Balance Difficulties Research Articles

A man in his eighties with gait problems and elevated CRP.

Rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitals is essential for early isolation and treatment. However, false positive test results can have adverse consequences for patient safety. A man in his eighties was admitted to hospital with fatigue and new-onset gait and balance difficulties, without fever or symptoms of focal infection, but with elevated C-reactive protein. On admission, he tested positive on screening for SARS-CoV-2 using a fully automated rapid reverse transcription polymerase chain reaction (RT-PCR) test. He was placed together with two patients with confirmed COVID-19 infection in cohort isolation. Due to very low exposure risk and nonspecific symptoms, the primary and multiple subsequent test swabs were analysed using RT-PCR analyses guided by laboratory personnel, and all gave negative results. The patient had several risk factors for developing severe COVID-19 illness, but fortunately he remained COVID-19 negative on repeated tests. The case presentation highlights the danger of false-positive SARS-CoV-2 test results, and the importance of interpreting a diagnostic test in the context of pretest probability and test accuracy. It also underlines the risk of using cohort isolation instead of individual isolation.

Review of distributed energy storage aggregation technology under multi-energy interconnection

At present, with the rapid growth of intermittent renewable energy, volatile power supply is replacing controllable power supply, and the difficulty of real-time balance between supply and demand is increasing year by year. In the future, the continuous development and utilization of this new energy will make the development and innovation of distributed energy storage technology become the general trend. Firstly, this paper briefly introduces the principle of distributed energy storage and the basic principle of multi energy coordinated operation, and analyzes its advantages and disadvantages from the perspective of economic optimization and energy utilization maximization. Secondly, it analyzes the application status and shortcomings at home and abroad, and puts forward the direction and expectation of possible breakthrough. Aiming at the problem that distributed energy storage can not participate in peak load regulation, the feasibility of multi energy interconnection distributed energy storage aggregation technology is discussed.

Short term functional training improves completion quality of body difficulty of juvenile rhythmic gymnasts

ABSTRACT To explore the impact of functional training on completion quality of body difficulty, 24 rhythmic gymnasts aged 10-11 years old were randomly and averagely divided into functional training and control group and trained 2h/day for 1 month. Body difficulty – including balance, rotation, and leap difficulties – was measured before and after training. The results showed that the total score, the score of 360° passé pivot and the score of split leap for the functional training group was respectively 1.87, 0.77, and 0.42 points higher than those for the control group (P<0.05) after 1 month of training. Therefore, it can be concluded that functional training based on Functional Movement Screen (FMS) can clearly improve completion quality of body difficulty in juvenile rhythmic gymnastics within a short period of time.

Comparing Objective and Subjective Measures of Sleep Loss with Balance Performance in Farmers.

HIGHLIGHTS The farming population is at risk of injury due to sleep deprivation. Loss of sleep during previous night affects balance performance in farmers. Objective measures of sleep are more reliable than subjective measures for predicting balance performance. ABSTRACT. This study aimed to investigate the ability of both subjective and objective sleep measures to predict balance difficulty in agricultural workers. Seven male farmers from rural Nebraska were analyzed for static balance performance following a bout of sleep. Actiwatches were used to measure objective sleep hours and subjective questionnaires, including the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, were used to measure subjective hours of sleep and sleep quality. The participants were observed for 12 sessions, with six in planting season and six in harvest season. Static balance testing consisted of measuring the area, total displacement, and maximum range in the anteroposterior and mediolateral directions of the individual's center of pressure with Tekscan pressure mats. Overall, it was found that objective measures had a higher correlation with the magnitude of balance deviations than subjective measures.

Prolonged nightly fasting and lower-extremity functioning in community-dwelling older adults.

