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Anterior cruciate ligament (ACL) rupture can impair balance performance, particularly during cognitive motor dual-tasks, This study aimed to determine the effects of various modalities of cognitive load (working memory, and visuospatial and executive function) on postural control parameters in individuals with ACL injury. Twenty-seven ACL-injured and 27 healthy participants were evaluated doing different cognitive tasks (silent backward counting. Benton's judgment of line orientation. and Stroop color-word test) while standing on a rigid surface or a foam. Each task was repeated three times and then averaged. Center of pressure variables used to measure postural performance included sway area and sway velocity in anterior-posterior and medial-lateral directions, Cognitive performance was also assessed by calculating errors and the score of cognitive tasks. A mixed model analysis of variance for center of pressure parameters indicated that patients had more sways than the healthy group. The interaction of group by postural difficulty by cognitive tasks was statistically significant for cognitive errors (p < .01), and patients with ACL injury indicated more cognitive errors compared to healthy controls while standing on the foam. The main effect of cognitive task was statistically significant for all postural parameters, representing reduced postural sways in both groups with all cognitive tasks. However, ACL-injured patients showed more cognitive errors in difficult postural conditions, suggesting that individuals with ACL injury may prioritize postural control over cognitive task accuracy and adopt the posture-first strategy to maintain balance under dual-task conditions. [ABSTRACT FROM AUTHOR]

Previous work assessing the effect of additive noise on the postural control system has found a positive effect of additive white noise on postural dynamics. This study covers two separate experiments that were run sequentially to better understand how the structure of the additive noise signal affects postural dynamics, while also furthering our knowledge of how the intensity of auditory stimulation of noise may elicit this phenomenon. Across the two experiments, we introduced three auditory noise stimulations of varying structure (white, pink, and brown noise). Experiment 1 presented the stimuli at 35 dB while Experiment 2 was presented at 75 dB. Our findings demonstrate a decrease in variability of the postural control system regardless of the structure of the noise signal presented, but only for high intensity auditory stimulation.

Purpose: We tested the hypothesis that heat stress influences the closed-loop cardio-postural control by an increased blood pressure (BP) drop and postural sway. Methods: Fourteen healthy individuals (eight women) performed two orthostatic tests under thermal reference (TC; ~ 24 ºC) and HOT (~ 38 ºC) conditions. The center-of-pressure (COP) displacements and the electromyography (EMG) activity of the calf muscles (medial gastrocnemius and tibialis anterior) were recorded during the initial orthostasis (ORT onset) after the supine-to-stand challenge. At the same period, BP (beat-to-beat) was continuously monitored, and supine-to-stand variations (∆%) were calculated. Sublingual temperature (Tsl) was measured as a surrogate of internal temperature. Results: Tsl increased in HOT compared to TC (TC 36.5 ± 0.3 vs. HOT 36.7 ± 0.3 ºC; p < 0.01). COP distance was greater in HOT compared to TC condition (TC 596.6 ± 242.4 vs. HOT 680.2 ± 249.1 mm; p < 0.01). EMG activity of the gastrocnemius decreased in HOT compared to TC condition (TC 95.5 ± 19.8 vs. HOT 78.4 ± 22.8%mV; p = 0.02). EMG of tibialis did not change between TC and HOT (TC 83.5 ± 42.9 vs. HOT 66.1 ± 31.9% mV; p = 0.29). BP showed a greater fall in HOT compared to TC condition (∆%TC − 24.5 ± 13.2 vs. ∆%HOT − 33.2 ± 20.2%; p = 0.01). Conclusion: Heat stress causes a greater fall in blood pressure and a reduction in musculoskeletal pump activity during orthostatic onset. These effects could be potential mechanisms that underlie augmented postural instability under a heated environment. [ABSTRACT FROM AUTHOR]

Background: Postural control is dependent on the central nervous system's accurate interpretation of sensory information to formulate and execute adequate motor actions. Research has shown that cognitive functions are associated with both postural control and fall risk, but specific associations are not established. The aim of this study was to explore how specific components of everyday postural control tasks are associated with both general and specific cognitive functions. Methods: Forty-six community-dwelling older adults reported their age, sex, physical activity level, falls and fall-related concerns. The following cognitive aspects were assessed: global cognition, executive functions, processing speed and intraindividual variability. Postural control was quantified by measuring postural sway in quiet stance, walking at a self-selected pace, and walking while performing a concurrent arithmetical task. Separate orthogonal projections of latent structures models were generated for each postural control outcome using descriptive and cognitive variables as explanatory variables. Results: Longer step length and faster gait speed were related to faster processing speed and less intraindividual variability in the choice reaction test. Moreover, longer step length was also related to less fall-related concerns and less severe fall-related injuries, while faster gait speed was also related to female sex and poorer global cognition. Lower dual-task cost for gait speed was explained by the executive function inhibition and faster processing speed. Postural sway in quiet stance was not explained by cognitive functions. Conclusions: Cognitive functions explained gait speed and step length during normal walking, as well as the decrease of gait speed while performing a concurrent cognitive task. The results suggest that different cognitive processes are important for different postural control aspects. Postural sway in quiet stance, step time and gait variability seem to depend more on physical and automatic processes rather than higher cognitive functions among physically active older people. The relationships between cognitive functions and postural control likely vary depending on the specific tasks and the characteristics of different populations. [ABSTRACT FROM AUTHOR]

Lateral ankle ligament reconstruction (LALR) is fundamental to avoid instability and the risk of osteoarthritis. After surgery, deficits in muscular strength and the proprioceptive system lead to functional changes. This study aimed to investigate if proprioceptive and isokinetic training can be incorporated to manage a professional soccer player after LALR. A 25-year-old professional soccer player, who injured his right ankle while playing, participated in the study. An MRI revealed partial rupture of the anterior talofibular ligament and associated fracture of the posterolateral distal fibular. Three months after the reconstruction surgery, the participant performed 20 sessions of isokinetic training along with 10 proprioceptive exercises. Outcomes were isokinetic inversion and eversion variables in concentric mode at 60, 120, and 240°/s (during the isokinetic phase – sustained velocity), postural sway (assessed in single-limb stance, using a force platform), and physical function (Foot and Ankle Ability Measure (FAAM) and the Lower Extremity Functional Scale (LEFS)). Post-treatment, the sustained velocity increased by ∼6% and decreased by 3% in the other isokinetic phases in inversion and eversion. At 60°/s, the Peak Torque/Body Mass for the evertor muscle was 30% higher post-treatment. Center of Pressure (CoP) data with eyes open showed a decrease for anteroposterior dispersions and displacement. The FAAM (sports sub-section) and LEFS increased by 15.6 and 9 points, respectively. Isokinetic and proprioceptive training improved postural control parameters, physical function, and inversion and eversion isokinetic variables in a professional soccer player after lateral ligament reconstruction. [ABSTRACT FROM AUTHOR]

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks–Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention. [ABSTRACT FROM AUTHOR]

