Research articles on Standing Balance
Works Cited Exercise Therapy Lesson 9 Balance
Citations 2014 for exercise therapy on standing balance research
Notes from Kim Byrd-Rider
proprioception
Type: Term Pronunciation: prō′prē-ō-sep′shŭn
Definitions: 1. A sense or perception, usually at a subconscious level, of the movements and position of the body and especially its limbs, independent of vision; this sense is gained primarily from input from sensory nerve terminals in muscles and tendons (muscle spindles) and the fibrous capsule of joints combined with input from the vestibular apparatus.
Perception of stimuli relating to position, posture, equilibrium, or internal condition. Receptors (nerve endings) in skeletalmuscles and on tendons provide constant information on limb position and muscle action for coordination of limb movements. Awareness of equilibrium changes usually involves perception of gravity. In humans, gravity, position, and orientation are registered by tiny grains called otoliths moving within two fluid-filled sacs in the inner ear in response to any change in position or orientation. Their motion is detected by sense hairs. Rotation is detected by the inertial lag of fluid in the semicircular canals acting on the sense hairs. The central nervous system integrates signals from the canals to perceive rotation in three dimensions. See alsosense.
balance
Type: Term Pronunciation: bal′ants
Definitions: 1. An apparatus for weighing (scales). 2. The normal state of action and reaction between two or more parts or organs of the body. 3. Quantities, concentrations, and proportionate amounts of bodily constituents. 4. The difference between intake and use, storage, or excretion of a substance by the body. 5. The act of maintaining an upright posture in standing or locomotion. 6. The system that depends on vestibular function, vision, and proprioception to maintain posture, navigate in one's surroundings, coordinate motion of body parts, modulate fine motor control, and initiate the vestibulooculomotor reflexes.
J Phys Ther Sci. 2013 Oct;25(10):1353-6. doi: 10.1589/jpts.25.1353. Epub 2013 Nov 20.
Effect of different insoles on postural balance: a systematic review.
Christovão TC, Neto HP, Grecco LA, Ferreira LA, Franco de Moura RC, Eliege de Souza M, Franco de Oliveira LV, Oliveira CS.
Author information
Abstract
[Purpose] The aim of the present study was to perform a systematic review of the literature on the effect of different insoles on postural balance. [Subjects and Methods] A systematic review was conducted of four databases. The papers retrieved were evaluated based on the following inclusion criteria: 1) design: controlled clinical trial; 2) intervention: insole; 3) outcome: change in static postural balance; and 4) year of publication: 2005 to 2012. [Results] Twelve controlled trials were found comparing the effects of different insoles on postural balance. The papers had methodological quality scores of 3 or 4 on the PEDro scale. [Conclusion] Insoles have benefits that favor better postural balance and control.
KEYWORDS:
Foot, Postural balance, Proprioception
PMID:
24259792
[PubMed]
PMCID:
PMC3820199
J Physiother. 2013 Jun;59(2):93-9. doi: 10.1016/S1836-9553(13)70161-9.
The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: asystematic review.
Downs S, Marquez J, Chiarelli P.
Author information
Abstract
QUESTIONS:
What is the intra-rater and inter-rater relative reliability of the Berg Balance Scale? What is the absolute reliability of the Berg BalanceScale? Does the absolute reliability of the Berg Balance Scale vary across the scale?
DESIGN:
Systematic review with meta-analysis of reliability studies.
PARTICIPANTS:
Any clinical population that has undergone assessment with the Berg Balance Scale.
OUTCOME MEASURES:
Relative intra-rater reliability, relative inter-rater reliability, and absolute reliability.
RESULTS:
Eleven studies involving 668 participants were included in the review. The relative intrarater reliability of the Berg Balance Scale was high, with a pooled estimate of 0.98 (95% CI 0.97 to 0.99). Relative inter-rater reliability was also high, with a pooled estimate of 0.97 (95% CI 0.96 to 0.98). A ceiling effect of the Berg Balance Scale was evident for some participants. In the analysis of absolute reliability, all of the relevant studies had an average score of 20 or above on the 0 to 56 point Berg Balance Scale. The absolute reliability across this part of the scale, as measured by the minimal detectable change with 95% confidence, varied between 2.8 points and 6.6 points. The Berg Balance Scale has a higher absolute reliability when close to 56 points due to the ceiling effect. We identified no data that estimated the absolute reliability of the Berg Balance Scale among participants with a mean score below 20 out of 56.
