Balance assessment in selected stages of Parkinson's disease using trend change analysis.

BACKGROUND: Balance disorders in patients diagnosed with Parkinson's disease (PD) are associated with a change in balance-keeping strategy and reflex disorders which regulate the maintenance of vertical body posture. Center of foot pressure (COP) displacement signals were analyzed during quiet standing experiments to define such changes. The research aimed to apply stock exchange indices based on the trend change analyses to the assessment of a level of the Parkinson disease progression on the grounds of the analysis of the COP signals. METHODS: 30 patients in two stages of PD, 40 elderly participants, and 20 individuals at a young age were studied. Each person was subjected to 3 measurements with open and closed eyes. A technical analysis of the COP displacement signal was performed, and the following quantities were determined: indices related to the number of trend changes (TCI), indices defining a mean time (TCI_dT), and mean displacement (TCI_dS) and mean velocity (TCI_dV) between such changes. RESULTS: The results indicate a higher TCI value for PD than for aged-matched control group (p < 0.05). In the case of PD patients, there was also an increase in the TCI_dS value by 2-5 mm, which mainly contributed to the increase in TCI_dV. Statistically significant differences for the TCI_dT values occurred between all groups in which differences in the average COP velocity were noted. CONCLUSIONS: The TCI and TCI_dV results obtained for the healthy participants enabled the development of indices supporting PD diagnostics. The causes of the TCI_dV changes in patients were determined, i.e., whether they resulted from an increase in the TCI_dT or TCI_dS between the moments of trend changes indicated by the developed algorithm. The developed methodology provides new information on the impact of PD on the strategy of maintaining balance, which was impossible to obtain using currently used analyses. Trial registration The conducted research is an observational study and does not include a health care intervention. Participants gave their consent to participate in the research and the procedure was approved by the Institutional Bioethics Committee.

Modulation of center-of-pressure signal in children on the autism spectrum: A case-control study.

BACKGROUND: Proper postural and motor control plays a fundamental role in the child's ontogenetic development. So far, the postural control in children on the autism spectrum has mainly been assessed with standard posturographic measurements of center of pressure (COP) displacements. RESEARCH QUESTION: What are the differences in postural control between autistic and typically developing children? METHODS: The study group comprised 16 autistic children aged 6-10 years, identified by a psychiatrist. The control group consisted of 16 typically developing children aged 6-10 years with no posture deformities, no pervasive developmental disorder and no history of postural control or movement deficits. The data were collected during quiet standing with eyes open using a force plate. To gain a better insight into the postural control processes, the rambling-trembling and sample entropy analyses were used in COP data processing. RESULTS: Compared to typically developing children, those with autism spectrum had significantly higher values of COP and rambling trajectory parameters in the antero-posterior direction during quiet standing. The variables of the trembling trajectory did not differ significantly between the groups. The autistic children had significantly lower values of sample entropy in the antero-posterior direction compared to typically developing children. SIGNIFICANCE: More advanced measures of COP displacements including the rambling-trembling method and sample entropy revealed differences in postural control between autistic and typically developing children. These methods may therefore contribute to functional assessment of postural control deficits in children on the autism spectrum.

Intravaginal electrical stimulation as a monotherapy for female stress urinary incontinence: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Since patients, physiotherapists and gynaecologists continue to seek effective conservative treatments for stress urinary incontinence (SUI), the aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of intravaginal electrical stimulation (ES) in women with SUI. METHODS: We searched PubMed, Embase, EBSCOHost and Ovid for randomized controlled trials. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous data, we calculated the mean difference (MD) and 95% CI. Heterogeneity was assessed with I2 statistics. RESULTS: Of the 686 records identified, a total of 10 articles met the inclusion criteria. A meta-analysis revealed significant differences between the ES and no active treatment groups in the pooled objective cure rates (RR: 4.20; 95% CI: 1.70 to 10.40; p = 0.001; I2 = 0%) and subjective cure or improvement rates (RR: 4.96; 95%: 1.01 to 24.37; p = 0.04; I2 = 0%). No significant differences were found in the pooled number of incontinence episodes per 24 h (MD: 0.16; 95% CI: 0.68 to 0.37; p = 0.56; I2 = 0%), the pooled Incontinence Quality of Life Questionnaire scores (MD: 1.84; 95% CI: 2.11 to 5.80; p = 0.36; I2 = 0%) or the pooled number of adverse effects (RR: 0.69; 95% CI: 0.38 to 1.27; p = 0.23; I2 = 0%) between the ES and other conservative treatment groups. CONCLUSION: There was insufficient evidence for or against the use of intravaginal ES therapy for women with SUI, partly due to the variability in the interventions of the included trials and the small number of trials included.

