Name: screening people on standing balance with romberg testing and walking balance with tandem walking
Uploaded: 2023-09-01T14:00:00.000+00:00
Duration: 6 min 28 s
Description: Watch this Scientific Journal Video about Developing Low-Tech Balance Assessment Methods for Broad-Spectrum Healthcare Applications at JoVE.com

这项研究工作得到了 NIH 资助 R01 DC009031 的支持。感谢 Sharon L Congdon、Melody A Fregia 和 Nathan Silver 的技术支持。

本研究中描述的测试方法是在健康对照受试者和前庭疾病患者中开发的。健康对照受试者没有已知的神经系统、耳科或肌肉骨骼疾病史。前庭疾病患者在前庭系统的一系列客观测试中反应异常，包括黑暗中的前庭眼反射测试、位置测试和颈椎前庭诱发肌源性电位。这些研究得到了美国德克萨斯州休斯顿贝勒医学院人类受试者研究机构审查委员会的批准。
注:在 1869 年的一项研究中，年龄在 4 至 85 岁之间的健康受试者在休斯顿航天中心（社区科学教育中心）接受了测试，受试者使用本文中描述的方法进行了测试。参与者首先脱掉鞋子，但穿着袜子。然后，科学教育工作者在闭眼双人行走和CTSIB上测试参与者在顺应泡沫上，每个条件都闭上眼睛，头部静止不动，站立不动，缓慢点头（向上/向下），站立不动，偏航时缓慢摇头（右/左）。
1. 患者/研究对象
<ol><li>确保个人可以在没有支撑的情况下直立至少 30 秒。他们必须能够按照说明进行操作。</li>
</ol>2、环境与设备
<ol><li>在光线充足且表面坚固的房间内进行测试，例如乙烯基瓷砖或工业地毯。不要在毛绒地毯上进行这些测试。</li>
	<li>使用秒表、秒针时钟或数字计时器进行 CTSIB。TW不需要定时器件。</li>
	<li>要进行 CTSIB，请使用符合以下合规标准的中密度、顺应性泡沫:PSI = 0.85-0.95。这种类型的泡沫通常被称为回火泡沫或记忆泡沫。这些规范是用以下尺寸的泡沫开发的:40.64 cm X 45.72 cm X 10 cm。如果需要，可以使用更大的泡沫板，但这不是必需的。 注意:不止一家制造商生产这种泡沫。使用具有正确顺应特性的泡沫至关重要。如果使用其他类型的泡沫，则已发布的规范将不适用。</li>
</ol>第3章 CTSIB的方法
<ol><li>为了安全起见，将泡沫放在房间的一角或墙壁附近。让个人首先睁大眼睛在地板上练习测试，以学习所涉及的基本动作。<ol><li>指导被测试者直立，不要接触腿部或背部的任何东西，双脚并拢，并排。确保个人的手臂交叉在腰部，每只手握住对侧肘部或舒适地交叉在腰部。</li>
		<li>指导个人直视前方。在泡沫上进行 1-3 次测试试验，持续 5-10 秒，双臂交叉在腰部，双脚相邻，直立并直视前方，不要接触腿部或背部。</li>
		<li>为了稳定患者，将一只手放在患者的肩膀上，同时患者直视前方。</li>
		<li>要开始测试试验，请说"闭上眼睛"。将手从患者的肩膀上移开，说"开始"，然后开始计时试验长达 30 秒。仅执行一次此试用。如果个人表现出害怕、被噪音分散注意力或不理解说明，请进行第二次试验，并将第一次试验视为训练试验。 注意:闭上眼睛时，个体的姿势摇摆会增加，这可能是被测试者关注的问题。温和地建议个人不要担心。</li>
		<li>依赖测量:测量个人在犯错前可以保持直立姿势的时间，对于每种 CTSIB 条件，最多 30 秒。 注意:错误是睁开眼睛、移动手臂、迈出一步或靠在墙上。</li>
	</ol></li>
	<li>在头部静止的情况下执行试验 1。如果该人在第一次试验 1 中遇到困难，请将该试验视为培训试验，并进行第二次试验。使用第二次试验的分数。</li>
	<li>执行试验 2，以 0.3 Hz 的速度缓慢点头（向上/向下），以实际节拍器或数字节拍器应用。<ol><li>在开始试验 2 之前，让个人睁开眼睛站在地板上，练习及时点头，直到最大上下头部运动及时出现在应用程序上的最大和最小声音中，以便个人可以以 0.3 Hz 的速度移动。</li>
		<li>要进行试验 2，请指示个人站在泡沫上，双脚相邻，双臂交叉，如试验 1 所示。</li>
		<li>在个人闭上眼睛之前，在节拍器或节拍器应用程序上开始声音。然后指示该人闭上眼睛，而调查员的手放在该人的肩膀上以稳定他/她。</li>
		<li>要开始试验 2，当听到"Go"时，指示个人及时点头（头部向上/向下移动）。</li>
		<li>将手从个人的肩膀上移开，说"开始"，同时启动计时器。</li>
		<li>试验结束后，如果需要，让个人从泡沫上下来坐下，让个人休息几秒钟。</li>
	</ol></li>
	<li>执行试验 3，头部以 0.3 Hz 的频率摇晃（左/右），与声音同步。否则，请对试用版 2 使用相同的过程。</li>
</ol>4. 串联行走的方法论
<ol><li>确保房间没有障碍物，个人将向前走约 4.5 m 的距离，在个人的两侧行走约 1 m。可以使用更多空间，但不是必需的。</li>
	<li>为个人演示 3 到 5 个步骤的测试:将一只脚从脚跟到脚趾放在另一只脚的前面。再重复 4 个步骤，以便个人知道任务。</li>
	<li>实践试用:<ol><li>指导个人在CTSIB中睁开眼睛，双臂交叉在腰部进行练习试验，不穿鞋，但穿袜子以保持良好的卫生。</li>
		<li>让个人将一只脚放在另一只脚的正前方，前后脚之间的距离不超过 2.4 厘米（1 英寸）。确保个人执行最多 5 个步骤的练习试验。如果需要，对个人使用多个练习试验来了解运动任务。</li>
	</ol></li>
	<li>测试试验:让个人双臂交叉站立，双脚分开保持舒适的距离，不穿鞋，但穿袜子以保持良好的卫生。指导患者闭上眼睛并执行 10 个从脚跟到脚趾的步骤，如步骤 4.3 中所述，当调查员说"开始"时。</li>
	<li>不要为测试计时。</li>
	<li>相关测量:测量 10 个步骤中执行的正确串联步骤的总数，即使这些步骤不是连续的。要计算不正确的步数，请用一只手的手指数数，就像孩子们用手指数数一样。大声计算总步数，但不要在测试过程中大声说出不正确的步数。 注意: 错误是:睁开眼睛、移动手臂、越线或后脚走得太远。</li>
</ol>5. CTSIB和TW评分
<ol><li>为了对试验进行评分，两个来源提供了数据。使用论文中关于CTSIB和TW的儿童和年轻人的规范以及这些已发表的数据9。此外，论文中提供了 21 至 90 岁成年人的 CTSIB 和 TW 规范，这些已发表的数据为8。</li>
	<li>将个人的分数与已公布的数据进行比较，以确定个人年龄组的分数是正常还是异常，对于 CTSIB，则确定每种情况的分数是正常还是异常。</li>
</ol>

实施前庭疾病筛查测试

<ol>
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作者没有什么可透露的。

这些筛查测试需要最少或不需要技术和最小的空间。管理和评分既快速又简单。因此，这些筛查测试被医疗提供者、职业治疗师和物理治疗师广泛用于康复诊所和流行病学筛查研究中的医疗保健环境中。这些检查可用于筛查患者的前庭疾病，也可用于筛查患有非前庭疾病（如老花病）的患者。其他平衡障碍也可以通过这些检查进行筛查，但可能的疾病列表太长，无法在这里描述。接受过各种类型的前庭和非前庭平衡障碍评估和治疗培训的临床医生可以将这些筛查测试用作临床工具箱的一部分。
这些测试有一些局限性。这些测试只能用于能够遵循说明并能够在独立的情况下站立的人。肌肉骨骼问题，如关节炎和关节畸形、脚趾截肢、严重无力以及影响足部和下肢的不协调都会影响测试结果。同样，神经系统的运动障碍，如帕金森病，也会影响测试结果。肌肉骨骼和运动障碍可能会干扰站立足够长的时间进行测试的能力，是否具有足够好的重量转移能力，甚至影响执行测试的运动控制。为了与规范数据保持一致，不应穿鞋，但应穿袜子以保持良好的卫生。肥胖影响结局5.用于 CTSIB 的顺应泡沫类型会影响结果。如果测试管理员更喜欢使用不同类型的泡沫，那么测试管理员应遵循 CTSIB 的创始人 Shumway-Cook 和 Horak 的建议，并在与患者15 进行测试之前制定健康个体规范。
这些规范的平衡测试可用于筛查不同年龄段的平衡。它们需要最少的设备和最短的时间，但为在各种环境中使用提供有效和可靠的数据。测试管理员应使用具有正确密度特性的泡沫，个人应不穿鞋但穿着袜子，闭上眼睛进行测试。如果同时使用这两种测试，测试的敏感性（对患者）和特异性（对健康对照）将得到改善。考试成绩将受到运动障碍、肌肉骨骼疾病或难以遵循指示的影响。因此，在存在此类问题的情况下，请谨慎解释数据。

