Sensory Organization and Postural Control Strategies in Individuals With Mild and Moderate-to-Severe Forward Head Posture: A Comparative Study.

OBJECTIVE: This study aimed to compare sensory organization test and postural control strategies between individuals with mild and moderate-to-severe forward head posture (FHP). METHODS: A sensory organization test (SOT) was performed in 6 conditions using computerized dynamic posturography, to assess postural control. Equilibrium scores representing overall balance, strategy analysis to assess ankle vs hip strategy dominance, and sensory analysis (Somatosensory, visual, vestibular, visual preference ratio) as an indicator of the use of sensory systems were obtained. RESULTS: Our results revealed a significant difference between the 2 groups in terms of equilibrium score (P < .05) and strategy scores (P < .05) in conditions of 4 to 6 of the SOT. The results of sensory analysis of SOT showed visual and vestibular ratios were significantly different between the 2 study groups (P < .05), but somatosensory and visual preference ratios were not significantly different between these 2 groups (P > .05). CONCLUSION: Individuals with moderate-to-severe FHP swayed more in comparison with mild FHP ones in conditions with the Sway-referenced platform of the SOT. They tended to rely on the hip strategy more than the ankle strategy excessively when sensory difficulty increased. Overall, it can be concluded that individuals with moderate-to-severe FHP are more likely to have postural deficits.

Effectiveness of telerehabilitation intervention to improve pain and physical function in people with patellofemoral pain syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition in young and active adults. Exercise therapy is an essential part of rehabilitation in people with PFPS (PwPFPS). Telerehabilitation is an innovative treatment approach that has been used in several musculoskeletal conditions. This study aims to investigate the non-inferiority of telerehabilitation through a smartphone application, the Vito App, compared to face-to-face physical therapy on reducing pain and improving physical function, quality of life, and psychological factors. METHODS: This randomized controlled trial will include 60 PwPFPS. to a control group (face-to-face physical therapy) or an experimental group (telerehabilitation). The intervention for both groups consists of stretching, strengthening, balance, and functional exercises for 6 weeks and three sessions per week. The primary outcomes are pain intensity by visual analog scale (VAS), physical function by the Kujala questionnaire and functional tests including the bilateral squat, anteromedial lunge, and step down, and quality of life by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire quality of life subscale. Secondary outcomes are psychological factors such as anxiety and depression assessed with the Hospital Anxiety and Depression Scale (HADS) questionnaire, kinesiophobia assessed with the Tampa scale, and pain catastrophizing assessed with the Pain Catastrophizing Scale (PCS). Assessments will be held in 3 phases: pre-test (before the intervention), post-test (after the 6 weeks of intervention), and follow-up (1 month after the end of the intervention). DISCUSSION: We expect that both the control group and experimental group will show similar improvements in clinical and psychological outcome measures. If our hypothesis becomes true, PwPFPS can use telerehabilitation as a practical treatment approach. Telerehabilitation can also enhance accessibility to rehabilitation services for active adults and for people living in remote and rural areas. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20201112049361N1. Registered on 29 October 2022.

The Effects of Various Cognitive Tasks Including Working Memory, Visuospatial, and Executive Function on Postural Control in Patients With Anterior Cruciate Ligament Injury.

Anterior cruciate ligament (ACL) rupture can impair balance performance, particularly during cognitive motor dual-tasks. This study aimed to determine the effects of various modalities of cognitive load (working memory, and visuospatial and executive function) on postural control parameters in individuals with ACL injury. Twenty-seven ACL-injured and 27 healthy participants were evaluated doing different cognitive tasks (silent backward counting, Benton's judgment of line orientation, and Stroop color-word test) while standing on a rigid surface or a foam. Each task was repeated three times and then averaged. Center of pressure variables used to measure postural performance included sway area and sway velocity in anterior-posterior and medial-lateral directions. Cognitive performance was also assessed by calculating errors and the score of cognitive tasks. A mixed model analysis of variance for center of pressure parameters indicated that patients had more sways than the healthy group. The interaction of group by postural difficulty by cognitive tasks was statistically significant for cognitive errors (p < .01), and patients with ACL injury indicated more cognitive errors compared to healthy controls while standing on the foam. The main effect of cognitive task was statistically significant for all postural parameters, representing reduced postural sways in both groups with all cognitive tasks. However, ACL-injured patients showed more cognitive errors in difficult postural conditions, suggesting that individuals with ACL injury may prioritize postural control over cognitive task accuracy and adopt the posture-first strategy to maintain balance under dual-task conditions.

Walking Performance during Concurrent Cognitive and Motor Tasks in Individuals with Nonspecific Chronic Low Back Pain: A Case-Control Study.

Background: The present study aimed to compare the effects of simultaneous cognitive and motor tasks on walking performance between individuals with nonspecific chronic low back pain (NSCLBP) and healthy controls. Methods: A total of 20 patients with NSCLBP and 20 healthy controls participated in this study. They walked at their self-selected speed on a treadmill under 3 walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task, and walking while performing a concurrent motor task. Two-way repeated measure analysis of variance with additional post hoc comparison (Bonferroni test) was used to evaluate the effects of group and walking conditions on gait parameters. Results: The result showed a significant main effect of the group for swing time ( P = 0.012) and double support time (P = 0.021) in those with NSCLBP compared with healthy controls. Moreover, there was a significant interaction between the group and condition for cadence ( P = 0.004) and step width variability (P = 0.016).Regarding stride length variability and stride time variability, the analysis indicated a significant effect of condition (P = 0.002 and P = 0.030, respectively). In both groups, no significant differences were observed in gait parameters between motor dual task and single walking ( P > 0.05). Conclusion: Our findings indicated that those with NSCLBP adapted successfully to walking performance to maintain the performance of the concurrent cognitive task under the cognitive dual-task walking condition. Moreover, the present study observed no dual-task interference under the motor dual-task condition.

Protocol for double-blinded randomized trial to enhance postural control after anterior cruciate ligament reconstruction by balance training and concurrent cognitive demands or external focus of attention.

Anterior cruciate ligament (ACL) injury is one of the most common injuries among athletes that lead to postural control disorders. The aim of this study is to compare the effects of balance training with and without cognitive task and external focus of attention on postural control in individuals with ACL reconstruction. Sixty participants with ACL reconstruction, between the ages of 18 and 47 will be randomly allocated to three group's including routine balance training, balance training with external focus of attention. Patients will be assessed at the baseline, after receiving eight weeks of intervention, and four weeks later. A double-blinded design will be used. Center of pressure data acquired from a forceplate will be used to assess amount and velocity of sway, local dynamical stability, and global stability of upright balance. Also, dynamic balance will be assessed using Star Excursion balance test. The results of this research will be used to establish effectiveness of treatment strategies for postural control in individuals with anterior cruciate ligament reconstruction. The suggested interventions would be clinically applicable in the athlete with ACL injury.

Effects of exergaming on cognition, lower limb functional coordination, and stepping time in people with multiple sclerosis: a randomized controlled trial.

PURPOSE: To compare the effects of exergaming versus conventional exercises on cognition, lower-limb functional coordination, and stepping time in people with multiple sclerosis (PwMS). METHODS: Thirty-six PwMS were randomly assigned to either intervention (n = 18) or control (n = 18) group and received 18 training sessions during six weeks. The intervention group performed exergames that required multidirectional timed-stepping, weight-shifting, and walking while the control group performed conventional matched exercises. Trail making test (TMT part A, B; TMT-A, TMT-B, TMT B-A), six-spot step test (SSST), and choice stepping reaction time (CSRT-including reaction time (RT), movement time (MVT), and total response time (TRT)) were assessed pre- and post-intervention (short-term), and after three-month follow-up (mid-term). RESULTS: The intervention group showed faster TMT-B (p = 0.003) and TMT B-A (p = 0.002) at post-intervention and faster SSST at both post-intervention (p = 0.002) and follow-up (p = 0.04). The CSRT components showed no between-group differences at post-intervention; however, at follow-up, the intervention group had lower TRT (p = 0.046) and MVT (p = 0.015). TMT-A and RT had no significant between-group differences. CONCLUSIONS: In short-term, exergames led to more improvements in complex attention, executive function, and lower-limb functional coordination comparing to the matched conventional exercises. In mid-term, exergaming was more effective for improving stepping time and lower-limb functional coordination. However, the two approaches did not show any superiority over each other for improving simple attention and RT.Implications for rehabilitationWhen designed properly, exergames have great potential to improve attention and executive function of people with multiple sclerosis (PwMS), at least in the short-term.Exergames seem like an appropriate option for improving lower limb coordination and decreasing choice stepping response time among PwMS in the mid-term.Exergames do not have superiority in improving the choice stepping reaction time compared to their matched conventional treatment.

Comparison of proprioceptive postural control strategies between prolonged standing induced low back pain developers and non-low back pain developers.

BACKGROUND: Proprioception deficit has been suggested as a possible mechanism contributing for the impaired postural control in low back pain (LBP) patients. Whether proprioception deficit is a result of or a cause of LBP has not been investigated. OBJECTIVE: The purpose of this study was to compare proprioceptive postural control strategies between prolonged standing induced low back pain developers (PDs) and non-pain developers (NPDs). METHOD: Thirty-two healthy subjects performed 1-h prolonged standing and their ratings of perceived LBP have been recorded. Eight quiet standing trials for 60 s performed immediately before and after the prolonged standing. Postural control was challenged by muscle vibration and different postural conditions during quiet standing. Data were recorded using a force platform. RESULTS: Forty percentage of participants is classified as PD. Before the prolonged standing, relative proprioceptive weighting was greater in the PD compared to NPD group (P = .029). Main effect of postural condition (F1,24 = 5.21, P = .032) and interaction of time by group (F1,24 = 8.08, P = .009) were significant for COP displacement in anteroposterior direction. Interaction of postural condition by group (F1,26 = 7.82, P = .010) and time by group (F1,26 = 9.71, P = .004) were significant for COP displacement in mediolateral direction. Main effect of postural condition (F1,26 = 6.31, P = .018) and interaction of postural condition by group (F1,26 = 7.07, P = .013) were significant for mean velocity in mediolateral direction. CONCLUSION: The PD group has altered proprioceptive postural control strategies before and after prolonged standing. Proprioception deficit should not be considered to be solely an adaptive response and may be causal for LBP development.

Perturbation-based Balance Training to improve postural responses and falls in people with multiple sclerosis: a randomized controlled trial.

PURPOSE: To determine the effects of Perturbation-based Balance Training (PBT) on postural responses and falls in people with multiple sclerosis (PwMS) and compare the results with conventional balance training (CBT). MATERIALS AND METHODS: Thirty-four PwMS were randomized to receive 4 weeks of PBT or CBT. Latency of postural responses to external perturbations, Timed-Up-and-Go (TUG), 10-meter-walk (10MW), Berg Balance Scale (BBS), and Activities-specific Balance Confidence Scale (ABC) were measured at baseline and post-training. Also, the proportion of fallers and fall rate were assessed at a 3-month follow-up. RESULTS: The latency of postural responses significantly decreased in PBT compared to CBT. TUG, 10MW, BBS, and ABC, at post-training, and relative risk of falls and fall rate at 3-month follow-up had no statistically significant between-group differences. CONCLUSIONS: The results show that PBT is at least as effective as CBT in improving balance and decreasing falls, while it has superiority over CBT whenever the clinicians mainly aim to improve reactive balance strategies. Future studies with a larger sample size are warranted to complement the results of this study.Implication for rehabilitationPerturbation-based Balance Training is at least as effective as conventional balance training (CBT) in improving proactive postural control in people with multiple sclerosis (PwMS).Perturbation-based Balance Training has superiority over CBT in improving reactive postural control in PwMS.Perturbation-based Balance Training has no superiority over CBT in improving fall-related outcomes.

The effects of intrinsic foot muscles strengthening exercises on foot kinetic parameters in pronated foot subjects during forward jump landing.

Background: Pronated foot is one of the most important factors that may lead to musculoskeletal injuries of the lower extremities. Among all treatments for this disorder, intrinsic foot muscles strengthening exercises (IFMSE) have an important role in management of the individuals with pronated foot. Although the effect of the IFMSE is well accepted in this population; however, their impacts on foot kinetic are yet to be clarified. The present study aims to identify the effects of the IFMSE on foot kinetic parameters in pronated foot individuals during forward jump landing. Materials and Methods: In this quasi-experimental study, 20 asymptomatic male and female subjects (mean age of 22.65 ± 2.51 years) with pronated foot structures were selected by using a simple non-random sampling method. The ground reaction force (GRF), rate of loading (ROL), and the resultant vector of time to stabilization (RVTTS) were examined during a forward jump landing task by using a force plate before and after six weeks of the IFMSE. Result: The findings showed that the following parameters were not significantly change before and after of the IFMSE: GRF (1.97 ± 0.49 vs. 2.03 ± 0.54, P =0.667), ROL (.09 ±0.12 vs. 08 ±.12, P =.632), and RVTTS (2836.60 ± 1144.62 vs. 2644.35 ± 704.71, P =.479). Conclusion: In the pronated feet subjects, the IFMSE alone was not capable of changing the kinetic parameters of the foot, or the duration of using these exercises. In this study, six weeks may not be enough to make changes the foot kinetic parameters and therefore these exercises should be used for a longer period of time.

Quantifying lower extremity inter-segmental coordination variability during walking in people with multiple sclerosis with high and low fear of falling.

BACKGROUND: Fear of falling (FOF) is associated with gait disturbances in people with multiple sclerosis (PwMS). However, previous studies mostly assessed FOF-related changes in gait patterns of PwMS using spatio-temporal gait parameters. Considering the complex nature of gait control, investigation of the higher order properties of the human movement system, particularly inter-segmental coordination variability may provide valuable information about underlying deficits in motor control patterns in PwMS with different levels of FOF. Therefore, the purpose of this study was to clarify the differences in lower extremity inter-segmental coordination variability between healthy controls and PwMS with high and low FOF. METHODS: This cross-sectional study examined gait patterns of 40 PwMS and 20 age-and-sex-matched healthy controls during treadmill walking at a preferred walking speed for 3 min. The falls efficacy scale-international questionnaire was used to stratify PwMS into high and low FOF subgroups. Variability in coordinative relationships between shank-thigh and foot-shank segments was determined using deviation phase (DP), which is the average standard deviation calculated from all points of the ensemble continuous relative phase (CRP) curve during the stance and swing phases of gait. RESULTS: DP values for shank-thigh (p = 0.005 and p < 0.001, respectively) and foot-shank inter-segmental relationships (p < 0.001) during the stance phase as well as for foot-shank inter-segmental relationships during the swing phase (p = 0.03) were significantly greater in PwMS with high FOF compared to those with low FOF and healthy controls. In addition, both groups of PwMS with high and low FOF indicated greater shank-thigh DP values compared to healthy controls during the swing phase (p < 0.001 and p = 0.002, respectively). CONCLUSION: The findings suggest unsteadiness in neuromuscular organization during walking in PwMS with high FOF. Rehabilitative interventions targeting impairments in lower extremity inter-segmental coordination and FOF may be useful to improve walking and reduce risk of falls in PwMS with high FOF.

The effects of intrinsic foot muscles strengthening exercises on knee kinematic in pronated foot subjects during forward jump landing.

Introduction: The foot and ankle are a complex set of multiple joints with multiple degrees of freedom that play an important role in static and dynamic activities. The intrinsic and extrinsic muscles of this complex play a role in controlling the deformity of the arch; thus, the aim of this study was to investigate the effect of the intrinsic foot muscle-strengthening exercises on knee kinematic parameters in pronated foot subjects during forward jump landing. Methods: This interventional study was performed on students aged 20-30-years old with foot pronation in the School of Rehabilitation. In this study, the kinematic changes of the knee in the frontal, sagittal and transverse plane before and after 6 weeks of strengthening exercises of the intrinsic foot muscles during the forward jump-landing task were examined using a motion analyser. All data analysis was performed offline using a special software program in the MATLAB software environment. Results: Knee angle variables have a normal distribution before and after exercise. The ICC coefficient of all variables was calculated as between 0.44 and 0.71; therefore, the reproducibility of the variables under study in this study was considered moderate to good. The knee angle on the frontal plate was 2.54 ± 2.4 before the exercises and 2.49 ± 2.14 after the exercises, and there was no significant difference between them (P = 0.21). Conclusion: Plantar intrinsic foot muscle-strengthening exercises alone have no effect on the kinematic changes of the knee in people with foot pronation, or the duration of strengthening exercises should be increased during the day to see the effect of strengthening the intrinsic muscles among pronated foot subjects.

Comparison of Kinematic Movement Patterns Between 2 Subgroups of Females With Low Back Pain and Healthy Women During Sit-to-Stand and Stand-to-Sit.

The purpose of study was to compare the kinematic patterns of the thoracic, lumbar, and pelvis segments and hip joints between 2 low back pain subgroups and healthy women during sit-to-stand and stand-to-sit. Kinematic data of 44 healthy women and 2 subgroups of females with low back pain in 2 subgroups of movement system impairment model (rotation-extension [Rot.Ext] and rotation-flexion [Rot.Flex]) were recorded. Participants performed sit-to-stand and stand-to-sit at a preferred speed. Each task was divided into a pre buttock lifted off/on (pre-BOff/n) phase and a post-BOff/n phase. The Rot.Ext subgroup showed greater range of motion in the thoracic during pre-BOff phase of sit-to-stand (P < .001) and pre-BOn phase of stand-to-sit (P = .01) compared to the other 2 groups. The Rot.Flex subgroup displayed limited left hip joint excursion during sit-to-stand pre-BOff (P = .04) and stand-to-sit post-BOn phases (P = .02). The Rot.Flex subgroup showed greater pelvis tilt excursion during sit-to-stand post-BOff (P = .04) and stand-to-sit pre-BOn (P = .01) and post-BOn phases (P = .01). In subgroups of women with chronic low back pain, there were kinematic changes in adjacent body segments/joints of lumbar spine during sit-to-stand and stand-to-sit tasks.

Validity, reliability, and responsiveness of Persian version of mini-balance evaluation system test among ambulatory people with multiple sclerosis.

BACKGROUND AND PURPOSE: Mini-Balance Evaluation Systems Test (mini-BESTest) is a widely used measure to assess balance impairments. This study aimed to assess the validity, reliability, responsiveness, and minimal clinically important change (MCIC) of the Persian mini-BESTest among ambulatory People with Multiple Sclerosis (PwMS). METHODS: Fifty ambulatory PwMS participated in this study. Persian mini-BESTest validated against Berg Balance Scale (BBS) and Timed-Up and Go (TUG) with/without a cognitive task. To assess the reliability, the Persian mini-BESTest was re-administered for a sample of 30 participants after 1 week. Also, 32 PwMS were tested before and after a 4-week of balance and gait training to assess the responsiveness. RESULTS: No floor/ceiling effect was found for the mini-BESTest total score. There were significant excellent correlations (p < .001) between mini-BESTest and BBS (r = 0.71), TUG (r = -0.76), and cognitive TUG (r = -0.73). No strong correlations were observed between the subscales (r = 0.37-0.55). Test-retest reliability and internal consistency of Persian mini-BESTest total score were excellent, with Intra-class Correlation Coefficient (ICC3,1 and Cronbach's alpha level of 0.89 and 0.80, respectively. The minimal detectable change was 4 points. The Persian mini-BESTest had acceptable responsiveness (AUC = 0.83), and MCIC was 5 points. CONCLUSION: The Persian mini-BESTest is a valid, reliable, and responsive measure of balance performance in Iranian ambulatory PwMS.

Responsiveness and clinically meaningful changes for the Persian versions of the multiple sclerosis walking scale-12 and the modified fatigue impact scale following balance and gait rehabilitation in people with multiple sclerosis.

Background and Purpose: The Multiple sclerosis walking scale-12 (MSWS-12) and the Modified Fatigue Impact Scale (MFIS) are two popular outcome measures applied widely for assessing self-perceived walking ability and fatigue in people with multiple sclerosis (PwMS). The present study aimed to examine responsiveness and clinically meaningful changes for the Persian versions of the MSWS-12 and the MFIS following balance and gait rehabilitation in PwMS.Methods: Fifty-eight PwMS completed the Persian versions of the MSWS-12 and the MFIS before and after 4 weeks of balance and gait rehabilitation. Also, a 7-point global rating scale as an external criterion of change was completed at the post-intervention evaluation. The area under the receiver operating characteristics curve (AUC) and the correlation analysis were used to assess the responsiveness. In addition, the minimally clinically important change (MCIC) was measured to determine clinically meaningful changes following rehabilitation.Results: The AUC values for the Persian MSWS-12 and MFIS were 0.74 and 0.73, respectively. There were good to excellent correlations between the global rating scale of change and the Persian MSWS-12 (Gamma = 0.77) also MFIS (Gamma = 0.80) change scores (p = .001). Moreover, the MCICs of 7.5 and 4 points were obtained for the Persian MSWS-12 and MFIS, respectively.Conclusion: The Persian versions of the MSWS-12 and the MFIS were responsive outcome measures for monitoring changes in walking and fatigue after balance and gait rehabilitation in PwMS. The calculation of MCIC values would enhance the interpretation of changes in clinical and research settings.

Effects of back extensor and hip abductor fatigue on dynamic postural stability in patients with nonspecific chronic low back pain: A case-control study.

INTRODUCTION: Patients with nonspecific chronic low back pain (NSCLBP) complain of pain and fatigue during functional activities. Poor back muscle endurance has been associated with recurrent pain and long-term disability. However, the relationship between proximal muscle fatigue and postural stability is not well understood. PURPOSE: To investigate the effects of lumbar extensor and hip abductor fatigue on postural stability in NSCLBPs. METHODS: To induce isolated fatigue, participants (24 LBPs, 24 controls) were asked to perform multiple back extension and hip abduction in the separate sessions until the muscle force reached 60% of pre-fatigued force. The overall (OSI), anteroposterior (APSI), and mediolateral (MLSI) stability indices were measured during single-leg stance using the Biodex dynamic platform. RESULTS: The results revealed higher postural instability (APSI and OSI) following fatiguing lumbar extensor and hip abductor muscles (greater effect size for APSI than OSI) in LBPs than controls. Furthermore, significant and inverse relationships were found between the level of physical activity, pain, and post-fatigue postural instability (OSI) in NSCLBPs. CONCLUSION: Fatigue of proximal muscles could differentiate postural stability primarily in the sagittal plane between NSCLBPs and controls. Therefore, reducing the fatigability of these muscles by endurance training in addition to balance training may improve physical activity.

Cervical movement kinematic analysis in patients with chronic neck pain: A comparative study with healthy subjects.

BACKGROUND: Several studies have investigated cervical kinematic performance in patients with chronic neck pain, especially with fast movements. A recent systematic review recommended further study of cervical spine kinematics cervical motions in individuals with neck pain. OBJECTIVES: This study aimed to examine cervical spine kinematics of naturally paced cervical motions in patients with chronic neck pain compared with a group of asymptomatic participants. Also, the relationships between cervical kinematic measures with neck pain intensity and disability were determined. METHOD: Kinematic performance was measured in 20 individuals with chronic nonspecific neck pain and 20 healthy controls. Data were captured using a 7-camera motion analysis system. Parameters were range of cervical motion, peak velocity, duration of movement, and jerk index (smoothness of movement). Pain intensity and Neck Disability Index were also measured. RESULTS: Duration of movements, peak velocities, and jerk indexes were significantly different between the two groups (p < 0.05). Pain intensity was significantly associated with duration of movement, range of motion, peak velocity, and smoothness predominantly in extension (r range = 0.4 to 0.6, p < 0.05). CONCLUSION: This study's findings indicated altered cervical kinematic performance during naturally paced motions (particularly reduced smoothness of movement)in patients with chronic nonspecific neck pain compared to asymptomatic participants. Also, pain intensity was moderately associated with most kinematic measures, especially in extension. This study's results can help to understand better the impairments associated with chronic nonspecific neck pain.

Immediate Effect of Modifying Lumbopelvic Motion During Sitting Knee Extension in People With Low Back Pain: A Repeated-Measures Study.

Objective: The aim of this study was to investigate the ability of people with low back pain (LBP) to modify the pattern of lumbopelvic rotation (LPR) when actively moving their lower limbs in sitting. Methods: In this repeated-measures study in 38 men with chronic mechanical LBP (mean age, 38.4 ± 10.6 years), the timing and magnitude of LPR were investigated before and during the contraction of abdominal muscles during active knee extension while sitting. The kinematic data were collected using a motion-capture system, and OpenSim software was used for data analysis. The time difference between the start of knee extension and the start of LPR was measured and then adjusted to the movement time of the knee. The maximum LPR angle was also measured. Results: Participants increased the time difference between the start of knee extension and the start of LPR when contracting the abdominal muscles (P < .01). Before and during contraction of abdominal muscles, however, there were no differences in maximum LPR. Conclusion: People with LBP are able to modify early lumbopelvic motion during active lower limb movement while sitting. This may reduce the frequency of lumbopelvic motion during activities of daily living in sitting in these people.

Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial.

OBJECTIVE: To assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS). DESIGN: Single-blinded, randomized, controlled trial. SETTING: Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences. PARTICIPANTS: PwMS (N=39), randomized into VR (n=19) and control (n=20) groups. INTERVENTION: The VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks. MAIN OUTCOME MEASURES: Limits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up. RESULTS: At both post intervention and follow-up, TUGcognitive and DTCs on the TUG were significantly lower and the 10-m walkcognitive was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up. CONCLUSIONS: Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.

Inter-joint coordination during obstacle crossing in people with diabetic neuropathy.

Sensori-motor deficit due to diabetic peripheral neuropathy (DPN) alters the quality of obstacle-crossing which may increase the risk of falling. The aim of this study was to compare inter-joint coordination (IJC) during obstacle-crossing between people with DPN and healthy controls. Fifteen DPN and 15 healthy people crossed over obstacles with heights of 10% and 20% of the subject's leg length. The mean absolute relative phase (MARP) and deviation phase (DP) of both leading and trailing limbs were used to calculate the phase dynamic and variability of IJC. Furthermore, correlation between Berg Balance Scale (BBS), Fall Efficacy Scale (FES-I), Timed Up and Go (TUG) and MARP, DP were assessed in DPN group. There was no significant interaction between group and obstacle height on measured variables. However, Group had significant main effect on DP of hip-knee in leading limb (p < 0.05). Additionally, the main effects of the obstacle's height were significant on MARP of hip-knee of trailing limb (p < 0.01) and knee-ankle in leading limb (p < 0.05). FES-I was significantly correlated to hip-knee and knee-ankle MARPs of leading limb for crossing over 20% and knee-ankle MARP for crossing over 10% height obstacle (r = 0.68, 0.69, 0.59, respectively, p < 0.05). This score was also significantly correlated with hip-knee DP of both trailing and leading limbs when crossing 10% obstacle (r = 0.59, 0.57, respectively, p < 0.05). In conclusion, IJC during obstacle-crossing was less variable and more out-of-phase, as a result of DPN and obstacle height, respectively. Moreover, when crossing over lower obstacles, fear of falling is related to IJC dynamics and variability of more proximal segment, especially in the leading limb.

Comparison of the lower limb inter-segmental coordination during walking between healthy controls and people with multiple sclerosis with and without fall history.

BACKGROUND: This research aims to compare lower limb inter-segmental coordination, a higher order property of the human movement system, during walking between healthy controls and people with multiple sclerosis (PwMS) with and without fall history. METHODS: Fifty PwMS (25 patients with fall history and 25 patients without fall history) and 25 healthy controls participated in the present study. Three-dimensional coordinate data of the lower limbs were collected during treadmill walking at a preferred walking speed. The phasing relationship and its variability between lower limb segments were evaluated using the mean absolute relative phase (MARP) and deviation phase (DP) during the stance and swing phases of gait. RESULTS: Compared to healthy controls, both groups of PwMS demonstrated significantly greater shank-thigh MARP values during the stance phase (p < 0.001). In addition, MARP values of foot-shank coordination were significantly smaller in both groups of PwMS than the healthy controls during both the stance and swing phases (p < 0.001). For the DP of shank-thigh coordination, our analysis revealed greater values in both MS fallers and non-fallers compared to healthy controls during the stance (p < 0.001) and swing phases (p < 0.001, p = 0.004, respectively). Moreover, MS fallers demonstrated greater DP values than non-fallers in swing phase (p = 0.02). For the DP of foot-shank coordination, MS fallers showed greater values compared to non-fallers and healthy controls during the stance (p = 0.009, p = 0.001, respectively) and swing phases (p = 0.01, p = 0.006, respectively). CONCLUSION: Our results suggest that in addition to traditional gait parameters, examining and also facilitating lower limb inter-segmental coordination should be considered in future studies aimed at improving gait performance and reducing risk of falling in PwMS.