Contribution of static and dynamic balance skills to activities of daily living in children with intellectual disabilities.

BACKGROUND: Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non-syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self-care, mobility, and social function). METHODS: The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills. RESULTS: Significant positive correlations were found between the one-leg standing and PEDI (r = .841 for self-care, r = .700 for mobility, and r = .760 for social function). Our analysis showed that static balance skills affected self-care, dynamic balance skills affected mobility, and intelligence quotient affected social function. CONCLUSIONS: Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL.

Quiet standing and anteroposterior limits of stability in adolescents and young adults with bilateral spastic cerebral palsy.

Stance stability in individuals with bilateral spastic cerebral palsy (BSCP) in various standing postures including the quiet standing (QS) and limits of stability (LoS) has been widely studied. However, the relationships between the QS and LoS remain unclear. This study aimed to determine the relationships between the positions and postural sway in the QS and anteroposterior LoS in individuals with BSCP. It included 27 adolescents and young adults with BSCP (BSCP group) and 27 adolescents and young adults without disability (control group). The position of center of pressure in the anteroposterior direction (CoPy position) and the path length of center of pressure (CoP path length) during the QS and the anterior and posterior LoS (A-LoS and P-LoS, respectively) were measured using a force platform. The CoPy positions in the A-LoS and P-LoS in the BSCP group were limited compared with those in the control group. In the BSCP group, the more anterior the CoPy position in the QS, the more anterior (i.e., limited) it was in the P-LoS. Although the CoP path length in the QS was larger in the BSCP group, those in the A-LoS and P-LoS were larger in the control group. The BSCP group also showed that the more anterior the CoPy position or the longer the CoP path length in the QS, the more decreased the anteroposterior LoS range was. Therefore, assessing various standing postures, including QS and anteroposterior LoS, is important to manage balance impairments in individuals with BSCP.

Effect of controlled start position on the reach distance distribution range in the functional reach test among community-dwelling older adults.

[Purpose] This study investigated the effect of controlled start position (CSP) on the reach distance distribution range (RDDR) in the functional reach test (FRT) in community-dwelling older adults. [Participants and Methods] The participants were 34 community-dwelling older adults. We compared the RDDR in CSP and non-CSP and analyzed the relationship between the mean reach distance (MRD) and the length of movement of the center of pressure (LMCOP). [Results] The RDDR in CSP condition was significantly lower than non-CSP condition. A significant positive correlation was observed only for CSP condition. In the non-CSP condition, MRD was not reflected in the LMCOP. [Conclusion] The FRT in the CSP effectively reflects the standing balance ability of community-dwelling older adults.

Application of new waveform analysis methods reflecting F-wave diversity -classification of F-wave diversity according to differences in the derived muscles.

Background: The F wave waveforms show diversity according to the number and size of re-firing cells, but there is still no analytical method that reflects this feature. We previously reported that five classifications of F waves are obtained from the ulnar nerve. However, the diversity of F waves derived from the lower extremities may not be similar. We therefore compared the diversity of F waves in the upper and lower extremities in healthy subjects. New method: F waves were measured during tibial nerve stimulation in 26 healthy subjects. The amount of amplitude decrease was calculated from the amplitude value after the additive averaging process and based on the average amplitude value of each stimulus, and the relationship between the peak latency and density was examined. Results: The amount of amplitude decrease due to the additive averaging process was negatively correlated with the density of negative peaks. The diversity of F waves could be categorized into four class based on the histograms. Comparison with existing method: The new method uses a novel additive average method that reflects the diversity of F waves. Furthermore, it uses a histogram to visualize the cancellation between waveforms. Conclusion: We developed an analysis method that reflects the diversity of F waves in a novel manner, which visualizes cancellation between waveforms using a histogram.

The Kuchi-kara Taberu index as a predictive marker of oral intake recovery in patients with aspiration pneumonia.

AIM: In recent years, the Kuchi-kara Taberu (KT) index has been used as a new tool for the evaluation of dysphagia; however, its predictive ability remains unknown. This study was conducted to examine the validity of oral intake recovery prediction using the KT index in patients with aspiration pneumonia. METHODS: The subjects were older inpatients admitted to an acute-care hospital for the treatment of aspiration pneumonia. A logistic regression analysis was conducted to clarify factors significantly associated with oral intake recovery. In addition, cut-off values of the predictors were calculated using a receiver operating characteristic curve analysis with the area under the curve (P < 0.05). RESULTS: A total of 124 patients (mean age 84.3 ± 7.9 years old, 70 males, 54 females) were enrolled in this study and divided into two groups at discharge: the oral intake group (62.1%) and the non-oral intake group (37.9%). The significant predictors of the recovery of oral intake were the pre-treatment period, treatment period, and the total score of the KT index; the respective odds ratios were 1.082 (95% confidence interval [CI] 1.013-1.156), 1.018 (1.003-1.033) and 0.850 (0.780-0.927), and the respective areas under the curve were 0.407 (95% CI 0.300-0.515), 0.304 (0.208-0.399), and 0.732 (0.640-0.824). The cut-off value of the total score of the KT index was 30. The model showed 85.7% sensitivity and 57.4% specificity. CONCLUSION: The KT index is suggested to be a valid variable for predicting whether or not a patient with aspiration pneumonia can recover their oral intake ability during acute-care hospitalization. Geriatr Gerontol Int 2023; 23: 221-226.

Exploring the factors associated with decreased dynamic balance ability in older patients with heart failure.

BACKGROUND: Older patients with heart failure (HF) have a higher prevalence of frailty and poorer dynamic balance ability than other community-dwelling older adults. However, the association of frailty and other clinical characteristics with dynamic balance ability in these patients remains unclear. OBJECTIVES: We aimed to determine the clinical characteristics associated with decreased dynamic balance ability in older patients with HF. METHODS: This observational study included patients aged ≥65 years who could walk independently and were admitted to our university hospitals to undergo a cardiac rehabilitation. The timed up and go test (TUG) was used to evaluate dynamic balance ability. Pearson's and Spearman's correlation analyses were performed to determine the relationships between TUG scores and clinical characteristics. A multiple regression model based on the forced entry method was used to determine independent predictors of TUG scores. RESULTS: Of the 183 participants in this study (94 women; mean age, 82.5 ± 8.1 years), 116 (61.7%) had frailty. Pearson's and Spearman's correlation analyses revealed that age, frailty, sex, knee extensor muscle strength, maximum calf circumference, and Mini-Mental State Examination-Japanese version (MMSE-J) score were significantly correlated with TUG score (p < 0.001). Further, multiple regression analysis showed that age (p < 0.001), frailty (p = 0.041), knee extensor muscle strength (p = 0.002), and MMSE-J score (p = 0.048) were independent predictors of TUG scores. CONCLUSION: Multiple factors, including age, frailty, knee extensor muscle weakness, and cognitive function impairment are independently associated with decreased dynamic balance ability in older patients with HF.

Effect of a controlled starting position on the relationship between the forward reach distance and movement distance of the center of pressure in the functional reach test using the ankle joint strategy.

[Purpose] This study aimed to clarify whether the distribution range of the forward reach distance and the relationship between the forward reach distance and the movement distance of the center of pressure differed depending on whether the controlled starting standing position during the functional reach test with an ankle joint strategy. [Participants and Methods] Sixteen healthy male volunteers participated in the study. The distribution range of the forward reach distance and the relationship between the forward reach distance and movement distance of the center of pressure in the controlled starting standing position and non-controlled starting standing position conditions were analyzed. [Results] The distribution range of the forward reach distance was significantly smaller in the controlled starting standing position than in the non-controlled starting standing position. In both groups, the forward reach distance was associated with the movement distance of the center of pressure. [Conclusion] The findings suggested that the use of an ankle joint strategy with a controlled starting standing position in the functional reach test may be a more accurate method to evaluate standing balance ability.

The effects of the pressure on the coccygeal skin on the perception of backward-leaning sitting positions in stroke patients.

The present study investigated the effects of an additional pressure stimulus on coccygeal skin using an original tool to evaluate the perceptibility of sitting while leaning backward in 13 chronic stroke patients who were able to walk independently and 12 age-matched healthy subjects. Each participant's perception of the trunk reference angle at which they felt the highest-pressure stimulation of the coccygeal skin while leaning backward from a quiet sitting position was evaluated based on the accuracy of each reproduction under both normal and additional pressure conditions. The absolute error under the pressure condition was significantly smaller than that under the normal condition in the control group, while no marked difference between conditions was found in the stroke group. The relationship between the absolute error under the normal condition and the pressure effect index showed a significant negative correlation in the stroke group. In stroke patients with a high trunk position perceptibility under the normal condition, the additional pressure information may have functioned as a disturbance and reduced the position perceptibility. In contrast, stroke patients with a low perceptibility in the normal condition may have been able to re-weight and prioritize the additional pressure information in the reference frame. In the control group, the added pressure information may have been re-weighted as prior position information in the reference frame.

A new waveform analysis method reflecting the diversity of F-wave Waveforms-Waveform types in healthy subjects based on the combined use of the additive averaging method and histograms.

BACKGROUND: F-waves, which are an indicator of the excitability of spinal cord anterior horn cells, are characterized by diverse waveforms. However, no analytical method has yet been development that fully reflects the diversity of such waveforms. The present study examined whether or not the change in the amplitude by the additive averaging process reflects the dispersion of the peak. NEW METHOD: The average amplitude of each waveform and the decrease in the amplitude after the additive averaging process were determined. The correlation between the decrease in the amplitude and the density of the peak was then examined. The histogram was also used to classify the type of waveform dispersion based on the characteristics of the peak latency. RESULTS: No correlation was found between the change in the amplitude and the peak density. However, the F-waves obtained from the ulnar nerve of healthy subjects were able to be classified into five types. COMPARISON WITH EXISTING METHOD: The parameters of an F-wave analysis are the rise latency, the amplitude and the persistence, and many reports have examined F-waves based on the changes in these values. The present study explored new parameters focusing on the waveform of F-waves reflecting the motor unit. CONCLUSION: The results of this study may help to establish a standard of comparison when using the F wave to evaluate spasticity due to upper motor neuron disorders.

Effect of performing daily activities while standing on the quantity and quality of the thigh muscles in adults with severe cerebral palsy: a cross-sectional study.

[Purpose] To observe the effect of daily standing, as indicated by gross motor function, on the quantity and quality of the thigh muscles in adults with severe cerebral palsy and to obtain data to determine an appropriate intervention that will improve their quality of life. [Participants and Methods] Thirty-three adults with severe cerebral palsy participated in the study. We assessed the gross motor function using the GMFM-66-IS. We then evaluated the quadriceps muscle thickness and the rectus femoris muscle echo intensity using ultrasonography. We divided the participants into the standing and non-standing groups and then examined the correlations of the GMFM-66-IS score to muscle thickness and echo intensity. We calculated the difference in mean muscle thickness and echo intensity between the two groups using an independent t-test. [Results] Significant positive correlations were found between the GMFM-66-IS score and muscle thickness and echo intensity. In the group-specific analysis, no significant correlation was found between echo intensity and the GMFM-66-IS score in either group. Muscle thickness and echo intensity were greater in the participants of the standing group. [Conclusion] Daily standing, as indicated by gross motor function, affected muscle thickness and echo intensity. Quantitative and qualitative data might need to be evaluated when assessing the muscles of adults with severe cerebral palsy using ultrasonography.

The role of the pressure information from the heel on the perception of the backward-leaning standing position.

The purpose of this study was to clarify the functional role of the heel pressure information for perceiving a backward-leaning position through a decrease in sensory information using local cooling on the heel in healthy participants (n = 11). The position of the center of pressure in the anteroposterior direction (CoPy position) while standing was represented as the percentage distance (%FL) from the hindmost point of the heel (0 %FL) in relation to the foot length. The most backward-leaning position was measured under cool-heel condition and normal-heel condition. The perceptibility of six reference positions (45 %FL, 40 %FL, 35 %FL, 30 %FL, 25 %FL, and 20 %FL) was evaluated with regard to the reproducibility of these positions under both heel conditions. The most backward-leaning position under cool-heel condition was located significantly further backward than that under normal-heel condition. The absolute error at 25 %FL under cool-heel condition was significantly larger than that under normal-heel condition. The sensory information from the heels may have a decisive meaning in the perception of the most backward-leaning position. At 25 %FL, there may be no other sources of sensory information for sensory reweighting aside from the heel pressure for position perception under cooled condition.

Measurement of the cross-sectional area of the hamstring muscles during initial and stretch positions with gravity magnetic resonance imaging.

[Purpose] We aimed to investigate the change rate in the cross-sectional area of each hamstring component to evaluate muscle extensibility and to contribute to the studies on hamstring strain prevention. [Participants and Methods] Fifteen healthy young males volunteered to participate in this study. They performed a knee extension test. For the measurements, we used multi-posture magnetic resonance imaging (gravity magnetic resonance imaging), the open shape of which allows performing body scanning in various positions. We measured the maximum cross-sectional area of the hamstring during the initial and stretch positions from the obtained images. Then, for each muscle, we calculated the maximum cross-sectional area change rate relative to the initial position. [Results] For all hamstring muscles, the maximum cross-sectional area during stretching was significantly smaller than that in the initial position. The maximum cross-sectional area change rate of the semimembranosus was significantly smaller than that of the other 3 muscles (there were no significant differences among these 3 muscles). [Conclusion] The results suggest that the semimembranosus has higher resistance to morphological change than the other muscles, which could be an important limiting factor for the extensibility of the hamstring muscle group.

Perception of trunk inclination during sitting with feet in contact with the floor.

[Purpose] To clarify the sitting postural control, the influences of several reference sitting positions on the perception of the trunk position while sitting with the feet in contact with the floor and keeping the eyes closed were investigated. [Participants and Methods] Fifteen young healthy volunteers participated in the present study. The perception of the trunk position was evaluated by calculating the absolute error (error magnitude) and constant error (error direction) between the reference trunk position (which the subjects memorized; the reference position) and the position that they adopted when reproducing the reference position (the reproduced position). Eight reference positions were set at 5° increments (from 15° backward inclination [-] to 20° forward inclination [+]). [Results] The reference positions had a significant effect on the absolute error, and the absolute error values at -15° and -10° were significantly smaller than at 20°. However, the reference positions had no effect on the constant error. [Conclusion] The present study revealed that the perception of the trunk position while sitting with the feet in contact with the floor is better when inclining backward than when inclining forward. The perception of the trunk position may be higher in a low-stability position and lower in a high-stability position.

Anteroposterior perception of the trunk position while seated without the feet touching the floor.

[Purpose] The purpose of this study was to investigate the trunk position perception in the anteroposterior direction in young participants sitting without their feet touching the floor to avoid the influence of the hamstrings tension and the feet pressure on the perception. [Subjects and Methods] Fourteen healthy volunteers were seated on a chair fitted with an original manual goniometer. There were 7 reference positions set at 5° increments, from -15° to 15°, and reproductions of each position were conducted 5 times. Trunk position perception was evaluated by the absolute error between the reproduced trunk angle and the reference position angle. [Results] The results revealed a significant effect of reference position on the absolute error. The absolute error at the -5° reference position was significantly larger than at the -15° and 15° positions, and the absolute error at the 0° position was significantly larger than at the -15°, 10°, and 15° positions. [Conclusion] These results suggest that the perception of extreme forward- and backward-leaning trunk positions while sitting without the feet touching the floor would be higher than in a neutral sitting position. The relationship between the stability of the posture and the perception may be involved in the sitting position.

Perception of leaning backward while standing and patellar movement.

[Purpose] The purpose of this study was to investigate the relationship between the patellar movement and the standing backward leaning perceptibility. [Subjects and Methods] Fourteen volunteers who were confirmed presence of upward patellar movement during backward leaning from the quiet standing posture participated in this study. The quiet standing position, the standing backward leaning position at patellar movement onset and standing position perceptibility were measured. The position of the center of pressure in the anteroposterior direction in standing is represented as the percentage distance from the hindmost point of the heel in relation to the foot length (%FL). [Results] The mean value of the center of pressure on anteroposterior direction positions in quiet standing was 43.2%FL. The patellar movement onset position was 35.1%FL. The individual mean value of standard deviations for the onset position was 2.5%FL. The absolute error at the onset position is specifically and significantly small. [Conclusion] For the subjects whose patellas move during backward leaning in this study, the standing position near the onset position was perceived accurately, probably by the substantial change in sensory information associated with the onset of patellar movement while backward leaning.

Patellar movement perception related to a backward-leaning standing position.

[Purpose] To investigate the patellar movement perception related to backward-leaning standing. [Subjects and Methods] Both the patellar range of motion during backward-leaning standing and perception related to patellar movement were analyzed using television-x irradiation images in 12 randomly selected healthy young individuals. [Results] Starting in a relaxed condition, two types of patellar movements were confirmed: those where the patella moves (patellar movement trials) and those where the patella does not move (patellar non-movement trials) during backward-leaning standing. The rate of the perceived patellar motion in the patellar movement trials was significantly higher (90.9%) than that in the patellar non-movement trials (66.7%). When starting in a quadriceps-contracted condition, the rate of perceived trials (77.0%) was significantly lower than that of the trials started in a relaxed condition. [Conclusion] The perception of patellar movement while backward-leaning standing may contribute to the perception of a backward standing position especially when the patella really moves.

Walking gait changes after stepping-in-place training using a foot lifting device in chronic stroke patients.

[Purpose] The goal of this study was to investigate the efficacy of stepping-in-place training using a foot lifting assist device on the walking gait of chronic hemiparetic stroke patients. [Subjects] Seven patients with chronic hemiplegic stroke (age 80.9±4.9 years) who were attending a local adult daycare facility participated in this study. [Methods] The participants had 2 or 16 weeks of intervention after a baseline period of 2 weeks. Evaluations were performed before the baseline period and before and after the intervention period. The evaluation consisted of a two-dimensional motion analysis of walking and stepping-in-place exercises and a clinical evaluation. [Results] Walking speed increased in three participants after 2 or 16 weeks of intervention. The swing phase percentage increased in the paretic gait cycle, and the time from non-paretic heel contact to paretic heel off decreased during stepping-in-place in these participants. [Conclusion] Given that the transition from the support phase support to the swing phase was shortened after the intervention, the stepping-in-place exercise using the device designed for this study may improve the muscle strength of the lower limb and coordination in the pre-swing phase of the paretic limb.

Relationship between the ability to perform the sit-to-stand movement and the maximum pelvic anteversion and retroversion angles in patients with stroke.

[Purpose] The purpose of this study was to investigate the relationship between the ability to perform the sit-to-stand movement and the maximum pelvic anteversion and retroversion angles of patients. [Subjects] Thirty-two stroke patients (66.7±7.6 years) (>3 months post-stroke) who were able to sit unsupported and 50 age-matched healthy subjects participated in this study. The stroke patients were classified into two groups according to the sit-to-stand movement test: the group that was able to stand up (the stand-able group) (18 persons) and the group that was unable to stand up (the stand-unable group) (14 persons). [Methods] Pelvic anteversion and retroversion maximum angles were measured by a manual goniometer attached to an inclinometer. [Results] The maximum pelvic anteversion angles were -1.6 ± 5.0°, 1.2 ± 2.8°, and -12.4 ± 6.1° in the control group, the stand-able stroke group, and the stand-unable stroke group, respectively. A significant main effect of group was found. An angle discriminating between the two stroke groups was found: the maximum anteversion angles in the stand-able group were distributed above -5°. [Conclusion] The maximum pelvic anteversion angle was significantly smaller in the stand-unable group than in the stand-able and control groups.

Age-related Changes in Maximum Pelvic Anteversion and Retroversion Angles Measured in the Sitting Position.

[Purpose] The purpose of this study was to investigate the relationship between age and the maximum pelvic anteversion and retroversion angles, as well as the associated pelvic range of motion, measured in a sitting position with free knee movement. [Subjects] A total of 132 healthy volunteers (74 women, 58 men; age range, 20-79 years) were divided into six groups based on age (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years). [Methods] The maximum pelvic anteversion and retroversion angles were measured manually five times by a goniometer in a sitting position that allowed free movement of the knee joints. [Results] There was a significant effect of age group on the maximum pelvic anteversion and retroversion angles and pelvic range of motion (the difference between these angles). There was a significant correlation between age and the maximum pelvic anteversion angle, maximum pelvic retroversion angle, and pelvic range of motion. [Conclusion] The maximum pelvic anteversion and retroversion angles and pelvic range of motion were significantly correlated with age. The maximum pelvic anteversion angle and pelvic range of motion were most affected by age.

Effects of regular heel-raise training aimed at the soleus muscle on dynamic balance associated with arm movement in elderly women.

The effects of low-intensity muscle training with heel-raises on dynamic balance associated with bilateral arm flexion were investigated in postmenopausal elderly women. Twenty-six elderly women were evenly grouped into training and control groups. Training group subjects performed 100 heel raises per day for 2 months. The training was aimed at hypertrophy of the soleus muscle, which has a relatively high proportion (ca. 90%) of slow-twitch muscle fibers and is one of the main postural muscles. Dynamic balance was measured while arm flexion was performed in response to a visual stimulus (simple-reaction condition) or at the subjects' own pace (own-timing condition). The following parameters were compared before and after the training period: plantar flexion strength, thicknesses of the gastrocnemius and soleus (by ultrasound), reaction time of the anterior deltoid in the simple-reaction condition, activation onset timing of postural muscles with respect to the deltoid, movement angles of ankle and hip joints, and postural fluctuation. In the training group only, the following training-related effects were demonstrated: (a) increase in plantar flexor strength and thickness of the soleus, (b) shortening of the deltoid reaction time, (c) earlier activation of the erector spinae in the simple-reaction condition and the soleus in the own-timing condition, and (d) increase in ankle movement in the own-timing condition and a decrease in postural fluctuation. This heel-raise training in the elderly can increase soleus thickness within the triceps surae and improve postural control modality and stability that are effectively contributed to by the leg muscle. This training consists of a low-intensity exercise that requires neither special machines nor a specific environment and can be performed safely for all old-aged groups.