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Background: Results from studies investigating the effects of rehabilitation robots, including those using robots combined with functional electrostimulation (FES), on gait quality and postural control post-stroke are conflicting. Therefore, the evidence supporting the use of this approach to rehabilitation remains inconclusive and further research is required into how robotic therapy and FES can improve gait function and postural control at different times after stroke. Aim of the study: To gain knowledge on the effectiveness of stationary robotic exercises, and robotic exercises combined with FES of the lower extremity muscles, on activities of daily living, gait quality, postural control, and quality of life, in people who were between one and six months post-stroke. Material and Methods: A randomized controlled clinical pilot study was conducted. Forty-three post-stroke patients hospitalized at a rehabilitation center were randomly assigned to the following three groups: the GEO Group, for whom stationary robotic exercises were provided, the GEO+FES Group, for whom stationary robotic exercises were provided in combination with FES, and the Control Group, for whom conventional overground gait training was provided. Exercises were undertaken by all groups for 20 minutes a day, six days a week, for three weeks. In addition, all patients were provided with basic post-stroke therapy based on the principles of best clinical practice. All patients were assessed for stroke symptoms before and after therapy using the National Institutes of Health Stroke Scale (NIHSS), for independence in activities of daily living using the Barthel Index, and for quality of life using the Stroke Impact Scale Questionnaire. Static and dynamic postural control and gait performance were assessed using the Berg Balance Scale, the Timed Up and Go Test, the Functional Reach Test, and the 10 Meter Walk Test. Static postural control and gait quality were also assessed using a treadmill with a stabilometric platform. Results. Exercising on a stationary robot, both with and without FES of the lower extremity muscles, contributed to a statistically significant reduction in stroke symptoms (NIHSS, p

Akbaş, A, Marszałek, W, and Król, H. Presence of an overhead goal does not improve the effectiveness of jump training. J Strength Cond Res XX(X): 000-000, 2022-This study investigated the effectiveness of jump training with and without an overhead goal (OG) on a modified countermovement jump (CMJ) tested in a similar manner, with and without OG. Fifty-two men divided into 3 groups-trained with OG, trained without OG, and untrained-were examined: before the commencement of training; after 2, 4, and 6 weeks of training; and 2 weeks after the discontinuation of training. Each session consisted of 50 modified CMJ and was performed 3 times per week. Countermovement jump height, mean power, peak power, countermovement depth, and take-off phase time were quantified, and the statistical level was set at p0.05. Although the results showed the beneficial effect of OG on jump height (p0.01), the training with OG did not bring significantly better results than training without OG. In addition, the group trained without OG improved after 2 weeks in both testing conditions (with and without OG), whereas the group trained with OG improved after 2 weeks when tested with OG and only after 6 weeks when tested without OG. We believe the use of OG in jump training may be detrimental when the OG is withdrawn from the testing procedure because of its strong motivational and feedback features. Consequently, athletes in disciplines which require them to jump toward an object located over their head during a game, e.g., a ball or crossbar, should be tested with the presence of OG. Despite this, OG is still an important factor in maximizing jump performance.

Introduction One of the basic goals of post-stroke rehabilitation is the improvement of postural control and gait quality. Modern post-stroke rehabilitation implements treadmill training with controlled body balance perturbations (PBT). Aim This study aimed to assess the influence of the PBT treadmill training on activities of daily living (ADL), gait quality and postural control in people with chronic stroke. Methods Seventeen patients with stroke hospitalized in a rehabilitation centre were randomly allocated to 3-week PBT training. Functional independence was assessed using Fugl-Meyer Motor Assessment (FMA). ADL were assessed using Barthel Scale. Static and dynamic postural control was assessed using Berg Balance Scale (BBS), Timed Up And Go Test (TUG) and Functional Reach Test (FRT). Static postural control was assessed using stabilometric platform tests (Alfa and Gamma, Ac International East, Poland). The 10-meter walk test was used to evaluate gait. Spatial, temporal gait parameters were also assessed using the MyoMotion (Noraxon, USA). Results A significant improvement was found in the patients’ motor functions (FMA; p = 0.01), independence in daily activities (Barthel Scale; p = 0.01), static and dynamic balance (BBS; p = 0.01). There was no statistically significant improvement in the dynamic balance (TUG; p = 0.15; and FRT; p = 0.19). Conclusions Inclusion of perturbation training during rehabilitation of patients with chronic stroke improved ADL, gait quality and postural control.