筛查前庭系统是众所周知的困难，前庭系统是内耳中具有检测头部运动的受体的感觉系统。由于前庭脊髓束的存在，前庭脊髓束从喙髓质的前庭核向下投射到脊髓的颈椎、胸椎和腰骶水平，前庭系统产生的头部速度信号会影响站立和行走过程中的平衡1.因此，许多患有前庭系统疾病的人平衡受损，有跌倒的风险。例如，25% 的 65 岁以上的美国老年人每年跌倒 2,2016 年美国跌倒的死亡率从每 100,000 人 24.2 人到 142.7 人不等，具体取决于各州3。因此，平衡测试通常是临床评估或筛查前庭损伤的一个组成部分，并且通常用于临床研究4。这些测试也可用于对运动员、飞行后宇航员、军事人员和其他可能表现出一些平衡问题的个人进行现场筛查。这些人可能需要分别在运动场附近、着陆点、紧急野战医院或其他紧急情况下进行筛查，然后才能被长途运送到综合医疗机构进行详细检测。
为了筛查人们的平衡障碍，通常使用两种不同类型的平衡测试。站立不动和转移重心，例如在厨房水槽洗碗时，涉及的技能与走路时通过空间翻译身体的技能有些不同。应该检查这两种平衡。平衡测试通常在狭窄的支撑基础下进行，以使测试对个人具有挑战性。例如，双脚并拢、闭上眼睛时的站立平衡测试基于 Romberg 征，即患者睁开眼睛时保持良好平衡，但闭上眼睛时失去平衡1。多年来，该测试已经过多次改进，直到 Romberg 或感觉统合和平衡临床测试 （CTSIB）4 的当前修改版本比以前的测试更简单、更短且已证明具有良好的灵敏度，因此对临床筛查更有用。当前版本在支撑表面上使用不稳定、中等密度、柔顺的泡沫，并通过头部运动进一步锐化。这些修改已被用于最近的研究，显示了儿童和成人与年龄相关的规范数据，也用于表明这些规范特定于所用泡沫的研究 7,8,9,10。
双人行走（TW），也称为脚跟-脚趾行走，在地板上进行，受试者穿着袜子但不穿鞋，闭上眼睛。最近的研究提供了与儿童和成人年龄相关的规范数据11,12,13。TW 和 CTSIB 表现下降可能与前庭系统疾病一致，尽管平衡测试不是前庭系统的直接测试。当 TW 和 CTSIB 一起给予没有肌肉骨骼畸形或明显神经系统问题的患者时，测试对前庭疾病的敏感性高于仅给予 TW 或 CTSIB 时12。
使用本文中描述的方法，已经对健康参与者进行了几项研究。例如，一项针对 292 名健康对照组和 90 名前庭疾病患者的研究（如使用双热热量测试、前庭诱发肌源电位和 Dix-Hallpike 测试对前庭系统进行的标准临床客观测试所示）显示，CTSIB 条件和 TW11、12、13 的对照组与年龄相关的下降。TW7 和 CTSIB8 的单个测试的灵敏度中等，但组合电池的灵敏度> 0.9。在波士顿科学博物馆的一项 CTSIB 研究中，健康参与者能够在头部仍处于14 状态的情况下，在顺应性泡沫上测试自己在 CTSIB 上。该组也发现了儿童和成人中与年龄相关的变化。
这些基于表现的筛选测试无法通过阅读研究论文中的内容来学习。本文旨在准确告知读者如何执行这些测试。

<table><tbody><tr><td>10 cm thick, medium density, Sunmate foam</td><td>Dynamic Systems, Leicester, NC, USA;</td><td>sunmatecushions.com</td><td>Either this foam or foam by another manufacturer that has the same compliance characteristics as medium density Sunmate foam will be sufficient. Use a slab of foam large enough for an adult man&#039;s feet, e.g. 40.65 cm X 45.72 cm or larger</td></tr><tr><td>Metronome app</td><td>Any source</td><td>N/A</td><td>Either a real, physical metronome or a metronome app that can provide an auditory cue at 0.3 Hz. 0.3 Hz is the equivalent of 18 beats per minute, but using 20 beats per minute is acceptable if your app only goes that low.</td></tr><tr><td>Stopwatch</td><td>Any source</td><td>N/A</td><td>Any timing device in tenths of seconds will be sufficient</td></tr></tbody></table>

screening people on standing balance with romberg testing and walking balance with tandem walking

该协议的目的是告知读者用于执行前庭疾病两种筛查测试的确切程序:闭眼串联行走 （TW），也称为脚跟-脚趾行走，以及感觉统合和平衡临床测试 （CTSIB），也称为改良的 Romberg。该研究描述了执行每项测试和三个 CTSIB 子测试中每个测试的步骤，以便读者能够复制测试条件，以便在临床、临床实验室或任何其他需要有效和可靠筛查的情况下使用平衡技能，这些平衡技能可能会受到前庭系统功能变化的影响。此处详述的程序易于管理，每次试验只需不到 1 分钟。提供了已发表论文和规范性数据的参考文献。代表性结果部分包括通过这些筛查测试收集的数据示例。

与其他研究一样，在双人步行和CTSIB中发现了与年龄相关的变化，特别是对于幼儿和老年人，尽管由于样本量小，年龄最大的老年人的数据可能不可靠。 图 1 显示了 CTSIB 三种条件的数据。 图 2 显示了闭眼串联行走的数据。与10岁及以上的儿童相比，幼儿在两项测试中的得分都有所降低。分数在中年，尤其是老年时下降。在这项特殊的研究中，由于样本量小，最年长受试者的数据不可靠。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65663/65663fig01.jpg"> 图 1:按年龄组划分的平均 CTSIB 数据。 数据是以秒为单位的时间。（A） CTSIB头部静止。（B） CTSIB头部偏航。（C） CTSIB头部螺距。该图已从原始论文修改，并经 Friello 等人许可使用13。 <a href="https://www.jove.com/files/ftp_upload/65663/65663fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65663/65663fig02.jpg"> 图 2:按年龄组划分的 TW 中位数数据。 数据是正确串联步数。范围从 1 到 10 不等，但因年龄而异;有关详细信息，请参阅 Friello 等人 13 。该图已从原始论文修改，并经 Friello 等人许可使用13。 <a href="https://www.jove.com/files/ftp_upload/65663/65663fig02large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>

Watch this Scientific Journal Video about Developing Low-Tech Balance Assessment Methods for Broad-Spectrum Healthcare Applications at JoVE.com

作者聚焦:为广泛的医疗保健应用开发低技术平衡评估方法 

本文介绍了使用两种规范的、快速的、低技术含量的平衡测试来筛查人们站立和行走平衡障碍的程序。

通过 Romberg 测试筛查站立平衡的人，并通过串联步行筛查步行平衡

The goal of this protocol is to inform readers about the exact procedures to use to perform two screening tests for vestibular disorders: tandem walking ...

科学挑战是在不依赖大量技术的情况下创造可靠和有效的测量平衡的技术。这些测试应适用于实地研究、小型诊所以及在医疗保健技术有限的地方筛查患者。测试足够多的不同年龄段的健康个体，以及足够多的前庭疾病和其他平衡问题患者至关重要。招募足够多的人可能具有挑战性，但有必要确定这些测试是否可以有效地筛查个人的各种平衡问题。临床医生和研究人员可以在复杂的医疗环境中使用这些测试，也可以在小型诊所、疗养院、社区护理设施、用于基于人群的流行病学研究的移动实验室，甚至在飞行后宇航员的着陆点使用这些测试。这些数据有助于临床决策。

screening-people-on-standing-balance-with-romberg-testing-walking

Research

JoVE Journal

Behavior

Screening People on Standing Balance with Romberg Testing and Walking Balance with Tandem Walking

4.4K 次观看.  Baylor College of Medicine. 科学挑战是在不依赖大量技术的情况下创造可靠和有效的测量平衡的技术。这些测试应适用于实地研究、小型诊所以及在医疗保健技术有限的地方筛查患者。测试足够多的不同年龄段的健康个体，以及足够多的前庭疾病和其他平衡问题患者至关重要。招募足够多的人可能具有挑战性，但有必要确定这些测试是否可以有效地筛查个人的各种平衡问题。临床医生和研究人员?...

