Four Weeks of Neuromuscular Training Improve Static and Dynamic Postural Control in Overweight and Obese Children: A Randomized Controlled Trial

Abstract

Thirty-two children with overweight or obesity were randomly divided into a neuromuscular training group (NTG) (n = 16) and a control group (CG) (n = 16). All individuals participated in the measurement of static postural control under two conditions: the double-leg stance with eyes open (EO) and eyes closed (EC). The center of pressure variables was obtained. mSEBT was used for dynamic postural control. Neuromuscular training was performed twice per week and lasted 4 weeks. The results of this study indicate that 4 weeks of neuromuscular training improve static and dynamic postural control in children with excess body weight.     

Age-related Changes in Postural Sway During Sit-to-stand in Typical Children and Children with Cerebral Palsy

Objective: To assess age-related changes in postural sway during sit-to-stand (STS) in typical children (TC) and children with mild cerebral palsy (CP). Methods: Thirty-five TC and 23 children with mild CP were allocated in four different age groups: 5–6, 7–9, 10–12, and 13–15 years; they all performed STS movements over a force plate. Anterior-posterior and medial-lateral amplitude of center of pressure (CoP) displacement, area and velocity of CoP sway were analyzed and compared between the age groups for TC and children with CP. Results: TC at 5 to 6 years of age showed higher values of anterior-posterior CoP displacement and Area of CoP sway than at 10–12 years, during the stabilization phase. There were no age-related changes for CP. Conclusion: TC change their postural sway during the last STS phase over the years, reducing their body sway. Children with CP did not show age-related changes in sway during STS, reflecting a distinct rhythm of postural control development in this population.     

Impact of Spina Bifida on Parental Caregivers: Findings from a Survey of Arkansas Families

The well-being of caregivers of children with spina bifida and other conditions is an important topic. We interviewed the primary caregivers of 98 children aged 0–17 years with spina bifida sampled from a population-based birth defects registry in Arkansas and the caregivers of 49 unaffected children. Measures of caregiver well-being were compared between the groups and by level of lesion (sacral, lower lumbar, and upper lumbar/thoracic). We performed linear and logistic regression analysis to test the associations controlling for other characteristics. Among caregivers of children with spina bifida, the average number of hours of sleep was significantly less than reported by other caregivers and was associated with lesion level among children less than 7 years of age. Significant associations, often varying by child age, were also found for the caregiver’s reports of lower Quality of Well-Being (QWB) score, often feeling blue, rarely feeling happy, fair or poor health, lack of leisure days, and not hosting friends, but no significant association was found with not visiting friends. The intensive long-term care required by children with spina bifida, particularly by those with higher lesions, can negatively impact caregiver health and well-being. Support for these caregivers is needed.     

Relation between spina bifida occulta and various epileptic syndromes

Radiographs of the lumbar vertebral column and sacral region obtained for 182 epileptic patients after spina bifida occulta were studied. Spina bifida occulta was twice as common in patients with idiopathic epilepsy as in those with symptomatic epilepsy and twice as common as in the normal population. A relationship between spina bifida occulta and idiopathic epilepsy is discussed.     

Ankle muscles activation and postural stability with Star Excursion Balance Test in healthy individuals

IntroductionThe ankle joint, a part of the kinetic chain of the lower limb, plays a significant role in the maintenance of postural stability during bipedal and unipedal balancing activities. This study aimed to evaluate the neuromuscular control of the ankle joint and the postural stability while executing the Star Excursion Balance Test (SEBT), by recording the EMG activity of the extrinsic ankle musculature and the displacement of the center of pressure (CoP).MethodsThe EMG activity of the tibialis anterior (TA), the peroneus brevis (PB) and the medial and lateral gastrocnemius (GM, GL), along with the anteroposterior and mediolateral displacements (APd and MLd) of CoP as well as the plantar pressure distribution of the supportive lower limb were recorded during reaching to the eight directions of SEBT in 29 healthy, physically active college students (15 males and 14 females; mean ± SD of age 25.6 ± 4.5 yrs.; height: 172.5 ± 8.2 cm; body weight: 67.7 ± 13.6 kg; and BMI: 22.6 ± 2.9 kg/m²).ResultsThe tibialis anterior muscle demonstrated the greatest EMG activity during SEBT, followed by the PB, GL and GM muscles. The increased EMG activity of TA and PB during the execution of all posterior-oriented and lateral directions coincided with a decreased APd of CoP and increased reaching distances. The opposite occurred during the execution of all the anterior-oriented and medial directions. The differences among the directions of SEBT regarding the EMG activity of GL, GM and the mediolateral displacement of CoP were, in general, not significant.ConclusionsThe neuromuscular control of the ankle joint and the associated postural stability during SEBT was highly depended upon the activation level of TA and PB, which should be considered by clinicians and sports specialists when using this test for screening and/or rehabilitation purposes.     

