Revisiting the Instrumented Romberg Test: Can Today's Technology Offer a Risk-of-Fall Screening Device for Senior Citizens? An Experience-Based Approach.

Risk of fall (ROF) is a worldwide major concern for its prevalence and consequent dramatic outcomes in the elderly population. The growing age-related risk appears to be associated with increasing motor, sensory, and cognitive problems in the elderly population. There is a consensus on the need to screen for these balance dysfunctions, but the available methods are largely based on subjectively assessed performances. The instrumented Romberg test using a force plate represents a validated assessment process for the evaluation of balance performances. The purpose of this study is to propose an innovative instrumental method to identify balance deficits, assess their severity, and give an automated indication of the most likely etiology. The proposed new method was applied to the instrumented Romberg test, using force plate data recorded in a cohort of 551 females aged >65 participating in adapted physical activity courses. The method allowed us to identify 145 dysfunctional subjects and to determine the likely origin of their deficit: 21 central, 5 vestibular, 9 visual, 59 proprioceptive (musculoskeletal etiology), and 51 functional. Based on the preliminary findings of the study, this test could be an efficient and cost-effective mass screening tool for identifying subjects at risk of fall, since the procedure proves to be rapid, non-invasive, and apparently devoid of any contraindications.

Laser Acupuncture in Open-Angle Glaucoma Treatment: A Retrospective Study of Eye Blood Flow.

Patients with glaucoma can show blood flow anomalies at the eye vessel level. A causal relationship is reasonably expected, but so far, it has not been demonstrated. Traditional Chinese medicine indicates that acupuncture can promote specific blood perfusion in specific body districts. Ninety-eight patients with open-angle glaucoma were treated with an ultralow light-level laser, according to a specific acupuncture protocol, and their blood flow was measured before and after a six-week treatment cycle. Doppler measurements showed significant modifications in both pulsatility and resistivity indexes. The most relevant outcome of this study is that the applied treatment demonstrated its effectiveness not only in vasodilation but also in perfusion control that seems to restore appropriate functionality. The protocol therefore should be investigated in future controlled studies and perhaps in other blood perfusion-related pathologies.

Ultra-Low-Level Laser Therapy and Acupuncture Libralux: What Is so Special?

BACKGROUND: Contrary to the most credited theories on laser therapy that see power/energy as the major factors to its effectiveness, a technique using an extremely low power/energy laser stimulation to treat musculoskeletal pain and dysfunction is proposed. The stimulus consists of a 20 s train of modulated pulses with an average power below 0.02 mW and is applied on sequences of acupuncture points selected according to the impaired segment of the patient's body. Methods: Modifications on the extracellular soft tissue matrix and on the "fascia" were sonographically demonstrated. Laboratory and clinical tests confirmed the effectiveness. Results: Responses similar to those experienced in acupuncture were observed. The device-a CE Class IIa certified medical device named Libralux-affords a clinically proven effectiveness exceeding 80% in the treatment of musculoskeletal conditions and associated motor dysfunctions. An average of just three application sessions was generally sufficient to overcome the dysfunction. Conclusions: The development of the method is supported by over 20 years of R&D activities, with a range of experiments discussed in several papers published in indexed peer-reviewed journals. A few considerations regarding the possible physiological action mechanisms involved are proposed in this paper.

Amblyopia: Can Laser Acupuncture be an Option?

This paper describes the results of the treatment of amblyopia in young patients using an unconventional laser-acupuncture technique. After obtaining satisfactory results in the treatment of a 14-year-old amblyopic girl, the treatment was applied to 13 amblyopic children aged 3-11 years, with an encouraging outcome. An ultralow-light-intensity laser with a square-wave modulated emission was applied over a sequence of acupuncture points. Each session lasted < 15 minutes, and the treatment was performed once a week in 6-week cycles. Patients were followed for several years to evaluate the long-term results and/or to extend the treatment. All except two of the treated patients showed a rapid increase in visual acuity after several treatment sessions. Some required retreatment for regressions in visual acuity. The need for medium-term treatment cycles seems, however, to suggest that results may not be stable for all individuals. Although acupuncture has already been proved to be effective in the treatment of amblyopia, the results reported in this paper suggest that laser acupuncture at ultra-low-light-intensity levels can provide similar, if not better, results to conventional acupuncture stimulation, but with higher patient compliance.

Biolite: A Patented Ultra-Low-Level Laser-Therapy Device for Treating Musculoskeletal Pain and Associated Impairments.