CONCLUSION:
The Berg Balance Scale has acceptable reliability, although it might not detect modest, clinically important changes in balance in individual subjects. The review was only able to comment on the absolute reliability of the Berg Balance Scale among people with moderately poor to normal balance.
PLoS One. 2013;8(4):e60349. doi: 10.1371/journal.pone.0060349. Epub 2013 Apr 2.
The role of textured material in supporting perceptual-motor functions.
Orth D, Davids K, Wheat J, Seifert L, Liukkonen J, Jaakkola T, Ashford D, Kerr G.
Author information
Abstract
Simple deformation of the skin surface with textured materials can improve human perceptual-motor performance. The implications of these findings are inexpensive, adaptable and easily integrated clothing, equipment and tools for improving perceptual-motor functionality. However, some clarification is needed because mixed results have been reported in the literature, highlighting positive, absent and/or negative effects of added texture on measures of perceptual-motor performance. Therefore the aim of this study was to evaluate the efficacy of textured materials for enhancing perceptual-motor functionality. The systematic review uncovered two variables suitable for sub-group analysis within and between studies: participant age (groupings were 18-51 years and 64.7-79.4 years) and experimental task (upright balance and walking). Evaluation of studies that observed texture effects during upright balance tasks, uncovered two additional candidate sub-groups for future work: vision (eyes open and eyes closed) and stability (stable and unstable). Meta-analysis (random effects) revealed that young participants improve performance by a small to moderate amount in upright balance tasks with added texture (SMD = 0.28, 95%CI = 0.46-0.09, Z = 2.99, P = 0.001; Tau(2) = 0.02; Chi(2) = 9.87, df = 6, P = 0.13; I(2) = 39.22). Significant heterogeneity was found in, the overall effect of texture: Tau(2) = 0.13; Chi(2) = 130.71, df = 26, P<0.0001; I(2) = 85.98%, pooled samples in upright balance tasks: Tau(2) = 0.09; Chi(2) = 101.57, df = 13, P<0.001; I(2) = 72.67%, and in elderly in upright balance tasks: Tau(2) = 0.16; Chi(2) = 39.42, df = 5, P<0.001; I(2) = 83.05%. No effect was shown for walking tasks: Tau(2) = 0.00; Chi(2) = 3.45, df = 4, P = 0.27, I(2) = 22.99%. Data provides unequivocal support for utilizing textured materials in young healthy populations for improving perceptual-motor performance. Future research is needed in young healthy populations under conditions where visual and proprioceptive information is challenged, as in high-speed movements, or where use of equipment mediates the performer-environment interaction or where dysfunctional information sources 'compete' for attention. In elderly and ailing populations data suggests further research is required to better understand contexts where texture can facilitate improved perceptual-motor performance.
J Vestib Res. 2012;22(5-6):283-98. doi: 10.3233/VES-120464.
The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review.
Porciuncula F, Johnson CC, Glickman LB.
Author information
Abstract
PURPOSE:
Adults with bilateral vestibular hypofunction (BVH) experience significant disability. A systematic review assessed evidence for vestibular rehabilitation (VR). NUMBER OF STUDIES: 14 studies.
MATERIALS/METHODS:
Search identification of studies based on inclusion criteria: (a) population: adults with BVH of peripheral origin; (b) interventions: vestibular exercises, balance training, education, or sensory prosthetics; (c) comparison: single interventions or compared to another psychophysical intervention, placebo, or healthy population; (d) outcomes: based on International Classification of Functioning, Disability and Health (ICF) Body Functions and Structure, Activity, and Participation; (e) study designs: prospective and interventional, Levels of Evidence I to III per Centre of Evidence-based Medicine grading. Coding and appraisal based on ICF framework and strength of evidence synthesis.
RESULTS:
Five Level II studies and nine Level III studies: All had outcomes on gaze and postural stability, five with outcomes on gait speed and perceptions of oscillopsia and disequilibrium.
CONCLUSIONS:
(a) Moderate evidence strength on improved gaze and postural stability (ICF-Body Functions) following exercise-based VR; (b) Inadequate number of studies supporting benefit of VR on ICF-Participation outcomes; (c) Sensory prosthetics in early phase of development.
CLINICAL RELEVANCE:
Moderate evidence strength in support of VR from an impairment level; clinical practice and research needed to explore interventions extending to ICF-Activity and Participation.
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J Sport Rehabil. 2013 May;22(2):143-9. Epub 2012 Oct 30.
