Postural Deficits Research Articles

The Tinetti Balance Test Is an Effective Predictor of Functional Decline in Non-Hospitalized Post-COVID-19 Individuals: A Cross-Sectional Study

Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. Methods: This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). Results: Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = −0.584), FRT (r = −0.542), MBT (r = −0.530), BBS (r = −0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted R2 = 0.318, p < 0.001). Conclusions: Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation.

Anticipatory postural adjustment deficits in children with developmental coordination disorder during a self-induced prehension task while standing on one leg

Effective postural control is essential for motor skill development, yet the specific nature of anticipatory control in children with Developmental Coordination Disorder (DCD) remains poorly understood for complex or dynamic stability tasks. This study investigated anticipatory postural adjustments (APA) during a self-initiated dynamic stability task. The Can Placement Task (CPT)—a self-initiated dynamic stability task—was performed by 23 children with DCD and 30 typically developing (TD) children aged 9–12 years. The task involved standing on one leg while also repositioning a can on the floor. Center of pressure (COP) movement was recorded by two force platforms during the five phases of the movement. The ground reaction force measured external support during both descent to pick up the can and ascent after replacing the can. The study used a mixed-design approach with group (DCD, TD) as a between-subject factor and condition (can position close or far) and phase of movement as within-subject. Distinct movement control characteristics were shown for children with DCD including a greater range of COP movement and higher COP velocity in the anterior-posterior direction prior to movement initiation compared with TD. The DCD group also relied more on external support during both the downward and upward phases of the CPT and needed more trials to complete the task. Only two significant interaction effects involving Group and the within-subject factors emerged. Children with DCD swayed significantly more at specific phases of the task, especially when coming up and restoring balance, and did not adapt COP velocity as a function of reaching distance. Dynamic control of posture in children with DCD is impaired as they struggle to generate the effective APAs necessary to maintain dynamic stability which leads to greater reliance on external support and more corrective movements. The CPT provides a valuable assessment of posture and dynamic balance control during a complex prehension movement performed on one leg; the task highlights distinct movement patterns between children with and without DCD.

Cognitive impairments and neurobiological changes induced by unilateral vestibular dysfunction in mice

The vestibular system is essential for balance and spatial orientation, and its dysfunction can lead to cognitive deficits. This study investigates the effects of unilateral vestibular dysfunction (UVL) on cognitive function and the underlying neurobiological changes in mice. We established a unilateral labyrinthectomy (UL) model in mice and assessed cognitive function at 28 days post-surgery using a comprehensive battery of behavioral tests. We found significant impairments in spatial reference memory, working memory, and synaptic plasticity in UL mice, which persisted despite compensation for vestibular and postural motor deficits. Immunofluorescence staining revealed enhanced activation of c-Fos in the hippocampal dentate gyrus (DG) at various time points post-UL, suggesting a role of the hippocampus in cognitive deficits following UVL. RNA sequencing of the DG identified differentially expressed genes (DEGs) and altered pathways related to cognitive function, synaptic plasticity, and neuronal activation. Quantitative real-time PCR (qRT-PCR) validated the expression changes of selected genes. Our findings indicate that UVL leads to persistent cognitive impairments in mice, associated with altered neuronal activation and gene expression in the hippocampus. This study offers valuable insights into the neurobiological mechanisms underlying cognitive deficits associated with UVL. Moreover, it underscores the importance of early cognitive screening in patients with vestibular diseases, as this approach is instrumental in comprehensive condition assessment, precise diagnosis, targeted treatment, and effective rehabilitation.

