Postural Balance, Aging, Frailty
Conditions
Keywords
older adults, Vojta Therapy, Reflex Locomotion Therapy, Postural Control, Stabilometry, Center of pressure, Balance, Fall risk
Brief summary
• This exploratory randomized assessor-blinded study aimed to determine whether a single session of Reflex Locomotion Therapy according to Vojta produces immediate changes in postural control in community-dwelling older adults classified as robust or prefrail. The study focused on stabilometric variables during standing tasks, because demanding balance conditions may reveal subtle postural control changes that are not evident during quiet standing. Participants were randomly allocated to an intervention group receiving standardized Vojta therapy or to a control group receiving an educational session of equivalent duration. Postural control was assessed using force platform stabilometry during five standing conditions: eyes open, eyes closed, tandem stance, right single-leg stance, and left single-leg stance. Assessments were performed at baseline, immediately after the intervention, and 20 minutes after the intervention. Positional, dynamic, spectral and nonlinear center of pressure variables were analyzed to explore acute changes in postural sway magnitude, corrective dynamics, frequency-domain organization, and temporal regularity and complexity of postural control.
Detailed description
Falls and balance impairments are major health concerns in older adults because they are associated with functional decline, loss of independence, fear of falling, and increased healthcare burden. Postural control is a key modifiable factor related to fall risk. Subtle changes in postural regulation may not be fully captured during quiet standing alone; therefore, more demanding standing tasks may provide additional information about the ability of the postural control system to adapt to reduce base of support and increased sensorimotor demands. Reflex Locomotion Therapy according to Vojta is a non-pharmacological neurorehabilitation approach based on sustained somatosensory stimulation applied to specific body zones. This stimulation is intended to activate automatic postural and movement patterns and may influence neuromotor control mechanisms involved in postural regulation. Although Vojta therapy has been used mainly in pediatric and neurological populations, evidence regarding its effects on postural control in older adults remains limited. This exploratory randomized assessor -blinded study examined the acute effects of a single session of Vojta therapy on stabilometric variables of standing postural control in robust and prefrail older adults. The study was designed to characterize postural response under both quiet and challenging balance conditions, with special interest in task-dependent changes that could be relevant to fall-related postural control. Centre of pressure variables were selected to provide a multidimensional characterization of postural control. Positional variables, including root mean square displacement in the mediolateral and anteroposterior directions, were used to characterize the magnitude of postural sway. Within the dynamic dimension, root mean square acceleration was considered the primary variables of corrective postural adjustments, complemented by mean velocity as a secondary variable of sway dynamics and postural effort. Spectral variables, including mean power frequency and dominant frequency in the mediolateral and anteroposterior directions, were used to describe the frequency domain organization of postural sway across the five standing conditions. Nonlinear variables, including sample entropy and Higuchi fractal dimension, were used to explore temporal regularity, predictability, and complexity of center of pressure fluctuations. Together, these measures were intended to capture complementary aspects of postural control beyond traditional sway magnitude.
Interventions
OTHERReflex Locomotion Therapy according to Vojta
A non-pharmacological neurorehabilitation intervention based on sustained somatosensory stimulation applied to specific body zones. In this study, a standardized protocol of the second phase of reflex rolling, was used to explore immediate effects on postural control.
BEHAVIORALEducational Session
An educational session focused on general health and well-being in older adulthood, delivered without physical therapy, balance exercises, or specific therapeutic stimulation.
Sponsors
Marianela Alejandra Valenzuela Sandoval
Universidad de Concepcion
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Due to the nature of the intervention, participants and the treating therapist could not be blinded. The outcomes assessor responsible for stabilometric measurements was blinded to group allocation
Intervention model description
Participants were randomly allocated to one of two parallel groups: an intervention group receiving Reflex Locomotion Therapy according to Vojta or a control group receiving an educational session of equivalent duration.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* \- Community-dwelling adults aged 60 years or older * Residents of Santiago, Chile. * Classified as robust or prefrail according to the FRAIL scale: robust=0 positive criteria; prefrail= 1-2 positive criteria * Functional performance compatible with safe standing balance assessment, defined as a Short Physical Performance Battery (SPPB) score of 9-10 points * Able to stand independently and safely perform standing balance assessments * Sufficient cognitive ability to understand and follow simple instructions, assessed using the abbreviated Mini Mental State Examination with a cut-off score of 13 points or higher * Able to provide written informed consent
Exclusion criteria
* \- Neurological conditions affecting postural stability, such as stroke, Parkinson disease, multiple sclerosis, or other relevant neurological disorders. * Musculoskeletal disorders, chronic pain, or lower limb prosthesis affecting mobility or balance assessment * Permanent use of assistive devices for standing or walking * Vestibular disorders, including vertigo * Use of medications with potential effects on balance according to clinical history * Any medical condition preventing safe participation in the intervention or stabilometric assessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Root Mean Square (RMS) of Center of Pressure Acceleration During Standing Balance Tasks. | Baselines, immediately post-intervention, and 20 minutes post-intervention | Root mean square (RMS) of center of pressure acceleration is a time domain measure derived from the acceleration of center of pressure signal recorded by force platform stabilometry during standing. It quantifies the magnitude of center of pressure acceleration asociated with corrective postural adjustments made to maintain balance. Higher values indicate greater corrective accelerations. IT is expressed in cm/s2. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Mean Center of Pressure Velocity During Standing Balance Tasks. | Baselines, immediately post-intervention, and 20 minutes post-intervention | Mean center of pressure velocity is the average speed of displacement of the center over the recording period, reflecting the overall dynamics and effort of postural sway during standing. Higher values indicate faster CoP displacement and greater postural sway activity. It is expressed in cm/s. |
| Change in Positional Center of Pressure Measures (RMS in the Mediolateral and Anteroposterior Directions) During Standing Balance Tasks. | Baseline, immediately post-intervention, and 20 minutes post-intervention. | Root mean square (RMS) displacement of the center of pressure in the mediolateral (ML) and anteroposterior (AP) directions quantifies the average magnitude of postural sway around the mean center of pressure position during standing, in each respective axis. Higher values indicate greater postural sway in that direction. It is expressed in cm |
| Change in Spectral Center of Pressure Measures (Mean Power Frequency, Dominant Frequency) During Standing Balance Tasks. | Baseline, immediately post-intervention, and 20 minutes post-intervention. | Mean power frequency (MPF) is the average frequency of the power spectrum of the center of pressure signal, weighted by spectral power, reflecting the overall frequency-domain organization of postural sway. Dominant frequency is the frequency at wich the power spectrum reaches its maximum value. Both measures are calculated in the mediolateral and anteroposterior directions and are expressed in Hz. |
| Change in Nonlinear Center of Pressure Measures During Standing Balance Tasks. | Baseline, immediately post-intervention, and 20 minutes post-intervention | Sample entropy quantifies the regularity and predictability of center of pressure time series, with lower values indicating more regular and predictable postural sway, whereas higher values indicate greater irregularity and unpredictability. Higuchi fractal dimension quantifies the temporal complexity of center of pressure time series, with values closer to 1 indicating a smoother and less complex signal and values closer to 2 indicating greater complexity. Both measures are calculated separately for mediolateral (ML) and anteroposterior (AP) directions and are dimensionless. |
| Adverse events and Tolerability during the Experimental Session | Baseline, immediately post-intervention, and 20 minutes post-intervention. | Adverse events, clinical complications, discomfort, or interruptions during the intervention and stabilometric assessments were recorder to describe safety and tolerability. |
Countries
Chile
Outcome results
None listed