title: Visual conflict and cognitive load modify postural responses to vibrotactile noise.
abstract: BACKGROUND
  Underlying the increased incidence of falls during multitasking is a reduced ability to detect or attend to the sensory information signaling postural instability. Adding noise to a biological system has been shown to enhance the detection and transmission of weakened or sub-threshold cutaneous signals. If stochastic resonance is to become an effective adjunct to rehabilitation, we need to determine whether vibrotactile noise can be effective when added to an environment presenting with other sensory noise.
  
  
  METHODS
  Sub-threshold vibration noise was applied for 30 sec at the soles of the feet in 21 healthy adults (20-29 yrs) between two 30-sec periods of no vibration. During the trials, subjects stood quietly with eyes closed or while viewing a visual scene that rotated in continuous upward pitch at 30 deg/sec. Subjects were also tested with these two visual conditions while performing a mental calculation task. It was hypothesized that sub-threshold vibration would increase regularity of postural sway, thereby improving postural stabilization during an attention demanding task but exerting less effect with multiple sensory demands. An ellipse fit to the covariance matrix revealed excursion of center of pressure (COP) and center of mass (COM) responses in the anterior-posterior and lateral planes. RMS values and approximate entropy of the COP and COM were calculated and statistically compared.
  
  
  RESULTS
  The addition of vibrotactile noise to the plantar surface during quiet stance with eyes closed reduced the area of the COM and COP responses, which then returned to pre-vibration levels after vibration was removed. Postural sway was generally increased with both visual field rotations and mental calculation compared to the eyes closed condition. The effect of sub-threshold vibratory noise on postural behavior was modified when visual field rotations and mental calculation was combined. It was shown that the measure of approximate entropy reflected increased task complexity.
  
  
  CONCLUSIONS
  Our results suggest that the impact of destabilizing signals is modulated when combined with vibrotactile stimulation. The strong aftereffects of the vibration stimulus suggest that the system has adapted to the sensory array even in the short time period tested here. The results imply that application of vibrotactile stimulation has the potential for diminishing sway magnitudes while increasing the potential for response variability, thereby presenting a non-invasive method of reducing the potential for falls.
authors.affiliation: Department of Physical Therapy, Temple University, 3307 N, Broad St,, 19140 Philadelphia, PA, USA. ekeshner@temple.edu.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Keshner
authors.forename: Jill C
authors.initials: JC
authors.lastname: Slaboda
authors.forename: Lois Lanaria
authors.initials: LL
authors.lastname: Day
authors.forename: Kurosh
authors.initials: K
authors.lastname: Darvish
mesh_terms: D000328:Adult; D001288:Attention; D006801:Humans; D010775:Photic Stimulation; D010812:Physical Stimulation / Q000379:methods*; D004856:Postural Balance / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D013850:Thinking; D014110:Touch; D014732:Vibration; D055815:Young Adult