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Xie H, Liang M, Mo Y, Schmidt C, Wang C, Chien JH. Comparison Between Effects of Galvanic and Vibration-Based Vestibular Stimulation on Postural Control and Gait Performance in Healthy Participants: A Systematic Review of Cross-Sectional Studies. Ann Biomed Eng 2024; 52:757-793. [PMID: 38148425 DOI: 10.1007/s10439-023-03425-5] [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: 07/20/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
Electricity and vibration were two commonly used physical agents to provide vestibular stimulation in previous studies. This study aimed to systematically review the effects of galvanic (GVS) and vibration-based vestibular stimulation (VVS) on gait performance and postural control in healthy participants. Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until March 19th, 2023. Studies published between 2000 and 2023 in English involving GVS and VVS related to gait performance and postural control were included. The procedure was followed via the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies. A total of 55 cross-sectional studies met the inclusion criteria and were included in this study. Five studies were good-quality while 49 were moderate-quality and 1 was poor-quality. There were 50 included studies involving GVS and 5 included studies involving VVS. GVS and VVS utilized different physical agents to provide vestibular stimulation and demonstrated similar effects on vestibular perception. Supra-threshold GVS and VVS produced vestibular perturbation that impaired gait performance and postural control, while sub-threshold GVS and VVS induced stochastic resonance phenomenon that led to an improvement. Bilateral vestibular stimulation demonstrated a greater effect on gait and posture than unilateral vestibular stimulation. Compared to GVS, VVS had the characteristics of better tolerance and fewer side effects, which may substitute GVS to provide more acceptable vestibular stimulation.
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Affiliation(s)
- Haoyu Xie
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Meizhen Liang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yujia Mo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Cindy Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, USA
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Xie H, Song H, Schmidt C, Chang WP, Chien JH. The effect of mechanical vibration-based stimulation on dynamic balance control and gait characteristics in healthy young and older adults: A systematic review of cross-sectional study. Gait Posture 2023; 102:18-38. [PMID: 36871475 DOI: 10.1016/j.gaitpost.2023.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND A good dynamic balance control and stable gait played an important role in the daily ambulation, especially for older adults with sensorimotor degeneration. This study aimed to systematically review the effects and potential mechanisms of mechanical vibration-based stimulation (MVBS) on dynamic balance control and gait characteristics in healthy young and older adults. METHOD Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until September 4th, 2022. Studies published between 2000 and 2022 in English and Chinese involving mechanical vibration related to gait and dynamic balance were included. The procedure was followed via the preferred reporting items for systematic reviews and meta-analysis method. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies. RESULTS A total of 41 cross-sectional studies met the inclusion criteria and were included in this study. Eight studies were good-quality while 26 were moderate-quality and 7 were poor-quality. There were six categories of MVBS at various frequencies and amplitudes utilized in included studies, including plantar vibration, focal muscle vibration, Achilles tendon vibration, vestibular vibration, cervical vibration, and vibration on nail of hallux. SIGNIFICANCE Different types of MVBS targeting different sensory systems affected the dynamic balance control and gait characteristics differently. MVBS could be used to provide improvement or perturbation to specific sensory systems, to induce different sensory reweight strategies during gait.
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Affiliation(s)
- Haoyu Xie
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Huiyan Song
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Cindy Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wen-Pin Chang
- Department of Occupational Therapy, Rocky Mountain University of Health Professions, Provo, UT, USA
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Ren M, Lin T, Chien JH. Different Types of Visual Perturbation Induced Different Demands and Patterns in Active Control: Implication for Future Sensorimotor Training. Front Physiol 2022; 13:919816. [PMID: 35910572 PMCID: PMC9325964 DOI: 10.3389/fphys.2022.919816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sensorimotor training using visual perturbations has been widely applied to astronauts for rapidly handling and adapting to unpredictable environments. However, these visual perturbations might not be strong enough to trigger long-term effects. Therefore, this study aimed to develop a novel sensorimotor training paradigm using pseudo-random visual perturbations and to determine the demands and patterns of active control under different types of visual perturbations. Method: Thirty healthy young adults participated in this study. Four walking conditions were randomly assigned to these participants: 1) walking without optic flow (NoOptic), 2) walking with the optic flow (Optic), 3) walking under reduced visual capability (Vre), and 4) walking under perturbed optic flow (Vpe). The dependent variables were the step length variability, the step width variability, the 95% confidence interval ellipse area, the long axis of the ellipse, and the short axis of the ellipse. Results: The results indicated that 1) the step length variability and the ellipse area were greater in Vre compared to Optic (p < 0.001, p < 0.001). Moreover, the step width variability and ellipse area were greater in Vpe than Optic (p < 0.001, p = 0.002). Conclusion: The abovementioned results demonstrated that 1) walking in both Vre and Vpe conditions required greater demands and different patterns in active controls compared to the Optic condition, suggesting both Vre and Vpe conditions could be applied for sensorimotor training; 2) the Vre condition would be the first choice if there were no concerns in potential trips on the treadmill.
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Affiliation(s)
- Muchen Ren
- Department of Health and Rehabilitation Science, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tangdi Lin
- Department of Health and Rehabilitation Science, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jung Hung Chien
- Independent Researcher, Omaha, NE, United States
- *Correspondence: Jung Hung Chien,
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Lu J, Xie H, Chien JH. Different Types of Mastoid Process Vibrations Affect Dynamic Margin of Stability Differently. Front Hum Neurosci 2022; 16:896221. [PMID: 35832875 PMCID: PMC9271872 DOI: 10.3389/fnhum.2022.896221] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
The vestibular system is critical for human locomotion. Any deteriorated vestibular system leads to gait instability. In the past decades, these alternations in gait patterns have been majorly measured by the spatial-temporal gait parameters and respective variabilities. However, measuring gait characteristics cannot capture the full aspect of motor controls. Thus, to further understand the effects of deteriorated vestibular system on gait performance, additional measurement needs to be taken into consideration. This study proposed using the margin of stability (MOS) to identify the patterns of dynamic control under different types of mastoid vibrations in walking. This study hypothesized that (1) using the MOS method could facilitate the understanding of another aspect of motor control induced by different types of mastoid vibrations, and (2) applying the mastoid vibrations could induce the asymmetric MOS. Twenty healthy young adults were recruited. Two electromechanical vibrotactile transducers were placed on the bilateral mastoid process to apply different types of vestibular vibrations (bilateral, unilateral, and no vibration). A motion capture system with eight cameras was used to measure the MOSap (margin of stability in the anterior-posterior direction), MOSml (margin of stability in the medial-lateral direction), and respective variabilities. The results were in line with the hypotheses that both bilateral and unilateral mastoid vibrations significantly increased MOSap (p = 0.036, p < 0.001), MOSml (p = 0.012, p < 0.001), and respective variabilities p = 0.001, p < 0.001; p = 0.001, p < 0.01 when compared to the no vibration condition. Also, significantly larger MOSml (p = 0.001), MOSml variability (p < 0.023), MOSap (p < 0.001), and MOSap variability (p = 0.002) were observed under the unilateral vibration condition than that observed under the bilateral vibration condition. The above-mentioned result found that different types of mastoid vibrations affected the MOS differently, suggesting different patterns of control mechanisms under different sensory-conflicted situations. Besides, a significant difference between the dominant and non-dominant legs was observed in MOSml. Moreover, applying the unilateral mastoid vibrations induced a greater symmetric index of MOSml, suggesting that more active control in balance was needed in the medial-lateral than in the anterior-posterior direction.
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Affiliation(s)
- Jiani Lu
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoyu Xie
- Department of Health and Rehabilitation Science, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jung Hung Chien
- Independent Researcher, Omaha, NE, United States
- *Correspondence: Jung Hung Chien
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Using a Portable Pressure-Sensing Walkway to Detect Age-Related Alternations in Foot Integrated Pressure During Multiple Obstacle Negotiation. J Aging Phys Act 2022; 30:963-971. [PMID: 35231881 DOI: 10.1123/japa.2021-0186] [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: 05/17/2021] [Revised: 01/07/2022] [Accepted: 01/30/2022] [Indexed: 11/18/2022]
Abstract
Multiple obstacle avoidance induces a higher potential of falls among older adults. This study attempted to add other important measurements by investigating the pressure-related gait parameters when stepping over multiple obstacles on a portable pressure-sensing walkway. Twenty-six young and 26 older participants were recruited in this study. A portable pressure-sensing Zeno walkway and cyclogram intersection point analysis method was introduced to collect both spatial-temporal and pressure-related gait parameters. Older adults significantly reduced foot integrated pressure of the leading leg when stepping over the second obstacle compared with young adults (p = .0078). A significantly larger cyclogram intersection point shift in medial-lateral direction was found in older adults than in young adults (p = .024) when stepping over the second obstacle, especially in the lateral direction. The results of this study showed that a pressure-sensing walking combined with cyclogram intersection point method could detect foot pressure distribution differences caused by aging.
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Lin Y, Mukherjee M, Stergiou N, Chien JH. Using mastoid vibration can detect the uni/bilateral vestibular deterioration by aging during standing. J Vestib Res 2021; 32:145-154. [PMID: 34180442 DOI: 10.3233/ves-210042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The mastoid vibration (MV) has been used to investigate unilateral vestibular dysfunction by inducing nystagmus. Additionally, this MV can be used to quantify the effect of deterioration by aging on the vestibular system during walking. Could such MV be used to assess the uni/bilateral vestibular deterioration by aging during standing? OBJECTIVE This study attempted to determine the feasibility of using MV for identifying the uni/bilateral vestibular deterioration by aging during standing. METHODS Fifteen young and ten old adults' balance control patterns were assessed by three random MV conditions: 1) No MV; 2) Unilateral MV; 3) Bilateral MV. The dependent variables were the 95% confidence ellipse areas and the sample entropy values, which were calculated based on the center of gravity displacement within each condition. RESULTS Significant main effects of MV and aging were found on all outcome variables. A significant interaction between aging and different MV types was observed in the 95% confidence ellipse area (p = 0.002) and the length of the short axis (anterior-posterior direction, p = 0.001). CONCLUSIONS We concluded that the MV could be used to identify different vestibular dysfunctions, specifically in old adults.
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Affiliation(s)
- Yufeng Lin
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, USA
| | - Mukul Mukherjee
- Department of Biomechanics, College of Education, University of Nebraska Omaha, USA
| | - Nicholas Stergiou
- Department of Biomechanics, College of Education, University of Nebraska Omaha, USA
| | - Jung Hung Chien
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, USA
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Magnani RM, Bruijn SM, van Dieën JH, Vieira MF. Head orientation and gait stability in young adults, dancers and older adults. Gait Posture 2020; 80:68-73. [PMID: 32492622 DOI: 10.1016/j.gaitpost.2020.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Control of body orientation requires head motion detection by the vestibular system and small changes with respect to the gravitational acceleration vector could cause destabilization. RESEARCH QUESTION We aimed to compare the effects of different head orientations on gait stability in young adults, dancers and older adults. METHODS Three groups of 10 subjects were evaluated, the first composed of young adults (aged 18-30 years), the second composed of young healthy dancers under high performance dance training (aged 18-30 years), and the third group composed of community-dwelling older adults (aged 65-80 years). Participants walked on a treadmill at their preferred speed in four distinct head orientation conditions for four minutes each: control (neutral orientation); dynamic yaw (following a target over 45° bilaterally); up (15° neck extension), and down (40° neck flexion). Foot and trunk kinematic data were acquired using a 3D motion capture system and the gait pattern was assessed by basic gait parameters (step length, stride width and corresponding variability) and gait stability (local divergence exponents and margins of stability). Main effects of conditions and groups, as well as their interaction effects, were evaluated by repeated-measures analysis of variance. RESULTS Interactions of group and head orientation were found for both step length and stride width variability; main effects of head orientation were found for all evaluated parameters and main effects of group were found for step length and its variability and local divergence exponents in all directions. SIGNIFICANCE As expected, the older adults group showed less stable gait (higher local divergence exponent), the shortest step length and greater step length variability. However, contrary to expectation, the dancers were not more stable. The yaw condition was the most challenging for all groups and the down condition seemed to be least challenging.
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Affiliation(s)
- Rina M Magnani
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Brazil.
| | - Sjoerd M Bruijn
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Marcus F Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Brazil
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Chien JE, Hsu WL. Effects of Dynamic Perturbation-Based Training on Balance Control of Community-Dwelling Older Adults. Sci Rep 2018; 8:17231. [PMID: 30467355 PMCID: PMC6250668 DOI: 10.1038/s41598-018-35644-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/18/2018] [Indexed: 11/09/2022] Open
Abstract
Walking is one of the daily activities that may cause falling in older adults. We developed a novel dynamic balance training program using a perturbation-based training on a custom-made treadmill, which can generate forward, backward, and lateral sway perturbations during walking. The purpose of this study was to investigate the changes in the balance performance of community-dwelling older adults after 8-weeks of perturbation-based balance training. A three-dimensional motion analysis system was used to collect kinematic and kinetic data. Seventeen community-dwelling older adults performed quiet standing with and without the balance perturbation. Biomechanical parameters such as center of pressure (COP) and center of mass (COM) were calculated. A paired t-test was used to compare the difference in balance performance before and after the training. After training, the results showed that the COM control of the older adults was significantly improved during quiet standing with perturbation, while the COP control during quiet standing without perturbation was not changed. The perturbation-based balance training exerted a positive effect on dynamic balance control in older adults. This translational research offers a new paradigm of balance training and can be applied to patient populations who have a high risk of falling.
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Affiliation(s)
- Jo-En Chien
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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Effects of Aging on the Obstacle Negotiation Strategy while Stepping over Multiple Obstacles. Sci Rep 2018; 8:8576. [PMID: 29872074 PMCID: PMC5988752 DOI: 10.1038/s41598-018-26807-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/11/2018] [Indexed: 11/08/2022] Open
Abstract
Forty-seven percent of falling accidents in older adults are caused by tripping over obstacles. Understanding what strategies are involved in obstacle negotiation in older adults could reduce fall risks. There is a paucity of research investigating how healthy adults negotiate multiple obstacles, which may better reflect the complexity of the real environment. The presence of a second obstacle has induced mixed results in the obstacle negotiation of healthy older adults with the interval between obstacles two steps apart. This study extended the knowledge to understand what strategies healthy younger and older adults used to step over two obstacles placed at three-step-length apart. Twenty healthy subjects performed 2 tasks: level ground walking and stepping over two obstacles. The height of each obstacle was set at 10% of subjects' leg height. We found that aging significantly increased the toe clearance in leading and trailing legs when stepping over the obstacles at a three-step-length interval. Toe clearance was higher while stepping over the second obstacle than the first one in older adults. These results had two-fold meanings: the three-step-length interval was long enough to trigger the adjustment of the obstacle negotiation strategy, and aging led older adults to use conservative negotiation strategies.
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