Postural Stability Research Articles

The Influence of high kinesiophobia on dynamic postural stability among females with patellofemoral pain syndrome during a single-leg squat test

Objective. The purpose of this study was to examine the effect of Kinesiophobia level on postural stability during Single Leg Squat Test (SLST) in females with patellofemoral pain syndrome (PFPS). Methods. Forty women with PFPS were divided into a High Kinesiophobia level group (HK), a Low Kinesiophobia level group (LK), and a pain-free control group of twenty participants. Postural stability was measured during the performance of the Single Leg Squat Test (SLST) on a force platform. The centre of pressure (COP) excursion and velocity were recorded. Results. The HK group had a significantly higher mean medial–lateral and anterior-posterior COP displacement compared to the LK and control groups. However, the results showed no significant differences in COP variables (velocity and displacement) between LK and healthy subjects. Muscle strength of participants with PFPS presented a significant deficit compared to healthy control group. Conclusions. High Kinesiophobia negatively affects postural stability during the SLST. Kinesiophobia should be considered during the assessment and management of PFPS.

Quantifying the weights of sensory influences on postural control across development

BACKGROUND: This study examined the weighting of multisensory and anthropometric factors in driving children’s and adult’s postural control. METHOD: A data set was created by aggregating individual participants’ postural stability measures from four target studies, employing participants ranging in age from 3 to 11 years, along with young adults. Using a meta-regression approach, this aggregate data set was then predicted from dummy codings of the including visual, haptic, and proprioceptive sensory inputs manipulated in these studies, as well as the anthropometric factor of participant height. Two forms of coding regimens were examined – one capturing simple presence versus absence of sensory sources, and one quantifying the degree of stability provided by sensory sources. RESULTS: The results of this study revealed that proprioceptive input had the strongest impact on stability, followed by roughly equivalent visual and haptic inputs, and finally anthropometric factors. Developmentally, this pattern of findings was stable by 5- to 7-years of age. Although both coding schemes predicted posture, the degree of stability coding scheme provided consistently superior predictions. INTERPRETATION: These findings are discussed with respect to a multicomponential approach to postural control, a framework that emphasizes the importance of multiple component factors in characterizing complex behavior.

The effect of internal and external visualization of rotation on postural stability

IntroductionDuring mental rotation tasks, it is assumed that participants visualize a rotation of objects in their minds (internal visualization), but mental rotation has also been linked to the visible rotation of objects on a screen (external visualization). The angular disparity in mental rotation also influences postural sway, the movements of the body center. Postural sway is thus suspected as one type of indirect measurement of the rotation process. We compare the external visualization of rotation with the suspected internal visualization during mental rotation tasks. We suspect both are similar and thus produce a comparable effect on postural sway.MethodsOne hundred and fifty participants completed three rotation tasks with cube figures, two of which were aided by external visualization. Their center of pressure was measured throughout. The effects of external visualization, angular disparity, and their interaction on postural sway were compared using Bayesian statistics and a decision boundary of 3 or 1/3.Results and discussionThe results indicate no differences between conditions for all postural sway parameters. We observe differences between conditions in cognitive load and reaction time. However, as these partially also differ between the two external visualization conditions and do not transfer to differences between the postural sway parameters, the underlying processes in the three conditions are likely similar. Our results support the notion that the visualization of rotation is central to postural sway during mental rotation. This further supports that the rotation process of the external visualization and mental rotation are similar and thus that stimuli are indeed rotated mentally during mental rotation tasks. Our results further support that the common process between mental and manual rotation lies in the visualization instead of mental rotation being an imagined motor action. Because visual control and feedback play an essential role in many motor tasks, the results could also be of further interest for a more general link between motor and cognitive tasks and bidirectional benefits through the construction of visual similarities.

Effects of Different Auditory Stimuli and Cognitive Tasks on Balance in Healthy Young Adults

Introduction: This study investigated the effect of different auditory stimuli and cognitive tasks on balance in healthy young adults. Methods: Thirty-three participants, aged 23.33 ± 2.43 years, were included in the study. The hearing levels of the participants were determined. Static and dynamic postural stability and limits of stability (LOS) tests were performed in the absence of auditory stimuli, in the presence of spondee word lists at 70 dB(A) and in the presence of spondee+white noise (−6 dB signal-to-noise ratio [SNR]), while auditory stimuli were presented bilaterally with supra-aural headphones. Participants were asked to repeat the words they listened to while performing balance-related tasks. Results: No significant differences between the three conditions were observed in the postural stability and LOS results. Increase in total repetition error was observed as the listening task became more difficult. Conclusion: The presence of auditory stimuli and the cognitive tasks did not cause any changes in the participants’ balance.

Age-Related Changes in Postural Stability in Response to Varying Surface Instability in Young and Middle-Aged Adults

As individuals transition into middle age, subtle declines in postural control may occur due to gradual reductions in neuromuscular control. The current study aimed to examine the effect of age on bipedal postural control across three support surfaces with varying degrees of instability: a firm surface, a foam pad, and a multiaxial balance board. The effect of surface stability was also assessed. Postural accelerations were recorded using a tri-axial accelerometer placed over the lumbar spine (L5) in 24 young female adults (23.9 ± 5.3 years) and 24 middle-aged female adults (51.4 ± 5.9 years). Sample entropy (SampEn) was used to analyze the complexity of postural control by measuring the regularity of postural acceleration. The main results show significant age-related differences in the mediolateral and anteroposterior acceleration directions (p ≤ 0.012). Young adults exhibit more irregular fluctuations in postural acceleration (high SampEn), reflecting greater efficiency or automaticity in postural control compared to middle-aged adults. Increased surface instability also progressively decreases SampEn in the mediolateral direction (p < 0.001), reflecting less automaticity with increased instability. However, no interaction effects are observed. These findings imply that incorporating balance training on unstable surfaces might help middle-aged adults maintain postural control and prevent future falls.

Effect of Vestibular Stimulation on Balance and Gait in Parkinson’s Disease: A Systematic Review

Background/Objectives: Parkinson’s Disease (PD) can be associated with balance and gait impairments leading to increased risk of falls. Several studies have reported positive effects of various forms of vestibular stimulation (VS) for improving balance and stability in people with PD (PwP). The purpose of present study was to synthesise the current evidence on the effectiveness of VS, highlighting its potential benefits in improving postural stability and reducing gait impairments in people with Parkinson’s Disease. Method: A systematic search was conducted across databases Cochrane, Medline, PEDro, PubMed, Web of Science, and Google Scholar. Studies were included if they involved PwP at stages 3 or 4 of the Hoehn and Yahr scale, aged 60 years or older. The Risk of Bias (RoB) was assessed using the ROBINS-I tool. The review followed the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42022283898). Results: demonstrated that various forms of VS have shown promise in mitigating symptoms of vestibular dysfunction and improving gait and balance in PwP. However, the overall RoB ranged from moderate to critical, with variations across different domains. Conclusions: While VS appears to offer potential benefits in improving balance and gait in PwP, the presence of biases in the reviewed studies necessitate caution in interpreting the results. Further research should focus on addressing these biases to confirm the therapeutic potential of VS in PD.

Posterior Correction and Fusion Using a 4D Anatomical Spinal Reconstruction Technique Improves Postural Stability Under the Eye-Closed Condition in Patients with Adolescent Idiopathic Scoliosis

Posterior Correction and Fusion Using a 4D Anatomical Spinal Reconstruction Technique Improves Postural Stability Under the Eye-Closed Condition in Patients with Adolescent Idiopathic Scoliosis

Effects of Balance-Based Recreational Therapy on Postural Stability in Those Diagnosed with Parkinson’s Disease

Individuals diagnosed with Parkinson’s disease (PD) have reported increased incidence rates of falling in compari-son to undiagnosed peers. Falls in this population have been found to be related to increasing symptom intensity as well as decreases in overall quality of life. The follow-ing examines the effectiveness of balance-based Recre-ational Therapy within the community setting as part of a multidiscipline treatment team known as the Stillwater Communication, Arts, Nutrition, & Exercise program. A combination of previous data analysis from this longitudinal study have found that participants improved or main-tained their physical functioning and reported less occurrences of falling. Treatment protocol focused on strength, balance, and gait-utilizing modalities such as exercise, obstacle courses, boxing training, and tai chi. Data collection of postural stability, or static balance, occurred throughout the 8-month treatment period on a monthly ba-sis and the month 1 and month 8 mean differences were analyzed for statistical and clinical significance. Assessments revealed the successful increase and/or maintenance of overall postural stability through the 8-month treatment period. Results were not statistically significant, yet provide clinical evidence to the effectiveness of RT com-munity-based balance training for individuals diagnosed with PD. The following study builds upon previous evidence that recreational therapy can be an effective treatment option for those who have been diagnosed with PD and potentially others who are ex-periencing issues with their balance. Implications for future studies and current prac-tice are provided.

Oral pharmacological management of Bertolotti syndrome presenting as chronic low back pain – A case report and review of literature

BackgroundBertolotti syndrome (BS) is often a missed cause of chronic lower back pain in young individuals, commonly associated with the presence of anomalous lumbosacral transitional vertebrae. Case presentationA 19-year-old female with no significant medical or family history presented with persistent lower back pain localized to the gluteal region and posterolateral aspect of the left lower back. The pain worsened over time and limited their movements, including walking. A Ferguson radiograph revealed fusion of the left transverse process of the L5 vertebral segment with the left sacral ala. History, examination findings, and radiological workup confirmed the diagnosis of BS. The patient preferred conservative management, receiving oral pharmacological therapy for six weeks, along with education on preventive measures and routine exercises for postural stability. At a six-month follow-up, the patient remained asymptomatic and managed well. ConclusionsConservative oral pharmacological treatment presents a unique and viable alternative to traditional methods for managing BS, which often involve surgery or steroids/anesthetics at the pseudo-articulation site. Given that BS is common yet underdiagnosed in young patients with chronic back pain, this report also underscores the importance of including it in differential diagnoses for chronic lower back pain in this demographic.

Theta oscillations in observers’ temporal cortex index postural instability of point-light displays

This study investigates whether postural equilibration follows the same principles of motor resonance as goal-oriented actions, namely, whether an individual activates the same neuronal substrates when experiencing postural perturbation as when observing another individual in this condition. To address this question, we examined electroencephalographic dynamics while subjects observed point-light displays featuring an unstable human display, a stable human display, and their respective scrambled counterparts lacking shape information and biological motion. We focused on theta band (4–7 Hz), which is a fundamental frequency for modulating brain activity during challenging balance tasks and reflects postural stability monitoring. Rather than mirroring activity, our findings suggest an inhibitory response to postural instability. Theta event-related synchronization in the left temporal cortex was dampened for the unstable display as compared to its scramble counterpart and to the stable display. This low theta response coincided with an increase in left temporal-prefrontal connectivity, compatible with top-down inhibitory mechanisms. By contrast, the stronger theta response to the stable display as compared to the unstable one could be due to the difficulty of recognizing low-motion biological stimuli, or alternatively, to a facilitation of stimulus processing and strengthening of the mirroring response. The response facilitation for stable posture, coupled with a diminished response to the unstable display, could contribute to a broader mechanism mitigating postural threats and ensuring stable balance. Future investigations should leverage these findings to explore how posture-related responses correlate with perceptual and motor expertise, and to more clearly define these mechanisms during dynamic social interactions.

Vehicle posture wheelbase preview control of in-wheel motors drive intelligent vehicle on potholed road

The in-wheel motors drive intelligent vehicle (IMDIV) has a strong ability of dynamic control, which makes it be a major development path of intelligent vehicles in the future. However, its stability is easily deteriorated by the impact of the road when driving on potholed road. To tackle this issue, a vehicle posture control method based on road feedback and elevation recognition is proposed. Firstly, an elevation recognition algorithm of adaptive Kalman filter (AKF) based on vehicle dynamic response is proposed after considering the flooded road and the system noise uncertainty. Secondly, a vehicle posture controller of fuzzy active disturbance rejection control (FADRC) is designed, with the function of dynamically adjusting the active disturbance rejection control (ADRC) parameters. It is designed to implement front suspension feedback control and rear suspension wheelbase preview control. At last, the road elevation recognition algorithm and vehicle posture control method are proved by Simulink simulation and off-line hardware in the loop test. The results revealed that the AKF can effectively recognize both white noise pavement and potholed road, and the recognition accuracy is greater than 90%. The FADRC controller realizes accurate front suspension feedback control and rear suspension wheelbase preview control by adjusting the real-time online parameters of ADRC. The proposed vehicle posture control method can effectively control the pitch and roll motion, which significantly improves the stability of IMDIV on potholed road. This study can serve as a reference for the posture stability control of IMDIV on potholed road.

The Relationship between Components of Postural Control and Locomotive Syndrome in Older Adults.

Locomotive Syndrome (LS), a condition related to impaired mobility, is influenced by balance control, which comprises six components. Deficiencies in these components can lead to reduced mobility and decreased quality of life. This study aimed to evaluate the relationship between the components of postural control and LS in older adults using the Brief-BESTest. Therefore, this cross-sectional study involved 122 elderly participants from Tha Sala District, Nakhon Si Thammarat Province, both with and without LS. Participants underwent assessments using the Instrumental Activities of Daily Living (IADL) assessment, the Thai Mental State Examination (TMSE), the Two-Step Test, and the Brief-BESTest. The Brief-BESTest covers six balance components: Biomechanical Constraints, Stability Limits, Anticipatory Postural Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait. Descriptive statistics were used to summarize participant characteristics, and Chi-square tests were conducted to examine the relationship between each balance component and LS. Cramer's V was used to assess the strength of the relationships. The results showed the average age of the sample was 67.67 ± 6.01 years with 85.20 percent female and 14.80 percent male. There were significant relationships between LS and three balance components: Biomechanical Constraints (Chi-square = 5.35, p = 0.021, Cramer's V = 0.209), Stability Limits (Chi-square = 5.00, p = 0.025, Cramer's V = 0.204), and Anticipatory Postural Adjustments (left: Chi-square = 4.12, p = 0.042, Cramer's V = 0.213; right: Chi-square = 5.50, p = 0.019, Cramer's V = 0.213). No significant associations were found for Reactive Postural Response, Sensory Orientation, and Stability in Gait. These findings suggest that targeted interventions focusing on specific balance components consist of Biomechanical Constraints, Stability Limits, and Anticipatory Postural Adjustments could help reduce the risk of LS in older adults.

Antagonistic Feedback Control of Muscle Length Changes for Efficient Involuntary Posture Stabilization.

Simultaneous and cooperative muscle activation results in involuntary posture stabilization in vertebrates. However, the mechanism through which more muscles than joints contribute to this stabilization remains unclear. We developed a computational human body model with 949 muscle action lines and 22 joints and examined muscle activation patterns for stabilizing right upper or lower extremity motions at a neutral body posture (NBP) under gravity using actor-critic reinforcement learning (ACRL). Two feedback control models (FCM), muscle length change (FCM-ML) and joint angle differences, were applied to ACRL with a normalized Gaussian network (ACRL-NGN) or deep deterministic policy gradient. Our findings indicate that among the six control methods, ACRL-NGN with FCM-ML, utilizing solely antagonistic feedback control of muscle length change without relying on synergy pattern control or categorizing muscles as flexors, extensors, agonists, or synergists, achieved the most efficient involuntary NBP stabilization. This finding suggests that vertebrate muscles are fundamentally controlled without categorization of muscles for targeted joint motion and are involuntarily controlled to achieve the NBP, which is the most comfortable posture under gravity. Thus, ACRL-NGN with FCM-ML is suitable for controlling humanoid muscles and enables the development of a comfortable seat design.

Postural control strategies with alterations in visual input conditions in a standing position.

Mediated by balance systems, postural control relies heavily on visual input. However, the precise relationship between various visual conditions and postural strategies for balance remains unclear. This study investigated alterations in the center of pressure (COP) and ankle muscle activity during standing positions in healthy individuals under different visual conditions. Fifty-three healthy university students participated in the study. Stabilometry was conducted to evaluate the total path length and outer circumferential area for the COP. Further, surface electromyography was utilized to assess the activity of the bilateral tibialis anterior (TA) and lateral head of gastrocnemius muscles. Participants were instructed to maintain an upright posture under three visual conditions: binocular (eyes open) and monocular (either closing the dominant or nondominant eye). The three conditions were compared using a one-way analysis of variance. No significant differences were observed in the COP across visual conditions. However, in the TA of the nondominant leg, the mean values for the binocular, dominant eye, and nondominant eye conditions were 0.91, 1.08, and 1.14 times that of the resting standing position. Notably, the TA of the nondominant leg was significantly lower in the binocular condition than the dominant and nondominant eye conditions. The study findings indicate that the COP remain consistent despite variations in external visual input. This stability is likely maintained through compensatory adjustments, such as increased TA muscle activity in the nondominant leg under the nondominant eye condition. These observations highlight the complex interplay between the visual perception and postural stability.

Correlation between the biomechanical characteristics and stability of the 143D movement during the balance phase in competitive Tai Chi.

To explore the biomechanical factors affecting the stability of athletes in the 143D balance phase of competitive Tai Chi. The Vicon 3D motion capture system, Kistler 3D force platform, and Noraxon surface electromyography (sEMG) system were used to measure the joint angle, joint moment, center of gravity, ground reaction force, and sEMG data of athletes. The stability index was then calculated according to the formula. Pearson's or Spearman's correlation tests were used to analyze the associations between the biomechanical factors and stability index. (1) Medial lateral stability index (MLSI): A significant negative correlation was found between the ankle inversion angle of the supporting leg (SL) and MLSI (p < 0.05). (2) Anterior posterior stability index (APSI): Significant negative correlations were observed between the ankle intorsion angle, integrated electromyography (iEMG) of the gastrocnemius, and muscle contribution rates of the tibialis anterior, external oblique, and gastrocnemius of the non-supporting leg (NL) with the APSI (p < 0.05). The ankle dorsiflexion moment, iEMG of the rectus femoris and tibialis anterior, muscle contribution rate of the biceps femoris, and root mean-squared (RMS) amplitude of the gluteus maximus of the SL also showed significant negative correlations with the APSI (p < 0.05). Strong and significant negative correlations were also identified between the hip intorsion angle, iEMG of the tibialis anterior, and RMS amplitude of the rectus femoris of the NL with the APSI (p < 0.01). Further strong and significant negative correlation was also found between the RMS amplitude of the biceps femoris of the SL and APSI (p < 0.01). The knee extorsion angle of the NL was positively correlated with the APSI (p < 0.05). (3) Dynamic postural stability index (DPSI): The knee adduction angle, iEMG of the tibialis anterior, and RMS amplitude of the erector spinae of the NL were significantly positively correlated with the DPSI (p < 0.05). The knee abduction and hip extension moments of the SL were also significantly positively correlated with the DPSI (p < 0.05). The ankle inversion angle of the SL impacts left-right stability, while the NL's hip and ankle intorsion angles, knee extorsion angle, and exertion on the core muscle and SL's main muscles, as well as exertion of specific muscles of the NL affect anterior-posterior stability. The hip extension and knee abduction moments of the SL, knee adduction angle, exertion on the tibialis anterior, and activation of the erector spinae of the NL significantly affect the overall stability of an athlete.

The Effect of Attention Focus Instructions on Strength and Balance in Subjects With Generalized Joint Hypermobility

ABSTRACT This study aims to examine the effects of different attention focuses on muscle strength and balance performance in individuals with Generalized Joint Hypermobility (GJH). This randomized crossover trial included 32 individuals with GJH whose Beighton score was greater than 5. Subjects performed each task under external attentional focus, internal attentional focus, and neutral attentional focus condition. Knee extensor muscle strength was measured using the Isokinetic Dynamometer. Postural stability was evaluated using the Biodex Balance System, while dynamic balance was assessed using the Y Balance Test. The main effects of attentional focus on the outcomes were analyzed using repeated measures ANOVA and post-hoc corrections with a 95% confidence interval. Subjects produced significantly higher quadriceps peak torque during external focus instruction and internal focus instruction compared to neutral condition (p = .006). Postural stability performance were found to be better during external attention focus compared to the internal focus of attention and the neutral group (p = .008). In addition, an increase in Y balance composite score was observed during external condition compared to internal condition and neutral condition (p < .001). Whether internal or external, the use of attentional focus may be beneficial for optimal force production during training in individuals with GJH. External attention focus enabled better postural stability and dynamic balance performances.

Long-range cross-correlations between center of pressure velocity and colored noises provided during quiet standing

Unperceivable electrical noise stimulation has been applied to improve postural control through the enhancement of somatosensory feedback. It has been observed that stimulation with a pink noise (1/f) structure is more effective than stimulation with other noise structures. In addition, the 1/f structure embedded in the postural control system may have a superior effect on postural control stabilization. However, the direct relationship between the long-range correlations of the pink-noise signal applied to somatosensory receptors and those of the postural control system has not been elucidated. Thus, we aimed to explore a common long-range correlation factor shared in the time series of the provided noise and foot center of pressure (CoP) during quiet standing. Sixteen young adults stood quietly on the force platform for 65 s. Four noise conditions (no stimulation and stimulation of knee joints with white-, pink-, and red-noise-like signals) were employed during the standing trials. The detrending moving-average cross-correlation analysis revealed that in each of the anteroposterior and mediolateral directions, the CoP velocity time series displayed significant long-range cross-correlations with the white and pink noise signals provided at that time, whereas such an effect was not observed in the red noise signal. This result indicates that pink and white noise signals would alter the temporal behavior of the CoP during quiet standing, although the mechanism remains to be elucidated.

Enhancing postural stability in musculoskeletal quadrupedal locomotion through tension feedback for CPG-based controller.

A central pattern generator (CPG)-based controller enhances the adaptability of quadrupedal locomotion, for example, by controlling the trunk posture. The conventional CPG-based controllers with attitude control often utilized the posture angle as feedback information. However, if the robot's body is as soft as a musculoskeletal structure, it can measure the over-tilting of the trunk based on proprioceptive information of the muscles. In general, proprioceptive information such as muscle tension changes more rapidly than posture angle information. Therefore, a feedback loop based on proprioceptive information has great potential to respond to sudden disturbances that occur during locomotion over uneven terrain. In this research, we proposed a CPG-based controller utilizing the tension of soft pneumatic artificial muscles (PAMs). Musculoskeletal quadruped robots driven by PAMs are so soft, which prevents over-extension of the leg and over-tilting of the trunk to some extent. In addition, tension, one of the proprioceptive information of PAMs, exhibits high sensitivity to changes in trunk posture because the soft body's motion easily changes due to over-titing of the trunk. To validate the efficacy of the proposed controller, we conducted numerical simulations with a simple quadruped model and experiments with a musculoskeletal quadruped robot. As a result, the tension feedback was effective for posture stabilization when the robot's locomotion was subjected to disturbances. Moreover, the tension feedback was effective in improving the running velocity over uneven terrain. These results will enhance the locomotion capability of musculoskeletal quadruped robots, advancing their practical application.&#xD.

Influence of Walking, Manual Techniques, and Elastic Resistance Exercise on Shoulder Posture in Healthy Elderly Individuals.

The world population is rapidly aging; therefore, it is necessary to respond to this challenge in time. One of the typical involutional signs of old age is a hunched posture combined with a forward position of the shoulder girdle. This posture negatively impacts various bodily functions, postural stability, and strain on the musculoskeletal system. We aimed to evaluate the effect of walking and walking combined with manual therapy/resistance exercise on scapular positioning in healthy elderly individuals. Participants of experimental groups underwent a 4-week training session that involved walking and manual techniques/resistance training applied 2x/week. Participants of the control group maintained their usual daily habits. Our results showed statistically significant improvement in scapular positioning of the left shoulder in participants who underwent regular walking combined with resistance exercise training. These results suggest that regular walking combined with resistance training, when properly dosed, may beneficially influence scapular positioning in healthy elderly individuals.

Assessing postural stability in flatfoot using a time-in-boundary method during single-leg standing.

Flatfoot, a foot deformity characterized by the collapse of the arch, significantly impacts an individual's balance and stability. This study explored postural adjustments and sway excursions in individuals with and without flatfoot using the Time-in-Boundary method. This method assessed relative stability by exploring various center of pressure radius thresholds during three trials of single-leg stance. We observed significant interactions in threshold levels (F = 4.37, p = 0.04) and normalized relative stable times (F = 7.64, p = 0.01), particularly in the initial trials. Initially, the flatfoot group showed marked decreases in stable times at 10 mm, 15 mm, and 20 mm thresholds, which expanded to 25 mm and 30 mm in subsequent trials. Despite a significant decrease in stability at the 30 mm threshold in early trials, participants exhibited improved stability control as trials progressed. This enhancement likely reflects a combination of a learning effect and an increased understanding of the task requirements, underscoring the adaptability of postural control systems to the biomechanical challenges posed by flatfoot. The Time-in-Boundary method has proven to be an effective tool for clinicians to assess postural control, playing a vital role in developing customized rehabilitation strategies for individuals with flatfoot.