Postural Instability and Risk of Falls in Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Stabilometric Platform Study.

Postural instability (PI) in Parkinson's disease (PD) exposes patients to an increased risk of falls (RF). While dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF remain elusive. PI and RF were assessed using a stabilometric platform in six advanced PD patients. Patients were evaluated in OFF and ON dopaminergic medication and under four DBS settings: with DBS off, DBS bilateral, and unilateral DBS of the more- or less-affected side. Our findings indicate that dopaminergic medication by itself exacerbated PI and RF, and DBS alone led to a decline in RF. No combination of medication and DBS yielded a superior improvement in postural control compared to the baseline combination of OFF medication and the DBS-off condition. Yet, for ON medication, DBS significantly improved both PI and RF. Among DBS conditions, DBS bilateral provided the most favorable outcomes, improving PI and RF in the ON medication state and presenting the smallest setbacks in the OFF state. Conversely, the more-affected side DBS was less beneficial. These preliminary results could inform therapeutic strategies for advanced PD patients experiencing postural disorders.

To evaluate whether there is a relationship between occlusion and body posture as delineated by a stabilometric platform: A systematic review.

OBJECTIVE: To evaluate whether there is a relationship between occlusion and body posture evaluated using a stabilometric platform. METHODS: Observational studies that analyzed the relationship between dental occlusion (changes in mandibular position and/or dental malocclusion) and body posture evaluated with a stabilometric platform in patients older than 13 years without orthodontic or orthopedic intervention and systemically healthy were considered eligible for inclusion. PubMed, EMBASE, Science Direct, LILACS, and Google Scholar databases were searched to obtain articles published from September 2019 up to March 2020. RESULTS: Twelve articles met the inclusion criteria, of which 66.7% showed a relationship between dental occlusion and body posture, and 33.3% found no relationship. The marked heterogeneity between studies did not allow data to be combined for meta-analyses. CONCLUSION: For the mandibular positions, the postural changes were mainly in the mediolateral direction, while in the malocclusions, they were in the anteroposterior direction.

Stabilometric assessments of two rehabilitation protocols on postural parameters after posterior total hip arthroplasty: A prospective randomized comparative study.

INTRODUCTION: After total hip arthroplasty (THA), patients continue to have muscular, functional and postural deficits. The literature seems to support the use of postoperative rehabilitation, especially self-directed programs. However, there is no set protocol for the management of postural disorders. Therefore, the purpose of this study was to compare postural parameters of a group of patients who underwent posterior THA followed by 2 different types of rehabilitation (stabilometric platform (SP) and home-based self-directed protocols) with a control group of operated patients who did not undergo rehabilitation and a control group of age-matched asymptomatic subjects. HYPOTHESIS: We hypothesized that rehabilitation would normalize the stabilometric parameters. PATIENTS AND METHODS: A total of 67 subjects were enrolled in this study (mean age 67.85±1.22years) and divided into 4 groups. Forty-one of these subjects had undergone a posterior THA were randomly assigned between D10 and D21 to one of the following 3 groups: no rehabilitation control group (THACG=14), supervised rehabilitation with a stabilometric platform group (RSPG=16), and a self-directed home-based rehabilitation group (SDHRG=11). The 4th group was a control group made up of 26 age-matched asymptomatic nonoperated subjects (CG55-80). These rehabilitation protocols lasted 3weeks. At the end of the 3weeks, the groups performed the same stabilometric single leg and double leg stance tests (considering lower limb dominance) on an SP. RESULTS: No significant differences were observed between groups in the bipedal stance, except between the CG55-80 and the THACG, where a higher energy expenditure was observed in the THACG during the static stance with eyes open (EO) and eyes closed (EC): increase in the path length (Plength) covered by the center of pressure (COP) (EO: p=01; EC: p=03) and the average velocity (Vavg) of the COP (EO: p=01; EC: p=03). These differences were not observed in the SDHRG and RSPG whether they were compared with one another or with both control groups. In the unipedal stance, subjects in the RSPG and SDHRG showed greater muscle activity in the anterior and posterior chains and hip abductors, and used less energy to maintain the stance than those in the CG55-80, regardless of lower limb dominance: decrease in the mediolateral range of COP displacement (Xrange) (hip abductor muscles) (p=02) and anteroposterior range of COP displacement (Yrange) (anterior and posterior chains) (p=3.49.10-3), 95% confidence ellipse area (Earea) of COP data (p=1.47.10-3), Plength (p=04) and Vavg (p=04). The RSPG had a smaller Earea than the SDHRG (p=04), demonstrating a better postural stability during the unipedal stance performed on the dominant operated leg. DISCUSSION: Our results were consistent with the literature on the benefits of rehabilitation after THA, thus confirming our hypothesis that rehabilitation normalized stabilometric parameters between D31-D45, depending on the subjects. These results provide new information regarding rehabilitation techniques to be implemented postoperatively after a THA. A home-based self-directed rehabilitation program is just as effective as an SP program in managing postural disorders. LEVEL OF EVIDENCE: II; randomized controlled trial with low statistical power.

Increased body sway in phobic patients exposed to images of spiders

Objective: The aim of the present study was to analyze the body sway response in specific phobia (SP) patients and healthy controls while viewing neutral, phobic, and disgusting images. Methods: The participants' heart rate (HR) and skin conductance were also recorded during the procedure. Nineteen patients with arachnophobia and 19 healthy volunteers matched by age, gender, and years of education underwent a postural control test on a stabilometric platform. Results: The platform recorded increased body sway in the SP group when exposed to spider images (SPI). The SP group presented increases in most parameters (SD, velocity, frequency, area, p ≤ 0.05) when viewing pictures of the SPI category. Psychometric measures of subjective anxiety (State-Trait Anxiety Inventory, STAI) and physiological states (HR; skin conductance responses; spontaneous fluctuations in skin conductance) showed increased anxiety (p ≤ 0.05) in the SP group compared to healthy volunteers. High anxiety levels were observed throughout the assessment, including the task of exposure to SPI (p ≤ 0.05). No significant effect or correlation was found between skin conductance and body sway measures (p > 0.05). Conclusions: The results of the postural control test suggest the occurrence of a defensive escape response in SP, in agreement with previous evidence.

Learning effect and repeatability of stabilometric measurements: "standard" vs. usual foot placement.

The existence of a learning effect by which subjects progressively reduce body sway over the course of repetitive stabilometric measurements is currently debated. Also, the position and orientation of the feet on the platform can have a substantial influence on the outcome measurements. The aim of the present work was to assess the effect of feet positions on mean total velocity (V) of the center of pressure and the area (AR) covered by its displacements during quiet standing. A group of 35 healthy young subjects was examined during two successive sessions consisting of five recordings with their feet placed either in the recommended (standard, SP) or their usual most comfortable (UP) position. Results show a slight decreasing trend that failed to be statistically significant checked with Friedman's ANOVA (SP AR, χ2(4)=6.10, p=0.19 and V, χ2(4)=8.66, p=0.07 and UP AR, χ2(4)=2.32, p=0.68 and V, χ2(4)=1.19, p=0.88). Nonetheless, values of AR and V showed a notable decrement especially evident in the SP exam reaching, respectively, 24% and 11% from baseline, whereas variability measured by the coefficient of variation was the same in the two exams. Given the results, a learning effect should not be ruled out with confidence. Also, usual foot placement would be preferable to avoid this effect. Further research is needed to take into consideration the great variability of stabilometric measurements and the fact that different subjects could adapt more readily to the test conditions than others.

Gnathological and osteopathic treatments with digital evalua- tions before and after therapies: a case report of a patient with ehlers-danlos syndrome.

BACKGROUND: Ehlers-Danlos syndromes (EDS) are inherited connective tissue disorders, requiring specific care along with a multidisciplinary approach by an expert medical staff, as for both the diagnosis and the treatment management. Chronic generalized pain and musculoskeletal dysfunctions due to joint hypermobility are common traits. Temporomandibular disorders (TMDs) are among the most frequent complaints. The authors report the diagnostic and therapeutic management of an EDS subject. CASE PRESENTATION: A 33-year old woman with Ehlers-Danlos syndrome, hypermobile type, was clinically evalu-ated and treated. She underwent a gnathological therapy with an anterior repositioning splint and proprioception ex-ercises, and a physical rehabilitation through an osteopathic manipulation treatment (OMT). Technology - surface Elec-tromyography (sEMG) of masticatory muscles, T-scan and stabilometric platform- supported diagnostic and therapeutic phases, giving objective and quantifiable information on the patient's assessment before and after treatments. CONCLUSION: According to a targeted therapeutic strategy, both the gnathological and the osteopathic therapy proved to be effective in improving patient's symptomatology and functionality, as confirmed by digital findings.

