Balance Recovery Research Articles

Physical therapy of persons after acute cerebrovascular accident in a long-term rehabilitation period

Purpose: to study the dynamics of recovery of walking, balance and quality of life of persons after acute cerebrovascular accident in a long-term rehabilitation period. Material and methods: patients were randomly divided into a main group (MG), which included 35 patients (n=35), and a comparison group (CG), which included 38 patients (n=38). The groups received rehabilitation intervention in accordance with the concept of the International Classification of Functioning, Disability, and Health (ICF). A categorical profile was created for each person and SMART goals were set. A physical therapy (PT) program was developed for MG after acute cerebrovascular accident (ACVA) in the long-term rehabilitation period. Short- and long-term goals were set in the SMART format, which included the use of therapeutic exercises. Functional capabilities and quality of life were assessed before and after the rehabilitation intervention using the ten-meter walk test, the Tinetty balance and fall risk scale, the modified Renkin functional independence scale and quality of life. Results: the dynamics of the ten-meter walking test during the PT program among patients in the MG is reflected in a decrease in the test completion time, which amounted to 23,6 s, and in the CG – 7 s. By the time of the final examination, the range of the obtained values was limited to 8 and 15 s in the MG, and among the CG, the extreme values were found at the levels of 12 and 160 s. By the time of the final examination, the "balance" item on the Tinetty balance and risk of falls scale in the MG was 13,8 ± 1,69 points out of a possible 16 points; the Me (25%; 75%) indicators were 14 (13; 15) points. In the CG, the indicator was slightly lower and was 12,3 ± 2,61 points; the Me (25%; 75%) indicators were 13 (10; 15) points. The difference between the groups by the end of the study for this indicator was significant (p<0.05). As for the increase, it was 4.7 points in the MG and 3.1 points in the CG. The average statistical results of the assessment of the “Risk of Falls” section in the MG were 9.2±1.59 points out of a possible 12; the Me (25%; 75%) indicators were 9 (8; 11) points. In the CG patients, the indicator was slightly lower and was 5,2±1,99 points; the Me (25%; 75%) indicators were 6 (4; 6.3) points. The difference between the groups by the end of the study for this indicator was significant. (р<0,01). As for the increase, it was 5 points in MG and 1,4 points in CG. The intermediate results on the Renkin scale were 1,83±0,62 and 2,13±0,74 points in MG and CG with Me (25%; 75%) – 2 (2; 2) and 2 (2; 3), respectively. At this stage, there was no statistical difference between the groups (p>0,05), but both groups showed a reliable improvement compared to the initial result (p<0,01). During the final examination, the results in MG patients improved and were 1,11±0,62 points, where the Me (25%; 75%) indicators were found at the level of 1 (1; 2) point. Among the CG patients, the final result was worse (p<0.01) and was found at the level of 1,55±0,72 points with Me (25%; 75%) 1 (1; 2) point. Conclusions: Analysis of the dynamics of walking, balance and quality of life indicators after acute cerebrovascular accident in a long-term rehabilitation period confirmed the advantages of the developed physical therapy program for individuals from the MG.

Experimental study on mechanical transfer regularity and step distance of individuals under different collision impulse

In the process of emergency evacuation, the fall of an individual may lead to the instability of surrounding pedestrians. The evacuation routes would be obstructed by fallen pedestrians, thereby diminishing the evacuation efficiency and increasing the overall crowd risk. The purpose of this study is to explore the balance-recovery process of pedestrians under collision. The study conducted a series of experiments to obtain the total step distance and number of steps taken by individuals during the balance-recovery process under different impulses. The impulse applied by the unstable individual to the obstacle ahead for balance recovery was also measured. The gait characteristics and mechanical principles of the individuals in the balance-recovery process after collision force were analyzed. The results indicate that individuals can recover balance within a 90 cm step distance if the impulse received is in the range of 20–160 N s. The relationship between the step distance of an individual and the impulse received can be expressed as a quadratic function. When stepping is prohibited, the impulse applied by the individual to the obstacle ahead is approximately 1.85 times the impulse he received. However, if stepping is allowed, the dispersion of the impulse applied to the obstacle gradually decreases with increasing step space. Additionally, logistic regression models were constructed to calculate individual instability probabilities for different conditions based on the experimental data. These results can serve as a foundation method for evaluating the individual and group instability risk during emergency evacuation scenarios.

