Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study.

BACKGROUND: Amivantamab plus carboplatin-pemetrexed (chemotherapy) with and without lazertinib demonstrated antitumor activity in patients with refractory epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC) in phase I studies. These combinations were evaluated in a global phase III trial. PATIENTS AND METHODS: A total of 657 patients with EGFR-mutated (exon 19 deletions or L858R) locally advanced or metastatic NSCLC after disease progression on osimertinib were randomized 2 : 2 : 1 to receive amivantamab-lazertinib-chemotherapy, chemotherapy, or amivantamab-chemotherapy. The dual primary endpoints were progression-free survival (PFS) of amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy. During the study, hematologic toxicities observed in the amivantamab-lazertinib-chemotherapy arm necessitated a regimen change to start lazertinib after carboplatin completion. RESULTS: All baseline characteristics were well balanced across the three arms, including by history of brain metastases and prior brain radiation. PFS was significantly longer for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy [hazard ratio (HR) for disease progression or death 0.48 and 0.44, respectively; P < 0.001 for both; median of 6.3 and 8.3 versus 4.2 months, respectively]. Consistent PFS results were seen by investigator assessment (HR for disease progression or death 0.41 and 0.38 for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy, respectively; P < 0.001 for both; median of 8.2 and 8.3 versus 4.2 months, respectively). Objective response rate was significantly higher for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (64% and 63% versus 36%, respectively; P < 0.001 for both). Median intracranial PFS was 12.5 and 12.8 versus 8.3 months for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (HR for intracranial disease progression or death 0.55 and 0.58, respectively). Predominant adverse events (AEs) in the amivantamab-containing regimens were hematologic, EGFR-, and MET-related toxicities. Amivantamab-chemotherapy had lower rates of hematologic AEs than amivantamab-lazertinib-chemotherapy. CONCLUSIONS: Amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy improved PFS and intracranial PFS versus chemotherapy in a population with limited options after disease progression on osimertinib. Longer follow-up is needed for the modified amivantamab-lazertinib-chemotherapy regimen.

Psychometric Properties of Brief-Balance Evaluation Systems Test Among Multiple Populations: A Systematic Review and Meta-analysis.

OBJECTIVE: To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations. DATA SOURCES: Articles were searched in 9 databases from inception to March 2020. STUDY SELECTION: Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions. DATA EXTRACTION: The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted. DATA SYNTHESIS: Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach α>0.82), criterion validity (ρ≥0.73, r≥0.71), and construct validity (ρ≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown. CONCLUSIONS: The Brief-BESTest is a valid (criterion- and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice.

Weekly paclitaxel, carboplatin, cetuximab, and cetuximab, docetaxel, cisplatin, and fluorouracil, followed by local therapy in previously untreated, locally advanced head and neck squamous cell carcinoma.

BACKGROUND: The survival advantage of induction chemotherapy (IC) followed by locoregional treatment is controversial in locally advanced head and neck squamous cell carcinoma (LAHNSCC). We previously showed feasibility and safety of cetuximab-based IC (paclitaxel/carboplatin/cetuximab-PCC, and docetaxel/cisplatin/5-fluorouracil/cetuximab-C-TPF) followed by local therapy in LAHNSCC. The primary end point of this phase II clinical trial with randomization to PCC and C-TPF followed by combined local therapy in patients with LAHNSCC stratified by human papillomavirus (HPV) status and T-stage was 2-year progression-free survival (PFS) compared with historical control. PATIENTS AND METHODS: Eligible patients were ≥18 years with squamous cell carcinoma of the oropharynx, oral cavity, nasopharynx, hypopharynx, or larynx with measurable stage IV (T0-4N2b-2c/3M0) and known HPV by p16 status. Stratification was by HPV and T-stage into one of the two risk groups: (i) low-risk: HPV-positive and T0-3 or HPV-negative and T0-2; (ii) intermediate/high-risk: HPV-positive and T4 or HPV-negative and T3-4. Patient reported outcomes were carried out. RESULTS: A total of 136 patients were randomized in the study, 68 to each arm. With a median follow up of 3.2 years, the 2-year PFS in the PCC arm was 89% in the overall, 96% in the low-risk and 67% in the intermediate/high-risk groups; in the C-TPF arm 2-year PFS was 88% in the overall, 88% in the low-risk and 89% in the intermediate/high-risk groups. CONCLUSION: The observed 2-year PFS of PCC in the low-risk group and of C-TPF in the intermediate/high-risk group showed a 20% improvement compared with the historical control derived from RTOG-0129, therefore reaching the primary end point of the trial.