MCQ-Balance: a method to monitor patients with balance disorders and improve clinical interpretation of posturography.

BACKGROUND: An estimated 20% to 30% of the global population has suffered a vertiginous episode. Among them, 20% do not receive a clear diagnosis. Improved methods, indicators and metrics are necessary to assess the sensory systems related to balance, especially when patients are undergoing treatment for vertiginous episodes. Patients with balance disorders should be monitored for changes at the individual level to gather objective information. In this study, we evaluate the use of the MCQ-Balance (Measure, Classify and Qualify) assessment for examining a patient's balance progression using tests to measure static balance control and dynamic postural balance with a stabilometric platform. MATERIALS AND METHODS: The MCQ-Balance assessment comprises three stages: (i) measuring the progression of each variable between two separate and consecutive days (called sessions) using the Magnitude-Based Decision analysis; (ii) classifying the progression of the patient's balance with a score; and (iii) qualifying the progression of the patient's balance from the resulting scores using a set of rules. This method was applied to 42 patients with balance disorders of peripheral or central origin characterised by vertigo as the cardinal symptom. Balance progression was measured using the MCQ-Balance assessment over the course of three months, and these results were compared with the assessment of a clinical expert. RESULTS: The MCQ-Balance assessment showed an accuracy of 83.4% and a Cohen's Kappa coefficient of 0.752 compared to the assessment of a clinical expert. CONCLUSION: The MCQ-Balance assessment facilitates the monitoring of patient balance and provides objective information that has the potential to improve medical decision making and the adjustment of individual treatment.

[Achievement of consensus and standardization of methods in dentistry on the example of studies of support reactions (posturography, stabilometry)]. / Dostizhenie konsensusa i standartizatsiia metodov v stomatologii na primere issledovanii opornykh reaktsii (posturografii, stabilometrii).

Comprehensive treatment of dental pathology involves a multidisciplinary integration of doctors, the use of general physiological control methods and correction of human conditions, such as study of support reactions (on the stabilometric platform). Participation of dentists in the public scientific-methodological initiative 'Moscow consensus on the use of stabilometry and biofeedback for the support reactions in public health practice and research' increases the efficiency of application of this method in dentistry and the development of relationships with other practical areas.

Body balance analysis of children and youth with intellectual disabilities.

BACKGROUND: Children and adolescents with intellectual disabilities (IDs) are an identified group with postural disturbances resulting from a lack of integration among the visual, vestibular and proprioceptive systems. The insufficient level of maturity of the sensory systems is at least partly responsible for disturbances in maintaining body balance. More sway can increase the risk of falls and body injuries. The aims of the study were (1) to compare the ability to maintain the body balance of children and youth with a varying degree of ID, both with the eyes open and closed, and (2) to determine to what extent factors such as sex, level of ID, visual stimulus and body height independently affect the ability to maintain body balance in children and adolescents with ID. METHOD: The study involved 131 people aged 13-21 years (65 girls and 66 boys). The participants were classified as (1) with mild disability (42 girls and 47 boys) and (2) with moderate disability (23 girls and 19 boys), based on IQ test results. Sway measures were collected with the Zebris platform, with the eyes open and closed. Sway path, sway path in anterio-posterior and medio-lateral directions and sway area were analysed. RESULTS: Boys with moderate ID were characterised by a significantly more sway indicating their worse postural balance ability than boys with mild ID, both in the trials with open eyes and closed ones. The type of test (eyes open/eyes closed) to a small extent had influenced the body balance of the examined children with ID. Results of analyses of covariance had showed that all analysed factors (sex, level of ID, type of the test performance and body height), irrespectively from direction of sway (sway path in anterio-posterior and medio-lateral directions), worked independently influencing body balance. CONCLUSIONS: It could be assumed that lower height, moderate disability and male sex are factors significantly reducing ability of maintenance of balance of children and youth with ID.

Postural Disorders Produced by School Furniture on a Population of a Junior High School.

In recent years people suffering of backache has significantly increased. This led us to focus our attention on the adequacy of school furniture for the correct development of the adult posture. The standing posture of 67 students of middle school has been analyzed at the beginning and at the end of two consecutive scholastic years using a stabilometric platform. Starting from the second year, about half of the students were provided with the furniture designed following European standard (UNI EN 1729:2006), while the other half maintained the traditional one. The main purpose of this research has been to verify by means of posturometric analysis the effects on postural parameters of the use of traditional furniture in comparison to the furniture following the UNI EN 1729:2006. We observed that prolonged sitting at school changes some posturometric variables of schoolchildren. Since no differences has been found between the two groups, the validity of the European standards is questioned. The present study allowed us to single out four anthropometric parameters that should be considered in order to devise a new model of adjustable furniture. By adjusting every year the furniture of each student, it would be possible to avoid (at least at school) the adoption of wrong postural positions that could be responsible for backache and other common musculoskeletal disorders.

Impact of selected magnetic fields on the therapeutic effect in patients with lumbar discopathy: A prospective, randomized, single-blinded, and placebo-controlled clinical trial.

BACKGROUND: Interdisciplinary physical therapy together with pharmacological treatment constitute conservative treatment strategies related to low back pain (LBP). There is still a lack of high quality studies aimed at an objective evaluation of physiotherapeutic procedures according to their effectiveness in LBP. OBJECTIVES: The aim of this study is to carry out a prospective, randomized, single-blinded, and placebocontrolled clinical trial to evaluate the effectiveness of magnetic fields in discopathy-related LBP. MATERIAL AND METHODS: A group of 177 patients was assessed for eligibility based on inclusion and exclusion criteria. In the end, 106 patients were randomly assigned into 5 comparative groups: A (n = 23; magnetic therapy: 10 mT, 50 Hz); B (n = 23; magnetic therapy: 5 mT, 50 Hz); C (n = 20; placebo magnetic therapy); D (n = 20; magnetic stimulation: 49.2 µT, 195 Hz); and E (n = 20; placebo magnetic stimulation). All patients were assessed using tests for pain intensity, degree of disability and range of motion. Also, postural stability was assessed using a stabilographic platform. RESULTS: In this study, positive changes in all clinical outcomes were demonstrated in group A (p < 0.05). The most effective clinical effect was observed for pain reduction (p < 0.05), improvement of the range of motion (p < 0.05) and functional ability of the spine (p <0.05). It is also worth noting that the effects in the majority of the measured indicators were mostly short-term (p > 0.05). CONCLUSIONS: It was determined that the application of magnetic therapy (10 mT, 50 Hz, 20 min) significantly reduces pain symptoms and leads to an improvement of functional ability in patients with LBP.

Pulmonary Rehabilitation with a Stabilometric Platform after Thoracic Surgery: A Preliminary Report.

The aim of this study was to evaluate the influence of exercises on a stabilometric platform on the physical fitness and mobility of patients with lung cancer after thoracic surgery. The Experimental Group included 22, and the Control Group consisted of 21 patients. All included patients were enrolled after thoracic surgery due to lung cancer. The Experimental and Control Groups were enrolled in a 3-week in-hospital pulmonary rehabilitation program. The Experimental Group additionally performed daily 20-min training sessions on a stabilometric platform. Agility and flexibility were assessed with the Fullerton test before and after rehabilitation in both groups, and quality of life was assessed with the SF-36 questionnaire. Exercise performance stated as a distance in a 6 min walking test (6MWT) significantly improved in both groups with a medium effect size. The results of the Fullerton test indicated improvements in flexibility in both groups after the completion of the program without a significant difference between the groups and with a small effect size. In the Experimental Group, the best results were observed in the Arm curl (p = 0.0001), Chair stand (p = 0.04), Up and go (p = 0.001) and Chair sit and reach (p = 0.0001) tasks. No deterioration in the quality of life was observed in the Experimental or the Control Group after the completion of the program. Between-group analyses revealed significant differences in the Role-Physical (RP) (p = 0.020) and Mental-Health (MH) (p = 0.025) domains of the SF-36. The rehabilitation program with a stabilometric platform improved agility and flexibility of patients after thoracic surgery without an effect size or significant differences between the Experimental and Control Groups.

Favorable effect of rehabilitation on balance in ankylosing spondylitis: a quasi-randomized controlled clinical trial.

