Research on balance, coordination, and how we learn is abundant. The process of excavating relevant research from the various sources available on the internet can sometimes feel like navigating a dense thicket. As research studies and articles cross my path I will update this page. Please contribute to this page by writing a comment below in the reply box. Please include a web link to the study or article you are citing.
For statistics and research specific to falling and fall prevention, also view the post on “falling statistics”: https://balanceandcoordination.wordpress.com/2010/06/27/falling-statistics/
> Date: 13 Dec 2012: Study performed as part of Leonardo Barbosa Barreto de Brito’s dissertation at Gama Filho University, Rio de Janeiro, Brazil.
“If a middle-aged or older man or woman can sit and rise from the floor using just one hand – or even better without the help of a hand – they are not only in the higher quartile of musculo-skeletal fitness but their survival prognosis is probably better than that of those unable to do so.”
Dr Araújo emphasised the great potential of the sitting-rising test among primary care physicians looking for a quick appraisal of musculo-skeletal fitness in clinical or industrial settings.
“When compared to other approaches to functional testing,” added Dr Araújo, “the sitting-rising test does not require specific equipment and is safe, easy to apply in a short time period (less than 2 minutes), and reliably scored. In our clinical practice, the test has been shown over the past ten years to be useful and practical for application to a large spectrum of populations, ranging from paediatric to geriatric.”
ESC Press Office: firstname.lastname@example.org 00 33 492 94 86 27
The PDF of the paper is available here. Please acknowledge the journal as a source in any articles. The European Journal of Cardiovascular Prevention and Rehabilitation is a journal of the European Society of Cardiology. The European Society of Cardiology (ESC) represents more than 75,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
1. Brito LBB, Ricardo DR, Araujo DSMS, et al. Eur J Prevent Cardiol 2012; DOI: 10.1177/2047487312471759
2. The reported study was performed as part of Leonardo Barbosa Barreto de Brito’s dissertation at Gama Filho University, Rio de Janeiro, Brazil.
* The European Journal of Cardiovascular Prevention and Rehabilitation is a journal of the European Society of Cardiology.
Thanks to Jeff Haller for sending me this link!
> Postural compensation for vestibular loss and implications for rehabilitation.
Department of Neurology and Biomechanical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Road OP32, Portland, OR 97239, USA. email@example.com
This chapter summarizes the role of the vestibular system in postural control so that specific and effective rehabilitation can be designed that facilitates compensation for loss of vestibular function.
Patients with bilateral or unilateral loss of peripheral vestibular function are exposed to surface perturbations to quantify automatic postural responses. Studies also evaluated the effects of audio- and vibrotactile-biofeedback to improve stability in stance and gait.
The most important role of vestibular information for postural control is to control orientation of the head and trunk in space with respect to gravitoinertial forces, particularly when balancing on unstable surfaces. Vestibular sensory references are particularly important for postural control at high frequencies and velocities of self-motion, to reduce trunk drift and variability, to provide an external reference frame for the trunk and head in space; and to uncouple coordination of the trunk from the legs and the head-in-space from the body CoM.
The goal of balance rehabilitation for patients with vestibular loss is to help patients 1) use remaining vestibular function, 2) depend upon surface somatosensory information as their primary postural sensory system, 3) learn to use stable visual references, and 4) identify efficient and effective postural movement strategies.
[PubMed – indexed for MEDLINE]
The abstract below is from:
Restor Neurol Neurosci. Author manuscript; available in PMC 2010 October 27.
Published in final edited form as:
Restor Neurol Neurosci. 2010; 28(1): 57–68.
NIHMSID: NIHMS243423 the author manuscript.
Postural Compensation for Vestibular Loss
Fay B. Horak, PhD, PT
To what extent can remaining sensory information and/or sensory biofeedback compensate for loss of vestibular information in controlling postural equilibrium? The primary role of the vestibulospinal system is as a vertical reference for control of the trunk in space, with increasing importance as the surface becomes increasingly unstable. Our studies with patients with bilateral loss of vestibular function show that vision or light touch from a fingertip can substitute as a reference for earth vertical to decrease variability of trunk sway when standing on an unstable surface. However, some patients with bilateral loss compensate better than others and we find that those with more complete loss of bilateral vestibular function compensate better than those with measurable vestibulo-ocular reflexes. In contrast, patients with unilateral vestibular loss who reweight sensory dependence to rely on their remaining unilateral vestibular function show better functional performance than those who do not increase vestibular weighting on an unstable surface. Light touch of <100 grams or auditory biofeedback can be added as a vestibular vertical reference to stabilize trunk sway during stance. Postural ataxia during tandem gait in patients with unilateral vestibular loss is also significantly improved with vibrotactile biofeedback to the trunk, beyond improvements due to practice. Vestibular rehabilitation should focus on decreasing hypermetria, decreasing an over-dependence on surface somatosensory inputs, increasing use of any remaining vestibular function, substituting or adding alternative sensory feedback related to trunk sway, and practicing challenging balance tasks on unstable surfaces.
