A comparison of the efficacy of textured insoles on balance performance in older people with versus without plantar callosities

BackgroundTextured insoles have been suggested to enhance foot sensation, which contributes to controlling upright balance. However, the interaction between plantar callosity and the textured surface has not been studied.Research questionFirstly, to compare the efficacy of textured insoles on balance performance and foot position sense between two groups of older people: one group had plantar callosity, and the other did not. Secondly, to investigate the efficacy of textured insoles within each study group.MethodsThirty older people with a history of falls (15 with plantar callosity and 15 without callosity) participated in this study. All participants underwent assessments of postural sway on a force plate, joint position sensation of the ankle with a slope box, and mobility using the "Timed Up and Go" test under three insole surface conditions: 1) smooth (control), 2) placebo and 3) textured surface. Two-way analyses of variance were used to compare the outcomes of the two groups and three conditions.ResultsOlder people with plantar callosity had worse ankle joint position sense and slower antero-posterior and mediolateral postural sway velocity than their peers who did not have plantar callosity. The textured insoles improved ankle joint position sense and mobility regardless of callus status in the plantar surface of older peoples’ feet. The insole-callosity interaction was not significant for any study outcome.SignificanceTextured insoles could be beneficial to older people with and without callosity as they have shown immediate improvements in ankle joint position sense and mobility.     

The effects of cryotherapy on athletes’ muscle strength,flexibility, and neuromuscular control: A systematic review of the literature

PurposeThis review aimed to investigate the effects of cryotherapy on the functional capacity parameters of athletes, such as muscular strength, flexibility, neuromuscular control, and balance.MethodsA computerized search of EBSCO Host databases, Proquest, Medline, SportDiscus, CinahlPlus, Health Source Nursing/Academic Edition, Academic Search Complete, and GoogleScholar databases was performed to identify clinical trials with a focus on cryotherapy applications in sport. Thekeywords used were “cryotherapy,” “sports,”“strength,”“flexibility,” and “proprioception.”Study selectionRandomized control trials and randomized crossover studies of healthy athletes were included in this review. The methodological quality of the studies was assessed by the validation criteria given by Furlan et al (2009).ResultsA total of 50 randomized controlled trials (RCTs) and randomized crossover studies met the above criteria and were included in the final analysis. The studies available indicate that there is no strong research evidence to suggest that cryotherapy can definitely influence joint strength and neuromuscular control. The only positive effect of cryotherapy appears to be an improvement in joint flexibility.ConclusionsLimited and equivocal evidence is available to address the effect of cryotherapy on muscular function. The only evidence-based positive impact after the applications of cryotherapy is improved joint flexibility. Despite the extensive use of cryotherapy in sports, further research is needed to document the actual effects of cryotherapy applications on athletes' functional performance and rehabilitation parameters.     

Seven cervical sensorimotor control tests measure different skills in individuals with chronic idiopathic neck pain

BackgroundSensorimotor control is commonly reported in neck pain research and rapidly gaining interest in clinical practice. Joint position error (conventional and torsion), postural balance, subjective visual vertical, head tilt response, The Fly®, smooth pursuit neck torsion and head steadiness are tests that have been reported to assess cervical sensorimotor control. However, it is unknown whether clinicians could use one test, or a test battery, to appropriately assess cervical sensorimotor control and improve efficiency. Our main research question is: Do seven cervical sensorimotor control tests measure unique or similar characteristics of sensorimotor control in individuals with chronic idiopathic neck pain?MethodsPrinciple components factor analysis. Data from seven cervical sensorimotor control tests of 50 participants with chronic idiopathic neck pain were included. Individual factors, potentially related to sensorimotor control, were determined by Eigen values >1.00 and inspection of a loading plot. Items with loadings ≥0.40 were considered satisfactory for inclusion in a factor.ResultsAll cervical sensorimotor control tests were found to measure unique skills. Four factors were isolated with two, postural balance and head steadiness, accounting for most of the variance across tests. The remaining two factors, continuous movement accuracy and perceived verticality, contributed less to the observed variance.ConclusionPostural balance and head steadiness were the major underlying factors explaining cervical sensorimotor control in the current sample. However, our results imply that all seven tests are independent and measure different skills. It is not possible to recommend a test battery for clinical practice, as all tests measure unique skills which appear to be independent of each other.     

Vibratory stimulus to the masseter muscle impairs the oral fine motor control during biting tasks

PurposeTo investigated the effect of vibratory stimulus on masseter muscles during oral fine motor biting tasks.MethodsSixteen healthy individuals (age: 24.5 ± 2.4 years) participated in experiment I during which the participants were asked to “hold and split” half a roasted peanut placed on a force transducer with their front teeth. The participant performed ten series with ten trials of the “hold and split” behavioral task while vibratory stimulus was applied on the masseter muscle every alternate series. Further, fourteen participants participated (age: 25.2 ± 4.8 years) in experiment II during which they performed a series each of the behavioral task at baseline, an adjusted baseline without and with vibration as well as with and without visual feedback. Hold and split forces along with the variability of hold force and duration and force rate during the split were measured.ResultsThe results of the study showed an increase in the magnitude of the hold force (P = 0.002), force rate during the split (P < 0.001) and a significant decrease in the duration of split (P < 0.001) due to the vibratory stimulus. However, there was no significant effect of the vibratory stimulus on the variability of hold forces (P = 0.879) or mean split force (P = 0.683) during the “hold and split” behavioral task. The results of experiment II also showed an increase in hold force due to the vibratory stimulus (P < 0.001).ConclusionsVibratory stimulus to the masseter muscles impairs the oral force control during a standardized biting task and provide further insight into the sensorimotor regulation of the masticatory system.     

A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report

Study DesignCase report.IntroductionStudies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation.Purpose of the StudyTo describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury.MethodsThe patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation.ResultsThe patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values.DiscussionThe results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury.ConclusionsThis is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.     

Test-retest reliability of upper-limb proprioception and balance tests in older nursing home residents

AimTo examine the test-retest reliability of two upper-limb proprioception tests (Weight Detection Test, or WDT, and Arm Ruler Positioning Test, or ARPT) and two balance tests (Functional Reach Test, or FRT, and Timed Up and Go test, or TUG) in older nursing home residents.MethodsFifty-three nursing home residents (85.9 ± 3.9 years) participated in this study. Outcome measures were assessed on two occasions, 10–14 days apart. The same rater administered all tests. The relative reliability was estimated using the intraclass correlation coefficients (ICCs) with a two-way mixed-effects model. The absolute reliability was analyzed using the standard error of the mean (SEM) to estimate the minimal detectable change (MDC) at the 95 % confidence level. Systematic bias was studied using the paired-samples t-test or the Wilcoxon signed-rank test.ResultsThe WDT (ICC = 0.84), ARPT (ICC = 0.87) and FRT (ICC = 0.85) had good relative reliability, and the TUG (ICC = 0.99) had excellent reliability. Our results suggest acceptable measurement precision: the SEMs were equal to 1.0 points, and 0.3 cm, 1.5 cm, and 0.5 s for the WDT, ARPT, FRT, and TUG, respectively. The mean difference between sessions was 0.3 points (1.4 %; w=-1.37, p = 0.17) in the WDT, 0.1 cm (-0.74 %; t = 0.41, p = 0.68) in the ARPT, 0.1 cm (0.45 %; w=-0.33, p = 0.74) in the FRT, and 0.2 s (1.37 %; w=-2.28, p = 0.02) in the TUG.ConclusionsThis study showed that the four field-usable motor tests had good to excellent test-retest reliability and had acceptable measurement precision in older nursing home residents. These tests could be valuable clinical tools for assessing proprioception and balance in nursing home residents.     

Center of pressure position in the touches of the star excursion balance test in healthy individuals

BackgroundThe Star Excursion Balance Test (SEBT) is a clinical test that aims to assess postural control. Its interpretation is related to the understanding of the motor specificities required. Adjustments must be made to the center of pressure (COP) to maintain balance during testing movements. Comprehend the specifics of these adjustments for each direction can allow the development of more suitable exercises for balance training. The aim was to compare the positions of the COP on the different directions of the SEBT and correlate the reachs obtained in the SEBT with the distances from the COP to the borders of the base of support (BOS).MethodsSixteen healthy subjects participated in the study. Measurements were made by performing the SEBT over the force platform. The Kruskal-Wallis test followed by Bonferroni's post hoc test was used to compare directions. The Pearson correlation test was used to check the correlation of parametric variables and Spearman correlation test for the nonparametric ones.ResultsThe position of the COP at the touch differs from the anterior direction to the other directions of the SEBT and the performance in this direction is correlated with the proximity of the COP to the anterior limit of the support base. The performances in the other directions did not correlate with the COP position.ConclusionThe requirements of the compensation mechanisms for postural control are different between the directions of the SEBT.     

Cognitive loading-induced sway alterations are similar in those with chronic ankle instability and uninjured controls

Performing a cognitive task while balancing can result in either increased or decreased sway depending on the nature of the cognitive task, and is commonly used in pathologic populations to evaluate postural performance. A total of 39 participants were recruited into two groups: uninjured controls (n = 20, age: 21.9 ± 2.1 years, height: 175.0 ± 11.2 cm, mass: 71.3 ± 14.9 kg) and chronic ankle instability (n = 19, age: 22.1 ± 5.6 years, height: 169.7 ± 7.7 cm, mass: 72.9 ± 17.3 kg). Participants were asked to perform one of three cognitive tasks while maintaining single limb balance. Cognitive tasks included backwards counting by 3 (BC), the manikin test (MAN), and random number generation (RNG). Time-to-boundary minima, mean, and standard deviations were calculated and compared between groups as pre to post change scores. Effect sizes and 95% confidence intervals were also calculated to test for group differences and the effect of task performance on sway. No significant main effects of Group or Group by Task interactions were identified (p > 0.05). However, a significant multivariate main effect of Task was identified in BC (p = 0.001, F(6, 32) = 4.804) and RNG (p < 0.001, F(6, 32) = 6.233) but not for MAN (p = 0.117). The results suggest that those with chronic ankle instability and uninjured controls have similar postural–suprapostural interactions across multiple cognitive task domains. Both the BC and RNG tasks resulted in less sway for all participants. Our results suggest that dual-task interference in the CAI population may not be present as previous research would suggest.     

The effect of ice stimulation on sensory loss in chronic stroke patients—a feasibility study

Objectives

Ice stimulation has often been used in sensory bombardment programmes after stroke. This feasibility study explored the effects of ice as a single stimulus on disturbed wrist position sense, sensation of light touch and temperature discrimination of the affected hand.

Design

A multiple baseline single case study design across subjects.

Setting

Physiotherapy department at the Royal Star and Garter Home.

Participants

Four patients following cerebrovascular accident with left hemiparesis.

Methods

Eight baseline measurements were collected over a minimum of 8 days. The intervention phase was started for the first, second, third and fourth subjects staggered on the 8th, 11th, 13th and 15th days of the study, respectively.

Intervention

The intervention phase involved daily short, repeated ice-water immersions of each subject's affected hand.

Main outcome measure

Repeated measurements of wrist position sense, sensation of light touch and temperature discrimination.

Results

Visual and statistical analysis indicated that changes of wrist position error were neither significant nor consistent across subjects. Results for sensation of light touch were inconclusive: one subject improved and two subjects showed deterioration. Temperature discrimination of warm stimuli improved in one subject.

Conclusion

These observations suggest that ice-water immersions of the affected hand did not improve wrist position sense in three chronic stroke patients. Further exploration of the effects of ice stimulation on disturbed sensation of light touch and temperature after stroke is justified.