Sway Area Research Articles

Exploring the relationship between cardiac awareness and balance

SummaryPostural balance requires the interplay between several physiological signals. Indirect evidence suggests that the perception of signals arising from the autonomic nervous system might play a role (e.g. cardiac awareness). Here, we tested this hypothesis by investigating the relationship between postural control and cardiac awareness (i.e. interoception) in a sample of N = 70 healthy individuals. Postural control was measured using a medical robotic device, while cardiac awareness was evaluated using the heartbeat counting task. A within-subject design included two platform configurations (static, unstable) and two visual feedback conditions (eyes open, eyes closed). For each condition, we measured the sway area and the range of oscillation of the platform, as well as the range of oscillation and the quantity of movement of participants’ trunk. In the “platform unstable, eyes closed” condition, participants with higher cardiac awareness demonstrated a significantly smaller sway area and reduced oscillations of both the platform and their trunk. These findings hint at a potential link between interoception and postural control, suggesting that the perception of internal body signals might sustain balance.

THE RELATIONSHIPS AMONG GYMNASTS’ TRAINING AGE, BODY MASS INDEX, BALANCE CONTROL, AND GYMNASTICS PERFORMANCE

The aim of the study was the examination of the relationships among gymnasts’ training age, body mass index (BMI), balance control during the execution of handstand, standing scale forward, and stork standing in relevé position, and their performance in competition settings. Forty young competitive gymnasts (20 males; age: 12.20 ± 1.98 years, and 20 females; age: 12.33 ± 2.07 years, mean ± SD) participated in this study. A portable digital platform for posturography was used to measure maximal pressure, center of pressure (CoP) sway area, CoP linear distance displacement and CoP velocity. The resulting data were analyzed using an integrated software module (Foot Checker, version 4.0). The results confirm the reliability of the measurements. Strong positive correlations were found between gymnasts' performance in the gymnastics competition, and their training age and BMI, with relationships also identified between performance and variables related to balance control. Regression analysis revealed that gymnasts' training age, BMI, and balance control in performing the assessed gymnastics skills had predictive significance in determining their performance in the competition, taking into account differences between age groups. Despite the limitations of the study, the results represent a valuable contribution to the literature by expanding knowledge about predicting gymnastics performance in competition. Furthermore, the results provide evidence for the identification of talent in gymnasts, offer coaches insights to improve training efficiency, and provide recommendations for future research in this area.

Mixed Reality-Based Smart Occupational Therapy Personalized Protocol for Cerebellar Ataxic Patients.

Occupational therapy (OT) is an essential component of patient care, and it is especially beneficial if focused on meaningful activities. For ataxic patients, traditional procedures are currently the most efficient, although without specific guidelines and suggestions for virtual reality integration. In this context, this study proposes Hybrid Smart Rehabilitation (HSR) based on mixed reality (MR) as an aid in overcoming limitations of the traditional OT procedures. MR-HSR is designed specifically for ataxic patients and developed in Unity with the Holographic Remoting setting for run-time intervention on the scene. The subject reaches a book and grabs it with their hand inside a holographic guide with audio-visive feedback. Hand trajectories acquired from eight ataxic patients and eight healthy subjects were compared and new variables were analyzed to evaluate the performance. The Trust in Automation questionnaire was submitted to assess the opinion of the patients. Patients confirmed their trust in the developer and in the improvement that this system can bring to their rehabilitation. The "total time" and "sway area" of the trajectory were statistically significant and, together with the deviation of the trajectory from the main axis of the guide, although not statistically significant, made it possible to build a classifier. The patient-specific MR-HSR can be considered as an integrative tool for assessing the subject's condition by analyzing new quantitative variables which, if matched to the Scale for the Assessment and Rating of Ataxia (SARA), could be the basis of a new index to assess the progressiveness of ataxia.

The Impact of Bilateral Cerebellar Transcranial Direct Current Stimulation on Balance Control in Healthy Young Adults.

