Undisturbed Upright Stance Control in the Elderly: Part 1. Age-Related Changes in Undisturbed Upright Stance Control

The authors investigated age-related changes in postural control in 33 healthy young adults (18-31 years), 29 seniors (62-75 years), and 22 elderly people (75-96 years). A force platform recorded the results. The horizontal motions of the center of gravity (CG_h) and their difference in the plane of support CP - CG_v were deduced from the complex center of pressure (CP) trajectories. With fractional Brownian modeling, one can establish that the aging process seems to induce a transition phase in which seniors take more time to initiate the corrective process in the mediolateral (ML) axis than do younger people. The elderly develop a new strategy characterized by the mobilization of higher neuromuscular energy to maintain equilibrium. In the ML axis, the larger displacements could be caused mainly by a hip strategy that could facilitate step initiation. In the anteroposterior (AP) axis, seniors and elderly individuals maintain a relative ability to stabilize their CG into the base of support compared with younger people.     

Undisturbed upright stance control in the elderly: Part 2. Postural-control impairments of elderly fallers

A common way of predicting falling risks in elderly people can be to study center of pressure (CP) trajectories during undisturbed upright stance maintenance. By estimating the difference between CP and center of gravity (CG) motions (CP - CGv), one can estimate the neuromuscular activity. The results of this study, which included 34 sedentary elderly persons aged over 75 years (21 fallers and 13 nonfallers), demonstrated significantly increased CGh and CP - CGv motions in both axes for the fallers. In addition, the fallers presented larger CGh motions in the mediolateral axis, suggesting an enlarged loading-unloading mechanism, which could have reflected the adoption of a step-initiating strategy. As highlighted by fractional Brownian motion modeling, the distance covered by the CP - CGv motions before the successive control mechanisms switched was enhanced for the fallers in both axes, therefore increasing the risk that the CG would be outside of the base of support.     

Undisturbed Upright Stance Control in the Elderly: Part 2. Postural-Control Impairments of Elderly Fallers

A common way of predicting falling risks in elderly people can be to study center of pressure (CP) trajectories during undisturbed upright stance maintenance. By estimating the difference between CP and center of gravity (CG) motions (CP - CG_v), one can estimate the neuromuscular activity. The results of this study, which included 34 sedentary elderly persons aged over 75 years (21 fallers and 13 nonfallers), demonstrated significantly increased CG_h and CP - CG_v motions in both axes for the fallers. In addition, the fallers presented larger CG_h motions in the mediolateral axis, suggesting an enlarged loading—unloading mechanism, which could have reflected the adoption of a step-initiating strategy. As highlighted by fractional Brownian motion modeling, the distance covered by the CP - CG_v motions before the successive control mechanisms switched was enhanced for the fallers in both axes, therefore increasing the risk that the CG would be outside of the base of support.     

Center of gravity motions and ankle joint stiffness control in upright undisturbed stance modeled through a fractional Brownian motion framework

The authors modeled the center of gravity vertical projection (CG(v)) and the difference, CP - CG(v), which, combined, constitute the center of pressure (CP) trajectory, as fractional Brownian motion in order to investigate their relative contributions and their spatiotemporal articulation. The results demonstrated that CG(v) and CP - CG(v) motions are both endowed in complementary fashion with strong stochastic and part-deterministic behaviors. In addition, if the temporal coordinates remain similar for all 3 trajectories by definition, the switch between the successive control mechanisms appears for shorter displacements for CP - CG(v) and CG(v) than for CP trajectories. Results deduced from both input (CG(v)) and muscular stiffness (CP - CG(v)) thus provide insight into the way the central nervous system regulates stance control and in particular how CG and CP - CG are controlled.     

Age-related differences in postural reaction time and coordination during voluntary sway movements

The elderly are known to exhibit declines in postural control during standing and walking, however little is known about how the elderly react under time-critical and challenging postural situations. The purpose of this study was to examine age-related differences in reaction time (RT) and the pattern of temporal coordination between center of pressure (COP), trunk and head motion during voluntary postural sway movements. Healthy young (n=10; mean=24 years; SD=5 years) and elderly men (n=8; mean=75 years; SD=2 years) stood on a force plate with tri-axial accelerometers attached to the head and lower trunk. Participants were required to generate sway in the anterior-posterior (AP) or medial-lateral (ML) direction in response to an auditory cue during two different testing conditions called Static reaction and Dynamic reaction. Static reactions involved the initiation of voluntary sway in either the AP or ML direction from quiet stance. Dynamic reactions involved an orthogonal switch of voluntary sway between the AP and ML directions. Compared to the young, elderly individuals exhibited slower RT during both Static and Dynamic reaction, and smaller differences in RT and phasing between COP, trunk, and head motion. The results of this study suggest that the elderly adopted more rigid coordination strategies compared to the young when executing a rapid change in direction of whole body motion. The rigid movement strategy of the elderly was presumably generated in an effort to compensate for increased challenge to the maintenance of stability.     

Interaction between eye and body movements to perform visual tasks in upright stance

Synergistic interactions between visual and postural behaviors were observed in a previous study during a precise visual task (search for a specific target in a picture) performed upright as steady as possible. The goal of the present study was to confirm and extend these novel findings in a more ecological condition with no steadiness requirement. Twelve healthy young adults performed two visual tasks, i.e. a precise task and a control task (free-viewing). Center of pressure, lower back, neck, head and eye movements were recorded during each task. The subjective cognitive workload was assessed after each task (NASA-TLX questionnaire). Pearson correlations and cross-correlations between eyes (time-series, characteristics of fixation) and center of pressure/body movements were used to test the synergistic model. As expected, significant negative Pearson correlations between eye and head-neck movement variables were only observed in searching. They indicated that larger precise gaze shifts were correlated with lower head and neck movements. One cross-correlation coefficient (between COP on the AP axis and eyes in the up/down direction) was also significantly higher, i.e. stronger, in searching than in free-viewing. These synergistic interactions likely required greater cognitive demand as indicated by the greater NASA-TLX score in searching. Moreover, the previous Pearson correlations were no longer significant after controlling for the NASA-TLX global score (thanks to partial correlations). This study provides new evidence of the existence of a synergistic process between visual and postural behaviors during visual search tasks.     

Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients

The goal of this study was to compare young and elderly healthy individuals and elderly stroke patients in their capacity to use visual CP feedback (VF) in controlling both quiet standing and weight shifting and to assess their sensory re-weighing when this VF is withdrawn. A total of 40 participants were involved in this study. Participants were asked to either quietly stand on a force platform for a period of 45 s with eyes open (EO), using visual feedback (VF) or without visual feedback (No VF) or to perform a dynamic weight shifting task while using VF or No VF. During the quiet standing trials with VF, only the young (YO) were able to decrease the amplitude and increase the frequency of their sway in either plane. Removal of the VF resulted in a 'destabilizing' effect in both healthy elderly (EL) and stroke patients (ST) in the sagittal plane. With regard to the dynamic task, both the YO and EL were generally more successful at weight shifting in terms of speed and control when compared to the ST. Yet, when VF was removed, only the YO were able to largely maintain speed and precision of control. Hence, providing or removing visual CP feedback during quiet standing or removing VF during visually controlled weight shifting can discriminate healthy young participants from healthy elderly, but does not clearly discriminate healthy elderly from stroke patients in the same age group. Results revealed that sagittal plane imbalance in healthy elderly and stroke patients may be largely due to the effects of aging, whereas frontal plane imbalance is much more specific for the postural problems associated with stroke.     

Effects of breathing on multijoint control of center of mass position during upright stance

ABSTRACT Breathing exerts destabilizing effects on postural stability during quiet stance. The authors conducted an experiment to evaluate the role of motor abundance in the organization of the postural synergy compensating for the effects of breathing. They measured the kinematic pattern of covariation among the major joints of the postural chain (ankle, knee, hip, trunk, and neck) as a function of different breathing modes (spontaneous, paced, and increased volume) and different stance instructions (still vs. relaxed) using the uncontrolled manifold approach. Joint variability was structured to preserve the stable position of the center of mass. This result supports the hypothesis that motor abundance of the postural chain plays an important role in the flexible compensation for breathing during quiet stance.     

Anticipatory balance control is affected by loadless training experiences

The main purpose of this study was to identify whether a lot of sports training had any effect on the balance control associated with a leg movement. The nature of the training experience was also an important concern and we chose subject who had undergone specific training experience in absence of equilibrium constraints. To this end a comparison between control (untrained) subjects, triathletes and swimmers was designed to establish whether a general training in sports (triathletes) or a specific loadless training (swimmers), leads to differences in the balance control. A leg movement is preceded by a shift of the center of mass (CM) towards the supporting side to maintain equilibrium and forward to create the condition for progression. To provide an acceleration of the CM sideward and forward, an initial displacement of the center of pressure (CP) towards the moving limb and in posterior direction was performed. Interestingly, the lateral pressure onto the ground was greater increased in swimmers in both leg raising and obstacle avoidance tasks compared to the control group and/or triathletes whereas the backward CP shift in all group was the same. The initial control of the CM shift is very different in swimmers compared to triathletes and controls. The increased lateral pressure onto the ground in swimmers may be a result of a prolonged training in water. This suggests that prolonged training in the absence of equilibrium constraints has more of an effect on balance control than a prolonged general training. In addition, the lack of differences in the backward CP shift suggests that M/L and A/P controls support two functional goals: equilibrium maintenance and movement initiation.     

Age-stage differences in body sway during a static upright posture based on sway factors and relative accumulation of power frequency

This study was done to examine age-stage (preschool children, young adults, and elderly people) differences in the center-of-pressure sway using body-sway factors (unit-time sway, front-back sway, left-right sway, and high frequency-band power), power-spectrum distribution, and relative accumulation of power frequency (25%, 50%, and 75% RAPF) of the center-of-pressure spectrum. The center-of-pressure movement for 1 min. was measured twice using Anima's stabilometer. Data-sampling frequency was set at 20 Hz. Significant age-stage differences were found for 3 factors except for left-right sway, which was larger for preschool children and elderly than for young adults. The power spectrum of body sway in any age-stage was noted mainly in low frequency bands. A marked age-stage difference was found at 75% RAPF. Body-sway characteristics in each age-stage differ, and differences of postural-sway frequency are marked in the low frequency bands.     

Accuracy of weightbearing at three target levels during bilateral upright stance in patients with neuropathic feet and control subjects

The purposes of this study were to (1) describe errors in weightbearing at three target levels for patients with neuropathic feet and control subjects, (2) compare the absolute errors at the three target levels between groups, and (3) identify predictor variables of errors in weightbearing by the neuropathic group. The groups of 26 subjects were matched for age and height. Weightbearing was measured with digital scales while subjects attempted to adjust their weight through a designated lower extremity to each target level (25, 50, and 75% of body weight). Analysis of variance indicated no significant difference in the percentage weightbearing between groups at the three target levels. There was a significant difference in errors made in weightbearing by the groups at the three target levels. Mean errors ranged from 8.5 to 9.7% for the neuropathic group and from 2.4 to 6.6% for the control group. The findings cast doubt on the utility (in the absence of feedback) of requesting individuals, particularly those with neuropathic feet, to weightbear at specific target levels.     

Flow structure versus retinal location in the optical control of stance

In four experiments I examined the importance of the retinal center and periphery in the pickup of optical information for controlling stance as a function of the dynamic geometrical structure of the optical flow. All experiments were performed in a moving room so that the magnitude of compensatory sway in response to room movements could be measured. In Experiments 1 and 2 I found stronger sway response to flow having a largely lamellar structure that was presented to the retinal periphery than to more radially structured flow in the center. In Experiment 3 observers turned their heads to face the right wall of the room, placing radial flow in the periphery and lamellar flow in the center of the visual field. Radial flow presented to the retinal periphery induced no compensatory sway. Lamellar flow in the center of the retina produced some sway. Flow structure apparently interacts with the exposed retinal area in controlling stance.     

Comparison of power spectrum characteristics of body sway during a static upright standing posture in healthy elderly people and young adults

This study was designed to compare peak frequency, mean power frequency, and power spectrum of each frequency band of body-sway time series and velocity time series power spectra between 30 healthy elderly people and 30 young adults and to clarify their frequency characteristics. Peak frequency and mean power frequency differed between groups, being higher for elderly persons, and the difference was marked in the front-back direction. When comparing power spectra of three domains (A: 0.02-0.2 Hz, B: 0.2-2.0 Hz, and C: 2.0-10.0 Hz) of an international standard, a significant age-group difference was found only in the front-back direction. Young adults were higher in the low frequency band (A domain) in sway time series, and the elderly group was higher in the high frequency band (C domain) in body-sway velocity time series. However, almost all power spectra of both groups appeared in the low frequency band. The present results suggested frequency characteristics of healthy people occur in the low frequency band, but the elderly group compared with the young adults had more characteristics in the high frequency band. Their frequency characteristics cannot be properly evaluated by the international standard established to screen disorders. It may be necessary for healthy people to have new evaluation frequency sections when considering power spectrum characteristics of sway time series and sway-velocity time series.     

A wearable vibrotactile biofeedback system improves balance control of healthy young adults following perturbations from quiet stance

Maintaining postural equilibrium requires fast reactions and constant adjustments of the center of mass (CoM) position to prevent falls, especially when there is a sudden perturbation of the support surface. During this study, a newly developed wearable feedback system provided immediate vibrotactile clues to users based on plantar force measurement, in an attempt to reduce reaction time and CoM displacement in response to a perturbation of the floor. Ten healthy young adults participated in this study. They stood on a support surface, which suddenly moved in one of four horizontal directions (forward, backward, left and right), with the biofeedback system turned on or off. The testing sequence of the four perturbation directions and the two system conditions (turned on or off) was randomized. The resulting reaction time and CoM displacement were analysed. Results showed that the vibrotactile feedback system significantly improved balance control during translational perturbations. The positive results of this preliminary study highlight the potential of a plantar force measurement based biofeedback system in improving balance under perturbations of the support surface. Future system optimizations could facilitate its application in fall prevention in real life conditions, such as standing in buses or trains that suddenly decelerate or accelerate.     

Dynamics of postural control during bilateral stance – Effect of support area,visual input and age

The present study investigated the effect of support area, visual input and aging of the dynamics of postural control during bilateral stance. Fifteen young (22.1 ± 1.7 years) and fifteen older (68.3 ± 2.7 years) individuals completed four different 90 s bilateral stance trials: 1) shoulder wide feet distance with eyes open, 2) shoulder wide feet distance with eyes closed, 3) narrow feet distance with eyes open, and 4) narrow feet distance with eyes closed on a force plate form. The anterior (AP) and mediolateral (ML) center of pressure (COP) trajectories were calculated from the middle 60 s of the ground reaction forces and moments. Sample entropy (SaEn), correlation dimension (CoD), the largest Lyapunov exponent (LyE) and entropic half-life (ENT½) were calculated for the COP in both directions. In young individuals, a narrower support area resulted in a restricted movement solution space with lower SaEn, lower LyE and longer ENT½ in the executed motor control strategy, whereas it increased the CoD in the older individuals. During the eyes closed trials, SaEn, CoD and LyE increased and decreased ENT½ for both groups in the AP direction and increased SaEn and LyE in the ML direction for the older individuals alone. This indicates that aging is associated with direction- and task-dependent changes in the dynamics of the executed COP movements during postural stance tasks.     

Assessment of postural control in patients with Parkinson’s disease: Sway ratio analysis

Analysis of the postural stability impairments in neurodegenerative diseases is a very demanding task. Age-related declines in posturographic indices are usually superimposed on effects associated with the pathology and its treatment. We present the results of a novel postural sway ratio (SR) analysis in patients with Parkinson’s disease (PD) and age-matched healthy subjects. The sway ratios have been assessed based upon center of foot-pressure (CP) signals recorded in 55 parkinsonians (Hoehn and Yahr: 1-3) and 55 age-matched healthy volunteers while standing quiet with eyes open (EO) and then with eyes closed (EC). Complementing classical sway measure abnormalities, the SR exhibited a high discriminative power for all controlled factors: pathology, vision, and direction of sway. Both the anteroposterior (AP) and mediolateral (ML) sway ratios were significantly increased in PD patients when compared to the control group. An additional SR increase was observed in the response to eyes closure. The sway ratio changes documented here can be attributed to a progressive decline of a postural stability control due to pathology. In fact, a significant correlation between the mediolateral SR under EO conditions and Motor Exam (section III) score of the UPDRS was found. The mediolateral sway ratios computed for EO and EC conditions significantly correlated with the CP path length (r = .87) and the mean anteroposterior CP position within the base of support (r = .38). Both indices reflect postural stability decline and fall tendency # in parkinsonians. The tremor-type PD patients (N = 34) showed more pronounced relationships between the mediolateral SR and selected items from the UPDRS scale, including: falls (Kendall Tau = .47, p < .05), rigidity (.45, p < .05), postural stability (retropulsion) (.52), and the Motor Exam score (.73). The anteroposterior SR correlated only with tremor (Kendal Tau = .77, p < .05). It seems that in force plate posturography the SR can be recommended as a single reliable measure that allows for a better quantitative assessment of postural stability impairments.     

Broad stance conditions change postural control and postural sway

Intuitively, a broad stance (i.e., standing with the feet farther apart than usual) should significantly improve postural stability. However, this intuition was not confirmed in quiet stance. Hence, a motion analysis system (markers attached to the trunk and head) and a force platform were used to investigate 13 healthy, young adults who performed 8 trials in standard and broad stances. In broad stance, the medialateral center of pressure (COP) sway mean power frequency was expected to be greater, whereas the variability (standard deviation) of COP, head, and trunk sway and the mean velocity of head and trunk sway was expected to be significantly lower. Accordingly, adoption of a broad stance significantly increased the medialateral mean power frequency of COP sway; decreased the standard deviation of medialateral COP, trunk, and head sway; and decreased the medialateral mean velocity of head sway. A broad stance was also associated with lower variability for head and COP sways in the anteroposterior axis. Unexpectedly, an effect of trial repetition was found for the variability of medialateral trunk sway. This was probably due to the break halfway through the study. In practical terms, broad stance conditions can improve postural control in the medialateral and anteroposterior axes.     

老年人乐观、领悟社会支持与主观幸福感的关系—控制策略的中介作用

基于毕生控制理论，方便选取杭州市60~95岁的老年人320名，采用问卷法考察了老年人控制策略使用的现状和特点，并在控制了年龄、健康状况、日常活动数量后，探讨了老年人的乐观、领悟社会支持与主观幸福感的关系，以及控制策略的中介作用。结果发现：低龄的老年男性和女性更偏好选择初级和补偿初级策略，而高龄老年女性更偏好补偿初级策略；乐观和领悟社会支持不仅可以直接影响老年人的主观幸福感，还可以通过选择初级策略间接影响主观幸福感。初级控制在老年人中依然具有首要性地位，老年人的资源越丰富，越有可能采用积极的控制策略（选择初级），进而提高主观幸福感，实现成功老龄化。     

Age effects on the control of dynamic balance during step adjustments under temporal constraints

This study investigated the age effects on the control of dynamic balance during step adjustments under temporal constraints. Fifteen young adults and 14 older adults avoided a virtual white planar obstacle by lengthening or shortening their steps under free or constrained conditions. In the anterior–posterior direction, older adults demonstrated significantly decreased center of mass velocity at the swing foot contact under temporal constraints. Additionally, the distances between the ‘extrapolated center of mass’ position and base of support at the swing foot contact were greater in older adults than young adults. In the mediolateral direction, center of mass displacement was significantly increased in older adults compared with young adults. Consequently, older adults showed a significantly increased step width at the swing foot contact in the constraint condition. Overall, these data suggest that older adults demonstrate a conservative strategy to maintain anterior–posterior stability. By contrast, although older adults are able to modulate their step width to maintain mediolateral dynamic balance, age-related changes in mediolateral balance control under temporal constraints may increase the risk of falls in the lateral direction during obstacle negotiation.     

How providing more or less time to solve a cognitive task interferes with upright stance control; a posturographic analysis on healthy young adults

Contrasted postural effects have been reported in dual-task protocols associating balance control and cognitive task that could be explained by the nature and the relative difficulty of the cognitive task and the biomechanical significance of the force platform data. To better assess their respective role, eleven healthy young adults were required to stand upright quietly on a force platform while concomitantly solving mental-calculation or mental-navigation cognitive tasks. Various levels of difficulty were applied by adjusting the velocity rate at which the instructions were provided to the subject according to his/her maximal capacities measured beforehand. A condition without any concomitant cognitive task was added to constitute a baseline behavior. Two basic components, the horizontal center-of-gravity movements and the horizontal difference between center-of-gravity and center-of-pressures were computed from the complex center-of-pressure recorded movements. It was hypothesized that increasing the delay should infer less interaction between postural control and task solution. The results indicate that both mental-calculation and mental-navigation tasks induce reduced amplitudes for the center-of-pressure minus center-of-gravity movements, only along the mediolateral axis, whereas center-of-gravity movements were not affected, suggesting that different circuits are involved in the central nervous system to control these two movements. Moreover, increasing the delays task does not infer any effect for both movements. Since center-of-pressure minus center-of-gravity expresses the horizontal acceleration communicated to the center-of-gravity, one may assume that the control of the latter should be facilitated in dual-tasks conditions, inferring reduced center-of-gravity movements, which is not seen in our results. This lack of effect should be thus interpreted as a modification in the control of these center-of-gravity movements. Taken together, these results emphasized how undisturbed upright stance control can be impacted by mental tasks requiring attention, whatever their nature (calculation or navigation) and their relative difficulty. Depending on the provided instructions, i.e. focusing our attention on body movements or on the opposite diverting this attention toward other objectives, the evaluation of upright stance control capacities might be drastically altered.