Postural prioritization defines the interaction between a reaction time task and postural perturbations

Effects of postural instability on the coordination between posture and arm reaching

Reaching from standing requires adjustments of hand movement and posture, which are assured by redundant kinematic degrees of freedom. However, the increased demand for postural adjustments may interfere with the stability of reaching. The objective of this study was to investigate the effect of postural instability on the use of kinematic redundancy to stabilize the finger and center-of-mass trajectories during reaching from standing in healthy adults. Sixteen healthy young adults performed reaching movements from standing with and without postural instability induced by small base-of-support. The three-dimensional positions of 48 markers were recorded at 100 Hz. The uncontrolled manifold (UCM) analysis was performed separately with the finger and center-of-mass positions being the performance variables, and joint angles being the elemental variables. ΔV, the normalized difference between the variance in joint angle that does not affect task performance (V_UCM) and the variance that does affect task performance (V_ORT), was calculated separately for finger (ΔV_EP) and center-of-mass (ΔV_COM) positions, and was compared between stable and unstable base-of-support conditions. ΔV_EP decreased after movement onset and reached its minimum value at around 30-50% of the normalized movement time, and increased until movement offset, while ΔV_COM remained stable. At 60%-100% normalized movement time, ΔV_EP was significantly reduced in the unstable base-of-support, compared to the stable base-of-support condition. ΔV_COM remained similar between the two conditions. At movement offset, ΔV_EP was significantly reduced in the unstable base-of-support, compared to the stable base-of-support condition, and was associated with a substantial increase in V_ORT. Postural instability might reduce the ability to use kinematic redundancy to stabilize the reaching movement. The central nervous system may prioritize the maintenance of postural stability over focal movement when postural stability is challenged.

Can vigilance predict the status of safe functional gait and risk of falls in patients with peripheral vestibular disorders? A cross-sectional study

OBJECTIVES

Peripheral vestibular disorders except from reflexes dysfunction correspond also to cognitive decline. The objectives of this cross-sectional study were to a) identify correlations among variables of functional gait, cognitive function, and perceived dizziness and b) explore variables that could be used as prognostic factors of functional gait in people with peripheral vestibular deficits.

METHODS

We recruited 154 people with peripheral vestibular deficits. The participants presented with moderate disability in terms of the Dizziness Handicap Inventory questionnaire (mean: 48.00, 95% confidence interval: 45.24-50.75), deficits in the Functional Gait Assessment test (mean: 22.75, 95% confidence interval: 22.13-23.40) and indication of mild cognitive impairment based on Montreal Cognitive Assessment tool (mean: 25.18, 95% confidence interval: 24.75-25.60).

RESULTS

Statistically significant correlations found among functional gait and gender, age, educational level, perceived level of disability and the total score of the Montreal Cognitive Assessment tool. Several components of the cognitive screening test (executive function, vigilance, language skills, verbal fluency) also correlated statistically significant with functional gait. Linear regression models revealed that age, perceived level of disability and vigilance significantly predicted functional gait variability (R² = 0.350; p < 0.001) as well as high risk of falling, as indicated by a score on Functional Gait Assessment test <22/30 (R² = 0.380).

CONCLUSIONS

Cognitive impairments affect functional gait in people with peripheral vestibular disorders. Thus, the integration of cognitive functional assessment must be considered as a prerequisite for functional assessment and designing rehabilitation programs that will include dual task training.

The impact of divided attention on automatic postural responses: A systematic review and meta-analysis

Quick responses to a loss of balance or "automatic postural responses" (APRs) are critical for fall prevention. The addition of a distracting task- dual-tasking (DT), typically worsens performance on mobility tasks. However, the effect of DT on APRs is unclear. We conducted a systematic review and meta-analyses to examine the effects of DT on spatial, temporal, and neuromuscular components of APRs and the effect of DT on cognitive performance. A Meta-analysis of 19 cohorts (n = 329) showed significant worsening in spatial kinematic features of APRs under DT conditions (P = 0.01), and a meta-analysis of 9 cohorts (n = 123) demonstrated later muscle onset during DT (P = 0.003). No significant DT effect was observed for temporal kinematic outcomes in 18 cohorts (n = 328; P = 0.47). Finally, significant declines in cognitive performance were evident in 20 cohorts (n = 400; P = 0.002). These results indicate that, despite the somewhat reactive nature of APRs, the addition of a secondary task negatively impacts some aspects of the response. These findings underscore the importance of cortical structures in APR generation. Given the importance of APRs for falls, identifying aspects of APRs that are altered under DT may inform fall-prevention treatment approaches.

