Several standardized balance measures provide only partial information on postural control and omit important components of balance related to avoiding falls. As such, the choice of measure(s) may limit the overall interpretation of an individual's balance ability. Continued work is necessary to increase the implementation of comprehensive balance assessment in research and practice.

We examined changes in the motor organization of postural control in response to continuous, variable amplitude oscillations evoked by a translating platform and explored whether these changes reflected implicit sequence learning. The platform underwent random amplitude (maximum ± 15 cm) and constant frequency (0.5 Hz) oscillations. Each trial was composed of three 15-second segments containing seemingly random oscillations. Unbeknownst to participants, the middle segment was repeated in each of 42 trials on the first day of testing and in an additional seven trials completed approximately 24 hours later. Kinematic data were used to determine spatial and temporal components of total body centre of mass (COM) and joint segment coordination. Results showed that with repeated trials, participants reduced the magnitude of horizontal body COM displacement, shifted from a COM phase lag to a phase lead relative to platform motion and increased correlations between ankle/platform motion and hip/platform motion as they evolved from an ankle strategy to a multi-segment control strategy involving the ankle and hip. Maintenance of these changes across days provided evidence for learning. Similar improvements for the random and repeated segments, however, indicate that participants did not exploit the sequence of perturbations to improve balance control. Rather, the central nervous system (CNS) may have been tuning into more general features of platform motion. These findings provide important insight into the generalizabilty of improved compensatory balance control with training.jsfrank@uwindsor.ca,

Background: Impairments of gait and balance often progress through the course of dementia, and are associated with increased risk of falls. Summary: This systematic review provides a critical analysis of the evidence linking quantitative measures of gait and balance to fall risk in older adults with dementia. Various instrumented measures of gait and postural stability including gait speed and non-instrumented performance measures including Timed Up and Go were shown to be capable of distinguishing fallers from non-fallers. Key Messages: Existing reviews indicate that impairments of gait and balance are associated with increased risk of falls in cognitively intact older people. There are inconsistencies, however, regarding the characteristics most predictive of a fall. In order to advance fall prevention efforts, there is an important need to understand the relationship between gait, balance, and fall risk, particularly in high-risk populations such as individuals with dementia.

Healthy older adults were repeatedly exposed to continuous, variable amplitude oscillations of the support surface to determine 1) whether age affects the capacity for postural motor learning under continuous perturbation conditions with limited predictability and 2) whether practice leads to modifications in the control strategy used to maintain balance in older adults. During training, a translating platform underwent 45-second trials of constant frequency (0.5 Hz) and seemingly random amplitude oscillations (range ± 2 to 15 cm). The middle 15 seconds of each trial contained the same sequence of oscillation amplitudes. This repeated middle segment was used for analyses because young adults in Van Ooteghem et al (2008) experienced the same segment, allowing group comparisons to be made in the present study. To examine learning, participants performed a retention test following a 24-hour delay. Kinematic data were used to derive spatial and temporal measures of whole body centre of mass (COM), trunk, thigh, and shank segment orientation, and ankle and knee angle from performance during the repeated middle segment. Results showed that with training, older adults maintained the capacity to learn adaptive postural responses in the form of improved temporal control of the COM and minimization of trunk instability at a rate comparable to young adults. With practice however, older adults maintained a more rigid, ‘platform-fixed’ control strategy which differed from young adults who shifted toward ‘gravity-fixed’ control that minimized their COM motion. This study provides important insight into the ability of older adults to demonstrate longer-term improvements in postural regulation.

People with MS have the capacity to improve use of a feed-forward postural strategy with practice and retain the learned behavior for temporal not spatial control of CoM, despite their significant postural response impairments.

Assessing children's balance with valid and comprehensive measures is important for ensuring development of safe mobility and independence with functional tasks. Balance measures validated in pediatric populations to date do not comprehensively assess standing postural control and omit some key components for safe mobility and independence. Existing balance measures, that have been validated in adult populations and address some of the existing gaps in pediatric measures, warrant consideration for validation in children.

Postural motor learning for dynamic balance tasks has been demonstrated in healthy older adults (Van Ooteghem et al. 2009). The purpose of this study was to investigate the type of knowledge (general or specific) obtained with balance training in this age group and to examine whether embedding perturbation regularities within a balance task masks specific learning. Two groups of older adults maintained balance on a constant frequency-variable amplitude oscillating platform. One group was trained using an embedded sequence (ES) protocol which contained the same 15-s sequence of variable amplitude oscillations in the middle of each trial. A second group was trained using a looped sequence (LS) protocol which contained a 15-s sequence repeated three times to form each trial. All trials were 45-s. Participants were not informed of any repetition. To examine learning, participants performed a retention test following a 24-h delay. LS participants also completed a transfer task. Specificity of learning was examined by comparing performance for repeated versus random sequences (ES) and training versus transfer sequences (LS). Performance was measured by deriving spatial and temporal measures of whole body centre of mass (COM), and trunk orientation. Both groups improved performance with practice as characterized by reduced COM displacement, improved COM-platform phase relationships, and decreased angular trunk motion. Improvements were also characterized by general rather than specific postural motor learning. These findings are similar to young adults (Van Ooteghem et al. 2008) and indicate that age does not influence the type of learning which occurs for balance control.

Background Remote health monitoring with wearable sensor technology may positively impact patient self-management and clinical care. In individuals with complex health conditions, multi-sensor wear may yield meaningful information about health-related behaviors. Despite available technology, feasibility of device-wearing in daily life has received little attention in persons with physical or cognitive limitations. This mixed methods study assessed the feasibility of continuous, multi-sensor wear in persons with cerebrovascular (CVD) or neurodegenerative disease (NDD). Methods Thirty-nine participants with CVD, Alzheimer’s disease/amnestic mild cognitive impairment, frontotemporal dementia, Parkinson’s disease, or amyotrophic lateral sclerosis (median age 68 (45–83) years, 36% female) wore five devices (bilateral ankles and wrists, chest) continuously for a 7-day period. Adherence to device wearing was quantified by examining volume and pattern of device removal (non-wear). A thematic analysis of semi-structured de-brief interviews with participants and study partners was used to examine user acceptance. Results Adherence to multi-sensor wear, defined as a minimum of three devices worn concurrently, was high (median 98.2% of the study period). Non-wear rates were low across all sensor locations (median 17–22 min/day), with significant differences between some locations ( p = 0.006). Multi-sensor non-wear was higher for daytime versus nighttime wear ( p < 0.001) and there was a small but significant increase in non-wear over the collection period ( p = 0.04). Feedback from de-brief interviews suggested that multi-sensor wear was generally well accepted by both participants and study partners. Conclusion A continuous, multi-sensor remote health monitoring approach is feasible in a cohort of persons with CVD or NDD.