Postural Body Sway Research Articles

International validation of meaningfulness of postural sway and gait to assess myeloneuropathy in adults with adrenoleukodystrophy.

The most common manifestation of X-linked adrenoleukodystrophy (ALD) is a slowly progressive myeloneuropathy, which leads to imbalance and gait disturbances. The variable progression of the disease complicates evaluation of its progression rate. Wearable sensors allow for easy and frequent balance and gait collection. This study reports baseline data from a longitudinal study on the quantitative assessment of balance and gait with wearable sensors and their clinical relevance. Data were collected from adult patients in two institutions. Postural body sway and gait parameters were measured using accelerometers. Disease severity was measured by the Expanded Disability Severity Scale (EDSS). Falling frequency and quality of life (QOL) were collected in men. The relationship between sway and gait variables and EDSS score, participants' use of a walking aid, and falling frequency was evaluated. One hundred twenty individuals with ALD were included. Sway variables significantly differentiate participants' assistive device use. Sway and gait variables were correlated to the EDSS in both sexes. Both gait speed and sway were correlated with falling frequency in men from one institution. Select QOL subscores were correlated with the EDSS in males from one institution. Accelerometry generated comparable results across sites. This study confirms the clinical correlation between spinal cord disease and imbalance and gait in ALD. For the first time, this study shows clinically meaningful relationships for sway and gait with use of an assistive device, falling frequency and QOL. Wearable accelerometers are a valid means to measure sway and gait in ALD. These measures are promising outcomes for clinical trial designs to assess myeloneuropathy in ALD and to monitor disease progression in individuals.

Cohort study of postural sway and low back pain: the Copenhagen City Heart Study

PurposeLow back pain is a significant health problem with a high prevalence. Studies of smaller cohorts of low back pain patients have indicated increased body sway. The present paper tests the hypothesis of an association between low back pain and postural sway in a large randomly selected population.MethodsThe current study used the fifth examination (2011–2015) of The Copenhagen City Heart Study where 4543 participated. The participants answered a self-administered questionnaire regarding pain, physical activity, smoking, alcohol consumption, education, and other lifestyle factors. Measurement of postural body sway was performed using the CATSYS system.ResultsTotally 1134 participants (25%) reported to have low back pain. Subjects with low back pain had higher sway area and sway velocity than subjects without.ConclusionWhen using multivariate statistical analysis, confounding factors such as male gender, higher age, larger body height, low education level, smoking, and low activity level explained the association between low back pain and postural sway.

Feasibility of at-home motor assessments using wireless technology in patients with myelopathy: year 1 follow up of CYGNET, an observational study of patients with adrenomyeloneuropathy (P6-6.006)

Feasibility of at-home motor assessments using wireless technology in patients with myelopathy: year 1 follow up of CYGNET, an observational study of patients with adrenomyeloneuropathy (P6-6.006)

Postural Body Sway as Surrogate Outcome for Myelopathy in Adrenoleukodystrophy.

BackgroundMyelopathy is the core clinical manifestation of adrenoleukodystrophy (ALD), which is the most common peroxisomal disorder. Development of therapies requires sensitive and clinically relevant outcome measures. Together with spastic paraparesis, balance disturbance is the main cause of disability from myelopathy in ALD. In this cross-sectional study, we evaluated whether postural body sway – a measure of balance – could serve as a surrogate outcome in clinical trials.MethodsForty-eight male ALD patients and 49 age-matched healthy male controls were included in this study. We compared sway amplitude and sway path of ALD patients to controls. We then correlated the body sway parameters showing the largest between-group differences with clinical measures of severity of myelopathy. To correct for age, we performed multiple linear regression analysis with age and severity of myelopathy as independent variables.ResultsAll body sway parameters were significantly higher in patients than in controls, with medium to large effect sizes (r = 0.43–0.66, p < 0.001). In the subgroup of asymptomatic patients, body sway amplitude was also higher, but the difference with controls was smaller than for symptomatic patients (effect size r = 0.38–0.46). We found moderate to strong correlations between body sway amplitude and clinical severity of myelopathy (r = 0.40–0.79, p < 0.005). After correction for age, severity of myelopathy was a significant predictor of body sway amplitude in all regression models.ConclusionsThese results indicate that postural body sway may serve as a surrogate outcome for myelopathy in ALD. Such outcomes are important to evaluate new therapies in clinical trials. Further longitudinal studies are needed and ongoing in this cohort.

