: 35247709 DOI: 10.1016/j.clinbiomech.2022.105595] [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: 03/05/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Retraining stepping reactions in people post-stroke is vital. However, the relationship between the stimulus and resulting stepping performance in people post-stroke is unknown. We explored relationships between stepping stimulus and stepping reactions initiated by either paretic or non-paretic legs of people post-stroke and controls. Relationships were examined in the context of clinical measures of balance. METHODS Centre of mass dynamics were measured during self-initiated destabilizing leaning stimuli that required stepping reactions by paretic and non-paretic legs of people post-stroke (n = 10) and controls (n = 10) to recover balance. Step characteristics of the first two steps of stepping reactions were measured. Correlations were calculated between clinical measures of balance and mobility and the centre of mass and step characteristics. FINDINGS Steps were shorter and slower with decreased centre of mass fore-aft and downward displacement and velocity when initiated by paretic and non-paretic legs compared with controls. However, increase in centre of mass displacement and velocity in the fore-aft and downward direction tended to be associated with a greater increase in step length and speed when stepping reactions were initiated by the paretic and non-paretic legs compared with controls. Time to step initiation in response to onset of falling stimulus did not differ between groups. Strong positive correlations were found between clinical balance and mobility scores and centre of mass and step dynamics in fore-aft and vertical directions. INTERPRETATION These results support objective measurement of centre of mass to quantify the stimulus influencing step dynamics and stepping performance during retraining interventions following stroke.
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Affiliation(s)
- Adrian K M Lai
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - James M Wakeling
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - S Jayne Garland
- Faculty of Health Sciences, Western University, London, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada
| | - Tanya D Ivanova
- Faculty of Health Sciences, Western University, London, Canada
| | - Courtney L Pollock
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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16
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Siedhoff HR, Chen S, Song H, Cui J, Cernak I, Cifu DX, DePalma RG, Gu Z. Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury. Front Neurol 2022; 12:818169. [PMID: 35095749 PMCID: PMC8794583 DOI: 10.3389/fneur.2021.818169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022] Open
Abstract
Most traumatic brain injuries (TBIs) during military deployment or training are clinically "mild" and frequently caused by non-impact blast exposures. Experimental models were developed to reproduce the biological consequences of high-intensity blasts causing moderate to severe brain injuries. However, the pathophysiological mechanisms of low-intensity blast (LIB)-induced neurological deficits have been understudied. This review provides perspectives on primary blast-induced mild TBI models and discusses translational aspects of LIB exposures as defined by standardized physical parameters including overpressure, impulse, and shock wave velocity. Our mouse LIB-exposure model, which reproduces deployment-related scenarios of open-field blast (OFB), caused neurobehavioral changes, including reduced exploratory activities, elevated anxiety-like levels, impaired nesting behavior, and compromised spatial reference learning and memory. These functional impairments associate with subcellular and ultrastructural neuropathological changes, such as myelinated axonal damage, synaptic alterations, and mitochondrial abnormalities occurring in the absence of gross- or cellular damage. Biochemically, we observed dysfunctional mitochondrial pathways that led to elevated oxidative stress, impaired fission-fusion dynamics, diminished mitophagy, decreased oxidative phosphorylation, and compensated cell respiration-relevant enzyme activity. LIB also induced increased levels of total tau, phosphorylated tau, and amyloid β peptide, suggesting initiation of signaling cascades leading to neurodegeneration. We also compare translational aspects of OFB findings to alternative blast injury models. By scoping relevant recent research findings, we provide recommendations for future preclinical studies to better reflect military-operational and clinical realities. Overall, better alignment of preclinical models with clinical observations and experience related to military injuries will facilitate development of more precise diagnosis, clinical evaluation, treatment, and rehabilitation.
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Affiliation(s)
- Heather R. Siedhoff
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Shanyan Chen
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Hailong Song
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Jiankun Cui
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Ibolja Cernak
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, United States
| | - David X. Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Ralph G. DePalma
- Office of Research and Development, Department of Veterans Affairs, Washington, DC, United States
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Zezong Gu
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
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Wakida M, Mori K, Kubota R, Kuwabara T, Mano N, Wada T, Taguchi M, Ohata K, Yamada S, Hase K. Novel gait training using a dual-belt treadmill in older adults: A randomized controlled trial. Arch Gerontol Geriatr 2022; 98:104573. [DOI: 10.1016/j.archger.2021.104573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 11/02/2022]
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18
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Joubran K, Bar-Haim S, Shmuelof L. Dynamic balance recovery in chronic acquired brain injury participants following a perturbation training. Int J Rehabil Res 2021; 44:350-357. [PMID: 34739006 DOI: 10.1097/mrr.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acquired brain injury (ABI) is defined as a damage to the brain that occurs after birth. Subjects post-ABI frequently suffer from dynamic balance impairments that persist years after the injury. This study aimed to investigate the effect of a perturbation method using mechatronic shoes that introduce unexpected balance perturbations on the recovery of dynamic balance and gait velocity in chronic ABI participants. In an intervention trial, 35 chronic ABI participants (stroke and traumatic brain injury) participated in 22 sessions of perturbation training, twice a week for 3 months. Dynamic balance was assessed pre- and post-training using Community Balance and Mobility Scale (CB&M). Gait velocity was also assessed in the stroke participants using the 10 Meter Walking Test (10MWT). Dynamic balance improved significantly post-training (P = 0.001). This improvement was greater than the improvement that was observed in a sub-group that was tested twice before training (P = 0.04). Sixteen participants (45.7%) out of 35 met or exceeded minimal detectable change (MDC) of the CB&M Scale. Self-paced velocity also improved significantly (P = 0.02) but only two participants (9.5%) out of 21 exceeded the MDC of 10MWT post-stroke. Our results suggest that unexpected balance perturbation training using mechatronic shoes leads to an improvement in dynamic balance and gait velocity in chronic ABI participants. The advantage of perturbation training using mechatronic shoes with respect to conventional balance training should be further examined.
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Affiliation(s)
- Katherin Joubran
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Shmuelof
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev
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19
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Dsouza ZL, Rebello SR, Dsilva C. Correlation between community balance and mobility scale (CB&M) with a battery of outcome measures to assess balance in Parkinson's disease - a cross-sectional study. Arch Physiother 2021; 11:25. [PMID: 34749815 PMCID: PMC8576918 DOI: 10.1186/s40945-021-00117-y] [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: 01/13/2021] [Accepted: 09/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluating balance in a functional context that integrates challenging tasks frequently performed in the community is essential to identify community-dwelling individuals who are at risk of falls in early Parkinson Disease (PD) than a simple balance measure. Community Balance and Mobility (CB&M) scale is one such measure that evaluates severe deficits in gait, balance, and mobility. The risk of falling and fear of fall is common among PD individuals and this affects the day to day functioning as well as the quality of life. Early identification of individuals who may be at risk to fall will lead to intervention strategies that can help to with balance issues. The aim of this study was to correlate between Community Balance and Mobility with a battery of outcome measures commonly used to assess balance in Parkinson's disease. METHODS A cross sectional study design; with individuals referred to Outpatient physiotherapy department, diagnosed with idiopathic Parkinson's disease, independently mobile and on a stable drug regimen referred by the neurologist; were screened and recruited by convenience sampling. With written informed consent, demographic data gathered and scales such as Berg Balance scale, Community balance & mobility scale, Functional Reach test and Timed up and go test were administered with an ample amount of rest. RESULTS The results obtained were documented and analysed using Karl Pearson's correlation coefficient. Significant correlation between CB&M and BBS (r = 0.795) was found, CB&M and TUG (r = - 0.755), CB&M and FRT (r = 0.772). CONCLUSION CB&M is a useful measure which integrates items that challenge balance in the community context. It has been used to assess high functioning community dwelling individuals and hence may be apt for individuals with early Parkinson's, since the tasks to be performed in CB&M are challenging and these simulate community level activities where the risk of falls is higher. It may well be a good tool to assess early Parkinson's; their level of balance, community level activity and without need for sophisticated & expensive equipment.
