Impact of frailty and sex-related differences on postural control and gait in older adults with Parkinson's Disease.

BACKGROUND: Parkinson's Disease (PD), a neurodegenerative condition, affects normal aging and leads to reduced motor abilities. In addition, frailty syndrome can increase vulnerability and risks of undesirable effects such as disease progression, falls, disability, and premature death among individuals with PD. AIMS: To assess the impact of frailty on balance and gait parameters in older with PD and to determine if sex mediates these measures. METHODS: Twenty-seven (27) participants (n = 18 men; n = 10 frail) performed 4 balance tasks on a force platform (eyes opened/closed in bipodal/semi-tandem position) while linear center of pressure (COP) parameters were calculated. Participants also performed two different speed walks on a gait analysis system to assess gait parameters. RESULTS: Significant differences between the frail and non-frail group were observed on postural control (mainly for area of COP p = 0.013/d = 0.47/70 %; sway velocity p = 0.048/d = 0.41/23 %) where frail reported poor balance. No significant sex differences were reported for postural control. Gait analysis was comparable between frail and non-frail, while significant differences between men and women were observed for step length (p = 0.002, d = 0.71), step width (p = 0.001, d = 0.75) and base of support (p = 0.012, d = 0.64) variables. CONCLUSION: Frail Parkinson's individuals present poorer postural control than non-frail individuals, but comparable gait parameters. Men and women are comparable on postural control but show different gait parameters. These results may have implications in clinical decision-making in rehabilitation for frailty in older adults, men and women with Parkinson's disease when balance and gait are of concern.

Bilateral Idiopathic Carpal Tunnel Syndrome: Clinical-Functional Characterization and Efficacy of Two Combined Postoperative Physiotherapeutic Treatments.

OBJECTIVE: To evaluate the efficacy of combined association instrument myofascial mobilization (IASTM) and stretching in patients with idiopathic bilateral carpal tunnel syndrome (CTS) operated on one hand and to analyze the response of the operated (OH) and non-operated (NH) hand according to the sequence of therapies. Research on these parameters has not yet been found in the literature. METHODS: Randomized controlled crossover study with 43 participants using the objective and subjective outcome variables. Patients were randomly assigned to two groups: starting with stretching followed by IASTM and starting with IASTM followed by stretching. Then patients underwent surgery on the hand with more severe involvement and physical therapy rehabilitation was started 30 days after for a period of 4 weeks. After the 1-week interval the participants who started with stretching were referred to IASTM and vice versa, following the same previous patterns. The outpatient reassessments took place at 3 to 6 months. Crossover ANOVA and effect sizes were used as analysis methods. RESULTS: Time was the most significant outcome for all variables both during therapies and at 6-month follow-up. Regarding response to the combined therapies between OH and NH, there were differences for both OH and NH, with the greatest impact on NH for the palmar grip and VAS variables. The treatment sequences were significant for pain on the NH and mental SF-12, suggesting that starting with IASTM followed by stretching had a superior outcome for these outcomes. CONCLUSION: The combination of IASTM with stretching, used in the postoperative period of bilateral idiopathic CTS, proved to be supplementary, with significant results and large effect sizes for most of the outcomes assessed, both during the time of application of the therapies and in the 6-month follow-up for both hands, and may constitute a viable therapeutic alternative for this population.

Distinctive phases and variability of vibration-induced postural reactions highlighted by center of pressure analysis.

