Effects of physical therapy interventions on balance ability in people with traumatic brain injury: A systematic review

BACKGROUND: Balance deficits are common impairments in individuals with post-traumatic brain injury (TBI). Balance deficits can restrict the activities of daily living and productive participation in social life. To date, no systematic reviews have examined the impact of physical therapy intervention on balance post-TBI.OBJECTIVE: To examine the effects of physical therapy interventions on balance impairments in individuals with TBI.METHODS: We systematically searched in PubMed, EMBASE, Scopus, PEDro, MEDLINE, REHABDATA, and Web of Science for randomized controlled trials (RCTs), clinical control trials, and pilot studies that examined the effects of physical therapy interventions on balance deficits in individuals post-TBI. The methodological quality was estimated using the Physiotherapy Evidence Database (PEDro) scale.RESULTS: Eight studies published from 2003 to 2019 were included in this study. A total of 259 TBI participants post-TBI were included in this review, 71 (27.41%) of which were females. The methodological quality of the selected studies ranged from low to high. There were no significant differences between experimental interventions, virtual reality (VR), vestibular rehabilitation therapy (VRT), control group interventions, and other traditional physical therapy interventions.CONCLUSIONS: The evidence about the effects of the physical therapy interventions in improving the balance ability post-TBI was limited. Further randomized controlled trials are strongly warranted to understand the role of physical therapy in patients with TBI who complain about balance deficits

Prevention of Secondary Injury after Anterior Cruciate Ligament Reconstruction: Relationship between Pelvic-Drop and Dynamic Knee Valgus.

Background: Optimal neuromuscular, Lumbo-Pelvic-Hip Complex, and lower extremity control are associated with decreased risk factors for secondary anterior cruciate ligament (ACL) injury. This study aimed to analyze any asymmetries and malalignments in the Lumbo-Pelvic-Hip Complex and the lower limbs at 6 months after ACL reconstruction (ACLR). (2) Methods: We conducted an exploratory retrospective observational single-center study in patients during the outpatient postoperative rehabilitation program at ICOT (Latina, Italy). From January 2014 to June 2020, 181 patients were recruited, but only 100 patients (86 male 28 ± 0.6 years, 178 ± 0.5 height; 14 female 24 ± 2.0 years, 178 ± 3.0 height) were eligible for the inclusion criteria and studied 6 months after ACL reconstruction surgery. (3) Statistical analysis: Student's t-tests and Pearson's product-moment correlation coefficient were used to determine significant differences between affected and non-affected limbs and variables' association. (4) Results: The study shows a decrease in neuromuscular control of the Lumbo-Pelvic-Hip Complex and dynamic adaptive valgus of the knee at 6 months after ACLR (mean difference between pathological and healthy limb of dynamic adaptive valgus was -10.11 ± 8.19° 95% CI -14.84 to -9.34; mean value was 16.3 ± 6.8° 95% CI 14.04 to 18.55 for healthy limb and 4.2 ± 3.1° 95% CI 3.15 to 5.21 for pathological limb, p < 0.0001). The results also showed a relationship between dynamic adaptive valgus and contralateral pelvic drop (r = 0.78, 95% CI 0.62 to 0.88, magnitude of correlation very large). (5) Conclusions: The analysis showed an associative correlation between decreased postural control of the pelvic girdle and dynamic adaptive valgus of the knee in 38% of patients; this study highlights the usefulness of the Single-Leg Squat Test (SLST) as a clinical/functional assessment to evaluate the rehabilitation process and as a preventive tool to reduce the risk of second ACL injuries during the return to sport

Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat.

