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Falls in the elderly constitute a major health issue associated to population ageing. Current clinical tests evaluating fall risk mostly consist in assessing balance abilities. The devices used for these tests can be expensive or inconvenient to set up. We investigated whether, how and to which extent fall risk could be assessed using a low cost ambient sensor to monitor balance tasks.Method: Eighty four participants, forty of which were 65 or older, performed eight simple balance tasks in front of a Microsoft Kinect sensor. Custom-made algorithms coupled to the Kinect sensor were used to automatically extract body configuration parameters such as body centroid and dispersion. Participants were then classified in two groups using a clustering method. The clusters were formed based on the parameters measured by the sensor for each balance task. For each participant, fall risk was independently assessed using known risk factors as age and average physical activity, as well as the participant’s performance on the Timed Up and Go clinical test.Results: Standing with a normal stance and the eyes closed on a foam pad, and standing with a narrow stance and the eyes closed on regular ground were the two balance tasks for which the classification’s outcome best matched fall risk as assessed by the three known risk factors. Standing on a foam pad with eyes closed was the task driving to the most robust results.Conclusion: Our method constitutes a simple, fast, and reliable way to assess fall risk more often with elderly people. Importantly, this method requires very little space, time and equipment, so that it could be easily and frequently used by a large number of health professionals, and in particular by family physicians. Therefore, we believe that the use of this method would substantially contribute to improve fall prevention.

Intracortical inhibitory modulation seems crucial for an intact motor control and motor learning. However, the influence of long(er) term training on short-interval intracortical inhibition (SICI) is scarcely investigated. With respect to balance, it was previously shown that with increasing postural task difficulty, SICI decreased but the effect of balance training (BT) is unknown. The present study tested whether improvements in postural control due to BT are accompanied by changes in SICI. SICI was measured in the tibialis anterior by applying paired-pulse magnetic stimuli to the motor cortex in a BT group (n = 13) training 2 weeks on an unstable platform and a control (CON) group (n = 13) while performing three progressively demanding postural tasks: stable stance (‘Stable’), standing on a movable platform partly secured with elastic straps (‘Straps’) or freely moving (‘Free’). The BT group improved postural control significantly more than the CON-group (‘Free’ condition: +80% vs. + 21%; p < 0.001). For SICI, there was a main effect of POSTURAL TASK (F2, 48 = 24.6; p < 0.001) with decreasing SICI when task difficulty increased and a TIME × GROUP interaction (F1, 24 = 5.9; p = 0.02) caused by significantly enhanced SICI in the BT group in all three postural tasks after the training. The increases in SICI were significantly correlated with improvements in balance performance (r = 0.56; p = 0.047). The present study confirms previous findings of task-specific modulation of SICI when balancing. More importantly, training was shown to increase SICI and this increase was correlated with changes in balance performance. Thus, changes in SICI seem to be involved not only for the control but also when adapting upright posture with training.

Aging is associated with a shift from an automatic to a more cortical postural control strategy, which goes along with deteriorations in postural stability. Although balance training has been shown to effectively counteract these behavioral deteriorations, little is known about the effect of balance training on brain activity during postural tasks in older adults. We, therefore, assessed postural stability and brain activity using fMRI during motor imagery alone (MI) and in combination with action observation (AO; i.e., AO+MI) of a challenging balance task in older adults before and after 5 weeks of balance training. Results showed a nonsignificant trend toward improvements in postural stability after balance training, accompanied by reductions in brain activity during AO+MI of the balance task in areas relevant for postural control, which have been shown to be over-activated in older adults during (simulation of) motor performance, including motor, premotor, and multisensory vestibular areas. This suggests that balance training may reverse the age-related cortical over-activations and lead to changes in the control of upright posture toward the one observed in young adults.

Age-related changes in brain activation other than in the primary motor cortex are not well known with respect to dynamic balance control. Therefore, the current study aimed to explore age-related differences in the control of static and dynamic postural tasks using fMRI during mental simulation of balance tasks. For this purpose, 16 elderly (72 ± 5 years) and 16 young adults (27 ± 5 years) were asked to mentally simulate a static and a dynamic balance task by motor imagery (MI), action observation (AO), or the combination of AO and MI (AO + MI). Age-related differences were detected in the form of larger brain activations in elderly compared to young participants, especially in the challenging dynamic task when applying AO + MI. Interestingly, when MI (no visual input) was contrasted to AO (visual input), elderly participants revealed deactivation of subcortical areas. The finding that the elderly demonstrated overactivation in mostly cortical areas in challenging postural conditions with visual input (AO + MI and AO) but deactivation in subcortical areas during MI (no vision) may indicate that elderly individuals allocate more cortical resources to the internal representation of dynamic postural tasks. Furthermore, it might be assumed that they depend more strongly on visual input to activate subcortical internal representations.

Background: While the positive effect of balance training on age-related impairments in postural stability is well-documented, the neural correlates of such training adaptations in older adults remain poorly understood. This study therefore aimed to shed more light on neural adaptations in response to balance training in older adults.Methods: Postural stability as well as spinal reflex and cortical excitability was measured in older adults (65–80 years) before and after 5 weeks of balance training (n = 15) or habitual activity (n = 13). Postural stability was assessed during one- and two-legged quiet standing on a force plate (static task) and a free-swinging platform (dynamic task). The total sway path was calculated for all tasks. Additionally, the number of errors was counted for the one-legged tasks. To investigate changes in spinal reflex excitability, the H-reflex was assessed in the soleus muscle during quiet upright stance. Cortical excitability was assessed during an antero-posterior perturbation by conditioning the H-reflex with single-pulse transcranial magnetic stimulation.Results: A significant training effect in favor of the training group was found for the number of errors conducted during one-legged standing (p = .050 for the static and p = .042 for the dynamic task) but not for the sway parameters in any task. In contrast, no significant effect was found for cortical excitability (p = 0.703). For spinal excitability, an effect of session (p < .001) as well as an interaction of session and group (p = .009) was found; however, these effects were mainly due to a reduced excitability in the control group.Conclusions: In line with previous results, older adults’ postural stability was improved after balance training. However, these improvements were not accompanied by significant neural adaptations. Since almost identical studies in young adults found significant behavioral and neural adaptations after four weeks of training, we assume that age has an in

Postural control declines across adult lifespan. Non-physical balance training has been suggested as an alternative to improve postural control in frail/immobilized elderly people. Previous studies showed that this kind of training can improve balance control in young and older adults. However, it is unclear whether the brain of young and older adults is activated differently during mental simulations of balance tasks. For this purpose, soleus (SOL) and tibialis motor evoked potentials (MEPs) and SOL H- reflexes were elicited while 15 elderly (mean ± SD = 71 ± 4.6 years) and 15 young participants (mean ± SD = 27 ± 4.6 years) mentally simulated static and dynamic balance tasks using motor imagery (MI), action observation (AO) or the combination of AO and MI (AO + MI). Young subjects displayed significant modulations of MEPs that depended on the kind of mental simulation and the postural task. Elderly adults also revealed differences between tasks, but not between mental simulation conditions. Furthermore, the elderly displayed larger MEP facilitation during mental simulation (AGE-GROUP; F(1,28) = 5.9; p = 0.02) in the SOL muscle compared to the young and a task-dependent modulation of the tibialis background electromyography (bEMG) activity. H-reflex amplitudes and bEMG in the SOL showed neither task- nor age- dependent modulation. As neither mental simulation nor balance tasks modulated H- reflexes and bEMG in the SOL muscle, despite large variations in the MEP-amplitudes, there seems to be an age-related change in the internal cortical representation of balance tasks. Moreover, the modulation of the tibialis bEMG in the elderly suggests that aging partially affects the ability to inhibit motor output.

Chronic neck pain patients display functional impairments like decreased range of motion, decreased strength, and reduced sensorimotor function. In patients without structural damage, the reason for the persistence of pain is not well understood. Therefore, it is assumed that in chronic pain states, memory processes play an important role. We have now detected and tested a patient that might help us to better understand the neural correlates of maladaptive pain expectation/memory. This patient displays chronic neck pain and restricted unilateral motion of the cervical spine to the left. However, when the patient is distracted, she can perform head rotations without experiencing pain and without restricting her range of movement. Based on this observation, we asked her to imagine movements shown in a video: conscious, non- distracted head rotations (pain-provoking) versus distracted head rotations (pain-free) and compared these results with an age and gender matched control volunteer. Functional magnetic resonance imaging (fMRI) showed distinct brain activation patterns that depended on the side of rotation (pain-free versus painful side) and the kind of movement (distracted versus non-distracted head rotation). Interestingly, brain areas related to the processing of pain such as primary somatosensory cortex, thalamus, insula, anterior cingulate cortex, primary motor cortex, supplementary motor area, prefrontal cortex, and posterior cingulate cortex were always more strongly activated in the non-distracted condition and when turning to the left. The age and gender matched control volunteer displayed no comparable activation of pain centers. In the patient, maladaptive pain behavior and the activity of pain-related brain areas during imagined head rotations were task-specific, indicating that the activation and/or recall of pain memories were context-dependent. These findings are important not only to improve the understanding of the neural organization of maladaptive

Non-physical balance training has demonstrated to be efficient to improve postural control in young people. However, little is known about the potential to increase corticospinal excitability by mental simulation in lower leg muscles. Mental simulation of isolated, voluntary contractions of limb muscles increase corticospinal excitability but more automated tasks like walking seem to have no or only minor effects on motor-evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS). This may be related to the way of performing the mental simulation or the task itself. Therefore, the present study aimed to clarify how corticospinal excitability is modulated during AO + MI, MI and action observation (AO) of balance tasks. For this purpose, MEPs and H-reflexes were elicited during three different mental simulations (a) AO + MI, (b) MI and (c) passive AO. For each condition, two balance tasks were evaluated: (1) quiet upright stance (static) and (2) compensating a medio-lateral perturbation while standing on a free-swinging platform (dynamic).AO + MI resulted in the largest facilitation of MEPs followed by MI and passive AO. MEP facilitation was significantly larger in the dynamic perturbation than in the static standing task. Interestingly, passive observation resulted in hardly any facilitation independent of the task. H-reflex amplitudes were not modulated.The current results demonstrate that corticospinal excitability during mental simulation of balance tasks is influenced by both the type of mental simulation and the task difficulty. As H-reflexes and background EMG were not modulated, it may be argued that changes in excitability of the primary motor cortex were responsible for the MEP modulation. From a functional point of view, our findings suggest best training/rehabilitation effects when combining MI with AO during challenging postural tasks.

Postural control undergoes rapid changes during child development. However, the influence of balance training (BT) on the compensation of perturbations has not yet been investigated in children. For this purpose, young (6.7 ± 0.6 years) and old children (12.0 ± 0.4 years) were exposed to externally induced anticipated (direction known) and non-anticipated (direction unknown) perturbations on a free swinging platform before and after either child-oriented BT (INT; young: n = 12, old: n = 18) or regular physical education (CON; young: n = 9, old: n = 9). At baseline, old children exhibited less platform sway after perturbations than young children (p = .004; η2p = 0.17). However, no differences were found between anticipated and non- anticipated perturbations. After training, INT reduced the platform sway path while CON remained stable (−11.1% vs. +2.7%; p < .001; η2p = 0.26). Furthermore, the young INT group adapted statistically similarly in anticipated and non-anticipated situations (−7.9% vs. −12.6%; p = .556; r = 0.33), whereas the old INT group tended to improve more in anticipated perturbations (−15.1% vs. −8.2%; p = .052; r = 0.51). Thus, the maturity of the postural system seems to influence the extent of training adaptations in anticipated perturbations. Furthermore, this study provides evidence that BT can improve postural responses to external perturbations in children and may represent a useful intervention to prevent falls.

Purpose: Balance training studies in children reported conflicting results without evidence for improvements in children under the age of eight. The aim of this study therefore was to compare balance training adaptations in children of different age groups to clarify whether young age prevents positive training outcomes.Method: The effects of five weeks of child-oriented balance training were tested in 77 (38 girls; 39 boys) participants of different age groups (6-7, 11-12, and 14-15 years) and compared to age-matched controls. Static and dynamic postural control, explosive strength, and jump height were assessed.Results: Across age groups, dynamic postural sway decreased (-18.7%; p = .012; η2p = .09) and explosive force increased (8.6%; p = .040; η2p = .06) in the intervention groups. Age-specific improvements were observed in dynamic postural sway, with greatest effects in the youngest group (-28.8%; p = .026; r = .61).Conclusion: In contrast to previous research using adult-oriented balance exercises, this study demonstrated for the first time that postural control can be trained from as early as the age of six years in children when using child-oriented balance training. Therefore, the conception of the training seems to be essential in improving balance skills in young children.

Falls in the elderly constitute a major health issue associated to population ageing. Current clinical tests evaluating fall risk mostly consist in assessing balance abilities. The devices used for these tests can be expensive or inconvenient to set up. We investigated whether, how and to which extent fall risk could be assessed using a low cost ambient sensor to monitor balance tasks.Method: Eighty four participants, forty of which were 65 or older, performed eight simple balance tasks in front of a Microsoft Kinect sensor. Custom-made algorithms coupled to the Kinect sensor were used to automatically extract body configuration parameters such as body centroid and dispersion. Participants were then classified in two groups using a clustering method. The clusters were formed based on the parameters measured by the sensor for each balance task. For each participant, fall risk was independently assessed using known risk factors as age and average physical activity, as well as the participant’s performance on the Timed Up and Go clinical test.Results: Standing with a normal stance and the eyes closed on a foam pad, and standing with a narrow stance and the eyes closed on regular ground were the two balance tasks for which the classification’s outcome best matched fall risk as assessed by the three known risk factors. Standing on a foam pad with eyes closed was the task driving to the most robust results.Conclusion: Our method constitutes a simple, fast, and reliable way to assess fall risk more often with elderly people. Importantly, this method requires very little space, time and equipment, so that it could be easily and frequently used by a large number of health professionals, and in particular by family physicians. Therefore, we believe that the use of this method would substantially contribute to improve fall prevention.

Intracortical inhibitory modulation seems crucial for an intact motor control and motor learning. However, the influence of long(er) term training on short-interval intracortical inhibition (SICI) is scarcely investigated. With respect to balance, it was previously shown that with increasing postural task difficulty, SICI decreased but the effect of balance training (BT) is unknown. The present study tested whether improvements in postural control due to BT are accompanied by changes in SICI. SICI was measured in the tibialis anterior by applying paired-pulse magnetic stimuli to the motor cortex in a BT group (n = 13) training 2 weeks on an unstable platform and a control (CON) group (n = 13) while performing three progressively demanding postural tasks: stable stance (‘Stable’), standing on a movable platform partly secured with elastic straps (‘Straps’) or freely moving (‘Free’). The BT group improved postural control significantly more than the CON-group (‘Free’ condition: +80% vs. + 21%; p < 0.001). For SICI, there was a main effect of POSTURAL TASK (F2, 48 = 24.6; p < 0.001) with decreasing SICI when task difficulty increased and a TIME × GROUP interaction (F1, 24 = 5.9; p = 0.02) caused by significantly enhanced SICI in the BT group in all three postural tasks after the training. The increases in SICI were significantly correlated with improvements in balance performance (r = 0.56; p = 0.047). The present study confirms previous findings of task-specific modulation of SICI when balancing. More importantly, training was shown to increase SICI and this increase was correlated with changes in balance performance. Thus, changes in SICI seem to be involved not only for the control but also when adapting upright posture with training.

Aging is associated with a shift from an automatic to a more cortical postural control strategy, which goes along with deteriorations in postural stability. Although balance training has been shown to effectively counteract these behavioral deteriorations, little is known about the effect of balance training on brain activity during postural tasks in older adults. We, therefore, assessed postural stability and brain activity using fMRI during motor imagery alone (MI) and in combination with action observation (AO; i.e., AO+MI) of a challenging balance task in older adults before and after 5 weeks of balance training. Results showed a nonsignificant trend toward improvements in postural stability after balance training, accompanied by reductions in brain activity during AO+MI of the balance task in areas relevant for postural control, which have been shown to be over-activated in older adults during (simulation of) motor performance, including motor, premotor, and multisensory vestibular areas. This suggests that balance training may reverse the age-related cortical over-activations and lead to changes in the control of upright posture toward the one observed in young adults.

Background: While the positive effect of balance training on age-related impairments in postural stability is well-documented, the neural correlates of such training adaptations in older adults remain poorly understood. This study therefore aimed to shed more light on neural adaptations in response to balance training in older adults.Methods: Postural stability as well as spinal reflex and cortical excitability was measured in older adults (65–80 years) before and after 5 weeks of balance training (n = 15) or habitual activity (n = 13). Postural stability was assessed during one- and two-legged quiet standing on a force plate (static task) and a free-swinging platform (dynamic task). The total sway path was calculated for all tasks. Additionally, the number of errors was counted for the one-legged tasks. To investigate changes in spinal reflex excitability, the H-reflex was assessed in the soleus muscle during quiet upright stance. Cortical excitability was assessed during an antero-posterior perturbation by conditioning the H-reflex with single-pulse transcranial magnetic stimulation.Results: A significant training effect in favor of the training group was found for the number of errors conducted during one-legged standing (p = .050 for the static and p = .042 for the dynamic task) but not for the sway parameters in any task. In contrast, no significant effect was found for cortical excitability (p = 0.703). For spinal excitability, an effect of session (p < .001) as well as an interaction of session and group (p = .009) was found; however, these effects were mainly due to a reduced excitability in the control group.Conclusions: In line with previous results, older adults’ postural stability was improved after balance training. However, these improvements were not accompanied by significant neural adaptations. Since almost identical studies in young adults found significant behavioral and neural adaptations after four weeks of training, we assume that age has an in

Chronic neck pain patients display functional impairments like decreased range of motion, decreased strength, and reduced sensorimotor function. In patients without structural damage, the reason for the persistence of pain is not well understood. Therefore, it is assumed that in chronic pain states, memory processes play an important role. We have now detected and tested a patient that might help us to better understand the neural correlates of maladaptive pain expectation/memory. This patient displays chronic neck pain and restricted unilateral motion of the cervical spine to the left. However, when the patient is distracted, she can perform head rotations without experiencing pain and without restricting her range of movement. Based on this observation, we asked her to imagine movements shown in a video: conscious, non- distracted head rotations (pain-provoking) versus distracted head rotations (pain-free) and compared these results with an age and gender matched control volunteer. Functional magnetic resonance imaging (fMRI) showed distinct brain activation patterns that depended on the side of rotation (pain-free versus painful side) and the kind of movement (distracted versus non-distracted head rotation). Interestingly, brain areas related to the processing of pain such as primary somatosensory cortex, thalamus, insula, anterior cingulate cortex, primary motor cortex, supplementary motor area, prefrontal cortex, and posterior cingulate cortex were always more strongly activated in the non-distracted condition and when turning to the left. The age and gender matched control volunteer displayed no comparable activation of pain centers. In the patient, maladaptive pain behavior and the activity of pain-related brain areas during imagined head rotations were task-specific, indicating that the activation and/or recall of pain memories were context-dependent. These findings are important not only to improve the understanding of the neural organization of maladaptive

Postural control declines across adult lifespan. Non-physical balance training has been suggested as an alternative to improve postural control in frail/immobilized elderly people. Previous studies showed that this kind of training can improve balance control in young and older adults. However, it is unclear whether the brain of young and older adults is activated differently during mental simulations of balance tasks. For this purpose, soleus (SOL) and tibialis motor evoked potentials (MEPs) and SOL H- reflexes were elicited while 15 elderly (mean ± SD = 71 ± 4.6 years) and 15 young participants (mean ± SD = 27 ± 4.6 years) mentally simulated static and dynamic balance tasks using motor imagery (MI), action observation (AO) or the combination of AO and MI (AO + MI). Young subjects displayed significant modulations of MEPs that depended on the kind of mental simulation and the postural task. Elderly adults also revealed differences between tasks, but not between mental simulation conditions. Furthermore, the elderly displayed larger MEP facilitation during mental simulation (AGE-GROUP; F(1,28) = 5.9; p = 0.02) in the SOL muscle compared to the young and a task-dependent modulation of the tibialis background electromyography (bEMG) activity. H-reflex amplitudes and bEMG in the SOL showed neither task- nor age- dependent modulation. As neither mental simulation nor balance tasks modulated H- reflexes and bEMG in the SOL muscle, despite large variations in the MEP-amplitudes, there seems to be an age-related change in the internal cortical representation of balance tasks. Moreover, the modulation of the tibialis bEMG in the elderly suggests that aging partially affects the ability to inhibit motor output.

Age-related changes in brain activation other than in the primary motor cortex are not well known with respect to dynamic balance control. Therefore, the current study aimed to explore age-related differences in the control of static and dynamic postural tasks using fMRI during mental simulation of balance tasks. For this purpose, 16 elderly (72 ± 5 years) and 16 young adults (27 ± 5 years) were asked to mentally simulate a static and a dynamic balance task by motor imagery (MI), action observation (AO), or the combination of AO and MI (AO + MI). Age-related differences were detected in the form of larger brain activations in elderly compared to young participants, especially in the challenging dynamic task when applying AO + MI. Interestingly, when MI (no visual input) was contrasted to AO (visual input), elderly participants revealed deactivation of subcortical areas. The finding that the elderly demonstrated overactivation in mostly cortical areas in challenging postural conditions with visual input (AO + MI and AO) but deactivation in subcortical areas during MI (no vision) may indicate that elderly individuals allocate more cortical resources to the internal representation of dynamic postural tasks. Furthermore, it might be assumed that they depend more strongly on visual input to activate subcortical internal representations.

Non-physical balance training has demonstrated to be efficient to improve postural control in young people. However, little is known about the potential to increase corticospinal excitability by mental simulation in lower leg muscles. Mental simulation of isolated, voluntary contractions of limb muscles increase corticospinal excitability but more automated tasks like walking seem to have no or only minor effects on motor-evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS). This may be related to the way of performing the mental simulation or the task itself. Therefore, the present study aimed to clarify how corticospinal excitability is modulated during AO + MI, MI and action observation (AO) of balance tasks. For this purpose, MEPs and H-reflexes were elicited during three different mental simulations (a) AO + MI, (b) MI and (c) passive AO. For each condition, two balance tasks were evaluated: (1) quiet upright stance (static) and (2) compensating a medio-lateral perturbation while standing on a free-swinging platform (dynamic).AO + MI resulted in the largest facilitation of MEPs followed by MI and passive AO. MEP facilitation was significantly larger in the dynamic perturbation than in the static standing task. Interestingly, passive observation resulted in hardly any facilitation independent of the task. H-reflex amplitudes were not modulated.The current results demonstrate that corticospinal excitability during mental simulation of balance tasks is influenced by both the type of mental simulation and the task difficulty. As H-reflexes and background EMG were not modulated, it may be argued that changes in excitability of the primary motor cortex were responsible for the MEP modulation. From a functional point of view, our findings suggest best training/rehabilitation effects when combining MI with AO during challenging postural tasks.