BACKGROUND: The vibration-induced postural reaction paradigm (VIB-PR) offers a unique way for investigating sensorimotor control mechanisms. Measures of VIB-PR are usually calculated from the whole VIB period, yet recent evidence proposed that distinctive mechanisms are likely at play between the early vs. later phases of the postural reaction. OBJECTIVES: The present work verified if spatiotemporal analyses of center of pressure (COP) displacements can detect differences between these early/later phases of VIB-PR. Also, we further characterized the intra/inter-individual variability of COP measurements, since the underlying variability of VIB-PR remains largely unexplored. METHODS: Twenty young volunteers realized two experimental conditions of bipodal stance with eyes closed: (i) bilateral VIB of tibialis anterior (TIB) and (ii) Achilles' (ACH) tendons. Each condition consisted of five trials and lasted 30 s as follows: 10 s baseline, 10 s VIB and 10 s post-VIB. Linear COP variables (antero-posterior (AP) amplitude & velocity) were computed for both VIB and post-VIB periods using the following time-windows: early 2 s, the later 8 s and the whole 10 s duration. Intra- and inter-individual variability were respectively estimated using the standard error of the measurement and the coefficient of variation. Both variability metrics were obtained using five vs. the first three trials. RESULTS: Significant contrasts were found between time-windows for both VIB and post-VIB periods. COP variables were generally higher during the early 2 s phase compared to the later 8 s phase for both TIB [mean difference between 8 s- 2 s phases: Amplitude AP = -1.11 ± 1.14 cm during VIB and -2.99 ± 1.31 during post-VIB; Velocity AP = -1.17 ± 0.86 cm/s during VIB and -3.13 ± 1.31 cm/s during post-VIB] and ACH tendons [Amplitude AP = -0.37 ± 0.98 cm during VIB and -3.41 ± 1.20 during post-VIB; Velocity AP = -0.31 ± 0.59 cm/s during VIB and -3.89 ± 1.52 cm/s during post-VIB]. Most within- and between-subject variability scores were below 30% and using three instead of five trials had no impact on variability. VIB-PR patterns were quite similar within a same person, but variable behaviors were observed between individuals during the later phase. CONCLUSION: Our study highlights the relevance of identifying and separately analyzing distinct phases within VIB-PR patterns, as well as characterizing how these patterns vary at the individual level.

Vibration-induced postural reactions: a scoping review on parameters and populations studied.

Objective: Mechanical vibration is an effective way for externally activating Ia primary endings of the muscle spindles and skin mechanoreceptors. Despite its popularity in proprioception and postural control studies, there is still no review covering the wide variety of vibration parameters or locations used in studies. The main purpose of this scoping review was thus to give an overview of general vibration parameters and to identify, if available, the rationale for justifying methodological choices concerning vibration parameters. Methods: Three databases (Pubmed, CINHAL, and SPORTDiscus) were searched from inception to July 2022. Included articles were to focus on the study of muscle spindles and skin mechanoreceptors vibration in humans and assess postural control. Following inclusion, data regarding demographic information, populations, vibration parameters and rationale were extracted and summarized. Results: One hundred forty-seven articles were included, mostly targeting lower extremities (n = 137) and adults (n = 126). The parameters used varied widely but were most often around 80 Hz, at an amplitude of 1 mm for 10-20 s. Regarding rationales, nearly 50% of the studies did not include any, whereas those including one mainly cited the same two studies, without elaborating specifically on the parameter's choice. Conclusion: This scoping review provided a comprehensive description of the population recruited and parameters used for vibration protocols in current studies with humans. Despite many studies, there remain important gaps of knowledge that needs to be filled, especially for vibration amplitude and duration parameters in various populations.

Impact of plantar fasciitis on postural control and walking in young middle-aged adults.

PURPOSE: To assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions. METHODS: Thirty participants (n = 15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants. RESULTS: Clinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests. CONCLUSIONS: Individuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.

Immediate Effect of Lumbosacral Orthosis and Abdominal Drawing-In Maneuver on Postural Control in Adults With Nonspecific Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to examine the immediate effects of lumbosacral orthosis and the abdominal drawing-in maneuver on the trunk postural control of adults with chronic low back pain compared with asymptomatic controls during 1-legged and semi-tandem stances. METHODS: An experimental and comparative study (cross-sectional design) was conducted in a laboratory setting. Twenty adults with chronic low back pain and 20 asymptomatic controls randomly performed 2 postural balance tasks over a force platform, considering 3 experimental conditions: (1) natural posture (baseline-control), (2) lumbosacral orthosis, and (3) abdominal drawing-in maneuver. Linear variables (mean amplitude, ellipse area, and sway velocity) derived from the center of pressure were computed, and 2-way analysis of variance (group × condition) for repeated measures were conducted. RESULTS: No group × condition interactions (.139 ≤ P ≤.938) were detected in any center of pressure parameters. No condition effect was detected, but a group effect (P = .042) was observed for 1 center of pressure parameter. The chronic low back pain group presented with a lower mean anteroposterior center of pressure amplitude than asymptomatic controls (∆ = 0.31 ± 0.66 cm [95% confidence interval, 0.05-0.56], P = .019) during the semi-tandem stance balance task. CONCLUSION: Neither lumbosacral orthosis nor the abdominal drawing-in maneuver showed immediate improvement in trunk postural control in any group. Thus, clinicians should not expect immediate benefits or improvements yielded by lumbosacral orthosis or the abdominal drawing-in maneuver when patients with chronic low back pain undergo these interventions.

Accuracy and precision of simpler and lower-cost technologies to measure the initial lean angle, step length and step velocity for forward lean releases.

Current technologies to measure the maximum forward lean angle, step length and velocity in a clinical setting are neither simple nor cheap. Therefore, the purpose of this study was to determine the accuracy and precision of four live and one post-processing measurement methods compared to the 3D motion analysis gold standard. Twelve healthy younger adults recovered balance, after being released from six randomly ordered forward initial lean angles, using four different live measurement methods: LabVIEW, load cell, inclinometer and protractor. The initial lean angle, step length and velocity were also calculated in post-processing using 2D video analysis and 3D motion analysis. The LabVIEW method was the most accurate and precise, followed by the protractor, inclinometer and load cell methods. The load cell method was the most complex, followed by the LabVIEW, inclinometer and protractor methods. The LabVIEW method was the most expensive, followed by the load cell, inclinometer and protractor methods. Video analysis was sufficiently accurate and precise, equal in complexity and much less expensive than the gold standard. Simpler and lower-cost technologies to measure the initial lean angle, step length and velocity are sufficiently accurate and precise (live: protractor, post-processing: video analysis) to potentially use in a clinical setting.

Effectiveness of muscle energy technique in patients with nonspecific low back pain: a systematic review with meta-analysis.

INTRODUCTION: Low back pain (LBP) is a major cause of physical disability in the world. The origin of this condition can be due to differents causes, with a specific cause or of unknown mechanical origin,being characterized as unspecific. In this case a physical therapy treatment approach with manual therapy is relevant, which includes the muscle energy technique (MET) classified as a common conservative treatment for pathologies of the spine, mainly in LBP and disability. This study assessed the effectiveness of the muscle energy technique on nonspecific low back pain. EVIDENCE ACQUISITION: Patients with acute, subacute or chronic non-specific low back pain. The primary outcomes were pain and disability. This study was designed by a systematic review and meta-analysis, registered in PROSPERO (CRD42020219295). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed, respectively. EVIDENCE SYNTHESIS: The search yielded 164 citations, which 19 were eligible randomised trials were included in the review (N.=609 patients with low back pain). The methodological quality of the studies averaged 4.2 points, with an interval of 2 to 7 points. Three RCTs showed satisfactory methodological quality (PEDro Score ≥6). For patients with chronic LBP, a significant result on pain (but with a small and clinically unimportant effect) in favor of MET versus other (MD=-0.51 [95% CI,-0.93 to -0.09] P=0.02, N.=376, studies=11, I2=80%). In patients with subacute LBP, MET enabled a significant and moderate effect to reduce pain intensity when compared to the control group (MD=-1.32 [95% CI,-2.57 to -0.06] P=0.04, N.=120, studies=3, I2=88%). No significant effects were observed for the disability. CONCLUSIONS: MET is not considered an efficient treatment to improve the incapacity of the lumbar spine, but it may be beneficial in reducing the intensity of LBP, although showing a small clinical effect in chronic LBP and a moderate effect in subacute LBP.

