Neural substrates involved in the control of posture

Dual-Task Effect on Center of Pressure Oscillations and Prefrontal Cortex Activation Between Young and Older Adults

Purpose: This study aimed to investigate the dual-task effect on conventional center of pressure (CoP) outcomes, CoP oscillations, and prefrontal cortex (PFC) activation between young and older adults. Methods: Fourteen healthy older adults (age: 66.25 ± 3.43 years) and another fourteen gender-matched young adults (age: 19.80 ± 0.75 years) participated in this study. Participants completed single-task and dual-task standing trials in a fixed order. The displacement of CoP and PFC activation were recorded using a Force plate and a functional near-infrared spectroscopy system, respectively. Two-way MANOVAs were used to examine the group and task effects. Additionally, the Pearson correlation analyses were used to investigate the relationship between CoP oscillations and PFC activation. Results: Our results showed a worse balance performance, greater CoP oscillations of 0-0.1 (11.03 ± 8.24 vs. 23.20 ± 12.54 cm2) and 0.1-0.5 (13.62 ± 9.30 vs. 30.00 ± 23.12 cm2) Hz in the medial-lateral direction and higher right (dorsomedial: -0.0003 ± 0.021 vs. 0.021 ± 0.021 & ventrolateral: 0.0087 ± 0.047 vs. 0.025 ± 0.045 mol/ml) and left (dorsomedial: 0.0033 ± 0.024 vs. 0.020 ± 0.025 & ventrolateral: 0.0060 ± 0.037 vs. 0.034 ± 0.037 mol/ml) PFC activation in response to a secondary cognitive task in older adults (p < .05). Older adults also showed significant positive correlations between CoP oscillations in the anterior-posterior direction and PFC activation under the single-task standing. Conclusion: These results suggest that older adults presented a loss of postural automaticity contributing to cognitive dysfunction. Moreover, heightened CoP oscillations at 0-0.5 Hz in response to a secondary cognitive task could provide evidence of a loss of automaticity, which might be associated with a greater reliance on the sensory inputs.

Direct Current Stimulation over the Primary Motor Cortex, Cerebellum, and Spinal Cord to Modulate Balance Performance: A Randomized Placebo-Controlled Trial

OBJECTIVES

Existing applications of non-invasive brain stimulation in the modulation of balance ability are focused on the primary motor cortex (M1). It is conceivable that other brain and spinal cord areas may be comparable or more promising targets in this regard. This study compares transcranial direct current stimulation (tDCS) over (i) the M1, (ii) the cerebellum, and (iii) trans-spinal direct current stimulation (tsDCS) in the modulation of balance ability.

METHODS

Forty-two sports students were randomized in this placebo-controlled study. Twenty minutes of anodal 1.5 mA t/tsDCS over (i) the M1, (ii) the cerebellum, and (iii) the spinal cord, as well as (iv) sham tDCS were applied to each subject. The Y Balance Test, Single Leg Landing Test, and Single Leg Squat Test were performed prior to and after each intervention.

RESULTS

The Y Balance Test showed significant improvement after real stimulation of each region compared to sham stimulation. While tsDCS supported the balance ability of both legs, M1 and cerebellar tDCS supported right leg stand only. No significant differences were found in the Single Leg Landing Test and the Single Leg Squat Test.

CONCLUSIONS

Our data encourage the application of DCS over the cerebellum and spinal cord (in addition to the M1 region) in supporting balance control. Future research should investigate and compare the effects of different stimulation protocols (anodal or cathodal direct current stimulation (DCS), alternating current stimulation (ACS), high-definition DCS/ACS, closed-loop ACS) over these regions in healthy people and examine the potential of these approaches in the neurorehabilitation.

Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis

Sensory conflict impacts postural control, yet its effect on cortico-muscular interaction remains underexplored. We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability. We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input, recorded EEG (electroencephalogram) and EMG (electromyogram) data, and constructed a directed connectivity network. The results suggest that, compared to sensory congruence, during sensory conflict: (1) connectivity among the sensorimotor, visual, and posterior parietal cortex generally decreases, (2) cortical control over the muscles is weakened, (3) feedback from muscles to the cortex is strengthened, and (4) the range of body sway increases and its complexity decreases. These results underline the intricate effects of sensory conflict on cortico-muscular networks. During the sensory conflict, the brain adaptively decreases the integration of conflicting information. Without this integrated information, cortical control over muscles may be lessened, whereas the muscle feedback may be enhanced in compensation.