Effect of balance training on postural stability in subjects with chronic ankle instability.
Wortmann MA, Docherty CL.
Author information
Abstract
The lateral ligament complex of the ankle is a frequently injured structure in sports and recreational activities, which often results in chronic ankle instability (CAI). Balance exercise training has become a common component of clinical rehabilitation for CAI to address postural deficits. To determine the effect of balance training on postural stability, this critically appraised topic presents a summary and analysis of 4 relevant studies that address the effectiveness of balance training in subjects with CAI. Information about the methods and sources used in the article is provided. The findings imply that there is moderate evidence that 4-6 wk of balance training can enhance static and dynamic postural stability in subjects with CAI.
Gait Posture. 2013 Mar;37(3):391-6. doi: 10.1016/j.gaitpost.2012.08.007. Epub 2012 Sep 28.
Determining the preferred modality for real-time biofeedback during balance training.
Bechly KE, Carender WJ, Myles JD, Sienko KH.
Author information
Abstract
Vestibular rehabilitation therapy has been shown to improve balance and gait stability in individuals with vestibular deficits. However, patient compliance with prescribed home exercise programs is variable. Real-time feedback of exercise performance can potentially improve exercise execution, exercise motivation, and rehabilitation outcomes. The goal of this study is to directly compare the effects of visual and vibrotactile feedback on postural performance to inform the selection of a feedback modality for inclusion in a home-based balance rehabilitation device. Eight subjects (46.6±10.6years) with peripheral vestibular deficits and eight age-matched control subjects (45.3±11.1years) participated in the study. Subjects performed eyes-open tandem Romberg stance trials with (vibrotactile, discrete visual, continuous visual, and multimodal) and without (baseline) feedback. Main outcome measures included medial-lateral (M/L) and anterior-posterior mean and standard deviation of body tilt, percent time spent within a no-feedback zone, and mean score on a comparative ranking survey. Both groups improved performance for each feedback modality compared to baseline, with no significant differences in performance observed among vibrotactile, discrete visual, or multimodal feedback for either group. Subjects with vestibular deficits performed best with continuous visual feedback and ranked it highest. Although the control subjects performed best with continuous visual feedback in terms of mean M/L tilt, they ranked it lowest. Despite the observed improvements, continuous visual feedback involves tracking a moving target, which was noted to induce dizziness in some subjects with vestibular deficits and cannot be used during exercises in which head position is actively changed or during eyes-closed conditions.
Copyright © 2012 Elsevier B.V. All rights reserved.
Oncol Nurs Forum. 2012 Sep;39(5):E416-24. doi: 10.1188/12.ONF.E416-E424.
Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research.
Tofthagen C, Visovsky C, Berry DL.
Author information
Abstract
PURPOSE/OBJECTIVES:
To evaluate the evidence for strength- and balance-training programs in patients at high risk for falls, discuss how results of existing studies might guide clinical practice, and discuss directions for additional research.
DATA SOURCES:
A search of PubMed and CINAHL® databases was conducted in June 2011 using the terms strength, balance training, falls, elderly, and neuropathy. Only clinical trials conducted using specific strength- or balance-training exercises that included community-dwelling adults and examined falls, fall risk, balance, and/or strength as outcome measures were included in this review.
DATA SYNTHESIS:
One matched case-control study and two randomized, controlled studies evaluating strength and balance training in patients with diabetes-related peripheral neuropathy were identified. Eleven studies evaluating strength and balance programs in community-dwelling adults at high risk for falls were identified.
CONCLUSIONS:
The findings from the reviewed studies provide substantial evidence to support the use of strength and balance training for older adults at risk for falls, and detail early evidence to support strength and balance training for individuals with peripheral neuropathy.
IMPLICATIONS FOR NURSING:
The evidence demonstrates that strength and balance training is safe and effective at reducing falls and improving lower extremity strength and balance in adults aged 50 years and older at high risk for falls, including patients with diabetic peripheral neuropathy. Future studies should evaluate the effects of strength and balance training in patients with cancer, particularly individuals with chemotherapy-induced peripheral neuropathy.
Rheumatol Int. 2012 Nov;32(11):3339-51. doi: 10.1007/s00296-012-2480-7. Epub 2012 Jul 22.
The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis.
Smith TO, King JJ, Hing CB.
