The Belgian physiotherapy reimbursement criteria for fall prevention fails in screening appropriately fall-prone community-dwelling older adults.

OBJECTIVES: The incidence of falling in older adults has remained unchanged over the past decades, despite evidence-based prevention initiatives. Therefore, it is appropriate to reflect on the current screening approach for preventive initiatives. The objective of this study was to determine whether the multifactorial algorithm proposed by Lusardi et al. (2017) exhibits superior predictive validity compared to the currently employed algorithm by the Belgian National Institute for Health and Disability Insurance (NIHDI). METHODS: The current study includes a secondary analysis of data collected from a falls-related study in the Department of Rehabilitation Sciences at Ghent University to compare the predictive validity of the two algorithms. Sensitivity, specificity, positive and negative predictive value and area under the curve (AUC) were calculated to ascertain which algorithm is more accurate. RESULTS: The database included a total of 94 community-dwelling older adults (mean age 76 years ±7.4, 35% male). Thirty-nine participants experienced at least one fall in the 8 month follow up. Lusardi's approach has a higher sensitivity score (89.7% compared to 10.3%) and negative predictive value (89.9% compared to 61.1%), but a lower specificity score (61.8% compared to 100%) and positive predictive value (62.2% compared to 100%) than the NIHDI approach. The AUC is 0.76 for Lusardi's approach and 0.55 for the NIHDI approach. CONCLUSION: The use of the multifactorial algorithm proposed by Lusardi et al. may be significant and more accurate in identifying adults at risk to falls. Further research is needed particularly with a larger, more heterogenous group of older adults.

Defining characteristics of independent walking persons after stroke presenting with different arm swing coordination patterns.

BACKGROUND: Persons after stroke present with an altered arm swing during walking. Given the known influence of the arm swing on gait, it is important to identify the characteristics of persons with stroke with different arm-to-leg coordination patterns during walking. METHODS: Twenty-five persons after stroke walked on a self-paced treadmill at comfortable walking speed. The frequency of shoulder movements per stride was detected by Fast Fourier transform analysis on the kinematic data for hemiplegic shoulder movements in the sagittal plane. An independent-sample t-test or Mann-Whitney U test was used to compare clinical and biomechanical parameters between identified subgroups. RESULTS: Two earlier described subgroups based on the number of shoulder flexion-extension movements during one stride could be confirmed. Participants in the 1:1 ratio subgroup (one arm swing during one stride, N = 15) presented with a less upper limb impairment and less spasticity of the elbow extensors (p = 0.012) than the participants in the 2:1 ratio subgroup (two arm swings during one stride, N = 9). Although not significant, the participants in the 1:1 subgroup also seemed to have less spasticity of the shoulder internal rotators (p = 0.06) and a less walking variability based on the standard deviation of the step width. Further research on a greater sample should confirm these findings. CONCLUSION: Fast Fourier transform analysis was used to identify subgroups based on sagittal shoulder kinematics during walking. The clinical and gait related differences between the identified subgroups can be taken into account in future research investigating post-stroke gait interventions aiming to improve the arm swing.

The impact of vestibular function on cognitive-motor interference: a case-control study on dual-tasking in persons with bilateral vestibulopathy and normal hearing.