Towards the Objective Identification of the Presence of Pain Based on Electroencephalography Signals' Analysis: A Proof-of-Concept.

This proof-of-concept study explores the potential of developing objective pain identification based on the analysis of electroencephalography (EEG) signals. Data were collected from participants living with chronic fibromyalgia pain (n = 4) and from healthy volunteers (n = 7) submitted to experimental pain by the application of capsaicin cream (1%) on the right upper trapezius. This data collection was conducted in two parts: (1) baseline measures including pain intensity and EEG signals, with the participant at rest; (2) active measures collected under the execution of a visuo-motor task, including EEG signals and the task performance index. The main measure for the objective identification of the presence of pain was the coefficient of variation of the upper envelope (CVUE) of the EEG signal from left fronto-central (FC5) and left temporal (T7) electrodes, in alpha (8-12 Hz), beta (12-30 Hz) and gamma (30-43 Hz) frequency bands. The task performance index was also calculated. CVUE (%) was compared between groups: those with chronic fibromyalgia pain, healthy volunteers with "No pain" and healthy volunteers with experimentally-induced pain. The identification of the presence of pain was determined by an increased CVUE in beta (CVUEß) from the EEG signals captured at the left FC5 electrode. More specifically, CVUEß increased up to 20% in the pain condition at rest. In addition, no correlation was found between CVUEß and pain intensity or the task performance index. These results support the objective identification of the presence of pain based on the quantification of the coefficient of variation of the upper envelope of the EEG signal.

Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Québec: A Retrospective Study at La Baie Hospital.

Musculoskeletal disorders, cardiovascular and neurological diseases were the most commonly debilitating conditions and risk factors associated with pain, mobility limitations, increased risk of falls and disability. Studies barely address the profile of older adults in care within a specialized geriatric rehabilitation service (SGRS) to provide subsidies for new actions within the public healthcare to reduce falls and improve management in health investments. This study aimed to establish a clinical physical and functional profile of the patients with neuromusculoskeletal and cognitive disorders and fallers in interventions within SGRS. From a retrospective study design, 127 medical records were compiled and analyzed to determine the physical and functional profile of older adults and differences according to sex, age groups and the benefits for local physical therapy intervention. The users were between 76 and 85 years of age, with diverse clinical diagnoses and debilitating conditions and impairments. A higher proportion presented gait and balance impairments and had two or more falls in 12 months. A significant effect for advanced age was observed. Overall, real benefits were reported with intervention for functional improvement, although the absence of a control group. These results have direct implications for a better understanding of a local SGRS and provide subsidies for developing new approaches for the assessment and treatment of older adults with high a risk of falls in order to reduce costs for the public health system.

Reproducibility of dynamometers in handrail format in evaluating handgrip strength and traction in young and older adults.

BACKGROUND: The aim of the present study was twofold: (1) to assess the reproducibility of two dynamometers in handrail format to measure handgrip strength and traction force in the young and older adults; (2) to compare the handgrip strength and traction of these two populations. APPROACH: Twenty-four volunteers (12 older adults and 12 young adults) performed a functional effort related to handgrip strength and traction force during stair climbing. The participants were evaluated two times (separated by one week) using a coupled dynamometer that quantifies the muscular effort in grip and traction simultaneously to simulate stair climbing in bus service. RESULTS: The young adults performed significantly better (p < 0.04) than the older adults in both handgrip and traction efforts (medium to large effect size), with excellent reliability (Intraclass Coefficient Correlation > 0.9) and low error of measure. The dynamometers were able to discriminate the two population groups (sensitive validity) and showed excellent reproducibility estimates for handgrip and traction strength in both young and older adults. CONCLUSION: These instruments could be useful in assessing handgrip and traction strength needed to climb stairs, especially for the older adults, who normally have more difficulty performing this task.

The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old.

BACKGROUND: Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis. OBJECTIVE: This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old. METHODS: Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance). RESULTS: A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = -0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group. CONCLUSION: Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.

