A sensitive data analysis approach for detecting changes in dynamic postural stability

BackgroundWhile measures of asymmetry may provide a means of identifying individuals predisposed to injury, normative asymmetry values for challenging sport specific movements in elite athletes are currently lacking in the literature. In addition, previous studies have typically investigated symmetry using discrete point analyses alone. This study examined biomechanical symmetry in elite rugby union players using both discrete point and continuous data analysis techniques.MethodsTwenty elite injury free international rugby union players (mean ± SD: age 20.4 ± 1.0 years; height 1.86 ± 0.08 m; mass 98.4 ± 9.9 kg) underwent biomechanical assessment. A single leg drop landing, a single leg hurdle hop, and a running cut were analysed. Peak joint angles and moments were examined in the discrete point analysis while analysis of characterising phases (ACP) techniques were used to examine the continuous data. Dominant side was compared to non-dominant side using dependent t-tests for normally distributed data or Wilcoxon signed-rank test for non-normally distributed data. The significance level was set at α = 0.05.ResultsThe majority of variables were found to be symmetrical with a total of 57/60 variables displaying symmetry in the discrete point analysis and 55/60 in the ACP. The five variables that were found to be asymmetrical were hip abductor moment in the drop landing (p = 0.02), pelvis lift/drop in the drop landing (p = 0.04) and hurdle hop (p = 0.02), ankle internal rotation moment in the cut (p = 0.04) and ankle dorsiflexion angle also in the cut (p = 0.01). The ACP identified two additional asymmetries not identified in the discrete point analysis.ConclusionsElite injury free rugby union players tended to exhibit bi-lateral symmetry across a range of biomechanical variables in a drop landing, hurdle hop and cut. This study provides useful normative values for inter-limb symmetry in these movement tests. When examining symmetry it is recommended to incorporate continuous data analysis techniques rather than a discrete point analysis alone; a discrete point analysis was unable to detect two of the five asymmetries identified.Electronic supplementary materialThe online version of this article (doi:10.1186/s13102-015-0006-9) contains supplementary material, which is available to authorized users.

Objective To investigate the value of statistical parametric mapping (SPM) analysis of 18F-fluorodeoxyglucose (FDG) PET imaging in the differential diagnosis of Parkinsonism in single-case level. Methods SPM software was used to retrospectively analyze the 18F-FDG PET images of 160 patients (104 males, 56 females, age: 30-82 years) who were suspected with Parkinsonism at baseline and were clinical confirmed by follow-up from April 2010 to December 2017. 18F-FDG PET images of patients was compared with those of age-matched healthy controls in single-case level using two-sample t test in SPM software to obtain the imaging diagnosis. By comparing imaging diagnosis with the final clinical diagnosis, the diagnostic accuracy of SPM in the overall cohort as well as the early subcohort (duration of disease less than 2 years (56 males, 22 females, age: 50-82 years)) were calculated respectively. Results Among 160 patients with Parkinsonism, 146(91.2%) had the same 18F-FDG PET diagnosis as their final clinical diagnosis. The diagnostic sensitivity for Parkinson′s disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and cortical basal ganglia degeneration (CBD) were 93.5%(86/92), 92.3%(24/26), 84.0%(21/25) and 15/17, respectively. The specificity were 95.6%(65/68), 95.5%(128/134), 96.3%(130/135) and 100%(143/143), respectively. In the early subcohort, the analysis also achieved similar differential diagnosis effectiveness(92.3%). Conclusion The single-case 18F-FDG PET imaging SPM analysis can be helpful in the early differential diagnosis of Parkinsonism effectively. Key words: Parkinsonian disorders; Positron-emission tomography; Diagnosis, differential; Deoxyglucose

Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1-17.8 years (9.8+/-4.3 years; mean+/-SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential epileptogenic zone but does not provide additional benefit beyond SPET in presurgical assessment of children with intractable epilepsy. The impact of different pathologies on the efficacy of SPM warrants further study.

