Aging and postural control: postural perturbations caused by changing the visual anchor

Lifespan changes in postural control

Lifespan development of postural control shows as an inverted U-shaped function with optimal performance in young adults and similar levels of underperformance in children and older adults. However, similarities in children and older adults might conceal differences in underlying control processes. We mapped out age-related differences in postural control using center-of-pressure trajectories of 299 participants ranging from 7 to 81 years old in three tasks: stable stance, compromised vision, and narrowed base of support. Summary statistics (path length, ellipse area) replicated the well-known U-shape function also showing that compromising vision and narrowing the base of support affected older adults more than children. Stabilogram diffusion analysis (SDA) allows to assess postural control performance in terms of diffusion at short (< 1 s) and longer timescales. SDA parameters showed the strongest short-term drift in older adults, especially under compromised vision or narrowed base of support conditions. However, older adults accommodated their poor short-term control by corrective adjustments as reflected in long-term diffusion under eyes closed conditions and initiating anti-persistent behavior earlier compared with children and young adults in tandem stance. We argue that these results highlight the adaptability of the postural control system and warrant a reinterpretation of previous postural control frameworks.

Embodied Mental Rotation - Does It Affect Postural Stability?

The effect of different human body part stimuli in mental rotation tasks (MRTs) on postural stability was investigated in two dual-task experiments. There were significant differences within egocentric MRTs (Experiment 1, N = 46): Hand and foot stimuli tended to cause more body sway than whole-body figures and showed increased body sway for higher rotation angles in the MRTs. In object-based MRTs (Experiment 2, N = 109) different stimuli did not evoke different levels of body sway, but higher rotation angles led to higher body sway. Both experiments showed a stabilizing effect of MRTs compared to the control condition. Exploratorily analyses identified reaction time in MRTs as a significant predictor of body sway. The results suggest a heterogeneous impact of mental rotation on postural stability.

Less Vibrotactile Feedback Is Effective to Improve Human Balance Control during Sensory Cues Alteration

For individuals with altered sensory cues, vibrotactile feedback improves their balance control. However, should vibrotactile feedback be provided every time balance control is compromised, or only one-third of the time their balance is compromised? We hypothesized that vibrotactile feedback would improve balance control more when provided every time their balance is compromised. Healthy young adults were randomly assigned to two groups: group 33% feedback (6 males and 6 females) and group 100% feedback (6 males and 6 females). Vibrotactile feedbacks related to the body's sway angle amplitude and direction were provided, while participants stood upright on a foam surface with their eyes closed. Then, we assessed if balance control improvement lasted when the vibrotactile feedback was removed (i.e., post-vibration condition). Finally, we verified whether or not vibrotactile feedback unrelated to the body's sway angle and direction (sham condition) altered balance control. The results revealed no significant group difference in balance control improvement during vibrotactile feedback. Immediately following vibrotactile feedback, both groups reduced their balance control commands; body sway velocity and the ground reaction forces variability decreased. For both groups, unrelated vibrotactile feedback worsened balance control. These results confirmed that participants processed and implemented vibrotactile feedback to control their body sways. Less vibrotactile feedback was effective in improving balance control.

Effect of cognitive task complexity on dual task postural stability: a systematic review and meta-analysis

The dual task experimental paradigm is used to probe the attentional requirements of postural control. However, findings of dual task postural studies have been inconsistent with many studies even reporting improvement in postural stability during dual tasking and thus raising questions about cognitive involvement in postural control. A U-shaped non-linear relationship has been hypothesized between cognitive task complexity and dual task postural stability suggesting that the inconsistent results might have arisen from the use of cognitive tasks of varying complexities. To systematically review experimental studies that compared the effect of simple and complex cognitive tasks on postural stability during dual tasking, we searched seven electronic databases for relevant studies published between 1980 to September 2020. 33 studies involving a total of 1068 participants met the review's inclusion criteria, 17 of which were included in meta-analysis (healthy young adults: 15 studies, 281 participants; Stroke patients: 2 studies, 52 participants). Narrative synthesis of the findings in studies involving healthy old adults was carried out. Our result suggests that in healthy population, cognitive task complexity may not determine whether postural stability increases or decreases during dual tasking (effect of cognitive task complexity was not statistically significant; P > 0.1), and thus the U-shaped non-linear hypothesis is not supported. Rather, differential effect of dual tasking on postural stability was observed mainly based on the age of the participants and postural task challenge, implying that the involvement of cognitive resources or higher cortical functions in the control of postural stability may largely depends on these two factors.

The Relation of Mental Rotation and Postural Stability

Main goal of this study was to investigate the influence of mental rotation tasks on postural stability. 84 participants were tested with two object-based mental rotation tasks (cube vs. human figures), an egocentric mental rotation task with one human figure, a math- (cognitive control) and a neutral task, while standing on a force plate in a both-legged narrow stance. Parameters related to the Center of Pressure course over time were used to quantify postural stability. The simultaneous solution of mental rotation tasks has led to postural stabilisation compared to the neutral condition. Egocentric tasks provoked more postural stability than object-based tasks with cube figures. Furthermore, a more stable stance was observed for embodied stimuli than for cube figures. An explorative approach showed the tendency that higher rotation angles of the object-based mental rotation task stimuli lead to more postural sway. These results contribute to a better understanding of the interaction between mental rotation and motor skills and emphasize the role of type of task and embodiment in dual task research.

Minimal shoes improve stability and mobility in persons with a history of falls

Postural and walking instabilities contribute to falls in older adults. Given that shoes affect human locomotor stability and that visual, cognitive and somatosensory systems deteriorate during aging, we aimed to: (1) compare the effects of footwear type on stability and mobility in persons with a history of falls, and (2) determine whether the effect of footwear type on stability is altered by the absence of visual input or by an additional cognitive load. Thirty participants performed standing and walking trials in three footwear conditions, i.e. conventional shoes, minimal shoes, and barefoot. The outcomes were: (1) postural stability (movement of the center of pressure during eyes open/closed), (2) walking stability (Margin of Stability during normal/dual-task walking), (3) mobility (the Timed Up and Go test and the Star Excursion Balance test), and (4) perceptions of the shoes (Monitor Orthopaedic Shoes questionnaire). Participants were more stable during standing and walking in minimal shoes than in conventional shoes, independent of visual or walking condition. Minimal shoes were more beneficial for mobility than conventional shoes and barefoot. This study supports the need for longitudinal studies investigating whether minimal footwear is more beneficial for fall prevention in older people than conventional footwear.

Postural control in paw distance after labyrinthectomy-induced vestibular imbalance

Balance control is accomplished by the anatomical link which provides the neural information for the coordination of skeletal muscles. However, there are few experimental proofs to directly show the neuroanatomical connection. Here, we examined the behavioral alterations by constructing an animal model with chemically induced unilateral labyrinthectomy (UL). In the experiment using rats (26 for UL, 14 for volume cavity, 355-498 g, male), the models were initially evaluated by the rota-rod (RR) test (21/26, 80.8%) and ocular displacement (23/26, 88.5%). The duration on the rolling rod decreased from 234.71 ± 64.25 s (4th trial before UL) to 11.81 ± 17.94 s (1st trial after UL). Also, the ocular skewed deviation (OSD) was observed in the model with left (5.79 ± 3.06°) and right lesion (3.74 ± 2.69°). Paw distance (PW) was separated as the front (FPW) and the hind side (HPW), and the relative changes of HPW (1.71 ± 1.20 cm) was larger than those of FPW (1.39 ± 1.06 cm), providing a statistical significance (p = 1.51 × 10^-4, t test). Moreover, the results of the RR tests matched to those of the changing rates (18/21, 85.7%), and the changes (16/18, 88.9%) were dominantly observed in HPW (in FPW, 2/18, 11.1%). Current results indicated that the UL directly affected the changes in HPW more than those in FPW. In conclusion, the missing neural information from the peripheral vestibular system caused the abnormal posture in HPW, and the postural instability might reduce the performance during the voluntary movement shown in the RR test, identifying the relation between the walking imbalance and the unstable posture in PW. Graphical abstract.

Age-Related Changes in Postural Control in Physically Inactive Older Women

BACKGROUND AND PURPOSE

The maintenance of postural control is influenced by the complexity of a given task. Tasks that require greater attention and cognitive involvement increase the risk of falls among older adults. The aim of the present study was to evaluate the adaptation of the postural control system to different levels of task complexity in physically inactive young and older women.

METHODS

A cross-sectional study was conducted with adult women classified as physically inactive based on the results of the International Physical Activity Questionnaire. The participants were 27 young (20-30 years of age) and 27 older (60-80 years of age) women. Sway velocity of the center of pressure in the anterior-posterior and medial-lateral directions was calculated using a force plate under 6 conditions: standing directly on the force plate or on a foam placed over the force plate, eyes open or closed, and dual-task complexity with and without the foam.

RESULTS AND DISCUSSION

A 2-way analysis of variance revealed that sway velocity increased in both groups when the task conditions were altered. The older women exhibited significantly greater sway velocity compared with the young women on all tasks. However, the patterns of postural control adaptation to the different levels of complexity were similar among all participants.

CONCLUSIONS

In this study, the adaption of the postural control system to different levels of task complexity did not differ between physically inactive young and physically inactive older women. However, the physically inactive older women exhibited greater sway velocity compared with the young women.

Agreement of Three Posturographic Force Plates in the Assessment of Postural Stability

This study was designed to assess how the results obtained for three different posturographic platforms agreed with each other in an assessment of static postural stability. The study included 111 young healthy participants. A measurement of postural stability was made for each participant, with their eyes open and then closed, on each platform in a random order. The Romberg ratio, path length, and center of pressure (COP) area were analyzed. For all measures, significant differences (p < 0.05) were observed among the three force plates. The highest Spearman's rank correlation was observed between Alfa vs. CQStab2P (0.20 to 0.38), and the lowest between Alfa vs. AccuGait (-0.19 to 0.09). Similar results were obtained for the concordance correlation coefficient (0.10 to 0.22 for Alfa vs. CQStab2P and -0.6 to 0.02 for Alfa vs. AccuGait). Bland-Altman analysis for values standardized (z-scores) against AccuGait indicated a low level of agreement between compared platforms, with the largest error between AccuGait vs. Alfa, and a slightly lower error between AccuGait vs. CQStab2P or Alfa vs. CQStab2P. The 95% limits of agreement ranged from 2.38 to 7.16 (Alfa vs. AccuGait), 2.09 to 5.69 (CQStab2P vs. AccuGait), and 1.39 to 7.44 (AccuGait vs. Alfa) in COP length with eyes open and COP length Romberg ratio, respectively. Special care is recommended when comparing values relating to COPs from different devices that are analyzed by different software. Moreover, unperturbed stance tests among young healthy adults can be questioned as a valid postural control parameter.

Postural Control Profiles of Typically Developing Children From 6 to 12 Years old: An Approach Using Self-Organizing Maps

The purposes of the present study were a) to establish postural control profiles for individuals 6–12 years of age, b) to analyze the participants’ characteristics (age, sex, weight, height, and physical activity) in those profiles, and c) to analyze the influence of visual information in the profiles found. Two hundred and eight typically developing children aged 6–12 years performed two trials in bipedal standing position with eyes open and closed. Feature extraction involved time, frequency, and sway-density plot variables using signals from the center of pressure. A Self-Organizing Map was used to classify and visualize the values of the participants in all the postural control variables tested. A k-means cluster analysis was applied to generate a small number of postural control profiles. The results determined six postural control profiles; three with participants denoting high stability and three considered as low stability profiles. Age, sex, and height were related to the postural control profiles. Boys were more frequently allocated in high stability clusters than girls, while the other factors yielded unclear difference between high and low stability profiles. The analysis of children’s profiles reflecting postural stability should therefore involve more than one factor including the individuals’ age, sex, and height.

Minimal footwear improves stability and physical function in middle-aged and older people compared to conventional shoes

BACKGROUND

Effects of minimal shoes on stability and physical function in older people are under-researched. No studies have systematically explored effects of a range of minimal footwear features on these factors in older people.

METHODS

A within-participant repeated-measures design was used. Participants were subjected to thirteen footwear conditions: (i) barefoot, (ii) a conventional shoe, (iii) a control minimal shoe, (iv-xiii) minimal shoes differing from the control minimal shoe by one design feature. The outcomes were: (i) postural stability expressed with movement of the center of pressure (CoP) during standing (ii) dynamic stability expressed with the CoP movement during walking, (iv) physical function assessed with the Timed Up and Go test (TUG), and (iv) perceptions of footwear assessed with the Monitor Orthopaedic Shoes questionnaire. Linear Mixed Models were applied for statistical analyses.

FINDINGS

Twenty-two people participated in the study. Compared to the conventional shoe, participants: (i) were more stable during standing and walking in the majority of minimal shoes, and (ii) completed the TUG test faster when wearing the minimal shoe with wider sole. Compared to the control minimal shoe, participants: (i) completed the TUG test faster when wearing the minimal shoe with wider sole; and (ii) perceived features such as a split toe and a higher ankle collar as less fashionable and wearable.

INTERPRETATION

Wearing minimal shoes might be more beneficial for stability and physical function in older adults than wearing conventional shoes. The results will be highly valuable for the design of minimal footwear for older adults.