Effect of standing desk use on cognitive performance and physical workload while engaged with high cognitive demand tasks

It is clear that the cognitive resources invested in standing are greater than in sitting, but six of eight previous studies suggested that there is no difference in cognitive performance. This study investigated the effects of sitting and standing workstations on the physical workload and cognitive performance under variable cognitive demand conditions. Fifteen participants visited two times for testing sitting and standing workstations, and were asked to play two difficulty levels of Tetris game for 40 min while kinematic variables, CoP regularity, CoP SD, and cognitive performances were captured every 5 min. Results revealed a more neural posture in standing than in sitting, but using the standing workstation degraded attention and executive function. The CoP SD was 7 times greater in standing, but the CoP regularity was 1/4 in sitting, denoting greater attentional investment while engaged at the standing workstation.

Attention and sensory integration for postural control in young adults with autism spectrum disorders

Postural control impairments have been reported in adults with autism spectrum disorders (ASD). Balance relies on the integration of multisensory cues, a process that requires attention. The purpose of this study was to determine if the influence of attention demands on sensory integration abilities relevant for balance partially contributes to postural control impairments in ASD. Young adults with ASD (N = 24) and neurotypical participants (N = 24) were exposed to sensory perturbations during standing. An established dual-task paradigm was used, requiring participants to maintain balance in these sensory challenging environments and to perform auditory information processing tasks (simple reaction time task and choice reaction time task). Balance was assessed using sway magnitude and sway speed, and attention demands were evaluated based on the response time in the auditory tasks. While young adults with ASD were able to maintain balance in destabilizing sensory conditions, they were more challenged (greater sway speed) than their neurotypical counterparts. Additionally, when exposed for an extended amount of time (3 min) to the most challenging sensory condition included in this study, adults with ASD exhibited a reduced ability to adapt their postural control strategies (sway speed was minimally reduced), demonstrating a postural inflexibility pattern in ASD compared to neurotypical counterparts. Finally, the impact of performing an auditory information processing task on balance and the dual-task cost on information processing (response time) was similar in both groups. ASD may disrupt temporal adaptive postural control processes associated with sensory reweighting that occurs in neurotypicals.

Functional Gait Can Be Affected by Noise: Effects of Age and Cognitive Function: A Pilot Study

Background: The ageing process may degrade an individual's balance control, hearing capacity, and cognitive function. Older adults perform worse on simultaneously executed balance and secondary tasks (i.e., dual-task performance) than younger adults and may be more vulnerable to auditory distraction.

Aim: The purpose of this study was to determine the effect of passive listening on functional gait in healthy older vs. younger adults, and to investigate the effect of age, functional gait, hearing ability and cognitive functioning on dual-task performance.

Methods: Twenty young and 20 older healthy adults were recruited. Functional gait (Functional Gait Assessment in silent and noisy condition), hearing function (audiogram; Speech in Babble test), and cognitive ability (Cambridge Neuropsychological Test Automated Battery) were measured.

Results: Overall, a significant difference between functional gait performance in silent vs. noisy conditions was found (p = 0.022), with no significant difference in dual-task cost between the two groups (p = 0.11). Correlations were found between increasing age, worse functional gait performance, poorer hearing capacity and lower performance on cognitive function tasks. Interestingly, worse performance on attention tasks appeared to be associated with a worse functional gait performance in the noisy condition.

Conclusion: Passive listening to multi-talker babble noise can affect functional gait in both young and older adults. This effect could result from the cognitive load of the babble noise, due to the engagement of attention networks by the unattended speech.

Characteristics of Postural Muscle Activity in Response to A Motor-Motor Task in Elderly

The purpose of the current study was to evaluate postural muscle performance of older adults in response to a combination of two motor tasks perturbations. Fifteen older participants were instructed to perform a pushing task as an upper limb perturbation while standing on a fixed or sliding board as a lower limb perturbation. Postural responses were characterized by onsets and magnitudes of muscle activities as well as onsets of segment movements. The sliding board did not affect the onset timing and sequence of muscle initiations and segment movements. However, significant large muscle activities of tibialis anterior and erector spinae were observed in the sliding condition (p < 0.05). The co-contraction values of the trunk and shank segments were significantly larger in the sliding condition through the studied periods (p < 0.05). Lastly, heavy pushing weight did not change the timing, magnitude, sequence of all studied parameters. Older adults enhanced postural stability by increasing the segment stiffness then started to handle two perturbations. In conclusion, they were able to deal with a dual motor-motor task after having secured their balance but could not make corresponding adjustments to the level of the perturbation difficulty.

Control of vertical posture while standing on a sliding board and pushing an object

Voluntary pushing or translation perturbation of the support surface each induces a body perturbation that affects postural control. The objective of the study was to investigate anticipatory (APA) and compensatory (CPA) postural adjustments when pushing an object (that induces self-initiated perturbation) and standing on a sliding board (that induces translational perturbation). Thirteen healthy young participants were instructed to push a handle with both hands while standing on a sliding board that was either free to move in the anterior-posterior direction or stationary. Electromyographic activity (EMG) of trunk and lower extremity muscles, center of pressure (COP) displacements, and the forces exerted by the hand were recorded and analyzed during the APA and CPA phases. When the sliding board was free to move during pushing (translation perturbation), onsets of activity of ventral leg muscles and COP displacement were delayed as compared to pushing when standing on a stationary board. Moreover, magnitudes of shank muscle activity and the COP displacement were decreased. When pushing heavier weight, magnitudes of muscle activity, COP displacement, and pushing force increased. The magnitude of activity of the shank muscles during the APA and CPA phases in conditions with translational perturbation varied with the magnitude of the pushing weight. The outcome of the study suggests that the central nervous system prioritizes the pushing task while attenuates the source of additional perturbation induced by translation perturbation. These results could be used in the development of balance re-training paradigms involving pushing weight while standing on a sliding surface.

Sensory and motoric influences on attention dynamics during standing balance recovery in young and older adults

This study investigated the impact of attention on the sensory and motor actions during postural recovery from underfoot perturbations in young and older adults. A dual-task paradigm was used involving disjunctive and choice reaction time (RT) tasks to auditory and visual stimuli at different delays from the onset of two types of platform perturbations (rotations and translations). The RTs were increased prior to the perturbation (preparation phase) and during the immediate recovery response (response initiation) in young and older adults, but this interference dissipated rapidly after the perturbation response was initiated (<220 ms). The sensory modality of the RT task impacted the results with interference being greater for the auditory task compared to the visual task. As motor complexity of the RT task increased (disjunctive versus choice) there was greater interference from the perturbation. Finally, increasing the complexity of the postural perturbation by mixing the rotational and translational perturbations together increased interference for the auditory RT tasks, but did not affect the visual RT responses. These results suggest that sensory and motoric components of postural control are under the influence of different dynamic attentional processes.

Postural stability in young healthy subjects - Impact of reduced base of support, visual deprivation, dual tasking

OBJECTIVE

To provide normative postural stability data in young subjects.

METHODS

Ninety-six healthy participants (58W, 28±6y) stood on a force plate during 60s. We measured effects of support width (feet apart, FA; feet together, FT), vision (eyes open, EO; closed, EC), and cognitive load (single task, ST; dual tasking, DT) on anteroposterior (AP) and medio-lateral (ML) ranges, area and planar velocity of center of pressure (COP) trajectory.

RESULTS

All variables increased with FT (AP range, +15%; ML, +185%; area, +242%; velocity, +50%, p<0.0002 for all, MANOVA). Visual deprivation increased COP ranges with added constraints (FT or DT, p=0.002) and increased velocity in all conditions (FA/ST, +16%; DT, +18%; FT/ST, +29%; DT, +23%, p<0.0002 for all). Dual tasking reduced COP displacements with FT (AP range, EO, -15%; EC, -11%; ML range, EO, -19%; EC, -13%; area, EO, -40%; EC, -28%, p<0.0002 for all) and increased velocity in most conditions (FA/EO, +15%; FA/EC, +16%; FT/EO, +7%, p<0.0002 for all).

