Tag: postural control

Proprioception and Postural Control: Clinical Insights from Recent Research

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Blog Post Author Biography: Dr. Brice Picot currently works at the Sciences et Technologies des Activités Physique et Sportives (STAPS), Université Savoie Mont Blanc and in the French association of Sports Physical Therapy. Brice does research in Traumatology, Rehabilitation Medicine and Physiotherapy. His current projects are focused on injury rehabilitation and prevention of Chronic Ankle Instability and ACL among athletes.

Citation: Sagnard T, Picot B, Forestier N. Proprioceptive acuity, proprioceptive weighting and balance in individuals with chronic ankle instability. Gait Posture. Published online March 15, 2025. doi:10.1016/j.gaitpost.2025.03.006

Take-to-the-Clinic Message:

  • Not all patients suffering from CAI exhibits postural impairments or proprioceptive acuity and reweighting deficits.
  • Poorer proprioceptive acuity is associated with increases postural sway, only in CAI patients.
  • Higher proprioceptive reweighting is observed when proprioception is disrupted in healthy individuals only.

Background: Chronic ankle instability (CAI) is a common consequence of repeated ankle sprains, often leading to impaired postural control and proprioception. Understanding the impact of these deficits is crucial for improving rehabilitation strategies.

Purpose: The purposes of this study were to evaluate proprioceptive and postural control deficits among CAI and healthy control individuals, and to assess whether these parameters were correlated among those two groups.

Methods: The study assessed 13 participants with chronic ankle instability (CAI) and 15 healthy controls to examine proprioception and balance deficits. Joint position sense (JPS) was evaluated in dorsiflexion and plantarflexion by calculating absolute and constant repositioning errors. Unipedal balance was measured using center of pressure (CoP) ellipse area and velocity to assess postural stability. Relative proprioceptive weighting (RPW) was determined by analyzing postural responses to triceps surae and lumbar multifidus tendinous vibrations.

Results: This study found nodifferences in proprioception or balance between CAI patients and healthy controls. However, within the CAI group, poorer accuracy in proprioceptive acuity was linked to greater difficulty maintaining balance, as shown by increased body sway. In contrast, for the control group, a different relationship emerged—those with greater proprioceptive errors tended to rely more on other sensory inputs for balance.

Rolling the field forward: Contrary to previous belief, not all CAI patients exhibited poor postural control or impaired proprioception. However, results from the present study suggests that contrary to healthy individuals, people with CAI still maintain an ankle steered strategy when proprioceptive signals are inaccurate. This could explain why CAI patients with unreliable acuity (i.e. high errors in JPS) exhibit poorer postural control while healthy control individuals do not. These findings highlight the importance of assessing both proprioception and balance in CAI patients to better address potential deficits in rehabilitation programs.

Question for the researchers:

  • How can we easily evaluate postural control deficits in CAI patients?
  • What are the normative values in errors of repositioning among healthy individuals?

Sensory Reweighting System Differences on Vestibular Feedback with Increased Task Constraints

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Blog Post Author Biography: Yuki Sugimoto is an Assistant Professor in the Department of Physical Therapy & Human Movement Science at the Feinberg School of Medicine, Northwestern University, and has a clinical background as a certified athletic trainer. One of Dr. Sugimoto’s research interests is the sensory reweighting system and changes in reliance on visual and vestibular feedback in individuals with chronic ankle instability.

Citation: Sugimoto YA, McKeon PO, Rhea CK, et al. Sensory Reweighting System Differences on Vestibular Feedback With Increased Task Constraints in Individuals With and Without Chronic Ankle Instability. J Athl Train. 2024;59(7):713-723. doi:10.4085/1062-6050-0246.22

Take-to-the-clinic message: The results highlight the importance of considering vestibular feedback reliance during postural control assessment and rehabilitation in individuals with chronic ankle instability (CAI). Combining tests such as the horizontal head impulse test with single-limb postural assessments may reveal underlying sensory reweighting dysfunction, especially under varying environmental and task conditions. Clinicians should explore multisensory feedback approaches that challenge vestibular function to improve rehabilitation outcomes in individuals with CAI.

Background: Postural stability is critical for motor behavior in dynamic environments and relies on the ability to reweight sensory feedback from somatosensory, visual, and vestibular systems as environmental and task constraints change. Individuals with CAI may have sensory reweighting deficits, leading to an over-reliance on visual feedback and difficulties maintaining postural control, especially in complex tasks like single-limb stance. However, current evidence suggests that somatosensory feedback contributions to postural control in individuals with CAI cannot be ruled out based solely on balance scores in single-limb stance with and without eyes closed. In addition, the sensory reweighting system in individuals with CAI and whether they upweight visual feedback to maintain posture in bilateral and unilateral (uninjured, injured) stances compared to healthy individuals remains unknown.

Purpose: The primary purpose of the study was to examine the sensory reweighting system changes to control posture in a simple double-limb stance and a more complex uninjured- or injured-limb stance under increased environmental constraints, manipulating somatosensory and visual information, for individuals with and without CAI. The secondary purpose of the study was to determine the effect of environmental and task constraints on postural stability.

Methods: The study included 42 physically active individuals with and without unilateral CAI. Participants completed postural control assessments using the Sensory Organization Test (SOT) on a NeuroCom dynamic posturography platform, which measures the ability to integrate somatosensory, visual, and vestibular feedback across six conditions of varying complexity. Equilibrium balance scores were calculated based on center-of-gravity sway, and sensory reweighting ratios were determined to assess the weighting of different sensory systems.

Results: The study is the first investigation of how the sensory reweighting system adapts to control posture under increased task constraints and how postural control is influenced by both environmental and task constraints in individuals with and without CAI. Notably, the CAI group did not reduce their reliance on vestibular feedback when standing on the injured limb. However, the inability to downweight vestibular feedback may represent a compensatory reliance for individuals with CAI, as they maintained postural stability on the injured limb better than healthy controls. Both groups showed different patterns of sensory feedback use depending on the task. Somatosensory input was the most emphasized during double-limb stance, whereas visual feedback was prioritized during single-limb stance in both injured and uninjured limbs. Differences in postural control between groups were shaped by task and environmental demands, although individuals with CAI demonstrated postural control similar to that of healthy participants.

Rolling the field forward: This research demonstrates that while individuals with CAI do not downweight vestibular feedback to maintain posture on their injured limb, this reliance may serve as a compensatory mechanism, allowing them to maintain better postural stability than those without CAI. In addition, postural control in both groups was influenced by the specific sensory systems engaged and the constraints imposed by the task. Clinicians should consider using a multisensory feedback approach in their interventions, challenging vestibular input, with and without visual cues, during tasks with increased demands to improve postural control for individuals with CAI.

Question for the researchers: How might clinicians implement multisensory feedback approaches in rehabilitation programs to specifically address the compensatory reliance on vestibular feedback observed in individuals with CAI?

Dual-Task Postural Control Assessment in Individuals with Chronic Ankle Instability

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Blog Post Author Biography: Dr. Matthew Hoch is a Professor in the Department of Athletic Training and Clinical Nutrition and the Senior Associate Director for the Sports Medicine Research Institute at the University of Kentucky. Dr. Hoch’s interests include the investigation of rehabilitation interventions for patients with chronic ankle instability.

Citation: Choi JY, Yoo T, Burcal CJ, Rosen AB. Dual-task differences in individuals with chronic ankle instability: A systematic review with meta-analysis. Gait Posture. 2023; 106(28-33). DOI: 10.1016/j.gaitpost.2023.08.013

Take-to-the-clinic message: The clinical utility of dual-task assessments is continually evolving for an array of sports medicine applications. This meta-analysis sought to examine the ability of dual-task balance and gait assessments to identify performance deficits in people with chronic ankle instability. The literature to date is unable to consistently identify balance or gait deficits using dual-task testing paradigms. However, trends in the data suggest that further examining dual-task assessments utilizing more challenging tasks may yield different insights.

Background: Ligamentous injuries, such as lateral ankle sprains, create complex sensorimotor alterations which often manifest clinically as impairments in postural control and gait. Understanding the interaction of cognitive and sensorimotor function using dual-task assessments has emerged as a potential area to advance care for musculoskeletal conditions. Several studies have applied dual-task balance and gait assessments to assess performance in people with chronic ankle instability. However, the conclusiveness of these studies is difficult to determine without more advanced analysis.

Purpose: The purpose of this systematic review and meta-analysis was to determine differences in dual-tasking assessing gait and postural control in individuals with chronic ankle instability compared to healthy controls.

Methods: This systematic review and meta-analysis searched for articles using multiple relevant databases from inception through 2022. Peer-reviewed observational studies which incorporated single- and dual-task assessments to study motor performance related to gait, balance, or other functional performance outcomes in patients with a history of ankle sprain or chronic ankle instability along with either a healthy reference group or limb were included. Two reviewers applied the 22-item Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement to assess risk of bias and methodological quality of the included studies. Separate, random effect meta-analyses were used to evaluate mediolateral and anteroposterior directions of balance-related outcomes. Additional supporting analyses were applied to evaluate heterogeneity and potential bias from unpublished studies.

Results: A total of nine studies were included in the systematic review. Five studies met the requirements to be included in the meta-analysis. The average STROBE score was 13.3±3.8 indicating a moderate level of study quality. Six the included studies examined dual-task balance while three focused on dual-task gait. The results of the meta-analyses determined that dual-tasking affected postural control outcomes in the control group. However, no differences were identified in the chronic ankle instability group or when comparing healthy and chronic ankle instability groups.

Rolling the field forward: The primary finding of this study was that dual-tasking did not significantly impact postural control outcomes in individuals with chronic ankle instability. However, trends within the available data indicated that studies applying more challenging balance tasks demonstrated trends towards poorer postural control under the dual-task condition. This indicates that future studies and clinical investigations should explore coupling dual-task balance assessments or exercises with more challenging and potentially dynamic balance tasks. This systematic review was only able to identify three studies which examined dual-task gait in chronic ankle instability patients and identified mixed results. The application of dual-task gait requires additional study before strong recommendations can be made. Cumulatively, this study suggests that the field may need to explore different mechanisms to effectively integrate dual-task paradigms into the clinical management for patients with a history of ankle sprain.

Question for the researchers: Many of the included studies used an approach to dual-tasking by adding cognitive load through tasks such as serial subtraction. Do you think utilizing cognitive challenges associated with greater demand on sensory integration or decision making could produce different results in patients with a history of ankle sprain or instability?