The effects of early stages of aging on postural sway: A multiple domain balance assessment using a force platform

Technical advancements in instrumentation and analytical methods have improved the ability of assessing balance control. This study investigated the effects of early stages of aging on postural sway using traditional and contemporary postural indices from different domains. Eleven healthy young adults and fourteen healthy non-faller older adults performed two postural tasks: (a) functional limits of stability and (b) unperturbed bipedal stance for 120 s. Postural indices from spatial, temporal, frequency, and structural domains were extracted from the body’s center of pressure (COP) signals and its Rambling and Trembling components. Results revealed a preservation of functional limits of upright stability in older adults accompanied by larger, faster, and shakier body sway in both anterior-posterior and medio-lateral directions; increased medio-lateral sway frequency; increased irregularity of body sway pattern in time in both directions; and increased area, variability, velocity, and jerkiness of both rambling and trembling components of the COP displacement in the anterior-posterior direction (p < 0.02). Such changes might be interpreted as compensatory adjustments to the age-related decline of sensory, neural, and motor functions. In conclusion, balance assessment using postural indices from different domains extracted from the COP displacement was able to capture subtle effects of the natural process of aging on the mechanisms of postural control. Our findings suggest the use of such indices as potential markers for postural instability and fall risk in older adults.     

Validating a low-cost,consumer force-measuring platform as an accessible alternative for measuring postural sway

The Zibrio SmartScale is a low-cost, portable force platform designed to perform an objective assessment of postural stability. The purpose of the present study was to validate the center of pressure (COP) measurements in the Zibrio SmartScale. Simultaneous COP data was collected by a Zibrio SmartScale and a laboratory-grade force platform (LFP) under the dynamic motion of an inverted pendulum device intended to mimic the sway of a standing human. The inverted pendulum was placed on the Zibrio SmartScale which was placed on the LFP. The pendulum was then displaced to angles of 3° and 5° in both the anterior-posterior (AP) and medial–lateral (ML) directions. The findings of this study show low mean average error (MAE) among the measures taken simultaneously upon the LFP and Zibrio SmartScale with no appreciable difference in error in either AP or ML COP directions. Averaged over repeated trials, the MAE did not surpass 0.5 mm. This represented 0.4% of the total range (±50 to 60 mm in 5° displacement trials) of simulated COP. The results of this study strongly indicate that the Zibrio SmartScale can perform adequately as a light-weight and low-cost alternative method of COP measurement in comparison to a traditional LFP.     

Early postural adjustments in preparation to whole-body voluntary sway

We studied postural adjustments associated with a quick voluntary postural sway under two conditions, self-paced and simple reaction-time. Standing subjects were required to produce quick discrete shifts of the center of pressure (COP) forward. About 400-500 ms prior to the instructed COP shift, there were deviations of the COP in the opposite direction (backwards) accompanied by changes in the activation levels of several postural muscles. Under the reaction-time conditions, the timing of those early postural adjustments did not change (repeated measures MANOVA: p > 0.05) while its magnitude increased significantly (confirmed by repeated measures MANOVA: p < 0.05). These observations are opposite to those reported for anticipatory postural adjustments under simple reaction time conditions (a significant change in the timing without major changes in the magnitude). We conclude that there are two types of feed-forward postural adjustments. Early postural adjustments prepare the body for the planned action and/or expected perturbation. Some of these preparatory actions may be mechanically necessary. Later, anticipatory postural adjustments generate net forces and moments of force acting against those associated with the expected perturbation. Both types of adjustments fit well the referent configuration hypothesis, which offers a unified view on movement-posture control.     

Magnifying the Scale of Visual Biofeedback Improves Posture

Biofeedback has been shown to minimize body sway during quiet standing. However, limited research has reported the optimal sensitivity parameters of visual biofeedback related to the center of pressure (COP) sway. Accordingly, 19 young adults (6 males; 13 females; aged 21.3 ± 2.5) stood with feet together and performed three visual biofeedback intensities [unmodified biofeedback (UMBF), BF magnified by 5 (BF5), BF magnified by 10 (BF10)], along with control trials with no biofeedback (NBF). The participants were instructed to stand as still as possible while minimizing the movements of the visual target. The findings revealed that UMBF produced significantly greater COP displacement in both the anterior–posterior (AP) and medial–lateral directions, as well as greater standard deviation of the COP in the AP direction (p < 0.05). Additionally, NBF showed significantly greater 95 % area ellipse than the UMBF, BF5, and BF10 intensities (p < 0.001). Therefore, the most sensitive COP scales generated the least amount of postural sway. However, there were no significant differences on any of the COP measures between BF5 and BF10. This research provides insight with respect to the proper scale on which biofeedback should be given in order to improve postural control (i.e., BF5 or BF10).     

