Assessing the effects of sway-back posture on global and regional spinal sagittal angles using inertial measurement units.

BACKGROUND: Sway-back posture in the sagittal profile is a commonly adopted poor standing posture. Although the terms, definitions, and adverse health problems of sway-back posture are widely used clinically, few studies have quantified sway-back posture. OBJECTIVE: To investigate spinal sagittal alignment in sway-back posture while standing based on global and regional angles using inertial measurement units (IMUs). METHODS: This cross-sectional study recruited 30 asymptomatic young adults. After measuring the sway angle while standing, the participants were divided into sway-back and non-sway-back groups (normal thoracic group). Each participant stood in a comfortable posture for 5 seconds with IMUs at the T1, T7, T12, L3, and S2 levels. Then, we measured the global and regional lumbar and thoracic angles and sacral inclination in the standing position. RESULTS: Although there was no difference in the global lumbar angle, there was a difference in regional lumbar angles between the two groups. The normal thoracic group had balanced lumbar lordosis between the upper and lower lordotic arcs, whereas the sway back group tended to have a flat upper lumbar angle and increased lower lumbar angle. CONCLUSION: It is useful to assess the global and regional angles in the spinal sagittal assessment of individuals with sway-back posture.

Effects of the abdominal drawing-in maneuver on hamstring rotational activity and pelvic stability in females.

BACKGROUND: The medial hamstring (MH) and lateral hamstring (LH) can be selectively trained through tibial internal and external rotation during prone knee flexion. However, no study has identified how a combined tibial rotation and lumbo-pelvic stability strategy influences MH and LH muscle activities. OBJECTIVE: To investigate the combined effects of tibial rotation and the abdominal drawing-in maneuver (ADIM) on MH and LH muscle activities as well as pelvic rotation during prone knee flexion. METHODS: Fifteen female volunteers performed prone knee flexion with tibial internal and external rotation, with and without the ADIM. Under each condition, MH and LH muscle activities were measured by surface electromyography (EMG), and the pelvic rotation angle by a smartphone inclinometer application. RESULTS: The results showed increased MH (without the ADIM: p< 0.001, effect size (d) = 2.05; with the ADIM: p< 0.001, d= 1.71) and LH (without the ADIM: p< 0.001, d= 1.64; with the ADIM: p= 0.001, d= 1.58) muscle activities under internal and external tibial rotation, respectively. However, addition of the ADIM led to increased MH (internal tibial rotation: p= 0.001, d= 0.67; external tibial rotation: p= 0.019, d= 0.45) and LH (internal tibial rotation: p= 0.003, d= 0.79; external tibial rotation: p< 0.001, d= 1.05) muscle activities combined with reduced pelvic rotation (internal tibial rotation: p< 0.001, d= 3.45; external tibial rotation: p< 0.001, d= 3.01) during prone knee flexion. CONCLUSIONS: These findings suggest that the ADIM could be useful for reducing compensatory pelvic rotation and enhancing selective muscle activation in the MH and LH, according to the direction of tibial rotation, during prone knee flexion.

Reliability, standard error of measurement, and minimal detectable change of the star excursion balance test in children with cerebral palsy.

OBJECTIVE: The present study aimed to estimate the reliability, standard error of measurement (SEM), and minimum detectable change (MDC) of the star excursion balance test (SEBT) in children with cerebral palsy (CP). METHODS: Eight children with CP (five boys and three girls, sixteen legs) participated in this study. Each child carried out the SEBT and was assessed by two examiners. To determine intra-rater reliability, the intra-class correlation coefficient (ICC) model (3, 3) was calculated. To determine the inter-rater reliability, the ICC model (2, 3) was computed. RESULTS: In terms of the intra-rater reliability of the SEBT, the ICC varied from 0.98 to 0.99 and the total ICC score was 0.99 (p< 0.001). For the inter-rater reliability, the ICC varied from 0.98 to 1.00 and the total ICC score was 0.99 (p< 0.001). The SEBT had an SEM of 2.63 and an MDC of 7.31. CONCLUSION: The SEBT is not only reliable with a small SEM, but is also a simple and cheap assessment of dynamic balance in children with CP.

Effects of resistive jaw opening exercise in stroke patients with dysphagia: A double- blind, randomized controlled study.