It is unknown if time-restricted feeding confers a protective effect on the physical function of older adults. The aim of this study was to assess prolonged nightly fasting in association with performance-based lower-extremity function (LEF) in a large population of community-dwelling older adults. A cross-sectional study was carried out among 1226 individuals ≥64 years from the Seniors-ENRICA-II (Study on Nutrition and Cardiovascular Risk in Spain) cohort. Habitual diet was assessed through a validated diet history. Fasting time was classified into the following categories: ≤9, 10-11 and ≥12 h/d (prolonged nightly fasting). Performance-based LEF was assessed with the Short Physical Performance Battery (SPPB). After adjusting for potential confounders, a longer fasting period was associated with a higher likelihood of impaired LEF (OR for the second and third categories v. ≤ 9 h/d fasting: 2·27 (95 % CI 1·56, 3·33) and 2·70 (95 % CI 1·80, 4·04), respectively; Ptrend < 0·001). Fasting time showed a significant association with the SPPB subtests balance impairment (OR for highest v. shortest fasting time: 2.48; 95 % CI 1·51, 4·08; Ptrend = 0·001) and difficulty to rise from a chair (OR 1·47; 95 % CI 1·05, 2·06; Ptrend = 0·01). The risk associated with ≥12 h fasting among those with the lowest levels of physical activity was three times higher than among those with ≤9 h fasting with the same low level of physical activity. Prolonged nightly fasting was associated with a higher likelihood of impaired LEF, balance impairment, and difficulty to rise from a chair in older adults, especially among those with low levels of physical activity.

Mobility Measures in Older Cancer Survivors: An Examination of Reliability, Validity, and Minimal Detectable Change

Background: Cancer and its treatment contribute to multiple sequelae affecting physical function, including difficulty in balance and walking. Although clinical tests should be used to assess fall risks in older cancer survivors, the literature describing the validity, reliability, measurement error, and minimal detectable change (MDC) of mobility measures is lacking. Objective: The purpose of this study was to describe the reliability, validity, standard error of the measurement (SEM), and minimal detectable change at 95% confidence (MDC95) of mobility measures in older cancer survivors. Methods: Fifty cancer survivors (breast, prostate, lung, or colorectal) aged 65+ years participated. Measures of gait speed (GS) (usual, fast, and dual-task) and mobility (Timed Up and Go [TUG], TUG-cognitive, and TUG-manual) were performed once and then repeated 2 weeks later. Test-retest reliability was assessed using intraclass correlation coefficient (ICC2,1). MDC95 and SEM were calculated. Construct validity was examined using Pearson's correlation coefficient with 6-item Activities-specific Balance Confidence scale and Short Physical Performance Battery performance. Results: Test-retest reliability was excellent for all mobility measures, with ICC values ranging from 0.89 to 0.94 for GS and 0.95 to 0.98 for TUG measures. Construct validity was present for TUG (r = −0.53 to −0.73) and GS (r = 0.29 to 0.5) measures. Low SEM values demonstrated excellent reproducibility. To be considered real change, usual GS should be 0.14 m/s or more and TUG 2.49 seconds or more. Conclusions: Measures of GS and TUG have excellent reliability and construct validity and should be considered for use in older cancer survivors. Further study is indicated to establish the psychometric values of mobility measures by cancer type.

Families in the Pandemic Between Challenges and Opportunities: An Empirical Study of Parents with Preschool and School-Age Children

The study explored the effects of social isolation from lockdown on Italian families in terms of work-family balance, family functioning and parenting. 104 parents (80.8% mothers) with at least one child aged from 2 to 14 years participated in the study. An ad-hoc scale explored work-family balance; Family Environment Scale and Perceived collective family efficacy scale examined respectively parents’ perceived quality of family relationships and beliefs in family’s efficacy; one single question and an ad-hoc scale measured respectively parenting stress and positive parenting. Our findings evidenced an increase of parenting stress due to the social isolation and the persistency of gender inequalities in not-paid work division causing a penalty for mothers. Nevertheless, during the lockdown, families rediscovered the values of being together inside the house, improving both their cohesion and expressiveness and their positive parenting. Overall, the study shows that Italian families have been resilient and not overwhelmed by family stress, being able to adjust to cope with lifestyle changes. However, the social changes caused by the emergency requires to plan adequate policies to support especially dual-earner families with younger children in these times, both to reduce parenting stress and to avoid that work-family balance difficulties and gender gap will be exacerbated, increasing the risk to relegating women to the domestic sphere during the next phases of this pandemic.