Bilateral vestibulopathy (BV) is a chronic vestibular disorder, characterized by bilaterally absent or significantly impaired vestibular function. Symptoms typically include, but are not limited to, unsteadiness and movement-induced blurred vision (oscillopsia). This prospective case-control study aimed to elucidate the impact of BV on cognitive and motor performance and on cognitive-motor interference. Cognitive and motor performance, as well as cognitive-motor interference were measured in persons with BV and normal hearing using the 2BALANCE dual-task protocol. The experimental group was matched to a healthy control group based on age, sex, and educational level. The 2BALANCE protocol comprises cognitive tests assessing visuospatial memory, mental rotation, visual and auditory response inhibition, visual and auditory working memory, and processing speed. The cognitive tests were performed in single-task condition (while seated), and in dual-task condition (during a static and a dynamic motor task). The static motor task consisted of balancing on a force platform with foam pad. The dynamic motor task consisted of walking at a self-selected speed. These motor tasks were also performed in single-task condition. A generalized estimating equations model was used to investigate group differences for all cognitive and motor outcome measures. The estimated marginal means, as well as the odds ratios (OR), and their 95% confidence intervals (CI) were calculated. For the backward digit recall test, a baseline measurement was performed and analyzed using a student-t test. A total of 22 patients with BV and normal hearing and 22 healthy control subjects were assessed [mean age (SD), BV = 53.66 (13.35) and HC = 53.21 (13.35), 68% male]. The BV group had poorer mental rotation skills in single-task condition, compared to the control group [odds ratio (OR) = 2.30, confidence interval (CI) = 1.12-4.73, P = 0.024]. Similarly, auditory and visual working memory were also poorer in the BV group in single-task condition (P = 0.028 and P = 0.003, respectively). The BV group also performed poorer on the mental rotation task and the visual response inhibition task in dual-task condition (OR = 2.96, CI = 1.57-5.59, P < 0.001 and OR = 1.08, CI = 1.01-1.16, P = 0.032, respectively). Additionally, an interaction effect, indicating increased cognitive-motor interference in the BV group, was observed for mental rotation, response inhibition, and auditory working memory (P = 0.003 to 0.028). All static motor outcome parameters indicated more postural sway in the BV group compared to the control group for all test conditions (P < 0.001 to 0.026). No group differences were noted for the dynamic motor task. These findings suggest a link between vestibular function and cognitive performance, as well as a greater interference between cognitive and motor performance in BV, compared to healthy controls.

Association of Bilateral Vestibulopathy With and Without Hearing Loss With Cognitive-Motor Interference.

Importance: The past years, evidence suggested that the primary symptoms traditionally associated with bilateral vestibulopathy (BV) do not represent the full picture of this patient population. Recent literature also demonstrated cognitive impairment. However, although multitasking and dual-tasking are widely present in everyday activities, most of these studies assessed cognitive function only in single-task conditions. Objective: To uncover the association of BV with and without hearing loss with cognitive and motor performance and cognitive-motor interference. Design, Setting, and Participants: This prospective case-control study assessed persons with an isolated BV and persons with BV and a concomitant hearing loss compared with a healthy control group. Data were analyzed in December 2022. The study was conducted at Ghent University (Ghent, Belgium). Data collection took place between March 26, 2021, and November 29, 2022. Main Outcomes and Measures: All participants completed the 2BALANCE dual-task protocol, comprising a static and a dynamic motor task that was combined with 5 visual cognitive tasks. These cognitive tasks assessed mental rotation, visuospatial memory, working memory, response inhibition (executive function), and processing speed. All cognitive tasks were performed in a single-task condition (while seated) and in a dual-task condition (combined with a static and a dynamic motor task). The static task comprised balancing on a force platform with foam pad, and the dynamic task comprised walking at a self-selected speed on the GAITRite Walkway. Both motor tasks were performed in the single-task and dual-task condition. Results: Nineteen persons with BV and hearing loss (mean [SD] age, 56.70 [10.12] years; 10 women [52.6%]), 22 persons with an isolated BV (mean [SD] age, 53.66 [13.35] years; 7 women [31.8%]), and 28 healthy control participants were included (mean [SD] age, 53.73 [12.77] years; 12 women [42.9%]). Both patient groups had mental rotation and working memory impairment in a single-task condition and slower processing speed when walking (ie, during the dynamic dual-task condition). Additionally, the patient group with hearing loss had impaired visuospatial memory and executive function deficits in single-task and dual-task conditions, while this could only be elicited when performing a motor task in persons with isolated BV (ie, when dual-tasking). Conclusion and Relevance: The findings of this case-control study suggest an association between vestibular function and cognitive and motor performance, even greater in persons with a concomitant hearing loss than in persons with an isolated BV.

