Effectiveness of Treadmill Training on Walking Ability in Adults with Cerebral Palsy: A Systematic Review and Meta-Analysis

Background: Patients with cerebral palsy (CP) may necessitate long-term treatment and monitoring of their condition, not only during the period of development but also during adulthood. Objectives: This systematic review aimed to analyze evidence from randomized controlled trials (RCTs) that have investigated the effect of treadmill training on walking ability in adults with cerebral palsy. Methods: RCTs were identified and selected systematically, with appropriate keywords applied in four scientific databases (Medline, Scopus, the Cochrane Library, and the Physiotherapy Evidence Database) and one bibliographic search engine (Google Scholar) from January 1980 to September 2021. Two assessors extracted and analyzed data from relevant RCTs published in English and then independently rated those studies for risk of bias with the Risk of Bias (RoB 2) tool. Results: Out of the 96 studies that were initially identified, 93 were excluded, as these either did not meet the inclusion criteria or were duplicates. Three clinical trials were finally included, characterized by some concerns and a high risk of bias (RoB 2). Meta-analysis was only performed for the maximum distance in the ‘6-minute walk for distance test’, due to differences in the remaining outcomes utilized between studies. Overall, there was evidence of some concerns and high risk of bias that treadmill training did not significantly improve the walking ability in adult patients with CP relative to the control conditions. Conclusion: More high-quality RCTs are required, examining the effectiveness of treadmill training on different aspects of walking ability such as gait speed, endurance, and energy expenditure

The Effect of Virtual Reality Intervention Programs on the Functionality of Children and Adolescents with Cerebral Palsy. A Systematic Review

Background: Cerebral Palsy (CP) is a neurological disorder of movement and posture. Recent studies have shown that Virtual Reality (VR) is a useful and low-cost tool used in treating children and adolescents with cerebral palsy. Nevertheless, there is no substantial evidence supporting that VR therapy can help CP patients, not only as the primary treatment, but as a supplement. Objectives: The present systematic review aimed to investigate the effectiveness of VR intervention programs on the functional capacity of children and adolescents with CP, according to the International Classification of Functioning, Disability and Health (ICF). Methods: A systematic online search was conducted in PubMed, Scopus, and PEDro databases, as well as in the Google Scholar search engine, from inception till September 2022. The methodological quality of included studies was rated with the PEDro scale. Results: Twenty-two randomized-controlled trials were eligible for inclusion. The results indicated that there was a significant improvement after the implementation, of interventional VR programs, in balance and visual perception, while the results were controversial for muscle strength, coordination, gross motor function, gait, upper limb function, independence in activities of Daily Life Activities and participation. Conclusion: Significant balance and visual perception improvements may result from VR programs applied in children and adolescents with CP. Important factors that may influence the results are the functional level of the participants, the sample size, the context in which the therapeutic intervention is carried out (rehabilitation center, home), and the conventional treatments that the VR intervention programs are compared against

The effects of sensory inputs and hyperventilation on postural stability in man

The studies involved in this thesis were undertaken to investigate postural stability during auditory and visual stimuli and assess the effect of hyperventilation (HV) on postural mechanisms. Recording techniques included a force platform and an electro-magnetic head motion recorder (for body sway measurements), transcutaneous carbon dioxide tension measurements, surface electromyography and electro-oculography. The research strategy involved establishing relationships between the physical characteristics (frequency, intensity, direction) of the stimuli used (eg visual, proprioceptive) and the physical characteristics of the sway pattern elicited (amplitude, velocity and direction). HYPERVENTILATION EXPERIMENTS: Initially postural instability after voluntary HV was documented. The HV effects were more intense with eyes closed. HV preferentially increased low frequency oscillations, and this effect was present both in healthy and labyrinthine defective subjects. Additional experiments were undertaken in order to clarify by which mechanisms HV can interfere with balance control. Neurophysiological studies showed that the electrically evoked sural nerve action potential increased its amplitude whereas the scalp somatosensory evoked potentials decreased during HV. In contrast, no significant effects of HV on short-latency vestibulo-spinal responses were detected (click-evoked vestibulo-colic EMG response). The hypothesis that the vestibulo-cerebellum might also be affected by HV was also investigated by recording ocular-motor functions mediated by this neural structure (vestibulo-ocular reflex suppression and smooth pursuit eye movements). Ocular performance, however, was unchanged by HV. VISUAL MOTION EXPERIMENTS: The question investigated was if the main direction of a visually evoked postural response can be re-oriented as a function of eye-in-orbit and head-on-trunk position. The visual motion stimulus used consisted of a large disc rotating around the line of sight. Subjects viewed the rotating disc with various combinations of eye and neck deviations. It was found that the plane of motion of the visual stimulus with respect to the body modulated the direction of postural reactions. The findings indicate that signals of the eye-in-orbit and head-on-trunk position are used in the visual control of postural sway. It is argued that these signals are of proprioceptive origin. AUDITORY EXPERIMENTS: Changes in postural stability during sounds of different frequency and intensity were examined with and without visual input. It was shown that increased loudness tended to increase lateral sway; sound frequency influenced anterior- posterior sway. Vision had a significant stabilising effect on most sway parameters. The work undertaken for this thesis has 1) identified a potential role for eye and neck proprioceptors in visuo-postural control, 2) described postural sway under different sound characteristics, 3) shown that HV decreases postural stability and 4) that the effects of HV on balance control are selective, i.e., certain postural mechanisms are affected by HV whereas others not