The problems faced by Saudi students on scholarship who are studying in American universities: المشكلات التي تواجه الطلبة السعوديين المبتعثين للدراسة في الجامعات الأمريكية

The study aimed at identifying the problems faced by Saudi students on scholarship who are studying in American universities. A descriptive method was used and an electronic questionnaire was selected to collect data. The sample size of this study was 226 students. The results revealed that academic problems ranked first where half of the sample agreed that the length of the administrative procedures for the students' transactions in the mission caused them academic problems, followed by the low skills of some students in the English language which represent a hindrance to passing the language test to join the American universities. The other complication was the provided list of distinguished universities, which caused the students to face difficulties to obtain university admission. The economic problems ranked second. The main concern included; "I was forced to deprive myself of the things I love because of my limited income", followed by the difficulty of balancing between the necessary needs and the amount of the monthly allowance, followed by their monthly expenses which exceeded the amount of allowance they receive. Social problems ranked third, the most important of which was the difficulty of studying during the month of Ramadan away from the family, followed by difficulties of social interaction with the local population, and the feeling of alienation in the country of scholarship. The results showed that there were statistically significant differences among the sample according to the age variable, and their monthly income in the social problems they face. The result also indicated that the source of the monthly income showed a difference statistically in their economic problems. The study major variable also showed statistically significant differences in academic problems.

“Following the Science”: In Search of Evidence-Based Policy for Indoor Air Pollution from Radon in Ireland

Radon, a naturally occurring radioactive gas that can accumulate inside dwellings, represents the second biggest cause of lung cancer globally. In Ireland, radon is linked to approximately 300 lung cancer cases every year, equating to 12% of all lung cancer deaths. Despite the health risks posed by radon air pollution, Ireland lacks well-defined and universally applicable air pollution-related public health policies. Through purposive literature sampling, we critically examine the case of indoor radon policy development in Ireland. Specifically, we analyse the evidence-based policymaking process relating to indoor radon pollution from three different knowledge dimensions, namely political, scientific, and practical knowledge. In doing so, we identify various challenges inherent to pollution-related public policymaking. We highlight the difficulties of balancing and integrating information from multiple disciplines and perspectives and argue that input from multiple scientific areas is crucial, but can only be achieved through continued, dialogic communication between stakeholders. On the basis of our analysis, we suggest that a transdisciplinary perspective, defined as a holistic approach which subordinates disciplines and looks at the dynamics of whole systems, will allow evidence-based policymaking to be effective. We end with recommendations for evidence-based policymaking when it comes to public health hazards such as radon, which are applicable to sustainable air pollution management beyond Ireland.

Analysis of the motor performance of children with ASD and its relationship with personal and contextual variables

Background A high number of individuals with Autism Spectrum Disorder (ASD) present motor deficits. The objectives of this study were (1) to evaluate the motor performance of children with ASD and (2) to analyze the influence that sociodemographic variables and difficulties related to learning have in the development of motor deficits. Method Participants were 23 boys and 5 girls with ASD between 4-14 years old. Impairments in motor development were evaluated using the Movement assessment battery for children-2 (MABC-2). Parents provided information on the personal and contextual variables of the participants through a sociodemographic questionnaire and they reported the motor skills of their children through the Checklist of the MABC-2. Results The results suggest that most children with ASD present difficulties in balance and in fine and gross motor skills. Likewise, the analysis of the χ2 tests suggested that curricular adaptations, the presence of siblings and traits such as impulsivity, hyperactivity and speech difficulties are factors related to their motor development. Conclusions The findings highlight the need to address these difficulties from an early age to stimulate and encourage their development.

Characterization of Gait and Postural Regulation in Late-Onset Pompe Disease

Pompe disease is a multisystemic disorder with the hallmark of progressive skeletal muscle weakness that often results in difficulties in walking and balance. However, detailed characterization of gait and postural regulation with this disease is lacking. The objective of this investigation was to determine if differences exist between the gait and postural regulation of LOPD patients and a matched control group. The gaits of 16 patients with LOPD were assessed using a gait analysis mobile system (RehaGait) and a dynamometric treadmill (FDM-T 1.8). The Interactive Balance System (IBS) was used to evaluate postural regulation and stability. All measures were compared to individual reference data. Demographic (age, gender), morphological (body height, body mass) and clinical data (muscle strength according to the Medical Research Council Scale (MRC Scale), as well as the 6-min walking test and a 10-m fast walk) were also recorded. Compared to individual reference data, LOPD patients presented with reduced gait velocity, cadence and time in single stand. A total of 87% of LOPD patients had abnormalities during posturographic analysis presenting with differences in postural subsystems. This study provides objective data demonstrating impaired gait and posture in LOPD patients. For follow-up analysis and as outcome measurements during medical or physiotherapeutic interventions, the findings of this investigation may be useful.

