IPod-based in-home system for monitoring gaze-stabilization exercise compliance of individuals with vestibular hypofunction

Background: In the physical therapy setting, physical therapists (PTs) often prescribe exercises for their clients to perform at home. However, it is difficult for PTs to obtain information about their clients' compliance with the prescribed exercises, the quality of performance and symptom magnitude. We present an iPod-based system for capturing this information from individuals with vestibular hypofunction while they perform gaze stabilization exercises at home. Method. The system's accuracy for measurement of rotational velocity against an independent motion tracker was validated. Then a seven day in-home trial was conducted with 10 individuals to assess the feasibility of implementing the system. Compliance was measured by comparing the recorded frequency and duration of the exercises with the exercise prescription. The velocity and range of motion of head movements was recorded in the pitch and yaw planes. The system also recorded dizziness severity before and after each exercise was performed. Each patient was interviewed briefly after the trial to ascertain ease of use. In addition, an interview was performed with PTs in order to assess how the information would be utilized. Results: The correlation of the velocity measurements between the iPod-based system and the motion tracker was 0.99. Half of the subjects were under-compliant with the prescribed exercises. The average head velocity during performance was 140 deg/s in the yaw plane and 101 deg/s in the pitch plane. Conclusions: The iPod-based system was able to be used in-home. Interviews with PTs suggest that the quantitative data from the system will be valuable for assisting PTs in understanding exercise performance of patients, documenting progress, making treatment decisions, and communicating patient status to other PTs. © 2014 Huang et al.; licensee BioMed Central Ltd

Backward walking training improves balance in school-aged boys

<p>Abstract</p> <p>Background</p> <p>Falls remain a major cause of childhood morbidity and mortality. It is suggested that backward walking (BW) may offer some benefits especially in balance and motor control ability beyond those experienced through forward walking (FW), and may be a potential intervention for prevention of falls. The objective of this study was to investigate the effects of BW on balance in boys.</p> <p>Methods</p> <p>Sixteen healthy boys (age: 7.19 ± 0.40 y) were randomly assigned to either an experimental or a control group. The experimental group participated in a BW training program (12-week, 2 times weekly, and 25-min each time) but not the control group. Both groups had five dynamic balance assessments with a Biodex Stability System (anterior/posterior, medial/lateral, and overall balance index) before, during and after the training (week- 0, 4, 8, 12, 24). Six control and six experimental boys participated in a study comparing kinematics of lower limbs between FW and BW after the training (week-12).</p> <p>Results</p> <p>The balance of experimental group was better than that of control group after 8 weeks of training (<it>P </it>< 0.01), and was still better than that of control group (<it>P </it>< 0.05), when the BW training program had finished for 12 weeks. The kinematic analysis indicated that there was no difference between control and experimental groups in the kinematics of both FW and BW gaits after the BW training (<it>P </it>> 0.05). Compared to FW, the duration of stance phase of BW tended to be longer, while the swing phase, stride length, walking speed, and moving ranges of the thigh, calf and foot of BW decreased (<it>P </it>< 0.01).</p> <p>Conclusion</p> <p>Backward walking training in school-aged boys can improve balance.</p

Dynamic Exertion Testing (EXiT): An Assessment to Inform to Return to Play/Activity following Sport-related Concussion

