Balance assessment during squatting exercise: A comparison between laboratory grade force plate and a commercial,low-cost device

Testing balance through squatting exercise is a central part of many rehabilitation programs and sports and plays also an important role in clinical evaluation of residual motor ability. The assessment of center of pressure (CoP) displacement and its parametrization is commonly used to describe and analyze squat movement and the laboratory-grade force plates (FP) are the gold standard for measuring balance performances from a dynamic view-point. However, the Nintendo Wii Balance Board (NWBB) has been recently proposed as an inexpensive and easily available device for measuring ground reaction force and CoP displacement in standing balance tasks. Thus, this study aimed to compare the NWBB-CoP data with those obtained from a laboratory FP during a dynamic motor task, such as the squat task. CoP data of forty-eight subjects were acquired simultaneously from a NWBB and a FP and the analyses were performed over the descending squatting phase. Outcomes showed a very high correlation (r) and limited root-mean-square differences between CoP trajectories in anterior-posterior (r > 0.99, 1.63 ± 1.27 mm) and medial-lateral (r > 0.98, 1.01 ± 0.75 mm) direction. Spatial parameters computed from CoP displacement and ground reaction force peak presented fixed biases between NWBB and FP. Errors showed a high consistency (standard deviation < 2.4% of the FP outcomes) and a random spread distribution around the mean difference. Mean velocity is the only parameter which exhibited a tendency towards proportional values. Findings of this study suggested the NWBB as a valid device for the assessment and parametrization of CoP displacement during squatting movement.     

Effects of foot orthoses on dynamic balance and basketball free-throw accuracy before and after physical fatigue

While it is not uncommon for athletes to use foot orthoses to relieve pain and improve sports performance, little has been known about their effects on basketball performance. Free-throw basketball shooting is very important. However, fatigue deteriorates postural balance which might decrease free-throw shooting performance. This study investigated the effects of foot orthoses on dynamic balance and accuracy performance during free-throw shooting before and after physical fatigue was induced. Thirteen male recreational basketball players were tested with two foot orthoses (medial-arch support versus flat control) and fatigue conditions (before and after fatigue), when they performed standard free-throw shooting on a force platform. Results revealed that fatigue significantly increased coefficient of variance of medial-lateral center of pressure (CoP) excursion when participants worn flat control orthoses (p < 0.05). Meanwhile, foot orthoses improved dynamic balance during shooting as they significantly reduced total resultant and anterior-posterior sway excursions as well as resultant and anterior-posterior CoP velocities, and base of support area. Although this study found that fatigue and orthoses did not significantly affect the scores gained by free-throw shooting, the significant improvements in dynamic balance during shooting with the use of foot orthoses could have considerable impact on motor control during basketball shooting.     

Effect of sensory stimulation applied under the great toe on postural ability in patients with fibromyalgia

Abstract

Fibromyalgia (FM) is a chronic pain syndrome, characterised by several symptoms. One of the most prevalent symptoms in FM is balance impairment that compromise the autonomy, function and performance status of patients.

Purpose: The main objective of the present study was to evaluate the effect of sensory stimulation provided by the use of a low additional thickness of 0.8?mm placed under the great toes bilaterally on the centre of pressure (CoP) measures in patients with FM. It was hypothesised that postural ability would change with a low focal additional thickness used to compute these measures.

Materials and Method: Twenty-four patients with FM voluntarily participated in this study. Postural performance during quiet standing was investigated through the CoP displacements recorded using a force-plate. Sensory stimulation was provided by a small additional thickness of 0.8?mm placed under the great toe bilaterally and two conditions were compared: additional thickness 0 (control) and 0.8?mm.

Results: An improvement of body balance through spatial parameters with sensory cutaneous stimulation applied under the great toe bilaterally were observed in patients with FM. Our results showed a significant decrease of surface area and mean speed of CoP, associated to a significant decrease of variance of speed. An additional observation is that sagittal (Y) mean position of the CoP gets more anterior (+ 5?mm) relative to control condition.

Conclusion: These findings brings new clinical perspectives in the development of intervention strategies in the management of patients with FM and balance disorders, completing validated therapeutic strategies.     

Spectral analysis of the human body sway during standing on firm and compliant surfaces under different visual conditions

Effects of different visual conditions on the vertical posture maintenance were compared in subjects standing on a firm or compliant surface. These visual conditions included a motionless visual environment (MVE), eyes-closed condition (EC), and a virtual visual environment (VVE). The VVE consisted of two planes: the foreground and background. The foreground displayed a room window with adjacent walls, and the background was represented by an aqueduct with the adjacent landscape. The VVE was destabilized by inducing either the cophased or the antiphased relation between the foreground of the visual scene and the body sway. We evaluated changes in the amplitude spectra of two elementary variables calculated from the trajectories of the plantar center of pressure (CoP) displacements in the anteroposterior and lateral directions, namely, the trajectories for the center of gravity projections on the support (the CG variable) and the differences between the CoP and CG trajectories (the CoP–CG variable).The CG trajectory was considered as a controlled variable, and the difference between the CoP and CG trajectories were considered as a variable related to the body acceleration and reflecting changes in the resultant stiffness in ankle joints. The rootmean-square (RMS) values for the spectra of both variables calculated from the body sway in the anteroposterior direction in standing on a firm support decreased proportionately with antiphased relation between the foreground and the body sway and increased with the cophased relation, compared with the RMS calculated for the MVE conditions. RMS for the spectra of the CG variable in the cophased relation were nearly the same, as in standing with eyes closed (EC), while the RMS for the spectra of the CoP–CG variable were significantly less than with EC. The body sway during standing on a compliant support significantly increased in both the anteroposterior and the lateral directions under all visual conditions. RMS for the spectra of both variables with EC increased considerably higher than in the cophased relation. Furthermore, the RMS for the spectra of the CG variable calculated from the body sway in the lateral direction on a compliant support was substantially higher in the antiphased relation than in the cophased relation, whereas the RMS for the spectra of the CoP–CG variable under both conditions had similar values. The analysis of body sway and the results under some visual conditions have shown that the amplitude characteristics of the CG and CoP–CG variables changed not always proportionately with the passage from standing on a firm support to a compliant support. It is suggested that the found disproportion of changes in these two variables is probably associated with the contribution of another additional factor to the process of postural control, the passive elastic component of musculo-articular stiffness generated by fascial-tendon tissues.     

Human stability in the erect stance: Alcohol effects and audio-visual perturbations

AimIn this article, we discuss the connection between alcohol and the control strategies carried out by the central nervous system to maintain the erect stance. Audio-visual perturbations were coupled with the consumption of an alcoholic beverage to simulate the possible perturbation affecting people at disco clubs, and the effects measured with a stabilometric platform.MethodsWe studied the statokinesigrams (SKG) of 14 volunteers; 11 of them were healthy, 3 were injured. We made a series of numerical tests using a stabilometric platform to record the statokinesigrams.The tests were carried out using statistical methods, time-series analysis, and applying the “p” parameter, recently proposed by Pascolo and Marini [2006. On the introduction of a new parameter for the analysis of posture. Europa Medicophysica, 42, 145–149] as a new tool to evaluate the reactions of the central control system with respect to posture-affecting diseases (for instance Parkinson) and perturbations.ConclusionThis work shows that it is theoretically possible to define non-invasive parameters able to distinguish sober subjects from drunk subjects, with an evaluation that only uses a stabilometric platform.     

How does cryotherapy effect ankle proprioception in healthy individuals?

Objectives To investigate how a 15-min cryotherapy intervention effects proprioception by measuring joint positional sense (JPS) and static single legged balance. Design Repeated measures design. Setting Laboratory. Participants Eighteen healthy university sports team students (11 males, 7 females) aged between 20 and 21?years old. Main outcome measures Participants were treated with 15?min of Aircast Cryo-cuff. The subject’s skin temperature was measured before and immediately after 15?min of cryotherapy treatment. Ankle active joint positional sense (A-JPS) and passive joint positional sense (P-JPS) were measured at pre-test, immediately post-test, and 5?min post-test. Static balance was measured by centre of pressure (CoP) mean path length, medial–lateral (ML) CoP mean deviation, and anterior–posterior (AP) CoP mean deviation and mean time-to-boundary (TtB) minima for AP and ML directions. Results No significant differences were found for the variables of JPS and static single balance testing after 15?min of cryotherapy treatment. However, mean differences for CoP mean path length and ML mean deviation were shown to improve following cryotherapy treatment, results not previously found in the literature. Conclusion Results suggest that 15?min of Cryo-cuff treatment does not significantly affect proprioception. Although the effect of cryotherapy on proprioception depends on cooling modality used, time frame applied, and joint applied to.     

