Balance Deficits Research Articles

Vestibular afferent neurons develop normally in the absence of quantal/glutamatergic input

IntroductionThe vestibular nerve is comprised of neuron sub-groups with diverse functions related to their intrinsic biophysical properties. This diversity is partly due to differences in the types and numbers of low-voltage-gated potassium channels found in the neurons’ membranes. Expression for some low-voltage gated ion channels like KCNQ4 is upregulated during early post-natal development; suggesting that ion channel composition and neuronal diversity may be shaped by hair cell activity. This idea is consistent with recent work showing that glutamatergic input from hair cells is necessary for the normal diversification auditory neurons.MethodsTo test if biophysical diversity is similarly dependent on glutamatergic input in vestibular neurons, we examined vestibular function and the maturation of the vestibular epithelium and ganglion neurons by immunohistochemistry and patch-clamp electrophysiology in Vglut3-ko mice whose hair cell synapses lack glutamate.ResultsThe knockout mice showed no obvious balance deficits and crossed challenging balance beams with little difficulty. Immunolabeling of the Vglut3-ko vestibular epithelia showed normal development as indicated by an identifiable striolar zone with calyceal terminals labeled by molecular marker calretinin, and normal expression of KCNQ4 by the end of the second post-natal week. We found similar numbers of Type I and Type II hair cells in the knockout and wild-type animals, regardless of epithelial zone. Thus, the presumably quiescent Type II hair cells are not cleared from the epithelium. Patch-clamp recordings showed that biophysical diversity of vestibular ganglion neurons in the Vglut3-ko mice is comparable to that found in wild-type controls, with a similar range firing patterns at both immature and juvenile ages. However, our results suggest a subtle biophysical alteration to the largest ganglion cells (putative somata of central zone afferents); those in the knockout had smaller net conductance and were more excitable than those in the wild type.DiscussionThus, unlike in the auditory nerve, glutamatergic signaling is unnecessary for producing biophysical diversity in vestibular ganglion neurons. And yet, because the input signals from vestibular hair cells are complex and not solely reliant on quantal release of glutamate, whether diversity of vestibular ganglion neurons is simply hardwired or regulated by a more complex set of input signals remains to be determined.

Gait Speed, Mobility, Balance, and Dual-Tasking Deficits Among People Living With HIV Globally: A Systematic Review and Meta-Analysis.

People living with HIV (PLWH) may experience premature physical deficits, including walking, mobility, and balance problems. The purpose was to measure deficits in walking, mobility, balance, and dual tasking in PLWH. The secondary objective was to make recommendations regarding the use of rehabilitation outcome measures. CINAHL, PubMed, and SPORTDiscus databases were searched. Two independent reviewers screened titles/abstracts and full-text articles, extracted data, and performed a quality assessment. Fifty-six articles with 14,053 PLWH and 8,454 uninfected controls were included. A meta-analysis revealed significantly worse performance among PLWH on the five times sit to stand mobility test versus controls (Cohen d = 0.68, 95% confidence interval [CI 0.08-1.29], p = .03). Meta-analyses revealed no differences between PLWH and controls for usual gait speed (Cohen d = -0.47, 95% CI [-1.10 to 0.15], p = .14) and fast gait speed (Cohen d = -0.39, 95% CI [-0.87 to 0.08], p = .10). Ten of 12 studies comparing PLWH with controls found differences in balance outcomes. PLWH have significantly worse mobility than uninfected controls.

Standing balance test for fall prediction in older adults: a 6-month longitudinal study

BackgroundA core component of older adult health care assessment includes identifying fall risk, which also includes identifying those with subtle balance deficits.ObjectiveTo compare body displacement of the Center of Pressure (CoP) and time held during the balance test. Also, to examine whether balance tests at baseline can predict falls after 6 months.MethodsA longitudinal study with 153 community-dwelling older adults, between 60–89 years old. Anteroposterior (AP) and mediolateral (ML) amplitude and velocity CoP displacements were assessed in four upright positions using a force platform: double-leg, semi-tandem, tandem, and single-leg stances, with a maximum duration of 30 s each. Adjusted repeated measures ANOVA were used to compare the differences among the balance positions. Comparisons between males and females were also conducted. Logistic regression adjusted for confounders was performed to verify whether upright balance tests can predict future falls.ResultsAs the base of support narrows, body sway increases. A decrease in stance time was observed across the balance stages, i.e., double-leg/semi-tandem versus tandem versus single-leg stances. The mean duration held in the single-leg stance was 14.8 s and for tandem was 22.2 s. Similar stance durations were observed for double-leg and semi-tandem stances. Males were able to maintain balance positions longer than females even with greater CoP displacement. ML amplitude of CoP displacement and the time held during tandem and single-leg positions were able to predict falls after 6 months (p < 0.05).ConclusionIn clinical practice in which only stance time is recorded, it is possible to interchangeably use the double-leg or semi-tandem stance. To identify early signs of imbalance, we suggest setting a time limit for the balance test equal to or greater than 23 s, as 10 s appear to be insufficient to detect subtle balance deficits. The time maintenance on tandem and single-leg positions was able to predict future falls.