Cervical mobility and cervical proprioception in relation to fall risk among older adults: a prospective cohort study.

PURPOSE: Age-related decreases in cervical mobility and proprioception have previously been demonstrated. Potential associations of these deteriorations with fall risk have not been investigated so far. This study aims to compare cervical mobility and proprioception between fallers and non-fallers and prospectively assess the contribution of these parameters in fall risk identification among healthy older adults. METHODS: 95 community-dwelling older adults underwent a cervical screening. Active cervical range of motion (aCROM) was measured using a digital inclinometer and cervical proprioception was assessed by determining joint position error (JPE). Fear of falling was identified through the Iconographical Falls Efficacy Scale (iconFES). Falls were prospectively recorded during a 1-year follow-up period using monthly calendars. Univariate and multivariate logistic regression analyses were conducted to examine the association between these parameters and falls occurrence. RESULTS: Baseline measurements revealed reduced cervical performance (i.e., smaller aCROM and larger JPE) among individuals who reported at least one fall during the following year ("fallers"). The multivariate logistic regression model contained eight independent variables (age, sex, walking aid, fall history, iconFES, aCROM F, aCROM E and JPE) and correctly classified 77.8% of cases. CONCLUSION: Although the contribution of cervical parameters to fall risk identification seems to be rather small compared to well-known (though often unmodifiable) major risk factors, further research is needed to elucidate underlying mechanisms of cervical functions in relation to falls. Second, it would be interesting to develop a targeted fall preventive cervical exercise program and assess its effectiveness in terms of falls occurrence.

Self-Reported Cycling Performance and Impact on Falls in Persons With Bilateral Vestibulopathy.

OBJECTIVES: The aim of this study was to investigate cycling skills, cycling difficulties, fall concern, and fall history while cycling in persons with bilateral vestibulopathy. DESIGN: Fifty-one persons with bilateral vestibulopathy and 51 healthy control subjects filled out a questionnaire about cycling abilities. This questionnaire consisted of four parts: (1) general information about audiovestibular function, vision, and physical activity; (2) general cycling abilities, history, and difficulties; (3) fall concern while cycling in various situations; and (4) fall history. RESULTS: Out of the 51 patients, 61% found riding a bicycle difficult, 29% were not able to cycle anymore, and 10% reported not having any problems riding a bicycle. Their mean cycling time decreased from 3.15 hrs weekly before to 1.27 hrs weekly after disease onset ( p = 0.002). The latter also differed significantly from the mean cycling time of 3.51 hrs weekly in control subjects ( p < 0.001). The main complaints while cycling were not being able to look behind (88%), having difficulties with visually stabilizing the environment (65%), and not being able to ride in a straight line (61%). The fall concern was significantly higher in the patient group, with cycling in the dark and at dusk, and turning the head as their main concerns ( p < 0.001). Falls and near-falls were respectively reported in 50% and 65% of the patient group. Only the latter differed significantly from the control group. However, the number of reported falls differed significantly between both groups. CONCLUSIONS: This study demonstrates cycling difficulties in persons with bilateral vestibulopathy, related to problems with postural control and gaze stabilization. Knowledge about specific complaints and triggers is important to prevent future falls. A combination of coping strategies and aids, with vestibular rehabilitation focused on gaze stabilization might be considered, as well as avoidance of cycling in specific cases.

Proportion of falls reported in persons with Parkinson's disease: A meta-analysis.

