Efeitos do treino de equilíbrio na velocidade de marcha, mobilidade e qualidade de vida de indivíduos pós acidente vascular encefálico / Effects of the balance training on walking speed, mobility and quality of life of stroke survivors

Introdução: O objetivo do presente estudo foi realizar uma revisão sistemática da literatura investigando os efeitos do treino de equilíbrio na velocidade de marcha, mobilidade e qualidade de vida de indivíduos hemiparéticos. Métodos: Foram realizadas buscas nas bases de dados Medline, Cinahl, Web of Science, Lilacs e PEDro, sem restrição em relação ao idioma e ano de publicação do estudo. Os artigos foram avaliados pelo título, resumo e posteriormente pelo texto completo e, enfim, selecionados em relação à elegibilidade por dois autores independentes. A qualidade metodológica dos estudos experimentais incluídos foi avaliada de acordo com a escala PEDro. Resultados: Oito artigos foram incluídos na presente revisão. A descrição dos resultados sugere que o treino de equilíbrio pode ser eficaz para aumentar a velocidade de marcha e melhorar a mobilidade de indivíduos hemiparéticos. Embora esses resultados sejam promissores, os estudos apresentam uma qualidade metodológica entre moderada a baixa. Além disso, os efeitos na participação social/qualidade de vida ainda são inconclusivos, uma vez que apenas um estudo avaliou essa variável. Conclusão: O treino de equilíbrio parece melhorar a velocidade de marcha e mobilidade de indivíduos hemiparéticos, porém o efeito na participação social ainda deve ser melhor investigado. (AU)

Introduction: The aim of this systematic literature review was to investigate the effects of balance training on walking speed, mobility and social participation/quality of life of hemiparetic individuals. Methods: Searches were conducted on Medline, Cinahl, Web of Science, Lilacs and PEDro databases, without restriction regarding the language and year of publication. The articles were evaluated by title, abstract and full text and, finally, selected in relation to the eligibility by two independent authors. The methodological quality of the included experimental studies was evaluated according to the PEDro scale. Results: Eight articles were included in the present review. The description of the results suggests that balance training may be effective in increasing walking speed and improving the mobility of hemiparetic individuals. Although these results are promising, the studies show a moderate to low methodological quality. The effects on social participation/quality of life are still inconclusive, since only one study evaluated this variable. Conclusion: Balance training seems to improve walking speed and mobility of hemiparetic individuals, but the effect on social participation should still be better investigated. (AU)

Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial : Variable- and fixed-priority dual-task for older adults.

BACKGROUND: Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults. METHODS: This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle. DISCUSSION: This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people. TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.

Combining balance-training interventions with other active interventions may enhance effects on postural control in children and adolescents with cerebral palsy: a systematic review and meta-analysis.

BACKGROUND: Improvement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation. OBJECTIVE: A systematic review investigated whether combining balance-training interventions with other active interventions enhances the effects of the active intervention alone on postural control of children and adolescents with cerebral palsy. METHODS: Searches were performed in MEDLINE, PEDro, CINAHL, Cochrane and EMBASE databases without date or language restrictions. Randomized controlled trials investigating the combination of balance-training interventions with other active interventions on the postural control of children and adolescents with cerebral palsy were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. Meta-analysis was conducted, and quality of the evidence followed the GRADE methodology. Pooled data were presented using standardized mean difference and 95% confidence interval. RESULTS: Seven studies involving 194 participants were included in this review. A large additional effect on postural control was found when balance-training interventions were combined with Neurodevelopmental Treatment at short-term (standardized mean difference of 1.3; 95% confidence interval 0.5, 2.0, p=0.001). The quality of the evidence was very low due to publication bias, imprecision and inconsistency. CONCLUSION: Combining balance-training interventions with other active interventions may enhance effects on postural control of this population at short-term. As the estimated effect had only very low quality of evidence to support it, larger studies with low risk of bias are needed.

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.