CONCLUSION

In young healthy adults, base of support reduction increases COP displacements. Vision particularly affects postural stability with feet together or dual tasking. Dual tasking increases velocity but decreases COP displacements in challenging postural tasks, potentially by enhanced lower limb stiffness.

Control of grip force and vertical posture while holding an object and being perturbed

We investigated motor control perspectives of coordinating maintenance of posture and application of grip force when holding an object and being perturbed. Ten subjects stood on the force platform holding an instrumented object in their dominant hand and were exposed to an external perturbation applied to their shoulders. Task demands were manipulated by positioning a slippery cap on top of the instrumented object. Grip force applied to the object, the object acceleration and the center of pressure (COP) were recorded and analyzed during the time intervals typical for the anticipatory (APA) and compensatory (CPA) components of postural control. Onsets of grip force were seen before the onsets of the COP displacement and initiation of movements of the handheld object during the APA phase of postural control, while the onsets of maximum grip force preceded the maximum COP displacement during the CPA phase. When the task demands increased by holding a handheld object with the slippery cap, subjects tended to generate grip force earlier and of a smaller magnitude; also, the COP displacement in the APA phase was smaller as compared to holding a handheld object only. The outcome provides a foundation for future studies of maintenance of vertical posture in people with impairments of balance and grip force control when holding an object and being perturbed.

The effect of exercise intensity on cognitive performance during short duration treadmill running

This study examined the effect of short duration, moderate and high-intensity exercise on a Go/NoGo task. Fifteen, habitually active (9 females and 6 males aged 28 ± 5 years) agreed to participate in the study and cognitive performance was measured in three sessions lasting 10 min each, performed at three different exercise intensities: rest, moderate and high. Results indicated significant exercise intensity main effects for reaction time (RT) (p = 0.01), the omission error rate (p = 0.027) and the decision error rate (p = 0.011), with significantly longer RTs during high intensity exercise compared to moderate intensity exercise (p = 0.039) and rest (p = 0.023). Mean ± SE of RT (ms) was 395.8 ± 9.1, 396.3 ± 9.1 and 433.5 ± 16.1 for rest, moderate and high intensity exercise, respectively. This pattern was replicated for the error rate with a significantly higher omission error and decision error rate during high intensity exercise compared to moderate intensity exercise (p = 0.003) and rest (p = 0.001). Mean ± SE of omission errors (%) was 0.88 ± 0.23, 0.8 ± 0.23 and 1.8 ± 0.46% for rest, moderate and high intensity exercise, respectively. Likewise, mean ± SE of decision errors (%) was 0.73 ± 0.24, 0.73 ± 0.21 and 1.8 ± 0.31 for rest, moderate and high intensity exercise, respectively. The present study’s results suggest that 10 min workout at high intensity impairs RT performances in habitually active adults compared to rest or moderate intensity exercise.

Neural Correlates of Task Cost for Stance Control with an Additional Motor Task: Phase-Locked Electroencephalogram Responses

With appropriate reallocation of central resources, the ability to maintain an erect posture is not necessarily degraded by a concurrent motor task. This study investigated the neural control of a particular postural-suprapostural procedure involving brain mechanisms to solve crosstalk between posture and motor subtasks. Participants completed a single posture task and a dual-task while concurrently conducting force-matching and maintaining a tilted stabilometer stance at a target angle. Stabilometer movements and event-related potentials (ERPs) were recorded. The added force-matching task increased the irregularity of postural response rather than the size of postural response prior to force-matching. In addition, the added force-matching task during stabilometer stance led to marked topographic ERP modulation, with greater P2 positivity in the frontal and sensorimotor-parietal areas of the N1-P2 transitional phase and in the sensorimotor-parietal area of the late P2 phase. The time-frequency distribution of the ERP primary principal component revealed that the dual-task condition manifested more pronounced delta (1–4 Hz) and beta (13–35 Hz) synchronizations but suppressed theta activity (4–8 Hz) before force-matching. The dual-task condition also manifested coherent fronto-parietal delta activity in the P2 period. In addition to a decrease in postural regularity, this study reveals spatio-temporal and temporal-spectral reorganizations of ERPs in the fronto-sensorimotor-parietal network due to the added suprapostural motor task. For a particular set of postural-suprapostural task, the behavior and neural data suggest a facilitatory role of autonomous postural response and central resource expansion with increasing interregional interactions for task-shift and planning the motor-suprapostural task.

