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1.
N Engl J Med ; 384(6): 521-532, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33567192

RESUMO

BACKGROUND: Bilateral vestibular hypofunction is associated with chronic disequilibrium, postural instability, and unsteady gait owing to failure of vestibular reflexes that stabilize the eyes, head, and body. A vestibular implant may be effective in alleviating symptoms. METHODS: Persons who had had ototoxic (7 participants) or idiopathic (1 participant) bilateral vestibular hypofunction for 2 to 23 years underwent unilateral implantation of a prosthesis that electrically stimulates the three semicircular canal branches of the vestibular nerve. Clinical outcomes included the score on the Bruininks-Oseretsky Test of Motor Proficiency balance subtest (range, 0 to 36, with higher scores indicating better balance), time to failure on the modified Romberg test (range, 0 to 30 seconds), score on the Dynamic Gait Index (range, 0 to 24, with higher scores indicating better gait performance), time needed to complete the Timed Up and Go test, gait speed, pure-tone auditory detection thresholds, speech discrimination scores, and quality of life. We compared participants' results at baseline (before implantation) with those at 6 months (8 participants) and at 1 year (6 participants) with the device set in its usual treatment mode (varying stimulus pulse rate and amplitude to represent rotational head motion) and in a placebo mode (holding pulse rate and amplitude constant). RESULTS: The median scores at baseline and at 6 months on the Bruininks-Oseretsky test were 17.5 and 21.0, respectively (median within-participant difference, 5.5 points; 95% confidence interval [CI], 0 to 10.0); the median times on the modified Romberg test were 3.6 seconds and 8.3 seconds (difference, 5.1; 95% CI, 1.5 to 27.6); the median scores on the Dynamic Gait Index were 12.5 and 22.5 (difference, 10.5 points; 95% CI, 1.5 to 12.0); the median times on the Timed Up and Go test were 11.0 seconds and 8.7 seconds (difference, 2.3; 95% CI, -1.7 to 5.0); and the median speeds on the gait-speed test were 1.03 m per second and 1.10 m per second (difference, 0.13; 95% CI, -0.25 to 0.30). Placebo-mode testing confirmed that improvements were due to treatment-mode stimulation. Among the 6 participants who were also assessed at 1 year, the median within-participant changes from baseline to 1 year were generally consistent with results at 6 months. Implantation caused ipsilateral hearing loss, with the air-conducted pure-tone average detection threshold at 6 months increasing by 3 to 16 dB in 5 participants and by 74 to 104 dB in 3 participants. Changes in participant-reported disability and quality of life paralleled changes in posture and gait. CONCLUSIONS: Six months and 1 year after unilateral implantation of a vestibular prosthesis for bilateral vestibular hypofunction, measures of posture, gait, and quality of life were generally in the direction of improvement from baseline, but hearing was reduced in the ear with the implant in all but 1 participant. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02725463.).


Assuntos
Vestibulopatia Bilateral/cirurgia , Marcha/fisiologia , Perda Auditiva/etiologia , Neuroestimuladores Implantáveis , Equilíbrio Postural/fisiologia , Qualidade de Vida , Vestíbulo do Labirinto/cirurgia , Idoso , Vestibulopatia Bilateral/induzido quimicamente , Vestibulopatia Bilateral/complicações , Tontura/etiologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Neuroestimuladores Implantáveis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Canais Semicirculares/inervação , Nervo Vestibular/efeitos dos fármacos
2.
BMC Neurol ; 21(1): 38, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504334

RESUMO

BACKGROUND: Ambulatory and balance functions are important for maintaining general health in humans. Gait analysis allows clinicians and researchers to identify the parameters to be focused on when assessing balance and ambulatory functions. In this study, we performed gait analysis with pressure sensors to identify the gait-analysis parameters related to balance and ambulatory functions in hemiplegic stroke patients. METHODS: We retrospectively reviewed the medical records of 102 patients with hemiplegic stroke who underwent gait analysis. Correlations between various temporospatial parameters in the gait analysis and the motor and balance functions assessed using functional ambulation category, modified Barthel index, and Berg balance scale were analyzed. RESULTS: Gait speed/height and the lower-limb stance-phase time/height were the only temporal and spatial parameters, respectively, that showed a statistical correlation with motor and balance functions. CONCLUSIONS: Measurements of walking speed and stance-phase time of the unaffected lower limb can allow clinicians to easily assess the ambulatory and balance functions of hemiplegic stroke patients. Rehabilitative treatment focusing on increasing gait speed and shortening the stance-phase time of the unaffected side may improve the ambulatory and balance functions in these patients.


