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Si B, Zhu H, Wei X, Li S, Wu X. The mechanism of static postural control in the impact of lower limb muscle strength asymmetry on gait performance in the elderly. PeerJ 2024; 12:e17626. [PMID: 38948226 PMCID: PMC11214735 DOI: 10.7717/peerj.17626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/02/2024] [Indexed: 07/02/2024] Open
Abstract
Background Abnormal gait is prevalent among the elderly population, leading to reduced physical activity, increased risk of falls, and the potential development of dementia and disabilities, thus degrading the quality of life in later years. Numerous studies have highlighted the crucial roles of lower limb muscle strength asymmetry and static postural control in gait, and the reciprocal influence of lower limb muscle strength asymmetry on static postural control. However, research exploring the interrelationship between lower limb muscle strength asymmetry, static postural control, and gait performance has been limited. Methods A total of 55 elderly participants aged 60 to 75 years were recruited. Isokinetic muscle strength testing was used to assess bilateral knee extension strength, and asymmetry values were calculated. Participants with asymmetry greater than 15% were categorized as the Asymmetry Group (AG), while those with asymmetry less than 15% were classified in the Symmetry Group (SG). Gait parameters were measured using a plantar pressure gait analysis system to evaluate gait performance, and static postural control was assessed through comfortable and narrow stance tests. Results First, participants in the AG demonstrated inferior gait performance, characterized by slower gait speed, longer stance time and percentage of stance time in gait, and smaller swing time and percentage of swing time in gait. Spatial-temporal gait parameters of the weaker limb tended to be abnormal. Second, static postural control indices were higher in AG compared to SG in all aspects except for the area of ellipse during the comfortable stance with eyes open test. Third, abnormal gait parameters were associated with static postural control. Conclusion Firstly, elderly individuals with lower limb muscle strength asymmetry are prone to abnormal gait, with the weaker limb exhibiting poorer gait performance. Secondly, lower limb muscle strength asymmetry contributes to diminished static postural control in the elderly. Thirdly, the mechanism underlying abnormal gait in the elderly due to lower limb muscle strength asymmetry may be linked to a decline in static postural control.
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Affiliation(s)
- Beili Si
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Hao Zhu
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xinmei Wei
- School of Economics and Management, Shanghai University of Sport, Shanghai, China
| | - Shun Li
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Xueping Wu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
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2
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Rosiak O, Puzio A, Kaminska D, Zwolinski G, Jozefowicz-Korczynska M. Virtual Reality-A Supplement to Posturography or a Novel Balance Assessment Tool? SENSORS (BASEL, SWITZERLAND) 2022; 22:s22207904. [PMID: 36298254 PMCID: PMC9608655 DOI: 10.3390/s22207904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 06/08/2023]
Abstract
Virtual reality (VR) is a well-established technology in medicine. Head-mounted displays (HMDs) have made VR more accessible in many branches of medical research. However, its application in balance evaluation has been vague, and comprehensive literature on possible applications of VR in posture measurement is scarce. The aim of this review is to conduct a literature search on the application of immersive VR delivered using a head-mounted display in posturographic measurements. A systematic search of two databases, PubMed and Scopus, using the keywords "virtual reality" and "posturography," was performed following PRISMA guidelines for systematic reviews. Initial search results returned 89 non-duplicate records. Two reviewers independently screened the abstracts. Sixteen papers fulfilled the inclusion criteria and none of the exclusion criteria and were selected for complete text retrieval. An additional 16 records were identified from citation searching. Ultimately, 21 studies were included in this review. virtual reality is often used as additional visual stimuli in static and dynamic posturography evaluation. Only one study has attempted to evaluate a VR environment in a head-mounted display as an independent method in the assessment of posture. Further research should be conducted to assess HMD VR as a standalone posturography replacement.
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Affiliation(s)
- Oskar Rosiak
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, 90-153 Lodz, Poland
| | - Anna Puzio
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, 90-153 Lodz, Poland
| | - Dorota Kaminska
- Institute of Mechatronics and Information Systems, Lodz University of Technology, 90-924 Lodz, Poland
| | - Grzegorz Zwolinski
- Institute of Mechatronics and Information Systems, Lodz University of Technology, 90-924 Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, 90-153 Lodz, Poland
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Kwak C, Han W, Bahng J. Systematic Review and Meta-Analysis of the Application of Virtual Reality in Hearing Disorders. J Audiol Otol 2022; 26:169-181. [PMID: 36285466 PMCID: PMC9597270 DOI: 10.7874/jao.2022.00234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Objectives Trendy technologies, such as artificial intelligence, virtual reality (VR), and augmented reality (AR) are being increasingly used for hearing loss, tinnitus, and vestibular disease. Thus, we conducted this systematic review and meta-analysis to identify the possible benefits of the use of VR and AR technologies in patients with hearing loss, tinnitus, and/or vestibular dysfunction, with the aim of suggesting potential applications of these technologies for both researchers and clinicians. Materials and Methods Published articles from 1968 to 2022 were gathered from six electronic journal databases. Applying our specified inclusion and/or exclusion criteria, 23 studies were analyzed. As only one article on hearing loss and two articles on tinnitus were found, 20 studies on vestibular dysfunction were only finally included for the meta-analysis. Standardized mean differences (SMDs) were chosen as estimates to compare the studies. A funnel plot and Egger’s regression analysis were used to identify any risk of bias. Results High heterogeneity (I2: 83%, τ2: 0.5431, p<0.01) was identified across the studies on vestibular dysfunction. VR-based rehabilitation was significantly effective for individuals with vestibular disease (SMDs: 0.03, 95% confidence interval [CI]: -0.08 to 0.15, p<0.05). A subgroup analysis revealed that only improvement in the subjective questionnaire was meaningful and statistically significant (SMDs: -0.66, 95% CI: -1.10 to -0.22). Conclusions VR-based vestibular rehabilitation showed potential for subjective rating measures like Dizziness Handicap Index. The negative effect of aging on vestibular disease was indirectly confirmed. More clinical trials and an evidence-based approach are needed to confirm the implementation of state-of-the-art technology for hearing loss and tinnitus, representative diseases in neurotology.
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Affiliation(s)
- Chanbeom Kwak
- Division of Speech Pathology and Audiology, College of Natural Sciences, Hallym University, Chuncheon, Korea,Laboratory of Hearing and Technology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Woojae Han
- Division of Speech Pathology and Audiology, College of Natural Sciences, Hallym University, Chuncheon, Korea,Laboratory of Hearing and Technology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Junghwa Bahng
- Department of Audiology and Speech Language Pathology, Hallym University of Graduate Studies, Seoul, Korea,Center for Hearing and Speech Research, Hallym University of Graduate Studies, Seoul, Korea,Address for correspondence Junghwa Bahng, PhD Department of Audiology and Speech Language Pathology, Hallym University of Graduate Studies, 427 Yeoksam-ro, Gangnam-gu, Seoul 06197, Korea Tel +82-2-3453-6618 Fax +82-70-8638-6833 E-mail
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Lee J, Yu J, Hong J, Lee D, Kim J, Kim S. The Effect of Augmented Reality-Based Proprioceptive Training Program on Balance, Positioning Sensation and Flexibility in Healthy Young Adults: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10071202. [PMID: 35885731 PMCID: PMC9317612 DOI: 10.3390/healthcare10071202] [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: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigates whether Augmented Reality (AR)-based interventions can be as effective as physical therapists (PT) regarding balance, positioning sensation, and flexibility. A sample of 39 regular people who voluntarily participated in this study were randomly distributed into two groups. Then AR was applied in the experimental group and PT was applied in the control group. Variables were measured by Tetrax (static balance), Y-balance test (dynamic balance), CSMI (proprioception), and sit and reach test (flexibility). All measurements were analyzed using paired t-test and independent t-test. The exercise program of this study improved the stability index (ST) of the static balance in both groups after the intervention, and there was a significant difference (p < 0.05) at normal eye close (NC) and Pillow with eye close (PC) positions. Moreover, regarding the case of dynamic balance, there were significant differences in AR and PT groups to reach in all directions (p < 0.05). In the case of positioning sensation, there was no significant difference in both groups (p > 0.05), and there was a significant difference in flexibility (p < 0.05). When comparing the two groups, there was no significant difference in all categories (p > 0.05). As a result, AR can be considered an effective form of therapy and can be selected according to individual conditions.
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Affiliation(s)
- Jaewon Lee
- Correspondence: ; Tel.: +82-10-7390-4699
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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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Grove CR, Whitney SL, Hetzel SJ, Heiderscheit BC, Pyle GM. Validation of a next-generation sensory organization test in adults with and without vestibular dysfunction. J Vestib Res 2021; 31:33-45. [PMID: 33325418 DOI: 10.3233/ves-200040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The traditional Sensory Organization Test (T-SOT) is a gold standard balance test; however, the psychometric properties of assessing sensory organization with a virtual-reality-based posturography device have not been established. OBJECTIVE Our overall aims were to assess the criterion, concurrent, and convergent validity of a next-generation Sensory Organization Test (NG-SOT). METHODS Thirty-four adults (17 vestibular-impaired) participated. We compared the area under the curve (AUC) for receiver operator characteristic (ROC) analysis for the T-SOT and NG-SOT composite scores. Between-group and between-test differences for the composite and sensory analysis scores from each SOT were assessed using Wilcoxon Rank Sum tests. Additionally, we ran Spearman correlations between the NG-SOT composite score and outcomes of interest. RESULTS The AUCs for the NG-SOT and T-SOT were 0.950 (0.883, 1) and 0.990 (0.969, 1) respectively (p = 0.168). The median composite, vision, and visual preference scores were lower on the NG-SOT compared to the T-SOT; whereas, the median somatosensory score was higher on the NG-SOT compared to the T-SOT. Associations between the composite score and patient-reported or performance-based outcomes ranged from poor to strong. CONCLUSIONS The NG-SOT is a valid measure of balance in adults. However, the results of the NG-SOT and T-SOT should not be used interchangeably.
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Affiliation(s)
| | | | | | | | - G Mark Pyle
- University of Wisconsin-Madison, Madison, WI, USA
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Matsugi A, Oku K, Mori N. The Effects of Stochastic Galvanic Vestibular Stimulation on Body Sway and Muscle Activity. Front Hum Neurosci 2020; 14:591671. [PMID: 33381017 PMCID: PMC7767904 DOI: 10.3389/fnhum.2020.591671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022] Open
Abstract
Objective: This study aimed to investigate whether galvanic vestibular stimulation with stochastic noise (nGVS) modulates the body sway and muscle activity of the lower limbs, depending on visual and somatosensory information from the foot using rubber-foam. Methods: Seventeen healthy young adults participated in the study. Each subject maintained an upright standing position on a force plate with/without rubber-foam, with their eyes open/closed, to measure the position of their foot center of pressure. Thirty minutes after baseline measurements under four possible conditions (eyes open/closed with/without rubber-foam) performed without nGVS (intensity: 1 mA, duration: 40 s), the stimulation trials (sham-nGVS/real-nGVS) were conducted under the same conditions in random order, which were then repeated a week or more later. The total center of pressure (COP) path length movement (COP-TL) and COP movement velocity in the mediolateral (Vel-ML) and anteroposterior (Vel-AP) directions were recorded for 30 s during nGVS. Furthermore, electromyography activity of the right tibial anterior muscle and soleus muscle was recorded for the same time and analyzed. Results: Three-way analysis of variance and post-hoc multiple comparison revealed a significant increment in COP-related parameters by nGVS, and a significant increment in soleus muscle activity on rubber. There was no significant effect of eye condition on any parameter. Conclusions: During nGVS (1 mA), body sway and muscle activity in the lower limb may be increased depending not on the visual condition, but on the foot somatosensory condition.
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Affiliation(s)
- Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Daitou, Japan
| | - Kosuke Oku
- Department of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Nobuhiko Mori
- Department of Neuromodulation and Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
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8
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Nooristani M, Bigras C, Lafontaine L, Bacon BA, Maheu M, Champoux F. Vestibular function modulates the impact of nGVS on postural control in older adults. J Neurophysiol 2020; 125:489-495. [PMID: 33296620 DOI: 10.1152/jn.00512.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Previous studies have reported an important relationship between increasing age, vestibular impairment, and increased risk of falls. Recently, noisy galvanic vestibular stimulation (nGVS) has been shown to improve postural control in older adults during and potentially following stimulation. However, this effect of nGVS in older adults has not been examined in interaction with the integrity of the vestibular function. We aimed at determining the effect of nGVS on postural control in older adults with and without vestibular impairment and examining the sustained effect of nGVS as compared with a sham stimulation. Thirty-six older adults were assigned to the nGVS group (n = 24) or the sham group (n = 12). In the nGVS group, 12 participants had normal vestibular function and 12 had vestibular impairment. Static postural control was assessed prior to stimulation, during stimulation, and immediately following 30 min of nGVS. Results showed that nGVS induced a significant improvement in sway velocity (P < 0.001) and path length (P < 0.001) compared with sham stimulation. Furthermore, nGVS induced a significantly greater improvement of sway velocity (P < 0.05) and path length (P < 0.05) in older adults with vestibular impairment compared with older adults with normal vestibular function. Improvements in sway velocity (P < 0.001) and path length (P < 0.001) induced by nGVS were sustained immediately following stimulation. These findings suggest that nGVS improves postural control in older adults, and that the effect of nGVS varies depending on the integrity of the vestibular function. Results also show that nGVS effect on postural control, compared with a sham stimulation, can be sustained after the end of stimulation.NEW & NOTEWORTHY The present study is the first study to investigate the impact of vestibular function on the improvement of postural control induced by nGVS in older adults and to compare the improvement of postural control of older adults with and without vestibular impairment. Our results also suggest that nGVS is beneficial for all older adults, and even more for those with a vestibular impairment. Therefore, it could be an approach to reduce falls.
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Affiliation(s)
- Mujda Nooristani
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Québec, Canada.,Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Charlotte Bigras
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Québec, Canada
| | - Louise Lafontaine
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Québec, Canada.,Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | | | - Maxime Maheu
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Québec, Canada
| | - François Champoux
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Québec, Canada.,Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
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Cohen HS. A review on screening tests for vestibular disorders. J Neurophysiol 2019; 122:81-92. [PMID: 30995137 PMCID: PMC6689777 DOI: 10.1152/jn.00819.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/08/2023] Open
Abstract
Although many studies have reported on tests of the vestibular system a valid and reliable, evidence-based screening battery for easy clinical use remains elusive. Many screening tests attempt to assess the vestibulo-ocular reflex. Therefore, head shaking, the Dix-Hallpike maneuver, the supine roll test, and head impulse tests are discussed. Other tests address the spatial orientation functions of the vestibular system, such as the Bucket Test and the Fukuda Stepping test. Still, other tests are based on the known correlates with balance skills, both static and dynamic, such as tandem walking and the modern variation of the Romberg test, the modified Clinical Test of Sensory Interaction and Balance. This review provides a critical overview of the literature on some of these tests and their value for clinical use and in epidemiological studies.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine , Houston, Texas
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10
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Gazzola JM, Caovilla HH, Doná F, Ganança MM, Ganança FF. A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality. Braz J Otorhinolaryngol 2019; 86:593-601. [PMID: 31175041 PMCID: PMC9422685 DOI: 10.1016/j.bjorl.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Postural instability is one the most common disabling features in vestibular disorders. Objective This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual–vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls. Methods Cross-sectional study. Participants – 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual–vestibular interaction. Results Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual–vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual–vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1. Conclusion Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual–vestibular interaction. Deterioration in postural control was significantly associated with history of falls.
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Affiliation(s)
- Juliana Maria Gazzola
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal, RN, Brazil
| | - Heloísa Helena Caovilla
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Flávia Doná
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Maurício Malavasi Ganança
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fernando Freitas Ganança
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
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Comparison of Walking, Muscle Strength, Balance, and Fear of Falling Between Repeated Fall Group, One-time Fall Group, and Nonfall Group of the Elderly Receiving Home Care Service. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11:290-296. [PMID: 29290277 DOI: 10.1016/j.anr.2017.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to provide information to develop a program to prevent repeated falls by analyzing the difference in gait, muscle strength, balance, and fear of falling according to their fall experience. METHODS The study subjects were 110 elderly individuals aged over 60 years who agreed to their participation in this research. The study participants were categorized into a repeated fall group (n = 40), a one-time fall group (n = 15), and a nonfall group (n = 46) of the elderly. Measurements of gait, muscle strength, balance, and fear of falling were taken in each group. RESULTS With regard to gait, there were significant differences among three groups in gait cycle (F = 3.50, p = .034), speed (F = 13.06, p < .001), and cadence (F = 5.59, p = .005). Regarding muscle strength in the upper and lower limbs, statistically significant differences were shown among three groups in muscle strength of upper (F = 16.98, p < .001) and lower (F = 10.55, p < .001) limbs. With regard to balance, the nonfall group had significantly greater results than the one-time fall group and repeated fall group in dynamic balance (F = 10.80, p < .001) and static balance (F = 8.20, p = .001). In the case of the fear of falling, the repeated fall group had significantly higher score than other two groups (F = 20.62, p < .001). CONCLUSION This study suggests that intervention program should be tailored to fall risk factors to enhance gait and balance and lower body muscle strength and reduce the fear of falling to prevent repeated incidences of falls in this population.
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Ribeiro KMOBD, Freitas RVDM, Ferreira LMDBM, Deshpande N, Guerra RO. Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial. Disabil Rehabil 2016; 39:1198-1206. [DOI: 10.1080/09638288.2016.1190870] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Karyna Myrelly Oliveira Bezerra de Ribeiro
- Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Nandini Deshpande
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Ricardo Oliveira Guerra
- Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Post-Graduation Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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Chang CJ, Yang TF, Yang SW, Chern JS. Cortical Modulation of Motor Control Biofeedback among the Elderly with High Fall Risk during a Posture Perturbation Task with Augmented Reality. Front Aging Neurosci 2016; 8:80. [PMID: 27199732 PMCID: PMC4848299 DOI: 10.3389/fnagi.2016.00080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/29/2016] [Indexed: 12/29/2022] Open
Abstract
The cerebral cortex provides sensorimotor integration and coordination during motor control of daily functional activities. Power spectrum density based on electroencephalography (EEG) has been employed as an approach that allows an investigation of the spatial–temporal characteristics of neuromuscular modulation; however, the biofeedback mechanism associated with cortical activation during motor control remains unclear among elderly individuals. Thirty one community-dwelling elderly participants were divided into low fall-risk potential (LF) and high fall-risk potential (HF) groups based upon the results obtained from a receiver operating characteristic analysis of the ellipse area of the center of pressure. Electroencephalography (EEG) was performed while the participants stood on a 6-degree-of-freedom Stewart platform, which generated continuous perturbations and done either with or without the virtual reality scene. The present study showed that when there was visual stimulation and poor somatosensory coordination, a higher level of cortical response was activated in order to keep postural balance. The elderly participants in the LF group demonstrated a significant and strong correlation between postural-related cortical regions; however, the elderly individuals in the HF group did not show such a relationship. Moreover, we were able to clarify the roles of various brainwave bands functioning in motor control. Specifically, the gamma and beta bands in the parietal–occipital region facilitate the high-level cortical modulation and sensorimotor integration, whereas the theta band in the frontal–central region is responsible for mediating error detection during perceptual motor tasks. Finally, the alpha band is associated with processing visual challenges in the occipital lobe.With a variety of motor control demands, increment in brainwave band coordination is required to maintain postural stability. These investigations shed light on the cortical modulation of motor control among elderly participants with varying fall-risk potentials. The results suggest that, although elderly adults may be without neurological deficits, inefficient central modulation during challenging postural conditions could be an internal factor that contributes to the risk of fall. Furthermore, training that helps to improve coordinated sensorimotor integration may be a useful approach to reduce the risk of fall among elderly populations or when patients suffer from neurological deficits.
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Affiliation(s)
- Chun-Ju Chang
- Department of Biomedical Engineering, National Yang-Ming University Taipei, Taiwan
| | - Tsui-Fen Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General HospitalTaipei, Taiwan; Department of Physical Therapy and Assistive Technology, National Yang-Ming UniversityTaipei, Taiwan
| | - Sai-Wei Yang
- Department of Biomedical Engineering, National Yang-Ming University Taipei, Taiwan
| | - Jen-Suh Chern
- Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University Taipei, Taiwan
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