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What is actually happening inside the “cone of economy”: compensatory mechanisms during a dynamic balance test

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Abstract

Study design

A nonrandomized, prospective, concurrent control cohort study.

Objective

To further develop cone of economy (CoE) measurements by identifying compensatory mechanisms at the extremes of the CoE and comparing balance control strategies in a group of adult degenerative scoliosis (ADS) patients with non-scoliotic controls.

Summary of background data

The CoE concept was first proposed by Dubousset and is frequently referred to when assessing balance in spinal deformity patients. Recently, a method that quantifies the CoE of individual patients through 3D video kinematic and electromyography data was developed. However, this method lacks measurements that describe the motor control strategies utilized by spinal disorder patients to maintain balance.

Patient sample

Twenty ADS patients and 15 non-scoliotic controls.

Methods

All test subjects were fitted with a full body marker set. Each subject performed a series of functional balance tests (Romberg’s with eyes opened) while being recorded in a human motion capture system. Three-dimensional CoE dimensions, range of sway (RoS), overall sway and lower extremity and trunk range of motion (RoM) were measured and analyzed.

Results

Patients with ADS demonstrated greater overall sway and RoS in the sagittal and coronal planes compared to controls. Moreover, ADS patients presented with more hip flexion and trunk flexion at maximal points of sway and more ankle, knee, hip and trunk RoM when swaying in comparison with controls.

Conclusions

ADS patients have larger CoE dimensions and increased sway when compared to non-scoliotic controls. ADS patients rely on a hip balance control “strategy” and lower extremity RoM to maintain balance, which differed from control subjects. Unlike prior attempts to define compensatory mechanisms in ADS patients, the described technique utilizes dynamic, three-dimensional measurements to define what is occurring within the CoE. By expanding on prior CoE measurements, we were able to define a unique dynamic balance control strategy for each patient.

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References

  1. Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. The pediatric spine: principles and practice. Raven Press Ltd, New York

    Google Scholar 

  2. Haddas R, Lieberman I, Boah A, Arakal R, Belanger T, Ju KL (2019) Functional balance testing in cervical spondylotic myelopathy patients. Spine (Phila Pa 1976) 44:103–109. https://doi.org/10.1097/BRS.0000000000002768

    Article  Google Scholar 

  3. Haddas R, Lieberman I (2019) The change in sway and neuromuscular activity in adult degenerative scoliosis patients pre and post surgery compared with controls. Spine (Phila Pa 1976) 44(15):E899–E907. https://doi.org/10.1097/BRS.0000000000003009

    Article  Google Scholar 

  4. Haddas R, Lieberman IH (2018) A method to quantify the “cone of economy”. Eur Spine J 27:1178–1187. https://doi.org/10.1007/s00586-017-5321-2

    Article  PubMed  Google Scholar 

  5. Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Ono M, Homma T, Watanabe K (2017) Standing sagittal alignment of the whole axial skeleton with reference to the gravity line in humans. J Anat 230:619–630. https://doi.org/10.1111/joa.12586

    Article  PubMed  PubMed Central  Google Scholar 

  6. Barrey C, Roussouly P, Perrin G, Le Huec JC (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20(Suppl 5):626–633. https://doi.org/10.1007/s00586-011-1930-3

    Article  PubMed  PubMed Central  Google Scholar 

  7. Diebo BG, Ferrero E, Lafage R, Challier V, Liabaud B, Liu S, Vital JM, Errico TJ, Schwab FJ, Lafage V (2015) Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine 40:642–649

    Article  PubMed  Google Scholar 

  8. Diebo BG, Varghese JJ, Lafage R, Schwab FJ, Lafage V (2015) Sagittal alignment of the spine: what do you need to know? Clin Neurol Neurosurg 139:295–301

    Article  PubMed  Google Scholar 

  9. Yagi M, Ohne H, Kaneko S, Machida M, Yato Y, Asazuma T (2017) Does corrective spine surgery improve the standing balance in patients with adult spinal deformity? Spine J. https://doi.org/10.1016/j.spinee.2017.05.023

    Article  PubMed  Google Scholar 

  10. Barrey C, Roussouly P, Perrin G, Le Huec J-C (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20:626

    Article  PubMed  PubMed Central  Google Scholar 

  11. Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital J-M (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20:681

    Article  PubMed  PubMed Central  Google Scholar 

  12. Haddas R, Lieberman I, Boah A, Arakal R, Belanger T, Ju KL (2018) Functional balance testing in cervical spondylotic myelopathy patients. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002768

    Article  Google Scholar 

  13. Haddas R, Lieberman I, Block A, Derman P (2019) The effect of surgical decompression and fusion on functional balance in patients with degenerative lumbar spondylolisthesis. Spine. https://doi.org/10.1097/BRS.0000000000003436

    Article  PubMed  Google Scholar 

  14. Horak FB, Nashner LM (1986) Central programming of postural movements: adaptation to altered support-surface configurations. J Neurophysiol 55:1369–1381. https://doi.org/10.1152/jn.1986.55.6.1369

    Article  CAS  PubMed  Google Scholar 

  15. Bardy BG, Oullier O, Lagarde J, Stoffregen TA (2007) On perturbation and pattern coexistence in postural coordination dynamics. J Mot Behav 39:326–336. https://doi.org/10.3200/JMBR.39.4.326-336

    Article  PubMed  Google Scholar 

  16. Horak FB, Henry SM, Shumway-Cook A (1997) Postural perturbations: new insights for treatment of balance disorders. Phys Ther 77:517–533. https://doi.org/10.1093/ptj/77.5.517

    Article  CAS  PubMed  Google Scholar 

  17. Nashner LM, McCollum G (2010) The organization of human postural movements: a formal basis and experimental synthesis. Behavior Brain Sci 8:135. https://doi.org/10.1017/s0140525x00020008

    Article  Google Scholar 

  18. Blenkinsop GM, Pain MTG, Hiley MJ (2017) Balance control strategies during perturbed and unperturbed balance in standing and handstand. R Soc Open Sci 4:161018. https://doi.org/10.1098/rsos.161018

    Article  PubMed  PubMed Central  Google Scholar 

  19. O’Sullivan S, Schmitz T (2007) Physical rehabilitation. F.A. Davis Company, Philadelphia

    Google Scholar 

  20. Grivas TB, de Mauroy JC, Wood G, Rigo M, Hresko MT, Kotwicki T, Negrini S (2016) Brace Classification Study Group (BCSG): part one—definitions and atlas. Scoliosis Spinal Disord 11:43. https://doi.org/10.1186/s13013-016-0102-y

    Article  PubMed  Google Scholar 

  21. Savage JW, Patel AA (2014) Fixed sagittal plane imbalance. Glob Spine J 4:287–296. https://doi.org/10.1055/s-0034-1394126

    Article  Google Scholar 

  22. Mok NW, Brauer SG, