Changes in vestibular-related responses to combined noisy galvanic vestibular stimulation and cerebellar transcranial direct current stimulation.

Vestibular nuclei and cerebellar function comprise vestibular neural networks that control vestibular-related responses. However, the vestibular-related responses to simultaneous stimulation of these regions are unclear. This study aimed to examine whether the combination of noisy galvanic vestibular stimulation (nGVS) and cerebellar transcranial direct current stimulation (ctDCS) using a complex transcranial electrical stimulation device alters vestibular-dominant standing stability and vestibulo-ocular reflex (VOR) function. The center of foot pressure (COP) sway and VOR of participants (28 healthy, young adults) were assessed under four conditions of transcranial electrical stimulation using nGVS and ctDCS. The COP was calculated with the participant standing on a soft-foam surface with eyes closed using a force plate to evaluate body sway. VOR measurements were collected via passive head movements and fixation on a target projected onto the front wall using a video head impulse test (vHIT). VOR gain was calculated in six directions using a semicircular canal structure based on the ratio of eye movement to head movement. The nGVS + ctDCS and nGVS + sham ctDCS conditions decreased COP sway compared to the sham nGVS + ctDCS and sham nGVS + sham ctDCS conditions. No significant differences were observed in the main effect of stimulation or the interaction of stimulation and direction on the vHIT parameters. The results of this study suggest that postural stability may be independently affected by nGVS. Our findings contribute to the basic neurological foundation for the clinical application of neurorehabilitation using transcranial electrical stimulation of the vestibular system.

Effects of Non-Face-to-Face and Noncontact Interventions on Knee Pain and Physical Activity in Older Adults With Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Increased physical activity is an effective treatment for knee osteoarthritis that causes knee pain. However, due to the coronavirus disease 2019, noncontact and non-face-to-face interventions have increased, but the quality of evidence supporting their effectiveness remains unclear. The purpose of the study was to assess the quality of evidence of the effects of non-face-to-face and noncontact interventions on knee pain and physical activity in older adults with knee osteoarthritis. A meta-analysis was conducted to determine the effects of different intervention methods (education and exercise). The Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were systematically searched. Four randomized controlled trials were included in the analysis. The meta-analysis demonstrated that the educational intervention group was significantly effective, although supportive evidence was low quality. Educational intervention may be effective, but the effects need to be confirmed by higher quality clinical trials.

Increased Trailing Limb Angle is Associated with Regular and Stable Trunk Movements in Patients with Hemiplegia.

OBJECTIVES: In post-stroke patients, shifts in the center of gravity may affect joint movement patterns of the paraplegic lower limb during walking. The impact of changes in ankle dorsiflexion angle and trailing limb angle due to slight weight-shifting is unknown. This study aimed to investigate the effect of the abovementioned parameters on gait characteristics measured by trunk acceleration. MATERIALS AND METHODS: During walking, the ankle dorsiflexion angle and trailing limb angle were assessed using two-dimensional motion analysis. Shifts in the center of gravity were assessed to evaluate symmetry, regularity, and sway of trunk movements by calculating the harmonic ratio, autocorrelation coefficient, and root mean square using a wearable trunk accelerometer. RESULTS: Ankle dorsiflexion angle showed a significant negative correlation with the root mean square of the anteroposterior axis (r = -0.460, p = 0.005). Trailing limb angle was significantly correlated with the autocorrelation coefficient of the vertical axis (r = 0.585, p < 0.001) and root mean square of the vertical (r = -0.579, p < 0.001), mediolateral (r = -0.474, p = 0.004), and anteroposterior axes (r = -0.548, p = 0.001). Trailing limb angle was a significant predictor (autocorrelation coefficient vertical axis, p = 0.001; root mean square vertical axis, p = 0.001; mediolateral axis, p = 0.007; anteroposterior axis, p = 0.001). CONCLUSIONS: Trailing limb angle can indicate the acquisition of forward propulsion during walking; an increase in it may contribute to improvements of the regular vertical movement ability and stability of the center of gravity sway.

Clinical Prediction Rule for Identifying the Stroke Patients who will Obtain Clinically Important Improvement of Upper Limb Motor Function by Robot-Assisted Upper Limb.

BACKGROUND: The number of studies on the characteristics of patients with stroke who would benefit from robot-assisted upper limb rehabilitation is limited, and there are no clear criteria for determining which individuals should receive such treatment. The current study aimed to develop a clinical prediction rule using machine learning to identify the characteristics of patients with stroke who can the achieve minimal clinically important difference of the Fugl-Meyer Upper Extremity Evaluation (FMA-UE) after single-joint hybrid assistive limb (HAL-SJ) rehabilitation. METHODS: This study included 71 patients with subacute stroke who received HAL-SJ rehabilitation. The chi-square automatic interaction detector (CHAID) model was applied to predict improvement in upper limb motor function. Based the analysis using CHAID, age, sex, days from stroke onset to the initiation of HAL-SJ rehabilitation, and upper limb motor and cognitive functions were used as independent variables. Improvement in upper limb motor function was determined based on the minimal clinically important difference of the FMA-UE, which was used as a dependent variable. RESULTS: According to the CHAID model, the FMA-UE score during the initiation of HAL-SJ rehabilitation was the most significant predictive factor for patients who are likely to respond to the intervention. Interestingly, this therapy was more effective in patients with moderate upper limb motor dysfunction and early initiation of HAL-SJ rehabilitation. The accuracy of the CHAID model was 0.89 (95% confidence interval: 0.81-0.96). CONCLUSION: We developed a clinical prediction rule for identifying the characteristics of patients with stroke whose upper limb motor function can improve with HAL-SJ rehabilitation.

Association between generalized joint laxity and knee joint movement in female university students.

[Purpose] This study investigated the association between generalized joint laxity and knee joint movement in female university students. [Participants and Methods] The study included 21 female university students. Generalized joint laxity was measured using the Beighton criteria for joint hypermobility. Acceleration and angular velocities of the tibia during knee extension were measured along three axes using a triaxial accelerometer. Sampling data were expressed as root mean squares. The Mann-Whitney U test was used to determine differences in the acceleration and angular velocities along each axis between the generalized joint laxity and non-generalized joint laxity groups. Spearman's rank correlations were used to confirm the association between these parameters. [Results] The rotational angular velocity was greater in the generalized joint laxity than in the non-generalized joint laxity group, and we observed a significant correlation between Beighton scores and the X-axis angular velocity. Furthermore, rotational angular velocity was positively correlated with anterior-posterior acceleration and extension angular velocity. [Conclusion] These findings suggest that rotational angular velocity of the tibia during knee extension is associated with generalized joint laxity in female university students.

The Effects of Combining Transcranial Direct Current Stimulation and Gait Training with Functional Electrical Stimulation on Trunk Acceleration During Walking in Patients with Subacute Stroke.

OBJECTIVES: This study aimed to investigate whether the combination of transcranial direct current stimulation (tDCS) and gait training with FES affected walking speed and trunk accelerometry-based gait characteristics in patients with subacute stroke, compared with FES or tDCS gait training only. MATERIALS AND METHODS: Stroke patients (n = 34; female 15; mean age, 72.5 ± 11.2 years; mean days poststroke, 38.7) with resultant paresis in the lower extremity (mean Fugl-Meyer score, 25.5) were enrolled. Patients were randomly assigned to one of three groups: combined anodal tDCS and gait training with FES (tDCS+FES, n = 11), anodal tDCS with gait training (tDCS, n = 11), or combined sham tDCS and gait training with FES (FES, n = 12). Participants received the intervention for 20 minutes and a 40-minute conventional rehabilitative intervention daily for a week. Patients' walking ability was evaluated using walking speed, harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) along each axis using a wearable trunk accelerometer. RESULTS: The tDCS+FES group had a significantly greater change in AC in the anteroposterior axis and mediolateral axis than the FES and tDCS groups and FES group, respectively. There were no significant effects on walking speed or other parameters (HR and RMS) among the groups. CONCLUSIONS: The combination of anodal tDCS and gait training with FES improved the post-stroke patients' gait regularity than FES gait training intervention only. Thus, combined tDCS and FES gait training, as a novel intervention, could be an important therapeutic tool in improving walking performance.

Greater functional activation during galvanic vestibular stimulation is associated with improved postural stability: a GVS-fMRI study.

