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Objective To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes. Methods This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season). Results Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25). Conclusions Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.

The objective of this study was to describe and classify common variations and compensation mechanisms in the sagittal alignment of the spine with lumbar degenerative disease.A total of 230 patients over 18 years old who underwent whole-spine X-rays to evaluate lower back pain were enrolled in this study. C7 slope, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), cervical lordosis (CL), thoracolumbar kyphosis (TLK), and sagittal vertical axis (SVA) were measured. Patients were divided into Group A (balance without compensation), B (balance with compensation), C (unbalance with compensation), and D (unbalance without compensation) according to spinopelvic balance and thoracic compensation.Group A had the largest LL, smallest PT, largest SS, and best clinical parameters of the four groups (p 0.001, p 0.001, p 0.001, p 0.001). The age increased gradually from Group B to Group D. Group B had an increased TK compared with Group A (p 0.001). Group C had an increased TK compared with Group A (p 0.001). Group D had an increased C7 slope compared with Group A (p = 0.022).This classification is shown four different regional and global alignments of the spine. Compensation took place to keep the balance of the spine. Classification types were consistent with age, compensation abilities, and clinical parameters. This classification potentially represents a valuable tool for comprehensive analysis of lumbar degenerative before surgical treatment considering sagittal balance.

Background: Critically ill patients are at increased risk for fluid overload, but objective prediction tools to guide clinical decision-making are lacking. The MRC-ICU scoring tool is an objective tool for measuring medication regimen complexity. Objective: To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patients. Methods: In this multi-center, retrospective, observational study, the relationship between MRC-ICU and the risk of fluid overload was examined. Patient demographics, fluid balance at day 3 of ICU admission, MRC-ICU score at 24 hours, and clinical outcomes were collected from the medical record. The primary outcome was relationship between MRC-ICU and fluid overload. To analyze this, MRC-ICU scores were divided into tertiles (low, moderate, high), and binary logistic regression was performed. Linear regression was performed to determine variables associated with positive fluid balance. Results: A total of 125 patients were included. The median MRC-ICU score at 24 hours of ICU admission for low, moderate, and high tertiles were 9, 15, and 21, respectively. For each point increase in MRC-ICU, a 13% increase in the likelihood of fluid overload was observed (OR 1.128, 95% CI 1.028-1.238, p = 0.011). The MRC-ICU score was positively associated with fluid balance at day 3 (β-coefficient 218.455, 95% CI 94.693-342.217, p = 0.001) when controlling for age, gender, and SOFA score. Conclusions: Medication regimen complexity demonstrated a weakly positive correlation with fluid overload in critically ill patients. Future studies are necessary to establish the MRC-ICU as a predictor to identify patients at risk of fluid overload.

To investigate how postural balance is affected by thoracic hyperkyphosis compared to healthy children and elucidate the relationship between balance and strength and tightness.A cross-sectional analysis using standardized measures to identify balance function in children with thoracic hyperkyphosis (n = 31) and compare age-matched healthy children (n = 31). Primary outcome measurements were performed for the static and dynamic balance with the biodex balance system and limits of stability with the functional reach test. Secondary outcome measurements were strength with a hand-held dynamometry, tightness with the length test of pectoralis minor and hip flexors, and the sit-reach test for hamstrings. Mann-Whitney U test was used to compare the difference between the groups. Spearman's correlation was used to analyze the possible correlations between balance and strength and tightness.A significant difference was found between the groups for static balance with eyes closed (except double-leg stance anteroposterior stability index) and for the forward reach distance (p 0.05). Strength and tightness were significantly different in children with thoracic hyperkyphosis than in healthy children (p 0.05). Also, it was found that muscle strength of trunk extension and hip abduction and tightness of hip flexors and hamstring were factors associated with static balance with eyes closed (r 0.10, p 0.05).Static balance in children with thoracic hyperkyphosis is affected when visual input is particularly removed, and static balance with eyes closed is correlated with changed strength and tightness in some of the trunk and lower extremity muscles.

Objectives: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. Methods: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n = 16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n = 16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. Results: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p < 0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p < 0.05). Conclusion: The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness. © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial

BACKGROUND: Functional stability of the shoulder requires a balance of active forces, passive forces, and control subsystems of the joint complex. Although whole-body vibration enhances shoulder muscle function and proprioception, the impact of vibration on the sensorimotor control of the shoulder joint remains unclear. OBJECTIVE: To investigate the acute effect of vibratory stimuli on the sensorimotor control of the shoulder joint. METHODS: Fifteen male participants (age, 22.7 ± 2.3 years) were included and performed the exercise in a modified push-up position with partial weight-bearing on a vibration platform with and without vibratory stimuli. The vibration protocol included six sets lasting for 30 s each with a 30-s rest between sets. The main outcome measures included the upper limb static stability test, Upper Quarter Y Balance Test (UQYBT), and electromyography data of the upper limb. RESULTS: Vibratory stimuli resulted in an increased UQYBT score (all directions; P< 0.01) and infraspinatus, serratus anterior, and lower trapezius muscle activity (P< 0.05) between pre- and post-exercise versus the control condition. Stabilometric parameters showed no significant interaction between condition and time. CONCLUSIONS: Vibratory stimuli could maximize training benefits while limiting injury risk for athletes. Our findings could guide the development of rehabilitation programs for patients with shoulder instability.

Background Physical exercise has contributed significantly to the quality of life of the population. Therefore, countless specialists have established relationships between t people who perform physical exercise and success in the treatment of diseases, such as Parkinson’s disease in older adults. Objective The aim of this research is to analyse the influence of resistance training in the correlation of balance and postural control in people with Parkinson’s disease. Method A systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews And Meta-Analyses (PRISMA), in consultation with the PubMed, Scielo, BVS (Lilacs), ScienceDirect and Cochrane databases, based on the influence of resistance training on postural balance and control in older adults with Parkinson’s disease, highlighting as the main assessment tool the Movement Disorders Society — Unified Parkinson’s Disease Rating Scale. Results After searching the selected databases and considering the inclusion and exclusion criteria of this study, 10 studies were selected to compose this review and a total of 556 participants were pooled. It was observed that most of the interventions (60%) had a duration of approximately 30−45 min over eight to twelve weeks, the most used measuring instruments were the BESTest (Balance Evaluation System Test), FOG-Q (Freezing of Gait Questionnaire) and the MDS-UPDRS (Movement Disorders Society-Unified Parkinson’s Disease Rating Scale). Conclusion Physical exercise plays a fundamental role in the intervention and prevention of Parkinson’s disease symptoms with regard to balance, strength, and quality of life.

Reactive stepping is one of the only strategies that can lead to successful stabilization following a large challenge to balance. Improving function of specific muscles associated with reactive stepping may improve features of reactive balance control. Accordingly, this study aimed to determine the relationship between lower limb muscle strength and explosive force with force plate-derived timing measures of reactive stepping. Nineteen young, healthy adults (27.6 ± 3.0 years of age; 10 women: 9 men) responded to 6 perturbations (~13-15% of body weight) using an anterior lean-and-release system (causing a forward fall), where they were instructed to recover balance in as few steps as possible. Foot-off, swing, and restabilization times were estimated from force plates. Peak isokinetic torque, isometric torque, and explosive force of the knee extensors/flexors and plantar/dorsiflexors were measured using isokinetic dynamometry. Correlations were run based on a priori hypotheses and corrected for the number of comparisons (Bonferroni) for each variable. Knee extensor explosive force was negatively correlated with swing time (r = −0.582, p = 0.009). Knee flexor peak isometric torque also showed a negative association with restabilization time (r = −0.459, p = 0.048), however this was not statistically significant after correcting for multiple comparisons. There was no significant relationship between foot-off time and knee or plantar flexor explosive force (p > 0.025). These findings suggest that there may be utility to identifying specific aspects of reactive step timing when studying the relationship between muscle strength and reactive balance control. Exercise training aimed at improving falls risk should consider targeting specific aspects of muscle strength depending on specific deficits in reactive stepping.

BACKGROUND: Wearable lower extremity exoskeletons can provide walking assistance for the physical rehabilitation of paralyzed individuals. However, most of the existing exoskeletons require crutches to maintain balance, thus a self-balancing type is needed to improve applicability. OBJECTIVE: The purpose of this work is to study the kinematic characteristics of a novel lower extremity exoskeleton for crutch-less walking rehabilitation, and evaluate the movement performance through practical experiments. METHODS: Based on the human lower limb structure and movement characteristics, a fully actuated 10 degrees-of-freedom (DoF) lower extremity exoskeleton was proposed. The kinematic characteristics of the exoskeleton were analyzed by the D-H method and geometric method, and the model validity was verified through simulations and experiments. RESULTS: The closed-form solutions for both forward and inverse kinematics models were obtained. The consistent results of theoretical calculation and numerical simulation have shown the accuracy of the established models. The practical experiments regarding six trials have demonstrated the movement performance of the proposed exoskeleton, including sit, stance, leg extension/flexion, and left/right swing. CONCLUSIONS: The kinematic characteristics of the proposed 10-DoF lower extremity exoskeleton are similar to the human lower limb, and it could meet the motion demands of crutch-less walking rehabilitation.

BACKGROUND: Optoelectronic systems and force platforms represent the gold standard for postural sway assessment, but pose disadvantages in terms of equipment, cost and preparation time. OBJECTIVE: Wearable inertial measurement units (IMUs) have been proposed to overcome these issues, but have never been compared to an optoelectronic system. The study aim was therefore to investigate agreement between inertial measurement unit and optoelectronic system in postural sway assessment. METHODS: Thirty healthy volunteers performed four balance tasks. IMU was placed on the sacrum (S2) with a retroreflective marker over the sensor and subjects’ performance was simultaneously recorded by both systems. Total (TOT), anterior-posterior (AP) and medial-lateral (ML) length of trace, range, speed, root mean squared (RMS), and confidence ellipse were computed. RESULTS: ICCs revealed excellent correlations for Length-TOT, Length-AP and Speed-AP, good correlation for Length-ML, Speed-ML, Confidence Ellipse, Range-AP and RMS-AP, and moderate correlation for range-ML and RMS-ML. Bland-Altman plot showed greater estimation for Length-TOT, Length-AP, Speed-AP, confidence ellipse and RMS-AP using optoelectronic system, and for Length-ML, Range-AP, Range-ML, Speed-ML, RMS-ML using IMU. Both systems revealed the same differences among tasks. CONCLUSION: The excellent to good agreement of IMU for length of trace and speed parameters and its user-friendly application suggest its potential implementations in clinical practice.

Patients with hallux rigidus (HR) tend to develop a characteristic alteration in walking to lessening pain and compensate for the limited range of motion at the first metatarsophalangeal (MTP1) joint that might be affected balance and gait. The goal of this study was to perform an integrated biomechanical description of gait and balance of symptomatic patients with either grade as III or IV HR in comparison with healthy subjects. Eleven patients (7 men) with HR (60 ± 7 years, 1.60 ± 0.07 m, and 70 ± 13 kg) and 16 (7 men) healthy subjects (70 ± 8 years, 1.66 ± 0.10 m, and 74 ± 14 kg) were included. Subjects performed 2 tasks: walking (5 trials of straight walking for at least 6 meters) and bipedal quiet standing for 30 seconds. For these 2 tasks the following variables were measured: range of motion of the MTP1 joint, plantar pressure distribution during the stance phase of walking, and the postural sway during quiet standing. Plantar pressure was measured in up 15 walking trials with a mat pressure sensor. The MTP1 joint range of motion for flexion/extension during walking was significantly smaller for the patients with HR than for the control group (HR: 14 ± 8°, control: 44 ± 5°; t(17) = -9.7, p.001). The forefoot plantar pressure distribution among different regions of the foot in patients with HR was not statistically different than the control group, but there was a tendency of higher pressures in the lateral metatarsal heads (p = .06). As description of the postural sway during quiet standing, the center of pressure area was not different between HR and the control group (p.05). Decreased MTP1 joint range of motion for flexion/extension during walking in symptomatic high-grade HR patients can be associated with higher pressure in the lateral metatarsal heads while the impact on postural sway is not affected.

To study the effect of decentration on the quality of vision in 2 aspheric intraocular lenses (IOLs): aspheric balance curve (ABC) design Vivinex iSert XY1 (Hoya Surgical Opticals, Inc.) and posterior aspheric design AcrySof IQ SN60WF (Alcon Laboratories, Inc.).Advanced Eye Centre, PGIMER, Chandigarh, India.Randomized prospective trial using a random number table.85 eyes were randomized to group 1 (Vivinex XY1) and group 2 (AcrySof IQ) with 40 and 45 eyes, respectively. The higher-order aberration (HOA) profile, Strehl ratio, decentration of the IOL from the visual axis (decentration from the visual axis [DVA]) and the geometric axis (decentration from the geometric axis [DGA]), angle α, and κ were recorded on the iTrace aberrometer, and contrast sensitivity was measured using the Functional Acuity Contrast Test at 12 weeks postsurgery.A total of 85 eyes in 60 patients were evaluated in this study. The mean values of the Strehl ratio (P = .48) and the HOAs (P = .12) of both IOLs were comparable. The HOAs gradually increased with increasing DVA for both lenses at 3.0 mm, 4.0 mm, and 5.0 mm pupil sizes. On comparing the HOAs with the DGA, a statistically insignificant positive correlation was observed. The Strehl ratio did not deteriorate with an increasing angle α in the Vivinex XY1 group; however, it worsened in the AcrySof IQ group. Contrast sensitivity was comparable in both the IOLs except at 1.5 cycles per degree under photopic conditions where the AcrySof IQ was better.Decentration of the lens was best measured with respect to the visual axis. In eyes with a large α, the ABC design induced lesser HOAs and maintained a better Strehl ratio.

Context: Objective and expedient assessments of standing postural control incorporating static and dynamic tasks are necessary for identifying subtle motor deficits and clearing children to return to high-risk activities after concussion. The Revised Physical and Neurological Examination for Subtle Signs (PANESS) gaits and stations tasks evaluate both static and dynamic aspects of postural control. While the PANESS gaits and stations subscale is sensitive to concussion in youth, the benefit of each specific task for this purpose is unknown. Purpose: This study evaluated whether specific PANESS tasks identify postural impairments after youth concussion. Design: Cross-sectional study. Setting: Academicallyaffiliated research laboratory. Participants: Sixty youth, ages 10–17 years, comprised 3 groups: (1) youth symptomatic from concussion (4–14 d postinjury [n = 18]), (2) clinically-recovered youth (27–122 d postinjury [n = 15]), and (3) age- and gender-matched never-concussed controls (n = 27). Main Outcome Measure: PANESS gaits and stations tasks (6 dynamic and 3 static) at the time of the initial research visit. Results: Kruskal–Wallis statistic identified a significant main effect of group on standing on one foot (a 30-s task). Both symptomatic and clinically-recovered youth showed deficits on standing on one foot relative to controls. Conclusions: Single-leg tasks of longer duration may maximize the ability to detect residual postural deficits after concussion and can be readily incorporated in targeted sport rehabilitation protocols.

BACKGROUND: Various interventions have been recommended to increase ankle dorsiflexion range of motion (DFROM); however, few studies have investigated the long-term effects of applying gastrocnemius stretching with talus-stabilizing taping (GSTST). OBJECTIVE: To compare the effects of gastrocnemius stretching (GS) and GSTST on DFROM and balance in subjects with limited DFROM. METHODS: Twenty-six subjects with limited DFROM were randomly allocated to either the GS group (n= 13) or GSTST group (n= 13) for 6 weeks. Maximum DFROM before heel-off during gait, passive DFROM, posterior talar glide, flexibility of the gastrocnemius, and the lower-quarter Y-balance test (YBT-LQ) were assessed pre-intervention and post-intervention. Two-way repeated-measures analysis of variance was used to compare the changes in variables. RESULTS: The GSTST group had greater maximum DFROM before heel-off, passive DFROM, and posterior talar glide than the GS group. Gastrocnemius flexibility and YBT-LQ scores increased significantly post-intervention in both groups; however, there was no significant difference between the groups. CONCLUSIONS: GSTST is recommend for improving ankle DFROM and balance in subjects with limited DFROM.

As an important movement of the daily living activities, sit-to-stand (STS) movement is usually a difficult task facing elderly and dependent people. In this article, a novel impedance modulation strategy of a lower-limb exoskeleton is proposed to provide appropriate power and balance assistance during STS movements while preserving the wearer’s control priority. The impedance modulation control strategy ensures adaptation of the mechanical impedance of the human–exoskeleton system toward a desired one requiring less wearer’s effect while reinforcing the wearer’s balance control ability during STS movements. A human joint torque observer is designed to estimate the joint torques developed by the wearer using joint position kinematics instead of electromyography or force sensors; a time-varying desired impedance model is proposed according to the wearer’s lower-limb motion ability. A virtual environmental force is designed for balance reinforcement control. Stability and robustness of the proposed method are theoretically analyzed. Simulations are implemented to illustrate the characteristics and performance of the proposed approach. Experiments with four healthy subjects are carried out to evaluate the effectiveness of the proposed method and show satisfactory results in terms of appropriate power assist and balance reinforcement.

To compare the effects of single- versus dual-task balance training on the gait smoothness and balance of community-dwelling older adults, 69 volunteers were randomized to single-, dual-task training, and control (no intervention) groups. Exercises were received in 18 sessions through 6 weeks. The gait smoothness was measured by the harmonic ratio of trunk accelerations using a triaxial accelerometer. Balance performance was assessed through the Fullerton Advanced Balance scale, Timed Up and Go test, Activities-specific Balance Confidence, and gait speed. After the trial, all variables improved significantly in the training groups. Moreover, differences in the mean change of all variables, except the Timed Up and Go test, were statistically significant between the interventional groups and the control group, but no significant difference was reported between the two training groups. This study suggests that balance training can improve gait smoothness as well as balance status in healthy older adults.

Efforts made to prevent road traffic crashes have reduced the number of crashes involving young drivers, however, overall, they are still the most common age group reported in these incidents. In this study, the driving behaviors of ten young male drivers were compared based on lane change—under time pressure and in normal conditions—on open roads where the surroundings constantly change. The study also chronologically analyzed the motions within five seconds from when the driver started steering. The results of the analysis revealed that, compared to normal conditions, drivers under time pressure responded by steering first and viewing their surroundings second. It was also estimated that, regardless of the conditions, the driver tended to use the indicator two to zero seconds before adjusting the steering. This finding indicates that the delay in viewing their surroundings resulted in delayed signaling, and the series of driving behaviors to change lanes may have been overcrowded in time. The findings of this study suggest that it is possible to prevent human error by focusing on the balance and connection between cognition and the behaviors required for a series of driving behaviors.

Introduction Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. Objective To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. Methods We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. Results A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 55.5% of falls occurred in the bedroom; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. Conclusions Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.

A 22-year-old man presented to the emergency department with a 3-week history of spontaneous right arm ache and swelling. He reported that his symptoms were exacerbated by exercise. There was no history of trauma, weight loss or fever. He had no previous medical history. He was a right-handed

OBJECTIVE To examine the association between postconcussion exercise volume and changes in depression, anxiety, dizziness, and postural stability. DESIGN Secondary analysis of a single-site prospective clinical trial. SETTING Cerebrovascular research laboratory. PARTICIPANTS Participants completed questionnaires and underwent tests of gait and balance within 2 weeks of a concussion (mean = 11 ± 3 days postconcussion) and approximately 1 month later (mean = 41 ± 7 days postconcussion). Exercise volume was tracked by weekly exercise logs. INTERVENTIONS On the basis of a previous work classifying exercise volume following concussion, we grouped participants according to self-reported exercise volume between visits as high exercise volume (≥150 min/wk) or low exercise volume (

The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls (“fallers”) from people who are not at risk for falls (“nonfallers”). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable measurements that can be used for assessing falls risk and evaluating the effectiveness of interventions and is suitable for use in a range of physical therapy and health care settings.

Background A near-fall is defined as a loss of balance that would result in a fall if sufficient balance recovery manoeuvres are not executed. Compared to falls, near-falls and its associated balance recovery manoeuvres have been understudied. Older adults may not recognise a near-fall or identify the use of their balance recovery manoeuvres to prevent a fall. The consensus on the methods to collect near-fall data is lacking. The primary objective of this study was to determine the feasibility of recruitment and retention. Secondary objectives were to establish evidence that Singapore community-dwelling older adults can identify near-falls and associated balance recovery manoeuvres. Texting and calling methods were explored as reporting methods. Methods This study took place in Singapore (September to October 2019). Participants were healthy, community-dwelling adults aged 65 or older. Recruitment was done through poster advertisement, and all participants gave informed consent. Participants attended a briefing session and reported their near-fall or fall incidence over 21 days using either daily texting or calling. The primary outcome measures were the recruitment rate, retention rate, preferred modes for data reporting and ability to report near-falls or falls. Secondary outcomes included the self-reported incidence of falls and near-falls. Results Thirty older adults were recruited in 5 weeks. All participants completed the study. They understood near-fall concepts and were able to report the occurrence and relevant balance recovery manoeuvres used to prevent a fall. 87% (26/30) chose to text while 13% (4/30) selected calling as their reporting method. One actual fall (0.16%) out of 630 responses was reported. Thirty-six incidents (5.7%) of near-falls were recorded. Sixteen participants (53.3%) experienced near-falls and half of this group experienced two or more near-falls. The use of reach-to-grasp strategy (36%), compensatory stepping (52.8%), and other body regions (11.2%) were used to prevent the fall. Conclusions The study provided evidence that studying near-falls in Singapore community-dwelling older adults is feasible and can be applied to a large-scale study. Recruitment and retention rates were good. Older adults were able to identify near-falls and balance recovery manoeuvres. Both texting and calling were feasible reporting methods, but texting was preferred. Trial registration ClinicalTrials identifier: NCT04087551. Registered on September 12, 2019

