This study investigated the effects of chronic ankle instability (CAI) on postural control following landing with an unanticipated task and on shank-rearfoot coordination during side-cutting in female soccer players. The association between postural stability and coordination patterns was investigated to identify shared control characteristics across tasks. Eighteen female soccer players were categorized into CAI (n = 10) and control (n = 8) groups. Participants performed 20-s single-leg stances and side-cutting following landing with an unanticipated task. Postural control during single-leg stance was quantified using the largest Lyapunov exponent of the mediolateral center of pressure. Shank-rearfoot coordination during side-cutting was analyzed using a modified vector-coding technique. The CAI group exhibited a significantly lower largest Lyapunov exponent of mediolateral center of pressure during single-leg stance (p = .043). During side-cutting, the CAI group demonstrated an increased proportion of in-phase with distal dominancy during the deceleration phase (p = .027). Within the CAI group, largest Lyapunov exponent was associated with coordination patterns, where a negative correlation with anti-phase with proximal dominancy and a positive correlation with in-phase with distal dominancy (r = -.680 and .648, respectively; p < .050) were observed. Female soccer players with CAI exhibit reduced adaptability to postural control following landing with an unanticipated task and diminished flexibility in shank-rearfoot coordination during sport-specific cutting. The observed association between static postural instability and altered dynamic coordination may reflect a reduced capacity to flexibly modulate control strategies in patients with CAI, which may be related to the risk of recurrent ankle sprains.

This study evaluated the effects of passive back-support exoskeletons (BSEs) on biomechanical load and postural stability during simulated manual timber felling at three cutting heights. Twenty healthy adult male participants performed timber felling tasks under four BSE conditions (two rigid, one soft, and no BSE). During the tasks, electromyographic (EMG) activity, trunk angle, postural sway, and perceived exertion were measured. Results showed that rigid BSEs reduced trunk flexion and low back EMG activity at the middle cutting height, where trunk flexion was greatest. No significant changes were observed at low or high cutting heights, likely due to insufficient exoskeleton engagement. BSE use shifted postural control strategies rather than providing a uniform stabilizing effect. Additionally, BSEs lowered perceived exertion for the whole body and low back. These findings suggest that BSEs may help reduce low back loading at the middle cutting height during manual timber felling, but further field testing is warranted.

Analysis of anticipatory postural adjustment characteristics in preschool children with different motor development profiles.

Comparative effects of bilateral and unilateral ankle-foot orthoses on balance and gait in children with spastic unilateral cerebral palsy.

To investigate the effects of swelling on postural control and patient-reported outcomes in individuals with chronic ankle instability (CAI). Cross-sectional study. Controlled laboratory. A total of 60 participants-20 CAI individuals with swelling (swelling), 20 CAI individuals without swelling (nonswelling), and 20 healthy controls (control)-were recruited. Group (swelling, nonswelling, and control). Participants performed 3 trials of single-leg hop-to-stabilization and single-leg stance tasks, along with patient-reported outcomes. A one-way analysis of variance was used to assess group differences in dynamic and static postural control and patient-reported outcomes. The swelling group exhibited worse dynamic postural control in vertical stability index and dynamic postural stability index compared with the nonswelling ( P = 0.03, P = 0.04) and control ( P < 0.01 and P < 0.01) groups. The nonswelling group showed similar dynamic postural control with the control group. Swelling ( P < 0.01 and P < 0.01) and nonswelling ( P = 0.01 and P < 0.01) groups showed worse static postural control center of pressure mediolateral velocity and center of pressure anteroposterior velocity compared with the control group. Swelling and nonswelling groups showed differences in patient-reported outcomes about ankle function and instability compared with the control group, but there was no difference in patient-reported outcomes between the swelling and nonswelling groups themselves. Ankle swelling contributes to altered neuromuscular control, resulting in worse dynamic postural control, but affects neither static postural control nor patient-reported outcomes in CAI individuals.

Chronic Obstructive Pulmonary Disease (COPD) is associated with diaphragm dysfunction and reduced functional capacity. Altered deep core muscle function, particularly of deep abdominal muscles may further compromise postural stability and functional performance. However, objective clinical assessment of deep core muscle activation across COPD severity remains underexplored. To explore potential associations between deep core muscle function using a pressure biofeedback unit (PBU) and Pulmonary Function parameters (PFT) across Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages in individuals with COPD. In this cross-sectional exploratory study, 84 individuals with COPD were assessed. Pulmonary function (FEV1, FVC and FEV1/FVC) was measured using spirometry. Deep core muscle function was evaluated using a Pressure Biofeedback Unit (PBU) during the Abdominal Drawing-In Maneuver (ADIM) in prone position. Associations between PBU measures and pulmonary function parameters were examined using Spearman's correlation including exploratory analysis across GOLD stages. Deep core muscle function demonstrated statistically significant negative correlations with pulmonary function parameters, including FEV1/FVC (ρ=-0.55; p<0.001), FEV1 (ρ=-0.72; p<0.001) and FVC (ρ=-0.59; p<0.001). Mean PBU pressure values progressively increased across GOLD stages (Kruskal-Wallis H (3)=50.053; p<0.001; Ɛ2=0.59). Stage-wise exploratory analyses demonstrated variable correlations across GOLD stages, however findings should be interpreted cautiously due to small subgroup sample sizes. Deep core muscle function assessed via pressure biofeedback demonstrated exploratory association with pulmonary function and varied across COPD severity categories. Participants with greater airflow limitation generally exhibited poorer deep abdominal muscle activation. These findings indicate a possible association between COPD severity and altered deep core muscle activation patterns. However, due to the exploratory cross-sectional design and methodological limitations, the findings should be considered hypothesis-generating rather than confirmatory. Longitudinal and interventional studies are required to further investigate these associations. The data for the present study were collected as part of a PhD thesis and the study was registered with the Clinical Trials Registry of India (CTRI/2022/12/048039).

Evidence linking menstrual characteristics to knee-related functional measures in female athletes remains inconsistent, partly due to an emphasis on menstrual phase without adequate consideration of cycle regularity. This study examined associations between menstrual cycle regularity, neuromuscular activation variables, and Dynamic Postural Stability Index (DPSI) measures across standardized menstrual phases. A longitudinal repeated-measures study was conducted among 90 female athletes (46 with regular cycles and 44 with irregular cycles). Participants were assessed during the early follicular, ovulatory, and mid-luteal phases across three consecutive menstrual cycles. DPSI was used to assess dynamic postural stability, while quadriceps activation latency and hamstring-to-quadriceps co-contraction ratio were assessed using surface electromyography. Linear mixed-effects models were used to examine group, phase, and interaction effects, adjusting for age and training volume. Athletes with irregular cycles demonstrated higher DPSI values overall compared with athletes with regular cycles (β=+0.05, 95% CI: 0.01-0.09; p=0.012). No significant main effect of menstrual phase was observed; however, significant group×phase interactions were identified, with the largest between-group differences occurring during the ovulatory phase. Athletes with regular cycles demonstrated shorter quadriceps activation latency and higher hamstring-to-quadriceps co-contraction ratios across phases. Menstrual cycle regularity was significantly associated with DPSI values (r=-0.38, p<0.001). Menstrual cycle regularity was associated with DPSI and neuromuscular activation variables across menstrual phases. These findings support the consideration of cycle regularity as a stratification variable in future studies examining knee function-related outcomes in female athletes.

Background: Falls are a major cause of injury and disability in older persons. While cognitive impairment is known to be a risk factor, the types of cognitive domains most significantly linked to postural instability and falls, especially in community-dwelling older adults, are understudied. Objective: This study was carried out to compare the cognitive function of older adult fallers and non-fallers and to find out which specific cognitive domains are most significantly related to postural instability. Methodology: A cross-sectional study was carried out in Karachi, Pakistan, among 324 community-dwelling older adults between the ages of 65 and 75 years. Patients with diagnosed dementia, severe cognitive impairment defined by Montreal Cognitive Assessment score below 20, Parkinson’s disease or stroke, recent fractures or joint replacement, amputated limbs, or vestibular dysfunction or uncorrected visual impairment were excluded. Participants were divided into fallers and non-fallers (162 in each group) on the basis of Berg Balance Scale scores and self-reported fall history. Cognitive function was measured with the Montreal Cognitive Assessment measurement tool, and postural stability was measured with the Berg Balance Scale. The inferential analysis consisted of an independent samples t-test to compare the cognitive scores of groups. Multivariate Analysis of Variance to test the difference between the cognitive domains. Results: Fallers exhibited worse balance (Berg Balance Scale: 34.35 vs. 46.51, p&lt;0.001) and worse overall cognitive function (Montreal Cognitive Assessment: 22.99 vs. 25.11, p&lt;0.001) than non-fallers. There was a moderate positive relationship between Montreal Cognitive Assessment and Berg Balance Scale scores (r=0.33, p&lt;.001). Domain analysis revealed that fallers scored significantly lower in Visuospatial/Executive function, Naming, Attention, Language, and Delayed Recall. Logistic regression identified Montreal Cognitive Assessment score as the only significant predictor of falls (Odds ratio=0.66, p&lt;.001), indicating a 34% reduction in fall odds for every one-point increase in Montreal Cognitive Assessment score. Conclusion: Cognitive dysfunction, particularly in the domains of memory, attention, and executive function, is significantly associated with postural instability and is an independent 10 predictor of falls in community-dwelling older adults. Integrating cognitive screening, especially of specific domains, into routine fall risk assessments is crucial for developing effective, proactive fall prevention strategies.

Pelvic alignment plays a central role in maintaining postural stability, and asymmetries in pelvic orientation may alter plantar pressure distribution. In adolescents with idiopathic scoliosis (AIS), compensatory adaptations of the pelvis and lower limbs may contribute to imbalance and asymmetrical weight bearing. The aim of this study is to investigate the association between pelvic torsion, rotation, and tilt with static and dynamic plantar pressure asymmetries in adolescents with idiopathic scoliosis. This study included 60 adolescents with AIS aged 10-18 years. Pelvic parameters were obtained using the DIERS Formetric 4D surface topography system, and static and dynamic plantar pressure distributions were measured with the GaitScan system. Side-to-side differences in forefoot and rearfoot loading were compared using paired t-tests, and correlations between pelvic parameters and plantar pressure asymmetries were analyzed with Spearman's Correlation test (p < 0.05). Significant plantar pressure differences were found between the convex and concave side of curve. Forefoot loading was lower on the convex side (28.8% vs. 33.9%), whereas rearfoot loading was higher (71.6% vs. 66.6%, exact p = 0.002, effect size r = 0.48). Dynamic loading also favored the convex side (55.4% vs. 45.6%, exact p < 0.001, effect size r = 0.61). Correlations between pelvic torsion, rotation, and tilt with pressure asymmetries were weak and not significant. Adolescents with idiopathic scoliosis exhibit marked plantar pressure asymmetries, particularly under dynamic conditions.

Nutrition plays a vital role in musculoskeletal health, bone density, fall risk, and postural stability, alongside being a reflection of overall health status. Nutritional assessment indices are rapid and noninvasive tools for several indications, yet their association with falls remains uncertain. We aimed to investigate four commonly used nutritional indices: GNRI (Geriatric Nutritional Index), PNI (Prognostic Nutritional Index), CONUT (Controlling Nutritional Status), and MNA-SF (Mini Nutritional Assessment Short Form) to establish their relationship with falls in older adults with potential implications for clinical practice. Patients aged ≥ 65 years who underwent comprehensive geriatric assessment between 1 January 2022 and 31 January 2024 were included in the analysis. After application of the exclusion criteria, the final study population comprised 952 individuals. Fall history and fall frequency during the preceding 12 months were recorded. Associations between nutritional indices and falls were evaluated using receiver operating characteristic (ROC) analysis and logistic regression models, with additional post-hoc group comparisons based on fall frequency. MNA-SF, GNRI, and PNI were significantly associated with both fall risk and fall frequency (all p < 0.001), whereas CONUT showed no significant association (p = 0.171). Post-hoc analyses demonstrated that MNA-SF was the only index that showed significant differences between single and recurrent fallers in post-hoc group comparisons (p = 0.010). MNA-SF (OR:0.67, 95% CI:0.62-0.74), GNRI (OR:0.85, 95% CI:0.82-0.88), and PNI (OR:0.92, 95% CI:0.86-0.97) continued to have an independent association with falls in regression analysis (all p < 0.005). ROC analysis showed the highest discrimination for MNA-SF (AUC: 0.697, 95% CI: 0.660-0.733), followed by GNRI (AUC: 0.619, 95% CI: 0.581-0.656) and PNI (AUC: 0.615, 95% CI: 0.578-0.653). Fallers also exhibited greater frailty, poorer physical performance, and higher medication burden (all p < 0.001). In older adults, poorer nutritional status assessed by MNA-SF, GNRI, and PNI was independently associated with falls, supporting the potential role of nutritional assessment within a broader fall-risk evaluation framework. However, the discriminative performance of all indices was low, indicating that these tools should not be solely considered predictors of falls, but rather complementary markers. In exploratory analyses, MNA-SF showed differences between single and recurrent fallers, which suggests a potentially relevant association that warrants prospective validation. Variability in cut-off definitions across nutritional indices remains an important limitation, underscoring the need for prospective studies to refine clinically relevant thresholds.

Quantifying Postural Recovery After Lumbar Decompression: Cone of Economy Biomarkers of Balance Effort and Stability in Patients with Radiculopathy and Neurogenic Claudication.

Prefrailty is a reversible transitional stage of frailty and is associated with impaired postural stability and increased fall risk. Tai Chi may improve balance-related performance in older adults, but its effects on postural stability and gait biomechanics in prefrail populations remain insufficiently characterized. In this single-blind randomized controlled trial, 68 prefrail older adults defined by the Fried Frailty Phenotype were allocated to a Tai Chi plus health education group or a health education control group. Sixty-four participants completed the study (mean age 71.1 years; 31 women; 33 men). The intervention group performed 24-form Tai Chi three times weekly for 12 weeks, while both groups received health education. Functional postural stability was assessed using the Timed Up-and-Go Test (TUGT), Berg Balance Scale (BBS), and Short Physical Performance Battery (SPPB). Static balance was evaluated using center-of-pressure (COP) measures, and gait biomechanics were assessed using three-dimensional gait analysis. Continuous outcomes were analyzed using baseline-adjusted ANCOVA, with complementary group × time interaction analyses. Exploratory change-score correlations were conducted within the intervention group, with full-sample sensitivity analyses adjusted for group assignment. After 12 weeks, the intervention group showed better postural stability than controls, including shorter TUGT time (P < 0.001), higher BBS (FDR q < 0.001) and SPPB scores (FDR q = 0.002), lower COP path length and sway velocity under eyes-open conditions (both FDR q = 0.003), and lower COP path length, sway ellipse area, and sway velocity under eyes-closed conditions (FDR q = 0.014-0.018). Gait analysis showed significant improvements in gait speed (FDR q = 0.033), gait profile score (GPS; FDR q < 0.001), gait deviation index (GDI; FDR q < 0.001), and hip rotation deviation (FDR q = 0.007), whereas other joint-specific kinematic variables were only nominally significant. Group × time analyses supported changes in TUGT, BBS, SPPB, gait speed, GPS, and GDI. Exploratory correlation analyses showed that changes in postural stability were mainly associated with changes in hip kinematics, step length, and selected ankle-related features; however, these associations did not remain significant after FDR correction. A 12-week Tai Chi program improved functional performance and static postural control in prefrail older adults and was associated with favorable changes in gait speed and global gait-quality indices. Correlation findings should be interpreted as preliminary mechanistic clues. Larger studies with longer follow-up are needed. Trial registration Chinese Clinical Trial Registry, ChiCTR2300073905, Registered on [2023-07-25]. https://www.chictr.org.cn.

Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as a neuromodulatory intervention to facilitate motor recovery after stroke. However, the frequency-specific effects of rTMS on lower-limb motor control and their neurophysiological correlates remain insufficiently clarified. To compare the effects of low-frequency (1 Hz) rTMS applied over the contralesional (unaffected) lower-limb motor area of the primary motor cortex and high-frequency (10 Hz) rTMS applied over the ipsilesional (affected) lower-limb motor area on electroencephalographic (EEG) activity, affected-side lower-limb muscle activation, balance, and gait in individuals with chronic stroke. Thirty-nine participants with chronic stroke were randomly assigned to a low-frequency rTMS group (n = 13), a high-frequency rTMS group (n = 13), or a sham group (n = 13). rTMS was delivered for 10 sessions over 2 weeks. Resting-state EEG (relative beta-band power at Cz), surface EMG of the affected-side rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius during sit-to-stand, Timed Up and Go (TUG), 10-meter walk test (10MWT), and limits of stability (LOS) were assessed before and after the intervention. A 3 × 2 mixed-design analysis of variance (ANOVA) (group × time) was conducted. Significant group × time interactions were observed for rectus femoris activation (p < 0.001) and TUG performance (p = 0.037). Post hoc pairwise comparisons confirmed significantly greater improvements in TUG performance and rectus femoris activation in the low-frequency rTMS group than in the high-frequency and sham groups. Relative beta-band activity at Cz demonstrated a significant main effect of time (p < 0.001) without a significant interaction effect. Similarly, 10MWT and LOS showed significant time effects (p < 0.05) but no significant group × time interactions. No significant main effects of group were identified across outcomes. Short-term rTMS was associated with improvements in selected neuromuscular outcomes, while changes in resting cortical activity, gait speed, and postural stability appeared to reflect general time-related effects. Low-frequency rTMS demonstrated greater improvements in rectus femoris activation and TUG performance compared with high-frequency and sham stimulation. These findings suggest that frequency-specific rTMS may preferentially influence neuromuscular strategies underlying dynamic mobility rather than steady-state gait performance.

Cervical dizziness (CD) is associated with altered cervical musculoskeletal and proprioceptive input, leading to impaired sensorimotor integration and balance control. Vitamin D deficiency has been linked to musculoskeletal pain, muscle dysfunction, and impaired postural stability; however, its role in CD remains unclear. This prospective observational study included 210 patients diagnosed with CD. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at baseline, and participants were categorized into deficiency (< 20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥ 30 ng/mL) groups. All patients received a standardized multimodal cervical rehabilitation program, with vitamin D supplementation provided to the deficient and insufficient groups. Clinical outcomes were assessed using the Neck Disability Index (NDI), Dizziness Handicap Inventory (DHI), and Vertigo Dizziness Imbalance questionnaires (VDI-SS and VDI-QOL). Associations between vitamin D levels, baseline symptom severity, and recovery duration were analyzed using correlation, multivariable regression, receiver operating characteristic (ROC) analysis, and partial least squares discriminant analysis (PLS-DA). Lower serum 25(OH)D levels were significantly associated with higher baseline NDI, DHI, VDI-SS, and VDI-QOL scores (all p < 0.001), indicating greater symptom severity and functional impairment. Serum 25(OH)D levels showed a strong inverse correlation with recovery duration (rho = -0.77, p < 0.001) and remained associated with a longer recovery duration in multivariable linear regression. ROC analysis demonstrated high discriminatory performance for delayed recovery (AUC = 0.937), with an exploratory optimal threshold of ≤ 17 ng/mL. In exploratory PLS-DA, serum 25(OH)D contributed more to group separation than did age, sex, or BMI. Lower serum vitamin D levels were associated with greater baseline clinical severity and longer recovery duration in patients with CD. These findings suggest that vitamin D status may be clinically relevant in the assessment of disease severity and recovery in this population. Further prospective controlled studies are required to clarify the clinical significance of this association.

Halteres stabilize standing posture in crane flies.

Young-onset ischemic stroke may lead to persistent motor impairment, despite favorable survival outcomes. However, a detailed longitudinal characterization of gait and balance recovery in young patients remains limited. Instrumented assessments using inertial measurement units and force platforms may provide objective insights into the temporal patterns of functional recovery. We report the case of a previously healthy 11-year-old Japanese girl who developed left hemiparesis due to an ischemic stroke associated with reversible cerebral vasoconstriction syndrome. Gait and balance were assessed longitudinally at 1, 2, 6, 9, and 12months after onset, using instrumented analysis. Gait stability was quantified using the root mean square (RMS) of trunk acceleration, symmetry using the Lissajous index (LI), and rhythmicity using stride-to-stride time variability (STV). Balance was evaluated using the index of postural stability (IPS). The RMS and IPS improved markedly within the first 6months, followed by more gradual changes. Gait symmetry continued to improve for up to 9months. The STV showed a transient increase during early recovery and decreased after 12months. Lower limb motor function improved from Brunnstrom stage II to stage V during the subacute phase, with corresponding gains in the Fugl-Meyer lower extremity scores. This case suggests that the recovery of gait stability, symmetry, and rhythmicity after childhood ischemic stroke may follow partially distinct temporal patterns during the first year. Longitudinal instrumented assessments may support stage-specific rehabilitation planning. Further studies are warranted to determine whether similar recovery patterns are consistently observed in larger cohorts.

Current research indicates that Virtual Reality (VR) can serve as an effective tool for evaluating and training postural control responses and its processing, to distorted sensory input. The aim was to evaluate posturographic spectral responses and adaptation to repeated visual VR-stimulation in young and older adults with wavelet analysis. Twenty-eight young (mean 25.3 years) and 25 older (mean 74.8 years) adults were included. Participants were standing on a force plate performing two control tests (eyes open and closed) and thereafter repeatedly watched a 120-second VR-simulation of a roller-coast ride five times. The first VR session produced a marked two-fold stability response: (1) significant spectral energy increased within 0.4–8.5 Hz in anteroposterior and lateral directions, and (2) significant spectral energy decreased within 0.03–0.13 Hz in anteroposterior direction. Older adults used significantly more high frequency energy and less low frequency energy. Repeated VR sessions significantly decreased high frequency energy in both groups. Wavelet analysis indicates that both younger and older adults employed similar spectral response patterns in response to immersive visual stimulation. However, older adults showed larger shifts in spectral characteristics, suggesting age-related differences in resilience. Postural control appeared capable of rapidly adapting to adjust biomechanical strategies and sensory weighting.

The objective of this review is to evaluate the effectiveness of therapeutic (structured asana- and pranayama-based) yoga versus physiotherapy-based balance and proprioceptive neuromuscular facilitation (PNF) training in improving postural stability and fall-related outcomes in older adults with early-stage Parkinsonism. Parkinsonism in older adults is characterized by postural instability and gait impairment, increasing risks of falls, fractures, and loss of independence. Physiotherapy interventions, particularly balance training and PNF, remain the clinical standard for fall prevention. Therapeutic yoga integrating asana (postural practice) and pranayama (breath regulation) may provide complementary benefits through improved proprioception, sensorimotor integration, core strength, and attentional control. However, evidence is fragmented due to variability in yoga styles, intervention intensity, and outcome measures. Randomized controlled trials published between 2015 and 2025 involving adults aged ≥60 years with early-stage Parkinsonism (Hoehn and Yahr stage ≤2 or disease duration ≤5 years) will be included. Eligible interventions will involve structured therapeutic yoga integrating asana and pranayama, which will be compared with physiotherapy-based balance or PNF training. This protocol follows JBI guidance. Searches will be conducted in MEDLINE, ScienceDirect, Cochrane CENTRAL, Web of Science, PEDro, and PsycINFO, with supplementary searches in trial registries and gray literature. Two reviewers will independently screen studies, extract data, and assess bias. Meta-analysis will use a random-effects model, and evidence will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). PROSPERO CRD420251149898.

During voluntary movement, somatosensory input is attenuated, a phenomenon known as sensory gating, which may prevent the CNS from being overwhelmed by predictable afferent feedback not essential for motor control. In the cerebral cortex, sensory gating has been demonstrated in primary (S1) and higher-order sensory areas. The primary motor cortex (M1) is the major cortical output relay to the spinal cord and muscles, and proprioceptive feedback is crucial for shaping motor output. However, whether proprioceptive signals to M1 are attenuated during movement and, if so, for what functional purpose remains unclear. We recorded somatosensory-evoked potentials (SEPs) in M1 of two male monkeys performing a wrist task while electrically stimulating muscle and cutaneous afferents innervating forearm extensors and adjacent skin. Both local field potentials and single-neuron recordings revealed significant suppression of muscle-evoked SEPs during active movement and static hold phases, providing direct evidence that proprioceptive input to M1 is generally gated during motor execution, consistent with previous findings for cutaneous input. However, a subset of M1 neurons preserved SEPs during static hold, particularly those evoked by afferents from antagonistic muscles and stretched skin. Because maintaining a stable posture required precise joint-angle control, these findings suggest that specific muscle and cutaneous afferents escape attenuation to provide information critical for posture control. Overall, our findings demonstrate that while proprioceptive muscle and cutaneous inputs to M1 are broadly suppressed during motor output, specific afferent signals are selectively maintained in a context-dependent manner to support posture control.

This study aimed to assess postural stability and vestibulo-ocular reflex (VOR) function in patients with chronic suppurative otitis media (CSOM) and to elucidate how vestibular involvement varies according to otoscopic findings and demographic characteristics. The study included 51 individuals with CSOM aged 18-65 years (Mage = 34.55 years) and 40 healthy controls (Mage = 33.26 years). All patients had tympanic membrane perforation in at least one ear, for which localization and perforation size were documented. Pure-tone audiometry and immittance measurements were performed. Vestibular assessment consisted of subjective symptom evaluation using the Dizziness Handicap Inventory, semicircular canal-specific VOR gain measurements using the video head impulse test (vHIT), and functional balance analysis using computerized dynamic posturography (CDP). No significant differences were found between groups in vHIT gains for any semicircular canal. While anteroposterior CDP parameters showed no group differences, mediolateral vestibular (VEST), preference (PREF), and Global scores were significantly reduced in the CSOM group. Both disease duration and perforation severity significantly affected mediolateral CDP outcomes, with higher severity and durations longer than 5 years associated with lower VEST, PREF, and Global scores. Somatosensory score, visual score, perforation location, laterality, and anteroposterior sway measures showed no significant differences. CSOM is associated with subclinical yet measurable impairments in vestibular function and postural stability, characterized by preserved high-frequency semicircular canal function on vHIT but significant mediolateral instability on posturography, even in the absence of self-reported dizziness. These findings indicate early vestibular-mediated balance deficits beyond conductive hearing loss and underscore the importance of routine vestibular assessment for timely identification and targeted rehabilitation.