Investigating postural control as a predictor of low back and pelvic girdle pain during and after pregnancy

BackgroundFalls are common during pregnancy, posing risks to maternal and fetal health. Pregnant individuals also commonly experience low back and/or pelvic girdle pain. Other populations with pain, such as older adults with back pain demonstrate increased fall risk. This study assessed the relationship between standing balance control characteristics during single leg stance and low back/pelvic girdle pain scores during and after pregnancy with eyes open and closed. We hypothesized that standing balance control characteristics of smaller sway and sway velocity would be related to greater low back/pelvic girdle pain during the third trimester. MethodsDuring the second trimester, third trimester, and postpartum nineteen individuals performed single leg stance on a force platform with eyes open and closed and completed the Quebec Back Pain Disability Scale. Stepwise multiple linear regressions were used to investigate the variance of Quebec Back Pain Disability Scale scores that could be explained by postural control variables for each time point and condition. FindingsDuring the third trimester, decreased total sway and anterior/posterior sway range with eyes closed were significantly associated with higher low back/pelvic girdle pain disability scores (P = 0.005, R2 = 0.480). No significant relationships were found during the second trimester or postpartum nor for eyes open conditions. InterpretationThis study suggests a potential association between low back/pelvic girdle pain and postural control during pregnancy. Pregnant individuals with lumbopelvic pain may demonstrate postural stability deficits, particularly without visual input. Balance assessments and interventions should be considered during routine care for pregnant individuals, especially for those with pain.

Tau load in select brainstem neurons predicts the severity and nature of balance deficits in the absence of cell death.

Patients with tauopathies present with profoundly different clinical symptoms 1 , even within the same disorder 2 . A central hypothesis in the field, well-supported by biomarker studies 3,4 and post-mortem pathology 5-7 , is that clinical heterogeneity reflects differential degeneration of vulnerable neuronal populations responsible for specific neurological functions. Recent work has revealed mechanisms underlying susceptibility of particular cell types 8-10 , but relating tau load to disrupted behavior - es- pecially before cell death - requires a targeted circuit-level approach. Here we studied two distinct balance behaviors in larval zebrafish 11 expressing a human 0N/4R-tau allele 12 in select populations of evolutionarily-conserved and well-characterized brainstem vestibular circuits 13,14 . We observed that human tau load predicted the severity of circuit-specific deficits in posture and navigation in the ab- sence of cell death. Targeting expression to either mid- or hindbrain balance neurons recapitulated these particular deficits in posture and navigation. By parametrically linking tau load in specific neu- rons to early behavioral deficits, our work moves beyond cell type to close the gap between pathological and neurological conceptions of tauopathy.

Evaluation of gabapentin administration on neurologic examination in 2 different age groups of healthy cats.

Gabapentin is often administered PO for preappointment or in-hospital anxiolysis in cats. A previous study reported mild changes on the neurologic examination after administration. Investigate the effects of gabapentin on anxiety, sedation, compliance, and neurologic examination in 2 age groups of cats. Thirty-one young cats and 12 geriatric cats perceived by their owners to be healthy and neurologically normal. Prospective double-blinded clinical crossover study. Assessment of baseline sedation and anxiety was performed before initial neurologic examinations and after gabapentin administration (100 mg/cat). Assessments were repeated 90 to 120 minutes after administration. Ease of handling pregabapentin and postgabapentin was assessed in the younger cats. All examinations were performed by a board-certified veterinary neurologist and scoring of examinations was performed by a different, masked board-certified neurologist. Sixteen cats (50%) in the younger cohort and 6 cats (50%) in the geriatric cohort exhibited an increase in their overall neurologic examination score postgabapentin administration, mainly through new or progressive postural reaction deficits and gait changes. Anxiety and sedation scores were significantly changed in the geriatric population (P < .01, P = .004, respectively); however, only sedation scores were significantly increased in the younger cats after gabapentin administration (P = .004). All study participants showed mild neurologic changes after gabapentin administration, most markedly noted in the geriatric population. Dose reduction of gabapentin for preappointment anxiolysis and neurologic examination in geriatric patients should be considered.

Mobility Assistive Technology (AT) for Children with Cerebral Palsy (CP): A Literature Review

This paper comprehensively reviews the use of mobility Assistive Technology (MAT) in children with Cerebral Palsy (CP). Currently, 9 million people are severely affected by CP, the most serious form of movement disability, characterized by deficits in movement, posture, and more, alongside cognitive and sensory deficits. These impairments restrict the child’s functionality in self-care, performing tasks associated with daily living, and socialization. The main purpose of this paper is to establish the role of MAT in supporting children with CP and assess its impact on their lives. This review describes a range of devices that enhance mobility in motor-disabled patients such as powered wheelchairs, robotic exoskeletons, ankle-foot orthoses (AFO), and gait trainers, and examines their effects on the psychosocial well-being and physical growth of children with CP. A methodical search performed within the PRISMA framework enabled us to analyze papers from 2010 to 2024, discussing the advantages and disadvantages of assistive technology (AT). It was noted that although ATs can improve independence, social involvement, and mobility, challenges remain such as high costs, poor design, and unavailability of these resources in underprivileged regions. New information technologies, including intelligent systems and virtual reality (VR) training tools, are effective in addressing health-related issues; however, the optimization of these techniques over a long period needs further study. This paper underscores the importance of a more child-centred design of AT devices and additional policy adjustments to enhance accessibility across different socio-economic strata. Through this review, we seek to advance the emerging understanding of the role of mobility AT in enhancing the lives of children with CP, focusing on identifying weaknesses in the existing research and suggesting possible advancements.

A versatile knee exoskeleton mitigates quadriceps fatigue in lifting, lowering, and carrying tasks.

The quadriceps are particularly susceptible to fatigue during repetitive lifting, lowering, and carrying (LLC), affecting worker performance, posture, and ultimately lower-back injury risk. Although robotic exoskeletons have been developed and optimized for specific use cases like lifting-lowering, their controllers lack the versatility or customizability to target critical muscles across many fatiguing tasks. Here, we present a task-adaptive knee exoskeleton controller that automatically modulates virtual springs, dampers, and gravity and inertia compensation to assist squatting, level walking, and ramp and stairs ascent/descent. Unlike end-to-end neural networks, the controller is composed of predictable, bounded components with interpretable parameters that are amenable to data-driven optimization for biomimetic assistance and subsequent application-specific tuning, for example, maximizing quadriceps assistance over multiterrain LLC. When deployed on a backdrivable knee exoskeleton, the assistance torques holistically reduced quadriceps effort across multiterrain LLC tasks (significantly except for level walking) in 10 human users without user-specific calibration. The exoskeleton also significantly improved fatigue-induced deficits in time-based performance and posture during repetitive lifting-lowering. Last, the system facilitated seamless task transitions and garnered a high effectiveness rating postfatigue over a multiterrain circuit. These findings indicate that this versatile control framework can target critical muscles across multiple tasks, specifically mitigating quadriceps fatigue and its deleterious effects.

Vestibular Function and Postural Control in Children with Autism Spectrum Disorder.

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks-Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention.

The effect of dual-task training on postural and cognitive performances in adolescents with down syndrome

BackgroundThe dual task training (DTT) has been shown to improve postural and cognitive performances in many populations. Therefore, it seems of interest to explore the effect of such training modality in individuals with Down syndrome (DS) presenting both cognitive and postural deficits. AimsThis study explored the effect of a DTT compared to a single task training (STT) on postural and cognitive performances in adolescents with DS. Methods and proceduresThe center of pressure velocity (CoPVm) and the cognitive performance in the selective word recall test were recorded under single task (ST) and DT conditions before and after 8 weeks in the STT group (STTG), the DTTG and the control group (CG). Outcomes and resultsBefore training, CoPVm values increased and cognitive performances decreased (p < 0.001) during the DT compared to ST conditions in all groups. After training, CoPVm decreased (p < 0.001) in the DTTG and the STTG under the ST conditions. However, under DT conditions, these values decreased (p < 0.001) only in the DTTG. The cognitive performance increased (p < 0.001) only in the DTTG in both ST and DT conditions. ConclusionThe DTT is strongly recommended to improve both postural and cognitive performances in individuals with DS notably in DT conditions.