Effects of Tai Chi on Lower Limb Proprioception in Adults Aged Over 55: A Systematic Review and Meta-Analysis.

OBJECTIVE: To summarize and critically evaluate the effects of Tai Chi on lower limb proprioception in adults older than 55. DATA SOURCES: Seven databases (Scopus, PubMed, Web of Science, SPORTDiscus, Cochrane Library, Wanfang, CNKI) were searched from inception until April 14, 2018. STUDY SELECTION: Eleven randomized controlled trials were included for meta-analysis. DATA EXTRACTION: Two independent reviewers screened potentially relevant studies based on the inclusion criteria, extracted data, and assessed methodological quality of the eligible studies using the Physiotherapy Evidence Database (PEDro). DATA SYNTHESIS: The pooled effect size (standardized mean difference [SMD]) was calculated while the random-effects model was selected. Physiotherapy Evidence Database scores ranged from 5 to 8 points (mean=6.7). The study results showed that Tai Chi had significantly positive effects on lower limb joint proprioception. Effect sizes were moderate to large, including ankle plantar flexion (SMD=-0.55; 95% confidence interval [95% CI], -0.9 to -0.2; P=.002; I2=0%; n=162), dorsiflexion (SMD=-0.75; 95% CI, -1.11 to -0.39; P<.001; I2=0%; n=162), nondominant or left knee flexion (SMD=-0.71; 95% CI, -1.10 to -0.41; P<.001; I2=25.1%; n=266), dominant or right knee flexion (SMD=-0.82; 95% CI, -1.06 to -0.58; P<.001; I2=33.8%; n=464). CONCLUSIONS: There is moderate to strong evidence that suggests that Tai Chi is an effective intervention to maintain and improve lower limb proprioception in adults older than 55. More robust multicenter studies including oldest-old participants, with longer follow-ups and validated outcome measures, are needed before a definitive conclusion is drawn.

Falls prevention through physical and cognitive training (falls PACT) in older adults with mild cognitive impairment: a randomized controlled trial protocol.

BACKGROUND: The presence of mild cognitive impairment (MCI) in older adults increases their fall risk. While physical exercise is effective in reducing falls rate and risk of falls, and cognitive training in improving cognitive functioning in healthy older adults, their effectiveness in preventing falls and reducing risks of falls in MCI when administered simultaneously is not yet established. Therefore, this study aims to determine the effectiveness of combined physical and cognitive training in preventing falls and decreasing risks of falls among community-dwelling older persons with MCI. METHODS/DESIGN: This is a single-blind, multicentre, randomized controlled trial. At least ninety-three community-dwelling older adults with MCI aged 60 or above will be recruited. They will be randomly allocated into four groups: Physical Training alone (PT), Cognitive Training alone (CT), combined Physical And Cognitive Training (PACT) and Waitlist Group (WG). The PT group will perform exercises (flexibility, endurance, strengthening, and balance training) for 60-90 min three times per week for 12 weeks. The CT group will be involved in a paper-based training focusing on orientation, memory, attention and executive functioning for 60-90 min per session, once a week for 12 weeks. The PACT group will undergo cognitive training incorporated in physical exercise for 60-90 min three times per week for 12 weeks. The WG will receive the intervention, combined physical and cognitive training, at a later date. Assessors blinded to participant allocation will conduct pre-intervention, post-intervention, and 6-month follow-up assessments. The primary outcome measure will be falls rate. The secondary outcome measures will be Physiologic Profile Assessment and Falls Risk for Older Persons in the Community, and assessments that evaluate cognitive, physical and psychological factors related to falls. DISCUSSION: Considering the possible physical, social, financial and psychological consequences of a fall, we hope to provide insights on the effectiveness of combining physical and cognitive training on falls and fall-related factors for older adults with MCI. It is projected that the combined interventions will lead to significantly lower falls rate and reduced risk of falls compared to using single or no intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03167840 . Registered on May 30, 2017.

