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Background: Both age‐associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality. Methods: We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person‐years of follow‐up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality. Results: 501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13–1.64] and 1.32 [1.10–1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25–1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance. Conclusions: Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex. [ABSTRACT FROM AUTHOR]

Objective: Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individuals aged 65–74 years (young‐old), 75–84 years (old‐old), and ≥85 years (oldest‐old). Methods: We conducted an observational mail survey among community‐dwelling older adults in Japan and collected detailed information on the incidence of falls over the past 3 years. The month, time, location, trigger, direction, and resulting trauma of each fall were analyzed and compared across the different age groups (young‐old, old‐old, and oldest‐old). Results: A total of 1695 falls among 1074 community‐dwelling older adults were analyzed in this study. Falls were frequent during May and October as well as during the winter season from December to February, especially between 10:00 a.m. and 11:00 a.m. These fall characteristics were consistent across all the age groups. There was a higher incidence of outdoor falls among relatively young older adults, which were typically caused by tripping or slipping. However, as one progresses with age, there is a higher incidence of falls indoors, typically due to loss of balance or leg entrapment. Approximately 60% of older fallers experience some form of injury due to falls, with fractures considered the most serious, occurring in ≈10% of all falls. Conclusion: We clarified the characteristics of falls including the "when, where, who, what, why, and how" of the fall. A future challenge is to use this valuable information to develop effective fall prevention programs for older populations worldwide. Geriatr Gerontol Int 2024; 24: 1181–1188. [ABSTRACT FROM AUTHOR]

Objectives: Assess the association of hearing on sex‐specific overall mortality and death from acute cardiovascular disease and evaluate if these effects are modulated by postural balance. Study Design: Cohort study. Setting: Otolaryngology department at an academic hospital. Methods: Patients underwent standard clinical examination, laboratory examination including stabilometry and audiometry. Pure tone average on the best hearing ear was calculated from 0.5, 1, 2, and 3 kHz. Cause of death was retrieved from the Norwegian Cause of Death Registry. Results: A total of 1036 patients (58.8% women) were followed for 26 ± 3 years. In Cox regression analyses for overall mortality adjusted for age, past medical history, and vestibular disease, 10 dB increase in hearing threshold was associated with a 14% increase in mortality among men (hazard ratio 95% confidence interval: 1.02‐1.28, P =.02), but no significant association was seen between hearing and mortality in women (0.92‐1.15, P =.60). The same analyses for acute cardiovascular death found that a 10 dB increase in hearing threshold was associated with a 57% increase in hazard ratio in men (1.21‐2.05, P <.001), but no significant effect of hearing on survival was seen in women (P =.71). Adjusting for postural balance did not change the association between hearing and mortality. Conclusion: This study finds hearing threshold is associated with overall mortality and acute cardiovascular death among men, with no such association observed among women. Our findings indicate important differences between men and women and suggest that such differences should be taken into consideration in audiological research. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Patients with episodic ataxia type 2 (EA2) suffer from recurrent paroxysmal episodes of vertigo and oscillopsia. Pathophysiologically, altered neuronal excitability has been suspected. Vestibular excitability in 22 EA2 patients and 22 age‐matched healthy participants was compared.Galvanic vestibular stimulation (GVS) was used to assess vestibular excitability by vestibular motion perception thresholds and mean postural sway velocity during various visual and proprioceptive conditions in the two groups. Control stimuli using sham and no GVS were established to identify the specificity of GVS‐induced postural sway.In the baseline condition, EA2 patients showed larger postural instability. However, motion perception thresholds and the increase in mean postural sway velocity during vestibular stimulation (stimulation ratio) did not differ between groups. Postural sway during suprathreshold GVS increased with the vestibular motion perception threshold in EA2 patients, in contrast to healthy participants.The larger postural unsteadiness of EA2 patients probably reflects their progressive cerebellar degeneration. It is not related to abnormal visual (Romberg's ratio) or proprioceptive control of stance. Postural unsteadiness during vestibular stimulation does not indicate altered vestibular excitability in EA2 patients. However, vestibular stimulation increasingly destabilized postural control of EA2 patients with higher motion perception thresholds when proprioceptive information was diminished. This conclusion, however, is restricted to the postural control of EA2 patients in the interval between the vestibulo‐cerebellar episodes. [ABSTRACT FROM AUTHOR]

Background: Balance while seated and the capacity to conduct selective trunk movements are significant predictors of functional outcomes following stroke. Patients with inappropriate muscle activation and inadequate movement control in the trunk muscles cause mobility and daily function difficulties. Stroke patients have weak leg muscles and decreased balance, resulting in compensatory changes. Functional postural strategy training is necessary to restore balance in these patients. Few studies have examined the effect of physical therapy trunk exercises with hip strategy training on improving balance and increasing independence after stroke. Purpose: This study aimed to explore the effect of selective trunk exercises (STE) with hip strategy training in improving balance in patients with stroke as well as independence levels. Method: A multicenter inpatient stroke treatment randomized pre‐ and post‐test control trial. Forty‐six stroke survivors were randomly allocated to experimental or control groups (n = 23 each). The experimental group received hip strategy training and trunk exercises. All groups received Neuro‐Developmental Treatment (NDT)‐based physical therapy four times a week for 6 weeks. Trunk impairment scale, Berg Balance Scale (BBS), and functional independence measure (FIM) measured static and dynamic seated balance, functional balance, and trunk movement coordination pre‐ and post‐therapy. Results: The experimental group's post‐therapeutic measures were substantially higher than the control group. The experimental group's TIS score, and subscale improved more than the control group. The experimental group considerably increased the BBS score. The experimental group also showed greater FIM gains. Conclusions: This study demonstrated that adding STE in conjunction with hip strategy training to patients after has a positive impact on trunk control while maintaining static and dynamic sitting balance, functional balance, and independence levels which are effective in stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Background and purpose: Enhancing physical function and quality of life in older adults at higher risk of falls is challenging because of the lack of established interventions. This study examines the impact of a 6‐week balance training program using the shuttle balance device on gait speed, postural control, and quality of life in older men. Methods: This single‐blinded randomized controlled trial was conducted in a research laboratory. Thirty‐two participants aged ≥60 years were randomly assigned to either an experimental group (EG; n = 16) or a control group (CG; n = 14). The EG participated in a 6‐week shuttle balance exercise program, while the CG maintained regular physical activity routines. The main outcome measures included gait speed (assessed via the timed up and go test), postural control (assessed via center of pressure data on a force plate), and quality of life (evaluated using the SF‐36 questionnaire). Results: Post‐intervention, the EG showed significant improvements compared with the CG (p < 0.05). The 95% confidence intervals for the differences between groups were as follows: closed eyes (CE) mean velocity (−39.07, −0.13), CE sway area (−48.86, −0.18), SF‐36 total score (9.01, 16.81), SF‐36 physical functioning (7.00, 24.81), SF‐36 physical role functioning (1.80, 27.57), SF‐36 pain (15.01, 36.82), SF‐36 general health state (7.48, 26.08), SF‐36 vitality (5.60, 28.35), and SF‐36 mental health (0.21, 21.12). Discussion: A 6‐week shuttle balance training program significantly improves postural control and quality of life in older males. These findings suggest the potential effectiveness of shuttle balance exercises in enhancing physical function and well‐being in this population. Further research is needed to validate these findings and explore the long‐term effects with larger sample sizes. [ABSTRACT FROM AUTHOR]

