Evaluating Postural Transition Movement Performance in Individuals with Essential Tremor via the Instrumented Timed Up and Go.

Flexibility in performing various movements like standing, walking, and turning is crucial for navigating dynamic environments in daily life. Individuals with essential tremor often experience movement difficulties that can affect these postural transitions, limiting mobility and independence. Yet, little research has examined the performance of postural transitions in people with essential tremor. Therefore, we assessed postural transition performance using two versions of the timed up and go test: the standard version and a more complex water-carry version. We examined the total duration of the standard and water-carry timed up and go in 15 people with and 15 people without essential tremor. We also compared the time taken for each phase (sit-to-stand phase, straight-line walk phase, stand-to-sit phase) and the turning velocity between groups. Our findings revealed decreased performance across all phases of standard and water-carry timed up and go assessments. Further, both ET and non-ET groups exhibited reduced performance during the water-carry timed up and go compared to the standard timed up and go. Evaluating specific phases of the timed up and go offers valuable insights into functional movement performance in essential tremor, permitting more tailored therapeutic interventions to improve functional performance during activities of daily living.

A State-of-the-Art of Exoskeletons in Line with the WHO's Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities.

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO's healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson's Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso®, HAL®, Stride Management Assist®, Honda Walking Assist®, Lokomat®, Walkbot®, Healbot®, Keeogo Rehab®, EX1®, overground wearable exoskeletons, Eksoband®, powered ankle-foot orthoses, HAL® lumbar type, Human Body Posturizer®, Gait Enhancing and Motivation System®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.

Associations between respiratory function, balance, postural control, and fatigue in persons with multiple sclerosis: an observational study.

Introduction: Fatigue, postural control impairments, and reduced respiratory capacities are common symptoms in persons diagnosed with Multiple Sclerosis (MS). However, there is a paucity of evidence establishing correlations among these factors. The aim of this study is to analyze respiratory function in persons with MS compared to the control group as well as to analyze the relationship between fatigue, respiratory function and postural control in persons with MS. Materials and methods: A total of 17 persons with MS and 17 healthy individuals were enrolled for this cross-sectional study. The evaluated parameters included fatigue assessed using the Visual Analog Scale-fatigue (VAS-F) and the Borg Dyspnea Scale, postural control assessed through the Mini Balance Evaluation System Test (Mini-BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Trunk Impairment Scale (TIS); and respiratory capacities measured by Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC ratio, Diaphragmatic excursion and diaphragmatic thickness. Results: A very high correlation was observed between the Borg Dyspnoea Scale and the BBS (r = -0.768), TUG (0.867), and Mini-BESTest (r = -0.775). The VAS-F exhibited an almost perfect correlation solely with the TUG (0.927). However, none of the variables related to fatigue exhibited any correlation with the respiratory variables under study. Balance-related variables such as BBS and Mini-BESTest demonstrated a very high and high correlation. Respectively, with respiratory function variables MEP (r = 0.783; r = 0.686), FVC (r = 0.709; r = 0.596), FEV1 (r = 0.615; r = 0.518). BBS exhibited a high correlation with diaphragmatic excursion (r = 0.591). Statistically significant differences were noted between the persons with MS group and the control group in all respiratory and ultrasound parameters except for diaphragmatic thickness. Conclusion: The findings suggest that decreased postural control and balance are associated with both respiratory capacity impairments and the presence of fatigue in persons with MS. However, it is important to note that the alterations in respiratory capacities and fatigue are not mutually related, as indicated by the data obtained in this study. Discrepancies were identified in abdominal wall thickness, diaphragmatic excursion, and respiratory capacities between persons with MS and their healthy counterparts.

Mobility-related brain regions linking carotid intima-media thickness to specific gait performances in old age.