Author information
Abstract
Osteoarthritis (OA) is a leading cause of functional impairment and pain. Proprioceptive defects may be associated with the onset and progression of OA of the knee. The purpose of this study was to determine the effectiveness of proprioceptive exercises for knee OA using meta-analysis. Asystematic review was conducted on 12th December 2011 using published (Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, PubMed, PEDro) and unpublished/trial registry (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research Register Archive) databases. Studies were included if they were full publications of randomized or non-randomised controlled trials (RCT) comparing a proprioceptive exercise regime, against a non-proprioceptive exercise programme or non-treatment control for adults with knee OA. Methodological appraisal was performed using the PEDro checklist. Seven RCTs including 560 participants (203 males and 357 females) with a mean age of 63 years were eligible. The methodological quality of the evidence base was moderate. Compared to a non-treatment control, proprioceptive exercises significantly improved functional outcomes in people with knee OA during the first 8 weeks following commencement of their exercises (p < 0.02). When compared against a general non-proprioceptive exercise programme, proprioceptive exercises demonstrated similar outcomes, only providing superior results with respect to joint position sense-related measurements such as timed walk over uneven ground (p = 0.03) and joint position angulation error (p < 0.01). Proprioceptive exercises are efficacious in the treatment of knee OA. There is some evidence to indicate the effectiveness of proprioceptive exercises compared to general strengthening exercises in functional outcomes.
Prev Chronic Dis. 2012;9:E103. Epub 2012 May 24.
Dissemination of an evidence-based program to reduce fear of falling, South Carolina, 2006-2009.
Ullmann G, Williams HG, Plass CF.
Author information
Abstract
INTRODUCTION:
Falls among older adults are a serious public health issue, and fear of falling can limit mobility, which in turn increases fall risk. A Matter of Balance/Volunteer Lay Leader Model is an evidence-based program designed to address fear of falling. The objective of this study was to describe implementation, dissemination, and outcomes of this program in 3 regions of South Carolina with a predominantly African American and largely underserved population.
METHODS:
We developed partnerships throughout the state, organized master and lay leader trainings, and documented numbers of lay leaders, programs offered, demographic characteristics of participants, program fidelity, and attendance. Outcome measures were self-reported confidence to prevent and manage falls and a quantitative measure of functional mobility. Both measures were assessed at baseline and after program completion.
RESULTS:
Older adults (N = 235) attended 18 classes at 16 sites. Barriers to implementation were program teams' limited familiarity with the concept of evidence-based programs and the importance of adhering to program content. Facilitators were state-level leadership and a history of state, regional, and local groups collaborating successfully on other projects. Outcomes indicated greater confidence in managing falls and carrying out activities of daily living. Mobility improved significantly, suggesting a reduced risk for falls.
CONCLUSION:
Evidence-based programs such as A Matter of Balance/Volunteer Lay Leader Model can be successfully disseminated in underserved areas. Outcomes indicate that participation in fall prevention programs can benefit groups of predominantly African American older adults
Maturitas. 2012 Jul;72(3):206-13. doi: 10.1016/j.maturitas.2012.04.009. Epub 2012 May 18.
The effect of whole body vibration on balance, mobility and falls in older adults: a systematic review and meta-analysis.
Lam FM, Lau RW, Chung RC, Pang MY.
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Abstract
This systematic review aimed to examine the effect of WBV on balance, mobility and falls among older adults. The databases used included MEDLINE, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library Databases ofSystematic Reviews, Physiotherapy Evidence Database (PEDro), PubMed, and Science Citation Index (last search in October 2011). Randomized controlled trials that investigated the effect of WBV on balance, mobility or falls in older adults were included in this review. The PEDro score was used to examine the methodological quality of the selected studies. The effect of WBV on balance, mobility and fall-related outcomes were extracted. The data extraction and rating were performed by a researcher and the results were confirmed by the principal investigator. Meta-analysis was done if 3 or more studies measured the same outcome of interest. Among 920 articles screened, fifteen articles (thirteen trials) satisfied the criteria and were included in this review. Methodological quality was good for six of the studies (PEDro score=6-7). Meta-analysis revealed that WBV has a significant treatment effect in Tinetti Total Score (p<0.001), Tinetti Body Balance Score (p=0.010) and Timed-Up-and-Go test (p=0.004). No significant improvement was noted in Tinetti Gait Score after WBV training (p=0.120). The effect of WBV on other balance/mobility outcomes and fall rate remains inconclusive. To conclude, WBV may be effective in improving relatively basic balance ability and mobility among older adults, particularly frailer ones. More good-quality WBV trials are required.
