The Effects of Chiropractic Spinal Adjustment on EEG in Adults with Alzheimer's and Parkinson's Disease: A Pilot Randomised Cross-over Trial.

OBJECTIVES: In this study, we explored the effects of chiropractic spinal adjustments on resting-state electroencephalography (EEG) recordings and early somatosensory evoked potentials (SEPs) in Alzheimer's and Parkinson's disease. METHODS: In this randomized cross-over study, 14 adults with Alzheimer's disease (average age 67 ± 6 years, 2 females:12 males) and 14 adults with Parkinson's disease (average age 62 ± 11 years, 1 female:13 males) participated. The participants underwent chiropractic spinal adjustments and a control (sham) intervention in a randomized order, with a minimum of one week between each intervention. EEG was recorded before and after each intervention, both during rest and stimulation of the right median nerve. The power-spectra was calculated for resting-state EEG, and the amplitude of the N30 peak was assessed for the SEPs. The source localization was performed on the power-spectra of resting-state EEG and the N30 SEP peak. RESULTS: Chiropractic spinal adjustment significantly reduced the N30 peak in individuals with Alzheimer's by 15% (p = 0.027). While other outcomes did not reach significance, resting-state EEG showed an increase in absolute power in all frequency bands after chiropractic spinal adjustments in individuals with Alzheimer's and Parkinson's disease. The findings revealed a notable enhancement in connectivity within the Default Mode Network (DMN) at the alpha, beta, and theta frequency bands among individuals undergoing chiropractic adjustments. CONCLUSIONS: We found that it is feasible to record EEG/SEP in individuals with Alzheimer's and Parkinson's disease. Additionally, a single session of chiropractic spinal adjustment reduced the somatosensory evoked N30 potential and enhancement in connectivity within the DMN at the alpha, beta, and theta frequency bands in individuals with Alzheimer's disease. Future studies may require a larger sample size to estimate the effects of chiropractic spinal adjustment on brain activity. Given the preliminary nature of our findings, caution is warranted when considering the clinical implications. CLINICAL TRIAL REGISTRATION: The study was registered by the Australian New Zealand Clinical Trials Registry (registration number ACTRN12618001217291 and 12618001218280).

Comparison of classic constraint-induced movement therapy and its modified form on upper extremity motor functions and psychosocial impact in hemiplegic cerebral palsy.

A prospective randomised control trial (RCT) was conducted in National Institute of Rehabilitation Medicine (NIRM), Islamabad, on 40 children with hemiplegic cerebral palsy (HCP). Children between the ages of four and12 years with ipsilateral, bilateral or severely asymmetrical impairments who had wrist extension (20°) and fingers flexion (10°) were included. The outcomes tools, Box and Block Test, Quality of Upper Extremity Skill Test, CP (Quality of Life) and Kid screen were used at baseline, mid- and post- treatment assessment. Both the treatment approaches (CCIMT AND MCIMT) equally improved upper limb motor functions and psychosocial life of the children with HCP. On Quest tool, results of dissociated movement were significant (p=0.021) and on CPQOL tool two domains (participation & physical health and family health) showed significant difference (p=0.042, p=0.025). But no significant difference was noted regarding other domains of the tools. The study concluded that both the treatment approaches (CCIMT AND MCIMT) are effective in enhancing the upper limb motor functions and psychosocial life of children with HCP.

Effects of aerobic exercise and progressive muscle relaxation on migraine.

OBJECTIVE: To determine the effect of aerobic exercises and progressive muscle relaxation in migraine patients. METHODS: The quasi-experimental study was conducted at the Sheikh Khalifa Bin Zayed Al Nayhan Hospital / Combined Military Hospital, Muzaffarabad, Azad Jammu and Kashmir, from February to July 2017, and comprised migraine patients of either gender aged 20-50 years. They were divided into experimental and control group. Experimental group A received supervised exercises protocol, including aerobic exercise (stationary bicycle) 30min with 10min warm-up and 5min cool-down followed by progressive muscle relaxation for 15min 3 times a week for 6 weeks along with prophylactic medicine. The control group received prophylactic medicines flunarazine 5mg twice daily, inderal 10mg thrice daily and nortriptyline 25mg at night. Patients were assessed using Numeric Pain Rating Scale, Migraine Disability Assessment Scale, Headache Disability Index, Headache Impact test-6 and the Central Sensitisation Inventory at baseline, midline and at the completion of intervention. Data was analysed using SPSS 21. RESULTS: Of the 28 patients, there were 14(50%) in each of the two groups. Overall, there were 24(85.7%) females and 4(14.3%) males with a mean age of 29.7±10 years. There were significant improvements in all parameters in both the groups, but group A had significantly better outcome post-intervention (p<0.05). CONCLUSIONS: Prophylactic medicine, aerobic exercises and progressive muscle relaxation, when used together, were found to be effective means of intervention for migraine.

