Evaluation Of Balance Research Articles

Use of the Brief-BESTest partially instrumented with accelerometry to detect balance deterioration in middle-age

BackgroundMost standardized balance tests cannot detect subtle balance deterioration in middle age, or identify those at higher risk for accelerated balance decline due to a ceiling effect.AimsTo determine whether the Brief Balance Evaluation Systems Test (Brief-BESTest), partially instrumented with accelerometry, can detect balance deterioration in middle age and identify individuals with poor balance.MethodsWe studied young (25.3 ± 2.3 years), early middle-aged (47.7 ± 2.6 years), and late middle-aged adults (60.6 ± 3.6 years), with 25 participants in each age group. Subjects wore an accelerometer on their lower back while performing the Brief-BESTest. Balance measurements included the Brief-BESTest total and sub-measures scores, and postural sway during the Brief-BESTest standing tasks, calculated by the 95% confidence ellipse trajectory of the center of mass (COM-95% ellipse).ResultsCompared to the two middle-aged groups, young adults had better total Brief-BESTest and sub-measures scores, apart from the Stability-in-Gait sub-measure, and less postural sway during the Sensory-Orientation sub-measure. The total Brief-BESTest scores as well as the Biomechanical-Constraints and Sensory-Orientation sub-measures differed also between early and late middle-aged adults. Both the Brief-BESTest total scores and the Sensory-Orientation postural sway values demonstrated increased variation with age, allowing to identify subjects with poor balance. A moderate negative correlation (r = -0.43) was found between the Brief-BESTest total score and the COM-95% ellipse size, and a moderate agreement (k = 0.56) in identifying subjects with poor performance in the early but not the late middle age group.ConclusionsThe Brief-BESTest test combined with accelerometry could be a suitable screening tool to identify middle-aged people with early balance deterioration and potentially identify those with poor balance and a possible higher risk for falls. Clinicians and policymakers can use our findings to implement balance assessment programs in patients < 65 years, leading to preventive strategies before the risk increases.

The Effects of Using Modern Technologies in the Neurorehabilitation Process of a Patient after Traumatic Brain Injury – A Case Study

This study presents an analysis of the case of a 44-year-old male patient who experienced a traumatic brain injury, resulting in spastic quadriplegia, meningitis, right-sided craniotomy, ventriculoperitoneal shunt placement, and right hip arthroplasty. Data was collected over a four-year comprehensive therapy process involving treatment periods, during which the patient was under the care of an interdisciplinary team and participated in an individualized rehabilitation program, consisting of 3-4 hours of physical therapy daily for 5-6 days per week. The material included results from functional tests, muscle tone assessments, and balance evaluations. Numerical data from robotic gait therapy devices were also considered. With the consent of the patient and his family, the therapy process was documented via video recordings and photographs, which were then used for a retrospective visual analysis of recorded material at various stages of rehabilitation. For this purpose, the ShapeCare.Fizjo device was used, along with Blaze Pose software, based on a moving person’s skeletal detection model. The results indicated that comprehensive therapy using innovative tools such as C-eye, ReoGo, ReoAmbulator, and LeviActive system improved the patient’s balance and motor skills, as well as facilitated the gait re-education process. The use of modern technologies in neurorehabilitation not only optimizes therapeutic outcomes but also reduces the risk of musculoskeletal strain for the therapist during their professional work.

Use of an inertial sensor and a force platform to assess static balance in participants affected by multibacillary leprosy.

Leprosy is a chronic, slowly developing infectious disease that affects the peripheral nerves, specifically Schwann cells. Individuals with the multibacillary type exhibit a propensity for developing chronic pain and a decrease in sensitivity in the plantar region, which directly interferes with balance maintenance. The evaluation of static balance in this population is made through the measurement of the center of pressure (COP) oscillations. Therefore, there is a need to investigate the association between postural control and COP oscillations using a force platform and finding accelerations of the center of mass (COM) from inertial sensors for reliable and portable balance assessment in leprosy patients. To validate the application of inertial sensors for patients with leprosy by establishing a correlation with the outcomes obtained from a force platform. This is an observational study with a case-control design, in which 30 participants with leprosy and 30 healthy participants were recruited to evaluate static balance using an inertial sensor and a force platform. Participants underwent balance assessment under two conditions (Eyes Open: OE and Eyes Closed: CE), and data from the platform and sensor were processed using Matlab computational routines. The data were quantified using four parameters: Total Displacement (TD), Area, Antero-Posterior Displacement (APdisp), and Medio-Lateral Displacement (MLdisp). The evaluated parameters showed significantly different values between the groups, where the Leprosy group exhibited significantly higher values compared to the control group, both in the OE and CE conditions for all four parameters. The sensor corroborated the differences demonstrated by the platform and followed the same trend for medio-lateral displacements and accelerations. It can be observed that the evaluated parameters exhibited a varied correlation ranging from moderate to large between the platform and the sensor. Among the four variables, MLdisp had the lowest correlation. The results partially confirmed the first hypothesis of concurrent validation, showing a moderate to large correlation between the force platform and the inertial sensor. The second hypothesis of clinical validation was also partially confirmed, as not all group differences observed in the COP measurements from the force platform were reflected in the COM measurements from the inertial sensor. Specifically, the force platform indicated greater oscillations in participants with multibacillary leprosy compared to controls, a finding statistically confirmed by the sensor for all measures except MLdisp. This research confirmed the concurrent validity of the inertial sensor with the force platform and its clinical validation, demonstrating that this instrument can be applied in clinical settings due to its low cost and ease of use. The findings may contribute to public health by identifying postural control tools for patients with multibacillary leprosy.

Differences in the Impact of Intensive Rehabilitation on Hereditary Ataxias and the Cerebellar Subtype of Multiple System Atrophy.

Multiple system atrophy-cerebellar type (MSA-C) exhibits faster disease progression than does hereditary spinocerebellar degeneration (hSCD). In this study, we aimed to investigate the differences in the treatment effects and sustainability of intensive rehabilitation between patients with hSCD and those with MSA-C. Forty-nine patients (hSCD = 30, MSA-C = 19) underwent a 2- or 4-week intensive rehabilitation program. Balance function was evaluated using the scale for the assessment and rating of ataxia (SARA) and the balance evaluation systems test (BESTest) at pre-intervention, post-intervention, and 6-month follow-up. Notably, both groups demonstrated beneficial effects from the rehabilitation intervention. However, differences were observed in the magnitude and duration of these effects. In the hSCD group, the SARA scores at follow-up remained similar to those at baseline, indicating sustained benefits. However, the MSA-C group showed some deterioration in SARA scores compared with baseline scores but maintained improvements on the BESTest, demonstrating partial sustainability. Differences, mainly in sustainability, were observed between the hSCD and MSA-C groups. This may be due to varying rates of symptom progression. The findings of this study are significant when considering the frequency of follow-ups based on disease type.

Shoulder-assist exoskeleton effects on balance and muscle activity during a block-laying task on a simulated mast climber

Interest in utilizing exoskeletons to mitigate the risks of musculoskeletal disorders (MSDs) among construction workers is growing, spurred by encouraging results in other industries. However, it is crucial to carefully examine their impact on workers' stability and balance before implementation. In this study, seven male participants lifted a 35-lb cinder block from a production table to a simulated wall at two heights—elbow and shoulder levels—using three different exoskeleton models on an unstable platform, where their balance and shoulder muscle activity were assessed. Balance-related parameters, included mean distance (MDIST), total excursion (EXCUR), and mean velocity (VEL) of the center of pressure, were derived from force plate data. Muscle activity in six shoulder and upper arm muscles was estimated using electromyography (EMG) data. The results indicated that wearing two of the exoskeletons significantly increased both total and medio-lateral (ML) MDIST compared to not wearing an exoskeleton. Wearing one of the exoskeletons significantly increased total and ML VEL and ML EXCUR. Although lifting level did not have a significant impact on the balance parameters, it did affect the muscle activity in most of the measured muscles. Moreover, only one exoskeleton significantly reduced the activity in a particular shoulder muscle compared to no exoskeleton use. In conclusion, the evaluated shoulder-assist exoskeletons showed limited benefits for preventing upper extremity MSDs and may negatively affect whole-body balance during a block-laying task on an unstable platform. These findings underscore the importance of comprehensive evaluations of balance and effectiveness prior to adopting exoskeletons in construction.

Delayed Cortical Responses During Reactive Balance After Stroke Associated With Slower Kinetics and Clinical Balance Dysfunction.

Slowed balance and mobility after stroke have been well-characterized. Yet the effects of unilateral cortical lesions on whole-body neuromechanical control is poorly understood, despite increased reliance on cortical resources for balance and mobility with aging. Objective. We tested whether individuals post stroke show impaired cortical responses evoked during reactive balance, and the effect of asymmetrical interlimb contributions to balance recovery and the evoked cortical response. Using electroencephalography, we assessed cortical N1 responses evoked over fronto-midline regions (Cz) during backward support-surface perturbations loading both legs and posterior-lateral directions that preferentially load the paretic or nonparetic leg in individuals' post-stroke and age-matched controls. We tested relationships between cortical responses and clinical balance/mobility function, as well as to center of pressure (CoP) rate of rise (RoR) during balance recovery. Cortical N1 responses were smaller and delayed after stroke (P < .047), regardless of perturbation condition. In contrast to controls, slower cortical response latencies associated with lower clinical function in stroke (Mini Balance Evaluation Systems Test: r = -.61, P = .007; Timed-Up-and-Go: r = .53, P = .024; walking speed: r = -.46, P = .055). Paretic-loaded balance recovery revealed slower CoP RoR (P = .012) that was associated with delayed cortical response latencies (r = -.70, P = .003); these relationships were not present during bilateral and nonparetic-loaded conditions, nor in the older adults control group. Individuals after stroke may be limited in their balance ability by the slowed speed of their cortical responses to destabilization. In particular, paretic leg loading may reveal cortical response impairments that reflect reduced paretic motor capacity.

Effects of Neuromuscular Exercise on Dynamic Balance, Vertical Jump and Trunk Endurance in Ice Hockey Players: A Randomized Controlled Trial

This study aims to investigate the impact of a 12-week neuromuscular exercise program on balance, vertical jump, and core endurance parameters in female ice hockey players. Y balance test, vertical jump test and McGill test were used for evaluation of dynamic balance, vertical jump and trunk endurance, respectively. A 12-week training program was conducted on 50 female ice hockey players. The exercise group showed significant differences in anterior and posteromedial balance scores for both right and left (p&amp;lt;0.05), but there was no significant difference in posterolateral scores (p&amp;gt;0.05). The control group didn't show significant improvements in the vertical jump (p&amp;gt;0.05), while the neuromuscular exercise group demonstrated a statistically significant improvement (p&amp;lt;0.05). Trunk extension endurance improved significantly in the control group (p&amp;lt;0.05), but there were no significant differences in trunk flexion and lateral endurance (p&amp;gt;0.05). In contrast, the neuromuscular exercise group significantly improved all trunk endurance values (p&amp;lt;0.05). Neuromuscular exercise training applied to ice hockey players can improve the balance, vertical jump, and trunk endurance parameters. Therefore, the inclusion of neuromuscular exercise programs in the training programs of female ice hockey players can enhance their physical performance and may reduce the risk of injury.

Evaluation of energy balance and greenhouse gas emissions in major crops in the Ardabil plain

ABSTRACT The present study evaluated energy flow and the emission of greenhouse gases in the major crop production of the Ardabil plain, Iran, including wheat, potato, alfalfa, barley, and canola. The information required for this study was obtained using a questionnaire and face-to-face interviews with 1,078 farmers in the Ardabil plain during the crop year 2017–2018. Indices of input energy, output energy, specific energy, energy use efficiency, energy productivity, and global warming potential were calculated. The results showed that among the studied crops, the highest energy use efficiency was obtained with wheat and barley, being 5.2 and 5.14, respectively, and the lowest energy efficiency was obtained with alfalfa, rapeseed, and potato, being 4.6, 4.5, and 2.15, respectively. Potato (equivalent to 3,186.2 kg CO2/ha) and wheat (equivalent to 1,727.5 kg CO2/ha) had the largest share in the potential of global warming and greenhouse gas emissions compared to canola (equivalent to 1,326.22 kg CO2/ha), alfalfa (equivalent to 1,157.04 kg CO2/ha), and barley (equivalent to 952.39 kg CO2/ha). The production of crops with high water requirements and high chemical fertilizer consumption using old machines had a greater share in the amount of energy consumption and global warming compared to other crops.