Physiother Theory Pract. 2013 Jan;29(1):1-18. doi: 10.3109/09593985.2012.677111. Epub 2012 Apr 20.
Standing balance in patients with whiplash-associated neck pain and idiopathic neck pain when compared with asymptomatic participants: A systematic review.
Silva AG, Cruz AL.
Author information
Abstract
Neck proprioception is one of the information sources that helps regulate postural balance. However, it is believed to be impaired as patients with both idiopathic neck pain (INP) and whiplash-associated disorders (WAD) have been shown to have a more unstable balance than healthy controls. Thissystematic review aims to determine if there are significant differences in balance between patients with INP and healthy controls and between patients with WAD and healthy controls. Studies were sought from PubMed, Cinahl, Physiotherapy Evidence Database, Web of Science, Academic Search Complete, Science Direct, and Scielo. Two reviewers independently screened titles and abstracts, assessed full reports for potentially eligible studies, and extracted information on participants' characteristics, pain characteristics, study methods, study results, and study quality. Twelve studies were included in this systematic review. Of these, six compared INP and healthy controls and eight compared WAD and healthy controls. All but one study (11/12) found a statistically significant difference for at least one measurement between patients with INP and WAD and healthy controls. The results of this systematic review suggest that both patients with INP and patients with WAD have poorer balance
Arch Phys Med Rehabil. 2012 Jun;93(6):1101-7. doi: 10.1016/j.apmr.2012.01.020. Epub 2012 Apr 11.
Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke.
Schmid AA, Van Puymbroeck M, Altenburger PA, Dierks TA, Miller KK, Damush TM, Williams LS.
Author information
Abstract
OBJECTIVES:
To (1) examine the relationships between multiple poststroke mobility variables (gait speed, walking capacity, balance, balance self-efficacy, and falls self-efficacy) and activity and participation; and (2) determine which poststroke mobility variables are independently associated with activity and participation.
DESIGN:
This is the primary analysis of a prospective cross-sectional study completed to understand the impact of mobility on activity and participation in people with chronic stroke.
SETTING:
University-based research laboratory, hospitals, and stroke support groups.
PARTICIPANTS:
People (N=77) with stroke greater than 6 months ago were included in the study if they were referred to occupational or physical therapy for physical deficits as a result of the stroke, completed all stroke related inpatient rehabilitation, had residual functional disability, scored a ≥4 out of 6 on the short, 6-item Mini-Mental State Examination, and were between the ages of 50 and 85.
INTERVENTIONS:
Not applicable, this is a cross-sectional data collection of 1 timepoint.
MAIN OUTCOME MEASURES:
We measured activity and participation with the validated International Classification of Functioning, Disability and Health Measure of Participation and Activities. Other variables included gait speed (10-meter walk), walking capacity (6-minute walk), balance (BergBalance Scale), balance self-efficacy (Activities Specific Balance Confidence Scale), and falls self-efficacy (Modified Falls Efficacy Scale).
RESULTS:
Only balance self-efficacy was found to be independently associated with poststroke activity (β=-.430, P<.022, 95% confidence interval [CI], -.247 to -.021) and participation (β=-.439, P<.032, 95% CI, -.210 to -.010).
CONCLUSIONS:
Among people with chronic stroke, balance self-efficacy, not physical aspects of gait, was independently associated with activity and participation. While gait training continues to be important, this study indicates a need to further evaluate and address the psychological factors of balance and falls self-efficacy to obtain the best stroke recovery.
Arch Phys Med Rehabil. 2012 Jul;93(7):1138-46. doi: 10.1016/j.apmr.2012.01.023. Epub 2012 Mar 11.
Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs.
Pluchino A, Lee SY, Asfour S, Roos BA, Signorile JF.
Author information
Abstract
OBJECTIVE:
To compare the impacts of Tai Chi, a standard balance exercise program, and a video game balance board program on postural control and perceived falls risk.
DESIGN:
Randomized controlled trial.
SETTING:
Research laboratory.
PARTICIPANTS:
Independent seniors (N=40; 72.5±8.40) began the training, 27 completed.
INTERVENTIONS:
Tai Chi, a standard balance exercise program, and a video game balance board program.
MAIN OUTCOME MEASURES:
The following were used as measures: Timed Up & Go, One-Leg Stance, functional reach, Tinetti Performance Oriented Mobility Assessment, force plate center of pressure (COP) and time to boundary, dynamic posturography (DP), Falls Risk for Older People-Community Setting, and Falls Efficacy Scale.