Dual task performance in older adults: Examining visual discrimination performance whilst treadmill walking at preferred and non-preferred speeds

This study examined visual discrimination performance in a sample of older adults before, during and post treadmill walking at preferred walking speed and preferred walking speed +20%. Nine adults (6 females and 3 males) aged 60-77 years (mean age=67.1±5.7 years) undertook three trials each lasting 15 min, rest, walking at preferred speed and walking at preferred speed +20%. Pre, during and post each condition, participants undertook measures of visual-cognitive performance. There were no significant main effects or higher order interactions for condition (rest, vs. walking preferred speed, vs. walking preferred speed +20%) or time (pre, during, post) (all P>0.05). There was a significant condition X time interaction for response time (P=0.014, partial ɳ(2)=0.352). Post hoc analysis indicated that response times were significantly faster during exercise at preferred speed compared to pre exercise at preferred speed (P=0.042). Response times were significantly slower during walking at preferred speed +20% compared to pre exercise (P=0.002) and to post exercise (P=0.012). Response times were significantly faster during PSW compared to during rest (P=0.05), during PSW compared to during PSW20 (P=0.001) and significantly slower during PSW20 compared to during rest (P=0.001). Post PSW20 response times were significantly slower than post PSW (P=0.04). These results suggest that visual discrimination performance is facilitated when walking at preferred speeds but walking at 20% faster than preferred speed significantly impedes visual discrimination in older adults.

Coincidence Anticipation Timing Performance during an Acute Bout of Brisk Walking in Older Adults: Effect of Stimulus Speed

This study examined coincidence anticipation timing (CAT) performance at slow and fast stimulus speeds before, during, and after an acute bout of walking in adults aged 60–76 years. Results from a series of repeated measures ANOVAs indicated significant rest versus exercise × stimulus speed × time interactions for absolute and variable errors (both P = 0.0001) whereby absolute and variable error scores, when stimulus speed was slow, improved as the duration of exercise increased. When stimulus speed was fast there were significantly greater absolute and variable errors at 18 minutes of the walking bout. There was also greater error at 18 minutes during walking compared to rest. These results suggest that, in a task involving walking and CAT, stimulus speeds plays an important role; specifically walking (exercise) enhances CAT performance at slow stimulus speeds but reduces CAT performance at fast stimulus speeds. The implications are that in everyday situations, where events require dual-task responses to be made at different speeds, for example, walking on the pavement whilst avoiding a crowd, compared to crossing a busy road, an understanding of how different stimulus speeds influence dual-task performance is extremely important, particularly in the older adult population.

Postural adjustments to support surface perturbations during reaching depend upon body-target reference frame

We investigated whether target position relative to the body modifies the postural adjustments produced when reaching movements are perturbed by unexpected displacements of the support surface. Eleven healthy participants reached to a target located at their midline, acromion height and at 130% their outstretched arm length. They stood on two force plates mounted on a moveable platform, capable of delivering horizontal forward ramp-and-hold perturbations. Three types of trial were given: reach only (R), perturbations only (P) and reaching movements during which a perturbation was given at a random delay after reach onset (RP). The target could be mounted either on a frame suspended from the ceiling such that it remained world-fixed (exocentric target, RP/X) or at an equivalent position on the moving platform so that it moved with the body (egocentric target, RP/E). Arm and body 3D kinematics and muscle activity from the right tibialis anterior (rTA) and soleus (rSOL) muscles were recorded. Normalised rTA activity was significantly lower in RP than in P trials. Furthermore, long-latency rTA muscle activity was lower in RP/E than in RP/X conditions when perturbations were given during either the arm deceleration phase of reaching. The rSOL muscle activity was lowest for the RP/E (arm deceleration) condition. When balance is perturbed during reaching, the manner in which the target moves relative to the body determines the muscle activity produced in the lower-limb muscles. Furthermore, a target that moves with the body requires a different regulation of muscle activity compared with one that moves independently of the body.

First trial and StartReact effects induced by balance perturbations to upright stance

Postural responses (PR) to a balance perturbation differ between the first and subsequent perturbations. One explanation for this first trial effect is that perturbations act as startling stimuli that initiate a generalized startle response (GSR) as well as the PR. Startling stimuli, such as startling acoustic stimuli (SAS), are known to elicit GSRs, as well as a StartReact effect, in which prepared movements are initiated earlier by a startling stimulus. In this study, a StartReact effect paradigm was used to determine if balance perturbations can also act as startle stimuli. Subjects completed two blocks of simple reaction time trials involving wrist extension to a visual imperative stimulus (IS). Each block included 15 CONTROL trials that involved a warning cue and subsequent IS, followed by 10 repeated TEST trials, where either a SAS (TESTSAS) or a toes-up support-surface rotation (TESTPERT) was presented coincident with the IS. StartReact effects were observed during the first trial in both TESTSAS and TESTPERT conditions as evidenced by significantly earlier wrist movement and muscle onsets compared with CONTROL. Likewise, StartReact effects were observed in all repeated TESTSAS and TESTPERT trials. In contrast, GSRs in sternocleidomastoid and PRs were large in the first trial, but significantly attenuated over repeated presentation of the TESTPERT trials. Results suggest that balance perturbations can act as startling stimuli. Thus first trial effects are likely PRs which are superimposed with a GSR that is initially large, but habituates over time with repeated exposure to the startling influence of the balance perturbation.

The effect of exercise intensity on coincidence anticipation performance at different stimulus speeds

The aim of this study was to examine the effect of exercise intensity on coincidence anticipation timing [CAT] performance at different stimulus speeds. Fourteen young adults (11 males and 3 females) volunteered to participate in the study following ethical approval. After familiarisation, coincidence anticipation was measured using the Bassin Anticipation Timer under three conditions: rest, moderate-intensity and high-intensity exercise with stimulus speeds of 3, 5 and 8 mph, set using an incremental running protocol until the participants reached a steady state of 70% and 90% of heart rate reserve (HRR), respectively. Results indicated a significant exercise intensity × stimulus speed interaction (p=0.0001) for absolute error (AE). There were no significant differences in AE across exercise intensities at a stimulus speed of 3 mph (p>0.05). AE was poorer during high-intensity exercise (90% HRR) compared to rest (p=0.022), and moderate-intensity (70% HRR) exercise (all, p=0.004 or better) at 5 and 8 mph. Variable error (VE) was similar across exercise intensities at stimulus speeds of both 3 and 5 mph (p>0.05). At a stimulus speed of 8 mph, VE was significantly poorer during high-intensity exercise compared to rest (p=0.006) and moderate-intensity exercise (p=0.008). There were no significant differences for constant error (p>0.05) across exercise intensities or stimulus speeds. High-intensity exercise is associated with poorer CAT performance. However, stimulus speed plays a key role within this association where faster stimulus speeds were associated with a more marked decrease in coincidence anticipation performance.

Startle induces early initiation of classically conditioned postural responses

Startling acoustic stimuli (SAS) induce the early release of prepared motor responses. The current study used SAS, in conjunction with a classical conditioning paradigm, to examine advanced motor preparation of conditioned postural responses (PRs). After generalized startle responses were induced, standing posture was perturbed in 2 blocks of 15 Conditioning trials, where in each trial the onset of a nonstartling auditory cue [i.e., a conditioned stimulus (CS)] preceded a leftward support-surface translation. Upon completion of each block, a single trial was conducted. After block 1, a CS-Only trial was used to induce conditioned PRs in the absence of balance perturbations. After block 2, a post-Conditioning Startle trial that involved a CS subsequently followed by a SAS was used to examine motor preparation of conditioned PRs. PRs were quantified in terms of center of pressure displacements, ankle and hip kinematics, as well as surface electromyography of proximal and distal bilateral muscle pairs. Results indicated that repeated experience with cued balance perturbations led to PR conditioning and, more importantly, motor preparation of PRs. Conditioning was evidenced in biomechanical and electromyographic responses observed in CS-Only trials, as well as the progressive changes to evoked response parameters during repeated Conditioning trials. SAS presented in post-Conditioning Startle trials evoked early onsets of biomechanical and electromyographic responses, while preserving relative response parameters that were each distinct from generalized startle responses. These results provide important insight into both the consequences of using cues in dynamic postural control studies and the neural mechanisms governing PRs.

Effects of an interactive computer game exercise regimen on balance impairment in frail community-dwelling older adults: a randomized controlled trial

BACKGROUND

Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills.

OBJECTIVES

The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction.

DESIGN

This study was a randomized controlled trial.

SETTING

The study was conducted in a geriatric day hospital.

PARTICIPANTS

Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study.

INTERVENTIONS

Participants were randomly assigned to either a control group or an experimental group. The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital. The experimental group received a program of dynamic balance exercises coupled with video game play, using a center-of-pressure position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface, with progression to a compliant sponge pad. Each group received 16 sessions, scheduled 2 per week, with each session lasting 45 minutes.

MEASUREMENTS

Data for the following measures were obtained before and after treatment: Berg Balance Scale, Timed "Up & Go" Test, Activities-specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction and Balance, and spatiotemporal gait variables assessed in an instrumented carpet system test.

RESULTS

Findings demonstrated significant improvements in posttreatment balance performance scores for both groups, and change scores were significantly greater in the experimental group compared with the control group. No significant treatment effect was observed in either group for the Timed "Up & Go" Test or spatiotemporal gait variables.

LIMITATIONS

The sample size was small, and there were group differences at baseline in some performance measures.

CONCLUSION

Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise. This coupling, in turn, resulted in a greater improvement in dynamic standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.

Postural responses to unexpected perturbations of balance during reaching

To study the interaction between feedforward and feedback modes of postural control, we investigated postural responses during unexpected perturbations of the support surface that occurred during forward reaching in a standing position. We examined postural responses in lower limb muscles of nine human subjects. Baseline measures were obtained when subjects executed reaching movements to a target placed in front of them (R condition) and during postural responses to forward and backward support-surface perturbations (no reaching, P condition) during quiet stance. Perturbations were also given at different delays after the onset of reaching movements (RP conditions) as well as with the arm extended in the direction of the target, but not reaching (P/AE condition). Results showed that during perturbations to reaching (RP), the initial automatic postural response, occurring around 100 ms after the onset of perturbations, was relatively unchanged in latency or amplitude compared to control conditions (P and P/AE). However, longer latency postural responses were modulated to aid in the reaching movements during forward perturbations but not during backward perturbations. Our results suggest that the nervous system prioritizes the maintenance of a stable postural base during reaching, and that later components of the postural responses can be modulated to ensure the performance of the voluntary task.

Fear of heights: cognitive performance and postural control

INTRODUCTION

Fear of heights, or acrophobia, is one of the most frequent subtypes of specific phobia frequently associated to depression and other anxiety disorders. Previous evidence suggests a correlation between acrophobia and abnormalities in balance control, particularly involving the use of visual information to keep postural stability. This study investigates the hypotheses that (1) abnormalities in balance control are more frequent in individuals with acrophobia even when not exposed to heights, that (2) acrophobic symptoms are associated to abnormalities in visual perception of movement; and that (3) individuals with acrophobia are more sensitive to balance-cognition interactions.

METHOD

Thirty-one individuals with specific phobia of heights and thirty one non-phobic controls were compared using dynamic posturography and a manual tracking task.

RESULTS

Acrophobics had poorer performance in both tasks, especially when carried out simultaneously. Previously described interference between posture control and cognitive activity seems to play a major role in these individuals.

DISCUSSION

The presence of physiologic abnormalities is compatible with the hypothesis of a non-associative acquisition of fear of heights, i.e., not associated to previous traumatic events or other learning experiences. Clinically, this preliminary study corroborates the hypothesis that vestibular physical therapy can be particularly useful in treating individuals with fear of heights.