Effects of Visual Manipulation in Sit-to-Stand Movement in Children With Cerebral Palsy

The authors sought to verify the effects of vision on sit-to-stand (STS) movement performance by means of postural sway in children with cerebral palsy (CP) and typical children (TC). Participants were 42 TC and 21 children with CP. STS movement was assessed with eyes open and with eyes closed. Area and velocity of center of pressure sway were analyzed in each of the 3 STS phases. We observed greater postural sway during STS movement with eyes closed. Children with CP presented greater postural sway than TC did. Both groups exhibited greater postural instability with absence of vision expressing the role of vision to keep postural stability. Moreover, the greater postural instability was observed in children with CP.     

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.     

Harnessing the Power of a Novel Program for Dynamic Balance Perturbation with Supported Body Weight

Abstract

Self-initiated postural adjustments commonly occur in daily life. To accessibly measure this type of dynamic balance, we developed a simple computer program to induce virtual perturbations and combined it with a commercially available balance board and portable EMG system to measure resulting self-initiated postural adjustments. When performing perturbed balance tests, safety harness with body weight support (BWS) is often used. However, influences of these harnesses on postural reactions are not well known. This study investigated the sensitivity of our assessment tool under different BWS conditions and muscle responses during postural adjustments following perturbation at different directions. Fifteen neurologically intact participants performed self-initiated postural adjustments under conditions with: (1) no harness; (2) harness with no BWS; and (3) harness with 10% BWS. Postural adjustment time and muscle activities of the lower leg were measured. We observed significant increases in postural adjustment time in the harness with no BWS condition and differneces in lower leg muscles response to virtual perturbation. Our findings suggest that the combination of our customized program with EMG is a sensitive and convenient tool to measure postural adjustments that approximate real-world scenarios. This method can be used with light body weight support to ensure safety without influencing muscle synergies.     

Impairment of a motor skill in children with spina bifida cystica and hydrocephalus: an exploratory study.

Twenty 7-10 year old children with spina bifida cystica and hydrocephalus and 20 normals matched for age, sex and IQ were compared on a 12-trial target task, first used by Connolly, Brown & Bassett (1968). Analysis of the results, in which particular attention was paid to statistical method and to ways of analysing individual differences, showed a significant impairment in dotting speed in the spina bifida group, although both groups improved with practice. In a second experiment immediately following the first, visual monitoring of this task was restricted. The spina bifida children were initially more affected than the controls but able to recover. The findings are discussed in relation to neurological abnormalities in the spina bifida group.     

Psychiatric Symptomatology and Family Functioning in Children and Adolescents with Spina Bifida

The purpose of this study was to (a) examine the occurrence of psychiatric symptomatology in children and adolescents with spina bifida, (b) investigate the relationship between psychiatric features and aspects of disability, and (c) explore the impact of spina bifida and psychiatric status on family functioning. Fifty-four children and adolescents ages 6 to 18 years (M = 12.94, SD = 3.59) were examined. Parents completed the Child Symptom Inventory (CSI) and the Family Assessment Device (FAD). Using the CSI, a psychiatric diagnostic screen, 43% of the sample obtained one, and 13% obtained two or more screening cutoff scores reflective of psychiatric diagnoses. The two most prevalent diagnostic categories were Attention-Deficit/Hyperactivity Disorder (33%) and Oppositional Defiant Disorder (13%). The sample as a whole exhibited elevated levels of clinical symptoms, with internalizing symptoms more prominent than externalizing symptoms. No differences in diagnostic categories or overall symptomatology were found based on age, gender, ambulation status, or lesion level. Overall symptom counts were positively correlated with scales on the FAD reflecting problematic family functioning (.42–.65). Results suggest that psychiatric symptomatology occurs at a high rate in children and youth with spina bifida. Although ADHD was the modal diagnostic category, the sample as a whole exhibited extensive psychiatric symptoms independent of specific diagnostic categories. Psychiatric symptoms were also associated with increased problematic functioning in families.     

Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure

Abstract

Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms.

Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5?±?11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant.

Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.     

Mechanisms of postural control in older adults based on surface electromyography data

ObjectivesThe present study aimed to clarify the mechanisms of postural control during standing in older adults and document the mechanisms of age-related motor control based on changes in muscle activities.MethodsA total of 26 healthy male adults (older adult group, ≥65–78 years: n = 16; younger adult group, 20–23 years: n = 10) participated in this study. Ground reaction force and kinematic data of the lower limbs (hip, knee, and ankle), and electromyographic data from 6 postural muscles on the right side were recorded and quantified for each motor phase during rapid voluntary center of pressure (COP) shift.ResultsAlthough hip strategy was more frequently observed in older adults than in young adults (56.3% vs. 20.0%), no muscle activity of hip agonists was observed in some (31.3%) older adults. Furthermore, older adults had a statistically significant delay in the inhibition of postural muscles during anticipatory postural adjustments (p < 0.05). After the onset of COP motion, the co-contraction time between agonists and antagonists was significantly prolonged in the older adults than in the younger adults (p < 0.05), and the reciprocal muscle pattern was unclear in the older adults. Prior to the termination of movement, agonist activity continued longer in the older adult group than in the younger adult group; that is, inhibition was insufficient in the older adult group.ConclusionA series of postural strategies during the voluntary movement task were altered in older adults, and this was significantly related not only with the activation but also the inhibition of postural muscles.     

Postural stability with exhaustive repetitive sit-to-stand exercise in young adults

Previous research has indicated that muscle fatigue due to repeated bouts of physical activity can have negative residual effects on balance; however investigations using multi-joint forms of exercise involved in everyday settings and determination of how control of posture is altered during the physical activity itself are limited. The purpose of this investigation was to evaluate alterations in postural stability before, during, and after prolonged multi-joint STS exercise in healthy young adults. Center of pressure (COP) acquisitions were collected during repetitive STS exercise, while voluntary limits of stability (LOS) testing was performed before, immediately after, and 10 min after STS exercise. By 50% total STS exercise time, fatigue resulted in increased anterio-posterior (y) and medio-lateral (x) COP path lengths (p = 0.003 and p = 0.018 respectively) and an anterior shift of COP at seat-off towards the mid-foot (p = 0.010). No significant change in LOS mean amplitude was found after STS exercise; however a significant fatigue effect resulted in increased COPy sway velocity at maximal lean positions (p = 0.006), but returned to PRE values after 10 min of rest. Declines in postural stability during repetitive STS exercise was associated with reduced control of COP, as well as a reduced ability to stably control COP at extreme postural limits; however, 10 min was adequate in young adults for recovery. These results may have important implications for monitoring fall risk due to acute bouts of exercise induced muscle fatigue from repetitive multi-joint activities such as the STS.     

Assessing the factorial invariance of Harter's self-concept measures: comparing preadolescents with and without spina bifida using child,parent, and teacher report

The purpose of this study was to determine whether the structure of children's self-concept, as rated by children themselves on the Self-Perception Profile for Children (SPPC; Harter, 1985), and the structure of children's competence, as rated by their parents on the Rating Scale of Child's Actual Behavior (PRS) and teachers on the Rating Scale of Child's Actual Behavior (TRS; Harter, 1985), are similar across samples of children with and without spina bifida (children were 8 and 9 years of age; n = 68 in each sample). Using confirmatory factor analyses, results revealed that a multidimensional model for the SPPC and the TRS fit the data well for both samples. On the other hand, the model for both mothers' and fathers' PRS ratings did not fit the data for the spina bifida sample. Further tests of factorial invariance conducted on the SPPC and TRS revealed that the spina bifida and able-bodied samples tended to have the same pattern and magnitude of factor loadings for both instruments. There was some invariance, however, in the amount of unique error variance accounted for across samples. These results bolster our confidence in using the SPPC and TRS to compare children with and without spina bifida.     

Specific language deficiencies in children with early onset hydrocephalus

Specific language abilities of children with early onset hydrocephalus were compared to nonhydrocephalic comparison groups. Ninety children, aged 5 to 7 years, composed six subject groups: three groups having a history of hydrocephalus due to spina bifida, prematurity-intraventricular hemorrhage, or aqueductal stenosis. and three comparison groups of children with spina bifida who had never been shunted, premature children with no hydrocephalus, and normal controls. Group performance scores were compared on measures of phonological awareness, semantics, fluency, and word retrieval. Children with hydrocephalus performed below their peers on all measures. These results indicate that early onset hydrocephalus has a substantial adverse impact on the development of a wide range of specific language abilities.     

