Poor Postural Control Research Articles

Patients With Becker Muscular Dystrophy Have Severe Paraspinal Muscle Involvement.

Introduction: Paraspinal muscles are important for gross motor functions. Impairment of these muscles can lead to poor postural control and ambulation difficulty. Little knowledge exists about the involvement of paraspinal muscles in Becker muscular dystrophy.Objective: In this cross-sectional study, we investigated the involvement of paraspinal muscles with quantitative trunk strength measure and quantitative muscle MRI.Methods and Materials: Eighteen patients with Becker muscular dystrophy underwent trunk, hip, and thigh strength assessment using a Biodex dynamometer and an MRI Dixon scan. Fourteen age- and body mass index-matched healthy men were included for comparison.Results: Muscle fat fraction (FF) of the paraspinal muscles (multifidus and erector spinae) was higher in participants with Becker muscular dystrophy vs. healthy controls at all three examined spinal levels (C6, Th12, and L4/L5) (p < 0.05). There was a strong and inverse correlation between paraspinal muscle FF and trunk extension strength (ρ = −0.829, p < 0.001), gluteus maximus FF and hip extension strength (ρ = −0.701, p = 0.005), FF of the knee extensor muscles (quadriceps and sartorius) and knee extension strength (ρ = −0.842, p < 0.001), and FF of the knee flexor muscles (hamstring muscles) and knee flexion strength (ρ = −0.864, p < 0.001). Fat fraction of the paraspinal muscles also correlated with muscle FF of the thigh muscles and lower leg muscles.Conclusion: In conclusion, patients with Becker muscular dystrophy demonstrate severe paraspinal muscular involvement indicated by low back extension strength and high levels of fat replacement, which parallel involvement of lower limb muscles. Assessment of paraspinal muscle strength and fat replacement may serve as a possible biomarker for both the clinical management and further study of the disease.

Low-Back Pain and Knee Position-Related Differences on Postural Control Measures During a One-Legged Stance in Athletes.

Chronic low-back pain (CLBP) may be associated with changes in postural balance in athletes as poor postural control during sports practice. To compare the postural control of athletes with and without CLBP during 2 one-legged stance tasks and identify the center of pressure (COP) cutoff values to determine the main differences. Designed: A cross-sectional study. Laboratory of functional evaluation and human motor performance. A total of 56 male athletes, 28 with and 28 without CLBP (mean age = 26y). The one-legged stance with knee extension and with the knee at 30° flexion tasks were measured and analyzed on a force platform. The participants completed three 30-second trials (30s of rest between each trial). The COP parameters: the area of COP, mean COP sway velocity in both the anteroposterior and mediolateral directions, and total COP displacement were computed, and a receiver operating characteristics curve analysis was applied to determine the group differences. Athletes with CLBP had poorer postural control (P < .01) in both tasks. The 30° knee flexion reported more postural instability than the knee extension for all COP parameters (a large effect size d = 0.80).The knee extension cutoffs identified were >7.1 cm2 for the COP area, >2.6 cm/s for the COP sway velocity in the anterior-posterior direction, and >3.2 cm/s for the mediolateral direction. Whereas, the 30° knee flexion cutoffs were >10.9 cm2 for the COP area, >2.9 cm/s for the COP sway velocity in the anterior-posterior direction, and >4.1 cm/s for the mediolateral direction. Both measures showed enough sensitivity and specificity (ie,area under the curve = 0.88 in and 0.80, respectively) to discriminate both groups. The athletes with CLBP had poorer postural control than the healthy athletes and obtained specific cutoff scores from the COP values.

Game Exposure, Player Characteristics, and Neuromuscular Performance Influence Injury Risk in Professional and Youth Field Hockey Players.

