Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke.

OBJECTIVES: To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke. DESIGN: Two-group randomized controlled trial with pretest-posttest design. SETTING: Hospital rehabilitation center. PARTICIPANTS: Adults with chronic hemiparetic stroke (N=28). INTERVENTIONS: Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period. MAIN OUTCOME MEASURES: Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling. RESULTS: Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilization and DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003). CONCLUSIONS: This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke.

Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation-in vitro fertilization-embryo transfer cycle.

OBJECTIVE: Although extensive evidence indicates the hyperinsulinemia directly contributes to reproductive dysfunction in polycystic ovarian syndrome (PCOS), influence of insulin resistance (IR) on assisted reproductive technology outcomes is poorly understood. In this study we aimed to evaluate the effects of IR on in vitro maturation-in vitro fertilization-embryo transfer (IVM-IVF-ET) in patients with PCOS. DESIGN: Prospective observational study. PATIENTS: Women with PCOS (n = 115) commencing IVM. MEASURMENTS: IR (n = 51) and non-IR (n = 64) women with PCOS ready to commence an IVM cycle were recruited. IR was diagnosed using the glucose tolerance test (GTT) and homeostasis model assessment (HOMA) index. Patients with an abnormal GTT and/or HOMA index >2·4 were considered IR. Patients underwent 115 cycles of unstimulated hCG-primed IVM. RESULTS: Maturation, fertilization, cleavage rates, the number of good-quality embryo, and blastocyst formation rates were not significantly different between groups. However, implantation (11·6% vs 28·7%, P = 0·001, respectively), clinical pregnancy (23·5% vs 53·1%, P = 0·002, respectively), and ongoing pregnancy rates (21·6% vs 46·9%. P = 0·006, respectively) were significantly decreased in the IR group. The negative effect of IR on pregnancy outcomes remained after controlling for age, body mass index (BMI) and lipid profiles (OR 4·928, 95% CI 1·735-13·991, P = 0·003). CONCLUSIONS: Pregnancy rate after IVM is impaired in IR patients with PCOS. Oocyte development and embryo quality are not affected, suggesting that the effects of hyperinsulinemia on endometrial function and implantation process underlie the decreased pregnancy rate.

Feasibility and test-retest reliability of an electroencephalography-based brain mapping system in children with cerebral palsy: a preliminary investigation.

OBJECTIVE: To investigate the feasibility and test-retest reliability of a novel electroencephalography (EEG)-based brain mapping system in healthy children and children with cerebral palsy (CP). DESIGN: Correlation statistics. SETTING: University brain mapping and neurorehabilitation laboratory. PARTICIPANTS: A convenience sample of children (N=12; 5 healthy children, mean ± SD, 12.6±0.89y; 7 children with CP, mean ± SD, 9.71±1.1y) participated in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mu band (8-12Hz) power values in event-related spectral perturbation maps during reach and grasp hand movements were repeatedly measured on 2 separate occasions (2h apart). Intraclass correlation coefficient (ICC(1,2)) tests were computed to determine test-retest reliability at the standard level of significance (P<.004). In addition, the feasibility of the system was determined by evaluating potential differences in the cortical activation areas obtained from topographical maps during actual reach and grasp motor tasks between healthy children and children with CP. RESULTS: The test-retest reliability results showed excellent reliability between the repeated measures, ranging from .93 (P=.000) to .99 (P=.000). Our EEG brain mapping system was capable of distinguishing differences in the cortical activity power (mu band power spectra) between healthy children and children with CP. CONCLUSIONS: To our knowledge, this study is the first evidence demonstrating the feasibility and reliability of the EEG brain mapping system. Clinically, this system provides important insights into neuroplasticity associated with motor recovery after treatment and can also be used as real-time neurofeedback or noninvasive neuromodulation in the course of neurologic rehabilitation.