Search Results (312)

Introduction: A validated clinical decision tool predictive of favorable functional outcomes following endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) remains elusive. We performed a retrospective case series of patients at our regional Comprehensive Stroke Center, over a four-year period, who have undergone EVT to elucidate patient characteristics and factors associated with a favorable functional outcome after EVT. Methods: We reviewed all cases of EVT at our institution between February 2018 and February 2022 in the extended time window from 6–24 h. Demographic, clinical, imaging, and procedure co-variates were included. A favorable clinical outcome was defined as a modified Rankin scale of 0–2. We included patients with M1 or internal carotid artery occlusion treated with EVT within 6–24 h after symptom onset. We used a univariate and multivariate logistic regression analysis to identify patient factors associated with a favorable clinical outcome at 90 days. Results: Our study included evaluation of 121 patients who underwent EVT at our comprehensive stroke center. Our analysis demonstrates that a higher recanalization score based on the modified Thrombolysis In Cerebral Infarction (mTICI) scale (2B-3) was a strong indicator of a favorable outcome (OR 7.33; CI 2.06–26.07; p = 0.0021). Our data also showed that a higher baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.0095) and the presence of pre-existing hypertension (p = 0.0035) may also be predictors of an unfavorable outcome (mRS > 2) per our multivariate analysis. Conclusion: Patients without pre-existing hypertension had more favorable outcomes following EVT in the expanded time window. This is consistent with other multicenter data in the expanded time window that demonstrates greater odds of a poor outcome with elevated pre-, peri-, and post-endovascular-treatment blood pressure. Our data also demonstrate that the mTICI score is a strong predictor of favorable outcome, even after controlling for other variables. A lower baseline NIHSS at the time of thrombectomy may also indicate a favorable outcome. Furthermore, the presence of clinical or radiographic mismatch based on the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and NIHSS per DAWN and DEFUSE-3 criteria did not emerge as a predictor of favorable outcome, which is congruent with recent randomized controlled trials and meta-analyses. Full article

Background/Objectives: Frailty is a prevalent geriatric syndrome associated with impaired postural control and elevated fall risk. Although conventional exercise is a core strategy for frailty management, adherence remains limited. Virtual reality (VR)-based interventions have emerged as potentially engaging alternatives, but their effects on objective postural control and task-specific confidence in frail populations remain understudied. This study aimed to evaluate the effectiveness of a supervised VR training program using the Nintendo Ring Fit Plus™ on postural control, functional mobility, and balance confidence among frail community-dwelling older adults. Methods: Fifty-one adults aged ≥65 years classified as frail or prefrail were enrolled in a four-week trial. Participants were assigned to either a VR intervention group (n = 28) or control group (n = 23). Participants were non-randomly assigned based on availability and preference. Outcome measures were collected at baseline and post-intervention. Primary outcomes included center of pressure (CoP) metrics—sway area, mean velocity, and sway path. Secondary outcomes were the Timed Up and Go (TUG), Berg Balance Scale (BBS), Activities-specific Balance Confidence (ABC), and Falls Efficacy Scale–International (FES-I). Results: After adjusting for baseline values, age, and BMI, the intervention group showed significantly greater improvements than the control group across all postural control outcomes. Notably, reductions in sway area, mean velocity, and sway path were observed under both eyes-open and eyes-closed conditions, with effect sizes ranging from moderate to very large (Cohen’s d = 0.57 to 1.61). For secondary outcomes, significant between-group differences were found in functional mobility (TUG), balance performance (BBS), and balance confidence (ABC), with moderate-to-large effect sizes (Cohen’s d = 0.53 to 0.73). However, no significant improvement was observed in fear of falling (FES-I), despite a small-to-moderate effect size. Conclusions: A supervised VR program significantly enhanced postural control, mobility, and task-specific balance confidence in frail older adults. These findings support the feasibility and efficacy of VR-based training as a scalable strategy for mitigating frailty-related mobility impairments. Full article

In the study of biomechanical models, balance represents a complex problem due to the issue of indeterminate forces while standing. In order to solve this problem, it is essential to measure the ground reaction forces (GRFs) applied to each foot independently. The present work proposes a methodology for determining the independent GRF applied to each foot while standing when only one forceplate is available. For this purpose, an analytical method is proposed to determine the distribution of vertical GRFs and the position of the independent center of pressure (CoP) in each foot. Concurrently, several neural network (NN) models are trained to improve the results obtained. This hypothesis is experimentally validated by a self-developed device that allows one to simultaneously obtain the vertical GRF and CoP location of each foot at the same time that the GRF and the global CoP location are obtained from a single forceplate. The results obtained achieve a CoP position error of less than 8% and a vertical force error of 2%. The analytical hypothesis is demonstrated to offer a satisfactory level of precision, while the NN is shown to result in considerable improvement in some cases. Full article

Multiple Sclerosis (MS) is a chronic neurological disorder affecting the central nervous system that significantly impairs postural control and functional abilities. Robotic-assisted gait training mitigates this functional deterioration. This preliminary study aims to investigate the effects of a four-week gait training with the ExoAtlet II exoskeleton on static balance control and functional mobility in five individuals with MS (Expanded Disability Status Scale ≤ 2.5). Before and after the training, they were assessed in quiet standing under Eyes Open (EO) and Eyes Closed (EC) conditions and with the Timed Up and Go (TUG) test. Center of Pressure (CoP) Sway Area, Antero–Posterior (AP) and Medio–Lateral (ML) CoP displacement, Stay Time, and Total Instability Duration were computed. TUG test Total Duration, sit-to-stand, stand-to-sit, and linear walking phase duration were analyzed. To establish target reference values for rehabilitation advancement, the same evaluations were performed on a matched healthy cohort. After the training, an improvement in static balance with EO was observed towards HS values (reduced Sway Area, AP and ML CoP displacement, and Total Instability Duration and increased Stay Time). Enhancements under EC condition were less marked. TUG test performance improved, particularly in the stand-to-sit phase. These preliminary findings suggest functional benefits of exoskeleton gait training for individuals with MS. Full article

The present study aims to investigate the multi-year effects (5 years) of individualized whole-body vibration (WBV) on locomotion, postural control, and handgrip strength in a 68-year-old man with relapse remitting multiple sclerosis (PwRRMS). The dose–response relationship induced by a single session was quantified by determining the surface electromyographic activity (sEMG) of the participant. The participant wore an orthosis to limit the lack of foot dorsiflexion in the weakest limb during walking in daily life. The gait alteration during walking was assessed at 1, 2 and 3 km/h (without the orthosis) through angle–angle diagrams by quantifying the area, perimeter and shape of the loops, and the sEMG of leg muscles was recorded in both limbs. The evaluation of postural control was conducted during upright standing by quantifying the displacement of the center of pressure (CoP). The handgrip strength was assessed by measuring the force–time profile synchronized with the sEMG activity of upper arm muscles. The participant improved his ability to walk at higher speeds (2–3 km/h) without the orthosis. There were greater improvements in the area and perimeter of angle–angle diagrams for the weakest limb (Δ = 36–51%). The sEMG activity of the shank muscles increased at all speeds, particularly in the tibialis anterior of weakest limbs (Δ = 10–68%). The CoP displacement during upright standing decreased (Δ = 40–60%), whereas the handgrip strength increased (Δ = 32% average). Over the 5-year period of intervention, the individualized WBV improved locomotion, postural control and handgrip strength without side effects. Future studies should consider the possibility of implementing an individualized WBV in PwRRMS. Full article

Background: This study aimed to investigate how barbell type (elastic vs. inelastic) and lifting speed affect postural stability and lower limb muscle activation during the single-leg deadlift (SLDL), a common unilateral exercise in rehabilitation and performance training. Methods: Twenty-seven healthy adults performed SLDLs using both elastic and inelastic barbells under three lifting speeds (normal, fast, and power). Center of pressure (COP) displacement in the anterior–posterior (AP) and medial–lateral (ML) directions and electromyographic (EMG) activity of eight lower limb muscles were measured. Results: COP displacement was significantly lower when using elastic barbells (AP: F = 6.509, p = 0.017, η² = 0.200, ω² = 0.164; ML: F = 9.996, p = 0.004, η² = 0.278, ω² = 0.243). EMG activation was significantly higher for the gluteus medius, biceps femoris, semitendinosus, and gastrocnemius (all p < 0.01), especially under power conditions. Significant interactions between barbell type and speed were found for the gluteus medius (F = 13.737, p < 0.001, η² = 0.346, ω² = 0.176), semitendinosus (F = 6.757, p = 0.002, η² = 0.206, ω² = 0.080), and tibialis anterior (F = 3.617, p = 0.034, η² = 0.122, ω² = 0.029). Conclusions: The findings suggest that elastic barbells improve postural control and enhance neuromuscular activation during the SLDL, particularly at higher speeds. These results support the integration of elastic resistance in dynamic balance and injury prevention programs. Full article