Postural stability in young healthy subjects – Impact of reduced base of support,visual deprivation,dual tasking

ObjectiveTo provide normative postural stability data in young subjects.MethodsNinety-six healthy participants (58 W, 28 ± 6y) stood on a force plate during 60 s. We measured effects of support width (feet apart, FA; feet together, FT), vision (eyes open, EO; closed, EC), and cognitive load (single task, ST; dual tasking, DT) on anteroposterior (AP) and medio-lateral (ML) ranges, area and planar velocity of center of pressure (COP) trajectory.ResultsAll variables increased with FT (AP range, +15%; ML, +185%; area, +242%; velocity, +50%, p < 0.0002 for all, MANOVA). Visual deprivation increased COP ranges with added constraints (FT or DT, p = 0.002) and increased velocity in all conditions (FA/ST, +16%; DT, +18%; FT/ST, +29%; DT, +23%, p < 0.0002 for all). Dual tasking reduced COP displacements with FT (AP range, EO, −15%; EC, −11%; ML range, EO, −19%; EC, −13%; area, EO, −40%; EC, −28%, p < 0.0002 for all) and increased velocity in most conditions (FA/EO, +15%; FA/EC, +16%; FT/EO, +7%, p < 0.0002 for all).ConclusionIn young healthy adults, base of support reduction increases COP displacements. Vision particularly affects postural stability with feet together or dual tasking. Dual tasking increases velocity but decreases COP displacements in challenging postural tasks, potentially by enhanced lower limb stiffness.     

Postural impairments in Parkinson’s disease are not associated with changes in circadian rhythms changes

ABSTRACT

Parkinson’s disease (PD) is a progressive neurodegenerative disease, with a worldwide incidence of 1% in individuals >60 years of age. Its primary characteristics include postural impairments and changes in circadian rhythms. The authors investigated the association between postural impairment and changes in circadian rhythms in 24 PD subjects diagnosed with stages 1 to 3 on the Hoehn-Yard (HY) scale and regularly used dopaminergic medication for at least 1 year (experimental group – EG) and 24 healthy elderly individuals without a history of neurological impairment as the control group (CG). Static balance tests using a force plate were performed, and activity/rest rhythm, according to the relative amplitude of L5 and M10 values, was monitored for seven consecutive days using actimetry. The results indicated differences in posturographic indicators of mediolateral displacement (ML) [EG, 4.71 ± 0.85 mm; CG, 2.79 ± 0.53 mm (p < .0001)] and anteroposterior displacement of the center of pressure (COP) [EG, 5.61 ± 2.43 mm; CG, 8.23 ± 1.72 mm (< 0.0001)], ML velocity of the COP [EG, 2.39 ± 0.83 mm/s; CG, 1.40 ± 0.18 mm/s (p < .0001)], and total distance of the COP in the tandem stance condition [EG, 227.6 ± 75 mm; CG, 53.4 ± 6.1 mm (p < .0001)] between the EG and CG. There was no correlation between relative amplitude and posturographic data for the EG. Postural impairments were verified in comparing the EG and CG; however, there was no association between posturographic indicators and activity/rest rhythm.     

The influence of adipose tissue location on postural control

A growing body of evidence suggests, that excessive body weight is inseparably connected with postural instability. In none of previous studies, body weight distribution has been considered as a factor, which may affect results of a static posturography. The purpose of the present study is to quantify some center of foot pressure (COP) characteristics in 40 obese women with android type of obesity (waist-to-hip ratio - WHR ≥ 0.85, BMI: 37.5 ± 5.4) and 40 obese women with gynoid type of obesity (WHR < 0.85, BMI: 36.9 ± 5.1). Variables of postural sway were acquired while subjects were standing quietly on a force plate with eyes open and closed. Both in the sagittal and frontal plane sway range, average velocity, and maximal velocity of COP were calculated. Moreover, the total average velocity and total maximal velocity of the COP displacement were computed.Women with abdominal obesity showed a larger sway range in the anterior-posterior plane with eyes open (p < 0.0282) and eyes closed conditions (p < 0.0115) and a greater maximal COP velocity to compare with subjects with gynoidal obese type (p < 0.0112) with eyes closed condition.The postural stability in obese women from the biomechanical point of view is strongly dependent on body distribution. Women with the abdominal obesity type may be exposed to a greater risk of postural instability as compare to women with gynoid fat distribution.     

