Vestibular Dysfunction Among Children with Otitis Media and Effusion in a Multiracial Setting

Otitis media with effusion (OME) is a common presentation to the Otorhinolaryngology clinic. Besides hearing impairment, recent evidence shows that approximately 30% of these children have some degree of vestibular and balance impairment. To assess the presence of vestibular dysfunction among children with OME. Children between 4 and 17, with and without OME, underwent vestibular assessment using video head impulse test (VHIT), subjective visual subjective (SVV), and single leg raising test (SLS). Data were recorded and analysed. 24 OME children were included with male predominance. No statistical significance was found between the VOR gain (p > 0.05), SVV (p = 0.056) and SLS (p = 0.06). Simple linear regression analysis showed that age and gender are potential factors for VOR gain. Our study found that children with OME have normal vestibular function.

Child and Adolescent Manganese Biomarkers and Adolescent Postural Balance in Marietta CARES Cohort Participants

BACKGROUND

Manganese (Mn) plays a significant role in both human health and global industries. Epidemiological studies of exposed populations demonstrate a dose-dependent association between Mn and neuromotor effects ranging from subclinical effects to a clinically defined syndrome. However, little is known about the relationship between early life Mn biomarkers and adolescent postural balance.

OBJECTIVES

This study investigated the associations between childhood and adolescent Mn biomarkers and adolescent postural balance in participants from the longitudinal Marietta Communities Actively Researching Exposures Study (CARES) cohort.

METHODS

Participants were recruited into CARES when they were 7-9 y old, and reenrolled at 13-18 years of age. At both time points, participants provided samples of blood, hair, and toenails that were analyzed for blood Mn and lead (Pb), serum cotinine, hair Mn, and toenail Mn. In adolescence, participants completed a postural balance assessment. Greater sway indicates postural instability (harmful effect), whereas lesser sway indicates postural stability (beneficial effect). Multivariable linear regression models were conducted to investigate the associations between childhood and adolescent Mn biomarkers and adolescent postural balance adjusted for age, sex, height-weight ratio, parent/caregiver intelligence quotient, socioeconomic status, blood Pb, and serum cotinine.

RESULTS

CARES participants who completed the adolescent postural balance assessment (n = 123 ) were 98% White and 54% female and had a mean age of 16 y (range: 13-18 y). In both childhood and adolescence, higher Mn biomarker concentrations were significantly associated with greater adolescent sway measures. Supplemental analyses revealed sex-specific associations; higher childhood Mn biomarker concentrations were significantly associated with greater sway in females compared with males.

DISCUSSION

This study found childhood and adolescent Mn biomarkers were associated with subclinical neuromotor effects in adolescence. This study demonstrates postural balance as a sensitive measure to assess the association between Mn biomarkers and neuromotor function. https://doi.org/10.1289/EHP13381.

Instrumented Balance Error Scoring System in Children and Adolescents-A Cross Sectional Study

Background: The Balance Error Scoring System (BESS) is a commonly used method for clinically evaluating balance after traumatic brain injury. The utilization of force plates, characterized by their cost-effectiveness and portability, facilitates the integration of instrumentation into the BESS protocol. Despite the enhanced precision associated with instrumented measures, there remains a need to determine the clinical significance and feasibility of such measures within pediatric cohorts. Objective: To report a comprehensive set of posturographic measures obtained during instrumented BESS and to examine the concurrent validity, reliability, and feasibility of instrumented BESS in the pediatric point of care setting. Methods: Thirty-seven participants (18 female; aged 13.32 ± 3.31 years) performed BESS while standing on a force plate to simultaneously compute stabilometric measures (instrumented BESS). Ellipse area (EA), path length (PL), and sway velocity (VM) were obtained for each of the six BESS positions and compared with the respective BESS scores. Additionally, the effects of sex and age were explored. A second BESS repetition was performed to evaluate the test-retest reliability. Feedback questionnaires were handed out after testing to evaluate the feasibility of the proposed protocol. Results: The BESS total score was 20.81 ± 6.28. While there was no statistically significant age or sex dependency in the BESS results, instrumented posturography demonstrated an age dependency in EA, VM, and PL. The one-leg stance on a soft surface resulted in the highest BESS score (8.38 ± 1.76), EA (218.78 cm2 ± 168.65), PL (4386.91 mm ± 1859.00), and VM (21.93 mm/s ± 9.29). The Spearman's coefficient displayed moderate to high correlations between the EA (rs = 0.429-0.770, p = 0.001-0.009), PL (rs = 0.451-0.809, p = 0.001-0.006), and VM (rs = 0.451-0.809, p = 0.001-0.006) when compared with the BESS scores for all testing positions, except for the one-leg stance on a soft surface. The BESS total score significantly correlated during the first and second repetition (rs = 0.734, p ≤ 0.001), as did errors during the different testing positions (rs = 0.489-0.799, p ≤ 0.001-0.002), except during the two-legged stance on a soft surface. VM and PL correlated significantly in all testing positions (rs = 0.465-0.675, p ≤ 0.001-0.004; (rs = 0.465-0.675, p ≤ 0.001-0.004), as did EA for all positions except for the two-legged stance on a soft surface (rs = 0.392-0.581, p ≤ 0.001-0.016). A total of 92% of participants stated that the instructions for the testing procedure were very well-explained, while 78% of participants enjoyed the balance testing, and 61% of participants could not decide whether the testing was easy or hard to perform. Conclusions: Instrumented posturography may complement clinical assessment in investigating postural control in children and adolescents. While the BESS score only allows for the consideration of a total score approximating postural control, instrumented posturography offers several parameters representing the responsiveness and magnitude of body sway as well as a more differentiated analysis of movement trajectory. Concise instrumented posturography protocols should be developed to augment neuropediatric assessments in cases where a deficiency in postural control is suspected, potentially stemming from disruptions in the processing of visual, proprioceptive, and/or vestibular information.

Static Postural Control during Single-Leg Stance in Endurance, Team and Combat Athletes from the Spanish National Sport Technification Program

In the context of pediatric physical exercise, the analysis of factors affecting postural control (PC) provides insight into the development of sport-specific motor skills. This study aims to evaluate the static PC during single-leg stance in endurance, team and combat athletes from the Spanish National Sport Technification Program. A total of 29 boys and 32 girls, aged 12 to 16 years old, were recruited. Centre of pressure (CoP) was measured on a force platform in standing position for 40 s under two sensorial and leg dominance conditions. Girls showed lower MVeloc (p < 0.001), MFreq (p > 0.001) and Sway (p < 0.001) values than boys in both sensorial conditions (open and closed eyes). The highest values in all PC variables were observed with eyes closed in both genders (p < 0.001). Sway values were lower in boys combat-athletes compared to endurance athletes in two sensorial conditions and with non-dominant leg (p < 0.05). Young athletes in their teens enrolled in a Sport Technification Program have shown differences in PC when comparing different visual conditions, sport disciplines and gender. This study opens a window to a better understanding of the determinants of PC during single-leg stance as a critical element in the sport specialization of young athletes.

