Firm Surface Research Articles

Altered Visual Reliance Induced by Stroboscopic Glasses during Postural Control.

Little is known about how disrupted vision affects visual reliance during postural control. postural control. Twenty-four physically active adults volunteered to participate in the study. Static postural control was quantified with center of pressure measures during a one-legged balance test with four different visual inputs (eyes-open (EO), high frequency of strobe vision (HSV), low frequency of strobe vision (LSV), and eyes-closed (EC)) and on two different surfaces (firm and foam). Dynamic postural control was calculated by the dynamic postural stability index and the Y-Balance test for three different visual inputs (EO, HSV, and LSV) and the two different surfaces. Romberg ratios (HSV/EO, LSV/EO, and EC/EO) were then calculated and used for statistical analysis to assess visual contribution during postural control. In the results, Romberg ratios were higher when people were on the foam surface than the firm surface in center of pressure total path in medial-lateral and anterior-posterior directions (p < 0.05, both directions). Similarly, Romberg ratios were higher on the foam surface than the firm surface in dynamic stability index in medial-lateral and anterior-posterior directions (p < 0.05, both directions). Stroboscopic glasses could alter visual reliance when the somatosensory system is disturbed by a foam pad during both static and dynamic postural control. Clinicians could use the glasses to manipulate visual reliance during dynamic balance training for patients with musculoskeletal injuries.

The Effects of Proprioceptive Training on Balance, Strength, Agility and Dribbling in Adolescent Male Soccer Players.

The aim of the study was to determine the effects of proprioceptive training (PT) on balance, strength, agility and dribbling in adolescent soccer players. In this research, we included an experimental (n = 48) and a control (n = 48) group (CG) with 14 years old players. The experimental group (EG) participated in an 8 week PT program, with four 30 min sessions per week. The experimental program included 12 bosu ball exercises to improve balance, stability and strength which were grouped into two subprograms: the first not using the soccer ball, the second subprogram using the soccer ball. The subprograms were implemented alternately during 16 proprioceptive training sessions, on two types of firm and foam surfaces. Pre- and post-tests included the static balance [Balance Error Scoring System (BESS)], vertical, horizontal, and lateral jumping, and the completion of agility (“arrowhead”) and dribbling (“short dribbling”) tests. Regarding the total BESS score, the CG has demonstrated progress between the pre- and the post-test, with 0.780 ± 0.895, fewer errors, while the EG had 5.828 ± 1.017 fewer errors. The difference between the two groups was of 5.148 fewer errors for the EG who had practiced the proposed program of proprioceptive training. The highest difference registered between the pre- and the post-test was at the test “single-leg forward jump with the right leg”, with a result of 1.083 ± 0.459 cm for the CG and of 3.916 ± 0. 761 cm for the EG. Through the analysis of average differences between the pre- and the post-tests, we observe that, regarding the “Agility right side test”, the EG has progressed with 0.382 s in comparison with the CG; regarding the “Agility left side test”, the EG has progressed with 0.233 s compared to the CG; regarding the “Agility right and left side test”, the EG has progressed with 0.196 s compared to the CG; in the “Short dribbling test”, the EG has progressed with 0.174 s compared to the CG. The highest progress was made at the “Agility right side test”, of 0.402 s for the EG, while the CG registered 0.120 s. Most of the results in all tests for both experimental groups show an effect size ranging from small to medium. The progress made by the experimental group in all tests was statistically significant, while in the control group the progress was mostly statistically insignificant for p < 0.05. The results suggest that a PT program performed at about 14 years of age could be successfully implemented in the training regime of soccer players to improve components of fitness along with dribbling skills. The results of the study revealed that sports training on the foam surfaces determined a superior progress of the development of proprioception compared to the increased training on the firm surfaces.

