Search Results (62)

Background: Postural disability develops in almost all patients with diabetic polyneuropathy (DPN). While transcutaneous electrical nerve stimulation (TENS) has proven effective in regressing sensory and motor impairments, its efficacy in improving postural control remains insufficiently studied. Purpose: To evaluate and compare the efficacy of direct peroneal and tibial high-frequency low-amplitude (HFLA) TENS and low-frequency high-amplitude (LFHA) TENS in correcting DPN-related postural disability, among European female patients without a documented history of falls, motor deficits, or pronounced electromyographic impairments, using computerized static posturography and the tandem walk test. Materials and methods: In this single-center, three-arm, randomized controlled trial (registration number: ISRCTN47534508, 3 December 2024), we conducted a longitudinal prospective analysis of European women with DPN-related postural disability. All enrolled patients were non-fallers with no motor deficits and baseline compound muscle action potential (CMAP) amplitudes of the peroneal and tibial nerves of at least 1.5 mV. The intervention groups received HFLA TENS (n = 24) or LFHA TENS (n = 25), while the control group underwent sham TENS (n = 24). Primary endpoints were assessed via static posturography and the tandem walk test (TWT); secondary endpoints were evaluated using hypoesthesia and pain evaluation, the Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), and electromyography. Assessments were performed before treatment, immediately post-treatment, and at the conclusion of a 2-month follow-up period. Results: Comparative analysis incorporating the Bonferroni adjustment demonstrated that LFHA TENS is significantly superior to HFLA TENS. Post-treatment, LFHA TENS induced a reduction in envelope area by 20.7% under the eyes-open (EO) condition (p < α_adj; α_adj = 0.0028) and 32.9% under the eyes-closed (EC) condition (p < α_adj; α_adj = 0.0028), alongside a 16.6% decrease in the Romberg uotient (RQ) (p < α_adj; α_adj = 0.0056). Furthermore, LFHA TENS elicited a significant 39.0% reduction in velocity of CoP sway (VCS) under the EO condition (p < α_adj; α_adj = 0.0042), and decreased total CoP sway excursion by an average of 35.8% (EO) (p < α_adj; α_adj = 0.0042) and 43.8% (EC) (p < α_adj; α_adj = 0.0042) compared to baseline. In contrast, no statistically significant changes in these parameters were observed after HFLA TENS. Ultimately, LFHA TENS outperformed HFLA TENS in improving postural stability by 7.04% under the EO condition (p < α_adj; α_adj = 0.0042) and by 25.5% under the EC condition (p < α_adj; α_adj = 0.0042) in both the tandem walk test (TWT) and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Notably, a statistically significant increase in the CMAP amplitude of the affected peroneal nerves by 22.2% was observed exclusively following LFHA TENS treatment (p < α_adj; α_adj = 0.0056). Conclusions: The clinical efficacy of direct peroneal and tibial TENS compared to sham stimulation in reducing postural disability during both static and dynamic conditions was established in European female patients with moderate-to-severe DPN and unremarkable EMG impairments. Comparative analysis reveals a clear therapeutic superiority of LFHA TENS over HFLA TENS, as evidenced by significantly greater improvements in both posturographic parameters (envelope area, total CoP excursion under EO and EC conditions, and VCS under the EO condition) and functional clinical tests (TWT and mCTSIB), demonstrating long-term stability for up to 2 months post-intervention. Full article

Background and Objectives: Idiopathic scoliosis (IS) has been conceptualized as a structural spinal deformity; emerging evidence suggests that postural control and vestibular mechanisms may contribute to curve development and functional severity. This study investigated the relationship between radiological parameters, postural stability, and vestibular dysfunction in adolescents with IS. Materials and Methods: A retrospective cohort of 177 patients aged 8–22 years was analyzed between 2022 and 2024. Standard radiography was performed on 135 participants to evaluate the major curve as established by the Cobb method, Nash–Moe classification, and Risser stage. Peripheral vestibular syndrome (PVS) was investigated using the Fukuda (FST), video-nystagmography (VNG), and instrumental Romberg tests on a stable and unstable platform. Associations between vestibular variables and radiographic parameters were explored using Mann–Whitney U and Kruskal–Wallis tests, supported by non-parametric correlations. Results: Female participants (63%) exhibited significantly higher initial major curve angle value compared with males (median 14° vs. 10.5°, p = 0.004). Positive FTS findings and the presence of peripheral vestibular syndrome were strongly associated with higher baseline and final major curve angles (both p < 0.001). Romberg performance showed significant correlations with major curve angle across stable and unstable conditions (r = 0.298–0.396, all p < 0.001). VNG identified multi-canal vestibular involvement, particularly anterior–horizontal combinations on the right ear, as being associated with substantially greater curve magnitude; left-ear impairment demonstrated similar non-significant trends. Curve localization did not differ by vestibular involvement. Conclusions: Patients with idiopathic scoliosis (IS) display consistent associations between vestibular dysfunction, impaired postural control, and greater curve severity. These findings support the clinical relevance of vestibular assessment in scoliosis evaluation and suggest a potential role for sensorimotor rehabilitation strategies. Integrating vestibular screening into standard care may enhance risk stratification and inform the clinician on individualized conservative management. Full article

Elite karate performance depends on neuromuscular power, joint mobility, and postural stability, yet sex-specific biomechanical profiles in this population remain insufficiently characterized. This study examined differences in lower-limb explosive power, joint kinematics, and visual-dependent postural control in 28 international-level karatekas. Assessments included vertical jump tests, joint mobility tasks performed at preferred and maximum velocities, and stabilometric evaluations under eyes-open and eyes-closed conditions. Males demonstrated significantly longer flight and phase times across all jump tests (all p < 0.05), and higher maximum angular velocities during shoulder flexion and extension, while females exhibited greater hip abduction range of motion during the Wall Split test (all p < 0.05). In postural control, females showed larger Ellipse Area and Path Length under eyes-open conditions (p < 0.05), but these differences were eliminated when vision was removed. The Romberg Index indicated comparable reliance on visual input between sexes. These findings may support the development of more individualized, sex-specific conditioning strategies in elite karate. Full article

Postural control relies on the integration of visual, vestibular, and somatosensory inputs under biomechanical constraints. Conventional Romberg testing provides limited quantitative insight, particularly regarding directional control and sensory dependence. Wearable inertial measurement units (IMUs) enable portable, multidimensional assessment of postural sway. Thirty healthy adults (15 females, 15 males) completed a modified Romberg protocol with systematic manipulation of stance (normal, tandem), visual condition (eyes open, eyes closed), and arm position (arms at sides, arms forward), including both left and right leading foot during tandem stance. Whole-body kinematics were recorded using a full-body IMU system comprising 17 wireless sensors. Center-of-mass (CoM) trajectories were derived from a 23-segment biomechanical model, and linear, spatial, and nonlinear sway metrics were computed. Statistical analyses were conducted using repeated-measures ANOVA, with significance set at p < 0.05. Visual deprivation significantly increased sway path length, mean sway velocity, and sway area across all stance conditions (p < 0.001). Tandem stance elicited greater mediolateral sway than normal stance (p < 0.001). Romberg ratios exceeded unity for all metrics and were significantly higher in tandem stance (p < 0.01). Arm position effects were negligible in normal stance but showed significant Vision × Arm interactions during tandem stance (p < 0.05). Leading foot position had no significant main effects. Combining a modified Romberg protocol with full-body IMU-based CoM analysis enables sensitive characterization of sensory dependence and directional postural control. Tandem stance with visual deprivation increases mediolateral postural demands under reduced base-of-support conditions, providing a more challenging context for evaluating directional postural control. Full article

