Postural Disturbances Research Articles

The effects of textured insoles on quiet standing balance in four stance types with and without vision

BackgroundWearing a textured shoe insole can decrease postural sway during static balance. Previous studies assessed bipedal and/or unipedal standing. In contrast, we aimed to investigate if textured insoles modulated postural sway during four stance types (bipedal, standard Romberg, tandem Romberg, and unipedal), with and without vision.MethodsThe repeated measures design involved 28 healthy young adults (13 females; mean age = 26.86 ± 6.6 yrs) performing quiet standing in the four stance types on a force platform, under two different insole conditions (textured insole; TI vs. smooth insole; SI), with eyes open and eyes closed. Postural sway was assessed via the range and standard deviation of the COP excursions in the anterior-posterior and medial-lateral sway, and overall mean velocity.ResultsThe main effect of insole type was statistically significant at the alpha p = 0.05 level (p = 0.045). Compared to smooth insoles, textured insoles reduced the standard deviation of anterior-posterior excursions (APSD). While simple main effect analyses revealed this was most pronounced during eyes closed bipedal standing, insole type did not provide a statistically significant interaction with either stance or vision in this measure, or any other. Postural sway showed statistically significant increases across both stance type (bipedal < standard Romberg < tandem Romberg < unipedal), and vision (eyes closed < eyes open), in almost all measures. Stance and vision did have a statistically significant interaction in each measure, reflecting greater postural disturbances with eyes closed when stance stability decreased.ConclusionsOverall, these results support textured insole use in healthy young adults to reduce postural sway measures. This is because APSD is an index of spatial variability, where a decrease is associated with improved balance and possibly translates to reduced falls risk. Placing a novel texture in the shoe presumably modulated somatosensory inputs. It is important to understand the underlying mechanisms by which textured insoles influence postural sway. As such, utilising a healthy adult group allows us to investigate possible mechanisms of textured insoles. Future research could investigate the potential underlying mechanisms of textured insole effects at a neuromuscular and cortical level, in healthy young adults.

The Validity of an Oculus Rift to Assess Postural Changes During Balance Tasks.

To investigate whether shifts in head position, measured via an Oculus Rift head-mounted display (HMD), is a valid measure of whole-body postural stability. The inverted single-link pendulum model of balance suggests shifts in whole-body center of mass can be estimated from individual body segments. However, whether head position describes postural stability such as center-of-pressure (COP) remains unclear. Participants (N = 10) performed six conditions while wearing an HMD and performing a previously validated virtual reality (VR)-based balance assessment. COP was recorded with a Wii Balance Board force plate (WBB), while an HMD recorded linear and angular head displacement. Visual input was presented in the HMD (stable scene, dark scene, or dynamic scene) and somatosensory information (with or without foam) was varied across each condition. The HMD time series data were compared with the criterion-measure WBB. Significant correlations were found between COP measures (standard deviation, range, sway area, velocity) and head-centered angular and linear displacements (roll, pitch, mediolateral and anteroposterior directions). The Oculus Rift HMD shows promise as a measure of postural stability without additional posturography equipment. These findings support the application of VR HMD technology for assessment of postural stability across a variety of challenging conditions. The human factors and ergonomic benefit of such an approach is in its portability, low cost, and widespread availability for clinic and home-based investigation of postural disturbances. Fall injury affects millions of people annually, so assessment of fall risk and treatment of the underlying causes has enormous public health benefit.

Is cannabidiol the ideal drug to treat non-motor Parkinson's disease symptoms?

Parkinson's disease (PD) is a chronic neurodegenerative disorder characterized by motor symptoms such as bradykinesia, rest tremor, postural disturbances, and rigidity. PD is also characterized by non-motor symptoms such as sleep disturbances, cognitive deficits, and psychiatric disorders such as psychosis, depression, and anxiety. The pharmacological treatment for these symptoms is limited in efficacy and induce significant adverse reactions, highlighting the need for better treatment options. Cannabidiol (CBD) is a phytocannabinoid devoid of the euphoriant and cognitive effects of tetrahydrocannabinol, and preclinical and preliminary clinical studies suggest that this compound has therapeutic effect in non-motor symptoms of PD. In the present text, we review the clinical studies of cannabinoids in PD and the preclinical and clinical studies specifically on CBD. We found four randomized controlled trials (RCTs) involving the administration of agonists/antagonists of the cannabinoid 1 receptor, showing that these compounds were well tolerated, but only one study found positive results (reductions on levodopa-induced dyskinesia). We found seven preclinical models of PD using CBD, with six studies showing a neuroprotective effect of CBD. We found three trials involving CBD and PD: an open-label study, a case series, and an RCT. CBD was well tolerated, and all three studies reported significant therapeutic effects in non-motor symptoms (psychosis, rapid eye movement sleep behaviour disorder, daily activities, and stigma). However, sample sizes were small and CBD treatment was short (up to 6weeks). Large-scale RCTs are needed to try to replicate these results and to assess the long-term safety of CBD.

