Slacklining and stroke: A rehabilitation case study considering balance and lower limb weakness

To ascertain the effectiveness of slacklining as a supplementary therapy for elderly stroke patients who are functionally non-progressing. This case study involved an 18-mo prospective observation of the management of an 87-year-old female stroke-patient of the left hemisphere with reduced balance, reduced lower limb muscular activation, hypertonia, and concurrent postural deficits. This entailed the initial acute care phase through to discharge to home and 18-mo final status in her original independent living setting. The introduction of slacklining as an adjunct therapy was made 12 mo post incident. Slacklining involves balance retention on a tightened band where external environmental changes cause a whole-body dynamic response to retain equilibrium. It is a complex neuromechanical task enabling individualized self-developed response strategies to be learned and adapted. This facilitates the innate process of balance retention, lower-limb and core muscle activation, and stable posture through a combination of learned motor skills and neurological system down regulation. Individuals adopt and follow established sequential motor learning stages where the acquired balance skillsare achieved in a challenging composite-chain activity. Slacklining could be considered an adjunct therapy for lower limb stroke rehabilitation where function is compromised due to decreased muscle recruitment, decreased postural control and compromised balance. Initial inpatient rehabilitation involved one-month acute-care, one-month rehabilitation, and one-month transitional care prior to home discharge. A further six months of intensive outpatient rehabilitation was provided with five hourly sessions per week including:supervised and self-managed hydrotherapy, plus one individual and two group falls' prevention sessions. These were supported by daily home exercises. At 12 mo post incident, recovery plateaued, then regressed following three falls. Rehabilitation was subsequently modified with the hydrotherapy retained and the group sessions replaced with an additional individual session supplemented with slacklining. The slacklining followed stages one and two of a standardized five-stage protocol. Self-reported functional progression resumed with improvement by 14 mo which further increased and was sustained 18 mo(Students' t test P < 0.05). Slacklining's external stimulations activate global-body responses through innate balance, optimal postural and potentially down-regulated reflex control. Incorporated into stroke rehabilitation programs, slacklining can provide measurable functional gains.

Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition

Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition with multiple diagnoses and causes.In the absence of consensus definitions,partly because of terminology inconsistency,it is further referred to as non-specific LBP(NSLBP).In NSLBP patients,the lumbar multifidus(MF),a key stabilizing muscle,has a depleted role due to recognized myocellular lipid infiltration and wasting,with the potential primary cause hypothesized as arthrogenic muscle inhibition(AMI).This link between AMI and NSLBP continues to gain increasing recognition.To date there is no‘gold standard’or consensus treatment to alleviate symptoms and disability due to NSLBP,though the advocated interventions are numerous,with marked variations in costs and levels of supportive evidence.However,there is consensus that NSLBP management be cost-effective,self-administered,educational,exercise-based,and use multi-modal and multi-disciplinary approaches.An adjuvant therapy fulfilling these consensus criteria is‘slacklining’,within an overall rehabilitation program.Slacklining,the neuromechanical action of balance retention on a tightened band,induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control.Though several models have been proposed,understanding slacklining’s neuro-motor mechanism of action remains incomplete.Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints,particularly the knee,and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI(MF-AMI).Therefore,this paper aims to:rationalize why and how adjuvant,slacklining therapeutic exercise may positively affect patients with NSLBP,due to MF-AMI induced depletion of spinal stabilization;considers current understandings and interventions for NSLBP,including the contributing role of MF-AMI;and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action.This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency,present due to AMI.This subsequently allows neuroplasticity,normal neuro-motor sequencing and muscle re-activation,which facilitates innate advantageous spinal stabilization.This in-turn addresses and reduces NSLBP,its concurrent symptoms and functional disability.This process is hypothesized to occur through four neuro-physiological processing pathways:finite neural delay;movement-control phenotypes;inhibition of action and the innate primordial imperative;and accentuated corticospinal drive.Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.

Slacklining:An explanatory multi-dimensional model considering classical mechanics,biopsychosocial health and time

This paper aims to overcome slacklining’s limited formulated explanatory models.Slacklining is an activity with increasing recreational use,but also has progressive adoption into prehabilitation and rehabilitation.Slacklining is achieved through self-learned strategies that optimize energy expenditure without conceding dynamic stability,during the neuromechanical action of balance retention on a tightened band.Evolved from rope-walking or‘Funambulus’,slacklining has an extensive history,yet limited and only recent published research,particularly for clinical interventions and in-depth hypothesized multi-dimensional models describing the neuromechanical control strategies.These‘knowledge-gaps’can be overcome by providing an,explanatory model,that evolves and progresses existing standards,and explains the broader circumstances of slacklining’s use.This model details the individual’s capacity to employ control strategies that achieve stability,functional movement and progressive technical ability.The model considers contributing entities derived from:Self-learned control of movement patterns;subjected to classical mechanical forces governed by Newton’s physical laws;influenced by biopsychosocial health factors;and within time’s multi-faceted perspectives,including as a quantified unit and as a spatial and cortical experience.Consequently,specific patient and situational uses may be initiated within the framework of evidence based medicine that ensures a multi-tiered context of slacklining applications in movement,balance and stability.Further research is required to investigate and mathematically define this proposed model and potentially enable an improved understanding of human functional movement.This will include its application in other diverse constructed and mechanical applications in varied environments,automation levels,robotics,mechatronics and artificial-intelligence factors,including machine learning related to movement phenotypes and applications.

Slacklining:A narrative review on the origins,neuromechanical models and therapeutic use

Slacklining,the neuromechanical action of balance retention on a tightened band,is achieved through self-learned strategies combining dynamic stability with optimal energy expenditure.Published slacklining literature is recent and limited,including for neuromechanical control strategy models.This paper explores slacklining’s definitions and origins to provide background that facilitates understanding its evolution and progressive incorporation into both prehabilitation and rehabilitation.Existing explanatory slacklining models are considered,their application to balance and stability,and knowledge-gaps highlighted.Current slacklining models predominantly derive from human quiet-standing and frontal plane movement on stable surfaces.These provide a multi-tiered context of the unique and complex neuro-motoric requirements for slacklining’s multiple applications,but are not sufficiently comprehensive.This consequently leaves an incomplete understanding of how slacklining is achieved,in relation to multi-directional instability and complex multi-dimensional human movement and behavior.This paper highlights the knowledge-gaps and sets a foundation for the required explanatory control mechanisms that evolve and expand a more detailed model of multi-dimensional slacklining and human functional movement.Such a model facilitates a more complete understanding of existing performance and rehabilitation applications that opens the potential for future applications into broader areas of movement in diverse fields including prostheses,automation and machine-learning related to movement phenotypes.