Single-leg Standing Research Articles

Evaluating the short term effects of kinesiology taping and stretching of gastrocnemius on postural control: A randomized clinical trial

IntroductionThe ability to maintain balance is essential for both remaining in the standing position and preventing falls. Physical therapy techniques such as kinesiology taping (KT) and stretching are considered to be effective measures in ameliorating balance issues. However, there is no available study comparing the effects of these two methods on postural control. Thus, the current study aims to investigate and compare the efficacy of interventions accomplished through these methods on young and elderly subjects. MethodIn a single-blind randomized clinical trial, 40 young subjects (<30 years) and 40 elderly subjects (>60 years) were randomly assigned to two groups of KT and stretching. In the first group, inhibitory tape was applied to the gastrocnemius muscle. In the second group, 60 s of stretch was repeated 4 times. The static balance was evaluated before and after the interventions using the single-leg standing (SLS) test along with measurements of the velocity and displacement of the center of pressure by the force plate. ResultsBased on the Mann-Whitney test, there were no significant differences between the tape and stretching techniques in the study variables of either group of participants, before and after the interventions (p > 0.05). However, the results of the Wilcoxon test showed a significant increase in single-leg stance time in the stretching group in the elderly subjects (p = 0.03). MANOVA results demonstrated significant group and time effects only in the SLS parameter (p < 0.05). ConclusionStretching the gastrocnemius seems to be more efficacious than KT for improving balance problems in older adults. Level of evidenceII.

The Relationship Between Foot Feature Parameters and Postural Stability in Healthy Subjects.

Little has been explored about the disparate contribution of medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) to human gait and postural stability. This study aims to investigate the correlation of foot feature parameters including both MLA and LLA with postural stability. Thirteen young and healthy subjects participated in this study. The newly developed FFMS extracted foot feature parameters in nonweight-bearing (NWB) and weight-bearing (WB) conditions along with postural stability parameters in single-leg-standing (SLS) condition. A bivariate correlation analysis was carried out to investigate the correlation between the foot characteristics and the postural stability parameters. The foot length and width showed negative correlation with center of pressure (CoP) distance in medio-lateral (ML) and total direction, whereas the foot length in NWB and WB conditions, and the foot width in WB condition showed positive correlation with CoP distance in anterior-posterior (AP) direction. The height of the LLA curve and the area of the MLA were correlated with the postural stability parameters in AP direction. The ratios of the LLA height and area showed moderate correlation with the CoP distance in ML direction and total direction. The size of a foot, such as the length and width, is correlated with postural stability. Whereas the MLA features are associated with postural stability in AP direction, the LLA features are associated with that in ML and total direction. The findings suggest that the roles and contributions of the MLA and LLA features in and to the postural control are different.

Development of postural control during single-leg standing in children aged 3–10 years

BackgroundThe ability to control the center of mass (COM) during single-leg standing (SLS) is imperative for individuals to walk independently. However, detailed biomechanical features of postural control during SLS performed by children remain to be comprehensively investigated. Research question: We aimed to investigate the development of postural control during SLS in children aged 3–10 years. MethodsForty-eight healthy children (26 boys and 22 girls) aged 3–10 years and 11 young adults participated in this experiment. The child population was divided into four groups by age: 3–4, 5–6, 7–8, and 9–10 years. The SLS task included standing on a single leg as long and as steady as possible for up to 30 s. A three-dimensional motion capture system and two force plates were used for calculating the COM and center of pressure (COP). The task was divided into three phases (accelerated, decelerated, and steady) on the basis of the relationship between COM and COP. ResultsCOP–COM distances in the 5–6 years’ and 7–8 years’ groups were significantly increased during the acceleration phase when compared with those in the adult group. Furthermore, COP–COM distances during the decelerated phase were significantly higher in all children’s groups compared with those in the adult group. Lastly, COP–COM distance during the steady phase was significantly higher in the 3–4 year age group than in the 9–10 year age and adults groups. SignificanceThese results suggest that postural control during the acceleration and steady phases mature by 9 years. Conversely, children ∼10 years did not attain adult-like levels of postural control during the decelerated phase. The developmental process for postural control at each phase possibly plays a significant role in the basic biomechanics of movement and does not display a monotonic pattern.

Muscle co-contraction in elderly people change due to postural stability during single-leg standing

BackgroundMuscle co-contraction is the simultaneous contraction of agonist and antagonist muscles crossing a joint, and it increases with age. This study primarily aimed to clarify the difference in the effect of a light fingertip contact to stationary surface on postural sway and muscle co-contraction during single-leg standing (SLS) between young and elderly groups; the secondary aim was to reveal the quantitative difference in the muscle co-contraction of the ankle joint among the three different support structure conditions in the elderly group.MethodsThis study included eight young adults (age 23.4 ± 2.6 years) and nine community dwelling older adults (age 74.7 ± 3.4 years). The task was SLS under the following conditions: (1) no supporting structure, FR; (2) light index fingertip contact to a stationary supporting structure (to touch in force < 1 N), LT; and (3) dependence on a supporting structure for stabilization as desired, DO. Center of pressure (COP) variables [root-mean-square distance (RDIST), total excursion (TOTEX), mean velocity (MVELO), and standard deviation area (AREA-SD)] and the co-contraction index (CI) between the tibialis anterior and soleus were measured using surface electromyography.ResultsWith regard to the effect of the light fingertip contact to stationary surface, in the young group, TOTEX, MVELO, AREA-SD, and CI during SLS were smaller under the LT condition than under the FR condition. However, in the elderly group, only AREA-SD and CI were smaller under the LT condition than under the FR condition. No significant difference was observed in COP variables and CI under the DO condition between the young and elderly groups.ConclusionBoth young and elderly groups could decrease muscle co-contraction using the light fingertip contact. On the other hand, in the elderly group, COP variables showed a limited effect from the light fingertip contact; only the “sway” domain measure (AREA-SD). Both young and elderly groups showed the smallest CI under the DO condition. Therefore, the elderly group could decrease muscle co-contraction of the ankle joint depending on postural stability.

Transient Effects of Calf Muscle Fatigue and Visual Control on Postural Balance During Single Leg Standing

Other SectionsAbstractI. IntroductionII. MethodsIII. ResultsIV. DiscussionV. ConclusionAcknowledgementsReference

Analysis of Stability on Single-leg Standing by Wearing a Head Mounted Display

Objective: The purpose of this study was to investigate the effects of three visual conditions (eyes opened, eyes closed, and wearing of a head mounted display [HMD]) on single-leg standing through kinematics and kinetic analysis. Method: Twelve college students (age: 24.5±2.6 years, height: 175.0±6.4 cm, weight: 69.2±5.1 kg) participated in this study. The study method adopted three-dimensional analysis with six cameras and ground reaction force measurement with one force plate. The analysis variables were coefficient of variation (CV) of the center of body mass, head movement, ground reaction force, and center of pressure, which were analyzed using one-way analysis of variance with repeated measures according to visual conditions. Results: In most cases, the results of this study showed that the CV was significantly higher in the order of HMD wearing, eyes closed, and eyes opened conditions. Conclusion: Our results indicated that body sway was the largest in the HMD wearing condition, and the risk of falling was high owing to the low stability.

Balance Assessment using Microsoft Xbox Kinect

Reduction in balance has been identified as an indicator of risk of fall, and thus, an accurate and cost effective balance assessment tool is essential for prescribing effective postural control strategies. PURPOSE: To establish the validity of the Microsoft Xbox Kinect (Kinect v2) in assessing the whole body center of mass (CoM) excursion and velocity during single leg balance and voluntary ankle sway tasks among young and elderly subjects. METHODS: Twenty subjects (10 young: age = 20.5±2.3 years, Height = 171.8±7.2 cm, Weight = 70.7±11.6 kg; 10 elderly: age = 70.6±9.5 years, Height = 169.1±8.7 cm, Weight = 74.0±17.8 kg), with no history of lower extremity injury, participated in this study. Subjects performed a total of six randomized trials; four single leg stand (SLS) and two ankle sway trials. A comparison between the balance outcome measures (anteroposterior (AP) and mediolateral (ML) CoM excursion and velocity and average sway length) from the Kinect v2 and a traditional three-dimensional motion analysis (3DMA) system was performed. RESULTS: Results from the SLS and voluntary ankle sway trials showed that consistency, agreement, and correlation between systems was excellent (ICC > 0.75) for all CoM related variables when all subjects were considered a single group as well as when the elderly and young groups were analyzed. Concordance between systems ranged from poor to almost perfect depending on the group, task, and variable assessed. CONCLUSION: This new technique, using a low cost motion analysis technology, may enable real time, objective assessments of balance parameters in the clinical and research environments, which represents a clear advancement in clinical balance assessment and home-based rehabilitation programs.

Validation of Static and Dynamic Balance Assessment Using Microsoft Kinect for Young and Elderly Populations

Reduction in balance is an indicator of fall risk, and therefore, an accurate and cost-effective balance assessment tool is essential for prescribing effective postural control strategies. This study established the validity of the Kinect v2 sensor in assessing center of mass (CoM) excursion and velocity during single-leg balance and voluntary ankle sway tasks among young and elderly subjects. We compared balance outcome measures (anteroposterior (AP) and mediolateral (ML) CoM excursion and velocity and average sway length) to a traditional three-dimensional motion analysis system. Twenty subjects (10 young: age = y, height cm, weight kg; 10 elderly: age y, height cm, weight kg), with no history of lower extremity injury, participated in this study. Subjects performed six randomized trials; four single-leg stand (SLS) and two ankle sway trials. SLS and voluntary ankle sway trials showed that consistency (ICC(2, k)) and agreement (ICC(3, k)) for all variables when all subjects were considered, as well as when the elderly and young groups were analyzed separately. Concordance between systems ranged from poor to nearly perfect depending on the group, task, and variable assessed.

Effects of Progressive Exercise Programs on Balance Ability in Elderly Women: A Randomized Controlled Trial

The decline of neuromuscular control with aging causes harm decline of lower limb muscular strength in elderly women to result in losing balance or falling. A 12-week progressive resistance exercise or aerobic exercise significantly improved balance ability, reaction and reduced the risk of falling. The purpose of this investigation was to determine whether balance ability changes in response to resistance exercise training or aerobic exercise increased muscular strength. Forty-five elderly women (age 68.3 ± 4.2 years; BMI = 24.4 ± 4.3 kg/m^2) were recruited and randomly assigned into 3 groups (15 subjects each): resistance training group (RT), aerobic training group (AT) and control group (CON). Participants in At and RT groups attended a progressive 12-week exercise at a moderate intensity (5-6 on the ratings of perceived exertion scale), 30 min per session, and three sessions per week. Control group remains normal routine. All subjects underwent Chair Stand Test, Arm Curl Test, 8-Foot Up-and-Go Test and Open-Eye Single-Leg Stand Test before the training programs, after 12-week training programs, or 12-week after stop training. Functional fitness changes to training and detraining were evaluated with mixed-models of repeated measurement method and Pearson's product-moment correlation methods. After 12-week exercise training intervention, the efficiency of muscular endurance fitness, static balance and dynamic balance were significantly increased in RT and AT groups as compared with CON group. However, the results of the percent change for ULME, U-LMS, SB and DB were different between the groups (RT, AT vs. CON, P ＜ 0.05). The percent change for U-LME, U-LMS, SB and DB was different between the time intervals (RT: Post-test vs. retention %; AT: Post-test vs. retention %, P ＜ 0.05). The muscular endurance fitness, static balance and dynamic balance in elderly women have retention effect 1 week after detraining. There are significant correlations (P ＜ 0.05) between U-LME and U-LMS (r = 0.568), U-LME and SB (r = 0.374), U-LME and DB (r = -0.441), U-LMS and SB (r = 0.262), U-LMS and DB (r = -0.246), SD and DB (r = -0.260). Therefore, the results reveal the muscular endurance fitness; SB and DB have some correlations. A 12-week progressive RT or AT training significantly improved muscular function and balance ability, reaction and reduced the risk of falling. Thus, this study could be a model for progressive exercise programsfor elderly women to increase functional capacities in daily lives.

A Quantified Pre-frailty Prediction Score in Frailty Syndrome

Frailty syndrome is currently a novel but emerging concept in geriatrics and leads to disability of older adults and escalation of healthcare costs. Early Pre-frail detection is essential for Frailty prevention. Fried Frailty Criteria contained five clinical physiological items helps to determine whether an elder is in Frailty or Pre-frail stage; however, no quantitative index of Frailty has been developed so far. PURPOSE: To organize common clinical physical performance tests and to form a quantitative score to indicate the degree of Pre-frail severity. METHODS: Thirty-five community-dwelled elders were recruited and screened into Frailty (n=4, 72.5±5.52 y/o), Pre-Frail (n=19, 74.63±5.33 y/o) and Robust groups (n=12, 71.42±5.82 y/o). Only Pre-frail and Robust groups participated and performed six physical performance tests, including Single Leg Stand (SLS), Repeated Chair Rise (RCRT), Timed Up and Go (TUG), Self-selected Walking Speed (SWS), Functional Reach (FR), and Grip Power (GP). Differences between groups were compared using independent t-test and Mann-Whitney U test, and a binary logistic regression model were used to build a Pre-frail index, the “FAT score”. Statistically significant level was set at .05. (α = .05) RESULTS: Five tests were valid to detect Pre-Frail from Robust, i.e. RCRT (20.26 vs 9.25 sec, p = .001), TUG (19.58 vs 10.33 sec, p = .006), SWS (75.19±12.76 vs 111.09±26.1 m/s, p = .000), FR (17.59±2.7 vs 19.53±1.84 %, p = .037), and GP (21.83±6.97 vs 30.27±9.54 kg, p = .008), and a Pre-frail predict equation was formulated: FAT score = 1/(1+e^(Z_Robust)); Z_Robust = -80.857+0.188(CRT)+1.708(TUG)+0.482(SWS)+0.156(FR)+0.559(GP). The average FAT score of Pre-Frail and Robust were 90.73±19.95% and 15.01±25.25% respectively. Coincidentally, one higher FAT Robust elder (46.88%) had suffered a pontine infarction in the 7th month after accomplishing the study. CONCLUSIONS: FAT score gathered by five physical performance tests is a beneficial Pre-Frailty predictor, and the pontine infarcted Robust demonstrated the potential to predict Pre-frailty. It contributes to detect elders who are entering Pre-frail stage and determine intervention strategy before obvious signs arise. Further studies are needed to recruit more elders and organize other effective physical performance tests.

Clinical assessment tools identify functional deficits in fragility fracture patients.

PurposeTo identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.Patients and methodsTwenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt) that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB), handgrip strength (handheld dynamometer), and lumbopelvic control (iPod Touch Level Belt), which were compared between fragility fracture patients and healthy controls.ResultsFragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042) and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026) when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020) and total components (P=0.010) of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003).ConclusionThe clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls.

The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

IntroductionDiabetic neuropathy (DN) is a prevalent complication of Type 2 Diabetes Mellitus (T2DM) with a major impact on the health of the affected patient. We hypothesized that mediated by the dysfunctionalities associated with DN’s three major components: sensitive (lack of motion associated sensory), motor (impairments in movement coordination) and autonomic (the presence of postural hypotension), the presence of DN may impair the balance in the affected patients. Our study’s main aim is to evaluate the possible association between the presence and severity of DN and both the balance impairment and the risk of falls in patients with T2DM.Material and MethodIn this cross-sectional study we enrolled, according to a consecutive-case population-based setting 198 patients with T2DM. The presence and severity of DN was evaluated using the Michigan Neuropathy Screening Instrument, a tool which allows both diagnosing and severity staging of DN. The balance impairment and the risk of falls were evaluated using four validated and standardized tools: Berg Balance Scale (BBS), Timed-up and Go test (TUG), Single Leg Stand test (SLS) and Fall Efficacy Scale (FES-I).ResultsThe presence of DN was associated with significant decreases in the BBS score (40.5 vs. 43.7 points; p<0.001) and SLS time (9.3 vs. 10.3 seconds; p = 0.003) respectively increases in TUG time (8.9 vs. 7.6 seconds; p = 0.002) and FES-I score (38 vs. 33 points; p = 0.034). The MNSI score was reverse and significantly correlated with both BBS score (Spearman’s r = -0.479; p<0.001) and SLS time (Spearman’s r = -0.169; p = 0.017). In the multivariate regression model, we observed that patient’s age, DN severity and depression’s symptoms acted as independent, significant predictors for the risk of falls in patients with T2DM.ConclusionsThe presence of DN in patients with DM is associated with impaired balance and with a consecutively increase in the risk of falls.

A Meta-analysis:Effect of Tai Chi on Single-leg Standing Time of the Elderly

A Meta-analysis:Effect of Tai Chi on Single-leg Standing Time of the Elderly

片脚立位保持と片脚膝立ち位保持における運動学的特性の差異

片脚立位保持と片脚膝立ち位保持における運動学的特性の差異

The Postural Control Characteristics of Individuals with and without a History of Ankle Sprain during Single-leg Standing: Relationship between Center of Pressure and Acceleration of the Head and Foot Parameters.

[Purpose] This study aimed to investigate the postural control characteristics of individuals with and without a history of ankle sprain during single-leg standing by examining the relationship between various parameters of center of pressure (COP) and head and foot acceleration. [Subjects] Twenty subjects with and 23 subjects without a history of ankle sprain (sprain and control groups, respectively) participated. [Methods] Mean and maximum COP velocity and maximum COP range in the anteroposterior and mediolateral components of movement were calculated using a gravicorder. The anteroposterior and mediolateral maximum accelerations of the head and foot, as well as the root mean square (RMS) of each acceleration parameter, were measured using accelerometers. [Results] In the mediolateral component, a significant positive correlation was found between maximum acceleration of the foot and all COP parameters in the sprain group. [Conclusion] Our findings suggest that mediolateral momentary motion of the foot in individuals with a history of ankle sprain has relevance to various parameters of COP.

Postural Control Characteristics during Single Leg Standing of Individuals with a History of Ankle Sprain: Measurements Obtained Using a Gravicorder and Head and Foot Accelerometry

[Purpose] This study aimed to validate the postural control characteristics of individuals with a history of ankle sprain during single leg standing by using a gravicorder and head and foot accelerometry. [Subjects] Twenty subjects with and 23 subjects without a history of ankle sprain (sprain and control groups, respectively) participated. [Methods] The anteroposterior, mediolateral, and total path lengths, as well as root mean square (RMS) of each length, were calculated using the gravicorder. The anteroposterior, mediolateral, and resultant acceleration of the head and foot were measured using accelerometers and were evaluated as the ratio of the acceleration of the head to the foot. [Results] There was no significant difference between the two groups in path length or RMS acceleration of the head and foot. However, the ratios of the mediolateral and resultant components were significantly higher in the sprain group than in the control group. [Conclusion] Our findings suggest that individuals with a history of ankle sprain have a higher head-to-foot acceleration ratio and different postural control characteristics than those of control subjects.

Effects of Textured Socks on Balance Control During Single-leg Standing in Healthy Adults

Balance is important in many activities of daily living and sports movements. Texture, added to shoe insole material, has been shown to improve balance in young, older and pathological populations. The aim of this study was to develop and test textured socks, which might have several potential benefits over insole use including: they can be worn without, or transferred between, shoes, and texture can be applied to areas of the foot other than the plantar surface. Prototypes socks were made with nodules (5mm diameter) sewn onto socks on: 1) the plantar surface, 2) the dorsal surface, 3) sides of the foot and 4) covering the entire surface. Participants (n=13) performed three single-legged stance trials, standing on a force platform. with eyes open and eyes closed, whilst wearing each of the prototype socks and a control sock. Balance was quantified using the postural time-to- boundary measure. Results revealed a trend towards improved balance in the Sides sock condition (eyes open d = 0.62, eyes closed d = 0.51) conditions. This finding supported previous data from studies showing benefits of wearing insoles with plastic tubing around the perimeter of the foot, suggesting that textured socks might be useful as an intervention to improve balance.

Maximum Isometric Abduction of Contralateral Hip during Single-leg Standing Induces Activity of the Gluteus Medius on the Weight-bearing Side

〔目的〕荷重位で中殿筋活動を促す運動の考案と，その運動時の中殿筋活動を定量化することとした．対象：健常成人男性31名とした．〔方法〕右下肢に荷重をかけた片脚立位で左股関節に対する最大等尺性外転収縮を行っている際の右中殿筋の筋活動を記録し，正規化のための基準とする右股関節外転の最大随意収縮時（maximum voluntary contraction：MVC）の筋活動で除した値（％MVC）を筋活動量の指標とした．〔結果〕運動時の筋活動量は108 ％MVCを示した．〔結語〕本研究で用いた運動は，荷重をかけた状態での中殿筋の筋力増強運動のバリエーションを増やすことにつながるものと期待される．

Effects of Differences in Duration of Single-leg Standing on Motor Efficiency in Stair Climbing

〔目的〕階段昇段における一足一段の単脚立脚相の時間違いが運動効率（NE）に与える影響を明らかにすることを目的とした．〔対象〕健常成人男性11名を対象とした．〔方法〕階段昇段は鉛直方向への速度3.5 m/minの一足一段として，時間条件を単脚立脚相のステップ頻度に自然に合わせた（普通）と単脚立脚相の時間を短くした昇段（短縮）の2条件とした．各条件での昇段時間は3分間で，酸素摂取量（VO2）及び心拍数を測定し，NEを算出した．VO2とNEに対して，時間条件の比較のために対応のあるt検定を行った．〔結果〕VO2は短縮が普通よりも低い値を示した．NEは短縮が普通よりも高い値を示した．〔結語〕階段昇段におけるNEは，単脚立脚相の時間を短縮することにより，改善できることが明らかになった．

Effectiveness of a progressive stepping program on lower limb function in community dwelling older adults

A progressive stepping program (PSP) comprising of 28 sessions each of 75 minutes were offered to two groups of community dwelling older adults with different levels of mobility at a frequency of 3 times a week so as to assess the program's effect on lower limb function as reflected in the Timed Up-and-Go test (TUG) and the Timed Open-eyed Single Leg Stand test (TOLS). Significant differences were found among the different groups in the TUG score (F = 11.05, p < 0.05). Moreover, the TUG score gain was greater in the lower mobility group (21.5%) than in the higher mobility group (7.8%). It was concluded that while the PSP was effective in improving dynamic balance, alternative modes would be needed in order to achieve improvements in the TOLS scores.