Test Position Research Articles

THU623 Leuprolide Treatment Of Mild Cortisol Secretion (MACS) Due To Primary Bilateral Macronodular Hyperplasia (PBMAH) Expressing Aberrant LH Receptors

Abstract Disclosure: L. Branchaud-Croisetière: None. M. St-Jean: Speaker; Self; Recordati rare disease, GlaxoSmithKline. Stock Owner; Self; Spruce bioscience. Cushing syndrome (CS) is caused by PBMAH in <2% of cases. Treatment is mostly surgical with unilateral or bilateral adrenalectomy, but in some cases, identification of aberrant receptors can allow the use of targeted medical therapies. Only a few cases of adrenal CS associated with an aberrant LH/hCG receptors that were treated with GnRH agonist were described. In December 2020, we saw a 72-year-old woman for bilateral adrenal nodules and an ACTH independent hypercortisolism. Her past medical history includes depression, insomnia, and osteoporosis with multiples fragility fractures. She was taking citalopram, calcium, vitamin D and alendronate was added in 2021. In the follow-up she developed dyslipidemia and hypertension. There were no sign of CS on physical examination. In 2020, a non-contrast thoracic scan was done and showed a right adrenal nodule of 3x1,4 cm and a left adrenal nodule of 3 x 2 cm both with densities < 10 HU and no atrophy of the adrenal limbs. In August 2021, a FDG PET scan showed an SUV of 3,4 on the right side and 3,7 on the left side. Morning cortisol after 1 mg DST (done twice) were 122 and 133 nmol/L (N <50). Aldosterone to renin ratio and 17-OHP were normal. In September 2020, a 4 mg IV dexamethasone suppression test was done and cortisol was 189 nmol/L at 9h am on day 2. Between 2020 and 2021, ACTH (3 values) were between 1,3-1,7 pmol/L (N 0-10 pmol/L) and DHEAS (3 values) between 1-1,6 (N 0,95-11,67 mol/L). 24h UFC (7 values) varied from 280,6 to 600,6 nmol/d (N 153-789 nmol/d). LNSC (8 values) were normal <2 to 3 nmol/L (N <5) except for one value at 6 nmol/L. In February 2022, systematic research for aberrant receptors was done. The cortisol have showed an ACTH-independent increased of 242% following 100 mcg IV of LHRH. There was also a significant ACTH-independent increase after 10 IU of vasopressin (+ 66%) and 10 mg of maxeran PO (+ 98%). There was no significant increase in cortisol after stimulation with glucagon 1mg IV and the upright posture test. We couldn’t obtain cortisol measures after stimulation with cortrosyn and the mixed-meal test because of issues with samples. Treatment with Leuprolide 3,75mg IM monthly was started in April 2022 and the dose was increased to 7,5 mg in August 2022 because of partial response observed initially. There was a response with an increase in ACTH from <1,1 to 2,6 pmol/L until December 2022. Since January 2023, ACTH (3 values) have decreased between 1,8-2 pmol/L. In January 2023, the morning cortisol after 1 mg DST was 104 nmol/L and 24h UFC were 161 and 306 nmol/d and two LNSC were <2 nmol/L. However, with the recent decrease in ACTH, we suspect an escape to Leuprolide. In summary, this is a rare case of MACS due to PBMAH expressing aberrant LH receptors with initial response to Leuprolide. We are waiting for the results of genetic testing. The patient could eventually benefit from a left unilateral adrenalectomy if escape from medical treatment is confirmed. Presentation: Thursday, June 15, 2023

FRI130 Usefulness Of The Upright Posture Test In The Diagnosis Of Primary Aldosteronism