The impact of coordination-based movement education model on balance development of 5-year-old children

With this study, it was aimed to examine the effect of coordination-based movement education model on the development of balance in 5-year-old children. The research was designed with a control group pre-test post-test design, which is one of the quasi-experimental research models. The research group consists of a total of 42 (n = 20 experimental n = 22 control) 5-year-old children formed by using the convenient sampling method, which is one of the purposeful sampling methods. Each participant's age, body weight, body length and lower extremity limb lengths were measured. As a data collection tool and used the three-part Y Balance Test (YBT) platform, which was previously stated to have high reliability (ICC = 0.85-0.93). Reach distances of the participants were measured in three directions, anterior posteromedial and posterolateral. YBT scores were determined by calculating the average and normalized values for lower extremity limb length for each reach direction of the obtained scores, and composite YBT scores were determined by taking the averages of anterior, posteromedial and posterolateral reach distance scores. In order to determine whether the collected data are suitable for normal distribution, Levene test was applied first and it was determined that p > 0.05 for all parameters as a result of the test. Independent sample T-test from parametric tests was used to determine the differences between groups. Paired-group T-test was used to determine within-group differences. According to the results of the research, it was found that the balance motor capacity levels between the experimental and control groups did not differ significantly compared to the pre-test, but there was a significant difference in all reach directions scores in favor of the post-test and experimental group compared to the control group and the pre-test. When the results of the right and left lower extremity ANT, PM, PL and Composite reach distances were examined according to gender, although there was no statistically significant difference, when the averages were considered, it was seen that all parameters were in favor of girls (p > 0.05). As a result, it was concluded that coordination-based movement education model had a positive effect on the balance motor capacities of 5-year-old children.

Factors associated with balance ability in Duchenne and Becker muscular dystrophies

BACKGROUND

Problems such as progressive muscle function loss, postural deteriorations, and contractures seen in patients with Duchenne and Becker muscular dystrophies (D/BMD) may affect children's balance ability, and impaired balance ability may lead to limitations in children's functional level.

RESEARCH QUESTION

What factors are associated with balance ability in children with D/BMD?

METHODS

Twenty participants with D/BMD were included in the study. Participants' ages were asked; height, body weight, and body mass index (BMI) were recorded. Children's functional level was assessed with the Motor Function Measurement-32 (MFM-32), Brooke and Vignos Scales. Muscle strength of hip flexion and extension, knee flexion and extension, and ankle dorsiflexion was measured with a handheld dynamometer. Balance measurements were performed using the Balance Master System. The relationship between balance and continuous independent variables was determined using Spearman's test.

RESULTS

The mean age of the participants was 8.57 ± 3.27 years. The balance abilities of children with BMD were better than those of children with DMD (p < 0.05). The balance diminished with age (p < 0.05), while there was a positive correlation between balance and weight, height, BMI (p < 0.05). There was a positive correlation between the balance and the MFM-32 total and subsection scores. Muscle strength was positively related to balance (p < 0.05).

SIGNIFICANCE

The results showed the balance ability in children with D/BMD was affected by age, height, weight, BMI, functional level, and muscle strength. Based on the results of this study, balance and strength training should be an integral part of the rehabilitation of children with D/BMD.

The Most Active Child Is Not Always the Fittest: Physical Activity and Fitness Are Weakly Correlated

The present cross-sectional study aimed to evaluate the impact of physical activity level (PA) on physical fitness by controlling for individual characteristics in Italian children. A total of 329 children (girls n = 155, 42.6%; from five primary schools, 17 classes) aged 8-10 filled out the Physical Activity Questionnaire for Older Children (PAQ-C) to assess their PA level and performed anthropometric measurements (body mass, height, and BMI) and physical tests for measuring sprint (20 m sprint), cardiorespiratory fitness (shuttle-run test), balance (single-leg stance), handgrip strength (handgrip), lower-limb power (standing long-jump), peak force (countermovement jump), and low-back flexibility (sit-and-reach) skills. Linear mixed-effects models were applied to determine the relationship between physical fitness and PAQ-C score controlling for individual characteristics (i.e., gender, age, BMI). Results reported significant relationships between PAQ-C scores and sit-and-reach, shuttle-run, long-jump, and sprint tests. All considered physical tests were correlated with gender, age, and BMI, except for sit-and-reach from BMI. The variance in age, gender, BMI, and PAQ-C score accounted altogether for 30.0% of the variance in handgrip, 23.0% in single-leg stance, 26% in sit-and-reach, 36% in shuttle-run, 31% in long-jump, 34% in sprint, and 31% in countermovement jump. Therefore, the relationship between PA and fitness is not absolute and depends on the test and children's characteristics.

Age and gender differences in static and dynamic balance of Chinese preschool children

Objectives: Balance is a crucial ability of early age, but there is conflicting evidence with regard to age and gender differences in preschool children's balance ability. Additionally, there are several tools available to measure balance, yet, wide variation in their use has restricted the capacity to synthesize the reference values. Therefore, the primary purpose of this study was to investigate the balance ability of preschool-aged children and determine how it is moderated by age and gender. The analysis pertained to determining whether different testing methods affect the results of static or dynamic balancing ability to provide a basis for normative balance ability data for healthy boys and girls between 3 and 6 years of age. Method: Six hundred and nineteen preschool children (296 boys and 323 girls) aged 3-6 years participated in the study. The static balance (SB) was assessed with children standing on one leg (OST) and in a tandem stance (TS) with respect to time. The balance beam test (BBT) and functional reach test (FRT) were used to evaluate dynamic balance (DB) by measuring the time spent and the distance reached, respectively. Result: The results revealed significant differences in OST with respect to gender (η2 = 0.037, p < 0.001), TS (η2 = 0.026, p < 0.001) and FRT (η2 = 0.016, p = 0.002); the girls performed better than boys on most balance tests except on BBT (η2 = 0.000, p = 0.596). Age had positive effects on the static and dynamic balance performance on the OST (η2 = 0.336, p < 0.001), TS (η2 = 0.205, p < 0.001), BBT (η2 = 0.367, p < 0.001) and FRT (η2 = 0.392, p < 0.001). Older children performed better than their younger counterparts. No significant interactions between age groups and sex were found. Conclusion: This study revealed that static and dynamic balance stability in preschool-aged children was affected by gender and age. Gender dimorphism is present in preschool children, older girls displayed better postural stability than boys, and balance performance improved with age. In addition, the study provides age- and gender-specific balance performance reference values for preschool children across multiple methods, which can be used to monitor static and dynamic balance development.

What Does Provide Better Effects on Balance, Strength, and Lower Extremity Muscle Function in Professional Male Soccer Players with Chronic Ankle Instability? Hopping or a Balance Plus Strength Intervention? A Randomized Control Study

Chronic ankle instability (CAI) has a higher frequency in soccer due to the rapid changes in body movement. Thus, this study compared the effects of eight weeks of a hopping protocol and a combined protocol of balance plus strength in a within-between group analysis. Thirty-six male professional soccer players participated in this study and were randomly allocated in three groups: control group (CG, n = 12), hopping group (HG, n = 12), and balance plus strength group (BSG, n = 12). Strength, static and dynamic balance, and function were assessed at baseline and eight weeks post intervention. First, Foot and Ankle Ability Measure (FAAM) and FAAM sport scales were applied. Then, a dynamometer was used to measure strength of the muscles around the hip, knee, and ankle joints. The Bass stick measured static balance and the Y balance test measured dynamic balance. Additionally, functional tests were carried out by Triple Hop, the Figure 8 hop, and vertical jump. A repeated measures ANOVA [(3 groups) × 2 moments] was used to compare the within and between group differences. In general, all tests improved after eight weeks of training with both protocols. Specifically, the BSG improved with large ES for all tests, while the HG improved all test with small to large effect sizes (ES). Furthermore, HG showed higher values for vertical jump (p < 0.01, ES = 1.88) and FAAMSPORT (p < 0.05, ES = 0.15) than BSG. BSG showed higher values for hip abduction (p < 0.05, ES = 2.77), hip adduction (p < 0.05, ES = 0.87), and ankle inversion (p < 0.001, ES = 1.50) strength tests, while HG showed higher values for knee flexion [ES = 0.86, (0.02, 1.69)] and ankle plantarflexion [ES = 0.52, (−0.29, 1.33)]. Balance plus strength protocol showed more positive effects than the hopping protocol alone for soccer players with CAI.

Differences in the manifestation of balance according to BMI levels for women students of the Faculty of Physical Education and Sports

Abstract Background: Static and dynamic balance are factors of major importance in the manifestation of human motor skills at a higher level. Purpose: The determination of vari-ations in the performance of balance tests for young women students at the Faculty of Physical Education and Sports (48 cases in the 1st year of bachelor's degree), divided and analyzed 3 BMI levels (underweight / 7 cases, normal weight / 34 cases and overweight / 7 cases) and comparing these results with other similar research. Material and method: The testing of the group was scheduled at the Research Center for Human Performance, be-longing to the Faculty of Physical Education and Sports in Galați, in the month of April of the 2018-2019 academic year. For the assessment of balance, 7 tests were used, of which 4 associated with dynamic postural stability (Walk and turn field sobriety test/errors, Func-tional reach test/cm, Fukuda test/degrees of rotation, Bass test/ points) and 3 measuring static stability (Flamingo test/falls, One leg standing with eyes closed/sec, Stork test/sec). Nonparametric tests (Mann-Whitney U) were applied to compare differences between batches. Results: The average values of underweight and normal-weight women are better than those of overweight women for the entire set of assessment tests. The underweight group has the best results for the Standing balance test, Functional reach test, Flamingo test, Walk and turn field sobriety test, Fukuda test, and the normal weight women for Stork test, respectively Bass test. We found a lack of significant thresholds when comparing the results between the 3 groups (P> 0.05) for Stork test, Standing balance test and Functional reach test, so the working hypothesis formulated is only partially confirmed. The only significant difference between underweight and normal weight (P <0.05) is found in the Flamingo test, with better values for underweight. Significant difference thresholds for Flamingo test and Fukuda test are recorded between the underweight and overweight groups (Z values have associated thresholds P<0.05). The most significant differences are found between the normal weight and overweight groups (P <0.05), respectively for the Bass test, Fukuda test and Walk and turn field sobriety test. Conclusion: Constant physical activity (as a feature of the analyzed group) reduces the chances of significant differences in all balance tests between BMI levels. Keywords: female students; university specialization; static and dynamic postural control; physical activity

The effect of educational gymnastics on postural control of young children

Fundamental movement skill (FMS) proficiency does not develop solely due to maturation, but also via diverse perceptual-motor experiences across childhood. Practicing gymnastics has been shown to improve postural control. The purpose of the present study was to examine potential changes to postural control of children following a course of educational gymnastics. Two groups of children both completed 20 × 45-min physical education (PE) lessons; one group (n = 43, age = 6.4 ± 0.7, 56% male) completed educational gymnastics lessons in school delivered by a professional coach, the other group completed their typical PE classes (n = 18, age = 6.5 ± 0.3, 33% male). Unipedal balancing performance was assessed by calculating the percentage of successful trials made. Postural sway dynamics were explored by calculating center-of-pressure sample entropy, 95% ellipse sway area and sway velocity. Measurements were taken before the lessons began and immediately after the lessons were completed. The gymnastics group performed better than the typical PE group at unipedal balancing. Females outperformed males in both groups. Males made different changes to postural control (i.e., increased sway regularity and improved stability) compared to females across 3 months. Educational gymnastics enabled children in a critical period of development to make more rapid improvements to postural performance and control. Novel movement experiences, like those offered by educational gymnastics, may have a positive influence on postural control and importantly, physical literacy. Future work should examine how sex effects the development of postural control strategies in young children.

Postural Stability in Single-Leg Quiet Stance in Highly Trained Athletes: Sex and Sport Differences

This study aimed to determine if there is a difference in postural stability in highly trained adolescents and young adult athletes regarding sex and sport. The participants were young athletes (n = 464) from seven different sports. We considered the center of pressure (CoP) velocity (total, anterior–posterior (AP) and medial–lateral (ML)), CoP amplitude (AP and ML), and CoP frequency (AP and ML), as assessed by single-leg quiet stance test. Significant interactions were found between sex and sport for all CoP variables (p < 0.02). Additionally, a significant main effect of sport was also found in all CoP variables (p = 0.01). Regarding sex, significant effects were found for all CoP amplitude variables (p = 0.01), as well as for CoP velocity variables, except for CoP ML (p = 0.06). Moreover, there was no sex effect for CoP frequency AP (p = 0.18). The results of the current study confirm the claim that the criteria for optimal postural strategies for elite athletes likely depend on a given sport.

Limb Dominance Does Not Affect Y-Balance Test Performance in Non-Athlete Adolescents

BACKGROUND

The Lower Quarter Y-Balance Test (YBT-LQ) has been shown to be reliable for assessing dynamic balance in children and adolescents. However, limited research is available about the effects of leg dominance on YBT-LQ performance in adolescents. In addition, there is no consensus on the use of maximum reach or mean reach distance being a better measure of YBT-LQ performance.

HYPOTHESIS/PURPOSE

The purposes of this study were to determine if there is a difference in the YBT-LQ performance between the dominant and non-dominant limbs in non-athlete adolescents, and to compare the reliability of the maximum reach scores to that of the mean reach scores in this population.

STUDY DESIGN

Prospective cohort study.

METHODS

Twenty-six healthy non-athlete adolescents (13.6 ± 1.0 years, 22 girls, 4 boys) performed the YBT-LQ on two separate days while the same investigator scored their performance. Paired t-tests were used to compare reach distances on dominant and non-dominate stance limbs. Intraclass correlation coefficients (ICC3,1) were calculated for the maximum and mean reach distances for three directions (anterior, posterolateral, posteromedial) and the composite scores on each limb.

RESULTS

There was no significant difference in YBT-LQ performance between dominant and non-dominant stance limbs (p > 0.05). Overall, the between-day intra-rater reliability for maximum reach and mean reach scores was moderate-to-good for both limbs (ICC3,1 = 0.59 - 0.83), but was poor for the composite score on the dominant limb (ICC3,1 = 0.42) and maximum anterior reach on non-dominant limb (ICC3,1 = 0.48).

CONCLUSION

Limb dominance does not seem to be a factor for YBT-LQ performance in this population. The YBT-LQ appears to be a reliable tool for dynamic balance assessment in non-athlete adolescents using the individual score of each direction. The use of mean reach measures seems to slightly improve reliability, specifically the anterior reach direction, in this population.

LEVEL OF EVIDENCE

Level 2b.

Postural control in adolescent boys and girls before the age of peak height velocity: Effects of task difficulty

BACKGROUND

Adolescent children experience a critical developmental period marked by rapid biological changes. Research question To describe the longitudinal changes in postural control that occur in adolescent boys and girls before the age of peak height velocity (PHV).

METHODS

Here, to address the gap of knowledge, we compared the postural control and activation strategies of the muscles that control the ankle joint in twenty-three boys (age 12.5 ± 0.29) and twenty-one girls (age 10.5 ± 0.32). They performed easy (two legs) and difficult (two legs-eyes closed; one leg) postural balance tasks at 18 and 9 months before PHV and at PHV. We quantified the center of pressure (COP) displacements in the anterior-posterior (AP) and mediolateral (ML) directions and electromyographic (EMG) activity of tibialis anterior (TA) and medial gastrocnemius (MG) muscles.

