Effect of Mirror Therapy on Upper Limb Function in Children and Adolescents with Hemiplegic Cerebral Palsy: A Systematic Review and Meta-Analysis.

BACKGROUND: This review aimed to explore the effect of mirror therapy (MT) on upper limb function in children and adolescents with hemiplegic cerebral palsy (HCP). METHODS: MEDLINE, CENTRAL, Scopus, PEDro, and Web of Science were systematically searched. PEDro scale  was used for the quality assessment of included trials. Risk of Bias assessment was done using Cochrane Risk-of-bias tool version 2. Meta-analysis was performed on four of the seven studies included. RESULTS & CONCLUSION: The majority of the trials included in this review found MT efficacious in improving motor function in HCP. Quantitative analysis of the included trials using QUEST scores for evaluation of quality of upper extremity function revealed positive but non-significant difference between the groups (MD = -0.12; 95% CI = -2.57,2.33; Z = 0.09, p = .92). Pooled analysis of the included trials using BBT, however, favored control (MD = 4.98; 95% CI = 2.32,7.63; Z = 3.67, p = .0002).

Exploring the Mediating Role of Sleep Deficit-Related Functional Status in Subacute Stroke Survivors.

Background: Understanding post-stroke fatigue (PSF) and its associated factors is crucial for effective therapy and rehabilitation. This study aimed to assess the mediating role of the excessive daytime sleepiness-related functional status (SFS) on the relationship between sleep and the severity of fatigue in subacute stroke survivors. Methods: Subacute stroke survivors (n = 50; male = 38; female = 12), completed a cross-sectional study involving the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the insomnia severity index (ISI), the functional outcome of the sleep questionnaire (FOSQ), and the fatigue severity scale (FSS). Results: The SFS mediated the association between the severity of fatigue and sleep problems. The PSQI and FOSQ (b = -0.37, p < 0.001), and the FOSQ and FSS were correlated (b = -0.18, p < 0.05), with a significant indirect effect of the PSQI on the FSS. The ISI correlated with the FOSQ (b = -0.20, p < 0.001), with significant direct (b = 0.15, p < 0.001), as well as indirect, effects of the ISI on the FSS. The ESS correlated with the FOSQ (b = -0.23, p < 0.001), with a significant indirect effect of the ESS on the FSS. Conclusions: In subacute stroke survivors, fatigue and sleep are linked. Increased understanding of sleep-PSF may help in exploring new targets for supplement therapy.

Association between P300 parameters and cognitive function in people with diabetic neuropathy.

Purpose: The purpose of this study was to investigate the association between event-related potential (ERP) P300 with cognitive function in people with diabetic peripheral neuropathy (DPN). Methods: We performed a cross-sectional analysis of 19 type 2 diabetes mellitus (T2DM) patients, aged 18 and older with DPN. The participants were assessed for neuropathy, cognitive function, & dual-task performance. DPN was examined via the administration of diabetic neuropathy symptom score (DNSS) and vibration perception threshold (VPT). Cognitive dysfunction was evaluated using Mini-mental state examination (MMSE), trail making test-B (TMT-B), and ERP P300 wave latency & amplitude. For assessing dual-task performance, the dual-task cost (DTC) was calculated using the timed-up and go (TUG) test and TUG with dual task (TUG-DT). Results: P300 latency was linearly related to TMT-B (R = 0.31, p = 0.01) and DTC (R = 0.22, p = 0.04). A similar trend was observed in TMT-B (R = 0.13, p = 0.04) & DTC (R =0 .67, p = 0.001) with respect to P300 amplitude. MMSE did not relate with P300 latency (R = 0.14, p = 0.58) & amplitude (R = 0.63, p = .44). Conclusion: P300 latency and amplitude are associated with cognitive function and DTC of individuals with DPN.

Effects of Neural Mobilization in Diabetic Peripheral Neuropathy: A Scoping Review.

