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Migraine is a neurological disease that affects proportionally more women. It has been documented that migraineurs often experience balance disturbances. To evaluate the balance between migraineur patients (MG) and healthy volunteers classified as control group (CG). A cross-sectional study. Seventy-four women were evaluated: 37 MG and 37 CG. The evaluation of the center of pressure (COP) variables was carried out using a balance platform in three postures, bipodal eyes closed (BEC), right monopodal with eyes open (RMEO), and left monopodal with eyes open (LMEO). Self-report questionnaires (dizziness handicap inventory (DHI), fall risk efficacy scale (FES I), the functional impact scale (HIT 6) and the timed up and go test (TUG test) were used. The U-Mann Whitney test was used to verify differences in the COP between MG and CG. The Kruskal-Wallis one-way ANOVA was used to analyze the differences between migraine groups (MGs) with postures, self-report questionnaires, and TUG test. A p < 0.05 was considered statistically significant. No statistically significant changes were found in the balance variables, except the medial-lateral excursion variable in the BEC (p < 0.02) and LMEO (p = 0.04) postures. No significant differences were found between the MGs with HIT 6 (p = 0.48) or FES I (p = 0.49). Significant differences were found between the MGs with DHI (p = 0.003). The TUG test showed statistically significant changes between groups (p < 0.01). The women with migraine in this sample did not show differences in postural balance, however, dizziness and functional differences are shown compared to healthy women. [ABSTRACT FROM AUTHOR]

When examining postural sway measures of single-leg squat (SLS), there is a lack of consensus on how many trials are required to obtain reliable and clinically relevant data. Forty adults with chronic low back pain performed five consecutive trials of SLS for each side on a portable force plate. The left and right sides were categorized into problem and non-problem sides by Clinical Pilates assessment. SLS performance was characterized by terminal knee flexion angle, squat duration, peak vertical force and postural sway parameters. Data across five trials were first examined with repeated measures analysis of variance; variables with significant differences were further analyzed using intraclass correlation coefficients (ICC). Using all trials as a reference, the reliability of other trial combinations was assessed to examine the potential effects of learning (2-5 squats, 3-5 squats, 4-5 squats), fatigue (1-2 squats, 1-3 squats, 1-4 squats) and steady-state (2-4 squats). For the non-problem side, postural sway measures were highly reliable (ICC≥0.9) regardless of the number of trials analyzed. For the problem side, analyzing the 1-4 squats combination offered consistently reliable results across all postural measures (ICC≥0.72). Thus, it is recommended to analyze the first four consecutive trials to obtain reliable postural sway measures. [ABSTRACT FROM AUTHOR]

The main aim of the study was to investigate the relationship between ground reaction force (GRF) derived postural sway and 180° turn performance in soccer players on the axis of dominant and non-dominant legs. Twenty-seven male soccer players (mean age 22.45 ± 2.7 years) from the same league level agreed to participate in the study. The participants underwent GRF-derived postural sway and 180⁰ turn tests using a force plate in separate sessions, with at least 24-hour intervals between sessions. Postural sway was assessed in anteroposterior and mediolateral directions during a single-leg stance, while the 180° turn performance was evaluated through GRF-derived turn time and turn sway. The correlation, multiple regression, and group differences were computed to test study hypotheses. Positive correlations were observed between postural sway measures and 180⁰ turn time for dominant and non-dominant legs (r-range from 0.384 to 0.550). No measure of postural sway was significantly related to the 180⁰ turn sway (p> 0.05). Multiple stepwise regression analysis indicated that mediolateral sway velocity explained 30% and 17% of the variance of 180⁰ turn time for dominant and non-dominant legs, respectively. No statistical inter-limb differences were noted for 180⁰ turn and postural sway parameters. The results suggest that improving single-leg postural performance may enhance male soccer players' 180° turn performance. Therefore, unilateral stability in the mediolateral direction should be considered a potential indicator of change of direction-based performances.

Maintaining balance is critical to minimizing astronauts' risk of falling and reducing injury or suit damage. Previous studies involving spacesuits have not examined the effects of the superior shift of the center of gravity (CoG) on astronauts' ability to balance. Here, the purpose of our study was to investigate the effects of CoG shift due to a simulated Extravehicular Mobility Unit (xEMU) on balance. Seventeen participants' standing balance was examined for three test configurations: unsuited, weighted with an Extravehicular Mobility Unit (xEMU) vest, and xEMU hard upper body torso (HUT). Using a Tekscan forceplate walkway, the CoG locations were determined. Balance assessments were performed to determine the limits of stability and standing balance performance during wide or tandem stances with eyes open/closed. The center of pressure (CoP) time series was examined in terms of displacement, velocity, and frequency measures. During the eyes-open wide stance, the xEMU vest significantly increased the mediolateral balance parameters, while the HUT significantly increased the total displacement (TOTEX), mean velocity (MVELO), and mean frequency (MFREQ) of the CoP. In the eyes-closed wide stance, the HUT significantly increased these parameters. In the eyes-closed tandem stance, the xEMU vest significantly decreased the parameters. The xEMU vest significantly reduced the TOTEX, MVELO, and MFREQ (improved standing balance), while the HUT decreased standing balance ability, seen with significant increases in said parameters. By quantifying CoG's effect on balance, our results form the basis for future balance and posture studies of xEMU spacesuits. [ABSTRACT FROM AUTHOR]

Trunk postural control differs between individuals with and without chronic low back pain (LBP). Whether this corresponds to differences in hip/spine coordination during the early acute phase of LBP (ALBP) is unclear. To compare hip/spine coordination in relation to seat movements between individuals with and without ALBP when balancing on an unstable seat and to identify coordination strategies to maintain balance using cluster analysis. Cross-sectional observational study. ALBP (n=130) and pain-free (n=72) individuals. Frequency domain measures to evaluate hip/spine coordination (amplitude spectrum, phase angle, and coherence) and time-series measures to assess overall balance performance (center of pressure [CoP] reflecting the amount of seat movements, upper thorax motion as a surrogate for head motion). Participants maintained balance while sitting on a seat fixed to a hemisphere. Seat, hip, and spine (lower lumbar, lumbar, upper lumbar, and thoracic) angular motion and force plate data were recorded. Overall, seat/CoP movements (amplitude spectrum and RMS displacement) were greater (in both planes) and sagittal coordination (coherence) between the hip or lower spine and seat movements was lower in ALBP than controls. Cluster analysis using coherence data revealed different coordination strategies to maintain balance. Separate clusters used a " lower lumbar strategy " and " hip strategy " in the sagittal plane, and a " lower and upper lumbar strategy " and " lower lumbar strategy " in the frontal plane. A cluster using a " low coherence strategy " in both planes was also identified. Hip and lower spine coordination was less in individuals with ALBP in conjunction with a lower quality of overall balance performance. However, interpretation of the relationship between coherence and overall balance performance was not straightforward. Clusters in both the ALBP group and the control group adopted a low coherence strategy, and this was not consistently related to poor overall balance performance. This suggests overall balance performance cannot be inferred from coherence alone and requires consideration of interaction of other different features. [ABSTRACT FROM AUTHOR]

Background and Objectives: Children with intellectual disabilities (ID) not only have impairments in cognitive functioning but also experience difficulties in perceptual and motor skills, which may lead to balance deficits and increased risk of falls. The preset study aimed to assess the relationship between fundamental motor skills and postural control adaptability and compare them in teachable children with ID and normal children. Materials and Methods: This descriptive study involved 34 girls with ID and 30 age-matched healthy peers aged 7-13. Balance variables, including amplitude, variability, and velocity of the center of pressure (CoP), were evaluated using the force plate in Tandem and Feet-together conditions. Fundamental motor skills were also assessed using the third edition of the Test of Gross Motor Development (TGMD-3). The independent t-test and repeated measures were used to examine between-group and within-group differences in balance variables. The Mann-Whitney U-test and Spearman's rank correlation were also employed to assess group differences and the relationship between variables. All statistical analyses were performed using SPSS software. A p-value less than 0.0 was considered statistically significant. Results: The results pointed out that children with ID had lower scores on the TGMD-3 test compared to the control group (P0.05). The correlation analysis also demonstrated that displacement scales and object control had a moderate and significant relationship with balance variables (P

