Pouzdanost modifikovanog kliničkog testa uticaja senzornih interakcija na posturalnu stabilnost sportista uzrasta od 10 do 12 godina

Based on the literature, reports about bilateral stance assessments based on force plate measurements in elementary schoolchildren and athletes are limited. The present study was designed to report reliability values for postural stability in 10 to 12 years old athletes using the Balance Master system. Twenty young athletes who regularly practice their sport activities at least three times per week, participated in the reproducibility study (mean age 11.4±1.0). The modified clinical test of sensory interaction on balance (mCT­SIB) quantified children's static standing balance. Intraclass correlation and Cronbach's alpha coefficients for three repeated measures reliability of the four sensory conditions of the mCTSIB showed good to excellent reliability, ranged between 0.772 and 0.949. Reproducibility was assessed with one way ANOVA with replication and non statistical differences among three measurements were recorded. Based on the obtained findings, it could be concluded that applied tests can be used in reliable assessment of standing balance in 10 to 12 age athletes. .Kratak naslov: Statička posturalna stabilnost sportista uzrasta od 10 do 12 godina. Na osnovu pregleda literature, može se zaključiti da o primeni kompjuterizovane posturografije u proceni posturalnog statusa dece i sportista nema dovoljno podataka. Zbog toga je osmišljeno istraživanje kojim je ispitana pouzdanost testa za procenu posturalnog statusa sportista uzrasta 10 do 12 godina, pri­menom kompjuterizovane posturografije. U istraživanju je učestvovalo 40 dečaka starosti 11,4 (±1.0) godina, koji se aktivno (bar tri puta nedeljno) bave nekim sportom. Za procenu sposobnosti održavanja posturalne stabilnosti, korišćen je tzv. modifikovani klinički test uticaja senzornih informacija na ravnotežu. Intraklas korelacioni koeficijent i krombah alfa koeficijent za tri ponovljena merenja bili su u intervalu od 0,772 do 0,949. Ponovljivost testa proveravana je jednofaktorskom analizom varijanse sa ponavljanjem za tri uzastopna merenja i nisu dobijene statistički značajne razlike. Dobijeni rezultati ukazuju da su evaluirani testovi za procenu posturalne stabilnosti pouzdani, te se mogu koristiti u proceni ravnoteže kod sportista uzrasta od 10 do 12 godina

Static and dynamic balance in young athletes

Ricotti L. Static and dynamic balance in young athletes. J. Hum. Sport Exerc. Vol. 6, No. 4, pp. 616628, 2011. The creation of a mature athlete necessarily passes through the expression of his potential during each phase of his development. Young athletes' trainers often neglect specific balance programs, above all in certain sports (e.g. soccer) where balance is poorly considered, but that is fundamental for the execution of complex technical movements, as well as for the prevention of future injuries. In this paper we highlight that balance training at specific ages is important for the maturation of the sensorimotor abilities that are important for a high level athlete. We discuss the main methods used to assess balance in sports, including some useful formulae that can be used to quantify postural performances, and we report the major findings concerning static and dynamic analyses on children and adolescents. Finally, we discuss the existing literature regarding balance recordings on adults, adolescents and children involved in one or more sport activities at regional, national or international level, highlighting the need of further research on the mechanisms underlying balance improvements related to different sport activities at various ages. Keywords: STATIC BALANCE, DYNAMIC BALANCE, COP, CHILDREN TRAINING, YOUNG ATHLETES, POSTURAL PERFORMANCES

Cognitive Behavioral Therapy in Social Anxiety Disorder: Current Concepts

Cognitive behavioral therapy is still one of the most important treatment modalities in social anxiety disorder with a high level of evidence. However, some patients do not fully benefit from these therapies and this fact leads to ongoing search for new approaches. This paper reviews use of cognitive behavioral therapy in social anxiety disorder studies and discusses related updated concepts. The frequent use of computer-assisted therapy for most of recent studies was found noteworthy. Recent studies regarding social anxiety disorder focused on concepts such as attention bias, biased information processing, attention training, judgment biases, internet-based cognitive behavioral therapies and social mishap exposure. Internet-based cognitive-behavioral therapy seemed to be a good option for people who were unable to access face to face treatment. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(3.000): 229-243

La réalité virtuelle : une solution thérapeutique visant à augmenter l'intérêt et la motivation envers le traitement des phobies spécifiques chez l'enfant?

Les troubles anxieux représentent les problèmes mentaux les plus souvent répertoriés chez les enfants et les adolescents, et la phobie spécifique figure au premier rang (Albano, Chorpita, & Barlow, 2003). Afin de rendre l'aspect thérapeutique moins aversif à un enfant, d'augmenter le désir de recevoir un traitement, et ultimement de pouvoir diminuer les abandons causés par le manque de motivation, la réalité virtuelle offre une alternative intéressante à l'exposition in vivo. L'objectif premier de la thèse est de vérifier si le degré de motivation d'enfants souffrant d'arachnophobie est plus élevé selon qu'ils reçoivent un traitement combinant de l'exposition en réalité virtuelle (in virtuo) à de l'exposition in vivo ou un traitement comportant seulement de l'exposition in vivo. De plus, un objectif secondaire consiste à vérifier si la motivation peut s'avérer un prédicteur de l'efficacité thérapeutique. Finalement, un dernier objectif vise à documenter de façon exploratoire l'efficacité de la méthode d'exposition utilisée (in virtuo vs in vivo). Afin de réaliser cette étude, un travail préparatoire s'est avéré nécessaire pour en préparer les assises. Ainsi, la thèse se compose de trois chapitres, dont deux recensions et une étude empirique. Le premier chapitre se veut une mise à jour des traitements d'exposition pour la phobie spécifique chez l'enfant et confirme l'efficacité de cette méthode pour traiter la phobie spécifique chez l'enfant. Il est aussi possible de noter une tendance à diminuer la longueur des thérapies d'exposition ou encore à combiner l'exposition graduée à d'autres techniques thérapeutiques, telles l'apprentissage vicariant ou encore la désensibilisation par mouvements oculaires et traitement de l'information. Une seconde recension, le deuxième chapitre, met en lumière les travaux réalisés au cours des dernières années impliquant la réalité virtuelle au profit des enfants et des adolescents. Les études sélectionnées et qui font usage d'un système de type immersif s'avèrent peu nombreuses. La recension permet de mettre en évidence que cette technologie a surtout été utilisée à des fins thérapeutiques, médicales et éducatives. Au niveau de la psychothérapie, une seule étude permet d'observer un intérêt envers l'usage de cette technologie avec cette population. Finalement, le dernier chapitre permet de tester empiriquement si l'usage de la réalité virtuelle augmente la motivation des enfants face à la thérapie. Ainsi, 31 enfants et adolescents âgés de 8 à 15 ans ont été recrutés et assignés aléatoirement entre deux conditions : exposition in vivo seulement ou exposition in virtuo combinée à une séance d'exposition in vivo. Des mesures concernant la motivation et l'efficacité thérapeutique ont été prises avant, pendant et après la thérapie. Les résultats montrent qu'il n'existe pas de différence significative entre les deux groupes en ce qui a trait au degré de motivation face aux deux modalités de traitement. De plus, l'analyse des résultats indique que la motivation semble être importante pour expliquer le succès thérapeutique. Pour ce qui a trait à l'efficacité des traitements, les résultats indiquent que l'ajout de la séance d'exposition in vivo serait utile pour augmenter les succès thérapeutiques des enfants ayant reçu le traitement via la réalité virtuelle. Les résultats de cette étude ont des retombées cliniques intéressantes concernant la motivation des enfants phobiques envers la thérapie et des pistes de solutions sont suggérées afin d'adapter la thérapie à leurs besoins.\ud ______________________________________________________________________________ \ud MOTS-CLÉS DE L’AUTEUR : motivation, enfants, réalité virtuell

Efeitos da vibração de corpo inteiro na sensibilidade cutânea, equilíbrio, variáveis fisiológicas e cargas de aceleração associadas

O estímulo vibratório gerado pela utilização das plataformas vibratórias tem sido aplicado como método eficaz para promover desempenho esportivo e também na reabilitação de pacientes com diversificadas disfunções. Acredita-se que a vibração de corpo inteiro (VCI) é capaz de diminuir os déficits de ativação muscular voluntária através de reflexos de estiramento neuromuscular, tornando-se um meio eficaz e de fácil aplicabilidade para pacientes com maiores incapacitações. Resultados controversos na literatura, com relação aos benefícios dos estímulos vibratórios, tornam a escolha dos parâmetros do equipamento (frequência, amplitude, tempo de exposição e modo de vibração) um desafio na obtenção dos melhores resultados. Assim, o objetivo desta tese visa a avaliação dos efeitos fisiológicos agudos da vibração de corpo inteiro (sensibilidade cutânea tátil e dolorosa, equilíbrio, temperatura superficial da pele, transmissibilidade da vibração) e a construção de um mapa de percepção corporal da VCI. Foram utilizados diferentes parâmetros e marcas desses equipamentos. Para investigar cada variável, quatro diferentes estudos foram realizados separadamente. O primeiro estudo investigou os efeitos da VCI na sensibilidade cutânea vibratória medidos a 30 Hz (corpúsculos de Meissner) e 200Hz (corpúsculos de Pacini) e de toque-pressão dos pés de 20 sujeitos normais e o tempo de duração dos efeitos da vibração nesses receptores. Como principais resultados, foram constatadas que as descargas aferentes dos mecanorreceptores de adaptação rápida foram fortemente afetadas pela vibração assim como a sensibilidade de toquepressão. Após 10 min de exposição à VCI o tempo de recuperação para a sensibilidade voltar aos limiares basais nos pés foi entre 2 e 3 h. Para continuar elucidando os efeitos agudos pós-exercício com vibração, um segundo estudo foi realizado avaliando variáveis fisiológicas em quatro diferentes frequências de exposição de VCI (30, 35, 40, 44 Hz). Foram avaliadas pressão arterial, frequências cardíaca e respiratória, temperatura axilar e a temperatura cutânea através de termografia por infravermelho dos membros inferiores dos 24 participantes avaliados. Por fim, o equilibro desses indivíduos foi avaliado através das análises dos deslocamentos, da velocidade e da área do centro de pressão (COP), em uma plataforma de força. Os dados do segundo estudo mostraram que, para as frequências de 40 e 44 Hz do equipamento, houve uma alteração significativa para as variáveis velocidade e comprimento ântero-posterior do centro de pressão. Além disso, durante a vibração e 10 min após, a temperatura dos membros inferiores foi reduzida, provavelmente em virtude da vasoconstrição gerada. Na investigação da sensibilidade dolorosa um terceiro estudo foi proposto, tendo em vista que as vias dos mecanorreceptores de sensibilidade cutânea tátil diferem daqueles relacionados com a sensibilidade dolorosa. Um modelo de dor crônica com ratos Wistar foi realizado e os animais foram tratados com VCI, esteira e a combinação de esteira com VCI. Como principais resultados deste estudo, os grupos tratados com VCI mostraram redução significativa da sensibilidade de toque-pressão após todas as sessões em comparação aos demais grupos. Efeitos analgésicos através do tempo de latência medidos com o hot plate foram encontrados após o terceiro dia de tratamento com 5 min de exposição por dia à VCI, nos primeiros 5 dias e 10 min nos 5 dias subsequentes. Como finalização das variáveis de interesse, o último estudo combinou dados quantitativos advindos da acelerometria (com medições na cabeça, quadril e tíbia) com dados qualitativos através da escala de Borg. Sessenta e cinco adultosjovens foram avaliados e este estudo propôs um método para escolher os diversificados parâmetros da plataforma vibratória, para alcançar os efeitos desejados na reabilitação ou desempenho esportivo. Este estudo mostrou que os índices de percepção de severidade medidos através da escala de Borg corresponderam com os dados quantitativos da acelerometria e assim os parâmetros do equipamento podem ser escolhidos com base na sensação subjetiva proveniente da escala de Borg. Os níveis de desconforto no equipamento podem estar relacionados com a frequência de ressonância das diferentes partes do corpo. Futuros estudos devem considerar aplicações clínicas da plataforma vibratória em pacientes com dor crônica musculoesquelética utilizando o modelo para escolha dos parâmetros do equipamento proposto nesta tese.The vibratory stimuli generated by the use of vibrating platforms have been used as an effective method to promote sports performance and also in the rehabilitation of patients with several dysfunctions. It is believed that the whole body vibration (WBV) is able to decrease the deficits in voluntary muscle activation by neuromuscular stretch reflexes making it an efficient and easy exercise method applied to patients with greater disabilities. Controversial results in the literature regarding the benefits of the vibratory stimuli make the choice of the equipment parameters (frequency, amplitude, time of exposure and vibration mode) a challenge in getting the best results. The goal of this dissertation involves the evaluation of the acute physiological effects of whole body vibration (skin tactile and pain sensitivity, balance, skin temperature and vibration transmissibility) and the construction of a WBV perception body map. Parameters settings and different brands of these devices were used. To investigate each variable, four different studies were conducted separately. The first study investigated the effects of WBV on fast adapting mechanoreceptors measured at 30 Hz (Meissner corpuscles) and 200Hz (Pacinian corpuscles) and touch-pressure sensitivity from the right foot of 20 health subjects and the duration of the vibration effects on these receptors. The main results show that the afferent discharges of the fast adapting mechanoreceptors are strongly affected by vibration and sensitivity of touch-pressure was also impaired. After a single 10 minutes exposure to WBV, the time required to recover baseline tactile sensitivity on the feet was between 2 and 3 hours. To further elucidate the acute postexercise vibration effects, a second study was conducted assessing physiological variables at four different WBV frequencies (31, 35, 40, 44 Hz). Blood pressure, heart and respiratory rates, skin temperature and balance were measured. Skin temperature was measured by an infrared thermography of the lower limbs of 24 subjects. Balance was accessed with a force plate through the analysis of the center of pressure (COP) velocity, area and displacements variables. The results from this study show that for 40 and 44 Hz of the device’s frequencies, a significant decrease in balance was found for the center of pressure variables velocity and anterior-posterior displacement. Also, during WBV exposition and 10 minutes post vibration, the temperature of the lower limbs was reduced, probably due to vasoconstriction. To investigate the variable "pain", a third study was proposed, considering that the pathways and receptors of the cutaneous touch-pressure and vibration sensitivity differ from those related to pain sensitivity, the C and A fibers. A chronic pain model was applied in male Wistar rats and the animals were treated with WBV exercise (vibration platform), a low intensity exercise (treadmill) and a combined treatment involving both. The main results show that the groups treated with WBV showed a significant reduction in sensitivity to touchpressure after every session compared to the other groups. Analgesic effects through the time latency measured by the hot plate were found after the third treatment day with 5 min of exposure to WBV during the first 5 days and 10 min next 5 days. As completion of the fourth variable of interest, the last study by deriving quantitative data from accelerometry (with measurements on the head, hip and tibia) was combined with qualitative data arising from the Borg scale. Sixty five health young adults were measured and the study proposes a method for choosing the parameters settings of the vibrating platform, to achieve the desired goals in rehabilitation or sports performance. Discomfort perception ratings measured by the Borg scale corresponded well with the measured acceleration magnitudes and so the parameters settings of the device can be chosen based on the subjective sensation from the Borg scale. The level of discomfort ratings might be related to the frequency resonance phenomena of body parts. Future clinical applications with vibration platform in patients with muscle-skeletal chronic pain should be considered applying the model for choosing the parameter settings of the device proposed in this dissertation

