Abstract

Understanding the mechanisms behind human balance has been a subject of interest as various postural instabilities have been linked to neuromuscular diseases (e.g., Parkinson's, multiple sclerosis, and concussion). This paper presents a method to characterize an individual's postural stability and estimate of their neuromuscular feedback control parameters. The method uses a generated topological mapping between a subject's experimental data and a dataset consisting of time-series realizations generated using an inverted pendulum mathematical model of upright balance. The performance of the method is quantified using a set of validation time-series realizations with known stability and neuromuscular control parameters. The method was found to have an overall sensitivity of 85.1% and a specificity of 91.9%. Furthermore, the method was most accurate when identifying limit cycle oscillations (LCOs) with a sensitivity of 91.1% and a specificity of 97.6%. Such a method has the capability of classifying an individual's stability and revealing possible neuromuscular impairment related to balance control, ultimately providing useful information to clinicians for diagnostic and rehabilitation purposes.

References

References
1.
Chang
,
J. T.
,
Morton
,
S. C.
,
Rubenstein
,
L. Z.
,
Mojica
,
W. A.
,
Maglione
,
M.
,
Suttorp
,
M. J.
,
Roth
,
E. A.
, and
Shekelle
,
P. G.
,
2004
, “
Interventions for the Prevention of Falls in Older Adults: Systematic Review and Meta-Analysis of Randomised Clinical Trials
,”
Br. Med. J.
,
328
(
7441
), p.
680
.10.1136/bmj.328.7441.680
2.
Kannus
,
P.
,
Sievanen
,
H.
,
Palvanen
,
M.
,
Jarvinen
,
T.
, and
Parkkari
,
J.
,
2005
, “
Prevention of Falls and Consequent Injuries in Elderly People
,”
Lancet
,
366
(
9500
), pp.
1885
1893
.10.1016/S0140-6736(05)67604-0
3.
Parry
,
S. W.
,
Steen
,
N.
,
Galloway
,
S. R.
,
Kenny
,
R. A.
, and
Bond
,
J.
,
2001
, “
Falls and Confidence Related Quality of Life Outcome Measures in an Older British Cohort
,”
Postgrad. Med. J.
,
77
(
904
), pp.
103
108
.10.1136/pmj.77.904.103
4.
Stevens
,
J. A.
,
Corso
,
P. S.
,
Finkelstein
,
E. A.
, and
Miller
,
T. R.
,
2006
, “
The Costs of Fatal and Non-Fatal Falls Among Older Adults
,”
Injury Prev.
,
12
(
5
), pp.
290
295
.10.1136/ip.2005.011015
5.
CDC
,
2005
, “https://www.cdc.gov/ncipc/wisqars/Web-Based Injury Statistics Query and Reporting System (WISQARS), Atlanta, GA,” Centers for Disease Control and Prevention, accessed Aug. 12, 2020, https://www.cdc.gov/ncipc/wisqars/
6.
Scuffham
,
P.
,
Chaplin
,
S.
, and
Legood
,
R.
,
2003
, “
Incidence and Costs of Unintentional Falls in Older People in the United Kingdom
,”
J. Epidemiol. Commun. Health
,
57
(
9
), pp.
740
744
.10.1136/jech.57.9.740
7.
Burns
,
E. R.
,
Stevens
,
J. A.
, and
Lee
,
R.
,
2016
, “
The Direct Costs of Fatal and Non-Fatal Falls Among Older adults-United States
,”
J. Saf. Res.
,
58
, pp.
99
103
.10.1016/j.jsr.2016.05.001
8.
Campbell
,
A. J.
,
Reinken
,
J.
,
Allan
,
B. C.
, and
Martinez
,
G. S.
,
1981
, “
Falls in Old Age: A Study of Frequency and Related Clinical Factors
,”
Age Ageing
,
10
(
4
), pp.
264
270
.10.1093/ageing/10.4.264
9.
Prudham
,
D.