The aim of the study was to examine whether the width of the base of support (BOS) has an influence on early postural adjustments (EPA) and armed upper limb and COM kinematics during lunging. Eight elite female fencers participated in the study. The displacement of the centre of foot pressure (COP) and kinematics of centre of mass (COM) were recorded using force platforms. The kinematics of the wrist of the armed upper limb were obtained using a 3D accelerometer. The results show that EPA were characterised by a very small COP displacement (about 0.6 to 1.2 cm). The COP amplitude showed a tendency to decrease with an increase in BOS width under reaction time conditions. In contrast, a greater BOS width was associated with a significant increase in COM acceleration at foot-off and peak COM acceleration during lunging also under reaction time instructions. The kinematics of the wrist were not influenced by BOS. The results show that in elite fencers, the upper limb movement is dissociated from the whole body movement. We suppose that a small COP amplitude is a postural skill which is integrated into the lunging skill and might influence the acceleration of COM.

The aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of extracorporeal shockwave therapy (ESWT) for athletes with patellar tendinopathy. We searched PubMed, EBSCOHost and Ovid for randomized controlled trials (RCTs) which evaluated the therapeutic efficacy of ESWT in athletes with jumper’s knee. The methodological quality of RCTs was rated with the Physiotherapy Evidence Database scale. Data in the meta-analysis were expressed as standardized mean difference (SMDs) and 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Of 192 records identified, a total of seven articles met the inclusion criteria. The ESWT and control groups with any other conservative treatment did not differ significantly with respect to the Visual Analogue Scale (VAS) long-term scores obtained at ≥ 6 months of therapy completion (SMD: -0.33; 95% CI: -4.64 to 3.98; p = 0.87; I2= 98%). Furthermore, no significant differences were found between the ESWT and control groups regarding the pooled Victorian Institute of Sports Assessment for Patella (VISA-P) scores for long-term outcomes (SMD: 8.21; 95% CI: -39.3 to 55.73; p = 0.73; I2= 99%). The ESWT and control groups did not differ significantly on the VAS and VISA-P scores for long-term outcomes. In both cases, heterogeneity was considered to be high. Hence, no clear and generalized conclusions can be drawn regarding ESWT effectiveness in athletes with patellar tendinopathy.

Tissue flossing is an increasingly popular method in physiotherapy and sports. There is a belief that tissue flossing can improve range of motion and muscle strength, shorten muscle recovery time, and reduce the risk of injury. The aim of this study was to analyse the effectiveness of tissue flossing for immediately improving muscle strength in recreational athletes when it is performed during warm-up. All participants were randomly assigned to either an experimental group (n = 36) or a control group (n = 34) using a random number generator. The experimental group (n = 36) performed an intervention comprising exercises with muscle tissue flossing and exercises without flossing. The control group (n = 30) performed the same protocol without a floss band. Muscle strength was measured for knee flexion end extension at three speeds (60, 120, and 180 °/s) 3 times. Analysed parameters include peak torque, work, and power related to body weight, flexors–extensors ratio, and time to peak torque. There were no significant changes in the muscle strength parameters from before to after the warm-up in either group (p > 0.05). Significantly lower values of peak torque, work, and power were observed in the experimental group during the warm-up with the floss band applied to muscles (p < 0.05). No clinically significant changes in time to peak torque or flexors–extensors ratio were observed. A single application of flossing does not improve muscle strength or power and can even reduce individuals’ maximum muscle strength capabilities.

The uncontrolled manifold hypothesis is a method used to quantify motor synergies, defined as a specific central nervous system organization that maintains the task-specific stability of motor actions. The UCM allows for inter-trial variance analysis between consecutive trials. However, despite the large body of literature within this framework, there is no report on the number of movement repetitions required for reliable results. Based on the hypothetical hierarchical control of motor synergies, this study aims to determine the minimum number of trials necessary to achieve a good to excellent level of reliability. Thirteen young, healthy participants performed fifteen bilateral isometric contractions of elbow flexion when visual feedback was provided. The force and electromyography data were recorded to investigate synergies at different levels of hierarchical control. The intraclass correlation coefficient was used to determine the reliability of the variance indices. Based on the obtained results, at least twelve trials are required to analyze the inter-trial variance in both force and muscle synergies within the UCM framework.