Background: Orthostatic intolerance (OI) is an important factor affecting daily functional capacity in patients with long COVID. Traditionally, most OI symptoms have been attributed to exaggerated sympathetic nervous system activation associated with postural orthostatic tachycardia syndrome (POTS). Disequilibrium, also referred to as postural instability, may contribute to the development of OI in patients with long COVID. Methods: This study evaluated 32 patients with long COVID using neurological examinations and the active 10-min standing test. Disequilibrium was assessed using the Romberg and tandem gait tests. OI was defined as the inability to complete the active 10-min standing test. Results: Seven patients (22%) were diagnosed with OI. None of them had POTS, whereas six (86%) demonstrated disequilibrium, as detected by the Romberg and/or tandem gait test. POTS was observed in eight patients (25%), none of whom had OI. Disequilibrium was observed in nine patients (28%), six of whom (67%) had OI. Multiple regression analysis revealed that disequilibrium was positively associated with OI (r = 0.64, p < 0.001), whereas POTS was inversely associated (r = −0.38, p < 0.05). After 6 weeks of oral minocycline treatment in six patients and 2 weeks of repetitive transcranial magnetic stimulation therapy following minocycline in the other one patient, symptom amelioration was reported in six patients with OI. OI concomitant with disequilibrium recovered in five of the six patients treated and tested, although one patient who experienced symptom recovery failed to undergo the repeated standing test. Conclusions: Disequilibrium, rather than POTS, was the primary determinant of OI in patients with long COVID. Full article

Background: The aim of the study was to examine the relationship between body weight (weight category groups) and the ability to maintain balance in conditions of restricted field of vision and support area in female wrestlers. Methods: The study involved female wrestlers (n = 34), who were divided into three weight categories. The Romberg test was performer using a freeSTEP STANDARD stabilometric platform. The analysed stabilometric parameters measuring the range of centre-of-pressure (CoP) deviation included total path length (PL) of foot pressure on the ground. Results: The postural stability of female wrestlers was determined by their position, the quality of visual information, the limitation of the support base, and their weight category. As visual information and the support base were limited (when standing on one leg), the deviation of the centre of gravity increased (right leg: f² = 0.293, p < 0.005). Lightweight competitors showed the biggest body deviations in the ‘standing with both feet and eyes open’ position compared to the middleweight and heavyweight categories (eyes open EO f² = 0.233, p < 0.05; eyes closed EC f² = 0.217, p < 0.05). The differences between the tests with eyes open and closed were statistically significant only in the lightweight category. Conclusions: Balance training on the right leg with eyes open can be a sensitive diagnostic test, highlighting differences in stability levels between weight groups. It indicates the need to develop stability while eliminating visual compensation in order to compensate for these differences in competitive sports. Full article

Objective: This study aimed to investigate the effects of dual-task stroboscopic visual training (DTSVT) on balance, functional mobility, and gait in children who are hard-of-hearing. Methods: This randomized controlled study included 31 children (17 girls, 14 boys) with congenital sensorineural hearing loss. Participants were assigned to one of three groups: control group, conventional balance training (CBT) group, and DTSVT group. The CBT and DTSVT groups participated in an exercise program for 16 weeks, twice weekly, for 40 min (a total of 24 sessions). Static balance was assessed using the Tandem Romberg test and Single-Leg Stance (SLS) test, while dynamic balance was evaluated using the Functional Reach Test (FRT), balance disc test, and the Four Square Step Test (FSST). The Pediatric Balance Scale (PBS) was used as a subjective balance assessment. Functional mobility was assessed using the Timed Up and Go (TUG) Test, Step Test, 10 m Walk Test (10 MWT), and Functional Gait Assessment (FGA). Postural sway parameters were recorded using the GyKo device, including Sway Area (EA, cm²), Distance Length (DL, cm), Length (anterior–posterior (AP)) (cm), Length (medial–lateral (ML)) (cm), Mean Distance (D) (cm), Mean Distance (AP) (cm), and Mean Distance (ML) (cm). Results: Significant between-group differences were primarily observed in favor of the DTSVT group post-treatment, particularly in PBS scores, GyKoDL values during the eyes-open SLS test, and TUG test completion times (p < 0.05). Some baseline differences were noted among groups in functional reach distance, FSST completion time, and eyes-closed duration on the Balance Disc test (p < 0.05). Within-group comparisons revealed significant improvements in FSST times in both intervention groups, reduced postural sway parameters during the FRT in the DTSVT and control groups, and increased eyes-closed Tandem Romberg duration in the CBT group (p < 0.05). Most other outcome measures did not demonstrate statistically significant changes either within or between groups (p > 0.05). Conclusions: Dual-task stroboscopic visual training was more effective than conventional balance training in improving specific aspects of balance and functional mobility in children who are hard-of-hearing. These findings highlight the potential of adding cognitively demanding and visually engaging balance tasks to rehabilitation programs for this population. Larger and more diverse samples in future studies are needed to enhance the generalizability of these results. Studies that assess balance and gait using standardized clinical or laboratory tests may be particularly valuable. Given the small sample size and multiple comparisons, the results should be considered preliminary and exploratory. Full article

Background: Posturography is a diagnostic method used to evaluate postural stability by recording body sway and the distribution of pressure on the ground. Temporomandibular disorders (TMDs) involve musculoskeletal and neuromuscular dysfunctions affecting the temporomandibular joint, masticatory muscles, and associated structures. Given the anatomical and functional connections between the stomatognathic system and postural control mechanisms, this study aimed to assess whether TMDs influence body posture and balance as measured by posturographic parameters. Methods: 75 volunteers, aged 19–48, were included. The TMD group (n = 45) was diagnosed based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and the control group (n = 30) showed no signs of TMD. All participants underwent posturographic assessment and jaw opening range measurement. Posturography was performed using a pressure platform that recorded the center of pressure (COP) in static conditions. Postural stability was assessed using the Romberg test with eyes open and closed. Results: No statistically significant differences were found between the TMD and control groups in COP parameters, including ellipse area (EA) and total load distribution. Within both groups, COP sway increased significantly in the eyes-closed (EC) condition, as reflected by a greater unsteadiness length (UL). In contrast, EA was larger in the eyes-open (EO) condition in both groups, indicating a wider but more controlled spatial dispersion of COP. Intra-group analysis further revealed a significantly higher load on the left side in the control group only. Conclusions: The results do not support a significant postural imbalance in individuals with TMD compared to healthy controls. However, increased sway with eyes closed suggests that visual input plays a key role in postural control, regardless of TMD status. Full article

Incomplete spinal cord injury (iSCI) results in impaired postural control and walking ability. Visual over-reliance may occur in iSCI individuals to maintain postural control. This can challenge their postural stability in various contexts of daily life activities. The present study assessed the feasibility, acceptability, and preliminary outcomes of balance training with intermittent visual deprivation using stroboscopic glasses on postural control and visual reliance during quiet standing in iSCI individuals. Training impact on walking performance was also evaluated. Seven chronic iSCI individuals participated in a 6-week home-based balance training program, three times weekly, using stroboscopic glasses. Postural and walking abilities were assessed pre- and post-training using a bipedal stance test (BST) and 10 m walking test (10 MWT). BST was performed, with open-eyes (OE) and closed-eyes (CE), on a force plate for three 30 s trials. The center of pressure (CoP) variables included were CoP area (A-CoP) and CoP mean velocity (MV-CoP). Romberg ratios (CE/OE) for two CoP variables were calculated. Duration and speed were measured in 10 MWT. Intervention feasibility was assessed using the feasibility and acceptability questionnaire. Data from able-bodied individuals were recorded and used as references of physiological performance. iSCI individuals were significantly less stable and showed visual over-reliance for postural steadiness compared to controls. Also, their walking ability was impaired. All iSCI individuals completed the training (adherence rate: 84%) and rated it highly feasible. A-CoP and MV-CoP significantly reduced after training in CE condition (p = 0.018, respectively) but not in OE condition (p > 0.05). The Romberg ratio of A-CoP was significantly lower (p = 0.018), but the Romberg ratio of MV-CoP was not (p > 0.05). A significant reduction in duration and increase in speed (p = 0.018, respectively) in performing the 10 MWT were observed. Preliminary findings from this explorative study indicated that 6-week home-based balance training with intermittent visual deprivation was feasible, acceptable, and had promising potential benefits in improving postural control with a reduction in visual over-reliance in iSCI individuals. The training enhanced also their walking performance. Full article

Background: The vestibular Romberg test, which assesses the deterioration of balance while standing on rubber foam with closed eyes, is a well-established method in the physical neurological assessment of patients with peripheral vestibulopathy. This study aims to determine whether it can differentiate peripheral vestibulopathy from its main differential diagnosis, namely sensory ataxia, as both conditions typically present with a positive classical Romberg test. Methods: Static balance was assessed in three groups: patients with peripheral vestibulopathy, patients with pure sensory neuropathy, and healthy age-matched controls. Participants stood quietly on a force platform under varying visual and proprioceptive feedback conditions. Conventional and advanced postural sway metrics were investigated to establish a quantitative analogy to both the clinical Romberg and vestibular Romberg tests. Results: Posturographic analysis revealed that, in contrast to healthy controls, patients with vestibular disorders exhibited higher vestibular Romberg quotient values. However, the classical vestibular Romberg quotient did not show diagnostic discrimination between vestibulopathy and sensory neuropathy patients. This lack of discrimination was mainly due to the increased body sway observed in all patient groups under the “eyes open” condition. Nevertheless, a refined vestibular Romberg quotient—comparing standing on foam versus standing on firm support with eyes closed—was able to reliably distinguish vestibulopathy from sensory ataxia. This distinction was evident in both conventional linear sway and spectral postural sway metrics. Conclusions: We conclude that a refined Romberg test, performed solely under conditions of visual deprivation, offers valuable classification potential in differentiating peripheral vestibulopathy not only from healthy controls but also from patients with disequilibrium due to sensory loss. Full article

Athletic Tape is widely used as an immediate and cost-effective intervention for flexible flat feet, offering a practical alternative to orthotic devices and exercise therapies. This study aimed to compare the effects of low-dye and anti-pronation taping (elastic and inelastic) on ankle strength, gait parameters, and balance control in women with flexible flat feet. Thirty women were evaluated under four conditions: no taping, low-dye taping, elastic anti-pronation taping, and inelastic anti-pronation taping. Each condition was tested at 3-day intervals. Outcome measures included ankle muscle strength, step length, stride length, balance control ability assessed using the Romberg and limits of stability tests. Repeated-measures analysis of variance and post hoc least significant difference analyses were used to determine statistical significance. Additionally, effect sizes (η²) were calculated for the primary outcomes. Dorsiflexion strength significantly improved with elastic taping (p < 0.05). Step length increased with both elastic and inelastic taping, whereas stride length improved only with elastic taping. All taping methods significantly reduced the limits of stability compared with the no-taping condition (p < 0.05). Athletic Tape interventions, especially elastic anti-pronation taping, may reduce excessive foot pronation and improve ankle strength and gait performance in women with flexible flat feet. Full article

