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Li Y, Li J, Wang P, Yu D, Chen Z, Shi Z, Wu Y, Qi W, Lu W, Shi H. Electroencephalography microstate alterations reflect potential double-edged cognitive adaptation in Ménière's disease. CNS Neurosci Ther 2024; 30:e14896. [PMID: 39107944 PMCID: PMC11303265 DOI: 10.1111/cns.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To explore the microstate characteristics and underlying brain network activity of Ménière's disease (MD) patients based on high-density electroencephalography (EEG), elucidate the association between microstate dynamics and clinical manifestation, and explore the potential of EEG microstate features as future neurobiomarkers for MD. METHODS Thirty-two patients diagnosed with MD and 29 healthy controls (HC) matched for demographic characteristics were included in the study. Dysfunction and subjective symptom severity were assessed by neuropsychological questionnaires, pure tone audiometry, and vestibular function tests. Resting-state EEG recordings were obtained using a 256-channel EEG system, and the electric field topographies were clustered into four dominant microstate classes (A, B, C, and D). The dynamic parameters of each microstate were analyzed and utilized as input for a support vector machine (SVM) classifier to identify significant microstate signatures associated with MD. The clinical significance was further explored through Spearman correlation analysis. RESULTS MD patients exhibited an increased presence of microstate class C and a decreased frequency of transitions between microstate class A and B, as well as between class A and D. The transitions from microstate class A to C were also elevated. Further analysis revealed a positive correlation between equilibrium scores and the transitions from microstate class A to C under somatosensory challenging conditions. Conversely, transitions between class A and B were negatively correlated with vertigo symptoms. No significant correlations were detected between these characteristics and auditory test results or emotional scores. Utilizing the microstate features identified via sequential backward selection, the linear SVM classifier achieved a sensitivity of 86.21% and a specificity of 90.61% in distinguishing MD patients from HC. CONCLUSIONS We identified several EEG microstate characteristics in MD patients that facilitate postural control yet exacerbate subjective symptoms, and effectively discriminate MD from HC. The microstate features may offer a new approach for optimizing cognitive compensation strategies and exploring potential neurobiological markers in MD.
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Affiliation(s)
- Yi‐Ni Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jie Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Peng‐Jun Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dong‐Zhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zheng‐Nong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zheng‐Yu Shi
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ya‐Qin Wu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wei‐Dong Qi
- Department of Otolaryngology Head and Neck SurgeryHuashan Hospital Fudan UniversityShanghaiChina
| | - Wen Lu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hai‐Bo Shi
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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2
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Castro P, Ibitoye R, Ellmers T, Kaski D, Arshad Q, Bronstein AM. Towards an explanation for 'unexplained' dizziness in older people. Age Ageing 2024; 53:afae137. [PMID: 38965033 PMCID: PMC11223895 DOI: 10.1093/ageing/afae137] [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: 10/04/2023] [Revised: 04/29/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Subjective unsteadiness or dizziness, usually without increase in body sway, is common in older people. The absence of mechanistic understanding of such symptoms renders clinical management difficult. Here, we explore the mechanisms behind such idiopathic dizziness (ID), focusing on postural control abnormalities. METHODS Thirty patients with ID and 30 age-matched controls stood on a moving platform. Platform oscillations were randomly delivered at different velocities (from 0 to 0.2 m/s). Markers of postural control, including objective sway (trunk sway path, recorded via a sensor attached to vertebrae C7), stepping responses, subjective instability and anxiety ratings were obtained. MRI scans were available for correlations with levels of cerebral small vessel disease in 28 patients and 24 controls. RESULTS We observed a significant relationship between objective and subjective instability in all groups. The slope of this fit was significantly steeper for patients than controls, indicating greater perceived instability for the same body sway. Stepwise linear regression showed that the slopes of this objective-subjective instability relationship were best explained by concerns about falling (Falls Efficacy Scale-International), clinical physical functioning (Short Physical Performance Battery) and, to some degree, by neuroimaging markers of cerebral small vessel disease. In addition, patients had a reduced stepping threshold, suggesting an overly cautious postural response. CONCLUSION The distorted perception of instability and subtle impairments in balance control, including abnormal and overly cautious stepping responses, underlies the emergence of ID. It appears to relate to changes in postural performance, psychological functioning and disruption of postural brain networks associated with cerebral small vessel disease.
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Affiliation(s)
- Patricia Castro
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Escuela de Fonoaudiología, Santiago, Chile
| | - Richard Ibitoye
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Toby Ellmers
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Qadeer Arshad
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Adolfo M Bronstein
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
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3
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Hill MW, Johnson E, Ellmers TJ. The influence of false interoceptive feedback on emotional state and balance responses to height-induced postural threat. Biol Psychol 2024; 189:108803. [PMID: 38663458 DOI: 10.1016/j.biopsycho.2024.108803] [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: 09/12/2023] [Revised: 03/01/2024] [Accepted: 04/18/2024] [Indexed: 06/19/2024]
Abstract
Postural threat elicits a robust emotional response (e.g., fear and anxiety about falling), with concomitant modifications in balance. Recent theoretical accounts propose that emotional responses to postural threats are manifested, in part, from the conscious monitoring and appraisal of bodily signals ('interoception'). Here, we empirically probe the role of interoception in shaping emotional responses to a postural threat by experimentally manipulating interoceptive cardiac feedback. Sixty young adults completed a single 60-s trial under the following conditions: Ground (no threat) without heart rate (HR) feedback, followed by Threat (standing on the edge of a raised surface), during which participants received either false heart rate feedback (either slow [n = 20] or fast [n = 20] HR feedback) or no feedback (n = 20). Participants provided with false fast HR feedback during postural threat felt more fearful, reported feeling less stable, and rated the task more difficult than participants who did not receive HR feedback, or those who received false slow HR feedback (Cohen's d effect size = 0.79 - 1.78). However, behavioural responses did not significantly differ across the three groups. When compared to the no HR feedback group, false slow HR feedback did not significantly affect emotional or behavioural responses to the postural threat. These observations provide the first experimental evidence for emerging theoretical accounts describing the role of interoception in the generation of emotional responses to postural threats.
