Mohan Ganesan

Enhancement of anticipatory postural adjustments in older adults as a result of a single session of ball throwing exercise

The aim of the study was to investigate the role of short-term training in improvement of anticipatory postural adjustments (APAs) and its effect on subsequent control of posture in older adults. Nine healthy older adults were exposed to self-initiated and predictable external perturbations before and after a single training session consisting of throwing a medicine ball. EMG activity of eight trunk and leg muscles and ground reaction forces were recorded before and immediately after the training session. Muscle onsets and center of pressure displacements were analyzed during the anticipatory and compensatory phases of postural control. The training involving throwing of a medicine ball resulted in enhancement of the generation of APAs seen as significantly early onsets of leg and trunk muscle activity prior to the bilateral arm flexion task. Significantly early activation of postural muscles observed prior to the predictable external perturbation, the task that was not a part of training, indicates the transfer of the effect of the single training session. The observed training-related improvements of APAs suggest that APA-focused rehabilitation could be effective in improving postural control, functional balance, mobility, and quality of life in the elderly.

Direction-specific impairments of limits of stability in individuals with multiple sclerosis

OBJECTIVES Impaired postural control in individuals with multiple sclerosis (MS) is associated with falls. The objective was to evaluate the direction-specific limits of stability in people with MS. METHODS Balance control of 18 individuals with relapsing-remitting MS and 18 healthy controls was assessed using instrumented (Limits of Stability (LOS) test) and clinical (Berg Balance Scale (BBS) and Activities-specific Balance Confidence (ABC) scale) tests. RESULTS There were significant differences in reaction time, movement velocity, endpoint excursion, maximum excursion, and directional control measures of the LOS test between individuals with MS and healthy controls. The BBS and ABC clinical balance measures were significantly lower in individuals with MS compared to control subjects. The directional control impairment was seen in the right side and backward diagonals (backward-right and backward-left) directions. A significant difference between the fallers and non-fallers was found on all the components of the LOS test. There was a significant correlation between the BBS and ABC scores and different components of the LOS test. CONCLUSIONS Direction-specific impairment of limits of stability components was observed in individuals with MS. This information could be used in balance rehabilitation of people with MS.

The effect of lateral or medial wedges on control of postural sway in standing

The objective of this study was to evaluate the effects of lateral and medial wedges on postural sway. Twenty healthy volunteers (mean age range of 28.45±3.34) participated in the study. They stood barefoot with eyes open or closed on each of the three surfaces: 10° lateral wedges, 10° medial wedges, and no wedges. Force platform data were collected and the mean and root mean square (RMS) distance, range, and velocity and the mean frequency of the center of pressure (COP) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. Standing on both lateral and medial wedges was associated with improved postural stability seen through the decreased mean and RMS distance of COP displacement in ML direction. The results of this study suggest that standing on either lateral or medial wedges might enhance postural control in standing.

Partial Body Weight-Supported Treadmill Training in Patients With Parkinson Disease: Impact on Gait and Clinical Manifestation

OBJECTIVE To evaluate the effect of conventional gait training (CGT) and partial weight-supported treadmill training (PWSTT) on gait and clinical manifestation. DESIGN Prospective experimental research design. SETTING Hospital. PARTICIPANTS Patients with idiopathic Parkinson disease (PD) (N=60; mean age, 58.15±8.7y) on stable dosage of dopaminomimetic drugs were randomly assigned into the 3 following groups (20 patients in each group): (1) nonexercising PD group, (2) CGT group, and (3) PWSTT group. INTERVENTIONS The interventions included in the study were CGT and PWSTT. The sessions of the CGT and PWSTT groups were given in patients self-reported best on status after regular medications. The interventions were given for 30min/d, 4d/wk, for 4 weeks (16 sessions). MAIN OUTCOME MEASURES Clinical severity was measured by the Unified Parkinson Disease Rating Scale (UPDRS) and its subscores. Gait was measured by 2 minutes of treadmill walking and the 10-m walk test. Outcome measures were evaluated in their best on status at baseline and after the second and fourth weeks. RESULTS Four weeks of CGT and PWSTT gait training showed significant improvements of UPDRS scores, its subscores, and gait performance measures. Moreover, the effects of PWSTT were significantly better than CGT on most measures. CONCLUSIONS PWSTT is a promising intervention tool to improve the clinical and gait outcome measures in patients with PD.

Do Commonly Used Functional Outcome Measures Capture Activities that Are Relevant for People with Stroke in India

Objectives: In India, post-stroke outcomes are determined using functional outcome measures (FOMs), the contents of which have not been validated for their relevance to the Indian population. In this study, we aimed to evaluate the cultural validity of five frequently used stroke-specific FOMs by comparing their contents with the problems reported by patients with stroke in India. Methods: Face-to-face structured interviews were conducted with 152 patients diagnosed with stroke in India. Problems and goals identified by the patients were compared to each item included in the FOMs used in stroke rehabilitation. Results: The Stroke Impact Scale (SIS) and the Frenchay Activities Index (FAI) include items related to the most frequently identified problems. However, neither covers problems related to the need for squatting and sitting on the floor. Use of public transport and community walking are not included in the SIS. Leisure and recreational activities (e.g. gardening, reading books), cognitive and speech functions (e.g. memory, thinking) and bowel and bladder dysfunctions were the common items identified as “not a problem” or “not relevant” by the patients. Discussion: Our findings suggest that the SIS and FAI are the most appropriate FOMs for patients with stroke in India as they include items related to the majority of problems identified by study participants. Many items on both measures, however, were identified as not a problem or not relevant. There is a need for developing culture-specific FOMs that incorporate all major concerns expressed by patients with stroke in India.

Dynamic Postural Instability in Individuals with High Body Mass Index

Objective(s): To evaluate and compare static and dynamic balance between individuals with high body mass index (BMI) and normal BMI.Methods: This case-control study included 19 individuals with high BMI and 7 individuals with normal BMI. It was conducted at a regional level university setting. The center of pressure (COP) changes during double limb stance and single limb stance were obtained using a force plate (Brazil Do). The main COP outcome measures included total displacement, area of sway, amplitude, velocity, and mean power frequency changes in anteroposterior (AP) and mediolateral (ML) directions.Results: During single limb stance, there was a significant difference in COP amplitude (cm) (p=0.015) and velocity (cm/s) (p=0.012) between the 2 groups in the AP direction. However, there were no significant differences found in the ML direction for amplitude (cm) (p=0.155) or velocity (cm/s) (p=0.186). There was no significant difference in the COP outcome measure for double limb stability for both the eyes closed and eyes opened conditions.Conclusion: Individuals with high BMI have impaired dynamic balance control in the AP direction reflected through higher COP amplitude and velocity. They have preserved stability in the ML direction during single limb stance stability. The COP changes during the double limb stance are unimpaired, both with eyes opened and closed.

Standing on wedges modifies side-specific postural control in the presence of lateral external perturbations

Standing on wedges changes the position in the ankle joints and affects postural stability in the medial-lateral direction. The objective of the study was to investigate the role of wedges and external lateral perturbations on anticipatory (APA) and compensatory postural adjustments (CPA). Ten healthy young participants were exposed to perturbations applied to the lateral part of their right shoulder when standing on a planar surface, on a medial or lateral wedges. Bilateral electromyographic activity of dorsal and ventral postural muscles and the center of pressure (COP) displacement were recorded and analyzed during the APA and CPA phases. When exposed to the lateral perturbation, reciprocal activation of shank muscles was seen on the side of the perturbation while co-contraction of shank muscles was seen on the contralateral side during the APA and CPA phases. Standing on a wedge was associated with decreased magnitudes of co-contraction and reciprocal activation of shank muscles. The COP displacements were smaller in the APA phase and larger in the CPA phase while standing on wedges compared to standing on the planar surface. The outcome of the study provides a basis for future investigations of incorporating wedges in balance re-training paradigms for the elderly or individuals with neurological impairment.