Assessment of grassland carrying capacity drivers and evaluation of pasture-livestock balance: A case study of Xinjiang, China

Evaluating the spatiotemporal variations and driving mechanisms of carrying capacity (CC) is critical for optimizing grassland resource utilization and promoting sustainable development in grassland animal husbandry. This study focuses on Xinjiang, an arid and semi-arid region significantly impacted by environmental changes and human activities. To capture the dynamics of grassland CC, we employed Theil-Sen trend analysis and the Mann-Kendall test to assess spatiotemporal trends. The innovative use of the Geodetector method allowed for a detailed quantification of the influence of various environmental and human-related factors on grassland CC. Additionally, we incorporated livestock data to evaluate the overgrazing conditions of the grassland ecosystem. Our findings demonstrate that: (1) Grassland CC has shown a pronounced overall upward trajectory over the last twenty years, with notable inter-annual fluctuations and significant spatial variations, particularly between the northern and southern regions. (2) The spatial distribution of grassland CC is primarily influenced by precipitation patterns and population density, with key determining factors varying across different types of grasslands. Except for alpine steppe and alpine desert, the spatial distribution of grassland CC was primarily influenced by two-factor interactions, surpassing the impacts of single-factor effects. (3) The overgrazing rate has generally declined, peaking in 2014 and showing the mildest condition in 2017. In comparison, the overgrazing situation in Northern Xinjiang is relatively more favorable, whereas the southern and eastern regions necessitates more immediate and comprehensive ecological restoration and management measures. In summary, this study provides important scientific evidence for prioritizing grassland protection and planning for the sustainable animal husbandry development in arid and semi-arid regions.

Soft tissue elasticity in total knee arthroplasty: An in vivo quantitative analysis

BackgroundSoft tissue balance is essential for total knee arthroplasty success. The elastic properties of soft tissues affect knee-joint stability and flexibility. This study proposed a novel methodology for in vivo quantitative analysis of soft tissue elasticity during total knee arthroplasty. In this study, we aimed to (1) establish a mathematical model to depict medial and lateral soft tissue elasticity, (2) report the individual differences and interindividual commonalities in soft tissue elasticity. MethodsA specifically designed knee tensor was used to evaluate soft tissue elasticity by dynamically applying sequential tensions to medial and lateral compartments while measuring knee joint gaps in both compartments. Measurements were performed on ten knees of six cadavers. Bivariate polynomial regression was used for analysis, and the equivalent elastic coefficient (N/mm) was calculated. FindingsSoft-tissue elasticity showed high individual differences. The equivalent elastic coefficient was larger in the medial compartment than in the lateral compartment, and the equivalent elastic coefficient of the lateral compartment gradually decreased while the medial equivalent elastic coefficient remained constant when the knee was flexed. The lateral gaps increased from 0.1 to 3.9 mm, and the medial gaps increased from 0 to 1.5 mm when the tension increased from 60 to 90 N. The shapes and distributions of the silkworm-like lattices in elasticity and balance evaluations are clinically relevant to knee balance. InterpretationSoft-tissue balance in total knee arthroplasty is significantly affected by soft-tissue elasticity. An intraoperative quantitative analysis of elasticity helps to tail an individualized balancing target for total knee arthroplasty.

Causal technological model for predicting void fraction and energy consumption in material extrusion process of polylactic acid

The rapid expansion of Additive Manufacturing (AM) technologies within the framework of Industry 4.0 raises important questions about their sustainability. Specifically, the widespread use of Material Extrusion (MEx) processes for polymeric materials necessitates a thorough evaluation of the possible balance between performance efficiency and sustainability, highlighting the need for further research into optimizing process parameters to ensure high product quality and reduced energy consumption. The present work focuses on Fused Filament Fabrication (FFF) technology, investigating the relationship between sustainability and print quality. A causal technology model is proposed to elucidate this relationship, underlining the impact of process parameters on defect generation and energy use. A real-time monitoring system for energy consumption measurements was employed to create an energy model that accounts for each component of the CreatBot F430 printer. An image analysis procedure was performed on a special configuration of the HIROX RH-2000 digital microscope to determine the void fraction of each sample. An experimental campaign was conducted, producing single-layer samples in polylactic acid (PLA) following a full factorial plan with four process parameters. A void fraction of up to 18 % was observed, with energy consumption per sample ranging between 638 J and 8843 J. Statistical analysis was performed to assess the impact of each process parameter and to determine operational ranges through the Response Surfaces Method. These results showed good agreement with the predicted conditions, demonstrating the model's effectiveness in supporting decision-making processes in technology selection.

Timed Up‐and‐Go Test and Sit‐to‐Stand Test in Community‐Dwelling Older Person: Inter and Intraobserver Reliability Among Turkish Nurses

ABSTRACTBackgroundA decrease in dynamic balance and muscle strength related to ageing is associated with a decreased quality of life, reduced life expectancy and increased risk of falls. Timed stand‐up test (TUG) is one of the most used clinical tests for the evaluation of dynamic balance and sit‐to‐stand test (STS). Although these tests are reported to be reliable in pathological conditions in different populations and different countries, there is a gap in the evaluation of the reliability of the tests by nurses in the older persons living in Turkish society.ObjectiveThe present study aimed to investigate the inter‐ and intra‐observer reliability of the timed up‐and‐go test (TUG) and sit‐to‐stand test (STS) performed by nurses in Turkish community‐dwelling older persons.MethodsA total of 97 community‐dwelling older persons participated in this study. To determine the interobserver reliability of the TUG and STS tests, all tests were performed at an interval of 30 min by two nurses. To determine the intra‐observer reliability of the tests, each measurement was repeated 1 week after the first measurement by another nurse.ResultsExcellent intra‐observer reliability was found for the TUG (intraclass correlation coefficient [ICC] = 0.962) and STS tests (ICC = 0.996), with a total range of 0.943–0.997. Excellent interobserver reliability was found for the TUG (ICC = 0.995) and STS (ICC = 0.996) tests. The coefficient of variant values for the tests was &lt; 15%.ConclusionOur results demonstrated that the TUG and STS tests can be reliably used by nurses in community‐dwelling older persons.Implications for PracticeThis study is important in terms of determining the risk of falling among older persons aged 60 and over in Turkey, preventing hospitalisations due to falls and developing nursing policies that promote the safety of older persons individuals.

Multicentre investigation on the effect of decompressive surgery on Balance and physical ActiviTy Levels amongst patients with lumbar Spinal stenosis (B-ATLAS): protocol for a prospective cohort study

IntroductionPatients with lumbar spinal stenosis may have poor balance, decreased physical function and problems maintaining physical activity levels due to radiculopathy. Decompressive surgery is often indicated if conservative management fails...

Feasibility of Using Standardized Outcome Measures in the Remote Assessment of Patients with Chronic Stroke: A Case Series

Introduction: With the increase of telerehabilitation utilization worldwide after the COVID-19 pandemic, a review of the current literature shows a concurrent increase in telerehabilitation studies focusing on interventions and delivery models. There is a gap in research on valid and reliable tests and measures that can be used in the physical therapy examination of people with stroke via telerehabilitation. Current reports on psychometric properties of most standardized outcome measures are only applicable in an in-person setting and may not be directly applicable in a remote setting where various challenges contribute to the reliability of results. This report describes the feasibility of administering selected standardized outcome measures in the remote assessment of three patients with chronic stroke with different contexts. Methods: Three patients with chronic stroke underwent physical therapy examination and intervention sessions via telerehabilitation with varying contexts. Results: Various factors affected the results of the assessment including patient and caregiver’s (if present) ability to follow instructions, availability of material and spatial resources, and stability of internet connection. Strategies to improve reliability of assessment results can also be employed such as performing repeat trials, reviewing recordings for accuracy and confirmation, using highly visible markers, and confirming measurement accuracy on video. Discussion: Physical therapy outcome measures that can feasibly be administered remotely are the Timed Up and Go Test, the 10-Meter Walk Test, the 6-Minute Walk Test, the 5-Times Sit to Stand Test, and the Stroke Impact Scale. The Mini Balance Evaluation Systems Test could not be administered remotely as close to standard protocol as possible due to the difficulty of administering the reactive postural component with patient anxiety and safety considerations and materials required.

The Association of Conventional Therapy Associated with Somatosensory Interactive Game Enhances the Effects of Early Pulmonary Rehabilitation for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.