Aim: To examine if a novel reactive balance training program (ReacStep) designed for clinical settings is acceptable to clinicians prescribing balance and mobility training. Methods: ReacStep consists of tether‐release reactive step training, volitional trip and slip training, and functional strength training. An open survey comprising 11‐point visual analog scale items (0 = strongly disagree to 10 = strongly agree) based on the Theoretical Framework of Acceptability was sent to clinicians working in balance and mobility training. Items evaluated the acceptability of ReacStep across seven domains (intervention coherence, perceived efficacy, self‐efficacy, ethicality, affective attitude, burden and opportunity cost). Results: Two hundred and seven clinicians (169 Physiotherapists, 22 Exercise Physiologists, 11 Occupational Therapists and five others) completed the survey. Respondents considered ReacStep to have good overall acceptability, intervention coherence, effectiveness, ethicality and self‐efficacy (mean acceptability scores >7). However, respondent's ratings of ReacStep's affective attitude, burden and opportunity cost were more variable (mean acceptability scores 2–8) due to concerns about client anxiety, the need for a safety harness and staffing and training requirements. Respondents considered that ReacStep would be more effective and safer to conduct in geriatrics clients compared with neurological clients, and that it would be more appropriate for rehabilitation and private practice settings compared to home settings. Conclusions: ReacStep was generally acceptable from the perspective of clinicians who prescribe balance and mobility training in various clinical settings, and was deemed more effective and safer for older clients without neurological conditions, and beneficial in outpatient rehabilitation and private practice settings. [ABSTRACT FROM AUTHOR]

Background: The patient with pusher syndrome (PS) is characterized by showing postural control alterations due to a lack of perception of his own body in the space. It appears when the patient actively pushes with his unaffected limbs towards the injured side, reacting with resistance to passive straightening towards the midline. Between 10% and 50% of strokes present PS. Nowadays, there is no clearly defined treatment for PS. Objective: To design and validate an exercise program using visual feedback and specific core stability exercises (FeViCoS) for the treatment of patients with PS. Methods: Validation was conducted by expert consensus using the Delphi method. Thirteen neurorehabilitation experts participated in the process. An online questionnaire with 18 Likert‐type questions was used to evaluate the designed program. Consensus was considered reached if there was convergence between the quartile 1 and 3 values (RIQ = Q1‐Q3) or if the relative interquartile range (RIR) was less than 20%. The degree of agreement between experts was measured by calculating the Fleiss' kappa coefficient. Results: A total of 2 rounds were required to achieve 97.44% consensus with 100% participation. The RIR was less than or equal to 20% for all questions. The Fleiss' kappa index (0.831) showed that the degree of agreement between experts was excellent. Conclusion: Neurorehabilitation experts considered FeViCoS valid for the therapeutic approach to patients with PS. Expert consensus suggests a novel strategy in physical therapy clinical practice to improve balance and postural orientation in patients with subacute stroke and PS. [ABSTRACT FROM AUTHOR]

Background and Purpose: The article's significance lies in the substantial rise in the risk of developing Parkinson's disease (PD), necessitating the exploration of various approaches to rehabilitation and medical treatment. The purpose of the article is to detect the direct effect of physiotherapy for patients with PD and to identify how it helps in slowing down cardio‐pulmonary failure, improving the posture, balance, bradykinesia and tremor. Methods: The research utilised clinical data from 407 PD patients aged 30–100 years at the Central Polyclinic of Durrës, spanning 2011–2022, and included a systematic literature review and statistical analysis comparing physiotherapy outcomes with European Union standards. Results: The research demonstrates the efficiency of physiotherapy in the short and long term in the treatment of PD for patients and medical personnel. All information can be used to increase the functional abilities of patients and minimise complications after physiotherapy and to estimate the effectiveness of different exercises in delaying PD. Older adults, particularly those aged 71–80, are most affected by PD, with males more likely to be diagnosed. Physiotherapy rehabilitation improves motor symptoms, posture, and balance in 30‐80‐year‐olds, but its effectiveness declines with age. Advanced rehabilitation methods in Italy lead to better outcomes, suggesting the potential for improvement in Durres disease. Conclusions: The study emphasises the need for improved rehabilitation strategies for older patients by recommending tailored programs, advanced methods, standardisation, training, and long‐term monitoring. Further research should concentrate on the long‐term sustainability of physiotherapy benefits, the development of targeted interventions for older patients, and the integration of innovative therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background and Purpose: Assessing lower limb strength, balance, and fall risk are crucial components of rehabilitation, especially for the older adult population. With the growing interest in telehealth, teleassessment has been investigated as an alternative when in‐person assessments are not possible. The Five Times Sit‐to‐Stand test (5TSTS) provides a quick measure of balance during chair transfers, muscle power, endurance, and the hability to change and maintain body position, and is highly recommended by guidelines. However, the literature is unclear about the viability and safety of teleassessment using the 5TSTS in older adults with and without Parkinson's disease (PD). This study aimed to evaluate the reliability of teleassessment using the 5TSTS and to determine its feasibility and safety for older adults with and without PD. Methods: This cross‐sectional study included older adults with and without PD who were evaluated remotely through a videoconference platform. To ensure effective and comprehensive instructions for the test, we developed a guideline called OMPEPE (an acronym for: Objective; Materials; Position‐Start; Execution; Position‐End; Environment). We assessed the 5TSTS intra‐ and inter‐rater reliability by comparing scores obtained from the same examiner and from different examiners, respectively. Participants and examiners completed online surveys to provide information about feasibility and safety. Results: Twelve older adults with PD and 17 older adults without PD were included in this study (mean ages 69.0 and 67.6 years, respectively). Based on the participants' perspectives and the absence of adverse effects, teleassessment using the 5TSTS is feasible and safe for older adults with and without PD. Excellent intra‐ and inter‐rater reliability (intraclass correlation coefficient >0.90) was found for all measurements of the 5TSTS. Discussion: This study demonstrated the feasibility, safety, and reliability of teleassessment using the 5TSTS. The guidelines developed may help health professionals minimize barriers and safely conduct an online assessment that includes a physical test such as the 5TSTS in older adults with or without PD. In addition to addressing technological barriers, the OMPEPE guideline might ensure the optimal execution of evaluations. Conclusion: Teleassessment using the 5TSTS for older adults with and without PD is feasible and safe. Both synchronous (i.e., live) and asynchronous (i.e., recorded) online 5TSTS tests demonstrate excellent intra‐ and inter‐rate reliability. [ABSTRACT FROM AUTHOR]

The article discusses research which examined whether maintaining greater cerebral blood flow velocity (CBFv) can support dual-task cognitive and balance function in older adults resistant to cognitive decline. Cited are the relationship between CBFv and older adults' prioritization of balance compared to cognitive performance under dual-task conditions, and the effect of advanced age on the relationship between CBFv and cognitive-balance dual-task interference (DTI).

Introduction: Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15–64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community‐dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance. Methods: A cross‐sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression. Results: The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04–1.23) was found. Conclusion: The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community‐dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance. PLAIN LANGUAGE SUMMARY: People who have a stroke can experience difficulties with managing everyday activities, including performance of a specific task but also to have a balance between activities that are needed and those that are enjoyed. Previous studies have showed that stroke survivors in working age did not perceive they had a balance in their daily activities, but similar studies in older stroke survivors were lacking. This study therefore described balance in daily activities in 58 community‐dwelling stroke survivors 65 years or older. The participants answered questionnaires on balance in daily activities and what impact the stroke had in their life. The results showed that they had a very high balance in daily activities and a low stroke impact and perceived a good stroke recovery. Our conclusion is that because many of the older community‐dwelling stroke survivors are retired, they therefore have more time to spend on activities they want to engage in. Since they can decide themselves how their time will be spent, this can explain why they experience a better balance in daily activities. Future studies should include a larger number of participants. Still, we believe that since this is a new research area, the results are interesting for researchers and clinicians in this field. [ABSTRACT FROM AUTHOR]

