Changes in postural control in healthy elderly subjects are related to vibration sensation, vision and vestibular...

The aim of this study was to analyze the composition of sway in adults and "healthy" elderly people and to evaluate the influence of vibration sensation and asymmetric vestibular function on the sway pattern. Ten adults with a mean age of 37.5 years and 40 healthy senior citizens with a mean age of 74.6 years living independently in the community were studied. Vibration-induced body sway was measured on a force platform. The sway was analyzed and separated into its high and low frequency components above and below 0.1 Hz, respectively. Additionally the elderly subjects were observed for the occurrence of spontaneous gaze and head shake-induced nystagmus using infrared charge-coupled device cameras and the vibration perception in the lower limbs was tested with a tuning fork. Vibration perception was the major determinant for postural control in the elderly subjects. Postural control among the elderly subjects with intact vibration perception in their lower limbs was very similar to that of the adults. The elderly subjects with impaired vibration sensation had increased high frequency sway compared to adults and the elderly subjects with intact sensation. Regardless of the strong influence of vibration sensation on postural control, asymmetric vestibular function might also be a contributing factor to postural instability in the elderly. Age per se had little effect on the outcome of the tests except that the elderly subjects had diminished ability to use visual cues to reduce postural sway. We concluded that sensory status in the lower limbs is of utmost importance for postural control in the elderly. Rehabilitation programs for senior citizens should therefore include exercises to preserve recognition of body motion by the lower limbs. Exercises to facilitate vestibular compensation could be useful for elderly people with vestibular dysfunction.