The Effect of Physiotherapy Interventions in the Workplace through Active Micro-Break Activities for Employees with Standing and Sedentary Work

Workers worldwide experience a range of occupational musculoskeletal disorders that affect both the functionality of many parts of their body and their overall performance. Physiotherapists provide counseling and treatment programs during work. Recently, physiotherapy interventions have been introduced during work breaks. This study aimed to investigate the value of different types of workplace-based exercise programs administered during work breaks and compare them with counseling methods. Electronic searches were performed in relevant databases by keywords such as: workplace, musculoskeletal disorders, sedentary, standing, employees, micro-breaks, exercise interventions, and ergonomics. Initially, 706 articles were identified. An article sorting procedure was employed by two independent researchers, based on the inclusion and exclusion criteria set for this study, and after the removal of non-relevant articles (n = 391) or duplicates (n = 300), 15 randomized controlled trials (RCTs) remained for qualitative analysis. The methodological quality of the 13 RCTs was performed using the PEDro scale. No risk of bias evaluation was made. The findings suggested that active micro-breaks that contained various exercise programs including stretching, strengthening, torso stabilization, and ergonomic interventions were more beneficial than passive micro-breaks, reducing pain and the feeling of fatigue and increasing employees’ mood. It is concluded that micro-breaks are beneficial to employees with either orthostatic or sedentary work

Gait Kinetic and Kinematic Changes in Chronic Low Back Pain Patients and the Effect of Manual Therapy: A Randomized Controlled Trial

Patients with chronic back pain as a result of degenerated disc disease, besides pain, also present with impaired gait. The purpose of the article was to evaluate kinetic and kinematic characteristics during gait analysis in patients with chronic low back pain as a result of degenerated disc disease, before and after the application of physiotherapy, including manual therapy techniques. Seventy-five patients suffering from chronic low back pain were randomly divided into 3 groups of 25 each. Each group received five sessions (one per week) of interventions with the first group receiving manual therapy treatment, the second a sham treatment and the third, classic physiotherapy (stretching exercises, TENS and massage). The effectiveness of each treatment was evaluated using an optoelectronic system for recording and analysis of gait (kinetic and kinematic data). Patients overall showed an impaired gait pattern with a difference in kinetic and kinematic data between the left and the right side. Following the application of the above-named interventions, only the group that received manual therapy showed a tendency towards symmetry between the right and left side. In patients suffering from chronic low back pain as a result of degenerated disc disease, the application of five manual therapy sessions seems to produce a tendency towards symmetry in gait

Gait Kinetic and Kinematic Changes in Chronic Low Back Pain Patients and the Effect of Manual Therapy: A Randomized Controlled Trial

Patients with chronic back pain as a result of degenerated disc disease, besides pain, also present with impaired gait. The purpose of the article was to evaluate kinetic and kinematic characteristics during gait analysis in patients with chronic low back pain as a result of degenerated disc disease, before and after the application of physiotherapy, including manual therapy techniques. Seventy-five patients suffering from chronic low back pain were randomly divided into 3 groups of 25 each. Each group received five sessions (one per week) of interventions with the first group receiving manual therapy treatment, the second a sham treatment and the third, classic physiotherapy (stretching exercises, TENS and massage). The effectiveness of each treatment was evaluated using an optoelectronic system for recording and analysis of gait (kinetic and kinematic data). Patients overall showed an impaired gait pattern with a difference in kinetic and kinematic data between the left and the right side. Following the application of the above-named interventions, only the group that received manual therapy showed a tendency towards symmetry between the right and left side. In patients suffering from chronic low back pain as a result of degenerated disc disease, the application of five manual therapy sessions seems to produce a tendency towards symmetry in gait