Effect of 6-week BFRT combined with IASTAM therapy on international standard dancers with chronic ankle instability.

Background: In sports dance events, athletes often face the risk of ankle injury and instability, which may have a negative impact on their training and athletic performance, and even hinder their rehabilitation process and increase the likelihood of re-injury. Objective: This study aims to observe the effects of exercise intervention (low-load ankle muscle strength training with blood flow restriction training (BFRT) equipment and balance training with blood flow restriction training equipment) combined with instrumentation therapy (Instrument-assisted soft tissue mobilization, IASTM) on ankle function, joint range of motion, and strength in sports dancers with chronic ankle instability (CAI). This study aims to provide an evidence-based approach to rehabilitation for athletes by comparing the effects of combination therapy approaches to traditional ankle strength and stability training. Methods: Forty-two subjects with ankle instability, restriction, or discomfort were selected as observation objects and randomly divided into three groups: the combined group (n = 14, blood flow restriction training combined with IASTM), the simple blood flow restriction training group (n = 15), and the conventional ankle strength and stability training group (n = 13). The intervention lasted for 6 weeks, once a week. The three groups were assessed with the Cumberland ankle instability assessment, Foot and Ankle Ability Measure (FAAM) ankle function assessment score, and ankle range of motion measurement before intervention, after the first intervention, and after 6 weeks of intervention. The ankle strength test was compared and analyzed only before and after intervention. Result: There was no significant difference in the participant characteristics of the three intervention groups. In terms of Cumberland Ankle Instability Tool (CAIT) scores, within-group comparisons showed that the scores after the first intervention and at the 6-week mark were significantly higher than before the intervention (P < 0.05). Between-group comparisons revealed that the combined intervention group had higher CAIT scores than the other two groups after the 6-week intervention. Regarding the FAAM functional scores, all three interventions significantly improved ankle joint function in patients with chronic ankle instability (P < 0.05), with the BFRT group showing significantly higher FAAM - Activities of Daily Living scale (FAAM-ADL) scores than the control group (P < 0.05). Both the combined and BFRT groups also had significantly higher FAAM-SPORT scores after the first intervention compared to the control (P < 0.05). In terms of ankle range of motion improvement, the combined intervention group showed a significant increase in ankle joint motion after the intervention (P < 0.05), particularly in the improvement of dorsiflexion ability (P < 0.05). As for ankle strength enhancement, all three intervention groups experienced an increase in ankle strength after the intervention (P < 0.05), with the combined intervention group showing a significant improvement in both dorsiflexion and inversion strength compared to the control group (P < 0.05). Conclusion: BFRT combined with IASTM, isolated BFRT, and conventional ankle strength and stability training significantly improve stability, functionality, and strength in CAI patients. The combined intervention demonstrates superior efficacy in improving ankle range of motion compared to isolated BFRT and conventional approaches.

Effects of visual feedback balance system combined with weight loss training system on balance and walking ability in the early rehabilitation stage of stroke: a randomized controlled exploratory study.

Background: Previous studies have suggested that the Pro-Kin visual feedback balance system can promote the recovery of balance function in stroke patients. Objectives: However, this system has not been used effectively in the early stages of stroke rehabilitation. This study aimed to investigate the effect of Pro-Kin system combined with weight loss system for the early recovery of balance and walking ability following a stroke. Methods: A total of 62 patients who underwent radiological diagnosis of stroke were randomly divided into two groups: a control group (n = 31) and a treatment group (n = 31). Both groups received conventional balance training. The treatment group also received training on the Pro-Kin system in conjunction with a weight loss system. Balance was measured using the Berg Balance Scale (BBS), Timed 'Up & Go' (TUG) test and Pro-Kin system. Walking ability was assessed using the Functional Ambulation Classification (FAC). The tests were performed before the start of treatment and on the 4th week following the training. There was no statistically significant difference between the groups before training. Results: After 4 weeks of training in both groups, there were significant improvements in balance and walking ability. BBS values and FAC were significantly higher (p < 0.01), TUG times, ellipse area and motion trajectory length were significantly reduced (p < 0.01, p < 0.05) after training. The treatment group outperformed the control group (p < 0.05). In addition, there was a positive correlation between balance function and walking ability (p < 0.01). Conclusion: The Pro-Kin system combined with weight loss system is a viable method that promotes early reconstruction of balance and walking ability following a stroke. Trial registration: Clinical trial number ChiCTR1900026370. https://www.chictr.org.cn/showprojEN.html?proj=43736.

Utilising Xsens Gait Analysis to Improve Functional Outcomes in Chronic Ankle Instability: A Multifaceted Physiotherapy Approach.

Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains, resulting in persistent pain, instability, and functional limitations. This case report investigates the effectiveness of a physiotherapy intervention for a 25-year-old female patient with CAI, marked by recurrent ankle sprains and persistent symptoms despite prior conservative treatments. The patient exhibited swelling, pain, and instability, with clinical assessment revealing significant ligament laxity and a high longitudinal arch in both feet. A comprehensive physiotherapy regimen focused on core, hip, and ankle muscle strength, dynamic balance, and proprioception was implemented, incorporating ankle stretches, joint mobilization, core strengthening, hip strengthening, and dynamic balance exercises on unstable surfaces. Pre-rehabilitation outcome measures included a numeric pain rating of 7/10, a Cumberland ankle instability tool (CAIT) score of 15/30, and a foot and ankle outcome score (FAOS) of 63%. Gait analysis revealed a speed of 0.79 m/s, a cadence of 99.24 steps/min, and a distance of 14.23 meters. Post-intervention, significant improvements were observed: pain reduced to 1/10, the CAIT score increased to 28/30, and the FAOS rose to 89%. Gait parameters also improved, with speed increasing to 0.90 m/s and distance to 15 meters. This case underscores the effectiveness of a targeted physiotherapy approach in managing CAI, highlighting the importance of a multi-dimensional rehabilitation strategy to enhance functional outcomes and reduce associated symptoms of CAI.

Rebuilding Stability: Exploring the Best Rehabilitation Methods for Chronic Ankle Instability.

Background: Chronic Ankle Instability (CAI) is a common condition characterized by repeated episodes of ankle "giving way" and impaired balance, leading to functional limitations. Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address these deficits. This review evaluates the effectiveness of different rehabilitation interventions for CAI management. Methods: A review was conducted by analyzing 11 randomized controlled trials that investigated the impact of balance and proprioceptive training programs on CAI. The primary outcomes assessed were the Star Excursion Balance Test (SEBT), Cumberland Ankle Instability Tool (CAIT), and Foot and Ankle Ability Measure (FAAM). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the ROB 2 tool. Results: All rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores. However, no single intervention was found to be consistently superior. Traditional balance training, strength exercises, BAPS, and WBV all provided meaningful functional gains. Stroboscopic vision training showed similar effectiveness compared to conventional approaches. The evidence supports a combination of balance and strength training for optimal recovery. Conclusions: Balance and proprioceptive exercises are effective in managing CAI, with improvements in both dynamic stability and subjective outcomes. No intervention stands out as the best, but personalized programs incorporating various methods are recommended. Future research should explore the long-term effects and potential synergies of combined interventions.

Development of a closed-loop controller for functional electrical stimulation therapy plus visual feedback balance training for standing balance training.

Individuals with incomplete spinal cord injury (iSCI) demonstrate impaired upright balance, resulting in increased fall risk. Task-specific visual feedback balance training (VFBT) has previously been shown to improve upright balance. In addition, therapies using functional electrical stimulation (FES) have been shown to improve various motor functions. Combining VFBT with FES therapy (FES+VFBT) may synergistically improve balance control for those with iSCI. Here we developed the FES+VFBT system that delivered physiologically relevant electrical stimulations to soleus (SOL) and tibialis anterior (TA) muscles during VFBT. Ten young able-bodied individuals participated. Kinematic, kinetic, SOL and TA electromyography (EMG) data during quiet standing and limits-of-stability test were used to design the controller for the FES+VFBT system. To evaluate the performance of the designed controller, the controller outputs, which represented stimulation intensities, were compared with the recorded SOL and TA EMG during the four tasks associated with VFBT (i.e., bullseye, hunting, colour-matching, and ellipse tasks). Except for the bullseye task, the designed controller outputs were highly correlated with the recorded EMG, suggesting that the controller could generate electrical stimulations in a physiological manner. We expect that the addition of FES therapy to VFBT could contribute to improving standing balance for individuals with iSCI.

Cross-step detection using center-of-pressure based algorithm for real-time applications.