Motor function in Rett syndrome: comparing clinical and parental assessments.

To describe a new clinical tool, the Rett Syndrome Motor Evaluation Scale (RESMES) and to assess (loco-)motor function in people with Rett syndrome (RTT). Formal assessment provided by physicians was followed by parents' direct observation at home using the RESMES. Sixty females (mean [SD] age 12y 5mo [8y 9mo], range 3-40y) with a clinical diagnosis and genetically determined RTT participated in the study. Spearman's/Pearson's coefficients assessed the correlation between the clinicians' and caregivers' evaluations, as well as the correlation of RESMES scores with other scales, namely the Pain Assessment in Advanced Dementia, the Rett Assessment Rating Scale, the Modified Ashworth Scale, and hand function (assessed with a scale of evaluation of purposeful hand function). Scores provided by parents and clinicians were tested statistically by Mann-Whitney U test. Approximately 88% of patients had moderate to severe RTT symptoms and, on average, moderate motor impairment based on the RESMES. RESMES total scores provided by clinicians and caregivers were highly correlated (r=0.91), as were the subscale scores. Postural transition was a critical area of the RESMES, where parents systematically provided lower scores than clinicians, indicating milder degrees of disability. Severity of scoliosis and mutation type emerged as significant predictors of motor function. The RESMES characterized the (loco-)motor impairments of the patients with RTT well. It also showed a close correlation between the evaluations of clinicians and caregivers, with the possible exception of postural transition tasks, which should be carefully addressed in a clinical setting. The type of mutation and presence of scoliosis should be evaluated, as they predicted the ability to walk. Caregivers at home can reliably assess motor function in Rett syndrome using the Rett Syndrome Motor Evaluation Scale (RESMES). RESMES scores provided by clinicians and parents were highly correlated. The severity of scoliosis and the genetic mutation predicted standing and walking abilities.

Voluntary and electrically-induced muscle fatigue differently affect postural control mechanisms in unipedal stance.

The repetition of muscle contractions is likely to generate fatigue which can provoke alterations of postural control. Regulatory mechanisms can be triggered to counteract these alterations. However, these mechanisms would occur only when fatigue is induced through voluntary (VOL) contractions and not with electrically stimulated (ES) contractions. Hence the aim was to compare the effects of VOL and ES fatiguing contractions inducing a similar level of strength loss on unipedal postural control (assessed by means of force platform and EMG measurements), maximal voluntary contraction (MVC) and central activation ratio (CAR) to characterize the alterations induced by both modalities of fatigue and the associated regulatory mechanisms. Results showed that the VOL exercise induced a significant decrease of the CAR whereas the ES exercise did not, thus illustrating that central fatigue was present only after voluntary contractions. The VOL exercise also induced greater postural disturbances and larger regulatory mechanisms than the ES exercise, which also induced postural regulatory mechanisms. The present study reveals that postural control mechanisms are modulated according to the nature of the fatiguing contractions, likely due integration of specific fatigue signals according to the modality of the contraction. Because of a larger neurophysiological impact of VOL than ES fatiguing contractions due to greater central disturbances, VOL exercise-induced larger regulatory mechanisms. Nevertheless, the presence of regulatory mechanisms with ES contractions clearly underlines the ability of the central nervous system to display an accurate motor control following acute externally induced neuromuscular perturbations.

Forecast or Fall: Prediction's Importance to Postural Control.

To interact successfully with an uncertain environment, organisms must be able to respond to both unanticipated and anticipated events. For unanticipated events, organisms have evolved stereotyped motor behaviors mapped to the statistical regularities of the environment, which can be trigged by specific sensory stimuli. These “reflexive” responses are more or less hardwired to prevent falls and represent, maybe, the best available solution to maintaining posture given limited available time and information. With the gift of foresight, however, motor behaviors can be tuned or prepared in advance, improving the ability of the organism to compensate for, and interact with, the changing environment. Indeed, foresight's improvement of our interactive capacity occurs through several means, such as better action selection, processing, and conduction delay compensation and by providing a prediction with which to compare our actual behaviors to, thereby facilitating error identification and learning. Here we review the various roles foresight (prediction) plays in maintaining our postural equilibrium. We start by describing some of the more recent findings related to the prediction of instability. Specifically, we cover recent advancements in the understanding of anticipatory postural behaviors that are used broadly to stabilize volitional movement and compensate for impending postural disturbances. We also describe anticipatory changes in the state, or set, of the nervous system that may facilitate anticipatory behaviors. From changes in central set, we briefly discuss prediction of postural instability online before moving into a discussion of how predictive mechanisms, such as internal models, permit us to tune, perhaps our highest level predictive behaviors, namely the priming associated with motor affordances. Lastly, we explore methods best suited to expose the contribution of prediction to postural equilibrium control across a variety of contexts.

Static postural control disturbances among the different multiple sclerosis phenotypes: A Neurocom Balance Manager® evaluation study

BackgroundThe computerized stabilometric platform can be used and privileged over clinical scales, as self-administered questionnaires to asses postural control and balance evaluation in Multiple sclerosis (MS). Aim of our study was to evaluate static postural control assessed by Neurocom Balance Manager® through the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) in relapsing-remitting MS (RRMS), progressive MS (PMS) and CIS, compared to healthy controls (HC). MethodsWe screened MS patients consecutively referring to our MS Center at University of Catania, during July 2013–June 2014 diagnosed as CIS, RRMS and PMS. All MS patients underwent clinical and neurological evaluations and a complete postural exam by Neurocom Balance Manager® in order to evaluate Center of Pressure (COP), through mCTSIB. We evaluated the following parameters: Total Path Length-open eyes (TPL-OE), Total Path Length-closed eyes (TPL-CE), Sway Area-open eyes (SA-OE), Sway Area-closed eyes (SA-CE), Mean sway velocity-open eyes (MSV-OE), Mean sway velocity-closed eyes (MSV-CE). Additionally, patients were tested by Berg balance scale (BBS) for balance and Barthel Index (BI) for disability outcomes. ResultsOut of 170 MS patients assessed for eligibility, 163 met the inclusion/exclusion criteria and were finally enrolled. All balance parameters were found more impaired in MS group compared to controls and CIS. Moreover, no differences in terms of balance assessment were found between HC and CIS. The correlation analysis showed that BBS was strongly associated to SA-OE, SA-CE, TPL-OE and MSV-OE. We also found a correlation between BI and SA-CE. ConclusionOur study revealed significant differences among HCs, CIS and MS. MS, especially PMS, exhibit the worst balance performances especially in EC trials. The higher correlation between balance parameters, especially sway area, and BBS score confirmed the reliability and sensibility of mCTSIB assessment in evaluating static postural control in MS patients.

The contribution of counter-rotation movements during fall recovery: A validation study

Three mechanisms of maintaining standing stability include M1 – moving the COP within the base of support, M2 – segment counter-rotation, and M3 – applying an external force. To date, the contributions of these mechanisms have not been quantified for the response to an external postural disturbance. The purpose of this study was to evaluate the construct validity of measures that quantify the M2 contribution to anteroposterior fall recovery. We evaluated the whole-body rotation contribution, as well as a measure specific to arm motion (MARMS). With segment counter-rotation as the main focus of this study, we examined standing feet-in-place responses to treadmill-induced falls. The treatment validity of our measures was assessed by comparing unconstrained responses to those with constrained arm motion. The convergent validity of our measures was assessed by correlating peak shoulder flexion and extension velocities with counter-rotation contributions. Eleven unimpaired participants responded to anteroposterior belt accelerations from a treadmill, and the M2 and MARMS contributions were quantified from three-dimensional segment motion. The treatment validity of these measures was partially supported. Constraining the arms reduced M2 for anterior, but not posterior falls. Conversely, MARMS was reduced for posterior, but not anterior falls. Convergent validity was supported for MARMS (r = 0.64–0.78), but not M2 (r = −0.40 to −0.15). These results support the use of MARMS over M2 when interested in the role of arm motion. Given that arm constraints did not change the contribution of MARMS during a forward fall, unimpaired participants may not necessarily rely on arm motion as part of their recovery strategy in this context.

