Postural Stability In Older Adults Research Articles

Moving together-benefits of a 12-week online dance training intervention on static and dynamic postural stability and gait speed in older women: an exploratory pre-post study.

Physical inactivity negatively affects gait performance and postural stability in older adults resulting in a higher risk of fall accidents. Previous research has shown that in-person dance training improves various aspects of balance and lower-extremity function, however, little is known about the potential benefits of dance training delivered online on variables used for fall risk stratification in older adults. We aimed to explore the benefits of a 12-week online dance training intervention on static and dynamic postural stability and gait speed in older women. Forty-five older adults (44 women) were included in this exploratory pre-post study. The 12-week dance intervention consisted of two weekly 60-min classes in contemporary (improvisation) and salsa dance delivered online through Zoom video calls. Static and dynamic postural stability was assessed using the center of pressure (CoP) area and velocity (force platform), and the Mini Balance Evaluation Systems Test (Mini-BESTest), respectively. 10-m gait speed was measured using photo gates. Before and after comparisons were performed using paired sample t-tests. Thirty-two older women completed the study. There were no significant changes for static postural stability assessed by CoP area or velocity (P ≥ 0.218, Cohen d ≤ 0.234). The Mini-BESTest total score was significantly improved at post-intervention (23.88 ± 3.01) compared to baseline (22.56 ± 1.41, P = 0.007, d = 0.52). 10-m gait speed was significantly faster at post-intervention (1.68 ± 0.25 m/s) compared to baseline (1.57 ± 0.22 m/s, P < 0.001, d = 0.737). Although some caution is needed due to the uncontrolled study design, the results indicate that online dance training has a small effect on static postural stability but may be beneficial for gait speed and in particular dynamic postural control among older women. While the absolute increase in gait speed suggests limited clinical relevance, the change in Mini-BESTest score may reflect a clinically meaningful enhancement of dynamic postural control.

Exploring the Nexus of lower extremity proprioception and postural stability in older adults with osteoporosis: a cross-sectional investigation.

Osteoporosis, characterized by reduced bone mass and micro-architectural deterioration, poses a significant public health concern due to increased fracture susceptibility. Beyond bone health, this cross-sectional study aimed to assess and compare lower extremity proprioception and postural stability in individuals with and without osteoporosis and to explore their correlation within the osteoporosis group. In this prospective cross-sectional study, 80 participants were divided into two groups: osteoporosis (n = 40) and control (n = 40). The demographic characteristics and clinical parameters of the participants were as follows: Age (years) - Osteoporosis group: 65.04 ± 4.33, Control group: 65.24 ± 4.63; Sex (%) - Osteoporosis group: Male 30%, Female 70%; Control group: Male 30%, Female 70%; Body mass index (kg/m2) - Osteoporosis group: 23.7 ± 3.2, Control group: 24.5 ± 4.6; T-score (Lumbar) - Osteoporosis group: -2.86 ± 1.23, Control group: 0.27 ± 0.58; T-score (hip) - Osteoporosis group: -2.28 ± 0.79, Control group: 0.68 ± 0.86. Joint Position Sense (JPS) at the hip, knee, and ankle was assessed using a digital inclinometer, and postural stability was measured using computerized force platforms. Osteoporosis participants exhibited higher errors in hip (5.63° vs. 2.36°), knee (4.86° vs. 1.98°), and ankle (4.46° vs. 2.02°) JPS compared to controls. Postural stability measures showed increased anterior-posterior sway (10.86 mm vs. 3.98 mm), medial-lateral sway (8.67 mm vs. 2.89 mm), and ellipse area (966.88 mm2 vs. 446.19 mm2) in osteoporosis participants. Furthermore, correlation analyses within the osteoporosis group unveiled significant positive associations between lower extremity proprioception and postural stability. Specifically, hip JPS exhibited a strong positive correlation with anterior-posterior sway (r = 0.493, p = 0.003), medial-lateral sway (r = 0.485, p = 0.003), and ellipse area (r = 0.496, p < 0.001). Knee JPS displayed a moderate positive correlation with anterior-posterior sway (r = 0.397, p = 0.012), medial-lateral sway (r = 0.337, p = 0.032), and ellipse area (r = 0.378, p < 0.001). Similarly, ankle JPS showed a moderate positive correlation with anterior-posterior sway (r = 0.373, p = 0.023), medial-lateral sway (r = 0.308, p = 0.045), and ellipse area (r = 0.368, p = 0.021). These findings underscore the interplay between proprioceptive deficits, compromised postural stability, and osteoporosis, emphasizing the need for targeted interventions to improve fall prevention strategies and enhance the quality of life for individuals with osteoporosis.

Sensory Reweighting for Postural Control in Older Adults with Age-Related Hearing Loss.

There is growing evidence linking hearing impairments and the deterioration of postural stability in older adults. To our knowledge, however, no study to date has investigated the effect of age-related hearing loss on the sensory reweighting process during postural control. In the absence of data, much is unknown about the possible mechanisms, both deleterious and compensatory, that could underly the deterioration of postural control following hearing loss in the elderly. The aim of this study was to empirically examine sensory reweighting for postural control in older adults with age-related hearing loss as compared to older adults with normal hearing. The center of pressure of all participants was recorded using a force platform and the modified clinical test of sensory interaction and balance protocol. The results suggest that individuals with age-related hearing loss displayed increased somatosensory reliance relative to normal hearing younger adults. This increased reliance on somatosensory input does not appear to be effective in mitigating the loss of postural control, probably due to the concomitant deterioration of tactile and proprioceptive sensitivity and acuity associated with aging. Beyond helping to further define the role of auditory perception in postural control, these results further the understanding of sensory-related mechanisms associated with postural instability in older adults.

Visual Predictors of Postural Sway in Older Adults.

PurposeAccurate perception of body position relative to the environment through visual cues provides sensory input to the control of postural stability. This study explored which vision measures are most important for control of postural sway in older adults with a range of visual characteristics.MethodsParticipants included 421 older adults (mean age = 72.6 ± 6.1), 220 with vision impairment associated with a range of eye diseases and 201 with normal vision. Participants completed a series of vision, cognitive, and physical function tests. Postural sway was measured using an electronic forceplate (HUR Labs) on a foam surface with eyes open. Linear regression analysis identified the strongest visual predictors of postural sway, controlling for potential confounding factors, including cognitive and physical function.ResultsIn univariate regression models, unadjusted and adjusted for age, all of the vision tests were significantly associated with postural sway (P < 0.05), with the strongest predictor being visual motion sensitivity (standardized regression coefficient, β = 0.340; age-adjusted β = 0.253). In multiple regression models, motion sensitivity (β = 0.187), integrated binocular visual fields (β = −0.109), and age (β = 0.234) were the only significant visual predictors of sway, adjusted for confounding factors, explaining 23% of the variance in postural sway.ConclusionsOf the vision tests, visual motion perception and binocular visual fields were most strongly associated with postural stability in older adults with and without vision impairment.Translational RelevanceFindings provide insight into the visual contributions to postural stability in older adults and have implications for falls risk assessment.

Exercise to Improve Postural Stability in Older Adults with Alzheimer's Disease: A Systematic Review of Randomized Control Trials.

In this systematic review, we aim to synthesize published evidence on the effects of exercise in improving postural stability among older adults with Alzheimer’s Disease (AD). A systematic electronic literature search was undertaken in Pedro, Cochrane, MEDLINE, ProQuest, Science direct and Clinical trial databases involving human participants published from year 2000–2022. This search was updated in June 2022. The studies chosen were based on predetermined criteria. Data relating to the contents and parameters of exercise in persons with AD were gathered and analyzed. A total of 8 experimental studies met the inclusion criteria. Overall, the selected studies were of a medium quality. In these studies, information and physical exercises were used to improve postural stability in older adults with AD. The findings of the review suggest that performing combined strength, balance and executive function training can improve postural stability. However, we are unable to conclude the specific dose for specific type of exercise. More high-quality studies are required pertaining to exercise prescription for older adults with AD. Mostly, information and physical exercise were delivered via face-to-face sessions conducted by health professionals. The structure of exercises summarized in this review may be beneficial for older adults with AD to improve postural stability and as a result reduce falls.

Mental Fatigue Impairs Postural Stability in Older Adults

ABSTRACT Purpose: Postural instability can increase the risk of a fall in older adults. In this study, the impact of mental fatigue on postural stability among healthy older adults was investigated. Method: Participants were randomly divided into two groups: experimental and control groups. Postural stability of all participants was tested using the Biodex Balance System (BBS) before and immediately after watching a 30-min documentary program (control group) or completing a 30-min Stroop task (experimental group). Subjective ratings of mental fatigue were measured before and after the Stroop task or watching documentary program. Results: The results indicated that experimental group revealed higher stability scores in the posttest compared to pretest (P ≥ 0.001). However, there were no significant differences for BBS scores between pre and posttest in control group (P = .688). In addition, posttest of subjective ratings of mental fatigue was significantly different between experimental and control groups. Finally, there was also evidence of an association between Visual analog scale and BBS scores in the experimental group (rs = 0.712, P = .002). Conclusions: Mental fatigue caused by Stroop task had a negative impact on postural stability in older adults. This may be due to reduction in attentional resources that was caused by mental fatigue. Thus, mental fatigue could be considered as a risk factor for increased risk of falls in older adults

The Association between Hearing Impairment and Postural Stability in Older Adults: A Systematic Review and Meta-analysis.

There is growing evidence linking hearing impairment to higher falls risk through alterations in postural stability, with studies showing mixed results. The primary aim of this systematic review and meta-analysis was to determine the association between hearing impairment and postural instability in older adults, including differences based on severity of hearing impairment. This review was pre-registered in PROSPERO and performed in accordance with PRISMA guidelines across six databases. Primary research on adults aged 60 years and older with hearing loss and an objective measure of postural stability or gait were eligible for inclusion. Methodological quality was assessed using the modified Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Data were analysed using meta-analyses and a narrative synthesis. Inclusion in the meta-analyses required clearly defined audiometrically-assessed hearing impairment, and two subgroups of participants: mild (25-40 dB HL) and moderate to-severe (>40 dB HL) hearing impairment. Twenty-five eligible studies (n = 27,847) were included in the narrative synthesis, with quality ratings ranging from unsatisfactory to very good on the modified NOS. Eight studies were included in the meta-analysis which showed individuals with moderate to-severe hearing impairment were significantly slower on the 5 x sit-to-stand test (mean difference[95%CI] = 0.50 s [0.04, 0.97], p = .03), had a slower gait speed (mean difference[95%CI] = -0.11 s [-0.16, -0.05], p < .001) and had lower total Short Physical Performance Battery scores (mean difference[95%CI] = -0.79[-1.17, -0.41], p < .001) than those with normal hearing. This review provides evidence there is an inverse association between increasing severity of hearing impairment and poorer postural stability across both the meta-analysis and narrative synthesis.

Effects of intrinsic-foot-muscle exercise combined with the lower extremity resistance training on postural stability in older adults with fall risk: study protocol for a randomised controlled trial

BackgroundFalls are one of the most common accidents in older adults, often leading to injury, disability and quality-of-life declines. Foot core function contributes to postural stability in most static postures and dynamic activities. As efficient foot core training, the intrinsic-foot-muscle exercise has been proposed to improve postural control. However, the effects of the exercise on postural stability in the elderly remain unclear. Therefore, this study attempts to investigate the effect of 12-week intrinsic-foot-muscle exercise on postural stability in older adults with fall risk.MethodsWe will conduct a prospective, single-blind randomised controlled trail on 120 older adults with fall risk. Participants will be randomly assigned to an intrinsic-foot-muscle exercise combining the lower extremity resistance training group (IFM group), an extrinsic-foot-muscle exercise combining the lower extremity resistance training group (EFM group) and a control group. The control group will perform lower extremity resistance training. The IFM and EFM groups will be given additional short-foot exercise or towel-curl exercise training, respectively. After the intervention, participants will be followed up for another 12 weeks with no active intervention. The outcome measures will include the postural stability measurements, self-reported postural stability, number of falls, intrinsic-foot-muscle strength and foot arch function. Furthermore, adverse events will be recorded and analysed. If any participant withdraws from the trial, an intention-to-treat analysis will be performed.DiscussionThe trial is designed to investigate the efficacy of a 12-week intrinsic foot muscle training combined with the lower extremity resistance training on postural stability outcomes in elderly people with fall risk. The trial will also examine the comprehensive outcomes of postural stability during static standing and dynamic movements. The function of intrinsic foot muscle to support the arch will also be evaluated. Important features of this trial mainly include intervention setting, outcome measure selection and study duration. The results of this study will determine the effectiveness and provide scientific evidence to establish comprehensive fall prevention intervention.Trial registrationChinese Clinical Trial Registry ChiCTR2000033623. Registered on 7 June 2020. http://www.chictr.org.cn/showproj.aspx?proj=54741

The effect of low light levels on postural stability in older adults with age-related macular degeneration.

To investigate the effect of low light levels on postural stability in older adults with and without age-related macular degeneration (AMD). Participants included 28 older adults [14 with AMD (mean age ± S.D., 83.4±6.7years) and 14 controls with normal vision (74.6±3.3years)]. Postural stability was assessed with eyes open on both a firm and foam surface under four lighting conditions in a randomised order: photopic (~436lux, vertically at the eye), sudden reduction to mesopic (~436 to ~1lux), adapted mesopic (~1lux) and adapted mesopic with a light emitting diode (LED) door frame lighting system (~1.3lux), using the root mean square (RMS) of the centre of pressure measures derived from an electronic force plate in the anterior-posterior (AP) and medio-lateral (ML) directions. Visual function was assessed binocularly (visual acuity, contrast sensitivity and visual fields), physical function was assessed using standardised measures (sit-to-stand, grip strength and the timed walk test) and self-reported difficulties under low light levels were recorded using the Low Luminance Questionnaire. Data were analysed using linear mixed models. For all participants, low light levels significantly increased postural sway on the foam surface in the AP (p=0.01) but not ML (p=0.80) direction, but had no effect on postural stability on the firm surface. On the foam surface, while AP-RMS sway was significantly greater in the sudden (p<0.001) and adapted (p=0.02) mesopic compared to the photopic condition, sway for the adapted mesopic with the LED lighting system was not significantly different to the photopic condition (p=0.20). On the foam surface, AP-RMS (p=0.02) and ML-RMS (p<0.001) sway were significantly greater in the AMD compared to the control group. None of the measures of visual function was significantly associated with AP- or ML-RMS sway. On the foam surface, low light levels significantly reduced postural stability in older adults with and without AMD, and postural stability was significantly reduced for the AMD group compared to controls, regardless of light level. Importantly, the LED lighting system reduced sway under mesopic conditions, which was not significantly greater than that measured under photopic conditions in either group. These findings have important implications for enhancing the visual environment for older adults with and without AMD to improve postural stability and reduce the risk of falls in low lighting environments.

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 the Wii balance board a valid and reliable instrument to assess postural stability in older adults with type 2 diabetes mellitus?

AimsEvaluate the validity and reliability of the data from the Wii balance board (WBB), against a force platform (FP) in patients with type 2 diabetes mellitus (T2DM). MethodsForty-three adults with T2DM (age 62.1 ± 12.1 yrs) in the validity trial and 27 (age 63.5 ± 10.8 yrs) in the reliability study, were tested. Total COP area (mm) and range of antero-posterior (AP) and medio-lateral (ML) COP excursion were collected simultaneously on a FP and a WBB. ResultsMean CoP sway path values were similar in all conditions in the FP when compared with the WBB. Regression model shows that WBB is able to explain most of the variation in CoP sway path data of the FP (between 42 and 72%) for all testing conditions, indicating that the WBB has good concurrent validity. Test–retest reliability for WBB was excellent, except for the COP sway area in the ‘eyes open’ condition (ICC = 0.55). Both conditions showed modest to excellent reliability in the AP (0.73–0.90) and the ML (0.77–0.91) directions. ConclusionThe WBB has been shown to be a valid and reliable method to quantify the COP displacement during different balance tests in older adults with T2DM.

Plantar Flexor Strength Training With Home-Based Neuromuscular Electrical Stimulation Improves Limits of Postural Stability in Older Adults

The study aimed to determine whether improved muscle strength after 12 weeks of neuromuscular electrical stimulation (NMES) of plantar and dorsiflexors could result in better limits of stability in older adults. Twenty-seven participants were divided into a control group and a neuromuscular home-based training group. The training group performed a 3-month long NMES training of both plantar and dorsiflexors. Ankle flexor strength and limits of stability were measured. A mediation analysis was conducted to determine whether the NMES effect on the limits of stability was mediated by increased strength. The NMES training increased plantar flexor strength (+47%; β = 0.217, P = .02), and this increase predicted the anterior limits of stability improvement (+27%; β = 0.527, P = .02). The effect of the NMES on the limits of stability was fully mediated by the plantar flexor strength increase (indirect effect: β = 0.1146; 95% confidence interval, 0.020-0.240). It seems that NMES improves the limits of stability through its positive effect on muscle strength. NMES may be utilized in fall-prevention programs.

Postural Stability in Older Adults With Alzheimer Disease.

The prevalence of adults with Alzheimer disease (AD) aged >65 years is increasing and estimated to quadruple by 2051. The aim of this study was to investigate postural stability in people with mild to moderate AD and factors contributing to postural instability compared with healthy peers (controls). A computerized systematic search of databases and a hand search of reference lists for articles published from 1984 onward (English-language articles only) were conducted on June 2, 2015, using the main key words "postural stability" and "Alzheimer's disease." Sixty-seven studies were assessed for eligibility (a confirmed diagnosis of AD, comparison of measured postural stability between participants with AD and controls, measured factors potentially contributing to postural instability). Data were extracted, and Downs and Black criteria were applied to evaluate study quality. Eighteen articles were analyzed using qualitative synthesis and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Strength of evidence was guided by the Grading of Recommendations Assessment, Development and Evaluation. Strong evidence was found that: (1) older adults with mild to moderate AD have reduced static and functional postural stability compared with healthy peers (controls) and (2) attentional demand during dual-task activity and loss of visual input were key factors contributing to postural instability. Deta-analysis was not possible due to heterogeneity of the data. Postural stability is impaired in older adults with mild to moderate AD. Decreasing visual input and concentrating on multiple tasks decrease postural stability. To reduce falls risk, more research discerning appropriate strategies for the early identification of impairment of postural stability is needed. Standardization of population description and consensus on outcome measures and the variables used to measure postural -instability and its contributing factors are necessary to ensure meaningful synthesis of data.

Multi-session anodal tDCS enhances the effects of postural training on balance and postural stability in older adults with high fall risk: Primary motor cortex versus cerebellar stimulation

BackgroundPostural control impairment is a key target for rehabilitation of older adults with high fall risk. ObjectiveTo investigate whether anodal transcranial direct current stimulation (a-tDCS) over primary motor cortex (M1) or cerebellum can enhance the positive effects of postural training on balance and postural stability in older adults with high fall risk. MethodIn this randomised, double-blinded sham-controlled study, 65 participants were randomly assigned into five groups; M1 a-tDCS with postural training, bilateral cerebellar a-tDCS with postural training, sham a-tDCS with postural training, postural training alone and cerebellar a-tDCS alone. Participants in the first two a-tDCS groups received 2 mA stimulation for 20 min concurrently with postural training. Postural training was conducted for three sessions of 20 min per week for two weeks. The Berg Balance Score (BBS) and the stability indices at both static and dynamic levels of the Biodex Balance System were evaluated before and after intervention. A general linear model repeated measure ANOVA was used to assess the effects of variables among groups. ResultSimultaneous postural training with M1 or bilateral cerebellar a-tDCS significantly improved postural stability indices (p < 0.05) and BBS scores (p < 0.05). Besides, the effects of bilateral cerebellar a-tDCS were significantly higher than that of M1 stimulation on these indices (p < 0.05). Moreover, two weeks postural training alone or cerebellar a-tDCS alone is not an adequate intervention to improve the postural stability indices (p > 0.05). ConclusionPostural training with M1 or bilateral cerebellar a-tDCS, especially bilateral cerebellar a-tDCS, can significantly improve postural control or balance in older adults with high fall risk, while two weeks of postural training alone or two weeks cerebellar a-tDCS alone is not a sufficient intervention.

Effect of hearing aids on static balance function in elderly with hearing loss

While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes–foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.

Acute Effects of Moderate Alcohol Consumption on Postural Stability in Older Adults.

This study involved healthy community-living older adults in an investigation of the association between moderate alcohol consumption (AC) and acute changes in postural stability and whether the association differed according to pre-AC balance skills. Thirty-nine moderate drinkers aged ≥ 65 years (62% women; mean age: 73.9 ± 6.1 years) consumed a moderate dose of alcohol (0.4 g/kg; administered as two drinks). Breath alcohol concentration and postural stability were measured at five time points (pre-AC and 40, 80, 120, and 160 minutes post-AC) using unipedal stance time (UPST) and center of pressure (CoP) displacement. Pre-AC UPST was used to categorize participants into good-balance (≥30 seconds) and poor-balance (<30 seconds) groups. Peak breath alcohol concentration was 30 mg/dL at 40 minutes post-AC. For all participants, postural stability declined significantly at 80 minutes post-AC (UPST, p = .005; anterior-posterior CoP displacement, p = .029). While the poor-balance group did not show a significant decrease in UPST duration over the course of the study, the good-balance group experienced significant decline at 80 minutes compared with baseline ( p < .001) and remained above the 30-second UPST cutoff. Both groups experienced similar worsening in anterior-posterior CoP displacement at 80 minutes post-AC. Thus, moderate AC was associated with acute decline in postural stability in older adults. The worsened anterior-posterior CoP displacement post-AC in the poor-balance group was of particular concern because these participants were already at lower balance functioning pre-AC. Larger, more representative studies of varying groups of participants are needed to further explore how this change relates to fall incidents and fall risk.

Manual tracking impairs postural stability in older adults

Introduction Older adults show increased postural sway and a greater risk of falls when completing activities with high cognitive demands. While dual-task approaches have clarified an association between cognitive processes and postural control, it is unclear how manual ability, which is also required for the successful completion of cognitively demanding tasks (such as putting a key into a lock), affects this relationship. Method Kinematic technology was used to explore the relationship between postural sway and manual control in healthy younger and older adults. Participants ( n = 82) remained standing to complete a visual-motor tracking task on a tablet computer. Root mean square tracking error measured manual performance, and a balance board measured deviations in centre of pressure as a marker of postural sway. Results Older adults displayed poorer manual accuracy and increased postural sway across all testing conditions. Conclusions Cognitive capacity can interact with multiple task demands, and in turn affect postural sway in older adults. Improving our understanding of factors that influence postural control will assist falls-prevention efforts and inform clinical practice.

Losing touch: age-related changes in plantar skin sensitivity, lower limb cutaneous reflex strength, and postural stability in older adults

Age-related changes in the density, morphology, and physiology of plantar cutaneous receptors negatively impact the quality and quantity of balance-relevant information arising from the foot soles. Plantar perceptual sensitivity declines with age and may predict postural instability; however, alteration in lower limb cutaneous reflex strength may also explain greater instability in older adults and has yet to be investigated. We replicated the age-related decline in sensitivity by assessing monofilament and vibrotactile (30 and 250 Hz) detection thresholds near the first metatarsal head bilaterally in healthy young and older adults. We additionally applied continuous 30- and 250-Hz vibration to drive mechanically evoked reflex responses in the tibialis anterior muscle, measured via surface electromyography. To investigate potential relationships between plantar sensitivity, cutaneous reflex strength, and postural stability, we performed posturography in subjects during quiet standing without vision. Anteroposterior and mediolateral postural stability decreased with age, and increases in postural sway amplitude and frequency were significantly correlated with increases in plantar detection thresholds. With 30-Hz vibration, cutaneous reflexes were observed in 95% of young adults but in only 53% of older adults, and reflex gain, coherence, and cumulant density at 30 Hz were lower in older adults. Reflexes were not observed with 250-Hz vibration, suggesting this high-frequency cutaneous input is filtered out by motoneurons innervating tibialis anterior. Our findings have important implications for assessing the risk of balance impairment in older adults.

Postural Stability in Older Adults with a Distal Radial Fracture.

The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effects Of Hopping Exercise Training On Postural Stability And Leg Power In Older People

PURPOSE: Reductions in muscle power and strength seem to be a cause of poor postural stability in older adults. This study was performed to investigate the effects of hopping exercise (HE) training on static postural stability and leg power in healthy older adults. METHODS: Twenty-six men and women (mean age ± standard deviation, 71.3 ± 5.0 years) were randomly assigned to either an HE group (n = 13) or balance exercise group (BE, n = 13). Both groups trained for 12 weeks. The HE group performed two sets of two-legged hopping at a frequency of 90 bpm until they reached a rate of 15 (hard) on the Borg scale of perceived exertion twice a week. The BE group performed on a foam stability pad or a narrow balance beam. They participated in a 30-min supervised group exercise session held once every 2 weeks at a local center. Outcome measures included the center of foot pressure (CoP) sway parameters (linear length of sway path, area of sway path, and linear length of sway path in a particular unit of time) and leg muscle power (cycling power and vertical jump). RESULTS: Repeated-measures analysis of variance showed only a significant main effect of time. After the training session, the HE group demonstrated a significantly decreased path length (45.0 ± 17.4 vs. 37.6 ± 12.5 cm, P < 0.05), sway area (2.71 ± 1.40 vs. 2.09 ± 1.25 cm2, P < 0.05), and sway velocity (2.25 ± 0.87 vs. 1.88 ± 0.63 cm/s, P < 0.05) and an increased cycling power (4.44 ± 0.97 vs. 4.68 ± 0.93 W/kg, P < 0.05), but no change in vertical jump (25.1 ± 6.3 vs. 23.5 ± 6.3 cm). The BE group demonstrated a significant change in cycling power (4.57 ± 0.61 vs. 4.80 ± 0.50 W/kg, P < 0.05), but no differences in the CoP sway parameters (path length: 43.9 ± 11.3 vs. 42.5 ± 9.8 cm, sway area: 2.83 ± 1.13 vs. 2.58 ± 0.99 cm2, sway velocity: 2.20 ± 0.57 vs. 2.12 ± 0.49 cm/s) or vertical jump (24.2 ± 6.3 vs. 23.9 ± 4.0 cm). CONCLUSIONS: Our results suggest that a dynamic two-legged HE program is more effective than static BE in improving postural stability and leg muscle power in healthy older adults. HE may be recommended as a technique to reduce the risk of falling; however, future studies should examine the safety of this method for older people. Supported by JSPS KAKENHI Number 26350767.