RESULTS:
No significant differences were seen between groups for any outcome measures at baseline, nor were significant time or group × time differences for any field test or questionnaire. No group × time differences were seen for any COP measures; however, significant time differences were seen for total COP, 3 of 4 anterior/posterior displacement and both velocity, and 1 displacement and 1 velocity medial/lateral measure across time for the entire sample. For DP, significant improvements in the overall score (dynamic movement analysis score), and in 2 of the 3 linear and angular measures were seen for the sample.
CONCLUSIONS:
The video game balance board program, which can be performed at home, was as effective as Tai Chi and the standard balanceexercise program in improving postural control and balance dictated by the force plate postural sway and DP measures. This finding may have implications for exercise adherence because the at-home nature of the intervention eliminates many obstacles to exercise training.
J Manipulative Physiol Ther. 2012 Mar-Apr;35(3):227-34. doi: 10.1016/j.jmpt.2012.01.007. Epub 2012 Feb 17.
The effects of manual therapy on balance and falls: a systematic review.
Holt KR, Haavik H, Elley CR.
Author information
Abstract
OBJECTIVE:
The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.
METHODS:
This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.
RESULTS:
Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.
CONCLUSION:
A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.
Neurologia. 2012 Feb 16. [Epub ahead of print]
Use of virtual reality systems as proprioception method in cerebral palsy: clinical practice guideline.
[Article in English, Spanish]
Monge Pereira E, Molina Rueda F, Alguacil Diego IM, Cano De La Cuerda R, De Mauro A, Miangolarra Page JC.
Author information
Abstract
INTRODUCTION:
The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions.
DEVELOPMENT:
All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait.
CONCLUSIONS:
The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy.
[PubMed - indexed for MEDLINE]
Cochrane Database Syst Rev. 2012 Feb 15;2:CD009097. doi: 10.1002/14651858.CD009097.pub2.
Whole-body vibration training for patients with neurodegenerative disease.
Sitjà Rabert M, Rigau Comas D, Fort Vanmeerhaeghe A, Santoyo Medina C, Roqué i Figuls M, Romero-Rodríguez D, Bonfill Cosp X.
Author information
Abstract
BACKGROUND:
Whole-body vibration (WBV) may be a complementary training to standard physical rehabilitation programmes and appears to have potential benefits in the sensorimotor system performance of patients with neurodegenerative diseases.
OBJECTIVES:
The aim of this review was to examine the efficacy of WBV to improve functional performance according to basic activities of daily living (ADL) in neurodegenerative diseases. Additionally, we wanted to assess the possible effect on signs and symptoms of the disease, bodybalance, gait, muscle performance, quality of life and adverse events.
SEARCH METHODS:
We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011 Issue 4), MEDLINE (1964 to 6 May 2011; via PubMed), EMBASE (1980 to 6 May 2011; via Ovid), PeDro (1929 to May 2011; via website), CINAHL (to September 2011; via Ovid) and PsycINFO (1806 to 6 May 2011; via Ovid).
SELECTION CRITERIA:
We included randomised controlled trials comparing single or multiple sessions of WBV to a passive intervention, any other active physical therapy or WBV with different vibration parameters.
DATA COLLECTION AND ANALYSIS:
Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. Disagreement was resolved by discussion or, if necessary, referred to a third review author.
MAIN RESULTS:
We included 10 trials, of which six focused on Parkinson's disease and four on multiple sclerosis. None of the studies reported data on the primary outcome (functional performance). In Parkinson's disease, after pooling two studies, a single session of WBV caused a significant improvement of gait measured using the Timed Up and Go test (TUG) in comparison to standing exercises (mean difference -3.09, 95% confidence interval -5.60 to -0.59; P = 0.02; I(2) = 0%). Nevertheless, longer duration of WBV did not show significant results in comparison with physical therapy in body balance or signs and symptoms measured with the Unified Parkinson's Disease Rating Scale (UPDRS). In multiple sclerosis there was no evidence of a short-term or long-term effect of WBV on body balance, gait, muscle performance or quality of life.Adverse events were reported in few trials. In those trials that reported them, the intervention appeared to be safe.
AUTHORS' CONCLUSIONS:
There is insufficient evidence of the effect of WBV training on functional performance of neurodegenerative disease patients. Also, there is insufficient evidence regarding its beneficial effects on signs and symptoms of the disease, body balance, gait, muscle strength and quality of life compared to other active physical therapy or passive interventions in Parkinson's disease or multiple sclerosis. More studies assessing other functional tests and accurately assessing safety are needed before a definitive recommendation is established.