The Tinetti Balance Test Is an Effective Predictor of Functional Decline in Non-Hospitalized Post-COVID-19 Individuals: A Cross-Sectional Study.

Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. Methods: This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). Results: Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = -0.584), FRT (r = -0.542), MBT (r = -0.530), BBS (r = -0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted R2 = 0.318, p < 0.001). Conclusions: Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation.

Analisis Pengaruh Ekspor dan Impor Terhadap Pertumbuhan Ekonomi Pendekatan Akuntansi Arus Dana yang Dimediasi Foreign Direct Investment di Indonesia Tahun 2019-2021

The purpose of this study was to determine and examine the effect of exports and imports before, during, and after the covid-19 outbreak on economic growth with an accounting approach to foreign direct investment mediated fund flows in indonesia. Quantitative approach with PLS analysis technique is used in this study. Secondary Data obtained from various official websites were used in this study. This study provides the results that exports and imports have a positive and significant influence on economic growth with the approach of accounting for the flow of funds mediated by foreign direct investment in Indonesia. This implies that exports and imports have an important role in economic growth approach to accounting for the flow of funds. Foreign direct investment plays an active role in mediating the relationship between exports and imports to economic growth. The declining value of exports, imports, and foreign direct investment during the pandemic also affected the decline in economic growth in Indonesia. Export activity needs to be increased so that economic growth also increases. Likewise with import activities, although imports are excessive trade balance deficit, imports also have some positive influence on economic growth such as by importing can meet domestic needs and open opportunities to attract investors to invest. For this reason, imports need to be controlled so that economic growth continues to increase.

Multimodal Feedback Methods for Advancing the Accessibility of Immersive Virtual Reality for People With Balance Impairments Due to Multiple Sclerosis.

Maintaining balance in immersive virtual reality (VR) environments poses a significant challenge for users, particularly affecting those with pre-existing balance disorders. This study investigates the efficacy of multimodal feedback-comprising auditory, vibrotactile, and visual stimuli-in mitigating balance issues within VR. A sample of 68 participants, divided equally between individuals with balance deficits related to multiple sclerosis and those without, was evaluated. The research explored the impact of various feedback conditions on balance performance. The results demonstrated that the multimodal feedback condition significantly enhanced balance control compared to other conditions, with statistical analysis confirming this improvement (p<.001). These findings underscore the potential of integrated sensory feedback in addressing balance-related difficulties in VR, thereby improving the overall accessibility and user experience for individuals affected by balance impairments. This research contributes valuable insights into optimizing VR environments for enhanced stability and user comfort.

The immediate effect of listening to music on postural balance and mobility in individuals with intellectual disability

ABSTRACT Background Individuals with intellectual disability have deficits in postural balance and mobility. This study aimed to explore the effect of listening to music on postural balance and mobility in individuals with intellectual disability. Method Ten participants with intellectual disability and 10 participants with typical development performed postural balance and mobility tests [Time Up and Go (TUGT)/Ten Metre Walking (TMWT)] in three music conditions: no music, preferred music, and Mozart’s Jupiter music. Results Results revealed that listening to Mozart’s Jupiter decreased (p < 0.001) the center of pressure mean velocity values for both groups. In individuals with intellectual disability, the TUGT and the TMWT time to execution increased (p < 0.001) in the preferred music compared to the no music condition whereas the Mozart music has no significant effect (p ≥ 0.05). Conclusion Listening to Mozart’s Jupiter enhanced static postural balance, whereas listening to the preferred music impaired mobility in individuals with intellectual disability.

Fall risk factors and prevention among older adults in primary care in Belgium, 2019-2021

Abstract Background Falls are a major public health problem and ageing populations further increase the burden of fall-induced injuries. Falling among older persons is a multifactorial health condition needing multifactorial care. General practitioners (GPs) are well placed to implement a multifactorial management. A surveillance study of accidental falls studied characteristics of falls, risk groups and fall risk factors as well as fall prevention by GPs. Methods A 3-year retrospective population-based study by the Belgian network of Sentinel General Practitioners (SGP) on all patients aged ≥ 65 years consulting their GP for new fall-related injuries. Descriptive statistics were used to characterize falls, fallers, fall risks and preventive measures. Logistic regression analyses were performed to identify factors associated with a multifactorial fall risk profile. Results During 2019-21, 1138 accidental falls were registered. Medical and/or nursing intervention was required for 24% and 22% had a severe injury. During consult, 30% was referred to hospital. 61% of patients showed at least one of the four most prevalent fall risks, i.e. deficits of mobility or balance, polypharmacy, cognitive impairment or psychotropic medication. A multifactorial fall risk profile was observed in 45% of fallers and was associated with recurrent falling (p &amp;lt; 0.001), fall location (p &amp;lt; 0.05), activity when falling (p &amp;lt; 0.01) and pandemic year 2020 (p &amp;lt; 0.05). Addressing surrounding and walking problems were the most frequently delivered preventive measures. For 28% of patients, other primary care providers (mainly nurse and physiotherapist) were involved in preventive care. Conclusions This study highlights the importance of identifying fall risk factors among fallers in primary care. Preventive fall measures, taken in about one in four general practice patients in collaboration with other healthcare providers, are crucial for preventing accidental falls in older persons in Belgium. Key messages • A multifactorial management of fall risk factors by GPs is crucial for preventing accidental falls in older primary care patients. • Strengthening collaboration between primary healthcare professionals is needed for improving fall prevention in Belgium.

Changes in Motor Strategy and Neuromuscular Control During Balance Tasks in People with a Bimalleolar Ankle Fracture: A Preliminary and Exploratory Study.

Ankle fractures can lead to issues such as limited dorsiflexion, strength deficits, swelling, stiffness, balance disorders, and functional limitations, which complicate daily activities. This study aimed to describe neuromuscular adaptations at 6 and 12 months post-surgery during static and dynamic balance tasks, specifically using the Y-Balance Test (YBT). Additionally, the relationship between neuromuscular patterns, balance, and musculoskeletal deficits was evaluated. In 21 participants (14 at 6 months and 21 at 12 months) with bimalleolar fractures, hip strength, ankle dorsiflexion, ankle functionality, and static and dynamic balance were assessed using electromyography of five lower limb muscles (tibialis anterior, peroneus longus, lateral gastrocnemius, biceps femoris, and gluteus medius). A significant interaction effect (limb × proximal [hip]-distal [ankle] muscle) (F = 30.806, p < 0.001) was observed in the anterior direction of the Y-Balance Test (YBTA) at 6 months post-surgery. During the YBTA and YBT posteromedial (YBTPM), it was found that a lower dorsiflexion range of movement was associated specifically at 6 months with greater activation of the lateral gastrocnemius. However, these differences tended to diminish by 12 months. These findings suggest that neuromuscular patterns differ between operated and non-operated limbs during the YBTA at 6 months post-surgery. The Y-Balance Test, particularly its anterior direction, effectively highlighted these neuromuscular changes. This is a preliminary study; further research is needed to explore these findings in depth.

Tau load in select brainstem neurons predicts the severity and nature of balance deficits in the absence of cell death.

Patients with tauopathies present with profoundly different clinical symptoms 1 , even within the same disorder 2 . A central hypothesis in the field, well-supported by biomarker studies 3,4 and post-mortem pathology 5-7 , is that clinical heterogeneity reflects differential degeneration of vulnerable neuronal populations responsible for specific neurological functions. Recent work has revealed mechanisms underlying susceptibility of particular cell types 8-10 , but relating tau load to disrupted behavior - es- pecially before cell death - requires a targeted circuit-level approach. Here we studied two distinct balance behaviors in larval zebrafish 11 expressing a human 0N/4R-tau allele 12 in select populations of evolutionarily-conserved and well-characterized brainstem vestibular circuits 13,14 . We observed that human tau load predicted the severity of circuit-specific deficits in posture and navigation in the ab- sence of cell death. Targeting expression to either mid- or hindbrain balance neurons recapitulated these particular deficits in posture and navigation. By parametrically linking tau load in specific neu- rons to early behavioral deficits, our work moves beyond cell type to close the gap between pathological and neurological conceptions of tauopathy.

