One-legged stance sway of older adults with and without falls

Assessing postural stability in flatfoot using a time-in-boundary method during single-leg standing

Flatfoot, a foot deformity characterized by the collapse of the arch, significantly impacts an individual's balance and stability. This study explored postural adjustments and sway excursions in individuals with and without flatfoot using the Time-in-Boundary method. This method assessed relative stability by exploring various center of pressure radius thresholds during three trials of single-leg stance. We observed significant interactions in threshold levels (F = 4.37, p = 0.04) and normalized relative stable times (F = 7.64, p = 0.01), particularly in the initial trials. Initially, the flatfoot group showed marked decreases in stable times at 10 mm, 15 mm, and 20 mm thresholds, which expanded to 25 mm and 30 mm in subsequent trials. Despite a significant decrease in stability at the 30 mm threshold in early trials, participants exhibited improved stability control as trials progressed. This enhancement likely reflects a combination of a learning effect and an increased understanding of the task requirements, underscoring the adaptability of postural control systems to the biomechanical challenges posed by flatfoot. The Time-in-Boundary method has proven to be an effective tool for clinicians to assess postural control, playing a vital role in developing customized rehabilitation strategies for individuals with flatfoot.

Effect of Cawthorne and Cooksey exercise on balance control and fall risk among middle-aged population: A single group pre-post experimental study

BACKGROUND

Balance impairment is one of the causes of the risk of falls among all age groups and is a continuing threat to morbidity and mortality across the world. Previous studies stated that the vestibular system is affected in middle-aged population, which leads to imbalance and a high risk of falls. There is a lack of research in this account so this study has been done to find the effect of Cawthorne and Cooksey exercise in vestibular rehabilitation on balance control and the risk of falls among middle-age population.

MATERIALS AND METHODS

According to the criteria of selection 30 subjects were recruited for this study. Baseline demographic measurements were recorded. Timed up and go (TUG) test time, Sway analysis using a force plate, and Morse fall scale measures were used as outcomes. Cawthorne and Cooksey exercise was given for 8 weeks 3 sessions per week. Pre and post-intervention outcome measures with 3-month follow-up were recorded for data analysis.

RESULTS

The mean age of participants was 49.55 ± 5.67 years. The paired sample t-test showed mean values of TUG 1.86 ± 1.03, COPx 1.17 ± 1.50, COPy 1.78 ± 1.78, MFS 8.75 ± 12.23 with P value of 0.00 (P < 0.05) for all measures. The repeated measures ANOVA showed 3-month follow-up results for TUG P ≤ 0.00, COPx P ≤ 0.01, COPy P ≤ 0.00, and MFS P ≤ 0.00.

CONCLUSION

There is a statistically significant effect of Cawthorne and Cooksey exercise on balance control and fall risk among middle-aged population of 40-60 years.

Standing balance test for fall prediction in older adults: a 6-month longitudinal study

BACKGROUND

A core component of older adult health care assessment includes identifying fall risk, which also includes identifying those with subtle balance deficits.

OBJECTIVE

To compare body displacement of the Center of Pressure (CoP) and time held during the balance test. Also, to examine whether balance tests at baseline can predict falls after 6 months.

METHODS

A longitudinal study with 153 community-dwelling older adults, between 60-89 years old. Anteroposterior (AP) and mediolateral (ML) amplitude and velocity CoP displacements were assessed in four upright positions using a force platform: double-leg, semi-tandem, tandem, and single-leg stances, with a maximum duration of 30 s each. Adjusted repeated measures ANOVA were used to compare the differences among the balance positions. Comparisons between males and females were also conducted. Logistic regression adjusted for confounders was performed to verify whether upright balance tests can predict future falls.

RESULTS

As the base of support narrows, body sway increases. A decrease in stance time was observed across the balance stages, i.e., double-leg/semi-tandem versus tandem versus single-leg stances. The mean duration held in the single-leg stance was 14.8 s and for tandem was 22.2 s. Similar stance durations were observed for double-leg and semi-tandem stances. Males were able to maintain balance positions longer than females even with greater CoP displacement. ML amplitude of CoP displacement and the time held during tandem and single-leg positions were able to predict falls after 6 months (p < 0.05).

CONCLUSION

In clinical practice in which only stance time is recorded, it is possible to interchangeably use the double-leg or semi-tandem stance. To identify early signs of imbalance, we suggest setting a time limit for the balance test equal to or greater than 23 s, as 10 s appear to be insufficient to detect subtle balance deficits. The time maintenance on tandem and single-leg positions was able to predict future falls.

Use of the Brief-BESTest partially instrumented with accelerometry to detect balance deterioration in middle-age

BACKGROUND

Most standardized balance tests cannot detect subtle balance deterioration in middle age, or identify those at higher risk for accelerated balance decline due to a ceiling effect.

AIMS

To determine whether the Brief Balance Evaluation Systems Test (Brief-BESTest), partially instrumented with accelerometry, can detect balance deterioration in middle age and identify individuals with poor balance.

METHODS

We studied young (25.3 ± 2.3 years), early middle-aged (47.7 ± 2.6 years), and late middle-aged adults (60.6 ± 3.6 years), with 25 participants in each age group. Subjects wore an accelerometer on their lower back while performing the Brief-BESTest. Balance measurements included the Brief-BESTest total and sub-measures scores, and postural sway during the Brief-BESTest standing tasks, calculated by the 95% confidence ellipse trajectory of the center of mass (COM-95% ellipse).

RESULTS

Compared to the two middle-aged groups, young adults had better total Brief-BESTest and sub-measures scores, apart from the Stability-in-Gait sub-measure, and less postural sway during the Sensory-Orientation sub-measure. The total Brief-BESTest scores as well as the Biomechanical-Constraints and Sensory-Orientation sub-measures differed also between early and late middle-aged adults. Both the Brief-BESTest total scores and the Sensory-Orientation postural sway values demonstrated increased variation with age, allowing to identify subjects with poor balance. A moderate negative correlation (r = -0.43) was found between the Brief-BESTest total score and the COM-95% ellipse size, and a moderate agreement (k = 0.56) in identifying subjects with poor performance in the early but not the late middle age group.

CONCLUSIONS

The Brief-BESTest test combined with accelerometry could be a suitable screening tool to identify middle-aged people with early balance deterioration and potentially identify those with poor balance and a possible higher risk for falls. Clinicians and policymakers can use our findings to implement balance assessment programs in patients < 65 years, leading to preventive strategies before the risk increases.

Optimizing Fall Risk Diagnosis in Older Adults Using a Bayesian Classifier and Simulated Annealing

The aim of this study was to improve the diagnostic ability of fall risk classifiers using a Bayesian approach and the Simulated Annealing (SA) algorithm. A total of 47 features from 181 records (40 Center of Pressure (CoP) indices and 7 patient descriptive variables) were analyzed. The wrapper method of feature selection using the SA algorithm was applied to optimize the cost function based on the difference of the mean minus the standard deviation of the Area Under the Curve (AUC) of the fall risk classifiers across multiple dimensions. A stratified 60-20-20% hold-out method was used for train, test, and validation sets, respectively. The results showed that although the highest performance was observed with 31 features (0.815 ± 0.110), lower variability and higher explainability were achieved with only 15 features (0.780 ± 0.055). These findings suggest that the SA algorithm is a valuable tool for feature selection for acceptable fall risk diagnosis. This method offers an alternative or complementary resource in situations where clinical tools are difficult to apply.

Process of dynamic balance recovery after voluntary perturbation: a time-series data analysis of young and older adults

[Purpose] This study investigated differences in the convergence mode of post-step sway between young and older adults using a step-down task to identify fall causes in older adults and assess consecutive postural adjustments. [Participants and Methods] This study included 15 young and 15 older adults (nine females and six males in each group). The participants stepped down from a standing position to a force platform 10 cm lower and maintained a one-leg standing position. The center-of-pressure total trajectory length was assessed using a force plate and regression equations for time and sway were derived from the associated time-series data for both groups. [Results] An inversely proportional aspect was observed for both groups, with significantly different coefficients and constants. The center-of-pressure total trajectory length per second from foot contact was significantly different between 2-3 s and 4-5 s in the older group but not in the younger group. [Conclusion] The results suggest a difference in the convergence mode of dynamic balance between the two groups, with young adults exhibiting a more rapid balance-sway reduction than older adults. The novel computational approach used in this study may be useful for dynamic balance measurements.

A novel score for predicting falls in community-dwelling older people: a derivation and validation study

BACKGROUND

Early detection of patients at risk of falling is crucial. This study was designed to develop and internally validate a novel risk score to classify patients at risk of falls.

METHODS

A total of 334 older people from a fall clinic in a medical center were selected. Least absolute shrinkage and selection operator (LASSO) regression was used to minimize the potential concatenation of variables measured from the same patient and the overfitting of variables. A logistic regression model for 1-year fall prediction was developed for the entire dataset using newly identified relevant variables. Model performance was evaluated using the bootstrap method, which included measures of overall predictive performance, discrimination, and calibration. To streamline the assessment process, a scoring system for predicting 1-year fall risk was created.

RESULTS

We developed a new model for predicting 1-year falls, which included the FRQ-Q1, FRQ-Q3, and single-leg standing time (left foot). After internal validation, the model showed good discrimination (C statistic, 0.803 [95% CI 0.749-0.857]) and overall accuracy (Brier score, 0.146). Compared to another model that used the total FRQ score instead, the new model showed better continuous net reclassification improvement (NRI) [0.468 (0.314-0.622), P < 0.01], categorical NRI [0.507 (0.291-0.724), P < 0.01; cutoff: 0.200-0.800], and integrated discrimination [0.205 (0.147-0.262), P < 0.01]. The variables in the new model were subsequently incorporated into a risk score. The discriminatory ability of the scoring system was similar (C statistic, 0.809; 95% CI, 0.756-0.861; optimism-corrected C statistic, 0.808) to that of the logistic regression model at internal bootstrap validation.

