Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training.

Virtual reality (VR) training has been used successfully to rehabilitate functional balance and mobility in both traumatic brain injury (TBI) survivors and elderly subjects. Similarly, computer-based biofeedback (BF) training has resulted in decreased sway during quiet stance and decreased reaction times during a dual-task reaction time paradigm in elderly subjects. The objective of this study was to determine the effect of VR and BF training on balance and reaction time in older adults. Two groups of twelve healthy older adults completed 10-week training programs consisting of two 30-min sessions per week. VR training required that participants lean sideways to juggle a virtual ball. Participants in the BF group viewed a red dot representing their center of gravity on a screen and were required to move the dot to the four corners of the monitor. Measures of functional balance and mobility (Community Balance and Mobility Scale [CB&M]), sway during quiet stance, and reaction time during a dual task paradigm were recorded before training, as well as 1 week and 1 month after the end of the program. Both groups showed significant improvements on the CB&M, as well as decreased reaction times with training. Postural sway during quiet stance did not change significantly.     

Short-term effect of whole-body vibration training on balance,flexibility and lower limb explosive strength in elite rhythmic gymnasts

The purpose of this study was to examine whether whole-body vibration (WBV) training results in short-term performance improvements in flexibility, strength and balance tests in comparison to an equivalent exercise program performed without vibration. Eleven elite rhythmic gymnasts completed a WBV trial, and a control, resistance training trial without vibration (NWBV). The vibration trial consisted of eccentric and concentric squatting exercises on a vibration platform that was turned on, whereas the NWBV involved the same training protocol with the platform turned off. Balance was assessed using the Rhythmic Weight Shift (RWS) based on the EquiTest Dynamic Posturography system; flexibility was measured using the sit & reach test, and lower limb explosive strength was evaluated using standard exercises (squat jump, counter movement jump, single leg squat). All measurements were performed before (pre) immediately after the training program (post 1), and 15 minutes after the end of the program (post 15). Data were analyzed using repeated measures ANOVA was used with condition (WBV-NWBV) as the primary factor and time (pre, post 1, post 15) as the nested within subjects factor, followed by post-hoc pairwise comparison with Bonferroni corrections. Results confirmed the hypothesis of the superiority of WBV training, especially in the post 15 measurement, in all flexibility and strength measures, as well as in a number of balance tests.     

Anxiety and heart rate under psychological stress: The effects of exercise-training

Abstract The effects of a 12-week exercise-training program on cognitive, somatic, and behavioral anxiety and on heart rate responses to evaluative stress were scrutinized in 89 subjects randomly assigned to an experimental (exercise) or a control group. The training program consisted of exercises that were aimed to the improvement of the general physical fitness (i.e., strength, flexibility, and endurance). Following the 12-week training period, exercising subjects showed improved motor skill capacity as well as higher VO(2) max. In an anxiety inciting test situation, that consisted of the video-taped delivery of a 5-min speech, a mental arithmetic and a fine motor task, exercising subjects showed more favourable responses than control subjects in three ways: (a) they exhibited lower behavioral anxiety during the anticipation phase of the three stressors, (b) they reported lower cognitive and somatic anxiety during the anxiety provoking situation, and (c) their heart rate recovered faster, in contrast to both their baseline heart rate and the control subjects' heart rate, from the stress episode. These results demonstrate that a fitness-oriented exercise program has anxiolytic properties. They also provide a primary evidence that overt behavioral anxiety, as opposed to the usually measured self-reported anxiety, may be affected by exercise.     

The Effects of Parent Training and Ritalin on the Parent-Child Interactions of Hyperactive Boys

Using a multiple baseline across subjects design, the present study assessed the effects of parent training alone and combined with methylphenidate on the social interactions of three mothers with their hyperactive boys. Two mothers received instruction in child behavior management while their sons remained off medication. Subsequently, these boys returned to medication to evaluate whether the drug further enhanced the effects of parent training. The third child received the drug treatment first and then remained on medication while his mother underwent the same parent training program. Results indicated that both treatments alone decreased the amount of commands given by the mother as well as parent ratings of deviant child behavior in the home, but produced variable improvements in child compliance to commands. More reliable improvements in child compliance to commands. More reliable improvements from each treatment occurred in the duration of compliance per command. the combination of treatments failed to produce any further improvements in mother-child interactions than that achieved by either treatment alone. Contrary to earlier research, only parent training resulted in increases in the mothers' use of positive attention following child compliance.     

