Effect of tDCS Combined With Physical Training on Physical Performance in a Healthy Population

Purpose: The effectiveness of transcranial direct current stimulation (tDCS) combined with physical training has shown inconsistent results through research. Hence, a study utilizing a long-term tDCS application over the primary motor cortex and a large sample size is required to determine whether tDCS combined with physical training can increase physical performance (muscular strength, endurance, and explosive strength) in healthy adults. Material and methods: Fifty-six healthy adults were randomly distributed into two groups: active (active tDCS+ physical training) and sham (sham tDCS + physical training) and received the intervention three times per week for six weeks. Muscle strength was assessed using maximal isometric muscle strength (MIMS) by a digital dynamometer. Muscular endurance and lower limb explosive strength were assessed by using muscle fitness testing (MFT), and the Sargent jump test. Results: The active and sham groups exhibited significant improvement in all measured parameters in intragroup analyses. However, intergroup analyses revealed no significant difference between the groups. Conclusion: Our findings suggest that only physical training improved MIMS in the upper and lower extremities, MFT endurance scores, and lower limb explosive power. Thus, tDCS failed to demonstrate its effectiveness in a healthy population according to the protocol used in this study.

Immediate effect of sling exercises combined with mechanic vibration and oscillation mobilization in chronic nonspecific low back pain patients: a randomized controlled trial

PURPOSE

This study determined whether the combined application of sling exercises (SE) with targeted vibration and oscillations using a device called the Vibraoscillator (VO) is effective in reducing pain intensity, increasing range of motion (ROM), and enhancing back-related functions in patients with chronic nonspecific low back pain (CNLBP).

MATERIALS AND METHODS

Thirty-six participants were randomized into experimental (SE + VO) and control (SE) groups. Both groups received the intervention twice a week for 4 weeks. The pain was assessed using the Numerical Rating Scale (NRS), ROM was measured using the Modified-Modified Schober's Test (MMST), and the level of disability was evaluated using the Oswestry Disability Scale (ODI). In addition, the global perceived effect (GPE) was determined.

RESULTS

NRS and ODI scores significantly improved after the intervention in the experimental group. Only lumbar spine extension improved significantly in the case of ROM. The GPE satisfaction rate was 14.5% higher in the experimental group than in the control group.

CONCLUSION

Based on the findings obtained in this study, the combined use of VO and SE in patients with CNLBP was effective in reducing pain, improving ROM, and reducing physical disability in comparison with the treatment of only SE.IMPLICATIONS FOR REHABILITATIONChronic nonspecific low back pain is a major public health problem because it affects almost every person at least once in their lifetime.A new device called a Vibraoscillator generates horizontal vibrations and vertical oscillation movements targeted to a specific area of treatment to promote the neurofacilitation of the targeted zone, aiming for a more focused treatment than general vibrations.This device, in combination with sling exercises, is hypothesized to reduce pain and increase the mobility of the targeted zone and back-related functions in these patients.Based on our findings, the combined use of these interventions twice a week for 4 weeks was effective in reducing pain and improving the range of movement, which consequently reduced physical disability in patients with chronic nonspecific low back pain.

Pain Reduction and Posture Alignment Improvement in Older Adults with Chronic Low Back Pain: A Novel Approach Using Spinal Thermal Massage Bed and Calf Pneumatic Cell Compression

BACKGROUND Chronic low back pain (CLBP) significantly affects the well-being of older adults, leading to diminished quality of life and heightened stress. Existing treatments have limited effectiveness and potential side effects. This study aimed to explore an integrative approach, employing a combination of spinal thermal massage bed (STMB) and intermittent pneumatic calf compression, as an alternative strategy for managing CLBP, improving body posture, reducing stress, and enhancing quality of life. MATERIAL AND METHODS Twenty-three participants aged 65-80 years completed a 4-week intervention involving eight sessions (2 per week) with the STMB device. Outcome measures included pain level assessed by the visual analog scale, trunk and pelvic tilting angles indicating spine curvature, stress level of the autonomic nervous system, Oswestry Disability Index, and EuroQol five-dimensions QoL questionnaire. RESULTS The study revealed significant reductions in pain intensity between baseline and mid-term scores (p=0.002) and between baseline and post-test scores (p=0.001). Moreover, notable improvements were observed in trunk and pelvic tilting angles (p<0.001) and stress scores between baseline and mid-term scores (p=0.037) and between baseline and post-test scores (p=0.019). However, no significant changes were observed in disability level or QoL. Participants expressed high satisfaction with the intervention, and no serious side effects were reported CONCLUSIONS This study provides compelling evidence supporting the safety and efficacy of combining STMB with intermittent pneumatic calf compression in reducing pain intensity and stress levels and improving trunk and pelvic tilting angles. Clinical trial number: KCT0008212.

Effects of transcranial direct current stimulation on physical and mental health in older adults with chronic musculoskeletal pain: a randomized controlled trial

PURPOSE

We investigated the effects of transcranial direct current stimulation (tDCS) combined with physical therapy (PT) on pain levels, physical activity levels, quality of life, and depression in older adults with chronic musculoskeletal pain.

METHODS

Twenty-five older adults (9 males and 16 females), aged between 66 and 86 years (active group 77.2 ± 3.9; sham group 76.6 ± 6.2), volunteers were randomly allocated in the active (active tDCS + PT) and sham groups (sham tDCS + PT), and received the intervention three times per week for 8 weeks. Pain level, physical activity level, depression state, and quality of life were assessed based on the Visual Analog Scale (VAS), Physical Activity Scale for the Elderly (PASE), Beck Depression Inventory (BDI) scale, and Short-Form 36 Health Survey Questionnaire (SF-36), respectively. Measurements were conducted four times: at baseline, mid-intervention, post-intervention, and 1-month follow-up.

RESULTS

As a result, at 8 weeks, the active group yielded greater improvements in VAS, BDI, and SF-36 scores than the sham tDCS group. At follow-up, the tDCS group led to a greater improvement in VAS, PASE, and SF-36 scores compared to sham tDCS group (p < 0.05).

CONCLUSION

Our results suggest a beneficial effect of tDCS combined with PT in older adults with chronic musculoskeletal pain in the reduction of pain sensation, increment of physical activity level, increment of the quality of life, and reduction of depression incidents. This opens the possibility the possibility of using tDCS as a regular treatment for this population's physical and mental health.

The Effects of tDCS with NDT on the Improvement of Motor Development in Cerebral Palsy

We investigated the effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) with neurodevelopmental treatment (NDT) on the improvement of motor development and reduction of spasticity in children with cerebral palsy (CP). Twenty-four children with CP were allocated to two groups: the tDCS + NDT group and the only NDT group, done 3 times per week for 5 weeks. The Gross Motor Function Measurement (GMFM-88) and Box and Block Test (BBT) were used to assess changes in motor development, and the Modified Ashworth Scale (MAS) was used to evaluate changes in spasticity. All measurements were carried out at 3 time points: baseline, post-intervention, and 1 month follow-up. We found improvements in the GMFM-88 total scores and in each individual GMFM-88 dimension scores, favoring the tDCS + NDT group over the only NDT group. The BBT scores improved only in the tDCS + NDT group. In addition, the MAS scores reduced in the hemibody with significant motor impairment only in the tDCS + NDT group. The present findings suggest that tDCS combined with NDT can be considered a promising intervention for children with CP, as it can enhance motor development and reduce spasticity in this population.

Influence of Anterior-Posterior External Surface Perturbation on Trunk Stability During Abdominal Stabilization Strategies While Sitting

Background

Spinal and pelvic injuries during an unexpected perturbation are closely related to spinal stability, which is known to be controlled by abdominal stabilization maneuvers. This study aimed to evaluate the effects of unexpected perturbations on trunk stability and abdominal stabilization strategies in 42 sedentary adults while sitting.

Material/Methods

Abdominal stabilization strategies consisted of bracing and hollowing maneuvers. Abdominal bracing maneuvers (ABM) were focused on the abdominal wall muscles [inferior oblique (IO), exterior oblique (EO)], and abdominal hollowing maneuvers (AHM) were focused on deep muscle (TrA) activation. The subjects were instructed in abdominal stabilization maneuvers. Afterward, subjects were seated in a chair that could be moved forward or backward suddenly with the support surface.

Results

Angular displacements of the upper thorax, lower thorax, and lumbopelvic during unexpected perturbation, with different abdominal stabilization maneuvers, were measured. During forward perturbation (d=0.71, F=10.324, P=0.001) and backward perturbation in high speed (d=0.62, F=9.265, P=0.011), there were significant differences in angular displacements of the upper thorax between hollowing and bracing maneuvers. Additionally, significant differences were found in the lumbopelvic angular displacement between the hollowing and bracing maneuvers (d=0.62, F=4.071, P=0.044).