After an excursus on state-of-the-art knowledge for low-level laser therapy (LLLT), Biolite, a patented ultra-low-level laser therapy device used to treat musculoskeletal pain and associated impairments, is presented. The application protocols include short stimulation of sequences of acupuncture points. The observed effects seem, however, to be far from those that might be expected after acupuncture. The primary effect seems more likely to be an extracellular soft-tissue matrix reaction. The development of the technique, the studies performed, and the evidence collected over > 10 years suggest that specifically modulated laser light can interact with human tissues at light fluences well under those previously considered as being capable of having any effect. Musculoskeletal pain very often becomes an autonomous dysfunction that is independent of the original injury and that can be effectively treated using specific peripheral acupuncture-like stimulation. Because such acupuncture is capable of reducing motor control "interferences" from noxious stimuli, it can improve motor control performance, thereby reducing the risk of falls in the elderly individuals. The proposal of acupuncture-derived protocols to be applied by Western physiotherapists using an ultra-low-level laser therapy device is a further "bridge" between two different, and sometimes very different, clinical worlds to better serve our patients.

Ultra-low power laser stimulation impairs the adhesion of Staphylococcus aureus to primary human cells, and interferes with the expression of staphylococcal pathogenic factors.

Lasers are commonly used in several fields of medicine as a complementary therapy for internal medicine, surgery and also diagnostics. The efficacy of ultra-low level laser therapy (ULLLT) at power levels around 0.15 mW/cm(2) has been demonstrated both in in vitro experiments and in the clinical environment. This work used an ULLLT laser source to analyze its efficacy on Staphylococcus aureus adhesion to cells and on its ability to produce pathogenic factors. Laser stimulation succeeded in impairing the binding of S. aureus to primary human cells in culture and in inhibiting the expression of coagulase, one of the main staphylococcal pathogenic factors. The importance of the extracellular matrix (ECM) and the modification of the ECM redox potential in these activities were also evidenced.

Treating balance disorders by ultra-low-level laser stimulation of acupoints.

BACKGROUND: Balance disorders, a widespread problem in the senior population, are very often related to painful musculoskeletal disabilities and/or to degenerative neurologic pathologies. In a previous work, we investigated the beneficial effects of acupuncture such as laser photobiostimulation, regardless of the etiological origin of the balance dysfunction. AIMS: Attention was focused on two individuals showing balance deficits with different etiologies. One healthy control individual was receiving treatment, one healthy control individual did not receive any treatment. Balance performances were measured before and after ultra-low-level laser (ULLL) stimulation as a basis for the design of further investigations. METHODS: Romberg's parameters were measured on a force platform. Of the four tested individuals, one showed dizziness symptoms, one was affected by a mild form of Parkinson's disease, and two showed no dysfunction and were used as controls. RESULTS: It was found that a ULLL stimulation of peripheral Traditional Chinese Medicine (TCM) acupuncture points can be effective, regardless of the pathology. DISCUSSION: A specific clinical analysis of the stability of the beneficial result as a function of homogeneous groups of dysfunctional individuals is needed.

Clinical stabilometry standardization: basic definitions--acquisition interval--sampling frequency.

Several statements on the still debated issue of stabilometry standardization were agreed upon by the ISPGR Standardization Committee. * A set of metrological characteristics for stabilometric platforms was defined. * Relying both on practice and experimental verification it was agreed that, to obtain appropriate accuracy and sensitivity in the Romberg Test: * The acquisition interval should not be less than 25 s. * The sampling frequency should be at least 50 Hz. * After careful consideration it was decided that the recommendations made in the previous Standardization proposal in 1983 regarding environmental conditions should be maintained.

Laser acupuncture and auriculotherapy in postural instability--a preliminary report.

The risk of falling is rather high among elderly people. Indexes obtained through the Romberg stabilometric test on a force platform have been suggested to be correlated with the risk of falling. This work aimed to test the effectiveness of auriculopuncture and ultralow-power laserpuncture versus placebo (sham stimulation) in improving postural control in an elderly population. Balance performance was measured on a force platform before and after both forms of stimulation. Main balance parameters pointed to an average short-term improvement of about 15% 1 hour after treatment and 5-10% after an interval of 3 days. However, a few participants showed a better than 30% improvement with the same parameters. Although the sample size does not allow reliable statistical analysis, the modifications are remarkable and some differences are observed between the two kinds of stimulation. Further testing with larger sized groups and including one further group using both stimulations is suggested. Although postural instability has to be defined as multi-factorial, it is often associated with balance dysfunctions that cannot be related to vestibular or central impairments but rather to proprioceptive deficits. A significant role may be ascribed to (even subliminal) nociceptive interferences with proprioceptive inputs and to a reduced capacity for updating cortical motor control models in the case of progressively declining locomotor capabilities. The explanation tentatively put forward to account for the results observed in the present preliminary study is that laser acupuncture and auriculopuncture stimulations reduce nociceptive interference and thus improve postural control.

Ultra-low-level laser therapy.

A growing number of laboratory and clinical studies over the past 10 years have shown that low-level laser stimulation (633 or 670 nm) at extremely low power densities (about 0.15 mW/cm(2)), when administered through a particular emission mode, is capable of eliciting significant biological effects. Studies on cell cultures and animal models as well as clinical trials give support to a novel therapeutic modality, which may be referred to as ultra low level laser therapy (ULLLT). In cultured neural cells, pulsed irradiation (670 nm, 0.45 mJ/cm(2)) has shown to stimulate NGF-induced neurite elongation and to protect cells against oxidative stress. In rats, anti-edema and anti-hyperalgesia effects following ULLL irradiation were found. Clinical studies have reported beneficial effects (also revealed through sonography) in the treatment of musculoskeletal disorders. The present paper reviews the existing experimental evidence available on ULLLT. Furthermore, the puzzling issue of the biophysical mechanisms that lie at the basis of the method is explored and some hypotheses are proposed. Besides presenting the state-of-the-art about this novel photobiostimulation therapy, the present paper aims to open up an interdisciplinary discussion and stimulate new research on this subject.

"Neural efficiency" of athletes' brain for upright standing: a high-resolution EEG study.

"Neural efficiency" hypothesis posits that neural activity is reduced in experts. Here we tested the hypothesis that compared with non-athletes, elite athletes are characterized by a reduction of cortical activation during an engaging upright standing. EEG (56 channels; Be-plus Eb-Neuro and stabilogram (RGM) data were simultaneously recorded in 10 elite karate, 10 elite fencing athletes, and 12 non-athletes during a simple bipodalic (standard Romberg) and a more engaging monopodalic upright standing. Balance was indexed by body "sway area". The EEG data were spatially enhanced by surface Laplacian estimation. Cortical activity was indexed by task-related power decrease (TRPD) of EEG alpha power (8-12Hz) during monopodalic referenced to bipodalic condition. The body "sway area" was larger during the monopodalic than bipodalic upright standing in all groups. Low-frequency alpha TRPD (about 8-10Hz) was lower in amplitude in the karate and fencing athletes than in the non-athletes at left central, right central, middle parietal, and right parietal areas (p<0.01). Similarly, the amplitude of high-frequency alpha TRPD (10-12Hz) was lower in the karate and fencing athletes than in the non-athletes at right frontal, left central, right central, and middle parietal areas (p<0.03). These results suggest that during monopodalic referenced to less engaging bipodalic condition, the power decrease (i.e. the desynchronization) of cortical activity at alpha rhythms is largely reduced in elite athletes than in non-athletes, in line with the "neural efficiency" hypothesis. The present study extends our understanding of the physiological mechanisms at the basis of the "neural efficiency" for engaging upright standing in elite athletes.

Low infra red laser light irradiation on cultured neural cells: effects on mitochondria and cell viability after oxidative stress.

BACKGROUND: Considerable interest has been aroused in recent years by the well-known notion that biological systems are sensitive to visible light. With clinical applications of visible radiation in the far-red to near-infrared region of the spectrum in mind, we explored the effect of coherent red light irradiation with extremely low energy transfer on a neural cell line derived from rat pheochromocytoma. We focused on the effect of pulsed light laser irradiation vis-à-vis two distinct biological effects: neurite elongation under NGF stimulus on laminin-collagen substrate and cell viability during oxidative stress. METHODS: We used a 670 nm laser, with extremely low peak power output (3 mW/cm2) and at an extremely low dose (0.45 mJ/cm2). Neurite elongation was measured over three days in culture. The effect of coherent red light irradiation on cell reaction to oxidative stress was evaluated through live-recording of mitochondria membrane potential (MMP) using JC1 vital dye and laser-confocal microscopy, in the absence (photo bleaching) and in the presence (oxidative stress) of H2O2, and by means of the MTT cell viability assay. RESULTS: We found that laser irradiation stimulates NGF-induced neurite elongation on a laminin-collagen coated substrate and protects PC12 cells against oxidative stress. CONCLUSION: These data suggest that red light radiation protects the viability of cell culture in case of oxidative stress, as indicated by MMP measurement and MTT assay. It also stimulates neurite outgrowth, and this effect could also have positive implications for axonal protection.

Auditory evoked potential abnormalities in cluster headache.

