Community-based respiratory health measures in children and young people with cerebral palsy: A scoping review.

AIM: To identify, map, and describe outcome measurement domains and instruments used within a community setting to assess respiratory health in children and young people aged 1 to 18 years, diagnosed with cerebral palsy (CP). METHOD: A scoping review methodology informed structured searches in nine databases, grey literature, and registries, conducted in August 2021 (updated in February 2023). Articles were screened for eligibility by two independent researchers. Any outcome measurement instruments used to assess respiratory health or associated impact were extracted, categorized, and mapped to health and health-related domains of the International Classification of Functioning, Disability, and Health. RESULTS: Seventy-six outcome measurement instruments were identified across 78 articles worldwide between 1970 and 2023. These were categorized into 'Body functions and structures' (n = 20), 'Activity and performance' (n = 22), and 'Participation and quality of life' (n = 19), with a further 15 mapped to 'Health care resources use'. INTERPRETATION: No consensus of 'what' to measure and 'how' to measure respiratory health in children and young people with CP was found. Moreover, many measures were not replicable in individuals with more severe forms of CP, excluding those at increased risk of respiratory-related morbidity and mortality. Further research is required to agree important outcome domains and associated measures in research and clinical practice. WHAT THIS PAPER ADDS: A limited number and size of experimental designs were found. Seventy-six measures were identified to assess respiratory health in cerebral palsy. No consensus was found in 'what' or 'how' to measure respiratory health. Many measures were not replicable in children and young people at risk of poorer respiratory health outcomes. Children and young people with comorbidities and learning disability were frequently excluded from studies.

A scoping review of stroke services within the Philippines.

BACKGROUND: Stroke is a leading cause of mortality and disability. In higher-income countries, mortality and disability have been reduced with advances in stroke care and early access to rehabilitation services. However, access to such services and the subsequent impact on stroke outcomes in the Philippines, which is a lower- and middle-income countries (LMIC), is unclear. Understanding gaps in service delivery and underpinning research from acute to chronic stages post-stroke will allow future targeting of resources. AIMS: This scoping review aimed to map available literature on stroke services in the Philippines, based on Arksey and O'Malley's five-stage-process. A targeted strategy was used to search relevant databases (Focused: MEDLINE (ovid), EMBASE (ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO (ebsco); broad-based: Scopus; review-based: Cochrane Library, International Prospective Register of Systematic Reviews (PROSPERO), JBI (formerly Joanna Briggs Institute) as well as grey literature (Open Grey, Google scholar). The searches were conducted between 12/2022-01/2023 and repeated 12/2023. Literature describing adults with stroke in the Philippines and stroke services that aimed to maximize well-being, participation and function were searched. Studies were selected if they included one or more of: (a) patient numbers and stroke characteristics (b) staff numbers, qualifications and role (c) service resources (e.g., access to a rehabilitation unit) (d) cost of services and methods of payment) (e) content of stroke care (f) duration of stroke care/rehabilitation and interventions undertaken (g) outcome measures used in clinical practice. A total of 70 papers were included. Articles were assessed, data extracted and classified according to structure, process, or outcome related information. Advances in stroke services, including stroke ready hospitals providing early access to acute care such as thrombectomy and thrombolysis and early referral to rehabilitation coupled with rehabilitation guidelines have been developed. Gaps exist in stroke services structure (e.g., low number of neurologists and neuroimaging, lack of stroke protocols and pathways, inequity of stroke care across urban and rural locations), processes (e.g., delayed arrival to hospital, lack of stroke training among health workers, low awareness of stroke among public and non-stroke care workers, inequitable access to rehabilitation both hospital and community) and outcomes (e.g., low government insurance coverage resulting in high out-of-pocket expenses, limited data on caregiver burden, absence of unified national stroke registry to determine prevalence, incidence and burden of stroke). Potential solutions such as increasing stroke knowledge and awareness, use of mobile stroke units, TeleMedicine, TeleRehab, improving access to rehabilitation, upgrading PhilHealth and a unified national long-term stroke registry representing the real situation across urban and rural were identified. CONCLUSION: This scoping review describes the existing evidence-base relating to structure, processes and outcomes of stroke services for adults within the Philippines. Developments in stroke services have been identified however, a wide gap exists between the availability of stroke services and the high burden of stroke in the Philippines. Strategies are critical to address the identified gaps as a precursor to improving stroke outcomes and reducing burden. Potential solutions identified within the review will require healthcare government and policymakers to focus on stroke awareness programs, primary and secondary stroke prevention, establishing and monitoring of stroke protocols and pathways, sustainable national stroke registry, and improve access to and availability of rehabilitation both hospital and community. WHAT IS ALREADY KNOWN?: Stroke services in the Philippines are inequitable, for example, urban versus rural due to the geography of the Philippines, location of acute stroke ready hospitals and stroke rehabilitation units, limited transport options, and low government healthcare insurance coverage resulting in high out-of-pocket costs for stroke survivors and their families. WHAT ARE THE NEW FINDINGS?: The Philippines have a higher incidence of stroke in younger adults than other LMICs, which impacts the available workforce and the country's economy. There is a lack of data on community stroke rehabilitation provision, the content and intensity of stroke rehabilitation being delivered and the role and knowledge/skills of those delivering stroke rehabilitation, unmet needs of stroke survivors and caregiver burden and strain, WHAT DO THE NEW FINDINGS IMPLY?: A wide gap exists between the availability of stroke services and the high burden of stroke. The impact of this is unclear due to the lack of a compulsory national stroke registry as well as published data on community or home-based stroke services that are not captured/published. WHAT DOES THIS REVIEW OFFER?: This review provides a broad overview of existing evidence-base of stroke services in the Philippines. It provides a catalyst for a) healthcare government to address stroke inequities and burden; b) development of future evidence-based interventions such as community-based rehabilitation; c) task-shifting e.g., training non-neurologists, barangay workers and caregivers; d) use of digital technologies and innovations e.g., stroke TeleRehab, TeleMedicine, mobile stroke units.