CONCLUSIONS

This study resulted in the development and internal verification of a scoring system to classify 334 patients at risk for falls. The newly developed score demonstrated greater accuracy in predicting falls in elderly people than did the Timed Up and Go test and the 30-Second Chair Sit-Stand test. Additionally, the scale demonstrated superior clinical validity for identifying fall risk.

Graceful gait: virtual ballet classes improve mobility and reduce falls more than wellness classes for older women

Introduction

Dance is an effective and motivating form of exercise for older women, but few studies have quantified the benefits of virtual dance classes nor, specifically, ballet. This study tested the effectiveness of virtual ballet compared to virtual wellness classes, with the goal of reaching underserved populations. It is among the first to explore the effects of virtual classical ballet on functional gait mobility, balance, and quality of life measures in older women.

Methods

Older women were recruited in two waves and randomized to two groups: a ballet class modified for older adults and a wellness-based control class. Both groups received 12 weeks of online classes, meeting twice per week for 45-min sessions. Classes were taught by a local company that offers community-based ballet classes. The same instructor led both the ballet and the wellness classes. Pre- and post-intervention assessments include gait and balance testing using wearable inertial sensors and self-report outcomes including quality of life and mood questionnaires.

Results

Forty-four older women completed the study: Ballet group (n = 21, 67.81 ± 7.3 years); Wellness group (n = 23, 69.96 ± 6.7 years). Pre- to post-intervention, both groups increased velocity on the two-minute walk test (F1,42 = 25.36, p < 0.001) and improved their time on the Timed Up and Go (F1,42 = 4.744, p = 0.035). Both groups improved balance on the Mini-BESTest (F1,42 = 38.154, p < 0.001), increased their scores on the Activities-Specific Balance Confidence Scale (F1,42 = 10.688, p < 0.001), and increased quality of life via the Short Form Health Survey (F1,42 = 7.663, p = 0.008). The ballet group improved gait variability in the backward direction (F1,42 = 14.577, p < 0.001) and reduced fall rates more than the wellness group [χ2(1) = 5.096, p = 0.024].

Discussion

Both virtual ballet and wellness classes improve select measures of gait, balance, and quality of life. The benefits seen in both groups highlight the importance of considering social interaction as a key component when developing future interventions to target mobility in older women.

A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women

Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.

Association between Objective and Subjective Sleep Parameters with Postural Control Responses among Brazilian Schoolteachers

Objective  To investigate the impact of sleep quality on postural control in teachers. Methods  Cross-sectional study with 41 schoolteachers (mean age 45.7 ± 10.4 years). Sleep quality was assessed in two ways: objectively (through actigraphy), and subjectively (through the Pittsburgh Sleep Quality Index). Postural control was assessed in an upright posture during 3 trials of 30s (bipedal and semitandem stances in rigid and foam surfaces with eyes open) with a period of rest across trials, on a force platform, based in the center of pressure measurements in the anteroposterior and mediolateral directions. Results  The prevalence of poor sleep quality in this study sample was 53.7% ( n  = 22). No differences were found between Poor and Good sleep in the posturographic parameters (p > 0.05). Although, there was moderate correlation between postural control in the semitandem stance and subjective sleep efficiency for center of pressure area (rs = -0.424; p  = 0.006) and amplitude in anteroposterior direction (rs = -0.386; p  = 0.013). Discussion  There is correlation between poor sleep quality and postural control in schoolteachers, as sleep efficiency decreases, postural sway increases. Poor sleep quality and postural control were investigated in other populations, but not in teachers. Several factors such as work overload, insufficient time for physical activities, among others, can contribute to a worse perception of sleep quality, as well as deterioration in postural control. Further studies with larger populations are needed to confirm these findings.

Plantar pressure and falling risk in older individuals: a cross-sectional study

BACKGROUND

Falls are commonplace among elderly people. It is urgent to prevent falls. Previous studies have confirmed that there is a difference in plantar pressure between falls and non-falls in elderly people, but the relationship between fall risk and foot pressure has not been studied. In this study, the differences in dynamic plantar pressure between elderly people with high and low fall risk were preliminarily discussed, and the characteristic parameters of plantar pressure were determined.

METHODS

Twenty four high-fall-risk elderly individuals (HR) and 24 low-fall-risk elderly individuals (LR) were selected using the Berg Balance Scale 40 score. They wore wearable foot pressure devices to walk along a 20-m-long corridor. The peak pressure (PP), pressure time integral (PTI), pressure gradient (maximum pressure gradient (MaxPG), minimum pressure gradient (MinPG), full width at half maximum (FWHM)) and average pressure (AP) of their feet were measured for inter-group and intra-group analysis.

RESULTS

The foot pressure difference comparing the high fall risk with low fall risk groups was manifested in PP and MaxPG, concentrated in the midfoot and heel (p < 0.05), while the only time parameter, FWHM, was manifested in the whole foot (p < 0.05). The differences between the left and right foot were reflected in all parameters. The differences between the left and right foot in LR were mainly reflected in the heel (p < 0.05), while it in the HR was mainly reflected in the forefoot (p < 0.05).

CONCLUSIONS

The differences comparing the high fall risk with low fall risk groups were mostly reflected in the midfoot and heel. The HR may have been more cautious when landing. In the intra-group comparison, the difference between the right and left foot of the LR was mainly reflected during heel striking, while it was mainly reflected during pedalling in the HR. The sensitivity of PP, PTI and AP was lower and the newly introduced pressure gradient could better reflect the difference in foot pressure between the two groups. The pressure gradient can be used as a new foot pressure parameter in scientific research.

Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort study

Introduction

The one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. The study aims were to assess the prognostic accuracy of one-legged balance performance in predicting falls and identify optimal cut-points to classify those at greater risk.

Methods

Data from up to 2,000 participants from a British birth cohort born in 1,946 were used. The times an individual could stand on one leg with their eyes open and closed were recorded (max: 30 s) at ages 53 and 60-64. Number of falls in the past year was self-reported at ages 53, 60-64 and 68; recurrent falls (0-1 vs. 2+) and any fall (0 vs. 1+) were considered binary outcomes. Four longitudinal associations between balance times and subsequent falls were investigated (age 53 → 60-64; age 53 → 68; age 60-64 → 68; age 53 & 60-64 → 68). For each temporal association, areas under the curve (AUC) were calculated and compared for a base sex-only model, a sex and balance model, a sex and fall history model and a combined model of sex, balance and fall history. The Liu method was used to identify optimal cut-points and sensitivity, specificity, and AUC at corresponding cut-points.

Results

Median eyes open balance time was 30 s at ages 53 and 60-64; median eyes closed balance times were 5 s and 3 s, respectively. The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.577-0.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.604-0.634). Optimal cut-points ranged from 27 s to 29 s for eyes open and 3 s to 5 s for eyes closed; AUC consistently indicated that using "optimal" cut-points to dichotomise balance time provided no discriminatory ability (AUC range:0.42-0.47), poor sensitivity (0.38-0.61) and poor specificity (0.23-0.56).

Discussion

Despite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.

One-Legged Balance Performance and Fall Risk in Mid and Later Life: Longitudinal Evidence From a British Birth Cohort

INTRODUCTION

The one-legged balance test is widely used as a fall risk screening tool in both clinical and research settings. Despite rising fall prevalence in midlife, there is little evidence examining balance and fall risk in those aged <65 years. This study investigated the longitudinal associations between one-legged balance and the number of falls between ages 53 and 68 years.

METHODS

The study included 2,046 individuals from the Medical Research Council National Survey of Health & Development, a British birth cohort study. One-legged balance times (eyes open, maximum: 30 seconds) were assessed at ages 53 years (1999) and 60-64 years (2006-2010). Fall history within the last year (none, 1, ≥2) was self-reported at ages 60-64 years and 68 years (2014). Multinomial logistic regressions assessed the associations between balance and change in balance with subsequent falls. Models adjusted for anthropometric, socioeconomic, behavioral, health status, and cognitive indicators. Analysis occurred between 2019 and 2022.

RESULTS

Balance performance was not associated with single falls. Better balance performance at age 53 years was associated with decreased risk of recurrent falls at ages 60-64 years and 68 years, with similar associations between balance at age 60-64 years and recurrent falls at age 68 years. Those with consistently lower balance times (<15 seconds) were at greater risk (RRR=3.33, 95% CI=1.91, 5.80) of recurrent falls at age 68 years in adjusted models than those who could balance for 30 seconds at ages 53 years and 60-64 years.

CONCLUSIONS

Lower balance and consistently low or declining performance were associated with a greater subsequent risk of recurrent falls. Earlier identification and intervention of those with poor balance ability can help to minimize the risk of recurrent falls in aging adults.

Impact of plantar fasciitis on postural control and walking in young middle-aged adults

PURPOSE

To assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions.

METHODS

Thirty participants (n = 15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants.

RESULTS

Clinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests.

CONCLUSIONS

Individuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.

Reliability and Usability Analysis of an Embedded System Capable of Evaluating Balance in Elderly Populations Based on a Modified Wii Balance Board

This paper analyzes the reliability and usability of a portable electronic instrument that measures balance and balance impairment in older adults. The center of pressure (CoP) metrics are measured with a modified Wii Balance Board (mWBB) platform. In the intra- and inter-rater testing, 16 and 43 volunteers (mean 75.66 and standard deviation (SD) of 7.86 years and 72.61 (SD 7.86) years, respectively) collaborated. Five volunteer raters (5.1 (SD 3.69) years of experience) answered the System Usability Scale (SUS). The most reliable CoP index in the intra-examiner tests was the 95% power frequency in the medial-lateral displacement of the CoP with closed-eyes. It had excellent reliability with an intraclass correlation coefficient ICC = 0.948 (C.I. 0.862-0.982) and a Pearson's correlation coefficient PCC = 0.966 (p < 0.001). The best index for the inter-rater reliability was the centroidal frequency in the anterior-posterior direction closed-eyes, which had an ICC (2,1) = 0.825. The mWBB also obtained a high usability score. These results support the mWBB as a reliable complementary tool for measuring balance in older adults. Additionally, it does not have the limitations of laboratory-grade systems and clinical screening instruments.

Does 8-Week Resistance Training with Slow Movement Cadenced by Pilates Breathing Affect Muscle Strength and Balance of Older Adults? An Age-Matched Controlled Trial

This study investigated the balance and dorsiflexion strength of older adults after eight weeks of resistance training, with the exercise velocity cadenced by the Pilates breathing technique and the volume modulated by the session duration. Forty-four older adults were divided into two groups: resistance training (TR; n = 22) and resistance training with the Pilates breathing technique cadencing all exercises (TR + P; n = 22), both during eight weeks. The total exercising volume was controlled by time of execution (50 min/session). The dorsiflexion strength and balance were assessed. The RT group showed higher dorsiflexion strength after the protocol: Right (RT = 29.1 ± 7.7 vs. RT + P = 22.9 ± 5.2, p = 0.001) and Left (RT = 29.5 ± 6.9 vs. RT + P = 24.0 ± 5.2, p = 0.001). All balance parameters were improved in RT + P group compared to its own baseline: Path Length (cm) (pre = 71.0 ± 14.3 vs. post = 59.7 ± 14.3, p = 0.003); Sway Velocity (cm/s) (pre = 3.6 ± 0.7; post = 2.9 ± 0.7; p = 0.001); Sway Area (cm2) (pre = 8.9 ± 5.3 vs. post = 5.7 ± 2.1, p = 0.003); Excursion Medio Lateral (cm) (pre = 3.0 ± 0.7 vs. post = 2.6 ± 0.5 cm, p = 0.002); and Excursion AP (cm) (pre = 3.6 ± 1.4 vs. post = 2.8 ± 0.7 cm, p = 0.010). Resistance training using slower velocity movement cadenced by Pilates breathing technique produced balance improvements compared to baseline (moderate to large effect sizes), but no between-group effect was observed at the end of the protocol. The dorsiflexion strength was higher in the RT group compared to RT + P group.

Immediate Effect of Augmented Reality, Virtual Reality, and Neurofunctional Physiotherapy on Postural Control and Executive Function of Individuals with Parkinson's Disease

Objective: To assess the immediate effect of augmented reality (AR), virtual reality (VR), and neurofunctional physiotherapy (NPT) on postural control (PC) and executive function (EF) of individuals with Parkinson's disease (PD). Materials and Methods: Forty subjects from mild-to-moderate PD stages, with no cognitive impairment were submitted to one session of NPT, one session of AR, and one session of VR for 50 minutes each (7 days interval between them). PC was evaluated before and after each therapy, using force platform in bipedal positions: tandem with eyes opened (EO), eyes closed (EC), and with double-task and one-legged stance. We recorded the center of pressure area, and anteroposterior (AP) and mediolateral (ML) displacement amplitude and velocity. EF was assessed by Trail Making Test (TMT). Results: PC improved (pre- vs. postintervention) after the three modalities: AP velocity decreased after AR (tandem EC 2.3 [1.7 to 2.9] vs. 2.1 [1.5 to 2.9], one-legged 3.0 [1.9 to 4.0] vs. 2.9 [1.9 to 3.6]), NPT (tandem EC 2.2 [1.7 to 3.1] vs. 2.1 [1.6 to 3.0]), and VR (tandem EO 1.9 [1.4 to 2.6] vs. 1.8 [1.4 to 2.4], tandem EC 2.3 [1.6 to 3.0] vs. 2.0 [1.5 to 2.8]); ML velocity decreased after AR in one-legged (P = 0.04); and permanence time in one-legged position increased in AR (Δ: 2.5 [-0.2 to 6.9]). There was also improvement in EF: TMT part A (TMTA)'s time decreased after AR (-9.3 [-15.7 to 1.9]), and TMT part B (TMTB)'s time decreased after the three modalities (ΔNPT: -7.7 [-29.4 to 0.0] vs. ΔAR: -4.6 [-34.6 to 0.6] vs. ΔVR: -4.9 [-28.2 to 0.9]). There were no differences between the modalities. Conclusion: The three treatment modalities improved PC and EF of subjects with PD. Moreover, AR and VR generated similar immediate effects to NPT on both outcomes in these patients. Trial registration: Brazilian Clinical Trial Registration: RBR-5r5dhf.

Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Québec: A Retrospective Study at La Baie Hospital

Musculoskeletal disorders, cardiovascular and neurological diseases were the most commonly debilitating conditions and risk factors associated with pain, mobility limitations, increased risk of falls and disability. Studies barely address the profile of older adults in care within a specialized geriatric rehabilitation service (SGRS) to provide subsidies for new actions within the public healthcare to reduce falls and improve management in health investments. This study aimed to establish a clinical physical and functional profile of the patients with neuromusculoskeletal and cognitive disorders and fallers in interventions within SGRS. From a retrospective study design, 127 medical records were compiled and analyzed to determine the physical and functional profile of older adults and differences according to sex, age groups and the benefits for local physical therapy intervention. The users were between 76 and 85 years of age, with diverse clinical diagnoses and debilitating conditions and impairments. A higher proportion presented gait and balance impairments and had two or more falls in 12 months. A significant effect for advanced age was observed. Overall, real benefits were reported with intervention for functional improvement, although the absence of a control group. These results have direct implications for a better understanding of a local SGRS and provide subsidies for developing new approaches for the assessment and treatment of older adults with high a risk of falls in order to reduce costs for the public health system.

Balance Differences between North and South American Older Adults: A Cross-Sectional, Age and Sex Matched Study

This study aimed to characterize the risk of falling in low-, moderate- and high-risk participants from two different geographical locations using a portable force-plate. A sample of 390 older adults from South and North America were matched for age, sex, height and weight. All participants performed a standardized balance assessment using a force plate. Participants were classified in low, moderate and high risk of falling. No differences were observed between South and North American men, nor comparing North American men and women. South American women showed the significantly shorter center of pressure path length compared to other groups. The majority of the sample was categorized as having low risk of falling (male: 65.69% and female: 61.87%), with no differences between men and women. Moreover, no differences were found between North vs. South Americans, nor between male and female groups compared separately. In conclusion, South American women had better balance compatible with the status of the 50–59 years’ normative age-range. The prevalence of low falls risk was~61–65%; the prevalence of moderate to high risk was~16–19%. The frequency of fall risk did not differ significantly between North and South Americans, nor between males and females.

Vitamin D deficiency, functional status, and balance in older adults with osteoarthritis

BACKGROUND

Low vitamin D levels are associated with a more severe case of knee osteoarthritis (OA). However, there are few published reports concerning an association between vitamin D deficiency and functional status of individuals with OA and no reports about postural balance in this population.

AIM

To analyze the relationship between vitamin D deficiency and severity, functional status, and balance in elderly patients with OA.

METHODS

In this cross-sectional study, 105 elderly patients with hip and knee OA were included. The severity was assessed by the Kellgren-Lawrence criteria. The functional status was assessed with the Lequesne index. Postural balance was assessed using a force platform, and center-of-pressure parameters (velocity at anteroposterior and mediolateral axis) were used as the balance outcomes. Serum 25(OH) vitamin D levels were measured using a chemiluminescence method.

RESULTS

Most of the patients (mean age: 70.6 ± 6.5 years) were female (n = 78, 74.3%). In the group with vitamin D deficiency, 43 patients (56.6%) had severe OA, while 33 patients (43.4%) had mild or moderate OA (χ² test, P = 0.04). Patients with vitamin D deficiency showed a higher Lequesne index score (Mann-Whitney test, P = 0.04), indicating a worse functional impairment when compared to individuals with normal vitamin D levels. Additionally, patients with vitamin D deficiency had worse postural balance according to the Mann-Whitney test (P = 0.03).

CONCLUSION

Vitamin D deficiency is associated with worse severity, functional status, and postural balance in patients with OA.

A novel model to quantify balance alterations in older adults based on the center of pressure (CoP) measurements with a cross-sectional study

Background

The timely detection of fall risk or balance impairment in older adults is transcendental because, based on a reliable diagnosis, clinical actions can be taken to prevent accidents. This study presents a statistical model to estimate the fall risk from the center of pressure (CoP) data.

Methods

This study is a cross-sectional analysis from a cohort of community-dwelling older adults aged 60 and over living in Mexico City. CoP balance assessments were conducted in 414 older adults (72.2% females) with a mean age of 70.23 ± 6.68, using a modified and previously validated Wii Balance Board (MWBB) platform. From this information, 78 CoP indexes were calculated and analyzed. Multiple logistic regression models were fitted in order to estimate the relationship between balance alteration and the CoP indexes and other covariables.

Results

The CoP velocity index in the Antero-Posterior direction with open eyes (MVELAPOE) had the best value of area under the curve (AUC) to identify a balance alteration (0.714), and in the adjusted model, AUC was increased to 0.827. Older adults with their mean velocity higher than 14.24 mm/s had more risk of presenting a balance alteration than those below this value (OR (Odd Ratio) = 2.94, p<0.001, 95% C.I.(Confidence Interval) 1.68–5.15). Individuals with increased age and BMI were more likely to present a balance alteration (OR 1.17, p<0.001, 95% C.I. 1.12–1.23; OR 1.17, p<0.001, 95% C.I. 1.10–1.25). Contrary to what is reported in the literature, sex was not associated with presenting a balance alteration (p = 0.441, 95% C.I. 0.70–2.27).

Significance

The proposed model had a discriminatory capacity higher than those estimated by similar means and resources to this research and was implemented in an embedded standalone system which is low-cost, portable, and easy-to-use, ideal for non-laboratory environments. The authors recommend using this technology to support and complement the clinical tools to attend to the serious public health problem represented by falls in older adults.

Age-Related Changes in Centre of Pressure Trajectories Analysed with a Novel 'Return to Central' Analysis

To evaluate age and fall-risk related changes in balance ability from measures of bipedal quiet stance, this study aims to investigate the characteristics of 'return to central' - Centre of Pressure (COP) trajectories. COP trajectories were extracted from 60-second COP recordings in bipedal stance. In anterior posterior direction, age was associated with a greater number of detected trajectories, increased velocity and more stringent control. No differences related to fall risk were established or to age or fall risk in mediolateral direction. The characteristics 'return to central' COP trajectories provided insight into the working of the postural control system and can be further developed for application if testing balance under challenging conditions is too risky.

Age-associated increase in postural variability relate to greater low-frequency center of pressure oscillations

BACKGROUND

Postural control is impaired in older adults, as evidenced from greater variability of the center of pressure (COP) during postural tasks. Although COP variability associates with low-frequency COP oscillations (<1 Hz) in young adults, it remains unknown if the age-associated increase in COP variability relates to greater low-frequency COP oscillations.

RESEARCH QUESTION

Do low-frequency oscillations contribute to greater postural sway (center of pressure (COP) variability) in older adults when attempting to voluntarily maintain posture in a forward leaning position compared to young adults?

METHODS

Seven young (25.7 ± 4.8) and seven older (71.0 ± 7.0) adults performed a postural lean forward task and attempted to match a COP target in the anterior-posterior direction as steady as possible. We quantified the COP variability as the standard deviation (SD) of COP displacements in the anterior-posterior and medial-lateral directions and quantified the frequency modulation of COP as the power in COP displacement spectra from 0-1 Hz.

RESULTS

We found that older adults had significantly greater anterior-posterior SD of COP (p = 0.027) and power below 0.5 Hz (p = 0.048) than young adults, but power from 0.5-1 Hz was similar (p = 0.083). In contrast, the medial-lateral SD of COP (p = 0.5) and power from 0-1 Hz (p = 0.228) was similar for the two age groups. For both the anterior-posterior and medial-lateral direction, the SD of COP was related to low frequency oscillations below 0.5 Hz.

SIGNIFICANCE

For the first time, we show that the age-associated increase in postural variability relates to greater COP oscillations below 0.5 Hz.

Noisy galvanic vestibular stimulation effect on center of pressure sway during one-legged standing

Noisy galvanic vestibular stimulation (nGVS) involves the application of a weak, noisy, electrical current to the vestibular end organs and their afferent nerves, through electrodes placed bilaterally over the mastoid process. Center of pressure (COP) sway was shown to decrease during nGVS under conditions of static standing posture. However, whether nGVS can improve balance functions other than the static standing posture remains unclear. This study aimed to elucidate the effects of nGVS on COP sway during one-legged standing. We randomly assigned 36 participants to either a control group (sham stimulation), a 0.2 mA group (nGVS at 0.2 mA), or a 0.4 mA group (nGVS at 0.4 mA). All participants were measured for COP sway standing on one leg, with open eyes, both before and during stimulation. In the 0.2 mA group, the sway path length, mediolateral mean velocity, and anteroposterior mean velocity decreased during stimulation compared with before stimulation. Conversely, no significant differences in COP sway were detected for either the control group or the 0.4 mA group. The stimulation effects for all COP sway parameters were significantly higher in the 0.2 mA group than in either the control group or the 0.4 mA group. The results of this study suggested that nGVS not only decreases COP sway during static standing postures but can also reduce COP sway during one-legged standing.

A 12-week exercise program improves functional status in postmenopausal osteoporotic women: randomized controlled study

BACKGROUND

Beside the importance of implementing physical activity in treatment of patients with osteoporosis, the multicomponent exercise program and assessment of its functional outcomes performed by five performance-based measures, have not been explored yet.

AIM

The present study evaluated the effect of the 12 weeks exercise program on functional outcomes of postmenopausal patients with densitometric diagnosed osteoporosis.

DESIGN

The study was designed as randomized control study.

SETTING

Female outpatients with diagnosed postmenopausal osteoporosis were included in the study.

POPULATION

The study included women from urban area.

METHODS

Patients were randomized in two groups: exercise group (EG) and control group (CG). Patients in the exercise group (N.=47) participated in a 12 weeks exercise program, which consisted of resistance training, balance exercise and aerobic exercise, while patients from control group (N.=49) had not participated in any exercise program during the intervention period. Functional outcomes determined by Time Up and Go Test (TUG), Sit To Stand test (STS) and One Leg Stance Test (OLST) were evaluated at baseline and 4 and 12 weeks after treatment, while Fall Efficacy Scale (FES-I) and Knowledge About Osteoporosis Questionnaire (OKAT-S) were assessed at baseline and after 12 weeks, respectively.

RESULTS

There were noticed statistically significant improvement in all observed measurements in EG after 4 and 12 weeks, respectively. Comparison between groups showed statistically significant difference in EG compared to CG in all functional outcomes in observed periods (P<0.001 for all). OLST significantly changed only in EG, not in CG, in both experimental periods. After 4 weeks, in CG there were no statistically significant changes in any of the monitored parameters, while after 12 weeks improvements were detected with TUG, STS, FES-I and OKAT-S.

CONCLUSIONS

Twelve weeks exercise program, as an effective, inexpensive and easily performed method, improved functional status in postmenopausal osteoporotic women.

CLINICAL REHABILITATION IMPACT

In the present study we found that supervised exercise program in postmenopausal osteoporotic female patients significantly improved their muscle strength and balance and decreased fear of falling. Thus, it is proposed to be a part of clinical protocol for osteoporosis treatment.

Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis

Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminated. While our analyses are limited due to the unbalanced representation of different test and outcome measures across studies, we can recommend the single-leg test for the assessment of the risk of falling, and the measurements of body sway for a more comprehensive assessment.

Agility-based exercise training compared to traditional strength and balance training in older adults: a pilot randomized trial

BACKGROUND

In addition to generally high levels of physical activity, multi-component exercise training is recommended for the maintenance of health and fitness in older adults, including the prevention of falls and frailty. This training often encompasses serial sequencing of balance, strength, endurance and other types of exercise. Exercise training featuring integrative training of these components (i.e. agility training) has been proposed, as it more likely reflects real life challenges like stop-and-go patterns, cutting manoeuvers, turns and decision-making. In this study, we compared the efficacy of an agility-based training to the traditional strength and balance training approach with regard to selected risk factors for falls and frailty.

METHODS

We trained twenty-seven community-dwelling healthy seniors (16♂; 11♀; age: 69.5 ± 5.3 y; BMI: 26.4 ± 3.7 kg/m2) for 8 weeks in a group setting with 3 sessions per week, each lasting 50 minutes. Participants were randomized into either the agility group (AGI; n = 12), that used the integrative multi-component training, or the traditional strength and balance group (TSB; n = 15). TSB performed balance and strength exercises separately, albeit within the same session. The training of both groups progressively increased in difficulty. Outcomes were static and dynamic balance (single leg eyes open stand, Y-balance test, reactive balance), lower limb (plantar flexion and dorsal extension) and trunk flexion and extension maximum strength and rate of torque development (RTD). In addition, we tested endurance by the six-minute walk test (6MWT). We calculated linear mixed effects models for between-groups comparisons as well as effect sizes (ES) with 95 % confidence intervals.

RESULTS

Small ES in favor of AGI were found for plantar flexion strength (ES > 0.18[-0.27;0.89]) and RTD (ES > 0.43[-0.19;1.36]) as well as trunk extension RTD (ES = 0.35[-0.05;0.75]). No other parameters showed notable between group differences. Compliance was high in both groups (AGI: 90 ± 8% of sessions; TSB: 91 ± 7% of sessions).

DISCUSSION

Agility-based exercise training seems at least as efficacious as traditional strength and balance training in affecting selected physical performance indicators among community-dwelling healthy seniors. In particular, lower limb and trunk extension explosive strength seem to benefit from the agility training.

Associations Between Factors Across Life and One-Legged Balance Performance in Mid and Later Life: Evidence From a British Birth Cohort Study

Introduction: Despite its associations with falls, disability, and mortality, balance is an under-recognized and frequently overlooked aspect of aging. Studies investigating associations between factors across life and balance are limited. Understanding the factors related to balance performance could help identify protective factors and appropriate interventions across the life course. This study aimed to: (i) identify socioeconomic, anthropometric, behavioral, health, and cognitive factors that are associated with one-legged balance performance; and (ii) explore how these associations change with age.

Methods: Data came from 3,111 members of the MRC National Survey of Health and Development, a British birth cohort study. Multilevel models examined how one-legged standing balance times (assessed at ages 53, 60–64, and 69) were associated with 15 factors across life: sex, maternal education (4 years), paternal occupation (4 years), own education (26 years), own occupation (53 years), and contemporaneous measures (53, 60–64, 69 years) of height, BMI, physical activity, smoking, diabetes, respiratory symptoms, cardiovascular events, knee pain, depression and verbal memory. Age and sex interactions with each variable were assessed.

Results: Men had 18.8% (95%CI: 13.6, 23.9) longer balance times than women at age 53, although this difference decreased with age (11.8% at age 60–64 and 7.6% at age 69). Disadvantaged socioeconomic position in childhood and adulthood, low educational attainment, less healthy behaviors, poor health status, lower cognition, higher body mass index (BMI), and shorter height were associated with poorer balance at all three ages. For example, at age 53, those from the lowest paternal occupational classes had 29.6% (22.2, 38.8) worse balance than those from the highest classes. Associations of balance with socioeconomic indicators, cognition and physical activity became smaller with age, while associations with knee pain and depression became larger. There were no sex differences in these associations. In a combined model, the majority of factors remained associated with balance.

Discussion: This study identified numerous risk factors across life that are associated with one-legged balance performance and highlighted diverse patterns of association with age, suggesting that there are opportunities to intervene in early, mid and later life. A multifactorial approach to intervention, at both societal and individual levels, may have more benefit than focusing on a single risk factor.

Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity

Background

Powered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment.

Methods

Participants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2–3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts.

Results

Twelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28–0.60 m/s, and distances of 0.74–1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments.

Conclusion

For individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries.

Trial registration

NCT02322125 Registered 22 December 2014.

Electronic supplementary material

The online version of this article (10.1186/s12984-019-0585-x) contains supplementary material, which is available to authorized users.