Background:Identifying factors that contribute to the occurrence of injury is an important step in designing training programs to minimize the risk of injury. However, despite high injury rates, variables contributing to injury in field hockey players remain relatively unexplored.Purpose:To identify factors that may predict injury in professional and youth field hockey players.Study Design:Cohort study; Level of evidence, 2.Method:Professional and youth hockey players completed preseason neuromuscular performance testing and were monitored for injuries, training, and game exposure throughout the subsequent 12-month indoor and outdoor hockey season. Least absolute shrinkage and selection operator analysis was conducted to identify injury risk factors. Receiver operating characteristic curves were then calculated to determine the individual predictive accuracy of the identified variables.Results:A total of 83 players (mean ± SD age, 20.7 ± 4.9 years; 34.9% female) with complete performance, injury, and exposure data were included for data analysis. Almost half of players (44.6%) sustained a time-loss injury during the season, and 73% of these injuries occurred in the lower limb. Playing more games and having an older age, asymmetrical and poor dynamic postural control, and better explosive performance were identified as jointly influencing the risk of injury. When considered individually, number of games played throughout the season was the most accurate predictor of injury risk (area under the curve [AUC] = 0.74; P < .001), while asymmetrical and poor dynamic postural control (AUCs = 0.61-0.65; P = .01-.04) and better explosive athletic performance (AUCs = 0.65-0.67; P < .01) were identified as moderate individual predictors of sustaining a general or lower limb injury.Conclusion:A number of modifiable factors were individually and jointly associated with an increased injury risk in field hockey players, providing initial evidence for the design of targeted and sport-specific training programs to mitigate the risk of injury.

Prevalence of Balance Impairments in Individuals with Parkinson Disease

Abstract:Postural or balance impairments is most common feature of advanced Parkinson's disease leading to falls. Balance disorder is predisposing symptom in Parkinson disease, difficult to cure and at high risk of falls. Objective: To find out the Prevalence of balance impairments in individual with Parkinson's disease This was the cross-sectional study. Data was collected by 23 Parkinson's patients in General Hospital of Lahore. Convenient sampling technique was used in this study. Berg Balance scale was used as data collection instrument. Data was analyzed by SPSS. Results: The result shows that out of 23 sample size (18 male and 5 female), there is 15(65.2%) of Parkinson patients had minimal level of balance impairments, 6(26.1%) had moderate balance impairments and only 2(8.7%) of Parkinson patients complained about severe balance impairments on Berg Balance Scale.Conclusions: The result shows that there is mild to moderate prevalence of balance impairments in individual with Parkinson's disease. Balance dysfunction or impairments in Parkinson patients due to abnormal gait pattern, poor postural control,muscles rigidity, tremors and lose of body movements. Balance impairments not depend on age and gender of Parkinson patients. Balance impairments, Berg balance scale, Parkinson's disease

Effects of Core Stabilization Exercise versus General Trunk-Strengthening Exercise on Balance Performance, Pain Intensity and Trunk Muscle Activity Patterns in Clinical Lumbar Instability Patients: A Single Blind Randomized Trial

Postural balance is important for activities of daily living. Patients with chronic low back pain (CLBP) exhibit balance problems, such as difficulty performing daily activities. Specifically, CLBP patients with clinical lumbar instability (CLI) have demonstrated deep trunk muscular dysfunction that induces poor postural control and may result in a high risk of falling. This study aimed to investigate the effect of a 10-week core stabilization exercise (CSE) regimen versus a strengthening trunk exercise (STE) regimen and conduct a 3-month follow-up on balance, pain, and trunk muscle activity patterns in CLI patients. A single-blind randomized controlled trial was used to compare the effects of CSE and STE on balance, pain, and trunk muscle activity patterns in 38 CLBP patients with CLI. The results of the 5-times-sit-to-stand test (FTSST) and pain intensity revealed significant improvements in both groups after ten weeks of exercise and at the 3-month follow-up point. However, the differences in the FTSST scores and pain intensity between the CSE and STE patients were not significant. Moreover, the CSE group presented significantly greater deep abdominal muscle activation than the STE group after ten weeks of exercise. In addition, both groups exhibited a trend of improvement in terms of deep back muscle activation. Therefore, the current study results suggest that both exercise regimens can improve balance performance and pain intensity. Moreover, the CSE group showed more significant improvements in deep abdominal muscle activation than the STE group.

Dynamic postural control correlates with activities of daily living and quality of life in patients with knee osteoarthritis

BackgroundKnee osteoarthritis (OA) negatively affects dynamic postural control, which is a basic function that individuals use to perform activities of daily living (ADL). The purpose of this study was to investigate the associations of center of pressure (COP) control during the transition from double-leg to single-leg standing with subjective assessments of ADL and quality of life (QOL) in patients with knee OA.MethodsThirty-six patients (29 females) with moderate-to-severe knee OA participated. Dynamic postural control was evaluated during the transition from double-leg to single-leg standing. Each patient stood on a force plate, lifted the less affected limb as fast as possible, and maintained single-leg standing with the more affected limb. The COP movements corresponding to anticipatory postural adjustment (APA) and transitional phases were assessed. The maximum displacement and peak velocity of the COP movements in the medial–lateral direction were calculated. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used for the subjective assessment of ADL and QOL. Pearson’s product correlation analysis was performed to investigate the associations of COP movements in the APA and transitional phases with KOOS-ADL and KOOS-QOL.ResultsIn the APA phase, the maximum COP displacement was significantly correlated with KOOS-ADL (r = -0.353, P = 0.035) and KOOS-QOL (r = -0.379, P = 0.023). In the transitional phase, the maximum COP displacement and peak COP velocity were significantly correlated with KOOS-ADL (maximum displacement: r = 0.352, P = 0.035; peak velocity: r = 0.438, P = 0.008) and with KOOS-QOL (maximum displacement: r = 0.357, P = 0.032; peak velocity: r = 0.343, P = 0.040).ConclusionsThe present study showed that smaller COP movements in the APA phase and smaller and slower COP movements in the transitional phase correlated with poorer ADL and QOL conditions in patients with knee OA. These findings suggest that poor dynamic postural control is associated with poor ADL and QOL conditions in patients with moderate-to-severe medial knee OA. Conservative treatment for patients with knee OA may need to focus on dynamic postural control during the transition from double-leg to single-leg standing.

Postural Control in Childhood: Investigating the Neurodevelopmental Gradient Hypothesis.

Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5–17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis.

Comparison of Postural Control and Functional Balance in Individuals People with Intellectual Disabilities with and Without Developmental Coordination Disorder

Introduction: Balance in individual with intellectual disability has a great importance due to the failure to perform motor tasks. The purpose of the present study was to compare postural control and balance function in two groups of individual with intellectually disabled with and without developmental coordination disorder. Methods: The present study was a cross-sectional and causal-comparative. The statistical population of this study included all students with intellectually disabilities studying in an exceptional school in Rasht in 2019. According to the inclusion and exclusion criteria, 52 people, including 32 students with intellectual disabilities with developmental coordination disorder and 20 students with intellectual disabilities without developmental coordination disorder were purposefully selected. BESS test, Y balance test, Timed Up and Go (TUG) test were used to evaluate postural control, dynamic balance and functional balance, respectively. For statistical analysis, SPSS version 16 software, independent t-test and Mann-Whitney U tests at a significance level of P &lt;0.05 was used. Results: Based on the results of the present study, a significant difference was observed in functional balance (p = 0.001), and overall score of postural control (p = 0.003), but no significant difference in dynamic balance (p &lt;0.05) was observed between the two groups. Conclusion: Developmental coordination disorder is highly prevalent among the individual with intellectual disabilities. At the same time, they have poorer postural control and functional balance compared to their peers without developmental coordination disorder. Due to the importance of controlling posture and maintaining proper balance in order to prevent injury of these people who are less physically fit than their peers, it is recommended to sports coaches, occupational therapists, physiotherapists and other related fields to take a variety of balance programs to emphasize on improving their balance.