Effects of a Single Session of Repetitive Transcranial Stimulation in Parkinson Disease

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique proposed for recovery of gait and balance in patients with Parkinson's disease (PD). Our aim was to evaluate the effects of rTMS in PD patients by clinical evaluation and computerized gait analysis. Ten patients were recruited. Each patient was assessed before and after a single session of rTMS by: Berg Scale, Unified Parkinson Disease Rating Scale (UPDRS), 6 Minute Walking Test (6MWT), 10MWT, Time Up and Go (TUG) and spatial-temporal gait analysis by Pablo Gait Assessment sensor. We availed of STM 9000, stimulating with 2000 pulses of 20 Hz rTMS, delivered in 5-second trains with 25 seconds between trains, on the hand area of the motor cortex at 90% resting motor threshold (RMT) on each hemisphere, with 5 minutes pause between hemispheres. Eighty percent of the patient reported subjective benefits, corroborated by objective examination of the results. A significant improvement on the Berg scale was observed. Moreover, a tendence to a significant decrease of stiffness at the lower limbs was evident at UPDRS. Gait analysis showed not significant improvements of evaluated parameters. Although it is premature to draw conclusions, because of the small number of patients, underwent to a single session of rTMS, we confirm the possible beneficial effects and the safety of rTMS. Further studies are needed to validate our findings by clinical evaluation and gait analysis at short, medium, and long term. These may be different in relation to the age, duration and stage of the disease, prevalence of tremor or akinesia and rigidity.

APPLICATION OF ANALYTICAL EXERCISES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION FOR STATIC, DYNAMIC BALANCE AND POSTURAL CONTROL IMPROVEMENT

Purpose: to assess the recovery of static, dynamic balance and postural control while overcoming muscle imbalance after an anterior cruciate ligament reconstruction by applying analytical exercises. Material and methods: Material: 15 men (mean age 25.16) were observed in the span of 14 weeks (three and a half months) after anterior cruciate ligament reconstruction. They underwent physiotherapy, including analytical kinetic chain exercises in hospital, ambulatory and at home conditions. Research, measurement, and evaluation methods include range of motion in the knee joint, manual muscle testing (MMT), static and dynamic balance tests, and postural control tests. Statistical methods include statistical data grouping, Cronbach’s test, descriptive method, testing of statistical hypotheses, and correlation analysis. The data was processed with SPSS v.24.0 for Windows. Results: The results show a change in the static postural control with a 1/4-point deviation from the standard. This requires the inclusion of additional sensorimotor exercises in combination with other specific and general strengthening exercises. Conclusion: From the performed observation and the obtained results, compared to those of 20 healthy men, the following conclusion has been drawn: the analytical exercises for lower extremities lead to the overcoming of dysfunction and increased stability in the extremities. The physiotherapy programme should include sensory stimulation exercises tailored for strengthening the weakened muscles and should contribute to the overcoming of muscle imbalance.

Cardiovascular Autonomic Modulation in Chronic Coronary Syndrome Following Percutaneous Coronary Intervention.

Introduction The risk of sudden death in patients with chronic coronary syndrome (CCS) is increased by unbalanced cardiovascular autonomic function. Since myocardial ischemia appears to be the causeof this condition of autonomic dysregulation, treating this condition should improve and correct the autonomic functions. Improving myocardial perfusion by PCI might have beneficial effects on the recovery of autonomic balance in ischemia-triggered autonomic dysregulation. Objective In the present study, autonomic modulation in patients with CCS was evaluated before and after percutaneous coronary intervention (PCI) using cardiovascular reflex tests. Methods A total of 30CCS patients were recruited from the cardiology outpatient department. The patients were tested withcardiovascular reflex tests (lying to standing, 30:15 ratio, Valsalva ratio, isometric handgrip test, and deep breathing test) before and after PCI. The licensed statistical software SPSS version 21.0 was used to compile and analyse the data. Results Out of 30 patients, parasympathetic reactivity tests conducted post-PCI were significantly higher as compared to pre-PCI patients: (1) lying to standing - 30:15 ratio (1.17± 0.102 versus 1.03± 0.064, p=0.000); (2) Valsalva ratio (1.42±0.276 versus 1.02±0.133, p=0.000), (3) delta heart rate in deep breathing test (17.23± 3.004 bpm versus 7.85± 4.076 bpm, p=0.000), and (4) expiration to inspiration (E:I) ratio (1.25± 0.050 versus 1.11± 0.064, p=0.000. Among sympathetic reactivity tests, lying to standing test for fall in systolic blood pressure was significantly higher in the pre-PCI state than post-PCI (-20.73± 10.29 versus -2.33± 7.67, p=0.000). The rise in DBP of the isometric handgrip test was significantly higher in post-PCI compared to pre-PCI patients (36.73±8.39 mm Hg versus 16.63±8.47 mm Hg, p=0.000). Conclusion Resting autonomic tone as determined by cardiovascular reflex testing reveals an increase in both parasympathetic and sympathetic reactivity following PCI in CCS, according to the findings of this preliminary study. As a result, we propose that noninvasive procedures like cardiovascular reflex tests be used to stratify the likelihood of illness development in the future.

Efficacy of plantar tactile sensation and balance in patients with subacute stroke following plantar kinesio taping: a randomized, cross-over preliminary study

ABSTRACT Background Kinesio tape (KT) is known to enhance tactile sensation. In stroke rehabilitation, KT is often used alongside conventional therapy (CT) to improve balance recovery. Objective In this study, we aimed to evaluate the effectiveness of plantar KT in enhancing plantar tactile sensation (PTS) and balance ability in subacute stroke patients. Methods In this randomized crossover trial, 22 subacute stroke participants were randomly assigned to receive no taping, paretic plantar KT, or bilateral plantar KT, with a 24-h washout period between each condition. All participants underwent 30 min of CT. The primary outcome was PTS, involving tactile sensitivity in five areas on the plantar surface and the contact area with the ground of the paretic foot. The one-leg stand (OLS) time, functional reach test (FRT), and timed up-and-go test (TUG) were employed as secondary outcomes. Results Paretic plantar KT application led to significant increases in the contact area, OLS, FRT, and TUG test times. Particularly, bilateral plantar KT showed significantly greater improvement in PTS compared to paretic plantar KT. Additionally, bilateral plantar KT significantly improved OLS (p < 0.001, η2 = 0.575), FRT (p < 0.001, η2 = 781), and TUG (p < 0.001, η2 = 0.771) times compared with paretic plantar KT. Conclusions This study demonstrated that plantar KT improved PTS and balance ability in stroke rehabilitation. The findings suggest that bilateral plantar KT as an adjunct to CT may have a beneficial effect on balance recovery in patients with subacute stroke. Trial registration Clinical trial KCT0009048

Balance recovery after trips is affected by the type of tripping obstacles

Occupational falls are often initiated by trips. Mechanical perturbations applied onto the tripped foot are different for different types of tripping obstacles. The present study aimed to determine how different types of tripping obstacles affect balance recovery after trips. Sixty-four healthy adults participated in an experimental study. They were instructed to perform several walking trials, during which two trips were randomly induced, one by a pole-like obstacle and the other by a board-like obstacle. Balance recovery after trips was measured and compared between the two obstacles. Results showed that the board-like obstacle led to longer step-off time, shorter recovery step duration, and smaller minimum hip height, suggesting that the risk of trip-initiated falls could be higher with the board-like obstacle vs. the pole-like obstacle. This finding presents the need for future research to consider the influence of obstacle type when exploring mechanisms for trips and falls.

Feedback Interventions in Motor Recovery of Lateropulsion after Stroke: A Literature Review and Case Series.

