Good times, bad times? An evaluation of event detection strategies in time to boundary postural assessments

Time-to-boundary (TtB) is a popular balance metric that identifies minimum reaction times available to correct balance challenges during quiet standing. Minimum event criteria is a critical methodological consideration to determine physiologically relevant TtB outcomes yet selection methodology appears inconsistent and/or vaguely defined across studies. This study aimed to identify a robust, objective methodology to select meaningful TtB outcomes. Ninety-seven healthy adults stood quietly on a force platform with eyes open and feet together. Anterior-posterior (AP) and medial-lateral (ML) center-of-pressure data from 150 s were utilized to compute a TtB series. The MATLAB findpeaks function identified minima with and without a time delay following selected events and/or a vertical axis threshold. An individualized time delay excluded excessively large values that hold no clinically relevant information, and this effect was enhanced by a vertical threshold at 22 s. The absolute minimum TtB was unaffected by any findpeaks criteria. The recommendations implicated by these results will help improve clarity and consistency among TtB studies, thereby enhancing the applicability of clinical findings.

A novel method to quantify individual limb contributions to standing postural control

BACKGROUND

Understanding individual limb contributions to standing postural control is valuable when evaluating populations with asymmetric function (e.g., stroke, amputations). We propose a method of quantifying three contributions to controlling the net anteroposterior center of pressure (CoP) during quiet standing: CoP moving under left and right limbs and weight shifting between the two limbs.

RESEARCH QUESTION

Can these contributions to standing postural control be quantified from CoP trajectories in neurotypical adults?

METHODS

Instantaneous contributions can be negative or larger than one, and integrated contributions sum to equal one. Proof-of-concept demonstrations validated these calculated contributions by restricting CoP motion under one or both feet. We evaluated these contributions in 30 neurotypical young adults who completed two (eyes opened; eyes closed) 30-s trials of bipedal standing. We evaluated the relationships between limb contributions, self-reported limb dominance, and between-limb weight distributions.

RESULTS

All participants self-reported as right-limb dominant; however, a range of mean limb contributions were observed with eyes opened (Left: mean [range] = 0.52 [0.37-0.63]; Right: 0.48 [0.31-0.63]) and with eyes closed (Left: 0.51 [0.39-0.63]; Right: 0.49 [0.37-0.61]). Weight-shift contributions were small with eyes opened (0.00 [-0.01 to 0.01]) and eyes closed (0.00 [-0.01 to 0.02]). We did not identify any between-limb differences in contributions when grouped by self-reported limb dominance (p > 0.10, d < 0.31). Contributions did not significantly correlate with Waterloo Footedness scores (-0.22 < r < 0.21, p > 0.25) or between-limb weight distributions (0 < r < 0.24, p > 0.20).

SIGNIFICANCE

Across neurotypical participants, we observed a notable range of limb contributions not related to self-reported limb dominance or between-limb weight distributions. With this tool, we can characterize differences in the amount of CoP motion and the underlying control strategies. Changes in limb contribution can be measured longitudinally (i.e., across rehabilitation programs, disease progression, aging) representative of limb function, which may be particularly useful in populations with asymmetric function.

Comparison of Postural Control of Females with and without Urinary Incontinence: A Case-Control Study

Background: So far, there is much less information about the effects of urinary incontinence on postural control. Therefore the aim of this study is to investigate the differences in postural control using linear and non-linear analyses of the center of pressure (COP) time-series in anteroposterior (AP) and mediolateral (ML) directions between females with and without stress urinary incontinence (SUI). Methods: This case-control study included 22 continent females and 22 SUI females. In this study, static postural control during four different postural tasks was evaluated using a force plate. All participants performed separate 60-sec standing trials with eyes open in the empty bladder and full bladder conditions. Mean, range, velocity, area circle of COP displacements, and approximate entropy (ApEn) of COP time-series were calculated from the 60-sec standing trials for all participants. The independent sample t-test was also used to compare COP variables between the two groups and paired sample t-test was used to assess changes between the full bladder and empty bladder conditions within each group. The effect size of Cohen's d was used to assess the magnitude of the differences between the two groups. Results: The findings revealed a significant group × task interaction for the mean of ML displacement and ApEn of COP. SUI females showed more AP displacement range in the full bladder (pvalue= 0.020, effect size=0.74) and a higher velocity (empty bladder: p=0.040, effect size=0.63) (full bladder: p=0.020, effect size=0.75) than the continent group. Generally, the SUI females had lower ApEn than the continent females, although the differences were not significant. While the variables of COP were unaffected by bladder fullness in the continent group, the SUI group in full bladder condition experienced more AP range (p=0.030), and area circle (p=0.007) of COP sway in quiet standing. Conclusion: These results provide more support for the hypothesis that postural control can be impaired following SUI, although future investigations on this topic are recommended.

The influence of equine limb conformation on the biomechanical responses of the hoof: An in vivo and finite element study

Hoof conformation plays a key role in equine locomotion. Toe-in conformation is an abnormal condition characterized by inward deviation of the limb from its frontal axis. Several studies have documented differences in hoof deformation and hoof kinematics in horses with toe-in and normal hoof conformations. However, the reason behind this has yet to be understood. The present study hypothesizes that a different center of pressure (COP) path underneath the hoof is the cause of different deformation patterns and hoof kinematics in toe-in hooves. In vivo measurements and finite element (FE) analysis were conducted to test the hypothesis. A normal and a toe-in limb were considered for in vivo strain measurements. Strains were measured at three different sites on the hoof wall, and the stride characteristics were investigated using video recording. The magnitude of the minimum principal strain measured at the medial aspect of the toe-in hoof was much lower relative to the normal hoof. Furthermore, the toe-in hoof had a different movement pattern (plaiting) compared to the normal hoof. In the second study, an entire hoof model was simulated from computed tomography (CT) scans of an equine left forelimb. The Neo-Hookean hyperelastic material model was used, and the hoof was under dynamic loading over a complete stride at the trot. Two different COP paths associated with normal and toe-in conformations were assigned to the model. The FE model produced the same in vivo minimum principal strain distributions and successfully showed the different kinematics of the toe-in and normal hooves.

Effects of a Prosthetic Foot With Increased Coronal Adaptability on Cross-Slope Walking

BACKGROUND

Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The uneven ground and the resulting functional leg length discrepancy in this situation requires adaptability of both user and prosthesis.

OBJECTIVES

This study investigated the effects of a novel prosthetic foot that offers adaptability on cross-slope surfaces, using instrumented gait analysis and patient-reported outcomes. Moreover, the results were compared with two common prosthetic feet.

METHODOLOGY

Twelve individuals with unilateral transtibial amputation and ten able-bodied control subjects participated in this randomized cross-over study. Participants walked on level ground and ±10° inclined cross-slopes at a self-selected walking speed. There were three prosthetic foot interventions: Triton Side Flex (TSF), Triton LP and Pro-Flex LP. The accommodation time for each foot was at least 4 weeks. The main outcome measures were as follows: frontal plane adaptation of shoe and prosthetic foot keel, mediolateral course of the center of pressure, ground reaction force in vertical and mediolateral direction, external knee adduction moment, gait speed, stance phase duration, step length and step width. Patient-reported outcomes assessed were the Activities specific Balanced Confidence (ABC) Scale, Prosthetic Limb Users Survey of Mobility (PLUS M) and Activities of Daily Living Questionnaire (ADL-Q).

FINDINGS

The TSF prosthetic foot adapted both faster and to a greater extent to the cross-slope conditions compared to the Triton LP and Pro-Flex LP. The graphs for the mediolateral center of pressure course and mediolateral ground reaction force showed a distinct grouping for level ground and ±10° cross-slopes, similar to control subjects. In the ADL-Q, participants reported a higher level of perceived safety and comfort when using the TSF on cross-slopes. Eight out of twelve participants preferred the TSF over the reference.

CONCLUSIONS

The frontal plane adaptation characteristics of the TSF prosthetic foot appear to be beneficial to the user and thus may enhance locomotion on uneven ground - specifically on cross-slopes.

Postural control in top-level female volleyball players

Background

The aim of this study was to compare the postural control of the Poland national women’s volleyball team players with a control group of non-training young women. It was hypothesized that volleyball players use a specific balance control strategy due to the high motor requirements of their team sport.

Methods

Static postural sway variables were measured in 31 athletes and 31 non-training women. Participants were standing on a force plate with eyes open, and their center of pressure signals were recorded for the 20s with the sampling rate of 20 Hz in the medial-lateral (ML) and anterior-posterior (AP) planes.

Results

In both AP and ML planes, athletes had lower range and higher fractal dimension of the COP. They had also higher peak frequency than control group in the ML plane only. The remaining COP indices including variability, mean velocity and mean frequency did not display any intergroup differences.

Conclusion

It can be assumed that due to the high motor requirements of their sport discipline Polish female volleyball players have developed a unique posture control. On the court they have to distribute their sensory resources optimally between balance control and actions resulting from the specifics of the volleyball game. There are no clearly defined criteria for optimal postural strategies for elite athletes, but they rather vary depending on a given sport. The results of our research confirm this claim.

Trial registration

The tests were previously approved by the Bioethical Commission of the Chamber of Physicians in Opole. (Resolution No. 151/13.12.2007). This study adheres to the CONSORT guidelines.

Toward more reliable stability measurements in stance: recommendations for number of measurements, foot position and feedback -- a cross-sectional study among servicemen

BACKGROUND

In the military, insufficient postural stability is a risk factor for developing lower extremity injuries. Postural stability training programs are effective in preventing these injuries. However, an objective method for the measurement of postural stability in servicemen is lacking. The primary objective of this study was to assess the influence of the number of repetitions, different foot positions and real-time visual feedback on postural stability, as well as their effects on the intrasession reliability of postural stability measurements in servicemen. The secondary objective was to assess the concurrent validity of the measurements.

METHODS

Twenty healthy servicemen between 20 and 50 years of age and in active duty were eligible for this quantitative, cross-sectional study. The measurements took place on a force plate, measuring the mean velocity of the center of pressure. The participants were asked to stand as still as possible in three different foot positions (wide stance, small stance, and on one leg), five times each for 45 s each time, and the measurements were performed with and without real-time visual feedback.

RESULTS

We observed a significant main effect of foot position (P < 0.001), but not of visual feedback (P = 0.119) or repetition number (P = 0.915). Postural stability decreased in the more challenging foot positions. The ICC estimates varied from 0.809 (one repetition in wide stance) to 0.985 (five repetitions on one leg). The common variance (R²) between different foot positions without feedback varied between 0.008 (wide stance) and 0.412.

CONCLUSIONS

To yield reliable data, wide-stance measurements should be conducted three times, and small-stance measurements and measurements on one leg should be conducted two times. The scores of a measurement in a particular foot position cannot predict the scores of measurements in other foot positions.

Increased postural stiffness during challenging postural tasks in patients with knee osteoarthritis with high pain sensitization

BACKGROUND

Postural stability is affected in knee osteoarthritis patients who present with pain but the link to pain sensitization is unclear.

METHODS

Patients with knee osteoarthritis completed the Knee Injury and Osteoarthritis Outcome Score and pressure pain thresholds were assessed bilaterally at the knee, lower leg and forearm prior to standing quietly (1 min) on a force platform in four conditions: Firm surface with open eyes, firm surface with closed eyes, soft surface with open eyes, and soft surface with closed eyes. Pain intensity during standing was assessed via numerical rating scale. Postural stability was assessed by the range, velocity, and standard deviation of the Center of Pressure (CoP) extracted from the force platform. The means of three repeated measures per standing condition were analysed. High-sensitization and low-sensitization groups were defined based on bilateral pressure pain thresholds from leg and arm.

FINDINGS

Fifty-six patients were included. Compared with the low-sensitization group, the high-sensitization group demonstrated 1) smaller pressure pain thresholds at the knee (P < 0.05) although the Knee Injury and Osteoarthritis Outcome Score and pain intensity were not significantly different between groups, and 2) smaller range of the CoP in the anterior-posterior direction during the soft surface with closed eyes condition (P < 0.05).

INTERPRETATION

Smaller CoP range suggest that patients with more widespread pain sensitivity have increased postural stiffness compared with the low-sensitization group. The greater stiffness found in high-sensitization patients under sensory restrictions (closed eyes and reduced proprioception) might relate to restricted integration of sensory information due to widespread pain sensitization.

A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain

Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain.

Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability.

Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was <0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4 weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in the orthosis group (t = 3.60, P<0.001).

Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.

Aging and the complexity of center of pressure in static and dynamic postural tasks

The experiment was set-up to investigate the hypothesis that there is an age-related bi-directional change in complexity of the center of pressure (COP) depending on postural task demands. Healthy young (19-28 year) and old (65-74 year) adults were instructed to match, in two 25s trials for each condition, the COP with constant and sine-wave targets at 2 levels (5 and 40%) of the maximal COP distance (MCD). The root mean square error of COP increased with aging in both MCD levels and tasks. Multi-scale entropy (MSE) and detrended fluctuation analysis showed that the complexity of COP in the old adults was lower compared to the young in the constant target, whereas it was higher in the sine-wave target. The task dependent age-related bi-directional change of COP complexity is counter to the hypothesis of a universal loss of complexity with aging but shows that there is loss of adaptive change in complexity driven by the COP dynamics.

Assessment of differenced center of pressure time series improves detection of age-related changes in postural coordination

Center of Pressure (CoP) time series exhibit non-stationarity. Most CoP analyses assume a stationary signal, which could lead to measurement inaccuracy. Despite this, few researchers have reported the incidence of CoP non-stationarity or employed procedures to mitigate non-stationarity prior to time-series analysis. Differencing is a pre-processing technique that reduces non-stationarity, though it has only recently been used with CoP data. This study sought to report the incidence of CoP non-stationarity in a sample data set and determine whether differencing mitigated any CoP non-stationarity that was detected. In addition, researchers examined whether analysis of differenced CoP improved the ability to detect age-related changes in postural coordination.