Ataxia-telangiectasia is a rare autosomal recessive disorder that is difficult to diagnose due to its unpredictable presentation. It is characterized by cerebellar degeneration, telangiectasias, immunodeficiency, frequent pulmonary infections, and tumors. Immune system abnormalities manifest as disruptions in both cellular and humoral immunity. The most common findings include decreased levels of immunoglobulin classes (IgA, IgM, IgG, and IgG subclasses) and a reduced number of T and B lymphocytes. A four-year-old girl was initially evaluated and treated for skin lesions that presented as crusts spreading across her body. She was monitored by a pulmonologist due to frequent bronchial obstructions. Over time, she developed bilateral scleral telangiectasia, saccadic eye movements, and impaired convergence. Her gait was wide-based and unstable, with truncal ataxia and a positive Romberg sign. Laboratory tests revealed decreased immunoglobulin G levels, subclass IgG4 levels, elevated alpha-fetoprotein, and a reduced number of T and B lymphocytes. Brain magnetic resonance imaging showed cerebellar atrophy. Whole-exome sequencing identified heterozygous variants c.1564-165del, p.(Glu5221lefsTer43), and c.7630-2A>C in the serine/threonine-protein kinase ATM (ataxia-telangiectasia mutated) gene, confirming the diagnosis of ataxia-telangiectasia. Following diagnosis, treatment with intravenous immunoglobulin replacement was initiated along with infection prevention and management. The goal of this case report is to raise awareness of the atypical initial presentation that may lead to a diagnostic delay. We emphasize the importance of considering ataxia-telangiectasia in the differential diagnosis, even when classical neurological signs are not yet evident. Full article

This study aimed to investigate the relationship between visual system parameters (visual acuity and refractive error) and postural balance under controlled conditions in elite football players. Visual acuity (monocular and binocular) and refractive errors were assessed in 34 male athletes using retinoscopy and subjective refraction. Postural stability was assessed with the Cyber-Sabots™ platform, recording the center of pressure (CoP) metrics, including sway amplitude, velocity, and distribution area. Visual and postural parameter correlations were assessed using Pearson’s test (p < 0.05). Athletes demonstrated good binocular visual acuity (−0.03 ± 0.09 logMAR) and were predominantly emmetropic. Visual acuity and postural parameters showed significant negative correlations, whereby visual acuity was associated with reduced CoP displacement (r = −0.352) and sway area (r = −0.367), indicating enhanced stability. Hyperopia and oblique astigmatism were moderately correlated with increased sway (r = 0.343) and antero-posterior sway amplitude in the sagittal plane (r = 0.324). Anisometropia showed moderately negative correlations with antero-posterior control (r = −0.421), suggesting a disruptive effect on postural stability. The postural analysis showed adaptations characteristic of football players, including anterior body inclination, increased forefoot loading, and medio-lateral sway. Romberg’s quotients highlighted significant visual input reliance for maintaining postural balance. Visual acuity, refractive errors, and interocular refractive asymmetries significantly influence postural stability in elite football players. These results support incorporating visual function assessment into training and injury prevention in elite sports. Full article

Background/Objectives: Axonal Charcot–Marie–Tooth disease type 2 (CMT2) accounts for 24% of Hereditary Motor/Sensory Peripheral Neuropathies. CMT2 type GG, due to four distinct heterozygous mutations in the Golgi brefeldin A resistant guanine nucleotide exchange factor 1 (GBF1) gene (OMIM 606483), was described in seven cases from four unrelated families with autosomal dominant inheritance. It is characterized by slowly progressive distal muscle weakness and atrophy, primarily affecting the lower limbs. Here, we present two siblings sharing a novel GBF1 variant. Methods: Patient II.1 (male, 61 years at onset) presented lower limb hypoesthesia and walking difficulty; the examination revealed a postural tremor, a positive Romberg test, and muscle atrophy in the lower limbs and hands. Patient II.2 (his sister, 59 years at onset) had lower limb dysesthesias, hand paresthesia, and lower-limb stiffness. They underwent clinical evaluations, blood tests, and electroneurography. Their father represents a potentially affected individual, although a genetic analysis was not conducted. Results: All tests for peripheral neuropathies were unremarkable, including metabolic and autoimmune screening. Both showed a mixed demyelinating–axonal sensory–motor neuropathy. Genetic analysis revealed a new heterozygous GBF1 variant of uncertain significance. Conclusions: Based on autosomal dominant inheritance, as well as clinical and physiological features, a possible novel CMT2GG was diagnosed. Further research, including functional assays and in vitro studies, is necessary to confirm this variant’s causal link. Full article