Objective: The purpose of this scoping review was to explore the effects of neural mobilization (NM) on outcomes in adults with diabetic peripheral neuropathy (DPN). Methods: Five databases were searched-PubMed, Web of Science (Web of Science Core Collection), Physiotherapy Evidence Database (PEDro), and Scopus-from inception to January 2022. The studies included were randomized controlled trials, pre-post single group design, multiple case studies, controlled case studies, quasi-experimental studies, and single case studies, which are published in full text in English. Results: Six studies were included in this review, and most were of low-level evidence. The sample size of the studies ranges from 20 to 43, except for 1 case study, with a total of 158 participants in all the studies combined. In 4 out of 6 studies, only NM was given, whereas in 2 studies, NM was used along with other treatment strategies. The tibial nerve was the most studied nerve, whereas 1 study administered NM to nerves of the upper limbs, and only 1 trial examined the sciatic nerve. The outcomes included the Michigan Neuropathy Screening Instrument questionnaire, nerve conduction velocity, vibration perception threshold, heat/cold perception threshold, weight-bearing asymmetry and range of motion of lower limb, quality of life, and magnetic imaging changes. Conclusion: At present, only a few low-level studies exist on the use of NM for the treatment of adults with DPN. The evidence for use of NM on DPN is still limited and insufficient.

Association of disease duration and sensorimotor function in type 2 diabetes mellitus: beyond diabetic peripheral neuropathy.

PURPOSE: The aim of the study is to assess association of the duration of diabetes and vibration, proprioception, muscle strength, reaction time and balance measures in people with type 2 diabetes mellitus (DM) without peripheral neuropathy. METHODS: Forty-seven type 2 diabetics without peripheral neuropathy and 23 healthy controls were recruited for the study. Patients with type 2 DM were further classified into 23 patients who suffered from diabetes for less than 5 years (<5yrDM) and 24 patients who had diabetes for 5 years and above (≥5yrDM). All participants were assessed for Michigan neuropathy screening instrument (MNSI), vibration perception threshold (VPT), proprioception, muscles strength, centre of pressure (COP) range, COP sway and reaction time. RESULTS: ≥5yrDM patients were found to significantly differ from healthy control in MNSI score (p ≤ 0.013), VPT score (p ≤ 0.002), reaction time (p ≤ 0.018), COP range (p ≤ 0.005) and COP sway (p ≤ 0.027). A significant difference was found only in reaction time (p < 0.002) except in the back direction (p = 0.089), and COP range (p ≤ 0.016) except in the front (p = 0.101) and right direction (p = 0.085) between <5yrDM patients and healthy controls. CONCLUSIONS: ≥5yrDM patients exhibit a subtle deterioration in VPT, reaction time, and balance measure while <5yr DM patients were impaired only in COP range and reaction time when compared with healthy control.

Effect of Modified Constrain Induced Movement Therapy on Fatigue and Motor Performance in Sub Acute Stroke.

OBJECTIVES: There is a little available information about the fatigue status among people receiving modified constraint induced movement therapy. The study examined such changes. The effect of using restraint on motor performance was also evaluated in sub acute phase after stroke. MATERIALS AND METHODS: The study was designed as two group pretest and post-test study. The experimental design included a pretest and post test measures of dependent variables fatigue and motor function. All patients were recruited from the Safdurjung Hospital. 20 patients in subacute phase of stroke (3-9 months), (N = 10) mean age±SD 51.90±15.27, MAS score mean ± SD 1.90±.316 and post stroke duration mean ±SD 6.45±2.26 were included in the experimental group and (N = 10) mean age ± SD 54.10±17.42, MAS score mean ±SD 1.52±0.52 and post stroke duration mean±SD score 4.55± 2.52 were included in the control group. The subjects in the experimental group were restrained for six hours every week day with task training for 2 h per day five times a week for three weeks and the subjects in the controlled group received task training for 2 h per day five times a week for three weeks with no restrain. Motor Performance and fatigue were measured on day to day basis by Wolf Motor Function Test Scores (WMFT) and 11th item of Barrow Neurological Institute (BNI) scale in both experimental and controlled group. RESULTS: The restraint group exhibited significant better motor performance than the controlled group. Mean difference between Pre- WMFT scores and Post WMFT scores were (0.533±.362) as compared to controlled group (0.192±.23). No significant statistical difference was observed in the difference of mean Pre- BNI and Post - BNI scores in either of the two groups (p = .57). Difference between the experimental and controlled group in motor performance and fatigue scores were nonsignificant. CONCLUSIONS: Restraint improves motor performance in subacute therapy group and the intensive practice associated with m-CIMT may be administered without the exacerbation of fatigue.

Insomnia Symptoms and Their Association with Anxiety and Poor Sleep Hygiene Practices Among Ethiopian University Students.

OBJECTIVE: There is a paucity of research evidence available regarding the impact of anxiety and sleep hygiene on insomnia and related sleep complaints among collegiate students in lower-income countries. The purpose of this study was to investigate if insomnia and insomnia-related sleep complaints are associated with anxiety, age, and sleep hygiene practices among a sample of university students in Ethiopia. DESIGN MEASURES SETTING AND PARTICIPANTS: The participants were young adults (n=525; mean age 21.5 ± 3.0 years; mean BMI of 20.7 ± 2.7kg/m2). Young collegiate adults at Mizan-Tepi University in southwestern Ethiopia were randomly selected to participate in this cross-sectional study. The measures included the Leeds Sleep Evaluation Questionnaire-Mizan (LSEQ-M), the Generalized Anxiety Disorder-7 Scale (GAD-7), and the Sleep Hygiene Index (SHI). Descriptive statistics, binary logistic regression, and multiple linear regressions were used. RESULTS: Insomnia was associated with young age group (≤25 years) (odds ratio (OR) = 2.20, 95% confidence interval (CI) 1.04-4.66), higher GAD-7 (anxiety) (OR = 1.05, 95% CI 1.0-1.10) and SHI (poor sleep hygiene) (OR = 1.15, 95% CI 1.05-1.26) scores. All four insomnia-related sleep complaints were associated with increasing GAD-7 scores, as well as higher SHI scores (p<0.001). CONCLUSION: Insomnia was associated with younger age group (≤25 years), higher anxiety level, and poor sleep hygiene. Four major sleep complaints in insomnia, ie, sleep onset problems, poor sleep quality, awakening problems, and daytime disturbances, were all associated with higher anxiety levels and poor sleep hygiene.

Leeds sleep evaluation questionnaire in Jordanian university students. A psychometric investigation using comparative confirmatory factor analysis.

OBJECTIVES: To analyze the fit of different competing factor models (a one-factor model, 3 2-factor models, and 2 4-factor models) of the Leeds sleep evaluation questionnaire (LSEQ) in the data from a Jordanian student population. METHODS: A cross-sectional study was conducted on university students, with 2 sleep-related tools - the LSEQ and the sleep hygiene index (SHI). The students (n=166) at Jordan University of Science and Technology, Irbid, Jordan participated in this study from January-April, 2019. A total of 12 LSEQ models (6 models with all 10-items, and 6 models with one item deleted) were evaluated by using confirmatory factor analysis. The summary statistics of correlation coefficients, descriptive measures of item analysis, the model fit, and Cronbach's alpha were determined. RESULTS: The findings show that a 4-factor correlated solution was a plausible model for the LSEQ with 9-items, compared to a one-factor, 2-factor, and other 4-factor variant models. The deletion of one item from the original LSEQ improved the data fit significantly in the studied population. Moreover, correlation analysis between the LSEQ and SHI confirmed the divergent validity of the LSEQ. CONCLUSION: The results support the validity of a 4-factor structure of the LSEQ with 9-items with adequate internal consistency and divergent validity.

Classification of functionality of people with diabetic peripheral neuropathy based on international classification of functioning, disability and health Core set (ICF-CS) of diabetes mellitus.

PURPOSE: The aim of this study was the application of International Classification of Functioning, Disability and Health Core Set (ICF- CS) of Diabetes Mellitus (DM) to investigate body function impairment (BF) & body structure (BS), activity limitation & participation restriction in people with diabetes mellitus with and without peripheral neuropathy. METHOD: A total of 120 subjects with diabetes were interviewed using four categories of the ICF-CS of DM through ICF documentation form including body functions, body structures, activities and participation, and environmental factors. RESULTS: Subjects with diabetic peripheral neuropathy (DPN) experienced more physical dysfunctions and impairments when compared with subjects having diabetes without peripheral neuropathy when assessed with ICF-CS of DM. DPN patients experienced significant problem in 19 categories in BF, 3 categories in BS, 10 categories in activity and participation and 4 categories in environmental factors when compared with diabetes patients without peripheral neuropathy on chi square analysis. Findings of regression analysis suggest that people with DPN have more chances of impairments in BF and BS, activities and participation, and environmental factors. CONCLUSION: The difference observed between subjects having diabetes with and without peripheral neuropathy on the scores of ICF-CS domains suggest that, people with DPN faces more problems in health and function. These people should be targeted with more intensive care for improving the health standards.

Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial.

OBJECTIVES: To examine the effect of sensorimotor and gait training on proprioception, nerve function, and muscle activation in diabetic peripheral neuropathy (DPN) patients. METHODS: Thirty-eight (25 male and 13 female) participants with DPN were selected and randomly allocated to intervention and control group. Participants in the intervention group were provided sensorimotor and gait training for eight weeks (3 days/week) along with diabetes and foot care education; participants in the control group received diabetes and foot care education only. Outcome measures involved proprioception, nerve conduction studies of peroneal and tibial nerve, and activation of lower limb muscles and multifidus while standing with eyes open and eyes closed, and treadmill walking. RESULTS: Mixed ANOVA revealed significant time effect and time×group interaction of proprioception in all four directions (p<0.05). The conduction velocity of peroneal nerve revealed significant time effect (p=0.007) and time×group interaction (p=0.022). Interaction effect was found to be significant for medial gastrocnemius and multifidus while standing with eyes open as well as with eyes closed (p≤0.004). Only multifidus showed significant group (p=0.002) and interaction effect (p=0.003) during walking. CONCLUSIONS: Sensorimotor and gait training is an effective tool for improvement of proprioception and nerve function. It benefits muscle activation around ankle and multifidus during postural control and walking in DPN patients. Clinical Trials Registry - India, National Institute of Medical Statistics (Indian Council of Medical Research): Registration Number - CTRI/2017/08/009328.

Prevalence of poor sleep quality in the Ethiopian population: a systematic review and meta-analysis.

BACKGROUND: Only a limited amount of data is available from lower-income countries regarding the prevalence of poor quality of sleep. This meta-analysis of the scientific literature was performed to estimate the pooled prevalence of poor sleep quality in the Ethiopian population. METHODS: The study protocol followed was the Preferred Reporting of Items for Systematic Review and meta-analysis (PRISMA) statement. RESULTS: The nine studies which met the inclusion criteria provided data based on a total of 9103 participants who were studied at various health and academic institutions. The incidences of self-reported poor sleep quality ranged from 26 to 66.2%. The pooled estimate of poor sleep quality was 53%.There was a high prevalence of reported poor quality of sleep among younger subjects and among those who were studied in community (noninstitutional) settings. CONCLUSION: The pooled prevalence of poor sleep quality is quite high among Ethiopians.

Psychometric Analysis Of The Sleep Hygiene Index And Correlation With Stress And Anxiety Among Saudi University Students.

AIMS: This study aimed to assess the psychometric properties of the Sleep Hygiene Index (SHI) instrument in screening poor sleep hygiene practices among Saudi university students. As a secondary goal, the association of sleep hygiene practices with stress and anxiety scores were assessed. METHODS: Two-hundred and four healthy college and university students aged 18 to 25 years participated in this cross-sectional questionnaire-based survey. Participants were asked to complete the English version of the SHI instrument, the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder (GAD-7) scale, and to provide demographic details. RESULTS: The average scores for the SHI, the GAD-7, and the PSS-10 were 6.6, 5.3, and 16.2, respectively. The internal consistency of the SHI was adequate (McDonald's Omega 0.76). The corrected item-total correlations for all the items were fair (range, 0.31-0.50). A statistically significant positive correlation/association of the SHI scores with the PSS score, GAD-7, and self-reported poor sleep were obtained in this sample of Saudi university students. Factor analysis favored a 4-factor model of the SHI in the study sample. CONCLUSION: The SHI scale demonstrated an adequate level of internal consistency as a self-reported instrument in the assessment of sleep hygiene among Saudi university students. In addition, poor sleep hygiene was correlated with stress and anxiety scores.

Comparison of two mobilization techniques in management of chronic non-specific low back pain.

AIM: The aim of the study was to compare between the effects of Maitland's postero-anterior (PA glide) mobilization and Mulligan's sustained natural apophyseal glide (SNAG) on pain, mobility, muscle activation and functional disability in subjects with chronic, non-specific low back pain. METHODS: The study was a two arm repeated measure design with random allocation of subjects (n = 33). Subjects in group 1 received Maitland's PA glide mobilization and those in group 2 received Mulligan's SNAG. Along with the respective mobilization technique, individualized exercises were common for subjects in both the groups. Subjects in both groups received treatment for 4 days a week for 4 weeks. The outcome measures were numeric pain rating scale (NPRS) scores, lumbar flexion and extension range of motion, erector spinae muscle activity and Oswestry low back pain disability questionnaire score. RESULTS: The outcome measure scores showed statistical significance in time effect on NPRS (p = 0.001); lumbar flexion and extension range of motion (p = 0.001); erector spinae muscle activity (0.001); Oswestry low back pain disability questionnaire score (p = 0.001); group effect on lumbar flexion (p = 0.03) and extension range of motion (p = 0.05); and interaction effect (time x group) on lumbar flexion (p = 0.003) and extension range of motion (p = 0.002); and, erector spinae muscle activity (p = 0.05) at the 3rd lumbar vertebral level. CONCLUSION: The addition of Maitland or Mulligan mobilization techniques of the spine does not show a difference in the improvement of symptoms associated with chronic non-specific low back pain.

Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy.

PURPOSE: The aim of the study was to evaluate the effect of sensorimotor training on balance measures, and proprioception, among middle-aged and older adults with diabetic peripheral neuropathy (DPN). METHODS: A randomized controlled study with four parallel arms (two intervention groups and two control groups) was conducted at CPRS, Jamia Millia Islamia. Thirty-seven individuals were selected on the basis of inclusion and exclusion criteria. Of these, 16 middle-aged and 21 older adults were randomly allocated to intervention and control groups, respectively. Subjects in the intervention group were administered eight weeks (3days/week) of sensorimotor training, involving 10 different types of exercises, progressed from easy to hard every two weeks, along with diabetes and foot care education; subjects in control group received diabetes and foot care education only. Outcomes measures involved static and dynamic balance measures, centre of pressure (COP) range, COP sway, and proprioception, measured before and after eight weeks. RESULTS: Baseline measures showed significant age effect for timed up and go test (TUG) (p =  0.002), one leg stance (OLS) in eyes open (EO) and eyes closed (EC) (p ≤ 0.041), COP range in front (p =  0.007), back (p =  0.009) and right direction (p =  0.013), COP sway with visual feedback in front-back direction (p =  0.027), COP sway without visual feedback in left-right direction (p =  0.028), and proprioception in right direction (p =  0.026). After intervention, OLS EO and EC on both legs showed significant time effect (p ≤  0.003), group effect as well as time×group interaction (p <  0.05), and age effect and time×age interaction (p ≤  0.04). Functional reach test, TUG, COP range, COP sway, and proprioception were found with significant time effect (p <  0.03), group effect, and time×group interaction (p ≤  0.035). Age effect and time×age interaction were found to be non-significant for all COP ranges and COP sway. CONCLUSION: Sensorimotor training improved static and dynamic balance as well as proprioception measures after eight weeks of exercise intervention. Static balance showed greater improvement in the middle-aged than older aged adults, while dynamic balance and proprioception showed similar results for both.

Scapular muscles strengthening on pain, functional outcome and muscle activity in chronic lateral epicondylalgia.

