Smartphone Technology Can Measure Postural Stability and Discriminate Fall Risk in Older Adults

Publication date: Available online 9 October 2018

Source: Gait & Posture

Author(s): Katherine L. Hsieh, Kathleen L. Roach, Douglas A. Wajda, Jacob J. Sosnoff

Abstract

Background

Falls are the leading cause of injury related death in older adults. Impaired postural stability is a predictor of falls but is seldom objectively assessed in clinical or home settings. Embedded accelerometers within smartphones offer potential to objectively measure postural stability. The purpose of this study was to determine if a smartphone embedded accelerometer can measure static postural stability and distinguish older adults at high levels of fall risk.

Methods

Thirty older adults (age: 65.9 ± 8.8) underwent seven balance tests while standing on a force plate and holding a smartphone against their chest in a standardized order. Participants also completed the Physiological Profile Assessment to assess their fall risk. Center of pressure (COP) parameters from the force plate including velocity in the anterioposterior (AP) and mediolateral (ML) directions and 95% confidence ellipse were derived. Maximum acceleration and root mean square (RMS) in ML, AP and vertical axes were derived from the smartphone. Spearman rank-order correlations between force plate and smartphone measures were conducted, and receiver operating characteristic (ROC) and the area under the curves (AUC) were constructed to distinguish between low and high fall risk.

Results

There were moderate to strong significant correlations between measures derived from the force plate and measures derived from the smartphone during challenging balance conditions (ρ = 0.42-0.81; p < 0.01-0.05). The AUC for ROC plots were significant for all COP measures during challenging balance conditions (p < 0.01-0.05). The AUC for ROC plots were significant for RMS vertical and AP during challenging balance conditions (p = 0.01-0.04).

Significance

This study provides evidence that a smartphone is a valid measure of postural stability and capable of distinguishing fall risk stratification in older adults. There is potential for smartphones to offer objective, fall risk assessments for older adults.

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Time-to-Boundary Analysis of Postural Control following Acute Lateral Ankle Sprain

Publication date: Available online 9 October 2018

Source: Gait & Posture

Author(s): Kyung-Min Kim, Joo-Sung Kim, Jeonghoon Oh, Sae Yong Lee

Abstract

Background

Acute lateral ankle sprain (ALAS) impairs unipedal balance both with the injured and uninjured limb, suggesting that balance during bipedal stance may also be compromised. However, a previous study failed to find such impairment because of poorly sensitive balance outcomes. Time-to-boundary (TTB) analysis may be sensitive enough for detecting latent deficits in bipedal balance following ALAS.

Research question

We aimed to examine postural stability during bipedal stance in patients with ALAS using TTB outcomes, and to determine bilateral deficits in unipedal balance.

Methods

Twenty-seven patients with ALAS and 26 persons without a history of ALAS participated. ALAS was operationally defined as a traumatic injury to the lateral ligaments of the ankle joint occurring within 24–72 hours. Both limbs of the control group were side-matched to those of the patients as either injured or uninjured limbs. All participants performed 3 trials of bipedal stance with eyes open and closed. Next, they completed 3 trials of unipedal stance on both the injured and uninjured limbs in both visual conditions. Order of limb and visual condition for each limb was randomly selected. Means and standard deviations of TTB minima in the anteroposterior and mediolateral directions were computed to assess balance, with lower values indicating poorer balance.

Results

Independent t-tests revealed significant group differences for almost all measures (p=<.001 to 0.021), indicating that the ALAS group presented poorer bipedal balance. For unipedal balance, there were no significant group-by-limb interactions for all measures (p > 0.05), indicating no side-to-side differences in the ALAS group. However, group main effects were found for all measures (p=<0.001 to 0.048), showing poorer unipedal balance in the ALAS group.

Significance

TTB analysis revealed impaired balance during both unipedal and bipedal stance conditions following ALAS. These results support the emerging hypothesis that centrally mediated changes in postural control may occur following ALAS.

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Side does not matter in healthy young and older individuals - Examining the importance of how we match limbs during gait studies

Publication date: Available online 9 October 2018

Source: Gait & Posture

Author(s): Erik Kowalski, Danilo S. Catelli, Mario Lamontagne

Abstract

Background

Various methods exist when comparing gait data between groups and include the analysis of a single limb, or taking an average of both limbs. Evidence exists suggesting that both limbs are not symmetrical, so statistical differences may exist in biomechanical variables when comparing gait with different limb-matching methods.

Research question

Does limb-matching method have an effect on statistical outcome when comparing biomechanical variables during a gait task?

Methods

This retrospective study compared forty participants separated into a younger and older group as they completed a gait task. Twenty-five commonly used biomechanical variables were compared between the two groups using four different limb-matching methods: (i) average of both limbs; (ii) dominant limb; (iii) non-dominant limb; (iv) random limb. A mixed linear model was used to compare all the biomechanical variables between the younger and older group using the different limb-matching methods.

Results

Limb-matching methods only had a significant effect for 1/25 variables examined. Group effects between the younger and older groups were more prevalent, with the most significant effects occurring at the ankle joint.