Assessment of human balance is one of the most common diagnostic tests, both in medical applications and during sports training. Many new methods of measuring are introduced in these studies; however, the analysis of results is still carried out mainly based on the values determined in the time domain – the average COP speed or the ellipse field of the prediction. The aim of the current work is to present the possibilities for the practical application of frequency analyses in assessment of the ability to maintain body balance as a method supplementing standard analyses. As part of the study, measurements of the ability to maintain balance in sensory conflict conditions introduced in the form of an oscillating, three-dimensional, virtual scenery were carried out. 27 healthy volunteers (13 women and 14 men) took part in the study. The three-dimensional scenery, presented by means of the Oculus system, oscillated in the sagittal plane with frequencies equal to 0.7 Hz and 1.4 Hz. The frequency value during the measurement was constant or changed in the middle of the test. Measurements were conducted on the FDM Zebris platform. The results were analyzed using developed coefficients determined on the basis of the Short-time Fourier transform (STFT). The use of frequency-domain analyses confirmed that in the COP movement, one can observe a cyclical component corresponding to following the scenery, as well as the appearance of other cyclical components whose observation is important in terms of assessing the ability to maintain balance. It has been shown that the changes in the average COP speed that occur during the measurement can result from changes related to the movement of following the scenery as well as additional body movements indicating a greater or lesser loss of balance. It has been shown that there are differences in the COP movement provoked by the movement of the surrounding scenery, which depend on the parameters of the introduced disturbances – something that can only be observed in results obtained in the frequency domain. The conducted research shows that in measurements involving the ability to maintain one’s balance conducted in sensory conflict conditions, standard time-domain analyses should be supplemented with other types of data analysis, e.g. frequency domain analyses.

The troublesome symptoms of Achilles tendinopathy prompt patients to seek effective forms of conservative treatment. The main aim of the study was to determine the therapeutic efficacy of shock wave and ultrasound therapies for Achilles tendinopathy in reducing pain intensity. Treatment efficacy was also assessed using objective posturographic measurements.Thirty-nine patients patients were randomly allocated to one of three experimental groups that received shock wave therapy (group A), ultrasound therapy (group B) and placebo ultrasound (group C). Posturographic measurements and subjective assessment of pain intensity were taken prior to therapy and at weeks 1 and 6 of therapy completion.A comparison of percentage change in activity-related pain from baseline to 6 weeks post-therapy revealed a significantly greater pain reduction in group A compared to group B. The three-way ANOVA demonstated an effect of treatment type on all posturographic variables. The Bonferroni post-hoc test showed the means of all variables were significantly smaller for group A than group B. Limb condition also had an effect on the center-of-pressure trajectories in anteroposterior plane; the post-hoc test showed the mean values of the variables were significantly greater for the non-affected compared to affected limb.Shock wave therapy was significantly more effective than sonotherapy for alleviation of activity-related pain of Achilles tendinopathy. An association was also shown between shock wave therapy and more efficient postural control in patients with Achilles tendinopathy. The parameters of center-of-pressure trajectories in the sagittal plane were significantly greater for the non-affected compared to affected limb. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).

Background Due to the high postural control demands of sport ju-jitsu, it is likely that long-term sport ju-jitsu training may induce sport-specific adaptations in postural control, especially in positions directly related to combat. The aim of the study was to assess the differences in postural control between elite sport ju-jitsu athletes and untrained controls in non-ecological and ecological conditions and to investigate the relative contribution of spinal and supraspinal mechanisms to postural control in expert athletes. Methods The study was conducted on eleven male elite ju-jitsu athletes and ten non-athletes. The data was collected with the use of a force plate under two conditions: quiet standing and ju-jitsu combat stance. Apart from the standard analysis of the spatial–temporal parameters of center of foot pressure, non-linear measures were used, namely rambling-trembling and sample entropy. The non-parametric Mann–Whitney U test was used to compare both groups. Results The main findings of the study showed that in quiet standing, elite ju-jitsu athletes and non-athletes had comparable postural control in both the anterior–posterior and mediolateral planes. In contrast, in the combat stance, elite athletes had lower values of postural sway and rambling component (range and rms) and higher values of sample entropy in comparison to the non-athletes (p p Conclusions Smaller postural sway and its rambling component in sport ju-jitsu athletes may indicate the more precise control of center of foot pressure and improved ability in estimating its position. The sample entropy results confirmed that the displacement of center of foot pressure for sport ju-jitsu athletes was more irregular, which demonstrates greater automatization in postural control. The results also confirm the importance of ecological validity in investigating postural adaptations associated with sports expertise.