The effect of sleep deprivation on postural stability among physically active young adults

The study aimed to evaluate the effect of sleep deprivation on postural stability among physically active young adults. The study involved 22 physical education students. Average velocities and spatial distribution of the center of pressure displacements were taken as indicators of postural stability (double and one-leg standing). Two-way ANOVA with two factors of repeated measurements-"session" (control-experimental) and "daytime" (evening-morning)-was used. For indicators of the spatial distribution of the center of pressure in double stance with eyes open and eyes closed, and for average velocities for measurements with eyes closed, statistically significant interaction effects were found (at least p < 0.01, ƞ2 > 0.36, power statistics > 0.90) with the general tendency of higher results in the morning in the session with sleep deprivation than in the control session. In one-leg standing, an increase of average velocities was observed in the control session, and no differences in the session with sleep deprivation (interaction effect: at least p < 0.01, ƞ2 > 0.37, power statistics > 0.90). Besides spatial distribution indicators in double stance, there were no statistical differences between evening-morning tests in the session with sleep deprivation. Despite significant interaction effects, only the results of spatial distribution indicators in double stance were higher in the morning than in the evening in the session with sleep deprivation. So, no clear decline in postural stability after sleep deprivation was observed. This may suggest that sleep deprivation prevents natural regeneration rather than significantly worsening postural stability among physically active adults. It's possible that systematic physical activity might be one of the factors decreasing the risk of accidents among people exposed to sleep deprivation.

Center of Pressure Behavior in Response to Unexpected Base of Support Shifting: A New Objective Tool for Dynamic Balance Assessment

The translation of the base of support represents a promising approach for the objective assessment of dynamic balance control. Therefore, this study aimed to present a servo-controlled, electrically driven movable plate and a new set of parameters based on the center-of-pressure (CoP) trajectory. Twenty subjects were assessed on a force platform screwed over a movable plate that could combine the following settings: direction (forward (FW) and backward (BW)), displacement (25 mm, 50 mm, and 100 mm), and ramp rate (100 mm/s and 200 mm/s). The subjects underwent two sets of 12 trials randomly combining the plate settings. From the CoP trajectory of the 2.5 s time window after the perturbation, the 95% confidence-interval ellipse (Area95) and the CoP mean velocity (Unit Path) were calculated. Within the same time window, the first peak (FP), the maximal oscillations (ΔCoPMax), and the standard deviation (PPV) of the CoP anterior-posterior trajectory were calculated. The plate direction (p < 0.01), ramp rate (p < 0.001), and displacement (p < 0.01) affected the Area95, FP, and ΔCoPMax, while the Unit Path and PPV were influenced only by the ramp rate (p < 0.001) and displacement (p < 0.001). The servo-controlled, electrically driven movable plate and the CoP-related parameters presented in this study represent a new promising objective tool for dynamic balance assessment.

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.

Dynamic postural control in individuals with and without chronic ankle instability-do the modified star-excursion balance test and jump-landing stabilization have the same control mechanism?

OBJECTIVE

To examine the relationship between two dynamic postural tasks in subjects with and without chronic ankle instability (CAI).

DESIGN

Cross-sectional study.

SETTING

Biomechanics lab.

PARTICIPANTS

Thirty subjects with CAI and 30 healthy controls.

MAIN OUTCOME MEASURE

Performance of two dynamic postural control tests: the modified Star-Excursion Balance Test (mSEBT) and an assessment of a single limb jump-landing on a force plate that yielded two outcomes: time to stabilization (TTS) and the absolute average force in the mediolateral plane during the first 0.4 s after landing (AAF_ML).

RESULTS

In the CAI group, a significant correlation was found between the mSEBT score and the AAF_ML (ρ = -0.54, p < 0.01), but not between the mSEBT or TTS or between the AAF_ML and the TTS. However, in the control group, a significant correlation was found between AAF_ML and the TTS (ρ = 0.43, p < 0.05), but not between the mSEBT and TTS or between the mSEBT and AAF_ML.

CONCLUSION

These results suggest that there is no association between the different dynamic balance tasks. The different pattern of association in individuals with CAI may indicate altered central neural control. Clinicians and researchers should therefore not use a single task to assess dynamic postural control.

Validity and reliability of an unstable board for dynamic balance assessment in young adults

Scientific literature is giving greater importance to dynamic balance in fall prevention. Recently, the validity and reliability of the most employed functional tests for dynamic balance assessment has been investigated. Although these functional tests are practical and require minimal equipment, they are inherently subjective, as most do not use instrumented measurement data in the scoring process. Therefore, this study aimed to assess the validity and reliability of an instrumented unstable board for dynamic balance objective assessment in young adults through double-leg standing trials. A test-retest design was outlined with the unstable board positioned over a force platform to collect objective Center of Pressure (CoP) related and kinematic parameters. Fifteen young adults participated in two evaluation sessions (7-day apart) that comprised ten trials per two dynamic conditions (anterior-posterior and medio-lateral oscillations) aiming to maintain the board parallel to the ground. Pearson's correlation coefficient (r) was employed to assess the validity of the kinematic parameters with those derived from the CoP. The test-retest reliability was investigated through Intraclass Correlation Coefficient (ICC), Standard Error of the measurement, Minimal Detectable Change, and Bland-Altman plots. Statistically significant correlations between the CoP and kinematic parameters were found, with r values ranging from 0.66 to 0.95. Good to excellent intrasession (0.89≤ICCs≤0.95) and intersession (0.66≤ICCs≤0.95) ICCs were found for the kinematics parameters. The Bland-Altman plots showed no significant systematic bias. The kinematics parameters derived from the unstable board resulted valid and reliable. The small size of the board makes it a suitable tool for the on-site dynamic balance assessment and a complement of computerized dynamic posturography.

Cortical activation and functional connectivity during locomotion tasks in Parkinson's disease with freezing of gait

Background

Freezing of gait (FoG) is a severely disabling symptom in Parkinson's disease (PD). The cortical mechanisms underlying FoG during locomotion tasks have rarely been investigated.

Objectives

We aimed to compare the cerebral haemodynamic response during FoG-prone locomotion tasks in patients with PD and FoG (PD-FoG), patients with PD but without FoG (PD-nFoG), and healthy controls (HCs).

Methods

Twelve PD-FoG patients, 10 PD-nFoG patients, and 12 HCs were included in the study. Locomotion tasks included normal stepping, normal turning and fast turning ranked as three difficulty levels based on kinematic requirements and probability of provoking FoG. During each task, we used functional near-infrared spectroscopy to capture concentration changes of oxygenated haemoglobin (ΔHBO₂) and deoxygenated haemoglobin (ΔHHB) that reflected cortical activation, and recorded task performance time. The cortical regions of interest (ROIs) were prefrontal cortex (PFC), supplementary motor area (SMA), premotor cortex (PMC), and sensorimotor cortex (SMC). Intra-cortical functional connectivity during each task was estimated based on correlation of ΔHBO₂ between ROIs. Two-way multivariate ANOVA with task performance time as a covariate was conducted to investigate task and group effects on cerebral haemodynamic responses of ROIs. Z statistics of z-scored connectivity between ROIs were used to determine task and group effects on functional connectivity.

Results

PD-FoG patients spent a nearly significant longer time completing locomotion tasks than PD-nFoG patients. Compared with PD-nFoG patients, they showed weaker activation (less ΔHBO₂) in the PFC and PMC. Compared with HCs, they had comparable ΔHBO₂ in all ROIs but more negative ΔHHB in the SMC, whereas PD-nFoG showed SMA and PMC hyperactivity but more negative ΔHHB in the SMC. With increased task difficulty, ΔHBO₂ increased in each ROI except in the PFC. Regarding functional connectivity during normal stepping, PD-FoG patients showed positive and strong PFC-PMC connectivity, in contrast to the negative PFC-PMC connectivity observed in HCs. They also had greater PFC-SMC connectivity than the other groups. However, they exhibited decreased SMA-SMC connectivity when task difficulty increased and had lower SMA-PMC connectivity than HCs during fast turning.

Conclusion

Insufficient compensatory cortical activation and depletion of functional connectivity during complex locomotion in PD-FoG patients could be potential mechanisms underlying FoG.

Clinical trial registration

Chinese clinical trial registry (URL: http://www.chictr.org.cn, registration number: ChiCTR2100042813).

Non-exercise activity thermogenesis in the workplace: The office is on fire

From the second half of the previous century, there has been a shift toward occupations largely composed of desk-based behaviors. This, inevitably, has led to a workload reduction and a consequent lower energy expenditure. On this point, small increments of the non-exercise activity thermogenesis (NEAT) could be the rationale to reach health benefits over a prolonged period. Different published researches suggest solutions to reverse sitting time and new alternative workstations have been thought to increase total physical activity. Therefore, the purpose of this narrative review is to summarize the current state of the research regarding the "NEAT approach" to weight-gain prevention in work environments. This review analyzes the main evidence regarding new alternative workstations such as standing, walking workstations, seated pedal, and gymnastic balls to replace a standard office chair.

Effects of different virtual reality technology driven dual-tasking paradigms on posture and saccadic eye movements in healthy older adults

Postural sway and eye movements are potential biomarkers for dementia screening. Assessing the two movements comprehensively could improve the understanding of complicated syndrome for more accurate screening. The purpose of this research is to evaluate the effects of comprehensive assessment in healthy older adults (OA), using a novel concurrent comprehensive assessment system consisting of stabilometer and virtual reality headset. 20 healthy OA (70.4 ± 4.9 years) were recruited. Using a cross-sectional study design, this study investigated the effects of various dual-tasking paradigms with integrated tasks of visuospatial memory (VM), spatial orientation (SO), and visual challenge on posture and saccades. Dual-task paradigms with VM and SO affected the saccadic eye movements significantly. Two highly intensive tests of anti-saccade with VM task and pro-saccade with SO task also influenced postural sway significantly. Strong associations were seen between postural sway and eye movements for the conditions where the two movements theoretically shared common neural pathways in the brain, and vice versa. This study suggests that assessing posture and saccades with the integrated tasks comprehensively and simultaneously could be useful to explain different functions of the brain. The results warrant a cross-sectional study in OA with and without dementia to explore differences between these groups.

Physical active lifestyle promotes static and dynamic balance performance in young and older adults

Although regular physical activity exposure leads to positive postural balance control (PBC) adaptations, few studies investigated its effects, or the one of inactivity, on PBC in populations of different age groups. Thus, this study investigated the impact of a physically active lifestyle on static and dynamic PBC in young and older adults. Thirty-five young physically active subjects (YA), 20 young sedentary subjects (YS), 16 physically active older adults (OA), and 15 sedentary older adults (OS) underwent a static and a dynamic PBC assessment. A force platform and an instrumented proprioceptive board were employed to measure the center of pressure (COP) trajectory and the anteroposterior oscillations, respectively. In static conditions, no significant differences were detected among groups considering the overall postural balance performance represented by the area of confidence ellipse values. Conversely, the YA highlighted a higher efficiency (i.e., lower sway path mean velocity) in PBC maintenance compared to the other groups (YA vs OA: p = 0.0057, Cohen’s d = 0.94; YA vs OS p = 0.043, d = 1.07; YA vs YS p = 0.08, d = 0.67). OS exhibited an overall worse performance in dynamic conditions than YA and YS. Surprisingly, no differences were found between YS and OA for all the static and dynamic parameters considered. In conclusion, our results suggest that a physically active lifestyle may promote static and dynamic balance performance in young and older adults, thus with potentially positive effects on the age-related decline of postural balance performance. Dynamic PBC assessment seems more sensitive in detecting differences between groups than the static evaluation.

Virtual Neuromuscular Control for Robotic Ankle Exoskeleton Standing Balance

The exoskeleton is often regarded as a tool for rehabilitation and assistance of human movement. The control schemes were conventionally implemented by developing accurate physical and kinematic models, which often lack robustness to external variational disturbing forces. This paper presents a virtual neuromuscular control for robotic ankle exoskeleton standing balance. The robustness of the proposed method was improved by applying a specific virtual neuromuscular model to estimate the desired ankle torques for ankle exoskeleton standing balance control. In specialty, the proposed control method has two key components, including musculoskeletal mechanics and neural control. A simple version of the ankle exoskeleton was designed, and three sets of comparative experiments were carried out. The experimentation results demonstrated that the proposed virtual neuromuscular control could effectively reduce the wearer’s lower limb muscle activation, and improve the robustness of the different external disturbances.

Muscle synergy analysis yields an efficient and physiologically relevant method of assessing stroke

The Fugl-Meyer Assessment is widely used to test motor function in stroke survivors. In the Fugl-Meyer Assessment, stroke survivors perform several movement tasks and clinicians subjectively rate the performance of each task item. The individual task items in the Fugl-Meyer Assessment are selected on the basis of clinical experience, and their physiological relevance has not yet been evaluated. In the present study, we aimed to objectively rate the performance of task items by measuring the muscle activity of 41 muscles from the upper body while stroke survivors and healthy participants performed 37 Fugl-Meyer Assessment upper extremity task items. We used muscle synergy analysis to compare muscle activity between subjects and found that 13 muscle synergies in the healthy participants (which we defined as standard synergies) were able to reconstruct all of the muscle activity in the Fugl-Meyer Assessment. Among the standard synergies, synergies involving the upper arms, forearms and fingers were activated to varying degrees during different task items. In contrast, synergies involving posterior trunk muscles were activated during all tasks, which suggests the importance of posterior trunk muscle synergies throughout all sequences. Furthermore, we noted the inactivation of posterior trunk muscle synergies in stroke survivors with severe but not mild impairments, suggesting that lower trunk stability and the underlying activity of posterior trunk muscle synergies may have a strong influence on stroke severity and recovery. By comparing the synergies of stroke survivors with standard synergies, we also revealed that some synergies in stroke survivors corresponded to merged standard synergies; the merging rate increased with the impairment of stroke survivors. Moreover, the degrees of severity-dependent changes in the merging rate (the merging rate–severity relationship) were different among different task items. This relationship was significant for 26 task items only and not for the other 11 task items. Because muscle synergy analysis evaluates coordinated muscle activities, this different dependency suggests that these 26 task items are appropriate for evaluating muscle coordination and the extent of its impairment in stroke survivors. Overall, we conclude that the Fugl-Meyer Assessment reflects physiological function and muscle coordination impairment and suggest that it could be performed using a subset of the 37 task items.

Postural Control Adaptations in Yoga Single-Leg Support Postures: Comparison Between Practitioners and Nonpractitioners

This paper investigates whether a group of regular Yoga practitioners shows postural control differences compared with healthy controls while performing single-leg Yoga postures. Ten Yoga practitioners were compared with a control group of 10 nonpractitioners performing two single-leg support Yoga postures: Vrksasana (tree posture) and Natarajasana (dancer posture). Rambling and trembling decomposition of the center of pressure trajectories was implemented using a genetic algorithm spectral optimization that avoids using horizontal forces and was validated with bipedal posture data. Additionally, the center of mass was estimated from body kinematics using OpenSim and compared with the rambling outputs. During Natarajasana, no postural control adaptations were observed. For Vrksasana, the Yoga practitioners showed a lower center of pressure ellipse confidence interval area, center of pressure anteroposterior SD, and smaller rambling SD in the mediolateral direction, suggesting possible supraspinal feed-forward motor adaptations associated with Yoga training.

A Neural Controller Model Considering the Vestibulospinal Tract in Human Postural Control

Humans are able to control their posture in their daily lives. It is important to understand how this is achieved in order to understand the mechanisms that lead to impaired postural control in various diseases. The descending tracts play an important role in controlling posture, particularly the reticulospinal and the vestibulospinal tracts (VST), and there is evidence that the latter is impaired in various diseases. However, the contribution of the VST to human postural control remains unclear, despite extensive research using neuroscientific methods. One reason for this is that the neuroscientific approach limits our understanding of the relationship between an array of sensory information and the muscle outputs. This limitation can be addressed by carrying out studies using computational models, where it is possible to make and validate hypotheses about postural control. However, previous computational models have not considered the VST. In this study, we present a neural controller model that mimics the VST, which was constructed on the basis of physiological data. The computational model is composed of a musculoskeletal model and a neural controller model. The musculoskeletal model had 18 degrees of freedom and 94 muscles, including those of the neck related to the function of the VST. We used an optimization method to adjust the control parameters for different conditions of muscle tone and with/without the VST. We examined the postural sway for each condition. The validity of the neural controller model was evaluated by comparing the modeled postural control with (1) experimental results in human subjects, and (2) the results of a previous study that used a computational model. It was found that the pattern of results was similar for both. This therefore validated the neural controller model, and we could present the neural controller model that mimics the VST.

Influence of age on postural control during dual task: a centre of pressure motion and electromyographic analysis

BACKGROUND

Dual task influences postural control. A cognitive task seems to reduce muscle excitation during a postural balance, especially in older adults (OA).

AIM

The aim of this study is to evaluate the effect of three cognitive tasks on muscle excitation and static postural control in OA and young adults (YA) in an upright posture maintenance task.

METHODS

31 YA and 30 OA were evaluated while performing a modified Romberg Test in five different conditions over a force plate: open eyes, closed eyes, spatial-memory brooks' test, counting backwards aloud test and mental arithmetic task. The surface electromyographic signals of Tibialis anterior (TA), Lateral Gastrocnemius (GL), Peroneus Longus (PL), and Erector Spinae (ES) was acquired with an 8-channel surface electromyographic system. The following variables were computed for both the electromyographic analysis and the posturographic assessment: Root mean square (RMS), centre of pressure (CoP) excursion (Path) and velocity, sway area, RMS of the CoP Path and 50%, 95% of the power frequency. Mixed ANOVA was used to detect differences with group membership as factor between and type of task as within. The analysis was performed on the differences between each condition from OE.

RESULTS

An interaction effect was found for Log (logarithmic) Sway Area. A main effect for task emerged on all posturographic variables except Log 95% frequencies and for Log PL and ES RMS. A main effect for group was never detected.

DISCUSSION AND CONCLUSION

This study indicates a facilitating effect of mental secondary task on posturographic variables. Non-silent secondary task causes increase in ES and TA muscle activation and a worsening in static postural control performance.

Are Static and Dynamic Postural Balance Assessments Two Sides of the Same Coin? A Cross-Sectional Study in the Older Adults

The aim of this study was to investigate if the combination of static and dynamic postural balance assessments gives more accurate indications on balance performance among healthy older adults. We also aimed at studying the effect of a dual-task condition on static and dynamic postural balance control. Fifty-seven healthy older adults (age = 73.2 ± 5.0 year, height = 1.66 ± 0.08 m, and body mass = 72.8 ± 13.8 kg) completed the study. Static and dynamic balance were assessed both in single-task and dual-task conditions through a force plate and an oscillating platform. The dominant handgrip strength was also measured with a dynamometer. Pearson’s correlation revealed non-statistically significant correlations between static and dynamic balance performance. The dual-task worsened the balance performance more in the dynamic (+147.8%) than in the static (+25.10%, +43.45%, and +72.93% for ellipse area, sway path, and AP oscillations, respectively) condition (p < 0.001). A weak correlation was found between dynamic balance performance and handgrip strength both in the single (p < 0.05; r = −0.264) and dual (p < 0.05; r = −0.302) task condition. The absence of correlations between static and dynamic balance performance suggests including both static and dynamic balance tests in the assessment of postural balance alterations among older adults. Since cognitive-interference tasks exacerbated the degradation of the postural control performance, dual-task condition should also be considered in the postural balance assessment.

Different Gymnastic Balls Affect Postural Balance Rather Than Core-Muscle Activation: A Preliminary Study

Background: In proprioceptive training, unstable devices produce multidirectional perturbations that must be counterbalanced by the postural control systems and core-muscle activation. We investigated whether different sizes and shapes of three gymnastic balls could affect core-muscle activation and postural balance when performing the same exercise. Methods: Eleven young healthy subjects were assessed on the balls, assuming two body postures (bipedal seated and unipedal seated) and performing a dynamic exercise. Two balls were spherical with different diameters, and one was ovoid. Postural balance and muscle activation were assessed through center of pressure (CoP)-related parameters and surface electromyography. Results: Statistical analysis showed a significant effect of the gymnastic balls (p < 0.001) and the body postures (p < 0.001) for the CoP-related parameters, with the ovoid shape and the bipedal sitting representing the easiest conditions. Core-muscle activation was affected only by body postures, with a higher activation in the unipedal sitting (p < 0.01). In the dynamic exercise, significant differences were only detected for the CoP-related parameters (p < 0.001). Conclusions: The shapes and sizes of the gymnastic balls produced different degrees of destabilization under the same body posture but left the core-muscle activation unaltered. In the dynamic exercise, the conformation of the balls did not represent the main determinant in producing destabilizing effects.

Analysis of Postural Control in Sitting by Pressure Mapping in Patients with Multiple Sclerosis, Spinal Cord Injury and Friedreich's Ataxia: A Case Series Study

The postural control assessments in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out to determine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich’s ataxia), and to determine whether the variables extracted from the pressure mapping analysis are more sensitive than functional tests to evaluate the postural trunk control. A case series study was carried out in a sample of 10 adult patients with multiple sclerosis (n = 2), spinal cord injury (n = 4) and Friedreich’s ataxia (n = 4). The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test. The participants with Friedreich’s ataxia showed a tendency to present a higher mean pressure on the seat of subject’s wheelchair compared to other groups. In parallel, users with spinal cord injury showed a tendency to present the highest values of maximum pressure and area of contact. People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. Although it is not possible to establish a strong statistical correlation, the relationships between the pressure mapping variables and the functional tests seem to be numerous, especially in the multiple sclerosis group.

Is freezing of gait correlated with postural control in patients with moderate-to-severe Parkinson's disease?

Freezing of gait (FoG) is one of the main reasons for movement initiation disorders and abnormal coupling of posture and gait in Parkinson's disease (PD). Patients with FoG have poor postural control when compared to patients without FoG. However, the nature of the interrelationship between FoG and domains of postural control remains unknown. The aim of this study was to estimate the association between different domains of postural control and severity of FoG in patients with moderate-to-severe PD. Thirty patients with idiopathic PD with FoG (age range 45-80 years, Hoehn & Yahr stages 3 and 4) participated in the study. We evaluated objective (FoG-ratio during turning task) and subjective (New Freezing of Gait Questionnaire, NFoG-Q) measures of FoG severity, reactive postural adjustments in response to an external perturbation, first step anticipatory adjustment for step initiation and quiet standing stability. In the multiple regression analysis, step initiation was the strongest significant correlation of the NFoG-Q score explaining 23% of the variance of the assessment. For the objective FoG measure, mediolateral CoP amplitude in quiet standing and mediolateral CoP amplitude in step initiation explained 39% of the variance of the FoG-ratio. As main conclusions, this study identified the association between objective and subjective measure for FoG severity and postural control domains. The results support conducting step initiation training during rehabilitation of individuals with FoG.

Dual-tasking effects on static and dynamic postural balance performance: a comparison between endurance and team sport athletes

In sports, postural balance control has been demonstrated to be one of the limiting factors of performance and a necessary component to achieve any sport technique. Team players (TP) must process and react to multiple external stimuli while executing at the same time the skills of the game. By contrast, endurance athletes (END) must perform the same gesture repetitively without a concurrent coordination of continuous stimuli-related actions. However, END are used to facilitate their physical performance by adopting cognitive strategies while performing their sport gesture. Therefore, we aimed to investigate static and dynamic balance performance in these two types of athletes, both in single and dual-task conditions. Nineteen END and sixteen TP underwent a static and a dynamic balance assessment on a dynamometric platform and an instrumented oscillating board, respectively. Among TP static but not dynamic postural balance performance was negatively affected by dual-tasking considering the area of the confidence ellipse (p < 0.001; d = 0.52) and the sway path mean speed (p < 0.001; d = 0.93). Conversely, END unaltered static balance performance but showed an overall improvement in the dynamic one when dual-tasking occurred. The limited human processing capacity accounted the worsening of the cognitive performance in both TP (p < 0.05; d = 0.22) and END (p < 0.001; d = 0.37). Although TP are more used coping dual tasking, the better performance of END could be accounted for by the employment of the external attentive focus (i.e. counting backward aloud) that called into play a strategy close to those adopted during training and competitions. These surprising results should be considered when driving and developing new trainings for team players in dual-tasking conditions.

Functional Neuroanatomy for Posture and Gait Control

Here we argue functional neuroanatomy for posture-gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture-gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.