Center of pressure palindromes reveals a wobbling standing balance in scoliotic girls.

BACKGROUND: This study characterized the center of pressure planar displacement by palindromic strings. The objective is to test if the center of pressure pathway of able-bodied girls and those with a moderate and severe scoliosis displayed similar palindromic tendencies. METHODS: The center of pressure excursions of 21 able-bodied girls were compared to 14 girls with a moderate scoliosis and 14 girls with severe one. Each girl was asked to stand upright on a force platform for 64 s. A crisscross grid of nine areas was centered around the mean center of pressure position (G) to define three other zones to use the MATLAB built-in nucleotide sequence analysis function. These were the antero-posterior extremities A, the coronal extremities C and the tilted or the four corners of the crisscross grid, T. The center of pressure positions were associated to any of the 4 zones using the GATC acronym. FINDINGS: For all groups center of pressure pattern in decreasing order was A, G, T and C. Able-bodied girls favored the A zones. Girls with moderate scoliosis displaced their center of pressure mostly in the A zones with shifts in the T sections (P ≤ 0.001). Girls with severe scoliosis, additionally displaced their center of pressure in the C zones (P ≤ 0.001). INTERPRETATION: An ankle modality characterized able-bodied girl's standing balance. Girls with a moderate scoliosis privilege the palindromic zones in the antero-posterior extremities with excursions in the corners of the base of support, girls with severe scoliosis further relied on the medio-lateral zones, suggesting a wobbling standing balance.

IMU positioning affects range of motion measurement during squat motion analysis.

Inertial Measurement Units (IMUs) provides embedded and accessible (financially and technically speaking) motion analysis for sports or clinical applications (rehabilitation, therapy…). Despite being advertised for it ease of use, the very nature of IMU sensor makes it prone to errors which are usually corrected through calibration processes thus adding extra complexity for the users. The main goal of this study is to estimate the effect of sensor positioning on the thigh for a simple assessment of squat motion range of motion (ROM) as could be done in a pragmatic clinical approach (i.e., without prior calibration). Kinematics, squat counts and timing of three IMU sensors along the thigh were recorded during squat motion and compared to an optoelectronic reference system. Results showed concordance coefficients of the IMU system over 0.944 without the need for calibration with a preference for placement on the distal part of the segment regarding kinematics data.

Upper limb contribution during tandem gait in multiple sclerosis: An early marker of balance impairments.

Tandem gait is widely used during clinical exams to evaluate dynamic balance in chronic diseases, such as multiple sclerosis (MS). The early detection of balance impairments in MS is challenging to improve the understanding of patients' complaints. The objective was to propose two indexes to quantify the contributions and inefficiency of limb and trunk movements during tandem gait in early-stage MS patients. Fifteen patients with remitting-relapsed MS, with a median Expanded Disability Status Scale of 2.5 [0-4] were compared to 15 matched healthy participants. Three-dimensional motion analysis was performed during tandem gait to calculate spatiotemporal parameters, contribution and inefficiency indexes, based on the linear momentum of body segments. Compared to healthy participants, MS patients at the early stage of disease executed tandem gait with higher speed (p = 0.03) and increased step length (p = 0.03). The contribution indexes of upper limbs were significantly decreased during swing phase in MS patients. The inefficiency index for the upper limbs were around twice higher for MS patients compared to healthy participants. Since the additional movements concerned only light body segments and not contribute to the whole-body forward progression during tandem gait, they could reflected more both upper limb movements alterations and restoring movements to avoid loss of balance during tandem gait around swing phase in MS. These quantified indexes could be used as physical markers to quantify both the balance deterioration and the efficiency of rehabilitation program during the follow up of MS from the early stage of their disease.

Description and rules of a new card game to learn clinical reasoning in musculoskeletal physiotherapy.

Teaching hypothetico-deductive clinical reasoning (CR) should be an essential part of the physiotherapy education system, but currently there are very few learning tools for teachers in the musculoskeletal discipline. The aim of this article was to describe and present the rules of a new game-based and structured didactic tool that can be used by teachers for 'players' (students and licensed clinicians) to learn systematic CR in musculoskeletal physiotherapy.Our tool is based on the 'Happy Families' card game, and we propose to use it as part of a classic musculoskeletal subjective examination-based hypothesis category framework and the International Classification of Functioning, Disability and Health model. It allows players to dynamically formulate hypotheses from clinical case studies. Each 'Family' of cards represents a hypothesis category. The game highlights the missing information and trains players to consider it in their CR.This game should efficiently structure all components of CR and is an interesting resource for all teachers. Its greatest strength is that it can be used with other category frameworks. Further studies are needed to assess the efficacy and efficiency of such a tool and to measure students' actual progress in learning the CR.

