Explanatory Capacity of Postural Control and Physical Fitness in Cognitive Impairment and Support Needs among Individuals with Intellectual Disabilities-A Cross-Sectional Pilot Study.

Postural control is a skill associated with most motor activities and is essential for the performance of activities of daily living. People with intellectual disabilities (ID) present postural control deficits that can be attributed to several causes. The aim of this study was to determine whether postural control and physical fitness could explain the cognitive impairment and support needs in this population. A cross-sectional pilot study was conducted with 18 people with ID. Data collection was based on assessments for postural control (Mini BESTest and Berg Balance Scale) and physical fitness (Senior Fitness Test). The data were analyzed using linear regression models. Anticipatory postural adjustments were associated with support needs, explaining up to 45% of these. Consecutive postural adjustments and upper limb strength were less significantly associated with support needs. However, none of the variables used explained cognitive impairment in ID. Knowledge of the relationships and behavior of the different measurement tools is essential for the development of appropriate interventions in this population.

Effects of visual deprivation on the injury of lower extremities among functional ankle instability patients during drop landing: A kinetics perspective.

Background: The ankle is prone to injury during drop landing with usual residual symptoms, and functional ankle instability (FAI) is the most common. Vision guarantees the postural stability of patients with FAI, and visual deprivation (VD) increases their risk of injury when completing various movements. This study explored injury risk during drop landing in patients with FAI under VD through the kinetics of lower extremities. Methods: A total of 12 males with FAI participated in the study (age, 23.0 ± 0.8 years; height, 1.68 ± 0.06 m; weight, and 62.2 ± 10.4 kg) completed single-leg drop landings under visual presence (VP) and VD conditions. Ground reaction force (GRF), time to peak GRF, joint torque, and vertical length variation (ΔL) were measured. Results: Significant effects were detected in the group for time to peak lateral GRF (p = 0.004), hip extensor torque (p = 0.022), ankle plantarflexion torque (p < 0.001), ankle varus torque (p = 0.021), lower extremity stiffness (p = 0.035), and ankle stiffness (p < 0.001). Significant effects of conditions were detected for vertical GRF, time to peak vertical and lateral GRF, loading rate, hip extensor torque, knee extensor torque, hip varus torque, knee varus torque, lower extremity stiffness, and ankle stiffness (p < 0.05). ΔL was affected by VD with a significant difference (p < 0.001). Conclusion: In patients with FAI, an unstable extremity has a higher injury risk than a stable extremity, and VD increases such risk. However, because the influence of the central nervous system on hip strategy is also affected, the effect on the unstable extremity is more significant and more likely to result in injury. Deepening the squat range may be an effective preventive measure for reducing injury risk of unstable extremities during drop landing.

Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial.

BACKGROUND: Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. METHODS: Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). RESULTS: R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen's d = - 0.81, p = 0.019), elbow extension (Cohen's d = - 0.71, p = 0.038), and trunk movement (Cohen's d = - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen's d = - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen's d = 1.16, p = 0.019). CONCLUSIONS: Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.

Neglect following stroke: the role of sensory sensitivity in visuo-spatial performance.

Both proprioceptive and visual manipulations have led to some improvement of the spatial neglect syndrome. Until now, their effects on visuo-spatial behaviour have never been compared simultaneously. The objective of this study was to determine their influence, as a function of the presence of neglect and the side of the brain damage. 19 stroke patients with right and 14 with left brain damage, without or with neglect; realized the Bells test in 5 conditions: a reference condition and 4 sensory conditions, defined according to the side of application (contralesional vs ipsilesional) and the type of perturbation (visual vs proprioceptive). The visuo-spatial behaviour was analyzed for global and spatial aspects and for individual extreme performances. For the neglect group, the restriction of the visual field to the ipsilesional hemi-field significantly diverted the centre of exploration towards the ipsilesional side compared to all other conditions. The weighting of visual cues from the ipsilesional hemi-field seems to be increased in sensory-motor integration processes in neglect patients. In all the groups, although some improvements in performance did occur with sensory manipulation, they were dependent on the individual, particularly for neglect patients. A same performance can be achieved through the use of different sensory-motor strategies, which are individual-related. It is thus important to consider the sensory sensitivity and the responsiveness of each patient before beginning any sensory therapies.

Preschoolers' motor and verbal self-control strategies during a resistance-to-temptation task.

Although prior research has shown that young children exhibit enhanced self-control when they use verbal strategies provided through adult instructions, little work has examined the role of children's spontaneous verbalizations or motor behavior as strategies for enhancing self-control. The present study examined the usefulness of spontaneous verbal and motor strategies for 39 3- and 4-year-old children's ability to exercise self-control during a resistance-to-temptation task. After a 2-min play period, participants were asked by an experimenter not to touch an attractive train set while he was out of the room. Children were videotaped during the 3-min waiting period and videos were coded for frequency and duration of touches, motor movements, and verbalizations. Results indicated that self-control was improved by using both motor and verbal strategies. Children who were unable to resist touching the forbidden toy used limited motor or verbal strategies. These findings add to the growing literature demonstrating the positive role of verbalizations on cognitive control and draw attention to motor behaviors as additional strategies used by young children to exercise self-control.

Functional reach test: movement strategies in diabetic subjects.

Functional reach (FR) is a clinical measure, defined as the maximum distance one can reach, forward beyond arm's length, able to identify elderly subjects at risk of recurrent falls. Subjects, exhibiting the same FR can perform the motor task in different ways: a kinematic analysis of the FR, task can help to identify the motor strategy adopted. The FR test was applied to 17 diabetic non-neuropathic, (CTRL) and 37 neuropathic (DN) subjects. Motor strategies adopted were defined as: "hip" or "other" strategy; the latter included: "mixed" and "trunk rotation" strategies. Principal Component Analysis and non-parametric statistical tests were used to study the different execution modalities of the FR test. Results show that, in CTRL, the most important parameters are those related to trunk flexion in the sagittal plane. Instead, for DN, the main features are related not only to trunk flexion but also to trunk rotation in the transverse plane. Percentages of subjects who used "hip" or "other" strategies are similar for CTRL and DN subjects. However, within the "other" strategy group, the percentage of DN that used a "trunk rotation" strategy was much higher than for CTRL. Results show that individuals, although exhibiting the same reaching distance, adopt different movement strategies. Consequently it is important to evaluate the kinematic behaviour and not only the clinical measure, because the evaluation of the motor strategy might be useful in the early detection of subjects at risk of postural instability.