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Introduction. Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes. Home-based virtual reality (VR) balance training has been shown to reduce postural instability in patients with Parkinson’s disease (PD). The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training (SIBT). Methods. In this multicenter study, 76 PD patients (modified Hoehn and Yahr stages 2.5–3) were randomly assigned to receive either in-home VR telerehabilitation (n=38) or in-clinic SIBT (n=38) in 21 sessions of 50 minutes each, 3 days/week for 7 consecutive weeks. VR telerehabilitation consisted of graded exergames using the Nintendo Wii Fit system; SIBT included exercises to improve postural stability. Patients were evaluated before treatment, after treatment, and at 1-month follow-up. Results. Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group (p=0.04) and significant Time × Group interactions in the Dynamic Gait Index (p=0.04) for the in-clinic group. Both groups showed differences in all outcome measures over time, except for fall frequency. Cost comparison yielded between-group differences in treatment and equipment costs. Conclusions. VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver.

ObjectiveNoisy galvanic vestibular stimulation (nGVS) has been shown to partly restore vestibular function and to stabilize stance and gait in patients with incomplete bilateral vestibulopathy (BVP). Here, we examined potential synergistic effects of nGVS when combined with standardized vestibular rehabilitation training (VRT).Methods23 patients with confirmed BVP received a 30-min vestibular rehabilitation training (VRT) program three times a week for 2 weeks. The intervention group (n = 12) was stimulated with nGVS (at individually determined optimal amplitudes) during training, whereas the control group (n = 11) received zero-amplitude nGVS (sham stimulation) during training. Outcome measurements assessed at baseline, after 2 weeks of training, and at 2-week follow-up included quantitative posturography, instrumented gait analysis, Timed Up and Go Test (TUG), Functional Gait Assessment (FGA), and clinical scores related to quality of life and balance confidence.ResultsAfter 2 weeks of VRT, all patients showed moderate improvement in balance. Irrespective of nGVS treatment, performance improved in the TUG (p < 0.013), and in the FGA (p < 0.040). Furthermore, base of support when walking with closed eyes was reduced after 2-week training (p < 0.003). Postural sway did not change. There was no difference between groups and thereby no evidence for an additional influence of nGVS on the VRT treatment effects.ConclusionnGVS does not induce synergistic treatment effects in combination with VRT in patients with BVP when applied during treatment sessions. Hence, rather than being applied in parallel, nGVS and VRT might be complementary therapeutic options with nGVS being used during postural activities in daily life, e.g., walking.

Aims/hypothesisThe aim of this study was to test the effectiveness of a structured strength and balance training intervention in improving health-related quality of life (HRQoL) and functional status in individuals with diabetic peripheral neuropathy (DPN).MethodsThe study was a single-blind parallel-group randomised controlled trial comparing 2 months of once-weekly home-based strength and balance training against standard medical therapy. Participants were patients with physician-diagnosed type 2 diabetes and neuropathy recruited from five public sector institutions in Singapore between July 2014 and October 2017. Participants were block-randomised to intervention or control arms. Outcomes were assessed at baseline, 2 months and 6 months by a trained assessor blinded to group assignment. Primary outcomes were change in physical component summary (PCS) score of SF-36v2 (a 36-item generic HRQoL instrument that has been validated for use in Singapore) and EQ-5D-5L index score (derived from a five-item generic HRQoL instrument [EQ-5D-5L]) over 6 months. Secondary outcomes were change in functional status (timed up-and-go [TUG], five times sit-to-stand [FTSTS], functional reach, static balance, ankle muscle strength and knee range of motion) and balance confidence over 6 months. Mean differences in scores between groups were compared using mixed models.ResultsOf the 143 participants randomised (intervention, n = 70; control, n = 73), 67 participants were included in each arm for the final intention-to-treat analysis. The two groups were similar, except in terms of sex. There were no significant differences between groups on the primary outcomes of PCS score (mean difference [MD] 1.56 [95% CI −1.75, 4.87]; p = 0.355) and EQ-5D-5L index score (MD 0.02 [95% CI −0.01, 0.06]; p = 0.175). There were significant improvements in TUG test performance (MD −1.14 [95% CI −2.18, −0.1] s; p = 0.032), FTSTS test performance (MD −1.31 [95% CI −2.12, −0.51] s; p = 0.001), ankle muscle strength (MD 4.18 [95% CI 0.4, 7.92] N; p = 0.031), knee range of motion (MD 6.82 [95% CI 2.87, 10.78]°; p = 0.001) and balance confidence score (MD 6.17 [95% CI 1.89, 10.44]; p = 0.005). No adverse events due to study participation or study intervention were reported.Conclusions/interpretationShort-term structured strength and balance training did not influence HRQoL but produced sustained improvements in functional status and balance confidence at 6 months. More intensive interventions may be needed to influence HRQoL in these individuals. However, this intervention may be a useful treatment option for individuals with DPN to reduce the risk of falls and injuries.Trial registrationClinicalTrials.gov NCT02115932FundingThis work was supported by the National Medical Research Council, Singapore.