A two-stage disto-proximal braking modality to interrupt gait initiation in healthy adults.

The purpose of this investigation was to determine the effect of unexpected gait termination in able-bodied participants during gait initiation on spatiotemporal and stance limb biomechanical parameters. Twenty-one healthy adults took part in this study and were divided into two groups based on the natural anterior or posterior incline of their trunk. Each participant performed 15 random trials of gait initiation: 10 trials with a Go signal and 5 with Go-&-Stop signals. Spatiotemporal parameters were assessed between the Go signal and the first heel contact. Ankle, knee, and hip joint moments were calculated in the sagittal plane. Free moment and impulse were also calculated for the stance limb. Spatiotemporal parameters were not influenced by the mean trunk inclination (p > 0.05), but participants with a forwardly-inclined trunk presented higher hip extension moments (p < 0.05). Unexpected stopping required smaller ankle and knee moments compared to the Go condition (p < 0.05). The hip extension moments appeared to be independent of gait initiation conditions (p > 0.05). The capacity of able-bodied people to interrupt their gait initiation relied on a two-stage disto-proximal braking modality involving explosive motor patterns at the ankle and hip joints. Such a pattern could be altered in vulnerable people, and further studies are needed to investigate this. This study determined a clinical method applicable as a functional protocol to assess and improve the postural control of people suffering from a lack of motor modulation during crucial transient tasks. Such tasks are essential in activities of daily living.

Simplified stance limb kinetics patterns revealed during gait initiation in early stage of multiple sclerosis.

BACKGROUND: Although patients with an early stage of Multiple Sclerosis (MS) commonly complain about balance and gait impairments, their troubles remain misunderstood. The objective was to compare body kinematics and lower limb kinetics during gait initiation between patients with MS with an EDSS score ≤ 4 and healthy participants. METHODS: Sixteen patients with MS with a median EDSS score of 2.5 [0-4] and disease duration of 7.4 ± 4.2 years, as well as 16 healthy participants were included, and 3-D motion analysis was performed during gait initiation to calculate spatiotemporal, kinematic and kinetic parameters. FINDINGS: The center of pressure position at the beginning of the gait initiation was more anterior (p = 0.02) in patients with MS than healthy participants. The kinetic parameters of the stance limb were highly affected in patients with MS compared to healthy participants during gait initiation. The net muscular moments for each joint were significantly different during the anticipatory postural adjustment phase with smoother variations for patients with MS compared to healthy participants. INTERPRETATION: Early stage MS strongly affects the motor modulation of stance limb kinetics during the anticipatory postural adjustment of gait initiation, without alteration of the execution phase. The net muscular moments are sensitive in detecting unobservable balance impairments and can be used to assess disease progression at the early stage. These results suggest that early rehabilitation programs aimed at improving motor modulation and flexibility in gait initiation should be implemented.

Is treadmill walking biomechanically comparable to overground walking? A systematic review.

BACKGROUND: The equivalency of treadmill and overground walking has been investigated in a large number of studies. However, no systematic review has been performed on this topic. RESEARCH QUESTION: The aim of this study was to compare the biomechanical, electromyographical and energy consumption outcomes of motorized treadmill and overground walking. METHODS: Five databases, ScienceDirect, SpringerLink, Web of Science, PubMed, and Scopus, were searched until January 13, 2021. Studies written in English comparing lower limb biomechanics, electromyography and energy consumption during treadmill and overground walking in healthy young adults (20-40 years) were included. RESULTS: Twenty-two studies (n = 409 participants) were included and evaluated via the Cochrane Collaboration's tool. These 22 studies showed that some kinematic (reduced pelvic ROM, maximum hip flexion angle for females, maximum knee flexion angle for males and cautious gait pattern), kinetic (sagittal plane joint moments: dorsiflexor moments, knee extensor moments and hip extensor moments and sagittal plane joint powers at the knee and hip joints, peak backwards, lateral and medial COP velocities and propulsive forces during late stance) and electromyographic (lower limbs muscles activities) outcome measures were significantly different for motorized treadmill and overground walking. SIGNIFICANCE: Spatiotemporal, kinematic, kinetic, electromyographic and energy consumption outcome measures were largely comparable for motorized treadmill and overground walking. However, the differences in kinematic, kinetic and electromyographic parameters should be taken into consideration by clinicians, trainers, and researchers when working on new protocols related to patient rehabilitation, fitness rooms or research as to be as close as possible to the outcome measures of overground walking. The protocol registration number is CRD42021236335 (PROSPERO International Prospective Register of Systematic Reviews).

Untreated adolescent idiopathic scoliotic girls display altered balance modalities during self-paced voluntary body sways compared to able-bodied girls.

INTRODUCTION: This study investigated self-paced voluntary oscillations of scoliotic and non-scoliotic girls. Temporal variables and frequency coherence were calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment to identify which variables best describe sway balance modalities in both groups. METHODS: Twenty-three girls with adolescent idiopathic moderate scoliosis (spinal curves to the right) formed the scoliotic group and 19 matched able-bodied girls formed the non-scoliotic group. Each girl performed self-paced voluntary medio-lateral and antero-posterior sways while standing on a force platform. Center of pressure displacements, out of plane deviation and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. RESULTS: In both sway conditions, the center of pressure excursion parameters were on average 28% higher for the scoliotic group. Factor analysis revealed that balance modalities were essentially based on frequency coherence pair interactions whereas temporal parameters play a secondary role. However, these balance modalities were altered in the scoliotic group. They relied essentially on 2 additional principal components and 3 additional variables reflecting a fine tuning of the control mechanism to maintain dynamic balance. INTERPRETATION: Scoliotic girls appear to be performing a wide ellipsoidal trajectory when performing whole body oscillations. Superfluous variables could be related to the difficulty in preserving balance during body sway tasks and could parasitize the scoliotic dynamic control balance modalities. Self-paced voluntary sways could be an appropriate complementary balance test for untreated scoliotic girls.

Standing posture and balance modalities in unilateral transfemoral and transtibial amputees.

INTRODUCTION: Lower limb amputation impairs postural performance that could be characterized by biomechanical parameters. This study is to investigate postural performance of persons with transfemoral and transtibial amputation compared to controls without amputation. METHODS: Eight transtibial, nine transfemoral and twelve able-bodied males participated in this study. Lower limb joints, pelvis and trunk angles were obtained from an optoelectronic motion analysis system to evaluate body posture parameters. The mean, range and speed of the center of pressure (CoP) in both antero-posterior and medio-lateral axes as well as the ellipse area covered by 90% of CoP and free moment were calculated using a single force-plate. RESULTS AND DISCUSSION: Differences in body posture were only noted between the non-amputee and the transtibial groups. Transtibial amputees leaned more forwardly their trunk by 3.5° compared to able-bodied (p = 0.028). The mean CoP position in transfemoral amputees was closer to the non-amputated side than transtibial amputees (p = 0.034) and as compared to the dominant side in non-amputees (p = 0.042). Factor analysis revealed three postural performance modalities. Non-amputees postural performance was characterized solely by body posture parameters. Transfemoral amputees exclusively favored a modality associated with standing balance parameters, whereas transtibial amputees exhibited a mixed modality comprising a combination of postural and balance parameters. CONCLUSION: These findings support that the level of amputation is characterized by postural performance modalities different from non-amputees. Clinicians could apply this knowledge as part of their routine rehabilitation program to enhance postural and standing balance assessments in unilateral transfemoral and transtibial amputees.

Anti-pronator components are essential to effectively alter lower-limb kinematics and kinetics in individuals with flexible flatfeet.

