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Brain Sciences
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Balance, Gait and Falls in Peripheral and Central Neurological Disorders:...
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Balance, Gait and Falls in Peripheral and Central Neurological Disorders: From Pathophysiology to Rehabilitation

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Systems Neuroscience".

Deadline for manuscript submissions: closed (16 August 2021) | Viewed by 17430

Special Issue Editors

Dr. Shapour Jaberzadeh

E-Mail Website
Guest Editor
Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, 3800 Melbourne, Australia
Interests: non-invasive brain stimulation (NIBS); cognition; balance; movement control; pain; transcranial magnetic stimulation (TMS); transcranial direct current stimulation (tDCS); neuroplasticity; corticospinal excitability; electromyography (EMG)
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Jonathan Marsden

E-Mail Website
Co-Guest Editor
School of Health Professions, Faculty of Health, Peninsula Allied Health Centre, Plymouth University, Plymouth, UK
Interests: balance; gait; stroke; multiple sclerosis; cerebral palsy; peripheral neuropathy

Special Issue Information

Dear Colleagues,

Peripheral and central neurological conditions commonly result in problems with balance, gait and falls. These can have a significant impact on people’s ability, participation in the community and quality of life.

Understanding the pathophysiology of underlying balance and gait dysfunction, as well as the lived experience of these difficulties, can help rehabilitation teams to develop targeted interventions. Rehabilitation trials and practice should be supported by appropriate and psychometrically robust outcome measures. Due to the complexities of the underlying conditions and the interventions, full robust randomised controlled clinical trials should be developed, based on previous evidence, being supported by single case studies, proof of concept, and feasibility and pilot trials.

This Special Issue will highlight papers that focus on the pathophysiology and lived experience of balance and gait disorders and falls in people with central and peripheral nervous system disorders; as well as their rehabilitation and measurement using patient-reported and objective outcome measures.

Research that aims to understand the cause of balance or gait dysfunction providing clear implications for rehabilitation are welcome. We are particularly interested in papers that translate basic science findings into clinical trials.

Original research papers including systematic reviews and meta-analyses are welcome. These can include studies investigating the underlying problem of balance, gait and falls from the perspective of the user and carer as well as studies highlighting the underlying pathophysiology. Trials on rehabilitation, including those supporting the development of future trials (e.g., single case studies and feasibility trials) and studies on the psychometric properties of outcome measures used for rehabilitation are within scope.

Dr. Shapour Jaberzadeh
Prof. Jonathan Marsden
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Balance 
  • Gait 
  • Falls 
  • Nervous system 
  • Rehabilitation

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Published Papers (5 papers)