The review was performed across five different databases (Embase, Medline/PubMed, Scopus, Web of Science, and PEDro) up to February 2024, and haptic feedback intervention was incorporated into the case series (with lateropulsion and ambulation capacity as the main variables). In total, 211 records were identified and 6 studies were included after the review of the literature. The most used feedback modality was visual feedback. In the case series, positive results were observed from the intervention, particularly in the recovery of lateropulsion and balance, as well as in the improvement of gait for one patient. Patients demonstrated good adherence to the intervention protocol without adverse effects. Visual feedback is the most commonly used feedback modality in lateropulsion patients but other mechanisms such as haptic feedback also are feasible and should be taken into account. Larger sample sizes, extended follow-up periods, and the isolation of feedback mechanisms must be established to clarify evidence.

Standing balance recovery strategies of young adults in a densely populated environment following external perturbations

The recovery strategies used by young adults to maintain standing balance following external force-controlled perturbations in densely populated group formations was investigated in this work. In particular, the moment of step initiation as well and the characteristics of the first recovery steps and hand-raising were studied here. The experimental data considered in this work are part of a larger dataset relying on a new experimental paradigm inspired by Feldmann and Adrian (2023). In this experiment, 20 participants (8 females, 12 males, 24.8±3.7yo) equipped with motion capture suits were asked to stand in tightly packed formation before receiving a force-controlled perturbation. In total, four group configurations and two interpersonal distancing conditions have been investigated here. The standing balance recovery strategies observed in this dense groups experiment were then compared with the observed behaviour of single individuals following external perturbations (Chatagnon et al., 2023). Results suggest that the moment of initiation for recovery steps was affected by the initial interpersonal distancing conditions. The first recovery steps within the studied dense groups were observed to be slower, smaller and more dispersed than those of single individuals for comparable level of perturbation intensity. However, the relationship between the average speed of first recovery steps and the length of these steps remained similar to the one of single individuals. This suggests that the first recovery step duration remained almost constant during both the dense groups experiment and the experiment with single individuals. Finally, we observed a significant occurrence of participants raising their hands, as physical interactions played an important role in this dense groups experiment. This behaviour was mainly observed to be initiated before recovery steps.

The Effects of mirror therapy in postural and kinesthetic rehabilitation on stance phase of gait in subacute stroke

Background: This study explored the effectiveness of mirror therapy in improving postural and kinesthetic rehabilitation during the stance phase of gait in subacute stroke patients. Given the crucial role of balance and functional recovery in enhancing mobility and overall quality of life in stroke survivors, the primary focus was on these aspects. Objective: The primary objective was to evaluate the impacts of mirror therapy on postural and kinesthetic rehabilitation during the stance phase of gait in subacute stroke patients. Methods: A randomized controlled trial was conducted over nine months in Rahim Yar Khan, involving both private and government hospitals. Sixty-four participants were randomly assigned to two groups: the Conventional+KTR group and the Mirror Therapy group, with 32 participants in each. Inclusion criteria required participants to have a single episode of hemiplegic subacute stroke diagnosed by a neurologist, inclusion of both ischemic and hemorrhagic stroke, and sufficient cognitive ability to follow instructions as indicated by a Mini-Mental State Examination (MMSE) score of 24 or higher. Mild spasticity in all joints of the affected limb was defined by a Modified Ashworth Scale score of less than 3. The intervention for the experimental group involved mirror therapy conducted four days a week for six weeks, supplemented by a home plan for the remaining three days. The control group received conventional therapy, including proprioceptive neuromuscular facilitation (PNF) and electrical interventions, also for four days a week, with a home plan for the remaining days. Key outcome measures were the Berg Balance Scale (BBS) for balance and the Fugl-Meyer Assessment for functional recovery. Data were analyzed using SPSS Version 25, with significance set at p&lt;0.05. Results: The Mirror Therapy group showed significantly greater improvements in balance scores, with a mean BBS of 40.31 at week 6 compared to 36.78 in the Conventional+KTR group (p&lt;0.001). Functional recovery was more pronounced in the Conventional+KTR group, which had a mean Fugl-Meyer Assessment score of 35.63 at week 6 compared to 30.50 in the Mirror Therapy group (p&lt;0.001). Gender distribution was similar across both groups, with the Conventional+KTR group consisting of 21.9% males and 78.1% females, and the Mirror Therapy group having 18.8% males and 81.3% females. Conclusion: Mirror therapy significantly enhances postural and kinesthetic rehabilitation in subacute stroke patients, particularly in improving balance more effectively than Conventional+KTR therapy. Conversely, Conventional+KTR therapy showed better results in functional recovery. These findings suggest that mirror therapy can be a valuable addition to stroke rehabilitation programs, offering a potential avenue for improved patient outcomes. Keywords: Mirror Therapy, Subacute Stroke Rehabilitation, Gait Improvement, Postural Awareness, Kinesthetic Awareness, Berg Balance Scale, Fugl-Meyer Assessment, Randomized Controlled Trial, Stroke Recovery, Balance Rehabilitation.

