Dynamic Postural Balance Research Articles

Eldecalcitol improves muscle strength and dynamic balance in postmenopausal women with osteoporosis: an open-label randomized controlled study.

The antifracture efficacy of vitamin D in osteoporosis is due to its direct action on bones and indirect extraskeletal effects to prevent falls. Eldecalcitol is an analog of active vitamin D3 that improves bone mineral density and reduces the risk of osteoporotic fractures. However, the effects of eldecalcitol on muscle strength and static and dynamic postural balance are unclear. In this open-label randomized controlled study, we assessed the effects of eldecalcitol on muscle strength and static and dynamic postural balance in 50 postmenopausal women (mean age 74years) with osteoporosis treated with bisphosphonate. Participants were randomly divided into a bisphosphonate group (alendronate at 35mg/week; n=25) or an eldecalcitol group (eldecalcitol at 0.75μg/day and alendronate at 35mg/week; n=25) and were followed up for 6months. Trunk muscle strength, including back extensor strength and iliopsoas muscle strength, was measured. Static standing balance was evaluated and the one leg standing test was performed to assess static postural balance. Dynamic sitting balance was evaluated and the 10-m walk test, functional reach test, and timed up and go test were performed to assess dynamic postural balance. At 6months, there were no significant changes in any measure of muscle strength or balance in the bisphosphonate group, whereas eldecalcitol significantly increased back extensor strength (p=0.012) and iliopsoas muscle strength (p=0.035). Eldecalcitol also significantly improved findings on the timed up and go test (p=0.001) and dynamic sitting balance (p=0.015) at 6months. These results with eldecalcitol may have an impact on prevention of falls.

Combined Measures of Dynamic Bone Quality and Postural Balance—A Fracture Risk Assessment Approach in Osteoporosis

We evaluated functional measures of neuromuscular integrity and bone's resistance to fracture as a combined tool in discriminating osteoporosis patients with and without fractures. Functional aspects of neuromuscular integrity were quantified with a noninvasive measure of static and dynamic functional postural stability (FPS), and fracture resistance was obtained with bone shock absorption in patients with osteoporosis aged 65–85 and compared our measures with dual-energy X-ray absorptiometry and Fracture Risk Assessment Tool (FRAX [World Health Organization Collaborating Center for Metabolic Bone Diseases, Sheffield, UK]) in women with osteoporosis, some with and some without vertebral fractures. Patients with vertebral fracture showed larger static FPS (postural sway excursion) in the mediolateral and anterior-posterior directions, suggesting poorer balance. Most of the variables of dynamic FPS showed significant differences between fracture and no-fracture groups (e.g., the fracture group took significantly longer during turning, implying poorer dynamic balance control). Also, compared with healthy control subjects, all 4 dynamic FPS responses for osteoporosis patients with and without fracture were significantly poorer, suggesting potential risk for falls. In summary, patients with osteoporosis who have vertebral fractures (compared with patients with similarly low bone mineral density and other nonfracture risk fractures) have not only lower bone shock absorption damping (ζ) but also increased postural imbalance.

Effect of upright posture on tonsillar level in adolescent idiopathic scoliosis

Results In AIS patients, the cerebellar tonsil position was significantly lower in the upright than the supine position (-0.7 +/-1.5 vs +1.2+/-1.7, p<0.00001) while in normal subjects, there was no change in cerebellar tonsil position between upright and supine positions (mean +2.1+/-1.7 vs +2.2 +/-1.8, p = 0.93). AIS patients also had a greater degree of tonsillar excursion between upright and supine positions compared to normal subjects (mean -1.9 +/-1.6 vs -0.1 +/-1.7, p<0.00001). More AIS patients tended to have tonsillar descent in the upright position rather than the supine position though this did not reach statistical significance (28% in supine position vs 48% in standing position, p=0.15). There is slightly better correlation between tonsillar level and Cobb angle in upright position (r = 0.45, p = 0.01) than those in supine position (r= 0.31, p=0.03) in AIS patients. Conclusion AIS patients have more tonsillar descent in the upright position and a greater degree of tonsillar excursion between supine and upright positions compared to matched control subjects. Apart from supporting the hypothesis of relative cord tethering in AIS, the results also enhance the likelihood of more significant chronic dynamic compression of the brainstem and upper cervical cord in AIS. Whether this will lead to chronic insult with subclinical neurophysiological disturbance, affecting both dynamic postural balance and SSEP, and contributing to the etiopathogenesis of AIS, warrants further study.