Exploring the Feasibility of Bidirectional Control of Beta Oscillatory Power in Healthy Controls as a Potential Intervention for Parkinson's Disease Movement Impairment.

Neurofeedback (NF) is a promising intervention for improvements in motor performance in Parkinson's disease. This NF pilot study in healthy participants aimed to achieve the following: (1) determine participants' ability to bi-directionally modulate sensorimotor beta power and (2) determine the effect of NF on movement performance. A real-time EEG-NF protocol was used to train participants to increase and decrease their individual motor cortex beta power amplitude, using a within-subject double-blind sham-controlled approach. Movement was assessed using a Go/No-go task. Participants completed the NASA Task Load Index and provided verbal feedback of the NF task difficulty. All 17 participants (median age = 38 (19-65); 10 females) reliably reduced sensorimotor beta power. No participant could reliably increase their beta activity. Participants reported that the NF task was challenging, particularly increasing beta. A modest but significant increase in reaction time correlated with a reduction in beta power only in the real condition. Findings suggest that beta power control difficulty varies by modulation direction, affecting participant perceptions. A correlation between beta power reduction and reaction times only in the real condition suggests that intentional beta power reduction may shorten reaction times. Future research should examine the minimum beta threshold for meaningful motor improvements, and the relationship between EEG mechanisms and NF learning to optimise NF outcomes.

Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance.

To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p = 0; I2  = 0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p = 0.21, I2  = 51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.

Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis.

STUDY DESIGN: A systematic review and meta-analysis of clinical trials. OBJECTIVES: To determine the effect of non-invasive transcutaneous spinal direct current stimulation (tsDCS) on spasticity, activity limitations and participation restrictions in various upper motor neuron diseases. METHODS: Six databases including CINAHL plus, Cochrane CENTRAL, Embase, MEDLINE, SCOPUS and Web of Science were searched for the relevant records from January 2008 to December 2022. Two reviewers independently selected and extracted data on spasticity, activity limitations and participation restrictions. The risk of bias was evaluated using the PEDro scale while the GRADE approach established the certainty of the evidence. RESULTS: Eleven studies were identified of which 5 (45.5%) were rated as having a low risk of bias and 8 (72.7%) were meta-analyzed. The meta-analyses did not show any significant differences between cathodal (SMD = -0.67, 95% CI = -1.50 to 0.15, P = 0.11, I2 = 75%, 6 RCTs) or anodal (SMD = 0.11, 95% CI = -0.43 to -0.64, p = 0.69, I2 = 0%, 2 RCTs) and sham tsDCS for spasticity. There was also no significant difference between active and sham tsDCS for activity limitations (SMD = -0.42, 95% CI = -0.04 to 0.21, p = 0.2, I2 = 0%, 2 RCTs) and participation restrictions (MD = -8.10, 95% CI = -18.02 to 1.82, p = 0.11, 1 RCT). CONCLUSIONS: The meta-analysis of the available evidence provides an uncertain estimate of the effect of cathodal tsDCS on spasticity, activity limitation and participation restriction. It might be very helpful, or it may make no difference at all. However, considering the level of the evidence and the limitation in the quality of the majority of the included studies, further well-designed research may likely change the estimate of effect. TRIAL REGISTRATION: PROSPERO CRD42021245601.