User-centred design of an active computer gaming system for strength and balance exercises for older adults

Purpose

Active computer gaming (ACG) is a way for older people to participate in strength and balance exercise. Involving older adults in the development of a bespoke ACG system may optimise its usability and acceptability. The purpose of this paper is to employ user-centred design to develop an ACG system to deliver strength and balance exercises, and to explore its safety, usability and acceptability in older adults.

Design/methodology/approach

This paper describes user involvement from an early stage, and its influence on the development of the system to deliver strength and balance exercise suitable for display on a flat screen or using an Oculus Rift virtual reality (VR) headset. It describes user testing of this ACG system in older adults.

Findings

Service users were involved at two points in the development process. Their feedback was used to modify the ACG system prior to user testing of a prototype of the ACG system by n=9 older adults. Results indicated the safety, usability and acceptability of the system, with a strong preference for the screen display.

Research limitations/implications

The sample size for user testing was small; however, it is considered to have provided sufficient information to inform the further development of the system.

Practical implications

Findings from user testing were used to modify the ACG system. This paper identified that future research could explore the influence of repeated use on the usability and acceptability of ACG in older adults.

Originality/value

There is limited information on the usability and acceptability VR headsets in this population.

Age-related changes in leg proprioception: implications for postural control

In addition to being a prerequisite for many activities of daily living, the ability to maintain steady upright standing is a relevant model to study sensorimotor integrative function. Upright standing requires managing multimodal sensory inputs to produce finely tuned motor output that can be adjusted to accommodate changes in standing conditions and environment. The sensory information used for postural control mainly arises from the vestibular system of the inner ear, vision, and proprioception. Proprioception (sense of body position and movement) encompasses signals from mechanoreceptors (proprioceptors) located in muscles, tendons, and joint capsules. There is general agreement that proprioception signals from leg muscles provide the primary source of information for postural control. This is because of their exquisite sensitivity to detect body sway during unperturbed upright standing that mainly results from variations in leg muscle length induced by rotations around the ankle joint. However, aging is associated with alterations of muscle spindles and their neural pathways, which induce a decrease in the sensitivity, acuity, and integration of the proprioceptive signal. These alterations promote changes in postural control that reduce its efficiency and thereby may have deleterious consequences for the functional independence of an individual. This narrative review provides an overview of how aging alters the proprioceptive signal from the legs and presents compelling evidence that these changes modify the neural control of upright standing.

Effects of Hand and Hemispace on Multisensory Integration of Hand Position and Visual Feedback

The brain generally integrates a multitude of sensory signals to form a unified percept. Even in cursor control tasks, such as reaching while looking at rotated visual feedback on a monitor, visual information on cursor position and proprioceptive information on hand position are partially integrated (sensory coupling), resulting in mutual biases of the perceived positions of cursor and hand. Previous studies showed that the strength of sensory coupling (sum of the mutual biases) depends on the experience of kinematic correlations between hand movements and cursor motions, whereas the asymmetry of sensory coupling (difference between the biases) depends on the relative reliabilities (inverse of variability) of hand-position and cursor-position estimates (reliability rule). Furthermore, the precision of movement control and perception of hand position are known to differ between hands (left, right) and workspaces (ipsilateral, contralateral), and so does the experience of kinematic correlations from daily life activities. Thus, in the present study, we tested whether strength and asymmetry of sensory coupling for the endpoints of reaches in a cursor control task differ between the right and left hand and between ipsilateral and contralateral hemispace. No differences were found in the strength of sensory coupling between hands or between hemispaces. However, asymmetry of sensory coupling was less in ipsilateral than in contralateral hemispace: in ipsilateral hemispace, the bias of the perceived hand position was reduced, which was accompanied by a smaller variability of the estimates. The variability of position estimates of the dominant right hand was also less than for the non-dominant left hand, but this difference was not accompanied by a difference in the asymmetry of sensory coupling – a violation of the reliability rule, probably due a stronger influence of visual information on right-hand movements. According to these results, the long-term effects of the experienced kinematic correlation between hand movements and cursor motions on the strength of sensory coupling are generic and not specific for hemispaces or hands, whereas the effects of relative reliabilities on the asymmetry of sensory coupling are specific for hemispaces but not for hands.

The Promise of Stochastic Resonance in Falls Prevention

Multisensory integration is essential for maintenance of motor and cognitive abilities, thereby ensuring normal function and personal autonomy. Balance control is challenged during senescence or in motor disorders, leading to potential falls. Increased uncertainty in sensory signals is caused by a number of factors including noise, defined as a random and persistent disturbance that reduces the clarity of information. Counter-intuitively, noise can be beneficial in some conditions. Stochastic resonance is a mechanism whereby a particular level of noise actually enhances the response of non-linear systems to weak sensory signals. Here we review the effects of stochastic resonance on sensory modalities and systems directly involved in balance control. We highlight its potential for improving sensorimotor performance as well as cognitive and autonomic functions. These promising results demonstrate that stochastic resonance represents a flexible and non-invasive technique that can be applied to different modalities simultaneously. Finally we point out its benefits for a variety of scenarios including in ambulant elderly, skilled movements, sports and to patients with sensorimotor or autonomic dysfunctions.

How does ageing affect grasp adaptation to a visual-haptic size conflict?

Previous research suggests that the ability to adapt motor behaviour to sudden environmental changes may be impaired in older adults. Here, we investigated whether the adaptation of grasping behaviour in response to a visual-haptic size conflict is also affected by increasing age. 30 older and 18 young adults were instructed to grasp a hidden block whilst viewing a second block in a congruent position. Initially block sizes were equal, but after a set number of trials a sensory conflict was introduced by covertly changing the hidden block for a smaller or larger block. The scale and speed of maximum grasp aperture adaptation to the increase or decrease in the size of the hidden block was measured. Older adults successfully adapted to the visual-haptic size conflict in a similar manner to young adults, despite a tendency to adapt less when the hidden block increased in size. This finding is attributed to the physical capabilities of the grasping hand of older adults, rather than an effect of age-related sensory or cognitive decline. The speed of grasp adaptation did not differ between age groups; however, awareness of the visual-haptic conflict lead to faster adaptation. These findings suggest that sensorimotor adaptation for grasping is intact for cognitively healthy older adults.

