Balance training improves feedback control of perturbed balance in older adults

Alizadehsaravi, Leila; Bruijn, Sjoerd M.; Jh, van Dieën

doi:10.1101/2021.03.31.437824

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…However, such arm movement may have other functions, such as reaching for support or to break an eventual fall, or to affect body orientation rather than center of mass position as more extensively discussed below. In a recent study on standing balance 54 , in which participants received rotational perturbations of the platform they were standing on, we indeed found that the rate of change of angular momentum did not directly contribute to return of the center of mass within the base of support. Instead, the changes in angular momentum in that study seemed aimed at reorienting the body to an aligned and vertical configuration.…”

Section: Angular Momentum Changesmentioning

confidence: 62%

Mechanisms that stabilize human walking

Leeuwen

Bruijn

Dieën

2022

BJMB

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In this paper we review what mechanisms are used to stabilize human bipedal gait. Based on mechanical reasoning, potential mechanisms to control the body center of mass trajectory are modulation of foot placement, stance leg control consisting of modulation of ankle moments and push-off forces, and modulations of the body’s angular momentum. The first two mechanisms and especially the first are dominant in controlling center of mass accelerations during gait, while angular momentum control plays a lesser role, but may be important to control body alignment and orientation. The same control mechanisms stabilize both steady-state and perturbed gait in both the mediolateral and antero-posterior directions. Control is at least in part active and is affected by proprioceptive, visual and vestibular information. Results support that this reflects a feedback process in which sensory information is used to obtain an estimate of the center of mass state based on which foot placement and ankle moments are modulated. These active feedback mechanisms suggest training approaches for populations at risk of falling, such as augmenting their effective use by means of augmented feedback, or using their complementary nature to train one mechanism by constraining the other mechanisms.

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Section: Angular Momentum Changesmentioning

confidence: 62%

Mechanisms that stabilize human walking

Leeuwen

Bruijn

Dieën

2022

BJMB

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“…However, the desired direction is unclear. It could be that segmental rotations were used to achieve a proper orientation of segments such as regulating the orientation of the head in space, rather than controlling the CoM acceleration/position (Alizadehsaravi et al, 2021). Overall, the participants, even the children, kept their head quite stable, in comparison to the board.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the umbrella term "counter-rotation mechanism" will be used here. Especially when trunk rotations are included, the counter-rotation mechanism may result in head rotations and consequently affect visual and vestibular input (Alizadehsaravi, Bruijn, & van Dieën, 2021). Thus, people may prefer to keep their head orientation stable in space, rather than using rotations involving the head to change angular momentum to control the CoM (Fino, Raffegeau, Parrington, Peterka, & King, 2020).…”

Section: Introductionmentioning

confidence: 99%

Effects of age and surface instability on the control of the center of mass

Bogaart¹,

Bruijn

Spildooren³

et al. 2021

Preprint

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During standing, posture can be controlled by accelerating the Center of Mass (CoM) through shifting the center of pressure (CoP) within the base of support by applying ankle moments ('CoP mechanism'), or through the 'counter-rotation mechanism', i.e., changing the angular momentum of segments around the CoM to change the direction of the ground reaction force. Postural control develops over the lifespan; at both the beginning and the end of the lifespan adequate postural control appears more challenging. In this study, we aimed to assess mediolateral balance performance and the related use of the postural control mechanisms in children, older adults and young adults when standing on different (unstable) surfaces. Sixteen pre-pubertal children (6-9y), 17 young adults (18-24y) and eight older adults (65-80y) performed bipedal upright standing trials of 16 seconds on a rigid surface and on three balance boards that could freely move in the frontal plane, varying in height (15-19 cm) of the surface of the board above the point of contact with the floor. Full body kinematics (16 segments, 48 markers, using SIMI 3D-motion analysis system (GmbH) and DeepLabCut and Anipose) were retrieved. Performance related outcome measures, i.e., the number of trials with balance loss and the Root Mean Square (RMS) of the time series of the CoM acceleration, the contributions of the CoP mechanism and the counter-rotation mechanism to the CoM acceleration in the frontal plane and selected kinematic measures, i.e. the orientation of the board and the head and the Mean Power Frequency (MPF) of the balance board orientation and the CoM acceleration were determined. Balance loss only occurred when standing on the highest balance board, twice in one older adult once in one young adult. In children and older adults, the RMS of the CoM accelerations were larger, corresponding to poorer balance performance. Across age groups and conditions, the contribution of the CoP mechanism to the total CoM acceleration was much larger than that of the counter-rotation mechanisms, ranging from 94%-113% vs 23%-38% (with totals higher than 100% indicating opposite effects of both mechanisms). Deviations in head orientation were small compared to deviations in balance board orientation. We hypothesize that the CoP mechanism is dominant, since the counter rotation mechanism would conflict with stabilizing the orientation of the head in space.

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“…PBT is a promising approach to improve reactive balance, but the mechanisms underlying improvements in reactive balance are not yet understood. PBT has induced improvements in reactive balance for the task being trained within a session (Sakai et al, 2008 ; Bierbaum et al, 2010 ; Tanvi et al, 2012 ) or after a couple of sessions (Dijkstra et al, 2015 ; Alizadehsaravi et al, 2021 ). Improvements in the trained task have been shown to be retained (Pai and Bhatt, 2007 ), and there is even some evidence of decreased fall risk following PBT (Mansfield et al, 2015 ; Gerards et al, 2017 ; Mccrum et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program

Wouwe

Afschrift

Dalle

et al. 2021

Front. Sports Act. Living

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Both resistance training (RT) and perturbation-based training (PBT) have been proposed and applied as interventions to improve reactive balance performance in older adults. PBT is a promising approach but the adaptations in underlying balance-correcting mechanisms through which PBT improves reactive balance performance are not well-understood. Besides it is unclear whether PBT induces adaptations that generalize to movement tasks that were not part of the training and whether those potential improvements would be larger than improvements induced by RT. We performed two training interventions with two groups of healthy older adults: a traditional 12-week RT program and a 3-week PBT program consisting of support-surface perturbations of standing balance. Reactive balance performance during standing and walking as well as a set of neuro-muscular properties to quantify muscle strength, sensory and motor acuity, were assessed pre- and post-intervention. We found that both PBT and RT induced training specific improvements, i.e., standing PBT improved reactive balance during perturbed standing and RT increased strength, but neither intervention affected reactive balance performance during perturbed treadmill walking. Analysis of the reliance on different balance-correcting strategies indicated that specific improvements in the PBT group during reactive standing balance were due to adaptations in the stepping threshold. Our findings indicate that the strong specificity of PBT can present a challenge to transfer improvements to fall prevention and should be considered in the design of an intervention. Next, we found that lack of improvement in muscle strength did not limit improving reactive balance in healthy older adults. For improving our understanding of generalizability of specific PBT in future research, we suggest performing an analysis of the reliance on the different balance-correcting strategies during both the training and assessment tasks.

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Balance training improves feedback control of perturbed balance in older adults

Cited by 7 publications

References 27 publications

Mechanisms that stabilize human walking

Mechanisms that stabilize human walking

Effects of age and surface instability on the control of the center of mass

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program

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