Postural control is often quantified by recording the trajectory of the center of pressure (COP)-also called stabilogram-during human quiet standing. This quantification has many important applications, such as the early detection of balance degradation to prevent falls, a crucial task whose relevance increases with the aging of the population. Due to the complexity of the quantification process, the analyses of sway patterns have been performed empirically using a number of variables, such as ellipse confidence area or mean velocity. This study reviews and compares a wide range of state-of-the-art variables that are used to assess the risk of fall in elderly from a stabilogram. When appropriate, we discuss the hypothesis and mathematical assumptions that underlie these variables, and we propose a reproducible method to compute each of them. Additionally, we provide a statistical description of their behavior on two datasets recorded in two elderly populations and with different protocols, to hint at typical values of these variables. First, the balance of 133 elderly individuals, including 32 fallers, was measured on a relatively inexpensive, portable force platform (Wii Balance Board, Nintendo) with a 25-s open-eyes protocol. Second, the recordings of 76 elderly individuals, from an open access database commonly used to test static balance analyses, were used to compute the values of the variables on 60-s eyes-open recordings with a research laboratory standard force platform.

A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code.

Heightened reliance on the cerebral cortex for postural stability with aging is well-known, yet the cortical mechanisms for balance control, particularly in relation to balance function, remain unclear. Here we aimed to investigate motor cortical activity in relation to the level of balance challenge presented during reactive balance recovery and identify circuit-specific interactions between motor cortex and prefrontal or somatosensory regions in relation to metrics of balance function that predict fall risk. Using electroencephalography, we assessed motor cortical beta power, and beta coherence during balance reactions to perturbations in older adults. We found that individuals with greater motor cortical beta power evoked following standing balance perturbations demonstrated lower general clinical balance function. Individual older adults demonstrated a wide range of cortical responses during balance reactions at the same perturbation magnitude, showing no group-level change in prefrontal- or somatosensory-motor coherence in response to perturbations. However, older adults with the highest prefrontal-motor coherence during the post-perturbation, but not pre-perturbation, period showed greater cognitive dual-task interference (DTI) and elicited stepping reactions at lower perturbation magnitudes. Our results support motor cortical beta activity as a potential biomarker for individual level of balance challenge and implicate prefrontal-motor cortical networks in distinct aspects of balance control involving response inhibition of reactive stepping in older adults. Cortical network activity during balance may provide a neural target for precision-medicine efforts aimed at fall prevention with aging.

/pdf/cortical-engagement-metrics-during-reactive-balance-are-dpp9l1osed.pdf

Cortical Engagement Metrics During Reactive Balance Are Associated With Distinct Aspects of Balance Behavior in Older Adults.

Effect of Incorporating Short-Foot Exercises in the Balance Rehabilitation of Flat Foot: A Randomized Controlled Trial.

Research in movement science aims at unravelling mechanisms and designing methods for restoring and maximizing human functional capacity, and many techniques provide access to neural adjustments (acute changes) or long-term adaptations (chronic changes) underlying changes in movement capabilities. First described by Paul Hoffmann over a century ago, when an electrical stimulus is applied to a peripheral nerve, this causes action potentials in afferent axons, primarily the Ia afferents of the muscle spindles, which recruit homonymous motor neurons, thereby causing an electromyographic response known as the Hoffmann (H) reflex. This technique is a valuable tool in the study of the neuromuscular function in humans and has provided relevant information in the neural control of movement. The large use of the H reflex in motor control research on humans relies in part to its relative simplicity. However, such simplicity masks subtleties that require rigorous experimental protocols and careful data interpretation. After highlighting basic properties and methodological aspects that should be considered for the correct use of the H-reflex technique, this brief narrative review discusses the purpose of the H reflex and emphasizes its use as a tool to assess the effectiveness of Ia afferents in discharging motor neurones. The review also aims to reconsider the link between H-reflex modulation and Ia presynaptic inhibition, the use of the H-reflex technique in motor control studies, and the effects of ageing. These aspects are summarized as recommendations for the use of the H reflex in motor control research on humans. 

/pdf/revisiting-the-use-of-hoffmann-reflex-in-motor-control-tck21pz9.pdf

Revisiting the use of Hoffmann reflex in motor control research on humans

The underlying mechanisms of improved balance after one and ten sessions of balance training in older adults

This study aimed to assess modulation of lower leg muscle reflex excitability and co-contraction during unipedal balancing on compliant surfaces in young and older adults. Twenty healthy adults (ten aged 18–30 years and ten aged 65–80 years) were recruited. Soleus muscle H-reflexes were elicited by electrical stimulation of the tibial nerve, while participants stood unipedally on a robot-controlled balance platform, simulating different levels of surface compliance. In addition, electromyographic data (EMG) of soleus (SOL), tibialis anterior (TA), and peroneus longus (PL) and full-body 3D kinematic data were collected. The mean absolute center of mass velocity was determined as a measure of balance performance. Soleus H-reflex data were analyzed in terms of the amplitude related to the M wave and the background EMG activity 100 ms prior to the stimulation. The relative duration of co-contraction was calculated for soleus and tibialis anterior, as well as for peroneus longus and tibialis anterior. Center of mass velocity was significantly higher in older adults compared to young adults (
 $$p<0.001)$$
 and increased with increasing surface compliance in both groups (
 $$p<0.001)$$
 . The soleus H-reflex gain decreased with surface compliance in young adults $$(p= 0.003)$$
 , while co-contraction increased $${(p}_{\mathrm{S}\mathrm{O}\mathrm{L},\mathrm{T}\mathrm{A}}=0.003\ \mathrm{a}\mathrm{n}\mathrm{d}\ {p}_{\mathrm{P}\mathrm{L},\mathrm{T}\mathrm{A}}<0.001)$$
 . Older adults did not show such modulations, but showed overall lower H-reflex gains $$(p<0.001)$$
 and higher co-contraction than young adults $${(p}_{\mathrm{S}\mathrm{O}\mathrm{L},\mathrm{T}\mathrm{A}}<0.001\ \mathrm{a}\mathrm{n}\mathrm{d}\ {p}_{\mathrm{P}\mathrm{L},\mathrm{T}\mathrm{A}}=0.002)$$
 . These results suggest an overall shift in balance control from the spinal level to supraspinal levels in older adults, which also occurred in young adults when balancing at more compliant surfaces.

https://link.springer.com/content/pdf/10.1007/s00221-020-05784-0.pdf

Modulation of soleus muscle H-reflexes and ankle muscle co-contraction with surface compliance during unipedal balancing in young and older adults

Balance training aims to improve balance and transfer acquired skills to real-life tasks. How older adults adapt gait to different conditions, and whether these adaptations are altered by balance training, remains unclear. We hypothesized that reorganization of modular control of muscle activity is a mechanism underlying adaptation of gait to training and environmental constraints. We investigated the transfer of standing balance training, shown to enhance unipedal balance control, to gait and adaptations in neuromuscular control of gait between normal and narrow-base walking in twenty-two older adults (72.6 ± 4.2 years). At baseline, after one, and after ten training sessions, kinematics and EMG of normal and narrow-base treadmill walking were measured. Gait parameters and temporal activation profiles of five muscle synergies were compared between time-points and gait conditions. Effects of balance training and an interaction between training and gait condition on step width were found, but not on synergies. After ten training sessions step width decreased in narrow-base walking, while step width variability decreased in both conditions. Trunk center of mass displacement and velocity, and the local divergence exponent, were lower in narrow-base compared to normal walking. Activation duration in narrow-base compared to normal walking was shorter for synergies associated with dominant leg weight acceptance and non-dominant leg stance, and longer for the synergy associated with non-dominant heel-strike. Time of peak activation associated with dominant leg stance occurred earlier in narrow-base compared to normal walking, while it was delayed in synergies associated with heel-strikes and non-dominant leg stance. The adaptations of synergies to narrow-base walking may be interpreted as related to more cautious weight transfer to the new stance leg and enhanced control over center of mass movement in the stance phase. The improvement of gait stability due to standing balance training is promising for less mobile older adults.

/pdf/improvement-in-gait-stability-in-older-adults-after-ten-tqes478e.pdf

Improvement in gait stability in older adults after ten sessions of standing balance training

Recovering balance after perturbations becomes challenging with aging, but an effective balance training could reduce such challenges. In this study, we examined the effect of balance training on feedback control after unpredictable perturbations by investigating balance performance, recovery strategy, and muscle synergies. We assessed the effect of balance training on unipedal perturbed balance in twenty older adults (>65 years) after short-term (one session) and long-term (3-weeks) training. Participants were exposed to random medial and lateral perturbations consisting of 8-degree rotations of a robot-controlled balance platform. We measured full-body 3D kinematics and activation of 9 muscles (8 stance leg muscles, one trunk muscle) during 2.5 s after the onset of perturbation. The perturbation was divided into 3 phases: phase1 from the onset to maximum rotation of the platform, phase 2 from the maximum rotation angle to the 0-degree angle and phase 3 after platform movement. Balance performance improved after long-term training as evidenced by decreased amplitudes of center of mass acceleration and rate of change of body angular momentum. The rate of change of angular momentum did not directly contribute to return of the center of mass within the base of support, but it reoriented the body to an aligned and vertical position. The improved performance coincided with altered activation of synergies depending on the direction and phase of the perturbation. We concluded that balance training improves control of perturbed balance, and reorganizes feedback responses, by changing temporal patterns of muscle activation. These effects were more pronounced after long-term than short-term training.

/pdf/balance-training-improves-feedback-control-of-perturbed-2ds2mvmx2w.pdf

Balance training improves feedback control of perturbed balance in older adults

With training older adults can improve balance control, but the time course and neural mechanisms underlying these improvements are unclear. We studied changes in balance (robustness and performance), as well as in H-reflex gains, paired reflex depression (PRD) and co-contraction duration (CCI) in ankle muscles after short-term (1 session; STT) and long-term (3 weeks; LTT) balance training in 22 older adults. Mediolateral balance robustness during unipedal stance (time to balance loss in unipedal standing on a robotic platform with decreasing rotational stiffness) improved (33%) after STT, with no further improvement after LTT. Balance performance (mean absolute mediolateral center of mass velocity) improved (18.75%) after STT in perturbed unipedal standing and after LTT (18.18%) in unperturbed unipedal standing. CCI of soleus/tibialis anterior did not change after STT but increased (16%) after LTT. H-reflex gain and PRD excitability did not change with training. Cross-correlations showed that H-reflex gains in unipedal stance were lower and CCI was higher in participants with a more robust balance at the last time-point measurement and, CCI was higher in participants with better balance performance at several time-points. However, changes in robustness and performance were uncorrelated with changes in CCI, H-reflex gain, or PRD. Our results indicate that balance robustness improves over a single session, while balance performance improves more gradually over multiple sessions. Changes in co-contraction and motor neuron excitability of ankle muscles are not exclusive causes of improved balance performance and robustness.

https://biorxiv.org/content/10.1101/2020.10.01.322313v1.full.pdf

The underlying mechanisms of improved balance after short- and long-term training in older adults

Training improves balance control in older adults, but the time course and neural mechanisms underlying these improvements are unclear. We studied balance robustness and performance, H-reflex gains, paired reflex depression, and co-contraction duration in ankle muscles after one and ten training sessions in 22 older adults (+65yrs). Mediolateral balance robustness, time to balance loss in unipedal standing on a platform with decreasing rotational stiffness, improved (33%) after one session, with no further improvement after ten sessions. Balance performance, absolute mediolateral center of mass velocity, improved (18.75%) after one session in perturbed unipedal standing and (18.18%) after ten sessions in unperturbed unipedal standing. Co-contraction duration of soleus/tibialis anterior increased (16%) after ten sessions. H-reflex gain and paired reflex depression excitability did not change. H-reflex gains were lower, and soleus/tibialis anterior co-contraction duration was higher in participants with more robust balance after ten sessions, and co-contraction duration was higher in participants with better balance performance at several time-points. Changes in robustness and performance were uncorrelated with changes in co-contraction duration, H-reflex gain, or paired reflex depression. In older adults, balance robustness improved over a single session, while performance improved gradually over multiple sessions. Changes in co-contraction and excitability of ankle muscles were not exclusive causes of improved balance.

/pdf/the-underlying-mechanisms-of-improved-balance-after-one-and-a81j26ld32.pdf

Leila Alizadehsaravi

Papers

Modulation of soleus muscle H-reflexes and ankle muscle co-contraction with surface compliance during unipedal balancing in young and older adults

Improvement in gait stability in older adults after ten sessions of standing balance training

Balance training improves feedback control of perturbed balance in older adults

The underlying mechanisms of improved balance after short- and long-term training in older adults

The underlying mechanisms of improved balance after one and ten sessions of balance training in older adults