Stable Sitting Research Articles

The Effect on Muscle Activity of Reaching Beyond Arm's Length on a Mobile Seat: A Pilot Study for Trunk Control Training for People After Stroke

ObjectiveThis pilot study compared muscle activity during lateral reaching tasks between mobile and stable sitting using a novel therapy chair in people after stroke and healthy controls. DesignObservational pilot study. SettingThis study was conducted in a rehabilitation center for people after stroke and at the university's movement laboratory for healthy participants. ParticipantsA total of eleven people after stroke and fifteen healthy people (N=26) took part. InterventionsLateral reaching exercises to the ipsilateral and contralateral sides were performed on a mobile and a stable seat. Main Outcome MeasureMuscular activity of the multifidus, erector spinae and external oblique was measured bilaterally. A within-subject linear mixed model was applied to analyze the effects of seat condition, task, muscle side, and group. ResultsA seat condition effect was found for the multifidus and external oblique that was dependent on the muscle side and task. During ipsilateral reaching, the activity of the multifidi decreased for people after stroke on the mobile seat, while increasing for healthy participants. The erector spinae showed no condition effect. Decreased activity of the external oblique was found for both groups on the mobile seat. ConclusionsMobile sitting influences muscular activity. However, these preliminary results should be further investigated in order to generate recommendations for rehabilitation.

Use of the Baby-Led Weaning (BLW) Method in Complementary Feeding of the Infant-A Cross-Sectional Study of Mothers Using and Not Using the BLW Method.

Baby-led weaning (BLW) is an increasingly popular way of expanding a baby’s diet. It is based on the baby becoming physically ready to feed himself, effectively supplementing his diet, which until now has been based on breast milk or modified milk. The aim of the study was to assess mothers’ knowledge about the use of the BLW method to expand the diet of a young child. The essence of the study assumed the analysis of the advantages and disadvantages of using this method indicated by mothers. Materials and Methods: A total of 320 mothers participated in the study. Data for the study were collected anonymously using the CAWI method. The research tool was the original questionnaire relating to the knowledge about the BLW method and the application of the BLW method in practice. Results: The BLW method was used by 240 (75%) women. The reasons for not using the BLW method were: the child did not cooperate n = 30 (37.5%) and was not ready to use the BLW method n = 20 (25%). In total, 182 (75.8%) mothers using BLW and 63 (78.8%) mothers not using BLW started extending the diet before the child was 6 months old. According to 270 (84.4%) mothers, including 205 (85.4%) using BLW, stable sitting in a highchair/on the lap is a decisive factor for starting the dietary expansion with the BLW method. Conclusions: Mothers’ knowledge of the BLW method as a way of expanding a young child’s diet was insufficient. It seems important to implement appropriate educational activities on the methods of expanding children’s diets to broaden parents’ knowledge of the influence of nutrition on infant development.

Evaluation of real-life outcome data of patients with spinal muscular atrophy treated with nusinersen in Switzerland

Spinal muscular atrophy (SMA) is an autosomal recessive disorder causing progressive proximal muscular, respiratory, and bulbar weakness. We present outcome data on motor function, ventilation, nutrition, and language development of SMA patients treated with nusinersen in Switzerland. This multicenter, observational study included 44 patients. At treatment initiation, after 2 months and then every 4 months we assessed motor function with the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP–INTEND), Hammersmith Functional Motor Scale expanded (HFMSE) and 6-Minute Walk Test (6MWT). At treatment initiation, patients were 0.1–44.6 years old, treatment duration ranged from 6 to 41 months. All 11 SMA type 1 children achieved higher CHOP-INTEND scores at the last assessment compared to treatment initiation, 4 acquired stable sitting. Six type 1 children were <18 months-old at treatment initiation. Two of them did not need ventilation or nutritional support at the last assessment; three had delayed language development and 3 articulation difficulties. 5/21 SMA type 2 patients achieved higher HFMSE scores. All ambulant type 3 patients showed a gain in the 6MWT. Nusinersen is an effective treatment, with gains in motor function occurring particularly in children and SMA type 1, but also in type 2 and 3, adolescents and adults.

Low Back Pain Exacerbation Is Predictable Through Motif Identification in Center of Pressure Time Series Recorded During Dynamic Sitting.

