Reactive Postural Control Research Articles

Postural Responses to Sudden Horizontal Perturbations in Tai Chi Practitioners

Tai Chi has been shown to elicit numerous positive effects on health and well-being. In this study, we examined reactive postural control after sudden unloading horizontal perturbations, which resembled situations encountered during Tai Chi. The study involved 20 participants, 10 in the Tai Chi group (age: 37.4 ± 7.8 years), who had been regularly training the push-hand technique for at least 7 years, and 10 in the control group, consisting of healthy adults (age: 28.8 ± 5.0). Perturbations were applied at three different positions (hips, shoulders, and arms) via the load-release paradigm. Twenty measurements were carried out for each perturbation position. We measured peak vertical and horizontal forces on the ground (expressed percentage of body mass (%BM)), peak center of pressure displacement and peak horizontal and vertical velocities at the knee, hip and shoulder joints. The Tai Chi group exhibited smaller increases in vertical ground reaction forces when perturbations were applied at the hips (11.5 ± 2.1 vs. 19.6 ± 5.5 %BW; p = 0.002) and the arms (14.1 ± 4.2 vs. 23.2 ± 8.4 %BW; p = 0.005). They also responded with higher horizontal force increase after hip perturbation (16.2 ± 3.2 vs. 13.1 ± 2.5 %BW; p < 0.001). Similar findings were found when observing various outcomes related to velocities of vertical movement. The Tai Chi group also showed lower speeds of backward movement of the knee (p = 0.005–0.009) after hip (0.49 ± 0.13 vs. 0.85 ± 0.14 m/s; p = 0.005) and arm perturbations (0.97 ± 0.18 vs. 1.71 ± 0.29 m/s; p = 0.005). Center of pressure displacements were similar between groups. Our study demonstrated that engaging in Tai Chi could be beneficial to reactive postural responses after sudden perturbations in a horizontal direction; however, future interventional studies are needed to directly confirm this. Moreover, because of the age difference between the groups, some confounding effects of age cannot be ruled out.

Torque responses to in-place-perturbations in people with multiple sclerosis

BackgroundAutomatic postural responses are critical to prevent falls after a loss of balance. Although responses have been shown to be delayed in people with multiple sclerosis (PwMS), the degree to which other aspects of these movements are impacted by MS remains unknown. Research QuestionDo responses to in-place support-surface perturbations differ in PwMS compared to neurotypical adults? Are these responses related to a functional measure of postural response performance- center of mass (COM) displacement?. Method52 PwMS and 20 neurotypical, age-matched adults (NA) experienced backward support surface perturbations resulting in forward loss of balance and requiring an in-place response. Center of pressure (COP) and torque were calculated from force plates while center of mass (COM) approximations were collected via motion capture. Primary outcomes were maximal torque production at the foot and its timing, rate, and onset. ResultsPwMS and NA demonstrated no differences in maximal torque production (p = 0.79), timing of maximal torque (p = 0.29), rate of torque development (p = 0.76), or the onset of AP COP movement (p = 0.44). There was a significant negative association between the rate of torque development and forward COM displacement in both groups (Control: r=-0.64, p = 0.002; MS: r=-0.35, p = 0.01). Larger maximal torque production was also associated with smaller COM displacement in PwMS (r=-0.33, p = 0.02). ConclusionTorque profiles in response to backward support surface translations resulting in feet in-place responses were similar in people with mild MS and neurotypical adults. The rate of development and maximal torque were however correlated to functional postural response outcomes. These findings suggest that while not worse in PwMS during in-place perturbations, force-responses seem to be important predictors of the effectiveness of reactive postural control responses.

