Search

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose. To compare the kinetic characteristics of Tai Chi forms performed in standing and seated positions. Methods. An experienced Tai Chi master was invited to perform the Tai Chi Qi Qong 18-form while standing and seated. Two force platforms were used to track the centre of pressure (COP) during the Tai Chi movements. Centre of mass (COM) displacement was measured using a video motion analysis system. Results. In standing, the maximum COP displacements in the anteroposterior and mediolateral directions ranged from 2.6% to 9.5%, and 0.3% to 29.6% of the subject's height, respectively. The maximum COP displacements in sitting were smaller, with mean displacements of 0.7% and 0.1% of height in the anteroposterior and ML directions, respectively. The subject's COM moved in the vertical direction in slow, coordinated and smooth patterns. Conclusions. The kinetic data on each of the 18 Tai Chi forms studied can guide the choice of suitable Tai Chi forms for balance training. Sitting Tai Chi is recommended for rehabilitating the balance of frail older adults who have difficulty standing. Because of the minimal demands of sitting Tai Chi for balance control, progressing to practice in standing as quickly as possible is recommended. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the co-contraction of ankle muscles in older subjects with and without a history of falls during a stepping down activity, and whether the co-contraction was disrupted by a concurrent cognitive task. Method. Ten fallers and 9 non-fallers (mean age = 72.0 +/- 5.0 and 72.1 +/- 7.3 years, respectively) were recruited. Electromyography (EMG) of the tibialis anterior (TA) and medial gastrocnemius (MG) was recorded during stepping down with and without a concurrent cognitive task. Co-contraction was investigated using the time between the EMG onset and the foot touching a force-platform, termed the pre-landing muscle response latency. Results. The fallers showed longer pre-landing muscle response latencies in the TA compared with non-fallers (141.1 +/- 58.1 ms and 110.9 +/- 68.2 ms, respectively). With a concurrent cognitive task, the pre-landing muscle response latencies in the TA were shortened in fallers significantly more than in non-fallers (44.4% and 15.5%, respectively). No significant difference in MG activation was found between 2 groups in the stepping down activity with and without cognitive task. Conclusions. Subjects with history of falls exhibit a greater shortening in the pre-landing muscle response latency than non-fallers when distracted during stepping down. Disruption of their co-contraction in ankle joint might precipitate such older adults to fall. [ABSTRACT FROM AUTHOR]

PURPOSE: The objectives of this cross-sectional study were to examine whether older Tai Chi practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence than healthy older adults. METHODS: Tai Chi and control subjects (N = 24 each, aged 69.3 +/- 5.0 and 71.6 +/- 6.1 yr, respectively) were matched with respect to age, gender, height, weight, and physical activity level. Concentric and eccentric isokinetic tests of the subjects' dominant knee extensors and flexors were conducted at an angular velocity of 30 degrees.s(-1). Control of body sway was assessed in static double-leg stance and in single-leg stance perturbed by forward or backward platform perturbations. The Activities-specific Balance Confidence (ABC) scale was used to investigate subjects' balance confidence in daily activities. RESULTS: Tai Chi practitioners had higher peak torque-to-body weight ratios in concentric and eccentric isokinetic contractions of their knee extensors and flexors (P = 0.044). They manifested less anteroposterior body sway angles in perturbed single-leg but not static double-leg stance than did control subjects (P < 0.001). Tai Chi practitioners also reported significantly higher balance confidence score ratios (P = 0.001). Older adults' knee muscle strengths showed negative correlations with body sway angles in perturbed single-leg stance and positive correlations with ABC score ratios. Moreover, their body sway angles in perturbed single-leg stance were negatively correlated with their ABC score ratios (all P < 0.05). CONCLUSION: Our results demonstrate that long-term Tai Chi practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence. Significant correlations among these three measures uncover the importance of knee muscle strength and balance control during perturbed single-leg stance in older adults' balance confidence in their daily activities. [ABSTRACT FROM AUTHOR]

PURPOSE: Our previous studies showed that experienced Tai Chi practitioners had better joint proprioception and balance control during weight shifting. The objective of the present study was to examine whether experienced golfers had attained similar improvement when compared with the Tai Chi practitioners, as well as healthy elderly subjects and young university students. METHODS: We compared 12 experienced elderly Tai Chi practitioners, with 11 experienced elderly golfers, 12 healthy elderly subjects, and 12 young university students, who were all males, using: 1) passive knee joint repositioning test to assess their joint proprioceptive acuity and 2) limits of stability test to assess their ability to voluntarily weight shift within their base of support. RESULTS: Both Tai Chi practitioners and golfers had better knee joint proprioceptive acuity than did the elderly control subjects (P < 0.05). Of special interest is that their performance was similar to that of the young subjects. In the limits of stability test, Tai Chi practitioners and golfers had faster reaction time, leaned further without losing stability, and showed better control of leaning trajectory than did elderly control subjects (all P < 0.05). The latter two outcome measures were also comparable to those of the young subjects. CONCLUSION: These results demonstrate that both experienced Tai Chi practitioners and golfers had improved knee joint proprioception and limits of stability, when compared with those of elderly control subjects similar in age, gender (male), and physical activity level. Such improved outcome measures were comparable to those of young male subjects. These findings suggest that experienced Tai Chi practitioners and golfers had improved joint proprioceptive acuity and dynamic standing balance control, despite the known aging effects in these specific sensorimotor functions. [ABSTRACT FROM AUTHOR]