Abstract Disclosure: N. Younes: None. M. St-Jean: None. M. Desrochers: None. I. Bourdeau: None. A. Lacroix: None. Objectives: Renin-independent aldosterone excess characterizes primary aldosteronism (PA). We have previously shown that PA is frequently regulated by aberrant stimuli, including the upright posture stimulation test (UPT), in which plasma aldosterone concentrations (PAC) increase in a renin-independent manner. In this study, we further examined the usefulness of UPT in diagnosing PA. Methods: We conducted a retrospective analysis of the medical records of 187 adult patients who underwent an UPT as part of their evaluation for possible PA and 25 control subjects, in 2 referral university centers between January 2011 and December 2021. UPT was conducted in an ambulatory setting, mostly in patients with potential false negative or borderline results of oral/IV saline confirmation tests. UPT was performed in a fasting state, early morning, 72 hours off beta-blockers, ACE, or ARBS. Patients were in a supine posture for 1 hour, followed by ambulation for 2 hours. Blood samples were collected for PAC, renin, and cortisol, at baseline and at 30 minutes intervals during ambulation. An abnormal response was defined as a ≥50% rise in PAC with a suppressed renin (≤10.1 ng/L or ≤1 ng/mL/h) and a cortisol increase ≤50%. Results: Median age of patients was 55.0 [IQR (46.0; 63.0)], 52.4% were female. 93.6% were taking at least one antihypertensive medication and 32% had hypokalemia. 43.5% did not have adrenal nodules at imaging. 76.5% (n=143) were diagnosed with PA, based on either IV/oral sodium load or UPT. When compared to controls, PA patients had higher basal PAC and lower basal renin levels (p<.0001) and achieved a higher maximal PAC and lower maximal renin (renin max) in response to posture [median PAC (IQR): 802.0 pmol/L (569.0, 1244.0) in PA v/s 624.0 pmol/L (500.0, 736.0) in controls, p=0.0081 and median renin 5.0 ng/L [IQR (3.0, 8.0)] in PA v/s 27.5 ng/L in controls (19.0, 46.0); p<.0001]. Renin max ≤10.1 had the best sensitivity and specificity for predicting PA (90% and 92%, respectively). 95.3% of PA patients increased PAC by at least 50% on UPT (median increase 363%), while renin remained suppressed. All 42 PA patients with a false negative (PAC ≤162 pmol/L) on IV saline test had a renin max ≤10.1 during UPT and 97.6% increased aldosterone by at least 50%. 84% of PA patients with a borderline response (162-240 pmol/L) on IV saline test, had a renin max ≤10.1 and all patients increased aldosterone by at least 50%. 42 patients underwent adrenal vein sampling: 50% had lateralized PA (potassium was lower than in bilateral PA, p=0.003). However, the aldosterone and renin response to UPT did not significantly differ between the two subtypes of PA. Conclusion: A renin-independent aldosterone increase during UPT can be used to confirm PA diagnosis, which was particularly useful in patients with false negative saline loading tests. Renin-independent PAC response to UPT occurred equally in lateralized and bilateral PA. Presentation: Friday, June 16, 2023

The Effects of Core Stabilization Exercises on Respiratory Muscle Strength, Respiratory Functions, and Postural Control in Children With Hearing Loss: A Randomized Controlled Trial.

To evaluate the effects of core stabilization training on respiratory muscle strength, respiratory functions, and postural control in children with hearing loss. We conducted a randomized controlled trial at Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation. Thirty children with hearing loss who were diagnosed with prelingual sensorineural hearing loss were randomly allocated to the study (n = 15, 12.20 ± 1.69 years) and control (n = 15, 11.87 ± 2.20 years) groups. Core stabilization training protocol was performed by the study group for 8 weeks, 5 days/week, whereas the control group received no training. The primary outcome measure was respiratory muscle strength. The secondary outcome measures were: spirometry, postural control tests on Biodex Balance System, and Balance Error Scoring System (BESS). Exercise adherence was recorded via a diary for home sessions. Outcomes were assessed at baseline and the end of the 8 weeks. In the study group, a significant improvement was observed in force vital capacity, peak expiratory flow of the spirometry test, maximum inspiratory pressure/expiratory pressure (MEP) of the respiratory muscle strength test; postural stability test except "anterior/posterior stability index", limits of stability test except "backward" and "forward/right", all parameters of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) test except "eyes closed firm surface" of the Biodex Balance System, and total score of BESS. Group × time interaction was found in MEP, "overall" stability index in postural stability test, "overall," "left," and "backward left" of limits of stability test, all parameters of the mCTSIB, and BESS total. Core stabilization exercises were effective in improving respiratory muscle strength, spirometry, and postural control in children with hearing loss.

