Skip to main content
SpringerLink
Log in

Structural changes in postural sway lend insight into effects of balance training, vision, and support surface on postural control in a healthy population

  • Original Article
  • Published:
European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Postural sway was assessed [via center of pressure (COP) 95% elliptical area (EA), path length (PL), normalized path length (PLn) and sample entropy (SEn)] in four conditions of bipedal upright stance [compliant (Foam) vs. non-compliant (Hard) with eyes-open (EO) vs. eyes-closed (EC)] prior to, and immediately following, a six-week balance training intervention in a group of healthy adults (N = 26). The intervention was comprised of nine exercises progressed in difficulty based on the subjective assessments of individual competency. Results showed that EA and PL were increased, while PLn and SEn were decreased, in EC and Foam stance conditions (collapsed across effects of balance training). Interpretations were that restricted vision and a compliant surface represented constraints to postural control that caused increases in the amount (PL) and area (EA) of sway, but decreases in its coordinative twisting/turning (PLn) and temporal complexity (SEn). It was argued that these changes might represent compensatory adaptations in effort to maintain postural control given the demands of the imposed constraints. Balance training caused no change to EA, but did result in decreased PL, PLn, and SEn for stance conditions performed on the Foam (either EO or EC). These changes were interpreted to reflect improved postural control, potentially through the learned adoption of a more deterministic postural control strategy that is uniquely defined by the constraints imposed on upright stance by the compliant surface.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. In conditions where participants stood atop the Foam pad, the pad was placed directly in the middle of the forceplate to prevent it from touching or overlapping with the laboratory floor.

  2. This was done following previous research that has shown that visually-directed attention towards targets of varying distance can cause unique changes to postural sway (Smart et al. 2004).

  3. Training sessions were attended by anywhere from one to six participants. Because limited equipment and space were available, the order in which participants performed the exercises was not controlled.

  4. McKeon et al. (2008) used a set of objective performance criteria (e.g., touch downs, excessive trunk flexion, arm extension, etc.) to aid in determining when participants should be advanced to more difficult forms of each exercise in their holistic/progressive balance training intervention. In the current study, decisions to advance participants were not supported by such criteria, but instead were based solely on the subjective visual assessments made by an Athletic Trainer along with verbal consultation with each participant. In hind-sight, the approach used by McKeon et al. would have been preferred and should be encouraged for use in future studies.

  5. COP data for a single participant in a single trial (participant 2, EO-Foam condition) was discarded from analysis because of experimenter error (forceplate was not calibrated properly prior to data collection). Since a second trial was recorded for this condition, the postural sway measures obtained for this trial were used for inferential analysis (rather than average values between two trials).

  6. All main effects and interactions for Phase based on F-crit α = 0.05 (1, 25) = 4.24.

References

  • Bernier JN, Perrin DH (1998) Effect of coordination training on proprioception of the functionally unstable ankle. J Orthop Sport Phys 27:264–275

    CAS  Google Scholar 

  • Blackburn T, Guskiewicz KM, Petschauer MA, Prentice WE (2000) Balance and joint stability: the relative contributions of proprioception and muscular strength. J Sport Rehabil 9:315–328

    Google Scholar 

  • Carroll JP, Freedman W (1993) Nonstationarity properties of postural sway. J Biomech 26:409–416

    Article  PubMed  CAS  Google Scholar 

  • Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, Janssen PA, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L, McKay HA (2001) Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis. Br J Sport Med 35:348–351

    Article  CAS  Google Scholar 

  • Cavanaugh JT, Guskiewicz KM, Stergiou N (2005) A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion. Sport Med 35:935–950

    Article  Google Scholar 

  • Collins JJ, Deluca CJ (1994) Random walking during quiet standing. Phys Rev Lett 73:764–767

    Article  PubMed  Google Scholar 

  • Cornilleau-Peres V, Shabanac N, Droulezd J, Gohe JCH, Lee GSM, Chew PTK (2005) Measurement of the visual contribution to postural steadiness form the COP movement: methodology and reliability. Gait Posture 22:96–106

    Article  PubMed  CAS  Google Scholar 

  • DeHaart M, Geurts AC, Huidekoper SC, Fasotti L, van Limbeek J (2004) Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil 85:886–895

    Article  Google Scholar 

  • Donker SF, Roerdink M, Greven AJ, Beek PJ (2007) Regularity of center of pressure trajectories depends on the amount of attention invested in postural control. Exp Brain Res 181:1–11

    Article  PubMed  Google Scholar 

  • Donker SF, Ledebt A, Roerdink M, Savelbergh GJP, Beek PJ (2008) Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res 184:363–370

    Article  PubMed  Google Scholar 

  • Dunlap WP, Cortina JM, Vaslow JB, Burke MJ (1996) Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods 1:170–177

