Abstract
It has been just over 20 years since the effects of height-induced threat on human postural control were first investigated. Raising the height of the support surface on which individuals stood increased the perceived consequences of instability and generated postural control changes. Since this initial work, converging evidence has accumulated supporting the efficacy of using height-induced threat to study the effects of emotions on postural control and confirming a direct influence of threat-related changes in arousal, anxiety, and fear of falling on all aspects of postural control, including standing, anticipatory, and reactive balance. In general, threat-related postural changes promote a greater physical safety margin while maintaining upright stance. We use the static balance literature to critically examine the current state of knowledge regarding: (1) the extent to which threat-related changes in postural control are sensitive to threat-related changes in emotions; (2) the underlying neurophysiological and cognitive mechanisms that may contribute to explaining the relationship between emotions and postural control; and (3) the generalizability of threat-related changes across different populations and types of threat. These findings have important implications for understanding the neuromechanisms that control healthy balance, and highlight the need to recognize the potential contributions of psychological and physiological factors to balance deficits associated with age or pathology. We conclude with a discussion of the practical significance of this research, its impact on improving diagnosis and treatment of postural control deficits, and potential directions for future research.
Highlights
Fear of falling is frequently reported in older adults [1, 2] and patients with balance deficits [3,4,5,6,7,8] and is a significant predictor of future falls risk [9, 10]
Maki et al [11] were the first to report significant differences in balance control between fearful and non-fearful older adults, followed by evidence of balance control changes in individuals with anxiety disorders and phobias [12, 13]. While these observational studies provided important evidence for a link between balance deficits and emotions, such as fear and anxiety, the direction of the relationship was not determined due to limitations of the cross-sectional design
These early studies revealed that threat-related postural changes provided protection against a loss of balance by limiting body position and movement in the direction of the perceived risk associated with the threat
Summary
It has been just over 20 years since the effects of height-induced threat on human postural control were first investigated. We use the static balance literature to critically examine the current state of knowledge regarding: [1] the extent to which threat-related changes in postural control are sensitive to threat-related changes in emotions; [2] the underlying neurophysiological and cognitive mechanisms that may contribute to explaining the relationship between emotions and postural control; and [3] the generalizability of threat-related changes across different populations and types of threat These findings have important implications for understanding the neuromechanisms that control healthy balance, and highlight the need to recognize the potential contributions of psychological and physiological factors to balance deficits associated with age or pathology.
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