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Affiliation(s)
- Mathew W Hill
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Warwickshire, United Kingdom.
| | - Ellie Johnson
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Warwickshire, United Kingdom
| | - Toby J Ellmers
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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4
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Hill M, Brayne L, Hosseini E, Duncan M, Muehlbauer T, Lord SR, Ellmers TJ. The influence of fear of falling on the control of upright stance across the lifespan. Gait Posture 2024; 109:226-232. [PMID: 38364509 DOI: 10.1016/j.gaitpost.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/20/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Standing at height, and subsequent changes in emotional state (e.g., fear of falling), lead to robust alterations in balance in adults. However, little is known about how height-induced postural threat affects balance performance in children. Children may lack the cognitive capability necessary to inhibit the processing of threat and fear-related stimuli, and as a result, may show more marked (and perhaps detrimental) changes in postural control compared to adults. This work explored the emotional and balance responses to standing at height in children, and compared responses to young and older adults. METHODS Children (age: 9.7 ± 0.8 years, n = 38), young adults (age: 21.8 ± 4.0 years, n = 45) and older adults (age: 73.3 ± 5.0 years, n = 15) stood in bipedal stance in two conditions: at ground level and 80 cm above ground. Centre of pressure (COP) amplitude (RMS), frequency (MPF) and complexity (sample entropy) were calculated to infer postural performance and strategy. Emotional responses were quantified by assessing balance confidence, fear of falling and perceived instability. RESULTS Young and older adults demonstrated a postural adaptation characterised by increased frequency and decreased amplitude of the COP, in conjunction with increased COP complexity (sample entropy). In contrast, children demonstrated opposite patterns of changes: they exhibited an increase in COP amplitude and decrease in both frequency and complexity when standing at height. SIGNIFICANCE Children and adults adopted different postural control strategies when standing at height. Whilst young and older adults exhibited a potentially protective "stiffening" response to a height-induced threat, children demonstrated a potentially maladaptive and ineffective postural adaptation strategy. These observations expand upon existing postural threat related research in adults, providing important new insight into understanding how children respond to standing in a hazardous situation.
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Affiliation(s)
- M Hill
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom.
| | - L Brayne
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - E Hosseini
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - M Duncan
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - T Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Essen, Germany
| | - S R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - T J Ellmers
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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5
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Ellmers TJ, Kal EC. Exploring the role of attention towards balance in chronic dizziness: Development of the Balance Vigilance Questionnaire. Eur J Neurol 2024; 31:e16148. [PMID: 38015469 PMCID: PMC11235928 DOI: 10.1111/ene.16148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Vigilance towards balance has been proposed to underpin various chronic dizziness disorders, including persistent postural-perceptual dizziness (PPPD). The objective of this study was to develop (through patient input) a validated balance-specific measure of vigilance that comprehensively assesses the varied ways in which this construct may manifest. METHODS We developed the Balance Vigilance Questionnaire (Balance-VQ) through patient and clinician feedback, designed to assess vigilance towards balance. We then validated the questionnaire in 497 participants consisting of patients diagnosed with chronic dizziness disorders (including 97 individuals diagnosed with PPPD) and healthy controls. RESULTS The final six-item Balance-VQ was shown to be a valid and reliable way to assess vigilance towards balance. Scores were significantly higher in individuals diagnosed with PPPD compared to controls. Although scores were also higher in the PPPD group compared to individuals with diagnosed vestibular disorders other than PPPD, Balance-VQ scores did not discriminate between the two groups when confounding factors (including dizziness severity) were controlled for. Scores did, however, independently discriminate between the PPPD group and individuals who experience dizziness in daily life, but who have not been diagnosed with a neuro-otological disorder. CONCLUSIONS Our findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. As symptom vigilance has been identified as a key risk factor for developing chronic dizziness following acute vestibular symptoms or balance disruption, we recommend using the Balance-VQ as a screening tool in people presenting with such symptoms.
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Affiliation(s)
- Toby J. Ellmers
- Centre for Vestibular Neurology, Department of Brain SciencesImperial College LondonLondonUK
| | - Elmar C. Kal
- Centre for Cognitive Neuroscience, Department of Health Sciences, College of Health, Medicine, and Life SciencesBrunel University LondonUxbridgeUK
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Søndergaard K, Curtis DJ, Caye-Thomasen P, Juhl CB. The reliability and agreement of scores in a novel balance measure for older adults: Specific Training According to BaLance Evaluation (STABLE). Disabil Rehabil 2023; 45:3582-3594. [PMID: 36205568 DOI: 10.1080/09638288.2022.2130446] [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: 02/24/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Falls are the leading cause of injury and premature death among community dwelling elderly but can be prevented through comprehensive balance rehabilitation which ideally targets the patient's specific needs. In this study, we evaluate the reliability and agreement of six novel clinical measures of different balance domains which applied in a patient-specific balance profile guides exercise prescription in balance rehabilitation. MATERIALS AND METHODS The intra-rater reliability and agreement of the six measures were evaluated on the same day in six different cohorts of elderly with balance disability (n = 65-100). Further, the inter-day intra-rater and inter-rater and test-retest reliability and agreement of the measures and the balance profile were evaluated (n = 100). RESULTS The intra-day intra-rater reliability and agreement was moderate to excellent (ICC2.1 = 0.525-0.968, with SDC% = 6.5-284.9%) but poor to good for the inter-day conditions (ICC2.1 = 0.123-0.832, with SDC% = 6.6-229.2%). The reliability of classifying the lower domain in the balance profile was fair, with kappa = 0.56 (95%CI 0.36-0.76). CONCLUSIONS Five of the six measures may reliably be applied to measure balance disability and to guide rehabilitation. Implications for rehabilitationBalance disability is the primary reason for accidental falls among elderly but can be prevented through comprehensive individualized balance rehabilitation.Specific Training According to BaLance Evaluation (STABLE) is a novel approach for designing effective balance exercises based on clinical measurements.Five of the six measures are reliable when applied in a patient-specific balance profile to guide rehabilitation following the STABLE approach.
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Affiliation(s)
- Kasper Søndergaard
- Department of Occupational and Physical Therapy, University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of ORL, H&N Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense M, Denmark
| | - Derek John Curtis
- Child Centre Copenhagen, The Child and Youth Administration, Copenhagen Ø, Denmark
| | - Per Caye-Thomasen
- Department of ORL, H&N Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Department of Occupational and Physical Therapy, University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense M, Denmark
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7
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Hall KJ, Van Ooteghem K, McIlroy WE. Emotional state as a modulator of autonomic and somatic nervous system activity in postural control: a review. Front Neurol 2023; 14:1188799. [PMID: 37719760 PMCID: PMC10500443 DOI: 10.3389/fneur.2023.1188799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023] Open
Abstract
Advances in our understanding of postural control have highlighted the need to examine the influence of higher brain centers in the modulation of this complex function. There is strong evidence of a link between emotional state, autonomic nervous system (ANS) activity and somatic nervous system (somatic NS) activity in postural control. For example, relationships have been demonstrated between postural threat, anxiety, fear of falling, balance confidence, and physiological arousal. Behaviorally, increased arousal has been associated with changes in velocity and amplitude of postural sway during quiet standing. The potential links between ANS and somatic NS, observed in control of posture, are associated with shared neuroanatomical connections within the central nervous system (CNS). The influence of emotional state on postural control likely reflects the important influence the limbic system has on these ANS/somatic NS control networks. This narrative review will highlight several examples of behaviors which routinely require coordination between the ANS and somatic NS, highlighting the importance of the neurofunctional link between these systems. Furthermore, we will extend beyond the more historical focus on threat models and examine how disordered/altered emotional state and ANS processing may influence postural control and assessment. Finally, this paper will discuss studies that have been important in uncovering the modulatory effect of emotional state on postural control including links that may inform our understanding of disordered control, such as that observed in individuals living with Parkinson's disease and discuss methodological tools that have the potential to advance understanding of this complex relationship.
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Affiliation(s)
- Karlee J. Hall
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Danneels M, Van Hecke R, Leyssens L, van de Berg R, Dhooge I, Cambier D, Delrue S, Van Rompaey V, Maes L. The impact of vestibular function on cognitive-motor interference: a case-control study on dual-tasking in persons with bilateral vestibulopathy and normal hearing. Sci Rep 2023; 13:13772. [PMID: 37612342 PMCID: PMC10447548 DOI: 10.1038/s41598-023-40465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Bilateral vestibulopathy (BV) is a chronic vestibular disorder, characterized by bilaterally absent or significantly impaired vestibular function. Symptoms typically include, but are not limited to, unsteadiness and movement-induced blurred vision (oscillopsia). This prospective case-control study aimed to elucidate the impact of BV on cognitive and motor performance and on cognitive-motor interference. Cognitive and motor performance, as well as cognitive-motor interference were measured in persons with BV and normal hearing using the 2BALANCE dual-task protocol. The experimental group was matched to a healthy control group based on age, sex, and educational level. The 2BALANCE protocol comprises cognitive tests assessing visuospatial memory, mental rotation, visual and auditory response inhibition, visual and auditory working memory, and processing speed. The cognitive tests were performed in single-task condition (while seated), and in dual-task condition (during a static and a dynamic motor task). The static motor task consisted of balancing on a force platform with foam pad. The dynamic motor task consisted of walking at a self-selected speed. These motor tasks were also performed in single-task condition. A generalized estimating equations model was used to investigate group differences for all cognitive and motor outcome measures. The estimated marginal means, as well as the odds ratios (OR), and their 95% confidence intervals (CI) were calculated. For the backward digit recall test, a baseline measurement was performed and analyzed using a student-t test. A total of 22 patients with BV and normal hearing and 22 healthy control subjects were assessed [mean age (SD), BV = 53.66 (13.35) and HC = 53.21 (13.35), 68% male]. The BV group had poorer mental rotation skills in single-task condition, compared to the control group [odds ratio (OR) = 2.30, confidence interval (CI) = 1.12-4.73, P = 0.024]. Similarly, auditory and visual working memory were also poorer in the BV group in single-task condition (P = 0.028 and P = 0.003, respectively). The BV group also performed poorer on the mental rotation task and the visual response inhibition task in dual-task condition (OR = 2.96, CI = 1.57-5.59, P < 0.001 and OR = 1.08, CI = 1.01-1.16, P = 0.032, respectively). Additionally, an interaction effect, indicating increased cognitive-motor interference in the BV group, was observed for mental rotation, response inhibition, and auditory working memory (P = 0.003 to 0.028). All static motor outcome parameters indicated more postural sway in the BV group compared to the control group for all test conditions (P < 0.001 to 0.026). No group differences were noted for the dynamic motor task. These findings suggest a link between vestibular function and cognitive performance, as well as a greater interference between cognitive and motor performance in BV, compared to healthy controls.
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Affiliation(s)
- Maya Danneels
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stefan Delrue
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint Lucas Hospital, Ghent, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Ellmers TJ, Wilson MR, Kal EC, Young WR. The perceived control model of falling: developing a unified framework to understand and assess maladaptive fear of falling. Age Ageing 2023; 52:afad093. [PMID: 37466642 PMCID: PMC10355179 DOI: 10.1093/ageing/afad093] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND fear of falling is common in older adults and can have a profound influence on a variety of behaviours that increase fall risk. However, fear of falling can also have potentially positive outcomes for certain individuals. Without progressing our understanding of mechanisms underlying these contrasting outcomes, it is difficult to clinically manage fear of falling. METHODS this paper first summarises recent findings on the topic of fear of falling, balance and fall risk-including work highlighting the protective effects of fear. Specific focus is placed on describing how fear of falling influences perceptual, cognitive and motor process in ways that might either increase or reduce fall risk. Finally, it reports the development and validation of a new clinical tool that can be used to assess the maladaptive components of fear of falling. RESULTS we present a new conceptual framework-the Perceived Control Model of Falling-that describes specific mechanisms through which fear of falling can influence fall risk. The key conceptual advance is the identification of perceived control over situations that threaten one's balance as the crucial factor mediating the relationship between fear and increased fall risk. The new 4-item scale that we develop-the Updated Perceived Control over Falling Scale (UP-COF)-is a valid and reliable tool to clinically assess perceived control. CONCLUSION this new conceptualisation and tool (UP-COF) allows clinicians to identify individuals for whom fear of falling is likely to increase fall risk, and target specific underlying maladaptive processes such as low perceived control.
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Affiliation(s)
| | - Mark R Wilson
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Elmar C Kal
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
| | - William R Young
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
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10
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Fischer OM, Missen KJ, Tokuno CD, Carpenter MG, Adkin AL. Postural threat increases sample entropy of postural control. Front Neurol 2023; 14:1179237. [PMID: 37342783 PMCID: PMC10277644 DOI: 10.3389/fneur.2023.1179237] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Postural threat elicits modifications to standing balance. However, the underlying neural mechanism(s) responsible remain unclear. Shifts in attention focus including directing more attention to balance when threatened may contribute to the balance changes. Sample entropy, a measure of postural sway regularity with lower values reflecting less automatic and more conscious control of balance, may support attention to balance as a mechanism to explain threat-induced balance changes. The main objectives were to investigate the effects of postural threat on sample entropy, and the relationships between threat-induced changes in physiological arousal, perceived anxiety, attention focus, sample entropy, and traditional balance measures. A secondary objective was to explore if biological sex influenced these relationships. Methods Healthy young adults (63 females, 42 males) stood quietly on a force plate without (No Threat) and with (Threat) the expectation of receiving a postural perturbation (i.e., forward/backward support surface translation). Mean electrodermal activity and anterior-posterior centre of pressure (COP) sample entropy, mean position, root mean square, mean power frequency, and power within low (0-0.05 Hz), medium (0.5-1.8 Hz), and high-frequency (1.8-5 Hz) components were calculated for each trial. Perceived anxiety and attention focus to balance, task objectives, threat-related stimuli, self-regulatory strategies, and task-irrelevant information were rated after each trial. Results and Discussion Significant threat effects were observed for all measures, except low-frequency sway. Participants were more physiologically aroused, more anxious, and directed more attention to balance, task objectives, threat-related stimuli, and self-regulatory strategies, and less to task-irrelevant information in the Threat compared to No Threat condition. Participants also increased sample entropy, leaned further forward, and increased the amplitude and frequency of COP displacements, including medium and high-frequency sway, when threatened. Males and females responded in the same way when threatened, except males had significantly larger threat-induced increases in attention to balance and high-frequency sway. A combination of sex and threat-induced changes in physiological arousal, perceived anxiety, and attention focus accounted for threat-induced changes in specific traditional balance measures, but not sample entropy. Increased sample entropy when threatened may reflect a shift to more automatic control. Directing more conscious control to balance when threatened may act to constrain these threat-induced automatic changes to balance.