Background and Objectives: In patients with non-specific chronic low back pain (LBP), their pain and problem sides can differ. Clinical Pilates assessment provides an approach to identify the problem side, but this approach requires experience and can be subjective. This study aimed to investigate if objective measures of single-leg squat postural control and hamstrings flexibility could identify the problem side in adults with non-specific chronic LBP. Materials and Methods: Forty adults with non-specific chronic LBP were tested on single-leg squat postural control and hamstrings flexibility. The problem side of participants was assessed with the Clinical Pilates method. Paired t-tests were used to compare the postural sway parameters of the single-leg squat and hamstrings flexibility between the problem and non-problem sides. Cohen's kappa was then used to assess the agreement of postural sway and flexibility measures with the Clinical Pilates method. Results: The problem side showed smaller vertical force variance, larger sway path distances, lower peak vertical force, smaller terminal knee flexion angle, longer time to complete the five single-leg squats, and tighter hamstrings as compared to the non-problem side. However, only the overall and anteroposterior sway path distances, terminal knee flexion angle, total squat duration, and hamstrings flexibility yielded moderate to strong agreement with the Clinical Pilates method. Conclusions: Single-leg squat postural sway parameters and hamstrings flexibility can objectively identify the problem side in adults with non-specific chronic LBP. [ABSTRACT FROM AUTHOR]

Objectives. Knee injuries are prevalent among professional tennis players and have a significant impact on their athletic performance and longevity. This study aimed to evaluate the dynamic and postural balance differences between injured and healthy professional tennis players, reflecting the broader implications of knee injuries on player stability and performance. Materials and methods. A total of 80 professional tennis players, comprising 40 individuals in the knee injury group (IG) and 40 individuals in the non-injury group (NIG), were selected to participate in this cross-sectional study. Participants’ postural sway was assessed under various conditions, including standing on different surfaces with open and closed eyes using a Wii Balance Board. The Y-Balance Test was performed to evaluate the player’s dynamic balance. An Independent t-test was used to examine the difference in postural sway and dynamic balance between the two groups. Results. The results of this study indicated that players with knee injuries showed significantly worse performance in both dynamic balance (p

Introduction Postural control is essential for humans to maintain balance under both static and dynamic conditions. A variety of unstable support surfaces are used to evaluate postural control. Balance foam pads are relatively expensive, whereas natural rubber pads use a natural material with equivalent viscoelastic properties that are inexpensive and widely available. No postural sway and reliable data existed to support the practice of using a natural rubber pad. The purposes of the study were to determine the test-retest reliability of postural sway by using a natural rubber pad and to compare postural sway in healthy adults while using a foam pad, a natural rubber pad and a firm surface. Methods Nineteen healthy participants were measured for centre of pressure (COP) velocity and displacement during a quiet stance, with their eyes closed, on a balance foam pad (blue foam – Airex ® ), a natural rubber pad and a firm surface on a force platform. Two repeated sessions were conducted three days apart. Intraclass correlation coefficients were used to determine the test-retest reliability. A one-way repeated measures ANOVA was used to compare the three surface conditions. Results The natural rubber pad demonstrated moderate to good reliability for COP velocity and COP displacement. Also, there were no significant differences in anteroposterior (AP) and mediolateral (ML) COP velocity and displacement between the balance foam pad and the natural rubber pad. Conclusions Our findings indicate that a natural rubber pad could be employed as a low-cost alternative to the balance foam pad for evaluating the balance of healthy adults.

The stabilization of human quiet stance is achieved by a combination of the intrinsic elastic properties of ankle muscles and an active closed-loop activation of the ankle muscles, driven by the delayed feedback of the ongoing sway angle and the corresponding angular velocity in a way of a delayed proportional (P) and derivative (D) feedback controller. It has been shown that the active component of the stabilization process is likely to operate in an intermittent manner rather than as a continuous controller: the switching policy is defined in the phase-plane, which is divided in dangerous and safe regions, separated by appropriate switching boundaries. When the state enters a dangerous region, the delayed PD control is activated, and it is switched off when it enters a safe region, leaving the system to evolve freely. In comparison with continuous feedback control, the intermittent mechanism is more robust and capable to better reproduce postural sway patterns in healthy people. However, the superior performance of the intermittent control paradigm as well as its biological plausibility, suggested by experimental evidence of the intermittent activation of the ankle muscles, leaves open the quest of a feasible learning process, by which the brain can identify the appropriate state-dependent switching policy and tune accordingly the P and D parameters. In this work, it is shown how such a goal can be achieved with a reinforcement motor learning paradigm, building upon the evidence that, in general, the basal ganglia are known to play a central role in reinforcement learning for action selection and, in particular, were found to be specifically involved in postural stabilization. [ABSTRACT FROM AUTHOR]

Objectives. Knee injuries are prevalent among professional tennis players and have a significant impact on their athletic performance and longevity. This study aimed to evaluate the dynamic and postural balance differences between injured and healthy professional tennis players, reflecting the broader implications of knee injuries on player stability and performance. Materials and methods. A total of 80 professional tennis players, comprising 40 individuals in the knee injury group (IG) and 40 individuals in the non-injury group (NIG), were selected to participate in this cross-sectional study. Participants’ postural sway was assessed under various conditions, including standing on different surfaces with open and closed eyes using a Wii Balance Board. The Y-Balance Test was performed to evaluate the player’s dynamic balance. An Independent t-test was used to examine the difference in postural sway and dynamic balance between the two groups. Results. The results of this study indicated that players with knee injuries showed significantly worse performance in both dynamic balance (p < 0.05 for non-dominant legs) and postural sway (significant differences in mean velocity on foam surfaces with eyes open and closed, p < 0.001). These findings suggest that knee injuries contribute to substantial deficits in balance control, which could affect overall athletic performance and injury risk. Conclusion. The study underscores the necessity of incorporating targeted balance and proprioceptive training into rehabilitation programs for tennis players recovering from knee injuries. By improving balance, these interventions can enhance neuromuscular control, reduce reinjury risk, and support better overall performance in high-stakes environments. Future research should focus on refining balance training programs to maximize recovery outcomes and minimize injury impacts. [ABSTRACT FROM AUTHOR]

Implementation of the Sensory Organization Test (SOT) under the rambling-trembling (RM-TR) framework allows for an examination of both individual sensory contributions and compensatory mechanisms, a valuable insight in research and clinical settings. Such investigation could substantially improve our ability to assess and treat fall risk in older adults and people living with neurological disorders. How are RM and TR components of sway influenced by SOT-induced challenges in healthy adults? Twenty-three healthy adults (27.4±8 years; 10 male) volunteered to participate in this cross-sectional study. Each participant completed a VR-based SOT program, which included six conditions with varied visual environments (normal, blacked-out, conflict) and support surfaces (stable, unstable foam), while a force plate captured forces at the plantar surface. Center of pressure (COP) was calculated and decomposed into RM-TR components. For each time series, range, root-mean-square (RMS) and sample entropy (SampEn) were extracted. Individual contributions of somatosensation, vision, and vestibular sense, as well as the preference ratio, were calculated. Repeated measures ANOVA were used to compare the effects of time series type (COP, RM, TR) and SOT condition. Paired t-tests were used to assess the difference in preference ratio between RM and TR components. TR sway behavior was impacted significantly by the sensory challenges induced by the SOT procedure, while RM was largely unaffected. Such findings are characteristic of healthy individuals, capable of competently re-weighting sensory input, but still facing challenge-based adaptations. Additionally, the mediolateral SampEn preference ratio was higher in TR compared to RM, indicating potential differences in compensation strategies between supraspinal and spinal/peripheral control mechanisms. These findings serve as a foundation for future RM-TR analyses using SOT procedures, aiding in our ability to implement targeted diagnostic and treatment methods, ultimately reducing the incidence of falls in aging and individuals with neurological conditions. • Sensory re-weighting requires distinct rambling and trembling sway adaptations. • Spinal postural control mechanisms are greatly influenced by sensory conflict. • Rambling-trembling decomposition may be able to differentiate balance deficits by their sources. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionPostural control impairments in middle-aged or older people with chronic low back pain (CLBP) have been extensively documented. However, little is known about changes in postural control early in the disease process which may underlie compensatory movement strategies.Our purpose was to quantify postural sway and sensory weighting in emerging adults with and without CLBP.Nineteen emerging adults with CLBP (age = 18–26 years (21.11 ± 1.73)) and 19 matched peers without CLBP (18–27 years (22.20 ± 1.97)) participated in a cross-sectional study. Displacement of the center of mass during Quiet stance (QS), Tandem stance (TS), and Unilateral stance (US) on 2 surfaces (stable, unstable) were used to assess postural sway. Sensory Organization Test (SOT) was used to assess sensory weighting.Emerging adults with CLBP showed large, significant increases in postural sway during unstable TS (p ≤ .020). Participants with CLBP relied more on somatosensory input, as evidenced by lower equilibrium scores during conditions favoring visual (p = .020) or vestibular (p < .001) input during the SOT.Emerging adults with CLBP showed postural control impairments related to altered sensory weighting. These findings provide insights into the development of CLBP and its effects on postural control. This information may aid early identification, monitoring, and treatment of individuals in the initial stages of disease development who may have unrecognized postural impairments. [ABSTRACT FROM AUTHOR]