Background: Footwear worn indoors is generally less supportive than outdoor footwear and may increase the risk of falls. Objective: To evaluate balance ability and gait patterns in older women while wearing different styles of indoor footwear: a backless slipper and an enclosed slipper designed to optimise balance. Methods: Older women (n = 30) aged 65-83 years (mean 74.4, SD 5.6) performed a series of laboratory tests of balance ability (postural sway, limits of stability, and tandem walking, measured with the NeuroCom® Balance Master) and gait patterns (walking speed, cadence, and step length, measured with the GAITRite® walkway) while wearing (1) socks, (2) backless slippers with a soft sole, and (3) enclosed slippers with a firm sole and Velcro® fastening. Perceptions of the footwear were also documented using a structured questionnaire. Results: Significant overall effects of footwear were observed for postural sway, the limits of stability test (directional control), the tandem walk test (step width and end sway), and temporospatial gait patterns (walking speed, cadence, and step length). No footwear effects were observed for maximum excursion when performing the limits of stability test or for speed when performing the tandem walk test. Post hoc tests indicated that performances were best while wearing the enclosed slippers, intermediate with socks, and worst with backless slippers. The enclosed slippers were perceived to be more attractive, comfortable, and well fitted, but heavier than the backless slippers. Most participants (n = 23; 77%) reported that they would consider wearing the enclosed slippers to reduce their risk of falling. Conclusion: Indoor footwear with an enclosed heel, Velcro® fastening, and a firm sole optimises balance and gait compared to backless slippers, and is therefore recommended to reduce the risk of falling.

BACKGROUND: The mastoid vibration (MV) has been used to investigate unilateral vestibular dysfunction by inducing nystagmus. Additionally, this MV can be used to quantify the effect of deterioration by aging on the vestibular system during walking. Could such MV be used to assess the uni/bilateral vestibular deterioration by aging during standing? OBJECTIVE: This study attempted to determine the feasibility of using MV for identifying the uni/bilateral vestibular deterioration by aging during standing. METHODS: Fifteen young and ten old adults’ balance control patterns were assessed by three random MV conditions: 1) No MV; 2) Unilateral MV; 3) Bilateral MV. The dependent variables were the 95% confidence ellipse areas and the sample entropy values, which were calculated based on the center of gravity displacement within each condition. RESULTS: Significant main effects of MV and aging were found on all outcome variables. A significant interaction between aging and different MV types was observed in the 95% confidence ellipse area (p = 0.002) and the length of the short axis (anterior-posterior direction, p = 0.001). CONCLUSIONS: We concluded that the MV could be used to identify different vestibular dysfunctions, specifically in old adults.

BACKGROUND: Trunk control ability is an important component of functional independence after the onset of stroke. Recently, it has been reported that robot-assisted functional training is effective for stroke patients. However, most studies on robot-assisted training have been conducted on upper and lower extremities. OBJECTIVE: The purpose of this study was to evaluate the effects of robot-assisted trunk control training on trunk postural control and balance ability in stroke patients. METHODS: Forty participants with hemiparetic stroke were recruited and randomly divided into two groups: the RT (robot-assisted trunk control training) group (n= 20) and the control group (n= 20). All participants underwent 40 sessions of conventional trunk stabilization training based on the Bobath concept (for 30 minutes, five-times per week for 8 weeks). After to each training session, 15 minutes of robotassisted trunk control training was given in the RT group, whereas the control group received stretching exercise for the same amount of time. Robot-assisted trunk control training was conducted in three programs: sitting balance, sit-to stand, and standing balance using a robot system specially designed to improve trunk control ability. To measure trunk postural control ability, trunk impairment scale (TIS) was used. Center of pressure (COP) distance, limits of stability (LOS), Berg Balance Scale (BBS) and functional reach test (FRT) were used to analyze balance abilities. RESULTS: In TIS, COP distance, LOS, BBS and FRT, there were significant improvements in both groups after intervention. More significant changes were shown in the RT group than the control group (p< 0.05). CONCLUSIONS: Our findings indicate that robot-assisted trunk control training is beneficial and effective to improve trunk postural control and balance ability in stroke patients. Therefore robot-assisted training may be suggested as an effective intervention to improve trunk control ability in patients with stroke.

BACKGROUND: Lumbar radiculopathy is characterized by a significant amount of backache causing loss of workforce and is a significant health problem frequently seen in the general population. OBJECTIVE: The purpose of this study was to compare the effects of conventional physiotherapy (CT) and proprioception exercises (PE) on ankle proprioception and lumbar pain between patients with lumbar radiculopathy and a healthy control group. METHODS: In this randomized clinical trial, 89 patients referred to the Physical Medicine and Rehabilitation outpatient clinic were selected through convenience sampling. They were randomly assigned to three groups: CT (n= 27), PE (n= 31), CT&PE (n= 31). Thirty healthy volunteers were included in the study as the control group. Proprioception measurements were made with an isokinetic dynamometer at 10∘ dorsiflexion (DF), 11∘, and 25∘ plantarflexion (PF) angles. Lumbar pain was assessed by using the Numerical Pain Rating Scale (NPRS). The data were analyzed by IBM SPSS Statistics version 22.0 via the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: There was a statistically significant difference between the groups in terms of ankle proprioception and NPRS measurements in post-treatment evaluations (p< 0.05). Statistically significant differences were found between CT and PE groups and CT&PE and control groups. There was no statistically significant difference in comparing CT and PE groups and CT&PE and control groups within themselves (p> 0.05). CONCLUSION: The combined use of CT and PE is an effective method that can be used in the clinic to reduce angular differences in ankle proprioception which is one of the primary factors of balance and coordination and lumbar pain.

BACKGROUND It is important to recognize stroke in the general public. OBJECTIVES The purpose of this study was to investigate factors affecting knowledge of stroke warning signs (SWSs) according to age group in the Korean population. METHODS This study is a cross-sectional study. Using data from the Korean Community Health Survey conducted in Korea in 2017, 198 403 subjects were analyzed. Knowledge about SWSs was assessed by face-to-face interviews using structured close-ended questionnaires with 5 items about stroke symptoms (sudden unilateral weakness of face, arm or leg; sudden difficulty in speaking, or trouble understanding speech; sudden visual impairment in 1 eye, or double vision; sudden dizziness or loss of balance; and sudden severe headache). RESULTS The overall percentage of subjects with good knowledge of SWSs (>4 correct answers to the SWS questionnaire) was 66.5%. It was highest in the middle-aged subjects (72.6%), followed by the young subjects (63.5%) and the older subjects (61.5%). The youngest of the young subjects and the oldest of the older subjects had the least knowledge. Subjects with conventional risk factors generally had more knowledge about SWSs, except for those with diabetes mellitus. However, in the young subjects, knowledge about SWSs was not increased by the presence of conventional risk factors such as hypertension and dyslipidemia. CONCLUSION Stoke risk factors are increasing among young people; they still have poor knowledge about SWSs. More education is needed to increase appropriate treatment, especially in young people with stroke-related risk factors.