The Effect of Dual Task on Attentional Performance in Children With ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder without validated objective markers. Oculomotor behavior and executive motor control could potentially be used to investigate attention disorders. The aim of this study was to explore an oculomotor and postural dual task in children with ADHD. Forty-two children were included in the study, gathering children with ADHD (n = 21) (mean 8.15 age ± years 0.36) and sex-, age-, and IQ-matched typically developing children (TD). Children performed two distinct fixation tasks in three different postural conditions. Eye movements and postural body sway were recorded simultaneously, using an eye tracker and a force platform. Results showed that children with ADHD had poor fixation capability and poor postural stability when compared to TD children. Both groups showed less postural control on the unstable platform and displayed more saccades during the fixation task. Surprisingly, in the dual unstable platform/fixation with distractor task, the instability of children with ADHD was similar to that observed in TD children. “Top-down” dys-regulation mediated by frontal-striatal dysfunction could be at the origin of both poor inhibitory oculomotor deficits and impaired body stability reported in children with ADHD. Finally, we could assume that the fact both groups of children focused their attention on a secondary task led to poor postural control. In the future it could be interesting to explore further this issue by developing new dual tasks in a more ecological situation in order to gain more insight on attentional processes in children with ADHD.HIGHLIGHTS– Children with ADHD showed poor fixation capability when compared to TD children.– “Top-down” dys-regulation mediated by frontal-striatal dysfunction could be at the origin of both poor inhibitory oculomotor deficits and impaired body stability reported in children with ADHD.– Both groups of children focused their attention on the visual fixation task leading to poor postural control.– In the future it could be interesting to develop new dual tasks in an ecological situation in order to gain more insight on attentional processes in children with ADHD.

Comparison of postural sway depending on balance pad type.

[Purpose] The purpose of the present study was to compare the postural sway of healthy adults standing on different types of balance pads. [Subjects and Methods] Nine healthy adults participated in this study. Postural body sway was measured while participants were standing on four different types of balance pads: Balance-pad Elite (BE), Aero-Step XL (AS), Dynair Ballkissen Senso (DBS), and Dynair Ballkissen XXL Meditation and Yoga (DBMY). A Wii Balance Board interfaced with Balancia software was used to measure postural body sway. [Results] In the sway velocity, sway path length, and sway area, no significant differences were found between baseline conditions (participants were standing on the floor with no balance pad) and the use of the BE or AS. However, significant increases in all parameters were found comparing baseline conditions to the use of either Dynair balance pad. Furthermore, the use of either Dynair balance pad significantly increased postural sway compared to both the BE and the AS. [Conclusion] These findings suggest that the DBS and DBMY balance pads may serve as superior tools for providing unstable condition for balance training than the BE and the AS balance pads.

Viewing pain and happy faces elicited similar changes in postural body sway.

Affective facial expressions are potent social cues that can induce relevant physiological changes, as well as behavioral dispositions in the observer. Previous studies have revealed that angry faces induced significant reductions in body sway as compared with neutral and happy faces, reflecting an avoidance behavioral tendency as freezing. The expression of pain is usually considered an unpleasant stimulus, but also a relevant cue for delivering effective care and social support. Nevertheless, there are few data about behavioral dispositions elicited by the observation of pain expressions in others. The aim of the present research was to evaluate approach–avoidance tendencies by using video recordings of postural body sway when participants were standing and observing facial expressions of pain, happy and neutral. We hypothesized that although pain faces would be rated as more unpleasant than the other faces, they would provoke significant changes in postural body sway as compared to neutral facial expressions. Forty healthy female volunteers (mean age 25) participated in the study. Amplitude of forward movements and backward movements in the anterior-posterior and medial-lateral axes were obtained. Statistical analyses revealed that pain faces were the most unpleasant stimuli, and that both happy and pain faces were more arousing than neutral ones. Happy and pain faces also elicited greater amplitude of body sway in the anterior-posterior axes as compared with neutral faces. In addition, significant positive correlations were found between body sway elicited by pain faces and pleasantness and empathic ratings, suggesting that changes in postural body sway elicited by pain faces might be associated with approach and cooperative behavioral responses.