Effects of repetitive neck muscle vibrations on postural disturbances in standing position in chronic patients

Asymmetrical postural behaviors are frequent and related to poor equilibrium after a stroke. Proprioceptive neck vibration corrects in the short term the postural asymmetry probably through a sensory recalibration, but the effects of repetitive has yet to be tested. The objective was to test the effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in right (RBD) and left (LBD) brain damage patients. Thirty-two chronic stroke patients (mean age 60.9 ± 10 y and mean delay after stroke 4.9 ± 4 years), 16 RBD and 16 LBD, underwent a program of 10 sessions of vibrations (10 min) during a period of two weeks. Postural asymmetry on force platform (Weight Body Asymmetry WBA), spatial frames (Subjective Straight Ahead SSA, Longitudinal Body Axis LBA, Subjective Visual Vertical SVV) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, Time Up and Go) were ascertained at the end of the vibrations (D + 15) and at D + 22, D + 45. In the post-test, the results were depending of the side of the lesion with a significant reduction in WBA in the RBD ( P = 0.0001), whereas no effect was observed in the LBD. No significant modification was found on the spatial frame in both groups. A significant improvement was found for the Motricity, TUG and BBS in the both groups at the end and at distance. rNMV causes a reduction of postural asymmetry only in the RBD patients. These results suggest that rNMV could be effective on sustainable disorders of balance of spatial cognition disorders. Further, this result was not maintained at distance.

Reduced Balance Restoration Capacities Following Unilateral Vestibular Insult in Elderly Mice.

Acute vestibular syndrome (AVS) is characterized by severe posturo-locomotor and vestibulo-oculomotor impairment and accompanies several types of peripheral vestibulopathies (PVP). We know very little about its etiology, how its various symptoms are expressed and how it evolves with age. Robust repair capabilities of primary vestibular synapses have recently been shown to restore behavioral functionality. In this study, we used a mouse model of an excitotoxically induced unilateral vestibular lesion to compare the ability to restore balance and posture between old and young adult mice. We compared the temporal evolution of the evoked vestibular syndrome using a battery of behavioral tests to follow the evolution of postural-locomotor alterations and equilibrium. For the first time, we show that young adult (3 months) and elderly (22 months) mice are together able to restore normal postural-locomotor function following transient unilateral excitotoxic vestibular insult, though with different time courses. This animal study paves way for future, more detailed studies of how the early postural and locomotor disturbances following a unilateral insult are compensated for by various plasticity mechanisms, and in particular how age influences these mechanisms.

The relationships between compensatory stepping thresholds and measures of gait, standing postural control, strength, and balance confidence in older women

BackgroundCompensatory stepping thresholds evaluate the response to postural disturbances. Although such fall-recovery measures are a promising indicator of fall risk, the relationships between stepping thresholds and other measures used to predict falls are not well established. Research QuestionWe sought to quantify the relationships between stepping thresholds and other measurements used to assess fall risk in older women, a population at high risk for falls and related injuries, including fractures. MethodsWe studied 112 ambulatory, community-dwelling women, age 65 years or older. Using a treadmill to deliver standing postural disturbances, we determined anterior and posterior single-stepping and multiple-stepping thresholds. These thresholds represented the magnitude of the disturbance that elicited one step or more than one step, respectively. We also assessed balance confidence, functional reach, unipedal stance time, isometric strength, obstacle crossing, postural sway, and gait kinematics. Outcomes were normalized to body size. ResultsAfter accounting for age, stepping thresholds were, at most, moderately correlated (Pearson partial correlation coefficients r = 0.20 to 0.40 and r = -0.21 to -0.31) to several assessments of gait, postural control, and strength. Approximately 24–52% of the variance in stepping thresholds was explained by a combination of age and other fall risk assessments, which frequently consisted of balance confidence, unipedal stance time, obstacle crossing, the Romberg ratio of postural sway, and/or strength. SignificanceOur results suggest that anteroposterior fall-recovery ability, as assessed by stepping thresholds, can only be partially inferred from age and a combination of assessments of sway, strength, unipedal tasks, and balance confidence. Compensatory stepping thresholds may provide information on stability maintenance unique from other assessments of fall risk. Further investigation would be necessary to determine whether stepping thresholds are better predictors of falls in older women.

Incidence des troubles posturaux chez les patients souffrant d’algies pelvipérinéales chroniques

Pelvic-perineal pain often accompanied by pain of the perineum and pelvi-trochanteric muscles, we sought to observe the frequency of postural disturbances in relation to the pelvi-perineal muscles in patients who consult for pelvic perineal pain compared to a control population free of these pain. The prospective monocentric study was conducted during consultations of pelvic perineal pain in the urology department of Nantes and was based on 5clinical tests successively looking for the presence of thoraco-lumbar hinge syndrome, myofascial syndrome in the pelvic diaphragm, pelvic instability, pelvic-pedic quadrilateral dysfunction and paravertebral muscle hypertonia. A total of 51subjects were included in the study and divided into two populations: 26patients, 25controls. Thoraco-lumbar hinge syndrome was found in 28% of patients vs 4% of controls (P=0.024); myofascial syndromes were present in 68% of patients vs 25% of controls (P=0.005); pelvic instability concerned 76% of patients vs 33% of controls (P=0.002); the dysfunctions of the pelvic-pedic quadrilateral concerned 96% of the patients vs 58% of the controls (P=0.001); paravertebral muscle hypertonia was found bilaterally in 32% of patients vs 4% of controls (P=0.077) and unilaterally in 36% of patients vs 0% of controls (P=0.001). Patients with chronic pelvic perineal pain had significantly more posture problems than non-pain patients. It seemed relevant to us that the postural assessment was integrated into their usual clinical examination. 4.

Managing Gait, Balance, and Posture in Parkinson's Disease.

Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.

Modeling margin of stability with feet in place following a postural perturbation: Effect of altered anthropometric models for estimated extrapolated centre of mass

BackgroundMaintaining the centre of mass (CoM) of the body within the base of support is a critical component of upright balance; the ability to accurately quantify balance recovery mechanisms is critical for many research teams. Research questionThe purpose of this study was to investigate how exclusion of specific body segments in an anthropometric CoM model influenced a dynamic measure of postural stability, the margin of stability (MoS), following a support-surface perturbation. MethodsHealthy young adults (n = 10) were instrumented with kinematic markers and a safety harness. Sixteen support-surface translations, scaled to ensure responses did not involve a change in base of support, were then issued (backwards, forwards, left, or right). Whole-body CoM was estimated using four variations of a 13-segment anthropometric model: i) the full-model (WFM), and three simplified models, ii) excluding upper limbs (NAr); iii) excluding upper and lower limbs (HTP); iv) pelvis CoM (CoMp). The CoM calculated for each variant was then used to estimate extrapolated CoM (xCoM) position and the resulting MoS within the plane of postural disturbance. ResultsComparisons of simplified models to the full model revealed significant differences (p < 0.05) in MoS for all models in each perturbation condition; however, the largest differences were following sagittal plane based perturbations. Poor estimates of WFM MoS were most evident for HTP and CoMp models; these were associated with the greatest values of RMS/maximum error, poorest correlations, etc. The simplified models provided low-error approximates for frontal plane perturbations. SignificanceFindings suggest that simplified calculations of CoM can be used by researchers without reducing MoS measurement accuracy; however, the degree of simplification should be context-dependent. For example, CoMp models may be appropriate for questions pertaining to frontal plane MoS; sagittal plane MoS necessitates inclusion of lower limb and HTP segments to prevent underestimation of postural stability.

Schizotypal traits and forearm motor control against self-other produced action in a bimanual unloading task

The present study investigated the relation between schizotypy and motor control against self- or other-produced action. We used an unloading task to focus on the timing component of anticipatory motor control. In the task, a weight was removed from a participants’ hand by the participants themselves or by an experimenter (voluntary versus imposed unloading). Postural disturbance at the removal timing was measured as an index of predictive function in motor control. We hypothesized that the postural disturbance in the voluntary unloading would be positively related to schizotypal traits; however, the results did not support this theory. The results showed almost zero correlation between the schizotypy scores and the postural disturbance in the voluntary unloading condition. In contrast, the schizotypy scores positively correlated with the postural disturbance in the imposed unloading condition. These findings were replicated across two participant groups and two schizotypy scales. Further analyses on subscales of the schizotypy questionnaire found moderate levels of positive correlation between each subscale for Cognitive-Perceptual and Disorganization factors and the disturbance. Accordingly, the present study did not support the idea that non-pathological individuals with high schizotypal traits have deficits in prediction of self-produced actions, at least for a temporal domain. Instead, the results suggested that individuals with high schizotypal traits, particularly for the positive and disorganization symptoms, are not good at responding to others-produced actions. The schizophrenic symptoms were discussed in terms of the failure in the processes executed after calculating prediction of sensory consequences and dysfunction in internal models for “other people”.