BACKGROUND: Recently developed dynamic exertion testing (EXiT) incorporates a combination of treadmill running, functional movements, and agility tasks to inform return to play and activity (RTP/A) decision making following sport-related concussion. The identification of an assessment’s stability on repeated assessments, inter-rater agreement, minimal detectable change (MDC), and examination of age, sex, body mass index (BMI), and sport-type are necessary to interpret EXiT. Additionally, previously injured athletes upon medical clearance to RTP/A should have similar physiological, performance, and clinical outcomes on EXiT as healthy athletes, including heart rate variability (HRV) responses to EXiT as a proxy of autonomic nervous system functioning. PURPOSE: The aims of the current investigation included the following: Aim 1) Establish intra-rater, test-retest and inter-rater reliability for EXiT physiological (age estimated percentage of maximum heart rate (HR %max)) and blood pressure (BP)), performance (agility task completion time and errors), and clinical (endorsed symptoms and rating of perceived exertion (RPE)) outcomes. Aim 2) Compare age, sex, BMI, and sport-type subgroups across EXiT physiological, performance, and clinical outcomes among a heterogeneous physically active sample. Aim 3) Determine concurrent validity of EXiT by comparing physiological, performance, and clinical EXiT outcomes and ultrashort heart rate variability responses to EXiT between athletes at medical clearance to RTP/A from SRC with healthy controls. METHODS: Aim 1) From a total sample of 92 healthy physically active adolescents and adults, 79 (F:34, 43%) completed a demographic questionnaire, weight and height measurements for BMI ([BMI]= weight [kg]/height[m]2), and the EXiT across 2 visits (8.7±4.7 days apart). EXiT included an aerobic component: 12- min treadmill run; and dynamic component: dynamic circuit, ball toss, box-drill shuffle and carioca, zig zag, pro agility, and arrow agility tasks. A 2nd rater separately assessed agility task completion time and errors for 15 healthy participants and 15 athletes upon medical clearance to RTP/A. Two-way, mixed, intra-class correlation coefficients were used to evaluate agility task completion time between consecutive trials (intra-rater reliability), fastest trial across visits (test-retest reliability), and agreement between raters (inter-rater reliability). Paired samples t-tests were used for HR %max and agility task completion time, and Wilcoxon tests were used for endorsed symptoms, RPE, and errors. Internal consistency of symptoms at each visit was determined with Cronbach’s alpha, and MDC of EXiT outcomes were calculated using the equation: MDC= standard deviation x √((1-ICC) ) • 1.96 • √(2 ). Aim 2) 87 (F= 55, 37.4%; 19.5 ± 4.4 years) participants (from aim 1) were categorized in adolescent (14- 17 years) or adult (≥18 years), male or female (self-report), LO-BMI (BMI < 50th percentile) or HI-BMI (BMI ≥50th percentile), and collision, contact, or non-contact sport-types. Independent samples t-tests were conducted for HR %max, BP, and agility task completion time, and Mann-Whitney U tests for RPE, endorsed symptoms, and errors between age, sex, and BMI groups across aerobic and dynamic components. A series of 1-way ANOVAs were conducted to compare HR %max, BP, and agility task completion time, and Kruskal Wallis- H tests to compare RPE, symptoms, and committed errors between collision, contact, and non-contact sport-types. Aim 3) A sample of 46 healthy athletes including 23 (F= 10, 43.5%) healthy control (from aim 1; CONTROL) and age-, sex-, and sport- matched to patients completing EXiT at medical clearance to RTP/A (CONCUSS) completed a 5-minute seated rest period prior to and following EXiT. The final 3-min were used to calculate ultrashort HRV outcomes, including the root-mean-square of successive differences (RMSSD) and standard deviation of successive heart beats (SDNN). Independent samples t-tests were conducted to compare CONTROL and CONCUSS groups for HR %max, BP, and agility task completion time, and Mann-Whitney U tests were utilized for endorsed symptoms, RPE, committed errors. A series of 2X2 (GROUP X TIME) mixed model ANOVAs were conducted to compare CONCUSS and CONTROL groups on RMSSD and SDNN outcomes across time points (pre- and post-EXiT rest periods). RESULTS: Aim 1) Pre- and post-EXiT resting HR %max and BP, and HR %max were reliable throughout aerobic and dynamic components (ICC=.696-.838). Symptoms and RPE were similar across visits but less errors were committed at the 2nd visit. Agility task completion time (MDC range=0.75-8.70 seconds) had good to excellent test-retest (ICC=.703-.948) and inter-rater reliability (ICC=.932-.965), but ratings of committed errors have acceptable agreement for committed errors for only the ball toss and pro agility tasks. Endorsed symptoms had a high internal consistency at both visits (α =.805-.894) and were reliable across visits during aerobic (ICC=.765) and dynamic components (ICC .519) were reliable across visits. Aim 2) Adolescents were faster than adults on arrow agility (p=.01); males were faster than females on box drill carioca (p=.01), zig zag (p.05). Aim 3) The CONCUSS group had group had lower (faster) completion time during zig zag p=0.048 and pro agility p=0.018) tasks and had lower (less variable) SDNN (F=4.569, p=.047, Ƞ_p^2=. 212) and RMSSD (F=4.517, p=.049, Ƞ_p^2=.=.209) than CONTROL group. CONCUSS and CONTROL groups had similar HR %max, total endorsed symptoms, and RPE (p>.05). CONCLUSION: EXiT physiological, performance, and clinical outcomes are reliable, and generalizable to physically active population of varied age, sex, BMI, and sport-type factors. The multiple objective outcomes of EXiT present a new evidence-based approach to inform clinical recovery from SRC and RTP/A decision making