视频: 作者聚焦:为广泛的医疗保健应用开发低技术平衡评估方法 

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango&#8217;s demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson&#8217;s Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression.

Adapted tango has demonstrated efficacy for improving mobility and balance. We describe the dissemination of adapted tango teaching methods to dance instructor trainees and the implementation of adapted tango by the trainees in the community for improving mobility and balance in older adults and individuals with Parkinson&#8217;s disease.

以社区为基础改编的探戈舞的个人与帕金森氏病和老年人

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple ...

科研

行为学

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

充实适当的运动捕捉技术的越野行走步态中老年人的评估和姿势

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

Sit-to-stand-and-walk from 120% Knee Height: A Novel Approach to Assess Dynamic Postural Control Independent of Lead-limb

Individuals with sensorimotor pathology e.g., stroke have difficulty executing the common task of rising from sitting and initiating gait (sit-to-walk: STW). Thus, in clinical rehabilitation separation of sit-to-stand and gait initiation - termed sit-to-stand-and-walk (STSW) - is usual. However, a standardized STSW protocol with a clearly defined analytical approach suitable for pathological assessment has yet to be defined.
Hence, a goal-orientated protocol is defined that is suitable for healthy and compromised individuals by requiring the rising phase to be initiated from 120% knee height with a wide base of support independent of lead limb. Optical capture of three-dimensional (3D) segmental movement trajectories, and force platforms to yield two-dimensional (2D) center-of-pressure (COP) trajectories permit tracking of the horizontal distance between COP and whole-body-center-of-mass (BCOM), the decrease of which increases positional stability but is proposed to represent poor dynamic postural control.
BCOM-COP distance is expressed with and without normalization to subjects&#39; leg length. Whilst COP-BCOM distances vary through STSW, normalized data at the key movement events of seat-off and initial toe-off (TO1) during steps 1 and 2 have low intra and inter subject variability in 5 repeated trials performed by 10 young healthy individuals. Thus, comparing COP-BCOM distance at key events during performance of an STSW paradigm between patients with upper motor neuron injury, or other compromised patient groups, and normative data in young healthy individuals is a novel methodology for evaluation of dynamic postural stability.

Here, we present a novel protocol to measure positional stability at key events during the sit-to-stand-to-walk using the center-of-pressure to the whole-body-center-of-mass distance. This was derived from the force platform and three-dimensional motion-capture technology. The paradigm is reliable and can be utilized for the assessment of neurologically compromised individuals.

坐姿到站姿和步行距离120％膝盖高度:新方法来评估铅肢体的动态姿势控制独立

Individuals with sensorimotor pathology e.g., stroke have difficulty executing the common task of rising from sitting and initiating gait (sit-to-walk: ...

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic conditions. As part of a diagnostic assessment, the early detection of postural deficits is important so that appropriate and targeted interventions can be prescribed. The Sensory Organization Test (SOT) on the EquiTest determines an individual&#39;s use of the sensory systems (somatosensory, visual, and vestibular) that are responsible for postural control. Somatosensory and visual input are altered by the calibrated sway-referenced support surface and visual surround, which move in the anterior-posterior direction in response to the individual&#39;s postural sway. This creates a conflicting sensory experience. The Motor Control Test (MCT) challenges postural control by creating unexpected postural disturbances in the form of backwards and forwards translations. The translations are graded in magnitude and the time to recover from the perturbation is computed.
Intermittent claudication, the most common symptom of peripheral arterial disease, is characterized by a cramping pain in the lower limbs and caused by muscle ischemia secondary to reduced blood flow to working muscles during physical exertion. Claudicants often display poor balance, making them susceptible to falls and activity avoidance. The Ankle Brachial Pressure Index (ABPI) is a noninvasive method for indicating the presence of peripheral arterial disease and intermittent claudication, a common symptom in the lower extremities. ABPI is measured as the highest systolic pressure from either the dorsalis pedis or posterior tibial artery divided by the highest brachial artery systolic pressure from either arm. This paper will focus on the use of computerized dynamic posturography in the assessment of balance in claudicants.

