Balance Outcomes Research Articles

Mothers balancing work and family: the associations with emotional well-being, sleep–wake problems and the role of basic needs

BackgroundThe transition to motherhood involves significant changes, extending from pregnancy to the early years of a child's life. This period, characterized by multiple stressors and adjustments, can profoundly impact maternal well-being. For this reason, the aim of this study was to investigate the associations between work-family balance, need satisfaction, depression, anger, vitality and sleep–wake problems, using Self-determination Theory (SDT) as a theoretical framework.MethodsParticipated in this study 218 working mothers in Italy with children aged between 1 and 36 months. Using a correlational design, SEM with latent variables was used to test an integrative model.ResultsResults revealed significant positive associations between work-family balance and need satisfaction, and vitality, and negative direct associations of need satisfaction with sleep–wake problems, depression, and anger. Indirect associations were also visible between work-family balance and psychological outcomes through need satisfaction.Conclusions.Overall, findings underscore the importance of conditions that support the satisfaction autonomy, competence, and relatedness of working mothers during this critical life stage. These insights have implications for organizational policies and interventions aimed at supporting the mental health of working mothers.

Navigated versus conventionally instrumented total knee arthroplasty techniques: No difference in functional alignment or balance.

Much debate exists about the superiority of navigated versus conventional instrumentation for achieving optimal balance and alignment during total knee arthroplasty (TKA). Recent registry data indicate no long-term survivorship benefit for TKAs performed using technology assistance, despite the added resource and financial costs. However, outcome comparisons are confounded by varying surgeon techniques and targets for ideal balance and alignment. This study aimed to investigate alignment or balance outcome differences between navigated and conventionally instrumented TKAs performed using an identical operative sequence and alignment strategy. Fifty navigated and 50 conventionally instrumented primary TKAs, using an identical inverse kinematic alignment strategy, were included. Navigation equipment was used intraoperatively to 'post-cut' record the conventionally instrumented TKAs. Intraoperative balance, range, and alignment; and post-operative radiographic accuracy for restoration of constitutional alignment were compared. Forty-nine navigated and 49 conventionally instrumented TKAs were compared (n = 2 excluded due to inadequate radiographs). No preoperative demographic or deformity severity differences existed. No intraoperative balance, range or alignment difference existed. Neither technique was more accurate for restoration of constitutional alignment. Whilst large registry data may be confounded by uncaptured variables such as surgeon balancing techniques or surgeon alignment strategy preferences, this study found no alignment or balance differences between navigated versus conventionally instrumented TKA techniques for a surgeon and technique-controlled study. Although the increased resources necessary for technology assistance are not justified by this study, further studies may identify significance using larger samples or comparison of alternative outcomes. Level II.

Feasibility and preliminary evidence of the immediate effect on balance, functionality, and cognition in adults over 50 through postural sway-meter training.

An accelerometer-based device (postural sway-meter) is increasingly used for balance assessment, training, and fall prevention. However, limited information exists regarding its immediate effect on physical and cognitive performance, especially among middle-aged and older adults. This study aims to investigate the immediate effects of a balance training program using a postural sway-meter on balance, functional, and cognitive performance in adults over 50 years. This experimental study involved 72 participants aged 50 years and over, randomly assigned to either the intervention or control group. The intervention group underwent a 30-minute balance training session using the sway-meter with sound feedback (set at 75% of the stability limits at baseline). The control group participated in a 30-minute fall prevention knowledge session. The sway-meter measured balance during quiet stance and leaning. Functional performance was assessed using the multi-dimensional reach test (MDRT). Cognitive performance was evaluated through Trail Making Tests (TMT) A & B, as well as hand/foot reaction time assessments. Between-group comparisons at post-intervention showed no significant differences in balance, functional, and cognitive performance outcomes. Within-group analysis revealed a significant decrease in maximum reaching distance in the forward direction (MDRT) (p = 0.032, d = 0.31, 95% CI [-0.15, 0.78]) and the time to complete TMT-B (p = 0.036, d = 0.24, 95% CI [-0.22, 0.71]) in the intervention group. The control group showed a significant increase in COM angle sway excursion (lateral direction) (p = 0.011, d = 0.27, 95% CI [-0.19, 0.74]) and a decrease in TMT-A time (p = 0.031, d = 0.38, 95% CI [-0.09, 0.85]). Both groups significantly reduced hand reaction time (intervention: p = 0.036, d = 0.24, 95% CI [-0.22, 0.70]; control: p = 0.034, d = 0.20, 95% CI [-0.26, 0.66]) at post-intervention assessment. The findings of this study suggest that a single 30-minute balance training session using a postural sway-meter, delivered by a physiotherapist, is not only feasible and safe for community-dwelling older adults but also has the potential to significantly improve balance and cognitive outcomes. Enhancing the training program by increasing the amount of leaning and duration could further amplify these benefits, underscoring the need for a more robust training regimen.

