Improvements In Postural Control Research Articles

Influence of gymnastics training on the development of postural control

This study investigated the influence of gymnastics training on the postural control of children with and without the use of visual information. Two age groups, aged 5–7 and 9–11 years old, of gymnasts and nongymnasts were asked to maintain an upright and quiet stance on a force platform with eyes open (EO) and eyes closed (EC) for 30 s. Area of the stabilogram (AOS) and mean velocity of the center of pressure (COP) in anterior–posterior (AP) and medial–lateral (ML) directions were calculated and used to investigate the effects of gymnastics training, age, and visual information. Younger gymnasts presented greater postural control compared to younger nongymnasts while visual information did not improve postural control in younger nongymnasts. Younger gymnasts displayed improved postural control with EO compared to EC. The mean velocity of the COP in the ML direction was: less for younger gymnasts than younger nongymnasts with EO. These results suggest that gymnastics training promotes improvements in postural control of younger children only, which results from their use of visual information when available.

Effects of soft and semi-rigid ankle orthoses on postural sway in people with and without functional ankle instability

Some studies have demonstrated improvement of postural control following use of ankle supports, whereas others reported no effect or even negative effects of bracing. The present study aimed to investigate the immediate effects of soft and semi-rigid orthosis on postural sway in patients with functional ankle instability (FAI). Twenty patients with unilateral FAI and twenty matched healthy individuals participated in the study. Balance in single limb stance on force platform with eyes-open was assessed for both legs while wearing no orthosis (control condition), soft or semi-rigid orthosis. The center of pressure (COP) measures derived from force platform signals were mean total velocity, standard deviation (SD) of velocity and phase plane portrait. A 2 × 2 × 3 (group by foot by orthotics) mixed model analysis of variance was used for statistical analysis. In the FAI group, there was a tendency to lower COP parameters while wearing either of the orthoses, with soft brace having a greater effect. For 2 dependent variables, significant effect of brace was found only for the injured limb. In the healthy group, postural sway increased from no-brace condition, to soft, to semi-rigid orthosis. Both injured and non-injured limbs of patients with FAI had greater postural sway compared to control limbs of healthy individuals.

Visual input is critical for postural control in patients with chronic right hemisphere infarcts

Stroke remains a leading cause of long-term disability and is the second most common cause of death worldwide.1 Many persons face restrictions in the performance of day to day tasks after stroke. The return of postural control is an early and central element for both motor and functional recovery and is a prerequisite for recovery of sitting, standing, transferring, turning, and reaching. Poor postural control predicts higher levels of dependence, handicap, and falls.2 A high quality of life is thus strongly dependent on improvement of postural control. Patients with stroke, as compared to healthy age-matched individuals, compensate for motor and sensory impairments with greater dependence on visual information for postural control in both planes, the medial-lateral (ML) and anterior-posterior (AP).3 This increased visual dependence may be a nonspecific strategy to compensate for the loss or distortion of other sensory inputs. Subjects shift their spatial reference frame …

Improvements in postural control through a dynamic balance training protocol in older overweight women

Background and Aims: Many studies have reported a greater frequency of falls among older women than men under conditions which stress balance. Previously, we have found an improvement in static balance in older women with an increased support surface area and an equal load redistribution on both feet in response to a dynamic balance training protocol. The aim of the present study was to examine whether the same training program and body composition would have effects on the postural control of older overweight women. Methods: Ten healthy women (68.67 ± 5.50 years; 28.17 ± 3.35 BMI) participated in a five-week physical activity program. This included dynamic balance exercises such as heel-to-toe walking in different directions, putting their hands on their hips, eyes open (EO) or closed (EC), with a tablet on the head, going up and down a step and walking on a mat. Postural stability was assessed before and after the training protocol with an optoelectronic platform and a uni-pedal balance performance test. Body composition of the trunk, upper limbs and lower limbs was measured by a bio-impedence analysis. Results: The mean speed (MS), medial-lateral MS (MS-x), anterior-posterior MS (MS-y), sway path (SP) and ellipse surface area (ESA) of the pressure centre was reduced in the older women after the training protocol. However, only MS; MS-x, MS-y and SP significantly decreased under bipodalic conditions with EO and MS-y also with EC (p Language: en