Individuals with intermittent claudication exhibit poor balance compared to healthy controls. Computerized dynamic posturography is an objective method for measuring an individual's postural responses to balance disturbances. This provides an objective reflection of the person&#x2019;s ability to respond to situations under which sensory stimuli are altered and unexpected perturbations occur.

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

医学

Quantitative Static and Dynamic Assessment of Balance Control in Stroke Patients

In patients with stroke, damage to the central nervous system (CNS) can affect the postural stability and increase the risk of falling. Therefore, accurately assessing the balance is important to understand the type, extent, and causes of balance deficit, and to identify individualized interventions. Clinical assessment methods for balance function can be broadly divided into observation, scale assessment, and balance instrument testing. Here, a clinical protocol is presented for static and dynamic balance assessment in stroke patients, which includes three semiquantitative balance function scale assessments (i.e., Berg Balance Scale, Timed Up and Go Test, and Fugl-Meyer Assessment) and three quantitative instrumental balance evaluation (i.e., Stability Assessment Module, Proprioceptive Assessment Module, and Limit of Stability Module). It is recommended that clinicians consider the use of both classic clinical balance scales and instrumental balance measurements when assessing stroke patients to improve the accuracy of assessments, leading to a better individualized treatment plan.

Presented here is a quantitative, clinical balance assessment method suitable for stroke patients with balance disorders.

In patients with stroke, damage to the central nervous system (CNS) can affect the postural stability and increase the risk of falling. Therefore, ...

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is aging. HIV-positive individuals have a high incidence of frailty (~20%) characterized by depression and sedentary behavior. Exercise would be healthy, but due to the frail status of many HIV-positive individuals, conventional exercise is too taxing. The aim of this study was to evaluate the effectiveness and acceptability of a novel game-based training program (exergame) in ameliorating some aspects of frailty in HIV-infected individuals. Ten older people living with HIV were enrolled in an exergame intervention. Patients performed balance exercises such as weight shifting, ankle reaching, and obstacle crossing. Real-time visual/audio lower-extremity joint motion feedback was provided using wearable sensors to assist feedback and encourage subjects to accurately execute each exercise task. Patients trained twice a week for 45 min for 6 weeks. Changes in balance, gait, psychosocial parameters and quality of life parameters were assessed at the beginning, midterm and at conclusion of the training program. Ten patients completed the study and their results analyzed. The mean age was 57.2 &#177; 9.2 years. The participants showed a significant reduction in center of mass sway (78.2%, p = .045) during the semi-tandem balance stance with eyes closed and showed a significant increase in gait speed during a dual task motor-cognitive assessment (9.3%, p = .048) with an increase in stride velocity of over 0.1 m/sec. A significant reduction in reported pain occurred (43.5%, p = .041). Preliminary results of this exergame intervention show promise in improving balance and mobility while requiring older people living with HIV to be more active. The exergame can be continued at home and may have long term as well as short-term benefits for ameliorating frailty associated with HIV infection.

Persons infected with HIV are often frail, depressed and live a sedentary lifestyle for which conventional exercise is too taxing. Here, we present an exercise protocol that ameliorates aspects of frailty in HIV-infected persons. An exergame integrating cognitive control was developed using biosensors that measured balance, weight-shifting and obstacle crossing.

老年人艾滋病感染者健身游戏平衡改善，流动性和可改善虚弱的几个问题

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is ...

Motor Dual-Tasks for Gait Analysis and Evaluation in Post-Stroke Patients

Eighteen stroke patients were recruited for this study involving the evaluation of cognition and walking ability and multitask gait analysis. Multitask gait analysis consisted of a single walking task (Task 0), a simple motor dual-task (water-holding, Task 1), and a complex motor dual-task (crossing obstacles, Task 2). The task of crossing obstacles was considered to be equivalent to the combination of a simple walking task and a complex motor task as it involved more nervous system, skeletal movement, and cognitive resources. To eliminate heterogeneity in the results of the gait analysis of the stroke patients, the dual-task gait cost values were calculated for various kinematic parameters. The major differences were observed in the proximal joint angles, especially in the angles of the trunk, pelvis, and hip joints, which were significantly larger in the dual motor tasks than in the single walking task. This research protocol aims to provide a basis for the clinical diagnosis of gait function and an in-depth study of motor control in stroke patients with motor control deficits through the analyses of dual-motor walking tasks.