Assuntos
Análise da Marcha/estatística & dados numéricos , Hemiplegia/fisiopatologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Caminhada/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemiplegia/complicações , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Adulto Jovem
3.
J Clin Neurosci ; 82(Pt A): 173-178, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317728

RESUMO

Noisy galvanic vestibular stimulation (nGVS) involves the application of a weak, noisy, electrical current to the vestibular end organs and their afferent nerves, through electrodes placed bilaterally over the mastoid process. Center of pressure (COP) sway was shown to decrease during nGVS under conditions of static standing posture. However, whether nGVS can improve balance functions other than the static standing posture remains unclear. This study aimed to elucidate the effects of nGVS on COP sway during one-legged standing. We randomly assigned 36 participants to either a control group (sham stimulation), a 0.2 mA group (nGVS at 0.2 mA), or a 0.4 mA group (nGVS at 0.4 mA). All participants were measured for COP sway standing on one leg, with open eyes, both before and during stimulation. In the 0.2 mA group, the sway path length, mediolateral mean velocity, and anteroposterior mean velocity decreased during stimulation compared with before stimulation. Conversely, no significant differences in COP sway were detected for either the control group or the 0.4 mA group. The stimulation effects for all COP sway parameters were significantly higher in the 0.2 mA group than in either the control group or the 0.4 mA group. The results of this study suggested that nGVS not only decreases COP sway during static standing postures but can also reduce COP sway during one-legged standing.


Assuntos
Equilíbrio Postural/fisiologia , Postura/fisiologia , Vestíbulo do Labirinto/fisiologia , Adulto , Estimulação Elétrica , Eletrodos , Feminino , Humanos , Masculino , Adulto Jovem
5.
PLoS One ; 15(12): e0242215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332421

RESUMO

Step-by-step foot placement control, relative to the center of mass (CoM) kinematic state, is generally considered a dominant mechanism for maintenance of gait stability. By adequate (mediolateral) positioning of the center of pressure with respect to the CoM, the ground reaction force generates a moment that prevents falling. In healthy individuals, foot placement is complemented mainly by ankle moment control ensuring stability. To evaluate possible compensatory relationships between step-by-step foot placement and complementary ankle moments, we investigated the degree of (active) foot placement control during steady-state walking, and under either foot placement-, or ankle moment constraints. Thirty healthy participants walked on a treadmill, while full-body kinematics, ground reaction forces and EMG activities were recorded. As a replication of earlier findings, we first showed step-by-step foot placement is associated with preceding CoM state and hip ab-/adductor activity during steady-state walking. Tight control of foot placement appears to be important at normal walking speed because there was a limited change in the degree of foot placement control despite the presence of a foot placement constraint. At slow speed, the degree of foot placement control decreased substantially, suggesting that tight control of foot placement is less essential when walking slowly. Step-by-step foot placement control was not tightened to compensate for constrained ankle moments. Instead compensation was achieved through increases in step width and stride frequency.


Assuntos
Articulação do Tornozelo/fisiologia , Pé/fisiologia , Modelos Biológicos , Velocidade de Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Feminino , Análise da Marcha , Voluntários Saudáveis , Humanos , Modelos Lineares , Masculino , Equilíbrio Postural/fisiologia , Adulto Jovem
6.
Nefrología (Madrid) ; 40(6): 655-663, nov.-dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-197202

RESUMO

INTRODUCCIÓN: El equilibrio postural es el resultado de una compleja interacción de aferencias sensoriales que nos mantiene erguidos. Los pacientes en hemodiálisis presentan alteraciones que pueden generar inestabilidad postural y riesgo de caídas. Nuestro objetivo es analizar, mediante una plataforma de fuerzas, la estabilidad postural en pacientes hemodializados y su relación con el riesgo de caídas. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo transversal. El balanceo postural se registró mediante una plataforma de fuerzas en los pacientes prevalentes en hemodiálisis. Se recogen datos epidemiológicos, de diálisis, analíticos y de tratamiento. La incidencia de caídas fue registrada durante los 6 meses siguientes a las pruebas. El análisis de la estabilidad postural se realizó con una plataforma portátil de galgas extensiométricas (AMTI AccuGait®) y una unidad de software específico para estabilometría (programa Balance Trainer®). Se determinan 31 parámetros de equilibrio; las variables de equilibrio utilizadas son: Area 95, AreaEffect, VyMax, Xrange y Yrange. Los estudios de estabilometría se realizan en 3 situaciones: con los ojos abiertos, con los ojos cerrados y mientras el paciente realiza una tarea simultánea. Se realiza un estudio al iniciar la sesión de diálisis y el segundo, al terminar. La estabilometría en condiciones semejantes se mide en un grupo control. RESULTADOS: Se estudian 32 pacientes, con una edad media de 68 años; 20 hombres y 12 mujeres. Su peso medio es de 74 kg y el IMC, de 27,6 kg/m2. En los controles no hay diferencias significativas en la estabilometría entre las 3 situaciones estudiadas. Los pacientes con los ojos cerrados, pre y poshemodiálisis, presentan más desequilibrio, con diferencias significativas con el resto de las situaciones y los controles. Después de la sesión de hemodiálisis se observa un aumento significativo de la inestabilidad. Se observa mayor inestabilidad en los 13 pacientes diabéticos (p < 0,05). Los 4 pacientes con hiponatremia (Na < 136 mmol/L) presentaban peor equilibrio en la situación de tarea simultánea (p= 0,038). Varios fármacos, como la insulina (p = 0,022), los antiagregantes (p = 0,036) y los betabloqueantes (p = 0,029), se relacionaban con el desequilibrio. Los 10 pacientes que sufrieron caídas presentaban mayor desequilibrio, Yrange, Xrange, Area 95 y AreaEffect, pre y poshemodiálisis (p < 0,05) que los que no tuvieron caídas. CONCLUSIONES: Los pacientes en hemodiálisis presentan alteraciones que pueden generar inestabilidad postural y riesgo de caídas. Programas de prevención que incluyan ejercicios específicos para mejorar el equilibrio podrían ser beneficiosos, reduciendo el riesgo de caídas en esta población


INTRODUCTION: Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform. MATERIAL AND METHODS: This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the 6 months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; AreaEffect; VyMax; Xrange and Yrange. The stabilometry studies were performed in 3 situations: with eyes open; with eyes closed; and with the patient performing a simultaneous task. We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions. RESULTS: We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74kg, with a mean BMI of 27.6kg/m2. In the controls, there were no significant differences in the stabilometry between the 3 situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (P < .05). The 4 patients with hyponatraemia (Na < 136 mmol/l) had worse balance in the simultaneous task situation (P = .038). Various drugs, such as insulin (P = .022), antiplatelet agents (P =.036) and beta-blockers (P = .029), were associated with imbalance. The 10 patients who suffered falls had greater imbalance, Yrange, Xrange, Area 95 and AreaEffect, both pre- and post-haemodialysis (P < .05) than those without falls. CONCLUSIONS: Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Prevention programmes which include specific exercises to improve balance could be beneficial in reducing the risk of falls in this population


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diálise Renal/efeitos adversos , Acidentes por Quedas , Equilíbrio Postural/fisiologia , Estudos Prospectivos , Estudos Transversais , Fatores de Risco , Valores de Referência , Estatísticas não Paramétricas , Qualidade de Vida , Fatores de Tempo
7.
Arch Osteoporos ; 15(1): 166, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33079259

RESUMO

In our study investigating the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and possible factors responsible for falls, we have found that prevalence of OSO is 10.7%. OSO does not significantly increase the odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. PURPOSES: The purposes of the study were (a) to determine the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and (b) to investigate the association between falls and possible factors in individuals with and without OSO. METHODS: Medical records of patients aged ≥ 65 years were retrospectively reviewed. Individuals were diagnosed with OSO based on their T-score assessed by dual x-ray absorptiometry, handgrip strength, appendicular lean mass index (ALMi), gait speed and body fat percentile. Comorbidities, history of falls, depressive state, medications and anthropometric measures were also noted. RESULTS: A sample of 460 individuals were assessed (337 females; 123 males) and 49 patients were diagnosed with OSO. There was no statistically significant difference in falls between the two groups (OR: 0.768, 95% CI: 0.409-1.440, p: 0.41) and the presence of OSO was not significantly associated with increased odds of falling (OR: 1.755, 95% CI: 0.547-5.628, p: 0.344). Handgrip strength (OR: 0.931, 95% CI: 0.893-0.971, p: 0.001), ALMi (OR: 0.799, 95% CI: 0.708-0.901, p < 0.0001) and gait speed (OR: 0.529, 95% CI: 0.283-0.988, p: 0.046) were independently associated with falls in overall group, whereas interaction analysis did not reveal any significant moderator effect of OSO vs. non-OSO in the associations between risk factors and falls. CONCLUSION: The prevalence of OSO was 10.7%. OSO was not associated with elevated odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. Further prospective research is needed to clarify the effect of OSO on odds of falling, in consideration with possible risk factors. TRIAL REGISTRATION NUMBER AND DATE: NCT04288401 /26.02.2020.


Assuntos
Fragilidade/fisiopatologia , Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Obesidade/epidemiologia , Osteoporose Pós-Menopausa/epidemiologia , Osteoporose/epidemiologia , Sarcopenia/epidemiologia , Absorciometria de Fóton/métodos , Idoso , Antropometria/métodos , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Obesidade/fisiopatologia , Osteoporose/fisiopatologia , Equilíbrio Postural/fisiologia , Prevalência , Estudos Retrospectivos , Sarcopenia/fisiopatologia
8.
J Vis Exp ; (163)2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-33016940

