Posturography characteristics of obese children with and without associated disorders

Screening for balance in children and adults in a community science education setting: Normative data, influence of age, sex, and body mass index, and feasibility

BACKGROUND

Screening standing and walking balance is useful for people suspected of having vestibular disorders, a variety of neurologic and musculoskeletal disorders, and for screening astronauts returning after exposure to microgravity. Visitors to a community science education center children and adults, aged 4 to 85, were tested on tandem walking with eyes closed and the modified Romberg test on compliant foam. They were then asked about their experience participating in research, many people for the first time.

METHODS

Subjects performed 10 steps of tandem walking with eyes closed, and three trials of the modified Romberg, or Clinical Test of Sensory Integration and Balance, with eyes closed, standing on compliant memory foam, with a) head still, b) head shaking in yaw, and c) head nodding in pitch. Afterward, staff queried subjects about the experience of participating in science.

RESULTS

Age-related changes across the life span occurred in both sets of tests. Therefore, look-up tables by age are provided. Body mass index significantly affected tandem walking. Some sex differences were found. The tests were easy to administer in a community setting. Most participants enjoyed the experience and reported that they learned about the process of scientific research.

DISCUSSION

These data support and extend the evidence for age-related changes in balance performance across the lifespan and for an influence of body mass index on some balance skills. Clinicians and sports educators should be cognizant of these differences when they use these tests for screening. The community science education environment provided a useful laboratory in which to collect valid and reliable data, while simultaneously educating participants about the process of science.

Achilles Tendon Tissue Structure in Children with Overweight and Children with Obesity

Aim: To investigate differences in Achilles tendon structure between children with overweight/obesity and children with normal weight.Methods: Twenty-two children with obesity, 10 children with overweight, and 44 children with normal weight participated in the study. BMI% was calculated. The Achilles tendon was examined using ultrasound tissue characterization (UTC) imaging to capture a three-dimensional structure of four echo-type fibers and a cross-sectional area.Results: A significantly higher percentile of echo-types II, a lower percentile of echo-types III and IV, and a lower cross-sectional area were found for children with normal weight compared with children with overweight/obesity (p < .05). Following a piecewise linear regression model according to tendon structure, a BMI percentile of 75% was found to be the most accurate cutoff point of the children into the "unaffected" (BMI% <75%) and "affected" tendon structure groups (BMI% ≥ 75%), as the children with BMI%≥75% already had an Achilles tendon structure similar to that of the children with overweight/obesity.Conclusions: Tendon integrity as examined with UTC differs between children with obesity and children with normal weight. Children with a BMI percentile of ≥75 already demonstrate a different tendon structure pattern compared with children with BMI percentile of <75. This may put children with obesity at a greater risk of injury and should be addressed when applying an exercise program for children with overweight/obesity.

Comparison of posturographic outcomes between two different devices

The Interactive Balance System (IBS), a posturography device for assessing posture control, is widely used in clinical and rehabilitation settings. However, data on the validity of the device are unavailable. Fluctuations of the center of pressure (COP) were measured in 24 healthy participants (age: 29 ± 5 (mean ± SD) years, 12 females) synchronously using the IBS, which was rigidly mounted on a Kistler platform. Four different bipedal conditions were examined: eyes open or closed on stable or soft surfaces. Time series were compared using congruity (CON, proportion of the measurement time during which values of both devices changed similarly in direction), whereas IBS-specific postural outcomes were correlated with traditional postural control outcomes of the Kistler force platform. The time-displacement curves showed similar shapes for CON (>0.9) for each of the four standing conditions without differences between male and female participants (P > 0.39). The path length results of both devices showed very high linear associations, explaining on average 92% (medio-lateral) or 96% (anterior-posterior) of the common variance. The Kistler path length of the anterior-posterior direction revealed nearly perfect linear associations with the stability index of the IBS (r² > 0.99). The results of this study indicate that the IBS provides valid posturographic results. Since the medial-lateral and anterior-posterior trajectories of the IBS can be used to calculate COP fluctuations, comparisons between different measurement systems are possible.

Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review

The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.

Balance Screening of Vestibular Function in Subjects Aged 4 Years and Older: A Living Laboratory Experience

To better understand the various individual factors that contribute to balance and the relation to fall risk, we performed the modified Romberg Test of Standing Balance on Firm and Compliant Support, with 1,174 participants between 4 and 83 years of age. This research was conducted in the Living Laboratory^® at the Museum of Science, Boston. We specifically focus on balance test condition 4, in which individuals stand on memory foam with eyes closed, and must rely on their vestibular system; therefore, performance in this balance test condition provides a proxy for vestibular function. We looked for balance variations associated with sex, race/ethnicity, health factors, and age. We found that balance test performance was stable between 10 and 39 years of age, with a slight increase in the failure rate for participants 4-9 years of age, suggesting a period of balance development in younger children. For participants 40 years and older, the balance test failure rate increased progressively with age. Diabetes and obesity are the two main health factors we found associated with poor balance, with test condition 4 failure rates of 57 and 19%, respectively. An increase in the odds of having fallen in the last year was associated with a decrease in the time to failure; once individuals dropped below a time to failure of 10 s, there was a significant 5.5-fold increase in the odds of having fallen in the last 12 months. These data alert us to screen for poor vestibular function in individuals 40 years and older or suffering from diabetes, in order to undertake the necessary diagnostic and rehabilitation measures, with a focus on reducing the morbidity and mortality of falls.

Effects of a Program for Improving Biomechanical Characteristics During Walking and Running in Children Who Are Obese

PURPOSE

To investigate the influence of a weight-reduction program with locomotion-emphasis on improving biomechanical characteristics of children who are obese (OW).

METHODS

Ten children who are OW participated in a 6-month multidisciplinary childhood obesity management program (GRP1); another 10 children who are OW participated in the same multidisciplinary childhood obesity management program with additional locomotion-emphasis exercises for improving biomechanical characteristics (GRP2); and 10 control children who are OW with no intervention program. Outcomes were anthropometric measurements and temporal and foot pressure parameters.

RESULTS

GRP2 had significantly improved foot pressure in the different walking/running speeds compared with GRP1. In the temporal parameters, pretests by speed by group interactions were significantly improved for GRP2 compared with GRP1.

CONCLUSIONS

We found evidence to support beneficial effects of combined dietary and physical activity/locomotion-emphasis exercises on the movement characteristics of children who are OW.

Association between Body Composition and Sport Injury in Canadian Adolescents

Purpose: To examine the association between overweight or obesity and sport injury in a population-based sample of Canadian adolescents. Methods: Cross-sectional analyses were performed using the Canadian Community Health Survey (2009-2010), a nationally representative sample (n=12,407) of adolescents aged 12-19 years. Body composition was quantified using BMI, grouping participants into healthy weight, overweight, or obese. The outcome of interest was acute or repetitive strain injury sustained during sport in the previous year. We examined the relationship between sport injury and overweight or obesity compared with healthy weight using multivariate logistic regression, controlling for sex, ethnicity, physical activity, and socio-economic status. We also examined the interaction between physical activity and body composition in a secondary analysis with a subset of active adolescents. Results: No significant relationship was found between being overweight and sport injury (odds ratio [OR]=1.04, 95% CI: 0.92, 1.17); however, a protective effect was seen between obesity and sport injury (OR=0.67, 95% CI: 0.53, 0.84). Secondary analysis revealed that overweight youths with the highest activity level (quartile 4) did have increased odds of sport injury (OR=1.38, 95% CI: 1.04, 1.83), yet obese youths with a moderate activity level (quartile 2) were protected compared with healthy-weight youths (OR=0.46, 95% CI: 0.24, 0.91). Conclusions: Further examination of active adolescents is warranted. Studies should consider sport-specific differences and comprehensive measurement of exposure to sport.

Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder, preliminary study

INTRODUCTION

Attention deficit hyperactivity disorder is a common impairing neuropsychiatric disorder with onset in early childhood. Almost half of the children with attention deficit hyperactivity disorder also experience a variety of motor-related dysfunctions ranging from fine/gross motor control problems to difficulties in maintaining balance.

OBJECTIVES

The main purpose of this study was to investigate the effects of distractors two different auditory distractors namely, relaxing music and white noise on upright balance performance in children with attention deficit hyperactivity disorder.

METHODS

We compared upright balance performance and the involvement of different sensory systems in the presence of auditory distractors between school-aged children with attention deficit hyperactivity disorder (n=26) and typically developing controls (n=20). Neurocom SMART Balance Master Dynamic Posturography device was used for the sensory organization test. Sensory organization test was repeated three times for each participant in three different test environments.