Novel C. elegans models of Lewy body disease reveal pathological protein interactions and widespread miRNA dysregulation

Lewy body diseases (LBD) comprise a group of complex neurodegenerative conditions originating from accumulation of misfolded alpha-synuclein (α-syn) in the form of Lewy bodies. LBD pathologies are characterized by α-syn deposition in association with other proteins such as Amyloid β (Aβ), Tau, and TAR-DNA-binding protein. To investigate the complex interactions of these proteins, we constructed 2 novel transgenic overexpressing (OE) C. elegans strains (α-synA53T;Taupro-agg (OE) and α-synA53T;Aβ1-42;Taupro-agg (OE)) and compared them with previously established Parkinson’s, Alzheimer’s, and Lewy Body Dementia disease models. The LBD models presented here demonstrate impairments including uncoordinated movement, egg-laying deficits, altered serotonergic and cholinergic signaling, memory and posture deficits, as well as dopaminergic neuron damage and loss. Expression levels of total and prone to aggregation α-syn protein were increased in α-synA53T;Aβ1-42 but decreased in α-synA53T;Taupro-agg animals when compared to α-synA53T animals suggesting protein interactions. These alterations were also observed at the mRNA level suggesting a pre-transcriptional mechanism. miRNA-seq revealed that cel-miR-1018 was upregulated in LBD models α-synA53T, α-synA53T;Aβ1-42, and α-synA53T;Taupro-agg compared with WT. cel-miR-58c was upregulated in α-synA53T;Taupro-agg but downregulated in α-synA53T and α-synA53T;Aβ1-42 compared with WT. cel-miR-41-3p and cel-miR-355-5p were significantly downregulated in 3 LBD models. Our results obtained in a model organism provide evidence of interactions between different pathological proteins and alterations in specific miRNAs that may further exacerbate or ameliorate LBD pathology.

Dynamic balance and gait impairments in Parkinson's disease: novel cholinergic patterns.

The cholinergic system has been implicated in postural deficits, in particular falls, in Parkinson's disease (PD). Falls and freezing of gait typically occur during dynamic and challenging balance and gait conditions, such as when initiating gait, experiencing postural perturbations, or making turns. However, the precise cholinergic neural substrate underlying dynamic postural and gait changes remains poorly understood. The aim of this study was to investigate whether brain vesicular acetylcholine transporter binding, as measured with [18F]-fluoroethoxybenzovesamicol binding PET, correlates with dynamic gait and balance impairments in 125 patients with PD (mean age 66.89 ± 7.71 years) using the abbreviated balance evaluation systems test total and its four functional domain sub-scores (anticipatory postural control, reactive postural control, dynamic gait, and sensory integration). Whole brain false discovery-corrected (P < 0.05) correlations for total abbreviated balance evaluation systems test scores included the following bilateral or asymmetric hemispheric regions: gyrus rectus, orbitofrontal cortex, anterior part of the dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, cingulum, frontotemporal opercula, insula, fimbria, right temporal pole, mesiotemporal, parietal and visual cortices, caudate nucleus, lateral and medial geniculate bodies, thalamus, lingual gyrus, cerebellar hemisphere lobule VI, left cerebellar crus I, superior cerebellar peduncles, flocculus, and nodulus. No significant correlations were found for the putamen or anteroventral putamen. The four domain-specific sub-scores demonstrated overlapping cholinergic topography in the metathalamus, fimbria, thalamus proper, and prefrontal cortices but also showed distinct topographic variations. For example, reactive postural control functions involved the right flocculus but not the upper brainstem regions. The anterior cingulum associated with reactive postural control whereas the posterior cingulum correlated with anticipatory control. The spatial extent of associated cholinergic system changes were least for dynamic gait and sensory orientation functional domains compared to the anticipatory and reactive postural control functions. We conclude that specific aspects of dynamic balance and gait deficits in PD associate with overlapping but also distinct patterns of cerebral cholinergic system changes in numerous brain regions. Our study also presents novel evidence of cholinergic topography involved in dynamic balance and gait in PD that have not been typically associated with mobility disturbances, such as the right anterior temporal pole, right anterior part of the dorsomedial prefrontal cortex, gyrus rectus, fimbria, lingual gyrus, flocculus, nodulus, and right cerebellar hemisphere lobules VI and left crus I.

