Improvements In Postural Control Research Articles

The effect of the KNEE program for Netball players on the modified Star Excursion Balance Test – a randomized controlled trial

BackgroundThe aim was to investigate the effect of the KNEE program on postural control as measured by the modified Star Excursion Balance test (mSEBT) in Australian club level netball players. MethodsTwo netball teams from Netball NSW Premier-League were recruited and randomized to complete either the KNEE program or a traditional warm-up. Cumulative, anterior, posteromedial, and posterolateral directions of the mSEBT were measured for both limbs at baseline, 8-weeks, and 5-months. Linear mixed models were used to assess the effect of the intervention on mSEBT outcomes. ResultsWhen compared to a traditional warm-up, the KNEE program led to improvements in postural control in the PM direction of the mSEBT at 8 weeks (R: p = 0.005; L = 0.016) and 5 months (R: p = 0.006 and L: p = 0.026). For the cumulative score, there was a main effect of time with significant improvements between baseline and subsequent time points (p < 0.03), but there was no effect of group or interaction. No significant changes were found in ANT and PL directions. ConclusionThe KNEE program when implemented as a warm-up prior to training and match-play can improve postural control in the PM direction which is integral to Netball.

The relationship between postural control and cognitive functioning following Zumba dancing in middle-aged women: A randomized clinical trial

This study aimed to investigate the effect of 12-week Zumba dancing on postural control and cognitive parameters and the correlations between these parameters in middle-aged women. Thirty-eight women, aged between 50 and 60 years, were randomly allocated to a Zumba group (ZG) or control group. Postural control and cognitive functions [working memory (WM) and reaction time (RT)] were assessed before and after 12 weeks of a Zumba dancing program using a stabilometric force platform, Corsi Block-Tapping Task and Simple RT tests, respectively. The results indicate that ZG showed significantly (p<.01) better balance performances when standing on a stable surface in both visual conditions [firm surface with eyes opened (EO) (20,9%) and eyes closed (EC) (12.3%)]. However, when standing on an unstable surface in both visual conditions (foam surface with EO/EC), the ZG showed no significant improvement in postural control. It seems that the benefits of Zumba on postural control depend on the sensory condition. Besides, 12-week Zumba dancing was not sufficient to significantly enhance cognitive performances (RT/WM) performances. These cognitive performances were related to postural control in challenging conditions and can be considered an effective tool for monitoring postural performances following an intervention program. Clinicians should, therefore, focus on interventions that boost cognitive functions in middle-aged women to achieve optimal postural control, mainly in challenging conditions, in order to prevent the risk and fear of falls as well as the incidence of falling.

Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics.

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12-18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability-LoS), balance, and mobility (Community Balance and Mobility Scale-CB&M; Functional Walking Test-FWT; Timed Up and Down Stair test-TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.

Improvement of postural control in the frail older adults through foot care: A pre- and post-intervention study

Frailty in older adults often leads to foot issues, increasing fall-related fracture risk. Mechanoreceptors, the pressure receptors in the foot sole, are pivotal for postural control. Foot problems can impair mechanoreceptor function, compromising balance. This study aimed to examine the effect of foot care on postural control in frail older adults. Forty-eight participants underwent a five-month monthly foot care intervention. Measurements were taken before and after this intervention. Participants stood for 45 s in a static, open-eyed position on a stabilometer. Center-of-pressure (CoP) analysis included total trajectory length, integrated triangle area, rectangular area, and range of motion in anterior–posterior and medio-lateral directions. Results indicated that foot care significantly increased toe ground contact area by 1.3 times and improved anterior–posterior motion control during static standing. Enhanced postural control resulted from improved skin condition due to foot care that intensified mechanoreceptor signal input and improved postural control output. These findings underscore the potential for reducing fracture risks in older adults through proactive foot care. The study highlights the vital role of foot care in enhancing postural control, with broader implications for aging population well-being and safety.

