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Objective: The study aimed to examine postural stability changes in individuals who have recovered from COVID-19 infection. Methods: Fifty patients who recovered from the COVID-19 infection and 50 healthy controls were compared using the dizziness handicap inventory (DHI), a modified clinical test of sensory interaction balance (mCTSIB), limits of stability (LOS), rhythmic weight shift (RWS), and Romberg and fall risk (FR) tests. Results: Regarding mCTSIB, regardless of gender patients, female patients, or male patients, there were no significant differences from controls (p > 0.05). There was a significant difference in LOS between the patients and controls regarding (p < 0.05) in some parameters. There was a significant difference between the patients and controls concerning RWS (p < 0.05) for some parameters. There was a significant difference between the patients and controls regarding the Romberg test in some parameters (p < 0.05). There was no statistically significant difference between the patients and control groups regarding FR. Conclusion: Studies in which the effects of COVID-19 infection sequels have been evaluated on the vestibular system in the literature are subjective. The main concern is the prevalence of dizziness or vertigo in subjective studies. There may be a decrease in postural reflexes in female individuals who recovered from the COVID-19 infection in this study, thanks to the objective test measurement. Increased oscillations with eyes closed on regular ground and soft ground in the Romberg test may likely indicate vestibular problems. [ABSTRACT FROM AUTHOR]

Background/Objectives: Instability is one of the main symptoms in patients with vestibular and neurological disorders and therapeutic exercise interventions are increasing in popularity as a form of treatment. Additionally, the limits of stability measurement are known to be a good tool for balance evaluation and monitoring of these interventions. The aim of this work is to better understand how a specific protocol provokes changes on this variable and to study the characteristics of those who do and do not respond to it. Methods: A retrospective study was developed with the data of 40 patients treated in the Otorhinolaryngology department in Clínica Universidad de Navarra (Madrid, Spain). They had an initial reduction in limits of stability, completed the proposed protocol with home-based and hospital-based exercises and with frequent limits of stability remeasurement, and were assisted to a follow-up retest after 1–2 months. Results: A progressive improvement in limits of stability measure was developed through the intervention and was partially retained at follow-up visit. Several differences were found between those patients who improved with the treatment (responders) and those who did not improve (non-responders). More specifically an initial measure of the limits of stability was able to differentiate those groups with a cut-off data of 56 cm2. Conclusions: The proposed protocol was able to induce motor learning in patients included in this study with good retention after 1–2 months. Furthermore, there is some variability in how patients respond to the treatment. Age and diagnosis should be considered and an interesting cut-off data for clinal decision making was found. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusionsThe prosthetic socket provides the critical interface between prosthesis and residuum. The purpose of this pilot study was to explore the effect of altering socket-residuum coupling integrity on limb and body control, through the use of vacuum-assisted suspension. A secondary purpose was to explore the potential use of two measurement tools designed to assess mobility in a clinical context.Individuals with unilateral transtibial amputation performed intentional sway (n = 7) and treadmill walking (n = 6) tasks at three vacuum levels. Sway deviation from a straight-line path to peripheral targets was measured using an instrumented balance platform. Step width variability and targeting accuracy were measured using an augmented reality treadmill.There was a significant difference in intentional sway performance toward the target on the anterior diagonal toward the prosthetic side (p = 0.036); higher vacuum levels tended toward less deviation from a straight-line path. We found no group differences between total intentional sway deviation, step width variability or stepping accuracy across vacuum levels.Improved socket-residuum coupling integrity via vacuum may have measurable effects on functional control that warrant further investigation. We highlight limitations of the clinical testing paradigms to inform future work.Implications for rehabilitationThe fit of the socket is a critical factor in the success of lower limb prosthesis use.Vacuum-assisted suspension modifies the coupling between the residuum and socket.Changes in socket-residuum coupling may lead to measurable differences in control; however, these may be activity and person-specific.Clinically intended instrumented tests of movement function derived for an intact anatomy should be used with caution when assessing prosthesis users.The fit of the socket is a critical factor in the success of lower limb prosthesis use.Vacuum-assisted suspension modifies the coupling between the residuum and socket.Changes in socket-residuum coupling may lead to measurable differences in control; however, these may be activity and person-specific.Clinically intended instrumented tests of movement function derived for an intact anatomy should be used with caution when assessing prosthesis users. [ABSTRACT FROM AUTHOR]

Background: The "SEBT group," which includes the Star Excursion Balance Test (SEBT), its modified version (mSEBT), and the Lower Quarter Y-Balance Test (YBT-LQ), is used to assess the limits of stability. Interestingly, the testing protocol allows users a considerable degree of flexibility, which can affect the obtained results. Therefore, the objective of this systematic review was to analyze the impact of different protocol variants within the "SEBT group" on outcomes. Methods: Data were acquired by searching 4 databases (MEDLINE, ScienceDirect, Wiley, Springer Link) focusing on studies published in English in peer-reviewed journals, empirical in nature, conducted on healthy individuals, and examining the effects of various protocol variants on test outcomes. Study quality was assessed with the NHLBI quality assessment tool for pre-post studies with no control group. Results: The calculation method based on the maximum repetition yields statistically significantly higher results compared to other calculation methods. Allowing unrestricted arm movements during the test results in statistically significantly higher scores compared to the procedure that restricts arm movements. The impact of a warm-up, wearing footwear during testing, and using a dedicated kit remains ambiguous. To obtain reliable results, 4-6 familiarization trials are necessary, though fewer may suffice for athletes experienced in performing the test. Conclusion: This systematic review highlights the significant impact of the calculation method and arm movement restrictions on the outcomes of the "SEBT group." The effects of wearing footwear during testing, warm-up, and using a dedicated test kit remain unclear. The required number of familiarization repetitions may varies depending on biological maturity level of the person being tested. Future research should develop a warm-up protocol tailored to the needs of the "SEBT group," and investigate the impact of heel elevation during testing on outcomes. [ABSTRACT FROM AUTHOR]

BackgroundHip osteoarthritis (OA) is a degenerative joint disease that predominantly affects the elderly, causing significant morbidity due to joint pain, stiffness, and loss of function. This study aimed to assess the limits of stability (LOS) using computerized posturography and evaluate the correlations with functional mobility in elderly individuals with hip OA.MethodsThis cross-sectional study included elderly individuals aged 65 years and above with a clinical diagnosis of hip OA and age-matched asymptomatic controls. The LOS was measured using a computerized dynamic posturography system, which quantified the maximum distance and angle participants could shift their center of gravity without losing balance. Functional mobility was assessed using the Timed Up and Go (TUG) test, which measures the time taken for participants to stand up, walk 3 m, turn around, walk back, and sit down.ResultsThe study included 86 elderly individuals with hip OA and 86 age-matched asymptomatic controls. LOS assessments showed that individuals with hip OA had significantly lower stability scores across all directions compared to controls (p < 0.001). TUG test times were significantly slower for the OA group (10.50 ± 2.20 s) compared to controls (8.70 ± 2.00 s, p < 0.001). Positive correlations were found between LOS and functional mobility (r = 0.50, p = 0.009). Moderation analysis revealed that age and duration of OA significantly influenced the relationship between stability and mobility.ConclusionHip OA significantly impacts stability and functional mobility in elderly individuals. Enhanced stability is associated with improved mobility, and demographic and clinical variables such as age and duration of OA play crucial roles in these relationships. These findings underscore the importance of targeted therapeutic interventions to improve stability and mobility in this population.