0137 Acute cognitive effects of MRI related magnetic fields: the role of vestibular sensitivity

ObjectivesMovement in the magnetic fields around MRI systems showed acute negative effects on concentration, memory, visuo-spatial orientation and postural body sway. A crucial role of the vestibular system has been...

Vitamin D deficiency intensifies deterioration of risk factors, such as male sex and absence of vision, leading to increased postural body sway

IntroductionDue to inconsistent findings, the influence of vitamin D on postural body sway (PBS) is currently under debate. This study evaluated the impact of vitamin D on PBS with regards to different foot positions and eye opening states in community-dwelling older individuals. MethodsIn a cross-sectional study, we assessed PBS in 342 older individuals (264 females [average age (±SD): 68.3±9.0 years], 78 males [65.7±9.6 years]). A detailed medical history and vitamin D level were obtained for each individual. Fall risk was evaluated using the New York-Presbyterian Fall Risk Assessment Tool (NY PFRA). PBS parameters (area, distance, velocity, frequency) were evaluated on a pressure plate with feet in closed stance (CS) or hip-width stance (HWS), open eyes and closed eyes. Statistical analysis included logarithmic mixed models for repeated measures with the MIXED model procedure to test the influence of vitamin D (categorized in <10μg/l, 10–20μg/l, 21–30μg/l, >30μg/l), foot position, eye opening state, age, sex and frequency of physical activity on PBS. ResultsVitamin D was not an independent risk factor for falls experienced in the last 12 months. Nonetheless, PBS was higher in patients with vitamin D deficiency (<10μg/l) in HWS (A/P p=0.028 and area p=0.037). Additionally, vitamin D deficiency intensified the deleterious effects of male sex (distance p=0.002) and absence of vision (area p<0.001) on PBS. ConclusionIndependent risk factors for increased PBS like male sex and absence of vision are additionally compromised by vitamin D deficiency.

O1-E-2. Patterns of sensory electrophysiological abnormalities in Fisher syndrome

Fisher syndrome (FS) is characterized by triad of ataxia, areflexia, and ophthalmoplegia. To elucidate the pathophysiology of ataxia in FS, we reviewed extensively electrophysiological data of FS patients. We reviewed results of sensory nerve conduction studies, soleus H-reflex, postural body sway analysis and somatosensory-evoked potentials (SEP) in consecutive 47 FS patients. Reduction of SNAP amplitudes was only seen in 32% of the patients in routine nerve conduction studies. In contrast, the absence of soleus H-reflex was shown in 67%. 1 Hz peak of postural body sway analysis was in 57%. SEPs were abnormal in 17%. This abnormal pattern of sensory electrophysiology is characterized by predominant involvement of group 1a afferents with relatively preserved cutaneous afferents. Our findings suggest that involvement of group 1a fibers could be responsible for ataxia as well as areflexia in FS.

MRI‐related static magnetic stray fields and postural body sway: A double‐blind randomized crossover study

We assessed postural body sway performance after exposure to movement induced time-varying magnetic fields in the static magnetic stray field in front of a 7 Tesla (T) magnetic resonance imaging scanner. Using a double blind randomized crossover design, 30 healthy volunteers performed two balance tasks (i.e., standing with eyes closed and feet in parallel and then in tandem position) after standardized head movements in a sham, low exposure (on average 0.24 T static magnetic stray field and 0.49 T·s(-1) time-varying magnetic field) and high exposure condition (0.37 T and 0.70 T·s(-1)). Personal exposure to static magnetic stray fields and time-varying magnetic fields was measured with a personal dosimeter. Postural body sway was expressed in sway path, area, and velocity. Mixed-effects model regression analysis showed that postural body sway in the parallel task was negatively affected (P < 0.05) by exposure on all three measures. The tandem task revealed the same trend, but did not reach statistical significance. Further studies are needed to investigate the possibility of independent or synergetic effects of static magnetic stray field and time-varying magnetic field exposure. In addition, practical safety implications of these findings, e.g., for surgeons and others working near magnetic resonance imaging scanners need to be investigated.