Aims: To assess whether impaired vestibular perception of self‐motion is a risk factor for unsteadiness and falls in elderly patients with type 2 diabetes (T2D). Materials and methods: 113 participants (65–75 years old) with T2D underwent tests of roll and pitch discrimination, postural stability (Berg Balance Scale, Modified Romberg Test, and quantitative posturography), clinical examination and blood chemistry analyses. Falls 1‐year after enrolment were self‐reported. We performed cluster analysis based on the values of the vestibular motion thresholds, and logistic stepwise regression to compare the clinical‐biochemical parameters between clusters. Results: We identified two clusters (VC1 n = 65 and VC2 n = 48 participants). VC2 had significantly (p < 0.001) higher (poorer) thresholds than VC1: mean pitch threshold 1.62°/s (95% CI 1.48–1.78) in VC2 and 0.91°/s (95% CI 0.84–0.98) in VC1, mean roll threshold 1.34°/s (95% CI 1.21–1.48) in VC2 and 0.69°/s (95% CI 0.64–0.74) in VC1. Diabetes duration was significantly (p = 0.024) longer in VC2 (11.96 years, 95% CI 9.23–14.68) than in VC1 (8.37 years, 95% CI 6.85–9.88). Glycaemic control was significantly (p = 0.014) poorer in VC2 (mean HbA1c 6.74%, 95% CI 6.47–7.06) than in VC1 (mean HbA1c 6.34%, 95% CI 6.16–6.53). VC2 had a significantly higher incidence of postural instability than VC1, with a higher risk of failing the Modified Romberg Test C4 (RR = 1.57, χ2 = 5.33, p = 0.021), reporting falls during follow‐up (RR = 11.48, χ2 = 9.40, p = 0.002), and greater postural sway in the medio‐lateral direction (p < 0.025). Conclusions: Assessing vestibular motion thresholds identifies individuals with T2D at risk of postural instability due to altered motion perception and guides vestibular rehabilitation. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Dental trauma (DT) and falls have shown to be associated. On the other hand, postural balance is associated with falls and depends on the integration of the body's regulatory systems. The aim of this study was to investigate the potential relationship between DT and alteration of orthostatic balance in children.This was a population‐based case–control study involving 296 six‐year‐old schoolchildren. The case group included children with previous history of DT. The control group included children with no previous history of DT. Stabilometric measurements were the main exposure of this study. Logistic regression analyzes were performed to estimate potential differences in terms of chance of occurrence.The cases reviewed showed a 4.37 times chance of reduced balance in the measurement of the anteroposterior trajectory speed of the orthostatic center of pressure (COP), when children had their eyes closed. It also presented a chance of 3.06 times reduced balance in the measurement of the orthostatic center of pressure latero‐lateral sway, with children with open eyes and stepping on a foam pad, and 4.00 times of reduced balance in the width of the latero‐lateral sway of the orthostatic center of pressure, with children with open eyes and stepping on a foam pad.Children with previous history of DT showed a higher chance of experiencing a reduced orthostatic balance in different conditions when compared to children without the occurrence of trauma. [ABSTRACT FROM AUTHOR]

Background: Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised. Objective: The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA). Methods: PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full‐texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised. Results: A total of 1485 records were retrieved. Sixty‐four articles were included for screening full‐texts, and four articles were ultimately included. Core exercises were administered for three to 6 weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p < 0.05). Conclusions: Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted. Trial Registration: PROSPERO Registration Number: CRD42024542992 [ABSTRACT FROM AUTHOR]

The relationship between structural changes in the cerebral gray matter and diminished balance control performance in patients with chronic ankle instability (CAI) has remained unclear. This paper aimed to assess the difference in gray matter volume (GMV) between participants with CAI and healthy controls (HC) and to characterize the role of GMV in the relationship between disease duration and balance performance in CAI. 42 participants with CAI and 33 HC completed the structural brain MRI scans, one‐legged standing test, and Y‐balance test. Regional GMV was measured by applying voxel‐based morphometry methods. The result showed that, compared with HC, participants with CAI exhibited lower GMV in multiple brain regions (familywise error [FWE] corrected p < 0.021). Within CAI only, but not in HC, lower GMV in the thalamus (β = −0.53, p = 0.003) and hippocampus (β = −0.57, p = 0.001) was associated with faster sway velocity of the center of pressure (CoP) in eyes closed condition (i.e., worse balance control performance). The GMV in the thalamus (percentage mediated [PM] = 32.02%; indirect effect β = 0.119, 95% CI = 0.003 to 0.282) and hippocampus (PM = 33.71%; indirect effect β = 0.122, 95% CI = 0.005 to 0.278) significantly mediated the association between the disease duration and balance performance. These findings suggest that the structural characteristics of the supraspinal elements is critical to the maintenance of balance control performance in individuals suffering from CAI, which deserve careful consideration in the management and rehabilitation programs in this population. [ABSTRACT FROM AUTHOR]

Background: An improved understanding of the current practice of standing frame use may have implications for supporting parents in managing standing frames. We aimed to investigate how parents of children with cerebral palsy perceive and manage standing frame use in home settings. Methods: We conducted a mixed methods study with an explanatory sequential design, first collecting and analysing quantitative questionnaire data and then using these results to inform a qualitative follow‐up phase to explain them. The questionnaire was answered by 103 parents of children with cerebral palsy across five countries, Denmark, Norway, Great Britain, Canada and the United States, and 12 Danish families participated in the subsequent interviews. A descriptive analysis was conducted using the questionnaire data. The qualitative data were analysed using a directed content analysis, enabling integration of the quantitative and qualitative data. Results: The quantitative analysis showed that 89% of the parents felt confident with their child's standing frame, and 82% felt they had sufficient knowledge about how their child's standing frame could/should be used. However, the qualitative analysis showed that even when feeling confident, the parents experienced insecurity regarding whether their child was positioned correctly, and being responsible for positioning was challenging. Conclusion: Our study implies a need for providing educational materials to assist the parents in ensuring optimal positioning of their child in the standing frame to decrease insecurity. Additionally, our study suggests a need to provide more thorough information about the benefits of using a standing frame and ensure alignment of expectations in relation to the child's prognosis of functional independence. [ABSTRACT FROM AUTHOR]

Objective s : This pilot study examined the feasibility, acceptability, and effects of a Nintendo Ring Fit Adventure™‐based balance and muscle strengthening exercise program in community‐dwelling older adults with a history of falls. Methods: Older adults who have had at least one fall in the past year were randomly assigned to an experimental (n = 21) or control group (n = 21). The experimental group performed 16 exercise sessions in total, lasting 60 min each, twice a week for 8 weeks, whereas the control group received usual care. Feasibility was evaluated based on the scores of participants in the exercises. Acceptance was evaluated using a customised questionnaire examining participants' self‐perceived enjoyment, feasibility and improvements. Clinical outcomes including balance (Mini‐BESTest), lower limb muscle strength (Five‐Time Sit‐to‐Stand test), mobility (Timed‐Up and Go test), dual‐task ability (Timed‐Up and Go test—Dual Task), fear of falling (Icon‐FES) and executive function (Color Trails Test) were evaluated at baseline and 8 weeks. Results: Thirty‐one participants (74%) finished the 8‐week assessment. The experimental group significantly improved their scores in six out of eight exercises (all p <.031). The mean scores of the self‐perceived enjoyment, feasibility and improvement domains of the acceptability questionnaire were 3.46 ±.53, 3.08 ±.59, and 3.47 ±.57 respectively. A significant improvement in the anticipatory subscore of the Mini‐BESTest was found in the experimental group compared to the control group (p =.02; Partial eta squared =.14). Conclusions: The Nintendo Ring Fit Adventure™‐based exercise program was feasible, acceptable, and potentially effective in community‐dwelling older adults with a history of falls. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this assessor‐blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild‐to‐moderate dementia. Methods: The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6‐month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370). Results: Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6‐ or 12‐months (between‐group differences [95% CI] for primary outcomes at 6‐months: Forward Digit Span −0.3 [−0.8, 0.3]; TMT‐A 2.7 s [−14.1, 19.5]; TMT‐B −17.1 s [−79.3, 45.2]). At the 12‐month follow‐up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver‐rated participant quality of life and higher caregiver quality of life compared to control. Conclusions: This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild–moderate dementia. [ABSTRACT FROM AUTHOR]

Background: A decrease in dynamic balance and muscle strength related to ageing is associated with a decreased quality of life, reduced life expectancy and increased risk of falls. Timed stand‐up test (TUG) is one of the most used clinical tests for the evaluation of dynamic balance and sit‐to‐stand test (STS). Although these tests are reported to be reliable in pathological conditions in different populations and different countries, there is a gap in the evaluation of the reliability of the tests by nurses in the older persons living in Turkish society. Objective: The present study aimed to investigate the inter‐ and intra‐observer reliability of the timed up‐and‐go test (TUG) and sit‐to‐stand test (STS) performed by nurses in Turkish community‐dwelling older persons. Methods: A total of 97 community‐dwelling older persons participated in this study. To determine the interobserver reliability of the TUG and STS tests, all tests were performed at an interval of 30 min by two nurses. To determine the intra‐observer reliability of the tests, each measurement was repeated 1 week after the first measurement by another nurse. Results: Excellent intra‐observer reliability was found for the TUG (intraclass correlation coefficient [ICC] = 0.962) and STS tests (ICC = 0.996), with a total range of 0.943–0.997. Excellent interobserver reliability was found for the TUG (ICC = 0.995) and STS (ICC = 0.996) tests. The coefficient of variant values for the tests was < 15%. Conclusion: Our results demonstrated that the TUG and STS tests can be reliably used by nurses in community‐dwelling older persons. Implications for Practice: This study is important in terms of determining the risk of falling among older persons aged 60 and over in Turkey, preventing hospitalisations due to falls and developing nursing policies that promote the safety of older persons individuals. [ABSTRACT FROM AUTHOR]

Ageing induces a decline in GABAergic intracortical inhibition, which seems to be associated not only with decremental changes in well‐being, sleep quality, cognition and pain management but also with impaired motor control. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. Therefore, the present study investigated whether age‐related cortical dis‐inhibition could be reversed after 6 months of balance learning and whether improvements in postural control correlated with the extent of reversed dis‐inhibition. The results demonstrated that intracortical inhibition can be upregulated in elderly subjects after long‐term balance learning and revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity‐related upregulation of GABAergic inhibition in a population with chronic dis‐inhibition and may therefore be seminal for many pathologies in which the equilibrium between inhibitory and excitatory neurotransmitters is disturbed. Key points: Ageing induces a decline in GABAergic intracortical inhibition.So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly.After 6 months of balance learning, intracortical inhibition can be upregulated in elderly subjects.The results of this study also revealed a correlation between changes in balance performance and intracortical inhibition.This is the first study to show physical activity‐related upregulation of GABAergic inhibition in a population with chronic dis‐inhibition. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to study how acid accumulation (lower plasma bicarbonate and higher anion gap [AG] and corrected anion gap [CAG]) correlates with metabolic parameters, food intake, and 24‐h energy expenditure (EE). Methods: Acid accumulation was measured in 286 healthy adults with estimated glomerular filtration rate > 60 mL/min/1.73 m2. Measurements included body composition by dual‐energy x‐ray absorptiometry scan, ad libitum energy intake by a vending machine paradigm over 3 days, and 24‐h EE in a whole‐room indirect calorimeter. Results: Lower bicarbonate, higher AG, and higher CAG were correlated with higher waist and thigh circumferences, body fat (percentage), fat mass, triglycerides, and lower high‐density lipoprotein cholesterol. Acid accumulation markers were correlated with higher total energy (CAG partial r = 0.17; p = 0.02), fat (CAG partial r = 0.17; p = 0.02), protein intake (CAG partial r = 0.20; p = 0.006), and 24‐h EE (CAG partial r = 0.24; p = 0.0007). A mediation analysis of CAG and total energy intake found that 24‐h EE was a partial mediator (40%), but the association remained significant (β = 0.15; p < 0.0001). Conclusions: In healthy individuals, acid accumulation was associated with an unfavorable metabolic phenotype; higher 24‐h EE; and increased total energy, fat, and protein intake. Acid accumulation markers, as putative markers of higher dietary acid load (e.g., from protein), may affect energy balance physiology promoting weight gain. [ABSTRACT FROM AUTHOR]

Background: Diabetic peripheral neuropathy (DPN) occurs in >50% of diabetic patients and is a high risk‐factor of balance problems and risk of falls. Impaired balance can lead to reduced function, which has a detrimental effect on patients' quality of life. Structured strength and balance training can result in sustained improvements in muscle strength, coordination, balance, functional status and quality of life. Objective: To determine the combined effects of strength and balance training versus aerobic training on balance, severity of symptoms of DPN, and quality of life in patients with DPN. Methods: This double blinded, two arm parallel design Randomized Clinical Trial. The study was conducted from March to December 2020 in the AIMS diabetic center Peshawar, Pakistan. Participants were selected through convenience sampling technique and randomly allocated into strength plus balance and aerobic training groups. Type 2 diabetic patients of both sexes, aged 40 to 80 years, with a Toronto neuropathy score ≥6 recruited, while patients with ulceration/infection of feet, medical/Surgical conditions, and non‐ambulatory patients were excluded from this study. Intervention was applied 3 days a week for 8 weeks. The Toronto clinical neuropathy system was used to assess neuropathy severity, SF‐36 to assess quality of life and the Berg balance scale was used for assessment of balance. Assessment was done at the baseline and after 8 weeks of intervention using SPSS. Version 22 was used for analysis. Results: The mean age of the participants was 60.80 ± 9.73. Between group analysis, which showed were statistically insignificant for neuropathy severity, balance and all domains of quality of life (p‐value >0.05) except SF‐36 General Health Perception Score, with Mean ± SD of 62.50 ± 7.54 in group A versus Mean ± SD of in group B 60.00 ± 15.98 (p‐value = 0.05). Within group analysis showed statistically significant results for neuropathy severity, balance and all domains of quality of life (p‐value<0.05). Conclusion: This study concluded that there is a statistically significant effect of structured balance and strength training and aerobic training on severity of DPN, balance and quality of life. But there was no statistically significant difference in improvement between the two intervention groups. [ABSTRACT FROM AUTHOR]

Quantifying movement coordination in cross‐country (XC) skiing, specifically the technique with its elemental forms, is challenging. Particularly, this applies when trying to establish a bidirectional transfer between scientific theory and practical experts' knowledge as expressed, for example, in ski instruction curricula. The objective of this study was to translate 14 curricula‐informed distinct elements of the V2 ski‐skating technique (horizontal and vertical posture, lateral tilt, head position, upper body rotation, arm swing, shoulder abduction, elbow flexion, hand and leg distance, plantar flexion, ski set‐down, leg push‐off, and gliding phase) into plausible, valid and applicable measures to make the technique training process more quantifiable and scientifically grounded. Inertial measurement unit (IMU) data of 10 highly experienced XC skiers who demonstrated the technique elements by two extreme forms each (e.g., anterior versus posterior positioning for the horizontal posture) were recorded. Element‐specific principal component analyses (PCAs)—driven by the variance produced by the technique extremes—resulted in movement components that express quantifiable measures of the underlying technique elements. Ten measures were found to be sensitive in distinguishing between the inputted extreme variations using statistical parametric mapping (SPM), whereas for four elements the SPM did not detect differences (lateral tilt, plantar flexion, ski set‐down, and leg push‐off). Applicability of the established technique measures was determined based on quantifying individual techniques through them. The study introduces a novel approach to quantitatively assess V2 ski‐skating technique, which might help to enhance technique feedback and bridge the communication gap that often exists between practitioners and scientists. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to develop a clinical support tool for osteoporosis clinic providers to support risk assessment and referrals for evidence‐based exercise therapy programs. Methods: A sequential Delphi method was used with a multidisciplinary group of national falls experts, to provide consensus on referral to exercise therapy for patients at risk for falls. The Delphi study included a primary research team, expert panel, and clinical partners to answer the questions: (1) "What patient characteristics are needed to develop a clinical support tool?"; (2) "What are the recommended exercise referrals for patients with osteoporosis at risk for falls?" The consensus process consisted of two rounds with 8 weeks between meetings. Two qualitative researchers analyzed the data using a modified version of a matrix analysis approach. Results: The following were the most important variables to include when determining exercise therapy referrals for patients with osteoporosis: Patient history and demographics, falls history over the last year, current physical function and balance, caregiver and transportation status, socioeconomic and insurance status, and patient preference. Potential exercise therapy referrals included one‐on‐one physical therapy, group physical therapy, home health, community‐based exercise programs, and not acceptable for exercise therapy. Conclusions: Patient characteristics including patient history, physical function and balance performance, socioeconomic and insurance status, and patient preference for exercise therapy are important to inform both the medical provider and patient with osteoporosis to choose the most appropriate exercise therapy referral. Adoption of the algorithmic suggestions may have a significant impact on uptake and adherence to exercise therapy, ultimately improving patient physical function and reducing falls risk. [ABSTRACT FROM AUTHOR]

Individuals are recommended to lead active lifestyles throughout the life course. The model of physical activity‐related health competence (PAHCO) adopts a competence approach by integrating physical, cognitive, and motivational determinants for health‐enhancing PA (movement competence, control competence, self‐regulation competence). Drawing on a comprehensive dataset pooling, the goal of the present study was to model the idiosyncratic courses of 10 PAHCO indicators over the life span. We identified studies that empirically operationalized PAHCO, combining data of 7134 individuals (age range: 15–97 years; 61% female) from 18 different populations (prevention and rehabilitation sectors). We applied a stepwise multilevel analysis approach with disjunct sub‐samples (n = 48) to examine linear and quadratic associations between age and PAHCO. Indicators of movement competence (i.e., manageability of endurance, strength, and balance demands; task‐specific self‐efficacy) congruently showed negative associations with age (0.054 ≤ Rmarg2 ${R}_{\text{marg}}^{2}$ ≤ 0.211). However, parameters of control competence remained stable across the life span (−0.066 ≤ β ≤ 0.028). The three indicators of self‐regulation competence revealed an inconsistent relationship with age, though uncovering positive associations for self‐control (β = 0.106) and emotional attitude toward PA (β = 0.088). The associations of some indicators varied significantly across sub‐samples. The results suggest differential analyses for associations between PAHCO and age. While the physically determined PAHCO indicators (movement competence) probably decline across the life span, the ability to ensure regularity of PA (self‐regulation competence) or align PAs with an individual's health (control competence) appear to remain constant or improve with increasing age. The findings reinforce a de‐stigmatizing approach for PA promotion practices with considerable space for aligning activities with health also in the elderly. Highlights: As hypothesized, movement competence appears to decline throughout the life span.The ability to align physical activities with an individual's health (control competence) appears to remain stable throughout the life span.Unexpectedly, an individual's ability to ensure regularity of physical activity (PA; self‐regulation competence) appears to improve throughout the life span and, therefore, conflicts with actual PA behavior.Age‐related changes in competencies for health‐enhancing PA systematically vary between samples (i.e., groups with a certain disease or working environment). [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the validity and reliability of the Sitting Assessment Scale (SAS) in individuals with cerebral palsy (CP). Methods: The study included 34 individuals with a diagnosis of spastic CP. Individuals were evaluated with the Gross Motor Function Classification System and the Manual Ability Classification System. SAS and Trunk Control Measurement Scale (TCMS) were applied to the participants. The intraclass correlation coefficient (ICC) was calculated to determine the intraobserver and interobserver reliability of the scale scored by three different physiotherapists at two different time intervals. Internal consistency was calculated with Cronbach's ⍺ coefficient. The fit between SAS and TCMS for criterion‐dependent validity was evaluated using Pearson Correlation Analysis. Results: According to the GMFCS level, 79.41% of the children were mildly (Level I‐II), 14.71% were moderately affected (level III), and 5.88% were severely affected (level IV). Intra > observer and interobserver reliability values of SAS were extremely high (ICCinterrater > 0.923, ICCintrarater > 0.930). It was observed that the internal consistency of SAS had high values (Cronbach ⍺test > 0.822, Cronbach ⍺retest > 0.804). For the criterion‐dependent reliability; positive medium correlations found between SAS with Total TCMS Static Sitting Balance (r = 0.579, p < 0.001), with TCMS Selective Movement Control (r = 0.597, p < 0.001), with TCMS Dynamic Reaching (r = 0.609, p < 0.001), and with TCMS Total (r = 0.619, p < 0.001). Conclusion: SAS was found to have high validity and reliability in children with CP. In addition, the test–retest reliability of the scale was also high. SAS is a practical tool that can be used to assess sitting balance in children with CP. [ABSTRACT FROM AUTHOR]

Background: Jaw clenching improves dynamic reactive balance on an oscillating platform during forward acceleration and is associated with decreased mean sway speed of different body regions. Objective: It is suggested that jaw clenching as a concurrent muscle activity facilitates human motor excitability, increasing the neural drive to distal muscles. The underlying mechanism behind this phenomenon was studied based on leg and trunk muscle activity (iEMG) and co‐contraction ratio (CCR). Methods: Forty‐eight physically active and healthy adults were assigned to three groups, performing three oral motor tasks (jaw clenching, tongue pressing against the palate or habitual lower jaw position) during a dynamic one‐legged stance reactive balance task on an oscillating platform. The iEMG and CCR of posture‐relevant muscles and muscle pairs were analysed during platform forward acceleration. Results: Tongue pressing caused an adjustment of co‐contraction patterns of distal muscle groups based on changes in biomechanical coupling between the head and trunk during static balancing at the beginning of the experiment. Neither iEMG nor CCR measurement helped detect a general neuromuscular effect of jaw clenching on the dynamic reactive balance. Conclusion: The findings might indicate the existence of robust fixed patterns of rapid postural responses during the important initial phases of balance recovery. [ABSTRACT FROM AUTHOR]

Objective: To analyze the factors associated with low functional mobility in older adults residing in Alcobaça, BA. Methods: This is an epidemiological survey with a cross‐sectional design, conducted in 2015 with 473 older adults (62.4% women; mean age 70.2 ± 8.2 years) from Alcobaça, BA. The interview script addressed sociodemographic characteristics, health, and behavioral aspects. Functional mobility was assessed using the Short Physical Performance Battery (≤6 points). Inferential analyses were conducted using the Mann–Whitney U test and Poisson regression (with robust variance and estimation of prevalence ratios and their respective 95.0% confidence intervals). Results: The prevalence of low functional mobility was 9.6%, with associated factors including the use of alcoholic beverages (PR = 1.7, 95% CI: 1.01–1.13) and the number of repetitions in elbow flexion (PR = 1.01, 95% CI: 1.01–1.05). Additionally, older adults with low mobility had lower height, thigh circumference, and lower performance in handgrip strength tests, elbow flexion, and flexibility. They also spent more time in sedentary behavior and less time in physical activity compared to older adults with preserved mobility (p < 0.05). Conclusion: Older adults with low mobility exhibit poorer values in anthropometric parameters, lower performance in motor tests, spend less time engaged in physical activities, and more time in sedentary behavior. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS). Methods: A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID‐19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI). Results: In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p <.05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p <.05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p >.05). Conclusions: It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL. [ABSTRACT FROM AUTHOR]

Background: Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non‐syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self‐care, mobility, and social function). Methods: The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills. Results: Significant positive correlations were found between the one‐leg standing and PEDI (r =.841 for self‐care, r =.700 for mobility, and r =.760 for social function). Our analysis showed that static balance skills affected self‐care, dynamic balance skills affected mobility, and intelligence quotient affected social function. Conclusions: Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the impact of neuromuscular training (NMT) on static and dynamic postural balance (PB) among high‐level male runners with intellectual disability. Method: Twenty‐seven runners were randomly assigned to a NMT group and a control group who maintained their conventional training. Static and dynamic PB were assessed using the centre of pressure (CoP) excursions (in bipedal and unipedal stances under open eyes (OE) and closed eyes (CE) conditions) and the star excursion balance test (SEBT), respectively, at pre‐training and post‐training. Results: The NMT group showed significantly (p < 0.05) decreased CoP values and increased SEBT scores at post‐training compared to pre‐training. The switch from OE to CE did not affect static PB in the bipedal stance, only in the NMT group. Conclusions: The NMT was effective in improving static and dynamic PB in runners with intellectual disability. The NMT could reduce visual dependency. [ABSTRACT FROM AUTHOR]

Introduction: Age‐related decline in physical functioning has significant implications for health in later life but declines begin earlier in midlife. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between patterns of PA accumulation, including the composition, variation, and temporal distribution of upright and stepping events, with physical function in midlife. Methods: Participants (n = 4378) from the 1970 British Cohort Study wore an activPAL3 accelerometer on the thigh for 7 consecutive days. Exposure measures included a suite of metrics describing the frequency, duration, and composition of upright events, as well as the duration and volume (total steps) of stepping events. In addition, patterns of accumulation of upright and sedentary events were examined including how fragmented/transient they were (upright‐to‐sedentary transition probability [USTP]) and their burstiness (the tendency for events to be clustered together followed by longer interevent times). Physical function outcomes included grip strength (GS), balance, and SF‐36 physical functioning subscale (SF‐36pf). Cross‐sectional analyses included multivariable linear regression models to assess associations, adjusting for covariates including overall PA volume (mean daily step count). Results: Higher upright event burstiness was associated with higher GS, and higher USTP was associated with lower GS. Duration and step volume of stepping events were positively associated with SF‐36pf in females. Step‐weighted cadence was positively associated with SF‐36pf and balance. Contradictory findings were also present (e.g., more transient stepping events were associated with better GS) particularly for GS in males. Inconsistencies between sexes were observed across some associations. Conclusion: Our study reveals that diverse patterns of PA accumulation exhibit distinct associations with various measures of physical function in midlife, irrespective of the overall volume. Contradictory findings and inconsistency between sexes warrant further investigation. Patterns of PA accumulation, in addition to volume, should be considered in future PA research. Longitudinal studies are required to determine whether a given volume of activity accumulated in different patterns, impacts associations between PA and health outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how additional cognitive tasks (Stroop test and counting backwards task) influence young adults' ability to generate appropriate postural responses while standing on a continuously oscillating platform. Twenty young adults (25.95 ± 2.97 years) stood on a moving platform which was translated in the anterior–posterior direction at three different frequencies (0.10, 0.25 and 0.50 Hz) in three dual‐task conditions (counting backwards task, a Stroop task or no additional cognitive task). Postural muscle onset latencies and tonic activity levels of the leg muscles were measured through surface electromyography; the number of steps taken and cognitive errors made were recorded. Results showed no significant differences in muscle activity between dual and single‐tasking conditions nor between the two dual tasking conditions. Cognitive errors were made in the counting backwards task but not the Stroop task. A frequency effect was identified with participants showing greater tonic activity in rectus femoris (p = 0.012), gastrocnemius medialis (p = 0.016) and bicep femoris (p = 0.043) at 0.5 Hz, as well as earlier muscle activation in tibialis anterior, gastrocnemius medialis and bicep femoris (p < 0.001) at 0.50 Hz. Transition and steady state muscle onset latencies were only significantly different for gastrocnemius medialis at 0.25 Hz (p = 0.001). Dual tasking did not seem to influence anticipatory postural adjustments in young adults; however, perturbation intensities did. The differences observed in the number of cognitive errors made could be indicative of the regional cortical activations and overlapping demand for resources interfering with balance control, though cortical activation was not recorded. Future research should include detailed cognitive behavior, including cortical activations and task reaction times to better understand the allocation of attentional resources during perturbed balance dual tasking. Highlights: Directionally specific muscle onset latencies in the tibialis anterior, gastrocnemius medialis and bicep femoris were triggered sooner at 0.50 Hz than in the other lower frequencies.Postural responses were largely unchanged between single and dual tasking, suggesting that for young adults, dual‐tasking appears to have no more strength to alter postural control responses than altered support surface stability alone.Only the counting backwards dual‐task condition elicited cognitive errors, suggesting a potential overlapping demand for resource allocation between tasks, though this will need to be confirmed in future work with observation of cortical activation (e.g., through EEG or fNIRS) [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by diverse clinical manifestations including inattention, hyperactivity and impulsivity. Objective: The present study aims to investigate the effects of neurocognitive training (NT), a personalized and specialized exercise programme on symptoms, attention and dynamic balance in treatment‐naïve children diagnosed with ADHD. Methods: Fourteen treatment‐naïve children aged 7–12 years diagnosed with ADHD were enrolled in the intervention group. The NT intervention was administered weekly for 10 consecutive weeks, supplemented by a structured home exercise programme for 6 days a week over the same 10‐week period. ADHD‐related symptoms, attention and dynamic balance were assessed in pre‐treatment, post‐treatment, 6 months, and 12 months. Fifteen typically developing (TD) children, matched for age, underwent evaluation only once to establish baseline normative values. Results: Following the NT (post‐treatment), significant improvements were observed in hyperactivity‐impulsivity scores, oppositional‐defiant behaviours and dynamic balance when compared to the TD children (p < 0.05). In the ADHD group, a significant difference was found in the long term (12‐month follow‐up) in hyperactivity–impulsivity, oppositional‐defiant behaviours and dynamic balance (p < 0.05). Conclusion: The findings suggest that the NT yields favourable effects on hyperactivity–impulsivity, oppositional defiant behaviours and dynamic balance in children diagnosed with ADHD, with these improvements appearing to be sustained over the long term. Clinical trial registration number: NCT04707040. [ABSTRACT FROM AUTHOR]

Background: 'PD Warrior' (PDW) is a popular exercise programme for Parkinson disease; however, there are no published studies on the outcomes of the programme. Aims: To investigate short‐term functional and quality of life (QoL) outcomes after the PDW 10‐week programme in a pilot study of individuals with early Parkinson Disease (PD). Methods: Twenty individuals with PD (Hoehn & Yahr 1–3) attending a hospital outpatient clinic were recruited into the PDW 10‐week programme, comprising a weekly 1‐h supervised class complemented by an individualised daily home exercise programme. Participants had the following assessments at baseline and after completion of the programme: Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS‐UPDRS) Part III, timed up‐and‐go (TUG), 10‐m walk test (10mWT), 6‐min walking test (6MWT), balance tests, fine motor skills, 7‐day Parkinson KinetiGraph (PKG) and PDQ‐39 QoL scale. Results: Seventeen individuals completed the programme. Significant improvements were observed in MDS‐UPDRS motor score (P = 0.019, d = 0.68, MCID 7); 6MWT distance (P < 0.001, d = 1.16); walking time during motor or cognitive dual tasking (P = 0.006, d = 0.77; P = 0.005, d = 0.79, respectively); and the PDQ‐39 emotional well‐being subdomain (P = 0.009; MCID 4.2); as well as improvements trending to significance in bradykinesia (P = 0.025, d = 0.73), 10mWT walking time (P = 0.023, d = 0.61) and borderline improvement in balance (P = 0.056, d = 0.50). Conclusions: The outcomes of this study support the efficacy of the PDW programme in individuals with early PD and provide justification for future trials and investigation of its effects. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual disabilities (IDs) often present deficiencies in motor, balance and postural control. On the other hand, the practice of physical activity and dance usually reduces these deficiencies. Therefore, in this study, we aimed to compare the control of the centre of pressure (COP) in people with Down syndrome (DS) or other causes of ID in relation to people without disabilities and to observe the influence of vision and the practice of dance. Methods: This cross‐sectional study analyses the COP in a static standing position with open and closed eyes in four study groups. A total of 273 people were recruited (80 adults without ID, 46 adults with DS, 120 adults with other causes of ID and 27 dancers with DS). Results: A greater area of oscillation and path of the COP was observed in the participants with ID compared with the participants without ID, especially in the sway area of the COP. The oscillation speed of the COP was also higher. When analysing the displacement of the COP, anteroposterior and mediolateral components, there were also differences, except when comparing the group of dancers with DS with respect to the group without ID. The visual condition only influenced the group of participants without disabilities. Conclusions: The results of our study show that there is a less efficient static postural control in people with ID, as greater displacements were observed in the COP of the participants with ID. The differences in some specific variables that analyse the displacement of the COP were smaller when comparing the group of dancers with DS and the individuals without ID. [ABSTRACT FROM AUTHOR]

Background: The Sensory Organization Test (SOT), an integral part of computerized dynamic posturography, plays a crucial role in evaluating postural stability under various altered sensory conditions. Despite its importance, there have been noted inconsistencies in the results pertaining to equilibrium and sensory system evaluations. This study aimed to compare four sensory analysis scores and equilibrium indices between older adults with and without fall risks. Methods: The study included 34 participants identified as being at risk of falls and 42 control subjects. To categorize individuals between the two groups, we performed area under the receiver operating characteristic curve analyses. This classification was based on scores from the Modified Falls Efficacy Scale (MFES) and the composite scores obtained from the SOT. In addition, we used the Tampa Scale for Kinesiophobia (TSK) as well as the level of disability. Results: The fall risk group demonstrated significantly higher TSK scores (39.39 ± 15.24 for control group vs. 54.65 ± 10.70 for fall risk group; t = −5.09, p = 0.001). The groups demonstrated a significant interaction on the equilibrium index (F = 4.59, p = 0.03), which was lower in the fall risk group in Condition 6 with a moving surface and surround and eyes open (t = 2.29, p = 0.01). The fall risk group demonstrated a higher somatosensory score (t = −1.73, p = 0.04). Conclusions: The fall risk group had a lower equilibrium index score in Condition six of the SOT, which was useful for identifying deficits in vestibular function to integrate sensory information under challenging conditions for postural adaptation. This strategy suggested that the fall risk group could compensate for their risk of falls by utilizing more effective somatosensory reweighting strategies compared with the control group. [ABSTRACT FROM AUTHOR]

Background and Purpose: Celiac Disease (CD) is a chronic form of autoimmune enteropathy caused by gluten and related prolamin consumption. CD presents as a neurological, rheumatological, and musculoskeletal disorder, with ataxia and peripheral neuropathy being the most common. These symptoms could affect balance control and consequently the daily activities and decreased bone mass of these individuals. Although balance disorders are increasingly common, and the diagnosis of celiac diseases is growing worldwide, there is no consensus on the influence of a gluten‐free diet (GFD) on balance control and bone mineral density (BMD). This study aimed to analyze the influence of celiac disease on balance control and BMD in adult women. Methods: A total of 52 adult women aged 18–56 years participated in the study and were divided into two groups: with (26 patients) and without celiac disease (26 patients). The outcome variables were obtained by anthropometry and sociodemographic data. The Celiac Dietary Adherence Test questionnaire was used to assess adherence to the GFD, Neurocom ™ Smart Equitest® to determine balance control, and GE® Lunar Prodigy Advance DXA Bone densitometer for evaluation of BMD. The displacement of the center of pressure in the anteroposterior and mediolateral directions was evaluated under six conditions of the sensory organization test through a routine test performed in MATLAB. Results: Adult women with CD who adhered to a GFD had vestibular system deficits and normal BMD. Discussion: Adult women with CD presented less balance control when they required greater activation of the vestibular system, suggesting that adherence to a GFD leads to normal bone mass. [ABSTRACT FROM AUTHOR]

Introduction: The potential consequences of repeated concussions in sport are well documented. However, it remains unclear whether the cumulative impact of sports‐related concussions differs between different contact sports. Therefore, the aim of the current study was to investigate the cumulative effects of sports‐related concussions on clinical and neurocognitive health in different contact sports. Materials and Methods: In a prospective multicenter study, we examined 507 (74 females) active professional athletes between 18 and 40 years of age from five different contact sports (soccer, handball, American football, basketball, and ice hockey). Data collection involved concussion history, clinical symptom evaluation, neurocognitive assessment, and the collection of other sports‐related information. Composite scores were built for clinical symptoms (such as neck pain and balance disturbances) and for neurocognitive symptoms (such as memory and attention impairments). Results: Athletes having suffered 3+ concussions in the past showed disproportionally higher clinical symptom severity than athletes with less than three concussions across all sports. The level of clinical symptom burden in athletes with 3+ concussions indicated mild impairment. The number of past concussions did not affect neurocognitive performance. Discussion: Repeated sports‐related concussions appear to have a cumulative impact on clinical—but not cognitive—symptom severity. Although clinical symptom burden in athletes with 3+ concussions in the past was not alarmingly high yet in our sample, increased caution should be advised at this point. Despite few exceptions, results are similar for different contact sports, suggesting a similar multidisciplinary concussion management across all types of sport. [ABSTRACT FROM AUTHOR]

See related editorial by Powers and Sehgal in this issue. [ABSTRACT FROM AUTHOR]

The present study investigated whether there is an anticipatory postural adjustment (APA) prior to the onset of predictable perturbation generated by a releasing in the archery performance task. Eighteen volunteers were divided into two groups (expert vs. novice) depending on skill levels. Participants stood on a force plate holding a bow with a laser pointer and took a full drawing motion aiming the laser pointer to the center of target, placed 10 m away from the force plate, then released motion was performed based on the individual's preferred timing. Motion capture system measured the bow motion in 3D, two force plates estimated center of pressure (COP) displacements, and electromyographic (EMG) recorded eight lower limb muscles during the anticipatory and compensatory phases of postural control. The results revealed that, compared to the novice group, (1) the expert group showed smaller variability of bow motion, (2) the APA patterns of the COP and muscle activities before the onset of perturbation (releasing), and (3) shorter time interval between the perturbation onset and the COP peak displacement. The findings suggest that a long‐term practice results in the experts could be adopted to use APA generating mechanical benefit to compensate for predictable perturbation. This would be able to lead to a more stable subsequent postural control to realize the task goal. Highlights: Skill level generates anticipatory postural adjustment (APA) to compensate for a predictable perturbation in the archery performance.The expert showed smaller bow motions in the vertical direction from APA to CPA2 phase.The expert showed the center of pressure (COP) and electromyographic (EMG) activities before the perturbation onset.The expert showed a shorter time interval between the perturbation onset and the COP peak displacement. [ABSTRACT FROM AUTHOR]

Idiopathic toe walking (ITW) refers to ambulation with a toe‐to‐toe gait in the absence of a known cause. Although it is exhibited by typically developing children, it is more common among children with autism spectrum disorder (ASD). Persistent ITW can cause several long‐term medical problems, including ankle deformities and balance and posture abnormalities. In the current study, we first conducted a series of no interaction or alone conditions to verify that ITW exhibited by four children with ASD persisted in the absence of social consequences. We then evaluated a hands‐on‐shoulder plus praise procedure in which gentle pressure is applied to participants' shoulders to prompt their heels to contact the ground, along with praise for appropriate steps in order to reduce ITW. Results suggest that the procedure was effective with all participants, and measures of social validity indicate that caregivers approved of the procedure. We discuss the results in terms of the putative mechanisms responsible for the effects of the procedure as well as the conditions under which the procedure might be used. [ABSTRACT FROM AUTHOR]

Objectives: Determine if (a) a better trunk stability and endurance are associated with an improved whole‐body dynamic balance, and if (b) the assessment tests can be interchanged within each capability. Methods: Sixty‐three physically active young males performed three trunk stability (i.e., the lumbopelvic stability, the unstable sitting and the sudden loading sitting tests), three trunk muscle endurance (i.e., the Biering–Sørensen, the side bridge and the front bridge tests) and four whole‐body dynamic balance (i.e., the tandem and the single‐leg stance, the Y‐Balance, and the single‐leg triple hop tests) tests two times. After assessing the reliability of the variables, a Pearson correlation analysis was performed. Results: The correlations between trunk stability and endurance tests with dynamic balance tests were non‐significant except for the unstable sitting test with both the tandem (r = 0.502) and the single‐leg stance (r = 0.522) tests. Moreover, no relationships were observed between the trunk stability and the trunk muscle endurance tests. Interestingly, no relationships were found between most tests within each capability (i.e., trunk stability, trunk endurance, and dynamic balance) except: (i) the front bridge stability test and the back (r = 0.461) and the side (r = 0.499) bridge stability tests; (ii) the two side bridge endurance tests (r = 0.786); (iii) the tandem and the single‐leg stance tests (0.439 ≤ r ≤ 0.463); (iv) the Y‐Balance and the single‐leg triple hop tests (0.446 ≤ r ≤ 0.477). Conclusion: Better trunk function does not seem to be a relevant factor for dynamic balance in young active males. In this population, specific measures are needed as the test interchangeability is questioned. [ABSTRACT FROM AUTHOR]

The article focuses on diagnosing Chediak-Higashi syndrome through peripheral blood smear findings in a 45-year-old woman with neurological issues, recurrent infections, and neutropenia. Topics include the identification of characteristic giant cytoplasmic granules in leukocytes, the clinical presentation and challenges of diagnosing atypical cases, and the diagnostic importance of peripheral blood smear analysis.

Background: Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied. Purpose: To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women. Method: A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS‐atDCS), and Sham Group (VGT combined with sham tDCS‐stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20‐min sessions using VGT associated with tDCS. Postural balance was assessed pre‐and post‐training and 30 days after the end of the eight sessions using the Mini‐Balance Evaluation Systems Test. Results: Compared to pre‐intervention the Mini BEST test increased similarly in the three groups in post‐intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow‐up (control: pre 23.7 ± 2.8 to follow‐up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow‐up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow‐up 26.8 ± 1.5; p < 0.001). Conclusion: There was an improvement in the postural balance of the three training groups that were independent of tDCS. Discussion: Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic‐tDCS compared to sham‐tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people. [ABSTRACT FROM AUTHOR]

Introduction: Crossfit is a sport that combines cardio‐respiratory and muscle endurance, strength, flexibility, muscle power, speed, coordination, agility and balance. However, there is no information in the literature regarding functional performance of the lower limbs and the endurance of core muscles in this population. The objective of this study was to evaluate the correlation between trunk strength/endurance and lower limb function through lower limb symmetry and balance tests. Methods: Forty‐one young adults aged 19–41 years (26.3 ± 5.4) participated, 15 sedentary and 26 cross fit practitioners for at least one year. The tests were as follows: Biering‐Sørensen Test of trunk extensor endurance, Trunk Flexors Endurance Test at 60°, Side Plank Endurance Test, Lumbar Dynamometry, Single‐Leg Hop Test and Star Excursion Balance Test. Results and Discussion: Although there were higher values, there was no significant difference (p > 0.05) between the groups for lower limb symmetry and strength of trunk flexor muscles. For balance, strength and resistance variables of trunk extensor muscles, the values found were higher in crossfit practitioners than in sedentary subjects. Conclusion: There is a relationship between trunk muscle strength and endurance and lower limb balance. Moreover, cross fit athletes showed higher values of trunk muscle strength/endurance and lower limb balance compared to sedentary adults. [ABSTRACT FROM AUTHOR]

Aim: The inability to quickly react to an external event can lead to an increased risk for accidents (e.g., falls, car crashes) in patients with cirrhosis. The aim of this study was to determine whether a novel clinically feasible measure of simple reaction time (SRT) and reaction accuracy (RA)—a go/no‐go task occurring within 400 ms—could differentiate patients with cirrhosis from controls. Methods: This retrospective study included 160 patients with cirrhosis and 160 controls assessed between January 2010 and October 2022. SRT and RA were evaluated using a ruler drop paradigm and compared using propensity score matching. Factors distinguishing patients with cirrhosis from controls were assessed using logistic regression and receiver operating characteristics curve (ROC) analyses. Results: Propensity score matching identified 112 participants in each group with comparable baseline characteristics. As compared with controls, patients with cirrhosis exhibited significantly prolonged SRT (200 vs. 174 ms; P < 0.001) and diminished total RA (63% vs. 73%; P < 0.001). After adjustment for confounding factors, SRT and RA independently identified patients with cirrhosis. ROC analyses showed that SRT more effectively identified patients with cirrhosis than did the number‐connection test/trail‐making test‐B (area under the curve, 0.87 vs. 0.60; P < 0.001). Conclusions: Patients with cirrhosis demonstrated impairments in short‐latency cognitive function. Given that SRT and RA are associated with balance, falls, and response to perturbation, these parameters may present a task‐specific method to identify patients with cirrhosis at high risk of falls and motor vehicle crashes. Geriatr Gerontol Int 2024; 24: 25–31. [ABSTRACT FROM AUTHOR]

Arthrogenic muscle inhibition (AMI) is induced by pathological knee conditions. The present study aimed to investigate the effect of tactile stimulation on reflex changes induced by simulated AMI during unpredictable landing performances. Twenty participants performed six unilateral landing tasks: 15 cm normal landing (15NL), 30 cm normal landing (30NL), surprise landing (SL), 30 cm normal landing following vibration (30NLV), SL following vibration (SLV), and SL following vibration with Kinesiology tape (SLK). For SL, the solid landing platform (15 cm) was removed and replaced by a false floor. Since the false floor dislodged easily under load, participants unpredictably fell through the platform to the actual landing surface 15 cm below. After completing 15NL, 30NL, and SL, vibration was applied to participants' knees to induce neurological changes similar to AMI. After vibration, participants performed 30NLV, SLV, and SLK in a random order. EMG signals in the post‐landing short latency (31–60 ms) and medium latency (61–90 ms) periods were examined. EMG signals from the vastus lateralis (VL), vastus medialis (VM), and biceps femoris (BF) were recorded and compared between tasks. EMG signals of all muscles in SL were significantly enhanced in the medium latency period as compared with 30NL. Enhanced EMG signals in SL were suppressed by vibration stimulation in the VL, but the suppressed EMG signals were restored after cutaneous stimulation with Kinesiology tape (p < 0.01). Our findings suggest that AMI could alter motor control patterns during unpredictable landing and that tactile stimulation could restore the altered motor control to a normal state. [ABSTRACT FROM AUTHOR]