scholarly journals Balance control enhancement using sub-sensory stimulation and visual-auditory biofeedback strategies for amputee subjects

2007 ◽  
Vol 31 (4) ◽  
pp. 342-352 ◽  
Author(s):  
Ming-Yih Lee ◽  
Chih-Feng Lin ◽  
Kok-Soon Soon
Keyword(s):  
Electrical Stimulation ◽  
Balance Control ◽  
Sensory Stimulation ◽  
Quiet Standing ◽  
Static Balance ◽  
Balance Performance ◽  
Foot Pressure ◽  
Gait Performance ◽  
Sound Side ◽  
Dynamic Gait

Sub-sensory electrical or mechanical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capabilities of elderly. In addition, clinical studies suggest that visual-auditory biofeedback can improve sensory compensation for the elderly. This study hypothesizes that the static balance and gait performance of single leg quiet standing and treadmill walking could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation and visual-auditory biofeedback in amputee subjects. To test this, a computerized foot pressure biofeedback sensory compensation system using sub-threshold low-level electrical stimulation combined with visual-auditory biofeedback was developed. Seven unilateral trans-tibial amputees who wore prostheses over 2 years were recruited. The subjects performed multiple single leg quiet standing trials with sub-sensory electrical stimulation applied at the quadriceps muscle during half of the trials. Static balance performance was characterized by using a Zebris motion analysis system to measure the sway distance and duration of the centre of mass on the second sacral (S2) of the subjects. In addition, multiple treadmill ambulatory trials with or without visual-auditory biofeedback was performed. Dynamic gait performance was characterized with a Zebris instrumented insole to measure the temporal responses of foot pressure sensors. Experimental results showed an improvement in three balance performance indices (Holding Time Index, HTI, Maximum Sway Distance Index, MSDI, and Average Sway Distance Index, ASDI) during single leg quiet standing by applying sub-sensory stimulation. The improvement ratio of these balance performance indices across subjects for single leg quiet standing tests resulted in 132.34% in HTI, 44.61% in MSDI, and 61.45% in ASDI. With visual-auditory biofeedback as a cue for heel contact and toe push-off condition during treadmill ambulation, the improvement of four dynamic gait performance measures (Double Support Period, DSP, Constant Time Cadence, CTC, Single Support Period, SSP, and Stance/Swing Ratio, SSR) in amputees was verified. This resulted in 7.89% in DSP (affected side), 5.09% in CTC, 16.67% in SSP (sound side), 45.30% in SSR (sound side), and 40.30% in SSR (affected side) respectively. These findings suggest that sub-threshold electrical stimulation and visual-auditory biofeedback rehabilitation strategies may be effective in compensating sensory loss and improving static balance and dynamic ambulation performance for amputees.

scholarly journals Static Standing Trunk Sway Assessment in Amputees – Effects of Sub-Threshold Stimulation

2007 ◽  
Vol 4 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. Ming-Yih ◽  
S. Kok-Soon ◽  
L. Chih-Feng
Keyword(s):  
Electrical Stimulation ◽  
Postural Sway ◽  
Balance Control ◽  
Somatosensory System ◽  
Sensory Stimulation ◽  
Quiet Standing ◽  
Static Balance ◽  
Balance Performance ◽  
Standing Test ◽  
Postural Steadiness

Sub-threshold electrical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capability of elderly was shown in recent rehabilitation articles. The purpose of this study was to evaluate the postural sway of trans-tibial amputees when performing single leg quiet standing on firm surface. Four unilateral trans-tibial amputees who consecutively wore prosthetics over 2 years were recruited in this study. Subjects performed single leg quiet standing trails with sub-threshold electrical stimulation applied at the quadriceps muscle during the trails. Spatial co-ordinates for the determination kinematic data (sway distance) of the center of mass (COM) on second sacral (S2) were collected using an ultrasound-based Zebris CMS-HS system. The single leg quiet standing test is measure considered to assess postural steadiness in a static position by a spatial measurement. The common notion is that a better postural steadiness, i.e. less postural sway, allows for longer time single leg quiet standing. However, there is lack of evidence how postural steadiness during single leg quiet standing changes over time. In this article, we hypothesized that the static balance of single leg quiet standing could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation in amputees. To test this hypothesis, a computerized sub-threshold low-level electrical stimulation device was developed and proposed for clinical study. Experimental results show that reduction in all of the postural sway indices (constant time sway length, max sway distance and average sway distance) and increase in single leg support time index during single leg quiet standing by applying sub-sensory stimulation. The single leg quiet standing test findings suggest that sub-threshold electrical stimulation rehabilitation strategies may be effective in improving static balance performance for amputees.

DESIGN OF A NEW BIOFEEDBACK PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION SYSTEM FOR BELOW-KNEE AMPUTEES

2006 ◽  
Vol 18 (04) ◽  
pp. 190-197 ◽  
Author(s):  
MING-YIH LEE ◽  
CHIH-FENG LIN ◽  
KOK-SOON SOON
Keyword(s):  
Electrical Stimulation ◽  
Balance Control ◽  
Balance Performance ◽  
Performance Indices ◽  
Gait Performance ◽  
Time Index ◽  
Affected Side ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Sound Side ◽  
Sensory Compensation

Proprioceptive neuromuscular facilitation and foot sensory compensation are critical to balance control and ambulatory performance in below-knee amputees. Sub-sensory stimulation has been shown to be effective in enhancing the sensitivity of the human somatosensory system. In addition, visual-auditory biofeedback to improve foot sensory compensation for amputees was suggested in recent articles. The purpose of this study is to develop a new biofeedback proprioceptive neuromuscular facilitation system for improving balance control and foot sensory compensation in below-knee amputees. The proposed system functioned with sub-threshold electrical stimulation and visual-auditory biofeedback was developed for clinical study. Two unilateral trans-tibial amputees who consecutively wore prosthetics over 10 years were participated in this study. Subjects performed multiple single leg quite standing trails with sub-sensory electrical stimulation applied at the quadriceps muscle during half of the trails. Four static balance performance indices (i.e. Holding Time Index, HTI; Sway Length Index, SLI; Max Sway Distance Index, MSDI; Average Sway Distance Index, ASDI) were characterized using Zebris motion analysis system. The improvement ratio of these static balance performance indices across subjects for single leg quiet standing tests were resulted in a 209.7% in HTI, 39.1% in SLI, 24.3% in MSDI, and 65.4% in ASDI respectively. In addition, multiple treadmill ambulatory trails with or without visual-auditory biofeedback were evaluated. Four dynamic gait performance indices (i.e. Double Support Time Index, DSTI; Constant Time Cadence Index, CTCI; Single Support Time Index, SSTI; Stance/Swing Phase Index, SSPI) were characterized with Zebris instrumented insole and associated FMS analysis software. With visual-auditory biofeedback, the improvement of all four dynamic gait performance indices in below-knee amputees was verified. The improvement ratio of four gait performance indices across subjects resulted in a 14.81% in DSTI (sound side), 14.29% in DSTI (affected side), 14% in CTCI, 13.00% in SSTI (sound side), 6.02% in SSTI (affected side), 45.17% in SSPI (sound side), and 27.49% in SSPI (affected side) respectively. These findings suggest that sub-threshold electrical stimulation and visual-auditory biofeedback proprioceptive neuromuscular facilitation strategies may be effective in compensating foot sensory loss and improving balance control for below-knee amputees.

Static and Dynamic Plantar Pressure and Normalized Plantar Pressure Characteristics among Children, Adults, and the Elderly

2021 ◽  
Vol 104 (12) ◽  
pp. 1881-1887
Keyword(s):  
Young Adults ◽  
Plantar Pressure ◽  
Center Of Pressure ◽  
The Elderly ◽  
Quiet Standing ◽  
Foot Pressure ◽  
Gait Performance ◽  
Plantar Pressures ◽  
Balance Ability ◽  
Pressure Characteristics

