Extending the center of pressure to incorporate handhold forces: Derivation and sample application.

Measures describing movement of the center of pressure (CoP) are frequently used to characterize postural control. Estimates of CoP often focus on forces that individuals exert in a single plane through the feet (standing on force plates). However, balance may also be supported by forces other than those developed at the feet, especially when walkers, handrails, and other aids are used. In these cases, it is common to neglect the contributions of handheld supports. Here, we derive and apply equations for an extended CoP that incorporates handhold forces. We then examine the influence of CoP definition (i.e., including or ignoring handhold forces) on common metrics (path length; RMS and maximum excursion; average and maximum velocity) for 12 younger adults with a handrail located lateral to the participants' dominant hand. Participants attempted balance recovery in response to a range of small, medium and large forward and backward platform translations. Significant interactions between perturbation magnitude and CoP definition were found for most metrics. Notably, the interaction of CoP definition and perturbation magnitude significantly affected path length (p-values < 0.001). Post-hoc analyses revealed larger CoP path length when handrail forces were incorporated in CoP estimates compared to ignoring handrail forces at medium (backward: 59.9 vs. 19.0% height; forward: 70.5 vs 22.4% height) and large perturbation magnitudes (backward: 69.9 vs 22.4% height; forward: 103.5 vs 24.6% height). Incorporation of hand forces in CoP calculations can present a different view of postural balance control than relying on a feet-only CoP. This measure could be useful in assessing balance control tasks that involve the use of handrails or hand-held mobility devices.