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PubMed1995

Postural control and vestibulospinal function in patients selected for cochlear implantation.

Postural control, vestibular and eye motor function were evaluated in seven postlingually deaf patients before cochlear implantation and were compared with 21 control subjects. Vibration to the calf muscles or galvanic electrical stimulation of the vestibular nerves, perturbed stance and body sway velocity, statistical variance of antero-posterior body sway and identification of characteristic parameters of postural dynamics were all evaluated. Vibration-induced body sway was increased among the patients compared with the normal subjects and there were differences in characteristic parameters of postural dynamics, indicating decreased postural control. Galvanic stimulation induced a body sway not significantly different from the control group suggesting that the patients selected for cochlear implantation, and with an otherwise reduced postural control, are sensitive to electrical stimulation of the vestibular nerve. Thus, postlingually deaf subjects who perceive a sensation of sound at electrical promontorial stimulation also respond with increased body sway to electrical stimulation aimed at the vestibular nerves. This finding may contribute an additional hypothesis to the causes of dizziness among cochlear implant patients, complementary to the that of wrongly placed electrodes and peroperative vestibular lesions.

Adult↗

PubMed2006

Comparison of different structural foot types for measures of standing postural control.

STUDY DESIGN: Matched group comparison of 3 subject groups with 3 different foot structures for force plate and clinical measures of postural control. OBJECTIVES: To determine if subjects with different weight-bearing foot structure would demonstrate differences in static standing postural control, and to determine the reliability of study procedures. BACKGROUND: Weight-bearing foot structure may influence postural control either because of a decreased base of support (supinated foot structure) or because of passive instability of the joints of the foot (pronated foot structure). METHODS AND MEASURES: Young adults were categorized based on weight-bearing foot structure into neutral, pronated, or supinated groups (15 subjects per group). Postural control in single-limb stance with eyes closed was assessed using force plate measures and by measuring duration of single-limb stance on a firm floor and on a balance pad. Force plate measures were normalized center-of-pressure average speed; and standard deviation and maximum displacement in the anterior-posterior and medial-lateral directions. RESULTS: Individuals in the supinated group had significantly greater center-of-pressure average speed, greater maximum displacement in the anterior-posterior direction, and greater SD and maximum displacement in the medial-lateral direction than individuals in the neutral group. The individuals in the pronated group had significantly greater SD and maximum displacement in the anterior-posterior direction, used more trials to complete force plate testing, and had shorter single-limb stance duration than those in the neutral group. CONCLUSION: Individuals with pronated feet or supinated feet have poorer postural control than individuals with neutral feet, but perhaps through different mechanisms.

Adolescent↗

PubMed2005

Acute effects of a single bout of resistance exercise on postural control in elderly persons.

Many elderly persons are engaging in resistance exercise to counter muscle atrophy due to aging. Here, the acute effects of resistance exercise on postural control mechanisms were examined. Postural control was quantified by mean square center-of-pressure displacements were calculated utilizing force vectors in accordance with previously developed equations. Stabilogram-diffusion plots utilized the displacements as data points after curve-fitting techniques were applied. Two regions, representing the open-loop and closed-loop postural control mechanisms, are shown by the plots and separated at the critical point, which represents the shift in control mechanisms. 21 older adults (age M=71.2, SD=3.84, range 66-81 years) performed three sets of 10-12 repetitions for six resistance exercises for the lower extremity until fatigue. Immediately after exercise, postural stability was reduced. This was represented by a shift of the critical point to the right, indicating an increase in open-loop control. Since resistance training has an acute negative effect on postural control, it is advised to assist elderly clients carefully and immediately after resistance training.

Aged↗

PubMedDate not supplied

Effects of random whole-body vibration on postural control in Parkinson's disease.

We investigated spontaneous effects of random whole-body vibration (rWBV) on postural control in Parkinsonian subjects. Effects were examined in biomechanical tests from a total of 52 patients divided equally into one experimental and one control group. Postural control was tested pre- and post-treatment in two standardized conditions (narrow standing and tandem standing). The intervention was based on rWBV (ŷ: 3 mm, f: 6 Hz 1 Hz/sec) consisting of 5 series lasting 60 seconds each. The main findings from this study were that (1) rWBV can improve postural stability in Parkinson's disease (PD) spontaneously (2) these effects depend on the test condition. Based on the results of this study, rWBV can be regarded as an additional device in physical therapy in PD.

Aged↗

PubMed2006

Functional mobility and postural control in essential tremor.

OBJECTIVE: To evaluate functional mobility and postural control in participants with essential tremor (ET). DESIGN: Cross-sectional cohort study. SETTING: Motor performance research laboratory. PARTICIPANTS: Sixteen participants with ET including head tremor (age, 59.4+/-12.0 y), 14 participants with ET and no head tremor (age, 57.1+/-15.9 y), and 28 healthy controls (age, 58.4+/-12.4 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We assessed the Timed Up & Go, time to ascend and descend stairs, Dynamic Gait Index, and Berg Balance Scale (BBS). Participants completed the Activities-specific Balance Confidence Scale and the Human Activity Profile. We assessed postural control using center-of-pressure measures from force platform recordings of quiet standing in 5 conditions. RESULTS: Participants with ET including head tremor performed worse than controls on all functional mobility performance and self-report measures (P<.05) except the BBS and stair descent time. Mean performance of ET participants without head tremor was intermediate between the other 2 groups. Sway speed measures of postural control showed similar patterns, but no significant group differences in post hoc analysis. There were no statistically significant or clinically important correlations between measures of tremor status and functional mobility status. CONCLUSIONS: Participants with ET show reduced functional mobility, especially those with head tremor.

Cohort Studies↗

PubMed1991

Dual-task assessment of reorganization of postural control in persons with lower limb amputation.

Postural control in persons with lower limb amputation was studied using a cognitive approach to motor learning. The aim of this study was to show that an important characteristic of the central reorganization process after a lower limb amputation is the gradually decreasing need of attentional resources to perform a motor task. A dual-task procedure was developed to estimate the level of automaticity of a quiet, upright standing task. The effect of a concurrent attention-demanding task (Stroop task) on the efficiency of balance control was determined using force-platform measurements at the start and the end of the rehabilitation process. In contrast with a control group, the amputation group showed interference effects on body sway caused by the concurrent task both at the start (p less than .05) and, less severe, at the end of rehabilitation (p less than .05). Improvement of balance control was significant only for the dual-task condition (p less than .05). The results corroborated the hypothesis that dual tasks give information about the restoration of automaticity of postural control as an essential characteristic of the central reorganization process in persons with lower limb amputation. The role of dual-task procedures as a useful approach to skill assessment is discussed.

Adult↗

PubMed2001

Age-related differences in postural control in humans in response to a sudden deceleration generated by postural disturbance.

Age-related differences in postural control in response to a relatively large deceleration resulting from postural disturbance were investigated in eight normal elderly men (age range 67-72 years) and eight young men as controls (age range 19-22 years) using a moving platform. Data were obtained for the hip, knee and ankle angles, position of the centre of foot pressure (CFP), head acceleration, and muscle activity of the leg muscles. The elderly subjects had slower and larger ankle and hip joint movements, and CFP displacement in response to the disturbance compared to the young controls. The elderly subjects also had a delayed occurrence, and greater magnitude of peak acceleration of head rotation than did the young subjects. For the elderly subjects, the CFP was closely related to angular changes in the hip joint movement, but not to those of the ankle and knee joint movements. For the young subjects, on the other hand, the CFP was significantly correlated with angular change in the ankle joint. Cocontraction of the tibialis anterior and gastrocnemius muscles was observed in the elderly subjects. The results indicated that a movement pattern for postural correction in the elderly adults was different from that of the young adults. The elderly relied more on hip movements while the young controls relied on ankle movements to control postural stability.

Adult↗

PubMed1998

Postural control--a comparison between patients with chronic anterior cruciate ligament insufficiency and healthy individuals.

Postural control in the sagittal plane was evaluated in 22 patients with chronic anterior cruciate ligament (ACL) deficiency and the result was compared to that of a control group of 20 uninjured subjects. Measurement of the body sway was done on a fixed and sway-referenced force plate in both single-limb and two-limb stance, with the eyes open and closed, respectively. Further, an analysis of the postural reactions to perturbations backwards and forwards, respectively, was made in single-limb stance. The results demonstrated statistically significant deficits of the postural control in the patient group compared to the control group, but also within the patient group. There was a significantly higher body sway within the patient group when standing on a stable support surface on the injured limb than standing on the uninjured limb with the eyes open, but no difference with the eyes closed. When standing on a stable support surface, there was a significantly higher body sway in the patient group standing on the injured leg than in the control group, both with eyes open and closed. The patient group also showed a significantly impaired postural control compared to the control group when standing on the uninjured leg with the eyes closed. There was no difference between the groups in the two-limb stance. When standing on the sway-referenced support surface, the patient group had a significantly larger body sway than the control group when the eyes were open, but there was no significant difference between the groups with the eyes closed. The measurement of the postural corrective responses to perturbations backwards and forwards showed that the reaction time measured from the initiation of the force plate translation, and the amplitude of the body sway was significantly greater in the patient group than in the control group. We conclude that patients with a continuing chronic ACL insufficiency several years after injury have an impaired postural control in the antero-posterior direction in single-limb stance on their injured leg. They also show a greater body sway and a prolonged reaction time when subjected to antero-posterior perturbations when standing on their injured leg.

Adolescent↗

PubMed2001

Influence of supervised and nonsupervised training on postural control after an acute anterior cruciate ligament rupture: a three-year longitudinal prospective study.

STUDY DESIGN: Prospective randomized longitudinal clinical trial with matched controls. OBJECTIVES: To investigate the long-term effect of training on postural control and extremity function after an acute anterior cruciate ligament (ACL) injury. BACKGROUND: ACL injuries may cause severe problems with recurrent giving way of the knee and reduced functional capacity. The effect of an acute ACL injury and the effect of various training programs on postural control, as well as the relation between postural control and extremity function after such an injury, have not been studied longitudinally. METHODS: Sixty-three consecutive patients, 35 men and 28 women (median age 24 years, quartiles 19-33 years), with an acute nonoperated ACL injury, randomized to neuromuscular supervised or self-monitored training, were examined with stabilometry (amplitude and average speed of center of pressure movements) and a one-leg hop test for distance after 6 weeks (stabilometry only), and after 3, 12, and 36 months, and were compared to a control group. RESULTS: Regardless of treatment, center of pressure amplitude was persistently higher in both the injured and uninjured legs during the 3-year follow-up, but average speed was less affected or unaffected compared to the control group. The one-leg hop had normalized in the neuromuscular group at the 12-month follow-up, but was shorter in both legs throughout the 3-year period in the self-monitored group. The median value (quartiles) for injured/uninjured legs at 3 months was 150 cm (120-174 cm)/177 cm (140-199 cm), at 12 months was 174 cm (140-200 cm)/180 cm (150-202 cm), and at 36 months was 172 cm (146-200 cm)/178 cm (150-200 cm) in the self-monitored group, compared to the control group (median 186 cm, quartiles 177-216 cm). CONCLUSIONS: The higher center of pressure amplitude in both legs over the 3-year period indicate persistently impaired postural control in single-limb stance. However, functional performance, as measured with the one-leg hop test, was restored by neuromuscular training, but not by self-monitored training.

Adolescent↗

PubMed2003

Dynamic postural control in patients with hemiparesis.

OBJECTIVE: Decreased postural stability is a common problem associated with hemiparesis secondary to stroke. The purpose of this study was to evaluate dynamic postural control in patients with hemiparesis and in normal subjects matched for age. DESIGN: Quantitative posturography (EquiTest System) was performed to assess the response of subjects to sudden perturbations. A total of 59 patients with hemiparesis and 98 healthy volunteers were evaluated. All the patients were able to walk inside their house without lower limb orthoses. Both the patients and the healthy volunteers were subjected to forward and backward perturbations while standing on a movable force platform. Balance responses were analyzed in terms of weight symmetry, latency, amplitude (relative response strength), and strength symmetry. They were also subjected to toes-up and toes-down perturbations to evaluate their response to a disruptive balance force. RESULTS: The response latency to perturbations was longer and the response strength was weaker on the paretic side of patients with hemiparesis. The dynamic postural control was impaired in patients with hemiparesis as compared with healthy subjects. CONCLUSION: The results suggest that patients with hemiparesis tend to fall easily and that the risk of falls toward the paretic side is high.

Adaptation, Physiological↗

PubMed2005

Adaptation of a seated postural control measure for adult wheelchair users.

PURPOSE: Clinical measures of seated postural control in adults are not standardized and most are derived from in-house tools. The purpose of this study is to adapt a pediatric instrument to evaluate seated postural control in adult wheelchair users. METHOD: The new instrument is called the Seated Postural Control Measure for Adults (SPCMA) 1.0. Five preliminary versions were pretested with some 20 adults by two raters and a group of experts. RESULTS: This instrument comprises three sections: Section 1, level of sitting scale for adults (1 item, 7-point ordinal scale); Section 2, static postural alignment (22 items, 7-point ordinal scale); and Section 3, postural alignment after a dynamic activity, propulsion of the wheelchair on flat terrain and an incline (22 items, 7-point ordinal scale). CONCLUSIONS: The SPCMA for Adults 1.0 improves the quality and uniformity of evaluations done by different raters, which facilitates more rigorous follow-up of clients over time, communication between professionals, and objective verification of the attainment of intervention objectives.

