Free Energy Principle in Human Postural Control System: Skin Stretch Feedback Reduces the Entropy

Benefits associated with the standing position during visual search tasks

The literature on postural control highlights that task performance should be worse in challenging dual tasks than in a single task, because the brain has limited attentional resources. Instead, in the context of visual tasks, we assumed that (i) performance in a visual search task should be better when standing than when sitting and (ii) when standing, postural control should be better when searching than performing the control task. 32 and 16 young adults participated in studies 1 and 2, respectively. They performed three visual tasks (searching to locate targets, free-viewing and fixating a stationary cross) displayed in small images (visual angle: 22°) either when standing or when sitting. Task performance, eye, head, upper back, lower back and center of pressure displacements were recorded. In both studies, task performance in searching was as good (and clearly not worse) when standing as when sitting. Sway magnitude was smaller during the search task (vs. other tasks) when standing but not when sitting. Hence, only when standing, postural control was adapted to perform the challenging search task. When exploring images, and especially so in the search task, participants rotated their head instead of their eyes as if they used an eye-centered strategy. Remarkably in Study 2, head rotation was greater when sitting than when standing. Overall, we consider that variability in postural control was not detrimental but instead useful to facilitate visual task performance. When sitting, this variability may be lacking, thus requiring compensatory movements.

Adaptations of postural sway dynamics and cortical response to unstable stance with stroboscopic vision in older adults

Background: Stroboscopic vision (SV), intermittent visual blocking, has recently been incorporated into postural training in rehabilitation. This study investigated interactions of postural fluctuation dynamics and cortical processing for the elderly during stabilometer stance with SV.

Methods: Thirty-five healthy elderly maintained an upright stance on a stabilometer. Along with postural fluctuation dynamics, EEG relative power and EEG-EEG connectivity were used to contrast neuromechanical controls of stabilometer stance with SV and full-vision.

Results: Compared with the full-vision, SV led to greater postural fluctuations with lower sample entropy and mean frequency (MF). SV also reduced regional power in the mid-frontal theta cluster, which was correlated to SV-dependent changes in the size of postural fluctuations. SV also enhanced the alpha band supra-threshold connectivity in the visual dorsal and frontal–occipital loops of the right hemisphere, and the supra-threshold connectivity from Fp2 positively related to variations in the MF of postural fluctuations.

Conclusion: SV adds challenge to postural regulation on the stabilometer, with the increasing regularity of postural movements and fewer corrective attempts to achieve the postural goal. The elderly shift over-reliance on visual inputs for posture control with more non-visual awareness, considering deactivation of the dorsal visual stream and visual error processing.

Wearable Technologies Using Peripheral Neuromodulation to Enhance Mobility and Gait Function in Older Adults - A Narrative Review

BACKGROUND

Mounting evidence suggests that wearable technologies using peripheral neuromodulation can provide novel ways of improving mobility and gait function in various patient populations including older adults. The purpose of this narrative review is to provide an overview of wearable technologies/devices to improve mobility and gait function through noninvasive peripheral neuromodulation in older adults over the age of 65 and to indicate the suggested mechanism of action behind these technologies.

METHODS

We performed searches for articles and conference abstracts written in English, using the following databases: Embase Classic+Embase from 1947 to July 15, 2021; Ovid MEDLINE®; Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions® from 1946 to July 15, 2021; PubMed; and Scopus.

RESULTS

Forty-one technologies met the inclusion/exclusion criteria. We found that the primary implementation of the 41 technologies can be divided into three main categories: sensory substitution, sensory augmentation (open loop, closed loop), and motor stimulation. Using these technologies, various aspects of mobility are treated or addressed, including e.g., gait function, fall risk, foot drop, navigating environment, postural control.

CONCLUSIONS

This narrative review summarizes wearable technologies that are currently commercially available and in stages of research and development. Overall, studies suggest that wearable peripheral neuromodulation technologies can improve aspects of mobility for older adults. Existing literature suggests that these technologies may lead to physiological changes in the brain through sensory re-weighting or other neuroplastic mechanisms to enhance the performance of mobility and gait function in older adults over the age of 65.

