Three-dimensional exergaming conjunction with vestibular rehabilitation in individuals with Benign Paroxysmal Positional Vertigo: A feasibility randomized controlled study.

BACKGROUND: To examine the effectiveness of 3D (dimensional)-vestibular rehabilitation therapy (VRT) on gait, balance problems, processing time speed and subjective complaints in patients with Benign Paroxysmal Positional Vertigo (BPPV) compared to a control group (CG). This study aimed to test the feasibility of virtual reality-based 3D exergaming conjunction with vestibular rehabilitation. METHODS: Twenty-two patients with BPPV (negative DixHallpike/Roll test results, existing dizziness/balance complaints) were randomly allocated to the study group (SG, n:11 3D-VRT) or Control group (CG n:11, no exercise-rehabilitation) for 8 week. The SG performed 3D-VRT for 45 to 50 min/d, 3 times/wk, and the CG did receive only Canalith Repositioning Maneuver (CRM). CRM was applied in both groups before the study. Outcome measures included 10-Meter-Walk-Test (10-MWT) (with/without head turns), Dynamic Gait Index (DGI), Choice-Stepping-Reaction-Time-ped (CSRT-MAT), Fullerton Advanced Balance Scale (FAB), and Visual Analog Scale (VAS). RESULTS: The SG showed significantly improvement in 10-MWT without (p5 = 0.00,η2 = 0.49), with horizontal (p5 = 0.00,η2 = 0.57),vertical (p5 = 0.01,η2 = 0.48) head turns, DGI (p5 = 0.00,η2 = 0.74), CSRT-MAT, FAB (p5 = 0.00,η2 = 0.78) and VAS-dizziness (p5 = 0.00,η2 = 0.65), VAS-balance problem (p5 = 0.00,η2 = 0.43), VAS-fear of falling (p5 = 0.00,η2 = 0.42) compared to the CG. CONCLUSION: The 3D-VRT were effective in improving gait, balance, processing speed and resolving the subjective complaints in BPPV. The 3D-VRT method is feasible for patients who suffer from residual dizziness or balance complaints after CRM. Furthermore, the 3D-VRT is more accessible and less expensive than other virtual reality applications, which may facilitate further research or clinical use.

Assessment of proprioception, muscle strength and endurance during dynamic isokinetic test in patients with breast cancer-related lymphedema.

BACKGROUND: Breast cancer-related lymphedema is a common complication after breast cancer treatment.This study examined isokinetic proprioception, muscular strength, and endurance by comparing extremity with lymphedema and the extremity without lymphedema in women with breast cancer-related lymphedema. METHODS: A total of 15 individuals aged between 35 and 70 years participated in this study. Cybex Humac NORM Isokinetic dynamometer (CSMi, Stoughton, MA) were used to assess upper extremity passive proprioception, active proprioception, kinesthesia, muscle strength, and muscle endurance. The upper extremity lymphedema was measured with the water displacement arm volumetry test using a volumeter. FINDINGS: All isokinetic measurements demonstrated a statistically significant difference between the extremity with lymphedema and the extremity without lymphedema, suggesting lower scores in the extremity with lymphedema (p < .05). There was a positive correlation between passive internal rotation in the extremity with lymphedema and the time after mastectomy (r= 0.628, p = .012) and a moderate positive relationship was found between the time after lymphedema and passive internal rotation (r = 0.577; p = .024), and active external rotation position sense (r = 0.540; p = .038) in the extremity with lymphedema. Also, a unidirectional positive moderate (r = 0.594; p = .020) relationship was found between the lymphedema stage and passive external rotation in the extremity with lymphedema. INTERPRETATION: The difference in proprioception, muscle strength, and endurance between the extremity with lymphedema and the extremity without lymphedema in women with breast cancer-related lymphedema will provide valuable information in terms of prioritizing these parameters in treatment.

Fall history in older adults impacts acceleration profiles after a near collision with a moving pedestrian hazard.

BACKGROUND: Environmental hazards (e.g., pedestrian traffic) cause falls and testing environment impacts gait in older adults. However, most fall risk evaluations do not assess real-world moving hazard avoidance. AIMS: This study examined the effect of fall history in older adults on acceleration profiles before, during, and after a near collision with a moving hazard, in laboratory and real-world settings. METHODS: Older adults with (n = 14) and without a fall history (n = 15) performed a collision avoidance walking task with a sudden moving hazard in real-world and laboratory settings. Gait acceleration and video data of participants' first-person views were recorded. Four mixed effects multilevel models analyzed the magnitude and variability of mean and peak anteroposterior and mediolateral acceleration while walking before, during, and after the moving hazard in both environments. RESULTS: In the real-world environment, older adults without a fall history increased their mean anteroposterior acceleration after the moving hazard (p = 0.046), but those with a fall history did not (p > 0.05). Older adults without a fall history exhibited more intersubject variability than those with a fall history in mean (p < 0.001) and peak anteroposterior (p = 0.015) acceleration across environments and epochs. Older adults without a fall history exhibited a slower peak mediolateral reaction during the moving hazard (p = 0.014) than those with a fall history. CONCLUSIONS: These results suggest that compared to older adults with a fall history, older adults without a fall history are more adaptable and able to respond last-minute to unexpected hazards. Older adults with a fall history exhibited more homogenous responses.

Multitask Versus Multicomponent Training on Cognitive and Motor Functions in Persons With Mild Cognitive Impairment: A Randomized Trial.

This study aims to compare the effects of multitask (MTT; multiple tasks performed simultaneously) and multicomponent training (MCT; various types of exercise performed sequentially) on processing speed, cognitive functions, gait speed, and balance functions in persons with mild cognitive impairment. Forty-two persons with mild cognitive impairment were randomly allocated to MTT (n = 21) or MCT (n = 21). Outcome measures included processing speed, cognitive functions (attention and executive functions), single-task gait speed, dual-task gait speed (DTGS-Arithmetic and DTGS-Verbal), and balance functions. Processing speed (except inhibition), cognitive functions, gait speed, and balance functions improved in the MTT and MCT groups following training, with no significant differences between the groups in processing speed or cognitive functions. The MCT group improved more on single-task gait speed (F = 15.097; p = .000; r = .270) and DTGS (DTGS-Arithmetic; F = 10.594; p = .002; r = .214), while the MTT group improved more on balance functions (F = 4.366; p = .043; r = .101). MTT and MCT strategies can be used to improve cognitive and physical outcomes in persons with mild cognitive impairment.

Dual-tasking impacts gait, cognitive performance, and gaze behavior during walking in a real-world environment in older adult fallers and non-fallers.

INTRODUCTION: Everyday walking often involves simultaneous performance of a cognitive task in environments with competing auditory and visual stimuli. Previous research has not evaluated task performance in these situations, where older adults are known to fall, limiting our understanding of how older adults adjust their gait, visual scanning (gaze), and cognitive processing to avoid falls (or not). The purpose of this study was to examine the effect of dual-task walking in a high-distraction real-world environment on cognitive performance, gait performance, and gaze behavior in older adult fallers relative to non-fallers. METHODS: Fourteen community-dwelling, older adult fallers (76.6 ± 9.1 years, 11 females) and 15 community-dwelling, older adult non-fallers (77.4 ± 7.6 years, 11 females) participated. Participants performed single-task walking, single-task cognitive (seated category naming), and dual-task walking (category naming + walking) trials for 1 min each in a real-world environment (busy hospital lobby). Gait speed, stride length variability, stride duration variability, gaze fixation duration on 6 areas of interest (AOIs), and percentage of time fixating on 6 AOIs were recorded during single- and dual-task walking trials. Number of correct responses, time to first response, and mean subsequent response time (measure of rate of decline of response retrieval throughout trial) were determined for single-task cognitive and dual-task walking trials. Two-way MANCOVAs and MANOVAs were used to compare the effects of fall status and task condition on gait and cognitive variables. Hierarchical linear regression models were used to assess predictors of gaze behavior variables. RESULTS: Compared to single-task, during dual-task trials, participants walked 0.21 m/s slower, had 1.5 fewer verbal responses, and a 2823 ms shorter mean subsequent response time, indicating a faster declining rate of retrieval during the cognitive task. Additionally, during dual-task walking, participants fixated their gaze on Far People (AOI) for a significantly smaller percentage of time and on the Near Walking Path (AOI) for a significantly greater percentage of time than during single-task walking. During all trials, being a non-faller predicted a longer average fixation duration on the Far Environment (AOI) than for fallers. Environmental busyness, baseline gait speed, and baseline executive function impacted gaze behavior. CONCLUSION: All participants exhibited dual-task decrements in gait and cognitive performance and changes in gaze behavior from single- to dual-task walking. Perhaps of more importance, non-fallers appear to have had more freedom to divert their gaze to less relevant environmental stimuli while walking, and two measures of fall risk impacted patterns of gaze behavior differently. Thus, overt visual attention during walking in real-world environments should be further explored in relation to fall risk.

Boxing training in patients with stroke causes improvement of upper extremity, balance, and cognitive functions but should it be applied as virtual or real?

Background: Upper extremity hemiparesis is one of the most common post-stroke disabilities requiring rehabilitation. Objective: To compare the effects of virtual and real boxing training in addition to neurodevelopmental treatment on the upper extremity, balance, and cognitive functions in hemiparetic stroke patients. Methods: Forty hemiparetic stroke patients were assigned to either real boxing group-RBG (n=20) or virtual boxing group-VBG (n=20), for a total of 24 sessions (3 sessions/week for 8 weeks). The primary outcome was upper extremity motor ability (Wolf Motor Function Test-WMFT). The secondary outcomes were arm-hand dexterity (Manual Dexterity Test-MMDT), goal-oriented performance (Video Boxing Analysis-VBA), balance functions (Fullerton Advanced Balance Scale-FAB-T), and cognitive functions (Addenbrooke's Cognitive Examination-Revised-ACE-R). Results: There was small treatment effect on ACE-R, small-medium effect for WFMT and MMDT and large effect on bilateral punching time [VBA (Cohen's d- VBG=0.83; RBG=0.95)] and balance [FAB-T (Cohen's d - VBG=0.89; RBG=0.82)] after treatment in both groups. No significant differences were found for training effects between the groups for upper extremity functions [WMFT (p=0.799; Cohen's d=-0.07), MMDT-PT (p=0.327; Cohen's d=-0.10), MMDT-THTPT (p=0.779; Cohen's d=-0.17) and VBA bilateral punch number (p=0.068; Cohen's d=0.15)], balance functions [FAB-T (p=0.602; Cohen's d=-0.19)] and cognitive functions [ACE-R total (p=0.947, Cohen's d=0.09)]. Conclusion: The study showed that virtual and real boxing training methods, in addition to neurodevelopmental treatment, are effective in improving upper extremity, balance, and cognitive functions in patients with hemiparetic stroke. The training effects were higher on bilateral punching time and balance functions for both groups. There was no superiority of either approach.

Effect of the environment on gait and gaze behavior in older adult fallers compared to older adult non-fallers.

INTRODUCTION: Compared to controlled laboratory settings, the real world is highly distracting with constant demands on visual attention to avoid hazards and falling. Fall-risk assessments do not adequately take into account the potential role of everyday distractions and environmental hazards. The purpose of this project was to identify the effect of the environment on gait and gaze behavior during walking in older adult fallers relative to non-fallers. METHODS: Thirteen older adult fallers (76.8±9.4 years, 3.2±2.3 falls in last year) and 13 age-matched non-fallers (78.3±7.3 years, 0 falls in last year) participated. Participants walked in a real-world and lab setting while gait and gaze were recorded. Gait variables were stride length variability, stride duration variability, and stride velocity. Gaze was analyzed for percentage of time fixating and average fixation duration coded across 6 areas of interest (AOIs) in the visual surroundings. RESULTS: Non-fallers walked faster than fallers, but there were no other group or environment effects on gait. For gaze behavior, fallers had shorter fixation durations on the near environment than non-fallers, but only in the real world. In the real world relative to the lab, fallers decreased fixation durations on the near environment but increased durations on near people. In the real world, participants spent a greater proportion of time fixating on people than on the walking path or the near environment compared to the lab. After adjusting for baseline gait speed, fallers had shorter fixation durations than non-fallers in both environments. CONCLUSIONS: Our results indicate that in a busy environment, older adults concentrate most of their overt visual attention on people when navigating their walking path. Fallers in particular focus longer on people near to them and have overall shorter fixations than non-fallers. Visual focus while walking in a busy environment should be further explored as a fall-risk factor.

The Effectiveness of Kinesio Taping in Recovering From Delayed Onset Muscle Soreness: A Crossover Study.

CONTEXT: Kinesio taping (KT) is a popular taping technique used in the recovery process; however, in the relevant literature, there is no real consensus on its efficacy. OBJECTIVE: To investigate whether rectus femoris KT application after delayed onset muscle soreness enhances recovery of muscle soreness, edema, and physical performance. PARTICIPANTS: A total of 22 healthy amateur male athletes participated in this study. DESIGN: Randomized, crossover study. SETTING: Human performance laboratory of the university. INTERVENTIONS: Participants performed an exercise protocol inducing delayed onset muscle soreness. They accomplished 2 distinct trials, with or without KT. The washout period between trials was 6 weeks. For the KT condition, KT inhibition technique was used and applied immediately after exercise bilaterally on rectus femoris. MAIN OUTCOME MEASURES: Range of motion, muscle soreness, and edema were measured at baseline, 30 minutes, 24, 48, and 72 hours postexercise. Dynamic balance, sprint, and horizontal jump were evaluated at similar time frame except for 30-minute postexercise. RESULTS: The findings showed that there were no significant differences between the KT group (KTG) and control group for all outcome variables (P > .05). Muscle soreness returned to baseline values 72 hours postexercise only within the KTG (P > .05). Although the horizontal jump performance decreased substantially from baseline to 24 and 48 hours postexercise only within the control group (P < .05), the performance increased significantly from 24 to 72 hours postexercise within the KTG (P < .05). Balance increased significantly from baseline to 48 hours postexercise (P < .05) in both groups. Balance also increased significantly from baseline to 72 hours postexercise only within the KTG (P < .05). The effect size of soreness which is our primary outcome was large in both groups (r > .5). CONCLUSIONS: KT is favorable in the recovery of muscle soreness after delayed onset muscle soreness. KT has beneficial effects on horizontal jump performance and dynamic balance.

Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals.

BACKGROUND: Hypertension (HT) contributes substantially to poor physical function, cognitive dysfunction, cardiovascular problems and to all-cause mortality. Performance in activities requiring attention, speed and coordination might also be affected in individuals with HT. OBJECTIVE: This study compared the processing speed, static and dynamic balance, functional mobility and fear of falling between individuals with hypertension (HT group) and normotensive individuals (NT group). METHODS: One-hundred and twenty-eight individuals were included: NT group (n = 64) and HT group (n = 64). The Choice Stepping Reaction Time Test was used for the evaluation of processing speed, Single Leg Stance test for static balance evaluation, "Y" Balance Test for dynamic balance evaluation, Timed Up and Go test with single and dual tasking for the evaluation of functional mobility and Falls Efficacy Scale for assessing fear of falling. RESULTS: The processing speed of the HT group was slower than that of the NT group; the total response time (RsT) in Stepping Reaction Test (SRT) (mean difference [MD] = -0.2, 95% CI = -0.3, 0), and Stroop Test (ST) [ST-A (MD = -0.4, 95% CI = -0.5, -0.2), ST-B (MD = -0.5, 95% CI = -0.7, -0.2) and ST-C (MD = -0.6, 95% CI = -0.8, -0.3). Additionally, the static [single leg stance, eyes open, right side (MD = 12.7, 95% CI = 6.3, 19.0) and left side (MD = 13.6, 95% CI = 7.2, 19.9)] and dynamic balance [Y balance test, composite score, right lower extremity (MD = 8.5, 95% CI = 4.4, 12.5) and left lower extremity (MD = 5.2, 95% CI = 1.5, 8.8) scores of the HT group were lower than those of the NT group. The HT group required a longer time to complete the functional mobility test measured with Timed Up And Go Test during both single task (MD = -0.8, 95% CI = -1.1, -0.4), cognitive dual task (MD = -1.5, 95% CI = -2.4, -0.5) and manual dual task (MD = -0.9, 95% CI = -1.3, -0.4) in comparison to the NT group. Also, the HT group had higher levels of fear of falling (MD = -7.6, 95% CI = -10.9, -4.2). CONCLUSION: Hypertensive individuals present slower processing speed, reduced static and dynamic balance, decreased functional mobility and higher fear of falling in comparison to normotensive individuals.

A comparison of physical characteristics, functions and quality of life between breast cancer survivor women who had a mastectomy and healthy women.

BACKGROUND: The quality of life of breast cancer survivors who had a mastectomy may decrease due to potential physical problems and reduced upper extremity functions. OBJECTIVE: This study aimed to compare the physical characteristics, upper extremity functions and quality of life of breast cancer survivors and healthy women. METHODS: A total of 66 women participated in this study: breast cancer survivors (n= 33) and healthy counterparts (n= 33) participated in this study. The Lateral Scapular Dyskinesia Slide Test was used to evaluate scapular dyskinesia, the hand-held dynamometer was used to measure upper extremity muscular strength, the Angle Reproduction Test was used to measure upper extremity position sense, the Disabilities of the Arm, Shoulder and Hand questionnaire was used to assess upper extremity functions, and the Short Form-36 was used to assess the quality of life. RESULTS: The findings showed that the prevalence of scapular dyskinesia was higher, whereas upper extremity muscle strength, shoulder joint position sense, upper extremity functions and many sub-dimensions of quality of life were reduced in breast cancer survivor women compared to the healthy women (p< 0.05). CONCLUSIONS: Several physical characteristics, upper extremity functions and quality of life of breast cancer survivor women who had a mastectomy were affected more in comparison to healthy women. Thus, these parameters should be included in physiotherapy assessment and treatment programs.

The comparison of clinical and computerized measurement of sitting balance in stroke patients and healthy individuals.

BACKGROUND: Balance problems are common after stroke. OBJECTIVE: The aims of this study was to compare the results of computerized and clinical sitting balance measurements in stroke patients and healthy individuals and to identify the agreement and relationship between the two measurement methods in stroke patients. METHODS: This study included 30 chronic stroke patients and 30 age-matched healthy individuals. A force platform chair was used for the computerized and the Function in Sitting Test (FIST) was used for the clinical sitting balance measurement. RESULTS: The sitting balance of the stroke patients, measured with computerized and clinical measurements, were still affected in the chronic phase. The CoP deviation (eyes-open and eyes-closed) was higher whereas the FIST score was lower in the stroke group than the healthy group (p < 0.05). The computerized sitting balance measurements [eyes-open (r = -0.177, p = 0.349) and eyes-closed (r = -0.294, p = 0.114)] CoP deviation was not correlated with the FIST scores (p < 0.05). However, there was an excellent agreement (96.6%) between the methods. CONCLUSION: The results of this study implies that both the computerized and clinical sitting balance measurements can be used objectively for the assessment of sitting balance but the computerized methods might be preferable due to requiring shorter time with less intra-tester variability.

The reliability and validity of the Turkish version of Fullerton Advanced Balance (FAB-T) scale.

