New Directions to Approach Oxidative Stress Related to Physical Activity and Nutraceuticals in Normal Aging and Neurodegenerative Aging.

Oxidative stress (OS) plays, perhaps, the most important role in the advanced aging process, cognitive impairment and pathogenesis of neurodegenerative disorders. The process generates tissue damage via specific mechanisms on proteins, lipids and nucleic acids of the cells. An imbalance between the excessive production of oxygen- and nitrogen-reactive species and antioxidants leads to a progressive decline in physiological, biological and cognitive functions. Accordingly, we need to design and develop favourable strategies for stopping the early aging process as well as the development of neurodegenerative diseases. Exercise training and natural or artificial nutraceutical intake are considered therapeutic interventions that reduce the inflammatory process, increase antioxidant capacities and promote healthy aging by decreasing the amount of reactive oxygen species (ROS). The aim of our review is to present research results in the field of oxidative stress related to physical activity and nutraceutical administration for the improvement of the aging process, but also related to reducing the neurodegeneration process based on analysing the beneficial effects of several antioxidants, such as physical activity, artificial and natural nutraceuticals, as well as the tools by which they are evaluated. In this paper, we assess the recent findings in the field of oxidative stress by analysing intervention antioxidants, anti-inflammatory markers and physical activity in healthy older adults and the elderly population with dementia and Parkinson's disease. By searching for studies from the last few years, we observed new trends for approaching the reduction in redox potential using different tools that evaluate regular physical activity, as well as antioxidant and anti-inflammatory markers preventing premature aging and the progress of disabilities in neurodegenerative diseases. The results of our review show that regular physical activity, supplemented with vitamins and oligomolecules, results in a decrease in IL-6 and an increase in IL-10, and has an influence on the oxidative metabolism capacity. In conclusion, physical activity provides an antioxidant-protective effect by decreasing free radicals and proinflammatory markers.

Tensiomyography and Statistical Analysis Based Muscle Change Detection in Multiple Sclerosis for Smart Healthcare.

The impact of demyelinization on muscle fiber changes and the type of changes in multiple sclerosis (MS) is very hard to estimate. One of the major problems of MS patients is muscle fatigue and decrease of muscle force in the range of 16-57%. The objective of this research work is to estimate various aspects of muscle changes at tibial muscle (mTA) level using a noninvasive method named as tensiomyography (TMG). TMG provides information about muscle functions in MS. This study includes 40 MS patients among which 18 are males (45%) and 22 are females (55%). They are divided in two subgroups: subgroup A and subgroup B. Subgroup A includes 20 MS patients without clinical decelable gait disorders and subgroup B includes 20 MS patients with clinical decelable gait disorders. Also, we have a control group that includes 20 healthy people with the same average age. Average age is 38.15 ± 11.19 y for MS patients and 39.34 ± 10.57 for healthy people. Evaluation measures include ADL score and EDSS scale. The ADL score is 0 for patients from subgroup A and 1 for patients from subgroup B. The EDSS score is 1 for subgroup A and 2.5 for subgroup B. This study confirms the importance of TMG based evaluation of muscle changes in MS patients. This smart healthcare system is also used for prediction of the muscle changes and muscle imbalance. Contraction time (Tc) recordings are used to detect the muscle fatigue which is a specific symptom of MS. The value of Tc for subgroup A is 45.8 ms and subgroup B is 61.37 ms for right side. Analysis of these two parameters such as Dm and Tc could define the muscle behaviour and help provide early information about the possibility of developing gait disorders. This smart TMG system analyses the muscle tone in the best possible way to predict the onset of any diseases which is an integral part of the smart healthcare system.

Balance Rehabilitation Approach by Bobath and Vojta Methods in Cerebral Palsy: A Pilot Study.

In cerebral palsy (CP) the basis for rehabilitation comes from neuroplasticity. One of the leading therapeutic approaches used in the management of CP is the NDT Bobath therapy and Vojta therapy consists in trying to program the ideal movement patterns for the age. The aim of our research was to analyze, from a functional point of view, the evolution of the biomechanical parameters characterizing the balance, in children with CP. The group of 12 subjects average age of 7 ± 3.28 years. The subject's evaluation included a functional clinical evaluation by Berg pediatric scale and a biomechanical evaluation performed using the "Stabilometry footboard PoData 2.00" for evaluation the body weight distribution on the foot level. The rehabilitation program was developed based on two methods, NDT Bobath and Vojta. A 90-min physiotherapy session starts with a Vojta therapy activation, for 20 min. Between the two therapies there is a 10-min break, then the session continues with NDT Bobath exercises within the 3 physical exercises proposed for 60 min. 5 days per week, 6 months. The analysis of the data collected before and after the application of the rehabilitation program, regarding the using the Berg scale indicates a progress of 32.35%, (p = 0.0001 < 0.05) and the effect size is large. The evolution of the data that indicate the distribution of body weight at the level of the two lower limbs, at the two moments pre/post, evaluation. For left side a progress of 8.39%, (p = 0.027 < 0.05) but a small effect size of 0.86. For right side a progress of 10.36% (p = 0.027 < 0.05) and also a small effect size of 0.86. Analyzing the results, we find that there is a left-right rebalancing in most patients. The favorable results that were obtained by drawing up a physiotherapy program composed of the combination of the two Vojta and NDT Bobath methods are proof of the fact that both methods are based on the creation of a stimulating peripheral pressure, which, if maintained, generates an extended stereotyped motor response. A pattern of symmetrical muscle contraction is thus created and thus balance and postural control can be achieved. The left-right rebalancing, proven by the percentage distribution analysis of the weight at the lower segmental level, demonstrated that the body alignment approach through the Vojta method on the one hand and the inhibitory facilitating postures/exercises promoted by the NDT Bobath method, allows obtaining a symmetry.

Physical Activity Design for Balance Rehabilitation in Children with Autism Spectrum Disorder.

One of the characteristics of autism spectrum disorder (ASD) subjects is postural control deficit, which is significant when somatosensory perception is affected. This study analyzed postural stability evolution after physical therapy exercises based on balance training. The study included 28 children with ASD (average age 8 years, average weight 32.18 kg). The rehabilitation program involved performing balance exercises twice a week for three months. Subject assessment was carried out using the RSScan platform. The parameters were the surface of the confidence ellipse (A) and the length of the curve (L) described by the pressure center, which were evaluated before and after the rehabilitation program. Following data processing, we observed a significant decrease in the surface of the confidence ellipse by 92% from EV1 to EV2. Additionally, a decrease of 42% in the curve length was observed from EV1 to EV2. A t test applied to the ellipse surface showed a p = 0.021 and a Cohen's coefficient of 0.8 (very large effect size). A t test applied to the length L showed p = 0.029 and Cohen's coefficient of 1.27 mm. Thus, the results show a significant improvement in the two parameters. The application of the program based on physical exercise led to an improvement in the balance of children with autism under complex evaluation conditions.

Monitoring the Role of Physical Activity in Children with Flat Feet by Assessing Subtalar Flexibility and Plantar Arch Index.

Flat foot is a common pediatric foot deformity which involves subtalar flexibility; it can affect the plantar arch. This study analyzes the evolution of two parameters, i.e., plantar index arch and subtalar flexibility, before and after physiotherapy and orthoses interventions, and examines the correlation between these two parameters. METHODS: The study included 30 participants (17 boys, 12 girls, average age 9.37 ± 1.42 years) with bilateral flat foot. We made two groups, each with 15 subjects. Assessments of the subtalar flexibility and plantar arch index used RSScan the platform, and were undertaken at two time points. Therapeutic interventions: Group 1-short foot exercises (SFE); Group 2-SFE and insoles. Statistical analyses included Student's t-test, Cohen's D coefficient, Pearson and Sperman correlation. RESULTS: Group 1-subtalar flexibility decreased for the left and right feet by 28.6% and 15.9% respectively, indicating good evolution for the left foot. For both feet, a decrease of the plantar index arch was observed. Group 2-subtalar flexibility decreased for the right and left feet by 43.4% and 37.7% respectively, indicating a good evolution for the right foot. For both feet, a decrease of plantar index arch was observed. Between groups, subtalar flexibility evolved well for Group 2; this was attributed to mixt intervention, physical therapy and orthosis. For plantar arch index, differences were not significant between the two groups. We observed an inverse correlation between subtalar flexibility and plantar arch index. CONCLUSIONS: Improvement of plantar index arch in static and dynamic situations creates the premise of a good therapeutic intervention and increases foot balance and postural control. The parameter which showed the most beneficial influence was the evolution is subtalar flexibility.

Plantar Pressure and Contact Area Measurement of Foot Abnormalities in Stroke Rehabilitation.

BACKGROUND: Evaluation of plantar pressure in stroke patients is a parameter that could be used for monitoring and comparing how the timing of starting a rehabilitation program effects patient improvement. METHODS: We performed the following clinical and functional evaluations: initial moment (T1), intermediate (T2), and final evaluation at one year (T3). At T1 we studied 100 stroke patients in two groups, A and B (each 50 patients). The first group, A, started rehabilitation in the first three months after having a stroke, and group B started after three months from the time of stroke. Due to the impediments observed during rehabilitation, we made biomechanic evaluation for two lots, I and II (each 25 patients). Assessment of the patient was carried out by clinical (neurologic examination), functional (using the Tinetti Functional Gait Assessment Test for classifying the gait), and biomechanical evaluation (maximal plantar pressure (Pmax), contact area (CA), and pressure distribution (COP)). RESULTS: The Tinetti scale for gait had the following scores: for group A, from 1.34 at the initial moment (T1) to 10.64 at final evaluation (T3), and for group B, 3.08 at initial moment (T1) to 9 at final evaluation (T3). Distribution of COP in the left hemiparesis was uneven at T1 but evolved after rehabilitation. The right hemiparesis had uniform COP distribution even at T1, explained by motor dominance on the right side. CA and Pmax for lot I increased more than 100%, meaning that there is a possibility for favorable improvement if the patients start the rehabilitation program in the first three months after stroke. For lot II, increases of the parameters were less than lot I. DISCUSSIONS: The recovery potential is higher for patients with right hemiparesis. Biomechanic evaluation showed diversity regarding compensatory mechanisms for the paretic and nonparetic lower limb. CONCLUSIONS: CA and Pmax are relevant assessments for evaluating the effects on timing of starting a rehabilitation program after a stroke.

Functional muscle balance assessment in multiple sclerosis.

BACKGROUND: Chronic demyelinisation in multiple sclerosis (MS) involves changes in the muscle structure and development of motor disorders. OBJECTIVE: The aim of this research is to assess the muscle balance of thigh muscle in MS using a noninvasive method, to have information about the muscle status prior to the rehabilitation and to prevent muscle damage. METHODS: The studied group consisted of 20 patients: 9 men and 11 women, with a mean age of 42 years. The patients were diagnosed with MS in different stages. The clinical evaluation included clinical examination, neurological examination, functional evaluation by using the Hamilton score, the activity daily living (ADL) scale and the Kurtze (EDSS) scale. For the muscle assessment we used tensiomyography (TMG), an evaluation method for the functional potential of the muscle, depending on the muscle composition. The TMG parameters are displacement (Dm), contraction time (Tc) and sustain time (Ts) for biceps femoris (mBF) and rectus femoris (mRF). RESULTS: The value of Dm shows low values for both studied muscle groups, but closer to the normal value for mBF. The average normal Tc values for mBF are 30.25 ± 3.5 ms and 32.83 ± 4.5 for mRF. The values are low values for mRF and high for mBF. The normal values of Ts are not standard values and can be compared healthy individuals' values. These parameters could monitor the evolution and in our research have lower values for mRF. In the thigh, there was a significant difference in the Dm values, with higher values in mBF and also with higher values in the right lower limb. Analyzing the Ts results, we noticed a difference between the two muscle groups with a significant reduction in mRF, showing the inability to achieve anterior-posterior symmetry and the tendency to develop type I fibers at mBF level. CONCLUSIONS: Our study showed the presence of a structural and functional asymmetry explained by the tendency of increasing the tonus at mRF level in order to compensate the knee stability. We noticed a decrease in Tc value at the mRF level, but close to the value of the two lower limbs. TMG analysis revealed the asymmetry of the muscle composition at the level of the antagonist muscle groups of the thigh, with an increase in the percentage of type II fibers in the previous group, which became hyperton, and a decrease in the percentage of type I fibers in the posterior group.

Morphofunctional changes in distribution of pressure center in multiple sclerosis.

INTRODUCTION: Gait evaluation and assessment of motor performance are of utmost importance in the clinical management of multiple sclerosis (MS). A new approach to the analysis of static and dynamic balance of MS patients is the use of complex biomechanical analysis that includes an analysis of the distribution of the center of pressure (DCP) and loading, measured by using the pressure and force platforms. PATIENTS AND METHODS: The study was conducted on a total of 18 patients with MS, with the mean age of 41.2 years old, divided into two groups, according to the presence of clinically detectable gait disturbances. The biomechanical analysis that included the assessment of the loading and DPC was performed using the platform of force distribution. DPC represented the center of all the forces applied and its value could appreciate the mediolateral stability, hence the pronation or, respectively, the supination. Group 1, consisting of 12 patients with MS with clinically detectable gait disorders, including six men and six women, and group 2, of six MS patients without clinically detectable gait disorders, including two men and four women. RESULTS: For group 1, the center of pressure had a left-right asymmetric distribution, and also an anterior-posterior one. There was a predominant distribution at the medial heel, at metatarsals 1-3 and at the hallux. For group 2, the analysis of the plantograms recorded in our study indicated a tendency of the distribution of the pressure center in the metatarsals 2, 3 and less in the heel. CONCLUSIONS: The analysis of the loading and distribution of the pressure center was important not only to appreciate the static equilibrium disorders but also to appreciate how these disorders affected the gait initiation, since the patients suffered from anterior-posterior and mediolateral disorders, which produced spatial and temporal distortion preventing gait initiation. In the study of pressure and force, we noticed a predominant distribution on the lateral region of the heel, explained by an attempt of the body to compensate the disorders of balance and orientation of the reaction force of the ground to normalize the gait.

Morphofunctional muscle changes influence on foot stability in multiple sclerosis during gait prediction: The rehabilitation potential.

BACKGROUND: Multiple sclerosis patients may suffer muscle changes that involve gait disorders of the kinetic and kinematic parameters also their gait may be clinically symmetrical or asymmetrical. OBJECTIVE: The aim of this study is to analyze how the muscle change, could affect the biomechanical parameters of foot stability during the gait, by disturb the motor control. METHODS: The study group consisted of 13 patients diagnosed with multiple sclerosis, presenting clinically detectable abnormal gait. The biomechanical evaluation included the foot axes and angles -external and internal rotation; the foot angle deviation from the gait direction; the subtalar angle. RESULTS: The values of the foot angle were between -10.74∘ to 26.38∘ for the left foot and between -11.16∘ to 30.04∘ for the right foot. The foot axis angle is the axis of the foot in relation to the gait direction, and the subtalar angle is in relation to the vertical axis of the foot. The rotation of the right foot into pronation during the initial contact phase was followed by supination in the semi-support phase, to return to the neutral position during the propulsion phase, which meant being in free zone of minimal risk. CONCLUSIONS: Biomechanical analysis of the foot angle and of subtalar angle in the patients with multiple sclerosis allows us to objectify the existence of a right-left asymmetry, the behavior ankle-foot during the gait. At the same time this evolution is closely correlated with the contact surface that tends to increase, which means involving the reflex mechanisms that place the foot in the zone of minimum risk and assure the stability of the body.

Prediction of motor disorders in multiple sclerosis using muscle change structure assessment.

INTRODUCTION: The neuropathogenesis of multiple sclerosis (MS) lesions has been explained by several mechanisms, which emphasize the unpredictable nature of these lesions. The aim of this study is to present the neuromuscular changes in MS at the patients without gait or motor disorders using a noninvasive method named tensiomyography (TMG). PATIENTS AND METHODS: The studied group included a number of seven MS patients without clinically detected gait disorders, with mean age of 33.28 years (min. 22 years-max. 60 years), diagnosed with progressive multiple sclerosis with relapses - three patients and with relapsing-remitting multiple sclerosis (RRMS). They have been evaluated using clinical, functional scales for evaluation and neuromuscular assessment using TMG parameters (displacement Dm, contraction time - Tc, delay time - Td, supporting time - Ts, relaxation time - Tr), for rectus femoris (mRF). RESULTS: The group with MS patients recorded functional asymmetries with higher values in the left lower limb. We determined Tc values lower than the minimum normally required, which meant that in the group with MS there was an increase in the percentage of type II fibers. Other TMG parameters show important difference between left and right side even if they do not have gait disorders. DISCUSSION AND CONCLUSIONS: These patients with MS underwent modifications in their muscle tone, muscle strength and other changes related to the presence or absence of muscle atrophy. The muscle tone could be affected by the muscle atrophy or hypertrophy. In conclusion, this type of assessment performs the non-invasive assessment of contractile properties of the muscles, without the integration of the tendon properties, joint mechanics or connective tissue in the mechanical response to muscle deformation produced by electrical stimulation.

Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation.

BACKGROUND: Multiple sclerosis (MS) is a disease of the central nervous system probably based on the autoimmune mechanism against myelin and the action of lymphocyte T. In the last 50 years, more than 150 descriptive studies regarding MS have focused on the etiopathogeny, treatment, diagnosis and prevention of the progressive evolution of MS. Most recently, studies in the field of rehabilitation and diagnosis have tried to present the postural aspects of control/foot and ankle control and gait pattern in MS. The aim of this study is focused on biomechanical foot analyses of MS patients. METHODS: Our clinical research and functional assessment was based on a scale like the EDSS/Kurtzke score: biomechanical foot assessment used the RSscan force plate to assess the foot loading, impulse and foot-ankle angle (subtalar angle), and pressure distribution methods for statistical analyses. The study included MS patients at the Neurologic Rehabilitation Unit, Craiova, we studied 48 patients (46.04 ± 10.99 years) diagnosed with MS. RESULTS: This study shows that the major lesion is to the pyramidal system and the average value for functionality index (EDSS score) is 3.03 ± 0.13, where 3 means easy paraparesis or hemiparesis. In considering postural strategies, we observed an instability left to right to be more evident in the swing phase and it influences the under the foot impulse for the next step and postural control. From the analysis of the data and pressure centre position, we can see that the high pressure is on metatarsian II to III and more or less at the heel. This means the development of an ankle strategy necessary to restore balance, stability and motor control cannot be assessed other than by clinical evaluation. Even if many physicians and physical therapists do use the functional scale in their daily assessment, it does not help us achieve a complex assessment of gait and lower limb behaviour during gait, nor does it provide information about the impact of gait on daily activities and on quality of life. CONCLUSIONS: Biomechanical assessment can help the clinician predict the functional evolution of MS patients without visible clinical gait disorders and allows the development of a strategy for rehabilitation to prevent an incorrect ankle/ankle and foot position, resulting in a lack of motor control.

Complex assessment in progressive multiple sclerosis: a case report.

UNLABELLED: The study presents the case of a patient with progressive multiple sclerosis in relapses (PPMS) and proposes a comprehensive neuromuscular and biomechanical evaluation in order to achieve a predictive picture of gait evolution and balance disorders with disease progression. PATIENT AND METHODS: The evaluation included: clinical, functional and neuromuscular evaluation by tensiomyography (TMG) and biomechanics (by RSscan platform force). Elements evaluated included the calf muscle groups (tibialis anterior and gastrocnemius) and the following parameters were assessed from neuromuscular point of view: contraction time, sustain time, delay, relax time and displacement amplitude after electrical stimulation. Biomechanically, we assessed the subtalar angle, foot loading in metatarsian area, foot balance and pressure center distribution. RESULTS AND CONCLUSIONS: From neuromuscular point of view, we concluded that the right anterior tibial muscle developed compensatory muscle fibers resistant to fatigue. TMG analysis can estimate the possibility of developing gait disorders even in the absence of visible clinical manifestations. We also noted an increased muscle tone in the muscles of bilateral twins. Biomechanical evaluation revealed a symmetrical, abnormal gait, explained by the difference in the angle of left and right foot and in subtalar angle, which expresses the degree of coordination and control of foot gait initiation and execution. In this context, there is an exorotation of both feet.

Analysis of neuromuscular parameters in patients with multiple sclerosis and gait disorders.

UNLABELLED: Gait is a motor activity that requires understanding the dynamics and functional anatomical elements that make possible its cyclical conduct. Patients with multiple sclerosis record impaired balance and gait due to the process of demyelination, disorders that can be estimated by quantifying neuromuscular and cortical parameters. The aim of this paper is to present both an analysis of these parameters in the thigh muscles and an evaluation of cortical parameters obtained by visual evoked potentials (VEP). PATIENTS AND METHODS: The study was conducted on a group of 13 patients (mean age 38 years) with multiple sclerosis (MS), who had clinically detectable gait disturbance. Evaluation methods used were tensiomyography (TMG) and VEP, the monitored parameters were: contraction time (Tc), stance time (Ts), displacement (Dm), if TMG in the two muscle groups of the thigh (biceps femoris and right femoris), and if VEP the assessed waves were N75, P100, N135-145. RESULTS: There were estimated the average values of latency and duration of the three analyzed waves in VEP, the values of wave N135-145 were far higher than physiological values. In terms of TMG values, they results indicate the existence of a clear right-left functional asymmetry. DISCUSSION AND CONCLUSIONS: Analyzing these results, we note an increase in the muscular tone of the groups studied, a functional asymmetry agonist/antagonist, low speed response to stimulus. Regarding VEP wave parameters, we find significant variations of these waves' latencies, particularly of P100 wave, while the duration of these waves did not register significant figures. In conclusion, we can emphasize a change in muscle structure with predominantly type I muscular fibers and inter-neuronal connections between areas of the association to substitute the lesions occurred in specific areas.