Attila A. Priplata

Vibrating insoles and balance control in elderly people

Somatosensory function declines with age, and such changes have been associated with diminished motor performance. Input noise can enhance sensory and motor function. We asked young and elderly participants to stand quietly on vibrating gel-based insoles, and calculated sway parameters and random-walk variables. In our 27 participants, application of noise resulted in a reduction in seven of eight sway parameters in young participants and all of the sway variables in elderly participants. Elderly participants showed greater improvement than young people in two variables, mediolateral range (p=0.008), and critical mean square displacement (p=0.012). Noise-based devices, such as randomly vibrating insoles, could ameliorate age-related impairments in balance control.

Noise-enhanced balance control in patients with diabetes and patients with stroke

Somatosensory function declines with diabetic neuropathy and often with stroke, resulting in diminished motor performance. Recently, it has been shown that input noise can enhance human sensorimotor function. The goal of this study was to investigate whether subsensory mechanical noise applied to the soles of the feet via vibrating insoles can be used to improve quiet‐standing balance control in 15 patients with diabetic neuropathy and 15 patients with stroke. Sway data of 12 healthy elderly subjects from a previous study on vibrating insoles were added for comparison.

Noise and poise : Enhancement of postural complexity in the elderly with a stochastic-resonance-based therapy

Pathologic states are associated with a loss of dynamical complexity. Therefore, therapeutic interventions that increase physiologic complexity may enhance health status. Using multiscale entropy analysis, we show that the postural sway dynamics of healthy young and healthy elderly subjects are more complex than that of elderly subjects with a history of falls. Application of subsensory noise to the feet has been demonstrated to improve postural stability in the elderly. We next show that this therapy significantly increases the multiscale complexity of sway fluctuations in healthy elderly subjects. Quantification of changes in dynamical complexity of biologic variability may be the basis of a new approach to assessing risk and to predicting the efficacy of clinical interventions, including noise-based therapies.

Noise-enhanced human sensorimotor function

We review our work on using input noise (mechanical and electrical, respectively) to enhance somatosensation in humans and improve the performance of the human balance control system. We also discuss bioengineering applications and future directions for stochastic resonance (SR) based techniques and devices. Age- and disease-related sensory loss may be reversible by exploiting SR-type effects.

Frailty and the Degradation of Complex Balance Dynamics During a Dual-Task Protocol

BACKGROUND Balance during quiet stance involves the complex interactions of multiple postural control systems, which may degrade with frailty. The complexity of center of pressure (COP) dynamics, as quantified using multiscale entropy (MSE), during quiet standing is lower in older adults, especially those with falls. We hypothesized that COP dynamics from frail elderly individuals demonstrate less complexity than those from nonfrail elderly controls; complexity decreases when performing a dual task; and postural complexity during quiet standing is independent of other conventional correlates of balance control, such as age and vision. METHODS We analyzed data from a population-based study of community-dwelling older adults. Frailty phenotype (nonfrail, prefrail, or frail) was determined for 550 participants (age 77.9 +/- 5.5 years). COP excursions were quantified for 10 trials of 30 seconds each. Participants concurrently performed a serial subtraction task in half of the trials. Complexity of balance dynamics was quantified using MSE. Root-mean-square sway amplitude was also computed. RESULTS Of the 550, 38% were prefrail and 9% were frail. Complexity of the COP dynamics in the anteroposterior direction was lower in prefrail (8.78 +/- 1.91 [mean +/- SD]) and frail (8.38 +/- 2.13) versus nonfrail (9.20 +/- 1.74) groups (p < .001). Complexity reduced by a comparable amount in all three groups while performing the subtraction task (p < .001). Quiet standing complexity was independently associated with frailty after adjusting for covariates related to balance while sway amplitude was not. CONCLUSION Cognitive distractions during standing may further compromise balance control in frail individuals, leading to an increased risk of falls.

Subsensory vibrations to the feet reduce gait variability in elderly fallers

The purpose of this study was to investigate the effect of subsensory vibratory noise applied to the soles of the feet on gait variability in a population of elderly recurrent fallers compared to non-fallers and young controls. Eighteen elderly recurrent fallers and 18 elderly non-fallers were recruited from the MOBILIZE Boston Study (MBS), a population-based cohort study investigating novel risk factors for falls. Twelve young participants were included as controls. Participants performed three 6-min walking trials while wearing a pair of insoles containing vibrating actuators. During each trial, the noise stimulus was applied for 3 of the 6min, and differences in stride, stance, and swing time variability were analyzed between noise and no-noise conditions. The use of vibrating insoles significantly reduced stride, stance, and swing time variability measures for elderly recurrent fallers. Elderly non-fallers also demonstrated significant reductions in stride and stance time variability. Although young participants showed decreases in all variability measures, the results did not achieve statistical significance. Gait variability reductions with noise were similar between the elderly recurrent fallers and elderly non-fallers. This study supports the hypothesis that subsensory vibratory noise applied to the soles of the feet can reduce gait variability in elderly participants. Future studies are needed to determine if this intervention reduces falls risk.

Complexity and Frailty: Multiscale Entropy of Balance Dynamics During Quiet Standing and Dual-Task: The Mobilize Boston Study

Balance control during standing is attributable to the complex, nonlinear interactions of multiple postural control systems, manifested as the highly irregular displacements in center of pressure (COP) during standing. Aging and associated frailty may result in the degradation of these complex interactions and manifest as a loss of complexity in COP dynamics. Furthermore, frail individuals may not be able to adapt to a superimposed stress that challenges balance, leading to falls. To test these hypotheses, data were analyzed from the MOBILIZE Boston Study, an ongoing population-based study of community-dwelling older adults. Each participant’s frailty phenotype (not frail, pre-frail, frail) was determined using the Fried et al. 2001 definition. 551 participants (age 77.9±5.5) stood on a balance platform, with or without concurrently performing serial subtractions. Complexity of balance dynamics over multiple time scales was quantified using multiscale entropy (MSE), a more sensitive measure of physiologic health than variance. Of the participants, 39% were pre-frail and 6% were frail. Baseline MSE was lower with each successive frailty condition (p<0.002). When performing the cognitive task, MSE was lowered similarly in all groups (p<0.001). Frailty was associated with a loss of complexity in the dynamics of postural sway, which may be due to the degradation of integrated postural control networks that enable upright stance. Performance of a dual-task further reduced this complexity. Cognitive distractions during standing may further compromise balance control in frail individuals, which may explain their increased fall risk.Copyright