Balance deficits are present in a variety of clinical populations and can negatively impact quality of life. The integration of wearable sensors and machine learning technology (ML) provides unique opportunities to quantify biomechanical characteristics related to balance outside of a laboratory setting. This article provides a general overview of recent developments in using wearable sensors and ML to estimate or predict biomechanical characteristics such as center of pressure (CoP) and center of mass (CoM) motion. This systematic review was conducted according to PRISMA guidelines. Databases including Scopus, PubMed, CINHAL, Trip PRO, Cochrane, and Otseeker databases were searched for publications on the use of wearable sensors combined with ML to predict biomechanical characteristics. Fourteen publications met the inclusion criteria and were included in this review. From each publication, information on study characteristics, testing conditions, ML models applied, estimated biomechanical characteristics, and sensor positions were extracted. Additionally, the study type, level of evidence, and Downs and Black scale score were reported to evaluate methodological quality and bias. Most studies tested subjects during walking and utilized some type of neural network (NN) ML model to estimate biomechanical characteristics. Many of the studies focused on minimizing the necessary number of sensors and placed them on areas near or below the waist. Nearly all studies reporting RMSE and correlation coefficients had values 0.85, respectively, indicating strong ML model estimation accuracy. Overall, this review can help guide the future development of ML algorithms and wearable sensor technologies to estimate postural mechanics.

AbstractBackground: The 4-Stage Balance test is one of the most commonly used tests to assess balance for older adults. Although it is generally accepted that the four positions (including side-by-side (SBSS), semi-tandem (STS), tandem (TS), and single-leg stance (SLS)) in this test are progressively more difficult, there are no studies comparing the balance parameters of the four positions in older adults to prove this result. The purpose of this study is to determine the difficulty of 4 positions in the 4-Stage Balance test and the effect of the dominant and non-dominant lower extremities on static balance among healthy older adults; Methods: A total of 115 community-dwelling healthy older adults were included. The postural parameters (including sway range standard deviation (SR), velocity of body sway (V), total sway area (TSA) and sway perimeter (TSP) of the center of pressure) were measured during 8 static postures (including SBSS, left STS, right STS, left TS, right TS, left SLS, right SLS and comfortable stance (CS)). Repeated measures ANOVA was used to analyze the postural parameters in 8 static postures; Results: The static balance stability of the five stances in older adults can be ranked in the following sequence: CS > SBSS/STS > TS > SLS. Moreover, changing foot placement in STS, TS and SLS tasks has no influence on stability. This study has been registered in China Clinical Trial Registry (ChiCTR2200065803). Conclusions: Our findings suggest that it is feasible to simplify the 4-Stage Balance test to a 3-Stage Balance test in the older adults. [ABSTRACT FROM AUTHOR]

Myofascial release is a popular therapy technique used to manipulate connective muscle tissue to become more pliable. The maintenance of body posture relies on mechanoreceptors located in connective tissue, thus manipulation of connective tissue should affect postural control. The effects of this phenomenon have not been well studied, leaving room for this investigation. PURPOSE: To observe if postural sway scores changed before and after foam rolling proximal (quadriceps and hamstrings) in comparison to distal (calves) muscles. METHODS: Thirty-six, college-aged female athletes (age 20.39 ± 0.25 years, mass 68.70 ± 1.97 kg, height 170.18 ± 1.56 cm.) performed approximately two and one-half minutes of moderate intensity foam rolling to their calves (n = 19, Group A) or to their hamstrings and quadricep muscle (n = 17, Group B). Center of Pressure (CoP) and Limit of Stability (LoS) testing was assessed both pre-and post-foam rolling using a computerized posturography balance plate. CoP sway was measured under both eyes open (EO) and eye closed (EC) Conditions on both stable and unstable surfaces. LoS was measured in the Anterior, Posterior, Left, and Right Directions. Effects of foam rolling on CoP and LoS were assessed using a repeated-measures MANOVA (α = 0.05). RESULTS: Eyes Open Stable Surface had the lowest postural sway (p = 0.001). However, CoP did not differ for any condition either between Groups (p ≥ 0.6) or from pre- to post-foam rolling (p = 0.3). LoS significantly differed between Directions such that LoS was greater in the frontal plane than in the sagittal plane (p = 0.011). There was also a significant Time X Group X Direction interaction effect (p = 0.001) such that LoS for Group A decreased after foam rolling (mean change = -1.621 cm) but increased for Group B after foam rolling (mean change = + 0.878 cm). No differences were found for any other Direction (p ≥ 0.1). CONCLUSION: This study demonstrated CoP and LoS improvements between the two groups based on acute effects of foam rolling intervention. Further research is suggested to determine if long-term gains are observed within or between groups. [ABSTRACT FROM AUTHOR]

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The main aim of the study was to investigate the relationship between ground reaction force (GRF) derived postural sway and 180° turn performance in soccer players on the axis of dominant and nondominant legs. Twenty-seven male soccer players (mean age 22.45 ± 2.7 years) from the same league level agreed to participate in the study. The participants underwent GRF-derived postural sway and 180° turn tests using a force plate in separate sessions, with at least 24-hour intervals between sessions. Postural sway was assessed in anteroposterior and mediolateral directions during a single-leg stance, while the 180° turn performance was evaluated through GRF-derived turn time and turn sway. The correlation, multiple regression, and group differences were computed to test study hypotheses. Positive correlations were observed between postural sway measures and 180° turn time for dominant and non-dominant legs (r-range from 0.384 to 0.550). No measure of postural sway was significantly related to the 180° turn sway (p> 0.05). Multiple stepwise regression analysis indicated that mediolateral sway velocity explained 30% and 17% of the variance of 180° turn time for dominant and non-dominant legs, respectively. No statistical inter-limb differences were noted for 180° turn and postural sway parameters. The results suggest that improving single-leg postural performance may enhance male soccer players' 180° turn performance. Therefore, unilateral stability in the mediolateral direction should be considered a potential indicator of change of direction-based performances. [ABSTRACT FROM AUTHOR]

Background: Agreement between the activities-specific balance confidence scale (ABC) and center of pressure (CoP) in prosthesis users is still very much unknown. The purpose of this study was to investigate the agreement between ABC and CoP in lower-limb prosthesis users. Methods: Twenty-one individuals with lower-limb prostheses were recruited. Participants were provided with the ABC scale and performed static balance tasks during eyes opened (EO) and eyes closed (EC) conditions whilst standing on a force platform. Pearson product moment coefficients between CoP displacements and ABC scores were performed. Participants were also stratified by those who had better (≥80 on ABC scale) and less (t-test with Cohen’s d to estimate effect size with alpha set at 0.05 for these tests. Results: There was a significant inverse moderate relationship between eyes opened displacement (EOD) (18.3 ± 12.5 cm) and ABC (75.1 ± 18.3%), r = (19)−0.58, p = 0.006, as well as eyes closed displacement (ECD) (37.7 ± 22.1 cm) and ABC, r = (19)−0.56, p = 0.008. No significant difference in EOD (t(19) = 1.36, p = 0.189, d = 0.61) and ECD (t(19) = 1.47, p = 0.156, d = 0.66) was seen between those with greater and less balance confidence. Conclusions: Self-report and performance-based balance outcome measures are recommended when assessing lower-limb prostheses users.

Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. Objective: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. Design: Retrospective cohort. Setting: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. Intervention(s): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. Main Outcome Measures: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. Results: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior–posterior direction (P =.030), and higher TTB anterior–posterior absolute minimum (P =.033) and mean minima (P =.050) compared with those who did not attend supervised rehabilitation. Conclusions: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Limits of stability is required to perform functional activities and other advanced tasks of life without losing balance, and assessment of limits of stability is essential in clinical practice. Forward, Lateral, and Oblique direction reach tests are clinical balance tests that assess limits of stability, and these reach distances in various directions may be symmetrical or asymmetrical. The aim was to establish the symmetry between various reach distances on three reach tests and to establish the concurrent validity of oblique, forward, and lateral direction reach test distances with limits of stability measured by the Iso Free machine of TecnoBody company. Methods: The measurements of oblique, forward, and lateral reach tests and limits of stability excursions of center of pressure were taken in eight directions on Iso Free machine of Techno Body in fifty typical college-going young adults who were recruited through convenience sampling. Pearson correlation test was used to find the relationship between forward, lateral, and oblique direction reaches and limits of stability in forward, lateral, and oblique directions. Regression analysis was used to find the factors influencing the forward, lateral, and oblique reach tests. Results: The reach distances were symmetrical, and out of the three tests, the lateral and oblique direction reach tests have a moderate positive correlation with limits of stability test in lateral and oblique directions with an r-value of 0.569 (p

Static stretching (SS) and dynamic stretching (DS) are widely used as warm-ups before sports. However, whether stretching affects postural control remains unclear. We compared the effects of SS and DS on the plantar flexors and postural control during single-leg standing. Fifteen healthy young participants performed SS, DS, or no stretching (control). The stretch condition consisted of four sets lasting 30 s each. The control condition was a rest with standing for 210 s. Center of pressure (COP) displacement was measured using a force plate before and after each intervention to assess postural control during the single-leg standing task. The COP area, COP velocity, and anteroposterior (COPAP) and mediolateral (COPML) range were calculated. DS significantly decreased in the COPML range (21.5 ± 4.1 to 19.0 ± 2.5 mm; P = 0.02), COP velocity (33.8 ± 7.6 to 29.8 ± 6.5 mm/s; P < 0.01), and COP area (498.6 ± 148.3 to 393.3 ± 101.1 mm2; P < 0.01), whereas SS did not change in the COP parameters (COP area 457.2 ± 108.3 to 477.8 ± 106.1 mm2, P = .49; COP velocity 31.2 ± 4.2 to 30.7 ± 5.8 mm/s, P = 0.60; COPAP 25.4 ± 3.1 to 25.3 ± 3.2 mm, P = 0.02; COPML 20.7 ± 3.3 to 21.1 ± 2.5 mm, P = 0.94). Therefore, DS of the plantar flexors enhances postural control during single-leg standing and may be effective for both injury prevention and performance enhancement. [ABSTRACT FROM AUTHOR]

Background: Agreement between the activities-specific balance confidence scale (ABC) and center of pressure (CoP) in prosthesis users is still very much unknown. The purpose of this study was to investigate the agreement between ABC and CoP in lower-limb prosthesis users. Methods: Twenty-one individuals with lower-limb prostheses were recruited. Participants were provided with the ABC scale and performed static balance tasks during eyes opened (EO) and eyes closed (EC) conditions whilst standing on a force platform. Pearson product moment coefficients between CoP displacements and ABC scores were performed. Participants were also stratified by those who had better (≥80 on ABC scale) and less (<80 on ABC scale) perceived balance confidence. Displacement was compared using an independent t-test with Cohen's d to estimate effect size with alpha set at 0.05 for these tests. Results: There was a significant inverse moderate relationship between eyes opened displacement (EOD) (18.3 ± 12.5 cm) and ABC (75.1 ± 18.3%), r = (19)−0.58, p = 0.006, as well as eyes closed displacement (ECD) (37.7 ± 22.1 cm) and ABC, r = (19)−0.56, p = 0.008. No significant difference in EOD (t(19) = 1.36, p = 0.189, d = 0.61) and ECD (t(19) = 1.47, p = 0.156, d = 0.66) was seen between those with greater and less balance confidence. Conclusions: Self-report and performance-based balance outcome measures are recommended when assessing lower-limb prostheses users. [ABSTRACT FROM AUTHOR]

Inadequate response to balance perturbations lead to posture instability in the elderly. The fall risks are increased by a reduced capacity to control the center of pressure (COP) displacement within the safety limit of the supporting base. This study developed an interactive evaluation and training platform. The system incorporated a computerized program with instantaneous force plate evaluation. Ten young subjects underwent a baseline evaluation and twenty-nine community-dwelling elderly received pre- and post-intervention testing. The ability to reach the stability limit was assessed by measuring the maximum voluntary excursion of the COP in anterior–posterior and medial–lateral directions. Functional mobility tests including Berg Balance Scale, Timed-Up-and-Go and functional reach were used as functional outcomes. The experimental group (n = 15) received a 40 min intervention three times a week for six weeks. The interactive game-based training focused on multi-directional weight shifting by tracing a COPcontrolled target to challenge an individual's stability limit. The control group (n = 14) maintained daily activities as usual. The young group revealed a superior COP displacement through active ankle control than the elderly, especially in the anterior–posterior direction. The experimental group improved their COP displacement control more in the medial–lateral direction due to the predominant side-to-side gameplay movement. The functional outcome measures were also significantly improved after training. Using the COPcontrolled game-based program, the stability limit was challenged to facilitate dynamic posture control by an incremental increase in self-initiated perturbations. The platform system could assist in transferring the immediate training effects into daily functional mobility in the elderly. [ABSTRACT FROM AUTHOR]

Maintaining balance is critical to minimizing astronauts’ risk of falling and reducing injury or suit damage. Previous studies involving spacesuits have not examined the effects of the superior shift of the center of gravity (CoG) on astronauts’ ability to balance. Here, the purpose of our study was to investigate the effects of CoG shift due to a simulated Extravehicular Mobility Unit (xEMU) on balance. Seventeen participants’ standing balance was examined for three test configurations: unsuited, weighted with an Extravehicular Mobility Unit (xEMU) vest, and xEMU hard upper body torso (HUT). Using a Tekscan forceplate walkway, the CoG locations were determined. Balance assessments were performed to determine the limits of stability and standing balance performance during wide or tandem stances with eyes open/closed. The center of pressure (CoP) time series was examined in terms of displacement, velocity, and frequency measures. During the eyes-open wide stance, the xEMU vest significantly increased the mediolateral balance parameters, while the HUT significantly increased the total displacement (TOTEX), mean velocity (MVELO), and mean frequency (MFREQ) of the CoP. In the eyes-closed wide stance, the HUT significantly increased these parameters. In the eyes-closed tandem stance, the xEMU vest significantly decreased the parameters. The xEMU vest significantly reduced the TOTEX, MVELO, and MFREQ (improved standing balance), while the HUT decreased standing balance ability, seen with significant increases in said parameters. By quantifying CoG’s effect on balance, our results form the basis for future balance and posture studies of xEMU spacesuits.

