The relationship between structural changes in the cerebral gray matter and diminished balance control performance in patients with chronic ankle instability (CAI) has remained unclear. This paper aimed to assess the difference in gray matter volume (GMV) between participants with CAI and healthy controls (HC) and to characterize the role of GMV in the relationship between disease duration and balance performance in CAI. 42 participants with CAI and 33 HC completed the structural brain MRI scans, one-legged standing test, and Y-balance test. Regional GMV was measured by applying voxel-based morphometry methods. The result showed that, compared with HC, participants with CAI exhibited lower GMV in multiple brain regions (familywise error [FWE] corrected p < 0.021). Within CAI only, but not in HC, lower GMV in the thalamus (β = -0.53, p = 0.003) and hippocampus (β = -0.57, p = 0.001) was associated with faster sway velocity of the center of pressure (CoP) in eyes closed condition (i.e., worse balance control performance). The GMV in the thalamus (percentage mediated [PM] = 32.02%; indirect effect β = 0.119, 95% CI = 0.003 to 0.282) and hippocampus (PM = 33.71%; indirect effect β = 0.122, 95% CI = 0.005 to 0.278) significantly mediated the association between the disease duration and balance performance. These findings suggest that the structural characteristics of the supraspinal elements is critical to the maintenance of balance control performance in individuals suffering from CAI, which deserve careful consideration in the management and rehabilitation programs in this population.

We explored whether ankle torque variability or plantar perceptual threshold explains human balance control more effectively. We hypothesized that ankle torque variance is a better indicator of center of pressure (COP) velocity variance than plantar perceptual sensitivity. Two conditions were tested: loaded (23 kg vest added) and unloaded, as loading should diminish plantar sensitivity and increase COP velocity variability. We created a linear feedback model to assess the noise change in the sensorimotor loop induced by loading. Plantar sensitivity was quantified using a psychophysical approach while participants stood barefoot. A linear motor applied a force impulse on the participant\'s heel. A \'yes-no\' method of limits was selected to identify plantar sole sensory thresholds in both conditions. We observed reduced plantar sensitivity in loaded compared to unloaded conditions. In the loaded condition, participants exhibited greater COP velocity variance, with significant positive Pearson\'s correlations confirming a substantial association between ankle torque and COP velocity variances for both loaded (variance accounted for (VAR): r2 = 44.56%, p = 0.018) and unloaded conditions (VAF: r2 = 58.83 %, p = 0.004). No significant correlation existed between COP velocity variance and plantar sensitivity threshold for both loaded (VAF: r2 = 0.002 %, p = 0.99) and unloaded conditions (VAF: r2 = 21.81%, p = 0.35). The model confirmed a ~88% rise in sensorimotor loop noise in the loaded condition. Ankle torque variance assesses the precision of non-perceptual and perceptual detection mechanisms in evaluating whole-body motions and the accuracy in converting sensory cues into ankle torque.

UNASSIGNED: The study aimed to determine the test-retest reliability and concurrent validity of the Ratings of Perceived Stability (RPS) scale as a measure of balance exercise intensity in persons with multiple sclerosis (MS).
UNASSIGNED: Twenty participants with MS (mean age: 58.1 ± 15.29; 60% female) performed 14 balance tasks on two separate occasions wearing body-worn inertial sensors and rated their perceived stability for each task. Sensor data included sway velocity and angle, gait speed, turn velocity, and lean angle. Intraclass correlation coefficients (ICC) and Spearman rank correlations (rs) were employed to assess reliability and validity, respectively.
UNASSIGNED: The RPS showed good to excellent test-retest reliability (ICC> 0.75) on 12 out of the 14 tasks. The stability ratings revealed moderate relationships with postural sway outcomes in static balance tasks (rs: 0.49 to 0.77) and weak to moderate associations with gait speed (rs: -0.69 to -0.14). Ratings of stability were also strongly related to turn velocity (rs= -0.77) and moderately related to lean angle (rs= 0.58).
UNASSIGNED: The RPS scale offers a promising clinical tool to measure balance exercise intensity for persons with MS. This standardized scale allows for tailored balance training with a novel means for exercise monitoring and progression in this population.
The Ratings of Perceived Stability (RPS) scale is a reliable and valid measure for determining balance exercise intensity in persons with multiple sclerosis.The RPS scale can contribute to clear evaluation, description, and replication of balance training intensity in future balance interventions.

Background: Balance impairment is one of the most debilitating consequences of Traumatic Brain Injury (TBI). To study the neurophysiological underpinnings of balance impairment, the brain functional connectivity during perturbation tasks can provide new insights. To better characterize the association between the task-relevant functional connectivity and the degree of balance deficits in TBI, the analysis needs to be performed on the data stratified based on the balance impairment. However, such stratification is not straightforward, and it warrants a data-driven approach. Approach: We conducted a study to assess the balance control using a computerized posturography platform in 17 individuals with TBI and 15 age-matched healthy controls. We stratified the TBI participants into balance-impaired and non-impaired TBI using k-means clustering of either center of pressure (COP) displacement during a balance perturbation task or Berg Balance Scale (BBS) score as a functional outcome measure. We analyzed brain functional connectivity using the imaginary part of coherence across different cortical regions in various frequency bands. These connectivity features are then studied using the mean-centered partial least squares correlation (MC-PLSC) analysis, which is a multivariate statistical framework with the advantage of handling more features than the number of samples, thus making it suitable for a small-sample study. Main Results: Based on the nonparametric significance testing using permutation and bootstrap procedure, we noticed that the theta-band connectivity strength in the following regions of interest significantly contributed to distinguishing balance impaired from non-impaired population, regardless of the type of stratification: left middle frontal gyrus, right paracentral lobule, precuneus, and bilateral middle occipital gyri. Significance: Identifying neural regions linked to balance impairment enhances our understanding of TBI-related balance dysfunction and could inform new treatment strategies. Future work will explore the impact of balance platform training on sensorimotor and visuomotor connectivity. .

Reciprocal inhibition and coactivation are strategies of the central nervous system used to perform various daily tasks. In automatic postural responses (APR), coactivation is widely investigated in the ankle joint muscles, however reciprocal inhibition, although clear in manipulative motor actions, has not been investigated in the context of APRs. The aim was to identify whether reciprocal inhibition can be observed as a strategy in the recruitment of gastrocnemius Medialis (GM), Soleus (So) and Tibialis Anterior (TA) muscles in low- and high-velocity forward and backward perturbations. We applied two balance perturbations with a low and a high velocity of displacement of the movable platform in forward and backward conditions and we evaluated the magnitude and latency time of TA, GM and So activation latency, measured by electromyography (EMG). In forward perturbations, coactivation of the three muscles was observed, with greater activation amplitude of the GM and lesser amplitude of the So and TA muscles. For backward, the pattern of response observed was activation of the TA muscle, a decrease in the EMG signal, which characterizes reciprocal inhibition of the GM muscle and maintenance of the basal state of the So muscle. This result indicates that backward perturbations are more challenging.

UNASSIGNED: Differences in motor control between the lower limbs may influence the risk of sports injury and recovery from rehabilitation. In this study, differences in the visual feedback ability of the left and right lower limbs were assessed using visual target tracking tasks.
UNASSIGNED: Thirty-four healthy young subjects (aged 20.4 ± 1.2 years) were asked to move their bodies back and forth while tracking a visual target displayed on a monitor in front of them for 30 s. The two target motions were sinusoidal (i.e., predictable patterns) and more complex (random) patterns. To assess the ability of the lower limbs to follow visual target tracking, antero-posterior CoP (right limb, CoPap-r; left limb, CoPap-l) and medio-lateral CoP (right limb, CoPml-r; left limb, CoPml-l) data were measured using a stabilometer. Tracking ability by visual feedback ability was calculated as the difference in displacement between the target signal and the trajectories of the right and left pressure centers as trapezoidal areas, and a smaller sum of area (SoA) over the entire measurement time was defined as a greater tracking ability.
UNASSIGNED: Regarding the SoA in the anterior-posterior CoP, the mean SoA in the sinusoidal and random tasks was significantly lower in the CoP-r data than in the CoP-l data, indicating that the right lower limb had a more remarkable ability to follow visual target tracking. Regarding the SoA in the medial-lateral direction (CoP), the mean SoA in the sinusoidal and random tasks did not significantly differ between the two legs.
UNASSIGNED: The right lower limb may have a tracking function activated by the target signal when responding to visual stimuli. Identifying the motor strategies of each lower limb in response to visual stimuli will not only help identify potential differences between each lower limb but also suggest the possibility of enhancing the role of each lower limb in balance control.

BACKGROUND: Clinical dynamic posturography concentrates on the pitch and roll but not on the yaw plane instability measures. This emphasis may not represent the axis instability observed in clinical stance and gait tasks for patients with balance deficits in comparison to healthy control (HC) subjects, nor the expected instability based on correlations with vestibulo-ocular reflex (VOR) deficits. To examine the axis stability changes with vestibular loss, we measured trunk sway in all three directions (pitch, roll, and yaw) during the stance and gait tasks of patients with acute unilateral vestibular neuritis (aUVN) and compared the results with those of HC. Concurrent changes in VORs were also examined and correlated with trunk balance deficits.
METHODS: The results of 11 patients (mean age of 61 years) recorded within 6 days of aUVN onset were compared within those of 8 age-matched healthy controls (HCs). All subjects performed a two-legged stance task-standing with eyes closed on foam (s2ecf), a semi-gait task-walking eight tandem steps (tan8), and four gait tasks-walking 3 m with head rotating laterally, pitching, or eyes closed (w3hr, w3hp, w3ec), and walking over four barriers 24 cm high, spaced 1 m apart (barr). The tasks\' peak-to-peak yaw, pitch and roll angles, and angular velocities were measured with a gyroscope system (SwayStarTM) mounted at L1-3 and combined into three, axis-specific, balance control indexes (BCI), using angles (a) for the tandem gait and barriers task, and angular velocities (v) for all other tasks, as follows: axis BCI = (2 × 2ecf)v + 1.5 × (w3hr + w3hp + w3ec)v + (tan8 + 12 × barr)a.
RESULTS: Yaw and pitch BCIs were significantly (p ≤ 0.004) greater (88 and 30%, respectively) than roll BCIs for aUVN patients. For HCs, only yaw but not pitch BCIs were greater (p = 0.002) than those of roll (72%). The order of BCI aUVN vs. HC differences was pitch, yaw, and roll at 55, 44, and 31%, respectively (p ≤ 0.002). This difference with respect to roll corresponded to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN based on VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses did not correspond with the pitch plane instability observed in the balance control tests. The increases in pitch plane instability in UVL subjects were, however, highly correlated with those of roll and yaw.
CONCLUSIONS: These results indicate that greater yaw than pitch and roll trunk motion during clinical balance tasks is common for aUVN patients and HCs. However, aUVN leads to a larger increase in pitch than yaw plane instability and a smaller increase in roll plane instability. This difference with respect to roll corresponds to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN observed in VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses does not correspond with the enhanced movements in the pitch plane, observed in balance control tasks. Whether asymmetries in vestibular-evoked myogenic potentials (Vemps) are better correlated with the deficits in pitch plane balance control remains to be investigated. The current results provide a strong rationale for the clinical testing of directional specific balance responses, especially yaw and pitch, and the linking of balance results for yaw and roll to VOR asymmetries.

This study examines the impact of Human-Drone Interaction (HDI) modalities on construction workers\' safety and balance control within virtual environments. Utilising virtual reality (VR) simulations, the study explored how gesture and speech-based communications influence workers\' physical postures and balance, contrasting these modalities with a non-interactive control group. One hundred participants were recruited, and their movements and balance control were tracked using motion sensors while they interacted with virtual drones through either gesture, speech, or without communication. Results showed that interactive modalities significantly improved balance control and reduced the risk of falls, suggesting that advanced HDI can enhance safety on construction sites. However, speech-based interaction increased cognitive workload, highlighting a trade-off between physical safety and mental strain. These findings underscore the potential of integrating intuitive communication methods into construction operations, although further research is needed to optimise these interactions for long-term use and in diverse noise environments.
This study examines the impact of Human-Drone Interaction (HDI) modalities on construction workers’ safety and balance control within virtual environments with a human subject experiment. Results showed that interactive modalities significantly improved balance control and reduced the risk of falls.

BACKGROUND: There has been growing interest in using unstable devices in training protocols. This study aimed to assess the effectiveness of two multimodal exercise interventions (i.e., on stable and unstable surfaces) on dynamic balance control and lower limb strength in older adults.
METHODS: Sixty-two older adults were randomly assigned to two intervention groups (N = 20, stable group; N = 19, unstable group), and to a control group (N = 18). In this single-blinded randomized controlled study, the two intervention groups underwent a 12-week training program twice a week for 45 min, consisting of strength and balance exercises. The stable (ST) group performed the training program over stable surfaces, while the unstable (UNST) group over unstable surfaces. Dynamic balance was assessed by computing the center of pressure (CoP) trajectory while a driven movable platform induced an unexpected perturbation of the base of support. Specifically, we considered the following CoP-related parameters within a 2.5-s temporal window from the beginning of the perturbation: displacement (Area95), mean velocity (Unit Path), anterior-posterior first peak (FP), post perturbation variability (PPV), and maximal oscillations (ΔCoPMax). The dominant quadriceps strength was measured through an isometric maximal voluntary contraction on an instrumented chair.
RESULTS: Four out of five CoP-related parameters (i.e., Area95, Unit Path, ΔCoPMax, and PPV) significantly improved in the UNST group from a minimum of 14.28% (d = 0.44) to a maximum of 52.82% (d = 0.58). The ST group significantly improved only in two (i.e., ΔCoPMax, and PPV) out of five CoP-related parameters with an enhancement of 12.48% (d = 0.68) and 19.10% (d = 1.06). Both intervention groups increased the maximal isometric quadriceps strength (UNST:17.27%, d = 0.69; ST:22.29%, d = 0.98). The control group did not show changes in any of the parameters considered.
CONCLUSIONS: Stable surfaces promoted faster increments of muscular strength. Unstable surfaces were more effective in enhancing dynamic balance efficiency. These findings suggested the employment of multimodal training on unstable rather than stable surfaces to potentially lower the incidence of falls in older adults.
BACKGROUND: NCT05769361, retrospectively registered 13 March 2023, https://clinicaltrials.gov/study/NCT05769361?lat=45.3661864&lng=11.8209139&locStr=Padova,%20Italy&distance=50&page=11&rank=107 .

Virtual error amplification (VEA) in visual feedback enhances attentive control over postural stability, although the neural mechanisms are still debated. This study investigated the distinct cortical control of unsteady stance in older adults using VEA through cross-frequency modulation of postural fluctuations and scalp EEG. Thirty-seven community-dwelling older adults (68.1 ± 3.6 years) maintained an upright stance on a stabilometer while receiving either VEA or real error feedback. Along with postural fluctuation dynamics, phase-amplitude coupling (PAC) and amplitude-amplitude coupling (AAC) were analyzed for postural fluctuations under 2 Hz and EEG sub-bands (theta, alpha, and beta). The results revealed a higher mean frequency of the postural fluctuation phase (p = .005) and a greater root mean square of the postural fluctuation amplitude (p = .003) with VEA compared to the control condition. VEA also reduced PAC between the postural fluctuation phase and beta-band EEG in the left frontal (p = .009), sensorimotor (p = .002), and occipital (p = .018) areas. Conversely, VEA increased the AAC of posture fluctuation amplitude and beta-band EEG in FP2 (p = .027). Neither theta nor alpha band PAC or AAC were affected by VEA. VEA optimizes postural strategies in older adults during stabilometer stance by enhancing visuospatial attentive control of postural responses and facilitating the transition of motor states against postural perturbations through a disinhibitory process. Incorporating VEA into virtual reality technology is advocated as a valuable strategy for optimizing therapeutic interventions in postural therapy, particularly to mitigate the risk of falls among older adults.