Dynamic Sitting Research Articles

A new treatment of Pusher syndrome based on central integration concept

To observe the effect of central integration concept based treatment on Pusher Syndrome after stroke and illustrate the relationship between cognition integration and motor control after stroke, providing a new potential way to treat stroke. Thirty stroke patients with Pusher Syndrome who were unable to maintain sitting and standing balance were included in this study. The experimental group (15 cases) received the treatment based on central integration concept mainly including: 1. Dynamic assessment showed the major dysfunction of patients was lack of directional and spatial ability. 2. Auditory and visual information was inputted and the appropriate environment were set accordingly, making the brain regain sequential cognitive function and the subjects actively establish the directional and spatial ability in static and dynamic sitting and standing process. 3. A 24-hour rehabilitation management was used to strengthen the spatial direction ability and the formation of implicit memory. The control group (15 cases) adopted routine rehabilitation training methods (sitting and standing balance training, muscle strength training, core control training, etc.). Fugl-Meyer balance scale and ADL scale (Modified Barthel Index) were used for functional assessment before and after 1 week of treatment. Time to reconstruct sitting and standing balance were recorded also. Compared with the control group, the time to regain sitting and standing balance was significantly shorter. No significant difference showed between two groups before treatment. Experimental group demonstrated significantly higher scores both in Fugl-Meyer balance scale ( P < 0.001) and ADL (modified Barthel index) scale ( P < 0.001) after 1 week of treatment. Compared with the conventional rehabilitation training, central integration based treatment can effectively improve balance function and ADL ability of patients with Pusher syndrome after stroke so as to shorten the hospitalization period and return to family and society as soon as possible.

A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE.

Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings. To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy's Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions. Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient's balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care. The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

Wheelchair Neuroprosthesis for Improving Dynamic Trunk Stability.

Trunk instability is a major problem for individuals with thoracic and cervical spinal cord injury. Functional electrical stimulation (FES) neuroprosthesis, a technology that uses small electrical currents to artificially contract muscles, has previously been utilized to improve trunk stability during quasi-static and dynamic sitting. The aim of this paper was to develop the first powered wheelchair-based neuroprosthesis and to test its feasibility for improving trunk stability. Eleven male, able-bodied individuals participated in the feasibility study. While participants were seated, the wheelchair was moved in the forward or backward directions with slow and fast accelerations. Two different FES protocols were tested: 1) co-contraction and 2) directionally-dependent contraction of trunk extensors and flexors. Sham stimulations with intensities below the motor threshold were applied as the control conditions. Inertial motion sensors were used to quantify the maximum angular displacement and velocity of the trunk. Results showed that both directional contractions and co-contraction reduced trunk displacement and velocity, compared with the control conditions. However, directionally-dependent muscle contractions were more effective in improving trunk stability, compared with co-contractions. Overall, feasibility of the wheelchair-based neuroprosthesis was demonstrated. Future research will incorporate feedback from wheelchair movements and test the neuroprosthesis with individuals who sustained spinal cord injury.

An Under-the-Table Leg-Movement Apparatus and Changes in Energy Expenditure.

Introduction: Deskwork contributes substantially to sedentariness. Here, we evaluated an under-the-table apparatus that was designed to promote leg movement (fidgeting) while seated. Our hypothesis was that the under-the-table apparatus would increase energy expenditure.Methods: We measured energy expenditure and heart rate in 26 people while they sat and worked using a standard chair, walked on a treadmill, and sat and worked using an under-the-desk apparatus that encouraged leg movement.Results: Energy expenditure increased significantly while using the under-the-table apparatus when compared to the standard office chair (standard chair, 81 ± 18 kcal/h; under-the-table apparatus, 96 ± 23 kcal/h) (P < 0.001); representing an 18 ± 16% increase. The changes in energy expenditure were not as great as walking (1 mph, 168 ± 46 kcal/h, P < 0.001; 2 mph, 205 ± 51 kcal/, P < 0.001), representing 107 ± 37% and 155 ± 48% increases over baseline, respectively.Conclusions: An under-the-table apparatus that promotes leg movement can increase energy expenditure by approximately 20%. Dynamic sitting is promoted by this apparatus and may be among a lexicon of options to help people move more while seated at work.

Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients

Objective: Analyse the effect of core stability exercises in addition to conventional physiotherapy training three months after the intervention ended. Design: A randomized controlled trial. Setting: Outpatient services. Subjects: Seventy-nine stroke survivors. Interventions: In the intervention period, both groups underwent conventional physiotherapy performed five days/week for five weeks, and in addition the experimental group performed core stability exercises for 15 minutes/day. Afterwards, during a three-month follow-up period, both groups underwent usual care that could eventually include conventional physiotherapy or physical exercise but not in a controlled condition. Main measures: Primary outcome was trunk control and dynamic sitting balance assessed by the Spanish-Version of Trunk Impairment Scale 2.0 and Function in Sitting Test. Secondary outcomes were standing balance and gait evaluated by the Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Spanish-Version of Postural Assessment Scale for Stroke and activities of daily living using the Barthel Index. Results: A total of 68 subjects out of 79 completed the three-month follow-up period. The mean difference (SD) between groups was 0.78 (1.51) points (p = 0.003) for total score on the Spanish-Version of Trunk Impairment Scale 2.0, 2.52 (6.46) points (p = 0.009) for Function in Sitting Test, dynamic standing balance was 3.30 (9.21) points (p= 0.009) on the Berg Balance Scale, gait was 0.82 (1.88) points (p = 0.002) by Brunel Balance Assessment (stepping), and 1.11 (2.94) points (p = 0.044) by Tinetti Test (gait), all in favour of core stability exercises. Conclusions: Core stability exercises plus conventional physiotherapy have a positive long-term effect on improving dynamic sitting and standing balance and gait in post-stroke patients.

Chair-based fidgeting and energy expenditure.

IntroductionSedentariness is associated with chronic health conditions, impaired cognitive function and obesity. Work contributes significantly to sedentariness because many work tasks necessitate sitting. Few sustained solutions exist to reverse workplace sedentariness. Here, we evaluated a chair and an under-table device that were designed to promote fidgeting while seated. Our hypothesis was that an under-table leg-fidget bar and/or a fidget-promoting chair significantly increased energy expenditure. We compared these devices with chair-based exercise and walking.Materials and methodsWe measured energy expenditure and heart rate in 16 people while they sat and worked using a standard chair, an under-desk device that encourages leg fidgeting and a fidget-promoting chair. We compared outcomes with chair-based exercise and walking.ResultsEnergy expenditure increased significantly while using either an under-table leg-fidget bar or a fidget-promoting chair, when compared to the standard office chair (standard chair, 76±31 kcal/hour; leg-fidget bar, 98±42 kcal/hour (p<0.001); fidget chair, 89±40 kcal/hour (p=0.03)). However, heart rate did not increase significantly in either case. Bouts of exercise performed while seated provided energetic and heart rate equivalency to walking at 2 mph.ConclusionsChairs and devices that promote fidgeting can increase energy expenditure by ∼20–30% but not increase heart rate. Dynamic sitting may be among a lexicon of options to help people move more while at work.

The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial

Objective: To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients. Design: A randomized controlled trial. Setting: Inpatient rehabilitation hospital in two centres. Subjects: Eighty patients (mean of 23.25 (±16.7) days post-stroke) were randomly assigned to an experimental group and a control group. Interventions: Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention. Main measures: The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index. Results: The experimental group showed statistically significant differences for all of the total scale scores (P<0.05), except for the sitting section of the Brunel Balance Assessment. The mean (SD) difference between groups in Trunk Impairment Scale total score was 3.40 (±4.12) points, and its subscale dynamic sitting balance was 2.28 (±3.29). The Berg Balance Scale was 14.54 (±18.19) points, and the Barthel Index was 13.17 (±25.27) points. Collectively, these results were in favour of the experimental group. Conclusions: Core stability exercises in addition to conventional therapy improves trunk control, dynamic sitting balance, standing balance, gait and activities of daily living in subacute post-stroke patients.