Background: Low back pain (LBP) is a common health problem — sitting on a chair for a prolonged time is considered a significant risk factor. Furthermore, the level of LBP may vary at different times of the day. However, the role of the time-sequence property of sitting behavior in relation to LBP has not been considered. During the dynamic sitting, small changes, such as slight or big sways, have been identified. Therefore, it is possible to identify the motif consisting of such changes, which may be associated with the incidence, exacerbation, or improvement of LBP.Method: Office chairs installed with pressure sensors were provided to a total of 22 office workers (age = 43.4 ± 8.3 years) in Japan. Pressure sensors data were collected during working days and hours (from morning to evening). The participants were asked to answer subjective levels of pain including LBP. Center of pressure (COP) was calculated from the load level, the changes in COP were analyzed by applying the Toeplitz inverse covariance-based clustering (TICC) analysis, COP changes were categorized into several states. Based on the states, common motifs were identified as a recurring sitting behavior pattern combination of different states by motif-aware state assignment (MASA). Finally, the identified motif was tested as a feature to infer the changing levels of LBP within a day. Changes in the levels of LBP from morning to evening were categorized as exacerbated, did not change, or improved based on the survey questions. Here, we present a novel approach based on social spider algorithm (SSA) and probabilistic neural network (PNN) for the prediction of LBP. The specificity and sensitivity of the LBP inference were compared among ten different models, including SSA-PNN.Result: There exists a common motif, consisting of stable sitting and slight sway. When LBP level improved toward the evening, the frequency of motif appearance was higher than when LBP was exacerbated (p < 0.05) or the level did not change. The performance of the SSA-PNN optimization was better than that of the other algorithms. Accuracy, precision, recall, and F1-score were 59.20, 72.46, 40.94, and 63.24%, respectively.Conclusion: A lower frequency of a common motif of the COP dynamic changes characterized by stable sitting and slight sway was found to be associated with the exacerbation of LBP in the evening. LBP exacerbation is predictable by AI-based analysis of COP changes during the sitting behavior of the office workers.

Impaired postural control of axial segments in children with cerebral palsy

BackgroundSensorimotor control of axial segments, which develops during childhood and is not mature until adolescence, is essential for the development of balance control during motor activities. Children with cerebral palsy (CP) have deficits in postural control when standing or walking, including less stabilization of the head and trunk which could affect postural control. Research questionIs dynamic stabilization of axial segments during an unstable sitting task deficient in children with CP compared to typically developing children? Is this deficit correlated with the deficit of postural control during standing? MethodSeventeen children with CP (GMFCS I-II) and 17 typically-developing children from 6 to 12 years old were rated on the Trunk Control Measurement Scale (TCMS). In addition, posturography was evaluated in participants while they maintained their balance in stable sitting, unstable sitting, and quiet standing, under “eyes open” and “eyes closed” conditions. In sitting tasks, the participants had to remain stable while being prevented from using the lower and upper limbs (i.e. to ensure the involvement of axial segments alone). ResultsChildren with CP compared to TD children had significantly larger surface area, mean velocity and RMS values of CoP displacements measured during the unstable sitting task and the standing task, under both “eyes open” and “eyes closed” conditions. No significant group effects were observed during the stable sitting task. The TCMS total score was significantly lower, indicating trunk postural deficit, in the CP group than in the TD group and was significantly correlated with postural variables in the sitting and standing tasks. SignificanceChildren with CP indeed have a specific impairment in the postural control of axial segments. Since the postural control of axial segments is important for standing and walking, its impairment should be taken into account in rehabilitation programs for children with CP.

Validity and variability of center of pressure measures to quantify trunk control in stroke patients during quiet sitting and reaching tasks

BackgroundIn the immediate period following stroke, sitting balance is one of the most important predictors of functional recovery at discharge after rehabilitation. Thus, sitting balance determines the content of the early phase of stroke rehabilitation and an appropriate measurement tool is important. Research QuestionThe aim of this study is to investigate the concurrent validity of center of pressure (CoP) excursions of patients seated on a force plate, as well as to examine the daily variability of trunk control after stroke. MethodsTwenty stroke patients at an inpatient rehabilitation clinic underwent two assessment sessions, on average eight hours apart. Each session comprised two trials: quiet sitting for 30 s; extended reaching in forward, backward, left and right directions. The Trunk Impairment Scale (TIS) was measured during the first session. CoP excursions were measured to determine the outcomes of sway area and sway velocity during stable sitting and the maximal excursions in frontal and sagittal planes during the reaching tasks. ResultsHigh Spearman’s correlations (0.72, 0.79) were found between the TIS and the frontal and sagittal excursions. However, only low correlations between the TIS and the sway area and sway velocity were observed. Within sessions, all CoP outcomes showed high ICCs (0.73–1.00). Between sessions, high ICCs (0.86-0.93) were found except for sway velocity (ICC 0.51). Sway velocity increased significantly between sessions. SignificanceFrontal and sagittal CoP excursions during reaching tasks appear to be valid measurement parameters to evaluate trunk control in patients after stroke. Only small variability was observed and no significant differences between consecutive days.

Sole-ground contact and sitting leg position influence suprahyoid and sternocleidomastoid muscle activity during swallowing of liquids.

Clinically, the stable sole‐ground contact in the diet is considered as important for achieving safe swallows in the dysphagic patients. However, the effects of varied sole‐ground contacts on swallow‐related muscles activities remain unclear. The aim of this study was to investigate the effects of sole‐ground contacts on the muscle activities during swallow for various materials; 26 healthy adult subjects participated in this study. Three different sole‐ground contact conditions were investigated; sole‐ground contact with knees bent to 90° (KB 90°), sole‐ground contact with knees bent to 135° (KB 135°), and sole‐ground off the floor (Off). Participants swallowed four bolus materials (saliva, 5‐ml water, 10‐ml water, and 5‐ml yogurt) in each sole‐ground contact condition. The muscular activities of the suprahyoid (SH) muscle and the sternocleidomastoid muscle during swallowing were detected and recorded using surface electromyography. The sole‐ground contact pressure was evaluated using the data acquisition system. Duration of SH during 10‐ml water swallow for Off was significantly longer than that for KB 90°. Duration of SH during 5‐ml yogurt swallow for Off was significantly longer than that for KB 90°. Integration of SH during 10‐ml water swallow for Off was significantly greater than that for KB 135°. Integration of SH during 5‐ml yogurt swallow for Off was significantly greater than that for KB 90°. No significant differences were found in peak of SH. Sole‐ground contact conditions had significant effect on swallow‐related muscles activities. The stable sitting positions might be more advantageous for performing effective swallows compared with less stable sitting positions.

Wearable Sensors for Measuring Movement in Short Sessions of Mindfulness Sitting Meditation: A Pilot Study.

Mindfulness techniques are useful tools in health and well-being. To improve and facilitate formal training, beginners need to know if they are in a stable sitting posture and if they can hold it. Previous monitoring studies did not consider stability during sitting meditation or were specific for longer traditional practices. In this paper, we have extended and adapted previous studies to modern mindfulness practices and posed two questions: (a) Which is the best meditation seat for short sessions? In this way, the applications of stability measures are expanded to meditation activities, in which the sitting posture favors stability, and (b) Which is the most sensitive location of an accelerometer to measure body motion during short meditation sessions? A pilot study involving 31 volunteers was conducted using inertial sensors. The results suggest that thumb, head, or infraclavicular locations can be chosen to measure stability despite the habitual lumbar or sacral region found in the literature. Another important finding of this study is that zafus, chairs, and meditation benches are suitable for short meditation sessions in a sitting posture, although the zafu seems to allow for fewer postural changes. This finding opens new opportunities to design very simple and comfortable measuring systems.

Exploratory Study of the Influence of Posture and Hand Task on Corticomotor Excitability of Upper Extremity Muscles After Stroke

ObjectiveTo explore the interaction between postural stability and hand task on the corticospinal excitability (CE) of upper extremity muscles and how it is affected by lesion location. DesignCross-sectional explorative survey. SettingInpatient rehabilitation center. ParticipantsParticipants (N=81) were neurologically healthy subjects (volunteer sample, n=36) and patients with stroke (convenience sample, n=45; mean time since stroke, 45d), stratified according to lesion location: pure subcortical strokes (n=25) and strokes with cortical involvement (n=20). InterventionsNot applicable. Main Outcome MeasuresMotor-evoked potentials were recorded simultaneously from the first dorsal interosseus (FDI) muscle and biceps brachii (BB) during rest and during low and forceful activation of the FDI in 4 different postural positions (supine, sitting, sitting unsupported, standing) and compared. ResultsPosture modulated CE of the FDI and BB during performance of a motor task but not at rest. The influence of postural position on CE of the FDI depended on force demand and lesion location: the control and subcortical stroke group demonstrated significantly higher CE of the FDI when performing the forceful task in the supine and stable sitting positions, respectively, compared with standing. In contrast, the cortical stroke group exhibited significantly higher CE of the FDI when performing the low-force task in a stable sitting position compared with standing. ConclusionsPosture influences CE of the FDI and BB in healthy subjects and patients with stroke differentially depending on hand task, but not at rest. A stable sitting posture increased excitability of the FDI in patients with stroke. These findings imply that hand rehabilitation protocols may be influenced by posture.

