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Age and Ageing Nov 2023Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults.
OBJECTIVE
This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs.
METHODS
Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria.
RESULTS
Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed.
CONCLUSION
Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
Topics: Humans; Aged; Telerehabilitation; Quality of Life; Postural Balance; Physical Therapists; Time and Motion Studies
PubMed: 37979183
DOI: 10.1093/ageing/afad207 -
Aging Clinical and Experimental Research Apr 2024Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has... (Review)
Review
Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has been long established for assessment in geriatric medicine and instrumented versions (iTUG) have been developed and validated. This scoping review includes studies that applied the iTUG and aims to identify use cases to show where and how iTUG assessment could guide interventions and clinical management. The literature search was limited to peer-reviewed studies that performed pre- and post-intervention measurements with a 3-meter TUG instrumented with body-worn technology in samples of at least 20 subjects aged 60+ years. Of 3018 identified articles 20 were included. Four clinical use cases were identified: stratification for subsequent therapy, monitoring of disease or treatment-associated changes and evaluation of interventions in patients with idiopathic normal pressure hydrocephalus (1), and patients with Parkinson's disease (2); monitoring after joint replacement surgery (3), and evaluation after different exercise and rehabilitation interventions (4). The included studies show diversity in terms of iTUG technology and procedures. The identified use cases highlight clinical relevance and high potential for the clinical application of the iTUG. A consensual approach as well as comprehensive reporting would help to further exploit the potential of the iTUG to support clinical management. Future studies should investigate the benefits of segmental iTUG analysis, responsiveness and participants' perspectives on clinically meaningful changes in iTUG.
Topics: Humans; Aged; Geriatric Assessment; Middle Aged; Postural Balance
PubMed: 38676844
DOI: 10.1007/s40520-024-02733-7 -
Experimental Brain Research Aug 2023Human hands are complex biomechanical systems that allow for dexterous tasks with many degrees of freedom. Coordination of the fingers is essential for many activities...
Human hands are complex biomechanical systems that allow for dexterous tasks with many degrees of freedom. Coordination of the fingers is essential for many activities of daily living and involves integrating sensory signals. During this sensory integration, the central nervous system deals with the uncertainty of sensory signals. When handling compliant objects, force and position are related. Interactions with stiff objects result in reduced position changes and increased force changes compared to compliant objects. Literature has shown sensory integration of force and position at the shoulder. Nevertheless, differences in sensory requirements between proximal and distal joints may lead to different proprioceptive representations, hence findings at proximal joints cannot be directly transferred to distal joints, such as the digits. Here, we investigate the sensory integration of force and position during pinching. A haptic manipulator rendered a virtual spring with adjustable stiffness between the index finger and the thumb. Participants had to blindly reproduce a force against the spring. In both visual reference trials and blind reproduction trials, the relation between pinch force and spring compression was constant. However, by covertly changing the spring characteristics in catch trials into an adjusted force-position relation, the participants' weighting of force and position could be revealed. In agreement with previous studies on the shoulder, participants relied more on force sense in trials with higher stiffness. This study demonstrated stiffness-dependent sensory integration of force and position feedback during pinching.
Topics: Humans; Feedback; Activities of Daily Living; Fingers; Proprioception; Feedback, Sensory
PubMed: 37382669
DOI: 10.1007/s00221-023-06654-1 -
Scientific Reports May 2024Chronic imbalance is a frequent and limiting symptom of patients with chronic unilateral and bilateral vestibulopathy. A full-body kinematic analysis of the movement of...
Chronic imbalance is a frequent and limiting symptom of patients with chronic unilateral and bilateral vestibulopathy. A full-body kinematic analysis of the movement of patients with vestibulopathy would provide a better understanding of the impact of the pathology on dynamic tasks such as walking. Therefore, this study aimed to investigate the global body movement during walking, its variability (assessed with the GaitSD), and the strategies to stabilise the head (assessed with the head Anchoring Index). The full-body motion capture data of 10 patients with bilateral vestibulopathy (BV), 10 patients with unilateral vestibulopathy (UV), and 10 healthy subjects (HS) walking at several speeds (slow, comfortable, and fast) were analysed in this prospective cohort study. We observed only a few significant differences between groups in parts of the gait cycle (shoulder abduction-adduction, pelvis rotation, and hip flexion-extension) during the analysis of kinematic curves. Only BV patients had significantly higher gait variability (GaitSD) for all three walking speeds. Head stabilisation strategies depended on the plan of motion and walking speed condition, but BV and UV patients tended to stabilise their head in relation to the trunk and HS tended to stabilise their head in space. These results suggest that GaitSD could be a relevant biomarker of chronic instability in BV and that the head Anchoring Index tends to confirm clinical observations of abnormal head-trunk dynamics in patients with vestibulopathy while walking.
Topics: Humans; Male; Biomechanical Phenomena; Female; Middle Aged; Walking; Head; Bilateral Vestibulopathy; Gait; Adult; Prospective Studies; Aged; Postural Balance; Chronic Disease
PubMed: 38783000
DOI: 10.1038/s41598-024-62335-1 -
BMC Musculoskeletal Disorders Jul 2023Afferent input from the sole affects postural stability. Cutaneous reflexes from the foot are important to posture and gait. Lower-limb afferents alone provide enough...
BACKGROUND & PURPOSE
Afferent input from the sole affects postural stability. Cutaneous reflexes from the foot are important to posture and gait. Lower-limb afferents alone provide enough information to maintain upright stance and are critical in perceiving postural sway. Altered feedback from propreoceptive receptors alters gait and patterns of muscle activation. The position and posture of the foot and ankle may also play an important role in proprioceptive input.Therefore, the current research aims to compare static balance and ankle and knee proprioception in people with and without flexible flatfeet.