Feasibility of Cerebellar Transcranial Direct Current Stimulation to Facilitate Goal-Directed Weight Shifting in Chronic Post-Stroke Hemiplegics.

Neurological disorder such as stroke can adversely affect one's weight-bearing symmetry leading to dysfunctional postural control. Recovery after stroke is facilitated through functionally-relevant neuroplastic modulation. Functionally-relevant cerebellum coordinates voluntary movements. Specifically, the dentate nuclei and lower limb representations (lobules VII-IX) of the cerebellum are involved in error-correction, crucial for postural control. It is postulated that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and lobules VII-IX can modulate postural control in chronic stroke survivors. The objectives of this work were to (1) present a refined Virtual Reality (VR)-based balance training platform (VBaT) that can measure Center of Pressure (CoP) and (2) carry out a study to understand the implication of ctDCS stimulating the dentate nuclei (PhaseD) and lobules VII-IX (PhaseL) on the postural control of chronic stroke patients when they interacted with VBaT. Also, we investigated whether hemiplegic patients (with intact cerebellum) having Basal Ganglia (BG) infarction had any differential abilities to correct postural sway from those with no BG infarction (while shifting weight to the Affected side). Results of a single-session single-blind crossover study on randomized PhaseD and PhaseL stimulation (with an intermediate resting state bipolar bilateral ctDCS) on 12 chronic hemiplegic patients on separate days indicated differentiated findings (post stimulation) on CoP-related indices. We observed an incremental effect on one's postural control during PhaseD and inhibitory effect on the dentate nuclei during PhaseL. Clustering analysis showed that those with BG infarction demonstrated poor postural control and deficit in error correction ability irrespective of the ctDCS Phase.

Validation of a smartphone embedded inertial measurement unit for measuring postural stability in older adults

BackgroundIdentifying older adults with increased fall risk due to poor postural control on a large scale is only possible through omnipresent and low cost measuring devices such as the inertial measurement units (IMU) embedded in smartphones. However, the correlation between smartphone measures of postural stability and state-of-the-art force plate measures has never been assessed in a large sample allowing us to take into account age as a covariate. Research questionHow reliably can postural stability be measured with a smartphone embedded IMU in comparison to a force plate? MethodsWe assessed balance in 97 adults aged 50–90 years in four different conditions (eyes open, eyes closed, semi-tandem and dual-task) in the anterio-posterior and medio-lateral directions. We used six different parameters (root mean square and average absolute value of COP displacement, velocity and acceleration) for the force plate and two different parameters (root mean square and average absolute value of COM acceleration) for the smartphone. ResultsTest-retest reliability was smaller for the smartphone than for the force plate (intra class correlation) but both devices could equally well detect differences between conditions (similar Cohen’s d). Parameters from the smartphone and the force plate, with age regressed out, were moderately correlated (robust correlation coefficients of around 0.5). SignificanceThis study comprehensively documents test-retest reliability and effect sizes for stability measures obtained with a force plate and smartphone as well as correlations between force plate and smartphone measures based on a large sample of older adults. Our large sample size allowed us to reliably determine the strength of the correlations between force plate and smartphone measures. The most important practical implication of our results is that more repetitions or longer trials are required when using a smartphone instead of a force plate to assess balance.

Is freezing of gait correlated with postural control in patients with moderate-to-severe Parkinson's disease?