Comparison between Romberg test with sensor-based balance assessment using electronic wobble board

The number of fall-related injuries resulting in hospital admissions could place a significant load on hospitals. Prior research revealed that balance impairment is the most reliable indicator of future falls, and postural instability testing is expensive and tedious to be applied in clinical settings. This paper presents an objective based balance assessment method using an electronic wobble board to examine the balance ability among individuals, with minimal specialist intervention. The balancing assessment software modules provide visual feedback such as visual concentration, test procedure teaching, and time counting. Quick objective balance evaluation is facilitated by the software modules, which also can comprise visual feedback and provides instant biofeedback with objective measurements of user’s progress. The balance assessment score obtained from this electronic wobble board was compared against physiotherapists’ ratings using the Romberg test. The results indicated that the sensor-based balance score is comparable with the expert ratings using the Romberg test. Additionally, the sensor-based score provides higher sensitivity in differentiating among similar categories of subjects as compared to the conventional Romberg test.

How Many Trials Is Enough To Access Balance On The Biodex Balance System?

While the Biodex Balance System (BBS) proved to be a reliable apparatus for testing balance, there is lacking evidence on the number of familiarization trials the subject must undergo before being tested, especially when lower stability levels are used on the BBS. The goal of this study was to determine after how many attempts the result of the balance test on the BBS stabilize. The sample consisted of 66 boys (13.42±0.50 years old) and 57 girls (13.39±0.49 years old) not active in sports. The subjects underwent the Postural Stability Test three times and the Overall Stability Index variable of the BBS was examined. In the analysis the results were separately examined for boys and girls using the t-test. Significant differences were found in all three measurements for boys while for girls there was no significant difference between the second and third measurement. The results of this study indicate that, for boys of this age, the results did not stabilize through the three trials conducted which could mean a need for more than three attempts so the negative effects of familiarization could be avoided. For girls it seems that the result stabilized at the second trial which could indicate that only one trial is needed for them to familiarize themselves with the test. These findings can be important for future studies with a similar female sample to save time and conduct just one test trial before the actual testing, since testing balance on the BBS requires a significant amount of time.

Effects of Ankle Orthoses, Taping, and Insoles on Postural Stability of Individuals with Chronic Ankle Instability: A Systematic Review.

Chronic ankle instability (CAI) is a prevalent condition characterized by recurring instances of the ankle giving way and persistent symptoms, including pain and diminished function. Foot and ankle external supports are commonly used in clinical practice and research for treating CAI. This systematic review aimed to assess the effects of foot and ankle external supports on the postural stability of individuals with CAI to guide clinical practice and inform future research. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases from 1 January 2012 to 1 November 2022. Eighteen studies involving individuals with CAI were chosen in this systematic review. The quality of the included studies and risk of bias were assessed using Cochrane Collaboration's tool for randomized controlled trials, the Newcastle-Ottawa Scale for case-control studies, and the DELPHl-list for crossover trial studies. The external supports included in this review were ankle orthoses (elastic, semi-rigid, and active orthoses), taping (kinesiotaping and fibular reposition taping), and insoles (textured and supportive insoles). The outcome measures included static and dynamic postural stability tests, such as the single-leg stance test, star excursion balance test, Y-balance test, single-leg landing test, lateral jump test, walking test, and running test. The results showed that elastic orthoses, Kinesiotaping, and textured insoles demonstrated potential benefits in improving postural stability in individuals with CAI. Elastic orthoses decreased ankle joint motion variability, kinesiotaping facilitated cutaneous receptors and proprioceptive feedback, while textured insoles increased tactile stimulation and foot position awareness. However, the effects of semi-rigid orthoses, fibular reposition taping, and arch support insoles were inconsistent across studies. Future research should explore the long-term effects of these external supports, analyze the effects of different characteristics and combinations of supports, and employ standardized outcome measures and testing protocols for assessing postural stability.

Do The Core Stability and Position Sense of Trunk Affect Balance in Patients with Multiple Sclerosis?

Objective: The trunk is known to be the most important key point where sensory inputs are received and motor responses occur, necessary for the maintenance of balance and postural control. The aims of the present study were to investigate the relationship between balance with core stability and position sense of trunk in patients with Multiple Sclerosis (PwMS) and to compare core stability, position sense of trunk and balance in PwMS and healthy controls. 
 Methods: The study was completed with 45 PwMS and 29 healthy controls with matching age and gender. Balance was assessed with Postural Stability Test (PST) and Modified Sensory Organization Test (MSOT) by using Biodex Balance System®. Core stability was evaluated with core endurance tests according to McGill procedure. Position sense of trunk was evaluated with the lumbosacral (LS) reposition tests by using Dualer IQTM digital inclinometer. 
 Results: PST, MSOT and LS repositioning tests scores were higher (p

The Relevance of Intraoperative Clinical and Accelerometric Measurements for Thalamotomy Outcome.

Thalamotomy alleviates medication-refractory tremors in patients with movement disorders such as Parkinson's Disease (PD), Essential tremor (ET), and Holmes tremor (HT). However, limited data are available on tremor intensity during different thalamotomy stages. Also, the predictive value of the intraoperative tremor status for treatment outcomes remains unclear. Therefore, we aimed to quantify tremor status during thalamotomy and postoperatively. Data were gathered between January 2020 and June 2023 during consecutive unilateral thalamotomy procedures in patients with PD (n = 13), ET (n = 8), and HT (n = 3). MDS-UPDRS scores and tri-axial accelerometry data were obtained during rest, postural, and intention tremor tests. Measurements were performed intraoperatively (1) before lesioning-probe insertion, (2) directly after lesioning-probe insertion, (3) during coagulation, (4) directly after coagulation, and (5) 4-6 months post-surgery. Accelerometric data were recorded continuously during the coagulation process. Outcome measures included MDS-UPDRS tremor scores and accelerometric parameters (peak frequency, tremor amplitude, and area under the curve of power (AUCP)). Tremor intensity was assessed for the insertion effect (1-2), during coagulation (3), post-coagulation effect (1-4), and postoperative effect (1-5). Following insertion and coagulation, tremor intensity improved significantly compared to baseline (p < 0.001). The insertion effect clearly correlated with the postoperative effect (ρ = 0.863, p < 0.001). Both tremor amplitude and AUCP declined gradually during coagulation. Peak frequency did not change significantly intraoperatively. In conclusion, the study data show that both the intraoperative insertion effect and the post-coagulation effect are good predictors for thalamotomy outcomes.

Abstract P413: Association Between Supine Hypertension And Autonomic Impairment In Patients With Autonomic Failure

Autonomic failure is characterized by an inability to regulate blood pressure (BP). The dominant clinical manifestation of these patients is orthostatic hypotension (OH). However, at least half of them also have supine hypertension, which can arise de novo or due to worsening of preexisting essential hypertension. We hypothesized that, regardless of the cause of hypertension, the loss of baroreflex buffering capacity in these patients contributes to the severity of their hypertension. Thus, we tested whether supine hypertension reflects the severity of autonomic impairment (i.e., reduced BP buffering capacity) in a retrospective cohort of 307 patients (66±1 yr, 183 males, BMI 26.1±0.3) with a diagnosis of neurogenic OH due to multiple system atrophy (MSA, n=95) or peripheral autonomic failure (pAF, n=212). Autonomic impairment was assessed by standard autonomic testing (posture test, Valsalva maneuver [VM], and sinus arrhythmia [SA] ratio) performed off pressor and antihypertensive medications. The association between supine systolic BP (SBP; median [interquartile range, IQR], 146 [130-168] mmHg) and autonomic testing was assessed using multiple regression analyses. After adjusting for age, sex, BMI, and type of autonomic failure (MSA vs. pAF), we found that supine SBP was positively related to age (β=0.33; P=0.034), the severity of OH (the drop in SBP on standing; β= -0.48, P&lt;0.001), and indices of severity of autonomic impairment, including the lack of adequate compensatory increase in heart rate in the setting of OH (ΔHR/ΔSBP, β=-15.43, P=0.044), and lack of recovery of SBP during late phase 2 of the Valsalva maneuver (β=-0.31; P&lt;0.001; model R 2 =0.55, P&lt;0.001). VM and SA ratios were not related to supine hypertension. In conclusion, we postulate that the magnitude of supine hypertension correlates with the severity of autonomic impairment and that both OH and supine hypertension reflect the inability of autonomic failure to regulate blood pressure.

크로스핏 훈련이 스키선수의 순발력, 동적균형조절 및 고유수용성 감각에 미치는 영향

The purpose of this study was to investigate the effect of 6 weeks of crossfit training on power, dynamic posture control and proprioceptive sensory in ski athletes. Twenty four subjects participated in this study and were randomly divided into two groups : exercise group (Ex=12) and control group (Con=12). The crossfit training program consisted of a Push-ups, Squat(deep), Sit-ups, 1 Leg raises on Sweden wall, Handstand push-ups, Elevated heels, Burpees and carried out three times a week for 60 minutes at 60-70% intensity for 6 weeks. The dependent varialbes sargent jump, standing long jump, dynamic posture control test and proprioceptive snesory. The results are as a follows. The sargent jump and standing long jump were significantly difference. Dynamic postural control were significantly difference in anterior, postero-medial and postero-lateral reach of the left and right leg, and significant decrease in the proprioceptive sensory on the form pad. In conclusion, 6 weeks of crossfit training have been shown to improve power, dynamic posture control and proprioceptive sensory in ski athletes.

Relationship Of Serum Hemoglobin And Vitamin D Levels With Posutral Balance

Background: The population of the elderly in Indonesia has increased significantly in recent years. The incidence of falls is influenced by postural balance. Vitamin D and hemoglobin deficiency are associated with decreased muscle function and postural balance. This study is to investigate the relationship between vitamin D and hemoglobin levels with postural balance in the elderly. Methods: The study used a cross-sectional design with the participation of 33 patients (aged 64.94±5.42 years). The study sample was elderly individuals who fulfilled the inclusion criteria at Semarang Elderly Posyandu. Patients performed postural balance test, with Sharpened romberg and tandem gait test. The examination of vitamin D and hemoglobin was taken from the patient's venous blood. Vitamin D was measured using ELISA. Results: The results of the independent sample t-test analytic test revealed a P value of vitamin D (0.007) and a P value of hemoglobin of (0.021) (p&lt;0.05). There is a meaningful relationship between vitamin D and hemoglobin levels with postural balance in the elderly.. Conclusion: Decreasing Haemoglobine and Vitamin D impair the postural balance.

Young type 1 diabetes subjects sway more than healthy persons when somatosensory system is challenged in static standing postural stability tests.