PURPOSE: The objective of this study was to examine whether 4 and/or 8 wk of intensive Tai Chi practice could improve balance control in the healthy elderly subjects. METHODS: Forty-nine community-dwelling elderly subjects (aged 69.1 +/- SD 5.8 yr) voluntarily participated in an intervention program of either supervised Tai Chi or general education for 1.5 h, 6x wk for 8 wk. Two balance tests were administered using computerized dynamic posturography before, at 4 and 8 wk during training, and at 4 wk after training ended: 1) the sensory organization test measured subjects' abilities to use somatosensory, visual, and vestibular information to control their body sway during stance under six sensory conditions; and 2) the limits of stability test measured subjects' abilities to voluntarily weight shift to eight spatial positions within their base of support. These outcome measures were compared between the two intervention groups, and with those of experienced Tai Chi practitioners having means of 7.2 and 10.1 yr of practice from two previous studies. RESULTS: Statistical analysis demonstrated that, after 4 and 8 wk of intensive Tai Chi training, the elderly subjects achieved significantly better 1) vestibular ratio in the sensory organization test (P = 0.006) and 2) directional control of their leaning trajectory in the limits of stability test (P = 0.018), when compared with those of the control group. These improvements were maintained even at follow-up 4 wk afterward. Furthermore, the improved balance performance from week 4 on was comparable to that of experienced Tai Chi practitioners. CONCLUSIONS: The above findings indicated that even 4 wk of intensive Tai Chi training are sufficient to improve balance control in the elderly subjects. [ABSTRACT FROM AUTHOR]

PURPOSE: The objectives of this study were to examine whether elderly Tai Chi practitioners have developed better knee joint proprioception and standing balance control than control subjects. METHODS: Tai Chi and control subjects (N = 21 each, aged 69.4 +/- SD 5.5 and 72.3 +/- 6.1 yr, respectively) were matched with respect to age, sex, and physical activity level. Passive knee joint repositioning was used to test joint proprioceptive acuity. Control of body sway during static standing and subjects' intentional weight shifting to eight different spatial limits of stability within their base of support were conducted using force platform measurements. RESULT: Tai Chi practitioners were found to have better knee joint proprioceptive acuity, in that they made less absolute angle error (2.1 +/- 1.2 degrees ) than control subjects (4.0 +/- 3.4 degrees, with P = 0.023) in passive knee joint repositioning. No significant difference was found in the anteroposterior and mediolateral body sway during static standing (P > 0.05). However, Tai Chi practitioners initiated voluntary weight shifting in the limits of stability test more quickly (reaction time: 0.8 +/- 0.2 s for Tai Chi practitioners) than control subjects (1.1 +/- 0.3 s; P = 0.008). Moreover, they could lean further without losing stability (maximum excursion: 5.2 +/- 0.6% for Tai Chi practitioners and 4.6 +/- 0.5% for control subjects; P = 0.001) and showed better control of their leaning trajectory (directional control: 75.9 +/- 10.0% for Tai Chi practitioners and 68.5 +/- 6.9% for control subjects; P = 0.008). CONCLUSIONS: These results demonstrate that long-term Tai Chi practitioners had improved knee joint proprioception and expanded their limits of stability during weight shifting in stance. [ABSTRACT FROM AUTHOR]

Purpose: To measure intervention fidelity of the Photo-with-Movement Program (PMP) and to report the findings of the program., Methods: This study was a two-arm, pilot randomized controlled trial of the PMP. An intervention fidelity checklist and semi-structured interviews were utilize to evaluate the fidelity of the PMP. Twenty-four older adults and informal caregiver dyads enrolled in the study, with 12 dyads in the experimental group and another 12 in the control group. The PMP integrated visual stimulation, physical exercise, and digital-based activity to deliver a comprehensive, non-pharmacological pain relief syllabus to the participants in the experimental group. The control group received pain management pamphlets. The data collected were analyzed using SPSS to compare the outcomes between the experimental and control groups., Results: The PMP led to significant findings on reducing pain intensity and high scores on intervention fidelity. Participants showed great acceptance of this delivery format., Conclusions: This study revealed the fidelity and effectiveness of a multimodal non-pharmacological intervention, suggesting that it could be used for pain management and caregiving., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Inspiratory muscle training (IMT) is often employed to enhance improvement in inspiratory muscle strength. However, the relationship between inspiratory muscle recruitment patterns and increasing inspiratory load remains unclear. Furthermore, the effect of breathing instructions on diaphragm activity at various inspiratory loads is unknown., Objective: To investigate the recruitment activity of the diaphragm and sternocleidomastoid (SCM) muscle under increased inspiratory pressure loading, with and without diaphragmatic breathing instructions, in healthy young adults., Methods: Participants were invited to breathe, in random order, 6 sets of 10 breaths at inspiratory loads of 30 % to 80 % maximal inspiratory pressure (MIP), in 10 % increments. The measurement process was repeated with a specific focus of diaphragmatic descent during inspiration. During each targeted breath, recordings of surface electromyography of the right SCM muscle and thickness of the right hemi-diaphragm measured by ultrasonography were undertaken concurrently., Results: Sixty-two adults (31 males, age: 23±3 years) participated in the study. Irrespective of breathing instructions, computed diaphragm thickening fraction (DTf) increased with increasing inspiratory load but peaked at 50 % MIP and declined with increasing load to 80 % MIP. SCM recruitment increased with increasing inspiratory load to 80 % MIP. Forced inspiration with diaphragmatic breathing was associated with a higher DTf and lower SCM muscle activity. The above pattern was similar for both male and female participants. Female participants produced higher SCM activity compared with males but only at inspiration loads below 50 % MIP., Conclusions: In a cohort of young healthy adults, magnitude of diaphragmatic effort was greatest at 50 % MIP but declined with increasing inspiratory load to 80 % MIP. Forced inspiration combined with focused diaphragmatic breathing accentuated diaphragm contraction and reduced SCM muscle contribution. Our findings show that diaphragmatic muscle recruitment is non-linear and that the generic clinical prescription of an IMT program may need to be reconfigured., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: To examine the effects of inspiratory muscle training (IMT) on pulmonary and diaphragmatic function, exercise capacity, balance and quality of life (QOL), in post-stroke individuals., Methods: A literature search was conducted using MEDLINE, CINAHL, EMBASE, PubMed, PEDro, Web of Science and China Biological Medicine databases. Randomized controlled trials (RCTs) with a PEDro score ≥6 focusing on the effects of IMT were included. The GRADE system was used to determine the certainty of evidence for each outcome., Results: Nine studies (255 participants) were included. IMT significantly increased forced expiratory volume in one second (FEV 1 ) (4 studies, 112 participants, mean difference (MD)=0.18 litre, 95% confidence interval (CI): 0.14-0.23); maximal inspiratory pressure (MIP) (8 studies, 226 participants, MD = 6.37 cm H 2 O, 95% CI: 1.26-11.49); and diaphragm thickness fraction (DTf) on both sides (MD of affected side vs. unaffected side: 51 vs. 37%). The evidence certainty for diaphragmatic function was moderate. No significant change was observed in forced vital capacity (FVC), balance function, exercise capacity and QOL., Conclusion: This review reveals moderate evidence certainty in support of IMT improving diaphragmatic function. It appears that a training intensity between 30 and 50% MIP results in a significantly improved MIP.

Descending stairs is an indicator of independence among stroke survivors, but is demanding in terms of both neuromuscular control and cognitive functioning. Previous studies found a compromised performance when stepping down with a concurrent cognitive task among healthy older adults, but whether stroke survivors react similarly is not known. This cross-sectional study thus investigated how stroke survivors responded to a dual-task that involved stepping down and compared their performance with that of control subjects. Thirty-four healthy individuals and 26 stroke survivors reacted to an auditory Stroop test while stepping off a 19-cm high platform. The auditory Stroop test was evaluated with a composite score (dividing accuracy by averaged reaction time). Stepping down performances were quantified with subjects' sway amplitudes in anteroposterior and mediolateral directions after landing and sway velocities of their center of pressure. Stroke survivors demonstrated significantly lower composite scores when dual-tasking (76.4 ± 31.2) than when single-tasking (90.0 ± 25.6), while no significant change in stepping down performance was observed. Stroke survivors also swayed significantly more and with a higher velocity than controls when dual-tasking. The results suggested that stroke survivors adopted a posture-first strategy to deal with this dual-tasking challenge. This study raised the awareness on dual-tasking ability among stroke survivors.

Background: Adaptive postural control is an important yet underexamined area in children with developmental coordination disorder (DCD). This study compared adaptive postural responses between children with DCD and those with typical development., Methods: This was an exploratory cross-sectional study. Fifty-two children with DCD (aged 6-9 years) and 52 age- and sex-matched children with typical development participated in the study. Their adaptive postural (motor) responses were assessed using the Adaptation Test (ADT) on a computerized dynamic posturography machine. The sway energy score (SES) for each ADT trial and the average SES of five trials for both toes-up and toes-down platform inclination conditions were recorded., Results: The SESs were lower in the DCD group than in the control group in ADT toes-up trial 1 (p = 0.009) and on average (p = 0.044). In the control group, the SES decreased from trial 1 to trial 2 for both the ADT toes-up (p = 0.005) and toes-down conditions (p < 0.001)., Significance: Adaptive postural responses were absent in children with DCD, and these children used less force (i.e., sway energy) to overcome postural instability. Therefore, both adaptive balance and neuromuscular training should be factored into rehabilitation programs for children with DCD., Competing Interests: Declaration of Competing Interest No potential conflict of interest is reported by the authors., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic balance of patients although it is difficult to objectively quantify these balance parameters in a clinical setting. Therefore, this pilot study aimed to evaluate the feasibility of using wearable devices in a clinical setting to examine whether people with MP-TKA have better postoperative outcomes than PS-TKA, and their balance control is more akin to age-matched asymptomatic controls., Methods: The current cross-sectional pilot study recruited 57 participants with 2 different prosthesis designs (20 PS-TKA, 18 MP-TKA) and 19 asymptomatic controls. At 1-year post-TKA, pain, knee stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Static balance, mobility, and gait stability of the participants were evaluated based on data collected from wearable motion sensors during the near tandem stance, timed-up-and-go, and 6-min walk tests., Results: Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness and demonstrated reduced functional mobility, increased stride-time-variability, and impaired balance. After Bonferroni adjustment, no significant differences in pain, balance, and mobility performance were observed between PS-TKA and MP-TKA participants 1 year after surgery. However, there was a trend for increased anteroposterior sway of the lumbar and head regions in the MP-TKA participants when undertaking the near tandem stance test. The wearable motion sensors were easy to use without any adverse effects., Conclusions: It is feasible to use wearable motion sensors in a clinical setting to compare balance and mobility performance of patients with different TKA prothesis designs. Since this was a pilot study and no definite conclusions could be drawn, future clinical trials should determine the impacts of different TKA prosthesis designs on post-operative outcomes over a longer follow-up period., (© 2022. The Author(s).)

Background: Foot posture which forms the distal supporting structure influences on postural stability. Children with developmental coordination disorder (DCD) who are more likely to be overweight or obese may present with flat foot with symptoms that affect daily activities. The aim of this study was to compare the foot posture and body composition measures between children with and without DCD. In addition, this study aimed to investigate the relationship between foot posture and fat percentage., Methods: Fifty-nine children with DCD (mean age = 8.07±1.10) and sixty-two typically developing children (mean age = 7.97±1.05) were recruited to the DCD and control group respectively. All children received a foot posture assessment and a whole-body dual-energy X-ray absorptiometry (DXA) scan. Foot Posture Index 6 (FPI-6) total scores, sub-scores and lower limb body composition measures including fat mass, lean mass, total mass, fat percentage and fat mass index were measured., Results: Children with DCD revealed a significantly higher FPI-6 left (1.12; 95% CI: 0.172, 2.061) and right (1.15; 95% CI: 0.218, 2.079) total score. FPI-6 sub-scores (talar head palpation and abduction/adduction forefoot on rearfoot) illustrated significant differences between children with and without DCD. Children with DCD had a significantly higher total fat mass (1247.48g; 95% CI: 121.654, 2373.304), total fat percentage (1.82%; 95% CI: 0.115, 3.525) and fat mass index (0.56kg/m2; 95% CI: 0.036, 1.069). There was a significant relationship between FPI-6 right total score and total fat percentage., Conclusion: The findings of this study showed that children with DCD exhibited significantly more pronated foot posture and higher body composition measures compared to typically developing children. Moreover, with FPI-6 right total score significantly related to the total fat percentage, it may require more than just detecting abnormal foot structures in children with DCD but also promoting a healthy lifestyle to prevent obesity., Competing Interests: The authors have declared that no competing interests exist.

Objective: To evaluate the immediate and long-term effects of 12 weeks of Tai Chi training on dynamic balance and disease severity among individuals with cerebellar ataxia (CA). Design: An assessor-blinded, two-arm, parallel-group randomized-controlled trial was conducted among 24 participants with CA. Participants were randomized to receive either Tai Chi intervention ( n  = 12) or usual care ( n  = 12). Dynamic balance was assessed using the Berg Balance Scale (BBS), Scale for the Assessment and Rating of Ataxia (SARA) balance sub-component of the SARA (SARAbal), Sensory Organization Test, and Limits of Stability test. Disease severity was assessed using the SARA and health-related quality of life using the EuroQol visual analog scale. Assessments were completed at baseline (week 0: T1), postintervention (week 12: T2), and at the end of the 24-week (week 36: T3) follow-up period. Interventions: The 8-form Tai Chi exercise was delivered in 60-min sessions, three times a week for 12 weeks. Participants were asked to complete an unsupervised home Tai Chi exercise program over the next 24 weeks. Participants in the usual care control group completed all study measures but did not receive any intervention. Results: Compared with the usual care control group, after 12 weeks of Tai Chi training, the experimental group demonstrated beneficial effects for dynamic balance assessed using the BBS (mean difference [MD]: 4, 95% confidence interval [CI]: -1.06 to 8.71) and the SARAbal (MD: -1.33, 95% CI: -2.66 to 2.33). The effect size ranged from small to large. The benefits gained were not sustained after 24 weeks during the follow-up assessment. Tai Chi did not benefit disease severity and health-related quality of life in this population. Conclusion: Some evidence supports the immediate beneficial effects of 12 weeks of Tai Chi training on the dynamic balance among individuals with CA. Australia New Zealand Clinical Trials Registry (ACTRN12617000327381).

Objective: To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations., Data Sources: Articles were searched in 9 databases from inception to March 2020., Study Selection: Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions., Data Extraction: The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted., Data Synthesis: Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach α>0.82), criterion validity (ρ≥0.73, r≥0.71), and construct validity (ρ≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown., Conclusions: The Brief-BESTest is a valid (criterion- and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to explore alternative strategies to enhance balance and physical functioning in post-TKA patients. As Tai Chi is a proven strategy for improving balance in older people, the proposed study aims to determine the feasibility and acceptability of a 12-week community-based post-TKA multimodal Tai Chi program and to collect preliminary data with respect to the efficacy of such a program in improving balance and physical functioning in post-TKA patients as compared to usual postoperative care., Methods: A single-blinded 2-arm pilot randomized controlled trial will recruit 52 community-dwelling post-TKA patients (aged > 60 years) in Hong Kong. In addition, 26 untreated asymptomatic controls will be recruited for comparison purposes. The TKA patients will be randomized into either a 12-week multimodal Tai Chi rehabilitation group or a postoperative usual care group (26 each). Participants will perform the outcome assessments at baseline, 6, 12, 24, and 52 weeks after TKA, while asymptomatic controls will have the same assessments at baseline, 12, and 52 weeks after baseline. The rate of recruitment, retention, and attrition, as well as adherence to the intervention, will be measured and used to determine the feasibility of the study and whether a full-scale effectiveness trial is warranted. Further, qualitative interviews will be conducted to explore the acceptability and possible barriers to the implementation of the intervention. Primary and secondary outcomes including both patient-reported surveys and performance-based tests will be compared within and between groups., Discussion: The study will determine the feasibility and acceptability/potential efficacy of community-based rehabilitation for post-TKA patients and assess whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the study design and guide the conduction of a future definitive randomized controlled trial., Trial Registration: ClinicalTrials.gov NCT03615638. Registered on 30 May 2018. https://clinicaltrials.gov/ct2/show/NCT03565380.

Purpose: The Falls Efficacy Scale - International is universally used in assessing the level of concern about falling in older adults. The objectives of this study were to conduct a cross-cultural adaptation and to establish psychometric properties of Falls Efficacy Scale - International in Filipino (FES-I F). Methods: The standardized 10-step translation protocol of the Prevention of Falls Network Europe was followed. Community-dwelling older adults aged 60 or above ( N  = 211) from Manila, Philippines were recruited. The internal consistency and test-retest reliability of the translated tool was assessed. Convergent validity was compared with fall-related factors. The receiver operating characteristics were used to determine the cutoff score. Results: The FES-I F has high internal consistency ( α  = 0.91) and good test-retest reliability (intraclass correlation coefficient = 0.86). Overall scores were significantly higher among those with subjective report of fear of falling ( p  < 0.001), lower timed up and go test scores ( p  = 0.014), slower gait speed ( p  = 0.003), and lower perceived well-being scores ( p  = 0.003) indicating acceptable convergent validity. The cutoff score of FES-I F was 22 points. Conclusions : The FES-I F has high internal reliability and acceptable validity, and can be a practical tool to measure the concern about falling in Filipino older adults. Future research is necessary to establish its utilization as an outcome measure in intervention studies.Implications for rehabilitationThe psychometric properties of the Filipino version of the Falls Efficacy Scale - International were good when assessed in older adults living in the community.The cutoff score to demarcate those with fear of falling from those without is 22 points.Falls Efficacy Scale - International in Filipino is recommended for the assessment of fear of falling for research and clinical purposes.

Background: Adaptive balance control is often compromised in children with developmental coordination disorder (DCD). Neuromuscular training (NMT) is commonly used in clinical settings to improve neuromuscular control and hence balance performance in these children. However, its effectiveness has not been proven scientifically. This randomized controlled study aimed to explore the effectiveness of NMT for improving adaptive balance performance and the associated leg muscle activation times in children with DCD., Methods: Eighty-eight children with DCD were randomly assigned to the NMT or control group (44 per group). The NMT group received two 40-minute NMT sessions/week for 3 months, whereas the control group received no intervention. The outcomes were measured at baseline and 3 and 6 months. The primary outcome was the sway energy score (SES) in both the toes-up and toes-down conditions as derived using the Adaptation Test (ADT). Secondary outcomes included the medial gastrocnemius, medial hamstring, tibialis anterior and rectus femoris muscle activation onset latencies during ADT, measured using surface electromyography and accelerometry. Data were analyzed using a repeated measures analysis of covariance based on the intention-to-treat principle., Results: At 3 months, no significant within-group or between-group differences were noted in the SESs for either group. At 6 months, the toes-down SES decreased by 6.8% compared to the baseline value in exclusively the NMT group (P = .004). No significant time, group or group-by-time interaction effects were observed in any leg muscle activation outcomes., Conclusions: Short-term NMT failed to improve adaptive balance performance and leg muscle activation times in children with DCD. Further studies should explore the clinical applications of longer-term task-specific interventions intended to improve the adaptive balance performance of these children.

Objective: Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in patients following THA and TKA, no systematic reviews have summarized these risk factors. Therefore, the current systematic review aimed to summarize evidence regarding risk factors for falls in patients after THA and/or TKA., Methods: MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (from inception to June 30, 2018) were searched. The methodological quality and quality of evidence of the included studies were assessed by two independent reviewers. Relevant data regarding participants' characteristics, study design, follow-up time points, and identified risk factors were extracted. Meta-analyses and narrative syntheses were performed., Results: Twelve studies with a total of 1,292,689 participants were included. Twenty-nine identified risk factors for post-THA/TKA falls were classified into either inpatient or post-discharge risk factors. Key risk factors for both post-THA and/or post-TKA inpatient falls that showed moderate level of evidence included: postoperative complications or comorbidities and revision THA/TKA. Likewise, risk factors for post-discharge falls after THA and/or TKA that demonstrated moderate level of evidence included: medications, psychiatric diseases, living alone, prior history of TKA, falls history and female gender. The quality of the included studies varied and sample sizes were not justified., Conclusions: This review summarized both non-modifiable and modifiable risk factors for post-THA/TKA falls. Our findings highlight the importance of developing strategies to lower the falls risk among patients following THA/TKA., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To summarize and critically evaluate the effects of Tai Chi on lower limb proprioception in adults older than 55., Data Sources: Seven databases (Scopus, PubMed, Web of Science, SPORTDiscus, Cochrane Library, Wanfang, CNKI) were searched from inception until April 14, 2018., Study Selection: Eleven randomized controlled trials were included for meta-analysis., Data Extraction: Two independent reviewers screened potentially relevant studies based on the inclusion criteria, extracted data, and assessed methodological quality of the eligible studies using the Physiotherapy Evidence Database (PEDro)., Data Synthesis: The pooled effect size (standardized mean difference [SMD]) was calculated while the random-effects model was selected. Physiotherapy Evidence Database scores ranged from 5 to 8 points (mean=6.7). The study results showed that Tai Chi had significantly positive effects on lower limb joint proprioception. Effect sizes were moderate to large, including ankle plantar flexion (SMD=-0.55; 95% confidence interval [95% CI], -0.9 to -0.2; P=.002; I 2 =0%; n=162), dorsiflexion (SMD=-0.75; 95% CI, -1.11 to -0.39; P<.001; I 2 =0%; n=162), nondominant or left knee flexion (SMD=-0.71; 95% CI, -1.10 to -0.41; P<.001; I 2 =25.1%; n=266), dominant or right knee flexion (SMD=-0.82; 95% CI, -1.06 to -0.58; P<.001; I 2 =33.8%; n=464)., Conclusions: There is moderate to strong evidence that suggests that Tai Chi is an effective intervention to maintain and improve lower limb proprioception in adults older than 55. More robust multicenter studies including oldest-old participants, with longer follow-ups and validated outcome measures, are needed before a definitive conclusion is drawn., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The role of exercise in preventing or delaying age-related cognitive decline is an important focus of rehabilitation. Tai Chi (TC) is a traditional Chinese exercise that has been found to improve cognitive function. However, the mechanism underlying this improvement is still unknown. We compared the effects of TC practice (mind-body exercise) and arm ergometry (AE; body focused exercise) on prefrontal cortex activity between TC practitioners and non-practitioners., Design: This cross-sectional study included 16 older female subjects (8 TC practitioners and 8 non-practitioners). The practitioners had each practiced TC for at least 7 years. Prefrontal cortex activity was measured using the prefrontal oxygenation level obtained with near-infrared spectroscopy. During the spectroscopy measurement, the participants performed TC, after watching a video of 12-form seated Yang Style TC, and AE in a subsequent session., Results: We found significantly greater changes in the levels of oxyhemoglobin (HbO2; p = 0.022) and total hemoglobin (cHb; p = 0.002) in the TC condition compared with the AE condition in all participants. In the TC practitioner group, a similar trend was shown in the change of HbO2 (p = 0.117) and cHb (p = 0.051) when practicing TC versus AE. However, in the non-practitioner group, we found a statistically greater change in cHb (p = 0.005) but not in HbO2 (p = 0.056)., Conclusion: The older adults had higher brain activity when practicing TC compared with AE, and a significant effect was observed in the non-practitioner group. These pilot results may provide insight into the underlying mechanism of the effectiveness of TC practice in preventing cognitive decline in older adults., (Copyright © 2018. Published by Elsevier Ltd.)