The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials.

Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation.

Development of optimized artificial diets for enhanced growth of Zophobas atratus larvae

AbstractThis study evaluates the effects of various artificial diets on the development of Zophobas atratus larvae. Artificial diets containing various concentrations of agar were also investigated for their ability to reduce death rates during the early stages of larval development. Our results indicated that larvae fed artificial diets experienced a slightly longer developmental period but achieved significantly higher weights. Notably, wheat bran + fish meal 6% resulted in the highest weight gain; however, wheat bran + fish meal 6%, wheat bran + fish meal 5% + ginseng leaf 1%, and wheat bran + fish meal 4% + ginseng leaf 2% yielded higher death rates. The diet with 4% agar resulted in the shortest developmental period, whereas that with 3% agar produced the highest weight gain. However, considering death rates, the diet with 2% agar provided the most balanced outcome across developmental time, weight gain, and survival, making it the most suitable diet for Z. atratus larvae. In conclusion, wheat bran + fish meal + agar 2% artificial diet is more suitable for Z. atratus larval development than wheat bran, leading to greater weight gain, shorter development periods, and higher adult emergence rates. Additionally, this diet showed the potential to reduce the dust issues and labor demands associated with wheat bran usage. Our findings suggest that wheat bran + fish meal + agar 2% could be an effective artificial diet for the optimal development of Z. atratus larvae.

일-가족 균형, 일-여가 균형, 일-성장 균형이 직무열의에 미치는 영향 비교: 잡 크래프팅의 매개효과를 중심으로

The purpose of this study is to compare the impact of work-family balance, work-leisure balance, and work-growth balance on work engagement and to empirically demonstrate the mediating effect of job crafting in this process. Unlike previous studies that have assumed only positive outcomes of work-life balance, this study attempts a new perspective. Specifically, while previous research has either integrated the three sub-dimensions of work-life balance (family, leisure, growth) to examine their effects or focused on a specific life domain, this study differentiates itself by comparing the individual effects of these life sub-domains to see how their effects and mechanisms differ. To achieve this, an online survey was conducted targeting office workers, and out of the 184 responses collected, 161 were used for the final analysis after excluding insincere responses. The results indicated that, first, work-family balance showed a negative relationship with both job crafting and work engagement, with job crafting mediating the relationship between work-family balance and work engagement. Second, work-leisure balance was found to be statistically insignificant in all cases. Third, work-growth balance showed a positive relationship with both job crafting and work engagement, with job crafting mediating the relationship between work-growth balance and work engagement. The interpretation of these findings is as follows: reducing work-family balance, which shows a negative relationship with work-centric variables, is not the implication. Rather, this study is closer to a counterargument questioning whether the Western-centric perspective on balance is appropriate in the domestic context, whether a quantitative focus on balance can truly measure real balance, and whether work-family balance and its outcomes can be assumed solely as a matter of individual choice. The goal is to suggest the need for ongoing discourse on work-life balance that changes with time and place within organizational contexts.

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.

