Biofeedback for training balance and mobility tasks in older populations: a systematic review

<p>Abstract</p> <p>Context</p> <p>An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity.</p> <p>Objective</p> <p>To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults.</p> <p>Data Sources</p> <p>PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists.</p> <p>Study Selection</p> <p>For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task.</p> <p>Data Extraction</p> <p>Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated.</p> <p>Results and Conclusions</p> <p>Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery.</p> <p>Implications</p> <p>Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.</p

Adaptive robot training for the treatment of incoordination in Multiple Sclerosis

<p>Abstract</p> <p>Background</p> <p>Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) subjects. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects.</p> <p>Methods</p> <p>Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects' impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting of two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-weeks rest period. The order of application of ER and EE exercises was randomized across subjects. The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes.</p> <p>Results</p> <p>Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24% decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions.</p> <p>Conclusions</p> <p>The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.</p

Big issues for small feet : developmental, biomechanical and clinical narratives on children's footwear

The effects of footwear on the development of children's feet has been debated for many years and recent work from the developmental and biomechanical literature has challenged long-held views about footwear and the impact on foot development. This narrative review draws upon existing studies from developmental, biomechanical and clinical literature to explore the effects of footwear on the development of the foot. The emerging findings from this support the need for progress in [children's] footwear science and advance understanding of the interaction between the foot and shoe. Ensuring clear and credible messages inform practice requires a progressive evidence base but this remains big issue in children's footwear research

Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review

Background Several types of cognitive or combined cognitive-motor intervention types that might influence physical functions have been proposed in the past: training of dual-tasking abilities, and improving cognitive function through behavioral interventions or the use of computer games. The objective of this systematic review was to examine the literature regarding the use of cognitive and cognitive-motor interventions to improve physical functioning in older adults or people with neurological impairments that are similar to cognitive impairments seen in aging. The aim was to identify potentially promising methods that might be used in future intervention type studies for older adults. Methods A systematic search was conducted for the Medline/Premedline, PsycINFO, CINAHL and EMBASE databases. The search was focused on older adults over the age of 65. To increase the number of articles for review, we also included those discussing adult patients with neurological impairments due to trauma, as these cognitive impairments are similar to those seen in the aging population. The search was restricted to English, German and French language literature without any limitation of publication date or restriction by study design. Cognitive or cognitive-motor interventions were defined as dual-tasking, virtual reality exercise, cognitive exercise, or a combination of these. Results 28 articles met our inclusion criteria. Three articles used an isolated cognitive rehabilitation intervention, seven articles used a dual-task intervention and 19 applied a computerized intervention. There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively. The majority of the included studies resulted in improvements of the assessed functional outcome measures. Conclusions The current evidence on the effectiveness of cognitive or motor-cognitive interventions to improve physical functioning in older adults or people with neurological impairments is limited. The heterogeneity of the studies published so far does not allow defining the training methodology with the greatest effectiveness. This review nevertheless provides important foundational information in order to encourage further development of novel cognitive or cognitive-motor interventions, preferably with a randomized control design. Future research that aims to examine the relation between improvements in cognitive skills and the translation to better performance on selected physical tasks should explicitly take the relation between the cognitive and physical skills into account.ISSN:1471-231

The influence of a rythmical-motor activity program on the development of fundamental motor skills in pre-school children

The purpose of the present study was to examine the influence of a rhythmical-motor education program on the development of fundamental motor skills in pre-school children. Twenty-two female children between the ages of 4 and 6 years were selected to participate in the study. Twelve of them were randomly assigned to the experimental group which received musical-rhythmical activity classes for a period of 8 weeks while the rest of the children (n = 10) formed the control group which simply followed the kindergarten program. After implementation of the 8-week program, both groups were tested on 8 fundamental motor skills (body awareness, moving and stationary balance, body roll, vertical jump, skip, run and kicking) using the Motor Skills Inventory for assessing motor development (Werber & Bruininks, 1988). The results revealed that the rhythmical activity group was classified in more advanced levels of the developmental scale suggested by the MSI in four of the eight skills examined and this superiority was confirmed by the statistical analysis. The findings of the present study suggest that a rhythmical-motor activity program could provide the ideal setting for pre-school children to develop the basic motor skills that are required for their successful future performance in sports skills

Rhythm or music? Contrasting two types of auditory stimuli in the performance of a dancing routine

The purpose of the present study was to investigate whether rhythmic beats only or music would be more effective as accompaniment for the motor performance of specific rhythmic-dance steps by 30 female Students of physical education (M age 20.1 yr.), without prior experience in music or dance. They performed a dance routine in synchronization with a Musical phrase of eight rhythmical meters, with the general value of 4/4 each. Each meter involved representative steps of the rhythmical values of 4/4, 1/4, 1/8, and 1/16 like rhythmical walking, Small kicks, galloping, chasse, cat leap, and different ways of balancing. Subjects performed these in synchronization to the rhythm played on a tambourine or to music played on an harmonium. All movement performances were registered using two video cameras. Differences between the two groups ("rhythm" and "music") and across the different meters (4/4, 1/8, 1/8, 1/16, 1/4) were analyzed by a mixed between-within Subjects 2 X 3 analysis of variance with repeated measures of "meter." Students who performed with the tambourine showed better synchrony with that external auditory stimulus than students who performed the same routine guided by music played on the harmonium. Also, students showed better synchrony with the external rhythm when performing a whole (4/4 meter) than when performing either the 1/8 or the mixed 1/8-1/16-1/4 meters. These findings suggest that for highly complex artistic movements Such as the ones involved in dance, beginners perform much better when their movements are guided by a rhythmical sequence of single beats than when guided by a musical phrase having identical metrical structure

The effect of visual and kinesthetic feedback on the performance of a static balance task in rhythmic gymnastics

The purpose of this study was to examine the role of kinesthetic or visual plus kinesthetic feedback in the performance of a complex static balance in rhythmic gymnastics. Thirty-six female P.E. students between the ages of 19-21 years old (M = 20.7), performed a dynamic balance task requiring standing on the right leg while the left leg was extended in the lateral plane forming a 90degrees angle to the body ("balance a la second with passe developpe"). Participants were divided in two practice groups. The first group practiced the skill facing a white wall while the second group practiced the skill facing a mirror. Performance was evaluated by two independent observers under the same sensory conditions: a) just after the practice phase (post-test) and b) one week later (retention test) according to fifteen technical points defined by the Code of Points of the International Federation of Gymnastics. The duration of tip-tow stance, the total and partial technical performance scores were analyzed using a 2(group) x 2 (test) multivariate ANOVA model. When the performance was evaluated just after the practice session (post-test), it was noted than the group practicing the skill in front of the mirror had significantly higher partial and total technical performance scores and stayed longer in the tip-toe stance than the group who practiced the skill using only kinesthetic feedback. However, this superiority of performance by the group using kinesthetic plus visual feedback was not permanent, as this was confirmed by the absence of significant differences between the groups in the retention test one week later. It is concluded that kinesthetic feedback plays the same crucial role as visual plus kinesthetic feedback in complex and difficult sport skills that require high level of total body coordination