The effect of transcranial direct current stimulation on rating of perceived exertion: A systematic review of the literature.

The rating of perceived exertion (RPE) is a widely used method for monitoring the load during training, as it provides insight into the subjective intensity of effort experienced during exercises. Considering the role of brain in monitoring and perception of the effort, several studies explored the effect of transcranial direct current stimulation (tDCS) on RPE in different populations. The aim of current study is to review the studies that investigated the effect of tDCS on RPE in three groups including healthy untrained people, physically active persons, and athletes. Nine databases were searched for papers assessing the effect of tDCS on RPE. The data from the included studies were extracted and methodological quality was examined using the risk of bias 2 (ROB2) tool. Thirty-three studies met the inclusion criteria. According to the meta-analysis, active a-tDCS significantly decreased the RPE compared to the sham stimulation. The a-tDCS could decrease the RPE when it was applied over M1 or DLPF. Regarding the measurement tool, Borg's scale 6-20 and OMNI scale could show an improvement in RPE scale. A-tDCS is a promising technique that can decrease the RPE. M1 and DLPFC are suggested as the target area of stimulation. From the tools that measure the RPE, Borg's RPE 6-20 and OMNI scale could better show the effect of a-tDCS.

The Effect of Non-invasive Brain Stimulation on Gait in Healthy Young and Older Adults: A Systematic Review of the Literature.

BACKGROUND AND OBJECTIVES: Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory technique with motor function-improving effects. This study aimed to determine the effect of different types of NIBS interventions explored in randomized controlled trials on gait in healthy young and older adults. METHODS: Based on the PRISMA approach, we conducted an electronic search in PubMed, Web of Science, Scopus, and PEDro for randomized clinical trials assessing the effect of NIBS on gait in healthy young and older adults and performed a narrative review. RESULTS: Fourteen studies were included in this systematic review. According to the outcomes, transcranial direct current stimulation (tDCS) over the motor cortex and transcranial alternating current stimulation (tACS) over the cerebellum seem to be promising for improving gait characteristics such as speed, synchronization, and variability. Furthermore, tDCS over the dorsolateral prefrontal cortex (DLPFC) improved gait speed and reduced gait parameter variability under dual-task conditions. Only one repetitive transcranial magnetic stimulation was available, which showed no effects. No studies were available for transcranial random noise stimulation, and transcranial pulsed current stimulation. Moreover, the intervention parameters of the included studies were heterogeneous, and studies comparing directly specific intervention protocols were missing. CONCLUSION: NIBS is a promising approach to improve gait in healthy young and older adults. Anodal tDCS over the motor areas and DLPFC, and tACS over the cerebellum have shown positive effects on gait.

Foot and ankle biomechanics during walking in older adults: A systematic review and meta-analysis of observational studies.

BACKGROUND: The foot and ankle complex undergoes significant structural and functional changes with advancing age. RESEARCH QUESTION: The objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults. METHODS: Electronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. RESULTS: A total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference [WMD]: -5.15; 95 %CI: -6.47 to -3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference [SMD]: -0.62; 95 %CI: -0.82 to -0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible. SIGNIFICANCE: Older adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.

The effects of transcranial direct current stimulation on gait in patients with Parkinson's disease: a systematic review.

BACKGROUND: Gait problems are an important symptom in Parkinson's disease (PD), a progressive neurodegenerative disease. Transcranial direct current stimulation (tDCS) is a neuromodulatory intervention that can modulate cortical excitability of the gait-related regions. Despite an increasing number of gait-related tDCS studies in PD, the efficacy of this technique for improving gait has not been systematically investigated yet. Here, we aimed to systematically explore the effects of tDCS on gait in PD, based on available experimental studies. METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, PubMed, Web of Science, Scopus, and PEDro databases were searched for randomized clinical trials assessing the effect of tDCS on gait in patients with PD. RESULTS: Eighteen studies were included in this systematic review. Overall, tDCS targeting the motor cortex and supplementary motor area bilaterally seems to be promising for gait rehabilitation in PD. Studies of tDCS targeting the dorosolateral prefrontal cortex or cerebellum showed more heterogeneous results. More studies are needed to systematically compare the efficacy of different tDCS protocols, including protocols applying tDCS alone and/or in combination with conventional gait rehabilitation treatment in PD. CONCLUSIONS: tDCS is a promising intervention approach to improving gait in PD. Anodal tDCS over the motor areas has shown a positive effect on gait, but stimulation of other areas is less promising. However, the heterogeneities of methods and results have made it difficult to draw firm conclusions. Therefore, systematic explorations of tDCS protocols are required to optimize the efficacy.

The effect of quadriceps kinesiotaping on the dynamic balance of young healthy women after fatigue: A randomized controlled trial.

BACKGROUND: Balance is a key factor in performing daily activities and the quadriceps muscle plays an important role in regaining balance following imbalance. Quadriceps fatigue may cause disruption in sending proprioception signals to the central nervous system and may, ultimately, lead to motor dysfunction and increased fluctuating dynamic and static balance which is followed by an increased risk of falling. Based on conclusions from previous studies it is proposed that kinesiotaping (KT) might be effective in the reduction of muscle fatigue and eventually balance. OBJECTIVE: To investigate the effect of quadriceps KT on the dynamic balance of young healthy non-athlete women following local fatigue. DESIGN: A Single-blind parallel randomized clinical trial. METHOD: 28 healthy women aged from 18 to 30 years were selected using the convenience sampling method. They were thoroughly evaluated with regard to the inclusion and exclusion criteria and randomly divided into two groups of kinesiotaping (n = 14) and non-tape (n = 14) using coin tossing. Balance measurement was performed on both groups before and after fatigue using the Y balance test. Both groups performed the fatigue protocol, but only the KT group was taped. RESULTS: Results demonstrated that, the mean of normalized reach distances at anterior (KT: 1.014 ±â€¯0.073, non-tape: 0.964 ±â€¯0.097), posteromedial (KT: 0.816 ±â€¯0.125, non-tape: 0.809 ±â€¯0.076) and posterolateral (KT: 0.794 ±â€¯0.102, non-tape: 0.753 ±â€¯0.093) directions in the Y balance test had no significant difference between both groups after fatigue (p > 0.05). CONCLUSION: Our findings indicated no significant effect of quadriceps KT on the dynamic balance of young healthy women after fatigue.

Translation and Cross-cultural Adaptation of the Fremantle Back Awareness Questionnaire into Persian language and the assessment of reliability and validity in patients with chronic low back pain.

BACKGROUND: Chronic low back pain (LBP) causes some neuroplastic changes in the brain, which result in body perception impairment. The Fremantle Back Awareness Questionnaire (FreBAQ) is a suggested tool for the diagnosis and evaluation of back perception in people with LBP. The aim of this study is to translate and cross culturally adapt the FreBAQ into Persian language and to assess its reliability and validity in patients with chronic LBP (CLBP). MATERIALS AND METHODS: Fifty people with CLBP and fifty healthy people participated in this study. To evaluate the discriminant validity, we assessed the ability of the FreBAQ to discriminate between people with and without LBP. After an interval of 1 week, 25 patients with CLBP completed the questionnaire in the retest session. Data obtained from the first test administration were used for internal consistency and data obtained from repeated testing were used for test-retest reliability. Construct validity was assessed by investigating a correlation between the FreBAQ with the Roland-Morris Disability Questionnaire (RDQ), Visual Analog Scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale, and Tampa Scale of Kinesiophobia. In addition, the construct validity of Persian FreBAQ was measured by factor analysis. RESULTS: The test-retest reliability of the questionnaire was confirmed by intraclass correlation coefficient = 0.96. Cronbach's alpha was 0.74 for Persian FreBAQ. The standard error of measurement and minimal detectable change were 0.91 and 2.52, respectively. Construct validity was demonstrated by statistically significant relationship between the Persian FreBAQ and questionnaires of PCS (P < 0.001) and RDQ (P = 0.01). CONCLUSION: The Persian version of FreBAQ is a valid and reliable measurement tool for evaluating back perception changes in Persian-speaking patients with LBP.

Evaluating the short term effects of kinesiology taping and stretching of gastrocnemius on postural control: A randomized clinical trial.

INTRODUCTION: The ability to maintain balance is essential for both remaining in the standing position and preventing falls. Physical therapy techniques such as kinesiology taping (KT) and stretching are considered to be effective measures in ameliorating balance issues. However, there is no available study comparing the effects of these two methods on postural control. Thus, the current study aims to investigate and compare the efficacy of interventions accomplished through these methods on young and elderly subjects. METHOD: In a single-blind randomized clinical trial, 40 young subjects (<30 years) and 40 elderly subjects (>60 years) were randomly assigned to two groups of KT and stretching. In the first group, inhibitory tape was applied to the gastrocnemius muscle. In the second group, 60 s of stretch was repeated 4 times. The static balance was evaluated before and after the interventions using the single-leg standing (SLS) test along with measurements of the velocity and displacement of the center of pressure by the force plate. RESULTS: Based on the Mann-Whitney test, there were no significant differences between the tape and stretching techniques in the study variables of either group of participants, before and after the interventions (p > 0.05). However, the results of the Wilcoxon test showed a significant increase in single-leg stance time in the stretching group in the elderly subjects (p = 0.03). MANOVA results demonstrated significant group and time effects only in the SLS parameter (p < 0.05). CONCLUSION: Stretching the gastrocnemius seems to be more efficacious than KT for improving balance problems in older adults. LEVEL OF EVIDENCE: II.

The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature.

Various studies have investigated the effect of noninvasive brain stimulation methods such as transcranial direct stimulation (tDCS) on postural control in healthy young and older adults. However, the use of different treatment protocols and outcome measures makes it difficult to interpret the research results. This systematic review provides a comprehensive overview of the current literature on the effect of tDCS on postural control. Nine databases were searched for papers assessing the effect of tDCS on postural control in young healthy and/or older adults. The data of included studies were extracted and methodological quality examined using PEDro. Sixteen studies met the inclusion criteria. The results showed that anodal tDCS (a-tDCS) of primary motor cortex may improve dynamic balance in young healthy individuals. In older adults, a-tDCS of dorsolateral prefrontal cortex and cerebellum showed a positive effect on dual task and dynamic balance, respectively. In conclusion, tDCS may improve both static and dynamic balance in younger and older adults. However, due to lack of consensus in the results, caution is required when drawing conclusions with regards to these findings.

Effect of Pulsed Electromagnetic Fields on Clinical Signs and Quality of Life in Patients with Hemophilic Arthropathy of the Knee Joint: A Randomized Controlled Trial.

BACKGROUND: Hemophilic arthropathy (HA) causes severe joint damage and impairs the quality of life (QoL) of hemophiliacs. This study was undertaken to evaluate the effect of pulsed electromagnetic fields (PEMFs) on the clinical signs and QoL of patients with severe hemophilia A experiencing moderate HA in the knee joint. MATERIALS AND METHODS: Thirty-six severe hemophiliacs with HA of the knee joint were randomly assigned into the PEMF (n = 20) or placebo (n = 16) groups. The PEMF group received 60 min of PEMF (2 Hz, 25 Gauss for 30 min and 70 Hz, 30 Gauss for 30 min) on the knee joint, three times per week for 6 weeks. The clinical signs, QoL, and pain intensity were measured by the Hemophilia Joint Health Score, A36 Hemofilia-QoL Questionnaire, and visual analog scale, respectively, before and after treatment. RESULTS: In the PEMF group, a significant difference before and after intervention in terms of clinical signs, QoL, and pain intensity (P < 0.05) was founded. Between-group analysis showed a significant improvement in clinical signs (except for atrophy, strength, and swelling duration), QoL, and pain intensity in the PEMF versus control group (P < 0.05). CONCLUSIONS: PEMF can improve the clinical signs, QoL, and pain intensity of severe hemophilia A patient with moderate knee hemophilic arthropathy.

Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review.

AIMS: To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP). DATA SOURCES: Six databases were searched from inception to January 2016. REVIEW METHODS: Aquatic studies for children aged 1-21 years with any type or CP classification and at least one outcome measuring gross motor skills were included. Information was extracted on study design, outcomes, and aquatic program type, frequency, duration, and intensity. Quality was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale. RESULTS: Of the 11 studies which met inclusion criteria, only two used randomized control trial design, and the results were mixed. Quality of evidence was rated as moderate to high for only one study. Most studies used quasi-experimental designs and reported improvements in gross motor skills for within group analyses after aquatic programs were held for two to three times per week and lasting for 6-16 weeks. Participants were classified according to the Gross Motor Function Classification System (GMFCS) levels I-V, and were aged 3-21 years. Mild to no adverse reactions were reported. CONCLUSIONS: Evidence on aquatic interventions for ambulatory children with CP is limited. Aquatic exercise is feasible and adverse effects are minimal; however, dosing parameters are unclear. Further research is needed to determine aquatic intervention effectiveness and exercise dosing across age categories and GMFCS levels.

The comparison of spinal curves and hip and ankle range of motions between old and young persons.

BACKGROUND: Falls have been strongly associated with decreased physical activity and impaired mobility. Reduced range of motion, as a consequence of muscle stiffness, has been indicated to assume a positive relationship to fall incidence. Also clinical observations suggest that maintaining the normal spinal curves is associated with the prevention of spinal, knee and hip disorders. Thus, the aim of this study was to compare hip and ankle range of motions and thoracic and lumbar curves between young and old persons Methods: Using a nonprobability sampling 30 elderly persons at average of 68.14 ±4.03 years of age and 30 young people (age 23.37 ± 2.31 years) through a case - control design participated in the study. Maximal hip extension and ankle dorsiflexion range of motions were measured by a standard goniometer. Thoracic and lumbar curvatures were measured by a flexible ruler in both groups. Independent t test were used to statistically analyze differences between groups. RESULTS: Compared with the young group, the elderly group had decreased hip extension and ankle dorsiflexion motions (p<0.01). The result of independent t test showed that the mean of lumbar curve was higher in young group (31.29± 6.37) than elderly subjects (27.93±8.11) ,however, no significant difference was found between two groups (p=0.08). The result also showed increasing thoracic curvature with aging (young group=34.43±13.27, old group= 36.19±8.97), however, no significant difference was found between two groups CONCLUSION: Findings suggest decreased ankle and hip joint range of motions should be considered in rehabilitation of elderly people.

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults.

FES-I has been designed to assess fear of falling (FoF). The purpose of this study was to establish the Persian-language version of the FES-I and to assess its psychometric properties under different modes of administration: self-report and interview-based. Participants included 191 elderly people aged over 60 who were mostly community dwelling. With an interval of 14 days, 97 volunteers completed the questionnaire in the retest session. To evaluate the construct validity, we assessed the ability of the FES-I to discriminate people based on gender, level of education, number of falls and FoF. The correlation with the Short Form of Health Survey (SF-36), Timed Up and Go (TUG) and Functional Reach Test (FRT) was also determined to test validity. Internal consistency was excellent in both self-report (0.93) and interview (0.92) versions. All intra-class correlations (ICCs) were above 0.70 with the highest reliability obtained for the condition where the interview based FES-I was used in both test and retest sessions. The strength of correlation between the FES-I and TUG varied based on mode of administration: moderate for interview and high for self-report mode. The FES-I had a higher correlation with the SF-36 subscales of physical health than subscales of mental health. The FES-I had the ability to discriminate the participants based on gender, educational level, and number of falls and FoF. In conclusion, both interview and self-report versions of the FES-I demonstrated acceptable measurement properties to assess FoF in Iranian elderly persons.