Intra and intersession reliability of balance measures during one-leg standing in young adults

A study was designed to investigate the intra and intersession reliability during 1-leg standing recorded from a computerized balance platform. Thirty-nine healthy young men (n = 17, age range: 20-30 years) and women (n = 22, age range: 21-28 years) performed 3 testing sessions, with the second session 30 minutes (intrasession comparison) and the third session 1 week (intersession comparison) after the initial testing session. Within each testing session, participants completed 3 trials of 1-leg standing with their dominant leg. Reliability statistics were calculated using the mean of all 3 trials during each session for 6 balance measures (i.e., total displacements of the center of pressure [CoP], the CoP displacements in mediolateral and anterior-posterior directions, and the CoP speed and CoP area and their SD). Test-retest reliability was examined calculating both, intraclass correlation coefficient (ICC) with 95% confidence interval (95% CI) and Bland-Altman plots. In both sexes and irrespective of balance measure, ICC values were ≥0.75 except for 1 parameter in men. This indicates an excellent intra and intersession reliability. Bland-Altman plots confirmed these findings by showing that only 1 or 2 (4.5-11.8%) of the data points were beyond the 95% CI. Practitioners and clinicians are provided with a posturographic test setup that proved to be reliable. Researchers can use these data to identify the range in which the true value of a subject's score lies and estimate a priori sample sizes.     

Data Processing Techniques May Influence Numerical Results and Interpretation of Single Leg Stance Test

Purposeto evaluate how different data sampling and different analysis methods may effect numerical results and interpretation of single leg stance test using parameters derived from CoP trajectories.MethodsThirty healthy active subjects were recruited for this study on voluntary. Each participant was asked to stand as still as possible for 20 s on the dominant limb, with the supporting foot placed on the force platform. Balancing task in two conditions, with eyes open (EO) and closed (EC). Three trials were collected for each condition.Medial-lateral and anterior-posterior CoP force platform data were obtained and downsampling techniques was applied to get data at original (500 Hz), 100 Hz and 20 Hz of sampling frequencies.Time series data were then analysed to get CoP variables including medial-lateral total path, anterior-posterior total path, total path, maximal excursion for the ML plane and maximal excursion for the AP plane. Sway area was evaluated as 95% confidence ellipse area (CEA) and as 95% prediction ellipse area (PEA)Main findingsSignificant different results were obtained for the same variable evaluated at different sampling frequency. In addition, at all sampling frequencies variables were significantly different (p.<0.05) between EO and EC conditions. High correlation (>0.9) between the same CoP variable calculated at different sampling frequencies was found for all CoP variables. Regarding sway area calculation, both methods were able to distinguish between EO and EC conditions and high correlation was found between CEA and PEA methods.ConclusionOverall results of this study demonstrated the importance of reporting data processing techniques, which includes sampling frequency and variable calculation methods, as they shown to influence one leg stance CoP results, thus data analysed in different manner cannot be directly compared. However, for the variables included in the study, researchers can choose preferred data collection and data analysis methods as they all return same data analysis interpretation as long as they keep consistency in the method.     

Efectos del estado cognitivo sobre las alteraciones del equilibrio y la marcha en ancianos institucionalizados

BackgroundAgeing has been linked to a high prevalence of cognitive impairment, which, in turn, has been related to balance disturbances and gait disorders. The aim of this study was to identify whether there are differences between subjects with and without cognitive impairment regarding the quality of gait and balance.Material and methodsAn observational study was conducted on institutionalised people older than 65 years (n = 82). Gait and balance was evaluated after the assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Single and dual tests were used including, the 6-minute walking, stride length, and gait speed. Timed Up and Go tests were also used to evaluate balance.ResultsThe participants were divided into three groups: 28 subjects in the group without cognitive impairment (MMSE ≥ 27), 29 subjects with mild (27 < MMSE ≤ 21) and 26 subjects with moderate cognitive impairment (MMSE < 21). Gait assessment showed significant between-groups differences in all the variables (P < .05). The variables assessing balance also showed significantly worse values in those groups with cognitive impairment.ConclusionThe severity of cognitive impairment is related to impaired balance and gait, thus the clinical monitoring of these variables in population at risk is needed.     