The Added Effect of Respiratory Training on Stabilometric, Respiratory and Agility Outcomes Among Recreational Athletes: an Experimental Design

Background Diaphragm activation plays a crucial role in various function activities through the adequate core muscle setup. In order to bring a change in balance, agility, and respiratory outcomes in recreational athletes, the role of combined diaphragm and balance training is still under debate. Purpose The study aimed to investigate the added effect of respiratory training on balance training in recreational athletes. Methods Forty-two male recreational athletes were randomized into either the balance training group alone or the added respiratory training group. Result The result of the study revealed that the agility, balance, and respiratory outcomes were improved significantly (p &lt; 0.05) in the combined respiratory and balance training group. However, in the balance training group seperately, the respiratory and agility outcomes did not improve significantly (p &gt; 0.05), but the balance outcomes improved significantly (p &lt; 0.05). Conclusion The study concludes that additional respiratory training can help enhance respiratory and agility outcomes compared to balance training alone.

Comparing the effectiveness of five traditional Chinese exercises in improving balance function in older adults: a systematic review and Bayesian network meta-analysis.

Despite numerous studies affirming the potential of traditional Chinese exercises (TCEs) in enhancing balance in older adults, systematic integration is lacking. This study evaluated the effectiveness of five TCEs-Baduanjin, Liuzijue, Tai Chi, Wuqinxi, and Yijinjing-in improving balance among older adults using network meta-analysis. This meta-analysis was registered in PROSPERO with the registration number CRD42023481450. Related articles indexed by Web of Science, Cochrane, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases before October 2023 were searched. Randomized controlled trials (RCTs) involving TCEs interventions to improve balance function conducted in older adults who aged ≥60 years were included. Two researchers used Review Manager to assess the quality of the studies, and analyzed the data using Stata and R. In total, 46 RCTs and 3,333 older adults were included. The aforementioned TCEs had positive effects on improving balance in older adults. Tai Chi revealed significant intervention effects in performing the Single-Leg Stand with eyes Closed (SLSC), 6-Min Walk Test (6MWT), and Short Form 36-Item Physical Component Summary (SF-36PCS). Liuzijue significantly improved performance in the Timed Up and Go Test (TUGT), 6MWT, SF-36PCS, and Berg Balance Scale (BBS). Baduanjin, Wuqinxi, and Yijinjing showed noteworthy intervention effects on the BBS. Tai Chi ranked highest in the SLSC, 6MWT, and SF-36PCS in the surface under the cumulative ranking, while Liuzijue and Yijinjing ranked highest in the TUGT and BBS, respectively. Tai Chi, Liuzijue, and Yijinjing improved the static, dynamic, and overall balance outcomes, respectively. Older adults can make a reasonable choice among these TCEs based on their needs.

Effectiveness and Feasibility of Blood Flow Restriction Training for People with Multiple Sclerosis: A Systematic Review.

Multiple sclerosis (MS) is an immune-mediated inflammatory disease that primarily targets the myelin of axons. Extremities are frequently affected, resulting in a negative impact on both activities of daily living (ADL) and quality of life. In recent years, there has been increasing interest in the potential benefits of exercise and blood flow restriction training (BFRT) programs as a therapeutic tool in people with neurological disorders. The aim of the present systematic review was to know the clinical effects of BFRT programs in people with MS. A systematically comprehensive literature search was conducted and registered in PROSPERO prior to its execution under the reference number CRD42024588963. The following data sources were used: Pubmed, Scopus, Web of Science (WOS) and the Cochrane Library. The following data were extracted from the papers: study design, sample, interventions, dosage, outcome measures and results. To assess the methodological quality of the papers included, the Quality Index of Downs and Black was used. Additionally, the articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. Also, the Cochrane Handbook for Systematic Reviews of Interventions was used by two independent reviewers to assess risk of bias, assessing the six different domains. Seven articles with a total of 71 participants were included in the review. Of the seven articles, five papers studied the effectiveness of BFRT combined with strengthening exercises and two papers studied the effect of BFRT combined with aerobic exercise. Of the five articles that analyzed BFRT combined with strengthening exercises, only two presented a control group. Both performed a low-load resistance training in combination with BFRT with four series, 30/15/15/15 repetitions and a rest of 1 min between the series and 3 min between the exercises. The control groups to which they were compared performed a high intensity strengthening exercise protocol which had the same exercises, sets, rests and duration of the protocol as the experimental groups. For those two papers which investigated the effects of BFRT combined with aerobic training, exercise was performed in two sessions per week for a period of 8 and 6 weeks, respectively. In both studies, the experimental protocol began with a warm-up phase and ended with a cool-down phase, and there were differences in cuff management. All these investigations found positive effects in the interventions that combined exercise with BFRT. The characteristics, outcome measures, effects of the interventions and the assessment of the methodological quality of the included studies and risk of bias are shown in the tables. BFRT in people with MS appears to be effective and safe for people with MS. BFRT might show positive clinical effects on strength, hypertrophy and balance outcomes. Nevertheless, future research should be conducted with better methodological quality to ensure the potential benefits of BFRT in people with MS since the studies analyzed present a high risk of bias and methodological limitations.