Differences in neuromuscular activity of ankle stabilizing muscles during postural disturbances: A gender-specific analysis

The purpose was to examine gender differences in ankle stabilizing muscle activation during postural disturbances. Seventeen participants (9 females: 27 ± 2yrs., 1.69 ± 0.1 m, 63 ± 7 kg; 8 males: 29 ± 2yrs., 1.81 ± 0.1 m; 83 ± 7 kg) were included in the study. After familiarization on a split-belt-treadmill, participants walked (1 m/s) while 15 right-sided perturbations were randomly applied 200 ms after initial heel contact. Muscle activity of M. tibialis anterior (TA), peroneus longus (PL) and gastrocnemius medialis (GM) was recorded during unperturbed and perturbed walking. The root mean square (RMS; [%]) was analyzed within 200 ms after perturbation. Co-activation was quantified as ratio of antagonist (GM)/agonist (TA) EMG-RMS during unperturbed and perturbed walking. Time to onset was calculated (ms). Data were analyzed descriptively (mean ± SD) followed by three-way-ANOVA (gender/condition/muscle; α = 0.05). Perturbed walking elicited higher EMG activity compared to normal walking for TA and PL in both genders (p < 0.000). RMS amplitude gender comparisons revealed an interaction between gender and condition (F = 4.6, p = 0.049) and, a triple interaction among gender, condition and muscle (F = 4.7, p = 0.02). Women presented significantly higher EMG-RMS [%] PL amplitude than men during perturbed walking (mean difference = 209.6%, 95% confidence interval = −367.0 to −52.2%, p < 0.000). Co-activation showed significant lower values for perturbed compared to normal walking (p < 0.000), without significant gender differences for both walking conditions. GM activated significantly earlier than TA and PL (p < 0.01) without significant differences between the muscle activation onsets of men and women (p = 0.7). The results reflect that activation strategies of the ankle encompassing muscles differ between genders. In provoked stumbling, higher PL EMG activity in women compared to men is present. Future studies should aim to elucidate if this specific behavior has any relationship with ankle injury occurrence between genders.

Assessment of Backpacks Parameters and Postural Structure Disturbances Association among Iranian Children

Background: Postural structure abnormalities have been highly prevalent among children in primary school children.The present study aimed to assess the relationship between the backpacks weight and method of carrying with postural structure disturbances in primary school children. Materials and Methods: This cross-sectional study was performed on 472 primary school children in Karaj-Iran. Study investigators, assessed stature structure disturbances of head, neck, and spinal cord based on the New York scoring protocol. Ergonomic data of backpacks such as type of bag, weight of students' bags, the method of carrying bag, feeling pain when carrying the backpack, the mean time for carrying the backpack from school to home, was evaluated Results: In this study 97.2% of students carried backpacks as the school bags and only 1.9% carried their bags correctly. The mean time for carrying backpacks was associated with the increased risk for posture disorder including forward head (p<0.001), crookneck (p = 0.006), scoliosis (p = 0.006), lordosis (p = 0.006), and kyphosis (p<0.001). Also, the risk for all disturbances was significantly higher in those students who carried their bags themselves than others used services. Kyphosis was significantly more prevalent in students having backpacks weighted higher than 10% of their body weight (odds ration [OR] = 2.50, 95%confidence interval[CI]: 1.61-4.10, p < 0.001). Conclusion: According to the results the postural structure disturbances was partially high among primary school children and were closely associated with some ergonomic parameters such as weight and type of backpack.

Trip-specific training enhances recovery after large postural disturbances for which there is NO expectation