A virtual reality approach to the study of visually driven postural control in developing and aging humans

L'être humain utilise trois systèmes sensoriels distincts pour réguler le maintien de la station debout: la somesthésie, le système vestibulaire, et le système visuel. Le rôle de la vision dans la régulation posturale demeure peu connu, notamment sa variabilité en fonction de l'âge, du type développemental, et des atteintes neurologiques. Dans notre travail, la régulation posturale induite visuellement a été évaluée chez des participants au développement et vieillissement normaux âgés de 5-85 ans, chez des individus autistes (développement atypique) âgés de 12-33 ans, ainsi que chez des enfants entre 9-18 ans ayant subi un TCC léger. À cet effet, la réactivité posturale des participants en réponse à un tunnel virtuel entièrement immersif, se mouvant à trois niveaux de vélocité, a été mesurée; des conditions contrôles, où le tunnel était statique ou absent, ont été incluses. Les résultats montrent que la réactivité (i.e. instabilité) posturale induite visuellement est plus élevée chez les jeunes enfants; ensuite, elle s'atténue pour rejoindre des valeurs adultes vers 16-19 ans et augmente de façon linéaire en fonction de l'âge après 45 ans jusqu'à redevenir élevée vers 60 ans. De plus, à la plus haute vélocité du tunnel, les plus jeunes participants autistes ont manifesté significativement moins de réactivité posturale comparativement à leurs contrôles; cette différence n'était pas présente chez des participants plus âgés (16-33 ans). Enfin, les enfants ayant subi un TCC léger, et qui étaient initialement modérément symptomatiques, ont montré un niveau plus élevé d'instabilité posturale induite visuellement que les contrôles, et ce jusqu'à 12 semaines post-trauma malgré le fait que la majorité d'entre eux (89%) n'étaient plus symptomatiques à ce stade. En somme, cela suggère la présence d'une importante période de transition dans la maturation des systèmes sous-tendant l'intégration sensorimotrice impliquée dans le contrôle postural vers l'âge de 16 ans, et d'autres changements sensorimoteurs vers l'âge de 60 ans; cette sur-dépendance visuelle pour la régulation posturale chez les enfants et les aînés pourrait guider l'aménagement d'espaces et l'élaboration d'activités ajustés à l'âge des individus. De plus, le fait que l'hypo-réactivité posturale aux informations visuelles chez les autistes dépende des caractéristiques de l'environnement visuel et de l'âge chronologique, affine notre compréhension des anomalies sensorielles propres à l'autisme. Par ailleurs, le fait que les enfants ayant subi un TCC léger montrent des anomalies posturales jusqu'à 3 mois post-trauma, malgré une diminution significative des symptômes rapportés, pourrait être relié à une altération du traitement de l'information visuelle dynamique et pourrait avoir des implications quant à la gestion clinique des patients aux prises avec un TCC léger, puisque la résolution des symptômes est actuellement le principal critère utilisé pour la prise de décision quant au retour aux activités. Enfin, les résultats obtenus chez une population à développement atypique (autisme) et une population avec atteinte neurologique dite transitoire (TCC léger), contribuent non seulement à une meilleure compréhension des mécanismes d'intégration sensorimotrice sous-tendant le contrôle postural mais pourraient aussi servir comme marqueurs sensibles et spécifiques de dysfonction chez ces populations. Mots-clés : posture, équilibre, vision, développement/vieillissement sensorimoteur, autisme, TCC léger symptomatique, réalité virtuelle.Maintaining upright stance is essential for the accomplishment of several goal-directed behaviors, such as walking. Humans use three distinct sensory systems to regulate their posture: the somatosensory, the vestibular and the visual systems. The role of vision in postural regulation remains poorly understood, notably its variability across the life-span, developmental type and neurological insult. Hence, visually-driven postural regulation was examined in typically developing and aging participants (5-85 years-old), as well as in atypically developing individuals with autism (12-33 years-old) and in children having sustained mTBI (9-18 years-old). In order to do so, participants' postural reactivity was assessed in response to a fully immersive virtual tunnel moving at 3 different velocities; control conditions were also included wherein the tunnel was either static or absent. Results show that visually-induced postural reactivity was strongest in young children, then attenuated to become adult-like between 16-19 years of age, and started increasing again linearly with age after 45 years until becoming strong again around 60 years. Moreover, at the highest tunnel velocity, younger autistic participants showed significantly less postural reactivity compared to age-matched controls and young adults (16-33 years-old). Finally, children having sustained mTBI, who were initially moderately symptomatic, exhibited increased visually-induced instability compared to their matched controls up to 12 weeks post-injury, although most of them (89%) were no longer highly symptomatic. Altogether, this suggests the presence of an important transition period for the maturation of the systems underlying sensorimotor integration in postural control at around 16 years of age, and further sensorimotor changes after 60 years of age; this over-reliance on vision for postural regulation in childhood and late adulthood could guide the design of age-appropriate facilities/ activities. Furthermore, the fact that postural hypo-reactivity to visual information present in autism is contingent on both the visual environment and on chronological age, enhances our understanding of autism-specific sensory anomalies. Additionally, the fact that children with mTBI show balance anomalies up to 3 months post-injury, even when they are no longer highly symptomatic may be related to altered processing of dynamic visual information and could have implications for the clinical management of mTBI patients, since symptoms resolution is commonly used as a criterion for return to activities. Finally, results stemming from populations with atypical development (autism) and with so-called transient neurological insult (mild TBI) not only contribute to enhance our understanding of sensorimotor integration mechanisms underlying postural control, but could also consist of sensitive and specific markers of dysfunction in these populations. Keywords : posture, balance, vision, sensorimotor development/ aging, autism, symptomatic mTBI, virtual reality

Back functioning: the effectiveness of an intervention promoting good body mechanics in elementary schoolchildren

While back pain in childhood is a common condition, at young age symptoms are generally mild, do not often lead to restrictions of daily activities and represent little health consequences. However, the predictive value of back pain at young age for back pain as an adult, stresses the need for primary prevention. The multi-factorial nature of the risk for developing back pain in childhood is widely accepted. On the other hand, the causative mechanisms for back pain occurrence at young age remain largely undetermined. Based on epidemiological evidence in relation to the biomechanical concept suggesting a U-shaped relationship for optimal loading, several correlates may influence children’s back function. In this way, environmental factors that may counterbalance optimal spinal loading of children’s young body structures may be present at school, which is the workplace of the young. In this line, children’s postural behavior in the Flemish class environment was pictured. This pilot study was grounded because sitting is the most reported factor in relation to back pain reporting at young age and due to the reality that standard school managements prescribe long sitting periods. The study findings pointed out that prolonged static kyphotic sitting without use of the backrest is common in Flemish elementary schoolchildren and children who spend more time sitting with a flexed trunk reported significantly more thoraco-lumbar pain