Prevention and treatment of scoliosis by Garches Brace in children with type Ib SMA

To evaluate the effectiveness of use of Garches Brace (GB) on prevention and treatment of scoliosis and its impact on quality of life, in a group of patients with spinal muscular atrophy (SMA) type Ib. We identified 102 patients with SMA not acquiring sitting position, but acquiring head dress (type Ib SMA) followed at our center between 1975 and 2009. We reviewed the charts and identified 25 patients that were treated by GB and had a follow-up in our department of three years or more. We collected and analyzed data including functional aspects in activities of daily living, quality of life, respiratory management, radiological Cobb angle (taken in lying position without brace). The GB treatment started at a mean age of 2,08 years (range 0,74–5,77) and GB was worn for a mean of 10,63 years (SD 2,55) before spinal fusion. Eighteen patients (72%) had spinal fusion, of whom 16 patients (64%) had less than 50° of Cobb angle when arriving at the age of spinal fusion, with a mean preoperative Cobb angle of 46,70° (range 0–85). Evolution of Cobb angle function to age was 2,4° per year. Sixteen patients (64%) gained mobility with an electric wheelchair and 12 patients (48%) accessed to school. Current studies on orthopedic management of scoliosis in most severe SMA patients are limited to type 2 and 3 SMA with scoliosis evolving between 54 and 95 °Cobb angle before spinal surgery. There is not available data on the therapeutic effects of orthopedic treatment of spine in type 1b SMA patients. The Garches Brace has shown to be an effective tool in the prevention and management of spinal deformities and in the stabilization of the pelvis. Besides, it allows stable sitting and upright head position, contributing to a better quality of life and a better accessibility to activities of daily living. The Garches Brace is generally well tolerated in children without significant side effects.

The Relationship between Sitting and the Use of Symmetry As a Cue to Figure-Ground Assignment in 6.5-Month-Old Infants.

Two experiments examined the relationship between emerging sitting ability and sensitivity to symmetry as a cue to figure-ground (FG) assignment in 6.5-month-old infants (N = 80). In each experiment, infants who could sit unassisted (as indicated by parental report in Experiment 1 and by an in-lab assessment in Experiment 2) exhibited sensitivity to symmetry as a cue to FG assignment, whereas non-sitting infants did not. Experiment 2 further revealed that sensitivity to this cue is not related to general cognitive abilities as indexed using a non-related visual habituation task. Results demonstrate an important relationship between motor development and visual perception and further suggest that the achievement of important motor milestones such as stable sitting may be related to qualitative changes in sensitivity to monocular depth assignment cues such as symmetry.

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes.

BackgroundTo date the main treatment approach for neuropathic onset scoliosis has utilised thoracic lumbar sacral orthoses (TLSO) to stabilize the spine and enable stable sitting. Dynamic elastomeric fabric orthoses (DEFOs) may achieve both of these aims if used as an early intervention. Due to a lack of evidence in this area, a retrospective audit of case notes was undertaken to understand current orthotic practice investigating the usage, outcomes and clinical characteristics of treated children with neuropathic onset scoliosis. Clinical notes of 180 children at risk for, or identified with, scoliosis were audited using a search matrix to identify diagnostic group, spinal muscle tone, Gross Motor Functional Classification Scale (GMFCS) level, orthotic treatment modalities, scoliosis specific data, surgical interventions, adaptive technologies used, and outcome measurements reported.ResultsOf the 180 notes examined, 85 were male; mean age nine years one month [SD four years seven months]. Spinal muscle tone was reported in 137 cases: 122/137 presented as low tone, 4/137 high tone, 6/137 fluctuating tone and 5/137 typical tone. Scoliosis was confirmed in (77/180) of whom (39/77) used a DEFO. Another (43/180) had a spinal curve developing, of whom (22/43) used a DEFO. The remaining (60/180) had no report of spinal curvature, but used a DEFO as a preventative measure. GMFCS scores were reported for 49 children of whom 14/49 were graded as level 4 and 17/49 level 5. Of the children with scoliosis who had spinal curve shapes reported, 48/60 had a C-shape presentation and 12/60 had an S-shape.ConclusionsThe findings confirm previously reported papers in children with neuropathic onset scoliosis in relation to curve shape and GMFCS levels. It provides some evidence of the role DEFOs may have in the management of these children, and highlights the need for further research in this area due to the lack of peer-reviewed publications.

Evaluation of the Effect of Hypercapnia on Vascular Function in Normal Tension Glaucoma.