Bickerstaff's brainstem encephalitis and Fisher syndrome form a continuous spectrum

Whether Bickerstaff's brainstem encephalitis (BBE) is a distinct disease or a subtype of Fisher syndrome (FS) is unclear as there have been no clinical studies with sufficiently large numbers of patients with FS or BBE. Our aim was to clarify the nosological relationship. Medical records of patients suffering acute ophthalmoplegia and ataxia within four weeks of onset were reviewed. BBE was the diagnosis for patients with impaired consciousness, FS for those with clear consciousness and areflexia. Clinical features, neuroimages, and laboratory findings were analyzed. Patients were grouped as having BBE (n = 53), FS (n = 466), or as unclassified (n = 62). The BBE and FS groups had similar features; positive serum anti-GQ1b IgG antibody (68 % versus 83 %), antecedent Campylobacter jejuni infection (23 % versus 21 %), CSF albuminocytological dissociation (46 % versus 76 %), brain MRI abnormality (11 % versus 2 %), and abnormal EEG findings (57 % versus 25 %). BBE (n = 4) and FS (n = 28) subgroups underwent detailed electrophysiological testing. Both groups frequently showed absent soleus H-reflexes, but normal sensory nerve conduction (75 % versus 74 %) and a 1-Hz power spectrum peak on postural body sway analysis (67 % versus 72 %). Common autoantibodies, antecedent infections, and MRI and neurophysiological results found in this large study offer conclusive evidence that Bickerstaff's brainstem encephalitis and Fisher syndrome form a continuous spectrum with variable CNS and PNS involvement.

Effects of repeated ankle plantar-flexions on H-reflex and body sway during standing

The study investigated relations between effects of repeated ankle plantar-flexion movements exercise on the soleus Hoffmann (H) reflex and on postural body sway when maintaining upright stance. Ten young volunteers performed five sets of ankle plantar-flexions of both lower limbs. Assessment of the feet centre-of-pressure (COP) displacement and H-reflex tests were carried out in quiet stance before, during and after the exercise. H-max and M-max responses were obtained in 8 subjects and reported as the peak-to-peak amplitudes of the right soleus muscle electromyographic waves. Mean dispersion of COP along the antero-posterior direction increased significantly during the exercise; whilst the overall H-reflex response indicated a reduction without a concomitant modification in the M-max response. H-reflex responses, however, varied between participants during the first sets of exercise, showing two main trends of modulation: either depression or early facilitation followed by reduction of the H-reflex amplitude. The extent of reflex modulation in standing position was correlated to the concentric work performed during the exercise ( r = 0.85; p < 0.01), but not to the antero-posterior COP dispersion. These results suggest that during a repeated ankle plantar-flexions exercise, modulation of the H-reflex measured in upright stance differs across individuals and is not related to changes of postural sway.

Neck muscle fatigue and postural control in patients with whiplash injury

Objectives To examine if patients with whiplash injury show identifiable increases in neck muscle fatigability and associated increase in postural body sway after contractions of dorsal neck muscles, and if physiotherapy treatment reduces these effects. Methods Sway was measured during stance in 13 patients before and after 5 min of isometric dorsal neck muscle contractions and after recovery, pre- and post-physiotherapy, using a force platform. Amplitude and median frequency of neck muscle EMG were calculated during the contracting period. After each stance trial, patients gave a subjective score of sway. Results Pre-treatment, seven patients showed EMG signs of fatigue (increases in amplitude, decreases in median frequency) and increases in sway (eyes closed) after contractions. The other patients showed neither fatigue nor increased sway. Post-treatment, no signs of fatigue or imbalance were recorded in all patients, for the same levels of muscle contraction. Conclusions As in normal human subjects, increases in sway are associated with signs of neck muscle fatigue in some whiplash injury patients. Physiotherapy decreases the susceptibility to fatigue of neck muscles and is an effective choice of treatment of subjective instability and sway. Significance This study demonstrates a pathophysiological link between neck muscle fatigue and impaired postural control, and also that physiotherapy can relieve symptoms and signs of impaired neck muscle function by reducing muscle fatigability.

