Fear of heights shapes postural responses to vibration-induced balance perturbation at virtual height.

Introduction: Standing upright at height is a challenging situation involving intense threat of balance loss and fall. The ability to maintain balance in such conditions requires properly resolving sensory conflicts and is influenced by fear. To get more insight on the role of fear in balance control at height, we explored the dynamics of postural behavior in the situation of enhanced threat of potential balance loss. Methods: In 40 young individuals with varying fear of heights, we combined simulated exposure to height in a virtual reality environment with bilateral vibration of tibialis anterior muscles which evokes posture destabilization (the so-called vibration-induced falling). Results: Under such condition of enhanced postural threat, individuals with intense fear of heights showed stronger stiffening of posture compared with individuals with low fear of heights who react more flexibly and adaptively to posture destabilization. This group difference was evident already at ground level but further increased during virtual height exposure. Discussion: Our data show that fear of height significantly affects posture adaptation to balance-destabilizing events. Our findings demonstrate that the assessment of postural behavior during threatening situations in the virtual reality environment provides valuable insights into the mechanisms of balance control and may be used to develop novel strategies aimed at prevention of falls.

Age-Related Changes of the Anticipatory Postural Adjustments During Gait Initiation Preceded by Vibration of Lower Leg Muscles.

Gait initiation (GI) challenges the balance control system, especially in the elderly. To date, however, there is no consensus about the age effect on the anticipatory postural adjustments (APAs). There is also a lack of research on APAs in older adults after proprioceptive perturbation in the sagittal plane. This study aimed to compare the ability of young and older participants to generate APAs in response to the vibratory-induced perturbation delivered immediately before GI. Twenty-two young and 22 older adults performed a series of GI trials: (1) without previous vibration; (2) preceded by the vibration of triceps surae muscles; and (3) preceded by the vibration of tibialis anterior muscles. The APAs magnitude, velocity, time-to-peak, and duration were extracted from the center of pressure displacement in the sagittal plane. Young participants significantly modified their APAs during GI, whereas older adults did not markedly change their APAs when the body vertical was shifted neither backward nor forward. Significant age-related declines in APAs were observed also regardless of the altered proprioception.The results show that young adults actively responded to the altered proprioception from lower leg muscles and sensitively scaled APAs according to the actual position of the body verticality. Contrary, older adults were unable to adjust their postural responses indicating that the challenging transition from standing to walking probably requires higher reliance on the visual input. The understanding of age-related differences in APAs may help to design training programs for the elderly specifically targeted to improve balance control in different sensory conditions, particularly during gait initiation.

The Effects of Virtual Height Exposure on Postural Control and Psychophysiological Stress Are Moderated by Individual Height Intolerance.

Virtual reality (VR) enables individuals to be exposed to naturalistic environments in laboratory settings, offering new possibilities for research in human neuroscience and treatment of mental disorders. We used VR to study psychological, autonomic and postural reactions to heights in individuals with varying intensity of fear of heights. Study participants (N = 42) were immersed in a VR of an unprotected open-air elevator platform in an urban area, while standing on an unstable ground. Virtual elevation of the platform (up to 40 m above the ground level) elicited robust and reliable psychophysiological activation including increased distress, heart rate, and electrodermal activity, which was higher in individuals suffering from fear of heights. In these individuals, compared with individuals with low fear of heights, the VR height exposure resulted in higher velocity of postural movements as well as decreased low-frequency (<0.5 Hz) and increased high-frequency (>1 Hz) body sway oscillations. This indicates that individuals with strong fear of heights react to heights with maladaptive rigidity of posture due to increased weight of visual input for balance control, while the visual information is less reliable at heights. Our findings show that exposure to height in a naturalistic VR environment elicits a complex reaction involving correlated changes of the emotional state, autonomic activity, and postural balance, which are exaggerated in individuals with fear of heights.

Postural stability after treadmill and overground walking in young and elderly.

BACKGROUND: Ageing commonly disrupts the balance control and compensatory postural responses that contribute to maintaining balance and preventing falls during perturbation of posture. Improvement of compensatory postural responses during walking is one of the main goals in fall prevention programs which often include treadmill walking training. However, during treadmill walking, there is a sensory (visualsomatosensory and vestibular-somatosensory) conflict that can evoke aftereffects of self-motion sensation and could alter postural stability after training. RESEARCH QUESTION: The aim of this study was to compare the effect of overground and treadmill walking on postural stability in healthy young and elderly subjects. METHODS: Postural responses of 31 Young and 19 healthy Elderly before and after overground and treadmill walking were assessed by a force platform in four stance conditions: firm and foam surface with eyes open and eyes closed. RESULTS: In Elderly group, velocity parameters significantly increased after treadmill walking but not after overground walking. This increase was found particularly in the conditions with eyes open in both types of surfaces (firm, foam). The velocity parameters values (expect Vx) were significantly increased in Elderly compared to Young almost in all four conditions after treadmill and overground walking. SIGNIFICANCE: Our study suggests that Elderly become more unstable after treadmill walking and have greater difficulties to adapt to new balance circumstances caused by sensory conflict associated with treadmill walking. It seems that during treadmill walking and subsequent stance, vision is the major factor contributing to posture stabilization. Thus, the suitability of treadmill walking as a part of training programs for elderly adults with higher fall risk should be seriously considered.

Impairments in Postural Control and Retest Reliability of Dynamic Posturographic Measures After Lung Transplantation.

OBJECTIVES: The aims of the study were to classify impairments in postural control using computerized posturography in lung transplant recipients undergoing subacute rehabilitation and to examine the retest reliability of these measures. METHODS: In a prospective repeated-measures study, 50 lung transplant recipients underwent clinical and quantitative posturographic testing (SMART EquiTest), which included the sensory organization test, motor control test, and limits of stability test. Testing was repeated after 1 to 2 days and upon completion of rehabilitation, 2 mos later. Main outcome measures were the following: sensory organization test-composite score, motor control test-latency and amplitude scaling, limits of stability test-movement velocity, and endpoint excursion/maximum excursion. RESULTS: At the beginning of rehabilitation, the mean sensory organization test-composite score and limits of stability test, but not the motor control test scores, were below normative reference values and and did not return to normal after rehabilitation. Intraclass correlation coefficients(2,1) yielded excellent relative reliability for all posturographic tests. The smallest detectable differences observed for the sensory organization test and limits of stability test exceeded the mean changes observed upon completion of rehabilitation. CONCLUSIONS: Impairments in sensory and anticipatory postural control were insufficiently restored after subacute lung transplantation rehabilitation. The little sensitivity of the sensory organization test-composite score or limits of stability test scores to detect a minimal change in performance due to rehabilitation limits the clinical applicability of these tests as objective outcome measures in lung transplantation rehabilitation.

The differences between overground and treadmill walking in nonlinear, entropy-based and frequency variables derived from accelerometers in young and older women - preliminary report.

PURPOSE: The aim of this study was to compare gait stability and variability between walking conditions and age groups. METHODS: Twenty-six healthy younger and older females participated. Trunk acceleration in the vertical (V), medial-lateral (ML) and anteriorposterior (AP) directions during 5 minutes walking overground and 3 minutes walking on the treadmill at self-selected speed were recorded. Root mean square and standard deviations of acceleration, stride time and its variability, Lyapunov exponents (LE), multiscale entropy (MSE) and harmonic ratios (HR) were computed. RESULTS: Both age groups showed significantly higher stride time variability and short-term LE in all directions during overground walking. For the older group, overground walking showed higher V and AP standard deviation. Significantly lower values for overground walking were observed for long-term LE (V and ML for the younger group, ML for the older group), HR (ML for the older group) and MSE (V for the older group). Significant age-related differences were found for V long-term LE for overground walking. CONCLUSIONS: The present findings suggest that both linear and advanced computational techniques for gait stability and variability assessment in older adults are sensitive to walking conditions.

Parkinson's disease versus ageing: different postural responses to soleus muscle vibration.

BACKGROUND: Impairments of postural stability occur with increasing age and in neurodegenerative diseases like the Parkinson's disease (PD). While changes in balance have been described in many studies under steady-state conditions, less is known about the dynamic changes in balance following sudden transition to different sensory inputs. RESEARCH QUESTION: The aim was to clarify different effects of age and Parkinson's disease on dynamic postural responses immediately after lower leg muscle stimulation offset. Sudden removing of active sensory input represents a transient period in balance control. METHODS: Postural responses of 13 young, 13 healthy elderly and 13 PD patients to proprioceptive bilateral vibration of soleus muscles during stance were assessed by a force platform and two accelerometers attached on the upper and the lower trunk. The experimental protocol consisted of 2 conditions of soleus muscle vibration with 1) eyes open and 2) eyes closed randomly repeated four times. RESULTS: During vibration period before stimulus offset, postural responses were similar in elderly and PD patients. Contrary, immediately after vibration offset significantly larger backward amplitude of centre of foot pressure (CoP) displacement and trunk tilts were observed in PD patients compared to healthy peers. In returning to vertical position, peak-to-peak amplitudes, maximal velocity of CoP and trunk tilts significantly increased in PD patients. Without vision, their postural responses were more enhanced. The differences between young and elderly were found in most parameters in transient period after vibration offset and also during vibration. SIGNIFICANCE: The PD patients showed more unstable transient postural responses to selective sensory stimulation switch off, which may reflect impairment of sensory reweighting in balance control. Understanding how early stages PD patients differ in balance control from neurologically intact peers may help researchers and clinicians to refine their intervention and fall prevention programs.

Breathing changes accompanying balance improvement during biofeedback.

The aim of this study was to determine whether respiration would be altered during visual biofeedback condition while standing on a foam surface. Fifty young, healthy subjects (24 men, 26 women) were divided into a spirometry group, in which additional spirometry analysis was performed, and a control group. All subjects were tested in two conditions: 1) standing on a foam surface and 2) standing on a foam surface with visual biofeedback (VF) based on the centre of pressure (CoP). CoP amplitude and velocity in anterior-posterior (Aap, Vap) and medial-lateral (Aml, Vml) directions were measured by the force platform. Breathing movements were recorded by two pairs of 3D accelerometers attached on the upper chest (upper chest breathing - UCB) and the lower chest (lower chest breathing - LCB). Results showed that significant decreases of CoP amplitude and velocity in both directions were accompanied by a significant decrease of lower chest breathing, and an increase of LCB frequency was seen during VF condition compared to control condition in both groups. Moreover, a significant decrease in tidal volume and increased breathing frequency during VF condition were confirmed by spirometric analysis. Reduced breathing movements and volumes as well as increased breathing frequency are probably part of an involuntary strategy activated to maximize balance improvement during VF condition.