The PROPRIO® Reactive Balance Systems are creating a lot of buzz in research circles. Here are some of the studies that are finished, in progress, and just starting. Warning: these studies are thought provoking.

 

Vestibular Research

 

  • The Effects of Perturbation as a Vestibular Rehabilitation Intervention. This study found significant improvements with chronic vestibular patients that trained on the PROPRIO® 5000 System who were not showing improvements in their rehabilitation with conventional balance training. (Winkler, P.; Dixon, B.; King, F.; Marrero, A.; Nelson, M.; Randolph, E.; Stucchi, P. The Effects of Perturbation as a Vestibular Rehabilitation Intervention. Journal of Neurologic Physical Therapy, (2011).

 

  • The Role of Vestibular and Somatosensory Systems in Intersegmental Control of Upright Stance. This research perturbed the surface on healthy controls and Bi-Lateral Vestibular Loss patients in upright stance using sinusoidal platform rotations to see how vestibular and somatosensory information are used to control segment and intersegmental dynamics. The results showed that as the frequency of the surface rotation increased, healthy subjects oriented their trunks in a stationary position in space while their legs moved with the platform underneath them, whereas, the BVLs continued to follow the platform with both trunk and legs, often resulting in a fall or temporary loss of stability. (Creath, R.; Kiemel, T.; Horak, F.; Jeka, J. The Role of Vestibular and Somatosensory Systems in Intersegmental Control of Upright Stance. Journal of Vestibular Research 18 (2008) 39-49.)

 

  • Vestibular Loss Disrupts Control of Head and Trunk on a Sinusoidally Moving Platform. This study suggests when using a sinusoidal translating surface that when the surface is so unstable or sways so fast that hip and knee motion must be added to control the body CoM, the vestibular system becomes critical for postural stability. (Buchanan, J.; Horak, F. Vestibular Loss Disrupts Control of Head and Trunk on a Sinusoidally Moving Platform. Journal of Vestibular Research 11 (2001/2002) 371-389.

 

Orthopedic Research

 

  • Collection of Data on Pre- and Post-Operative ACL Patients. This study takes the PROPRIO® Test pre-op ACL and post-op ACL patients to measure improvements utilizing the PROPRIO® Test and compares it to norms. (Nunley, R.; Barracks, R.; Motley, J. Washington University-St. Louis. 2009).

 

  • Fatigue Induced ACL Injury Risk Stems from a Degradation in Central Control. The research suggests that training the brain to respond to unexpected stimuli, thus sharpening their anticipatory skills when faced with unexpected scenarios, may be more beneficial than performing rote training exercises in a controlled lab setting, which is much less random than a true competitive scenario. In this case, expanding the anticipated training to include shorter stimulus-response times could improve reaction time in random sports settings. If you expose them to more scenarios, and train the brain to respond more rapidly, you can decrease the likelihood of a dangerous response. (McLean SG, Samorezov JE. Fatigue Induced ACL Injury Risk stems from a Degradation in Central Control. Medicine and Science in Sports and Exercise. August 2009).

  • Postural Stability in Older Adults with a Distal Radial Fracture
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994855/

 

TBI/Concussion Research

 

  • Validating the PROPRIO® 4000 Test as a Tool for TBI Patients. Using the PROPRIO® 4000, data was collected from 10 TBI patients and 10 norms to compare PROPRIO® 4000 Test results to clinical measurements. The test results will also be comparing EMG and full body kinematics to the PROPRIO® Test results to see if there are any movement patterns found in TBI patients that are not found in the norms. (Burnfield, J.; Buster, T. Madonna Rehabilitation Hospital 2011).

 

  • Development of a Concussion Test utilizing the PROPRIO® Systems. This study is using the PROPRIO® System to measure the postural control of an athlete following a concussion and provide an objective score. Baseline tests of all the athletes were performed as well as BESS tests to compare the results. (Dean, J.; McVeigh, J. University of Tennessee. 2009)

 

  • Assessment of Balance using Computerized Dynamic Posturography in Individuals with and without Chronic Severe Traumatic Brain Injury. Brain Injury.  Buster TW, Chernyavskiy P, Harms NR, Kaste G, Burnfield JM (2016)

 

  •  Computerized Dynamic Posturography detects balance deficits and is robust to ceiling effects for individuals with chronic sever TBI.  Proceedings, 9th World Congress for Neurorehabilitation. May 10-13, Philadelphia, PA  Buster TW, Lowndes BR, Burnfield JM (2016). 

 

 

Stroke Research

 

  • Use of the PROPRIO® 5000 to Improve Trunk Control in Sitting Post Stroke. Chronic stroke patients who were no longer showing improvement with conventional training methods showed progression when training on the PROPRIO® Reactive Balance Systems in the sitting position. (Karas-Reinthal, A. Cleveland State University. 2008).

 

Measurement Research

 

  • A Comparison of Balance Performance: Computerized Dynamic Posturography and a Random Motion Platform. The first 30 seconds of the PROPRIO® Test used by the PROPRIO® 5000 shows a significant correlation with the overall score of the Neurocom SOT test. (Broglio S P; Sosnoff J J; Rosengren K S; McShane K. A comparison of balance performance: computerized dynamic posturography and a random motion platform. Archives of physical medicine and rehabilitation 2009 Jan.; 90(1): 145-50).

 

  • PROPRIO® 5000: A New Method for Assessing Dynamic Balance. This study validated use of the PROPRIO® Reactive Balance Systems’ ultrasonic technology for measuring core movement and center of mass by comparing the measurements from the PROPRIO® 5000 to 3-D motion capture. (Sims E L; Williams M W; Charnock B; Garrett W E; Queen R M; PROPRIO® 5000: A New Method for Assessing Dynamic Balance. Medicine and Science in Sports and Exercise. Volume 39 (S5): 2007).

 

  • Differential Diagnosis of Proprioceptive and Vestibular Deficits using Dynamic Support-Surface Posturography. This study evaluated how effective dynamic support-surface posturography could be as a diagnostic tool in patients with balance disorders (proprioceptive or vestibular deficits). Specifically, whether measures of trunk control and simple toe-up rotational perturbations, selected using statistical techniques, could provide a better diagnostic yield than either the analysis of lower-body movements or use of a "nulled" ankle input paradigm. The conclusion was that a simple toe-up rotation of the support surface provides a better differential diagnostic specificity than nulling the ankle input during a backward translation and that measurement of trunk movements provides a considerably better diagnostic yield than assessment of lower-leg postural responses. (Allum J H; Bloem B R; Carpenter M G; Honegger F. Differential diagnosis of proprioceptive and vestibular deficits using dynamic support-surface posturography. Gait & posture 2001; 14(3):217-26).

 

  • Body Sway as a Function of Foot Position. Based on this data and practical considerations, they recommend using a foot position at shoulder-width. The shoulder-width position produced the smallest difference between genders. In addition, there is the practical consideration that shoulder-width is relatively easy to judge by sight, obviating the need for time-consuming measurement. (St. James, J. Body Sway as a Function of Foot Position. 2006).

 

  • Collection of Normative Data on Adolescence Ages 13-20. This study is gathering normative data by performing three trials on the PROPRIO® Test. In addition to collecting the data, they are also noting improvements between the tests. This information will also compare the scores with their level of activity. (Nunley, R.; Barracks, R.; Motley, J. Washington University-St. Louis. 2009).

 

Fall Prevention Research

 

  • Time-course of Improved Trunk Control in Young Adults during a Multi-directional Training Protocol. This study demonstrated that young subjects can learn to control the trunk motion induced by a tilting platform that can neither be predicted nor controlled. Training on the PROPRIO® 5000 resulted in a 52 percent improvement in trunk control. The maximum improvement in trunk control occurred during the first 50 percent of the training trials. Maximum improvement in trunk control was strongly and nonlinearly related to the subjects’ initial trunk path length. (Marone, J.R.; Troy, K.L.; Grabiner, M.D. Time-course of Improved Trunk Control in Young Adults during a Multi-directional Training Protocol. 2005).

 

  • Assessment of Balance Control in Humans. This study demonstrates that the site and type of perturbation elicits different responses in character and organization. They state that static balance training does not train hip strategy, therefore does not translate to improved balance for functional activities. Unexpected perturbations present the most serious threat to standing posture and are triggered by sensory inputs. It follows that a single assessment technique cannot be used as a true indicator of the overall integrity of the balance control system. It may be that we require a battery of tests to properly assess the balance control system. (Winter, D.; Patla, A.; Frank, J. (Assessment of Balance Control in Humans. Medical Progress through Technology 16: 31-51, 1990).

 

  • Practice-Related Improvements in Posture Control Differ Between Young and Older Adults Exposed to Continuous, Variable Amplitude Oscillations of the Support Surface. The study exposed healthy older adults to continuous, variable amplitude oscillations of the support surface to determine (1) whether age affects the capacity for postural motor learning under continuous perturbation conditions with limited predictability and (2) whether practice leads to modifications in the control strategy used to maintain balance in older adults. It found that older adults adopted a rigid, flexed knee posture with their trunk fixed to the surface rather than to gravity, even after practice. They found that both COM phase and trunk tilt variability, retention test outcomes were better than pre-practice performance demonstrating older adults’ capacity for postural motor learning in a variable amplitude environment. (Van Ooteghem, K.; Frank, J.; Horak, F. Practice-Related Improvements in Posture Control Differ Between Young and Older Adults Exposed to Continuous, Variable Amplitude Oscillations of the Support Surface. Experimental Brain Research (2009) 199:185-193.)

