Endpoint Excursion Research Articles

Evaluating the Stability Limits Between Individuals with Mild and Moderate-to-Severe Grades of Forward Head Posture

Background: Forward head posture (FHP) leads to the anterior excursion of the center of gravity, which can affect a person's standing balance. Evaluating the balance in different degrees of severity of FHP can help design and plan appropriate balance exercises for people with FHP. Objectives: This study aimed to evaluate the changes in the limits of stability (LOS) in people with mild and moderate-to-severe grades of FHP. Methods: The participants in this study were 70 individuals suffering from FHP, aged between 17 - 45. They were divided into two groups based on their craniovertebral angle: Mild (> 45.5 degrees) and moderate-to-severe (< 45.5 degrees). The LOS test was performed using a posturography device (NeuroCom, Equitest, USA). Five indices—movement reaction time (RCT), movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL)—were evaluated. Results: Based on the results of the LOS test, RCT, MVL, EPE, MXE, and DCL were significantly different between the mild and moderate-to-severe FHP groups in both anterior and posterior directions (P < 0.05). However, in other directions, no significant difference was observed in these variables based on the LOS test (P > 0.05). Conclusions: It can be concluded that individuals with moderate-to-severe FHP are more likely to have postural control deficits. Therefore, it is necessary to design appropriate targeted interventions to prevent falls in these individuals. Specifically, they should receive balance exercises in dynamic situations.

Preliminary observation of wearable balance diagnosis and treatment system in evaluating dynamic and static balance function in patients with vestibular vertigo

A newly developed wearable balance diagnosis and treatment system was studied to evaluate the indexes of the abnormal balance function in patients with vestibular vertigo. A cross-sectional study was carried out. A total of 30 patients diagnosed with non-acute vestibular vertigo in the outpatient department of Eye, Ear, Nose and Throat Hospital Affiliated to Fudan University from July 2022 to May 2023 were selected as the vertigo group, including 13 males and 17 females, and aged (45.7±13.9) years. Meanwhile, 20 healthy controls (8 males and 12 females) were included as the control group, with a mean age of (43.6±8.0) years. The static balance and limits of stability (LOS) function of all subjects were assessed with wearable balance diagnosis and treatment system developed under the leadership of Eye & ENT Hospital of Fudan University. In the static balance test, the ratio of eyes open with cushions to eyes open without cushions in the vertigo group was less than that of the control group[1.20% (0.92%, 1.53%) vs 1.49% (1.22%, 1.81%), P=0.008], indicating that patients with non-acute vestibular vertigo may compensate static balance ability earlier. In vertigo group, the directional control in 8 directions, the maximum excursion in anterior, posterior, right anterior and right posterior directions, the endpoint excursion in the posterior, right posterior, and left posterior directions were all smaller than those of the control group (all P<0.05). The reaction time in the left posterior direction of vertigo group was longer than that of the control group (all P<0.05). Those results indicated that the directional control, maximum excursion and endpoint excursion of LOS could be considered as important reference indexes for dynamic balance function.

Effects of body awareness therapy on balance and fear of falling in patients with chronic obstructive pulmonary disease: a randomized controlled trial

BackgroundAssessment of extrapulmonary comorbidities is essential in chronic obstructive pulmonary disease (COPD). Deterioration of balance and increasing fear of falling are two of the most significant extrapulmonary manifestations. Although pulmonary rehabilitation (PR) is well-known and effective for COPD patients, there is a need for alternative treatments to enhance balance and alleviate concerns about falling. This study aimed to investigate the effect of Body Awareness Therapy (BAT), in addition to the PR program, on balance and fear of falling in patients with COPD.MethodsForty-three patients were randomized into two groups: the BAT + PR group (BAT: once a week, 60 min + PR: 30 min, seven days of the week) or the PR group (PR: 30 min, seven days of the week) for eight weeks. Primary (balance, fear of falling) and secondary (dyspnea, muscle strength, functional capacity) outcomes were assessed at two different times: the baseline and end of the eight weeks.ResultsSignificant improvements were found in dynamic balance (reaction time η2 = 0.777, movement velocity η2 = 0.789, endpoint excursion η2 = 0.687, maximal excursion η2 = 0.887), static balance on firm ground (eyes opened η2 = 0.679, eyes closed η2 = 0.705), dyspnea (η2 = 0.546), muscle strength (η2 = 0.803), and functional capacity (η2 = 0.859) of the BAT + PR group (p < 0.05 for all). The improvement in fear of falling was significantly greater in the BAT + PR group than in the PR group (p < 0.001, η2 = 0.331).ConclusionThe BAT method added to PR was more effective than PR alone in improving balance and reducing the fear of falling in COPD patients.Trial registrationThis randomized controlled study was registered at clinicaltrials.gov, NCT04212676, Registered 28 December 2019.

The stepping test, and infrared depth sensor, provide reliable measures of balance in community-dwelling older adults.

[Purpose] The purpose was to examine relationships between variables characterizing the 20-second stepping test movement pattern, assessed with an infrared depth sensor (KinectTM), and measurements of dynamic and static balance. [Participants and Methods] A total of 27 independent-living, older adults (7 males and 20 females) participated in this study. For each participant, the stepping test total movement distance, movement displacement, knee movement distance, and step number were calculated from Kinect closed joint-point coordinate data. Dynamic and static balance were assessed using a NeuroCom Balance Master Platform system. [Results] The stepping test total movement distance had a moderate negative correlation with endpoint excursion (r=-0.469) and a moderate positive correlation with total movement distance, corrected for knee movement distance (r=0.557). Step numbers had a moderate negative correlation with stepping test total movement distance (r=-0.667) and total movement distance, corrected for knee movement distance (r=-0.531). Division into high and low-balance sub-groups (based on endpoint excursion or sway velocity scores) revealed that stepping test total movement distances and movement displacements were greater, and step numbers were fewer, in low balance groups. [Conclusion] The stepping test, combined with a KinectTM-assessed movement pattern provides a simple, objective, reliable means for assessing balance in community-dwelling, independent-living older adults.

Nintendo Ring Fit Adventure improves balance ability in sedentary young adults

IntroductionExercising with a game console is a novel type of exercise. One game that is currently popular is Nintendo Ring Fit Adventure, but its impact on balancing ability in young adults who are sedentary has yet to be investigated. This study aimed to investigate the effects of Nintendo Ring Fit Adventure exercise on balance ability in young adults with sedentary lifestyles.MethodsThirty participants were randomly divided into two groups: the Nintendo and control groups. The experimental group completed a workout routine using the Nintendo Ring Fit for 30 minutes per day, three times per week for four weeks, while the control group received no intervention. Participants’ balance abilities were evaluated pre- and post-intervention by the single leg stance test, Modified Clinical Test of Sensory Interaction in Balance (MCTSIB), and limit of stability. A one-way ANCOVA with the pre-intervention value as a covariate was used to compare groups.ResultsComparisons between groups after the intervention revealed a significant decrease in MCTSIB sway for the firm surface with eyes open condition (p = 0.043) and a significant increase in endpoint excursion in the backward direction (p = 0.038). The other variables did not show statistically significant differences between groups.ConclusionsExercise with Nintendo Ring Fit improved the participants’ ability to balance in certain dimensions. Nintendo Ring Fit may increase the balance ability of young adults with sedentary behaviour.

Quantitative analysis of balance function characteristics in older patients with mild to moderate cognitive impairment

BackgroundCognitive decline in older adults may affect balance function, but the relationship between the two is not fully understood, especially in the early stages of cognitive impairment. Mild to moderate cognitive impairment can be assessed with the Montreal Cognitive Assessment (MOCA). AimThis study quantitatively analyzed balance function in older adults with mild to moderate cognitive impairment using computerized dynamic posturography (CDP) testing. Methods248 older patients were divided into a cognitive impaired group (MOCA <26, n = 126) and a normal group (MOCA ≥26, n = 122) based on the Montreal Cognitive Assessment (MOCA) Beijing Version. Patients underwent CDP testing, which included the sensory organization test (SOT) and the limits of stability test (LOS). ResultsThe cognitive impaired group had significantly lower SOT composite and visual scores, as well as reaction time (RT), movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL) of the LOS test. Binary logistic regression analysis revealed that RT and MXE were independent factors significantly associated with MOCA, even after adjustment for age and sex. ConclusionsOlder patients with mild to moderate cognitive impairment may have reduced sensory integration and balance stability limits, mainly manifested as prolonged motor reaction time and shortened maximum movement distance.

Reliability and validity of the supine-to-stand test in people with stroke.

To investigate the psychometric properties of the supine-to-stand test in people with stroke. Cross-sectional design. Fifty-two people with stroke (mean (standard deviation) age 63.13 (6.09) years; time post-stroke 93.13 (61.36) months) and 49 healthy older adults (61.90 (7.29) months). Subjects with stroke were recruited from the community dwelling in Hong Kong and assessed with the supineto- stand test, Fugl-Meyer Motor Assessment, ankle muscle strength test, Berg Balance Scale, limit of stability test, Timed Up-and-Go Test, Six-Minute Walk Test, Chinese version of Activities-specific Balance Confidence scale, Community Integration Measure (CIM-C), and 12-item Short-Form Health Survey (SF-12) in a university-based rehabilitation laboratory. The supine-to-stand test completion time demonstrated excellent intra-rater, inter-rater and test-retest reliability (intraclass correlation coefficient 0.946-1.000) for the people with stroke. The completion time was significantly negatively correlated with Berg Balance Scale, Six-Minute Walk Test, limit of stability - maximal excursion, and limit of stability - endpoint excursion results (r = -0.391 to -0.507), whereas it was positively correlated with the Timed Up-and-Go test results (r = 0.461). The optimal cut-off supine-to-stand test completion time of 5.25 s is feasible for a clinical measure to distinguish the performance of people with stroke from healthy older adults (area under the curve = 0.852, sensitivity = 81.1%, specificity = 84.0%). The supine-to-stand test is a reliable, sensitive, specific and easy-to-administer clinical test for assessing the supine-to-stand ability of people with stroke.

Alternatif bir postüral kontrol testi: modifiye edilmiş fonksiyonel uzanmanın kararlılık sınırları ile korelasyonu

Purpose: To evaluate the correlation of Functional Reach Test (FRT) and its modified versions (mFRTs) with the outcomes of Limits of Stability (LoS), and to identify the most appropriate test method to use in postural control assessment.&#x0D; Methods: Forty-six participants were included in the study. The participants performed FRT and mFRTs: firm ground dominant arm (FRT), firm ground both arms (FRTFB), soft ground dominant arm (FRTSD), soft ground both arms (FRTSB) and firm ground lateral FRTs. LoS was carried out with static posturography. The correlation of FRT and mFRTs with LoS parameters was evaluated as reaching distance and movement time.&#x0D; Results: A strong positive correlation was found between FRTFB and LoS-I (forward direction) endpoint excursion and maximum excursion (p

Durable improvement in participant-reported measures of disability and objective posturography after computerized vestibular retraining.

Unilateral vestibular deficits are associated with postural instability and loss of quality of life. Common treatments frequently fail to achieve satisfactory outcomes. To assess the durability of changes in participant-reported disability and objective posturography after computerized vestibular retraining. This was a single-group study. Individuals with persistent symptoms of an objectively determined unilateral vestibular deficit completed questionnaires and posturography assessments before and after twelve sessions of computerized retraining, and 4-6 months and 10-12 months after treatment. 13 participants completed the post-treatment assessments; 9 completed the follow up. Mean improvements in perceived disability at 4-6 months after retraining were: DHI 14.3 points (95% confidence interval 4.0 to 24.5), ABC scale 14.9 points (4.3 to 25.6), FES-I 11.6 points (-3.2 to 26.5).The SOT composite score increased by 11.4 points (95% CI 1.9 to 20.9; p = 0.0175) immediately after treatment, 8.9 points (-2.9 to 20.7; p = 0.1528) at 4-6 months, and 10.6 points (2.2 to 19.0; p = 0.0162) after 10-12 months. At the 10-12 month time point, the areas of the functional stability region increased significantly for both endpoint excursion (p = 0.0086) and maximum excursion (p = 0.0025). Computerized vestibular retraining was associated with improved participant reported disability and objective measures of postural stability.

