A Feasibility Study of an Integrated System Using a Force Plate and a Plantar Vibrotactile Stimulator for Fostering Postural Control in the Elderly

What are the temporal and physical characteristics of locally applied vibration that modulate balance in older adults? - A systematic review of the literature

BACKGROUND

Compromised balance is known to contribute to falls, which are associated with increased morbidity and mortality for older adults. Evidence suggests that the application of local vibration to the lower limbs of older adults has the potential to modulate balance.

RESEARCH QUESTION

To identify the temporal and mechanical parameters of vibration applied locally to the lower limbs of older adults that modulate measures of balance, and to define the short- and long-term effects of vibration on balance in this population.

METHODS

The PRISMA 2020 guidelines were used to conduct a systematic search including the PUBMED, EMBASE, and Scopus databases to identify peer-reviewed literature where vibration was applied to the lower limbs of older adults to modulate balance. Data was extracted using a study-specific data extraction form and risk of bias assessed. Where possible, effect sizes were calculated.

RESULTS

Of 7777 records screened, ten randomised controlled trials and 43 prospective laboratory-based studies met the inclusion criteria. Vibration frequencies ranged from 1 to 272 Hz, most studies (n=41) used ≤100 Hz. Amplitude ranged from 0.2 to 3.0 mm, most studies (n=28) used ≤1 mm. Effects of short-term vibration (applied for seconds to hours) were measured during and/or immediately after application. Short-term suprathreshold perceived muscle/tendon vibration had a 'large' destabilising effect size on balance in healthy older adults, but little or no effect on older fallers. Short-term subthreshold vibration to the soles of the feet had a 'small' stabilising effect size. Suprathreshold muscle, tendon or sole vibration applied for 10-30 min over days to weeks improved balance measures, but most (8 of 10) had increased risk of bias.

SIGNIFICANCE

The heterogeneity of methodology, populations, and vibration and balance parameters precluded conclusions about the relative effects of lower limb vibration in older adults. However, these results suggest that the application of local vibration to the lower limbs of older adults can modulate balance in the short- and long-term.

ASSISTIVE VIBROTACTILE BIOFEEDBACK SYSTEM FOR POSTURAL CONTROL ON PERTURBED SURFACE

Postural control is an important aspect of human locomotion and stance. When inputs to the Central Nervous System (CNS), consisting of the vestibular, somatosensory, and visual senses, degrade or become dysfunctional, the postural control is affected. Biofeedback has been established as a potential intervention method to assist individuals improve postural control, by augmenting or complementing signals to the CNS. This paper presents an approach to help achieve better postural control using vibrotactile biofeedback. Tests to monitor postural control, in eyes open and eyes closed states, on a wobble board were introduced to assess the viability of the designed system in providing accurate real-time biofeedback responses. Postural control was gauged by measuring the angular displacement of perturbations experienced. Perturbations along the anterior and posterior direction are used to determine the level of provided vibrotactile biofeedback. The feedback informs subjects the severity of perturbation and direction of imbalance. Significant improvement (p-value < 0.05) in postural control while on perturbed surface was detected when the designed biofeedback system was used. The wearable system was found to be effective in improving postural control of the subjects and can be expanded for rehabilitation, conditioning, and strengthening applications dealing with human postural control.