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PubMed1997

Effects of vestibular rehabilitation on postural control.

We evaluated the effects of vestibular rehabilitation on postural instability in 2 patients with unilateral and bilateral reduced vestibular function. Another patient with unilateral vestibular disorder was treated with drugs without vestibular rehabilitation. The outcome of postural control in these 3 patients was measured using an EquiTest. With this apparatus, improvement of postural stability and change of postural strategy were measured under the condition eyes closed and platform movement was dependent on the subject's anterior-posterior sway. The observations suggest that the vestibular rehabilitation had a positive effect not only on postural stability but also on postural strategy.

Adult↗

PubMed2004

Habituation to galvanic vestibular stimulation for analysis of postural control abilities in gymnasts.

The possible correlation between postural control abilities in gymnasts and the sensitivity for and the degree of short-term habituation to galvanic vestibular stimulation (GVS) was studied. Seven balance trained young girls (Dutch National Junior Gymnasts Championship) versus seven non-trained girls and twenty-five women underwent computer-controlled GVS using a monaural continuous 1-cosinusoidal stimulus of 0.5 Hz and 2 mA, repeated three times on each side [Balter, Stokroos, Boumans, Kingma, Acta Otolaryngol. (in press); Balter, Stokroos, Eterman, Paredis, Orbons, Kingma, Acta Otolaryngol. (in press)]. Results showed that mean total galvanic-induced body sway (GBS) gain was significantly lower in the trained and untrained girls compared to the adult women (P < 0.05). Mean habituation to GVS (learning abilities), however, showed no significant differences between the three groups. We suggest that the superior balance control in professional gymnasts is primarily achieved through motor training and not by learning abilities or a higher sensitivity of the vestibular system [Neurosci. Lett. 225 (1998) 155].

Adult↗

PubMed2002

Fear of falling modifies anticipatory postural control.

This study investigated the influence of fear of falling or postural threat on the control of posture and movement during a voluntary rise to toes task for 12 healthy young adults. Postural threat was modified through alterations to the surface height at which individuals stood (low or high platform) and changes in step restriction (away from or at the edge of the platform) creating four levels of postural threat: LOW AWAY, LOW EDGE, HIGH AWAY and HIGH EDGE. To rise to the toes, an initial postural adjustment must destabilise the body so that it can be moved forward and elevated to a new position of support over the toes. Centre of pressure and centre of mass profiles, as well as tibialis anterior (TA), soleus (SO) and gastrocnemius (GA) muscle activity patterns were used to describe this behaviour. The results showed that the performance of the rise to toes task was significantly modified when positioned at the edge of the high platform. In this situation, the central nervous system reduced the magnitude and rate of the postural adjustments and subsequent voluntary movement. Although the duration of the movement was lengthened for this most threatening condition, the sequencing and relative timing of TA, SO and GA muscle activity was preserved. These changes in rise to toes behaviour were accompanied by evidence of increased physiological arousal and participant reports of decreased confidence, increased anxiety and decreased stability. Evidence of fear of falling effects on anticipatory postural control is clinically relevant as it may explain deficits in this control observed in individuals with balance disorders. For example, individuals with Parkinson's disease or cerebellar dysfunction demonstrate impaired performance on the rise to toes task as reflected in alterations of both the timing and magnitude of their anticipatory postural adjustments. Our findings suggest alterations in the magnitude of postural adjustments may be magnified by fear of falling while changes in the timing of postural adjustments may reflect underlying pathology.

Accidental Falls↗

PubMed1990

Postural control in standing following stroke: test-retest reliability of some quantitative clinical tests.