Block-sequence of plyometric and balance training is superior to the alternating-sequence for enhancing motor function in children with hemiplegic cerebral palsy: A comparative randomized clinical trial

BACKGROUND: Postural control deficits are prevalent in children with hemiplegic cerebral palsy (CwHCP). Therefore, the best rehabilitative strategies for remediating these deficits are warranted, which could then enhance function. OBJECTIVE: To examine effects of a block versus an alternating sequence of balance training (BT) and plyometric training (PT) on postural control in CwHCP. METHODS: Forty-eight CwHCP (812 years) were randomized to a block or an alternating BT/PT training. The block BT/PT group (n= 24) received a six-week BT followed by a six-week PT, twice/week over 12 consecutive weeks. The alternating BT/PT group (n= 24) received an interchanging sequence of BT and PT changed every two weeks for 12 weeks. Postural control [center-of-pressure reaction time (RT), movement velocity (MV), maximum excursion (ME), end-point excursion (EE), and directional control (DC)], functional balance (indicated by pediatric balance scale; PBS), and balance/risk-of-falls during walking (denoted by dynamic gait index; DGI) were assessed before and after training. RESULTS: The block BT/PT group showed greater enhancements in postural control variables [RT (P= 0.004), MV (P= 0.028), ME (P= 0.002), EE (P= 0.003), and DC (P= 0.012)] and functional balance (P= 0.006), and lesser risk-of-falls during walking (P= 0.018) when compared to the alternating BT/PT group. CONCLUSION: The block BT/PT sequence is more effective to enhance postural control than the alternating sequence in CwHCP.

Effect of a structured aqua-plyometric exercise program on postural control and functional ability in children with hemiparetic cerebral palsy: A two-arm randomized controlled trial.

Individuals with hemiparetic cerebral palsy (h-CP) encounter postural control issues that largely interfere with activity and participation. So, there might be a need for improved, clearly effective rehabilitation protocols that target postural control dysfunction, which may, then, reduce activity limitations and participation restrictions. This trial was undertaken to examine the effect of a structured, 12-week aqua-plyometric (Aqua-PLYO) exercise program on postural control and functional ability in children with h-CP. Fifty-six children with h-CP took part in a two-arm, randomized single-blind controlled trial. They were randomly assigned to either receive the standard physical therapy (Control group; n = 28) or the Aqua-PLYO training program (Aqua-PLYO group; n = 28), three times/week over 12 consecutive weeks. The dynamic limit of stability [i.e., movement directional control (M-DC), reaction time (ReT), movement velocity (M-Vel), endpoint excursion (EP-Exc), and maximum excursion (M-Exc)] and functional ability [i.e., 30-second sit-to-stand test (30sec-STS), timed up and down stairs test (TUDS), and the dynamic gait index (DGI)] were assessed pre- and post-treatment. From the pre- to post-treatment occasion, the Aqua-PLYO group achieved greater improvement for the M-DC (P = 0.013), ReT (P = 0.004), M-Vel (P = 0.03), EP-Exc (P = 0.002), and M-Exc (P = 0.006), compared to controls. Besides, the Aqua-PLYO group showed more conducive changes in functional ability [as evidenced by the 30sec-STS (P = 0.005), TUDS (P = 0.002), and DGI (P = 0.004) scores]. Aqua-PLYO training is likely an effective training paradigm for enhancing postural control and functional ability in children with h-CP. Further studies are, however, recommended to substantiate the current evidence.