Background Osteoarthritis (OA) is a chronic degenerative joint disease that leads to disability. The prevalence of symptomatic knee OA is approximately 22% to 39% in India, which causes significant morbidity and impairment in elderly individuals. Objective To study the effects of Otago exercise versus square-stepping exercises (SSEs) on balance, fall, and functional activities in geriatric individuals with OA knee. Methods A study was carried out at Pune among 40 geriatric individuals with age over 65 years. The individuals were assigned at random to the Otago exercise group or SSE. Both groups performed exercises for 40–45 min for 10 days. The primary outcome was balance, which was measured by the Berg Balance Scale and Limits of Stability test. The secondary outcomes were risk of fall, measured by the Morse fall scale and functional activity, measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale. Results Both the groups showed significant differences post intervention within the groups (P < 0.05). Between-group analysis showed that the Otago exercise group showed a higher mean difference in the primary outcomes that is in the Berg Balance Scale (19.25 > 15.24) and limits of stability. The SSE group showed a higher mean difference in Morse fall scale (18.81 > 8.8) and WOMAC scale (18.81 > 8.8). Conclusion The study concluded that, in older patients with OA knee, Otago exercise is more successful at enhancing balance but SSE is more effective at enhancing fall risk and functional activity.

Abstract This study investigates the relationship between ankle and toe strength and functional stability in young adults, with a sample comprising sixteen females and fourteen males. The research employed force platform data to determine the center of foot pressure (COP) and calculated the forward functional stability index (FFSI) through foot anthropometric measurements. Strength measurements of toe and ankle muscles, during maximal isometric flexion and extension, were conducted using force transducers. Notable positive correlations were found between toe flexor strength and FFSI (left flexor: r = 0.4, right flexor: r = 0.38, p

Limits of Stability protocols are typically target-oriented, leaving volitional aspects of control unobservable. A novel unconstrained protocol, volitional Limits of Stability (vLOS), shows high test-retest-reliability. We tested if verbal encouragement impacts this protocol. Forty healthy young adults (age 20.1 ±.9 years) performed three trials of vLoS with instructions that were agnostic to strategy or vigor, except trial three included verbal encouragement. Total sway area was used to metric the maximum volitional dynamic sway during each 1-min trial. One-way, repeated-measures ANOVA revealed significant differences (F(2,117) = 41.56, p < 0.0001, η p 2 = 0.52) due to encouragement. Specifically, follow-up paired t-tests showed no difference in sway area between the first two trials (p = 0.61), while trial three was much larger than trials one and two (p < 0.0001). Significant, large increases in sway area with verbal encouragement indicate that top-down mechanisms should be considered in theories of postural control. As well, clinical utilization of novel vLOS should be careful with word selection and delivery of protocol instructions. Limits of Stability balance tests typically include a goal directed instruction and metrics. Dynamic postural sway should be tested in a task affording participant volitional control. A novel volitional Limits of Stability protocol has been developed. Maximal dynamic postural sway responds to motivating instructions. Psychological factors of postural sway control deserve further investigation. [ABSTRACT FROM AUTHOR]

BackgroundThe “SEBT group,” which includes the Star Excursion Balance Test (SEBT), its modified version (mSEBT), and the Lower Quarter Y-Balance Test (YBT-LQ), is used to assess the limits of stability. Interestingly, the testing protocol allows users a considerable degree of flexibility, which can affect the obtained results. Therefore, the objective of this systematic review was to analyze the impact of different protocol variants within the “SEBT group” on outcomes.MethodsData were acquired by searching 4 databases (MEDLINE, ScienceDirect, Wiley, Springer Link) focusing on studies published in English in peer-reviewed journals, empirical in nature, conducted on healthy individuals, and examining the effects of various protocol variants on test outcomes. Study quality was assessed with the NHLBI quality assessment tool for pre-post studies with no control group.ResultsThe calculation method based on the maximum repetition yields statistically significantly higher results compared to other calculation methods. Allowing unrestricted arm movements during the test results in statistically significantly higher scores compared to the procedure that restricts arm movements. The impact of a warm-up, wearing footwear during testing, and using a dedicated kit remains ambiguous. To obtain reliable results, 4–6 familiarization trials are necessary, though fewer may suffice for athletes experienced in performing the test.ConclusionThis systematic review highlights the significant impact of the calculation method and arm movement restrictions on the outcomes of the “SEBT group.” The effects of wearing footwear during testing, warm-up, and using a dedicated test kit remain unclear. The required number of familiarization repetitions may varies depending on biological maturity level of the person being tested. Future research should develop a warm-up protocol tailored to the needs of the “SEBT group,” and investigate the impact of heel elevation during testing on outcomes.Systematic review registrationThe protocol for this systematic review was prospectively registered in the OSF Registries (https://doi.org/10.17605/OSF.IO/JSKH2).

Background: The significance of studying Kinesiophobia, Limits of Stability (LOS), and functional balance in geriatric patients with CLBP and osteoporosis lies in their profound impact on rehabilitation outcomes and fall risk, ultimately affecting patients’ quality of life. This study aimed to examine LOS and functional balance in the geriatric population concurrently experiencing Chronic Low Back Pain (CLBP) and osteoporosis, in comparison to age-matched healthy controls; to assess the correlations between Kinesiophobia, LOS, and functional balance assessments; and to evaluate the mediating influence of Kinesiophobia on the association between LOS and functional balance tests. Methods: This cross-sectional study included a total of 86 participants in each group. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). LOS variables were evaluated with a computerized Iso-free platform in eight different directions. Functional balance was measured using the Timed Up and Go (TUG) test and the Berg Balance Scale (BBS). Results: Patients with CLBP and osteoporosis showed significantly lower LOS percentages (45.78  ±  6.92) and impaired Functional Balance, reflected in a TUG Score (10.45  ±  2.23), compared to asymptomatic controls (LOS: 76.95  ±  8.21; TUG: 8.73  ±  1.90). Kinesiophobia showed a significant moderate negative correlation with LOS, indicated by r  = −0.362 (p <  0.01). Additionally, Kinesiophobia was found to correlate with functional balance tests. Specifically, there was a moderate positive correlation with the TUG Score (r  =  0.322, p <  0.01), indicating that higher Kinesiophobia is associated with slower TUG performance. Conversely, a stronger moderate negative correlation was observed with the Berg Balance Scale (BBS) Score (r  = −0.436, p <  0.001), suggesting that increased Kinesiophobia is associated with lower BBS scores, indicating poorer balance performance. Mediation analysis revealed that Kinesiophobia significantly influences LOS and Functional Balance. For LOS and the TUG score, Kinesiophobia showed a direct effect (B =  0.24), an indirect effect (B =  0.09), and a total effect (B =  0.13). Similarly, for LOS and the BBS score, the direct effect of Kinesiophobia was B =  0.38, with an indirect effect of B =  0.10 and a total effect of B =  0.20. Conclusion: This study underscores the substantial impact of Kinesiophobia on both stability and functional balance in individuals coping with CLBP and osteoporosis. The findings emphasize the clinical relevance of addressing Kinesiophobia as a potential target for interventions aimed at improving LOS and functional balance in this specific patient population. [ABSTRACT FROM AUTHOR]