>Increased dynamic regulation of postural tone through Alexander Technique training.
Cacciatore TW, Gurfinkel VS, Horak FB, Cordo PJ, Ames KE.
Hum Mov Sci. 2011 Feb;30(1):74-89. Epub 2010 Dec 23.
Neurological Sciences Institute, Oregon Health & Science University, Beaverton, OR, USA. firstname.lastname@example.org
Gurfinkel and colleagues (2006) recently found that healthy adults dynamically modulate postural muscle tone in the body axis during anti-gravity postural maintenance and that this modulation is inversely correlated with axial stiffness. Our objective in the present study was to investigate whether dynamic modulation of axial postural tone can change through training. We examined whether teachers of the Alexander Technique (AT), who undergo “long-term” (3-year) training, have greater modulation of axial postural tone than matched control subjects. In addition, we performed a longitudinal study on the effect of “short-term” (10-week) AT training on the axial postural tone of individuals with low back pain (LBP), since short term AT training has previously been shown to reduce LBP. Axial postural tone was quantified by measuring the resistance of the neck, trunk and hips to small (±10°), slow (1°/s) torsional rotation during stance. Modulation of tone was determined by the torsional resistance to rotation (peak-to-peak, phase-advance, and variability of torque) and axial muscle activity (EMG). Peak-to-peak torque was lower (∼50%), while phase-advance and cycle-to-cycle variability were enhanced for AT teachers compared to matched control subjects at all levels of the axis. In addition, LBP subjects decreased trunk and hip stiffness following short-term AT training compared to a control intervention. While changes in static levels of postural tone may have contributed to the reduced stiffness observed with the AT, our results suggest that dynamic modulation of postural tone can be enhanced through long-term training in the AT, which may constitute an important direction for therapeutic intervention.
Copyright © 2010 Elsevier B.V. All rights reserved.
[PubMed – indexed for MEDLINE]
The “Conclusion” below can be found at this url:
We have found that AT teachers, who undergo long-term training, and short-term AT training in LBP subjects are associated with decreased axial stiffness. Our results suggest dynamic modulation of postural tone is enhanced in AT teachers, and that this contributes to lower axial stiffness. The increased variability of axial tone and shift in neutral position in AT teachers cannot be explained by simple reduction in static background levels of muscle tone. Short-term AT training in LBP subjects also reduced axial stiffness similar to, but less than, the AT teachers. Future studies are necessary to understand the influence of static and dynamic tonic regulation on coordination and pain. ”
> Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction.
Szturm T, Ireland DJ, Lessing-Turner M.
J Vestib Res. 1994 Nov-Dec;4(6):461-79.
School of Medical Rehabilitation, University of Manitoba, Winnipeg, Canada.
