The objective was to determine the effects of the side of brain lesion on recovery of functional abilities and balance control among subjects 2 months following a stroke. There were 104 patients admitted consecutively to a geriatric rehabilitation center following their first stroke to the anterior brain circulation who were followed for 2 months. Fifteen age-matched individuals with no known impairments served as the control group. Functional ability was assessed with the Barthel Index and the Functional Ambulation Category. Posturographic testing was used to determine total sway and symmetry of weight distribution with eyes open and closed. Tests were performed 1 and 2 months poststroke. The results show that lesion side affects the recovery of independent stance 2 months following a stroke, with more patients with right hemiparesis able to reach this milestone. However, no difference was found in functional ability and balance control between patients with left and right hemiparesis who are able to stand independently by 1 month poststroke. Function and mobility improve during the 2nd month of rehabilitation (P = 0.001), but stance unsteadiness and asymmetry do not. The side of brain lesion seems to affect recovery of independent stance with an advantage to patients with right hemiparesis. However, there is no difference between balance control of individuals with left versus right hemiparesis in patients who reach independent stance by the end of the 1st month following their stroke.

BackgroundExercise programs that challenge an individual’s balance have been shown to reduce the risk of falls among older adults. Virtual reality computer-based technology that provides the user with opportunities to interact with virtual objects is used extensively for entertainment. There is a growing interest in the potential of virtual reality-based interventions for balance training in older adults. This work comprises a systematic review of the literature to determine the effects of intervention programs utilizing the Nintendo Wii console on balance control and functional performance in independently functioning older adults.MethodsStudies were obtained by searching the following databases: PubMed, CINAHL, PEDro, EMBASE, SPORTdiscus, and Google Scholar, followed by a hand search of bibliographic references of the included studies. Included were randomized controlled trials written in English in which Nintendo Wii Fit was used to enhance standing balance performance in older adults and compared with an alternative exercise treatment, placebo, or no treatment.ResultsSeven relevant studies were retrieved. The four studies examining the effect of Wii-based exercise compared with no exercise reported positive effects on at least one outcome measure related to balance performance in older adults. Studies comparing Wii-based training with alternative exercise programs generally indicated that the balance improvements achieved by Wii-based training are comparable with those achieved by other exercise programs.ConclusionThe review indicates that Wii-based exercise programs may serve as an alternative to more conventional forms of exercise aimed at improving balance control. However, due to the great variability between studies in terms of the intervention protocols and outcome measures, as well as methodological limitations, definitive recommendations as to optimal treatment protocols and the potential of such an intervention as a safe and effective home-based treatment cannot be made at this point.

Elderly persons demonstrate difficulties in walking backward, with stride length particularly affected. These difficulties must be considered when using backward ambulation for rehabilitation of elderly persons.

When comfort, strength, and fatigue are considered jointly, the LPC is advantageous. Electrically induced fatigue is affected by the number of cycles per second, rather than the number of bursts per second.

It seems that central neuropathic pain (CNP) is associated with altered abilities to modulate pain; whereas dysfunction in descending pain inhibition is associated with the extent of chronic pain distribution, enhanced pain excitation is associated with the intensity of chronic pain. We investigated the hypothesis that CNP is associated with decreased descending pain inhibition along with increased neuronal excitability and that both traits are associated with spinothalamic tract (STT) damage. Chronic spinal cord injury subjects with CNP (n = 27) and without CNP (n = 23) and healthy controls (n = 20) underwent the measurement of pain adaptation, conditioned pain modulation (CPM), tonic suprathreshold pain (TSP), and spatial summation of pain above injury level. Central neuropathic pain subjects also underwent at and below-lesion STT evaluation and completed the questionnaires. Central neuropathic pain subjects showed decreased CPM and increased enhancement of TSP compared with controls. Among CNP subjects, the dysfunction of CPM and pain adaptation correlated positively with the number of painful body regions. The magnitude of TSP and spatial summation of pain correlated positively with CNP intensity. STT scores correlated with CNP intensity and with TSP, so that the more affected the STT below injury level, the greater the CNP and TSP magnitude. It seems that CNP is associated with altered abilities to modulate pain, whereas dysfunction in descending pain inhibition is associated with the extent of chronic pain distribution and enhanced pain excitation is associated with the intensity of chronic pain. Thus, top-down processes may determine the spread of CNP, whereas bottom-up processes may determine CNP intensity. It also seems that the mechanisms of CNP may involve STT-induced hyperexcitability. Future, longitudinal studies may investigate the timeline of this scenario.