Exoskeleton rehabilitation robot training for balance and lower limb function in sub-acute stroke patients: a pilot, randomized controlled trial

PurposeThis pilot study aimed to investigate the effects of REX exoskeleton rehabilitation robot training on the balance and lower limb function in patients with sub-acute stroke.MethodsThis was a pilot, single-blind, randomized controlled trial. Twenty-four patients with sub-acute stroke (with the course of disease ranging from 3 weeks to 3 months) were randomized into two groups, including a robot group and a control group. Patients in control group received upright bed rehabilitation (n = 12) and those in robot group received exoskeleton rehabilitation robot training (n = 12). The frequency of training in both groups was once a day (60 min each) for 5 days a week for a total of 4 weeks. Besides, the two groups were evaluated before, 2 weeks after and 4 weeks after the intervention, respectively. The primary assessment index was the Berg Balance Scale (BBS), whereas the secondary assessment indexes included the Fugl-Meyer Lower Extremity Motor Function Scale (FMA-LE), the Posture Assessment Scale for Stroke Patients (PASS), the Activities of Daily Living Scale (Modified Barthel Index, MBI), the Tecnobody Balance Tester, and lower extremity muscle surface electromyography (sEMG).ResultsThe robot group showed significant improvements (P < 0.05) in the primary efficacy index BBS, as well as the secondary efficacy indexes PASS, FMA-LE, MBI, Tecnobody Balance Tester, and sEMG of the lower limb muscles. Besides, there were a significant differences in BBS, PASS, static eye-opening area or dynamic stability limit evaluation indexes between the robotic and control groups (P < 0.05).ConclusionsThis is the first study to investigate the effectiveness of the REX exoskeleton rehabilitation robot in the rehabilitation of patients with stroke. According to our results, the REX exoskeleton rehabilitation robot demonstrated superior potential efficacy in promoting the early recovery of balance and motor functions in patients with sub-acute stroke. Future large-scale randomized controlled studies and follow-up assessments are needed to validate the current findings.Clinical trials registrationURL: https://www.chictr.org.cn/index.html.Unique identifier: ChiCTR2300068398.

Gait balance recovery after tripping: The influence of walking speed and ground inclination on muscle and joint function

Reactive lower limb muscle function during walking plays a key role in balance recovery following tripping, and ultimately fall prevention. The objective of this study was to evaluate muscle and joint function in the recovery limb during balance recovery after trip-based perturbations during walking. Twenty-four healthy participants underwent gait analysis while walking at slow, moderate and fast speeds over level, uphill and downhill inclines. Trip perturbations were performed randomly during stance, and lower limb kinematics, kinetics, and muscle contribution to the acceleration of the whole-body centre of mass (COM) were computed pre- and post-perturbation in the recovery limb. Ground slope and walking speed had a significant effect on lower limb joint angles, net joint moments and muscle contributions to support and propulsion during trip recovery (p < 0.05). Specifically, increasing walking speed during trip recovery significantly reduced hip extension in the recovery limb and increased knee flexion, particularly when walking uphill and at higher walking speeds (p < 0.05). Gluteus maximus played a critical role in providing support and forward propulsion of the body during trip recovery across all gait speeds and ground inclinations. This study provides a mechanistic link between muscle action, joint motion and COM acceleration during trip recovery, and underscores the potential of increased walking speed and ground inclination to increase fall risk, particularly in individuals prone to falling. The findings of this study may provide guidelines for targeted exercise therapy such as muscle strengthening for fall prevention.