RESULTS

Boys exhibited greater AP and ML COP displacement than girls only for the one leg task (difficult task). Although boys and girls had similar postural control 18 months prior to PHV, girls exhibited lesser COP displacement at 9 months before PHV, which related to greater TA-MG coactivation (R² = 0.26; p < 0.01). In contrast, postural control was not different between boys and girls with an easy balance task (two legs) performed with eyes open and closed. Rather, we found that all children improved their COP displacement in the ML direction with maturity and both AP and ML COP was significantly lower with eyes open.

CONCLUSION

These findings provide novel evidence that postural control is superior in early adolescent girls than boys 9 months prior to PHV, likely associated with an earlier maturation of muscle coordination.

Anthropometric and demographic properties affect balance in healthy adults: an observational study

BACKGROUND

Anthropometric and demographic properties may affect balance, but there is no consensus on this subject; so, there is a need for studies that explore it. This study aimed to assess the relationship between balance and anthropometric as well as demographic properties; and to determine the effect of anthropometric and demographic properties on balance in healthy adults.

METHODS

Sixty healthy adults were included in this study. The ages of the participants were questioned; height, body weight, Body Mass Index, head circumference, upper extremity, lower extremity, and foot length were evaluated, and shoe numbers were recorded. Balance assessments were performed with the Balance Master System device.

RESULTS

The mean age of the participants was 23.50±1.97 years. The balance developed with age (P<0.05), while there was a negative correlation between height and balance (P<0.05). Weight gain affected balance negatively (P<0.05). The increase in head circumference, extremity, and foot length was associated with a deterioration in balance (P<0.05).

CONCLUSIONS

The results of the current study were showed that anthropometric and demographic properties affect balance. The increase in some of the anthropometric and demographic properties including height, weight, head circumference, extremity, and foot length harms the balance. During balance assessments, anthropometric and demographic characteristics should be considered as a factor that affects balance.

Ankle Muscle Activations during Different Foot-Strike Patterns in Running

This study analysed the landing performance and muscle activity of athletes in forefoot strike (FFS) and rearfoot strike (RFS) patterns. Ten male college participants were asked to perform two foot strikes patterns, each at a running speed of 6 km/h. Three inertial sensors and five EMG sensors as well as one 24 G accelerometer were synchronised to acquire joint kinematics parameters as well as muscle activation, respectively. In both the FFS and RFS patterns, according to the intraclass correlation coefficient, excellent reliability was found for landing performance and muscle activation. Paired t tests indicated significantly higher ankle plantar flexion in the FFS pattern. Moreover, biceps femoris (BF) and gastrocnemius medialis (GM) activation increased in the pre-stance phase of the FFS compared with that of RFS. The FFS pattern had significantly decreased tibialis anterior (TA) muscle activity compared with the RFS pattern during the pre-stance phase. The results demonstrated that the ankle strategy focused on controlling the foot strike pattern. The influence of the FFS pattern on muscle activity likely indicates that an athlete can increase both BF and GM muscles activity. Altered landing strategy in cases of FFS pattern may contribute both to the running efficiency and muscle activation of the lower extremity. Therefore, neuromuscular training and education are required to enable activation in dynamic running tasks.

Sex and Age Comparisons in Neuromuscular And Biomechanical Characteristics of the Knee in Young Athletes

BACKGROUND

The identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs.

HYPOTHESIS/PURPOSE

This study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes.

STUDY DESIGN

Cross-sectional.

METHODS

Forty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic knee flexion and extension strength tests, single-leg static balance and single-leg vertical stop jump tasks.

RESULTS

High school athletes were significantly stronger (~67% and 35% stronger for males and females, respectively) and jumped higher (regardless of sex) compared to school age athletes. High school males had worse balance (~28%) compared to their younger counterparts. High school females had lower strength (~23%) compared to males but had better balance (~46%). Conclusion: Maturation had different effects on the variables analyzed and sex differences were mainly observed after maturation. These differences may be minimized through appropriate age and sex specific training programs.

LEVELS OF EVIDENCE

3a.

CLINICAL RELEVANCE

Neuromuscular and biomechanical differences between sex and age groups should be accounted for in injury prevention and rehabilitation. Inadequate training may be a primary factor contributing to injuries in a young athletic population. When designing training programs for long term athlete development, programs should be dependent on decrements seen at specific time points throughout maturation.What is known about the subject: Generally, both males and females get stronger and jump higher as they get older but the results comparing balance and biomechanics between genders or across age groups have been mixed.What this study adds to existing knowledge: The current study looks at multiple neuromuscular and biomechanical variables in male and female participants at different maturation statuses. The current data supports the significant changes observed in strength and jump height, as both genders age, but the data also demonstrates significant differences in balance between age groups in males and between genders in balance and knee flexion angles.

Is Postural Control Different in Boys and Girls? Comparison Between Sex

ABSTRACT The purpose of this study was to compare the postural control between eight-year-old boys and girls, considering the nutritional classification and level of physical activity. This was a cross-sectional study, with a sample of 346 participants, classified by the WHO AnthroPlus software, evaluated on the force platform and the Questionnaire Physical Activity for Children. The results demonstrated that girls showed lower values in relation to the opposite sex (p<0.001), in the center of pressure area (COP) (girls: 11.88 vs boys: 15.86cm2), Antero-posterior Amplitude (girl: 5.40 vs boy: 6.05cm), Medial-lateral Amplitude (girl: 3.97 vs boy: 4.40cm), Antero-posterior velocity (girl: 3.98 vs boy: 4.94cm/s), Medial-lateral velocity (girl: 3.98 vs boy: 4.59cm/s), Antero-posterior frequency (girl: 0.70 vs boy: 0.84Hz). Physical activity was associated with male sex (p=0.001; X2=11.195; odds ratio=0.372). In relation to the center of pressure of sedentary children, girls showed better postural control (p<0.001), but when we analyzed the center of pressure of both sexes who were active there was no statistically significant difference (p=0.112). The Z score of both sexes presented no difference in the center of pressure area (p=0.809 and p=0.785 respectively). Girls showed better postural control, while boys are more active; when both sexes performed physical activity COP area was similar. Therefore, special care should be taken when assessing postural control in boys and girls due to their differences in test performance and stage of development. As for interventions, exercise should be considered for better performance of the COP.

Postural Stability in Athletes: The Role of Age, Sex, Performance Level, and Athlete Shoe Features

The effects of different factors-such as age, sex, performance level, and athletic shoe features-on postural balance in athletes remain unclear. The main objective of our study is to identify the features of postural stability in athletes of different age, sex, performance level, and using different types of athletic shoes. This study assessed postural stability in athletes (n = 936, 6-47 years) in a normal bipedal stance with eyes open (EO) and eyes closed (EC). Postural stability was evaluated based on the center of pressure (COP), sway area (AS), and velocity (VCP) while standing on a stabiloplatform. Children (6-12 years) and teen athletes (13-17 years) showed reduced AS-EO (p < 0.01) and VCP-EO (p < 0.01) compared to control (n = 225, 7-30 years). In male and female athletes aged 18+, only VCP-EC was lower versus control. In females (13-17 and 18+), VCP-EO and EC were lower than in males (p < 0.05). Only in the Shooting group, the athletes' performance levels had an effect on VCP-EO (p = 0.020). Long use of rigid athletic shoes with stiff ankle support was associated with reduced posture stability. Postural stability in athletes was mostly influenced by the athlete's age, and, to a lesser extent, by their sex, performance level, and athlete shoe features.