Objective: This study aimed to evaluate the effect of somatosensory interactive games in combination with pulmonary rehabilitation programs (PRPs) on exercise tolerance, balance function, pulmonary function, inflammatory markers, and healthcare utilization in individuals with acute exacerbation of chronic obstructive pulmonary disease over 12 months. Design: In a randomized controlled trial, 80 patients were divided into two groups. The control group participated in a lasted 30 minutes daily program composed of postural training for 10 minutes, limb movement for 10 minutes, and breathing exercises for 10 minutes based on regular oxygen therapy and medication. The experimental group received a once-daily, 20-minute somatosensory interactive game session based on the control group. Patients began treatment within 48 hours after admission and lasted for 6 weeks. Results: The time × group interactions on 6-minute walk distance (6MWD) and Brief Balance Evaluation Systems Test (Brief-BESTest) between the two groups were significant (P < 0.001). At the postintervention and each time point of follow-up, the 6-minute walk distance (6MWD) and Brief-BESTest of the intervention group were significantly higher than those of the control group (P < 0.05). The effects of time factor on forced expiratory volume in one second and forced vital capacity were statistically significant (P < 0.05). The 6MWD and Brief-BESTest of the intervention group peaked 3 months after the intervention and were higher than the control group within 12 months. C-reactive protein and procalcitonin were similar between the groups before and after intervention (P > 0.05). The readmission rates and mean length of time spent in the hospital were comparable between the groups at 12 months (P > 0.05). Conclusions: The addition of somatosensory interactive games based on a PRP was safe and feasible, and this benefit persisted for 12 months, peaked at 3 months after the intervention, and then gradually decreased.

Dynamic balance and gait impairments in Parkinson's disease: novel cholinergic patterns.

The cholinergic system has been implicated in postural deficits, in particular falls, in Parkinson's disease (PD). Falls and freezing of gait typically occur during dynamic and challenging balance and gait conditions, such as when initiating gait, experiencing postural perturbations, or making turns. However, the precise cholinergic neural substrate underlying dynamic postural and gait changes remains poorly understood. The aim of this study was to investigate whether brain vesicular acetylcholine transporter binding, as measured with [18F]-fluoroethoxybenzovesamicol binding PET, correlates with dynamic gait and balance impairments in 125 patients with PD (mean age 66.89 ± 7.71 years) using the abbreviated balance evaluation systems test total and its four functional domain sub-scores (anticipatory postural control, reactive postural control, dynamic gait, and sensory integration). Whole brain false discovery-corrected (P < 0.05) correlations for total abbreviated balance evaluation systems test scores included the following bilateral or asymmetric hemispheric regions: gyrus rectus, orbitofrontal cortex, anterior part of the dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, cingulum, frontotemporal opercula, insula, fimbria, right temporal pole, mesiotemporal, parietal and visual cortices, caudate nucleus, lateral and medial geniculate bodies, thalamus, lingual gyrus, cerebellar hemisphere lobule VI, left cerebellar crus I, superior cerebellar peduncles, flocculus, and nodulus. No significant correlations were found for the putamen or anteroventral putamen. The four domain-specific sub-scores demonstrated overlapping cholinergic topography in the metathalamus, fimbria, thalamus proper, and prefrontal cortices but also showed distinct topographic variations. For example, reactive postural control functions involved the right flocculus but not the upper brainstem regions. The anterior cingulum associated with reactive postural control whereas the posterior cingulum correlated with anticipatory control. The spatial extent of associated cholinergic system changes were least for dynamic gait and sensory orientation functional domains compared to the anticipatory and reactive postural control functions. We conclude that specific aspects of dynamic balance and gait deficits in PD associate with overlapping but also distinct patterns of cerebral cholinergic system changes in numerous brain regions. Our study also presents novel evidence of cholinergic topography involved in dynamic balance and gait in PD that have not been typically associated with mobility disturbances, such as the right anterior temporal pole, right anterior part of the dorsomedial prefrontal cortex, gyrus rectus, fimbria, lingual gyrus, flocculus, nodulus, and right cerebellar hemisphere lobules VI and left crus I.

Limits of Stability during a Therapeutic Exercise Intervention for Instability: Progression, Responders' and Non-Responders' Analysis and Predictors.

Background/Objectives: Instability is one of the main symptoms in patients with vestibular and neurological disorders and therapeutic exercise interventions are increasing in popularity as a form of treatment. Additionally, the limits of stability measurement are known to be a good tool for balance evaluation and monitoring of these interventions. The aim of this work is to better understand how a specific protocol provokes changes on this variable and to study the characteristics of those who do and do not respond to it. Methods: A retrospective study was developed with the data of 40 patients treated in the Otorhinolaryngology department in Clínica Universidad de Navarra (Madrid, Spain). They had an initial reduction in limits of stability, completed the proposed protocol with home-based and hospital-based exercises and with frequent limits of stability remeasurement, and were assisted to a follow-up retest after 1-2 months. Results: A progressive improvement in limits of stability measure was developed through the intervention and was partially retained at follow-up visit. Several differences were found between those patients who improved with the treatment (responders) and those who did not improve (non-responders). More specifically an initial measure of the limits of stability was able to differentiate those groups with a cut-off data of 56 cm2. Conclusions: The proposed protocol was able to induce motor learning in patients included in this study with good retention after 1-2 months. Furthermore, there is some variability in how patients respond to the treatment. Age and diagnosis should be considered and an interesting cut-off data for clinal decision making was found.