Background: Progressive loss of standing balance is a feature of Friedreich's ataxia (FRDA). Objectives: This study aimed to identify standing balance conditions and digital postural sway measures that best discriminate between FRDA and healthy controls (HC). We assessed test–retest reliability and correlations between sway measures and clinical scores. Methods: Twenty‐eight subjects with FRDA and 20 HC completed six standing conditions: feet apart, feet together, and feet tandem, both with eyes opened (EO) and eyes closed. Sway was measured using a wearable sensor on the lumbar spine for 30 seconds. Test completion rate, test–retest reliability with intraclass correlation coefficients, and areas under the receiver operating characteristic curves (AUCs) for each measure were compared to identify distinguishable FRDA sway characteristics from HC. Pearson correlations were used to evaluate the relationships between discriminative measures and clinical scores. Results: Three of the six standing conditions had completion rates over 70%. Of these three conditions, natural stance and feet together with EO showed the greatest completion rates. All six of the sway measures' mean values were significantly different between FRDA and HC. Four of these six measures discriminated between groups with >0.9 AUC in all three conditions. The Friedreich Ataxia Rating Scale Upright Stability and Total scores correlated with sway measures with P‐values <0.05 and r‐values (0.63–0.86) and (0.65–0.81), respectively. Conclusion: Digital postural sway measures using wearable sensors are discriminative and reliable for assessing standing balance in individuals with FRDA. Natural stance and feet together stance with EO conditions suggest use in clinical trials for FRDA. © 2024 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

One of the basic skills of a dancer is the ability to keep the body balance (aplomb) while performing various dance figures. These movements are often performed with limited vision control due to dynamic motion or environmental conditions. Our aim was to verify whether the exercises with eyes closed of the ballet school students would reduce postural sway whilst improving the body balance. The training without visual feedback forces the body to rely more on information from the proprioceptive system about the alignment and motion of body parts in relation to each other and the external environment. In a group of thirteen female students of Comprehensive Ballet School, a significant reduction in postural sway was already found after three weeks of the nine-week training. This phenomenon occurred only during quiet standing with eyes closed. The use of stabilographic testing can be recommended as an objective evaluation of the aplomb level in ballet dancers. At the same time, this research showed that the introduction of ballet exercises with eyes closed improved postural stability without compromising stability with eyes open. Therefore, it can be assumed that such exercises do not harm but rather may be beneficial for the development of aplomb. [ABSTRACT FROM AUTHOR]

This study aimed to compare trunk position sense, spine posture and postural stability, among non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS) patients and healthy controls and explore the potential relationships between these parameters and disease-related characteristics. Twenty four patients with AS, 23 patients with nr-axSpA, and 24 age and gender-matched healthy controls were participated in this study. A digital inclinometer was used to measure trunk repositioning error (TRE) and spine posture. Postural stability was evaluated with a stabilometric platform. In addition, disease activity, spinal mobility and functional capacity were evaluated with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index and Bath Ankylosing Spondylitis Functional Index, respectively. The 47 patients mean age was 38.83 ± 9.3 years and were 34 females and 13 males. TRE was higher in AS and nr-axSpA patients compared to control (p < 0.001). AS and nr-axSpA patients presented higher thoracic curvature and lower lumbal lordosis compared to controls (p < 0.05) whereas there was no significant difference between nr-axSpA and AS (p = 0.97). The degree of thoracic curvature was higher in AS compared to nr-axSpA (p = 0.002). Mediolateral stability in eyes closed was significantly higher in AS and nraxSpA than control (p = 0.001). Time since onset of symptoms, which might affect radiographic spinal damage, was significantly associated with TRE in patients with AS (r = 0.703, p = 0.005). Radiographic status may alter spinal mobility, spine posture and trunk position sense in axSpA patients. Different approaches might need to improve these parameters in different subtypes of axSpA. [ABSTRACT FROM AUTHOR]

Background: Tai Chi has been recommended as a fall prevention exercise for older adults and may be particularly beneficial during the coronavirus (COVID-19) pandemic. This study aimed to investigate the benefits of regular Tai Chi practice on standing balance among older adults living in a nursing home during COVID-19 restrictions. Methods: A cross-sectional study was conducted with 38 older adults from a nursing home during COVID-19 extended restrictions. Participants were assigned to a Tai Chi group (n = 18, with more than five years of Tai Chi experience) and a control group (n = 20, with no Tai Chi experience). Postural sway during standing balance was assessed under four conditions: eyes open (EO); eyes closed (EC); eyes open with the right leg crossed forward (ER); and eyes open with the left leg crossed forward (EL). Furthermore, participants completed questionnaires face-to-face regarding their physical activity (PA) and sleep quality during the COVID-19 period. Results: The Tai Chi group exhibited significantly less postural sway than the control group, particularly under EO and EL conditions (p < 0.05). Both groups had similar sleep quality but different PA profiles. Conclusion: Regular Tai Chi practice may help maintain standing balance in older adults, even with limited outdoor mobility due to COVID-19 restrictions. Tai Chi could be an effective home-based exercise for preventing balance decline and potential falls among older adults living in nursing homes during the pandemic. Future studies should investigate the long-term effects of Tai Chi on fall prevention in this population.

