Directional measures of postural sway as predictors of balance instability and accidental falls

Despite the obvious advantages and popularity of static posturography, universal standards for posturographic tests have not been developed thus far. Most of the center-of-foot pressure (COP) indices are strongly dependent on an individual experimental design, and are susceptible to distortions, which makes results of their analysis incomparable. In this research, we present a novel approach to the analysis of the COP trajectory based on the directional features of postural sway. Our novel output measures: the sway directional indices (DI) and sway vector (SV) were applied to assess the postural stability in the group of young able-bodied subjects. Towards this aim, the COP trajectories were recorded in 100 students standing still for 60 s, with eyes open (EO) and then, with eyes closed (EC). Each record was subdivided then into 20, 30 and 60 s samples. Interclass correlation coefficients were calculated from the samples. The controlled variables (visual conditions) uniquely affected the output measures, but only in case of proper signal pretreatment (low-pass filtering). In filtering below 6 Hz, the DI and SV provided a unique set of descriptors for postural control. Both sway measures were highly independent of the trial length and the sampling frequency, and were unaffected by the sampling noise. Directional indices of COP filtered at 6 Hz showed high to very high reliability, with ICC range of 0.7-0.9. Results of a single 60 s trial are sufficient to reach acceptable reliability for both DI and SV. In conclusion, the directional sway measures may be recommended as the primary standard in static posturography.