Clinical and magnetic resonance imaging features of unilateral thalamic porencephaly in a dog

AbstractA 1‐year‐3‐month‐old, female, neutered labrador retriever was presented with a history of circling behaviour since 2 months of age and a recently detected blindness affecting its right eye. Neurological examination revealed a left‐sided head tilt, compulsive tight circling towards the left, postural reaction deficits in the right thoracic and pelvic limbs, absent menace response in the right eye and ventral positional strabismus of the left eye. The neurological examination findings were localised to the left thalamus. Magnetic resonance imaging of the head revealed porencephaly involving the left dorsal aspect of the thalamus. Furthermore, reduced volume of the left rostral colliculus, crus cerebri and optic chiasm, alongside marked thinning of the left cerebral hemispheric white matter tracts with associated left lateral ventriculomegaly, were present. Based on magnetic resonance imaging features and clinical history, a congenital or perinatal encephaloclastic porencephaly with secondary hypoplasia or atrophy of the associated thalamic projection pathways was prioritised.

Is Visual Reliance Increased in Athletes After ACL Injury? A Scoping Review.

Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive-motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury. The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance. Scoping review. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases. Only primary studies published in English were included without time limitations. Qualitative analysis of the included studies was performed. We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual-cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls. Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual-cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R. IV. The protocol was a priori registered on Open Science Framework ( https://osf.io/p4j95/ ).

Checks and balances: a meta-analysis on the known-groups validity of functional postural control tests in children.

Pediatric physical therapists commonly treat children with postural control deficits. Ideally, pediatric functional postural control tests should therefore be able to identify postural control deficits in children with various disorders. Despite a plethora of available tests, evidence for their validity - especially known-groups - remains scarce. This review aims to determine the known-group validity of available functional postural control tests to differentiate various pediatric pathological groups of different ages from their typically developing (TD) peers. PubMed, Web of Science and Scopus were systematically searched (last update: February 2023; PROSPERO: CRD42023408982). Forty case-control studies with a pathological pediatric sample (N.=1331) and TD peers (N.=1889) were included and selected for data-extraction and -analysis. Risk of bias was assessed using the SIGN checklist and level of evidence was scored using GRADE. Random-effect meta-analyses were performed to estimate pooled standardized mean differences (SMD) for the various test types and subclassified based on pathology and/or age. When compared with TD peers, children with underlying pathologies performed significantly worse on pediatric functional postural control test batteries (SMD=-2.21), the Timed Up and Go Test and variants (SMD=2.30), the One Leg Stance test and variants (SMD=-2.14), while the Reach tests showed a smaller difference (SMD=-1.19). Subclassification within the meta-analyses showed that pathology was an influencing factor for the test batteries and the one leg stance test and variants. Age was an influencing factor for the reach tests. None of the included functional postural control tests exceeded a low level of evidence. Pediatric functional postural control tests that assess multiple aspects of postural control (such as test batteries) seem to offer higher known-groups validity than single-task tests (e.g. reach tests). The underlying pathology has a larger impact on the validity of these tests than age. There remains an overall low level of evidence for the known-groups validity of pediatric functional postural control tests indicating the need for research with more homogenous groups and norm reference data.

Balance Control Impairments in Usher Syndrome.

