Cognitive functions explain discrete parameters of normal walking and dual-task walking, but not postural sway in quiet stance among physically active older people.

BACKGROUND: Postural control is dependent on the central nervous system's accurate interpretation of sensory information to formulate and execute adequate motor actions. Research has shown that cognitive functions are associated with both postural control and fall risk, but specific associations are not established. The aim of this study was to explore how specific components of everyday postural control tasks are associated with both general and specific cognitive functions. METHODS: Forty-six community-dwelling older adults reported their age, sex, physical activity level, falls and fall-related concerns. The following cognitive aspects were assessed: global cognition, executive functions, processing speed and intraindividual variability. Postural control was quantified by measuring postural sway in quiet stance, walking at a self-selected pace, and walking while performing a concurrent arithmetical task. Separate orthogonal projections of latent structures models were generated for each postural control outcome using descriptive and cognitive variables as explanatory variables. RESULTS: Longer step length and faster gait speed were related to faster processing speed and less intraindividual variability in the choice reaction test. Moreover, longer step length was also related to less fall-related concerns and less severe fall-related injuries, while faster gait speed was also related to female sex and poorer global cognition. Lower dual-task cost for gait speed was explained by the executive function inhibition and faster processing speed. Postural sway in quiet stance was not explained by cognitive functions. CONCLUSIONS: Cognitive functions explained gait speed and step length during normal walking, as well as the decrease of gait speed while performing a concurrent cognitive task. The results suggest that different cognitive processes are important for different postural control aspects. Postural sway in quiet stance, step time and gait variability seem to depend more on physical and automatic processes rather than higher cognitive functions among physically active older people. The relationships between cognitive functions and postural control likely vary depending on the specific tasks and the characteristics of different populations.

Identifying the Problem Side with Single-Leg Squat and Hamstrings Flexibility for Non-Specific Chronic Low Back Pain.

Background and Objectives: In patients with non-specific chronic low back pain (LBP), their pain and problem sides can differ. Clinical Pilates assessment provides an approach to identify the problem side, but this approach requires experience and can be subjective. This study aimed to investigate if objective measures of single-leg squat postural control and hamstrings flexibility could identify the problem side in adults with non-specific chronic LBP. Materials and Methods: Forty adults with non-specific chronic LBP were tested on single-leg squat postural control and hamstrings flexibility. The problem side of participants was assessed with the Clinical Pilates method. Paired t-tests were used to compare the postural sway parameters of the single-leg squat and hamstrings flexibility between the problem and non-problem sides. Cohen's kappa was then used to assess the agreement of postural sway and flexibility measures with the Clinical Pilates method. Results: The problem side showed smaller vertical force variance, larger sway path distances, lower peak vertical force, smaller terminal knee flexion angle, longer time to complete the five single-leg squats, and tighter hamstrings as compared to the non-problem side. However, only the overall and anteroposterior sway path distances, terminal knee flexion angle, total squat duration, and hamstrings flexibility yielded moderate to strong agreement with the Clinical Pilates method. Conclusions: Single-leg squat postural sway parameters and hamstrings flexibility can objectively identify the problem side in adults with non-specific chronic LBP.

Vestibular Function and Postural Control in Children with Autism Spectrum Disorder.

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks-Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention.

Investigating the relationship of trunk and postural control with pulmonary functions in subacute stroke patients.

Stroke is a disease with high mortality and morbidity that not only causes weakness in the extremities, loss of balance, and disturbances in trunk and postural control, but also affects respiratory function. The aim of this study was to investigate the relationship between trunk and postural control and pulmonary function in subacute stroke patients. Herein, 32 volunteer patients who were diagnosed with hemiplegia by a competent physician after unilateral hemorrhagic or ischemic stroke and who met the inclusion criteria participated in the study. Functional independence of the participants was evaluated using the Modified Rankin Scale (mRS) and their cognitive function was assessed with the Standardized Mini Mental State Examination. Respiratory function was evaluated with spirometric measurements, inspiratory muscle strength was evaluated with intraoral pressure measurements, trunk control was evaluated using the Trunk Impairment Scale (TIS), postural control was evaluated using the Postural Assessment Scale for Stroke Patients (PASS-T), computerized postural sway evaluation, and static posture analysis. A significant correlation was found between the TIS scores and inspiratory muscle strength (p < 0.05). A significant correlation was also found between the PASS-T scores and inspiratory muscle strength and pulmonary function (p < 0.05). All of the COP parameters measured were significantly correlated with the PEF(L/s) and FEF25-75 (L/s) (p < 0.05). In conclusion, this study showed that trunk and postural control are associated with inspiratory muscle strength and pulmonary function. It is recommended that evaluation of trunk and postural control and respiratory functions, as well as exercise training to improve these parameters, should be included in rehabilitation programs for individuals with stroke.

Effects of attentional focus on quiet standing balance control in individuals with non-specific chronic low back pain.

Despite the widespread research about the effects of attentional focus on balance control in different populations, to the best of our knowledge, no study has yet investigated the effects of attentional focus instructions on balance control in individuals with chronic low back pain (CLBP). Therefore, this study was aimed to compare the effects of internal focus (IF) and external focus (EF) of attention on quiet standing balance control between individuals with CLBP and healthy controls. Twenty individuals with CLBP and 20 healthy controls were enrolled in this quasi-experimental study. The participants were asked to stand still with eyes open and eyes closed while performing three tasks: baseline standing with no focus instructions, internally focusing on their feet, and externally focusing on two markers were placed on the force platform. Statistical analyses showed a significant main effect of group for mean total velocity (p = 0.02), area (p = 0.01), and displacement in mediolateral (ML) direction (p = 0.003). Moreover, a significant main effect of vision was observed for mean total velocity (p < 0.001), area (p < 0.001), and displacement in anteroposterior (AP) (p < 0.001) and ML directions (p < 0.001). Also, the results revealed a significant main effect of attentional focus for mean total velocity (p < 0.001), area (p < 0.001), and displacement in AP (p < 0.001) and ML directions (p = 0.01). Our results showed that in both healthy controls and individuals with CLBP, EF led to improve quiet standing balance control compared to IF and control conditions. From a clinical perspective, it may be useful for physical therapists to consider the use of instruction cues that direct performer's attention away from the body for improving quiet standing balance control in individuals with CLBP.

Discriminative ability of instrumented cognitive-motor assessments to distinguish fallers from non-fallers.

In older populations, sensitive fall risk assessment tools are important to timely intervene and prevent falls. Instrumented assessments have shown to be superior to standardized fall risk assessments such as the Timed Up and Go Test (TUG) and should capture both motor and cognitive functions. Therefore, the aim was to test novel instrumented assessments with and without a cognitive component. One hundred thirty-seven older adults aged 73.1 ± 7.3 years, 38 categorized as fallers and 99 as non-fallers, conducted five instrumented assessments on the Dividat Senso, a pressure sensitive stepping platform, and three standardized geriatric assessments (TUG, TUG-dual task, 30-s Sit-to-Stand Test (STS)). T-tests were applied to compare the test performance of fallers versus non-fallers. Furthermore, logistic regression analyses and area under the curve (AUC) analyses were performed. Statistically significant differences between fallers and non-fallers were found in the Go/No-Go test (p = .001, d = .72), the TUG (p = .014, d = .48), and the STS (p = .008, d = .51). Only the Go/No-Go test contributed significantly to all regression models. Significant AUC values were found for the Reaction Time Test (RTT) (AUC = .628, p = .023), Go/No-Go (AUC = .673, p = .002), TUG (AUC = .642, p = .012), and STS (AUC = .690, p = .001). The Go/No-Go test measuring inhibition showed the best discriminative ability suggesting added value of instrumented assessments with a cognitive component for clinical fall risk assessment in relatively healthy older adults. The study should be extended with a frailer population, in which TUG and the other instrumented assessments are possibly good predictors as well.

Romberg's test revisited: Changes in classical and advanced sway metrics in patients with pure sensory neuropathy.

OBJECTIVES: The Romberg test, undoubtedly a classical and well-established method in physical neurological assessment of patients with sensory ataxia, has long been suspected to be prone to several limitations. Here, we quantified upright stance before and after visual deprivation in a selected cohort of patients with pure sensory neuropathy. METHODS: Static balance was assessed in sensory neuropathy patients during quiet stance on a force platform under different visual and proprioceptive feedback conditions. Sural nerve neurography was employed to evaluate the severity of peripheral neuropathy. Conventional and advanced postural sway metrics were investigated to draw a quantitative analogy to the clinical Romberg test. RESULTS: Posturographic analyses showed that patients displayed Romberg and vestibular Romberg quotient values around 2, indicating an approximately twofold increase in body sway in the absence of vision. However, the diagnostic discrimination ability between patients and controls was only modest. Even less impactful were the diagnostic contributions of frequency domain and non-linear sway analyses. This was primarily attributed to the heightened body sway exhibited by patients with sensory neuropathy under 'eyes open' conditions, diminishing the contrast with the 'eyes closed' condition as assessed in the classical Romberg test. CONCLUSION: We conclude that the Romberg test, even in its quantitative form with the aid of an apparatus, had an unsatisfactory classification value in terms of distinguishing patients from healthy controls. Instead, it should be interpreted within the comprehensive context of the broader neurological examination and the electrodiagnosis of peripheral nerve function.

How the brain can be trained to achieve an intermittent control strategy for stabilizing quiet stance by means of reinforcement learning.

The stabilization of human quiet stance is achieved by a combination of the intrinsic elastic properties of ankle muscles and an active closed-loop activation of the ankle muscles, driven by the delayed feedback of the ongoing sway angle and the corresponding angular velocity in a way of a delayed proportional (P) and derivative (D) feedback controller. It has been shown that the active component of the stabilization process is likely to operate in an intermittent manner rather than as a continuous controller: the switching policy is defined in the phase-plane, which is divided in dangerous and safe regions, separated by appropriate switching boundaries. When the state enters a dangerous region, the delayed PD control is activated, and it is switched off when it enters a safe region, leaving the system to evolve freely. In comparison with continuous feedback control, the intermittent mechanism is more robust and capable to better reproduce postural sway patterns in healthy people. However, the superior performance of the intermittent control paradigm as well as its biological plausibility, suggested by experimental evidence of the intermittent activation of the ankle muscles, leaves open the quest of a feasible learning process, by which the brain can identify the appropriate state-dependent switching policy and tune accordingly the P and D parameters. In this work, it is shown how such a goal can be achieved with a reinforcement motor learning paradigm, building upon the evidence that, in general, the basal ganglia are known to play a central role in reinforcement learning for action selection and, in particular, were found to be specifically involved in postural stabilization.

Heated environment increases blood pressure drop and postural sway during initial orthostasis in healthy subjects.

PURPOSE: We tested the hypothesis that heat stress influences the closed-loop cardio-postural control by an increased blood pressure (BP) drop and postural sway. METHODS: Fourteen healthy individuals (eight women) performed two orthostatic tests under thermal reference (TC; ~ 24 ºC) and HOT (~ 38 ºC) conditions. The center-of-pressure (COP) displacements and the electromyography (EMG) activity of the calf muscles (medial gastrocnemius and tibialis anterior) were recorded during the initial orthostasis (ORT onset) after the supine-to-stand challenge. At the same period, BP (beat-to-beat) was continuously monitored, and supine-to-stand variations (∆%) were calculated. Sublingual temperature (Tsl) was measured as a surrogate of internal temperature. RESULTS: Tsl increased in HOT compared to TC (TC 36.5 ± 0.3 vs. HOT 36.7 ± 0.3 ºC; p < 0.01). COP distance was greater in HOT compared to TC condition (TC 596.6 ± 242.4 vs. HOT 680.2 ± 249.1 mm; p < 0.01). EMG activity of the gastrocnemius decreased in HOT compared to TC condition (TC 95.5 ± 19.8 vs. HOT 78.4 ± 22.8%mV; p = 0.02). EMG of tibialis did not change between TC and HOT (TC 83.5 ± 42.9 vs. HOT 66.1 ± 31.9% mV; p = 0.29). BP showed a greater fall in HOT compared to TC condition (∆%TC - 24.5 ± 13.2 vs. ∆%HOT - 33.2 ± 20.2%; p = 0.01). CONCLUSION: Heat stress causes a greater fall in blood pressure and a reduction in musculoskeletal pump activity during orthostatic onset. These effects could be potential mechanisms that underlie augmented postural instability under a heated environment.

Effects of non-specific low back pain on static balance in emerging adults.

BACKGROUND: Postural control impairments in middle-aged or older people with chronic low back pain (CLBP) have been extensively documented. However, little is known about changes in postural control early in the disease process which may underlie compensatory movement strategies. OBJECTIVE: Our purpose was to quantify postural sway and sensory weighting in emerging adults with and without CLBP. METHODS: Nineteen emerging adults with CLBP (age = 18-26 years (21.11 ± 1.73)) and 19 matched peers without CLBP (18-27 years (22.20 ± 1.97)) participated in a cross-sectional study. Displacement of the center of mass during Quiet stance (QS), Tandem stance (TS), and Unilateral stance (US) on 2 surfaces (stable, unstable) were used to assess postural sway. Sensory Organization Test (SOT) was used to assess sensory weighting. RESULTS: Emerging adults with CLBP showed large, significant increases in postural sway during unstable TS (p ≤ .020). Participants with CLBP relied more on somatosensory input, as evidenced by lower equilibrium scores during conditions favoring visual (p = .020) or vestibular (p < .001) input during the SOT. CONCLUSION: Emerging adults with CLBP showed postural control impairments related to altered sensory weighting. These findings provide insights into the development of CLBP and its effects on postural control. This information may aid early identification, monitoring, and treatment of individuals in the initial stages of disease development who may have unrecognized postural impairments.

Effects of auditory noise intensity and color on the dynamics of upright stance.

Previous work assessing the effect of additive noise on the postural control system has found a positive effect of additive white noise on postural dynamics. This study covers two separate experiments that were run sequentially to better understand how the structure of the additive noise signal affects postural dynamics, while also furthering our knowledge of how the intensity of auditory stimulation of noise may elicit this phenomenon. Across the two experiments, we introduced three auditory noise stimulations of varying structure (white, pink, and brown noise). Experiment 1 presented the stimuli at 35 dB while Experiment 2 was presented at 75 dB. Our findings demonstrate a decrease in variability of the postural control system regardless of the structure of the noise signal presented, but only for high intensity auditory stimulation.

Feasibility Study of a Prototype Wearable Inertial Measurement Unit for Elderly Postural Sway Assessment.

Background: Falls are a major public health problem among older adults since they are a primary cause of injuries, functional decline and mortality. Identifying individuals susceptible to falls enables early intervention and prevention strategies. Currently, wearable sensors have emerged as a promising tool for assessing balance and mobility due to their affordability, compact size, and established efficacy. Therefore, the objective of the present study was to evaluate inertial measurement unit (IMU)-based postural sway metrics during quiet stance with four different bases of support and compare them among elderly individuals who are at risk of falling and those who are not. Methods: A triaxial IMU prototype was developed for evaluating postural sway during quiet stance, with various bases of support. Totally, 103 elderly participants with mean age of 68.5 ± 5.7 years were included. Sway metrics, including the root mean square (RMS) of magnitude, summation of range of signal (Range), summation of sway area (SA) and summation of distance (SD) were employed to detect sway perturbations. Results: All of the sway metrics revealed a significantly increasing magnitude of signal trajectory with a decreasing base of support. When comparing IMU sway metrics between groups of individuals at potential risk and non-risk of falls, statistically significant differences were observed in some variables, including RMS, Range, and SA during semi-tandem stance, and Range and SA during one-leg standing. Conclusions: The findings support earlier studies that demonstrated the objective nature of the IMU in assessing balance and predicting future risk of falls. Limited significant findings in this study may be due to the lower sampling rate of the IMU prototype (50 Hz) compared to commonly reported frequencies (100 Hz), as well as the inclusion of elderly ambulatory participants who were capable of being independent in their daily activities. The IMU is capable of providing comprehensive data, and detecting subtle changes, early signs of balance impairment and fall tendencies.

Sensory integration and segmental control of posture during pregnancy.

BACKGROUND: Approximately 25% of pregnant people fall, yet the underlying mechanisms of this increased fall-risk remain unclear. Prior studies examining pregnancy and balance have utilized center of pressure analyses and reported mixed results. The purpose of this study was to examine sensory and segmental contributions to postural control throughout pregnancy using accelerometer-based measures of sway. METHODS: Thirty pregnant people (first trimester: n = 10, second trimester: n = 10, third trimester: n = 10) and 10 healthy, nonpregnant control people stood quietly for one minute in four conditions: eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam pad, and eyes closed on foam. Postural sway was quantified using the root mean square accelerations in the anterior-posterior and medial-lateral directions from an inertial sensor at the lumbar region. Sensory sway ratios, segmental coherence and co-phase, were calculated to assess sensory contributions and segmental control, respectively. FINDINGS: Pregnant people did not display greater sway compared to healthy, nonpregnant controls. There were no group differences in vestibular, visual, or somatosensory sway ratios, and no significant differences in balance control strategies between pregnant and nonpregnant participants across sensory conditions. INTERPRETATION: The small effects observed here contrast prior studies and suggest larger, definitive studies are needed to assess the effect of pregnancy on postural control. This study serves as a preliminary exploration of pregnant sensory and segmental postural control and highlights the need for future to hone the role of balance in fall risk during pregnancy.

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.

How virtual reality is impacting balance: An examination of postural stability.

BACKGROUND: The interest in virtual reality (VR) applications has been on the rise in recent years. However, the impact of VR on postural stability remains unclear. RESEARCH QUESTION: The study has two primary objectives: first, to compare postural stability in a 3D-immersed virtual reality environment (VE) and a real environment (RE), and second, to investigate the effect of positive and negative visual feedback, which are subconditions of VE on postural stability. METHODS: The observational study recruited 20 healthy adults (10 male, 10 female, 22.8 ± 1.8 years) who underwent postural stability assessments in both RE and VE. In VE, participants received visual stimuli in three different ways: without visual feedback, with positive and negative visual feedback that they would consider themselves to be directed towards postural stability outcomes. The RE included two conditions: eyes open (EO) and eyes closed (EC). Postural stability was evaluated with sway velocity, sway area, and perimeter variables obtained from a force platform. RESULTS: All postural stability variables were significantly lower in the RE than in the VE (p < 0.05). There was no significant difference between the VE and EC in terms of sway velocity and sway area (p > 0.05). The visual feedback in the VE did not affect participants' postural stability (p > 0.05). VE may cause an increase in postural sway variables compared to RE and postural requirements may be higher in VE compared to RE. SIGNIFICANCE: This is the first and only study examining the effect of different visual feedback on postural stability in VE.

Sensory reweighting of postural control requires distinct rambling and trembling sway adaptations.

BACKGROUND: Implementation of the Sensory Organization Test (SOT) under the rambling-trembling (RM-TR) framework allows for an examination of both individual sensory contributions and compensatory mechanisms, a valuable insight in research and clinical settings. Such investigation could substantially improve our ability to assess and treat fall risk in older adults and people living with neurological disorders. RESEARCH QUESTION: How are RM and TR components of sway influenced by SOT-induced challenges in healthy adults? METHODS: Twenty-three healthy adults (27.4±8 years; 10 male) volunteered to participate in this cross-sectional study. Each participant completed a VR-based SOT program, which included six conditions with varied visual environments (normal, blacked-out, conflict) and support surfaces (stable, unstable foam), while a force plate captured forces at the plantar surface. Center of pressure (COP) was calculated and decomposed into RM-TR components. For each time series, range, root-mean-square (RMS) and sample entropy (SampEn) were extracted. Individual contributions of somatosensation, vision, and vestibular sense, as well as the preference ratio, were calculated. Repeated measures ANOVA were used to compare the effects of time series type (COP, RM, TR) and SOT condition. Paired t-tests were used to assess the difference in preference ratio between RM and TR components. RESULTS AND SIGNIFICANCE: TR sway behavior was impacted significantly by the sensory challenges induced by the SOT procedure, while RM was largely unaffected. Such findings are characteristic of healthy individuals, capable of competently re-weighting sensory input, but still facing challenge-based adaptations. Additionally, the mediolateral SampEn preference ratio was higher in TR compared to RM, indicating potential differences in compensation strategies between supraspinal and spinal/peripheral control mechanisms. These findings serve as a foundation for future RM-TR analyses using SOT procedures, aiding in our ability to implement targeted diagnostic and treatment methods, ultimately reducing the incidence of falls in aging and individuals with neurological conditions.

Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults.

Purpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.

The impacts of exercise training programs on balance in children with hearing loss: A systematic review and meta-analysis.

INTRODUCTION AND PURPOSE: According to the prevalence of balance disorders among children with hearing loss (HL), researchers used exercise programs to improve balance in children with HL. So, the present systematic review and meta-analysis briefly summarize findings regarding the impacts of exercise training programs on balance in children with HL. METHODS: Science Direct, MEDLINE/PubMed, SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar were searched from inception until November 11th, 2023. Two independent researchers analyzed and extracted the data from potential papers whose eligibility was confirmed. Then, the PEDro scale was used to obtain quality assessment scores. The total PEDro score is 11 and incorporates the presentation of statistical analysis and evaluation criteria of internal validity. Studies that scored 7-11 were considered methodologically "high", 5 to 6 were "fair", and ≤4 were considered "poor". RESULTS: 10 studies involving a total of 304 participations were included in the systematic review. Our results demonstrate that exercise training programs positively impact static balance (p = 0.001) with level 1a evidence, the postural sway (p = 0.001) with level 1a evidence, and dynamic balance (p = 0.001) with level 1a evidence in children with HL. CONCLUSION: The findings of this systematic review and meta-analysis related to studies with excellent methodological quality revealed that the intended training programs significantly impact postural sway along with static and dynamic balance in children with HL. It is recommended that future exercise training programs be paired with rehabilitation programs for children with HL.

Does an outdoor virtual environment projected in a head-mounted display affect balance in healthy young adults?

BACKGROUND: Virtual reality head-mounted display (VR-HMD) is increasingly used for balance evaluation and rehabilitation. However, more studies must be conducted on virtual environments (VE) effects. This study aimed to assess the impact of an outdoor VE projected in a high-quality VR-HMD and of the VR-HMD mass on postural stability, postural control and leaning. METHODS: This study involved ten healthy young men who performed five 30-s stabilometric trials. Four experimental conditions were randomly performed: eyes open (EO) or eyes closed (EC), with (VR) or without (No VR) VR-HMD. Postural stability (antero-posterior (AP) and medio-lateral (ML) ranges of the center of pressure (CoP), 90% confidence ellipse area), postural control (CoP velocity (global, AP and ML)) and standard deviation of the CoP mean position), and postural leaning (AP/ML CoP mean position) were assessed. The comparisons between EO VR and EO No VR were used to analyze the VE effects and comparisons between EC VR and EC No VR for the VR-HMD mass effects. RESULTS: Spatiotemporal parameters that characterised postural stability and postural control, except ML velocity (p > 0.05), were significantly influenced by the simulated VE with higher values in EO VR than EO No VR (p < 0.05), but not by the VR-HMD mass. The mean position of the CoP showed no significant differences between conditions. SIGNIFICANCE: Postural stability and postural control modification due to the VE used in this study revealed that this VE could be interesting for VR-HMD rehabilitation and assessment. VR-HMD is not a factor to be considered for stabilometric analysis.