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Affiliation(s)
- Ziona Lionel Dsouza
- Department of Physiotherapy, Ramaiah Medical College Hospital, M S Ramaiah nagar, MSRIT Post, Bangalore, 560054, India
| | - Sydney Roshan Rebello
- Department of Physiotherapy, Father Muller College of Allied Health Sciences, Mangalore, 575002, India.
| | - Cherishma Dsilva
- Department of Physiotherapy, Father Muller College of Allied Health Sciences, Mangalore, 575002, India
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20
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The Use of Home-Based Nonimmersive Virtual Reality to Encourage Physical and Cognitive Exercise in People With Mild Cognitive Impairment: A Feasibility Study. J Aging Phys Act 2021; 30:297-307. [PMID: 34453024 DOI: 10.1123/japa.2021-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
Individuals with mild cognitive impairment are at risk of cognitive and physical decline. Virtual reality (VR) exercise may provide beneficial physical and cognitive exercise. The objectives of this study were to assess the feasibility and safety of home-based VR exercise and to provide pilot data for physical and cognitive efficacy. Eleven individuals with mild cognitive impairment (seven males/four females, average 78 years old, and average 3 years since diagnosis) performed a 30-min home-based VR exercise program 5 days a week for 6 weeks. The VR platform was successfully installed in participants' homes, and all participants were able to learn the VR program and progress. Participants completed 99% of the prescribed exercise. There were no major adverse events. Most participants enjoyed the VR program and reported physical benefits; fewer reported cognitive benefits. No physical or cognitive outcome measures showed change after 6 weeks. Home-based VR exercise is safe and feasible in individuals with mild cognitive impairment.
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21
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Pears M, Biyani CS, Joyce AD, Spearpoint K, Yiasemidou M, Cleynenbreugel BV, Patterson J, Mushtaq F. Capturing the non-technical skills of a technical skills trainer (NTS-TeST) during simulation. Scott Med J 2021; 66:124-133. [PMID: 33847552 DOI: 10.1177/00369330211008594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop an assessment instrument that can be used as a comprehensive feedback record to convey to a trainer the non-technical aspects of skill acquisition and training. METHODS The instrument was developed across three rounds. In Round 1, 6 endourological consultants undertook a modified Delphi process. Round 2 included 10 trainers who assessed each question's relevance and practicability. Round 3 involved a pilot study with fifteen urology residents who participated in a technical skills simulation session with the incorporation of the instrument. We report the content, face, and construct validity, and the internal consistency of an NTS instrument for trainers. RESULTS The instrument had a consistent and a high positive average for each of the 4 sections of the instrument, regardless of the type of user. Positive Spearman's correlation coefficients (0.02 to .64) for content validity and Cronbach's alpha (a = 0.70) indicated good validity and moderate reliability of the instrument. CONCLUSION We propose a novel NTS instrument for trainers during a simulation. This instrument can be used for benchmarking the quality of technical skills simulation training.
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Affiliation(s)
- Matthew Pears
- Applied Cognition and Healthcare Researcher, School of Psychology, University of Leeds, UK
| | | | | | - Ken Spearpoint
- Honorary Consultant Urologist, St James University Hospital, UK
| | - Marina Yiasemidou
- Principal Lecturer, Programme Lead, MSc Health & Medical Simulation University of Hertfordshire, Hatfield, UK
| | - Ben Van Cleynenbreugel
- NIHR Academic Clinical Lecturer in General Surgery, Academic Surgery, Hull York Medical School, ST6 Colorectal Surgery, Bradford Teaching Hospitals, UK
| | | | - Faisal Mushtaq
- Consultant Urologist, Royal Hallamshire Hospital, Sheffield, UK
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22
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Ng YL, Hill KD, Jacques A, Burton E. Reliability and Validity of a Modified Version of the Community Balance and Mobility Scale (CBMS-Home) for Use in Home Assessment. Phys Ther 2021; 101:6290102. [PMID: 34077548 DOI: 10.1093/ptj/pzab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/09/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Community Balance and Mobility Scale (CBMS) has been shown to be a valid and reliable outcome measure for evaluating balance and mobility among older adults; however, some items cannot be conducted in all home environments, limiting its use in home-based assessments. The purpose of this study was to evaluate the accuracy and selected measurement properties of a modified 12-item CBMS-Home (8 original items and 4 modified items of the CBMS) feasible for use within the constraints of home assessments for older adults. METHODS Fifty-five people (mean [SD] age = 77.2 [6.0] years) were recruited for this validation study. Participants completed the full original CBMS, CBMS-Home (the modified items of the CBMS), the Functional Reach Test, and Step Test. Principal components analysis, internal consistency, test-retest and intermethod reliability, agreements within and between methods, and criterion validity were calculated. RESULTS Principal components analysis of CBMS and CBMS-Home both revealed 3 similar components and loadings. Bland-Altman and weighted κ analyses revealed that the CBMS-Home demonstrated moderate to almost perfect agreement (weighted κ = 0.45-0.84) with CBMS. The distribution of scores of CBMS-Home were satisfactory, and other results showed excellent test-retest (intraclass correlation coefficient [ICC] = 0.95) and intermethod reliability (ICC = 0.94) and internal consistency (Cronbach α = 0.94). There were no ceiling effects (0%) or floor (1.8%) effects. CBMS-Home demonstrated a low (Spearman ρ = 0.39) and moderate positive (Spearman ρ = 0.63) relationship with the Functional Reach Test and Step Test, respectively. CONCLUSIONS The CBMS-Home has good psychometric properties and provides a useful multidimensional assessment tool. IMPACT A modified version of the CBMS (CBMS-Home) can be confidently used to assess older adults-within their own home-who might have mild balance impairments.
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Affiliation(s)
- Yoke Leng Ng
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Angela Jacques
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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23
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Sheridan C, Thaut C, Brooks D, Patterson KK. Feasibility of a rhythmic auditory stimulation gait training program in community-dwelling adults after TBI: A case report. NeuroRehabilitation 2021; 48:221-230. [PMID: 33664159 DOI: 10.3233/nre-208016] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traumatic brain injury has multiple impacts on gait including decreased speed and increased gait variability. Rhythmic auditory stimulation (RAS) gait training uses the rhythm and timing structure of music to train and ultimately improve slow and variable walking patterns. OBJECTIVE To describe the feasibility of RAS gait training in community-dwelling adults with traumatic brain injury (TBI). A secondary objective is to report changes in spatiotemporal gait parameters and clinical measures of balance and walking endurance. METHODS Two individuals with a TBI participated in nine sessions of gait training with RAS over a 3-week period. At baseline, post-training and 3-week follow-up, spatiotemporal parameters of walking were analyzed at preferred pace, maximum pace and dual-task walking conditions. Secondary outcomes included the Community Balance and Mobility Scale and the 6-Minute Walk Test. Feasibility was assessed using reports of physical fatigue, adverse event reporting, and perceived satisfaction. RESULTS Both participants completed all 9 planned intervention sessions. The sessions were well tolerated with no adverse events. Participant 1 and 2 exhibited different responses to the intervention in line with the therapeutic goals set with the therapist. Participant 1 exhibited improved speed and decreased gait variability. Participant 2 exhibited reduced gait speed but less fatigue during the 6MWT. CONCLUSIONS RAS was found to be a safe and feasible gait intervention with the potential to improve some aspects of gait impairments related to gait speed, gait variability, dynamic balance and walking endurance. Further investigation including a pilot randomized controlled trial is warranted.
