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Brain Sciences
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Balance Rehabilitation in Neurological Disorders
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Balance Rehabilitation in Neurological Disorders

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Behavioral Neuroscience".

Deadline for manuscript submissions: closed (20 March 2021) | Viewed by 47075

Special Issue Editors

Prof. Dr. Tanvi Bhatt

E-Mail Website
Guest Editor
Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
Interests: neurorehabilitation; balance control; perturbation training; exergaming; falls prevention
Special Issues, Collections and Topics in MDPI journals
Dr. Kelly Westlake

E-Mail Website
Guest Editor
Department of Physical Therapy and Rehabilitation Science, University of Mayland School of Medicine, Baltimore, MD 21042, USA
Interests: neurorehabilitation; balance control; fear of falling; falls prevention

Special Issue Information

Dear Colleagues,

Almost every neurological disorder requires some form of balance rehabilitation to restore or maintain balance in order to reduce fall risk and maximize independence. Recent systematic reviews and meta-analyses suggest that conventional balance interventions, while efficacious for improving clinical outcomes and reducing fall risk, might not actually reduce the incidence of falls. Further, these interventions might have a varied dose–response effect within and between neurological diagnoses. Lastly, compliance with conventional exercise-based interventions has been a challenge.

Recent technological advances have led to emerging alternative therapies for balance rehabilitation, including but not limited to virtual reality, exergaming, and perturbation training. These interventions have been found to increase motivation and adherence, thereby allowing a greater dosage delivery. Further, they can be integrated and translated into community- or home-based programs.

While the concept of dosage is well utilized in exercise physiology and locomotor training via the FITT principle (Frequency, Intensity, Time and Type), it is rather novel and underutilized in balance rehabilitation. Thus, it is still unknown whether the efficacy of interventions is dependent on the type of intervention or dosage parameters.

While developing novel and efficacious interventions is important, of equal significance is developing sensitive and quantitative outcome measures to assess the various balance control domains as well as tests that can identify underlying sensorimotor impairments contributing to the balance disorder for various neurological disorders.

Lastly, the neural targets of both conventional and alternative balance interventions remain sparsely examined and known. A greater appreciation of neural substrates and mechanisms that could serve as therapeutic targets could probably further enhance the efficacy of the interventions.

The overall aim of this Brain Sciences Special Topic is to disseminate and discuss recent advances in the balance rehabilitation of neurological disorders, with a focus on the following subtopics:

  • Emerging/alternative interventions for balance rehabilitation;
  • Enhancing knowledge of dose–response for balance rehabilitation;
  • Neural plasticity in relation to balance rehabilitation;
  • Novel tools and tests for balance assessment and fall-risk prediction;
  • Telerehabilitation and community translation of balance interventions.

We invite you to submit manuscripts in any of the following categories: original research (basic, laboratory-based, clinical, and translational), review papers, rapid communications or commentaries, and brief research reports or methodical/protocol papers.

Dr. Tanvi Bhatt
Dr. Kelly Westlake
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • balance control
  • fall prevention
  • stability
  • rehabilitation
  • nervous system disorders

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Published Papers (14 papers)

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Research

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14 pages, 1305 KiB  
Article
Effect of Multisession Progressive Gait-Slip Training on Fall-Resisting Skills of People with Chronic Stroke: Examining Motor Adaptation in Reactive Stability
by Shamali Dusane and Tanvi Bhatt
Brain Sci. 2021, 11(7), 894; https://doi.org/10.3390/brainsci11070894 - 7 Jul 2021
Cited by 11 | Viewed by 2830
Abstract
Background: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). Methods: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed [...] Read more.
Background: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). Methods: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed on six intensities of gait-slips (levels 1–6). Training consisted of 10 blocks of each progressively increasing intensity (four trials per block) until participants fell at >2 trials per block (fall threshold). In the next session, training began at a sub-fall threshold and progressed further. Fall outcome and threshold, number of compensatory steps, multiple stepping threshold, progression to higher intensities, pre- and post-slip center of mass (CoM), state stability, clinical measures, and treadmill walking speed were analyzed. Results: Post-training, PwCS demonstrated a reduction in falls and compensatory steps on levels 5 and 6 (p < 0.05) compared to pre-training. While an increase in pre-slip stability was limited to level 6 (p < 0.05), improvement in post-slip stability at lift-off was noted on levels 2, 3, and 5 (p < 0.05) along with improved post-slip minimum stability on levels 5 and 6 (p < 0.05). Post-training demonstrated improved fall (p < 0.05) and multiple stepping thresholds (p = 0.05). While most participants could progress to level 4 between the first and last training sessions, more participants progressed to level 6 (p < 0.05). Participants’ treadmill walking speed increased (p < 0.05); however, clinical measures remained unchanged (p > 0.05). Conclusions: Multisession, progressively increasing intensity of treadmill-based gait-slip training appears to induce significant adaptive improvement in falls, compensatory stepping, and postural stability among PwCS. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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9 pages, 1516 KiB  
Communication
Gait and Balance Changes with Investigational Peripheral Nerve Cell Therapy during Deep Brain Stimulation in People with Parkinson’s Disease
by Geetanjali Gera, Zain Guduru, Tritia Yamasaki, Julie A. Gurwell, Monica J. Chau, Anna Krotinger, Frederick A. Schmitt, John T. Slevin, Greg A. Gerhardt, Craig van Horne and Jorge E. Quintero
Brain Sci. 2021, 11(4), 500; https://doi.org/10.3390/brainsci11040500 - 15 Apr 2021
Viewed by 3553
Abstract
Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: [...] Read more.
Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the role of APNG implantation alone. We hypothesized that APNG might improve gait and balance deficits associated with PD. Results: While people with a degenerative movement disorder typically worsen with time, none of the gait parameters significantly changed across visits in this 24 month study. The postural stability item in the UPDRS did not worsen from baseline to the 24-month follow-up. However, we measured gait and balance improvements in the two most affected individuals, who had moderate PD. In these two individuals, we observed an increase in gait velocity and step length that persisted over 6 and 24 months. Conclusions: Participants did not show worsening of gait and balance performance in the off therapy state two years after surgery, while the two most severely affected participants showed improved performance. Further studies may better address the long-term maintanenace of these results. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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15 pages, 884 KiB  
Article
Does Exercise-Based Conventional Training Improve Reactive Balance Control among People with Chronic Stroke?
by Lakshmi Kannan, Jinal Vora, Gonzalo Varas-Diaz, Tanvi Bhatt and Susan Hughes
Brain Sci. 2021, 11(1), 2; https://doi.org/10.3390/brainsci11010002 - 22 Dec 2020
Cited by 6 | Viewed by 3504
Abstract
Background: Exercise-based conventional training has predominantly benefited fall-associated volitional balance control domain; however, the effect on reactive balance control is under-examined. Therefore, the purpose of this study was to examine the effect of exercise-based conventional training on reactive balance control. Methods: Eleven people [...] Read more.
Background: Exercise-based conventional training has predominantly benefited fall-associated volitional balance control domain; however, the effect on reactive balance control is under-examined. Therefore, the purpose of this study was to examine the effect of exercise-based conventional training on reactive balance control. Methods: Eleven people with chronic stroke (PwCS) underwent multi-component training for six weeks (20 sessions) in a tapering manner. Training focused on four constructs-stretching, functional strengthening, balance, and endurance. Volitional balance was measured via movement velocity on the Limits of Stability (LOS) test and reactive balance via center of mass (COM) state stability on the Stance Perturbation Test (SPT). Additionally, behavioral outcomes (fall incidence and/or number of steps taken) were recorded. Results: Movement velocity significantly increased on the LOS test (p < 0.05) post-intervention with a significant decrease in fall incidence (p < 0.05). However, no significant changes were observed in the COM state stability, fall incidence and number of recovery steps on the SPT post-intervention. Conclusion: Although volitional and reactive balance control may share some neurophysiological and biomechanical components, training based on volitional movements might not significantly improve reactive balance control for recovery from large-magnitude perturbations due to its task-specificity. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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19 pages, 5420 KiB  
Article
Head Position and Posturography: A Novel Biomarker to Identify Concussion Sufferers