BACKGROUND: Foot orthoses are commonly used to correct for foot alterations and especially address excessive foot pronation in individuals with flatfeet. In recent years, 3D printing has taken a key place in orthotic manufacturing processes as it offers more options and can be patient specific. Hence, the purpose of this study was to evaluate whether stiffness of 3D printed foot orthoses and a newly designed rearfoot posting have an effect on lower limb kinematics and kinetics in individuals with flatfeet. METHODS: Nineteen patients with flexible flatfeet were provided two pairs of customized 3D printed ¾ length orthotics. Foot orthoses were of different stiffness and could feature a rearfoot posting, consisting of 2-mm carbon fiber plate. Lower limb kinematics and kinetics were computed using a multi-segment foot model. One-way ANOVAs using statistical non-parametric mapping, refined by effect sizes, were performed to determine the magnitude of the effect between conditions. FINDINGS: Foot orthoses stiffness had little effect on midfoot and forefoot biomechanics. Reductions in midfoot eversion and forefoot abduction were observed during short periods of stance with rigid foot orthoses. Adding the posting had notable effects on rearfoot kinematics and on the ankle and knee kinetics in the frontal plane; it significantly reduced the eversion angle and inversion moment at the ankle, and increased the knee abduction moment. INTERPRETATION: Using an anti-pronator component is more effective than increasing foot orthoses stiffness to observe a beneficial impact of foot orthoses on the control of excessive foot pronation in individuals with flatfeet.

Ankle dysfunction in multiple sclerosis and the effects on walking.

PURPOSE: Even in the early stage of the disease, for patients suffering from multiple sclerosis (MS), the most common and reported biomechanical alterations in the lower limb are located at the ankle joint. However, the effects of these impairments on gait deterioration should be discussed. MATERIALS AND METHODS: This review was written according to the PRISMA guidelines. The search focussed on biomechanical changes (kinetic, kinematic, and electromyographic data) at the ankle during gait in MS patients. The search was performed in the databases: Pubmed, Web of Science, and Cochrane Library. RESULTS: Eleven studies were included. The reduction in the ankle range of motion (RoM) induced by increased cocontractions of the tibialis anterior and triceps surae muscles could be a compensatory strategy to improve body-weight support and balance during the stance phase. CONCLUSIONS: Future rehabilitation programmes should consider the control of weight support at the ankle during gait training.Implications for rehabilitationThe ankle supports and stabilises the body during the stance phase of gait.The reduced ankle range of motion in multiple sclerosis (MS), even at an early stage of the disease, is due to cocontractions of tibialis anterior and triceps surae and could be a compensatory strategy to be more stable.Rehabilitation programmes for MS patients should focus on the control of body segments motion during the weight transfer above the ankle.

Contribution of Achilles tendon mechanical properties to torque steadiness in persons with transfemoral amputation.

BACKGROUND: How Achilles tendon mechanics and plantar flexion strength and torque steadiness are altered in the intact leg of persons with trauma-related amputation is unknown. Understanding Achilles tendon mechanics following amputation will further inform rehabilitation approaches to enhance posture, balance, and force control. OBJECTIVE: Conduct a pilot study to quantify plantar flexion maximal voluntary contraction torque, torque steadiness, and Achilles tendon mechanics in persons with unilateral trauma-related transfemoral amputation and controls without amputation. STUDY DESIGN: Cross-sectional study. METHODS: Isometric plantar flexion maximal voluntary contractions were performed with the intact leg of ten males with transfemoral amputation (48 ± 14 years) and the dominant leg of age-matched male controls without amputation. Torque steadiness was calculated as the coefficient of variation in torque over 6 s during submaximal tracking tasks (5%, 10%, 25%, 50%, and 75% maximal voluntary contraction). Achilles tendon elongation and cross-sectional area were recorded with ultrasound to calculate strain, stress, and stiffness. RESULTS: Maximal voluntary contraction and torque steadiness did not differ between persons with amputation (90.6 ± 31.6 N m, 3.7 ± 2.0%) and controls (95.8 ± 26.8 N m, 2.9 ± 1.2%; p > 0.05). Tendon stiffness (21.1 ± 18.2 N/mm) and strain (5.2 ± 1.3%) did not differ between groups (p > 0.05). Tendon cross-sectional area was 10% greater in persons with amputation leading to 29% lower stress (p = 0.021). Maximal voluntary contraction was a predictor of a lower coefficient of variation in torque (R2 = 0.11, p < 0.05). CONCLUSION: Persons with trauma-related transfemoral amputation do not differ in plantar flexion maximal voluntary contraction and torque steadiness of the intact leg compared with controls without amputation. Larger tendon cross-sectional area reduces stress and enables distribution of force across a greater area.

Effect of 3D printed foot orthoses stiffness and design on foot kinematics and plantar pressures in healthy people.

BACKGROUND: Foot orthoses (FOs) have been widely prescribed to alter various lower limb disorders. FOs' geometrical design and material properties have been shown to influence their impact on foot biomechanics. New technologies such as 3D printing provide the potential to produce custom shapes and add functionalities to FOs by adding extra-components. RESEARCH QUESTION: The purpose of this study was to determine the effect of 3D printed FOs stiffness and newly design postings on foot kinematics and plantar pressures in healthy people. METHODS: Two pairs of ¾ length prefabricated 3D printed FOs were administered to 15 healthy participants with normal foot posture. FOs were of different stiffness and were designed so that extra-components, innovative flat postings, could be inserted at the rearfoot. In-shoe multi-segment foot kinematics as well as plantar pressures were recorded while participants walked on a treadmill. One-way ANOVAs using statistical non-parametric mapping were performed to estimate the effect of FOs stiffness and then the addition of postings during the stance phase of walking. RESULTS: Increasing FOs stiffness altered frontal and transverse plane foot kinematics, especially by further reducing rearfoot eversion and increasing the rearfoot abduction. Postings had notable effect on rearfoot frontal plane kinematics, by enhancing FOs effect. Looking at plantar pressures, wearing FOs was associated with a shift of the loads from the rearfoot to the midfoot region. Higher peak pressures under the rearfoot and midfoot (up to +31.7 %) were also observed when increasing the stiffness of the FOs. SIGNIFICANCE: 3D printing techniques offer a wide range of possibilities in terms of material properties and design, providing clinicians the opportunity to administer FOs that could be modulated according to pathologies as well as during the treatment by adding extra-components. Further studies including people presenting musculoskeletal disorders are required.

Less Than One Millimeter Under the Great Toe is Enough to Change Balance Ability in Elite Women Handball Players.

Team handball is a complex intermittent sport game, which requires several motor abilities and effective postural control. Objective evaluation of stabilometric variables may be interesting to assess and improve functional parameters by postural control management. The purpose of the study was to evaluate the effects of a small additional thickness placed under the great toe (TUGT) on the Centre of Pressure (CoP) parameters in elite women handball players. Fourteen elite women handball players voluntarily participated in this study. Two conditions were compared: TUGT 0 (control) and TUGT 0.8 mm; four variables were computed from the CoP displacements. A paired T-test was performed for each variable. This study concludes that a low focal additional thickness placed under both great toes has an effect on the CoP measures used to assess postural control during an unperturbed stance. These results suggest that a low TUGT could contribute to a change in balance ability, and may be of clinical interest. This brings new perspectives in the management of athletes to prevent injury risk and optimize performance.

Frequency coherence analysis of postural balance in able-bodied and in non-treated adolescent idiopathic scoliotic girls.

BACKGROUND: This study test if the frequency coherence calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment calculated during standing balance are similar between scoliotic and non-scoliotic girls and if the coherence values within each frequency band are comparable for a given group of girls. METHODS: Twenty-nine girls with adolescent idiopathic scoliosis formed the scoliotic group and 22 able-bodied girls formed the non-scoliotic group. Each girl maintained a quiet upright stance on a force plate. Three trials were performed at a sampling frequency of 64 Hz for 64 s. Mean anterio-posterior, medio-lateral center of pressure positions and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. RESULTS: The magnitude of the medio-lateral center of pressure/free-moment coherence in the low and high frequency bands was significantly different between the groups. Within each group, the magnitude of the medio-lateral center of pressure/free-moment coherence was significantly higher than the other two coherence pairs at low frequencies (P < 0.001). Factor analysis revealed that able-bodied girls exhibited a mixed standing balance modality consisting of posture (center of pressure) and proprioceptive information (free-moment). Scoliotic girls adopted an adaptive modality mostly based on proprioception information to maintain their standing balance. INTERPRETATION: Scoliotic girls systematically depend on the free-moment to modulate their antero-posterior center of pressure displacements. These results suggest a postural reeducation program aimed at improving proprioception while repositioning the mean center of pressure by postural corrections.

How can the stimulation of plantar cutaneous receptors improve postural control? Review and clinical commentary.

Postural control requires constant and subconscious postural sway to manage balance and achieve postural stability. These movements of regulation are based in particular on cutaneous plantar information. The foot constitutes a functional whole that participates in the mechanisms of postural control and regulation. It represents the direct interface between the body and the ground during quiet standing, and plantar cutaneous information contributes to postural control. Upright balance mechanically depends on the gravitational torque produced by the forces of gravity and reaction of the ground. In this context, the foot behaves like a sensory system for postural regulation whose objective is to maintain a state of stability within a changing and constraining environment. There is a relation between balance improvement and the facilitation of sensory feedback related to the activation of the plantar cutaneous mechanoreceptors. From a clinical point of view, the application of additional tactile cues may have therapeutic benefits in relation to fall prevention, or to improve specific types of chronic pain.

Does Unilateral Lower Limb Amputation Influence Ankle Joint Torque in the Intact Leg?

OBJECTIVE: To investigate ankle torque and steadiness in the intact leg of transtibial and transfemoral unilateral amputees. DESIGN: Comparative study. SETTING: Medical rehabilitation centers. PARTICIPANTS: Fifteen persons with a unilateral transfemoral amputation, 8 persons with a transtibial amputation, and 14 able-bodied male participants volunteered to participate in this study (N=37). INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Maximal isometric torque performed during ankle plantarflexion and dorsiflexion in the intact limb of amputees and in the dominant limb of able-bodied persons. The coefficient of variation (CV) of the plantarflexion torque was calculated over 5 seconds during a submaximal isometric contraction (15%) in order to assess torque steadiness. Furthermore, electromyographic activity (the root mean square amplitude) of the gastrocnemius medialis and tibialis anterior muscles was analyzed. RESULTS: Plantarflexion maximal torque was significantly higher for the able-bodied group (115±39 Nm) than for the group with a transfemoral amputation (77±34 Nm) (P<.01), and did not differ between able-bodied group and the group with a transtibial amputation (97±26 Nm) (P=.25). Furthermore, the transfemoral amputee group was 29% less steady than the able-bodied group (P=.01). However, there were no significant differences in torque steadiness between the able-bodied group and transtibial amputee group (P=.26) or between transtibial and transfemoral amputee groups (P=.27). The amputation had no significant effect between groups on dorsiflexion maximal torque (P=.10), gastrocnemius medialis electromyography (EMG) (P=.85), tibialis anterior coactivation (P=.95), and coactivation ratio (P=.75). CONCLUSION: The present study suggests that as the level of amputation progresses from below the knee to above the knee, the effect on the intact ankle is progressively more negative.

Low additional thickness under the toes could change upright balance of healthy subjects.

The purpose of the study was to evaluate the effect of an additional thickness placed under the toes (TUT) on the CoP measures and to determine the optimum thickness required to maximize the postural control performance. Four conditions were compared: TUT 0 (control), 0.8, 3, and 6mm and four variables were computed from the CoP displacements. These results suggest that the lowest TUT could contribute to changing balance control, and may have clinical interest. This brings perspectives in the management of patients with risk of falling or with chronic pain syndromes, complementing validated therapeutic strategies.

Effect of natural sagittal trunk lean on standing balance in untreated scoliotic girls.

BACKGROUND: Generally, scoliotic girls have a tendency to lean further back than a comparable group of non-scoliotic girls. To date, no study has addressed how standing balance in untreated scoliotic girls is affected by a natural backwardly or forwardly inclined trunk. METHODS: 27 able-bodied young girls and 27 young girls with a right thoracic curve were classified as leaning forward or backward according to the median of their trunk sagittal inclination. Participants stood upright barefoot. Trunk and pelvis orientations were calculated from 8 bony landmarks. Upright standing balance was assessed by 9 parameters calculated from the excursion of the center of pressure and the free moment. FINDINGS: In the anterior-posterior direction, backward scoliotic girls had a greater center of pressure range (P=0.036) and speed (P=0.015) by 10.4mm and 2.8mm/s respectively than the forward scoliotic group. Compared to their matching non-scoliotic group, the backward scoliotic girls stood more on their heels by 14.6mm (P=0.017) and display greater center of pressure speed by 2.5mm/s (P=0.028). Medio-lateral center of pressure range (P=0.018) and speed (P=0.008) were statistically higher by 8.7mm and 3.6mm/s for the backward group. Only the free moment RMS was significantly larger (P=0.045) for the backward scoliotic group when compared to the forwardly inclined scoliotic group. INTERPRETATION: Only those with a backward lean displayed statistically significant differences from both forward scoliotic girls and non-scoliotic girls. Untreated scoliotic girls with an exaggerated back extension could profit more from postural rehabilitation to improve their standing balance.