Background: The presence of mild cognitive impairment (MCI) in older adults increases their fall risk. While physical exercise is effective in reducing falls rate and risk of falls, and cognitive training in improving cognitive functioning in healthy older adults, their effectiveness in preventing falls and reducing risks of falls in MCI when administered simultaneously is not yet established. Therefore, this study aims to determine the effectiveness of combined physical and cognitive training in preventing falls and decreasing risks of falls among community-dwelling older persons with MCI., Methods/design: This is a single-blind, multicentre, randomized controlled trial. At least ninety-three community-dwelling older adults with MCI aged 60 or above will be recruited. They will be randomly allocated into four groups: Physical Training alone (PT), Cognitive Training alone (CT), combined Physical And Cognitive Training (PACT) and Waitlist Group (WG). The PT group will perform exercises (flexibility, endurance, strengthening, and balance training) for 60-90 min three times per week for 12 weeks. The CT group will be involved in a paper-based training focusing on orientation, memory, attention and executive functioning for 60-90 min per session, once a week for 12 weeks. The PACT group will undergo cognitive training incorporated in physical exercise for 60-90 min three times per week for 12 weeks. The WG will receive the intervention, combined physical and cognitive training, at a later date. Assessors blinded to participant allocation will conduct pre-intervention, post-intervention, and 6-month follow-up assessments. The primary outcome measure will be falls rate. The secondary outcome measures will be Physiologic Profile Assessment and Falls Risk for Older Persons in the Community, and assessments that evaluate cognitive, physical and psychological factors related to falls., Discussion: Considering the possible physical, social, financial and psychological consequences of a fall, we hope to provide insights on the effectiveness of combining physical and cognitive training on falls and fall-related factors for older adults with MCI. It is projected that the combined interventions will lead to significantly lower falls rate and reduced risk of falls compared to using single or no intervention., Trial Registration: ClinicalTrials.gov NCT03167840 . Registered on May 30, 2017.

This study evaluated the effectiveness of adapted Taekwondo (TKD) training on skeletal development and motor performance in children with developmental coordination disorder (DCD). One hundred forty-five prepubertal children with DCD were allocated to either the TKD or control groups. Children in the TKD group participated in a weekly 1-hour adapted TKD intervention and daily TKD home exercises for 12 weeks. The primary outcome (delay in skeletal development) and secondary outcomes (Movement Assessment Battery for Children (MABC) total impairment score, eye-hand coordination (EHC) scores, and a standing balance score) were measured at baseline, after the intervention and 3 months after the intervention. Skeletal development improved in both groups over time (p < 0.017). The TKD group had a significant delay in skeletal development at baseline compared to the control group (p = 0.003) but caught up with the controls at 3 months (p = 0.041). Improvements in the MABC scores were also seen in both groups across time (p < 0.017). Only the TKD group had a significant improvement in the EHC movement time at 3 (p = 0.009) and 6 months (p = 0.016). The adapted TKD intervention may be effective in improving the skeletal development and EHC movement time of children with DCD. For motor performance, the effect of maturation might be more profound.

Developmental coordination disorder (DCD) is a common motor disorder affecting balance performance. However, few studies have investigated reactive balance performance and the underlying mechanisms in children with DCD. This study aimed to compare the reactive balance performance, lower limb muscle reflex contraction latency and attention level in response to unpredictable balance perturbations between 100 typically developing children and 120 children with DCD (with and without comorbid autism spectrum disorder) aged 6-9 years. Reactive balance performance was evaluated using a motor control test (MCT) conducted on a computerized dynamic posturography machine. The lower limb postural muscle responses and attention level before, during and after a MCT were measured using surface electromyography and electroencephalography, respectively. The results revealed that relative to typically developing children, those with DCD had a significantly longer MCT latency score in the backward platform translation condition (p = 0.048) but a significantly shorter latency score in the forward platform translation condition (p = 0.024). The MCT composite latency scores and the corresponding lower limb muscle onset latencies were similar between the groups. Children with DCD also demonstrated a lower attention level during and after sudden backward (p = 0.042) and forward (p = 0.031) platform translations, compared to typically developing children. Children with DCD were less attentive in response to postural threats, and their balance responses were direction-specific. Balance training for children with DCD might require an additional emphasis on sudden posterior-to-anterior balance perturbations, as well as on problems with inattention., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This study explored the immediate effects of Tai Chi (TC) training on attention and meditation, perceived stress level, heart rate, oxygen saturation level in blood, and palmar skin temperature in late middle-aged adults. Twenty TC practitioners and 20 nonpractitioners volunteered to join the study. After baseline measurements were taken, the TC group performed TC for 10 minutes while their cognitive states and cardiovascular responses were concurrently monitored. The control group rested for the same duration in a standing position. Both groups were then reassessed. The participants' attention and meditation levels were measured using electroencephalography; stress levels were measured using Perceived Stress Scale; heart rate and blood oxygenation were measured using an oximeter; and palmar skin temperature was measured using an infrared thermometer. Attention level tended to increase during TC and dropped immediately thereafter ( p < 0.001). Perceived stress level decreased from baseline to posttest in exclusively the TC group ( p = 0.005). Heart rate increased during TC ( p < 0.001) and decreased thereafter ( p = 0.001). No significant group, time, or group-by-time interaction effects were found in the meditation level, palmar skin temperature, and blood oxygenation outcomes. While a 10-minute TC training could temporarily improve attention and decrease perceived stress levels, it could not improve meditation, palmar skin temperature, or blood oxygenation among late middle-aged adults.