An improved transfer learning method for rotor unbalance position identification from simulated data to experimental data

In the study of dynamic balancing for flexible rotors operating at high speeds, determining the unbalanced position of the rotor has consistently posed significant challenges. Accurate identification of the unbalanced position enables low-speed dynamic balancing to serve as a viable alternative to high-speed methods, ultimately reducing costs and enhancing operational efficiency. Although deep learning techniques utilizing limited labeled data have shown promising results in identifying unbalanced positions, the challenge of gathering a sufficient amount of labeled data for effectively training diagnostic models remains substantial. To address this issue, we propose a Pre-Adaptive Transfer Learning (PATL) approach that employs sample reconstruction through frequency domain correlation analysis. This technique facilitates cross-domain deep transfer recognition of rotor unbalanced positions by transferring insights from simulated dynamic model data to experimental datasets. Compared to existing methodologies, the proposed approach demonstrates significant improvements in both the accuracy and generalization of unbalanced position identification. The novelty of this research lies in the introduction of pre-adaptive transfer learning, which effectively minimizes the disparity between experimental and simulation data, thereby enhancing the model's recognition capabilities. Experimental results indicate that the proposed method achieves effective balancing outcomes across various operating conditions.

Comparison of static and dynamic balance performances of sports science students by gender

Background and Study Aim. Static and dynamic balance performance are fundamental skills that can exhibit significant differences between genders and are critically important in motor skills and sports science. The aim of this study was to compare the static and dynamic balance performance of sports science students by gender. Material and Methods. Ten male students (age: 22.70 ± 1.33 years) and ten female students (age: 23.00 ± 1.05 years) studying in the sports science faculty voluntarily participated in the study. The Biodex Balance System (BBS, Biodex Medical Systems Inc., Shirley, NY) was utilized to assess balance performance. Independent samples t-test and paired t-test were conducted for analysis using SPSS. Results. In intergroup comparisons, static and dynamic balance performances were similar between genders, with a significant difference found only in the S-APSI parameter (p = 0.021). Among male participants, a significant difference was observed in the S-MLSI parameter (p = 0.015), while no significant differences were found in the other parameters. For female participants, dynamic balance performance significantly outperformed static performance (OSI p = 0.018, APSI p = 0.035, MLSI p = 0.046). Apart from anterior-posterior balance outcomes, no significant differences were observed between males and females in the other parameters. It was also evident that female participants exhibited significantly superior dynamic balance performance compared to static performance. Conclusions. Understanding gender differences in balance performance is crucial for creating effective training programs in sports education. By recognizing these differences, trainers can develop strategies that better meet the specific needs of male and female athletes. This approach can help enhance overall athletic performance.

Functional Assessment of Anterior Cruciate Ligament Reconstruction Using Peroneus Longus vs. Hamstring Tendon at 6, 12, And 24 Months Follow Up: A Meta-Analysis

Background: Anterior cruciate ligament (ACL) tear occurs between 29 to 38 cases per 100.000 people annually with more than half of cases requiring an ACL reconstruction. Peroneus longus tendon (PLT) has growing popularity as an autograft for ACL reconstruction providing comparable outcomes with proper graft diameter size, lack of donor site morbidity and uncomplicated harvesting technique. Unfortunately, certain studies did not agree with the superiority of PLT to the standard hamstring tendon (HT). Objective: The aim of study is to compare the knee functional outcome of an ACL reconstruction using peroneus longus and hamstring tendon according to recent publications. Methods: This study conducted a thorough systematic search for relevant scientific reports on multiple medical databases, including PubMed, Embase, and Google Scholar, using a combination of keywords such as "peroneus longus," “hamstring tendon,” "ACL reconstruction," “IKDC,” and “Lysholm”. The search was performed in April 2013-2023, resulting in 1567 studies. Two reviewers (RR, WA) independently screened the abstracts and reference lists, with any discrepancies resolved through consensus, concluding 5 included studies. Results: Five studies are included with a total of 538 patients consisting of 267 patients who underwent ACL reconstruction with PLT and 271 patients who underwent ACL reconstruction with HT. Up to 24 months follow-up, there are equally balanced satisfactory functional outcomes between ACL reconstruction using peroneus longus and hamstring tendon, in terms of IKDC (I2 = 74%; SMD = 0.08 95%CI, -0.21 to 0.38; p = 0.57) and Lysholm score (I2 = 75%; SMD = 0.06 95%CI, -0.27 to 0.39; p = 0.73). Conclusion: ACL reconstruction using the peroneus longus tendon is a safe and effective procedure with excellent short to long term functional outcome of the knee. Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon.

Balance and Walking Speed Outcomes in Individuals Receiving Inpatient Rehabilitation for Acute Cerebellar Stroke.

Cerebellar strokes account for only 2-3% of all strokes occurring annually in the United States but represent a disproportionally higher share of morbidity and mortality. Evidence examining the effect of inpatient rehabilitation on functional outcomes following a cerebellar stroke is limited. This study aimed to examine the effects of inpatient rehabilitation on balance and walking speed in individuals with cerebellar stroke. A secondary purpose of this study was to examine the length of inpatient rehabilitation stay of the included patients. A retrospective analysis was conducted using review of patient records during their inpatient rehabilitation stay from January 2021 to February 2022 at a large hospital system in the southeast United States. Balance and gait outcomes were examined on admission and discharge from inpatient rehabilitation that included physical therapy interventions. A paired t-test examined for changes in outcomes from admission to discharge. Pearson correlation examined for the association between length of stay and outcomes. A total of 15 records were reviewed. There were significant improvements in the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), and the 10-Meter Walk Test (10MWT) (p's < 0.01) from admission to discharge with large effect sizes (range d = 0.70-1.67) following inpatient rehabilitation. The average length of stay was 12.67 days (SD = 6.5) and the mean total hours of combined occupational, physical, and speech therapy was 27.33 (SD = 6.52) h. There was a moderate association between length of stay and PASS (r = 0.525, p = 0.04) and BBS (r = 0.546, p = 0.04) outcomes. Patients who underwent inpatient rehabilitation following acute cerebellar strokes demonstrated improvements in balance and gait speed. Study results could assist clinicians designing interventions for patients with cerebellar strokes in the inpatient rehabilitation setting.

Managing Personalization and Collaboration in Education: A Systematic Review of Educational Practices

This systematic literature review analyzes 20 carefully selected documents from the Scopus database. This study explores ways that align with Islamic educational management's principles to balance personalized learning outcomes and community empowerment in academic settings. The selection of documents is based on relevance to the focus and recent developments in Islamic education. The qualitative analysis method uses thematic coding and VOS Viewer. The analysis results indicate that Islamic approaches like collaboration, reflection, and feedback can achieve balanced learning outcomes. Collaborative filtering helps select learning materials according to student's needs, while reflection and feedback strengthen positive interactions and ukhuwah within the learning community. In addition, computer-based learning and e-learning allow students to learn at their own pace. A flexible curriculum allows for adjustments to students' interests by the principle of taysir (making it easy). These findings recommend that educational institutions integrate a multifaceted approach to create an inclusive, adaptive, and Islamic-oriented learning environment.