The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function.

PURPOSE: There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function. METHODS: The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. RESULTS: Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column's central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. CONCLUSION: Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column's central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.

Effects of bilateral arm training on upper extremity function in right and left hemispheric stroke.

OBJECTIVE: This experimental study on 24 stroke patients aimed at evaluating and comparing the effects of bilateral arm training on upper extremity (UE) motor function between right and left hemispheric chronic stroke patients. METHODS: Both groups received the same intervention involving 5 functional tasks for 1 hour, 3 days per week, for a total of 6 weeks. Fugl-Meyer Assessment-Upper Extremity and Wolf-Motor Function Test were applied as outcome measures at baseline and after 6 weeks of training to assess the recovery of function in the affected area. RESULTS: Intra-group analysis showed no significant improvement in the wrist and hand function in the left hemispheric stroke (LHS) (p>0.05), while right hemispheric stroke (RHS) patients did not improve significantly in the coordination/speed domain (p>0.05). Inter-group analysis showed no significant difference between right and left hemispheric stroke patients (p>0.05). CONCLUSIONS: Bilateral arm training showed beneficial effects in improving UE function in both RHS and LHS patients. Distal UE function in LHS and coordination and speed of movement in RHS patients did not show any significant improvement.

The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review.

The current COVID-19 pandemic has necessitated the need to find healthcare solutions that boost or support immunity. There is some evidence that high-velocity, low-amplitude (HVLA) controlled vertebral thrusts have the potential to modulate immune mediators. However, the mechanisms of the link between HVLA controlled vertebral thrusts and neuroimmune function and the associated potential clinical implications are less clear. This review aims to elucidate the underlying mechanisms that can explain the HVLA controlled vertebral thrust--neuroimmune link and discuss what this link implies for clinical practice and future research needs. A search for relevant articles published up until April 2021 was undertaken. Twenty-three published papers were found that explored the impact of HVLA controlled vertebral thrusts on neuroimmune markers, of which eighteen found a significant effect. These basic science studies show that HVLA controlled vertebral thrust influence the levels of immune mediators in the body, including neuropeptides, inflammatory markers, and endocrine markers. This narravtive review discusses the most likely mechanisms for how HVLA controlled vertebral thrusts could impact these immune markers. The mechanisms are most likely due to the known changes in proprioceptive processing that occur within the central nervous system (CNS), in particular within the prefrontal cortex, following HVLA spinal thrusts. The prefrontal cortex is involved in the regulation of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and the immune system. Bi-directional neuro-immune interactions are affected by emotional or pain-related stress. Stress-induced sympathetic nervous system activity also alters vertebral motor control. Therefore, there are biologically plausible direct and indirect mechanisms that link HVLA controlled vertebral thrusts to the immune system, suggesting HVLA controlled vertebral thrusts have the potential to modulate immune function. However, it is not yet known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity. Further research is needed to explore the clinical impact of HVLA controlled vertebral thrusts on immune function.

Decoding Attempted Hand Movements in Stroke Patients Using Surface Electromyography.