Dose-response characteristics of exercise training in individuals with Parkinson's disease

Exercise training is often prescribed as an adjunct to medication to improve postural instability in individuals with Parkinson's disease. As the association between exercise dose and the corresponding effects on postural stability has not been established in this population, we aimed to explore this topic in the present study. This is an exploratory study conducted in the Gait and Balance Laboratory at the Hong Kong Polytechnic University in a period from June 2011 to June 2013. Eligible participants with Parkinson's disease (n = 51) were randomly assigned to either a balance and gait training group or a strength training group. The 12-week training period included two 4-week phases of physiotherapist-supervised laboratory-based training separated by a 4-week phase of self-supervised home-based training. Blinded testers examined postural stability using the limit of stability test, single-leg-stance test, walking test, and the activities-specific balance confidence scale, at baseline and after each training phase. Baseline evaluations revealed no significant difference between the balance and gait training and strength training groups. In the balance and gait training group, the first 4-week training phase led to significant improvement in most measures of balance and gait performance (P &lt; 0.025), and the 12-week training phase yielded further improvements in gait velocity and activities-specific balance confidence scale score. In the strength training group, the first 4-week training phase led to significant improvement in the endpoint excursion in the limit of stability test and gait velocity, and the 12-week training phase resulted in an improvement in the single-leg-stance time and stride length in the walking test. All improvements occurred during the laboratory-based training sessions. Therefore, in individuals with Parkinson's disease, a 4-week period of balance and gait training could improve postural stability, whereas longer durations of strength training are required to gain comparable improvements.

Psychometric Properties of the Trail Walking Test for People With Stroke.

ObjectiveTo investigate (i) the inter-rater and test–retest reliability of the trail walking test (TWT) and the minimum detectable change in the TWT completion time; (ii) the correlations between the TWT completion time and stroke-specific impairments; and (iii) the cutoff TWT completion time to distinguish between people with stroke and healthy older adults according to dual-tasking ambulation ability.DesignCross-sectional study.SettingUniversity-based rehabilitation center.ParticipantsIn total, 104 people with stroke and 53 healthy older adults.Main Outcome MeasuresThe TWT, the Fugl–Meyer Assessment of Lower Extremity (FMA-LE), the ankle muscle strength test, the limit of stability (LOS) test, the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the Community Integration Measure (CIM).ResultsThe mean TWT completion time in subjects with stroke was 124.906 s. The TWT demonstrated excellent inter-rater reliability [intraclass correlation (ICC) = 0.999] and good test–retest reliability (ICC = 0.876) in people with stroke. The TWT performance demonstrated significant negative correlations with the FMA-LE scores (r = −0.409), LOS movement velocity (affected and unaffected sides; r = −0.320 and −0.388, respectively), and LOS endpoint excursion (affected and unaffected sides; r = −0.357 and −0.394, respectively); a significant positive correlation with the LOS reaction time (affected side; r = 0.256); a moderate negative correlation with the BBS scores (r = −0.72); and an excellent positive correlation with the TUG completion time (r = 0.944). The receiver operating characteristic curve analysis revealed that an optimal cutoff of 69.61 s for the TWT completion time had an outstanding diagnostic power to distinguish between people with stroke and healthy older adults (area under the curve = 0.919) with high sensitivity (88.5%) and specificity (83.0%).ConclusionResults of our preliminary study demonstrated that the TWT is a reliable, valid, sensitive, and specific clinical test for evaluating dual-tasking ambulation ability in people with stroke aged 45 years or above and without cognitive impairments. It can differentiate the dual-tasking ambulation ability between people with stroke and healthy older adults.

Quantitative Analysis of Postural Instability in Patients with Parkinson's Disease.

Introduction Postural instability is commonly observed in Parkinson's disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson's disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions (p < 0.05). Conclusions The postural abnormalities of Parkinson's disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.

Exoskeletal-assisted walking may improve seated balance in persons with chronic spinal cord injury: a pilot study.

