Postural Balance

The effective treatment of pain is typically limited by a decrease in the pain-relieving action of morphine that follows its chronic administration (tolerance). Therefore, restoring opioid efficacy is of great clinical importance. In a murine model of opioid antinociceptive tolerance, repeated administration of morphine significantly stimulated the enzymatic activities of spinal cord serine palmitoyltransferase, ceramide synthase, and acid sphingomyelinase (enzymes involved in the de novo and sphingomyelinase pathways of ceramide biosynthesis, respectively) and led to peroxynitrite-derive nitroxidative stress and neuroimmune activation [activation of spinal glial cells and increase formation of tumor necrosis factor-␣, interleukin (IL)-1␤, and

Introducción: la propiocepción es importante para el rendimiento deportivo, especialmente en los movimientos y gestos que requieren un mayor nivel de estabilidad y de coordinación. Objetivo: diseñar un programa de entrenamiento de ejercicios propioceptivos para la prevención de lesiones en futbolistas. Método: búsqueda realizada en las bases de datos PubMed, SportDiscus, Google Scholar y PEDro entre 2011 y 2024. Los descriptores de búsqueda fueron "propioceptive training", "sports injuries", "prevention program" y "soccer". Se analizaron 14 artículos que cumplieron con los criterios de inclusión. Resultados: elaboración de un programa de entrenamiento propioceptivo en fútbol. Contiene 4 circuitos, cada uno con 7 ejercicios, para ser aplicados por 3 meses; incluye la dosificación y la progresión de ejercicios por niveles. Conclusión: se espera que el programa de entrenamiento de propiocepción en fútbol genere adherencia, mejore la fuerza, el balance, la estabilidad, el rendimiento del deportista y la reducción de lesiones deportivas en fútbol.

Storage of acetylcholine in synaptic vesicles plays a key role in maintaining cholinergic function. Here we used mice with a targeted mutation in the vesicular acetylcholine transporter (VAChT) gene that reduces transporter expression by 40% to investigate cognitive processing under conditions of VAChT deficiency. Motor skill learning in the rotarod revealed that VAChT mutant mice were slower to learn this task, but once they reached maximum performance they were indistinguishable from wild-type mice. Interestingly, motor skill performance maintenance after 10 days was unaffected in these mutant mice. We also tested whether reduced VAChT levels affected learning in an object recognition memory task. We found that VAChT mutant mice presented a deficit in memory encoding necessary for the temporal order version of the object recognition memory, but showed no alteration in spatial working memory, or spatial memory in general when tested in the Morris water maze test. The memory deficit in object recognition memory observed in VAChT mutant mice could be reversed by cholinesterase inhibitors, suggesting that learning deficits caused by reduced VAChT expression can be ameliorated by restoring ACh levels in the synapse. These data indicate an important role for cholinergic tone in motor learning and object recognition memory.

Background and Purpose: Falls in the elderly are a major cause of morbidity and mortality. There is growing evidence that Jixian Wang etal 2025 1 balance disturbance is the main symptom of aging in older adults. Therefore, understanding the mechanisms of balance disorders and developing effective early detection and intervention becomes crucial 1. Exercise intervention in form of novel dynamic movement skill-based training is now recognized as a new strategy to improve verbal memory, working memory and processing speed in mild cognitive impairment 2,3,4. So, the purpose of this study was to see the effect of dynamic movement skill, task-oriented training, active exercise with falls awareness prevention guide on balance in community dwelling elderly. Aim: This study is to compare dynamic movement skill, task-oriented training and active exercise with falls awareness prevention guide on balance in community dwelling elderly. Study Design: Experimental study design. Method: The study participants are randomly assigned into Group A (n=20) dynamic movement skill, Group B (n=20) task-oriented training, Group C (n=20) active exercise with falls awareness prevention guide. All three groups underwent their session 5 days/week for 12 weeks. Outcome Measure: Berg Balance Scale used to evaluate balance performance. Result: The subject in all the groups were benefitted from the exercise intervention with a significant improvement in post-intervention balance scores as compared to their pre-intervention scores. Percentage increase between the group shows that Group A and Group B produced highly significant improvements over the Group C (control group). Conclusion: This study concluded that dynamic movement skill showed greater balance performance than task-oriented

Background: Osteogenesis imperfecta (OI) is a genetic connective tissue disorder characterized by bone fragility and multisystem involvement. Hearing loss - conductive, sensorineural, or mixed - affects a significant proportion of individuals with OI and often emerges during childhood or
adolescence. Vestibular dysfunction, though under-recognized, contributes to balance impairments and reduced participation. Physiotherapy-based interventions targeting hearing- and vestibular-related deficits remain limited in literature despite their relevance to functional outcomes.
Objective: To synthesize current evidence on hearing loss and vestibular dysfunction in OI and to highlight the transformative role of physiotherapy in managing these overlooked disabilities.
Methods: A narrative review approach was used. Literature from PubMed, Scopus, ScienceDirect, and Google Scholar was screened for publications on OI, hearing loss, vestibular disorders, balance assessment, and paediatric physiotherapy interventions. Relevant findings were thematically
integrated.
Conclusion: Hearing loss in OI has extensive functional implications, including balance deficits and heightened fall risk. Physiotherapy - through vestibular rehabilitation, gaze stabilization, proprioceptive training, and fall-prevention strategies - offers significant potential in improving functional outcomes. Incorporating physiotherapy into multidisciplinary management can enhance mobility, safety, and participation in children with OI.
Keywords: Osteogenesis imperfecta; Hearing loss; Vestibular dysfunction; Physiotherapy; Paediatric rehabilitation; Balance; Vestibular rehabilitation.

Purpose: Recent research on head shake posturography has demonstrated a modest increase in sensitivity to identifying peripheral vestibular system asymmetry when horizontal head movements were added to portions of the standard Sensory Organization Test (SOT) battery. However, limitations with respect to the head shake protocol were outlined, and usable data for assessing performance could not be established. The purpose of this study was to test a change in protocol for use of head shake SOT to address the noted limitations. Method: Forty participants ranging in age from 20 to 79 years with no history of dizziness completed Conditions 2 and 5 of the SOT portion of computerized dynamic posturography on EquiTest equipment, while maintaining head still as well as 4 horizontal head movement velocity tasks. Results: Slope of a linear regression fit to 6 performance points was used to characterize each participant. Spearman's ranked correlation (r) indicated a significant relationship between the slope of the line representing a decline in performance with age (r = -.52, p = .0006). Conclusions: The head shake modification showed a trend in increasing the separation of normal individuals across age and eliminated the limitations addressed in earlier research. Future research will investigate the head shake modification for identifying vestibular peripheral system asymmetries.

