Determinants of musculoskeletal frailty and the risk of falls in old age

Neuromuscular parameters that describe locomotion are indispensable variables for the diagnosis and treatment of frailty, fall risk and osteoporosis. A scientifically-based standardized locomotor assessment should be an essential part of medical examinations in research and clinical practice. There has been no previous consensus regarding which test procedures should be included in a locomotor assessment. The goal of this article is to provide a rationale for the selection of appropriate locomotor tests in a comprehensive locomotor assessment for elderly patients. We propose that a locomotor assessment should comprise the parameters that have been proven predictive for both falls and impending disability. The parameters should be measured in the standard units of physics. Therefore, we propose the following tests for a standardized locomotor assessment: (1) Self-selected gait velocity as the single best measure of general locomotor status and a good predictor of age-related adverse events; (2) Chair rise test (timed 5 chair rises) which measures power on vertical movement and the hip surrounding muscles as the most important neuromuscular risk factor for falls and fall-related fractures; (3) Tandem standing and tandem walking to measure postural capacity (balance) to the side; (4) Timed up and go test as a global screening procedure; (5) Clinical gait analysis with special focus on regularity; and (6) At least on a research level, movement must be measured referring to the terms of physics by mechanography. Mechanography (Leonardo force plate system, Novotec Pforzheim, Germany) records the time course of ground reaction forces, velocity of the vertical movements of the center of mass and power during unrestricted physiological movements. In the mechanogram the eccentric and concentric phases of movements can be differentiated and the storage of energy in the elastic elements of the body can be examined. The kinetics of human movement is explained by mechanograms of a two-legged jump. The ground reaction forces resulting from a jump down from a height of 0,46 m are demonstrated as a performance that is representative for human coordination. One goal of this text is to underline the insights that arise if the rules of physics are applied to human movement. A deeper understanding enables us to create more effective treatments for disorders of the muscle-bone unit. Bringing physics and cybernetics into the field of osteoporosis is a great heritage of Harold Frost.     

Is there an association between variables of postural control and strength in prepubertal children?

The risk of sustaining falls and sports-related injuries is particularly high in children. Deficits in balance and muscle strength represent 2 important intrinsic fall and injury-risk factors. Therefore, the purpose of this study was to investigate the relationship between variables of static and dynamic postural control and isometric and dynamic muscle strength and to find out whether there is an association between measures of postural control and muscle strength in prepubertal children. Thirty children participated in this study (age 6.7 ± 0.5 years; body mass index 16.0 ± 1.8 kg·m(-2)). Biomechanic tests included the measurements of maximal isometric torque and rate of force development (RFD) of the plantar flexors on an isokinetic device, jumping power and height (countermovement jump [CMJ]) on a force plate, and the assessment of static and dynamic posture during bipedal stance on a balance platform. The significance level was set at p < 0.05. No significant associations were observed between variables of static and dynamic postural control. Significant positive correlations were detected between the RFD of the plantar flexors and CMJ height (r = 0.425, p < 0.01). No statistically significant associations were found between measures of postural control and muscle strength. The nonsignificant correlations between static and dynamic postural control and muscle strength imply that primarily dynamic measures of postural control should be incorporated in fall and injury-risk assessment and that postural control and muscle strength appear to be independent of each other and may have to be trained in a complementary manner for fall and injury-preventive purposes.     

Balance control is impaired in adults with sickle cell anaemia

Abstract

Background: Musculoskeletal involvement and cerebrovascular disease are common in sickle cell anaemia (SCA). These changes are potentially important factors that modify the control of balance in this population.

Objective: To assess balance control in adults with SCA and investigate the associations among balance, posture and muscle function.

Methods: Twenty neurologically intact (i.e. without previous episodes of overt stroke or transient ischaemic attack) adults with SCA and 18 controls were evaluated. All participants underwent static balance measurement through stabilometry, postural evaluation through photogrammetry and assessment of muscle function through handgrip and respiratory muscle strength.