METHODOLOGY
91 female students between the ages of 18 and 25 voluntarily participated in this study, of which 24 were in the flexible flatfoot group and 67 were in the regular foot group after evaluating the longitudinal arch of the foot. The position sense of ankle and knee joints were measured using the active reconstruction test of the ankle and knee angle; Static balance was measured using the Sharpened Romberg test. Data were non-normally distributed. Accordingly, non-parametric tests were applied. The Kruskal-Wallis test was applied to compare differences between groups in variables.
RESULT
Kruskal-Wallis test showed a significant difference between two groups of flat feet and normal feet in the variables of static balance and position sense of ankle plantarflexion, ankle dorsiflexion, and knee flexion (p ≤ 0.05). A significant correlation was found between static balance and sense of ankle and knee position in the group with normal feet. The analysis of the regression line also showed that ankle and knee position sense could predict the static balance score in the regular foot group (ankle dorsiflexion position sense 17% (R = 0.17), ankle plantarflexion position sense 17% (R = 0.17) and knee flexion position sense 46% (R = 0.46) explain of changes in static balance).
DISCUSSION & CONCLUSION
Flexible flatfoot soles can cause loss of balance and sense of joint position; therefore, according to this preliminary study, clinicians must be aware and should take into account this possible deficit in the management of these patients.
Topics: Humans; Female; Adolescent; Young Adult; Adult; Ankle; Cross-Sectional Studies; Flatfoot; Ankle Joint; Knee Joint; Proprioception; Posture; Postural Balance
PubMed: 37403076
DOI: 10.1186/s12891-023-06678-2 -
Sensors (Basel, Switzerland) Aug 2023The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor...
The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.
Topics: Young Adult; Humans; Aged; Postural Balance; Time and Motion Studies; Gait; Walking; Vision Disorders
PubMed: 37631797
DOI: 10.3390/s23167261 -
Journal of Hand Therapy : Official... 2024Hand therapist should take into consideration the importance of hand proprioception in long-term functional outcomes and its potential impairment due to various factors....
Hand therapist should take into consideration the importance of hand proprioception in long-term functional outcomes and its potential impairment due to various factors. Rehabilitation programs should focus on proprioceptive training for hand injuries but also consider broader aspects such as global proprioception, plantar support, posture, and balance. Patient's experience after a significant hand and forearm injury resulting from a sports accident, multiple surgeries, and the challenges of recovery emphasizes the importance of holistic approaches to rehabilitation, considering both physical and mental aspects, and praises the role of the physiotherapist in providing comprehensive support and building confidence.
Topics: Humans; Proprioception; Hand Injuries; Male; Adult; Female
PubMed: 38342641
DOI: 10.1016/j.jht.2023.10.002 -
Scientific Reports Oct 2023Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on the quality of life in...
Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on the quality of life in the aging population. Most falls in older fallers result from unrecoverable limb collapse during falling momentum control in the single limb support (SLS) phase. To understand why older adults are more likely to fall than younger adults, we investigated age-related differences in knee extensor eccentric control, lower limb muscle activation patterns, and their relation to balance control. Ten older and ten younger healthy adults were compared during balance control while walking on a compliant surface. There was a positive correlation between knee extensor eccentric work in the perturbed leg and the swinging leg's speed and margin of stability. In comparison to younger adults, older adults demonstrated (1) less eccentric work, reduced eccentric electromyography burst duration in the perturbed leg, (2) higher postural sway during SLS, and (3) impaired swinging leg balance control. The group-specific muscle synergy showed that older adults had a prominent ankle muscle activation, while younger adults exhibited a more prominent hip muscle activation. These findings provide insight into targeted balance rehabilitation directions to improve postural stability and reduce falls in older adults.
Topics: Humans; Aged; Quality of Life; Postural Balance; Lower Extremity; Walking; Muscle, Skeletal; Aging; Accidental Falls
PubMed: 37783842
DOI: 10.1038/s41598-023-43728-0 -
Scientific Reports Mar 2024Although there is no doubt from an empirical viewpoint that reflex mechanisms can contribute to tongue motor control in humans, there is limited neurophysiological...
Although there is no doubt from an empirical viewpoint that reflex mechanisms can contribute to tongue motor control in humans, there is limited neurophysiological evidence to support this idea. Previous results failing to observe any tonic stretch reflex in the tongue had reduced the likelihood of a reflex contribution in tongue motor control. The current study presents experimental evidence of a human tongue reflex in response to a sudden stretch while holding a posture for speech. The latency was relatively long (50 ms), which is possibly mediated through cortical-arc. The activation peak in a speech task was greater than in a non-speech task while background activation levels were similar in both tasks, and the peak amplitude in a speech task was not modulated by the additional task to react voluntarily to the perturbation. Computer simulations with a simplified linear mass-spring-damper model showed that the recorded muscle activation response is suited for the generation of tongue movement responses that were observed in a previous study with the appropriate timing when taking into account a possible physiological delay between reflex muscle activation and the corresponding force. Our results evidenced clearly that reflex mechanisms contribute to tongue posture stabilization for speech production.
Topics: Humans; Electromyography; Speech; Reflex; Postural Balance; Tongue; Muscle, Skeletal
PubMed: 38493261
DOI: 10.1038/s41598-024-56813-9 -
Clinical Interventions in Aging 2024Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high... (Review)
Review
Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.
Topics: Humans; Accidental Falls; Multiple Sclerosis; Postural Balance; Risk Factors; Fear; Fatigue; Disease Progression; Cognitive Dysfunction; Severity of Illness Index
PubMed: 38803468
DOI: 10.2147/CIA.S460475