Background: The testing of athletes in ecological conditions is based on the concept that sport-specific adaptations in postural control are observed mostly in positions or tasks that are related to the practice of a specific movement. Due to the high postural control demands of ju-jitsu, it is likely that long-term ju-jitsu training may influence the process of maintaining a stable posture, especially in positions directly related to combat. The purpose of this study was to examine the postural sway characteristics of elite ju-jitsu athletes in ecological and non-ecological conditions with an approach not previously used in martial arts.Methods: The study was conducted on eleven male elite ju-jitsu athletes and ten non-athletes. The data was collected with the use of a force plate under two conditions: quiet standing and ju-jitsu combat stance. Apart from the standard analysis of the spatial-temporal parameters of COP, sensitive methods in COP data processing were used, namely rambling-trembling and sample entropy. The non-parametric U Mann-Whitney test was used to compare both positions.Results: The main findings of the study showed that in quiet standing, elite ju-jitsu athletes and non-athletes had comparable postural control in both the anterior-posterior and mediolateral planes. In contrast, elite athletes had lower values of postural sway and higher values of sample entropy in comparison to the non-trainees in the combat stance (pConclusions: Our results confirmed the importance of a sport-specific environment in investigating the subtle differences in the postural regulation of elite athletes. The sample entropy results indicated more irregular characteristics of postural sway in the elite ju-jitsu athletes, representing more automated postural control.

The purpose of this study was to determine the state of the art in the area of virtual reality in competitive athletes of different levels of expertise in various disciplines and point the areas of its application. Articles published before August 2018 were considered in our review. The PubMed, SCOPUS, SportDiscus and Medline databases were searched. A combination of the following search terms was used: virtual reality, virtual environment, virtual system, athletes, sports, physical training, sport performance, physical exercises. Studies involved healthy competitive athletes. A total of 18 articles met the inclusion criteria. There were three areas of application of virtual reality to sport: performance analysis, simulation improvement and virtual training. Competitive athletes were mostly examined in a semi‐immersive setting. In conclusion, virtual reality seems to play a marginal role in competitive athletes’ training. Due to the fact that virtual reality interventions bring significant improvements in clinical research, well‐designed randomized control trials with detailed virtual training programmes are required in the future. Practically, virtual reality is effectively and commonly used to analyse performance in competitive athletes. There is still a need of creating fully interactive VR, where athletes will be able to cooperate with a virtual partner and influence the environment.

Our aim was to observe, through objective testing using an assessment module incorporated in a new exergaming system, whether elderly people’s static and functional balance is improved by a balance exergaming training program based on movements performed in everyday life. Thirteen healthy elderly women participated in 12 sessions of balance-based exergaming training (three times a week, 30 min per session). All objective outcomes, the quiet standing test, functional balance test (FBT), and limit of stability (LOS) test, were measured on three occasions: before intervention, after six training sessions, and after the completion of the four-week program. The results showed a significant improvement in LOS performance after the intervention. In FBT, participants exhibited a significant decrease (p &lt, 0.01, Kendall’s W = 0.5) in the average time to target hit after six trainings. The average center of pressure velocity increased after six and 12 sessions, however did not reach significance (p = 0.053), nevertheless the size of the effect was large (ηp2 = 0.22). The parameters of the quiet standing test were not significantly affected by the training. The results support the need for more definite and objective studies assessing exergaming for balance in elderly.

Introduction Although previous studies have contributed to our understanding of the effects of implementing the virtual reality as a rehabilitation tool in patients with Parkinson’s disease (PD), additional research is needed to examine the effects of applying balance-based exergaming training on quantitative biomechanical measures of balance. Research question To investigate the effects of balance-based conventional and exergaming training on posture parameters. Methods The study involved 24 patients with PD (Hoehn and Yahr stages II-III).Participants underwent twelve training sessions during the 4-week training period. The experimental group (n=12) was trained with a custom-made exergaming balance based training system, the control group (n=12) underwent a conventional balance training. All objective outcomes were measured before intervention and the day after completion of training program. Postural stability was assessed using the quiet standing test, dynamic balance was assessed using limits of stability (LOS) and functional balance (FBT) tests. Results After training, participants in both groups showed significantly better results in static balance performance. However, only exergaming training significantly improved LOS performance (higher values of Range of forward lean (p = 0.039, dz = 0.67) and leaning rate (p=0.007, dz=0.96). Also FBT test improved significantly only in experimental group (decrease in time to target hit (p=0.02, dz=0.76) and significant increase of average COP velocity (p=0.008, dz=0.93). Conclusion This study found that exergaming training created for patients with PD enhanced static and dynamic balance whereas conventional balance training improved static balance. Posturography is sensitive enough to reveal differential effects of training for both groups. These findings support the inclusion of our exergaming training in the exercise program for participants with PD.

Background: People with Parkinson's disease (PD) exhibit deficits in maintaining balance both during quiet standing and during walking, turning, standing up from sitting, and step initiation.Objective: The purpose of this study was to examine balance disorders during a transitional task under different conditions in participants with PD.Methods: The research was conducted on 15 PD-II (mild) and 15 PD-III (moderate) individuals (H&Y II-III stage) and 30 healthy elderly. The transitional task was measured on two force platforms (A and B). The procedure consisted of three phases: (1) quiet standing on platform A, (2) crossing to platform B, and (3) quiet standing on platform B, each until measurements were completed. There were four conditions: crossing without an obstacle, crossing with an obstacle, and walking up and down the step.Results: There were no significant differences between mild PD individuals and healthy elderly during quiet standing before the transitional task and after completing the task. The temporal aspects describing the different transitional tasks were comparable between mild PD and healthy subjects. Moderate PD participants presented a significantly higher COP velocity after the transitional task compared to the healthy older adults (p < 0.05). Additionally, the moderate PD group showed significantly higher values for transit time relative to healthy subjects during the transitional task in all conditions (p < 0.05).Conclusions: Disease severity affects the temporal aspects of different transitional tasks in people with PD. The procedure of completing a transitional task under different conditions allowed differences between moderate and mild PD stages and healthy subjects to be observed.

Graphical abstract, Functional stability has been studied in diverse populations, yet the possibility to compare the results across them and the knowledge about actual performance referenced to the maximum capacity is limited. Our aim was to improve the functional limits of stability testing and introduced Forward Functional Stability Indicator (FFSI) as a reliable measure of functional stability. The study participants were not able to cross the projected forward anatomical stability limit (FASL). It is located at the level of first metatarsophalangeal joints and should be considered a mechanical limit of the maximal voluntary centre of foot pressure (COP) excursion (MVE). It was only true when the whole feet were in contact with the ground. There were statistically significant differences in limits of stability (LOS) test results in the conditions when the heels were raised and the toes muscles were contracted isometrically. The proposed forward functional stability indicator (FFSI) is a highly reliable measure of functional stability, which provides information about the actual performance with reference to maximum capacity and is easy to compare across normal and clinical populations. • The proposed forward functional stability indicator (FFSI) is a highly reliable measure of functional stability. • FFSI provides information about the actual performance with reference to maximum capacity and is easy to compare across normal and clinical populations. • The forward anatomical stability limit (FASL) is located at the level of first metatarsophalangeal joints and should be considered a mechanical limit of the maximal voluntary centre of pressure (COP) excursion when certain measurement criteria are met.

The paper presents the results of preliminary research carried out using the developed rehabilitation system. The system uses a single measurement module with a reduced architecture that enables to control the virtual or extended environment. The reduced architecture allows to minimize the dimensions of the electronic system. The measuring module is based on two main components - SoC Wi-Fi module and inertial sensor. The Digital Motion Processor included in inertial sensor allows for precise monitoring of the rehabilitative movement. The measuring module was placed on the exerciser’s back so as to minimize the impact of chest movements during respiratory activities. Sensor data are transmitted to the server, which simultaneously registers them and displays the game.Gameplay is controlled by torso movements. During the tests, the sensor's behaviour on the exerciser’s body was verified and its measurements were compared with an optoelectronic reference system.

Radial shock wave therapy (RSWT) has been recommended as an appropriate, safe and effective method in the treatment of chronic plantar fasciitis (PF). The main purpose of this study was to examine how RSWT affects gait parameters. This study included 23 patients with unilateral, chronic PF. RSWT were administered in 5 interventions, during a consecutive 3-week period. Objective kinetic (force distribution under the forefoot, midfoot, rearfoot) and spatiotemporal parameters (cadence, step length, stance phase duration) during treadmill walking at, preferred” speed were evaluated on. 4 sessions: before therapy, immediately after (primary endpoint), 3 and 6 weeks after therapy. The mean reduction in the reported pain when taking first steps in the morning from baseline to the primary endpoint, 3- and 6-weeks post procedure was 42.7%, 50.1% and 66.9% respectively. Similar reduction was seen in the reported pain during walking. After the therapy during gait at the preferred speed patients had a significantly higher force beneath the rearfoot and forefoot of both limbs. Force beneath the midfoot was not significantly affected by treatment. The step length in both limbs increased by 3.3–3.6 cm after RSWT. After the therapy stance phase duration in symptomatic foot was longer by 7% and it slightly decreased until POST-6wk. Similar changes were seen in an asymptomatic limb. The spatiotemporal and kinetic results indicate that RSWT therapy induces changes in patient’s gait structure and alter regional loading in the affected foot.

Falls pose a serious problem in elderly and clinical populations. Most often, they lead to a loss of mobility and independence. They might also be an indirect cause of death. The aim of this study was to determine an objective predictor of the fear of falling and falls in elderly subjects (ESs) and Parkinson’s disease (PD) subjects. Thirty-two ESs were examined in this study, of whom sixteen were diagnosed with PD. The testing procedures comprised force plate measurements (limit of stability test–LOS test) and clinical tests (Berg Balance Scale, Functional Reach Test, Timed Up and Go test, Tinetti test). The Falls Efficacy Scale International (FES-I) was used to evaluate the fear of falling. The range of the maximum forward lean was normalized to the length from the ankle joint to the head of the first metatarsal bone and was named the functional forward stability indicator (FFSI). The FFSI, derived from the LOS test, allowed us to demonstrate the real deficit in functional stability and individual safety margins. Moreover, the FFSI was highly correlated with the FES-I score and almost all clinical test results in elderly subjects (r>0,6; p0,6, p

Introduction/Background Elderly people often use a smaller percentage of their base of support during maximal weight shifting, which leads to balance instability, that can lead to frequent falls and serious injuries. Even the most active people cannot reach theoretical limits of stability, therefore the need to investigate the functional BOS i.e. the real stability boundary and the factors that can affect this ability. Aim The new index of anterior stability limit (IASL) explaining the functional base of support (BOS) in sagittal plane (while participants voluntarily displace their COP in the front direction) that can assess fear and risk of falling. Material and method Twenty five students of the University of the Third Age voluntarily participated in the study. The force plate measurements allowed to investigate functional limit of stability in addition to clinical tests (BBS, Duncan, TUG). The FES-I questionnaire was used to evaluate fear of falling. Additionally, the anthropometric parameters of the foot were measured. The IALS is proportion between range of COP displacement during maximum forward lean and distance from the ankle joint to the head of first metatarsal bone. The Pearson's linear correlation between FES-I, BBS, Duncan test, TUG test and IASL was conducted. Results High negative correlation was observed between IASL and main scores of FES-I (r = −0.64, P Conclusion The use of IASL indicate that elderly people used on average 70% of their functional BOS. Use of smaller functional BOS determines increase the fear of falling. Lower values of IASL correlate with clinical test, which assess risk of falling. IASL has potential as screening tools for fear and risk of falls.