AIM: The aim of the study was to investigate the effect of lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) strengthening on pain, pain free grip strength, functional outcome, scapular muscles strength, scapular position and electromyographic (EMG) activity of lower trapezius, serratus anterior, extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) in individuals with chronic lateral epicondylalgia (LE). METHODS: Twenty six patients with chronic lateral epicondylalgia were recruited. Subjects were divided into two groups. Group 1 received scapular muscles strengthening along with conventional physiotherapy and Group 2 received only conventional physiotherapy for 6 weeks. Subjects were measured for pain (VAS), pain free grip strength, functional outcome (PRTEE), scapular muscle strength, scapular positioning (LSST) and EMG activity before and after the intervention.2 × 2 mixed ANOVA was used to investigate for main effect of time and group and interaction effect (time × group). RESULTS: The results revealed that there was statistically significant difference for time effect for all the outcome measures. In time × group interaction there was significant difference for all the outcome measures except scapular position (LSST3). Significant difference for group effect was observed in EMG activity of LT and ECRB. CONCLUSION: The scapular muscle strengthening should be used along with the conventional physiotherapy in individuals with chronic LE to improve pain, pain free grip strength, functional outcome, muscle strength, scapular position and muscle activity.

Reliability and validity of transfer assessment instrument version 3.0 in individuals with acute spinal cord injury in early rehabilitation phase.

BACKGROUND: Transfers are very important in functional activities of subjects with spinal cord injury (SCI). The transfer assessment instrument (TAI) was the first tool to standardize the assessment of transfer technique. OBJECTIVE: The purpose of this study was to establish the reliability and validity of TAI 3.0 in people with SCI in early rehabilitation phase. METHODS: Thirty subjects with acute traumatic SCI were recruited from a tertiary care center for SCI management. Four raters assessed the quality of transfer using TAI 3.0 and a fifth rater used global assessment of transfer scale (VAS). TAI 3.0's intraclass correlation coefficient (ICC) for intrarater and interrater reliability, standard error of measurement (SEM), minimal detectable change (MDC), limits of agreement and concurrent validity was determined. RESULTS: The intrarater ICC was 0.93 to 0.98 and interrater ICC was 0.99, indicating high levels of reliability. The SEMs among the raters for TAI 3.0 total was from 0.23 to 0.28. The MDC among the raters TAI 3.0 total was from 0.54 to 0.86. Correlation for different raters between the TAI 3.0 and VAS ranged between 0.88 and 0.90. CONCLUSION: TAI 3.0 is a reliable and valid tool to assess the transfer skill in individuals with SCI in early rehabilitation phase.

Activities-specific balance confidence scale for predicting future falls in Indian older adults.

BACKGROUND: Activities-specific balance confidence (ABC) scale is a subjective measure of confidence in performing various ambulatory activities without falling or experiencing a sense of unsteadiness. OBJECTIVE: This study aimed to examine the ability of the Hindi version of the ABC scale (ABC-H scale) to discriminate between fallers and non-fallers and to examine its predictive validity for prospective falls. DESIGN: This was a prospective cohort study. MATERIALS AND METHODS: A total of 125 community-dwelling older adults (88 were men) completed the ABC-H scale. The occurrence of falls over the follow-up period of 12 months was recorded. Discriminative validity was analyzed by comparing the total ABC-H scale scores between the faller and non-faller groups. A receiver operating characteristic curve analysis and a logistic regression analysis were used to examine the predictive accuracy of the ABC-H scale. RESULTS: The mean ABC-H scale score of the faller group was significantly lower than that of the non-faller group (52.6±8.1 vs 73.1±12.2; P<0.001). The optimal cutoff value for distinguishing faller and non-faller adults was ≤58.13. The sensitivity, specificity, area under the curve, and positive and negative likelihood ratios of the cutoff score were 86.3%, 87.3%, 0.91 (P<0.001), 6.84, and 0.16, respectively. The percentage test accuracy and false-positive and false-negative rates were 86.87%, 12.2%, and 13.6%, respectively. A dichotomized total ABC-H scale score of ≤58.13% (adjusted odds ratio =0.032, 95% confidence interval =0.004-0.25, P=0.001) was significantly related with future falls. CONCLUSION: The ABC-H scores were significantly and independently related with future falls in the community-dwelling Indian older adults. The ability of the ABC-H scale to predict future falls was adequate with high sensitivity and specificity values.

Evaluation of psychometric properties of Tinetti performance-oriented mobility assessment scale in subjects with knee osteoarthritis.

