Reliability of System Identification Techniques to Assess Standing Balance in Healthy Elderly.

OBJECTIVES: System identification techniques have the potential to assess the contribution of the underlying systems involved in standing balance by applying well-known disturbances. We investigated the reliability of standing balance parameters obtained with multivariate closed loop system identification techniques. METHODS: In twelve healthy elderly balance tests were performed twice a day during three days. Body sway was measured during two minutes of standing with eyes closed and the Balance test Room (BalRoom) was used to apply four disturbances simultaneously: two sensory disturbances, to the proprioceptive and the visual system, and two mechanical disturbances applied at the leg and trunk segment. Using system identification techniques, sensitivity functions of the sensory disturbances and the neuromuscular controller were estimated. Based on the generalizability theory (G theory), systematic errors and sources of variability were assessed using linear mixed models and reliability was assessed by computing indexes of dependability (ID), standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS: A systematic error was found between the first and second trial in the sensitivity functions. No systematic error was found in the neuromuscular controller and body sway. The reliability of 15 of 25 parameters and body sway were moderate to excellent when the results of two trials on three days were averaged. To reach an excellent reliability on one day in 7 out of 25 parameters, it was predicted that at least seven trials must be averaged. CONCLUSION: This study shows that system identification techniques are a promising method to assess the underlying systems involved in standing balance in elderly. However, most of the parameters do not appear to be reliable unless a large number of trials are collected across multiple days. To reach an excellent reliability in one third of the parameters, a training session for participants is needed and at least seven trials of two minutes must be performed on one day.

Asymmetries in reactive and anticipatory balance control are of similar magnitude in Parkinson's disease patients.

Many Parkinson's disease (PD) patients show asymmetries in balance control during quiet stance and in response to perturbations (i.e., reactive balance control) in the sagittal plane. In addition, PD patients show a reduced ability to anticipate to self-induced disturbances, but it is not clear whether these anticipatory responses can be asymmetric too. Furthermore, it is not known how reactive balance control and anticipatory balance control are related in PD patients. Therefore, we investigated whether reactive and anticipatory balance control are asymmetric to the same extent in PD patients. 14 PD patients and 10 controls participated. Reactive balance control (RBC) was investigated by applying external platform and force perturbations and relating the response of the left and right ankle torque to the body sway angle at the excited frequencies. Anticipatory postural adjustments (APAs) were investigated by determining the increase in the left and right ankle torque just before the subjects released a force exerted with the hands against a force sensor. The symmetry ratio between the contribution of the left and right ankle was used to express the asymmetry in reactive and anticipatory balance control; the correlation between the two ratio's was investigated with Spearman's rank correlation coefficients. PD patients were more asymmetric in anticipatory (p=0.026) and reactive balance control (p=0.004) compared to controls and the symmetry ratios were significantly related (ρ=0.74; p=0.003) in PD patients. These findings suggest that asymmetric reactive balance control during bipedal stance may share a common pathophysiology with asymmetries in the anticipation of voluntary perturbations during, for instance, gait initiation.

Assessment of Multi-Joint Coordination and Adaptation in Standing Balance: A Novel Device and System Identification Technique.

The ankles and hips play an important role in maintaining standing balance and the coordination between joints adapts with task and conditions, like the disturbance magnitude and type, and changes with age. Assessment of multi-joint coordination requires the application of multiple continuous and independent disturbances and closed loop system identification techniques (CLSIT). This paper presents a novel device, the double inverted pendulum perturbator (DIPP), which can apply disturbing forces at the hip level and between the shoulder blades. In addition to the disturbances, the device can provide force fields to study adaptation of multi-joint coordination. The performance of the DIPP and a novel CLSIT was assessed by identifying a system with known mechanical properties and model simulations. A double inverted pendulum was successfully identified, while force fields were able to keep the pendulum upright. The estimated dynamics were similar as the theoretical derived dynamics. The DIPP has a sufficient bandwidth of 7 Hz to identify multi-joint coordination dynamics. An experiment with human subjects where a stabilizing force field was rendered at the hip (1500 N/m), showed that subjects adapt by lowering their control actions around the ankles. The stiffness from upper and lower segment motion to ankle torque dropped with 30% and 48%, respectively. Our methods allow to study (pathological) changes in multi-joint coordination as well as adaptive capacity to maintain standing balance.

Impaired standing balance in elderly: a new engineering method helps to unravel causes and effects.

Deteriorated balance control is the most frequent cause of falls and injuries in the elderly. Balance control comprises a complex interplay of several underlying systems (ie, the sensory systems, the motor system, and the nervous system). Available clinical balance tests determine the patient's ability to maintain standing balance under defined test conditions and aim to describe the current state of this ability. However, these tests do not reveal which of the underlying systems is deteriorated and to what extent, so that the relation between cause and effect often remains unclear. Especially detection of early-stage balance control deterioration is difficult, because the balance control system is redundant and elderly may use compensation strategies. This article describes a new method that is able to identify causal relationships in deteriorated balance control, called CLSIT (Closed Loop System Identification Technique). Identification of impaired balance with CLSIT is a base for development of tailored interventions and compensation strategies to reduce the often serious consequences of deteriorated balance control in the elderly.