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Affiliation(s)
- Conor Sheridan
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Corene Thaut
- Music and Health Science Research Collaboratory (MaHRC), University of Toronto, Toronto, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Music and Health Science Research Collaboratory (MaHRC), University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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24
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Herssens N, Dobbels B, Moyaert J, Van de Berg R, Saeys W, Hallemans A, Vereeck L, Van Rompaey V. Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation. Front Neurol 2021; 12:611648. [PMID: 33732204 PMCID: PMC7957054 DOI: 10.3389/fneur.2021.611648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with bilateral vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life and, more importantly, resulting in an increased risk of falling. In BVP patients, falls are considered as one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanying burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables, and fall status in 27 BVP patients. Based on the history of falls in the preceding 12 months, the patients were subdivided in a "faller" or "non-faller" group. Results on the different outcome measures were compared between the "faller" and "non-faller" subgroups using Pearson's chi-square test in the case of categorical data; for continuous data, Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers, indicating that, independent from fall status, the BVP patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speed. These results may thus imply that, when aiming to distinguish fallers from non-fallers, the BVP patients' beliefs concerning their capabilities may be more important than the moderately or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behavior and falls in BVP.
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Affiliation(s)
- Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bieke Dobbels
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Julie Moyaert
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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25
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Pollock CL, Hunt MA, Garland SJ, Ivanova TD, Wakeling JM. Relationships Between Stepping-Reaction Movement Patterns and Clinical Measures of Balance, Motor Impairment, and Step Characteristics After Stroke. Phys Ther 2021; 101:6145045. [PMID: 33615368 PMCID: PMC8164842 DOI: 10.1093/ptj/pzab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/14/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Successful stepping reactions, led by either the paretic or nonparetic leg, in response to a loss of balance are critical to safe mobility poststroke. The purpose of this study was to measure sagittal plane hip, knee, ankle, and trunk kinematics during 2-step stepping reactions initiated by paretic and nonparetic legs of people who had stroke and members of a control group. METHODS Principal component analysis (PCA) was used to reduce the data into movement patterns explaining interlimb coordination of the stepping and stance legs. Correlations among principal components loading scores and clinical measures of balance ability (as measured on the Community Balance and Mobility scale), motor impairment (as measured on the foot and leg sections of the Chedoke-McMaster Stroke Assessment), and step characteristics (length and velocity) were used to examine the effect of stroke on stepping reaction movement patterns. RESULTS The first 5 principal components explained 95.9% of the movement pattern of stepping reactions and differentiated between stepping reactions initiated by paretic legs, nonparetic legs, or the legs of controls. Moderate-strong associations (ρ/r > 0.50) between specific principal component loading scores and clinical measures and step characteristics were dependent on the initiating leg. Lower levels of motor impairment, higher levels of balance ability, and faster and longer steps were associated with stepping reactions initiated by the paretic leg that comprised paretic leg flexion and nonparetic leg extension. Step initiation with the nonparetic leg showed associations between higher scores on clinical measures and movement patterns of flexion in both paretic and nonparetic legs. CONCLUSIONS Movement patterns of stepping reactions poststroke were influenced by the initiating leg. After stroke, specific movement patterns showed associations with clinical measures depending on the initiating leg, suggesting that these movement patterns are important to retraining of stepping reactions. Specifically, use of flexion patterning and assessment of between-leg pattern differentiation may be important aspects to consider during retraining of stepping reactions poststroke. IMPACT Evidence-based interventions targeting balance reactions are still in their infancy. This investigation of stepping reactions poststroke addresses a major gap in research.
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Affiliation(s)
- Courtney L Pollock
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada,Address all correspondence to Dr Pollock at:
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - S Jayne Garland
- Faculty of Health Sciences, Western University, London, Canada
| | - Tanya D Ivanova
- Faculty of Health Sciences, Western University, London, Canada
| | - James M Wakeling
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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26
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Song JZ, Catizzone M, Arbour-Nicitopoulos KP, Luong D, Perrier L, Bayley M, Munce SEP. Physical performance outcome measures used in exercise interventions for adults with childhood-onset disabilities: A scoping review. NeuroRehabilitation 2020; 47:359-380. [PMID: 33164958 DOI: 10.3233/nre-203250] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND People with childhood-onset disabilities face unique physical and social challenges in adulthood. Exercise interventions may improve physical performance in children, but there is a lack of research on adults. OBJECTIVE To describe studies that investigate exercise interventions and to evaluate the quality of physical performance outcome measures for adults with childhood-onset disabilities. METHODS Eligible studies reported on exercise interventions for adults (ages 16+) with cerebral palsy, spina bifida, or acquired brain injuries. Only randomized controlled trials published in English from 2008 to 2019 were included. MEDLINE, CINAHL, PEDro, EMBASE, and Cochrane Central Register of Controlled Trials were searched. Two reviewers independently screened studies and abstracted data. RESULTS This scoping review included 4 trials reporting on cerebral palsy only. Three strength training programs found significant improvements in gait, and one mixed training program found significant improvements in strength and fitness. Only two outcome measures used are valid/reliable for adults (6 Minute Walk Test and Borg-20 Grades). CONCLUSION Certain interventions may improve physical performance, but there is a lack of research on appropriate exercise interventions and physical performance outcome measures for adults with childhood-onset disabilities. Different exercise interventions should be investigated using larger sample sizes and outcome measures should be standardized.
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Affiliation(s)
- Jessica Z Song
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Margot Catizzone
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | | | - Dorothy Luong
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, Toronto, ON, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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27
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Bergquist R, Nerz C, Taraldsen K, Mellone S, Ihlen EA, Vereijken B, Helbostad JL, Becker C, Mikolaizak AS. Predicting Advanced Balance Ability and Mobility with an Instrumented Timed Up and Go Test. SENSORS 2020; 20:s20174987. [PMID: 32899143 PMCID: PMC7506906 DOI: 10.3390/s20174987] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 01/14/2023]
Abstract
Extensive test batteries are often needed to obtain a comprehensive picture of a person’s functional status. Many test batteries are not suitable for active and healthy adults due to ceiling effects, or require a lot of space, time, and training. The Community Balance and Mobility Scale (CBMS) is considered a gold standard for this population, but the test is complex, as well as time- and resource intensive. There is a strong need for a faster, yet sensitive and robust test of physical function in seniors. We sought to investigate whether an instrumented Timed Up and Go (iTUG) could predict the CBMS score in 60 outpatients and healthy community-dwelling seniors, where features of the iTUG were predictive, and how the prediction of CBMS with the iTUG compared to standard clinical tests. A partial least squares regression analysis was used to identify latent components explaining variation in CBMS total score. The model with iTUG features was able to predict the CBMS total score with an accuracy of 85.2% (84.9–85.5%), while standard clinical tests predicted 82.5% (82.2–82.8%) of the score. These findings suggest that a fast and easily administered iTUG could be used to predict CBMS score, providing a valuable tool for research and clinical care.
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Affiliation(s)
- Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (K.T.); (E.A.F.I.); (B.V.); (J.L.H.)
- Correspondence:
| | - Corinna Nerz
- Department for Clinical Gerontology, Robert-Bosch-Hospital, 70376 Stuttgart, Germany; (C.N.); (C.B.); (A.S.M.)
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (K.T.); (E.A.F.I.); (B.V.); (J.L.H.)
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, 40136 Bologna, Italy;
| | - Espen A.F. Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (K.T.); (E.A.F.I.); (B.V.); (J.L.H.)
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (K.T.); (E.A.F.I.); (B.V.); (J.L.H.)
| | - Jorunn L. Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (K.T.); (E.A.F.I.); (B.V.); (J.L.H.)
| | - Clemens Becker
- Department for Clinical Gerontology, Robert-Bosch-Hospital, 70376 Stuttgart, Germany; (C.N.); (C.B.); (A.S.M.)
| | - A. Stefanie Mikolaizak
- Department for Clinical Gerontology, Robert-Bosch-Hospital, 70376 Stuttgart, Germany; (C.N.); (C.B.); (A.S.M.)