Brain- and muscle-triggered exoskeletons have been proposed as a means for motor training after a stroke. With the possibility of performing different movement types with an exoskeleton, it is possible to introduce task variability in training. It is difficult to decode different movement types simultaneously from brain activity, but it may be possible from residual muscle activity that many patients have or quickly regain. This study investigates whether nine different motion classes of the hand and forearm could be decoded from forearm EMG in 15 stroke patients. This study also evaluates the test-retest reliability of a classical, but simple, classifier (linear discriminant analysis) and advanced, but more computationally intensive, classifiers (autoencoders and convolutional neural networks). Moreover, the association between the level of motor impairment and classification accuracy was tested. Three channels of surface EMG were recorded during the following motion classes: Hand Close, Hand Open, Wrist Extension, Wrist Flexion, Supination, Pronation, Lateral Grasp, Pinch Grasp, and Rest. Six repetitions of each motion class were performed on two different days. Hudgins time-domain features were extracted and classified using linear discriminant analysis and autoencoders, and raw EMG was classified with convolutional neural networks. On average, 79 ± 12% and 80 ± 12% (autoencoders) of the movements were correctly classified for days 1 and 2, respectively, with an intraclass correlation coefficient of 0.88. No association was found between the level of motor impairment and classification accuracy (Spearman correlation: 0.24). It was shown that nine motion classes could be decoded from residual EMG, with autoencoders being the best classification approach, and that the results were reliable across days; this may have implications for the development of EMG-controlled exoskeletons for training in the patient's home.

Level of satisfaction regarding physical therapy services in district Poonch, Azad Jammu Kashmir.

OBJECTIVE: To determine the patients' satisfaction level regarding physical therapy services at districtlevel hospitals. METHODS: The cross-sectional study was conducted at tertiary hospitals of Poonch district in Azad Jammu and Kashmir from January to June 2018, and comprised patients of either gender aged 15-70 years receiving physical therapy treatment. A semi-structured questionnaire was used to collect data regarding patients' satisfaction from physiotherapy services.. The demographics were recorded and standardized assessment tools used included Short-Form Patient Satisfaction Questionnaire and Medrisk instrument for measuring patient satisfaction. Data was analysed using SPSS 22. RESULTS: Of the 392 subjects, 209(53%) were males and 183(47%) were females, with an overall mean age of 39.7±12.6 years. The response regarding satisfaction was positive in 376(95.85%) cases and negative in 16(4.15%) cases (p<0.05). CONCLUSION: There was a high level of satisfaction regarding physiotherapy services in the studied area.

Therapeutic effects of aerobic exercise on EEG parameters and higher cognitive functions in mild cognitive impairment patients.

BACKGROUND: Mild cognitive impairment (MCI) is becoming an emerging problem for developing countries where there is an increase in expected age. There is no specific curative therapeutic treatment available for these patients. OBJECTIVE: The objective of this study was to evaluate short and long-term changes in the electroencephalogram (EEG) parameters and cognition of MCI patients with aerobic exercises. METHODS: A randomized controlled trial was conducted on 40 patients which were randomly divided into two groups, 'aerobic exercise treatment group (n = 21)' and 'no-aerobic control group (n = 19)'. Short-term effects of exercise were measured after single session of exercise and long-term effects were measured after an 18 sessions (6 weeks) treatment. The outcomes which were measured were, electroenphelogram paramaters (slowness and complexity of the EEG) and cognitive functions (using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and trail making test (TMT) A and B). RESULTS: After one session of aerobic exercise there were significant improvements in slowness (delta waves; 0.678 ± 0.035 vs 0.791 ± 0.033; p = .015) and complexity (0.601 ± 0.051 vs 0.470 ± 0.042; p = .027) of the EEG in aerobic exercise treated group as compared to no-aerobic exercise group. After six weeks there were significant improvements in slowness (delta waves; 0.581 ± 0.036 vs 0.815 ± 0.025; p = .005) and complexity (0.751 ± 0.045 vs 0.533 ± 0.046; p = .001) of the EEG in the aerobic group as compared to no-aerobic group. Moreover, significant improvements were observed in the MMSE (p = .032), MoCA (p = .036), TMT-A (p = .005), and TMT-B (p = .007) in aerobic exercise group as compared to no-aerobic group. CONCLUSION: Aerobic exercise showed improvement in cognition after short and long-term treatment in MCI subjects and can be used as potential therapeutic candidate.

Frequency of mirror movements and comparison of hand function in spastic cerebral palsy children with and without mirror movements.