Separate-layer balanced waterflooding development technology for thick and complex carbonate reservoirs in the Middle East

Based on the waterflooding development in carbonate reservoirs in the Middle East, in order to solve the problem of the poor development effects caused by commingled injection and production, taking the thick bioclastic limestone reservoirs of Cretaceous in Iran-Iraq as an example, this paper proposes a balanced waterflooding development technology for thick and complex carbonate reservoirs. This technology includes the fine division of development units by concealed baffles and barriers, the combination of multi well type and multi well pattern, and the construction of balanced water injection and recovery system. Thick carbonate reservoirs in Iran-Iraq are characterized by extremely vertical heterogeneity, development of multi-genesis ultra-high permeability zones, and highly concealed baffles and barriers. Based on the technologies of identification, characterization, and sealing evaluation for concealed baffles and barriers, the balanced waterflooding development technology is proposed, and three types of balanced waterflooding development modes/techniques are formed, namely, conventional stratigraphic framework, fine stratigraphic framework, and deepened stratigraphic framework. Numerical simulations show that this technology is able to realize a fine and efficient waterflooding development to recover, in a balanced manner, the reserves of thick and complex carbonate reservoirs in Iran and Iraq. The proposed technology provides a reference for the development optimization of similar reservoirs.

The CT Classification of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament to Guide Hybrid Anterior Controllable Antedisplacement and Fusion vs. Posterior Laminoplasty.

For precise and minimally invasive treatment of ossification of the posterior longitudinal ligament of the cervical spine, the lifting segment is minimized, anterior controllable antedisplacement and fusion (ACAF) was refined and improved. In addition, the development of appropriate surgical procedures for the ossification of each segment was rarely reported. Therefore, this study aimed to compare the efficacy and safety of hybrid anterior controlled antedisplacement fusion (Hybrid ACAF) with laminoplasty for multilevel ossification of the posterior longitudinal ligament (OPLL). Between May 2018 and May 2021, 70 patients with multilevel OPLL were divided into a hybrid ACAF group and a laminoplasty group according to surgical methods. All patients were followed up for at least 1 year. Japanese Orthopaedic Association (JOA) score and recovery rate (JOARR), (VAS, NDI) score and C2-C7 Cobb angle, the sagittal vertical axis of the neck (SVA), and complications (cerebrospinal fluid leakage, C5 paralysis, etc.) were compared between the two groups by t test or non-parametric test. The operation time of hybrid ACAF was longer. C5 paralysis and axial pain were more common in the laminoplasty group, while dysphagia and hoarseness were more common in the hybrid ACAF group. At the last follow-up, the hybrid ACAF group had better recovery and maintenance of cervical lordosis and sagittal plane balance and a higher JOA score and recovery rate than the laminoplasty group. Hybrid ACAF can reduce the number of vertebral bodies and expand the decompression range, which is safe, effective, and tailored to local conditions. Compared with laminoplasty, hybrid ACAF is a precise alternative for patients with OPLL.

The effect of visual sensory interference during multitask obstacle crossing in younger and older adults.

When older adults step over obstacles during multitasking, their performance is impaired; the impairment results from central and/or sensory interference. The purpose was to determine if sensory interference alters performance under low levels of cognitive, temporal, and gait demand, and if the change in performance is different for younger versus older adults. Participants included 17 younger adults (20.9±1.9 years) and 14 older adults (69.7±5.4 years). The concurrent task was a single, simple reaction time (RT) task: depress button in response to light cue. The gait task was stepping over an obstacle (8 m walkway) in three conditions: (1) no sensory interference (no RT task), (2) low sensory interference (light cue on obstacle, allowed concurrent foveation of cue and obstacle), or (3) high sensory interference (light cue away from obstacle, prevented concurrent foveation of cue and obstacle). When standing, the light cue location was not relevant (no sensory interference). An interaction (sensory interference by task, p<0.01) indicated that RT was longer for high sensory interference during walking, but RT was not altered for standing, confirming that sensory interference increased RT during obstacle approach. An interaction (sensory interference by age, p<0.01) was observed for foot placement before the obstacle: With high sensory interference, younger adults placed the trail foot closer to the obstacle while older adults placed it farther back from the obstacle. The change increases the likelihood of tripping with the trail foot for younger adults, but with the lead limb for older adults. Recovery from a lead limb trip is more difficult due to shorter time for corrective actions. Overall, visual sensory interference impaired both RT and gait behavior with low levels of multitask demand. Changes in foot placement increased trip risk for both ages, but for different limbs, reducing the likelihood of balance recovery in older adults.