Comparing balance using the BESTest in Alzheimer, Huntington and Parkinson disease.

Aim: Individuals with Alzheimer disease (AD), Huntington disease (HD) and Parkinson disease (PD) have impaired balance, and comparing these deficits could improve management of neurological diseases.Methods: Scores on the Balance Evaluation Systems Test (BESTest) were compared across three groups, consisting of individuals with AD, HD and PD in early stages of their respective disease.Results: Individuals with PD had significantly higher scores on the BESTest than individuals with AD (95% CI [4.30, 21.37], p<0.01) or HD (95% CI [6.53, 24.18], p<0.001). Individuals with AD and HD were not significantly different on the overall BESTest or any of its subsections.Conclusion: AD and HD may have overlapping pathologies resulting in early and similar balance impairments in these groups.

Evaluation of water resource balance in the Urmia Lake Basin: Integrating carrying capacity and water footprint model for sustainable management

Given the scarcity of water resources and the ever-growing demand, effective water flow management becomes crucial. The Lake Urmia Basin, a critical region in Iran, faces severe water scarcity exacerbated by climatic changes, land use alterations, over-extraction of groundwater, and mismanagement. This study evaluates the water resource balance by integrating carrying capacity and water footprint models to assess sustainable water management practices. Utilizing the InVEST model, water provisioning ecosystem services have been estimated as the supply, while the ecological footprint method quantifies water demand across various sectors. Three scenarios are evaluated: continuation of the current situation, an ideal scenario with substantial reductions in water consumption and pollution, and implementation of operational programs. The findings reveal significant water deficits in certain sub-basins, highlighting the need for a fundamental revision of resource allocation based on each region’s ecological capacity. Lake Urmia, the central nucleus of the basin, has experienced a significant size reduction, approximately 10 % of its original size, from the early 1990s to 2018, due to climatic changes, land use alterations, over-extraction of groundwater, and mismanagement. The environmental deficit in some sub-basins raises serious concerns, even in the best scenario where ecological footprint reduction is considered. These results underscore the effectiveness of ecosystem-based comprehensive capacity analysis for sustainable watershed development. This research offers a unified spatial system for quantifying ecological footprints and land resilience, providing critical insights into addressing water scarcity and supporting holistic regional planning.

Sudden sensorineural hearing loss during pregnancy. A case study and literature review

&lt;b&gt;Introduction:&lt;/b&gt; Sudden sensorineural hearing loss (SSNHL) is defined as the sudden onset of hearing loss of 30 dB or more, across three consecutive frequencies in a pure-tone audiogram occurring within a 72-hour period. The term “sensorineural” indicates that the cause of the hearing loss lies in disturbances within the cochlea or auditory nerve. SSNHL typically presents as unilateral, transient hearing loss that occurs upon awakening. Bilateral hearing loss occurs in less than 2% of patients. Additionally, patients may report sensations of ear fullness or blockage, tinnitus, dizziness, nausea, and vomiting.&lt;b&gt;Aim:&lt;/b&gt; Defining the management of SSNHL in pregnant women.&lt;b&gt;Case report:&lt;/b&gt; This article describes the case of a 36-years-old pregnant woman who developed hearing impairment in the left ear in the third trimester along with tinnitus and balance disorders.&lt;b&gt;Discussion:&lt;/b&gt; The occurrence of SSNHL in pregnant women is rare and not well understood. Majority of pregnant patients with SSNHL experienced the condition in second or third trimester. Key elements facilitating an accurate diagnosis include: interview and physical examination, hearing tests, balance evaluation, and imaging studies. The exact causes of SSNHL in pregnant women remain unknown. However, hormonal changes during pregnancy can have some contribution to development of this condition. Onset of SSNHL symptoms could resemble Ménière’s disease.&lt;b&gt;Conclusions:&lt;/b&gt; Due to rare occurrence of SSNHL in pregnant women, there is no standardized approach to managing this medical issue. Given that most cases of SSNHL are classified as idiopathic, empirical treatment primarily involves steroids.