Balance performance in aged mice is dependent on unipolar brush cells.

The vestibular processing regions of the cerebellum integrate vestibular information with other sensory modalities and motor signals to regulate balance, gaze stability, and spatial orientation. A class of excitatory glutamatergic interneurons known as unipolar brush cells (UBCs) are highly concentrated within the granule cell layer of these regions. UBCs receive vestibular signals directly from primary vestibular afferents and indirectly from mossy fibers. Each UBC excites numerous granule cells and could contribute to computations necessary for balance-related motor function. Prior research has implicated UBCs in motor function, but their influence on balance performance remains unclear, especially in aged mice that have age-related impairment. Here we tested whether UBCs contribute to motor coordination and balance by disrupting their activity with chemogenetics in aged and young mice. Age-related balance deficits were apparent in mice > 6 months old. Disrupting the activity of a subpopulation of UBCs caused aged mice to fall off a balance beam more frequently and altered swimming behaviors that are sensitive to vestibular dysfunction. These effects were not seen in young (7-week-old) mice. Thus, disrupting the activity of UBCs impairs mice with age-related balance issues and suggest that UBCs are essential for balance and vestibular function in aged mice.

Can L-Methionine and S-Adenosyl-L-Methionine effectively mitigate scopolamine-induced cognitive and motor deficits in mice?

Motor balance deficits often coincide with cognitive deficits in older adults. Current medications provide temporary relief with several potential side effects. Essential amino acids and their derivatives, such as S-Adenosyl-L-Methionine (SAMe), can improve nerve function, mood regulation, and neuroprotection against neurodegenerative diseases. This study investigated the protective effects of SAMe in scopolamine-degraded memory, and motor balance in an animal model. To evaluate the possible effects of SAMe on cognitive and motor balance improvement, both Shuttle box and rotarod methods were performed in seven groups of animals (n=7). The mice groups received the saline (control), scopolamine, scopolamine+rivastigmine, scopolamine +methionine, and scopolamine+ three different doses of SAMe daily and separately for two weeks. Data were analyzed independently by one-way ANOVA and P<0.05 was considered significant. SAMe 150 mg/kg worsened scopolamine-induced memory impairment (P<0.001), while methionine (100 mg/kg) or SAMe (only 100 mg/kg) together with scopolamine could reduce the duration of the animal's presence in the dark chamber (P<0.05). Daily administration of methionine and SAMe at the rate of 100 mg/kg daily could significantly improve the decrease in motor balance caused by scopolamine (P<0.05). Rivastigmine improved memory and motor balance impairment caused by scopolamine (P<0.05). No difference between SAMe and L-methionine for memory, and balance. The results suggest that while L-methionine and SAMe may not be effective in improving memory impairments (Even SAMe high doses can aggravate the destruction of passive avoidance memory), they may be beneficial in enhancing motor balance.

Obstacle negotiation while dual-tasking in children with Developmental Coordination Disorder (DCD): An augmented-reality approach

BackgroundChildren with Developmental Coordination Disorder (DCD) exhibit deficits in predictive motor control, balance, and aspects of cognitive control, which are important for safely negotiating obstacles while walking. As concurrent performance of cognitive and motor tasks (dual-tasking) may exacerbate these deficits, we examined motor and cognitive dual-tasking differences between children with DCD and their typically developing (TD) peers during obstacle negotiation. Methods34 children aged 6–12 years (16 TD, 18 DCD) walked along a 12 m path, stepping over an obstacle (30 % or 50 % of leg length) at its mid-point. On dual-task trials, participants completed a simple or complex (cognitive) visual discrimination task presented via an augmented reality headset. Proportional dual-task costs (pDTCs) were measured on cognitive and gait outcomes over three phases: pre-obstacle, obstacle step-over, and post-obstacle. ResultsDuring the obstacle step-over phase, both groups increased their leading leg clearance when dual-tasking, while the DCD group had larger pDTC than TD for the high obstacle under simple stimulus conditions (viz simple-high combination). The complex cognitive task produced larger pDTCs than the simple one on leading leg clearance and post-obstacle gait variability. ConclusionsIn general, both DCD and TD groups showed similar pDTCs under complex conditions, while the specific deficit in DCD under the simple-high combination suggests a (default) compensatory strategy during step-over when attention is diverted to a secondary task. Competing cognitive and motor demands during obstacle negotiation present a potential safety risk for children.

A continuum of balance performance between children with developmental coordination disorder, spastic cerebral palsy, and typical development.

Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood. To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD). Cross-sectional case-control study. Different outpatient settings and the community. Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]). We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01). Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η2=0.25-0.66 [P<0.001], total: η2=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012). There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits. The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.

Effects of Cervical Mobilization on Balance and Proprioception in Patients With Nonspecific Neck Pain

ObjectiveThis study investigates the effect of cervical mobilization on balance and cervical proprioception in patients with nonspecific neck pain. MethodsA prospective, double-blind, randomized clinical trial was conducted involving a 3-week treatment protocol for which 66 patients were randomly assigned to 2 groups. Both groups underwent conventional physiotherapy (hot pack and transcutaneous electrical nerve stimulation) twice a week for 3 weeks along with additional cervical mobilization in the mobilization group, and sham mobilization in the sham control group. Static and dynamic balance, cervical proprioception, cervical mobility, and pain intensity were evaluated using a Kinesthetic Skill Training System 3000 device, the “Joint Position Error Test,” Cervical Range-of-Motion Instrument, and the visual analog scale, respectively. ResultsAfter treatment, significant improvements were noted in dynamic balance, mobility, pain intensity (P < .001, P < .001, P < .001, respectively), and proprioception in the left direction of rotation in the mobilization group (P = .003) that were significantly greater than those observed in the sham mobilization group (P < .001, P < .001, P < .001, P = .003, respectively). Although a significant decrease was observed in the deficits of static balance (P = .044) and proprioception in the right direction of rotation (P = .011) after mobilization, the changes were similar in both the mobilization and sham mobilization groups (P = .192, P = .154, respectively). ConclusionCervical mobilization led to significant improvements in dynamic balance, pain intensity, mobility, and partial improvements to proprioception in a comparison with a sham mobilization group, while the effect on static balance was not significant.

Efficacy of virtual reality on balance impairment in ataxic cerebral palsy children: randomized controlled trial.

Children with ataxic cerebral palsy have unsteady movements and poor balance. Many therapeutic interventions are used to improve their upper and lower functioning. To assess the effectiveness of virtual reality (VR) on balance impairment in ataxic cerebral palsy children. RCT. Sixty-four children with ataxic cerebral palsy. Children were randomly assigned into two equal groups with 32 patients in each group. The control group received a specially developed physical therapy program and the VR group received VR training on a Wii balance board in addition to the control group's program. For three successive months the intervention program was implemented three times a week for both groups. Stability indices (overall, anteroposterior, and mediolateral) were measured using the Biodex balance system and Pediatric Balance Scale (PBS) at baseline and after three months of intervention for both groups. At the beginning of the intervention, there were no statistically significant differences between the two groups (P>0.05). However, following three months of the intervention, there was a statistically significant decline in the stability index scores., as well as a statistically significant improvement in the score of the PBS in both groups with a notable advancement in favor of the VR group (P≤0.05). Adding VR training on a Wii balance board to a designed physical therapy program has a significant impact on improving balance deficits in ataxic cerebral palsy children. VR has a therapeutic effect on improving balance that may result in better and more efficient rehabilitation program of children with ataxic cerebral palsy.

Twin Deficit Assumptions: A Case Study of Pakistan (Cab from 2000 to 2023) and (FD from 2008 to 2024)

The aim of this article is to investigate the link between fiscal deficit and current account deficit which is the high rate of fiscal deficit budget and commonly known as twin deficit or deficits assumptions in the Pakistani economy (Khalil Mudassar, Amjad Fakher, Sajid Ali &amp; Fozia Sarwar 2013); present economy below growing stress in the fiscal and foreign fronts as a output of huge fiscal deficit &amp; current account balance deficit. The error rectification specification is used to find evidence of long-running connection from fiscal deficit to current account deficit. The analysis results suggest that the current account balance deficit can be determined but the fiscal deficit budget balance is very challenging and from deficit to growth rate but through strong policies of the government for imposing direct and indirect taxes which will be strong can reduce the fiscal deficit and growing towards the growth rate of the economy.