Pre-post intervention. To explore the potential effect of exoskeletal-assisted walking (EAW) on seated balance for persons with chronic motor complete spinal cord injury (SCI). A SCI research center. Eight participants who were over 18 years of age with chronic SCI and used a wheelchair for mobility were enrolled. Seven able-bodied participants were used for normal seated balance comparative values. Participants with chronic SCI received supervised EAW training using a powered exoskeleton (ReWalkTM) for a median 30 sessions (range from 7 to 90 sessions). Before and after EAW training, seated balance testing outcomes were collected using computerized dynamic posturography, providing measurements of endpoint excursion (EPE), maximal excursion (MXE), and directional control (DCL). Modified functional reach test (MFRT) and the sub-scales of physical functioning and role limitations due to physical health from the Short Form (36) Health Survey (SF-36) were used to identify changes in functional activities. After EAW training, seated balance significantly improved in total-direction EPE and MXE (P < 0.01 and P < 0.017 respectively). The results of MFRT and sub-scales of physical functioning and role limitations due to physical health improved after EAW training but were not statistically significant. EAW training may have the potential to improve seated balance for persons with chronic motor complete SCI. Due to the limitations of the study, such as small sample size and lack of a control group, further studies are needed to clarify the effect of improving seated balance through EAW training.

Effects Of 24-week Wuqinxi Intervention On Posture Control Ability Of Patients With Parkinson’S Disease

PURPOSE: This study was to determine the effects of 24-week’s Wuqinxi routine on posture control ability in patients with Parkinson’s disease (PD). METHODS: A randomized, controlled trial design was used in this study. Forty-six patients (23 women) with stage 1 through 3 Parkinson’s on the Hoehn and Yahr staging scale were randomly assigned into a Wuqinxi training group or a stretching group. All participants practiced 60-minute exercise sessions twice weekly for 24 weeks. The NeuroCom Balance Manager System was used to assess Limit of Stability and Unilateral Stance. Limit of Stability (LOS) is a test that evaluates the movement of the center of gravity on a test platform to the farthest boundary that can be achieved. Limit Of Stability was performed to assess posture control ability, along with the standing time of Unilateral Stance and the Unified Parkinson’s Disease Rating Scale(UPDRS)III scores before and after the 24-week exercise interventions. Mixed-model (group by time) Repeated measures ANOVAs using SPSS 24.0 were conducted to determine the differences in balance ability between the Qigong and Wuqinxi groups before and after the intervention. Statistical significance was set at p<0.05. RESULTS: After 24 weeks of exercise intervention, PD patients in the Wuqinxi group showed a significant increase in forward maximum excursion and endpoint excursion.(Table 1) CONCLUSIONS: After 24 weeks of exercise intervention, the posture control ability of patients with Parkinson's disease in the Wuqinxi group was significantly improved and it has already been appeared after the 12th week.

Effects of Unstable Support Surface and Weight Load on Muscle Activity and Balance During Squat Exercise

Purpose: The purpose of this study is to find and compare the differences between muscle activity change and balance during unstable support and weight load during the squat exercise. Methods: The subjects were 36 normal adults (18 male and 18 female). It was randomly divided into a stable support group (control group), an unstable support group (experimental group 1), and an unstable support surface weighted group (experimental group 2), and the squat exercise was performed for 4 weeks. Togu jumper (TOGU, Germany) was applied as the unstable support surface, and 4 kg of Kettlebell (Schmidt, China) was applied for the weight load. The squat exercise was conducted three times a week and consisted of 10 minutes of warm-up, 20 minutes of the main exercise, and 10 minutes of down exercise. This exercise was repeated three sets of 15 squats. Results: The result is as follows. First, changes in muscle activity according to the experimental period increased in both the stable and unstable support groups and the unstable support and the largest increase in the weight load group (p<.05). Second, change in the balance ability according to the experiment period was most improved in the unstable support according to the experiment period in the change of Endpoint excursion (EPE) and the Directional control (DCL) than the other two groups (p<.05). Conclusion: Squat exercise is effective as an exercise to improve the strength and balance of leg muscles. As in previous studies, it was found that exercise is more effective on the unstable support than on the stable support and that it is most effective to give weight load on the unstable support.