Falls are a significant health concern among older adults, leading to reduced mobility, fear of falling, and poor quality of life. Diaphragmatic breathing (DB) and diaphragmatic mobilization (DM) may serve as therapeutic interventions to address these issues. This study evaluated the effects of DB and combined DB and DM (DB + DM) on physical performance, fear of falling, and quality of life in community-dwelling older adults. Fifty-four older adults (65-75 years) were randomized into group 1, DB; group 2, DB + DM; and group 3, control groups (18 per group). Interventions were delivered twice weekly for 8 weeks. Outcomes, including balance, gait performance, lower extremity strength, fear of falling (FoF), fatigue, and quality of life (QoL), were measured at baseline, post-treatment (8th week), and follow-up (10th week). Significant group-by-time interaction effects (p < 0.05) were observed in all outcome measures except a few domains of Short-form 36 (SF-36). At post-treatment, the mini-BEST scores and the time to complete 5-time sit-to-stand test (5xSTS) of the DB and DB + DM groups did not significantly increase compared to baseline. The timed up-and-go (TUG) scores (η² = 0.279) and gait velocity (GV) (η² = 0.619) of both interventions significantly improved (p < 0.05) from baseline to post-treatment and follow-up. Scores for active balance confidence (ABC) (η² = 0.706), fatigue severity scale (FSS) (η² = 0.584), and specific domains of SF-36, physical function (η² = 0.211), pain (η² = 0.173), and general health (η² = 0.168) showed significant improvements in both intervention groups compared to the control group. DB and DB + DM interventions significantly improved gait performance, FoF, fatigue, and QoL in community-dwelling older adults. However, their therapeutic effects on balance were limited and need further investigation.

This study aims to investigate the effects of dual-task physical–cognitive the training on body balance (BB), gait performance (GP), lower limb muscle strength (LEMS), and cognitive performance (CP) in a group of cognitively normal older adult women (n = 44; 66.20 ± 4.05 years). Of these, 22 were randomly allocated to the dual-task training (DT) group, and 22 participated in the control group (CG). Assessments were performed at baseline, after 12 weeks of intervention, and at the end of 12 weeks of follow-up, using the following instruments: Timed Up & Go (TUG), Timed Up & Go manual (TUGm), Timed Up & Go cognitive (TUGc), Balance Test (TEC), sit-to-stand test (STS), and verbal fluency test (VF). After 12 weeks of DT training, participants showed a significant time × group interaction in all motor assessments (BB, GP, LEMS), as well as in three cognitive tests (VF-grouping, VF-exchange, VF-total). No time–group interaction effect was indicated for the VF-category test. At all evaluation times, CG members maintained constant physical and cognitive performance. We conclude that 12 weeks of physical–cognitive DT training was effective in promoting BB, GP, and LEMS, as well as CP in cognitively normal older adult women, with lasting effects up to 12 weeks after the intervention.

The stabilizing influence of a light touch (LT) on a postural sway has been consistently shown in the literature, however there is still no consensus in what way attentional resources are used when adopting LT during standing. To better elucidate the underlying mechanisms we introduced additional feedback (LT), which seems to distracts from postural control, and verified it by center of pressure (COP) regularity level and simple reaction time task. 25 healthy students randomly performed eight postural tasks, four without (NoRT)/ four with simple reaction task (RT). COP displacements were measured on a force plate in two visual conditions: eyes open/closed and two sensory conditions: without (NoLT)/with light touch (LT). Participants were asked to consider the postural task as the primary task. Although simple reaction time did not differ between postural conditions ( p  > 0.05), LT decreased postural sway velocity in anteroposterior direction ( p  < 0.001, η2 = 0.86) and decreased standard deviation ( p  < 0.001, η2 = 0.91) in both, reaction and visual conditions. Interestingly, RT task modified subjects behavior in NoLT conditions and caused slower COP velocity ( p  < 0.001, η2 = 0.53) without changes in signal regularity. Results also showed a significant increase in irregularity during standing with LT ( p  < 0.001, η2 = 0.86) in both vision and reaction conditions, suggesting that the signal was more random. Current results suggests that providing LT enhance postural steadiness and also seem to redirect attention externally, as shown by increased signal irregularity. Hence, LT possibly reduce the attention invested in the postural task itself. A RT task can be not sensitive enough to detect such subtle changes.