To explore postural disability in Usher Syndrome (USH) patients using temporal posturographic analysis to better elucidate sensory compensation strategies of deafblind patients for posture control and correlate the Activities-specific Balance Confidence (ABC) scale with posturographic variables. Thirty-four genetically confirmed USH patients (11 USH1, 21 USH2, 2 USH 4) from the Otolaryngology Outpatient Clinic and 35 controls were prospectively studied using both classical and wavelet temporal analysis of center of pressure (CoP) under different visual conditions on static and dynamic platforms. The functional impact of balance was assessed with the ABC scale. Classical data in the spatial domain, Sensorial Organization Test, and frequency analysis of the CoP were analyzed. On unstable surfaces, USH1 had greater CoP surface area with eyes open (38.51 ± 68.67) and closed (28.14 ± 31.64) versus controls (3.31 ± 4.60), p < 0.001 and (7.37 ± 7.91), p < 0.001, respectively. On an unstable platform, USH consistently showed increased postural sway, with elevated angular velocity versus controls with eyes open (USH1 [44.94 ± 62.54]; USH2 [55.64 ± 38.61]; controls [13.4 ± 8.57]) (p = 0.003; p < 0.001) and closed (USH1 [60.36 ± 49.85], USH2 [57.62 ± 42.36]; controls [27.31 ± 19.79]) (p = 0.002; p = 0.042). USH visual impairment appears to be the primary factor influencing postural deficits, with a statistically significant difference observed in the visual Sensorial Organization Test ratio for USH1 (80.73 ± 40.07, p = 0.04) and a highly significant difference for USH2 (75.48 ± 31.67, p < 0.001) versus controls (100). In contrast, vestibular (p = 0.08) and somatosensory (p = 0.537) factors did not reach statistical significance. USH exhibited lower visual dependence than controls (30.31 ± 30.08) (USH1 [6 ± 11.46], p = 0.004; USH2 [8 ± 14.15], p = 0.005). The postural instability index, that corresponds to the ratio of spectral power index and canceling time, differentiated USH from controls on unstable surface with eyes open USH1 (3.33 ± 1.85) p < 0.001; USH2 (3.87 ± 1.05) p < 0.002; controls (1.91 ± 0.85) and closed USH1 (3.91 ± 1.65) p = 0.005; USH2 (3.92 ± 1.05) p = 0.045; controls (2.74 ± 1.27), but not USH1 from USH2. The canceling time in the anteroposterior direction in lower zone distinguished USH subtypes on stable surface with optokinetic USH1 (0.88 ± 1.03), USH2 (0.29 ± 0.23), p = 0.026 and on unstable surface with eyes open USH1 (0.56 ± 1.26), USH2 (0.072 ± 0.09), p = 0.036. ABC scale could distinguish between USH patients and controls, but not between USH subtypes and it correlated with CoP surface area on unstable surface with eyes open only in USH1(ρ = 0.714, p = 0.047). USH patients, particularly USH1, exhibited poorer balance control than controls on unstable platform with eyes open and appeared to rely more on proprioceptive information while suppressing visual input. USH2 seems to use different multisensory balance strategies that do not align as well with the ABC scale. The advanced analysis provided insights into sensory compensation strategies in USH subtypes.

Effects of Functional Fatigue Protocol and Visual Information on Postural Control in Patients with Chronic Ankle Instability

Chronic ankle instability (CAI) patients often exhibit postural control deficits and rely on visual information to maintain static balance to compensate for decreased proprioception. Fatigue impairs neuromuscular control, in addition to postural control, in CAI patients. However, whether functional fatiguing exercises alter postural control and sensory organization strategies during single-leg balance tests in CAI patients remains unclear. This study involved a controlled trial on 28 CAI patients in a laboratory setting. Each participant performed a single-leg balance test with eyes open (EO) and eyes closed (EC) before and after a functional fatigue protocol. Two-way repeated-measures ANOVA evaluated fatigue (pre- vs. post-fatigue) × vision (EO vs. EC) interactions for outcome variables. Additionally, paired-sample t-tests examined differences between two conditions (pre- vs. post-fatigue) for time-to-boundary (TTB) minima (%modulation). We found significant interactions between fatigue and vision conditions in ML and AP TTBmeans and AP TTBsds. %Modulations were significantly decreased after fatigue in AP TTBmean, ML TTBsd, and AP TTBsd. In conclusion, static postural control ability decreased after the functional fatigue protocol with EO, but was unchanged with EC. This suggests that decreased balance ability is more pronounced with EO under fatigue due to less visual dependence. This may increase ankle sprain incidence under fatigue.

Evaluating the Stability Limits Between Individuals with Mild and Moderate-to-Severe Grades of Forward Head Posture

Background: Forward head posture (FHP) leads to the anterior excursion of the center of gravity, which can affect a person's standing balance. Evaluating the balance in different degrees of severity of FHP can help design and plan appropriate balance exercises for people with FHP. Objectives: This study aimed to evaluate the changes in the limits of stability (LOS) in people with mild and moderate-to-severe grades of FHP. Methods: The participants in this study were 70 individuals suffering from FHP, aged between 17 - 45. They were divided into two groups based on their craniovertebral angle: Mild (&gt; 45.5 degrees) and moderate-to-severe (&lt; 45.5 degrees). The LOS test was performed using a posturography device (Neurocom, Equitest, USA). Five indices—movement reaction time (RCT), movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL)—were evaluated. Results: Based on the results of the LOS test, RCT, MVL, EPE, MXE, and DCL were significantly different between the mild and moderate-to-severe FHP groups in both anterior and posterior directions (P &lt; 0.05). However, in other directions, no significant difference was observed in these variables based on the LOS test (P &gt; 0.05). Conclusions: It can be concluded that individuals with moderate-to-severe FHP are more likely to have postural control deficits. Therefore, it is necessary to design appropriate targeted interventions to prevent falls in these individuals. Specifically, they should receive balance exercises in dynamic situations.

Postural control imbalance in individuals with a minor lower extremity amputation: a scoping review protocol.

Introduction Lower extremity amputations (LEA) impact the quality of life and physical abilities and increase the risk of developing secondary health complications. Current literature predominantly focuses on major LEA, leaving a gap in understanding biomechanics related to balance and postural control in minor LEA. The shifts towards increased rates of minor LEA, due to improved quality of care and patient management, highlights the need for a focused exploration of postural control deficits in this population. The scoping review will address this gap in the literature. Objectives The purpose of the review is to synthesize current research on postural control deficits following a minor foot amputation, focusing on any resections through or distal to the ankle joint, and to evaluate interventions aimed at improving balance in affected individuals. Inclusion criteria The review will encompass individuals of all ages who underwent a minor foot amputation, including various levels and etiologies. It will focus on quantitative data related to standing posture, ability to perform self-balanced activities of daily living, and external aids or treatments to improve postural control. The outcomes will include modifications in the sensation of balance, fall predictors, and biomechanical changes in postural control. Methods A preliminary search of MEDLINE (PubMed) was conducted to develop a full search strategy aimed at compiling all existing scientific articles on postural control and balance in individuals with a minor LEA. A comprehensive search will be performed across multiple databases and grey literature. Two reviewers will independently extract the data. The Mixed Methods Appraisal Tool will be used to assess risk and quality. Discussion By emphasizing the understudied aspects of postural control imbalances induced by minor LEA, the review will highlight potential areas for therapeutic intervention and contribute to a better understanding of rehabilitation for those affected.

Potential Prodromal Digital Postural Sway Markers for Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Detected via Dual-Tasking and Sensory Manipulation.

FXTAS is a neurodegenerative disorder occurring in some Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutation carriers (PMCs) and is characterized by cerebellar ataxia, tremor, and cognitive deficits that negatively impact balance and gait and increase fall risk. Dual-tasking (DT) cognitive-motor paradigms and challenging balance conditions may have the capacity to reveal markers of FXTAS onset. Our objectives were to determine the impact of dual-tasking and sensory and stance manipulation on balance in FXTAS and potentially detect subtle postural sway deficits in FMR1 PMCs who are asymptomatic for signs of FXTAS on clinical exam. Participants with FXTAS, PMCs without FXTAS, and controls underwent balance testing using an inertial sensor system. Stance, vision, surface stability, and cognitive demand were manipulated in 30 s trials. FXTAS participants had significantly greater total sway area, jerk, and RMS sway than controls under almost all balance conditions but were most impaired in those requiring vestibular control. PMCs without FXTAS had significantly greater RMS sway compared with controls in the feet apart, firm, single task conditions both with eyes open and closed (EC) and the feet together, firm, EC, DT condition. Postural sway deficits in the RMS postural sway variability domain in asymptomatic PMCs might represent prodromal signs of FXTAS. This information may be useful in providing sensitive biomarkers of FXTAS onset and as quantitative balance measures in future interventional trials and longitudinal natural history studies.