Significance

Limb-matching methods do not have a direct effect on biomechanical outcomes when comparing gait in healthy young and old groups. Gait is cyclical, so limb symmetry is often assumed. However, if the complexity of the task increases, or when comparing against groups with impaired gait, both limbs may behave differently, so limb-matching method may become more crucial.

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Smartphone Technology Can Measure Postural Stability and Discriminate Fall Risk in Older Adults

Publication date: Available online 9 October 2018

Source: Gait & Posture

Author(s): Katherine L. Hsieh, Kathleen L. Roach, Douglas A. Wajda, Jacob J. Sosnoff

Abstract

Background

Falls are the leading cause of injury related death in older adults. Impaired postural stability is a predictor of falls but is seldom objectively assessed in clinical or home settings. Embedded accelerometers within smartphones offer potential to objectively measure postural stability. The purpose of this study was to determine if a smartphone embedded accelerometer can measure static postural stability and distinguish older adults at high levels of fall risk.

Methods

Thirty older adults (age: 65.9 ± 8.8) underwent seven balance tests while standing on a force plate and holding a smartphone against their chest in a standardized order. Participants also completed the Physiological Profile Assessment to assess their fall risk. Center of pressure (COP) parameters from the force plate including velocity in the anterioposterior (AP) and mediolateral (ML) directions and 95% confidence ellipse were derived. Maximum acceleration and root mean square (RMS) in ML, AP and vertical axes were derived from the smartphone. Spearman rank-order correlations between force plate and smartphone measures were conducted, and receiver operating characteristic (ROC) and the area under the curves (AUC) were constructed to distinguish between low and high fall risk.

Results

There were moderate to strong significant correlations between measures derived from the force plate and measures derived from the smartphone during challenging balance conditions (ρ = 0.42-0.81; p < 0.01-0.05). The AUC for ROC plots were significant for all COP measures during challenging balance conditions (p < 0.01-0.05). The AUC for ROC plots were significant for RMS vertical and AP during challenging balance conditions (p = 0.01-0.04).

Significance

This study provides evidence that a smartphone is a valid measure of postural stability and capable of distinguishing fall risk stratification in older adults. There is potential for smartphones to offer objective, fall risk assessments for older adults.

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Time-to-Boundary Analysis of Postural Control following Acute Lateral Ankle Sprain

Publication date: Available online 9 October 2018

Source: Gait & Posture

Author(s): Kyung-Min Kim, Joo-Sung Kim, Jeonghoon Oh, Sae Yong Lee

Abstract

Background

Acute lateral ankle sprain (ALAS) impairs unipedal balance both with the injured and uninjured limb, suggesting that balance during bipedal stance may also be compromised. However, a previous study failed to find such impairment because of poorly sensitive balance outcomes. Time-to-boundary (TTB) analysis may be sensitive enough for detecting latent deficits in bipedal balance following ALAS.

Research question

We aimed to examine postural stability during bipedal stance in patients with ALAS using TTB outcomes, and to determine bilateral deficits in unipedal balance.

Methods

Twenty-seven patients with ALAS and 26 persons without a history of ALAS participated. ALAS was operationally defined as a traumatic injury to the lateral ligaments of the ankle joint occurring within 24–72 hours. Both limbs of the control group were side-matched to those of the patients as either injured or uninjured limbs. All participants performed 3 trials of bipedal stance with eyes open and closed. Next, they completed 3 trials of unipedal stance on both the injured and uninjured limbs in both visual conditions. Order of limb and visual condition for each limb was randomly selected. Means and standard deviations of TTB minima in the anteroposterior and mediolateral directions were computed to assess balance, with lower values indicating poorer balance.

Results

Independent t-tests revealed significant group differences for almost all measures (p=<.001 to 0.021), indicating that the ALAS group presented poorer bipedal balance. For unipedal balance, there were no significant group-by-limb interactions for all measures (p > 0.05), indicating no side-to-side differences in the ALAS group. However, group main effects were found for all measures (p=<0.001 to 0.048), showing poorer unipedal balance in the ALAS group.

Significance

TTB analysis revealed impaired balance during both unipedal and bipedal stance conditions following ALAS. These results support the emerging hypothesis that centrally mediated changes in postural control may occur following ALAS.

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Side does not matter in healthy young and older individuals - Examining the importance of how we match limbs during gait studies

Publication date: Available online 9 October 2018

Source: Gait & Posture

Author(s): Erik Kowalski, Danilo S. Catelli, Mario Lamontagne

Abstract

Background

Various methods exist when comparing gait data between groups and include the analysis of a single limb, or taking an average of both limbs. Evidence exists suggesting that both limbs are not symmetrical, so statistical differences may exist in biomechanical variables when comparing gait with different limb-matching methods.

Research question

Does limb-matching method have an effect on statistical outcome when comparing biomechanical variables during a gait task?

Methods

This retrospective study compared forty participants separated into a younger and older group as they completed a gait task. Twenty-five commonly used biomechanical variables were compared between the two groups using four different limb-matching methods: (i) average of both limbs; (ii) dominant limb; (iii) non-dominant limb; (iv) random limb. A mixed linear model was used to compare all the biomechanical variables between the younger and older group using the different limb-matching methods.

Results

Limb-matching methods only had a significant effect for 1/25 variables examined. Group effects between the younger and older groups were more prevalent, with the most significant effects occurring at the ankle joint.

Significance

Limb-matching methods do not have a direct effect on biomechanical outcomes when comparing gait in healthy young and old groups. Gait is cyclical, so limb symmetry is often assumed. However, if the complexity of the task increases, or when comparing against groups with impaired gait, both limbs may behave differently, so limb-matching method may become more crucial.

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Frequency of audiological complaints in patients with fibromyalgia syndrome and its relationship with oxidative stress.

Related Articles

Frequency of audiological complaints in patients with fibromyalgia syndrome and its relationship with oxidative stress.

Niger J Clin Pract. 2018 Oct;21(10):1271-1277

Authors: Koca TT, Seyithanoglu M, Sagiroglu S, Berk E, Dagli H

Abstract
Aim: Central sensitization-related neuroaudiological symptoms are frequently seen in patients with fibromyalgia syndrome (FMS). This study aimed to evaluate the audiological signs and symptoms in patients with FMS and explore their relationship with oxidative stress markers.
Methods: This prospective controlled cross-sectional study compared the serum myeloperoxidase, superoxide dismutase, glutathione peroxidase (GPx), nitric oxide (NO), and malondialdehyde (MDA) concentrations in 44 patients with FMS diagnosed according to the 2010 American College of Rheumatology criteria and 44 healthy volunteers. FMS severity was assessed using the visual analog scale and Fibromyalgia Impact Questionnaire. An audiological assessment including vocalizations, vertigo, balance problems, and hearing problems was done to all participants.
Results: The two groups were of similar age (P = 0.24), gender (P = 0.40), and weight distribution (P = 0.6). Vertigo, tinnitus, hearing, and balance complaints (P = 0.01/P = 0.00/P = 0.00/P = 0.01) were significantly higher in the FMS group. All subunits and total scores of dizziness handicap inventory were significantly higher (P = 0.00/P = 0.00/P = 0.01/P = 0.01) in the FMS group. An antioxidant GPx and oxidant parameters such as NO and MDA were found to be significantly higher (P = 0.00/P = 0.01/P = 0.02). The hearing assessments at frequencies between 250 and 12,000 Hz showed a significant difference between the two groups (high hearing frequencies in the FMS group) in audiometry. No significant difference was found between the two groups in terms of the presence of stabilo-acoustic reflex, intraaural pressure, and compliance (P = 0.18/P = 0.33/P = 0.41) in tympanogram.
Conclusions: Patients with FMS have high levels of oxidative stress markers (GPx, NO, and MDA), highly frequent audiological symptoms with high hearing frequencies in audiometry, independent of disease severity.

PMID: 30297558 [PubMed - in process]

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Frequency of audiological complaints in patients with fibromyalgia syndrome and its relationship with oxidative stress.

Related Articles

Frequency of audiological complaints in patients with fibromyalgia syndrome and its relationship with oxidative stress.

Niger J Clin Pract. 2018 Oct;21(10):1271-1277

Authors: Koca TT, Seyithanoglu M, Sagiroglu S, Berk E, Dagli H

Abstract
Aim: Central sensitization-related neuroaudiological symptoms are frequently seen in patients with fibromyalgia syndrome (FMS). This study aimed to evaluate the audiological signs and symptoms in patients with FMS and explore their relationship with oxidative stress markers.
Methods: This prospective controlled cross-sectional study compared the serum myeloperoxidase, superoxide dismutase, glutathione peroxidase (GPx), nitric oxide (NO), and malondialdehyde (MDA) concentrations in 44 patients with FMS diagnosed according to the 2010 American College of Rheumatology criteria and 44 healthy volunteers. FMS severity was assessed using the visual analog scale and Fibromyalgia Impact Questionnaire. An audiological assessment including vocalizations, vertigo, balance problems, and hearing problems was done to all participants.
Results: The two groups were of similar age (P = 0.24), gender (P = 0.40), and weight distribution (P = 0.6). Vertigo, tinnitus, hearing, and balance complaints (P = 0.01/P = 0.00/P = 0.00/P = 0.01) were significantly higher in the FMS group. All subunits and total scores of dizziness handicap inventory were significantly higher (P = 0.00/P = 0.00/P = 0.01/P = 0.01) in the FMS group. An antioxidant GPx and oxidant parameters such as NO and MDA were found to be significantly higher (P = 0.00/P = 0.01/P = 0.02). The hearing assessments at frequencies between 250 and 12,000 Hz showed a significant difference between the two groups (high hearing frequencies in the FMS group) in audiometry. No significant difference was found between the two groups in terms of the presence of stabilo-acoustic reflex, intraaural pressure, and compliance (P = 0.18/P = 0.33/P = 0.41) in tympanogram.
Conclusions: Patients with FMS have high levels of oxidative stress markers (GPx, NO, and MDA), highly frequent audiological symptoms with high hearing frequencies in audiometry, independent of disease severity.

PMID: 30297558 [PubMed - in process]

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