Testing the Validity of the Diamond Steps Test for Balance in Healthy Adults

ObjectivesTo test the validity of the Diamond Steps Test (DST), a new test to assess balance. DesignThis cross-sectional study evaluated the validity of the DST, a brief new balance assessment tool. SettingThe implementation site was the rehabilitation center of a hospital. Data collection was conducted from February to June 2017. ParticipantsHealthy adults (N=65) between the ages of 40 and 72 years who volunteered to participate. InterventionsNot applicable. Main Outcome MeasuresTwo measures were used to assess DST: the time required to step around the diamond 5 times (5-DS) and the time required to step around the diamond twice, once using the dominant foot and the other using the non-dominant foot (LRDS). ResultsMultiple regression analysis was performed for each of the 2 methods for measuring DST. Five variables were predictive of DST as measured by the 5-DS test: the 10-Second Open Close Stepping Test, timed Up and Go (TUG) test, Y Balance Test (YBT) posterolateral reach for the left leg, Standing on One Leg with Eyes Closed (SOLEC) test for the right leg, and sex. The coefficient of determination was 0.54. For DST measured by the LRDS, 4 variables were found to be predictive: the 30-Second Chair Stand Test, YBT posterolateral reach for the left leg, TUG, and SOLEC for the right leg. The coefficient of determination was 0.49. ConclusionThe DST was shown to assess 7 of the 9 components of balance (static stability, functional stability limits, underlying motor systems, anticipatory posture control, dynamic stability, reactive postural control, and sensory integration), suggesting that it is a valid test to use for balance assessment.

Action observation improves sit-to-walk in patients with Parkinson's disease and freezing of gait. Biomechanical analysis of performance

IntroductionFreezing of gait (FoG) is one of the most disabling gait disorders in Parkinson's disease (PD), reflecting motor and cognitive impairments, mainly related to dopamine deficiency. Recent studies investigating kinematic and kinetic factors affecting gait in these patients showed a postural instability characterized by disturbed weight-shifting, inappropriate anticipatory postural adjustment, worse reactive postural control, and a difficulty executing complex motor tasks (i.e. sit-to-walk). These symptoms are difficult to alleviate and not very responsive to Levodopa. For this reason, additional therapeutic actions based on specific therapeutic protocols may help patients with their daily lives. We conducted a randomized control trial aimed to test if two clinical protocols for PD patients with FoG were effective to improve postural control. MethodsRehabilitation protocols, conceived to improve gait, were based on learning motor exercises with the Action Observation plus Sonification (AOS) technique, or by the use of external sensory cues. We collected biomechanical data (Center of Mass COM, Center of Pressure COP, and moving timings), using the sit-to-walk task as a measure of motor and gait performance. ResultsKinetic and kinematic data showed that when treatment effects consolidate, patients treated with AOS protocol are more efficient in merging subsequent motor tasks (sit-to-stand and gait initiation), and diminished the total moving time and the area of the COP positions. ConclusionWe demonstrated for the first time that PD patients with FoG treated with an AOS protocol aimed at relearning appropriate gait patterns increased balance control and re-acquired more efficient postural control.

Lower-limb coordination during gait: The effects of age and walking surface

Automatic postural responses are critical to prevent falls after a loss of balance. Although responses have been shown to be delayed in people with multiple sclerosis (PwMS), the degree to which other aspects of these movements are impacted by MS remains unknown.Do responses to in-place support-surface perturbations differ in PwMS compared to neurotypical adults? Are these responses related to a functional measure of postural response performance- center of mass (COM) displacement?.52 PwMS and 20 neurotypical, age-matched adults (NA) experienced backward support surface perturbations resulting in forward loss of balance and requiring an in-place response. Center of pressure (COP) and torque were calculated from force plates while center of mass (COM) approximations were collected via motion capture. Primary outcomes were maximal torque production at the foot and its timing, rate, and onset.PwMS and NA demonstrated no differences in maximal torque production (p = 0.79), timing of maximal torque (p = 0.29), rate of torque development (p = 0.76), or the onset of AP COP movement (p = 0.44). There was a significant negative association between the rate of torque development and forward COM displacement in both groups (Control: r=-0.64, p = 0.002; MS: r=-0.35, p = 0.01). Larger maximal torque production was also associated with smaller COM displacement in PwMS (r=-0.33, p = 0.02).Torque profiles in response to backward support surface translations resulting in feet in-place responses were similar in people with mild MS and neurotypical adults. The rate of development and maximal torque were however correlated to functional postural response outcomes. These findings suggest that while not worse in PwMS during in-place perturbations, force-responses seem to be important predictors of the effectiveness of reactive postural control responses.

