Walking on a Balance Beam as a New Measure of Dynamic Balance to Predict Falls in Older Adults and Patients with Neurological Conditions.

BACKGROUND: Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months. METHODS: Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20-60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery. RESULTS: Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy. CONCLUSION: Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.

Effects of the Anchor System on Postural Balance of Women Undergoing Breast Cancer Treatment: A Clinical, Randomized, Controlled, and Crossover Trial.

OBJECTIVE: Investigate the effects of multisensory training with and without the anchor system on breast cancer survivors' postural balance and self-efficacy of falls. DESIGN: Clinical randomized, controlled, and crossover trial. SETTING: Teaching, Research, and Assistance Center in Mastectomized Rehabilitation. PARTICIPANTS: Eighty breast cancer survivors homogeneously distributed in the groups of adults and elderly affected, or not, by lymphedema. INTERVENTIONS: Participants were randomized to multisensory training with and without the anchor system involving 3 sessions per week for 12 weeks. After the 4-week washout period, the remaining therapeutic intervention was applied. MAIN OUTCOME MEASURES: The primary outcome was semi-static and dynamic balance as evaluated by baropodometry and Mini Balance Evaluation Systems Test, and the secondary outcome was self-efficacy of the fall episode as assessed by Falls Efficacy Scale - International in the pre-, post-immediate, and 4-week follow-up period. RESULTS: Both therapeutic interventions caused positive and significant effects on postural balance and self-efficacy of falls in the immediate period. The multisensory training with the anchor system induced significant functional retention in the short term, related to the clinical effect of small to moderate variation. CONCLUSIONS: Multisensory training with the anchor system is convenient for postural balance and self-efficacy for falls, regardless of age and upper limb volume, for breast cancer survivors.

Postural Stability When Grasping an Object While Standing: Younger and Older Adults (Fallers and Non-Fallers).

We investigated postural stability through the margin of stability (MoS) while reaching and grasping an object with increasing difficulty levels in younger, fallers and non-fallers. Forty-five individuals distributed into three groups participated in this study: younger adults (YA), non-fallers (OA), and fallers (FOA). They stood upright and reached and grasped a dowel. Six conditions combining the stability of the dowel's base and obstacles close to the dowel were manipulated to characterize different difficulty levels. We computed the MoS in both anterior-posterior (AP) and medial-lateral (ML) directions in the interval between reaching onset and dowel contact. From the MoS time series, we analyzed the minimum and maximum, including the time of occurrence of these events. The MoS was smaller for OA than for YA in both directions. In the ML direction, the minimum MoS was smaller for FOA than for YA. The minimum MoS took place earlier for FOA than YA in the AP direction. FOA and OA exhibited similar behavior with reduced MoS, suggesting impaired postural control during reaching-to-grasping in a standing posture. FOA used a more cautious strategy by reverting the MoS earlier than YA, allowing them to increase their MoS before YA when preparing to grasp the dowel.

Viability of Collagen Matrix Grafts Associated with Nanohydroxyapatite and Elastin in Bone Repair in the Experimental Condition of Ovariectomy.

Bone lesions have the capacity for regeneration under normal conditions of the bone metabolism process. However, due to the increasing incidence of major traumas and diseases that cause bone-mineral deficiency, such as osteoporosis, scaffolds are needed that can assist in the bone regeneration process. Currently, natural polymeric scaffolds and bioactive nanoparticles stand out. Therefore, the objective of the study was to evaluate the osteoregenerative potential in tibiae of healthy and ovariectomized rats using mineralized collagen and nanohydroxyapatite (nHA) scaffolds associated with elastin. The in-vivo experimental study was performed with 60 20-week-old Wistar rats, distributed into non-ovariectomized (NO) and ovariectomized (O) groups, as follows: Controls (G1-NO-C and G4-O-C); Collagen with nHA scaffold (G2-NO-MSH and G5-O-MSH); and Collagen with nHA and elastin scaffold (G3-NO-MSHC and G6-O-MSHC). The animals were euthanized 6 weeks after surgery and the samples were analyzed by macroscopy, radiology, and histomorphometry. ANOVA and Tukey tests were performed with a 95% CI and a significance index of p < 0.05. In the histological analyses, it was possible to observe new bone formed with an organized and compact morphology that was rich in osteocytes and with maturity characteristics. This is compatible with osteoconductivity in both matrices (MSH and MSHC) in rats with normal conditions of bone metabolism and with gonadal deficiency. Furthermore, they demonstrated superior osteogenic potential when compared to control groups. There was no significant difference in the rate of new bone formation between the scaffolds. Ovariectomy did not exacerbate the immune response but negatively influenced the bone-defect repair process.

