Elsevier

Gait & Posture

Volume 60, February 2018, Pages 88-92
Gait & Posture

Full length article
Altered postural control variability in older-aged individuals with a history of lateral ankle sprain

https://doi.org/10.1016/j.gaitpost.2017.11.009Get rights and content

Highlights

  • Elderly participants with ankle sprain history exhibited altered postural control.

  • Elderly participants with ankle sprain history had more rigid postural control.

  • Ankle sprain history may be a factor for postural control degradation in elderly.

Abstract

The current study aimed to examine postural control performance during a single-leg balance task in elderly individuals with and without a previous history of lateral ankle sprain (LAS). Eighteen adults with a previous history of LAS (mean age = 66 years old) and 12 healthy controls (mean age = 65 years old) were included in the study. Participants performed three trials of a single-leg balance task during an eyes-opened condition for 20-s. Center of pressure (COP) trajectories in the anteroposterior (AP) and mediolateral (ML) directions were collected with a force plate. The following postural control measures were calculated in the AP and ML directions: 1) Sample Entropy (SampEn); 2) Approximate Entropy (ApEn); 3) mean of Time-to-Boundary minima (mean TTB); and 4) COP velocity (COPV). Older-age participants with a history LAS exhibited lower ApEn-AP, SampEn-AP, and SampEn-ML values compared to healthy controls (p < 0.05). The information gained from this investigation indicates more rigid postural control patterns, less adaptability, and more difficulty maintaining COP during a single-leg balance task in adults with a previous history of LAS. Our data suggest that there is a need to consider history of musculoskeletal injury when evaluating factors for postural control and fall risk in the elderly. Future investigations are needed to assess the effect of LAS on age-related declines in postural control and discern associations between potential risk factors of fall-related injuries and LAS in an elderly population.

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.

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