BACKGROUND: Gait disturbance is common in older adults with vascular diseases. However, how carotid atherosclerosis affects gait remains poorly understood. The objectives were to investigate the associations between carotid intima-media thickness and specific gait performances and explore the potential role of brain structure in mediating these associations. METHODS: A cross-sectional analysis of data from the Taizhou Imaging Study was conducted, including 707 individuals who underwent both gait and carotid ultrasound examinations. Gait assessments include the Timed-Up-and-Go test, the Tinetti test, and quantitative gait assessment using a wearable device. Quantitative parameters were summarized into independent gait domains with factor analysis. Magnetic resonance images were obtained on a 3.0-Tesla scanner, and the volumes of fifteen brain regions related to motor function (primary motor, sensorimotor), visuospatial attention (inferior posterior parietal lobules, superior posterior parietal lobules), executive control function (dorsolateral prefrontal cortex, anterior cingulate), memory (hippocampus, entorhinal cortex), motor imagery (precuneus, parahippocampus, posterior cingulated cortex), and balance (basal ganglia: pallidum, putamen, caudate, thalamus) were computed using FreeSurfer and the Desikan-Killiany atlas. Mediation analysis was conducted with carotid intima-media thickness as the predictor and mobility-related brain regions as mediators. RESULTS: Carotid intima-media thickness was found to be associated with the Timed-Up-and-Go performance (ß = 0.129, p = 0.010) as well as gait performances related to pace (ß=-0.213, p < 0.001) and symmetry (ß = 0.096, p = 0.045). Besides, gait performances were correlated with mobility-related brain regions responsible for motor, visuospatial attention, executive control, memory, and balance (all FDR < 0.05). Notably, significant regions differed depending on the gait outcomes measured. The primary motor (41.9%), sensorimotor (29.3%), visuospatial attention (inferior posterior parietal lobules, superior posterior parietal lobules) (13.8%), entorhinal cortex (36.4%), and motor imagery (precuneus, parahippocampus, posterior cingulated cortex) (27.3%) mediated the association between increased carotid intima-media thickness and poorer Timed-Up-and-Go performance. For the pace domain, the primary motor (37.5%), sensorimotor (25.8%), visuospatial attention (12.3%), entorhinal cortex (20.7%), motor imagery (24.9%), and balance (basal ganglia: pallidum, putamen, caudate, thalamus) (11.6%) acted as mediators. CONCLUSIONS: Carotid intima-media thickness is associated with gait performances, and mobility-related brain volume mediates these associations. Moreover, the distribution of brain regions regulating mobility varies in the different gait domains. Our study adds value in exploring the underlying mechanisms of gait disturbance in the aging population.

Minimal detectable change of gait and balance measures in older neurological patients: estimating the standard error of the measurement from before-after rehabilitation data thanks to the linear mixed-effects models.

BACKGROUND: Tracking gait and balance impairment in time is paramount in the care of older neurological patients. The Minimal Detectable Change (MDC), built upon the Standard Error of the Measurement (SEM), is the smallest modification of a measure exceeding the measurement error. Here, a novel method based on linear mixed-effects models (LMMs) is applied to estimate the standard error of the measurement from data collected before and after rehabilitation and calculate the MDC of gait and balance measures. METHODS: One hundred nine older adults with a gait impairment due to neurological disease (66 stroke patients) completed two assessment sessions before and after inpatient rehabilitation. In each session, two trials of the 10-meter walking test and the Timed Up and Go (TUG) test, instrumented with inertial sensors, have been collected. The 95% MDC was calculated for the gait speed, TUG test duration (TTD) and other measures from the TUG test, including the angular velocity peak (ωpeak) in the TUG test's turning phase. Random intercepts and slopes LMMs with sessions as fixed effects were used to estimate SEM. LMMs assumptions (residuals normality and homoscedasticity) were checked, and the predictor variable ln-transformed if needed. RESULTS: The MDC of gait speed was 0.13 m/s. The TTD MDC, ln-transformed and then expressed as a percentage of the baseline value to meet LMMs' assumptions, was 15%, i.e. TTD should be < 85% of the baseline value to conclude the patient's improvement. ωpeak MDC, also ln-transformed and expressed as the baseline percentage change, was 25%. CONCLUSIONS: LMMs allowed calculating the MDC of gait and balance measures even if the test-retest steady-state assumption did not hold. The MDC of gait speed, TTD and ωpeak from the TUG test with an inertial sensor have been provided. These indices allow monitoring of the gait and balance impairment, which is central for patients with an increased falling risk, such as neurological old persons. TRIAL REGISTRATION: NA.

Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study.

BACKGROUND: Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT). METHODS: Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system. RESULTS: Both the SPPB total score improved significantly (p = < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p = < 0.001), walk ratio (p = 0.011), step length (p = < 0.001), stride length (p = < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible. CONCLUSIONS: SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care. TRIAL REGISTRATION: DRKS00026191.

The effect of high-intensity laser therapy on pain and lower extremity function in patellofemoral pain syndrome: a single-blind randomized controlled trial.