Low back pain influences trunk-lower limb joint coordination and balance control during standing in persons with lower limb loss

BackgroundBalance is sustained through multi-joint coordination in response to postural perturbations. Low back pain alters postural responses; however, it is unknown how coordination between the trunk and lower extremities affects center of mass control during standing balance among persons with limb loss, particularly those with back pain. MethodsForty participants with unilateral lower limb loss (23 with back pain) stood with eyes open and closed on a firm surface, while wearing IMUs on the sternum, pelvis, and bilaterally on the thigh, shank, and foot. A state-space model with Kalman filter calculated sagittal trunk, hip, knee, and ankle joint angles. Fuzzy entropy quantified center of mass variability of sagittal angular velocity at the sacrum. Normalized cross-correlation functions identified coordination patterns (trunk-hip, trunk-knee, trunk-ankle). Multiple linear regression predicted fuzzy entropy from cross-correlation values for each pattern, with body mass and amputation level as covariates. FindingsWith eyes open, trunk-lower limb joint coordination on either limb did not predict fuzzy entropy. With eyes closed, positive trunk-hip coordination on the intact limb predicted fuzzy entropy in the pain group (p = 0.02), but not the no pain group. On the prosthetic side, inverse trunk-hip coordination patterns predicted fuzzy entropy in pain group (p = 0.03) only. InterpretationPersons with limb loss and back pain demonstrated opposing coordination strategies between the lower limbs and trunk when vision was removed, perhaps identifying a mechanism for pain recurrence. Vision is the dominant source of balance stabilization in this population, which may increase fall risk when visual feedback is compromised.

Examination of the Relationship Among Balance, Physical Activity, and Anthropometry in Athletes With Visual Impairments

Introduction Although it is well documented in the literature that individuals with visual impairments have low physical activity levels and impaired body compositions and postural controls compared with peers without vision loss, the relation between these parameters in athletes with visual impairments is unknown. Research Question Here, we (i) evaluated the physical activity levels, balance measures, and anthropometry parameters in athletes with visual impairments and peers without vision loss controls and (ii) compared these variables between the two groups. Methods We designed a retrospective observational study with parallel groups conducted on 33 athletes with visual impairments and 33 sighted controls matched for age and sex. We also utilized a questionnaire about physical activity levels and assessed static balance for 4 conditions (eyes-open firm surface, eyes-closed firm surface, eyes-open foam surface, and eyes-closed foam surface) and anthropometry. Results In athletes with visual impairments, body composition, body mass index (BMI), physical activity level, and static balance parameters revealed no significant relationship ( p &gt; .05), whereas eyes-open and -closed firm and foam surface conditions were positively related with physical activity at a moderate level ( r = 0.39, r = 0.38, p &lt; .05, respectively). Moderate-intensity and high-intensity physical activity was positively associated with fat-free mass ( r = 0.82, r = 0.68, p &lt; .01, respectively) and negatively related with body mass, fat %, and fat mass ( r = −0.67, r = −0.52, r = −0.72, r = −0.66, r = −0.50, r = −0.50, p &lt; .01, respectively). Athletes with visual impairments presented lower static balance than the sighted controls for three conditions, while eyes-closed foam surface scores were similar in both groups. The physical activity levels were higher for athletes with visual impairments ( p &lt; .05). However, we found no difference in the body composition and BMI between two groups ( p &gt; .05). Discussion Sports participation from individuals with visual impairments is related to higher physical activity levels, resulting in better anthropometric profile. The balance control was not related to physical activity levels in athletes with visual impairments.

Effects of mobile phone texting on postural control and gait parameters in college students

Background: Mobile phone has become a part of everyday life. Mobile phone texting is one of the major causes of road traffic accidents, falls and injuries in young adults. Dual-task activities while using mobile phone increases the risk of falls. Objectives: To find out the changes in postural control and gait parameters while using mobile phone in young college students. Materials and Methods: A total of 100 college students of age 18–25 years participated in the study. NeuroCom Balance Master was used and the subjects were tested with and without phone. The participants had to maintain balance on firm surface and foam surfaces with and without phone. For walking, participants had to walk without phone followed by walking with phone. Outcome measures used were Modified Clinical test for Sensory Interaction on balance and Walk Across for balance and gait respectively. Results: The study showed statistically significant changes in postural control on firm and foam surfaces. Furthermore, the gait parameters such as step length, speed and step length symmetry were altered significantly, except step width while using the mobile phone. Conclusion: Subjects showed increased postural sway, step length and step length symmetry while the step width and speed decreased on using the mobile phone.

Examining the Relationship Between a Neuromuscular Control Baseline Battery for Sport-Related Concussion and Anterior Cruciate Ligament Injury Risk

To examine the relationship between the m-CTSIB and Landing Error Scoring System in a sample of collegiate female athletes. Recent literature has linked concussion and neuromuscular deficits in the lower extremity after injury. Neuromuscular control is frequently assessed using balance measures for concussion, but also dynamically to identify anterior cruciate ligament injury (ACL) risk via jump-landing movement screening. Thirty-nine healthy, collegiate female soccer (n = 22) and volleyball (n = 17) athletes completed the modified-Clinical Test of Sensory Interaction of Balance (m-CTSIB) and the Landing Error Scoring System (LESS). Measures consisted of total m-CTSIB sway index scores on individual conditions (firm surface eyes open [condition 1] and eyes closed [2], foam surface eyes open [3] and eyes closed [4]), m-CTSIB overall score, and total LESS errors. LESS scores were also categorized into a low (0-4 errors) and high (5 + errors) risk to determine if athletes with worse neuromuscular control on the LESS has worse balance on the m-CTSIB. A Spearman's rank-order correlation was conducted to determine the strength of the relationship between LESS and m-CTSIB performance. A series of Mann-Whitney U test were performed to determine differences between low and high LESS performance on m-CTSIB performance. There was a weak, negative correlation between LESS and m-CTSIB performance (rs(37) = -0.153, p = 0.35). Further, there were no differences between the low and high risk LESS groups on sway index scores on conditions 1 (U = 158.5, p = 0.39), 2 (U = 156.0, p = 0.36), 3 (U = 165.5, p = 0.51), or 4 (U = 128.5, p = 0.08), as well as overall m-CTSIB scores (U = 150.5, p = 0.28). There appears to be a lack of relationship between the LESS and m-CTSIB tests, revealing the independence of static and dynamic lower extremity neuromuscular function. Athletes who may be more at risk for ACL injury due to abnormal jump-landing biomechanics, do not differ from low-risk athletes on baseline balance assessment.

Validity and Reliability of a Smartphone App for Gait and Balance Assessment.

Advances in technology provide an opportunity to enhance the accuracy of gait and balance assessment, improving the diagnosis and rehabilitation processes for people with acute or chronic health conditions. This study investigated the validity and reliability of a smartphone-based application to measure postural stability and spatiotemporal aspects of gait during four static balance and two gait tasks. Thirty healthy participants (aged 20–69 years) performed the following tasks: (1) standing on a firm surface with eyes opened, (2) standing on a firm surface with eyes closed, (3) standing on a compliant surface with eyes open, (4) standing on a compliant surface with eyes closed, (5) walking in a straight line, and (6) walking in a straight line while turning their head from side to side. During these tasks, the app quantified the participants’ postural stability and spatiotemporal gait parameters. The concurrent validity of the smartphone app with respect to a 3D motion capture system was evaluated using partial Pearson’s correlations (rp) and limits of the agreement (LoA%). The within-session test–retest reliability over three repeated measures was assessed with the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). One-way repeated measures analyses of variance (ANOVAs) were used to evaluate responsiveness to differences across tasks and repetitions. Periodicity index, step length, step time, and walking speed during the gait tasks and postural stability outcomes during the static tasks showed moderate-to-excellent validity (0.55 ≤ rp ≤ 0.98; 3% ≤ LoA% ≤ 12%) and reliability scores (0.52 ≤ ICC ≤ 0.92; 1% ≤ SEM% ≤ 6%) when the repetition effect was removed. Conversely, step variability and asymmetry parameters during both gait tasks generally showed poor validity and reliability except step length asymmetry, which showed moderate reliability (0.53 ≤ ICC ≤ 0.62) in both tasks when the repetition effect was removed. Postural stability and spatiotemporal gait parameters were found responsive (p < 0.05) to differences across tasks and test repetitions. Along with sound clinical judgement, the app can potentially be used in clinical practice to detect gait and balance impairments and track the effectiveness of rehabilitation programs. Further evaluation and refinement of the app in people with significant gait and balance deficits is needed.