, and
Evans
,
J. G.
,
1981
, “
Factors Associated With Falls in the Elderly: A Community Study
,”
Age Ageing
,
10
(
3
), pp.
141
146
.10.1093/ageing/10.3.141
10.
Downton
,
J. H.
, and
Andrews
,
K.
,
1991
, “
Prevalence, Characteristics and Factors Associated With Falls Among the Elderly Living at Home
,”
Aging (Milano)
,
3
(
3
), pp.
219
228
10.1007/BF03324009.
11.
Stalenhoef
,
P. A.
,
Diederiks
,
J. P. M.
,
Knottnerus
,
J. A.
,
Kester
,
A. D. M.
, and
Crebolder
,
H. F. J. M.
,
2002
, “
A Risk Model for the Prediction of Recurrent Falls in Community-Dwelling Elderly: A Prospective Cohort Study
,”
J. Clin. Epidemiol.
,
55
(
11
), pp.
1088
1094
.10.1016/S0895-4356(02)00502-4
12.
Tinetti
,
M. E.
,
Speechley
,
M.
, and
Ginter
,
S. F.
,
1988
, “
Risk Factors for Falls Among Elderly Persons Living in the Community
,”
New Engl. J. Med.
,
319
(
26
), pp.
1701
1707
.10.1056/NEJM198812293192604
13.
Błaszczyk
,
J. W.
,
Orawiec
,
R.
,
Duda-Kłodowska
,
D.
, and
Opala
,
G.
,
2007
, “
Assessment of Postural Instability in Patients With Parkinson's Disease
,”
Exp. Brain Res.
,
183
(
1
), pp.
107
114
.10.1007/s00221-007-1024-y
14.
Bonan
,
I. V.
,
Colle
,
F. M.
,
Guichard
,
J. P.
,
Vicaut
,
E.
,
Eisenfisz
,
M.
,
Tran Ba Huy
,
P.
, and
Yelnik
,
A. P.
,
2004
, “
Reliance on Visual Information After Stroke. Part I: Balance on Dynamic Posturography
,”
Arch. Phys. Med. Rehabil.
,
85
(
2
), pp.
268
273
.10.1016/j.apmr.2003.06.017
15.
Corradini
,
M. L.
,
Fioretti
,
S.
,
Leo
,
T.
, and
Piperno
,
R.
,
1997
, “
Early Recognition of Postural Disorders in Multiple Sclerosis Through Movement Analysis: A Modeling Study
,”
IEEE Trans. Biomed. Eng.
,
44
(
11
), pp.
1029
1038
.10.1109/10.641330
16.
Stolze
,
H.
,
Klebe
,
S.
,
Zechlin
,
C.
,
Baecker
,
C.
,
Friege
,
L.
, and
Deuschl
,
G.
,
2004
, “
Falls in Frequent Neurological diseases—Prevalence, Risk Factors and Aetiology
,”
J. Neurol.
,
251
(
1
), pp.
79
84
.10.1007/s00415-004-0276-8
17.
Tinetti
,
M. E.
,
Baker
,
D. I.
,
McAvay
,
G.
,
Claus
,
E. B.
,
Garrett
,
P.
,
Gottschalk
,
M.
,
Koch
,
M. L.
,
Trainor
,
K.
, and
Horwitz
,
R. I.
,
1994
, “
A Multifactorial Intervention to Reduce the Risk of Falling Among Elderly People Living in the Community
,”
New Engl. J. Med.
,
331
(
13
), pp.
821
827
.10.1056/NEJM199409293311301
18.
Wampler
,
M. A.
,
Topp
,
K. S.
,
Miaskowski
,
C.
,
Byl
,
N. N.
,
Rugo
,
H. S.
, and
Hamel
,
K.
,
2007
, “
Quantitative and Clinical Description of Postural Instability in Women With Breast Cancer Treated With Taxane Chemotherapy
,”
Arch. Phys. Med. Rehabil.
,
88
(
8
), pp.
1002
1008
.10.1016/j.apmr.2007.05.007
19.
Winters-Stone
,
K. M.
,
Torgrimson
,
B.
,
Horak
,
F. B.
,
Eisner
,
A.
,
Nail
,
L.
,
Leo
,
M. C.
,
Chui
,
S.
, and
Luoh
,
S. W.
,
2011
, “
Identifying Factors Associated With Falls in Postmenopausal Breast Cancer Survivors: A Multi-Disciplinary Approach
,”
Arch. Phys. Med. Rehabil.
,
92
(
4
), pp.
646
652
.10.1016/j.apmr.2010.10.039
20.
Suzman
,
R.
, and
Beard
,
J.
,
2011
, “Global Health and Aging,”
WHO
,
Geneva, Switzerland
, NIH Publ. No 117737.
21.
WHO
,
2006
, “Neurological Disorders: Public Health Challenges,”
WHO
,
Geneva, Switzerland
, p.
229
.
22.
Collins
,
J. J.
, and
De Luca
,
C. J.
,
1994
, “
Random Walking During Quiet Standing
,”
Phys. Rev. Lett.
,
73
(
5
), pp.
764
767
.10.1103/PhysRevLett.73.764
23.
Donker
,
S. F.
,
Roerdink
,
M.
,
Greven
,
A. J.
, and
Beek
,
P. J.
,
2007
, “
Regularity of Center-of-Pressure Trajectories Depends on the Amount of Attention Invested in Postural Control
,”
Exp. Brain Res.
,
181
(
1
), pp.
1
11
.10.1007/s00221-007-0905-4
24.
Ladislao
,
L.
, and
Fioretti
,
S.
,
2007
, “
Nonlinear Analysis of Posturographic Data
,”
Medical Biol. Eng. Comput.
,
45
(
7
), pp.
679
688
.10.1007/s11517-007-0213-y
25.
Roerdink
,
M.
,
De Haart
,
M.
,
Daffertshofer
,
A.
,
Donker
,
S. F.
,
Geurts
,
A. C. H.
, and
Beek
,
P. J.
,
2006
, “
Dynamical Structure of Center-of-Pressure Trajectories in Patients Recovering From Stroke
,”
Exp. Brain Res.
,
174
(
2
), pp.
256
269
.10.1007/s00221-006-0441-7
26.
Yamada
,
N.
,
1995
, “
Chaotic Swaying of the Upright Posture
,”
Human Movement Sci.
,
14
(
6
), pp.
711
726
.10.1016/0167-9457(95)00032-1
27.
Cavanaugh
,
J. T.
,
Guskiewicz
,
K. M.
, and
Stergiou
,
N.
,
2005
, “
A Nonlinear Dynamic Approach for Evaluating Postural control - New Directions for the Management of Sport-Related Cerebral Concussion
,”
Sports Med.
,
35
(
11
), pp.
935
950
.10.2165/00007256-200535110-00002
28.
Haddad
,
J. M.
,
Rietdyk
,
S.
,
Claxton
,
L. J.
, and
Huber
,
J. E.
,
2013
, “
Task-Dependent Postural Control Throughout the Lifespan
,”
Exercise Sport Sci. Rev.
,
41
(
2
), pp.
123
132
.10.1097/JES.0b013e3182877cc8
29.
Rhea
,
C. K.
,
Silver
,
T. A.
,
Hong
,
S. L.
,
Ryu
,
J. H.
,
Studenka
,
B. E.
,
Hughes
,
C. M. L.
, and
Haddad
,
J. M.
,
2011
, “
Noise and Complexity in Human Postural Control: Interpreting the Different Estimations of Entropy
,”
PloS One
,
6
(
3
), p.
e17696
.10.1371/journal.pone.0017696
30.
Haddad
,
J. M.
,
Van Emmerik
,
R. E. A.
,
Wheat
,
J. S.
, and
Hamill
,
J.