OBJECTIVE: The objective of this study was to determine the psychometric properties of the Tinetti Performance-Oriented Mobility Assessment (POMA) scale to measure balance and gait impairments in individuals with knee osteoarthritis (OA). METHODS: A convenient sample of 25 individuals with bilateral OA knee were recruited. The convergent validity was determined by correlation analysis between scores of Berg Balance Scale (BBS) with balance subscale (POMA-B) and the Timed Up and Go Test (TUGT) with gait subscale (POMA-G). The intrarater reliability [intraclass correlation coefficient (ICC 3,1)], the Bland-Altman plots limits of agreement (LOA), the standard error of measurement (SEM), minimum detectable change (MDC) and ceiling/floor effects were determined. RESULTS: Score of BBS was significantly correlated with POMA-B scores, rs = 0.63, p = 0.001, whereas TUGT showed a negative correlation with POMA-G, rs = -0.481, p = 0.020, showing moderate convergent validity. ICC results of the total POMA scale (POMA-T), POMA-B, and POMA-G were 0.96, 0.93, and 0.96, respectively, indicating high test retest reliability. SEM, for POMA-T, POMA-B, and POMA-G was 0.35, 0.27, and 0.35, respectively; MDC values were 0.97 for POMA-T, 0.75 for POMA-B, and 0.63 for POMA-G. CONCLUSION: The findings indicate that the POMA is a valid and reliable tool to assess balance and gait impairments in people with OA knee.

Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia.

Objective: To determine whether there is any difference between virtual reality game-based balance training and real-world task-specific balance training in improving sitting balance and functional performance in individuals with paraplegia. Methods: The study was a pre test-post test experimental design. There were 30 participants (28 males, 2 females) with traumatic spinal cord injury randomly assigned to 2 groups (group A and B). The levels of spinal injury of the participants were between T6 and T12. The virtual reality game-based balance training and real-world task-specific balance training were used as interventions in groups A and B, respectively. The total duration of the intervention was 4 weeks, with a frequency of 5 times a week; each training session lasted 45 minutes. The outcome measures were modified Functional Reach Test (mFRT), t-shirt test, and the self-care component of the Spinal Cord Independence Measure-III (SCIM-III). Results: There was a significant difference for time (p = .001) and Time × Group effect (p = .001) in mFRT scores, group effect (p = .05) in t-shirt test scores, and time effect (p = .001) in the self-care component of SCIM-III. Conclusions: Virtual reality game-based training is better in improving balance and functional performance in individuals with paraplegia than real-world task-specific balance training.

Polysomnographic correlates of inflammatory complement components in young healthy males.

A growing body of evidence has delineated the predominant role of humoral mediators of inflammation in linking sleep with immunity. Nonetheless, characterization of the relationship between complement components with inflammatory functions and objective sleep measures has not been performed. In this study we investigated the relationships between objective measures of sleep and complement components with inflammatory functions. Thirty-six healthy male university students (age, 23.94±4.23 years; BMI, 23.44±2.67 kg/m(2)) completed the study. An RMS Quest 32 polysomnograph (PSG) was used for sleep recording. Non-fasting blood was collected before subjects went to bed on the second night in the sleep laboratory to estimate complement component 3 (C-3), complement component 4 (C-4), complement factor-H (Factor-H), C1-inhibitor (C1INH), complement factor I (CFI) and other inflammatory mediators, such as IL-6 and sICAM-1. Multiple linear regression analysis was used to assess the association between PSG sleep measures and inflammatory mediators. Higher values of C-3 and lower values of sICAM-1, C1INH, and CFI (adjusted model, R2=0.211, p<0.041) predicted longer sleep duration. Lower C-3 (adjusted model, R2=0.078, p<0.055) predicted higher N1 (%). Higher levels of C1INH and CFI and lower values of C-4 (model adjusted R2=0.269, p<0.008) predicted higher N3 (%). Higher C-3, higher C-4, lower IL-6, lower C1INH and lower CFI (model adjusted R2=0.296, p<0.007) predicted higher REM (%). Poor sleep measures were associated with increased levels of pro-inflammatory complement components and decreased anti-inflammatory complement components.