Relationship between static and dynamic balance in 4-to-5-year-old preschoolers: a cross-sectional study

BACKGROUND

Balance is crucial for physical development in preschool children. Exploring the relationship between different types of balance can help understand early physical development in children. Currently, research is mostly focused on the relationship between different types of balance in the adult population and lacks exploration of the preschool population. The aim of this study explored the relationship between static and dynamic balance in preschool children aged 4 to 5 years.

METHODS

A total of 128 preschool children between the ages of 4 to 5 years were selected. The following tests were conducted as they wore inertial sensors detecting their centers of mass (COM): T1, standing with eyes open; T2, standing with eyes closed; T3, standing with eyes open on foam; T4, standing with eyes closed on foam; and T5, walking on the balance beam. Static balance was measured by the angular velocity modulus (ω-T1-ω-T4) of the shaking COM, as well as the pitch angle (θ-T1-θ-T4) and roll angle (φ-T1-φ-T4) indicators in T1-T4 testing. Dynamic balance was measured by the time (t) and angular velocity modulus (ω-T5), as well as the pitch angle (θ-T5) and roll angle (φ-T5) indicators in the T5 test. The Pearson product-moment correlation coefficient was used to test the correlation between static and dynamic balance indicators.

RESULTS

There is no correlation between ω-T1-ω-T4 and t (P > 0.05), while ω-T1-ω-T4 and ω-T5 (r = 0.19-0.27, P < 0.05) and ω-T1-ω-T4 and θ-T5, φ-T5 (r = 0.18-0.33, P < 0.05) were weakly correlated. There is no correlation between θ-T1-θ-T4, φ-T1-φ-T4 and t (P > 0.05), while θ-T1-θ-T4, φ-T1-φ-T4, and θ-T5, φ-T5 were weakly correlated (r = 0.01-0.28, P < 0.05).

CONCLUSIONS

The relationship between static and dynamic balance in preschool children aged 4-5 years is weak. Static and dynamic balance in children needs to be intervened separately for the development of children.

Effect of Corrective Exercise on Static Balance, Food Consumption, and Body Composition in the Early Period After Bariatric Surgery

PURPOSE

To determine the impact of corrective exercise program applied during the period of rapid weight loss following bariatric surgery on static balance, dietary intake, and body composition.

MATERIALS AND METHODS

Participants who had undergone Sleeve Gastrectomy (SG) surgery were divided into as Corrective Exercise Group (CEG), and Control Group (CG). CEG underwent a 12-week supervised corrective exercise program. Body composition and static balance of all participants were assessed before and after the study. Their physical activity levels and dietary intake were also evaluated.

RESULTS

Following of the corrective exercise program, both groups exhibited significant reductions in body weight, BMI, fat mass, fat percentage, muscle mass, waist circumference-to-height ratio, and visceral adiposity values (p < 0.05). Additionally, the CEG showed increase in lean body mass percentage (p < 0.001). In measurements related to static balance, values for eyes-closed perimeter (p = 0.015), eyes-closed (p = 0.006), eyes-open (p = 0.028) ellipses area, average F-B speed, and eyes-open center of pressure in the X-axis (C.O.P.X.) sway distance significantly decreased in both groups (p = 0.025). However, the difference in eyes-open C.O.P.X. sway distance was found to be higher in the CG (mean difference = 8.67; p = 0.034). Postoperatively, there were significant decreases in energy, protein, fat, CHO (carbohydrate), CHO percentage, fiber, and iron values, while protein percentage (p < 0.001), vitamin D (p = 0.003), and B12 (p < 0.001) values increased.

CONCLUSION

It has been observed that the corrective exercise program implemented in the early postoperative period following SG surgery had a positive impact on eyes-open static balance.

Lower limb lymphedema disrupts both static and dynamic balance

BACKGROUND

The impact of lower-limb-lymphedema on quality of life of patients regarding balance is unclear due to the scarcity of literature. The aim of this study was to determine the static and dynamic balance of patients with lower-limb-lymphedema in comparison with healthy subjects.

METHODS

This case-control designed study included 30 lymphedema patients and 30 healthy individuals, of whom were 52 female and 8 male with a mean age of 50.63 ± 9.72 years. Static balance stability and anterior-posterior with lateral sway parameters on four conditions (eyes-opened-stable-ground, eyes-closed-stable-ground, eyes-opened-unstable-ground, eyes-closed-unstable-ground) and dynamic stability of all participants were evaluated.

FINDINGS

The demographic variables were similar between the groups. Majority of the patients had lymphedema due to cancer surgery with a stage of 2. Dynamic stability was significantly disrupted in lymphedema group in comparison with controls (P = 0.049). Static balance parameters were impaired on all conditions except the eyes opened-stable ground in lymphedema patients (P = 0.048,P = 0.043,P = 0.017). The dynamic with static balance and lateral sway parameters were correlated with the duration of lymphedema(P = 0.046,P = 0.002,P = 0.005). Anterior-posterior sway on eyes-closed-unstable-ground condition was correlated with functional status (P = 0.02). Static balance on eyes-opened-unstable-ground condition and anterior-posterior sway parameters were correlated with physical activity level (P = 0.015,P = 0.016,P < 0.05).

INTERPRETATION

Closing eyes and the deterioration of ground caused significant alteration of the static and dynamic balance both separately and together in patients with lower-limb-lymphedema compared to healthy subjects. Regarding the static and dynamic imbalance, we suggest the evaluation of balance and inclusion of balance exercises in routine lymphedema rehabilitation program, especially in the early period of disease.

How virtual reality is impacting balance: An examination of postural stability

BACKGROUND

The interest in virtual reality (VR) applications has been on the rise in recent years. However, the impact of VR on postural stability remains unclear.

RESEARCH QUESTION

The study has two primary objectives: first, to compare postural stability in a 3D-immersed virtual reality environment (VE) and a real environment (RE), and second, to investigate the effect of positive and negative visual feedback, which are subconditions of VE on postural stability.

METHODS

The observational study recruited 20 healthy adults (10 male, 10 female, 22.8 ± 1.8 years) who underwent postural stability assessments in both RE and VE. In VE, participants received visual stimuli in three different ways: without visual feedback, with positive and negative visual feedback that they would consider themselves to be directed towards postural stability outcomes. The RE included two conditions: eyes open (EO) and eyes closed (EC). Postural stability was evaluated with sway velocity, sway area, and perimeter variables obtained from a force platform.

RESULTS

All postural stability variables were significantly lower in the RE than in the VE (p < 0.05). There was no significant difference between the VE and EC in terms of sway velocity and sway area (p > 0.05). The visual feedback in the VE did not affect participants' postural stability (p > 0.05). VE may cause an increase in postural sway variables compared to RE and postural requirements may be higher in VE compared to RE.

SIGNIFICANCE

This is the first and only study examining the effect of different visual feedback on postural stability in VE.

Effects of lunges inserted in walking (eccentric walking) on lower limb muscle strength, physical and cognitive function of regular walkers

INTRODUCTION

Walking is a popular exercise but does not increase lower limb muscle strength and balance. We hypothesized that muscle strength, physical and cognitive function would be improved by inserting lunges in conventional walking.

METHODS

Eleven regular walkers (54-88 years) who had more than 5000 steps in exercise walking a day at least 5 days a week participated in this study. They walked as usual for the first 4 weeks and included lunges and descending stairs or slope walking (i.e., eccentric walking) for the next 8 weeks. The steps of eccentric walking were gradually increased from 100 to 1000 steps per week over 8 weeks.

RESULTS

The average steps per day were 10,535 ± 3516 in the first 4 weeks, and 10,118 ± 3199 in the eccentric walking period without a significant difference. No significant changes in maximal voluntary isometric contraction torque of the knee extensors (MVC), 30-s chair stand (CS), 2-min step, balance assessed by center of pressure movement area with eyes close, sit and reach, a digit symbol substitution test (DSST) for cognitive function were observed in the first 4 weeks. However, significant (P < 0.05) improvements were evident in MVC (18.6 ± 15.7%), CS (24.2 ± 17.3%), balance ( - 45.3 ± 34.5%), and DSST (20.8 ± 16.7%) from weeks 4 to 12. Serum complement component 1q concentration decreased (P < 0.05) from weeks 4 to 12, although no changes in serum glucose, triglyceride, and cholesterol concentrations were observed.

CONCLUSION

These results supported the hypothesis, and suggest that eccentric walking provides effects that are not achieved by conventional walking.

Is there a relationship between static postural control and core stability? A cross-sectional study in soccer players with groin pain

Background

Static postural control disorders have been documented in soccer players suffering from groin pain (GP). Understanding the mechanisms of these disorders is crucial in designing rehabilitation programs.

Objectives

To (i) assess static postural control and core stability in soccer players suffering from GP compared to their peers and (ii) explore the relationship between these two parameters.