Results: Compared to the controls, the adults with SCA exhibited greater displacement of the centre of mass, particularly in the mediolateral direction. Moreover, the adults with SCA exhibited greater postural deviations for the following variables: angles of the right and left hip, horizontal asymmetry of the scapula in relation to T3, angles of the right and left leg-heel and horizontal alignment of the pelvis. Handgrip strength, respiratory muscle strength and haemoglobin (Hb) levels were significantly correlated with postural balance measurements. Significant correlations between balance and posture were only observed between the variables of balance and the postural parameters that involved the angulations calculated from the vertical alignment of the pelvis, hip and ankle.

Conclusions: Neurologically intact adults with SCA exhibit damage in static balance, particularly in the mediolateral direction. These patients present postural deviations due to changes in the hip and ankle joints. In addition, balance control is related to posture, Hb level and muscle function.     

Relationship of multiscale entropy to task difficulty and sway velocity in healthy young adults

Abstract

Purpose/background: Multiscale entropy (MSE) is a nonlinear measure of postural control that quantifies how complex the postural sway is by assigning a complexity index to the center of pressure (COP) oscillations. While complexity has been shown to be task dependent, the relationship between sway complexity and level of task challenge is currently unclear. This study tested whether MSE can detect short-term changes in postural control in response to increased standing balance task difficulty in healthy young adults and compared this response to that of a traditional measure of postural steadiness, root mean square of velocity (VRMS).

Methods: COP data from 20?s of quiet stance were analyzed when 30 healthy young adults stood on the following surfaces: on floor and foam with eyes open and closed and on the compliant side of a Both Sides Up (BOSU) ball with eyes open. Complexity index (CompI) was derived from MSE curves.

Results: Repeated measures analysis of variance across standing conditions showed a statistically significant effect of condition (p?<?0.001) in both the anterior–posterior and medio-lateral directions for both CompI and VRMS. In the medio-lateral direction there was a gradual increase in CompI and VRMS with increased standing challenge. In the anterior–posterior direction, VRMS showed a gradual increase whereas CompI showed significant differences between the BOSU and all other conditions. CompI was moderately and significantly correlated with VRMS.

Conclusions: Both nonlinear and traditional measures of postural control were sensitive to the task and increased with increasing difficulty of standing balance tasks in healthy young adults.     

Muscle force and power in obese and overweight children

The study investigated differences in skeletal muscle function between obese and non-obese children using a force platform. Forty obese children and adolescents (age range 8 to 18 years; 21 girls) and 40 age- and sex-matched controls performed two tests: (1) single two-legged jump, a countermovement jump for maximal height; (2) multiple one-legged hopping on the forefoot, a test of maximal force. In the single two-legged jump, obese subjects had higher absolute peak force (1.62 kN vs 1.09 kN) and peak power (2.46 kW vs 2.06 kW), but lower body weight-related peak force (2.10 vs 2.33) and lower peak power per body mass (30.9 W/kg vs 41.6 W/kg). Jump height (29.3 cm vs 37.5 cm) and maximal vertical velocity (1.92 ms(-1) vs 2.31 ms(-1)) were reduced in obese children. In multiple one-legged hopping, obese subjects had 72% and 84% higher absolute peak force on the left and right foot, respectively. However, forces relative to body weight were 24% and 23% lower in the obese group than in the control group. In conclusion, obese children and adolescents have increased muscle force and power. This partly compensates for the effect of high body weight on muscle performance.     

Blood Pressure Associates with Standing Balance in Elderly Outpatients

Objectives

Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment.

Materials and Methods

In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197) and continuously (subsample, n = 58) before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1) the ability to maintain standing balance; 2) self-reported impaired standing balance; and 3) history of falls, adjusted for age and sex.

Results

Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements.

Conclusion

Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.     

