Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Immune Reconstitution Inflammatory Syndrome/chemically induced , Immune Reconstitution Inflammatory Syndrome/diagnosis , Leukoencephalopathy, Progressive Multifocal/chemically induced , Leukoencephalopathy, Progressive Multifocal/diagnosis , Magnetic Resonance Imaging , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Brain/blood supply , Brain/pathology , Cerebral Arteries/pathology , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Image Enhancement , Image Interpretation, Computer-Assisted , Immune Reconstitution Inflammatory Syndrome/drug therapy , Infusions, Intravenous , Methylprednisolone/therapeutic use , Middle Aged , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Natalizumab , Neurologic Examination/drug effects , Plasma ExchangeABSTRACT
We examined the effect of biofeedback of trunk sway on balance control while walking and performing a simultaneous cognitive or motor task. Thirteen healthy elderly (mean age (+/-S.E.M.) 70.8+/-2.0 years) and 16 healthy young (mean age 21.5+/-0.7 years) subjects performed three gait tasks while wearing body-worn gyroscopes, mounted at L1-3, to measure trunk sway. The gait tasks were walking normally, walking and counting backwards in 7's, and walking while carrying a tray with cups of water. Differences in trunk sway were examined when subjects performed the gait tasks with or without a head mounted actuator system which provided subjects with vibro-tactile, auditory and visual biofeedback of trunk sway. In the young, trunk pitch (fore-aft) angles, and trunk roll (sideways) and pitch angular velocities were significantly reduced using biofeedback across all three gait tasks. In the elderly, the same angle and angular velocities were also significantly reduced while walking normally. During walking while carrying a tray, only trunk sway velocities were significantly reduced, whereas no improvements were seen for walking while counting backwards. Counting backwards ability significantly improved with feedback. Young participants were able to perform a dual task during gait and employ biofeedback to reduce trunk sway. Elderly participants were not able to reduce sway using biofeedback during the cognitive task but were able to reduce sway velocities with biofeedback during the motor task.
Subject(s)
Biofeedback, Psychology , Gait/physiology , Postural Balance/physiology , Proprioception/physiology , Task Performance and Analysis , Age Factors , Aged , Aging/physiology , Analysis of Variance , Biomechanical Phenomena , Cohort Studies , Female , Humans , Male , Posture/physiology , Probability , Reference Values , Risk Assessment , Sensitivity and Specificity , Walking/physiology , Young AdultABSTRACT
Biofeedback of trunk sway is a possible remedy for patients with balance disorders. Because these patients have a tendency to fall more in one direction, we investigated whether biofeedback has a directional effect on trunk sway during gait. Forty healthy young participants (mean age 23.1 years) performed 10 gait tasks with and without biofeedback. Combined vibrotactile, auditory and visual feedback on trunk sway in either the lateral or anterior-posterior (AP) direction was provided by a head-mounted actuator system. Trunk roll and pitch angles, calculated from trunk angular velocities measured with gyroscopes, were used to drive the feedback. A reduction in sway velocities occurred across all tasks regardless of feedback direction. Reductions in sway angles depended on the task. Generally, reductions were greater in pitch. For walking up and down stairs, or over barriers, pitch angle reductions were greater with AP than lateral feedback. For tandem and normal walking, reductions were similar in pitch and roll angles for both feedback directions. For walking while rotating or pitching the head or with eyes closed, only pitch angle was reduced for both feedback directions. These results indicate that the central nervous system is able to incorporate biofeedback of trunk sway from either the AP or lateral direction to achieve a reduction in both pitch and roll sway. Greater reductions in pitch suggest a greater ability to use this direction of trunk sway biofeedback during gait.