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28
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Dittmann K, Allen KA, Bergner A, Chen J, Inness E, Linkewich E, Pacione S, Shaffer J, Tang A, McEwen S. The cognitive augmented mobility program (CAMP): feasibility and preliminary efficacy. Physiother Theory Pract 2020; 38:737-749. [PMID: 32748666 DOI: 10.1080/09593985.2020.1790068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Best evidence suggests incorporating task-specific training, aerobics, and strengthening to improve mobility and gait in persons with stroke (PWS). Related research suggests incorporating cognitive problem-solving strategy training may lead to better skill maintenance and transfer. The present study examined the feasibility and preliminary outcomes of an evidence-based cognitive augmented mobility program (CAMP) for PWS. METHODS A single-arm pre-post and follow-up design was conducted, in two blocks (NCT03683160). Participants completed an exercise intervention with an integrated cognitive strategy component and had weekly 1:1 sessions with a physiotherapist trained in Cognitive Orientation to daily Occupational Performance (CO-OP), focusing on goal practice and cognitive strategy use. CAMP consisted of a pre-intervention education and goal-setting session and 16 90-minute sessions held in a group format, 2x/wk for 8 weeks. Assessments were conducted 1 week prior to beginning the intervention, 1 week post-intervention, and at a 4-5 week follow-up. RESULTS CAMP was found to be feasible with 96% session attendance and strong participant satisfaction. Pre to post-CAMP intervention, a large effect was found for endurance (r = 0.53), balance (r = 0.59), mobility (r = 0.63) and goal attainment (r = 0.63) indicators, and large effects were maintained at follow-up for balance, mobility, and goal attainment. A medium effect was found for functional independence (r = 0.38), gait speed (r = 0.39), and balance confidence (r = 0.38). A small effect was found for participation (r = 0.27) and overall stroke recovery (r = 0.25). CONCLUSIONS Preliminary results suggest CAMP is feasible; there may be a beneficial effect of combining best evidence for mobility and fitness with cognitive strategy training. The positive results for skill maintenance and transfer suggest further investigation is warranted.
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Affiliation(s)
- Katherine Dittmann
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kay-Ann Allen
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ashley Bergner
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Joyce Chen
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Linkewich
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sandra Pacione
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Jennifer Shaffer
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Professional Practice and Education, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Sara McEwen
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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29
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Gordt K, Paraschiv-Ionescu A, Mikolaizak AS, Taraldsen K, Mellone S, Bergquist R, Van Ancum JM, Nerz C, Pijnappels M, Maier AB, Helbostad JL, Vereijken B, Becker C, Aminian K, Schwenk M. The association of basic and challenging motor capacity with mobility performance and falls in young seniors. Arch Gerontol Geriatr 2020; 90:104134. [PMID: 32575015 DOI: 10.1016/j.archger.2020.104134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/15/2020] [Accepted: 05/30/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Understanding the association between motor capacity (MC) (what people can do in a standardized environment), mobility performance (MP) (what people actually do in real-life) and falls is important for early detection of and counteracting on functional decline, particularly in the rapidly growing population of young seniors. Therefore, this study aims to 1) explore the association between MC and MP, and between MC and falls, and 2) investigate whether challenging MC measures are better associated with MP and falls than basic MC measures. METHODS Basic (habitual gait speed, Timed Up-and-Go) and challenging (fast gait speed, Community Balance & Mobility Scale) MC measures were performed in 169 young seniors (61-70 years). MP was assessed using one-week sensor-monitoring including time being sedentary, light active, and at least moderately active. Falls in the previous six months were reported. Associations and discriminative ability were calculated using correlation, regression and receiver operating curve analysis. RESULTS Mean age was 66.4 (SD 2.4) years (50.6 % women). Small to moderate associations (r = 0.06-0.31; p < .001-.461) were found between MC, MP and falls. Challenging MC measures showed closer associations with MP and falls (r = 0.10-0.31; p < .001-.461) compared to basic (r = 0.06-0.22; p = .012-.181), remained significant in three out of four regression models explaining 2.5-8.6 % of the variance, and showed highest discriminative ability (area under the curve = 0.59-0.70) in all analyses. CONCLUSIONS Challenging MC measures are closer associated with mobility performance and falls as compared to basic MC measures in young seniors. This indicates the importance of applying challenging motor capacity assessments in young seniors. On the same note, small to moderate associations imply a need for an assessment of both MC and MP in order to capture the best possible MC and the actual daily-life MP in young seniors.
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Affiliation(s)
- Katharina Gordt
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, 1015, Lausanne, Switzerland.
| | - A Stefanie Mikolaizak
- Department of Clinical Gerontology and Rehabilitation, Robert Bosch Hospital Stuttgart, Auerbachstr. 110, 70376, Stuttgart, Germany.
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Høgskoleringen 1, 7491, Trondheim, Norway.
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering «Guglielmo Marconi», University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy.
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Høgskoleringen 1, 7491, Trondheim, Norway.
| | - Jeanine M Van Ancum
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Corinna Nerz
- Department of Clinical Gerontology and Rehabilitation, Robert Bosch Hospital Stuttgart, Auerbachstr. 110, 70376, Stuttgart, Germany.
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Centre for Medical Research Building, Victoria, 3010, Melbourne, Australia.
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Høgskoleringen 1, 7491, Trondheim, Norway.
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Høgskoleringen 1, 7491, Trondheim, Norway.
| | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert Bosch Hospital Stuttgart, Auerbachstr. 110, 70376, Stuttgart, Germany.
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, 1015, Lausanne, Switzerland.
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany; Department of Clinical Gerontology and Rehabilitation, Robert Bosch Hospital Stuttgart, Auerbachstr. 110, 70376, Stuttgart, Germany; Institute of Sports and Sports Sciences, Heidelberg University, Im Neuenheimer Feld 700, 69120, Heidelberg, Germany.
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30
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Beauchamp MK. Screening for Preclinical Balance Limitations in Younger Older Adults: Time for a Paradigm Shift? Phys Ther 2020; 100:589-590. [PMID: 31965177 DOI: 10.1093/ptj/pzaa017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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31
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Psychometric properties and domains of postural control tests for individuals with knee osteoarthritis: a systematic review. Int J Rehabil Res 2020; 43:102-115. [PMID: 32282571 DOI: 10.1097/mrr.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with knee osteoarthritis (OA) commonly demonstrate impaired postural control. We aimed to systematically review psychometric properties of tests that assess postural control in people with knee OA and secondly, to determine domains of postural control measured by these tests. PubMed, CINAHL, Embase and Web of Science databases were searched to January 2019. Two independent review authors screened references according to eligibility criteria. The Consensus-based Standards for the selection of health Measurement Instruments were used to evaluate study methodological quality. Postural control tests identified from included studies were assessed to determine postural control constructs using the Systems Framework for Postural Control identifying nine domains. Following the screening of 2643 references, five cross-sectional studies and one longitudinal study (n = 408) were included. Four studies evaluated reliability, validity or responsiveness of three clinical measures: Community Balance and Mobility Scale, Star Excursion Balance Test and Tinetti Performance Oriented Mobility Assessment. Two assessed reliability or validity of a force platform. Results showed that evidence for reliability, validity and responsiveness of all these postural measures is limited. The most common domain of postural control assessed was 'static stability'. No study used measures that evaluated all nine postural control domains. Our results highlight limited investigation of psychometric properties specific to postural control in knee OA. The few existing ones have limitations regarding psychometric robustness and completeness regarding different domains of postural control. Future research should focus on verifying the quality of existing tools to evaluate postural control in knee OA for research and clinical purposes.