Postural sway parameters using a triaxial accelerometer: comparing elderly and young healthy adults

The purpose of this study was to evaluate the sensitivity of 16 parameters derived from acceleration to detect changes caused by age and visual conditions during quiet standing and detect and minimise possible sources of unwanted variability that could affect accelerometer measures on the trunk. Twenty-seven healthy subjects, including 16 elderly (age, 69.3 ± 3.6 years) and 11 young (age, 23.6 ± 2.2 years) subjects, were evaluated. The parameters evaluated include root-mean-square values, fractal dimensions, path length, range, frequency dispersion and power spectrum among others derived from these values. These 16 parameters evaluated for each axis of movement and/or derivations resulted in 59 sub-parameters. These 59 sub-parameters were analysed in the elderly and young groups and under the open-eye and closed-eye conditions. The results showed that 30 sub-parameters detected differences for an age effect with open eyes, 18 detected differences with closed eyes, 25 detected differences for the young group standing with closed–open eyes and 37 detected differences for the elderly with closed and open eyes (p < 0.01). We used simple signal processing for the accelerometry signals to minimise the effects of unwanted variability that could affect the results. The results showed better performance compared with those results published previously using force platforms to evaluate postural sway. The results presented here should be useful for researchers who want to use accelerometry to evaluate steady postural balance.     

Difference in Postural Control during Quiet Standing between Young Children and Adults: Assessment with Center of Mass Acceleration

The development of upright postural control has often been investigated using time series of center of foot pressure (COP), which is proportional to the ankle joint torque (i.e., the motor output of a single joint). However, the center of body mass acceleration (COM_acc), which can reflect joint motions throughout the body as well as multi-joint coordination, is useful for the assessment of the postural control strategy at the whole-body level. The purpose of the present study was to investigate children’s postural control during quiet standing by using the COM_acc. Ten healthy children and 15 healthy young adults were instructed to stand upright quietly on a force platform with their eyes open or closed. The COM_acc as well as the COP in the anterior–posterior direction was obtained from ground reaction force measurement. We found that both the COM_acc and COP could clearly distinguish the difference between age groups and visual conditions. We also found that the sway frequency of COM_acc in children was higher than that in adults, for which differences in biomechanical and/or neural factors between age groups may be responsible. Our results imply that the COM_acc can be an alternative force platform measure for assessing developmental changes in upright postural control.     

Are there changes in postural regulation across the lifespan?

Abstract

The purpose was to obtain parameters of postural regulation (n?=?1724) of asymptomatic subjects (6–97 years). The maximum postural stability and capacity of postural subsystems were calculated for the age ranges from 34 to 35 years (men) and from 38 to 44 years (women). A significant decline in postural performance was observed in the 40s (men) and 50s (women). Data can be used in the evaluation of dizziness and balance disorders in people of all ages.     

Assessment of haemophilic arthropathy through balance analysis: a promising tool

The purpose of this study was to develop a tool able to distinguish between subjects who have haemophilic arthropathy in lower limbs and those who do not by analyzing the centre of pressure displacement. The second objective was to assess the possible different responses of haemophiliacs and healthy subjects by creating a classifier that could distinguish between both groups. Fifty-four haemophilic patients (28 with and 26 without arthropathy) and 23 healthy subjects took part voluntarily in the study. A force plate was used to measure postural stability. A total of 276 centre of pressure displacement parameters were calculated under different conditions: unipedal/bipedal balance with eyes open/closed. These parameters were used to design a Quadratic Discriminant Analysis classifier. The arthropathy versus non-arthropathy classifier had an overall accuracy of 97.5% when only 10 features were used in its design. Similarly, the haemophiliac versus non-haemophiliac classifier had an overall accuracy of 97.2% when only 7 features were used. In conclusion, an objective haemophilic arthropathy in lower limbs evaluation system was developed by analyzing centre of pressure displacement signals. The haemophiliac vs. non-haemophiliac classifier designed was also able to corroborate the existing differences in postural control between haemophilic patients (with and without arthropathy) and healthy subjects.     

