The assessment of body sway and the choice of the stability parameter(s)

This methodological study aims at comparison of the practical usefulness of several parameters of body sway derived from recordings of the center of pressure (CoP) with the aid of a static force platform as proposed in the literature. These included: mean displacement velocity, maximal range of movement along x- and y-co-ordinates, movement area, planar deviation, phase plane parameter of Riley and the parameters of the diffusion stabilogram according to Collins. They were compared in over 850 experiments in a group of young healthy subjects (n = 10, age 21-45 years), a group of elderly healthy (n = 38, age 61-78 years) and two groups of elderly subjects (n = 10 and n = 21, age 65-89 years) with stability problems under different conditions known to interfere with stability as compared to standing with open eyes fixing a visual anchoring point: closing the eyes, standing on plastic foam in stead of a firm surface and performing a cognitive task: the modified stroop test. A force platform (Kistler) was used and co-ordinates of the body's center of pressure were recorded during 60 s of quiet barefoot standing with a sampling frequency of 10 Hz. In general, the results show important overlapping among groups and test conditions. Mean displacement velocity shows the most consistent differences between test situations, health conditions and age ranges, but is not affected by an extra cognitive task in healthy old people. Mean maximal sideways sway range is different among groups and test conditions except for the cognitive task in young and elderly subjects. Standardised displacement parameters such as standard deviations of displacements and planar deviation discriminate less well than the actual range of motion or the velocity. The critical time interval derived from the diffusion stabilogram according to Collins et al. seems to add a specific type of information since it shows significant influence from addition of a cognitive task in old subjects standing on a firm surface but not when standing on plastic foam. The critical time interval shows no consistent relation to any other parameter. The influence of cognitive activity on balance merits further exploration. A new parameter, sum of maximal deviation time (SDT) was proposed showing complete discrimination between frail elderly and other old subjects when obtained while visual input was suppressed. It was concluded that mean displacement velocity seems to be the most informative parameter in most situations.