PURPOSE: Previous literature has shown that standing stability relies on the vestibular system; however, the neural correlates underlying standing stability remains unclear. This study aimed to investigate the neural correlates of standing stability using functional magnetic resonance imaging (fMRI) following galvanic vestibular stimulation (GVS). MATERIALS AND METHODS: Forty-five healthy right-handed healthy volunteers were included. Postural stability was measured using the modified Clinical Test of Sensory Interaction and Balance (mCTSIB), which measures swaying speed and area on hard and soft surfaces when the volunteer's eyes are open and closed. Functional activation as determined by the blood oxygenation level-dependent (BOLD) response, was measured during GVS using fMRI. We investigated the association between BOLD responses during GVS and postural stability. RESULTS: Relative to rest, participants showed significantly higher BOLD signal during GVS in the parietal operculum, central operculum, and the opercular part of the inferior frontal gyrus. Moreover, functional activation in the central operculum was negatively correlated with standing stability, indexed using swaying speed when volunteers stood on a foam surface with their eyes closed. CONCLUSIONS: Our findings suggest that the neural correlates of standing stability involve greater functional activation in the central operculum.

The Independent Relationship Between Leg Skeletal Muscle Mass Asymmetry and Gait Speed in Community-Dwelling Older Adults.

OBJECTIVES: To investigate the relationship between leg skeletal muscle mass asymmetry and usual gait speed in older adults. METHODS: The subjects were 139 community-dwelling older adults. The asymmetry index was calculated using the leg skeletal muscle mass index (LSMI) values of both legs. The subjects were divided into "large" and "small" asymmetry groups based on the asymmetry index. The relationship between asymmetry and gait speed was analyzed using a linear regression model. The appendicular skeletal muscle mass index and LSMI were included as adjustment variables in the analysis. RESULTS: The asymmetry index and having a "large" asymmetry were independently related to gait speed, even after adjusting for covariates such as appendicular skeletal muscle mass index and LSMI. DISCUSSION: Leg skeletal muscle mass asymmetry was related to gait speed independently of the appendicular skeletal muscle mass index and LSMI values. A skeletal muscle mass evaluation among older adults should include an assessment of the total skeletal muscle mass and its asymmetry.

The Effects of Vestibular Rehabilitation on Gait Performance in Patients with Stroke: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke. METHODS: The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence. RESULTS: Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding. CONCLUSION: This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.

Effects of the combination therapy of tilt sensor functional electrical stimulation and integrated volitional control electrical stimulation on brain activity during the subacute phase following stroke: a feasibility study.

[Purpose] The aim of this study was to investigate whether the combination of integrated volitional control functional electrical stimulation and tilt sensor functional electrical stimulation training affected brain activation during the subacute phase following a stroke. [Participant and Methods] The patient was a 60-year-old male with right hemiparesis, secondary to stroke in the left thalamus. Conventional intervention was performed for 60 minutes per day during the first two weeks of treatment (the control condition). Functional electrical stimulation intervention, including integrated volitional control functional electrical stimulation and tilt sensor functional electrical stimulation training, was then performed for 60 minutes per day for two weeks (the experimental condition). These sessions were repeated four times. Brain activity was measured during voluntary right ankle dorsiflexion in both sessions, using functional magnetic resonance imaging. Brain activity measurements were obtained a total of eight times every two weeks (34, 48, 62, 76, 90, 104, 118, and 132 days following the stroke). [Results] There was a significantly higher level of activation in the bilateral cerebellum and the left side of the supplementary motor area in the experimental condition than in the control condition. [Conclusion] The present study demonstrates that the combination of integrated volitional control functional.

Factors influencing executive function by physical activity level among young adults: a near-infrared spectroscopy study.