What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region. METHOD: RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed. RESULTS: Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]). CONCLUSION: There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.

The effect of Ai Chi aquatic therapy on individuals with knee osteoarthritis: a pilot study.

[Purpose] To examine the efficacy of Ai Chi in relieving the pain and stiffness of knee osteoarthritis and improving, physical functioning, proprioception and quality of life. [Subjects and Methods] Twenty-five persons with knee osteoarthritis completed 5 weeks Ai Chi practice (60 minutes per session, twice per week, 10 sessions in total). Knee pain and stiffness were measured before and after the intervention program. [Results] Significant improvements in pain, self-perceived physical functioning and self-perceived stiffness were observed after the Ai-Chi intervention. On average, no significant change in knee range of motion, 6-minute walk test distances or proprioception was observed. [Conclusion] A five-week Ai Chi intervention can improve the pain and stiffness of knee osteoarthritis and self-perceived physical functions and quality of life improvement. Ai Chi may be another treatment choice for people with knee OA to practice in the community.

Mahjong playing and eye-hand coordination in older adults-a cross-sectional study.

[Purpose] Eye-hand coordination declines with age, but physical activity is known to slow down the degeneration. Playing mahjong involves lots of eye-hand coordination. The objective was to investigate the relationship between playing mahjong and eye-hand coordination in older adults using a fast finger-pointing paradigm. [Subjects and Methods] Forty-one community dwelling older adults aged sixty or above were recruited by convenience sampling in this cross-sectional study. They were tested on their ability to point quickly and accurately 1) toward a stationary visual target and 2) toward a moving visual target. [Results] The mahjong players demonstrated significantly better end-point accuracy when pointing with their non-dominant hand toward a stationary target. They also demonstrated significantly faster movement of their dominant hands; shorter reaction times and better end-point accuracy when pointing with their non-dominant hands toward a moving target. [Conclusion] Mahjong players have better eye-hand coordination than non-players. Playing mahjong could usefully be introduced to older adults as a leisure time activity.

Reliability and validity of the sequential weight-shifting test: a new functional approach to the assessment of the sitting balance of older adults.

[Purpose] The evaluation of sitting balance is important for the prevention of falls in older adults, especially those who have a disability involving the lower extremities. However, no studies have been designed to assess a patient's dynamic sitting balance using a sequential protocol. The objective of this study was to investigate the psychometric properties of the sequential weight-shifting (SWS) test. [Subjects and Methods] Twenty-three older adults who were physically dependent with regard to ambulation were recruited by convenience sampling. In study 1, 10 participants performed the SWS test and repeated the procedure 1 week later. In study 2, 23 participants were assessed using the SWS test, forward and lateral reach tests in a sitting position, tests of shoulder flexor and hand grip strength, an eye-hand coordination test, mobility tests, and pulmonary function tests. The test-retest reliability of the SWS test and its correlations with the different physical dimensions were examined. [Results] The intraclass correlation coefficient (3,1) of the SWS test was 0.67. The results of the SWS test correlated significantly with forward reach in the sitting position, arm muscle strength, eye-hand coordination, mobility, and pulmonary function (all p<0.05). [Conclusion] The SWS test demonstrated satisfactory psychometric properties and can be considered a useful functional approach for the measurement of sitting balance.

Effects of inspiratory muscle training on pulmonary function, diaphragmatic thickness, balance and exercise capacity in people after stroke: a systematic review and meta-analysis.