In this paper, we review a physiological task that is predominant in preventing humans from falling, but that simultaneously also challenges balance: taking a step. In particular, two variants of this task are presented and compared: the voluntary step versus a step induced by an external and unpredictable perturbation. We show that, while these contribute different information, it is interesting to compare these. Indeed, they both are relevant in a global balance assessment and should be included within this, at the same level as tests usually dispensed in the clinical environment such as posturography. We choose to focus on the community-dwelling elderly population, to discuss means of early detection of risk of falls, in order to prescribe an appropriate prevention. An overview of posture-movement coordination and balance recovery strategies is also provided. Finally, a working hypothesis is suggested on how "compensatory protective" steps are controlled and how their e...

Background: The temporomandibular joints (TMJs) play a crucial role in the functioning of the masticatory system. TMJ dysfunctions may manifest as pain, limited range of motion, and altered body posture. Digital axiography is an objective method for evaluating TMJ function.

Many studies have attempted to correlate changes of motor cortex activity with progression of Parkinson's disease, although results have been controversial. In the present study we used intracortical microstimulation (ICMS) combined with behavioral testing in 6-hydroxydopamine hemilesioned rats to evaluate the impact of dopamine depletion on movement representations in primary motor cortex (M1) and motor behavior. ICMS allows for motor-effective stimulation of corticofugal neurons in motor areas so as to obtain topographic movements representations based on movement type, area size, and threshold currents. Rats received unilateral 6-hydroxydopamine in the nigrostriatal bundle, causing motor impairment. Changes in M1 were time dependent and bilateral, although stronger in the lesioned than the intact hemisphere. Representation size and threshold current were maximally impaired at 15 d, although inhibition was still detectable at 60–120 d after lesion. Proximal forelimb movements ...

This study was set to investigate whether motor effects of nociceptin/orphanin FQ (N/OFQ) can be related to changes in primary motor cortex output. N/OFQ injected i.c.v. biphasically modulated motor performance, low doses being facilitating and higher ones inhibitory. These effects were counteracted by the N/OFQ receptor antagonist [Nphe 1 Arg 14 ,Lys 15 ]N/OFQ-NH 2 (UFP-101) confirming the specificity of N/OFQ action. However, UFP-101 alone facilitated motor performance, suggesting that endogenous N/OFQ inhibits motor function. N/OFQ and UFP-101 injected into the substantia nigra reticulata but not motor cortex replicated these effects, suggesting motor responses were mediated by subcortical circuits involving the basal ganglia. Intracortical microstimulation technique showed that i.c.v. N/OFQ also biphasically modulated motor cortex excitability and movement representation. Low N/OFQ doses caused a leftward shift of threshold distribution curve in the forelimb area without affecting the number of effective sites. Conversely, high N/OFQ doses increased unresponsive and reduced excitable (movement) sites in vibrissa but not forelimb area. However, increased threshold currents and rightward shift of threshold distribution curve were observed in both areas, suggesting an overall inhibitory effect on cortical motor output. UFP-101 alone evoked effects similar to low N/OFQ doses, suggesting tonic inhibitory control over forelimb movement by endogenous N/OFQ. As shown in behavioral experiments, these effects were replicated by intranigral, but not intracortical, N/OFQ or UFP-101 injections. We conclude that N/OFQ receptors located in the substantia nigra reticulata mediate N/OFQ biphasic control over motor behavior, possibly through changes of primary motor cortex output.

To perform daily activity under both static and dynamic conditions maintenance of balance and stability plays an important role to prevent slip and falls. Maintenance of balance is essential in an occupational workplace and industrial setting during performing tasks. The effect of footwear on balance is poorly understood in military setting. Proper military footwear helps improve balance and postural stability, minimizing the risk injuries. This study was aimed to observe the influence of military footwear on balance and postural sway during quiet standing. Twenty one (n=21) physically fit Indian infantry soldiers volunteered for the study. Two types of footwear, namely footwear 1 & 2 (without & with proper foot bed respectively) were investigated for suitability or fitness during standing. Participants stood on force platform for 40 seconds in each condition. Bioware was used to collect and process the data. Results suggest that in footwear 2, sway area is more concentrated than footwear 1 and a shifting of the center of pressure (COP) to midline was also observed in footwear 2. All the parameters were decreased in Footwear 2 compared to footwear 1. The use of footwear with proper foot bed for absorbing impact force (footwear 2) improves balance and stability during quiet standing.

(1) To determine the feasibility of the use of a modified postural control test under altered sensory conditions in children over 8 years of age, and (2) to assess how deaf children use sensory information for postural control when they have normal or abnormal vestibular responses, and if hearing input from a unilateral cochlear implant, changes their postural behavior. Patients: We selected 36 children, 8 to 11 years of age, with congenital or earlyacquired profound sensorineural hearing loss, 13 of them with unilateral cochlear implantation and 22 normal-hearing children. Methods: The Postural Control (PC) test consists of a force platform with 2 stimulation paradigm conditions: (1) standing on the platform with opened eyes; (2) standing on foam placed on the force platform with closed eyes. Implanted children were tested with the implant turn on and turn off in this condition, in order to evaluate eventual change in the postural control parameters when they have hearing habilitation. The body center of pressure distribution area (COP) and the body sway velocity (SV) were the parameter to evaluate the postural control. Results: Deaf children were classified into two groups according with the vestibular responses: group A (n = 28) Children with normal vestibular rotary responses; group B (n = 8) children with hypoactive responses. Children in group A had diagnoses of syndromic and non-syndromic hereditary deafness, and children in group B had inner ear malformations, post-meningitis deafness, and one child had non-syndromic hereditary deafness with hypoactive vestibular response. In condition 1, when vestibular, somatosensory and visual information were enabled, the COP and SV values did not show any statistically significant differences between groups A, B and control. In condition 2, when visual information was removed and the somatosensory

Objective-The aim of this study was to determine postural responses before and after a vestibular rehabilitation program (VRP) in 14 patients with central vestibular disorders (CVD). Material and Methods -The confidence ellipse (CE) of the center of pressure distribution area and the sway velocity (SV) were the parameters used for the quantitative assessment of postural control (PC). These two parameters were analyzed before and after a VRP for two visual conditions. Behavioral postural responses were studied by means of the time-frequency scalogram using wavelets and the sway frequency content was measured in arbitrary units of energy density. Results -Ten patients showed a significant decrease in the CE and SV after the rehabilitative treatment, thus improving their PC. Seven of these patients were assessed again after a period of 12 9 5 months, during which they had not received any physical training. All of them showed increases in the CE and SV, indicating an impairment of PC. Conclusions -Many CVD patients damage the neural mechanisms involved in retaining the plastic changes in the PC parameters after rehabilitative treatment. Continuation of training may be necessary in order to maintain the improvement in PC obtained with a VRP.

Effects of Aging on Feedforward Postural Synergies We investigated the effects of aging on postural muscles covariate patterns prior to voluntary perturbations. Nine healthy young and nine older subjects were instructed to release a load in a self-paced manner. The results of cross-correlation analyses showed that the average time lag corresponding peak correlation coefficient between trunk flexor and extensor muscles in the older group was significantly shorter, compared to that in the young group. The results of principal component analysis showed that the co-contraction Muscle-modes in the older group were observed more frequently than those in the young group. These results indicate that the older group showed changes in the anticipatory postural muscle co-variation, suggesting the transition from reciprocal to co-activation pattern with aging.

In this study, we have explored whether the impact of visual information on postural reactions is due to the same perceptual mechanisms that produce vection. Pitch motion of the visual Weld was presented at varying velocities to eight healthy subjects (29.9 § 2.8 years) standing quietly on a stationary base of support or receiving a 3° toes-up tilt of the base of support. An infrared motion system recorded markers placed on body segments to record angular displacement of head and ankle and calculate whole body center of mass. Onset of the visual Weld motion and base of support movement were synchronized in all trials. We found that in the Wrst 2 s following onset of visual Weld motion, both direction and amplitude of the linear displacement of whole body center of mass and angular displacement of the head, hip, and ankle were modulated by the velocity of visual scene motion. When the visual scene rotated in upward pitch, subjects overshot their initial vertical position with amplitudes that increased as velocity of the visual Weld increased. This behavior was even more evident when the base of support was tilted. These responses were much shorter than those observed in studies of vection. The dependence of the postural response amplitudes on the velocity of the visual Weld suggests, however, that there might be well-shared control pathways for visual inXuences on postural reactions and postural sway elicited by an illusion of self-motion.

This small clinical trial utilized a novel rehabilitation strategy, rapid-resisted elliptical training, in an effort to increase motor, and thereby cognitive, processing speed in ambulatory individuals with traumatic brain injury (TBI). As an initial step, multimodal functional abilities were quantified and compared in 12 ambulatory adults with and 12 without TBI. After the baseline assessment, the group with TBI participated in an intensive 8-week daily exercise program using an elliptical trainer and was reassessed after completion and at an 8-week follow-up. The focus of training was on achieving a fast movement speed, and once the target was reached, resistance to motion was increased in small increments to increase intensity of muscle activation. Primary outcomes were: High-Level Mobility Assessment Tool (HiMAT), instrumented balance tests, dual-task (DT) performance and neurobehavioral questionnaires. The group with TBI had poorer movement excursion during balance tests and poorer dual-task (DT) performance. After training, balance reaction times improved and were correlated with gains in the HiMAT and DT. Sleep quality also improved and was correlated with improved depression and learning. This study illustrates how brain injury can affect multiple linked aspects of functioning and provides preliminary evidence

Background: Inclusion Body Myositis (IBM) is an inflammatory myopathy that commonly affects quadriceps strength, resulting in knee buckling and falls. Therefore, patients with IBM should be ideal candidates for stance control orthoses (SCOs). Objectives: Evaluate the effectiveness of SCO use in patients with IBM who have functional deficits due to quadriceps weakness. Study Design: Cohort study. Methods: Nine subjects with IBM were provided a stance control orthosis and followed for six months of home use. All patients had objective testing of their strength and gait and completed a questionnaire at baseline and six months. Gait analysis was performed both with and without the orthosis. Results: Velocity and cadence were lower and step width was higher when using the orthosis. Kinematic measures were largely unchanged with orthosis use. Subjects with less knee extensor weakness had a better outcome than weaker participants. Those who spent more time wearing the orthosis also had a more positive outcome. The participants felt that the SCO was helpful in safeguarding against falls and providing stability. Conclusions: SCO use will benefit patients with IBM, but care should be taken to choose the SCO option that best suits their individual clinical presentation. This is the first study to examine SCO use in the IBM population. Patients with IBM have quadriceps weakness and will potentially benefit from SCO use. This study suggests that successful SCO management of patients with IBM depends on severity of weakness.

Cancer remains one of the most complex and heterogeneous diseases confronting modern medicine, characterized by genetic instability, clonal evolution, and dynamic tumor-microenvironment interactions that render population-level treatment paradigms insufficient for a substantial proportion of patients. Digital Twin (DT) technology — computational models that continuously integrate patient-specific, multi-scale data to simulate physiological and pathological processes in real time — offers a transformative framework for advancing precision oncology.

This book, Oncology Reimagined: Treating Cancer Through Digital Twins, provides a comprehensive academic reference spanning the biological foundations, technical architecture, and full clinical spectrum of cancer DT applications. Beginning with the molecular hallmarks of cancer and the computational infrastructure required for DT construction — including genomics, proteomics, medical imaging, electronic health records, and wearable sensors — the text systematically examines DT-guided approaches to early detection, differential diagnosis, personalized treatment planning, chemotherapy and targeted therapy optimization, immunotherapy response prediction, CAR-T cell behavior simulation, and adaptive radiation oncology. Dedicated chapters address DT-based prediction and mitigation of treatment-related toxicities including cardiotoxicity, nephrotoxicity, and chemotherapy-induced peripheral neuropathy, as well as quality-of-life modeling. The book further examines the ethical, legal, and regulatory challenges attendant to clinical DT deployment, and concludes with emerging convergences between DT technology, quantum computing, IoT-integrated real-time monitoring, population-level digital twins, and CRISPR-based gene therapy planning.

