Invariant density analysis: modeling and analysis of the postural control system using Markov chains

A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code

Postural control is often quantified by recording the trajectory of the center of pressure (COP)-also called stabilogram-during human quiet standing. This quantification has many important applications, such as the early detection of balance degradation to prevent falls, a crucial task whose relevance increases with the aging of the population. Due to the complexity of the quantification process, the analyses of sway patterns have been performed empirically using a number of variables, such as ellipse confidence area or mean velocity. This study reviews and compares a wide range of state-of-the-art variables that are used to assess the risk of fall in elderly from a stabilogram. When appropriate, we discuss the hypothesis and mathematical assumptions that underlie these variables, and we propose a reproducible method to compute each of them. Additionally, we provide a statistical description of their behavior on two datasets recorded in two elderly populations and with different protocols, to hint at typical values of these variables. First, the balance of 133 elderly individuals, including 32 fallers, was measured on a relatively inexpensive, portable force platform (Wii Balance Board, Nintendo) with a 25-s open-eyes protocol. Second, the recordings of 76 elderly individuals, from an open access database commonly used to test static balance analyses, were used to compute the values of the variables on 60-s eyes-open recordings with a research laboratory standard force platform.

Free Energy Principle in Human Postural Control System: Skin Stretch Feedback Reduces the Entropy

Human upright standing involves an integration of multiple sensory inputs such as vision, vestibular and somatosensory systems. It has been known that sensory deficits worsen the standing balance. However, how the modulation of sensory information contributes to postural stabilization still remains an open question for researchers. The purpose of this work was to formulate the human standing postural control system in the framework of the free-energy principle, and to investigate the efficacy of the skin stretch feedback in enhancing the human standing balance. Previously, we have shown that sensory augmentation by skin stretch feedback at the fingertip could modulate the standing balance of the people with simulated sensory deficits. In this study, subjects underwent ten 30-second trials of quiet standing balance with and without skin stretch feedback. Visual and vestibular sensory deficits were simulated by having each subject close their eyes and tilt their head back. We found that sensory augmentation by velocity-based skin stretch feedback at the fingertip reduced the entropy of the standing postural sway of the people with simulated sensory deficits. This result aligns with the framework of the free energy principle which states that a self-organizing biological system at its equilibrium state tries to minimize its free energy either by updating the internal state or by correcting body movement with appropriate actions. The velocity-based skin stretch feedback at the fingertip may increase the signal-to-noise ratio of the sensory signals, which in turn enhances the accuracy of the internal states in the central nervous system. With more accurate internal states, the human postural control system can further adjust the standing posture to minimize the entropy, and thus the free energy.

Effects of Foot Placement on Postural Sway in the Anteroposterior and Mediolateral Directions

The common practice of standardizing foot placement in postural research and in clinical practice may serve to increase postural sway. The focus of this study was to investigate foot placement strategies in the tandem (anteroposterior, AP) and side-to-side (mediolateral, ML) stance in healthy adults. Foot placement was either experimenter-controlled or selected by the participant. Greater sway was observed for the AP stance than the ML stance, where sway was minimal. When foot placement was self-selected, participants recruited additional degrees of freedom by rotating both feet outward to expand the base of support; they narrowed their stance width in the AP stance only. Self-selection served to decrease AP sway for the AP stance and increase ML sway for both the AP and ML stances. A dynamical measure, the largest Lyapunov exponent, supported the finding that self-selection of foot placement serves to stabilize posture. The implication is that improvements in postural control were due primarily to self-selection of foot placement and not to adjustments in stance width. Experimental and perhaps clinical procedures should be revised to allow participants to self-select foot placement during postural tasks.

The effect of firefighter protective garments, self-contained breathing apparatus and exertion in the heat on postural sway

Fire suppression wearing thermal protective clothing (TPC) and self-contained breathing apparatus (SCBA) challenges a firefighter's balance and may explain firefighter falls. Postural control based on force plate centre of pressure (COP) was compared for healthy subjects wearing TPC and SCBA before and after 20 min of heavy physical exertion in hot conditions. Baseline measures with and without TPC and SCBA (two different SCBA cylinder masses) were compared before and after exertion that included elements of fire suppression activities in an environmental chamber. COP excursion and variability increased with exertion for TPC and SCBA conditions compared to non-stressed conditions. The two different cylinder masses had no significant effect. Wearing TPC and SCBA when physically stressed in a hot environment increases postural sway and exacerbates postural control. Subjects compensated for the extra mass and adjusted to control postural sway with the addition of TPC and SCBA, but the stress protocol amplified these adjustments. Practitioner Summary: Firefighters wear thermal protective clothing (TPC) and self-contained breathing apparatus (SCBA) when heat-stressed and fatigued. Wearing TPC and SCBA was found to negatively impact balance when stressed, but not for non-stressed or two different sized SCBA tanks. Simulating fire-ground conditions wearing TPC and SCBA should be considered for improving balance.

Effects of spinal manipulation on sensorimotor function in low back pain patients--A randomised controlled trial

BACKGROUND

Low back pain (LBP) is a major health problem in industrialized societies. Spinal manipulation (SM) is often used for treating LBP, though the therapeutic mechanisms remain elusive. Research suggests that sensorimotor changes may be involved in LBP. It is hypothesized that SM may generate its beneficial effects by affecting sensorimotor functions.

OBJECTIVES

To compare changes in sensorimotor function, as measured by postural sway and response to sudden load, in LBP patients following the delivery of high-velocity low amplitude (HVLA)-SM or low-velocity variable amplitude (LVVA)-SM versus a sham control intervention.

DESIGN

A three-arm (1:1:1 ratio) randomized controlled trial.

METHODS

A total of 221 participants who were between 21 and 65 years, having LBP intensity (numerical rating scale) ≥4 at either phone screen or the first baseline visit and ≥2 at phone screen and both baseline visits, and Quebec Task Force diagnostic classifications of 1, 2, 3 or 7 were enrolled to receive four SM treatments over two weeks. Study outcomes were measured at the first and fifth visits with the examiners blinded from participant group assignment.

RESULTS

The LVVA-SM group demonstrated a significant increase in medial-to-lateral postural excursion on the soft surface at the first visit when compared to the control group. No other significant between-group differences were found for the two sensorimotor tests, whether during the first visit or over two weeks.

CONCLUSIONS

It appears that short-term SM does not affect the sensorimotor functions as measured by postural sway and response to sudden load in this study.

Effects of air bottle design on postural control of firefighters

The purpose of this study was to investigate the effect of firefighter's self-contained breathing apparatus (SCBA) air bottle design and vision on postural control of firefighters. Twenty-four firefighters were tested using four 30-minute SCBA bottle designs that varied by mass and size. Postural sway measures were collected using a forceplate under two visual conditions (eyes open and closed) and two stance conditions (quiet and perturbed stances). For perturbed stance, a mild backward impulsive pull at the waist was applied. In addition to examining center of pressure postural sway measures for both stance conditions, a robustness measure was assessed for the perturbation condition. The results suggest that wearing heavy bottles significantly increased excursion and randomness of postural sway only in medial-lateral direction but not in anterior-posterior direction. This result may be due to stiffening of plantar-flexor muscles. A significant interaction was obtained between SCBA bottle design and vision in anterior-posterior postural sway, suggesting that wearing heavy and large SCBA air bottles can significantly threaten postural stability in AP direction in the absence of vision. SCBA bottle should be redesigned with reduced weight, smaller height, and COM closer to the body of the firefighters. Firefighters should also widen their stance width when wearing heavy PPE with SCBA.