A case of unusual cerebellar ataxia

Case: Pt is a 76 year old male with a four year history of progressive gait imbalance and dysarthria. Symptoms started at age 72. He had fallen multiple times since onset of symptoms with one of his falls resulting in radial fracture. He also endorsed incoordination of upper extremities, frequently dropping objects, difficulty picking up small objects, and frequent spilling when eating and drinking. At initial presentation he was wheelchair bound due to balance difficulties.

Lassa Fever Induced Hearing Loss: The Neglected Disability of Hemorrhagic Fever

ObjectiveLassa fever (LF) a hemorrhagic fever endemic to Western has an incidence of approximately 500,000 cases per year. Here, we evaluate hearing loss and other sequelae following LF. MethodsThis case-control study enrolled laboratory confirmed LF survivors, non-LF Febrile controls and Matched Community controls with no history of LF or recent hospitalization for a febrile illness.Study participants completed a symptom questionnaire. Pure-tone audiometry was completed by a subset of participants. ResultsOne hundred forty-seven subjects were enrolled aged from 3-66 years (mean = 23.3). LF survivors were significantly more likely to report balance difficulties (55% vs 20%, p < 0.001), hair loss (32% vs 7%, p < 0.001), difficulty speaking (19% vs 1%, p < 0.001), social isolation (50% vs 0%, p < 0.001), and hearing loss (17% vs 1%, p = 0.002) in comparison to Matched-Community Controls. Similar trends were noted in comparison to Febrile Controls, although these findings were non-significant. Fifty subjects completed audiometry. Audiometry found that LF survivors had significantly more bilateral hearing loss in comparison to Matched-Community Controls (30% vs 4%, p = 0.029). ConclusionThis study characterizes the sequelae of LF and highlights the need for increased access to hearing care in West Africa.

Immune checkpoint inhibitor induced autoimmune encephalitis in a patient with metastatic melanoma

Background: Immune checkpoint inhibitors have changed the therapeutic milieu for patients with metastatic melanoma. However, their use may promote autoimmunity in virtually any organ in the body due to the blockade of intrinsic immune down regulators such as cytotoxic T-lymphocyte antigen- 4 (CTLA-4), programmed cell death 1 (PD1) or its ligand (PDL1). Immune mediated adverse neurological events are rare with these agents, however, and are seen in &lt; 1% of treated patients. We report a patient with immune checkpoint inhibitor associated autoimmune encephalitis, with complete clinical recovery after treatment.Case Report: A 49-year-old female with metastatic melanoma currently on nivolumab therapy but recently on ipilimumab/nivolumab combined therapy presented with a new headache. She also reported associated confusion, loss of balance, personality changes and language difficulty. Magnetic resonance imaging of the brain did not reveal any evidence of metastasis, infarct, meningitis, or encephalitis. Lumbar puncture revealed an elevated protein level and pleocytosis, with a normal glucose level. She was started on empiric glucocorticoid therapy with a presumptive diagnosis of immune checkpoint inhibitor associated autoimmune encephalitis. She improved considerably by day 3 of treatment with complete resolution of neurological symptoms by day 5.Conclusion: Immune checkpoint inhibitors are increasingly important in cancer immunotherapy as they can cause sustained remissions in patients with metastatic melanoma and other malignancies. Because these drugs block immune-regulatory targets, they can lead to enhanced activation of immune system resulting in immune-related adverse events. Autoimmune encephalitis is a rare immune-related adverse event associated with immune checkpoint inhibitors. The incidence of autoimmune encephalitis is higher with combination or sequential CTLA-4 (ipilimumab) and PD1(nivolumab) inhibitor therapy than with monotherapy. With more widespread use of immunotherapy, it is important for clinicians to be aware of this rare and reversible cause of encephalitis. Early recognition and prompt initiation of immunosuppressive therapy with glucocorticoids is essential to enhance neurological recovery.

