Improved postural control in response to a 4-week balance training with partially unloaded bodyweight

Freyler, Kathrin; Weltin, Elmar; Gollhofer, Albert; Ritzmann, Ramona

doi:10.1016/j.gaitpost.2014.04.186

Cited by 28 publications

(25 citation statements)

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“…For instance, patients suffering from motor impairments or reduced mobility (elderly, post-surgery, neurological diseases), unable to bear their full bodyweight and incapable of participating in conventional training interventions, could benefit from balance training in under loading. As already described by Freyler et al [ 9 ], balance training with partial loading serves as an appropriate solution improving relevant neuromuscular and functional parameters in an early stage of therapy [ 9 ]. Load compensation by means of artificial loading is of particular interest as a countermeasure for astronauts during long term-space flight [ 15 , 20 ]: regarding manned inter-planetary space missions scheduled in the future, impairments in balance control and motor coordination [ 15 , 20 ] in response to changes within the neuromuscular system [ 63 ] due to prolonged exposure to zero gravity are the space agencies’ major concerns [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Besides modulated proprioceptive sensory feedback, altered joint torques due to load variations may have led to the opposed postural strategies. Concerning training and therapy, this aspect seems to be of major relevance: our results could help to establish new therapy and space-relevant training modalities addressing particular strategies and adaptations by means of over loading or under loading conditions [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Load Dependency of Postural Control - Kinematic and Neuromuscular Changes in Response to over and under Load Conditions

et al. 2015

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IntroductionLoad variation is associated with changes in joint torque and compensatory reflex activation and thus, has a considerable impact on balance control. Previous studies dealing with over (OL) and under loading (UL) used water buoyancy or additional weight with the side effects of increased friction and inertia, resulting in substantially modified test paradigms. The purpose of this study was to identify gravity-induced load dependency of postural control in comparable experimental conditions and to determine the underlying neuromuscular mechanisms.MethodsBalance performance was recorded under normal loading (NL, 1g), UL (0.16g; 0.38g) and OL (1.8g) in monopedal stance. Center of pressure (COP) displacement and frequency distribution (low 0.15-0.5Hz (LF), medium 0.5-2Hz (MF), high 2-6Hz (HF)) as well as ankle, knee and hip joint kinematics were assessed. Soleus spinal excitability was determined by H/M-recruitment curves (H/M-ratios).ResultsCompared to NL, OL caused an increase in ankle joint excursion, COP HF domain and H/M-ratio. Concomitantly, hip joint excursion and COP LF decreased. Compared to NL, UL caused modulations in the opposite direction: UL decreased ankle joint excursions, COP HF and H/M-ratio. Collaterally, hip joint excursion and COP LF increased. COP was augmented both in UL and in OL compared to NL.ConclusionSubjects achieved postural stability in OL and UL with greater difficulty compared to NL. Reduced postural control was accompanied by modified balance strategies and compensatory reflex activation. With increasing load, a shift from hip to ankle strategy was observed. Accompanying, COP frequency distribution shifted from LF to HF and spinal excitability was enhanced. It is suggested that in OL, augmented ankle joint torques are compensated by quick reflex-induced postural reactions in distal muscles. Contrarily, UL is associated with diminished joint torques and thus, postural equilibrium may be controlled by the proximal segments to adjust the center of gravity above the base of support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Load Dependency of Postural Control - Kinematic and Neuromuscular Changes in Response to over and under Load Conditions

et al. 2015

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“…They are also correlated with personal perceptions of inability following hospital discharge (Desrosiers et al, 2002). Thus, intervention protocols were developed to accelerate the recovery of balance control in patients (Freyler et al, 2014;An and Shaughnessy, 2011); the effectiveness of these protocols should be assessed via reliable and objective measures.…”

Section: Introductionmentioning

confidence: 99%

“…Conventional measures of the center of pressure (COP), such as speed and area and amplitude of sway, which are obtained via posturography using a single force plate, are used to quantify changes in postural control and analyze the effects of therapeutic interventions following a stroke (Freyler et al, 2014;De Haart et al, 2004). However, it is not possible to identify mechanisms related to unilateral deficits and compensations of a non-paretic lower limb (van Asseldonk et al, 2006) by using only one force plate.…”

Section: Introductionmentioning

confidence: 99%

Reliability and minimal detectable change of between-limb synchronization, weight-bearing symmetry, and amplitude of postural sway in individuals with stroke

et al. 2017

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Introduction: Recently, variables related to between-limb synchronization of the centers of pressure (COP) have been proposed as measures of postural control in post-stroke patients. Although it is crucial in verifying their potential clinical use, the reliability of these variables is unknown. The aim of this work was to determine the reliability and minimal detectable change (MDC) of the peak of synchronization (ρ max ) in the anteroposterior (AP) and mediolateral (ML) directions, the time lag for the peak (ρ max lag), synchronization at lag zero (ρ 0 ), weight-bearing symmetry, and amplitude of postural sway, measured as the root mean square (RMS) values of the COP displacements in both directions (AP and ML COP displacement). Methods: COP data of 16 participants with stroke were collected at quiet standing with two force plates at two sessions separated by 2 to 7 days. The procedure was repeated three times in each session. The within and between sessions reliability was determined by the intraclass correlation coefficient (ICC), and the MDC was obtained from the ICC between sessions. Results: The variables ρ max lag in the AP and ML directions, as well as ρ 0 in the AP direction, exhibited poor within session reliability (ICC ≤ 0.4). The findings revealed excellent within and between sessions reliability (ICC ≥ 0.89) for weight-bearing symmetry and the RMS displacement in the AP direction, with MDC values of 5% and 2.07 mm, respectively. The remaining variables exhibited moderate reliability. Conclusion: Weight-bearing symmetry and AP COP displacement can be considered reliable variables for use in clinical practice.

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“…Free stance is controlled by the central nervous system (CNS) using sensory signals derived from visual, vestibular and proprioceptive afferent information (Dichgans et al, 1976 ; Lestienne et al, 1976 ; Nashner and Berthoz, 1978 ; Freyler et al, 2014 ; Ritzmann et al, 2015 ). Stabilization of the center of mass of the human body resembles balancing an inverted pendulum (Ritzmann et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Virtual Balancing for Studying and Training Postural Control

et al. 2017

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Postural control during free stance has been frequently interpreted in terms of balancing an inverted pendulum. This even holds, if subjects do not balance their own, but an external body weight. We introduce here a virtual balancing apparatus, which produces torque in the ankle joint as a function of ankle angle resembling the gravity and inertial effects of free standing. As a first aim of this study, we systematically modified gravity, damping, and inertia to examine its effect on postural control beyond the physical constraints given in the real world. As a second aim, we compared virtual balancing to free stance to test its suitability for balance training in patients who are not able to balance their full body weight due to certain medical conditions. In a feasibility study, we analyzed postural control during free stance and virtual balancing in 15 healthy subjects. Postural control was characterized by spontaneous sway measures and measures of perturbed stance. During free stance, perturbations were induced by pseudorandom anterior-posterior tilts of the body support surface. In the virtual balancing task, we systematically varied the anterior-posterior position of the foot plate where the balancing forces are zero following a similar pseudorandom stimulus profile. We found that subjects' behavior during virtual balancing resembles free stance on a tilting platform. This specifically holds for the profile of body excursions as a function of stimulus frequencies. Moreover, non-linearity between stimulus and response amplitude is similar in free and virtual balancing. The overall larger stimulus induced body excursions together with an altered phase behavior between stimulus and response could be in part explained by the limited use of vestibular and visual feedback in our experimental setting. Varying gravity or damping significantly affected postural behavior. Inertia as an isolated factor had a mild effect on the response functions. We conclude that virtual balancing may be well suited to simulate conditions which could otherwise only be realized in space experiments or during parabolic flights. Further studies are needed to examine patients' potential benefit of virtual balance training.

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Improved postural control in response to a 4-week balance training with partially unloaded bodyweight

Cited by 28 publications

References 30 publications

Load Dependency of Postural Control - Kinematic and Neuromuscular Changes in Response to over and under Load Conditions

Load Dependency of Postural Control - Kinematic and Neuromuscular Changes in Response to over and under Load Conditions

Reliability and minimal detectable change of between-limb synchronization, weight-bearing symmetry, and amplitude of postural sway in individuals with stroke

Virtual Balancing for Studying and Training Postural Control

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