Evaluation of the effects of different applications of kinesio taping on postural control in healthy women.

It has been demonstrated that Kinesio Tape (KT) application has immediate positive effects on balance in healthy individuals, but its mid-term effects have not yet been investigated. OBJECTIVE: Evaluate the effects of KT on postural control in young women, using four strategies. METHODS: Forty-eight healthy women aged 18-35 years old were randomly assigned to four groups with different elastic bandages (G1: ankle; G2: hamstrings; G3: lumbar; G4: different taping applications) and their postural control was evaluated using stabilographic parameters obtained on a force platform during right and left unipodal (UNP-R and UNP-L) and semi-tamdem tests at pre-intervention (PRE), immediately after (IME), and 24 and 48 h after the application of bandages. RESULTS: G1 showed a significantly lower velocity in the antero-posterior direction for the PRE compared to the IME period (p = 0.0204) in the UNP-R task, and the same was observed in the medio-lateral velocity when comparing the results for PRE with IME (p = 0.0340 and p = 0.0244) in the UNP-L task. Regarding the frequency, G2 had a significantly lower mean for the PRE, compared to IME (p < 0.001) in the UNP-R in antero-posterior direction, and in medio-lateral direction in the UNP-R (p = 0.003) and in the UNP-L task (p = 0.020). CONCLUSIONS: The use of KT changed postural control, mainly considering the velocity and frequency of COP oscillations, and especially immediately after its application.

The Impact of Parkinson's Disease on Postural Control in Older People and How Sex can Mediate These Results: A Systematic Review.

INTRODUCTION: Parkinson's disease is most prevalent among elderly people, 65 years and over, and leads to an alteration in motor control associated with postural instability. Current evidence shows that postural control decreases with the aging process. In addition, postural control is more altered in healthy aged men than in women. Until today, few studies have evaluated the combined impact of Parkinson's disease and sex on postural control. This review has allowed to evaluate the impact of Parkinson's disease and sex on postural control measurements in elderly people. METHODOLOGY: Studies have been selected from two main databases: PubMed and EBSCO using the keywords "Parkinson", "postural control OR balance" and "sex". Articles related to the evaluation of postural control, including men and women with Parkinson's aged over 65 years old, regardless of stage, were included (n = 179). Articles were excluded if not written in French or English or not presenting original content. RESULTS: Ten (10) studies out of 179 that fulfilled inclusion and exclusion criteria were reported in the final analysis, which cumulates a total of 944 individuals with Parkinson's (410 women). In general, results show greater postural instability among people with Parkinson's compared to healthy subjects, and this according to different objective measurements using stabilographic parameters from force platforms. Only two studies out of ten evaluated postural control while briefly considering distinctions between sex, but without showing a significant difference between men and women with Parkinson's. Parkinson's severity, length of time of Parkinson's disease and cognitive state of the person are the three variables with a negative impact on postural control. CONCLUSION: Older people with Parkinson's disease have greater postural instability. Sex does not seem to influence the postural control of elderly people with Parkinson's, although more studies are necessary.

Vibration of the Whole Foot Soles Surface Using an Inexpensive Portable Device to Investigate Age-Related Alterations of Postural Control.

Background: Standing on a foam surface is used to investigate how aging affect the ability to keep balance when somatosensory inputs from feet soles become unreliable. However, since standing on foam also affects the efficacy of postural adjustments, the respective contributions of sensory and motor components are impossible to separate. This study tested the hypothesis that these components can be untangled by comparing changes of center of pressure (CoP) parameters induced by standing on a foam pad vs. a novel vibration (VIB) platform developed by our team and targeting feet soles' mechanoreceptors. Methods: Bipedal postural control of young (n = 20) and healthy elders (n = 20) was assessed while standing barefoot on a force platform through 3 randomized conditions: (1) Baseline (BL); (2) VIB; and (3) Foam. CoP Amplitude and Velocity in the antero-posterior/medio-lateral (AP/ML) directions and COP Surface were compared between conditions and groups. Findings: Both VIB and Foam increased CoP parameters compared to BL, but Foam had a significantly greater impact than VIB for both groups. Young and Old participants significantly differed for all three Conditions. However, when correcting for BL levels of postural performance, VIB-related increase of COP parameters was no longer different between groups, conversely to Foam. Interpretation: Although both VIB and Foam highlighted age-related differences of postural control, their combined use revealed that "motor" and "sensory" components are differently affected by aging, the latter being relatively unaltered, at least in healthy/active elders. The combined used of these methods could provide relevant knowledge to better understand and manage postural impairments in the aging population.