OBJECTIVE: Falls can be highly debilitating and have an important negative impact on the quality of life of patients with Parkinson's disease (PD). The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the prevalence of ≥1 fall and ≥2 falls in idiopathic PD. DATA SOURCES: MEDLINE, Web of Science, Embase and Cinahl databases were systematically searched until 04 July 2022 for prospective studies reporting fall prevalence in persons with idiopathic PD. METHODS: Pooled prevalence rates with 95% confidence intervals (CIs) were computed using random-effects models. Heterogeneity among studies was assessed using the I2 statistic. RESULTS: A total of 54 studies (7546 participants) were included, and random-effects meta-analysis yielded a pooled proportional fall rate of 0.48 (95% CI [0.43-0.52], I2 = 93%, 46 studies, 6874 participants) for classification 1 (≥1 fall) and a pooled proportional fall rate of 0.32 (95% CI [0.27-0.37], I2 = 78%, 31 studies, 5672 participants) for classification 2 (≥2 falls). Subgroup analysis on the classification of falls, and length and method of monitoring falls did not reveal significant differences and did not reduce between-study variability. CONCLUSION: Pooled estimates suggest that one in two persons with PD fall at least once, and one in three fall at least twice within the registered time period. Substantial variability remains after pooling fall prevalence rates according to the length and method of monitoring. Therefore, no recommendations can be made concerning these methodological aspects. Future research on falls in PD is encouraged to implement best practice recommendations to monitor and report fall data.

Comparing spatiotemporal gait parameters between overground walking and self-paced treadmill walking in persons after stroke.

PURPOSE: Since self-paced treadmills enable more natural gait patterns compared to fixed-speed treadmills we examined the use of a self-paced treadmill as a alternative for overground gait analysis in persons after stroke. MATERIAL AND METHODS: Twenty-five persons after stroke (10 males/15 females; 53 ± 12.05 years; 40.72 ± 42.94 months post-stroke) walked at self-selected speed overground (GAITRite, CIR Systems) and on a self-paced treadmill (GRAIL, Motek) in randomized order. Spatiotemporal parameters, variability and symmetry measures were compared using paired-sample t-tests or Wilcoxon Signed Rank tests. Concurrent validity was assessed using intraclass correlation coefficients and Bland-Altman plots. A regression model determined the contribution of the walking velocity to the changes in spatiotemporal parameters. RESULTS: The velocity on the treadmill was significant lower compared to overground (p < 0.001). This difference predicted the significant changes in other spatiotemporal parameters to varying degrees (27.7%-83.8%). Bland-Altman plots showed large percentage of bias and limits of agreement. Variability and symmetry measures were similar between conditions. CONCLUSIONS: When considering gait analysis in persons after stroke a self-paced treadmill may be a valuable alternative for overground analysis. Although a slower walking velocity, and accompanying changes in other spatiotemporal parameters, should be taken into account compared to overground walking.Implications for rehabilitationConsidering the advantages regarding space and time, instrumented treadmills provide opportunities for gait assessment and training in a stroke population.When using self-paced treadmills for clinical gait analysis in persons after stroke, the slower walking velocity and accompanying changes in other spatiotemporal parameters need to be taken into account.Stroke patients seem to preserve their walking pattern on a self-paced treadmill.

The role of a socially assistive robot in enabling older adults with mild cognitive impairment to cope with the measures of the COVID-19 lockdown: A qualitative study.

BACKGROUND: During the COVID-19 pandemic, mandatory containment measures led to lockdowns and severely diminished social interaction, with older adults being one vulnerable group. Socially assistive robots (SARs) could prove to be an effective intervention. OBJECTIVES: To explore the experiences of older adults with mild cognitive impairment (MCI) with a SAR during the first lockdown in Belgium. METHODS: Inductive thematic analysis was used. After a two-week interaction period with robot James®, semi-structured interviews were conducted. RESULTS: Four people were interviewed (median: 86 years; range: 70-90 years; 2 men, 2 women). Four themes were identified. The first theme described the robot as a companion, alleviating feelings of loneliness and social isolation. The second theme explored the robot in light of meaningful activity. The third theme detailed the technical aspects of the robot and the fourth theme described notable barriers and areas of improvement. CONCLUSION: The study demonstrated the potential of SARs during the first lockdown period in Belgium. The robot proved to be promising in terms of alleviating feelings of loneliness and social isolation. It was found to be both motivating and facilitating in terms of meaningful activity. SIGNIFICANCE: The study provided valuable insights for the care of lonely and occupationally deprived older adults.

Biomechanical differences between self-paced and fixed-speed treadmill walking in persons after stroke.

BACKGROUND: Using self-paced treadmills for gait analysis requires less space compared to overground gait labs while a more natural walking pattern could be preserved compared to fixed-speed treadmill walking. Although self-paced treadmills have been used in stroke related intervention studies, studies comparing self-paced to fixed-speed treadmill walking in this population are scarce. METHODS: Twenty-five persons after stroke (10 males/15 females; 53 ± 12.05 years; 40.72 ± 42.94 months post stroke) walked on a treadmill in a virtual environment (GRAIL, Motek) in two conditions (self-paced and fixed-speed). After familiarization, all participants completed two trials (3 min) at comfortable walking velocity in randomized order. A paired-sample t-test or Wilcoxon Signed Rank test was used to calculate differences between both conditions for spatiotemporal parameters. Statistical Parametric mapping was conducted using the t-tests (SPM(t)), to statistically compare the kinematic and kinetic curves. RESULTS: The self-selected walking velocity on the treadmill was higher in the self-paced condition compared to the fixed-speed condition (p < 0.001). However, most variability and symmetry measures were similar in both conditions. Only the standard deviation of the step length at the paretic side was significant higher (p = 0.007) and step length symmetry was significantly better (p = 0.032) in the self-paced condition. Detected kinematic and kinetic differences were small (< 3°, < 0.1 Nm/kg) and stride to stride variability was comparable in both conditions. CONCLUSION: Based on the results of the current study, self-paced walking can be used as an equivalent to fixed-speed treadmill walking in persons after stroke. Accordingly, this justifies the use of this more functional mode in clinical gait assessment and rehabilitation trials.

The perspectives of older adults with mild cognitive impairment and their caregivers on the use of socially assistive robots in healthcare: exploring factors that influence attitude in a pre-implementation stage.

BACKGROUND: Due to increasing age and an increasing prevalence rate of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and dementia, independent living may become challenging. The use of socially assistive robots (SARs) is one solution that can enable older adults with cognitive impairment to remain independent. However, at present, there is a lack of knowledge about the attitudes of older adults with MCI and their caregivers towards SARs. METHODS: This study relies on a constructivist grounded theory approach. Semi-structured interviews were conducted to gain a deeper insight into attitudes of two different stakeholder groups; older adults with MCI and their (in)formal caregivers. RESULTS: Forty individual semi-structured interviews were conducted with older adults with MCI (N = 30) and (in)formal caregivers (N = 10). Data revealed different perspectives on SARs in healthcare for the involved stakeholders. Two main topics could be derived: (1) perspectives on robot assistance, discussing different viewpoints on the potential value of robots as helpers, and (2) perspectives on implementation, revealing different factors that could affect implementation. Both topics may explain a positive, impartial or negative attitude towards SARs. CONCLUSIONS: This study identified different factors that should be taken into account when implementing a SAR in the home environment of older adults. Despite the fact that the benefits of SARs are often recognized, many older participants currently seem not ready yet to commit to the use of a SAR.IMPLICATIONS FOR REHABILITATIONThis study explores the attitudes towards a SAR, developed to stimulate and support older adults with Mild Cognitive Impairment (MCI) on a physical, cognitive and social level.The results give a deeper insight into different factors contributing to a (non-) successful implementation of SARs in the home environment of older adults with MCI.

Passive mobilisation of the shoulder in subacute stroke patients with persistent arm paresis: A randomised multiple treatment trial.

