Aging and postural control. A comparison of spontaneous- and induced-sway balance tests

Two different balance testing methods were compared: (1) measurement of spontaneous postural sway during quiet standing, and (2) measurement of induced postural sway in response to an applied postural perturbation. Eyes-open tests were performed in 64 healthy young and elderly adults and in five elderly subjects with a history of falling. In both balance tests, the sway was defined in terms of the displacement of the center of pressure on the feet. Spontaneous sway was quantified using a number of different amplitude- and frequency-based parameters. Induced sway was measured in response to anterior-posterior acceleration of a platform on which the subject stood. The induced-sway test was specially designed to be safe and nonthreatening for elderly subjects; thus, the platform perturbation was confined to small accelerations and a gentle pseudorandom motion was used. To derive a measure of postural stability, the data from this test were fitted with a model that was then used to predict the response to sudden (transient) perturbations, thereby simulating the response in actual falls. Although both induced- and spontaneous-sway measures demonstrated significant aging-related decreases in stability, the differences were more pronounced for the induced-sway data. Conversely, some of the spontaneous-sway measures were much more successful in distinguishing the fallers from the nonfallers. There was a significant correlation between induced-sway and certain spontaneous-sway measures in the normal young adults; however, in the elderly normals and fallers, the data from the two types of balance tests either showed no correlation or, for certain spontaneous-sway measures, tended to show an inverse relationship.