RESUMO

Computerized dynamic posturography (CDP) is an objective technique for the evaluation of postural stability under static and dynamic conditions and perturbation. CDP is based on the inverted pendulum model that traces the interrelationship between the center of pressure and the center of gravity. CDP can be used to analyze the proportions of vision, proprioception, and vestibular sensation to maintain postural stability. The following characters define chronic ankle instability (CAI): persistent ankle pain, swelling, the feeling of "giving way," and self-reported disability. Postural stability and fibular muscle activation level in individuals with CAI decreased due to lateral ankle ligament complex injuries. Few studies have used CDP to explore the postural stability of individuals with CAI. Studies that investigate postural stability and related muscle activation by using synchronized CDP with surface electromyography are lacking. This CDP protocol includes a sensory organization test (SOT), a motor control test (MCT), and an adaption test (ADT), as well as tests that measure unilateral stance (US) and limit of stability (LOS). The surface electromyography system is synchronized with CDP to collect data on lower limb muscle activation during measurement. This protocol presents a novel approach for evaluating the coordination of the visual, somatosensory, and vestibular systems and related muscle activation to maintain postural stability. Moreover, it provides new insights into the neuromuscular control of individuals with CAI when coping with real complex environments.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiopatologia , Músculos/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Doença Crônica , Eletromiografia , Feminino , Humanos , Masculino , Propriocepção/fisiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-32867306

RESUMO

This study examined postural control during single leg stance test with progressively increased balance-task difficulty in soccer players with unilateral transfemoral amputation (n = 11) compared to able-bodied soccer players (n = 11). The overall stability index (OSI), the anterior/posterior stability index, and the medial/lateral stability index during three balance tasks with increasing surface instability were estimated. The oculomotor and visuomotor contribution to postural control in disabled athletes was analyzed. Oculomotor function, simple and choice reaction times, and peripheral perception were assessed in a series of visuomotor tests. The variation in OSI demonstrated significantly greater increases during postural tests with increased balance-task difficulty in the able-bodied soccer players compared to amputees (F(2,40) = 3.336, p < 0.05). Ocular mobility index correlated (p < 0.05) with OSI in conditions of increasing balance-task difficulty. Moreover, speed of eye-foot reaction has positive influence (p < 0.05) on stability indexes in tasks with an unstable surface. Amputee soccer players displayed comparable postural stability to able-bodied soccer players. Disabled athletes had better adaptability in restoring a state of balance in conditions of increased balance-task difficulty than the controls. The speed of visuomotor processing, characterized mainly by speed of eye-foot reaction, significantly contributed to these results.


Assuntos
Amputação , Atletas , Equilíbrio Postural/fisiologia , Futebol/fisiologia , Adulto , Humanos , Masculino , Músculos Oculomotores , Amplitude de Movimento Articular , Análise e Desempenho de Tarefas
10.
Artigo em Inglês | MEDLINE | ID: mdl-32872251

RESUMO

Sixteen female soccer players (age = 20.19 ± 1.52 years; body mass = 56.52 ± 4.95 kg; body height = 164.81 ± 4.21 cm) with no history of lower extremity injury participated in the study. The Biodex SD Balance system was used to determine the non-dominant single-leg stability. In anaerobic exercise, each subject performed four maximal cycling efforts against a resistance equivalent to 0.075 kg/body mass for 30 s with three-minute rest intervals. In aerobic exercise, subjects performed the Bruce protocol on a motorized treadmill. After each exercise, subjects subsequently performed a single-leg stability test and then repeated the same test for four times with five-minute passive rest periods. In accordance with the results, it was found that the impairment observed right after the aerobic loading was higher (p < 0.001) compared to the anaerobic one. However, the time-related deterioration in both aerobic and anaerobic loadings was similar. The B-pre value was lower than Bpost and B5 (p < 0.01) and B10 (p < 0.05) in both conditions. Subjects could reach the initial balance level at B15 after aerobic and anaerobic loadings. The lactate level did not reach resting value even after 20 min of both fatigue protocols. Although the fatigue after aerobic and aerobic exercise negatively affects a single-leg dynamic balance level, single leg balance ability returns to the baseline status after 10 min of passive recovery duration.


Assuntos
Limiar Anaeróbio/fisiologia , Exercício Físico/fisiologia , Fadiga , Equilíbrio Postural/fisiologia , Recuperação de Função Fisiológica/fisiologia , Futebol/fisiologia , Adulto , Anaerobiose , Teste de Esforço , Feminino , Humanos
11.
PLoS One ; 15(9): e0238436, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877426

RESUMO

Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Patients with chronic subjective dizziness have some troubles with their postural stability. The present study aimed to assess the benefit of home-based vestibular rehabilitation in patients with chronic subjective dizziness using computerized dynamic posturography. Therefore, 100 subjects, between 19 to 86 years, diagnosed with dizziness were included in the study. Computerized dynamic posturography was performed to assess postural stability. Vestibular rehabilitation programs included exercises tailored to the particular needs of each patient. After vestibular rehabilitation, patients were re-examined using the same tests. Posturographic data were analyzed and compared for before and after vestibular rehabilitation findings. The mean composite scores before the intervention (58,92 ±11,64) was significantly (p<0.01) lower than the mean composite scores after vestibular rehabilitation (73,83 ± 8,26). This result is found to be statistically significant. In conclusion it could be suggested that the effectiveness of vestibular rehabilitation could be verified by means of computerized dynamic posturography as a concrete method.