Methods

This cross-sectional study involved 42 male soccer players suffering from GP (GP group: GPG) and 42 healthy players (control group: CG). Static postural control (stabilometric platform) and core stability (core endurance tests) were assessed.

Results

Center of pressure velocity in the GPG was significantly higher compared to the CG during bipedal stance on the firm surface with eyes closed (2.66 [95 % CI: 0.86-3.67]; p < 0.01) and on the foam one (p < 0.001) in both conditions; eyes opened (2.88 [95 % CI: 1.42-4.43]) and closed (5.88 [95 % CI: 2.66-9.10]), and on the IL in eyes closed (12.54 [95 % CI: 4.27-20.80]; p < 0.01). Besides, GPG revealed significant (p < 0.001) lower core stability measures compared to CG. No significant associations (p > 0.05) were observed between static postural control and core stability in GPG.

Conclusion

Soccer players suffering from GP showed static disorders of postural control compared with their peers. These impairments were not associated with measures of core stability. These findings provide insight into the direction of future research exploring the mechanisms underlying deficits in static postural control in soccer players suffering from GP.

The stepping test, and infrared depth sensor, provide reliable measures of balance in community-dwelling older adults

[Purpose] The purpose was to examine relationships between variables characterizing the 20-second stepping test movement pattern, assessed with an infrared depth sensor (KinectTM), and measurements of dynamic and static balance. [Participants and Methods] A total of 27 independent-living, older adults (7 males and 20 females) participated in this study. For each participant, the stepping test total movement distance, movement displacement, knee movement distance, and step number were calculated from Kinect closed joint-point coordinate data. Dynamic and static balance were assessed using a NeuroCom Balance Master Platform system. [Results] The stepping test total movement distance had a moderate negative correlation with endpoint excursion (r=-0.469) and a moderate positive correlation with total movement distance, corrected for knee movement distance (r=0.557). Step numbers had a moderate negative correlation with stepping test total movement distance (r=-0.667) and total movement distance, corrected for knee movement distance (r=-0.531). Division into high and low-balance sub-groups (based on endpoint excursion or sway velocity scores) revealed that stepping test total movement distances and movement displacements were greater, and step numbers were fewer, in low balance groups. [Conclusion] The stepping test, combined with a KinectTM-assessed movement pattern provides a simple, objective, reliable means for assessing balance in community-dwelling, independent-living older adults.

Factors associated with balance impairments in the community-dwelling elderly in urban China

BACKGROUND

Identification of factors relevant to balance performance impairments in the elderly population was critical for developing effective interventions and preventions. However, there have been very limited data available based on large scale studies. The present study identified factors that independently contributed to performance impairments in overall balance, domains of static balance, postural stability, and dynamic balance, and individual items.

METHODS

A total of 1984 community-dwelling Chinese elderly from urban areas of Shanghai were recruited. Information on demographic characteristic, exercise, and health status were collected with a face-to-face interview. Balance performances were assessed on site by trained investigators based on the X16 balance testing scale. To identify the effectors, ordinal logistic regression analysis was applied for overall balance, static balance, postural stability, and dynamic balance. Binary logistic regression analysis was used for 16 items.

RESULTS

The community-dwelling elderly residents were aged from 60 to 97 years old. With increases of age, risks of impairments in overall balance increased gradually (ORs from 1.26 to 3.20, all P < 0.01). In the elderly with overweight and obesity, there was higher proportion of balance impairments compared to the elderly with normal BMI (OR = 1.26, P < 0.001). Regular exercise every week was associated with reduced risks of balance impairments (ORs from 0.63 to 0.73, all P < 0.001). Presences with vision lesion (ORs from 1.28 to 1.59, all P < 0.001), moderate hearing impairment (OR = 1.54, P < 0.001), somesthesis dysfunction (ORs from 1.59 to 13.26, all P < 0.001), and cerebrovascular disease (OR = 1.45, P = 0.001) were related to increased risks of balance impairments. Likewise, age, exercise, vision, hearing, somesthesis, and cerebrovascular disease were significantly associated with static balance, postural stability, and dynamic balance. Both overweight and obesity and underweight were associated with higher proportions of dynamic balance impairments. Regular exercise was significantly related to reduced risks of impairments in 15 out of the 16 items.

CONCLUSIONS

In the elderly, age, overweight and obesity, exercise, vision, hearing, somesthesia, and cerebrovascular disease were dominant factors associated with impairments in overall balance, domains of static balance, postural stability, and dynamic balance, and most individual items.

TRIAL REGISTRATION

Not applicable.

Mental fatigue does not affect static balance under both single and dual task conditions in young adults

The ability to control balance and prevent falls while carrying out daily life activities may require a predominantly controlled (cognitive) or automatic processing depending on the balance challenge, age, or other factors. Consequently, this process may be affected by mental fatigue which has been shown to impair cognitive abilities. Controlling static balance in young adults is a relatively easy task that may proceed automatically with minimal cognitive input making it insusceptible to mental fatigue. To investigate this hypothesis, static single and dual task (while concurrently counting backward by seven) balance was assessed in 60 young adults (25.2 ± 2.4 years) before and after 45 min of Stroop task (mental fatigue condition) and watching documentary (control), presented in a randomized counterbalanced order on separate days. Moreover, because mental fatigue can occur due to task underload or overload, participants carried out two different Stroop tasks (i.e., all congruent, and mainly incongruent trials) on separate days in the mental fatigue condition. Results of the study revealed a significantly higher feeling of mental fatigue after the mental fatigue conditions compared to control (p < 0.001). Similarly, the performance on congruent Stroop trials decreases with time indicating objective mental fatigue (p < 0.01). However, there was no difference in balance or concurrent task performance under both single and dual task assessments between the three conditions (p  > 0.05) indicating lack of effect of mental fatigue on static balance in this population. Therefore, future studies investigating this phenomenon in occupational or sport settings in similar population should consider using more challenging balance tasks.

Effects of arm movement strategies on emotional state and balance control during height-induced postural threat in young adults

BACKGROUND

It is firmly established that postural threat seems to lead to an increased. reliance on an ankle control ('stiffening') strategy. However, little is known about how. postural threat affects performance in challenging tasks that require the use of upper. body postural control strategies for stability. It is logical to assume that in such. conditions, being able to utilise an upper body strategy may reduce the reliance on. such ankle stiffening strategy. Research question The objective of this study was to determine how arm movement. influences balance control during a challenging balance task performed under. conditions of postural threat.

METHODS

Thirty young adults (mean ± SD age; 22.0 ± 4.0 years) balanced in tandem. stance whilst standing at both ground-level (no threat) and 0.8 m above ground. (threat). In both conditions, participants performed the task under two different arm.

POSITIONS

restricted arm movements and free arm movements. Postural sway. amplitude and frequency were calculated to infer postural stiffening response. Selfreported. emotional responses were quantified by assessing balance confidence, fear. of falling, perceived stability, and conscious balance processing.

RESULTS

Independent of arm movements, postural threat evoked an increase in fear of. falling and conscious balance processing, and reductions in balance confidence and. perceived stability. These threat-related changes in emotional state were further. amplified when arm movements were restricted. Whilst significant increases in sway. frequency during threat were observed in both arm conditions, reductions in sway. amplitude were only observed during the restricted arm movement condition.

SIGNIFICANCE

We propose that these responses likely reflect a fear-related cautious. strategy intended to reduce the postural destabilisation associated with individuals. being unable to use their arms to counter any destabilisation, as would normally be the. case in daily life.

Effects of Motor-Cognitive Dual-Task Standing Balance Exergaming Training on Healthy Older Adults' Standing Balance and Walking Performance

Objective: This study examined the effects of motor-cognitive dual-task exergaming standing balance training on healthy older adults' static, dynamic, and walking balance. Methods: Twenty-four adults older than 70 years (control group: n = 9, males = 6, balance training group: n = 15, males = 8) completed the experiment. Dual-tasking standing balance training comprised the accurate control of a ping-pong ball on a tray held with both hands, while standing on one leg (analog training) and three modules of Wii Fit™ exergaming (digital training). The duration of balance training was ∼15 minutes per day, 2 days per week for 8 weeks, in total 16 sessions. We measured one-leg standing time, functional reach distance, walking balance evaluated by the distance walked on a narrow beam (4-cm long, 4-cm wide, and 2-cm high) with single and dual tasking, habitual and maximal walking speed, and muscle strength of the hip extensor, hip abductor, hip adductor, knee extensor, and plantarflexor muscle groups in the right leg at baseline and after 8 weeks. Results: Control group decreased, but balance training group increased one-leg standing time. Only the balance training group improved functional reach distance and hip and knee extensor strength. There was no change in walking speed and walking balance in either group. In the balance training group, changes in maximal speed correlated with changes in dual-tasking walking balance and changes in one-leg standing time correlated with changes in single-tasking walking balance. Conclusion: These results suggest that 16 sessions of motor-cognitive dual-task standing exergaming balance training substantially improved healthy older adults' static and dynamic balance and leg muscle strength but failed to improve walking speed and walking balance. Balance exercises specific to walking balance need to be included in balance training to improve walking balance.

Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies?

PURPOSE

To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance.

MATERIALS AND METHODS

Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05±7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60Hz and off-stimulation. Static balance tests were 'stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)'. These tests reported the centre of pressure data 'ellipse area, perimeter, front/back and mediolateral standard deviations'.

RESULTS

There were no statically differences between the static balance test results at any frequency (p>0.05), but results were found better at 90Hz. Stabilometric compared bipedal opened eye forward-backward standard deviation result was significant between off-stimulation and 130Hz (p=0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all p>0.05).

CONCLUSION

This study showed that STN-DBS did not affect the static balance negatively. Low-frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges.

Clinical Evaluation of Balance in Children With Hemophilic Arthropathy

Purpose

Hemophilia is a hereditary coagulation disorder characterized by acute hemorrhages into the musculoskeletal system, leading eventually to arthropathy and disability. Chronic inflammation of the synovial membrane arises as a result of frequent joint hemorrhage. Proteolytic enzymes in the blood and cartilage cause deterioration after that, and joint space narrows. Chronic hemophilic arthropathy develops as a result of these unfavorable developments, which occur more quickly, especially in the target joints. Balance is a process that allows us to maintain our orientation in three-dimensional space while also regulating our body posture to avoid falling. After the central nervous system evaluates deep stimuli from sensory, visual, and auditory receptors, movement of the corresponding muscle groups is delivered.

Methods

The goal of this study was to investigate how impairment to deep sensory receptors (proprioception) in the arthropathic joint structure affected hemophiliacs' balance. The study comprised 34 patients with hemophilic arthropathy, and 34 age and weight matched healthy volunteers.

Results

When balance tests of patients with hemophilic arthropathy were compared to healthy controls, hemophiliacs had a greater risk of falling. As the degree of arthropathy increased, so did the risk of falling and balance test values in individuals with hemophilic arthropathy.

Conclusions

Treatment and coagulation factor prophylaxis to prevent the onset of arthropathy will improve patients' quality of life and reduce morbidity associated with frequent falls and bleeding.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12288-022-01526-0.

Dysfunction in dynamic, but not static balance is associated with risk of accidental falls in hemodialysis patients: a prospective cohort study

Background

Patients with chronic kidney disease undergoing hemodialysis (HD) have a high incidence of falls. Impairment of balance function is a risk factor for falls in the general elderly, and no report examining the association between balance dysfunction and fall incidence in HD patients exists.

Methods

This prospective cohort study was conducted at a single center. The timed-up-and-go test (TUG) as a dynamic balance function was performed and length of the center of pressure (CoP) as a static balance function was measured before and after the HD session at baseline. Data of the number and detailed information of accidental falls for 1 year were collected. Multiple regression analyses were performed to assess the relationships between the number of falls and balance function.

Results

Forty-three patients undergoing HD were enrolled in the study. During 1 year of observation, 24 (55.8%) patients experienced accidental falls. TUG time was longer, and CoP was shorter in the post-HD session than in the pre-HD session. Adjusted multiple regression analyses showed that the number of accidental falls was independently associated with TUG time in the pre-HD session (B 0.267, p < 0.001, R² 0.413) and that in the post-HD session (B 0.257, p < 0.001, R² 0.530), but not with CoP.

Conclusions

Dynamic balance was associated with fall incidence in maintenance HD patients. The evaluation and intervention of dynamic balance function might reduce the risk of falls in HD patients.

Trial registration

This study was carried out with the approval of the Niigata Rinko Hospital Ethics Committee (approval number 2005–92) (Registered on December 11, 2019) and registered in The University Hospital Medical Information Network (registration number 000040618).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02877-6.

Quantitative Romberg using a force plate: an objective measure for cervical myelopathy

BACKGROUND CONTEXT

Surgical decision making for cervical spondylotic myelopathy (CSM) relies on evaluation of symptoms and physical examination. The Romberg test is a clinical exam used to identify balance issues with CSM. However, the Romberg test has a subjective interpretation and has a binary (positive or negative) result.

PURPOSE

This study aims to compare force plate pressure readings during a standard Romberg test in patients with CSM to age-matched normal healthy volunteers.

STUDY DESIGN/SETTING

Prospective cross sectional observational comparative cohort from a single multi-surgeon spine center.

PATIENT SAMPLE

Patients who were clinically diagnosed with CSM were compared to age-matched healthy volunteers without a clinical history of spine pathology.

OUTCOME MEASURES

Quantitative Romberg Force Plate Measurements METHODS: Patients with CSM requiring surgery and healthy normal volunteers were asked to perform the Romberg test while on a force plate measuring the center of pressure (COP): standing up straight with arms extended for 30 seconds with eyes open, followed by 30 seconds with eyes closed. The change for total sway area, sway frequency and sway speed with eyes closed and eyes open were calculated and compared between patients with CSM and healthy volunteers.

RESULTS

Thirty-four CSM patients were age-matched to 34 healthy volunteers. There was a larger change in quantitative Romberg measurements with eyes open versus eyes closed in CSM patients compared to normal volunteers for maximum lateral movement (10.79 cm vs. 0.94 cm, p=.003), maximum anterior-posterior movement (15.06 cm vs. 10.00 cm p=.201), total lateral CoP movement (89.82cm vs. 18.71cm, p=.007), total AP CoP movement (154.68 cm vs. 87.47 cm, p=.601), total CoP trace movement (199.79 cm vs. 88.44 cm, p=.014), sway area (284.74 cm² vs. 57.76 cm², p=.006), and average speed (7.00 cm/s vs. 2.91 cm/s, p=.006).

DISCUSSION

Poor standing balance can be quantified in patients with CSM. Quantifying standing balance in patients with CSM shows significantly worse objective measures than age-matched healthy volunteers. The Romberg test on a force plate may help diagnose and evaluate patients with CSM, guide patient management and potentially grade the severity of spinal pathology. Further studies are needed to determine its utility in monitoring disease progression and measure treatment effectiveness.

Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers

Objective

Tibial cortex transverse distraction (TCTD) has been recently reported for the treatment of diabetic foot ulcers. Herein, we explored the characteristics of the impairments in static balance and plantar load distribution in patients.

Methods

We performed a retrospective study of 21 patients with diabetic foot ulcers who underwent TCTD, who were regularly followed up for > 1 year after surgery, and 20 healthy individuals (control group). A pressure platform was used to assess the standing balance functions of the lower extremities and the plantar load distribution.

Results

One patient underwent amputation because of severe infection. In patient group, center of pressure (COP) ellipse sway area, COP path length and angle θ were all larger, compared with those of control group (250.15 ± 98.36 mm² vs. 135.67 ± 53.21 mm², 145.15 ± 67.43 mm vs. 78.47 ± 34.15 mm, 39.75 ± 17.61° vs. 22.17 ± 14.15°), with statistically significant differences (P < 0.01). The average plantar load and backfoot load of the unaffected side was significantly larger than that of the affected side (58.4 ± 5.5% vs. 41.6 ± 5.5%, 45.3 ± 6.4% vs. 36.5 ± 5.6%), but they were similar for the two feet of members of the control group.

Conclusions

Although TCTD may represent an appropriate method for the treatment of diabetic foot ulcers, postoperative impairments in static balance and plantar load distribution remain in the long term. These potential long-term problems should be taken into account in further rehabilitation planning.

Type of study/level of evidence: Therapeutic III.

Reliability analysis of inertial sensors for testing static balance of 4-to-5-year-old preschoolers

BACKGROUND

Balance ability is important for preschoolers' motor and physical development. Portable accelerometers can provide resolution tests and identification of preschoolers with balance defects.

RESEARCH QUESTION

Despite previous studies on the balance measures of accelerometer tests, there is a lack of complete analyses for preschoolers aged 4-5 years. In this study, we aim to verify the reliability of measuring the static balance of preschoolers in this age range based on inertia sensors for the acceleration and angular velocity moduli.

METHODS

Thirty children wore an inertial sensor in the 5th lumbar vertebra and completed four tests, i.e., standing on a firm surface and on a foam surface with open and closed eyes. The standard deviation of the acceleration modulus and root mean square of the angular velocity modulus were calculated. The analysis was based on the intraclass correlation coefficient (ICC) to determine the internal consistency and feasibility.

RESULTS

The ICC of the acceleration modulus was between 0.597 and 0.683 (P < 0.01), and the test-retest reliability was medium. The ICC of the angular velocity modulus was between 0.683 and 0.812 (P < 0.01, P < 0.001), and the test-retest reliability was medium to good. The standard error of measurement (SEM) of the acceleration modulus was between 0.001591 and 0.007248 (g), and the SEM% was between 21.24% and 34.12%. The angular velocity modulus SEM values ranged from 1.296 to 3.441 (deg/s), and the SEM% ranged from 25.17% to 33.26%. The difference between the two tests was evenly distributed on both sides of the mean value, and the difference between the test results was within the consistency limit.