Relationship between Phenylglyoxylic Acid in Urine and Postural Body Sway in Styrene Exposed Workers

Relationship between Phenylglyoxylic Acid in Urine and Postural Body Sway in Styrene Exposed Workers

Smoking and balance: correlation of nicotine-induced nystagmus and postural body sway

Unaccustomed smoking may elicit transient nystagmus, dizziness, unsteadiness, and nausea. Infrared videonystagmography and posturography were performed simultaneously to study the differential effects of nicotine on the association of ocular motor and postural disturbances in 25 non- or occasional smokers. Sixteen showed nicotine-induced nystagmus (NIN) of various directions (mainly horizontal or upbeat) which was associated with a significant increase in postural sway after smoking a cigarette (total sway path (SP) before smoking 2.22 +/- 0.82 m/min (mean +/- s.d.), 1 min after smoking 3.83 +/- 1.41 m/min; p < 0.0004, ANOVA); nine showed neither effect. There was a high correlation between the intensity of the nystagmus (measured as peak slow phase velocity) and the increase in total SP (correlation coefficient 0.78) as well as the time courses of both. Visual fixation of an LED integrated in the mask not only caused a suppression of NIN but also a decrease in body sway. Transient ocular motor and postural effects are compatible with simultaneous nicotine-induced effects on the vestibulo-ocular and vestibulo-spinal functions.

Posture sway and the transition rate for a fall

Postural body sway displacements for quiet standing subjects (measured with a new ultrasonic device) are reported. Two of the well-known strategies for balancing, namely ankle and hip movements, were probed. The data are modeled using a Fokker–Planck–Langevin stochastic theory. Both analytic and computer simulation techniques are employed. The Kramers transition rate for a fall is expressed as a function of experimental parameters. The root mean square velocity is especially important for determining the fall probability.

Special sensory ataxia in Miller Fisher syndrome detected by postural body sway analysis.

To investigate whether ataxia in Miller Fisher syndrome (MFS) is caused by loss of proprioception or cerebellar dysfunction, we studied the power spectrum peak of the body sway frequency in 10 MFS patients, and compared the results with those of patients with cerebellar or sensory ataxia. The cerebellar patients had a peak at 2.4 Hz, whereas sensory ataxia patients had a 1-Hz peak. Nine of the MFS patients had a distinct 1-Hz peak. Clinical sensory loss or abnormal sensory nerve potentials were present in only 3 patients, whereas soleus H-reflexes were absent in all the MFS patients. MFS patients have dysfunction of the proprioceptive afferent system, and the special sensory ataxia may be caused by the selective involvement of muscle spindle afferents.

Brain Slow Potentials and Postural Sway Behavior During Sharpshooting Performance

In the present study, the relation of preparatory brain slow potentials (SPs) to postural body sway during sharp-shooting performance was examined. SPs from frontal, left-central, and right-central areas were recorded from 6 elite and 6 non-elite sharpshooters during a realistic simulated shooting task. A force platform technique was used in the recording of postural sway. The results showed that body sway, as indexed by sway amplitude and mean velocity, was associated with the concomitant SP changes. That relationship was dependent on the shooter's expertise level, however. The main finding among the elite shooters was that the reduced amplitude of body sway coincided with reduced frontal positivity, whereas in the non-elite shooters, the amplitude of sway and the mean sway velocity in the anteroposterior direction were typically accompanied by the lateralization of central negativity. Those findings offer some new insights for evaluating the functional significance of preparatory brain SPs associated with psychomotor processing in sharpshooting. The results from the present study also have implications for the understanding of the postural strategies employed by shooters of different expertise levels.