Center Of Pressure Research Articles

Increasing Visual Biofeedback Scale Changes Postural Control Complexity.

Visual biofeedback (vFB) during quiet stance has been shown to improve postural control. While this improvement has been quantified by a reduction in the center of pressure (COP) sway, the effect on COP complexity remains unexplored. As such, 20 young adults (12 females; aged 23.63 ± 3.17 years) were asked to remain in a static upright posture under different visual biofeedback magnitude (no feedback [NoFB], magnified by 1 [vFB1], magnified by 5 [vBF5] and magnified by 10 [vBF10]). In addition to confirming, through traditional COP variables (i.e. standard deviation, mean velocity, sway area), that vFB scaling improved postural control, results also suggested changes in COP complexity. Specifically, sample entropy and wavelet analysis showed that increasing the vFB scale from 1:1 to 1:5 and 1:10 led to a more irregular COP and a shift toward higher frequency. Together, and particularly from a complexity standpoint, these findings provided additional understandings of how vFB and vFB scaling improved postural control.

Salivary cardiac-enriched FHL2-interacting protein is associated with higher diastolic-to-systolic-blood pressure ratio, sedentary time and center of pressure displacement in healthy 7-9 years old school-children.

Cardiac-enriched FHL2-interacting protein (CEFIP) is a recently identified protein, first found in the z-disc of striated muscles, and related to cardiovascular diseases. Our objectives are: 1) to quantify CEFIP in saliva in healthy 7-9 years old school-children; and 2) to assess the associations of salivary CEFIP concentration and blood pressure, physical (in)activity and physical fitness in these children. A total of 72 children (7.6 ± 0.3 years) were included in the study, recruited in primary schools in Girona (Spain). A sandwich enzyme-linked immunosorbent assay was used (abx506878; Abbexa, United Kingdom) to quantify CEFIP in saliva. Anthropometric evaluation was performed [body mass, height and body mass index (BMI)]. Systolic and diastolic blood pressure were measured by means of an electronic oscillometer and the diastolic-to-systolic blood pressure ratio (D/S BP ratio) was calculated. Physical (in)activity [sedentary time and time spent in physical activity (PA)] were assessed by means of a triaxial Actigraph GT3X accelerometer (Actigraph, Pensacola, FL, USA) that children were instructed to wear for 24h during 7 conssecutive days. Finally, physical fitness (speed and agility, explosive power of legs, handgrip strength, flexibility and balance) were assessed through validated and standardized testing batteries. CEFIP was easily detected and measured in all saliva samples (mean concentration: 0.6 ± 0.2 pg/ml). Salivary CEFIP was positively associated with D/S BP ratio (r=0.305, p=0.010) and sedentary time (r=0.317, p=0.012), but negatively associated with PA in 7-9 years old school-children (r=-0.350, p=0.002). Furthermore, salivary CEFIP was related to lower level of balance i.e., higher center of pressure (CoP) displacement in these children (r=0.411, p<0.001). The associations of salivary CEFIP with D/S BP ratio (Beta=0.349, p=0.004), sedentary time (Beta=0.354, p=0.009) and CoP displacement (Beta=0.401, p=0.001), were maintained significant after adjustment for potential confounding variables such as age, gender and BMI in linear regression analyses. CEFIP can be easily assessed in saliva as a promising biomarker associated with cardiovascular health in 7-9 years old school-children. Interestingly, higher salivary CEFIP concentration was related to higher D/S BP ratio, more sedentary time and higher CoP displacement i.e., lower level of balance in these children.