Mid-latency and long-latency auditory evoked responses were investigated in 27 patients with cluster headache who had a mean age of 38.7+/-9.7 years and who were free of pain at the time of testing. Twenty-five age-matched healthy persons served as controls. Latencies and amplitudes of corresponding responses (N100, P200, and P300) were measured. The parameters were calculated at Pz for the P300 and Cz electrodes for the N100 and P200. Multiple analysis of variance revealed a significant overall effect of group (P=0.011). P200 amplitude was significantly smaller in cluster headache patients (P=0.0002). No differences were found for N100 or P300. These data suggest a hitherto unrecognized defect in the information processing pathways, in the early attentive phase represented by the P200 component.

Functional cortico-muscular coupling during upright standing in athletes and nonathletes: a coherence electroencephalographic-electromyographic study.

We tested the hypothesis that functional cortico-muscular coupling of brain rhythms is implied in the control of lower limb muscles for upright standing. Electroencephalographic (EEG; Be-plus Eb-Neuro) and electromyographic (EMG) data were recorded in 18 fencing and 19 karate elite athletes, 14 karate amateurs, and 9 non-athletes, during quiet upright standing with open and closed eyes conditions. Cortico-muscular coupling was evaluated by computing EEG-EMG spectral coherence and directed transfer function (DTF). Body sway area did not differ among the groups. In non-athletes, the EEG-EMG coherence (gastrocnemius lateralis) at centro-parietal and parasylvian alpha rhythms (about 8-12 Hz) was higher during the open than closed eyes condition. This was not true in the elite athletes. At the same alpha rhythms, the sport amateurs presented values halfway between the non-athletes and elite athletes. Finally, the DTF was higher for cortico-muscular than muscular-cortical direction. These results suggest that visual information affects cortico-muscular coherence at 8-12 Hz in non-athletes and amateur athletes but not in elite athletes. In elite athletes, this might be due to a long training for the control of equilibrium based on proprioceptive and tactile inputs.

Golf putt outcomes are predicted by sensorimotor cerebral EEG rhythms.

It is not known whether frontal cerebral rhythms of the two hemispheres are implicated in fine motor control and balance. To address this issue, electroencephalographic (EEG) and stabilometric recordings were simultaneously performed in 12 right-handed expert golfers. The subjects were asked to stand upright on a stabilometric force platform placed at a golf green simulator while playing about 100 golf putts. Balance during the putts was indexed by body sway area. Cortical activity was indexed by the power reduction in spatially enhanced alpha (8-12 Hz) and beta (13-30 Hz) rhythms during movement, referred to as the pre-movement period. It was found that the body sway area displayed similar values in the successful and unsuccessful putts. In contrast, the high-frequency alpha power (about 10-12 Hz) was smaller in amplitude in the successful than in the unsuccessful putts over the frontal midline and the arm and hand region of the right primary sensorimotor area; the stronger the reduction of the alpha power, the smaller the error of the unsuccessful putts (i.e. distance from the hole). These results indicate that high-frequency alpha rhythms over associative, premotor and non-dominant primary sensorimotor areas subserve motor control and are predictive of the golfer's performance.

Cortical alpha rhythms are correlated with body sway during quiet open-eyes standing in athletes: a high-resolution EEG study.

Electroencephalographic (EEG; Be-plus Eb-Neuro) and stabilogram (RGM) data were simultaneously recorded in 19 elite karate and 18 fencing athletes and in 10 non-athletes during quiet upright standing at open- and closed-eyes condition in order to investigate the correlation between cortical activity and body sway when the visual inputs are available for balance. Our working hypothesis is that, at difference of non-athletes, athletes are characterized by enhanced cortical information processing as indexed by the amplitude reduction of EEG oscillations at alpha rhythms (about 8-12 Hz) during open- referenced to closed-eyes condition (event-related desynchronization, ERD). Balance during quiet standing was indexed by body "sway area". Correlation between alpha ERD and event-related change of the sway area was computed by a non-parametric test (p<0.05). It was found that alpha ERD (10-12 Hz) is stronger in amplitude in the karate and fencing athletes than in the non-athletes at ventral centro-parietal electrodes of the right hemisphere (p<0.02). Furthermore, there was a statistically significant correlation in the karate athletes between right ventral centro-parietal alpha ERD and body sway area (r=0.61; p<0.008): specifically, the greater the alpha ERD, the greater the percentage reduction of the body sway area when the visual inputs were available. These results suggest that parasylvian alpha ERD of the right hemisphere may reflect the cortical information processing for the balance in elite athletes subjected to a long training for equilibrium control.