The Effects of Exergame on Postural Control in Individuals with Ataxia: a Rater-Blinded, Randomized Controlled, Cross-over Study.

Exergame trainings might have therapeutic value in ataxic patients. The aim of this study was to investigate the effect of exergame training with an exercise program on postural control by comparing it with traditional balance and coordination exercise program. Nineteen patients were randomly allocated to two groups. In the first group, exergame training and an exercise program (EEP) were applied together for the first 8 weeks; after 10 weeks washout, a conventional exercise program (CEP) was applied for the second 8 weeks. In the second group, the CEP was applied first followed by the EEP. Outcome measures were Limits of Stability test (LoS), International Classification Ataxia Ratio Scale (ICARS), Berg Balance Scale (BBS), and Timed-Up and Go test with a cognitive task (TUG-C), Reactive postural control and sensory orientation subscales of the Mini-BESTest. Seventeen patients (mean age ± SD, 32.53 ± 11.07 years) completed the study. ICARS, BBS scores improved only after EEP (p < 0.05). While there was no change in the RT and MVL parameters of the LoS test after EEP, the MXE, EPE, and DCL parameters improved significantly (p < 0.05). The MXE and MVL parameters of LoS improved after CEP (p < 0.05). There were no significant improvements in the Mini-BESTest's reactive postural control and sensory orientation subscale scores after both EEP and CEP (p > 0.05). The results of the present study demonstrated that exergame training can be used as a complementary training option in physiotherapy to improve postural control in patients with ataxia. ClinicalTrial.gov Identifier: NCT03607058.

The Effect of Whole Body Vibration on Postural Control of Ataxic Patients: a Randomized Controlled Cross-Over Study.

Whole body vibration (WBV) applications have been used in recent years to increase muscle strength, power, and postural control in healthy and various disease populations. This study aims to investigate the effects of WBV on postural control in patients with ataxia. Twenty-four patients were randomly allocated to two groups. In the first group, whole body vibration and exercise therapy (WBV + E) were applied together for the first 8 weeks; after 1 week washout, only exercise program (OE) was applied for the second 8 weeks. In the second group, the OE program was applied first followed by the WBV + E program. Outcome measures were Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability Test (LOS), International Classification Ataxia Ratio Scale (ICARS), Berg Balance Scale (BBS), and Timed Up and Go Test with cognitive task (TUG-C). Twenty patients (mean age ± SD, 34.00 ± 9.16 years) completed the study. The scores of SOT, ICARS, and BBS improved significantly after both OE and WBV + E program (p < 0.05). Improvements in the WBV + E program were higher (p < 0.05). The scores of ADT, TUG-C, and three parameters of LOS improved significantly after WBV + E (p < 0.05), while there was no significant change after OE (p > 0.05). This study demonstrated that exercise programs supported by WBV can play an important role in the improvement of all components of postural control in patients with ataxia. ClinicalTrial.gov Identifier: NCT02977377.

Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy.

The aim of this study is to investigate the effects of scapular taping on scapular kinematics by three-dimensional electromagnetic system during shoulder elevation in facioscapulohumeral muscular dystrophy patients. A total of 11 patients with facioscapulohumeral muscular dystrophy were included in the study. Scapular anterior-posterior tilt, upward-downward rotation, and internal-external rotations were evaluated using the three-dimensional electromagnetic system during the elevation of the upper limbs in the scapular plane before and after kinesio taping. For maximum humerothoracic elevation, there were no differences between the patients before and after taping on both dominant (p = 0.72) and non-dominant sides (p = 0.64). For scapular internal rotation, upward rotation, and posterior tilt, there were no differences between patients before and after taping during humerothoracic elevation on both dominant and non-dominant sides (p > 0.05). These results showed us that the excessive and abnormal movements of the scapula observed during the humeral elevation in facioscapulohumeral muscular dystrophy patients cannot be supported with flexible methods like kinesio taping. Therefore, we recommend to evaluate the scapula position by applying flexible and rigid taping to the patients who can reach over 90o in humerothoracic elevation in future studies.

Correction to: Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy.

The published version of this article unfortunately contained a mistake in Fig. 2. Only one graphic of different movement of scapula was published instead of three. The Figure is corrected here.

Effects of scapulo-humeral training on ultrasonographic and clinical evaluations in stroke: a randomized controlled trial.

BACKGROUND: After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature. OBJECTIVES: This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles. METHODS: Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II - control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances. RESULTS: FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side (p < 0.05 for all). CONCLUSIONS: Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability.

Trunk and lower extremity biomechanics during sit-to-stand after stroke: A systematic review.

OBJECTIVES: This systematic review aimed to pool available evidence of differences in trunk and lower extremity biomechanics during the different phases of a sit-to-stand (STS) task between persons with stroke and to healthy controls. METHODS: Four electronic databases (Medline, Web of Science, EMBASE, and Cochrane Library) were systematically searched up to, and including, December 2021. Studies were included if they investigated kinematic, kinetic and/or electromyographic outcome measures of adults with stroke during STS and compared results with healthy controls. Data from eligible studies were categorized according to STS subphases if reported (Phase I: Movement onset to seat-off; Seat-off; Phase II: Seat-off to movement termination; Whole task [if no subtasks reported]). The Newcastle-Ottawa Scale was used to assess risk of bias. RESULTS: Twenty-one studies were included in this systematic review. Methodological quality ranged from 13% to 75%; mean score was 55%. The findings of this systematic review suggest that after stroke, people rise to stand (phase I) with increased lateral trunk flexion and displacement of the center of pressure (COP) towards the non-paretic side, decreased anterior pelvic tilt, decreased hip flexion and altered timing of lower limb muscle activation. In addition, during phase II, lateral pelvic translation and weight distribution asymmetry was increased, knee extension velocity was decreased and delayed, stabilization was decreased and COP velocity was increased compared with healthy subjects. CONCLUSIONS: This systematic review clearly showed changes in kinematics, kinetics and muscle recruitment after stroke, with differences between the different phases of STS. Therapeutic interventions should focus on subphases of this functional task to optimize performance in daily living.

Association of posturography with clinical measures in balance rehabilitation of ataxic patients.

The assessment of balance includes posturography measures and clinical balance tests in individuals with ataxia. Although both advantages and disadvantages of these assessments have been stated, no relationship between them in individuals with ataxia has been shown in the literature. The aim of this cross-sectional study was to investigate the relationships between commonly used clinical balance tests and posturography measures in ataxic individuals. The study included a total of 42 patients (mean age: 33.90 ± 8.75 years) with different diagnoses causing ataxia. The sensory organization test (SOT), limits of stability (LOS), unilateral stance and rhythmic weight shift (RWS) tests in computerized dynamic posturography and the clinical balance tests of Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS) and timed up and go (TUG) test were used to assess balance. The Spearman correlation test was used to evaluate the relationships between the clinical balance tests and posturography variables. Moderate and strong correlations were found between the ICARS, BBS and TUG scores and Unilateral Stance sway velocity, directional control parameter of RWS and LOS (P < 0.01-0.05). The ICARS and BBS scores were correlated with the SOT-Composite Equilibrium Score (P < 0.01-0.05). The results of this study suggest the use of both posturography and clinical balance tests in the rehabilitation of ataxic individuals with mild-moderate balance impairment, because posturography variables determine the underlying cause of imbalance and clinical tests evaluate balance in functional activities.

Functional range of motion in the upper extremity and trunk joints: Nine functional everyday tasks with inertial sensors.

BACKGROUND: Functional range of motion is defined as the required range of motions for individuals to maintain maximal independence, along with optimal conditions for activities of daily living. Intervention plans for rehabilitation are directed towards the acquisition of anatomical range of motion. However, this isn't always possible based on person's etiology, prognosis, or severity of disease. RESEARCH QUESTION: The aim of this study is to determine functional range of motion during different unilateral, bilateral symmetrical and bimanual asymmetrical tasks of activities of daily living. METHODS: Participants completed nine basic activities of daily living (hand to head, hanging jacket, eating, wallet placement to back pocket, washing hands and face, removing belt, water pouring, brushing teeth) linked according to International Classification of Functioning, Disability and Health, while joint kinematics of the trunk and upper extremity were recorded with inertial measurement units. Peak values of mean joint angles were determined for each activities of daily living. MVN BIOMECH Awinda MTW2-3A7G6 sensors (Xsens Technologies B.V. Enschede, Netherlands) were used for 3D kinematic analysis of activities. RESULTS: Forty-six healthy subjects (right-dominant) were included in this study. Range of motion requirements of all activities were defined 37.85° extension, 91.18° flexion, 1.25° adduction, 39.45° abduction, 63.6° internal rotation, 21.8° external rotation in the dominant shoulder, 124.17° flexion in the dominant elbow, 40.29° extension, 23.66° flexion, 18.31° supination, 12.56° pronation, 18.27 ulnar deviation and, 18.36° radial deviation in the dominant wrist. Maximum trunk range of motions were found to be 29.75° flexion in C7-T1, 10.74° flexion in T12-L1, and 24.16° flexion in L5-S1. SIGNIFICANCE: It is thought that the results of this research will contribute to the determination of normative data needed for surgical interventions, technological rehabilitation devices and task-spesific rehabilitation programs which based patient's motor skill level.

The relationship between trunk position sense and postural control in ataxic individuals.

BACKGROUND: The proprioceptive system plays a role in the maintenance of postural control more than the visual and vestibular systems in ataxic patients with postural control disorders, but the relationship between trunk proprioception and postural control has not been sufficiently investigated yet. This relationship can provide a different perspective to the ataxia rehabilitation. RESEARCH QUESTION: This study aimed to examine the relationship between trunk position sense and postural control in ataxic individuals by comparing them to healthy individuals. METHODS: Twenty ataxic and 20 healthy individuals were included. The Sensory Organization Test, Limits of Stability Test, and Unilateral Stance Test in the Computerized Dynamic Posturography and Berg Balance Scale were used to evaluate postural control. The Baseline Digital Inclinometer (Norwalk, CA, USA) measured trunk position sense. RESULTS: It was found that repositioning error degree of the trunk position sense was higher in ataxic individuals than in healthy individuals, including scores of clinical and objective tests in postural control evaluation: they were lower in ataxic individuals (p < 0.05). As a result, trunk position sense was associated with almost all evaluated parameters, including sensory integration, postural sway, limits of stability, and functional balance (p < 0.05). SIGNIFICANCE: The impairment of postural control, which is the most important cause of activity and participation limitations in ataxic patients, is not only affected by motor disorders, but by sensory disturbances. Our study demonstrated that impairment of the trunk position sense in ataxic individuals was higher than that of healthy individuals, and affected the different components of postural control.