PURPOSE: To examine the effects of inspiratory muscle training (IMT) on pulmonary and diaphragmatic function, exercise capacity, balance and quality of life (QOL), in post-stroke individuals. METHODS: A literature search was conducted using MEDLINE, CINAHL, EMBASE, PubMed, PEDro, Web of Science and China Biological Medicine databases. Randomized controlled trials (RCTs) with a PEDro score ≥6 focusing on the effects of IMT were included. The GRADE system was used to determine the certainty of evidence for each outcome. RESULTS: Nine studies (255 participants) were included. IMT significantly increased forced expiratory volume in one second (FEV1) (4 studies, 112 participants, mean difference (MD)=0.18 litre, 95% confidence interval (CI): 0.14-0.23); maximal inspiratory pressure (MIP) (8 studies, 226 participants, MD = 6.37 cm H2O, 95% CI: 1.26-11.49); and diaphragm thickness fraction (DTf) on both sides (MD of affected side vs. unaffected side: 51 vs. 37%). The evidence certainty for diaphragmatic function was moderate. No significant change was observed in forced vital capacity (FVC), balance function, exercise capacity and QOL. CONCLUSION: This review reveals moderate evidence certainty in support of IMT improving diaphragmatic function. It appears that a training intensity between 30 and 50% MIP results in a significantly improved MIP.

Stroke not only impacts motor function but also affects respiratory function, especially diaphragmatic function.Inspiratory muscle training (IMT) is an intervention that has been used to improve the strength and endurance of inspiratory muscles.There is evidence of moderate certainty which cautiously recommends IMT to improve diaphragmatic function after stroke.The evidence supporting IMT for the enhancement of forced vital capacity, balance function, exercise capacity and quality of life in stroke patients is inadequate.

The effects of aging on postural control and selective attention when stepping down while performing a concurrent auditory response task.

PURPOSE: To investigate the effects of aging on postural control and cognitive performance in single- and dual-tasking. METHODS: A cross-sectional comparative design was conducted in a university motion analysis laboratory. Young adults (n = 30; age 21.9 ± 2.4 years) and older adults (n = 30; age 71.9 ± 6.4 years) were recruited. Postural control after stepping down was measured with and without performing a concurrent auditory response task. Measurement included: (1) reaction time and (2) error rate in performing the cognitive task; (3) total sway path and (4) total sway area after stepping down. RESULTS: Our findings showed that the older adults had significantly longer reaction times and higher error rates than the younger subjects in both the single-tasking and dual-tasking conditions. The older adults had significantly longer reaction times and higher error rates when dual-tasking compared with single-tasking, but the younger adults did not. The older adults demonstrated significantly less total sway path, but larger total sway area in single-leg stance after stepping down than the young adults. The older adults showed no significant change in total sway path and area between the dual-tasking and when compared with single-tasking conditions, while the younger adults showed significant decreases in sway. CONCLUSION: Older adults prioritize postural control by sacrificing cognitive performance when faced with dual-tasking.

Tai Chi practitioners have better postural control and selective attention in stepping down with and without a concurrent auditory response task.

To compare the performance of older experienced Tai Chi practitioners and healthy controls in dual-task versus single-task paradigms, namely stepping down with and without performing an auditory response task, a cross-sectional study was conducted in the Center for East-meets-West in Rehabilitation Sciences at The Hong Kong Polytechnic University, Hong Kong. Twenty-eight Tai Chi practitioners (73.6 ± 4.2 years) and 30 healthy control subjects (72.4 ± 6.1 years) were recruited. Participants were asked to step down from a 19-cm-high platform and maintain a single-leg stance for 10 s with and without a concurrent cognitive task. The cognitive task was an auditory Stroop test in which the participants were required to respond to different tones of voices regardless of their word meanings. Postural stability after stepping down under single- and dual-task paradigms, in terms of excursion of the subject's center of pressure (COP) and cognitive performance, was measured for comparison between the two groups. Our findings demonstrated significant between-group differences in more outcome measures during dual-task than single-task performance. Thus, the auditory Stroop test showed that Tai Chi practitioners achieved not only significantly less error rate in single-task, but also significantly faster reaction time in dual-task, when compared with healthy controls similar in age and other relevant demographics. Similarly, the stepping-down task showed that Tai Chi practitioners not only displayed significantly less COP sway area in single-task, but also significantly less COP sway path than healthy controls in dual-task. These results showed that Tai Chi practitioners achieved better postural stability after stepping down as well as better performance in auditory response task than healthy controls. The improved performance that was magnified by dual motor-cognitive task performance may point to the benefits of Tai Chi being a mind-and-body exercise.