The purposes of the study were (1) to compare postural sway between participants with Parkinson's disease (PD) and healthy controls and (2) to develop and validate an automated classification of PD postural control patterns using a machine learning approach. A total of 9 participants in the early stage of PD and 12 healthy controls were recruited. Participants were instructed to stand on a force plate and maintain stillness for 2 minutes with eyes open and eyes closed. The center of pressure data were collected at 50 Hz. Linear displacements, standard deviations, total distances, sway areas, and multiscale entropy of center of pressure were calculated and compared using mixed-model analysis of variance. Five supervised machine learning algorithms (ie, logistic regression, K-nearest neighbors, Naive Bayes, decision trees, and random forest) were used to classify PD postural control patterns. Participants with PD exhibited greater center of pressure sway and variability compared with controls. The K-nearest neighbormethod exhibited the best prediction performancewith an accuracy rate of up to 0.86. In conclusion, participants with PD exhibited impaired postural stability and their postural sway features could be identified by machine learning algorithms. [ABSTRACT FROM AUTHOR]

Featured Application: The key finding of this project suggests approximate entropy and velocity of the center of pressure may be useful metrics for detecting small changes in quiet standing stability. The body's postural control system is responsible for responding to perturbations of balance and keeping the body upright. During quiet standing, the center of pressure oscillates about the center of mass, counteracting imbalances. These oscillations can be analyzed to determine the degree of stability, which could be helpful in quantifying the effects of brain injuries. In this research, the center of pressure was recorded for stances with feet together and feet tandem, with eyes opened and eyes closed, in neurotypical participants. These signals were analyzed using indices of approximate entropy and velocity to determine how sensitive the measures were in tracking changes to stability levels. One-way ANOVA test results showed increased approximate entropy in anterior/posterior and medial/lateral directions (p = 1.21 × 10−11, 3 × 10−14) and increased velocity in both directions (p = 2.87 × 10−6, 4.87 × 10−7) during conditions with decreased stability. Dunnett's post hoc testing indicated that approximate entropy was significantly greater in all the less stable feet tandem trials in comparison to the most stable eyes open, feet together condition with p < 0.001 in nearly every participant and that velocity was significantly greater in the least stable eyes closed, feet tandem trials in comparison to the most stable condition with p < 0.01 in nearly every participant. [ABSTRACT FROM AUTHOR]

After a transtibial amputation, the prosthetic foot aims at replacing the missing ankle joint. Due to alteration of proprioception and mobility, the static balance of amputees is challenging. The stiffness of most of the usual prosthetic feet cannot adapt according to the situation. Thus, the control of the user’s balance is closely related to the ankle stiffness value. The aim of this study is to evaluate both the impact of the ankle stiffness and the visual system on static balance. In order to avoid bias relative to different levels of residual proprioception among individuals, the study has been carried out on healthy subjects wearing lower limb prosthetic simulators under each foot. This configuration could be considered as a relevant model to isolate the effect of the stiffness. Eleven subjects wearing prosthetic feet with different modules were asked to remain as static as possible both with open eyes (OE) and closed eyes (CE). The center of pressure (COP) displacements and the joint angles range of motion (ROM) were experimentally assessed. The length of the major axis of the COP 95% confidence ellipse was projected on the antero-posterior direction (AP range). Linear regression models of the AP range and joint angles ROM as a function of the situation (OE and CE) and of the normalized ankle stiffness were created. A one-way analysis of variance test was performed on the model of the AP range. Linear regression coefficients and 95% confidence intervals (CI) were calculated between the AP range and the normalized ankle stiffness and between the joint angles ROM and the normalized ankle stiffness both in OE and CE. This study confirmed that static balance decreases when ankle stiffness decreases. The results also showed that a visual system alteration amplifies more significantly the decrease of static balance of people wearing prosthetic feet and has no significant influence on non-amputated subjects. The slope of the linear regression for the AP range according to the normalized ankle stiffness was equal to −9.86 (CI: −16.03, −3.69) with CE and −2.39 (CI: −4.94, 0.17) with OE. Both the normalized ankle stiffness and the visual system had a significant impact on the AP range (pvalue<0.05). The ankle stiffness is an interesting parameter as it has a high impact on the gait and on the static balance of the users and it must be controlled to properly design prosthetic feet.

Understanding individual limb contributions to standing postural control is valuable when evaluating populations with asymmetric function (e.g., stroke, amputations). We propose a method of quantifying three contributions to controlling the net anteroposterior center of pressure (CoP) during quiet standing: CoP moving under left and right limbs and weight shifting between the two limbs. Can these contributions to standing postural control be quantified from CoP trajectories in neurotypical adults? Instantaneous contributions can be negative or larger than one, and integrated contributions sum to equal one. Proof-of-concept demonstrations validated these calculated contributions by restricting CoP motion under one or both feet. We evaluated these contributions in 30 neurotypical young adults who completed two (eyes opened; eyes closed) 30-s trials of bipedal standing. We evaluated the relationships between limb contributions, self-reported limb dominance, and between-limb weight distributions. All participants self-reported as right-limb dominant; however, a range of mean limb contributions were observed with eyes opened (Left: mean [range] = 0.52 [0.37–0.63]; Right: 0.48 [0.31–0.63]) and with eyes closed (Left: 0.51 [0.39–0.63]; Right: 0.49 [0.37–0.61]). Weight-shift contributions were small with eyes opened (0.00 [−0.01 to 0.01]) and eyes closed (0.00 [−0.01 to 0.02]). We did not identify any between-limb differences in contributions when grouped by self-reported limb dominance (p > 0.10, d < 0.31). Contributions did not significantly correlate with Waterloo Footedness scores (−0.22 < r < 0.21, p > 0.25) or between-limb weight distributions (0 < r < 0.24, p > 0.20). Across neurotypical participants, we observed a notable range of limb contributions not related to self-reported limb dominance or between-limb weight distributions. With this tool, we can characterize differences in the amount of CoP motion and the underlying control strategies. Changes in limb contribution can be measured longitudinally (i.e., across rehabilitation programs, disease progression, aging) representative of limb function, which may be particularly useful in populations with asymmetric function. • Each limb and between-limb weight shifts control anteroposterior center of pressure. • We quantified these three variable's contributions to standing postural control. • We observed a range of limb contributions to the net center of pressure trajectory. • During quiet standing, shifting weight between limbs contributed little to control. • Limb dominance was not correlated to limb contributions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Children with Down syndrome (DS) may struggle adjusting their posture during gait or standing and tend to adapt slower to demanding motor tasks and environmental changes. The functionality in their daily activities is frequently diminished or they are slower, with poor postural control and balance as possible reasons. There is limited research on exercise programmes to improve postural control in children with DS. OBJECTIVE: To determine the effectivenes of an exercise programm with the Nintendo Wii Balance Board (NWBB) interface o postural control and functional balance of children with DS. METHODS: Participants were five children age 6–9 years belonging to the legal organization Espacio Down (in Talca, Chile), who underwen an exercise programm with the NWBB. The duration of the intervention wa 9 weeks, with two 25-minute sessions per week and a total intervention timeof 7.5 hours for each subject. Postural control pre-/postintervention was evaluated at a functional level with clinical tests: Timed Up and Go (TUG), One-Leg Standing (TOLS) and posturographic measures using centre of pressure (CoP) variables Descriptive statistics and the Wilcoxon test were applied, with p < 0.05 considered to be significant. RESULTS: Th NWBB programme showed a significant decrease in the CoP total velocity, mean velocity and displacements in themediolateral and anteroposterior directions (p = 0.021) for the closed-eyes condition and a decrease in the time of the TUG test (p = 0.021). CONCLUSIONS: This pilot study provides initial evidence for the effectiveness of the NWBB programme in children with DS. A 9-week NWBB programme improves the postural control and functional balanceof children with DS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vision is the primary sensory system to maintain balance. Approximately 50% of visually impaired youth have an increased risk of falling. Chinese reports focus more on the epidemiological survey of the number of people with visual impairment, but ignore balance performance and control strategies in such people, especially the study of influencing factors. OBJECTIVE: To explore the effects of visual factors (degree of visual impairment: blind, partially sighted and normal vision group; vision condition: eyes open and eyes closed conditions) on balance function of young adults. METHODS: Forty-three young adults were recruited and divided into three groups: blind (n=12), partially sighted (n=9) and normal vision group (n=22), and then underwent the following tests: one-leg stance test (eyes open and eyes closed conditions) and functional reach test (normal vision group: eyes open and closed conditions; partially sighted or blind groups: daily state). Measurement parameters between groups were analyzed using one-way analysis of variance. Paired sample t-tests were used to compare differences between different vision conditions within groups. RESULTS AND CONCLUSION: In the one-leg stance test, the center of pressure trajectory length in the normal vision group with eyes open was significantly shorter than that in the blind and partially sighted groups (P < 0.05), and there was no significant difference between the groups when the eyes were closed (P > 0.05). Degree of injury and visual status had no significant effect on the static balance of visually impaired youth (P > 0.05). In the functional reach test, the reaching distance with eyes open was significantly greater than that with eyes closed in the normal vision group (P < 0.05) and the distance with eyes closed was significantly less than that of the blind group (P < 0.05). To conclude, visual impairment dramatically reduces the static balance of young adults, and vision conditions remarkably affect postural stability of the sighted youth, while the degree of visual impairment has no significant effect on static and dynamic balance of visually impaired youth. The lack of visual feedback can be compensated by non-visual factors in visually impaired youth. [ABSTRACT FROM AUTHOR]

Introduction: Postural instability increases with age and is exacerbated in neurological disorders such as Parkinson's disease (PD). Reducing the base of support from bipedal to unipedal stance increases center of pressure (CoP) parameters and intermuscular coherence in lower-leg muscles of healthy older adults. To further develop an understanding of postural control in an altered state of neurological impairment, we explored intermuscular coherence in lower-leg muscles and CoP displacement in older adults with PD. Methods: This study measured surface EMG from the medial (MG) and lateral (LG) gastrocnemii, soleus (SOL), and tibialis anterior (TA), and examined EMG amplitude and intermuscular coherence during bipedal and unipedal stance on a force plate with firm (no foam) and compliant (standing on foam) surface conditions in nine older adults with PD (70±5 years, 6 females) and 8 age-matched non-Parkinsonian older adults (5 females). Intermuscular coherence was analyzed between agonistagonist and agonist-antagonist muscle pairs in the alpha (8-13 Hz) and beta (15-35 Hz) frequency bands. Results: CoP parameters increased from bipedal to unipedal stance in both groups (p < 0.01), but did not increase from the firm to compliant surface condition (p > 0.05). During unipedal stance, CoP path length was shorter in older adults with PD (2027.9 ± 1074.1 mm) compared to controls (3128.5 ± 1198.7 mm) (p < 0.01). Alpha and beta agonist-agonist and agonist-antagonist coherence increased by 28% from bipedal to unipedal stance (p > 0.05), but did not differ between older adults with PD (0.09 ± 0.07) and controls (0.08 ± 0.05) (p > 0.05). The older adults with PD also had greater normalized EMG amplitude of the LG (63.5 ± 31.7%) and TA (60.6 ± 38.4%) during the balance tasks (p > 0.05) than the non-Parkinsonian counterparts. Discussion: Older adults with PD had shorter path lengths during unipedal stance and required greater muscle activation than older adults without PD to perform the tasks, but intermuscular coherence did not differ between the groups. This may be attributable to their early disease stage and high motor function. [ABSTRACT FROM AUTHOR]

PURPOSE: This study evaluated the effects of an instrumented balance board on the balance parameters in children with spastic cerebral palsy by carrying out a pilot single-group pre-post clinical trial. METHODS: Five children aged 5 to 15 years with spastic diplegia and a Gross Motor Function Classification System level of I or II were included. All participants attended 20 sessions with an instrumented balance board, 45 minutes per session, 3 times a week for 7 weeks. The main outcome measures included the center of pressure excursion, velocity, and overshoot during quiet standing with open and closed eyes. The assessments were performed in the mediolateral and anteroposterior directions at pre- and one week post-intervention. RESULTS: Non-parametric tests showed that the excursion did not change significantly except in the mediolateral direction with eyes closed (p < 0.05). The velocity of the center of pressure improved in both directions and eye conditions (p < 0.05). Also, the maximum velocity decreased with eyes open (mediolateral, anteroposterior, and total) (p < 0.05), while the change was not significant with the eyes closed. The overshoot measurements did not change significantly. CONCLUSION: It is recommended to consider balance board training for improving balance parameters in children with cerebral palsy. [ABSTRACT FROM AUTHOR]

Abstract Background Low back pain patients suffer from balance disturbance. Balance allows a person to interact with the surrounding environment and to do his daily activities. As recent technology has facilitated patient monitoring and enhanced our ability to monitor patients remotely, smartphone apps have been developed to achieve this goal. There are various balance assessment instruments used nowadays. It may be subjective or objective assessments. This study was applied to verify if the measurements of balance Y-MED smartphone applications are valid and reliable compared to the HUMAC balance board in order to offer easy, fast, cost-effective, and time-effective valid and reliable balance assessment that can be used in a clinical setting. Methods Fifty-four patients (12 males and 42 females) with chronic mechanical low back pain for more than 3 months was volunteered to participate in the current study with an age range of 25–60 years and BMI range of 18–34 kg/m2. Compared with the HUMAC balance board, the validity of the balance Y-MED smartphone application is evaluated, and the test-retest reliability of the balance Y-MED smartphone application is obtained by the same examiner 3 times. Results For concurrent validity, the correlations between balance measurements by Y-MED smartphone application and HUMAC balance board were not significant in both eyes open (r = − 0.12, p = 0.38) and eyes closed (r = 0.26, p = 0.054). The smartphone application showed poor test-retest reliability measurement of balance with eyes open; (ICC was 0.279, with 95% CI − 0.117–0.554) and with eyes closed (ICC was − 0.159, with 95% CI − 0.814–0.287). Conclusions According to the evaluation scheme selected in this study, the researchers were unable to confirm the validity of the balance Y-MED smartphone application in the balance assessment of patients with mechanical chronic low back pain. More than that, the balance Y-MED smartphone application has been shown poor score reliability. This makes it inaccurate for use in assessment balance.

Inadequate response to balance perturbations lead to posture instability in the elderly. The fall risks are increased by a reduced capacity to control the center of pressure (COP) displacement within the safety limit of the supporting base. This study developed an interactive evaluation and training platform. The system incorporated a computerized program with instantaneous force plate evaluation. Ten young subjects underwent a baseline evaluation and twenty-nine community-dwelling elderly received pre- and post-intervention testing. The ability to reach the stability limit was assessed by measuring the maximum voluntary excursion of the COP in anterior–posterior and medial–lateral directions. Functional mobility tests including Berg Balance Scale, Timed-Up-and-Go and functional reach were used as functional outcomes. The experimental group (n = 15) received a 40 min intervention three times a week for six weeks. The interactive game-based training focused on multi-directional weight shifting by tracing a COPcontrolled target to challenge an individual’s stability limit. The control group (n = 14) maintained daily activities as usual. The young group revealed a superior COP displacement through active ankle control than the elderly, especially in the anterior–posterior direction. The experimental group improved their COP displacement control more in the medial–lateral direction due to the predominant side-to-side gameplay movement. The functional outcome measures were also significantly improved after training. Using the COPcontrolled game-based program, the stability limit was challenged to facilitate dynamic posture control by an incremental increase in self-initiated perturbations. The platform system could assist in transferring the immediate training effects into daily functional mobility in the elderly.

IntroductionPostural instability increases with age and is exacerbated in neurological disorders such as Parkinson’s disease (PD). Reducing the base of support from bipedal to unipedal stance increases center of pressure (CoP) parameters and intermuscular coherence in lower-leg muscles of healthy older adults. To further develop an understanding of postural control in an altered state of neurological impairment, we explored intermuscular coherence in lower-leg muscles and CoP displacement in older adults with PD.MethodsThis study measured surface EMG from the medial (MG) and lateral (LG) gastrocnemii, soleus (SOL), and tibialis anterior (TA), and examined EMG amplitude and intermuscular coherence during bipedal and unipedal stance on a force plate with firm (no foam) and compliant (standing on foam) surface conditions in nine older adults with PD (70±5 years, 6 females) and 8 age-matched non-Parkinsonian older adults (5 females). Intermuscular coherence was analyzed between agonist-agonist and agonist-antagonist muscle pairs in the alpha (8-13 Hz) and beta (15-35 Hz) frequency bands.ResultsCoP parameters increased from bipedal to unipedal stance in both groups (p 0.05). During unipedal stance, CoP path length was shorter in older adults with PD (2027.9 ± 1074.1 mm) compared to controls (3128.5 ± 1198.7 mm) (p 0.05), but did not differ between older adults with PD (0.09 ± 0.07) and controls (0.08 ± 0.05) (p > 0.05). The older adults with PD also had greater normalized EMG amplitude of the LG (63.5 ± 31.7%) and TA (60.6 ± 38.4%) during the balance tasks (p > 0.05) than the non-Parkinsonian counterparts.DiscussionOlder adults with PD had shorter path lengths during unipedal stance and required greater muscle activation than older adults without PD to perform the tasks, but intermuscular coherence did not differ between the groups. This may be attributable to their early disease stage and high motor function.

This study evaluated the amount, and particularly, the structure of variability in postural control accompanying an unstable shoe (US) application. Mediolateral and anterior-posterior center of pressure signals plus electromyographic profiles of the tibialis anterior and gastrocnemius medialis were recorded in 29 asymptomatic men while wearing both US and flat shoes. Statistical analysis included common measures of dispersion as well as sample entropy and largest Lyapunov exponent estimates. Data were compared by two-way repeated-measures analysis of variance. Corresponding main effects of footwear revealed that, in contrast to the flat shoes condition, the US intervention consistently increased center of pressure and electromyographic net fluctuations and rendered the overall system less complex, as reflected by the lower sample entropy and higher Lyapunov exponent values observed throughout. Accordingly, employing US in stance should be functional concerning motor development; however, the greater sensitivity of US users to external perturbations must not be overlooked and warrants further investigation. [ABSTRACT FROM AUTHOR]

After a transtibial amputation, the prosthetic foot aims at replacing the missing ankle joint. Due to alteration of proprioception and mobility, the static balance of amputees is challenging. The stiffness of most of the usual prosthetic feet cannot adapt according to the situation. Thus, the control of the user's balance is closely related to the ankle stiffness value. The aim of this study is to evaluate both the impact of the ankle stiffness and the visual system on static balance. In order to avoid bias relative to different levels of residual proprioception among individuals, the study has been carried out on healthy subjects wearing lower limb prosthetic simulators under each foot. This configuration could be considered as a relevant model to isolate the effect of the stiffness. Eleven subjects wearing prosthetic feet with different modules were asked to remain as static as possible both with open eyes (OE) and closed eyes (CE). The center of pressure (COP) displacements and the joint angles range of motion (ROM) were experimentally assessed. The length of the major axis of the COP 95% confidence ellipse was projected on the antero-posterior direction (AP range). Linear regression models of the AP range and joint angles ROM as a function of the situation (OE and CE) and of the normalized ankle stiffness were created. A one-way analysis of variance test was performed on the model of the AP range. Linear regression coefficients and 95% confidence intervals (CI) were calculated between the AP range and the normalized ankle stiffness and between the joint angles ROM and the normalized ankle stiffness both in OE and CE. This study confirmed that static balance decreases when ankle stiffness decreases. The results also showed that a visual system alteration amplifies more significantly the decrease of static balance of people wearing prosthetic feet and has no significant influence on non-amputated subjects. The slope of the linear regression for the AP range according to the normalized ankle stiffness was equal to −9.86 (CI: −16.03, −3.69) with CE and −2.39 (CI: −4.94, 0.17) with OE. Both the normalized ankle stiffness and the visual system had a significant impact on the AP range ( p v a l u e < 0.05 ). The ankle stiffness is an interesting parameter as it has a high impact on the gait and on the static balance of the users and it must be controlled to properly design prosthetic feet. [ABSTRACT FROM AUTHOR]

The primary aim of this systematic review is to evaluate how postural balance and visual system are related in cross-eyed patients. The secondary goal is to assess the benefits of eye realignment on motor skills and body balance. Analyzing two different approaches: surgical or conservative, a systematic literature search was conducted using PubMed–Medline, Google Scholar and Cochrane Central in order to identify randomized controlled trials, case series and case–control studies which contained clinical evaluation of balance in strabismic patients as well as re-evaluation after surgery or conservative treatments via posturography to evaluate surface, length and mean speed of the center of pressure (CoP). A total of 11 studies were included in this review. The MINORS score is used to assess the methodological quality of the included studies, and its mean value was 12.8 for non‐comparative studies and 17.5 for comparative studies. The postural balance was lower in strabismic patients compared with the control group, with statically higher value (p < 0.05) of surface, length and mean speed of the CoP in the study group. All patients show improvement in stability after surgery, as surface, length and mean speed of the CoP decreased after surgery in all the studies with statistical significance (p < 0.05). [ABSTRACT FROM AUTHOR]

Introduction: Huntington's disease (HD) is a progressive neurodegenerative disorder with motor, cognitive, and psychiatric symptoms that typically manifest in middle adulthood. Balance assessments may be useful for predicting disease onset and progression, but studies are limited. We aimed to enhance estimates of HD onset using an inexpensive and practical body sway assessment device [i.e., Wii Balance Board (WBB)].Methods: We assessed total body sway (TBS) on 64 HD gene carriers [Presymptomatic HD (PsHD; n = 16); Prodromal HD (ProHD; n = 16); HD (n = 32)] and 21 demographically similar normal controls (NC) employing a WBB and custom-designed laptop software. Participants completed balance test trials that included combinations of eyes open or closed while standing on a stable versus unstable surface. Non-parametric analyses were conducted to assess group differences in TBS conditions.Results: The HD group had significantly higher TBS in most balance conditions relative to NC, PsHD, and ProHD groups (ps < .05). Importantly, the ProHD group demonstrated higher TBS relative to NC in all balance conditions (ps < .05) with medium to large effect size ranges (r≥ 0.40). No differences in TBS were exhibited between NC and PsHD groups (ps > .05).Conclusions: Increased body sway, easily evaluated using a brief, objective balance assessment, may serve as an important functional marker in patients with, and during the transition to, HD. Further studies are needed to confirm and extend these findings. [ABSTRACT FROM AUTHOR]

The body’s postural control system is responsible for responding to perturbations of balance and keeping the body upright. During quiet standing, the center of pressure oscillates about the center of mass, counteracting imbalances. These oscillations can be analyzed to determine the degree of stability, which could be helpful in quantifying the effects of brain injuries. In this research, the center of pressure was recorded for stances with feet together and feet tandem, with eyes opened and eyes closed, in neurotypical participants. These signals were analyzed using indices of approximate entropy and velocity to determine how sensitive the measures were in tracking changes to stability levels. One-way ANOVA test results showed increased approximate entropy in anterior/posterior and medial/lateral directions (p = 1.21 × 10−11, 3 × 10−14) and increased velocity in both directions (p = 2.87 × 10−6, 4.87 × 10−7) during conditions with decreased stability. Dunnett’s post hoc testing indicated that approximate entropy was significantly greater in all the less stable feet tandem trials in comparison to the most stable eyes open, feet together condition with p < 0.001 in nearly every participant and that velocity was significantly greater in the least stable eyes closed, feet tandem trials in comparison to the most stable condition with p < 0.01 in nearly every participant.

In popular fitness modalities, the participants often perform abdominal breathing while maintaining stable or rather unstable as well as inverted body stances that may challenge the respiratory muscles' activation. This study aimed to examine the abdominal breathing effect on postural stability and the respiratory muscles' activation during four body stances: the Upright Stance, the Quadrupled Inverted V, the Elbow Side-Bridge, and the Headstand. Participants (n = 29) maintained (40 s) the body stances under regular and abdominal breathing (the latter verified through visual inspection and 3D inertial sensing of the abdominal wall angular displacements, LORD-MicroStrain®, 100 Hz, MicroStrain, Inc., Williston, VT, USA). The trajectory of the center of pressure (CoP) (Kistler force plate, 100 Hz, Kistler Group, Winterthur, Switzerland) was recorded in synchronization with the respiratory muscles' (sternocleidomastoid, external intercostals, diaphragm, rectus abdominis) vibromyographic activation (Biopac VMG sensors, 2000 Hz, Biopac Systems, Inc., Santa Barbara, CA, USA). Abdominal breathing had a significant (p ≤ 0.05) deteriorating effect on postural stability and an increasing one on the respiratory muscles' activation; however, this was not consistent across body stances. The body stance specificity of the abdominal breathing effect justifies the purpose of the present study. Thus, before the request for abdominal breathing in popular fitness modalities, one should acknowledge the postural and the breathing demands of each particular stance, particularly for the inverted ones. [ABSTRACT FROM AUTHOR]

Background: Theoretically, balance is affected by the height of center of mass (COM) during quiet standing. However, no one examined this in humans with variables derived from the center of pressure (COP). Objects: We have conducted balance experiment to measure COP data during quiet standing, in order to examine how the COP measures were affected by the height of COM, vision, floor conditions, and gender. Methods: Twenty individuals stood still with feet together and arms at sides for 30 seconds on a force plate. Trials were acquired with three COM heights: 1% increased or decreased, and not changed, with two vision conditions: eyes closed (EC) and eyes open (EO), and with two floor conditions: unstable (foam pad) and stable (force plate) floor. Outcome variables included the mean distance, root mean square distance, total excursion, mean velocity, and 95% confidence circle area. Results: All outcome variables were associated with the COM height (p < 0.0005), vision (p < 0.0005), and floor condition (p < 0.003). The mean velocity and 95% confidence circle area were 5.7% and 21.8% greater, respectively, in raised COM than in lowered COM (24.6 versus 23.2 mm/s; 1,013.4 versus 832.3 mm2). However, there were no interactions between the COM height and vision condition (p > 0.096), and between the COM height and floor condition (p > 0.183) for all outcome variables. Furthermore, there was no gender difference in all outcome variables (p > 0.186). Conclusion: Balance was affected by the change of COM height induced by a weight belt in human. However, the effect was not affected by vision or floor condition. Our results should inform the design of balance exercise program to improve the outcome of the balance training.

Background: Medial knee osteoarthritis can contribute to pain and stiffness, interfere with balance and limit functional activities of daily living. Unloader knee orthosis or lateral wedged insoles are current conservative approaches used to treat these conditions. The aim of this study was to identify and compare the effects of them on the balance parameters. Methods: 66 subjects with mild to moderate medial knee osteoarthritis were randomly assigned to wear unloader knee brace or full-length 6° lateral wedge insole. Primary outcome balance parameters were stability %, path length and average velocity of center of pressure and mobility score which were investigated by HUMAC® Balance and Tilt system. Secondary outcome measures were knee function score using Knee Injury and Osteoarthritis Outcome Score scale. Assessment was performed at baseline and six months post orthotic intervention period. Findings: Both orthoses improved all parameters compared to the baseline condition (p < 0.05). Unloader knee orthosis showed a significant improvement in all balance parameters compared to lateral wedged insoles (p < 0.001) except mobility scores (p=0.527). Except activities of daily living (p=0.752) and sports and recreational activities (p=0.437), unloader knee orthosis had a greater effect on the pain (p=0.002) and symptoms (p < 0.001) sub scales than lateral wedged insoles. However, quality of life sub-scale scores for insoles were more effective than the knee orthosis. Interpretation: Unloader knee orthosis improved balance and knee function scores more than lateral wedged insole, though both orthoses produced significantly improved results compared to baseline assessment. [ABSTRACT FROM AUTHOR]

Virtual reality environments can be manipulated allowing controlled visual disturbances. These environmental manipulations (textures, objects, and movements) can affect postural control by creating a sensory mismatch, making it possible to investigate multisensory reweighting. VR integration with motion capture equipment is relatively new; these environmental factors have not received sufficient attention to be employed in postural related research and in VR environment development. Seventeen subjects performed 48 trials of forward and backward translational optic flow in single and double support presented on a head mounted display. Each condition was presented in three different velocities: 3 m/s, 5 m/s and 8 m/s. The effect on center of pressure distance and velocity were analyzed. A repeated measures, counterbalanced experimental design was used. Center of pressure distance travelled increased in the single support condition (p < 0.001). The largest single support postural disturbance was observed in the slowest velocity and longest duration (3 m/s) and the smallest in the fastest velocity shortest duration (8 m/s). A slow optic flow velocity and higher duration of sudden visual translations generates greater disruption to postural control in single support. The velocity and duration of perturbations need to be carefully considered when studying human postural control and the design of VR environments. [ABSTRACT FROM AUTHOR]

The goal of this study was to examine the effects of 3 factors and their interactions on posturography: a period of time to become accustomed to the force platform before the initiation of data collection, presence of a visual fixation point, and participant talking during testing. The postural stability of 30 young adults and 30 older adults was evaluated to determine whether any observed effects were confounded with age. Analysis of variance techniques were used to test all possible combinations of the 3 factors. We hypothesized that all 3 factors would significantly affect postural stability. For both participant groups, the results suggest that a period of time to become accustomed to the force platform before the initiation of data collection and a visual fixation point significantly affect postural control measures, while brief participant talking does not. Despite this, no significant interactions existed suggesting that the effects of these factors, which may occur in clinical testing, do not depend on each other. Our results suggest that inconsistencies in posturography testing methods have the potential to significantly affect the results of posturography, underscoring the importance of developing a standardized testing methodology. [ABSTRACT FROM AUTHOR]

Accurate quantification of the impact of visual, somatosensory, and vestibular systems on postural control may inform tailor-made balance intervention strategies. The aim of this proof-of-concept study was to determine the safety, sense of presence, system usability, and face validity of a newly developed Virtual Reality Comprehensive Balance Assessment and Training (VR-ComBAT) in healthy young individuals. The VR-ComBAT included six balance condition: (1) stable surface with fixed virtual reality (VR) surroundings; (2) stable surface with blacked out VR surroundings; (3) stable surface with VR visual conflict; (4) unstable surface with fixed VR surroundings; (5) unstable surface with blacked out VR surroundings; and (6) unstable surface with VR visual conflict. Safety was evaluated using the number of adverse events, including scores on the Simulator Sickness Questionnaire. Sense of presence was evaluated using the igroup Presence Questionnaire (iPQ). System usability was assessed using the Systems Usability Scale (SUS). Friedman analyses with post hoc Wilcoxon Signed Rank tests were employed to demonstrate face validity by quantifying center of pressure (COP) changes in mean distance, mean velocity, and mean frequency in the anteroposterior (AP) and mediolateral (ML) direction across the six conditions. Twenty-three participants (27.4 ± 8.0 years old; 13 women) reported no adverse events. Participants scores on average 44.9 ± 9.6 on the iPQ and 79.7 ± 9.9 on the SUS. Post hoc analyses showed significant changes in COP-based measures when compared to baseline. The mean frequency change of COP showed direction-dependence in which increased frequency change in AP was observed while decreased change in ML was noted. The VR-ComBAT provides a safe, feasible, and cost-effective VR environment that demonstrates consistent sensory re-weighting between visual, somatosensory, and vestibular systems. Future studies should investigate whether VR-ComBAT can be used to inform precision rehabilitation of balance and fall prevention in older adults without and with neurological conditions.

Study design: This is a retrospective cohort with multiple regression modeling. Objective: The aim is to develop a new method for estimating cone of economy (CoE) using a force plate rather than traditional motion capture. Background: Currently, most spinal deformity surgeons rely on static radiographic parameters for alignment, balance, and outcomes data alongside patient-reported outcome measures. The CoE, the stable region of upright posture, can be objectively measured to determine the efficiency and balance of the spine. Motion capture technology is currently used to collect data to calculate CoE, but this requires expensive and complex equipment, which is a barrier to widespread adoption and clinical use of CoE measurements. Force plates, which measure pressure, are less expensive and can be used in a clinical setting. Methods: Motion capture and a force plate were used to quantify the CoE of 473 subjects (423 spinal surgical candidates; 50 healthy controls; 271 females; age: 58.60 ± 15.27; height: 1.69 ± 0.13; weight: 81.07 ± 20.91), and a linear multiple regression model was used to predict CoE using force plate data in a human motion laboratory setting. Patients were required to stand erect with feet together and eyes open in their self-perceived balanced and natural position for a full minute while measures of sway and center of pressure (CoP) were recorded. Results: The CoP variable regression model successfully predicted CoE measurements. The variables that were used to predict vertical CoE were CoP coronal sway, CoP sagittal sway, and CoP total sway in several combinations. The coefficient of determination for the head total sway model indicated a 87.0% correlation (F(3,469) = 1044.14, p < 0.001). The coefficient of determination for the head sagittal sway model indicated a 69.2% correlation (F(3,469) = 351.70, p < 0.001). The coefficient of determination for the head coronal sway model indicated a 85.2% correlation (F(3,469) = 899.27, p < 0001). Conclusion: Cone of economy was estimated from force plate data using center of pressure with high correlation without the use of motion capture in healthy controls and a variety of spine patients. This could lower the entry burden for measurement of the CoE in patients, enabling widespread use. This would provide surgeons objective global balance data, along with Haddas' CoE classification system, that could assist with surgical decision-making and facilitate objective monitoring surgical outcomes. [ABSTRACT FROM AUTHOR]

Stance stability in individuals with bilateral spastic cerebral palsy (BSCP) in various standing postures including the quiet standing (QS) and limits of stability (LoS) has been widely studied. However, the relationships between the QS and LoS remain unclear. This study aimed to determine the relationships between the positions and postural sway in the QS and anteroposterior LoS in individuals with BSCP. It included 27 adolescents and young adults with BSCP (BSCP group) and 27 adolescents and young adults without disability (control group). The position of center of pressure in the anteroposterior direction (CoPy position) and the path length of center of pressure (CoP path length) during the QS and the anterior and posterior LoS (A-LoS and P-LoS, respectively) were measured using a force platform. The CoPy positions in the A-LoS and P-LoS in the BSCP group were limited compared with those in the control group. In the BSCP group, the more anterior the CoPy position in the QS, the more anterior (i.e., limited) it was in the P-LoS. Although the CoP path length in the QS was larger in the BSCP group, those in the A-LoS and P-LoS were larger in the control group. The BSCP group also showed that the more anterior the CoPy position or the longer the CoP path length in the QS, the more decreased the anteroposterior LoS range was. Therefore, assessing various standing postures, including QS and anteroposterior LoS, is important to manage balance impairments in individuals with BSCP. [ABSTRACT FROM AUTHOR]

Abstract Background The limb center of pressure (COP) path measures and quantifies the load distribution within a limb in a still or moving subject. Under this premise, the aim of this study was to test whether data derived from this parameter could detect the differences between sound and lame limbs in unilaterally lame dogs with elbow dysplasia. To accomplish this purpose, ten unilaterally lame dogs of similar conformation were walked over a pressure platform. Next, the COP path, in relation to the position of sound and lame limbs, was measured in a coordinate system over a standard paw template obtained by pedobarography during the whole support phase. To compare variables, force platform data (peak vertical force and vertical impulse) from the same animals were obtained. Sound and lame limb statokinesiograms were also obtained while the animals stood still. Results The statistical analysis clearly showed that COP in lame limbs start cranially and were shorter than sound limbs. In addition, the value of the COP excursion index was lower in lame limbs. Finally, the area of statokinesiograms was greater in lame limbs. Conclusion This methodology based in limb COP characteristics serves to discriminate between sound and lame limbs in dogs with elbow dysplasia.

Background: The maintenance of postural control is a key component in dynamic physical activity, especially during muscle fatigue and against external forces. Despite many studies in this field, there is no consensus regarding the effects of plantar flexor muscles fatigue on postural control during different postural tasks. Objective: To evaluate the effects of plantar flexor muscles fatigue on postural control during quiet stance and external perturbation in healthy subjects. Material and Methods: Twenty four healthy individuals (20-35 years) participated this interventional study. The foot center of pressure data was measured using a single force platform, and then the postural control parameters, including the center of pressure displacement and velocity in the anterior-posterior and medial-lateral direction and also path length calculated under two conditions; quiet and perturbed stance, before and after plantar flexor muscles fatigue. Results: The statistical analysis demonstrated that mean displacement and velocity of the center of pressure in the anterior-posterior direction and also path length increased after the fatigue protocol in the perturbed condition. However, fatigue had no significant effects on postural control parameters in the quiet standing condition. Conclusion: These results indicated that the effects of muscle fatigue on postural control depend on the difficulty of the task and the relevance of proprioceptive information. The postural control system appears to use distinct control strategies in different situations such as quiet and perturbed stance conditions, and these strategies may be differentially altered by fatigue. In conclusion, due to the potential risk of loss of balance, it is important to take the role of plantar flexor muscle fatigue into account during more difficult postural tasks.

Background: Cancer and cancer treatments negatively affect somatosensory, vestibular, and visual inputs that regulate postural stability and balance, increasing the risk of falling. Exercise training has been shown to mitigate other negative side effects of cancer treatments, such as reducing peripheral neuropathy.Research Question: How does 12 weeks of supervised exercise training influence postural stability in cancer survivors who receive chemotherapy?Methods: Postural stability of cancer survivors (n = 25; mass = 79.0 ± 22.6 kg; height = 1.66 ± 0.08 m; age = 61 ± 10 years) receiving chemotherapy was assessed prior to and following a 12-week individualized exercise training program by quantifying changes in center of pressure data. A series of 2-factor (pre/post x condition) analysis of variance with repeated measures were used to identify differences between conditions and pre- and post- training program on time and frequency domain measures.Results: Mediolateral root mean square excursion (p = 0.040; es = 0.20) and resultant mean frequency (p = 0.044; es = 0.29) of the center of pressure trajectory were found to be significantly different between pre- and post-training program. Further, participants dealt better with perturbations after completing the training program by reducing mediolateral root mean square excursion and 95 % confidence ellipse when visual stimulus was removed.Significance: Supervised exercise training in cancer patients undergoing chemotherapy improves postural stability in the mediolateral direction. Given that mediolateral movement of the center of pressure has previously been associated with fallers in other populations, exercise training during cancer treatments may be beneficial. [ABSTRACT FROM AUTHOR]

Background: Standing postural sway is often quantified from center of pressure trajectories. During assessments of longer durations, children may fidget, thus limiting the feasibility and validity of sway recordings.Research Question: Do postural sway sample durations less than 30 s maintain construct and concurrent validity?Methods: In this case-control, observational study, we measured postural sway in 41 children (age 5-12 years, 23 typically developing (TD); 18 with spastic cerebral palsy (CP), 13 diplegic and 5 hemiplegic, 11 GMFCS level I and 7 level II) for 30-second eyes-opened and eyes-closed conditions. From a single recording, 5-second incremental durations of 5-30 s were considered in this analysis. We quantified anteroposterior, mediolateral, and transverse-plane sway using seven time-domain variables: root-mean-square error, total excursion, mean frequency, mean distance, sway area, and 95 % confidence circle and ellipse areas. Variables were calculated in eyes-opened and eyes-closed conditions, as well as the ratio of the two. Construct validity was evaluated by the persistence of large effect sizes (Glass's Δ ≥ 0.80) between CP and TD participants at shorter durations than 30 s. Concurrent validity was evaluated by the correlations of shorter duration measures to the 30 s measure.Results: Seven sway measures had large between-group effects (Glass's Δ ≥ 1.02) for the 30 s measure that persisted (Glass's Δ ≥ 0.81) at shorter durations (5-25 s) and also maintained concurrent validity (r ≥ 0.83). Six of these seven measures were taken in the eyes-closed condition, and all seven measures were in the mediolateral direction or transverse plane.Significance: Our analysis suggests that sway durations less than 30 s can uphold construct and concurrent validity. These measures were primarily in the eyes-closed conditions and mediolateral direction. These results are a promising indicator that shorter-duration sway measures may be of utility when fidgeting prevents longer recordings. [ABSTRACT FROM AUTHOR]