Assuntos
Tontura/terapia , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tontura/diagnóstico , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Resultado do Tratamento , Vertigem/diagnóstico , Vertigem/terapia , Doenças Vestibulares/patologia , Testes de Função Vestibular/métodos , Núcleos Vestibulares/metabolismo
12.
Artigo em Inglês | MEDLINE | ID: mdl-32933208

RESUMO

Backward jump-landing during sports performance will result in dynamic postural instability with a greater risk of injury, and most research studies have focused on forward landing. Differences in kinematic temporal characteristics between single-leg and double-leg backward jump-landing are seldom researched and understood. The purpose of this study was to compare and analyze lower extremity kinematic differences throughout the landing phases of forward and backward jumping using single-leg and double-leg landings (FS and BS, FD and BD). Kinematic data were collected during the landing phases of FS and BS, FD and BD in 45 participants. Through statistical parametric mapping (SPM) analysis, we found that the BS showed smaller hip and knee flexion and greater vertical ground reactive force (VGRF) than the FS during 0-37.42% (p = 0.031), 16.07-32.11% (p = 0.045), and 23.03-17.32% (p = 0.041) landing phases. The BD showed smaller hip and knee flexion than the FD during 0-20.66% (p = 0.047) and 0-100% (p < 0.001) landing phases. Most differences appeared within a time frame during the landing phase at 30-50 ms in which non-contact anterior cruciate ligament (ACL) injuries are thought to occur and are consistent with the identification of risk in biomechanical analysis. A landing strategy that consciously increases the knee and hip flexion angles during backward landing should be considered for people as a measure to avoid injury during the performance of this type of physical activity.


Assuntos
Lesões do Ligamento Cruzado Anterior , Desempenho Atlético/fisiologia , Traumatismos do Joelho/prevenção & controle , Perna (Membro)/fisiologia , Extremidade Inferior/fisiologia , Movimento/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Atletas , Fenômenos Biomecânicos/fisiologia , Humanos , Articulação do Joelho/fisiologia
13.
PLoS One ; 15(9): e0239148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936793

RESUMO

Lower limb exoskeletons and lower limb prostheses have the potential to reduce gait limitations during stair ambulation. To develop robotic assistance devices, the biomechanics of stair ambulation and the required transitions to level walking have to be understood. This study aimed to identify the timing of these transitions, to determine if transition phases exist and how long they last, and to investigate if there exists a joint-related order and timing for the start and end of the transitions. Therefore, this study analyzed the kinematics and kinetics of both transitions between level walking and stair ascent, and between level walking and stair descent (12 subjects, 25.4 yrs, 74.6 kg). We found that transitions primarily start within the stance phase and end within the swing phase. Transition phases exist for each limb, all joints (hip, knee, ankle), and types of transitions. They have a mean duration of half of one stride and they do not last longer than one stride. The duration of the transition phase for all joints of a single limb in aggregate is less than 35% of one stride in all but one case. The distal joints initialize stair ascent, while the proximal joints primarily initialize the stair descent transitions. In general, the distal joints complete the transitions first. We believe that energy- and balance-related processes are responsible for the joint-specific transition timing. Regarding the existence of a transition phase for all joints and transitions, we believe that lower limb exoskeleton or prosthetic control concepts should account for these transitions in order to improve the smoothness of the transition and to thus increase the user comfort, safety, and user experience. Our gait data and the identified transition timings can provide a reference for the design and the performance of stair ambulation- related control concepts.


Assuntos
Articulação do Tornozelo/fisiologia , Marcha/fisiologia , Articulação do Quadril/fisiologia , Articulação do Joelho/fisiologia , Subida de Escada/fisiologia , Adulto , Membros Artificiais , Fenômenos Biomecânicos/fisiologia , Exoesqueleto Energizado , Humanos , Extremidade Inferior , Masculino , Equilíbrio Postural/fisiologia , Desenho de Prótese/métodos , Amplitude de Movimento Articular/fisiologia , Fatores de Tempo , Adulto Jovem
14.
Geriatr Gerontol Int ; 20(10): 899-903, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32886828