Leucine Supplementation Does Not Improve Muscle Recovery from Resistance Exercise in Young Adults: A Randomized, Double-Blinded, Crossover Study.

This study aimed to investigate the effects of free leucine supplementation on muscle recovery from resistance exercise (RE) in young adults. Fourteen untrained subjects (23.9 ± 3.6 years old) underwent RE sessions (leg press and hack squat: three sets of 8-12 reps at 70% 1RM) supplemented with leucine (LEU: two daily doses of 3g) or a placebo (PLA), separated by a seven-day washout period. Following each occasion, participants were evaluated in three subsequent days (24h, 48h, and 72h) for muscle recovery via a repetition-to-failure test. The following markers were assessed: repetition performance, perceived exertion, lactate, creatine kinase, muscle soreness (DOMS), testosterone, and cortisol. No significant difference was observed between LEU and PLA conditions (p > 0.05). Number of repetitions performed in the repetition-to-failure tests, perceived exertion, cortisol, and testosterone:cortisol ratio did not change over time (p > 0.05). Creatine kinase increased immediately after exercise, at 24h, and 48h, and was attenuated at 72h post-exercise, while testosterone, lactate, and DOMS increased at 24h post-exercise (p < 0.05) and remained elevated up to 72h. All outcomes were similar between LEU and PLA. Results indicate that a 6g daily dose of free leucine supplementation does not improve muscle recovery following lower-limb RE in untrained young adults.

A Neurophysiological Pattern as a Precursor of Work-Related Musculoskeletal Disorders Using EEG Combined with EMG.

We aimed to determine the neurophysiological pattern that is associated with the development of musculoskeletal pain that is induced by biomechanical constraints. Twelve (12) young healthy volunteers (two females) performed two experimental realistic manual tasks for 30 min each: (1) with the high risk of musculoskeletal pain development and (2) with low risk for pain development. During the tasks, synchronized electroencephalographic (EEG) and electromyography (EMG) signals data were collected, as well as pain scores. Subsequently, two main variables were computed from neurophysiological signals: (1) cortical inhibition as Task-Related Power Increase (TRPI) in beta EEG frequency band (ß.TRPI) and (2) muscle variability as Coefficient of Variation (CoV) from EMG signals. A strong effect size was observed for pain measurement under the high risk condition during the last 5 min of the task execution; with muscle fatigue, because the CoV has decreased below 18%. An increase in cortical inhibition (ß.TRPI >50%) was observed after the 5th min of the task in both experimental conditions. These results suggest the following neurophysiological pattern-ß.TRPI ≥ 50% and CoV ≤ 18%-as a possible indicator to monitor the development of musculoskeletal pain in the shoulder in the context of repeated and prolonged exposure to manual tasks.

The immediate effect of two lumbar stabilization methods on postural control parameters and their reliability during two balance tasks.