Efectos del entrenamiento en superficies inestables sobre el equilibrio y funcionalidad en adultos mayores / Effect of training on an unstable balance and function in eldery people

OBJETIVO: determinar los efectos de un programa de ocho semanas de entrenamiento en superficies inestables con y sin trabajo de fuerza, sobre el equilibrio y la capacidad funcional en adultos mayores de 60 años, pertenecientes al programa "Escuelas populares del deporte" del INDER Medellín. METODOLOGIA: se llevó a cabo un estudio experimental simple, ciego y enmascarado con asignación al azar de 34 sujetos a dos grupos de intervención con y sin trabajo de fuerza sobre superficies inestables; se midió el equilibrio unipodal, bipodal con ojos abiertos y cerrados, además de pruebas funcionales como Up and Go, arm curl y chair test. RESULTADOS:las intervenciones con y sin trabajo de fuerza mejoraron el equilibrio total en 57,0 y 69,5 segundos respectivamente, sin diferencias estadísticamente significativas en la comparación entre los grupos (p= 0,13). Se mejoró la velocidad de la marcha con ambas intervenciones sin diferencias intragrupos estadísticamente significativas (p= 0,33) pero importantes para la práctica. CONCLUSION: ambas intervenciones mejoran el equilibrio, sin embargo existen diferencias importantes para la práctica a favor del programa sobre superficies inestables sin trabajo de fuerza, pues la intervención tiene un mejor efecto sobre el equilibrio unipodal y bipodal tanto con ojos abiertos como con cerrados.

OBJECTIVE:to determine the effects of an eight-week training program on unstable surfaces with and without strength work regarding balance and functional capacity in adults over 60 who belong to the inder sport schools program in Medellín. METHODOLOGY: simple single-blind and masked experimental trials were conducted on 34 subjects who were randomly assigned to two intervention groups with and without strength work on unstable surfaces. Unipodal and bipodal balance was measured while the subjects' eyes were open and closed. In addition, functional tests such as Up and Go, Arm Curl and Chair Test were conducted. RESULTS : interventions with and without strength work improved total balance in 57.0 and 69.5 seconds respectively. The differences between the groups were not statistically significant (p = 0.33), nonetheless they were important. CONCLUSION: both interventions improve balance, however there are differences that are important in practice. These differences favor the program involving unstable surfaces without an unstable without strength work because the intervention has a better effect on unipodal and bipodal balance both with open and closed eyes.

Influência de exercícios de equilíbrio na redução de oscilações corporais e aumento de força em idosos / Influence of balance exercises on reduction of body oscillations and increase of strength in the elderly

Introdução: O equilíbrio, assim como os demais componentes da capacidade física é treinável com a pratica de exercícios físicos, no entanto, há uma falta de padronização do treinamento de equilíbrio. Objetivo: Avaliar a influência de um protocolo específico de exercícios voltados a melhora do equilíbrio em um programa global de atividade física para idosos sobre as variáveis: equilíbrio corporal e força de membros inferiores. Metodologia: Pesquisa do tipo experimental, com a duração de 3 meses. Fizeram parte deste estudo 39 mulheres idosas, sendo 21 no G-Equi e 18 no G-Cont. Para a avaliação foram utilizados questionários para a identificação de possíveis fatores de risco a saúde, variáveis socioeconômicas, nível de atividade física, histórico de quedas, como também, o questionário Mini mental, como exames físicos e testes motores; foram realizadas reavaliações ao final dos 3 meses. Resultados: Após os 3 meses pode-se perceber que o G-Equi apresentou uma diferença significativa entre os resultados dos testes TAFA, o TAFLD, o TAFLE, o TLA e o TC, no entanto, não apresentou para o TU apesar de uma tendência a um melhor desempenho. O G-CONT apresentou diferença significativa para o TLA, tendo as medianas muito próximas para os testes de alcance e TU. Em relação ao resultado da interação entre os grupos pode-se observar que o grupo que realizou a intervenção obteve melhores resultados, tendo diferenças significativas para os testes TAFA, o TAFLD, o TAFLE, e o TC, não apresentando para o TLA e o TU apesar de apresentar melhores resultados nos testes. Para os dados estabilométricos houve uma redução significativa do deslocamento total e da velocidade bidirecional, para o GEqui com olhos abertos e fechados, e um aumento do deslocamento total e uma redução da velocidade bidirecional para o G-Cont com olhos abertos. Discussão: Os achados revelaram que o treinamento de equilíbrio auxilia na melhora do desempenho do controle postural em idosas, corroborando com a literatura. Conclusão: Os efeitos do treinamento de equilíbrio adicionado em um programa global de exercícios físicos para idosas apresentaram efeitos positivos no equilíbrio corporal e força de membros inferiores, além de evidenciar novas inquietações a respeito da afirmação que uma menor área e oscilação é o que representa maior estabilidade