Relation of age and passive properties of an ankle dorsiflexion stretch to the timed one-leg stance test in older women

26 older women (aged 65 to 89 years) participated in this study, which examined the relationship of age and passive properties of a dorsiflexion stretch of the calf muscle-tendon unit with one-leg stance times. Age was negatively correlated with the time stance (r = -.75). The maximal passive dorsiflexion angle, length extensibility, maximal passive dorsiflexion torque, and the area under the passive curve (total passive elastic energy) were all positively correlated with the stance time (range: r = .49-.69). A multiple regression analysis indicated age was the best predictor of the times. Age and the maximal passive dorsiflexion angle together accounting for 71% of the variance in the time (R = .84, R(2) = .71). The addition of the remaining passive measurements did not improve the variance accounted for in the one-leg stance time. The results indicated that the maximal ankle dorsiflexion range of motion may be important for one-leg standing balance of older women. Accordingly, stretching exercises designed to increase the maximal dorsiflexion angle may have a role for maintaining or improving their standing balance.     

Postural Balance Following Aerobic Fatigue Tests: A Longitudinal Study Among Young Athletes

General fatigue can cause aggravation of postural balance, with increased risk for injuries. The present longitudinal study aimed to evaluate the postural balance of young athletes following field aerobic tests throughout 1 year of training. Thirty children from a sports center in Nazareth, participating in a 3 times/week training program (specific to basketball, soccer, or athletic training), were assessed. Postural balance parameters were taken before, immediately after, and 10 min after a 20 m shuttle-run aerobic test, at 3 time points during 1 training year (Start/Y, Mid/Y, and End/Y). Fitness improved at the Mid/Y and End/Y compared to Start/Y. Postural balance significantly deteriorated immediately after the aerobic test and improved significantly in the 10-min testing in all 3 time points, with significant deterioration in the End/Y compared with the Start/Y. In conclusions, postural balance deteriorates immediately after aerobic exercises, and at the end of the year. To better practice drills related to postural balance and possibly to prevent injuries, it is best for young athletes to properly rest immediately following aerobic exercises and to practice postural balance mainly at the beginning and at the middle of the training year.     

Athletic background is related to superior trunk proprioceptive ability,postural control,and neuromuscular responses to sudden perturbations

Trunk motor control is essential for athletic performance, and inadequate trunk motor control has been linked to an increased risk of developing low back and lower limb injury in athletes. Research is limited in comparing relationships between trunk neuromuscular control, postural control, and trunk proprioception in athletes from different sporting backgrounds. To test for these relationships, collegiate level long distance runners and golfers, along with non-athletic controls were recruited. Trunk postural control was investigated using a seated balance task. Neuromuscular control in response to sudden trunk loading perturbations was measured using electromyography and kinematics. Proprioceptive ability was examined using active trunk repositioning tasks. Both athlete groups demonstrated greater trunk postural control (less centre of pressure movement) during the seated task compared to controls. Athletes further demonstrated faster trunk muscle activation onsets, higher muscle activation amplitudes, and less lumbar spine angular displacement in response to sudden trunk loading perturbations when compared to controls. Golfers demonstrated less absolute error and variable error in trunk repositioning tasks compared to both runners and controls, suggestive of greater proprioceptive ability. This suggests an interactive relationship between neuromuscular control, postural control, and proprioception in athletes, and that differences exist between athletes of various training backgrounds.     

Anxiety management and applied relaxation in reducing general anxiety

Sixty-three generally anxious subjects were assigned to anxiety management training, applied relaxation training, relaxation-only, placebo and untreated control conditions. After 6 weeks of treatment, anxiety management training led to reductions on a variety of self-report measures of state and trait anxiety and decreases in maladaptive cognitions during a laboratory stress procedure. On several measures, subjects in anxiety management training differed from relaxation-only and placebo subjects as well as untreated controls. However, treatment effects did not extend to performance and physiological measures of anxiety. Applied relaxation training, which in contrast to anxiety management training lacks structured rehearsal involving the recognition and reduction of tension cues during the treatment sessions, resulted in less consistent decreases in measures of general anxiety.     