,
2008
, “
Developmental Changes in the Dynamical Structure of Postural Sway During a Precision Fitting Task
,”
Exp. Brain Res.
,
190
(
4
), pp.
431
441
.10.1007/s00221-008-1483-9
31.
Kinsella-Shaw
,
J. M.
,
Harrison
,
S. J.
,
Colon-Semenza
,
C.
, and
Turvey
,
M. T.
,
2006
, “
Effects of Visual Environment on Quiet Standing by Young and Old Adults
,”
J. Motor Behav.
,
38
(
4
), pp.
251
264
.10.3200/JMBR.38.4.251-264
32.
Schmit
,
J. M.
,
Riley
,
M. A.
,
Dalvi
,
A.
,
Sahay
,
A.
,
Shear
,
P. K.
,
Shockley
,
K. D.
, and
Pun
,
R. Y. K.
,
2006
, “
Deterministic Center of Pressure Patterns Characterize Postural Instability in Parkinson's Disease
,”
Exp. Brain Res.
,
168
(
3
), pp.
357
367
.10.1007/s00221-005-0094-y
33.
Chagdes
,
J. R.
,
Huber
,
J. E.
,
Saletta
,
M.
,
Darling-White
,
M.
,
Raman
,
A.
,
Rietdyk
,
S.
,
Zelaznik
,
H. N.
, and
Haddad
,
J. M.
,
2016
, “
The Relationship Between Intermittent Limit Cycles and Postural Instability Associated With Parkinson's Disease
,”
J. Sport Health Sci.
,
5
(
1
), pp.
14
24
.10.1016/j.jshs.2016.01.005
34.
Chagdes
,
J. R.
,
Rietdyk
,
S.
,
Haddad
,
J. M.
,
Zelaznik
,
H. N.
,
Cinelli
,
M. E.
,
Denomme
,
L. T.
,
Powers
,
K. C.
, and
Raman
,
A.
, Jr
,
2016
, “
Limit Cycle Oscillations in Standing Human Posture
,”
J. Biomech.
,
49
(
7
), pp.
1170
1179
.10.1016/j.jbiomech.2016.03.005
35.
Carlsson
,
G.
,
2009
, “
Topology and Data
,”
Bull. Am. Math. Soc.
,
46
(
2
), pp.
255
308
.10.1090/S0273-0979-09-01249-X
36.
Singh, G., Mémoli
,
F.
, and
Carlsson
,
G.
,
2007
, “
Topological Methods for the Analysis of High Dimensional Data Sets and 3D Object Recognition
,”
Eurographics Symposium on Point-Based Graphics
, Prague, Czech Republic, Sept. 2–3, pp.
91
100
.https://research.math.osu.edu/tgda/mapperPBG.pdf
37.
Lum
,
P. Y.
,
Singh
,
G.
,
Lehman
,
A.
,
Ishkanov
,
T.
,
Vejdemo-Johansson
,
M.
,
Alagappan
,
M.
,
Carlsson
,
J.
, and
Carlsson
,
G.
,
2013
, “
Extracting Insights From the Shape of Complex Data Using Topology
,”
Sci. Rep.
,
3
(
1
), p.
1236
.10.1038/srep01236
38.
Nicolau
,
M.
,
Levine
,
A. J.
, and
Carlsson
,
G.
,
2011
, “
Topology Based Data Analysis Identifies a Subgroup of Breast Cancers With a Unique Mutational Profile and Excellent Survival
,”
Proc. Natl. Acad. Sci.
,
108
(
17
), pp.
7265
7270
.10.1073/pnas.1102826108
39.
Saggar
,
M.
,
Sporns
,
O.
,
Gonzalez-Castillo
,
J.
,
Bandettini
,
P. A.
,
Carlsson
,
G.
,
Glover
,
G.
, and
Reiss
,
A. L.
,
2018
, “
Towards a New Approach to Reveal Dynamical Organization of the Brain Using Topological Data Analysis
,”
Nat. Commun.
,
9
(
1
), p.
1399
.10.1038/s41467-018-03664-4
40.
Li
,
L.
,
Cheng
,
W. Y.
,
Glicksberg
,
B. S.
,
Gottesman
,
O.
,
Tamler
,
R.
,
Chen
,
R.
,
Bottinger
,
E. P.
, and
Dudley
,
J. T.
,
2015
, “
Identification of Type 2 Diabetes Subgroups Through Topological Analysis of Patient Similarity
,”
Sci. Transl. Med.
,
7
(
311
), p.
311ra174
.10.1126/scitranslmed.aaa9364
41.
The Mathworks, Inc.
,
2018
,
MATLAB Version 9.5.0.944444 (R2018b)
,
The Mathworks, Massachusetts
,
Natick
.
42.
Winter
,
D. A.
,
2009
,
Biomechanics and Motor Control of Human Movement
, 4th ed., Wiley, New York.
43.
Cavanaugh
,
J. T.
,
Guskiewicz
,
K. M.
,
Giuliani
,
C.
,
Marshall
,
S.
,
Mercer
,
V. S.
, and
Stergiou
,
N.
,
2006
, “
Recovery of Postural Control After Cerebral Concussion: New Insights Using Approximate Entropy
,”
J. Athletic Training
,
41
(
3
), pp.
305
313
.
44.
Richman
,
J. S.
, and
Moorman
,
J. R.
,
2000
, “
Physiological Time-Series Analysis Using Approximate Entropy and Sample Entropy
,”
Am. J. Physiol. Heart Circ. Physiol.
,
278
(
6
), pp.
H2039
H2049
.10.1152/ajpheart.2000.278.6.H2039
45.
Ramdani
,
S.
,
Seigle
,
B.
,
Lagarde
,
J.
,
Bouchara
,
F.
, and
Bernard
,
P. L.
,
2009
, “
On the Use of Sample Entropy to Analyze Human Postural Sway Data
,”
Med. Eng. Phys.
,
31
(
8
), pp.
1023
1031
.10.1016/j.medengphy.2009.06.004
46.
Perea
,
J.
, and
Harer
,
J.
,
2013
, “
Sliding Windows and Persistence: An Application of Topological Methods to Signal Analysis
,”
Found. Comput. Math.
,
15
, pp.
799
838
.10.1007/s10208-014-9206-z
47.
Loram
,
I. D.
,
Gawthrop
,
P. J.
, and
Lakie
,
M.
,
2006
, “
The Frequency of Human, Manual Adjustments in Balancing an Inverted Pendulum is Constrained by Intrinsic Physiological Factors
,”
J. Physiol.
,
577
(
Pt.  1
), pp.
417
432
.10.1113/jphysiol.2006.118786
48.
Alexandroff
,
P.
,
1928
, “
Über Den Allgemeinen Dimensionsbegriff Und Seine Beziehungen Zur Elementaren Geometrischen Anschauung
,”
Math. Ann.
,
98
(
1
), pp.
617
635
.10.1007/BF01451612
49.
Chazal
,
F.
, and
Michel
,
B.
,
2017
, “
An Introduction to Topological Data Analysis: Fundamental and Practical Aspects for Data Scientists
,” arXiv: 1710.04019.
50.
Winter
,
D. A.
,
Patla
,
A. E.
,
Prince
,
F.
,
Ishac
,
M.
, and
Gielo-Perczak
,
K.
,
1998
, “
Stiffness Control of Balance in Quiet Standing
,”
J. Neurophysiol.
,
80
(
3
), pp.
1211
1221
.10.1152/jn.1998.80.3.1211
51.
Brown
,
K.
,
Doran
,
D.
,
Kramer
,
R.
, and
Reynolds
,
B.
,
2018
, “
HELOC Applicant Risk Performance Evaluation by Topological Hierarchical Decomposition
,” arXiv:1811.10658.
You do not currently have access to this content.