Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability.

CONTEXT: Rehabilitation programs for patients with chronic ankle instability (CAI) generally involve balance-perturbation training (BPT). Anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are the primary strategies used to maintain equilibrium during body perturbations. Little is known, however, about how APAs and CPAs are modified to promote better postural control for individuals with CAI after BPT. OBJECTIVE: To investigate the effect of BPT that involves kicking a ball on postural-control strategies in individuals with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: We randomly assigned 44 volunteers with CAI to either a training group (TG; 11 women, 11 men; age = 24 ± 4 years, height = 173.0 ± 9.8 cm, mass = 72.64 ± 11.98 kg) or control group (CG; 11 women, 11 men; age = 22 ± 3 years, height = 171.0 ± 9.7 cm, mass = 70.00 ± 11.03 kg). INTERVENTION(S): The TG performed a single 30-minute training session that involved kicking a ball while standing on 1 foot. The CG received no intervention. MAIN OUTCOME MEASURE(S): The primary outcome was the sum of the integrated electromyographic activity (∑∫EMG) of the lower extremity muscles in the supporting limb that were calculated during typical intervals for APAs and CPAs. A secondary outcome was center-of-pressure displacement during similar intervals. RESULTS: In the TG after training, the ∑∫EMG decreased in both dorsal and ventral muscles during compensatory adjustment (ie, the time interval that followed lower limb movement). During this interval, muscle activity (∑∫EMG) was less in the TG than in the CG. Consequently, center-of-pressure displacement increased during the task after training. CONCLUSIONS: A single session of ball-kicking BPT promoted changes in postural-control strategies in individuals with CAI. These results should stimulate new and more comprehensive studies to investigate the effect of this and other BPT techniques on postural control in patients with CAI.

Anticipatory and Compensatory Postural Adjustments in Response to External Lateral Shoulder Perturbations in Subjects with Parkinson's Disease.

The purpose of this study was to investigate the anticipatory (APA) and compensatory (CPA) postural adjustments in individuals with Parkinson's disease (PD) during lateral instability of posture. Twenty-six subjects (13 individuals with PD and 13 healthy matched controls) were exposed to predictable lateral postural perturbations. The electromyographic (EMG) activity of the lateral muscles and the displacement of the center of pressure (COP) were recorded during four time intervals that are typical for postural adjustments, i.e., immediately before (APA1, APA2) and after (CPA1 and CPA2) the postural disturbances. The magnitude of the activity of the lateral muscles in the group with PD was lower only during the CPA time intervals and not during the anticipatory adjustments (APAs). Despite this finding, subjects with PD exhibit smaller COP excursions before and after the disturbance, probably due to lack of flexibility and proprioceptive impairments. The results of this study suggest that postural instability in subjects with PD can be partially explained by decreased postural sway, before and after perturbations, and reduced muscular activity after body disturbances. Our findings can motivate new studies to investigate therapeutic interventions that optimize the use of postural adjustment strategies in subjects with PD.

The influence of seat heights and foot placement positions on postural control in children with cerebral palsy during a sit-to-stand task.

This paper aimed to analyze, from both a kinetic and kinematic perspective, the postural control of children with cerebral palsy (CP) able to independently perform the sit-to-stand (STS) task (ICP) and children who needed support (SCP) typically developing children during the STS; and also investigate the influence of seats heights and foot placement positions on postural control of these children. Fourteen children with CP and fourteen typically developing controls were recruited. Based on the Gross Motor Function Classification System (GMFCS) the children with CP were divided into ICP (level I) and SCP (levels II and III). Balance was assessed using the Pediatric Balance Scale. Motor function was rated using the GMFCS. Kinematic and kinetic data were recorded and analyzed during the STS task at two different seat heights and foot placement positions. The SCP exhibited significantly less balance according to the PBS and smaller displacement of their center of pressure (COP) in anteroposterior (COPAP) and mediolateral (COPML) direction relative to the other two groups. ICP demonstrated significant greater in the COPML displacement than the other groups. Children with CP required more time to complete the STS than controls. Those in the SCP group had lower linear displacement of the shoulder and knee than others during the STS task. During the high bench condition, the linear displacements of the shoulder and knee were reduced also. We conclude that the SCP has less COPAP and COPML oscillation, what means the better postural control during STS than the other two groups, which may be related to the support provided. The ICP exhibited greater COPML oscillations than controls, suggesting that they utilized different strategies in the frontal plane during the STS task. The seat height and foot placement did not influence postural control in children with CP, at least in terms of kinetic parameters. Seat height influenced the kinematic variables, with a high bench reducing linear displacement of the shoulder (vertical and horizontal) and knee (vertical) both in children with CP and control children.

Eficácia do método Pilates no solo em pacientes com lombalgia crônica: relato de casos / Efficacy of ground Pilates for chronic low back pain patients: case reports

JUSTIFICATIVA E OBJETIVOS: A incapacidade de estabilização da coluna vertebral, causada pelo desequilíbrio entre a função dos músculos extensores e flexores do tronco, é um forte indício de desenvolvimento de distúrbios da coluna lombar. O exercício, frequentemente referido como Pilates® preconiza a melhora das relações musculares agonista e antagonista, favorecendo o trabalho dos músculos estabilizadores, prevenindo diversos distúrbios na coluna lombar. O objetivo deste estudo foi avaliar a efetividade do método Pilates no tratamento de pacientes com lombalgia crônica. RELATO DOS CASOS: Foram estudadas 7 pacientes do sexo feminino, com idade entre 18 e 50 anos, com diagnóstico clínico de lombalgia crônica e com habilidade para executar os exercícios do nível básico e intermediário do método Pilates. Foram utilizados como instrumentos de avaliação e medida a escala analógica visual (EAV) de dor e o Questionário de Oswestry de lombalgia, além de um Questionário de Identificação. A análise dos dados foi feita por média aritmética simples. Houve melhora significativa da dor, demonstrada pela EAV que, inicialmente, apresentava média de 7 e após 3 meses de tratamento, diminuiu para 1,7. Houve melhora na qualidade de vida, com redução do Índice de Oswestry de 36,8% para 8% após 3 meses de tratamento. CONCLUSÃO: O método Pilates foi efetivo no tratamento de pacientes portadores de lombalgia crônica, diminuindo a dor e as incapacidades.

BACKGROUND AND OBJECTIVES: The inability to stabilize the spine due to the unbalance between trunk extensor and flexor muscles is a strong indication of the development of lumbar spine disorders. The exercise commonly referred to as Pilates® advocates improvement of muscle agonist and antagonist relations favoring the work of stabilizing muscles and preventing several lumbar spine disorders. This study aimed at evaluating the effectiveness of Pilates to treat chronic low back pain. CASE REPORTS: We have evaluated seven female patients aged between 18 and 50 years, with clinical diagnosis of chronic low back pain and able to perform basic and intermediate Pilates exercises. Evaluation tools were the pain visual analog scale (VAS) and Oswestry's low back pain questionnaire, in addition to an Identification Questionnaire. Data were analyzed by simple arithmetic average. There has been significant pain improvement by VAS which initially had a mean of 7 and after 3 months of treatment has decreased to 1.7. There has been improvement in quality of life, with Owestry's index decreasing from 36.8% to 8% after 3 months of treatment. CONCLUSION: Pilates was effective to treat chronic low back pain, having improved pain and incapacities.