Center of Pressure Motion After Calf Vibration Is More Random in Fallers Than Non-fallers: Prospective Study of Older Individuals

Aging is associated with changes in balance control and elderly take longer to adapt to changing sensory conditions, which may increase falls risk. Low amplitude calf muscle vibration stimulates local sensory afferents/receptors and affects sense of upright when applied in stance. It has been used to assess the extent the nervous system relies on calf muscle somatosensory information and to rapidly change/perturb part of the somatosensory information causing balance unsteadiness by addition and removal of the vibratory stimulus. This study assessed the effect of addition and removal of calf vibration on balance control (in the absence of vision) in elderly individuals (>65 years, n = 99) who did (n = 41) or did not prospectively report falls (n = 58), and in a group of young individuals (18-25 years, n = 23). Participants stood barefoot and blindfolded on a force plate for 135 s. Vibrators (60 Hz, 1 mm) attached bilaterally over the triceps surae muscles were activated twice for 15 s; after 15 and 75 s (45 s for recovery). Balance measures were applied in a windowed (15 s epoch) manner to compare center-of-pressure (CoP) motion before, during and after removal of calf vibration between groups. In each epoch, CoP motion was quantified using linear measures, and non-linear measures to assess temporal structure of CoP motion [using recurrence quantification analysis (RQA) and detrended fluctuation analysis]. Mean CoP displacement during and after vibration did not differ between groups, which suggests that calf proprioception and/or weighting assigned by the nervous system to calf proprioception was similar for the young and both groups of older individuals. Overall, compared to the elderly, CoP motion of young was more predictable and persistent. Balance measures were not different between fallers and non-fallers before and during vibration. However, non-linear aspects of CoP motion of fallers and non-fallers differed after removal of vibration, when dynamic re-weighting is required. During this period fallers exhibited more random CoP motion, which could result from a reduced ability to control balance and/or a reduced ability to dynamically reweight proprioceptive information. These results show that non-linear measures of balance provide evidence for deficits in balance control in people who go on to fall in the following 12 months.

Changes in Regional Brain Grey-Matter Volume Following Successful Completion of a Sensori-Motor Intervention Targeted at Healthy and Fall-Prone Older Adults

Previous studies have suggested that discrete cross-sensory events could be incorrectly combined in the brain of older adults with a history of falls, possibly undermining motor and balance control. Based on previous findings that multisensory integration is modifiable with practice, even in an ageing population, we designed a serious game, named CityQuest, to train typical, everyday multisensory processes including sensori-motor control, spatial navigation, obstacle avoidance and balance control. Played over several sessions, this game was shown to improve these functions in older adults with and without a history of falls, depending on the specific condition of the game on which they were trained. Here, using voxel-based morphometry analysis of anatomical magnetic resonance imaging (MRI) data, we investigated structural changes in the brain of a smaller group of older adults from those who successfully completed this five-week intervention. A grey-matter (GM) volume increase in the precentral gyrus, and GM volume reduction in the inferior temporal and orbitofrontal gyri, was found for all participants. Changes in GM volume within regions of the cerebellum were differentially associated with fall-prone and healthy older adults. Furthermore, a greater GM volume increase in the precentral gyrus was observed in participants who performed the full CityQuest intervention relative to those required to avoid obstacles only. Our results support previous evidence that multisensory training can affect structural changes in the older brain and have implications for programmes designed for the successful rehabilitation of perceptual and cognitive functions.

Dynamic modulation of visual and electrosensory gains for locomotor control

Animal nervous systems resolve sensory conflict for the control of movement. For example, the glass knifefish, Eigenmannia virescens, relies on visual and electrosensory feedback as it swims to maintain position within a moving refuge. To study how signals from these two parallel sensory streams are used in refuge tracking, we constructed a novel augmented reality apparatus that enables the independent manipulation of visual and electrosensory cues to freely swimming fish (n = 5). We evaluated the linearity of multisensory integration, the change to the relative perceptual weights given to vision and electrosense in relation to sensory salience, and the effect of the magnitude of sensory conflict on sensorimotor gain. First, we found that tracking behaviour obeys superposition of the sensory inputs, suggesting linear sensorimotor integration. In addition, fish rely more on vision when electrosensory salience is reduced, suggesting that fish dynamically alter sensorimotor gains in a manner consistent with Bayesian integration. However, the magnitude of sensory conflict did not significantly affect sensorimotor gain. These studies lay the theoretical and experimental groundwork for future work investigating multisensory control of locomotion.

Feet deformities are correlated with impaired balance and postural stability in seniors over 75

Objective

Understanding the factors and mechanisms that determine balance in seniors appears vital in terms of their self-reliance and overall safety. The study aimed to determine the relationship between the features of feet structure and the indicators of postural stability in the elderly.

Methods

The study group comprised 80 seniors (41F, 39M; aged 75–85 years). CQ-ST podoscope and the CQ-Stab 2P two-platform posturograph were used as primary research tools. The data were analyzed based on Spearman’s rank correlation and forward stepwise regression.

Results

Analysis of forward stepwise regression identified the left foot length in females and Clarke’s angle of the left foot in men as significant and independent predictors of postural up to 30% of the variance of dependent variables.

Conclusions

Longer feet provide older women with better stability, whereas in men, the lowering of the longitudinal arch results in postural deterioration. In the elderly, the left lower limb shows greater activity in the stabilizing processes in the standing position than the right one. In gerontological rehabilitation special attention should be paid to the individually tailored, gender-specific treatment, with a view to enhancing overall safety and quality of seniors’ lives.

Inclination of standing posture due to the presentation of tilted view through an immersive head-mounted display

[Purpose] The purpose of the present study is to clarify whether tilted scenery presented through an immersive head-mounted display (HMD) causes the inclination of standing posture. [Subjects and Methods] Eleven healthy young adult males who provided informed consent participated in the experiment. An immersive HMD and a stereo camera were employed to develop a visual inclination system. The subjects maintained a standing posture twice for 5s each while wearing the visual inclination system. They performed this task under two conditions: normal view and 20° leftward tilted view. A three-dimensional motion analysis system was used to measure the subjects’ postures, and two force plates were used to measure the vertical component of the floor reaction force of each leg. [Results] In the 20° leftward tilted view, the head and trunk angles in the frontal plane were similarly inclined toward the left, and the vertical component of the floor reaction force increased in the left leg, whereas it decreased in the right leg. [Conclusion] When the view in the immersive HMD was tilted, the participants’ trunk side bent toward the same side as that of the view. This visual inclination system seems to be a simple intervention for changing standing posture.

Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions

Objective: We compared falling and non-falling healthy elderly subjects to identify balance disorders associated with falling. Gait parameters were determined when carrying out single and dual tasks.

Design: Case comparison study.

Setting: Subjects were studied in the gait laboratory at Hopital Roger Salengro, Lille, France.

Subjects: A group of 40 healthy elderly women were assigned to one of two groups according to their falling history: 21 fallers aged 70.4±6.4 years and 19 non-fallers aged 67.0±4.8 years. All subjects performed first a single leg balance test with two conditions (eyes open/closed). Then, gait parameters were analysed under single-task and dual motor-task conditions (walking with a glass of water in the hand).