by Frederick Robert Carrick, Guido Pagnacco, Melissa Hunfalvay, Sergio Azzolino and Elena Oggero
Brain Sci. 2020, 10(12), 1003; https://doi.org/10.3390/brainsci10121003 - 17 Dec 2020
Cited by 6 | Viewed by 4758
Abstract
Balance control systems involve complex systems directing muscle activity to prevent internal and external influences that destabilize posture, especially when body positions change. The computerized dynamic posturography stability score has been established to be the most repeatable posturographic measure using variations of the [...] Read more.
Balance control systems involve complex systems directing muscle activity to prevent internal and external influences that destabilize posture, especially when body positions change. The computerized dynamic posturography stability score has been established to be the most repeatable posturographic measure using variations of the modified Clinical Test of Sensory Integration in Balance (mCTSIB). However, the mCTSIB is a standard group of tests relying largely on eyes-open and -closed standing positions with the head in a neutral position, associated with probability of missing postural instabilities associated with head positions off the neutral plane. Postural stability scores are compromised with changes in head positions after concussion. The position of the head and neck induced by statically maintained head turns is associated with significantly lower stability scores than the standardized head neutral position of the mCTSIB in Post-Concussion Syndrome (PCS) subjects but not in normal healthy controls. This phenomenon may serve as a diagnostic biomarker to differentiate PCS subjects from normal ones as well as serving as a measurement with which to quantify function or the success or failure of a treatment. Head positions off the neutral plane provide novel biomarkers that identify and differentiate subjects suffering from PCS from healthy normal subjects. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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9 pages, 1156 KiB  
Communication
Feasibility of Using Foot–Ground Clearance Biofeedback Training in Treadmill Walking for Post-Stroke Gait Rehabilitation
by Hanatsu Nagano, Catherine M. Said, Lisa James and Rezaul K. Begg
Brain Sci. 2020, 10(12), 978; https://doi.org/10.3390/brainsci10120978 - 13 Dec 2020
Cited by 15 | Viewed by 2960
Abstract
Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous [...] Read more.
Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous reports, real-time biofeedback training may increase MFC. Six post-stroke individuals undertook eight biofeedback training sessions over a month, in which an infrared marker attached to the front part of the shoe was tracked in real-time, showing vertical swing foot motion on a monitor installed in front of the subject during treadmill walking. A target increased MFC range was determined, and participants were instructed to control their MFC within the safe range. Gait assessment was conducted three times: Baseline, Post-training and one month from the final biofeedback training session. In addition to MFC, step length, step width, double support time and foot contact angle were measured. After biofeedback training, increased MFC with a trend of reduced step-to-step variability was observed. Correlation analysis revealed that MFC height of the unaffected limb had interlinks with step length and ankle angle. In contrast, for the affected limb, step width variability and MFC height were positively correlated. The current pilot-study suggested that biofeedback gait training may reduce tripping falls for post-stroke individuals. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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18 pages, 2125 KiB  
Article
Cortical Beta Oscillatory Activity Evoked during Reactive Balance Recovery Scales with Perturbation Difficulty and Individual Balance Ability
by Nina J. Ghosn, Jacqueline A. Palmer, Michael R. Borich, Lena H. Ting and Aiden M. Payne
Brain Sci. 2020, 10(11), 860; https://doi.org/10.3390/brainsci10110860 - 16 Nov 2020
Cited by 18 | Viewed by 3057
Abstract
Cortical beta oscillations (13–30 Hz) reflect sensorimotor processing, but are not well understood in balance recovery. We hypothesized that sensorimotor cortical activity would increase under challenging balance conditions. We predicted greater beta power when balance was challenged, either by more difficult perturbations or [...] Read more.
Cortical beta oscillations (13–30 Hz) reflect sensorimotor processing, but are not well understood in balance recovery. We hypothesized that sensorimotor cortical activity would increase under challenging balance conditions. We predicted greater beta power when balance was challenged, either by more difficult perturbations or by lower balance ability. In 19 young adults, we measured beta power over motor cortical areas (electroencephalography, Cz electrode) during three magnitudes of backward support -surface translations. Peak beta power was measured during early (50–150 ms), late (150–250 ms), and overall (0–400 ms) time bins, and wavelet-based analyses quantified the time course of evoked beta power. An ANOVA was used to compare peak beta power across perturbation magnitudes in each time bin. We further tested the association between perturbation-evoked beta power and individual balance ability measured in a challenging beam walking task. Beta power increased ~50 ms after perturbation, and to a greater extent in larger perturbations. Lower individual balance ability was associated with greater beta power in only the late (150–250 ms) time bin. These findings demonstrate greater sensorimotor cortical engagement under more challenging balance conditions, which may provide a biomarker for reduced automaticity in balance control that could be used in populations with neurological impairments. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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11 pages, 780 KiB  
Article
Percentiles and Reference Values for Accelerometric Gait Assessment in Women Aged 50–80 Years
by Raquel Leirós-Rodríguez, Jesús García-Liñeira, Anxela Soto-Rodríguez and Jose L. García-Soidán
Brain Sci. 2020, 10(11), 832; https://doi.org/10.3390/brainsci10110832 - 9 Nov 2020
Cited by 2 | Viewed by 2076
Abstract
