Rapid assessment of age-related differences in standing balance

Effects of Short-Term Dynamic Balance Training on Postural Stability in School-Aged Football Players and Gymnasts

Static and dynamic balance abilities enable simple and complex movements and are determinants of top athletic performance. Balance abilities and their proficiency differ fundamentally with respect to age, gender, type of balance intervention, and type of sport. With this study, we aim to investigate whether 4weeks of dynamic balance training (DBT) improves static balance performance in school-aged gymnasts and football players. For this purpose, young male gymnasts (n=21) and male football players (n=20) completed an initial static balance assessment consisting of two one-legged stance (left and right foot) and two two-legged stance (eyes open and eyes closed) tasks. Subsequently, all participants underwent a 4-week intervention. DBT consisting of nine individual tasks was performed two times per week. Another static balance assessment followed 1day after the last training session and retention was assessed 2weeks later. Dynamic balance scores and total path length were analyzed via rank-based repeated measures designs using ANOVA-type statistics. The influence of factors GROUP and TIME on the static and dynamic balance performance was examined. Prior to DBT, young gymnasts showed better static balance performance than football players. However, after intervention, both groups improved in both one-legged stance tasks and also had high retention rates in these tasks. No significant improvements were seen in either group in the two-legged balance tests. Both groups improved in the dynamic balance tasks, although no differences in learning rates were evident. Our findings imply an inter-relationship between both static and dynamic balance components. Consequently, training regimes should include both balance components to facilitate early development of balance ability.

Reliability and Validity of the Spanish-Language Version of the NIH Toolbox

The psychometric properties of the English-language NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) have been examined in numerous populations. This study evaluated the reliability and validity of the Spanish-language NIH Toolbox. Participants were children aged 3 to 7 years and adults aged 18 to 85 years who took part in the NIH Toolbox norming study in Spanish. Results supported the internal consistency reliability of included measures. Test-retest reliability was strong for most tests, though it was weaker for the test of olfaction among children and the test of locomotion among adults. Spearman's correlations and general linear models showed Spanish tests were often associated with age, sex, and education. Convergent validity for the two language measures that underwent more intensive development, evaluated via Spearman's correlations with legacy measures, was strong. Results support using the Spanish-language NIH Toolbox to measure neurological and behavioral functioning among Spanish-speaking individuals in the United States.

Bipedal hopping timed to a metronome to detect impairments in anticipatory motor control in people with mild multiple sclerosis

BACKGROUND

People with mild multiple sclerosis (MS) often report subtle deficits in balance and cognition but display no measurable impairment on clinical assessments. We examined whether hopping to a metronome beat had the potential to detect anticipatory motor control deficits among people with mild MS (Expanded Disability Status Scale ≤ 3.5).

METHODS

Participants with MS (n = 13), matched controls (n = 9), and elderly subjects (n = 13) completed tests of cognition (Montreal Cognitive Assessment (MoCA)) and motor performance (Timed 25 Foot Walk Test (T25FWT)). Participants performed two bipedal hopping tasks: at 40 beats/min (bpm) and 60-bpm in random order. Hop characteristics (length, symmetry, variability) and delay from the metronome beat were extracted from an instrumented walkway and compared between groups.

RESULTS

The MS group became more delayed from the metronome beat over time whereas elderly subjects tended to hop closer to the beat (F = 4.52, p = 0.02). Delay of the first hop during 60-bpm predicted cognition in people with MS (R = 0.55, β = 4.64 (SD 4.63), F = 4.85, p = 0.05) but not among control (R = 0.07, p = 0.86) or elderly subjects (R = 0.17, p = 0.57). In terms of hopping characteristics, at 60-bpm, people with MS and matched controls were significantly different from the elderly group. However, at 40-bpm, the MS group was no longer significantly different from the elderly group, even though matched controls and elderly still differed significantly.

CONCLUSIONS

This new timed hopping test may be able to detect both physical ability, and feed-forward anticipatory control impairments in people with mild MS. Hopping at a frequency of 40-bpm seemed more challenging. Several aspects of anticipatory motor control can be measured: including reaction time to the first metronome cue and the ability to adapt and anticipate the beat over time.

Effect of Taichi Softball on Function-Related Outcomes in Older Adults: A Randomized Control Trial

The purpose of this present study was to examine the effect of Taichi softball (TCSB) on physical function in Chinese older adults. Eighty Chinese older adults were randomly assigned into either an experimental group experiencing four 90-minute TCSB sessions weekly for seven consecutive weeks or a control group. At baseline and 7 weeks later, all participants were asked to perform physical functional tests for both lower and upper limbs. Multiple separate Analyses of Variance (ANOVA) with repeated measures were applied to evaluate the effects of TCSB on function-related outcomes between baseline and postintervention in the two groups. The findings indicate that a short-term and intensive TCSB training program does not only improve low limb-related physical function such as dynamic balance and leg strength, but also strengthen upper limb-related physical function (e.g., arm and forearm strength, shoulder mobility, fine motor control, handgrip strength, and fine motor function). Health professionals could take into account TCSB exercise as an alternative method to help maintain or alleviate the inevitable age-related physical function degeneration in healthy older adults. In addition, researchers could investigate the effect of TCSB exercise on physical function in special populations such as patients with different chronic diseases or neurological disorder (e.g., Parkinson's disease).

On the relationship between subjective and objective measures of fatigue

OBJECTIVE

Objective and subjective methods have been used in the past to assess workplace fatigue, but little is known about correlations between them. We examine correlations between subjective and objective measures, including measures collected in a workplace scenario.

METHODS

15 young and 17 older participants were assessed before and after work with four types of fatigue measure: objective physical (posturography), objective mental (psychomotor vigilance task), subjective physical and mental (self-assessment), objective and subjective realistic (oculomotor behaviour, observer-rated facial expression, typing performance).

RESULTS

Pre- and post-test scores were analysed with an ANOVA, significant differences were submitted to a factor analysis. It yielded three factors: one representing posturography, the second self-rated mental and physical fatigue and the third observer-rated facial expression.

CONCLUSIONS

Results advocate the existence of three independent fatigue components: Objective physical fatigue, introspective and extrospective fatigue. Practitioner Summary: This study analyses correlations between different subjective and objective fatigue markers to better understand the complex nature of workplace fatigue. Measurements were conducted directly at the workplace. Results reveal that fatigue comprises three independent fatigue components: Objective physical fatigue, introspective and extrospective fatigue.

Relation between Multiple Markers of Work-Related Fatigue

BACKGROUND

Work-related fatigue has a strong impact on performance and safety but so far, no agreed upon method exists to detect and quantify it. It has been suggested that work-related fatigue cannot be quantified with just one test alone, possibly because fatigue is not a uniform construct. The purpose of this study is therefore to measure work-related fatigue with multiple tests and then to determine the underlying factorial structure.

METHODS

Twenty-eight employees (mean: 36.11; standard deviation 13.17) participated in five common fatigue tests, namely, posturography, heart rate variability, distributed attention, simple reaction time, and subjective fatigue before and after work. To evaluate changes from morning to afternoon, t tests were conducted. For further data analysis, the differences between afternoon and morning scores for each outcome measure and participant (Δ scores) were submitted to factor analysis with varimax rotation and each factor with the highest-loading outcome measure was selected. The Δ scores from tests with single and multiple outcome measures were submitted for a further factor analysis with varimax rotation.

RESULTS

The statistical analysis of the multiple tests determine a factorial structure with three factors: The first factor is best represented by center of pressure (COP) path length, COP confidence area, and simple reaction time. The second factor is associated with root mean square of successive difference and useful field of view (UFOV). The third factor is represented by the single Δ score of subjective fatigue.

CONCLUSION

Work-related fatigue is a multidimensional phenomenon that should be assessed by multiple tests. Based on data structure and practicability, we recommend carrying out further studies to assess work-related fatigue with manual reaction time and UFOV Subtest 2.

Efficacy of a trunk orthosis with joints providing resistive force on low-back load in elderly persons during static standing

Purpose

Postural alignment of elderly people becomes poor due to aging, possibly leading to low-back pain and spinal deformity. Although there are several interventions for treating these conditions, no previous study has reported the effectiveness of a spinal orthosis or lumbosacral orthosis (LSO) in healthy elderly people without specific spinal deformity. We therefore developed a trunk orthosis to decrease low-back muscle activity while training good postural alignment through resistive force provided by joints with springs (here, called the ORF, which stands for orthosis with joints providing resistive force) as a preventive method against abnormal posture and low-back pain in healthy elderly persons.

Patients and methods

Fifteen community-dwelling elderly men participated in this study. Participants stood freely for 10 seconds in a laboratory setting under three conditions: without an orthosis, with the ORF, and with an LSO. The Damen corset LSO was selected as it is frequently prescribed for patients with low-back pain. Postural alignment during static standing was recorded using a three-dimensional motion capture system employing infrared cameras. Two force plates were used to record center of pressure. Electromyograms were obtained for bilateral erector spinae (ES), left internal abdominal oblique, and right gluteus medius muscles.