Freezing of gait (FoG) is one of the main reasons for movement initiation disorders and abnormal coupling of posture and gait in Parkinson's disease (PD). Patients with FoG have poor postural control when compared to patients without FoG. However, the nature of the interrelationship between FoG and domains of postural control remains unknown. The aim of this study was to estimate the association between different domains of postural control and severity of FoG in patients with moderate-to-severe PD. Thirty patients with idiopathic PD with FoG (age range 45-80years, Hoehn & Yahr stages 3 and 4) participated in the study. We evaluated objective (FoG-ratio during turning task) and subjective (New Freezing of Gait Questionnaire, NFoG-Q) measures of FoG severity, reactive postural adjustments in response to an external perturbation, first step anticipatory adjustment for step initiation and quiet standing stability. In the multiple regression analysis, step initiation was the strongest significant correlation of the NFoG-Q score explaining 23% of the variance of the assessment. For the objective FoG measure, mediolateral CoP amplitude in quiet standing and mediolateral CoP amplitude in step initiation explained 39% of the variance of the FoG-ratio. As main conclusions, this study identified the association between objective and subjective measure for FoG severity and postural control domains. The results support conducting step initiation training during rehabilitation of individuals with FoG.

Advanced characterization of static postural control dysfunction in persons with multiple sclerosis and associated neural mechanisms

BackgroundMultiple sclerosis (MS) is an autoimmune-based chronic inflammatory disease characterized by the neurodegeneration of the central nervous system and produces postural dysfunction. Quiet or static standing is a complex task carried out through afferent sensory inputs and efferent postural corrective outputs. Currently the mechanisms underlying these outputs remain largely unknown. Research questionAssess the relationship between multi-dimensional measures of postural control and microstructural integrity of the cortical sensorimotor pathway (CSP) in persons with MS (PwMS) and neurotypical adults. MethodsPostural control performance was assessed by both overall and directional time-to-boundary measures across four manipulated sensory stance conditions (eyes open/closed; stance firm/foam) in twenty-nine neurotypical and twenty-seven PwMS. These postural outcomes were evaluated with mixed-model repeated measures analysis of variance across group (MS and control) and stance condition. Postural performance was also correlated with magnetic resonance imaging diffusion tensor-derived measures of microstructural integrity of the CSP. ResultsPwMS displayed significantly (p = 0.026) worse anterior-posterior postural control compared to their neurotypical counterparts across sensory testing conditions and poorer CSP microstructural integrity in comparison to neurotypical adults (p = 0.008). Additionally, PwMS displayed a significant association (2D (rho = -0.384, p = 0.048), AP (rho = -0.355, p = 0.035), and ML (rho = -0.365, p = 0.030) between integrity of the CSP and postural control performance during proprioceptive-based balance, such that those with worse cortical structure had poorer balance control. SignificanceThis is the first study to establish connections between the microstructural integrity of the CSP and multi-dimensional postural control performance. Results indicate that a reduction in the CSP microstructural integrity is associated with poorer postural control in PwMS. These outcomes identify neural underpinnings of postural control dysfunction in PwMS and provide new avenues for evaluating the efficacy of postural rehabilitation strategies in PwMS that express proprioceptive-based postural deficits.

Study of postural control and body balance in subjects with Down syndrome

PurposeBody imbalance and poor postural control have negative impact on gait and may increase the risk of falling in healthy individuals as well as those with Down syndrome (DS). Since people with DS have lower physical levels than people who do not present this condition, the purpose of our research was to compare features of postural control and body balance between subjects affected by DS and a control sampleMethodsParticipants enrolled were divided into the following two groups: a DS group (DSG; &lt;i&gt;n&lt;/i&gt; = 22; 9 females and 13 males; age range: 16–36 years) and an age-matched control group (CG; &lt;i&gt;n&lt;/i&gt; = 25; 11 females and 14 males; age range: 16–36 years). All participants were subjected to two stabilometric tests: eyes open (EO) and eyes closed (EC), 30 s each, in bipedal upright stance on a platformResultsThe main results showed significantly higher values for the ellipse sway area in DSG compared with CG, both in the EO (&lt;i&gt;p&lt;/i&gt; = 0.009) and in the EC trial (&lt;i&gt;p&lt;/i&gt; = 0.000). Moreover, significantly higher values were revealed for the sway path length (&lt;i&gt;p&lt;/i&gt; = 0.013), maximum speed of sway (&lt;i&gt;p&lt;/i&gt; = 0.001), and average speed of sway (&lt;i&gt;p&lt;/i&gt; = 0.046) in the EC than in the EO trial.ConclusionsWe infer that a delay in multi-sensory integration processes in the nervous system for controlling body posture could underlie lower body balance in DS.