Relationship between different methods to measure ankle range of motion in children with idiopathic toe walking

Automatic postural responses are critical to prevent falls after a loss of balance. Although responses have been shown to be delayed in people with multiple sclerosis (PwMS), the degree to which other aspects of these movements are impacted by MS remains unknown.Do responses to in-place support-surface perturbations differ in PwMS compared to neurotypical adults? Are these responses related to a functional measure of postural response performance- center of mass (COM) displacement?.52 PwMS and 20 neurotypical, age-matched adults (NA) experienced backward support surface perturbations resulting in forward loss of balance and requiring an in-place response. Center of pressure (COP) and torque were calculated from force plates while center of mass (COM) approximations were collected via motion capture. Primary outcomes were maximal torque production at the foot and its timing, rate, and onset.PwMS and NA demonstrated no differences in maximal torque production (p = 0.79), timing of maximal torque (p = 0.29), rate of torque development (p = 0.76), or the onset of AP COP movement (p = 0.44). There was a significant negative association between the rate of torque development and forward COM displacement in both groups (Control: r=-0.64, p = 0.002; MS: r=-0.35, p = 0.01). Larger maximal torque production was also associated with smaller COM displacement in PwMS (r=-0.33, p = 0.02).Torque profiles in response to backward support surface translations resulting in feet in-place responses were similar in people with mild MS and neurotypical adults. The rate of development and maximal torque were however correlated to functional postural response outcomes. These findings suggest that while not worse in PwMS during in-place perturbations, force-responses seem to be important predictors of the effectiveness of reactive postural control responses.

Independent walking and balance in children with CHARGE syndrome

Children with CHARGE syndrome (CWCS) are born with multiple physical disabilities, several of which impair balance and the onset of motor milestones. Early motor development problems can include delayed independent walking, which has been found in CWCS. In addition, few studies have examined balance in CWCS and these studies have been limited in scope, necessitating a more comprehensive examination of balance in this population. Motor development occurs as a progression of stages as represented by Seefeldt’s conceptual model. As such, it is essential to examine the association of early development of foundational skills, such as balance, with the onset of motor milestones as they are building blocks to motor competence. The aims of this study are to (1) examine the differential effects of children with and without CHARGE syndrome on balance and (2) examine the association of age of walking to these balance measures. In this study, 27 CWCS and 22 children without CHARGE syndrome, aged 7 to 16 years, were assessed on four components of balance including anticipatory control, reactive postural control, sensory orientation, and dynamic gait using the shortened version of the Balance Evaluation Systems Test (mini-BESTest) and parental reported age of independent walking. Their balance and age of walking were compared to 22 typically developing peers of similar age and gender distribution. Results revealed that CWCS walked three times later than their peers without CHARGE syndrome and had significant deficits on all balance systems assessed with the largest difference occurring in anticipatory control. Anticipatory control is critically important in maintaining static and dynamic postural control. These results indicate a critical need for early functional balance training and compensatory strategies in CWCS.

Reactive Stepping Responses Mediated by Predictable Manual Waist-Pull Perturbations are Associated with Fall History in Older Adults

Background and Purpose The ability to respond effectively to perturbations is a key element of reactive postural control and is a crucial mediator of falls. Several studies exist in the literature that determine older adults’ responses to perturbations, however those studies typically involve procedures that lack objectivity or applicability outside a laboratory. A study involving waist-pull perturbations with a spring-scale (SS) is an exception. In that study, fall history was most accurately differentiated by a reactive stepping response to a perturbing force of 10% total body weight. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. For perspective, the association of fall history with Timed-Up-and-Go (TUG) and single limb stance (SLS) times was also determined. Methods Fifty-eight healthy older adults (mean age = 80.7 years) participated in the study. Their 2-year fall history (yes, no) was recorded. All participants underwent SS testing with one-pound incremental, horizontal sagittal plane manual waist-pull perturbations. The number of steps in response to perturbation with 10% total body weight was recorded; TUG and SLS tests were performed. Associations between variables were examined using Spearman (rank-biserial) correlations. Results The median number of steps for fallers was 5 in both anterior and posterior directions. For non-fallers, the median number of steps was 1 and 2 in the anterior and posterior directions, respectively. The significant correlations between fall status and number of steps were 0.772 and 0.813 for the anterior and posterior directions, respectively. Similarly, the significant correlations between fall status and balance tests were 0.722 and -0.456 for the TUG and the SLS, respectively. Conclusions The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years.

