Dynamic Posturographic Testing and Motor Learning Predictability in Gymnasts
Condition: Gymnastics Injury, Motor Learning, Balance
Study type: Interventional
Phase: Early Phase 1

Summary: 
      One aim of this study was to find if there was a difference between balance and stability
      between elite level gymnasts and non-gymnasts. Another aim was to find if there was a
      relationship between dynamic posturographic scores associated with sway fatigue or
      adaptability and the ability to learn new gymnastic routines. The ultimate aim of the study
      was to improve gymnastic performance while reducing the probability of injury.
    

Detailed description: 
      Computerized dynamic posturography outcomes will be obtained on elite level gymnasts and non
      gymnasts who will be age matched. The outcome measurement will be obtained using computerized
      dynamic posturography, a standard diagnostic test of balance function (41-46). The subject's
      balance was tested using a three-component force platform (CAPS test) under one sensory
      condition of the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), the eyes
      closed on perturbing surface condition. This condition was chosen as studies have shown it to
      be the single test that best correlates with balance impairment and falls. The stability
      score, already used in several studies by other authors will be used as the primary outcome
      measure in this research. It is defined as 1 minus the ratio between the measured sway during
      the test (computed as the major axis of a standard 95% confidence ellipse) and the amount of
      sway a normal subject of the same height as the one being tested should be able to sway
      before falling (also known as the theoretical maximum sway or the theoretical limit of
      stability, calculated using a regression formula based on the subject's height developed by
      NASA in 1962 and commonly used in all posturographic tests). For convenience, the stability
      score will be expressed as a percentage. Its definition makes it a convenient and easy to
      understand measure to use as a subject able to stand perfectly still with no sway will have a
      score of 100%, whereas one that sways as much as the limit of stability will have a score of
      0%. During each test, the subject's sway will be determined by the force platform and its
      related software. The CAPS three-component force platform uses 3 load cells arranged in a
      triangle to measure the distribution of the vertical ground reaction force on the platform.
      The analog load cell signals are amplified and simultaneously sampled by the platform
      electronics using three synchronized individual 24bit delta-sigma analog to digital
      converters sampling at 312kHz and decimating the samples to a data rate of 64Hz. The use of
      three A/D converters insures that the signals from the 3 load cells are acquired
      simultaneously with no timing error. The high sampling rate with the high decimation and low
      data rate of the sigma-delta converters eliminates aliasing and provides a resolution of
      about 4 parts per million. The digital load cell data was then sent via a USB connection to
      the PC where software uses a calibration matrix determined by the manufacturer to compute the
      total vertical force and the two horizontal moments acting on the platform. From these data,
      the software computed the point of application of the vertical force acting on the platform,
      commonly referred to as the Center of Pressure (CoP). The location of the CoP coincides in
      static conditions with the projection of the subject's Center of Mass (CoM) onto the
      platform, and its movement relates to the movements of the subject's CoM (sway). The
      determination of the actual sway will require the determination of the instantaneous location
      of the CoM via the location and inertial properties of each body segment of the specific
      subject being tested. The CAPS test, like all posturographic equipment, uses the movement of
      the CoP as an approximation of the sway. Because it is an approximation, and because for
      kinetic reasons the CoP moves more than the CoM, the 95% confidence interval of the CoP
      motion was considered. This will allow the CAPS software to compute the ellipse that
      represents the location of all of the sway samples collected during the test with 95%
      confidence. The major axis of this ellipse will represent the maximum sway of the subject in
      any direction during the test and it will be used to compute the stability score. To assess
      the accuracy and resolution of the measurement chain, calibrated weights of 75kg and 100kg
      will be positioned in the center of the force platform (as if it were a subject) and 20s
      acquisitions will be performed: the accuracy of the weight must be within the instrument's
      factory specifications (+-2N). Therefore the accuracy for the position claimed by the
      manufacturer of +-1mm for a weight of 75kg will be accepted as correct as it determination
      will require specialized equipment and software available only to the manufacturer. It should
      be noted that the overall accuracy of the position of the CoP given by the instrument will
      not be relevant in this study as the motion of the CoP determined the sway. The sway
      measurement error will be estimated considering the fact that during the test at both weights
      the dead weight must not move, but the measurement chain will indicate a "sway" of less then
      0.05mm (measurement noise), therefore the resolution of the measurement chain and the sway
      measurement error will be considered to be 0.05mm. To verify the repeatability of the
      measurement chain, the same type of tests will be repeated two times, obtaining similar
      results (within the specified accuracy and resolution). Given the sway measurement error, the
      measurement error in the stability score will be determined. From the definition of the
      stability score it is clear that the least the theoretical limit of stability, the more
      pronounced the effect of the sway measurement error is. As the theoretical limit of stability
      is computed by using the formula 0.55*height*2*sin(6.25°), the shorter the subject, the more
      the stability score is sensitive to the measurement errors. To estimate the stability score
      measurement error a subject's height of 1.6m will be considered. Such a subject will have a
      theoretical limit of stability of 191.6mm. For such a subject, a sway measurement error of
      0.05mm means a stability score measurement error of 0.05/191.6 or, if the score is expressed
      in percentage, of 0.026%. Thus, any changes in the stability score greater than that will be
      a consequence of the subject's sway and not of measurement errors. A CAPS dynamic
      posturography test in the eyes closed perturbed stance will be obtained on all subjects.
      Subjects will be instructed that they will stand on a foam platform and close their eyes
      while data will be obtained from a computerized force plate. The subjects will be given
      practice sessions so that they will be familiar with the test prior to the collection of
      data. The CAPS test occurs over 25 seconds. We will divide the degree of sway observed during
      the first half of the test and the second half of the test and will obtain ratios. Subjects
      whose sway will increase in the second half of the test in reference to the first half will
      be identified as demonstrating a fatigability ratio. Individuals who will demonstrate less
      sway in the second half of the test will be identified as demonstrating an adaptability ratio
      that we consider might be related to some type of motor learning. All gymnasts will be
      instructed in a novel gymnastic routine which will include a variety of inverted postures and
      ground routines unfamiliar to the subjects. The athletes will be allowed to practice the
      routine for one hour after which they will be asked to perform the routine in front of the
      same judge who will be blinded as to the outcome measures previously obtained. The
      performance scores will be then compared to the CDP measurements to ascertain if there would
      be any relationship.
    

Intervention name(s): Gymnastic Routine
Intervention type(s): Procedure
Intervention description(s): A combination of gymnastic movements are performed
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Gymnastics, Computerized Dynamic Posturography, Balance