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"Postural balance"
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Wearable Inertial Sensors to Assess Standing Balance: A Systematic Review
Wearable sensors are de facto revolutionizing the assessment of standing balance. The aim of this work is to review the state-of-the-art literature that adopts this new posturographic paradigm, i.e., to analyse human postural sway through inertial sensors directly worn on the subject body. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 73 full-text articles, selecting 47 high-quality contributions. A good inter-rater reliability was obtained (Cohen’s kappa = 0.79). This selection of papers was used to summarize the available knowledge on the types of sensors used and their positioning, the data acquisition protocols and the main applications in this field (e.g., “active aging”, biofeedback-based rehabilitation for fall prevention, and the management of Parkinson’s disease and other balance-related pathologies), as well as the most adopted outcome measures. A critical discussion on the validation of wearable systems against gold standards is also presented.
Journal Article
Falls in Parkinson’s Disease Subtypes: Risk Factors, Locations and Circumstances
People with Parkinson’s disease (PD) can be classified into those with postural instability and gait difficulty (PIGD subtype) and those manifesting tremor as the main symptoms (non-PIGD subtype). In a prospective cohort study of 113 people with PD we aimed to contrast fall rates and circumstances as well as a range of disease-related, clinical, and functional measures between the PD subtypes. Compared with non-PIGD participants, PIGD participants were significantly more likely to suffer more falls overall as well as more falls due to freezing of gait, balance-related falls and falls at home. The PIGD group also performed significantly worse in a range of fall-related clinical and functional measures including general cognitive status, executive function, quadriceps muscle strength, postural sway and the timed up and go test. These findings document the extent to which people with the PIGD subtype are at increased risk of falls, the circumstances in which they fall and their disease-related, clinical and functional impairments.
Journal Article
Validity and reliability of a novel device to evaluate balance and postural control − Quadrotics Poise Q10
Assessment of balance using force platform-based methods are crucial for diagnosis and treatment in the fields of physiotherapy. This study evaluated the validity and reliability of the Quadrotics Poise Q10 in measuring postural sway and limits of stability, using simultaneous assessments with the Bertec force platform in 40 healthy participants. Postural sway was evaluated under four conditions. Limits of stability were analysed in the four directions. Pearson’s correlation analysis was used to assess the concurrent and absolute validity of the Quadrotics Poise Q10. Intra and Inter-Rater reliability were examined using intraclass correlation coefficients (ICC), standard error of measurement, and Minimum Detectable Change. Additionally Limits of Agreement and Bland–Altman plots were conducted. A strong relationship was observed in anteroposterior and mediolateral sway on both hard and soft surfaces, with eyes open and closed (p < 0.05). Moderate to strong correlations were found for all directions excursions during the limits of stability test (p < 0.05). Intra-rater reliability analysis demonstrated high reliability for postural sway (ICC:0.60–0.87) and excellent reliability for LoS (ICC:0.91–0.95). Inter-rater reliability was found to be high across all test conditions, with ICC values ranging from 0.67 to 0.83 for postural sway and excellent reliability for LoS in the right and left directions (ICC = 0.93 and 0.91, respectively) and high in the forward and backward direcions (ICC = 0.67–0.71). The study’s findings indicate that the newly developed device is valid and reliable for evaluating limits of stability and postural sway. However, Bland–Altman analysis variations highlighted in lower agreement under more challenging test conditions.
Journal Article
Analyzing the Use of Accelerometers as a Method of Early Diagnosis of Alterations in Balance in Elderly People: A Systematic Review
Alterations of balance are a growing public health problem as they affect one in three adults over the age of 65, and one in two over the age of 80. Identifying the factors that affect postural stability is essential in designing specific interventions to maintain the independence and mobility of older people. The aim of this review was to understand the use of accelerometers in order to assess the balance in older people. Analyzing the most appropriate evaluation methodology and protocolizing it will optimize the processes of early identification of balance alterations. However, quantitative assessment methods of balance are usually limited to a laboratory environment, a factor that can be overcome by accelerometers. A systematic search was carried out across eight databases where accelerometers were employed to assess balance in older people. Articles were excluded if they focused on sensor design and did not measure balance or apply the technology on targeted participants. A total of 19 articles were included for full-text analysis, where participants took part in the balance evaluation monitored by accelerometers. The analysis of spatio-temporal parameters and the magnitude of the accelerations recorded by the devices were the most common study variables. Accelerometer usage has potential to positively influence interventions based on physical exercise to improve balance and prevent falls in older people.
Journal Article
Long noncoding RNA MALAT1 in exosomes drives regenerative function and modulates inflammation-linked networks following traumatic brain injury
Background
Neuroinflammation is a common therapeutic target for traumatic brain injury (TBI) due to its contribution to delayed secondary cell death and has the potential to occur for years after the initial insult. Exosomes from adipose-derived stem cells (hASCs) containing the long noncoding RNA MALAT1 are a novel, cell-free regenerative approach to long-term recovery after traumatic brain injury (TBI) that have the potential to modulate inflammation at the genomic level. The long noncoding RNA MALAT1 has been shown to be an important component of the secretome of hASCs.
Methods
We isolated exosomes from hASC containing or depleted of MALAT1. The hASC-derived exosomes were then administered intravenously to rats following a mild controlled cortical impact (CCI). We followed the rats with behavior, in vivo imaging, histology, and RNA sequencing (RNA Seq).
Results
Using in vivo imaging, we show that exosomes migrate into the spleen within 1 h following administration and enter the brain several hours later following TBI. Significant recovery of function on motor behavior as well as a reduction in cortical brain injury was observed after TBI in rats treated with exosomes. Treatment with either exosomes depleted of MALAT1 or conditioned media depleted of exosomes showed limited regenerative effects, demonstrating the importance of MALAT1 in exosome-mediated recovery. Analysis of the brain and spleen transcriptome using RNA Seq showed MALAT1-dependent modulation of inflammation-related pathways, cell cycle, cell death, and regenerative molecular pathways. Importantly, our data demonstrates that MALAT1 regulates expression of other noncoding RNAs including snoRNAs.
Conclusion
We demonstrate that MALAT1 in hASC-derived exosomes modulates multiple therapeutic targets, including inflammation, and has tremendous therapeutic potential for treatment of TBI.
Journal Article
The relevance of clinical balance assessment tools to differentiate balance deficits
Control of balance is complex and involves maintaining postures, facilitating movement, and recovering equilibrium. Balance control consists of controlling the body center of mass over its limits of stability. Clinical balance assessment can help to assess fall risk and/or determine the underlying reasons for balance disorders. Most functional balance assessment scales assess fall risk and the need for balance rehabilitation but do not differentiate types of balance deficits. A system approach to clinical balance assessment can differentiate different kinds of balance disorders and a physiological approach can determine underlying sensorimotor mechanisms contributing to balance disorders. Objective measures of balance using computerized systems and wearable inertial sensors can bring more sensitive, specific and responsive balance testing to clinical practice.
Journal Article
Exploring the relationship between cardiac awareness and balance
Summary
Postural 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.
Journal Article
Dynamic postural stability indices in athletes: a case-control study on chronic ankle instability during multi-directional landing assessments
Background
Our understanding of the impact of chronic ankle instability (CAI) on dynamic postural stability remains limited, primarily due to the absence of reliable and accurate assessment tools. This study aimed to explore two aspects of dynamic postural stability: (1) differences in the dynamic postural stability index (DPSI) and its directional components between athletes with CAI and those with stable ankles; and (2) the impact of jump direction (forward vs. lateral) on these indices across both groups.
Methods
We recruited fifteen athletes with CAI and fifteen healthy athletes as controls. The injured side of CAI subjects and the matched side of controls performed forward and lateral single-leg landing tasks (from a 20 cm height onto a force platform, three repetitions). DPSI and its directional indices (anterior-posterior, medial-lateral, and vertical) were calculated according to Wikstrom’s method.
Results
Athletes with CAI demonstrated significantly greater anterior-posterior stability index (APSI) scores (F
(1,28)
= 9.864,
p
= 0.004, η
2
p
= 0.261) and vertical stability index (VSI) scores (F
(1,28)
= 6.193,
p
= 0.019, η
2
p
= 0.181) during the forward landing task, and significantly greater medial-lateral stability index (MLSI) scores (F
(1,28)
= 10.144,
p
= 0.004, η
2
p
= 0.266) during the lateral landing task. APSI (CAI: F
(1,28)
= 42.616,
p
< 0.001, η
2
p
= 0.603; CON: F
(1,28)
= 6.229,
p
= 0.019, η
2
p
= 0.182) and DPSI (CAI: F
(1,28)
= 13.062,
p
= 0.001, η
2
p
= 0.318; CON: F
(1,28)
= 9.673,
p
= 0.004, η
2
p
= 0.257) scores revealed a significant difference between directions in both groups. MLSI scores exhibited a significant increase in the lateral direction in the CAI group (F
(1,28)
= 18.289,
p
< 0.001, η
2
p
= 0.395).
Conclusions
Athletes with CAI demonstrated dynamic stability deficits, and the direction of the jump can affect dynamic postural stability in the sagittal and frontal planes.
Trial registration
Chinese Clinical Trial Registry, ChiCTR2200062443, Registered 7 August 2022.
Journal Article
Postural Sway Velocity of Deaf Children with and without Vestibular Dysfunction
Background: Sensory information obtained from the visual, somatosensory, and vestibular systems is responsible for regulating postural control, and if damage occurs in one or more of these sensory systems, postural control may be altered. Objective: To evaluate and compare the postural sway velocity between children with normal hearing and with sensorineural hearing loss (SNHL), matched by sex and age group, and to compare the postural sway velocity between children with normal hearing and with SNHL, with and without vestibular dysfunction. Methods: Cross-sectional study that evaluated 130 children (65 with normal hearing and 65 with SNHL), of both sexes and aged between 7 and 11 years, from public schools of the city of Caruaru, Pernambuco state, Brazil. The postural sway velocity of the center of pressure (COP) was assessed by a force platform, in two directions, anteroposterior (AP) and mediolateral (ML)), in three positions, namely bipedal support with feet together and parallel (parallel feet (PF)), bipedal support with one foot in front of the other (tandem foot (TF)), and single-leg support (one foot (OF)), evaluated with the eyes open and closed. Results: Children with SNHL demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, with significant differences in the AP direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.003) and closed (PF: p = 0.050; TF: p = 0.005). The same occurred in the ML direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.001) and closed (PF: p = 0.002; TF: p = 0.000). The same occurred in relation to vestibular function, where the children with SNHL with an associated vestibular dysfunction demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, demonstrating significant differences in the AP direction, with the eyes open (TF: p = 0.001; OF: p = 0.029) and eyes closed (PF: p = 0.036; TF: p = 0.033). The same occurred in the ML direction, with the eyes open (TF: p = 0.000) and with the eyes closed (PF: p = 0.008; TF: p = 0.009). Conclusions: Children with SNHL demonstrated greater instability of postural control than children with normal hearing in all the directions assessed. Children with SNHL and an associated vestibular dysfunction demonstrated the greatest instability of postural control in this study.
Journal Article