Bruno Leban

Effectiveness and Limitations of Unsupervised Home-Based Balance Rehabilitation with Nintendo Wii in People with Multiple Sclerosis

Balance training represents a critical part of the rehabilitation process of individuals living with multiple sclerosis (MS) since impaired postural control is a distinctive symptom of the disease. In recent years, the use of the Nintendo Wii system has become widespread among rehabilitation specialists for this purpose, but few studies have verified the effectiveness of such an approach using quantitative measures of balance. In this study, we analyzed the postural sway features of a cohort of twenty-seven individuals with MS before and after 5 weeks of unsupervised home-based balance training with the Wii system. Center of pressure (COP) time-series were recorded using a pressure platform and processed to calculate sway area, COP path length, displacements, and velocities in mediolateral (ML) and anteroposterior (AP) directions. Although the results show a significant reduction in sway area, COP displacements, and velocity, such improvements are essentially restricted to the ML direction, as the Wii platform appears to properly stimulate the postural control system in the frontal plane but not in the sagittal one. Available Wii games, although somewhat beneficial, appear not fully suitable for rehabilitation in MS owing to scarce flexibility and adaptability to MS needs and thus specific software should be developed.

Effect of light and vigorous physical activity on balance and gait of older adults

This study aims to quantitatively assess the effects of vigorous and light physical activity (VPA, LPA) on static balance, gait and sit-to-stand (STS) tasks in a cohort of healthy older adults. To this end, 34 individuals of age >65 years were divided into two groups (n=17 each) who underwent 36 sessions (3×12 weeks) of PA characterized by different levels of intensity, assessed through continuous heart rate monitoring during the training session. Their balance and mobility were objectively evaluated on the basis of postural sway and time of STS measurements performed using a force platform. The main spatiotemporal parameters of gait (i.e. speed, stride and gait cycle duration, stance, swing and double support phase duration) were also acquired using a wearable inertial measurement unit. The results show that most gait parameters and STS time significantly improve in the VPA group but not in the LPA one. For the latter group a reduction only of swing phase duration was detected. PA also induced a generalized reduction of postural sway in both groups in the case of absence of visual input. These findings suggest that PA programs characterized by superior levels of intensity might be more suitable in generally improving static and dynamic daily motor tasks, while in terms of static balance acceptable results can be achieved even when only light activity is performed.

Effects of backpack carriage on foot-ground relationship in children during upright stance.

Although the scientific community widely recognizes that backpack carriage in primary school children represents a critical issue, its consequences in terms of postural alterations and possible onset of musculoskeletal pathologies are still not fully understood. In particular, little information is available on the way load carriage modifies the foot-ground relationship in terms of plantar pressure distribution. This issue is of particular relevance, because the presence of a load alters the physiological weightbearing functions and, when mechanical overloading is repeated in time, it can act as a co-factor in promoting foot discomfort or pain. On the basis of these considerations, this study analyzed plantar pressure maps of 359 children attending primary schools (6-10 years old) under static upright posture conditions, to assess the magnitude and features of effects originated by load carriage on the foot-ground relationship. The collected data showed that backpack introduces significant increases in overall contact area (up to 10%) and in the plantar pressure peaks in midfoot and forefoot regions (20-30%). A significant shift in the average position of the center of pressure towards the forefoot was also observed, as an indicator of the bodys attempt to restore the initial balance conditions threatened by the load. These results suggest that heavy loads, in the case of significant exposure times, may increase the risk of foot discomfort and act as a co-factor in the onset of foot structure alterations or pathologies.

Short-term effects of backpack carriage on plantar pressure and gait in schoolchildren

PURPOSE To assess the effects of backpack carriage on plantar pressure distributions and spatio-temporal gait parameters among children. PARTICIPANTS Two hundred-eighteen schoolchildren, aged 6-13, and attending primary and secondary schools in the city of Cagliari (Italy). METHODS Participants were tested at school, during regular days. A pressure plate and wearable inertial sensors were used to measure plantar pressures and spatio-temporal parameters of gait. Measures were obtained during both quiet standing and walking, and both with and without a backpack. The latter contained those items a child had on the testing day. RESULTS Participants carried a mean mass in their backpacks of 5.2 kg, and more than half had a backpack/body mass ratio higher than 15%. While spatio-temporal gait parameters were not affected by backpack carriage, significant increases (up to 25%) in plantar pressures were found during both static standing and walking, especially in the forefoot. CONCLUSION Under realistic conditions, the impact of backpack carriage was more evident on foot-ground interaction than on gait features. However, long-term consequences of altered plantar pressure need to be assessed in future work, considering the actual durations typically spent carrying school items.

Relationship between static and dynamic balance abilities in Italian professional and youth league soccer players

OBJECTIVES To assess the existence of correlations between static and dynamic balance abilities in young and professional elite soccer players. DESIGN Cross-sectional. PARTICIPANTS Fifty-one elite players who regularly compete at national level divided into two groups: Professional (age 18-34, n = 20) and Under 15-17 (age 14-16, n = 31). MAIN OUTCOME MEASURES Dynamic balance was assessed for the case of a single-leg landing task by means of vertical time to stabilization (TTS) and postural sway calculated on the basis of center-of-pressure (COP) trajectories (sway area, COP displacements in antero-posterior and medio-lateral direction, COP path length). The same parameters were also measured for a 20 s one-legged stance to assess static balance abilities. RESULTS No significant correlations were found between static and dynamic balance parameters except for TTS and COP displacements in the antero-posterior direction (r = 0.29, p = 0.003). Professional players are characterized by lower TTS in comparison with youth leagues players (0.767 vs. 1.188 s for the dominant limb, p < 0.001) and exhibit reduced sway area (of 34-40%, p < 0.05) for both conditions tested. CONCLUSION The assessment of balance in soccer players should be performed with both dynamic and static tests, considering that the postural control performances in the two cases are not related.

Clinical Assessment of Gait in Individuals with Multiple Sclerosis Using Wearable Inertial Sensors: Comparison with Patient-Based Measure

BACKGROUND This study aims to verify the feasibility of use of wearable accelerometers in an ambulatory environment to assess spatiotemporal parameters of gait in people with Multiple Sclerosis (pwMS), as well as the correlation of objective data with patient-reported outcomes. METHODS One hundred and five pwMS (Expanded Disability Status Scale, EDSS in the range 0-6.5) classified in three sub-groups (EDSS 0-1.5, EDSS 2-4, EDSS 4.5-6.5) and 47 healthy controls (HC) participated in the study. All the subjects were evaluated with the timed 25-foot walking test (T25FW) while wearing a commercially available accelerometer. PwMS also rated the impact of the disease on their walking abilities using the 12-item MS walking scale (MSWS-12). RESULTS All parameters objectively measured, except stride length, were significantly modified in pwMS with higher EDSS, with respect to HC and lower disability participants. Moderate to high correlations (r =0.57-0.79) were observed between gait parameters and MSWS-12 for pwMS of higher EDSS. The correlation was found moderate for the intermediate EDSS category (r =0.42-0.62). CONCLUSION Wearable accelerometers are a useful tool for assessing gait performance for pwMS in a clinical setting, especially in cases of mild to moderate disability. Compared with other quantitative techniques, these devices allow patient testing under realistic conditions (i.e., fully dressed, with their usual shoes) using a simple procedure with immediate availability of data.

Ultrasonic Measurements of Contact Area and Pressure Distribution of a Pneumatic Tire on a Rigid Surface3

Abstract Contact phenomena which occur at the tire-ground interface play a crucial role in most issues related to optimal performances of the vehicle, safety, comfort, and energy consumption. Thus, it is essential to have available experimental tools capable of supplying detailed information about the main contact parameters (size and shape of nominal contact area and contact pressure distribution), especially when unknown or unpredictable external conditions make it difficult to use numerical tools in assessing them. Although a number of laboratory techniques have been devised to address this problem, here we propose a novel approach that exploits the property of ultrasonic waves to be differently reflected by a contact interface depending on its stress state. This noninvasive method is capable of supplying in real-time detailed maps of contact conditions as well as quantitative information with regard to geometric features of the contact area and contact pressure distribution values after suitable postp...

School-based screening of plantar pressures during level walking with a backpack among overweight and obese schoolchildren

Abstract Among children, postural modifications due to backpack carriage have direct consequences on how forces are exchanged between body and ground and thus on plantar pressure distribution. However, it is unknown whether such alterations are influenced by the foot structure and functionality typical of obesity. In this study, we tested 65 overweight/obese primary schoolchildren using a pressure platform while walking with and without the backpack. Contact areas, arch index, peak and mean plantar pressures in the forefoot, midfoot and rearfoot were compared with those from an additional 65 age- and gender-matched group of normal-weight children. Backpack carriage modified pressure distribution similarly in both groups, with the exception of mean midfoot pressure, which increased significantly among normal-weight children but not in the overweight/obese group. Notably, the pressure values associated with mass excess and backpack carriage still raise some concerns regarding potential long-term adverse consequences on foot structure and functionality of overweight/obese children. Practitioner summary: Backpack carriage by overweight/obese schoolchildren altered plantar pressures similar to what was observed in their normal-weight peers. Yet, high pressures were found among the overweight/obese children. This raises concerns regarding potential long-term adverse consequences on foot structure and functionality, and supports establishing more specific limits for the carried load.

Characterization of Static Balance Abilities in Elite Soccer Players by Playing Position and Age

In this study, we investigated the static balance of adult and adolescent elite soccer players to understand how expertise and playing position influence postural control. Seventy-one national level players were tested using a force platform to acquire Center-of-Pressure (COP) data in uni- and bipedal stance and calculate sway area (SA), COP path length, velocity and displacements. The results show significant differences in postural sway related to age and playing position only for single-limb stance. In particular, midfielders exhibited significantly lower values of SA with respect to defenders (–48%, p = 0.001) and the under-15 players exhibited SA 42–64% higher than all the others (p = 0.001). In the light of planning training or rehabilitation programs specific for each player’s role and age, sway measurements may supply useful, objective and reliable information only for the unipedal test as the bipedal standing appears not challenging enough to let differences in balance abilities emerge.

Foot pressure distribution in children with Cerebral Palsy while standing

Foot deformity is a major component of impaired functioning in cerebral palsy (CP). While gait and balance issues related to CP have been studied extensively, there is little information to date on foot-ground interaction (i.e. contact area and plantar pressure distribution). This study aimed to characterize quantitatively the foot-ground contact parameters during static upright standing in hemiplegia and diplegia. We studied 64 children with hemiplegia (mean age 8.2 years; SD 2.8 years) and 43 with diplegia (mean age 8.8 years; SD 2.3 years) while standing on both legs statically on a pressure sensitive mat. We calculated pressure data for the whole foot and sub-regions (i.e. rearfoot, midfoot and forefoot) and average contact pressure. The Arch Index (AI) served for classifying the feet as flat, normal or cavus feet. The data were compared with those from a sample of age- and gender-matched participants (control group, 68 children). Most of the feet showed very high AI values, thus indicating a flat foot. This deformity was more common in diplegia (74.4%) than in hemiplegia (54.7%). In both diplegic and hemiplegic children, average plantar pressure was significantly increased in the forefoot and midfoot and decreased in the rearfoot (p<0.001). The present data indicate an increased load on the front parts of the foot, which may be due to plantarflexor overactivity or knee flexion, combined with an increased incidence of low foot arches. As a low foot arch does not necessarily increase forefoot load, this deformity can be regarded as secondary.