Stroke survivors’ priorities for research related to life after stroke

ABSTRACT Background Stroke has transitioned from an untreatable, unpreventable disease to a highly treatable and preventable disease over recent decades, and the number of stroke survivors is expected to increase. The number is also foreseen to grow larger as a result of an aging population. With an escalating number of stroke survivors, research on how to improve life after stroke is needed. Aims The primary aim was to determine which area of research related to life after stroke that stroke patients and their informal carers prioritized as being relevant and valuable. Methods A cross-sectional study of all patients who had completed the 12 months of follow-up in the EFFECTS trial. In the questionnaire the stroke patients and their informal carers were asked to prioritize areas of research they considered important and valuable with respect to their life after stroke. Results Of the 731 patients who were still alive after the 12 months-follow-up, 589 responded. The most prioritized areas of research were Balance and walking difficulties (290 (49%) responders) and Post-stroke fatigue (173 (29%) responders). Women answered the undefined alternative “other” more often than men (43 women (11%) versus 11 men (6%), p = .04). Younger patients prioritized Post-stroke fatigue to a higher extent (88 (45%) versus (22%), p < .001), and elderly prioritized Balance and walking difficulties (214 (54%) versus 76 (40%), p = .002) and Speech difficulties (38 (10%) versus 9 (5%), p = .045). Conclusions Life after stroke is perceived differentely with aging. Future research should address strategies to face challenges such as imbalance and walking difficulties and post-stroke-fatigue.

A 4.6 Mb Inversion Leading to PCDH15-LINC00844 and BICC1-PCDH15 Fusion Transcripts as a New Pathogenic Mechanism Implicated in Usher Syndrome Type 1.

Usher type 1 syndrome is a rare autosomal recessive disorder involving congenital severe-to-profound hearing loss, development of vision impairment in the first decade, and severe balance difficulties. The PCDH15 gene, one of the five genes implicated in this disease, is involved in 8–20% of cases. In this study, we aimed to identify and characterize the two causal variants in a French patient with typical Usher syndrome clinical features. Massively parallel sequencing-based gene panel and screening for large rearrangements were used, which detected a single multi-exon deletion in the PCDH15 gene. As the second pathogenic event was likely localized in the unscreened regions of the gene, PCDH15 transcripts from cultured nasal cells were analyzed and revealed a loss of junction between exon 13 and exon 14. This aberration could be explained by the identification of two fusion transcripts, PCDH15-LINC00844 and BICC1-PCDH15, originating from a 4.6 Mb inversion. This complex chromosomal rearrangement could not be detected by our diagnostic approach but was instead characterized by long-read sequencing, which offers the possibility of detecting balanced structural variants (SVs). This finding extends our knowledge of the mutational spectrum of the PCDH15 gene with the first ever identification of a large causal paracentric inversion of chromosome 10 and illustrates the utility of screening balanced SVs in an exhaustive molecular diagnostic approach.

Adenoids with Glue Ear: Incidence, Management and Outcome

Background: In the 17th and 18th centuries, Santorini and Wilhem Mayer described the adenoids. Enlarged adenoid or adenoids is a common disorder in children, not only compromise the natural pathway of breathing, but it also obstructs the nasopharyngeal opening of Eustachian tubes. As a result, retention of fluid in the middle ear cavity and the development of glue ear or otitis media with effusion (OME). If it happens, the children present with hearing loss, delayed speech and language, poor social behavior, and may with difficulties of balance. Methods: It is a cohort retrospective study of 251 cases in the Department of Otolaryngology and Head-Neck Surgery, Cumilla Medical College, and Cumilla Medical Centre, Bangladesh, from 01 July 2016 to 31 June 2019. Results: Incidence of adenoids with glue ear, out of total ENT routine operations was 3.54%, and adenoidectomy-tonsillectomy operations were 29.05%. Of them, the male was 102(40.64%), the female was 149(59.36%), 3-5 years were 83(33.07%), 6-10 years 107(42.63%), and 11-15 years 61(24.30%).

Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged ≥75 years living in the community.