Postural Control While Listening in Younger and Middle-Aged Adults.

The motivation for this research is to determine whether a listening-while-balancing task would be sensitive to quantifying listening effort in middle age. The premise behind this exploratory work is that a decrease in postural control would be demonstrated in challenging acoustic conditions, more so in middle-aged than in younger adults. A dual-task paradigm was employed with speech understanding as one task and postural control as the other. For the speech perception task, participants listened to and repeated back sentences in the presence of other sentences or steady-state noise. Targets and maskers were presented in both spatially-coincident and spatially-separated conditions. The postural control task required participants to stand on a force platform either in normal stance (with feet approximately shoulder-width apart) or in tandem stance (with one foot behind the other). Participants also rated their subjective listening effort at the end of each block of trials. Postural control was poorer for both groups of participants when the listening task was completed at a more adverse (vs. less adverse) signal-to-noise ratio. When participants were standing normally, postural control in dual-task conditions was negatively associated with degree of high-frequency hearing loss, with individuals who had higher pure-tone thresholds exhibiting poorer balance. Correlation analyses also indicated that reduced speech recognition ability was associated with poorer postural control in both single- and dual-task conditions. Middle-aged participants exhibited larger dual-task costs when the masker was speech, as compared to when it was noise. Individuals who reported expending greater effort on the listening task exhibited larger dual-task costs when in normal stance. Listening under challenging acoustic conditions can have a negative impact on postural control, more so in middle-aged than in younger adults. One explanation for this finding is that the increased effort required to successfully listen in adverse environments leaves fewer resources for maintaining balance, particularly as people age. These results provide preliminary support for using this type of ecologically-valid dual-task paradigm to quantify the costs associated with understanding speech in adverse acoustic environments.

Upper and Lower Limb Strength and Body Posture in Children with Congenital Hypothyroidism: An Observational Case-Control Study.

Background: Congenital hypothyroidism (CH) is an endocrine disease with a precocious significant impairment of growth and neuromotor development. Thyroid hormones are essential for central nervous system development, maturation, and myelination. Furthermore, thyroid hormone deficiency affects the function of several systems, including the musculoskeletal system. The disease has a significant incidence in the general population (1:3000–1:2000 newborns in Italy). The aim of the present study was to evaluate any differences in upper and lower limb strength, body sway, and plantar loading distribution in children with CH compared to healthy children. Methods: In this study, the case group was composed of children with CH (CHG), while the control group included healthy children (CG). Both groups comprised 19 children (CHG: female = 12; CG: female = 9). The maximum isometric handgrip strength and explosive-elastic lower limb strength were assessed with the handgrip test and the Sargent test, respectively. The stabilometric and baropodometric analyses were used to measure the Center of Pressure displacements and the plantar loading distribution between feet, respectively. The differences between groups were analyzed by a univariate analysis of covariance using as covariates weight and height with the significant level set at < 0.05. Results: We found that CHG children were shorter and thinner than CG ones (p < 0.05). No significant difference in the upper and lower limb strength was found between groups. CHG exhibited a significant greater Sway Path Length (p < 0.01) and Ellipse Surface (p < 0.05) than CG. Moreover, CHG displayed an asymmetric plantar loading distribution with a significant lower percentage in the right than in the left foot (p < 0.05). Moreover, a significant lower plantar loading percentage in the right foot of CHG than in the right foot of CG was observed (p < 0.05). Conclusions: These findings seem to suggest that CH does not affect muscle strength in early treated children. However, these patients show poor postural control ability and asymmetric plantar loading distribution. Increasing the physical activity in these children could improve their body posture.

Determinants of Recurrent Falls Poststroke: A 1-Year Follow-up of the Fall Study of Gothenburg

ObjectiveTo identify the occurrence of recurrent falls and the determinants in the acute phase poststroke that are associated with recurrent falls within the first year poststroke. DesignProspective follow-up study. SettingStroke unit and community. ParticipantsPatients (N=504) with acute stroke. InterventionsNot applicable. Main Outcome MeasuresThe dependent variable was recurrent falls, defined as ≥2 falls, within the first year poststroke. The independent baseline variables were related to function, activity, participation, personal and environmental factors, and comorbidity and were assessed within 4 days after admission to a stroke unit. Fall data were registered at the stroke unit, and self-reported fall data were collected during follow-up using a standardized questionnaire. Determinants of recurrent falls were identified using univariable and multivariable logistic regression analyses. ResultsWithin 12 months poststroke, 95 of 348 participants (27%) had experienced recurrent falls. Poor postural control (odds ratio [OR] 5.85; 95% confidence interval [CI], 2.84-12.02; P<.0001), moderate postural control (OR 2.41; 95% CI, 1.21-4.80; P=.012), and using a walking aid in the acute phase (OR 2.51; 95% CI, 1.45-4.36; P=.0010) are statistically significant determinants that are associated with recurrent falls within the first year poststroke. The determinant of using a walking aid appears to be primarily driven by those younger than 80 years. In addition to impaired postural control and using a walking aid, a fall at the stroke unit is a determinant associated with recurrent falls after discharge within 6 months poststroke. ConclusionsMore than 1 in 4 individuals with stroke experienced recurrent falls within the first year poststroke. Impaired postural control, using a walking aid in the acute phase, and fall during hospitalization are determinants associated with recurrent falls during follow-up. The determinants differ somewhat at different ages.

Quantitative Gait Analysis in Duplication 15q Syndrome and Nonsyndromic ASD.

Motor impairments occur frequently in genetic syndromes highly penetrant for autism spectrum disorder (syndromic ASD) and in individuals with ASD without a genetic diagnosis (nonsyndromic ASD). In particular, abnormalities in gait in ASD have been linked to language delay, ASD severity, and likelihood of having a genetic disorder. Quantitative measures of motor function can improve our ability to evaluate motor differences in individuals with syndromic and nonsyndromic ASD with varying levels of intellectual disability and adaptive skills. To evaluate this methodology, we chose to use quantitative gait analysis to study duplication 15q syndrome (dup15q syndrome), a genetic disorder highly penetrant for motor delays, intellectual disability, and ASD. We evaluated quantitative gait variables in individuals with dup15q syndrome (n = 39) and nonsyndromic ASD (n = 21) and compared these data to a reference typically developing cohort. We found a gait pattern of slow pace, poor postural control, and large gait variability in dup15q syndrome. Our findings improve characterization of motor function in dup15q syndrome and nonsyndromic ASD. Quantitative gait analysis can be used as a translational method and can improve our identification of clinical endpoints to be used in treatment trials for these syndromes. Autism Res 2020, 13: 1102-1110. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Motor impairments, particularly abnormalities in walking, occur frequently in genetic syndromes highly penetrant for autism spectrum disorder (syndromic ASD). Here, using quantitative gait analysis, we find that individuals with duplication 15q syndrome have an atypical gait pattern that differentiates them from typically developing and nonsyndromic ASD individuals. Our findings improve motor characterization in dup15q syndrome and nonsyndromic ASD.

Shared neural substrates of cognitive function and postural control in older adults.

Poor cognitive function and postural control co-occur in older adults. It is unclear whether they share neural substrates. Postural sway error during a novel visual tracking (VT) condition and gray matter volume (GMV) were compared between participants with normal cognition (NC), mild cognitive impairment (MCI), or dementia (n = 179, mean age 82, 56% females, 56% white). Associations between VT error, cognitive function, and GMV were examined. Greater VT error was associated with having dementia compared to NC or MCI (odds ratio [95% CI] = 2.15 [1.38, 3.36] and 1.58 [1.05, 2.38]). Regions with lower GMV related to greater VT error and worse cognition were: bilateral hippocampi, parahippocampi, entorhinal, and parietal cortices (all P ≤0.05). GMV of bilateral hippocampi and left parahippocampus explained >20% of VT error between dementia and NC. Postural control during visuospatial tasks and dementia may share neural substrates, specifically memory-related regions.

Out of balance – Postural control in cancer patients before and after neurotoxic chemotherapy

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect deriving from neurotoxic chemotherapeutic agents. The underlying nerve injury can affect proprioception causing impaired postural control, gait difficulties and a higher risk of falling. Overall, the symptoms and functional limitations negatively affect patients’ independence and quality of life. Research questionOur objective was to analyze postural control in cancer patients before and after neurotoxic chemotherapy and to compare these data to healthy controls. MethodsParticipants were 35 cancer patients (PAT) and 35 healthy, one-to-one gender, age, height, and weight matched controls (HMC). Postural control of HMC was tested once, whereas PAT were tested prior to (PATpre) and three weeks after completion of neurotoxic chemotherapy (PATpost). Temporal, spatial and frequency domain measures of the center of pressure (COP) were calculated using a force plate. The following balance conditions were analyzed: bipedal stance with open (BPEO) and closed eyes (BPEC), semi-tandem (STEO, STEC) and monopedal stance (MPEO). CIPN was assessed clinically (Total Neuropathy Score) and via questionnaire. Time and group differences were determined by using Wilcoxon-signed-rank tests. Spearman correlation was applied to analyze associations between severity of CIPN and postural control. ResultsPATpost showed significantly increased temporal and spatial measures of the COP (p < .05) – both after neurotoxic chemotherapy (PATpre–PATpost) and in comparison to HMC. Withdrawal of visual control resulted in greater temporal and spatial COP displacements in PATpost than in the comparative groups (PATpre, HMC). Correlation analyzes revealed moderate associations of COP measures with clinical CIPN measures and low to none for the questionnaires. SignificanceThree weeks after completion of neurotoxic chemotherapy, PATpost showed significant balance deficits compared to PATpre and HMC. Especially the deficits in the standing conditions with closed eyes may indicate an impaired proprioception. This hypothesis is supported by the finding that stronger CIPN symptoms were associated with poorer postural control. However, future studies need to take further influencing factors on postural control into account (e.g. strength) in order to generate efficacious rehabilitation measures.

Intensified visual clutter induces increased sympathetic signalling, poorer postural control, and faster torsional eye movements during visual rotation

Many dizzy patients express a hypersensitivity to visual motion and clutter. This study aims to investigate how exposure to rotating visual clutter affects ocular torsion, vertical skewing, body-sway, the autonomic pupillary response, and the subjective feeling of discomfort to the stimulation. Sixteen healthy subjects were exposed to 20 seconds rotational visual stimulation (72 deg/s; 50 deg visual field). Visual stimuli were comprised of black lines on a white background, presented at low and high intensity levels of visual clutter, holding 19 lines and 38 lines respectively. Ocular torsion and vertical skewing were recorded using the Chronos Eye Tracker, which also measured pupil size as a reflection of the autonomic response. Postural control was evaluated by measuring body-sway area on the Wii Balance Board. Values were compared to data retrieved 20 seconds before and after the optokinetic stimulation, as subjects viewed the stationary visual scene. The high intensity stimulus resulted in significantly higher torsional velocities. Subjects who were exposed to low intensity first exhibited higher velocities for both intensities. Both pupil size and body sway increased for the higher intensity to both the moving and stationary visual scene, and were positively correlated to torsional velocity. In conclusion, exposure to visual clutter was reflected in the eye movement response, changes in postural control, and the autonomic response. This response may hold clinical utility when assessing patients suffering from visual motion hypersensitivity, while also providing some context as to why some healthy people feel discomfort in visually cluttered surroundings.