The importance of home practice for progressive relaxation training

The efficacy of home practice assignments was evaluated as a component of standardized progressive relaxation training. Subjects reporting general anxiety and tension problems were assigned to either a home practice relaxation, no home practice relaxation or wait-list control condition. Treatment was conducted for 10 sessions over a 5-week period. In addition, subjects in both conditions engaged in in-vivo application of their relaxation skills during a final 2-week application period. Group comparisons showed that both progressive relaxation conditions significantly improved on daily self-monitored general anxiety and tension levels relative to the wait-list control condition. Group analyses of percent subject improvements supported the effectiveness of home practice assignments, especially during the application period. No systematic differences between groups, on physiological and self-report variables, were found during several laboratory relaxation evaluation sessions. This study supports the contribution of home practice assignments to progressive relaxation training.     

Effect of Wii-Based Balance Training on Corticomotor Excitability Post Stroke

The objective was to examine the effectiveness of a 3-week balance training program using the Nintendo Wii Fit gaming system (Nintendo Wii Sports, Nintendo, Redmond, WA) on lower limb corticomotor excitability and other clinical measures in chronic stroke survivors. Ten individuals diagnosed with ischemic stroke with residual hemiparesis received balance training using the Wii Fit for 60 min/day, three times/week, for three weeks. At the end of training, an increase in interhemispheric symmetry of corticomotor excitability of the tibialis anterior muscle representations was noted (n = 9). Participants also showed improvements in reaction time, time to perform the Dual Timed-Up-and-Go test, and balance confidence. The training-induced balance in corticomotor excitability suggests that this Wii-based balance training paradigm has the potential to influence neural plasticity and thereby functional recovery.     

Catecholamine training effects from exercise programs: A bridge to exercise-temperament relationships

Three studies were conducted to test whether a catecholamine training effect results from a long-term aerobic exercise program. Study I showed significant increases in urinary adrenaline and noradrenaline following moderate mental stress/challenge for male aerobics subjects after a semester of training. Control groups of nonexercisers and continuously in-condition marathoners showed no comparable pre- to post semester catecholamine increases. Male and female Aerobics subjects were contrasted with nonexercisers across a semester in Study 2; the hypothesis was confirmed that postsemester increases in catecholamines occurred only following an episode of mental challenges/stress, and not following base-rate-rest conditions. Under conditions of more active challenge than in Studies 1 and 2, women subjects in Study 3 provided directional but nonsignificant support for the Study 2 findings. The results are discussed in the context of literature on the relationship of catecholamine availability during challenge/stress to temperament and on the relationship of aerobic training to temperament. At a theoretical level, the question is discussed of increased catecholamine availability being a likely mediator in the exercise program to temperament relationship.This research was supported by a grant from the Research Council of the University of Nebraska Lincoln. Our thanks to Prof. James Crabbe for assistance in recruiting subjects in Study 2, and to Pamela Brown and Prof. Wes Sime for assistance with Study 3.     

Static balance and developmental coordination disorder

The development of static balance is a basic characteristic of normal motor development. Most of the developmental motor tests include a measure of static balance. Children with a developmental coordination disorder (DCD) often fail this item. Twenty-four children at risk for DCD with balance problems (DCD-BP) and 24 matched control children in the age range of 6-12 years participated in a detailed study of balance control. Additional groups of children (6-7 years, N=25; 10-11 years, n=16; with M-ABC scores >15th percentile) were selected randomly to study developmental changes in balance control in the age range of interest. Three experiments were conducted to examine developmental and clinical differences in the control of static balance. In the first, we measured the excursion of the centre of pressure (force-plate) in conditions with and without vision while standing still on one or two legs for 20 s. In the second experiment, EMGs were measured while standing on one leg. In the third experiment, in which only a subgroup of the DCD-BP and matched control children participated, a short unexpected force in the back lightly perturbed normal standing and EMG and force-plate responses were measured during balance recovery. In conditions of one-leg stance, children were not always able to maintain balance. Only epochs of stable postural control (7.5-20 s) were analysed. The results showed improvement of static balance with age, but only subtle differences between the DCD and control groups. Centre of pressure measures differed in the more difficult conditions. DCD-BP children had more difficulty standing on one leg with eyes closed. While standing on the non-preferred leg the EMGs of the DCD-BP children showed slightly more co-activation of the muscles of lower and upper leg. Perturbation of standing resulted in longer duration of recovery in the first trial in this group. Apparently DCD children learn to compensate for the perturbation within a few trials as well as control children do. The clear improvement with age shows that our measures of balance control are sensitive to detect changes. The general conclusion that may be drawn from this study is that under normal conditions static balance control is not a problem for children with DCD. Only in difficult or novel situations they seem to suffer from increased postural sway as a result of non-optimal balance control.     

The growth of stability: postural control from a development perspective

This study compared central nervous system organizational processes underlying balance in children of three age groups: 15-31 months, 4-6 years, and 7-10 years, using a movable platform capable of antero-posterior (A-P) displacements or dorsi-plantar flexing rotations of the ankle joint. A servo system capable of linking platform rotations to A-P sway angle allowed disruption of ankle joint inputs, to test the effects of incongruent sensory inputs on response patterns. Surface electromyography was used to quantify latency and response patterns. Surface electromyography was used to quantify latency and amplitude of the gastrocnemius, hamstrings, tibialis anterior, and quadriceps muscle responses. Cinematography provided biomechanical analysis of the sway motion. Results demonstrated that while directionally specific response synergies are present in children under the age of six, structured organization of the synergies is not yet fully developed since variability in timing and amplitude relationships between proximal and distal muscles is high. Transition from immature to mature response patterns was not linear but stage-like with greatest variability in the 4- to 6- year-old children. Results from balance tests under altered sensory conditions (eyes closed and/or ankle joint inputs altered) suggested that: (a) with development a shift in controlling inputs to posture from visual dependence to more adult-like dependence on a combination of ankle joint and visual inputs occurred in the 4- to 6-year-old, and reached adult form in the 7- to 10-year-old age group. It is proposed that the age 4-6 is a transition period in the development of posture control. At this time the nervous system (a) uses visual-vestibular inputs to fine tune ankle-joint proprioception in preparation for its increased importance in posture control and (b) fine tunes the structural organization of the postural synergies themselves.     

BEHAVIORAL RESEARCH IN PREVENTIVE DENTISTRY: EDUCATIONAL AND CONTINGENCY MANAGEMENT APPROACHES TO THE PROBLEM OF PATIENT COMPLIANCE

This study examined the effects of reinforcement on compliance with an oral hygiene education program. Patients 18 years of age or older who enrolled in an ongoing program at a periodontal practice received 3–5 sessions of instruction in preventive dental care. Using a between-subjects design, patients who entered the program during alternating months also had a portion of their fees refunded contingent upon improvements in their dental plaque scores. Pre- and posttreatment data showed that all subjects exhibited lower plaque levels following the program, but that greater improvements were seen in patients who were exposed to the fee reduction contingency. Plaque scores taken at a 6-month follow-up revealed some relapse for the Fee Reduction subjects. However, their scores were still substantially better than pretreatment, and better than those of the Education only subjects, whose data differed little from untreated Controls. Methodological and practical issues related to behavioral research in preventive dentistry are discussed.     

Feedback training for facial image comparison

People are typically poor at matching the identity of unfamiliar faces from photographs. This observation has broad implications for face matching in operational settings (e.g., border control). Here, we report significant improvements in face matching ability following feedback training. In Experiment 1, we show cumulative improvement in performance on a standard test of face matching ability when participants were provided with trial-by-trial feedback. More important, Experiment 2 shows that training benefits can generalize to novel, widely varying, unfamiliar face images for which no feedback is provided. The transfer effect specifically benefited participants who had performed poorly on an initial screening test. These findings are discussed in the context of existing literature on unfamiliar face matching and perceptual training. Given the reliability of the performance enhancement and its generalization to diverse image sets, we suggest that feedback training may be useful for face matching in occupational settings.     

Effectiveness of taping and bracing in balance

Taping and bracing are thought to be effective methods in restricting the ankle's joint motion and assisting prevention of injuries. Research evidence suggests that taping and bracing enhance both the mechanical support and the proprioception of the ankle. However, there is little research concerning the influence of taping and bracing on sport performance. Research has mainly examined tasks with demands on the frontal plane. Therefore, the present study examined the effect of taping and bracing on the performance of a task with demands on the frontal plane. A sample of 30 physical education students (Mage=21.9 yr.) performed a balance task requiring estimation of balance and both right and left deviations. The subjects performed the balance task on four different conditions, with tape, with Swede-O (a lace-up, boot style stabilizer), with Aircast (an inflatable cast), and without any stabilizer. There were no significant differences among the conditions. These findings indicate that taping and bracing do not have negative effects on balance in the frontal plane. This study created concerns regarding the appropriate stabilizer for different tasks, bilateral coordination after the application of a stabilizer, and the influence of psychological factors on prevention of injury.     