PURPOSE: The aim of this study was to evaluate the reliability and validity of the Turkish version of the FAB(FAB-T) scale in the older Turkish adults. METHODS: The reliability and validity of the scale was tested on 200 community-dwelling older adults. FAB-T scale was scored by different physiotherapists on different days to evaluate inter-rater and intrarater reliability. The Berg Balance Scale (BBS) was used for the evaluation of convergent validity, and the content validity of the FAB-T scale was investigated. RESULTS: The FAB-T scale showed very high inter- and intra-rater reliability. For inter-rater agreement, on the individual test items and total score ICC values were 0.92 (95 %CI; 0.90-0.94) and 0.96 (95% CI; 0.95-0.97) respectively. The intra-rater agreement, on the individual test items and total score ICC values were 0.93 (95 %CI; 0.91- 0.95) and 0.96 (95% CI; 0.95- 0.97) respectively. There was a good agreement between the FAB-T and BBS scales. A high correlation was found between the BBS and FAB-T scales [rho = 0.70 (%95 CI; 0.62-0.76)] indicating good convergent validity. Considering the content validity of the FAB-T scale, no floor (floor score: 0%) or ceiling (ceiling score: 6.5%) effect was detected. CONCLUSION: The FAB-T scale was successfully translated from the original English version (FAB) and demonstrated strong psychometric features. It was found that the FAB-T scale has very high inter-rater and intra-rater reliability. Considering the convergent validity, the scale has high correlation with the BBS. The FAB-T has no floor and ceiling effect.

Evaluation of the physical activity level, nutrition quality, and depression in patients with metabolic syndrome: Comparative study.

Metabolic syndrome (MetS) is a complex problem that contains risk factors related with obesity, cardiovascular diseases, and type-II diabetes. The incidence of MetS is increasing every year throughout the world.The aim of this study was to evaluate and compare physical activity levels, nutrition quality, and depression status of the individuals who are diagnosed with and without MetS.International Physical Activity Questionnaire (IPAQ), Mediterranean Diet Adherence Screener (MEDAS), Beck Depression Inventory (BDI) was used. In addition, biochemical analysis and anthropometric measurements were also taken.According to IPAQ, 81.1% of the MetS group is inactive, 6.8% is active, and 5.1% is highly active, whereas 22.3% of the non-MetS group is inactive, 46.2% is active, and 31.5% is highly active. MEDAS was found to be lower in the MetS group. BDI levels were also determined high in the MetS group.Sedentary lifestyle, depression, and unhealthy nutrition habits are among the significant factors for the development of MetS. The knowledge levels of the people should be increased by developing national physical activity and nutrition guidelines.

Effects of Physical Exercise Interventions on Dual-Task Gait Speed Following Stroke: A Systematic Review and Meta-Analysis.

OBJECTIVES: To estimate the treatment effects of exercise and/or gait training interventions on dual-task walking in people with stroke. The secondary objective was to conduct subgroup analyses to compare the treatment effects of interventions involving dual-task training to those without any dual-task training. DATA SOURCES: A systematic search of the literature was conducted in 6 databases (PubMed, CINAHL, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database) up to July 18, 2017. STUDY SELECTION: Randomized controlled trials (RCTs), nonrandomized controlled trials, or uncontrolled studies involving individuals with stroke and examining the effects of exercise and/or gait training interventions on dual-task gait speed. DATA EXTRACTION: We extracted data on participant characteristics, intervention duration, frequency, and type; pre and post gait speed and secondary nongait task performance for single and dual-task conditions, types of tasks used for dual-task assessment and dual-task prioritization instructions. DATA SYNTHESIS: Of 313 articles identified, 7 studies involving 12 independent treatment arms (n=124) met the inclusion criteria. There was a significant pre-post intervention increase in dual-task gait speed (MD: 0.03m/s, 95% CI: 0.01, 0.06) and single-task gait speed (MD: 0.06m/s, 95% CI: 0.03, 0.09). Dual-task training tended to have a larger effect on dual-task gait speed than interventions without dual-task training. Between-group analysis of three RCTs found evidence of superiority of dual-task gait training over single-task gait training for improving dual-task gait speed (MD: 0.08m/s, 95% CI: 0.02, 0.14). CONCLUSIONS: Exercise and gait training interventions, especially those involving dual-task practice, may improve dual-task gait speed after stroke, but the clinical significance is unclear. Current effect size estimates lack precision due to small sample sizes of existing studies.