Alteration in corticospinal excitability, talocrural joint range of motion, and lower extremity function following manipulation in non-disabled individuals

Background: Clinical outcomes of manual therapy procedures, including manipulation, have been studied. However, mechanisms underlying observed improvements remain unclear. Objective: To determine the effect of ankle joint manipulation on corticospinal excitability, ankle dorsiflexion range of motion (DF ROM), and lower extremity functional behavior in nondisabled individuals. Method: Six nondisabled individuals (age range: 31-50 years) received the main outcomes measurements of this study, before and after long axis distraction manipulation of the talocrural joint. Main outcomes measures were motor evoked potential (MEP) amplitude of gastrocnemius (GN) and tibialis anterior (TA) using transcranial magnetic stimulation, ankle DF ROM with the knee flexed and extended using standard goniometric techniques, and unilateral anterior squat reach (ASR) distance. All subjects received the main outcomes measures. Results: Significant increase in GN MEP amplitude (P \u3c .05), but not TA MEP amplitude, were documented following intervention. Significant improvements also were noted in ankle DF ROM with knee extended and flexed (P \u3c .001) and ASR distance (P \u3c .05) Significant correlations were found between standardized change in GN MEP amplitude and ankle dorsiflexion with knee flexed (ρ = .582, ρ 2 = .339, P \u3c .01), and standardized changes in GN MEP amplitude and ASR distance (ρ = .601, ρ 2 = .361, P \u3c .01). Conclusions: Increased corticospinal excitability appears to mediate improvements in ankle DF ROM and lower extremity function following long axis distraction manipulation 1 Assistant Professor, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, to the talocrural joint in nondisabled individuals. These results establish comparative values with which to compare the corticospinal responses to manual therapy intervention in individuals with pathology. INTRODUCTION Ankle sprains are the most common injury to the ankle joint, affecting up to 2 million people and approximately 53 per 10,000 individuals per year. 1,2 Ankle sprains are common in younger and active individuals. 3-8 Certain sports and work activities may result in an even higher incidence and risk for injury. 9-15 Ankle sprains are a clinically important problem because they result in a substantial number of missed work days 8 and participation in sports activity, 3,5 as well as lead to potential early arthritic changes in the talocrural joint. 16 The prognosis for functional recovery following ankle sprain typically includes a rapid clinical improvement within the first two weeks after injury. 17 However, a series of recent studies indicate a subgroup of individuals appears predisposed to continued pain, functional deficits, and prolonged risk for additional reinjury between 6 weeks and 3 years post injury. 17-25 The prolonged disability associated with ankle sprains represents the possibility of increased direct and indirect health care costs associated with ankle sprains, and may be reduced through identification of optimal approaches to clinical management. One reason for continued pain and elevated risk for reinjury may be limited ankle joint mobility, which may occur as either a cause or consequence of ankle sprain. Limited ankle dorsiflexion has been documented as a major short-term sequel to ankle sprain. 26,27 In addition, several studies have identified limited talocrural joint dorsiflexion range of motion (DF ROM) as an important predisposing factor to ankle sprains. 28-30 Limited ankle DF ROM will position the talocrural joint in plantar flexion during weight bearing activities. This position is notable because the most common mechanism of injury for ankle sprains involves plantar flex-ion and inversion of the ankle and foot. The injury mechanism places excessive load on the anterior talofibular ligament (ATFL). With failure of ATFL, secondary restraint to inversion occurs by way of the calcaneo-fibular and posterior talofibular ligaments, placing them at similar risk for injury. Thus, limited ankle DF ROM may result in injury and consequent structural and functional compromise of the ankle lateral collateral ligaments. Physical therapists use mobilization and manipulation to improve ankle DF ROM following ankle sprains. Despite the intuitive appeal of applying these procedures to promote parallel improvements in talocrural DF ROM and functioning in individuals following ankle sprains, this notion has been the focus of relatively few prospective studies. 31 Pellow and Brantingham 32 were among the first to report reduced pain and improved function in individuals with ankle sprains receiving an ankle mortise distraction technique. Whitman and colleagues 33 reported rapid functional improvement after talocrural manipulation in a competitive volleyball player with a mild unilateral

Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults

Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults

Impaired standing balance in individuals with cervicogenic headache and migraine

Aims: To determine whether a difference in standing balance exists among individuals with cervicogenic headache, those with migraine, and asymptomatic controls. Methods: A total of 24 participants with cervicogenic headache, 24 with migraine, and 24 asymptomatic controls of similar age, gender, and body mass index were included. Standing balance was assessed with a swaymeter under the conditions of eyes open and closed; on firm and soft surfaces; and in comfortable and narrow stances (for a total of eight testing conditions). Each condition was tested for 30 seconds. The outcome measures were sway area and displacement. Multivariate analysis of variance with Bonferroni post hoc test were used to analyze between-group differences in the postural sway variables. Results: Both headache groups had significantly larger sway areas than the control group during comfortable stance with eyes open and with eyes closed on a soft surface (P < .05) and during narrow stance with eyes closed on firm and soft surfaces (P < .05). The overall results demonstrated significantly greater sway in the anterior-posterior direction and less sway in the medial-lateral direction in selected tests in the cervicogenic headache group compared to the migraine group. Conclusion: Individuals with cervicogenic headache and those with migraine have impaired balance during standing, but possibly to a different extent and pattern. Assessment of balance in patients with cervicogenic headache and migraine should be considered in clinical practice

Physical Frailty and Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study

Introduction. Frailty is a condition in older adults with decreased physical and cognitive performance that can affect health outcomes associated with fracture, disability, and falls. The aim of this study was to compare fall risk with different physical frailty statuses and investigate factors associated with fall risk in community-dwelling older adults. Methods. The population studied included 367 older adults (mean age = 73.2 years ± 7.0; 237 females (64.6%) and 130 males (35.4%)) who live in Chiang Mai, Thailand. This study was of cross-sectional design. Fried’s phenotype was used to screen the physical frailty status. The physiological profile assessment (PPA) was used to screen for fall risk. One-way ANOVA analysis was used to compare the fall risk between the different levels of frailty status. Linear regression analysis was used to assess the association between frailty status and fall risk. Results. The prevalence of the frailty group was 8.7% and that of the prefrailty group was 76.8%. The three statuses of frailty identified were found to have different levels of risk of falling. The frailty group had a higher fall risk than the nonfrailty group and the prefrailty group. In addition, the nonfrailty group had a lower fall risk than the prefrailty group. Conclusion. The frailty group had the highest fall risk in this cohort of older adults living in a community-dwelling facility. Therefore, it is important to assess the frailty status among older adults as it can be a predictor for fall risk. This assessment will therefore lead to a reduction in the rate of disability and death in the community

The influence of neck pain on sensorimotor function in the elderly

Greater disturbances in sensorimotor control have been demonstrated in younger to middle aged groups. However, it is unknown whether or not the impairments documented in these populations can be extrapolated to elders with neck pain. The aim of this study was to investigate the influence of neck pain on sensorimotor function in elders. Twenty elders with neck pain (12 women and 8 men) and 20 healthy elder controls (14 women and 6 men) aged 65 years and over were recruited from the general community. Tests for sensorimotor function included; cervical joint position sense (JPS); computerised rod-and-frame test (RFT); smooth pursuit neck torsion test (SPNT); standing balance (under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable stance); step test and ten-meter walk test with and without head movement. Elders with neck pain had greater deficits in the majority of sensorimotor function tests after controlling for effects of age and comorbidities. Significant differences were found in the SPNT (p < 0.01), error in the RFT (frame angled at 10 degrees and 15 degrees anticlockwise) (p < 0.05), standing balance (amplitude of sway) - eyes open on a firm surface in the medio-lateral (ML) direction (p = 0.03), and total number of steps on the step test, both left and right sides (p < 0.01). Elders with neck pain have greater sensorimotor disturbances than elders without neck pain, supporting a contribution of altered afferent information originating from the cervical spine to such disturbances. The findings may inform falls prevention and management programs. (C) 2012 Elsevier Ireland Ltd. All rights reserved

An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study

BackgroundDeclines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. ObjectiveThe aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. MethodsIn the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants’ characteristics and PACES scores. ResultsThe results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. ConclusionsThese findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined

Effects of tandem walk and cognitive and motor dual- tasks on gait speed in individuals with chronic idiopathic neck pain: a preliminary study

Introduction: Gait impairment has been associated with neck pain. It is relevant to understand the possible influence of narrow-based walk and an attention-demanding secondary task on gait performance in neck pain. Purpose: To investigate the effects of tandem walk and cognitive and motor dual-tasks on gait speed in persons with chronic idiopathic neck pain (CINP) compared with controls. Methods: A cross-sectional study. Thirty participants with CINP and 30 asymptomatic controls participated in the study. Gait speed was assessed using a timed 10-m walk test at a comfortable pace under four conditions: (1) comfortable walk (as reference); (2) tandem walk (single task); (3) cognitive dual-task walking; and (4) motor dual-task walking. Dual-task interference was calculated. Results: There was no difference in comfortable gait speed between groups (p= 0.40). The CINP group had slower gait speed during the tandem walk than controls (p= 0.02). The dual-task interference on gait speed was not different between groups (p = 0.67 for cognitive, p = 0.93 for motor). Conclusion: Participants with CINP had impaired gait stability during tandem walk. An attention-demanding secondary task did not influence gait speed in individuals with CINP compared to controls. The study suggests that tandem walk could be considered as an assessment tool and part of rehabilitation for neck pain

Multi-System Physical Exercise Intervention for Fall Prevention and Quality of Life in Pre-Frail Older Adults: A Randomized Controlled Trial

Effective interventions for indicated fall prevention are necessary for older adults with frailty. We aimed to determine the effectiveness of a Multi-system Physical Exercise (MPE) for fall prevention and Health-Related Quality of Life (HRQOL) in pre-frail older adults. This randomized control trial with allocation concealment included 72 adults aged 65 and above, identified as pre-frailty and with mild and moderate fall risk scores measured by the Physiological Profile Assessment (PPA). Randomly, using block randomization, participants were divided into two groups: an MPE group (n = 36) and a control group (n = 36). The intervention consisted mainly of proprioception, muscle strengthening, reaction time, and balance training and was carried out three days per week for 12 weeks. The primary outcome was fall risk assessed using PPA at 12 weeks post-baseline and at a 24 week follow-up. Significant differences were found in the improvement in fall risk, proprioception, muscle strength, reaction time and postural sway, and fear of fall scores in the MPE group compared with controls at week 12 and 24. In addition, HRQOL had increased significantly in the MPE group in comparison to controls. The MPE program significantly increased muscle strength and improved proprioception, reaction time, and postural sway leading to fall risk reduction in older adults with pre-frailty. Therefore, the MPE program is recommended for used in day-to-day primary care practice in the pre-frail population

Cognitive Benefits of Physical Exercise, Physical&ndash;Cognitive Training, and Technology-Based Intervention in Obese Individuals with and without Postmenopausal Condition: A Narrative Review

Obesity and estrogen deprivation have been identified as significant risk factors for cognitive impairment. Thus, postmenopausal conditions when paired with obesity may amplify the risks of developing dementia. Physical exercise has been recommended as a primary treatment for preventing obesity-related comorbidities and alleviating menopausal symptoms. This narrative review aimed to summarize the effects of exercise on cognition in obese individuals with and without menopausal condition, along with potential physiological mechanisms linking these interventions to cognitive improvement. Research evidence has demonstrated that exercise benefits not only physical but also cognitive and brain health. Among various types of exercise, recent studies have suggested that combined physical&ndash;cognitive exercise may exert larger gains in cognitive benefits than physical or cognitive exercise alone. Despite the scarcity of studies investigating the effects of physical and combined physical&ndash;cognitive exercise in obese individuals, especially those with menopausal condition, existing evidence has shown promising findings. Applying these exercises through technology-based interventions may be a viable approach to increase accessibility and adherence to the intervention. More evidence from randomized clinical trials with large samples and rigorous methodology is required. Further, investigations of biochemical and physiological outcomes along with behavioral changes will provide insight into underlying mechanisms linking these interventions to cognitive improvement