Greater exposure to repetitive subconcussive head impacts is associated with vestibular dysfunction and balance impairments during walking

Exposure to repetitive subconcussive head impacts (RSHI), specifically soccer heading, is associated with white matter microstructural changes and cognitive performance impairments. However, the effect of soccer heading exposure on vestibular processing and balance control during walking has not been studied. Galvanic vestibular stimulation (GVS) is a tool that can be used to probe the vestibular system during standing and walking. The purpose of this study was to investigate the association of soccer heading with subclinical balance deficits during walking. Twenty adult amateur soccer players (10 males and 10 females, 22.3 ± 4.5 years, 170.5 ± 9.8 cm, 70.0 ± 10.5 kg) walked along a foam walkway with the eyes closed under 2 conditions: with GVS (∼40 trials) and without GVS (∼40 trials). Outcome measures included mediolateral center-of-mass (COM), center-of-pressure (COP) separation, foot placement, mediolateral ankle modulation, hip adduction, and ankle push off. For each balance mechanism, a GVS response was calculated (GVS, mean [without GVS]). In addition, participants completed a questionnaire, reporting soccer heading exposure over the past year. A linear regression model was used to determine if vestibular processing and balance during walking were related to RSHI exposure. Both foot placement (R2 = 0.324, p = 0.009) and hip adduction (R2 = 0.183, p = 0.50) were predicted by RSHI; whereby, greater exposure to RSHI was associated with greater foot placement and hip adduction responses. However, COM-COP separation (R2 < 0.001, p = 0.927), ankle modulation (R2 = 0.037, p = 0.417), and push off (R2 < 0.001, p = 0.968) were not related to RSHI exposure. Individuals who were exposed to greater RSHI were more perturbed by vestibular stimulation during walking, suggesting that there may be vestibular dysfunction and balance impairments with frequent heading; specifically, individuals with greater exposure to RSHI responded with larger foot placement and hip adduction responses to GVS.

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Original study. The clinical value of foam posturography in assessing patients with peripheral vestibular dysfunction – our experience

Romanian Journal of Rhinology ◽

10.1515/rjr-2017-0010 ◽

2017 ◽

Vol 7 (26) ◽

pp. 93-101

Author(s):

Raluca Enache ◽

Dorin Sarafoleanu ◽

Codrut Sarafoleanu

Keyword(s):

Center Of Pressure ◽

Balance Control ◽

Vestibular Dysfunction ◽

Control Group ◽

Vestibular Disorders ◽

Clinical Value ◽

Dynamic Posturography ◽

Eyes Closed ◽

Peripheral Vestibulopathy ◽

Romberg Test

Abstract BACKGROUND. Computerized dynamic posturography is the most important battery test designed to assess the ability to use visual, vestibular and proprioceptive cues in the maintenance of posture. Foam posturography reduces the availability of proprioceptive inputs, which makes more difficult the balance control. OBJECTIVE. The objective of the study was to assess the clinical use of foam posturography in evaluating peripheral vestibular dysfunction. MATERIAL AND METHODS. We evaluated 41 patients with vestibular disorders and 41 normal patients by using the sensory organization test in eyes opened, eyes closed and mislead vision conditions with and without the foam. We measured several parameters: the position of the center of pressure, the displacement in the center of pressure in anteroposterior and mediolateral planes and Romberg’s ratio on static and foam rubber. RESULTS. The values of all parameters were significantly higher in patients with peripheral vestibular disorders than in the control group (p<0.05). Also. comparing the Romberg test results, the foam surface used by the patient was larger than the static one. CONCLUSION. Foam posturography can be a reliable test in assessing patients with peripheral vestibulopathy, being also able to identify the visual and proprioceptive dependence levels.

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Association between Statin Use and Balance in Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134662 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4662

Author(s):

Antoine Langeard ◽

Kathia Saillant ◽

Elisabeth Charlebois Cloutier ◽

Mathieu Gayda ◽

Frédéric Lesage ◽

...

Keyword(s):

Older Adults ◽

Center Of Pressure ◽

Balance Control ◽

Balance Assessment ◽

Pressure Sensing ◽

Heart Attacks ◽

Eyes Closed ◽

Increased Risk ◽

Balance Deficits ◽

Statin Use

Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing a large health and economic issue. Statins are regularly prescribed to prevent strokes and heart attacks, but their impact on balance is unknown. The aim of this paper was to determine whether statin use is associated with poorer balance performances in older adults. Methods: All participants, one group taking statins (n = 34), and the other group not taking statins (n = 31), completed a balance assessment with their eyes closed and their eyes opened on a MatScan Pressure Sensing Mat. Center of Pressure (CoP) velocity, peak-to-peak distance, and standard deviation were collected in both anteroposterior (AP) and mediolateral (ML) directions. Multiple linear regression analyses were performed for each balance outcome, testing the statin use status as a predictor and controlling for appropriate factors including participants characteristics, lipid profile, and cardiovascular disease. Results: After controlling for confounding factors, statin use significantly predicted both CoP ML-Amplitude (β = 0.638, p = 0.004) and ML-Velocity (β = 0.653, p = 0.002) in the eyes-opened condition. Conclusions: The present study detected a negative association between statin use and balance control in the ML direction, suggesting that caution should be taken when prescribing statins in older adults, as this could decrease ML stability and ultimately increase fall and fracture risks.

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Assessing head acceleration to identify a motor threshold to galvanic vestibular stimulation

Journal of Neurophysiology ◽

10.1152/jn.00254.2020 ◽

2021 ◽

Author(s):

Youstina Mikhail ◽

Jonathan Charron ◽

Jean-Marc Mac Thiong ◽

Dorothy Barthélemy

Keyword(s):

Center Of Pressure ◽

Vestibular Function ◽

Vestibular Stimulation ◽

Galvanic Vestibular Stimulation ◽

Head Acceleration ◽

Motor Threshold ◽

Recruitment Curve ◽

Eyes Closed ◽

Postural Responses ◽

Significant Difference

Galvanic vestibular stimulation (GVS) is used to assess vestibular function, but vestibular responses can exhibit variability depending on protocols or intensities used. We measured head acceleration in healthy subjects to identify an objective motor threshold on which to base GVS intensity when assessing postural responses. Thirteen healthy right-handed subjects stood on a force platform, eyes closed, head facing forward. An accelerometer was placed on the vertex to detect head acceleration, and electromyography activity of the right soleus was recorded. GVS (200 ms; current steps 0.5;1-4mA) was applied in a binaural and bipolar configuration. 1) GVS induced a biphasic accelerometer response at a latency of 15 ms. Based on response amplitude, we constructed a recruitment curve for all participants and determined the motor threshold. In parallel, the method of limits was used to devise a more rapid approach to determine motor threshold. 2) We observed significant differences between motor threshold based on therecruitment curve and perceptual thresholds (sensation/perception of movement). No significant difference was observed between the motor threshold based on the method of limits and perceptual thresholds . 3) Using orthogonal polynomial contrasts, we observed a linear progression between multiples of the objective motor threshold (0.5, 0.75, 1, 1.5x motor threshold) and the 95% confidence ellipse area, the first peak of center of pressure velocity, and the short and medium latency responses in the soleus. Hence, an objective motor threshold and a recruitment curve for GVS were determined based on head acceleration, which could increase understanding of the vestibular system.

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Active foot placement control ensures stable gait: Effect of constraints on foot placement and ankle moments

PLoS ONE ◽

10.1371/journal.pone.0242215 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242215

Author(s):

A. M. van Leeuwen ◽

J. H. van Dieën ◽

A. Daffertshofer ◽

S. M. Bruijn

Keyword(s):

Steady State ◽

Center Of Pressure ◽

Center Of Mass ◽

Reaction Force ◽

Stride Frequency ◽

Tight Control ◽

Foot Placement ◽

Ankle Moment ◽

Reaction Forces ◽

Moment Control

Step-by-step foot placement control, relative to the center of mass (CoM) kinematic state, is generally considered a dominant mechanism for maintenance of gait stability. By adequate (mediolateral) positioning of the center of pressure with respect to the CoM, the ground reaction force generates a moment that prevents falling. In healthy individuals, foot placement is complemented mainly by ankle moment control ensuring stability. To evaluate possible compensatory relationships between step-by-step foot placement and complementary ankle moments, we investigated the degree of (active) foot placement control during steady-state walking, and under either foot placement-, or ankle moment constraints. Thirty healthy participants walked on a treadmill, while full-body kinematics, ground reaction forces and EMG activities were recorded. As a replication of earlier findings, we first showed step-by-step foot placement is associated with preceding CoM state and hip ab-/adductor activity during steady-state walking. Tight control of foot placement appears to be important at normal walking speed because there was a limited change in the degree of foot placement control despite the presence of a foot placement constraint. At slow speed, the degree of foot placement control decreased substantially, suggesting that tight control of foot placement is less essential when walking slowly. Step-by-step foot placement control was not tightened to compensate for constrained ankle moments. Instead compensation was achieved through increases in step width and stride frequency.

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Reactive Postural Responses to Continuous Yaw Perturbations in Healthy Humans: The Effect of Aging

Sensors ◽

10.3390/s20010063 ◽

2019 ◽

Vol 20 (1) ◽

pp. 63 ◽

Cited By ~ 6

Author(s):

Ilaria Mileti ◽

Juri Taborri ◽

Stefano Rossi ◽

Zaccaria Del Prete ◽

Marco Paoloni ◽

...