Background: A better understanding of plantar pressure while standing and walking would help in improving balance and gait performance across different age ranges. Objective: To clarify the differences of plantar pressure while standing and walking among children, adults, and the elderly. Materials and Methods: Fifty-three participants including eleven aged 3 to 8 years, thirty aged 20 to 40 years, and twelve aged 60 to 90 years were included in the present study. Plantar pressure and related parameters while quiet standing and walking with self-selected speed were assessed. Results: In static plantar pressure, no significant differences were observed of mean different pressure and mean different contact area between dominant and non-dominant limbs among the three groups, while center of pressure (COP) displacement was shown as significantly greater between children and adults (p<0.05). For dynamic plantar pressure, no significant differences in COP velocity were found among the three groups. The elderly showed significant lower normalized maximum plantar pressure in areas of the second and third metatarsal, and internal heel compared with the young adults (p<0.05). Additionally, normalized maximum plantar pressures among children seemed to differ from adults. Conclusion: Plantar pressure characteristics could indicate that children develop gait ability in braking and propulsion phases with greater heel and toe function, while the ability of braking and propulsion declined with aging. These could reflect balance ability while standing or walking. Keywords: Foot pressure; Children; Elderly; Normalization

scholarly journals Trends in the Analysis of Static Balance

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Vilma Juodžbalienė ◽  
Kazimieras Muckus
Keyword(s):  
Postural Control ◽  
Physiological Parameters ◽  
Quiet Standing ◽  
Static Balance ◽  
Foot Pressure ◽  
Postural Control System ◽  
Balance Disorders ◽  
Dependent Variables ◽  
Center Of Foot Pressure ◽  
Anterior Posterior

The aim of the paper was to discuss the trends in the analysis of static balance and relation between physiological parameters and characteristics of posturograms. Static balance is ability to keep steady posture in certain stance [2, 3]. Posturography is one of most popular research methods of static balance [10, 11]. During the last decade it was maintained that the most informative dependent variables defining postural stability were the amplitude of the center of foot pressure (COP) sway in anterior-posterior and mediolateral directions, the length of the COP pathway and the area of the COP sway [9, 15]. The output of the posturograms registered during quiet standing is irregular and erratic [14]. Therefore, methods analyzing the structure of the posturograms are very topical for physiology and Rehabilitation science. The scientists attempt to determine certain noise and oscillation patterns in the posturogram [20]. According to researchers [14], the structure and roughness or smoothness of the posturogram could reflect the changes in postural control system. It is still questionable which of the methods analyzing the posturogram outcomes could be the most informative and useful for the diagnostics of postural control disorders. It is important to be able to repeat the scientific study, but it is still complicated to solve tasks related to postural control disorders diagnostics and the evaluation of the treatment means effectiveness. It is important to define the relation between physiological parameters and characteristics of posturograms in order to apply the posturography for balance disorders diagnostics. We suppose that methods of posturogram structure analysis could improve the differential balance disorders diagnostics essentially.Keywords: static balance, static posturography, center of foot pressure.

Footwear Interventions

2013 ◽  
Vol 103 (6) ◽  
pp. 516-533 ◽  
Author(s):  
Anna L. Hatton ◽  
Keith Rome ◽  
John Dixon ◽  
Denis J. Martin ◽  
Patrick O. McKeon
Keyword(s):  
Older People ◽  
Balance Control ◽  
Dynamic Balance ◽  
The Elderly ◽  
Quiet Standing ◽  
Long Term Effects ◽  
Balance Performance ◽  
Dynamic Movement ◽  
Balance Task ◽  
Older Populations

Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and explored proposed theories for underlying sensorimotor and mechanical mechanisms. We searched the Medline, EMBASE, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and AMED databases and conducted hand searches. Of 115 relevant articles screened, 14 met the predefined inclusion criteria. Articles were grouped into one of three categories based on balance task (static balance performance during quiet standing, dynamic balance performance during walking, and dynamic balance performance during perturbed standing or functional tasks) and were scored for methodological quality using the Downs and Black Quality Index tool. Footwear interventions seem to alter underlying strategies controlling static and dynamic movement patterns through a combination of sensorimotor and mechanical mechanisms in older people, including those with chronic sensory and musculoskeletal conditions. Evidence shows a consistent trend toward footwear interventions markedly improving lateral stability measures, which are predictors of falls in the elderly. In-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations. The long-term effects of footwear interventions on balance, gait, and the prevention of falls in older people require further investigation. (J Am Podiatr Med Assoc 103(6): 516–533, 2013)

scholarly journals Static balance adaptations after neuromuscular electrical stimulation on quadriceps and lumbar paraspinal muscles in healthy elderly

2021 ◽  
Author(s):  
Danilo Bondi ◽  
Tereza Jandova ◽  
Vittore Verratti ◽  
Moreno D’Amico ◽  
Edyta Kinel ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Balance Control ◽  
Neuromuscular Electrical Stimulation ◽  
Static Balance ◽  
Paraspinal Muscles ◽  
Combined Training ◽  
Healthy Elderly ◽  
Age Related ◽  
Paravertebral Muscles ◽  
Lumbar Paraspinal Muscles

Abstract Background Strength training as neuromuscular electrical stimulation (NMES) is effective in counteracting age-related postural impairments in elderly. However, it remains unknown whether training different muscle groups would entail in different adaptations. Aim To evaluate the effect of NMES training on balance function in healthy inactive elderly, targeting paravertebral muscles, in addition to thigh muscles. Methods Eleven healthy elderly were trained with NMES for 8 week allocated to combined training (CT: quadriceps and lumbar paraspinal muscles) or to quadriceps training (QT), after completing lifestyle questionnaire and spine morphology measurements. Functional balance, static stabilometry, and isometric strength tests were assessed before and after the training period. Results and conclusion The CT group showed a greater improve in static balance control, i.e., reducing the CEA of the CoP displacement from 99 ± 38 to 76 ± 42 mm2 (Cohen’s d = 0.947). Benefits for improving static balance through CT might be due to NMES training, which increases spinal stabilization.

scholarly journals Concussion History and Balance Performance in Adolescent Rugby Union Players

2021 ◽  
pp. 036354652199870
Author(s):  
Mark Matthews ◽  
William Johnston ◽  
Chris M. Bleakley ◽  
Richard J. Davies ◽  
Alan T. Rankin ◽  
...  
Keyword(s):  
Dual Task ◽  
Inertial Sensor ◽  
Dynamic Balance ◽  
Rugby Union ◽  
Static Balance ◽  
Balance Performance ◽  
Eyes Closed ◽  
History Of ◽  
Concussion History ◽  
Rugby Players

Background: Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. Hypothesis: Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes ( x, y, and z). Results: Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- ( P = .47) and dual-task ( P = .67) conditions. Conclusion: Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.

scholarly journals Effects of offloading devices on static and dynamic balance in patients with diabetic peripheral neuropathy: A systematic review

2021 ◽  
Author(s):  
Koen Andre Horstink ◽  
Lucas Henricus Vincentius van der Woude ◽  
Juha Markus Hijmans
Keyword(s):  
Systematic Review ◽  
Peripheral Neuropathy ◽  
Plantar Pressure ◽  
Diabetic Peripheral Neuropathy ◽  
Balance Control ◽  
Dynamic Balance ◽  
Movement Control ◽  
Future Research ◽  
Static Balance ◽  
Somatosensory Information

AbstractPatients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk. The aim of this systematic review is to investigate the effects of plantar offloading devices used for ulcer prevention on their role in static and dynamic balance control in patients with DPN. PubMed and Embase were systematically searched using relevant search terms. After title selection, abstract selection, and full-text selection only five articles could be included for further analysis. Two articles included static balance measurements, two articles included dynamic balance measurements, and one article included both. Results suggested that static balance control is reduced when rocker bottom shoes and different insole configurations are used, however, toe-only rockers showed less evidence for reduced static balance control. There was no evidence for reduced dynamic balance control in combination with offloading devices. However, these results should be interpreted with care, since the number of studies was very small and the quality of the studies was moderate. Future research should evaluate balance in combination with different offloading devices, so that clinicians subscribing them are more aware of their potential unwanted consequences.

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