BACKGROUND: Gait event detection is crucial for assessment, evaluation and provision of biofeedback during rehabilitation of walking. Existing online gait event detection algorithms mostly rely on add-on sensors, limiting their practicality. Instrumented treadmills offer a promising alternative by utilizing the Center of Pressure (CoP) signal for real-time gait event detection. However, current methods have limitations, particularly in detecting cross-step events during perturbed walking conditions. METHODS: We present and validate a CoP-based algorithm to detect gait events and cross-steps in real-time, which combines thresholding and logic techniques. The algorithm was evaluated on CoP datasets from healthy participants (age range 21-61 years), stroke survivors (age range 20-67 years), and people with unilateral transtibial amputation (age range 28-63 years) that underwent perturbation-based balance assessments, encompassing different walking speeds. Detected gait events from a simulated real-time processing operation were compared to offline identified counterparts in order to present related temporal absolute mean errors (AME) and success rate. RESULTS: The proposed algorithm demonstrated high accuracy in detecting gait events during native gait, as well as cross-step events during perturbed walking conditions. It successfully recognized the majority of cross-steps, with a detection success rate of 94%. However, some misclassifications or missed events occurred, mainly due to the complexity of cross-step events. AME for heel strikes (HS) during native gait and cross-step events averaged at 78 ms and 64 ms respectively, while toe off (TO) AME were 126 ms and 111 ms respectively. A statistically significant difference in the algorithm's success rate score in detecting gait events during cross-step intervals was observed across various walking speeds in a sample of 12 healthy participants, while there was no significant difference among groups. CONCLUSION: The proposed algorithm represents an advancement in gait event detection on instrumented treadmills. By leveraging the CoP signal, it successfully identifies gait events and cross-steps in the simulated real-time processing operation, providing valuable insights into human locomotion. The algorithm's ability to accommodate diverse CoP patterns enhance its applicability to a wide range of individuals and gait characteristics. The algorithm's performance was consistent across different populations, suggesting its potential for diverse clinical and research settings, particularly in the domains of gait analysis and rehabilitation practices.

Reliability and validity of the ratings of perceived stability scale as a measure of balance exercise intensity in persons with multiple sclerosis.

PURPOSE: The study aimed to determine the test-retest reliability and concurrent validity of the Ratings of Perceived Stability (RPS) scale as a measure of balance exercise intensity in persons with multiple sclerosis (MS). METHODS: Twenty participants with MS (mean age: 58.1 ± 15.29; 60% female) performed 14 balance tasks on two separate occasions wearing body-worn inertial sensors and rated their perceived stability for each task. Sensor data included sway velocity and angle, gait speed, turn velocity, and lean angle. Intraclass correlation coefficients (ICC) and Spearman rank correlations (rs) were employed to assess reliability and validity, respectively. RESULTS: The RPS showed good to excellent test-retest reliability (ICC> 0.75) on 12 out of the 14 tasks. The stability ratings revealed moderate relationships with postural sway outcomes in static balance tasks (rs: 0.49 to 0.77) and weak to moderate associations with gait speed (rs: -0.69 to -0.14). Ratings of stability were also strongly related to turn velocity (rs= -0.77) and moderately related to lean angle (rs= 0.58). CONCLUSIONS: The RPS scale offers a promising clinical tool to measure balance exercise intensity for persons with MS. This standardized scale allows for tailored balance training with a novel means for exercise monitoring and progression in this population.

The Ratings of Perceived Stability (RPS) scale is a reliable and valid measure for determining balance exercise intensity in persons with multiple sclerosis.The RPS scale can contribute to clear evaluation, description, and replication of balance training intensity in future balance interventions.

Neuromuscular adaptations to perturbation-based balance training using treadmill belt accelerations do not transfer to an obstacle trip in older people: A cross-over randomised controlled trial.

BACKGROUND: This study examined (i) adaptations in muscle activity following perturbation-based balance training (PBT) using treadmill belt-accelerations or PBT using walkway trips and (ii) whether adaptations during treadmill PBT transfer to a walkway trip. METHODS: Thirty-eight older people (65+ years) undertook two PBT sessions, including 11 treadmill belt-accelerations and 11 walkway trips. Surface electromyography (EMG) was measured bilaterally on the rectus femoris (RF), tibialis anterior (TA), semitendinosus (ST) and gastrocnemius medial head (GM) during the first (T1) and eleventh (T11) perturbations. Adaptations (within-subjects - 1st vs 11th perturbations for treadmill and walkway PBT) and their transfer (between-subjects - 1st walkway trip after treadmill PBT vs 1st walkway trip with no prior training) effects were examined for the EMG parameters. RESULTS: Treadmill PBT reduced post-perturbation peak muscle activation magnitude (left RF, TA, ST, right RF, ST, GM), onset latency (right TA), time to peak (right RF) and co-contraction index (knee muscles) (P < 0.05). Walkway PBT reduced post-trip onset latencies (right TA, ST), peak magnitude (left ST, right GM), time to peak (right RF, ST) and pre-perturbation muscle activity (right TA) (P < 0.05). Those who undertook treadmill PBT were not different to those without prior training during the first walkway trip (P > 0.05). CONCLUSIONS: Both treadmill and walkway PBT induced earlier initiation and peak activation of right limb muscles responsible for the first recovery step. Treadmill PBT also reduced co-contraction of the knee muscles. Adaptations in muscle activity following treadmill PBT did not transfer to a walkway trip.

Effect of Comprehensive Balance Modulating Strategies on Physical Performance Among the Elderly in Care Home Settings in Southern India.

Purpose Globally, the proportion of the elderly population is rising. Age-related physical performance impairments are more common and affect quality of life. This study aimed to investigate the impact of a new exercise regimen called Comprehensive Balance-Modulating Strategies (CBMS) on the physical performance of older adults living in care home settings. Methods Forty-eight functionally independent elderly individuals were randomized into two groups: group A received the CBMS programme for eight weeks, and group B received routine medical care. The Short Physical Performance Battery (SPPB) and the Four Square Step Test (FSST) were outcome measures. Outcomes were measured at baseline, immediately after the intervention, and eight weeks after the intervention. Results The mean and standard deviation of subjects' ages in both groups were 72.46 (8.28) and 68.12 (6.95), respectively. The CBMS programme significantly improved physical performance among the intervention group (p = <0.0001). Conclusion The present study found that CBMS was effective in improving physical performance among institutionalized elderly. Large-scale clinical trials and research exploring the effect of CBMS among community-dwelling elderly individuals are recommended.

Clinician acceptability of the ReacStep reactive balance training program for fall prevention.

AIM: To examine if a novel reactive balance training program (ReacStep) designed for clinical settings is acceptable to clinicians prescribing balance and mobility training. METHODS: ReacStep consists of tether-release reactive step training, volitional trip and slip training, and functional strength training. An open survey comprising 11-point visual analog scale items (0 = strongly disagree to 10 = strongly agree) based on the Theoretical Framework of Acceptability was sent to clinicians working in balance and mobility training. Items evaluated the acceptability of ReacStep across seven domains (intervention coherence, perceived efficacy, self-efficacy, ethicality, affective attitude, burden and opportunity cost). RESULTS: Two hundred and seven clinicians (169 Physiotherapists, 22 Exercise Physiologists, 11 Occupational Therapists and five others) completed the survey. Respondents considered ReacStep to have good overall acceptability, intervention coherence, effectiveness, ethicality and self-efficacy (mean acceptability scores >7). However, respondent's ratings of ReacStep's affective attitude, burden and opportunity cost were more variable (mean acceptability scores 2-8) due to concerns about client anxiety, the need for a safety harness and staffing and training requirements. Respondents considered that ReacStep would be more effective and safer to conduct in geriatrics clients compared with neurological clients, and that it would be more appropriate for rehabilitation and private practice settings compared to home settings. CONCLUSIONS: ReacStep was generally acceptable from the perspective of clinicians who prescribe balance and mobility training in various clinical settings, and was deemed more effective and safer for older clients without neurological conditions, and beneficial in outpatient rehabilitation and private practice settings.

Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Balance training covers a range of different modalities and complexity levels for people with multiple sclerosis (MS). When evaluating the effects of balance training across different kinds of interventions, determination of the specific intervention content that predict effects are needed. OBJECTIVE: To investigate the effects of balance training on gait and dynamic balance outcomes. METHODS: Four databases were systematically searched. Randomized controlled trials involving people with MS (Expanded Disability Status Scale [EDSS] score ≤7.5) where at least 50% of the intervention targeted balance control were included. Interventions were categorized based on training types. Risk-of-bias was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX). RESULTS: A total of 18 included studies involved 902 people with MS (EDSS range from 0 to 7.5). Interventions evaluated with a balance composite score or a mobility test showed a moderate effect size (ES = 0.46 [95% confidence interval (CI) = 0.18 to 0.74]; p < .01) and a small overall ES (ES = 0.19 [95% CI = 0.01-0.36]; p = .04), respectively, across different training types. Stepping and gait speed outcomes showed no effect. Cognitive dual-task training showed a significant effect (ES = 0.81 [95% CI = 0.24 to 1.37]) on subgroup level, when evaluated with a mobility outcome measure. The median TESTEX score on study quality and reporting was 11 (maximum score = 15). CONCLUSIONS: Improvements of balance were found across interventions when measured by balance composite scores and mobility tests, but not when measured by stepping or gait speed outcomes. Large training volume was positively associated with effect on balance. A definition of intensity in balance training is needed for evaluation of its impact on the effect of balance interventions.

Meta-analysis of the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability.

OBJECTIVE: To explore and compare the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability (CAI). METHODS: The PubMed, Embase, Web of Science, Medline, and Cochrane databases were searched up to December 2023. Quality assessment was carried out using the risk-of-bias guidelines of the Cochrane Collaboration, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were compute. RESULTS: Among 20 eligible studies, including 682 participants were analyzed in this meta-analysis. The results of the meta-analysis demonstrated that balance training was effective in enhancing ankle function with self-functional scores (SMD = 1.02; 95% CI, 0.61 to 1.43; p < 0.00001; I2 = 72%) and variables associated with the ability of dynamic balance such as SEBT-A (MD = 5.88; 95% CI, 3.37 to 8.40; p < 0.00001; I2 = 84%), SEBT-PM (MD = 5.47; 95% CI, 3.40 to 7.54; p < 0.00001; I2 = 61%), and SEBT-PL (MD = 6.04; 95% CI, 3.30 to 8.79; p < 0.0001; I2 = 79%) of CAI patients. Meta-regression indicated that the intervention time might be the principal cause of heterogeneity (p = 0.046) in self-functional scores. In subgroup analyses of self-functional score across intervention types, among the intervention time, more than 20 min and less than 30 min had the most favorable effect (MD = 1.21, 95% CI: 0.96 to 1.46, p < 0.00001, I2 = 55%); among the intervention period, 4 weeks (MD = 0.84, 95% CI: 0.50 to 1.19, p < 0.00001, I2 = 78%) and 6 weeks (MD = 1.21, 95% CI: 0.91 to 1.51, p < 0.00001, I2 = 71%) had significant effects; among the intervention frequency, 3 times (MD = 1.14, 95% CI: 0.89 to 1.38), p < 0.00001, I2 = 57%) had significant effects. Secondly, in subgroup analyses of SEBT across intervention types, a 4-week and 6-week intervention with balance training 3 times a week for 20-30 min is the optimal combination of interventions to improve SEBT (dynamic balance) in patients with chronic ankle instability. CONCLUSION: Balance training proves beneficial for ankle function in patients with CAI. Intervention time constitutes a major factor influencing self-function in patients with CAI. It is recommended that the optimal dosage of balance training for CAI involves intervention three times a week, lasting for 20 to 30 min over a period of 4 to 6 weeks for superior rehabilitation.

Assessment of Balance During a Single-Limb Stance Task in Healthy Adults: A Cross-Sectional Study.

Single-limb stance (SLS) is a demanding postural task, widely used for balance assessment in both research and clinical practice. Despite extensive data on elderly and clinical populations, less is known about younger and healthier adults. Our aim in this study was to assess balance during a SLS task among a cohort of healthy adults to determine whether there are age or sex group or testing condition differences in performances. In this cross-sectional study, we involved 120 participants aged 30-65 years and divided them into four age sub-groups with equal numbers of males and females in each. We assessed balance during a 45-s SLS task on a] the Delos Postural Proprioceptive System for both lower limbs in two conditions - open eyes (OE) and closed eyes (CE). We calculated stability (SI) and autonomy (AU) indices and used analysis of variance to determine that there was no significant effect of limb dominance or sex on balance parameters. However, there was a significant interaction effect between age group and testing condition for both SI and AU (p < .001 for both), with balance worsening as age increased only in the CE condition. These results highlight a pattern of balance decline with age when vision is eliminated from balance performance, underscoring the critical relationship between sensory input and postural control as people age.