Despite their importance to stroke rehabilitation, appropriate clinical tests of postural control in standing appear to be inadequately developed. Several quantitative clinical tests, therefore, were constructed. These tests were used to measure functionally relevant aspects of postural control in standing in 24 stroke patients within a mean time interval of two months following a cerebrovascular accident. Subjects were tested in two stance positions (step and parallel) for five tasks that assessed their ability to withstand perturbations produced by self-generated body movements during functional activities. Intrasession reliability coefficients were very high (r = .94-.99). Intersession reliability coefficients were also high (r = .85-.94). Because the test battery requires minimal training and equipment, it can be easily applied in the clinical setting. The high reliability obtained justifies further evaluation of these tests, which appear to be very promising for use in stroke rehabilitation.

Activities of Daily Living↗

PubMed2004

Short-term effects of whole-body vibration on postural control in unilateral chronic stroke patients: preliminary evidence.

The short-term effects of whole-body vibration as a novel method of somatosensory stimulation on postural control were investigated in 23 chronic stroke patients. While standing on a commercial platform, patients received 30-Hz oscillations at 3 mm of amplitude in the frontal plane. Balance was assessed four times at 45-min intervals with a dual-plate force platform, while quietly standing with the eyes opened and closed and while performing a voluntary weight-shifting task with visual feedback of center-of-pressure movements. Between the second and third assessments, four repetitions of 45-sec whole-body vibrations were given. The results indicated a stable baseline performance from the first to the second assessment for all tasks. After the whole-body vibration, the third assessment demonstrated a reduction in the root mean square (RMS) center-of-pressure velocity in the anteroposterior direction when standing with the eyes closed (P < 0.01), which persisted during the fourth assessment. Furthermore, patients showed an increase in their weight-shifting speed at the third balance assessment (P < 0.05) while their precision remained constant. No adverse effects of whole-body vibration were observed. It is concluded that whole-body vibration may be a promising candidate to improve proprioceptive control of posture in stroke patients.

Chronic Disease↗

PubMed1992

[Postural control in the elderly].

In order to investigate postural control in the elderly, a stabilometric investigation including fast Fourier Transform (FFT) analysis was conducted in three different age groups. The oldest group was composed of 16 subjects who ranged in age from 75 to 86 years: another group consisted of eight 65 to 74 year olds; the control group was composed of 21 young students. The subject was instructed to stand and look for 30 seconds at a spot in a CRT 50 cm ahead of his eyes, and to control body sway as indicated by the gravitational spot in the CRT. The subject was then told to stand with eyes closed for 30 seconds. Next, a 100 Hz vibratory stimulation was applied to the bilateral Achilles tendon in each trial. The data was filtered with a 10 Hz high cut filter and digitized at 25 Hz, and subsequently analyzed by a microcomputer (PC9801 VM 2). Thus, statistical analysis was performed in terms of area, length, and total frequency spectra from 0.10 Hz to 10.0 Hz in both lateral and antero-posterior directions. Sixteen power spectra of 0.249 Hz step from 0.10 to 3.96 Hz were demonstrated in the CRT and were also compared with those of the young group. When standing naturally, significant increases in body sway were found in terms of area, length, and total frequency spectra in the most elderly group as compared with the other two groups. There was no significant change in Romberg ratio between the elderly and the young groups. However, FFT analysis confirmed the influence of visual cues. When vibration was applied, no increases in body sway with regard to these parameters were demonstrated in the elderly, whereas significant increases were found in the young control group. This was especially evident in the eyes-closed trials, as previously reported. There were few increased frequency ranges in either lateral or antero-posterior sway in the elderly. This might suggest that proprioceptive afferent information play a less important role in elderly than in young subjects. When the subject was requested to minimize his own sway by utilizing visual feedback, no difference was found in this parameter between the elderly and young groups. However, FFT analysis of the elderly group revealed an increase of the power spectra close to 1.0 Hz in both lateral and antero-posterior sway, whereas increases of approximately 1.0 and 2.0 Hz in the power spectra and a decrease in the power spectrum from 0.10 to 0.29 Hz were found in both directions in young subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1999

Postural control and lifetime alcohol consumption in alcohol-dependent patients.