Background: Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce. Objectives: A randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM. Method: Eleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 × 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period. Results: Using combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation (p = 0.006). An average increase of 6.82° (± 9.20°) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation -7.27° ± 10.81°; angular mobilisation -5.45° ± 11.72°). Conclusion: These preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis. Clinical implications: Performing a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms.

2BALANCE: Test-retest reliability of a cognitive-motor dual-task protocol.

PURPOSE: Aside from typical symptoms such as dizziness and vertigo, persons with vestibular disorders often have cognitive and motor problems. These symptoms have been assessed in single-task condition. However, dual-tasks assessing cognitive-motor interference might be an added value as they reflect daily life situations better. Therefore, the 2BALANCE protocol was developed. In the current study, the test-retest reliability of this protocol was assessed. METHODS: The 2BALANCE protocol was performed twice in 20 healthy young adults with an in-between test interval of two weeks. Two motor tasks and five different cognitive tasks were performed in single and dual-task condition. Intraclass correlation coefficients (ICC), the standard error of measurement, and the minimal detectable difference were calculated. RESULTS: All cognitive tasks, with the exception of the mental rotation task, had favorable reliability results (0.26≤ICC≤0.91). The dynamic motor task indicated overall substantial reliability values in all conditions (0.67≤ICC≤0.98). Similar results were found for the static motor task during dual-tasking (0.50≤ICC≤0.92), but were slightly lower in single-task condition (-0.26≤ICC≤0.75). CONCLUSIONS: The 2BALANCE protocol was overall consistent across trials. However, the mental rotation task showed lowest reliability values.

The impact of diabetic neuropathy on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 diabetes mellitus: a cross-sectional study.

OBJECTIVES: This study aimed to determine the impact of diabetic neuropathy (dNP) on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 Diabetes Mellitus (T2DM). METHODS: 19 healthy male controls without neuropathy (HC) and 35 male T2DM patients, without dNP (n=8), with sensory dNP (n=13) or with sensorimotor dNP (dNPsm; n=14), were enrolled in this study. Maximal isometric (IM) and isokinetic (IK) muscle strength and IK muscle endurance of the dominant knee, ankle and elbow, and maximal IM handgrip strength were measured by means of dynamometry. RESULTS: Ankle muscle endurance was lower compared to the knee, independently of dNP (p<0.001). Maximal IK ankle muscle strength was also lower compared to the knee, albeit only in dNPsm (p=0.003). No differences were found between maximal IM handgrip and elbow strength. CONCLUSIONS: Our results suggest an impact of T2DM -with or without dNP- on lower limb muscle strength more distally than proximally, while this was not observed in the upper limb. The gradient of dNP seemed to be a determining factor for the maximal muscle strength, and not for muscle endurance, in the lower limb.

The Effects of Aerobic Exercise in Patients with Early-Onset Dementia: A Scoping Review.

BACKGROUND: Early-onset dementia (EOD) defines all dementia related conditions with an onset before the age of 65 years. EOD places a large and distressing psychological, emotional and financial burden on the individuals themselves and their caregivers. For various reasons, diagnostic and treatment strategies for EOD are very challenging. There is a general agreement that not only the human body but also the mind benefits from physical activity and/or exercise. Especially aerobic exercise has shown to have favorable effects on cognitive functions in healthy older adults, as well as in patients with MCI and dementia. However, there are major differences in age, physical fitness level and clinical presentation between EOD and late-onset dementia. Therefore, one cannot just assume that the same type and intensity of exercise will lead to similar effects in the former population. By conducting this scoping review, the authors aimed to identify the evidence on the effectiveness of aerobic exercise on physical and mental health outcomes in individuals with EOD, display gaps in this context, and formulate related directions for future research. SUMMARY: There are a number of reasons to assume that aerobic exercise might be extremely valuable within individuals with EOD. However, this scoping review led to the surprising and striking finding that not a single study so far has investigated the effects of physical exercise on cognition, physical performance and feelings of well-being and quality of life in EOD. Although nowadays the disease is increasingly recognized, coping and (non-pharmacological) treatment strategies for EOD are virtually non-existent. Key Messages: Exercise intervention studies in EOD are lacking. With this scoping review the authors hope to inspire researchers in the field for related directions for future research. The potential beneficial effects of aerobic exercise in individuals with EOD should be explored and assessed extensively. Secondarily, decent guidelines for non-pharmacological treatment and coping strategies should be developed, with the aim of supporting people with EOD and their caregivers.