Written for physicians, researchers, and advanced students in oncology, biomedical engineering, and clinical informatics, this reference aims to bridge the gap between rapidly expanding scientific literature and consolidated, clinically actionable knowledge on cancer Digital Twins — providing the foundation for a paradigm shift from reactive, trial-and-error oncology toward proactive, model-driven, patient-centered cancer care.

Keywords: digital twin, oncology, precision medicine, personalized cancer treatment, computational modeling, artificial intelligence, pharmacokinetics, immunotherapy, radiation oncology, tumor microenvironment

Background: Chronic low back pain (CLBP) is one of the most prevalent musculoskeletal disorders worldwide and is associated with pain, disability, reduced functional capacity, and decreased quality of life. Exercise-based rehabilitation remains a primary conservative intervention for chronic nonspecific low back pain. Among commonly prescribed approaches, core stabilization exercises emphasize neuromuscular control and lumbopelvic stability, whereas general strengthening exercises focus on improving the strength and endurance of global trunk musculature.

Objective: To compare the effectiveness of core stabilization exercises and general strengthening exercises in individuals with chronic low back pain.

Methods: A structured comparative review was conducted using literature identified through PubMed, Scopus, and Google Scholar databases. Peer-reviewed studies published between 2008 and 2024 were screened. Twenty relevant studies were included, comprising randomized controlled trials, systematic reviews, meta-analyses, epidemiological evidence, and clinical practice guidelines. Outcomes analyzed included pain intensity, disability, functional performance, proprioception, balance, lumbopelvic stability, muscle thickness, and long-term clinical effectiveness.

Results: Both approaches demonstrated improvements in pain and disability outcomes. Several studies reported greater short-term improvements with core stabilization exercises, particularly in pain reduction, functional performance, proprioception, and lumbopelvic stability, whereas long-term outcomes were often comparable between groups.
Conclusion: Core stabilization exercises appear to offer additional early benefits, particularly in neuromuscular control and symptom reduction. Nevertheless, conventional strengthening remains clinically effective, and long-term improvements are often comparable across both approaches.

reflecting both the rarity of the condition and the predominant focus on immunotherapies [6, 7]. We report a case describing the clinical effects of AP treatment in anti-GAD cerebellar ataxia, raising the possibility of a limited adjunctive symptomatic role. Case Presentation A 69-year-old Caucasian woman was diagnosed with anti-GAD cerebellar ataxia, confirmed by markedly elevated serum anti-GAD antibodies (ELISA index > 400; norm < 1). She initially experienced episodic vestibular symptoms, but after a second episode developed a chronic, progressive course characterised by blurred vision, diplopia, dizziness, dysarthria, and gait and stance ataxia. Oculomotor function was evaluated clinically and with videonystagmography (VNG) at baseline, day 7, and day 30 following initiation of sustained-release fampridine (4-aminopyridine) 20 mg/day. All assessments were performed by the same clinician, and written informed consent was obtained. No other symptomatic or immunomodulatory treatment was given to a patient during this period.

reflecting both the rarity of the condition and the predominant focus on immunotherapies [6, 7]. We report a case describing the clinical effects of AP treatment in anti-GAD cerebellar ataxia, raising the possibility of a limited adjunctive symptomatic role. Case Presentation A 69-year-old Caucasian woman was diagnosed with anti-GAD cerebellar ataxia, confirmed by markedly elevated serum anti-GAD antibodies (ELISA index > 400; norm < 1). She initially experienced episodic vestibular symptoms, but after a second episode developed a chronic, progressive course characterised by blurred vision, diplopia, dizziness, dysarthria, and gait and stance ataxia. Oculomotor function was evaluated clinically and with videonystagmography (VNG) at baseline, day 7, and day 30 following initiation of sustained-release fampridine (4-aminopyridine) 20 mg/day. All assessments were performed by the same clinician, and written informed consent was obtained. No other symptomatic or immunomodulatory treatment was given to a patient during this period.

Background: This study explored the effects of diabetes mellitus (DM) and peripheral neuropathy (PN) on the ability to detect near-threshold postural perturbations. Methods: 83 subjects participated; 32 with type II DM (25 with PN and 7 without PN), 19 with PN without DM, and 32 without DM or PN. Peak acceleration thresholds for detecting anterior platform translations of 1 mm, 4 mm, and 16 mm displacements were determined. A 2(DM) × 2(PN) factorial MANCOVA with weight as a covariate was calculated to compare acceleration detection thresholds among subjects who had DM or did not and who had PN or did not. Results: There was a main effect for DM but not for PN. Post hoc analysis revealed that subjects with DM required higher accelerations to detect a 1 mm and 4 mm displacement. Conclusion: Our findings suggest that PN may not be the only cause of impaired balance in people with DM. Clinicians should be aware that diabetes itself might negatively impact the postural control system.

Altered gait kinematics in individuals with functional ankle instability (FAI) are thought to contribute to instability; however, research fi ndings are inconsistent. Findings may be clarifi ed with the use of a multisegment foot model and a coper group. Participants included 69 individuals: 23 with FAI, 23 controls, and 23 copers (individuals with a history of ankle sprain but no instability). Forefoot and hindfoot sagittal and frontal plane angles at initial contact (IC) were calculated during gait. For the forefoot and hindfoot, a multivariate analysis of variance tested group diff erences. For the forefoot in the frontal plane, there was a signifi cant group diff erence at IC. The FAI group had signifi cantly more inverted ankles than controls, but copers were not signifi cantly diff erent from the FAI or control groups. The lack of diff erence between the FAI and coper groups may indicate that increased inversion error in FAI does not explain symptoms of instability. [

Poor posture control has been associated with an increased risk of falls and mobility disability among older adults. This study was conducted to assess the test-retest reliability and sensitivity to group differences regarding the time-limit (T Limit ) of one-leg standing and selected balance parameters obtained with a force platform in older and young adults. A secondary purpose was to assess the relationship between T Limit and these balance parameters. Twenty-eight healthy older adults (age: 69 ± 5 years) and thirty young adults (age: 21 ± 4 years) participated in this study. Two one-leg stance tasks were performed: (1) three trials of 30 s maximum and (2) one T Limit trial. The following balance parameters were computed: center of pressure area, RMS sway amplitude, and mean velocity and mean frequency in both the anterio-posterior and medio-lateral directions. All balance parameters obtained with the force platform as well as the T Limit variable were sensitive to differences in balance performance between older and young adults. The test-retest reliability of these measures was found to be acceptable (ICC: 0.40-0.85), with better ICC scores observed for mean velocity and mean frequency in the older group. Pearson correlations coefficients (r) between balance parameters and T Limit ranged from À0.16 to À0.54. These results add to the current literature that can be used in the development of measurement tools for evaluating balance in older and young adults.

Mass-inertia loads on muscles change with posture and with changing mechanical interactions between the body and the environment. The nervous system must anticipate changing mass-inertia loads, especially during fast multi-joint coordinated movements. Riemannian geometry provides a mathematical framework for movement planning that takes these inertial interactions into account. To demonstrate this we introduce the controlled (vs. biomechanical) degrees of freedom of the body as the coordinate system for a configuration space with movements represented as trajectories. This space is not Euclidean. It is endowed at each point with a metric equal to the mass-inertia matrix of the body in that configuration. This warps the space to become Riemannian with curvature at each point determined by the differentials of the mass-inertia at that point. This curvature takes nonlinear mass-inertia interactions into account with lengths, velocities, accelerations and directions of movement trajecto...

Anterior cruciate ligament (ACL) injuries are among the most studied musculoskeletal injuries and are traditionally associated with athletic activity. However, long-term clinical physiotherapy experience suggests that a considerable number of ACL injuries occur in non-athletic populations and often follow events described as "accidental". The aim of this article is to present 30 years of clinical observations suggesting that pre-existing neuromusculoskeletal dysfunctions-particularly in the lumbar spinemay contribute to knee joint vulnerability prior to ACL injury. Repeated clinical findings indicated that concurrent therapeutic intervention in the lumbar region was consistently associated with significant reduction in knee pain and improved rehabilitation outcomes following ACL reconstruction. These observations support the hypothesis that pre-injury neuromusculoskeletal imbalance may play a role in both ACL injury occurrence and recurrence. The purpose of this paper is to stimulate further research regarding the contribution of proximal neuromusculoskeletal factors to ACL injury mechanisms.

INTRODUCTION
Walk into any waiting room, university corridor, or commuter train today and the scene is identical — heads tilted forward, eyes
fixed on glowing screens. What might appear a benign habit has quietly begun generating a recognizable pattern of cervical
complaints among young adults and working professionals alike. Text Neck Syndrome — describing the cumulative
musculoskeletal strain caused by sustained forward flexion of the cervical spine during handheld device use — has moved from
clinical curiosity to a genuine public health concern. Yet awareness of its long-term biomechanical consequences remains
surprisingly poor, both among clinicians and the populations most affected.
METHODS
A narrative review was undertaken drawing on contemporary literature spanning pain medicine, spinal biomechanics,
orthopedics, and musculoskeletal rehabilitation. Sources were critically examined for evidence on prolonged smartphone
use, abnormal cervical loading patterns, and the trajectory toward chronic pain — with particular attention to postural stress
mechanisms, neuromuscular adaptation, and the evidence base for preventive strategies.
RESULTS

Neutral Posture
5–6 kg
Cervical load

→

60° Forward Flexion
25–30 kg
Cervical load

Repetitive mechanical strain at this magnitude sets in motion a familiar cascade: muscular fatigue, ligamentous stress,
progressive postural imbalance, and the development of myofascial trigger points across the cervical and upper back
musculature. Clinically, patients present with chronic neck pain, cervicogenic headache, restricted cervical range of motion, and
diffuse upper back discomfort. Unrelenting poor ergonomics also appears to contribute to central pain sensitization and early
degenerative changes within the cervical spine.
CONCLUSION
Text Neck Syndrome is no longer a peripheral concern. It sits at the intersection of evolving lifestyle habits and musculoskeletal
health, and its trajectory — alongside continued growth in device dependency — suggests the burden will only deepen.
Ergonomic awareness, postural education, and the discipline of regular movement breaks may prove among the most
impactful interventions available. Few chronic pain conditions carry this degree of preventability.
“
As digital dependency continues to reshape modern behavior, Text Neck Syndrome may well prove to be one of the
most avoidable chronic pain epidemics of our generation.

Acknowledgement: Prepared for the 25th GE Daradia Online Fellowship in Pain Medicine | Dr. P. Snigdha Reddy, MBBS, M.D. Anaesthesiology

Falling is the leading medical complication in patients with all stages of stroke. The present study was carried out to predict the risk of falling in patients with stroke for evaluating the agreement between the FES-I and BBS balance measures and to establish the strongest scale for measuring the risk of falls in clinical practice. Total 50 stroke patients were collected whose age were ≥40 years and post stroke period was ≥6 months. Kappa measure of agreement and Intraclass Correlation Coefficient (ICC) were estimated for determining the agreement between the FES-I and BBS tools. Logistic Regression (LR) was done for the falling history over the last six months with age on the BBS. The Symmetric Measures of Kappa for determining the agreement between FES-I and BBS was -0.466. Sixteen subjects (32%) had low agreement on status of falling. The ICC was -0.769 (-77%). Considerable relation was found on BBS without significant value. The Kappa and ICC measures declared that, there was lower to moderate agreement between FES-I and BBS to predict the risk of falls. Patients with stroke had a reasonable BBS score to predict the risk of falls as compared to FES-I.

PurposeDecline of the sensory and motor systems in older people negatively affects postural control. This increases the risk of falls, which is dangerous for older people in long-term care. Being aware of the quality of postural control and the factors affecting it among elderly people, is crucial in implementing an effective fall-prevention program. This study aimed to measure postural control and the demographic, health-related, and functional factors presumed to be correlated with it among nursing home residents. Another aim was to find valid screening tools based on these factors.Materials and methodsSeventy one nursing home residents were included. Postural control was measured using the Berg Balance Scale. Grip strength, the 30-s chair stand test, and the Timed Up and Go test were used to measure global muscle strength, and functional mobility, respectively. The results of these functional tests were dichotomized using age-specific reference values.ResultsPostural control was ...

Background: Postural instability is a particularly incapacitating disorder, whose loss of motor independence by Parkinson´s Disease (PD) patients marks a significant stage of disease onset. Evidence suggests that deficits in automatic motor control, sensory integration and attention are associated with the lack of balance in PD. Physiotherapy together with medication play an important role in the treatment of this state, although no consensus has been reached on the best treatment modality. The aim of this randomized controlled trial protocol is to evaluate the effects of balance training with rhythmical (BRT), which is a motor program to improve balance associated with rhythmical auditory cues (RACs). This study is ongoing in the stage 1. Methods and design: A total of 150 PD patients at H&Y stages II-III and asymptomatic for depression and dementia are enrolled in a single-blind randomized study. Randomization is achieved via a computer-generated random-sequence table. All patients should also present a fall history. They will be assigned into one of three groups, and their balance and gait will be assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the end of the training. The BRT group will receive a motor program to improve balance associated with RACs, the MT group will perform motor training with the same aims as those in the BRT group but without RACs, and the control group (CG) will be trained only in orientations. The exercise program specific to balance is of 5 weeks' duration with two sessions per week, 45 min each, and consists of general physiotherapy exercises. Each session will be divided into five warm-up minutes-30 min for the main part and 10 min for the cool down. The training progresses and intensifies each week depending on the individual's performance. The subjects should be able to execute 10 repetitions of the exercise sequences correctly to progress to the next movement. Discussion: This randomized study protocol will evaluate the effects of a motor program designed to improve balance associated with RACs, and will also assess whether balance training leads to activation of balance reactions at the appropriate time. We hypothesize that if this motor program is maintained long-term, it will prevent falls.

Older adults are more prone to falls during walking than young adults, although they walk more slowly and demonstrate higher stability state. This paradox of higher stability state but less safe locomotion let us hypothesize that older people may move closer to their dynamic stability limits. In order to investigate this hypothesis, the present study examined the safety factor of dynamic stability in old and young individuals when walking at their preferred velocity. Twelve older and 12 young male participants walked at their (a) walk-to-run transition velocity (WRV, i.e., maximum capacity) and (b) preferred walking velocity (PWV, i.e., actual applied load). Whole body kinematic data and ground reaction forces were captured. Dynamic stability was assessed using the "margin of stability (MoS)" as a criterion for the stability state of the body (extrapolated center of mass concept). The safety factor was calculated as the ratio between MoS at WRVand MoS at PWV. We found that, although older participants walked slower and provided a higher stability state compared to young ones, they showed a significantly reduced safety factor during preferred walking. This confirmed our hypothesis. Old adults do not walk slowly enough in relation to their maximum walking velocity, resulting to a lower safety factor during normal locomotion. Apparently, the agerelated muscle degeneration affects WRV more than PWV. The resulting lower safety factor for the older participants may partly explain the increased risk of falls in their daily life, in spite of slower locomotion.

Background: Bilateral motor asymmetries reflect the hierarchical organization of neuromotor control, where task complexity differentially engages cortical and subcortical systems. Understanding these asymmetries has implications for motor learning, rehabilitation, and performance optimization. Objective: To examine bilateral lower extremity asymmetries across three levels of hierarchical motor control: explosive force generation (automatic control), precision tasks (moderate cognitive control), and complex motor skills (maximal cognitive control). Methods: In this cross-sectional observational study, 107 healthy adults (51 males, 56 females; age 21.2±2.1 years) completed three motor tasks. Explosive force was assessed via single-leg drop jumps, measuring peak ground reaction force and jump height (n=55). Precision control was evaluated through ball-kicking accuracy (n=52). Complex motor skills were assessed via ball-dribbling speed through a standardized course (n=52). Leg dominance was determined using validated protocols, and task order was randomized. Results: Explosive force tasks demonstrated no significant bilateral differences in peak ground reaction force (dominant: 19.95±4.49 N/kg vs. non-dominant: 20.08±3.88 N/kg, p>0.05) or jump height (17.94±6.89 cm vs. 16.46±10.12 cm, p>0.05). Precision tasks revealed significant asymmetries favoring the dominant leg in kicking accuracy (3.12±2.25 vs. 1.83±1.67 points, p<0.001). Complex motor skills showed superior dominant leg performance in dribbling speed (26.68±6.61 vs. 29.91±6.89 seconds, p<0.001). Conclusions: These findings are consistent with predictions of hierarchical neuromotor control theory, though interpretation is limited by a non-identical participant group, demonstrating task-dependent bilateral asymmetries that trend toward greater asymmetry in tasks with higher cognitive motor demands. Results suggest symmetrical subcortical control for explosive tasks but pronounced cortical lateralization for precision and complex skills, with implications for targeted motor training and rehabilitation strategies.

Presenting a large optic flow pattern to observers is likely to cause postural sway. However, directional anisotropies have been reported, in that contracting optic flow induces more postural sway than expanding optic flow. Recently, we showed that the biomechanics of the lower leg cannot account for this anisotropy (Holten, Donker, Verstraten, & van der Smagt, 2013, Experimental Brain Research, 228, 117-129). The question we address in the current study is whether differences in visual processing of optic flow directions, in particular the perceptual strength of these directions, mirrors the anisotropy apparent in postural sway. That is, can contracting optic flow be considered to be a perceptually stronger visual stimulus than expanding optic flow? In the current study we use a breaking continuous flash suppression paradigm where we assume that perceptually stronger visual stimuli will break the flash suppression earlier, making the suppressed optic flow stimulus visible sooner. Surprisingly, our results show the opposite, in that expanding optic flow is detected earlier than contracting optic flow.

Objectives: This study aimed to examine the effects of open and closed kinetic chain exercise interventions and to determine
how these structured training programs influence selected physical performance variables, specifically flexibility, among
inter-collegiate cricketers. Materials and Methods: A total of inter-collegiate male cricketers aged 18–25 years from AAA
College of Engineering and Technology, Amathur, Sivakasi, Tamilnadu were selected for the study. The participants were
randomly assigned into three groups: An Open Kinetic Chain Exercise Group (OKCEG), a Closed Kinetic Chain Exercise
Group (CKCEG), and a Control Group (CG). The experimental groups underwent their respective structured kinetic chain
training programs for a specified intervention period, while the control group continued with their regular physical activities
without any specialized training. Flexibility was selected as the dependent physical performance variable and was assessed
using a standardized flexibility test. Pre- and post-intervention data were statistically analyzed using appropriate inferential
statistical techniques to determine significant differences among the groups. The level of significance was set at p < 0.05.
Results: The results revealed significant improvements in flexibility in both the open and closed kinetic chain exercise
groups when compared to the control group (p < 0.05). The control group did not exhibit any significant change in
flexibility. Comparative analysis between the experimental groups indicated differences in the magnitude of improvement,
with kinetic chain–based training demonstrating a positive influence on flexibility development. Conclusions: The findings
of the study indicate that structured open and closed kinetic chain exercise interventions are effective in enhancing
flexibility among inter-collegiate cricket players. Both training methods proved superior to regular activity alone,
highlighting the importance of incorporating kinetic chain exercises into cricket training programs to improve physical
performance.

Huntington disease (HD) is a disorder characterized by chorea, dystonia, bradykinesia, cognitive decline and psychiatric comorbidities. Balance and gait impairments, as well as falls, are common manifestations of the disease. The importance of compensatory rapid stepping to maintain equilibrium in older adults is established, yet little is known of the role of stepping response times (SRTs) in balance control in people with HD. SRTs and commonly-used clinical measures of balance and mobility were evaluated in fourteen symptomatic participants with HD, and nine controls at a university mobility research laboratory. Relative and absolute reliability, as well as minimal detectable change in SRT were quantified in the HD participants. HD participants exhibited slower SRTs and poorer dynamic balance, mobility and motor performance than controls. HD participants also reported lower balance confidence than controls. Deficits in SRT were associated with low balance confidence and impairments on clinical measures of balance, mobility, and motor performance in HD participants. Measures of relative and absolute reliability indicate that SRT is reliable and reproducible across trials in people with HD. A moderately low percent minimal detectable change suggests that SRT appears sensitive to detecting real change in people with HD. SRT is impaired in people with HD and may be a valid and objective marker of disease progression.

A shortened version of the ABC 16-item scale (ABC-16), the ABC-6, has been proposed as an alternative balance confidence measure. We investigated whether the ABC-6 is a valid and reliable measure of balance confidence and examined its relationship to balance impairment and falls in older adults. Thirty-five community-dwelling older adults completed the ABC-16, including the six questions of the ABC-6. They also completed the following clinical balance tests: unipedal stance time (UST), functional reach (FR), Timed Up and Go (TUG), and maximum step length (MSL). Participants reported twelve-month falls history. Balance confidence on the ABC-6 was significantly lower than on the ABC-16, however scores were highly correlated. Fallers reported lower balance confidence than non-fallers as measured by the ABC-6 scale, but confidence did not differ between the groups with the ABC-16. The ABC-6 significantly correlated with all balance tests assessed and number of falls. The ABC-16 significantly correlated with all balance tests assessed, but not with number of falls. Test-retest reliability for the ABC-16 and ABC-6 was good to excellent. The ABC-6 is a valid and reliable measure of balance confidence in community-dwelling older adults, and shows stronger relationships to falls than does the ABC-16. The ABC-6 may be a more useful balance confidence assessment tool than the ABC-16.

OBJECTIVE. We attempted to determine whether multimedia fall prevention education using different instructional strategies increases older adults’ knowledge of fall threats and their fall prevention behaviors. METHOD. Fifty-three community-dwelling older adults were randomized to two educational groups or a control group. Multimedia-based educational interventions to increase fall threats knowledge and encourage fall prevention behaviors had two tailoring strategies: (1) improve content realism for individual learners (authenticity group) and (2) highlight program goals and benefits while using participants’ content selections (motivation group). Knowledge was measured at baseline and 1-mo follow-up. Participants recorded prevention behaviors for 1 mo. RESULTS. Intervention group participants showed greater knowledge gains and posttest knowledge than did control group participants. The motivation group engaged in more prevention behaviors over 1 mo than did the other groups. CONCLUS...

This study aimed to investigate how skiing speed (SS), number of missed targets (MT) and range time (RT) were associated with final rank in biathlon pursuit and mass start competitions. Data were collected from the International Biathlon Union's database over 17 seasons. Biathletes were categorised into three groups (rank 1-3, G3; rank 4-10, G10; rank 11-20, G20). Multinomial regression was used to identify odds ratios associated with group rank in both sexes. The only variable found to be consistently related to G3 in both pursuit and mass start was MT (men OR 1.206-1.729 and women OR 1.340-3.124, all p < 0.01). SS during lap four of pursuit and mass start was most strongly related to G3 for both sexes (men OR 0.231-0.094 and women OR 0.339-0.126, all p < 0.001). RT during shooting four in pursuit was most strongly related to G3 compared to G10 and G20 (men OR 1.067; 95% CI, 1.030-1.105 and women OR 1.076; 95% CI, 1.020-1.134, all p < 0.001, respectively). Accordingly, MT was most strongly related to final rank in both sexes, while SS during lap four and last RT was also significant.

Problem statement: Deaflympic athletes often face additional psychological and neurophysiological challenges due to communication barriers and sensory limitations. While the general psychophysiological traits of hearingimpaired athletes have been explored, little is known about how participation in professional sports impacts the mental reliability, personality traits, and nervous system properties of Deaflympic athletes within the same national team. The importance of examining differences in nervous system characteristics, personality profiles, and mental reliability between basketball players of the Ukrainian Deaflympics national team who compete for professional clubs (n=6) and those who play only for the national team (n=5). Purpose: This study aimed to identify the differences in mental reliability, typological features of the nervous system, and personality profiles between Ukrainian Deaflympic basketball players who compete only for the national team and those who also play for professional clubs. Method: The study was performed in October 2024. The research instruments included the: "Mental Reliability of an "Athlete" scale, the "Typological Properties of the Nervous System" assessment, and "Cattell's 16-Factor Questionnaire". Data were collected online following individualized instructions provided to participants. Comparisons were made using Student's t-test. Results: The study revealed statistically significant differences (p < 0.05) between the groups on key psychodiagnostic scales. Athletes with additional experience in professional basketball clubs demonstrated higher scores in obstacle resistance, endurance under physical exertion, mobility of nervous processes, social boldness, self-reliance, and perfectionism. A slightly elevated tendency toward anxiety was also noted. No significant differences were observed on other scales. Conclusions: Basketball players of the Ukrainian Deaflympic national team with professional club experience demonstrate higher levels of mental reliability, stress endurance, and neurodynamic adaptability. They are characterized by greater self-regulation, social boldness, and autonomy, alongside a slightly increased tendency toward anxiety. These differences justify the inclusion of club-level athletes in national team selection and highlight the need for additional psychological support for those without professional experience. Further research is recommended across genders and Deaflympic sports to deepen understanding of psychophysiological profiles in this population.

Mass-inertia loads on muscles change with posture and with changing mechanical interactions between the body and the environment. The nervous system must anticipate changing mass-inertia loads, especially during fast multi-joint coordinated movements. Riemannian geometry provides a mathematical framework for movement planning that takes these inertial interactions into account. To demonstrate this we introduce the controlled (vs. biomechanical) degrees of freedom of the body as the coordinate system for a configuration space with movements represented as trajectories. This space is not Euclidean. It is endowed at each point with a metric equal to the mass-inertia matrix of the body in that configuration. This warps the space to become Riemannian with curvature at each point determined by the differentials of the mass-inertia at that point. This curvature takes nonlinear mass-inertia interactions into account with lengths, velocities, accelerations and directions of movement trajectories all differing from those in Euclidean space. For newcomers to Riemannian geometry we develop the intuitive groundwork for a Riemannian field theory of human movement encompassing the entire body moving in gravity and in mechanical interaction with the environment. In particular we present a geodesic synergy hypothesis concerning planning of multi-joint coordinated movements to achieve goals with minimal muscular effort.

Background: Information from other sensory organs may become more important for the visually impaired individuals. However, very few reports on this type of sensory compensation have been published. Objectives: This study aimed to investigate the impact of visual information and plantar sensory information on standing postural control by comparing visually impaired and sighted individuals. The study included 22 adult men with no visual impairment (sighted group) and 13 adult men with visual impairment (visually impaired group). We performed Equitest measurements under conditions with 12 possible factors, including visual information (eyes closed, eyes open, and dynamic visual environment), plantar sensory information (with or without a textured sheet placed under the feet), and platform stability (stable or unstable). A three-way analysis of variance was performed. Results: Significantly higher balance strategy scores were observed in the sighted group than in the visually impaired group, indicating better balance without a textured sheet and on an unstable platform. Latency was significantly shorter in the sighted group than in the visually impaired group. Relative response strength scores were higher in the visually impaired group with the textured sheet and backward shifting platform than in the sighted group, indicating a superior stability. In postural control without visual information while standing on a surface in motion, plantar information that originated from textured sheets was more effective in assisting balance in visually impaired individuals than in sighted individuals.

Background: Consideration of the quality of life in relation to individual health status is crucial for planning and maintaining a system of patient-centered care. Until recently, there have been no suitable instruments to assess health-related quality of life (HRQoL,) of children and adolescents with severe, non-ambulant cerebral palsy (GMFCS functional levels IV and V). The "Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire" (CPCHILD © ) was developed in English specifically for this population, and has been validated in Canada. The aim of this study was to translate and adapt the CPCHILD © Questionnaire into Brazilian Portuguese, thus permitting researchers in Brazil to access this important tool for measuring HRQoL in this population, as well as the possibility of making comparisons with other studies that use the same questionnaire in other languages. The cross-cultural adaptation included two forward translations by independent translators, their synthesis, two back-translations by independent translators, an assessment of the versions by an expert committee and the development of a pre-final version, which was tested on 30 caregivers of children (5 -18) with severe cerebral palsy (GMFCS IV & V). Results: Despite the relative equivalence between the two translations, some items required adaptations for the synthesized version. Certain modifications were necessary in the pre-final version to achieve idiomatic equivalence. The modifications were required to account for the socioeconomic and cultural levels of the target population. The translation and cross-cultural adaptation of the CPCHILD © questionnaire provides a Brazilian Portuguese equivalent to measure the HRQoL of children with severe developmental disabilities, with the potential to measure the benefits of various procedures that are indicated for these patients. This adaptation exhibited a satisfactory level of semantic equivalence between the Portuguese target and the original English source versions. The validity of the Brazilian version of the instrument must be established in the future by assessing its psychometric properties on Brazilian epidemiological samples.

Background The Berg Balance Scale (BBS) is a balance measure commonly used for people with multiple sclerosis (MS). The Mini-BESTest is an alternative based on balance systems. Objective The study objective was to compare the BBS and the Mini-BESTest for sensitivity to change, likelihood ratios for walking aid use and falls, and associations with clinical variables in people who have MS and are ambulatory. Design This was a cohort study with measurements before and after exposure to 8 weeks of routine physical therapy intervention. Methods For 52 participants who had a primary diagnosis of MS and who were independently mobile, with or without an aid, demographic details and a history of falls and near falls were collected. Participants completed the Mini-BESTest, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, BBS, Modified Fatigue Impact Scale, and Six-Minute Walk Test. Results No participant started with a baseline Mini-BESTest maximum score of 28, whereas...

Background: Upper cross syndrome refers to a particular configuration of overlapping overactive and underactive muscle groups in the neck, chest and shoulders. Typically, poor posture causes the syndrome, including the forward head posture, which occurs when people use electronic devices, read, and drive. The present study is intended to investigate the effect of kinesio taping on upper cross syndrome Objectives: 1. To study the effectiveness of kinesio taping, Hot Moist Pack and exercises in upper cross syndrome, 2. To study the effectiveness of IFT, HMP and exercises in upper cross syndrome and 3. To compare the effectiveness of kinesio taping and IFT in upper cross syndrome. Methodology: The study consisted of 2 groups. Group A was experimental group and Group B was conventional group. Both the groups received treatment protocol for 2 weeks. Sample size was 60 with 30 in each group. Results: Visual analogue scale, cranio-vertebral angle and forward shoulder angle were used as outcome measures. Statistically significant results were found with VAS p=<0.0001, cranio-vertebral angle p=0.0632 and forward shoulder angle p=0.285 Conclusion: The study concluded that the use of kinesio taping is recommended in reducing pain and improving the neck angles in participants with upper cross syndrome as compared to conventional therapy.