Activities of Daily Living↗

PubMed2000

Postural control of trunk during unstable sitting.

A method for quantifying postural control of the lumbar spine during unstable sitting was developed. The unstable seat apparatus was equipped with leg and foot supports to isolate the control of the lumbar spine and trunk from the adjustments in the lower body joints. Polyester resin hemispheres with decreasing diameters were attached to the bottom of the seat to achieve increasing levels of task difficulty. The seat was placed on a force plate at the edge of a table and the participating subjects were instructed to maintain their balance while sitting on the seat. Coordinates of center of pressure (CoP) were recorded and quantified with summary statistics and random walk analysis. The CoP movement increased significantly with increased seat instability (task difficulty) (p<0.01). Stabilogram plots of the CoP movement revealed short and long-term regions consistent with the hypothesis that the two regions reflect open and closed-loop postural control mechanisms. Repeatability of the CoP parameters was excellent for the summary statistics and the short-term random walk coefficients (0.77<R<0.96). It was fair for the long-term diffusion coefficients (0.56<R<0.57) and poor for the long-term scaling exponents (0.14<R<0.40). Summary statistics of the CoP movement were positively correlated with body weight (0.69<R<0. 73) and the T9 to L4/L5 distance (0.43<R<0.54) of the subjects. This method can be applied to study the deficits in postural control of the lumbar spine in low-back pain population.

Adult↗

PubMed1995

Age-related changes in postural control and locomotion.

Age-related changes in both postural control and locomotion were investigated. Postural control was evaluated by magnitude of body sway for 131 healthy persons aged 21 to 84 years. Locomotion was evaluated by walking velocity for 217 healthy persons aged 21 to 88 years. Analysis showed that both abilities deteriorated for older persons and particularly age-related changes were more remarkable in locomotion.

Adult↗

PubMed2005

Comparison of postural control in unilateral stance between healthy controls and lumbar discectomy patients with and without pain.

MAIN PROBLEM: Previous studies have demonstrated that sciatica patients have poorer postural control than healthy controls and that postural control remains unchanged 3 months after lumbar discectomy in sciatica patients. The aims of the current study were to investigate whether static balance control recovers in pain-free discectomy patients long-term after lumbar discectomy. Next is to determine whether static balance responses of asymptomatic and symptomatic lumbar discectomy patients differed from each other and from healthy controls. In addition, the influence of the extent of disc resection (unilateral/bilateral removal) and the side of operation on static balance control were investigated. METHODS: Fifteen pain-free lumbar discectomy patients, 23 lumbar discectomy patients with residual pain and 72 controls performed unilateral stance tasks with eyes open and eyes closed on a force plate were taken up for the investigation. Three repetitions of a 10 s unilateral stance test were performed on each leg. Postural sway was determined. Patients were divided into three age groups. RESULTS: In the eyes open condition, there was no significant difference between postural sway of pain-free lumbar discectomy patients and controls (P=0.68), whereas balance of patients with pain was significantly worse than in controls (P=0.003). In the eyes closed condition, the sway in both groups of lumbar discectomy patients was significantly worse than in controls (pain-free P=0.009/painful P<0.001). No significant differences were found in postural sway between patients with unilateral and bilateral disc resection. In unilateral stance on the leg of the operated side, centre of gravity sway was not significantly different in the eyes open condition compared to the eyes closed condition, whereas in stance on the leg of the non-operated side, postural sway was significantly lower in the eyes open condition compared to the eyes closed condition. In both conditions, postural sway in the age group of 50-65 years was significantly higher than in the age groups of 30-39 years (eyes open P=0.005; eyes closed P<0.001) and 40-49 years (eyes open P=0.002; eyes closed P=0.006). There was no significant difference between the age group of 30-39 years and the age group of 40-49 years (P=0.51). CONCLUSION: As for long-term following lumbar discectomy, there is no complete recovery of postural control. Patients seem to develop visual compensation mechanisms for underlying sensory-motor deficits, which are, however, sufficient in case of pain relief only. Further study is needed to determine the cause of the balance disturbances in lumbar discectomy patients.

Adult↗

PubMed2004

Effect of an acute bout of soccer heading on postural control and self-reported concussion symptoms.