RESUMO

AIM: Exercise therapy is a key intervention in the management of knee osteoarthritis (OA). This study aimed to test the 6-month effectiveness of Wu Qin Xi Qigong (WQXQ) exercise versus a conventional physical therapy (control group [CG]) on physical functioning in patients with early knee OA. METHODS: This study was a 6-month follow-up from a randomized controlled trial. Participants with knee OA were randomly allocated to the WQXQ or CG. Data from the Berg Balance Scale, Timed Up and Go Test, 6-Minute Walk Test, 30-Second Chair Stand Test, the Western Ontario and McMaster Universities Osteoarthritis Index, knee extension strength and knee flexion strength were collected before and after the 6-month intervention. RESULTS: Both treatment groups demonstrated large (20%-50%) and clinically relevant reductions in activity limitations, pain and knee instability, which were sustained at 6 months post-treatment. No differences in effectiveness between experimental and control treatment were found on Timed Up and Go Test, 6-Minute Walk Test, knee extension strength and knee flexion strength except for a higher Berg Balance Scale score (P = 0.029) and lower Western Ontario and McMaster Universities Osteoarthritis Index pain score (P = 0.031) in the WQXQ group. CONCLUSIONS: Both WQXQ and conventional physical therapy exercise programs were highly effective in reducing activity limitations and pain, and promoting balance and muscle power. WQXQ was found to be more effective in promoting balance and reducing pain than conventional physical therapy exercise in patients with knee OA. Geriatr Gerontol Int 2020; 20: 899-903.


Assuntos
Osteoartrite do Joelho/terapia , Modalidades de Fisioterapia , Qigong/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , China , Terapia por Exercício , Feminino , Humanos , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Dor/reabilitação , Manejo da Dor/métodos , Medição da Dor , Equilíbrio Postural/fisiologia , Estudos de Tempo e Movimento , Resultado do Tratamento
15.
J Sports Med Phys Fitness ; 60(8): 1148-1158, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32955841

RESUMO

BACKGROUND: There is paucity of data examining the effectiveness of long-term Hatha yoga-based (HY) programs focused on the health-related fitness (H-RF) of asymptomatic, sedentary women. The purpose of this study was to examine the effects of a 6-month HY-based training program on H-RF components in sedentary middle-aged women. METHODS: Eighty sedentary women were randomly assigned into either the HY group (HYG) (N.=42) or the control group (CG) (N.=38). The 6-month HYG program involved a progressive series of Vinyasa Flow poses performed 3 times/week for 60 minutes (40 minutes within the exercise zone of 60-75% HRmax). The CG participants did not undergo any physical training or education. Health-related fitness parameters included measures of pre- and post-training: body composition, muscular strength and maximal voluntary isometric torques of elbow flexors and knee extensors, cardio-respiratory fitness, lower back and hamstring flexibility and a static-dynamic balance. RESULTS: Two-way mixed design ANOVA revealed significant main effects for all the indicators of H-RF. Tukey post-hoc tests confirmed that the HYG demonstrated significant improvements in every variable tested. Examples of the benefits achieved include (all P<.001): an average loss of 1.03 kg and a 4.82% decrease in body fat, 14.6% and 13.1% gains in isometric strength of the knee extensors and elbow flexors respectively, an increase in relative VO2max of 6.1% (33.12±5.30 to 35.14±4.82 mL/kg/min), a 4-cm or 10.4% increase in their MSAR, and an average improved Balance Index of 5.6 mm/s. Reversely, the CG showed non-significant changes in H-RF variables (all P>0.05; percent range from -1.4% to 1.1%). CONCLUSIONS: By participating in a moderate-intensity 6-month HY-based training program, middle-aged women can significantly improve their HR-F status. The application of progressive target heart rate goals facilitated greater than expected improvements in cardio-respiratory fitness and improvements in body composition.


Assuntos
Aptidão Física/fisiologia , Comportamento Sedentário , Ioga , Adulto , Composição Corporal , Aptidão Cardiorrespiratória , Cotovelo/fisiologia , Feminino , Frequência Cardíaca , Humanos , Contração Isométrica/fisiologia , Joelho/fisiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Torque
16.
Rehabilitación (Madr., Ed. impr.) ; 54(3): 200-210, jul.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196736

RESUMO

Las evidencias sobre la efectividad de las intervenciones rehabilitadoras en las ataxias espinocerebelosas son escasas y variables. OBJETIVO: Recopilar las evidencias existentes sobre dicha efectividad. Material y MÉTODOS: Se han analizado todos los ensayos clínicos publicados hasta la fecha y evaluado los resultados obtenidos en cuanto a la mejora del equilibrio, marcha y realización de actividades diarias postratamiento. Encontramos una mejora significativa de la postura (p <0,008), marcha (p <0,02), así como una reducción de la puntuación de la subescala SARAg&p (marcha y postura) e índice SCAFI 8MW (velocidad de marcha) (p = 0,02). También observamos mejora en desórdenes del habla (p = 0,02), síntomas depresivos (p <0,0001) y caídas accidentales (p <0,005). CONCLUSIONES: A pesar de la controversia en aspectos relacionados con la intensidad, la temporalidad y la duración de las mejoras conseguidas, queda constatada la efectividad clínica del tratamiento rehabilitador en estos pacientes, especialmente en aspectos como la marcha y el equilibrio