Kinematic movement and balance parameter analysis in neurological gait disorders

BackgroundNeurological gait disorders are mainly classified based on clinical observation, and therefore difficult to objectify or quantify. Movement analysis systems provide objective parameters, which may increase diagnostic accuracy and may aid in monitoring the disease course. Despite the increasing wealth of kinematic movement and balance parameter data, the discriminative value for the differentiation of neurological gait disorders is still unclear. We hypothesized that kinematic motion and balance parameter metrics would be differently altered across neurological gait disorders when compared to healthy controls.MethodsThirty one patients (9 normal pressure hydrocephalus < NPH > , 16 cervical myelopathy < CM > , 6 lumbar stenosis < LST >) and 14 healthy participants were investigated preoperatively in an outpatient setting using an inertial measurement system (MyoMotion) during 3 different walking tasks (normal walking, dual-task walking with simultaneous backward counting, fast walking). In addition, the natural postural sway of participants was measured by pedobarography, with the eyes opened and closed. The range of motion (ROM) in different joint angles, stride time, as well as sway were compared between different groups (between-subject factor), and different task conditions (within-subject factor) by a mixed model ANOVA.ResultsKinematic metrics and balance parameters were differently altered across different gait disorders compared to healthy controls. Overall, NPH patients significantly differed from controls in all movement parameters except for stride time, while they differed in balance parameters only with regard to AP movement. LST patients had significantly reduced ROMs of the shoulders, hips, and ankles, with significantly altered balance parameters regarding AP movement and passed center-of-pressure (COP) distance. CM patients differed from controls only in the ROM of the hip and ankle, but were affected in nearly all balance parameters, except for force distribution.ConclusionThe application of inertial measurement systems and pedobarography is feasible in an outpatient setting in patients with different neurological gait disorders. Rather than defining singular discriminative values, kinematic gait and balance metrics may provide characteristic profiles of movement parameter alterations in the sense of specific ´gait signatures´ for different pathologies, which could improve diagnostic accuracy by defining objective and quantifiable measures for the discrimination of different neurological gait disorders.Trial registrationThe study was retrospectively registered on the 27th of March 2023 in the ‘Deutsches Register für Klinische Studien’ under the number DRKS00031555.

Unsteady interaction and dynamic stability analysis of a two-stage-to-orbit vehicle during transverse stage separation

Hypersonic stage separation is a significant process for the future two-stage-to-orbit (TSTO) vehicle. Strong and complex interstage aerodynamic interference may result in drastic aerodynamic forces and moments, potentially conflicting with the safe separation. Therefore, the dynamic stability of the vehicle during separation is critical to aerospace safety. In this study, numerical analysis of a hypersonic flow with Ma = 6.7 past a parallel-staged TSTO vehicle during stage separation is performed by laminar flow simulations. The TSTO vehicle consists of a wave-rider and a spaceplane as booster and orbiter, respectively. Considering the different centers of gravity for the orbiter during separation, the longitudinal dynamic stability of the orbiter is analyzed based on the dynamic characteristic of the center of pressure (CoP) in different cases. The dynamic separation behavior, aerodynamic characteristics, and typical flowfield patterns are clarified. Moreover, the derivative of CoP to time is proposed and analyzed in detail, which serves as an indicator to determine the dynamic stability and the safe stage separation. A safety separation judgment criterion is also proposed based on the CoP dynamic characteristics for the TSTO vehicle, and the mechanism of CoP variations associated with the unsteady aerodynamic interference during stage separation is revealed.

Clubfoot patients show more anterior-posterior displacement during one-leg-standing and less ankle power and plantarflexor moment during one-leg-hopping than typically developing children

BackgroundClubfoot patients show good-to-excellent foot correction after the Ponseti method. Nevertheless, underlying functional problems that limit motor abilities such as one-leg-standing and one-leg-hopping still persist. These restrictions have been proposed to arise due to problems with maintaining balance and the limited force-generating capacity of clubfoot patients. More insight is needed to understand the underlying limiting factors to improve overall motor ability in clubfoot patients. Research questionThe aim of this study was to determine the differences between clubfoot patients and typically developing children (TDC) in force and balance parameters during walking, one-leg-standing and hopping. MethodsThree-dimensional motion analysis was performed in 19 TDC and 16 idiopathic Ponseti-treated clubfoot patients between 5–9 years old. Kinematic and kinetic parameters were calculated during walking and one-leg-hopping. To describe the balance parameters, center of pressure (CoP) data was assessed during walking, one-leg-hopping and one-leg-standing. Mean group values were calculated and compared using nonparametric statistical tests. A general linear model with repeated measures was used to determine which activity showed the largest group differences. ResultsClubfoot patients showed lower peak plantarflexor moment and peak ankle power absorption and generation during one-leg-hopping compared to TDC. Furthermore, clubfoot patients showed a lower hop length and velocity than TDC. The difference in peak plantarflexor moment and ankle power between the study groups was larger during one-leg-hopping than during walking. Finally, clubfoot patients showed a higher anterior-posterior CoP range during one-leg-standing. SignificanceDeviations in force parameters seemed to limit one-leg-hopping in clubfoot patients, and impaired anterior-posterior static balance was thought to be the underlying cause of problems with one-leg-standing. Furthermore, one-leg-hopping was more sensitive to distinguish between clubfoot patients and TDC than walking. Individualized physiotherapy targeting static balance and force parameters, with extra emphasis on including eccentric contractions, might improve the overall motor abilities of clubfoot patients.

ZMP — Where Are We After Fifty-Five Years?

Twenty years ago in the first issue of IJHR, among others, there was a published paper [M. Vukobratović and B. Borovac, Zero-moment point — Thirty five years of its life, Int. J. Humanoid Robot. 1(1) (2004) 157–173], devoted to well-known zero-moment point (ZMP) concept. Its role in biped locomotion (in the preservation of dynamic balance during walking and gait synthesis) was (and still is) extremely significant. This paper is aimed to present, how far we have gone in the past 20 years in the realization of bipedal walking, what are remaining open challenges and what we can expect in the further development. At the beginning of the paper, we will briefly refer to some still existing misinterpretations of the ZMP notion, related to specific boundary cases, when the terms Center of Pressure (CoP) and ZMP are still being mixed. Then, we will point your attention to the discussion of two important issues: attempts of generalization of ZMP notion in case of motion in the presence of multiple, spatially distributed and non-planar contacts and walk realization in a non-laboratory environment (unstructured environment and on the non-flat ground surface). Of course, looking at “how humans do it” has always been an inspiration for the realization of complex tasks by humanoids. Learning to walk is a task where several successful realizations have appeared only recently, so we will look at this topic at the end of this paper.

The effect of complex cognitive context on the dynamic stability during gait initiation in older women.

Changes in cognitive control are considered potential factors affecting voluntary motor movements during gait initiation (GI). Simulating environments with higher cognitive resource demands have an effect on the stability of GI task performance, which is of significant importance for assessing fall risk in the older adults and devising fall risk management measures in multiple environments. This study aims to reveal the influence of complex cognitive competitive environment with increased cognitive demands on the dynamic stability during GI in the older women. Twenty-three older females and twenty-three younger females performed walking tests under three conditions: voluntary initiation (SI), visual light reaction time task (LRT), and cognitive interference + visual light reaction time task (C + LRT). Eight cameras (Qualisys, Sweden, model: Oqus 600) and three force plates (Kistler, Switzerland, model: 9287C) are used to obtain kinematic and kinetic data. To recorde the trajectory of center of pressure (CoP) and the position of the foot placement, and compute the anterior-posterior (A-P) and medio-lateral (M-L) dynamic stability at the onset and end moments of the single-leg support by means of center of mass (CoM) and gait spatiotemporal parameters. Older women responded to the effect of complex environments involving cognitive competition on body stability by prolonging the lateral displacement time of the CoP during the anticipatory postural adjustments (APAs) phase, reducing step length and velocity, and increasing step width and foot inclination angle. Complex initiation environments lead to competition for cognitive resources in the brain, resulting in decreased stability of GI motor control in older adults. The higher the complexity of the cognitive resource demands environment, the lower the stability of GI in older adults, and the greater the effect on their M-L stability at the onset of stepping.

Influences of cognitive load on center of pressure trajectory of young male adults with excess weight during gait initiation.

Introduction: Falls and fall-related injuries in young male adults with excess weight are closely related to an increased cognitive load. Previous research mainly focuses on analyzing the postural control status of these populations performing cognitive tasks while stabilized walking progress but overlooked a specific period of walking known as gait initiation (GI). It is yet unknown the influences of cognitive load on this population's postural control status during GI. Objective: This study aimed to determine the influences of cognitive load on the center of pressure (CoP) trajectory of young male adults with excess weight during GI. Design: A controlled laboratory study. Methods: Thirty-six male undergraduate students were recruited and divided into normal-weight, overweight, and obese groups based on their body mass index (BMI). Participants' CoP parameters during GI under single and dual-task conditions were collected by two force platforms. A mixed ANOVA was utilized to detect significant differences. Results: Compared with the normal-weight group, the obese group showed significant changes in the duration and CoP parameters during sub-phases of GI, mainly reflecting prolonged duration, increased CoP path length, higher mediolateral CoP displacement amplitude, and decreased velocity of anteroposterior CoP displacement. During GI with 1-back task, significantly increased mediolateral CoP displacement amplitude occurred in the obese group. During GI with 2-back task, the obese group had increased CoP path length, higher mediolateral CoP displacement amplitude, as well as a decreased velocity of CoP displacement. Conclusion: Based on the changes in CoP parameters during GI with cognitive tasks, young male adults with excess weight, mainly obese ones, have compromised postural stability. During GI with a difficult cognitive task, obese young male adults are more susceptible to deterioration in their lateral postural balance. These findings indicate that the increased cognitive load could exacerbate obese young male adults' postural control difficulty during GI under dual-task conditions, putting them at a higher risk of experiencing incidents of falls. Based on these findings, we offer suggestions for therapists to intervene with these young male adults to ensure their safety of GI.

Concurrent activation potentiation improves lower-limb maximal strength but not dynamic balance control in rugby players.

Concurrent activation potentiation (CAP) increases athletic performance by activating muscles not involved in the performed activity. Among the CAP strategies, jaw clenching is the most practical to implement in sports contexts. Muscle strength and balance control are essential among rugby players to cope tackles. Besides combat sports, mouthguard has become mandatory also in rugby. Therefore, this study aimed to understand whether mouthguard jaw-clenching could improve rugby players' dynamic balance and quadriceps isometric strength. Thirteen rugby players were tested under maximal-bite (MB) and no-bite (NB) conditions. During standing balance tests, an electro-actuated platform with a force plate screwed on it allowed for the perturbation of the support base of the rugby players. A verbal signal warned the subject that the perturbation was coming, mentally recalling an in-field expected collision. In the first 2.5s window after the perturbation, the center of pressure (CoP) displacement and mean velocity were measured. The first peak, the maximal oscillations, and the standard deviation of the anterior-posterior CoP trajectory were calculated within the same time window. In the isometric leg-extension test, a custom-built chair instrumented with a uni-axial load cell allowed to collect the maximal strength and rate of force development (RFD). Mouthguard jaw-clenching did not affect CoP-related parameters but increased maximal strength (p < 0.05) and RFD (0-50ms: p < 0.01; 50-100ms: p < 0.001; 100-150ms: p < 0.05) in the isometric leg-extension test. Mouthguard jaw-clenching alone could be useful to increase lower-limb maximal isometric strength and RFD but did not improve dynamic balance performance in a sport-oriented postural balance test.

Effects of a Passive Back-Support Exosuit on Postural Control and Cognitive Performance During a Fatigue-Inducing Posture Maintenance Task.

To evaluate the effectiveness of passive back-support exosuit on postural control and cognitive performance during a fatigue-inducing posture maintenance task. Wearable support systems (exoskeletons/exosuits) reduce physical demands but may also influence postural control and cognitive performance by reducing muscular fatigue. Eighteen participants visited on two different days to test an exosuit system and performed dual-task cognitive assessments based on human information processing (information acquisition, information integration, and action implementation) while maintaining a 35° trunk flexion posture for 16minutes. Center-of-pressure (CoP), cognitive performance, and perceived workload were recorded, while erector spinae muscle activity was captured to quantify muscle fatigue. The exosuit was effective in reducing erector spinae muscle fatigue during the static posture maintenance task (61% less in Δmedian frequency: -9.5Hz (EXO-Off) versus -3.7Hz (EXO-On)). The fatigue-inducing task increased CoP velocity as a function of time (29% greater: 9.3mm/sec (pre) versus 12.0mm/sec (post)), and exosuit use decreased CoP velocity (23% less: 12.1mm/sec (EXO-Off) versus 9.4mm/sec (EXO-On)). The exosuit was also effective at mitigating cognitive degradation, as evidenced by a higher hit-to-signal ratio (8% greater: 81.3 (EXO-Off) versus 87.9 (EXO-On)) in the information integration task and reducing perceived workload in all stages of human information processing. Exosuit provided benefits of postural control and information integration processing during a 16-min static posture maintenance task. Torso exoskeletons/suits can have positive implications for occupations with concurrent physical and cognitive demands.