Benefits of Autologous Bone Marrow Mononuclear Cell Transplantation in Chronic Ischemic Pontine Infarct

Introduction: Ischemic stroke is brain injury due to hypoperfusion leading to sudden neurological symptoms. Despite advances in medicine, prognosis is still grim especially with chronic residual neurodeficits. Autologous bone marrow mononuclear cells (BMMNCs) transplantation is safe and has shown positive outcomes in previous studies of ischemic stroke. Our aim was to study the effect of autologous BMMNCs transplantation in chronic ischemic stroke. Intervention and Results: We treated a case of pontine ischemic infarct three years later, with BMMNCs transplantation followed by standard rehabilitation. Seven months after transplantation he showed significant improvement in spasticity, motor function and voluntary control of upper and lower extremity, static and dynamic sitting and standing balance. Improvement was noted in the scales like Modified Ashworth scale (mAS), Motor Assessment scale (MAS), Disabilities of Shoulder, arm and hand questionnaire (DASH), Modified Rankin Scale (MRS), Berg Balance Scale (BBS) and Brunnstrom Voluntary Control Grading (BVCG). Functional Independence Measure score increased from 59 to 81. BMMNCs exert paracrine effects, neoangiogenesis and trophic effect which facilitate various reparative and regenerative processes in the penumbral area. Conclusion: In this case, the clinical changes exhibited by BMMNCs transplantation even at a chronic stage in stroke substantiate their therapeutic potential. Although a single case report, these findings provide foundation for further research. Larger randomized controlled trials are warranted to study the safety and efficacy.

Effects of a dynamic chair on pelvic mobility, fatigue, and work efficiency during work performed while sitting: a comparison of dynamic sitting and static sitting.

[Purpose] Working while sitting for long periods can cause lumbar pain, fatigue, and reduced work efficiency. How a dynamic chair with a seat that moves three-dimensionally affects pelvic mobility before and after work, work efficiency, and post-work fatigue were examined. [Subjects and Methods] Subjects were 17 healthy adults (10 males, 7 females, mean age 21.8 ± 2.7 years). Subjects performed a 30-min Kraepelin test under two conditions: sitting in a standard office chair and sitting in a dynamic sitting balance chair. Root mean square (RMS) values of pelvic movement measured by a triaxial accelerometer during 30 minutes of work, finger-floor distance before and after work, lumbar fatigue, and pelvic movement RMS values during finger-floor distance measurement were used as outcome measures. [Results] Pelvic movement RMS values collected every 5 minutes during 30 minutes of work were significantly higher while sitting in the dynamic balance chair. Changes in pelvic movement RMS values during finger-floor distance measurement after work and amount of work performed during 30 minutes were significantly higher and lumbar fatigue was significantly lower for the dynamic balance chair. [Conclusion] Dynamic sitting maintained or increased pelvic flexibility. The dynamic balance chair may effectively help workers work continuously in seated postures with little fatigue.

Trunk Impairment Scale -TIS precise tool for evaluating trunk motor deficit of stroke patients

Abstract Stroke causes impairment of brain function resulting in the disorder of motor control of the trunk. Assessment of the movement of a patient with hemiparesis poses many difficulties and limitations. A standard clinical neurological diagnosis does not provide an accurate assessment in terms of trunk deficit. This is the reason for the relatively small and insufficient monitoring of motor changes in patients. Post stroke assessment of the trunk is still insufficient despite the fact that disorders are a common problem in patients with stroke. Trunk function has been identified as an important early predictor of functional outcome after stroke. Trunk Impairment Scale-TIS is the only well-validated tool to examine a patient with hemiparesis taking into account qualitative and quantitative assessment of the trunk deficit. This scale consists of three subscales: static balance in sitting, dynamic balance sitting and coordination. TIS assesses existing compensation during motor tasks. The scale was translated into Polish and pre-adapted to clinical practice The scale supports clinical reasoning in terms of structure and function, body disorders and activity limitations of patients after stroke It appears that the introduction of scale in the clinical study for patients with stroke hemiplegia may not only affect the expansion of detailed documentation of motor deficits, but to support planning and carrying out appropriate (suitable) physiotherapy strategies.

Evaluating Abdominal and Lower-Back Muscle Activity While Performing Core Exercises on a Stability Ball and a Dynamic Office Chair.

