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.

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.

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.

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.

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.

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.