Biomechanical response of lower limb joints to lateral wedge insoles

Lateral wedge insole (LWI) is a frequently recommended treatment option for early and midterm stages of medial knee osteoarthritis. However, studies of its effects on the lower limb joints are incomplete and imperfect. The main purpose of this study was to quantitatively analyze the response of intervention of LWI on lower-limb joint kinematics, ground reaction forces (GRFs), and centre of pressure (COP). Gait analysis of 16 healthy subjects was conducted. Three-dimensional motion data and force plate measurements were collected in the control (barefoot) and experimental conditions (wearing a pair of assigned shoes with 0, 7, and 10 mm LWIs). Results showed that the peak knee flexion angle was increased by 3.43°, 3.09°, and 3.27° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The ankle peak dorsiflexion angle was significantly decreased by 3.79°, 2.19°, and 1.66° with 0, 7, and 10 mm LWIs, respectively (p = 0.02). The internal rotation angle was increased by 2.78°, 3.76°, and 4.58° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The forefoot with LWIs showed highly significantly smaller inversion, eversion, and adduction angles (all p < 0.01). The 1st peak of the vertical GRF (p = 0.016) also increased significantly by a maximum of 0.06 body weight (BW) with LWIs. These results indicated that biomechanical changes and limitations of lateral wedges insole should be analyzed in more detail, possibly leading to new guidelines for the design and application.

Effect of test duration and sensor location on the reliability of standing balance parameters derived using body-mounted accelerometers

BackgroundBalance parameters derived from wearable sensor measurements during postural sway have been shown to be sensitive to experimental variables such as test duration, sensor number, and sensor location that influence the magnitude and frequency-related properties of measured center-of-mass (COM) and center-of-pressure (COP) excursions. In this study, we investigated the effects of test duration, the number of sensors, and sensor location on the reliability of standing balance parameters derived using body-mounted accelerometers.MethodsTwelve volunteers without any prior history of balance disorders were enrolled in the study. They were asked to perform two 2-min quiet standing tests with two different testing conditions (eyes open and eyes closed). Five inertial measurement units (IMUs) were employed to capture postural sway data from each participant. IMUs were attached to the participants’ right legs, the second sacral vertebra, sternum, and the left mastoid processes. Balance parameters of interest were calculated for the single head, sternum, and sacrum accelerometers, as well as, a three-sensor combination (leg, sacrum, and sternum). Accelerometer data were used to estimate COP-based and COM-based balance parameters during quiet standing. To examine the effect of test duration and sensor location, each 120-s recording from different sensor locations was segmented into 20-, 30-, 40-, 50-, 60-, 70-, 80-, 90-, 100-, and 110-s intervals. For each of these time intervals, time- and frequency-domain balance parameters were calculated for all sensor locations.ResultsMost COM-based and COP-based balance parameters could be derived reliably for clinical applications (Intraclass-Correlation Coefficient, ICC ≥ 0.90) with a minimum test duration of 70 and 110 s, respectively. The exceptions were COP-based parameters obtained using a sacrum-mounted sensor, especially in the eyes-closed condition, which could not be reliably used for clinical applications even with a 120-s test duration.ConclusionsMost standing balance parameters can be reliably measured using a single head- or sternum-mounted sensor within a 120-s test duration. For other sensor locations, the minimum test duration may be longer and may depend on the specific test conditions.

Effects of arousal and valence on center of pressure and ankle muscle activity during quiet standing.