PMID:
22336858
[PubMed - indexed for MEDLINE]
J Altern Complement Med. 2012 Jan;18(1):29-41. doi: 10.1089/acm.2010.0691. Epub 2012 Jan 10.
Using whole-body vibration training in patients affected with common neurological diseases: a systematicliterature review.
del Pozo-Cruz B, Adsuar JC, Parraca JA, del Pozo-Cruz J, Olivares PR, Gusi N.
Author information
Abstract
OBJECTIVES:
This systematic review critically evaluates the effects of whole body vibration (WBV) exercises on gait, balance, proprioception, strength, and health-related quality of life in patients with common neurological diseases. It specifically focuses on assessing the quality of reported studies and comparing quantitative results.
DESIGN:
This is a systematic literature review.
RESULTS:
A specific search strategy of 11 databases identified 13 published articles (5 studies of patients with Parkinson disease, 2 with cerebral palsy, 3 with multiple sclerosis, and 3 with stroke) that fulfilled the selection criteria. The quality of the articles was evaluated using a Physiotherapy Evidence Database scale and Dutch Institute for Healthcare Improvement guidelines.
CONCLUSIONS:
There is moderate evidence that one session of WBV has positive effects on strength, whereas there is a weak level of evidence that WBV could improve proprioception and health-related quality of life measures in neurological patients. With respect to long-term effects of WBV, there is minor evidence from the studies with the best methodological quality that WBV improves strength, proprioception, gait, and balance. Further research on the intervention is strongly needed.
Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S114-9. doi: 10.1016/S1353-8020(11)70036-0.
Rehabilitation, exercise therapy and music in patients with Parkinson's disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life.
de Dreu MJ, van der Wilk AS, Poppe E, Kwakkel G, van Wegen EE.
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Abstract
Recent evidence suggests that music-based movement (MbM) therapy may be a promising intervention to improve gait and gait-related activities in Parkinson's disease (PD) patients, because it naturally combines cognitive movement strategies, cueing techniques, balance exercises and physical activity while focussing on the enjoyment of moving on music instead of the current mobility limitations of the patient. A meta-analysis of RCTs on the efficacy of MbM-therapy, including individual rhythmic music training and partnered dance classes, was performed. Identified studies (K = 6) were evaluated on methodological quality, and summary effect sizes (SES) were calculated. Studies were generally small (total N= 168). Significant homogeneous SESs were found for the Berg Balance Scale, Timed Up and Go test and stride length (SESs: 4.1,2.2,0.11; P-values <0.01; I(2) 0,0,7%, respectively). A sensitivity analysis on type of MbM-therapy (dance- or gait-related interventions) revealed a significant improvement in walking velocity for gait-related MbM-therapy, but not for dance-related MbM-therapy. No significant effects were found for UPDRS-motor score, Freezing of Gait and Quality of Life. Overall, MbM-therapy appears promising for the improvement of gait and gait-related activities in PD. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
Res Dev Disabil. 2012 Jan-Feb;33(1):291-306. doi: 10.1016/j.ridd.2011.08.028. Epub 2011 Oct 21.
A review of balance and gait capacities in relation to falls in persons with intellectual disability.
Enkelaar L, Smulders E, van Schrojenstein Lantman-de Valk H, Geurts AC, Weerdesteyn V.
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Abstract
Limitations in mobility are common in persons with intellectual disabilities (ID). As balance and gait capacities are key aspects of mobility, the prevalence of balance and gait problems is also expected to be high in this population. The objective of this study was to critically review the available literature on balance and gait characteristics in persons with ID. Furthermore, the consequences of balance and gait problems in relation to falls were studied, as well as the trainability of balance and gait in persons with ID. The systematic literature search identified 48 articles to be included in this review. The literature consistently reports that balance and gait capacities are affected in persons with ID compared to their age-matched peers. These problems start at a young age and remain present during the entire lifespan of persons with ID, with a relatively early occurrence of age-related decline. From these results a conceptual model was suggested in which the development of balance and gait capacities in the ID population across the life span are compared to the general population. Regarding the second objective, our review showed that, although the relationship of balance and gait problems with falls has not yet been thoroughly investigated in persons with ID, there is some preliminary evidence that these aspects are also important in the ID population. Finally, this review demonstrates that balance and gait are potentially trainable in persons with ID. These results suggest that falls might be prevented with ID-specific exercise interventions.