Effectiveness of Abdominal Activation on Motor Control in Diplegic Cerebral Palsy: A Randomized Control Trial

Background: Cerebral palsy (CP) is a disorder of the nervous system manifested in movement, posture, muscle tone, and functional activity. Poor postural control is the most common problem related to CP. Neuro-developmental techniques, or facilitation techniques, were used to activate muscles and improve trunk control. Aim: To determine the influence of the effects of abdominal activation for correcting posture in spastic diaplegic CP children. Methods: A quantitative, randomized clinical trial was conducted, allocating 26 CP patients randomly into two groups: the control group and the treatment group. Baseline treatment was given to the control group, which included lower-limb passive stretching exercises and interrupted direct current. However, baseline treatment with neuro-developmental techniques was given to the treatment group. The measuring tool used for assessment of postural correction and stability was the trunk control measurement scale. Results: The study recruited 26 CP patients, of who 10 belonged to the age groups 8–10 years and 11–13 years, respectively, while 6 children were from the age group 14–15 years. An independent sample t-test was used for between-group analysis, and the results showed a significant improvement in the TCMS score post-treatment, as the p-value was 0.012, while within-group analysis was done by applying a paired sample t-test. There was a significant improvement in the treatment group (p-value 0.000) where NTD was applied, compared to the control group (p-value 0.096), where only baseline treatment was given. Implication: Neurodevelopmental approaches can improve trunk control in children with cerebral palsy, enhancing mobility, independence, posture, and functional skills. This reduces the risk of musculoskeletal issues and facilitates activity participation. Conclusion: The study showed significant improvement in postural control with the use of Neuro-developmental techniques in CP children. Children with cerebral palsy (CP) can benefit from improved trunk control using neurodevelopmental approaches, which can increase their mobility, independence, posture, ability to participate in activities, and functional skills. Keywords: Cerebral palsy (CP), Neuro-developmental techniques (NDT), Interrupted direct current (IDC).

Postural Control and Weight Bearing Symmetry Patterns in Patients Post Lumbar Spinal Decompression Surgery

Background Prolapsed intervertebral disc is one of the most common reasons for low back pain often causing altered postural control and weight bearing symmetry of foot. Although these components are known to be affected there is limited literature available explaining the postural control and weight bearing symmetry post spinal decompression surgical procedures.Objective The study was formulated with the objective to understand postural control and symmetry of weight bearing patterns among patients post lumbar spinal decompression surgery.Methods The study was conducted involving 65 patients who were assessed pre-and post-lumbar decompression surgery. Nintendo Wii balance board was used to assess the patients at all intervals.Results The post-surgical values at discharge showed a clinical improvement in postural control bilaterally left P0.068 and right P0.031 but showed deterioration at one month with right P0.076 and significant on left side P0.009. Contrary to this the follow up values at one month showed a significant improvement in weight bearing symmetry P0.001. Pain values both on activity and at rest taken at both follow-up intervals F1 and F2 showed a statistically significant reduction P0.001.Conclusion Postural control assessed with single limb stance shows worsening at one month post decompression procedure. Weight bearing symmetry parameters may demonstrate a decline immediately post lumbar decompression surgery but may show a significant improvement along with reduction in pain post surgically as early as one month.

Investigating the Effect of Addition of Cervical Proprioceptive Training to Conventional Physiotherapy on Visual, Vestibular and Proprioceptive Dependency of Postural Control in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Clinical Trial.

While cervical proprioception deficit has been suggested as a contributing factor to clinical consequences of chronic non-specific neck pain (CNSNP), the effect of addressing such impairments on postural control strategies has remained unexplored. The aim of this study was to compare the response of the postural control system to alteration of sensory afferents in CNSNP with asymptomatic individuals. Furthermore, we examined whether proprioceptive training would yield superior outcomes to routine physiotherapy for improvement of postural control, pain and disability. Center of pressure (CoP) variables of sixty CNSNP patients equally distributed in any of the proprioception-specific or conventional physiotherapy groups and 30 asymptomatic participants were evaluated under four standing conditions:1) normal, 2) foam, 3) cervical extension/eyes open and 4) cervical extension/eyes closed standing. CoP anteroposterior range and anteroposterior and mediolateral velocity in patients were significantly higher than the control group under condition 2 (P<0.05). Patients also demonstrated lower anteroposterior lyapunov exponent under conditions 2 and 4 (P<0.05). Both interventions significantly decreased anteroposterior range and anteroposterior velocity(P<0.05). Anteroposterior lyapunov exponent also increased under condition 2 (P<0.05).. After the interventions, CoP anteroposterior range and anteroposterior velocity were significantly lower in the proprioceptive exercise group than the conventional physiotherapy group (P<0.05). Anteroposterior lyapunov exponent was also significantly higher in the proprioceptive exercise group (P<0.05).This while there was no significant difference between these patients and control group participants in any of the CoP variables after intervention. Our results rejected the hypothesis that impaired neck proprioception in the presence of CNSNP is compensated by overweighting other sources of sensory afferent information. The findings also revealed that while proprioceptive exercises successfully returned postural strategies of CNSNP patients to those in asymptomatic participants, they do not add to clinical recovery of these patients.

Supervised Exercise Training May Improve Postural Control in Patients with Symptomatic Lower Extremity Peripheral Artery Disease.

Patients with symptomatic peripheral artery disease (PAD) have been shown to present balance disorders and a history of falling, which are associated with functional and daily life impairments. Although postural control improvement is an important outcome, the benefits of supervised exercise training (SET) on postural control have been seldom investigated in these patients. This article investigates the effects of SET on traditional measures of postural control and on stabilogram-diffusion analysis (SDA) parameters in patients with symptomatic PAD. Patients with symptomatic chronic lower limb claudication were investigated. All subjects who completed the 3-month multimodal SET program and postural control assessment before and after SET were included. Center of pressure trajectory analysis and SDA parameters were investigated using a posturographic platform. Patients were instructed to stand on the platform and maintain balance to their best ability. Treadmill pain-free (PFWD) and maximal (MWD) walking distances were also assessed prior and following SET. Forty-four patients with PAD (65.2 ± 9.8 years, 34% women) were investigated. All postural control parameters were unchanged following SET, except the length of center of pressure displacement as a function of the surface of center of pressure trajectory (LFS), which was significantly increased (before SET: 1.4 ± 0.4; after SET: 1.5 ± 0.5; p = 0.042). PFWD (before SET: 103.5 ± 77.9 m; after SET: 176.8 ± 130.6 m; p ≤ 0.001) and MWD (before SET: 383.6 ± 272.0 m; after SET: 686.4 ± 509.0 m; p ≤ 0.001) significantly improved following SET. The increased LFS suggests a better postural control accuracy following SET in patients with symptomatic PAD.

Effect of Balance Exercises with Smart Phone Based Virtual Reality Programme on Balance in Stroke Patients

Background and objectives: A stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post-stroke patients are associated with a high risk of falls among stroke patients. The perturbation-based balance training is mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize computer-generated environments with a full field of view through Head-mounted displays (HMD-VR). This study was conducted to assess and investigate the effect of balance exercises with smartphone-based virtual reality programs on balance in stroke patients. Methods: This was a randomized single-group pre and post-test study design. 30 subjects met the inclusion criteria and were enrolled, assigned, and received intervention. Subjects were given perturbation-based balance exercises and smartphone-based virtual reality along with conventional physiotherapy. The intervention protocol was for 6 days/week for 4 weeks period. Results: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, and SIS 3.0. Paired t-test was used to differentiate the mean significance. The mean pre to post-intervention difference is 12.6 with a p - value &lt; 0.05. TUG score improved from pre to post-intervention difference is 1.443 with a p - value &lt; 0.05. VR BESS score improved from pre to post-intervention difference is 10.266 with a p value &lt; 0.05. The mean BESTest pre to post-intervention difference is 11.467 with a p - value &lt; 0.05. SIS 3.0 score improved from a pre to post-intervention difference is 20.33 with p - value &lt; 0.05. The result of this study showed a highly significant difference in pre and post-treatment. Conclusion: The study concludes that perturbation-based balance exercises with smartphone-based virtual reality programs are a useful adjunct to improving balance in stroke patients along with conventional physiotherapy.

Posture of Healthy Subjects Modulated by Transcutaneous Spinal Cord Stimulation.

Transcutaneous electrical stimulation of the spinal cord is used to restore locomotion and body weight support in patients with severe motor disorders. We studied the effects of this non-invasive stimulation on postural control in healthy subjects. Stimulation at the L1-L2 vertebrae was performed to activate the extensor muscles of the lower limbs. Because postural regulation depends on the cognitive style, the effects of the stimulation were analyzed separately in field-dependent (FD) and field-independent (FI) participants. During the study, FD and FI participants (N = 16, 25 ± 5 years, all right dominant leg) stood on a force platform in a soundproof chamber with their eyes closed. Stimulation was applied in the midline between the L1 and L2 vertebrae or over the left or right dorsal roots of the spinal cord; under the control condition, there was no stimulation. Stimulation destabilized posture in healthy subjects, whereas patients with movement disorders usually showed an improvement in postural control. In the FD participants, left dorsal root and midline stimulation increased several postural parameters by up to 30%. Dorsal root stimulation on the side of the supporting leg reduced postural control, while stimulation on the side of the dominant leg did not. No significant changes were observed in the FI participants.