An Efficient Approach for Detection of Compromised SDN Switches and Restoration of Network Flow

In Software Defined Networking (SDN) the data plane is separated from the controller plane to achieve better functionality than the traditional networking. Although this approach poses a lot of security vulnerabilities due to its centralized approach. One significant issue is compromised SDN switches because the switches are dumb in SDN architecture and in absence of any intelligence it can be a easy target to the attackers. If one or more switches are attacked and compromised by the attackers, then the whole network might be down or defunct. Therefore, in this work we have devised a strategy to successfully detect the compromised SDN switches, isolate them and then reconstruct the whole network flow again by bypassing the compromised switches. In our proposed approach of detection, we have used two controllers, one as primary and another as secondary which is used to run and validate our algorithm in the detection process. Flow reconstruction is the next job of the secondary controller which after execution is conveyed to the primary controller. A two-controller strategy has been used to balance the additional load of detection and reconstruction activity from the master controller and thus achieved a balanced outcome in terms of running time and CPU utilization. All the propositions are validated by experimental analysis of the results and compared with existing state of the art to satisfy our claim.

Balancing the prescription of virtual reality balance training for Parkinson disease: a critically appraised topic

Clinical Scenario Individuals with Parkinson Disease (PD) often present with impaired balance, resulting in increased fall risk. Evidence suggests that balance can be improved with physical therapy balance training interventions applied through video game play, or ‘exergaming’. However, best practices regarding the prescription of exergaming for persons with PD are unknown. The goal of this appraisal was to identify the Nintendo Wii exergame (NWE) parameters that have been shown to improve dynamic balance in individuals with PD, specifically Hoehn and Yahr (HY) stages 1-3, and make recommendations for the prescription of NWE balance interventions for this population. Methods The literature was searched to identify randomized controlled trials (RCT) that utilized NWE as a balance intervention for individuals with PD within HY stages 1-3. The search was limited to articles published within the last 10 years that assessed dynamic balance outcomes via the Dynamic Gait Index (DGI) or Functional Gait Assessment (FGA). Participants had no other known comorbidities that would impact dynamic balance and were on a stable dopaminergic prescription. 3 RCTs were identified and included in this appraisal. Conclusion and Implications for Practice NWE may improve dynamic balance in individuals with PD, HY stages 1-3. Recommended parameters include a variety of NWE modes, performed for 45-50 min per session, at a frequency of 2-3 times a week for 6-8 weeks. Clinicians should utilize a skilled approach when prescribing NWE including ongoing assessment to determine progress and to maintain safety. Future research is needed to determine the necessary intensity of NWE to improve dynamic balance in individuals with PD.

Craniectomy and Cranioplasty Effects on Balance and Gait in Rehabilitation: A Retrospective Study

ObjectiveTo analyze changes in balance and gait in patients undergoing rehabilitation postcraniectomy and postcranioplasty, including comparison of outcomes across time periods, rate of change, and among diagnoses. DesignRetrospective cohort study. SettingInpatient rehabilitation. ParticipantsFifty-three patients (mean age 52.3±16.9y; 62% male) with stroke, traumatic, or nontraumatic brain injury postcraniectomy or postcranioplasty. InterventionsNot applicable. Main Outcome MeasuresBerg Balance Scale (BBS), Functional Gait Assessment (FGA), 6-minute walk test (6MWT), and 10-meter walk test (10MWT) were collected at baseline, first discharge, readmission, and final discharge. ResultsAcross the full rehabilitation course, all 4 outcomes improved: BBS, 17.9 points (95% confidence interval [CI], 12.7-23.2); FGA, 7.8 points (95% CI, 0.6-15.0); 6MWT, 141.0 m (95% CI, 89.0-192.0); and 10MWT, 0.381 m/s (95% CI, 0.188-0.575). All outcomes improved at postcraniectomy admission: BBS, 13.0 points (95% CI, 8.4-17.5); FGA, 4.0 points (95% CI. −1.65 to 9.65); 6MWT, 100.0 m (95% CI, 58.2-142.0); and 10MW, 0.160 m/s (95% CI, 0.004-0.316). During leave of absence from rehabilitation, BBS decreased 6.3 points (95% CI, −11.8 to −0.8); FGA decreased 6.6 points (95% CI, −13.8 to 0.6); 6MWT decreased 19.2 m (95% CI, −73.5 to 35.2); and 10MWT increased 0.089 m/s (95% CI, −0.097 to 0.276). All outcomes improved at postcranioplasty admission: BBS, 11.3 points (95% CI, 6.6-16.0); FGA, 10.4 points (95% CI, 4.8-16.1); 6MWT, 59.4 m (95% CI, 14.1-105.0); and 10MWT, 0.132 m/s (95% CI, −0.039 to 0.303). Diagnosis was not associated with changes in outcomes. ConclusionsGait and balance outcomes improved during postcraniectomy and postcranioplasty rehabilitation admissions but not immediately post cranioplasty.