Identifying neural correlates of balance impairment in traumatic brain injury using partial least squares correlation analysis

Objective.Balance impairment is one of the most debilitating consequences of traumatic brain injury (TBI). To study the neurophysiological underpinnings of balance impairment, the brain functional connectivity during perturbation tasks can provide new insights. To better characterize the association between the task-relevant functional connectivity and the degree of balance deficits in TBI, the analysis needs to be performed on the data stratified based on the balance impairment. However, such stratification is not straightforward, and it warrants a data-driven approach.Approach.We conducted a study to assess the balance control using a computerized posturography platform in 17 individuals with TBI and 15 age-matched healthy controls. We stratified the TBI participants into balance-impaired and non-impaired TBI usingk-means clustering of either center of pressure (COP) displacement during a balance perturbation task or Berg Balance Scale score as a functional outcome measure. We analyzed brain functional connectivity using the imaginary part of coherence across different cortical regions in various frequency bands. These connectivity features are then studied using the mean-centered partial least squares correlation analysis, which is a multivariate statistical framework with the advantage of handling more features than the number of samples, thus making it suitable for a small-sample study.Main results.Based on the nonparametric significance testing using permutation and bootstrap procedure, we noticed that the weakened theta-band connectivity strength in the following regions of interest significantly contributed to distinguishing balance impaired from non-impaired population, regardless of the type of stratification:left middle frontal gyrus, right paracentral lobule, precuneus, andbilateral middle occipital gyri. Significance.Identifying neural regions linked to balance impairment enhances our understanding of TBI-related balance dysfunction and could inform new treatment strategies. Future work will explore the impact of balance platform training on sensorimotor and visuomotor connectivity.

A useful cognitive motor dual task paradigm in prodromal and manifest Huntington’s disease

IntroductionIndividuals with Huntington's disease (HD) experience increased difficulty with balance throughout disease progression. Adding a simultaneous cognitive task to a balance assessment, referred to as a dual task (DT) paradigm, may have a deleterious effect on balance, which can be expressed in terms of a Dual Task Cost (DTC), relative to a single task (ST) condition. The aim of this study is to explore whether a cognitive-motor DT paradigm uncovers balance deficits in prodromal (Pro-HD) and manifest HD, compared to healthy adults (HA). MethodsBalance under ST and DT conditions was examined using the BTracks Balance Plate and Balance software in 30 individuals with HD, 17 individuals with Pro-HD, and 20 HA. During the DT condition, participants were simultaneously administered a version of the Paced Auditory Serial Addition Test (PASAT). DTC is calculated as the relative ratio of ST to DT, controlling for ST performance: DTC= (ST − DT)/ST x100. ResultsThe HA group performed significantly better than the HD group on both the ST and DT conditions (p < 0.01), while balance scores between the HA and the Pro-HD groups were not significantly different. The DTC scores, however, were significantly better in the HA compared to both the HD (p < 0.001) and Pro-HD (p < 0.05) groups. ConclusionOur findings indicate that the addition of a cognitive task interferes with participant's balance, reflecting real-life performance, and may have additional value for estimating transition to manifest disease, appraising fall risk, or serving as a valid outcome measure in observational and interventional trials in HD.

Integrating traditional Chinese Medicine reduced the risk of hip fracture in patients with dementia

Background/purposeThe high incidence of hip fracture is an important problem among dementia patients because of their higher risk of falls and balance deficits due to a lack of physical activity. The aim of this study was to investigate whether traditional Chinese medicine (TCM) therapy could reduce the risk of hip fracture in dementia patients. MethodsWe identified 38,071 patients who were first diagnosed with dementia from January 1, 2000, to December 31, 2017, from the database of the 2000 Longitudinal Generation Tracking Database (LGTD 2000) provided by the Health and Welfare Data Science Center (HWDC) in Taiwan. Patients who received TCM treatment after the initial diagnosis of dementia were assigned to the TCM group, and patients who never received TCM treatment were assigned to the non-TCM group. After performing 1:1 propensity score matching (1:1) based on age, sex, comorbidities and medication between the TCM and non-TCM groups, there were 902 patients in each group. Patients were followed up to December 31, 2018, and incidences of hip fracture after the initial diagnosis of dementia between the two groups were compared with Cox regression analysis. ResultsNinety-four patients in the non-TCM group (10.42%) and 58 patients in the TCM group (6.43%) suffered from hip fracture during the follow-up period. Patients in the TCM group had a lower incidence of hip fracture than those in the non-TCM group (adjusted hazard ratio = 0.54, 95% confidence interval = 0.38–0.76). ConclusionsIntegrating TCM health care for dementia patients might reduce the risk of hip fracture.