Patellofemoral pain syndrome (PFPS) is a set of symptoms that negatively affect the daily life activities of the individual, leading to functional disability and significant loss of labor, especially in young adults. PFPS is usually due to weakness of the vastus medialis obliquus (VMO) resulting in abnormal patellar tracking and pain. Our study aims to compare the efficacy of high-intensity laser therapy (HILT) on pain and lower extremity function in the treatment of PFPS with different electrophysical agents (EPAs). The study was designed as a single-blind randomized controlled trial. Forty-five people with PFPS (aged 25-45 years) were included in the study. The patients were randomly divided into three groups and a total of ten sessions of treatment were administered to all three groups for 2 weeks, 5 days a week. High-intensity laser (HILT) and exercise program were applied to group 1. Ultrasound (US), transcutaneous electrical nerve stimulation (TENS), and exercise program were applied to group 2. In group 3, US, interferential current (IFC), and exercise program were applied. Both groups underwent three evaluations: pre-treatment, post-treatment, and 12 weeks after treatment. Outcome measures included the visual analog scale for pain severity (VAS), knee flexion range of motion (FROM), Q angle, pain threshold, muscle strength of quadriceps and hamstring, Kujala patellofemoral scoring, lower extremity functional scale (LEFS), and Timed Up and Go Test (TUG). The ANOVA was used for comparing the data of the groups, and two-way repeated measure ANOVA was used to compare at the pre-post and post-intervention 3rd month. The LSD and Bonferroni post hoc tests were also used to identify the between-group differences. Groups 2 and 3 were statistically effective in pain and functionality (p < 0.05). Group 1 was found to be statistically more effective than other groups in reducing pain (95% confidence interval (CI), 0.000/0.000; p = 0.000), increasing knee flexion angle (95% CI, 127.524/135.809; p = 0.000), and increasing lower extremity function (95% CI, 75.970/79.362; p = 0.000). This study indicated that high-intensity laser therapy was found to be a more effective method in the treatment of patellofemoral pain syndrome after 3 months of follow-up compared to US-TENS combination and US-interferential current combination treatments. Also, HILT can be used as an effective method in combination with an appropriate exercise program including vastus medialis strengthening to reduce pain and increase functionality in the patients with PFPS.

The effects of dance interventions on physical function and quality of life among middle-aged and older adults: A systematic review.

BACKGROUND: Fundamental physical functions such as postural control and balance are vital in preserving everyday life, affecting an individual's quality of life. Dance is a physical activity that offers health advantages across various life stages. Nevertheless, the effects of dance interventions on physical function, postural control, and quality of life among older adults have remained underexplored. The review aimed to examine the strength of evidence for dance interventions on physical function and quality of life among middle-aged and older adults. METHODS: A systematic review was conducted across four databases (PubMed, Cochrane Library, Web of Science, and Medline), focusing on studies involving more than four weeks of dance interventions. MeSH terms [dance or dance intervention or dance rehabilitation or dance movement] and [motor function or functional capacity or postural control or functional mobility or mobility or postural balance or balance or flexibility or gait] and [well-being or quality of life or life satisfaction] were utilized in the search. This review was registered in the PROSPERO database (CRD42023422857). Included studies were assessed using the Cochrane Risk of Bias. RESULTS: The search revealed 885 studies, and 16 met the inclusion criteria. The effects of various dance genres on physical functions and quality of life were compared. Most studies showed that dance intervention improved physical function, balance, postural control and quality of life. Dance intervention showed a high level of adherence compared to physiotherapy, self-care, conventional therapy, and aerobic and resistance exercise. CONCLUSION: In terms of improving physical function and quality of life, structured dance is a safe and relatively effective alternative to exercise. Note the effect of movement selection and intensity in the dance interventions. Dance with music may increase participants' interest, encouraging more physical activity among middle-aged and older adults.

Towards efficient motor imagery interventions after lower-limb amputation.

BACKGROUND: The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations. OBJECTIVES: The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation. METHODS: Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks. RESULTS: While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group. CONCLUSION: Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

Low Hand Grip Strength, Mid-Upper Arm Muscle Area, Calf Circumference, Serum Albumin Level, and Muscle Fiber Diameter as Risk Factors for Independent Walking Inability in Patients with Hip Fracture 6 Weeks after Bipolar Hemiarthroplasty Surgery.

Background: Bipolar hemiarthroplasty, one of the main treatment modalities for hip fracture, does not always promise the ability to walk independently after surgery. Patients with the same fracture characteristics and comorbidities, implants, and operators may also have different outcomes. Sarcopenia is thought to be one of the causes of the inability to walk independently after this operation; however, it has not been widely studied and is often overlooked. Methods: This study used a case-control design with 23 patients in the case group (patients unable to walk independently) and 23 patients in the control group (patients able to walk independently). Sampling was carried out consecutively according to the inclusion and exclusion criteria based on the medical records of patients with hip fractures after bipolar hemiarthroplasty at our hospital. In the preoperative period, hand grip strength (HGS), mid-upper arm muscle area (MUAMA), calf circumference (CC), serum albumin level, and total lymphocyte count were measured. A muscle biopsy was performed intraoperatively from the gluteus muscle with the amount of 200-350 mg. The patient's walking ability was assessed in the polyclinic using the Timed Up and Go test 6 weeks postoperatively. The statistical tests used were descriptive statistics, proportion comparison analysis with the chi-square test, and multiple logistic regression test. Results: Univariate analysis using chi-square test proved HGS, MUAMA, CC, serum albumin level, and muscle fiber diameter as risk factors for inability to walk independently 6 weeks after bipolar hemiarthroplasty (p = 0.003, p = 0.003, p = 0.006, p = 0.044, and p = 0.000, respectively). Logistic regression test proved 3 direct risk factors for the inability to walk independently 6 weeks after bipolar hemiarthroplasty, namely MUAMA, serum albumin level, and muscle fiber diameter, as the strongest predictive factor (adjusted odds ratio, 63.12). Conclusions: Low MUAMA, serum albumin levels, and muscle fiber diameter are direct risk factors for the inability to walk independently in hip fracture patients 6 weeks after bipolar hemiarthroplasty.

Effects of arousal and valence on center of pressure and ankle muscle activity during quiet standing.

Emotion affects postural control during quiet standing. Emotional states can be defined as two-dimensional models comprising valence (pleasant/unpleasant) and arousal (aroused/calm). Most previous studies have investigated the effects of valence on postural control without considering arousal. In addition, studies have focused on the center of pressure (COP) trajectory to examine emotional effects on the quiet standing control; however, the relationship between neuromuscular mechanisms and the emotionally affected quiet standing control is largely unknown. This study aimed to investigate the effects of arousal and valence on the COP trajectory and ankle muscle activity during quiet standing. Twenty-two participants were instructed to stand on a force platform and look at affective pictures for 72 seconds. The tasks were repeated six times, according to the picture conditions composed of arousal (High and Low) and valence (Pleasant, Neutral, and Unpleasant). During the task, the COP, electromyogram (EMG) of the tibialis anterior and soleus muscles, and electrocardiogram (ECG) were recorded. The heart rate calculated from the ECG was significantly affected by valence; the value was lower in Unpleasant than that in Neutral and Pleasant. The 95% confidence ellipse area and standard deviation of COP in the anterior-posterior direction were lower, and the mean power frequency of COP in the anterior-posterior direction was higher in Unpleasant than in Pleasant. Although the mean velocity of the COP in the medio-lateral direction was significantly lower in Unpleasant than in Pleasant, the effect was observed only when arousal was low. Although the EMG variables were not significantly affected by emotional conditions, some EMG variables were significantly correlated with the COP variables that were affected by emotional conditions. Therefore, ankle muscle activity may be partially associated with postural changes triggered by emotional intervention. In conclusion, both valence and arousal affect the COP variables, and ankle muscle activity may be partially associated with these COP changes.

The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability.

Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.

Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults.

Purpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.

[Comparison of efficacy between short-term personalized vestibular rehabilitation supervised by special personnel and fixed vestibular rehabilitation on recurrent peripheral vertigo].

Objective: To explore the efficacy of short-term personalized vestibular rehabilitation supervised by special personnel (ST-PVR) versus fixed vestibular rehabilitation (FVR) on decompensated recurrent peripheral vertigo. Methods: A randomized controlled trial was carried out. Patients diagnosed with decompensated recurrent vertigo in the clinic of Eye & ENT Hospital, Fudan University from January to December 2018 were randomly allocated into FVR and ST-PVR groups via computer-generated randomization. The FVR group received fixed scheme involving gaze stabilization exercises, habituation exercises, balance and gait training, while the ST-PVR group received individualized training programs based on symptoms and vestibular function examination results, with adjustments made according to the progress of recovery. Patient symptoms and vestibular function improvement were assessed using the dizziness handicap inventory (DHI), activities-specific balance confidence (ABC), self-rating anxiety scale (SAS), caloric test, and sensory organization test (SOT) at 2, 4, and 8 weeks of treatment. Results: A total of 44 patients were included, including 16 males and 28 females, with an average age of (50.6±13.5) years. There were 21 cases in the FVR group and 23 cases in the ST-PVR group. In the ST-PVR group, DHI score (49.5±26.8 vs 61.3±21.4, P=0.046) and SAS score (39.1±7.8 vs 44.3±6.6, P=0.021) significantly improved after 2 weeks of treatment, while significant improvement occurred only after 8 weeks of treatment in the FVR group (DHI score: 28.1±15.9 vs 53.1±18.5, P=0.001; SAS score: 35.3±6.7 vs 43.1±8.4, P=0.010). There was no significant change of ABC score in the FVR group after 8 weeks of treatment (86.5±12.9 vs 83.4±18.1, P=0.373), while a significant improvement was observed in the ST-PVR group after 4 weeks of treatment (83.6±15.2 vs 78.4±15.1, P=0.015). The caloric test results showed that after 8 weeks of treatment, the proportion of patients with unilateral weakness<25% increased in both groups [FVR group: 57.1% (12/21) vs 9.5% (2/21), P=0.001; ST-PVR group: 52.2% (12/23) vs 17.4% (4/23), P=0.014]. In the ST-PVR group, the proportion of patients with dominant preference≤25% significantly increased [91.3% (21/23) vs 60.9% (14/23), P=0.016], while there was no significant change in the FVR group [61.9 (13/21) vs 57.1% (12/21), P=0.500]. The proportion of patients with SOT score≥70 in the ST-PVR group increased significantly after 2 weeks of treatment [69.6% (16/23) vs 30.4% (7/23), P=0.009], while the FVR group showed a significant increase only after 8 weeks of treatment [81.0% (17/21) vs 42.9% (9/21), P=0.012]. Conclusion: Both FVR and ST-PVR effectively promote vestibular compensation by improving objective vestibular functions and relieving subjective symptoms and anxiety of the patients with decompensation recurrent vertigo, while ST-PVR might shorten the recovery time and increase balance confidence.

[Expert consensus on vestibular rehabilitation in vestibular disorders].

Vestibular rehabilitation therapy (VRT) is a highly effective treatment approach for addressing both peripheral and central vestibular disorders, offering the ability to significantly improve patients' coordination and control across the vestibular, visual, and proprioceptive systems, all of which are crucial factors in maintaining balance. By promoting vestibular compensation, VRT has been shown to mitigate or even eliminate symptoms of dizziness, vertigo, and instability. With the rapid development of vestibular research, VRT has evolved into a more individualized and precise treatment approach based on evidence-based medicine. Its clinical effectiveness has been increasingly validated in numerous studies. With the involvement of multidisciplinary experts, this article aims to reach a consensus on the pre-treatment evaluation, formulation/implementation of treatment plans, and evidence-based treatment recommendations for common vestibular disorders, focusing on the prospects of vestibular rehabilitation. The goal is to further standardize and update VRT protocols for different vestibular disorders, providing comprehensive and context-specific guidance primarily tailored to the Chinese healthcare landscape, with a notable emphasis on its clinical applicability. Concurrently, it aspires to present new insights and serve as a valuable reference point for forthcoming high-quality clinical research on vestibular rehabilitation in China.

[Preliminary observation of wearable balance diagnosis and treatment system in evaluating dynamic and static balance function in patients with vestibular vertigo].

A newly developed wearable balance diagnosis and treatment system was studied to evaluate the indexes of the abnormal balance function in patients with vestibular vertigo. A cross-sectional study was carried out. A total of 30 patients diagnosed with non-acute vestibular vertigo in the outpatient department of Eye, Ear, Nose and Throat Hospital Affiliated to Fudan University from July 2022 to May 2023 were selected as the vertigo group, including 13 males and 17 females, and aged (45.7±13.9) years. Meanwhile, 20 healthy controls (8 males and 12 females) were included as the control group, with a mean age of (43.6±8.0) years. The static balance and limits of stability (LOS) function of all subjects were assessed with wearable balance diagnosis and treatment system developed under the leadership of Eye & ENT Hospital of Fudan University. In the static balance test, the ratio of eyes open with cushions to eyes open without cushions in the vertigo group was less than that of the control group[1.20% (0.92%, 1.53%) vs 1.49% (1.22%, 1.81%), P=0.008], indicating that patients with non-acute vestibular vertigo may compensate static balance ability earlier. In vertigo group, the directional control in 8 directions, the maximum excursion in anterior, posterior, right anterior and right posterior directions, the endpoint excursion in the posterior, right posterior, and left posterior directions were all smaller than those of the control group (all P<0.05). The reaction time in the left posterior direction of vertigo group was longer than that of the control group (all P<0.05). Those results indicated that the directional control, maximum excursion and endpoint excursion of LOS could be considered as important reference indexes for dynamic balance function.

Timed Up and Go test score and factors associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries-a cross-sectional study.

Introduction: Peripheral artery and aorta diseases contribute to complex consequences in various areas, as well as increasing physical and mental discomfort resulting from the progressive limitation or loss of functional capacities, in particular in relation to walking, decreased endurance during physical exercise, a drop in effort tolerance, and pain suffered by patients. Limitations in functional capacities also increase the risk of falls. Most falls take place during the performance of simple activities. The aim of this study was to investigate factors associated with moderate-to-high risk of future falls in patients scheduled for vascular surgeries. Methods: This cross-sectional study included patients aged 33-87, scheduled for vascular surgeries. Based on the Timed Up and Go test, patients were categorized as having a moderate-to-high (≥ 10 s) or low risk of falls. Multiple logistic regression was carried out to assess the relationship between fall-risk levels and independent sociodemographic and clinical variables. Results: Forty-eight percent of patients were categorized as having a moderate-to-high risk of future falls. Females (OR = 1.67; Cl95%: 1.07-2.60) and patients who suffered from hypertension (OR = 2.54; Cl95%: 1.19-5.40) were associated with a moderate-to-high risk of future falls. The Barthel Index correlated negatively (OR = 0.69; Cl95%: 0.59-0.80), while age correlated positively with fall-risk levels (OR = 1.07; Cl95%: 1.02-1.12). Conclusion: Factors that may be associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries include age, female gender, hypertension, and the Barthel Index.

Dynamic stability evaluation of trunk accelerations during walking in blind and sighted individuals.

BACKGROUND: Dynamic stability is a fundamental goal in standing activities. In this regard, monitoring, analysis, and interventions made to improve stability is a research topic investigated in the biomechanics of human movements. Vision has a major role to play in controlling human movement. Nonetheless, little is known about the effects of visual deprivation, especially from birth on dynamic gait stability. METHODS: The current study was conducted on 20 congenital blind and 10 sighted people (15-38 years). To evaluate the dynamic stability, descriptive data, harmonic ratio (HR), improved harmonic ratio (iHR), and root mean square (RMS), based on trunk acceleration data were measured in three axes: anteroposterior (AP), vertical (V), and mediolateral (ML) while participants walked an eight-meter straight path. RESULTS: In the comparison of blind and sighted people (eyes open), standard deviation, HR, iHR, and RMS indices were found to be significantly different in both AP and V directions. All the mentioned parameters were significantly lower in blind than in sighted participants. In the comparison of blind people and sighted ones with closed eyes, changes were observed in the maximum, range, standard deviation, and RMS only in the AP axis. In the comparison between eyes open and closed in sighted people, a significant difference was found only in the harmonic ratio of the vertical axis. CONCLUSION: Visual deprivation led to a decrease in dynamic stability parameters in the AP and V axes. Even the movement of sighted people in unchallenged conditions is dependent on visual information.

The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial.

BACKGROUND: Lee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m-LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks). METHODS: In this randomized controlled trial, 16 PwPD (aged 18-80 years, Hoehn and Yahr stages I-III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m-LSVT BIG exercises, but unlike the LSVT group, the m-LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G-Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis. RESULTS: Significant group-by-time interactions on the eyes open-firm surface score of the modified clinical test of sensory integration of balance (F = 10.138, p = .007) and gait cycle symmetry index (F = 10.470, p = .010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p < .05). CONCLUSION: The results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m-LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.