The effects of six weeks of combined balance and plyometric training on postural control performance in elite badminton players: A pilot randomized, controlled study.

Background/Objectives: The athletic performance in badminton players largely depends on the capability of dynamic postural control to quickly restore balance when performing high-paced movements (e.g., frequent single-leg jumps). Our aim was to examine the effects of a novel intervention that combines balance training on an unstable surface and plyometric training on the performance of restoring balance after jumping, as well as related postural control in elite badminton players. Methods: Sixteen elite male badminton players were randomly allocated to either a combined balance and plyometric training group (CT, n = 8) or a plyometric training group (PT, n = 8). The CT group participated in a six-week training program, which included three training sessions per week. Each session comprised 40 min of plyometric exercises and 20 min of balance training. The PT group underwent plyometric training using the identical protocol as that of the CT group. All participants underwent identical technical training in badminton throughout the duration of the study. At baseline and immediately after the intervention, participants completed a single-leg jumping test. The capacity to restore balance was evaluated using the time to stabilization (TTS) after landing; and the related center of pressure (COP) fluctuations were also recorded. The effect of intervention was examined by two-way repeated-measures of ANOVA. Results: The primary two-way repeated-measures ANOVA models showed no significant interactions between group and time on either the time to stability in the dominant leg (D-TTS) or the time to stability in the non-dominant leg (N-TTS) (p > 0.70). Significant main effects of time, group, and their interactions on dominant legs of the anterior-posterior displacement difference (D-COPAP) (time: p = 0.001; group: p = 0.001; interaction: p = 0.014), non-dominant legs of the anterior-posterior displacement difference (N-COPAP) (time: p < 0.001; group: p = 0.003; interaction: p = 0.021) and non-dominant legs of the medial-lateral displacement difference (N-COPML) (time: p < 0.001; group: p < 0.001; interaction: p = 0.026), that is, compared to baseline of both groups and post PT, the COP metrics were significantly reduced after CT. Secondarily, within the CT and PT group, after the intervention, the N-TTS (CT: p = 0.001, post: 0.58 ± 0.87; PT: p = 0.03, post: 0.71 ± 0.11) was significantly decreased compared to baseline (CT pre: 0.76 ± 0.16; PT pre: 0.88 ± 0.13). Conclusion: This pilot study demonstrated that, compared to PT-only, the 6-week CT which combines balance training induced comparable improvements in the capacity to restoring balance after landing from a single-leg jump, and significantly improved the postural control performance as measured by COP metrics.

Content and effects of balance training in people with diabetic peripheral neuropathy - a systematic review and meta-analysis.

BACKGROUND: Diabetic Peripheral Neuropathy (DPN) impairs balance due to sensory loss, proprioceptive deficits, muscle weakness, altered gait, and delayed reflexes. Targeted aerobic and balance training seem promising to mitigate these issues. However, the exact content of a recommended training regime is yet to be determined. OBJECTIVE: To delineate and synthesise balance training content and efficacy for people with DPN. METHODS: The literature search was conducted on PubMed and Embase in accordance with the PRISMA-checklist. Last search was performed on April 29, 2024. Inclusion criteria were established using the PICO-framework. Methodological quality was assessed using the TESTEX Scale. Meta-analyses were exclusively applied to studies featuring a passive control group. RESULTS: A total of 2007 articles were identified. Twelve studies were included in the qualitative synthesis. Seven studies were included in the meta-analyses. Two studies were of high quality. Most studies reported the frequency, session time, duration, and setting of balance training, while none reported the intensity. The meta-analyses showed a standardized mean difference in favor of balance training compared to passive control for One-Legged Stance (openeyes) (0.89[0.5,1.28]), One-Legged Stance (closed eyes) (1.48[0.36, 2.60]), Postural sway (-0.71[-1.04, -0,37]), Timed Up and Go(-0.94[-1.78, -0.10]), and Berg Balance Scale (2.26[0.48, 4.05]), respectively. CONCLUSION: Studies are few and generally of low methodological quality. The content of balance training interventions is minimally described, especially concerning the applied intensity. However, balance training does seem to improve balance outcomes in people with DPN, but given the methodological limitations, interpretation must be cautious.