2BALANCE: a cognitive-motor dual-task protocol for individuals with vestibular dysfunction.

INTRODUCTION: Aside from primary vestibular symptoms such as vertigo and dizziness, persons with vestibular dysfunction frequently express cognitive and motor problems. These symptoms have mainly been assessed in single-task setting, which might not represent activities of daily living accurately. Therefore, a dual-task protocol, consisting of the simultaneous performance of cognitive and motor tasks, was developed. This protocol assesses cognitive and motor performance in general, as well as cognitive-motor interference in specific. METHODS AND ANALYSIS: The motor component of the 2BALANCE protocol consists of a static and dynamic postural task. These motor tasks are combined with different cognitive tasks assessing visuospatial cognition, processing speed, working memory and response inhibition. First, test-retest reliability will be assessed with an interval of 2 weeks in a group of young adults. Second, the 2BALANCE protocol will be validated in persons with bilateral vestibulopathy. Finally, the protocol will be implemented in persons with unilateral vestibular loss. DISCUSSION AND CONCLUSIONS: The 2BALANCE project aims to elucidate the impact of vestibular dysfunction on cognitive and motor performance in dual-task setting. This protocol represents everyday situations better than single-task protocols, as dual-tasks such as reading street signs while walking are often encountered during daily activities. Ultimately, this project could enable individualised and holistic clinical care in these patients, taking into account single as well as dual-task performance. ETHICS AND DISSEMINATION: The current study was approved by the ethics committee of Ghent University Hospital on 5 July 2019 with registration number B670201940465. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings. TRIALS REGISTRATION NUMBER: NCT04126798, pre-results phase.

The use of shoulder orthoses post-stroke: effects on balance and gait. A systematic review.

INTRODUCTION: Since there is no clear conclusion concerning the use of arm slings in the prevention or reduction of shoulder subluxation or shoulder pain in stroke patients, it seems important to explore other potentially beneficial effects. Earlier research already suggested that the upper limb might play a considerable role in efficient balance and gait in stroke patients. Therefore, the aim of this systematic review was to investigate the effects of wearing an arm sling on balance and/or gait in stroke patients. This information could support the decision-making concerning the use of shoulder orthoses after stroke. EVIDENCE ACQUISITION: Four electronic databases (Pubmed/MEDLINE, Embase, Web of Science and CINAHL/EBSCO) were searched until April 8th, 2019. Search alerts were set and followed until January 2020 to assure no new eligible articles were published. Reference lists of included studies were hand searched. All studies examining the effect of wearing an upper limb orthosis on balance and gait in stroke patients were included. Two reviewers independently identified eligible studies and extracted data. The methodological quality of included trials was assessed using the QualSyst assessment tool for quantitative studies. Prospero registration number: CRD42019130282. EVIDENCE SYNTHESIS: Ten studies, examining 283 stroke patients with moderate to low level of upper limb impairment, were included in the quantitative synthesis of the results. The pooled mean time since stroke was 21.88±9.03 months. Only minor effects on balance or gait related outcome parameters could be detected in favor of wearing an arm sling. However, these changes did not exceed the minimal clinical important difference (MCID). CONCLUSIONS: So far no strong evidence is available regarding a potential benefit of wearing an arm sling on balance and gait for stroke patients. However, further research with longer intervention periods, can be useful to determine if stroke patients in the early phases after stroke or with persistent UL paresis might possibly benefit from wearing an arm sling.