Relationship between soleus H-reflex asymmetry and postural control in multiple sclerosis

Background Impaired postural control is a common symptom in people with multiple sclerosis. Multiple sclerosis frequently presents with asymmetric motor involvement. One measurement yet to be evaluated for asymmetry in people with multiple sclerosis is the soleus Hoffmann reflex. Purpose To measure the soleus Hoffmann reflex between limbs and correlate reflex asymmetry with postural control. Material and methods 16 participants completed four sessions of Hoffmann reflex testing and one session of balance testing. Results Multiple sclerosis participants had significantly greater reflex asymmetry (p = 0.01). The multiple sclerosis group had a significantly lower overall sensory organization testing composite score (p < 0.05), indicating sensory interpretation conflict that resulted in greater postural instability. Multiple sclerosis participants produced a significantly shorter endpoint and maximum excursion (p < 0.01) during limits of stability testing. Hoffmann reflex asymmetry was negatively related to forward endpoint excursion (p < 0.05), maximum excursion (p 0.01). Conclusions Multiple sclerosis participants had greater soleus Hoffmann reflex asymmetry, which appears to significantly influence forward postural control. Implications for rehabilitation Soleus Hoffmann reflex asymmetry appears to influence postural stability. The soleus Hoffmann reflex is capable of adapting to different modes of exercise; therefore, to reduce H-reflex asymmetry it is recommended to individualize physical rehabilitative programming. Assessing the soleus Hoffmann reflex in people with multiple sclerosis during health screenings could be of use to clinical and rehabilitative practitioners.

Effect on the Limit of Stability of the Lowered Center of Mass With a Weight Belt

Background: The consequences of falls are often debilitating, and prevention is important. In theory, the lower the center of mass (COM), the greater postural stability during standing, and a weight belt at the waist level may help to lower the COM and improve the standing balance. Objects: We examined how the limit of stability (LOS) was affected by the lowered center of mass with the weight belt. Methods: Twenty healthy individuals participated in the LOS test. After calculating each participant’s COM, a weight belt was fastened ten centimeters below the COM. Trials were acquired with five weight belt conditions: 0%, 2%, 4%, 6%, and 8% of body weight. Outcome measures included reaction time, movement velocity, endpoint excursion, maximum excursion, and directional control in 4 cardinal moving directions. Results: None of our outcome variables were associated with a weight belt (p > 0.075), but all of them were associated with moving direction (p < 0.01). On average, movement velocity of the COM and maximum excursion were 31% and 18% greater, respectively, in mediolateral than anteroposterior direction (5.4°/s vs. 4.1°/s; 97.5% vs. 82.6%). Conclusion: Our results suggest that postural stability was not affected by the weightinduced lowered COM, informing the development and improvement of balance training strategies.

Balance performance in patients with heart failure

BackgroundIt has been suggested that patients with heart failure (HF) have an increased fall rate. Although balance is one of the most important risk factors for fall, there is not sufficient information about balance in HF. ObjectiveTo compare static, dynamic and functional balance between patients with HF and healthy controls. MethodsTwenty-seven patients with HF and 22 healthy controls were recruited in this study. The Unilateral Stance (US) and Limits of Stability (LOS) tests were used to measure static and dynamic balance, respectively. Functional balance was assessed with Berg Balance Scale. ResultsThere was no significant difference in age, gender and body mass index between the groups (p > 0.05). There was a significant difference in US with open eyes between the groups (p < 0.05). Reaction time (backward and left), endpoint excursion (backward), maximum excursion (forward and backward) and directional control (forward and right) variables of LOS were significantly different between the groups (p < 0.05). ConclusionsPatients with HF have impaired static, dynamic and functional balance. Considering the balance impairment, a comprehensive balance assessment performed and balance training should be included in the management of HF as a part of the cardiac rehabilitation program.