SIGNIFICANCE

Inertial sensors can be used to evaluate the static balance ability of preschoolers aged 4-5 years. Further, the angular velocity modulus is more reliable than the acceleration modulus.

Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia

Purpose

In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied.

Methods

Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance.

Results

In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05).

Conclusions

The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.

Auditory noise improves balance control by cross-modal stochastic resonance

It is known that enhanced somatosensory function leads to improved balance, and somatosensory function can be enhanced by the appropriate level of mechanical, visual, or auditory noise. In this study, we tested the potential benefit of an auditory noise on balance control. We first assessed static balance by measuring 10 times the duration of standing on the toes of one leg with closed eyes. For the 18 healthy adult participants, the median standing times ranged from 2.1 to 45.6 s, and the median of the distribution was 9.9 s. From the above, the participants were divided into two groups: lower (below 10 s, n = 9) and higher (above 10 s, n = 9) balance groups. We then investigated the effect on balance control of an auditory white noise emitted at the detection threshold. Each individual performed 20 trials. The auditory noise was applied in half the trials, while the remaining trials were conducted without noise. The order of the noise and no-noise trials was quasi-random. In the lower-balance group, the median standing time significantly increased during the noise trials (10.3 s) compared with the time in the no-noise controls (5.2 s). On the other hand, noise had no significant effect in the higher-balance group, presumably because of a ceiling effect. These findings suggest that static balance in the lower-balance participants can be improved by applying a weak noise through cross-modal stochastic resonance.

Characteristics of balance performance in the Chinese elderly by age and gender

BACKGROUND

Population aging has been an emerging public and health concern globally. Balance performance can be applied as an indicator of functional status and a predictor of health outcomes in the elderly. However, reference data of balance performance in the elderly generated from large scale studies have been very limited. In research and geriatric assessment settings, the age and gender specific data on balance performance are indispensable prerequisites for identifying subpopulation with and at risk of impairments and subsequently implementing targeted interventions in clinics and public health to improve their balance performance.

METHODS

A total of 1984 elderly subjects aged 60 to 97 years from community settings in urban China were investigated. The balance performances together with 3 individual domains and 16 items were evaluated using the X16 balance testing scale.

RESULTS

In the elderly, with age increases each item, individual domain, and overall balance performance scores decreased gradually. Meanwhile, individual variations of individual domains and overall balance performance were all increased over age. Relative to levels of 60- years, postural stability and overall balance performance decreased significantly since 65 years old, static balance and dynamic balance capacities started to decrease significantly since 70 years old. There was no significant difference in each balance domain and overall balance performance between men and women. Across age groups, portions of individuals able to perform task 4, 8 and 11 successfully were the lowest amongst their corresponding domains static balance, postural stability, and dynamic balance, respectively. Similar patterns were observed in both men and women. Balance performances were categorized into poor, fair, and good groups with scores of 0 to 10, 11 to 17, and 18 to 20, respectively. With increases of age, proportions with poor and fair balance capacities elevated stably.

CONCLUSIONS

In the elderly, with advances in age, abilities of overall balance performance, individual domains of static balance, postural stability, and dynamic balance, and successful performances on specific tasks declined gradually and stably. The deterioration started to be obvious since 65-75 years. Men and women had similar patterns.

Initial experience of balance assessment introduces 'first trial' effects on emotional state and postural control

BACKGROUND

Anxiety and arousal have been shown to influence balance control and, therefore, have the potential to confound balance assessment. It has been suggested that the 'first-trial' effect, where performance on the first trial of a balance task differs from subsequent trials, may be a result of participants being more anxious during their first experience of having their balance assessed. However, this remains speculative since limited work has simultaneously examined emotional state and balance control during repeated assessment of the same balance task.

RESEARCH QUESTION

Determine how emotional state and standing balance control change over the course of repeated assessment.

METHODS

Seventy-five healthy young adults completed five 120-s quiet standing trials. Psychological state was probed at each trial using self-report measures that assessed confidence, anxiety, and attention focus. Arousal was estimated from electrodermal activity and balance control was assessed from centre of pressure (COP) measures derived from forceplate data. Repeated measures ANOVAs were conducted to determine how each of these estimates changed with repeated testing.

RESULTS

There were significant changes in emotional state with repeated testing; self-report and autonomic measures indicated that participants were most anxious and physiologically aroused during the first trial. This emotional response diminished with repeated testing, although the greatest changes occurred from the first to second trial. Despite these changes in emotional state, only some COP outcomes significantly changed. Individuals leaned further forward during only the first trial and demonstrated higher frequency and velocity mediolateral COP oscillations during the first two trials.

SIGNIFICANCE

When balance is assessed for the first time in an unfamiliar laboratory setting, there is a transient emotional response which appears sufficient to influence some aspects of balance control. It is critical to control for these confounds when designing experiments or interventions involving balance assessment.

Effects of Pilates training VS. Suspension training on quality of life in women with knee osteoarthritis: A randomized controlled trial

INTRODUCTION

Osteoarthritis is the most common synovial joint disease and is characterized by progressive destruction of the articular cartilage. This study aimed to compare the effect of Pilates and suspension training in patients with knee Osteoarthritis.

METHODS

The participants in this randomized trial study were patients with knee Osteoarthritis. In this study, 30 females (61.40 ± 4.85 years) were divided into three groups of suspension training, Pilates, and control group. Participants were randomly assigned to 8-week (3x/week, 1 h/session) Pilates and suspension training program groups. The static and dynamic balance, range of motion, and knee function were respectively measured by The Stork stand balance test, Y balance test, Goniometers, and The WOMAC performance disability questionnaire. To analyze the findings, a dependent sample t-test, covariance test, and Bonferroni's post hoc test were used (P ≤ 0.05).

RESULTS

Dynamic and static balance in the suspension training and Pilates training caused a significant increase (P ≤ 0.05) compared to the control group. Also, the range of motion and motor performance in the suspension training and Pilates training showed a significant decrease (P ≤ 0.05) compared to the control group. The suspension training compared to the Pilates training was more effective on dynamic and static balance (P ≤ 0.05). Also, the suspension training compared to the Pilates training had more effect on Range of motion and Motor performance (P ≤ 0.05).

CONCLUSION

It seems that Pilates and suspension training can be used in medical centers as a complementary rehabilitation method among female patients with knee Osteoarthritis to improve the dynamic and static balance, range of motion, and performance.

Brain connectivity during simulated balance in older adults with and without Parkinson's disease

Individuals with Parkinson's disease often experience postural instability, a debilitating and largely treatment-resistant symptom. A better understanding of the neural substrates contributing to postural instability could lead to more effective treatments. Constraints of current functional neuroimaging techniques, such as the horizontal orientation of most MRI scanners (forcing participants to lie supine), complicates investigating cortical and subcortical activation patterns and connectivity networks involved in healthy and parkinsonian balance control. In this cross-sectional study, we utilized a newly-validated MRI-compatible balance simulator (based on an inverted pendulum) that enabled participants to perform balance-relevant tasks while supine in the scanner. We utilized functional MRI to explore effective connectivity underlying static and dynamic balance control in healthy older adults (n = 17) and individuals with Parkinson's disease while on medication (n = 17). Participants performed four tasks within the scanner with eyes closed: resting, proprioceptive tracking of passive ankle movement, static balancing of the simulator, and dynamic responses to random perturbations of the simulator. All analyses were done in the participant's native space without spatial transformation to a common template. Effective connectivity between 57 regions of interest was computed using a Bayesian Network learning approach with false discovery rate set to 5%. The first 12 principal components of the connection weights, binomial logistic regression, and cross-validation were used to create 4 separate models: contrasting static balancing vs {rest, proprioception} and dynamic balancing vs {rest, proprioception} for both controls and individuals with Parkinson's disease. In order to directly compare relevant connections between controls and individuals with Parkinson's disease, we used connections relevant for predicting a task in either controls or individuals with Parkinson's disease in logistic regression with Least Absolute Shrinkage and Selection Operator regularization. During dynamic balancing, we observed decreased connectivity between different motor areas and increased connectivity from the brainstem to several cortical and subcortical areas in controls, while individuals with Parkinson's disease showed increased connectivity associated with motor and parietal areas, and decreased connectivity from brainstem to other subcortical areas. No significant models were found for static balancing in either group. Our results support the notion that dynamic balance control in individuals with Parkinson's disease relies more on cortical motor areas compared to healthy older adults, who show a preference of subcortical control during dynamic balancing.

The relationship between attention and static balance disturbance in patients with Parkinson's disease

OBJECTIVE

Balance disturbance is one of the main complications of the Parkinson's disease (PD). As studies have shown that impairments in some cognitive processes can lead to balance problems, we investigated the relationship between focused and divided attention and static balance in patients with PD and a healthy control group.