 

Reactive/Perturbation Training Research

 

  • A Perturbation-based Balance Training Program for Older Adults: Study Protocol for a Randomized Controlled Trial. This study is among the first to use perturbation-based training as an intervention to reverse age-related impairments in the ability to recover from sudden loss of balance using rapid stepping or grasping reactions. They believe the perturbation-based training program outlined in the study will increase the probability that the program will bring about functionally significant improvements in the control of compensatory stepping and grasping. Ultimately, such improvements should help to reduce the incidence of falls. (Mansfield, A.; Peters, AL; Liu, BA; Maki, BE. A Perturbation-based Balance Training Program for Older Adults: Study Protocol for Randomized Controlled Trial. BMC Geriatrics. 2007, 7:12doi:10.1186/1471-2318-7-12).

 

  • A Relationship Between Anticipatory Postural Control and Reactive Postural Control in Young Individuals Between 18-26 Years Old. The purpose of this study was to explore the relationship between anticipatory postural control and reactive postural control. Generally this research suggests that in normal persons, measures in anticipatory balance control may not give insight into an individual’s ability in reactive postural control. Thus clinicians may need to find a way to objectively measure reactive postural control in order to fully assess an individual’s ability to balance under varied conditions. (Strubhar, AJ; Wagoner, S; Walk, A. The Relationship Between Anticipatory Postural Control and Reactive Postural Control in Young Individuals Between 18-26 Years-Old. 2009.

 

Other Research

 

  • Perturbation training for children with Down Syndrome. This study investigated the effects of massed practice postural perturbation training intervention on gross motor function in children with Down syndrome. The findings support the use of massed practice schedules for these children and suggest that postural perturbation training may be a promising intervention strategy to address gross motor delays in children with Down syndrome. (Footer C B; Bender A; James H; Marx A; Passon A; Schulz R; Tracey S; Trimble T. Postural Perturbation Training for Children with Down Syndrome. APTA Combined Sections Meeting, Las Vegas, NV. (2008).

 

  • Postural Perturbation Training in Children with Cerebral Palsy, Spastic Hemiplegia. This study investigated the effects of massed practice postural perturbation training on gross motor function in children with cerebral palsy (CP), spastic hemiplegia. These findings challenge conventional clinical distributed practice schedules for children with CP, spastic hemiplegia and support the use of massed practice schedules for these children. In addition, postural perturbation training may be a promising intervention strategy to address gross motor function in these children, including children with fairly good gross motor development. (Footer C.; Chandler, A.; Downey, R.; Hogan, M.; Hunt, S.; Smith, P.; Smulligan, K.; Whalen, A. Postural Perturbation Training for Children with Cerebral Palsy, Spastic Hemiplegia. APTA Combined Sections Meeting, San Diego, CA. (2010).

 

  • Comparison of Balance Responses in Single Leg and Double Leg Stance. The primary objective of this study was to examine one and two legged balance performance on the PROPRIO® 5000 to determine new parameters in future studies. (Ferguson, S.; Maher, R.; Tippett S. Comparison of Balance Responses in Single Leg and Double Leg Stance. 2009).

 

  • The Relationship between Proprioception Scores using the PROPRIO 5000® and Lower Extremity Alignment in College-Aged Students. The primary objective of this study was to examine if lower extremity alignment correlated with Postural Control Scores as measured on the PROPRIO 5000® System. This test was non-conclusive and study recommended future studies allow analyses using subjects that have asymmetrical alignment between extremities or alignment angles that are not in the accepted norms. (Tippett S.; Scales, A.; Setty, A.; Thoele, S. The Relationship between Proprioception Scores using the PROPRIO 5000® and Lower Extremity Alignment in College-Aged Students.. 2010).

 

  • Proprioceptive Contribution of Postural Control as Assessed from Very Slow Oscillations of the Support in Healthy Humans. This research suggests that proprioceptive cues are predominant in the control of body orientation in quasi-static condition and that head and trunk stabilization strategies used as the basis of postural control depend on the properties of the moving support. It concludes that the vestibular system requires large postural changes to detect any change in body orientation. (Vaugoyeau, M.; Viel, S.; Amblard, B.; Azulay, J.P.; Assaiante, C. Proprioceptive Contribution of Postural Control as Assessed from Very Slow Oscillations of the Support in Healthy Humans. Gait & Posture (2008) 295-302.)

 

  • A Strategy Utilizing Simple Clinical and laboratory Tests to Identify Fallers Among Healthy Independently-Living Older Persons. The purpose of this study was to examine the capacity of a number of field and laboratory tests to identify fallers in a sample of older independently-living, community-dwelling persons. Results showed the PROPRIO® could identify fallers. In addition, the laboratory tests revealed balance decrements in specific planes of motion that provide information concerning directional falls risk and offer a framework for the prescription of interventions to reduce that risk. (Bedient, Abigail M. Ph.D., A strategy utilizing simple clinical and laboratory tests to identify fallers among healthy independently-living older persons. University of Miami, 39 pages (2010).

 

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