Aging and the complexity of center of pressure in static and dynamic postural tasks

Age-Related Topological Organization of Phase-Amplitude Coupling Between Postural Fluctuations and Scalp EEG During Unsteady Stance

Through phase-amplitude analysis, this study investigated how low-frequency postural fluctuations interact with high-frequency scalp electroencephalography (EEG) amplitudes, shedding light on age-related mechanic differences in balance control during uneven surface navigation. Twenty young ( 24.1 ± 1.9 years) and twenty older adults ( 66.2 ± 2.7 years) stood on a training stabilometer with visual guidance, while their scalp EEG and stabilometer plate movements were monitored. In addition to analyzing the dynamics of the postural fluctuation phase, phase-amplitude coupling (PAC) for postural fluctuations below 2 Hz and within EEG sub-bands (theta: 4-7 Hz, alpha: 8-12 Hz, beta: 13-35 Hz) was calculated. The results indicated that older adults exhibited significantly larger postural fluctuation amplitudes(p <0.001) and lower mean frequencies of the postural fluctuation phase ( p = 0.005 ) than young adults. The PAC between postural fluctuation and theta EEG (FCz and bilateral temporal-parietal-occipital area), as well as that between postural fluctuation and alpha EEG oscillation, was lower in older adults than in young adults (p <0.05). In contrast, the PAC between the phase of postural fluctuation and beta EEG oscillation, particularly in C3 ( p=0.006 ), was higher in older adults than in young adults. In summary, the postural fluctuation phase and phase-amplitude coupling between postural fluctuation and EEG are sensitive indicators of the age-related decline in postural adjustments, reflecting less flexible motor state transitions and adaptive changes in error monitoring and visuospatial attention.

Cross-frequency modulation of postural fluctuations and scalp EEG in older adults: error amplification feedback for rapid balance adjustments

Virtual error amplification (VEA) in visual feedback enhances attentive control over postural stability, although the neural mechanisms are still debated. This study investigated the distinct cortical control of unsteady stance in older adults using VEA through cross-frequency modulation of postural fluctuations and scalp EEG. Thirty-seven community-dwelling older adults (68.1 ± 3.6 years) maintained an upright stance on a stabilometer while receiving either VEA or real error feedback. Along with postural fluctuation dynamics, phase-amplitude coupling (PAC) and amplitude-amplitude coupling (AAC) were analyzed for postural fluctuations under 2 Hz and EEG sub-bands (theta, alpha, and beta). The results revealed a higher mean frequency of the postural fluctuation phase (p = .005) and a greater root mean square of the postural fluctuation amplitude (p = .003) with VEA compared to the control condition. VEA also reduced PAC between the postural fluctuation phase and beta-band EEG in the left frontal (p = .009), sensorimotor (p = .002), and occipital (p = .018) areas. Conversely, VEA increased the AAC of posture fluctuation amplitude and beta-band EEG in FP2 (p = .027). Neither theta nor alpha band PAC or AAC were affected by VEA. VEA optimizes postural strategies in older adults during stabilometer stance by enhancing visuospatial attentive control of postural responses and facilitating the transition of motor states against postural perturbations through a disinhibitory process. Incorporating VEA into virtual reality technology is advocated as a valuable strategy for optimizing therapeutic interventions in postural therapy, particularly to mitigate the risk of falls among older adults.

The Effects of Hand Tremors on the Shooting Performance of Air Pistol Shooters with Different Skill Levels

Physiologic hand tremors are a critical factor affecting the aim of air pistol shooters. However, the extent of the effect of hand tremors on shooting performance is unclear. In this study, we aim to explore the relationship between hand tremors and shooting performance scores as well as investigate potential links between muscle activation and hand tremors. In this study, 17 male air pistol shooters from China's national team and the Air Pistol Sports Center were divided into two groups: the elite group and the sub-elite group. Each participant completed 40 shots during the experiment, with shooters' hand tremors recorded using three-axis digital accelerometers affixed to their right hands. Muscle activation was recorded using surface electromyography on the right anterior deltoid, posterior deltoid, biceps brachii (short head), triceps brachii (long head), flexor carpi radialis, and extensor carpi radialis. Our analysis revealed weak correlations between shooting scores and hand tremor amplitude in multiple directions (middle-lateral, ML: r2 = -0.22, p < 0.001; vertical, VT: r2 = -0.25, p < 0.001), as well as between shooting scores and hand tremor complexity (ML: r2 = -0.26, p < 0.001; VT: r2 = -0.28, p < 0.001), across all participants. Notably, weak correlations between shooting scores and hand tremor amplitude (ML: r2 = -0.27, p < 0.001; VT: r2 = -0.33, p < 0.001) and complexity (ML: r2 = -0.31, p < 0.001) were observed in the elite group but not in the sub-elite group. Moderate correlation were found between the biceps brachii (short head) RMS and hand tremor amplitude in the VT and ML directions (ML: r2 = 0.49, p = 0.010; VT: r2 = 0.44, p = 0.025) in all shooters, with a moderate correlation in the ML direction in elite shooters (ML: r2 = 0.49, p = 0.034). Our results suggest that hand tremors in air pistol shooters are associated with the skill of the shooters, and muscle activation of the biceps brachii (long head) might be a factor affecting hand tremors. By balancing the agonist and antagonist muscles of the shoulder joint, shooters might potentially reduce hand tremors and improve their shooting scores.

Spatial variability and directional shifts in postural control in Parkinson's disease

Individuals with Parkinson's disease exhibit tremors, rigidity, and bradykinesia, disrupting normal movement variability and resulting in postural instability. This comprehensive study aimed to investigate the link between the temporal structure of postural sway variability and Parkinsonism by analyzing multiple datasets from young and older adults, including individuals with Parkinson's disease, across various task conditions. We used the Oriented Fractal Scaling Component Analysis (OFSCA), which identifies minimal and maximal long-range correlations within the center of pressure time series, allowing for detecting directional changes in postural sway variability. The objective was to uncover the primary directions along which individuals exerted control during the posture. The results, as anticipated, revealed that healthy adults predominantly exerted control along two orthogonal directions, closely aligned with the anteroposterior (AP) and mediolateral (ML) axes. In stark contrast, older adults and individuals with Parkinson's disease exhibited control along suborthogonal directions that notably diverged from the AP and ML axes. While older adults and those with Parkinson's disease demonstrated a similar reduction in the angle between these two control directions compared to healthy older adults, their reliance on this suborthogonal angle concerning endogenous fractal correlations exhibited significant differences from the healthy aging cohort. Importantly, individuals with Parkinson's disease did not manifest the sensitivity to destabilizing task settings observed in their healthy counterparts, affirming the distinction between Parkinson's disease and healthy aging.

Concentrating to avoid falling: interaction between peripheral sensory and central attentional demands during a postural stability limit task in sedentary seniors

Evidence suggests falls and postural instabilities among seniors are attributed to a decline in both the processing of afferent signals (e.g., proprioceptive, vestibular) and attentional resources. We investigated the interaction between the non-visual and attentional demands of postural control in sedentary seniors. Old and young adults performed a postural stability limit task involving a maximal voluntary leaning movement with and without vision as well as a cognitive-attentional subtraction task. These tasks were performed alone (single-task) or simultaneously (dual-task) to vary the sensory-attentional demands. The functional limits of stability were quantified as the maximum center of pressure excursion during voluntary leaning. Seniors showed significantly smaller limits of postural stability compared to young adults in all sensory-attentional conditions. However, surprisingly, both groups of subjects reduced their stability limits by a similar amount when vision was removed. Furthermore, they similarly decreased their anterior-posterior stability limits when concurrently performing the postural and the cognitive-attentional tasks with vision. The overall average cognitive performance of young adults was higher than seniors and was only slightly affected during dual-tasking. In contrast, older adults markedly degraded their cognitive performance from the single- to the dual-task situations, especially when vision was unavailable. Thus, their dual-task costs were higher than those of young adults and increased in the eyes-closed condition, when postural control relied more heavily on non-visual sensory signals. Our findings provide the first evidence that as posture approaches its stability limits, sedentary seniors allot increasingly large cognitive attentional resources to process critical sensory inputs.

Integrating Motor Variability Evaluation Into Movement System Assessment

Common assessment tools for determining therapeutic success in rehabilitation typically focus on task-based outcomes. Task-based outcomes provide some understanding of the individual's functional ability and motor recovery; however, these clinical outcomes may have limited translation to a patient's functional ability in the real world. Limitations arise because (1) the focus on task-based outcome assessment often disregards the complexity of motor behavior, including motor variability, and (2) mobility in highly variable real-world environments requires movement adaptability that is made possible by motor variability. This Perspective argues that incorporating motor variability measures that reflect movement adaptability into routine clinical assessment would enable therapists to better evaluate progress toward optimal and safe real-world mobility. The challenges and opportunities associated with incorporating variability-based assessment of pathological movements are also discussed. This Perspective also indicates that the field of rehabilitation needs to leverage technology to advance the understanding of motor variability and its impact on an individual's ability to optimize movement.

IMPACT

This Perspective contends that traditional therapeutic assessments do not adequately evaluate the ability of individuals to adapt their movements to the challenges faced when negotiating the dynamic environments encountered during daily life. Assessment of motor variability derived during movement execution can address this issue and provide better insight into a patient's movement stability and maneuverability in the real world. Creating such a shift in motor system assessment would advance understanding of rehabilitative approaches to motor system recovery and intervention.

Different neuromuscular control mechanisms regulate static and dynamic balance: A center-of-pressure analysis in young adults

The analysis of the center of pressure (CoP) trajectory, derived from force platforms, is a widely accepted measure to investigate postural balance control. The CoP trajectory could be analyzed as a physiological time-series through a general stochastic modeling framework (i.e., Stabilogram Diffusion Analysis (SDA)). Critical point divides short-term from long-term regions and diffusion coefficients reflect the level of stochastic activity of the CoP. Sample Entropy (SampEn) allows quantifying the CoP complexity in terms of regularity. Thus, this study aimed to understand whether SDA and SampEn could discriminate the neuromuscular control mechanisms underpinning static and dynamic postural tasks. Static balance control and its relationship with dynamic balance control were investigated through the CoP velocity (Mean Velocity) and the area of the 95th percentile ellipse (Area95). Balance was assessed in 15 subjects (age: 23.13 ± 0.99 years; M = 9) over a force platform under two conditions: static (ST) and dynamic, both in anterior-posterior (DAP) and medio-lateral (DML) directions. During the DAP and DML, subjects stood on an unstable board positioned over a force platform. Short-term SDA diffusion coefficients and critical points were lower in ST than in DAP and DML (p < 0.05). SampEn values resulted greater in ST than in DAP and DML (p < 0.001). As expected, lower values of Area95 (p < 0.001) and Mean Velocity (p < 0.001) were detected in the easiest condition, the ST, compared to DAP and DML. No significant correlations between static and dynamic balance performances were detected. Moreover, differences in the diffusion coefficients were detected comparing DAP and DML (p < 0.05). In the anterior-posterior direction, the critical point occurred at relatively small intervals in DML compared to DAP (p < 0.001) and ST (p < 0.001). In the medio-lateral direction, the critical point differed only between DAP and DML (p < 0.05). Overall, SDA analysis pointed out a less tightly regulated neuromuscular control system in the dynamic tasks, with closed-loop corrective feedback mechanisms called into play at different time intervals in the three conditions. SampEn results reflected more attention and, thus, less automatic control mechanisms in the dynamic conditions, particularly in the medio-lateral task. The different neuromuscular control mechanisms that emerged in the static and dynamic balance tasks encourage using both static and dynamic tests for a more comprehensive balance performance assessment.

Postural Sway and Muscle Activity Dynamics of Upright Standing on Sloped Surfaces

During upright standing, individuals often use co-contraction muscle activity at the ankle joint when encountering increased postural difficulty; however, this strategy has been shown to be maladaptive. The purpose of the current investigation was to examine the effect of sloped standing on postural sway and muscle co-contraction at the ankle joint as a function of postural difficulty. Twelve young (21.67 ± 1.11 years) adults performed upright standing on flat, declined, and inclined support surfaces. Center of pressure displacements indexed postural sway while electromyography data were collected for the tibialis anterior and gastrocnemius medialis muscles. A co-contraction index and a nonlinear coupling metric (cross-approximate entropy) were computed between ankle dorsiflexor and plantar flexor muscles (tibialis anterior/gastrocnemius medialis) activity. The results showed that higher degrees of postural difficulty led to increased amounts of sway as well as increased sway regularity. Lower co-contraction index was observed for higher degrees of postural difficulty; however, increased dynamic coupling occurred with deviations from the flat standing condition. Overall, increased postural difficulty as manipulated by sloped standing (in either inclined or declined conditions) resulted in individuals adopting a more regular sway trajectory that may be due, in part, to a stronger dynamic coupling strategy occurring at the neuromuscular level.

Decreased Postural Complexity in Overweight to Obese Children and Adolescents: A Cross-Sectional Study

Introduction

Although a few studies suggest that young overweight to obese children and adolescents (YO) may have impaired postural control compared to young normal-weight (YN) peers, little information exists about how these two groups differ in the quality of the underlying balance strategies employed. Hence, the aim of the present study was a first comprehensive examination of the structural complexity of postural sways in these two cohorts during quiet bilateral standing.

Methods

Nineteen YO secondary school students (13.0 ± 1.4 years; male = 10, female = 9) were carefully matched to YN controls (13.0 ± 1.5 years) for age, sex, height, and school. Mediolateral (ML) and anteriorposterior (AP) acceleration signals were recorded with an inertial measurement unit (IMU) positioned at the trunk while standing barefoot in two conditions: firm and foam support surface. The magnitude of postural fluctuations was obtained using the root mean square (RMS). The temporal structure of the signals was analyzed via sample entropy (SEn), largest Lyapunov exponent (LyE), and detrended fluctuation analysis (α-DFA) algorithm. Reliability was assessed using a test–retest design.

Results

In both groups, foam standing caused higher postural fluctuations (higher RMS values) and reduced structural complexity (lower SEn values, higher LyE values, higher α-DFA values). In comparison to YN, YO exhibited a higher RMS_AP. Especially in ML direction, the acceleration signals of the YO had higher repeatability (smaller SEn values), greater long-range correlations (higher α-DFA values), and lower local stability (higher LyE values). However, these observations were largely independent of the task difficulty. Except for α-DFA_AP, the IMU approach proved reliable to characterize posture control.

Discussion

Our outcomes confirm postural control deficits in YO compared to their YN peers and indicate impaired regulatory mechanisms reflected as rigidity. Such less complex patterns usually reflect diverse pathologies, are detrimental to compensate for internal or external perturbations, and are attributed to lower adaptability and task performance. Without targeted balance stimuli, YO likely end in a lifelong vicious circle of mutually dependent poor balance regulation and low physical activity.

Discrimination capability of linear and nonlinear gait features in group classification

The variability of human movement can be defined as normal variations occurring in motor activity and quantified using linear statistics or nonlinear methods. In the human movement field, linear and nonlinear measures of variability have been used to discriminate groups and conditions in different contexts. Indeed, some authors support the idea that these gait features provide complementary information about movement. However, it is unclear which type of gait variability measure best discriminates different groups or conditions, as a comparison of the discrimination capacity between linear and nonlinear gait variability features in different groups has not been assessed. Therefore, the main objective of this study was to test the discrimination capacity of linear and nonlinear gait features to determine which type of feature would be the most efficient for discriminating older and younger adults and between lower limb amputees and nonamputees using classification algorithms. Data from previously published studies were used. The classification task was performed using the k-nearest neighbors and random forest algorithms. Our results showed that using a combination of linear and nonlinear features resulted in the highest mean accuracy rates (>90%) in group classification, reinforcing the idea that these features are complementary and express different aspects of movement.

Hypothetical control of postural sway

Quiet standing exhibits strongly intermittent variability that has inspired at least two interpretations. First, variability can be intermittent through the alternating engagement and disengagement of complementary control processes at distinct scales. A second and perhaps deeper way to interpret this intermittency is through the possibility that postural control depends on cascade-like interactions across many timescales at once, suggesting specific non-Gaussian distributional properties at different timescales. Multiscale probability density function (PDF) analysis shows that quiet standing on a stable surface exhibits a crossover from low, increasing non-Gaussianity (consistent with exponential distributions) at shorter timescales, reflecting inertial control, towards higher non-Gaussianity. Feedback-based control at medium to longer timescales yields a linear decrease that is characteristic of cascade dynamics. Destabilizing quiet standing with an unstable surface or closed eyes serves to attenuate inertial control and to elicit more of the feedback-based control over progressively shorter timescales. The result was to strengthen the appearance of the linear decay indicating cascade dynamics. Finally, both linear and nonlinear indices of postural sway also govern the relative strength of crossover or of linear decay, suggesting that tempering of non-Gaussianity across log-timescale is a function of both extrinsic constraints and endogenous postural control. These results provide new evidence that cascading interactions across longer timescales supporting postural corrections can even recruit shorter timescale processes with novel task constraints that can destabilize posture.

Multifractal roots of suprapostural dexterity

Visually guided postural control emerges in response to task constraints. Task constraints generate physiological fluctuations that foster the exploration of available sensory information at many scales. Temporally correlated fluctuations quantified using fractal and multifractal metrics have been shown to carry perceptual information across the body. The risk of temporally correlated fluctuations is that stable sway appears to depend on a healthy balance of standard deviation (SD): too much or too little SD entails destabilization of posture. This study presses on the visual guidance of posture by prompting participants to quietly stand and fixate at distances within, less than, and beyond comfortable viewing distance. Manipulations of the visual precision demands associated with fixating nearer and farther than comfortable viewing distance reveals an adaptive relationship between SD and temporal correlations in postural fluctuations. Changing the viewing distance of the fixation target shows that increases in temporal correlations and SD predict subsequent reductions in each other. These findings indicate that the balance of SD within stable bounds may depend on a tendency for temporal correlations to self-correct across time. Notably, these relationships became stronger with greater distance from the most comfortable viewing and reaching distance, suggesting that this self-correcting relationship allows the visual layout to press the postural system into a poise for engaging with objects and events. Incorporating multifractal analysis showed that all effects attributable to monofractal evidence were better attributed to multifractal evidence of nonlinear interactions across scales. These results offer a glimpse of how current nonlinear dynamical models of self-correction may play out in biological goal-oriented behavior. We interpret these findings as part of the growing evidence that multifractal nonlinearity is a modeling strategy that resonates strongly with ecological-psychological approaches to perception and action.

Visual effort moderates postural cascade dynamics

Standing still and focusing on a visible target in front of us is a preamble to many coordinated behaviors (e.g., reaching an object). Hiding behind its apparent simplicity is a deep layering of texture at many scales. The task of standing still laces together activities at multiple scales: from ensuring that a few photoreceptors on the retina cover the target in the visual field on an extremely fine scale to synergies spanning the limbs and joints at smaller scales to the mechanical layout of the ground underfoot and optic flow in the visual field on the coarser scales. Here, we used multiscale probability density function (PDF) analysis to show that postural fluctuations exhibit similar statistical signatures of cascade dynamics as found in fluid flow. In participants asked to stand quietly, the oculomotor strain of visually fixating at different distances moderated postural cascade dynamics. Visually fixating at a comfortable viewing distance elicited posture with a similar cascade dynamics as posture with eyes closed. Greater viewing distances known to stabilize posture showed more diminished cascade dynamics. In contrast, nearest and farthest viewing distances requiring greater oculomotor strain to focus on targets elicited a dramatic strengthening of postural cascade dynamics, reflecting active postural adjustments. Critically, these findings suggest that vision stabilizes posture by reconfiguring the prestressed poise that prepares the body to interact with different spatial layouts.

Postural constraints recruit shorter-timescale processes into the non-Gaussian cascade processes

Healthy human postural sway exhibits strong intermittency, reflecting a richly interactive foundation of postural control. From a linear perspective, intermittent fluctuations might be interpreted as engagement and disengagement of complementary control processes at distinct timescales or from a nonlinear perspective, as cascade-like interactions across many timescales at once. The diverse control processes entailed by cascade-like multiplicative dynamics suggest specific non-Gaussian distributional properties at different timescales. Multiscale probability density function (PDF) analysis showed that when standing quietly while balancing a sand-filled tube with the two arms elicited non-Gaussianity profiles showing a negative-quadratic crossover between short and long timescales. A more stringent task of balancing a water-filled tube elicited simpler monotonic decreases in non-Gaussianity, that is, a positive-quadratic cancellation of the negative-quadratic crossover. Multiple known indices of postural sway governed the appearance or disappearance of the crossover. Finally, both tasks elicited lognormal distributions over progressively larger timescales. These results provide the first evidence that more stringent postural constraints recruit shorter-timescale processes into the non-Gaussian cascade processes, that indices of postural sway moderate this recruitment, and that more stringent postural constraints show stronger statistical hallmarks of cascade structure.

The role of conscious processing of movements during balance by young and older adults

We examined the effect of verbalization of a phylogenetic motor skill, balance, in older and young adults with a low or a high propensity for conscious verbal engagement in their movements (reinvestment). Seventy-seven older adults and 53 young adults were categorized as high or low reinvestors, using the Movement Specific Reinvestment Scale, which assesses propensity for conscious processing of movements. Participants performed a pre- and post-test balance task that required quiet standing on a force-measuring plate. Prior to the post-test, participants described their pre-test balancing performance (verbalization) or listed animals (non-verbalization). Only young adults were affected by verbalization, with participants with a high propensity for reinvestment displaying increased medial-lateral entropy and participants with a low propensity for reinvestment displaying increased area of sway and medial-lateral sway variability following the intervention. The possible explanations for these results are discussed.

Analysis of center of mass acceleration and muscle activation in hemiplegic paralysis during quiet standing

Hemiplegic paralysis after stroke may augment postural instability and decrease the balance control ability for standing. The center of mass acceleration (COMacc) is considered to be an effective indicator of postural stability for standing balance control. However, it is less studied how the COMacc could be affected by the muscle activities on lower-limbs in post-stroke hemiplegic patients. This study aimed to examine the effects of hemiplegic paralysis in post-stroke individuals on the amplitude and structural variabilities of COMacc and surface electromyography (sEMG) signals during quiet standing. Eleven post-stroke hemiplegic patients and the same number of gender- and age-matched healthy volunteers participated in the experiment. The sEMG signals of tibialis anterior (TA) and lateral gastrocnemius (LG) muscles of the both limbs, and the COMacc in the anterior-posterior direction with and without visual feedback (VF vs. NVF) were recorded simultaneously during quiet standing. The sEMG and COMacc were analyzed using root mean square (RMS) or standard deviation (SD), and a modified detrended fluctuation analysis based on empirical mode decomposition (EMD-DFA). Results showed that the SD and the scale exponent α of EMD-DFA of the COMacc from the patients were significantly higher than the values from the controls under both VF (p < 0.01) and NVF (p < 0.001) conditions. The RMSs of TA and LG on the non-paretic limbs were significantly higher than those on paretic limbs (p < 0.05) for both the patients and controls (p < 0.05). The TA of both the paretic and non-paretic limbs of the patients showed augmented α values than the TA of the controls (p < 0.05). The α of the TA and LG of non-paretic limbs, and the α of COMacc were significantly increased after removing visual feedback in patients (p < 0.05). These results suggested an increased amplitude variability but decreased structural variability of COMacc, associated with asymmetric muscle contraction between the paretic and the non-paretic limbs in hemiplegic paralysis, revealing a deficiency in integration of sensorimotor information and a loss of flexibility of postural control due to stroke.

Complexity-Based Measures of Heart Rate Dynamics in Older Adults Following Long- and Short-Term Tai Chi Training: Cross-sectional and Randomized Trial Studies

Measures characterizing the complexity of heart rate (HR) dynamics have been informative in predicting age- and disease-related decline in cardiovascular health, but few studies have evaluated whether mind-body exercise can impact HR complexity. This study evaluated the effects of long-term Tai Chi (TC) practice on the complexity of HR dynamics using an observational comparison of TC experts and age- and gender-matched TC-naïve individuals. Shorter-term effects of TC were assessed by randomly assigning TC-naïve participants to either TC group to receive six months of TC training or to a waitlist control group. 23 TC experts (age = 63.3 ± 8.0 y; 24.6 ± 12.0 y TC experience) and 52 TC-naïve (age = 64.3 ± 7.7 y) were enrolled. In cross-sectional analyses, TC experts had a higher overall complexity index (CI, p = 0.004) and higher entropy at multiple individual time scales (p < 0.05); these findings persisted in models accounting for age, gender, body mass index (BMI), and physical activity levels. Longitudinal changes in complexity index did not differ significantly following random assignment to six months of TC vs. a waitlist control; however, within the TC group, complexity at select time scales showed statistically non-significant trends toward increases. Our study supports that longer-term TC mind-body training may be associated with increased complexity of HR dynamics.

An Ankle-Foot Prosthesis Emulator Capable of Modulating Center of Pressure

OBJECTIVE

Several powered ankle-foot prostheses have demonstrated moderate reductions in energy expenditure by restoring pushoff work in late stance or by assisting with balance. However, it is possible that center of pressure trajectory modulation could provide even further improvements in user performance. Here, we describe the design of a prosthesis emulator with two torque-controlled forefoot digits and a torque-controlled heel digit. Independent actuation of these three digits can modulate the origin and magnitude of the total ground reaction force vector.

METHODS

The emulator was designed to be compact and lightweight while exceeding the range of motion and torque requirements of the biological ankle during walking. We ran a series of tests to determine torque-measurement accuracy, closed-loop torque control bandwidth, torque-tracking error, and center of pressure control accuracy.

RESULTS

Each of the three digits demonstrated less than 2 Nm of RMS torque measurement error, a 90% rise time of 19 ms, and a bandwidth of 33 Hz. The untethered end-effector has a mass of 1.2 kg. During walking trials, the emulator demonstrated less than 2 Nm of RMS torque-tracking error and was able to maintain full digit ground contact for 56% of stance. In fixed, standing, and walking conditions, the emulator was able to control center of pressure along a prescribed pattern with RMS errors of about 10% the length of the pattern.

CONCLUSION

The proposed emulator system meets all design criteria and can effectively modulate center of pressure and ground reaction force magnitude.

SIGNIFICANCE

This emulator system will enable rapid development of controllers designed to enhance user balance and reduce user energy expenditure. Experiments conducted using this emulator could identify beneficial control behaviors that can be implemented on autonomous devices, thus improving mobility and quality of life of individuals with amputation.

Standing balance in preschoolers using nonlinear dynamics and sway density curve analysis

The aim of the present study was to investigate how age and sensory deprivation affect the temporal organization of CoP sway variability and the postural corrective commands during standing balance in typically developing preschoolers. A sample of 57 children aged 3-5 years participated in the study. Structural stabilometric descriptors of sample entropy (SEn), detrended fluctuation analysis (DFA), and sway density curve (SDC) analysis were employed to assess features of center of pressure sway. A force platform was used to collect center of pressure data during standing balance over 40 s in four conditions: standing on rigid and foam surfaces with eyes open and closed. The main results are as follows: (1) sample entropy decreased and DFA_coefficient increased with age, while the SDC variables remained unaltered among the 3-, 4-, and 5-year-old children; (2) as sensory conditions became more challenging, sample entropy decreased and DFA_coefficient increased, while MT and MD decreased and MD increased; age did not influence the responses to sensorial deprivation. In conclusion, 5-year-old children showed decreased variability of CoP sway during standing balance compared with the younger children, but all children used the same corrective torques to control for perturbations. More challenging sensory deprivation conditions resulted in decreased variability of postural sway, higher amplitudes and more frequent correcting torques for stabilization, but age did not influence these behaviors.

Effects of backpack load and positioning on nonlinear gait features in young adults

Overloaded backpacks can cause changes in posture and gait dynamic balance. Therefore, the aim of this study was to assess gait regularity and local dynamic stability in young adults as they carried a backpack in different positions, and with different loads. Twenty-one healthy young adults participated in the study, carrying a backpack that was loaded with 10 and 20% of their body weight (BW). The participants walked on a level treadmill at their preferred walking speeds for 4 min under different conditions of backpack load and position (i.e. with backpack positioned back bilaterally, back unilaterally, frontally or without a backpack). Results indicate that backpack load and positioning significantly influence gait stability and regularity, with the exception of the 10% BW bilateral back position. Therefore, the recommended safe load for school-age children and adolescents (10% of BW) should also be considered for young adults. Practitioner summary: Increase in load results in changes in posture, muscle activity and gait parameters, so we investigated the gait adaptations related to regularity and stability. Conditions with high backpack loads significantly influenced gait stability and regularity in a position-dependent manner, except for 10% body weight bilateral back position.

Spatial and temporal analysis center of pressure displacement during adolescence: Clinical implications of developmental changes

This study aimed to provide insight into the development of postural control abilities in youth. A total of 276 typically developing adolescents (155 males, 121 females) with a mean age of 13.23 years (range of 7.11-18.80) were recruited for participation. Subjects performed two-minute quiet standing trials in bipedal stance on a force plate. Center of pressure (COP) trajectories were quantified using Sample Entropy (SampEn) in the anterior-posterior direction (SampEn-AP), SampEn in the medial-lateral direction (SampEn-ML), and Path Length (PL) measures. Three separate linear regression analyses were conducted to predict the relationship between age and each of the response variables after adjusting for individuals' physical characteristics. Linear regression models showed an inverse relationship between age and entropy measures after adjusting for body mass index. Results indicated that chronological age was predictive of entropy and path length patterns. Specifically, older adolescents exhibited center of pressure displacement (smaller path length) and less complex, more regular center of pressure displacement patterns (lower SampEn-AP and SampEn-ML values) compared to the younger children. These findings support prior studies suggesting that developmental changes in postural control abilities may continue throughout adolescence and into adulthood.

The effect of prolonged level and uphill walking on the postural control of older adults

Prolonged walking could alter postural control leading to an increased risk of falls in older adults. The aim of this study was to determine the effect of level and uphill prolonged walking on the postural control of older adults. Sixteen participants (64 ± 5 years) attended 3 visits. Postural control was assessed during quiet standing and the limits of stability immediately pre, post and post 15 min rest a period of 30 min walking on level and uphill (5.25%) gradients on separate visits. Each 30 min walk was divided into 3 10 min blocks, the limits of stability were measured between each block. Postural sway elliptical area (PRE: 1.38 ± 0.22 cm², POST: 2.35 ± 0.50 cm², p = .01), medio-lateral (PRE: 1.33 ± 0.03, POST: 1.40 ± 0.03, p = .01) and anterio-posterior detrended fluctuation analysis alpha exponent (PRE: 1.43 ± 0.02, POST: 1.46 ± 0.02, p = .04) increased following walking. Medio-lateral alpha exponent decreased between post and post 15 min' rest (POST: 1.40 ± 0.03, POST15: 1.36 ± 0.03, p = .03). Forward limits of stability decreased between the second walking interval and post 15 min' rest (Interval 2: 28.1 ± 1.6%, POST15: 25.6 ± 1.6%, p = .01) and left limits of stability increased from pre-post 15 min' rest (PRE: 27.7 ± 1.2%, POST15: 29.4 ± 1.1%, p = .01). The neuromuscular alterations caused by prolonged walking decreased the anti-persistence of postural sway and altered the limits of stability in older adults. However, 15 min' rest was insufficient to return postural control to pre-exercise levels.

The effects of progressive neuromuscular training on postural balance and functionality in elderly patients with knee osteoarthritis: a pilot study

[Purpose] To determine the effects of progressive neuromuscular training on postural balance and functionality in elderly patients with knee osteoarthritis (OA). [Subjects and Methods] Eleven participants between 60 and 75 years of age performed the progressive neuromuscular training for 8 weeks and 4 weeks of follow-up. The area and velocity of the center of pressure were measured on a force platform, and the functionality was measured with a Western Ontario and McMaster Universities Osteoarthritis Index. [Results] The area and velocity (anteroposterior and mediolateral directions) of the center of pressure showed significant differences after 4 and 8 weeks of intervention. Additionally, the global score and some questionnaire dimensions (pain and physical function) showed significant differences after 4 and 8 weeks of intervention. These changes were maintained in all variables at week 4 of follow-up. [Conclusion] The intervention generated improvements in balance and functionality in elderly patients with knee OA. These changes were observed after 4 weeks of training and were maintained 4 weeks after the end of the intervention.

Postural Control of Elderly Adults on Inclined Surfaces

This study analyzed the postural control of older adults on inclined surfaces, and was conducted in 17 elderly adults and 18 young adults of both genders. Ground reaction forces and moments were collected using two AMTI force platforms, one of which was in a horizontal position (HOR), while the other was inclined 14° in relation to the horizontal plane. Each participant executed three 70 s-trials of bipedal standing with their eyes open and eyes closed in three inclination conditions: the HOR, the inclined position at ankle dorsi-flexion (UP), and the inclined position at ankle plantar-flexion (DOWN). Spectral analysis, global (mean velocity-Velm, ellipse area-Area and F80), and structural stabilometric descriptors (sway density curve-SDC, detrended fluctuation analysis-DFA, sample entropy-SEn) were employed to assess the center of pressure sway. Velm and F80 were greater for the elderly, whereas SDC, DFA, and SEn were smaller for this group. Global, SDC and DFA variables were sensitive to visual deprivation, however the relative difference from the EO to EC condition was higher in young than in elderly. The DOWN condition was more stable than the UP condition for both young and older adults. With regard to the UP condition, the challenge observed is essentially associated with the corresponding biomechanical constraints. In conclusion, the elderly showed significant differences compared to the young, but age per se may not necessarily result in compromised postural control.