The feasibility, safety, physiological and clinical effects of high-intensity interval training for people with Parkinson's: a systematic review and meta-analysis.

BACKGROUND: Exercise is important for people with Parkinson's (PwP), with high-intensity interval training (HIIT) proposed as a feasible and effective exercise modality. However, no literature synthesis for PwP has been undertaken. OBJECTIVES: To evaluate the feasibility, safety, physiological and clinical effects of HIIT for PwP. METHODS: Systematic searches of Medline, Embase, CINAHL, Web of Science, and Google Scholar were undertaken. Studies that included ≥ 2 weeks of HIIT for PwP and reported sufficient detail for full quality assessment were eligible. Quality was assessed with the TESTEX scale or the Downs and Black tool according to study design. Feasibility and safety data, physiological and clinical outcomes were extracted. Meta-analyses explored the pooled effects of HIIT on VO2peak/max compared to moderate-intensity continuous exercise (MICE) and usual care. RESULTS: Eleven articles were identified (seven controlled/comparator studies and four single group) including 117 HIIT participants predominantly of mild-to-moderate disease severity. HIIT programmes were professionally supervised and between 6 weeks and 24 months. Overall, study quality was deemed to be moderate to good. Following screening, nine studies reported 90-100% programme completion; however, only one was > 12 weeks in duration. Adverse events were uncommon. HIIT improved VO2peak/max compared to usual care, but not to MICE. Increased brain-derived neurotrophic factor (BDNF) and improved motor symptoms were also reported. CONCLUSION: Up to 12 weeks of supervised HIIT appears to be feasible and safe for some people with mild-to-moderate disease severity. HIIT improves cardiorespiratory fitness and may increase BDNF and improve motor symptoms in PwP. Future studies should explore safe ways to facilitate access and long-term adherence.

A nurse-led comprehensive geriatric assessment intervention in primary care: A feasibility cluster randomized controlled trial.

AIM: To determine the feasibility of a nurse-led, primary care-based comprehensive geriatric assessment (CGA) intervention. DESIGN: A feasibility cluster randomized controlled trial. METHODS: The trial was conducted in six general practices in the United Kingdom from May 2018 to April 2020. Participants were moderately/severely frail people aged 65 years and older living at home. Clusters were randomly assigned to the intervention arm control arms. A CGA was delivered to the intervention participants, with control participants receiving usual care. Study outcomes related to feasibility of the intervention and of conducting the trial including recruitment and retention. A range of outcome measures of quality of life, function, loneliness, self-determination, mortality, hospital admission/readmission and number of prescribed medications were evaluated. RESULTS: All pre-specified feasibility criteria relating to recruitment and retention were met with 56 participants recruited in total (30 intervention and 26 control). Retention was high with 94.6% of participants completing 13-week follow-up and 87.5% (n = 49) completing 26-week follow-up. All outcome measures instruments met feasibility criteria relating to completeness and responsiveness over time. Quality of life was recommended as the primary outcome for a definitive trial with numbers of prescribed medications as a secondary outcome measure. CONCLUSION: It is feasible to implement and conduct a randomized controlled trial of a nurse-led, primary care-based CGA intervention. IMPACT: The study provided evidence on the feasibility of a CGA intervention for older people delivered in primary care. It provides information to maximize the success of a definitive trial of the clinical effectiveness of the intervention. PATIENT OR PUBLIC CONTRIBUTION: Patient and public representatives were involved in the study design including intervention development and production of participant-facing documentation. Representatives served on the trial management and steering committees and, as part of this role, interpreted feasibility data. ISRCTN Number: 74345449.

Optimising curve fitting techniques to look for standardisation of the analysis of defocus curves derived from multifocal intraocular lenses.