Main measures: Falls, number of times suspended foot touched the floor during the single leg balance test, cadence, speed, stride time, step time, single-support time, stride length and step length during walking under single- and dual-task conditions.

Results: During the single leg balance test, fallers placed their feet on the floor three times more often than non-fallers under eyes open conditions (P < 0.05) and twice as often under eyes closed conditions (P < 0.05). In the single-task condition, no significant difference in gait parameters was reported between fallers and non fallers. There was a significant difference (P < 0.05) in the gait parameters (cadence, speed, stride and step time, single-support time) between fallers and non-fallers under dual-task conditions.

Conclusions: Dual tasks perturb walking in fallers, who exhibit deteriorated static balance. Consequently, walking under dual-task conditions plus a single leg balance test could be helpful in detecting walking disorders and planning physiotherapy to prevent falls.

Problems of older persons using a wheeled walker

BACKGROUND

Wheeled walkers (WWs) are used to improve mobility and for fall prevention in older persons, but not all users are satisfied with the usability of WWs. Intelligent WWs are being developed to improve the usability.

AIMS

The aim of this study was to support the development of intelligent WWs by investigating possible problems of using a WW.

METHODS

This study investigated 22 geriatric in-patients (median age 82 years) with and without their WW while opening a door against the direction of walking and passing through. Other possible problems when using WWs were identified by interview.

RESULTS

Walking through the door was faster without than with using the WW (8.71 versus 12.86 s, p < 0.001), while interference between door and WW was documented in 41 of 44 (93 %) cases. Backward walking performance was better when using a WW with regard to gait speed, step width and walk ratio (all p < 0.002). Most referred problems when using a WW were walking downhill (83 %) and uphill (77 %) and obstacle crossing in general (77 %).

CONCLUSIONS

Problems with opening a door against the direction of walking and the optimization of downhill and uphill walking as well as obstacle crossing should be regarded when developing an intelligent WW.

Sensory reweighting is altered in adolescent patients with scoliosis: Evidence from a neuromechanical model

Idiopathic scoliosis is the most frequent spinal deformity in adolescence. While its aetiology remains unclear, impairments in balance control suggest a dysfunction of the sensorimotor control mechanisms. The objective of this paper is to evaluate the ability of patients with idiopathic scoliosis to reweigh sensory information. Using a neuromechanical model, the relative sensory weighting of vestibular and proprioceptive information was assessed. Sixteen healthy adolescents and respectively 20 and 16 adolescents with mild or severe scoliosis were recruited. Binaural bipolar galvanic vestibular stimulation was delivered to elicit postural movement along the coronal plane. The kinematics of the upper body, using normalized horizontal displacement of the 7th cervical vertebra, was recorded 1s before, 2s during, and 1s following vestibular stimulation. The neuromechanical model included active feedback mechanisms that generated corrective torque from the vestibular and proprioceptive error signals. The model successfully predicted the normalized horizontal displacement of the 7th cervical vertebra. All groups showed similar balance control before vestibular stimulation; however, the amplitude (i.e., peak horizontal displacement) of the body sway during and immediately following vestibular stimulation was approximately 3 times larger in patients compared to control adolescents. The outcome of the model revealed that patients assigned a larger weight to vestibular information compared to controls; vestibular weight was 6.03% for controls, whereas it was 13.09% and 13.26% for the mild and severe scoliosis groups, respectively. These results suggest that despite the amplitude of spine deformation, the sensory reweighting mechanism is altered similarly in adolescent patients with scoliosis.

Age-Related Differences in Postural Control and Attentional Cost During Tasks Performed in a One-Legged Standing Posture

BACKGROUND AND PURPOSE

In dual-task situations, postural control is closely associated with attentional cost. Previous studies have reported age-related differences between attentional cost and postural control, but little is known about the association in conditions with a one-legged standing posture. The purpose of this study was to determine age-related differences in postural control and attentional cost while performing tasks at various difficulty levels in a one-legged standing posture.

METHODS

In total, 29 healthy older adults aged 64 to 78 years [15 males, 14 females, mean (SD) = 71.0 (3.8) years] and 29 healthy young adults aged 20 to 26 years [14 males, 15 females, mean (SD) = 22.5 (1.5) years] participated in this study. We measured the reaction time, trunk accelerations, and lower limb muscle activity under 3 different one-legged standing conditions-on a firm surface, on a soft surface with a urethane mat, and on a softer more unstable surface with 2 piled urethane mats. Reaction time as an indication of attentional cost was measured by pressing a handheld button as quickly as possible in response to an auditory stimulus. A 2-way repeated-measures analysis of variance was performed to examine the differences between the 3 task conditions and the 2 age groups for each outcome.

RESULTS AND DISCUSSION

Trunk accelerations showed a statistically significant group-by-condition interaction in the anteroposterior (F = 9.1, P < .05), mediolateral (F = 9.9, P < .05), and vertical (F = 9.3, P < .05) directions. Muscle activity did not show a statistically significant group-by-condition interaction, but there was a significant main effect of condition in the tibialis anterior muscle (F = 33.1, P < .01) and medial gastrocnemius muscle (F = 14.7, P < .01) in young adults and the tibialis anterior muscle (F = 24.8, P < .01) and medial gastrocnemius muscle (F = 10.8, P < .01) in older adults. In addition, there was a statistically significant interaction in reaction time (F = 8.2, P < .05) for group-by-condition.

CONCLUSIONS

The study results confirmed that reaction times in older adults are more prolonged than young adults in the same challenging postural control condition.

Balance control impairment in obese individuals is caused by larger balance motor commands variability

It is acknowledged that various factors impaired balance control. Among them, heavy body weight is associated with poor balance control because the location of the center of mass is further away from the ankle joint. Thus, a larger active ankle torque is required to counter the greater gravitational torque. Because balance motor commands have signal-dependent noise whose standard deviation increases with the absolute value of the neural control signal, it was hypothesized that faster center of pressure speed observed in obese individuals would be related to larger balance motor commands variability. A feedback-control model and parametric system identification technique was used to estimate the variability in the balance motor commands and neural controller parameters based on previously published experimental data. Results of the neuromechanical model confirmed that the balance motor commands of obese individuals are more variable than that of lean individuals.