Background Deficits in single-limb dynamic postural stability are predictive for reinjuries of the lower extremities, which are very common in sports. The use of force plates has become increasingly common to measure dynamic postural stability. Visual feedback on force-plate based stability outcomes have been shown to improve performance during static tasks. A similar effect might occur in dynamic tasks. Since dynamic tasks are generally more specific for performance during sport, this could have important training implications. Research question What is the effect of visual feedback on postural stability outcomes during a dynamic stability task? Methods Twenty-four healthy participants participated in this study. During measurements, subjects were standing on one leg while mediolateral position-controlled platform perturbations were used to evoke and measure balance responses. All participants were tested under three conditions: with visual Time-to-Stability (TTS) feedback, with visual Center of Pressure speed (COPs) feedback and without visual feedback. TTS and COPs outcomes were calculated over a 5-second time window after each perturbation and were compared between conditions. Results Visual feedback resulted in significantly better stability outcomes during the dynamic stability task. TTS feedback resulted in a task-specific feedback learning effect, as it resulted in a gradual improvement of TTS scores (from 1.09 s to 0.68 s; -38%) in absence of a significant change in COPs. COPs feedback resulted in a non-specific attention effect, directly improving COPs (without feedback 5.26 cm/s with feedback 4.95 cm/s; -6%) and TTS scores (without feedback 1.47 s with feedback 0.99 s; -39%) in absence of an apparent further improvement over time. Significance The ability to improve performance of dynamic stability tasks when visual feedback is added could have substantial impact for rehabilitation. Possibly, the use of visual feedback during stability training could improve the effectiveness of postural stability training.

Para-cycling has high rates of acute injuries. The underlying medical conditions of para-athletes predispose these cyclists to injury patterns and sequelae different from those of their able-bodied counterparts. Such injuries include an increased incidence of upper-extremity and soft tissue injuries, along with predisposition for respiratory, skin, genitourinary, and heat-related illnesses. There are no validated sideline assessment tools or return-to-play protocols for sports-related concussion in wheelchair user para-athletes or those with balance deficits. Para-cyclists may be at increased risk for relative energy deficiency in sport due to competitive pressure to maintain certain weights and increased incidence of low bone mineral density.

Purpose: Modeling intermittent work capacity is an exciting development to the critical power model with many possible applications across elite sport. With the Skiba 2 model validated using subelite participants, an adjustment to the model’s recovery rate has been proposed for use in elite cyclists (Bartram adjustment). The team pursuit provides an intermittent supramaximal event with which to validate the modeling of W′ in this population. Methods: Team pursuit data of 6 elite cyclists competing for Australia at a Track World Cup were solved for end W′ values using both the Skiba 2 model and the Bartram adjustment. Each model’s success was evaluated by its ability to approximate end W′ values of 0 kJ, as well as a count of races modeled to within a predetermined error threshold of ±1.840 kJ. Results: On average, using the Skiba 2 model found end W′ values different from zero (P = .007; mean ± 95% confidence limit, –2.7 ± 2.0 kJ), with 3 out of 8 cases ending within the predetermined error threshold. Using the Bartram adjustment on average resulted in end W′ values that were not different from zero (P = .626; mean ± 95% confidence limit, 0.5 ± 2.5 kJ), with 4 out of 8 cases falling within the predetermined error threshold. Conclusions: On average, the Bartram adjustment was an improvement to modeling intermittent work capacity in elite cyclists, with the Skiba 2 model underestimating the rate of W′ recovery. In the specific context of modeling team pursuit races, all models were too variable for effective use; hence, individual recovery rates should be explored beyond population-specific rates.

Objective ranscranial direct current stimulation (tDCS) is a non-invasive neuro-modulation technique that delivers current through the scalp by a pair of patch electrodes (2-Patch). This study proposes a new multi-channel tDCS (mc-tDCS) optimization method, the distributed constrained maximum intensity (D-CMI) approach. For targeting the P20/N20 somatosensory source at Brodmann area 3b, an integrated combined magnetoencephalography (MEG) and electroencephalography (EEG) source analysis is used with individualized skull conductivity calibrated realistic head modeling. Methods Simulated electric fields (EF) for our new D-CMI method and the already known maximum intensity (MI), alternating direction method of multipliers (ADMM) and 2-Patch methods were produced and compared for the individualized P20/N20 somatosensory target for 10 subjects. Results D-CMI and MI showed highest intensities parallel to the P20/N20 target compared to ADMM and 2-Patch, with ADMM achieving highest focality. D-CMI showed a slight reduction in intensity compared to MI while reducing side effects and skin level sensations by current distribution over multiple stimulation electrodes. Conclusion Individualized D-CMI montages are preferred for our follow up somatosensory experiment to provide a good balance between high current intensities at the target and reduced side effects and skin sensations. Significance An integrated combined MEG and EEG source analysis with D-CMI montages for mc-tDCS stimulation potentially can improve control, reproducibility and reduce sensitivity differences between sham and real stimulations.

Background Children with Down Syndrome (DS) present with neuromuscular disturbances leading to delayed developmental milestones, poor quality of movement and poor balance. The aim of this study is to discuss the role of trunk muscle strength in the functional performance of children with DS. Methodology 28 children were recruited in the study, 14 with DS and 14 age and gender-matched controls. Trunk muscle strength, reaching ability and balance were assessed using a Handheld Dynamometer, Modified Functional Reach test and Pediatric Balance Scale, respectively. Results Children with DS present with poorer trunk muscle strength, reaching ability and balance as compared to typically developing (TD) children. There was a positive correlation between trunk muscle strength and lateral reaching in children with DS. A strong to moderate correlation was observed between the trunk muscle strength and balance in children with DS. Discussion Children with DS demonstrated a significantly weak trunk muscle groups. Lateral reaching distance is reduced due to the poor proximal control and they present with near-normal forward reach distance attributed to compensation using the lower trunk muscles. They exhibit poor balance in the components that require a small base of support. Conclusion Children with DS exhibit weak trunk muscles along with lesser reaching distance and poor balance. Also, trunk muscle strength influences lateral reaching ability. Trunk muscle strength, mainly trunk extensors impacted functional balance in sitting, standing and while performing transfers.