Backward Protective Stepping During Dual-Task Scenarios in People With Parkinson’s Disease: A Pilot Study

Introduction. Reactive movements in response to a loss of balance are altered in people with Parkinson’s disease (PD) and are critical for fall prevention. Further, falls are more common while attention is divided. Although divided attention has been shown to impact postural responses in healthy older adults, the impact of dividing attention on reactive balance, and the natural prioritization across postural and cognitive tasks in people with PD is largely unknown. Objectives. To characterize (1) the impact of a secondary cognitive task on reactive postural control and (2) the prioritization across stepping and cognitive tasks in people with PD. Methods. Sixteen people with PD and 14 age-matched controls underwent step-inducing, support-surface perturbations from stance, with and without an auditory Stroop secondary cognitive task. Cognitive, neuromuscular, and protective stepping performance were calculated for single and dual task scenarios. Results. In PD and control participants, cognitive reaction times (P = .001) and muscle onset latency (P = .007), but not protective step outcomes (P > .12 for all) were worse during dual tasking compared with single-task scenarios. Both PD and control groups prioritized the protective stepping task over the cognitive task. Overall, people with PD exhibited worse first-step margin of stability (a measure of protective step performance) than controls (P = .044). Conclusion. This study provides preliminary evidence that people with PD, like age-matched controls, exhibit cognitive and neuromuscular, but not protective step, dual-task interference. The lack of dual-task interference on step performance indicates a postural prioritization for PD and healthy older adults during dual-task protective stepping.

Reactive Postural Responses In Collegiate Athletes

Athletes frequently need to recover balance after an external disturbance during tasks with high cognitive demand. Mobility impaired populations demonstrate deficits in reactive postural responses to backward and lateral perturbations but, little is known about postural responses in college athletes. PURPOSE: To examine differences in direction and task (single [ST] and dual task [DT]) in reactive postural response measures during the push-and-release (P&R) test. METHODS: Reactive postural responses in 98 healthy (F=42, age 19.3 ± 1.60 years, BMI 23.56 ± 3.29 kg/m2) college athletes were assessed using the P&R in four directions (forward, backward, right, left), with eyes closed, under ST and DT (concurrent verbal cognitive task) conditions. Inertial sensors on the sternum, lumbar, right tibia, and feet were used to assess step initiation latency, time of first heel contact (HC), and time to stabilization (TTS). A sensor on the tester’s hand determined release time. Linear mixed models with random intercepts were used to determine if postural response measures differed by direction and task. RESULTS: There was a significant interaction between direction and task for HC (p=0.04), with the largest difference in DT and ST in the forward direction (95%CI = [0.05, 0.08]), and the smallest difference in the backward direction (95%CI = [0.02, 0.05]). There were also significant main effects for direction (p <0.0001) and task (p<0.0001) for each postural response (latency, HC, TTS). Means adjusted for age, sex, and BMI are presented below.CONCLUSION: Postural responses differ by direction during the P&R in college athletes. The largest differences were between the forward and backward directions. These directions may be most sensitive to detecting changes in reactive postural control; future work will examine the utility of the P&R for return-to-play decisions. Supported by PAC 12 (PI: Fino, Dibble); University of Utah Study Design and Biostatistics Center (UL1TR002538)

Relationship Between Motor Skills, Balance, and Physical Activity in Children with CHARGE Syndrome

Introduction: Children with CHARGE syndrome often show delays in balance and motor skills due to multisensory impairments. Research also suggests that children with CHARGE syndrome have fewer opportunities to engage in physical activity. However, little research has examined the relationship among all of these variables. Thus, the purpose of this study was to examine the relationship between balance, motor skills, and physical activity. Methods: Participants consisted of 37 children with CHARGE syndrome aged 3–16 years who could walk independently. Parents of each child with CHARGE syndrome completed a demographics questionnaire and the Physical Activity Questionnaire for Children or Adolescents. Their child completed the Mini-BEST balance test and five motor skills (run, jump, slide, kick, and throw) from the Test of Gross Motor Development II. Results: Results indicate that anticipatory control had significant positive correlations with all five motor skills, sensory orientation with three motor skills, and reactive postural control and dynamic gait with two motor skills. Running was the only variable that had a significant positive correlation with physical activity. Discussion: The findings indicate that balance, especially anticipatory control, plays an important role in fundamental motor skills of children with CHARGE syndrome. There is also a strong connection between physical activity and running competence for this population; however, since this is based on a correlational analysis, the direction of the relationship is unclear. Implications for practitioners: Physical education teachers should work with students with CHARGE syndrome on increasing balance and motor skill performance to give them the competence and confidence to engage in physical activity. Moreover, parents can help by engaging in physical activity with their child at an early age and seeking out additional physical activity opportunities for their child outside of the physical education and school setting.

Reactive Balance Differences Between Collegiate Sports

Static and dynamic postural stability have been characterized in athletes and shown to differ across sports. However, these tests of stability may not specifically capture the balance required for reactive athletic movements. The Push-and-Release (P&R) test is a standardized clinical tool used to assess reactive postural control in balance-impaired populations. PURPOSE: To examine differences between sport team and task (single [ST] and dual task [DT]) in reactive postural response measures. METHODS: 40 healthy, male athletes (age 18.50 ± 0.75; body mass index [BMI] 24.11 ± 2.38) were recruited from 3 collegiate teams: baseball (n=12), lacrosse (n=17), and swimming (n=11). Reactive postural responses were assessed using the P&R in backward and forward directions under ST and DT (concurrent verbal cognitive task) conditions. All conditions were performed with eyes closed. Inertial sensors on the sternum, lumbar, feet, and right tibia were used to assess step latency (L), time of first heel contact (HC), and time to stabilization (TTS). A sensor on the tester’s hand was used to determine release time. To assess if postural response measures differ by sport and task, linear mixed effects models with random intercepts and stratified by direction (forward or backward), were used and adjusted for age and BMI. RESULTS: Lacrosse players had faster L compared to baseball players in the forward direction (p=0.018). No other differences by sport were observed. In the forward direction, DT outcomes were slower than ST outcomes (L: p<0.0001; HC: p=0.0004; TTS: p=0.0064). In the backward direction, L was slower in the DT condition (p=0.0034), but no task differences were found for HC or TTS (p=0.0628 and p=0.8733, respectively). CONCLUSION: In the forward direction only, DT slowed all postural responses. While L differed between lacrosse and baseball in the forward direction, no other differences were found across sports. As most outcomes were unaffected by sport, the P&R may be a clinically relevant assessment in athletics. However, due to the limited sample size, caution should be applied when interpreting these findings and future studies are needed. Supported by PAC 12 Student Athlete Health & Wellbeing (PI: Fino, Dibble) and University of Utah Study Design and Biostatistics Center through NCATS Grant 8UL1TR000105.

Assessment of Balance Control Subsystems by Artificial Intelligence.

Recent studies have shown that balance performance assessment based on artificial intelligence (AI) is feasible. However, balance control is very complex and requires different subsystems to participate, which have not been evaluated individually yet. Furthermore, these studies only classified individual's balance performance across limited grades. Therefore, in this study we attempted to implement AI to precisely evaluate different types of balance control subsystems (BCSes). First, a total of 224 commonly used and newly developed features were extracted from the center of pressure (CoP) data for each participant, respectively. Then, regressors were employed in order to map these features to the evaluation scores given by physical therapists, which include the total score in Mini-Balance-Evaluation-Systems-Tests (Mini-BESTest) and its sub-scores on BCSes, namely anticipatory postural adjustments (APA), reactive postural control (RPC), sensory orientation (SO), and dynamic gait (DG). Their scoring ranges should be 0-28, 0-6, 0-6, 0-6, and 0-10, respectively. The results show that their minimum mean absolute errors from AI estimation reach up to 2.658, 0.827, 0.970, 0.642, and 0.98, respectively. In sum, our study is a preliminary study for assessing BCSes based on AI, which shows its possibility to be used in the clinics in the future.

Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.