[Purpose] Prevention of dementia requires early intervention against it. To ensure that early interventions are effective it is crucial to study the cognitive functions related to dementia in young adulthood. Moreover, it is needed not only to verify the cognitive function test but also to elucidate the actual brain activity and the influence of related factors on the brain activity. To investigate the factors influencing cognitive function among young adults and examine the differences in executive function by physical activity level. [Subjects and Methods] Forty healthy university students (mean age, 20.4 years) were classified into two groups by cognitive function score (HIGH and LOW), determined according to Trail Making Test performance and Stroop task processing time. We then assessed what factors were related to cognitive function by logistic regression analysis. Executive function was determined by brain blood flow using near-infrared spectroscopy during the Stroop task, and was then compared by physical activity levels (determined according to number of steps per hour). [Results] Full-scale Intelligence Quotient according to the 3rd Wechsler Adult Intelligent Scale and number of steps per hour influenced cognitive function score, with odds ratios of 1.104 and 1.012, respectively. Oxy-hemoglobin concentrations in areas related to executive function during the Stroop task were significantly higher among those in the high physical activity group than among those in the low physical activity group. [Conclusion] The study revealed that Full-scale Intelligence Quotient and a number of steps per hour are factors associated with the cognitive functions in young adulthood. In addition, activity in execution function related area was found to be significantly higher in the high physical activity group than in the low physical activity group, suggesting the importance of physical activity for enhancing young adulthood cognitive functions.

Effect of neck and trunk rotation speeds on cerebral cortex activity and standing postural stability: a functional near-infrared spectroscopy study.

[Purpose] The aim of the present study was to determine whether different neck and trunk rotation speeds influence standing postural stability or frontal and temporal cortical activity during rotation in healthy young adults. [Subjects and Methods] Twelve healthy volunteers participated in this study. A custom turn-table operated by one of the experimenters was placed on a platform to assess postural perturbation. Subjects were asked to stand barefoot on the turn-table in an upright position with their feet together, and measurements were obtained during high- and low-speed rotations. Postural stability was tested using a force platform and a head sensor. Cerebral cortex activity was measured using functional near-infrared spectroscopy. Brain activity, center of pressure, and head perturbation were measured simultaneously for each subject. [Results] Significant differences were found in the center of pressure and the head angular velocity between high- and low-speed rotations. However, compared to baseline, oxygenated hemoglobin levels were not significantly different during high- or low-speed rotations. [Conclusion] Automatic postural responses to neck and trunk rotation while standing did not significantly activate the cerebral cortex. Therefore, the response to stimuli from the feet may be controlled by the spinal reflex rather than the cerebral cortex.

The Control of Postural Stability during Standing is Decreased in Stroke Patients during Active Head Rotation.

[Purpose] The aim of this study was to evaluate the effect of active head rotation on postural control in stroke patients during standing as compared with age-matched healthy subjects. [Subjects and Methods] In total, 46 stroke patients and 37 age-matched healthy subjects were recruited for the study. A stabilometer was used to assess postural stability in participants during standing, with or without active head rotation, and with their eyes open or closed. Subjects were asked to stand on a force plate while rotating their head in the yaw plane at a frequency of 1.0 Hz. A metronome was used to maintain the head rotation frequency, and the head rotation range was maintained at a total of 70° during the postural stability examinations. [Results] The control of postural stability during standing with active head rotation was significantly decreased in the stroke group as compared with the healthy group with both the eyes open and closed. No significant differences in relation to standing without head motion were observed between groups. [Conclusion] The findings suggest that postural instability is increased in stroke patients during active head rotation, and therefore, vestibular function in relation to head rotation might be reduced in stroke patients.

Noisy galvanic vestibular stimulation influences head stability in young healthy adults while standing on a moving platform.

BACKGROUND: The ability to stand with eyes closed on a sinusoidal translational moving platform may be affected by spatial orientation owing to vestibular input information. Moreover, changes in the frequency of the moving platform may affect the sensory reweighting through somatosensory and vestibular sensations. However, it is unclear whether noisy galvanic vestibular stimulation (nGVS), which activates vestibular-related brain regions, affects the stability of individuals standing on a platform moving at different frequencies. RESEARCH QUESTION: Do vestibular stimulation by nGVS and changes in the frequency of translationally moving platforms affect the standing stability of individuals? METHODS: Thirty-one healthy young adult participants were provided both sham and nGVS interventions while they maintained a static standing position, with their eyes closed, on an anterior-posterior sinusoidal translation platform. The nGVS was adapted to an optimal intensity below the perceptual threshold (frequency band: 100-640 Hz), and the sham stimulus was adapted to 0 µA. The participants were randomly assessed for postural stability at 0.2, 0.6, and 1.2 Hz moving platform frequencies for 80 s each under both stimulus conditions. Postural stability was calculated as the root mean square (RMS) sway from head accelerations in the anteroposterior (AP) and mediolateral (ML) directions for 50 s between 20 and 70 s during the 80 s period, measured using an inertial sensor placed on the external occipital ridge. RESULTS: nGVS significantly reduced the RMS sway of head acceleration in the AP direction compared with sham stimulation. Furthermore, nGVS significantly reduced RMS sway in the ML direction compared with sham stimulation at a 1.2 Hz moving platform oscillation. SIGNIFICANCE: These findings suggest that postural adjustment by the vestibular system influences head stability on a moving platform at specific sinusoidal translation frequencies, suggesting that nGVS may reduce head sway.