Results

Pelvis forward tilt angle tended to increase while wearing the ORF and decrease while wearing the LSO, but these results were not significant compared to no orthosis. Thorax extension angle and thorax angle on pelvis coordinate system significantly increased while wearing the ORF compared to the other two conditions. ES activity significantly decreased while wearing the ORF compared to the other two conditions. Internal oblique activity was significantly smaller while wearing the LSO than with no orthosis. Center of pressure did not significantly differ among the conditions.

Conclusion

The ORF significantly improved trunk alignment and decreased ES activity in healthy elderly subjects during static standing.

Body Sway as a Possible Indicator of Fatigue in Clerical Workers

BACKGROUND

Fatigue has a strong impact on workers' performance and safety, but expedient methods for assessing fatigue on the job are not yet available. Studies discuss posturography as an indicator of fatigue, but further evidence for its use in the workplace is needed. The purpose of the study is to examine whether posturography is a suitable indicator of fatigue in clerical workers.

METHODS

Thirty-six employees (Ø 34.8 years, standard deviation = 12.5) participated in postural tasks (eyes open, eyes closed, arm swinging, and dual task) in the morning and afternoon. Position of their center of pressure (COP) was registered using a Nintendo Wii Balance Board and commercial software. From registered COP time series, we calculated the following parameters: path length (mm), velocity (mm/s), anterior-posterior variance (mm), mediolateral variance (mm), and confidence area (mm(2)). These parameters were reduced to two orthogonal factors in a factor analysis with varimax rotation.

RESULTS

Statistical analysis of the first factor (path length and velocity) showed a significant effect of time of day: COP moved along a shorter path at a lower velocity in the afternoon compared with that in the morning. There also was a significant effect of task, but no significant interaction.

CONCLUSION

Data suggest that postural stability of clerical workers was comparable in the morning and afternoon, but COP movement was greater in the morning. Within the framework of dynamic systems theory, this could indicate that the postural system explored the state space in more detail, and thus was more ready to respond to unexpected perturbations in the morning.

Intra-session test-retest reliability of magnitude and structure of center of pressure from the Nintendo Wii Balance Board™ for a visually impaired and normally sighted population

Individuals with visual impairment (VI) have irreparable damage to one of the input streams contributing to postural stability. Here, we evaluated the intra-session test-retest reliability of the Wii Balance Board (WBB) for measuring Center of Pressure (COP) magnitude and structure, i.e. approximate entropy (ApEn) in fourteen legally blind participants and 21 participants with corrected-to-normal vision. Participants completed a validated balance protocol which included four sensory conditions: double-leg standing on a firm surface with eyes open (EO-firm); a firm surface with eyes closed (EC-firm); a foam surface with EO (EO-foam); and a foam surface with EC (EC-foam). Participants performed the full balance protocol twice during the session, separated by a period of 15min, to determine the intraclass correlation coefficient (ICC). Absolute reliability was determined by the standard error of measurement (SEM). The minimal difference (MD) was estimated to determine clinical significance for future studies. COP measures were derived from data sent by the WBB to a laptop via Bluetooth. COP scores increased with the difficulty of sensory condition indicating WBB sensitivity (all p<0.01). ICCs in the VI group ranged from 0.73 to 0.95, indicating high to very high correlations, and the normal group showed moderate to very high ICCs (0.62-0.94). The SEM was comparable between groups regardless of between-subject variability. The reliability of the WBB makes it practical to screen for balance impairment among VI persons.

Interpreting lateral dynamic weight shifts using a simple inverted pendulum model

Seventy-five young, healthy adults completed a lateral weight-shifting activity in which each shifted his/her center of pressure (CoP) to visually displayed target locations with the aid of visual CoP feedback. Each subject's CoP data were modeled using a single-link inverted pendulum system with a spring-damper at the joint. This extends the simple inverted pendulum model of static balance in the sagittal plane to lateral weight-shifting balance. The model controlled pendulum angle using PD control and a ramp setpoint trajectory, and weight-shifting was characterized by both shift speed and a non-minimum phase (NMP) behavior metric. This NMP behavior metric examines the force magnitude at shift initiation and provides weight-shifting balance performance information that parallels the examination of peak ground reaction forces in gait analysis. Control parameters were optimized on a subject-by-subject basis to match balance metrics for modeled results to metric values calculated from experimental data. Overall, the model matches experimental data well (average percent error of 0.35% for shifting speed and 0.05% for NMP behavior). These results suggest that the single-link inverted pendulum model can be used effectively to capture lateral weight-shifting balance, as it has been shown to model static balance.

