Group exercise for balance in people with Parkinson's disease: a systematic review with meta-analysis.

BACKGROUND: High-quality evidence shows that exercise helps people with Parkinson's disease improve functional abilities including balance. However, few studies have investigated whether the setting and format through which balance-focused exercise programs are provided matters. This systematic review investigated group exercise compared to individual exercise, and to no-exercise control (CTL), on clinical measures of balance for people with Parkinson's disease. METHODS: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases were searched through March 24, 2024, on terms for Parkinson's disease; exercise or physical activity; community-based or group classes; balance or postural control. Citations, abstracts and full-text articles were independently reviewed, and included studies were rated on risk of bias by two authors. RESULTS: Twenty-seven randomized controlled trials (30 reports) with 1200 participants met criteria. Meta-analysis using mean difference (MD) compared group exercise to CTL on seven clinical measures of balance. Three yielded significant differences favoring group exercise: Timed Up and Go = -2.29 (MD), -3.56 to -1.02 (95% Confidence interval) (95% CI); Mini-BEST = 2.72 (MD), 1.88 to 3.57 (95% CI); Berg Balance Scale = 4.31 (MD), 1.33 to 7.29 (95% CI). Meta-analyses were also conducted on six clinical measures of balance, comparing group exercise to individual exercise, yielding no significant differences. CONCLUSIONS: For people with Parkinson's disease, group exercise may be more effective than CTL on some clinical measures of balance and it yields similar results to individual exercise. People with Parkinson's disease are encouraged to participate regularly in group or individual exercise based on preference and accessibility.

Participants with restricted dominant shoulder internal rotation range of motion demonstrate no side-to-side difference in humeral head translation; and no difference before and after joint mobilization: a pilot study.

[Purpose] To compare humeral head translation (HHT) during shoulder elevation between dominant and non-dominant shoulders in participants with limited dominant shoulder internal rotation range of motion (ROM). To determine if joint mobilization alters HHT, and if relationships exist between the bicipital forearm angle and HHT. [Participants and Methods] Fifteen (9 female) participants (age 25.7 ± 6.8 years) with a minimum 15-degree dominant shoulder internal rotation ROM deficit compared to the opposite shoulder participated. All participants underwent bicipital forearm angle (BFA) measurements and ultrasound imaging to measure acromiohumeral and posterior glenohumeral distances in 3 positions: Resting, 90 degrees of shoulder flexion, and 60 degrees of shoulder abduction with full external rotation. Ultrasound images were used to calculate HHT. Participants' dominant shoulders underwent posterior glide mobilization, followed immediately by repeated ultrasound images and ROM measures. [Results] There was no dominant to non-dominant shoulder, or before and after mobilization HHT differences. No correlations existed between bicipital forearm angles and HHT or ROM gains after mobilization. [Conclusion] Participants with internal rotation ROM loss demonstrated symmetrical HHT. Joint mobilization increased ROM, but HHT was unchanged. No relationships existed between BFA and HHT.

Outcomes of direct access telehealth physical therapy for patients with musculoskeletal pain: a single cohort observational retrospective study.

BACKGROUND: Telehealth direct access physical therapy is becoming more prevalent in the management of outpatient musculoskeletal pain. This innovative model affords more opportunity to reach potential patients who otherwise would not be able to access services due to geographical isolation, travel barriers, and timely access to quality care. OBJECTIVE: The purpose of the study was to investigate if pain, function, and ability to perform jobs improved after direct access telehealth physical therapy in patients with musculoskeletal pain. METHODS: A single cohort retrospective design was implemented to offer telehealth physical therapy to patients with musculoskeletal pain from March to November 2021. Eligible patients were at least 18 years old, located in California, and had a history of peripartum pelvic dysfunction, muscle pain, joint pain, or neural symptoms. Paired-samples t-tests and the Wilcoxon signed-rank test were used to analyze normally distributed and non-parametric data (α = 0.05), respectively, to compare pretest and post scores. RESULTS: Based on 89 participants, paired-samples t-tests showed statistically significant differences in function [t(87) = 20.71, p < .0001] and pain [t(82) = -8.15, p < .0001]. Wilcoxon's signed-rank test showed statistically significant differences in ability to perform job (Z = -7.345, p < .0001). CONCLUSION: This study demonstrated that in a cohort of individuals with multiregional musculoskeletal pain, there was a decrease in pain and improvements in function and ability to perform job after direct access telehealth physical therapy.

Adaptation in motor strategies for postural control associated with sensory reweighting.

The purpose of this study was to identify and differentiate the motor strategies associated with sensory reweighting adapted during specific sensory integration tasks by healthy young adults. Thirty-six subjects (age range: 21-33 years) performed standing computerized dynamic posturography balance tasks across progressively increasing amplitudes of visual (VIS), somatosensory (SOM) and both (VIS+SOM) systems perturbation conditions. Adaptation in the motor strategy was measured as changes in electromyographic (EMG) activities and joint angles. The contribution of the perturbed sensory input in maintaining postural stability was calculated to determine the sensory reweighting. A multivariate design was used to model a linear combination of motor adaptation variables that discriminates specific sensory integration tasks. Results showed a significant progressive decrease in postural sway per unit amplitude of sensory perturbation in each condition, indicating dynamic sensory reweighting. Linear discriminant function analysis indicated that the adaptation in motor strategy during the VIS condition was associated with increased activity of EMG and joint angles in the upper body compared to the lower body. Conversely, during the SOM and VIS+SOM conditions, the adaptation in motor strategy was associated with decreased activity of EMG and joint angles in the lower body compared to the upper body. Therefore, the adaptation in motor strategies associated with sensory reweighting were different for different sensory integration tasks.

Three-Dimensional Spinal Position With and Without Manual Distraction Load Increases Spinal Height.

OBJECTIVE: The purpose of this study was to investigate if spinal height increases using 3-dimensional (3-D) spinal position with and without manual distraction load and to assess the correlation between spine height changes and degrees of trunk rotation. METHODS: Fifty-six participants were randomly placed in one of two groups: (1) 3-D spinal position with manual distraction load, and (2) without manual distraction load. Spinal height was measured before and after the interventions using a stadiometer. For the statistical analysis, we used a 2 (Loading status: pre- versus post-intervention height) X 2 (3-D spinal position: with versus without manual distraction load) repeated measures Analysis of Variance (ANOVA) was used to identify significant interaction and main effects. Paired t-tests were used to calculate differences in spinal height changes between the two interventions. Pearson correlation coefficient was used to measure correlations between changes in spinal heights and degrees of trunk rotation. RESULTS: Mean spinal height increase with 3-D spinal position with and without manual distraction load was 6.30 mm (±6.22) and 5.69 mm (±4.13), respectively. No significant interaction effect was present between loading status and 3-D spinal position but a significant main effect in loading status was. Paired t-tests revealed significant differences in spinal heights between pre-and post-3-D spinal position with and without manual distraction load. No significant correlation was measured between trunk rotation and spinal height changes. CONCLUSION: 3-D spinal position with or without distraction load increased spinal height. This suggests that 3-D spinal positioning without manual distraction could be used in home settings to help maintain intervertebral disc (IVD) health.

Can 5 minutes of repetitive prone press-ups and sustained prone press-ups following a period of spinal loading reverse spinal shrinkage?

Objective: The objective of this study is to investigate if sustained and repetitive prone press-ups could reverse decreased spinal height following spinal loading and if there was a correlation between the degree of end range of motion spinal extension and spinal height gains. Design: Pretest-posttest crossover design is used in this study. Setting: Study was carried out in research laboratory. Subjects: Forty-one healthy men and women were included in this study. Intervention: Participants were seated in the stadiometer for 5 min with a 4.5-kg weight placed on each shoulder; the load was removed for 5 min and spinal height was measured using a stadiometer before and after 5 min of repetitive or sustained prone press-ups. Main Measures: Two-by-two repeated-measures ANOVA to identify significant interactions and main effects is used in this study. Significance of α = 0.05. A Pearson correlation coefficient was used to assess the correlation between spinal height changes and spinal extension ROM. Results: Participants 24.1 ± 2.03 years grew using both repetitive (4.85 ± 3.01 mm) and sustained press ups (4.46 ± 2.57 mm). There was no significant interaction between the repetitive versus sustained press-ups and the time before and after each prone press-ups strategy and no main effect for strategy (sustained vs. repetitive press-ups). There was a significant main effect for time (before vs. after press-ups) (F(1,30) = 140.771; p < 0.0001; partial η2 = 0.82). No correlation was found between the degree of end ROM spinal extension and spinal height changes following press-ups strategies. Conclusion: Following periods of spinal loading, both repetitive and sustained press-ups increased spinal height. Such strategies could be used to help recover spinal height and limit the effects of decreased spinal height as a result of activities of daily living.

Kinematic Validation of Postural Sway Measured by Biodex Biosway (Force Plate) and SWAY Balance (Accelerometer) Technology.

BACKGROUND: The Biodex Biosway® Balance System and SWAY Balance® Mobile smartphone application (SBMA) are portable instruments that assess balance function with force plate and accelerometer technology, respectively. The validity of these indirect clinical measures of postural sway merits investigation. PURPOSE: The purpose of this study was to investigate the concurrent validity of standing postural sway measurements by using the portable Biosway and SBMA systems with kinematic measurements of the whole body Center of Mass (COM) derived from a gold-standard reference, a motion capture system. STUDY DESIGN: Cross-sectional; repeated measures. METHODS: Forty healthy young adults (21 female, 19 male) participated in this study. Participants performed 10 standing balance tasks that included combinations of standing on one or two legs, with eyes open or closed, on a firm surface or foam surface and voluntary rhythmic sway. Postural sway was measured simultaneously from SBMA, Biosway, and the motion capture system. The linear relationships between the measurements were analyzed. RESULTS: Significant correlations were found between Biosway and COM velocity for both progressively challenging single and double leg stances (τ b = 0.3 to 0.5, p < 0.01 to <0.0001). SBMA scores and COM velocity were significantly correlated only for single leg stances (τ b = -0.5 to -0.6, p < 0.0001). SBMA scores had near-maximal values with zero to near-zero variance in double leg stances, indicating a ceiling effect. CONCLUSION: The force plate-based Biodex Biosway is valid for assessing standing postural sway for a wide range of test conditions and challenges to standing balance, whereas an accelerometer-based SWAY Balance smartphone application is valid for assessing postural sway in progressively challenging single leg stance but is not sensitive enough to detect lower-magnitude postural sway changes in progressively challenging double leg stances.

Increased spinal height using propped slouched sitting postures: Innovative ways to rehydrate intervertebral discs.

BACKGROUND: Upright and slouched sitting are frequently adopted postures associated with increased intradiscal pressure, spinal height loss and intervertebral disc pathology. OBJECTIVES: To examine the effects of two sustained propped slouched sitting (PSS) postures on spinal height after a period of trunk loading. METHODS: Thirty-four participants without a history of low back pain (LBP) were recruited (age 24.4 ± 1.6 years). Subjects sat in (1) PSS without lumbar support and (2) PSS with lumbar support for 10 min, after a period of trunk loading. Spinal height was measured using a stadiometer. RESULTS: Mean spinal height increase during PSS without lumbar support was 2.94 ± 3.63 mm and with lumbar support 4.74 ± 3.07 mm. CONCLUSIONS: Both PSS with and without lumbar support significantly increased spinal height after a period of trunk loading (p < 0.001). Such PSS postures can provide a valuable alternative to upright sitting and may be recommended for recovering spinal height in the working environment following periods of loading.