Postural Instability and Risk of Falls in Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Stabilometric Platform Study.

Postural instability (PI) in Parkinson's disease (PD) exposes patients to an increased risk of falls (RF). While dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF remain elusive. PI and RF were assessed using a stabilometric platform in six advanced PD patients. Patients were evaluated in OFF and ON dopaminergic medication and under four DBS settings: with DBS off, DBS bilateral, and unilateral DBS of the more- or less-affected side. Our findings indicate that dopaminergic medication by itself exacerbated PI and RF, and DBS alone led to a decline in RF. No combination of medication and DBS yielded a superior improvement in postural control compared to the baseline combination of OFF medication and the DBS-off condition. Yet, for ON medication, DBS significantly improved both PI and RF. Among DBS conditions, DBS bilateral provided the most favorable outcomes, improving PI and RF in the ON medication state and presenting the smallest setbacks in the OFF state. Conversely, the more-affected side DBS was less beneficial. These preliminary results could inform therapeutic strategies for advanced PD patients experiencing postural disorders.

Effect of Balance Exercises with Smart Phone Based Virtual Reality Programme on Balance in Stroke Patients

BACKGROUND AND OBJECTIVES: Stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post stroke patients, associated with high risk of fall among the stroke patients. The perturbation - based balance training mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize the computer - generated environments with full field of view by Head mounted displays (HMD-VR) .This study was conducted to assess and investigate the effect of balance exercises with smart phone based virtual reality programme on balance in stroke patients. METHOD: This was a randomized single-group pre and post test study design. 30 subjects met the inclusion criteria and were enrolled, assigned and received intervention. Subjects were given perturbation based balance exercise and smart phone based virtual reality along with conventional physiotherapy. Intervention protocol was for 6 days/week for 4 weeks period. RESULTS: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, SIS 3.0. Paired t test was used to differentiate the mean significance. The mean pre to post intervention difference is 12.6 with P value &lt; 0.05. TUG score improved from pre to post intervention difference is 1.443 with P value &lt; 0.05. VR BESS score improved from pre to post intervention difference is 10.266 with P value &lt; 0.05. The mean BESTest pre to post intervention difference is 11.467 with P value &lt; 0.05. SIS 3.0 score improved from pre to post intervention difference is 20.33 with P value &lt; 0.05. The result of this study showed highly significant difference in pre and post treatment. CONCLUSION: The study concludes that perturbation based balance exercises with smart phone based virtual reality programme is a useful adjunct on improving balance in stroke patients along with conventional physiotherapy.

Vibroacoustic Therapy in Parkinsonian Patients. A Complementary Approach to Improve Rehabilitation Outcome

Background: Parkinson’s Disease (PD) is a chronic progressive neurodegenerative disorder with motor and non-motor symptoms. Rehabilitation represents an adjuvant intervention to pharmacological and surgical therapy. Our study aim was to investigate the effectiveness of the Vibroacoustic Therapy (VAT) according to the Metodo Magic Music combined with conventional Training (Tr) versus Tr alone in improving motor symptoms and postural control in PD patients. Methods: Twenty-four patients with idiopathic PD were enrolled. They were randomly assigned to the Tr-VAT or the Tr group. Total intervention time was 40 min (Tr) and 60 min (Tr-VAT) 3 times a week for 3 months. Both groups carried out at baseline and follow-up clininetric scales and tests to assess clinical outcome. Speed of postural transitions and gait parameters (endurance and comfortable and fast speed) have been measured. Results: Follow-up evaluation showed in PD patients from the Tr-VAT group as compared to those from the Tr group an improvement of postural control assessed with Berg Balance Scale (p = 0.054) and Timed-Up and Go test (TUG) test (p = 0.058). Moreover, significant (p &lt; 0.05) differences between groups were found for comfortable gait speed (p = 0.004) and speed of postural changes - from right side to supine (p = 0.03), from supine to right and left side (p = 0.01), from supine to prone (p = 0.002) and supine to sitting (p = 0.005), respectively. Conclusions: Our study demonstrated the effectiveness of VAT as complementary treatment with conventional rehabilitation approaches, by improving mobility, agility and motor flexibility in PD patients.