Psycho-physical and neurophysiological effects of qigong on depressed elders with chronic illness.

This randomized controlled trial examined the psychological, physical, and neurophysiological effects of a qigong exercise program on depressed elders with chronic medical illness. The experimental group (n = 21, 80 ± 7 years) was given a 12-week qigong exercise program, while the comparison group (n = 17, 81 ± 8 years) participated in a newspaper reading program with the same duration and frequency. Measurement of depression symptoms, psychosocial functioning, muscle strengths, salivary cortisol, and serum serotonin was conducted. At 12 weeks, the qigong group had significant reduction in depressive symptoms (F = 11.68; p < 0.025). Improvement in self-efficacy (F = 4.30; p < 0.050), self-concept of physical well-being (F = 6.82; p < 0.025), and right-hand grip strength (F = 5.25; p = 0.034) was also found when compared with the comparison group. A change in salivary cortisol level was found marginally insignificant between groups (F = 3.16; p = 0.087). However, a decreasing trend of cortisol level was observed. The results provided preliminary evidence for the hypotheses that the antidepressive effect of qigong exercise could be explained by improvement in psychosocial functioning and possibly down-regulation of hyperactivity of the hypothalamic-pituitary-adrenal axis.

The impact of phosphorylated AMP-activated protein kinase expression on lung cancer survival.

BACKGROUND: The aim of this study is to investigate the prognostic role of phosphorylated AMP-activated protein kinase (pAMPK) in surgically resected non-small-cell lung cancer (NSCLC). METHODS: Immunohistochemical staining of pAMPK was carried out on tissue microarrays containing 463 samples obtained from patients with NSCLC and correlated with clinicopathological characteristics and survival. RESULTS: pAMPK expression levels were significantly higher in never smokers versus former smokers versus current smokers (P=0.045). A positive pAMPK expression was associated with increased overall survival (OS) and recurrence-free survival (RFS) (P=0.0009 and P=0.0007, respectively). OS and RFS were statistically superior in pAMPK-positive than in pAMPK-negative patients with adenocarcinoma (ADC; median OS: 5.6 and 4.2 years, respectively, P=0.0001; median RFS: 5.0 and 2.4 years, respectively, P=0.001), whereas they were similar in those patients with squamous cell carcinoma. Multivariate analysis confirmed that pAMPK positivity was associated with OS [hazard ratio (HR)=0.574, 95% confidence interval (CI) 0.418-0.789, P=0.0006) and RFS (HR=0.608, 95% CI 0.459-0.807, and P=0.0006), independent of clinical covariates. CONCLUSIONS: High pAMPK expression levels are associated with increased survival in patients with NSCLC, especially those with ADC. Our results support further evaluation of AMP-activated protein kinase as a potential prognostic and therapeutic target for lung cancer.

The effects of Tai Chi on the balance control of elderly persons with visual impairment: a randomised clinical trial.