INTRODUCTION: To establish the most appropriate curve fitting method to allow accurate comparison of defocus curves derived from intraocular lenses (IOLs). METHODS: Defocus curves were plotted in five IOL groups (monofocal, extended depth of focus, refractive bifocal, diffractive bifocal and trifocal). Polynomial curves from 2nd to 11th order and cubic splines were fitted. Goodness of fit (GOF) was assessed using five methods: least squares, coefficient of determination (R2adj ), Akaike information criteria (AIC), visual inspection and Snedecor and Cochran. Additional defocus steps at -2.25 D and -2.75 D were measured and compared to the calculated visual acuity (VA) values. Area under the defocus curve and range of focus were also compared. RESULTS: Goodness of fit demonstrated variable results, with more lenient methods such as R2adj leading to overfitting and conservative methods such as AIC resulting in underfitting. Furthermore, conservative methods diminished the inflection points resulting in an underestimation of VA. Polynomial of at least 8th order was required for comparison of area methods, but overfitted the EDoF and monofocal groups; the spline curve was consistent for all IOLs and methods. CONCLUSIONS: This study demonstrates the inherent difficulty of selecting a single polynomial function. The R2 method can be used cautiously along with visual inspection to guard against overfitting. Spline curves are suitable for all IOLs, guarding against the issues of overfitting. Therefore, for analysis of the defocus profile of IOLs, the fitting of a spline curves is advocated and should be used wherever possible.

Designing a nurse-led assessment and care planning intervention to support frail older people in primary care: An e-Delphi study.

AIM: To identify and establish expert consensus on important and feasible components of a nurse-led, comprehensive geriatric assessment (CGA)-based intervention for community-dwelling older people who live with frailty. DESIGN: A three-round modified e-Delphi survey. METHODS: An expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three-round e-Delphi survey over a 12-month period in 2017-2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus. RESULTS: In round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility. CONCLUSION: Based on expert panel opinion, the content of a nurse-led CGA-based intervention was established, with the aim of future feasibility testing in a randomized controlled trial. IMPACT: This study provides feasible components of a CGA-based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community-dwelling frail older people.

Defining usual physiotherapy care in ambulant children with cerebral palsy in the United Kingdom: A mixed methods consensus study.

BACKGROUND: Ambulant children with cerebral palsy (CP) undertake physiotherapy to improve balance and walking. However, there are no relevant clinical guidelines to standardize usual physiotherapy care in the United Kingdom. A consensus process can be used to define usual physiotherapy care for children with CP. The resulting usual care checklist can support the development of clinical guidelines and be used to measure fidelity to usual care in the control groups of trials for children with CP. METHODS: Twelve expert physiotherapists were recruited. In Phase 1, statements on usual care were developed using a survey and two nominal groups. Phase 2 included a literature review to support usual physiotherapy interventions. Phase 3 used a confirmatory survey, which also captured changes to provision during the COVID-19 pandemic. Consensus was calculated by deriving the mean of the deviations from the median score (MDM). High consensus was deemed to be where MDM < 0.42. RESULTS: Physiotherapists reached high consensus on five outcome measures (MDM range 0-0.375) and nine areas of assessment (MDM range 0-0.25). Physiotherapists reached moderate consensus on task-specific training (MDM = 0.75), delivered at weekly intensity for 4-6 weeks (MDM = 0.43). There was high consensus (MDM = 0) that children should participate in modified sport and fitness activities and that children with Gross Motor Function Classification System Level III should be monitored on long-term pathways (MDM = 0.29). CONCLUSIONS: Physiotherapists reached consensus on two usual care interventions, and a checklist was developed to inform the control groups of future randomized controlled trials. Further consensus work is required to establish clinical guidelines to standardize usual physiotherapy care in the United Kingdom.

Improving dental student confidence through the use of simulated patient cases.

INTRODUCTION: This study investigates whether student confidence could be improved through the use of simulated patient case-based scenarios. MATERIALS AND METHODS: Students in their 4th and 5th year of undergraduate study completed an online e-portfolio workbook consisting of activities related to five simulated patient cases. Following completion of the relevant learning activities within the e-portfolio, students then viewed a tutor case presentation video and attended simulated clinic sessions to complete corresponding exercises involving 3D-printed teeth related to the case. Subsequently, students undertook online self-reflection and goal-setting activities to aid their development. An anonymous questionnaire was distributed to all participants to gain insight into the themes of student confidence and learning support. The Cronbach's Alpha coefficient was calculated for both sections of the student questionnaire. The values for "student confidence" and "learning support" were α = 0.91 and α = 0.87, respectively. RESULTS: There was a total of 89 valid student responses to the questionnaire (65%). A Spearman's correlation of rs  = 0.50 (p < .001) suggests a tentative causative correlation between the learning support offered through the simulated patient cases and student confidence. There was a positive directional relationship between engagement with the learning support of the simulated patient cases and student confidence scores. CONCLUSION: Student confidence increased following the completion of simulated patient cases and students found the learning support offered beneficial to their development. This learning intervention has the potential to improve student self-efficacy, develop contextual competency and facilitate reflective practice. Simulated patient cases may be a useful precursor or adjunct to traditional patient clinics.

Body representation in people with apraxia post Stroke- an observational study.

Objective: To investigate how two types of body representation (body schema and body image) were affected in people with and without apraxia following a supratentorial stroke.Design: Observational cross-sectional studySetting: Level 1 Specialist Neurological Rehabilitation UnitParticipants: 30 participants post-stroke diagnosed with (n = 10) and without apraxia (n = 20) according to a modified version of the short Ideomotor Apraxia Test.Interventions: Not applicableMain Outcome Measures: Body schema assessed using the hand laterality recognition test and body part knowledge test; Implicit body image assessed using the sidedness test.Results: Left-sided lesions were more common in the apraxic group. Compared to people without apraxia post-stroke, those with apraxia showed significantly reduced accuracy and longer reaction times on the hand laterality test and fewer correct responses on the body part knowledge test. There was no between-groups difference in the sidedness test.Conclusions: People with apraxia showed deficits in online body representations (body schema) that are used to plan and execute actions. Future research studies could target body schema deficits as an adjunct in the rehabilitation of apraxia.

Physio4FMD: protocol for a multicentre randomised controlled trial of specialist physiotherapy for functional motor disorder.

BACKGROUND: Patients with functional motor disorder (FMD) experience persistent and disabling neurological symptoms such as weakness, tremor, dystonia and disordered gait. Physiotherapy is usually considered an important part of treatment; however, sufficiently-powered controlled studies are lacking. Here we present the protocol of a randomised controlled trial (RCT) that aims to evaluate the clinical and cost effectiveness of a specialist physiotherapy programme for FMD. METHODS/DESIGN: The trial is a pragmatic, multicentre, single blind parallel arm randomised controlled trial (RCT). 264 Adults with a clinically definite diagnosis of FMD will be recruited from neurology clinics and randomised to receive either the trial intervention (a specialist physiotherapy protocol) or treatment as usual control (referral to a community physiotherapy service suitable for people with neurological symptoms). Participants will be followed up at 6 and 12 months. The primary outcome is the Physical Function domain of the Short Form 36 questionnaire at 12 months. Secondary domains of measurement will include participant perception of change, mobility, health-related quality of life, health service utilisation, anxiety and depression. Health economic analysis will evaluate the cost impact of trial and control interventions from a health and social care perspective as well as societal perspective. DISCUSSION: This trial will be the first adequately-powered RCT of physical-based rehabilitation for FMD. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number ISRCTN56136713 . Registered 27 March 2018.

The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial.

AIM: During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. METHODS: The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. DISCUSSION: There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. IMPACT: This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. TRIAL REGISTRATION NUMBER: ISRCTN: 74345449.

A Pilot RCT Investigating the Effects of Targeted Compression on Athletes With Pelvic/Groin Pain.