Do Combined Oculomotor and Bimanual Coordination Exercises Instantly Stabilize Balance in Athletes?

Purpose: This study examined the immediate effects of oculomotor and bimanual coordination exercises, as well as a combination of the two, on stability of balance in athletes. Patients and Methods: Changes in center-of-gravity sway were measured in 30 college student athletes before and after the following three exercise conditions: 1) oculomotor exercises, 2) bimanual coordination exercises, and 3) a combination of oculomotor and bimanual coordination exercises (1+2). The order of these exercises was counterbalanced. Results: The combination of exercises (condition 3) reduced large swaying during balancing and immediately increased postural stability. Moreover, the oculomotor and bimanual coordination exercises (conditions 1 and 2) immediately reduced large sway during balancing when performed independently. Thus, the present study revealed that the combination of oculomotor and bimanual coordination exercises immediately reduced accidental swaying during balancing and also improved postural stability. Conclusion: This combination could be effective as an immediate balance adjustment method for athletes.

Reflections on the challenges of conducting an international multicentre randomized controlled trial of balance training in addition to pulmonary rehabilitation and its impact on fall incidence in people with COPD.

BACKGROUND: Pulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials. METHODS: This was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned. RESULTS: Ten outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study. CONCLUSIONS: We identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.

Age-related decline in GABAergic intracortical inhibition can be counteracted by long-term learning of balance skills.

Ageing induces a decline in GABAergic intracortical inhibition, which seems to be associated not only with decremental changes in well-being, sleep quality, cognition and pain management but also with impaired motor control. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. Therefore, the present study investigated whether age-related cortical dis-inhibition could be reversed after 6 months of balance learning and whether improvements in postural control correlated with the extent of reversed dis-inhibition. The results demonstrated that intracortical inhibition can be upregulated in elderly subjects after long-term balance learning and revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition and may therefore be seminal for many pathologies in which the equilibrium between inhibitory and excitatory neurotransmitters is disturbed. KEY POINTS: Ageing induces a decline in GABAergic intracortical inhibition. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. After 6 months of balance learning, intracortical inhibition can be upregulated in elderly subjects. The results of this study also revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition.

The effects of visual information deprivation and feedback balance training on balance in patients with stroke.

BACKGROUND: Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. OBJECTIVE: The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. METHODS: The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. RESULTS: The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. CONCLUSION: The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.

Validity and Responsiveness of a Modified Balance Error Scoring System Assessment Using a Mobile Device Application in Patients Recovering from Ankle Sprain.

Background: Static balance is often impaired in patients after ankle sprains. The ability to identify static balance impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (SWAY App) (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess postural sway during a modified Balance Error Scoring System (mBESS) assessment and shows promise as an accessible method to quantify changes in static balance after injury. Purpose: The primary purposes of this study were to determine the ability to differentiate between those with ankle sprain versus controls (construct validity) and ability to detect change over time (responsiveness) of a mBESS assessment using a mobile device application to evaluate static balance after an acute ankle sprain. Study Design: Case-control study. Methods: Twenty-two military academy Cadets with an acute ankle sprain and 20 healthy Cadets were enrolled in the study. All participants completed an assessment measuring self-reported function, ankle dorsiflexion range of motion (via the weightbearing lunge), dynamic balance, and static balance. Static balance measured with the mBESS using the SWAY App was validated against laboratory-based measures. Cadets with ankle sprains completed their assessment twice: once within two weeks of injury (baseline) and again after four weeks of rehabilitation that included balance training. Independent and paired t-tests were utilized to analyze differences over time and between groups. Effect sizes were calculated and relationships explored using Pearson's correlation coefficients. Results: The mBESS scores measured by the SWAY App were lower in participants with acute ankle sprains than healthy Cadets (t = 3.15, p = 0.004). Injured participants improved their mBESS score measured by SWAY at four weeks following their initial assessments (t = 3.31, p = 0.004; Baseline: 74.2 +/- 16.1, 4-weeks: 82.7 +/- 9.5). The mBESS measured by the SWAY App demonstrated moderate to good correlation with a laboratory measure of static balance (r = -0.59, p \< 0.001). Conclusion: The mBESS assessed with a mobile device application is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated construct (known groups) validity detecting balance differences between a healthy and injured group, concurrent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain. Level of Evidence: Level 3.