Effects of supervised structured exercise program on postural control and gait in subjects with type-2 diabetes

Abstract Type-2 diabetes mellitus, one of the most common metabolic diseases in the world, is brought on by the interaction of two critical factors: reduced insulin secretion by pancreatic beta-cells and impaired insulin sensitivity of tissues. The objective of the study was to see the effects of supervised structured exercise program on postural control and gait in subjects with type-2 diabetes. The study recruited 44 type-2 diabetic subjects who were randomly divided into two groups: experimental group (n = 22) and control group (n = 22). Functional reach test and dynamic gait index were used as outcome measures for pre- and postevaluations of postural control and gait, respectively. The study identified a mean improvement of 2.54 ± 11.31 and 3 ± 14.31 in the experimental and control groups, respectively. Both groups showed significant improvements in postural control and gait after the intervention (P &lt; 0.05). The level of improvement in the experimental group was significantly higher in improving postural control compared with the control group (P &lt; 0.05). The results of the study demonstrated that structured exercise program is effective in improving postural control and gait in subjects with type-2 diabetes.

Efficacy of nGVS to improve postural stability in people with Bilateral Vestibulopathy

Bilateral vestibulopathy occurs when the neural signals from the balance organs (vestibular apparatus) to the brain are weak. This leads to imbalance and blurry vision during head movements (Fujimoto et al., 2019). To date, there are few successful treatment options once damage has occurred (Hain et al., 2018). Noisy galvanic vestibular stimulation (nGVS) is a non-invasive electrical stimulation, delivered at a low level to the vestibular system. When used to boost the weak physiological signal from the vestibular system nGVS has the potential to restore absent vestibular information and improve balance (Dlugaiczyk et al., 2019). This presentation will include the results of my systematic literature review and meta-analysis, examining the evidence for the use of nGVS as a means of improving postural control in people with bilateral vestibulopathy and discussing how these results will inform my research. A comprehensive systematic search of five databases up to July 2022 was performed. The search identified studies applying nGVS to people with bilateral vestibulopathy, with the aim of improving their postural control. Two independent reviewers screened and identified eligible studies, completed a Cochrane risk of bias evaluation, and extracted relevant data. Seven studies met the eligibility criteria with 5 studies being suitable for meta-analysis. The standardized mean difference (SMD) based on Hedges’ g was calculated as a measure of effect size, for the primary outcome measure that best identified postural control, and a forest plot generated. Meta-analysis found that nGVS improved postural control during standing and walking (pooled SMD = 0.47 95% CI, [0.25, 0.7]). nGVS-mediated improvements in postural control were most evident standing on a firm surface with eyes closed, and in measures of lateral stability during gait. Identifying that nGVS is effective in people with bilateral vestibulopathy, and that the efficacy is context-specific, will help inform the development of treatments for people with bilateral vestibulopathy.

Comparison of the Effects of an Exergame-Based Program with Conventional Physiotherapy Protocol Based on Core Areas of the European Guideline on Postural Control, Functional Mobility, and Quality of Life in Patients with Parkinson's Disease: Randomized Clinical Trial.

Introduction: Impairment of postural control and functional mobility are debilitating symptoms of Parkinson's disease (PD). In addition to limiting performance in activities of daily living, it is associated with a higher prevalence of falls in this population. Particularly, dysfunction in postural control does not respond to dopaminergic replacement therapy, but physiotherapy can improve this outcome in patients with PD. Objective: The aim of this study was to analyze the effects of training based on Kinect Adventures games compared with a conventional physiotherapy protocol based on the core areas of the European physiotherapy guideline in patients with PD on postural control, functional mobility, self-perception of confidence in the balance, quality of life (QoL), lower limb muscle strength, transfer skill and motor function, as well as to observe adherence and safety interventions. Methods: Thirty-eight patients diagnosed with idiopathic PD were randomized into two groups, and performed 14 training sessions, twice a week for 60 minutes. The primary outcome assessed postural control using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The following were evaluated as secondary outcomes: limit of stability; balance functional reserve and center of pressure area by computerized posturography; functional mobility by the Timed Up and Go test; self-confidence in balance through the Activities-specific Balance Confidence scale; QoL through the Parkinson's Disease Questionnaire; lower limb muscle strength by the Five Times Sit-To-Stand test; and motor function by the Unified Parkinson's Disease Rating Scale. Results: Patients completed training sessions with high rates of safety and adherence. After training, there was a significant improvement in postural control, motor function, and QoL. Conclusion: Both interventions proved to be safe, applicable, and effective to improve postural control, QoL, and motor function in patients with PD. However, there was no difference between the effects of Kinect Adventures games and conventional physiotherapeutic protocol in patients with PD. Brazilian Registry of Clinical Trials (RBR-27kqv5).

Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis

ObjectiveNoisy galvanic vestibular stimulation (nGVS) has been used to boost vestibular afferent information to the central nervous system. This has the potential to improve postural control for people for whom vestibular signals are weak, such as in bilateral vestibulopathy (BVP). The aim of this systematic review and meta-analysis is to investigate the evidence for nGVS as a modality to improve postural control in people with BVP.MethodsA comprehensive systematic search was conducted of five databases up to July 2022 to find studies applying nGVS to people with BVP, with the aim of improving postural control. Two independent reviewers screened and identified eligible studies, completed a risk of bias evaluation (Cochrane) and extracted relevant data. The standardized mean difference (SMD) based on Hedges' g was calculated as a measure of effect size for the primary outcome measure that best identified postural control, and a forest plot generated.ResultsSeven studies met the eligibility criteria, with five being suitable for meta-analysis. Meta-analysis revealed a moderate effect in favor of nGVS improving postural control during standing and walking [pooled SMD = 0.47 95% CI (0.25, 0.7)]. nGVS-mediated improvements in postural control were most evident in observations of reduced sway velocity when standing on a firm surface with eyes closed, and in the reduced variability of gait parameters, particularly those measuring lateral stability.ConclusionsCoincident nGVS in people with BVP improves postural control during standing and walking. This improvement appears to be context specific, in that vestibular augmentation is most effective in situations where visual inputs are limited, and where reliable context specific proprioceptive cues are available. Further research is warranted investigating additional circumstances in which nGVS improves postural control, including investigating the residual, and sustained effects of nGVS.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342147, identifier: 342147.

Effects of school-based neuromuscular training on fundamental movement skills and physical fitness in children: a systematic review.

ObjectivesThe primary purpose of this review was to clarify the effects of school-based integrated neuromuscular training (INT) on fundamental movement skills and physical fitness in children. The secondary purpose was to examine whether school-based INT intervention is superior to physical education (PE) intervention in enhancing motor skills and fitness.MethodsA systematic literature search was performed in four electronic databases: PubMed, Web of Science, MEDLINE (EBSCOhost), and Cochrane Central Register of Controlled Trials. The last search was performed on December 21, 2021, and was limited to the English language, human species, and peer reviewed journals. Randomized controlled trials and cluster randomized controlled trials that examine the effects of school-based INT on motor skills and/or fitness in healthy children who were aged up to 14 years old were included. Moreover, studies included in this study should compare school-based INT-induced adaptions with those generated by PE interventions. Studies that involve athletic children and additional exercise training were excluded. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the study.ResultsOf 1,026 studies identified, seven original trials that meet the inclusion criteria were included in this review. Based on the PEDro scale, the PEDro score of seven studies was between six and eight points with a mean score of 5.29. Among the seven studies included in this study, four studies assessed physical fitness including muscular fitness (n = 4), speed (n = 3), endurance (n = 2), and flexibility (n = 2). Three studies examined the effects of INT on postural control and three studies explored its effects on motor skills. Concerning movement competence, significant and greater improvements in postural control and fundamental motor skills were observed following school-based INT interventions compared to PE intervention in two and three studies, respectively. Regarding physical fitness, neuromuscular training significantly increased muscular fitness, speed, endurance, flexibility in three, two, one, and one studies, respectively. However, only greater improvements in muscle fitness were observed in school-based INT group compared to PE group. The main limitations of this review were the lack of descriptions of training intensity and volume and the low methodological quality of the included studies.ConclusionThis review provides evidence that school-based neuromuscular training programs are superior to PE lessons in improving postural control, fundamental motor skills and muscular strength. Therefore, INT could be incorporated into traditional physical education classes in school. Trial registration number: CRD42022297349.