Reducing Unnecessary Transfusions of RBCs in Inpatients Admitted Across Niagara Health Community Hospitals.

Blood products are scarce resources. Audits on the use of red blood cells (RBCs) in tertiary centers have repeatedly highlighted inappropriate use. Earlier retrospective audit at our local community hospitals has demonstrated that only 85% and 54% of all requests met Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (Hb) of 80 g/L or less and single unit, respectively.We sought to improve RBC utilization by 15% over a period of 12 months (meeting Choosing Wisely Canada criteria of pre-transfusion Hb ≤80g/L by >80% and single-unit transfusion by >65%). Following repeated PDSA (Plan-Do-Study-Act) cycles, we implemented educational strategies, prospective transfusion medicine (TM) technologist-led screening of orders, and an RBC order set. The 3-month median percentages of appropriate RBC use for pre-transfusion Hb and single unit (September-November 2021) across all 3 hospitals were 90% and 71%, respectively. Overall, the rate of appropriate RBCs based on pre-transfusion Hb remained above target (>80%), with minimal improvement across all hospitals (median percentage at pre- and post-technologist screening periods of 87% and 90%, respectively). The median percentage of appropriate RBCs based on single-unit transfusion orders has improved across all Niagara Health hospitals with sustained targets (3-month median percentage at pre- and post-technologist screening and most recent time periods of 54%, 56%, and 71%, respectively). We have taken a collaborative, multifaceted approach to optimizing utilization of RBCs across the Niagara Health hospitals. The rates of appropriate RBC use were comparable with the provincial and national accreditation benchmark standards. In particular, the TM technologist-led screening was effective in producing sustained improvement with respect to single-unit transfusion. One of the balancing outcomes was increasing workload on technologists. Local and provincial efforts are needed to facilitate recruitment and retention of laboratory technologists, especially in community hospitals.

Characterizing the Longitudinal Impact of Backward Locomotor Treadmill Training on Walking and Balance Outcomes in Chronic Stroke Survivors: A Randomized Single Center Clinical Trial.

Walking and balance impairments after stroke are a global health concern, causing significant morbidity and mortality. However, effective strategies for achieving meaningful recovery in the chronic stages are limited. Backward locomotor treadmill training (BLTT) is a novel walking rehabilitation protocol that is safe, feasible, and likely beneficial in stroke survivors; however, its efficacy has not been tested. This single-center, randomized, assessor-blind clinical trial aims to test the preliminary efficacy of BLTT compared to forward locomotor treadmill training (FLTT) on walking speed, symmetry, and postural stability. Forty stroke survivors [BLTT (N=19), FLTT (N=21); mean age= 56.3 ± 8.6 years; 53% Female; 30% Non-Hispanic Black] with mild-moderate walking impairment were enrolled. Participants underwent nine 30-minute BLTT or FLTT sessions over three weeks. The primary outcome was the mean change in the 10-meter walk test (10 MWT) at 24 hours post-training (24 hr POST). Secondary outcome measures were changes in spatiotemporal walking symmetry and postural stability during quiet standing at 24 hr POST. Retention was explored at Days 30- and 90 POST. We report clinically meaningful (≥ 0.16 m/s) improvements in overground walking speed at 24 hr POST, with retention up to Day 90 POST with BLTT and FLTT. However, contrary to our working hypothesis, no between-group differences in walking speed were observed. Nonetheless, we found that BLTT resulted in offline improvements in spatial symmetry and retention of subcomponents of the modified clinical test of sensory interaction on balance (mCTSIB), including the testing of proprio-vestibular integration up to Day 30 POST. Among chronic stroke patients with mild-moderate walking impairment, BLTT and FLTT both resulted in long-lasting and clinically meaningful improvement in walking speed. However, preliminary findings suggest that BLTT may better comprehensively target walking asymmetry and sensory systems processing and integration.