OBJECTIVES: The aim of this study was to examine the relationship between alcohol consumption and postural control in alcohol-dependent patients. MATERIAL AND METHODS: Posturographic measurements were performed in 82 abstinent patients and in 54 healthy controls. The findings in the patients were compared with those in the controls as well as with the daily alcohol consumption, the consumption during 6 months before the admission for alcohol withdrawal therapy and the estimated lifetime alcohol consumption. RESULTS: Postural control was impaired in alcohol-dependent patients compared to healthy controls. This impairment was related with the lifetime alcohol consumption, but not with the alcohol consumption per day and prior to admission, respectively. Comparing healthy controls, and alcohol-dependent patients with an estimated lifetime alcohol consumption of < 1000 kg and > or = 1000 kg revealed a significant increase in 6 of 8 sway parameters. Furthermore, the lifetime alcohol consumption increased significantly from patients with normal posturographic and clinical findings to those with abnormalities in both examinations. CONCLUSION: This study suggests that postural imbalance in abstinent alcohol-dependent patients is related to the lifetime alcohol consumption.

Adult↗

PubMed1999

Characteristics of visual feedback in postural control during standing.

In the present study, the visual feedback system in postural control was investigated. To suppress the vestibular and proprioceptive feedback paths, a subject stood on a force-measuring plate with a fixed back support. Because the subject's body was immovable under these conditions, the subject controlled a computer model which simulated body dynamics. Information on the sway angle of the model was fed visually. Under this condition, frequency response functions for the ankle moment in response to the sway angle were calculated. The experimental results suggest that the visual feedback system contains a large time delay and, consequently, the visual system does not by itself allow a subject to maintain an upright posture. Index Terms- Feedback control, frequency characteristics, identification, posture, visual sensory feedback.

Adult↗

PubMed1993

Effect of the aircast on unilateral postural control: amplitude and frequency variables.

Little objective data exist regarding the effect of the Aircast Air-Stirrup on motor performance. Thus, the effect of the Aircast on the amplitude and frequency of postural sway during unilateral stance was evaluated for 15 uninjured male subjects. Postural sway during static and dynamic tests was measured using the Chattecx Balance System. Use of the Aircast improved unilateral postural control as evidenced by decreases in some of the components of postural sway. Previously, a link was made between a large amplitude of unilateral sway and a high probability of ankle injury (14). Thus, since Aircast use was found to decrease the amplitude of unilateral sway, it may also be beneficial in reducing the probability of injury. Although the scope of this study did not allow for differentiation among the complex systems involved in postural control, the possibility of the Aircast enhancing afferent feedback was proposed. The restricted inversion-eversion range of motion associated with the Aircast, in conjunction with the present observation that unilateral stability was enhanced with its use, suggests that the Aircast may provide a valuable prophylactic role in helping to reduce the incidence of ankle injuries.

Adult↗

PubMed2006

Controlling posture using a plantar pressure-based, tongue-placed tactile biofeedback system.

The present paper introduces an original biofeedback system for improving human balance control, whose underlying principle consists in providing additional sensory information related to foot sole pressure distribution to the user through a tongue-placed tactile output device. To assess the effect of this biofeedback system on postural control during quiet standing, ten young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed reduced CoP displacements in the Biofeedback relative to the No-biofeedback condition. The present findings evidenced the ability of the central nervous system to efficiently integrate an artificial plantar-based, tongue-placed tactile biofeedback for controlling control posture during quiet standing.

Adult↗

PubMed1996

Effect of resistance training on strength, postural control, and gait velocity among older adults.

The purpose of this study was to examine the effects of a 14-week resistance training program on the ankle strength, training intensity, postural control, and gait velocity of older adults. Forty-two older adults (mean age = 72), 21 in the resistance and control groups, completed the 14-week project. The resistance training group participated in 14 weeks of resistance training three times per week using elastic bands (Theraband) for resistance. Isokinetic ankle strength, training intensity, postural stability, and gait velocity were measured prior to and following the 14-week intervention. Following the training, the resistance group exhibited improved ankle dorsiflexion, training resistances, and gait velocity, but showed no change in plantar flexion or postural control. The control group also exhibited improvements in dorsiflexion, but these gains were approximately one-half of the gains observed in the resistance training group. Finally, when adjusted for baseline differences, subjects in the resistance training group demonstrated no changes in the dependent measures over the control group.