Although humans are well-adapted to negotiating sloped terrain, balance recovery after a disturbance on slopes is poorly understood. This study investigated how slope affects recovery from unanticipated simulated trips and slips. Eighteen healthy young adults walked on a split-belt treadmill at 1.25 m/s and three slope angles (downhill: − 8°; level: 0°; uphill: + 8°), with slip- and trip-like perturbations applied randomly at heel-strike. We evaluated balance recovery using whole-body angular momentum (WBAM) and perturbation response (PR), for which larger PR values indicate greater deviation of the margin of stability from baseline, therefore, greater destabilisation after perturbation. Overall, trips were more destabilising than slips, producing larger PR and greater range and integral of WBAM across all tested slopes, most significantly in the sagittal plane. Contrary to expectation, sagittal-plane PR post-trip was greatest for level walking and smallest for downhill walking. Heightened vigilance during downhill walking may explain this finding. Recovery strategy in both frontal and sagittal planes was consistent across all slopes and perturbation types, characterized by a wider and shorter first recovery step, with trips requiring the greatest step adjustment. Our findings advance understanding of the robustness of human locomotion and may offer insights into fall prevention interventions.

The aim of this study was to determine whether and how young participants modulate their postural response to compensate for postural muscle fatigue during predictable but externally initiated continuous and oscillatory perturbations. Twelve participants performed ten postural trials before and after an ankle muscle fatigue protocol. Each postural trial was 1 min long and consisted of continuous backward and forward oscillations of the platform. Fatigue was induced by intermittent, bilateral isometric contractions of the ankle plantar- and dorsiflexors until the force production was reduced to 50 % of the pre-fatigue maximal voluntary contraction. Changes in the center of mass (COM) displacement, center of pressure (COP) displacement, and anterior–posterior location of the COP within the base of support were quantified as well as the activity of the tibialis anterior (TA), medial gastrocnemius (MG), quadriceps, and hamstring. All participants demonstrated postural stability post-fatigue by maintaining the displacement of their COM. Everyone also demonstrated a general forward shift in the anterior–posterior location of the COP within the base of support; however, two distinct postural modifications, corresponding to either an immediate fatigue-induced increase or decrease in the COP displacement during the backward platform translation, were recorded immediately post-fatigue. The changes in muscle onset latencies lasted beyond the recovery of the force production of the fatigued postural muscles. By 10 min post-fatigue, the participants showed a decrease in the COP displacement as well as an earlier activation of the postural muscles and an increased TA/MG co-activation relative to pre-fatigue. Although different strategies were used, the participants were able to adjust to and overcome postural muscle fatigue and remain balanced during the postural perturbations regardless of the direction of the platform movement. These adjustments lasted beyond the recovery of the ankle muscle force production indicating that they may be part of a centrally mediated protective response as opposed to a peripherally induced limitation to performance.

The study investigated the effects of FIFA 11+ and HarmoKnee, both being popular warm-up programs, on proprioception, and on the static and dynamic balance of professional male soccer players. Under 21 year-old soccer players (n = 36) were divided randomly into 11+, HarmoKnee and control groups. The programs were performed for 2 months (24 sessions). Proprioception was measured bilaterally at 30°, 45° and 60° knee flexion using the Biodex Isokinetic Dynamometer. Static and dynamic balances were evaluated using the stork stand test and Star Excursion Balance Test (SEBT), respectively. The proprioception error of dominant leg significantly decreased from pre- to post-test by 2.8% and 1.7% in the 11+ group at 45° and 60° knee flexion, compared to 3% and 2.1% in the HarmoKnee group. The largest joint positioning error was in the non-dominant leg at 30° knee flexion (mean error value = 5.047), (p<0.05). The static balance with the eyes opened increased in the 11+ by 10.9% and in the HarmoKnee by 6.1% (p<0.05). The static balance with eyes closed significantly increased in the 11+ by 12.4% and in the HarmoKnee by 17.6%. The results indicated that static balance was significantly higher in eyes opened compared to eyes closed (p = 0.000). Significant improvements in SEBT in the 11+ (12.4%) and HarmoKnee (17.6%) groups were also found. Both the 11+ and HarmoKnee programs were proven to be useful warm-up protocols in improving proprioception at 45° and 60° knee flexion as well as static and dynamic balance in professional male soccer players. Data from this research may be helpful in encouraging coaches or trainers to implement the two warm-up programs in their soccer teams.