In type 1 diabetes, it is important to prevent diabetes-related complications and postural instability may be one clinically observable manifestation early on. This study was set to investigate differences between type 1 diabetics and healthy controls in variables of instrumented posturography assessment to inform about the potential of the assessment in early detection of diabetes-related complications.Eighteen type 1 diabetics with no apparent complications (HbA1c = 58 ± 9 mmol/L, diabetes duration = 15 ± 7 years) and 35 healthy controls underwent six 1-mintwo feet standing postural stability tests on a force plate. Study groups were comparable in age and anthropometric and performed the test with eyes open, eyes closed (EC), and EC head up with and without unstable padding. Type 1 diabetics exhibited greater sway (path length, p = 0.044 and standard deviation of velocity, p = 0.039) during the EC test with the unstable pad. Also, power spectral density indicated greater relative power (p = 0.043) in the high-frequency band in the test with EC head up on the unstable pad and somatosensory activity increased more (p = 0.038) when the unstable pad was added to the EC test. Type 1 diabetes may induce subtle changes in postural control requiring more active balancing when stability is challenged. Postural assessment using a portable easy-to-use force plate shows promise in detecting a diabetes-related decline in postural control that may be used as a sensitive biomarker of early-phase diabetes-related complications.

Difference in the recruitment of intrinsic foot muscles in the elderly under static and dynamic postural conditions.

The effect of foot, especially intrinsic muscles, on postural control and its related mechanisms remain unclear due to the complex structure. Therefore, this study aims to investigate the activation of intrinsic foot muscles in the elderly under static and dynamic postural tasks. Twenty-one elderly participants were included to perform different postural tests (sensory organization test (SOT), motor control test (MCT), limit of stability test (LOS), and unilateral stance test) by a NeuroCom Balance Manager System. The participants were instructed to maintain postural stability under conditions with combined different sensory inputs (vision, vestibular, and proprioception) in SOT as well as conditions with translation disturbance in MCT, and to perform an active weight-shifting tasks in LOS. During these tasks, muscle activation were simultaneously acquired from intrinsic foot muscles (abductor halluces (AbH) and flexor digitorum brevis (FDB)) and ankle muscles (anterior tibialis, medial head of gastrocnemius, lateral head of gastrocnemius, and peroneus longus). The root-mean-square amplitude of these muscles in postural tasks was calculated and normalized with the EMG activity in unilateral stance task. The activation of intrinsic foot muscles significantly differed among different SOT tasks (p<0.001). Post-hoc tests showed that compared with that under normal condition 1 without sensory interference, EMGs increased significantly under sensory disturbance (conditions 2-6). By contrast, compared with that under the single-sensory disturbed conditions (conditions 2-4; 2 for disturbed vision, 3 for disturbed vestibular sensation, 4 for disturbed proprioception), activation was significantly greater under the dual-sensory disturbed postural tasks (conditions 5 and 6; 5 for disturbed vision and proprioception, 6 for disturbed vestibular sensation and proprioception). In MCT, EMGs of foot muscles increased significantly under different translation speeds (p<0.001). In LOS, moderate and significant correlations were found between muscle activations and postural stability parameters (AbH, r = 0. 355-0.636, p<0.05; FDB, r = 0.336-0.622, p<0.05). Intrinsic foot muscles play a complementary role to regulate postural stability when disturbances occur. In addition, the recruitment magnitude of intrinsic foot muscles is positively correlated with the limit of stability, indicating their contribution to increasing the limits of stability in the elderly.

Comparison of postural sway in individuals with and without dynamic knee valgus

BackgroundDynamic knee valgus (DKV) is a multi-planar faulty movement pattern that can cause faulty postural control. The primary objective of this study is to investigate the differences in postural sway (PS) between individuals aged 18–30 years old diagnosed with and without DKV.MethodsIn this cross-sectional study, 62 students (39 males and 23 females) with and without DKV (age: 24.58 ± 2.63 years) were selected and assigned to two groups by conducting the single-leg squat test in the screening stage. The Biodex balance system was then employed to compare the two groups in PS. Mann–Whitney U test was conducted to compare the groups in PS (p ≤ 0.05).ResultsThe study’s findings indicate that individuals with DKV did not exhibit any significant differences, compared to those without, about the anterior-posterior stability index (with p values for both static and dynamic situations at 0.309 and 0.198, respectively), medial-lateral stability index (with p values for both static and dynamic situations at 0.883 and 0.500, respectively), and overall stability index (with p values for both static and dynamic situations at 0.277 and 0.086, respectively).ConclusionThough several possible factors could contribute to the lack of significant differences in postural sway between individuals with and without DKV, such as measurement tool differences, variable sensitivity in postural stability tests, and differences in movement variability and test stance, we recommend analyzing postural sway in more functional tasks and with different methodological patterns in future studies. Such research could help develop targeted interventions for individuals with DKV and offer a better understanding of the relationship between postural control and DKV.

Prevalence and Determinants of Falls in Community-dwelling Older Adults in Türkiye: A Population-based Cross-sectional Study Conducted between 2014-2015.

Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at risk people. We present here a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults. In this population-based cross-sectional study, we included adults aged > 60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz's 6-item ADL and Lawton Brody's 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean ± standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required, and Chi-square and Fisher's exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses. The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR = 3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p = 0.020) were identified as associates of falls. Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.

Welder Work Position Planning with the REBA Method: Rapid Entire Body Assessment

Welding is a job with a high risk of danger for the welder, such as a hot working environment, dehydration, eye complaints, and uncomfortable working positions. One of the conditions that often occur in welding workers when carrying out work is the position of the welder's body when carrying out welding, which is required to stand. This condition will cause complaints that the welder feels because carrying out the welding process takes a long time. This causes the welder to experience pain in the legs and back and, if done continuously, will trigger long-term illness. The method used in this research is method Rapid Entire Body Assessment (REBA). From the results of manually calculating the REBA method, a score of 2 is obtained, which can be interpreted according to the REBA Classification and Risk Level as low risk. Based on the results of work posture testing on the welding section, the workload of the workers has been reduced from 5 to 2. Therefore, the best position is welding while standing with the body upright; this will help the welder work without injury and has been tested using the REBA method.

Quantitative Analysis of Postural Balance in Faller and Nonfaller Patients with Parkinson's Disease.

Postural instability has been identified as a fall risk factor with a significant impact on the quality of life of patients with Parkinson's disease (PD). The aim of this study was to compare the center of pressure (COP) between faller and nonfaller patients with PD during static standing. Thirty-two faller patients and 32 nonfaller patients with PD participated in this study. All patients performed the static balance test on a force plate. COP data were recorded during quiet standing. Mean distance, sway area, mean velocity, mean frequency, and peak power were derived from the COP data. Statistical analysis was performed using independent t-tests to compare faller and nonfaller patients. Fallers presented a greater average distance, wider sway area, faster average speed, and greater peak power than nonfallers (p < 0.05). In contrast, no significant group differences were observed in peak frequency and mean frequency (p > 0.05). Although falls occur during dynamic activities, our study demonstrated that even a safe and simple static postural balance test could significantly differentiate between faller and nonfaller patients. Thus, these results suggest that quantitatively assessed static postural sway variables would be useful for distinguishing prospective fallers among PD patients.

IMPAIRED VERTICALITY PERCEPTION AND POSTURAL BALANCE AT 1 MONTH AFTER HEMISPHERIC STROKE

Introduction. In some patients with hemispheric strokes the internal model of verticality is shifted to the opposite side, so patients actively tilt the body axis in the opposite direction from the affected hemisphere. Disturbances of verticality perception are associated with worse functional conditions and slower dynamics of their recovery, with the need for longer rehabilitation treatment, etc. Objective: to investigate the relationships between impaired perception of verticality and indicators of postural balance during the 1st month after hemispheric strokes. Material and methods. There were examined 205 patients with hemispheric strokes that occurred during the last month. The Scale for Contraversive Pushing was used to assess the orientation of the body axis in relation to the force of gravity in the frontal plane. For evaluating of static and dynamic balance we used Berg Balance Scale, Postural Assessment Scale for Stroke, Trunk Impairment Scale, Test Timed Up and Go. Results. Depending on the presence (absence) of verticality perception disorders it had been revealed significant differences in postural balance scales and tests. Severity of verticality perception impairment was associated with significant changes in postural balance: patients with pushing syndrome had reliably worse indicators of postural balance compared to patients with lateropulsion. Moreover, even minimal lateropulsion was associated with significant deterioration of postural balance indicators, compared to normal perception of verticality. In addition, increasing severity of lateropulsion was associated with significant deterioration of postural balance indicators, regardless of spatial hemineglect and hemiparesis severity. Conclusions. 1. Impaired verticality perception in the recovery period of hemispheric strokes was associated with reliable negative changes in postural balance status. 2. Increasing severity of verticality perception disorders corresponded to a reliable deterioration of postural balance indicators.

Healthy aging reduces dynamic balance control as measured by the simplified Star Excursion Balance Test

BackgroundDetecting and classifying factors that contribute to age-related balance decline are essential for targeted interventions. Dynamic postural tests that challenge neuromuscular balance control are important to detect subtle deficits that affect functional balance in healthy aging. Research questionHow does healthy aging affect specific components of dynamic postural control as measured by the simplified Star Excursion Balance Test (SEBT)? MethodsTwenty healthy younger (18–39 years) and twenty healthy older (58–74 years) adults performed the standardized simplified SEBT, which involved standing on one leg and reaching the contralateral leg as far as possible in the anterior, posteromedial, and posterolateral directions. Optical motion capture was used to quantify the maximum reach distance normalized by body height (%H) for three repeated trials in each direction per leg. Linear mixed effects models and pairwise comparisons of estimated marginal means were used to assess differences (p < 0.05) in normalized maximum reach distance by age group, reach direction, and leg dominance. Intersubject and intrasubject variability were also assessed by age group using coefficients of variation (CV). ResultsHealthy older adults had less dynamic postural control compared to younger adults, with shorter reach distances in the anterior (7.9 %), posteromedial (15.8 %), and posterolateral (30.0 %) directions (p < 0.05). Leg dominance and sex did not significantly affect SEBT score for either age group (p > 0.05). Low intrasubject variability (CV<0.25 %) was found for repeated trials in both the older and younger participants. Therefore, the comparatively higher intersubject variability (Range CV=8–25 %) was mostly attributed to differences in SEBT performance across participants. SignificanceQuantifying dynamic postural control in healthy older adults in a clinical setting is important for early detection of balance decline and guiding targeted and effective treatment. These results support that the simplified SEBT is more challenging for healthy older adults, who may benefit from dynamic postural training to mitigate age-related decline.

The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study.

determining the appropriate rehabilitation protocol is essential to influence the correction of flat feet, e.g., by activating the intrinsic muscles of the foot. Therefore, this study aimed to determine the impact of the exercises activating the intrinsic foot muscles for postural control in children with flat feet, with normal and excessive body weight. Fifty-four children aged 7 to 12 were enrolled in the research. Forty-five children were qualified for the final evaluation. Each child in the experimental group was demonstrated an appropriate technique for performing a short foot exercise without compensation by extrinsic muscle. The participants then performed a supervised short foot training session once a week and on other days of the week under the supervision of caregivers for 6 weeks. Flat feet were scored on the foot posture index scale. A postural test was evaluated with a Biodex balance system SD. Statistical significance in the foot posture index scale and postural test were evaluated using an analysis of variance (ANOVA) with Tukey's post-hoc test. according to the six indices of the foot posture index scale, five indicators showed statistically significant improvement after rehabilitation. At the 8-12 platform mobility level, it was revealed that the excessive body weight group had significant improvements in the overall stability index and medio-lateral stability index, with eyes closed. our results indicate that a 6-week rehabilitation program based on the activation of the intrinsic muscles of the foot resulted in an improvement in the foot position. This, in turn, affected balance control, especially in children with excess body weight in conditions of closed eyes.