Virtual reality in posturography

Comparing the effects of different circular vection stimuli on upright stance

BACKGROUND

Upright quiet stance is maintained through the complex integration of sensory information from the visual, vestibular, and somatosensory systems [1]. Virtual reality (VR) is a well-established tool that has been used to study sensory contributions to balance and induce visual perturbations. Previous assessments of virtual environments have suggested that VR can be used to create various visual stimuli that affect balance [2]; however, there is limited work examining which dynamic visual stimulus, in the form of circular vection (CV), is the most effective at inducing whole body lean.

RESEARCH QUESTION

Therefore, this study assessed the effects of two visual stimuli using VR to better understand their effects on postural control.

METHODS

33 healthy young adults between the ages of 18-40, free of neurological impairments, stood quietly on a force plate for 30 s while wearing a head-mounted display. Participants were exposed to a field of random white dots (DOTS) or a black and white striped tunnel (TUNNEL) that rotated in the roll plane at 60°/s clockwise or counterclockwise. Amplitude was calculated from head orientation data recorded from a head-mounted display, and centre of pressure (COP).

RESULTS

Independent of visual stimuli, postural lean was in the same direction as the stimulus. The DOTS stimulus increased Head orientation and COP position compared to the TUNNEL stimulus. There was no significant main effect or interaction with direction for Head or COP data.

SIGNIFICANCE

When comparing the effect of stimulus design on postural sway, a DOTS stimulus was most effective at inducing direction-modulated postural sway This study builds on our understanding of the VR-related destabilizing effects on postural control and shows evidence that a DOTS stimulus has a stronger effect than a TUNNEL stimulus. Overall, it is important to consider the design of visual stimuli when examining VR effects on upright stance.

Virtual Reality-A Supplement to Posturography or a Novel Balance Assessment Tool?

Virtual reality (VR) is a well-established technology in medicine. Head-mounted displays (HMDs) have made VR more accessible in many branches of medical research. However, its application in balance evaluation has been vague, and comprehensive literature on possible applications of VR in posture measurement is scarce. The aim of this review is to conduct a literature search on the application of immersive VR delivered using a head-mounted display in posturographic measurements. A systematic search of two databases, PubMed and Scopus, using the keywords "virtual reality" and "posturography," was performed following PRISMA guidelines for systematic reviews. Initial search results returned 89 non-duplicate records. Two reviewers independently screened the abstracts. Sixteen papers fulfilled the inclusion criteria and none of the exclusion criteria and were selected for complete text retrieval. An additional 16 records were identified from citation searching. Ultimately, 21 studies were included in this review. virtual reality is often used as additional visual stimuli in static and dynamic posturography evaluation. Only one study has attempted to evaluate a VR environment in a head-mounted display as an independent method in the assessment of posture. Further research should be conducted to assess HMD VR as a standalone posturography replacement.

Virtual Reality, Visual Cliffs, and Movement Disorders

We outline an experimental setup designed to dynamically understand neural responses to visual cliffs while walking. The goal of our work is understanding and mitigating fear of falling, particularly among the elderly. In our setup, an EEG cap monitors a subject's neural activity while the subject is immersed in a virtual world and walking on an instrumented treadmill. The subject's response to visual stimuli is measured by both the EEG cap and by speed and pressure data from the treadmill. Based on this data, we can dynamically alter the landscape in the virtual world. We hope that our setup may be useful in helping subjects develop mechanisms to compensate for significant fear of falling while walking.

Virtual reality applications in assessing the effect of anxiety on sensorimotor integration in human postural control

Falls are a leading cause of injury and mortality among adults over the age of 65 years. Given the strong relation between fear of falling and fall risk, identification of the mechanisms that underlie anxiety-related changes in postural control may pave the way to the development of novel therapeutic strategies aimed at reducing fall risk in older adults. First, we review potential mechanisms underlying anxiety-mediated changes in postural control in older adults with and without neurological conditions. We then present a system that allows for the simultaneous recording of neural, physiological, and behavioral data in an immersive virtual reality (VR) environment while implementing sensory and mechanical perturbations to evaluate alterations in sensorimotor integration under conditions with high postural threat. We also discuss applications of VR in minimizing falls in older adults and potential future studies.

Deception effects on standing center of pressure

Accurate deception detection is a desirable goal with many applications including credibility assessment, security screening, counter-terrorism, and homeland security. However, many deception detection methodologies involve intrusive sensors or other limitations that preclude their use in a covert manner. Posturography may overcome these limitations by using minimally invasive force platform technology. In this study, we tested the hypothesis that posturography would reveal deception-related increases in postural rigidity similar to those observed with previous methodologies. Participants were randomly assigned to a control (CG) or experimental group (EG), and interviewed about the contents of a backpack in their possession while standing on a force platform. EG participants were asked to conceal the presence of several "prohibited" items in the backpack from the interviewer. Center of pressure (COP) measures from the force platform were used to characterize postural sway during participants' verbal responses. We observed a significant deception-related increase in sway frequency, an effect primarily occurring during longer responses that is likely related to increased cognitive load. These findings suggest deception-related increases in postural rigidity as reported in previous work, and demonstrate the feasibility of using posturography as a deception detection tool.

Assessment of Visual Reliance in Balance Control: An Inexpensive Extension of the Static Posturography

Ability of humans to maintain balance in an upright stance and during movement activities is one of the most natural skills affecting everyday life. This ability progressively deteriorates with increasing age, and balance impairment, often aggravated by age-related diseases, can result in falls that adversely impact the quality of life. Falls represent serious problems of health concern associated with aging. Many investigators, involved in different science disciplines such as medicine, engineering, psychology, and sport, have been attracted by a research of the human upright stance. In a clinical practice, stabilometry based on the force plate is the most widely available procedure used to evaluate the balance. In this paper, we have proposed a low-cost extension of the conventional stabilometry by the multimedia technology that allows identifying potentially disturbing effects of visual sensory information. Due to the proposed extension, a stabilometric assessment in terms of line integral of center of pressure (COP) during moving scene stimuli shows higher discrimination power between young healthy and elderly subjects with supposed stronger visual reliance.

Posturography with virtual reality stimulations in normal young adults with no balance complaints

PURPOSE

To analyze the findings of posturography with virtual reality stimuli carried out in young healthy adults with no otoneurological complaints, based on the parameters center of pressure, limit of stability and sway speed for different visual stimuli, and regarding differences between female and male genders.

METHODS

Participants were 50 healthy individuals of both genders (50% female and 50% male) with ages ranging from 18 to 25 years (mean age 21.30 years), with no complaints regarding body balance, and with vestibular outcomes assessed through digital vectonistagmography within normal limits. Posturography was composed of 11 visual stimuli and determined the limit of stability area (LOS), the ellipse area, and the sway speed in ten sensorial conditions. Results were calculated for the studied age range and analyzed according to the values for each stimulus, with the aim to obtain normality parameters.

RESULTS

The average values obtained in posturography regarding limit of stability, ellipse area and sway speed for stimuli with viso-vestibular interaction presented significant differences between genders, and, in all cases, women obtained lower values than men.

CONCLUSION

The findings of posturography with virtual reality stimuli in healthy young adults evidence that the parameters center of pressure, limit of stability and sway speed present differences between genders and, therefore, must be considered separately.

Determining level of postural control in young adults using force-sensing resistors

A force-sensing platform (FSP), sensitive to changes of the postural control system was designed. The platform measured effects of postural perturbations in static and dynamic conditions. This paper describes the implementation of an FSP using force-sensing resistors as sensing elements. Real-time qualitative assessment utilized a rainbow color scale to identify areas with high force concentration. Postprocessing of the logged data provided end-users with quantitative measures of postural control. The objective of this research was to establish the feasibility of using an FSP to test and gauge human postural control. Tests were conducted in eye open and eye close states. Readings obtained were tested for repeatability using a one-way analysis of variance test. The platform gauged postural sway by measuring the area of distribution for the weighted center of applied pressure at the foot. A fuzzy clustering algorithm was applied to identify regions of the foot with repetitive pressure concentration. Potential application of the platform in a clinical setting includes monitoring rehabilitation progress of stability dysfunction. The platform functions as a qualitative tool for initial, on-the-spot assessment, and quantitative measure for postacquisition assessment on balance abilities.

Wavelet analysis to detect gait events

Manually detecting gait events by visual inspection of gait data is laborious. Currently, there are no robust techniques available to automate the process. However, detecting gait events is essentially a classification problem; an application for which wavelet analysis, a multiresolution technique, is well suited for. We employ wavelet analysis to classify heel strike- and toe off events using the ground reaction forces that are exerted during walking. We recorded the ground reaction forces for 30 unshod healthy subjects while they were stepping in place on a force platform for 30 s at a self-selected pace. Depending on the pace, each subject completed 14-26 gait cycles. We compared the timing of events detected with the wavelet analysis with the timing of events detected by analyzing the signal time-derivative. On average, the wavelet analysis detected the events 29 ms later. This difference corresponds to 1.2% of the average duration of the gait cycles, which was 2.4 s. Wavelet analysis shows promise for automated detection of gait events.

Space and motion discomfort and abnormal balance control in patients with anxiety disorders

OBJECTIVE

Previous research suggested that panic disorder with agoraphobia is associated with abnormalities on vestibular and balance function tests. The purpose of this study was to further examine psychiatric correlates of vestibular/balance dysfunction in patients with anxiety disorders and the specific nature of the correlated vestibular abnormalities. The psychiatric variables considered included anxiety disorder versus normal control status, panic disorder versus non-panic anxiety disorder diagnosis, presence or absence of comorbid fear of heights, and degree of space and motion discomfort (SMD). The role of anxiety responses to vestibular testing was also re-examined.

METHODS

104 subjects were recruited: 29 psychiatrically normal individuals and 75 psychiatric patients with anxiety disorders. Anxiety patients were assigned to four subgroups depending on whether or not they had panic disorder and comorbid fear of heights. SMD and anxiety responses were measured by questionnaires. Subjects were examined for abnormal unilateral vestibular hypofunction on caloric testing indicative of peripheral vestibular dysfunction, asymmetric responses on rotational testing as an indicator of an ongoing vestibular imbalance and balance function using Equitest dynamic posturography as an indicator of balance control. Logistic regression was used to establish the association between the psychiatric variables and vestibular or balance test abnormalities.

RESULTS

Rotational test results were not significantly related to any of the psychiatric variables. The presence of either panic attacks or fear of heights increased the probability of having caloric hypofunction in a non-additive fashion. SMD and anxiety responses were independently associated with abnormal balance. Among specific posturography conditions, the association with SMD was significant for a condition that involved the balance platform tilting codirectionally with body sway, suggesting an abnormal dependence on somatosensory cues in the control of balance.

CONCLUSION

In patients with anxiety disorders, higher SMD is indicative of somatosensory dependence in the control of balance. The absence of both panic and fear of heights reduces the probability of having peripheral vestibular dysfunction. Future research should examine if vestibular rehabilitation can be of value for patients with anxiety disorders complicated by SMD.

Modelling stabilograms with hidden Markov models

Hidden Markov models are an effective computational method for modelling and interpreting digital signals of biological, as well as other, origin. In the current investigation, we explored whether hidden Markov models can be used to control and represent phenomena in human balance signals recorded from subjects standing on a force platform. Additionally, our aim was to classify healthy controls and patients who suffered from Meniere's disease into their own classes. Hidden Markov models were capable of these tasks and of overcoming such disturbances as noise and other unforeseen perturbations in balance signals, which are inherently complex and possibly difficult to visually specify.

Modeling balance control during sustained waking allows posturographic sleepiness testing

We develop a method to quantify sleepiness. Sleepiness is a major risk factor in traffic and occupational accidents, but lack of convenient tests precludes monitoring impending sleepiness. Posturographic balance testing could address this need because sleepiness increases postural sway. It is, however, unclear how sleepiness influences balance control. Our results, for 12 subjects, show that balance control is more susceptible to increasing time awake (TA) compared to neuromuscular processes. This conclusion is reached since during sustained waking the control process slows down by 3.4% per hour of increased TA. This slowdown accounts for 65% of the variance in diurnal balance. We quantified balance control by modeling the body as an inverted pendulum and by expressing the control as the critical time interval for open-loop control (Deltat(c)) of the center-of-mass movements of this pendulum. To estimate the subjects' TA, we regressed the Deltat(c) scores recorded during sustained waking against increasing TA, and equated separate Deltat(c) test scores with the diurnal Deltat(c) scores. We estimated TA with 68% positive predictive value. The results encourage implementing balance modeling into a device that performs clinical or industrial balance testing because the model-based Deltat(c) score responded to increasing TA.

Daytime Changes in Postural Stability and Repeatability of Posturographic Measurements

OBJECTIVE

Daytime sleepiness correlates with sleep-related accidents, but convenient tests for occupational sleepiness monitoring are scarce. The effect of daytime on balance, on posturographic measurements, and on their repeatability was investigated in 30 healthy volunteers as part of our work to develop such a test.

METHODS

The daytime effect was assessed by measuring balance at 8:30 am, 10:30 am, and 1:30 pm. The repeatability was assessed with morning trials once a week for 1 month. The posturographic test was performed on a static force platform, and the balance was evaluated from a fractal dimension of sway, most common sway amplitude, and time interval for open-loop stance control.

RESULTS

The balance worsened during the day, and it was possible to determine whether the measurement was performed in the morning or in the afternoon. The morning balance remained unchanged during the month-long test.

CONCLUSIONS

Posturographic measurements are repeatable and have a circadian effect, which may be influenced by sleepiness.