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Affiliation(s)
- Olivia M. Fischer
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Kyle J. Missen
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Craig D. Tokuno
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Mark G. Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Allan L. Adkin
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
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11
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Steinmann J, Lewis A, Ellmers TJ, Jones M, MacBean V, Kal E. Validating the Breathing Vigilance Questionnaire for use in dysfunctional breathing. Eur Respir J 2023; 61:2300031. [PMID: 37024133 DOI: 10.1183/13993003.00031-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Dysfunctional breathing is common among people with and without primary respiratory pathology. While anxiety can contribute to dysfunctional breathing, the underpinning mechanism is unclear. One explanation is that anxiety induces conscious, vigilant monitoring of breathing, disrupting "automatic" breathing mechanics. We validated a new tool that quantifies such breathing-related "vigilance": the Breathing Vigilance Questionnaire (Breathe-VQ). METHODS 323 healthy adults (mean (range) age 27.3 (18-71) years; 161 males) were analysed. We developed an initial Breathe-VQ (11 items, 1-5 Likert scale) based on the Pain Vigilance and Awareness Scale, using feedback from the target population and clinicians. At baseline, participants completed the Breathe-VQ, Nijmegen Questionnaire (NQ), State-Trait Anxiety Inventory form 2 and Movement-Specific Reinvestment Scale (assessing general conscious processing). 83 people repeated the Breathe-VQ 3 weeks later. RESULTS Five items were removed based on item-level analysis. The resulting six-item Breathe-VQ questionnaire (score range 6-30) has excellent internal (α=0.892) and test-retest reliability (intraclass correlation 0.810), a minimal detectable change of 6.5 and no floor/ceiling effects. Validity was evidenced by significant positive correlations with trait anxiety and conscious processing scores (r=0.35-0.46). Participants at high risk of having dysfunctional breathing (NQ >23; n=76) had significantly higher Breathe-VQ score (mean±sd 19.1±5.0) than low-risk peers (n=225; mean±sd 13.8±5.4; p<0.001). In this "high risk of dysfunctional breathing" group, Breathe-VQ and NQ scores were significantly associated (p=0.005), even when controlling for risk factors (e.g. trait anxiety). CONCLUSIONS The Breathe-VQ is a valid and reliable tool to measure breathing vigilance. High breathing vigilance may contribute to dysfunctional breathing and could represent a therapeutic target. Further research is warranted to test Breathe-VQ's prognostic value and assess intervention effects.
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Affiliation(s)
- Jennifer Steinmann
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- J. Steinmann and A. Lewis are joint first authors
| | - Adam Lewis
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- Centre for Smart Technology Advancements for Health and Rehabilitation, Brunel University London, London, UK
- J. Steinmann and A. Lewis are joint first authors
| | - Toby J Ellmers
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
| | - Mandy Jones
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Vicky MacBean
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- Centre for Smart Technology Advancements for Health and Rehabilitation, Brunel University London, London, UK
| | - Elmar Kal
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- Centre for Smart Technology Advancements for Health and Rehabilitation, Brunel University London, London, UK
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
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12
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Brock K, Vine SJ, Ross JM, Trevarthen M, Harris DJ. Movement kinematic and postural control differences when performing a visuomotor skill in real and virtual environments. Exp Brain Res 2023:10.1007/s00221-023-06639-0. [PMID: 37222777 DOI: 10.1007/s00221-023-06639-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
Immersive technologies, like virtual and mixed reality, pose a novel challenge for our sensorimotor systems as they deliver simulated sensory inputs that may not match those of the natural environment. These include reduced fields of view, missing or inaccurate haptic information, and distortions of 3D space; differences that may impact the control of motor actions. For instance, reach-to-grasp movements without end-point haptic feedback are characterised by slower and more exaggerated movements. A general uncertainty about sensory input may also induce a more conscious form of movement control. We tested whether a more complex skill like golf putting was also characterized by more consciously controlled movement. In a repeated-measures design, kinematics of the putter swing and postural control were compared between (i) real-world putting, (ii) VR putting, and (iii) VR putting with haptic feedback from a real ball (i.e., mixed reality). Differences in putter swing were observed both between the real world and VR, and between VR conditions with and without haptic information. Further, clear differences in postural control emerged between real and virtual putting, with both VR conditions characterised by larger postural movements, which were more regular and less complex, suggesting a more conscious form of balance control. Conversely, participants actually reported less conscious awareness of their movements in VR. These findings highlight how fundamental movement differences may exist between virtual and natural environments, which may pose challenges for transfer of learning within applications to motor rehabilitation and sport.
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Affiliation(s)
- K Brock
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - S J Vine
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - J M Ross
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - M Trevarthen
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - D J Harris
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK.
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13
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Hill MW, Russel K, Wdowski M, Lord SR, Muehlbauer T, Ellmers T. Effects of arm movement strategies on emotional state and balance control during height-induced postural threat in young adults. Gait Posture 2023; 103:73-79. [PMID: 37121215 DOI: 10.1016/j.gaitpost.2023.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND It is firmly established that postural threat seems to lead to an increased. reliance on an ankle control ('stiffening') strategy. However, little is known about how. postural threat affects performance in challenging tasks that require the use of upper. body postural control strategies for stability. It is logical to assume that in such. conditions, being able to utilise an upper body strategy may reduce the reliance on. such ankle stiffening strategy. Research question The objective of this study was to determine how arm movement. influences balance control during a challenging balance task performed under. conditions of postural threat. METHODS Thirty young adults (mean ± SD age; 22.0 ± 4.0 years) balanced in tandem. stance whilst standing at both ground-level (no threat) and 0.8 m above ground. (threat). In both conditions, participants performed the task under two different arm. POSITIONS restricted arm movements and free arm movements. Postural sway. amplitude and frequency were calculated to infer postural stiffening response. Selfreported. emotional responses were quantified by assessing balance confidence, fear. of falling, perceived stability, and conscious balance processing. RESULTS Independent of arm movements, postural threat evoked an increase in fear of. falling and conscious balance processing, and reductions in balance confidence and. perceived stability. These threat-related changes in emotional state were further. amplified when arm movements were restricted. Whilst significant increases in sway. frequency during threat were observed in both arm conditions, reductions in sway. amplitude were only observed during the restricted arm movement condition. SIGNIFICANCE We propose that these responses likely reflect a fear-related cautious. strategy intended to reduce the postural destabilisation associated with individuals. being unable to use their arms to counter any destabilisation, as would normally be the. case in daily life.
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Affiliation(s)
- M W Hill
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom.
| | - K Russel
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom
| | - M Wdowski
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom
| | - S R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - T Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Essen, Germany
| | - T Ellmers
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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14
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From fear of falling to choking under pressure: A predictive processing perspective of disrupted motor control under anxiety. Neurosci Biobehav Rev 2023; 148:105115. [PMID: 36906243 DOI: 10.1016/j.neubiorev.2023.105115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
Under the Predictive Processing Framework, perception is guided by internal models that map the probabilistic relationship between sensory states and their causes. Predictive processing has contributed to a new understanding of both emotional states and motor control but is yet to be fully applied to their interaction during the breakdown of motor movements under heightened anxiety or threat. We bring together literature on anxiety and motor control to propose that predictive processing provides a unifying principle for understanding motor breakdowns as a disruption to the neuromodulatory control mechanisms that regulate the interactions of top-down predictions and bottom-up sensory signals. We illustrate this account using examples from disrupted balance and gait in populations who are anxious/fearful of falling, as well as 'choking' in elite sport. This approach can explain both rigid and inflexible movement strategies, as well as highly variable and imprecise action and conscious movement processing, and may also unite the apparently opposing self-focus and distraction approaches to choking. We generate predictions to guide future work and propose practical recommendations.
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15
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Jie LJ, Kal E, Ellmers TJ, Rosier J, Meijer K, Boonstra TW. The Effects of Conscious Movement Processing on the Neuromuscular Control of Posture. Neuroscience 2023; 509:63-73. [PMID: 36403689 DOI: 10.1016/j.neuroscience.2022.11.010] [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: 06/27/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
Maintaining balance is thought to primarily occur sub-consciously. Occasionally, however, individuals will direct conscious attention towards balance, e.g., in response to a threat to balance. Such conscious movement processing (CMP) increases the reliance on attentional resources and may disrupt balance performance. However, the underlying changes in neuromuscular control remain poorly understood. We investigated the effects of CMP (manipulated using verbal instructions) on neural control of posture in twenty-five adults (11 females, mean age = 23.9, range = 18-33). Participants performed 90-s, bipedal stance balance trials in high- and low-CMP conditions, during both stable (solid surface) and unstable (foam) task conditions. Postural sway amplitude, frequency and complexity were used to assess postural control. Surface EMG was recorded bilaterally from lower leg muscles (Soleus, Tibialis Anterior, Gastrocnemius Medialis, Peroneus Longus) and intermuscular coherence (IMC) was assessed for 12 muscle pairs across four frequency bands. We observed significantly increased sway amplitude, and decreased sway frequency and complexity in the high- compared to the low-CMP conditions. All sway variables increased in the unstable compared to the stable conditions. We observed reduced beta band IMC between several muscle pairs during high- compared to low-CMP, but these findings did not remain significant after controlling for multiple comparisons. Finally, IMC significantly increased in the unstable conditions for most muscle combinations and frequency bands. In all, results tentatively suggest that CMP-induced changes in sway outcomes may be facilitated by reduced beta-band IMC, but these findings need to be replicated before they can be interpreted more conclusively.
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Affiliation(s)
- Li-Juan Jie
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, the Netherlands; Research Centre for Nutrition, Lifestyle and Exercise, Zuyd University of Applied Sciences, the Netherlands.
| | - Elmar Kal
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK
| | - Toby J Ellmers
- Centre for Vestibular Neurology, Imperial College London, UK
| | - Joëlle Rosier
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, the Netherlands
| | - Tjeerd W Boonstra
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
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16
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Russell K, Duncan M, Price M, Mosewich A, Ellmers T, Hill M. A comparison of placebo and nocebo effects on objective and subjective postural stability: a double-edged sword? Front Hum Neurosci 2022; 16:967722. [PMID: 36061498 PMCID: PMC9434487 DOI: 10.3389/fnhum.2022.967722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Positive expectations (i.e., placebo effect) can improve postural control during quiet standing. This raises an important question: if postural control is susceptible to positive expectations, is it possible to elicit the opposite, a decline in postural stability, simply by suggesting a performance impairment (i.e., nocebo) will take place? Yet no studies have examined the nocebo effect on balance performance. To better understand both phenomena, comparative studies, which include both placebo and nocebo conditions, are needed. Method: Forty-two healthy adults were initially assessed for objective (center of pressure movement) and subjective (perceived) postural stability and performance expectations. Participants were then randomly assigned in equal numbers to a placebo (positive expectation), nocebo (negative expectation) or control (no suggestion) group. Participants in the placebo/nocebo groups were deceptively administered an inert capsule described as a potent supplement which would either positively or negatively influence their balance performance. Objective and subjective postural stability, and performance expectations were reassessed 20 min later. Results: The nocebo procedure evoked an increase in COP sway movements and reduced perceived stability compared to a control group. The placebo group presented with reductions COP sway movements and increased perceived stability following expectation manipulation. Compared to the control group, the placebo group showed a significantly higher performance expectation whilst the nocebo group showed a significantly lower performance expectation. Regression analyses also revealed that performance expectations following the placebo/nocebo procedure significantly predicted perceptions of postural instability (i.e., perceived performance), accounting for around 50% of the variance. These results remained even when controlling for actual performance (i.e., objective postural stability). Conclusion: Our findings indicate that positive and negative performance expectations evoked by instructional manipulation can profoundly influence both objective and subjective postural stability. Postural control—and perceptions regarding such—are clearly susceptible to expectation manipulation, which could have important practical implications and repercussions on testing, training interventions and rehabilitation programs. Positive and negative expectancies are a double-edged sword for postural control.
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Affiliation(s)
- Katherine Russell
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Michael Duncan
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Michael Price
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Amber Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Toby Ellmers
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mathew Hill
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
- *Correspondence: Mathew Hill
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17
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Kal EC, Young WR, Ellmers TJ. Balance capacity influences the effects of conscious movement processing on postural control in older adults. Hum Mov Sci 2022; 82:102933. [DOI: 10.1016/j.humov.2022.102933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 11/25/2022]
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18
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Zaback M, Adkin AL, Chua R, Timothy Inglis J, Carpenter MG. Facilitation and habituation of cortical and subcortical control of standing balance following repeated exposure to a height-related postural threat. Neuroscience 2022; 487:8-25. [DOI: 10.1016/j.neuroscience.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 01/21/2023]
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19
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Amiaz R, Kimel Naor S, Caspi A, Czerniak E, Noy S, Pelc T, Mintz M, Plotnik M. Responses to balance challenges in persons with panic disorder: A pilot study of computerized static and dynamic balance measurements. Brain Behav 2022; 12:e2411. [PMID: 34843172 PMCID: PMC8785611 DOI: 10.1002/brb3.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/22/2021] [Accepted: 09/05/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Several studies have shown an association between panic disorder (PD) and reduced balance abilities, mainly based on functional balance scales. This pilot study aims to demonstrate the feasibility of studying balance abilities of persons with PD (PwPD) using computerized static and, for the first time, dynamic balance measurements in order to characterize balance control strategies employed by PwPD. METHODS Twelve PwPD and 11 healthy controls were recruited. PD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the severity of symptoms was evaluated using the Hamilton Anxiety Scale (HAM-A), PD Severity Scales (PDSS), and Panic and Agoraphobia Scale (PAS). Balance was clinically assessed using the Activities-Specific Balance Confidence (ABC) scale and physically by the Mini-Balance Evaluation Systems Test (Mini-BESTest). Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) scale. Postural control was evaluated statically by measuring body sway and dynamically by measuring body responses to rapid unexpected physical perturbations. RESULTS PwPD had higher scores on the HAM-A (17.6 ± 10.3 vs. 3.0 ± 2.9; p < .001), PDSS (11.3 ± 5.1 vs. 0; p < .001), and PAS (20.3 ± 8.7 vs. 0; p < .001) questionnaires and lower scores on the balance scales compared to the controls (ABC scale: 156.2 ± 5.9 vs. 160 ± 0.0, p = .016; Mini-BESTest: 29.4 ± 2.1 vs. 31.4 ± 0.9, p = .014; DHI: 5.3 ± 4.4 vs. 0.09 ± 0.3, p < .001). In the static balance tests, PwPD showed a not-significantly smaller ellipse area of center of pressure trajectory (p = .36) and higher body sway velocity (p = .46), whereas in the dynamic balance tests, PwPD had shorter recovery time from physical perturbations in comparison to controls (2.1 ± 1.2s vs. 1.6 ± 0.9 s, p = .018). CONCLUSION The computerized balance tests results point to an adoption of a ''postural rigidity'' strategy by the PwPD, that is, reduced dynamic adaptations in the face of postural challenges. This may reflect a nonsecure compensatory behavior. Further research is needed to delineate this strategy.
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Affiliation(s)
- Revital Amiaz
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Kimel Naor
- The Center of Advanced Technologies in Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Caspi
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Czerniak
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Noy
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Pelc
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Matti Mintz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Meir Plotnik
- The Center of Advanced Technologies in Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Danneels M, Hecke RV, Leyssens L, Cambier D, van de Berg R, Van de Velde L, Rompaey VV, Maes L. 2BALANCE: Test-retest reliability of a cognitive-motor dual-task protocol. J Vestib Res 2021; 32:341-353. [PMID: 34974447 DOI: 10.3233/ves-210069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Aside from typical symptoms such as dizziness and vertigo, persons with vestibular disorders often have cognitive and motor problems. These symptoms have been assessed in single-task condition. However, dual-tasks assessing cognitive-motor interference might be an added value as they reflect daily life situations better. Therefore, the 2BALANCE protocol was developed. In the current study, the test-retest reliability of this protocol was assessed. METHODS The 2BALANCE protocol was performed twice in 20 healthy young adults with an in-between test interval of two weeks. Two motor tasks and five different cognitive tasks were performed in single and dual-task condition. Intraclass correlation coefficients (ICC), the standard error of measurement, and the minimal detectable difference were calculated. RESULTS All cognitive tasks, with the exception of the mental rotation task, had favorable reliability results (0.26≤ICC≤0.91). The dynamic motor task indicated overall substantial reliability values in all conditions (0.67≤ICC≤0.98). Similar results were found for the static motor task during dual-tasking (0.50≤ICC≤0.92), but were slightly lower in single-task condition (-0.26≤ICC≤0.75). CONCLUSIONS The 2BALANCE protocol was overall consistent across trials. However, the mental rotation task showed lowest reliability values.
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Affiliation(s)
- Maya Danneels
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| | - Ruth Van Hecke
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| | - Laura Leyssens
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| | - Dirk Cambier
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| | - Raymond van de Berg
- Maastricht University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | | | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Maes
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.,Ghent University Hospital, Department of Otorhinolaryngology, Ghent, Belgium
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21
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Postural Control in Older Adults During and Following a 12-Week Balance Training Intervention With Attentional Focus Instructions. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2021. [DOI: 10.1123/jmld.2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Adults (N = 54, 80.78 ± 6.08 years) who reported falling during the previous 12 months participated in a 12-week wobble board training program with internal focus or external focus (EF) instructions. Verbal manipulation checks were performed after training sessions as a self-report of the attentional foci used. The percentage of sessions in which participants reported using an EF (EFSR) was subsequently calculated. Mean velocity and mean power frequency in the anterior–posterior (MVELOAP and MPFAP) and medial–lateral (MVELOML and MPFML) direction were assessed during a 35-s wobble board task at Weeks 0, 6, 12, 13, 16, and 20, with the latter three as retention tests. Piecewise linear growth models estimated treatment effects on individual growth trajectories of MVELOAP and ML and MPFAP and ML during intervention and retention periods. Regardless of condition, MVELOML significantly decreased (π = −.0019, p = .005) and MPFML increased (π = .025, p < .02) during the intervention period. In analyses including interaction terms, participants in the EF group who reported greater EFSR had superior progression of MPFAP during the intervention (π = .0013, p = .025). Verbal manipulation checks suggest a preference for and advantage of EF for facilitating postural control performance and automaticity.
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22
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Ellmers TJ, Wilson MR, Kal EC, Young WR. Standing up to threats: Translating the two-system model of fear to balance control in older adults. Exp Gerontol 2021; 158:111647. [PMID: 34861355 DOI: 10.1016/j.exger.2021.111647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/27/2021] [Accepted: 11/28/2021] [Indexed: 11/04/2022]
Abstract
The 'two-system' view of fear builds on traditional conceptualisations of emotion; proposing that the mechanisms responsible for behavioural and physiological responses to threat may be distinct from those underpinning the (conscious) emotional experience itself. We empirically tested this notion within a novel, applied context of social and economic importance: fear of falling in older adults. Older adults stood on the edge of a raised platform and were stratified based on whether they reported fear in response to this postural threat. Irrespective of whether participants reported fear, we observed behaviours indicative of postural 'stiffening' during the threat condition. Self-reports indicated that participants cognitively monitored these changes in balance, and fear of falling was experienced in those who interpreted these behaviours to imply that harm was likely to occur. Fearful participants exhibited additional changes in balance (increased movement complexity and altered utilisation of sensory feedback) - behaviours likely influenced by attempts to consciously control balance. Taken together, these findings provide novel insight into the systems that regulate behavioural and emotional responses to postural threats. The novel conceptual framework developed from these findings helps identify specific mechanisms that might be targeted through clinical intervention.
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Affiliation(s)
- Toby J Ellmers
- Neuro-Otology Unit, Department of Brain Sciences, Imperial College London, UK; School of Sport and Health Sciences, University of Exeter, UK; Centre for Cognitive Neuroscience, Brunel University London, UK.
| | - Mark R Wilson
- School of Sport and Health Sciences, University of Exeter, UK.
| | - Elmar C Kal
- Centre for Cognitive Neuroscience, Brunel University London, UK.
| | - William R Young
- School of Sport and Health Sciences, University of Exeter, UK; Centre for Cognitive Neuroscience, Brunel University London, UK.
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23
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Aharoni MMH, Lubetzky AV, Arie L, Krasovsky T. Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test. J Neuroeng Rehabil 2021; 18:55. [PMID: 33766072 PMCID: PMC7993529 DOI: 10.1186/s12984-021-00852-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and high perceived disability were associated with reduced AP-ROM (|r| = 0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.
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Affiliation(s)
- Moshe M H Aharoni
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Liraz Arie
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Tal Krasovsky
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. .,Pediatric Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel.
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