CONTEXT: Athletic pelvic/groin pain is a common yet often challenging problem to both diagnose and manage. A new tool has been developed based on the clinical effects of applied force on the pelvis. Early findings indicate that this customized compression orthosis may have a positive effect on pelvic/groin pain and performance measures. OBJECTIVES: To inform the design and test the practicality of procedures for a future definitively powered randomized controlled trial and to provide an estimate of the effect size of this orthosis on selected clinical and performance measures. DESIGN: Pilot randomized controlled trial with participants randomly allocated to an intervention or waiting-list control group. SETTING: The training location of each athlete. PARTICIPANTS: 24 athletes with subacute and chronic pelvic conditions were proposed to be recruited. INTERVENTION: A customized compression orthosis, delivering targeted compression to the pelvic girdle. OUTCOME MEASURES: Measures were the active straight leg raise (ASLR) test, squeeze test, broad jump, and the multiple single-leg hop-stabilization test. RESULTS: A total of 16 athletes completed the study. The invention group demonstrated moderate to large estimated effect sizes on the squeeze test and active straight leg raise tests (d = 0.6-1.1) while wearing the orthosis. Small effect sizes (d = 0.2) were seen on jump distance and the dominant leg balance score. Compared with the control group, the intervention group also showed moderate to large estimated effect sizes on the active straight leg raise measures (d = 0.5-0.9) when wearing sports shorts. CONCLUSIONS: The protocol was feasible. Effect sizes and recruitment/attrition rates suggest that the intervention holds promise and that a future definitively powered randomized controlled trial appears feasible and is indicated.

Transient Alpha and Beta Synchrony Underlies Preparatory Recruitment of Directional Motor Networks.

Modulations in motor cortical beta and alpha activity have been implicated in the preparation, execution, and termination of voluntary movements. The functional role of motor cortex beta activity is yet to be defined, though two opposing theories prevail. The idling cortex theory suggests that large-scale motor networks, in the absence of input, revert to an intrinsic oscillatory state. The alternative theory proposes that beta activity promotes postural tone at the expense of voluntary movement. These theories are primarily based on observations of event-related desynchronization associated with movement onset. Here, we explore the changes in alpha and beta oscillatory activity associated with the specific behavioral patterns during an established directional uncertainty paradigm. We demonstrate that, consistent with current proposals, alpha and beta desynchronization reflects a process of disengagement from existing networks to enable the creation of functional assemblies. We demonstrate that, following desynchronization, a novel signature of transient alpha synchrony underlies the recruitment of functional assemblies required for directional control. Although alpha and beta desynchronization are dependent upon the number of cues presented, they are not predictive of movement preparation. However, the transient alpha synchrony occurs only when participants have sufficient information to prepare for movement and shows a direct relationship with behavioral performance measures.

Rater reliability and scoring duration of the Quality Function Measure in ambulant children with hyperkinetic movement disorders.

AIM: To examine intra- and interrater reliability/agreement, and time taken to score, when the Quality Function Measure (QFM) is applied to children with hyperkinetic movement disorders (HMD; e.g. dystonia, chorea, athetosis, tremor, and myoclonus). METHOD: Fifteen ambulant children with HMD participated (eight males, seven females; mean age 13y 7mo, SD 3y 7mo). Three trained raters (two physiotherapists, one occupational therapist) independently scored the QFM using videos of each child performing Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump dimensions. Reliability was evaluated using intraclass correlation coefficient (ICC) model 2.1, Standard Error of Measurement (SEM), and Bland-Altman methods. RESULTS: Rater reliability was excellent for all five QFM attributes: intrarater ICCs ≥0.98 (95% confidence interval [CI] 0.83-1.00), and interrater ICCs ≥0.96 (95% CI 0.91-1.00). SEM varied from 2.07% to 4.72% points for intra- and interrater scores across QFM attributes. Bland-Altman tests demonstrated close agreement between ratings, with absolute mean differences varying from 0.34% to 3.23% (intrarater) to 1.67% to 3.82% (interrater). Median scoring duration time was 83 minutes (range 56-144min, SD 16.02). INTERPRETATION: Low measurement error attributable to rater effects suggests the QFM has potential as an evaluative measure in research studies involving children with HMD, though its lengthy scoring requirements are an important consideration for clinical practice. Evaluation of test-retest reliability and responsiveness is required.

The Use of a Dynamic Elastomeric Fabric Orthosis in Supporting the Management of Athletic Pelvic and Groin Injury.

CONTEXT: Athletic pelvic and groin injuries are a common yet challenging problem. Pelvic belts have been successfully used to reduce pain and improve function but are not a practical solution for athletes. Therefore, there is scope to explore the use of a more dynamic intervention developed to aid in the management of this type of injury. OBJECTIVES: To undertake a preliminary investigation into the effectiveness of a dynamic elastomeric fabric orthosis (DEFO) in supporting the management of athletic pelvic and groin injury. DESIGN: A case series with an AB design. Daily assessments were undertaken over 15 days; the onset of intervention was randomized with a minimum baseline period of 6 d. Follow-up assessment was undertaken after 1 mo. SETTINGS: Community and university. PARTICIPANTS: 8 athletes presenting with pelvic or groin injury confirmed through clinical screening. INTERVENTION: A bespoke DEFO. MAIN OUTCOME MEASURES: Force produced on bilateral resisted hip adduction and self-scored pain (using a numerical rating scale of 0-10) at rest and during an active straight-leg raise and a broad jump. RESULTS: In 7 cases a significant improvement was observed on at least 1 measure (2-SD method, celeration line, and/or the point of nonoverlapping data). The remaining case showed minimal symptoms during testing.

Sensorimotor processing for balance in spinocerebellar ataxia type 6.

BACKGROUND: We investigated whether balance impairments caused by cerebellar disease are associated with specific sensorimotor processing deficits that generalize across all sensory modalities. Experiments focused on the putative cerebellar functions of scaling and coordinate transformation of balance responses evoked by stimulation of single sensory channels. METHODS: Vestibular, visual, and proprioceptive sensory channels were stimulated in isolation using galvanic vestibular stimulation, moving visual scenery, and muscle vibration, respectively, in 16 subjects with spinocerebellar ataxia type 6 (SCA6) and 16 matched healthy controls. Two polarities of each stimulus type evoked postural responses of similar form in the forward and backward directions. Disease severity was assessed using the Scale for Assessment and Rating of Ataxia. RESULTS: Impaired balance of SCA6 subjects during unperturbed stance was reflected in faster than normal body sway (P = 0.009), which correlated with disease severity (r = 0.705, P < 0.001). Sensory perturbations revealed a sensorimotor processing abnormality that was specific to response scaling for the visual channel. This manifested as visually evoked postural responses that were approximately three times larger than normal (backward, P < 0.001; forward P = 0.005) and correlated with disease severity (r = 0.543, P = 0.03). Response direction and habituation properties were no different from controls for all three sensory modalities. CONCLUSION: Cerebellar degeneration disturbs the scaling of postural responses evoked by visual motion, possibly through disinhibition of extracerebellar visuomotor centers. The excessively high gain of the visuomotor channel without compensatory decreases in gains of other sensorimotor channels provides a potential mechanism for instability of the balance control system in cerebellar disease.

Systematic Review: The Effectiveness of Interventions to Reduce Falls and Improve Balance in Adults With Multiple Sclerosis.

OBJECTIVES: To evaluate the effectiveness of interventions in reducing falls and/or improving balance as a falls risk in multiple sclerosis (MS). DATA SOURCES: Computer-based and manual searches included the following medical subject heading keywords: "Multiple Sclerosis AND accidental falls" OR "Multiple Sclerosis AND postural balance" OR "Multiple Sclerosis AND exercise" OR "Multiple Sclerosis AND physical/physio therapy" NOT animals. All literature published to November 2014 with available full-text details were included. STUDY SELECTION: Studies were reviewed against the PICO (participants, interventions, comparisons, outcomes) selection criteria: P, adults with MS; I, falls management/balance rehabilitation interventions; C, randomized/quasi-randomized studies comparing intervention with usual care or placebo control; O, falls outcomes and measures of balance. Fifteen articles of the original 529 search results were included. DATA EXTRACTION: Two reviewers independently extracted data and assessed methodological quality using the Cochrane Risk of Bias tool. DATA SYNTHESIS: Random-effects meta-analysis indicated a small decrease in falls risk (risk ratio, .74), although the 95% confidence interval (CI) crossed 1 (95% CI, .12-4.38). The pooled standardized mean difference (SMD) for balance outcomes was .55 (95% CI, .35-.74). SMD varied significantly between exercise subgroupings; gait, balance, and functional training interventions yielded the greatest pooled effect size (ES) (SMD=.82; 95% CI, 0.55-1.10). There was a moderate positive correlation between program volume (min/wk) and ES (Cohen's d) (r=.70, P=.009), and a moderate negative correlation between program duration in weeks and ES (r=-.62, P=.03). Variations in interventions and outcomes and methodological limitations mean that results must be viewed with caution. CONCLUSIONS: This review suggests that balance may improve through exercise interventions, but that the magnitude of the improvements achieved in existing programs may not be sufficient to impact falls outcomes. Supporting participants to achieve an appropriate intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness.