Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes.

PURPOSE: To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients. METHODS: Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment. RESULTS: The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04). CONCLUSIONS: Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

The effect of self-assessment on student competence in physiotherapy clinical training: a randomized controlled trial.

BACKGROUND: Self-assessment is a method that allows students to reflect on and critically evaluate their performance, increases students' involvement in learning, and improves academic achievement. In physiotherapy (PT) education, clinical training is a crucial component, guided by clinical educators (CEs), who assess and provide feedback, fostering student development. Limited research has investigated the impact of self-assessment on PT clinical training outcomes. This study aims to assess the effect of mid-term self-assessment during PT clinical training on students' competence and on level of agreement between students' self-assessment and CEs' assessment at the end of the training. METHODS: 23 CEs and their 52 undergraduate PT students participated in the study. The students underwent eight weeks of clinical training in outpatient PT clinics in groups of two or three. For each group, one CE performed student assessment at the mid-term and the end of the training using the Assessment of Physiotherapy Practice (APP) form, an assessment tool used to evaluate clinical competence in PT clinical training. One student from each group was randomly assigned to join the intervention group (IG). These students completed a self-assessment process at the mid-term of the training. All students were asked to complete a self-assessment form at the end of the training. RESULTS: The median CE's evaluation score halfway through the training was 80 [50-96] and 91 [65-100] at the end of the training, with no significant differences between the two groups. The level of agreement between the student and CE's evaluation at the end of the training was not significantly different between the groups (p = 0.05). It noted that students who scored themselves higher than their CEs tended to have lower APP scores than others, based on CEs' assessment. These students were found to have less academic experience. Nevertheless, those from the IG improved significantly, based on the CE's assessment, during the second half of the training, compared to the controls. CONCLUSION: The main finding of the present study is that student participation in self-assessment during PT clinical training is advantageous, mainly for individuals undergoing their initial clinical training and in the early stages of their academic studies.

Impact of Subarachnoid Hemorrhage on the Cardiac Autonomic Function During Rehabilitation in Children After Severe Traumatic Brain Injury.

This study aimed to investigate the impact of traumatic subarachnoid hemorrhage (tSAH) on cardiac autonomic control system (CACS) function in children after severe traumatic brain injury (TBI) during the subacute rehabilitation period. Thirty-three participants, 8-18 years of age, 42 (14-149) days after severe TBI at the beginning of the subacute rehabilitation, were included in the study. Six participants were diagnosed with tSAH during acute medical care (tSAH group). Heart rate variability (HRV) was assessed by the standard deviation of the N-N interval (SDNN) and the square root of the mean square differences of successive R-R interval (RMSSD) using a Polar RS800CX device while sitting at rest for 5 min. A second assessment was performed 8 weeks later. No significant difference between the tSAH and non-tSAH groups were found in the demographic and functional characteristics or injury severity. However, in comparison to the non-tSAH group, the tSAH group had lower SDNN (23.9 [10.5-47.3] vs. 43.9 [21.8-118.8], respectively; p = 0.005) and RMSSD values (11.8 [5.9-24.5] vs. 29.6 [8.9-71.7], respectively; p = 0.004). Neither group demonstrated changes in HRV values at rest in the second assessment, whereas the significant difference in SDNN (p = 0.035) and RMSSD (p = 0.008) remained. Children diagnosed with SAH after severe TBI presented poorer CACS function during the subacute rehabilitation. Given that reduced HRV values may be a marker for potential heart disease, the medical team should be aware of the influence of existing tSAH. Future studies with larger sample sizes and longer follow-up periods are warranted to further investigate this topic. ClinicalTrials.gov number: NCT03215082.

The dynamic control ratio and its equilibrium point: A preliminary study of isokinetic fatiguing internal-external rotational effort of the shoulder joint in healthy subjects.

The shoulder joint-related dynamic control ratio (DCR) is derived by dividing the peak eccentric moment of the external rotators (ER) by the peak concentric moment of the internal rotators (IR). However, given the inherent limitation associated with a single value DCR, an alternative approach is to calculate it at fixed angular intervals. This preliminary study aimed at exploring the variation in the DCR at a resolution of 1° and under fatiguing external and internal rotation exertions. Eighteen young men, 10 experienced and 8 without experience in overhead sporting activities completed two separate series of 45 ER eccentric and 45 IR concentric isokinetic repetitions at 120°/s. The analysis focused on repetitions 1-3 (TR1), 21-23 (TR2) and 41-43 (TR3). The relative fatigue values for both muscle groups and for both E and NE participants were 25-40% with significantly higher fatigue resistance in eccentric compared with concentric exertions. The DCR traces varied substantially linearly for most of the internal rotation range of motion while significant differences (p < 0.001) were found in their values within group between TR1, TR2 and TR3 and between experienced and non-experienced participants. An antagonistic moment equilibrium (DCR = 1) was reached in all instances and for both groups only during TR3 with a significant progressive reduction in this moment as fatigue increased. Thus, considering the DCR as an angle-based variable rather than a single value isokinetic parameter, may add new insight regarding the interplay between the rotatory muscles of the shoulder joint.

The Prevalence of Bladder and Bowel Dysfunction in Children with Cerebral Palsy and its Association with Motor, Cognitive, and Autonomic Function.

PURPOSE: To describe the prevalence of bladder and bowel dysfunction (BBD) in 8-10-year-old children with cerebral palsy and its association with motor, cognitive, and autonomic dysfunction. METHODS: A cross-sectional, random sample study of parents of 8-10-year-old children with cerebral palsy. Tools: The Enuresis/Urinary Incontinence Parental Questionnaire, the Functional Independence Measure children's version, the autonomic signs questionnaire, and the Gross Motor Function Classification System. RESULTS: 39 out of 59 parents consented to participate, whereas 25.64% reported complete continence. Of the 29 children with BBD, 21 (72.4%) had lower urinary tract symptoms and bowel problems. Only two of the children received conservative and noninvasive treatments. Lastly, motor, cognitive and autonomic impairments were associated with incontinence. CONCLUSIONS: BBD is common in 8-10-year-old children with cerebral palsy at all levels of functioning. Most having both lower urinary tract symptoms and bowel problems.

The association between cardiac autonomic system function at the entrance to rehabilitation and walking-endurance two months later among children following-ABI.

BACKGROUND: The cardiac autonomic control system function is frequently impaired after brain injury. An association exists between the cardiac autonomic control system and endurance performance. AIM: To evaluate the association between cardiac autonomic control system indices at the beginning of the inpatient rehabilitation and walking endurance two months later among children and adolescents following acquired brain injury. METHODS: A prospective study included 28 children and adolescents following acquired brain injury in the sub-acute phase. A Polar device (RS800CX) records heart rate as a proxy measure of autonomic function at sitting and lying supine on admission and two months later. The 6-minute walk test was assessed at the second assessment in 25 participants. Non-parametric tests were used with statistical significance defined as p < 0.05. RESULTS: There were statistically significant differences in heart rate variability between lying and sitting positions, which were positively correlated with the 6-minutes walk test results two months later, mainly in the parasympathetic components (rs = 0.51 p-value <0.01). CONCLUSIONS: At the beginning of the rehabilitation of children and adolescents following acquired brain injury, a simple manipulation - position change from sitting to lying, activates cardiac autonomic control system responses. These responses are positively associated with walking endurance two months later.

"I feel like this is an area where one can feel a lot of satisfaction": Physiotherapy students' preferences for their prospective area of practice.

OBJECTIVES: To identify physiotherapy students' preferences about their prospective area of practice and the reasons for their choices. METHODS: Tel-Aviv University physiotherapy students participated in a cross-sectional survey and three open-ended questions that comprise the qualitative component of the study. At the very beginning of their studies, and at the end of the first to fourth years, participants were asked about their area of preference, the factors that shaped their choice, and the reasons for prospective changes in their preference. RESULTS: In total, 289 students filled out the survey. Response rate was 68%. Interest in some areas of practice such as pediatrics remained stable throughout years of physiotherapy studies. In contrast, interest in other areas such as sports declined and interest in others such as rehabilitation increased. The open-ended questions yielded 1,616 codes sorted into five categories that shaped the students' preferences: "I/Me /My" the largest category, followed by "the physiotherapy studies program" and then the relational focused "physiotherapy practice." The number of codes for "working conditions" and "work-life balance" increased steeply with the progression of the studies and the age of the students. CONCLUSIONS: The choice for areas of practice of physiotherapy students vary during their professional formation. During their professional development, their preferences are shaped by their personal feelings, interest in and past experience with the specific areas of practice, as well as their practical exposure, experiences in practicums, and theoretical studies. Millennial physiotherapists prefer areas of practice in which personal as well as relational considerations are core.

Changes in the cardiac autonomic control system during rehabilitation in children after severe traumatic brain injury.

BACKGROUND: One of the sequalae of severe traumatic brain injury (TBI) in children is impaired function of the cardiac autonomic control system (CACS) at rest. The CACS response to conventional autonomic tests is little known. OBJECTIVE: To examine the CACS response to conventional autonomic tests in children after severe TBI during the rehabilitation period and to compare with typically developing (TD) children. METHODS: This study combined a case-control and follow-up design. The severe TBI group (cases) consisted of 33 children aged 9-18 years, 14-142 days after severe TBI who were followed for 8 weeks during rehabilitation. The control group consisted of 19 TD children matched for age and sex. Heart rate (HR) and heart rate variability (HRV) were evaluated with the Polar RS800CX device at rest (sitting), during a handgrip test and during a paced breathing test. RESULTS: At the first assessment, we found lower HRV values at rest and a lower HRV response during the paced breathing and handgrip tests in the TBI group than the TD group (p<0.01). After 8 weeks, HRV values did not change at rest in the TBI group, but the response to the autonomic tests improved significantly, with increased HRV values in response to the paced breathing test (p<0.01) and the handgrip test (p = 0.01). CONCLUSIONS: After severe TBI, children exhibited an impaired CACS response to autonomic tests, with parasympathetic suppression and sympathetic arousal. After 8 weeks of rehabilitation, CACS function recovered partially and the response to the autonomic tests improved with no change in CACS function at rest.

The cardiac autonomic control system response to vestibular stimulation in subjects with BPPV compared with healthy controls.

BACKGROUND: Vestibulo-sympathetic reflexes (VSR) demonstrate the autonomic interaction between the vestibular system and the cardiovascular system, however little is known about this interaction in patients with benign paroxysmal positional vertigo (BPPV). Although the main complaint of patients with BPPV is vertigo, additional symptoms such as nausea and sweating raise questions whether patients with BPPV have impaired VSR. OBJECTIVE: The aim of this study is to assess the cardiac autonomic control system (CACS) response to vestibular stimulation in subjects with BPPV compared with healthy controls. METHODS: This is a case-control study. Heart-rate variability (HRV) parameters were monitored in two groups (30-70 years old)- subjects with BPPV (N = 18) and gender and age-matched healthy controls (N = 18), at rest and during vestibular stimulation. RESULTS: No significant differences were found between groups in HRV parameters during rest. Both groups demonstrated an autonomic response to vestibular stimulation, yet no differences were found between groups. CONCLUSIONS: Patients with BPPV seem to have an intact cardiac response to vestibular stimulation. Over-activation of the Vestibular Semicircular Canals, as shown in BPPV, doesn't seem to alter the VSR in the cardiac autonomic control system.

The distinction between state and trait anxiety levels in patients with BPPV in comparison with healthy controls.

Introduction: An association exists between vestibular dysfunction and anxiety, yet a distinction between state and trait anxiety in patients with Benign Paroxysmal Positional Vertigo (BPPV) in comparison with healthy subjects has not been well established. The aim of this study is to assess both state and trait anxiety levels in patients with BPPV in comparison with healthy controls, and their relations with cardiac autonomic parameters. Materials and methods: A case-control study, that included patients with BPPV (N = 18) referred to vestibular physiotherapy and gender and age matched healthy controls (N = 18). All participants completed the State-Trait Anxiety Inventory (STAI) questionnaire, while heart-rate (HR) and heart-rate variability (HRV) measures were recorded. Results: Patients with BPPV (age range 32-66 years; 12 women and 6 men) showed a higher state anxiety level (10 points median difference, p = 0.001) in comparison with healthy controls (age range 34-66 years; 12 women and 6 men), yet no differences were found in trait anxiety score or total STAI score. Only among patients with BPPV, a positive-moderate correlation was found between state anxiety and HR (r = 0.53, p < 0.05), and a negative moderate-strong correlation was found between state anxiety and HRV (r = -0.67, p < 0.01). Discussion: Patients with BPPV do not differ from healthy subjects in terms of predisposition to feel anxious, and only their temporary state anxiety levels are higher in comparison with healthy controls. We recommend researchers and clinicians who assess anxiety levels in patients with BPPV to distinguish between anxiety as a temporary state (state anxiety) and anxiety as a personality trait (trait anxiety).

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents.

Objective: To (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. Design: Cross-sectional. Setting: This study was conducted at a tertiary care pediatric hospital. Participants: A total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). Interventions: None. Main Outcome Measures: Symptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. Results: No outcomes demonstrated agreement with symptom provocation (κ=-0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). Conclusions: Findings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.

Balance impairment in patients with moderate-to-severe traumatic brain injury: Which measures are appropriate for assessment?

Left untreated, balance impairment following moderate-to-severe traumatic brain injury (TBI) can be highly debilitating and hinder activities of daily life. To detect impairments, clinicians need appropriate assessment tools. The objective of this study was to evaluate the feasibility and utility of a battery of clinical balance assessments in adults with moderate-to-severe TBI within 6-months of injury. Thirty-seven adults with TBI [Glasgow Coma Scale score ≤ 12 (33 M/4 F) age 18-50 years] participated in balance testing. Assessments included the Balance Error Scoring System (BESS), National Institutes of Health Standing Balance Test (NIH-SBT), Functional Gait Assessment (FGA), Advanced Functional Gait Assessment (FGA-A), Tandem Gait Test (TGT), Berg Balance Scale (BBS), and Walking While Talking Test (WWTT). We identified pronounced ceiling effects on the BBS and FGA, two widely used clinical balance assessments. The NIH-SBT, WWTT, and FGA used in conjunction with the FGA-A, offered versatility in their capacity to assess patients across the balance severity spectrum. This study provides evidence to support a stepwise approach to balance assessment that can be adapted to the broad range of balance ability found in moderate-to-severe TBI.

Characterizing the evolution of oculomotor and vestibulo-ocular function over time in children and adolescents after a mild traumatic brain injury.

Background: Impairments to oculomotor (OM) and vestibulo-ocular reflex (VOR) function following pediatric mTBI have been demonstrated but are poorly understood. Such impairments can be associated with more negative prognosis, affecting physical and mental wellbeing, emphasizing the need to more fully understand how these evolve. Objectives: to determine i) the extent to which performance on clinical and computerized tests of OM and VOR function varies over time in children and adolescents at 21 days, 3-, and 6-months post-mTBI; ii) the proportion of children and adolescents with mTBI presenting with abnormal scores on these tests at each timepoint. Design: Prospective longitudinal design. Setting: Tertiary care pediatric hospital. Participants: 36 participants with mTBI aged 6 to18. Procedures: Participants were assessed on a battery of OM and VOR tests within 21 days, at 3- and 6-months post injury. Outcome measures: Clinical measures: Vestibular/ocular motor screening tool (VOMS) (symptom provocation and performance); Computerized measures: reflexive saccade test (response latency), video head impulse test (VOR gain), and dynamic visual acuity test (LogMAR change). Analysis: Generalized estimating equations (parameter estimates and odd ratios) estimated the effect of time. Proportions above and below normal cut-off values were determined. Results: Our sample consisted of 52.8% females [mean age 13.98 (2.4) years, assessed on average 19.07 (8-33) days post-injury]. Older children performed better on visual motion sensitivity (OR 1.43, p = 0.03) and female participants worse on near point of convergence (OR 0.19, p = 0.03). Change over time (toward recovery) was demonstrated by VOMS overall symptom provocation (OR 9.90, p = 0.012), vertical smooth pursuit (OR 4.04, p = 0.03), voluntary saccade performance (OR 6.06, p = 0.005) and right VOR gain (0.068, p = 0.013). Version performance and VOR symptom provocation showed high abnormal proportions at initial assessment. Discussion: Results indicate impairments to the VOR pathway may be present and driving symptom provocation. Vertical smooth pursuit and saccade findings underline the need to include these tasks in test batteries to comprehensively assess the integrity of OM and vestibular systems post-mTBI. Implications: Findings demonstrate 1) added value in including symptom and performance-based measures in when OM and VOR assessments; 2) the relative stability of constructs measured beyond 3 months post mTBI.

The Cardiac Autonomic Response Recovery to the Modified Tilt Test in Children Post Moderate-Severe Traumatic Brain Injury.

OBJECTIVE: To assess the recovery of the cardiac autonomic control system (CACS) response to the modified tilt-test during rehabilitation, in children post moderate-severe TBI at the subacute phase post-injury. METHOD: Thirty-seven children aged 6-18 years, 14-162 days post moderate-severe TBI, participated in the study. The assessment included CACS values evaluation (heart rate (HR), heart rate variability (HRV) and blood pressure) during the modified tilt-test: five minutes lying supine and five minutes passive standing. Re-assessment was performed after eight weeks of rehabilitation. RESULTS: In both assessments, only four children reported symptoms associated with orthostatic intolerance during the modified tilt-test. No change was found over time in the HR and HRV values at rest. In response to the modified tilt-test, the systolic blood pressure showed change over time, with a significant interaction effect (p=0.04); while in the first assessment the SBP values showed a hypertension trend in the second assessment the SBP values showed a hypotension trend. CONCLUSIONS: Children post moderate-severe TBI at the sub-acute phase post-injury, have a better systolic blood pressure response during the modified tilt-test after eight weeks of individually tailored rehabilitation program, despite no change in the CACS values at rest. CLINICAL TRIAL GOV. NUMBER: NCT03215082.

High frequency band limits in spectral analysis of heart rate variability in preterm infants.

OBJECTIVES: The current study aims to assess different high-frequency (HF) band power calculations based on different frequency bandwidth values, and compare them with the time domain the root mean square of successive RR differences (RMSSD) value in preterm infants. METHODS: At week 32, electrocardiogram (ECG) and breathing rate (BR) were recorded for 24 h on 30 preterm infants born between 28 and 32 weeks. The recording held in the neonatal intensive care unit without any interruption of routine. RESULTS: The median 24 h BR was 40-78 breaths per minute. The RMSSD was highly and positively correlated with frequency bands that were based on each preterms BR range, or on a constant frequency with band limits of 0.4-2 Hz. CONCLUSIONS: At week 32, HF band Hz limits should be calculated based on each child's breathing rate, generally between 0.4 and 2 Hz.

The development and the inter-rater agreement of a treatment protocol for vestibular/oculomotor rehabilitation in children and adolescents post-moderate-severe TBI.

Introduction:There is limited evidence investigating the effect of vestibular/oculomotor rehabilitation programs in children and adolescents post moderate-severe TBI at the sub-acute stage.Objective:To describe the development of a treatment protocol for vestibular/oculomotor interventions in this population, and to assess the inter-rater agreement of this protocol as an initial step of a clinical trial.Method:The protocol was developed by 10 health professionals, address the high variability of balance performance, the high prevalence of vestibular/oculomotor abnormalities and the low prevalence of symptoms reported in this population.Results:The protocol enables the clinician to use the assessment during the treatment exercise selection. The training position was defined by the Pediatric Balance Scale. Vestibular/oculomotor exercises were selected using a quantified version of the Vestibular/Ocular Motor Screening. The exercise protocol was selected based on impairment in function or reproduction of symptoms. The protocol planning was implemented by two assessors in 27 children and adolescents post-moderate-severe TBI (median age 14.1 [6-18.4] years) in the sub-acute stage (median 40 [14-162] days since injury). Very high agreement was found (k > 0.72) in all the parameters.Conclusion: This protocol could reliably be used in a randomized control trial that assesses the effect of vestibular/oculomotor rehabilitation program in children and adolescents post moderate-severe TBI at the sub-acute stage.

Exploring hand dexterity in children with myelomeningocele.

PURPOSE: To assess hand dexterity in children with myelomeningocele (MMC) and to explore factors related to hand dexterity in these children. METHODS: Ninety-four children with myelomeningocele, aged 4 to 18 years, were assessed. Demographic characteristics, disease factors, visual perception (Beery test of Visual Motor Integration), cognition (WeeFunctional Independence Measure), and self-care (Pediatric Evaluation of Disability Inventory) were assessed in relation to the Nine-Hole Peg Test (9HPT) for hand dexterity using Spearmen correlations and linear regressions. RESULTS: The children's performance on the 9HPT in both hands was significantly slower than the norms for their age groups. Children without a shunt showed significantly better function in both hands (p = .005) than those with a shunt. Factors most related to hand dexterity were neurological spinal level of MMC, presence of shunt, age, cognitive ability, and years of mother's education. CONCLUSION: Children with MMC appear to have poorer hand skills than typically developed children, which was related to pathology as well as functional and environmental factors. When addressing hand dexterity in children with MMC, it is important that rehabilitation professionals continue to work with these children as they get older, and put greater emphasis on parent education using materials that are adapted to varying educational levels.

Development of a prediction model for ascent and descent staircase independence during the sub-acute rehabilitation phase in individuals post-stroke.

BACKGROUND: Nearly half of individuals post-stroke are dependent in their daily activities. The ability to ascend and descend stairs is an important component of independence in the community. OBJECTIVE: To predict the future ability of post-stroke individuals at the beginning of the sub-acute rehabilitation phase to achieve ascending and descending staircase independence. METHODS: 36 participants were recruited for the study. OUTCOME MEASURES: independence in ascending and descending stairs up to the end of the sub-acute rehabilitation phase. Predictive measures included the knee extensors Muscles Strength (MS), the seated Modified Functional Reach (MFR) test, and Heart Rate Variability (HRV) measures. Logistic and Cox regression were used. RESULTS: Twenty-four participants (66.7%) completed the sub-acute rehabilitation phase being independent in ascending and descending stairs. MFR was the best predictor (R2 = 0.18), and with MS the best predictors for the time (days) to achieve this goal during the sub-acute rehabilitation. HRV measure was found to be the main predictor of the staircase ascent model (R2 = 0.32), and MFR the best predictor for the descent model (R2 = 0.24). CONCLUSIONS: Balance performance is the main predictor of independence in ascending and descending stairs. Improving this component during the sub-acute rehabilitation phase might be reflected in achieving staircase independence.

The correlation between rhythm perception and gait characteristics at different rhythms among children with cerebral palsy and typically developing children.

BACKGROUND: It has been shown that motor training while listening to constant rhythm, is associated with coupling between movement and rhythm. To gain a better understanding of how rhythm perception may affect gait in children with cerebral palsy (CP) it seems important first to assess rhythm perception (RP) in these children. RESEARCH QUESTION: To describe and compare RP and step characteristics in children with CP and typically-developing (TD) children, and to assess the impact of RP on step characteristics during different rhythms. METHODS: The study included 24 children with CP, Gross Motor Function Classification System (GMFCS) levels I-II, age 7-12 years, who walk without assistive device, and 24 TD children matched for age and gender. RP was assessed by the perceptual beat alignment test (BAT). Gait parameters were recorded using a pressure-sensitive mat - the Gaitrite® system. Each participant walked on the mat at a comfortable walking pace and with the metronome set at 92.5 %, 100 % and 107.5 % of his preferred walking rhythm. RESULTS: No significant difference in RP was noted between groups. Children with CP presented significantly larger step time and length variability. In TD children, those with better RP walked significantly slower, with lower step variability as compared to TD children with lower RP. Children in both groups, regardless of rhythm perception, successfully matched their cadence to the metronome's pace, both at the lower and higher rhythm, except TD children with lower rhythm perception, who failed to reduce their cadence sufficiently in the 92.5 % pace. Children with better RP in both groups changed more parameters in gait in response to rhythm changes. SIGNIFICANCE: Assessing RP may predict which parameters of gait are expected to change when employing a metronome during child's walk.

The integrated functions of the cardiac autonomic and vestibular/oculomotor systems in adolescents following severe traumatic brain injury and typically developing controls.

INTRODUCTION: The cardiac autonomic control system (CACS) is frequently impaired post-traumatic brain injury (TBI). However, the prevalence of vestibular/oculomotor impairment is less studied. These two systems interact during position change and contribute to blood-pressure regulation through the vestibulo-sympathetic reflex. Aim: To assess the CACS, the vestibular/oculomotor systems and their integrative function in adolescents post-TBI compared to typically-developing (TD) adolescents. Methods: 19 adolescents in the subacute stage following a severe TBI (14-117 days post injury) and 19 age and sex matched TD controls were recruited. Heart Rate Variability (HRV) was assessed at rest and during a modified tilt-test. A quantified version of the Vestibular/Ocular-Motor Screening (VOMS) was also administered. Results: At rest, the TBI group had higher HR and lower HRV values (p < .001). All participants with TBI demonstrated impairments in the VOMS (median of positive tests: 5 [range 2-9]) compared to only 6 out of 19 in the TD participants (median 0 [0-2]) (z = -5.34; p < .001). In response to the modified tilt test, the HRV increased significantly in the lifting period and decreased significantly once in standing only in the TBI group (z = -2.85, p = .025). Conclusion: Adolescents post severe TBI demonstrated impairments in the CACS, positive tests on the VOMS and significantly greater changes in the modified tilt test as compared to TD. Clinical trial gov. number: NCT03215082.