Diabetic Polyneuropathy May Increase the Handicap Related to Vestibular Disease

We undertook this study to assess the influence of diabetic peripheral neuropathy on self-reported disability and postural control during quiet stance of patients with peripheral vestibular disease, before and after a standardized program of vestibular rehabilitation (Cawthorne & Cooksey exercises). Twenty patients with peripheral vestibular disease participated in the study (mean age 56+/-7.8 years), 10 with and 10 without peripheral neuropathy (age matched). The Dizziness Handicap Inventory and static posturography (eyes open/closed and firm/soft surface) were evaluated prior to rehabilitation and at week 7 of follow-up. Compared to patients without neuropathy, patients with neuropathy had more time elapsed since the diabetes was diagnosed, higher glycemia and HbAc level and higher composite scores on the Dizziness Handicap Inventory, but similar results on static posturography. After rehabilitation, although scores on the Dizziness Handicap Inventory decreased in the two groups, the difference between them persisted. In patients with neuropathy, static posturography showed improvement of postural control only with the eyes closed and soft surface, whereas in patients without neuropathy the postural control improved during all sensory conditions (eyes open/closed and firm/soft surface). In diabetic patients with peripheral vestibular disease, peripheral neuropathy contributes to self-reported disability and may interfere with complete balance recovery.

Analysis of postural sway in patients with normal pressure hydrocephalus: effects of shunt implantation

Poor postural balance is one of the major risk factors for falling in normal pressure hydrocephalus (NPH). Postural instability in the clinic is commonly assessed based upon force platform posturography. In this study we focused on the identification of changes in sway characteristics while standing quiet in patients with NPH before and after shunt implantation. Postural sway area and sway radius were analyzed in a group of 9 patients and 46 controls of both genders. Subject's spontaneous sway was recorded while standing quiet on a force platform for 30-60 s, with eyes open and then closed. Both analyzed sway descriptors identified between-group differences and also an effect of shunt implantation in the NPH group. Sway radius and sway area in patients exhibited very high values compared with those in the control group. Importantly, the effect of eyesight in patients was not observed before shunt implantation and reappeared after the surgical treatment. The study documents that static force platform posturography may be a reliable measure of postural control improvement due to shunt surgery.

Rehabilitation program for traumatic chronic cervical pain associated with unsteadiness: a single case study.

BackgroundNeck problems are often recurring or chronic. After pain, unsteadiness and balance problems are among the most frequent symptoms reported by chronic neck pain (CNP) patients. Altered sensorimotor control of the cervical spine and sensorimotor integration problems affecting postural control have been observed in CNP patients. Very few data are available regarding the post-intervention effects of rehabilitation programs on postural control in CNP.Case presentationThis is a case study of a traumatic CNP patient (a 45-year old female) with postural unsteadiness who participated in an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy. Pre-intervention data revealed that the postural control system was challenged when postural control sensory inputs were altered, particularly during the head-extended-backward condition. Post-intervention centre of pressure measurements indicated a drastic reduction in postural sway during trials with changes in neck orientation.ConclusionThis case report indicates that an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy may have had an effect on improvement of postural control in a trauma CNP patient with unsteadiness. These results warrant further studies to investigate the relationships between pain amelioration, sensorimotor control of the cervical spine, muscle fitness and postural steadiness.

Vestibular rehabilitation by auditory feedback in otolith disorders

Rehabilitation strategies have been applied successfully over the last few decades to initiate central compensation of the tonus imbalance and to facilitate substitution in different types of peripheral vestibular dysfunction. However, these vestibular rehabilitation strategies are often not successful in patients with isolated otolith disorders. The aim of the present study was therefore to evaluate a specific rehabilitation strategy for patients with an isolated otolith disorder by using an auditory feedback system. Thirteen patients, which suffered from different types of otolith disorders, but no other vestibular pathology and 13 normal controls were included in this study. Vestibular rehabilitation exercises were performed daily over a 2-week period (weekends excluded). During all exercises the patients of the test group ( n = 13) obtained an acoustic feedback signal when their trunk angle velocity exceeded a preset level while the patients of the control group ( n = 13) performed the same exercises without auditory feedback. The most effective exercise in the test group was “walking eight tandem steps on a foam support surface”. Approximately 85% of the patients showed a significant decrease of trunk sway in this condition. In contrast to these results, patients of the control group showed no significant improvement of postural control after the training. The results indicate that an auditory feedback rehabilitation program with exercises related to the specific neurotological disease could significantly improve the postural control in patients with otolith disorders.

Proprioceptive and Sensorimotor Performance in Parkinson's Disease

We explored the effects of random whole-body vibration on leg proprioception in Parkinson's disease (PD). In earlier studies it was found that this treatment leads to improved postural control in these patients. Thus, one could speculate that these effects result from modified proprioceptive capabilities. Twenty-eight PD patients were subdivided in one experimental and one control group. Proprioceptive performance was analyzed using a tracking task basing on knee extension and flexion movements. Treatment consisted of 5 series of random whole-body vibration taking 60 seconds each. Control subjects had a rest period instead. Prominent over- and undershooting errors were found in both groups representing proprioceptive impairments. No significant differences became evident, however, either between pre- and post-tests or between experimental and control group. One might therefore conclude that spontaneous improvements in postural control are not directly connected with proprioceptive changes. Nevertheless, one also should keep in mind the general aspects and difficulties of analyzing proprioception.

Improvement of postural control in patients with peripheral vestibulopathy

We present here the results of a short-term prospective study on a group of 37 patients with persistent unsteadiness. The treatment of these patients was customized according to the results of the Sensory Organization Test carried out using computerized dynamic posturography. A 5-week period of instrumental rehabilitation was established involving visual biofeedback-based computerized balance intervention that manipulated the individuals' capacities, the goals of the tasks and the environmental context. Exercises were performed twice weekly. This adaptation of the treatment was based on the hypothesis that it would reduce the level of disability and handicap associated with the unsteadiness suffered by these patients. Of the patients, 73% improved their status according to the DHI results. Furthermore, in the group of patients that showed an improvement in the DHI, their SOT composite score increased significantly, their reaction time reduced and their sway velocity, endpoint excursion, maximum excursion and directional control all increased. However, for those patients who did not experience a significant improvement or who recorded an increase in the total DHI score, the modifications in the SOT and LOS tests were not significant.

Effect of bilateral subthalamic nucleus stimulation on balance and finger control in Parkinson's disease

We aimed to quantify the effects of bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease (PD) on stance and gait ("axial"motor control), and related this to effects on finger movements ("appendicular" motor control). Fourteen PD patients and 20 matched controls participated. Subjects completed several balance and gait tasks (standing with eyes open or closed, on a normal or foam surface; retropulsion test; walking with eyes closed; walking up and down stairs; Get Up and Go test). Postural control was quantified using trunk sway measurements (angle and angular velocity) in the roll and pitch directions. Subjects further performed a pinch grip reaction time task, where we measured isometric grip forces, as well as movement and reaction times. Patients were examined with STN stimulators switched on or off (order randomised across patients), always after a supramaximal levodopa dosage. STN stimulation improved postural control, as reflected by a reduced trunk sway tremor during stance, a reduced duration for all gait tasks, an increased trunk pitch velocity while rising from a chair, and improved roll stability. STN stimulation also improved finger control, as reflected by a reduced time to reach maximum grip force, without altering reaction times and maximum force levels. Improvements in finger control timing did not correlate with reduced task durations during gait. We conclude that STN stimulation affords improvement of postural control in PD, over and above optimal drug treatment. STN stimulation also provides a simultaneous effect on distal and axial motor control. Because improvements in distal and axial motor control were not correlated, we assume that these effects are mediated by stimulation of different structures within the STN.

An exploration of German and British physiotherapists' views on the effects of hippotherapy and their measurement

Hippotherapy (Greek hippos = horse) is a specialised physiotherapy treatment that makes use of the horses' unique three-dimensional movement impulses at a walk to facilitate movement responses in patients sitting on the horse's back (Strauß, ). Despite a substantial body of anecdotal and clinical evidence for its benefits, research evidence for hippotherapy is sparse. This questionnaire survey was the first study in a series of investigations exploring the views of physiotherapists and people with cerebral palsy who use hippotherapy. These investigations, in turn, form the basis from which the authors will recommend outcome measures for individuals with cerebral palsy in a hippotherapy environment. This study aimed to: (a) establish the pattern of hippotherapy practice in Germany and the U.K.; (b) examine the perceived main effects of hippotherapy on people with cerebral palsy in Germany and the U.K.; and (c) investigate how these effects are being measured in both countries. The results highlighted considerable differences in how hippotherapy is practised in the U.K. compared with in Germany. In spite of this, the study revealed agreement among respondents on the overall perceived effects of hippotherapy on individuals with cerebral palsy, namely, the regulation of muscle tone, improvement of postural control and psychological benefits. The results also indicate scant use of outcome measures to evaluate these effects. The impact of these findings is discussed in the light of published research, and suggestions for further research are made.

The influence of Tai Chi training on the center of pressure trajectory during gait initiation in older adults

Hass CJ, Gregor RJ, Waddell DE, Oliver A, Smith DW, Fleming RP, Wolf SL. The influence of Tai Chi training on the center of pressure trajectory during gait initiation in older adults. Arch Phys Med Rehabil 2004;85:1593–8. Objective To determine if a program of intense Tai Chi exercise that has been shown to reduce the risk of falling in older adults improves postural control by altering the center of pressure (COP) trajectory during gait initiation. Design Before-after trial. Setting Biomechanics research laboratory. Participants Twenty-eight older adults transitioning to frailty who participated in either a 48-week intervention of intense Tai Chi training or a wellness education (WE) program. Interventions Eight Tai Chi forms emphasizing trunk rotation, weight shifting, coordination, and narrowing of lower-extremity stance were taught twice weekly. WE program participants met once a week and received lectures focused on health. Main outcome measures The COP was recorded during gait initiation both before and after the 48-week intervention by using a forceplate sampling at 300Hz. The COP trajectory was divided into 3 periods (S1, S2, S3) by identifying 2 landmark events. Displacement and average velocity of the COP trace in the anteroposterior ( x) and mediolateral ( y) directions, as well as smoothness, were calculated. Results Tai Chi training increased the posterior displacement of the COP during S1 and improved the smoothness of the COP during S2. Conclusions Tai Chi improved the mechanism by which forward momentum is generated and improved coordination during gait initiation, suggesting improvements in postural control.

1208 Advanced, computerised cold cap for preventing chemotherapy induced alopecia

The purpose of this study was to determine how reduced plantar cutaneous sensation influences static postural control in individuals with and without CAI.A case-control study design.Twenty-six individuals with self-reported CAI and 26 matched healthy controls participated in this study. The plantar aspect of the participants’ foot was then submersed in ice water (0 °C) for 10 min to reduce plantar sensation. Before and after the cooling procedure, plantar cutaneous sensation thresholds and single leg balance with eyes open and closed were assessed.Significantly, higher scores were observed in both groups after ice water submersion (p < 0.001) indicating a significant reduction in the plantar cutaneous sensitivity after the cooling procedure. In single limb balance with eyes open, there were significant intervention main effects for the TTB ML mean (p < 0.001), TTB AP mean (p = 0.035) and TTB ML SD (p = 0.021); indicating postural control improvement in both groups post-cooling. In single limb balance with eyes closed, Group × Intervention interactions were observed for the TTB AP mean (p = 0.003) and TTB AP SD (p = 0.017); indicating postural control deficits in CAI group post-cooling, but no changes in the control group.The main finding of this study was that reduced plantar cutaneous sensation induced by an ice submersion procedure caused eyes closed postural control impairments in those with CAI but not healthy controls. The present investigation demonstrated that the ability to dynamically reweight among sensory inputs to maintain postural stability appears to be diminished in CAI patients compared to healthy controls.

Improvements in Trunk Sway Observed for Stance and Gait Tasks during Recovery from an Acute Unilateral Peripheral Vestibular Deficit

Objectives: Our aim was to track improvements in postural control during recovery from an acute unilateral peripheral vestibular deficit (UVL), presumably due to vestibular neuritis, and to determine if recovery rates were different for stance and gait tasks. Postural control was quantified using simple measurements of trunk sway: amplitudes of trunk sway angle and angular velocity, in the roll and pitch directions as well as task duration, were examined for a battery of stance and gait tasks. These measures were collected at the onset of the deficit and then 3 weeks and 3 months later. Study Design: A repeated-measures design was used for UVL subjects and age-matched healthy controls. Stance tasks involved standing on 1 or 2 legs with eyes open or closed. Gait tasks consisted of tandem gait, walking normally with eyes closed, or with the head rotating or head pitching, walking up and down stairs and walking over a series of low barriers. Stance and tandem gait tasks were repeated using a foam support surface instead of a normal floor. Patients: Twenty-eight patients with acute UVL were examined. Main Outcome Measures: The range of trunk sway angular displacement and angular velocity in the pitch and roll directions was measured for each task in addition to task duration. The measures were compared with those of normal subjects. Results: The amplitudes of pitch trunk sway for 2-legged stance tasks with eyes closed underwent the greatest reduction 3 weeks after UVL onset. At 3 months, trunk sway was almost normal for all 2-legged stance tasks. One-legged stance tasks with eyes open showed a similar but slower improvement. Stance time without a fall showed a very rapid improvement for 1-legged tasks but was still shorter than that of normal subjects at 3 months. Trunk sway for the simple gait tasks was within normal range at 3 months; however, task duration was still longer than normal. More complex gait tasks, such as walking 8 tandem steps on foam or walking up and down stairs, showed no improvement in trunk roll sway at 3 months. A mix of variables from mainly gait tasks best identified a balance deficit due to UVL, with complex gait tasks becoming more important for identification purposes as compensation progressed. The accuracy of UVL identification with durations alone was 75% of the accuracy with combined trunk sway and duration measures. Conclusions: These data suggest that recovery of normal trunk control during the compensation process for unilateral vestibular hypofunction is more rapid for stance tasks than gait tasks. Even at 3 months, trunk sway for complex gait tasks was not normal. Thus, trunk sway for gait tasks provides a better insight into remaining deficits in balance control of vestibular-loss patients than the sway of stance tasks.

Postural Control and Glycerol Test in Me´nie`re's Disease

Ménière's disease is a clinical disorder, characterized by fluctuating hearing loss, recurrent spontaneous episodic vertigo, tinnitus and aural fullness, which may be defined as the idiopathic syndrome of endolymphatic hydrops. The most important test for diagnosis of Ménière's disease is the glycerol test. This is a simple and rapid method and several authors have confirmed its efficiency for identifying endolymphatic hydrops. This test provides information on the cochlear response to the osmotic changes produced by glycerol in the inner ear, whereas modifications in the vestibular labyrinth are usually not evaluated. The aim of this study was to evaluate the effects of glycerol on postural control during attacks of Ménière's disease, and to correlate this data with data on cochlear function. After the glycerol test, an improvement in postural control was recorded in 70% of patients, with all patients reporting a recovery of vertigo. The impairment of postural control during endolymphatic hydrops could be related to a pressure increase in the labyrinth, which interferes with the normal dynamics of the endolymph, and a rapid functional recovery could occur during an osmotic depletion. Dynamic posturography improves the sensitivity of the glycerol test and may therefore be useful in the diagnosis and staging of Me´nie ¤ re's disease.

Dental occlusion modifies gaze and posture stabilization in human subjects

Repercussion of dental occlusion was tested upon postural and gaze stabilization, the latter with a visuo-motor task evaluated by shooting performances. Eighteen permit holders shooters and 18 controls were enrolled in this study. Postural control was evaluated in both groups according to four mandibular positions imposed by interocclusal splints: (i) intercuspal occlusion (IO), (ii) centric relation (CR), (iii) physiological side lateral occlusion and (iv) controlateral occlusion, in order to appreciate the impact of the splints upon orthostatism. Postural control and gaze stabilization quality decreased, from the best to the worst, with splints in CR, IO and lateral occlusion. In shooters, the improvement in postural control was parallel to superior shooting performance. A repercussion of dental occlusion upon proprioception and visual stabilization is suggested by these data.

Development of manipulation in capuchin monkeys during the first 6 months.

This study describes the orderly changes in manipulation over the first 6 months in capuchin monkeys (Cebus apella). By 6 months of age, all the basic forms of manipulation seen in adults have appeared. Actions that occur frequently in the first 8 weeks are gentle and involve sustained visual orientation and aimed reaching. Later actions are more vigorous, and involve grasping. Large increases in the rate of activity are evident over the period of development studied. The increase from the first 8 weeks to the second may be due to (a) an increase in the amount of time spent alert and active, (b) a decrease in the amount of time spent in a ventral position, (c) improvements in postural control and stamina and (d) the onset of independent locomotion. Changes in form can be attributed primarily to postural factors and to neuromuscular development (precisely aimed and controlled movements appearing in the 5th and 6th months).

Physical Therapy Management of Peripheral Vestibular Dysfunction: Two Clinical Case Reports

We describe the treatment of two patients with peripheral vestibular dysfunction using a novel, staged exercise program. Response to treatment was documented. The first patient, a 62-year-old woman with unilateral vestibular dysfunction (UVD) and a 6-month history of disequilibrium following herpes zoster oticus resulting in damage to the right inner ear, was treated with an 8-week course of vestibular physical therapy. During the 8 weeks, the patient attended weekly physical therapy sessions and was trained to perform vestibular adaptation exercises on a daily basis at home. The second patient, a 53-year-old woman with progressive disequilibrium secondary to profound bilateral vestibular hypofunction (BVH), was treated with a 16-week course of vestibular physical therapy. During the first 8 weeks, the patient attended weekly physical therapy sessions and was trained to perform vestibular adaptation and substitution exercises on a daily basis at home. During the second 8 weeks, the patient continued performing vestibular physical therapy exercises at home independently. Vestibular function (sinusoidal vertical axis rotation testing), postural control (clinical tests and posturography), stability during the performance of selected activities of daily living (ADLs), and self-perception of symptoms and handicap were measured prior to and at the conclusion of treatment for both patients and at the midpoint of treatment for the patient with BVH. After 8 weeks of treatment, both patients reported improvements in self-perception of symptoms and handicap and demonstrated objective improvements in clinical balance tests, posturography, and several kinematic indicators of stability during the performance of selected ADLs. Further improvements were noted in the patient with BVH after 16 weeks of treatment. Improvements in postural control were noted after 8 weeks of treatment for the patient with UVD and after 16 weeks for the patient with BVH. Vestibular function improved during the course of treatment for the patient with UVD only. These case reports describe two different individualized treatment programs and document self-reported and laboratory-measured functional improvements in two patients with vestibular deficients--one with unilateral damage and one with bilateral damage.

Efficacy of Physical Therapy in Improving Postural Control in Cerebral Palsy

The purpose of this paper was to review the research on the efficacy of physical therapy in preventing the manifestations of CNS dysfunction, improving postural tone, inhibiting primitive reflexes, and improving postural alignment and control in children with cerebral palsy. No conclusive evidence was found to support the efficacy of physical therapy in preventing CNS dysfunction or reducing the effects of primitive reflexes. A small amount of evidence suggests the possible effectiveness of biofeedback, NDT-based therapeutic horseback riding, and inhibitive casting in reducing hypertonicity and promoting functional improvement. Improvements in postural control, alignment, and stability have been reported in many research studies and most likely are true outcomes of several types of physical therapy in children with cerebral palsy. More definitive research is needed to support the hypotheses generated by this review of the research literature.