BACKGROUND: The resistive jaw opening exercise (RJOE) was suggested as a potential remedial treatment for patients with dysphagia. However, clinical evidence is insufficient. OBJECTIVE: To investigate the effect of RJOE on hyoid bone movement, aspiration, and oral intake level in stroke patients with dysphagia. METHODS: Forty stroke patients with dysphagia were randomly allocated into either the experimental group (n= 20) or placebo group (n= 20). The experimental group performed RJOE using a portable device, while the placebo group performed RJOE using a sham device with fewer loads. Intervention was conducted 5 times a week for 4 weeks. Hyoid bone movement was analyzed by two-dimensional analysis of anterior and superior motion based on a videofluoroscopic swallowing study. Aspiration was assessed using a penetration-aspiration scale (PAS), and oral intake level was assessed using the functional oral intake scale (FOIS). RESULTS: Both groups showed statistically significant differences in hyoid movement, PAS, and FOIS scale (p< 0.05). However, after the intervention, there was no significant difference between the two groups except for the liquid type of PAS. Effect sizes (Cohen's d) were 0.9 and 0.7, 0.6 and 0.6, and 1.1 for the anterior and superior movement of the hyoid bone, semisolid and liquid type of PAS, and FOIS scale respectively. CONCLUSIONS: This study suggests that RJOE helps in hyoid movement, aspiration reduction, and oral intake in patients with dysphagia after stroke.

Strategy on navigating obstacle in patients with lumbar spinal stenosis: Relationship among trunk and pelvic movement, swing toe clearance, and muscle coordination of the stance limb.

BACKGROUND AND OBJECTIVE: Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects gait, muscle activity, and trunk-pelvis-limb coordination because the lumbar spine and muscles interact to allow load transfer between the lower back and pelvis during sagittal trunk movement. Therefore, we investigated the relationships among trunk and pelvic movement, swing toe clearance, and muscle coordination (isolated contraction ratios) of the stance limb during obstacle-crossing by patients with LSS. METHODS: Ten patients with LSS and ten control subjects were enrolled. All navigated an obstacle during walking. Kinematic data from the trunk and lower extremities were monitored using a three-dimensional motion analysis system. In addition, we measured the isolated contraction ratios of the gluteus medius (GMed) and vastus lateralis (VL) using surface electromyography. RESULTS: The normalized lead limb distance was significantly lower in the LSS group than in controls. The spine flexion angle when the swinging limb toe was above the obstacle was higher, but the pelvic anterior tilting angle was lower, in the LSS group. LSS patients also had a significantly lower isolated contraction ratio of the GMed in the trailing stance limb but a significantly higher VL. CONCLUSIONS: Patients with LSS adapted a poor posture and their thoracic and spinal regions were hyperflexed with restricted pelvic obliquity. This created an inefficient gait, a shorter leading limb step, and less stable muscle coordination in the stance limb. Our findings may help healthcare professionals manage patients with LSS.

Changes in trunk sway and impairment during sitting and standing in children with cerebral palsy.

BACKGROUND: Poor postural control constitutes a major impairment in children with cerebral palsy (CP), compromising everyday activities such as sitting- and standing-position. PURPOSE: In this study, we measured trunk sway during sitting- and standing-position. Additionally, we assessed trunk control ability using the trunk impairment scale (TIS), trunk control measurement scale (TCMS), and sitting assessment test for children with neuromotor dysfunction (SACND), in children with CP. METHODS: Fifteen children (10 boys and 5 girls) were recruited for this study. Trunk sway was measured using a triaxial accelerometer that recorded variation in movement acceleration during quiet sitting- and standing-position. RESULTS: Anterior-posterior (AP) acceleration was significantly greater in the standing position than the sitting position (p= 0.001). Medio-lateral (ML) acceleration was significantly greater in the standing position than in the sitting position (p= 0.012). The TIS total score showed a moderate negative relationship with AP acceleration (r=-0.635, p= 0.011). The TCMS total score moderately and negatively correlated with AP acceleration (r=-0.582, p= 0.023). The SACND total score moderately and positively correlated with AP acceleration (r= 0.670, p= 0.006). CONCLUSION: Measurement of trunk sway using a triaxial accelerometer revealed a moderate correlation with trunk control test data and excellent reliability. Our findings suggest that measurement of trunk sway using a triaxial accelerometer is not time-consuming, and is simple and easy. Our approach can be applied in clinical settings to gain information on trunk control in children with CP.