J Rehabil Med. 2012 Oct;44(10):811-23. doi: 10.2340/16501977-1047.
Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.
Paltamaa J, Sjögren T, Peurala SH, Heinonen A.
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Abstract
OBJECTIVE:
To determine the effects of physiotherapy interventions on balance in people with multiple sclerosis.
DATA SOURCES:
A systematic literature search was conducted in Medline, Cinahl, Embase, PEDro, both electronically and by manual search up to March 2011.
STUDY SELECTION:
Randomized controlled trials of physiotherapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classification of Functioning, Disability and Health (ICF) category of "Changing and maintaining body position", were included.
DATA EXTRACTION:
The quality of studies was determined by the van Tulder criteria. Meta-analyses were performed in subgroups according to the intervention.
DATA SYNTHESIS:
After screening 233 full-text papers, 11 studies were included in a qualitative analysis and 7 in a meta-analysis. The methodological quality of the studies ranged from poor to moderate. Low evidence was found for the efficacy of specific balance exercises, physical therapy based on an individualized problem-solving approach, and resistance and aerobic exercises on improving balance among ambulatory people with multiple sclerosis.
CONCLUSION:
These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.
Erica
Res Sports Med. 2012 Jul;20(3-4):223-38. doi: 10.1080/15438627.2012.680988.
Preventing ACL injuries in team-sport athletes: a systematic review of training interventions.
Stojanovic MD, Ostojic SM.
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Abstract
The purpose of this systematic review was to assess the efficacy of training interventions aimed to prevent and to reduce anterior cruciate ligament injury (ACLI) rates in team sport players. We searched MEDLINE from January 1991 to July 2011 using the terms knee, ACL, anterior cruciate ligament, injury, prevention, training, exercise, and intervention. Nine out of 708 articles met the inclusion criteria and were independently rated by two reviewers using the McMaster Occupational Therapy Evidence-Based Practice Research Group scale. Consensus scores ranged from 3 to 8 out of 10. Seven out of nine studies demonstrated that training interventions have a preventive effect on ACLI. Collectively, the studies indicate there is moderate evidence to support the use of multifaceted training interventions, which consisted of stretching, proprioception, strength, plyometric and agility drills with additional verbal and/or visual feedback on proper landing technique to decrease the rate of ACLIs in team sport female athletes, while the paucity of data preclude any conclusions for male athletes.
Br J Sports Med. 2012 Jun;46(7):515-23. doi: 10.1136/bjsports-2011-090137. Epub 2011 Dec 14.
Intrinsic functional deficits associated with increased risk of ankle injuries: a systematic review with meta-analysis.
Witchalls J, Blanch P, Waddington G, Adams R.
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Abstract
BACKGROUND:
A history of ankle injury is known to be associated with an increased risk of future injuries. Prevention of a first-time injury to an ankle will also prevent subsequent re-injury; yet these participants are often overlooked in reports of preventive testing. Determining the functional deficits which promote injury risk in all ankles, through studies inclusive of previously injured and never injured ankles, will enable training to be directed at improving known deficits in all sports participants.
OBJECTIVE:
To review studies investigating the measurement of intrinsic functions in healthy ankles and assess their predictive value for injury.
METHOD:
Systematic review and meta-analysis of journal articles from selected electronic databases. Using all papers that included sufficient data for extraction in any paradigm, the authors pooled results for measures of strength, postural control, proprioception, muscle reaction time in response to perturbation, range of movement and ligament stability.
RESULTS:
Thirteen papers were found with adequate data reporting to allow calculation of pooled standardised mean difference (SMD) or pooled RR. The following are all associated with an increased risk of ankle injury: higher postural sway (SMD=0.693, 95% CI=0.151 to 1.235, p=0.012), being in the lower postural stability group (RR=2.06, 95% CI=1.364 to 3.111, p=0.001), lower inversion proprioception (0.573, 0.244 to 0.902, <0.001), higher concentric plantar flexion strength at faster speeds (0.372, 0.092 to 0.652, 0.009) and lower eccentric eversion strength at slower speeds (0.337, 0.117 to 0.557, 0.003).
CONCLUSION:
There is a set of intrinsic functional and structural ankle deficits associated with significantly increased risk of ankle injury. These findings will enable clinicians and sports trainers to measure and train specific deficits in sports people for the prevention of ankle injury.