BACKGROUND: balance control is a major problem for older individuals with poor vision. There are limitations, however, for visually impaired elderly persons wishing to participate in exercise programmes. The benefits of Tai Chi for balance control, muscle strength and preventing falls have been demonstrated with sighted elderly subjects. This study was designed to extend those findings to elderly persons with visual impairment. OBJECTIVE: to investigate the effects of Tai Chi on the balance control of elderly persons with visual impairment. DESIGN: randomised clinical trial. SETTING: residential care homes. SUBJECTS: forty visually impaired persons aged 70 or over. METHODS: the participants were randomly divided into Tai Chi and control groups and assessed pre- and post-intervention using three tests: (i) passive knee joint repositioning to test knee proprioception; (ii) concentric isokinetic strength of the knee extensors and flexors and (iii) a sensory organisation test to quantify an individual's ability to maintain balance in a variety of complex sensory conditions. RESULTS: after intervention, the Tai Chi participants showed significant improvements in knee proprioception and in their visual and vestibular ratios compared with the control group. CONCLUSION: practicing Tai Chi can improve the balance control of visually impaired elderly persons.

Balance control in very old adults with and without visual impairment.

Good balance, an important ability in controlling body movement, declines with age. Also, balance appears to decrease when visual input is restricted, while this has been poorly investigated among visually impaired very old adults. The objective of this study is thus to explore whether the balance control of the very old differs with varying degrees of visual impairment. This cross-sectional study was conducted in community centers and residential care homes. Thirty-three visually impaired (17 = low vision; 16 = blind) and 15 sighted elderly aged ≥ 70 years participated in the study. All participants were assessed: (1) concentric isokinetic strength of the knee extensors and flexors; (2) a sensory organization test to measure their ability to use somatosensory, visual, and vestibular information to control standing balance; (3) a perturbed double-leg stance test to assess the ability of the automatic motor system to quickly recover following an unexpected external disturbance; (4) the five times sit-to-stand test. Compared with low-vision subjects, the sighted elderly achieved higher peak torque-to-body weight ratios in concentric knee extension. The sighted elderly showed less body sway than the low vision and blind subjects in sensory conditions where they benefited from visual inputs to help them maintain standing balance. The sighted and low-vision subjects achieved smaller average body sway angles during forward and backward platform translations compared to the blind subjects. Low vision and blindness decrease balance control in elderly.

Effects of Tai Chi on pre-landing muscle response latency during stepping down while performing a concurrent mental task in older adults.

To investigate whether elderly Tai Chi practitioners are better able to descend a step while performing a concurrent mental task than non-practitioners. The design includes cross-sectional study. The setting includes university-based rehabilitation center. The subjects were 16 young women, 29 elderly women, and 31 elderly women who had been practicing Tai Chi regularly for at least half a year. Pre-landing muscle response latencies in their tibialis anterior (TA) and medial gastrocnemius (MG) muscles were measured during stepping down (single task) and stepping down while performing a concurrent mental activity (dual tasking). The non-practitioners had earlier onset of muscle activity in the TA in preparation for landing than the other subjects. The response latency of the Tai Chi practitioners was not significantly different from that of the young controls. When the cognitive task was added, the pre-landing response in the TA was significantly altered in both elderly groups. Response was significantly delayed among the non-practitioners, but significantly earlier among the Tai Chi subjects. The average change in response latency was significantly greater in the non-Tai Chi group compared with the young subjects and the Tai Chi practitioners (p = 0.006). Such findings suggest that practicing Tai Chi helps the elderly maintain the same strategy as much as younger subjects during stepping down. Tai Chi practitioners seem to have a greater capacity to shift attention between mental and physical tasks than other elderly women.

Tai Chi for Dynamic Balance Training Among Individuals with Cerebellar Ataxia: An Assessor-Blinded Randomized-Controlled Trial.