Monitoring Training Loads in Judo Athletes: Different Time Courses of Physiological, Neuromuscular, and Perceptual Responses.

This study aims to elucidate the internal load, performance, physiological, and perceptual recovery responses during four weeks of traditional judo training. Ten cadet and junior judo athletes were evaluated daily for four weeks, in which their perception of recovery, heart rate variability, handgrip strength, and countermovement jump performance were assessed. A one-way repeated-measures ANOVA was performed to analyze the variables across the weeks. A significant time effect in internal load (F = 6.51; p = 0.001) has been observed. Handgrip test performance showed significantly higher values in the 3rd and 4th weeks (p <0.001), while countermovement jump performance was significantly higher in the 4th week (p =0.0007). The heart rate variability's coefficient of variation was lower in both the 3rd and 4th weeks (p =0.02). Regarding perceptual aspects, the Hooper Index showed a significant time effect (p =0.04), but pairwise comparison did not reveal differences between weeks. The present study indicates that neuromuscular, physiological, and perceptual responses to training load alterations present different time courses. This must be considered for the adequate monitoring of training programs.

One-year changes in clinical and balance parameters in individuals of different subtypes of migraine.

BACKGROUND: Migraine has been associated with balance dysfunction, more pronounced in patients with aura and chronic migraine. Also, it has been suggested that balance deficits are progressive through the migraineurs lifetime. OBJECTIVE: To analyze the one-year progression of balance parameters and clinical parameters associated with balance in female patients with and without migraine. DESIGN: Prospective cohort study. METHODS: The participants were distributed in four groups: control (CG; n = 27) migraine with aura (MA; n = 25), migraine without aura (MwA; n = 26), and chronic migraine (CM; n = 27). They performed the Sensory Organization Test, Motor Control Test and Adaptation Test protocols of dynamic posturography tests. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. These assessments were performed twice: baseline and after 1-year (follow-up). No intervention was performed for balance improvement, and the participants maintained their usual migraine treatment prescribed. RESULTS: None of the groups differed in balance tests between baseline and follow-up. We observed a reduction in migraine frequency in MA (-2.2 days, p = 0.01) and CM (-10.8 days, p < 0.001) groups, and in the migraine intensity (-2.3 points, p = 0.001) in CM group. Significant decreases in the scores of fear of falling, dizziness disability, and kinesiophobia were observed in the migraine groups (p < 0.05), but the differences did not exceed the minimal detectable change of the questionaries scores. CONCLUSION: Women with different migraine subtypes did not present balance changes in a one-year interval. The improvements in migraine's clinical features were not accompanied by improvements in balance parameters.

Multicomponent and mat Pilates training increased gait speed in individuals with Parkinson's disease when walking and carrying a load: A single-blinded randomized controlled trial.

BACKGROUND AND PURPOSE: Gait disorders in individuals with Parkinson's disease (IwPD) are among the most disabling symptoms. Physical exercise has been proposed for the treatment of IwPD because it shows positive effects on gait variables. Given the importance of physical activity in the rehabilitation process of IwPD, the assessment of interventions to identify those most promising for improving or maintaining gait performance is of great relevance. Therefore, this study evaluated the effects of Mat Pilates Training (MPT) and Multicomponent Training (MCT) on the spatiotemporal variables of gait in situations of daily dual-task performance in IwPD. Gait analysis in a daily dual-task context allows the simulation of real-life conditions where individuals have a higher risk of falling than in single-task walking. METHODS: We conducted a single-blinded randomized controlled trial with 34 mild-to-moderate IwPD (Hoehn-Yahr stage 1-2). They were randomized to one of two interventions: MPT or MCT. All participants performed the training for 60 min, three times per week, for 20 weeks. Spatiotemporal gait variables were evaluated in a daily life situation to increase the ecological validity of the measurements, which included gait speed, stride time, double support time, swing time, and cadence. The individuals walked on a platform holding two bags with a load corresponding to 10% of their body mass. RESULTS: After the intervention, there was a significant improvement in gait speed in both groups: MPT (p = 0.047) and MCT (p = 0.015). The MPT group reduced the cadence (p = 0.005) and the MCT group increased the stride length (p = 0.026) after the intervention. DISCUSSION: Both groups had positive effects on gait speed with load transport resulting from the two proposed interventions. However, the MPT group showed a spatiotemporal adjustment of speed and cadence that can increase gait stability, which was not found in the MCT group.