Conclusions

Our findings indicate that the ABM is a better stabilizing technique for the upper thorax, and the AHM is a better stabilizing technique for the lumbopelvic region during unexpected perturbations at high speed in the seated position.

Effects of Transcranial Direct Current Stimulation Over the Dorsolateral Prefrontal Cortex (PFC) on Cognitive-Motor Dual Control Skills

This randomized crossover study investigated whether anodal transcranial direct current stimulation (tDCS) over the dorsolateral prefontal cortex (dlPFC) modulates memory-guided finger isometric maintenance during single motor and dual cognitive-motor tasks, based on electroencephalogram (EEG) signals. Twenty-three healthy participants (14 female; M age = 29.130 years, SD = 10.918) underwent both sham and 2-mA stimulation sessions over the dlPFC for 20 minutes, with a minimum washout period of seven days. We analyzed finger-force isometric maintenance and event-related spectral perturbation (ERSP) of the EEG during early and later phases of both tasks. We observed a significant motor accuracy improvement (p = .014) and significant variation of force output (p = .027) with significant decrease in ERSP on the dorsomedial prefrontal cortex (dmPFC) (early phase, p = .027; later phase, p = .023) only after 2 mA stimulation. Thus, anodal tDCS over the dlPFC may improve memory-guided force control during cognitive-motor dual tasks.

Bilateral Transcranial Direct Stimulation Over the Primary Motor Cortex Alters Motor Modularity of Multiple Muscles

Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) has been demonstrated to modulate the motor performance of both healthy individuals and patients with neuromuscular disorders. However, the effect of tDCS on motor control of multiple muscles, which is a prerequisite to change in motor performance, is currently unknown. Using dimensionality reduction analysis, we investigated whether bilateral tDCS over M1 modulates the coordinated activity of 12 muscles. Fifteen healthy men participated in this randomized, double-blind crossover study. Each participant received a 20-min sham and 2-mA stimulation bilaterally over M1 (anode on the right M1 and cathode on the left M1), with a minimum washout period of 4 days. Muscle activation and end-point kinematics were evaluated during a task where participants reached out to a marked target with non-dominant hand as fast as possible, before and immediately after tDCS application. We found decreased similarity in motor modularity and significant changes in muscle activation in a specific motor module, particularly when reaching out to a target placed within arm's length and improved smoothness index of movement only following 2-mA stimulation. These findings indicate that clinicians and researchers need to consider the simultaneous effect of bilateral tDCS over M1 on multiple muscles when they establish tDCS protocol to change in motor performance of patients with neuromuscular deficits.

Noninvasive brain stimulation over M1 and DLPFC cortex enhances the learning of bimanual isometric force control

Motor learning plays an important role in upper-limb function and the recovery of lost functionality. This study aimed to investigate the relative impact of transcranial direct current stimulation (tDCS) on learning in relation to the left primary motor cortex (M1) and left dorsolateral prefrontal cortex (DLPFC) during bimanual isometric force-control tasks performed with both hands under different task constraints. In a single-blind cross-over design, 20 right-handed participants were randomly assigned to either the M1 group (n = 10; mean age, 22.90 ± 1.66 years, mean ± standard deviation) or the DLPFC group (n = 10; mean age, 23.20 ± 1.54 years). Each participant received 30 min of tDCS (anodal or sham, applied randomly in two experiments) while performing the bimanual force control tasks. Anodal tDCS of the M1 improved the accuracy of maintenance and rhythmic alteration of force tasks, while anodal tDCS of the DLPFC improved only the maintenance of the force control tasks compared with sham tDCS. Hence, tDCS over the left M1 and DLPFC has a beneficial effect on the learning of bimanual force control.

Noninvasive Brain Stimulation over the M1 Enhances Bimanual Force Control Ability: A Randomized Double-Blind Sham-Controlled Study

Well-coordinated bimanual force control is common in daily life. We investigated the effects of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex on bimanual force control. Under a cross-over study, young adults (n = 19; female = 6, male = 13) completed three bimanual force control tasks at 5%, 25%, and 50% of bimanual maximum voluntary force (BMVF) before and after real or sham tDCS. Real tDCS enhanced accuracy at all BMVF, reduced variability at 5% BMVF, and increased coordination at 5% BMVF. Real tDCS improved force control at 5% and 25% BMVF, and especially increased bimanual coordination at 5% BMVF. These findings might have implications for establishing interventions for patients with hand force control deficits.

Noninvasive brain stimulation over dorsolateral prefrontal cortex for pain perception and executive function in aging

OBJECTIVES

Based on the evidence that the dorsolateral prefrontal cortex (DLPFC) is the main region affected by the aging process, and that tDCS modulates cortical excitability, the aim of the study is to prove the feasibility of tDCS for pain perception and executive function of community-dwelling elderly individuals.

METHODS

We performed a double-blind, single-arm trial, including a sham period. 5 consecutive anodal tDCS was applied over DLPFC of twenty-four elderly for 20 min during each intervention periods (in order of Sham-1 mA-2 mA). First, we classified chronic non-inflammatory pain sites into three domain (Neck and upper extremity, low back, lower extremity). Then, we used visual analogue scale, pain self-efficacy scale, Tampa scale for kinesiophobia, and Global perceived Effect scale to observe the change in pain perception, as well as Trailing Making Test and Timed Up and Go (dual) to observe the change in executive function. The changes in maximal grip strength and 12-item Short Form survey were measured secondarily.

RESULTS

In the results, we observed significant improvement in pain perception and quality of life, while executive function and grip strength did not change significantly.

CONCLUSION

Our findings demonstrated the feasibility of tDCS for aging-related pain perception and suggest that further randomized controlled trials with longer duration are necessary to examine the effects on executive function.

The Effectiveness of Hollowing and Bracing Strategies With Lumbar Stabilization Exercise in Older Adult Women With Nonspecific Low Back Pain: A Quasi-Experimental Study on a Community-based Rehabilitation

OBJECTIVE

The purpose of this study was to explore the therapeutic effectiveness of hollowing lumbar stabilization exercise (HLSE) and bracing lumbar stabilization exercise (BLSE) for older adult women with nonspecific low back pain (NSLBP) in community welfare centers.

METHOD

A total of 38 older adult women with NSLBP were allocated to either the HLSE group (n = 17, 70.4 ± 1.7 years) or the BLSE group (n = 21, 66.8 ± 4.4 years). Both groups performed intervention for 12 consecutive weeks, 3 times per week. Each group performed 5 lumbar stabilization exercises, including side plank exercise, bridge exercise, 4-kneeling exercise, prone plank exercise, and prone back extension exercise with hollowing and bracing strategy, respectively. The baseline and post-test values of trunk strength, low back disability (Korean Oswestry Disability Index [K-ODI] and Korean Roland Morris Disability Questionnaire [K-RMDQ]), and static balance (1-leg standing test) were compared by using per-protocol analysis.

RESULTS

In trunk strength, the trunk flexor had significant difference (F = 11.10, P = .001) between groups and within groups of BLSE (t = -5.56, P = .001) and HLSE (t = -2.50, P = .024). Trunk back extensor of HLSE (t = -6.00, P = .001) and BLSE (t = -9.19, P = .001) only had significant within-group difference. However, in trunk side flexor, HLSE and BLSE had only significant difference between groups. In low back disability, K-ODI for HLSE (t = 4.50, P = .001) and BLSE (t = 4.60, P = .001) had significant within-group difference but no significant difference between groups (F = 0.28, P = .202). In K-RMDQ, HLSE only had significant within-group difference (t = 3.97, P = .001). In trunk muscle strength, the effect size of HLSE and BLSE groups for trunk flexor was HLSE -0.53 (medium) and BLSE -1.21 (large); trunk side flexor: HLSE 0.27 (small) and BLSE -0.24 (small); and trunk back extensor: HLSE 1.1 (large) and BLSE 2.00 (large), respectively. In low back disability, the effect size of both groups for K-ODI was HLSE 0.88 (large) and BLSE 1.05 (large), and K-RMDQ, HLSE 0.19 (small) and BLSE 0.40 (small), respectively.

CONCLUSION

Our findings suggest that HLSE and BLSE could be recommended for community settings to improve trunk strength and low back disability in older adult women with NSLBP. Especially, HLSE and BLSE could be recommended for elderly women with NSLBP who have lower back disability and weak trunk muscle strength, respectively.

Reliability of histographic analysis for paraspinal muscle degeneration in patients with unilateral back pain using magnetic resonance imaging

BACKGROUND

Mixed use of T1- or T2-weighted magnetic resonance imaging (MRI) in histographic analysis has impeded cross-reference of studies on fatty degeneration of muscles in patients with back pain.

OBJECTIVE

The current study aimed to establish the measurement reliability of histographic analysis for normal and painful paraspinal muscles between T1- and T2-weighted MRI.

METHODS

T1- and T2-weighted MRI at the L4-5 level were performed in 31 patients with unilateral back pain. Two raters conducted the histographic analysis on 2 separate occasions. Multifidus, erector spinae, and psoas major muscles were assessed on both normal and painful sides.

RESULTS

Intra- and interrater reliability of the parameters were generally excellent for both T1- (intrarater: 0.83 ± 0.13 and interrater: 0.93 ± 0.08) and T2-weighted images (intrarater: 0.93 ± 0.12 and interrater: 0.92 ± 0.12). Histogram width was fair to good for both kinds of image. Intraclass correlation coefficients were similar between painful and normal sides.

CONCLUSIONS

The evidence that most histographic analysis parameters had excellent reliability for both T1- and T2-weighted images allows for cross-reference of the results between the two kinds of image. Moreover, the results of this study support the availability of histographic analysis for assessment of fatty degeneration in patients with back pain.

Muscle Synergies for Turning During Human Walking

Muscle synergy describes reduced set of functional muscle co-activation patterns. We aimed to identify muscle synergies of turning compared with straight walking. Twelve healthy adults (men: 7, women: 5) performed straight walking (SW), left turning (LT), and right turning (RT) at self-selected speeds. By using non-negative matrix factorization (NMF), we extracted muscle synergies from sixteen electromyography (EMG) signals on the right side and assigned similar muscle synergies among SW, LT, and RT into the same cluster by combining k-means clustering and intraclass correlation coefficient (ICC) analysis. We obtained task-specific clusters of muscle synergies extracted from SW, LT, or RT condition and identified the clusters that share synergies among the conditions. The central nervous system produces specific synergies involving turning behaviors and fundamental synergies for walking.

Equine Exercise in Younger and Older Adults: Simulated Versus Real Horseback Riding

Horseback riding is an effective exercise for improving postural control and balance. To reduce costs and improve accessibility, simulated horseback riding has been developed; but no differential effects of simulated and real horseback riding on muscle activation patterns in older adults have been studied. Thus, we compared muscle activation patterns for older and younger adults engaged in real and simulated horseback riding exercises, using surface electromyography recordings of the erector spinae, rectus abdominis, internal oblique abdominis, and rectus femoris muscles. We recorded muscle activity for three riding patterns: walk, slow trot, and fast trot. Muscle activation was uniformly higher for simulated (vs. real) horseback riding and increased from the walking pattern through slow and fast trot. There was no age effect, but among older participants, muscle activation was higher for simulated (vs. real) horseback riding across all gait types. Simulated and real riding produced a similar pattern of muscle activation of the thigh and trunk. These results demonstrate that simulated horseback riding can be an effective alternative to actual riding for increasing trunk and thigh muscle activation and improving postural control and balance, perhaps especially among older adults.

Examining impairment of adaptive compensation for stabilizing motor repetitions in stroke survivors

The hand, one of the most versatile but mechanically redundant parts of the human body, suffers more and longer than other body parts after stroke. One of the rehabilitation paradigms, task-oriented rehabilitation, encourages motor repeatability, the ability to produce similar motor performance over repetitions through compensatory strategies while taking advantage of the motor system's redundancy. The previous studies showed that stroke survivors inconsistently performed a given motor task with limited motor solutions. We hypothesized that stroke survivors would exhibit deficits in motor repeatability and adaptive compensation compared to healthy controls in during repetitive force-pulse (RFP) production tasks using multiple fingers. Seventeen hemiparetic stroke survivors and seven healthy controls were asked to repeatedly press force sensors as fast as possible using the four fingers of each hand. The hierarchical variability decomposition model was employed to compute motor repeatability and adaptive compensation across finger-force impulses, respectively. Stroke survivors showed decreased repeatability and adaptive compensation of force impulses between individual fingers as compared to the control (p < 0.05). The stroke survivors also showed decreased pulse frequency and greater peak-to-peak time variance than the control (p < 0.05). Force-related variables, such as mean peak force and peak force interval variability, demonstrated no significant difference between groups. Our findings indicate that stroke-induced brain injury negatively affects their ability to exploit their redundant or abundant motor system in an RFP task.

Optimal retraining time for regaining functional fitness using multicomponent training after long-term detraining in older adults

OBJECTIVES

Little is known about the optimal retraining time for regaining functional fitness through multicomponent training following long-term detraining in older adults. This study first investigated the time course of functional fitness changes during 12-month multicomponent training, 12-month detraining, and 9-month retraining in 18 older adults (68.33±3.46) and then determined the optimal retraining time for regaining the post-training functional fitness level after a 12-month detraining period.

METHODS

Functional fitness, including lower and upper limb strength, lower and upper limb flexibility, aerobic endurance, and dynamic balance, was assessed at baseline, 12 months post-training, 12 months post-detraining, and 3, 6, and 9 months post-retraining.

RESULTS

There were significant increases in all of the functional fitness components except upper limb flexibility at post-training and no significant decreases at post-detraining. For lower and upper limb strength and lower limb flexibility, a 3-month period was required to regain the post-training condition. For aerobic endurance and dynamic balance, a retraining period ≥9months was necessary to regain the post-training functional fitness condition.

CONCLUSIONS

To regain the post-training condition of all functional fitness components, a retraining period ≥9months was required. This information might be useful for health professionals to encourage older adults not to interrupt retraining until they regain their post-training functional fitness condition.

A self-determination theory-based self-myofascial release program in older adults with myofascial trigger points in the neck and back: A pilot study

PURPOSE

To examine the effectiveness and adherence to a self-determination theory (SDT)-based self-myofascial release (SMR) program in older adults with myofascial trigger points (MTrPs), and to investigate the factors that influence participant behavioral change while conducting the program in a home setting.

METHODS

An explanatory mixed-method design was used to evaluate a 12-week SDT-based SMR program, including a 4-week group-based education and practice (EP) phase and an 8-week home-based self-management (SM) phase. Pain intensity on palpation and sensitivity to pain were assessed at baseline and the post EP and post SM phase. Focus group interviews were conducted at the post SM phase.

FINDINGS

Fifteen participants completed the study. Pain intensity and sensitivity to pain significantly improved at the post SM phase compared with the baseline. Adherence increased during the SM phase compared with that during the EP phase. Four main themes emerged as factors that influenced participant behavioral change: 1) "awareness of the effectiveness"; 2) "a sense of duty to perform the exercise"; 3) "obedience to expert instruction"; and 4) "lack of friendship."

CONCLUSIONS

These results support the effectiveness of an SDT-based SMR program for the treatment of MTrPs and in motivating older adults to participate in the program.

Specific muscle synergies in national elite female ice hockey players in response to unexpected external perturbation

This study aimed to investigate specific muscle synergies in elite ice hockey players indicating highly developed postural control strategies used to restore balance against unexpected external perturbations. Seven elite athletes (EA) on the women's national ice hockey team and 7 non-athletes (NA) participated in this study. Based on trajectories of centre of mass (COM), analysis periods were divided into an initial phase (a balance disturbance after perturbation onset) and a reversal phase (a balance recovery response), respectively. Muscle synergies were extracted at each phase by using non-negative matrix factorization. k-means cluster analysis was performed to arrange similar muscle synergies in all participants. EA showed significantly shorter recovery period of COM and smaller body sway than NA. In the initial phase, we identified 2 EA-specific synergies related to ankle plantar flexors or neck extensors. In the case of an NA-specific synergy, co-activation of the ankle plantar flexors and dorsiflexors was found. In the reversal phase, no specific muscle synergies were identified. As the results, EA-specific muscle synergies showed low co-activation strategy of agonists and antagonists in ankle and neck extensors. Our results could provide critical information for rehabilitation strategies in athletes requiring high postural stability.

Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series

PURPOSE

The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation.

METHOD

A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation.

RESULTS

The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement.

CONCLUSIONS

Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program. Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.

Intensive unilateral core training improves trunk stability without preference for trunk left or right rotation

BACKGROUND AND OBJECTIVES

It is possible to increase multi-directional trunk stability using co-activation. However, it is unclear whether there is a preference for left or right trunk rotation after intensive unilateral stability training. The aim of this study was to examine the directional preference in trunk rotational stability after unilateral core training.

MATERIAL AND METHOD

This study was conducted on 16 female basketball players. For eight weeks, eight participants performed unilateral core training that focused on one side of the trunk. The remaining eight participants were not provided any additional training. To determine rotational trunk stability, all participants were requested to maintain an upright sitting posture against sudden, external, left or right rotational perturbations of the trunk. Angular displacement of the trunk was measured using a motion analyzer.

RESULTS

At the end of the training period, the angular displacement in response to the perturbation was reduced for both rotational directions (left: −26%, right: −24%) in the trained group (p < 0.05).

CONCLUSION

This study showed that trunk stability improved without particular directional preference in response to unilateral core training. This result adds to our understanding of the nature of trunk stability and multi-directional improvement.

LEVEL OF EVIDENCE

Intervention study, Level 1b.

Abdominal hollowing and bracing strategies increase joint stability in the trunk region during sudden support surface translation but not in the lower extremities

BACKGROUND AND OBJECTIVE

Application of hollowing and bracing, abdominal activation strategies (AAS), has focused on improving trunk stability. This study aimed to clarify the AAS effect on body sway during support surface translation while standing.

MATERIALS AND METHODS

Twenty healthy subjects (10 male, 10 female; aged 25.45 ± 3.22 years) performed hollowing, bracing, and natural strategies while standing, and exerted to maintain their balance during forward and backward translation. Ultrasonography evaluations confirmed the appropriate application of the 3 strategies by measuring abdominal muscle thickness. Additionally, a motion analysis system was used to capture the whole body sway along the sagittal plane.

RESULTS

During backward translation, angular displacements of the trunk were significantly different among the 3 strategies (upper thoracic: F = 13.758, p < 0.001; lower thoracic: F = 8.477, p = 0.001; and lumbopelvis: F = 8.651, p = 0.001). AAS significantly decreased the sway by 25-36% in all inter-spinal segments compared with the natural strategy (p < 0.05). During forward translation, only angular displacement of the lower thoracic was significantly different among the 3 strategies (F = 7.640, p = 0.002), and bracing decreased the sway by 33.48% compared with the natural strategy (p = 0.003). No significant differences were seen between hollowing and bracing during forward and backward translation.

CONCLUSIONS

AAS increased joint stability only in the trunk where joints are adjacent to abdominal muscles, but not in the lower extremities. The low impact of AAS on the lower extremities might have important implications on the paradigm of standing balance.

Myofascial Pain Syndrome in the Elderly and Self-Exercise: A Single-Blind, Randomized, Controlled Trial

OBJECTIVE

This study aimed to demonstrate the effect of self-exercise with a therapeutic inflatable ball (SEIB) in elderly patients with myofascial pain syndrome.

DESIGN

Single-blind, randomized, controlled noninferiority trial.

SETTING

University campus.

PARTICIPANTS

Forty elderly patients with myofascial pain syndrome completed the study. They were randomly allocated to SEIB (n = 22; mean age, 70.23 ± 6.11 years) or ultrasound (US) therapy (n = 18; mean age, 67.99 ± 5.64 years).

INTERVENTION

SEIB and US therapy (twice weekly for 4 consecutive weeks).

OUTCOME MEASURES

Visual analog scale (VAS), pressure pain threshold (PPT), and cervical lateral flexion (CLF) were measured at baseline and at 1, 2, 3, and 4 weeks.

RESULTS

The noninferiority test indicated that SEIB was not inferior to US for VAS, PPT, and CLF. Between-group comparisons showed no significant differences in the VAS (F = 2.579; p = 0.117), the PPT (F = 0.245; p = 0.624), and the CLF (F = 2.072; p = 0.159). In within-group comparisons, both groups presented significant differences in VAS (SEIB after 1 week and US after 1 week), PPT (SEIB after 3 weeks and US after 4 weeks), and CLF (SEIB after 4 weeks and US after 4 weeks) compared with baseline values.

CONCLUSIONS

SEIB for 4 weeks has an effect similar to that of US for desensitizing myofascial pain and increasing joint flexibility. High accessibility and low cost would make SEIB a practical self-treatment method in elderly patients with myofascial pain syndrome.