Background: Spinal cord injury (SCI) is a critical medical condition that causes numerous impairments leading to accompanying disability. Robotic-assisted gait training (RAGT) offers many advantages, including the capability to increase the intensity and total duration of training while maintaining a physiological gait pattern. The effects of the RAGT 'Lokomat' on various impairments following SCI remain unclear. Objectives: This review was conducted to examine the impacts of the RAGT 'Lokomat' on the impairments following SCI. Methods: We searched PubMed, SCOPUS, PEDro, REHABDATA, MEDLINE, EMBASE, and web of science from inception to January 2021. Experimental studies examining the effects of the Lokomat on the impairments following incomplete SCI were selected. The methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Results: Sixteen studies were met the inclusion criteria. Thirteen were randomized controlled trials, two were clinical trials, and one was a pilot study. The scores on the PEDro scale ranged from two to eight, with a median score of six. The results showed evidence for the beneficial effects of the Lokomat on many motor impairments following incomplete SCI. Conclusions: The Lokomat may improve gait speed, walking distance, strength, range of motion, and mobility after incomplete SCI. There is insufficient evidence for the effect of the Lokomat on balance, depression, cardiorespiratory fitness, and quality of life. The effects of the Lokomat on the lower extremity spasticity were limited

Rhythmic auditory stimulation in gait rehabilitation for traumatic brain and spinal cord injury

Walking impairments consider one from common secondary impairments post-traumatic brain injury (TBI) and spinal cord injury (SCI). As the evidence showed that RAS is effective in improving the gait ability in those with other neurological disorders, we propose that RAS is also effective in those with TBI and SCI. The aim was to test our hypothesis. Two pilot studies were included. In the first study, eight individuals with TBI participated in RAS experimental 1. Besides, five individuals participated in RAS experimental 2. In the second study, seventeen individuals with incomplete SCI participated RAS intervention. The included studies reported beneficial effects of RAS on gait ability in TBI and SCI population. Specifically, in the walking pattern aspect post-TBI, the cadence post thoracic incomplete SCI, besides, velocity and stride length post cervical incomplete SCI. Despite no confirmed conclusion that can be drawn, the initial findings of the existing evidence on the influences of RAS on gait ability in individuals with TBI and SCI are promising. Special attention should be given by researchers to conduct more researches on this topic to confirm using this approach in clinical practice in the future. (C) 2019 Elsevier Ltd. All rights reserved

Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review

Context: Spasticity is one of the most common secondary impairment after spinal cord injury (SCI). It can lead to an increase in the level of disability. The functional electrical stimulation cycling (FES-cycling) promotes recovery in patients with SCI. No systematic review has been published examining the influence of FES-cycling on the spasticity of lower extremities post-SCI. Objective: This review aimed to investigate the effects of the FES-cycling on the lower extremities spasticity in patients with SCI. Methods: PubMed, Scopus, PEDro, REHABDATA, Web of Science, and MEDLINE were searched until December 2019. The methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Results: Ten studies were met the inclusion criteria. Two were randomized clinical trials, cohort study (n = 2), and pilot study (n=6). The scores on the PEDro scale ranged from one to nine, with a median score of three. The results showed evidence for the beneficial effects of FES-cycling on the spasticity of lower extremities in individuals with SCI. Conclusion: The FES-cycling intervention may reduce the lower extremities spasticity in patients with various injury levels of SCI. It is not a suitable intervention for medically unstable patients or with contraindication for lower extremities movement. Further randomized controlled trials with a large sample size strongly warranted to confirm our findings

Effects of Whole-Body Vibration on Motor Impairments in Patients With Neurological Disorders A Systematic Review

Objective This systematic review was conducted to examine the effects of whole-body vibration training on motor impairments among patients with neurological disorders and to investigate which the whole-body vibration training parameters induced improvement in motor impairments. Design PubMed, SCOPUS, PEDro, REHABDATA, and Web of Science were searched for randomized controlled trials and pseudo-randomized controlled trials investigated the effect of whole-body vibration on motor impairments in patients with neurological disorders. The methodological quality was rated using the Cochrane Collaboration's tool. Results Twenty studies were included in this systematic review. Four studies included patients with multiple sclerosis, cerebral palsy (n = 2), stroke (n = 9), Parkinson disease (n = 3), spinal cord injuries (n = 1), and spinocerebellar ataxia (n = 1). The results showed different evidence of benefits and nonbenefits for whole-body vibration training in motor impairments outcomes. Conclusions There is weak evidence for a positive effect of short-term whole-body vibration training on spasticity of lower limbs, mobility, balance, and postural control. Besides, positive effect of the long-term effect of whole-body vibration training on mobility in patients with neurological disorders. The optimal whole-body vibration training parameters in treating patients with neurological disorders remain unclear

Role of music therapy in improving cognitive function post-traumatic brain injury: A systematic review.

Cognitive deficits are one of the most prevalent impairments in patients with traumatic brain injury (TBI). Music therapy has the potential to be a valuable intervention for improving cognitive function. This review aimed to investigate the effects of music therapy on cognitive function in patients with TBI. Scopus, PubMed, REHABDATA, PEDro, EMBASE, and web of science were searched for experimental trials examining the impacts of music therapy on cognition in patients with TBI from inception until December 2022. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the included studies. Five studies met the inclusion criteria. A total of 122 patients with TBI were included in this review, 32% of whom were females. The PEDro scores ranged from four to seven, with a median of five. The findings showed that music therapy could be effective in improving executive function post-TBI, with limited evidence for the effects on memory and attention. Music therapy might be safe in patients with TBI. The evidence for the effect of music therapy on executive function in patients with TBI is promising. Further studies with larger sample sizes and long-term follow-ups are strongly needed

Proprioceptive Focal Stimulation (Equistasi®) for gait and postural balance rehabilitation in patients with Parkinson's disease: A systematic review.

Gait and postural deficits are the most common impairments in patients with Parkinson's Disease (PD). These impairments often reduce patients' quality of life. Equistasi® is a wearable proprioceptive stabilizer that converts body thermic energy into mechanical vibration. No systematic reviews have been published investigating the influences of Equistasi® on gait and postural control in patients with PD. This review aimed to examine the effects of proprioceptive focal stimulation (Equistasi®) on gait deficits and postural instability in patients with PD. PubMed, Scopus, PEDro, REHABDATA, web of science, CHAINAL, EMBASE, and MEDLINE were searched from inception to July 2021. The methodological quality of the selected studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Five studies met the eligibility criteria. The scores on the PEDro scale ranged from 3 to 8, with a median score of 8. The results showed evidence for the benefits of the proprioceptive focal stimulation (Equistasi®) on gait and postural stability in individuals with PD. Proprioceptive focal stimulation (Equistasi®) appears to be safe and well-tolerated in patients with PD. Proprioceptive focal stimulation (Equistasi®) may improve gait ability and postural stability in patients with PD. Further high-quality studies with long-term follow-ups are strongly needed to clarify the long-term effects of proprioceptive focal stimulation (Equistasi®) in patients with PD

Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology

Background: Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes.Objectives: The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI.Methods: PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized.Results: Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training.Conclusion: Using different VR tools with following treatment protocol; 10-12 sessions, 20-40 min in duration with 2-4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI. (C) 2019 Elsevier Ltd. All rights reserved

Effectiveness of virtual reality on balance ability in individuals with incomplete spinal cord injury: A systematic review

Background: Balance dysfunctions are one of the most prevalent impairments post incomplete spinal cord injury (SCI). The evidence has proposed that the rehabilitation can be efficacious in treating balance dysfunctions in patients with SCI. Virtual reality (VR) is a computer technology designate 3-D setting which provides immersed users to generate numerous feedbacks such as visual, audio, and haptic.Objective: To investigate the effects of VR on balance ability in individuals with incomplete SCI and to identify efficient training protocol.Methods: We searched in SCOPUS, PEDro, PUBMED, REHABDATA, EMBASE, and web of science for experimental trials studying impacts of VR training on balance in patients with incomplete SCI that published in English. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality for selected studies.Results: Five pilot studies were met the inclusion criteria. The PEDro scores ranged from 2 to 3, with a median of 2. All selected studies enrolled less than 20 patients. The findings showed beneficial effects of VR in improving balance ability in patients with incomplete SCI.Conclusions: The preliminary findings showed that the influence of VR training on the balance ability in patients with incomplete SCI is promising. Applying 12 to 20 sessions of 30 to 60 min of VR training may show meaningful effects. Further randomized controlled trials strongly needed. (C) 2020 Elsevier Ltd. All rights reserved