The purpose of this study was to evaluate the effects of two exercise programs on balance performance in patients with chronic peripheral vestibular dysfunction and to assess whether these exercise programs induce adaptive modifications of the vestibulo-ocular reflex (VOR). Patients were randomly assigned to one of two groups. (1) Those in the Rehab (Reh) group (n = 11) received a comprehensive exercise program that consisted of balance retraining and goal-directed eye-head exercises under combinations of varied visual and somatosensory sensory conditions. Patients received 45-minute training sessions, three times per week for 12 weeks, and were instructed on a custom home exercise program. (2) Those in the Home group (n = 12) were instructed to perform the Cooksey-Cawthorne eye-head exercises at home, on a daily basis, for 12 weeks. In addition, after completion of the exercise program and a follow-up period, 7 of the participants in the Home group (here defined as the A group) chose to enter the Reh program (here defined as the B group). Balance performance was assessed by measuring the peak-to-peak magnitude and total amount of anterior-posterior body sway, and of horizontal (shear) ground reaction force during six test conditions, in which visual and somatosensory orientation cues were reduced or altered by rotation of the visual surround or support surface in proportion to the subject’s sway, and in which vision was eliminated (eyes closed). The VOR response to step chair rotations of 60 degrees/s and 120 degrees/s, and the optokinetic reflex (OKN) response to 60 degrees/s constant velocity optokinetic stimuli were recorded. Left-right difference in VOR gain, VOR time constant, and OKN gain were determined. These tests were performed 1 day prior to start of treatment (TD 1), 6 weeks after start of treatment (TD 2), at the end of the 12-week treatment period (TD 3), and 5 months after end of treatment (TD 4). The findings revealed a significant improvement in standing balance performance under dynamic conditions for patients in the Reh program (Reh and B groups) but not for patients performing the eye-head exercise (Home or A groups). Thus, even in patients with chronic vestibular dysfunction, compensation for the loss or disruption of peripheral vestibular inputs can be effectively induced by exercises that provide sensory feedback appropriate for behavioral changes involving sensory substitution or sensory-motor reorganization.(ABSTRACT TRUNCATED AT 400 WORDS)
[PubMed – indexed for MEDLINE]
Read on NCBI: http://www.ncbi.nlm.nih.gov/pubmed/7850042#
>Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit.
Corna S, Nardone A, Prestinari A, Galante M, Grasso M, Schieppati M.
Arch Phys Med Rehabil. 2003 Aug;84(8):1173-84.
Posture and Movement Laboratory, Division of Physical Therapy and Rehabilitation, Salvatore Maugeri Foundation, Scientific Institute of Veruno, Veruno, Novara, Italy.
To compare the effectiveness of vestibular rehabilitation by using Cawthorne-Cooksey exercises with that of instrumental rehabilitation.
The main study (n=32) used a pre-post rehabilitation (A-B) design; the ancillary studies used a subset of 11 patients 1 month before rehabilitation versus pre-post rehabilitation (A-A-B design) and 9 patients pre-post rehabilitation versus 1 month after (A-B-B design).
Division of physical therapy and rehabilitation at a scientific institute in Italy.
Patients (Cawthorne-Cooksey, n=17; instrumental rehabilitation, n=15) with a complete or incomplete unilateral vestibular lesion due to ischemic, inflammatory, cranial nerve VIII sectioning, or unknown cause.
Cawthorne-Cooksey exercises or instrumental rehabilitation training consisting of standing with eyes open (EO) or closed (EC) on a platform moving, relative to the subjects, in the anteroposterior (AP) or mediolateral direction, at a sinusoidal translation frequency of 0.2 or 0.6Hz; training sessions for both interventions were twice daily, 30 minutes per session, for 5 days.
MAIN OUTCOME MEASURES:
Body sway and subjective score of sway during quiet stance with EO or EC, with feet 10cm apart (FA) or together (FT); the standard deviation of the AP displacement of the malleolus, hip, and head during AP platform translations; the Dizziness Handicap Inventory (DHI); and performance-oriented evaluation of balance and gait (according to Tinetti).
Both interventions improved patients’ balance. Under each postural and visual condition, both groups showed reduction in body sway, and the post rehabilitation sway values approached those observed in normal subjects; improvement was significantly better for instrumental rehabilitation under FA EO, FA EC, and FT EC conditions. All patients reported a subjective feeling of increased steadiness. Sway recorded 1 month before treatment did not differ from that at the start of treatment. The follow-up evaluation showed persistence of effect. Parallel to the improved stability, a decrease in the SD of the displacement of hip and head in balancing on the movable platform was present in both groups; improvement was better in the instrumental rehabilitation group than the Cawthorne-Cooksey group under the EC condition. Balance and gait assessment improved to the same extent in both groups. Scores on the physical, functional, and emotional questions of the DHI improved significantly in both groups after treatment, but to a larger extent in the instrumental rehabilitation patients.
Both Cawthorne-Cooksey and instrumental rehabilitation are effective for treating balance disorders of vestibular origin. Improvement affects both control of body balance and performance of activities of daily living. The larger decrease in body sway and greater improvement of DHI after instrumental rehabilitation suggests that it is more effective than Cawthorne-Cooksey exercises in improving balance control.
[PubMed – indexed for MEDLINE]
> Research study on the Otago Exercise Programme:
J Am Geriatr Soc. 2008 Oct;56(10):1821-30. Epub 2008 Sep 15.
Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial.
Centre for Hip Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. email@example.com
To primarily ascertain the effect of the Otago Exercise Program (OEP) on physiological falls risk, functional mobility, and executive functioning after 6 months in older adults with a recent history of falls and to ascertain the effect of the OEP on falls during a 1-year follow-up period.
The above excerpt can be found on PubMed: http://www.ncbi.nlm.nih.gov/pubmed/18795987
The research study can be read in detail here.
For more information and links on the Otago Exercise Programme read this post.
>The International Conference on Integrative Medicine brings together physicians and therapists from all over the world for a scientific meeting and dialog on the methods, techniques and progress of integrative medicine. The conference will focus on various fields of Integrative Medicine such as: Complementary and Alternative Medicine, Naturopathy, Chiropractic Medicine, Herbalism, Traditional Chinese Medicine, Ayurveda, Meditation, Yoga, Biofeedback, Hypnosis, Homeopathy, Acupuncture, Nutritional-Based Therapies and many more. Topping the list of main topics:
- Motor System, Movement and Posture Study, Muscular Skeletal Pain,
>“Use of Awareness Through Movement® Improves Balance and Balance Confidence in People with Multiple Sclerosis,a Randomized Controlled Study, James Stephens, PT, PhD, et al.from Neurology Report Vol 25, No. 2, 2001.
“ Awareness Through Movement ® (ATM), which was developed by Moshe Feldenkrais, is a learning based approach in which participants are led by verbal suggestion through an exploratory movement process. In ATM, participants begin by doing a movement they are able to do and slowly expand their control repertoire by exploring the kinesthetic dimensions of that movement as it is expanded into a larger functional activity. This can be done through a hierarchy of tasks across a variety of human and object environments. The challenge for the clinician is to create a learning environment in which the individual capacity for learning, the challenge of the task, and the constraints of the environment are matched for a positive learning outcome. 14
This approach embodies the goals and processes needed to improve balance and postural control. 13, 16 ”
footnotes from the excerpt above:
13 Tesio L, Perucca L, Gatti R, et al. Balance Disturbance in Multiple Sclerosis patients: a prescription algorithm for rehabilitation exercise. In: Ketelaer P, Ruutiainen J, eds. Axtaxia ( ch. 12). Genova: Associazione Italiana Sclerosi Multipla; 1995.
14 Stephens J. Feldenkrais Method®: Background, research, and orthopedic case studies. Orthop Phys Ther Clin North Am. 2000;9(3):375-394
16 Goldfarb L. Understanding Standing. Urbana, Ill: University of Illinois: Unpublished doctoral dissertation, 1994
Full article can be found in the June 2001 issue of Neurology Report:
> Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis by Catherine Sherrington PhD, et al. Published in Journal of the American Geriatrics SocietyVolume 56, Issue 12, pages 2234–2243, December 2008
excerpt from abstract: The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48–0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program. CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention.
>Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial; M. M. Madureira, L. Takayama, A. L. Gallinaro, V. F. Caparbo, R. A. Costa and R. M. R. Pereira
>Research study investigated whether a fall prevention tool kit using health information technology decreases patient falls in hospitals. Published in JAMA in 2010. Fall Prevention in Acute Care Hospitals, A randomized trial. Patricia C. Dykes, RN, et al.
>Article about the the single leg balance test. Published in the Oregonian January 24, 2011. The following two listings are links to the study’s referenced in the Oregonian article:
>Single leg balance test to identify risk of ankle sprains
Br J Sports Med. 2006 July; 40(7): 610–613.
Published online 2006 May 10. doi:10.1136/bjsm.2005.024356.
>Feldenkrais Method Balance Classes Improve Balance in Older Adults: A Controlled Trial by Connors, Karol ; Said C; Galea M. 2009
published in Evidence-Based Complementary and Alternative Medicine:Volume 2011 (2011), Article ID 873672, 9 pages and featured on Feldenkrais Science Network.
Excerpt from abstract: A series of Feldenkrais Method balance classes (the ‘Getting Grounded Gracefully’ series), two classes per week for 10 weeks, were conducted. Main outcome measures were Activities-Specific Balance Confidence (ABC) questionnaire, Four Square Step Test (FSST), self- selected gait speed (using GAITRiteTM instrumented gait mat). At re-testing, the Intervention group showed significant improvement on all of the measures…
>Effects of Feldenkrais Exercises on Balance, Mobility, Balance Confidence, and Gait Performance in Community-Dwelling Adults Age 65 and Older
>Getting Grounded Gracefully: effectiveness and acceptability of Feldenkrais in improving balance
>Feldenkrais Versus Conventional Exercises for the Elderly1
>Feldenkrais Method improves Balance
There is growing research evidence that the Feldenkrais Method is effective for improving balance. The ability to balance is a fundamental requirement for safe mobility. People suffer from difficulties with balance due to a variety of causes. The results of this can be falls, injuries from falls and a loss of confidence. The Feldenkrais Method helps improve balance with gentle movements which:
- improve coordination
- improve body awareness
- improve flexibility
- improve confidence
- improve dynamic stability
Research studies indicate that the Feldenkrais Method uses the neurological plasticity of the brain to teach clients how to move more easily and more efficiently. Three research studies investigating the Feldenkrais Method and balance have been published recently in international peer–reviewed journals. These studies were all concerned with balance in older people. Each study found that people attending Feldenkrais balance classes improved in balance and mobility when compared with Control groups who did not attend the classes. These studies are summarised over the page….
click link to read more: http://www.feldenkrais.org.au/literature/2011/05/feldenkrais-method-improves-balance
You can download a two-page PDF: https://balanceandcoordination.wordpress.com/?attachment_id=401
The AustralianFeldenkrais Guild’s summary pdf : http://www.feldenkrais.org.au/sites/www.feldenkrais.org.au/files/documents/11/05/The_Feldenkrais_Method_improves_balance._Summary_2_.pdf
>Bibliography and Research links from the International Feldenkrais Federation:
> List of research abstracts and articles compiled by the Australian Feldenkrais Guild spanning 1969- 2009:
updated 2012, you can download a pdf: http://www.feldenkrais.org.au/literature/2010/07/feldenkrais-method-research-list
>Feldenkrais® Science Network: http://feldscinet.org
FeldSciNet, or Feldenkrais® Science Network, is a project of the Esther Thelen, Ph.D., G.C.F.P. Research and Education Fund of the Feldenkrais® Educational Foundation of North America (FEFNA). Under the auspices of FEFNA, the Esther Thelen Research Committee directs the Thelen Fund and spearheads the FeldSciNet project. Esther Thelen Research Committee is chaired by Pat Buchanan, PhD, ATC, PT, GCFT
The Feldenkrais Method® of Somatic Education
By Patricia A. Buchanan, Feldenkrais® training program graduate
Moshe Feldenkrais encapsulated his method in this statement: “Organic learning is essential. It can also be therapeutic in essence. It is healthier to learn than to be a patient or even be cured. Life is a process not a thing. And, processes go well if there are many ways to influence them. We need more ways to do what we want than the one we know—even if it is a good one in itself”. In this chapter (in the 2011 open access book A Compendium of Essays on Alternative Therapy available at http://www.intechopen.com/books/show/title/a-compendium-of-essays-on-alternative-therapy), I expand on Feldenkrais’ statement and make these key points:
• The Feldenkrais Method of somatic education self-identifies as a learning method that may have therapeutic effects. It presents itself as an approach to health promotion, when health is viewed broadly and not just as the absence of disease or injury.
• Through individual Functional Integration lessons and group Awareness Through Movement lessons, Feldenkrais teachers guide students to sense, move, think and feel in ways intended to facilitate self-improvement and create more individually appropriate options for functioning.
• The Feldenkrais Method shares many principles with dynamic systems theory, including: emergence of self-organized behavior via subsystem interactions; perception-action-cognition coupling; and an ideal of reliable, yet flexible and adaptable, behavior.
• Practitioners around the world complete similarly structured curricula typically spanning four years to earn certification, and follow comparable standards of practice.
• Others have categorized the Feldenkrais Method with a range of complementary and alternative medicine approaches, most appropriately with the Alexander Technique.
• Feldenkrais Method effectiveness and safety research has increased considerably in the past decade. Results are mostly favorable, but remain sparse and subject to design limitations. Much more research is needed that rigorously combines appropriate quantitative and qualitative methodologies to further evaluate the Feldenkrais Method.
>Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study byBrenda E Groen1,2 , Ellen Smulders1,2 , Jacques Duysens1,2,3 , Wim van Lankveld4 andVivian Weerdesteyn1,2,5
Osteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria.
Read the full article: http://www.biomedcentral.com/1756-0500/3/111
Please contribute to this page by writing a comment below in the reply box. Please include a web link to the study or article you are citing.