Purpose: We aimed to provide an extended analysis of the physiological handling of of the sodium burden induced by maintenance fluids. Materials and methods: We revisited two studies that demonstrated, in healthy volunteers and in surgical patients, that maintenance fluids with 154 mmol/L of sodium lead to a more positive fluid balance than a regimen containing 54 mmol/L. We report different unpublished data on the renal handling of the imposed sodium bur -dens with specific attention to the resulting fluid and sodium balances. Results: The kidneys adapt to the sodium-rich fluids not only by altering sodium excretion, but also by retaining extra free water by concentrating urine. Realigning urinary sodium excretion with an increased administration takes around one day in health and much longer in the clinical setting. This difference may be explained by the presence of hypovolemia-induced aldosterone secretion in the latter group. Non-osmotic storage of sodium limits an unrestrained fluid retention even when very high amounts of sodium are administered but fluid accu-mulation will inevitably be further prolonged. Conclusions: Sodium administration induced by sodium-rich maintenance fluids leads, especially in the clinical setting, to prolonged fluid retention when compared with a regimen that resembles a healthy dietary sodium in-take, even when kidney function is normal. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Background Postural sway during quiet standing has been shown as a useful task to assess risk of falling in older adults. While the risk of falling is consistently reported to be higher in older females than males, the sex-related differences in postural sway are not consistent across the studies. Research question What are the effects of age and sex on postural sway during quiet standing during different stance conditions? Methods We examined the effects of age (40 young and 34 older adults), sex (37 males and 37 females), and their interaction on the postural sway during different stance conditions. We compared the center of pressure (CoP) velocity, amplitude and frequency during parallel (eyes open and eyes closed) and semi-tandem (eyes open) stances. Results Our results suggest that postural sway is similar between sexes in young participants, while older males exhibit larger postural sway than older female participants (10/21 outcomes). Older female participants exhibited lower CoP amplitude (but larger total and anterior-posterior CoP velocity) compared to young female participants. We also found that the increase in the postural sway with increasing task difficulty is more pronounced in older vs. young adults. Significance This study shows that ageing-related changes in postural sway are sex- and task-specific. Researchers and clinicians need to be aware of these effects when comparing groups or monitoring changes in time.

Balance ability is important for preschoolers' motor and physical development. Portable accelerometers can provide resolution tests and identification of preschoolers with balance defects.Despite previous studies on the balance measures of accelerometer tests, there is a lack of complete analyses for preschoolers aged 4-5 years. In this study, we aim to verify the reliability of measuring the static balance of preschoolers in this age range based on inertia sensors for the acceleration and angular velocity moduli.Thirty children wore an inertial sensor in the 5th lumbar vertebra and completed four tests, i.e., standing on a firm surface and on a foam surface with open and closed eyes. The standard deviation of the acceleration modulus and root mean square of the angular velocity modulus were calculated. The analysis was based on the intraclass correlation coefficient (ICC) to determine the internal consistency and feasibility.The ICC of the acceleration modulus was between 0.597 and 0.683 (P 0.01), and the test-retest reliability was medium. The ICC of the angular velocity modulus was between 0.683 and 0.812 (P 0.01, P 0.001), and the test-retest reliability was medium to good. The standard error of measurement (SEM) of the acceleration modulus was between 0.001591 and 0.007248 (g), and the SEM% was between 21.24% and 34.12%. The angular velocity modulus SEM values ranged from 1.296 to 3.441 (deg/s), and the SEM% ranged from 25.17% to 33.26%. The difference between the two tests was evenly distributed on both sides of the mean value, and the difference between the test results was within the consistency limit.Inertial sensors can be used to evaluate the static balance ability of preschoolers aged 4-5 years. Further, the angular velocity modulus is more reliable than the acceleration modulus.

About 1% of the newborn population has developmental dysplasia of the hip (DDH), altering joint biomechanics, gait performance and balance control. Pemberton's osteotomy is used in early treatment but it remains unclear whether it will help the patient regain normal balance control during gait. The current study aimed to identify the changes of the whole-body balance control during level walking in children treated for unilateral DDH during toddlerhood, in terms of inclination angles (IA) of the line joining the body's center of mass (COM) and center of pressure (COP), and the rate of change of IA (RCIA).Twelve girls (DDH group; age: 7.1 ± 2.1 years) who had been treated with Pemberton's osteotomy for unilateral DDH during toddlerhood and twelve healthy controls (Control group; age: 7.6 ± 2.1 years) walked at their preferred walking speed while IA, RCIA and temporal-spatial parameters were calculated from measured kinematic and forceplate data, and were compared using independent t-tests.Compared to the Control group, the DDH group showed significantly decreased sagittal IA (p = 0.042) but increased range of sagittal RCIA during SLS on the unaffected side (p = 0.006), and increased peak sagittal RCIA during DLS (p 0.008). In the frontal plane, the altered COM-COP control occurred mainly during stance phase of the affected side, showing a decreased range of RCIA during SLS (p = 0.033) followed by decreased IA (p = 0.045) with an increased peak value of RCIA (p = 0.023) during terminal DLS.The children with treated unilateral DDH showed compromised, bilaterally different balance control strategies with altered COM-COP control during gait, not only during stance in the frontal plane as expected, but even more so during swing in the sagittal plane. It is thus suggested that routine assessment of the morphological changes and/or altered balance control of both the unaffected and affected hips is equally important for early identification of any signs of insidious hip problems, deteriorating balance control or increased risk of loss of balance.

Purpose: To assess weekly fluctuations in hormonal responses and their relationships with load and well-being during a congested in-season phase in basketball players. Methods: Ten semiprofessional, male basketball players were monitored during 4 congested in-season phase weeks consisting of 3 weekly matches. Salivary hormone variables (testosterone [T], cortisol [C], and T:C ratio) were measured weekly, and external load (PlayerLoad™ and PlayerLoad per minute), internal load session rating of perceived exertion, percentage of maximum heart rate (HR), summated HR zones, and well-being were assessed for each training session and match. Results: Significant (P < .05) moderate to large decreases in T were found in the third and fourth weeks compared with the first week. Nonsignificant moderate to large decreases in C were apparent in the last 2 weeks compared with previous weeks. Summated HR zones and perceived sleep significantly (P < .05) decreased in the fourth week compared with the first week; whereas, percentage of maximum HR significantly (P < .05) decreased in the fourth week compared with the second week. No significant relationships were found between weekly changes in hormonal responses and weekly changes in load and overall wellness. Conclusions: A congested schedule during the in-season negatively impacted the hormonal responses of players, suggesting that T and C measurements may be useful to detect fluctuations in hormone balance in such scenarios. The nonsignificant relationships between weekly changes in hormonal responses and changes in load and well-being indicate that other factors might induce hormonal changes across congested periods in basketball players.

OBJECTIVE: Mindful Mood Balance (MMB) is an effective web-based program for residual depressive symptoms that prevents major depressive relapse among patients who partially recovered from major depressive episodes. This is a cost-effectiveness analysis from the health plan perspective alongside a pragmatic randomized controlled trial of MMB. METHODS: Adult patients were recruited and randomized to MMB + Usual Depression Care or Usual Depression Care (UCD) from behavioral health and primary care settings in a large integrated health system. Patients had >=1 prior major depressive episode, current PHQ-9 score of 5–9 indicating residual depressive symptoms, and internet access. Program costs included recruitment, coaching and MMB licensing. Center for Medicare and Medicaid fee schedules were applied to EHR utilization for all psychotropic medications, psychiatric and psychotherapy visits. Effectiveness was measured as Depression Free Days, converted from PHQ-9 scores collected every month during 1-year follow-up. Incremental Cost Effectiveness Ratios were calculated with different sets of cost-inputs. RESULTS: There were 389 patients (210 UCD and 179 MMB+UDC) included with adequate follow-up PHQ-9 measures over 12 months. MMB patients had 28 more depression free days during the 12-month follow-up period. Overall, the incremental cost of MMB+UDC was $431.54 over 12-months. Incremental costs per depression free day gained ranged from $9.63 for program costs only to $15.04 when psychiatric visits, psychotherapy visits and psychotropic medications were included. CONCLUSION: MMB offers a cost-effective web-based program for reducing residual depressive symptoms and preventing major depressive relapse that health systems should consider adopting as adjunctive to traditional mental health care services.

Background Subjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited. Research Question What are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis? Methods Parent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn’s post hoc test with Bonferroni adjustment. Spearman’s rank correlations were performed to determine the relationship between responses and gait parameters. Results Data from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r=-0.31 p=0.000), normalised step length (r=-0.30 p=0.0000) and normalised gait speed (r=-0.24 p=0.0001). Significance Subjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.

A consistent finding in sensorimotor adaptation is a persistent undershoot of full compensation, such that performance asymptotes with residual errors greater than seen at baseline. This behaviour has been attributed to limiting factors within the implicit adaptation system, which reaches a sub-optimal equilibrium between trial-by-trial learning and forgetting. However, recent research has suggested that allowing longer motor planning periods prior to movement eliminates these residual errors. The additional planning time allows required cognitive processes to be completed before movement onset, thus increasing accuracy. Here we looked to extend these findings by investigating the relationship between increased motor preparation time and the size of imposed visuomotor rotation (30°, 45° or 60°), with regards to the final asymptotic level of adaptation. We found that restricting preparation time to 0.35 seconds impaired adaptation for moderate and larger rotations, resulting in larger residual errors compared to groups with additional preparation time. However, we found that even extended preparation time failed to eliminate persistent errors, regardless of magnitude of cursor rotation. Thus, the asymptote of adaptation was significantly less than the degree of imposed rotation, for all experimental groups. Additionally, there was a positive relationship between asymptotic error and implicit retention. These data suggest that a prolonged motor preparation period is insufficient to reliably achieve complete adaptation and therefore our results provide support for the proposal that limitations within the implicit learning system contributes to asymptotic adaptation levels.New & NoteworthyResidual errors in sensorimotor adaptation are commonly attributed to an equilibrium between trial-by-trial learning and forgetting. Recent research suggested that allowing sufficient time for mental rotation eliminates these errors. In a number of experimental conditions, we show that while restricted motor preparation time does limit adaptation - consistent with mental rotation - extending preparation time fails to eliminate the residual errors in motor adaptation.

Objectives Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. Design and methods Synthesis of published works within the field of exercise training in MS. Results Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. Conclusions Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.

BACKGROUND: In the long term, Parkinson’s disease (PD) leads to the development of difficulties in daily functional tasks. There remains a paucity of evidence on the effectiveness of physiotherapy on patient-perceived difficulties regarding basic activities of daily living (ADL). OBJECTIVES: To assess an effect of a versatile physiotherapy intervention on patient-perceived difficulties in basic ADL. METHODS: The study sample included 24 patients (10 men and 14 women) with PD. Participants were randomly assigned into intervention (IG) and control groups (CG). Two assessments were performed with a gap of 10 weeks. Following first assessment, during an 8-week period, IG participants attended sixteen physiotherapy 60-minutes sessions in groups that were divided into five parts to address the core areas recommended by the European Physiotherapy Guideline for PD (EPGPD): gait, transfers, balance, physical capacity, and manual activities. The main assessment tool was the Modified Patients Specific Functional Scale (ModPSFS), which represents a self-assessment rating on difficulties perceived in 17 different commonly occurring activities. RESULTS: IG members reported a significant reduction in self-perceived difficulties as assessed by ModPSFS (effect size 1.39; 95%CI 5.1, 26.6 points, p = 0.005). CONCLUSIONS: 2-months conventional physiotherapy with incorporated core areas recommended in EPGPD for PD reduced patient-perceived difficulties in basic ADL.

Background. Diseases of the hip joint are often accompanied by structural muscular changes, which are one of the reasons that make it difficult to select the components of the endoprosthesis, since it is impossible to take into account the elasticity of the muscle before the surgery. This leads to the fact that the global femoral offset, and it is determine the length of the abductor shoulder after endoprosthetics, does not always correspond to the length of the arm of force of the abductors from the opposite side, and often is less. This leads to disruption of the abduction mechanism and worsens the results of arthroplasty. The purpose of this study is to analyze the work of the muscles responsible for maintaining the postural balance at a different value of the global femoral offset. Materials and methods. A horizontal equilibrium model of the pelvis was used for the calculations. The model is constructed from the calculation of the patient’s weight of 70 kg. The absolute values of the forces developed by each muscle are used, the angles of attachment of muscles and the magnitude of the the arm of force of each muscle are taken into account. The calculations are based on the principle of equality of forces and moments of the forces of abductor muscles and moment of gravity, which provide a horizontal balance of the pelvis. Simulation implied an analysis of the forces that should develop the muscles to maintain horizontal equilibrium of the pelvis under different conditions: a decrease in the global femoral offset, an increase in the weight of the patient, a decrease in the absolute strength of the muscles. Results. As a result of the simulation, it was found that a decrease in the global femoral offset after arthroplasty to 5 mm does not have a critical effect on the efficiency of the abductor mechanism, but the more significant difference between the length of the arm of abductors’ force of the healthy femur and the value of the global femoral offset after arthroplasty significantly worsens the working conditions of the muscles. A very important factor negatively affecting the preservation of the postural balance after arthroplasty is the functional insufficiency of abductor muscles. Excess body weight of the patient is a factor that complicates the work of the abductor mechanism. And in conditions of functional deficiency of muscles, this factor has a critical effect on the process of maintaining the postural balance. Conclusions. The most significant factors negatively affecting the functioning of the abduction mechanism after hip arthroplasty are a decrease in the global femoral offset by more than 5 mm, an excess body weight of the patient, a preoperative decrease in the muscle strength responsible for maintaining the postural balance.

Background: Instrumented measures of balance and gait measure more specific balance and gait impairments than clinical rating scales. No prior studies have used objective balance/gait measures to examine associations with ventricular and brain volumes in people with Parkinson’s disease (PD). Objective: To test the hypothesis that larger ventricular and smaller cortical and subcortical volumes are associated with impaired balance and gait in people with PD. Methods: Regional volumes from structural brain images were included from 96 PD and 50 control subjects. Wearable inertial sensors quantified gait, anticipatory postural adjustments prior to step initiation (APAs), postural responses to a manual push, and standing postural sway on a foam surface. Multiple linear regression models assessed the relationship between brain volumes and balance/gait and their interactions in PD and controls, controlling for sex, age and corrected for multiple comparisons. Results: Smaller brainstem and subcortical gray matter volumes were associated with larger sway area in people with PD, but not healthy controls. In contrast, larger ventricle volume was associated with smaller APAs in healthy controls, but not in people with PD. A sub-analysis in PD showed significant interactions between freezers and non-freezers, in several subcortical areas with stride time variability, gait speed and step initiation. Conclusion: Our models indicate that smaller subcortical and brainstem volumes may be indicators of standing balance dysfunction in people with PD whereas enlarged ventricles may be related to step initiation difficulties in healthy aging. Also, multiple subcortical region atrophy may be associated with freezing of gait in PD.

Актуальність. Тривало існуючий патологічний процес в тазостегновому суглобі призводить до порушення його нормальної біомеханіки. При цьому страждають м’язи тазового пояса. Ендопротез кульшового суглоба, відновлюючи опор-ність і рух в оперованому суглобі, не відновлює роботу м’язів, у зв’язку з чим порушення опорно-кінематичної функції тазо- стегнового суглоба зберігається тривалий час. З огляду на складність вивчення функції м’язів метою даного дослідження є створення універсальної математичної моделі роботи м’язів тазового пояса для дослідження особливостей їх функціонування в процесі забезпечення горизонтальної рівноваги таза. Матеріали та методи. На основі натурного скелета людини була побудована фізична модель «поперековий відділ хребта — таз — стегно» з позначенням напрямів діяльності м’язів і кутів їх прикріплення і складена розрахункова схема з урахуванням напрямку і сили дії м’язів. Модель побудована з розрахунку ваги пацієнта 70 кг, показники абсолютної величини сил, що розвиваються кожним м’язом, кути прикріплення м’язів і величини плеча сили кожного м’яза взяті з літературних джерел. Були складені рівняння рівноваги моментів сили гравітації і сумарного м’язового моменту сил. Результати. Для перевірки валідності розробленої моделі досліджували її роботу на прикладі ендопротезування кульшового суглоба. Як розрахункові умови роботи моделі взяли ситуацію, при якій досліджуваний стоїть на одній нозі, зберігаючи горизонтальну рівновагу таза. Проведені розрахунки показують, що розроблена нами модель роботи м’язів тазового пояса по забезпеченню горизонтальної рівноваги таза працює з більш ніж триразовим запасом міцності, отримані результати відповідають літературним даним, отже, модель валідна і може застосовуватися для відповідних розрахунків. Висновки. Створена універсальна математична модель роботи м’язів тазового пояса дозволяє вивчати і аналізувати вплив різних зовнішніх факторів на можливість сталого одноопорного стояння., Актуальность. Длительно существующий патологический процесс в тазобедренном суставе приводит к нарушению его нормальной биомеханики. При этом страдают мышцы тазового пояса. Эндопротез тазобедренного сустава, восстанавливая опорность и движения в оперированном суставе, не восстанавливает работу мышц, в связи с чем нарушения опорно-кинематической функции тазобедренного сустава сохраняются длительное время. С учетом сложности изучения функции мышц целью данного исследования стало создание универсальной математической модели работы мышц тазового пояса для исследования особенностей их функционирования в процессе обеспечения горизонтального равновесия таза. Материалы и методы. На основе натурного скелета человека была построена физическая модель «поясничный отдел позвоночника — таз — бедро» с обозначением линий действия мышц и углов их прикрепления и составлена расчетная схема с учетом направления и силы действия мышц. Модель построена из расчета веса пациента 70 кг, показатели абсолютной величины сил, развиваемых каждой мышцей, углы прикрепления мышц и величины плеча силы каждой мышцы взяты из литературных источников. Были составлены уравнения равновесия моментов силы гравитации и суммарного мышечного момента сил. Результаты. Для проверки валидности разработанной модели исследовали ее работу на примере эндопротезирования тазобедренного сустава. В качестве расчетных условий работы модели приняли ситуацию, при которой исследуемый стоит на одной ноге, сохраняя горизонтальное равновесие таза. Проведенные расчеты показывают, что разработанная нами модель работы мышц тазового пояса по обеспечению горизонтального равновесия таза работает с более чем трехкратным запасом прочности, полученные результаты соответствуют литературным данным, следовательно, модель валидна и может применяться для соответствующих расчетов. Выводы. Создана универсальная математическая модель работы мышц тазового пояса, позволяющая изучать и анализировать влияние различных внешних факторов на возможность устойчивого одноопорного стояния., Background. A long-term pathological process in the hip joint leads to a disruption of its normal biomechanics. In this case, the muscles of the pelvic girdle suffer. Endoprosthesis of the hip joint helps to restore the support and movement in the operated joint, but does not restore the work of the muscles. So, a musculoskeletal dysfunction of the hip joint persists for a long time. Given the complexity of the study of muscle function, the purpose of this research is to create a universal mathematical model of the pelvic muscles to investigate the features of their function in providing a horizontal pelvic balance. Materials and methods. Based on the human skeleton, a physical model “lumbar spine — pelvis — hip” was simulated with the designation of the lines of muscular action and the angles of their attachment, and a design scheme was drawn up, taking into account the direction and strength of the muscles. The model is designed at the weight of the patient of 70 kg, the indices of the absolute magnitude of the forces developed by each muscle, the angles of attachment of the muscles and the magnitude of the shoulder strength of each muscle are taken from literary sources. Balance equations for the moments of the force of gravity and the total muscle torque of the forces were compiled. Results. To test the validity of the developed model, its work was studied using the example of hip joint arthroplasty. As the design conditions of the model, the situation was adopted, in which the “patient” stands on one leg, maintaining the horizontal balance of the pelvis. The performed calculations show that the model of the pelvic girdle muscles to ensure horizontal balance of the pelvis works with more than threefold safety factor, the results correspond to the literature data, therefore, the model is valid and can be used for appropriate calculations. Conclusions. A universal mathematical model for the work of pelvic girdle muscles has been created, which makes it possible to study and analyze the influence of various external factors on the possibility of a stable one-leg standing.

BACKGROUND: Many epidemiologic studies of vestibular disorders are based on responses to questionnaires which have not been tested against objective tests of the vestibular system. OBJECTIVE: The goal was to determine if the dizziness and balance questions used in the National Health Interview Survey (NHIS) are valid and predict performance on objective tests of the vestibular system (VNG). METHODS: Data from 367 participants recruited from the community, aged 21.4 to 87.6 years, were collected in the Otolaryngology department at a tertiary care center. They were asked the eight NHIS questions twice, at least 30 minutes apart and were tested on VNG. RESULTS: Question responses changed from Test 1 to Test 2 and differed between males and females. “Yes” responses did not predict abnormal VNG responses, for the total group and when the group was categorized into younger (60 years) subjects. The sensitivity and specificity of all questions was low. CONCLUSION: The NHIS questions provide some information about what people recall of their experiences, but they may not provide insight into the diagnostic prevalence of vestibular and balance disorders because the sensitivity and specificity are too low. Questionnaire-based epidemiologic studies should be interpreted with caution.

BACKGROUND: Adults with unilateral posterior canal benign paroxysmal positional vertigo (BPPV) may continue to present with residual dizziness and balance impairments after the canalith repositioning maneuver (CRM). Customized Vestibular rehabilitation (VR) in addition to the standard CRM may improve postural control in adults with BPPV. However, the effectiveness of this intervention for improving dyanmic gait measures in adults with BPPV is unknown. OBJECTIVE: We aimed to determine the effectiveness of customized VR in addition to the standard CRM on dynamic gait measures among adults with unilateral posterior canal BPPV. METHODS: In this double blind, randomized controlled trial, 28 adults with BPPV were randomized to either control (n = 14, age: 54.36±8.55) or experimental (n = 14, age: 50.71±9.88) groups. The experimental and control groups received customized VR plus standard CRM for six weeks and standard CRM for two weeks respectively. Dynamic gait measures (duration of a complete gait cycle, stride velocity, turning duration and number of steps while turning) were recorded using a portable mobility sensor (iTUG) at baseline, week 4 and 6. A mixed model ANOVA was used to estimate the main effects of the interventions. RESULTS: During walking, a group effect was demonstrated on gait duration, stride velocity, turning duration and number of steps while turning (p