Experimental evaluation of iterative reconstruction versus filtered back projection for 3D [ 15O]water PET activation studies using statistical parametric mapping analysis

In this paper, we utilized functional near-infrared spectroscopy (fNIRS) technology to examine the hemodynamic responses in the motor cortex for two conditions, namely standing and sitting tasks. Nine subjects performed five trials of standing and sitting (SAS) tasks with both real movements and imagery thinking of SAS. A group level of statistical parametric mapping (SPM) analysis during these tasks showed bilateral activation of oxy-hemoglobin for both real movements and imagery experiments. Interestingly, the SPM analysis clearly revealed that the sitting tasks induced a higher oxy-hemoglobin level activation compared to the standing task. Remarkably, this finding is persistent across the 22 measured channels at the individual and group levels for both experiments. Furthermore, six features were extracted from pre-processed HbO signals and the performance of four different classifiers was examined in order to test the viability of using SAS tasks in future fNIRS-brain-computer interface (fNIRS-BCI) systems. In particular, two features-combination tests revealed that the signal slope with signal variance represents one of the three best two-combined features for its consistency in providing high accuracy results for both real and imagery experiments. This study shows the potential of implementing such tasks into the fNIRS-BCI system. In the future, the results of this work could pave the way towards the application of fNIRS-BCI in lower limb rehabilitation.

Statistical Parametric Mapping (SPM) is a computational approach for analysing functional brain images like Positron Emission Tomography (PET). When performing SPM analysis for different patient populations, brain PET template images representing population-specific brain morphometry and metabolism features are helpful. However, most currently available brain PET templates were constructed using the Caucasian data. To enrich the family of publicly available brain PET templates, we created Chinese-specific template images based on 116 [18F]-fluorodeoxyglucose ([18F]-FDG) PET images of normal participants. These images were warped into a common averaged space, in which the mean and standard deviation templates were both computed. We also developed the SPM analysis programmes to facilitate easy use of the templates. Our templates were validated through the SPM analysis of Alzheimer’s and Parkinson’s patient images. The resultant SPM t-maps accurately depicted the disease-related brain regions with abnormal [18F]-FDG uptake, proving the templates’ effectiveness in brain function impairment analysis.

Only one large series using statistical parametric mapping (SPM) reports on FDG-PET in sporadic (Heidenhain and non-Heidenhain variant) Creutzfeldt-Jakob disease (sCJD), describing hypometabolism in bilateral parietal, frontal, and occipital cortices. Our aim was to study FDG-PET in non-Heidenhain probable sCJD patients in order to assess the most pertinent FDG-PET pattern, and to compare FDG-PET and MRI data. We used both SPM and NeuroGam(®) software analysis, compared with healthy controls, to describe the FDG-PET abnormalities. Individual FDG-PET and MRI-DWI data were compared. SPM group analysis showed lateralized hypometabolism in the medial parietal cortex, the lateral and medial frontal (sparing Brodmann's area 4 and 6 and the anterior cingulate cortex), and lateral parietal cortex, in the absence of basal ganglia or cerebellar hypometabolism. The most severe hypometabolism was seen in Brodmann's area 31, and to a lesser degree area 23 (both areas correspond to the posterior cingulate cortex) and the precuneus. On individual analysis using NeuroGam(®) software, additional variable temporal cortex and frequent basal ganglia (with caudate nucleus as the most frequently involved structure) hypometabolism was seen, in the absence of cerebellar hypometabolism. The cerebral lobe cortex was more frequently and more severely hypometabolic than basal ganglia structures. Concordance between FDG-PET and MRI abnormalities was most often present for both the cerebral lobe cortex and the basal ganglia. In the case of discordance, FDG-PET was more sensitive than MRI for the cortex, whereas MRI was more sensitive than FDG-PET for the basal ganglia. When pathological, both cortical lobe cortex and basal ganglia involvement were slightly more often lateralized on FDG-PET than on MRI. Despite the presence of overlapping features with other diseases presenting with rapidly progressive dementia, the FDG-PET pattern we found in our non-Heidenhain sCJD patients may help in the differential diagnosis of rapidly progressive dementia.

Statistical parametric mapping (SPM) and statistical probabilistic anatomical mapping (SPAM) were applied to basal/acetazolamide Tc-99m ECD brain perfusion SPECT images in patients with middle cerebral artery (MCA) stenosis to assess the efficacy of endovascular stenting of the MCA. Enrolled in the study were 11 patients (8 men and 3 women, mean age 54.2 +/- 6.2 years) who had undergone endovascular stent placement for MCA stenosis. Using SPM and SPAM analyses, we compared the number of significant voxels and cerebral counts in basal and acetazolamide SPECT images before and after stenting, and assessed the perfusion changes and cerebral vascular reserve index (CVRI). The numbers of hypoperfusion voxels in SPECT images were decreased from 10,083 +/- 8,326 to 4,531 +/- 5,091 in basal images (P = 0.0317) and from 13,398 +/- 14,222 to 7,699 +/- 10,199 in acetazolamide images (P = 0.0142) after MCA stenting. On SPAM analysis, the increases in cerebral counts were significant in acetazolamide images (90.9 +/- 2.2 to 93.5 +/- 2.3, P = 0.0098) but not in basal images (91 +/- 2.7 to 92 +/- 2.6, P = 0.1602). The CVRI also showed a statistically significant increase from before stenting (median 0.32; 95% CI -2.19-2.37) to after stenting (median 1.59; 95% CI -0.85-4.16; P = 0.0068). This study revealed the usefulness of voxel-based analysis of basal/acetazolamide brain perfusion SPECT after MCA stent placement. This study showed that SPM and SPAM analyses of basal/acetazolamide Tc-99m brain SPECT could be used to evaluate the short-term hemodynamic efficacy of successful MCA stent placement.

Simple SummaryTranscranial direct current stimulation (tDCS) is used as an adjuvant rehabilitation treatment to improve postural control and lower limb function. This study explored the effects of sham and anodal tDCS over the leg region of M1 on static and dynamic postural stability in healthy young adults. Jump-landing tasks were used to examine dynamic postural stability. Static postural stability was assessed by a single-leg stand on force plates with open eyes. Anodal tDCS had an immediate improving effect on static and dynamic postural stability, and might evolve as an adjuvant rehabilitation treatment to enhance postural deficits in the future.Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) is of increasing interest to improve motor performance in healthy adults and patients with respective deficits. This study aimed to examine whether tDCS over M1 can improve static and dynamic postural stability in young healthy adults. Seventeen healthy participants (mean age = 25.14 ± 2.50 (standard deviation, SD) years) received sham and anodal tDCS (2 mA) over the vertex at the Cz electrode position for 15 min. Static and dynamic postural stability were evaluated before and immediately after tDCS. The center of pressure (COP) sway area (COPSA) and COP maximum displacements to medio-lateral (COPML) and antero-posterior directions (COPAP) were used to evaluate static postural stability. The anterior–posterior stability index (APSI), medial–lateral stability index (MLSI), vertical stability index (VSI), dynamic postural stability index (DPSI), and time to stabilization (TTS) in forward (FL), 45° anterior lateral (LL), and 45° anterior medial (ML) direction landing, as well as the Y-balance composite score (YBTCS) were used to assess dynamic postural stability. The results showed that the LL-TTS (p = 0.044), non-dominant leg COPSA (p = 0.015), and YBTCS (p < 0.0001) were significantly improved in the real stimulation as compared with the sham stimulation session, and anodal tDCS significantly changed dominant leg COPAP (p = 0.021), FL-APSI (p < 0.0001), FL-TTS (p = 0.008), ML-TTS (p = 0.002), non-dominant leg YBTCS (p < 0.0001), and dominant leg YBTCS (p = 0.014). There were no significant differences in all obtained balance values in the sham stimulation session, except for non-dominant leg YBTCS (p = 0.049). We conclude that anodal tDCS over M1 has an immediate improving effect on static postural stability and dynamic performance in young healthy adults. This makes tDCS a promising adjuvant rehabilitation treatment to enhance postural stability deficits in the future.

Stroke survivors face a 73% fall rate within the first year after leaving the hospital. These falls cause serious injuries in 40% of cases and lead to healthcare costs of over $50 billion each year. Many of these falls are due to ongoing center of pressure (COP) abnormalities, such as velocity increases of 2-3 times normal levels, weight-bearing asymmetry exceeding 70%, and limits of stability reduced by 40-60%. These issues are often not addressed by standard rehabilitation. Although COP measurements provide objective indicators of fall risk, there has been no comprehensive review of interventions aimed at correcting these modifiable deficits. To systematically map the scope, variety, and characteristics of interventions aimed at adjusting COP variables in adult stroke survivors to reduce fall risk, while incorporating stakeholder insights on clinical implementation. We conducted a scoping review following PRISMA-ScR guidelines, searching PubMed, MEDLINE, and the Cochrane Library from January 2015 to June 2025 for studies on COP-targeted interventions with fall-related outcomes. We extracted data on intervention details, COP parameters, measurement protocols, and clinical results. A diverse stakeholder panel of seven members, including stroke survivors, physiotherapists, and technology specialists, offered insights on implementation through structured consultations. Nine studies with 306 participants mainly examined chronic stroke patients. The strongest evidence came from force-plate biofeedback across three studies, with effect sizes d = 0.52-0.84, showing consistent gains in sway velocity linked to a lower fall risk (r = 0.52-0.71). A 0.5 cm/s reduction in sway velocity correlated with about an 18% decrease in fall likelihood. Nevertheless, considerable methodological differences-such as equipment costs from $100 to $50,000 and varying measurement protocols-restrict clinical use. Stakeholders emphasized key factors: stroke survivors appreciated visual feedback ("seeing inside my own balance"), while clinicians highlighted the need to address time constraints and documentation. The review led to a resource-based implementation framework and consensus guidelines for standardized protocols. COP interventions show promising potential for addressing the hidden issue of post-stroke falls, with force-plate biofeedback being ready for careful clinical application.Success hinges on shifting from generic approaches to personalized rehabilitation that reveals and addresses subtle balance problems. The combination of moderate to large effect sizes and stakeholder-approved implementation strategies provides a clear path to transform these ongoing fall risks into confident community mobility. Nevertheless, realizing this potential requires coordinated efforts to standardize measurements, develop practical trials, and implement strategies across systems, balancing scientific rigor with clinical realities.

The current study aimed to categorize fall risk appraisal and quantify discrepancies between perceived fall risk measured subjectively using the short Fall Efficacy Scale-International and physiological fall risk measured objectively using the portable BTrackS™ Assess Balance System. One hundred two community-dwelling older adults were evaluated in this cross-sectional study. Approximately 40% of participants had maladaptive fall risk appraisals, which were either irrational (high perceived risk despite low physiological fall risk) or incongruent (low perceived risk but high physiological fall risk). The remaining 60% of participants had adaptive fall risk appraisals, which were either rational (low perceived risk aligned with low physiological fall risk) or congruent (high perceived risk aligned with high physiological fall risk). Among participants with rational, congruent, irrational, and incongruent appraisals, 21.7%, 66.7%, 28%, and 18.8%, respectively, reported having a history of falls (p < 0.01). Using technology to identify discrepancies in perceived and physiological fall risks can potentially increase the success of fall risk screening and guide fall interventions to target perceived or physiological components of balance. [Journal of Gerontological Nursing, 46(4), 41-47.].

Effects of attenuation correction and reconstruction method on PET activation studies

In the present study, we proposed an original and robust methodology which combines the spatial normalization of skeletal muscle images, the statistical parametric mapping (SPM) analysis and the use of a specific parcellation in order to accurately localize and quantify the extent of skeletal muscle damage within the four heads of the quadriceps femoris. T2 maps of thigh muscles were characterized before, two (D2) and four (D4) days after 40 maximal isometric electrically-evoked contractions in 25 healthy young males. On the basis of SPM analysis of coregistrated T2 maps, the alterations were similarly detected at D2 and D4 in the superficial and distal regions of the vastus medialis (VM) whereas the proportion of altered muscle was higher in deep muscle regions of the vastus lateralis at D4 (deep: 35 ± 25%, superficial: 23 ± 15%) as compared to D2 (deep: 18 ± 13%, superficial: 17 ± 13%). The present methodology used for the first time on skeletal muscle would be of utmost interest to detect subtle intramuscular alterations not only for the diagnosis of muscular diseases but also for assessing the efficacy of potential therapeutic interventions and clinical treatment strategies.

Background: Patients with knee osteoarthritis have balance issues and an increased fall risk; nevertheless, it is unclear whether the Otago exercise programme (OEP) or balance exercise will improve balance and reduce fall risk among individuals with knee osteoarthritis. Therefore, there is a need to compare the effectiveness of these exercises in treating knee osteoarthritis. This review aims to investigate the effects of an OEP and balance exercise programme to improve balance and reduce fall risk among the elderly population with knee osteoarthritis (OA). Methodology: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to conduct this systematic review. Four databases (PubMed, Cochrane central register of controlled trails (CENTRAL), Physiotherapy Evidence Database (PEDro), and Science Direct) were searched until September 2022 using predefined terms by two independent reviewers. The methodological quality of the studies was assessed using PEDro. All literature published from each source was selected according to the inclusion and exclusion criteria, and data extraction was performed independently with the outcomes of the Berg balance scale (BBS), time up and go test (TUG), chair stand test (CST), and short falls efficacy scale (SFES I). RESULT: The literature review studied seven full-text articles that met the selection criteria and PRISMA guidelines. Those articles were reviewed by grouping them into five different sub-groups based on the interventions. The quality of studies ranged from good (5 studies) to fair (2 studies). The improvement in balance and fall risk prevention following OEP and balance training showed mixed results, and the findings from this review may form the basis for a future systematic research program. CONCLUSION: It is difficult to conclude clear evidence-based recommendations for Otago exercise programmes and balance exercises in improving balance and reducing fall risk among the elderly population with knee OA due to limited availability and weak evidence. KEYWORDS: Fall risk, community dwelling older adults, elderly population, knee osteoarthritis.

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test