The Effects of Wearing the Toe Spreader During Adaptation Training on Plantar Pressure and Balance in Stroke Patients

Background: One of the significant causes of morbidity worldwide and an essential contributor to disability is Stroke. As said by the National Stroke Association, nine post-stroke survivors out of 10 experience some degree of weakness post-stroke. The hemiplegic patients with sub-acute stroke, who will undergo training to both the lower limb overtraining to only involved side will have an improvement in balance and walking. The goal of this study is to see how much training to both the lower limb improves functional recovery in patients who have had a subacute stroke compared to unilateral, more insufficient limb training.
 Objective: The goal of this study was to see how training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients.
 Methods: A randomized clinical study with assessor blinding will be conducted with participants with subacute stroke (n=40). Participants will be randomized to one of two groups after performing baseline assessments: Group A or Group B.1st group will receive training only to the hemiparetic side, i.e., Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation, and 2nd group participants will receive bilateral training, i.e., Strengthening to the unaffected side along with Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation to the affected side. During the therapy period, we will assess lower limb function through static and dynamic balance, walking, and gait measures.
 Results: The purpose of the research is to look into the effect of training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients. The results of this study will be based on the outcome measures that are static and dynamic balance in the stroke patients and walking.
 Conclusion: The study's findings will shed more light on the benefits of training to both the lower limb overtraining to only involved side in patients post-stroke. If this trial proves successful, it will help post-stroke patients improve their balance and walking.

The aim of the present study was to compare the balance ability between genders in elite athletes. A total of 152 athletes, 76 female and 76 male, from 10 different branches with similar demographic characteristics included to the study. A computerized balance platform (BT4, HUR Labs Oy, Tampere, Finland) was used to determine balance ability of the athletes. Static balance measurement, with eyes open and closed stability test on hard and soft ground; dynamic balance measurement was evaluated with forward, backward, left and right functional reach test and Romberg values calculated by the device. It was determined that the Romberg value of female athletes was higher than that of male athletes (p= 0.025). It was determined that the area scanned by female athletes in static balance ability on fixed ground with eyes open was less than that of male athletes (p= 0.025); the length drawn by female athletes in static balance ability on soft ground with eyes open was less (p= 0.010) and their scanning speed was slower (p= 0.007). Static balance ability of female athletes were significantly better than male athletes, and female athletes interpreted visual inputs better than male athletes in static balance ability. We recommend training with visual inputs and visual exercises in order to increase balance performance, especially in female athletes.

Effectiveness of the Mat Pilates on the postural control, plantar pressure and plantar arch of school children: A randomized clinical trial

Effects and Dose-Response Relationship of Balance Training on Balance Performance in Youth: A Systematic Review and Meta-Analysis.

The study aimed to investigate the impacts of Bosu training on the development of static and dynamic balance in male basketball players aged 14-16 years who play actively in basketball clubs in Bingöl and train more than 7 hours weekly according to a training schedule. The study included 30 basketball players, 15 in the control group and 15 in the experimental group. The experimental group attended 30 minutes of Bosu training in addition to basketball training for 8 weeks. Anthropometric measurements, such as height, weight, BMI, and static and dynamic balance measurements, were taken before and after the training period. The data were analysed using the SPSS package. The distribution of the pre-test and post-test data was examined for each group. Normality of the data distribution and homogeneity of variances were checked using the Mauchly sphericity test and the Levene test. Then, the dependent variables within each group were compared using the paired-sample t-test. The study used a p-value of less than 0.05 to assess the significance of the results. The mean values of height, weight, and BMI of the experimental group after the 8-week Bosu training program showed no significant difference (p>0.05). The analysis results regarding the Bosu training program's static and dynamic balance measurements yielded a statistically significant difference between the pre- and post-test comparisons of the experimental group for most of the static and dynamic balance variables (p<0.05). However, there was no statistical difference in the control group or between groups (p>0.05). It was concluded that Bosu training can positively contribute to the improvement of static and dynamic balance in young basketball players.

To examine associations between measures of static and dynamic balance and performance of mobility tasks in older adults. A cross-sectional analysis from 95 community dwelling participants (mean age 80.9 years, range 65 -03 years). Participants performed tests of static (tandem stance) and dynamic (360 degrees turn) balance and mobility (walking speed and timed chair rise). Associations among balance and mobility measures were examined using correlation and logistic regression. Static and dynamic balance were moderately associated (r = -.462). Relationships between dynamic balance and mobility were stronger than those between static balance and mobility. The association between dynamic balance and walking speed was particularly strong (r = -.701 ). Using logistic regression, age, and balance performance were significant predictors for outcomes of walking speed (dichotomized to < .0 m/s, >/= .0 m/s), and timed chair rise (dichotomized to </= 3.6 s, > 3.6 s). Faster 360 degrees turn times were independently associated with faster walking speed and chair rise time. Mobility tasks require both dynamic and static balance. As falls are a major health risk for older adults, including brief assessments of dynamic and static balance in the examination of older adults provides valuable information about physical function and mobility.

Double-leg stance and dynamic balance in individuals with functional ankle instability

IntroductionSeveral studies have shown an association between panic disorder (PD) and reduced balance abilities, mainly based on functional balance scales.This pilot study aims to demonstrate the feasibility of studying balance abilities of persons with PD (PwPD) using computerized static and, for the first time, dynamic balance measurements in order to characterize balance control strategies employed by PwPD.MethodsTwelve PwPD and 11 healthy controls were recruited. PD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV), and the severity of symptoms was evaluated using the Hamilton Anxiety Scale (HAM‐A), PD Severity Scales (PDSS), and Panic and Agoraphobia Scale (PAS). Balance was clinically assessed using the Activities‐Specific Balance Confidence (ABC) scale and physically by the Mini‐Balance Evaluation Systems Test (Mini‐BESTest). Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) scale. Postural control was evaluated statically by measuring body sway and dynamically by measuring body responses to rapid unexpected physical perturbations.ResultsPwPD had higher scores on the HAM‐A (17.6 ± 10.3 vs. 3.0 ± 2.9; p < .001), PDSS (11.3 ± 5.1 vs. 0; p < .001), and PAS (20.3 ± 8.7 vs. 0; p < .001) questionnaires and lower scores on the balance scales compared to the controls (ABC scale: 156.2 ± 5.9 vs. 160 ± 0.0, p = .016; Mini‐BESTest: 29.4 ± 2.1 vs. 31.4 ± 0.9, p = .014; DHI: 5.3 ± 4.4 vs. 0.09 ± 0.3, p < .001). In the static balance tests, PwPD showed a not‐significantly smaller ellipse area of center of pressure trajectory (p = .36) and higher body sway velocity (p = .46), whereas in the dynamic balance tests, PwPD had shorter recovery time from physical perturbations in comparison to controls (2.1 ± 1.2s vs. 1.6 ± 0.9 s, p = .018).ConclusionThe computerized balance tests results point to an adoption of a ‘‘postural rigidity’’ strategy by the PwPD, that is, reduced dynamic adaptations in the face of postural challenges. This may reflect a nonsecure compensatory behavior. Further research is needed to delineate this strategy.

Introduction: Balance is one of the pivotal and inseparable components in daily activities and sports performance. Better and more comprehensive recognize of effective factors on quality of balance and how they impress, provide the opportunity which helps to improve motor-base factors in whole life and avoids negative impacts. It seems that anatomical abnormalities such as flat and pescavus foot and morphologic features of the foot can affect motor fitness characteristics like balance. So, this research aimed to compare the static and dynamic balance of women college athletes which have different foot arch heights. Materials and Methods: Static and dynamic balance were assessed in 90 women athletes in three types of foot arch: flat foot (30 persons), pescavus foot (30 persons) and normal foot (30 persons); it was done using stabilometer device with open-eye participant and maintaining a single leg stance (a measure of static balance), while dynamic balance was tested with putting a dominant step on a device (a measure of dynamic balance). Besides, to differentiate between flat, pescavus and normal foot arch, the navicular drop was tested with Brady attributive method. To test and analyze statistical datum, also one-way ANOVA statistical method was used via SPSS19 software. Results: There was a significant difference in total area of the swing movement (P = 0.002) in static balance; however, there is not any significant difference between the study groups in dynamic balance (P = 0.098). Conclusion: Although static balance in person who suffers from flat and pescavus foot arch abnormality is lower than normal foot arch, but in dynamic balance, no significant differences between the three groups of foot arch height were noticed. So, the people who suffers from flat and pescavus foot arch should do their daily activities with more accuracy and attention.

Background: A number of researchers have attempted to improve the balance of stroke patients, however there is still a question as to whether taping is effective in increasing balance. Objective: To determine the effect of paretic and non-paretic side taping on the balance ability in patients with stroke. Design: A single-blind randomized controlled trial Methods: This randomized single-blind controlled clinical trial with a repeated measures study included 45 subjects who were randomly assigned to paretic side taping groups (n=15), non-paretic side taping groups (n=15), and trunk exercise groups (n=15). Trunk exercise and paretic side taping groups had taping on the paralyzed erector spinae, while the non-paretic side taping group had taping on the non-paralyzed erector spinae. Trunk exercises were performed for 30 minutes to promote core muscles. The balance ability measured the center of pressure movement (paretic side, non-paretic side,forward, backward, limit of stability) in the sitting position. All measurements were evaluated using BioRescue. Results: All three groups showed significant increase in all variables after 4 weeks. The paretic and non-paretic side taping groups had a significant increase in all variables after 30 min of attachment. However, there was no significant difference among the three groups. Conclusions: Paralysis and non-paralysis taping improved the balance ability of patients with stroke in an immediate effect of 30 min. However, after 4 weeks of intervention, taping with trunk exercise did not differ from single trunk exercise. In future studies, various analyses need to be conducted through more diverse evaluations.

Balance decreases with age, resulting in greater risk of falls for people aged 65 and older.1 Physical activity can address some aspects of this age-associated physiological decline,2 with exercise programs that incorporate balance retraining having been found to improve postural stability.3 Tai chi has been reported as a safe and enjoyable form of exercise that could improve balance in community-dwelling elderly adults, decreasing the risk of falls.4, 5 Another form of exercise that has become increasingly popular among many elderly people of Chinese descent is tai chi ball (TCB). TCB consists of more whole-body rotational and multisegmental circular movements than tai chi, with sequential weight shifting. TCB requires fine equilibrium control. A 12-month survey of the effect of TCB on postural balance of community-dwelling elderly women has provided information of unique value and is presented here. Seventy-two elderly persons (mean age 65.4 ± 6.9) were recruited from the community as the participants of the project. None had previous experience with TCB. The criteria for recruitment were age 60 to 70; ability to walk without support; and no symptoms of motor paresis, sensory deficits, vertigo, or uncorrectable visual defects. Participation was strictly voluntary. Participants were randomized into two groups: 36 who participated in TCB and 36 nonparticipating controls. Subjects in both groups participated in a physical exercise program. The training program was 12 months long, with three 1- to 2-hour sessions per week. Each session began with 5 minutes of warm-up and ended with 5 minutes of cool-down stretching exercises. The remaining time was devoted to TCB. The control group did not participate in TCB. Three clusters of outcome measures were used for each subject at baseline and 12 months later: static balance measures (unipedal and tandem stance), dynamic balance measures (Timed Up-and-Go), computerized dynamic posturography assessment, and balance confidence assessment (Activities-Specific Balance Confidence (ABC) Scale). After 12 months of TCB, participant performance improved in the unipedal stance (F = 7.332, P = .009), tandem stance (F = 7.227, P = .009), and sensory organization test for balance measurements composite (F = 14.865, P < .001) and on the visual (F = 5.922, P = .02) and vestibular (F = 6.425, P = .01) test and the ABC Scale (F = 8.486, P = .005) and worsened on the Timed Up-and-Go (F = 4.751, P = .03). After 12 months, the performance of the control group worsened on the Timed Up-and-Go (F = 6.34, P = .01); no other changes were observed (Table 1). The aim of this study was to compare changes in balance ability and balance confidence of TCB participants with those of a control group. TCB includes a series of graceful movements, constant weight shifting with different rotational and multi-segmental circular movements, and changes in the base of support from double- to single-leg standing and is known for its particular benefit to balance function. Analysis indicated that static balance performance (unipedal and tandem stance) improved significantly after a 12-month TCB intervention. This finding is consistent with those of a previous report.6 Dynamic balance performance data analysis showed that mean Timed Up-and-Go had decreased significantly in both groups 12 months later. TCB had a positive effect on muscle strength, endurance and muscle reaction time are likely to have contributed to the improvement in the walking speed,7, 8 and daily walking of the control group is likely to have contributed to their improvement in walking speed.9 Computerized dynamic posturography indicates the relative importance and proper use of sensory inputs, namely, somatosensation, vision, and vestibular sensation. The present study showed that the TCB group had greater improvement in their vestibular score (12.1%) than controls (0.51%); there was a significant difference between the TCB and control groups after the 12-month intervention. Practicing TCB involves head movements that could stimulate the vestibular system through head and body rotation and fixation of the eyes on the moving ball during the practice of its many forms.8 The finding showed that 12 months of TCB exercise improved visual and composite scores. The result is consistent with improvement in balance using tai chi as a form of exercise.4, 5 The average ABC Scale score of the TCB group increased after 12 months of intervention (mean change 7.3%). This change was similar to that reported in the only other progressive resistance training intervention study to have administered the ABC Scale (mean change 6%).10 The results suggest that it is possible to recommend a TCB program for 12 months to significantly improve balance confidence. These findings have demonstrated that a TCB intervention was both effective for community-dwelling elderly persons in improving balance performance in relation to falls and might delay the onset of deterioration of motor function. These findings can contribute to the future planning of community-based exercise programs. Conflict of Interest: The author has declared no conflict of interest. Author Contributions: Chun-Mei Xiao: study concept and design, performed the experiments, acquisition of subjects and data, analysis and interpretation of data, preparation of first draft and final manuscript. Sponsor's Role: No funding was received for this study.