The purpose of this study was to evaluate the ability of a dynamic office chair to activate the core muscles while participants performed exercises sitting on the chair compared to a stability ball. Prolonged sitting has become an accepted part of the modern office. However, epidemiological evidence suggests that sedentary postures are linked to many adverse effects on health. The concept of dynamic or active sitting is intended to promote movement while sitting to reduce the time spent in prolonged, static postures. Sixteen participants performed four pelvic rotation exercises (front-back, side-side, circular, and leg lift) on both a dynamic office chair and a stability ball. Muscle activity from 12 torso muscles were evaluated with surface electromyography. For all exercises, trunk muscle activity on the chair was comparable to that on a stability ball. The right external oblique was the only muscle to produce greater peak activity (p = .019) when using the ball compared to the chair (21.4 ± 14.0 percent maximal voluntary excitations (%MVE) and 14.7 ± 10.8 %MVE for the ball and chair, respectively). The left thoracic erector spinae produced greater average activity (p = .044) on the chair than on the ball. These findings suggest that this dynamic sitting approach could be an effective tool for core muscle activation while promoting movement and exercise while sitting at work. Muscle activations on the dynamic chair are comparable to those on a stability ball, and dynamic office chairs can promote movement and exercise while sitting at work.

Application of a novel spinal posture and motion measurement system in active and static sitting

The quantification of work-related musculoskeletal risk factors is of great importance; however, only a few tools allow objective, unrestricted measurements of spinal posture and motion in workplaces. This study was performed to evaluate the applicability of the Epionics system in a sedentary workplace. The system is mobile and wireless and assesses lumbar lordosis, pelvic orientation and spinal motion, without restricting subjects in their movements. In total, 10 males were monitored while sitting for 2 h on static and dynamic office chairs and on an exercise ball, to evaluate the effect of dynamic sitting. The volunteers were able to perform their work unhampered. No differences among the tested furniture could be detected with respect to either the lordosis or the number of spinal movements after habituation to the furniture; however, differences in pelvic orientation were statistically significant. The results of the present study indicate that Epionics may be useful for the quantitative assessment of work-related risk factors.

Modified Berg Balance Scale: making assessment appropriate for people with aphasia

Objective:Modifying assessments for people with aphasia has the potential to increase the validity of healthcare assessments across professional domains. This pilot study addressed the challenges of giving people with aphasia the power to fully participate in the assessment process. The study aimed to investigate the feasibility of using an aphasia-modified version of the Berg Balance Scale (BBS), a physical therapy assessment tool to quantify dynamic sitting and standing balance.Method:The study compared how people with aphasia performed on the original BBS to an aphasia-modified version (MBBS), created for this study. We examined the relationship between auditory comprehension scores and balance performance of 15 participants with chronic aphasia and three control participants. We tested the hypothesis that individuals with aphasia would perform higher on the MBBS rather than the BBS, thus more closely approaching a score reflective of their true physical abilities.Results:Overall people with aphasia performed significantly better on the MBBS than the BBS, indicating that at least some portion of their performance difficulty was likely due to poor auditory comprehension of test instructions rather than true balance difficulty.Conclusion:Implications of this study suggest that modifying assessments, such as the BBS, by reducing linguistic complexity and adding visual and written cues along with modeling and repetition has the potential to increase the validity of healthcare assessments for individuals with aphasia.

A Trend Analysis of Dynamic Chair and Applied Technology

Objective: The objective of this study was to define the Dynamic Sitting (DS) through trend analysis and research on the Dynamic Chair (DC) and applied technologies. BR BR Background: The effects of changing posture on the human body have been studied to find out healthy sitting postures. It is believed that changing posture is effective in reducing disc pressure on spinal cord and preventing back pain and musculoskeletal disease. But, the definition of DS and trends of DC have not been researched yet. Therefore, trend analysis of DC and its applied technologies are required to define dynamic sitting posture.BRBR Method: We researched the type of occupant postures from previous studies. And then, sitting behaviors were classified into three types; (1) sitting and standing, (2) working and studying, (3) taking a rest.BRBR Results: Variety shapes of DC and applied technologies were found out. From the result, the trend of DC and applied technology were summarized from three perspectives. ; (1) changing the chair functions according to user"s intention, (2) conversion of dynamic chair technologies to office chair mechanism, (3) enables the user to change their sitting posture without operating control device.BRBR Conclusion: From this study, we defined dynamic sitting posture and analyzed the trend of DC and its applied technologies. This result might be used to develop an office chair for healthy sitting. But further investigation is required to figure out the technologies and functions for development of healthy chair.BRBR Application: The results of the publishing trend analysis might help to determine design concept of office chair.

Office Chair Design Methods Based on Dynamic Sitting Behavior

Human sitting posture and dynamic behavior at work are analyzed systematically by using the principle and method of ergonomics. And from the scales and functionality limited by both aspects, put forward new design ideas of office chair which are fit to modern office work so as to provide reference to design practice.

Rethinking design parameters in the search for optimal dynamic seating

Dynamic seating design purports to lessen damage incurred during sedentary occupations by increasing sitter movement while modifying muscle activity. Dynamic sitting is currently defined by O'Sullivan etal. ( 2013a) as relating to 'the increased motion in sitting which is facilitated by the use of specific chairs or equipment' (p. 628). Yet the evidence is conflicting that dynamic seating creates variation in the sitter's lumbar posture or muscle activity with the overall consensus being that current dynamic seating design fails to fulfill its goals. Research is needed to determine if a new generation of chairs requiring active sitter involvement fulfills the goals of dynamic seating and aids cardio/metabolic health. This paper summarises the pursuit of knowledge regarding optimal seated spinal posture and seating design. Four new forms of dynamic seating encouraging active sitting are discussed. These are 1) The Core-flex with a split seatpan to facilitate a walking action while seated 2) the Duo balans requiring body action to create rocking 3) the Back App and 4) Locus pedestal stools both using the sitter's legs to drive movement. Unsubstantiated claims made by the designers of these new forms of dynamic seating are outlined. Avenues of research are suggested to validate designer claims and investigate whether these designs fulfill the goals of dynamic seating and assist cardio/metabolic health. Should these claims be efficacious then a new definition of dynamic sitting is suggested; 'Sitting in which the action is provided by the sitter, while the dynamic mechanism of the chair accommodates that action'.

Unsupported Eyes Closed Sitting and Quiet Standing Share Postural Control Strategies in Healthy Individuals

The study aimed to (1) compare postural stability between sitting and standing in healthy individuals and (2) define center-of-pressure (COP) measures during sitting that could also explain standing stability. Fourteen healthy individuals randomly maintained (1) two short-sitting positions with eyes open or closed, with or without hand support, and (2) one standing position with eyes open with both upper limbs resting alongside the body. Thirty-six COP measures based on time and frequency series were computed. Greater COP displacement and velocity along with lower frequency measures were found for almost all directional components during standing compared with both sitting positions. The velocity, 95% confidence ellipse area, and centroidal frequency were found to be correlated between unsupported sitting and standing. Despite evidenced differences between sitting and standing, similarities in postural control were highlighted when sitting stability was the most challenging. These findings support further investigation between dynamic sitting and standing balance.

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The effect of dynamic sitting on trunk muscle activation: A systematic review

The purpose of this systematic review was to investigate the effect of dynamic sitting on trunk muscle activation in sitting. Electronic databases were searched by two independent reviewers. Studies were included if they compared the effect of dynamic sitting on trunk muscle activation to a more static sitting condition. Seven studies were eligible for inclusion, six of which were rated as “high-quality” using the PEDro scale. Five studies reported no difference in trunk muscle activation. Two studies reported a difference in trunk muscle activation, yet this was associated with increased discomfort, increased fatigue and greater spinal shrinkage. Furthermore, the changes reported in these two studies may be more related to the absence of a backrest rather than dynamic sitting. Therefore, the findings of this review suggest dynamic sitting does not significantly change trunk muscle activation. No randomised clinical trials or longitudinal design studies were found which evaluated the effect of dynamic sitting on trunk muscle activation, limiting the ability to make definitive conclusions about causality. The implications of the results, and recommendations for future research, are discussed.

The effect of dynamic sitting on the prevention and management of low back pain and low back discomfort: a systematic review

Dynamic sitting has been proposed to reduce low back pain (LBP) and/or low back discomfort (LBD) while sitting. This is supported by studies suggesting that subjects with LBP assume more static, sustained postures while sitting. This systematic review investigated the effect of dynamic sitting on LBP among subjects with LBP and the development of LBD among pain-free subjects. Electronic databases were searched by two independent assessors. All prospective studies which compared the effect of a dynamic sitting condition on LBP or LBD to another sitting condition were eligible, with no minimum follow-up period applied. The quality of the included studies was assessed using the PEDro scale. Seven high-quality studies were eligible, including five crossover studies and two randomised controlled trials. The results suggest there is currently no evidence to support the use of dynamic sitting as a stand-alone approach in the management of LBP. Practitioner Summary: This systematic review investigated the effect of dynamic sitting on LBP or LBD. Seven high-quality studies met the inclusion and exclusion criteria. Overall, the evidence suggests that dynamic sitting approaches are not effective as a stand-alone management approach for LBP.