Study Design: This study is a single-blind, parallel, three-group, and randomized controlled trial.Purpose: This study aimed to investigate the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with incomplete spinal cord injury (iSCI).Overview of Literature: Individuals with iSCI often face significant balance and mobility impairments affecting their quality of life. Scientific studies focusing on standing balance training in the iSCI population are limited. Virtual reality-based balance training has shown positive results in several neurological populations. Electrical stimulation has also proved to be effective in improving voluntary muscle strength in partially paralyzed muscles after iSCI as well as promoting neuroplasticity.Methods: Forty-eight iSCI participants will be recruited based on the inclusion criteria. The participants will be randomly assigned to any of the three groups: virtual reality-based balance training along with the electrical stimulation group, virtual reality-based balance training along with sham stimulation group, or virtual reality-based balance training group. The intervention will be delivered as 60-minute sessions, thrice a week for 4 weeks.Results: The performance of the participants will be assessed using the lower extremity motor score, static and dynamic balance assessment using TechnoBody ProKin tilting platform and Berg Balance Scale, Walking Index for Spinal Cord Injury, and World Health Organization Quality of Life-BREF at pre-intervention, after 4 weeks post-intervention, and at 1-month follow-up.Conclusions: The trial will provide new knowledge about the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with iSCI. The study results will contribute to the design of better rehabilitation programs for individuals with iSCI.

Recovery of balance ability during standing is one of the primary and essential aims of rehabilitative programs in individuals with incomplete spinal cord injury (iSCI). A sample of ten participants (mean age: 35.7 years, range: 25-63 years) with traumatic or non-traumatic iSCI (AIS grade C or D) and were able to stand with or without the support of an assistive device for a minimum of 2 min were recruited from the rehabilitation department of the Indian Spinal Injuries Centre, New Delhi, India. The participants received Virtual Reality (VR) based balance training for one hour, three times a week for four weeks on the Nintendo Wii gaming console. Participants were assessed three times: pre-intervention, post-intervention and follow-up assessment for the total ellipse area (TEA), total sway perimeter (TSP), sway range (anterior-posterior/medio-lateral (AP/ML)) and limits of stability (LOS). At post-intervention assessment, significant increases in comparison with pre-intervention scores was found in LOS (P=0.00), TEA with eyes open (EO) (P=0.00) and eyes closed (EC) (P=0.00), TSP with EO (P=0.00) and EC (P=0.00), sway range in AP direction (SD-AP) with EO (P=0.01) and EC (P=0.02) and sway range in ML direction (SD-ML) with EO (P=0.02) and EC (P=0.01). At follow-up assessment, a significant improvement in comparison to post intervention scores was found in TEA measured both in EO (P=0.01) and EC conditions (P=0.02), TSP measured with EO (P=0.01) and SD-ML both with EO (P=0.04) and EC (P=0.01). No significant changes were found in LOS (P=0.89), TSP measured with EC (P=0.38) and SD-AP both with EO (P=0.50) and EC (P=1). However, significant improvement was seen on comparing follow-up assessment scores with pre-intervention scores for all variables, such as LOS (P=0.00), TEA in EO (P=0.00) and EC (P=0.00), TSP with EO (P=0.00) and EC (P=0.00), SD-AP with EO (P=0.01) and EC (P=0.02) and SD-ML with EO (P=0.01) and EC (P=0.00). VR-based balance training intervention was able to elicit improvements in balance ability and maintain it during follow-up despite a small training dosage suggesting that it is a promising intervention for standing balance rehabilitation among individuals with iSCI. The VR-based balance training challenges elements of balance, which physical therapists may want to consider when designing a comprehensive rehabilitation program. Clinical Trials Registry-India: CTRI/2018/12/016814.

Abnormal stress due to poor posture and work environment are contributing factors in musculoskeletal adaptations resulting in problems like neck pain, back pain, shoulder pain, etc. The scapula plays several roles in facilitating optimal shoulder function and it is very important for the function of the upper extremity. Thereby impact of work-related posture & stress on computer professionals with scapular dyskinesis should be established. 350 male computer professionals (Mean Age = 34.89±8.51 years) following written informed consent were recruited from IT companies and volunteered for this study. Computer professionals involved in fieldwork, with BMI ≥ 25 Kg/m2 , having congenital postural deformities, undergone neck/shoulder surgeries were excluded from the study. Each professional was examined for scapular dyskinesis using Kibler’s rating system (Yes/No method). Professionals were then examined for Work related posture using - Rapid Office Strain Assessment (ROSA) & Rapid Upper Limb Assessment (RULA) and perception of stress during work [Perceived stress scale (PSS)]. Results were analyzed using descriptive statistics and the association was analyzed using chi-square and bivariate logistic regression. (Level of significance p<0.05). In the present study, 78% (n = 273) of computer professionals were found to have scapular dyskinesis. Assessment using ROSA indicated 56.3% (n= 197, χ² (1, n=350) =11.0, p=0.004] [(OR = 0.54; p=0.01)] computer professionals have moderate risk, 15.1% (n=53) have mild and 6.6% (n=23) have a moderate risk of developing musculoskeletal disorders. Similarly, the RULA scale assessment highlighted 66% [(n=231, χ² (1, n=350) =11.3, p=0.045] [OR =0.87; p=0.28)] computer professionals having poor posture, 7.2% (n=25) with worst posture and only 4.8% (n=17) having mild deviation. Perception of stress during work was low in 4.3% (n=15), moderate in 67.1% [(n=235, χ² (1, n=350) =2.5, p=0.27][(Exp(B)=0.95; p=0.04)]) and high in 23% (n=23) computer professionals. The present study concluded that computer professionals with scapular dyskinesis represent poor posture and have a moderate risk of developing musculoskeletal disorders along with moderate stress while working on computers.

No abstract

No abstract