Six months of dance intervention enhances postural, sensorimotor, and cognitive performance in elderly without affecting cardio-respiratory functions

During aging, sensorimotor, cognitive and physical performance decline, but can improve by training and exercise indicating that age-related changes are treatable. Dancing is increasingly used as an intervention because it combines many diverse features making it a promising neuroplasticity-inducing tool. We here investigated the effects of a 6-month dance class (1 h/week) on a group of healthy elderly individuals compared to a matched control group (CG). We performed a broad assessment covering cognition, intelligence, attention, reaction time, motor, tactile, and postural performance, as well as subjective well-being and cardio-respiratory performance. After 6 months, in the CG no changes, or further degradation of performance was found. In the dance group, beneficial effects were found for dance-related parameters such as posture and reaction times, but also for cognitive, tactile, motor performance, and subjective well-being. These effects developed without alterations in the cardio-respiratory performance. Correlation of baseline performance with the improvement following intervention revealed that those individuals, who benefitted most from the intervention, were those who showed the lowest performance prior to the intervention. Our findings corroborate previous observations that dancing evokes widespread positive effects. The pre-post design used in the present study implies that the efficacy of dance is most likely not based on a selection bias of particularly gifted individuals. The lack of changes of cardio-respiratory fitness indicates that even moderate levels of physical activity can in combination with rich sensorimotor, cognitive, social, and emotional challenges act to ameliorate a wide spectrum of age-related decline.

Age-related changes in the joint position sense of the human hand

Age-related changes in lower limb joint position sense and their contributions to postural stability are well documented. In contrast, only a few studies have investigated the effect of age on proprioceptive hand function. Here, we introduce a novel test for measuring joint position sense in the fingers of the human hand. In a concurrent matching task, subjects had to detect volume differences between polystyrene balls grasped with their dominant (seven test stimuli: 126-505 cm(3)) and their nondominant hand (three reference stimuli: 210, 294, and 505 cm(3)). A total of 21 comparisons were performed to assess the number of errors, the weight of errors (ie, the volume difference between test and reference stimuli), and the direction of errors (ie, over- or underestimation of test stimulus). The test was applied to 45 healthy subjects aged 21 to 79 years. Our results revealed that all variables changed significantly with age, with the number of errors showing the strongest increase. We also assessed tactile acuity (two-point discrimination thresholds) and sensorimotor performance (pegboard performance) in a subset of subjects, but these scores did not correlate with joint position sense performance, indicating that the test reveals specific information about joint position sense that is not captured with pure sensory or motor tests. The average test-retest reliability assessed on 3 consecutive days was 0.8 (Cronbach's alpha). Our results demonstrate that this novel test reveals age-related decline in joint position sense acuity that is independent from sensorimotor performance.

Testing single and double limb standing balance performance: comparison of COP path length evaluation between two devices

Center of pressure (COP) path length evaluation was commonly applied to measure postural sway and usually obtained from gold standard force plates. Thus, we comparatively investigated the feasible and less-expensive GKS® balance system (GKS) with the Kistler® force platform (KIS). 34 non-specifically trained but active adults (14 males, 20 females, age: 25.4±4.8 years; weight: 69.3±12.3 kg; height: 1.75±0.09 m, sports activity: 5.8±3.6 hours per week) were randomly tested on both devices during double and single limb stance with opened and closed eyes. Irrespective of the analysed time frame, repeated measures analyses of variances revealed higher path length readings for GKS compared to KIS for 30 s (F=6.8, p=0.01) and 10 s (F=21.2, p=0.001). Large effect sizes of the COP path length differences between GKS and KIS decreased from easy tasks (double limb, eyes open; d(30-s)=2.55, d(10-s)=2.04) to the most severe task (single limb, eyes closed; d(30-s)=0.02, d(10-s)=0.23). According to Bland and Altman, the limits of agreements indicated a high random variability component (between 29%, double limb, eyes open and 67%, single limb, eyes closed). The overall intraclass correlation coefficients (ICC) across all four standing balance tasks were moderate for the 30 s- (0.57) as well as the 10 s-analysis (0.65). In conclusion, the COP path length displacements obtained from the GKS balance system seem to differ with a considerable random variability from Kistler force platform data. Thus, measurements of the evaluated devices should not be used interchangeably. Further methodological investigations regarding balance measures seem warranted.