Objectives:Previous research has shown that balance and gait difficulties are predictors of falls. The aim of this study was to evaluate the predictive validity of two tools reporting on balance and gait among older community-living adults independent in personal activities of daily living (p-ADL).Methods:Prospective study design. Baseline assessment included the Timed Up and Go test (TUG) and the Short Physical Performance Battery (SPPB). Following baseline, falls were recorded monthly for one year by 202 participants (70.1% women) who were independent in p-ADL, and at least 75 years old (79.2±3.5). ROC-curves were made and AUC were calculated.Results:Forty-seven percent of the participants reported falls. AUCs calculated for TUG were 0.5 (95%CI: 0.5-0.6) for those with at least one fall, and 0.5 (95% CI: 0.5-0.6) for recurrent fallers. Corresponding figures for SPPB were 0.5 (95% CI: 0.5-0.6) and 0.5 (95% CI: 0.5-0.6).Conclusion:This study does not support a recommendation to use the Timed Up and Go test or the Short Physical Performance Battery as tools for the identification of fall-prone persons among older adults living in the community. These results reinforce the need for further research into appropriate tools for identifying independent but fall-prone older adults.

Late-onset oro-facial dyskinesia in Spinocerebellar Ataxia type 2: a case report

BackgroundGenetic familiar causes of oro-facial dyskinesia are usually restricted to Huntington’s disease, whereas other causes are often missed or underestimated. Here, we report the case of late-onset oro-facial dyskinesia in an elderly patient with a genetic diagnosis of Spinocerebellar Ataxia type 2 (SCA2).Case presentationA 75-year-old man complained of progressive balance difficulty since the age of 60 years, associated with involuntary movements of the mouth and tongue over the last 3 months. No exposure to anti-dopaminergic agents, other neuroleptics, antidepressants, or other drugs was reported. Family history was positive for SCA2 (brother and the son of the brother). At rest, involuntary movements of the mouth and tongue were noted; they appeared partially suppressible and became more evident during stress and voluntary movements. Cognitive examination revealed frontal-executive dysfunction, memory impairment, and attention deficit. Brain magnetic resonance imaging (MRI) disclosed signs of posterior periventricular chronic cerebrovascular disease and a marked ponto-cerebellar atrophy, as confirmed by volumetric MRI analysis. A dopamine transporter imaging scan demonstrated a bilaterally reduced putamen and caudate nucleus uptake. Ataxin-2 (ATXN2) gene analysis revealed a 36 cytosine-adenine-guanine (CAG) repeat expansion, confirming the diagnosis of SCA2.ConclusionsSCA2 should be considered among the possible causes of adult-onset oro-facial dyskinesia, especially when the family history suggests an inherited cerebellar disorder. Additional clinical features, including parkinsonism and motor neuron disease, may represent relevant cues for an early diagnosis and adequate management.

Spatial and temporal relation of kinematics and muscle activity during unstable sitting

Recent work suggests that kinematics-based electrical stimulation may restore dynamic trunk stability following spinal cord injury. However, to ensure fatigue-resistant control, knowledge of the relation between body motion and the activity of relevant muscles during non-impaired, unstable sitting may be beneficial. Therefore, our objective was to quantify the spatial and temporal relationships between (1) characteristic angular kinematics (i.e., the kinematics characterizing trunk stabilization) and (2) trunk and upper leg muscle activity in unstable sitting as elicited via a wobble board. Wobble board motion and bilateral electromyograms from fourteen trunk and upper leg muscles were recorded in fifteen non-disabled participants (i.e., individuals with no history of neurological or musculoskeletal impairments or pain, gait or balance difficulties, or use of a walking aid) sitting on a wobble board. The relationship between wobble board tilt and the electromyograms was quantified using cross-correlation analysis. During unstable sitting, the trunk was stabilized through direction-specific activation of the trunk and upper leg muscles, preceding wobble board displacement by 110–230 ms. Direction-specific activation implies the presence of active neural control, while preceding activation may be needed to account for known torque generation time delays. Furthermore, the specific muscles activated for each direction of wobble board displacement suggest the use of stiffness control in the anterior-posterior, but not medial-lateral direction. Future work will use the gained insights in defining the muscle stimulation patterns of kinematics-based neuroprostheses that can restore trunk stability following impairment.