ASSESSMENT OF POSTURAL CONTROL AND GAIT IN LATE POST-STROKE PATIENTS SUBJECTED TO TREADMILL TRAINING WITH CONTROLLED BODY BALANCE PERTURBATIONS. PILOT STUDY

Introduction One of the basic goals of post-stroke rehabilitation is the improvement of postural control and gait quality. Modern post-stroke rehabilitation implements treadmill training with controlled body balance perturbations (PBT). Aim This study aimed to assess the influence of the PBT treadmill training on activities of daily living (ADL), gait quality and postural control in people with chronic stroke. Methods Seventeen patients with stroke hospitalized in a rehabilitation centre were randomly allocated to 3-week PBT training. Functional independence was assessed using Fugl-Meyer Motor Assessment (FMA). ADL were assessed using Barthel Scale. Static and dynamic postural control was assessed using Berg Balance Scale (BBS), Timed Up And Go Test (TUG) and Functional Reach Test (FRT). Static postural control was assessed using stabilometric platform tests (Alfa and Gamma, Ac International East, Poland). The 10-meter walk test was used to evaluate gait. Spatial, temporal gait parameters were also assessed using the MyoMotion (Noraxon, USA). Results A significant improvement was found in the patients’ motor functions (FMA; p = 0.01), independence in daily activities (Barthel Scale; p = 0.01), static and dynamic balance (BBS; p = 0.01). There was no statistically significant improvement in the dynamic balance (TUG; p = 0.15; and FRT; p = 0.19). Conclusions Inclusion of perturbation training during rehabilitation of patients with chronic stroke improved ADL, gait quality and postural control.

Improvement in Postural Control Following Concussion in Adolescent Athletes: From Clinical Presentation to Initiation of Return to Play

Background:Impairments in balance or postural control are common following sport-related concussion (SRC). The Balance Error Scoring System (BESS) is widely utilized to assess static postural stability, but laboratory-based balance measures have been shown to more accurately detect changes in postural control.Hypothesis/Purpose:To determine whether postural control improved between presentation to the sports medicine clinic and return-to-sport (RTS) initiation, and whether this trend mirrored symptom scores and cognitive performance. A secondary aim was to assess whether changes in postural control were more accurately captured with center of pressure (COP) based measures compared to BESS.Methods:Patients diagnosed with a SRC were tested within 10 days of presentation (V0) and when cleared by a physician to begin a RTS protocol (V1). Clinical measures included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the King-Devick (K-D) test. The BESS was performed with eyes closed while standing barefoot on a force platform for 6 conditions: double-limb stance, single-limb stance, and tandem stance on both firm and foam surfaces. BESS scores and total balance time were recorded for each condition, and COP-based measures were computed for both double-limb stance conditions (Table 1). Sample entropy was computed to quantify COP regularity over time with increased values indicating improvement in postural control. Wilcoxon signed-rank tests were performed to determine significance between visits (α<0.05).Results:Forty patients (17 males, 13.8±2.0 years) were included for analysis. ImPACT verbal and visual memory scores improved by 10% and 12%, respectively, total symptom score decreased (V0 18.03±13.85, V1 0.97±2.08; p<0.01), and visual motor speed and reaction time were both 11% faster on the K-D test. For postural control, the BESS indicated significant improvement given the reduction in errors on both surfaces (Firm Total: V0 3.23±2.09, V1 2.25±2.11, p=0.01; Foam Total: V0 7.38±2.05, V1 6.08±1.76, p<0.01; Table 1). Similarly, COP-based measures exhibited better overall balance between visits (Figure 1), primarily in the medial-lateral direction on the firm and the anterior-posterior direction on the foam. Lastly, sample entropy improved between visits, indicating more effective postural control.Conclusion:Significant improvement in postural control was observed during the recovery period which mirrored improvement in symptom scores and cognitive performance. Additionally, while COP-based measures showed similar trends to the BESS, they provided more detailed information in regards to balance recovery. Specifically, findings from the double stance condition highlight the utility of a more advanced assessment of postural control for determining RTS readiness following a SRC.Table 1.COP-based measures of balance performance at diagnosis (V0) and clearance (V1) visitsFigure 1.Representative stabilograms of double stance balance on firm and foam surfaces at diagnosis (V0) and clearance visits (V1)