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How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 27686

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Dr. Alessandro Piras

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Chief Guest Editor

Department for Life Quality Studies, University of Bologna, 40126 Bologna, Italy
Interests: exercise physiology; diabetes; autonomic nervous system; cardiovascular system; oculomotor system
Special Issues, Collections and Topics in MDPI journals

Dr. Milena Raffi

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Guest Editor

Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
Interests: neurophysiology; visual system; diabetes; exercise physiology; visuo-motor control
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The purpose of this Special Issue is to investigate neurophysiological, biomechanical, and physical exercise influences on balance dysfunction and postural instability. Our objective is to address the most important parameters influencing human performance in both healthy and diseased populations, considering both mechanisms influencing performance and the public health consequences of variation in performance. Balance dysfunction, postural instability, and falls are three of the most relevant determinants of an impaired quality of life, and exercise interventions are essential to reducing levels of disability. Falls, a consequence of the interplay among balance, postural instability, and the environment, are an important and costly public health problem due to their influence on morbidity and mortality. We encourage papers addressing exercise interventions and new methodologies addressing balance dysfunction and postural instability, including but not limited to:

New approaches (devices; physical tests; new methodologies) to assess posture and interventions studies related to public health;
Postural instability in Parkinson’s disease;
Postural instability after diabetic complications;
Effect of exercise on postural control;
Effect of different sports on postural adjustment;
Vision and vestibular signals on postural rearrangement;
Effect of optic flow on postural control;
How central and peripheral vision affect balance control;
Novel data concerning surveillance and population aspects of balance and postural instability.

Dr. Alessandro Piras
Prof. Milena Raffi
Guest Editors

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Keywords

posture
gait
diabetes
Parkinson’s disease
EMG
visual system
eye movements
sensorimotor integration
balance

Published Papers (11 papers)

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Research

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18 pages, 2357 KiB

Open AccessArticle

Cognitive Function and Postural Control Strategies in Relation to Disease Progression in Patients with Parkinson’s Disease

by Monika Zawadka-Kunikowska, Jacek J. Klawe, Małgorzata Tafil-Klawe, Monika Bejtka, Łukasz Rzepiński and Mirosława Cieślicka

Int. J. Environ. Res. Public Health 2022, 19(19), 12694; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912694 - 04 Oct 2022

Cited by 2 | Viewed by 1422

Abstract

Aim: This study assessed the influence of performing an additional cognitive task on center of pressure (COP) displacement in the early and advanced stages of patients with Parkinson’s disease (PD) compared to age-matched healthy controls (HCs). Methods: The study included 40 HCs and 62 patients with PD: early PD (n = 38) and advanced PD (n = 24). COP parameters were determined by static posturography during quiet standing with open eyes (ST, single task) and simultaneous performance of a cognitive task (DT, dual task). Cognitive functioning was examined with a Mini Mental State Examination, number-counting-backward test, and number of enunciated words during DT. Results: In the advanced-PD group, DT significantly reduced the sway radius (p = 0.009), area of stabilogram (p = 0.034), medio-lateral length (p = 0.027), and velocity (p = 0.033) compared to ST. In HCs, DT showed a significant increase in the sway radius (p = 0.006), total length (p = 0.039), sway velocity (p = 0.037), anterior–posterior length, and sway velocity. Both PD groups showed worse cognitive performance compared to HCs. Conclusions: Both early and advanced patients with PD showed significant delay in cognitive performance associated with executive function compared to the HCs. During additional cognitive tasks, patients with advanced stages of PD may reduce stabilographic parameters in medio-lateral direction, and this is probably an adaptive strategy to restore balance. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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11 pages, 2045 KiB

Open AccessArticle

The Speed of Optic Flow Stimuli Influences Body Sway

by Milena Raffi, Aurelio Trofè, Andrea Meoni and Alessandro Piras

Int. J. Environ. Res. Public Health 2022, 19(17), 10796; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191710796 - 30 Aug 2022

Cited by 1 | Viewed by 1464

Abstract

Optic flow is a perceptual cue processed for self-motion control. The aim of this study was to investigate whether postural control is modulated by the speed of radial optic flow stimuli. The experiments were performed on 20 healthy volunteers using stabilometry and surface electromyography (EMG). The subjects were instructed to fixate a central fixation point while radial optic flow stimuli were presented full field, in the foveal and in the peripheral visual field at different dots speed (8, 11, 14, 17 and 20°/s). Fixation in the dark was used as control stimulus. The EMG analysis showed that male and female subjects reacted to the stimuli with different muscle activity (main effects for gender, muscle and laterality: p < 0.001). The analysis of the center of pressure (COP) parameters showed that optic flow stimuli had a different effect on the left and right limbs of males and females (main effects of laterality: p < 0.015; interaction effects of gender and laterality: p < 0.016). The low speed of optic flow stimuli (8 and 11°/s) evoked non-uniform directions of oscillations especially in peripheral stimulation in all subjects, meaning that optic flow simulating slow self-motion stabilizes body sway. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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10 pages, 1623 KiB