Unveilling the cerebral and sensory contributions to automatic postural control during dual-task standing

ObjectivesThe postural control dual-task literature has demonstrated greater postural stability during dual-task in comparison to single task (i.e., standing balance alone through the examination of multiple kinetic and kinematic measures. This improve stability is thought to reflect an automatic mode of postural control during dual-task. Recently, sample entropy (SampEn) and wavelet discrete transform have supported the claim of automaticity, as higher SampEn values and a shift toward increased contributions from automatic sensory systems have been demonstrated in dual-task settings. In order to understand the cortical component of postural control, functional near-infrared spectroscopy has been used to measure cortical activation during postural control conditions. However, the neural correlates of automatic postural behaviour have yet to be fully investigated. Therefore, the purpose of this study is to confirm the presence of automatic postural control through static and dynamic balance measures, and to investigate the prefrontal cortex activation when concurrently performing quiet standing and the auditory cognitive tasks of varied difficulty.MethodEighteen healthy young adults (21.4 ± 3.96 yo), 12 females and 6 males, with no balance deficits were recruited. Participants were instructed to either quietly stand on a force platform (SM), perform three cognitive tasks while seated (SC) or perform both aforementioned tasks concurrently (DT).ResultsResults supported automatic postural control with lower area and standard deviation of center-of-pressure in DT conditions compared to SM. As for SampEn and the wavelet analysis, DT conditions demonstrated greater values than SM, and a shift from vision to a cerebellar contribution. For the most difficult cognitive task, the DNS task, a trend toward significantly lower right hemisphere prefrontal cortex activation compared to left hemisphere activation in DT was found, potentially representing a decrease in cognitive control, and the presence of automaticity.ConclusionThese findings suggest that the simultaneous performance of a difficult cognitive task and posture yields automatic postural behaviour, and provides insight into the neural correlates of automaticity.     

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents

Abstract

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4–18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (p?<?0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4–13 and 4–7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.     

Executive functioning and psychological adjustment in children and youth with spina bifida

Children and adolescents with spina bifida are at risk for poor neuropsychological functioning and psychological outcomes. The relationship between executive functioning and psychological adjustment is an area worthy of investigation in this population. The current study assessed executive functioning and psychological outcomes in a group of children and adolescents with spina bifida (SBM) (n = 51) and nondisabled controls (n = 45). A mediation model was hypothesized, such that Metacognition, as measured by the Behavior Rating Inventory of Executive Function (BRIEF), mediated the relationship between group status (spina bifida versus nondisabled controls) and psychological outcomes. Results indicated that metacognitive skills fully explained the relationship between group and internalizing and depressive symptoms as reported by mothers. In particular, specific components of the BRIEF Metacognition composite were most responsible for this relationship, including Initiate, Working Memory, and Plan/Organize. The study limitations include its cross-sectional nature that precludes drawing conclusions about causality. The results have implications for treatment interventions for children and adolescents with spina bifida and typically developing individuals.     

Hands Support and Postural Oscillation During Sit-to-Stand Movement in Children With Cerebral Palsy and Typical Children

The authors aimed to compare the weight bearing on hands during sit-to-stand (STS) movement in children with cerebral palsy (CP) and typical children (TC), verify its effect on postural oscillation, and analyze the relationship between weight bearing on hands and postural oscillation. Twenty children with CP (Gross Motor Function Classification System levels I and II) and 35 TC performed STS with and without anterior hands support. Mann-Whitney test compared weight bearing between groups. Wilcoxon test investigated differences in postural oscillation between the conditions with and without anterior hand support for both groups. The Spearman correlation tested the relationship between weight-bearing and postural oscillation during the hand support condition. Children with CP bore more weight on hands than TC to perform STS. The hand support reduced postural oscillation during the second phase of STS in both groups. In the CP group, greater weight bearing was related with lower postural oscillation in the beginning of STS. Although children with CP were able to perform STS without support, they bore more weight on their hands to perform the task than TC. Moreover, children with CP and TC use mechanical and somatosensory information to modulate their postural control during STS in different ways.     

Children with spina bifida perceive visual illusions but not multistable figures

We compared 32 children with spina bifida and 32 age-matched controls on two classes of illusory perception, one involving visual illusions and the other, multistable figures. Children with spina bifida were as adept as age peers in the perception of visual illusions concerned with size, length, and area, but were impaired in the perception of multistable figures that involved figure-ground reversals, illusory contours, perspective reversing, and paradoxical figures. That children with spina bifida reliably perceive illusions that rely on inappropriate constancy scaling of size, length, and area suggests that their brain dysmorphologies do not prevent the acquisition of basic perceptual operations that enhance the local coherence of object perception. That they do not perceive multistable figures suggests that their visual perception impairments may involve not object processing so much as poor top-down control from higher association areas to representations in the visual cortex.