Cerebellar transcranial direct current stimulation (tDCS) has been shown to influence movement functions, but little is known about the specific effects of stimulation polarity on balance control. This study investigated the impact of bilateral cerebellar tDCS on balance functions as a function of stimulation polarity. In this randomized, controlled trial, thirty-nine healthy young adults were assigned to one of three groups: right anodal/left cathodal cerebellar stimulation (AC group), right cathodal/left anodal cerebellar stimulation (CA group), and a control sham group. Each participant underwent a daily 30-minute session of tDCS at 2mA for one week. Balance function was assessed pre- and post-intervention and the data were analyzed using generalized estimating equations. The CA group exhibited a significant reduction in sway area when standing on the left leg and on both stable and unstable surfaces with eyes open, compared to both the AC and sham groups. However, there were no significant differences among the groups in terms of sway length, anteroposterior velocity, or mediolateral velocity. Our results indicate the polarity-dependent effects of bilateral cerebellar tDCS on balance functions, with enhanced stability observed only following cathodal tDCS over the right cerebellum paired with anodal tDCS over the left cerebellum. This polarity-specific modulation may have implications for developing cerebellar neuromodulation interventions for movement disorders.

Transiently worse postural effects after vestibulo-ocular reflex gain-down adaptation in healthy adults.

Suffering an acute asymmetry in vestibular function (i.e., vestibular neuritis) causes increased sway. Non-causal studies report associations between lateral semicircular canal function and balance ability, but direct links remain controversial. We investigate the immediate effect on body sway after unilateral vestibulo-ocular reflex (VOR) gain down adaptation simulating acute peripheral vestibular hypofunction. Eighteen healthy adults, mean age 27.4 (± 12.4), stood wearing an inertial measurement device with their eyes closed on foam before and after incremental VOR gain down adaptation to simulate mild unilateral vestibular neuritis. Active head impulse VOR gain was measured before and after the adaptation to ensure VOR gain adaptation. Percentage change for VOR gain was determined. Sway area was compared before and after VOR adaptation. VOR gain decreased unilaterally exceeding meaningful change values. Sway area was significantly greater immediately after VOR gain down adaptation, but quickly returned to baseline. In a subset of subjects VOR gain was re-assessed and found to remain adapted despite sway normalization. These results indicate that oculomotor adaptation targeting the lateral semicircular canal VOR pathway has an immediate, albeit transient increase in body sway. Rapid return of body sway to baseline levels suggests dynamic sensory reweighting between vestibular and somatosensory inputs to resolve the undesirable increased body sway.

Exploring the Interplay Between Kinesiophobia, Lumbar Joint Position Sense, Postural Stability, and Pain in Individuals With Chronic Low Back Pain: A Cross-Sectional Analysis

ObjectiveThe objectives of the study were to (1) determine the association between kinesiophobia and lumbar joint position sense (JPS) in individuals with chronic low back pain (CLBP); (2) examine the relationship between kinesiophobia and postural stability in individuals with CLBP; and (3) investigate whether pain intensity mediates the relationship between kinesiophobia, lumbar JPS, and postural stability in individuals with CLBP. MethodsIn this cross-sectional study, a total of 83 individuals diagnosed with CLBP were included. The level of fear of movement was assessed using the Tampa Scale for Kinesiophobia (TSK). Lumbar JPS was measured using the active target repositioning technique, which involved evaluating JPS in 3 directions: lumbar flexion, side-bending to the left, and side-bending to the right. The repositioning accuracy of the lumbar joint was quantified in degrees using a dual digital inclinometer. Postural stability was assessed using a stabilometric force platform, which measured anterior to posterior (A-P) sway, medial to lateral (M-L) sway, and the ellipse area in mm². ResultsThe findings of this study revealed a statistically significant and moderate positive correlation between kinesiophobia and lumbar JPS in various directions, including flexion (r = 0.51, P < .001), side-bending to the left (r = 0.37, P = .001), and side-bending to the right (r = 0.34, P = .002). Similarly, a significant positive association was observed between kinesiophobia and postural stability, as indicated by the correlation coefficients: A-P sway (r = .47, P < .001), M-L sway (r = 0.58, P < .001), and ellipse area (r = 0.51, P < .001). Furthermore, the analysis revealed that pain significantly mediated the relationship between kinesiophobia and both lumbar JPS (P < .05) and postural stability (P < .05). These findings were demonstrated through mediation analysis. ConclusionsThis study identified a significant association between kinesiophobia, lumbar JPS, and postural stability. Additionally, we observed the presence of pain as a potential mediator in this relationship. However, it is important to note that our cross-sectional study design precludes establishing causality or determining the direct mediation effect of pain on adverse outcomes.

Effects of shuttle balance exercises on gait speed, postural control, and quality of life in older males: A randomized controlled trial.

Enhancing physical function and quality of life in older adults at higher risk of falls is challenging because of the lack of established interventions. This study examines the impact of a 6-week balance training program using the shuttle balance device on gait speed, postural control, and quality of life in older men. This single-blinded randomized controlled trial was conducted in a research laboratory. Thirty-two participants aged ≥60years were randomly assigned to either an experimental group (EG; n=16) or a control group (CG; n=14). The EG participated in a 6-week shuttle balance exercise program, while the CG maintained regular physical activity routines. The main outcome measures included gait speed (assessed via the timed up and go test), postural control (assessed via center of pressure data on a force plate), and quality of life (evaluated using the SF-36 questionnaire). Post-intervention, the EG showed significant improvements compared with the CG (p<0.05). The 95% confidence intervals for the differences between groups were as follows: closed eyes (CE) mean velocity (-39.07, -0.13), CE sway area (-48.86, -0.18), SF-36 total score (9.01, 16.81), SF-36 physical functioning (7.00, 24.81), SF-36 physical role functioning (1.80, 27.57), SF-36 pain (15.01, 36.82), SF-36 general health state (7.48, 26.08), SF-36 vitality (5.60, 28.35), and SF-36 mental health (0.21, 21.12). A 6-week shuttle balance training program significantly improves postural control and quality of life in older males. These findings suggest the potential effectiveness of shuttle balance exercises in enhancing physical function and well-being in this population. Further research is needed to validate these findings and explore the long-term effects with larger sample sizes.

Multicentre investigation on the effect of decompressive surgery on Balance and physical ActiviTy Levels amongst patients with lumbar Spinal stenosis (B-ATLAS): protocol for a prospective cohort study

IntroductionPatients with lumbar spinal stenosis may have poor balance, decreased physical function and problems maintaining physical activity levels due to radiculopathy. Decompressive surgery is often indicated if conservative management fails...

The effect of kinesio taping on joint range of motion and balance in total knee replacement patients.

We adopted a within-subjects quasi-experimental approach to assess the impact of kinesio taping (KT) on joint range of motion (ROM), static balance, and dynamic balance. The research subjects were 15 patients who had, within the previous 3 weeks, undergone total knee replacement (TKR) by an orthopedic surgeon in 2022. We measured the ROM, static balance, and dynamic balance of the knee joint before and after applying KT. We then compared the pre- and post-tape measurements to assess the effects of KT on joint function and balance. The ROM of the knee joint was measured using a goniometer in the supine position before the KT application. The static and dynamic balance were assessed using a balance assessment device by measuring the sway area and length of the center of gravity during the measurement period. The effects of KT on the ROM and static and dynamic balance of the knee joint were investigated. The differences in joint ROM and static and dynamic balance between pre- and post-KT applications were analyzed using a paired-sample t-test. This study found that the ROM of the knee joint was significantly increased after applying KT. For static and dynamic balance, both the sway area and length of the center of gravity decreased after applying KT, indicating a significant improvement in static and dynamic balance. KT, when combined with standard physiotherapy, can be a useful therapeutic approach for TKR patients, effectively enhancing joint ROM and balance function.

Wobble Board Performance: A Practical and Useful Quantification in Balance Assessment

Balance is integral in ankle injury prevention and therapy, especially in high-risk sports like volleyball. For balance assessment, the recommended wobble board (WB) performance (i.e., time at equilibrium) has never been compared with the gold standard. The objective was to investigate the relationships of force-plate-derived center of pressure (CoP) with WB performance and the accuracy of WB-derived CoP estimates. Twelve high-level volleyball players completed six unipedal standing trials on a computerized WB. WB tilt angles and CoP were obtained simultaneously via tri-axis accelerometers on the WB (200 Hz) and a force plate (1000 Hz), respectively. WB performance, polynomial-transformed CoP estimates, and CoP fractal sway, sway area, and mean sway velocity were assessed via Pearson and concordance correlation, root mean square errors, and dependent t-tests. WB performance was related with CoP sway and sway area (|rlinear| = 0.714–0.842, |rnonlinear| = 0.833–0.910, p &lt; 0.01). The strongest concordance (0.878–0.893, p &lt; 0.001) and smallest errors (6.5–10.7%) were reported for anterior–posterior sway and sway area. Moderate to excellent relationships between the WB performance and force plate CoP variables supported the usefulness of WB performance and estimates (especially sway area) in balance assessment. Furthermore, this study presents recommendations for future analyses and modeling approaches to reflect the complexity of postural control.

Dual-task improvement of older adults after treadmill walking combined with blood flow restriction of low occlusion pressure: the effect on the heart–brain axis

ObjectiveThis study explored the impact of one session of low-pressure leg blood flow restriction (BFR) during treadmill walking on dual-task performance in older adults using the neurovisceral integration model framework.MethodsTwenty-seven older adults participated in 20-min treadmill sessions, either with BFR (100 mmHg cuff pressure on both thighs) or without it (NBFR). Dual-task performance, measured through light-pod tapping while standing on foam, and heart rate variability during treadmill walking were compared.ResultsFollowing BFR treadmill walking, the reaction time (p = 0.002) and sway area (p = 0.012) of the posture dual-task were significantly reduced. Participants exhibited a lower mean heart rate (p < 0.001) and higher heart rate variability (p = 0.038) during BFR treadmill walking. Notably, BFR also led to band-specific reductions in regional brain activities (theta, alpha, and beta bands, p < 0.05). The topology of the EEG network in the theta and alpha bands became more star-like in the post-test after BFR treadmill walking (p < 0.005).ConclusionBFR treadmill walking improves dual-task performance in older adults via vagally-mediated network integration with superior neural economy. This approach has the potential to prevent age-related falls by promoting cognitive reserves.

Assessing fall risk in osteoporosis patients: a comparative study of age-matched fallers and nonfallers.

This study aimed to investigate sway parameters and physical activity level of the age/gender-matched older adults with osteoporosis faller and nonfaller patients. By examining these factors, our objective was to understand how these faller and nonfaller groups with osteoporosis differed particularly in terms of balance capabilities and their impact on physical activity levels. We recruited 24 patients with osteoporosis: 12 who reported a fall within a year before recruitment (fallers) and 12 without falls (nonfallers). Given the close association between biochemical markers of musculoskeletal health such as serum calcium, parathyroid hormone (PTH), Vitamin D, and renal function, we compared these markers in both groups. As a result, elderly individuals with osteoporosis and with a history of falls within the preceding year indicated significantly higher sway velocity (P = 0.012*), sway area (P < 0.001*), and sway path length (P = 0.012*). Furthermore, fallers had significantly lower calcium (P = 0.02*) and Parathyroid hormone (PTH) (P = 0.02*), as well as higher Alkaline Phosphatase (ALP) (P = 0.02*) as compared to nonfallers despite similar vitamin D and creatinine levels. In conclusion, diminished biochemical factors in the osteoporosis faller group could possibly cause postural instability resulting in lower physical activity levels in the osteoporosis fall group and increasing the risk of falls.

The effect of cervical traction on stabilometric parameters in cervical radiculopathy patients: A randomized crossover study.

Cervical traction is effective on pain and function in patients with cervical radiculopathy but its effectiveness on balance disorders has not yet been studied. To evaluate the effect of mechanical intermittent cervical traction (MICT) on stabilometric parameters in patients with cervical radiculopathy. This randomized crossover study assigned 20patients with cervical radiculopathy to one of the two groups: Group effective traction (ET)/sham traction (ST) (n= 10) treated firstly with ET (traction force of 12Kg) then with ST (traction force of 2Kg) with one-week interval and group ST/ET (n= 10) treated invertedly with a ST then ET. Each traction procedure was maintained for 10minutes twice separated by 5minutes of rest. Patients were assessed before and immediately after MICT procedure. Main outcome measures were stabilometric parameters: center of pressure, sway area and lateral and anteroposterior displacements using a force platform. Secondary outcome measures were pain intensity, grip strength and dizziness. ET has provided a significantly greater improvement in both groups and in the total population in terms of stabilometric parameters (p< 0.01), pain intensity, and grip strength (p< 0.05), compared to ST. MICT seems to have an immediate beneficial effect on stabilometric parameters, pain and grip strength in patients with cervical radiculopathy.

Cortical Mechanisms Underlying Effects of Repetitive Peripheral Magnetic Stimulation on Dynamic and Static Postural Control in Patients with Chronic Non-Specific Low Back Pain: A Double-Blind Randomized Clinical Trial.

Patients with chronic non-specific low back pain (CNLBP) often experience impaired postural control, contributing to pain recurrence. Although repetitive peripheral magnetic stimulation (rPMS) combined with core muscle training (CMT) could improve postural control, its neural mechanism remains unclear. This study aims to investigate the postural control-related cortical mechanism of the effect of rPMS on patients with CNLBP. This unicentric, prospective, randomized, double-blind, controlled trial was conducted in a public hospital from May to December 2023. A total of 40 patients (27 females and 13 males, mean age 29.38±7.72) with CNLBP were randomly assigned to either the rPMS group (real rPMS with CMT) or the sham-rPMS group (sham-rPMS with CMT) for 12 sessions over 4weeks. The rPMS was applied to the lumbar paravertebral multifidus muscle on the painful side. Pain and disability were quantified using the visual analog scale (VAS) and Oswestry dysfunction index (ODI) pre- and post-intervention. Furthermore, the sway area and velocity of the center of pressure (COP) were measured using a force platform. The cortical activities in 6 regions of interest during 4 tasks (standing with eyes open/closed on a stable/unstable plane) were recorded by functional near-infrared spectroscopy (fNIRS) pre- and post-intervention. The repeated measure ANOVA was applied for statistical analysis. Spearman's correlation was used to determine the relationships between variables. After the intervention, the rPMS group showed decreased pain intensity (p=0.001) and sway area (unstable eyes-closed task) (p=0.046) compared to the sham-rPMS group. Additionally, the rPMS group exhibited increased activation in left primary motor cortex (M1) (p=0.042) and reduced in left supplementary motor area (SMA) (p=0.045), whereas the sham-rPMS group showed no significant changes. The increased activation of left M1 was negatively correlated to the reduction of pain intensity (r=-0.537, p=0.018) and sway area (r=-0.500, p=0.029) under the static balancing task. Furthermore, there was a positive correlation between sway velocity and VAS (r=0.451, p=0.046) post-rPMS intervention. Repetitive peripheral magnetic stimulation combined with core muscle training demonstrated better analgesic effects and postural control improvements, compared to sham-stimulation. This may be attributed to the increased activation of the left primary motor cortex. The trial was registered on ClinicalTrials.gov (ChiCTR2300070943).

Effect of wearing high heel and flat footwear on balance and stability dynamics: A kinetic study

Objectives: Maintaining balance and stability is essential for performing everyday activities and complex tasks that require coordination between muscles, tendons, bones, eyes, ears and the brain. However, slip, trip or fall incidents may occur if balance is compromised. Footwear (FW) design features have been identified as factors that affect balance. To investigate the impact of high-heeled and flat FW on balance stability during stationary standing, this study was conducted. Materials and Methods: Seven (n = 7) physically fit female subjects volunteered for the study. A repeated method was used to conduct this study. A high heel and flat FW were investigated for detailed kinetic parameters during standing. Participants stood on a force platform for 40 seconds in each condition. Bioware software was used to collect and process the data. Student’s t-test was applied to determine the significant effects (P &lt; 0.05) of the selected FW on dependent variables. Results: Ground reaction force (GRF) (Fx, P = 0.001), (Fy, P = 0.002), (Fz, P = 0.000), Centre of Pressure (CoP) Trajectories (Ax, P = 0.02), (Ay, P = 0.011), displacement (sx, P = 0.002), (sy, P = 0.001) and (sz, P = 0.002) and Absolute Coefficient of Friction (Cofxy) (P = 0.0012) values of high heel FW reflect poor balance and stability patterns compared to flat FW. Conclusion: Recent studies have shown that wearing high-heeled FW for extended periods can be detrimental to one’s health. This is due to the significantly elevated GRF, a more dispersed body sway area in terms of Centre of Pressure (CoP) movement, a curved displacement path and a lower coefficient of friction value. As a result, there is an increase in postural load and effort, which can lead to an increased risk of injury.

Chemotherapy-Induced Peripheral Neuropathy and Falls in Cancer Survivors Relate to Digital Balance and Gait Impairments.

Chemotherapy-induced peripheral neuropathy (CIPN) and falls can be persistent side effects of cancer treatment. Standing postural sway and gait tests with body-worn, inertial sensors provide objective digital balance and gait measures that represent several different domains controlling mobility. Specific domains of balance and gait that related to neuropathy and falls are unknown. The aim of this study was to determine which domains of balance and gait differed between cancer survivors who report (1) CIPN symptoms versus no symptoms, (2) a history of falls in the past 6 months versus no falls, and (3) prospective falls over 12 months versus no falls. Postural sway during 30 seconds of quiet standing and gait characteristics from a 7-m timed up and go test were recorded with six synchronized inertial sensors (Opals by APDM Wearable Technologies, a Clario Company) in 425 older, female cancer survivors (age: 62 ± 6 years). A principal component analysis (PCA) approach was used to identify independent domains of mobility from 15 balance and gait measures. PCA analysis revealed five independent domains (PC1 = sway amplitude, PC2 = gait pace, PC3 = sway frequency, PC4 = gait spatial-temporal, and PC5 = turning) that accounted for 81% of the variance of performance. Cancer survivors who reported CIPN symptoms had significantly higher sway frequency (PC3) than asymptomatic survivors. Past fallers had significantly larger sway area (PC1) and slower gait pace (PC2) than nonfallers. Prospective fallers showed a significantly smaller stride length (PC4) than nonfallers. Digital balance and gait measures using wearable sensors during brief standing and walking tests provide objective metrics of CIPN-related mobility impairment and fall risk that could be useful for oncology clinical trials.

Assessing the Impact of Fencing on Postural Parameters: Observational Study Findings on Elite Athletes.

The aim of the study was to evaluate whether the static stabilometric parameters among elite fencers, were affected by prolonged, asymmetric training regimen. A sample of 26 elite fencers of both genders, aged 19.15 ± 2.24 years, practising one of the three disciplines foil, épée, or sabre, was recruited for the study. Anthropometric measurements including thigh and calf circumferences and postural assessment based on the weight distribution on a stabilimeter platform were performed. Postural tone, as indicated by measures such as sway length and sway area ratio was calculated.. No notable anthropometric asymmetries were detected within the examined group The weight distribution patterns on the support quadrants in static stabilometric measurements did not suggest clinically significant issues. There were no significant differences among subgroups based on gender and lower limb dominance for both anthropometric and stabilimeter variables. However, 30.8% of participants showed anomalies in postural tone (hypertonic and hypotonic condition). Five out of eight athletes found with abnormal postural tone were foil fencers, suggesting a potential discipline-specific effect. Individual adjustments were found in foil fencers. These findings provide insights into the potential effects of fencing training on postural parameters among elite athletes.

Postural Control and Muscle Activity during Dual-Task in Young Adults.

In everyday life, we recurrently perform two tasks simultaneously, which is called dual-tasking. A common dual task is smartphone use while standing or walking. According to previous studies, this task can compromise postural stability. However, few studies have analyzed lower limb muscle activity during dual-tasking using smartphones. This study aimed to assess the postural sway and muscle activity during dual-tasking in young adults. Thirty-six healthy young adults (23.08 ± 3.92 years) participated in this study. They performed a single task (ST: keeping a quiet standing posture) and a dual task (DT: keeping the ST while simultaneously performing a cognitive task on their smartphone). Postural sway was assessed through the center of pressure (CoP) analysis using a force platform: total CoP displacement, CoP displacement in the anterior-posterior and medial-lateral directions, mean total velocity of the CoP, mean velocity of the CoP in the anterior-posterior and medial-lateral directions, and 95% confidence ellipse sway area. A surface electromyography system recorded the muscle activity of the lumbar spinal erector and five muscles of the lower limb (bilaterally). The results showed an increase in postural sway from the ST to the DT in all CoP variables (p < 0.05), and muscle activity in most muscles analyzed decreased from the ST to the DT (p < 0.05). In conclusion, our results reflect a decentralization of attention from motor performance once postural sway increased and muscle activity decreased in dual-task conditions.

Footwear Modification in Patients with Peripheral Neuropathy by Use of Three-dimensional Force Plate

Abstract Background: Peripheral neuropathy is the most common chronic complication of both type 1 and type 2 diabetes, with an estimated lifetime prevalence exceeding 50%. Loss of cutaneous sensory information from the foot sole is reported to be a critical factor contributing to walking instability, poor balance and falls, in people with diabetic peripheral neuropathy (DPN). Although there is a very little evidence in the literature on the effectiveness of microcellular rubber insoles, they may offer a new rehabilitative approach, which promotes self-management by the user, to improve balance and walking, and reduce the risk of falling, in adults with diabetes and this study aims to find out the effectiveness of microcellular rubber insoles in peripheral neuropathy. Materials and Methods: This was a prospective observational study. A total of 30 patients with DPN, fulfilling the inclusion criteria, were selected for the study. All of the participants were clinically tested for the presence of neuropathy and evaluated by the force platform, after which they were advised to wear micro cellular rubber insole footwear (which was made in institutional set up as per patient’s foot size) for a period of 4 weeks. At the end of the stipulated period, the participants were again evaluated on the same parameters in the force platform. Results: After 4 weeks of intervention, there was a significant improvement in the postural stability as evidenced by a decrease in the mean of anterior–posterior sway (7.1225 ± 0.7102/5.7972 ± 0.6901) (P &lt; 0.0001). Mean mediolateral sway also shows an improvement (4.9570 ± 0.5106/3.9639 ± 0.5749) (P &lt; 0.0001). Similarly, improvements shown in mean sway area (368.4048 ± 58.9558/313.8788 ± 57.5957) (P = 0.0040) and sway velocity (23.2842 ± 2.1151/21.8840 ± 1.8419) (P &lt; 0.0001). The step length, however, did not show any statistically significant improvement (0.6474 ± 0.0524/0.6333 ± 0.0597) (P = 0.2820). There was a significant reduction in the vertical component of the ground reaction force post-use of the insole (737.4333 ± 73.1577/659.3667 ± 82.7937) (P &lt; 0.0001) with a reduction of 13% mean value. Conclusion: This study demonstrates that neuropathy deteriorates postural balance and gait; the present evidence provides insight indicating that footwear interventions do significantly alter static balance performance in the neuropathy population. Footwear interventions seem to have the capacity to alter underlying strategies controlling static and dynamic movement patterns through a combination of mechanical and sensorimotor mechanisms, for which in-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations.

An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales.The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.