Background: Lumbosacral orthosis (LSO) and/or the isolated contraction of the transversus abdominis muscle by the abdominal drawing-in maneuver (ADIM) can increase lumbar stiffness, consequently influencing postural control. The purpose of this study was to compare the effects of LSO and ADIM on postural control during two balance tasks and determine their reliability.Methods: Twenty participants (50% men) randomly performed three experimental conditions: 1) without lumbar stabilization, 2) with LSO), and 3) with ADIM. Each experimental condition was tested in two postural tasks: semi-tandem and one-legged stance on a force platform for 30 seconds, while the Center of pressure postural (COP) parameters were computed.Results: The two methods of lumbar stabilization were comparable and did not significantly reduce the COP values across time, even though a few individuals presented a change in their COP data above the levels of measurement errors. The reliability of these measurements was generally acceptable and sometimes excellent (≥ 0.90 and ≤10% error measurement).Conclusions: Both LSO and isolated contraction of the transversus abdominis muscle by ADIM do not change postural control in one-legged stance and in semi-tandem tasks. These results have implications for use or not these methods for postural control on a rehabilitation perspective.

Combining transcutaneous electrical nerve stimulation with therapeutic exercise to reduce pain in an elderly population: a pilot study.

PURPOSE: Chronic pain is a highly prevalent and debilitating condition, and there is a pressing need to find safe, effective and affordable treatments to tackle this public health issue. This pilot study aimed to assess whether therapeutic exercises supplemented by transcutaneous electrical nerve stimulation induces a greater hypoalgesic effect than therapeutic exercises supplemented by sham transcutaneous electrical nerve stimulation, in an elderly population suffering from chronic pain. MATERIALS AND METHODS: Eighteen elderly participants suffering from chronic pain completed a therapeutic exercise program consisting of 45-min group sessions administered twice a week for 4 weeks. Half of the participants received real transcutaneous electrical nerve stimulation during the exercise sessions, while the others received sham transcutaneous electrical nerve stimulation. Participants completed pain questionnaires (McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Index) before and after the intervention, and recorded their pain levels on an 11-point numerical rating scale before and after each session (Clinical Trial.Gov ID: NCT02445677). RESULTS AND CONCLUSION: Our results suggest that supplementing exercise sessions with transcutaneous electrical nerve stimulation does not improve the long-term outcomes of elderly patients suffering from chronic pain, but does induce short-term hypoalgesia during exercise sessions. Our study also offers valuable guidelines for the implementation of a future and adequately powered study looking at this research question.Implications for rehabilitationThe application of transcutaneous electrical nerve stimulation during exercises is well tolerated by elderly individuals suffering from chronic pain.Supplementing exercises with transcutaneous electrical nerve stimulation does not seem to improve general outcome in elderly suffering from chronic pain.Notwithstanding, the addition of transcutaneous electrical nerve stimulation tends to produce a marked hypoalgesic effect during the exercise sessions, an effect that could prompt indirect benefits for pain patients.

tDCS Task-Oriented Approach Improves Function in Individuals With Fibromyalgia Pain. A Pilot Study.

Fibromyalgia (FM) is a complex pain syndrome accompanied by physical disability and loss of daily life activities. Evidences suggest that modulation of the primary motor cortex (M1) by transcranial direct current stimulation (tDCS) improves functional physical capacity in chronic pain conditions. However, the gain on physical function in people living with FM receiving tDCS is still unclear. This study aimed to evaluate whether the tDCS task-oriented approach improves function and reduces pain in a single cohort of 10 FM. A total of 10 women with FM (60.4 ± 15.37 years old) were enrolled in an intervention including anodal tDCS delivered on M1 (2 mA from a constant stimulator for 20 min); simultaneously they performed a functional task. The anode was placed on the contralateral hemisphere of the dominant hand. Outcome assessments were done before the stimulation, immediately after stimulation and 30 min after the end of tDCS. The same protocol was applied in subsequent sessions. A total of five consecutive days of tDCS were completed. The main outcomes were the number of repetitions achieved and time in active practice to evaluate functional physical task performance such as intensity of the pain (visual analog scale) and level of fatigue (Borg scale). After 5 days of tDCS, the number of repetitions achieved significantly increased by 49% (p = 0.012). No change was observed in active practice time. No increase in pain was observed despite the mobility of the painful parts of the body. These results are encouraging since an increase in pain due to the mobilization of painful body parts could have been observed at the end of the 5th day of the experiment. These results support the use of tDCS in task-based rehabilitation.