People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes. We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed participants with the Unified Parkinson's Disease Rating Scale (UPDRS) or Movement Disorders Society revision (MDS-UPDRS), and balance assessments: 360° turn test, one-leg stance, a reactive postural control test, and tandem walk. Participants were classified as PIGD or TD based on the UPDRS or MDS-UPDRS assessment results. Differences in balance variables between subtypes were assessed with univariate analyses. Receiver operating characteristic (ROC) curve analyses were performed to investigate the ability of balance variables to differentiate PD subtypes. No differences between subtypes were observed for tandem walk or reactive postural control. Participants with PIGD performed worse on number of steps and time to complete the 360° turn test and on one-leg stance time. ROC curves showed only the 360° turn test discriminated PIGD from TD with high specificity (0.84). Post hoc analyses revealed that the 360° turn test is the most discriminatory for classifying PD subtypes in early stages of the disease. ROC analyses based on combined models including both the 360° test and tandem walk test performance increased the specificity to 0.97. The 360° turn test requires minimal time to administer and may be useful in mild-moderate PD for distinguishing PIGD from TD subtypes.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A295).

Development of the balance exercise suit using pneumatic artificial muscles

Decrease in balance control ability leads to the risk of falling among the elderly, and reactive postural control is important to prevent falling. In this paper, we developed a wearable suit for improving balance function with pneumatic gel muscles (PGMs). This suit can make perturbations to the upper body and aims to improve the function of reactive postural control through balance exercise. Small perturbations are generated by contraction force of PGMs attached the suit. Furthermore, the suit was designed to be lighter using DhaibaDAQ as the accelerometer and switch module. We described the system configuration, the torque of PGMs, and the control method.

04 Verification of Balance Function on Exercise using a New Wearable Device with Pneumatic Gel Muscles

Abstract Brief Introduction Decrease in the ability to control posture correlates with the risk of falls in the elderly. Exercises for reactive postural control and dynamic stability can improve postural control ability. However, balance exercises for reactive postural control are difficult because they require expensive therapeutic instruments or an expert skill level to generate the proper disturbance. The purpose of this study is to design a new wearable device using pneumatic artificial muscles for balance exercises. Furthermore, we investigated the effect of using this device on balance function. Methods Used We used a pneumatic gel muscle (PGM) for the wearable balance exercise device. The balance exercise device consists of two PGMs, a soft supporter, a small air tank, and a hand switch. The PGMs were attached to both sides of the acromion processes and pointed vertically down to the height of the iliac crest. Therefore, these PGMs generated a force in the direction of lateral trunk bending. Eight healthy adult males participated in this study. The participants received balance exercise using this device. We compared center of pressure (COP) data between the pre-test and post-test of exercise. Key Results Using this device, the rectangle area, boundary length, and medio-lateral length of COP significantly decreased in the post-test, compared to the pre-test (p = 0.031, p = 0.031, and p = 0.049, respectively). Brief Discussion and Conclusion The balance exercises with disturbances have the effect of improving balance function. This device was able to add unexpected medio-lateral disturbances during balance exercises. Therefore, participants were able to learn reactive postural control and stability more effectively. Our results suggest that this device could immediately improve postural control by creating small disturbances. Funding This research was based on results obtained from a project commissioned by the New Energy and Industrial Technology Development Organization (NEDO).

Interindividual Balance Adaptations in Response to Perturbation Treadmill Training in Persons With Parkinson Disease.

Perturbation training is a promising approach to reduce fall incidence in persons with Parkinson disease (PwPD). This study aimed to evaluate interindividual differences in balance adaptations in response to perturbation treadmill training (PTT) and identify potential outcome predictors. PwPD (n = 43, Hoehn & Yahr stage 1-3.5) were randomly assigned to either 8 weeks of PTT or conventional treadmill training (CTT) without perturbations. At baseline and following intervention, data from 4 domains of balance function (reactive, anticipatory, dynamic postural control, and quiet stance) were collected. Using responder analysis we investigated interindividual differences (responder rates and magnitude of change) and potential predictive factors. PTT showed a significantly higher responder rate in the Mini Balance Evaluation Systems Test (Mini-BESTest) subscore reactive postural control, compared with CTT (PTT = 44%; CTT = 10%; risk ratio = 4.22, confidence interval = 1.03-17.28). Additionally, while between-groups differences were not significant, the proportion of responders in the measures of dynamic postural control was higher for PTT compared with CTT (PTT: 22%-39%; CTT: 5%-10%). The magnitude of change in responders and nonresponders was similar in both groups. PTT responders showed significantly lower initial balance performance (4/8 measures) and cognitive function (3/8 measures), and were older and at a more advanced disease stage, based on descriptive evaluation. Our findings suggest that PTT is beneficial to improve reactive balance in PwPD. Further, PTT appeared to be effective only for a part of PwPD, especially for those with lower balance and cognitive function, which needs further attention.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A1).

Balance in Transitional Age Youth with Autism Spectrum and Neurodevelopmental Disorders during a 6-Week Comprehensive Wellness Program

Young adults with Autism Spectrum Disorder (ASD) are at an increased risk of poor balance and coordination due to sensory deficits. Specifically, reactive postural control impairments have been well documented among individual's with ASD, however, research suggests that interventions can improve these associated deficiencies. The Piece It Together (PIT) program is a community-based comprehensive program designed to provide wellness opportunities among teens and young adults with ASD and other mild Neurodevelopmental Deficits (ND). The PIT curriculum includes exercise, nutrition, stress management, and socialization with a focus on strength and endurance training geared towards improving everyday functioning through the increase of awareness and participation in daily healthy lifestyle behaviors. Twenty participants, aged 14-29, attended 90-minute classes at the MUSC Wellness Center twice a week for six weeks and were encouraged to increase their physical activity daily.

Development of New Soft Wearable Balance Exercise Device Using Pneumatic Gel Muscles

Decreased ability to control posture is correlated with the risk of falls among older individuals. In particular, reactive postural control ability response to even small perturbations is important for fall prevention of older individuals. The current study sought to design a new wearable assistive device for improving balance function by generating small perturbations using pneumatic gel muscle (PGM). Furthermore, we investigated the effects of using the proposed device for balance training. The proposed wearable balance exercise device utilized PGMs possessing various features, such as a lightweight design and the ability to generate small perturbations with a small power source. We investigated the effects of the device on reactive postural control exercises. Seven healthy participants participated in this study. Three-dimensional acceleration data (Ax, Ay, and Az) were measured from participants during a single leg stance in each session. The peak Ax value generated by perturbations and responses significantly differed from baseline peak acceleration. The peak Ay value caused by perturbations was significantly decreased compared with baseline peak acceleration. In addition, the root mean square Ax value of the post-test significantly decreased compared with the pre-test value. Our results revealed that the proposed wearable balance exercise device was able to create small perturbations for assessing reactive postural balance control. Furthermore, the device was able to improve users’ stability.

Functional Performance and Balance in the Oldest-Old.

The group of individuals 85 years and over (termed oldest-old) is the fastest-growing population in the Western world. Although daily functional abilities and balance capabilities are known to decrease as an individual grows older, little is known about the balance and functional characteristics of the oldest-old population. The aims of this study were to characterize balance control, functional abilities, and balance self-efficacy in the oldest-old, to test the correlations between these constructs, and to explore differences between fallers and nonfallers in this age group. Forty-five individuals living in an assisted living facility who ambulated independently participated in the study. The mean age was 90.3 (3.7) years. Function was tested using the Late-Life Function and Disability Instrument (LLFDI). Balance was tested with the mini-Balance Evaluation System Test (mini-BESTest) and the Timed Up and Go (TUG) test. Balance self-efficacy was tested with the Activities-Specific Balance Confidence (ABC) scale. The mean total function LLFDI score was 63.2 (11.4). The mean mini-BESTest score was 69.8% (18.6%) and the mean TUG time was 12.6 (6.9) seconds. The mean ABC score was 80.2% (14.2%). Good correlation (r > 0.7) was observed between the ABC and the function component of the LLFDI, as well as with the lower extremity domains. Correlations between the mini-BESTest scores and the LLFDI were fair to moderate (r's range: 0.38-0.62). Age and ABC scores were significant independent explanators of LLFDI score (P = .0141 and P = .0009, respectively). Fallers and nonfallers differed significantly across all outcome measures scores, except for TUG and for the "Reactive Postural Control" and "Sensory Orientation" domains of the mini-BESTest. The results of this study provide normative data regarding the balance and functional abilities of the oldest-old, and indicate a strong association between self-efficacy and function. These results emphasize the importance of incorporating strategies that maintain and improve balance self-efficacy in interventions aimed at enhancing the functional level of this cohort.