This study investigated the interplay of bodily degrees of freedom (DoFs) governing the collective variable comprising the center of pressure (CoP) and center of mass (CoM) in postural control through the analytical lens of multiplicative interactions across scales. We employed a task combination involving a wobble board, introducing mechanical instability mainly along the mediolateral (ML) axis and the Trail Making Task (TMT), which imposes precise visual demands primarily along the anteroposterior (AP) axis. Using Multiscale Regression Analysis (MRA), a novel analytical method rooted in Detrended Fluctuation Analysis (DFA), we scrutinized CoP-to-CoM and CoM-to-CoP effects across multiple timescales ranging from $100\mathrm{ms}$ to $10\mathrm{s}$. CoP was computed from ground reaction forces recorded via a force plate, and CoM was derived from full-body 3D motion capture using a biomechanical model. We found that the wobble board attenuated CoM-to-CoP effects across timescales ranging from $100\mathrm{to}400\mathrm{ms}$. Further analysis revealed nuanced changes: while there was an overall reduction, this encompassed an accentuation of CoM-to-CoP effects along the AP axis and a decrease along the ML axis. Importantly, these alterations in CoP’s responses to CoM movements outweighed any nonsignificant effects attributable to the TMT. CoM exhibited no sensitivity to CoP movements, regardless of the visual and mechanical task demands. In addition to identifying the characteristic timescales associated with bodily DoFs in facilitating upright posture, our findings underscore the critical significance of directionally challenging biomechanical constraints, particularly evident in the amplification of CoP-to-CoM effects along the AP axis in response to ML instability. These results underscore the potential of wobble board training to enhance the coordinative and compensatory responses of bodily DoFs to the shifting CoM by prompting appropriate adjustments in CoP, thereby suggesting their application for reinstating healthy CoM–CoP dynamics in clinical populations with postural deficits. Full article

This study investigated the effects of virtual reality (VR)-based training combined with preliminary trunk stabilization education on postural control and balance in stroke patients. A single-blind randomized controlled trial enrolled 30 participants, randomly divided into a trunk stabilization group (n = 15) and a control group (n = 15). The trunk stabilization group engaged in 10 min of trunk stabilization education followed by 20 min of VR-based training, three times weekly for three weeks. The control group participated only in VR-based training. Outcomes were assessed using the Korean Trunk Impairment Scale (K-TIS), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), limit of stability (LOS), and center of pressure (COP) measurements. Both groups significantly improved in all measured outcomes post-intervention (p < 0.05). Notably, the trunk stabilization group exhibited significantly superior improvements in the K-TIS, PASS, BBS, LOS, and COP path length compared to the control group (p < 0.05). These results highlight the enhanced effectiveness of integrating trunk stabilization education with VR-based training, suggesting that it not only yields statistically significant improvements but also provides clinically meaningful benefits for functional postural control and balance recovery in stroke rehabilitation. Full article

Balance control in pirouettes has previously been characterized by constraint of the topple angle. However, there is a paucity of research using the margin of stability (MoS) as a dynamic measure of balance related to pirouettes. Therefore, this study aimed primarily to examine the MoS as a metric of balance during a single-turn en dehors pirouette in healthy female amateur ballet dancers. Four participants performed pirouettes until five successful pirouettes were achieved without hopping or loss of balance. Three-dimensional motion capture was used to record the motion trajectories of anatomical markers based on the Plug-in-Gait and Oxford Foot models. Motion synchronized with ground reaction forces was used to calculate the center of pressure (CoP), base of support (BoS), center of the pivot foot, center of mass (CoM), and extrapolated center of mass (XCoM) throughout the turn phase, using laboratory (LCS) and virtual left foot (LFT) coordinate systems. In the LCS and LFT coordinate system, the excursions and patterns of motion of both the CoM and XCoM relative to the CoP were similar, suggesting a neurological relationship. Two different measures of the margin of stability (MoS) in the LFT coordinate system were tabulated: the distance between the (1) XCoM and CoP and (2) XCoM and BoS center. The magnitude of both versions of the MoS was greatest at turn initiation and toe-touch, which was associated with two foot contacts. The MoS values were at a minimum approximately 50% of the stance during the turn phase: close to zero along the anteroposterior (A/P) axis and approximately 50 mm along the mediolateral (M/L) axis. On average, MoS magnitudes were reduced (mean across participants: approximately 20 mm) along the A/P axis, and larger MoS magnitudes (mean across participants: approximately 50 mm) along the M/L axis throughout the turn phase. Although all turns analyzed were completed successfully, the larger MoS values along the M/L axis suggest a fall potential. The variability between trials within a dancer and across participants and trials was documented and showed moderate inter-trial (16% to 51%) and across-participant CV% (range: 10% to 28%), with generally larger variations along the A/P axis. Although our results are preliminary, they suggest that the MoS may be useful for detecting faults in the control of dynamic balance in dehors pirouette performance, as a part of training and rehabilitation following injury. Full article

Tai Chi provides an age-appropriate exercise to decrease fall risks in older adults. However, the exact mechanism underlying the benefits of Tai Chi practice remains an open question. Thus, this study examined how aging and Tai Chi practice impact adaptation to sensory and motor perturbations while standing. We hypothesized that older Tai Chi practitioners would exhibit a decreased reliance on visual processes as sensory and motor perturbations increased, relative to naive healthy older adults. Using rambling and trembling decompositions of the center of pressure (COP) and frequency-domain features, we examined changes in low (0–0.3 Hz), medium (0.3–1 Hz), and high (1–3 Hz) frequency components, reflecting contributions from the visual, vestibular/somatosensory, and proprioceptive systems, respectively, in healthy young adults (HYA), healthy older adults (HOA), and Tai Chi practicing older adults (TCOA). Our results revealed statistically significant condition-by-group interactions in high-frequency COP-x and rambling-x and COP-y components, medium-frequency COP-y components, and all low-frequency components in COP and trembling (p < 0.05). Further, a significant trial-by-group interaction in high-frequency rambling-y was observed (p < 0.05). These results indicate age and Tai-chi-related differences in modulation of sensory contributions to balance as perturbations increase, and with repeated practice, which merit further investigation. Full article

Aim: To compare the three-year surgical outcomes among the Kahook dual blade (KDB), Tanito microhook (TMH), T-hook, and 360° suture trabeculotomy (S-lot) cohorts. Study design: Retrospective interventional comparative study conducted at a single eye center. Subjects and Methods: A total of 224 eyes that underwent combined cataract surgery with either KDB, TMH, T-hook, or S-lot procedures were retrospectively analyzed over the three-year period. Results: According to Tukey’s multiple comparison test, postoperative intraocular pressure (IOP) in the S-lot cohort was significantly lower than in the TMH cohort from 1 month to 3 years (p = 0.01 to <0.001), lower than in the KDB cohort between 6 months and 1 year (p = 0.026 to <0.001), and lower than in the T-hook cohort at 1 month (p = 0.012) and from 6 to 12 months (p < 0.001). The survival probability of achieving ≤15 mmHg and ≤18 mmHg in the S-lot cohort was significantly better than in others by p < 0.001 and 0.005, respectively. At 3 months, the T-hook cohort showed significantly lower IOP than the TMH cohort (p = 0.029), and at 1 week, IOP was marginally lower than in the KDB (p = 0.063) and TMH (p = 0.052) cohorts, based on Dunnett’s test. However, no significant differences in postoperative IOP were observed among the three sectorial canal-opening surgery (COS) groups beyond 6 months. Conclusions: Among the four MIGS cohorts, S-lot provided the most substantial mid-term postoperative IOP reduction. The T-hook cohort showed marginally superior IOP reduction at 1 week compared to the KDB and TMH groups. Full article

Background: Cheerleading is an emerging and increasingly popular sport among girls. The figures performed during routines require a high level of balance from the athletes. The aim of the study was to analyze the impact of participation in cheerleading classes on body balance in girls during early adolescence. Methods: A total of 35 female cheerleaders from the Power Stars Sząbruk Club (Poland) were divided into three age groups: 8–9 years (n = 15), 10–11 years (n = 11), and 12–14 years (n = 9). Balance assessment was performed using the E.P.S R/1 pedobarographic platform. The Kruskal–Wallis test with Bonferroni post hoc correction was used to analyze intergroup differences in foot load distribution and balance parameters. Results: The analysis revealed statistically significant differences in the pressure on the forefoot area of the right foot (p = 0.007) between the 8–9 and 12–14 age groups, and in the balance level between the youngest group (8–9 years) and the oldest group (12–14 years) at p = 0.028, as well as between the middle group (10–11 years) and the oldest group (p = 0.004). Conclusions: Participation in cheerleading classes may influence the increase in balance, particularly in terms of the distance of center of pressure (C.O.P.) shifts and the average speed of these shifts. In adolescence, muscle development is crucial, and when closely linked with motor coordination, it helps maintain body stability. Full article