Design, Fabrication, and Validation of a Portable Perturbation Treadmill for Balance Recovery Research.

Trips and falls are a major concern for older adults. The resulting injury and loss of mobility can have a significant impact on quality of life. An emerging field of study, known as Perturbation Training, has been shown to reduce injury rates associated with trips and falls in older adults. Treadmills traditionally used for Perturbation Training are large, expensive, and immobile, forcing users to travel long distances to receive care. A portable treadmill would serve a larger portion of the at-risk population than current methods. We developed a portable, low-cost, twin-belt perturbation treadmill capable of high-intensity Perturbation Training. Belt speeds are controlled by a custom mechanical and software interface, allowing operators with no programming experience to control the device. The treadmill can accommodate users up to 118 kg and provides a maximum acceleration and speed of 12 m/s2 and 3.3 m/s, respectively, under full load. The total weight is 180 kg, and the treadmill can be moved like a wheelbarrow, with handles in the back and wheels in the front. The prototype was validated with mechanical and human participant testing, showing it as a viable device for Perturbation Training. In this paper, we will go over the design, fabrication, and validation processes used to create the Portable Perturbation Treadmill.

From fumble to flourish: how workplace attachment drives service recovery performance

PurposeDrawing on the conservation of resources theory and attachment theory, this paper proposes that employee–organization relationship and satisfaction with work–life balance mediate the influence of workplace attachment on service recovery performance.Design/methodology/approachData collection was carried out through the distribution of questionnaires among a sample of healthcare providers from Lebanese private hospitals and analyzed via structural equation modeling.FindingsThe results indicate that workplace attachment has a significant impact on employee–organization relationship, satisfaction with work–life balance and service recovery performance. The findings further reveal that employee–organization relationship and satisfaction with work–life balance significantly influence service recovery performance and fully mediate the relationship between workplace attachment and service recovery performance.Originality/valueThis study is the first to investigate the mediating role of the employee–organization relationship and satisfaction with work–life balance between workplace attachment and service recovery performance. Over and above, this study is the first of its kind that the authors are aware of, being conducted in the healthcare sector, specifically in Lebanon. Based on the findings, the paper discusses the theoretical contributions, managerial implications and suggestions for further studies.

Long-term efficacy of Waveflex semi-rigid-dynamic-internal-fixation system in delaying intervertebral disc degeneration at adjacent segments and improving spinal sagittal imbalance

The Waveflex semi-rigid-dynamic-internal-fixation system shows good short-term effects in the treatment of lumbar degenerative diseases, but there are few long-term follow-up studies, especially for recovery of sagittal balance. Fifty patients with lumbar degenerative diseases treated from January 2016 to October 2017 were retrospectively analysed: 25 patients treated with Waveflex semi-rigid-dynamic-internal-fixation system (Waveflex group) and 25 patients treated with double-segment PLIF (PLIF group). Clinical efficacy was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Imaging data before surgery and at 3 months, 1 year, and 5 years postoperatively was used for imaging indicator assessment. Local disc degeneration of the cephalic adjacent segment (including disc height index (DHI), intervertebral foramen height (IFH), and range of motion (ROM)) and overall spinal motor function (including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and |PI-LL|) were analysed. Regarding clinical efficacy, comparison of VAS and ODI scores between the Waveflex and PLIF groups showed no significant preoperative or postoperative differences. The comparison of the objective imaging indicators showed no significant differences in the DHI, IFH, LL, |PI-LL|, and SS values between the Waveflex and PLIF groups preoperatively and 3 months postoperatively (P > 0.05). These values were significantly different at 1 and 5 years postoperatively (P < 0.05), and the Waveflex group showed better ROM values than those of the PLIF group (P < 0.05). PI values were not significantly different between the groups, but PT showed a significant improvement in the Waveflex group 5 years postoperatively (P < 0.05). The Waveflex semi-rigid dynamic fixation system can effectively reduce the probability of intervertebral disc degeneration in upper adjacent segments. Simultaneously, patients in the Waveflex group showed postoperative improvements in LL, spinal sagittal imbalance, and quality of life.