FUNCTIONAL ANALYSIS OF A PROGRAM FOR TRAINING HIGH AND LOW PREFERENCE PEERS TO MODIFY DISRUPTIVE CLASSROOM BEHAVIOR1

Although considerable evidence has accumulated regarding the effectivenes of peers as behavior managers, little attention has been directed toward the analysis of components of training programs. Also, it is not known whether high and low preference peers have different reinforcing effects. In this study, a two-phase peer training program was introduced to five high preference and five low preference peer managers. The Managers were assigned one to each of 10 grade-four elementary pupils with high rates of disruptive behavior. Peer Training I was composed of instructions to monitor and reinforce target subject behavior on a time-sample schedule, to record this reinforcement, and to ignore inappropriate behavior in target subjects. Peer Training II introduced, in addition, backup reinforcement for the monitoring behavior of managers. Measures were taken of target subject behavior, antecedent and consequent attention from managers and other peers, monitoring behavior of managers, teacher behavior, and preference ratings of peer managers by target subjects. Significant improvements in target subject behavior occurred following Peer Training I and further improvements occurred following Peer Training II. These changes were paralleled by decreases in the frequency of antecedent and consequent manager attention to problem behaviors, and improvements in the number and accuracy of monitoring checks. Recorded reductions in teacher attention to individual children and to target subjects were not statistically significant. Posttest preference scores improved significantly over pretest scores for low preference managers, while remaining high for high preference managers.     

A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy

Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.     

Errors in the ankle plantarflexor force production are related to the gait deficits of individuals with multiple sclerosis

BackgroundIndividuals with multiple sclerosis (MS) often have limited mobility that is thought to be due to the neuromuscular impairments of the ankle. Greater isometric motor control of the ankle has been associated with better standing postural balance but its relationship to mobility is less understood. The objectives of this investigation were to quantify the motor control of the ankle plantarflexors of individuals with MS during a dynamic isometric motor task, and explore the relationship between the ankle force control and gait alterations.MethodsFifteen individuals with MS and 15 healthy adults participated in both a dynamic isometric ankle plantarflexion force matching task and a biomechanical gait analysis.FindingsOur results displayed that the subjects with MS had a greater amount of error in their dynamic isometric force production, were weaker, walked with altered spatiotemporal kinematics, and had reduced maximal ankle moment at toe-off than the control group. The greater amount of error in the dynamic force production was related to the decreases in strength, step length, walking velocity, and maximal ankle moment during walking.InterpretationAltogether these results imply that errors in the ankle plantarflexion force production may be a limiting factor in the mobility of individuals with MS.     

Increased dynamic regulation of postural tone through Alexander Technique training

Gurfinkel and colleagues (2006) recently found that healthy adults dynamically modulate postural muscle tone in the body axis during anti-gravity postural maintenance and that this modulation is inversely correlated with axial stiffness. Our objective in the present study was to investigate whether dynamic modulation of axial postural tone can change through training. We examined whether teachers of the Alexander Technique (AT), who undergo “long-term” (3-year) training, have greater modulation of axial postural tone than matched control subjects. In addition, we performed a longitudinal study on the effect of “short-term” (10-week) AT training on the axial postural tone of individuals with low back pain (LBP), since short term AT training has previously been shown to reduce LBP. Axial postural tone was quantified by measuring the resistance of the neck, trunk and hips to small (±10°), slow (1°/s) torsional rotation during stance. Modulation of tone was determined by the torsional resistance to rotation (peak-to-peak, phase-advance, and variability of torque) and axial muscle activity (EMG). Peak-to-peak torque was lower (∼50%), while phase-advance and cycle-to-cycle variability were enhanced for AT teachers compared to matched control subjects at all levels of the axis. In addition, LBP subjects decreased trunk and hip stiffness following short-term AT training compared to a control intervention. While changes in static levels of postural tone may have contributed to the reduced stiffness observed with the AT, our results suggest that dynamic modulation of postural tone can be enhanced through long-term training in the AT, which may constitute an important direction for therapeutic intervention.