Does the practice of sports or recreational activities improve the balance and gait of children and adolescents with sensorineural hearing loss? A systematic review

BackgroundBalance and gait disorders have been observed in children and adolescents with sensorineural hearing loss (SNHL), justified by vestibular dysfunctions that these children may present, due to the injury to the inner ear. Therefore, some investigations have suggested that the practice of sports or recreational activities can improve the balance and gait of this population.ObjectiveAssess the evidence quality from randomized or quasi-randomized controlled trials that used sports or recreational activities as an intervention to improve the balance and /or gait of children and/or adolescents with SNHL.MethodsSystematic review that surveyed articles in nine databases, published up to January 10, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants from both groups with the clinical diagnosis of SNHL, aged 6–19 years old, without physical problems, cognitive or neurological deficits, except the vestibular dysfunction. (3) Using the practice of sports or recreational activities as an intervention, to improve the balance and/or gait outcomes.Results4732 articles were identified in the searches, after the removal of the duplicates articles and the reading of the titles and their abstracts, remained 16 articles for reading in full, being 5 trials eligible for this systematic review. Of the five eligible trials, three used sports activities and two recreational activities as intervention and presented very low-quality evidence for balance and gait outcomes.SignificanceSports and recreational practices seem to represent promising modalities to improve the balance and gait of children and adolescents with SNHL. However, due to the methodological limitations of the trials and the low quality of the current evidence on the topic, the results of the trials should be interpreted with caution. Due to the low quality of evidence observed, we suggest that new trials be proposed on this topic, with greater methodological rigor, to provide high-quality evidence on the effectiveness of sports and recreational practices to improve the balance and gait of children and adolescents with SNHL.     

Lower Quarter Y Balance Test performance: Reference values for healthy youth aged 10 to 17 years

BackgroundThe Lower Quarter Y Balance Test (YBT-LQ) has been widely used to register dynamic balance performance in children and adolescents. However, studies evaluating age- and sex-specific normative data to assess and classify YBT-LQ performance for these age-cohorts are missing.ObjectiveThus, we investigated YBT-LQ performance in healthy youth to provide age- and sex-specific reference values.MethodsSix-hundred and sixty-nine individuals (286 female, 383 male) aged 10–17 years performed the YBT-LQ with their left and right leg. Normalized maximal reach distances (% leg length) for all three directions (i.e., anterior, posterolateral, posteromedial) and the composite score were calculated. Further, age- and sex-specific percentile values (i.e., 10th to 90th percentile) were computed and plotted.ResultsIn boys, the oldest age group (16−17 years) performed better than the younger ones (14−15, 12−13, and 10−11 years). In girls, the youngest age group (10−11 years) often achieved better values compared to the 12−13-year olds. Further, 16−17-year old boys compared to the same aged girls showed better YBT-LQ performance in all but one measure (except left leg reach in posterolateral direction). For both sexes, curvilinear shaped curves were detected for percentile values across the reach directions.ConclusionsThe generated age- and sex-specific reference values for the YBT-LQ can be used by practitioners to evaluate dynamic balance performance in healthy youth aged 10–17 years.     

An external focus of attention compared to an internal focus of attention improves anticipatory postural adjustments among people post-stroke

BackgroundPeople after stroke often have postural impairments that can increase their risk of falling. Anticipatory postural adjustments (APAs) are changes in the activity of postural muscles prior to a voluntary movement in order to maintain vertical equilibrium. Previous research suggests that improving APAs leads to better postural control and reduces the risk of falls. Despite the importance of APAs and their impairment among people post-stroke, studies that aim to investigate methods for improving APAs are limited. Consistent evidence supports that an external focus of attention compared to an internal focus of attention, yields superior performance of motor skills that include postural control.Research questionWhat are the effects of adopting different foci of attention on measures of APAs and movement parameters when performing a lower extremity Fitts’ task among people post-stroke?MethodsTwelve individuals post-stroke performed a lower extremity stepping movement (Fitts’ task) while adopting an external focus or an internal focus of attention in a within-subject design. A motion capture system was used to record participants’ movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at endpoint (SD_T). Electromyography was used to measure muscle activity and determine APAs onset and magnitude. For all dependent variables separate repeated measures ANOVAs were conducted to compare performance between foci of attention.ResultsThe results showed that an external focus of attention yielded significantly better performance on all outcome measures. The improvement in performance was seen in shorter MT, higher PV, shorter ttPV, smaller SD_T, earlier APAs onset and more efficient APAs magnitude.SignificanceThe changes in outcome measures suggest that adopting an external focus of attention during postural tasks could be an effective strategy for improving balance control among people post-stroke.     

Laboratory-Based Gait Variability and Habitual Gait Entropy Do Not Differentiate Community-Dwelling Older Adults from Those with Subjective Memory Complaints

BackgroundAge-related cognitive decline may be delayed with appropriate interventions if those at high risk can be identified prior to clinical symptoms arising. Gait variability assessment has emerged as a promising candidate prognostic indicator, however, it remains unclear how sensitive gait variability is to early changes in cognitive abilities.Research questionDo community-dwelling adults over 65 years of age with subjective memory complaints differ from those with no subjective memory concerns in terms of laboratory-measured or free-living gait variability?MethodsThis cross-sectional study recruited 24 (age = 73.5(SD 6.4) years) community-dwelling people with subjective memory complaints and twenty seven (age = 70.9(4.3) years) individuals with no subjective memory concerns. A sample of 9 individuals with diagnosed mild dementia were also assessed (age = 86.5(7.0) years). Gait variability was assessed in a laboratory during walking at preferred pace (single-task) and while counting backward by seven (dual-task). Sixteen passes over a 4.88 m walkway in each condition were recorded and step length and duration variability was analysed. Free-living gait was assessed with a waist-worn accelerometer by identifying gait bouts of at least one min duration, and the mean multiscale sample entropy in one mins non-overlapping epochs is reported. Statistical inferences were based on analysis of variance using sex and group as the factors.ResultsNo difference between those with subjective memory complaints and those without were observed in either laboratory- or free-living gait variability estimates. Both laboratory- and free-living gait variability were higher in those with mild dementia compared to the other groups.SignificanceAssuming that subjective memory complaints are on the pathway from cognitively intact to cognitively frail, the findings raise the hypothesis that subjective memory complaints occur earlier in the pathophysiology than measurable changes in laboratory or free living gait. Alternatively the gait variability assessments utilised may have been too insensitive.