The impact of sensory and/or sensorimotor neuropathy on lower limb muscle endurance, explosive and maximal muscle strength in patients with type 2 diabetes mellitus.

AIMS: The purpose of this study was to investigate the impact of diabetic neuropathy (dNP) on lower limb endurance, explosive and maximal muscle strength in patients with Type 2 Diabetes Mellitus (T2DM). METHODS: Fifty-four participants, aged between 55 and 85, were enrolled in this observational comparative study. The patients with T2DM had an average HbA1c of 7.4% (±1.03) and diabetes duration of 13 years. Participants were classified by means of electroneuromyography as T2DM without dNP (dNP-; n = 8), T2DM with sensory dNP (dNPs; n = 13), T2DM with sensorimotor dNP (dNPsm; n = 14), and healthy controls without neuropathy (C; n = 19). Maximal muscle strength and muscle endurance of the dominant knee and ankle were measured by dynamometry, while explosive muscle strength was evaluated by mechanography. RESULTS: Muscle endurance "total work" in knee extension and ankle plantar flexion was higher in the healthy controls compared to dNP-, dNPs and dNPsm, in knee flexion compared to dNPs and dNPsm, and in ankle dorsiflexion compared to dNPsm only (p<0.05). Furthermore, relative explosive muscle strength "total power/body weight" and relative maximal muscle strength "peak torque/lean body mass of the dominant leg" considering knee flexion, ankle plantar flexion and dorsiflexion, were higher in healthy controls compared to the dNPsm group, and for maximal muscle strength ankle dorsiflexion even between dNP- and dNPsm (p < 0.05). CONCLUSIONS: Muscle endurance is impaired in patients with T2DM, independent of the presence of dNP. Explosive and maximal muscle strength are more likely affected by the presence and severity of dNP.

Psychometric Properties of Cognitive-Motor Dual-Task Studies With the Aim of Developing a Test Protocol for Persons With Vestibular Disorders: A Systematic Review.

OBJECTIVES: Patients suffering from vestibular disorders (VD) often present with impairments in cognitive domains such as visuospatial ability, memory, executive function, attention, and processing speed. These symptoms can be attributed to extensive vestibular projections throughout the cerebral cortex and subcortex on the one hand, and to increased cognitive-motor interference (CMI) on the other hand. CMI can be assessed by performing cognitive-motor dual-tasks (DTs). The existing literature on this topic is scarce and varies greatly when it comes to test protocol, type and degree of vestibular impairment, and outcome. To develop a reliable and sensitive test protocol for VD patients, an overview of the existing reliability and validity studies on DT paradigms will be given in a variety of populations, such as dementia, multiple sclerosis, Parkinson's disease, stroke, and elderly. DESIGN: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive literature search on psychometric properties of cognitive-motor DTs was run on MEDLINE, Embase, and Cochrane Databases. The studies were assessed for eligibility by two independent researchers, and their methodological quality was subsequently evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS AND CONCLUSIONS: Thirty-three studies were included in the current review. Based on the reliability and validity calculations, including a static as well as dynamic motor task seems valuable in a DT protocol for VD patients. To evoke CMI maximally in this population, both motor tasks should be performed while challenging the vestibular cognitive domains. Out of the large amount of cognitive tasks employed in DT studies, a clear selection for each of these domains, except for visuospatial abilities, could be made based on this review. The use of the suggested DTs will give a more accurate and daily life representation of cognitive and motor deficiencies and their interaction in the VD population.

Managing Paratonia in Persons With Dementia: Short-term Effects of Supporting Cushions and Harmonic Techniques.

OBJECTIVES: Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored. DESIGN: This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants. SETTING AND PARTICIPANTS: The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium. METHODS: Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items. RESULTS: After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P < .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT. CONCLUSIONS/IMPLICATIONS: This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.