Introduction: The balance, as well as other components of physical ability is trainable with the practice of physical activity, however, there is a lack of standardization of balance training. Objective: To evaluate the influence of a specific protocol of exercises aimed at improving balance in a comprehensive physical activity program for seniors on variables: body balance and lower limb strength. Methodology: Survey of experimental type, with a duration of 3 months. This study included 39 elderly women, with 21 in G- Equi and the G- 18 Cont. For the evaluation questionnaires to identify possible risk factors to health, socioeconomic variables, physical activity level, history of falls, as were also used, the Mini Mental questionnaire such as physical exams and testing engines; revaluations were carried out at the end of 3 months. Results: After 3 months it can be seen that the G-Equi showed a significant difference between the results of the tests TAFA the TAFLD the TAFLE, TLA and TC, however, not presented to the TU despite a tendency to better performance. The G- Cont significant difference to TLA, and very close to the testing range and TU medians. Regarding the result of the interaction between the groups can be seen that the group that performed the intervention achieved better results, with significant differences for TAFA tests, TAFLD the TAFLE, and TC, for not presenting the TLA and the TU despite provide better test results. For stabilometric data there was a significant reduction in the total displacement and bidirectional speed for the G- Equi with eyes open and closed, and an increase in total displacement and reduction of bidirectional speed for the G-Cont with open eyes. Discussion: The findings showed that the Balance training helps in improving the performance of postural control in elderly, corroborating with literature. Conclusion: The effects of balance added an overall exercise program for older training had positive effects on body balance and lower limb strength, besides highlighting new concerns regarding the assumption that a shorter swing and is what is most stability

Unilateral balance training enhances neuromuscular reactions to perturbations in the trained and contralateral limb.

The aim of this study was to investigate the effect of unilateral balance training on the reactive recovery of balance for both trained and untrained limbs. Twenty-three subjects were randomly assigned to either a control group (CG) or a training group (TG). The latter performed six weeks of balance training for the right leg. The pre- and post-training measurements were based on single leg standing posture on a moveable force platform which moved 6 cm anteriorly. TG subjects were tested on the trained (TR) and untrained leg (UTR), whereas CG subjects were tested on the right leg (CTR). The center of pressure trajectory length (CPLEN) and average speed (CPSPD) as well as onsets of muscular activation and time to peak (EMGTP) from lower limb muscles were calculated and compared by a 2-way ANOVA (three legs×two training status). Muscular onsets were reduced after training for TR (∼19 ms, p<0.05) and UTR (∼17 ms, p<0.05) with no significant changes for CTR. No effects of training for CPLEN and medial-lateral CPSPD were found. Furthermore, the EMGTP of UTR was predominantly greater before training (∼17 ms, p<0.05). However, after training the EMGTP was similar among limbs. These results suggest that concomitant with improved balance recovery and neuromuscular reactions in TR, there is also a cross-education effect in UTR, which might be predominantly related to supraspinal adaptations shared between interconnected structures in the brain.