Background: There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region., Method: RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed., Results: Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44])., Conclusion: There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.

Objective: To address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated., Design: A pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures., Results: Despite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21-25% versus 16-18%) and disability improvement (45-52% versus 39-42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity., Conclusion: It demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

[Purpose] To examine the efficacy of Ai Chi in relieving the pain and stiffness of knee osteoarthritis and improving, physical functioning, proprioception and quality of life. [Subjects and Methods] Twenty-five persons with knee osteoarthritis completed 5 weeks Ai Chi practice (60 minutes per session, twice per week, 10 sessions in total). Knee pain and stiffness were measured before and after the intervention program. [Results] Significant improvements in pain, self-perceived physical functioning and self-perceived stiffness were observed after the Ai-Chi intervention. On average, no significant change in knee range of motion, 6-minute walk test distances or proprioception was observed. [Conclusion] A five-week Ai Chi intervention can improve the pain and stiffness of knee osteoarthritis and self-perceived physical functions and quality of life improvement. Ai Chi may be another treatment choice for people with knee OA to practice in the community.

Unlabelled: This study aimed to compare the effectiveness of a specific functional movement-power training (FMPT) program, a functional movement training (FMT) program and no training in the improvement of balance strategies, and neuromuscular performance in children with developmental coordination disorder (DCD). It was a randomized, single-blinded, parallel group controlled trial., Methods: 161 children with DCD (age: 6-10 years) were randomly assigned to the FMPT, FMT, or control groups. The 2 intervention groups received FMPT or FMT twice a week for 3 months. Measurements were taken before, after, and 3 months after the end of the intervention period. The primary outcomes were the composite score and strategy scores on the sensory organization test as measured by a computerized dynamic posturography machine. Secondary outcomes included the knee muscle peak force and the time taken to reach the peak force. The balance strategies adopted in sensory challenging environments of the FMPT participants showed greater improvement from baseline to posttest than those of the FMT participants (7.10 points; 95% confidence interval, 1.51-12.69; P = 0.008) and the control participants (7.59 points; 95% confidence interval, 1.81-13.38; P = 0.005). The FMPT participants also exhibited greater improvement from baseline to the posttest in the knee extensor peak force and time to peak force in the knee flexors. The FMPT program was more effective than the conventional FMT program in the enhancement of balance strategies and neuromuscular performance in children with DCD.

The purpose of this study is to develop a reliable and valid tool for measuring the dynamic sitting balance of wheelchair users with spinal cord injury. The balance tests were performed in nine patients with chronic spinal cord injury (average of 17.2 years postinjury) between levels C6 and L1, while they were sitting in their wheelchairs and on a standardized stool (unsupported sitting), twice, 7 days apart. Limits of stability (LOS) and sequential weight shifting (SWS) were designed in this study. The balance tests measured participants' volitional weight shifting in multiple directions within their base of support. Their mobility scores on the Spinal Cord Independence Measure III were correlated with the balance test results. The LOS results showed moderate to excellent test-retest reliability (intraclass correlation coefficients ranged from 0.673 to 0.990) for both the wheelchair and the unsupported sitting. The SWS results showed moderate to excellent reliability (intraclass correlation coefficients ranged from 0.688 to 0.952). The LOS results correlated significantly with the Spinal Cord Independence Measure III mobility scores only in case of unsupported sitting, but the SWS test results showed significant correlations in both sitting conditions. To sum up, the sitting LOS and SWS tests are reliable and valid tools for assessing the dynamic sitting balance control of patients with spinal cord injury.

Background/aims: In addition to environmental factors, deteriorating sensorimotor control of balance will predispose older adults to falls. Understanding the aging effects on sensorimotor control of balance performance is important for designing fall prevention programs for older adults. How repeated practice of Tai Chi can improve limb joint proprioception, integration of neural signals in the central nervous system for balance control, and motor output at the level of knee muscles is discussed in this chapter., Results: Our previous studies showed that elderly Tai Chi practitioners performed significantly better than elderly nonpractitioners in (1) knee joint proprioception, (2) reduced or conflicting sensory situations that demand more visual or vestibular contributions, (3) standing balance control after vestibular stimulation without visual input, (4) voluntary weight shifting in different directions within the base of support, (5) single-leg stance during perturbations of the support surface, and (6) knee extensor and flexor muscle strength. In a prospective study, we further showed that 4 weeks of daily Tai Chi practice but not general education produced significant improvement in balance performance., Conclusion: The requirements of Tai Chi for accurate joint positioning and weight transfer involving smooth coordination of neck, trunk, upper and lower limb movements, make it particularly useful for improving the sensorimotor control of balance in the elderly. Because Tai Chi can be practiced any time and anywhere, and is well accepted by older people in both the East and now the West, it is especially suited to be a key component of a low-costing community-based fall prevention program alongside with education about environmental factors.