574 Giant left atrial myxoma in ischaemic stroke

Abstract Aims Primary cardiac tumours are rare; most are benign, and of these, around half are myxomas, often located in the left atrium. Clinical presentation is variable. Ischaemic stroke is a rare, although real and potentially fatal, complications of cardiac myxomas. Methods and results We present a case of a 51-year-old man, ex- smoker, obese, with a history of hypertension and COPD, presented to our emergency department with right-sided hemiplegia and aphasia caused by ischaemic stroke. Brain computed tomography revealed cerebral perfusion deficit. The patient was underwent intravenous thrombolytic strategy and intubated transferred in Reanimation. TTE showed a large left atrial mass attached to the interatrial septum, with a friable appearance, suggestive of myxoma. The 2D and 3D TEE detected a giant space-occupying mass (60 × 20 mm diameter) in the left atrium, coral-like, and with a friable appearance, the most apical portion prolapsed into the left ventricle during diastole, causing fixed obstruction to flow in the left ventricular inflow tract. Computed tomography angiography (CTA) confirmed the giant mass in the left atrium. In view of the risk of imminent embolization, the emergent surgical excision of the tumour was performed. The tumour and its neck, including part of the atrial septum, were fully resected and the atrial septum was directly closed. Subsequent histopathological findings confirmed the diagnosis of atrial myxoma. Post-operative echocardiography showed no residual tumour. Symptomatic cardiac myxoma may present with one of the three classic clinical presentations of the Goodwin’s triad, which include intracardiac obstruction, constitutional symptoms, and embolism. The obstructive pattern mimics mitral or tricuspid valve disease and results from atrioventricular valve obstruction. Constitutional or systemic manifestations include fatigue, fever, weight loss, arthralgia, myalgia, erythematous rash, and laboratory findings such as anaemia and elevated ESR, CRP, and globulins. Systemic embolization from myxoma occurs in around a third of cases. Of these, the most serious is cerebrovascular embolism, which may result in cerebral stroke. In addition, embolization of coronary arteries, kidneys, intestines, and extremities can also occur. The tumour size, location, and macroscopic appearance, along with mean platelet volume and platelet count, are closely associated with embolic events. Echocardiography remains the method of choice for diagnosis and morphological characterization of myxoma. Two patterns have been established by echocardiography: round, with a solid appearance and a firm surface, and polypoid, with an irregular outline and a friable surface. The incidence of systemic embolization is higher in those with an irregular and friable surface, as well as in polypoid tumours and those that prolapse into the ventricle. Once a diagnosis of myxoma is established, surgical resection is the only effective treatment and should be performed immediately, in view of the risk of embolic complications. Conclusions With this case report, we stress the fundamental importance of echocardiography in new onset of neurological deficit to prevent potentially fatal outcomes.

Factors influencing static postural control performance of collegiate marching artists

ABSTRACT The purpose of this study was to examine the influence of surface and instrument on static postural control performance of collegiate marching artists. Fifty-seven collegiate marching artists completed single- and double-leg stance balance with and without an instrument on firm and foam surfaces (four conditions per stance). Two, 15-s trials of each condition were performed on a tri-axial force plate. Total, antero-posterior, and medio-lateral centre-of-pressure excursion, and 95% ellipse sway area were collected. Means from the two trials were averaged. Linear mixed-effects models were fit with centre-of-pressure variables as predictors with fixed effects of surface and instrument, adjusting for number of seasons in marching band and type of instrument. Alpha level was set a priori at p ≤ 0.05. Standing on foam surface, regardless of stance, elicited longer excursion and larger sway area (p < 0.05 for all). Although number of seasons participated in marching band did not influence static postural control under single-leg stance, there was a significant effect for double-leg stance (p < 0.01). Marching artists commonly rehearse and perform on unstable surfaces. Understanding static postural control performance under similar conditions may provide novel and important information for injury risk assessment and performance evaluation.

Proprioceptive postural control strategies differ among non-injured athletes

Postural control during complex tasks requires adequate sensory integration and somaesthetic reweighting: suboptimal postural strategies can lead to injury. We assessed the ability of healthy athletes to reweight somaesthetic signals during postural perturbations on different surfaces. Thirty-five young (16 ± 1 years), healthy, elite handball players participated in this cross-sectional study. Proprioceptive reweighting was evaluated via vibration of the triceps surae and lumbar muscles on firm and foam surfaces. Postural variables and the electromyographic activity of the gluteus medius (GM), semitendinosus (ST) and fibularis longus (FL) were recorded during the PRE (10 s), VIBRATION (20 s) and POST (20 s) periods. Ankle proprioception was predominantly used on the firm compared to foam support. However, two opposing behaviours were observed: a “rigid” strategy in which reliance on ankle proprioception increased on the foam, and a “plastic” strategy that involved a proximal shift of proprioceptive reliance (p < 0.001). The plastic strategy was associated with a more effective recovery of balance after vibration cessation (p < 0.05). ST activation was higher during POST in the rigid strategy and did not return to the PRE level (p < 0.05) whereas it did in the plastic strategy. Proprioceptive strategies for postural control are highly variable and future studies should evaluate their contribution to injury.

Reliability analysis of inertial sensors for testing static balance of 4-to-5-year-old preschoolers

BackgroundBalance ability is important for preschoolers' motor and physical development. Portable accelerometers can provide resolution tests and identification of preschoolers with balance defects. Research questionDespite previous studies on the balance measures of accelerometer tests, there is a lack of complete analyses for preschoolers aged 4–5 years. In this study, we aim to verify the reliability of measuring the static balance of preschoolers in this age range based on inertia sensors for the acceleration and angular velocity moduli. MethodsThirty children wore an inertial sensor in the 5th lumbar vertebra and completed four tests, i.e., standing on a firm surface and on a foam surface with open and closed eyes. The standard deviation of the acceleration modulus and root mean square of the angular velocity modulus were calculated. The analysis was based on the intraclass correlation coefficient (ICC) to determine the internal consistency and feasibility. ResultsThe ICC of the acceleration modulus was between 0.597 and 0.683 (P < 0.01), and the test-retest reliability was medium. The ICC of the angular velocity modulus was between 0.683 and 0.812 (P < 0.01, P < 0.001), and the test-retest reliability was medium to good. The standard error of measurement (SEM) of the acceleration modulus was between 0.001591 and 0.007248 (g), and the SEM% was between 21.24% and 34.12%. The angular velocity modulus SEM values ranged from 1.296 to 3.441 (deg/s), and the SEM% ranged from 25.17% to 33.26%. The difference between the two tests was evenly distributed on both sides of the mean value, and the difference between the test results was within the consistency limit. SignificanceInertial sensors can be used to evaluate the static balance ability of preschoolers aged 4–5 years. Further, the angular velocity modulus is more reliable than the acceleration modulus.

Static Balance in Participants with Temporomandibular Joint Disc Displacement without Reduction Versus Healthy Participants: A Cross-Sectional Study.

BackgroundThere is no consensus on the association between body posture and temporomandibular disorders (TMDs). This study aimed to assess differences in static balance between healthy participants and patients with temporomandibular joint disc displacement without reduction.Material/MethodsSixteen patients with temporomandibular joint disc displacement without reduction and 14 healthy participants were included. Static balance tests were performed in the rest and “cotton rolls” (participants biting 2 cotton rolls with their upper and lower teeth) mandibular positions. The mean body’s center of gravity (COG) sway velocity was tested in each mandibular position on a firm surface with and without eyes open and on a foam surface with and without eyes open.ResultsThe COG sway velocity did not differ between the TMD and healthy groups regarding mandibular position or testing condition (P>0.05). However, in the control group, the COG sway velocity in the mandibular rest position was significantly higher than that in the “cotton rolls” mandibular position when standing on a foam surface with the eyes closed (P=0.024). In the TMD group, there was no difference in the COG sway velocity between the 2 mandible positions under any condition (P>0.05).ConclusionsThis study provides new evidence for static balance alterations in patients with temporomandibular joint disc displacement without reduction. Further studies are needed to investigate postural control changes in patients with arthrogenous TMDs. This study was registered in the Chinese Clinical Trial Registry (no. ChiCTR1800018369).

Force Control on Fingertip Using EMS to Maintain Light Touch.

Light touch on a rigid surface with minimal force below a specific threshold reduces postural sway by providing additional sensory cues from the fingertips. The feasibility of maintaining light touch depends on subject characteristics and task difficulty. Therefore, we introduce a method of maintaining light touch by using electrical muscle stimulation (EMS). We applied it in a single-leg standing task involving healthy adult subjects. The subjects stood upright in a single-leg stance on a firm surface and on foam rubber (FR), respectively, under three conditions: no touch (NT, NT-FR), light touch without EMS (LT, LT-FR), and light touch in which EMS was applied based on the contact force (LT-EMS, LT-EMS-FR). The results showed that the force control by EMS helped maintain light touch and reduce postural sway compared with the no-touch condition. The amplitude of postural sway under the touch condition with EMS was equivalent to that under the touch condition without EMS.

Massive Perivillous Fibrin Deposition-A Cause of Recurrent Fetal Demise: A Case Report

Abstract Introduction/Objective Massive perivillous fibrin deposition (MPFD) and maternal floor infarction (MFI) are rare placental lesions reported in less than 1% of all pregnancies and have a significant risk of recurrence ranging from 12% to 78%. MPFD/MFI is associated with high rates of adverse perinatal outcomes including preterm delivery, severe intrauterine growth restriction, spontaneous abortion, cystic renal cell dysplasia, fetal metabolic disease with reported mutations in the LCHAD (long-chain 3-hydroxy acyl-CoA-dehydrogenase) gene, neonatal death and long- term neurological impairment. Methods/Case Report We report a case of MFPD in a 28-year-old female gravida 3 para 1 with one uncomplicated pregnancy and one therapeutic abortion. The current pregnancy was complicated by abruption resulting in intrauterine fetal demise at 32 weeks of gestation. The placenta was examined. Grossly, the placenta weighed 260 grams (small placenta for the dates) with an eccentrically inserted three vessel umbilical cord and a diffuse, firm pale grey cut surface with focal cystic areas. The histological examination revealed MPFD characterized by extensive transmural perivillous fibrinoid material with encasement of almost entire chorionic villi (transmural type). The villi were viable but fibrotic with focal syncytiotrophoblastic necrosis and focal mild chronic inflammation. The etiology of MPFD is not well understood, but risk factors that have been reported include maternal thrombophilia, coagulopathies, and autoimmune diseases. Given the clinical associations, MFI/MPFD should be reported promptly to the obstetrician and pediatrician. As per the current literature, a combination of thrombolytic therapy (aspirin and heparin), intravenous immunoglobulin and a statin (pravastatin) helps to correct angiogenic/antiangiogenic imbalance which has been thought to be associated with recurrent MFI/MPFD. Results (if a Case Study enter NA) N/A Conclusion In summary, we present this rare recurring entity of MPFD to emphasize the awareness of this condition and the importance of placental examination in all abortions and fetal abnormalities/demise.

Effects of chronic exposure to head impacts on the balance function of combat sports athletes

We investigated static and dynamic balance in combat sport athletes chronically exposed to head impacts. MMA, boxing, kickboxing, and Muay Thai athletes exposed (AE: n = 19; 14 men, 5 women; 30.2 ± 4.5 years; 1.76 ± 0.1 m; 75 ± 9.2 kg) to head impacts were compared to athletes non-exposed (AnE: n = 25; 18 men, 7 women; 25.1 ± 3.2 years; 1.78 ± 0.1 m; 77.4 ± 10.3 kg), and control individuals (CON: n = 23, 13 men, 10 women; 25.5 ± 5.8 years; 1.75 ± 0.1m; 70.4 ± 12 kg). Static balance was assessed using the Balance Error Scoring System, and dynamic function by center of pressure shift and reactive object tracking. A low-cost balance board was used for both protocols. AE performed worse than CON (0.01 ± 0.006 vs 0.006 ± 0.003; P = .02, d = 0.75) in the ellipse area of sway for double-leg stance in firm condition (F2,62 = 3.94, P = .02, η2 = 0.11). Static center of pressure and dynamic balance did not differ among groups. The integration of a balance board and a widely used clinical protocol unveiled differences in the ellipse area of static postural sway in the double-leg stance over a firm surface in athletes chronically exposed to head impacts. The combined use of practical, objective, and clinically relevant test protocols is encouraged to detect lasting deficits in static and dynamic balance as a result of chronic exposure to repetitive head impacts.

Normative database of postural sway measures using inertial sensors in typically developing children and young adults.

Reference values utilizing the APDM MobilityLab® inertial sensor system have not been established in children and young adults ages 5-30. These values are necessary for clinicians and researchers to compare to children with balance impairments. A group of 144 typically developing children and young adults from age 5-30 years completed the instrumented SWAY test during 6 test conditions: normal stance, firm surface, eyes open (EO) and closed (EC); normal stance, foam surface, EO and EC; and tandem stance, firm surface, EO and EC. Selected variables for normative outcomes included total sway area, and the mean, sagittal and coronal values for RMS sway, jerk, sway velocity and path length. Sex differences were examined within age groups via t tests. The effect of age on postural sway variables was analyzed using a one-way ANOVA for the mean values of total sway area, RMS sway, velocity and jerk, followed by post-hoc pairwise comparisons. All sway parameters decreased significantly with age (p < 0.0001). Adult-like total sway area and jerk were achieved by ages 9-10 except for jerk during EC on foam. RMS sway and sway velocity reached adult levels by ages 11-13 during all EO and tandem stance conditions, and 14-21 with EC during normal stance on firm and foam surfaces for RMS sway and EC on firm surfaces for velocity. Females ages 5-6 performed more poorly during EO firm and EC foam for certain variables, but better during EO tandem and females ages 7-13 outperformed males when sex differences were found. These reference values can now be used by clinicians and researchers to evaluate abnormal postural sway and response to interventions in children and young adults.

Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study

Ankle osteoarthritis (OA) is associated with several physical impairments but investigations into balance impairments in this population are limited. Understanding balance impairments in ankle OA may help inform the management of this condition. Does balance overall performance differ between individuals with symptomatic radiographic ankle OA, asymptomatic radiographic ankle OA and healthy controls? Are there any differences in mediolateral or anteroposterior balance, or confidence to perform balance tasks between these groups? Ninety-six volunteers (31 symptomatic radiographic ankle OA, 41 asymptomatic radiographic ankle OA and 24 healthy controls) completed six static balance tasks: bilateral stance on a firm surface, bilateral stance on foam, and tandem stance, all performed with eyes open and closed. Centre of pressure (COP) data were collected using force plates. Confidence to perform each balance task was collected using an 11-point numerical rating scale. Compared to controls, participants with symptomatic radiographic ankle OA had greater COP area when standing on a firm surface, foam and in tandem with eyes closed (all p < 0.05) and greater total COP sway in both firm surface and tandem stance conditions (p < 0.04). Participants with symptomatic ankle OA had greater COP area (p < 0.04) and total COP sway (p = 0.01) than those with asymptomatic ankle OA during tandem stance. Total COP sway and area were similar between asymptomatic ankle OA and control participants. Some differences in mediolateral and anteroposterior balance were identified between groups. Individuals with symptomatic ankle OA had lower confidence to perform the tandem stance eyes closed task compared to controls. Balance impairments and decreased balance confidence were identified in those with symptomatic radiographic ankle OA compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that balance deficits in ankle OA may be related to symptoms, rather than radiographic evidence of disease.

Age is associated with postural control performance following youth concussion.

To examine the effect of age on postural control outcomes among patients being seen during their initial post-concussion clinical visit. Youth patients were seen≤14 days post-concussion, and completed a series of postural control evaluations: tandem gait, Romberg, and Balance Error Scoring System (BESS) tests. We included 109 children 8-12 years of age (24% female, evaluated median = 7 [interquartile range = 4-10] days post-injury) and 353 adolescents aged 13-18 years (36% female, evaluated median = 7 [4-10] days post-injury). There was a higher proportion of children who demonstrated abnormal tandem gait relative to adolescents (26% vs. 11%; p < 0.001). They also made more BESS errors in single (median = 5 [2-10] vs. 4 [2-6] errors) and tandem (median = 3 [1-6] vs. 2 [0-4]) firm stances. After covariate adjustment, children demonstrated worse tandem gait (adjusted odds ratio = 3.05, 95% CI = 1.68-5.53) and more firm surface BESS errors (double stance β=0.51, 95% CI = 0.22-0.80; single stance β= 1.18, 95% CI = 0.42-1.95; tandem stance β= 0.98, 95% CI = 0.28-1.68) than adolescents. Tandem gait and BESS performance following concussion differ in children compared to adolescents who present within 2 weeks of injury. Clinicians assessing and managing concussion should recognize age differences in postural control performance when assessing those with concussion.

Using virtual reality to assess vestibulo-visual interaction in people with Parkinson’s disease compared to healthy controls

People with Parkinson's disease (PD) have increased visual dependency for balance and suspected vestibular dysfunction. Immersive virtual reality (VR) allows graded manipulation of visual sensory inputs during balance tasks, and hence VR coupled with portable force platforms have emerged as feasible, affordable, and validated tools for assessing sensory-motor integration of balance. This study aims to determine (i) how people with PD perform on a VR-based visual perturbation standing balance task compared to healthy controls (HC), and (ii) whether balance performance is influenced by vestibular function, when other known factors are controlled for. This prospective observational study compared the balance performance under varying sensory conditions in 40 people with mild to moderate PD with 40 age-matched HC. Vestibular function was assessed via Head Impulse Test (HIMP), cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) and subjective visual vertical (SVV). Regression analyses were used to determine associations between VR balance performance on firm and foam surfaces with age, group, vestibular function, and lower limb proprioception. PD failed at significantly lower levels of visual perturbation than HC on both surfaces. In PD, greater disease severity was significantly associated with lower fall thresholds on both surfaces. Multiple PD participants failed prior to visual perturbation on foam. On firm, PD had a greater visual dependency. Increasing age, impaired proprioception, impaired SVV, abnormal HIMP and cVEMP scores were associated with worse balance performance. The multivariate model containing these factors explained 29% of the variability in balance performance on both surfaces. Quantitative VR-based balance assessment is safe and feasible in PD. Balance performance on both surfaces was associated with age, HIMP abnormality and proprioception.

Iron deficiency anemia induces postural control disorders in young women

BackgroundDue to menstruation and restrictive dietary practices, women are at a particular risk of iron deficiency anemia (IDA). This hematologic manifestation could impair postural control as it induces fatigue, muscle weakness, cognitive and neurological functions alteration. AimThis study aimed to investigate IDA effects on postural control in young women in comparison to healthy counterparts. Material and methodsTwenty-four young women with IDA and twenty-four controls participated in this study. Center of pressure (CoP) excursions, in the bipedal and semi-tandem postures on the firm and foam surfaces in the eyes opened (EO) and closed (EC), were recorded, and Romberg index was calculated to evaluate postural control. Besides physical performance, attentional capacity, fatigue, and heart and respiratory rates were assessed. ResultsYoung women with IDA had significantly higher CoP velocity (CoPv) values in the bipedal posture in both vision and surface conditions (EO [firm: P < 0.001 and foam: P < 0.01]; EC: P < 0.001), as well as in the semi-tandem posture (EO [firm: P < 0.01 and foam: P < 0.001]; EC: P < 0.001) compared to controls indicating that they had worse postural control than their peers. In addition, values of the respiratory rate (P < 0.001), attentional capacity (P < 0.001), physical performance (P < 0.001), fatigue (P < 0.001), and Romberg index on the foam surface in both postures (P < 0.05) were significantly higher in young women with IDA compared to controls. ConclusionsPhysical performance, fatigue, tachypnea and attentional capacity resulting from IDA may explain postural control disorder in young women.