Objective: To evaluate the immediate and long-term effects of 12 weeks of Tai Chi training on dynamic balance and disease severity among individuals with cerebellar ataxia (CA). Design: An assessor-blinded, two-arm, parallel-group randomized-controlled trial was conducted among 24 participants with CA. Participants were randomized to receive either Tai Chi intervention (n = 12) or usual care (n = 12). Dynamic balance was assessed using the Berg Balance Scale (BBS), Scale for the Assessment and Rating of Ataxia (SARA) balance sub-component of the SARA (SARAbal), Sensory Organization Test, and Limits of Stability test. Disease severity was assessed using the SARA and health-related quality of life using the EuroQol visual analog scale. Assessments were completed at baseline (week 0: T1), postintervention (week 12: T2), and at the end of the 24-week (week 36: T3) follow-up period. Interventions: The 8-form Tai Chi exercise was delivered in 60-min sessions, three times a week for 12 weeks. Participants were asked to complete an unsupervised home Tai Chi exercise program over the next 24 weeks. Participants in the usual care control group completed all study measures but did not receive any intervention. Results: Compared with the usual care control group, after 12 weeks of Tai Chi training, the experimental group demonstrated beneficial effects for dynamic balance assessed using the BBS (mean difference [MD]: 4, 95% confidence interval [CI]: -1.06 to 8.71) and the SARAbal (MD: -1.33, 95% CI: -2.66 to 2.33). The effect size ranged from small to large. The benefits gained were not sustained after 24 weeks during the follow-up assessment. Tai Chi did not benefit disease severity and health-related quality of life in this population. Conclusion: Some evidence supports the immediate beneficial effects of 12 weeks of Tai Chi training on the dynamic balance among individuals with CA. Australia New Zealand Clinical Trials Registry (ACTRN12617000327381).

Pain, balance, and mobility in people 1 year after total knee arthroplasty: a non-randomized cross-sectional pilot study contrasting posterior-stabilized and medial-pivot designs.

BACKGROUND: Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic balance of patients although it is difficult to objectively quantify these balance parameters in a clinical setting. Therefore, this pilot study aimed to evaluate the feasibility of using wearable devices in a clinical setting to examine whether people with MP-TKA have better postoperative outcomes than PS-TKA, and their balance control is more akin to age-matched asymptomatic controls. METHODS: The current cross-sectional pilot study recruited 57 participants with 2 different prosthesis designs (20 PS-TKA, 18 MP-TKA) and 19 asymptomatic controls. At 1-year post-TKA, pain, knee stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Static balance, mobility, and gait stability of the participants were evaluated based on data collected from wearable motion sensors during the near tandem stance, timed-up-and-go, and 6-min walk tests. RESULTS: Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness and demonstrated reduced functional mobility, increased stride-time-variability, and impaired balance. After Bonferroni adjustment, no significant differences in pain, balance, and mobility performance were observed between PS-TKA and MP-TKA participants 1 year after surgery. However, there was a trend for increased anteroposterior sway of the lumbar and head regions in the MP-TKA participants when undertaking the near tandem stance test. The wearable motion sensors were easy to use without any adverse effects. CONCLUSIONS: It is feasible to use wearable motion sensors in a clinical setting to compare balance and mobility performance of patients with different TKA prothesis designs. Since this was a pilot study and no definite conclusions could be drawn, future clinical trials should determine the impacts of different TKA prosthesis designs on post-operative outcomes over a longer follow-up period.

Atypical adaptive postural responses in children with developmental coordination disorder: Implications for rehabilitation.

BACKGROUND: Adaptive postural control is an important yet underexamined area in children with developmental coordination disorder (DCD). This study compared adaptive postural responses between children with DCD and those with typical development. METHODS: This was an exploratory cross-sectional study. Fifty-two children with DCD (aged 6-9 years) and 52 age- and sex-matched children with typical development participated in the study. Their adaptive postural (motor) responses were assessed using the Adaptation Test (ADT) on a computerized dynamic posturography machine. The sway energy score (SES) for each ADT trial and the average SES of five trials for both toes-up and toes-down platform inclination conditions were recorded. RESULTS: The SESs were lower in the DCD group than in the control group in ADT toes-up trial 1 (p = 0.009) and on average (p = 0.044). In the control group, the SES decreased from trial 1 to trial 2 for both the ADT toes-up (p = 0.005) and toes-down conditions (p < 0.001). SIGNIFICANCE: Adaptive postural responses were absent in children with DCD, and these children used less force (i.e., sway energy) to overcome postural instability. Therefore, both adaptive balance and neuromuscular training should be factored into rehabilitation programs for children with DCD.