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32
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Liao Y, Vakanski A, Xian M, Paul D, Baker R. A review of computational approaches for evaluation of rehabilitation exercises. Comput Biol Med 2020; 119:103687. [PMID: 32339122 PMCID: PMC7189627 DOI: 10.1016/j.compbiomed.2020.103687] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
Recent advances in data analytics and computer-aided diagnostics stimulate the vision of patient-centric precision healthcare, where treatment plans are customized based on the health records and needs of every patient. In physical rehabilitation, the progress in machine learning and the advent of affordable and reliable motion capture sensors have been conducive to the development of approaches for automated assessment of patient performance and progress toward functional recovery. The presented study reviews computational approaches for evaluating patient performance in rehabilitation programs using motion capture systems. Such approaches will play an important role in supplementing traditional rehabilitation assessment performed by trained clinicians, and in assisting patients participating in home-based rehabilitation. The reviewed computational methods for exercise evaluation are grouped into three main categories: discrete movement score, rule-based, and template-based approaches. The review places an emphasis on the application of machine learning methods for movement evaluation in rehabilitation. Related work in the literature on data representation, feature engineering, movement segmentation, and scoring functions is presented. The study also reviews existing sensors for capturing rehabilitation movements and provides an informative listing of pertinent benchmark datasets. The significance of this paper is in being the first to provide a comprehensive review of computational methods for evaluation of patient performance in rehabilitation programs.
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Affiliation(s)
- Yalin Liao
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | | | - Min Xian
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | - David Paul
- Department of Movement Sciences, University of Idaho, Moscow, USA
| | - Russell Baker
- Department of Movement Sciences, University of Idaho, Moscow, USA
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Gordt K, Mikolaizak AS, Taraldsen K, Bergquist R, Van Ancum JM, Nerz C, Pijnappels M, Maier AB, Helbostad JL, Vereijken B, Becker C, Schwenk M. Creating and Validating a Shortened Version of the Community Balance and Mobility Scale for Application in People Who Are 61 to 70 Years of Age. Phys Ther 2020; 100:180-191. [PMID: 31581286 DOI: 10.1093/ptj/pzz132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/30/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND The Community Balance and Mobility Scale (CBM) has been shown to be reliable and valid for detecting subtle balance and mobility deficits in people who are 61 to 70 years of age. However, item redundancy and assessment time call for a shortened version. OBJECTIVE The objective was to create and validate a shortened version of the CBM (s-CBM) without detectable loss of psychometric properties. DESIGN This was a cross-sectional study. METHODS Exploratory factor analysis with data from 189 young seniors (aged 61-70 years; mean [SD] age = 66.3 [2.5] years) was used to create the s-CBM. Sixty-one young seniors (aged 61-70 years; mean [SD] age = 66.5 [2.6] years) were recruited to assess construct validity (Pearson correlation coefficient) by comparing the CBM versions with Fullerton Advance Balance Scale, Timed Up-and-Go, habitual and fast gait speed, 8 Level Balance Scale, 3-m tandem walk, and 30-second chair stand test. Internal consistency (Cronbach α), ceiling effects, and discriminant validity (area under the curve [AUC]) between fallers and nonfallers, and self-reported high and low function (Late-Life Function and Disability Index) and balance confidence (Activities-Specific Balance Confidence Scale), respectively, were calculated. RESULTS The s-CBM, consisting of 4 items, correlated excellently with the CBM (r = 0.97). Correlations between s-CBM and other assessments (r = 0.07-0.72), and CBM and other assessments (r = 0.06-0.80) were statistically comparable in 90% of the correlations. Cronbach α was .84 for the s-CBM, and .87 for the CBM. No CBM-version showed ceiling effects. Discriminative ability of the s-CBM was statistically comparable with the CBM (AUC = 0.66-0.75 vs AUC = 0.65-0.79). LIMITATIONS Longitudinal studies with larger samples should confirm the results and assess the responsiveness for detecting changes over time. CONCLUSIONS The psychometric properties of the s-CBM were similar to those of the CBM. The s-CBM can be recommended as a valid and quick balance and mobility assessment in young seniors.
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Affiliation(s)
- Katharina Gordt
- Network Aging Research, Heidelberg University, Bergheimer Str 20, 69115 Heidelberg, Germany
| | | | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology
| | - Jeanine M Van Ancum
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - Corinna Nerz
- Department of Clinical Gerontology, Robert Bosch Hospital
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, and Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital
| | - Michael Schwenk
- Network Aging Research, and Institute of Sports and Sports Sciences, Heidelberg University
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Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Belluscio V, Bergamini E, Tramontano M, Orejel Bustos A, Allevi G, Formisano R, Vannozzi G, Buzzi MG. Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors. SENSORS 2019; 19:s19235315. [PMID: 31816843 PMCID: PMC6928771 DOI: 10.3390/s19235315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/15/2019] [Accepted: 11/28/2019] [Indexed: 12/21/2022]
Abstract
Despite existing evidence that gait disorders are a common consequence of severe traumatic brain injury (sTBI), the literature describing gait instability in sTBI survivors is scant. Thus, the present study aims at quantifying gait patterns in sTBI through wearable inertial sensors and investigating the association of sensor-based gait quality indices with the scores of commonly administered clinical scales. Twenty healthy adults (control group, CG) and 20 people who suffered from a sTBI were recruited. The Berg balance scale, community balance and mobility scale, and dynamic gait index (DGI) were administered to sTBI participants, who were further divided into two subgroups, severe and very severe, according to their score in the DGI. Participants performed the 10 m walk, the Figure-of-8 walk, and the Fukuda stepping tests, while wearing five inertial sensors. Significant differences were found among the three groups, discriminating not only between CG and sTBI, but also for walking ability levels. Several indices displayed a significant correlation with clinical scales scores, especially in the 10 m walking and Figure-of-8 walk tests. Results show that the use of wearable sensors allows the obtainment of quantitative information about a patient’s gait disorders and discrimination between different levels of walking abilities, supporting the rehabilitative staff in designing tailored therapeutic interventions.
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Affiliation(s)
- Valeria Belluscio
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
| | - Marco Tramontano
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Amaranta Orejel Bustos
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
| | - Giulia Allevi
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Rita Formisano
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
- Correspondence: ; Tel.: +39-063673-3522
| | - Maria Gabriella Buzzi
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
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Pape MM, Kodosky PN, Hoover P. The Community Balance and Mobility Scale: Detecting Impairments in Military Service Members With Mild Traumatic Brain Injury. Mil Med 2019; 185:428-435. [DOI: 10.1093/milmed/usz265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The objective of this study was to determine the utility of the Community Balance and Mobility scale (CB&M) among service members presenting with mild traumatic brain injury (mTBI), to compare the results against well-established balance assessments, and to find a new military-specific CB&M cut score to help differentiate those with and without mTBI.
Materials and Methods
The setting was a 4-week, intensive-outpatient, interdisciplinary program for active duty service members with mTBI. This was a nonrandomized, cross-sectional design that compared multiple measures between two groups: active duty service members with (n = 45) and without (n = 45) mTBI. The assessments, including the Activities-Specific Balance Confidence Scale, gait speed (comfortable and fast), the Functional Gait Assessment, and the CB&M, were provided to both sample groups.
Results
The mTBI group performed significantly worse (P ≤ 0.01) across all measures. A higher cut score for the CB&M of 81.5 is suggested. The CB&M demonstrated the best sensitivity (78%) and specificity (91%) ratio, as well as the largest effect size and area under the curve(0.92).
Conclusion
All objective measures distinguish participants with mTBI from controls, ranging from fair to excellent. The recommended CB&M cut score of 81.5 allows for good variance, standard deviation, and reduced risk of ceiling or floor effects. Further examination of the recommended CB&M cut score is warranted for use in the mTBI civilian populations.
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Affiliation(s)
- Marcy M Pape
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda MD 20889
| | - Paula N Kodosky
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda MD 20889
| | - Peter Hoover
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda MD 20889
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O'Neil J, Egan M, Marshall S, Bilodeau M, Pelletier L, Sveistrup H. Remotely Supervised Home-Based Intensive Exercise Intervention to Improve Balance, Functional Mobility, and Physical Activity in Survivors of Moderate or Severe Traumatic Brain Injury: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e14867. [PMID: 31599733 PMCID: PMC6812480 DOI: 10.2196/14867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/07/2023] Open
Abstract
Background Traumatic brain injury (TBI) may impact an individual physically, cognitively, socially, and emotionally. Poor balance, reduced mobility, and low daily physical activity often will require ongoing physical rehabilitation intervention. However, face-to-face specialized physiotherapy is not always accessible for individuals living in rural settings. Objective We will answer four questions: (1) What is the feasibility of a remotely supervised, home-based, intensive exercise intervention with survivors of moderate and severe TBI? (2) Does the frequency of remote supervision have an impact on the feasibility of completing a home-based intensive exercise program? (3) Does the frequency of remote supervision impact balance, functional mobility, and physical activity? (4) What is the lived experience of remote supervision for both survivors and caregivers? Methods Four participants will complete two intensive, 4-week (five days per week) home-based exercise interventions remotely supervised via synchronous videoconference. Each exercise intervention will have a goal of 160 to 300 repetitions or 60 minutes of tailored exercises to promote neuroplasticity and be defined as an intensive home-based exercise intervention. An alternating single-subject design will allow for the comparison between two frequencies of remote supervision, once weekly and five times weekly. Daily repeated outcome measures, pre- and postintervention outcome measures, and 1-month follow-up outcome measures will be collected to explore the effect on feasibility and physical variables. Daily outcome measures include step count and Five Times Sit-to-Stand test. Pre-post measures include assessment of quiet stance and the Community Balance and Mobility Scale. A semistructured interview will be completed at the end of each intervention segment to document the lived experience of both survivors and their study partners. Finally, five questionnaires will be used to understand the overall experience: the Mayo-Portland Adaptability Inventory-4 Participation Index, Satisfaction With Life Scale, Fall Efficacy Scale-International, Interpersonal Behavior Questionnaire, and System Usability Scale. Data will be analyzed following traditional single-subject methods of analysis. Results Ethics approval was received from both the Bruyère Research Institute and University of Ottawa review boards in March 2019. Recruitment is underway. Conclusions The proposed intervention is complex in nature due to the involvement of multiple technology sources and the inclusion of a complex dyad (survivors and caregivers) in a community setting. This type of research is timely given that alternative methods of physical intervention delivery are needed to facilitate gains in balance, mobility, physical activity among TBI survivors with limited access to clinical care, and the quality of the patients’ experience. International Registered Report Identifier (IRRID) PRR1-10.2196/14867
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Affiliation(s)
- Jennifer O'Neil
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Mary Egan
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Shawn Marshall
- Bruyère Research Institute, Ottawa, ON, Canada.,Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Martin Bilodeau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Luc Pelletier
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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Petrini FM, Valle G, Bumbasirevic M, Barberi F, Bortolotti D, Cvancara P, Hiairrassary A, Mijovic P, Sverrisson AÖ, Pedrocchi A, Divoux JL, Popovic I, Lechler K, Mijovic B, Guiraud D, Stieglitz T, Alexandersson A, Micera S, Lesic A, Raspopovic S. Enhancing functional abilities and cognitive integration of the lower limb prosthesis. Sci Transl Med 2019; 11:11/512/eaav8939. [DOI: 10.1126/scitranslmed.aav8939] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
Lower limb amputation (LLA) destroys the sensory communication between the brain and the external world during standing and walking. Current prostheses do not restore sensory feedback to amputees, who, relying on very limited haptic information from the stump-socket interaction, are forced to deal with serious issues: the risk of falls, decreased mobility, prosthesis being perceived as an external object (low embodiment), and increased cognitive burden. Poor mobility is one of the causes of eventual device abandonment. Restoring sensory feedback from the missing leg of above-knee (transfemoral) amputees and integrating the sensory feedback into the sensorimotor loop would markedly improve the life of patients. In this study, we developed a leg neuroprosthesis, which provided real-time tactile and emulated proprioceptive feedback to three transfemoral amputees through nerve stimulation. The feedback was exploited in active tasks, which proved that our approach promoted improved mobility, fall prevention, and agility. We also showed increased embodiment of the lower limb prosthesis (LLP), through phantom leg displacement perception and questionnaires, and ease of the cognitive effort during a dual-task paradigm, through electroencephalographic recordings. Our results demonstrate that induced sensory feedback can be integrated at supraspinal levels to restore functional abilities of the missing leg. This work paves the way for further investigations about how the brain interprets different artificial feedback strategies and for the development of fully implantable sensory-enhanced leg neuroprostheses, which could drastically ameliorate life quality in people with disability.
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Informal Dance Intervention Improves BMI and Functional Gait in an Adolescent With Cerebral Palsy: A Case Report. Pediatr Phys Ther 2019; 31:E26-E31. [PMID: 31469773 DOI: 10.1097/pep.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This case study examined the effects of incorporating Informal Dance Intervention into traditional therapy sessions on body mass index and functional walking in an adolescent girl with cerebral palsy. CASE DESCRIPTION A 15-year-old adolescent girl, Gross Motor Function Classification System Level II, participated in Informal Dance Intervention twice weekly in 2, 16 session phases. Sixty-minute sessions focused on waltzing, contra dancing, square dancing, and belly dancing to improve timing, endurance, vestibular functioning, and core strength. CONCLUSIONS Waist circumference decreased, walking speed increased on the 6-Minute Walk Test and Timed Up and Down Stairs, balance confidence increased per the Activities-specific Balance Confidence Scale, and vestibular functioning improved per changes in the Functional Gait Assessment. RECOMMENDATIONS FOR CLINICAL PRACTICE Incorporating Informal Dance Intervention, in conjunction with therapy, may be motivating and improve overall health for adolescents with cerebral palsy to combat their tendency of increased sedentary lifestyle.
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Tefertiller C, Hays K, Natale A, O'Dell D, Ketchum J, Sevigny M, Eagye CB, Philippus A, Harrison-Felix C. Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1409-1416. [PMID: 31009598 PMCID: PMC8594144 DOI: 10.1016/j.apmr.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an in-home 12-week physical therapy (PT) intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI). SETTING Home-based exercise program (HEP). PARTICIPANTS Individuals (N=63; traditional HEP n=32; VR n=31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving PT services. MAIN OUTCOME MEASURES Primary: Community Balance and Mobility Scale (CB&M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS No significant between-group differences were observed in the CB&M over the study duration (P=.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (P=.8822); ABC (P=.4343) and PART-O (P=.8822). However, both groups demonstrated significant improvements in CB&M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all P's <.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change of 8 points on the CB&M at 24 weeks and 38% met or exceeded the minimal detectable change of 7.81 points on the BESTest. CONCLUSION This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment.
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Affiliation(s)
| | - Kaitlin Hays
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Audrey Natale
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Denise O'Dell
- Department of Physical Therapy, Regis University, Denver, Colorado
| | | | - Mitch Sevigny
- Department of Research, Craig Hospital, Englewood, Colorado
| | - C B Eagye
- Department of Research, Craig Hospital, Englewood, Colorado
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Challenging Standing Balance Reduces the Asymmetry of Motor Control of Postural Sway Poststroke. Motor Control 2019; 23:327-343. [DOI: 10.1123/mc.2017-0098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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The Community Balance and Mobility Scale: A VALID ASSESSMENT TOOL OF BALANCE IN CARDIAC REHABILITATION PATIENTS. J Cardiopulm Rehabil Prev 2019; 38:100-103. [PMID: 28727674 DOI: 10.1097/hcr.0000000000000277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Many patients participating in cardiac rehabilitation (CR) programs have decreased balance. This is a concern, as it may affect their ability to optimally perform physical exercise in CR and thus decrease CR efficacy. Despite this concern, balance is typically not assessed as part of CR intake. This may be attributable to the fact that a suitable balance assessment tool has not been identified for higher-functioning CR patients. A potential solution to this issue is using the Community Balance and Mobility Scale (CBMS), which has been used to assess balance in higher-functioning clinical populations; however, its use in a CR population has never been investigated. Therefore, the purpose of this study was to determine the reliability and validity of the CBMS for assessing balance in CR patients. METHODS Fifty-three participants were recruited from local CR programs to perform the CBMS. Dynamic posturography was also measured in a subset of participants (n = 31) using the Limits of Stability (LOS) test. RESULTS Analysis of CBMS scores revealed that the mean CBMS score was 61.9 ± 16.2 (out of 96) and that no floor or ceiling effects were observed for any participants. CBMS scores were significantly correlated with the LOS results (0.41-0.53). Interrater reliability between novice and expert testers was strong (r = 0.95), with all differences falling within the 95% limits of agreement. CONCLUSION Overall, these results suggest that the CBMS is a valid tool to measure balance in CR patients and can be reliably administered by health care professionals with minimal training.
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A Systematic Review of Thirty-One Assessment Tests to Evaluate Mobility in Older Adults. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1354362. [PMID: 31321227 PMCID: PMC6610744 DOI: 10.1155/2019/1354362] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/28/2019] [Accepted: 05/27/2019] [Indexed: 12/05/2022]
Abstract
Assessments of gait, balance, and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility. Several evaluation tools have been proposed; however, clinicians should select the most accurate ones wisely, based on numerous criteria. This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible. Initially, a broad search was performed. Articles were screened based on their titles and abstracts, and only studies published in English were considered. Based on our inclusion and exclusion criteria, 31 assessment tests evaluating the mobility of healthy elderly people were found. Then, further searches were completed to identify the measurement properties of each test. These characteristics include the origin and year of establishment, several practicality factors, and validity. The analysis of our outcomes illustrates the similarities and differences between the identified tests.
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Home-based virtual reality training after discharge from hospital-based stroke rehabilitation: a parallel randomized feasibility trial. Trials 2019; 20:333. [PMID: 31174579 PMCID: PMC6555916 DOI: 10.1186/s13063-019-3438-9] [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] [Received: 12/07/2018] [Accepted: 05/10/2019] [Indexed: 01/19/2023] Open
Abstract
Background Virtual reality training (VRT) uses computer software to track a user’s movements and allow him or her to interact with a game presented on a television screen. VRT is increasingly being used for the rehabilitation of arm function, balance and walking after stroke. Patients often require ongoing therapy post discharge from inpatient rehabilitation. Outpatient therapy may be limited or inaccessible due to waiting lists, transportation issues, distance etc.; therefore, home-based VRT could provide the required therapy in a more convenient and accessible setting. The objectives of this parallel randomized feasibility trial are to determine (1) the feasibility of using VRT in the home post stroke and (2) the feasibility of a battery of quantitative and qualitative outcome measures of stroke recovery. Methods Forty patients who can stand for at least 2 min and are soon to be discharged from inpatient or outpatient rehabilitation post stroke are being recruited in Ottawa, Canada and being randomized to control and experimental groups. Participants in the experimental group use home-based VRT to do rehabilitative exercises for standing balance, stepping, reaching, strengthening and gentle aerobic fitness. Control group participants use an iPad with apps selected to rehabilitate cognition, hand fine motor skills and visual tracking/scanning. Both groups are instructed to perform 30 min of exercise 5 days a week for 6 weeks. VRT intensity and difficulty are monitored and adjusted remotely. Weekly telephone contact is made with all participants. Ability to recruit participants, ability to handle the technology and learn the activities, compliance, safety, enjoyment, perceived efficacy and cost of program delivery will be assessed. A battery of assessments of standing balance, gait and community integration will be assessed for feasibility of completion within this population and potential for improvement following the intervention. Effect sizes will be calculated. Discussion The results of this study will be used to support the creation of a definitive randomized controlled trial on the efficacy of home-based VRT for rehabilitation post stroke. Trial Registration ClinicalTrials.gov, NCT03261713. Registered on 21 August 2017. Registration amended on 1 June 2018 to decrease enrollment from 40 to 20 due to a cut in study funding and difficulty recruiting participants. Electronic supplementary material The online version of this article (10.1186/s13063-019-3438-9) contains supplementary material, which is available to authorized users.
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Quigley A, O'Brien KK, Brouillette MJ, MacKay-Lyons M. Evaluating the Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes in People Living With HIV: Protocol for a Randomized Pilot Trial. JMIR Res Protoc 2019; 8:e13818. [PMID: 31115343 PMCID: PMC6547772 DOI: 10.2196/13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial Registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw) International Registered Report Identifier (IRRID) DERR1-10.2196/13818
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Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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Yang CL, Creath RA, Magder L, Rogers MW, McCombe Waller S. Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke. J Neurophysiol 2019; 121:1465-1477. [PMID: 30785824 DOI: 10.1152/jn.00694.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Posture and movement planning, preparation, and execution of a goal-directed reaching movement are impaired in individuals with stroke. No studies have shown whether the deficits are generally impaired or are specific to the lesioned hemisphere/paretic arm. This study utilized StartReact (SR) responses elicited by loud acoustic stimuli (LAS) to investigate the preparation and execution of anticipatory postural adjustments (APAs) and reach movement response during both paretic and nonparetic arm reaching in individuals with stroke and in age-matched healthy controls. Subjects were asked to get ready after receiving a warning cue and to reach at a "go" cue. An LAS was delivered at -500, -200, and 0 ms relative to the go cue. Kinetic, kinematic, and electromyographic data were recorded to characterize APA-reach movement responses. Individuals with stroke demonstrated systemwide deficits in posture and in movement planning, preparation, and execution of APA-reach sequence as shown by significant reduction in the incidence of SR response and impaired APA-reach performance, with greater deficits during paretic arm reaching. Use of trunk compensation strategy as characterized by greater involvement of trunk and pelvic rotation was utilized by individuals with stroke during paretic arm reaching compared with nonparetic arm reaching and healthy controls. Our findings have implications for upper extremity and postural control, suggesting that intervention should include training not only for the paretic arm but also for the nonparetic arm with simultaneous postural control requirements to improve the coordination of the APA-reach performance and subsequently reduce instability while functional tasks are performed during standing. NEW & NOTEWORTHY Our study is the first to show that nonparetic arm reaching also demonstrates impairment in posture and movement planning, preparation, and execution when performed during standing by individuals with stroke. In addition, we found compensatory trunk and pelvic rotations were used during a standing reach task for the paretic arms. The findings have clinical implications for upper extremity and postural rehabilitation, suggesting that training should include the nonparetic arms and incorporate simultaneous postural control demands.
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Affiliation(s)
- Chieh-Ling Yang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine , Baltimore, Maryland
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine , Baltimore, Maryland
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine , Baltimore, Maryland
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine , Baltimore, Maryland
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Hays K, Tefertiller C, Ketchum JM, Sevigny M, O’Dell DR, Natale A, Eagye CB, Harrison-Felix C. Balance in chronic traumatic brain injury: correlations between clinical measures and a self-report measure. Brain Inj 2019; 33:435-441. [PMID: 30638404 PMCID: PMC8552983 DOI: 10.1080/02699052.2019.1565900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess associations among commonly used self-report and clinical measures of balance in chronic TBI. DESIGN Cross-sectional analysis of balance in a convenience sample of individuals at least one year post TBI. MAIN OUTCOME MEASURES Activities-Specific Balance Confidence Scale (ABC) (self-reported balance impairment), Community Balance and Mobility Scale (CB&M) (clinical measure validated in TBI), and Balance Evaluation Systems Test (BESTest) (clinical measure not validated in TBI). METHODS Fifty-nine individuals (64% male, mean age 48.2 years) ambulating independently within the home participated in testing. Pearson correlation coefficients were used to quantify the direction and magnitude of the relationships among the three balance impairment measures. RESULTS A significant positive correlation was noted between the ABC and CB&M (r = 0.42, p = 0.0008), between the ABC and BESTest (r = 0.46, p = 0.0002), and between the CB&M and BESTest (r = 0.86, p < 0.0001). CONCLUSIONS This is the first study we are aware of in the chronic moderate to severe TBI population directly comparing patient's self-reported balance impairment with clinical measures. Positive correlations were found between the self-report measure and both clinical measures. Overall, individuals with chronic TBI tend to self-report less impaired balance than clinical measures indicate. These results provide preliminary evidence to support the need for validation of the BESTest in this population. ABBREVIATIONS ABC: Activities-specific balance confidence scale; BESTest: balance evaluation systems test; BOS: base of support; COM: center of mass; CB&M: community balance and mobility scale; CI: confidence interval; IQR: interquartile range; PTs: physical therapists; SD: standard deviation; SE: standard error; TBI: traumatic brain injury.
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Affiliation(s)
- Kaitlin Hays
- Physical Therapy Department, Craig Hospital, Englewood, CO, USA
| | | | - Jessica M. Ketchum
- Research Department, Craig Hospital, Englewood, CO, USA
- Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, CO, USA
| | - Mitch Sevigny
- Research Department, Craig Hospital, Englewood, CO, USA
| | - Denise R. O’Dell
- Physical Therapy Department, Craig Hospital, Englewood, CO, USA
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - Audrey Natale
- Physical Therapy Department, Craig Hospital, Englewood, CO, USA
| | - CB Eagye
- Research Department, Craig Hospital, Englewood, CO, USA
| | - Cynthia Harrison-Felix
- Research Department, Craig Hospital, Englewood, CO, USA
- Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, USA
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Bergquist R, Weber M, Schwenk M, Ulseth S, Helbostad JL, Vereijken B, Taraldsen K. Performance-based clinical tests of balance and muscle strength used in young seniors: a systematic literature review. BMC Geriatr 2019; 19:9. [PMID: 30626340 PMCID: PMC6327480 DOI: 10.1186/s12877-018-1011-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many balance and strength tests exist that have been designed for older seniors, often aged ≥70 years. To guide strategies for preventing functional decline, valid and reliable tests are needed to detect early signs of functional decline in young seniors. Currently, little is known about which tests are being used in young seniors and their methodological quality. This two-step review aims to 1) identify commonly used tests of balance and strength, and 2) evaluate their measurement properties in young seniors. METHODS First, a systematic literature search was conducted in MEDLINE to identify primary studies that employed performance-based tests of balance and muscle strength, and which aspects of balance and strength these tests assess in young seniors aged 60-70. Subsequently, for tests used in ≥3 studies, a second search was performed to identify method studies evaluating their measurement properties. The quality of included method studies was evaluated using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) checklist. RESULTS Of 3454 articles identified, 295 met the inclusion criteria. For the first objective, 69 balance and 51 muscle strength tests were identified, with variations in administration mode and outcome reporting. Twenty-six balance tests and 15 muscle strength tests were used in ≥3 studies, with proactive balance tests and functional muscle power tests used most often. For the second objective, the search revealed 1880 method studies, of which nine studies (using 5 balance tests and 1 strength test) were included for quality assessment. The Timed Up and Go test was evaluated the most (4 studies), while the Community Balance and Mobility (CBM) scale was the second most assessed test (3 studies). For strength, one study assessed the reliability of the Five times sit-to-stand. CONCLUSION Commonly used balance and muscle strength tests in young seniors vary greatly with regards to administration mode and outcome reporting. Few studies have evaluated measurement properties of these tests when used in young seniors. There is a need for standardisation of existing tests to improve their informative value and comparability. For measuring balance, the CBM is a new and promising tool to detect even small balance deficits in balance in young seniors.
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Affiliation(s)
- Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian Univerity of Science and Technology, Trondheim, Norway.
| | - Michaela Weber
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.,Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Synnøve Ulseth
- Department of Neuromedicine and Movement Science, Norwegian Univerity of Science and Technology, Trondheim, Norway
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian Univerity of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian Univerity of Science and Technology, Trondheim, Norway
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian Univerity of Science and Technology, Trondheim, Norway
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49
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Wilson T, Martins O, Efrosman M, DiSabatino V, Benbrahim BM, Patterson KK. Physiotherapy practice patterns in gait rehabilitation for adults with acquired brain injury. Brain Inj 2018; 33:333-348. [PMID: 30540506 DOI: 10.1080/02699052.2018.1553067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Gait dysfunction is common following acquired brain injury (ABI). Clinical practice guidelines can improve patient outcomes; however, information regarding ABI-specific management of gait dysfunction is limited. This study aimed to describe practice patterns of Canadian physiotherapists regarding gait rehabilitation in adults post-ABI. METHODS An electronic questionnaire was developed and distributed across Canada to describe physiotherapy assessment methods, outcome measures, and treatment interventions used to manage gait dysfunction in adults with mild-moderate and severe ABI. RESULTS Of 103 respondents who accessed the questionnaire, 59 met inclusion criteria and participated in the study. Methods most frequently used "often or very often" at initial and discharge assessments included visual observation (≥88.2% for adults with mild-moderate and severe ABI) and the Berg Balance Scale (≥76.3% for adults with mild-moderate ABI). Higher level gait training exercises were used more often for adults with mild-moderate than severe ABI. Physiotherapists commonly reported further research was required to develop and validate gait-specific outcome measures (42.4%) and treatment techniques (76.3%). CONCLUSIONS Physiotherapists' use of gait-specific treatment interventions, but not assessment methods, differs depending on ABI severity. Future work should investigate factors influencing these practice patterns. In addition, clinician-identified research priorities include ABI gait-specific outcome measures and technology-based interventions.
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Affiliation(s)
- Terri Wilson
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | - Olivia Martins
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | - Michelle Efrosman
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | | | | | - Kara K Patterson
- a Department of Physical Therapy , University of Toronto , Toronto , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Canada.,c Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada
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50
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Neptune RR, Vistamehr A. Dynamic Balance during Human Movement: Measurement and Control Mechanisms. J Biomech Eng 2018; 141:2718203. [PMID: 30516241 PMCID: PMC6611347 DOI: 10.1115/1.4042170] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 11/16/2018] [Indexed: 11/08/2022]
Abstract
Walking can be exceedingly complex to analyze due to highly nonlinear multi-body dynamics, nonlinear relationships between muscle excitations and resulting muscle forces, dynamic coupling that allows muscles to accelerate joints and segments they do not span, and redundant muscle control. Walking requires the successful execution of a number of biomechanical functions such as providing body support, forward propulsion and balance control, with specific muscle groups contributing to their execution. Thus, muscle injury or neurological impairment that affects muscle output can alter the successful execution of these functions and impair walking performance. The loss of balance control in particular can result in falls and subsequent injuries that lead to the loss of mobility and functional independence. Thus, it is important to assess the mechanisms used to control balance in clinical populations using reliable methods with the ultimate goal of improving rehabilitation outcomes. In this review, we highlight common clinical and laboratory-based measures used to assess balance control and their potential limitations, show how these measures have been used to analyze balance in several clinical populations, and consider the translation of specific laboratory-based measures from the research laboratory to the clinic.
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Affiliation(s)
- Richard R. Neptune
- Walker Department of Mechanical Engineering,
The University of Texas at Austin,
Austin 204 E. Dean Keeton Street,
Stop C2200,
Austin, TX 78712
e-mail:
| | - Arian Vistamehr
- Brooks Rehabilitation Motion Analysis Center,
Jacksonville, FL 32216
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