The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication.

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Clinician’s Guide to Prevention and Treatment of Osteoporosis

Movement, posture and equilibrium: interaction and coordination

PurposeThe number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone—a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments

Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable

The sections in this article are:


1
Neural Control of Postural Orientation and Equilibrium
1.1
Behavioral Goals

1.2
Biomechanical Principles

1.3
Postural Strategies




2
Postural Orientation
2.1
Stiffness and Tonic Muscle Activation

2.2
Controlling Postural Orientation

2.3
Internal Representation of Postural Orientation




3
Coordination of Postural Equilibrium
3.1
Triggered Reactions to External Disturbances

3.2
Anticipatory Postural Adjustments for Voluntary Movement

3.3
Modeling of Postural Coordination




4
Sensory Control of Postural Orientation and Equilibrium
4.1
Sensory Integration

4.2
Somatosensory System

4.3
Vestibular System

4.4
Visual System




5
Central Neural Control of Posture
5.1
Spinal Cord and Brainstem

5.2
Basal Ganglia

5.3
Cerebellum

5.4
Cerebral Cortex




6
Concluding Remarks

Postural Orientation and Equilibrium

わが国における成人市中肺炎原因微生物についてのsystematic review/meta‐analysis

The aging process results in a number of functional (e.g., deficits in balance and strength/power performance), neural (e.g., loss of sensory/motor neurons), muscular (e.g., atrophy of type-II muscle fibers in particular), and bone-related (e.g., osteoporosis) deteriorations. Traditionally, balance and/or lower extremity resistance training were used to mitigate these age-related deficits. However, the effects of resistance training are limited and poorly translate into improvements in balance, functional tasks, activities of daily living, and fall rates. Thus, it is necessary to develop and design new intervention programs that are specifically tailored to counteract age-related weaknesses. Recent studies indicate that measures of trunk muscle strength (TMS) are associated with variables of static/dynamic balance, functional performance, and falls (i.e., occurrence, fear, rate, and/or risk of falls). Further, there is preliminary evidence in the literature that core strength training (CST) and Pilates exercise training (PET) have a positive influence on measures of strength, balance, functional performance, and falls in older adults. The objectives of this systematic literature review are: (a) to report potential associations between TMS/trunk muscle composition and balance, functional performance, and falls in old adults, and (b) to describe and discuss the effects of CST/PET on measures of TMS, balance, functional performance, and falls in seniors. A systematic approach was employed to capture all articles related to TMS/trunk muscle composition, balance, functional performance, and falls in seniors that were identified using the electronic databases PubMed and Web of Science (1972 to February 2013). A systematic approach was used to evaluate the 582 articles identified for initial review. Cross-sectional (i.e., relationship) or longitudinal (i.e., intervention) studies were included if they investigated TMS and an outcome-related measure of balance, functional performance, and/or falls. In total, 20 studies met the inclusionary criteria for review. Longitudinal studies were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes (ES) were calculated whenever possible. For ease of discussion, the 20 articles were separated into three groups [i.e., cross-sectional (n = 6), CST (n = 9), PET (n = 5)]. The cross-sectional studies reported small-to-medium correlations between TMS/trunk muscle composition and balance, functional performance, and falls in older adults. Further, CST and/or PET proved to be feasible exercise programs for seniors with high-adherence rates. Age-related deficits in measures of TMS, balance, functional performance, and falls can be mitigated by CST (mean strength gain = 30 %, mean effect size = 0.99; mean balance/functional performance gain = 23 %, mean ES = 0.88) and by PET (mean strength gain = 12 %, mean ES = 0.52; mean balance/functional performance gain = 18 %, mean ES = 0.71). Given that the mean PEDro quality score did not reach the predetermined cut-off of ≥6 for the intervention studies, there is a need for more high-quality studies to explicitly identify the relevance of CST and PET to the elderly population. Core strength training and/or PET can be used as an adjunct or even alternative to traditional balance and/or resistance training programs for old adults. Further, CST and PET are easy to administer in a group setting or in individual fall preventive or rehabilitative intervention programs because little equipment and space is needed to perform such exercises.

The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors a systematic review

The stretch-shortening cycle (SSC) of muscle function has a well-recognized purpose: enhancement of performance of the final phase (concentric action) when compared to the isolated concentric action (e.g., Komi, 1984). This can be demonstrated in isolated muscle preparations with constant electrical stimulation (e.g., Cavagna, Dusman, & Margaria, 1968), in animal locomotion with natural and variable muscle activation (e.g., Gregor et al., 1988), and in maximal effort conditions of human SSC actions (Cavagna et al., 1968; Komi, 1983). Ingen Schenau et al. seem to agree with this basic concept. However, in discussing the mechanisms involved in the performance potentiation, the authors use countermovement jump (CMJ) as their basic model of SSC. In our understanding, an effective SSC requires three fundamental conditions: a well-timed preactivation of the muscle(s) before the eccentric phase, a short and fast eccentric phase, and immediate transition (short delay) between stretch (eccentric) and shortening (concentric phase). While the CMJ can easily be demonstrated to produce higher jumping height as compared to the squatting jump (SJ) (Asmussen & Bonde-Petersen, 1974; Cavagna, Komarek, Citterio, & Margaria, 1971; Komi & Bosco, 1978), it does not meet well all the criteria for an efficient SSC. The purpose of this commentary is not to try to comment on all the aspects of performance enhancement as discussed in the target article. Instead, we have chosen to focus on the argument that stretch reflexes can have considerable importance in stiffness regulation of the muscle, which would consequently enhance force and power during SSCs. Thus, we do not agree with the target article that stretch reflexes have limited possibilities to operate in SSCs. We will not discuss H-reflex-as mentioned in the target article-because H-reflex is not a naturally occurring phenomenon and has little in common with true stretch reflexes. For many neurophysiological and mechanical aspects, it is evident that the CMJ is not a suitable model to elaborate on the specificity of SSCs. Instead, one has to look for more \"normal\" activities such as running and hopping, where the conditions of preactivation, faster stretch, and short transition time are well met. In addition, the forces measured in the muscle tendon complex during these activities can present a typical \"bouncing ball\" type form (Figure 1).

Stretch Reflexes Can Have an Important Role in Force Enhancement during SSC Exercise

Traditionally, balance training has been used to rehabilitate ankle injuries and postural deficits. Prospective studies have shown preventive effects with respect to ankle and knee joint injuries. Presently, balance training is not only applied for rehabilitation and prevention but also for improving motor performance, especially muscle power. The recent application of noninvasive electrophysiological and brain imaging techniques revealed insights into the central control of posture and the adaptations induced by balance training. This information is important for our understanding of the basic control and adaptation mechanisms and to conceptualize appropriate training programmes for athletes, elderly people and patients. The present review presents neurophysiological adaptations induced by balance training and their influence on motor behaviour. It emphasizes the plasticity of the sensorimotor system, particularly the spinal and supraspinal structures. The relevance of balance training is highlighted with respect to athletic performance, postural control within elderly people as well as injury prevention and rehabilitation.

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Spinal and supraspinal adaptations associated with balance training and their functional relevance

Background
The effects of balance training (BT) in older adults on proxies of postural control and mobility are well documented in the literature. However, evidence-based dose–response relationships in BT modalities (i.e., training period, training frequency, training volume) have not yet been established in healthy older adults.

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Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis

According to recent observations, influence of body load has to be taken into account for the neuronal control of upright stance in addition to the systems known to be involved in this regulation (e.g. afferent input from vestibular canals, visual and muscle stretch receptors). The modulation of compensatory leg muscle electromyographic (EMG) responses observed during horizontal body posture indicates the existence of a receptor system which responds to loading of the body against the supporting platform. This receptor should be located within the extensor muscles because a compensatory EMG response and a loading effect on this response was only present following translational, but not rotational impulses. As the EMG responses were identical to those obtained during upright stance, it is argued that these load receptors activate postural reflexes. According to recent observations in the spinal cat, this afferent input probably arises from Golgi tendon organs and represents a newly discovered function of these receptors in the regulation of stance and gait.

Albert Gollhofer

Papers

The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors a systematic review

Stretch Reflexes Can Have an Important Role in Force Enhancement during SSC Exercise

Spinal and supraspinal adaptations associated with balance training and their functional relevance

Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis

Regulation of bipedal stance: dependency on “load” receptors