Community-dwelling adults with a history of falling report lower perceived postural stability during a foam eyes closed test than non-fallers

Abstract

Perceived postural stability has been reported to decrease as sway area increases on firm surfaces. However, changes in perceived stability under increasingly challenging conditions (e.g. removal of sensory inputs) and the relationship with sway area are not well characterized. Moreover, whether perceived stability varies as a function of age or history of falls is unknown. Here we investigate how perceived postural stability is related to sway area and whether this relationship varies as a function of age and fall history while vision and proprioceptive information are manipulated. Sway area was measured in 426 participants from the Baltimore Longitudinal Study of Aging while standing with eyes open and eyes closed on the floor and a foam cushion. Participants rated their stability [0 (completely unstable) to 10 (completely stable)] after each condition, and reported whether they had fallen in the past year. Perceived stability was negatively associated with sway area (cm^2) such that individuals who swayed more felt less stable across all conditions (β = −0.53, p < 0.001). Perceived stability decreased with increasing age (β = −0.019, p < 0.001), independent of sway area. Fallers had a greater decline in perceived stability across conditions (F = 2.76, p = 0.042) compared to non-fallers, independent of sway area. Perceived postural stability declined as sway area increased during a multi-sensory balance test. A history of falling negatively impacts perceived postural stability when vision and proprioception are simultaneously challenged. Perceived postural stability may provide additional information useful for identifying individuals at risk of falls.

Visual Effect on Brain Connectome That Scales Feedforward and Feedback Processes of Aged Postural System During Unstable Stance

“…This fact lends neurophysiological support to a hypothetical model proposed by Collins and De Luca (1995), which posits that visual inputs modulate the operational characteristics of the closed-loop postural control from the proprioceptive and/or vestibular afferents (11). On account of the highly significant correlation between normalized changes in network integration and the long-term scaling exponent, visual input has a potent impact on the postural feedback systems of older adults, a finding which is compatible with empirical observations that older adults rely preferentially on the vision for posture control (Thibault et al, 2014;Spironelli et al, 2016) and that accidental falls occur in this population when vision and proprioception are simultaneously challenged (Lord and Menz, 2000;Anson et al, 2019).…”

Impaired Multisensory Integration Predisposes the Elderly People to Fall: A Systematic Review

“…Participants were required to achieve balance whenever possible. Some authors examined the postural sway when participants performed modified clinical tests, standing on various surfaces with eyes open or closed (Redfern et al, 2001(Redfern et al, , 2019Rosengren et al, 2007;Palazzo et al, 2015;Sparto et al, 2018;Anson et al, 2019) in the light or in the dark (Redfern et al, 2009). Similarly, in some studies, participants were asked to stand on a force platform with eyes open or closed under quiet or noisy condition (Ross et al, 2016).…”

Differences between physical therapist ratings, self-ratings, and posturographic measures when assessing static balance exercise intensity

“…The correlation coefficients were slightly higher when using the logarithm of the kinematic feature compared to the untransformed values, especially so for EA. Higher correlation between ratings and the logarithm of a kinematic feature than with the original measure were also reported by Alsubaie et al regarding intensity self-ratings and by Scieppati et al and Anson et al regarding postural stability self-ratings (5,53,85).…”

“…While higher ratings were not associated with more difficult head movement conditions, this could be due to the majority of balance participants having no vestibular dysfunction and consequently being less affected by head movement. Similarly, Alsubaie et al and Anson et al reported significant associations between balance exercise difficulty and self-ratings of exercise intensity or postural stability (5,53).…”

“…Balance ability deteriorates with age (1)(2)(3), leading to increased fall risk and fall prevalence in healthy older adults (4). Balance can also be impaired by the presence of sensory or neurologic disorders such as peripheral sensory loss (5,6), vestibular disorder (6)(7)(8), multiple sclerosis (9)(10)(11), cerebrovascular accident (12), traumatic brain injury (13, 14), and Parkinson's disease (15,16). Low balance confidence and fear of falling are associated with increased fall risk (17,18), anxiety (19)(20)(21), depression (19,20), and institutionalization (21, 22), and with decreased activity (3,19,23), social participation (23, 24), and quality of life (19,23).…”