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Janeiro Valenciano P, Emiliano Castan V, Henrique Martins Monteiro P, Augusto Teixeira L. Symmetric unipedal balance in quiet stance and dynamic tasks in older individuals. Brain Res 2024; 1830:148850. [PMID: 38460718 DOI: 10.1016/j.brainres.2024.148850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
Previous evidence of increased difference of muscular strength between the dominant and non-dominant legs in older adults suggests the possibility of dissimilar balance control between the legs (between-leg asymmetry) associated with aging. In the current investigation, we evaluated between-leg asymmetries in older adults when performing quiet and dynamic balance tasks. Fifty-two physically active and healthy older adults within the age range of 60 to 80 years were recruited. Participants performed balance tasks in unipedal stance, including quiet standing and cyclic sway (rhythmic oscillation) of the non-supporting leg in the anteroposterior or mediolateral directions, producing foot displacements with amplitudes of 20 cm paced in 1 Hz through a metronome. Body balance was evaluated through trunk accelerometry, by using the sensors embedded into a smartphone fixed at the height of the 10th-12th thoracic spines. Analysis revealed lack of significant differences in balance control between the legs either when comparing the right versus left or the preferred versus non-preferred legs, regardless of whether they were performing quiet stance or dynamic tasks. Further examination of the data showed high between-leg correlation coefficients (rs range: 0.71-0.84) across all tasks. Then, our results indicated symmetric and associated between-leg balance control in the examined older adults.
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Affiliation(s)
- Paola Janeiro Valenciano
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Victória Emiliano Castan
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | | | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
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Grasso C, Barresi M, Tramonti Fantozzi MP, Lazzerini F, Bruschini L, Berrettini S, Andre P, Dolciotti C, De Cicco V, De Cicco D, d'Ascanio P, Orsini P, Montanari F, Faraguna U, Manzoni D. Effects of a short period of postural training on postural stability and vestibulospinal reflexes. PLoS One 2023; 18:e0287123. [PMID: 37307276 DOI: 10.1371/journal.pone.0287123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
The effects of postural training on postural stability and vestibulospinal reflexes (VSRs) were investigated in normal subjects. A period (23 minutes) of repeated episodes (n = 10, 50 seconds) of unipedal stance elicited a progressive reduction of the area covered by centre of pressure (CoP) displacement, of average CoP displacement along the X and Y axes and of CoP velocity observed in this challenging postural task. All these changes were correlated to each other with the only exception of those in X and Y CoP displacement. Moreover, they were larger in the subjects showing higher initial instability in unipedal stance, suggesting that they were triggered by the modulation of sensory afferents signalling body sway. No changes in bipedal stance occurred soon and 1 hour after this period of postural training, while a reduction of CoP displacement was apparent after 24 hours, possibly due to a beneficial effect of overnight sleep on postural learning. The same period of postural training also reduced the CoP displacement elicited by electrical vestibular stimulation (EVS) along the X axis up to 24 hours following the training end. No significant changes in postural parameters of bipedal stance and VSRs could be observed in control experiments where subjects were tested at identical time points without performing the postural training. Therefore, postural training led to a stricter control of CoP displacement, possibly acting through the cerebellum by enhancing feedforward mechanisms of postural stability and by depressing the VSR, the most important reflex mechanism involved in balance maintenance under challenging conditions.
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Affiliation(s)
- Claudia Grasso
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Massimo Barresi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | | | - Francesco Lazzerini
- Department of Surgical, Medical, Molecular Pathology and Critical Cares, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Department of Surgical, Medical, Molecular Pathology and Critical Cares, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- Department of Surgical, Medical, Molecular Pathology and Critical Cares, University of Pisa, Pisa, Italy
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Andre
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Cristina Dolciotti
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Vincenzo De Cicco
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola d'Ascanio
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Paolo Orsini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Francesco Montanari
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Diego Manzoni
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
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McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR, Okubo Y. Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front Sports Act Living 2022; 4:1015394. [PMID: 36275443 PMCID: PMC9583884 DOI: 10.3389/fspor.2022.1015394] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tanvi S. Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Marissa H. G. Gerards
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Mark W. Rogers
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Ivusza P, Hortobágyi T, Sebesi B, Gáspár B, Fésüs Á, Varga M, Malmos V, Váczi M. No Difference in the Acute Effects of Randomization vs. Blocking of Units of Lower-Extremity Proprioceptive Training on Balance and Postural Control in Young Healthy Male Adults. Front Physiol 2022; 13:824651. [PMID: 35557968 PMCID: PMC9086394 DOI: 10.3389/fphys.2022.824651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Random practice is a form of differential learning and its favorable acute effects on motor performance are well described when visual tasks are practiced. However, no study to date has investigated the acute effects of differential learning using variable proprioceptive stimuli instead of the visual cues. The aim of the present study was to compare the acute effects of randomized versus blocked lower-extremity proprioceptive training stimuli on balance and postural adjustments. In two conditions, healthy young males (n = 15, age = 23 years) performed 16 one-legged landings on a board tilted in four directions: 1) tilt direction unknown and randomized and 2) tilt direction known with order of presentation blocked. Multi-segmental angular sway while balancing on an unstable surface and postural responses to perturbation stimulus by surface tilts were measured before and 4 min after training. Overall frontal-plane postural sway on the unstable surface decreased (p < 0.05, η2 = 0.022) in both conditions, while sagittal-plane postural sway remained unchanged. When the surface was toes-up tilted in the perturbation test, the sagittal-plane shank-thigh-pelvis alignment improved in both conditions (p < 0.05, η2 = 0.017), but the direction of the segmental positioning was non-uniform across participants. We conclude that randomization vs. blocking of units of lower-extremity proprioceptive training did not affect balance and postural control in our cohort of healthy young adults but the improvements were test-specific.
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Affiliation(s)
- Patrik Ivusza
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Tibor Hortobágyi
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary.,Center for Human Movement Sciences, University Medical Center, University of Groningen, Groningen, Netherlands
| | - Balázs Sebesi
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Balázs Gáspár
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Ádám Fésüs
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Mátyás Varga
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Vanessza Malmos
- Faculty of Humanities, Institute of English Studies, University of Pécs, Pécs, Hungary
| | - Márk Váczi
- Institution of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
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Can prior exposure to repeated non-paretic slips improve reactive responses on novel paretic slips among people with chronic stroke? Exp Brain Res 2022; 240:1069-1080. [PMID: 35106605 DOI: 10.1007/s00221-021-06300-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
This study examined if people with chronic stroke (PwCS) could adapt following non-paretic overground gait-slips and whether such prior exposure to non-paretic slips could improve reactive responses on novel paretic slip. Forty-nine PwCS were randomly assigned to either adaptation group, which received eight unexpected, overground, nonparetic-side gait-slips followed by two paretic-side slips or a control group, which received two paretic-side slips. Slip outcome, recovery strategies, center of mass (CoM) state stability, post-slip stride length and slipping kinematics were analyzed. The adaptation group demonstrated fall-reduction from first to eighth non-paretic slips, along with improved stability, stride length and slipping kinematics (p < 0.05). Within the adaptation group, on comparing novel slips, paretic-side demonstrated comparable pre-slip stability (p > 0.05); however, lower post-slip stability, increased slip velocity and falls was noted (p < 0.05). There was no difference in any variables between the novel paretic slips of adaptation and control group (p > 0.01). However, there was a rapid improvement on the 2nd slip such that adaptation group demonstrated improved performance from the first to second paretic slip compared to that in the control group (p < 0.01). PwCS demonstrated immediate proactive and reactive adaptation with overground, nonparetic-side gait-slips. However, PwCS did not demonstrate any inter-limb performance gain on the paretic-side after prior nonparetic-side adaptation when exposed to a novel paretic-side slip; but they did show significant positive gains with single slip priming on the paretic-side compared to controls without prior adaptation.Clinical registry number: NCT03205527.
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Marcori AJ, Monteiro PHM, Oliveira JA, Doumas M, Teixeira LA. Single Leg Balance Training: A Systematic Review. Percept Mot Skills 2022; 129:232-252. [PMID: 35084234 DOI: 10.1177/00315125211070104] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Single leg balance training promotes significant increments in balance control, but previous reviews on balance control have not analyzed this form of balance training. Accordingly, we aimed to review the single leg balance training literature to better understand the effects of applying this training to healthy individuals. We searched five databases-PubMed, EMBASE, Scopus, Lilacs, and Scielo-with the following inclusion criteria: (a) peer-reviewed articles published in English; (b) analysis of adult participants who had no musculoskeletal injuries or diseases that might impair balance control; and (c) use of methods containing at least a pre-test, exclusive single leg balance training, and a post-test assessment. We included 13 articles meeting these criteria and found that single leg balance training protocols were effective in inducing balance control gains in either single- or multiple-session training and with or without progression of difficulty. Balance control gains were achieved with different amounts of training, ranging from a single short session of 10 minutes to multiple sessions totaling as much as 390 min of unipedal balance time. Generalization of balance gains to untrained tasks and cross-education between legs from single leg balance training were consistent across studies. We concluded that single leg balance training can be used in various contexts to improve balance performance in healthy individuals. These results extend knowledge of expected outcomes from this form of training and aid single leg balance exercise prescription regarding volume, frequency, and potential progressions.
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Affiliation(s)
- Alexandre J Marcori
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
| | - Pedro H M Monteiro
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
| | - Júlia A Oliveira
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
| | - Michail Doumas
- School of Psychology, 1596Queen's University, Belfast, Northern Ireland
| | - Luis A Teixeira
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
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Kozinc Ž, Šarabon N. The effects of leg preference and leg dominance on static and dynamic balance performance in highly-trained tennis players. PLoS One 2021; 16:e0259854. [PMID: 34762690 PMCID: PMC8584696 DOI: 10.1371/journal.pone.0259854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
In this study, 90 (51 males, 39 females) tennis players performed single-leg quiet stance and single-leg landing tasks. For the static standing task, center-of pressure (CoP) velocities, amplitudes, frequency and area were calculated. For the landing tasks, time to stabilization as well as dynamic postural stability index were considered. The analysis of differences between the legs was done based on two methods for a priori determination of leg preference, one based on the preference of kicking a ball and one based on the preference for single-leg jumping. An additional analysis was done based on the leg dominance (determined post hoc), based on the observed performance of the tasks. In case of the classification based on kicking a ball, there was a statistically significantly lower CoP anterior-posterior velocity and anterior-posterior amplitude in static balance task (p ≤ 0.017; 0.17 ≤ d ≤ 0.28) for the preferred leg. The CoP frequency was higher in the preferred leg for both directions (p ≤ 0.002; 0.10 ≤ d ≤ 0.22). For the landing task, CoP medial-lateral time to stabilization was statistically significantly shorter for the preferred leg (0.28 ± 0.38 s) compared to the non-preferred leg (0.47 ± 0.60 s) (p = 0.012; d = 0.38). There were no differences between the legs for the landing task. Moreover, there were no differences between the legs when we used the preference based on jumping for either of the tasks (d ≤ 0.14). The differences between legs in terms of observed dominance were larger than the differences based on the preference, which stresses the need for clear distinction of limb preference and limb dominance in research and practice. Regarding the effect of leg preference, small differences in static balance may exist between the legs (when the preference is based on kicking a ball).
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Affiliation(s)
- Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Izola, Slovenia
- University of Primorska, Andrej Marušič Institute, Koper, Slovenia
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Izola, Slovenia
- University of Primorska, Andrej Marušič Institute, Koper, Slovenia
- InnoRenew CoE, Human Health Department, Izola, Slovenia
- S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behavior, Ljubljana, Slovenia
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Muehlbauer T, Abel L, Schedler S, Panzer S. Acute effects of a single unilateral balance training session on ipsi- and contralateral balance performance in healthy young adults. BMC Res Notes 2021; 14:356. [PMID: 34507606 PMCID: PMC8434721 DOI: 10.1186/s13104-021-05774-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Objective While there is evidence on the short-term effects of unilateral balance training (BT) on bipedal balance performance, less is known on the acute effects of unilateral BT on unilateral (i.e., ipsi- and contralateral) balance performance. Thus, the present study examined the acute effects of a single unilateral BT session conducted with the non-dominant, left leg or the dominant, right leg on ipsilateral (i.e. retention) and contralateral (i.e., inter-limb transfer) balance performance in healthy young adults (N = 28). Results Irrespective of practice condition, significant improvements (p < 0.001, d = 1.27) in balance performance following a single session of unilateral BT were observed for both legs. Further, significant performance differences at the pretest (p = 0.002, d = 0.44) to the detriment of the non-dominant, left leg diminished immediately and 30 min after the single unilateral BT session but occurred again 24 h following training (p = 0.030, d = 0.36). These findings indicate that a single session of unilateral BT is effective to reduced side-to-side differences in balance performance, but this impact is only temporary.
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Affiliation(s)
- Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141, Essen, Germany.
| | - Leander Abel
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141, Essen, Germany
| | - Simon Schedler
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141, Essen, Germany
| | - Stefan Panzer
- Institute of Sport Science, Saarland University, 66123, Saarbrücken, Germany.,Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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