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Changes in postural balance associated with a woman's aging process
Guilherme Carlos Brecha,b,
Corresponding author
guibrech@gmail.com

Corresponding author.
, Tatiana Godoy Bobbioc,d, Kelem de Negreiros Cabralb, Patrícia Mota Coutinhoa, Leila Regina de Castroa, Luis Mochizukib, Jose Maria Soares-Juniore, Edmund Chada Baracate, Luiz Eugênio Garcez Lemeb, Julia Maria D'Andréa Greveb, Angélica Castilho Alonsoa,b
a Graduate Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil
b Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
c Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
d University of St. Augustine for Health Sciences, Miami Campus, United States of America
e Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Introduction</span><p id="para0010" class="elsevierStylePara elsevierViewall">Aging does not necessarily mean disability&#59; however&#44; it increases the risk of injury&#44; especially those resulting from falls&#46; Falling is defined as an unexpected and abrupt event&#44; which is often due to the loss of balance and the postural control failure mechanisms&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">Cox et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> report that&#160;9&#46;7&#37; of emergency hospitals visits are due to falls&#46; Falls in the elderly accounted for&#160;32&#46;6&#37; of domestic accidents&#44; and they are associated with a deficiency of postural balance&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Falls are the common cause of major disability in the elderly&#46; Secondary consequences include traumatic brain injuries&#44; fractures&#44; and chronic disease as strokes&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">Women are more vulnerable to falls because they have a decline in bone mass is&#160;0&#46;5&#37;&#160;per year after the age of&#160;40&#44; and is more accentuated&#44; around&#160;3&#37;&#160;per year&#44; after menopause&#44; caused by the end of estrogen production by the ovaries&#44; combined with muscle weakness and decreased amplitude of movement in lower limbs&#44; capable of causing stumbling and loss of postural balance&#46; Insufficiency or deficiency of vitamin&#160;D can be associated with muscle hypotrophy and may increase the risk of falls&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0013" class="elsevierStylePara elsevierViewall">Postural balance is the capacity of maintaining the center of gravity within the base of support&#44; which is important for the efficient and safe execution of the Activities of the Daily Living &#40;ADL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> The preservation of balance contributes to the functional independence of the elderly people and to prevention of falls helping to maintain the functional capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0014" class="elsevierStylePara elsevierViewall">Age-related declines influence postural control mechanisms related to stability and function&#46; Stability is related to physiological and biomechanical changes such as sarcopenia&#44; resulting in reduced strength&#44; loss of flexibility&#44; mobility and&#44; consequently&#44; worsening of postural balance&#46; On the other hand&#44; the decline in function related to age and body morphology changes necessitate the use of different muscular combinations in support of postural goals&#59; these self-organizing coordinative synergies provide optimized combinations of muscle activation to help maintain postural balance during the life&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0015" class="elsevierStylePara elsevierViewall">Furthermore&#44; visual impairments and decline in somatosensory integration exacerbate postural stability&#44;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> and the postural balance<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> is aggravated by worsening of the visual and somatosensory system integration&#44; which can increase the risk of falls in the elderly&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a></p><p id="para0016" class="elsevierStylePara elsevierViewall">Postural control in the human body is controlled by neuromuscular responses&#44; which are essential in maintaining postural balance&#46; These responses come from the nervous&#44; sensorial&#44; and motor systems&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> The adaptive responses in the elderly are slower&#44; which causes greater postural oscillations and&#44; consequently&#44; a greater number of falls&#44; given to these intrinsic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> There is a decreased ability to adapt to an external stimulus&#44; which leads to progressive loss of physical performance and greater vulnerability&#46;<a class="elsevierStyleCrossRefs" href="#bib0013"><span class="elsevierStyleSup">13-15</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">Posturography &#40;static postural balance evaluation&#41; is being used as a tool to quantify this decline throughout life&#44; and it can be helpful in the creation and implementation of fall prevention programs&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0018" class="elsevierStylePara elsevierViewall">Adaptive mechanisms become less efficient over the years&#44; and in this study it was verified that the aging process increases the postural oscillations&#44; with the consequent worsening of postural balance&#46;</p><p id="para0019" class="elsevierStylePara elsevierViewall">The aim of the study was to evaluate the effect of aging on the static balance in women from&#160;50-years to&#160;89-years of age&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Study location and ethical issues</span><p id="para0020" class="elsevierStylePara elsevierViewall">This was a cross-sectional study performed at the Motion Study Laboratory of the Institute of Orthopedics and Traumatology&#44; Hospital das Clinics&#44; Faculty of Medicine&#44; University of S&#227;o Paulo&#46; All participants gave their written informed consent to participate in this study&#44; which was approved by the Ethics Committee at the Faculty of Medicine&#44; University of S&#227;o Paulo &#40;registration number&#160;320&#47;09&#41;&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Participants</span><p id="para0021" class="elsevierStylePara elsevierViewall">This is a convenience sample size of&#160;400&#160;women&#46; The inclusion criteria for this study were&#58; a&#41;&#160;Women aged&#160;50 and over&#44; b&#41;&#160;Participant report of absence of vestibular&#44; proprioceptive&#44; auditory&#44; or neurological impairment&#44; and&#47;or any mental disturbances or disorders&#59; c&#41;&#160;Participant report of no use of medications that might compromise postural balance&#59; d&#41;&#160;Participant report of absence of lesions&#44; surgery&#44; or disease that might have caused lower-limb joint limitations over the previous six months&#59; e&#41;&#160;Assessed absence of lower-limb dysmetria&#59; and f&#41;&#160;Assessed clinically normal gait&#44; without claudication&#59; g&#41;&#160;Assessed by a validated quiz of physical activity&#44; only include the participants with irregularly active&#58; women who engage in physical activities less than&#160;150&#160;minutes per week&#59; Participants were excluded if there was a presence of pain or inability to complete any of the tests&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Assessments</span><p id="para0022" class="elsevierStylePara elsevierViewall">Older adults were evaluated and screened in the Motion Study Laboratory of the Institute of Orthopedics and Traumatology&#44; Hospital das Clinics&#44; University of S&#227;o Paulo School of Medicine&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">All the research participants answered a questionnaire with demographic and anthropometric data prior to the assessment&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">The postural balance assessment &#40;posturography&#41; was performed on a portable force platform &#40;AccuSway Plus&#44; AMTI&#174;&#44; MA&#44; USA&#41;&#46; For data acquisition&#44; the force platform was connected to a signal-amplifying interface box &#40;AMTI Accus gait PJB&#160;101&#44; Watertown&#44; MA&#41; that was linked to a computer by means of an RS-232&#160;cable&#46; The data were gathered and stored using Balance Clinic&#174; software&#44; configured to a frequency of&#160;100&#160;Hz with a fourth-order Butterworth filter and a cutoff frequency of&#160;10&#160;Hz&#46; All subjects underwent the test with standardized positioning in relation to the maximum width of the support base &#40;smaller than hip-width&#41;&#44; with arms along the body and the head looking straight at a target&#46; The base of support was drawn on a paper on a fixed position on the force platform&#44; corresponding to the anatomical points of the distal hallux phalanx&#44; fifth metatarsal head&#44; lateral and medial malleolus for each foot&#46; Three measurements were made with Eyes Open &#40;EO&#41; and three with Eyes Closed &#40;EC&#41; for&#160;60&#160;seconds each&#44; without any randomization&#46; The arithmetic mean of the results was calculated from the three tests conducted under each condition and was processed using Balance Clinic&#174; software&#46; The parameters used to measure the subject&#39;s stability with eyes open and closed were the root mean square of the displacement from the COP in the medio-lateral and antero-posterior directions&#59; maximum range displacement of the COP &#40;sum of the maximum and minimum displacement&#47;amplitude&#41; antero-posterior and medio-lateral directions&#59; mean velocity calculated from the total displacement of the COP in all directions&#59; area of&#160;95&#37; from an ellipse of the total COP displacement&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Statistical analysis</span><p id="para0025" class="elsevierStylePara elsevierViewall">Data were analyzed in the GraphPad PRISM software &#40;GraphPad Software&#44; Inc&#46;&#41; presented by mean and standard deviation&#46; The data distribution was evaluated by the Kolmogorov Smirnov test&#44; followed by the single-factor ANOVA test with Bonferroni Post Hoc&#46; The significance level adopted was p&#8804;0&#46;05 for all statistical analyses&#46;</p></span></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Results</span><p id="para0026" class="elsevierStylePara elsevierViewall">The&#160;400&#160;women were grouped by age&#58; Group&#160;6<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;50&#160;to&#160;59&#41; &#8210; 58&#160;participants&#59; Group&#160;7<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;60&#160;to&#160;69&#41; &#8210; 214&#160;participants&#59; Group&#160;8<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;70&#160;to&#160;79&#41; &#8210; 92&#160;participants&#59; Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;80&#160;to&#160;89&#41; &#8210; 36&#160;participants&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">There was no difference in anthropometric characteristics &#40;body weight&#44; height&#44; and body mass index&#41; between the groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table&#160;1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0028" class="elsevierStylePara elsevierViewall">All posturography variables are related to the displacement of the Center of Pressure &#40;COP&#41; in the antero-posterior and medio-lateral directions&#46; The values of the postural instability assessment using the force platform are shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table&#160;2</a>&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Eyes open condition</span><p id="para0029" class="elsevierStylePara elsevierViewall">The medio-lateral displacement of the COP of Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade was higher compared to Groups&#160;6<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;009&#41; and 7<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;01&#41; decade&#46; The medio-lateral range of the COP of Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade was higher compared to Groups&#160;6<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;001&#41; and 7<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;003&#41;&#46; The Group&#160;8<span class="elsevierStyleSup">th</span>&#160;decade was higher compared to Group&#160;6<span class="elsevierStyleSup">th</span>&#160;&#40;p&#160;&#61;&#160;0&#46;05&#41; decade&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">The antero-posterior range displacement of the COP of Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade was higher when compared to Groups&#160;6<span class="elsevierStyleSup">th</span>&#160;decade &#40;p&#160;&#61;&#160;0&#46;04&#41;&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">Regarding the displacement velocity of the COP&#44; Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade showed higher values compared to Groups&#160;6<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;001&#41; and 7<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;002&#41;&#46; Also&#44; a significant difference in displacement velocity of the COP was also founded between Group&#160;8<span class="elsevierStyleSup">th</span> and Group&#160;6<span class="elsevierStyleSup">th</span> decade &#40;p&#160;&#61;&#160;0&#46;05&#41;&#46;</p><p id="para0032" class="elsevierStylePara elsevierViewall">There was no difference between age groups in a mean of&#160;95&#37; area of the ellipse displacement of COP and anteroposterior displacement of the COP &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46;&#160;1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Eyes closed condition</span><p id="para0033" class="elsevierStylePara elsevierViewall">The medio-lateral displacement of the COP in Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade was higher compared to&#160;6<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;003&#41; and 7<span class="elsevierStyleSup">th</span>&#160;&#40;p&#160;&#61;&#160;0&#46;006&#41; decades groups&#46; Also&#44; in the range&#44; medio-lateral displacement of the COP of Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade was higher when compared to&#160;6<span class="elsevierStyleSup">th</span> &#40;p&#160;&#61;&#160;0&#46;030&#41; decades groups&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">There was no difference between age groups in antero-posterior displacement and range&#44; medio-lateral range of the COP&#44; displacement velocity of the COP&#44; and a mean of&#160;95&#37; area of the ellipse displacement of COP&#46; Group&#160;8<span class="elsevierStyleSup">th</span>&#160;decades group did not present any difference between the other decades groups in all postural balance variables&#44; seen in <a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46;&#160;2</a>&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Discussion</span><p id="para0035" class="elsevierStylePara elsevierViewall">In this study&#44; it was verified that the aging process increases the postural oscillations&#44; with the consequent worsening of postural balance&#46; Variances between the groups are most evident in the elderly over&#160;80-years old due to greater deterioration of the postural control systems and the increased risk of falls&#46; Hartholt et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> reports an increase in the number of deaths of Dutch people aged&#160;80 and over due to falls&#58;&#160;391 in&#160;2000 and 2&#46;501 in&#160;2016&#46; The overall mortality rate per&#160;100&#46;000&#160;population increased from&#160;78&#46;1 &#40;95&#37;&#160;CI&#160;70&#46;4&#8210;85&#46;9&#41; in&#160;2000&#160;to&#160;334&#46;0 &#40;95&#37;&#160;CI&#160;320&#46;9&#8210;347&#46;1&#41; in&#160;2016&#46; The increase in the elderly population aged&#160;80-years and over shows that identifying the factors related to falls should be taken into account in setting priorities&#44; and the decline of postural balance may be the most important factor&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">Significant postural balance losses were seen from the&#160;9<span class="elsevierStyleSup">th</span>&#160;decade of life &#40;when compared to&#160;6<span class="elsevierStyleSup">th</span> and 7<span class="elsevierStyleSup">th</span>&#160;decades&#8217; groups&#46; The deterioration was observed in both evaluation conditions &#8211; eyes open and closed&#44; and in all variables&#46; Worsening of the postural balance is progressive and slow because the humans adapt themselves to the alterations of the senescence and try to maintain the correct postural responses to the physical and environmental demands&#46; However&#44; from the 9<span class="elsevierStyleSup">th</span>&#160;decade&#44; the organism can no longer maintain and activate the compensatory mechanisms&#44; and the deficiencies are more evident&#44; making it an aggravating circumstance of domestic falls&#44; which are usually associated with changing positions&#44; and engaging in tasks of daily living&#46; Garcia et&#160;al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> in&#160;2006 reported a&#160;50&#37;&#160;increase in falls among the elderly with&#160;80-years or more when compared to the age group of&#160;65&#160;to&#160;79&#160;years&#46; No studies showed the decline of postural balance comparing decades&#44; however&#44; some studies suggest a strong association between age and postural balance decrease&#46;<a class="elsevierStyleCrossRefs" href="#bib0022"><span class="elsevierStyleSup">22-24</span></a></p><p id="para0037" class="elsevierStylePara elsevierViewall">With eyes open&#44; many variables of displacement and velocity were greater in&#160;9<span class="elsevierStyleSup">th&#8722;</span>decade group compared to younger groups &#40;6<span class="elsevierStyleSup">th</span> and 7<span class="elsevierStyleSup">th</span>&#160;decades groups&#41;&#46; With eyes closed&#44; only medio-lateral displacement and range were greater in&#160;9<span class="elsevierStyleSup">th</span>&#160;decade group compared to&#160;6<span class="elsevierStyleSup">th</span> and 7<span class="elsevierStyleSup">th</span>&#160;decades&#44; which were the youngest groups&#46; Possibly&#44; the differences seen in the evaluations with eyes closed occurred due to the fact that this condition was more challenging&#44; by withdrawing visual control and medio-lateral sway is predictive of falls among elderly people&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Occlusion of vision may make possible deficiencies in other balance control systems more evident&#44; such as vestibular and sensorimotor systems&#46; It was observed that the mean and standard deviation were higher in all groups in the EC evaluation when compared to EO&#46;</p><p id="para0038" class="elsevierStylePara elsevierViewall">Another possible explanation for the antero-posterior postural balance preservation are strategies used by the body to maintain stability&#46; The control of antero-posterior balance is controlled by muscular responses that occur from distal to proximal strategies and initiate from the ankles to the trunk&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Strategies for maintaining medio-lateral stability occur mainly at the hip and trunk&#44; and less occurs at the ankle joint&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> The main medio-lateral movement of the body is a lateral movement from the pelvis with adduction of one leg and abduction of the other one&#46; The movement from the ankle is only used in narrow places&#44; which prevents the hip from moving&#46; In the medio-lateral slope&#44; the load displaced to one side is also assumed by the other&#46; The hip abductors &#40;gluteus medius and tensor fascia latae&#41; and hip adductors are activated in both lower extremities&#44; well before the ankle muscles&#46; When assessing subjects with eyes open&#44; Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade showed greater oscillation in many the measured variables&#46; With the occlusion of vision&#44; the oscillations increased&#44; but the differences between 9<span class="elsevierStyleSup">th</span>&#160;decade group in medio-lateral discpalecement and the range to&#160;6<span class="elsevierStyleSup">th</span> and 7<span class="elsevierStyleSup">th</span>&#160;decade groups remained the same&#46; Tomomitsu et&#160;al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> reported that with the occlusion of vision&#44; there is a greater demand for the adjustment of the sensorimotor system in order to maintain the balance&#44; even in stable semi-static and non-challenging situations&#46;</p><p id="para0039" class="elsevierStylePara elsevierViewall">Melzer et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> have shown that increased COP displacement in the medio-lateral plane is associated with recurrent falls&#46; The eyes closed condition seems to be considered the best predictor for recurrent falls&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p><p id="para0040" class="elsevierStylePara elsevierViewall">The multifactorial aspects of balance and the use of static posturography appear to be the limiting factors in this study&#46; However&#44; the posturography has been shown to be a good tool to identify decline in balance as people age&#44; data were consistent with Fujita et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a></p><p id="para0041" class="elsevierStylePara elsevierViewall">Balance maintenance is an acquired motor skill that improves with fitness throughout life&#46; Maintenance of postural control can be learned by individuals&#44; however&#44; the adaptive mechanisms become less efficient over the years&#44; particularly after the age of&#160;80&#46; The projected increase of population aging is accelerated&#44; and it will bring many elderly people over&#160;80-years&#46; Fall prevention programs with strategies to improve postural stability and balance will be essential to maintain the functional capacity and quality of life of that population&#46;</p><p id="para0042" class="elsevierStylePara elsevierViewall">Posturography showed a decline in postural balance with advancing age&#44; suggesting that the&#160;9<span class="elsevierStyleSup">th</span>&#160;decade of life is a borderline age to this detriment due to an increase in postural instability&#46;</p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Authors&#8217; contributions</span><p id="para0043" class="elsevierStylePara elsevierViewall">Guilherme Carlos Brech&#58; Investigation and Writing-original draft and Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0044" class="elsevierStylePara elsevierViewall">Tatiana Godoy Bobbio&#58; Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0045" class="elsevierStylePara elsevierViewall">Kelem de Negreiros Cabral&#58; Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0046" class="elsevierStylePara elsevierViewall">Patr&#237;cia Mota Coutinho&#58; Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0047" class="elsevierStylePara elsevierViewall">Leila Regina de Castro&#58; Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0048" class="elsevierStylePara elsevierViewall">Luis Mochizuki&#58; Formal analysis and Writing-review &#38; editing&#46;</p><p id="para0049" class="elsevierStylePara elsevierViewall">Jose Maria Soares-Junior&#58; Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0050" class="elsevierStylePara elsevierViewall">Edmund Chada Baracat&#58; Supporting Investigation and Writing-review &#38; editing&#46;</p><p id="para0051" class="elsevierStylePara elsevierViewall">Luiz Eug&#234;nio Garcez Leme&#58; Supervisor and Writing-review &#38; editing&#46;</p><p id="para0052" class="elsevierStylePara elsevierViewall">Julia Maria D&#39;Andr&#233;a Greve&#58; Supervisor and Writing-review &#38; editing&#46;</p><p id="para0053" class="elsevierStylePara elsevierViewall">Ang&#233;lica Castilho Alonso&#58; Formal analysis and Writing-review &#38; editing&#46;</p></span></span>"
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      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara007" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">Aging process increases postural oscillations&#44; worsening the postural balance&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">Poor postural balance is more evident in the elderly over&#160;80-years old&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">Deterioration of the postural control systems and the increased risk of falls&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0004"><span class="elsevierStyleLabel">&#8226;</span><p id="para0004" class="elsevierStylePara elsevierViewall">Important identify factors related to falls and postural balance&#46;</p></li></ul></p></span>"
    ]
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Context</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Aging causes a progressive worsening in postural balance&#44; affecting functional independence and increasing the risk of falls&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Objective</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">The aim of the study was to evaluate the effect of aging on the static balance in women from&#160;50-years to&#160;89-years of age&#46;</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Design</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study&#44; with&#160;400&#160;irregularly active women were evaluated and grouped by age&#58; Group&#160;6<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;50&#160;to&#160;59&#41; &#8210; 58&#160;participants&#59; Group&#160;7<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;60&#160;to&#160;69&#41; &#8210; 214&#160;participants&#59; Group&#160;8<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;70&#160;to&#160;79&#41; &#8210; 92&#160;participants&#59; Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade &#40;age&#160;80&#160;to&#160;89&#41; &#8210; 36&#160;participants&#46; Postural balance was evaluated using a portable force platform in a standard standing position&#44; with Eyes Open &#40;EO&#41; and Eyes Closed &#40;EC&#41;&#46;</p></span> <span id="abss0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Results</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">In the two measurement conditions&#44; the elderly women in Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade presented mediolateral displacement and range&#44; and mean velocity greater than the women&#39;s values in Groups&#160;6<span class="elsevierStyleSup">th</span>&#160;and&#160;7<span class="elsevierStyleSup">th</span>&#160;decade&#46; In the EO e EC situation&#44; the displacement was higher in the elderly Group&#160;9<span class="elsevierStyleSup">th</span>&#160;decade compared to younger groups&#46; Group&#160;8<span class="elsevierStyleSup">th</span>&#160;has a mean velocity greater than Group&#160;6<span class="elsevierStyleSup">th</span>&#160;decade in the EO situation&#46;</p></span> <span id="abss0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Conclusions</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">Posturography showed a decline in postural balance with advancing age&#44; suggesting that the&#160;9<span class="elsevierStyleSup">th</span>&#160;decade of life is a borderline age to this detriment due to an increase in postural instability&#46;</p></span>"
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Comparison of postural balance with eyes open between age groups&#46; &#40;A&#41; Latero-lateral COP displacement&#59; &#40;B&#41; Antero-posterior COP displacement&#59; &#40;C&#41; Mean velocity calculated from the total displacement of the COP in all directions&#59; &#40;D&#41; Range&#58; sum of the maximum and minimum displacement of the COP in latero-lateral direction&#59; &#40;E&#41; Range&#58; sum of the maximum and minimum displacement of the COP in anteroposterior direction&#59; &#40;F&#41; Area of&#160;95&#37; from an ellipse of the total COP displacement&#46; &#42;&#160;p-value &#8804;0&#46;05 ANOVA with Bonferroni Correction &#40;Pos hoc&#41;&#46;</p>"
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        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Postural balance comparison between age group with eyes closed&#46; &#40;A&#41; Latero-lateral COP displacement&#59; &#40;B&#41; Anteroposterior COP displacement&#59; &#40;C&#41; Mean velocity calculated from the total displacement of the COP in all directions&#59; &#40;D&#41; Range&#58; sum of the maximum and minimum displacement of the COP in latero-lateral direction&#59; &#40;E&#41; Range&#58; sum of the maximum and minimum displacement of the COP in anteroposterior direction&#59; &#40;F&#41; Area of&#160;95&#37; from an ellipse of the total COP displacement&#46; &#42;&#160;p-value&#160;&#8804;0&#46;05 ANOVA with Bonferroni Correction &#40;Pos-hoc&#41;&#46;</p>"
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          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Anova test and Bonferroni pos hoc&#46;</p><p id="spara005" class="elsevierStyleSimplePara elsevierViewall">p-value &#8804; 0&#46;05&#46;</p>"
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                  \t\t\t\t  " align="" valign="top" scope="col">Group&#160;6<span class="elsevierStyleSup">th</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top" scope="col">Group&#160;8<span class="elsevierStyleSup">th</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Group&#160;9<span class="elsevierStyleSup">th</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">50&#8210;59 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0008"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">60&#8210;69 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">70&#8210;79 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0010"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">80&#8210;89 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0012"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0013"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;214&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0014"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0015"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0017a"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0017"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">56&#46;8 &#40;&#177;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63&#46;8 &#40;&#177;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">73&#46;9 &#40;&#177;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">82&#46;6 &#40;&#177;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Body weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">69&#46;1 &#40;&#177;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">69&#46;1 &#40;&#177;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">154 &#40;&#177;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">155 &#40;&#177;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">155 &#40;&#177;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
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                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Anthropometrics characteristics by age groups &#40;decade&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0041"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Group&#160;7<span class="elsevierStyleSup">th</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0044"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Group&#160;8<span class="elsevierStyleSup">th</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0045"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Group&#160;9<span class="elsevierStyleSup">th</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">50&#8210;59 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0048"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">60&#8210;69 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0049"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">70&#8210;79 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">80&#8210;89 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0051"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0052"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0053"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;214&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0054"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0055"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#40;n&#160;&#61;&#160;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0056"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0057"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0058"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0059"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0060"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Eyes open</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0066"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Medio-lateral displacement &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;24 &#40;&#177;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;26 &#40;&#177;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;29 &#40;&#177;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;33 &#40;&#177;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Anteroposterior displacement &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;41 &#40;&#177;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;43 &#40;&#177;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;44 &#40;&#177;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;46 &#40;&#177;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0076"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Range medio-lateral &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;24 &#40;&#177;0&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;39 &#40;&#177;0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;55 &#40;&#177;0&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;83 &#40;&#177;0&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Antero-posterior range &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;09 &#40;&#177;0&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;29 &#40;&#177;0&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;40 &#40;&#177;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;61 &#40;&#177;0&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0086"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mean velocity &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;87 &#40;&#177;0&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;94 &#40;&#177;0&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;06 &#40;&#177;0&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;22 &#40;&#177;0&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Area 95&#37; &#40;cm&#178;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;89 &#40;&#177;1&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;06 &#40;&#177;1&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;41 &#40;&#177;1&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;90 &#40;&#177;2&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0096"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Eyes closed</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Medio-lateral displacement &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;25 &#40;&#177;0&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;26 &#40;&#177;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;28 &#40;&#177;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;35 &#40;&#177;0&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Anteroposterior displacement &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;44 &#40;&#177;0&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;48 &#40;&#177;0&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;46 &#40;&#177;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;49 &#40;&#177;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Medio-lateral range &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;39 &#40;&#177;0&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;53 &#40;&#177;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;66 &#40;&#177;1&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;86 &#40;&#177;0&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0116"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Range anteroposterior &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;48 &#40;&#177;0&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;85 &#40;&#177;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;82 &#40;&#177;1&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;80 &#40;&#177;1&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0121"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mean velocity &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;04 &#40;&#177;0&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;19 &#40;&#177;0&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;27 &#40;&#177;0&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;44 &#40;&#177;0&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0126"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Area 95&#37; &#40;cm&#178;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;16 &#40;&#177;1&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;42 &#40;&#177;1&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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ISSN: 18075932
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