A point of application study to determine the accuracy,precision and reliability of a low-cost balance plate for center of pressure measurement

Changes in postural sway measured via force plate center of pressure have been associated with many aspects of human motor ability. A previous study validated the accuracy and precision of a relatively new, low-cost and portable force plate called the Balance Tracking System (BTrackS). This work compared a laboratory-grade force plate versus BTrackS during human-like dynamic sway conditions generated by an inverted pendulum device. The present study sought to extend previous validation attempts for BTrackS using a more traditional point of application (POA) approach. Computer numerical control (CNC) guided application of ∼155 N of force was applied five times to each of 21 points on five different BTrackS Balance Plate (BBP) devices with a hex-nose plunger. Results showed excellent agreement (ICC > 0.999) between the POAs and measured COP by the BBP devices, as well as high accuracy (<1% average percent error) and precision (<0.1 cm average standard deviation of residuals). The ICC between BBP devices was exceptionally high (ICC > 0.999) providing evidence of almost perfect inter-device reliability. Taken together, these results provide an important, static corollary to the previously obtained dynamic COP results from inverted pendulum testing of the BBP.     

Synergistic co-activation in multi-directional postural control in humans

To examine the muscle synergies of multi-directional postural control, we calculated the target-directed variance fraction (η) and net action direction of each muscle using the electromyogram-weighted averaging (EWA) method. Subjects stood barefoot on a force platform and maintained their posture by producing a center of pressure (COP) in twelve target directions. Surface electromyograms were recorded from 6 right-sided muscles: tibialis anterior (TA), soleus (SOL), lateral gastrocnemius (LG), medial gastrocnemius (MG), fibularis longus (FL), and gluteus medius (GM). η was calculated from COP with duration of 20-s, during which the COP was relatively constant. The EWA method was applied to the EMG and the two COP components to estimate the net action direction of each muscle. The results showed that η values in all directions did not cross the 0.8 threshold. This suggests that human postural control is achieved by synergistic co-activation. The EWA revealed that the net action directions of TA, SOL, LG, MG, and GM were 277.6°, 71.1°, 87.7°, 94.0°, and 2.2°, respectively. This suggests that postural maintenance by muscle synergy can be attributed to the relevant muscles having various action directions. These results demonstrate that muscle synergies can be investigated using COP fluctuations.     

Altered neuromuscular activity and postural stability during standing balance tasks in persons with non-specific neck pain

ObjectivesTo compare neck, trunk, and lower extremity muscle activity in standing in persons with neck pain (NP) to healthy controls and determine associations with postural sway.MethodsParticipants included 25 persons with NP and 25 controls. Surface electromyography was recorded bilaterally from neck (sternocleidomastoid, SCM; splenius capitis, SC; upper trapezius, UT), trunk (erector spinae, ES), and lower extremity (rectus femoris, RF; biceps femoris, BF; tibialis anterior, TA; medial gastrocnemius, GN) muscles. Postural sway was measured using a force platform in narrow stance with eyes open/closed, on firm/soft surfaces.ResultsCompared to controls, the NP group demonstrated higher activity in all muscles, except UT and had higher amplitude ratios for neck muscles (SCM, SC) for all tasks (p < .05). No between-group difference was found in amplitude ratios for lower extremity muscles, except for GN. Lower extremity activity was moderately correlated with larger postural sway for both groups (r = 0.41–0.66, p < .05). There were no correlations between sway and neck and trunk muscle activity (p > .05).ConclusionIncreased muscle activity with NP is associated with increased postural sway. Both groups used similar postural control strategies, but the increased neck activity in the NP group is likely related to the NP disorder rather than postural instability.     