Open AccessArticle

Optic Flow Speed and Retinal Stimulation Influence Microsaccades

by Milena Raffi, Aurelio Trofè, Andrea Meoni, Luca Gallelli and Alessandro Piras

Int. J. Environ. Res. Public Health 2022, 19(11), 6765; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116765 - 01 Jun 2022

Cited by 2 | Viewed by 1502

Abstract

Microsaccades are linked with extraretinal mechanisms that significantly alter spatial perception before the onset of eye movements. We sought to investigate whether microsaccadic activity is modulated by the speed of radial optic flow stimuli. Experiments were performed in the dark on 19 subjects who stood in front of a screen covering 135 × 107° of the visual field. Subjects were instructed to fixate on a central fixation point while optic flow stimuli were presented in full field, in the foveal, and in the peripheral visual field at different dot speeds (8, 11, 14, 17, and 20°/s). Fixation in the dark was used as a control stimulus. For almost all tested speeds, the stimulation of the peripheral retina evoked the highest microsaccade rate. We also found combined effects of optic flow speed and the stimulated retinal region (foveal, peripheral, and full field) for microsaccade latency. These results show that optic flow speed modulates microsaccadic activity when presented in specific retinal portions, suggesting that eye movement generation is strictly dependent on the stimulated retinal regions. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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11 pages, 1104 KiB

Open AccessArticle

Variability of Postural Stability and Plantar Pressure Parameters in Healthy Subjects Evaluated by a Novel Pressure Plate

by Allegra Fullin, Paolo Caravaggi, Pietro Picerno, Massimiliano Mosca, Silvio Caravelli, Antonio De Luca, Angela Lucariello and Paolo De Blasiis

Int. J. Environ. Res. Public Health 2022, 19(5), 2913; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052913 - 02 Mar 2022

Cited by 9 | Viewed by 2243

Abstract

Background: Postural stability and plantar pressure parameters can be assessed by baropodometry; nevertheless, they are often affected by low repeatability. The aim of the study was to test the accuracy and repeatability of a novel resistive sensor pressure plate and to establish the most reliable baropodometric parameters. Methods: Accuracy and repeatability of the FM12050 BTS-Bioengineering plate measurements were assessed by using different weights in static conditions across three sessions. Subsequently, 20 healthy subjects were assessed by 30-s stabilometric analysis in bipedal standing with open eyes across four trials in two sessions, morning and afternoon. Results: Pressure plate repeatability in measuring the static weights was very high, and plate measurements were correlated to the scale measurements (Pearson’s coefficient = 0.99). Percentage of load distribution between left and right foot and in rearfoot and forefoot regions showed the largest repeatability (coefficient of variation < 5%) across trials. Eventually, median and percentiles (25–75%) were reported for each parameter. Conclusions: This study helped to assess the accuracy and repeatability of a novel pressure plate in static conditions and to define the most reliable parameters for the assessment of postural stability and foot morphology. The present healthy-subject stabilometric dataset may be used as reference data in the evaluation of pathological populations. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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7 pages, 1364 KiB

Open AccessArticle

Vestibular Disorders after Kidney Transplantation: Focus on the Pathophysiological Mechanisms Underlying the Vertical Nystagmus Associated with Tacrolimus-Related Hypomagnesamia

by Pasquale Viola, Vincenzo Marcelli, Domenico Sculco, Davide Pisani, Alfredo Caglioti, Filippo Ricciardiello, Alfonso Scarpa, Alessia Astorina, Giuseppe Tortoriello, Luca Gallelli, Giovambattista De Sarro and Giuseppe Chiarella

Int. J. Environ. Res. Public Health 2022, 19(4), 2260; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042260 - 16 Feb 2022

Cited by 1 | Viewed by 1863

Abstract

The purpose of this paper is to present the case of a patient undergoing kidney transplantation who developed limb tremor dizziness and vertical nystagmus (ny) during Tacrolimus (TAC) therapy and to investigate the pathophysiological mechanisms underlying the balance disorder. This case study regards a 51-year old kidney transplant male patient with hand tremors and lower limbs asthenia associated with dizziness and nausea. The symptoms started two months after the beginning of intravenous TAC for renal transplantation. The pure-tone audiometry showed a mild symmetrical high-frequencies down-sloping sensorineural hearing loss. Acoustic emittance measures showed a normal tympanogram; stapedial reflexes were normally elicited. The Auditory Brainstem Responses (ABR) and Cervical Vestibular Evoked Myogenic Potentials (c-VEMPs) were bilaterally normally evoked. The bedside vestibular examination showed spontaneous down-beating stationary persistent, omni-positional nystagmus, not inhibited by fixation. The Head-Shaking Test accentuates the spontaneous ny. The horizontal clinical head impulse test was negative, bilaterally. A biochemical blood test revealed a decrease in Magnesium (Mg) levels (0.8 mg/dL; normal range 1.58–2.55). The integration of Mg induced both a plasma levels normalization and an improvement of clinical symptoms. This case suggests that TAC treatment can induce a Mg depletion that caused the transient cerebellar lesion. Therefore, the monitoring of serum electrolytes during immunosuppressive treatment appears to be a useful tool in order to reduce the central system symptomatology. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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15 pages, 606 KiB

Open AccessArticle

Videoconference-Based Adapted Physical Exercise Training Is a Good and Safe Option for Seniors

by Olga Kuldavletova, Florane Pasquier, Lucile Bigot, Antoine Langeard, Antoine Gauthier and Gaëlle Quarck

Int. J. Environ. Res. Public Health 2021, 18(18), 9439; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189439 - 07 Sep 2021

Cited by 8 | Viewed by 2281

Abstract

Videoconference-based adapted physical exercise combines the benefits of supervised exercise training with staying at home, when conventional training is inaccessible. However, exercising with the use of a screen can be considered an optokinetic stimulation, and could therefore induce changes in sensory processing, affecting postural stability. The objectives of this study were to compare the effectiveness of the training delivered Face-to-Face and by Videoconferencing in improving physical capacities of older adults, and to evaluate the possible effects of the Videoconference mode on the processing of sensory information that could affect postural control. Twenty eight older adults underwent the supervised exercise program for sixteen weeks either Face-to-Face or by Videoconference. Muscular strength of knee and ankle flexors and extensors, maximum oxygen uptake, postural stability and horizontal rotational vestibulo-ocular reflex were evaluated before and after the training. Both modes of training similarly increased the VO₂ peak and strength of the motor muscles of lower limbs in all participants. The use of the Videoconference did not modify the vestibulo-ocular reflex in subjects or the importance of vision for postural control. Therefore, the Videoconference-based exercise training can be considered a safe and effective way to maintain good functional capacity in seniors. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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8 pages, 309 KiB

Open AccessArticle

Physical Fitness among Community-Dwelling Older Women with and without Risk of Falling—The Taipei Study, Taiwan

by Chen-Yi Song, Jau-Yih Tsauo, Pei-Hsin Fang, I-Yao Fang and Shao-Hsi Chang

Int. J. Environ. Res. Public Health 2021, 18(14), 7243; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147243 - 06 Jul 2021

Cited by 7 | Viewed by 2049

Abstract

The purposes of this study were to compare the differences in physical fitness between community-dwelling older women fallers and non-fallers, with and without a risk of falling, and to investigate the relation between physical fitness and falling risk factors. This study was a secondary data analysis from a community- and exercise-based fall-prevention program. Baseline assessments pertaining to body weight and height, self-reported chronic diseases, the 12-item fall risk questionnaire (FRQ), senior fitness test, single-leg stand test, and handgrip strength test were extracted. Participants (n = 264) were classified into fallers and non-fallers, and sub-classified according to the risk of falling (FRQ ≥4 and <4). While controlling for the effect of age, body mass index (BMI), and multimorbidity, one-way analysis of covariance indicated that older women with a risk of falling showed poorer performances of the 8-foot up-and-go, 2-min step and 30-s chair stand compared with those without a risk of falling, regardless of the history of falls. Additionally, weaker grip strength was found in non-fallers with falling risk. Some significant, but low-to-moderate, correlations were found between physical fitness tests and fall risk factors in the FRQ, particularly in gait/balance problem and leg muscle weakness. Proactive efforts are encouraged to screen and manage deterioration in the identified physical fitness. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

17 pages, 2107 KiB

Open AccessArticle

Sensory Input Modulates Microsaccades during Heading Perception

by Milena Raffi, Aurelio Trofè, Monica Perazzolo, Andrea Meoni and Alessandro Piras

Int. J. Environ. Res. Public Health 2021, 18(6), 2865; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062865 - 11 Mar 2021

Cited by 2 | Viewed by 1651

Abstract

Microsaccades are small eye movements produced during attempted fixation. During locomotion, the eyes scan the environment; the gaze is not always directed to the focus of expansion of the optic flow field. We sought to investigate whether the microsaccadic activity was modulated by eye position during the view of radial optic flow stimuli, and if the presence or lack of a proprioceptive input signal may influence the microsaccade characteristics during self-motion perception. We recorded the oculomotor activity when subjects were either standing or sitting in front of a screen during the view of optic flow stimuli that simulated specific heading directions with different gaze positions. We recorded five trials of each stimulus. Results showed that microsaccade duration, peak velocity, and rate were significantly modulated by optic flow stimuli and trial sequence. We found that the microsaccade rate increased in each condition from trial 1 to trial 5. Microsaccade peak velocity and duration were significantly different across trials. The analysis of the microsaccade directions showed that the different combinations of optic flow and eye position evoked non-uniform directions of microsaccades in standing condition with mean vectors in the upper-left quadrant of the visual field, uncorrelated with optic flow directions and eye positions. In sitting conditions, all stimuli evoked uniform directions of microsaccades. Present results indicate that the proprioceptive signals when the subjects stand up creates a different input that could alter the eye-movement characteristics during heading perceptions. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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14 pages, 1278 KiB

Open AccessArticle

Postural Control in Childhood: Investigating the Neurodevelopmental Gradient Hypothesis

by Leonardo Zoccante, Marco Luigi Ciceri, Liliya Chamitava, Gianfranco Di Gennaro, Lucia Cazzoletti, Maria Elisabetta Zanolin, Francesca Darra and Marco Colizzi

Int. J. Environ. Res. Public Health 2021, 18(4), 1693; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041693 - 10 Feb 2021

Cited by 5 | Viewed by 4711

Abstract

Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5–17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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10 pages, 1568 KiB

Open AccessArticle

Analysis of Gait for Disease Stage in Patients with Parkinson’s Disease

by Mᵃ Helena Vila, Rocío Pérez, Irimia Mollinedo and José Mᵃ Cancela

Int. J. Environ. Res. Public Health 2021, 18(2), 720; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020720 - 15 Jan 2021

Cited by 12 | Viewed by 2685

Abstract

Understanding the motor patterns underlying the movement of individuals with Parkinson’s disease (PD) is fundamental to the effective targeting of non-pharmacological therapies. This study aimed to analyze the gait pattern in relation to the evolutionary stages I–II and III–IV according to the Hoehn and Yahr (H&Y) scale in individuals affected by PD. The study was conducted with the participation of 37 PD patients with a mean age of 70.09 ± 9.53 years, and of whom 48.64% were women. The inclusion criteria were (1) to be diagnosed with PD; (2) to be in an evolutionary stage of the disease between I and IV: and (3) to be able to walk independently and without any assistance. Kinematic and spatial-temporal parameters of the gait were analyzed. The results showed differences in speed of movement, cadence, stride length, support duration, swing duration, step width, walking cycle duration, and double support time between the stages analyzed. These results confirmed the differences in PD gait pattern between stages I–II and III–IV. Different behaviors of the same variable were recorded depending on whether the right or left side was affected by PD. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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Review

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42 pages, 714 KiB

Open AccessReview

Drug–Drug Interactions in Vestibular Diseases, Clinical Problems, and Medico-Legal Implications

by Giulio Di Mizio, Gianmarco Marcianò, Caterina Palleria, Lucia Muraca, Vincenzo Rania, Roberta Roberti, Giuseppe Spaziano, Amalia Piscopo, Valeria Ciconte, Nunzio Di Nunno, Massimiliano Esposito, Pasquale Viola, Davide Pisani, Giovambattista De Sarro, Milena Raffi, Alessandro Piras, Giuseppe Chiarella and Luca Gallelli

Int. J. Environ. Res. Public Health 2021, 18(24), 12936; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182412936 - 08 Dec 2021

Cited by 9 | Viewed by 4444

Abstract

Peripheral vestibular disease can be treated with several approaches (e.g., maneuvers, surgery, or medical approach). Comorbidity is common in elderly patients, so polytherapy is used, but it can generate the development of drug–drug interactions (DDIs) that play a role in both adverse drug reactions and reduced adherence. For this reason, they need a complex kind of approach, considering all their individual characteristics. Physicians must be able to prescribe and deprescribe drugs based on a solid knowledge of pharmacokinetics, pharmacodynamics, and clinical indications. Moreover, full information is required to reach a real therapeutic alliance, to improve the safety of care and reduce possible malpractice claims related to drug–drug interactions. In this review, using PubMed, Embase, and Cochrane library, we searched articles published until 30 August 2021, and described both pharmacokinetic and pharmacodynamic DDIs in patients with vestibular disorders, focusing the interest on their clinical implications and on risk management strategies. Full article

(This article belongs to the Special Issue How Visual and Spatial Orientation Contribute to the Control of Postural Balance in Public Health)

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