There is a need in sports medicine for a static and dynamic standing balance measure to quantify balance ability in adolescents. The purposes of this study were to determine the test-retest reliability of timed static (eyes open) and dynamic (eyes open and eyes closed) unipedal balance measurements and to examine factors associated with balance. Adolescents (n=123) were randomly selected from 10 Calgary high schools. This study used a repeated-measures design. One rater measured unipedal standing balance, including timed eyes-closed static (ECS), eyes-open dynamic (EOD), and eyes-closed dynamic (ECD) balance at baseline and 1 week later. Dynamic balance was measured on a foam surface. Reliability was examined using both intraclass correlation coefficients (ICCs) and Bland and Altman statistical techniques. Multiple linear regressions were used to examine other potentially influencing factors. Based on ICCs, test-retest reliability was adequate for ECS, EOD, and ECD balance (ICC=.69, .59, and .46, respectively). The results of Bland and Altman methods, however, suggest that caution is required in interpreting reliability based on ICCs alone. Although both ECS balance and ECD balance appear to demonstrate adequate test-retest reliability by ICC, Bland and Altman methods of agreement demonstrate sufficient reliability for ECD balance only. Thirty percent of the subjects reached the 180-second maximum on EOD balance, suggesting that this test is not appropriate for use in this population. Balance ability (ECS and ECD) was better in adolescents with no past history of lower-extremity injury. Timed ECD balance is an appropriate and reliable clinical measurement for use in adolescents and is influenced by previous injury.

Objective: To examine the impact of lower-extremity and trunk muscle fatigue on static and dynamic balance tests. Methods: An isokinetic dynamometer at constant angular velocities of 60°/s, 90°/s, 120°/s, and 180°/s was used to test the isokinetic strength of knee and trunk muscles in 30 healthy sedentary volunteers (14 men and 16 women). Lower- extremity fatigue was produced with the StairMaster, and trunk muscle fatigue was produced with an isokinetic dyna- mometer. Static and dynamic balance measurements were assessed with a balance assessment system before and after muscle fatigue in each subject. Results: There was a significant difference between the prefatigue - postfatigue trunk and lower extremity muscles and the static balance scores. But the dynamic right, left and front balance test scores were not significantly different before and after fatigue of the trunk and lower-extremity muscles. Conclusion: Balance is affected by a generalized fatigue of trunk muscles and lower-extremity muscles. However, it ap- pears that static balance control is affected by the fatigue of trunk and lower-extremity muscles while dynamic balance is affected partly by trunk and lower-extremity muscular fatigue.

Ankle sprains are common in female soccer players. Ankle injuries have the potential to impact balance control, which can further contribute to recurrent injuries. This study aimed to examine if female collegiate soccer players exhibited worse ankle stability and single-leg balance than female non-soccer players, and whether there was a correlation between ankle stability and single-leg balance. Eighteen female collegiate soccer players and 22 female non-soccer players participated in the study. The Cumberland Ankle Instability Tool (CAIT) was used to evaluate ankle stability. The Athletic Single Leg Stability Test (ASLST) of the Biodex Balance System was used to examine static single-leg balance, and the Y-Balance Test (YBT) was used to examine dynamic single-leg balance. Results show that 55.56% of soccer players and 9.09% of non-soccer players exhibited chronic ankle instability. The CAIT score of soccer players was significantly lower than non-soccer players (p = .031). There were no significant differences between the two groups in the ASLST and the YBT. Very low correlations were found between the CAIT score and any static or dynamic balance measures (r < .094). Female soccer players who exhibited worsened ankle stability did not exhibit compromised static or dynamic single-leg balance. Future studies should examine if soccer players have established better motor control of single-leg standing through years of training to compensate for worse ankle stability. In addition, the CAIT score alone might not accurately represent static or dynamic balance control in female collegiate soccer players.

Patients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk. The aim of this systematic review is to investigate the effects of plantar offloading devices used for ulcer prevention on their role in static and dynamic balance control in patients with DPN. PubMed and Embase were systematically searched using relevant search terms. After title selection, abstract selection, and full-text selection only five articles could be included for further analysis. Two articles included static balance measurements, two articles included dynamic balance measurements, and one article included both. Results suggested that static balance control is reduced when rocker bottom shoes and different insole configurations are used, however, toe-only rockers showed less evidence for reduced static balance control. There was no evidence for reduced dynamic balance control in combination with offloading devices. However, these results should be interpreted with care, since the number of studies was very small and the quality of the studies was moderate. Future research should evaluate balance in combination with different offloading devices, so that clinicians subscribing them are more aware of their potential unwanted consequences.