Background: This study compared performance-based function and self-report function in lower-limb prosthesis users. Methods: Twenty-two lower-limb prosthesis users (aged 52.1 ± 14.2) were administered the Orthotic Prosthetic User Survey (OPUS) Lower Extremity Functional Status (LEF), Satisfaction With Devices (SWD), alongside the Godin Leisure-Time Exercise Questionnaire (GLTQ), Timed Up and Go (TUG) test, two-minute walk test (2MWT), and six-minute walk test (6MWT). Body composition and standing postural sway displacement and velocity were also measured. Pearson’s Product Moment coefficients were used to assess relationships between the OPUS and other outcome variables. ANOVAs were used to identify differences in all outcome variables between lower unilateral (LU) and all other (AO) amputees. Results: There was a moderate correlation between LEF and center of pressure (CoP) path length with eyes open (r₍₁₉₎ = −0.43, p = 0.048) and eyes closed (r₍₁₉₎ = −0.43, p = 0.049). While the relationship between LEF and TUG was significant (r₍₂₀₎ = −0.49, p = 0.021), this was not so with SWD and TUG (r₍₂₀₎ = −0.17, p = 0.456). Both the 2MWT (r₍₂₀₎ = 0.48, p = 0.023) and 6MWT (r₍₂₀₎ = 0.47, p = 0.028) were moderately correlated with LEF. GLTQ was significantly correlated with LEF (r₍₂₀₎ = 0.70, p = 0.001). The LU group outperformed the AP group during the TUG and 6MWT (p < 0.05). LU group scored significantly higher on LEF compared to the AO group (p < 0.05). The reliability of LEF between the measurement on day 1 (54.3 ± 12.0) and day 2 (53.6 ± 12.8) was high (α = 0.94). Conclusions: This study provides an insight into associations of balance and self-reported function in lower limb prosthesis users. Future work can target rehabilitation strategies to address challenges faced by multiple limb prosthesis users. Full article

The purpose of this study was to determine the effect of static stretching (SS) duration on balance. Twenty-two participants performed passive dorsiflexion measurements and balance tests before and after SS. Passive dorsiflexion measurements determined the maximal dorsiflexion angle, passive torque, displacement of the muscle–tendon junction, and electromyography amplitude during passive dorsiflexion. In the balance test, the participant stood on a single leg with their eyes open while the postural sway evaluated in the center of pressure (COP), standing duration, and electromyography amplitude were measured. The ankle and metatarsophalangeal joints underwent SS for 30 s × one set, two sets, and four sets. There were significant increases in COP displacement and COP velocity after two sets of SS but not after one and four sets. Standing duration and electromyography during balance tests were not changed after SS. No gender differences were found in changes in balance. Maximal dorsiflexion angle and passive torque were increased after SS, but the displacement of the muscle–tendon junction and electromyography during passive dorsiflexion were not changed. There was no significant correlation between changes in maximal dorsiflexion angle or passive torque and changes in COP variables after two sets of SS. These results therefore revealed that SS duration affects COP displacement and COP velocity. Full article

This study aimed to explore the independent and interactive effects of varying squat depths and movement speeds on dynamic postural stability during the Part the Wild Horse’s Mane (PWHM) movement. Thirteen male participants (age: 25.86 ± 1.35 years; height: 174.26 ± 6.09 cm; body mass: 68.64 ± 8.15 kg) performed the PWHM movement at three different squat heights, high squat (HS), middle squat (MS), low squat (LS), and two different speeds, fast and slow. Dynamic postural stability (DPSI) was assessed through the center-of-mass (CoM) trajectory and the center-of-pressure (CoP) trajectory. The analyses used two-factor repeated-measures ANOVA and statistical nonparametric mapping, with key metrics including anteroposterior stability (APSI), mediolateral stability (MLSI), vertical stability (VSI), DPSI indices, and the path lengths of the CoP and CoM. LS exhibited significantly greater CoP and CoM path lengths compared with MS and HS (p < 0.01). Furthermore, fast movements demonstrated higher VSI and DPSI than slow movements (p < 0.05). Tai Chi with different squat depths and speeds can affect postural stability. To reduce the fall risk, older adults and individuals with balance impairments should prioritize slower Tai Chi movements, particularly when using high squat postures. Full article