Clinically significant effects of gait modification on knee pain: A systematic review and meta-analysis.

BACKGROUND: Knee pain is the main symptom of knee osteoarthritis. Walking is effective against knee pain, and some studies have shown that gait modification can also relieve this condition. However, the quality of evidence for the clinically significant effects of gait modification on knee pain has not been examined. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the level of evidence for the clinically significant effects of gait modification on knee pain and determine if the effects are greater than the minimal clinically important difference (MCID). METHODS: We comprehensively searched electronic databases such as MEDLINE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. Intervention studies with experimental groups who received gait modification and control groups who did not were evaluated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the level of evidence. RESULTS: Nine studies met the inclusion criteria. All were included in the systematic review and two in the meta-analysis. Results showed that gait modification have significant effects (p= 0.02), and the quality of evidence was very low. However, several studies have revealed that the effects of gait modification, when used as a foot-focused intervention, were greater than the MCID. CONCLUSIONS: We concluded that there is a lack of high-quality evidence that supports the general efficacy of gait modification. Although based on low-quality evidence, when applied to the foot, it may have clinically significant effects.

The effects of nonpharmacological sleep hygiene on sleep quality in nonelderly individuals: A systematic review and network meta-analysis of randomized controlled trials.

The prevalence of locomotive syndrome naturally increases with age, but approximately half of nonelderly individuals also meet the criteria for locomotive syndrome, suggesting that even younger people need to pay attention to their own health status. Sleep is important for physical, cognitive, and psychological health. Some individuals with poor sleep quality may be at risk of developing negative health status. Although the effects of sleep hygiene strategies for elderly individuals have been well investigated, optimal nonpharmacological sleep hygiene strategies for improving sleep quality in nonelderly individuals has not been identified. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials aimed to elucidate the effects of various nonpharmacological interventions on sleep quality in nonelderly individuals and to identify the optimal intervention. Cochrane Central Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Scopus were comprehensively searched. We identified 27 studies focusing on the effects of various nonpharmacological sleep hygiene strategies in nonelderly individuals, and 24 studies were applied into NMA. The present results showed that resistance training was the most effective intervention for improving sleep quality in nonelderly individuals. In addition, this study revealed the effects of nonpharmacological interventions, such as physical activity, nutritional intervention, as well as exercise interventions. This is the first report that utilized NMA to compare the effects of various nonpharmacological interventions on sleep quality in nonelderly individuals.

Effects of transcranial electrical stimulation of the right posterior parietal cortex on physical control responses.

The posterior parietal cortex plays an important role in postural stability by adapting to changes in input from the visual, vestibular, and proprioceptive systems. However, little is known regarding whether transcranial electrical stimulation of the posterior parietal cortex affects reactive postural responses. This study aimed to investigate changes in physical control responses to anodal and cathodal transcranial direct current stimulation and transcranial random noise stimulation of the right posterior parietal cortex using a simultaneous inertial measurement unit. The joint movements of the lower limb of 33 healthy volunteers were measured while standing on a soft-foam surface with eyes closed during various stimulation modalities. These modalities included anodal, cathodal transcranial direct current stimulation, and sham stimulation in Experiment 1, and transcranial random noise and sham stimulations in Experiment 2. The results showed that cathodal stimulation significantly decreased the joint angular velocity in the hip rotation, ankle inversion-eversion, and abduction-adduction directions compared to anodal or sham stimulation in Experiment 1. In contrast, there were no significant differences in physical control responses with transcranial random noise stimulation coeducation in Experiment 2. These findings suggest that transcranial electrical stimulation of the right posterior parietal cortex may modulate physical control responses; however, the effect depends on the stimulus modality.