RESULTS

The balance scores in the silence environment were lower in the attention deficit hyperactivity disorder group but the differences were not statistically significant. In addition to lower balance scores the visual and vestibular ratios were also lower. Auditory distractors affected the general balance performance positively for both groups. More challenging conditions, using an unstable platform with distorted somatosensory signals were more affected. Relaxing music was more effective in the control group, and white noise was more effective in the attention deficit hyperactivity disorder group and the positive effects of white noise became more apparent in challenging conditions.

CONCLUSION

To the best of our knowledge, this is the first study evaluating balance performance in children with attention deficit hyperactivity disorder under the effects of auditory distractors. Although more studies are needed, our results indicate that auditory distractors may have enhancing effects on upright balance performance in children with attention deficit hyperactivity disorder.

Longitudinal Study Evaluating Postural Balance of Young Athletes

Repeated anaerobic conditions during athletic performance may cause general and local fatigue that result in postural balance deficit. Evidence suggests that improved postural balance during athletic training may decrease the risk for fallings and traumatic injuries among athletes. Twenty athletes (12 girls, 8 boys) and 20 controls (12 girls, 8 boys) ages 10–15 years participated in the current study. All athletes were active in an 8-month physical activity program, 3 times per week for 90 min., specific to basketball, soccer, or athletic training. The control children participated in physical education at school only, with no involvement in organized extracurricular sports. All participants were evaluated for postural balance in three assessments over one year (at 4-mo intervals); the Interactive Balance System machine (Tetrax device) was used to assess balance at three test times (pre-, post-, and 10 min) after a session of a repeated sprint anaerobic test, consisting of 12 × 20 m run starting every 20 sec. The athletes had better postural balance than controls. There were different group patterns of change over the sessions; a significant interaction of session and group indicated that postural balance of the groups differed. The contribution of low sway frequencies (F1) and high sway frequencies (F6) differed between the controls and the athletes group. Results suggested that although athletes had better postural balance, improvement should be encouraged during training over the sessions and seasons, with special awareness of the balance deficit that occurs immediately after anaerobic stress and at the end of the season, to decrease the risk of injuries.

Postural Balance Following Aerobic Fatigue Tests: A Longitudinal Study Among Young Athletes

General fatigue can cause aggravation of postural balance, with increased risk for injuries. The present longitudinal study aimed to evaluate the postural balance of young athletes following field aerobic tests throughout 1 year of training. Thirty children from a sports center in Nazareth, participating in a 3 times/week training program (specific to basketball, soccer, or athletic training), were assessed. Postural balance parameters were taken before, immediately after, and 10 min after a 20 m shuttle-run aerobic test, at 3 time points during 1 training year (Start/Y, Mid/Y, and End/Y). Fitness improved at the Mid/Y and End/Y compared to Start/Y. Postural balance significantly deteriorated immediately after the aerobic test and improved significantly in the 10-min testing in all 3 time points, with significant deterioration in the End/Y compared with the Start/Y. In conclusions, postural balance deteriorates immediately after aerobic exercises, and at the end of the year. To better practice drills related to postural balance and possibly to prevent injuries, it is best for young athletes to properly rest immediately following aerobic exercises and to practice postural balance mainly at the beginning and at the middle of the training year.

The effect of a weight management program on postural balance in obese children

The present study aimed to investigate whether obese children improve their balance and postural performance following a 6-month-weight management program. Twenty-nine obese children aged 6-14 years were examined posturographically before and after participation in weight management program. The interactive balance system evaluated the stability index, Fourier spectral analysis, weight distribution index, and falling index. The performance was evaluated for eight positions requiring closure of eyes, standing on pillows, as well as head turns. Anthropometric measurements (e.g., weight, height, BMI, and BMI percentiles) were also determined before and after the intervention. We found significant increase in height and significant decreased in BMI percentile following the intervention program (p<.05). Pre-intervention BMI percentile was found to be correlated with stability index in most of the positions measured (e.g., normal open position=.464; p=.011). Following the intervention program, an interaction was found between BMI percentile differences (pre- versus post-interventional) and balance (stability index and F2-F4 frequencies of most standing positions). Furthermore, a correlation was found between general stability and the falling index (.446; p=.015). Regression analysis showed that only initial weight distribution index and post-intervention BMI entered the equation as predictors of post-intervention weight distribution index.

CONCLUSION

Weight management program for childhood obesity improved stability, reduced potential vestibular stress/disturbances, and decreased falling probability of the participants. Further longitudinal studies are needed to verify the relationship between physical activity, weight loss, and reduction of subsequent injuries in obese children.