Efficacy of two intervention approaches on functional walking capacity and balance in children with Duchene muscular dystrophy

Objectives:Children with Duchene muscular dystrophy have weak muscles, which may impair postural adjustments. These postural adjustments are required for gait and dynamic balance during the daily living activities. The aim was to compare between the effect of bicycle ergometer versus treadmill on functional walking capacity and balance in children with Duchenne muscular dystrophy.Methods:Thirty boys aged from 6 to 10 years old diagnosed as Duchene muscular dystrophy participated in this study. Children were assigned randomly into two groups (A&B). Children in group (A) underwent a designed program of physical therapy plus aerobic exercise training in form of bicycle ergometer while, group (B) received the same program as group (A) and aerobic exercise training by treadmill for one hour, at three times a week for three successive months. Functional walking capacity and balance were assessed before and after treatment by using the 6-minute walk test and Biodex balance system equipment respectively.Results:The post treatment results revealed significant difference in all measured variables (P<0.05) as compared with its pre-treatment results. Post-treatment values indicated that there was a significant difference in all measured variables in favor of group B.Conclusions:treadmill training as an aerobic exercise can improve walking capacity and balance more effectively than bicycle ergometer in children with Duchenne muscular dystrophy.     

Postural stability in subjects with temporomandibular disorders and healthy controls: A comparative assessment

Purpose of the studyThe influence of the stomatognathic apparatus on body posture is a continuously discussed topic with contrasting results. The aim of this study is to analyze differences in postural stability between subjects with and without myogenous TMD.Methods25 subjects affected by myogenous TMD according with DC/TMD (6 males, 19 females; mean age 31.75 ± 6.68 years) and a healthy control group of 19 subjects (4 Males, 15 Females; mean age 27.26 ± 3.85 years) were enrolled in the study.Both groups underwent a posturo-stabilometric force platform exam under different mandibular and visual conditions. Sway area and sway velocity of the COP (Center Of foot Pressure) posturo-stabilometric parameters were evaluated and compared applying Mann-U-Whitney statistical test.ResultsThe sway area and sway velocity parameters resulted statistically significantly higher in the TMD group (sway area p < 0.01; sway velocity p < 0.05) in mandibular maximum intercuspation and rest positions with eyes open.ConclusionsThis study demonstrates a significant difference in body postural stability between subjects with myogenous TMD and healthy controls. In particular, sway area and sway velocity postural parameters are increased in these subjects.     

Age-related changes of human balance during quiet stance

Certain aspects of balance control change with age, resulting in a slight postural instability. We examined healthy subjects between 20-82 years of age during the quiet stance under static conditions: at stance on a firm surface and/or on a compliant surface with eyes either open or closed. Body sway was evaluated from centre of foot pressure (CoP) positions during a 50 sec interval. The seven CoP parameters were evaluated to assess quiet stance and were analyzed in three age groups: juniors, middle-aged and seniors. The regression analysis showed evident increase of body sway over 60 years of age. We found that CoP parameters were significantly different when comparing juniors and seniors in all static conditions. The most sensitive view on postural steadiness during quiet stance was provided by CoP amplitude and velocity in AP direction and root mean square (RMS) of statokinesigram. New physiological ranges of RMS parameter in each condition for each age group of healthy subjects were determined. Our results showed that CoP data from force platform in quiet stance may indicate small balance impairment due to age. The determined physiological ranges of RMS will be useful for better distinguishing between small postural instability due to aging in contrast to pathological processes in the human postural control.     

Postural sway parameters using a triaxial accelerometer: comparing elderly and young healthy adults

The purpose of this study was to evaluate the sensitivity of 16 parameters derived from acceleration to detect changes caused by age and visual conditions during quiet standing and detect and minimise possible sources of unwanted variability that could affect accelerometer measures on the trunk. Twenty-seven healthy subjects, including 16 elderly (age, 69.3 ± 3.6 years) and 11 young (age, 23.6 ± 2.2 years) subjects, were evaluated. The parameters evaluated include root-mean-square values, fractal dimensions, path length, range, frequency dispersion and power spectrum among others derived from these values. These 16 parameters evaluated for each axis of movement and/or derivations resulted in 59 sub-parameters. These 59 sub-parameters were analysed in the elderly and young groups and under the open-eye and closed-eye conditions. The results showed that 30 sub-parameters detected differences for an age effect with open eyes, 18 detected differences with closed eyes, 25 detected differences for the young group standing with closed-open eyes and 37 detected differences for the elderly with closed and open eyes (p < 0.01). We used simple signal processing for the accelerometry signals to minimise the effects of unwanted variability that could affect the results. The results showed better performance compared with those results published previously using force platforms to evaluate postural sway. The results presented here should be useful for researchers who want to use accelerometry to evaluate steady postural balance.     

平衡功能训练联合肌内效贴对脑卒中偏瘫患者平衡功能、步行功能和生活质量的影响

摘要 目的：观察脑卒中偏瘫患者经肌内效贴联合平衡功能训练治疗后,其步行功能、生活质量及平衡功能的变化。方法：于2018年6月~2020年8月期间,选取我院收治的300例脑卒中偏瘫患者,根据随机数字表法分为对照组（150例,常规康复训练和平衡功能训练）和研究组（150例,常规康复训练、平衡功能训练联合肌内效贴）,均治疗4周。对比两组平衡功能、步行功能、生活质量、睁眼站立、脚前后站立、闭眼站立的重心摆动速度及动态稳定时间。结果：治疗4周后,两组Fugl-Meyer下肢运动功能评定量表（FMA）、Berg平衡量表（BBS）评分较治疗前升高,且研究组高于对照组（P<0.05）。治疗4周后,两组步行功能指标：步频、步长、步速、步幅较治疗前升高,且研究组高于对照组（P<0.05）。治疗4周后,两组SF-36各维度评分较治疗前升高,且研究组高于对照组（P<0.05）。治疗4周后,两组睁眼站立、脚前后站立、闭眼站立的重心摆动速度和动态稳定时间较治疗前降低,且研究组低于对照组（P<0.05）。结论：脑卒中偏瘫患者经肌内效贴联合平衡功能训练治疗后,平衡功能得到较好的恢复,步行能力提高,其生活质量得到改善。     

Impaired Postural Control in Healthy Men at Moderate Altitude (1630 M and 2590 M): Data from a Randomized Trial

ObjectivesIntact postural control is essential for safe performance of mountain sports, operation of machinery at altitude, and for piloting airplanes. We tested whether exposure to hypobaric hypoxia at moderate altitude impairs the static postural control of healthy subjects.MethodsIn 51 healthy men, median age 24 y (quartiles 20;28), static control was evaluated on a balance platform in Zurich, 490 m, and during a 4-day sojourn in Swiss mountain villages at 1630 m and 2590 m, 2 days each. The order of altitude exposure was randomized. Total center of pressure path length (COPL) and sway amplitude measured in two directions by a balance platform, and pulse oximetry were recorded. Data were compared between altitudes.ResultsMedian (quartiles) COPL during standing on both legs with eyes open at 490 m and in the evenings on the first and second days at 1630 and 2590 m, respectively were: 50 (45;57), 55 (48;62), 56 (49;61), 53 (47;59), 54 (48;60) cm, P<0.001 ANOVA. Corresponding arterial oxygen saturation was 97% (96;97), 95% (94;96), 95%(94;96), 92%(90;93), 93%(91;93), P<0.001. Anterior-posterior sway amplitudes were larger at 1630 and 2590 m compared to 490 m, P<0.001. Multiple logistic regression analysis confirmed that higher altitudes (1630 and 2590m) were independently associated with increased COPL when controlled for the order of altitude exposure and age (P=0.001).ConclusionsExposure to 1630 and 2590m was associated with impaired static postural control even when visual references were available.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01130948","term_id":"NCT01130948"}}NCT01130948.     

The effect of a haptic biofeedback system on postural control in patients with stroke: An experimental pilot study

Background: Impaired balance in patients with hemiparesis caused by stroke is frequently related to deficits in the central integration of afferent inputs, and traditional rehabilitation reinforces excessive visual reliance by focusing on visual compensation.

Objective: The present study investigated whether a balance task involving a haptic biofeedback (BF) system, which provided supplementary vibrotactile sensory cues associated with center-of-foot-pressure displacement, improved postural control in patients with stroke.

Methods: Seventeen stroke patients were assigned to two groups: the Vibrotactile BF and Control groups. During the balance task (i.e., standing on a foam mat), participants in the Vibrotactile BF group tried to stabilize their postural sway while wearing the BF system around the pelvic girdle. In the Control group, participants performed an identical postural task without the BF system.

Results: Pre- and post-test measurements of postural control using a force plate revealed that the stability of bipedal posture in the Vibrotactile BF group was markedly improved compared with that in the Control group.

Conclusions: A balance task involving a vibrotactile BF system improved postural stability in patients with stroke immediately. This confirms the potential of a haptic-based BF system for balance training, both in routine clinical practice and in everyday life.     

静态姿势图在飞行任务负荷所致的疲劳评估中的作用

目的:研究静态姿势图在飞行任务负荷所致疲劳评估中的作用。方法:30名符合条件的男性大学生被要求持续进行4小时的模拟飞行任务负荷,其静态姿势图及任务负荷成绩将在每小时末进行重复测量。根据变化敏感的参数,静态立位平衡指数将通过主成分分析法进行计算。随后,该指数与任务负荷水平的相互关系将通过曲线拟合进行分析。结果:在模拟飞行任务负荷影响下,被试静态姿势控制能力明显下降。静态立位平衡指数随着任务负荷时间的持续而明显增大,并与任务负荷时间存在线性关系(R~2=0.949);多重任务成绩与任务负荷持续时间之间存在二次曲线的关系(R~2=0.968),与静态立位平衡指数也呈现相似的二次方曲线关系(R~2=0.976)。结论:静态姿势图与飞行任务负荷水平具有线性关系,能够反映任务负荷所致疲劳水平的大小。     

Is there an association between variables of postural control and strength in adolescents?

Is there an association between variables of postural control and strength in adolescents? The risk of sustaining sport injuries is particularly high in adolescents. Deficits in postural control and muscle strength represent 2 important intrinsic injury risk factors. Therefore, the purpose of this study was to investigate the relationship between variables of static and dynamic postural control and isometric and dynamic muscle strength and to find out whether there is an association between measures of postural control and muscle strength. Twenty-eight adolescents participated in this study (age 16.8 ± 0.6 years; body mass index 20.5 ± 1.8 kg · m(-2)). Biomechanic tests included the measurements of maximal isometric leg extension force (MIF) and rate of force development (RFDmax) of the leg extensors on a leg press with the feet resting on a force platform, vertical jumping force, and height (countermovement jump [CMJ]) on a force plate and the assessment of static (1-legged stance on a balance platform) and dynamic (mediolateral perturbation impulse on a balance platform) postural control. The significance level was set at p < 0.05. No significant associations were observed between measures of static and dynamic postural control. Significant positive correlations were detected between variables of isometric and dynamic muscle strength with r-values ranging from 0.441 to 0.779 (p < 0.05). Based on these models, a 100-N increase in MIF of the leg extensors was associated with 3.9, 4.2, and 6.5% better maximal CMJ force, CMJ height, and RFDmax, respectively. No significant correlations were observed between variables of postural control and muscle strength. The nonsignificant correlation between static/dynamic postural control and muscle strength implies that primarily dynamic measures of postural control should be incorporated in injury risk assessment and that postural control and muscle strength are independent of each other and may have to be trained complementary for lower extremity injury prevention and rehabilitation purposes.