METHODS

We included 111 patients with PD (M age = 49.41, SD = 6.33 years) and 142 healthy individuals (M age = 50.62, SD = 6.07 years). All participants were evaluated with the Trails Making Test A and B (TMT), and all participants' balance was evaluated with a Wii Balance Board, from which we measured the antero-posterior (AP), medio-lateral (ML), and total center of pressure (COP) velocity. We compared the two groups in terms of TMT-A, TMT-B, and COP velocity tests in both eyes-open and eyes-closed conditions with independent t-tests, and we calculated Pearson's correlation coefficients between the balance board-derived outcomes and the TMT scores.

RESULTS

The two groups differed significantly on TMT-A and TMT-B scores, in total and ML COP velocity in both eyes-closed and eyes-open conditions, and in AP COP velocity only in eyes-open condition. Among patients with PD, TMT-A and TMT-B scores were positively correlated with total, ML, and AP COP velocity, in both eyes-open and eyes-closed conditions.

CONCLUSIONS

Associated attention deficits may be among the causes of balance disturbances in patients with PD, though both attention and balance may have a common root in brain circuitry.

The effects of instrument-assisted soft tissue mobilization rehabilitation exercise on range of motion, isokinetic strength, and balance in chronic ankle instability taekwondo players

We aimed to investigate change the instrument-assisted soft tissue mobilization (IASTM) rehabilitation exercise on range of motion (ROM), isokinetic ankle strength, and balance. We included 20 elite taekwondo players (chronic ankle instability) in Korea. They were divided into the IASTM group (n=10), control group (n=10). IASTM group were exercised with IASTM rehabilitation exercise four times per week for 8 weeks. The remaining control group did not receive exercise intervention between tests and served as the control. A goniometer was used to measure dorsi-flexion (D/F), plantar-flexion (P/F), a dynamometer was used to measure ankle isokinetic strength, and plantar foot pressure was used to measure static balance. The data were analyzed using repeated-measures analysis of variance. Significant differences were observed between the two groups in IASTM group and control group: ROM (right P/F, P<0.001; right D/F, P<0.01; left P/F, P<0.000; left D/F, P<0.000), isokinetic strength (right P/F 60°, P<0.000; right D/F 60°, P<0.000; left P/F 60°, P<0.000; left D/F 60°, P<0.000; right P/F 180°, P<0.000; right D/F 180°, P<0.000; left: P/F 180°, P<0.000, left D/F 180°, P<0.000), and balance test (static eye open, P<0.000; static eye close, P<0.000; postural stability, P<0.041). These results suggest that IASTM rehabilitation exercise improves ankle stability, muscle power, and body balance in chronic ankle instability taekwondo players.

Effects of bodyweight neuromuscular training with and without instability on balance control in active universitarians

The purpose of this study was to analyse the effects of a nine-week unstable vs stable bodyweight neuromuscular training programme on balance control. Seventy-seven physically active universitarians were randomly distributed into an unstable training group (UTG), a stable training group (STG), and a control group (CG). The intervention was conducted three times a week for nine weeks. Pre- and post-intervention assessments included static balance control under an unstable surface (eyes open (EOFS), eyes closed (ECFS), challenging visual-vestibular system (CVVS)), assessed as centre-of-pressure fluctuations with a force plate. A mixed ANOVA was performed to test the within- and between-subjects factors. After the intervention, no significant differences were found between groups. All groups presented significant improvements in balance measurements in EOFS (p = 0.01), ECFS (p = 0.01; p = 0.02), and CVVS (p = 0.01) conditions. The training groups tended to have significantly better balance control (antero-posterior) than the CG on EOFS. In the CVVS condition, the UTG tended to have better balance control than the CG. There was no overall significant training advantage gained by using unstable or stable surfaces in terms of the improvement in static balance control in active universitarians. Both training groups exhibited similar training adaptations.

Balance alterations and reduction of pedunculopontine cholinergic neurons in early stages of parkinsonism in middle-aged rats

The purpose of the present study was to investigate balance alterations and the possible role of the cholinergic neurons in the pedunculopontine nucleus (PPN) in the early stages of a progressive animal model of Parkinson's disease (PD). Twenty-eight middle-aged (8-9 months) male Wistar rats received 4 or 10 subcutaneous vehicle (control, CTL) or reserpine (RES) injections (0.1 mg/kg). The animals were submitted to different behavioral tests. Forty-eight hours after the 4th injection, half of the animals of each group (n = 7) were perfused and submitted to immunohistochemical analysis for tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT). The remaining animals (n = 7 per group) were killed 48 h after the 10th injection. RES group presented motor deficits in the catalepsy and open field tests starting at days 12 and 20 of treatment, respectively (only for the animals that received 10 injections). On the other hand, dynamic and static balance changes were observed at earlier stages of RES treatment, starting at days 6 and 4, respectively. At this point of the treatment, there was no decrease in the number of TH immunoreactivity neurons in the substantia nigra pars compacta (SNpc), ventral tegmental area (VTA) and dorsal striatum (DS). However, a decrease was observed in SNpc and dorsal striatum of animals that received 10 injections. In contrast, there was a decrease in the number of ChAT immunoreactive cells in PPN concomitantly to the balance alterations at the early stages of treatment (after 4 RES injections). Thus, by mimicking the progressiveness of PD, the reserpine model made it possible to identify static and dynamic balance impairments prior to the motor alterations in the catalepsy and open field tests. In addition, changes in balance were accompanied by a reduction in the number of ChAT immunoreactive cells in NPP in the early stages of treatment.

The Effects of Aquatic Versus Kata Techniques Training on Static and Dynamic Balance in Children with Autism Spectrum Disorder

The present study aimed to compare the effect of a land-based and a swimming-based exercise program on balance abilities in children with autism. Thirty children were voluntarily selected and randomly assigned to karate exercise, aquatic training and control groups. Participants practiced for 10 weeks, 2 sessions of 60 min per week. Before and after the 10-week intervention, static and dynamic balance tests were administered. The results showed that both interventions had a significant effect on balance abilities (p < 0.001); interestingly, we found the greater improvement in balance performance in kata techniques group. Due to the importance of balance performance on daily functions, communication and interaction skills, karate and swimming exercises can be the valuable interventions added to autism's daily programs. Iranian Registry of Clinical Trials number: IRCT20180626040242N1.

Effects of Nintendo Wii fit game training on balance among Lebanese older adults

BACKGROUND

Falls are the second leading cause of accidental death, with persons older than 65 years being the most affected. Moreover, gait- and balance-related problems represent the most consistent predictors of future falls.

AIMS

The aim was to determine the effects of Wii fit game training on dynamic and static balance among Lebanese older adults.

METHODS

A randomized-controlled trial was conducted over a period of 8 weeks, where institutionalized older adults with no history of falls were randomized into two groups. The participants of each group were carefully followed up during the intervention and data collection periods. The intervention group was trained for standing balance during a 40-min session, starting with the "Soccer Heading" game during the first 4 weeks, followed by the "Table Tilt" game for the remaining 4 weeks. Timed up-and-go (TUG) test and the Nintendo Wii Balance Board were used to measure the dynamic and static balance, respectively, both at baseline and post-intervention.

RESULTS

Sixty-four participants recruited from both, the Tyre and Saida districts were enrolled in the study. Within-group comparison of TUG test values between baseline and post-intervention; both groups showed an extremely significant difference (P = 0.000). Similarly, the between-group comparison showed a significant difference (P = 0.013). Concerning the center of pressure measures, only the intervention group showed a very significant improvement between baseline and post-intervention measures (P = 0.002).

CONCLUSION

Wii fit balance training is a valid method for improving both dynamic and static balance among Lebanese older adults.

Static balance assessment in patients with severe osteoarthritis of the knee

BACKGROUND

Pain related to severe knee osteoarthritis may lead to static balance disorders. Patients with severe knee arthrosis with arthroplasty indication should be aware of the postoperative rehabilitation menu because their balance ability has decreased.

METHODS

The study involved 33 patients with unilateral severe osteoarthritis (the study group) and 33 healthy subjects (the control group). We conducted the measurements of static balance with the CQStab2P platform. Functional disability was assessed using the Knee Society Score (KSS).

RESULTS

In the study group, balance distribution asymmetry between lower limbs was higher. Patients unloaded the painful joints due to pain and knee instability. We observed statistically significant differences both with eyes open and with eyes closed only for balance symmetry. The study group had mean results of 53.9 (±19.1 SD) points in the KSS scales and 52.1 (±24.1) in the KSS function. There were statistically significant positive correlations regarding KSS and body height (0.270; P < 0.05), and negative correlations for body mass index (0.329; P < 0.01). In measurements with open eyes, patients' KSS correlated with mean amplitude of sways (-0,227; P < 0.01) and max anteroposterior (-0.279; P < 0.01). In measurements with eyes closed, KSS function correlated with number of sways in the sagittal plane (0.331; P < 0.01).

CONCLUSIONS

Patients with severe osteoarthritis suffered from balance disorders regarding limbs' asymmetrical loading both under visual control and without visual control.

Full-immersion virtual reality: Adverse effects related to static balance

The use of virtual reality (VR) is associated with several adverse effects including dizziness, headache, and motion sickness. This study investigates how full-immersion VR games cause changes in static balance with associated adverse effects, and whether a fixed or a changing game background is more likely to contribute to such problems. Static balance and adverse effects (eye fatigue and dizziness) were measured in 15 healthy adults under three conditions: baseline; after a full-immersion virtual reality game (PlayStation 4 Pro and PlayStation® VR headset) with a fixed background (15 min); and after a full-immersion virtual reality game with a unfixed background (15 min). Static balance was measured with an AMTI force plate, while eye fatigue and dizziness were measured with the Virtual Reality Symptom Questionnaire (VRSQ) and the Simulator Sickness Questionnaire (SSQ). It was determined that playing a full-immersion VR game had a negative effect on static balance and produced several adverse effects including eye fatigue and dizziness. Moreover, sway velocity and sway length increased significantly in the game with a moving background compared to both the baseline and the game with a fixed background (p < 0.05); VRSQ and SSQ were also significantly higher in this case. It is thus preferable from the perspective of reducing adverse effects that only fixed-background full-immersion VR games be used in rehabilitative interventions.

The effect of unilateral muscle fatigue of hip abductor muscles on balance and functional capacity in community-dwelling older women

BACKGROUND

Hip abductor muscles are important for the maintenance of postural stability, mainly on the mediolateral direction and unipodal support conditions. The objective of the present study was to evaluate the effect of unilateral induced fatigue of hip abductor muscles on balance and functional capacity of older women.

METHODS

The study included physically independent women aged 60-75 years. We assessed static balance with the single limb stance test (SLS) and evaluated functional capacity with the maximum gait speed (MGS) and step test (ST). We ran the protocol of hip abductor muscle fatigue with a Biodex isokinetic dynamometer. Assessment of balance and functional capacity happened before and after the muscle fatigue protocol. We applied the t-test for repeated measures to determine whether unilateral hip abductor muscle fatigue influences the performance in the tests (SLS, MGS and ST).

RESULTS

The protocol of hip abductor muscle fatigue negatively affected all three evaluated tasks: SLS (p = 0.000), ST (p = 0.000) and MGS (p = 0.000). However, the single limb stance test was the most task affected (effect size = 0.51, pre- and post-fatigue difference = 28.1 %).

CONCLUSION

After the unilateral muscle fatigue of hip abductors, we observed the worst performance on clinical tests, mainly regarding the SLS test, which shows the involvement of hip abductors during usual motor tasks. However, the small magnitude of the limitation of functional tests (MGS and ST) suggests the presence of postural compensations.

A temporary forward head posture decreases function of cervical proprioception

Increased use of smartphones can cause abnormal alignment of head and neck, resulting in forward head posture (FHP). This can lead to change in the structures and function of the cervical vertebrae. The purpose of this study was to determine the impact on deep neck flexor muscles, proprioception, vestibular function, and balance of subjects with induced FHP by using smartphone. Twenty-two healthy persons were randomly divided into two groups. The FHP group maintained a craniovertebral angle (CVA) of <49° and a normal head posture group maintained a CVA of >50° watching the smartphone for 40 min. We measured the area of the longus colli and longus capitis muscles, cervical joint position sense, Romberg test, subjective visual vertical test, and subjective visual horizontal test. There was no significant difference in the deep neck flexor muscles, vestibular function, and static balance between the groups. However, there was a significant difference in the cervical proprioception (P<0.05). Proprioception may be considered to be the most influential factor in induced FHP by smartphone viewing.

Effects of visual feedback training using transient Fresnel prism glasses on balance ability in stroke patients without hemispatial neglect

The center of mass of the body in patients with stroke was oriented toward the nonparetic side. Abnormal weight shift increases the risk of falls. Therefore, many therapists make an effort to help their functional recovery through balance training. Our aim was to investigate the effect of visual feedback intervention using a Fresnel prism on static and dynamic balance in stroke patients without hemispatial neglect. Participants were assigned to control group (n=10) and experimental group (n=9). In the control group, neurodevelopmental therapy was performance for 30 min. In the experimental group, Fresnel prism glasses were applied with neurodevelopmental therapy for 30 min. We executed motor-free visual perception test for visual perception, balancia for static balance ability, and functional reach test and Berg balance test for dynamic balance ability, respectively. All tests were measured immediately after intervention. The visual perception function showed significant difference between unaffected side performance behaviors and visual perceptual processing time (P<0.05). In the static balance, there was a significant difference in sway velocity and sway distances (P<0.05). Dynamic balance was also significant different between groups (P<0.05). Visual feedback using Fresnel prism helps to control the static and dynamic balance ability by inducing weight shift toward the affected side in stroke patients. Therefore, a Fresnel prism may be suggested as an intervention tool to assist weight training for patients with stroke.

Static and dynamic balances of patients with acromegaly and impact of exercise on balance

PURPOSE

Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly.

METHODS

This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device.

RESULTS

The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior-posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left-right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward-backward and medial-lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A.

CONCLUSIONS

Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.

Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy

PURPOSE

The aim of the study was to evaluate the effect of sensorimotor training on balance measures, and proprioception, among middle-aged and older adults with diabetic peripheral neuropathy (DPN).

METHODS

A randomized controlled study with four parallel arms (two intervention groups and two control groups) was conducted at CPRS, Jamia Millia Islamia. Thirty-seven individuals were selected on the basis of inclusion and exclusion criteria. Of these, 16 middle-aged and 21 older adults were randomly allocated to intervention and control groups, respectively. Subjects in the intervention group were administered eight weeks (3days/week) of sensorimotor training, involving 10 different types of exercises, progressed from easy to hard every two weeks, along with diabetes and foot care education; subjects in control group received diabetes and foot care education only. Outcomes measures involved static and dynamic balance measures, centre of pressure (COP) range, COP sway, and proprioception, measured before and after eight weeks.

RESULTS

Baseline measures showed significant age effect for timed up and go test (TUG) (p =  0.002), one leg stance (OLS) in eyes open (EO) and eyes closed (EC) (p ≤ 0.041), COP range in front (p =  0.007), back (p =  0.009) and right direction (p =  0.013), COP sway with visual feedback in front-back direction (p =  0.027), COP sway without visual feedback in left-right direction (p =  0.028), and proprioception in right direction (p =  0.026). After intervention, OLS EO and EC on both legs showed significant time effect (p ≤  0.003), group effect as well as time×group interaction (p <  0.05), and age effect and time×age interaction (p ≤  0.04). Functional reach test, TUG, COP range, COP sway, and proprioception were found with significant time effect (p <  0.03), group effect, and time×group interaction (p ≤  0.035). Age effect and time×age interaction were found to be non-significant for all COP ranges and COP sway.

CONCLUSION

Sensorimotor training improved static and dynamic balance as well as proprioception measures after eight weeks of exercise intervention. Static balance showed greater improvement in the middle-aged than older aged adults, while dynamic balance and proprioception showed similar results for both.

Comparison between eccentric and concentric resistance exercise training without equipment for changes in muscle strength and functional fitness of older adults

PURPOSE

The present study tested the hypothesis that resistance exercise training focusing on eccentric muscle contractions would improve muscle strength and functional physical fitness more than concentric contraction-focused resistance training in older adults.

METHODS

Healthy older adults (65-84 years) were placed into eccentric (ECC; n = 9) or concentric training group (CON; n = 8). They performed 4-6 basic manual resistance exercises focusing on either eccentric or concentric muscle contractions once at a community centre and at least twice at home a week for 8 weeks. Muscle thickness of the quadriceps femoris (MT), knee extensor maximal voluntary isometric contraction strength (MVC), 30-second chair stand (CS), 3-metre timed up and go (TUG), 2-minute step (2MS), sit and reach (SR), and static balance with eyes open and closed (Bal-EC) were assessed before and 7 days after the last community centre session.

RESULTS

Changes in MT (ECC: 21.6 ± 9.2% vs CON: 6.7 ± 7.1%), MVC (38.3 ± 22.6% vs 8.2 ± 8.4%), CS (51.0 ± 21.7% vs 34.6 ± 28.3%), TUG (16.7 ± 9.9% vs 6.3 ± 7.7%), 2MS (9.9 ± 6.0% vs 6.0 ± 7.3%) and Bal-EC (35.1 ± 6.7% vs 8.8 ± 16.2%) from baseline were greater (P < 0.05) for the ECC than the CON group.

CONCLUSION

These results show that the eccentric manual resistance exercise training was more effective for improving lower limb strength, mobility, and postural stability of older adults when compared with the concentric training. This suggests the significance of emphasising eccentric muscle contractions in movements to maintain and improve physical function.

The effects of textured insoles on quiet standing balance in four stance types with and without vision

Background

Wearing a textured shoe insole can decrease postural sway during static balance. Previous studies assessed bipedal and/or unipedal standing. In contrast, we aimed to investigate if textured insoles modulated postural sway during four stance types (bipedal, standard Romberg, tandem Romberg, and unipedal), with and without vision.

Methods

The repeated measures design involved 28 healthy young adults (13 females; mean age = 26.86 ± 6.6 yrs) performing quiet standing in the four stance types on a force platform, under two different insole conditions (textured insole; TI vs. smooth insole; SI), with eyes open and eyes closed. Postural sway was assessed via the range and standard deviation of the COP excursions in the anterior-posterior and medial-lateral sway, and overall mean velocity.

Results

The main effect of insole type was statistically significant at the alpha p = 0.05 level (p = 0.045). Compared to smooth insoles, textured insoles reduced the standard deviation of anterior-posterior excursions (APSD). While simple main effect analyses revealed this was most pronounced during eyes closed bipedal standing, insole type did not provide a statistically significant interaction with either stance or vision in this measure, or any other. Postural sway showed statistically significant increases across both stance type (bipedal < standard Romberg < tandem Romberg < unipedal), and vision (eyes closed < eyes open), in almost all measures. Stance and vision did have a statistically significant interaction in each measure, reflecting greater postural disturbances with eyes closed when stance stability decreased.

Conclusions

Overall, these results support textured insole use in healthy young adults to reduce postural sway measures. This is because APSD is an index of spatial variability, where a decrease is associated with improved balance and possibly translates to reduced falls risk. Placing a novel texture in the shoe presumably modulated somatosensory inputs. It is important to understand the underlying mechanisms by which textured insoles influence postural sway. As such, utilising a healthy adult group allows us to investigate possible mechanisms of textured insoles. Future research could investigate the potential underlying mechanisms of textured insole effects at a neuromuscular and cortical level, in healthy young adults.

Effects of heel height and high-heel experience on foot stability during quiet standing

BACKGROUND

The use of high-heeled shoes (HHS) introduces instability into the wearer's balance system but how high-heel experience might influence standing balance is less examined in literature.

RESEARCH QUESTION

(1) Does foot stability decrease in both the antero-posterior (AP) and medial-lateral (ML) directions with increasing heel height during quiet standing? (2) Does high-heel experience improve the wearer's foot stability during quiet standing in high-heeled conditions?

METHODS

Twenty-four young females (12 regular and 12 non-regular HHS wearers) were recruited to perform quiet standing while wearing shoes with heel heights of 1 cm, 5 cm, 8 cm and 10 cm. The effects of heel height on the mean center of pressure (COP), their variability (standard deviations) and mean COP velocities in both the AP and ML directions were analysed by one-way repeated measures ANOVA and Bonferroni post-hoc test. The effects of high-heel experience were analysed through independent samples t-tests.

RESULTS

The variability of the COP in both directions increased with heel height, although significance was found only in the ML direction. The COP velocities in both directions were highest for the 1 cm heel, decreased as the heel increased to 8 cm and increased again for the 10 cm heel. Experienced HHS wearers exhibited significantly smaller COP variances (AP) for the 8 cm and 10 cm heels, smaller COP velocities (AP) for all heels, and smaller COP variances (ML) and COP velocities (ML) for the 10 cm heel.

SIGNIFICANCE

The use of HHS results in greater stability distortions in both AP and ML directions but high-heel experience improves balance control under high-heeled conditions. Our findings enhance the understanding of how high-heel experience might influence standing balance in different heel height, and highlights the importance of the ML components of the in-foot COP measures in the examination of standing balance in HHS.

Evaluation of postural stability based on a force plate and inertial sensor during static balance measurements

BACKGROUND

Previous research on balance mostly focused on the assessment, training, and improvements of balance through interventions. We investigated tools commonly used to study static balance. Differences in postural stability were analyzed using multiscale entropy (MSE) and feature analysis.

METHODS

A force plate and inertial sensor were used to collect acceleration and center-of-pressure (COP) nonlinear signals. MSE was also used to detect fractal correlations and assess the complexity of univariate data complexity. Fifteen healthy subjects participated in the experiments. Each stood on a force plate and wore a sensor while attempting to maintain postural stability for 30 s in four randomized experiments to evaluate their static balance via a copositive experiment with eyes open/closed and with standing on one foot or both feet. A Wilcoxon-signed rank test was used to confirm that the conditions were significant. Considering the effect of the assessment tools, the influence of the visual and lower limb systems on postural stability was assessed and the results from the inertial sensor and force plate experiments were compared.

RESULTS

Force plate usage provided more accurate readings when completing static balance tasks based on the visual system, whereas an inertial sensor was preferred for lower-limb tasks. Further, the eyes-open-standing-on-one-foot case involved the highest complexity at the X, Y, and Z axes for acceleration and at the ML axis for COP compared with other conditions, from which the axial directions can be identified.

CONCLUSIONS

The findings suggested investigation of different evaluation tool choices that can be easily adapted to suit different needs. The results for the complexity index and traditional balance indicators were comparable in their implications on different conditions. We used MSE to determine the equipment that measures the postural stability performance. We attempted to generalize the applications of complexity index to tasks and training characteristics and explore different tools to obtain different results.

TRIAL REGISTRATION

This study was approved by the Research Ethics Committee of National Taiwan University and classified as expedited on August 24, 2017. The committee is organized under and operates in accordance with Social and Behavioral Research Ethical Principles and Regulations of National Taiwan University and government laws and regulations.

Dynamic postural stability, is associated with competitive level, in youth league soccer players

OBJECTIVES

To assess the effect of competitive level on dynamic postural stability in young elite and sub-elite soccer players.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PARTICIPANTS

Fifty-four male soccer players of Under 16 and Under 17 categories (mean age 15.9 ± 0.6), divided into two groups who regularly compete at national (n = 28) and regional (n = 26) levels.

MAIN OUTCOME MEASURES

Dynamic Postural Stability Index (DPSI) and vertical Time to Stabilization (vTTS) for a forward-jump landing. Static postural sway was calculated on the basis of center-of-pressure trajectories for a 20 s one-legged stance.

RESULTS

Players at national level exhibit better dynamic postural control than those at regional level, as indicated by the significantly lower DPSI (0.327 vs. 0.373, p < 0.001) and vTTS (0.887 vs. 1.158 s, p = 0.003). In contrast, no differences between groups were found in any of the postural sway parameters for the static test.

CONCLUSIONS

Young soccer players at national level are characterized by better balance performance in terms of faster and more efficient stabilization after a forward jump, while one-leg static standing tests appear not challenging enough to reveal differences in balance abilities associated with the combination of superior technical and physical features.

Postural control and posture-unrelated attention control in advanced age-An exploratory study

OBJECTIVES

The link between postural control and cognition is under-studied, especially in healthy older adults. In the present study, we examined the link between postural control and posture-unrelated attention control.

STUDY DESIGN AND OUTCOME MEASURES

Healthy individuals (n = 112) - men aged 77.2 ± 5.5, and two groups of women, aged 78.6 ± 3.5 and 68.9 ± 3.7 - participated in this cross-sectional study. Postural control was assessed by static balance (SB) posturography in eight standing positions, and by two measures of dynamic balance (DB): the Timed Up-and-Go (TUG) test, and the Functional Reach Test (FRT). Attention control (inhibition) was assessed by the Continuous Performance Test (CPT) measuring Go/NoGo tasks with and without visual and audio distractors.

RESULTS

Men tended to perform better on DB and women on SB. In the men, significant correlations were observed between Go/NoGo tasks and DB (r range: 0.373 to 0.653 for TUG, and -0.342 to -0.530 for FRT). In the younger women, Go/NoGo tasks were correlated with SB (r range: 0.323 to 0.572), and no correlations were observed in the older women. Go/NoGo tasks without distractions followed by tasks with audio distractors explained postural control measures.

CONCLUSIONS

Posture-unrelated attention inhibition was associated with SB in the women and with DB in the men. Tasks with no distractions explained the variability in postural control in both genders. It is recommended to examine the effect of balance exercises on postural control and posture-unrelated attention control in both genders, and the contribution of the relationship between postural control and posture-unrelated attention control to falls in old age.

Effects of Lycra suits in children with cerebral palsy

Lycra garments have recently been used for children with cerebral palsy (CP), with favorable effects on alignment, biomechanics and neuromuscular activity. The aim of the present study is to determine the efficacy of a Lycra suit in improving motor function and static balance in children with CP. Five children with CP wore the Lycra suit for more than 4 h per day for 6 months. They were all assessed at baseline and 6 months after with an evaluation of static balance, using a "seated stabilometry exam", and a motor function assessment, using the Gross Motor Function Measure and Gross Motor function Classification System. The assessment of static balance was performed with and without the suit. Another 5 children with CP performed the same assessments and were used as a control group. An immediate improvement of static balance was observed at baseline, with the first use of the Lycra suit. Further improvement was observed at the 6 month follow up, with a statistical significance for the parameters assessing the antero-posterior axis. Both parents and children also reported functional benefits. Further studies are needed on long-term functional effects in a large cohort of children.

Effect of somatosensory and neurofeedback training on balance in older healthy adults: a preliminary investigation

The aim of this study was to assess the effectiveness of balance training with somatosensory and neurofeedback training on dynamic and static balance in healthy, elderly adults. The sample group consisted of 45 healthy adults randomly assigned to one of the three test groups: somatosensory, neurofeedback, and a control. Individualization of the balance program started with pre-tests for static and dynamic balances. Each group had 15- and 30-min training sessions. All groups were tested for static (postural stability) and dynamic balances (Berg Balance Scale) in acquisition and transfer tests (fall risk of stability and timed up and go). Improvements in static and dynamic balances were assessed by somatosensory and neurofeedback groups and then compared with the control group. Results indicated significant improvements in static and dynamic balances in both test groups in the acquisition test. Results revealed a significant improvement in the transfer test in the neurofeedback and somatosensory groups, in static and dynamic conditions, respectively. The findings suggest that these methods of balance training had a significant influence on balance. Both the methods are appropriate to prevent falling in adults. Neurofeedback training helped the participants to learn static balance, while somatosensory training was effective on dynamic balance learning. Further research is needed to assess the effects of longer and discontinuous stimulation with somatosensory and neurofeedback training on balance in elderly adults.

Vibrotactile Feedback Alters Dynamics Of Static Postural Control In Persons With Parkinson's Disease But Not Older Adults At High Fall Risk

BACKGROUND

Aging and Parkinson's disease are often associated with impaired postural control. Providing extrinsic feedback via vibrotactile sensation could supplement intrinsic feedback to maintain postural control.

RESEARCH QUESTION

We investigated the postural control response to vibrotactile feedback provided at the trunk during challenging stance conditions in older adults at high fall risk and individuals with Parkinson's disease compared to healthy older adults.

METHODS

Nine older adults at high fall risk, 9 persons with Parkinson's disease and 10 healthy older adults performed 30s quiet standing on a force platform under five challenging stance conditions with eyes open/closed and standing on firm/foam surface with feet together, each with and without vibrotactile feedback. During vibrotactile feedback trials, feedback was provided when participants swayed >10% over the center of their base of support. Participants were instructed vibrations would be in response to their movement. Magnitude of postural sway was estimated using center of pressure path length, velocity, and sway area. Dynamics of individuals' postural control was evaluated using detrended fluctuation analysis.

RESULTS

Results showed that vibrotactile feedback induced a change in postural control dynamics among persons with Parkinson's disease when standing with intact intrinsic visual input and altered intrinsic somatosensory input, but there was no change in sway magnitude. However, use of vibrotactile feedback did not significantly alter dynamics of postural control in older adults with high risk of falling or reduce the magnitude of sway.

SIGNIFICANCE

Considering the effects of vibrotactile feedback were dependent on the population and stance condition, designing an optimal therapeutic regimen for balance training should be carefully considered and be specific to a target population. Furthermore, our results suggest that explicit instructions on how to respond to the vibrotactile feedback could affect training outcome.

Comparative Study of Two Systems for the Assessment of Static Balance in Veterans with Mild Traumatic Brain Injury

Background

Traditionally, the diagnosis of postural instability relies on the clinical examination of static balance. In recent years, computerized technologies have provided a new approach for the accurate detection of positional changes during functional balance.

Aim

The aim of this study was to investigate the similarities and differences between two electronic systems, NeuroCom and BioSensics, and their application in the clinical assessment of impaired balance in American veterans.

Materials and Methods

We examined the sway around the center of mass during static balance conditions in 25 veterans with mild traumatic brain injury, using the two electronic systems. These patients met the inclusion criteria and were assessed for their impaired balance at the District of Columbia Veterans Affair Medical Center, Washington, DC, USA.

Results

There were six static balance tests conducted on either NeuroCom or BioSensics system in triplicate. Of the data for 36 sets of statistical data analyses, there were significant correlations among those for eight data sets (22.2%) between the two systems. The strongest positive correlation between the data from the two systems was found during the baseline test, when inputs from visual, vestibular and sensorymotor sources were uninterrupted. The data from the remaining experimental conditions did not correlate significantly with one another.

Conclusions

Both NeuroCom and BioSensics provided comparable data in eight out of 36 experimental conditions in the assessment of static balance in patients with mild traumatic brain injury. The findings clarified the ambiguities in the application of NeuroCom versus BioSensics, provided new knowledge for the field of physical medicine and rehabilitation, and improved the clinical assessment of static balance in patients with mTBI.

The effects of the menstrual cycle on the static balance in healthy young women

[Purpose] The purpose of this study was to investigate the effects of the menstrual cycle on the static balance of healthy young women. [Subjects and Methods] Eighteen healthy young subjects (mean age 19.1 years; weight 57.5 kg; height 159.9 cm) participated in this study. The Good Balance system was used to measure the postural sway speed and velocity moment of subjects in the static standing posture. Subjects were measured for static balance between 1 and 3 days after menstruation and 13 days after menstruation. [Results] The velocity moment of postural sway was significantly higher at 13 days after menstruation. [Conclusion] Our results indicate that the menstrual cycle affects the static balance of healthy subjects. During the menstrual cycle, intensity for balance exercises in females should be carefully controlled for injury prevention.

Quantitative trunk sway and prediction of incident falls in older adults

Poor balance and balance impairments are major predictors of falls. The purpose of the current study was to determine the clinical validity of baseline quantitative static trunk sway measurements in predicting incident falls in a cohort of 287 community-dwelling non-demented older Americans (mean age 76.14±6.82years; 54% female). Trunk sway was measured using the SwayStar™ device, and quantified as angular displacement in degrees in anterior-posterior (pitch) and medio-lateral (roll) planes. Over a one-year follow-up period, 66 elders (23%) reported incident falls. Anterior-posterior angular displacement was a strong predictor of incident falls in older adults in Cox proportional hazards models (hazard ratio adjusted for age, gender, education, RBANS total score, medical comorbidities, geriatric depression scale score, sensory impairments, gait speed, and history of fall in the past 1year ((aHR)=1.59; p=0.033) whereas, angular displacement in the medio-lateral plane was not predictive of falls (aHR=1.35; p=0.276). Our results reveal the significance of quantitative trunk sway, specifically anterior-posterior angular displacement, in predicting incident falls in older adults.

Effects of functional level on balance in children with Duchenne Muscular Dystrophy

INTRODUCTION

This study was planned to compare the static and dynamic balance in children with Duchenne Muscular Dystrophy (DMD) at different functional levels with each other and with healthy peers.

MATERIAL AND METHODS

Sixty nine children between the ages of 6 and 11 were included in this study where 52 of them were diagnosed with DMD in Level I (18 patients), Level II (17 patients), and Level III (17 patients) according to Brooke Functional Classification Scale and 17 of them healthy peers were included. In order to assess static and dynamic balance pediatric functional reach test (PFRT) and timed up and go test (TUGT) were used.

RESULTS

When compared in terms of the TUGT, differences were found between all groups, i.e. Level 1 and 2, Level 2 and 3, Level 1 and 3, Healthy peers and Level 1, Healthy peers and Level 2, and Healthy peers and Level 3 (p < 0.0083). When compared in terms of the PFRT in the standing positions, there was difference between level 3 and healthy peers (p < 0.0083), but not between the other groups.

CONCLUSIONS

We found poor functional level in DMD to affect the dynamic and static balance parameters in this study. The dynamic balance of a child with DMD at Level 3 is decreased to a third of a healthy peer.

Static balance according to hip joint angle of unsupported leg during one-leg standing

[Purpose] This study aimed to determine static balance according to hip joint angle of the unsupported leg during one-leg standing. [Subjects and Methods] Subjects included 45 healthy adult males and females in their 20s. During one-leg standing on the non-dominant leg, the position of the unsupported leg was classified according to hip joint angles of point angle was class. Static balance was then measured using a force plate with eyes open and closed. The total length, sway velocity, maximum deviation, and velocity on the mediolateral and anteroposterior axes of center of pressure were measured. [Results] In balance assessment with eyes open, there were significant differences between groups according to hip joint angle, except for maximum deviation on the anteroposterior axis. In balance assessment with eyes closed, there were significant differences between total length measurements at 0° and 30°, 60° and between 30° and 90°. There were significant differences between sway velocity measurements at 0° and 30° and between 30° and 90°. [Conclusion] Thus, there were differences in static balance according to hip joint angle. It is necessary to clearly identify the hip joint angle during one-leg standing testing.