Characteristics of transitional locomotor tasks performed by patients with dementia.

Elderly individuals may be at increased risk of falls than their peers. Early identification of balance disorders and their appropriate intervention are crucial for patients with dementia. The aim of this study was to identify postural instability in patients from mild to moderate dementia while performing transitional locomotor tasks under different conditions. Fifty-four patients with dementia and 30 healthy controls voluntarily participated in the study. The transitional locomotor task was performed on two force platforms under four conditions: unimpeded transition, obstacle clearance, step-up and step-down trials. The recording of center of foot pressure displacements was divided into three distinct phases: 1st phase-quiet standing before the transitional locomotor task, 2nd phase-forward stepping, 3rd phase-quiet standing after the transitional locomotor task. Patients with dementia were characterized by a longer transitional locomotor task time than the control group under all conditions (P < 0.03). Significant differences in quiet standing before the transitional locomotor task were observed between patients with dementia and the control group, but only in unimpeded transition and obstacle clearance trials (P < 0.02). No significant differences in quiet standing after step transition were observed between patients with dementia and the control group (P > 0.05). Postural control research in patients with dementia should focus on the functional motor task rather than on a simple motor task (quiet standing). Because even patients with mild dementia have impaired dynamic balance, the assessment of transitional locomotor tasks performed by patients with dementia might provide an indicator of an early diagnosis of dementia and might lead to better individualized physiotherapy.

Biomechanical measures of balance after balance-based exergaming training dedicated for patients with Parkinson's disease.

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.

The Effects of Exergaming Training on Balance in Healthy Elderly Women-A Pilot Study.

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 < 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.

Age-related changes in postural control in older women: transitional tasks in step initiation.

BACKGROUND: Aging, being a natural process, involves many functional and structural changes within the body. Identifying the age-related postural changes will provide insight into the role of aging on postural control during locomotion. The aim of this study was to identify age-related postural changes during a transitional task under different conditions. METHODS: Sixty healthy females divided into three age groups: A (50-60 y/o), B (60-70 y/o), and C (70-80 y/o). The transitional task was measured by two force platforms. The procedure consisted of three phases: quiet standing, transfer onto a second platform, and quiet standing on the second platform. Four different conditions were applied: unperturbed transfer, obstacle crossing, step-up, and step-down. Double-support time, transit time, and stability time before and after the step task were analyzed. RESULTS: The transit time was longer by 30% for subjects over 70 y/o. The double-support time was longer by 11% among adults 60-70 y/o, while in people over 70 y/o it was longer by almost 50% compared to the 50-60 y/o subjects. The stability time before the transitional task was longer by 17% among adults over 60 y/o compared to middle-age subjects. The stability times before and after the transitional task were longer for adults in the 50-60 y/o category. CONCLUSION: The proposed procedure is adequate for assessing age-related changes in postural control while undergoing a transitional task. An analysis of the double-support time and stability time before and after the step task enabled the detection of early signs of balance changes in middle-age adults. Independent of age, the transitional task parameters changed with the increasing difficulty of the tasks.

Detection of postural control in early Parkinson's disease: Clinical testing vs. modulation of center of pressure.

INTRODUCTION: Little is known about the early stage balance changes in PD. Many clinicians assume that there are no postural issues in early PD because of failure to identify them on bedside and clinical testing. Here, we quantify balance changes in early and moderate stage PD and compared these values to healthy controls (HC) using clinical assessments of balance and posturography. METHODS: We compared 15 HC with 15 early PD (PD-II; Hoehn and Yahr stage II) and 15 moderate PD (PD-III; H&Y stage III). Participants performed various clinical tests of balance and a standing postural task on a force platform. We quantified the spatiotemporal parameters of the center of pressure (COP), the sample entropy and power spectral density (PSD) of the COP. RESULTS: The PSD of the COP differentiated PD-II from HC from 0-0.5 Hz and PD-II from PD-III from 0.5-1 Hz. Specifically, PD-II and PD-III manifested greater power than HC from 0-0.5 Hz, whereas PD-III exhibited greater power than PD-II and HC from 0.5-1.0 Hz (p<0.05). However, there were no significant differences between PD-II and HC in all clinical tests and in spatiotemporal parameters of the COP (p>0.05). Although the sample entropy was significantly lower in the PD groups (p<0.05), entropy failed to differentiate PD-II from PD-III. CONCLUSION: The low-frequency modulation of the COP in this small cohort differentiated early PD from HC and from moderate PD. Clinicians should be aware that there are early balance deficits in PD. A larger sample size is needed to confirm these findings.

Fall-related measures in elderly individuals and Parkinson's disease subjects.

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; p<0.05). In PD subjects, the FFSI was poorly correlated with the fear of falling, the BBS score and the FR distance; however, a high correlation with the Tinetii test (r>0,6, p<0.05) was noted. The PD subjects presented a different balance strategy when close to their stability limits, which was also reflected in the lower values of sample entropy (t = (-2.40); p<0.05; d = 0.87). The FFSI might be a good predictor of the fear of falling in the group of elderly people. Additionally, the FFSI allows us to show real balance deficits both in PD subjects and in their healthy peers without the need for a reference group and norms. In conclusion, it is postulated that the popular clinical assessments of postural balance in PD subjects should be accompanied by reliable posturography measurements.

Transitional Locomotor Tasks in People With Mild to Moderate Parkinson's Disease.

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.

Assessment of dynamic balance during step initiation in Parkinson's disease patients and elderly - a validity study.

PURPOSE: The aim of this study was to evaluate the reliability of the novel posturographic procedure and to investigate the relationships between parameters of this procedure and clinical tests. We hypothesised the proposed step initiation procedure to be reliable method of balance and motor disability assessment, especially in patients with neurological deficits. Also, we assumed high significant correlation between parameters of step initiation procedures and clinical tests. METHODS: The 35 subjects with idiopathic PD and 35 agedmatched healthy controls participated in this study. The gait initiation was measured using two force platforms. The procedure consisted of three phases: (1) quiet standing on a first platform (2) crossing on the second platform, (3) quiet standing on a second platform. Testing was carried out in four conditions: unperturbed trial, obstacle crossing, step-up and step-down. RESULTS: In the proposed gait initiation procedure, the vCOP, raCOP and rmsCOP showed an excellent reliability (ICC > 0.80). For transit phase, reliability of all variables in all conditions also was excellent (ICC = 0.8-0.9). There were only a few associations between Tinetti scores and posturographic variables in controls, but in PD patients the significant correlations were found between the proposed measures and the UPDRS, Tinetti, FRT, TUG and with the BBS. CONCLUSIONS: The proposed gait initiation procedure is reliable and very suitable for the assessment of patients with Parkinson's disease. It can be used as an objective assessment of the clinical condition and dynamic balance, and help in the designing and programming of the appropriate rehabilitation and treatment.

Application of Virtual Reality in Competitive Athletes - A Review.

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.

Standards of Virtual Reality Application in Balance Training Programs in Clinical Practice: A Systematic Review.

OBJECTIVE: To determine the effect of virtual reality (VR) games on improving balance in different groups of neurological patients with a particular focus on the study quality and to determine the gold standard in VR training in these groups. MATERIALS AND METHODS: A systematic review of controlled trials published between January 2009 and December 2017 was conducted. The PubMed, SCOPUS, SPORTDiscus, and Medline databases were searched. Studies involved patients with stroke or Parkinson's disease or children with cerebral palsy. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. RESULTS: A total of 20 studies met the inclusion criteria. The PEDro scores ranged from 4 to 8 points. Analysis of the rehabilitation programs revealed a very large discrepancy in the planned volume of exercises in different subgroups of patients. CONCLUSIONS: Overall, the comparison of VR interventions between conventional rehabilitation and no intervention exhibited significantly better results. However, these results should be interpreted with great caution due to the large diversity of the systems, games, and training volume used in the VR therapy. In all included studies, only several articles included objective methods to assess the effect of VR. In addition, most of the articles showed a high risk of bias, such as a lack of randomization and blinding or a small sample size. That is why further well-designed randomized control trials are required to evaluate the influence of VR on balance in different groups of neurological patients.

Effects of 8-Week Complex Balance Training in Young Alpine Skiers: A Pilot Study.

OBJECTIVES: The purpose of this study was to determine the effects of an 8-week complex balance training program on dynamic balance in skiers according to the new balance training protocol. DESIGN: Intervention study, comprising 8 weeks of core stability, plyometric, balance, and stretching exercises. PARTICIPANTS: Ten young skiers volunteered to take part in this study (average age, height, and body mass were 16,44 +/- 1,07 years, 172,76+/-8,84 cm, and 67,4 11,44 kg, respectively (mean +/- SD)). MAIN OUTCOME MEASURES: Subjects' dynamic balance performance was assessed and retested after training completion with the use of dynamic balance measurement within the Optojump Next System. RESULTS: The results of 8-week complex balance training showed significant improvements for jump height (H) and flight time (FT) for the left leg and jumping area in both legs. CONCLUSION: The complex balance training program improved parameters of dynamic stability in young skiers and led to decreased asymmetry between lower extremities.

A posturographic procedure assessing balance disorders in Parkinson's disease: a systematic review.

Postural instability is common in Parkinson's disease (PD), often contributing to falls, injuries, and reduced mobility. In the clinical setting, balance disorder is commonly diagnosed using clinical tests and balance scales, but it is suggested that the most sensitive measurement is the force platform. The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD. A systematic review was conducted of papers published from 2000 to 2017. Databases searched were PubMed and EBSCO. Studies must have involved patients with PD, used force platform or motion analysis system as a measurement tool, and described posturographic procedure. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. A total of 32 studies met the inclusion criteria. The PEDro scores ranged from 5 to 7 points. The analysis of the objective methods assessing balance disorders revealed a large discrepancy in the duration and procedures of measurements. The number of repetitions of each trial fluctuated between 1 and 8, and the duration of a single trial ranged from 10 to 60 seconds. Overall, there are many scales and tests used to assess the balance disorders and disabilities of people with PD. Although in many included studies the authors have used posturography as a method to evaluate the postural instability of PD patients, the results are contradictory. To solve this issue, it is indicated to establish a "gold standard" of procedures of measures of balance.

Effect of expertise in ballet dance on static and functional balance.

RESEARCH QUESTION: The purpose of this study was to examine the postural sway characteristics of the ballet dance experts in quiet standing and at their limits of stability with an approach not used before in dancers. METHODS: The study was conducted on thirteen female ballet dancers and thirteen non-training females. The data were collected with a use of a force plate. To gain a better insight into the postural control processes, we used the rambling-trembling and sample entropy analyses in the COP data processing. RESULTS: The main findings of the study showed professional dancers to have higher values of postural sway characteristics in comparison to the non-trainees while performing simple motor tasks. Also, higher values of the trembling component in the group of dancers during quiet standing and the inclined positions were observed. This might be a sign of higher capacity of the postural system to deal with postural instability in dancers. IMPORTANCE: Our results confirmed that the visual information is important in the process of postural control of dancers', which is proven by increased dislocations of the COP without visual feedback. The sample entropy results indicated more irregular characteristics of postural sway in ballet dancers representing more automated postural control. The data analysis methods showed high sensitivity to the subtle changes in postural control due to the dance training.

Balance Training Programs in Athletes - a Systematic Review.

It has become almost routine practice to incorporate balance exercises into training programs for athletes from different sports. However, the type of training that is most efficient remains unclear, as well as the frequency, intensity and duration of the exercise that would be most beneficial have not yet been determined. The following review is based on papers that were found through computerized searches of PubMed and SportDiscus from 2000 to 2016. Articles related to balance training, testing, and injury prevention in young healthy athletes were considered. Based on a Boolean search strategy the independent researchers performed a literature review. A total of 2395 articles were evaluated, yet only 50 studies met the inclusion criteria. In most of the reviewed articles, balance training has proven to be an effective tool for the improvement of postural control. It is difficult to establish one model of training that would be appropriate for each sport discipline, including its characteristics and demands. The main aim of this review was to identify a training protocol based on most commonly used interventions that led to improvements in balance. Our choice was specifically established on the assessment of the effects of balance training on postural control and injury prevention as well as balance training methods. The analyses including papers in which training protocols demonstrated positive effects on balance performance suggest that an efficient training protocol should last for 8 weeks, with a frequency of two training sessions per week, and a single training session of 45 min. This standard was established based on 36 reviewed studies.