Evidence of the effectiveness of rehabilitation interventions in spinocerebellar ataxia is scarce and variable. OBJECTIVES: The aim of this systematic review was to gather the existing evidence on the effectiveness of these interventions. MATERIAL AND METHODS: To do this, we analysed all the clinical trials published to date and assessed their results in terms of improved balance, gait, and performance of daily activities after treatment. Significant improvements were found for posture (P<.008) and gait (P<.02), as well as a reduction in the scores for the SARAg&p subscale (gait and posture) and SCAFI 8MW index (gait speed) (P=.02). We also observed improvements in speech disorders (P=.02), depressive symptoms (P<.0001) and accidental falls (P<.005)


Assuntos
Humanos , Degenerações Espinocerebelares/reabilitação , Ataxias Espinocerebelares/reabilitação , Transtornos das Sensações/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Equilíbrio Postural/fisiologia , Atividades Cotidianas/classificação , Postura/fisiologia
17.
PLoS One ; 15(7): e0236824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735569

RESUMO

In our daily life, we often interact with objects using both hands raising the question the question to what extent information between the hands is shared. It has, for instance, been shown that curvature adaptation aftereffects can transfer from the adapted hand to the non-adapted hand. However, this transfer only occurred for dynamic exploration, e.g. by moving a single finger over a surface, but not for static exploration when keeping static contact with the surface and combining the information from different parts of the hand. This raises the question to what extent adaptation to object shape is shared between the hands when both hands are used in static fashion simultaneously and the object shape estimates require information from both hands. Here we addressed this question in three experiments using a slant adaptation paradigm. In Experiment 1 we investigated whether an aftereffect of static bimanual adaptation occurs at all and whether it transfers to conditions in which one hand was moving. In Experiment 2 participants adapted either to a felt slanted surface or simply be holding their hands in mid-air at similar positions, to investigate to what extent the effects of static bimanual adaptation are posture-based rather than object based. Experiment 3 further explored the idea that bimanual adaptation is largely posture based. We found that bimanual adaptation using static touch did lead to aftereffects when using the same static exploration mode for testing. However, the aftereffect did not transfer to any exploration mode that included a dynamic component. Moreover, we found similar aftereffects both with and without a haptic surface. Thus, we conclude that static bimanual adaptation is of proprioceptive nature and does not occur at the level at which the object is represented.


Assuntos
Mãos/fisiologia , Desempenho Psicomotor , Percepção do Tato/fisiologia , Adaptação Fisiológica , Adulto , Feminino , Humanos , Masculino , Equilíbrio Postural/fisiologia , Tato , Adulto Jovem
18.
PLoS One ; 15(7): e0236702, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735602

RESUMO

When humans are administered continuous and predictable perturbations of stance, an adaptation period precedes the steady state of balancing behaviour. Little information is available on the modulation of adaptation by vision and perturbation frequency. Moreover, performance of supra-postural tasks may modulate adaptation in as yet unidentified ways. Our purpose was to identify differences in adaptation associated to distinct visual tasks and perturbation frequencies. Twenty non-disabled adult volunteers stood on a platform translating 10 cm in antero-posterior (AP) direction at low (LF, 0.18 Hz) and high frequency (HF, 0.56 Hz) with eyes open (EO) and closed (EC). Additional conditions were reading a text fixed to platform (EO-TP) and reading a text stationary on ground (EO-TG). Peak-to-peak (PP) displacement amplitude and AP position of head and pelvis markers were computed for each of 27 continuous perturbation cycles. The time constant and extent of head and pelvis adaptation and the cross-correlation coefficients between head and pelvis were compared across visual conditions and frequencies. Head and pelvis mean positions in space varied little across conditions and perturbation cycles but the mean head PP displacements changed over time. On average, at LF, the PP displacement of the head and pelvis increased progressively. Adaptation was rapid or ineffective with EO, but slower with EO-TG, EO-TP, EC. At HF, the head PP displacement amplitude decreased progressively with fast adaptation rates, while the pelvis adaptation was not apparent. The results show that visual tasks can modulate the adaptation rate, highlight the effect of the perturbation frequency on adaptation and provide evidence of priority assigned to pelvis stabilization over visual tasks at HF. The effects of perturbation frequency and optic flow and their interaction with other sensory inputs and cognitive tasks on the adaptation strategies should be investigated in impaired individuals and considered in the design of rehabilitation protocols.


