Background/Objectives. Balance problems are well-established modifiable risk factors for falls, which are common in older adults. The objective of this study was to establish the efficacy of a Wii-Fit interactive video-game-led physical exercise program to improve balance in older Veterans. Methods. A prospective randomized controlled parallel-group trial was conducted at Veterans Affairs Medical Center. Thirty community dwelling Veterans aged 68 (±6.7) years were randomized to either the exercise or control groups. The exercise group performed Wii-Fit program while the control group performed a computer-based cognitive program for 45 minutes, three days per week for 8-weeks. The primary (Berg Balance Scale (BBS)) and secondary outcomes (fear of falling, physical activity enjoyment, and quality of life) were measured at baseline, 4 weeks, and 8 weeks. Results. Of 30 randomized subjects, 27 completed all aspects of the study protocol. There were no study-related adverse events. Intent-to-treat analysis showed a significantly greater improvement in BBS in the exercise group (6.0; 95% CI, 5.1–6.9) compared to the control group (0.5; 95% CI, −0.3–1.3) at 8 weeks (average intergroup difference (95% CI), 5.5 (4.3–6.7), p < 0.001) after adjusting for baseline. Conclusion. This study establishes that the Wii-Fit exercise program is efficacious in improving balance in community dwelling older Veterans. This trial is registered with ClinicalTrials.gov Identifier NCT02190045.
Background: Ankle-foot orthoses (AFO) have been used to improve the gait of individuals post stroke, but their use has come into question secondary to increased understanding of motor re-learning. Objectives: The purpose of this study was to determine if there is a change in tibialis anterior muscle electromyography, ankle angle, or gait velocity when individuals post stroke walk with a posterior leaf-spring AFO (PLAFO) or a dynamic ankle orthosis (DAO). Study Design: Repeated measures. Methods: Fifteen participants post stroke walked without an orthosis, with a PLAFO, and with a DAO. Data were gathered using electromyography, force plates, and three-dimensional motion analysis cameras. A repeated measures ANOVA was used to test for statistical significance (p 0.05). Results: Participants exhibited significantly less tibialis anterior muscle electromyography during the swing phase of gait with use of a DAO (p < 0.001). No change in velocity or ankle angle was exhibited with use of either orthosis. Conclusions:The results support therapists' notions that bracing can lead to a decline in tibialis anterior muscle activity during the swing phase of gait. The results also showed no improvement in gait velocity when either orthosis was used by participants who could walk without an orthosis. Clinical relevanceFirst, the use of relatively flexible orthoses can cause a decline in tibialis anterior muscle activity during the swing phase of gait. Secondly, neither the posterior leaf-spring ankle-foot orthosis nor the dynamic ankle orthosis should be prescribed to improve gait velocity in individuals who are able to walk without bracing.
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