Background: The identification of factors that alter postural stability is fundamental in the design of interventions to maintain independence and mobility. This is especially important for women because of their longer life expectancy and higher incidence of falls than in men. We [...] Read more.
Background: The identification of factors that alter postural stability is fundamental in the design of interventions to maintain independence and mobility. This is especially important for women because of their longer life expectancy and higher incidence of falls than in men. We constructed the percentile box charts and determined the values of reference for the accelerometric assessment of the gait in women. Methods: We used a cross-sectional study with 1096 healthy adult women, who were asked to walk a distance of 20 m three times. Results: In all of the variables, a reduction in the magnitude of accelerations was detected as the age of the group advanced. The box charts show the amplitude of the interquartile ranges, which increases as the age of the participants advances. In addition, the interquartile ranges were greater in the variables that refer to the maximum values of the accelerations. Conclusions: The values obtained can be used to assess changes in gait due to aging, trauma and orthopaedic alterations that may alter postural stability and neurodegenerative processes that increase the risk of falling. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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12 pages, 572 KiB  
Article
Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS
by Nora E. Fritz, Erin M. Edwards, Jennifer Keller, Ani Eloyan, Peter A. Calabresi and Kathleen M. Zackowski
Brain Sci. 2020, 10(11), 822; https://doi.org/10.3390/brainsci10110822 - 6 Nov 2020
Cited by 3 | Viewed by 2162
Abstract
Multiple sclerosis (MS) impacts balance and walking function, resulting in accidental falls. History of falls and clinical assessment are commonly used for fall prediction, yet these measures have limited predictive validity. Falls are multifactorial; consideration of disease-specific pathology may be critical for improving [...] Read more.
Multiple sclerosis (MS) impacts balance and walking function, resulting in accidental falls. History of falls and clinical assessment are commonly used for fall prediction, yet these measures have limited predictive validity. Falls are multifactorial; consideration of disease-specific pathology may be critical for improving fall prediction in MS. The objective of this study was to examine the predictive value of clinical measures (i.e., walking, strength, sensation) and corticospinal tract (CST) MRI measures, both discretely and combined, to fall status in MS. Twenty-nine individuals with relapsing-remitting MS (mean ± SD age: 48.7 ± 11.5 years; 17 females; Expanded Disability Status Scale (EDSS): 4.0 (range 1–6.5); symptom duration: 11.9 ± 8.7 years; 14 fallers) participated in a 3T brain MRI including diffusion tensor imaging and magnetization transfer ratio (MTR) and clinical tests of walking, strength, sensation and falls history. Clinical measures of walking were significantly associated with CST fractional anisotropy and MTR. A model including CST MTR, walk velocity and vibration sensation explained >31% of the variance in fall status (R2 = 0.3181) and accurately distinguished 73.8% fallers, which was superior to stand-alone models that included only MRI or clinical measures. This study advances the field by combining clinical and MRI measures to improve fall prediction accuracy in MS. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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9 pages, 1631 KiB  
Communication
Exergames and Telerehabilitation on Smartphones to Improve Balance in Stroke Patients
by Pablo I. Burgos, Oriana Lara, Alejandro Lavado, Ignacia Rojas-Sepúlveda, Carolina Delgado, Eusebio Bravo, Cristian Kamisato, Julio Torres, Victor Castañeda and Mauricio Cerda
Brain Sci. 2020, 10(11), 773; https://doi.org/10.3390/brainsci10110773 - 23 Oct 2020
Cited by 24 | Viewed by 5481
Abstract
Stroke is currently the world’s second cause of disability. It can cause deficits such as postural control, and telerehabilitation could improve the therapeutic dose as well as functional results. The aim of this work is to determine the effectiveness and usability of a [...] Read more.
Stroke is currently the world’s second cause of disability. It can cause deficits such as postural control, and telerehabilitation could improve the therapeutic dose as well as functional results. The aim of this work is to determine the effectiveness and usability of a low-cost telerehabilitation system in patients with stroke. We developed a telerehabilitation system based on exergames on smartphones, inertial sensors, and a cloud database. We trained the balance of six participants (three men and three women) in early subacute stroke (seven weeks of progress). In addition to their conventional treatment, these participants trained for a total of nine sessions of 30 min per week, for four weeks. The telerehabilitation group was compared with a control group of four clinically similar participants (three men and one woman). Clinical and usability measurements were made before and after the training. The results show a significant improvement of 11.3 ± 3.5 points in the Berg Balance Scale, 8.3 ± 3.01 points in the Mini-BESTest, and 17.5 ± 9.87 points in the Barthel scale for the telerehabilitation group. However, only the improvements of Berg and Barthel scales were statistically higher for the telerehabilitation group compared to the control group. The proposed system achieved excellent usability on the System Usability Scale (87.5 ± 11.61). Our results demonstrate that a complementary low-cost telemedicine approach is feasible, and that it can significantly improve the balance of stroke patients; therefore, the proposed clinical strategy could potentially improve dosage and overall treatment effectiveness. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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8 pages, 242 KiB  
Communication
Effects of Subthalamic Nucleus Deep Brain Stimulation and Levodopa on Balance in People with Parkinson’s Disease: A Cross Sectional Study
by David S. May, Linda R. van Dillen, Gammon M. Earhart, Kerri S. Rawson, Joel S. Perlmutter and Ryan P. Duncan
Brain Sci. 2020, 10(10), 693; https://doi.org/10.3390/brainsci10100693 - 30 Sep 2020
Cited by 5 | Viewed by 2123
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa are common treatment strategies for Parkinson’s disease (PD). However, the specific effects of these treatment strategies on balance and its components remain unclear. This cross-sectional study of people with PD and STN-DBS compared balance in [...] Read more.
Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa are common treatment strategies for Parkinson’s disease (PD). However, the specific effects of these treatment strategies on balance and its components remain unclear. This cross-sectional study of people with PD and STN-DBS compared balance in the treated state (ON-medication/ON-stimulation) and untreated state (OFF-medication/OFF-stimulation) using the Balance Evaluation Systems Test (BESTest). Total BESTest scores from the treated and untreated states were compared to assess overall balance. Scores for the six sections of the BESTest were further compared to assess differences in specific components of balance between treatment conditions. Twenty-nine participants were included (Male: 21, Female: 8, Mean Age ± SD: 65.0 ± 6.9). Total BESTest scores showed improved balance in the treated state compared to the untreated state (Treated: 67.56 ± 10.92; Untreated: 59.23 ± 16.51, p < 0.001). Four sections (Stability Limits/Verticality, Anticipatory Postural Reactions, Sensory Orientation, Stability in Gait) of the BESTest significantly improved in the treated state relative to the untreated state, after correcting for multiple comparisons (p < 0.05). These results demonstrate that STN-DBS and levodopa improve overall balance and provide a first step toward understanding the effects of these treatment strategies on specific components of balance. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
14 pages, 2918 KiB  
Article
Age-Related Differences in Arm and Trunk Responses to First and Repeated Exposure to Laterally Induced Imbalances
by Ruth Y. Akinlosotu, Nesreen Alissa, John D. Sorkin, George F. Wittenberg and Kelly P. Westlake
Brain Sci. 2020, 10(9), 574; https://doi.org/10.3390/brainsci10090574 - 20 Aug 2020
Cited by 5 | Viewed by 2866
Abstract
The objective of this study was to examine age-related differences in arm and trunk responses during first and repeated step induced balance perturbations. Young and older adults received 10 trials of unpredictable lateral platform translations. Outcomes included maximum arm and trunk displacement within [...] Read more.
The objective of this study was to examine age-related differences in arm and trunk responses during first and repeated step induced balance perturbations. Young and older adults received 10 trials of unpredictable lateral platform translations. Outcomes included maximum arm and trunk displacement within 1 s of perturbation and at first foot lift off (FFLO), arm and neck muscle activity as recorded using electromyography (EMG), initial step type, balance confidence, and percentage of harness-assisted trials. Compared to young adults, older adults demonstrated greater arm and trunk angular displacements during the first trial, which were present at FFLO and negatively associated with balance confidence. Unlike young adults, recovery steps in older adults were directed towards the fall with a narrowed base of support. Over repeated trials, rapid habituation of first-trial responses of bilateral arm and trunk displacement and EMG amplitude was demonstrated in young adults, but was absent or limited in older adults. Older adults also relied more on harness assistance during balance recovery. Exaggerated arm and trunk responses to sudden lateral balance perturbations in older adults appear to influence step type and balance recovery. Associations of these persistently amplified movements with an increased reliance on harness assistance suggest that training to reduce these deficits could have positive effects in older adults with and without neurological disorders. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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17 pages, 1187 KiB  
Article
Effect of Mental Fatigue on Postural Sway in Healthy Older Adults and Stroke Populations
by Gonzalo Varas-Diaz, Lakshmi Kannan and Tanvi Bhatt
Brain Sci. 2020, 10(6), 388; https://doi.org/10.3390/brainsci10060388 - 19 Jun 2020
Cited by 23 | Viewed by 4301
Abstract
The aim of this study was to examine the effect of mental fatigue on postural sway under different sensory conditions in healthy older adults and in persons with chronic stroke (PwCS). Thirty healthy older adults (> 60 years old), randomly separated into experimental [...] Read more.
The aim of this study was to examine the effect of mental fatigue on postural sway under different sensory conditions in healthy older adults and in persons with chronic stroke (PwCS). Thirty healthy older adults (> 60 years old), randomly separated into experimental and control groups, as well as 15 PwCS participated in this study. Experimental groups were asked to stand on a force platform wearing seven inertial sensors while performing the Sensory Organization Test (SOT) under two cognitive conditions (single- and dual-task) before and after a mental fatigue task (stop-signal task for 60 min). The control group performed the same protocol before and after watching a movie for 60 min. Changes in subjective fatigue was assessed by the NASA Task Load Index and psychophysiological workload was assessed by heart rate variability (HRV). Postural sway was assessed by calculating the Jerk and root mean square (RMS) of center of mass (COM). Higher Jerk and RMS of COM (p < 0.05) were observed after the mental fatigue task in both healthy older adults and PwCS during SOT, which was not observed in the control group (p > 0.05). Additionally, postural sway increased in the three groups as the SOT conditions became more challenging. Our results indicate that mental fatigue, induced by sustained cognitive activity, can impair balance during SOT in older adult and stroke populations. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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Review

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18 pages, 265 KiB  
Review
Postural Control Dysfunction and Balance Rehabilitation in Older Adults with Mild Cognitive Impairment
by Xuan Liu, Michelle H. Chen and Guang H. Yue
Brain Sci. 2020, 10(11), 873; https://doi.org/10.3390/brainsci10110873 - 19 Nov 2020
Cited by 8 | Viewed by 3010
Abstract
Older adults with mild cognitive impairment (MCI) are at an increased risk for falls and fall-related injuries. It is unclear whether current balance rehabilitation techniques largely developed in cognitively intact populations would be successful in older adults with MCI. This mapping review examined [...] Read more.
Older adults with mild cognitive impairment (MCI) are at an increased risk for falls and fall-related injuries. It is unclear whether current balance rehabilitation techniques largely developed in cognitively intact populations would be successful in older adults with MCI. This mapping review examined the available balance rehabilitation research conducted in older adults with MCI. Databases Medline, Cinahl, Cochrane, PubMed, Scopus, and PsycINFO were systematically searched from inception to August 2020. Twenty-one studies with 16 original randomized controlled trials (RCTs) involving 1201 older adults with MCI (>age 60) met the inclusion criteria, of which 17 studies showed significant treatment effects on balance functions. However, only six studies demonstrated adequate quality (at least single-blind, no significant dropouts, and intervention and control groups are equivalent at baseline) and evidence (medium or large effect size on at least one balance outcome) in improving balance in this population, and none of them are double- or triple-blind. Therefore, more high-quality RCTs are needed to inform future balance rehabilitation program development for older adults with MCI. Moreover, few studies examined the incidence of falls after the intervention, which limits clinical utility. Future RCTs should prospectively monitor falls or changes in risk of falls after the intervention. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)

Other

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14 pages, 310 KiB  
Perspective
Promoting Generalized Learning in Balance Recovery Interventions
by Sara A. Harper, Anne Z. Beethe, Christopher J. Dakin and David A. E. Bolton
Brain Sci. 2021, 11(3), 402; https://doi.org/10.3390/brainsci11030402 - 22 Mar 2021
Cited by 13 | Viewed by 3171
Abstract
Recent studies have shown balance recovery can be enhanced via task-specific training, referred to as perturbation-based balance training (PBT). These interventions rely on principles of motor learning where repeated exposure to task-relevant postural perturbations results in more effective compensatory balance responses. Evidence indicates [...] Read more.
Recent studies have shown balance recovery can be enhanced via task-specific training, referred to as perturbation-based balance training (PBT). These interventions rely on principles of motor learning where repeated exposure to task-relevant postural perturbations results in more effective compensatory balance responses. Evidence indicates that compensatory responses trained using PBT can be retained for many months and can lead to a reduction in falls in community-dwelling older adults. A notable shortcoming with PBT is that it does not transfer well to similar but contextually different scenarios (e.g., falling sideways versus a forward trip). Given that it is not feasible to train all conditions in which someone could fall, this limited transfer presents a conundrum; namely, how do we best use PBT to appropriately equip people to deal with the enormous variety of fall-inducing scenarios encountered in daily life? In this perspective article, we draw from fields of research that explore how general learning can be promoted. From this, we propose a series of methods, gleaned from parallel streams of research, to inform and hopefully optimize this emerging field where people receive training to specifically improve their balance reactions. Full article
(This article belongs to the Special Issue Balance Rehabilitation in Neurological Disorders)
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