Different Effects of Motor Learning between Visual and Auditory Feedback Exercises in Dynamic Postural Balance

Different Effects of Motor Learning between Visual and Auditory Feedback Exercises in Dynamic Postural Balance

The Mulligan ankle taping does not affect balance performance in healthy subjects: a prospective, randomized blinded trial.

[Purpose] The aim of this study was to evaluate the immediate effects of Mulligan fibular taping on static and dynamic postural balance in healthy subjects using computerized dynamic posturography (CDP). [Subjects and Methods] Forty-four volunteers (26 males and 18 females) aged 21 ±2 years participated in the study. The Mulligan tape was applied by a specialist in this technique. The placebo group received a treatment with a similar tape but with several cuts to avoid the fibular repositioning effect produced by Mulligan tape. Main outcome measures: The Sensory Organization Test (SOT) and the Motor Control Test (MCT) were performed by each subject at baseline and after the interventions. Outcome measures included equilibrium and strategy scores from each trial and condition of the SOT, and speed of reaction (latency period) from the MCT. [Results] Mulligan ankle taping did not have an impact on postural control during static and dynamic balance in subjects with healthy ankles when compared with placebo taping. [Conclusion] There was no difference in, equilibrium and strategy (SOT) and speed of reaction (MCT) in any of the subjects in this study. Therefore, this study suggests that Mulligan ankle taping does not have an impact on balance in healthy subjects.

Effects of foot position of the nonparetic side during sit-to-stand training on postural balance in patients with stroke

[Purpose] We aimed to investigate postural balance after sit-to-stand (STS) training with different nonparetic foot positions in stroke patients. [Subjects] Thirty-six subjects who experienced a stroke (21 males, 15 females) participated and were divided into the symmetric foot position (SYMM), asymmetric foot position (ASYM), and step foot (STEP) groups. [Methods] Each group performed repetitive sit-to-stand training 5 times a week for 6 weeks. The timed up-and-go test (TUG), functional reach test (FRT), and F-mat system correcting the anterior/posterior (A-P) and medial/lateral (M-L) distance of the center of pressure (COP) were used to measure the static and dynamic postural balance pre- and postintervention. ANCOVA was used to analyze differences among groups, and preintervention variables were used as covariates. [Results] The TUG, FRT, and A-P and M-L distance of the COP in the ASYM and STEP groups were significantly decreased after intervention compared with the SYMM group. All parameters in the STEP group were lower than those in the ASYM group, without a significant difference. [Conclusion] The asymmetric foot position during STS is a good intervention to improve the static and dynamic postural balance in stroke patients. Especially, using a step to change the foot position is effective in improving STS performance.

Individuals with transtibial limb loss use interlimb force asymmetries to maintain multi-directional reactive balance control

BackgroundDeficits in balance control are one of the most common and serious mobility challenges facing individuals with lower limb loss. Yet, dynamic postural balance control among individuals with lower limb loss remains poorly understood. Here we examined the kinematics and kinetics of dynamic balance in individuals with unilateral transtibial limb loss. MethodsFive individuals with unilateral transtibial limb loss, and five age- and gender-matched controls completed a series of randomly applied multi-directional support surface translations. Whole-body metrics, e.g. peak center-of-mass displacement and net center-of-pressure displacement were compared across cohorts. Stability margin was computed as the difference between peak center-of-pressure and center-of-mass displacement. Additionally, center-of-pressure and ground reaction force magnitude and direction were compared between the prosthetic, intact, and control legs. FindingsPeak center-of-mass displacement and stability margin did not differ between individuals with transtibial limb loss and controls for all perturbation directions except those loading only the prosthetic leg; in such cases the stability margin was actually larger than controls. Despite similar center-of-mass displacement, greater center-of-pressure displacement was observed in the intact leg during anterior–posterior perturbations, and under the prosthetic leg in medial–lateral perturbations. Further, in the prosthetic leg, ground reaction forces were smaller and spanned fewer directions. InterpretationDeficits in balance control among individuals with transtibial limb loss may be due to their inability to use their prosthetic leg to generate forces that are equal in magnitude and direction to those of unimpaired adults. Targeting this force-generating deficit through technological or rehabilitation innovations may improve balance control.

