Development and validation of a semi-structured interview guide to explore patient perspectives on physiotherapy advancements in the management of diabetic peripheral neuropathy.

The effects of hybrid assistive limb (HAL) application on locomotor function and balance parameters in individuals with multiple sclerosis.

The effect of United States firefighters' personal protective equipment on mobility and functional task performance: A scoping review.

Despite individuals with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) often reporting impaired balance as a main concern, there is a lack of research characterizing balance impairments or evaluating whether immunomodulatory therapy improves balance. Therefore, this study aimed to determine how treatment affects static and dynamic balance in CIDP using objective, laboratory-based measures. Ten participants diagnosed with CIDP and receiving regular intravenous immunoglobulin (IVIg) treatments, and 13 healthy controls (HC) participated in this study. Participants completed two testing sessions corresponding to end- and mid-cycle IVIg treatment, which included: (1) clinical assessments of strength, sensation, balance, mobility and balance confidence and (2) standing balance and modified gait tasks while wearing a belt-worn velocity transducer to measure trunk sway. Clinical assessments revealed reduced strength, sensation, balance confidence and balance in the CIDP group compared to the HC group (all p < 0.05). Significantly larger trunk sway amplitudes were observed in the CIDP compared to the HC group across most balance tasks (ranging from 62% to 181% larger amplitudes; p < 0.05), with the largest group differences observed when vision was removed and tasks emphasized proximal lateral instability. IVIg treatment was associated with significantly reduced trunk sway during the most challenging postural tasks (tandem stance without vision by 47%-53%; p < 0.05). CIDP affects postural control during both static and dynamic balance tasks. IVIg may be associated with improved balance during more challenging, dynamic balance tasks, although further research is needed to demonstrate the full extent to which immunomodulatory treatments can improve balance function in CIDP.

We investigated the impact of an 8-week tailored balance program, with or without superimposed sensory stimulation (local vibration [LV], and/or transcutaneous electrical nerve stimulation [TENS]), on balance and walking performance in older adults. Seventy-five healthy elderly participants (age 79.9 ± 3.9 years) were randomly assigned to one of four groups: postural exercises only ( n = 17), exercises with LV ( n = 19), exercises with TENS ( n = 19), and exercises with LV+TENS ( n = 20). For LV, TENS, and LV+TENS groups, proprioceptive stimulation targeted the triceps surae and tibialis anterior. Participants completed a baseline assessment including the Berg Balance Scale, Short Physical Performance Battery, 6-min walk test, 10-meter walk test, and Timed Up and Go test. A similar assessment was performed 8 weeks later, and after the 8-week tailored intervention, which consisted of two 1-h sessions per week. Balance and walking capacities were finally reassessed 8 weeks after training. In all groups, reliability of the outcome measures was moderate to high between baseline and preintervention values (intraclass correlation coefficients >0.63). Postintervention, linear mixed-effects models revealed significant improvements in Berg Balance Scale and Short Physical Performance Battery scores (53.1 ± 2.4 and 10.9 ± 0.9 vs 54.9 ± 2.4 and 11.5 ± 0.9, P < 0.001), and reduced times for Timed Up and Go test (7.3 ± 1.7 s vs 6.6 ± 1.7 s, P < 0.001) and increased 10-meter walk test velocity (3.6 ± 0.7 m/sec vs 3.4 ± 0.7 m/sec, P = 0.004), with no group differences nor interactions. Benefits were partially maintained 8 weeks after training. The interventions did not affect 6-min walk test performance (525.5 ± 75.1 m vs 527.8 ± 74.1 m, P = 0.143). Tailored balance exercises alone significantly enhanced postural control and walking capacity in healthy older adults. Additional sensory stimulation provided no extra benefit, suggesting that for healthy older adults without major balance impairments, exercises alone may suffice to achieve meaningful functional improvements.

Virtual Reality illusions systematically perturb balance in young and older adults.

