Differences between trunk sway characteristics on a foam support surface and on the Equitest® ankle-sway-referenced support surface

Clinicians have sought ways to increase trunk sway so that it is easily observed and a balance deficit more easily identified. One technique often used for this purpose is to reduce the efficacy of ankle proprioceptive inputs on sway. To achieve this reduction either a foam mat is used as an unstable support surface or the subject stands on a surface made unstable with servo-driven ankle-sway-referencing. The purpose of the current study was to investigate differences in trunk pitch and roll sway characteristics using these techniques. Trunk sway while standing quietly on two legs was measured in 25 normal subjects in the age range 20–35 years for three support-surface conditions. Each condition was tested twice for 20 s, once with eyes open and once with eyes closed. The three conditions were standing on a foam support surface, standing on a support surface with pitch (fore-aft) ankle-sway-referencing as used for the standard Sensory Organization Test (SOT) of the Neurocom Equitest System (SOT 4 and 5), and standing with roll (lateral) ankle-sway-referencing. The latter was achieved by having the subjects stand turned 90° to the standard SOT position. Two angular velocity sensors mounted on a belt measured trunk sway in the pitch and roll directions. Trunk roll angle and angular velocity amplitudes for pitch sway-referencing were reduced compared to either the foam or roll sway-referencing conditions, but trunk pitch angle and angular velocities amplitudes were greater. For roll sway-referencing, the trunk roll angle was greater than for the other stimulus conditions. Analyses of the trunk sway velocity in the frequency domain indicated that ankle-sway-referencing in the pitch direction increased trunk pitch sway at 1 Hz and decreased trunk roll sway between 2 and 5 Hz compared to foam support frequency spectra. Roll ankle-sway-referencing decreased trunk roll between 2 and 4 Hz only. These results indicate that using a foam support surface provides multidirectional trunk sway with velocity content across all frequencies in the range 0.8–5.2 Hz. Roll ankle-sway-referencing, but not pitch ankle-sway-referencing, yields trunk sway with similar characteristics to those with foam. Pitch ankle-sway-referencing forces pitch trunk resonance to be around 1 Hz and yields very different trunk sway from that obtained with a foam support surface. Roll sway-referencing is an alternative means to test multidirectional control of sway. Clinically though, foam is simpler to use and provides a more difficult balance task for the patient.