Gender Differences in Postural Stability among 13-Year-Old Alpine Skiers

This experiment examined changes in body sway after Wingate test (WAnT) in 19 adolescents practicing alpine skiing, subjected to the same type of training load for 4–5 years (10 girls and nine boys). The postural examinations were performed with eyes open (EO), eyes closed (EC), and sway reverenced vision (SRV) in the medial-lateral (ML) and anterior-posterior (AP) planes. The displacement of center of foot pressure (CoP), range of sway (RS), mean sway velocity (MV), way length, and surface area were measured in bipedal upright stance before and after the WAnT to assess the influence of fatigue on postural balance. There were no significant differences in WAnT parameters between girls and boys. Relative peak power (RPP), relative total work (RWtot) were (girls vs. boys) 8.89 ± 0.70 vs. 9.57 ± 1.22 W/kg, p < 0.05 and 227.91 ± 14.98 vs. 243.22 ± 30.24 W/kg, p < 0.05 respectively. The fatigue index (FI) was also on similar level in both genders; however, blood lactate concentration (BLa) was significantly higher in boys (10.35 ± 1.16 mM) than in girls (8.67 ± 1.35 mM) p = 0.007. In the EO examination, statistically significant differences between resting and fatigue conditions in the whole group and after the division into girls and boys were found. In fatigue conditions, significant gender differences were noted for measurements in the ML plane (sway path and RS) and RS in the AP plane. Comparison of the three conditions shows differences between EO vs. EC and SRV in AP plane measured parameters, and for RS in ML plane in rest condition in girls. The strong correlations between FI and CoP parameters mainly in ML plane in the whole group for all examination conditions were noted. By genders, mainly RS in ML plane strongly correlates with FI (r > 0.7). No correlation was found between BLa and CoP parameters (p > 0.06). The presented results indicate that subjecting adolescents of both genders to the same training may reduce gender differences in the postural balance ability at rest but not in fatigue conditions and that girls are significantly superior in postural balance in the ML plane than boys. It was also shown that too little or too much information may be destructive to postural balance in young adolescents.

Postural stability of 5-year-old girls and boys with different body heights

Background

Postural stability is one of the determinants of proper body posture and a condition for developing motor abilities in every human being. The measurement of the centre of pressure (COP) location and displacement is the most common technique of postural stability assessment.

Objective

The aim of this study was to assess differences in postural stability depending on sex of 5-year-old children with different body heights.

Methods

A study included 435 healthy children (200 girls and 235 boys) born in 2010 whose parents gave a written consent to their participation in the project. Postural stability was assessed with the use of the dynamographic platform (Zebris FDM 1.8). The assessment of postural stability was based on COP shift parameters (sway path length of COP and average velocity of COP) and COP surface area parameters (area of the ellipse, length of ellipse in the anterior-posterior direction and length of the ellipse in the medial-lateral direction). Body height was measured with Holtein anthropometer and the obtained values were compared with percentile ranks determined by the WHO.

Results

The analysis of the parameters describing postural stability in the examined children revealed dimorphism. For the COP shift parameters and COP surface area parameters, the level of statistical significance was recorded for girls and boys. Girls achieved lower results of these parameters than boys regardless of their body height. In the groups of normal- and tall-statured children, differences between the genders were statistically significant.

Conclusions

The present study characterised sex differences in postural stability of 5-year-old children. Sex-related differences were found during a natural stance for all COP parameters. Girls maintained a two-legged standing position with lower sway velocity and a smaller range of sway than their male counterparts. Normal- and tall-statured girls demonstrated better postural stability significantly more often than boys.

Normative Data Set of SWAY Balance Mobile Assessment in Pediatric Athletes

OBJECTIVE

To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma).

DESIGN

Retrospective analysis of baseline balance assessments in a healthy pediatric population.

SETTING

Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL.

PARTICIPANTS

Test results of a sample of 466 athletes aged 5 to 18 years were included.

INTERVENTIONS

The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol.

MAIN OUTCOME MEASURES

Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined.

RESULTS

Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds.

CONCLUSIONS

Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.

Age and sex differences in human balance performance from 6-18 years of age: A systematic review and meta-analysis

Background

The process of growing leads to inter-individual differences in the timing of growth, maturational, and developmental processes during childhood and adolescence, also affecting balance performance in youth. However, differences in balance performance by age and sex in youth have not been systematically investigated yet.

Objective

The objective of the present study was to characterize and quantify age- and sex-related differences in balance performance in healthy youth.

Methods

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus. To be applicable for analysis, studies had to report at least one measure of static steady-state, dynamic steady-state, proactive or reactive balance in healthy children (6–12 years) and/or adolescents (13–18 years). Coding of the studies was done according to the following criteria: age, sex, and balance outcome. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies. Weighted standardized mean differences were calculated and classified according to their magnitude.

Results

Twenty-one studies examined age-related differences in balance performance. A large effect for measures of static steady-state balance (SMD_ba = 1.20) and small effects for proxies of dynamic steady-state (SMD_ba = 0.26) and proactive balance (SMD_ba = 0.28) were found; all in favor of adolescents. Twenty-five studies investigated sex-related differences in balance performance. A small-sized effect was observed for static steady-state balance (SMD_bs = 0.33) in favor of girls and for dynamic steady-state (SMD_bs -0.02) and proactive balance (SMD_bs = -0.15) in favor of boys. Due to a lack of studies, no analysis for measures of reactive balance was performed.

Conclusions

Our systematic review and meta-analysis revealed better balance performances in adolescents compared to children, irrespective of the measure considered. Sex-related differences were inconsistent. These findings may have implications for example in terms of trainability of balance in youth that should be investigated in future studies.

The validity and reliability of the Swaymeter for postural sway measurement in typically developing children aged between 7-12 years

BACKGROUND

The Swaymeter is a simple devicefor measuring postural sway. It consists of a 40-cm-long rod with a vertically mounted pen at the end of the rod that measures the displacement of the body at waist level.

RESEARCH QUESTION

This device could be an effective tool for measuring postural sway in children. However, the validity and reliability of the Swaymeter in children has not been evaluated. In this study, we aimed to evaluate the validity and reliability of the Swaymeter in typically developing children aged 7-12 years.

METHOD

The Swaymeter procedure was randomly measured in quiet bipedal stance under 4 conditions: eyes open and eyes closed on the floor, eyes open and eyes closed on foam, 30 s were performed in each condition. There were 15 children participated in the validity study. The postural sway was measured concurrently with the motion capture system with two reflective markers on the top of the pen and 12^th thoracic vertebra level in three trials with four testing conditions. Additionally, 36 children participated in test-retest reliability. Three measurements were performed on the same day and one week later.

RESULTS

Swaymeter had a moderate to good correlation with motion capture system (r = 0.637-0.979). The test-retest reliability of the Swaymeter showed moderate to good reliability for immediate test-retest (ICC = 0.51-0.87). However, inter-session reliability revealed moderate to good reliability except for the AP variable that showed low reliability. Good to excellent reliability was found in sway area variable (ICCs between 0.74 and 0.92) for all measurements.

SIGNIFICANCE

Postural sway measure by Swaymeter was valid and reliable in typically developing children aged 7-12 years and suitable for applying to assess postural sway in typically developing children.

Influence of heading perception in the control of posture

The optic flow visual input directly influences the postural control. The aim of the present study was to examine the relationship between visually induced heading perception and postural stability, using optic flow stimulation. The dots were accelerated to simulate a heading direction to the left or to the right of the vertical midline. The participants were instructed to indicate the perceived optic flow direction by making a saccade to the simulated heading direction. We simultaneously acquired electromyographyc and center of pressure (COP) signals. We analysed the postural sway during three different epochs: (i) the first 500 ms after the stimulus onset, (ii) 500 ms before saccade onset, epoch in which the perception is achieved and, (iii) 500 ms after saccade onset. Participants exhibited a greater postural instability before the saccade, when the perception of heading was achieved, and the sway increased further after the saccade. These results indicate that the conscious representation of the self-motion affects the neural control of posture more than the mere visual motion, producing more instability when visual signals are contrasting with eye movements. It could be that part of these effects are due to the interactions between gaze shift and optic flow.

Postural Stability in Healthy Child and Youth Athletes: The Effect of Age, Sex, and Concussion-Related Factors on Performance

Background:

Postural stability plays a key role in sport performance, especially after concussion. Specific to healthy child and youth athletes, little is known about the influence development and sex may have on postural stability while considering other subjective clinical measures used in baseline/preinjury concussion assessment. This study aims to describe age- and sex-based trends in postural stability in uninjured child and youth athletes at baseline while accounting for concussion-related factors.

Hypotheses:

(1) Postural stability performance will improve with age, (2) females will display better postural stability compared to males, and (3) concussion-like symptoms will affect postural stability performance in healthy children and youth.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

This study comprised 889 healthy/uninjured child and youth athletes (54% female, 46% male) between the ages of 9 and 18 years old. Participants completed preseason baseline testing, which included demographic information (age, sex, concussion history), self-report of concussion-like symptoms (Post-Concussion Symptom Inventory [PCSI]–Child and PCSI-Youth), and measures of postural stability (BioSway; Biodex Medical Systems). Two versions of the PCSI were used (PCSI-C, 9- to 12-year-olds; PCSI-Y, 13- to 18-year-olds). Postural stability was assessed via sway index under 4 sway conditions of increasing difficulty by removing visual and proprioceptive cues.

Results:

In children aged 9 to 12 years old, there were significant age- (P < 0.05) and sex-based effects (P < 0.05) on postural stability. Performance improved with age, and girls performed better than boys. For youth ages 13 to 18 years old, postural stability also improved with age (P < 0.05). In both child and youth subgroups, postural stability worsened with increasing concussion-like symptoms (P < 0.05).

Conclusion:

There are developmental and baseline symptom trends regarding postural stability performance.

Clinical Relevance:

These findings provide a preliminary foundation for postconcussion comparisons and highlight the need for a multimodal approach in assessing and understanding physical measures such as postural stability.

Balance, Proprioception, and Gross Motor Development of Chinese Children Aged 3 to 6 Years

The authors' aim was to find the features of balance, proprioception, and gross motor development of Chinese children 3-6 years old and their correlations, provide theoretical support for promoting children's motor development, and enrich the world theoretical system of motor development. This study used a Tekscan foot pressure measurement instrument (Tekscan, Inc., Boston, MA), walking on a balance beam, Xsens 3-dimensional positional measuring system (Xsens Technologies, Enschede, the Netherlands), and Test of Gross Motor Development-2 to assess static balance, dynamic balance, knee proprioception, and levels of gross motor development (GMD) of 3- to 6-year-old children (n = 60) in Beijing. The results are as follows: children had significant age differences in static balance, dynamic balance, proprioception, and levels of GMD; children had significant gender differences in static balance, proprioception, and levels of GMD; children's static balance, dynamic balance, and proprioception had a very significant positive correlation with GMD (p < .01), but no significant correlation with body mass index.

Assessment of the Postural Stability of Female and Male Athletes

OBJECTIVE

Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system.

DESIGN

Cross-sectional study.

SETTING

Sports injury prevention center.

PARTICIPANTS

Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation.

INDEPENDENT VARIABLES

We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache.

MAIN OUTCOME MEASURES

Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance.

RESULTS

Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P < 0.001, d = 0.62), and tandem stances (P < 0.001, d = 0.53) when compared with males.

CONCLUSIONS

Uninjured female athletes demonstrate better postural stability on video-force plate analysis than their uninjured male counterparts. These findings provide an important information assistive to clinicians during interpretation of postinjury balance tests.

Sex Differences in Vestibular/Ocular and Neurocognitive Outcomes After Sport-Related Concussion

OBJECTIVE

To examine sex differences in vestibular and oculomotor symptoms and impairment in athletes with sport-related concussion (SRC). The secondary purpose was to replicate previously reported sex differences in total concussion symptoms, and performance on neurocognitive and balance testing.

DESIGN

Prospective cross-sectional study of consecutively enrolled clinic patients within 21 days of a SRC.

SETTING

Specialty Concussion Clinic.

PARTICIPANTS

Included male (n = 36) and female (n = 28) athletes ages 9 to 18 years.

INTERVENTIONS

Vestibular symptoms and impairment was measured with the Vestibular/Ocular Motor Screening (VOMS). Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT), Post-concussion Symptom Scale (PCSS), and Balance Error Scoring System (BESS).

MAIN OUTCOMES MEASURES

Sex differences on clinical measures.

RESULTS

Females had higher PCSS scores (P = 0.01) and greater VOMS vestibular ocular reflex (VOR) score (P = 0.01) compared with males. There were no sex differences on BESS or ImPACT. Total PCSS scores together with female sex accounted for 45% of the variance in VOR scores.

CONCLUSIONS

Findings suggest higher VOR scores after SRC in female compared with male athletes. Findings did not extend to other components of the VOMS tool suggesting that sex differences may be specific to certain types of vestibular impairment after SRC. Additional research on the clinical significance of the current findings is needed.

Normative values for a video-force plate assessment of postural control in athletic children

The objective of this study was to provide normative data for young athletes during the three stances of the modified Balance Error Scoring System (mBESS) using an objective video-force plate system. Postural control was measured in 398 athletes between 8 and 18 years of age during the three stances of the mBESS using a video-force plate rating system. Girls exhibited better postural control than boys during each stance of the mBESS. Age was not significantly associated with postural control. We provide normative data for a video-force plate assessment of postural stability in pediatric athletes during the three stances of the mBESS.

Relation between the Sensory and Anthropometric Variables in the Quiet Standing Postural Control: Is the Inverted Pendulum Important for the Static Balance Control?

The aim of this study was to evaluate the relation between the sensory and anthropometric variables in the quiet standing. Methods. One hundred individuals (50 men, 50 women; 20–40 years old) participated in this study. For all participants, the body composition (fat tissue, lean mass, bone mineral content, and bone mineral density) and body mass, height, trunk-head length, lower limb length, and upper limb length were measured. The center of pressure was measured during the quiet standing posture, the eyes opened and closed with a force platform. Correlation and regression analysis were run to analyze the relation among body composition, anthropometric data, and postural sway. Results. The correlation analysis showed low relation between postural sway and anthropometric variables. The multiple linear regression analyses showed that the height explained 12% of the mediolateral displacement and 11% of the center of pressure area. The length of the trunk head explained 6% of displacement in the anteroposterior postural sway. During eyes closed condition, the support basis and height explained 18% of mediolateral postural sway. Conclusion. The postural control depends on body composition and dimension. This relation is mediated by the sensory information. The height was the anthropometric variable that most influenced the postural sway.

Baseline SCAT2 Assessment of Healthy Youth Student-Athletes: Preliminary Evidence for the Use of the Child-SCAT3 in Children Younger Than 13 Years

OBJECTIVE

To compare baseline scores of middle and high school students on the Sport Concussion Assessment Tool 2 (SCAT2) by sex and age.

DESIGN

Cross-sectional study.

SETTING

Single private school athletic program.

PARTICIPANTS

Three hundred sixty-one middle and high school student-athletes.

INTERVENTION

Preseason SCAT2 was administered to student-athletes before athletic participation.

MAIN OUTCOME MEASURES

Total SCAT2 score, symptoms, symptom severity, Glasgow coma scale, modified Balance Error Scoring System (BESS), coordination, and Standardized Assessment of Concussion (SAC) with subsections: Orientation, Immediate Memory, Concentration, and Delayed Recall.

RESULTS

No differences were found in total SCAT2 scores between sex (P = 0.463) or age (P = 0.21). Differences were found in subcomponents of the SCAT2. Twelve year olds had significantly lower concentration scores (3.3 ± 1.2) than 15 and 18 year olds (3.9 ± 1.0 and 4.2 ± 1.0, respectively). The 12 year olds also had the lowest percentage of correct responses for the SAC's concentration 5-digit (46%), 6-digit (21%), and months' backward (67%) tasks. Females presented with more symptoms (20.0 ± 2.2 vs. 20.6 ± 2.1 P = 0.007) better immediate memory (14.6 ± 0.9 vs. 14.3 ± 1.0, P = 0.022) and better BESS scores (27.2 ± 2.3 vs. 26.6 ± 2.6, P = 0.043) than their male counterparts.

CONCLUSIONS

Normative values for total SCAT2 and subscale scores show differences in concentration between ages, whereas symptoms, BESS, and immediate memory differed between sexes. We also found that 12 year olds have increased difficultly with the advanced concentration tasks, which lends support to the development of a separate instrument, such as the Child-SCAT3. The presence of developmental differences in the younger age groups suggests the need for annual baseline testing.

CLINICAL RELEVANCE

Subtle differences between age and sex have been identified in many components of the SCAT2 assessment. These differences may support the current evolution of concussion assessment tools to provide the most appropriate test. Baseline testing should be used when available, and clinicians should be aware of potential differences when using normalized values.

Development and validity of the early clinical assessment of balance for young children with cerebral palsy

OBJECTIVES

Validity of the Early Clinical Assessment of Balance (ECAB), to monitor postural stability in children with cerebral palsy (CP), was evaluated.

METHODS

410 children with CP, 1.5 to 5 years old, participated. Physical therapists scored children on the Movement Assessment of Infants Automatic Reactions section and Pediatric Balance Scale. Through consensus, researchers selected items from both measures to create the ECAB. Content and construct validity were examined through item correlations, comparison of ECAB scores among motor ability, age and gender groups and correlations with the Gross Motor Function Measure 66 basal and ceiling (GMFM-66-B&C).

RESULTS

Internal consistency was high (Cronbach's alpha = 0.92). ECAB differed significantly among motor ability, children <31 months old scored lower than older children, but there was no difference between boys and girls. ECAB and GMFM-66-B&C scores correlated strongly (r = 0.97).

CONCLUSION

Validity of the ECAB was supported. Reliability and responsiveness need study.

Sex differences in white matter abnormalities after mild traumatic brain injury: localization and correlation with outcome

PURPOSE

To evaluate sex differences in diffusion-tensor imaging (DTI) white matter abnormalities after mild traumatic brain injury (mTBI) using tract-based spatial statistics (TBSS) and to compare associated clinical outcomes.

MATERIALS AND METHODS

The institutional review board approved this study, with waiver of informed consent. DTI in 69 patients with mTBI (47 male and 22 female patients) and 21 control subjects (10 male and 11 female subjects) with normal conventional magnetic resonance (MR) images were retrospectively reviewed. Fractional anisotropy (FA) maps were generated as a measure of white matter integrity. Patients with mTBI underwent serial neurocognitive testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Correlation between sex, white matter FA values, ImPACT scores, and time to symptom resolution (TSR) were analyzed with multivariate analysis and TBSS.

RESULTS

No significant difference in age was seen between males and females (control subjects, P = .3; patients with mTBI, P = .34). No significant difference was seen in initial ImPACT symptom scores (P = .33) between male and female patients with mTBI. Male patients with mTBI had significantly decreased FA values in the uncinate fasciculus (UF) bilaterally (mean FA, 0.425; 95% confidence interval: 0.375, 0.476) compared with female patients with mTBI and control subjects (P < .05), with a significantly longer TSR (P = .04). Multivariate analysis showed sex and UF FA values independently correlated with TSR longer than 3 months (adjusted odds ratios, 2.27 and 2.38; P = .04 and P < .001, respectively), but initial symptom severity did not (adjusted odds ratio, 1.15; P = .35).

CONCLUSION

Relative sparing of the UF is seen in female compared with male patients after mTBI, with sex and UF FA values as stronger predictors of TSR than initial symptom severity.

Computerized dynamic posturography: the influence of platform stability on postural control

OBJECTIVE

Postural stability can be quantified using posturography systems, which allow different foot platform stability settings to be selected. It is unclear, however, how platform stability and postural control are mathematically correlated.

DESIGN

Twenty subjects performed tests on the Biodex Stability System at all 13 stability levels. Overall stability index, medial-lateral stability index, and anterior-posterior stability index scores were calculated, and data were analyzed using analysis of variance and linear regression analysis.

RESULTS

A decrease in platform stability from the static level to the second least stable level was associated with a linear decrease in postural control. The overall stability index scores were 1.5 ± 0.8 degrees (static), 2.2 ± 0.9 degrees (level 8), and 3.6 ± 1.7 degrees (level 2). The slope of the regression lines was 0.17 for the men and 0.10 for the women.

CONCLUSIONS

A linear correlation was demonstrated between platform stability and postural control. The influence of stability levels seems to be almost twice as high in men as in women.

Importance of optic flow for postural stability of male and female young adults

PURPOSE

A feedback control process based on self-motion perception contributes to postural stability; however, little is known about the visual modulation of postural muscles. The aim of this study was to investigate the effect of optic flow stimuli, presented full field, in the peripheral and foveal visual field, on muscular activation. Then, we assessed the correlation between optic flow, muscle activity and body sway in male and female subjects.

METHODS

We used surface electromyography (EMG) and stabilometry on 24 right-handed young adults. We recorded the bilateral activation of tibialis anterior, gastrocnemius medialis, biceps femoris and vastus medialis. EMG and center of pressure (COP) signals were acquired simultaneously. EMG signal amplitude was computed as root mean square normalized by baseline.

RESULTS

We found a significant effect for muscles, gender and an interaction effect of muscle by gender (ANOVA, p < 0.001). Results showed different postural alignments in males and females. The COP spatial variability during peripheral stimuli was generally reduced. The prevalent direction of oscillation evoked by peripheral stimuli was clustered, while foveal and random stimuli induced distributed and randomized directions. Also for muscle activity, we found gender differences in the prevalent oscillation distributions evoked by optic flow.

CONCLUSION

Visual stimuli always evoke an excitatory input on postural muscles, but the stimulus structure produces different postural effects. Peripheral optic flow stimuli stabilize postural sway, while random and foveal optic flow provoke larger sway variability similar to those evoked in the absence of visual stimulation.

Relationship between anthropometric factors, gender, and balance under unstable conditions in young adults

The objective of this study was to evaluate the relationship between the anthropometric factors of height, body mass, body mass index and postural balance and to compare the balance indices between genders in the upright standing position, in healthy adult subjects under conditions of instability. Forty individuals were subjected to functional tests of body stability using the Biodex Balance System, and the resulting indices were correlated with body mass, height, and body mass index, and also compared between genders. Body mass was the main anthropometric factor that influenced variations in postural balance, with a high correlation between groups and with all variables. A linear regression analysis showed that body mass associated with BMI explained 66% of the overall stability, and body mass explained 59% of the anteroposterior stability index and 65% of the mediolateral stability index. In the female group, body mass explained 72% of the overall balance, 66% of the anteroposterior, and 76% of the medio-lateral stability index. Increased body mass requires greater movements to maintain postural balance. Height and BMI presented moderate correlations with balance. Women showed less movement than men on the Biodex Balance System.