Cervical proprioception and postural stability play crucial roles in maintaining optimal head and neck positioning, yet their relationship and implications in cervical spondylosis (CS) remain underexplored. This study aims to investigate cervical proprioceptive reposition errors, limits of stability, and their association in individuals with CS while considering the mediating effects of pain and kinesiophobia. The primary objectives are to compare cervical proprioceptive reposition errors and limits of stability variables between individuals with CS and age-matched healthy controls, explore their associations within the CS group, and determine the mediating roles of pain and kinesiophobia. A cross-sectional study recruited 60 individuals with CS and 60 healthy controls. Cervical joint reposition errors (JREs) were assessed using a cervical range-of-motion device, while limits of stability were evaluated using a computerized dynamic posturography system. Pain, kinesiophobia, and demographic data were collected. Parametric tests, correlation analyses, and multiple regression were employed for data analysis. Individuals with CS exhibited significantly higher cervical JREs in flexion, extension, and rotation compared with healthy controls (p < 0.001). Within the CS group, correlations revealed associations between JREs and limits-of-stability variables (p < 0.05). Mediation analysis demonstrated significant direct and indirect effects of pain and kinesiophobia on the relationship between JREs and limits-of-stability variables in the CS group (p < 0.005). CS is associated with impaired cervical proprioception, increased reposition errors, and compromised postural stability. This study highlights the interplay between proprioception, stability, pain, and psychological factors, emphasizing the need for comprehensive interventions in individuals with CS to enhance functional outcomes and quality of life. [ABSTRACT FROM AUTHOR]

BackgroundThe significance of studying Kinesiophobia, Limits of Stability (LOS), and functional balance in geriatric patients with CLBP and osteoporosis lies in their profound impact on rehabilitation outcomes and fall risk, ultimately affecting patients’ quality of life. This study aimed to examine LOS and functional balance in the geriatric population concurrently experiencing Chronic Low Back Pain (CLBP) and osteoporosis, in comparison to age-matched healthy controls; to assess the correlations between Kinesiophobia, LOS, and functional balance assessments; and to evaluate the mediating influence of Kinesiophobia on the association between LOS and functional balance tests.MethodsThis cross-sectional study included a total of 86 participants in each group. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). LOS variables were evaluated with a computerized Iso-free platform in eight different directions. Functional balance was measured using the Timed Up and Go (TUG) test and the Berg Balance Scale (BBS).ResultsPatients with CLBP and osteoporosis showed significantly lower LOS percentages (45.78 ± 6.92) and impaired Functional Balance, reflected in a TUG Score (10.45 ± 2.23), compared to asymptomatic controls (LOS: 76.95 ± 8.21; TUG: 8.73 ± 1.90). Kinesiophobia showed a significant moderate negative correlation with LOS, indicated by r = −0.362 (p

Background: Limits of stability is required to perform functional activities and other advanced tasks of life without losing balance, and assessment of limits of stability is essential in clinical practice. Forward, Lateral, and Oblique direction reach tests are clinical balance tests that assess limits of stability, and these reach distances in various directions may be symmetrical or asymmetrical. The aim was to establish the symmetry between various reach distances on three reach tests and to establish the concurrent validity of oblique, forward, and lateral direction reach test distances with limits of stability measured by the Iso Free machine of TecnoBody company. Methods: The measurements of oblique, forward, and lateral reach tests and limits of stability excursions of center of pressure were taken in eight directions on Iso Free machine of Techno Body in fifty typical college-going young adults who were recruited through convenience sampling. Pearson correlation test was used to find the relationship between forward, lateral, and oblique direction reaches and limits of stability in forward, lateral, and oblique directions. Regression analysis was used to find the factors influencing the forward, lateral, and oblique reach tests. Results: The reach distances were symmetrical, and out of the three tests, the lateral and oblique direction reach tests have a moderate positive correlation with limits of stability test in lateral and oblique directions with an r-value of 0.569 (p

Background: Post-stroke individuals are observed to have reduced limits of stability (LOS) in all directions. Functional activities are rarely performed in pure cardinal planes; instead, they are most likely to be performed in an oblique direction. Existing tools are either expensive or sophisticated to assess the LOS in an oblique direction. Therefore, this study's primary objective is to evaluate the intra-rater, inter-rater reliability, and validity of the oblique direction reach test (ODRT) among stroke subjects. Materials & Methods: A total of 96 first-time stroke patients with age, gender, height, and weight-matched healthy controls aged 18-80 years were recruited for the study. Oblique, forward, and lateral reach distances were assessed using the standard procedure of ODRT, Functional Reach Test (FRT), and Lateral Reach Test (LRT), respectively. Validity was tested by correlating the ODRT distance with the Berg Balance Scale (BBS) Score using Spearman's rank correlation coefficient. Intraclass correlation coefficients (ICCs) and Bland Altman analysis were used to establish inter-rater reliability. ICCs were used to find intra-rater reliability. The Mann-Whitney U test was used to establish the mean difference of the FRT, LRT, and ODRT. Spearman's rank correlation coefficient and linear regression were used to correlate the distance of FRT and LRT with ODRT. Results: A high concurrent validity was found between BBS and ODRT with an r-value of 0.905 (p < 0.001). Inter-rater reliability was high with an ICC of 0.997 (95% CI [0.996-0.998]), and intra-rater reliability was highly significant with an ICC of 0.996 (95% CI [0.994-0.998]). The stroke subjects reached a significantly shorter distance than healthy individuals in FRT, ODRT, and LRT. ODRT was highly correlated with FRT (r = 0.985) and LRT (r = 0.978) (p < 0.001) and had an R² = 0.987. Conclusion: ODRT is a highly valid and reliable tool that can be used to evaluate balance in stroke patients. Individuals who reached less in the forward and lateral directions showed reduced reach distance in the oblique direction. [ABSTRACT FROM AUTHOR]

Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45–70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from −0.38 to −0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effects of backpack load carriage on quiet standing postural control and limits of stability (LOS) of older adults. Fourteen older adults (65 [6] y) performed quiet standing and a forward, right, and left LOS test in 3 conditions, unloaded, stable, and unstable backpack loads while activity of 4 leg muscles was recorded. Stable and unstable loads decreased postural sway (main effect ηp² = .84, stable P < .001, unstable P < .001), mediolateral (main effect ηp² = .49, stable P = .002, unstable P = .018) and anterior--posterior (main effect ηp² = .64, stable P < .001, unstable P = .001) fractal dimension, and LOS distance (main effect ηp² = .18, stable P = .011, unstable P = .046) compared with unloaded. Rectus femoris (main effect ηp² = .39, stable P = .001, unstable P = .010) and gastrocnemius (main effect ηp² = .30, unstable P = .027) activity increased in loaded conditions during LOS and quiet standing. Gastrocnemius--tibialis anterior coactivation was greater in unstable load than stable loaded quiet standing (main effect ηp² = .24, P = .040). These findings suggest older adults adopt conservative postural control strategies minimizing the need for postural corrections in loaded conditions. Reduced LOS may also increase fall risk when carrying a load. However, there was no difference between unstable and stable loads for postural control variables. [ABSTRACT FROM AUTHOR]

Background Post-stroke individuals are observed to have reduced limits of stability (LOS) in all directions. Functional activities are rarely performed in pure cardinal planes; instead, they are most likely to be performed in an oblique direction. Existing tools are either expensive or sophisticated to assess the LOS in an oblique direction. Therefore, this study’s primary objective is to evaluate the intra-rater, inter-rater reliability, and validity of the oblique direction reach test (ODRT) among stroke subjects. Materials & Methods A total of 96 first-time stroke patients with age, gender, height, and weight-matched healthy controls aged 18–80 years were recruited for the study. Oblique, forward, and lateral reach distances were assessed using the standard procedure of ODRT, Functional Reach Test (FRT), and Lateral Reach Test (LRT), respectively. Validity was tested by correlating the ODRT distance with the Berg Balance Scale (BBS) Score using Spearman’s rank correlation coefficient. Intraclass correlation coefficients (ICCs) and Bland Altman analysis were used to establish inter-rater reliability. ICCs were used to find intra-rater reliability. The Mann-Whitney U test was used to establish the mean difference of the FRT, LRT, and ODRT. Spearman’s rank correlation coefficient and linear regression were used to correlate the distance of FRT and LRT with ODRT. Results A high concurrent validity was found between BBS and ODRT with an r-value of 0.905 (p < 0.001). Inter-rater reliability was high with an ICC of 0.997 (95% CI [0.996–0.998]), and intra-rater reliability was highly significant with an ICC of 0.996 (95% CI [0.994–0.998]). The stroke subjects reached a significantly shorter distance than healthy individuals in FRT, ODRT, and LRT. ODRT was highly correlated with FRT (r = 0.985) and LRT (r = 0.978) (p < 0.001) and had an R2 = 0.987. Conclusion ODRT is a highly valid and reliable tool that can be used to evaluate balance in stroke patients. Individuals who reached less in the forward and lateral directions showed reduced reach distance in the oblique direction.

(1) Background: Human balance and equilibrium-maintaining abilities have been widely researched up to this day. Numerous publications have investigated the possibilities of enhancing these abilities, bringing the patient back to their original capabilities post-disease or accident, and training for fall prevention. Virtual reality technology (VR) is becoming a progressively more renowned technique for performing or enhancing rehabilitation or training. We aimed to explore whether the introduction of scenery oscillation can influence a person's limits of stability. (2) Methods: Sixteen healthy adults participated in measurements. Each of them underwent 10 trials, during which subjects were supposed to, on acoustic cue, lean as far forward and back as possible, without raising their heels or toes. Two trials were conducted without the use of VR, four with oscillating scenery, one with stationary scenery, one with displayed darkness, and two trials were performed for reference, which did not require leaning nor used VR technology. (3) Results: For the total as well as for each foot separately, COP displacements and velocities were calculated and analyzed. A post-hoc Wilcoxon pairwise test with Holm's correction was performed, resulting in 420 returned p-values, 4 of which indicated significant differences between medians when comparing trials with 0.2 Hz oscillating scenery with trials with eyes open and closed. (4) Conclusions: No statistically significant differences at α = 0.05 between reached maximums in trials using VR and trials without it were found, only trials using 0.2 Hz oscillations displayed statistically significant differences when comparing velocities of leaning. The authors believe that such oscillations resemble naturally occurring tinnitus; additionally, low-frequency oscillations are believed to influence postural balance more than high-frequency ones, therefore affecting the velocity and displacements of COP the most. [ABSTRACT FROM AUTHOR]

Cervical proprioception and its implications on postural stability are crucial in older adults. Understanding their relationship is important in understanding and preventing falls in older adults. This research aims to evaluate the proprioceptive, functional mobility, and limits of stability (LOS) variables among two age groups: individuals aged 65 and above and those below 65. A secondary goal of the study is to analyze the relationship between cervical proprioception, functional mobility, and the LOS. Methods: In this cross-sectional study, 100 participants each were included in the older and younger groups. Researchers employed the target reposition technique to assess cervical proprioception and measured the joint position error (JPE) in degrees. Functional mobility was estimated using the Berg balance scale (BBS) and timed up-and-go test (TUG). In addition, dynamic posturography was utilized to evaluate variables related to the LOS, including reaction time, maximum excursion, and directional control. Results: The magnitudes of the mean cervical JPE are larger (p < 0.001), and functional mobility (p < 0.001) and the LOS (p < 0.001) are impaired in older individuals compared to the younger ones. The cervical proprioception is significantly associated with functional mobility (p < 0.001), and the LOS (p < 0.001). Conclusion: In older adults aged above 65 years, cervical proprioception, functional mobility, and the LOS are impaired. Older adults with greater cervical JPE had more impaired functional mobility and LOS parameters. When evaluating or treating older adults with problems with their balance or falls, these factors should be considered. [ABSTRACT FROM AUTHOR]

Limits of stability—defined by the maximum distances a person is willing to reach without falling or changing the base of support—are measures of dynamic balance. Research question: What are infants' sitting stability limits in the forward and right directions? Twenty-one 6- to 10-month old infants participated in this cross-sectional study. To incentivize infants to reach beyond arm's length, caregivers began by holding a toy close to their infants at shoulder height. Caregivers then moved the toy farther away as infants tried to reach for it until infants lost balance, placed their hands on the floor, or transitioned out of sitting. All sessions were conducted via Zoom™ and video-recorded for further analyses using DeepLabCut for 2D pose estimation and Datavyu to determine timings of the reach and to code infants' postural behaviors. Infants' trunk excursions in the anterior-posterior plane (for forward reaches) and medio-lateral plane (for rightward reaches) represented their stability limits. Most infants ended the reach by returning to their original sitting position; however, infants with higher Alberta Infant Motor Scale (AIMS) scores transitioned out of sitting and infants with lower AIMS scores sometimes fell (mostly during rightward reaching). Trunk excursions were correlated with months of sitting experience. Rightward trunk excursions were also correlated with AIMS scores and age. Overall, infants' trunk excursions were larger in the forward than in the right direction, and such discrepancy was consistent across infants. Lastly, the more often infants adopted movement strategies with their legs (e.g., bending the knees), the greater the trunk excursion they attained. Sitting control entails learning to perceive the boundaries of stability limits and acquiring anticipatory postures to suit the needs of the task. Tests and interventions that target sitting stability limits could be beneficial for infants with or at risk of motor delays. • We used video and DeepLabCut to examine infants' sitting stability limits. • Stability limits were larger with more months of sitting experience. • Stability limits were larger in the forward than in the right direction. • Larger stability limits to the right required more advanced gross motor skills. • Movement strategies with the legs were associated with larger stability limits. [ABSTRACT FROM AUTHOR]

(1) Background: Individuals with fibromyalgia syndrome (FMS) may experience proprioceptive and balance impairments. Kinesiophobia is a factor that can mediate the relationship between cervical joint position sense (JPS) and limits of stability. The objectives of this study were to (1) compare the cervical JPS and limits of stability between FMS and asymptomatic individuals, (2) assess the relationship between cervical JPS and limits of stability, and (3) assess the mediation effect of kinesiophobia on the relationship between cervical JPS and limits of stability in FMS individuals. (2) Methods: In this comparative cross-sectional study, 100 individuals with FMS and 100 asymptomatic individuals were recruited. Cervical JPS was assessed using a cervical range of motion device, limits of stability (reaction time, maximum excursion, and direction control) were assessed using dynamic posturography, and FMS individuals' kinesiophobia was assessed using the Tampa scale of kinesiophobia (TSK). Comparison, correlation, and mediation analyses were performed. (3) Results: The magnitude of the mean cervical joint position error (JPE) was significantly larger in FMS individuals (p < 0.001) compared to the asymptomatic individuals. The limits of the stability test showed that FMS individuals had a longer reaction time (F = 128.74) and reduced maximum excursion (F = 976.75) and direction control (F = 396.49) compared to the asymptomatic individuals. Cervical JPE showed statistically significant moderate-to-strong correlations with reaction time (r = 0.56 to 0.64, p < 0.001), maximum excursion (r = −0.71 to −0.74, p < 0.001), and direction control (r = −0.66 to −0.68, p < 0.001) parameters of the limits of the stability test. (4) Conclusions: Cervical JPS and limits of stability were impaired in FMS individuals, and the cervical JPS showed a strong relationship with limits of stability variables. Moreover, kinesiophobia mediated the relationship between JPS and limits of stability. These factors may be taken into consideration when evaluating and developing treatment strategies for FMS patients. [ABSTRACT FROM AUTHOR]

(1) Background: Proprioception and limits of stability can significantly impact static and dynamic balance. Knee proprioception and limits of stability may be impaired in individuals with knee osteoarthritis (KOA). Impaired knee proprioception may impact the limits of stability, and understanding the associations between these factors is important for formulating treatment strategies in this population. The objectives of this study are to (a) compare the knee joint position error (JPE) and limits of stability between KOA and asymptomatic individuals and (b) assess the correlation between knee JPE and the limits of stability in KOA individuals. (2) Methods: This cross-sectional study included 50 individuals diagnosed with bilateral KOA and 50 asymptomatic individuals. Knee JPE was measured using a dual digital inclinometer at 25° and 45° of knee flexion (in the dominant and nondominant legs). The limits of stability variables, including reaction time (s), maximum excursion (%), and direction control (%), were evaluated using computerized dynamic posturography. (3) Results: The magnitude of the mean knee JPE is significantly larger in KOA individuals (p < 0.001) compared to asymptomatic individuals assessed at 25° and 45° of knee flexion in both the dominant and nondominant legs. The limits of stability test showed that KOA group individuals had a longer reaction time (1.64 ± 0.30 s) and reduced maximum excursion (4.37 ± 0.45) and direction control (78.42 ± 5.47) percentages compared to the asymptomatic group (reaction time = 0.89 ± 0.29, maximum excursion = 5.25 ± 1.34, direction control = 87.50 ± 4.49). Knee JPE showed moderate to strong correlations with the reaction time (r = 0.60 to 0.68, p < 0.001), maximum excursion (r = −0.28 to −0.38, p < 0.001) and direction control (r = −0.59 to −0.65, p < 0.001) parameters in the limits of stability test. (4) Conclusions: Knee proprioception and limits of stability are impaired in KOA individuals compared to asymptomatic individuals, and knee JPE showed significant relationships with the limits of stability variables. These factors and correlations may be considered when evaluating and developing treatment strategies for KOA patients. [ABSTRACT FROM AUTHOR]

Purpose: A variety of sensory-motor changes are reported in both the traumatic and non-traumatic neck pain. However, it is still unclear whether there is a significant difference between individuals with traumatic neck pain and those with non-traumatic in terms of postural control. The aim of this cross-sectional study was to investigate whether there was a difference between individuals with traumatic pain and nontraumatic neck pain in terms of postural control and disability. Material and Methods: Ninety-two patients with chronic neck pain were grouped according to the onset of pain. Clinical test of sensory interaction balance (CTSIB) and limits of stability (LOS) test were used for postural control assessment. The Numeric Rating Scale and Neck Pain Disability Index (NPDI) were used to measure pain intensity and disability, respectively. Mann-Whitney U test was used to compare groups. Results: There were no significant differences between groups in terms of LOS, CTSIB and NPDI scores (p>0.05). Conclusion: The results of this study suggest that postural control and disability do not differ between patients with traumatic and non-traumatic neck pain. Therefore, from a clinical perspective, postural control and disability should be evaluated without considering trauma history in patients with neck pain. [ABSTRACT FROM AUTHOR]

Cervical proprioception and postural stability play crucial roles in maintaining optimal head and neck positioning, yet their relationship and implications in cervical spondylosis (CS) remain underexplored. This study aims to investigate cervical proprioceptive reposition errors, limits of stability, and their association in individuals with CS while considering the mediating effects of pain and kinesiophobia. The primary objectives are to compare cervical proprioceptive reposition errors and limits of stability variables between individuals with CS and age-matched healthy controls, explore their associations within the CS group, and determine the mediating roles of pain and kinesiophobia. A cross-sectional study recruited 60 individuals with CS and 60 healthy controls. Cervical joint reposition errors (JREs) were assessed using a cervical range-of-motion device, while limits of stability were evaluated using a computerized dynamic posturography system. Pain, kinesiophobia, and demographic data were collected. Parametric tests, correlation analyses, and multiple regression were employed for data analysis. Individuals with CS exhibited significantly higher cervical JREs in flexion, extension, and rotation compared with healthy controls (p < 0.001). Within the CS group, correlations revealed associations between JREs and limits-of-stability variables (p < 0.05). Mediation analysis demonstrated significant direct and indirect effects of pain and kinesiophobia on the relationship between JREs and limits-of-stability variables in the CS group (p < 0.005). CS is associated with impaired cervical proprioception, increased reposition errors, and compromised postural stability. This study highlights the interplay between proprioception, stability, pain, and psychological factors, emphasizing the need for comprehensive interventions in individuals with CS to enhance functional outcomes and quality of life.

Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45–70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from −0.38 to −0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis.

Background: Hip osteoarthritis (OA) is a degenerative joint disease that predominantly affects the elderly, causing significant morbidity due to joint pain, stiffness, and loss of function. This study aimed to assess the limits of stability (LOS) using computerized posturography and evaluate the correlations with functional mobility in elderly individuals with hip OA., Methods: This cross-sectional study included elderly individuals aged 65 years and above with a clinical diagnosis of hip OA and age-matched asymptomatic controls. The LOS was measured using a computerized dynamic posturography system, which quantified the maximum distance and angle participants could shift their center of gravity without losing balance. Functional mobility was assessed using the Timed Up and Go (TUG) test, which measures the time taken for participants to stand up, walk 3 m, turn around, walk back, and sit down., Results: The study included 86 elderly individuals with hip OA and 86 age-matched asymptomatic controls. LOS assessments showed that individuals with hip OA had significantly lower stability scores across all directions compared to controls (p < 0.001). TUG test times were significantly slower for the OA group (10.50 ± 2.20 s) compared to controls (8.70 ± 2.00 s, p < 0.001). Positive correlations were found between LOS and functional mobility (r = 0.50, p = 0.009). Moderation analysis revealed that age and duration of OA significantly influenced the relationship between stability and mobility., Conclusion: Hip OA significantly impacts stability and functional mobility in elderly individuals. Enhanced stability is associated with improved mobility, and demographic and clinical variables such as age and duration of OA play crucial roles in these relationships. These findings underscore the importance of targeted therapeutic interventions to improve stability and mobility in this population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alahmari and Reddy.)

(1) Background: Human balance and equilibrium-maintaining abilities have been widely researched up to this day. Numerous publications have investigated the possibilities of enhancing these abilities, bringing the patient back to their original capabilities post-disease or accident, and training for fall prevention. Virtual reality technology (VR) is becoming a progressively more renowned technique for performing or enhancing rehabilitation or training. We aimed to explore whether the introduction of scenery oscillation can influence a person’s limits of stability. (2) Methods: Sixteen healthy adults participated in measurements. Each of them underwent 10 trials, during which subjects were supposed to, on acoustic cue, lean as far forward and back as possible, without raising their heels or toes. Two trials were conducted without the use of VR, four with oscillating scenery, one with stationary scenery, one with displayed darkness, and two trials were performed for reference, which did not require leaning nor used VR technology. (3) Results: For the total as well as for each foot separately, COP displacements and velocities were calculated and analyzed. A post-hoc Wilcoxon pairwise test with Holm’s correction was performed, resulting in 420 returned p-values, 4 of which indicated significant differences between medians when comparing trials with 0.2 Hz oscillating scenery with trials with eyes open and closed. (4) Conclusions: No statistically significant differences at α = 0.05 between reached maximums in trials using VR and trials without it were found, only trials using 0.2 Hz oscillations displayed statistically significant differences when comparing velocities of leaning. The authors believe that such oscillations resemble naturally occurring tinnitus; additionally, low-frequency oscillations are believed to influence postural balance more than high-frequency ones, therefore affecting the velocity and displacements of COP the most.

Background: Essential tremor (ET) is a neurological disorder characterized primarily by action tremor. Balance impairments in ET patients were formerly considered to be uncommon and simply age-related. However quantitative assessment with posturography has revealed impairments in control of both static and dynamic balance.Research Question: The aim of the present study is to assess postural stability with different posturographic techniques in ET patients.Methods: A prospective cross-sectional study conducted in two University Hospitals. Eleven patients diagnosed with essential tremor and twelve healthy controls were included. Balance assessment were performed with: sensory organization test (SOT) and limits of stability (LOS) of the computer dynamic posturography (CDP), results of free-field body sway analysis with mobile posturography (Vertiguard®), modified timed up and go test (TUG), Dizziness handicap inventory (DHI) and activities-specific balance confidence scale (ABC).Results: Patients with ET showed poorer scores in the SOT than controls for composite balance and somatosensory input. They also performed worse in LOS tests and Vertiguard® device indicated a higher risk of falling. There were no differences in the modified TUG. The mean score of DHI was 15.64 and 85.16 for ABC.Significance: Posturography assessment (CDP and Vertiguard®) is more accurate in showing balance impairment in ET patients than clinical evaluation (modified TUG). Balance impairment involves deteriorated processing of somatosensory input which could be explained by cerebellar dysfunction. Balance deficits could be included into future diagnostic criteria. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine if a foam testing condition and/or nonlinear analysis methods can be used to identify differences between age stratified subgroups of older adults when conducting the Limits of Stability assessment. Ninety older adults participated in this study. A force plate was used to record center of pressure data during Limits of Stability testing on a firm and foam surface. Participants were grouped into age-stratified subgroups: young-old (60-69 years), middle-old (70-79 years), and old-old (80+ years). Anterior-posterior (A/P) and medial-lateral (M/L) sway ranges and sample entropy values were calculated. The young-old group had significantly larger A/P and M/L sway ranges than the old-old group on both surfaces. A/P sample entropy increased significantly with age. M/L sample entropy increased significantly with age between the young-old and old-old and the middle-old and old-old groups. Sample entropy values between surfaces significantly differed for all groups. These results indicate Limits of Stability differences occur between older adults of different age groups and should be taken into consideration for clinical and research testing. Nonlinear analysis may help further identify differences in Limits of Stability performance while use of a foam surface is of limited additional value. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the limits of stability (LOS) and the movement patterns during reaching by applying the Multi-Directional Reach Test (MDRT) in children with Down syndrome (DS) aged 7–12 years old. Methods: Thirty children with DS and 30 age and gender typical development (TD) matched children, aged 7–12 years old were recruited. Each child was asked to reach as far as possible during standing in four directions using a self-selected movement pattern. The movement patterns were classified by two experienced pediatric physical therapists. Results: The reach distance in children with DS aged 7–9 years old was significantly shorter than TD children aged 7–9 years old for the forward and backward directions. Also, the reach distance in DS children aged 7–9 years old was significantly smaller than that of TD children aged 10–12 years old for all directions. For children with DS aged 10–12 years old, the reach distance was significantly less than that of TD children only in the backward direction. All children with DS in this study adopt a hip and mixed strategy during forward and backward reaching. In contrast, TD children adopt an adult-like movement pattern. Conclusion: The boundary of stability in an anteroposterior (AP) direction of children with DS aged 7–12 years old was lesser than the matched TD children, especially for the backward direction. These findings may assist therapists in detecting postural control and balance problems in children with DS.

Objective: The aim of this study was to determine whether there is a difference in postural control between nulligravida women and women who have given birth by vaginal or cesarean section.Methods: Women who had only vaginal delivery in the previous 1-3 years were included in the vaginal delivery group (n = 27), those who had only cesarean delivery in the previous 1-3 years were included in the cesarean section group (n = 28), and those who had never given birth were included in the control group (n = 32). Evaluations were administered 6-8 days after the ovulation phase. Postural control of the participants was evaluated with the computerized dynamic posturography device.Results: A total of 87 women with a mean age of 29.4 ± 4 years and a mean body mass index of 24.1 ± 3.1 kg/m2 were included in the study. Antero-posterior somatosensory organization test values of the vaginal delivery group were lower than the control group (p = 0.0016). The cesarean delivery group had statistically lower antero-posterior somatosensory (p < 0.001 and p = 0.0013) and medio-lateral somatosensory (p = 0.002 and p = 0.017, respectively) test scores compared to the control group and the vaginal delivery group.Conclusions: It was observed that women who birthed with vaginal or cesarean delivery had impaired somatosensory postural control. There is definitely a need for further studies with a long-term follow-up examining the effects of postural control during pregnancy and the postpartum period. [ABSTRACT FROM AUTHOR]

Purpose：Mouthguards are used by athletes to help improve athletic performance. This study examined the effects of changes in occlusal condition with a mouthguard. Method：The subjects were junior reinforcement designated archery athletes，（18 years old, 3 females）who were tested on a Balance Master. The balancing indices measured included sway velocity（SV）and limits of stability（LOS）. Results：The difference in sway velocity parameters decreased after wearing a mouthguard for 2 months, whereas the movement velocity increased after wearing for 2 months. Endo Point Excursion and Maximum Excursion approached the target point when wearing a mouthguard. Conclusions：It is thought that these results were because the feeling of strangeness had decreased after wearing a mouthguard for 2 months. [ABSTRACT FROM AUTHOR]

To compare elderly non-fallers and fallers for differences in the Clinical Test of Sensory Interaction for Balance (CTSIB) and Limits of Stability (LOS). Six hundred forty-six older women volunteers (69.5 ± 6.1 yr) participated in the study. Static and dynamic balance were assessed. The static balance (SB) indices in CTSIB were analyzed for four sway velocity conditions: a flat surface with eyes open (SV1); a flat surface with eyes closed (SV2); thick foam with eyes open (SV3); and thick foam with eyes closed (SV4), and composite scores (SVcomp) calculated based on all of conditions. The LOS components (endpoint excursion (EPE), maximum excursion (MXE), directional control (DCL), reaction time (RT), and movement mean velocity (MVL)) as a dynamic balance index were analyzed based on movements toward all eight targets, and composite scores. The fall incidence within the past 1 year was studied via questionnaire survey (faller = 172, non-faller = 474). There were significant differences in mean age and height between faller and non-faller groups. No significant differences were found in all balance indices between groups compared by age-adjusted ANCOVA. From the CTSIB and LOS measurement adopted in this study, no difference was observed between older fallers and non-fallers. However, in order to evaluate the presence or absence of falls based only on the balance ability, further measures such as examination by combining indicators are required. It is necessary to perform prospective studies to track the occurrence of falls after the balance ability assessment in the future. [ABSTRACT FROM AUTHOR]

Objective: The goal of this effort to investigate if experienced breachers, professionals with a career history of exposure to repeated low-level blasts, exhibited postural instability. Methods: Postural data were examined using traditional tests of means and compared to normative data. Results: Breachers had significantly lower NeuroCom Sensory Organization Test (SOT) visual scores (within normative limits), prolonged Limits of Stability (LOS) test reaction time (30% of breachers and 7% of controls testing abnormal), and slower LOS movement velocity (21% of breachers and 0% of controls testing abnormal) compared to controls. Conclusion: Our LOS test findings are like those previously reported for students in the military breacher training course and seem to indicate that while acute effects of blasts on sensory control of balance fade away, effects on postural LOS persist over time. [ABSTRACT FROM AUTHOR]

Balance can be defined as keeping the center of gravity of the body within the surface of the support and has crucial role in sport. However, there are insufficient knowledge regarding balance field testing. The main aim of this study was to determine association between Biodex laboratory balance test and Y balance field test. The participants in this study were 12 students (6 males, 6 females) of Faculty of Kinesiology in Split, Croatia. The set of variables included anthropometric measures (body height, body weight, body mass index), two laboratory balance tests conducted on Biodex (Postural stability test, Limits of stability test) and field balance test (Y balance test). The correlations between observed variables were calculated by Pearson's product moment correlation. No significant correlations were found between Y balance test and both Postural stability test (r=-0.06 and 0.02 respectively for left and right leg) and Limits of stability test (r=-0.06 and 0.02). The results of this study indicate that Y balance test is not a precise measure of balance ability in well-trained individuals. Authors hypothesize that Y balance test performance is greatly influenced by lower extremity strength and mobility. There is an obvious need for the construction and validation of new field tests to assess the level of balance in amateur and professional athletes. [ABSTRACT FROM AUTHOR]

Gait initiation (GI) includes automatic and voluntary movements. However, research on their impact on the first step in patients with Parkinson's disease (PD) and their relationship to freezing of gait (FOG) is lacking. We examined the effects of automatic movements (anticipatory postural adjustments [APAs]) and voluntary movements (limits of stability [LOS]) on the first step (first-step duration and first-step range of motion), along with their early recognition and prediction of slight FOG. Twenty-three patients with PD and slight freezing (PD + FOG) and 25 non-freezing patients with PD (PD-FOG) were tested while off medications and compared with 24 healthy controls (HC). All participants completed a 7-m Stand and Walk Test (7 m SAW) and wore inertial sensors to quantify the APAs and first step. LOS was quantified by dynamic posturography in different directions using a pressure platform. We compared differences among all three groups, analysed correlations, and evaluated their predictive value for slight FOG. In PD + FOG, APAs and LOS were worse than those in the PD-FOG and HC groups (p < 0.001), and the first step was worse than that in HC (p < 0.001). APAs were correlated mainly with the first-step duration. APAs and LOS were correlated with the first-step range of motion. APAs have been recognized as independent predictors of FOG, and their combination with LOS enhances predictive sensitivity. APAs and LOS in patients with PD directly affect the first step during GI. In addition, the combination of APAs and LOS helped predict slight FOG. • Anticipatory postural adjustments and limits of stability in patients with PD directly affected first-step duration and first-step range during the gait initiation. • Automatic movements such as anticipatory postural adjustments are more sensitive for predicting the occurrence of FOG than voluntary movements such as limits of stability. • The combination of anticipatory postural adjustments and limits of stability was helpful for predicting slight FOG. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the relationships between the Multi-Directional Reach Test (MDRT) and lower extremity strength in typical children. Methods: The MDRT including forward, backward, leftward, and rightward directions was measured in 60 children aged between 7 and 12 years old with typical development. The lower extremity muscle groups were measured using a hand-held dynamometer. Results: The reaching score in each direction had positive relationships with the strengths of several lower extremity muscle groups (r=0.26 to 0.52,p

Background: People with from Parkinson's disease (PD) and freezing of gait (FoG) have more frequent falls compared to those who do not freeze but there is no consensus on which, specific objective measures of postural instability are worse in freezers (PD + FoG) than non-freezers (PD-FoG).Research Question: Are functional limits of stability (fLoS) or postural sway during stance measured with wearable inertial sensors different between PD + FoG versus PD-FoG, as well as between PD versus healthy control subjects (HC)?Methods: Sixty-four PD subjects with FoG (MDS-UPDRS Part III: 45.9 ± 12.5) and 80 PD subjects without FoG (MDS-UPDRS Part III: 36.2 ± 10.9) were tested Off medication and compared with 79 HC. Balance was quantified with inertial sensors worn on the lumbar spine while performing the following balance tasks: 1) fLoS as defined by the maximum displacement in the forward and backward directions and 2) postural sway area while standing with eyes open on a firm and foam surface. An ANOVA, controlling for disease duration, compared postural control between groups.Results: PD + FoG had significantly smaller fLoS compared to PD-FoG (p =  0.004) and to healthy controls (p <  0.001). However, PD-FoG showed similar fLoS compared to healthy controls (p =  0.48). Both PD+FoG and PD-FoG showed larger postural sway on a foam surface compared to healthy controls (p =  0.001) but there was no significant difference in postural sway between PD+FoG and PD-FoG.Significance: People with PD and FoG showed task-specific, postural impairments with smaller fLoS compared to non-freezers, even when controlling for disease duration. However, individuals with PD with or without FoG had similar difficulties standing quietly on an unreliable surface compared to healthy controls. Wearable inertial sensors can reveal worse fLoS in freezers than non-freezers that may contribute to FoG and help explain their more frequent falls. [ABSTRACT FROM AUTHOR]

Background Limited research exists on the effects of both high and low frequency whole body vibration (WBV) on individuals with subacute lateral ankle sprains. Hypothesis/Purpose To examine the difference in the effects of high and low frequency WBV on limits of stability (LOS) in adults with a subacute ankle sprain. It was hypothesized that WBV would improve effects on outcome variables for LOS as a component of dynamic balance. Study Design Quasi-experimental, pretest-posttest design. Methods Fifteen participants ages 19-27 years (Mean age 22±2.36) with either a Grade I or Grade II lateral ankle sprain received WBV in bilateral stance under three randomized conditions (high frequency-25 Hz, low frequency-6 Hz, and control, which consisted of bilateral stance with machine off) for six minutes over three sessions (one time per week). The LOS test, consisting of 5 variables, were assessed using the NeuroCom® Balance Manager-SMART EquiTest® (Natus Medical Incorporated, Pleasanton, CA) at baseline and after the intervention period. The participants completed a practice LOS test and then had a six-minute standing rest break. After the rest break, they completed the pre-LOS (baseline) test. Intervention was administered using the Galileo® Med L Chip Research (Novotec Medical GmbH, Pforzheim, Germany) for six minutes for the appropriate condition of either high or low frequency WBV or control. Data analysis was performed using 2-Way (2x3) Repeated Measures ANOVAs with additional post hoc testing as needed. Results Significant interactions were found for reaction time (RT), movement velocity (MVL), and maximal excursion (MXE) composite scores with a decrease in RT of 0.117 seconds (p=0.022) between control and high frequency conditions during the post LOS. For composite MVL, an increase of 0.547 degrees/second (p=0.002) between pre- and post-high frequency WBV occurred. For composite MXE, an increase of 2.13% p=0.031 (when comparing pre- and post-high frequency WBV. Conclusion Findings suggest that a single session of high frequency WBV in individuals with a subacute lateral ankle sprain may result in improvement in several components of postural stability. WBV is a quick intervention that could be implemented in physical therapy clinics, athletic training rooms, and workout facilities to improve an individual's LOS as a component of dynamic balance one to eight weeks post lateral ankle sprain. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether young adolescent female artistic gymnasts demonstrate better functional stability than age- and sex-matched non-athletes. Different characteristics of the gymnasts' postural control were expected to be observed. Twenty-two 10- to 13-year-old healthy females (ten national-level artistic gymnasts and twelve non-athletes) participated in the study. To assess their forward functional stability, the 30-s limit of stability test was performed on a force plate. The test consisted of three phases: quiet standing, transition to maximal forward leaning, and standing in the maximal forward leaning position. Between-group comparisons of the directional subcomponents of the root mean squares and mean velocities of the center of pressure and rambling-trembling displacements in two phases (quiet standing and standing in maximal leaning) were conducted. Moreover, anterior stability limits were compared. During standing in maximal forward leaning, there were no differences in the center of pressure and rambling measures between gymnasts and non-athletes (p > 0.05). The values of trembling measures in both anterior-posterior and medial-lateral directions were significantly lower in gymnasts (p < 0.05). Both groups presented similar values for anterior stability limits (p > 0.05). The comparisons of rambling components may suggest a similar supraspinal control of standing in the maximal leaning position between gymnasts and healthy non-athletes. However, decreased trembling in gymnasts may indicate reduced noise in their postural control system possibly due to superior control processes at the spinal level. The anterior stability limit was not influenced by gymnastics training in female adolescents. [ABSTRACT FROM AUTHOR]

Introduction: The ability to react quickly to changing external stimuli, to move the body rapidly and precisely in any direction and to maintain the center of gravity above the support base, all contribute to maintaining balance in dynamic conditions. The Limits of Stability Test (LOS) provides information on the state of dynamic balance in a standing position. Aim: Assessment of dynamic postural control in developmental age. Material: 127 healthy children (65 girls and 62 boys) aged 6-17 years. Methods: All children underwent LOS test (NeuroCom posturograph) with registration of: reaction time (RT), movement velocity (MVL), directional control (DCL), maximum excursion (MXE), and endpoint excursion (EPE). Results: At the age of 6-7 years, we observed not fully developed jumping strategy and visual feedback mechanism in the control of movement. All tested parameters were significantly worse in children aged 6-9 years. After this period, a significant improvement in TR and MVL was noted, with no significant changes in subsequent age groups while significant improvement in MXE up to 12 years of age, and EPE and DCL up to 13 years of age was found. No significant gender differences were found in the LOS test parameters. Conclusions: (1) LOS test showed significantly lower dynamic balance development in children aged 6-7 years; (2) The study showed a significant improvement in all parameters of the LOS test up to 13 years of age, which supports the termination of the function at that time. [ABSTRACT FROM AUTHOR]

A 6-wk group balance-training program was conducted with physically active older adults (based on American College of Sports Medicine requirements) to investigate the effect of dose-related static and dynamic balance-specific training. All participants, age 60-87 yr, continued their regular exercise program while adding balance training in 1 of 3 doses: three 20-min sessions/wk (n = 20), one 20-min session/wk (n = 21), or no balance training (n = 19). Static balance (singleleg- stance, tandem), dynamic balance (alternate stepping, limits of stability), and balance confidence (ABC) were assessed pre- and posttraining. Significant interactions were observed for time in single-leg stance, excursion in limits of stability, and balance confidence, with the greatest increase observed in the group that completed 3 training sessions/wk. The results demonstrate a dose-response relationship indicating that those who are already physically active can improve balance performance with the addition of balance-specific training. [ABSTRACT FROM AUTHOR]

Objective: To determine exercise efficacy in improving dynamic balance in community-dwelling elderly with a fall history. Methods: Thirty-five participants were randomly assigned to a treatment (TG; n = 19, 77 ± 7 yr) or control group (CG; n = 16, 75 ± 8 yr). The TG received an individualized home exercise program, and the CG received phone calls twice per week for 12 weeks. Participants' dynamic-balance abilities- directional control (DC), endpoint excursion (EE), maximum excursion (ME), reaction time (RT), and movement velocity (MV)-were measured using the Balance Master at 75% limits of stability. Functional reach (FR) was also measured. Results: At 12 weeks the TG demonstrated significant improvements in DC (p < .0025), EE (p < .0005), and ME (p < .0005), but the CG did not. No significant group differences were found for MV, RT, or FR. Conclusions: Excursion distances and directional control improved but not reaction time, suggesting that exercises requiring quick responses may be needed. [ABSTRACT FROM AUTHOR]

Abstract Background Aging is associated with decreased balance, which increases falling risk. The objective of the current study was to determine the feasibility and effects of whole-body vibration (WBV) training on knee extensor muscle power, limits of stability, and sit-to-stand performance among community-dwelling middle-aged and older adults in the United States. Methods A randomized pilot study with participant blinding was conducted. Feasibility outcomes included recruitment and compliance rate. Twenty-nine community-dwelling older adults were randomly assigned to perform body-weight exercises with either an individualized vibration frequency and amplitude, a fixed vibration frequency and amplitude, or no vibration. Isokinetic knee extensor power, limits of stability, and sit-to-stand tests were conducted before beginning the exercises (baseline) and after 8 weeks of training. Results With a favorable recruitment rate (58%) and compliance rates (attrition 9%; adherence 85%), the intervention was deemed feasible. The limits of stability endpoint excursion score for the individualized frequency–amplitude group was increased by 8.8 (12.9%; P = 0.025) after training, and that group’s maximum excursion score was increased by 9.2 (11.5%; P = 0.006) after training. The average weight transfer time score was significantly decreased by 0.2 s in the fixed group. The participants in the individualized group demonstrated a significant increase (3.2%) in weight rising index score after 8 weeks of WBV training. Conclusions WBV training is feasible for use with elderly people, and this study achieved good recruitment and compliance. The present paper suggests that 8 weeks of WBV training improves limits of stability and sit-to-stand performance. Future studies must determine whether WBV training improves other factors that affect posture control. Trial registration This study was registered at the Texas Woman’s University Institutional Review Board [ TWU IRB 17632 ] on the 3rd of November 2014.

Background sufficient research has not been conducted to determine the role of core and lower limb muscles in providing balance in older people. Objective to investigate the relationships between the thickness of core/lower limb muscles and static/dynamic balance in older people. Methods the study included a total of 68 older people (≥ 65 years) and 68 gender-matched young subjects, aged 20–40 years. Balance, knee proprioception sense, regional and total muscle measurements and grip strength were assessed using a force platform system, isokinetic dynamometer, ultrasound imaging, bioelectrical impedance analysis and Jamar dynamometer, respectively. Results all the static (postural sway) parameters were higher and all the dynamic (limits of stability) parameters were lower in the older adults compared to the young adults (all P <0.05). The diaphragm was thicker and all the other muscles (except for multifidus and tibialis anterior) were thinner in the older group (all P <0.05). A higher error of knee proprioception sense was determined at 45 and 70 degrees in the older subjects (both P <0.001). According to the multivariate analyses, significant predictors for balance were age, gender, height, and rectus femoris, vastus intermedius and diaphragm muscle thicknesses in the older group, and age, gender, height, grip strength, and rectus abdominis, internal oblique, longissimus, tibialis anterior and soleus muscle thicknesses in the young group (all P <0.05). Conclusions the thickness of core/lower limb muscles are important determinants of balance in both older and young adults. These findings could provide a strong rationale for strengthening specific (abdominal and quadriceps) muscles to prevent falls and regional sarcopenia, and to improve posture/balance in the older population. Clinical trial registration number NCT03791047 Ethics committee approval Hacettepe University Non-interventional Clinical Research Ethics Board. Decision number:GO 18/506-39 [ABSTRACT FROM AUTHOR]