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18 pages, 2947 KiB  
Article
Plantar Pressure and Contact Area Measurement of Foot Abnormalities in Stroke Rehabilitation
by Ligia Rusu, Elvira Paun, Mihnea Ion Marin, Jude Hemanth, Mihai Robert Rusu, Mirela Lucia Calina, Manuela Violeta Bacanoiu, Mircea Danoiu and Daniel Danciulescu
Brain Sci. 2021, 11(9), 1213; https://doi.org/10.3390/brainsci11091213 - 14 Sep 2021
Cited by 10 | Viewed by 2735
Abstract
Background: Evaluation of plantar pressure in stroke patients is a parameter that could be used for monitoring and comparing how the timing of starting a rehabilitation program effects patient improvement. Methods: We performed the following clinical and functional evaluations: initial moment (T1), intermediate [...] Read more.
Background: Evaluation of plantar pressure in stroke patients is a parameter that could be used for monitoring and comparing how the timing of starting a rehabilitation program effects patient improvement. Methods: We performed the following clinical and functional evaluations: initial moment (T1), intermediate (T2), and final evaluation at one year (T3). At T1 we studied 100 stroke patients in two groups, A and B (each 50 patients). The first group, A, started rehabilitation in the first three months after having a stroke, and group B started after three months from the time of stroke. Due to the impediments observed during rehabilitation, we made biomechanic evaluation for two lots, I and II (each 25 patients). Assessment of the patient was carried out by clinical (neurologic examination), functional (using the Tinetti Functional Gait Assessment Test for classifying the gait), and biomechanical evaluation (maximal plantar pressure (Pmax), contact area (CA), and pressure distribution (COP)). Results: The Tinetti scale for gait had the following scores: for group A, from 1.34 at the initial moment (T1) to 10.64 at final evaluation (T3), and for group B, 3.08 at initial moment (T1) to 9 at final evaluation (T3). Distribution of COP in the left hemiparesis was uneven at T1 but evolved after rehabilitation. The right hemiparesis had uniform COP distribution even at T1, explained by motor dominance on the right side. CA and Pmax for lot I increased more than 100%, meaning that there is a possibility for favorable improvement if the patients start the rehabilitation program in the first three months after stroke. For lot II, increases of the parameters were less than lot I. Discussions: The recovery potential is higher for patients with right hemiparesis. Biomechanic evaluation showed diversity regarding compensatory mechanisms for the paretic and nonparetic lower limb. Conclusions: CA and Pmax are relevant assessments for evaluating the effects on timing of starting a rehabilitation program after a stroke. Full article
(This article belongs to the Special Issue Balance, Gait and Falls in Peripheral and Central Neurological Disorders: From Pathophysiology to Rehabilitation)
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10 pages, 937 KiB  
Article
Slow Walking in Individuals with Chronic Post-Stroke Hemiparesis: Speed Mediated Effects of Gait Kinetics and Ankle Kinematics
by Jing Nong Liang, Kai-Yu Ho, Yun-Ju Lee, Corey Ackley, Kiley Aki, Joshua Arias and Jassie Trinh
Brain Sci. 2021, 11(3), 365; https://doi.org/10.3390/brainsci11030365 - 13 Mar 2021
Cited by 4 | Viewed by 2741
Abstract
Post-stroke rehabilitation often aims to increase walking speeds, as faster walking is associated with improved functional status and quality of life. However, for successful community ambulation, ability to modulate (increase and decrease) walking speeds is more important than walking continuously at constant speeds. [...] Read more.
Post-stroke rehabilitation often aims to increase walking speeds, as faster walking is associated with improved functional status and quality of life. However, for successful community ambulation, ability to modulate (increase and decrease) walking speeds is more important than walking continuously at constant speeds. Increasing paretic propulsive forces to increase walking speed has been extensively examined; however, little is known about the mechanics of slow walking post-stroke. The primary purpose of this study was to identify the effects of increased and decreased walking speeds on post-stroke kinetics and ankle kinematics. Fifteen individuals with chronic post-stroke hemiparesis and 15 non-neurologically impaired controls walked over an instrumented treadmill under: slow, self-selected, and fast walking speeds. We examined the peak propulsive forces, propulsive impulse, peak braking forces, braking impulse, and ankle kinematics under each condition. When walking at slow walking speeds, paretic limbs were unable to reduce braking impulse and peak propulsive force or modulate ankle kinematics. Impaired modulation of paretic gait kinetics during slow walking places people post-stroke at high risks for slip-related falls. These findings suggest the need for developing gait retraining paradigms for slow walking in individuals chronically post-stroke that target the ability of the paretic limb to modulate braking forces. Full article
(This article belongs to the Special Issue Balance, Gait and Falls in Peripheral and Central Neurological Disorders: From Pathophysiology to Rehabilitation)
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11 pages, 643 KiB  
Article
Reliability and Validity of the Six Spot Step Test in People with Intellectual Disability
by María Mercedes Reguera-García, Raquel Leirós-Rodríguez, Eva Fernández-Baro and Lorena Álvarez-Barrio
Brain Sci. 2021, 11(2), 201; https://doi.org/10.3390/brainsci11020201 - 6 Feb 2021
Cited by 3 | Viewed by 2789
Abstract
Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been [...] Read more.
Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been developed, such as the Six Spot Step Test. The aim of this study was to determine the validity and within-day and day-to-day test–retest reliability of the Six Spot Step Test in people with intellectual disability. A descriptive cross-sectional study was conducted with 18 people with intellectual disability. The participants conducted the Six Spot Step Test three times and a set of five clinical tests for the balance assessment. The relative reliability was excellent (Intraclass Correlation Coefficient (ICC) = 0.86 − 0.97), and the absolute reliability ranged between 4.7% and 7.3% for coefficient variation and between 0.6 and 1.2 for the standard error of measurement. Linear regression models showed that that test can explain the results of the Timed Up & Go, Four Square Step Test and the Berg Balance Scale. The Six Spot Step Test proved to be as valid and reliable for the evaluation of dynamic balance in people with intellectual disability as the most frequently used tests for the clinical evaluation of postural control. Full article
(This article belongs to the Special Issue Balance, Gait and Falls in Peripheral and Central Neurological Disorders: From Pathophysiology to Rehabilitation)
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25 pages, 1889 KiB  
Article
Effects of 6-Month Multimodal Physical Exercise Program on Bone Mineral Density, Fall Risk, Balance, and Gait in Patients with Alzheimer’s Disease: A Controlled Clinical Trial
by A. Silvia Puente-González, M. Carmen Sánchez-Sánchez, Eduardo J. Fernández-Rodríguez, J. Elicio Hernández-Xumet, Fausto J. Barbero-Iglesias and Roberto Méndez-Sánchez
Brain Sci. 2021, 11(1), 63; https://doi.org/10.3390/brainsci11010063 - 6 Jan 2021
Cited by 16 | Viewed by 5070
Abstract
We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in [...] Read more.
We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ2 = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ2p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ2p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease. Full article
(This article belongs to the Special Issue Balance, Gait and Falls in Peripheral and Central Neurological Disorders: From Pathophysiology to Rehabilitation)
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15 pages, 1661 KiB  
Study Protocol
The Efficacy of Interlimb-Coordinated Intervention on Gait and Motor Function Recovery in Patients with Acute Stroke: A Multi-Center Randomized Controlled Trial Study Protocol
by Wai-Leung Ambrose Lo, Dandan Chen, Jiangli Zhao, Yan Leng, Ruihao Bian, Wenzhu Huang, Yahui Liang, Yu-Rong Mao and Dong-Feng Huang
Brain Sci. 2021, 11(11), 1495; https://doi.org/10.3390/brainsci11111495 - 12 Nov 2021
Viewed by 2706
Abstract
Background: The efficacy of interlimb-coordinated training on gait and upper limb functional improvement remains unclear. The latest published randomized controlled trials have supported the potential benefits of interlimb-coordinated training to enhance gait function. Upper limb functional recovery may also benefit from interlimb-coordinated training [...] Read more.
Background: The efficacy of interlimb-coordinated training on gait and upper limb functional improvement remains unclear. The latest published randomized controlled trials have supported the potential benefits of interlimb-coordinated training to enhance gait function. Upper limb functional recovery may also benefit from interlimb-coordinated training since most everyday activities require the coordinated use of both hands to complete a task. This study investigates the efficacy of interlimb-coordinated training on gait and upper limb functional recovery over a short-medium term period. Methods: A total of 226 acute stroke patients will be recruited from four centres over four years. Patients will be randomly allocated to either conventional therapy or conventional therapy plus interlimb-coordinated training. Outcomes will be recorded at baseline, after 2 weeks of intervention, and at 3- and 6-months post-intervention. Gait speed is the primary outcome measure. Secondary outcome measures include Fugl–Meyer Assessment of Motor Recovery, Berg Balance Scale, Timed Up and Go test, Action Research Arm Test, electroencephalography, and magnetic resonance imaging. Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early interlimb-coordinated intervention on gait and upper functional rehabilitation and how it may relate to the neural plasticity process. Full article
(This article belongs to the Special Issue Balance, Gait and Falls in Peripheral and Central Neurological Disorders: From Pathophysiology to Rehabilitation)
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