Introduction. Altered ocular perfusion and vascular dysregulation have been reported in glaucoma. The aim of this paper was to evaluate the vascular response to a hypercapnic stimulus. Methods. Twenty normal tension glaucoma (NTG) patients and eighteen age- and gender-matched controls had pulsatile ocular blood flow (POBF) measurements, systemic cardiovascular assessment, and laser Doppler digital blood flow (DBF) assessed. Measurements were taken at baseline, after 10-minutes rest, in the stable sitting and supine positions and following induction and stabilization of hypercapnia, which induced a 15% increase in end-tidal pCO2. The POBF response to hypercapnia was divided into high (>20%) and low responders (<20%). Results. 65% of NTG patients had a greater than 41% increase in POBF following CO2 rebreathing (high responders). These high responders had a lower baseline POBF, lower baseline DBF, and a greater DBF response to thermal stimulus. Conclusion. NTG patients that have a greater than 20% increase in POBF after a hypercapnic stimulus have lower baseline POBF and DBF values. This suggests that there is impaired regulation of blood flow in a significant subgroup of NTG patients. This observation may reflect a generalised dysfunction of the vascular endothelium.

Diagnosis of Sjögren-Larsson Syndrome by Magnetic Resonance Spectroscopy

A 25-month-old girl had been born, after an uneventful pregnancy, at 36 weeks of gestation. Her weight was low for her gestational age (2025 g). She was the first child of unrelated and healthy parents. She presented with marked congenital ichthyosis. Motor retardation was later observed (i.e., stable sitting and walking at ages 12 and 22 months, respectively). Her speech was also delayed. Her first clinical evaluation at age 25 months revealed hyperkeratotic ichthyosis, especially at the main flexor folds, with mild facial involvement. The girl manifested severe pruritus. Her hair, nails, and teeth were normal. No organomegaly was evident. A neurologic examination indicated spastic quadriplegia with axial hypotonia and a left convergent strabismus. Cranial magnetic resonance imaging and proton magnetic resonance spectroscopy were performed with a 1.5 T Signa HDXt scanner (General Electric Medical Systems, Milwaukee, WI) (echo times, 35 ms and 144 ms; repetition time, 1500 ms; volume of interest, 8 mL). Cranial magnetic resonance imaging indicated abnormal, hyperintense signals on T2-weighted sequences in the subcortical white matter, predominantly in periventricular areas (Fig 1A). Magnetic resonance spectra were analyzed in the parietal subcortical white matter (Fig 1B), and at various echo times indicated two abnormal peaks compatible with lipid content: one broad and small peak at 0.9 parts per million corresponding to CH3 lipids of the methyl group, and one high and sharp peak at 1.3 parts per million corresponding to (CH2)n lipids of the methylene group (Fig 1C,D). The remaining peaks for N-acetyl aspartate, creatine, choline, and myoinositol appeared normal in shape and relative proportions. The association of congenital ichthyosis with pruritus, spastic tetraplegia, mental retardation, and white-matter hyperintensities on magnetic resonance imaging was highly suggestive of Sjogren-Larsson syndrome. Fibroblast fatty aldehyde/NADþ oxidoreductase activity was not detectable, confirming our diagnosis of Sjogren-Larsson syndrome.

Lumbopelvic stabilization with external fixator in a patient with lumbosacral agenesis

A case of caudal regression syndrome in which rehabilitation was obtained by lumbopelvic distraction and stabilization with external fixation Orthofix(®) is presented. The objective of the study is to describe the benefit of spine external fixator in caudal regression syndrome. Caudal regression syndrome is a rare and sporadic neural defect of distal spinal segments affecting the development of the spinal cord. It is characterized by vertebropelvic instability and essentially manifests as neurological deficit in the lower limbs and absence of bladder and bowel control. Pluridisciplinary management of this affection is complex. The clinical presentation and treatment of caudal regression syndromes are reviewed. A case of a boy for whom physical rehabilitation was obtained with external fixation Orthofix(®) is presented. Lumbopelvic stabilization was performed with autograft and allograft bone. A spine distraction was performed with external fixation with pedicular screws in L1 and L2 and in the pelvis bone. An elongation of 19mm was obtained in 35days. The external fixator was removed after 4months and a spine cast was applied during 8months. This treatment resulted in lumbopelvic nonunion of very low mobility. Lumbopelvic stability and the disappearance of pain were achieved. Sitting position was stable without hand support. At 14years of follow-up, his condition is stable with possible deambulation at home with crutches. Lumbopelvic arthrodesis in caudal regression syndrome is difficult to obtain. The use of spine external fixator, however, allows trunk elongation and can achieve a stable sitting and upright position.

Conservative management of neuromuscular scoliosis: Personal experience and review of literature

Purpose. The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented.Methods. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis.Results. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression.Conclusions. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.