OBJECTIVE: To assess the frequency of mirror movements in spastic cerebral palsy children and to compare hand function and functional independence of such children with and without mirror movements. . METHODS: The comparative cross-sectional study was conducted in special education schools of Lahore and Islamabad from August 2017 to January 2018, and comprised children of either gender aged 5-18 years diagnosed with spastic cerebral palsy who were able to make a gross grip. Wood and Teuber criteria for the assessment of mirror movements and Jebsen-Taylor hand function test for hand function assessment were used, while manual ability classification system was used for the assessment of functional independence. Data was analysed using SPSS 21. RESULTS: Of the140 subjects, 113(80.7%) were boys and 27(19.3%) were girls. The overall mean age was 11.17}3.69 years. Of the total, 51(36.4%) subjects had diplegic cerebral palsy, while 50(35.7%) were suffering from mirror movements. There was no difference in the unimanual hand function of children with and without mirror movements (p>0.05). However, children without mirror movements had more functional independence (p<0.001). CONCLUSIONS: Mirror movement was found in one third of the sample, and there was no difference in hand function in children with and without mirror movements.

Effectiveness of resistance interval training versus aerobic interval training on peak oxygen uptake in patients with myocardial infarction.

Cardiac rehabilitation reduces the risk factors and improves the aerobic exercise capacity of patients after they have experienced cardiac events. This study compared the effects of two types of interval training in patients with myocardial infarction (MI). A single-blinded randomised controlled trial was conducted on 26 patients with MI which included 16 males and 10 females. After screening via non-probability convenience sampling, patients were randomised into two groups using toss and trial method. The control group was given aerobic interval training (AIT), consisting intervals of stationary cycling and walking on the treadmill. The experimental group received both AIT as well as resistance interval training comprising exercises of the upper and lower limbs. After 6 weeks, the outcomes of peak oxygen uptake (VO2) and 6-minute walk test distance (6MWT) were measured against the baseline. Non-parametric tests were applied for statistical analysis. In the group comparison, the experimental group showed significant improvement in peak VO2 and 6MWT (p=0.003 and 0.003 respectively), as well as in the quality of life measures. The combination of resistance interval training plus AIT proved more effective in improving cardiac outcomes and aerobic capacity.

Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus - Does Gender Make a Difference? A Randomized Controlled Clinical Trial.

OBJECTIVE: Because of the globally increasing occurrence of diabetes mellitus (DM) in the population, exercise is becoming vitally important for prevention and disease management, along with medical and dietary interventions. This study was designed to test the hypothesis that women with DM would respond similarly to men with DM following supervised structured aerobic exercise training (SSAET) program. METHODS: This randomized, single blind, controlled clinical trial was conducted on 102 patients with T2DM with ranging in age from 40 to 70 years. All the participants were randomly allocated to either an experimental or a control group. The experimental group participated in an SSAET program, routine medication, and dietary plan, while the control group was treated with routine medication and dietary plan, for 25 weeks. Assessments of physical and biochemical variables were carried out at baseline and after 25 weeks' intervention and gender-based response to the SSAET program was analyzed. RESULTS: Both the male and female patients responded to 25 weeks of SSAET, routine medication, and dietary plan equally in the experimental group, whereas in the control group IL-6 and NOS-1 showed slight differences. All male and female patients in the experimental group treated with SSAET, routine medication, and dietary plan showed significant improvement in all variables (P < 0.05), while in the control group, deterioration or no change was noted except in HDL and LDL. CONCLUSION: SSAET is equally effective in both male and female patients with T2DM when compared with a non-exercise control group, but no gender-based difference was found. (Trial ID ISRCTN16466697/ http://orcid.org/0000-0002-6682-9896).

Effect of circuit gait training vs traditional gait training on mobility performance in stroke.

Objective of the study was to determine the effect of circuit gait training versus traditional gait training on mobility performance and quality of life in sub-acute and chronic stroke patients. A randomized control trial was conducted and stroke patients of either gender having 2-4 score on Rankin Modified Scale and able to stand 10 seconds were included in study. A total of 32 individuals were randomly assigned into two groups. They were assigned a 40-50 min/session for 3-4 days/week over length of 06 weeks. Berg Balance Scale (BBS), Fall Efficacy Scale (FES) and Stroke Specific Quality of Life Scale (SS-QOL) tools assessed measures of interest. The sample comprise of 16 males and 14 females with mean age of 52.53±12.76 years. After six weeks, significant improvement was recorded in BBS (p=0.002). Quality of life and fall risk were also significantly improved and reported using FES (p=0.004) and SS-QOL (p=0.004). Circuit gait training improves mobility, balance and enhances quality of life in stroke patients.

Effect of balance training in older adults using Wii fit plus.

The Nintendo Wii-fit plus is a type of Virtual Reality exer-gaming with graphical and auditory response system. A case series was conducted at Shifa Tamer-e-Millat University Islamabad from January-July 2016. Sixteen adults more than 60 years age (07 males and 09 females) were recruited through convenient sampling. The specified Wii fit plus training was provided to all patients and the games included the Soccer heading, Ski slalom, table tilt and yoga. Berg balance test, time up and go and functional reach test were used before and after 06 weeks of treatment (4 days / week). Data was analysed by SPSS V-20. The mean age of the sample was 67.56±7.29 years, with 56% female and 44% males were in sample. There was a statistically significant difference in pre and post Berg Balance Score, time up and go test and functional reach. In this case series Wii-fit plus training was effective in improving dynamic balance and mobility in older adults. This should be explored further in large trials.

The effects of gait training with body weight support (BWS) with no body weight support (no-BWS) in stroke patients.

The purpose of this study was to measure the clinical outcomes for patients with stroke after gait training with body weight support (BWS) and with no body weight support (no-BWS).Experimental group was trained to walk by a BWS system with overhead harness (BWS group), and Control group was trained with full weight bearing walk on their lower extremities. Treatment session comprised of six weeks training. Treatment outcomes were assessed on the basis of Timed 10 Meter Walk Test, Timed Get Up and Go Test and Dynamic Gait Index. There was a significant (P<0.05) difference in BWS and NBWS for Dynamic Gait Index, Timed Get Up and Go Test, Timed 10 Meter Walk Test (Self-Selected Velocity), and Timed 10 Meter Walk Test (Fast-Velocity). Training of gait in stroke patients while a percentage of their body weight supported by a harness, resulted in better walking abilities than the Training of gait while full weight was placed on patient's lower extremities.

Comparison of low level laser therapy and interferential current on post stroke shoulder pain.

The objective of the study was to compare the effects of LASER therapy and Interferential current on post stroke shoulder pain. Diagnosed patients (n=38) of post stroke shoulder pain were randomly divided into two groups i.e., LASER group (LG =20 patients) and Interferential current group (IFCG=18 patients). The variables under study were pain, satisfaction, disability, and function level before and after treatment. Improvement in pain and satisfaction level after LASER therapy was significant (p<0.001). However improvement in functional level was not significant (p> 0.05). The study findings revealed that LASER therapy is more effective than Interferential current in decreasing pain and increasing satisfaction level of stroke patients having shoulder pain.

Effect of aerobic exercises on stuttering.

BACKGROUND AND OBJECTIVE: Stuttering is one of the most common speech disorders in adolescents than adults. Stuttering results in depression, anxiety, behavioral problem, social isolation and communication problems in daily life. Our objective was to determine the effect of Aerobic Exercises (AE) on stuttering. METHODS: A quasi trail was conducted at National Institute of Rehabilitation Medicine (NIRM) from January to June 2015. Thirty patients were selected and placed in three different groups Experimental Group A, (EG = 10 patients, age between 7-14 years), Experimental Group B (EG =10 patients age between 15-28 years) and control group -group C, (CG = 10 patients, age between 7-28 years). Patient who stutter were included in this study and those with any other pathology or comorbidity of speech disorders were excluded. The assessment tool used was Real-Time analysis of speech fluency scale. Participants in all the groups received speech therapy while only the EG - A and B received aerobic exercises (AE) using treadmill and stationary bicycle along with the speech therapy. Pre-interventional and post interventional assessments were analyzed using the SPSS 21 in order to determine the significance of new treatment approach and the effectiveness of physical therapy on speech disorders. RESULTS: All the groups showed significant treatment effects but both the EG groups (Group A, Group B) showed high improvement in the severity level of stuttering as compared to control group C. The results also showed that AE treated group B had significant difference in p-value (p=0.027) as compared to control group (p<0.05) while experimental group A had no significant difference (p > 0.05) between these groups. CONCLUSION: The eclectic approach of aerobic exercises with the traditional speech therapy provides proximal rehabilitation of stuttering.

Effectiveness of Constraint induced movement therapy as compared to bimanual therapy in Upper motor function outcome in child with hemiplegic Cerebral palsy.

OBJECTIVE: This study aims at determining the effectiveness of constraint induced movement therapy as compared to bimanual therapy for improving functional status in children with hemiplegic cerebral palsy. METHODS: This study was a randomized control trial, children (n = 20) with spastic hemiplegic cerebral palsy was randomly allocated to CIMT (constraint induced movement therapy) and BMT (bimanual therapy) group. The children with spastic hemiplegia, age between 1.5 and 12 year and having 10 degrees of wrist extension and 10 degrees of finger extension were included in study. Treatment regime was two hours of daily training six days a week for two weeks. Constraint was applied to CIMT group for six hours. The outcome tool QUEST was used for baseline and post treatment assessment. RESULT: CIMT had superior outcome as compared to BMT in improving functional status (p=0.007). On QUEST tool grasp and dissociated movements results were significant (p=0.005) and (p=0.028) respectively. Weight bearing and protective extension resulted in no significant outcome (p=0.080) and (p=0.149) respectively. Dissociated movements and grasp are significantly improved but there is no difference for weight bearing and protective extension in CIMT treated group as compared to BMT treated group. CONCLUSION: CIMT approach is better in improving functional status of child with cerebral palsy as compared to BMT. Significant improvement in grasp and dissociated movement is noted in group of CIMT while there was no significant improvement in weight bearing and protective extension in CIMT group when compared to BMT. CIMT is considered the appropriate treatment approach for unilateral conditions while BMT for bilateral conditions.

Task oriented training improves the balance outcome & reducing fall risk in diabetic population.

OBJECTIVES: The objective was to determine the balance impairments and to compare task oriented versus traditional balance training in fall reduction among diabetic patients. METHODS: The randomized control trial with descriptive survey and 196 diabetic patients were recruited to assess balance impairments through purposive sampling technique. Eighteen patients were randomly allocated into two groups; task oriented balance training group TOB (n=8) and traditional balance training group TBT (n=10). The inclusion criteria were 30-50 years age bracket and diagnosed cases of Diabetes Mellitus with neuropathy. The demographics were taken through standardized & valid assessment tools include Berg Balance Scale and Functional Reach Test. The measurements were obtained at baseline, after 04 and 08 weeks of training. RESULTS: The mean age of the participants was 49 ±6.79. The result shows that 165(84%) were at moderate risk of fall and 31(15%) were at mild risk of fall among total 196 diabetic patients. There was significant improvement (p <0.05) in task oriented balance training group for dynamic balance, anticipatory balance and reactive balance after 8 weeks of training as compare to traditional balance training. CONCLUSION: Task oriented balance training is effective in improving the dynamic, anticipator and reactive balance. The task oriented training reduces the risk of falling through enhancing balance outcome.

A tensor decomposition scheme for EEG-based diagnosis of mild cognitive impairment.

Mild Cognitive Impairment (MCI) is the primary stage of acute Alzheimer's disease, and early detection is crucial for the person and those around him. It is difficult to recognize since this mild stage does not have clear clinical signs, and its symptoms are between normal aging and severe dementia. Here, we propose a tensor decomposition-based scheme for automatically diagnosing MCI using Electroencephalogram (EEG) signals. A new projection is proposed, which preserves the spatial information of the electrodes to construct a data tensor. Then, using parallel factor analysis (PARAFAC) tensor decomposition, the features are extracted, and a support vector machine (SVM) is used to discriminate MCI from normal subjects. The proposed scheme was tested on two different datasets. The results showed that the tensor-based method outperformed conventional methods in diagnosing MCI with an average classification accuracy of 93.96% and 78.65% for the first and second datasets, respectively. Therefore, it seems that maintaining the spatial topology of the signals plays a vital role in the processing of EEG signals.