Introduction & Purpose Postural control is essential for maintaining balance during static and dynamic tasks. It is typically measured by centre of pressure (CoP) deviations using a ground reaction force plate (FP). Alternatively, more affordable and accessible accelerometer-based measures have been proposed. However, no consensus on the best protocol exists (Pinho et al., 2019). This study investigates the feasibility of assessing postural sway using linear acceleration data, considering sensor placement, task difficulty and analysed parameters. Methods The University of Vienna Ethics Committee approved this study (Ref. Nr. 01108). Ten healthy adults (6 M/4 F; 37.9 ± 14.8 years; BMI = 23.3 ± 2.3) performed eleven balance tasks, seven easy tasks from the Berg Balance Scale and four harder tasks with eyes closed, each lasting 20 seconds. Postural sway was assessed using a FP and five inertial measurement units (IMUs) attached to the upper spine (C7), lower spine (L1), sacrum and both thighs. Data were synchronously collected at 1500 Hz, zeroed, band pass filtered (3rd order Butterworth, 0.3-10 Hz; Martinez-Mendez et al., 2012), and cropped to 19 s. Outcomes included CoP path length, root mean square of sway amplitude in the anteroposterior (AP) and mediolateral (ML) directions for the FP, and RMS of the linear acceleration in AP and ML directions, along with their sum, for the ACC. Combinations of the two AP, two ML and two overall parameters were analysed by winsorised Pearson correlations and Bland Altman limits of agreement of z-scores for each task and for each sensor site. Fisher's Z-transformed correlation coefficients and limits of agreement were compared across task difficulty, parameter combinations, and sensor placement sites using a 3-way ANOVA. Results Pearson coefficients correlating the ACC parameters with the FP parameters averaged 0.60 (95% CI [0.54, 0.66]) for the easy tasks and 0.78 (95% CI [0.726, 0.84]) for the hard tasks, with no significant differences between sensor sites. A significant interaction (p < 0.001) was found between task difficulty and parameter combination. Simple main effect analysis showed no difference between correlations of AP, ML and overall parameters for hard tasks but for easy tasks, where overall parameters showed the highest correlation, followed by ML and then AP parameters, all differing significantly from each other. The Bland Altman mean difference of z-scores between FP and ACC parameters was on average -0.002 (95% CI [-0.027, 0.024]). The lower and upper limits of agreement were on average -0.72 (95% CI [-0.84, -0.62]) and 0.73 (95% CI [0.62, 0.83]) respectively. Discussion The correlations between FP and ACC were higher during more challenging tasks, while the limits of agreement were broader and less precise in these tasks (data not shown). No optimal sensor placement site was identified as correlation and agreement between the two methods did not differ significantly between sites. The broad limits of agreement suggest relatively low precision of ACC measures compared to FP. Overall parameters often outperformed ML and AP parameters in terms of correlation and precision. Conclusion Accelerometer-based measures of postural sway showed high correlations with force plate measures but low precision when tasks where difficult enough to challenge participants’ balance. Sensor placement site did not influence correlation and precision. References Pinho, A. S., Salazar, A. P., Hennig, E. M., Spessato, B. C., Domingo, A., & Pagnussat, A. S. (2019). Can we rely on mobile devices and other gadgets to assess the postural balance of healthy individuals? A systematic review. Sensors, 19(13), Article 13. https://doi.org/10.3390/s19132972 Martinez-Mendez, R., Sekine, M., & Tamura, T. (2012). Postural sway parameters using a triaxial accelerometer: Comparing elderly and young healthy adults. Computer Methods in Biomechanics and Biomedical Engineering, 15(9), 899–910. https://doi.org/10.1080/10255842.2011.565753

Auditory and somatosensory white noise can stabilize standing balance. However, the differential effects of auditory and tactile noise stimulation on balance are unknown. Prior work on unimodal noise stimulation showed gains in balance with white noise through the auditory and tactile modalities separately. The current study aims to examine whether multimodal noise elicits similar responses to unimodal noise. We recorded the postural sway of healthy young adults who were presented with continuous white noise through the auditory or tactile modalities and through a combination of both (multimodal condition) using a wearable device. Our results replicate previous work that showed that auditory or tactile noise reduces sway variability with and without vision. Additionally, we show that multimodal noise also reduces the variability of sway. Analysis of different frequency bands of sway is typically used to separate open-loop exploratory ( 0.3 Hz) sway. We performed this analysis and showed that unimodal and multimodal white noise affected postural sway variability similarly in both timescales. These results support that the sensory noise effects on balance are robust across unimodal and multimodal conditions and can affect both mechanisms of sway represented in the frequency spectrum. In future work, the parameters of acoustic/tactile manipulation should be optimized for the most effective balance stabilization, and multimodal therapies should be explored for older adults with typical age-related balance instabilities.

Abstract Previous work assessing the effect of additive noise on the postural control system has found a positive effect of additive white noise on postural dynamics. This study covers two separate experiments that were run sequentially to better understand how the structure of the additive noise signal affects postural dynamics, while also furthering our knowledge of how the intensity of auditory stimulation of noise may elicit this phenomenon. Across the two experiments, we introduced three auditory noise stimulations of varying structure (white, pink, and brown noise). Experiment 1 presented the stimuli at 35 dB while Experiment 2 was presented at 75 dB. Our findings demonstrate a decrease in variability of the postural control system regardless of the structure of the noise signal presented, but only for high intensity auditory stimulation.

Kworweinski Lafontant,1,2 Amber Blount,2,3 Jethro Raphael M Suarez,2,4 David H Fukuda,1 Jeffrey R Stout,1,5 Evette M Trahan,2 Nichole R Lighthall,3 Joon-Hyuk Park,4,5 Rui Xie,2,6 Ladda Thiamwong2,5 1Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA; 2College of Nursing, University of Central Florida, Orlando, FL, USA; 3Department of Psychology, University of Central Florida, Orlando, FL, USA; 4Mechanical and Aerospace Engineering Department, University of Central Florida, Orlando, FL, USA; 5Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA; 6Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USACorrespondence: Ladda Thiamwong, UCF College of Nursing, 12201 Research Parkway, Suite 300, Orlando, FL, 32826, USA, Tel +1 407 823 5091, Email ladda.thiamwong@ucf.eduPurpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults.Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests.Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%.Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.Plain Language Summary: Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.Keywords: balance, postural sway, fall efficacy, clinical practice

Abstract Background Chronic stress and diseases occur more frequently in middle-aged compared to younger women and this is often the result of physical, psychological and socio-economic changes. These health consequences reduce lower body muscle mass and flexibility, leading to generalized impairments in functional movement and balance. Dynamic Neuromuscular Stabilization (DNS) training using the inertial load of water is known for its positive impact on functional strength improvement and muscle stabilization. Objective This study aimed to determine the effect of DNS training using inertial water loads on functional movement and postural sway in middle-aged women. Method A sample of 24 middle-aged women participated in the study and were randomly divided into two groups: the experimental group, n = 12 (age: 58.33 ± 1.48 yrs, height: 162.16 ± 1.27 cm, weight: 61.77 ± 2.21 kg) and control group, n = 12 (age: 59.58 ± 1.13 yrs, height: 160.1 ± 1.13 cm, weight: 57.51 ± 1.12 kg). Center of Pressure (COP), moving distance, Root Mean Square (RMS), movement area and Functional Movement Screen (FMS) were conducted and analyzed pre- and post-examination. Participants engaged in the DNS training regimen, which utilized the inertial load of water, for 60 min each session, conducted twice weekly for 12 weeks. Results There were significant differences in the COP distance (p

