Is the method of signal analysis and test selection important for measuring standing balance in subjects with persistent whiplash?

Dizziness and or unsteadiness, associated with episodes of loss of balance, are frequent complaints in those suffering from persistent problems following a whiplash injury. Research has been inconclusive with respect to possible aetiology, discriminative tests and analyses used. The aim of this pilot research was to identify the test conditions and the most appropriate method for the analysis of sway that may differentiate subjects with persistent whiplash associated disorders (WAD) from healthy controls. The six conditions of the Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance in 20 subjects with persistent WAD compared to 20 control subjects. The analyses were carried out using a traditional method of measurement, total sway distance, to results obtained from the use of wavelet analysis. Subjects with WAD were significantly less able to complete the tandem stance tests on a firm surface than controls. In comfortable stance, using wavelet analysis, significant differences between subjects with WAD and the control group were evident in total energy of the trace for all test conditions apart from eyes open on the firm surface. In contrast, the results of the analysis using total sway distance revealed no significant differences between groups across all six conditions. Wavelet analysis may be more appropriate for detecting disturbances in balance in whiplash subjects because the technique allows separation of the noise from the underlying systematic effect of sway. These findings will be used to direct future studies on the aeitiology of balance disturbances in WAD. (c) 2004 Elsevier B.V. All rights reserved.

Effect of experimentally induced low back pain on postural sway with breathing

Although breathing perturbs balance, in healthy individuals little sway is detected in ground reaction forces because small movements of the spine and lower limbs compensate for the postural disturbance. When people have chronic low back pain (LBP), sway at the ground is increased, possibly as a result of reduced compensatory motion of the trunk. The aim of this study was to determine whether postural compensation for breathing is reduced during experimentally induced pain. Subjects stood on a force plate with eyes open, eyes closed, and while breathing with hypercapnoea before and after injection of hypertonic saline into the right lumbar longissimus muscle to induce LBP. Motion of the lumbar spine, pelvis, and lower limbs was measured with four inclinometers fixed over bony landmarks. During experimental pain, motion of the trunk in association with breathing was reduced. However, despite this reduction in motion, there was no increase in postural sway with breathing. These data suggest that increased body sway with breathing in people with chronic LBP is not simply because of reduced trunk movement, but instead, indicates changes in coordination by the central nervous system that are not replicated by experimental nociceptor stimulation.

Somatosensation, circulation and stance balance in elderly dysvascular transtibial amputees

Objective: To establish the relationship between poor lower limb somatosensory and circulatory status with standing balance, falls history, age and mobility level in dysvascular transtibial amputees (TTAs). Design: Within-subjects evaluation of somatosensation, circulation and stance balance measures in dysvascular transtibial amputees. Setting: Physiotherapy department of a tertiary metropolitan hospital in Australia. Participants: Twenty-two community-dwelling unilateral dysvascular transtibial amputee volunteers, aged between 54 and 86 recruited from a metropolitan hospital outpatient amputee clinic. Main outcome measures: Lower limb vibration sense, light touch sensation and circulatory status were related to centre of pressure excursion during quiet stance, dynamic balance measures of forward and lateral reach distance, and demographic information such as falls history and mobility level. Results: Overall, poor somatosensory status was associated with poor stance balance. There was an association between poor vibration and circulation and increased centre of pressure excursion in quiet stance and reduced reach distance, whereas poor light touch was linked with even weight-bearing in quiet stance. Poor vibration sense was associated with a history of frequent falls. Conclusions: Compromised lower limb somatosensation and circulation was linked with poor balance and a history of frequent falls in the elderly dysvascular amputee population.

The influence of natural body sway on neuromuscular responses to an unpredictable surface translation

Previous research has shown that the postural configuration adopted by a subject, such as active leaning, influences the postural response to an unpredictable support surface translation. While those studies have examined large differences in postural conditions, it is of additional interest to examine the effects of naturally occurring changes in standing posture. Thus, it was hypothesized that the normal postural sway observed during quiet standing would affect the responses to an unpredictable support surface translation. Seventeen young adults stood quietly on a moveable platform and were perturbed in either the forward or backward direction when the location of the center of pressure (COP) was either 1.5 standard deviations anterior or posterior to the mean baseline COP signal. Postural responses, in the form of electromyographic (EMG) latencies and amplitudes, were recorded from lower limb and trunk muscles. When the location of the COP at the time of the translation was in the opposite, as compared to the same, direction as the upcoming translation, there was a significantly earlier onset of the antagonists (10-23%, i.e. 15-45 ms) and a greater EMG amplitude (14-39%) in four of the six recorded muscles. Stepping responses were most frequently observed during trials where the position of the COP was opposite to the direction of the translation. The results support the hypothesis that postural responses to unpredictable support surface translations are influenced by the normal movements of postural sway. The results may help to explain the large variability of postural responses found between past studies.

Normal values of balance tests in women aged 20-80

OBJECTIVES: To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging. DESIGN: A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts. SETTING: The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia. PARTICIPANTS: Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region. MEASUREMENTS: The clinical balance measures/tests were the Timed Up and Go test, step test, Functional Reach test, and lateral reach test. Multivariate analysis was used to test the effect for age, height, and activity level. RESULTS: Normal data were produced for each test across each decade cohort. Gradual decline in balance performance was confirmed, with significant effect for age demonstrated. CONCLUSION: New normative data across the adult age decades are available for these clinical tests. Use of clinical balance tests could complement other balance tests and be used to screen women aged 40 to 60 whose performance is outside the normal values for age and to decrease later falls risk.

The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash

Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical ME alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The results indicated that over all subjects, significant but weak-to-moderate correlations existed between all comfortable stance balance tests and both the SPNT and rotation cervical ME tests. A weak correlation was found between the SPNT and right rotation cervical JPE. An abnormal rotation cervical JPE score had a high positive prediction value (88%) but low sensitivity (60%) and specificity (54%) to determine abnormality in balance and or SPNT test. The results suggest that in patients with persistent WAD, it is not sufficient to measure ME alone. All three measures are required to identify disturbances in the postural control system. (C) 2005 Elsevier Ltd. All rights reserved.

Estrogen replacement, muscle composition, and physical function: The health ABC study

Purpose: Although the beneficial effects of estrogen use on cardiovascular and cognitive function in postmenopausal women have been recently discredited, controversy remains regarding its usefulness for maintaining skeletal muscle mass or strength. Therefore, the purpose of this study was to determine whether estrogen use is associated with enhanced muscle composition and, if so, whether this translates into improved strength and physical function. Methods: Cross-sectional analysis of 840 well-functioning community-dwelling white women (current estrogen replacement therapy (ERT) users = 259, nonusers = 581) aged 70-79 yr participating in the Health, Aging and Body Composition Study. Muscle composition of the midthigh by computed tomography included cross-sectional area (CSA) of the quadriceps, hamstrings, intermuscular fat and subcutaneous fat, and muscle attenuation in Hounsfield units (HU) as a measure of muscle density. Isometric hand grip and isokinetic knee extensor strength were assessed by dynamometry. Physical function was assessed using a summary scale that included usual 6-m walk and narrow walk speed, repeated chair stands, and standing balance. Results: In analyses of covariance adjusted for relevant confounders. quadriceps muscle CSA and HU were greater in Current ERT than non-ERT women (P < 0.05). Grip strength was also greater (P < 0.05) in women taking ERT while knee extensor strength approached significance (P < 0.10). However, differences in muscle composition and strength were modest at <= 3.3%. There was no difference by ERT status for the hamstring, muscles. fat CSA. or for physical function. Conclusion: The associations between ERT and muscle composition and strength were minor and did not translate into improved physical function. Initiation of ERT for preservation of muscle composition and function may not be indicated.

Do you know where your arm is if you think your head has moved?

Reproduction of a previously presented elbow position is affected by changes in head position. As movement of the head is associated with local biomechanical changes, the aim of the present study was to determine if illusory changes in head position could induce similar effects on the reproduction of elbow position. Galvanic vestibular stimulation (GVS) was applied to healthy subjects in supine lying. The stimulus was applied during the presentation of an elbow position, which the subject then reproduced without stimulation. In the first study, 13 subjects received 1.5 mA stimuli, which caused postural sway in standing, confirming that the firing of vestibular afferents was affected, but no illusory changes in head position were reported. In the second study, 13 subjects received 2.0-3.0 mA GVS. Six out of 13 subjects reported consistent illusory changes in head position, away from the side of the anode. In these subjects, anode right stimulation induced illusory left lateral flexion and elbow joint position error towards extension (p=0.03), while anode left tended to have the opposite effect (p=0.16). The GVS had no effect on error in subjects who did not experience illusory head movement with either 1.5 mA stimulus (p=0.8) or 2.0-3.0 mA stimulus (p=0.7). This study demonstrates that the accuracy of elbow repositioning is affected by illusory changes in head position. These results support the hypothesis that the perceived position of proximal body segments is used in the planning and performance of accurate upper limb movements.

Hip strategy for balance control in quiet standing is reduced in people with low back pain

Study Design. Quiet stance on supporting bases with different lengths and with different visual inputs were tested in 24 study participants with chronic low back pain (LBP) and 24 matched control subjects. Objectives. To evaluate postural adjustment strategies and visual dependence associated with LBP. Summary of Background Data. Various studies have identified balance impairments in patients with chronic LBP, with many possible causes suggested. Recent evidence indicates that study participants with LBP have impaired trunk muscle control, which may compromise the control of trunk and hip movement during postural adjustments ( e. g., hip strategy). As balance on a short base emphasizes the utilization of the hip strategy for balance control, we hypothesized that patients with LBP might have difficulties standing on short bases. Methods. Subjects stood on either flat surface or short base with different visual inputs. A task was counted as successful if balance was maintained for 70 seconds during bilateral stance and 30 seconds during unilateral stance. The number of successful tasks, horizontal shear force, and center-of-pressure motion were evaluated. Results. The hip strategy was reduced with increased visual dependence in study participants with LBP. The failure rate was more than 4 times that of the controls in the bilateral standing task on short base with eyes closed. Analysis of center-of-pressure motion also showed that they have inability to initiate and control a hip strategy. Conclusions. The inability to control a hip strategy indicates a deficit of postural control and is hypothesized to result from altered muscle control and proprioceptive impairment.

Simplest tasks have greatest dual task interference with balance in brain injured adults

Attention difficulties and poor balance are both common sequel following a brain injury. This study aimed to determine whether brain injured adults had greater difficulty than controls in performing a basic balance task while concurrently completing several different cognitive tasks varying in visuo-spatial attentional load and complexity. Twenty brain injured adults and 20 age-, sex- and education level-matched controls performed a balance-only task (step stance held for 30s), five cognitive-only tasks (simple and complex non-spatial, visuo-spatial, and a control articulation task), and both together (dual tasks). Brain injured adults showed a greater centre of pressure (COP) excursion and velocity in all conditions than controls. Brain injured adults also demonstrated greater interference with balance when concurrently performing two cognitive tasks than control subjects. These were the control articulation and the simple non-spatial task. It is likely that distractibility during these simple tasks contributed to an increase in COP motion and interference with postural stability in stance. Performing visuo-spatial tasks concurrently with the balance task did not result in any change in COP motion. Dual task interference in this group is thus unlikely to be due to structural interference. Similarly, as the more complex tasks did not uniformly result in increased interference, a reduction in attentional capacity in the brain injured population is unlikely to be the primary cause of dual task interference in this group. (C) 2004 Elsevier B.V. All rights reserved.

Toposequential effects on water balance and productivity in rainfed lowland rice ecosystem in Southern Laos

In the Mekong region, most paddies in rainfed lowland rice (Oryza sativa L.) lie in a sequence on gentle sloping land, and grain yield (GY) often depends on the toposequence position. There is, however, lack of information on toposequential effects on field water supply in rainfed lowland rice and how that influences GY. A total of eight field experiments were carried out on sandy, coarse-textured soils in Southern Laos (Champassak Province and Savannakhet Province) over three wet seasons (2000-2002). Components of the water balance, including downward and lateral water movement (D and L, respectively), were quantified at three different positions along toposequences (top, middle and bottom). GY, days-to-flower (DTF) and rainfall were measured, and the water productivity (WP) was determined. In most experiments, standing water disappeared first in the top position and gradually in lower positions. This was associated with the observation that when there was standing water in the field, the higher position had larger D in both the provinces and also larger L in Champassak Province. However, in one experiment, water loss appeared later in the higher position, as the result of lower L, apparently due to some water inputs other than rainfall occurring at this position. Despite larger D plus L at the top position, seasonal sum of D and L were not much affected by the toposequence position, as the daily rate of D plus L became minimal when the standing water was lost earlier in the top position. Lower GY was associated with earlier disappearance of standing water from the field. Relatively low GY was expected in the top toposequence position. This was clearly shown in the toposequence of Phonthong, Champassak Province, as the timing of standing water disappearance relative to flowering was earlier in the top position. Variation in GY across the toposequence positions was coupled with the WP variation, and both GY and WP tended to decline with increased DTF. Therefore, variation in productivity of rainfed lowland rice across toposequence positions depends mainly on the field water status around flowering time. (c) 2005 Elsevier B.V. All rights reserved.

The effects of sway velocity on the triceps surae H-reflex during quiet standing

We have previously observed a change in the magnitude of the soleus (SOL) and medial gastrocnemius (MG) H-reflexes during different sway positions of quiet standing. The purpose of the present study was to extend the earlier finding by examining whether the SOL and MG H-reflexes are additionally influenced by the velocity of sway, i.e., whether the body is swaying in either the forward or backward direction. Five healthy subjects participated in the study. The mean position of the centre of pressure (COP) in the antero-posterior direction was determined while the subject stood quietly on a force plate for 60 s. In contrast to the earlier study, where the H-reflex was tested at the outermost positions of sway (±6 mm from the baseline mean), the current study elicited a SOL and MG H-reflex as the COP passed through the mean position of sway. This resulted in two sway conditions, where the position of the COP was the same but the sway velocity was different (10 mm s-1 forward and 10 mm s-1 backward). During the forward as compared to the backward velocity condition, there was a 20% and 25% increase in the amplitude of the H-reflex for the SOL and MG muscles, respectively, while the size of their respective background activities were the same. SOL and MG M-waves, as well as the level of background activity from the antagonist (tibialis anterior), were not different between the two sway conditions and thus cannot account for the observed changes to the amplitude of the H-reflexes. It can be concluded from these results that the direction (velocity) of sway has the ability to influence the size of the SOL and MG H-reflexes. The facilitation of the SOL and MG H-reflexes observed while swaying forward may be due to a reduction in presynaptic inhibition or an improvement in Ia synaptic efficacy brought about by changes in muscle length.