Postural stability during long duration quiet standing in post stroke hemiplegia

Effects of heel height and high-heel experience on foot stability during quiet standing

Carrying asymmetric loads while walking on an uneven surface

Postural instability marks a prevalent symptom of Parkinson’s disease (PD). It often manifests in increased body sway, which is commonly assessed by tracking the Center of Pressure (CoP). Yet, in terms of postural control, the body’s Center of Mass (CoM), and not CoP is what is regulated in a gravitational field. The aim of this study was to explore the effect of early- to mid-stage PD on these measures of postural control in response to unpredictable visual perturbations. We investigated three cohorts: (i) 18 patients with early to mid-stage PD [Hoehn & Yahr stage (1–3); 1.94 ± 0.70]; (ii) a group of 15 age-matched controls (ECT); and (iii) a group of 12 young healthy adults (YCT). Participants stood on a force plate to track their CoP, while the movement of their entire body was recorded with a video-based motion tracking system to monitor their CoM. A moving room paradigm was applied through a head-mounted virtual reality headset. The stimulus consisted of a virtual tunnel that stretched in the anterior-posterior direction which either remained static or moved back and forth in an unpredictable fashion.We found differences in mean sway amplitude (MSA) and mean velocities of CoP and CoM between the groups under both conditions, with higher MSA of CoP and CoM for PD and higher mean velocities of both variables for PD and ECT when compared with YCT. Visual perturbation increased mean CoP velocity in all groups but did not have effects on mean CoM velocity or MSA. While being significantly lower for the young adults, the net effect of visual perturbation on mean CoP velocity was similar between patients with PD and age-matched controls. There was no effect of the visual perturbation on mean CoM velocity for any of the groups.Our simultaneous assessment of CoP and CoM revealed that postural control is reflected differently in CoM and CoP. As the motion of CoM remained mostly unaffected, all groups successfully counteracted the perturbation and maintained their balance. Higher CoP velocity for PD and ECT revealed increased corrective motion needed to achieve this, which however was similar in both groups. Thus, our results suggest increased effort, expressed in CoP velocity, to be an effect of age rather than disease in earlier stages of PD.

Laboratory-based measurement of standing balance in individuals with knee osteoarthritis: A systematic review

Altered postural control has been observed in chronic ankle instability (CAI). Kinesiophobia (fear of re-injury) has been identified as a factor influencing postural stability. Therefore, postural control was assessed during jump landing among CAI athletes with and without kinesiophobia, as well as healthy controls. A total of 60 participants were recruited, including 40 individuals with CAI and 20 healthy controls. The CAI group was subdivided into two cohorts: 20 subjects with kinesiophobia (Tampa Scale of Kinesiophobia score > 37) and 20 without kinesiophobia. All participants performed a single-leg jump landing task on a force plate. The following postural stability metrics were calculated: time to stabilization (TTS), and the mean and standard deviation of center of pressure (COP) displacement and velocity in the anterior-posterior (AP), medial-lateral (ML), and total directions. CAI subjects with kinesiophobia exhibited longer TTSs in the AP (p = 0.019), vertical, and total directions (p < 0.001, p = 0.015, p = 0.002) than healthy subjects. Additionally, CAI subjects with kinesiophobia demonstrated a significant increase in the velocity of COP displacement in the AP and ML directions (p < 0.001, p = 0.004). These individuals showed greater variability in the velocity of COP displacement in the AP direction and in COP displacement in the ML direction than healthy subjects (p < 0.001). Also, CAI with kinesiophobia group presented less variability in the velocity of COP displacement in the ML direction than other groups (p < 0.001, p = 0.026). CAI with kinesiophobia group needed more time and more velocity in the AP direction than without kinesiophobia group (p = 0.003). Individuals with a high fear of re-injury may perceive the jump landing task as threatening, requiring more time to land and regain stability. This fear can restrict the variability of velocity in the ML direction, resulting in decreased control over the AP direction due to limitations on managing degrees of freedom.

In this study, we aimed to investigate the acute effects of exercise on postural measures in arthritic patients. We obtained posturographic measurements of 8 women with lower extremity arthritis for 30 s before and after a 60-min aquatic exercise. The center of pressure (COP) was recorded while the volunteers were in an upright position with their eyes open. The time domain measures and the frequency domain measures of the COP time series in the anterior-posterior (AP) and medial-lateral (ML) directions were calculated. In addition, the frequency domain measures were calculated for the COP velocity time series. A paired T-test revealed no significant differences in any time domain measures between pre- and post-exercise; however, there were significant decreases in the 95% power frequency of the COP in the AP direction (0.834 ± 0.296 to 0.627 ± 0.230 Hz, p=0.027) for the frequency domain measures. For the velocity time series, the mean power frequency in both the AP (1.47 ± 0.528 to 1.22 ± 0.360 Hz, p=0.047) and ML (1.28 ± 0.245 to 1.13 ± 0.151 Hz, p=0.022) directions, and the 95% power frequency in the ML direction (3.41 ± 0.653 to 2.96 ± 0.468 Hz, p=0.038) decreased significantly in the post-exercise condition. This study reports that a single session of exercise has a subtle but detectable acute effect on postural balance in arthritic patients.

This paper presents an experimental study to investigate how humans interact with a robotic arm simulating primarily unstable, damping-defined, mechanical environments, and to quantify lower bounds of robotic damping that humans can stably interact with. Human subjects performed posture maintenance tasks while a robotic arm simulated a range of negative damping-defined environments and transiently perturbed the human arm to challenge postural stability. Analysis of 2-dimensional kinematic responses in both the time domain and phase space allowed us to evaluate stability of the coupled human-robot system in both anterior-posterior (AP) and medial-lateral (ML) directions, and to determine the lower bounds of robotic damping for stable physical human-robot interaction (pHRI). All subjects demonstrated higher capacity to stabilize their arm against negative damping-defined environments in the AP direction than the ML direction, evidenced by all 3 stability measures used in this study. Further, the lower bound of robotic damping for stable pHRI was more than 3.5 times lower in the AP direction than the ML direction: -30.0 Ns/m and -8.2 Ns/m in the AP and ML directions, respectively. Sensitivity analysis confirmed that the results in this study were relatively insensitive to varying experimental conditions. Outcomes of this study would allow us to design a less conservative robotic impedance controller that utilizes a wide range of robotic damping, including negative damping, and achieves more transparent and agile operations without compromising coupled stability and safety of the human-robot system, and thus improves the overall performance of pHRI.

Four Dimensional Magnetic Resonance Imaging With 3D Radial Sampling and Self-gating Based K-space Sorting: Early Clinical Experience on Pancreatic Cancer Patients

Effects of assistive devices on postural control following a balance disturbance along the anterior-posterior direction.

BackgroundStroke is often associated with balance deficits that increase the risk of falls and may lead to severe mobility disfunctions or death. The purpose of this study is to establish the relation between the outcome of instrumented posturography and of the most commonly used clinical balance tests, and investigate their role for obtaining reliable feedback on stroke patients’ balance impairment.MethodsRomberg test was performed on 20 subjects, 10 hemiplegic post-stroke subjects (SS, 69.4 ± 8.2 years old) and 10 control subjects (CS, 61.6 ± 8.6 years old), with 1 Bertec force plate. The following parameters were estimated from the centre of pressure (CoP) trajectory, which can be used to define subjects’ performance during the balance task: sway area; ellipse (containing 95% of the data); mean CoP path and velocity in the anterior-posterior and medio-lateral directions. The following clinical scales and tests were administered to the subjects: Tinetti Balance test (TB); Berg Balance test (BBT); Time up and go test (TUG), Fugl-Meyer (lower limbs) (FM), Motricity Index (lower limbs), Trunk Control Test, Functional Independence Measure. Comparison between SS and CS subjects was performed by using the Student t-test. The Pearson Correlation coefficient was computed between instrumental and clinical parameters.ResultsMean ± standard deviation for the balance scales scores of SS were: 12.5 ± 3.6 for TB, 42.9 ± 13.1 for BBT, 24 s and 75 cent ± 25 s and 70 cent for TUG. Correlation was found among some CoP parameters and both BBT and TUG in the eyes open and closed conditions (0.9 ≤ R ≤ 0.8). Sway area correlated only with TUG. Statistically significant differences were found between SS and CS in all CoP parameters in eyes open condition (p < 0.04); whereas in eyes closed condition only CoP path and velocity (p < 0.02) differed significantly.ConclusionsCorrelation was found only among some of the clinical and instrumental balance outcomes, indicating that they might measure different aspects of balance control. Consistently with previous findings in healthy and pathological subjects, our results suggest that instrumented posturography should be recommended for use in clinical practice in addition to clinical functional tests.

Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there is insufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present study was to compare postural control between subgroups of chronic nonspecific LBP and healthy subjects during lifting. A total of 35 men with chronic LBP (19 active extension pattern [AEP] and 16 flexion pattern [FP]) and 15 healthy controls were enrolled in this cross-sectional study. Pooled LBP was subdivided based on the O'Sullivan's classification system (OCS). The participants were asked to lift a box from the ground to the waist level and hold it for 20 seconds. The load was 10% of the subject's weight. Force plate system was used to record balance parameters, including standard deviations (SDs) of center of pressure (COP) amplitude and COP velocity in anterior-posterior and medial-lateral directions and mean total velocity. The test was divided into two static and dynamic phases. Data were analyzed using one-way analysis of variance and independent t-test. There were no significant differences between pooled LBP and control groups in any of the variables, except for the SD of the anterior-posterior direction velocity in the X-plane in the static phase (P=0.017). After classifying LBP, the results showed that the healthy and AEP groups were significantly different in SD of COP velocity in the frontal plane (P=0.021), mean total velocity (P=0.010), and SD of COP velocity in the sagittal plane (P=0.039). The present study showed that postural control was not different between the pooled LBP and normal groups. After classifying pooled LBP based on OCS, we found that the AEP showed different postural control as compared to healthy controls in the dynamic phase. The FP and AEP exhibited different postural control relative to the healthy controls in the static phase, and COP velocity was lower in those groups compared to the control group. The results of this study support the concept of LBP classification.

Standing Data Disproves Biomechanical Mechanism for Balance-Based Torso-Weighting

We have previously developed a retrospective 4D‐MRI technique using body area as the respiratory surrogate, but generally, the reconstructed 4D MR images suffer from severe or mild artifacts mainly caused by irregular motion during image acquisition. Those image artifacts may potentially affect the accuracy of tumor target delineation or the shape representation of surrounding nontarget tissues and organs. So the purpose of this study is to propose an approach employing principal component analysis (PCA), combined with a linear polynomial fitting model, to remodel the displacement vector fields (DVFs) obtained from deformable image registration (DIR), with the main goal of reducing the motion artifacts in 4D MR images. Seven patients with hepatocellular carcinoma (2/7) or liver metastases (5/7) in the liver, as well as a patient with non‐small cell lung cancer (NSCLC), were enrolled in an IRB‐approved prospective study. Both CT and MR simulations were performed for each patient for treatment planning. Multiple‐slice, multiple‐phase, cine‐MRI images were acquired in the axial plane for 4D‐MRI reconstruction. Single‐slice 2D cine‐MR images were acquired across the center of the tumor in axial, coronal, and sagittal planes. For a 4D MR image dataset, the DVFs in three orthogonal direction (inferior–superior (SI), anterior–posterior (AP), and medial–lateral (ML)) relative to a specific reference phase were calculated using an in‐house DIR algorithm. The DVFs were preprocessed in three temporal and spatial dimensions using a polynomial fitting model, with the goal of correcting the potential registration errors introduced by three‐dimensional DIR. Then PCA was used to decompose each fitted DVF into a linear combination of three principal motion bases whose spanned subspaces combined with their projections had been validated to be sufficient to represent the regular respiratory motion. By wrapping the reference MR image using the remodeled DVFs, ‘synthetic’ MR images with reduced motion artifacts were generated at selected phase. Tumor motion trajectories derived from cine‐MRI, 4D CT, original 4D MRI, and ‘synthetic’ 4D MRI were analyzed in the SI, AP, and ML directions, respectively. Their correlation coefficient (CC) and difference (D) in motion amplitude were calculated for comparison. Of all the patients, the means and standard deviations (SDs) of CC comparing ‘synthetic’ 4D MRI and cine‐MRI were 0.98±0.01,0.98±0,01, and 0.99±0.01 in SI, AP, and ML directions, respectively. The mean±SD Ds were 0.59±0.09 mm,0.29±0.10 mm, and 0.15±0.05 mm in SI, AP and ML directions, respectively. The means and SDs of CC comparing ‘synthetic’ 4D MRI and 4D CT were 0.96±0.01,0.95±0.01, and 0.95±0.01 in SI, AP, and ML directions, respectively. The mean±SD Ds were 0.76±0.20 mm,0.33±0.14 mm, and 0.19±0.07 mm in SI, AP, and ML directions, respectively. The means and SDs of CC comparing ‘synthetic’ 4D MRI and original 4D MRI were 0.98±0.01,0.98±0.01, and 0.97±0.01 in SI, AP, and ML directions, respectively. The mean±SD Ds were 0.58±0.10 mm,0.30±0.09 mm, and 0.17±0.04 mm in SI, AP, and ML directions, respectively. In this study we have proposed an approach employing PCA combined with a linear polynomial fitting model to capture the regular respiratory motion from a 4D MR image dataset. And its potential usefulness in reducing motion artifacts and improving image quality has been demonstrated by the preliminary results in oncological patients.PACS numbers: 87.57.cp, 87.57.nj, 87.61.‐c

The aim of this study is to identify the appropriate movement for maintaining postural balance during Front Kick and Turning Side Kick motions. To do so, ten Taekwondo athletes: five skilled players(S, body mass: <TEX>$65.0{\pm}5.8kg$</TEX>, height: <TEX>$172.3{\pm}3.7cm$</TEX>, age: <TEX>$20.0{\pm}1.2yrs$</TEX>, career: <TEX>$9.0{\pm}1.9yrs$</TEX>) and five less-skilled players(LS, body mass: <TEX>$67.1{\pm}5.5kg$</TEX>, height: <TEX>$173.2{\pm}5.1cm$</TEX>, age: <TEX>$19.4{\pm}1.7yrs$</TEX>, career: <TEX>$9.6{\pm}1.7yrs$</TEX>) participated in this study. A three-dimensional motion analysis was performed on the participants using eight infrared cameras and two force plate(sampling frequency of 200 Hz and 2000 Hz for S and LS players, respectively). The participants' motions were divided into: a front-kick phase(P1) and a turning-side-kick phase(P2). For P2(p<.05), the range and root mean square(RMS) of the ground reaction torque and the M-L mean velocity of COP were greater for LS than for S; similarly, for P2(p<.05), the M-L range, A-P range, and velocity of the COP were greater for LS than for S. Further, the M-L range and maximum velocity of the COP was greater for failure than for success(p<.05). The femoral biceps muscle for bending the knee joint was significantly stronger in S than in LS(p<.05). It is expected that these results will be useful in developing a training program for improving the balance and stability of Taekwondo poomsae athletes and improve their front-kick and turning-side-kick motions.

This study aimed to determine if there is a difference in postural stability in highly trained adolescents and young adult athletes regarding sex and sport. The participants were young athletes (n = 464) from seven different sports. We considered the center of pressure (CoP) velocity (total, anterior–posterior (AP) and medial–lateral (ML)), CoP amplitude (AP and ML), and CoP frequency (AP and ML), as assessed by single-leg quiet stance test. Significant interactions were found between sex and sport for all CoP variables (p < 0.02). Additionally, a significant main effect of sport was also found in all CoP variables (p = 0.01). Regarding sex, significant effects were found for all CoP amplitude variables (p = 0.01), as well as for CoP velocity variables, except for CoP ML (p = 0.06). Moreover, there was no sex effect for CoP frequency AP (p = 0.18). The results of the current study confirm the claim that the criteria for optimal postural strategies for elite athletes likely depend on a given sport.