    Article  Google Scholar 

  • Fitzpatrick R, McCloskey DI (1994) Proprioceptive, visual and vestibular thresholds for the perception of sway during standing in humans. J Phys 478(1):173–186

    Google Scholar 

  • Heitkamp HC, Horstmann T, Mayer F, Weller J, Dickhuth HH (2001) Gain in strength and muscular balance after balance training. Int J Sport Med 22:285–290

    Article  CAS  Google Scholar 

  • Hess DM, Joyce CJ, Arnold BL, Gansneder BM (2001) Effect of a 4-week agility training program on postural sway in the functionally unstable ankle. J Sport Rehabil 10:24–35

    Google Scholar 

  • Hoffman M, Payne G (1995) The effects of proprioceptive ankle disk training on healthy subjects. J Occup Sport Phys Ther 21:90–93

    CAS  Google Scholar 

  • Holme E, Magnusson SP, Becher K, Bielder T, Aagaard P, Kjaer M (1999) The effect of supervised rehabilitation on strength, postural sway, positions sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sport 9:104–109

    Article  CAS  Google Scholar 

  • Hue O, Seymes O, Ledrole D, Colson SS, Bernard PL (2004) Effects of physical activity program on postural stability in older people. Aging Clin Exp Res 16:356–362

    PubMed  Google Scholar 

  • Kidgell DJ, Horvath DM, Jackson BM, Seymour PJ (2007) Effect of six weeks of dura disc and mini-trampoline balance training on postural sway in athletes with functional ankle instability. J Strength Cond Res 21:466–469

    PubMed  Google Scholar 

  • Kovac EJ, Birmingham TB, Forwell L, Litchfield RB (2004) Effect of training on postural control in figure skaters. Clin J Sport Med 14:215–224

    Article  Google Scholar 

  • Lephart SM, Pincivero DM, Rozzi SL (1998) Proprioception of the ankle and knee. Sports Med 25:149–155

    Article  PubMed  CAS  Google Scholar 

  • Lord SR, Menz HB (2000) Visual contributions to postural stability in older adults. Gerontology 46:306–310

    Article  PubMed  CAS  Google Scholar 

  • McKeon PO, Hertel J (2008a) Systematic review of postural control and lateral ankle instability. Part 1. Can deficits be detected with instrumented testing? J Athl Train 43:293–304

    Article  PubMed  Google Scholar 

  • McKeon PO, Hertel J (2008b) Systematic review of postural control and lateral ankle instability. Part 2. Is balance training clinically effective? J Athl Train 43:305–315

    Article  PubMed  Google Scholar 

  • McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J (2008) Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc 40:1810–1819

    Article  PubMed  Google Scholar 

  • Melzer I, Benjuya N, Kaplanski J (2004) Postural stability in the elderly: a comparison between fallers and non-fallers. Age Ageing 33:602–607

    Article  PubMed  CAS  Google Scholar 

  • Nagy E, Feher-Kiss A, Bamai M, Domnjan-Preszner A, Angyan L, Horvath G (2007) Postural control in elderly subjects participating in balance training. Eur J Appl Physiol 100:97–104

    Article  PubMed  Google Scholar 

  • Nashner LM, McCollum G (1985) The organization of human postural movements: a formal basis and experimental synthesis. Behav Brain Sci 8:135–172

    Article  Google Scholar 

  • Newell KM (1997) Degrees of freedom and the development of postural center of pressure profiles. In: Newell KM, Molenaar PCM (eds) Application of nonlinear dynamics to developmental process modeling. Erlbaum, Mahwah, pp 63–84

    Google Scholar 

  • Norris JA, Marsh AP, Smith IJ, Kohut RI, Miller ME (2005) Ability of static and statistical mechanics posturographic measures to distinguish between age and fall risk. J Biomech 38:1263–1272

    Article  PubMed  Google Scholar 

  • Palmieri RM, Ingersoll CD, Stone MB, Krause BA (2002) Center-of-pressure parameters used in the assessment of postural control. J Sport Rehabil 11:51–66

    Google Scholar 

  • Pellecchia G, Shockley K, Turvey MT (2005) Concurrent cognitive task modulates coordination dynamics. Cogn Sci 29:531–555

    Article  Google Scholar 

  • Prieto TE, Myklebust JB, Hoffmann RG, Lovett EG, Myklebust BM (1996) Measures of postural steadiness: differences between healthy you g and elderly adults. IEEE Trans Biomed Eng 43:956–966

    Article  PubMed  CAS  Google Scholar 

  • Puls A, Gribble PA (2007) Comparison of two thera-band training rehabilitation protocols on postural control. J Sport Rehabil 16:75–84

    PubMed  Google Scholar 

  • Ramdani S, Seigle B, Lagarde J, Bouchara F, Bernard PL (2009) On the use of sample entropy to analyze human postural sway data. Med Eng Phys 31:1023–1031

    Article  PubMed  Google Scholar 

  • Richman JS, Moorman JR (2000) Physiological time series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol 278:H2039–H2049

    PubMed  CAS  Google Scholar 

  • Riemann BL, Tray NC, Lephart SM (2003) Unilateral multiaxial coordination training and ankle kinesthesia, muscle strength, and postural control. J Sport Rehabil l2:13–30

    Google Scholar 

  • Roerdink M, DeHaart M, Daffertshofer A, Donker SF, Geurts ACH, Beek PJ (2006) Dynamical structure of center-of-pressure trajectories in patients recovering from stroke. Exp Brain Res 174:256–269

    Article  PubMed  CAS  Google Scholar 

  • Roerdink M, Hlavckova P, Vuillerme N (2010) Center-of-pressure regularity as a marker for attentional investment in postural control: a comparison between sitting and standing postures. Hum Mov Sci. doi:10.1016/j.humov.2010.04.005

  • Schmit JM, Regis DL, Riley MA (2005) Dynamic patterns of postural sway in ballet dancers and track athletes. Exp Brain Res 163:370–378

    Article  PubMed  Google Scholar 

  • Schmit JM, Riley MA, Dalvi A, Sahay A, Shear PK, Shockley KD, Pun RYK (2006) Deterministic center of pressure patterns characterize postural instability in Parkinson’s disease. Exp Brain Res 168:357–367

    Article  PubMed  Google Scholar 

  • Shumway-Cook A, Woollacott M, Kerns KA, Baldwin M (1997) The effects of two types of cognitive tasks on postural stability in older adults with and without a history of falls. Gerontol A Biol Sci Med Sci 52A:M232–M240

    Google Scholar 

  • Smart LJ, Smith DL (2001) Postural dynamics: clinical and empirical implications. J Manip Physiol Ther 24:340–348

    Article  Google Scholar 

  • Smart LJ, Mobley BS, Otten EW, Smith DL, Amin MR (2004) Not just standing there: the use of postural coordination to aid visual tasks. Hum Mov Sci 22:769–780

    Article  PubMed  Google Scholar 

  • Stins JF, Michielsen ME, Roerdink M, Beek PJ (2009) Sway regularity reflects attentional involvement in postural control: effects of expertise, vision and cognition. Gait Posture 30:106–109

    Article  PubMed  CAS  Google Scholar 

  • Teasdale N, Stelmach GE, Breunig A (1991) Postural sway characteristics of the elderly under normal and altered visual and support surface conditions. J Gerontol 46:B238–B244

    PubMed  CAS  Google Scholar 

  • Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechlen W (2004) The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med 32:1385–1393

    Article  PubMed  Google Scholar 

  • Vuillerme N, Danion F, Marin L, Boyadjian A, Prieur JM, Weis I, Nougier V (2001) The effect of expertise in gymnastics on postural control. Neurosci Lett 303:83–86

    Article  PubMed  CAS  Google Scholar 

  • Webster KA, Gribble PA (2010) Functional rehabilitation for chronic ankle instability: a systematic review. J Sport Rehabil 19:98–114

    PubMed  Google Scholar 

  • Yoke M, Kennedy C (2004) Functional exercise progressions. Healthy Learning, Monterey

    Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Consortium of Research Fellows Program, Alexandria, VA, USA

    Adam J. Strang

  2. Nebraska Biomechanics Core Facility, University of Nebraska-Omaha, Omaha, NE, USA

    Joshua Haworth

  3. Department of Health and Human Performance, University of Houston, Houston, TX, USA

    Mathias Hieronymus

  4. Department of Kinesiology and Health, Miami University, Oxford, OH, USA

    Mark Walsh

  5. Department of Psychology, Miami University, Oxford, OH, USA

    L. James Smart Jr

Authors
  1. Adam J. Strang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua Haworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathias Hieronymus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. James Smart Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam J. Strang.

Additional information

Communicated by Fausto Baldissera.

Electronic supplementary material

Below is the link to the electronic supplementary material.

421_2010_1770_MOESM1_ESM.tif

Supplementary Appendix. Statistical results for comparisons (paired t-tests) used to dissect Surface × Vision interactions for EA and PL. Mean and SE for these conditions can be viewed in Table 5 (TIFF 598 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strang, A.J., Haworth, J., Hieronymus, M. et al. Structural changes in postural sway lend insight into effects of balance training, vision, and support surface on postural control in a healthy population. Eur J Appl Physiol 111, 1485–1495 (2011). https://doi.org/10.1007/s00421-010-1770-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00421-010-1770-6

Keywords

Search

Navigation