Effects of task velocity and center of mass acceleration during Y-Balance Test in elderly females with good and poor visual acuity.

[Purpose] To explore the effects of good binocular visual acuity (BVA) compared to poor BVA, reach distance, task velocity, and center of mass (COM) acceleration were evaluated in elderly females performing the Y-Balance Test (YBT) using a cross-sectional design. [Subjects and Methods] A total of 13 participants had BVA of ≥0.4 log of the minimum angle of resolution (logMAR) (poor BVA group), and the other 13 had BVA of ≤0.3 logMAR (good BVA group). An accelerometer was attached over participants' L3 spinous process, and they then performed the YBT. [Results] The normalized reach distances in the three directions among the good BVA group were longer than those among the poor BVA group. The task velocity in the good BVA group was significantly higher, whereas COM acceleration in the A direction was significantly lower compared with the poor BVA group. [Conclusion] Visual status must be considered when older adult individuals undergo physical therapy and functional training to ensure that healthcare professionals can better assist older adult women.

Effects of live and video form action observation training on upper limb function in children with hemiparetic cerebral palsy.

PURPOSE: The purpose of this study was to investigate the effects of live and video form action observation training (AOT) on upper limb (UL) movement acceleration and function in children with cerebral palsy (CP). METHODS: In total, 12 children (7 boys, 5 girls) with CP participated in this study. The children were allocated randomly to live (experimental) and video (control) AOT groups. All children completed 20 treatment sessions, each 30 minutes in duration, 5 days per week for a month. Mediolateral (ML) and vertical (VT) acceleration data, Jebsen-Taylor Hand Function (JTHF) scores, and Box and Block Test (BBT) scores were obtained at baseline and at 4 weeks after the intervention. RESULTS: ML and VT movement acceleration and JTHF scores were significantly lower in the live group (p< 0.05). The BBT score was significantly higher in the live than in the video group (p< 0.05). CONCLUSIONS: Our findings suggest that live AOT is more effective than video AOT for improving UL movement acceleration and function. Clinically, our findings offer important insights for clinicians when planning AOT interventions to reduce UL movement acceleration and improve UL function.

Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: A randomized pilot study.

BACKGROUND: Recently, chin tuck against resistance exercise (CTAR) has been reported as a remedial treatment for pharyngeal dysphagia. However, the clinical evidence of the effect is still lacking. OBJECTIVE: This study investigated the effect of CTAR on the swallowing function in patients with dysphagia following subacute stroke. METHODS: The patients were randomly assigned to an experimental (n = 11) or a control group (n = 11). The experimental group performed CTAR using the CTAR device. The control group received only conventional dysphagia treatment. Both groups received training on five days a week, for four weeks. The swallowing function was measured using functional dysphagia scale (FDS) and penetration-aspiration scale (PAS), based on a videofluoroscopic swallowing study (VFSS). RESULTS: The experimental group showed more improvements in the oral cavity, laryngeal elevation/epiglottic closure, residue in valleculae, and residue in pyriform sinuses of FDS and PAS compared to the control group (p < 0.05, all). CONCLUSIONS: This study demonstrated that CTAR is effective in improving the pharyngeal swallowing function in patients with dysphagia after stroke. Therefore, we recommend CTAR as a new remedial training alternative to HLE.

The relationship between trunk control and upper limb function in children with cerebral palsy.

BACKGROUND: Trunk control ability greatly influences functional movement of the upper limbs. PURPOSE: Our primary aims were to assess trunk control ability, sway, and upper limb functions in children with cerebral palsy (CP), and to investigate the relationship between trunk control ability and upper limb function. METHODS: We included 15 children (8 boys and 7 girls) with CP. We used the Trunk Control Measurement Scale (TCMS) to evaluate trunk control ability and sway. We employed the Jebsen-Taylor Hand Function Test (JTHFT), the Quality of Upper Extremity Skills Test (QUEST), the Box and Blocks Test (BBT), and the ABILHAND-Kids questionnaire to explore upper limb function and arm movement acceleration. We calculated correlations between trunk control ability and parameters of upper limb function. RESULTS: TCMS scores correlated positively with the QUEST, BBT, and ABILHAND-Kids data, but negatively with the JTHFT findings. Anteroposterior acceleration correlated positively with JTHFT data, but negatively with QUEST, BBT, and ABILHAND-Kids data. Mediolateral acceleration correlated positively with the JTHFT outcomes, but negatively with those of QUEST, BBT, and ABILHAND-Kids. CONCLUSIONS: Upper limb function test data exhibited moderate to strong correlations with trunk control ability, as measured via the TCMS and triaxial accelerometry, in children with CP. Our results suggest that trunk control ability should be assessed when evaluating upper limb function in such children.