Our purpose was to determine if an acute bout of heading soccer balls adversely affected postural control and self-reported symptoms of cerebral concussion. Thirty-one college-aged soccer players were randomly placed into either a kicking group or a heading group. Subjects either kicked or headed 18 soccer balls over the course of 40 minutes. Subjects had their postural control assessed while standing on a force plate and completed a concussion symptoms checklist on three separate occasions: prior to, immediately following, and 24 hours after kicking or heading. There were no significant differences between the heading and kicking groups on the postural control measures prior to, immediately following, and 24 hours after kicking/heading. The heading group did, however, report significantly more concussion symptoms than the kicking group immediately after heading, but not 24 hours after heading. The number of previous concussions sustained by subjects did not influence the effects of heading. An acute bout of soccer heading appears to cause an increase in self-reported symptoms of cerebral concussion lasting less than 24 hours but no quantifiable deficits in postural control. Further research is needed to investigate the cumulative effects of soccer heading on postural control and other objective measures of brain function.

Adult↗

PubMedDate not supplied

Improved ambulation and speech production in an adolescent post-traumatic brain injury through a therapeutic intervention to increase postural control.

PURPOSE: This case study examined the effectiveness of a programme designed to improve anticipatory postural control in an adolescent over years 2 and 3 post-traumatic brain injury (TBI). It was hypothesized that her difficulty in walking and talking simultaneously was caused by excessive co-activation of extremity, trunk, and oral musculature during upright activities. METHODS: The participant was treated weekly by physical and speech therapy. Treatment focussed on improving anticipatory postural control during gross motor activities in conjunction with oral-motor function. RESULTS: Initially, the participant walked using a walker at a speed of 23 cm s(-1). Two years later, she could walk without a device at 53 cm s(-1). Initial laryngoscopic examination showed minimal movement of the velum or pharyngeal walls; full movement was present after treatment. The measure of intelligibility improved from no single word intelligible utterances to 85% intelligible utterances after 2 years. DISCUSSION: The results suggest that less compensatory rigidification of oral musculature was needed to maintain an upright position against gravity as postural control improved. CONCLUSION: An adolescent 1-year post-TBI was followed as she underwent additional rehabilitation focussed on improving anticipatory postural control. The functional goal of simultaneously talking while walking was achieved through this intervention.

Accidents, Traffic↗

PubMed1998

Relationship between postural control and motion sickness in healthy subjects.

This study examined the relationship between reported susceptibility to motion sickness, anxious personality and postural control. Postural stability was assessed in 34 healthy subjects standing with eyes open, eyes closed and viewing a disorienting virtual reality display. These measures were repeated with vibration of the calf muscles to distort the somatosensory feedback from the legs. Susceptibility to motion sickness and anxious personality were evaluated by questionnaire. Greater postural instability was correlated with susceptibility to motion sickness. Motion sickness susceptibility correlated most strongly with increased sway when the visual and somatosensory feedback was absent or distorted. Anxiety was correlated with reported susceptibility to motion sickness but not with postural stability. These findings suggest that deficient perceptual-motor responses to disorienting conditions may contribute to motion sickness susceptibility.

Adult↗

PubMed2003

Does articulation contribute to modifications of postural control during dual-task paradigms?

Many studies have been carried out to investigate the attentional resources required for postural control, using a 'dual-task' methodology in which performance on mental and postural control tasks is compared when these are carried out separately and concurrently. Most mental tasks used in these dual-task studies have employed verbal responses. However, changes in respiration during speech production are known to produce changes in postural control. Hence, the goal of this study was to determine whether articulation might contribute to the changes found in postural sway when a spoken mental task is being performed and to determine if the type of postural control measurement might also have an impact on the outcome of the study. Twenty young healthy participants were asked to stand on a force platform while executing secondary tasks that were performed silently or required a verbal response, and that required high or low levels of attention. Vision and postural task difficulty were manipulated. Performance of all tasks produced an increased sway frequency and decreased sway amplitude relative to the no task baseline. However, tasks that required articulation resulted in a more pronounced increase in postural sway frequency and sway path than did the tasks that did not require any articulation. These findings could imply that the addition of a secondary task results in increased stiffness, whereas articulation results in a further increased frequency of sway, which leads to an increase in sway path. We conclude that changes in the various parameters of sway that accompany performance of secondary tasks are complex, and are not always wholly attributable to attentional load, but may also be partly due to the motor requirements of the task, such as those involved in articulation.

Adult↗