Age, Cognitive Task, and Arm Position Differently Affect Muscle Synergy Recruitment but have Similar Effects on Walking Balance.

Age modifies walking balance and neuromuscular control. Cognitive and postural constraints can increase walking balance difficulty and magnify age-related differences. However, how such challenges affect neuromuscular control remains unknown. We determined the effects of age, cognitive task, and arm position on neuromuscular control of walking balance. Young (YA) and older adults (OA) walked on a 6-cm wide beam with and without arm crossing and a cognitive task. Walking balance was quantified by the distance walked on the beam. We also computed step speed, margin of stability, and cognitive errors. Neuromuscular control was determined through muscle synergies extracted from 13 right leg and trunk muscles. We analyzed neuromuscular complexity by the number of synergies and the variance accounted for by the first synergy, coactivity by the number of significantly active muscles in each synergy, and efficiency by the sum of the activation of each significantly active muscle in each synergy. OA vs. YA walked a 14% shorter distance, made 12 times more cognitive errors, and showed less complex and efficient neuromuscular control. Cognitive task reduced walking balance mainly in OA. Decreases in step speed and margin of stability, along with increased muscle synergy coactivity and reduced efficiency were observed in both age groups. Arm-crossing also reduced walking balance mostly in OA, but step speed decreased mainly in YA, in whom the margin of stability increased. Arm-crossing reduced the complexity of synergies. Age, cognitive task, and arm position affect differently muscle synergy recruitment but have similar effects on walking balance.

Effect of the haptic anchors during balancing and walking tasks in older adults: A systematic review.

BACKGROUND: Older adults are benefited from the continuous tactile information to enhance postural control. Therefore, the aim was to evaluate the effect of the haptic anchors during balancing and walking tasks in older adults. METHODS: The search strategy (up to January 2023) was based on the PICOT (older adults; anchor system during balance and walking tasks; any control group; postural control measurements; short and/or long-term effect). Two pairs of reviewers independently examined all titles and abstracts for eligibility. The reviewers independently extracted data from the included studies, assessed the risk of bias, and certainty of the evidence. RESULTS: Six studies were included in the qualitative synthesis. All studies used a 125-g haptic anchor system. Four studies used anchors when standing in a semi-tandem position, two in tandem walking on different surfaces, and one in an upright position after plantar flexor muscle fatigue. Two studies showed that the anchor system reduced body sway. One study showed that the ellipse area was significantly lower for the 50% group (reduced frequency) in the post-practice phase. One study showed that the reduction in the ellipse area was independent of the fatigue condition. Two studies observed reduced trunk acceleration in the frontal plane during tandem waking tasks. The studies had low to moderate certainty of evidence. CONCLUSION: Haptic anchors can reduce postural sway during balance and walking tasks in older adults. Also, positive effects were seen during the delayed post-practice phase after the removal of anchors only in individuals who used a reduced anchor frequency.

The effects of age and postural constraints on prehension.

Older adults adapt the execution of complex motor tasks to use compensatory strategies in the reaching-to-grasping (i.e., prehension) movement. The presence of postural constraints may exacerbate these compensatory strategies. Therefore, we investigated the reach-to-grasp action with different postural constraints (sitting, standing, and walking) in younger and older people and evaluated the postural stability during the reach-to-grasp action. Thirty individuals (15 younger and 15 older adults) performed the prehension under three postural tasks: sitting, standing, and walking. The reaching movement was slower in the walking task than in the other two postural tasks; however, there was no difference between the age groups. For the grasping action, the older adults presented a larger grip aperture, and the peak grip aperture occurred earlier during hand transportation in sitting and standing tasks. In the standing task, the margin of stability was smaller for older adults. In the walking task, there was no difference between the groups for the margin of stability. Also, prehension during sitting and standing tasks were similar, and both differed from walking across age groups. Finally, older adults reduced their margin of stability compared to younger adults, but only in the standing task. The margin of stability was similar between age groups during the walking task. We concluded that age affected grasping (distal component) but not reaching (proximal component), suggesting that healthy older adults have more difficulty controlling distal than proximal body segments.

Occlusion of the lower visual field when wearing a facial mask does not compromise gait control when stepping into a hole in older adults.

Visual exproprioception obtained from the lower visual field (LVF) is used to control locomotion on uneven terrain. Wearing a facial mask obstructs the LVF and can compromise gait control. Therefore, this study aimed to investigate the effect of occluding the LVF when wearing a facial mask on gait control while walking and stepping into a hole in older adults. Fifteen older adults walked along a wooden walkway under two different surface conditions (without and with a hole [60 cm wide and long, with a depth of 9.5 cm] and three visual conditions (control, mask, and basketball goggles with an occluded LVF). We found that occlusion of the LVF with masks or goggles did not affect the adaptations necessary to step into a hole. Neither behavioral (gait speed, margin of stability, foot landing position) nor neuromuscular (EMG activation and co-activation) parameters were affected by either visual manipulation. Older adults used a downward head pitch strategy to compensate for visual obstruction and plan the anticipatory adjustments to step into the hole. The absence of lower limb visual exproprioception due to wearing a mask did not affect locomotion control when stepping into a hole in older adults. Older adults compensated for the obstruction of the LVF through head downward tilt, which allowed them to obtain visual information about the hole two steps ahead to make anticipatory locomotor adjustments.

Fatigue modifies hip and knee kinematics during single- and double-leg dynamic tasks: An investigation with female handball players.

This study investigated the effect of a handball-specific fatigue protocol on hip and knee kinematics. Twenty female handball athletes performed three trials of the single-leg landing (SLL), sidestep cutting manoeuvre (SCM), and drop vertical jump (DVJ) before and after the fatigue protocol. Knee and hip angle waveforms were compared using statistical parametric mapping (p < 0.05). During the SLL, the fatigue increased hip adduction (4-7% cycle) and knee abduction (4-9% and 25-27%). For the SCM, hip flexion was reduced under fatigue during 14-29% and 44-68% of the cycle. Similarly, the knee flexion decreased between 7-36% and 53-73%. Besides, during the fatigue state, the athletes reduced the hip abduction between 0-11% of the cycle and increased the knee abduction between 20-23%. During the DVJ task, when fatigued, the hip flexion decreased between 19-44% of the cycle and the knee flexion between 1-16% and 18-77%. The fatigue protocol altered the lower limb kinematics, decreasing knee and hip flexions during the SCM and DVJ and increasing the knee valgus during both single-leg landing tasks.

Migraine and balance impairment: Influence of subdiagnosis, otoneurological function, falls, and psychosocial factors.

OBJECTIVE: To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors. BACKGROUND: Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far. METHODS: Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross-sectional study (30 patients per group). Thirty headache-free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. RESULTS: All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5-85.3], MWoA: 76.5 [95% CI: 73.6-79.3], MWA: 66.5 [95% CI: 63.6-69.3], CM: 69.1 [95% CI: 66.3-72.0]; p < 0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3-80.4], MWoA: 67.3 [95% CI: 62.7-71.8], MWA: 55.7 [95% CI: 51.2-60.3], CM: 58.4 [95% CI: 53.8-63.0]; p < 0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2-94.9], MWoA: 83.2 [95% CI: 77.9-88.6], MWA: 68.6 [95% CI: 63.3-74.0], CM: 71.9 [95% CI: 66.5-77.2], p < 0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p = 0.001). The SOT scores correlated with fear of falls (r = -0.44), dizziness disability (r = -0.37), kinesiophobia (r = -0.38), and migraine frequency (r = -0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F = 3.33, p = 0.070], visual score [F = 2.11, p = 0.149], vestibular score [F = 1.88, p = 0.172], somatosensory score [F = 0.00, p = 0.993]). CONCLUSIONS: Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.

Three days of beam walking practice improves dynamic balance control regardless of the use of haptic anchors in older adults.

Balance deficits during walking increase the risk of falls in older adults. Providing haptic information through anchors improves dynamic balance control, but the benefits of practicing with anchors during walking need to be evaluated. We investigated the effect of practice with haptic anchors in the beam walking task in older adults. Twenty-five older adults participated in this study divided into 0% (G0, practice without the anchors) and 50% (G50, practice with the haptic anchors in 50% of the trials) groups. With the anchors, participants held in each hand a cable with a mass of 0.125 kg affixed to the end of the cable that contacted the ground. They walked and kept the anchors in contact with the ground such that they dragged them. Participants increased the distance walked on the beam and reduced the trunk angular acceleration after training, but this effect was independent of the anchors. The use of haptic anchors during beam walking training did not significantly affect older adults' performance and dynamic balance control. Both groups showed improvements in the post-test and 24-hr retention conditions, indicating that older adults can learn to adapt their gait to more challenging contexts.

Beam width and arm position but not cognitive task affect walking balance in older adults.

Detection of changes in dynamic balance could help identify older adults at fall risk. Walking on a narrow beam with its width, cognitive load, and arm position manipulated could be an alternative to current tests. Therefore, we examined additive and interactive effects of beam width, cognitive task (CT), and arm position on dynamic balance during beam walking in older adults. Twenty older adults (69 ± 4y) walked on 6, 8, and 10-cm wide beams (2-cm high, 4-m-long), with and without CT, with three arm positions (free, crossed, akimbo). We determined cognitive errors, distance walked, step speed, root mean square (RMS) of center of mass (COM) displacement and trunk acceleration in the frontal plane. Beam width decrease progressively reduced distance walked and increased trunk acceleration RMS. Step speed decreased on the narrowest beam and with CT. Arm crossing decreased distance walked and step speed. COM displacement RMS and cognitive errors were not affected by any manipulation. In conclusion, distance walked indicated that beam width and arm position, but less so CT, affected dynamic balance, implying that beam walking has the potential to become a test of fall risk. Stability measurements suggested effective trunk adjustments to control COM position and keep dynamic balance during the task.

Don't get tripped up: Haptic modalities alter gait characteristics during obstacle crossing.

The attentional capacity required of haptic modalities while obstacle crossing may limit their effectiveness. Therefore, this study examined the attentional demands of haptic modalities during obstacle crossing. Nineteen healthy young adults walked across a 10 m laboratory floor within two modality blocks using either: 1) light touch on a railing, or 2) pulling haptic anchors. Randomly dispersed within these blocks were trials without added haptic input and verbal reaction time (VRT) tasks. VRT was compared across the three walking conditions. Gait characteristics, obstacle crossing stability, and obstacle toe clearance were compared across the three walking conditions (normal walking, light touch walking, anchored walking) and 2 VRT conditions (absence vs. presence). VRTs did not differ according to walking conditions (p > .05). Step length variability for the normal walking condition was significantly greater than for both the light touch and anchored walking conditions (p = .026). Toe clearance for the trail leg was less during light touch than normal walking (p = .020). The presence of the VRT resulted in greater toe clearance for both lead (p = .018) and trail limbs (F(2,34) = 8.053, p = .011). Neither haptic modality required significantly increased attentional demand; however, light touch walking results in less obstacle toe clearance. Haptic modalities likely provide greater benefit than risk to users during obstacle crossing.

Gait control to step into a lowered surface with one limb with different demands for accuracy in younger and older adults.

Walking in a daily life context requires constant adaptations to meet the environment's requirements for successful locomotion. We investigated the walking adaptations of younger and older adults when dealing with holes of different lengths in the pathway (60-cm long and 1.3 times foot length [critical point] conditions). We used the critical point condition to increase the demand for accuracy as it reduces the safety margin between the foot and the borders of the hole. Fifteen younger and fifteen older adults walked barefoot on a wooden walkway in three conditions: no-hole, 60-cm hole (length: 0.60 m | width: 0.80 m | depth: 0.095 m), and critical point hole (length: participant's foot length × 1.3 | width: 0.80 m | depth: 0.095 m). Participants stepped into the hole with only one foot. We assessed the impulses based on the ground reaction forces, trunk and lower limb joint angles, stride speed, and the margin of stability based on the concept of the extrapolated center of mass in the sagittal plane. Across walking conditions, older adults exhibited a larger margin of stability than younger adults. Before the hole, both age groups increased the braking impulse and adopted a more flexed posture of the lower limbs to help to lower the body in the subsequent step. Only older adults increased the vertical braking impulse and markedly reduced stride speed when stepping into both holes. Both age groups adopted a more vertically oriented trunk posture as a strategy to contribute to stability control when stepping into the hole. The two age groups showed a larger margin of stability and a more flexed trunk posture after the hole than the no-hole condition. Older adults were able to control body stability adequately and even better than younger adults. Younger and older adults used the same anticipatory and compensatory locomotor adjustments before and after the hole. These adjustments resulted in improved stability control. The differences between younger and older adults were confined to the moment of stepping into the hole. Older adults used a more cautious strategy that ensured task accuracy and gait progression.

Gait control of migraine patients with increasing light and sound levels.

BACKGROUND: Under a typical light and sound environment context, individuals with migraine showed balance control deficits on a series of functional activities, which helps to explain why migraineurs report more falls. it isn't established, the effects of intensity light and sound in migraineurs during functional tasks. RESEARCH QUESTION: Based on the hypersensitivity to light and sound in migraineurs, not only during the attack but also in the interictal period, does the exposure to bright light and loud sound impact motor control in this population? METHODS: This cross-sectional study consisted of 51 women with migraine and 22 healthy women. They performed three walking tasks: crossing an obstacle, stepping-up and stepping-down a curb, in a control situation with ambient lighting (≅350 lux), bright light (≅1200 lux), and loud sound (≅90 dBa). For statistical analysis, a t-test, a Spearman correlation test, and a repeated measures mixed ANOVA were applied. RESULTS: Migraineurs presented higher discomfort induced by light (p ≤ 0.0001) and sound (p = 0.001). In the obstacle task, migraineurs had greater step width than controls in the ambient light condition (p = 0.038) and participants of both groups placed their leading foot farther away from the obstacle in the light (p = 0.033) than in the ambient light condition. For the step-up task, this distance increased for both groups and limbs in the light (leading limb: p = 0.015; trailing limb: p = 0.002) and sound (leading limb: p = 0.010; trailing limb: p ≤ 0.0001) conditions compared to the ambient light condition. Step speed increased for light and sound conditions compared to ambient light condition, except for the sound condition in the step-down task. SIGNIFICANCE: Despite the higher discomfort induced by light and sound in the migraineurs, the effects of these sensory manipulations were similar for both migraineurs and controls, except for step width. Light and sound manipulation induced a less conservative strategy to deal with uneven terrain in both groups.

Migraine With Aura Is Related to Delayed Motor Control Reaction and Imbalance Following External Perturbations.

Background: It is evidenced that migraineurs present balance deficits. However, the balance recovery following unexpected ground perturbations, which reflect conditions of everyday activities, has not been investigated in this population. Aim: We aimed to assess the reactive postural responses among patients with migraine with and without aura, chronic migraine, and controls. We further aimed to assess the factors associated with greater self-report of falls. Methods: Ninety patients diagnosed by headache specialists were equally classified into three migraine subgroups according to the presence of aura and chronic migraine. Thirty controls were also recruited. All participants underwent the motor control test (MCT) and adaptation test (ADT) protocols of dynamic posturography tests (EquiTest®, NeuroCom, USA). Clinical and headache features and information on falls in the previous year, fear of falling, and vestibular symptoms were also assessed. Results: Patients with aura presented a greater sway area in most of the MCT conditions than the other three groups (p = 0.001). The aura group also presented delayed latency responses after perturbations compared with controls and patients without aura (p < 0.03). In the ADT, a greater sway area was observed in patients with aura than in groups without aura, chronic migraine, and controls (p < 0.0001). The MCT and ADT sway area, the frequency of aura, and the fear of falling explained 46% of the falls in the previous 12 months. Conclusion: Patients with aura exhibited greater delay and sway area after unexpected ground perturbations than controls and other migraine subgroups, which are related to the reported number of falls.

Visual cues two-steps ahead are adequate to grasp an object while walking without compromising stability.

In our prior studies, participants walked and grasped a dowel using an anticipatory mode of control. However, it is unknown how this combined task would change in a less predictable environment. We investigated the online control aspects involved in the combined task of walking and grasping under different coordination patterns between upper- and lower-limbs in young adults. Fifteen young adults walked and grasped a dowel under several experimental conditions combining the instant of visual cue appearance and coordination pattern of upper and lower limbs used to grasp the dowel. Visual cues provided two steps ahead or earlier were enough for executing the combined task of walking and prehension appropriately. Visual cues provided within this window impacted both walking stability and the execution of the prehension movement. Although an ipsilateral arm-leg coordination pattern increased mediolateral stability, a contralateral pattern significantly decreased mediolateral center of mass stability when the visual cue appeared one-step before grasping the object. These results imply that acquiring information to plan the combined task of walking and reaching for an object two steps ahead allows the maintenance of the general movement characteristics present when the decision to reach out for the object is defined two or more steps ahead. These results indicate that the prehension movement is initiated well before heel contact on that side when given sufficient planning time, but that a disruption of the natural arm-leg coordination dynamics emerges to accomplish the task when the cue is provided one step before the object.