A Transformative Risk Assessment Approach for Osteoporosis Fracture-Combined Measures of Dynamic Bone Quality and Postural Balance

A Transformative Risk Assessment Approach for Osteoporosis Fracture-Combined Measures of Dynamic Bone Quality and Postural Balance

AB0737 Do Postural Deformities in Patients with Ankylosing Spondylitis Cause Balance Problems?

BackgroundAnkylosing spondylitis causes progressive postural deformities [1].ObjectivesWe aimed to assess the impact of postural deformities on balance.MethodsIn this cross-sectional study, 29 AS patients and 21 healthy controls were included. For...

AB0307 Impaired Balance and Fall Risk in Rheumatoid Arthritis Patients

BackgroundMany patients with rheumatoid arthritis blame decreased balance as a reason for limiting their physical activity (1,2). It is therefore important to improve balance and reducing the risk of falling.ObjectivesThis...

Anti-gravity training improves walking capacity and postural balance in patients with muscular dystrophy

Recent studies in patients with muscular dystrophies suggest positive effects of aerobic and strength training. These studies focused training on using bicycle ergometers and conventional strength training, which precludes more severely affected patients from participating, because of their weakness. We investigated the functional effects of combined aerobic and strength training in patients with Becker and limb-girdle muscular dystrophies with knee muscle strength levels as low as 3% of normal strength.Eight patients performed 10weeks of aerobic and strength training on an anti-gravity treadmill, which offered weight support up to 80% of their body weight. Six minute walking distance, dynamic postural balance, and plasma creatine kinase were assessed 10weeks prior to training, immediately before training and after 10weeks of training. Training elicited an improvement of walking distance by 8±2% and dynamic postural balance by 13±4%, indicating an improved physical function. Plasma creatine kinase remained unchanged. These results provide evidence that a combination of aerobic and strength training during anti-gravity has the potential to safely improve functional ability in severely affected patients with Becker and limb-girdle muscular dystrophies.

Center-of-pressure total trajectory length is a complementary measure to maximum excursion to better differentiate multidirectional standing limits of stability between individuals with incomplete spinal cord injury and able-bodied individuals

BackgroundSensorimotor impairments secondary to a spinal cord injury affect standing postural balance. While quasi-static postural balance impairments have been documented, little information is known about dynamic postural balance in this population. The aim of this study was to quantify and characterize dynamic postural balance while standing among individuals with a spinal cord injury using the comfortable multidirectional limits of stability test and to explore its association with the quasi-static standing postural balance test.MethodsSixteen individuals with an incomplete spinal cord injury and sixteen able-bodied individuals participated in this study. For the comfortable multidirectional limits of stability test, participants were instructed to lean as far as possible in 8 directions, separated by 45° while standing with each foot on a forceplate and real-time COP visual feedback provided. Measures computed using the center of pressure (COP), such as the absolute maximal distance reached (COPmax) and the total length travelled by the COP to reach the maximal distance (COPlength), were used to characterize performance in each direction. Quasi-static standing postural balance with eyes open was evaluated using time-domain measures of the COP. The difference between the groups and the association between the dynamic and quasi-static test were analyzed.ResultsThe COPlength of individuals with SCI was significantly greater (p ≤ 0.001) than that of able-bodied individuals in all tested directions except in the anterior and posterior directions (p ≤ 0.039), indicating an increased COP trajectory while progressing towards their maximal distance. The COPmax in the anterior direction was significantly smaller for individuals with SCI. Little association was found between the comfortable multidirectional limits of stability test and the quasi-static postural balance test (r ≥ −0.658).ConclusionStanding dynamic postural balance performance in individuals with an incomplete spinal cord injury can be differentiated from that of able-bodied individuals with the comfortable limits of stability test. Performance among individuals with an incomplete spinal cord injury is characterized by lack of precision when reaching. The comfortable limits of stability test provides supplementary information and could serve as an adjunct to the quasi-static test when evaluating postural balance in an incomplete spinal cord injury population.

