Community integration and its predictors in people with stroke: a multicenter longitudinal study

OBJECTIVE

To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up.

DESIGN

A multicenter, longitudinal, and observational study.

SUBJECTS

Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China.

METHODS

In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions.

RESULTS

The participants' scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p < 0.05). In addition, the participants' Community Integration Questionnaire scores in the follow-up assessment were significantly correlated with their ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination scores in the initial assessment (p < 0.05), and marginally significantly correlated with their scores on Fugl-Meyer Assessment in the initial assessment (p = 0.058). The participants' ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination, Fugl-Meyer Assessment of the lower extremity, and Fugl-Meyer Assessment scores in the initial assessment were predictive of their Community Integration Questionnaire scores at follow-up, with coefficients of determination ranging from 0.254 to 0.056 (p < 0.05).

CONCLUSIONS

The level of community integration of the participants was generally low, but it was greater at 1-year follow-up than it was initially. Balance function and daily living ability may be key predictors of community integration of patients following stroke.

The promotion-like effect of the M1-STN hyperdirect pathway induced by ccPAS enhanced balance performances: From the perspective of brain connectivity

AIMS

The present study aimed to explore the effect of cortico-cortical paired-associative stimulation (ccPAS) in modulating hyperdirect pathway and its influence on balance performance.

METHODS

Forty healthy participants were randomly allocated to the active ccPAS group (n = 20) or the sham ccPAS group (n = 20). The primary motor cortex and subthalamic nucleus were stimulated sequentially with ccPAS. Unlike the active ccPAS group, one wing of coil was tilted to form a 90° angle with scalp of stimulation locations for the sham ccPAS group. Magnetic resonance imaging, functional reach test (FRT), timed up and go (TUG) test, and limit of stability (LOS) test were performed, and correlation between them was also analyzed.

RESULTS

Three participants in the sham ccPAS group were excluded because of poor quality of NIfTI images. The active group had strengthened hyperdirect pathway, increased functional connectivity (FC) between orbital part of frontal cortex and bilateral precuneus, and decreased FC among basal ganglia (all p < 0.05). Regional network properties of triangular and orbital parts of IFG, middle cingulate cortex, and hippocampus increased. The active group performed better in FRT and LOS (all p < 0.05). FRT positively correlated with FC of the hyperdirect pathway (r = 0.439, p = 0.007) and FCs between orbital part of frontal cortex and bilateral precuneus (all p < 0.05).

CONCLUSION

The ccPAS enhanced balance performance by promotion-like plasticity mechanisms through the hyperdirect pathway.

Interactive scalp acupuncture combined with suspension digital occupational therapy for upper limb motor dysfunction after stroke: a multi-center randomized controlled trial

OBJECTIVES

To observe the effects of interactive scalp acupuncture on upper limb motor function and activities of daily living in patients with upper limb motor dysfunction after stroke.

METHODS

One hundred and twenty patients with upper limb motor dysfunction after stroke were randomly divided into an observation group(60 cases, 2 cases dropped out)and a control group(60 cases, 1 case dropped out). Both groups were treated with routine medication and rehabilitation. The observation group was treated with interactive scalp acupuncture combined with suspension digital occupational therapy, interactive scalp acupuncture was applied at middle 2/5 of the parietal and temporal anterior oblique line, middle 2/5 of the parietal and temporal posterior oblique line and second lateral line of parietal of the hemiparalysis contralateral side, 30 min each time.The control group was treated with suspension digital occupational therapy alone. The treatment was given once a day, 5 times a week for 4 weeks in the two groups. The scores of Fugl-Meyer assessment scale of upper extremity(FMA-UE), action research arm test(ARAT), the modified Barthel index (MBI) and surface electromyography(sEMG)signal of the biceps and triceps on the affected side were observed before and after treatment in the two groups, and the clinical efficacy was evaluated.

RESULTS

After treatment, the FMA-UE, ARAT and MBI scores were increased compared with those before treatment in both groups(P<0.05), the changes of the observation group were greater than those in the control group(P<0.05). After treatment, the integrated electromyography(iEMG)value and root mean square(RMS)value of the biceps and triceps on the affected side during elbow flexion and extension were increased compared with those before treatment in both groups(P<0.05), the changes of the observation group were greater than those in the control group(P<0.05). The total effective rate was 94.8%(55/58) in the observation group, which was higher than 83.1%(49/59) in the control group(P<0.05).

CONCLUSIONS

Interactive scalp acupuncture could improve upper limb motor function and activities of daily living in patients with upper limb motor dysfunction after stroke.

White matter fiber integrity and structural brain network topology: implications for balance function in postischemic stroke patients

Previous studies have suggested that ischemic stroke can result in white matter fiber injury and modifications in the structural brain network. However, the relationship with balance function scores remains insufficiently explored. Therefore, this study aims to explore the alterations in the microstructural properties of brain white matter and the topological characteristics of the structural brain network in postischemic stroke patients and their potential correlations with balance function. We enrolled 21 postischemic stroke patients and 21 age, sex, and education-matched healthy controls (HC). All participants underwent balance function assessment and brain diffusion tensor imaging. Tract-based spatial statistics (TBSS) were used to compare the fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of white matter fibers between the two groups. The white matter structural brain network was constructed based on the automated anatomical labeling atlas, and we conducted a graph theory-based analysis of its topological properties, including global network properties and local node properties. Additionally, the correlation between the significant structural differences and balance function score was analyzed. The TBSS results showed that in comparison to the HC, postischemic stroke patients exhibited extensive damage to their whole-brain white matter fiber tracts (P < 0.05). Graph theory analysis showed that in comparison to the HC, postischemic stroke patients exhibited statistically significant reductions in the values of global efficiency, local efficiency, and clustering coefficient, as well as an increase in characteristic path length (P < 0.05). In addition, the degree centrality and nodal efficiency of some nodes in postischemic stroke patients were significantly reduced (P < 0.05). The white matter fibers of the entire brain in postischemic stroke patients are extensively damaged, and the topological properties of the structural brain network are altered, which are closely related to balance function. This study is helpful in further understanding the neural mechanism of balance function after ischemic stroke from the white matter fiber and structural brain network topological properties.

Effect of robot-assisted gait training on motor dysfunction in Parkinson's patients:A systematic review and meta-analysis

BACKGROUND

Robot-assisted gait training (RAGT) has been reported to treat motor dysfunction in patients with Parkinson's disease (PD) in the last few years. However, the benefits of RAGT for treating motor dysfunction in PD are still unclear.

OBJECTIVES

To investigate the efficacy of RAGT for motor dysfunction in PD patients.

METHODS

We searched PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, Chinese Biomedical Literature Database (CBM), and Chinese VIP Database for randomized controlled trials investigating RAGT to improve motor dysfunction in PD from the databases' inception dates until September 1, 2022. The following outcome indexes were employed to evaluate motor dysfunction: the Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale (ABC), 10-Meter Walk Test gait speed (10-MWT), gait speed, stride length, cadence Unified Parkinson Disease Rating Scale Part III (UPDRS III), 6-Minute Walk Test (6MWT), and the Timed Up and Go test (TUG). The meta-analysis was performed using the proper randomeffect model or fixed-effect model to evaluate the difference in efficacy between the RAGT and the control groups. The Cochrane Risk of Bias Tool was used for the included studies and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to interpret the certainty of the results.

RESULTS

The results consisted of 17 studies comprising a total of 670 participants. Six hundred and seven PD patients with motor dysfunction were included: 335 in the RAGT group and 335 in the control group. This meta-analysis results established that when compared with the control group, robot-assisted gait training improved the BBS results of PD patients (MD: 2.80, 95%CI: 2.11-3.49, P< 0.00001), ABC score (MD: 7.30, 95%CI: 5.08-9.52, P< 0.00001), 10-MWT (MD: 0.06, 95%CI: 0.03-0.10, P= 0.0009), gait speed (MD: 3.67, 95%CI: 2.58-4.76, P< 0.00001), stride length (MD: 5.53, 95%CI: 3.64-7.42, P< 0.00001), cadence (MD: 4.52, 95%CI: 0.94-8.10, P= 0.01), UPDRS III (MD: -2.16, 95%CI: -2.48--1.83, P< 0.00001), 6MWT (MD: 13.87, 95%CI: 11.92-15.82, P< 0.00001). However, RAGT did not significantly improve the TUG test result of patients with PD (MD =-0.56, 95% CI: -1.12-0.00, P= 0.05). No safety concerns or adverse reactions among robot-assisted gait training patients were observed.

CONCLUSION

Even though RAGT can improve balance function, walking function, and gait performance and has demonstrated positive results in several studies, there is currently insufficient compelling evidence to suggest that it can improve all aspects of lower motor function.

Effects of sensory integration training on balance function and executive function in children with autism spectrum disorder: evidence from Footscan and fNIRS

Introduction

This study investigates the efficacy of sensory integration training (SIT) in enhancing balance and executive functions in children with autism spectrum disorder (ASD), with the aim of highlighting its potential for organizing and processing sensory information in the brain.

Methods

Utilizing Footscan for biomechanical evidence and functional near-infrared spectroscopy (fNIRS) for neural activation, we engaged two participant groups: a control group (n = 9) and an experimental group (n = 9). Assessments involved the Sharpened Romberg Test (SRT) for balance under varied visual conditions and the Go/No-Go task for executive function.

Results

The SIT intervention significantly improved balance function, particularly in Visual Deprivation (VD) scenarios. Neurophysiological data revealed heightened activation in the right Inferior Frontal Gyrus (R-IFG) and right Middle Frontal Gyrus (R-MFG), suggesting enhanced executive function. The potential of R-IFG/MFG activation as a reliable biomarker for assessing executive function in ASD was identified.

Discussion

The study provides empirical evidence supporting SIT's effectiveness in enhancing balance and executive functions in children with ASD. The therapy not only improves sensory processing and motor skills but also appears to compensate for sensory deficits, particularly in vision, vestibular perception, and proprioception. Enhanced neural activation in specific PFC regions underscores SIT's role in improving cognitive aspects, including inhibitory control and cognitive flexibility. The multidisciplinary approach adopted for this research highlights the intricate interplay between sensory-motor functions and cognitive control in ASD, paving the way for integrated therapeutic strategies. Despite these advancements, the mechanisms through which SIT exerts these multifaceted effects require further exploration.

Quantitative Assessment of Balance Function Characteristics in Older Patients with Orthostatic Hypotension

BACKGROUND

Orthostatic hypotension (OH) is a common blood pressure abnormality in older adults that makes them prone to balance disorders and falls. The maintenance of balance relies on a complex regulatory system. The use of computerized dynamic posturography (CDP) can provide a quantitative evaluation of balance function. The objective of this study was to utilize CDP to measure balance indicators in older individuals with OH.

METHODS

A total of 303 older adults were divided into an OH group of 91 and a non-OH group of 212. Various factors, including chronic diseases, medication history, laboratory tests, and balance indicators, were compared between the two groups.

RESULTS

① Participants with OH had more chronic diseases, including coronary heart disease (p = 0.049) and a history of falls (p < 0.001), than those without OH. A history of multiple medications in the OH group was significantly more likely than in the non-OH group (p = 0.006). ② There was a significant reduction in the composite equilibrium score (SOT-COM) (p < 0.001), vision ratio score (VIS) (p < 0.001), vestibular ratio score (VEST) (p < 0.001), and directional control (DCL) (p = 0.028) in the OH group. ③ A logistic regression analysis revealed that SOT-COM was a significant independent factor associated with OH. The area under the curve (AUC) of SOT-COM was 0.833 (95% confidence interval: 0.778-0.887, p < 0.001), with a sensitivity of 0.826 and a specificity of 0.759.

CONCLUSIONS

This study demonstrates that older individuals with OH are more prone to falls, due to decreased sensory integration for balance.

Balance-Associated Tests Contribute to Predicting the Need for Ambulatory Assistive Devices (AAD) among Community-Dwelling Older Adults

This study aims to analyze the use of ambulatory assistive devices (AAD) in relation to balance-associated tests and assist medical staff in providing professional objective reference values for older adults on whether to use AAD. Older adults (n = 228) were recruited from the local community to participate in this study. Participants were divided into the AAD-use group and the non-AAD-use group. Four balance-associated tests and scales were applied to predict the relationship between balance function and the use of AAD in older adults. They were used to assess the participant's balance function and confidence in maintaining balance and were considered the most reliable measures of balance. There were significant differences in the Berg Balance Scale (BBS) score and Timed Up and Go Test (TUGT) among the subjects in the AAD-use group and non-AAD-use group (p < 0.001). The ROC curve analysis presented the following cut-off values for balance tests and scales: 23.62 s for the TUGT test and 41.5 points for the BBS score. For example, if the TUGT score is greater than 23.62 s and the BBS score is below 41.5 points, AAD is recommended for older adults to maintain balance and prevent falls. These objective reference standards may be useful in guiding medical personnel to determine whether older adults need to use AAD. In future studies, we hope to include more participants for subgroup analysis, investigating different types of AAD and their effects on older adults.

Effects of health qigong exercise on upper extremity muscle activity, balance function, and quality of life in stroke patients

Introduction

This study explored the effects of Qigong exercises on upper extremity muscle activity, balance function, and quality of life in stroke patients.

Methods

A total of 30 stroke patients were randomly allocated to either control group or Qigong group. In the Qigong group, participants completed an intervention of Qigong Baduanjin over 8 weeks. Data on the electromyographic activities of the biceps brachii muscle, triceps brachii muscle, and muscle coordination were obtained using surface electromyography and the co-contraction ratio (CCR). Data on balance were obtained using the PK254P balance function detection system. Quality of life was measured using the brief version of the World Health Organization Quality of Life scale.

Results

The results for the Qigong group showed a significant difference in CCR of the triceps brachii muscle (p < 0.01). Concerning balance (assessed using the open-eye test), there was a significant decrease (p < 0.05) in Y-axis trajectory deviations and the Y-axis speed in the Qigong group. In the closed-eye test, the peripheral area of the Qigong group was significantly lower than that of the control group (p < 0.05). Significant differences were also observed in physical health (p < 0.05), psychological health (p < 0.01), environment (p < 0.01), and the total scores for quality of life (p < 0.01) in the Qigong group.

Discussion

We conclude that Qigong exercises improve the quality of life in stroke patients and have positive effects on the coordination of limb extremities and balance function.

Relationship between dysphagia and motor function in community-dwelling older people

AIM

Dysphagia is a problem typically associated with aging. The aim was to investigate the relationship between dysphagia and motor function using a simple assessment method that can be performed in the community setting, and to promote the early detection and prevention of dysphagia.

METHODS

Data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) were used. Those aged ≥65 years were included. Motor function was assessed using a grip strength test, single limb standing test (SLS), and timed up and go test (TUG). Swallowing function was assessed using the Japanese version of the 10-item Eating Assessment Tool (EAT-10). The association between motor function and swallowing function was analyzed.

RESULTS

In total, 1732 participants were included. In logistic regression modes in which grip strength, SLS, and TUG results were included separately, the odds ratio for dysphagia increased by 1.08 (P = 0.001) for each 1-kg decrease in grip strength, and increased by 1.15 (P < 0.001) for each 1-s increase in TUG time. No association was found for SLS. In the model in which grip strength and TUG were included simultaneously, the odds ratio for dysphagia increased by 1.06 (P = 0.01) in grip strength, and increased by 1.11 (P = 0.009) in TUG time.

CONCLUSION

Our results suggest that skeletal muscle strength and dynamic balance function are associated with dysphagia in community-dwelling older people. Geriatr Gerontol Int 2023; ••: ••-••.

N-of-1 Trial of Electrical Sensory Stimulation Therapy on the Tibial Innervated Area during Gait in a Case of Post-stroke Sensory Disturbance

Background

Transcutaneous electrical sensory nerve stimulation (TESS) is used to enhance the recovery of sensorimotor function in post-stroke hemiparesis. However, TESS efficacy for post-stroke gait disturbance remains unknown. We hypothesized that TESS on the area innervated by the tibial nerve, targeting the superficial plantar sensation, combined with gait training would improve gait function in patients with gait disturbance caused by severe superficial sensory disturbance after stroke.

Case

A 42-year-old man was referred to the convalescent rehabilitation hospital 4 months after a left pontine hemorrhage. He showed severe superficial sensory disturbance without motor paresis in the right lower leg and planta pedis. Gait training with TESS on the tibial nerve innervated area was performed, targeting plantar sensation according to an N-of-1 study design of a single-case ABCAB that included two 10-min sessions of gait training without TESS (phase A), two gait training sessions with TESS targeting the right plantar sensation (phase B), and one session with TESS targeting the upper leg sensation as control (phase C). The patient showed increased gait distance and stride length, improved superficial sensation on the right planta pedis, and improved balance after phase B, but not after phases A and C.

Discussion

Gait training with TESS on the tibial nerve innervated area improved gait ability, superficial plantar sensation on the targeted side, and balance function in a post-stroke patient with sensory disturbance. Gait training with TESS may be effective for gait dysfunction caused by sensory disturbance in patients with central nervous system disorders.

Effect of Tai Chi Yunshou training on the balance and motor functions of stroke patients: a systematic review and meta-analysis of randomized controlled trials

Background

There is insufficient evidence on the effect of Tai Chi Yunshou on improving balance and motor function in stroke survivors. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of Tai Chi Yunshou on improving balance and motor function in stroke patients through a comprehensive literature search.

Methods

English and Chinese databases were searched from inception to February 10, 2023, to collect randomized controlled trials (RCTs) investigating the effects of Tai Chi Yunshou on balance and motor function in stroke survivors. Two reviewers independently selected studies meeting eligibility criteria, extracted required data, and assessed the risk of bias using methods recommended by the Cochrane Reviewers' Handbook. Primary outcomes were balance function and motor function, while secondary outcomes included walking gait and activities of daily living. Review Manager software (version 5.4.1) was used for data analysis.

Results

Among the 1,400 identified records, 12 eligible randomized controlled trials were finally included, with a total of 966 subjects. The results of the meta-analysis showed that the balance function of the experimental group and the control group was assessed using the Berg Balance Scale (MD = 4.87, p < 0.001, I² = 90, 95% CI = 4.46-5.28). The motor function assessment of the experimental group and the control group used the Fugl-Meyer Motor Assessment (SMD = 1.11, p < 0.001, I² = 94, 95% CI = 0.94-1.28) and Simple Test of Extremity Function (MD = 10.28, p < 0.001, I² = 0, 95% CI = 7.89-12.68). Walking ability was measured using the Time-Up and Go Test (MD = -3.22, p < 0.001, I² = 83, 95% CI = -3.71--2.73). Activities of daily living were measured using the Modified Bathel Index (MD = 4.61, p < 0.001, I² = 81, 95% CI = 3.61-5.61).

Conclusion

Initial evidence seems to show that Tai Chi Yunshou training can improve the balance and motor function of stroke survivors and further improve walking ability and daily living ability, and the rehabilitation effect may be better than that of conventional rehabilitation training.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=376969, identifier [CRD42022376969].

Correlation analysis of balance function with plantar pressure distribution and gait parameters in patients with cerebral infarction in the basal ganglia region

Objective

To analyze the correlation between balance function and gait parameters of patients with basal ganglia infarction. And to observe the influence of balance function on plantar pressure and hemiplegia gait based on the Berg Balance Scale (BBS) score.

Methods

One hundred and forty patients with cerebral infarction hemiplegia in the basal ganglia region (a study group, n = 140) and healthy people (a control group, n = 140) were enrolled. The study group was evaluated with the BBS, the 10 m walking test (10MWT), and the timed up-and-go test (TUGT). The gait parameters and the peak plantar pressure were measured in both groups while walking, and the differences between the groups were compared. In addition, the characteristics of the plantar pressure curve of the hemiplegic and non-hemiplegic sides during walking and the correlation between the 10MWT, the TUGT, the plantar pressure peak, the gait parameters,and the BBS score were analyzed in the study group.

Results

The peak plantar pressure of the forefoot and heel, stride length, lateral symmetry, stand phase, swing phase, and dual stand phase of both sides in the study group were significantly lower than those in the control group (P < 0.05). The BBS score negatively correlated with the 10MWT, the TUGT, the peak plantar pressure of the hemiplegic forefoot, midfoot, and the non-hemiplegic midfoot, the anterior to posterior position (ant/post position), hemiplegic stand phase, and the dual stand phase (P < 0.05). The BBS score positively correlated with the hemiplegic swing phase and stride length (P < 0.05).

Conclusion

A correlation was found between the forefoot plantar pressure and the stand phase of the hemiplegic limbs, the ant/post position, and the balance function after basal ganglion cerebral infarction. This association can be used in walking and balance assessment for stroke rehabilitation. Correcting forefoot pressure or the front and ant/post position can improve balance function.

Effects of balance training in addition to auxiliary activity on balance function of patients with stroke at high risk for falls

Objective

The aim of this study was to investigate the effect of balance training in addition to auxiliary activity on the balance function of patients with stroke at high risk for falls.

Methods

A total of 112 patients with stroke at high risk for falls in our hospital from inception to January 2020 to December 2020 were selected as the research objects who were equally divided into the control group and study group according to the random number table method. Patients in the control group were intervened with auxiliary activity, and the patients in the study group received additional balance training for auxiliary activity. The balance function, lower extremity motor function, fall risk, walking ability, and other indicators were compared between the two groups of patients before and after treatment. The hospitalization time and the frequency of falls 3 months after discharge were also compared between the two groups.

Results

Before treatment, there was no significant difference in balance function, lower extremity motor function, fall risk, and walking ability scores between the two groups (P > 0.05). After 3 months of treatment, the balance function, lower extremity motor function, and walking ability scores of the study group were significantly higher than those of the control group, with the fall risk score significantly lower than that of the control group (P < 0.05). Evidently, lower hospitalization time and the frequency of falls in the 3-month follow-up of the study group were observed than those in the control group (P < 0.05). However, there was no significant difference in the frequency of falls between the two groups during hospitalization (P > 0.05).

Conclusion

Our results indeed revealed that balance training in addition to auxiliary activity elicited beneficial outcomes in terms of effectively improving the balance function and walking ability of patients with stroke at high risk of falling, which may have the potential for wide clinical application.

Differences in the Relationships Between Muscle Strength, Muscle Mass, Balance Function, and Quality of Life for Middle-Aged and Older Breast Cancer Survivors

PURPOSE

The purpose of this study was to investigate the differences in muscle strength, muscle mass, balance function, and quality of life (QOL) among middle-aged breast cancer survivors (BCSs) and older BCSs.

METHODS

The study included 53 middle-aged (<65 years old) BCSs and 49 older (≥65 years old) BCSs. Muscle strength was evaluated via handgrip and knee extensor strength, and muscle mass was assessed using a body composition test. Balance function was assessed using the Timed Up and Go test and the body sway test. QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey.

RESULTS

The older BCSs had significantly lower right grip strength, right knee extension strength, and muscle mass (P < .05) than the middle-aged BCSs. In addition, the body sway test showed that older BCSs had a significant increase in the length of center of pressure compared to middle-aged BCSs (P < .05). Older BCSs showed significantly lower physical functioning subscales in QOL compared to middle-aged BCSs (P < .05). The associations among muscle strength, muscle mass and QOL were more significantly observed in the older BCSs (P < .05). Furthermore, a significant correlation between QOL and balance function was observed in the older BCSs, but not in the middle-aged BCSs (P < .05).

CONCLUSION

There may be associations among muscle strength, muscle mass, balance and QOL in older BCSs, but not in middle-aged BCSs. We believe that the findings of this study will be relevant in the context of planning rehabilitation for older BCSs.

Baduanjin exercise for balance function in community-dwelling older adults with cognitive frailty: a randomized controlled trial protocol

Background

Balance function provides a physiological link between the physical and cognitive function, and is a potential predictor for cognitive frailty. As a gentle mind–body exercise, Baduanjin can develop flexibility and co-ordination, thus would be is helpful for the improvement of balance function. This trial will evaluate the effect of Baduanjin on balance function in older adults with CF.

Methods/design

A total of 72 community-dwelling older adults with CF will be recruited and randomly allocated (1:1) into the Baduanjin exercise group or usual physical activity control group. All participants will undergo a health education program on nutrition and diet-related knowledge for 6 sessions (30 min per session) during the intervention period. Moreover, participants in the Baduanjin exercise group will receive a 24-week Baduanjin training course of 60 min per session and 3 sessions per week, while those in the usual physical activity control group will be required to maintain their original physical activity. Primary and secondary outcomes will be measured at baseline and after the 24-week intervention period. A mixed linear model will be constructed to analyse the intervention effects.

Discussion

This protocol presents an objective design of a randomized, single-blind trial that will evaluate the effectiveness and safety of traditional Chinese mind–body exercise Baduanjin training on the balance ability of community-dwelling older adults with cognitive frailty. If the results are as expected, this trial will provide evidence of the effect of Baduanjin exercise on balance in an older community-based population.

Trial registration

This trial was registered in the Chinese Clinical Trial Registry with code ChiCTR2100050857 and was approved on 5 September 2021.

Effect of task-oriented training on gross motor function, balance and activities of daily living in children with cerebral palsy: A systematic review and meta-analysis

BACKGROUND

To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP).

METHODS

A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software.

RESULTS

A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group.

CONCLUSIONS

Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.

Dynamic and static balance functions in hemodialysis patients and non-dialysis dependent CKD patients

INTRODUCTION

Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) have a high risk of falls, whereas the impairment in balance function and their types in HD compared with non-dialysis dependent (ND) CKD have not been fully evaluated.

METHODS

We conducted a cross-sectional study to assess the balance function in 91 ND-CKD and 65 HD patients. The participants underwent the timed up-and-go test (TUG) to assess dynamic balance and length of the center of pressure (CoP) with open eyes or closed eyes to evaluate static balance.

RESULTS

TUG, length of CoP with open eyes, and length of CoP with closed eyes were longer in HD patients compared with those with ND-CKD. Multiple regression analysis showed that dialysis treatment independently affected TUG and length of CoP with open eyes.

CONCLUSION

The dynamic and static balance functions are impaired in HD patients compared with that ND-CKD patients. This article is protected by copyright. All rights reserved.

Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function

Background: A variety of functional disorders can be caused after stroke, among which impairment of respiratory function is a frequent and serious complication of stroke patients. The aim of this study was to examine diaphragmatic function after stroke by diaphragm ultrasonography and then to apply to explore its correlation with extremity motor function and balance function of the hemiplegia patients. Methods: This cross-sectional observational study recruited 48 hemiplegic patients after stroke and 20 matched healthy participants. The data of demographic and ultrasonographic assessment of all healthy subjects were recorded, and 45 patients successfully underwent baseline data assessment in the first 48 h following admission, including post-stroke duration, stroke type, hemiplegia side, pipeline feeding, pulmonary infection, ultrasonographic assessment for diaphragm, Fugl−Meyer Motor Function Assessment Scale (FMA Scale), and Berg Balance Scale assessment. Ultrasonographic assessment parameters included diaphragm mobility under quiet and deep breathing, diaphragm thickness at end-inspiratory and end-expiratory, and calculated thickening fraction of the diaphragm. The aim was to analyze the diaphragm function of hemiplegic patients after stroke and to explore its correlation with extremity motor function and balance function. Results: The incidence of diaphragmatic dysfunction under deep breath was 46.67% in 45 hemiplegia patients after stroke at the convalescent phase. The paralyzed hemidiaphragm had major impairments, and the mobility of the hemiplegic diaphragm was significantly reduced during deep breathing (p < 0.05). Moreover, the thickness fraction of hemiplegic side was extremely diminished when contrasted with the healthy control and non-hemiplegic side (p < 0.05). We respectively compared the diaphragm mobility under deep breath on the hemiplegic and non-hemiplegic side of patients with left and right hemiplegia and found there was no significant difference between the hemiplegic side of right and left hemiplegia (p > 0.05), but the non-hemiplegic side of right hemiplegia was significantly weaker than that of left hemiplegia patients (p < 0.05). The diaphragm mobility of stroke patients under quiet breath was positively correlated with age and FMA Scale score (R2 = 0.296, p < 0.05), and significant positive correlations were found between the diaphragm mobility under deep breath and Berg Balance Scale score (R2 = 0.11, p < 0.05), diaphragm thickness at end-inspiratory and FMA Scale score (R2 = 0.152, p < 0.05), and end-expiratory thickness and FMA Scale score (R2 = 0.204, p < 0.05). Conclusions: The mobility and thickness fraction of the hemiplegic diaphragm after stroke by diaphragm ultrasonography were significantly reduced during deep breathing. Diaphragm mobility on bilateral sides of the right hemiplegia patients were reduced during deep breathing. Moreover, the hemiplegic diaphragmatic function was positively correlated with extremity motor and balance function of the hemiplegia patients.

Relationship between balance function and QOL in cancer survivors and healthy subjects

A previous study reported that cancer survivors exhibit decreased postural stability compared to age-matched controls. Another study showed that cancer survivors have a lower quality of life (QOL) compared to healthy subjects, and there was a significant relationship between muscle strength and QOL in cancer survivors. We aimed to investigate differences in the associations between balance function and QOL in cancer survivors and healthy subjects.Forty-one cancer survivors and 33 healthy subjects were included. Balance function was evaluated using the timed up and go test, and body sway was tested using a force platform. QOL was assessed using the medical outcome study 36-item short-form health survey.Cancer survivors exhibited significantly higher timed up and go and lower QOL than that of healthy subjects (P < .05). There was a significant association between body sway and QOL (P < .05) among cancer survivors. However, healthy subjects had subscales for QOL related to the body sway test parameters more frequently than cancer survivors (P < .05).Cancer survivors' balance function may have little effect on QOL, unlike in healthy subjects.

Sequential changes in lower extremity function after total knee arthroplasty

PURPOSE

The effectiveness of total knee arthroplasty (TKA) for recovering ambulation and balance functions has not been investigated in detail. The present study aimed to measure functional changes in the lower limb before and after TKA by measuring ambulation function with the 3 m Timed Up and Go (TUG) test and balance function using one-leg standing time (ST).

METHODS

The study included 137 patients (116 women and 21 men) with osteoarthritis of the knee who underwent primary TKA. The mean age of the patients was 74.4 years. The mean postoperative hospital stay for rehabilitation was 23.9 days. The TUG test and ST were performed preoperatively, 2 weeks postoperatively, at discharge, and 3, 6, and 12 months postoperatively. These results from these six measurements were also compared using one-way repeated measures analysis of variance.

RESULTS

The TUG test and ST were significantly improved at 3 months after surgery. However, both the TUG test and ST did not improve further from 3 months to 6 months postoperatively or from 6 months to 1 year postoperatively.

CONCLUSION

TKA is useful for restoring lower limb function, as both ambulation and balance functions were significantly improved 3 months after surgery. However, no further improvement in ambulation or balance function was recognized beyond 3 months.

The effect of Wuqinxi exercises on the balance function and subjective quality of life in elderly, female knee osteoarthritis patients

OBJECTIVE

To investigate the balance function and subjective quality of life in elderly female knee osteoarthritis patients KOAKOA treated with Wuqinxi exercises.

METHODS

A total of 284 elderly female patients with knee osteoarthritis (KOA) were randomly divided into an experimental group, which did Wuqinxi exercises for 24-weeks (n=132), and a control group, which didn't do any regular physical exercises (n=134). The experimental group did Wuqinxi exercises for 24 weeks, and the control group didn't engage in any regular physical exercise. We performed limits of stability (LOS) tests, static posture stability (SPS) tests, and dynamic fall index (DFI) tests to assess the patients' balance, and we administered the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire to evaluate the physical functioning of the patients' knees.

RESULTS

The limits of stability (LOS) test, the static posture stability (SPS) test, and the dynamic fall index (DFI) test results were improved in the experimental group compared with the control group (P < 0.05). From baseline to the week 24 follow-up, the WOMAC tests, and the pain, joint stiffness, and lower limb muscle strength showed significant differences between the two groups (P < 0.05).

CONCLUSIONS

Wuqinxi exercises are an effective treatment for elderly female patients with knee osteoarthritis, and can improve their balance and subjective quality of life. The therapy effectively alleviates the clinical symptoms of the elderly female knee osteoarthritis patients.

Effects of robot-assisted training on balance function in patients with stroke: A systematic review and meta-analysis

Objective

To investigate the effectiveness of robot-assisted therapy on balance function in stroke survivors.

Data sources

PubMed, the Cochrane Library, Embase and China National Knowledge Infrastructure databases were searched systematically for relevant studies.

Study selection

Randomized controlled trials reporting robot-assisted therapy on balance function in patients after stroke were included.

Data extraction

Information on study characteristics, demographics, interventions strategies and outcome measures were extracted by 2 reviewers.

Data synthesis

A total of 19 randomized trials fulfilled the inclusion criteria and 13 out of 19 were included in the meta-analysis. Analysis revealed that robot-assisted therapy significantly improved balance function assessed by berg balance scale (weighted mean difference (WMD) 3.58, 95% confidence interval (95% CI) 1.89–5.28, p < 0.001) compared with conventional therapy. Secondary analysis indicated that there was a significant difference in balance recovery between the conventional therapy and robot-assisted therapy groups in the acute/subacute stages of stroke (WMD 5.40, 95% CI 3.94–6.86, p < 0.001), while it was not significant in the chronic stages. With exoskeleton devices, the balance recovery in robot-assisted therapy groups was significantly better than in the conventional therapy groups (WMD 3.73, 95% CI 1.83–5.63, p < 0.001). Analysis further revealed that a total training time of more than 10 h can significantly improve balance function (WMD 4.53, 95% CI 2.31–6.75, p < 0.001). No publication bias or small study effects were observed according to the Cochrane Collaboration tool.

Conclusion

These results suggest that robot-assisted therapy is an effective intervention for improving balance function in stroke survivors.

Early loss of cerebellar Purkinje cells in human and a transgenic mouse model of Alzheimer's disease

BACKGROUND

The cerebellum's involvement in AD has been under-appreciated by historically labeling as a normal control in AD research.

METHODS

We determined the involvement of the cerebellum in AD progression. Postmortem human and APPswe/PSEN1dE9 mice cerebellums were used to assess the cerebellar Purkinje cells (PC) by immunohistochemistry. The locomotor and spatial cognitive functions were assessed in 4- to 5-month-old APPswe/PSEN1dE9 mice. Aβ plaque and APP processing were determined in APPswe/PSEN1dE9 mice at different age groups by immunohistochemistry and Western blot.

RESULTS

We observed loss of cerebellar PC in mild cognitive impairment and AD patients compared with cognitively normal controls. A strong trend towards PC loss was found in AD mice as early as 5 months. Impairment of balance beam and rotorod performance, but no spatial learning and memory dysfunction was observed in AD mice at 4-5 months. Aβ plaque in the cerebral cortex was evidenced in AD mice at 2 months and dramatically increased at 6 months. Less and smaller Aβ plaques were observed in the cerebellum than in the cerebrum of AD mice. Similar intracellular APP staining was observed in the cerebellum and cerebrum of AD mice at 2 to 10 months. Similar expression of full-length APP and C-terminal fragments were indicated in the cerebrum and cerebellum of AD mice during aging.

DISCUSSION

Our study in post-mortem human brains and transgenic AD mice provided neuropathological and functional evidence that cerebellar dysfunction may occur at the early stage of AD and likely independent of Aβ plaque.

Investigating the Effects of Vestibular Rehabilitation on Balance Function in Cochlear Implant Recipients

BACKGROUND

Cochlear Implantation (CI) is an effective surgical approach to rehabilitate the severe to profound hearing-impaired patients. However, the insertion of CI electrodes into the cochlea may adversely affect vestibular receptors, resulting in vertigo or dizziness. The present study aimed to investigate the impacts of Vestibular Rehabilitation Therapy (VRT) exercises on dizziness symptoms of patients who underwent CI.

METHODS

A total of 21 consecutive patients (age range: 28 to 61 years) with profound sensorineural hearing loss undergoing CI operation participated. The VRT therapy plan consisted of a habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness was measured using a Dizziness Handicap Inventory (DHI) scale to measure the level of respondent's performance on physical, emotional, and functional dimensions. Visual Analogue Scale (VAS) was also conducted to assess the severity of dizziness symptoms. The DHI and VAS scales were conducted before VRT and at "oneweek", "two-week", and "four-week" following the last rehabilitation session.

RESULTS

A repeated-measure analysis of variance demonstrated a significant decrement and a consequent improvement in DHI scores after vestibular exercises in all emotional, physical and functional domains (p < 0.001). We also found that the influence of implanted ear (p=0.076) and gender (p=0.094) variables on DHI scores were not statistically significant. The mean VAS score was 5.87 ± 2.27 at baseline stage and it reduced significantly during the course of the therapy (second week, 2.02 ±1.75, p < 0.001; and forth week, 1.51 ± 1.29, p < 0.001).

CONCLUSION

The findings of this study showed that vestibular rehabilitation therapy has a positive impact on the symptoms of the patients who underwent CI surgery. These exercises lead to an improvement in balance and postural stability, and a reduction in the self-report measure of handicaps. These findings provide the basis for better pre-operative counseling and postoperative vestibular rehabilitation to CI recipients.

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia.

METHODS

In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer's program.

RESULTS

We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer's program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer's program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none.

CONCLUSIONS

High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.

Balance and muscle strength tests in patients with osteoporotic vertebral fractures to develop tailored rehabilitation programs

Authors perform a cross-sectional study of functional abilities of the patients with osteoporotic vertebral fractures (VFs). Trunk muscle isometric strength and postural balance impairments were estimated. The development of osteoporotic VFs is associated with a significant decrease in strength of all the body muscles, especially the deep spinal stabilization system, i.e trunk extensor (TE), trunk flexsor (TF), where the VFs contribute to inappropriate distribution of back muscle strength with TE:TF ration of 1:1 instead of 3:2, observed both normally and in patients with uncomplicated osteoporosis. There is also a deterioration of stabilometry and functional coordination assessment tests in patients with pathological VFs, that indicate abnormalities of both static and dynamic postural balance. The obtained data should be taken into account when developing rehabilitation programmes for osteoporosis patients who have suffered compression VFs.

Joint position sense of lower extremities is impaired and correlated with balance function in children with developmental coordination disorder

OBJECTIVE

To determine the joint position sense of the lower extremities and its relationship with motor function in children with developmental coordination disorder (DCD) and typically developing (TD) children.

METHODS

A total of 56 participants were recruited; 28 children with DCD (age 10.86±1.07 years; 13 females, 15 males) and 28 TD children (age 10.96±1.18 years; 12 females, 16 males). Knee and ankle joint position sense were assessed using a Biodex isokinetic dynamometer. Joint position acuity was measured by position error (PE) and position error variability (PEV). Motor function was examined using the 2nd edition of Movement Assessment Battery for children (MABC-2) and quantified via sub-scores from 3 MABC-2 domains.

RESULTS

Both PE and PEV at knee and ankle joints were significantly greater in children with DCD compared with TD children. In addition, both PE and PEV were significantly greater at the ankle joints than the knee joints in children with DCD. For children with DCD only, joint position acuity in the lower extremities significantly and negatively correlated with MABC-2 balance sub-score.

CONCLUSION

This study verifies that lower limb proprioception is impaired in children with DCD. Also, children with DCD displayed greater proprioceptive deficits at the ankle compared with the knee joint. Children with DCD who had poorer joint position acuity, i.e. greater PE and PEV, in the lower extremities tended to perform less well in balance function.

Association Between Acid-Sensing Ion Channel 3 Gene Variants and Balance Impairment in People With Mild Traumatic Brain Injury

Introduction: Dizziness and balance impairment are common symptoms of mild traumatic brain injury (mTBI). Acid-sensing ion channel 3 (ASIC3) is expressed in the vestibular and proprioceptive systems and associated with balance functions. However, whether the genetic variants of ASIC3 are associated with people who suffer dizziness and balance impairment after mTBI remained unknown. Materials and methods: A total of 200 people with mTBI and 109 non-mTBI controls were recruited. Dizziness, balance functions, and the ability to perform daily activities were assessed by Dizziness Handicap Inventory (DHI), and objective balance functions were investigated by the postural stability test. Three diseases-related genetic variants of ASIC3 were determined through polymerase chain reaction and followed by restriction fragment length polymorphism. The Student's t-test and Mann-Whitney U-test were used for normal and abnormal distributed data, respectively. The regression was applied to adjust gender and age. The normality of continuous data was evaluated by Shapiro-Wilk test. Results: In the mTBI people, the rs2288645-A allele carriers exhibited a significantly worse physical domain DHI score (A-allele carriers: 11.39 ± 8.42, non-A carriers: 8.76 ± 7.87, p = 0.03). The rs4148855-GTC deletion carriers an exhibited significantly worse overall postural stability (GTC deletion carriers: 0.53 ± 0.33, non-carriers: 0.46 ± 0.20, p = 0.03). In the controls, rs2288646-A allele carriers were significant worse in the medial-to-lateral postural stability (A-allele carriers: 0.31 ± 0.17, non-A carriers: 0.21 ± 0.10, p = 0.01). Conclusion: The present study demonstrated that ASIC3 genetic variants were associated with certain aspects of balance functions and dizziness questionnaires in people of mTBI and non-mTBI. It provides a possible evidence that ASIC3 could be a new target for the management of the balancing disorders. However, further investigations are warranted to elucidate the underlying mechanisms and clinical significance.

[Effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy]

OBJECTIVE

To study the effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy.

METHODS

A total of 97 children with spastic cerebral palsy were randomly divided into an observation group with 49 children and a control group with 48 children. Both groups were given routine rehabilitation training, and the children in the observation group were given suspension exercise training in addition. The scores of the D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88) and Berg Balance Scale (BBS) were recorded before treatment and at 1, 3, and 6 months after treatment. Surface electromyography was performed to observe the changes in the root mean square (RMS) of surface electromyogram signals of the adductor muscle and the gastrocnemius muscle.

RESULTS

Over the time of treatment, both groups had varying degrees of improvement in the scores of the D and E domains of GMFM-88 and BBS. Compared with the control group, the observation group had significantly greater improvements in D and E functional areas and balance function (P<0.05). Both groups had reductions in the RMS of the surface electromyogram signals of the adductor muscle and the gastrocnemius muscle over the time of treatment, and the observation group had significantly greater reductions than the control group (P<0.05).

CONCLUSIONS

Suspension exercise training can effectively improve the motor and balance functions of children with spastic cerebral palsy.

[Effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy]

OBJECTIVE

To study the effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy.

METHODS

A total of 97 children with spastic cerebral palsy were randomly divided into an observation group with 49 children and a control group with 48 children. Both groups were given routine rehabilitation training, and the children in the observation group were given suspension exercise training in addition. The scores of the D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88) and Berg Balance Scale (BBS) were recorded before treatment and at 1, 3, and 6 months after treatment. Surface electromyography was performed to observe the changes in the root mean square (RMS) of surface electromyogram signals of the adductor muscle and the gastrocnemius muscle.

RESULTS

Over the time of treatment, both groups had varying degrees of improvement in the scores of the D and E domains of GMFM-88 and BBS. Compared with the control group, the observation group had significantly greater improvements in D and E functional areas and balance function (P<0.05). Both groups had reductions in the RMS of the surface electromyogram signals of the adductor muscle and the gastrocnemius muscle over the time of treatment, and the observation group had significantly greater reductions than the control group (P<0.05).

CONCLUSIONS

Suspension exercise training can effectively improve the motor and balance functions of children with spastic cerebral palsy.

Baduanjin Exercise for Stroke Rehabilitation: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Objective: The purpose of this review was to objectively evaluate the effects of Baduanjin exercise on rehabilitative outcomes in stroke patients. Methods: Both Chinese and English electronic databases were searched for potentially relevant trials. Two review authors independently screened eligible trials against the inclusion criteria, extracted data, and assessed the methodological quality by using the revised PEDro scale. Meta-analysis was only performed for balance function. Results: In total, there were eight randomized controlled trials selected in this systematic review. The aggregated result of four trials has shown a significant benefit in favor of Baduanjin on balance function (Hedges’ g = 2.39, 95% CI 2.14 to 2.65, p < 0.001, I² = 61.54). Additionally, Baduanjin exercise effectively improved sensorimotor function of lower extremities and ability of daily activities as well as reduced depressive level, leading to improved quality of life. Conclusion: Baduanjin exercise as an adjunctive and safe method may be conducive to help stroke patients achieve the best possible short-term outcome and should be integrated with mainstream rehabilitation programs. More rigorous randomized controlled trials with long-term intervention periods among a large sample size of stroke patients are needed to draw a firm conclusion regarding the rehabilitative effects for this population.

Simple Indicator to Judge the Independence Level Required in Dressing in a Hospital Ward for Patients with Stroke

BACKGROUND

This study aimed to create a simple and objective indicator for use by inexperienced nurses and family members of patients to judge the assistance level required for dressing in a hospital, while encouraging independence in activities of daily living among inpatients with stroke using the Berg balance scale.

METHODS

We retrospectively analyzed the data of 108 hospitalized patients with first stroke in a rehabilitation hospital ward. Receiver operating characteristic curves were used to identify the Berg balance scale item with the highest discriminatory power against independence level in dressing.

RESULTS

For comparisons between the independence and supervision or less level groups, the area under the curve of the sum score of "Retrieving object from floor" and "Standing with one foot in front" was .954, and the calculated cutoff value was 6/5 (sensitivity, 86%; specificity, 94%). For comparisons between the supervision or higher level and dependence groups, the area under the curve of the score of "Retrieving object from floor" was .930, and the calculated cutoff value was 2/1 (sensitivity, 93%; specificity, 81%).

CONCLUSIONS

Our results suggested that Berg balance scale items are individually and in combination simple and useful indicators to judge independence level in dressing in a hospital ward for patients with stroke. These indices appear to be appropriate for individuals who are unfamiliar with Berg balance scale, such as inexperienced nurses and family members of patients.

Feasibility of early functional rehabilitation in acute stroke survivors using the Balance-Bed-a technology that emulates microgravity

Evidence-based guidelines recommend early functional rehabilitation of stroke patients when risk of patient harm can be managed. Current tools do not allow balance training under load conditions sufficiently low for acute stroke patients. This single-arm pilot study tested feasibility and safety for acute stroke survivors to use "Balance-Bed", a technology for balance exercises in supine initially developed to emulate microgravity effects on balance. Nine acute stroke patients (50-79 years) participated in 3-10 sessions over 16-46 days as part of their rehabilitation in a hospital inpatient setting. Standard inpatient measures of outcome were monitored where lack of progress from admission to discharge might indicate possible harm. Total FIM scores at admission (median 40, range 22-53) changed to (74, 50-96), Motor FIM scores from (23, 13-32) to (50, 32-68) and Berg Balance scores from (3, 0-6) to (19, 7-43) at discharge. Changes reached Minimal Clinical Important Difference for a sufficient proportion (>0.6) of the patients to indicate no harm to the patients. In addition, therapists reported the technology was safe, provided a positive experience for the patient and fit within the rehabilitation program. They reported the device should be easier to set up and exit. We conclude acute stroke patients tolerated Balance-Bed exercises such as standing on one or two legs, squats, stepping in place as well as balance perturbations provided by the therapist. We believe this is the first time it has been demonstrated that acute stroke patients can safely perform whole body balance training including balance perturbations as part of their rehabilitation program. Future studies should include a control group and compare outcomes from best practices to interventions using the Balance-Bed. In addition, the technology is relevant for countermeasure development for spaceflight and as a test-bed of balance function under microgravity-like conditions.

Usefulness of the tri-axial accelerometer for assessing balance function in children

BACKGROUND

The aim of this study was to verify whether the tri-axial accelerometer can be used for quantitatively evaluating balance function in children.

METHODS

In total, 198 participants, including 172 healthy children aged 3-11 years (87 boys, 85 girls) and 26 young adults aged 21-24 years (seven men, 19 women), were enrolled in this study. The participants undertook three types of balance tasks: quiet standing with eyes open and closed, one-leg standing on the dominant leg and non-dominant leg, and walking on the floor and a balance beam. We derived the root mean square from participants' accelerations measured by the tri-axial accelerometer.

RESULTS

We found that for quiet standing, one-leg standing, and walking tasks, postural sway decreased with age. Girls controlled their posture better than boys of the same age on all tasks. There was a significant sex difference in quiet standing for children aged 8-9 years. Furthermore, sex differences existed in one-leg standing for children aged 5-11 years. A mild positive correlation was observed between static and dynamic balance.

CONCLUSIONS

The tri-axial accelerometer is a useful quantitative tool for evaluating both static and dynamic balance function in children. Thus, it has the potential to be used clinically for diagnosis and rehabilitation.

Effect of Tai-chi exercise on lower limb muscle strength, bone mineral density and balance function of elderly women

To study the effect of Tai-chi exercise on lower limb muscle strength, bone mineral density and balance function of elderly female, 105 urban elderly women, who do insufficient exercise in daily life, are selected as the subject and randomly divided into an observation group (Tai Chi Group), a control group I (Dance Group) and a control group II (Walking Group). Each group is consists of 35 women. Among them, the women in the observation group do Tai-chi exercise once a day, while the women in the control group I dance once a day and in the control group II stick to brisk walking once a day. All women in the three groups do the above said exercises for 40 minutes and the exercise intensity is controlled to be medium. At the time of selection and after 4, 8 and 12 months upon their exercises, respectively detect and compare the lower limb skeletal muscle mass, lower limb muscle strength, bone mineral density and balance function of the subject.

RESULTS

At the time of selection, the general information of the subjects in the three groups show no significant difference (P > 0.05); however, after 4 months' exercise, most of the study indexes in the control group I and group II are improved significantly (P < 0.05), while most of the study indexes in the observation group show no significant difference (P > 0.05) in comparison with those at the time of selection and their general improvement effect is slightly lower than that in the control group; after 8 months, relevant study indexes of the subjects in the three groups are significantly improved (P < 0.05) in comparison with those at the time of selection, especially, the effect in the observation group is more obvious and is better than that of the control group II (P < 0.05). 12 months later, the effect of the observation group is improved significantly from day to day when comparing to theose in the control group I and group II (P < 0.05 or P < 0.01).

CONCLUSION

Compared with the senile dance and walking exercises, the short-term Tai-chi exercise effect is not obvious, however, once the exercise period is extended, that is, continuous exercise for 8 months or even above 12 months, the advantage of Tai Chi is more and more significant. The study suggests that as a fitness measure, Tai Chi is more suitable for long-term exercise and its short-term effect is not obvious.