Reactive Balance Control in Response to Perturbation in Unilateral Stance: Interaction Effects of Direction,Displacement and Velocity on Compensatory Neuromuscular and Kinematic Responses

Unexpected sudden perturbations challenge postural equilibrium and require reactive compensation. This study aimed to assess interaction effects of the direction, displacement and velocity of perturbations on electromyographic (EMG) activity, centre of pressure (COP) displacement and joint kinematics to detect neuromuscular characteristics (phasic and segmental) and kinematic strategies of compensatory reactions in an unilateral balance paradigm. In 20 subjects, COP displacement and velocity, ankle, knee and hip joint excursions and EMG during short (SLR), medium (MLR) and long latency response (LLR) of four shank and five thigh muscles were analysed during random surface translations varying in direction (anterior-posterior (sagittal plane), medial-lateral (frontal plane)), displacement (2 vs. 3cm) and velocity (0.11 vs. 0.18m/s) of perturbation when balancing on one leg on a movable platform. Phases: SLR and MLR were scaled to increased velocity (P<0.05); LLR was scaled to increased displacement (P<0.05). Segments: phasic interrelationships were accompanied by segmental distinctions: distal muscles were used for fast compensation in SLR (P<0.05) and proximal muscles to stabilise in LLR (P<0.05). Kinematics: ankle joints compensated for both increasing displacement and velocity in all directions (P<0.05), whereas knee joint deflections were particularly sensitive to increasing displacement in the sagittal (P<0.05) and hip joint deflections to increasing velocity in the frontal plane (P<0.05). COP measures increased with increasing perturbation velocity and displacement (P<0.05). Interaction effects indicate that compensatory responses are based on complex processes, including different postural strategies characterised by phasic and segmental specifications, precisely adjusted to the type of balance disturbance. To regain balance after surface translation, muscles of the distal segment govern the quick regain of equilibrium; the muscles of the proximal limb serve as delayed stabilisers after a balance disturbance. Further, a kinematic distinction regarding the compensation for balance disturbance indicated different plane- and segment-specific sensitivities with respect to the determinants displacement and velocity.     

Effects of coupled upper limbs movements on postural stabilisation

The preference for in-phase association of coupled cyclic limbs movements is well described (mirror-symmetrical patterns) and this is demonstrated by the ease of performing in-phase movements compared to anti-phase ones. The hypothesis of this study is that the easiest movement patterns are those with minor postural activity. The aim of this study was to describe postural activity in standing subjects in the sagittal and frontal planes during the execution of three upper limbs tasks (single arm, in-phase, anti-phase) at four different frequencies (from 0.6 to 1.2 Hz).We employed six infrared cameras for recording kinematics information, a force platform for measuring forces exerted on the ground, and a system for surface electromyography (SEMG). Outcome measures were: upper limb range of movement and relative-phase, centre of pressure displacement (COP), screw torque (T_z) exerted on the ground, and SEMG recordings of postural muscles (adductor longus, gluteus medius, rectus femoris, and biceps femoris).Our results show that in both the planes the in-phase task resulted in less COP displacement, torque production, and postural muscles involvement than the anti-phase and single arm tasks. This reduced need of postural control could explain the ease of performing in-phase coupled limb movements compared with anti-phase movements.     

Effects of repeated ankle plantar-flexions on H-reflex and body sway during standing

The study investigated relations between effects of repeated ankle plantar-flexion movements exercise on the soleus Hoffmann (H) reflex and on postural body sway when maintaining upright stance. Ten young volunteers performed five sets of ankle plantar-flexions of both lower limbs. Assessment of the feet centre-of-pressure (COP) displacement and H-reflex tests were carried out in quiet stance before, during and after the exercise. H-max and M-max responses were obtained in 8 subjects and reported as the peak-to-peak amplitudes of the right soleus muscle electromyographic waves. Mean dispersion of COP along the antero-posterior direction increased significantly during the exercise; whilst the overall H-reflex response indicated a reduction without a concomitant modification in the M-max response. H-reflex responses, however, varied between participants during the first sets of exercise, showing two main trends of modulation: either depression or early facilitation followed by reduction of the H-reflex amplitude. The extent of reflex modulation in standing position was correlated to the concentric work performed during the exercise (r = 0.85; p < 0.01), but not to the antero-posterior COP dispersion. These results suggest that during a repeated ankle plantar-flexions exercise, modulation of the H-reflex measured in upright stance differs across individuals and is not related to changes of postural sway.     

Unique neuromuscular activation of the rectus femoris during concentric and eccentric cycling

This study investigated neuromuscular activations of thigh muscles during concentric cycling (CON_cycling) and eccentric cycling (ECC_cycling). Eleven untrained men completed 30 s of CON_cycling and ECC_cycling each at 5 power outputs of 100–300 W (every 50-W interval). During cycling, root mean square of surface electromyographic signals (RMS-EMG) were obtained from the proximal and distal regions of the rectus femoris (RFp and RFd), vastus lateralis (VL), and biceps femoris (BF). The rating of perceived exertion (RPE) was evaluated using the 6–20 Borg Scale. The RMS-EMG of VL and BF were 21.6%–67.6% higher (P < 0.05) during CON_cycling than ECC_cycling at all power outputs, while those of RFp and RFd at 100–200 W were 29.6%–40.4% lower during CON_cycling than ECC_cycling. The RPE was similar between CON_cycling at 150 W (10 ± 2) and ECC at 250 W (10 ± 2). There were no significant differences in the RMS-EMG for VL or BF between CON_cycling at 150 W and ECC_cycling at 250 W; however, the RF RMS-EMG was greater during ECC_cycling as compared with CON_cycling. There were no regional differences in RF activations. These results demonstrated the unique neuromuscular activation of RF as compared to those of other thigh muscles during CON_cycling and ECC_cycling.     

Visual and somatosensory contributions to infant sitting postural control

Abstract

There are a limited number of studies that have investigated sitting posture during infancy and the contribution of the sensory systems. The goal of this study was to examine the effects of altered visual and somatosensory signals on infant sitting postural control. Thirteen infants (mean age?±?SD, 259.69?±?16.88?days) participated in the study. Initially, a single physical therapist performed the Peabody Developmental Motor Scale to determine typical motor development. Then the child was placed onto a force platform under four randomized conditions: (a) Control (C) – sat independently on the force plate, (b) Somatosensory (SS) – Sat independently on a foam pad (low density), (c) Visual (VS) – sat independently on the force plate while the lights were turned off creating dim lighting, and (d) Combination of b and c (NVSS). Center of pressure (COP) data from both the anterior-posterior (AP) and the medial-lateral (ML) directions were acquired through the Vicon software at 240?Hz. The lights off conditions, both VS and NVSS, lead to increased Root Mean Square (RMS) and Range values in the AP direction, as well as increased Lyapunov Exponent (LyE) values in the ML direction. Altered visual information lead to greater disturbances of sitting postural control in typically developing infants than altered somatosensory information. The lights off conditions (VS and NVSS), unveiled different control mechanisms for AP and ML direction during sitting. Thus, the present findings confirm the dominance of vision during the early acquisition of a new postural accomplishment.     

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.     

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.     

Transfemoral amputee’s limit of stability and sway analysis during weight shifting exercise with a vibrotactile feedback system

Amputation in the transfemoral amputee (TFA) results in loss of sensory feedback of the amputated limb and therefore results in the poor postural stability. To assess the postural stability, the limit of stability (LOS) is a reliable parameter. In this study, we have investigated the effect of vibrotactile feedback (VF) on the LOS during the weight shifting exercise (WSE) for a TFA. The data of centre of pressure (COP) during WSE was collected from five TFA and five healthy individuals using a zebris force plate. The VF was provided on the amputated/healthy limb’s anterior and posterior part of the stump/thigh during forward and backward WSE, respectively. A customized foot insole with 24 embedded dielectric sensors was used to drive the vibratory motor. The effect of VF was analyzed by pre and post-test. Results show that with the use of VF, TFA significantly improved (t-test, p?<?.05) the sound limb’s LOS during forward WSE. Also, ANOVA analysis between WSE divisions shows that the prosthetic limb does not follow the path of WSE. We further examine the spectral power using the Welch method to determine the dominant sway frequency of COP. It shows a decreased frequency between 0.5–2?Hz in the healthy and decreased frequency between 0–0.5?Hz and >2?Hz in the amputee with VF. It concluded that VF could improve the LOS of TFA during WSE which ultimately leads to postural stability enhancement.