Assessment of Dynamic Postural Balance among Saudi Adolescent Girls in Al-Khobar- Saudi Arabia

Aims: The aim of this study was to evaluate the dynamic postural balance in Saudi girls with different BMI. Design: Cross-sectional study. Participants: Sixty Saudi girls participated in this study and divided equally into three groups (Healthy weight, overweight and obese), their age range from 12-17 years. Method: Dynamic postural balance was evaluated for all study girls using the Biodex Stability System (BSS). Antroposterior, mediolateral, and overall stability indices were obtained during bilateral stance with open-eyes at the platform. Measurements were conducted on the BSS at a completely firm surface (stability level 12) and a very unstable surface (stability level 1). Results: Mean values of AP stability scores were greater than ML ones in all study girls in the two chosen stability levels (1 and 12). ML scores significantly impaired in obese girls at stability level 1&12 and in overweight girls at stability level 1 only. All stability indexes were significantly impaired in obese girls at stability level 1, when compared to overweight girls. Conclusions: Our results revealed when BMI increases, balance parameters deteriorate as captured by dynamic stability indexes of the BBS. This indicates that overweight and obesity have a negative effect on dynamic postural control in Saudi girls.

Effect of smart phone use on dynamic postural balance.

[Purpose] The present study investigated what kind of effect smart phone use has on dynamic postural balance. [Subjects] The study subjects were 30 healthy students in their 20’s who were recruited from a University in Busan, Korea. [Methods] The present experiment was quasi-experimental research which measured the postural balance (Biodex) of subjects while they sent text messages via smart phones in the standing position with the eyes open, and while they used two-way SNS. [Results] There were significant differences between standing and the dual-task situations. Among dual tasks using smart phones, SNS using situations showed the highest instability. [Conclusion] The use of smart phones in less stable conditions such as while walking or in moving vehicles should be discouraged.

The Influence of Time of Day on Static and Dynamic Postural Control in Normal Adults

[Purpose] We attempted to determine whether static and dynamic postural control ability fluctuated depending on the influence of the time of day (9 am, 1 pm, and 5 pm), and at which time point postural balance performance was best in healthy individuals. [Subjects and Methods] Twenty-four healthy subjects participated in this study. The static and dynamic postural balance test was conducted during three sessions (i.e., at 9 am, 1 pm, and 5 pm) with a counterbalanced order for prevention of learning effects. As outcome measurements, AP distance, ML distance, and velocity moment were adopted in the static balance test, and the performance time and total distance were measured in the dynamic balance test. [Results] For the static postural balance test, COP distance was shorter and COP velocity was slower at 9 am compared with those at 1 and 5 pm. In particular, the COP distance at 9 am was statistically different from that at 13 pm. During the dynamic postural balance test, performance time and total distance were influenced by the time of day, as the best performance was observed in the morning. [Conclusion] This study found that static and dynamic postural balance abilities were greatest in the morning and worst at 1 pm. Understanding of the mechanism of the time-of-day effect on postural balance will be helpful for assessment and treatment of postural balance by physical therapists and in making desirable clinical decisions.

The effect of trunk coordination exercise on dynamic postural control using a Core Noodle

To investigate the influence of trunk coordination exercise on dynamic postural control relative to postural sway. The effects of trunk coordination exercises were examined using a Core Noodle for the postural sway in healthy students who were assigned to an exercise or control group. The independent variable was the extent of exposure to Core Noodle exercise, and the dependent variable was dynamic postural control. A stabilometer, which measures dynamic postural control, was used to evaluate the effectiveness of the exercises. In addition, center of gravity movements were assessed using a Gravicorder G-620 stabilometer in which the subject was asked to shift their center of gravity between 2 circles on a computer monitor. Pre- and post-intervention dynamic postural control was statistically evaluated between the exercise group and control group using the Mann-Whitney test. Finally, we investigated the application of these exercises for a stroke patient. For post-intervention, the envelop area, mean length of the pathways between 2 circles, and the number of circles were significantly higher in the exercise group. Trunk coordination exercise performed Core Noodle may be used to enhance the dynamic postural balance of healthy young adults, and it can also be adapted for stroke patients.

35-45 YAŞ KADINLARDA BEDEN KİTLE İNDEKSİ İLE POSTURAL DİNAMİK DENGE İLİŞKİSİ

The aim of this study was to evaluate the relationship between body mass index (BMI) and postural dynamic balance among 35-45 aged women (n=40). It was measured BMI using Tanita BC-418 and stability indices were obtained using Biodex Stability System (eyes open and eyes closed). Subjects were tested 60 seconds, starting level 8 and finished level 3. It was found that 20% of subjects were normal (n=8), 45% were overweight (n=18), 35% were obese (n=14). There were found that statistically significantly difference between groups (normally, overweight and obese) in the open-eyed balance test (F(2, 37)= 7.845, p0.05). In conclusion, it can be state that a decrease in balance stability is strongly correlated to an increase in body weight among 35-45 aged healthy women. This suggests that women should be healthy weight before menopausal stage and keep it because of body weight may be an important risk factor for falling.

Equilíbrio estático e dinâmico em bailarinos: revisão da literatura

A dança envolve integração de movimento, equilíbrio postural e aspectos relacionados ao controle postural. Informações sobre o equilíbrio em bailarinos são de grande importância, pois eles são considerados modelos de controle postural. O objetivo foi revisar estudos sobre equilíbrio postural estático e dinâmico em bailarinos, caracterizando o controle e a dependência visual desses atletas para a manutenção do equilíbrio. Para isso, foi realizada uma revisão nas bases de dados PubMed, SciELO, Lilacs e Science Direct, considerando o período entre 1997 a 2013, utilizando os descritores equilíbrio, controle postural, plataforma de forças, ballet, bailarinos clássicos e aferência visual. Foram selecionados 18 artigos capazes de fornecer dados quantitativos para avaliação do equilíbrio nesses atletas classificados pelo nível de evidência científica Oxford. A literatura revisada mostra completa concordância quanto ao efeito da retirada da informação visual sobre a estabilidade postural de bailarinos considerados como executantes altamente treinados. Estudos mostrando a comparação do equilíbrio de bailarinos com outras técnicas desportivas confirmaram um padrão específico de equilíbrio nesses indivíduos. Entretanto, associando-se à restrição visual, bailarinos apresentaram maior deslocamento do centro de pressão comparado a outras modalidades desportivas, sugerindo maior dependência visual para a manutenção do equilíbrio. Bailarinos apresentam menor oscilação postural em relação a indivíduos não treinados e indivíduos treinados em outras práticas desportivas, com maior dependência visual para manutenção do equilíbrio.

3 차원 동적 자세균형 훈련기기의 능동/수동 체간 기울임에 따른 근 활성도 비교

The Interest in disease prevention and rehabilitation is increasing depending on increase of patients with spinal. This is being developed using the spine stabilization device is being studied. So far studies have only evaluated the effect on trunk stabilization exercises but analysis of human movement patterns for active movement and passive movement did not. We assessed the muscle activity of trunk and leg muscle during passive and active tilt mode on eight tilt directions at tilt angle of 30° using 3-D dynamic postural balance training system. We performed experimental study on the muscular activities of trunk muscle about rectus abdominis, external obliques, latissimus dorsi, erector spinae, and leg muscle about rectus femoris, Biceps femoris, Tibialis Anterior, gastrocnemius. As a result, muscle activation was different depending on the direction of movement and pattern. The results indicate that various patterns of spinal stabilization exercise system could be applied to an effective training of chronic low back pain patients.

Commentary on “Evaluation of Static and Dynamic Postural Balance in Children With Juvenile Idiopathic Arthritis”

“How should I apply this information?” Children with juvenile idiopathic arthritis (JIA) can be limited in their ambulation, mobility, and exercise tolerance. Balance can play an important role during physical activities. This article provides information on impaired leg balance in children with JIA compared with their peers who are healthy. The results show an increasing balance problem with progressive instability of the balance platform, especially in single-leg balance. Finding balance impairment in children with JIA might provide an indication that these children will face difficulties in activities where these skills are needed, for example, in sports and leisure activities or walking over an uneven surface. “What should I be mindful about when applying this information?” The balance system used in this study is a test used in a laboratory setting. Therefore, the clinical relevance of the finding of impaired leg balance should be further investigated in a more ecological context. The mean differences in balance scores between the children with JIA and controls that were found are not very distinct. Although the differences were statistically significant, this significance is possibly due to the smaller standard deviations in the control group. From a clinical standpoint, correlations between muscle strength and impaired balance are a bit far-fetched. Muscle strength of the knee extensors, important to stabilize the knee (the most affected joint), was not related to balance abilities while strength of other muscles was. Last, most of the children with JIA were in clinical remission with little to no disease activity. It might be that the children with active disease or restrictions in joint function of the lower limb have greater problems with their balance than the children with rheumatoid arthritis included in this study. Patrick van der Torre, MSc, PCS Janjaap van der Net, PhD, PCS University Children's Hospital, University Medical Center Utrecht Utrecht, the Netherlands