Balance impairment is one of the major problems commonly experienced by older adults as a result of degenerative processes, leading to an increased risk of falls. Falls may cause fear of recurrent falling, reduced physical activity, loss of physical capability, and may eventually result in disability and psychological consequences such as depression. Structured, occupation-based physical activity has been shown to provide various benefits for older adults, including improving physical function, slowing functional decline associated with degenerative processes, reducing fall risk, and enhancing postural control. This study aimed to analyze the effect of the occupation-based Lee Silverman Voice Treatment (LSVT) BIG method on functional balance in older adults. A quantitative approach with a pre-experimental pretest–posttest design was employed. A total of 10 participants were recruited using a total sampling technique and underwent 16 intervention sessions over a 4-week period, with each session lasting 60 minutes. Measurement instruments included a respondent characteristic questionnaire, the Berg Balance Scale as the primary outcome measure, and the Canadian Occupational Performance Measure (COPM) for intervention planning. The results indicated that individual factors (age, Body Mass Index, and comorbidities), as well as physical activity characteristics (frequency, intensity, and duration of exercise), were not significantly associated with functional balance in this sample (p &gt; 0.05). In contrast, the paired t-test analysis demonstrated a significant effect of the occupation-based LSVT BIG intervention on functional balance in older adults (p &lt; 0.001). These findings suggest that the occupation-based LSVT BIG method may be considered a promising intervention approach for improving functional balance in older adults.

Background Anterior cruciate ligament (ACL) injuries frequently necessitate anterior cruciate ligament reconstruction (ACLR), yet balance deficits persist during preoperative and postoperative periods. However, comprehensive longitudinal comparative studies remain scarce. This study utilized a high-resolution plantar pressure system to thoroughly assess these balance characteristics, aiming to optimize clinical rehabilitation. Methods Fifty participants [25 in the ACLR group, 25 in the normal control (NC) group] were assessed using the SMARTX-MFS plantar pressure system. The ACLR group was assessed preoperatively, 2 months postoperatively, and 6 months postoperatively. The static parameters included the pressure proportion of the affected side (P A ), the center of pressure (COP) 95% confidence ellipse area (S COP ) and the COP trajectory length (L COP ). The dynamic parameters included COP medial-lateral offset length (L COP-ML ), COP anterior-posterior offset length (L COP-AP ), gait line length (L G ), single-leg support line length (L S ), maximum moving speed of COP (V MAX ), proportion of swing period (P SW ), support period (P S ), weight-bearing response period (P WB ), single-leg support period (P SL ), pre-swing period (P SP ), and the maximum pressure in the forefoot (P MAX-F ), arch (P MAX-A ) and heel (P MAX-H ). Inter-group and intra-group comparisons were conducted. Results Preoperatively: The ACLR group exhibited impairments in both static and dynamic balance, alongside profound bilateral asymmetry. Two Months Postoperatively: Only L COP-AP showed significant improvement (P &amp;gt; 0.05). Six Months Postoperatively: Static balance and most dynamic parameters showed no statistically significant differences compared to the NC group, except for increased L COP-ML (P &amp;lt; 0.05) and decreased L G and L S of the affected side (P &amp;lt; 0.05). Within the ACLR group, the affected side still exhibited extremely significant decreased L G , L S , and P MAX-F (P &amp;lt; 0.001), while P MAX-A and P MAX-H decreased significantly (P &amp;lt; 0.05). Conclusion The ACLR group showed significant balance deficits at pre-operation. Only the L COP-AP showed significant improvement at 2 months post-operation. The deficits basically recovered at 6 months post-operation. However, the asymmetry of COP trajectory and plantar pressure still existed. The study provided a basis for clinical rehabilitation assessment.

Application of functional near-infrared spectroscopy in older adults with balance impairment: A review.

Fear of falling (FoF) is prevalent among older adults with sarcopenia, frequently causing activity-restricting fear and requiring targeted interventions. Although FoF is influenced by individual factors like impaired balance or weakness of limbs, few studies have comprehensively analyzed its multidimensional factors. This study examines the relationships between FoF latent classes and multilevel factors (individual, familial, societal) in community-dwelling older adults with sarcopenia. This cross-sectional study utilized convenience sampling to recruit 356 participants (age ≥ 60 years) diagnosed with sarcopenia between December 2023 and December 2024. Data were collected using a structured questionnaire, along with the Falls efficacy scale international (FES-I), the Hospital Anxiety and Depression Scale (HADS), the Family APGAR index, and the Social Support Rating Scale (SSRS). Latent profile analysis (LPA) identified distinct FoF classes. Multivariable logistic regression and a decision tree model were employed to identify the determinants of FoF profiles in older adults with sarcopenia. Four latent profiles were identified: Low Fear of falling (22.0%), Medium Fear of falling (40.7%), High Fear of falling (26.8%), Severe Fear of falling (10.5%). To identify the associated factors distinguishing these profiles, a CART decision tree was constructed. The analysis revealed that physical activity level, family APGAR index, and anxiety were the critical determinants for classifying FoF profiles. Multinomial logistic regression further quantified the associations between physical activity level and FoF profile membership, with physical activity level showing higher odds of membership in the lower-severity FoF profiles relative to the Severe Fear of Falling profile. Our study found that FoF among community-dwelling older adults with sarcopenia exhibits significant heterogeneity and offers valuable insights to more effectively customize targeted programs to reduce fear severity and related burdens.

Cervical dizziness (CD) is associated with altered cervical musculoskeletal and proprioceptive input, leading to impaired sensorimotor integration and balance control. Vitamin D deficiency has been linked to musculoskeletal pain, muscle dysfunction, and impaired postural stability; however, its role in CD remains unclear. This prospective observational study included 210 patients diagnosed with CD. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at baseline, and participants were categorized into deficiency (< 20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥ 30 ng/mL) groups. All patients received a standardized multimodal cervical rehabilitation program, with vitamin D supplementation provided to the deficient and insufficient groups. Clinical outcomes were assessed using the Neck Disability Index (NDI), Dizziness Handicap Inventory (DHI), and Vertigo Dizziness Imbalance questionnaires (VDI-SS and VDI-QOL). Associations between vitamin D levels, baseline symptom severity, and recovery duration were analyzed using correlation, multivariable regression, receiver operating characteristic (ROC) analysis, and partial least squares discriminant analysis (PLS-DA). Lower serum 25(OH)D levels were significantly associated with higher baseline NDI, DHI, VDI-SS, and VDI-QOL scores (all p < 0.001), indicating greater symptom severity and functional impairment. Serum 25(OH)D levels showed a strong inverse correlation with recovery duration (rho = -0.77, p < 0.001) and remained associated with a longer recovery duration in multivariable linear regression. ROC analysis demonstrated high discriminatory performance for delayed recovery (AUC = 0.937), with an exploratory optimal threshold of ≤ 17 ng/mL. In exploratory PLS-DA, serum 25(OH)D contributed more to group separation than did age, sex, or BMI. Lower serum vitamin D levels were associated with greater baseline clinical severity and longer recovery duration in patients with CD. These findings suggest that vitamin D status may be clinically relevant in the assessment of disease severity and recovery in this population. Further prospective controlled studies are required to clarify the clinical significance of this association.

Multiple sclerosis (MS) frequently leads to balance impairments and an increased risk of falls. Because laboratory-derived stability metrics are rarely feasible in clinical routine, clinicians commonly rely on functional balance assessments. This exploratory cross-sectional study examined associations between six clinical balance tests (DGI, BBS, TUG, Mini-BESTest, SSST, CTSIB) and laboratory-derived measures of static and dynamic balance, including margin of stability (MoS), whole-body angular momentum (WBAM), and center of pressure (CoP) in 30 people with MS (EDSS 3.6 ± 1.1). Patients completed 3D gait analysis, force-plate posturography, and clinical tests. Spearman correlations and nonparametric bootstrapping were used to estimate associations and 95% confidence intervals. Clinical test scores generally showed moderate-to-strong correlations with CoP measures, with the strongest association observed for the BBS (r = 0.76). For dynamic outcomes, larger MoS values were associated with poorer clinical test performance, most prominently for the TUG, suggesting that MoS may partly reflect compensatory gait strategies rather than superior balance capacity. Frontal-plane WBAM showed its strongest correlation with the TUG (r = 0.67). In conclusion, the BBS was most closely associated with static balance, whereas the TUG showed the most consistent associations across selected static and dynamic laboratory-derived balance measures.

In hemiplegic patients, joint cartilage alterations may arise from impaired balance reactions, decreased selective motor control, abnormal muscle tone, or reduced weight shifting toward the affected limb. This study aimed to investigate the thickness of talar, femoral, and metacarpal cartilage on the paretic and nonparetic sides in hemiplegic patients and to compare these findings with those of healthy controls. Thirty-one hemiplegic patients and 31 age and sex-matched healthy individuals participated. The thickness of talar, femoral, 2nd metacarpal, and 3rd metacarpal cartilage was measured using an ultrasound device equipped with a linear probe. Measurements were performed by the same experienced examiner to ensure reliability. Talar (p=0.012, r=0.453) and femoral (p=0.016, r=0.431) cartilage were significantly thicker on the paretic side compared with the nonparetic side, while no differences were found in 2nd and 3rd metacarpal cartilage. Compared with controls, talar (p=0.018, r=0.299) and femoral (p=0.036, r=0.266) cartilage on the paretic side was thicker, whereas the nonparetic side showed no significant difference (p>0.05). The increased talar and femoral cartilage thickness on the paretic side could potentially be consistent with cartilage oedema or other structural changes; however, ultrasonography alone cannot differentiate between structural thickening, increased water content, subclinical synovitis, or methodological artefacts. Several alternative mechanisms may also contribute to the observed findings, including altered joint alignment, muscular imbalance, and spasticity-related loading changes secondary to hemiplegia. These findings warrant further investigation with longitudinal and multimodal imaging studies.

Falls are a major global public health challenge and a leading cause of severe consequences, such as fractures, traumatic brain injuries and even death among older adults. Older adults with knee osteoarthritis (KOA) are at a higher risk of falling and tend to experience more severe injuries due to impaired balance. Baduanjin, a mind-body exercise, has been shown to improve lower limb muscle strength and balance in older adults and to reduce fall risk in those with KOA; however, its specific mechanisms remain unclear. Therefore, this study aims to examine the effectiveness of Baduanjin in reducing fall risk among older adults with KOA and to preliminarily elucidate its underlying mechanisms. In this prospective trial, 72 KOA participants will be recruited and randomly assigned (1:1:1) to perform Baduanjin training, brisk walking training and health education. The health education group will conduct health education for the participants in the group once a month, a total of 3 times. Based on the health education group, the Baduanjin group and the brisk walking group were respectively subjected to 12 weeks of Baduanjin exercise intervention (40 min each, 3 times a week) and 12 weeks of brisk walking exercise intervention (60 min each, 3 times a week). The primary outcome will be the fall-risk self-assessment questionnaire and modified falls efficacy scale. The secondary outcome will be balance function test, gait subscale of the Tinetti performance-oriented mobility assessment, lower limb muscle strength and functional MRI (fMRI). In addition to the fMRI scan, the results will be measured before and after the intervention. Other primary and secondary outcomes will be measured at baseline, at week 6 at week 12 (at the end of the trial) and after an additional 12-week follow-up period. The linear mixed model will be used to observe the effect of intervention. This study was approved by the Ethics Committee of Bao'an District People's Hospital, Shenzhen (No. BYL20230811). Our research findings will be published in peer-reviewed journal articles and conference presentations. ChiCTR2400081342.

This study evaluated the efficacy of endurance exercise on balance impairment and gait disturbance among individuals living with Human Immunodeficiency Virus (HIV)-related distal symmetrical polyneuropathy (DSPN). This was a multi-centre, single-blinded randomized controlled trial (RCT). The intervention consisted of moderate-intensity endurance exercise (three 30-minute sessions per week for 12 weeks) (n = 45). The control group was a non-exercise, waitlist group (n = 47). Non-parametric inferential statistics were used, with the Friedman test for within-group comparisons and the Mann-Whitney U test for between-group comparisons. The alpha level was set at 0.05. At 12 weeks, the training group showed significant improvements in balance performance (P = 0.001) and walking ability (P = 0.001). In contrast, no significant changes in balance (P = 0.531) or gait (P = 0.12) were observed in the control group. Endurance training can lead to improvements in muscle strength, coordination, balance, functional status, and quality of life. This study concludes that moderate-intensity endurance exercise has a positive effect on balance impairment and gait disturbance in individuals with HIV-related DSPN.