Age-Related Changes in Standing Balance in Preschoolers Using Traditional and Nonlinear Methods

Considerable disagreement exists on the linearity of the development of standing balance in children. This study aimed to use different traditional and nonlinear methods to investigate age-related changes in standing balance in preschoolers. A sample of 118 preschoolers took part in this study. A force platform was used to record the center of pressure during standing balance over 15 s in three conditions: eyes open, eyes closed, and/or head extended backward. Detrended fluctuation analysis (DFA), recurrence quantification analysis (RQA), and traditional measures were used to evaluate standing balance. The main results are as follows: (1) Higher range and SD in the anterior-posterior (AP) direction were observed for 5-year-old than for 4-year-old children, while higher DFA coefficient (at shorter time scales) and higher determinism and laminarity in the AP direction were found for 5-year-old children compared to 3- and 4-year-old children; and (2) as sensory conditions became more challenging, all traditional measures increased and DFA coefficients (at shorter and longer time scales) decreased in the AP and mediolateral directions, while determinism and laminarity significantly declined in the AP direction. In conclusion, although increased postural sway, 5-year-old preschool children's balance performance improved, and their control strategy changed significantly compared with the younger preschoolers. Sensory perturbation (eye closure and/or head extension) changed preschoolers' balance performance and control strategy. Moreover, both traditional and nonlinear methods provided complementary information on the control of standing balance in preschoolers.

Review of the Upright Balance Assessment Based on the Force Plate

Quantitative assessment is crucial for the evaluation of human postural balance. The force plate system is the key quantitative balance assessment method. The purpose of this study is to review the important concepts in balance assessment and analyze the experimental conditions, parameter variables, and application scope based on force plate technology. As there is a wide range of balance assessment tests and a variety of commercial force plate systems to choose from, there is room for further improvement of the test details and evaluation variables of the balance assessment. The recommendations presented in this article are the foundation and key part of the postural balance assessment; these recommendations focus on the type of force plate, the subject's foot posture, and the choice of assessment variables, which further enriches the content of posturography. In order to promote a more reasonable balance assessment method based on force plates, further methodological research and a stronger consensus are still needed.

Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic

The COVID-19 pandemic has highlighted the need for advancing the development and implementation of novel means for home-based telerehabilitation in order to enable remote assessment and training for individuals with disabling conditions in need of therapy. While somatosensory input is essential for motor function, to date, most telerehabilitation therapies and technologies focus on assessing and training motor impairments, while the somatosensorial aspect is largely neglected. The integration of tactile devices into home-based rehabilitation practice has the potential to enhance the recovery of sensorimotor impairments and to promote functional gains through practice in an enriched environment with augmented tactile feedback and haptic interactions. In the current review, we outline the clinical approaches for stimulating somatosensation in home-based telerehabilitation and review the existing technologies for conveying mechanical tactile feedback (i.e., vibration, stretch, pressure, and mid-air stimulations). We focus on tactile feedback technologies that can be integrated into home-based practice due to their relatively low cost, compact size, and lightweight. The advantages and opportunities, as well as the long-term challenges and gaps with regards to implementing these technologies into home-based telerehabilitation, are discussed.

Equimetrix Device: Criteria Based Validation and Reliability Analysis of the Center of Mass and Base of Support of a Human Postural Assessment System

Human postural control is a fundamental ability for static and dynamic tasks, especially in hiper- and hipo-functional populations, such as the elderly. The Equimetrix is a clinical device developed to assess both the base of support (BoS) and the center of mass (CoM) dynamics, thus allowing their use as new evaluation and training tools. This study aims to perform a criteria based validation of Equimetrix by comparing the BoS and CoM data with gold-standard equipment. A motion capture system, force platform, and pressure mat were used to calculate the CoM, center of pressure (CoP) and BoS during bipedal, unipedal, feet together and full tandem stances. Results demonstrate an excellent reliability of Equimetrix in terms of spatial accuracy of the CoM, although over-estimating the CoM height. Differences were found when comparing Mean velocity Path with the CoM, but not with the CoP, indicating a lower reliability in time-based parameters. The Equimetrix presents a tendency to overestimate the BoS, with mixed reliability values, which may be related to the different size of sensing elements between the Equimetrix and the pressure sensing mat. These are encouraging results that should be further explored during dynamic tasks.