Full length articleAltered postural control variability in older-aged individuals with a history of lateral ankle sprain
Introduction
Postural control is an important factor for completing activities of daily living and maintaining an active lifestyle. Age-related declines in postural control are significant public issues for older adults because of the limitations on participation in physical activity, social events, work, and driving [1]. Furthermore, age-related declines in postural control are directly associated with fall risk [2], which are linked to decreased quality of life (QOL), increased risk of hypokinetic disease and mortality, loss of independence, as well as significant healthcare expenditures as a leading causative factor for nonfatal and fatal injuries [3]. Thus, developing successful clinical interventions aimed to attenuate age-related postural instability is critical for prevention of associated negative effects of fall-related injury.
The ability to maintain balance and upright posture not only declines with age, but also is commonly compromised in younger adults with a history of lateral ankle sprain (LAS) [[4], [5]]. It has been estimated that up to 73.6% of individuals who incur an initial LAS continue to experience residual symptoms, recurrent ankle sprains, persistent ankle instability, and/or persistent disability [6], leading to reductions in physical activity levels and health-related QOL [6]. Furthermore, a history of LAS contributes significantly to the development of post-traumatic ankle osteoarthritis (PTOA) [6], which increases the risk for co-morbidities [7].
Altered integration of sensory input and motor output is common and persistent following an initial LAS [8] and is hypothesized to contribute to postural insufficiencies [9]. Both a history of LAS and aging have the potential to disrupt sensorimotor communication to the lower extremity postural muscles via the peripheral and central nervous systems, evidenced by decreased corticospinal excitability of postural muscles and reweighted dominance on hip musculature strategies in older adults [[10], [11]] and individuals with a history of LAS [[8], [12], [13]]. Furthermore, increased reliance on visual feedback for postural control has been observed in late adulthood [14] and in young adults following LAS [15], which may disrupt proper recruitment of postural muscles and postural corrections during a balance task, leading to postural instability.
Trajectories of the center of pressure (COP) during quiet standing, including linear (i.e., COP velocity) and nonlinear dynamic measures (i.e., entropy analysis and Time-to-Boundary [TTB]), have been used to detect sensorimotor alterations in young adults with a history of LAS [[4], [5], [16], [17]]. Entropy measures provide theoretical estimates to define randomness and regularity in postural control systems by identifying probability of point-to-point fluctuations in COP time series [18]. A COP time-series exhibiting more fluctuation (greater variation or less predictability) generates larger entropy values [18]. Decreased entropy values likely represent repeatable or predictable COP excursion patterns during single-leg stance, while increased entropy values represent more random or erratic COP excursion patterns, suggestive of unstable systems [19]. Both increased and decreased entropy following injury are considered to represent decreases in the optimal level of postural control variability [19]. Glass et al. [16] demonstrated decreased sample entropy (SampEn) during balance tasks in young adults with LAS history compared to healthy controls, suggesting a loss of an optimal state of postural control variability. Finally, TTB is a spatiotemporal COP analysis quantifying the amount of time needed for the COP to reach the boundaries of support [4]. Lower TTB values represent postural deficiencies, as an individual has less time and fewer movement solutions to make postural corrections [4]. Wikstrom et al. [5] identified decreased TTB during an eyes-open single-leg stance in those with ankle instability compared to healthy controls.
Young adults with LAS history [[4], [5], [16], [17]] and older adults without musclosketal injury [[20], [21]] present with altered postural control variability during quiet single-leg stance. However, little attention has been placed on the compound effect of LAS profile on postural control variability in older-aged adults. This restricts our understanding of how the development of postural deficiencies associated with LAS earlier in life may exacerbate expected negative consequences of aging on balance observed later in life. Therefore, the purpose of this study was to examine postural control variability during a single-leg balance task with linear and nonlinear measures in elderly individuals with and without a history of LAS.
Section snippets
Study design
In this case-control study, participants reported to the research laboratory for a single testing session. All methodological protocols were approved by a university Institutional Review Board.
Participants
Thirty older-age participants (60–69 years) were recruited from local and university communities. All participants read and signed a university-approved informed consent prior to study enrollment. All participants were in good health and had no history of 1) diagnosed balance or vestibular disorders; 2)
Results
Anthropometric characteristics were not different between the groups (p > 0.05) (Table 1). Participants with a previous history of LAS demonstrated significantly lower ApEn-AP (p = 0.01), SampEn-AP (p = 0.03), and SampEn-ML (p = 0.02) compared to controls (Table 2); all supported by moderate effect sizes. There were no between-group differences in ApEn-ML (p = 0.27), COPV-AP (p = 0.22), COPV-ML (p = 0.12), mean TTB-AP (p = 0.31), and mean TTB-ML (p = 0.20).
Discussion
Previous investigations assessing postural control in older age populations have not considered potential negative consequences of LAS history [20]. We observed lower values of ApEn and SampEn in elderly individuals with a history of LAS compared to controls. A lower value of ApEn and SampEn reflects repeatable patterns of COP displacements, indicating a potential association between LAS and a more rigid spatial postural control pattern. The information gained from this study may provide
Conclusion
We oberserved tthat older-age participants with a history of LAS had diminished postural sway variability (lower SampEn values), and therefore more rigid postural control patterns, compared to those without LAS. Rigid postural control patterns may help to prevent excessive motions within the base of support as a protective mechanism, but likely prevent older-aged adults with LAS from successfully coping with changes in task and environmental demands. Future investigation is necessary to
Conflict of Interest
None.
References (30)
- et al.
Postural control differs between those with and without chronic ankle instability
Gait Posture
(2010) Sensorimotor deficits with ankle sprains and chronic ankle instability
Clin. Sports Med.
(2008)- et al.
Influence of age and posture on spinal and corticospinal excitability
Exp. Gerontol.
(2015) - et al.
Age-induced modifications of static postural control in humans
Neurosci. Lett.
(2003) - et al.
Inter-joint coordination strategies during unilateral stance 6-months following first-time lateral ankle sprain
Clin. Biomech. (Bristol, Avon)
(2015) - et al.
Advanced age brings a greater reliance on visual feedback to maintain balance during walking
Hum. Mov. Sci.
(2015) - et al.
Postural orientation: age-related changes in variability and time-to-boundary
Hum. Mov. Sci.
(2002) - et al.
Mechanical and sensorimotor implications with ankle osteoarthritis
Arch. Phys. Med. Rehabil.
(2009) - et al.
Balance disorders in the elderly: epidemiology and functional impact
Laryngoscope
(2012) - et al.
A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population
J. Gerontol.
(1994)
The CDC Injury Center’s response to the growing public health problem of falls among older adults
Am. J. Lifestyle Med.
Spatiotemporal postural control deficits are present in those with chronic ankle instability
BMC Musculoskelet Disord.
Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains
Br. J. Sports Med.
Osteoarthritis as a determinant of an adverse coronary heart disease risk profile
J. Cardiovasc. Risk
Central nervous system adaptation after ligamentous injury: a summary of theories, evidence, and clinical interpretation
Sports Med.
Cited by (16)
Yoga as a balance intervention for middle-age and older adults with history of lateral ankle sprain: An exploratory study
2023, Journal of Bodywork and Movement TherapiesPosturography measures in specific ballet stance position discriminate ballet dancers with different occurrences of musculoskeletal injuries
2023, Journal of Bodywork and Movement TherapiesDifferences in postural control between healthy and subjects with chronic ankle instability
2022, Physical Therapy in SportCitation Excerpt :The nonlinear analysis of the variability of the displacement of CoP during the stance position can also be used to study CAI related to balance control. Several studies have shown that subjects with CAI present results in nonlinear variables that may signify a motor behaviour with less ability to adapt to the demands related to the task and environmental changes in balance control (Terada, Johnson, Kosik, & Gribble, 2019; Terada, Kosik, Johnson, & Gribble, 2018). In another study, Terada and colleagues did not found any difference between CAI subjects and healthy controls on sample entropy of CoP displacement (Terada, Beard, et al., 2019).
What is the best clinical assessment tool for identification of adults aged ≥80 years at high risk of falls?
2021, Physiotherapy (United Kingdom)Citation Excerpt :The BESTest was not included in the combinations as all of the tests are already included within this evaluation tool. It is known that increasing age is negatively associated with various changes in body systems, and that these changes may interfere with postural control and lead to a higher risk of falls [1]. In addition, people aged >80 years tend to fall more often than younger older adults.
Reduced force entropy in subacromial pain syndrome: A cross-sectional analysis
2020, Clinical BiomechanicsCitation Excerpt :In the musculoskeletal system, loss of complexity manifests by declined ability to generate precise levels of force, declined walking ability, disrupted (balance) control and frailty (Hausdorff, 2007; Lipsitz, 2002; Lipsitz and Goldberger, 1992; Madeleine and Madsen, 2009; Morrison and Newell, 2012; Sosnoff et al., 2015). Loss of motor output complexity has been associated with the clinical course of pain conditions involving among others, the low back (Georgoulis et al., 2006; Hausdorff, 2007; Madeleine and Madsen, 2009; Morrison and Newell, 2012; Sosnoff et al., 2015; Terada et al., 2018; van den Hoorn et al., 2012). We questioned whether the most common chronic pain condition of the shoulder (Subacromial Pain Syndrome, SAPS), is associated with reduced motor output complexity.