Assuntos
Adaptação Fisiológica/fisiologia , Equilíbrio Postural/fisiologia , Percepção Visual/fisiologia , Adulto , Feminino , Humanos , Masculino , Pelve/fisiologia
19.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 218-223, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193509

RESUMO

ANTECEDENTES Y OBJETIVO: La amputación de miembros inferiores genera ajustes en los sistemas somato sensorial y musculoesquelético modificando la manera como se mantiene la estabilidad, parámetro sensible y clínicamente relevante en la evaluación clínica. El objetivo de este trabajo fue determinar las características de la estabilidad en personas con amputación transtibial unilateral (ATU) en fase posprotésica. MATERIALES Y MÉTODOS: Estudio descriptivo de serie de casos que incluyó 5 varones con ATU con marcha independiente y que no usaran dispositivos de asistencia. Se evaluó la estabilidad estática y dinámica con ojos abiertos (OA) y ojos cerrados (OC). RESULTADOS: La estabilometría estática mostró una superficie de elipse de baricentro corporal mayor con OC y en el miembro inferior sano (MIS) respecto al miembro inferior protetizado (MIP), la media del índice de Romberg se ubicó en el rango de referencia; la estabilometría dinámica mostró límites de estabilidad menores en sentido anterior y hacia el MIS, y aún más reducidos con OC. CONCLUSIÓN: Las personas con ATU tienden a generar mayor apoyo y oscilaciones en el MIS y menores límites de estabilidad en el MIP para mantener el control de la estabilidad estática y dinámica


BACKGROUND AND OBJECTIVE: The amputation of lower limbs leads to adjustments in somatosensory and musculoskeletal systems to modify the way that stability is maintained. This is a sensitive and relevant parameter within clinical evaluation. The objective of this study was to determine the characteristics of stability in patients with a unilateral transtibial amputation (TTA) in the post-prosthetic phase. MATERIALS AND METHODS: A descriptive study of a case series including five men with TTA and an independent gait, and who did not use assistive devices. Static and dynamic stability was evaluated with open eyes (OE) and closed eyes (CE). RESULTS: Static stabilometry displayed a greater elliptical surface area of body centre of gravity with CE and in the Healthy Lower Limb (HLL) compared to the Prosthetic Lower Limb (PLL). The mean Romberg ratio (EC/EO) was within the reference range. Dynamic stabilometry showed lower limits of stability in the anterior direction and towards the HLL, and even more reduced stability with CE. CONCLUSION: People with TTA tend to generate more support and oscillations in the HLL and lower stability limits in the PLL to maintain static and dynamic stability control


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Amputação/métodos , Amputação/reabilitação , Cotos de Amputação , Amputados , Desenho de Prótese , Membros Artificiais , Marcha/fisiologia , Equilíbrio Postural/fisiologia
20.
Enferm. clín. (Ed. impr.) ; 30(4): 282-286, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196694

RESUMO

OBJETIVO: Las caídas son uno de los problemas más serios entre los adultos mayores. El deterioro del equilibrio es una de las causas importantes de la caída. Este estudio tiene como objetivo investigar el efecto de un ejercicio de equilibrio de ocho semanas sobre la estabilización postural y el riesgo de caídas entre los adultos mayores en la comunidad. MÉTODO: Este estudio cuasi experimental empleó un diseño previo y posterior a la prueba utilizando un grupo de control. El estudio incluyó un grupo de intervención de 30 encuestados y un grupo de control de otros 30 encuestados. La muestra se seleccionó usando muestreo aleatorio de múltiples etapas. Los datos se analizaron mediante una prueba t. RESULTADOS: El ejercicio de equilibrio afectó significativamente el equilibrio postural y el riesgo de caída. Hubo diferencias significativas entre los dos grupos (grupo de intervención y grupo de control) en el equilibrio postural (p < 0,001) y el riesgo de caída (p = 0,023). CONCLUSIÓN: El ejercicio de equilibrio se puede utilizar como uno de los esfuerzos preventivos para mantener el equilibrio postural y reducir el riesgo de caídas entre los adultos mayores en la comunidad. En el futuro, el estudio puede considerar la variación de edad para conocer la efectividad del ejercicio de equilibrio


OBJECTIVE: Falls are a serious problem for older adults. Balance impairment is one of the most significant reasons why adults fall from a standing position. This study aims to investigate the effect of an eight-week postural balance exercise intended to reduce the risk of falls among older adults in a community in Depok City, Indonesia. METHOD: This quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 30 respondents and a control group of a further 30 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test. RESULTS: The balance exercise significantly affected the respondents' postural balance and reduced their risk of falling. There were significant differences between the two groups (intervention group and control group) in postural balance (p < 0.001) and the risk of suffering a fall (p = 0.023). CONCLUSIÓN: Balance exercises can be utilized as one of the preventive efforts to maintain postural balance and reduce the risk of falls among older adults. Future studies may consider the variation of age to more accurately determine the effectiveness of this balance exercise


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Equilíbrio Postural/fisiologia , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Atividade Motora , Idoso Fragilizado , Resultado do Tratamento , Acidentes por Quedas/prevenção & controle , Terapia por Exercício/enfermagem , Indonésia , Inquéritos e Questionários
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