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Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.

Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C, Janssens W, Decramer M, Troosters T - PLoS ONE (2013)

Bottom Line: Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p = 0.047), decreased anterior body sway during back muscle vibration (p = 0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p = 0.002).Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls.These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Sciences, University of Leuven, KU Leuven, Leuven, Belgium. Lotte.Janssens@faber.kuleuven.be

ABSTRACT

Introduction: Balance deficits are identified as important risk factors for falling in individuals with chronic obstructive pulmonary disease (COPD). However, the specific use of proprioception, which is of primary importance during balance control, has not been studied in individuals with COPD. The objective was to determine the specific proprioceptive control strategy during postural balance in individuals with COPD and healthy controls, and to assess whether this was related to inspiratory muscle weakness.

Methods: Center of pressure displacement was determined in 20 individuals with COPD and 20 age/gender-matched controls during upright stance on an unstable support surface without vision. Ankle and back muscle vibration were applied to evaluate the relative contribution of different proprioceptive signals used in postural control.

Results: Individuals with COPD showed an increased anterior-posterior body sway during upright stance (p = 0.037). Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p = 0.047), decreased anterior body sway during back muscle vibration (p = 0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p = 0.002). Individuals with COPD with the weakest inspiratory muscles showed the greatest reliance on ankle muscle input when compared to the stronger individuals with COPD (p = 0.037).

Conclusions: Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls. These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability. Further research is required to determine whether interventions such as proprioceptive training and inspiratory muscle training improve postural balance and reduce the fall risk in individuals with COPD.

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Related in: MedlinePlus

Experimental set-up.Standing on unstable support surface on force plate with ankle and back muscles vibration and vision occlusion.
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pone-0057949-g001: Experimental set-up.Standing on unstable support surface on force plate with ankle and back muscles vibration and vision occlusion.

Mentions: Figure 1 shows the experimental set-up. The participants were instructed to stand barefoot on a foam pad (Airex balance pad; 49.5 cm length×40.5 cm width×6.5 cm height), placed on the force plate. On unstable support surface, ankle proprioceptive signals are less reliable, which enforces reliance upon proximal proprioceptive signals (i.e., proprioceptive weighting), thereby highlighting proprioceptive deficits [11]. A standardized foot position was used, with the heels placed 10 centimeter apart, and a free forefoot position. The vision of the participants was occluded by means of non-transparent goggles. Participants were instructed to maintain their balance at all times and an investigator was standing next to the participant to prevent actual falls. Four experimental trials were implemented (Table 1). Postural stability was measured in trial 1 by standing on unstable support surface without vision for 30 seconds. Subsequently, muscle vibration was added bilaterally for 15 seconds to the ankle muscles (trial 2), back muscles (trial 3), and to the ankle and back muscles simultaneously (trial 4). Each trial was performed once. Between trials, one minute of rest was taken and the subjects were asked to move their lower limbs and pelvis briefly to reset muscle spindles.


Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.

Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C, Janssens W, Decramer M, Troosters T - PLoS ONE (2013)

Experimental set-up.Standing on unstable support surface on force plate with ankle and back muscles vibration and vision occlusion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585868&req=5

pone-0057949-g001: Experimental set-up.Standing on unstable support surface on force plate with ankle and back muscles vibration and vision occlusion.
Mentions: Figure 1 shows the experimental set-up. The participants were instructed to stand barefoot on a foam pad (Airex balance pad; 49.5 cm length×40.5 cm width×6.5 cm height), placed on the force plate. On unstable support surface, ankle proprioceptive signals are less reliable, which enforces reliance upon proximal proprioceptive signals (i.e., proprioceptive weighting), thereby highlighting proprioceptive deficits [11]. A standardized foot position was used, with the heels placed 10 centimeter apart, and a free forefoot position. The vision of the participants was occluded by means of non-transparent goggles. Participants were instructed to maintain their balance at all times and an investigator was standing next to the participant to prevent actual falls. Four experimental trials were implemented (Table 1). Postural stability was measured in trial 1 by standing on unstable support surface without vision for 30 seconds. Subsequently, muscle vibration was added bilaterally for 15 seconds to the ankle muscles (trial 2), back muscles (trial 3), and to the ankle and back muscles simultaneously (trial 4). Each trial was performed once. Between trials, one minute of rest was taken and the subjects were asked to move their lower limbs and pelvis briefly to reset muscle spindles.

Bottom Line: Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p = 0.047), decreased anterior body sway during back muscle vibration (p = 0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p = 0.002).Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls.These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Sciences, University of Leuven, KU Leuven, Leuven, Belgium. Lotte.Janssens@faber.kuleuven.be

ABSTRACT

Introduction: Balance deficits are identified as important risk factors for falling in individuals with chronic obstructive pulmonary disease (COPD). However, the specific use of proprioception, which is of primary importance during balance control, has not been studied in individuals with COPD. The objective was to determine the specific proprioceptive control strategy during postural balance in individuals with COPD and healthy controls, and to assess whether this was related to inspiratory muscle weakness.

Methods: Center of pressure displacement was determined in 20 individuals with COPD and 20 age/gender-matched controls during upright stance on an unstable support surface without vision. Ankle and back muscle vibration were applied to evaluate the relative contribution of different proprioceptive signals used in postural control.

Results: Individuals with COPD showed an increased anterior-posterior body sway during upright stance (p = 0.037). Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p = 0.047), decreased anterior body sway during back muscle vibration (p = 0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p = 0.002). Individuals with COPD with the weakest inspiratory muscles showed the greatest reliance on ankle muscle input when compared to the stronger individuals with COPD (p = 0.037).

Conclusions: Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls. These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability. Further research is required to determine whether interventions such as proprioceptive training and inspiratory muscle training improve postural balance and reduce the fall risk in individuals with COPD.

Show MeSH
Related in: MedlinePlus