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Background: Recently, new methods have emerged that encourage voluntary participation by allowing patients to perform tasks, including exercises or treatments, in a virtual reality (VR) environment. Aim: This study aimed to examine the effects of full immersion virtual reality training on balance and knee function in patients who had undergone total knee replacement. Design: Single blind randomized controlled trial. Setting: Department of Physical Therapy in a rehabilitation center. Population: A total of 30 elderly patients ($\ge$65 years old) who had undergone total knee replacement. Methods: Participants were randomly allocated to an experimental group ($n=18$) and a control group ($n=18$). The experimental group received with a continuous passive motion machine, exercise therapy, and a full immersion VR training program; the control group received only with a continuous passive motion machine and exercise therapy. Biorescue was used to test static and dynamic balance ability, and the Timed Up and Go and Western Ontario and McMaster Universities tests were used to assess knee function. Paired $t$-tests were used to examine differences by time in each group, and independent $t$-tests were used to examine differences between the groups. Results: In terms of within-group differences by time, both the experimental group and the control group showed significant changes in the anterior, and posterior limits of stability in both sides; static balance; and knee function. In the between-groups comparison, among static balance tests, there was a significant difference in center of mass path length in the standing position with eyes open ($p=0.006$); among dynamic balance tests, there were significant differences in left, right, anterior, and posterior limits of stability ($p=0.00$). Conclusions: VR training produced better early balance ability and knee function than what was seen in the control group. We believe that VR training in initial post-operative rehabilitation of total knee replacement patients may increase the rate of recovery. Clinical Rehabilitation Impact: VR exercise programs are effective in early rehabilitation after total knee replacement, and have clinical value as inexpensive methods that can promote active participation.

This work introduces a new sensing system for biped robots based on plantar robot skin, which provides not only the resultant forces applied on the ankles but a precise shape of the pressure distribution in the sole together with other extra sensing modalities (temperature, pre-touch and acceleration). The information provided by the plantar robot skin can be used to compute the center of pressure and the ground reaction forces. This information also enables the online construction of the supporting polygon and its preemptive shape before foot landing using the proximity sensors in the robot skin. Two experiments were designed to show the advantages of this new sensing technology for improving balance and walking controllers for biped robots over unknown terrain.

Background: In the previous psychometric analysis paper in our series for identifying the core set of balance measures for the assessment of balance, we recommended the Berg Balance Scale (BBS) and balance sub-components of the Scale for the assessment and rating of ataxia (SARAbal) as psychometrically sound measures of balance for people with cerebellar ataxia (CA) secondary to multiple sclerosis.

Objective: The present study further examined the suitability of BBS and SARAbal for the assessment of balance in CA with regard to psychometric property strength, appropriateness, interpretability, precision, acceptability and feasibility.

Methods: Criteria to fulfill each factor was defined according to the framework of Fitzpatrick et al. (1998). Based on the findings of our previous psychometric analysis, each criterion was further analyzed.

Results: The psychometric analysis reported good reliability and validity estimates for the BBS and SARAbal recommending them as psychometrically sound measures; they fulfilled both criteria for appropriateness and interpretability, the measures showed evidence for precision and acceptability, and they were found to be feasible in terms of the time and cost involved for the balance assessment.

Conclusion: We have provided evidence for the use of the BBS and SARAbal for the assessment of balance among people with CA.

Background: With dramatic increase in the number of older individuals, special efforts have been made to promote the levels of independence and reduce fall rates among these individuals.

Objective: To investigate the effects of Thai dance exercises over 6 weeks on functional mobility and fall rates in community-dwelling older individuals.

Methods: Sixty-one community-dwelling older adults were interviewed and assessed for their demographics and fall data during 6 months prior to participation in the study. Then they completed the quasi-experimental Thai dance exercise program for 50 minutes$/$day, 3 days$/$week over 6 weeks. Their functional mobility relating to levels of independence and safety were assessed prior to training, at 3-week and 6-week training. After completing the program at 6 weeks, participants were prospectively monitored for fall data over 6 months.

Results: Participants improved their functional mobility significantly after 3- and 6-week training $(p<0.01)$. The number of faller individuals obviously decreased from 35% $(n=21)$ prior to training to only 8% $(n=5)$ after training $(p<0.01)$.

Conclusion: The current findings further extend benefits of Thai dance as an alternative musical exercise program to promote levels of independence and safety among community-dwelling older adults.

Background: Individuals with Parkinson’s disease (PD) invariably experience functional decline in a number of motor and non-motor domains affecting posture, balance and gait. Numerous clinical studies have examined effects of various types of exercise on motor and non-motor problems. But still much gap remains in our understanding of various therapies and their effect on delaying or slowing the dopamine neuron degeneration. Recently, Tai Chi and Yoga both have gained popularity as complementary therapies, since both have components for mind and body control.

Objective: The aim of this study was to determine whether eight weeks of home-based Tai Chi or Yoga was more effective than regular balance exercises on functional balance and mobility.

Methods: Twenty-seven individuals with Idiopathic PD (Modified Hoehn and Yahr stages 2.5–3) were randomly assigned to either Tai Chi, Yoga or Conventional exercise group. All the participants were evaluated for Functional Balance and Mobility using Berg Balance Scale, Timed 10m Walk test and Timed Up and Go test before and after eight weeks of training.

Results: The results were analyzed using two-way mixed ANOVA which showed that there was a significant main effect for time as F (1, 24) $=74.18$, $p=0.000$, $\eta p^2=0.76$ for overall balance in Berg Balance Scale. There was also significant main effect of time on mobility overall as F(1, 24) $=77.78$, $p=0.000$, $\eta p^2=0.76$ in Timed up and Go test and F(1, 24) $=48.24$, $p=0.000$, $\eta p^2=0.67$ for 10m Walk test. There was a significant interaction effect for $\mathrm{\text{time}}\times \mathrm{\text{group}}$ with F(2, 24) $=8.67$, $p=0.001$, $\eta p^2=0.420$ for balance. With respect to mobility, the values F(2, 24) $=5.92$, $p=0.008$, $\eta p^2=0.330$ in Timed Up and Go test and F(2, 24) $=10.40$, $p=0.001$, $\eta p^2=0.464$ in 10m Walk test showed a significant interaction. But there was no significant main effect between the groups for both balance and mobility.

Conclusion: The findings of this study suggest that Tai Chi as well as Yoga are well adhered and are attractive options for a home-based setting. As any form of physical activity is considered beneficial for individuals with PD either Tai Chi, Yoga or conventional balance exercises could be used as therapeutic intervention to optimize balance and mobility. Further studies are necessary to understand the mind–body benefits of Tai Chi and Yoga either as multicomponent physical activities or as individual therapies in various stages of PD.

Background: Trunk stability is key in controlling body balance and movements. Trunk Stabilization Exercises (TSE) and Conventional Trunk Exercises (CTE) are performed to improve dynamic balance. The authors have previously reported that dynamic balance was improved by a 12-week and 6-week TSE program. However, there is a dearth of research on its immediate effect on dynamic balance in trained soccer players.

Objective: To compare the immediate effect of TSE with that of CTE on dynamic balance in trained soccer players.

Methods: Forty-eight male soccer players (24.60 ± 1.38 years) participated in this crossover study, wherein each participant took part in three exercise sessions: TSE, CTE, and No Exercise control (NE), each consisting of three steps: pre-test, intervention and post-test, with an interval of one week between each exercise condition. To assess dynamic balance, the Y Balance Test-Lower Quarter (YBT-LQ) score in the anterior, posteromedial, and posterolateral directions was measured before and 5 minutes after each intervention.

Results: The YBT-LQ composite score was significantly improved after TSE (0.51) as compared to CTE (0.22) and NE (0.04) (p<0.05). Furthermore, in TSE and CTE conditions, YBT-LQ scores of the posterolateral and posteromedial directions significantly improved at the post-test (p<0.05).

Conclusion: Both TSE and CTE are effective in immediately improving dynamic balance; however, TSE showed greater improvement as compared to the latter. Immediate improvements in the posteromedial and posterolateral directions of the YBT-LQ were demonstrated after performing the TSE and CTE.

In this paper we demonstrate a new method to quantify direction and magnitude of sway in response to periodic inputs. The postural sway response was modeled as an ellipse, allowing the determination of angle of heading as well as the resultant magnitude. To demonstrate this methodology, center of pressure data obtained from a subject receiving sinusoidal (0.25 Hz, 1.2 mA peak-to-peak) galvanic vestibular stimulation in both the binaural-bipolar and binaural-monopolar configurations were analyzed. The binaural-bipolar and binaural-monopolar stimuli elicited sway patterns that were oriented at 4° and 97° to the medial-lateral axis, respectively. In addition, the binaural-monopolar stimulus generated twice as much sway as the binaural-bipolar stimulus. We propose that this method can be applied to sway obtained from sinusoidal inputs to the sensory systems controlling balance. Estimation of the direction and magnitude of postural sway will become an important tool for understanding postural control mechanisms for disturbances to balance that do not occur in a cardinal direction.