Effect of haptic supplementation on postural control of younger and older adults in an unstable sitting task

Standing postural control is known to be altered during aging, but age-related changes in sitting postural control have scarcely been explored. The present experiment studied the roles of visual and haptic information in a sitting task in both young and older adults. Fifteen young and fifteen older adults participated in this study. Six experimental conditions were performed with eyes open and eyes closed: quiet sitting, rocker-board sitting, and 4 conditions of haptic supplementation, provided by a hand-held pen, during rocker-board sitting. Classical variables were extracted from the center of pressure (COP) and pen trajectories, and the stabilogram diffusion analysis was performed on the COP data. Three-way ANOVAs (Group×Vision×Condition) were carried out. Postural instability was strongly attenuated by haptic supplementation in both age groups. Furthermore, instability due to visual deprivation was compensated by haptic supplementation. Long- and short-term diffusion coefficients were smaller in conditions of haptic supplementation. The present study confirmed the effect of haptic supplementation on both open-loop and closed-loop mechanisms of postural control and extended it to unstable sitting in young and older adults despite the complex biomechanical systems involved in sitting postural tasks.

Visual reliance for balance control in older adults persists when visual information is disrupted by artificial feedback delays

Sensory information from our eyes, skin and muscles helps guide and correct balance. Less appreciated, however, is that delays in the transmission of sensory information between our eyes, limbs and central nervous system can exceed several 10s of milliseconds. Investigating how these time-delayed sensory signals influence balance control is central to understanding the postural system. Here, we investigate how delayed visual feedback and cognitive performance influence postural control in healthy young and older adults. The task required that participants position their center of pressure (COP) in a fixed target as accurately as possible without visual feedback about their COP location (eyes-open balance), or with artificial time delays imposed on visual COP feedback. On selected trials, the participants also performed a silent arithmetic task (cognitive dual task). We separated COP time series into distinct frequency components using low and high-pass filtering routines. Visual feedback delays affected low frequency postural corrections in young and older adults, with larger increases in postural sway noted for the group of older adults. In comparison, cognitive performance reduced the variability of rapid center of pressure displacements in young adults, but did not alter postural sway in the group of older adults. Our results demonstrate that older adults prioritize vision to control posture. This visual reliance persists even when feedback about the task is delayed by several hundreds of milliseconds.

Does visual feedback during walking result in similar improvements in trunk control for young and older healthy adults?

BACKGROUND

Most current applications of visual feedback to improve postural control are limited to a fixed base of support and produce mixed results regarding improved postural control and transfer to functional tasks. Currently there are few options available to provide visual feedback regarding trunk motion while walking. We have developed a low cost platform to provide visual feedback of trunk motion during walking. Here we investigated whether augmented visual position feedback would reduce trunk movement variability in both young and older healthy adults.

METHODS

The subjects who participated were 10 young and 10 older adults. Subjects walked on a treadmill under conditions of visual position feedback and no feedback. The visual feedback consisted of anterior-posterior (AP) and medial-lateral (ML) position of the subject's trunk during treadmill walking. Fourier transforms of the AP and ML trunk kinematics were used to calculate power spectral densities which were integrated as frequency bins "below the gait cycle" and "gait cycle and above" for analysis purposes.

RESULTS

Visual feedback reduced movement power at very low frequencies for lumbar and neck translation but not trunk angle in both age groups. At very low frequencies of body movement, older adults had equivalent levels of movement variability with feedback as young adults without feedback. Lower variability was specific to translational (not angular) trunk movement. Visual feedback did not affect any of the measured lower extremity gait pattern characteristics of either group, suggesting that changes were not invoked by a different gait pattern.

CONCLUSIONS

Reduced translational variability while walking on the treadmill reflects more precise control maintaining a central position on the treadmill. Such feedback may provide an important technique to augment rehabilitation to minimize body translation while walking. Individuals with poor balance during walking may benefit from this type of training to enhance path consistency during over-ground locomotion.

Implicit and explicit representations of hand position in tool use

Understanding the interactions of visual and proprioceptive information in tool use is important as it is the basis for learning of the tool's kinematic transformation and thus skilled performance. This study investigated how the CNS combines seen cursor positions and felt hand positions under a visuo-motor rotation paradigm. Young and older adult participants performed aiming movements on a digitizer while looking at rotated visual feedback on a monitor. After each movement, they judged either the proprioceptively sensed hand direction or the visually sensed cursor direction. We identified asymmetric mutual biases with a strong visual dominance. Furthermore, we found a number of differences between explicit and implicit judgments of hand directions. The explicit judgments had considerably larger variability than the implicit judgments. The bias toward the cursor direction for the explicit judgments was about twice as strong as for the implicit judgments. The individual biases of explicit and implicit judgments were uncorrelated. Biases of these judgments exhibited opposite sequential effects. Moreover, age-related changes were also different between these judgments. The judgment variability was decreased and the bias toward the cursor direction was increased with increasing age only for the explicit judgments. These results indicate distinct explicit and implicit neural representations of hand direction, similar to the notion of distinct visual systems.

Wii Fit® training vs. Adapted Physical Activities: which one is the most appropriate to improve the balance of independent senior subjects? A randomized controlled study

Objective:

To compare the effectiveness of three protocols (Adapted Physical Activities, Wii Fit®, Adapted Physical Activities + Wii Fit®) on the balance of independent senior subjects.

Design:

Case comparison study.

Settings:

Healthy elderly subjects living in independent community dwellings.

Subjects:

Thirty-six subjects, average age 75.09 ± 10.26 years, took part in this study, and were randomly assigned to one of the four experimental groups: G1 followed an Adapted Physical Activities training programme, while the second group (G2) participated in Wii Fit® training and the third one (G3) combined both methods. There was no training for the fourth group (G4). All subjects trained once a week (1 hour) for 20 weeks and were assessed before and after treatment.

Main measures:

The Tinetti test, unipedal tests and the Wii Fit® tests.

Results:

After training, the scores in the Tinetti test decreased significantly ( P < 0.05) for G1, G2 and G3 respectively in static conditions and for G1 and G3 in dynamic conditions. After training, the performance in the unipedal tests decreased significantly ( P < 0.05) for G1 and G3. The position of the centre of gravity was modified significantly ( P < 0.05) for G2 and G3.

Conclusion:

After 20 training sessions, G1 (Adapted Physical Activities), G2 (Wii Fit®) and G3 (Adapted Physical Activities and Wii Fit®) improved their balance. In addition, G1 and G3 increased their dynamic balance. The findings suggest that Adapted Physical Activities training limits the decline in sensorial functions in the elderly.

The effects of muscle strength on center of pressure-based measures of postural sway in obese and heavy athletic individuals

INTRODUCTION

Obesity affects postural sway during normal quiet standing; however, the reasons for the increased postural sway are unknown. Improving muscular strength is regarded as a potential way to improve postural control, particularly for obese and overweight subjects. The purpose of this investigation is to evaluate the role of muscular strength on postural sway in obese and overweight individuals.

METHODS

Fifteen healthy weight (control group), seventeen obese (obese group) subjects and nine football players (heavy athletic group) participated in this investigation. Isometric knee extension force and postural sway were measured. Muscular strength was calculated in absolute measures as well as relative to body mass (muscular strength to body mass).

RESULTS

The heavy athletic group demonstrated significantly stronger (absolute) lower limb strength (1593.9 N (95% CI 1425.5, 1762.3)) than both the obese (796.2N (95% CI 673.8, 824.5)) and control (694.1N (95% CI 563.7, 824.5)) groups. As well, when muscular strength was expressed as a ratio to body mass the heavy athletic group had significantly higher values (1.27 (95% CI 1.11, 1.43)) than obese (0.78 (95% CI 0.66, 0.89) and control (1.00 (95% CI (0.88, 1.12)) individuals. Despite this, they swayed similarly to the obese (mean center of pressure speed of 0.83 cms(-1) (95% CI 0.72, 0.93) vs. 0.87 cms(-1) (95% CI 0.80, 0.95)), that is, significantly more than the controls (0.60 cms(-1) (95% CI 0.52, 0.68)).

CONCLUSION

Isometric knee extensor strength has a minimal effect on postural sway in heavier athletic individuals during normal quiet stance.

Obesity impact on the attentional cost for controlling posture

Background

This study investigated the effects of obesity on attentional resources allocated to postural control in seating and unipedal standing.

Methods

Ten non obese adults (BMI = 22.4±1.3, age = 42.4±15.1) and 10 obese adult patients (BMI = 35.2±2.8, age = 46.2±19.6) maintained postural stability on a force platform in two postural tasks (seated and unipedal). The two postural tasks were performed (1) alone and (2) in a dual-task paradigm in combination with an auditory reaction time task (RT). Performing the RT task together with the postural one was supposed to require some attentional resources that allowed estimating the attentional cost of postural control. 4 trials were performed in each condition for a total of 16 trials.

Findings

(1) Whereas seated non obese and obese patients exhibited similar centre of foot pressure oscillations (CoP), in the unipedal stance only obese patients strongly increased their CoP sway in comparison to controls. (2) Whatever the postural task, the additional RT task did not affect postural stability. (3) Seated, RT did not differ between the two groups. (4) RT strongly increased between the two postural conditions in the obese patients only, suggesting that body schema and the use of internal models was altered with obesity.

Interpretation

Obese patients needed more attentional resources to control postural stability during unipedal stance than non obese participants. This was not the case in a more simple posture such as seating. To reduce the risk of fall as indicated by the critical values of CoP displacement, obese patients must dedicate a strong large part of their attentional resources to postural control, to the detriment of non-postural events. Obese patients were not able to easily perform multitasking as healthy adults do, reflecting weakened psycho-motor abilities.

The dynamics of visual reweighting in healthy and fall-prone older adults

Multisensory reweighting (MSR) is an adaptive process that prioritizes the visual, vestibular, and somatosensory inputs to provide the most reliable information for postural stability when environmental conditions change. This process is thought to degrade with increasing age and to be particularly deficient in fall-prone versus healthy older adults. In the present study, the authors investigate the dynamics of sensory reweighting, which is not well-understood at any age. Postural sway of young, healthy, and fall-prone older adults was measured in response to large changes in the visual motion stimulus amplitude within a trial. Absolute levels of gain, and the rate of adaptive gain change were examined when visual stimulus amplitude changed from high to low and from low to high. Compared with young adults, gains in both older adult groups were higher when the stimulus amplitude was high. Gains in the fall-prone elderly were higher than both other groups when the stimulus amplitude was low. Both older groups demonstrated slowed sensory reweighting over prolonged time periods when the stimulus amplitude was high. The combination of higher vision gains and slower down weighting in older adults suggest deficits that may contribute to postural instability.

The role of head-in-space stability on stepping reactions in young and elderly adults

This study compared head kinematic responses and step latency following an anteriorly directed postural perturbation between two groups (Young, mean age 27.39; Elderly, mean age 71.9). We further attempted to demonstrate, for the first time, a positive linear relationship between sagittal plane head angular velocities and stepping responses in both groups. It was hypothesized that the Elderly would demonstrate higher head angular velocities and greater step latencies than the Young. We also hypothesized that a positive linear relationship would show that, following a perturbation, trials where head angular velocity was low yielded quicker step responses. Each participant experienced three perturbations under five different visual conditions designed to alter visual input and head/trunk coordination. Repeated-measures ANOVA was used, with α set at 0.05. For each test condition, the Elderly consistently demonstrated longer step latencies while exhibiting higher head angular velocities. For each group, a positive linear relationship was shown between the two dependent variables (Young: r=0.86; Elderly, r=0.84). During a postural perturbation, as head angular velocity increased, stepping responses were delayed.

Adaptation and reintegration of proprioceptive information in young and older adults' postural control

We investigated age-related changes in adaptation and sensory reintegration in postural control without vision. In two sessions, participants adapted their posture to sway reference and to reverse sway reference conditions, the former reducing (near eliminating) and the latter enhancing (near doubling) proprioceptive information for posture by means of support-surface rotations in proportion to body sway. Participants stood on a stable platform for 3 min (baseline) followed by 18 min of sway reference or reverse sway reference (adaptation) and finally again on a stable platform for 3 min (reintegration). Results showed that when inaccurate proprioception was introduced, anterior-posterior (AP) sway path length increased in comparable levels in the two age groups. During adaptation, young and older adults reduced postural sway at the same rate. On restoration of the stable platform in the reintegration phase, a sizeable aftereffect of increased AP path length was observed in both groups, which was greater in magnitude and duration for older adults. In line with linear feedback models of postural control, spectral analyses showed that this aftereffect differed between the two platform conditions. In the sway-referenced condition, a switch from low- to high-frequency COP sway marked the transition from reduced to normal proprioceptive information. The opposite switch was observed in the reverse sway referenced condition. Our findings illustrate age-related slowing in participants' postural control adjustments to sudden changes in environmental conditions. Over and above differences in postural control, our results implicate sensory reweighting as a specific mechanism highly sensitive to age-related decline.

Aging affects the ability to use optic flow in the control of heading during locomotion

Perceived self-motion from optic flow is implicated in the control of locomotion. Aging, which affects visual perception and sensorimotor integration, may result in an inability to use optic flow to guide heading while walking. The purpose of this study was to examine whether advanced age could impact on the steering of locomotion, when changing optic flow directions were presented in an immersive virtual environment (VE). Nine young adults (21.56 +/- 3.20 years) and nine older adults (66.11 +/- 3.95 years) participated in the study. Subjects were asked to walk while viewing a VE through a head-mounted display unit (Kaiser). The VE viewed by the subjects was a large room displayed as an expanding translational optic flow, with the focus of expansion (FOE) located at neutral, 20 degrees or 40 degrees to the right or left. Their task was to walk straight with respect to the VE. Kinematic data in 3D were collected, from which the body's centre of mass (CoM) position and heading direction were calculated. Young subjects were able to make proper heading adjustments in the VE, with respect to FOE shifts, but not older individuals. Young subjects altered their CoM trajectory so that it was oriented in the direction opposite to the FOE in the physical environment and resulted in small deviation in the VE. The older adults did not adjust their locomotor patterns in response to the different flows presented and maintained similar walking trajectories across all trials. Advanced age results in an altered control of steering of locomotion in response to changing directions of optic flow. This may be related to an impaired perception and/or use of the optic flow, or due to inherent problems in sensorimotor integration.

Visual determinants of instability and falls in older people

Poor vision (in particular, reduced contrast sensitivity, depth perception and visual field size) reduces postural stability and increases the risk of falls and fractures in older people. Multifocal glasses may add to this risk by impairing distance contrast sensitivity and depth perception. Maximizing vision through cataract surgery and occupational therapy interventions involving home hazards reduction in visually impaired older people are effective strategies for fall prevention. Although interventions involving vision assessment and provision of new spectacles improve visual acuity in older people, this strategy may not reduce, and may even increase, the risk of falls. Further randomized, controlled trials are required to determine whether restriction of use of multifocal glasses and multifaceted visual interventions can significantly reduce falls in older people.

The effect of a senior jazz dance class on static balance in healthy women over 50 years of age: a pilot study

The purpose of this pilot study is to assess the impact of a senior jazz dance class on static balance for healthy women over 50 years of age using the NeuroCom Smart Balance Master System (Balance Master). A total of 12 healthy women aged 54-88 years completed a 15-week jazz dance class which they attended 1 time per week for 90 min per class. Balance data were collected using the Sensory Organization Test (SOT) at baseline (pre), at 7 weeks (mid), and after 15 weeks (post). An equilibrium score measuring postural sway was calculated for each of six different conditions. The composite equilibrium score (all six conditions integrated to 1 score) was used as an overall measure of balance. Repeated measures analyses of variance (ANOVAs) were used to compare the means of each participant's SOT composite equilibrium score in addition to the equilibrium score for each individual condition (1-6) across the 3 time points (pre, mid, post). There was a statistically significant difference among the means, p < .0005. Pairwise (Bonferroni) post hoc analyses revealed the following statistically significant findings for SOT composite equilibrium scores for the pre (67.33 + 10.43), mid (75.25 + 6.97), and post (79.00 + 4.97) measurements: premid (p = .008); prepost (p < .0005); midpost (p = .033). In addition, correlational statistics were used to determine any relationship between SOT scores and age. Results indicated that administration of a 15-week jazz dance class 1 time per week was beneficial in improving static balance as measured by the Balance Master SOT.

Postural adaptations to repeated optic flow stimulation in older adults

The purpose of this study is to understand the processes of adaptation (changes in within-trial postural responses) and habituation (reductions in between-trial postural responses) to visual cues in older and young adults. Of particular interest were responses to sudden increases in optic flow magnitude. The postural sway of 25 healthy young adults and 24 healthy older adults was measured while subjects viewed anterior-posterior 0.4 Hz sinusoidal optic flow for 45 s. Three trials for each of three conditions were performed: (1) constant 12 cm optic flow amplitude (24 cm peak-to-peak), (2) constant 4 cm amplitude (8 cm p-t-p), and (3) a transition in amplitude from 4 to 12 cm. The average power of head sway velocity (P(vel)) was calculated for consecutive 5s intervals during the trial to examine the changes in sway within and between trials. A mixed factor repeated measures ANOVA was performed to examine the effects of subject Group, Trial, and Interval on the P(vel). P(vel) was greater in older adults in all conditions (p<0.001). During the 12 cm constant amplitude trials, within-trial adaptation occurred for all subjects, but there were differences in the between-trial habituation. P(vel) of the older adults decreased significantly between all 3 trials, but decreased only between Trials 1 and 2 in young adults. While the responses of the young adults to the transition in optic flow from 4 to 12 cm did not significantly change, older adults had an increase in P(vel) following the transition, ranging from 6.5 dB for the first trial to 3.4 dB for the third trial. These results show that older adults can habituate to repeated visual perturbation exposures; however, this habituation requires a greater number of exposures than young adults. This suggests aging impacts the ability to quickly modify the relative weighting of the sensory feedback for postural stabilization.

Relationship between age and measures of balance, strength and gait: linear and non-linear analyses

An age-related decline in balance, gait and lower-extremity muscle strength measures may lead to increased risk of falls and fractures. Previous studies have reported a possible non-linear age-related decline in these measures, but the choice of methodological approach has limited its interpretation. Healthy community-dwelling women (n=212) 21–82 years of age were evaluated for strength [Nicholas MMT (manual muscle tester)], gait [CSA (clinical stride analyser)], activity [HAP (human activity profile)] and static and dynamic balance [CBS (Chattecx balance system), LBT (Lord's balance test) and the ST (step test)]. A GAM (generalized additive model) was developed for each outcome variable to estimate the functional relationship, with age as a continuous variable. Performance was maintained until 45–55 years of age, depending on the outcome measure. Thereafter a decline in performance was evident with increasing age in all measures. Overall, a significant non-linear relationship with age was demonstrated for lower-extremity strength measures (MMT), velocity and double support duration of gait (CSA) and some clinical and laboratory balance tests [ST, LBT (eyes open) and the CBS]. Linear relationships were demonstrated by the LBT with eyes closed and activity measures. Balance, lower-extremity muscle strength and gait may decline non-linearly with age. Our study suggests possible threshold effects between age and balance, muscle strength and gait measures in women. Further research into these threshold effects may have implications for the optimal timing of exercise and other interventions to reduce the risk of falls and fractures.

The effect of anxiety on the regulation of upright standing among younger and older adults

We tested the hypothesis that fall anxiety would differentially influence the regulation of upright standing among younger and among older adults. Fall anxiety was imposed by a manipulation of environmental context that increased the threat to postural control by introducing the potential for injurious consequences should a fall occur. Fifteen younger and 15 older adults participated in this study. Regardless of age, postural control was more conservative when fall anxiety increased, however, age did not affect how anxiety influenced the regulation of postural control. Our findings imply that the motor consequences of fall anxiety are no more pervasive for older adults than for younger adults, and that age does not alter the ability to accommodate to environmental demands that heighten fall anxiety.