Emotion affects postural control during quiet standing. Emotional states can be defined as two-dimensional models comprising valence (pleasant/unpleasant) and arousal (aroused/calm). Most previous studies have investigated the effects of valence on postural control without considering arousal. In addition, studies have focused on the center of pressure (COP) trajectory to examine emotional effects on the quiet standing control; however, the relationship between neuromuscular mechanisms and the emotionally affected quiet standing control is largely unknown. This study aimed to investigate the effects of arousal and valence on the COP trajectory and ankle muscle activity during quiet standing. Twenty-two participants were instructed to stand on a force platform and look at affective pictures for 72 seconds. The tasks were repeated six times, according to the picture conditions composed of arousal (High and Low) and valence (Pleasant, Neutral, and Unpleasant). During the task, the COP, electromyogram (EMG) of the tibialis anterior and soleus muscles, and electrocardiogram (ECG) were recorded. The heart rate calculated from the ECG was significantly affected by valence; the value was lower in Unpleasant than that in Neutral and Pleasant. The 95% confidence ellipse area and standard deviation of COP in the anterior-posterior direction were lower, and the mean power frequency of COP in the anterior-posterior direction was higher in Unpleasant than in Pleasant. Although the mean velocity of the COP in the medio-lateral direction was significantly lower in Unpleasant than in Pleasant, the effect was observed only when arousal was low. Although the EMG variables were not significantly affected by emotional conditions, some EMG variables were significantly correlated with the COP variables that were affected by emotional conditions. Therefore, ankle muscle activity may be partially associated with postural changes triggered by emotional intervention. In conclusion, both valence and arousal affect the COP variables, and ankle muscle activity may be partially associated with these COP changes.

Dynamics of Center of Pressure Trajectory in Gait: Unilateral Transfemoral Amputees Versus Non-Disabled Individuals.

The primary goal of rehabilitation for individuals with lower limb amputation, particularly those with unilateral transfemoral amputation (uTFA), is to restore their ability to walk independently. Effective control of the center of pressure (COP) during gait is vital for maintaining balance and stability, yet it poses a significant challenge for individuals with uTFA. This study aims to study the COP during gait in individuals with uTFA and elucidate their unique compensatory strategies. This study involved 12 uTFA participants and age-matched non-disabled controls, with gait and COP trajectory data collected using an instrumented treadmill. Gait and COP parameters between the control limb (CL), prosthetic limb (PL), and intact limb (IL) were compared. Notably, the mediolateral displacement of COP in PL exhibited significant lateral displacement compared to the CL from 30% to 60% of the stance. In 20% to 45% of the stance, the COP forward speed of PL was significantly higher than that of the IL. Furthermore, during the initial 20% of the stance, the vertical ground reaction force of PL was significantly lower than that of IL. Additionally, individuals with uTFA exhibited a distinct gait pattern with altered duration of loading response, single limb support, pre-swing and swing phases, and step time. These findings indicate the adaptability of individuals with uTFA in weight transfer, balance control, and pressure distribution on gait stability. In conclusion, this study provides valuable insights into the unique gait dynamics and balance strategies of uTFA patients, highlighting the importance of optimizing prosthetic design, alignment procedures, and rehabilitation programs to enhance gait patterns and reduce the risk of injuries due to compensatory movements.

Postural Sway Characteristics in Static Balance Control of Youth Female Soccer Players

Purpose: Balance control, particularly in uni-lateral domain, is essential in soccer. Majority of the existing studies examined dynamic balance via clinical tools, and primarily involved male players. Thus, the purpose here was to examine the nature of Center of Pressure (COP) postural sway in youth female players across bipedal and unipedal conditions Methods: Sixteen pre-adolescent female competitive players (age 12.4±21.40 years) were asked to stand on a force plate in bi-pedal stance with the dominant and non-dominant legs respectively. Three, 10 second trials were carried out for each condition. Results: As expected, across the four COP measures bi-pedal stance resulted in least sway (P= .05). However, the subsequent analysis showed different center of pressure (COP) profiles in the dominant versus non-dominant condition across COP velocity (P= .003), path length (P= .001) and anterior-posterior (AP) sway (P= .003), with sway area revealing no statistical differences (P= .821). In addition, the analysis of stabilograms confirmed that in the non-dominant condition the pronounced COP oscillations were of lower amplitude and frequency as compared to the dominant leg. Conclusions: Overall, postural asymmetry was found as the sway characteristics on both legs differed, with dominant side exhibiting more sway and faster COP oscillations. In line with the inverted pendulum model, this may be due to less than optimal ability to modulate muscle torques generated at the ankle. It is hypothesized that the postural asymmetry between the dominant and non-dominant legs may result from muscular asymmetries that have been often reported in youth soccer players, as a result of their pronounced foot dominance.

A Computer-Aided Screening Solution for the Identification of Diabetic Neuropathy from Standing Balance by Leveraging Multi-Domain Features.

The early diagnosis of diabetic neuropathy (DN) is fundamental in order to enact timely therapeutic strategies for limiting disease progression. In this work, we explored the suitability of standing balance task for identifying the presence of DN. Further, we proposed two diagnosis pathways in order to succeed in distinguishing between different stages of the disease. We considered a cohort of non-neuropathic (NN), asymptomatic neuropathic (AN), and symptomatic neuropathic (SN) diabetic patients. From the center of pressure (COP), a series of features belonging to different description domains were extracted. In order to exploit the whole information retrievable from COP, a majority voting ensemble was applied to the output of classifiers trained separately on different COP components. The ensemble of kNN classifiers provided over 86% accuracy for the first diagnosis pathway, made by a 3-class classification task for distinguishing between NN, AN, and SN patients. The second pathway offered higher performances, with over 97% accuracy in identifying patients with symptomatic and asymptomatic neuropathy. Notably, in the last case, no asymptomatic patient went undetected. This work showed that properly leveraging all the information that can be mined from COP trajectory recorded during standing balance is effective for achieving reliable DN identification. This work is a step toward a clinical tool for neuropathy diagnosis, also in the early stages of the disease.

Is a portable pressure plate an alternative to force plates for measuring postural stability and interlimb coordination of quiet standing balance control?

Center-of-pressure (COP) synchronization and symmetry can inform adaptations in balance control following one-sided sensorimotor impairments (e.g., stroke). As established force plates are impossible to transport, we aimed to criterion validate a portable pressure plate for obtaining reliable COP synchronization and symmetry measures, next to conventional postural stability measures. Twenty healthy adults participated. In a single session, three 40-s eyes-open and eyes-closed quiet stance trials were performed per plate-type, randomly ordered. Individual-limb COPs were measured to calculate between-limb synchronization (BLS) and dynamic control asymmetry (DCA). Net COP (i.e., limbs combined) area, amplitude, and velocity were used to describe anteroposterior (AP) and mediolateral (ML) postural stability. Criterion validity was evaluated using Spearman correlations (r) and Bland-Altman plots. Test-retest reliability was tested using intraclass correlation coefficients (ICC). Strong correlations (r > 0.75) and acceptable reliability (ICC > 0.80) were found regarding individual-limb COP velocity and DCA, net COP ML amplitude and AP and ML velocities. Bland-Altman plots yielded possible proportional bias; the pressure plate systematically underestimated COP scores by force plates and a larger error associated with a larger measurement. Despite correlations between instruments and sufficient reliability for measuring postural stability and DCA, this technical note strongly suggests, due to a systematic deviation, using the same plate-type to accurately assess performance change within subjects longitudinally over time.

A Potential Mechanism Involved in the Regularity of Center-of-Pressure Displacements During Achieving Unipedal Equilibrium on Stable and Unstable Surfaces.

Sample entropy (SampEn) is a widely used measure for estimating the regularity of center-of-pressure (COP) trajectories, with high COP regularity (low SampEn) commonly interpreted as ineffective postural control. The current study aimed to investigate one possible source of COP regularity-agonist-antagonist coactivation-resulting in joint stiffness or action stability. A cross-correlation analysis was conducted to determine the similarity (coactivation) level of 5 pairs of lower limb agonist-antagonist electromyographic signals. SampEn was applied to anteroposterior (ap) and mediolateral (ml) COP displacements. Electromyographic and COP signals were simultaneously derived from 25 active young adults (25.6 ± 4.0years) during unipedal balancing on stable and multiaxial-unstable surfaces. Then, the correlation between individual agonist-antagonist cross-correlation coefficients and SampEn-COP was explored. The results show that only the tibialis anterior-peroneus longus (TA-PL) coactivations are negatively correlated with SampEn-COPap/ml (P ≤ .030) in both surface conditions, with greater TA-PL coactivation appearing with lower SampEn-COPap/ml. In addition, sex effects as one factor that might influence postural control were also tested. Women exhibited greater TA-PL coactivation (P = .017) and lower SampEn-COPap (P = .005) than men. Together, TA-PL coactivation could be one possible origin of COP regularity, but its effects might be detrimental to unipedal postural control, especially for women.

Investigating the Effect of Addition of Cervical Proprioceptive Training to Conventional Physiotherapy on Visual, Vestibular and Proprioceptive Dependency of Postural Control in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Clinical Trial.

While cervical proprioception deficit has been suggested as a contributing factor to clinical consequences of chronic non-specific neck pain (CNSNP), the effect of addressing such impairments on postural control strategies has remained unexplored. The aim of this study was to compare the response of the postural control system to alteration of sensory afferents in CNSNP with asymptomatic individuals. Furthermore, we examined whether proprioceptive training would yield superior outcomes to routine physiotherapy for improvement of postural control, pain and disability. Center of pressure (CoP) variables of sixty CNSNP patients equally distributed in any of the proprioception-specific or conventional physiotherapy groups and 30 asymptomatic participants were evaluated under four standing conditions:1) normal, 2) foam, 3) cervical extension/eyes open and 4) cervical extension/eyes closed standing. CoP anteroposterior range and anteroposterior and mediolateral velocity in patients were significantly higher than the control group under condition 2 (P<0.05). Patients also demonstrated lower anteroposterior lyapunov exponent under conditions 2 and 4 (P<0.05). Both interventions significantly decreased anteroposterior range and anteroposterior velocity(P<0.05). Anteroposterior lyapunov exponent also increased under condition 2 (P<0.05).. After the interventions, CoP anteroposterior range and anteroposterior velocity were significantly lower in the proprioceptive exercise group than the conventional physiotherapy group (P<0.05). Anteroposterior lyapunov exponent was also significantly higher in the proprioceptive exercise group (P<0.05).This while there was no significant difference between these patients and control group participants in any of the CoP variables after intervention. Our results rejected the hypothesis that impaired neck proprioception in the presence of CNSNP is compensated by overweighting other sources of sensory afferent information. The findings also revealed that while proprioceptive exercises successfully returned postural strategies of CNSNP patients to those in asymptomatic participants, they do not add to clinical recovery of these patients.

Comparing the Effects of 8-week Exercise Programs in the Sagittal and Frontal Planes on the Postural Sway of Elderly Men

Background and Aims Exercises are mostly used to control balance and reduce the risk of falling in the elderly. However, the effect of exercise in the frontal plane has been less studied. Therefore, this study aims to compare the effect of 8 week exercises in the sagittal and frontal planes on the postural sway of elderly men. Methods In this quasi-experimental study, 24 elderly males (Mean age: 67.21±1.56 years) were divided into two intervention groups of sagittal-plane and frontal-plane exercises. The exercises were performed for 8 weeks. The center of pressure (CoP) parameters in two groups before and after the intervention were evaluated using a foot scanner system. Finally, the ANCOVA was used for data analysis. P≤0.05 was considered statistically significant. Results The results showed a significant decrease in CoP perturbations in the Y-axis at the medial-lateral, anterior-posterior, and lateral-medial directions in the frontal plane group compared to the sagittal group (P&lt;0.05). Moreover, there was a significant decrease in the CoP area after perturbations at the medial-lateral, anterior-posterior, and lateral-medial directions in the frontal group compared to the sagittal group (P&lt;0.05). Conclusion It seems that exercises in the frontal plane can reduce postural sway in elderly men compared to sagittal-plane exercises. Therefore, it is recommended to emphasize the exercises of the hip abductor and adductor muscles in the frontal plane in designing exercise protocols for elderly men.