title: Dynamic Balanced Reach: A Temporal and Spectral Analysis Across Increasing Performance Demands.
abstract: Standing balanced reach is a fundamental task involved in many activities of daily living that has not been well analyzed quantitatively to assess and characterize the multisegmental nature of the body's movements. We developed a dynamic balanced reach test (BRT) to analyze performance in this activity; in which a standing subject is required to maintain balance while reaching and pointing to a target disk moving across a large projection screen according to a sum-of-sines function. This tracking and balance task is made progressively more difficult by increasing the disk's overall excursion amplitude. Using kinematic and ground reaction force data from 32 young healthy subjects, we investigated how the motions of the tracking finger and whole-body center of mass (CoM) varied in response to the motion of the disk across five overall disk excursion amplitudes. Group representative performance statistics for the cohort revealed a monotonically increasing root mean squared (RMS) tracking error (RMSE) and RMS deviation (RMSD) between whole-body CoM (projected onto the ground plane) and the center of the base of support (BoS) with increasing amplitude (p < 0.03). Tracking and CoM response delays remained constant, however, at 0.5 s and 1.0 s, respectively. We also performed detailed spectral analyses of group-representative response data for each of the five overall excursion amplitudes. We derived empirical and analytical transfer functions between the motion of the disk and that of the tracking finger and CoM, computed tracking and CoM responses to a step input, and RMSE and RMSD as functions of disk frequency. We found that for frequencies less than 1.0 Hz, RMSE generally decreased, while RMSE normalized to disk motion amplitude generally increased. RMSD, on the other hand, decreased monotonically. These findings quantitatively characterize the amplitude- and frequency-dependent nature of young healthy tracking and balance in this task. The BRT is not subject to floor or ceiling effects, overcoming an important deficiency associated with most research and clinical instruments used to assess balance. This makes a comprehensive quantification of young healthy balance performance possible. The results of such analyses could be used in work space design and in fall-prevention instructional materials, for both the home and work place. Young healthy performance represents "exemplar" performance and can also be used as a reference against which to compare the performance of aging and other clinical populations at risk for falling.
authors.affiliation: Research and Development Service, VA Maryland Health Care Center, Baltimore VA Medical Center, Baltimore, MD 21201;Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201;Department of Physical Therapy & Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201 e-mail: mailto:jbarton@som.umaryland.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Barton
authors.affiliation: Research and Development Service, VA Maryland Health Care Center, Baltimore VA Medical Center, Baltimore, MD 21201;Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201 e-mail: vgraci@som.umaryland.edu.
authors.forename: Valentina
authors.initials: V
authors.lastname: Graci
authors.affiliation: Geriatric Research Education and Clinical Center, VA Maryland Health Care Center, Baltimore VA Medical Center, Baltimore, MD 21201;Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201 e-mail: cmacko@grecc.umaryland.edu.
authors.forename: Charlene
authors.initials: C
authors.lastname: Hafer-Macko
authors.affiliation: Geriatric Research Education and Clinical Center, VA Maryland Health Care Center, Baltimore VA Medical Center, Baltimore, MD 21201;Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201 e-mail: jsorkin@grecc.umaryland.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Sorkin
authors.affiliation: Geriatric Research Education and Clinical Center, VA Maryland Health Care Center, Baltimore VA Medical Center, Baltimore, MD 21201;Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201 e-mail: rmacko@grecc.umaryland.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: F Macko
mesh_terms: D000328:Adult; D001132:Arm / Q000502:physiology*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D009068:Movement / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology*; D011187:Posture / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology*