Postural Balance in the Elderly with Mild Cognitive Impairment: Relationship to Accidental Falls

This study analyzed postural balance in the elderly with mild cognitive impairment and its relationship to accidental falls. A quantitative and quasi-experimental method was used in a sample of 43 elderlies between 64 and 88 years old, mostly females. Data collection was performed in two Basic Health Units in the city of Rio de Janeiro in 2014. The instruments used were the Mini-Mental State Examination (MMSE), Tinetti scale, Motor Scale for the Elderly (EMTI) scale, and Elderly Falls Diary. The data were analyzed with the SAS statistical software version 9.3.1. The scales were applied before and after the psychomotor interventions. A significant difference was observed between the evaluating moments. Balance improvements were observed in all age groups, suggesting that all elderlies, regardless of age, showed satisfactory responses to the implemented psychomotor activities. The elderlies who fell more frequently were those between 60 and 69 years old. It is noteworthy that the age group with the lowest incidence of falls was that of elderlies between 70 and 79 years old. It was concluded that psychomotor activities are beneficial, regardless of age, proving their effectiveness when continued stimuli with cognitive and psychomotor activities are carried out.

Athletes who train on unstable compared to stable surfaces exhibit unique postural control strategies in response to balance perturbations

Background:Athletes have been shown to exhibit better balance compared to non-athletes(NON).However,few studies have investigated how the surface on which athletes train affects the strategies adopted to maintain balance.Two distinct athlete groups who experience different types of sport-specific balance training are stable surface athletes(SSA) such as basketball players and those who train on unstable surfaces(USA) such as surfers.The purpose of this study was to investigate the effects of training surface on dynamic balance in athletes compared to NON.Methods:Eight NON,eight SSA,and eight USA performed five 20-s trials in each of five experimental conditions including a static condition and four dynamic conditions in which the support surface translated in the anteroposterior(AP) or mediolateral(ML) planes using positive or negative feedback paradigms.Approximate entropy(Ap En) and root mean square distance(RMS) of the center of pressure(Co P) were calculated for the AP and ML directions.Four 3 × 5(group × condition) repeated measures ANOVAs were used to determine significant effects of group and condition on variables of interest.Results:USA exhibited smaller Ap En values than SSA in the AP signals while no significant differences were observed in the ML Co P signals.Generally,the negative feedback conditions were associated with significantly greater RMS values than the positive feedback conditions.Conclusion:USA exhibit unique postural strategies compared to SSA.These unique strategies seemingly exhibit a direction-specific attribute and may be associated with divergent motor control strategies.

Differences in standing balance between patients with diplegic and hemiplegic cerebral palsy

Maintaining standing postural balance is important for walking and handling abilities in patients with cerebral palsy. This study included 23 patients with cerebral palsy （seven with spastic diplegia and 16 with spastic hemiplegia）, aged from 7 to 16 years of age. Standing posture balance measurements were performed using an AMTI model OR6-7 force platform with the eyes open and closed. Patients with diplegic cerebral palsy exhibited greater center of pressure displacement areas with the eyes open and greater center of pressure sway in the medial-lateral direction with the eyes open and closed compared with hemiplegic patients, Thus, diplegic patients exhibited weaker postural balance control ability and less standing stability compared with hemiplegic cerebral palsy patients.

Factors associated with balance function in patients with knee osteoarthritis:An integrative review

This integrative review is to identify the factors associated with balance function in patients with knee osteoarthritis and explore the relationship between these factors and balance function.Osteoarthritis commonly occurs in elderly people.Patients with knee osteoarthritis have balance impairment,and maintaining knee stability is important for such patients to prevent accidental injuries caused by falling.Therefore,it is important to clarify the factors related to balance function in patients with knee osteo-arthritis.The PubMed,Science Direct,CINAHL,Ovid,ProQuest,CNKI,WanFang databases were searched,and relevant articles published up to December 2015 were included.Twenty articles were included in the analysis.Age,gender,dominant limb,foot length,knee alignment,diurnal variation,and meniscus tears were the non-modifiable factors,whereas body mass index,knee pain,muscle strength,joint range of motion,severity,and cognitive loading were the modifiable factors.Knee sleeve and custom-molded insoles showed protective effects against knee osteoarthritis.

Postural control deficits identify lingering post-concussion neurological deficits

Concussion,or mild traumatic brain injury,incidence rates have reached epidemic levels and impaired postural control is a cardinal symptom.The purpose of this review is to provide an overview of the linear and non-linear assessments of post-concussion postural control.The current acute evaluation for concussion utilizes the subjective balance error scoring system(BESS) to assess postural control.While the sensitivity of the overall test battery is high,the sensitivity of the BESS is unacceptably low and,with repeat administration,is unable to accurately identify recovery.Sophisticated measures of postural control,utilizing traditional linear assessments,have identified impairments in postural control well beyond BESS recovery.Both assessments of quiet stance and gait have identified lingering impairments for at least 1 month post-concussion.Recently,the application of non-linear metrics to concussion recovery have begun to receive limited attention with the most commonly utilized metric being approximate entropy(Ap En).Ap En,most commonly in the medial-lateral plane,has successfully identified impaired postural control in the acute post-concussion timeframe even when linear assessments of instrumented measures are equivalent to healthy pre-injury values;unfortunately these studies have not gone beyond the acute phase of recovery.One study has identified lingering deficits in postural control,utilizing Shannon and Renyi entropy metrics,which persist at least through clinical recovery and return to participation.Finally,limited evidence from two studies suggest that individuals with a previous history of a single concussion,even months or years prior,may display altered Ap En metrics.Overall,non-linear metrics provide a fertile area for future study to further the understanding of postural control impairments acutely post-concussion and address the current challenge of sensitive identification of recovery.

Application of a hospital–community–family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction

BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.

The relationship between intermittent limit cycles and postural instability associated with Parkinson’s disease

Background:Many disease-specific factors such as muscular weakness,increased muscle stiffness,varying postural strategies,and changes in postural reflexes have been shown to lead to postural instability and fall risk in people with Parkinson's disease(PD).Recently,analytical techniques,inspired by the dynamical systems perspective on movement control and coordination,have been used to examine the mechanisms underlying the dynamics of postural declines and the emergence of postural instabilities in people with PD.Methods:A wavelet-based technique was used to identify limit cycle oscillations(LCOs) in the anterior–posterior(AP) postural sway of people with mild PD(n = 10) compared to age-matched controls(n = 10).Participants stood on a foam and on a rigid surface while completing a dual task(speaking).Results:There was no significant difference in the root mean square of center of pressure between groups.Three out of 10 participants with PD demonstrated LCOs on the foam surface,while none in the control group demonstrated LCOs.An inverted pendulum model of bipedal stance was used to demonstrate that LCOs occur due to disease-specific changes associated with PD:time-delay and neuromuscular feedback gain.Conclusion:Overall,the LCO analysis and mathematical model appear to capture the subtle postural instabilities associated with mild PD.In addition,these findings provide insights into the mechanisms that lead to the emergence of unstable posture in patients with PD.

Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases

Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels （hearing, sight, touch, and smell）, permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual real- ity interface devices such as the Nintendo~ Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addi- tion, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases （chronic stroke and cerebral palsy） have been shown by changes in the reorganization of neural networks in patients＇ brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

The influence of physiobiomechanical parameters,technical aspects of shooting,and psychophysiological factors on biathlon performance:A review

The biathlon, an Olympic sporting discipline that combines cross-country skiing with rifle marksmanship, entails considerable physiological demands, as well as fine motor control while shooting after intense exercise and under mental pressure. Although much of our knowledge about cross-country skiing is probably also applicable to the biathlon, carrying the rifle and shooting under stress make this discipline somewhat unique. The present review summarizes and examines the scientific literature related to biathlon performance, with a focus on physiological and biomechanical factors and shooting technique, as well as psychophysiological aspects of shooting performance. We conclude with suggestions for future research designed to extend our knowledge about the biathlon, which is presently quite limited.2018 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. （http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study

Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.

The Application of Scales in the Diagnosis of Perceived Needs in the Elderly with Mild Cognitive Impairment

The study evaluated the use of the Mini-Mental State Examination scale (MMSE), Tinettiscale, and Motor Scale for the Elderly (EMTI) toassist in the diagnosis of potential needs observed in elderlies with Mild Cognitive Impairment. This was aquasi-experimental research, conducted in a Basic Health Unit in thecityof Rio de Janeiro in 2014. The sample population consisted of 22 elderlies aged 64 to 88 years and 86.36% females. The SAS statistical software (version 9.3.1) and Kruskal-Wallis test were used at a 95% confidence interval and a significance level of 0.05 and demonstrated significant differences in the evaluations performed before and after the intervention. The detected diagnoses were: impaired memory, the risk of falls, and willingness to improved relationships, among others. The evaluations showed MMSE results that were suggestive of cognitive impairment in 22.73% of the elderlies;the Tinetti scale showed a high risk of falls in 31.82% of theelderlies;and EMTI with 88.36 points, which was equivalent to the normal low classification. The intervention took place through ten weekly activity sessions after the initial evaluations. In the second evaluation, the Tinetti showed 59.09% of the elderlies with a moderate risk of falls and the EMTI as the normal average classification with 90.32 points. It was concluded that the scales offered diagnostic possibilities, which allowed for the implementation of necessary interventions according to the detected problems.

Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder： a case-control study

Background Attention deficit hyperactivity disorder （ADHD） is one of the most commonly diagnosed psychiatric disorder in childhood. ADHD children with overlapping symptoms and signs of motor problems have more serious prognosis than that of children with ADHD only. However, the motor and sensory processing problems in children with ADHD have not been studied well. Few people adopt the technique of computerized dynamic posturography （CDP） in the study of ADHD, which is applied widely in clinical and laboratory research to objectively evaluate human＇s balance performance. This study aimed to assess the characteristics of postural control and sensory information processing of boys with two subtypes of ADHD by using CDP, so as to provide the proof for non-drug therapy of ADHD. Method From June 2003 to September 2004, a total of 73 boys （7-15 years of age） with ADHD and 73 normal developing boys matched by age and intelligence quotient from Peking University Institute of Mental Health were recruited in the study. The Sensory Organization Test was adopted to test the static balance performance under six sensory input conditions by SMART EquiTest 8.0 （NeuroCom） instrument. The sensory information from three sensory systems were available under condition 1, the visual inputs were removed or distorted under condition 2 or 3, the somatosensory inputs were in conflict with or without the visual inputs removed under condition 4 or 5, and both the visual and somatosensory inputs were in conflict under condition 6. The indexes of equilibrium score, somatosensory, vestibular, and visual ratios, and strategy scores were analyzed to indicate the subjects＇ postural control ability. Results ADHD boys had significantly lower composite equilibrium score （CES） than the normal group （P 〈0.05）. Under condition 1 and conditions 3-6, the equilibrium scores （ES） of the ADHD group were significantly lower （all P 〈0.05） than those of the control. Significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 were found in boys with ADHD compared with the control group （P 〈0.05）. Boys of ADHD-predominantly inattentive （ADHD-I） type had a significantly lower CES and ES under conditions 4-6 than the controls （all P 〈0.05） while the ESs of ADHD-combined type （ADHD-C） boys under each condition were similar with that of boys with ADHD-I and no significant difference was found between boys with ADHD-C and the control group （all P 〉0.05）. Compared with the control group, the ADHD-I boys showed significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 whereas the ADHD-C boys showed a trend of lower visual ratio （all P 〈0.05）. Conclusions ADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control. Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys. These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits. Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children.

Effect of Combining Tuina with Balance Training on Balance Functions of Stroke Patients

Objective： To observe the effect of combining tuina with balance training on balance functions of stroke patients. Methods： A total of 120 cases who met the inclusion criteria were randomly allocated into an observation group and a control group. In addition to routine medical and rehabilitation treatment in both groups, balance training was used in the control group, versus combining tuina with balance training in the observation group. The therapeutic efficacies in two groups were evaluated using the Balance Subscale of the FugI-Meyer Test （FM-B） before and after treatment. Results： After 3 courses of treatment, the FM-B scores were significantly improved in both groups （P〈O.01）; and there was statistical difference in FM-B scores between the two groups （P〈0.05）. Conclusion： Tuina manipulation of regulating the Governor Vessel can improve the balance function of stroke patients and benefit the patients＇ self-care abilities.

Effects of short-term active video game play on community adults： under International Classification of Functioning, Disability and Health consideration

Background The effects of active video game play on healthy individuals remain uncertain.A person＇s functional health status constitutes a dynamic interaction between components identified in the International Classification of Functioning,Disability,and Health （ICF）.The aim of this study was to investigate the short-term effects of active video game play on community adults using the ICF.Methods Sixty community adults with an average age of 59.3 years and without physical disabilities were recruited.Over 2 weeks,each adult participated in six sessions of active video game play lasting 20 minutes each.Participants were assessed before and af^er the intervention.Variables were collected using sources related to the ICF components,including the Hospital Anxiety and Depression Scale,Multidimensional Fatigue Inventory,Biodex Stability System,chairrising time,Frenchay Activity Index,Rivermead Mobility Index,Chronic Pain Grade Questionnaire,Work Ability Index,and World Health Organization Quality of Life-Brief Version.Results Compared to baseline data,significantly reduced risk of a fall measured by Biodex Stability System and improvements in disability scores measured by the Chronic Pain Grade Questionnaire were noted.There was no significant change in the other variables measured.Conclusion Short-term,active video game play reduces fall risks and ameliorates disabilities in community adults.