PurposeInformed consent usually provides foreknowledge of experimental methods that can potentially increase expectation of stimuli and, therefore, influence the response. We determined the effects of increased expectation and trip-specific training on the recovery response following a treadmill-delivered, trip-specific disturbance. To deliver unexpected disturbances, subjects were deceived during the informed consent process. The primary hypothesis was that the recovery response following an expected postural disturbance would be characterized by trunk kinematics that have been shown to decrease the likelihood of a fall, compared to following an unexpected postural disturbance. We further hypothesized that following an unexpected postural disturbance, the recovery response of the subjects who had completed a trip-specific training protocol would be more biomechanically favorable to recovery compared to those of subjects who had not received the training. MethodsYoung adults were randomized into Untrained or Trained groups. During the informed consent process, the purpose of the study was explained to subjects in both groups as being to determine the effect of trip-specific training on postural sway while performing an attention-demanding task. Untrained subjects completed two trials during which they minimized their postural sway. During the second trial, an unexpected disturbance was delivered while they performed the attention-demanding task. Trained subjects performed a pre-training postural sway trial, followed by the delivery of a series of expected, training disturbances. Finally, an unexpected disturbance was delivered while they minimized postural sway and performed the attention-demanding task. ResultsExpectation significantly improved trunk kinematics (p < .05). In addition, participation in the trip-specific training protocol following the unexpected disturbance the trunk kinematics of the Trained subjects were more biomechanically favorable to recovery than those of the Untrained subjects (p < .01). ConclusionImproved trunk kinematics following trip-specific training may be independent of the extent to which the disturbance is expected.

Apolipoprotein E allelic variants and cerebral palsy.

Gümüş E, Aras BD, Çilingir O, Yarar C, Çarman KB, Laçiner-Gürlevik S, Koçak O, Artan S. Apolipoprotein E allelic variants and cerebral palsy. Turk J Pediatr 2018; 60: 361-371. Cerebral palsy (CP) is the most frequent cause of mobility restriction and posture disturbance in childhood. Against the complexity in disease etiology, genetic factors, including Apolipoprotein E allelic distribution in this patient population, are worthy targets for investigation. ApoE is a lipoprotein of central nervous system encoded by ApoE gene with its 3 main co-dominant alleles, 2, 3 and 4. We aimed to evaluate the allelic frequencies of ApoE gene and its association with coexisting clinical entities such as vision and hearing impairment, cognitive problems, seizures and MRI findings in a pediatric patient population native to middle Anatolian region. Seventy-eight children with CP and 60 healthy controls were genotyped. Genotypic variations along with coexisting clinical conditions and CP-related medical findings were compared between the patient and control groups. The Denver Developmental Screening Test for all, the Wechsler Intelligence Scale for Children-IV (short form WISC-IV; Turkish version) for the patients > 6y and the Stanford-Binet Intelligence Scale (SB-5) for those who aged 2-6 years old were employed to evaluate cognitive and mental abilities of the patients. ApoE 2 and 4 alleles were more frequent in the patient group (p < 0.05), whereas ApoE 3 allele was more frequent in the healthy controls. ApoE 2/4 genotype has been determined 29% in the case group, but none in healthy control group. In the patient group with apolipoprotein 4 or 2 alleles, the rate of emergency cesarean section was found being significantly higher than the group with 3 allele. Brain MRI findings were not significantly different among ApoE allelic variants within the patient group. Our data show that the ApoE alleles may be effective in the development of cerebral palsy and may be associated with some clinical manifestations in those patients.

The Prevalence of Cerebral Microbleeds in Non-Demented Parkinson's Disease Patients.

BackgroundCerebral microbleeds (CMBs) are associated with cerebrovascular risk factors and cognitive dysfunction among patients with Parkinson's disease (PD). However, whether CMBs themselves are associated with PD is to be elucidated.MethodsWe analyzed the presence of CMBs using 3-Tesla brain magnetic resonance imaging in non-demented patients with PD and in age-, sex-, and hypertension-matched control subjects. PD patients were classified according to their motor subtypes: tremor-dominant, intermediate, and postural instability-gait disturbance (PIGD). Other cerebrovascular risk factors and small vessel disease (SVD) burdens were also evaluated.ResultsTwo-hundred and five patients with PD and 205 control subjects were included. The prevalence of CMBs was higher in PD patients than in controls (16.1% vs. 8.8%; odds ratio [OR], 2.126; P = 0.019); CMBs in the lobar area showed a significant difference between PD patients and controls (11.7% vs. 5.9%; OR, 2.234; P = 0.032). According to the motor subtype, CMBs in those with PIGD type showed significant difference from controls with respect to the overall brain area (21.1% vs. 8.9%; OR, 2.759; P = 0.010) and lobar area (14.6% vs. 4.9%; OR, 3.336; P = 0.016). Among PD patients, those with CMBs had higher age and more evidence of SVDs than those without CMBs.ConclusionWe found that CMBs are more frequent in PD patients than in controls, especially in those with the PIGD subtype and CMBs on the lobar area. Further study investigating the pathogenetic significance of CMBs is required.