Biofeedback is known to improve postural control and reduce postural sway. However, the effects that different biofeedback modes (coding for more or less complex movement information) may have on postural control improvement are still poorly investigated. In addition, most studies do not take into account the effects of spontaneous motor learning from repetition of a task when investigating biofeedback-induced improvement in postural control. In this study, we compared the effects of four different modes of audio-biofeedback (ABF), including direction and/or magnitude of sway information or just a non-specific-direction alarm, on the postural sway of 13 young healthy adults standing on a continuously rotating surface. Compared to the non-specific-direction alarm, ABF of continuous postural sway direction and/or amplitude resulted in larger postural sway reduction in the beginning of the experiment. However, over time, spontaneous postural motor learning flattened the effects of the different modes of ABF so that the alarm was as effective as more complex information about body sway. Nevertheless, motor learning did not make ABF useless, since all modes of ABF further reduced postural sway, even after subjects learned the task. All modes of ABF resulted in improved multi-segmental control of posture and stabilized the trunk-in-space. Spontaneous motor learning also improved multi-segmental control of posture but not trunk-in-space stabilization as much as ABF. In conclusion, although practice standing on a perturbing surface improved postural stability, the more body sway information provided to subjects using ABF, the greater the additional improvement in postural stability.
"Non-supportive light touch can also substitute as an earth vertical reference point and stabilize posture (Creath et al., 2002, 2008). Auditory biofeedback has also been used as a form of vestibular sensory substitution by notifying patients about the degree of postural sway through auditory cues (Dozza et al., 2007, 2011). "
[Show abstract][Hide abstract] ABSTRACT: Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH) produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that non-labyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.
Frontiers in Neurology 12/2011; 2:88. DOI:10.3389/fneur.2011.00088
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the effects of interactive video-game based (IVGB) training on the balance of older adults. The participants of the study included 30 community-living persons over the age of 65. The participants were divided into 2 groups. Group A underwent IVGB training for 6 weeks and received no intervention in the following 6 weeks. Group B received no intervention during the first 6 weeks and then participated in training in the following 6 weeks. After IVGB intervention, both groups showed improved balance based on the results from the following tests: the Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), Timed Up and Go (TUG) test, and the Sway Velocity (SV) test (assessing bipedal stance center pressure with eyes open and closed). Results from the Sway Area (SA) test (assessing bipedal stance center pressure with eyes open and closed) revealed a significant improvement in Group B after IVGB training. Group A retained some training effects after 6 weeks without IVGB intervention. Additionally, a moderate association emerged between the Xavix measured step system stepping tests and BBS, MFES, Unipedal Stance test, and TUG test measurements. In conclusion, IVGB training improves balance after 6 weeks of implementation, and the beneficial effects partially remain after training is complete. Further investigation is required to determine if this training is superior to traditional physical therapy.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine the effectiveness of visual biofeedback (VBF) signals from a force platform and accelerometer sensors placed on different body segments. The study was performed on 20 young subjects during standing on a firm and foam support surface with a VBF signal sensed from CoP, lower trunk (L5) and upper trunk (Th4). The VBF signal was controlled by 2D-movement of chosen body segment, which was presented as a red point on a monitor screen. Location of VBF signal had a significant effect on each postural parameter of CoP and trunk segments. RMS and amplitudes of postural sway in medial-lateral and anterior-posterior directions decreased during standing on both types of support surface due to VBF. L5-VBF and CoP-VBF significantly reduced CoP displacements and lower trunk tilts. Th4-VBF reduced upper trunk tilts. Frequency analysis of postural sway revealed a decrease of power spectral density (PSD) values in low frequency range (0.02-0.3Hz) and an increase of PSD values in higher frequency range (0.5-1.4Hz) in the VBF conditions during the stance on the firm surface in anterior-posterior direction. Reduction of body sway was the most significant in the body segment from which the VBF signal was sensed. The CoP position and L5 position provided the best signals for VBF. Changes in frequency ranges of body sway suggest voluntary activation of balance control. The results open new opportunities to optimize VBF system for balance improvement using accelerometers.
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