Comparison of the Effect of Cognitive Rehabilitation and Neurofeedback on Sustained Attention Among Elementary School Students with Specific Learning Disorder: A Preliminary Randomized Controlled Clinical Trial

Specific learning disorder (SLD) can occur along with the problems of attention performance and be complicated by them. Recent studies have reported the positive effects of cognitive rehabilitation (CR) and neurofeedback (NFB) on sustained attention (SA) in SLD. Nevertheless, it has not yet been determinedwhat kind of treatment may be the most appropriate option for this disorder in terms of the different functions of cognitive status, especially SA. This preliminary study aimed to compare CR and NFB effects on SA among elementary school students with SLD using a randomized controlled clinical trial (RCT). Fifty- three eligible students with a DSM-5 SLD diagnosis, aged 7–10, were randomly allocated in NFB (n?=?18), CR (n?=?18), and control groups (n?=?17). All the participants were evaluated for SA by performing the continuous performance test (CPT) on the studied groups at the time of their inclusion in the study and 7 weeks after it. The intervention groups took part in 20 sessions of CR and 20 sessions of NFB. Conversely, the untreated group were evaluated without any intervention.15 boys and 30 girls in 3 groups completed the study (n?=?15 per group). The mean and standard deviation of participants’ age were (8.66?±?1.48) years, (8.40?±?1.73) years and (8.53?±?1.63) years in CR, NFB and untreated groups, respectively. The results showed significant differences between the groups based on the variables of the CPT test (p?<?0.05). Also, the significant effects of the variables represented the higher scores of the CR compared to the NFB group (p?<?0.001). This study provides einitial evidence that CR is more effective than NFB on SA improvement among students with SLD.     

Potential of Artesunate in the treatment of visceral leishmaniasis in dogs naturally infected by Leishmania infantum: Efficacy evidence from a randomized field trial

Leishmaniasis is among the world’s most neglected diseases. Dogs are the main reservoirs/hosts of Leishmania infantum, causative agent of both canine and human visceral leishmaniosis. Canine leishmaniasis (CanL) represents a public health problem as one of the most prevalent zoonotic diseases worldwide. Current therapeutics present drawbacks; thus, there is a need for more effective, safer, and cheaper drugs. The aim of this study was to evaluate and to compare the efficacy of oral administration of artesunate or meglumine antimoniate/allopurinol in dogs with clinical leishmaniasis. Forty-two dogs with naturally occurring clinical leishmaniasis were included in this open-label, simple randomized positive-control clinical field trial with 6 months of follow-up. Dogs received meglumine antimoniate 100 mg/kg/day and allopurinol 30 mg/kg/day for 28 days (control group, n = 26) or artesunate 25 mg/kg/day for 6 days (test group, n = 16). The animals were evaluated for their clinical evolution, parasite load (by qPCR) and humoral response at different time points: 0, 30, 90, and 180 days after treatment. Data analyses showed a significant improvement in both groups in clinical scores, parasitemia and antibody titers after treatment. Compared to the control group, the artesunate group showed significantly lower clinical score (P = 0.0001), lower parasitemia (P = 0.0001) and antibody titers after 6 months of follow-up. Compared to baseline values, a rapid, significant reduction (P < 0.012) in antibody levels, 2.28- versus 3.04-fold for the control versus artesunate groups, respectively, was observed 30 days after treatment. Antibody levels continued to decrease further in the artesunate group, where 58% of cases became seronegative at the 6-month follow-up. All qPCR-positive dogs were negative after treatment with artesunate, while 14.3% remained positive with the appearance of two new cases in the control group. Artesunate was well tolerated, and no side effects were recorded. Treatment failures were similar in both groups with 27.27% (6/22), including 18.18% (4/22) mortality in the control group, versus 26.66% (4/15), including 13.33% (2/15) mortality in the artesunate group. This is the first report showing the potential of artesunate in the treatment of dogs with clinical leishmaniasis. Artesunate showed higher efficacy than the current first-line treatment for CanL without any adverse effects. It could be a good alternative chemotherapy for CanL, and may be considered for further studies in human leishmaniases. Further clinical trials are needed to confirm these findings, to determine if there are relapses after treatment and if dogs remain infective to sandflies, to define the ideal therapeutic dosage and duration of treatment with artesunate.     

Sex differences in the clinical and serologic presentation of early lyme disease: Results from a retrospective review

Background: Lyme disease is the most common vector-borne disease in the United States, and the number of reported cases has more than doubled between 1992 and 2008. Few studies have explicitly examined sex-based differences in the clinical presentation of or serologic response to early Lyme disease. It is unknown whether the sex-based variability observed in other infectious diseases is relevant to this clinical setting.Objective: This study retrospectively examined clinical and serologic differences by sex among a community case series of patients with a current or past episode of confirmed early Lyme disease.Methods: This was a retrospective, consecutive case series of adult patients in Maryland enrolled from August 2002 to August 2007 meeting criteria for a current or past episode of confirmed early Lyme disease. Clinical variables and patients' self-report surrounding illness onset were abstracted through chart review. All serologic tests drawn within 3 months of illness onset were interpreted using Centers for Disease Control and Prevention criteria.Results: In a total of 125 patients, there were no significant differences in clinical presentation by sex. The initial self-misdiagnosis rates for men and women were 10% and 18%, respectively (P = NS). Among the 62 patients with a serologic test as part of their clinical evaluation, 50% of men had a positive, 2-tier result compared with 32% of women (P = NS). Among the 41 patients with a positive ELISA, median ELISA values (3.4 vs 2.0; P = 0.03) and median number of immunoglobulin G (IgG) bands (4 vs 2; P = 0.03) were significantly higher among men.Conclusions: In this small, retrospective sample, we found evidence for sex-based differences in the magnitude of ELISA and IgG serologic response to early Lyme disease. Such differences could have implications for appropriate diagnosis, treatment, and disease classification. Larger, prospective studies are needed to replicate the results found in this study and to examine their relationship to sex-based immunologic variability.     

Assessment from Functional Perspectives: Using Sensorimotor Control in the Hand as an Outcome Indicator in the Surgical Treatment of Carpal Tunnel Syndrome

To investigate whether sensorimotor control of the hand could be an outcome indicator after carpal tunnel release (CTR), this work examined changes in the results of patients’ manual tactile test (MTT), pinch-holding-up activity (PHUA), two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) tests. Participants included 30 predominantly sensory neuropathy CTS patients, as confirmed by a nerve conduction study. The MTT, precision pinch performance in PHUA and traditional sensibility (2PD and SWM) tests were used to examine different aspects of sensory status at the time-points of two weeks before operation and one month post-operation, with a single-blind design. The results showed significant improvements in the sensory function as detected by the 2PD and SWM tests (p<0.001) and sensorimotor function as detected by the MTT (p<0.001) and PHUA test (p<0.05) for patients receiving CTR. The responsiveness of the SWM, MTT and PHUA tests (effect size>0.5, p<0.01) are better than that of two-point discrimination test (effect size<0.5, p<0.001). However, pinch strength saw a decline compared to baseline with a moderate effect sizes (effect size = 0.7, p<0.001). This cohort study found that the MTT and PHUA test can both meet all the statistical criteria with regard to assessing treatment outcomes for patients with CTS. In addition, the results of this work provide clinicians with the information that the sensorimotor functions of the hands, as assessed by MTT and PHUA, are responsive to clinical changes due to CTR.     

Analysis of Guidelines for Basal-Bolus Insulin Dosing: Basal Insulin,Correction Factor,and Carbohydrate-To-Insulin Ratio

ObjectiveTo analyze and compare the underlying mathematical models for basal-bolus insulin-dosing guidelines in patients with type 1 diabetes in a retrospective controlled study.MethodsAlgebraic model-development yielded several systems of models with unknown constants, including 3 systems currently in use. These systems were compared for logic and consistency. One of these systems was the accurate insulin management (AIM) system, which we developed in the setting of our large endocrine practice. Our database consisted of retrospective clinical records for a 7-month period. During this time, correction factor (CF), carbohydrate-to-insulin ratio (CIR), and basal insulin were being adjusted incrementally by titration. The variables studied were height, body weight in pounds (BWlb), CF, CIR, hemoglobin A1c (A1C), basal insulin, and 6-day mean total daily dose of insulin (TDD). The values of the variables used in the study were those determined on arrival of the patients at the office. The last 6 TDDs were entered into the database, and the mean was calculated by formulas within the database. We sorted our database into 2 groups, a well-controlled test group (n = 167; A1C ≤ 7%, time on pump > 180 days, no severe hypoglycemic events since the last office visit, and C-peptide level ≤ 0.5 ng/mL) and a control group with poor control (n = 209; A1C > 7% or time on pump < 180 days). We obtained one office visit per patient, as follows: from the test group, we chose the visit with the lowest A1C value; from the control group, we chose one visit by use of a computer’s random number generator. A significant difference was demonstrated between the correlation constants of the test group versus the control group by performing T tests between the means and F tests between the standard deviations. The least squares estimates of the correlation constants from the test group were recommended in the guidelines, in place of the means, to gain accuracy. By these methods, the guidelines used by the patients with good glycemic control are made available for all patients.ResultsWith use of the AIM system, the TDD for continuous subcutaneous insulin infusion = 0.24 * BWlb; basal insulin = 0.47 * TDD; CF = 1,700/TDD; and CIR = 2.8 * BWlb/TDD.ConclusionThree mathematical models for CIR are presented, with a rationale for supporting one of them (the AIM model). This model, together with 3 related AIM models, when provided with statistically correlated constants, constitutes the AIM system of guidelines, a consistent and convenient means of estimating insulin-dosing variables for patients with type 1 diabetes. (Endocr Pract. 2008;14:1095-1101)     

An Artificial Neural Network Estimation of Gait Balance Control in the Elderly Using Clinical Evaluations

The use of motion analysis to assess balance is essential for determining the underlying mechanisms of falls during dynamic activities. Clinicians evaluate patients using clinical examinations of static balance control, gait performance, cognition, and neuromuscular ability. Mapping these data to measures of dynamic balance control, and the subsequent categorization and identification of community dwelling elderly fallers at risk of falls in a quick and inexpensive manner is needed. The purpose of this study was to demonstrate that given clinical measures, an artificial neural network (ANN) could determine dynamic balance control, as defined by the interaction of the center of mass (CoM) with the base of support (BoS), during gait. Fifty-six elderly adults were included in this study. Using a feed-forward neural network with back propagation, combinations of five functional domains, the number of hidden layers and error goals were evaluated to determine the best parameters to assess dynamic balance control. Functional domain input parameters included subject characteristics, clinical examinations, cognitive performance, muscle strength, and clinical balance performance. The use of these functional domains demonstrated the ability to quickly converge to a solution, with the network learning the mapping within 5 epochs, when using up to 30 hidden nodes and an error goal of 0.001. The ability to correctly identify the interaction of the CoM with BoS demonstrated correlation values up to 0.89 (P<.001). On average, using all clinical measures, the ANN was able to estimate the dynamic CoM to BoS distance to within 1 cm and BoS area to within 75 cm². Our results demonstrated that an ANN could be trained to map clinical variables to biomechanical measures of gait balance control. A neural network could provide physicians and patients with a cost effective means to identify dynamic balance issues and possible risk of falls from routinely collected clinical examinations.     

Age-related changes in postural responses to backward platform translation

The aim of the study was to investigate age-related changes in postural responses to platform translation with 3 various velocities. We focused on the influence of linear velocity using the smoothed profile of platform acceleration (till 100 cm.s(-2)). Eleven healthy young (20-31 years) and eleven healthy elderly (65-76 years) subjects were examined. The subjects stood on the force platform with their eyes closed. Each trial (lasting for 8 sec) with different velocity (10, 15, 20 cm.s(-1)) of 20 cm backward platform translation was repeated 4 times. We have recorded displacements of the centre of pressure (CoP) and the EMG activity of gastrocnemius muscle (GS) and tibialis anterior muscle (TA). The results showed increased maximal values of CoP responses to the platform translation. There was also observed a scaling delay of CoP responses to platform translation with different velocities in elderly. The EMG activity of GS muscle during backward platform translation was of about similar shape in both groups during the slowest platform velocity, but it increased depending on rising velocity. EMG activity of TA was not related to the platform velocity. Early parts of postural responses showed significant co-activation of TA and GS muscles of elderly. It is likely that elderly increased body stiffening in order to help their further balance control.     

Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests.