Reliance on Visual Input for Balance Skill Transfer in Older Adults: EEG Connectome Analysis Using Minimal Spanning Tree

Enhancing anticipation control of the posture system in the elderly wearing stroboscopic glasses

BACKGROUND

Stroboscopic vision (SV), known for providing intermittent visual input, has been recently integrated into postural training to improve proprioceptive awareness. This research examined the impact of SV on cortico-posture coupling in older adults, along with the related changes in postural control throughout a spectrum of feedback and feedforward processes.

METHODS

A total of thirty-three adults, averaging 66.1 ± 2.5 years of age, were tasked with maintaining an upright posture on a stabilometer, utilizing either complete or intermittent visual guidance. Stabilogram diffusion analysis (SDA) was employed to assess balance strategies based on postural sway, while phase-amplitude coupling (PAC) between postural fluctuations and scalp EEG provided insights into the associated neural control mechanisms.

RESULTS

SV resulted in significantly increased postural sway as compared with that of full-vision feedback (p < 0.001). SDA results indicated greater critical point displacement (CD) (p < 0.001), short-term diffusion coefficients (Ds) (p < 0.001), and scaling exponents (Hs) (p = 0.014) under SV conditions. PAC analysis revealed that the coupling between the postural fluctuation phase and cortical oscillation amplitude in the theta and alpha bands of the fronto-central area was significantly greater in the SV condition than in the full-vision condition (p < 0.001). Additionally, SV led to increased beta PAC in the frontal and sensorimotor areas compared to that of full vision (p < 0.001), which negatively correlated to SV-dependent changes in open-loop gain (Hs) (p < 0.05).

CONCLUSIONS

SV transitions postural sway towards an open-loop process and influences cortico-posture interactions in older adults, emphasizing a neuromotor adaptation to the uncertainty in feedforward predictions when utilizing intermittent visual feedback.

Cortical adaptations in regional activity and backbone network following short-term postural training with visual feedback for older adults

This study investigated cortical reorganization in older adults following short-term interactive balance training. Twenty participants aged 65-74 received training in stabilometer stance, visually aligning plate movement with a horizontal line on a monitor. Pre-test and post-test measured posture fluctuations and scalp EEG during stabilometer stance. Results showed a training-related decrease in root mean square (RMS) (p = 0.001) and an increase in mean frequency (p = 0.006) of posture fluctuations. Despite a decline in theta relative power in Fp1 (p = 0.027), stabilometer training led to a post-test increase in alpha relative power around electrodes of the ventral visual pathway (p = 0.002). Additionally, augmentations were noted in theta relative power in Tp8 (p = 0.033) and beta relative power in F7 (p = 0.039). Analysis of the minimum spanning tree (MST) of alpha inter-regional connectivity indicated a training-related decrease in leaf fraction (p = 0.011) and increase in average eccentricity (p = 0.041), respectively. Training-related changes in the RMS of posture fluctuation were positively correlated with changes in pooled alpha relative power in electrodes of the ventral visual pathway (r = 0.459, p = 0.042) and negatively correlated with changes in average eccentricity of the alpha MST network (r =  - 0.487, p = 0.029). In conclusion, short-term interactive training enhances balance by reorganizing regional and alpha-band network activities, which supports improved visual attention and prevents early visual processing idling during initial postural learning.

Using 3D and 4D digital human modeling in extended reality-based rehabilitation: a systematic review

Introduction

Extended reality (XR) is increasingly used in rehabilitation, showing potential to enhance clinical outcomes. Recently, integrating digital human modeling (DHM) with XR has gained attention. This systematic review aimed to evaluate the effectiveness of combining 3D and 4D DHM with XR in rehabilitation.

Methods

A systematic literature search was conducted according to PRISMA 2020 guidelines on the 28th of May 2024 in five databases (PubMed, IEEE Database, Cochrane Library, Web of Science, and Science Direct). All types of experimental studies investigating the effectiveness of XR using 3D and 4D DHM in rehabilitation were included. Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Evidence-Based Guideline Development (EBRO) were used to evaluate the methodological quality of the studies included.

Results

Of the 1048 articles found, 16 were included in this review. These studies focused on 3D DHM in XR-based rehabilitation across various conditions and demonstrated superior effectiveness, especially in individuals with neglect, anorexia nervosa, bulimia nervosa, and type 2 diabetes in comparison with conventional therapy. DHM, captured via 3D cameras and combined with motion analysis or Wii remotes, was integrated into XR systems like VR games and avatar therapy. The studies reveal positive impacts on functional (e.g., upper limb function, gait, balance, quality of life), physical (e.g., pain reduction, spasticity, joint range), psychological (e.g., depression, emotional regulation, body image), and general health outcomes (e.g., body composition, metabolic health).

Conclusion

Despite variability in study parameters, limited evidence suggests that 3D DHM in XR-based rehabilitation may enhance physical and psychological recovery across various pathologies. This review highlights the potential of DHM and XR integration but underscores the need for further research with larger samples, longer follow-ups, and standardized measures to confirm these technologies' reliability and effectiveness in rehabilitation.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024553551, identifier CRD42024553551.

Age-Related Topological Organization of Phase-Amplitude Coupling Between Postural Fluctuations and Scalp EEG During Unsteady Stance

Through phase-amplitude analysis, this study investigated how low-frequency postural fluctuations interact with high-frequency scalp electroencephalography (EEG) amplitudes, shedding light on age-related mechanic differences in balance control during uneven surface navigation. Twenty young ( 24.1 ± 1.9 years) and twenty older adults ( 66.2 ± 2.7 years) stood on a training stabilometer with visual guidance, while their scalp EEG and stabilometer plate movements were monitored. In addition to analyzing the dynamics of the postural fluctuation phase, phase-amplitude coupling (PAC) for postural fluctuations below 2 Hz and within EEG sub-bands (theta: 4-7 Hz, alpha: 8-12 Hz, beta: 13-35 Hz) was calculated. The results indicated that older adults exhibited significantly larger postural fluctuation amplitudes(p <0.001) and lower mean frequencies of the postural fluctuation phase ( p = 0.005 ) than young adults. The PAC between postural fluctuation and theta EEG (FCz and bilateral temporal-parietal-occipital area), as well as that between postural fluctuation and alpha EEG oscillation, was lower in older adults than in young adults (p <0.05). In contrast, the PAC between the phase of postural fluctuation and beta EEG oscillation, particularly in C3 ( p=0.006 ), was higher in older adults than in young adults. In summary, the postural fluctuation phase and phase-amplitude coupling between postural fluctuation and EEG are sensitive indicators of the age-related decline in postural adjustments, reflecting less flexible motor state transitions and adaptive changes in error monitoring and visuospatial attention.

Dual-task improvement of older adults after treadmill walking combined with blood flow restriction of low occlusion pressure: the effect on the heart-brain axis

OBJECTIVE

This study explored the impact of one session of low-pressure leg blood flow restriction (BFR) during treadmill walking on dual-task performance in older adults using the neurovisceral integration model framework.

METHODS

Twenty-seven older adults participated in 20-min treadmill sessions, either with BFR (100 mmHg cuff pressure on both thighs) or without it (NBFR). Dual-task performance, measured through light-pod tapping while standing on foam, and heart rate variability during treadmill walking were compared.

RESULTS

Following BFR treadmill walking, the reaction time (p = 0.002) and sway area (p = 0.012) of the posture dual-task were significantly reduced. Participants exhibited a lower mean heart rate (p < 0.001) and higher heart rate variability (p = 0.038) during BFR treadmill walking. Notably, BFR also led to band-specific reductions in regional brain activities (theta, alpha, and beta bands, p < 0.05). The topology of the EEG network in the theta and alpha bands became more star-like in the post-test after BFR treadmill walking (p < 0.005).

CONCLUSION

BFR treadmill walking improves dual-task performance in older adults via vagally-mediated network integration with superior neural economy. This approach has the potential to prevent age-related falls by promoting cognitive reserves.

A comprehensive review of machine learning algorithms and their application in geriatric medicine: present and future

The increasing access to health data worldwide is driving a resurgence in machine learning research, including data-hungry deep learning algorithms. More computationally efficient algorithms now offer unique opportunities to enhance diagnosis, risk stratification, and individualised approaches to patient management. Such opportunities are particularly relevant for the management of older patients, a group that is characterised by complex multimorbidity patterns and significant interindividual variability in homeostatic capacity, organ function, and response to treatment. Clinical tools that utilise machine learning algorithms to determine the optimal choice of treatment are slowly gaining the necessary approval from governing bodies and being implemented into healthcare, with significant implications for virtually all medical disciplines during the next phase of digital medicine. Beyond obtaining regulatory approval, a crucial element in implementing these tools is the trust and support of the people that use them. In this context, an increased understanding by clinicians of artificial intelligence and machine learning algorithms provides an appreciation of the possible benefits, risks, and uncertainties, and improves the chances for successful adoption. This review provides a broad taxonomy of machine learning algorithms, followed by a more detailed description of each algorithm class, their purpose and capabilities, and examples of their applications, particularly in geriatric medicine. Additional focus is given on the clinical implications and challenges involved in relying on devices with reduced interpretability and the progress made in counteracting the latter via the development of explainable machine learning.

Stroboscopic visual training: The potential for clinical application in neurological populations

Visual problems are common in people who have neurological injury or disease, with deficits linked to postural control and gait impairment. Vision therapy could be a useful intervention for visual impairment in various neurological conditions such as stroke, head injury, or Parkinson's disease. Stroboscopic visual training (SVT) has been shown to improve aspects of visuomotor and cognitive performance in healthy populations, but approaches vary with respect to testing protocols, populations, and outcomes. The purpose of this structured review was to examine the use of strobe glasses as a training intervention to inform the development of robust protocols for use in clinical practice. Within this review, any studies using strobe glasses as a training intervention with visual or motor performance-related outcomes was considered. PubMed, Scopus, and ProQuest databases were searched in January 2023. Two independent reviewers (JD and RM) screened articles that used strobe glasses as a training tool. A total of 33 full text articles were screened, and 15 met inclusion/exclusion criteria. Reported outcomes of SVT included improvements in short-term memory, attention, and visual response times, with emerging evidence for training effects translating to balance and physical performance. However, the lack of standardisation across studies for SVT protocols, variation in intervention settings, duration and outcomes, and the limited evidence within clinical populations demonstrates that further work is required to determine optimal strobe dosage and delivery. This review highlights the potential benefits, and existing research gaps regarding the use of SVT in clinical practice, with recommendations for clinicians considering adopting this technology as part of future studies in this emerging field.

Quick balance skill improvement after short-term training with error amplification feedback for older adults

This study investigated behavioral and cortical mechanisms for short-term postural training with error amplification (EA) feedback in the elderly. Thirty-six elderly subjects (65.7 ± 2.2 years) were grouped (control and EA, n = 18) for training in stabilometer balance under visual guidance. During the training session (8 training rounds of 60 s in Day 2), the EA group received visual feedback that magnified errors to twice the real size, whereas the control group received visual feedback that displayed real errors. Scalp EEG and kinematic data of the stabilometer plate and ankle joint were recorded in the pre-test (Day 1) and post-test (Day 3). The EA group (-46.5 ± 4.7%) exhibited greater post-training error reduction than that of the control group (-27.1 ± 4.0%)(p = 0.020), together with a greater decline in kinematic coupling between the stabilometer plate and ankle joint (EA: -26.6 ± 4.8%, control: 2.3 ± 8.6%, p = 0.023). In contrast to the control group, the EA group manifested greater reductions in mean phase-lag index (PLI) connectivity in the theta (4-7 Hz)(p = 0.011) and alpha (8-12 Hz) (p = 0.027) bands. Only the EA group showed post-training declines in the mean PLI in the theta and alpha bands. Minimal spanning tree analysis revealed that EA-based training led to increases in the diameter (p = 0.002) and average eccentricity (p = 0.004) of the theta band for enhanced performance monitoring and reduction in the leaf fraction (p = 0.030) of the alpha band for postural response with enhanced automaticity. In conclusion, short-term EA training optimizes balance skill, favoring multi-segment coordination for the elderly, which is linked to more sophisticated error monitoring with less attentive control over the stabilometer stance.

Effects of perceptual-cognitive tasks on inter-joint coordination of soccer players and ordinary college students

Perceptual-cognitive tasks play a pivotal role in performing voluntary movements, which is crucial for good performances among soccer players. This study explored the effect of perceptual-cognitive tasks on the inter-joint coordination of soccer players and college students during landing. The classic multiple objective tracking (MOT) task was used to simulate the perceptual-cognitive task under a sports environment. Fifteen soccer players (age: 20.1 ± 1.5 year, height: 181.4 ± 7.4 cm, weight: 75.4 ± 10.7 kg) and twenty ordinary college students (age: 20.0 ± 2.3 years, height: 177.9 ± 4.9 cm, weight: 71.6 ± 9.9 kg) were enrolled to the study. Participants in the two groups were subjected to a single task (landing task) and dual-task (MOT task and landing task). Coordination and variability indicators were recorded using a Vicon infrared motion capture system and a force measuring platform. The results showed that the mean absolute relative phase of hip and knee joint (MARP_hip-knee), deviation phase of hip and knee joint (DP_hip-knee), and deviation phase of knee and ankle joint (DP_knee-ankle) of the two groups under the dual-task were significantly different compared with the parameters when participants were subjected to the single task. The dual-task had higher effect size on DP_hip-Knee and MARP_hip-knee, indicating that dual-task had a greater impact on coordination of the hip and knee joints. DP_hip-knee and DP_knee-ankle of ordinary students were more extensive relative to those of the soccer players, and hip joint stiffness (K_hip) for ordinary students was lower than that of the soccer players under the different tasks. These findings implied that the perceptual-cognitive task markedly affected the inter-joint coordination of soccer players and college students, mainly by impairing the hip and knee coordination. Although there is less variability in lower extremity coordination patterns of soccer players compared to college students, the MOT task still affects their coordination ability.

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.

Cortical reorganization to improve dynamic balance control with error amplification feedback

Background

Error amplification (EA), virtually magnify task errors in visual feedback, is a potential neurocognitive approach to facilitate motor performance. With regional activities and inter-regional connectivity of electroencephalography (EEG), this study investigated underlying cortical mechanisms associated with improvement of postural balance using EA.

Methods

Eighteen healthy young participants maintained postural stability on a stabilometer, guided by two visual feedbacks (error amplification (EA) vs. real error (RE)), while stabilometer plate movement and scalp EEG were recorded. Plate dynamics, including root mean square (RMS), sample entropy (SampEn), and mean frequency (MF) were used to characterize behavioral strategies. Regional cortical activity and inter-regional connectivity of EEG sub-bands were characterized to infer neural control with relative power and phase-lag index (PLI), respectively.

Results

In contrast to RE, EA magnified the errors in the visual feedback to twice its size during stabilometer stance. The results showed that EA led to smaller RMS of postural fluctuations with greater SampEn and MF than RE did. Compared with RE, EA altered cortical organizations with greater regional powers in the mid-frontal cluster (theta, 4–7 Hz), occipital cluster (alpha, 8–12 Hz), and left temporal cluster (beta, 13–35 Hz). In terms of the phase-lag index of EEG between electrode pairs, EA significantly reduced long-range prefrontal-parietal and prefrontal-occipital connectivity of the alpha/beta bands, and the right tempo-parietal connectivity of the theta/alpha bands. Alternatively, EA augmented the fronto-centro-parietal connectivity of the theta/alpha bands, along with the right temporo-frontal and temporo-parietal connectivity of the beta band.

Conclusion

EA alters postural strategies to improve stance stability on a stabilometer with visual feedback, attributable to enhanced error processing and attentional release for target localization. This study provides supporting neural correlates for the use of virtual reality with EA during balance training.

Visual Effect on Brain Connectome That Scales Feedforward and Feedback Processes of Aged Postural System During Unstable Stance

Older adults with degenerative declines in sensory systems depend strongly on visual input for postural control. By connecting advanced neural imaging and a postural control model, this study investigated the visual effect on the brain functional network that regulates feedback and feedforward processes of the postural system in older adults under somatosensory perturbations. Thirty-six older adults conducted bilateral stance on a foam surface in the eyes-open (EO) and eyes-closed (EC) conditions while their center of pressure (COP) and scalp EEG were recorded. The stochastic COP trajectory was modeled with non-linear stabilogram diffusion analysis (SDA) to characterize shifts in postural control in a continuum of feedback and feedforward processes. The EEG network was analyzed with the phase-lag index (PLI) and minimum spanning tree (MST). The results indicated that visual input rebalanced feedforward and feedback processes for postural sway, resulting in a greater critical point of displacement (CD), short-term effective diffusion coefficients (D_s) and short-term exponent (H_s), but the smaller critical point of time (CT) and long-term exponent (H_l) for the EC state. The EC network demonstrated stronger frontoparietal-occipital connectivity but weaker fronto-tempo-motor connectivity of the theta (4–7 Hz), alpha (8–12 Hz), and beta (13–35 Hz) bands than did the EO network. MST analysis revealed generally greater leaf fraction and maximal betweenness centrality (BC_max) and kappa of the EC network, as compared with those of the EO network. In contrast, the EC network exhibited a smaller diameter and average eccentricity than those of the EO network. The modulation of long-term negative feedback gain of the aged postural system with visual occlusion was positively correlated with leaf fraction, BC_max, and kappa, but negatively correlated with the diameter and average eccentricity for all EEG sub-bands. In conclusion, the aged brain functional network in older adults is tuned to visual information for modulating long-term negative feedback of the postural system under somatosensory perturbations.