This paper presents a protocol specifically for dual motor task gait analysis in stroke patients with motor control deficits.

用于中风后患者步态分析和评估的运动双任务

Eighteen stroke patients were recruited for this study involving the evaluation of cognition and walking ability and multitask gait analysis. Multitask ...

神经科学

Lower Limb Biomechanical Analysis of Healthy Participants

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb biomechanical assessment in healthy participants using commercially available systems. Separate protocols were introduced for the gait analysis and muscle strength testing systems. To ensure maximum accuracy for gait assessment, attention should be given to the marker placements and self-paced treadmill acclimatization time. Similarly, participant positioning, a practice trial, and verbal encouragement are three critical stages in muscle strength testing. The current evidence suggests that the methodology outlined in this article may be effective for the assessment of lower limb biomechanics.

This article introduces a comprehensive experimental methodology on two of the latest technologies available to measure the lower limb biomechanics of individuals.

健康参与者的下肢生物力学分析

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb ...

Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task assessment has advantages for identifying cognitive deficits in high-functioning stroke patients and has been gradually applied in clinical assessment and cognitive training. Moreover, the Stroop paradigm has higher sensitivity and specificity for attentional assessment than conventional clinical cognitive assessment scales. Therefore, this study presents the dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. This study demonstrates a single- and dual-task evaluation based on the Stroop paradigm and confirms its feasibility through case experiments and synchronized functional near-infrared spectroscopy evaluation. The Stroop reaction time and correct rate are used as the main indicators to evaluate the cognitive level of the subjects. This study protocol aims to provide new ideas to figure out the ceiling effect in general clinical assessment failure for high-functioning stroke patients.

Clinical assessment scales are notsensitive enough to cognitive dysfunction in high-functioning stroke patients. The dual-task paradigm presents advantages and potential in the assessment and cognitive training of cognitive dysfunction. The study here proposes a dual-task Stroop paradigm to identify cognitive dysfunction in high-functioning stroke patients.

检测高功能卒中患者认知缺陷的双任务斯特鲁普范式

General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task ...

Motor Exam II

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women&#39;s/Massachusetts General Hospital, Boston, Massachusetts, USA
There are two main types of reflexes that are tested on a neurological examination: stretch (or deep tendon reflexes) and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1).
DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTR examination is using a stick figure diagram. The DTR test can help distinguish upper and lower motor neuron problems, and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2).
Superficial reflexes are segmental reflex responses that result from stimulation of a specific sensory input (cutaneous or conjunctival) and the corresponding motor response. These reflexes include the corneal, conjunctival, abdominal, cremasteric, anal wink and plantar (Babinski) reflexes. The plantar reflex is a polysynaptic reflex elicited by stroking the lateral aspect of the sole with the normal response being plantar flexion of the great toe. This reflex changes with the normal development of the nervous system. In infants the toe will dorsiflex, but by 2 years of age the toe responds by plantar flexing. With damage to the pyramidal system, there is an unmasking of the more primitive reflex and the toe becomes &#34;upgoing&#34; or a positive Babinski sign.
The evaluations of coordination and gait are performed as a part of the neurological motor examination and can help a clinician localize lesions or recognize movement disorders. The coordination of movements and gait has complex multi-level regulation and requires an integrated function of different components of the nervous system. This part of the neurological examination allows the examiner to assess the function of the cerebellum, the cerebellar connections, and other tracts including brainstem structures. Coordination is assessed by looking for smooth and accurate movement, and requires the integration of sensory feedback with motor output, most of which occurs in the cerebellum. An impaired ability to coordinate the rate, range, timing, direction, or force of voluntary movement is called ataxia. Testing coordination includes evaluation of rapid alternating movements and point-to-point coordination, both of which can be altered as a result of cerebellar dysfunction. As in other parts of the examination, observation is the first step in the evaluation of the patient. A careful observation of a patient&#39;s gait can help the clinician screen for problems including weakness, movement disorders, spasticity, and cerebellar disease. No neurologic examination is complete without the assessment of gait. Occasionally, the only sign of a serious neurologic disorder is an impaired gait.

Motor Exam II: Reflex, Coordination, Gait and Station Testing

电机考试二

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women&#39;s/Massachusetts General Hospital, Boston, Massachusetts, USA
There ...