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Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.

ABSTRACT: Background and Objectives:Increased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson's disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults. Research Design and Methods:Nineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quiet standing on foam for 30 s with eyes open; (2) a 3-s foot lift. "Light" instructions relied on principles of reducing excess tension while encouraging length. "Effortful" instructions relied on popular concepts of effortful posture correction. "Relax" instructions encouraged minimization of effort. We measured kinematics and muscle activity. Results:During quiet stance, Effortful instructions increased mediolateral jerk and path length. In the foot lift task, Light instructions led to the longest foot-in-air duration and the smallest anteroposterior variability of the center of mass, Relax instructions led to the farthest forward head position, and Effortful instructions led to the highest activity in torso muscles. Discussion and Implications:Thinking of upright posture as effortless may reduce excessive co-contractions and improve static and dynamic balance, while thinking of upright posture as inherently effortful may make balance worse. This may partly account for the benefits of embodied mindfulness practices such as tai chi and Alexander technique for balance in older adults. Pending larger-scale replication, this discovery may enable physiotherapists and teachers of dance, exercise, and martial arts to improve balance and reduce fall risk in their older students and clients simply by modifying how they talk about posture.

SUBMITTER: Cohen RG

PROVIDER: S-EPMC7092748 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.

Cohen Rajal G RG Baer Jason L JL Ravichandra Ramyaa R Kral Daniel D McGowan Craig C Cacciatore Timothy W TW

Innovation in aging 20200324 2

<h4>Background and objectives</h4>Increased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson's disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults.<h4>Research design and methods</h4>Nineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quie ...[more]

PMID: 32226825

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Project description:IntroductionGlobally, 300 million adults have clinical obesity. Heightened adiposity and inadequate musculature secondary to obesity alter bipedal stance and gait, diminish musculoskeletal tissue quality, and compromise neuromuscular feedback; these physiological changes alter stability and increase injury risk from falls. Studies in the field focus on obese patients across a broad range of body mass indices (BMI >30 kg/m2) but without isolating the most morbidly obese subset (BMI ≥40 kg/m2). We investigated the impact of obesity in perturbing postural stability in morbidly obese subjects elected for bariatric intervention, harboring a higher-spectrum BMI.Subjects and methodsTraditional force plate measurements and stabilograms are gold standards employed when measuring center of pressure (COP) and postural sway. To quantify the extent of postural instability in subjects with obesity before bariatric surgery, we assessed 17 obese subjects with an average BMI of 40 kg/m2 in contrast to 13 nonobese subjects with an average BMI of 30 kg/m2. COP and postural sway were measured from static and dynamic tasks. Involuntary movements were measured when patients performed static stances, with eyes either opened or closed. Two additional voluntary movements were measured when subjects performed dynamic, upper torso tasks with eyes opened.ResultsMean body weight was 85% (p < 0.001) greater in obese than nonobese subjects. Following static balance assessments, we observed greater sway displacement in the anteroposterior (AP) direction in obese subjects with eyes open (87%, p < 0.002) and eyes closed (76%, p = 0.04) versus nonobese subjects. Obese subjects also exhibited a higher COP velocity in static tests when subjects' eyes were open (47%, p = 0.04). Dynamic tests demonstrated no differences between groups in sway displacement in either direction; however, COP velocity in the mediolateral (ML) direction was reduced (31%, p < 0.02) in obese subjects while voluntarily swaying in the AP direction, but increased in the same cohort when swaying in the ML direction (40%, p < 0.04).Discussion and conclusionImportantly, these data highlight obesity's contribution towards increased postural instability. Obese subjects exhibited greater COP displacement at higher AP velocities versus nonobese subjects, suggesting that clinically obese individuals show greater instability than nonobese subjects. Identifying factors contributory to instability could encourage patient-specific physical therapies and presurgical measures to mitigate instability and monitor postsurgical balance improvements.

Project description:Falls are the second most frequent cause of injury in the elderly. Physiological processes associated with aging affect the elderly's ability to respond to unexpected balance perturbations, leading to increased fall risk. Every year, approximately 30% of adults, 65 years and older, experiences at least one fall. Investigating the neurophysiological mechanisms underlying the control of static and dynamic balance in the elderly is an emerging research area. The study aimed to identify cortical and muscular correlates during static and dynamic balance tests in a cohort of young and old healthy adults. We recorded cortical and muscular activity in nine elderly and eight younger healthy participants during an upright stance task in static and dynamic (core board) conditions. To simulate real-life dual-task postural control conditions, the second set of experiments incorporated an oddball visual task. We observed higher electroencephalographic (EEG) delta rhythm over the anterior cortex in the elderly and more diffused fast rhythms (i.e., alpha, beta, gamma) in younger participants during the static balance tests. When adding a visual oddball, the elderly displayed an increase in theta activation over the sensorimotor and occipital cortices. During the dynamic balance tests, the elderly showed the recruitment of sensorimotor areas and increased muscle activity level, suggesting a preferential motor strategy for postural control. This strategy was even more prominent during the oddball task. Younger participants showed reduced cortical and muscular activity compared to the elderly, with the noteworthy difference of a preferential activation of occipital areas that increased during the oddball task. These results support the hypothesis that different strategies are used by the elderly compared to younger adults during postural tasks, particularly when postural and cognitive tasks are combined. The knowledge gained in this study could inform the development of age-specific rehabilitative and assistive interventions.

Project description:BackgroundIndividuals with premutation alleles of the fragile X mental retardation 1 (FMR1) gene are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS) during aging. Characterization of motor issues associated with aging in FMR1 premutation carriers is needed to determine neurodegenerative processes and establish new biobehavioral indicators to help identify individuals at greatest risk of developing FXTAS.MethodsWe examined postural stability in 18 premutation carriers ages 46-77?years and 14 age-matched healthy controls. Participants completed a test of static stance and two tests of dynamic postural sway on a force platform to quantify postural variability and complexity. CGG repeat length was measured for each premutation carrier, and MRI and neurological evaluations were conducted to identify carriers who currently met criteria for FXTAS. Of the 18 premutation carriers, seven met criteria for definite/probable FXTAS (FXTAS+), seven showed no MRI or neurological signs of FXTAS (FXTAS-), and four were inconclusive due to insufficient data.ResultsCompared to controls, premutation carriers showed increased center of pressure (COP) variability in the mediolateral (COPML) direction during static stance and reduced COP variability in the anterior-posterior (COPAP) direction during dynamic AP sway. They also showed reductions in COPML complexity during each postural condition. FXTAS+ individuals showed reduced COPAP variability compared to FXTAS- carriers and healthy controls during dynamic AP sway. Across all carriers, increased sway variability during static stance and decreased sway variability in target directions during dynamic sways were associated with greater CGG repeat length and more severe neurologically rated posture and gait abnormalities.ConclusionOur findings indicate that aging FMR1 premutation carriers show static and dynamic postural control deficits relative to healthy controls implicating degenerative processes of spinocerebellar and cerebellar-brainstem circuits that may be independent of or precede the onset of FXTAS. Our finding that FXTAS+ and FXTAS- premutation carriers differed on their level of intentional AP sway suggests that neural mechanisms of dynamic postural control may be differentially impacted in patients with FXTAS, and its measurement may be useful for rapidly and precisely identifying disease presence and onset.

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Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.

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Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.

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