Age Factors↗

PubMed1995

Open-loop and closed-loop postural control mechanisms in Parkinson's disease: increased mediolateral activity during quiet standing.

Stabilogram-diffusion analysis was used to gain insights into how idiopathic Parkinson's disease (IPD) affects the postural control mechanisms involved in maintaining erect stance. Twenty-two subjects with IPD and twenty-four healthy elderly subjects were studied under eyes-open, quiet-standing conditions. The postural control mechanisms in the parkinsonian subjects, compared to the healthy elderly, were characterized by an increase in the effective stochastic activity in the mediolateral direction. Mediolateral posturographic measures were also associated with a history of falls and poor performance on clinical measures of balance. It is hypothesized that the increase in mediolateral activity in subjects with IPD may reflect an attempt to maintain potentially stabilizing movements during quiet standing in the face of impaired movement in the anteroposterior direction. This study supports the notion that mediolateral instability is an important posturographic marker of functional balance impairment in the elderly.

Aged↗

PubMed1993

Postural control in young and elderly adults when stance is challenged: clinical versus laboratory measurements.

The use of dynamic posturography (EquiTest) for the characterization of postural control biomechanics would be aided by specific knowledge of what the measured data imply about body segment movements. To investigate this issue, the biomechanics of a group of 15 healthy elderly subjects were compared to those of healthy young subjects by using both dynamic posturography and a laboratory movement and force measuring system. The results from EquiTest were analyzed by 1) routine clinical interpretation of data and 2) a clinical research interpretation by subjecting the EquiTest parameters to additional statistical comparison of mean performance of the young and elderly groups. The young-elderly differences from the 2 EquiTest analyses were then compared to the young-elderly differences derived from the laboratory protocol. The routine clinical interpretation of EquiTest data identified the same increases in sway shown by the laboratory study, but did not reveal the more subtle differences indicated by the laboratory study. When the EquiTest data were subjected to additional statistical analysis, the characterization of difference between young and elderly subjects was the same as that of the laboratory study, with the exception of issues of head versus trunk movement, a measure not made by EquiTest. This essential similarity in the characterization of elderly compared to young subjects by both systems suggests 1) that EquiTest is able to detect subtle differences in biomechanics of postural control between young and elderly healthy adult groups and 2) that implied movements of center of gravity, trunk versus lower limbs, and strength of reaction measures are consistently detected by both EquiTest and the laboratory kinematics and dynamics measurement systems.

Adolescent↗

PubMed1998

Caloric response and postural control in patients with nasopharyngeal carcinoma after radiotherapy.

Since radiotherapy is the treatment of choice for nasopharyngeal carcinoma, the influence of irradiation on the temporal bone is of great concern for these patients. In this study, the caloric test and posturography were used to investigate vestibular function in 41 irradiated patients with nasopharyngeal carcinoma. Caloric testing showed a high incidence of canal paresis; five unilateral and 10 bilateral. Factors such as middle ear effusion had no significant effect on the occurrence of canal paresis. Posturography showed no difference from the control group. The authors conclude that the influence of irradiation on the vestibular apparatus of patients with nasopharyngeal carcinoma might result in a canal paresis, while postural control is preserved. Central compensation may play an important role in the postural control of these patients.

Adult↗

PubMed2004

Degradation of postural control system as a consequence of Parkinson's disease and ageing.

In this study we have shown how Parkinson's disease and ageing affect the postural control system. Our investigation of that system has involved analysis of quiet-standing center of pressure (COP) trajectories. Using the method derived from Langevin equation, we have found disease-specific and age-specific changes in the dynamics of the COP. These findings were obtained from a comparison of the diffusion matrix, the friction coefficient and the matrix of the fluctuation strength for healthy young, healthy elderly and parkinsonian (elderly) subjects under eyes-open and eyes-closed conditions. Especially the analysis of the friction coefficient and the matrix of the fluctuation strength have allowed the more detailed study of the postural control system of the parkinsonian and elderly subjects. We have found that the healthy elderly as well as parkinsonian subjects exhibit larger level of the muscular stochastic activity, compared to the young subjects. Furthermore, closure their eyes causes further increment of that activity. We have also shown that for the healthy elderly subjects a compensating mechanism, which can be described by the friction coefficient, acts under eyes-closed conditions, whereas for parkinsonian subjects this mechanism was not observed. Thus, the increase of the muscular activity is an age-specific indicator, whereas the absence of the compensation of that increase is a disease-specific indicator.

Adaptation, Physiological↗

PubMed1998

Training improves the adaptation to changing visual conditions in maintaining human posture control in a test of sinusoidal oscillation of the support.

Balance control relies on somesthetic, visual and vestibular afferences, their central processing, and adequate motor responses. We studied the consequences on postural control of the suppression of visual afferences by eye closure, during a dynamic posturographic test in six sportsmen and 14 non-sportsmen. Suppression of visual afferences during the test led to a prolongation of the pattern initially recorded with eyes open, followed by a transitory adaptive pattern, then a typical eyes closed pattern. Repetition of the test showed a progressively longer persistence of the eyes open pattern and disappearance of the adaptive one. This evolution was significantly faster in sportsmen. This progressively longer duration of the eyes open pattern may be explained by the intervention of short term memory. Our data further indicate that training improves adaptive posture control.

Adult↗

PubMed2002

Visual influence on postural control, with and without visual motion feedback.

Body sway was investigated in 20 healthy subjects to determine whether visual input must contain motion feedback information from the surroundings in order to influence postural control. Posturography was used to record body sway under the following visual conditions: eyes open with or without a restricted visual field; eyes open in ganzfield white light; eyes open in darkness with a head-fixed visual target; eyes open in darkness; and eyes closed in darkness. Stance was perturbed by means of a pseudorandomly applied vibratory stimulation to the calf muscles. Least sway was found with eyes open in an unrestricted visual field but increased in a restricted visual field. Greatest sway was found without visual motion feedback, i.e. under the following conditions: eyes closed; eyes open in darkness; eyes open in ganzfield white light; and with a head-mounted fixation point. Sway was significantly (p < 0.05) greater with eyes open in darkness compared with eyes closed during the initial 50 s with perturbations. After 150 s, sway was almost identical under the four test conditions without visual motion feedback. Standing with eyes open in darkness was initially a disadvantage compared with having the eyes closed. The postural control system may be programmed to expect visual feedback information when the eyes are open, which may delay changes in postural strategy.

Adaptation, Physiological↗

PubMedDate not supplied

Recovery of postural control after an acute unilateral vestibular lesion in humans.

Postural control during stance was investigated using the EQUITEST system in 10 patients during recovery after an acute unilateral vestibular lesion and was compared to the time course of recovery of the static and dynamic vestibulo-ocular imbalance. During the acute phase the patients showed a characteristic pattern with normal upright stance as long as at least one accurate sensory input (visual or somatosensory) was provided and severe postural disturbances when they had to rely primarily on vestibular afferences. Both static vestibulo-ocular and vestibulo-spinal balance recovered very fast, showing basically normal results on postural testing within about 2 weeks after the lesion. Thereafter, no pathological pattern was detectable during postural testing even in patients with persistent complete unilateral vestibular lesions. Reflexive postural responses to unexpected rapid displacements of the support surface seemed not to be influenced by vestibular imbalance even in the acute phase of the lesion.

Acute Disease↗