Balance impairment is a frequent and undertreated manifestation in ankylosing spondylitis, leading to increased risk of falls and lower quality of life. Our aim was to assess supervised training and home-based rehabilitation efficacy on balance improvement in ankylosing spondylitis subjects on biologic agents. This was a single-blinded, quasi-randomized parallel study in a single outpatient Rehabilitation Clinic of a tertiary referral center. Subjects with ankylosing spondylitis on biologic agents were assigned either to supervised training and home-based rehabilitation program (rehabilitation group) plus educational-behavioral therapy, or to educational-behavioral therapy alone (educational groups). The same therapist provided therapy. Outcome measures were assessed at baseline (T0), end of treatment (T1) and at 7-month follow-up (T2). Rheumatologic outcomes were Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Disease Activity Index. Balance parameters (anterior-posterior oscillation, latero-lateral oscillation, sway area, sway density and sway path) were evaluated by stabilometry in a condition of open and closed eyes. Forty-six subjects (36 M, 10 F) were enrolled. Demographic data and clinical status at baseline were comparable between the two groups (22 rehabilitation group, 20 educational group). Primary outcome was sway density that improved both at T1 (SDy: open eyes p = 0.003, closed eyes p = 0.004) and at T2 (SDx: open eyes p = 0.0015, closed eyes p = 0.032). A trend toward improvement in the rehabilitation group rather than in the educational group emerged for balance parameters, especially those measured with closed eyes (0.004 < p < 0.048 at T1 and 0.004 < p < 0.036 at T2). Supervised training and home exercise lead to balance improvement in people with ankylosing spondylitis. Eyes-closed trials show a more marked trend toward improvement, and this may suggest a positive effect of rehabilitation on proprioception.

Do visually impaired people have a static balance as effective as sighted people?

BACKGROUND: Neuroplastic compensations are reported to improve static balance in visually impaired people (VIP). OBJECTIVE: To compare the static balance of VIP with control sighted subjects in different conditions of proprioceptive disturbance. METHODS: Thanks to a stabilometric platform, static balance was determined by measuring (1) the speed of displacement of the center of pressure of the subjects and (2) its total surface. Recordings on surfaces with (foam) or without (hard) proprioceptive disturbance were taken with both open and closed eyes. RESULTS: We compared 38 VIP to 36 control subjects. On hard surface, the speed of displacement was always higher in VIP than in control. On the foam surface, the speed was higher in VIP with open eyes while no difference was seen with closed eyes. The total surface of displacement was larger in VIP on the foam surface with open eyes while there was no difference either with closed eyes or on hard surface between VIP and control. CONCLUSIONS: Static balance with open eyes is more precarious in VIP than in control. Nevertheless, VIP subjects do as well as control sighted subjects with closed eyes as shown by similar total surface of displacement irrespective with the type of surface.

Updating freeze: aligning animal and human research.

Freezing is widely used as the main outcome measure for fear in animal studies. Freezing is also getting attention more frequently in human stress research, as it is considered to play an important role in the development of psychopathology. Human models on defense behavior are largely based on animal models. Unfortunately, direct translations between animal and human studies are hampered by differences in definitions and methods. The present review therefore aims to clarify the conceptualization of freezing. Neurophysiological and neuroanatomical correlates are discussed and a translational model is proposed. We review the upcoming research on freezing in humans that aims to match animal studies by using physiological indicators of freezing (bradycardia and objective reduction in movement). Finally, we set the agenda for future research in order to optimize mutual animal-human translations and stimulate consistency and systematization in future empirical research on the freezing phenomenon.

Use of Stabilometric Platform and Evaluation of Methods for Further Measurments - A Pilot Study.

Posture in a still stance has been quantified by changes in the center of pressure (COP), in both anterior-posterior (A/P) and medial-lateral (M/L) directions and measured on a single force platform (Bertec PRO VEC 5.0). The purpose of this study was to estimate the variance in error and the intrasession test-retest reliability, and to determine which measures shall be taken for further measurements, especially with adults age 65 and older. We used two types of approximation for the reliability coefficient. Firstly, we used the equation according to Blahus (2) and secondly we used the Pearson's correlation coefficient for test-retest measurements. The findings allow us to say, among other things, that the tests of quiet standing Double Narrow Stance Eyes Open (DNSEO) and Double Narrow Stance Eyes Closed (DNSEC) are parallel, in the sense of parallel testing.