Keyword(s):

Older Adults ◽

Balance Control ◽

Center Of Mass ◽

Community Dwelling ◽

Body Segments ◽

Healthy Humans ◽

Eyes Closed ◽

Age Related ◽

Postural Responses ◽

Mass Displacement

Maintaining balance stability while turning in a quasi-static stance and/or in dynamic motion requires proper recovery mechanisms to manage sudden center-of-mass displacement. Furthermore, falls during turning are among the main concerns of community-dwelling elderly population. This study investigates the effect of aging on reactive postural responses to continuous yaw perturbations on a cohort of 10 young adults (mean age 28 ± 3 years old) and 10 older adults (mean age 61 ± 4 years old). Subjects underwent external continuous yaw perturbations provided by the RotoBit1D platform. Different conditions of visual feedback (eyes opened and eyes closed) and perturbation intensity, i.e., sinusoidal rotations on the horizontal plane at different frequencies (0.2 Hz and 0.3 Hz), were applied. Kinematics of axial body segments was gathered using three inertial measurement units. In order to measure reactive postural responses, we measured body-absolute and joint absolute rotations, center-of-mass displacement, body sway, and inter-joint coordination. Older adults showed significant reduction in horizontal rotations of body segments and joints, as well as in center-of-mass displacement. Furthermore, older adults manifested a greater variability in reactive postural responses than younger adults. The abnormal reactive postural responses observed in older adults might contribute to the well-known age-related difficulty in dealing with balance control during turning.

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Applying the Minimal Detectable Change of a Static and Dynamic Balance Test Using a Portable Stabilometric Platform to Individually Assess Patients with Balance Disorders

Healthcare ◽

10.3390/healthcare8040402 ◽

2020 ◽

Vol 8 (4) ◽

pp. 402 ◽

Cited By ~ 1

Author(s):

Juan De la Torre ◽

Javier Marin ◽

Marco Polo ◽

José J. Marín

Keyword(s):

Center Of Pressure ◽

Balance Control ◽

Dynamic Balance ◽

Static Balance ◽

Minimal Detectable Change ◽

Detectable Change ◽

Balance Test ◽

Balance Disorders ◽

Eyes Closed ◽

Specialist Physician

Balance disorders have a high prevalence among elderly people in developed countries, and falls resulting from balance disorders involve high healthcare costs. Therefore, tools and indicators are necessary to assess the response to treatments. Therefore, the aim of this study is to detect relevant changes through minimal detectable change (MDC) values in patients with balance disorders, specifically with vertigo. A test-retest of a static and dynamic balance test was conducted on 34 healthy young volunteer subjects using a portable stabilometric platform. Afterwards, in order to show the MDC applicability, eight patients diagnosed with balance disorders characterized by vertigo of vestibular origin performed the balance test before and after a treatment, contrasting the results with the assessment by a specialist physician. The balance test consisted of four tasks from the Romberg test for static balance control, assessing dynamic postural balance through the limits of stability (LOS). The results obtained in the test-retest show the reproducibility of the system as being similar to or better than those found in the literature. Regarding the static balance variables with the lowest MDC value, we highlight the average velocity of the center of pressure (COP) in all tasks and the root mean square (RMS), the area, and the mediolateral displacement in soft surface, with eyes closed. In LOS, all COP limits and the average speed of the COP and RMS were highlighted. Of the eight patients assessed, an agreement between the specialist physician and the balance test results exists in six of them, and for two of the patients, the specialist physician reported no progression, whereas the balance test showed worsening. Patients showed changes that exceeded the MDC values, and these changes were correlated with the results reported by the specialist physician. We conclude that (at least for these eight patients) certain variables were sufficiently sensitive to detect changes linked to balance progression. This is intended to improve decision making and individualized patient monitoring.

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Static Balance in Patients with Vestibular Impairments: A Preliminary Study

Scientifica ◽

10.1155/2016/6539858 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Hossein Talebi ◽

Mohammad Taghi Karimi ◽

Seyed Hamid Reza Abtahi ◽

Niloofar Fereshtenejad

Keyword(s):

Path Length ◽

Center Of Pressure ◽

Balance Control ◽

Force Plate ◽

Static Balance ◽

Eyes Closed ◽

Significant Difference ◽

Eyes Open ◽

Age Limits ◽

The Difference

Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments.Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50±7). We evaluated excursion and velocity of center of pressure (COP) and path length in anteroposterior (AP) and mediolateral (ML) planes with eyes open and with eyes closed.Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (pvalue > 0.05). In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (pvalue < 0.05).Conclusions. The present study showed the static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance.

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Active foot placement control ensures stable gait: Effect of constraints on foot placement and ankle moments

10.1101/2020.06.10.143867 ◽

2020 ◽

Cited By ~ 1

Author(s):

A.M. van Leeuwen ◽

J.H. van Dieën ◽

A. Daffertshofer ◽

S.M. Bruijn

Keyword(s):

Steady State ◽

Center Of Pressure ◽

Center Of Mass ◽

Reaction Force ◽

Stride Frequency ◽

Tight Control ◽

Foot Placement ◽

Ankle Moment ◽

Reaction Forces ◽

Moment Control

AbstractStep-by-step foot placement control, relative to the center of mass (CoM) kinematic state, is generally considered a dominant mechanism for maintenance of gait stability. By adequate (mediolateral) positioning of the center of pressure with respect to the CoM, the ground reaction force generates a moment that prevents falling. In healthy individuals, foot placement is complemented mainly by ankle moment control ensuring stability. To evaluate possible compensatory relationships between step-by-step foot placement and complementary ankle moments, we investigated the degree of (active) foot placement control during steady-state walking, and under either foot placement-, or ankle moment constraints. Thirty healthy participants walked on a treadmill, while full-body kinematics, ground reaction forces and EMG activities were recorded. As a replication of earlier findings, we first showed step-by-step foot placement is associated with preceding CoM state and hip ab-/adductor activity during steady-state walking. Tight control of foot placement appears to be important at normal walking speed because there was a limited change in the degree of foot placement control despite the presence of a foot placement constraint. At slow speed, the degree of foot placement control decreased substantially, suggesting that tight control of foot placement is less essential when walking slowly. Step-by-step foot placement control was not tightened to compensate for constrained ankle moments. Instead compensation was achieved through increases in step width and stride frequency.

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Head motion predictability explains activity-dependent suppression of vestibular balance control

10.1101/560664 ◽

2019 ◽

Author(s):

H Dietrich ◽

F Heidger ◽

R Schniepp ◽

PR MacNeilage ◽

S Glasauer ◽

...

Keyword(s):

Center Of Pressure ◽

Balance Control ◽

Vestibular Stimulation ◽

Head Movements ◽

Body Sway ◽

Cycle Phase ◽

Feed Forward ◽

Time Frequency ◽

Self Motion ◽

Activity Dependent

AbstractVestibular balance control is dynamically weighted during locomotion. This might result from a selective suppression of vestibular inputs in favor of a feed-forward balance regulation based on locomotor efference copies. The feasibility of such a feed-forward mechanism should however critically depend on the predictability of head movements (PHM) during locomotion. To test this, we studied in healthy subjects the differential impact of a stochastic vestibular stimulation (SVS) on body sway (center-of-pressure, COP) during standing and walking at different speeds using time-frequency analyses and compared it to activity-dependent changes in PHM. SVS-COP coupling decreased from standing to walking and further dropped with faster locomotion. Correspondingly, PHM increased with faster locomotion. Furthermore, SVS-COP coupling depended on the gait-cycle-phase with peaks corresponding to periods of least PHM. These findings support the assumption that during stereotyped human self-motion, locomotor efference copies selectively replace vestibular cues, similar to what was previously observed in animal models.

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Walking cadence affects the recruitment of the medial-lateral balance mechanisms

10.1101/658070 ◽

2019 ◽

Cited By ~ 2

Author(s):

Tyler Fettrow ◽

Hendrik Reimann ◽

David Grenet ◽

Jeremy Crenshaw ◽

Jill Higginson ◽

...

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Neural Control ◽

Gait Cycle ◽

Balance Control ◽

Vestibular Stimulation ◽

Lateral Ankle ◽

Foot Placement ◽

Ankle Inversion ◽

Gait Characteristics

AbstractWe have previously identified three balance mechanisms that young healthy adults use to maintain balance while walking. The three mechanisms are: 1) The lateral ankle mechanism, an active modulation of ankle inversion/eversion in stance; 2) The foot placement mechanism, an active shift of the swing foot placement; and 3) The push-off mechanism, an active modulation of the ankle plantarflexion angle during double stance. Here we seek to determine whether there are changes in neural control of balance when walking at different cadences and speeds. Twenty-one healthy young adults walked on a self-paced treadmill while immersed in a 3D virtual reality cave, and periodically received balance perturbations (bipolar galvanic vestibular stimulation) eliciting a perceived fall to the side. Subjects were instructed to match two cadences specified by a metronome, 110bpm (High) and 80bpm (Low), which led to faster and slower gait speeds, respectively. The results indicate that subjects altered the use of the balance mechanisms at different cadences. The lateral ankle mechanism was used more in the Low condition, while the foot placement mechanism was used more in the High condition. There was no difference in the use of the push-off mechanism between cadence conditions. These results suggest that neural control of balance is altered when gait characteristics such as cadence change, suggesting a flexible balance response that is sensitive to the constraints of the gait cycle. We speculate that the use of the balance mechanisms may be a factor resulting in well-known characteristics of gait in populations with compromised balance control, such as slower gait speed in older adults or higher cadence in people with Parkinson’s disease.

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