Identifying the characteristics of patients with stroke who have difficulty benefiting from gait training with the hybrid assistive limb: a retrospective cohort study.

Robot-assisted gait training is effective for walking independence in stroke rehabilitation, the hybrid assistive limb (HAL) is an example. However, gait training with HAL may not be effective for everyone, and it is not clear who is not expected to benefit. Therefore, we aimed to identify the characteristics of stroke patients who have difficulty gaining benefits from gait training with HAL. We conducted a single-institutional retrospective cohort study. The participants were 82 stroke patients who had received gait training with HAL during hospitalization. The dependent variable was the functional ambulation category (FAC) that a measure of gait independence in stroke patients, and five independent [age, National Institutes of Health Stroke Scale, Brunnstrom recovery stage (BRS), days from stroke onset, and functional independence measure total score (cognitive items)] variables were selected from previous studies and analyzed by logistic regression analysis. We evaluated the validity of logistic regression analysis by using several indicators, such as the area under the curve (AUC), and a confusion matrix. Age, days from stroke onset to HAL initiation, and BRS were identified as factors that significantly influenced walking independence through gait training with HAL. The AUC was 0.86. Furthermore, after building a confusion matrix, the calculated binary accuracy, sensitivity (recall), and specificity were 0.80, 0.80, and 0.81, respectively, indicated high accuracy. Our findings confirmed that older age, greater degree of paralysis, and delayed initiation of HAL-assisted training after stroke onset were associated with increased likelihood of walking dependence upon hospital discharge.

Impact of skin care on body image of aging people: A quasi-randomized pilot trial.

Aim: Support for various activities of daily living is essential for maintaining the health of residents in nursing homes. Although aging people who move to nursing homes often change their skin care habits, how these changes impact aging adults' social and mental well-being remains unclear. This study aimed to evaluate the effects of facial skin care on aging residents' self-body image, self-esteem, well-being, depressive symptoms and social cognitive function by a quasi-randomized controlled pilot trial in Japanese nursing homes. Method: Thirty-seven older adult women living in nursing homes took part in this quasi-randomized controlled pilot trial. Eighteen participants applied a skincare gel-cream to the face twice a day for three months, while 19 participants used no skincare products. Self-body image and psychological measures such as the Cutaneous Body Image Scale (CBIS), the Rosenberg Self-esteem Scale (RSES), Philadelphia Geriatric Center Morale Scale (PGCMS) and Geriatric Depression Scale (GDS) were used in each nursing home to evaluate the pre- and post-treatment scores. In addition, cognitive items of the Functional Independence Measure (FIM) were evaluated as social cognitive function at pre- and post-treatment. Results: There was a significant different change of the Cutaneous Body Image Scale scores (p = 0.045, r = 0.34) after three months between skin care group and control group. Although there were no clear significant differences in other psychological assessments, there was a higher number of them with positive changes in the skin care group compared to the control group. Conclusion: Skin care may help improve cutaneous self-body image and positive emotion in aging female residents of Japanese nursing homes.

Effects of Diamond Steps Exercises on Balance Improvement in Healthy Young and Older Adults: A Protocol Proposal.

Diamond step (DS) exercises are associated with multiple components of postural control and, thus, have the potential to efficiently improve balance ability. This study aimed to verify whether DS exercises contribute to improving balance ability. This study included 35 healthy young people and 29 older adults. DS exercises were performed continuously for 3 min, four times a week, for 1 month. Balance ability was assessed at baseline and after 1 and 2 months; eight items in total were examined: 30 s chair stand test, functional reach test, standing on one leg with eyes closed, time required for five rounds of DS, left-right DS, Y balance test, open-close stepping test, and finger-to-floor distance. The difficulty, achievement, and lightness/enjoyment of DS exercises were measured after the first practice and 1 month after beginning the exercises as subjective evaluations. Older adults showed improvement in seven of the eight items, with the exception being the one-legged stance with closed eyes. The subjective evaluation showed a decrease in the level of difficulty of DS exercises for older adults. DS exercises may improve balance by effectively utilizing various postural control strategies. These exercises can be effective and easy to implement, given their moderate difficulty level and self-efficacy.