Spinocerebellar ataxia type 10 in a Guatemalan family: Characterization and preliminary evaluation of neurofilament light chain as a biomarker.

Osteoporosis is a multifactorial skeletal disorder characterized by increased bone resorption and impaired remodeling balance. Osteoclast differentiation is accompanied by metabolic reprogramming toward enhanced glycolysis, yet whether nutritional factors modulate osteoclast metabolism remains incompletely understood. Vitamin B5 (VB5), a precursor of coenzyme A (CoA), has been implicated in metabolic regulation, but its role in osteoclast biology is unclear. An ovariectomy (OVX)-induced osteoporosis mouse model was established and fed VB5-deficient, normal, or VB5-supplemented diets. Bone microarchitecture was assessed by micro-computed tomography and histomorphometry. Osteoclast differentiation was evaluated in RAW264.7 cells and bone marrow-derived macrophages (BMDMs). Metabolic flux analysis, molecular docking, co-immunoprecipitation, and Western blotting were performed to investigate the involvement of the PANK-CoA-PKM2 axis. VB5 supplementation attenuated OVX-induced bone loss and reduced osteoclast numbers in vivo, whereas VB5 deficiency exacerbated bone deterioration. In vitro, VB5 and its metabolic derivative CoA suppressed osteoclast differentiation without inducing significant cytotoxicity. Mechanistically, VB5 increased intracellular CoA levels in a PANK-dependent manner. CoA interacted with PKM2, reduced Y105 phosphorylation, and decreased nuclear translocation, accompanied by suppression of glycolytic and oxidative phosphorylation activity. Pharmacological stabilization of PKM2 partially reversed molecular alterations associated with VB5 deficiency. VB5 is associated with inhibition of osteoclast differentiation and attenuation of estrogen deficiency-induced bone loss, potentially through modulation of metabolic reprogramming involving the PANK-CoA-PKM2 axis. These findings provide preliminary insight into a link between vitamin-dependent metabolic pathways and skeletal remodeling.

Sarcopenia, characterized by progressive loss of skeletal muscle mass, strength, and function, is a major contributor to disability, falls, and reduced quality of life in older adults. Degenerative scoliosis is also increasingly prevalent with aging and is associated with spinal instability, postural imbalance, and chronic pain. Despite their frequent coexistence, the interaction between sarcopenia and scoliosis remains poorly explored. Thus, this study aimed to highlight the bidirectional relationship between sarcopenia and scoliosis in older adults and to discuss its clinical and rehabilitative implications. A narrative synthesis of current literature was conducted, focusing on age-related changes in muscle composition, spinal alignment, trunk muscle function, and postural control. Emphasis was placed on studies examining muscle degeneration, spinal deformity progression, balance impairment, and functional outcomes. Emerging evidence suggests that older patients with degenerative lumbar scoliosis tend to have higher sarcopenia prevalence and lower skeletal muscle mass (appendicular/trunk) than controls or other spinal conditions. Sarcopenia may exacerbate spinal deformity by reducing trunk muscle strength and endurance, thereby compromising spinal stability and alignment. Conversely, scoliosis-related pain, asymmetry, and altered biomechanics may accelerate physical inactivity and muscle wasting, contributing to sarcopenia progression. The coexistence of both conditions appears to increase the risk of falls, mobility limitations, and functional dependence. Sarcopenia and scoliosis may form a vicious cycle that amplifies musculoskeletal decline in older adults. Integrated assessment strategies and targeted physiotherapy interventions addressing muscle strength, postural control, and spinal alignment are essential. Future research should focus on longitudinal designs and intervention studies to clarify causality and optimize rehabilitation strategies.

Consistency and robustness of virtual time-to-contact in assessing postural sway in people with multiple sclerosis.

Association Between Postoperative Mini-Balance Evaluation Systems Test Scores and Length of Hospital Stay in Patients with Chronic Subdural Hematoma: A Prospective Cohort Study.