Postural Dysfunction During Standing and Walking in Children With Cerebral Palsy: What are the Underlying Problems and What New Therapies Might Improve Balance?

In this review we explore studies related to constraints on balance and walking in children with cerebral palsy (CP) and the efficacy of training reactive balance (recovering from a slip induced by a platform displacement) in children with both spastic hemiplegic and diplegic CP. Children with CP show (a) crouched posture, contributing to decreased ability to recover balance (longer time/increased sway); (b) delayed responses in ankle muscles; (c) inappropriate muscle response sequencing; (d) increased coactivation of agonists/antagonists. Constraints on gait include (a) crouched gait; (b) increased co-activation of agonists/antagonists; (c) decreased muscle activation; (d) spasticity. The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP

A Review of Dual-Task Walking Deficits in People with Parkinson's Disease: Motor and Cognitive Contributions, Mechanisms, and Clinical Implications

Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or carrying an object. The consequences of gait impairments in PD are significant and include increased disability, increased fall risk, and reduced quality of life. However, effective therapeutic interventions for dual-task walking deficits are limited. The goals of this narrative review are to describe dual-task walking deficits in people with PD, to discuss motor and cognitive factors that may contribute to these deficits, to review potential mechanisms underlying dual-task deficits, and to discuss the effect of therapeutic interventions on dual-task walking deficits in persons with PD

Age-related differences in dual task performance: a cross-sectional study on women

Aim: Simultaneous performances of motor and attention‐demanding tasks are common in activities of everyday life. The present cross‐sectional study examined the changes and age‐related differences on mobility performance with an additional cognitive or motor task, and evaluated the relative dual‐task cost (DTC) on the motor performance in young, middle‐aged and older women. Methods: A total of 30 young (mean age 25.12 ± 3.00 years), 30 middle‐aged (mean age 47.82 ± 5.06 years) and 30 older women (mean age 72.74 ± 5.95 years) were recruited. Participants carried out: (i) single task: Timed Up & Go Test; (ii) cognitive dual‐task: Timed Up & Go Test while counting backwards by three; (iii) manual dual‐task: Timed Up & Go Test while carrying a glass of water. A repeated measures anova with between‐factor as age groups and within‐factor as tasks was carried out to assess the effect of aging on the performance of mobility tasks. DTC was calculated as ([performance in single‐task − performance in dual‐task] / performance in single task) × 100%. One‐way ancova were carried out to compare the DTC among the three age groups. Results: A significant interaction between age groups and task (F4,172 = 6.716, P < 0.001, partial η2 = 0.135) was observed. Specifically, older women showed a worse mobility performance under dual‐task condition compared with young and middle‐aged groups. Furthermore, DTC differences in cognitive task were observed in older women compared with younger and middle‐aged women (F2,86 = 7.649, P < 0.001, partial η2 = 0.151), but not in manual task. Conclusion: Dual‐task conditions might affect mobility performance differently across the lifespan, and could be particularly challenging in older women

The Modified Dynamic Gait Index and Limits of Stability in Myotonic Dystrophy Type 1

INTRODUCTION: The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). METHODS: Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. RESULTS: Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as fallers and those who had been classified as nonfallers. Significant correlations were found between mDGI scores and 10-m walking time. DISCUSSION: Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1

Balance, mobility and gaze stability deficits remain following surgical removal of vestibular schwannoma (acoustic neuroma): An observational study

Question Are there residual deficits in balance, mobility, and gaze stability after surgical removal of vestibular schwannoma? Design Observational study. Participants Twelve people with a mean age of 52 years who had undergone surgical removal of vestibular schwannoma at least three months previously and had not undergone vestibular rehabilitation. Twelve age- and gender-matched healthy people who acted as controls. Outcome measures Handicap due to dizziness, balance, mobility, and gaze stability was measured. Results Handicap due to dizziness was moderate for the clinical group. They swayed significantly more than the controls in comfortable stance: firm surface eyes open and visual conflict (p < 0.05); foam surface eyes closed (p < 0.05) and visual conflict (p < 0.05); and feet together: firm surface, eyes closed (p < 0.05), foam surface, eyes open (p < 0.05) and eyes closed (p < 0.01). They displayed a higher rate of failure for timed stance and gaze stability (p < 0.05) than the controls. Step Test (p < 0.01), Tandem Walk Test (p < 0.05) and Dynamic Gait Index (p < 0.01) scores were also significantly reduced compared with controls. There was a significant correlation between handicap due to dizziness and the inability to maintain balance in single limb and tandem stance (r = 0.68, p = 0.02) and the ability to maintain gaze stability during passive head movement (r = 0.78; p = 0.02). Conclusion A prospective study is required to evaluate vestibular rehabilitation to ameliorate dizziness and to improve balance, mobility, and gaze stability for this clinical group

Fall‐Associated Difficulty with Activities of Daily Living in Functionally Independent Individuals Aged 65 to 69 in the United States: A Cohort Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96257/1/jgs12071.pd

Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living. VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery. Here the authors review the mechanisms and the key exercises for each of the VRT goals