The influence of anthropometric factors on postural balance: the relationship between body composition and posturographic measurements in young adults

OBJECTIVE

The aim of the present study was to evaluate the influence of anthropometric characteristics and gender on postural balance in adults. One hundred individuals were examined (50 males, 50 females; age range 20-40 years).

METHODS

The following body composition measurements were collected (using bone densitometry measurements): fat percentage (% fat), tissue (g), fat (g), lean mass (g), bone mineral content (g), and bone mineral density (g/cm²). In addition, the following anthropometric measurements were collected: body mass (kg), height (cm), length of the trunk-cephalic region (cm), length of the lower limbs (cm) and length of the upper limbs (cm). The following indices were calculated: body mass index (kg/m²), waist-hip ratio and the support base (cm²). Also, a postural balance test was performed using posturography variables with open and closed eyes.

RESULTS

The analysis revealed poor correlations between postural balance and the anthropometric variables. A multiple linear regression analysis demonstrated that the whole group (female and male) height explained 12% of the medial-lateral displacement, 10% of the speed of oscillation, and 11% of the displacement area. The length of the trunk-cephalic length explained 6% of the displacement in the anteroposterior direction. With eyes closed, the support base and height explained 18% of the medial displacement, and the lateral height explained 10% of the displacement speed and 5% of the scroll area.

CONCLUSION

Measured using posturography, the postural balance was only slightly influenced by the anthropometric variables, both with open and closed eyes. Height was the anthropometric variable that most influenced postural balance, both in the whole group and separately for each gender. Postural balance was more influenced by anthropometric factors in males than females.

The effect on human balance of standing with toe-extension

Background

Postural balance is vital for safely carrying out many daily activities, such as locomotion. The purpose of this study was to determine how changes in normal standing (NS) and standing with toe-extension (SWT) impact postural control during quiet standing. Furthermore, the research aimed to examine the extent to which the effect of these factors differed between genders.

Methodology/Principal Findings

Thirty healthy young adults (age = 21.2±1.3 y; height = 1.63±0.07 m; mass = 56.0±9.3 kg) with no prior lower limb injuries participated in the study. A postural stability test using the Biodex Balance System was used for both NS and SWT conditions. The three measurements from the BBS were Overall Stability Index (OSI), Medial-Lateral Stability Index (MLSI) and Anterior-Posterior Stability Index (APSI). No significant difference was found between NS and SWT in the OSI, MLSI or APSI (F_{2, 28} = 3.357, p = 0.077). The main difference between the stability index scores was significant (F_{2, 28} = 275.1, p<0.001). The Bonferroni post-hoc test showed significant differences between the OSI and MLSI (p<0.001); the OSI and APSI (p<0.001); and the MLSI and the APSI (p<0.001). Significant differences were found during NS (p<0.001), for the MLSI when compared with the APSI, but this was not found during the SWT condition. Additionally, no gender effects were proven to exist that altered postural sway during quiet standing.

Conclusions/Significance

This study reveals significant interaction between the stability indices measured; OSI, APSI and MLSI in both NS and SWT. Standing with toe extended does not have a significant impact on an individual’s ability to control their balance during normal quiet standing. However, the findings revealed that the sway tendency in the medial-lateral direction might serve as a factor in an individual’s ability to regain balance.

Gender differences in postural stability among children

This study aimed to examine the gender differences in postural stability among 8–12 year-old children. Twenty-six children participated in this repeated measures study to measure the centre of pressure (COP) under one normal condition (CONTROL: hard surface, eyes open, and looking straight ahead) and two challenging sensory conditions (ECHB: eyes closed and head back; and EOCS: eyes open and compliant surface) in randomized order. Girls had significantly lower COP path velocity (COP-PV, p < 0.05, medium effect), smaller radial displacement (COP-RD, p < 0.05, medium effect), and lower area velocity (COP-AV, p < 0.05, medium effect) as compared to boys when the three conditions were pooled. Gender differences were found in the percentage changes in COP-RD during ECHB (p < 0.05, large effect) and EOCS (p < 0.05, medium effect), and in COP-AV during both ECHB and EOCS conditions (p < 0.05, medium effect). Postural stability performance of girls had higher correlations with age (−0.62 vs. −0.40), body mass (−0.60 vs. −0.42), foot length (−0.68 vs. −0.45), and physical activity level (−0.45 vs. 0.02), as compared to boys. Girls had better postural stability than boys but were more affected by altered sensory input information. Girls are more capable of integrating their sensory inputs, whereas boys treat each sensory input somewhat separately and rely more on somatosensory feedback. Exercises such as standing on unstable surfaces with eyes open instead of eye closed and head back are more beneficial to children’s postural stability control system.

The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion

BACKGROUND

Researchers have begun to focus on age and sex differences in concussion outcomes. Results suggest that younger athletes and female athletes may take longer to recover from a concussion. However, little is known about the interactive effects of age and sex on symptoms, neurocognitive testing (NCT), and postural stability.

HYPOTHESIS/PURPOSE

The purpose of the study was to examine sex and age differences in symptoms, NCT, and postural stability following concussion. We hypothesized that high school and female athletes would have worse symptoms, NCT, and postural stability than college and male athletes, respectively.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 296 concussed athletes from a multistate, 2-year study were enrolled in this study. Participants completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and Post-Concussion Symptom Scale (PCSS) at baseline and again at 2, 7, and 14 days after concussion. Participants completed the Balance Error Scoring System (BESS) at 1, 2, and 3 days after concussion.

RESULTS

Female athletes performed worse than male athletes on visual memory (mean, 65.1% and 70.1%, respectively; P = .049) and reported more symptoms (mean, 14.4 and 10.1, respectively) after concussion (P = .035). High school athletes performed worse than college athletes on verbal (mean, 78.8% and 82.7%, respectively; P = .001) and visual (mean, 65.8% and 69.4%, respectively; P = .01) memory. High school athletes were still impaired on verbal memory 7 days after concussion compared with collegiate athletes (P = .001). High school male athletes scored worse on the BESS than college male athletes (mean, 18.8 and 13.0, respectively; P = .001). College female athletes scored worse on the BESS than high school female athletes (mean, 21.1 and 16.9, respectively; P = .001).

CONCLUSION

The results of the current study supported age differences in memory and sex differences in memory and symptoms and an interaction between age and sex on postural stability after concussion that warrant consideration from clinicians and researchers when interpreting symptoms, specific components of NCT, and postural stability tests. Future research should develop and assess interventions tailored to age and sex differences and include younger (<14 years) participants.

Evaluation of a single leg stance balance test in children

Balance is a major determinate of gait. In high functioning individuals without significant vestibular or vision impairments, a ceiling effect may be present when using a double limb support protocol to assess balance function. For these populations, a single leg stance protocol may be more suitable. 47 typically developing (TD) subjects and 10 patients with CEV performed a single leg stance test on a force plate. The center of pressure (COP) was determined and several COP derived variables were calculated. Included measurements were: standard deviation, maximum excursion, area, average radial displacement, path velocity and frequency of the COP. Directional components of suitable variables were used to analyze anterior/posterior and medial/lateral contributions. Correlations with age of TD subjects indicated that all balance variables except frequency were significantly correlated. Most parameters were highly inter-correlated. Age adjusted COP balance variables also correlated to the Bruininks-Oseretsky balance subtest. Highest correlations were determined by the maximum excursion and velocity of the COP in the anterior/posterior direction. Statistical comparisons between the CEV group and a 4-6 TD group indicated significant differences between groups for most COP balance parameters. These results indicated that a single limb balance assessment may be a useful assessment for determining balance impairments in higher functioning children with orthopedic impairments.