The Metabolism and Disposition of Brepocitinib in Humans and Characterization of the Formation Mechanism of an Aminopyridine Metabolite.

Brepocitinib is an oral once-daily Janus kinase 1 and Tyrosine kinase 2 selective inhibitor currently in development for the treatment of several autoimmune disorders. Mass balance and metabolic profiles were determined using accelerator mass spectrometry in six healthy male participants following a single oral 60 mg dose of 14C-brepocitinib (∼300 nCi). The average mass balance recovery was 96.7% ± 6.3%, with the majority of dose (88.0% ± 8.0%) recovered in urine and 8.7% ± 2.1% of the dose recovered in feces. Absorption of brepocitinib was rapid, with maximal plasma concentrations of total radioactivity and brepocitinib achieved within 0.5 hours after dosing. Circulating radioactivity consisted primarily of brepocitinib (47.8%) and metabolite M1 (37.1%) derived from hydroxylation at the C5' position of the pyrazole ring. Fractional contributions to metabolism via cytochrome P450 enzymes were determined to be 0.77 for CYP3A4/5 and 0.14 for CYP1A2 based on phenotyping studies in human liver microsomes. However, additional clinical studies are required to understand the potential contribution of CYP1A1. Approximately 83% of the dose was eliminated as N-methylpyrazolyl oxidative metabolites, with 52.1% of the dose excreted as M1 alone. Notably, M1 was not observed as a circulating metabolite in earlier metabolic profiling of human plasma from a multiple ascending dose study with unlabeled brepocitinib. Mechanistic studies revealed that M1 was highly unstable in human plasma and phosphate buffer, undergoing chemical oxidation leading to loss of the 5-hydroxy-1-methylpyrazole moiety and formation of aminopyrimidine cleavage product M2. Time-dependent inhibition and trapping studies with M1 yielded insights into the mechanism of this unusual and unexpected instability. SIGNIFICANCE STATEMENT: This study provides a detailed understanding of the disposition and metabolism of brepocitinib, a JAK1/TYK2 inhibitor for atopic dermatitis, in humans as well as characterization of clearance pathways and pharmacokinetics of brepocitinib and its metabolites.

Balance recovery for lower limb exoskeleton in standing posture based on orbit energy analysis.

Introduction: The need for effective balance control in lower limb rehabilitation exoskeletons is critical for ensuring stability and safety during rehabilitation training. Current research into specialized balance recovery strategies is limited, highlighting a gap in biomechanics-inspired control methods. Methods: We introduce a new metric called "Orbit Energy" (OE), which assesses the balance state of the human-exoskeleton system based on the dynamics of the overall center of mass. Our control framework utilizes OE to choose appropriate balance recovery strategies, including torque controls at the ankle and hip joints. Results: The efficacy of our control algorithm was confirmed through Matlab Simulink simulations, which analyzed the recovery of balance under various disturbance forces and conditions. Further validation came from physical experiments with human subjects wearing the exoskeleton, where a significant reduction in muscle activation was observed during balance maintenance under external disturbances. Discussion: Our findings underscore the potential of biomechanics-inspired metrics like OE in enhancing exoskeleton functionality for rehabilitation purposes. The introduction of such metrics could lead to more targeted and effective balance recovery strategies, ultimately improving the safety and stability of exoskeleton use in rehabilitation settings.