To evaluate the immediate and 4-week effects of compression garments (CG) on balance using a force platform during 8 different visual, static, and dynamic conditions in hypermobile Ehlers-Danlos Syndrome (hEDS) patients. Thirty-six participants were randomly assigned to a group: physiotherapy alone (PT, n = 19) or physiotherapy and daily CG wearing for 4 weeks (PT + CG, n = 17). Both attended 12 physiotherapy sessions (strengthening, proprioception, and balance exercises) for 4 weeks. Primary outcome: sway velocity of the centre of pressure (COP) measured before, immediately with the CG, and at 4 weeks. Secondary outcomes: ellipse area, Romberg quotient, and pain. Sway velocity in dynamic conditions decreased immediately with the CG. After 4 weeks of intervention, sway velocity (95% CI 4.36–39.23, effect size 0.93) and area (95% CI 146–3274, effect size 0.45) on the laterally oscillating platform with eyes-closed improved more in the PT + CG group than the PT group. Romberg quotient on foam cushion improved more in the PT + CG than the PT group. Pain decreased in both groups after 4 weeks with no between-group difference. CG combined with physiotherapy improved dynamic balance measured with COP variables significantly more than physiotherapy alone in people with hEDS. NCT03359135 Compression garments immediately improve balance in people with hypermobile Ehlers-Danlos Syndrome (hEDS) Compression garments combined with regular physiotherapy improve balance in people with hEDS after 4 weeks of treatment Compression garments could compensate for proprioceptive impairment in hEDS [ABSTRACT FROM AUTHOR]

Background: Maintaining balance is crucial for independence and quality of life. Loss of balance is a hallmark of spinocerebellar ataxia (SCA). Objective: The aim of this study was to identify which standing balance conditions and digital measures of body sway were most discriminative, reliable, and valid for quantifying balance in SCA. Methods: Fifty-three people with SCA (13 SCA1, 13 SCA2, 14 SCA3, and 13 SCA6) and Scale for Assessment and Rating of Ataxia (SARA) scores 9.28 ( 4.36 and 31 healthy controls were recruited. Subjects stood in six test conditions (natural stance, feet together and tandem, each with eyes open [EO] and eyes closed [EC]) with an inertial sensor on their lower back for 30 seconds (2). We compared test completion rate, test–retest reliability, and areas under the receiver operating characteristic curve (AUC) for seven digital sway measures. Pearson’s correlations related sway with the SARA and the Patient-Reported Outcome Measure of Ataxia (PROM ataxia). Results: Most individuals with SCA (85%–100%) could stand for 30 seconds with natural stance EO or EC, and with feet together EO. The most discriminative digital sway measures (path length, range, area, and root mean square) from the two most reliable and discriminative conditions (natural stance EC and feet together EO) showed intraclass correlation coefficients from 0.70 to 0.91 and AUCs from 0.83 to 0.93. Correlations of sway with SARA were significant (maximum r = 0.65 and 0.73). Correlations with PROM ataxia were mild to moderate (maximum r = 0.56 and 0.34). Conclusion: Inertial sensor measures of extent of postural sway in conditions of natural stance EC and feet together stance EO were discriminative, reliable, and valid for monitoring SCA. © 2024 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background: Postural sway changes often reflect functional impairments in adults with chronic low back pain (LBP). However, there is a gap in understanding how these individuals adapt their postural strategies to maintain stability. Purpose: This study investigated postural sway distance and velocity, utilizing the center of pressure (COP) and center of gravity (COG), between adults with and without LBP during repeated unilateral standing trials. Methods: Twenty-six subjects with LBP and 39 control subjects participated in the study. Postural sway ranges, COP/COG sways, and sway velocities (computed by dividing path length by time in anteroposterior (AP) and mediolateral (ML) directions over 10 s) were analyzed across three unilateral standing trials. Results: A significant group interaction in sway range difference was observed following repeated trials (F = 5.90, p = 0.02). For COG sway range, significant group interactions were demonstrated in both directions (F = 4.28, p = 0.04) and repeated trials (F = 5.79, p = 0.02). The LBP group demonstrated reduced ML sway velocities in the first (5.21 ± 2.43 for the control group, 4.16 ± 2.33 for the LBP group; t = 1.72, p = 0.04) and second (4.87 ± 2.62 for the control group, 3.79 ± 2.22 for the LBP group; t = 1.73, p = 0.04) trials. Conclusion: The LBP group demonstrated decreased ML sway velocities to enhance trunk stability in the initial two trials. The COG results emphasized the potential use of trunk strategies in augmenting postural stability and optimizing neuromuscular control during unilateral standing. [ABSTRACT FROM AUTHOR]

The purpose of this study was to propose a model for estimating individual susceptibility to motion sickness by correlating measures of seated postural sway before exposure to a roller coaster movie displayed in a head-mounted display (HMD) with subjective ratings of visually induced motion sickness (VIMS). The participants were required to watch the content for 15 min, and seated center of pressure (sCOP) was measured using a force platform for 5 min before viewing. We developed a VIMS estimating model from 16 subjects and verified it on 15 subjects. SSQ scores for VIMS were strongly correlated with the area of sCOP, the main-to-minor ratio of the sCOP ellipse, and the total length of sCOP, respectively (r = 0.706, r = 0.555, and r = 0.622). When verifying the estimation model, the observed SSQ scores differed by 32.628 ± 29.749 from the expected SSQ scores, and both score sets were positively correlated (r = 0.622). The classification results between nil and mild, moderate, and severe groups for VIMS showed an accuracy of 0.74 using random under-sampling boost (RUSBoost). [ABSTRACT FROM AUTHOR]

Background Dementia often results in postural control impairment, which could signify central nervous system dysfunction. However, no studies have compared postural control characteristics among various types of dementia. This study aimed to compare static postural control in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD). Methods Cross-sectional relationship between the clinical diagnoses (AD, DLB, VaD, or normal cognition [NC]) of outpatients at a memory clinic and their upright postural control characteristics were examined. In the postural control test, participants were instructed to maintain a static upright standing on a stabilometer for 60 seconds under the eyes-open and eyes-closed conditions. Forty postural control parameters, including distance, position, and velocity in the anterior–posterior and medio–lateral directions, derived from the trajectory of the center of mass sway, were calculated. The characteristics of each type of dementia were compared to those of NC, and the differences among the 3 types of dementia were evaluated using linear regression models. Results The study included 1 789 participants (1 206 with AD, 111 with DLB, 49 with VaD, and 423 with NC). Patients with AD exhibited distinct postural control characteristics, particularly in some distance and velocity parameters, only in the eyes-closed condition. Those with DLB exhibited features in the mean position in the anterior–posterior direction. In patients with VaD, significant differences were observed in most parameters, except the power spectrum. Conclusions Patients with AD, DLB, and VaD display disease-specific postural control characteristics when compared to cognitively normal individuals. [ABSTRACT FROM AUTHOR]

The interest in virtual reality (VR) applications has been on the rise in recent years. However, the impact of VR on postural stability remains unclear. The study has two primary objectives: first, to compare postural stability in a 3D-immersed virtual reality environment (VE) and a real environment (RE), and second, to investigate the effect of positive and negative visual feedback, which are subconditions of VE on postural stability. The observational study recruited 20 healthy adults (10 male, 10 female, 22.8 ± 1.8 years) who underwent postural stability assessments in both RE and VE. In VE, participants received visual stimuli in three different ways: without visual feedback, with positive and negative visual feedback that they would consider themselves to be directed towards postural stability outcomes. The RE included two conditions: eyes open (EO) and eyes closed (EC). Postural stability was evaluated with sway velocity, sway area, and perimeter variables obtained from a force platform. Results : All postural stability variables were significantly lower in the RE than in the VE (p < 0.05). There was no significant difference between the VE and EC in terms of sway velocity and sway area (p > 0.05). The visual feedback in the VE did not affect participants' postural stability (p > 0.05). VE may cause an increase in postural sway variables compared to RE and postural requirements may be higher in VE compared to RE. Significance : This is the first and only study examining the effect of different visual feedback on postural stability in VE. • Postural requirements may be higher in VE compared to RE. • Even if the image presented in VE is a simulation of the RE, it affects postural stability differently than in the RE. • Different visual feedback within the VE did not appear to have any effect on the postural stability of participants. [ABSTRACT FROM AUTHOR]

Introduction. Postural control is essential for humans to maintain balance under both static and dynamic conditions. A variety of unstable support surfaces are used to evaluate postural control. Balance foam pads are relatively expensive, whereas natural rubber pads use a natural material with equivalent viscoelastic properties that are inexpensive and widely available. No postural sway and reliable data existed to support the practice of using a natural rubber pad. The purposes of the study were to determine the test-retest reliability of postural sway by using a natural rubber pad and to compare postural sway in healthy adults while using a foam pad, a natural rubber pad and a firm surface. Methods. Nineteen healthy participants were measured for centre of pressure (CoP) velocity and displacement during a quiet stance, with their eyes closed, on a balance foam pad (blue foam -- Airex®), a natural rubber pad and a firm surface on a force platform. Two repeated sessions were conducted three days apart. intraclass correlation coefficients were used to determine the test-retest reliability. A one-way repeated measures ANoVA was used to compare the three surface conditions. Results. The natural rubber pad demonstrated moderate to good reliability for CoP velocity and CoP displacement. Also, there were no significant differences in anteroposterior (AP) and mediolateral (ML) CoP velocity and displacement between the balance foam pad and the natural rubber pad. Conclusions. our findings indicate that a natural rubber pad could be employed as a low-cost alternative to the balance foam pad for evaluating the balance of healthy adults. [ABSTRACT FROM AUTHOR]

Single-limb balance training is integral to preventing and rehabilitating lower extremity injuries. Previous investigations have shown that when using instability devices, differences may or may not exist in the postural sway parameters during use, depending on the specific devices being assessed. Thus, this investigation sought to examine the differences between a commonly used foam pad and a novel instability device (block) in postural sway measures. Twenty-two healthy individuals with no history of lower extremity injury or neurological disorders participated in this investigation. The participants performed three single-limb static balance exercises on a force platform sampling at 120 Hz. Each condition contained three 10-s trials separated by thirty seconds. The mean CoP values of the three trials in each condition were then compared using a within-subjects repeated-measures analysis of variance. Statistically significant differences were seen in the sway area between conditions (p = 0.009), the CoP path length (p = 0.007), the peak medial–lateral CoP displacement (p = 0.004), and the average sway velocity (p = 0.007). All variables displayed similar trends whereby the control condition showed significantly lower values than both instability devices, with no differences between devices. This investigation provides supporting evidence that different instability devices may deliver similar changes to postural sway parameters compared to control conditions. The novel block instability device used in this investigation may be used similarly to the traditional foam pad in prevention and rehabilitation settings based on the absence of differences between the two devices. [ABSTRACT FROM AUTHOR]

Background: Chronic stress and diseases occur more frequently in middle-aged compared to younger women and this is often the result of physical, psychological and socio-economic changes. These health consequences reduce lower body muscle mass and flexibility, leading to generalized impairments in functional movement and balance. Dynamic Neuromuscular Stabilization (DNS) training using the inertial load of water is known for its positive impact on functional strength improvement and muscle stabilization. Objective: This study aimed to determine the effect of DNS training using inertial water loads on functional movement and postural sway in middle-aged women. Method: A sample of 24 middle-aged women participated in the study and were randomly divided into two groups: the experimental group, n = 12 (age: 58.33 ± 1.48 yrs, height: 162.16 ± 1.27 cm, weight: 61.77 ± 2.21 kg) and control group, n = 12 (age: 59.58 ± 1.13 yrs, height: 160.1 ± 1.13 cm, weight: 57.51 ± 1.12 kg). Center of Pressure (COP), moving distance, Root Mean Square (RMS), movement area and Functional Movement Screen (FMS) were conducted and analyzed pre- and post-examination. Participants engaged in the DNS training regimen, which utilized the inertial load of water, for 60 min each session, conducted twice weekly for 12 weeks. Results: There were significant differences in the COP distance (p < 0.001), RMS (p < 0.05), COP area and FMS test (p < 0.001) in the pre-post comparison of each group. And significant differences were found in COP distance (p < 0.05), RMS (p < 0.05), COP area (p < 0.05) and FMS test (p < 0.05) between groups. The DNS training improved the dynamic stability of single-leg standing, torso stability and functional movement in middle-aged women. Conclusion: DNS training programs using the inertial load of water have been shown to be effective in movement improvement and posture retention ability, which is beneficial for functional movement, equilibrium strategy, and dynamic stability of middle-aged women. Furthermore, the DNS training method designed in this study can be useful for trainees who require posture correction in a safe and effective way regardless of their age and gender. [ABSTRACT FROM AUTHOR]

Military and law enforcement members' shooting ability is influenced by their postural balance, which affects their performance and survivability. This study aimed to investigate the effects of a proprioception training program (standing or walking on unstable surfaces) on postural balance and shooting performance. Twenty participants, divided into two groups, completed 60 shots in a shooting simulator while standing, before and after a 4-week proprioception training program. One group (n = 10) followed the training program (EXP), while the other group followed the regular military academy program (CON). The shooting was conducted under four conditions: without load on a stable surface, with load on a stable surface, without load on an unstable surface, and with load on an unstable surface. The findings reveal that the training program had a significant impact on the EXP, improving their balance (p < 0.01). Additionally, only in the EXP, shooting score and the percentage center of gravity increased (p < 0.01) and the stability of the shots, measured by holding time on the target, doubled from 2.2 to 4.5 s (p < 0.01). These improvements were more pronounced when participants had a load and/or were on an unstable surface. In conclusion, a proprioception training program could be beneficial for improving postural balance and shooting performance. [ABSTRACT FROM AUTHOR]

Abstract Background Several potential causes can impair balance in older people. The neck torsion maneuver may be useful in demonstrating impaired balance caused by the stimulation of cervical proprioceptive input. Whereas evidence suggests impaired standing balance in older people with chronic neck pain, balance impairment during the neck torsion position and its relationship with clinical characteristics have not yet been investigated in this population. The aims of this study were to investigate whether the neck torsion position could significantly influence balance responses in older people with chronic non-specific neck pain and to determine the relationships between the balance responses and characteristics of neck pain. Methods Sixty-eight older people (34 with chronic non-specific neck pain and 34 controls) participated in the study. Balance was tested using a force plate during comfortable stance with eyes open under four conditions: neutral head on a firm surface, neutral head on a soft surface, neck torsion to left and right on a firm surface and neck torsion to left and right on a soft surface. Balance outcomes were anterior-posterior (AP) and medial-lateral (ML) displacements, sway area and velocity. Characteristics of neck pain were intensity, duration and disability. Results Overall, the neck pain group exhibited greater AP and ML displacements, sway area and velocity in the neck torsion position on firm and soft surfaces compared to controls (partial eta squared (η²p) = 0.06–0.15, p 0.05). Conclusion The neck torsion maneuver, stimulating the receptors resulted in increased postural sway in older people, with a more pronounced effect in those with neck pain. The study provides evidence supporting the use of neck torsion for assessing impaired balance related to abnormal cervical input in older people with chronic non-specific neck pain.

Postural instability is associated with disease status and fall risk in Persons with Multiple Sclerosis (PwMS). However, assessments of postural instability, known as postural sway, leverage force platforms or wearable accelerometers, and are most often conducted in laboratory environments and are thus not broadly accessible. Remote measures of postural sway captured during daily life may provide a more accessible alterative, but their ability to capture disease status and fall risk has not yet been established. We explored the utility of remote measures of postural sway in a sample of 33 PwMS. Remote measures of sway differed significantly from lab-based measures, but still demonstrated moderately strong associations with patient-reported measures of balance and mobility impairment. Machine learning models for predicting fall risk trained on lab data provided an Area Under Curve (AUC) of 0.79, while remote data only achieved an AUC of 0.51. Remote model performance improved to an AUC of 0.74 after a new, subject-specific k-means clustering approach was applied for identifying the remote data most appropriate for modelling. This cluster-based approach for analyzing remote data also strengthened associations with patient-reported measures, increasing their strength above those observed in the lab. This work introduces a new framework for analyzing data from remote patient monitoring technologies and demonstrates the promise of remote postural sway assessment for assessing fall risk and characterizing balance impairment in PwMS.

Background and Objectives: In patients with non-specific chronic low back pain (LBP), their pain and problem sides can differ. Clinical Pilates assessment provides an approach to identify the problem side, but this approach requires experience and can be subjective. This study aimed to investigate if objective measures of single-leg squat postural control and hamstrings flexibility could identify the problem side in adults with non-specific chronic LBP. Materials and Methods: Forty adults with non-specific chronic LBP were tested on single-leg squat postural control and hamstrings flexibility. The problem side of participants was assessed with the Clinical Pilates method. Paired t-tests were used to compare the postural sway parameters of the single-leg squat and hamstrings flexibility between the problem and non-problem sides. Cohen’s kappa was then used to assess the agreement of postural sway and flexibility measures with the Clinical Pilates method. Results: The problem side showed smaller vertical force variance, larger sway path distances, lower peak vertical force, smaller terminal knee flexion angle, longer time to complete the five single-leg squats, and tighter hamstrings as compared to the non-problem side. However, only the overall and anteroposterior sway path distances, terminal knee flexion angle, total squat duration, and hamstrings flexibility yielded moderate to strong agreement with the Clinical Pilates method. Conclusions: Single-leg squat postural sway parameters and hamstrings flexibility can objectively identify the problem side in adults with non-specific chronic LBP.

Background: Some evidence indicates that adults with attention deficit hyperactivity disorder (ADHD) may have balance impairments. This study examined the associations between moderate-to-vigorous physical activity (MVPA), response inhibition (RI), and static balance in this population while off and on psychostimulant medication (PS). Methods: Participants (n = 40; 30 females; M age = 29.0; SD = 6.3 years) wore an ActiGraph GT9X–link around their waist to estimate MVPA levels (minutes/day). To assess RI, participants completed the Delis–Kaplan Executive Function System (D–KEFS) subtests Trail-Making Test (TMT) and Color–Word Interference Test (CWIT). To evaluate static balance, participants completed postural sway area (cm2) assessments in four conditions: feet-apart eyes-open (FAEO), feet-apart eyes-closed (FAEC), feet-together eyes-open (FTEO), and feet-together eyes-closed (FTEC). Participants also completed the single-leg standing tests (seconds) with eyes open (SLEO) and with eyes closed (SLEC). Results: When off medication, MVPA significantly predicted SLEC (β = 0.30; p = 0.017). MVPA and TMT significantly predicted FTEO, explaining ~19% of the variance in FTEO; both MVPA and TMT were significant predictors (β = –0.33, p = 0.027 and β = –0.31, p = 0.039, respectively). When on medication, TMT significantly predicted FAEC (β = 0.17; p = 0.047). Conclusions: MVPA and RI may be effective parameters in predicting static balance in adults with ADHD when off medication only. [ABSTRACT FROM AUTHOR]

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0–6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild–moderate disability (i.e., EDSS in the range of 2.5–6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0–2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild–moderate disability) and COP path length relating to the use of VR (pwMS with mild–moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants. [ABSTRACT FROM AUTHOR]

Cranial electrotherapy stimulation (CES) delivers low-intensity electrical currents to the brain to treat anxiety, depression, and pain. Though CES is considered safe and cost-effective, little is known about side effects emerging across different contexts. Our objective was to investigate how varying physical and cognitive demands impact the frequency and intensity of CES vestibular sensations in a sample of healthy young adults. We used a 2 (stimulation: sham, active) × 2 (physical demand: static sway, dynamic sit-to-stand) × 2 (cognitive demand: single-task remain silent, dual-task count backward) repeated measures design. Vestibular sensations were measured with surveys and wearable sensors capturing balance changes. Active stimulation did not influence reported vestibular sensations. Instead, high physical demand predicted more sensation reports. High cognitive demand, but not active stimulation, predicted postural sway unsteadiness. Significant effects of active stimulation on balance were observed only during the dynamic sit-to-stand transitions. In summary, CES induces vestibular sensations only for a specific outcome under certain circumstances. Our findings imply that consumers can safely maximize the benefits of CES while ensuring they are taking steps to minimize any potential side effects by considering their context and circumstances. [ABSTRACT FROM AUTHOR]

Comprehensive insights into balance control of individuals with hearing impairment are compared with individuals with hearing. Primary sources were obtained from 7 databases including PubMed, LILACS, SCOPUS, CINAHL, PEDro, CENTRAL, and Web of Science. The search period extended from inception until January 5, 2022. The systematic review included 24 studies and 27 trials, with a total of 2,148 participants. The meta-analysis showed a significant difference in the average balance control between individuals with hearing impairment and individuals with hearing, with individuals with hearing having a favorable advantage (p = 0.001). Additionally, average balance control was found to be in favor of individuals with hearing (p = 0.001) when comparing individuals with hearing impairment who participated in sports. Finally, individuals with hearing impairment who participated in sports demonstrated a significantly higher average difference in balance control (p = 0.001) when compared to sedentary people with hearing impairment. Our meta-analysis results indicate a balance defect in individuals with hearing impairment compared to individuals with hearing. In addition, with increasing age, the balance in individuals with hearing impairment improved. Additionally, the dependence of individuals with hearing impairment on the visual and proprioception systems to maintain balance increased. Finally, there was more dependence on the proprioception than the visual system, while individuals with hearing had stronger average balance control than individuals with hearing impairment who participated in sports, when compared to sedentary people with hearing impairment. [ABSTRACT FROM AUTHOR]

According to the prevalence of balance disorders among children with hearing loss (HL), researchers used exercise programs to improve balance in children with HL. So, the present systematic review and meta-analysis briefly summarize findings regarding the impacts of exercise training programs on balance in children with HL. Science Direct, MEDLINE/PubMed, SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar were searched from inception until November 11th, 2023. Two independent researchers analyzed and extracted the data from potential papers whose eligibility was confirmed. Then, the PEDro scale was used to obtain quality assessment scores. The total PEDro score is 11 and incorporates the presentation of statistical analysis and evaluation criteria of internal validity. Studies that scored 7–11 were considered methodologically "high", 5 to 6 were "fair", and ≤4 were considered "poor". 10 studies involving a total of 304 participations were included in the systematic review. Our results demonstrate that exercise training programs positively impact static balance (p = 0.001) with level 1a evidence, the postural sway (p = 0.001) with level 1a evidence, and dynamic balance (p = 0.001) with level 1a evidence in children with HL. The findings of this systematic review and meta-analysis related to studies with excellent methodological quality revealed that the intended training programs significantly impact postural sway along with static and dynamic balance in children with HL. It is recommended that future exercise training programs be paired with rehabilitation programs for children with HL. [ABSTRACT FROM AUTHOR]

Virtual reality head-mounted display (VR-HMD) is increasingly used for balance evaluation and rehabilitation. However, more studies must be conducted on virtual environments (VE) effects. This study aimed to assess the impact of an outdoor VE projected in a high-quality VR-HMD and of the VR-HMD mass on postural stability, postural control and leaning. This study involved ten healthy young men who performed five 30-s stabilometric trials. Four experimental conditions were randomly performed: eyes open (EO) or eyes closed (EC), with (VR) or without (No VR) VR-HMD. Postural stability (antero-posterior (AP) and medio-lateral (ML) ranges of the center of pressure (CoP), 90% confidence ellipse area), postural control (CoP velocity (global, AP and ML)) and standard deviation of the CoP mean position), and postural leaning (AP/ML CoP mean position) were assessed. The comparisons between EO VR and EO No VR were used to analyze the VE effects and comparisons between EC VR and EC No VR for the VR-HMD mass effects. Spatiotemporal parameters that characterised postural stability and postural control, except ML velocity (p > 0.05), were significantly influenced by the simulated VE with higher values in EO VR than EO No VR (p < 0.05), but not by the VR-HMD mass. The mean position of the CoP showed no significant differences between conditions. Postural stability and postural control modification due to the VE used in this study revealed that this VE could be interesting for VR-HMD rehabilitation and assessment. VR-HMD is not a factor to be considered for stabilometric analysis. • Effect of head-mounted display mass and outdoor virtual environment on balance. • Spatio-temporal parameters of the center of pressures were analysed. • The outdoor virtual environment affects postural control and stability. [ABSTRACT FROM AUTHOR]

Background and Aims Exercises are mostly used to control balance and reduce the risk of falling in the elderly. However, the effect of exercise in the frontal plane has been less studied. Therefore, this study aims to compare the effect of 8 week exercises in the sagittal and frontal planes on the postural sway of elderly men. Methods In this quasi-experimental study, 24 elderly males (Mean age: 67.21±1.56 years) were divided into two intervention groups of sagittal-plane and frontal-plane exercises. The exercises were performed for 8 weeks. The center of pressure (CoP) parameters in two groups before and after the intervention were evaluated using a foot scanner system. Finally, the ANCOVA was used for data analysis. P≤0.05 was considered statistically significant. Results The results showed a significant decrease in CoP perturbations in the Y-axis at the medial-lateral, anterior-posterior, and lateral-medial directions in the frontal plane group compared to the sagittal group (P<0.05). Moreover, there was a significant decrease in the CoP area after perturbations at the medial-lateral, anterior-posterior, and lateral-medial directions in the frontal group compared to the sagittal group (P<0.05). Conclusion It seems that exercises in the frontal plane can reduce postural sway in elderly men compared to sagittal-plane exercises. Therefore, it is recommended to emphasize the exercises of the hip abductor and adductor muscles in the frontal plane in designing exercise protocols for elderly men. [ABSTRACT FROM AUTHOR]

Asymmetrically impaired standing control is a prevalent disability among stroke patients; however, most of the neuromuscular characteristics are unclear. Therefore, the main purpose of this study was to investigate between-limb differences in intermuscular coherence during quiet standing. Consequently, 15 patients who had sub-acute stroke performed a quiet standing task without assistive devices, and electromyography was measured on the bilateral tibialis anterior (TA), soleus (SL), and medial gastrocnemius (MG). The intermuscular coherence of the unilateral synergistic (SL–MG) pair and unilateral antagonist (TA–SL and TA–MG) pairs in the delta (0–5 Hz) and beta (15–35 Hz) bands were calculated and compared between the paretic and non-paretic limbs. The unilateral synergistic SL–MG coherence in the beta band was significantly greater in the non-paretic limb than in the paretic limb (p = 0.017), while unilateral antagonist TA–MG coherence in the delta band was significantly greater in the paretic limb than in the non-paretic limb (p < 0.01). During quiet standing, stroke patients showed asymmetry in the cortical control of the plantar flexor muscles, and synchronous control between the antagonistic muscles was characteristic of the paretic limb. This study identified abnormal muscle activity patterns and asymmetrical cortical control underlying impaired standing balance in patients with sub-acute stroke using an intermuscular coherence analysis. [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]

Purpose: Low back pain is a significant health problem with a high prevalence. Studies of smaller cohorts of low back pain patients have indicated increased body sway. The present paper tests the hypothesis of an association between low back pain and postural sway in a large randomly selected population. Methods: The current study used the fifth examination (2011–2015) of The Copenhagen City Heart Study where 4543 participated. The participants answered a self-administered questionnaire regarding pain, physical activity, smoking, alcohol consumption, education, and other lifestyle factors. Measurement of postural body sway was performed using the CATSYS system. Results: Totally 1134 participants (25%) reported to have low back pain. Subjects with low back pain had higher sway area and sway velocity than subjects without. Conclusion: When using multivariate statistical analysis, confounding factors such as male gender, higher age, larger body height, low education level, smoking, and low activity level explained the association between low back pain and postural sway. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relationship between postural sway and the severity of lumbar spinal canal stenosis as well as the effect on postoperative improvement. Methods: Stabilometry was performed before and 6 months after surgery in 52 patients (29 men and 23 women; mean age, 74.1 ± 7.8 years) who underwent decompression surgery for lumbar spinal canal stenosis. The environmental area (EA; the area surrounding the circumference of the stabilogram) and locus length per EA (L/EA) were evaluated. The patients were divided into moderate (n = 22) and severe (n = 30) groups according to the severity of canal stenosis. Patient characteristics and parameters were compared between the groups before and after surgery, including the visual analog scale (VAS) score for leg pain, Oswestry Disability Index (ODI), EA, and L/EA. In addition, factors affecting EA and L/EA were evaluated using multiple regression analysis. Results: Age (p = 0.031), preoperative EA (p < 0.001), preoperative L/EA (p = 0.032), and sagittal vertical axis (p = 0.033) were significantly different between groups. The VAS score and ODI significantly improved postoperatively in both groups (p < 0.001). The EA significantly improved postoperatively only in the severe group (p < 0.001), whereas the L/EA did not significantly improve in either group. Multiple regression analysis showed that only the severity of canal stenosis was significantly associated with preoperative EA (p = 0.030), whereas age (p = 0.040) and severity of canal stenosis (p = 0.030) were significantly associated with preoperative L/EA. Diabetes was significantly associated with postoperative EA (p = 0.046) and L/EA (p = 0.030). Conclusion: The severity of canal stenosis affected abnormal postural sway, which improved after decompression surgery. [ABSTRACT FROM AUTHOR]

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