Measurement of upper limb movement acceleration and functions in children with cerebral palsy.

OBJECTIVE: The main purpose of this study was to measure the peak acceleration of the upper limb (UL) during reaching, and to calculate correlations between peak acceleration data and functional test results in children with cerebral palsy (CP). METHODS: We recruited 15 children with CP (8 boys and 7 girls) and measured peak acceleration and function as revealed by the Jebsen Taylor Hand Function Test (JTHF), the Quality of Upper Extremity Skills Test (QUEST), the Box and Blocks Test (BBT), and the ABILHAND-Kids questionnaire. We calculated correlations between peak acceleration data and scores on the functional tests. RESULTS: The peak acceleration of the more-affected UL was significantly higher than that of the less-affected UL (p< 0.05). The peak acceleration data were positively correlated with JTHFT scores. On the other hand, the peak acceleration data were negatively correlated with QUEST, BBT, and ABILHAND-Kids scores. The test-retest reliability of the peak acceleration was excellent, with an intra-class correlation coefficient (ICC) 0.87-0.98. CONCLUSIONS: Peak acceleration data correlated with UL functional test results; as this proved to be reliable, the tri-axial accelerometer is a clinically useful assessment tool for evaluating UL movement. Therefore, our results suggest that measurement of acceleration using a tri-axial accelerometer is appropriate when clinicians quantify UL movement during therapeutic rehabilitation in clinical settings.

Validity and reliability of ankle dorsiflexion measures in children with cerebral palsy.

PURPOSE: We compared a goniometer method in a non-weight-bearing position with a tape measure method in a weight-bearing position to determine which was more reliable for assessing dorsiflexion range of motion (ROM) in children with cerebral palsy (CP). METHODS: Ankle dorsiflexion ROM was measured using goniometer and tape measure methods in non-weight- and weight-bearing positions, respectively. RESULTS: In the test-retest reliability of ankle dorsiflexion ROM using a universal goniometer, the intraclass correlation coefficient (ICC) varied from 0.75 to 0.96 and the overall ICC score was 0.91 (p< 0.001). In the test-retest reliability of ankle dorsiflexion ROM using a tape measure, ICC varied from 0.98 to 0.99 and the overall ICC score was 0.99 (p< 0.001). Ankle dorsiflexion ROM using a universal goniometer had a standard error of measurement (SEM) of 2.86 and a minimum detectable change (MDC) of 7.94. Ankle dorsiflexion ROM using a tape measure had an SEM of 1.01 and a MDC of 2.80. CONCLUSIONS: The tape measure method in a weight-bearing position was more reliable than using a universal goniometer in a non-weight-bearing position in children with CP.

Effects of mental practice combined with electromyogram-triggered electrical stimulation for upper extremity function in stroke patients.

[Purpose] To investigate the effect of mental practice combined with electromyogram-triggered electrical stimulation (MP-EMG ES) on the upper extremity of stroke patients. [Subjects and Methods] Participants were randomly assigned to experimental group or control group. The experimental group received MP-EMG ES plus conventional rehabilitation therapy for 5 days per week for 4 weeks. The control group received only conventional rehabilitation therapy. Outcome measure included the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL). [Results] Experimental group showed more improved in the FMA, MAL-AOU, MAL-QOM compared with the control group. [Conclusion] These results suggest that MP-EMG ES improves the upper extremity of subacute stroke patients better than conventional rehabilitation therapy alone.

Effects of 4 weeks of dynamic neuromuscular stabilization training on balance and gait performance in an adolescent with spastic hemiparetic cerebral palsy.

[Purpose] The purpose of this study investigated the effects of 4 weeks of dynamic neuromuscular stabilization training on balance ability. [Subject and Methods] An adolescent with spastic hemiparetic cerebral palsy was recruited. The subject performed 4 weeks of dynamic neuromuscular stabilization training. We assessed the balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, the 10-meter walk test, and the 6-min walk test. [Results] The balance subtest scores were improved significantly after training. [Conclusion] This study suggests that 4 weeks of dynamic neuromuscular stabilization training is effective for improving balance and gait performance in spastic hemiparetic cerebral palsy.

Difference in trunk stability during semicircular turns with and without a bag in elderly women.

BACKGROUND: Direction changes while walking are more likely to cause a hip fracture than is falling while walking in a straight line. Trunk stability is an important contributor to safe and effective walking, and arm movements influence trunk movement while walking. However, the difference in the trunk stability during semicircular turns performed by elderly women with a light bag has not been examined. OBJECTIVE: To investigate the effects of carrying a bag on trunk stability during semicircular turns in elderly women. METHODS: We enrolled 15 community-dwelling elderly women capable of independent walking. Participants walked with and without a bag at a self-selected speed along a marked path, which included semicircular turns, while fitted with an accelerometer attached over the L3 spinous process. RESULTS: Gait velocity was faster during semicircular turning with a bag versus without a bag. The normalized medial-lateral center of mass acceleration was lower during semicircular turning with a bag versus without a bag. CONCLUSIONS: We suggest that a light additional arm load and increased arm swing contributes to trunk stability and efficient walking during semicircular turning by elderly women.

The effect of isolating the paretic limb on weight-bearing distribution and EMG activity during squats in hemiplegic and healthy individuals.

BACKGROUND: Neural reorganization for movement therapy after a stroke is thought to be an important mechanism that facilitates motor recovery. However, there is a lack of evidence for the effectiveness of exercise programs in improving the lower limbs. OBJECTIVE: We investigated the immediate effect of isolating the paretic limb using different foot positions ((i) foot parallel; both feet parallel, (ii) foot asymmetry; paretic foot backward by 10 cm, and (iii) foot lifting; nonparetic foot lifting by normalization to 25% of knee height) on weight-bearing distribution and electromyography (EMG) of the thigh muscle during squats. METHODS: In total, 20 patients with hemiplegia and 16 healthy subjects randomly performed three squat conditions in which the knee joint was flexed to 30°. Weight distribution was measured using the BioRescue system. Muscle activity was measured using a surface EMG system. RESULTS: Patients with hemiplegia exhibited significantly decreased weight bearing on the paretic foot at 0° and 30° knee flexion compared with the nondominant foot of a healthy subject. The muscle activity of the quadriceps was significantly lower in patients with hemiplegia compared to healthy subjects. Weight bearing and EMG activity of the quadriceps femoris on the paretic or nondominant side significantly increased during a knee flexion of 30° with under the foot asymmetry and foot lifting positions compared with the parallel foot position. CONCLUSION: Isolating the paretic limb using the asymmetric foot positions and lifting of the foot during squats might help patients with hemiplegia to improve weight-bearing and achieve greater activation of the quadriceps muscle in the paretic limb.

Effects of Balance Control Through Trunk Movement During Square and Semicircular Turns on Gait Velocity, Center of Mass Acceleration, and Energy Expenditure in Older Adults.

BACKGROUND: Turning during ambulation is a common movement in everyday life, but complex and challenging for older adults. Balance control through trunk movement provides a stable platform during walking, thus it is an essential component of safe and efficient turning during walking in elderly individuals. OBJECTIVES: To investigate the effects of balance control during square turning (ST) and semicircular turning (SCT) on gait velocity, center of mass (COM) acceleration, and energy expenditure in elderly women. DESIGN: Cross-sectional design. SETTING: Village community center. PARTICIPANTS: Twenty community-dwelling elderly women capable of independent walking were enrolled in the study. METHODS: Participants walked at a self-selected speed along a marked path that included 2 types of turns (the path was divided into 3 segments: straight, turning, and straight return), while fitted with an accelerometer attached over the L3 spinous process. MAIN OUTCOME MEASUREMENTS: Differences in gait velocity, normalized COM acceleration, and energy expenditure were analyzed using paired t-tests for comparisons between ST and SCT tasks and using a one-way repeated-measures analysis of variance for within tasks. RESULTS: During the ST task, which was characterized by the use of a less-stable balance maintenance strategy, gait velocity and vertical COM acceleration were lower (P < .05), whereas greater medial-lateral COM acceleration (P < .05) and energy expenditure (P < .001) were observed during turning and return straight stages compared with the SCT task. For both tasks, velocity during turning stage was the slowest, among the 3 stages, the straight stage was the fastest (P < .05). For the SCT task, the anterior-posterior COM acceleration during the straight stage was significantly higher than during the turning stage, and the vertical COM acceleration during the straight stage was significantly lower than during the return-straight stage (P < .05). In both tasks, the energy expenditure of the turning stage was significantly higher than in the straight and return straight stage (P ≤ .001), and in the return straight stage was higher than the straight stage-only ST task (P < .05). CONCLUSIONS: We suggest that elderly individuals participate in balance and gait training using a variety of turns, including turns requiring medial-lateral and vertical COM balance control, to prevent falls and to improve energy efficiency of walking. LEVEL OF EVIDENCE: IV.

Differences in lumbar and pelvic angles and gluteal pressure in different sitting postures.

[Purpose] To investigate the effects of erect sitting, slouched posture with cross-legged sitting, and erect posture with cross-legged sitting on the lumbar and pelvic angles, and gluteal pressure. [Subjects] For the experiments, 17 healthy women were recruited. [Methods] All subjects were asked to perform three sitting postures: erect sitting, slouched posture with cross-legged sitting, and erect posture with cross-legged sitting. Lumbar and pelvic angles were measured using a three-dimensional motion-capture system, and gluteal pressure was measured using a pressure mat. [Results] Compared to erector sitting, slouched posture with cross-legged sitting showed significantly greater lumbar flexion, posterior pelvic tilt, and left pelvic tilt. Compared to erect sitting, erect posture with cross-legged sitting showed significantly greater lumbar flexion and posterior pelvic tilt. Compared to erect posture with cross-legged sitting, slouched posture with cross-legged sitting showed significantly greater lumbar flexion and posterior pelvic tilt. Compared to erect sitting and erect posture with cross-legged sitting, slouched posture with cross-legged sitting showed significantly greater left gluteal pressure; there was no significant difference in right gluteal pressure. [Conclusion] An erect posture can reduce changes in lumbar and pelvic angles, and gluteal pressure compared to a slouched posture during cross-legged sitting.

The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients.

[Purpose] The purpose of this study was to determine the effects of mirror therapy with tasks on upper extremity unction and self-care in stroke patients. [Subjects] Thirty participants were randomly assigned to either an experimental group (n=15) or a control group (n=15). [Methods] Subjects in the experimental group received mirror therapy with tasks, and those in the control group received a sham therapy; both therapies were administered, five times per week for six weeks. The main outcome measures were the Manual Function Test for the paralyzed upper limb and the Functional Independence Measure for self-care performance. [Results] The experimental group had more significant gains in change scores compared with the control group after the intervention. [Conclusion] We consider mirror therapy with tasks to be an effective form of intervention for upper extremity function and self-care in stroke patients.

Comparison of energy expenditure during the Y-balance test in older adults with different visual acuities.

[Purpose] This study compared the energy expenditure during the Y-balance test (YBT) between elderly women with good binocular visual acuity (BVA) and those with poor BVA. [Subjects] Twenty-one elderly women who could walk independently were recruited from a community dwelling. Eleven participants had a BVA equal to or less than 0.4 logarithm of the minimum angle of resolution (logMAR), and the other 10 participants had a BVA equal to or better than 0.3 logMAR. [Methods] The participants had an accelerometer attached over the L3 spinous process for measurement of energy expenditure and performed the YBT in the anterior, posteromedial, and posterolateral directions. [Results] The normalized reach distance in the good BVA group during the YBT in three directions and composite reach distance were significantly longer compared with the values in the poor BVA group. The energy expenditure in the good BVA group during the YBT in the three directions was significantly reduced compared with the values in the poor BVA group. [Conclusion] We suggest that visual acuity in the elderly influences dynamic balance and energy expenditure. Elderly subjects with poor BVA showed poor dynamic balance control and an inefficient biomechanical cost strategy compared to subjects with good BVA.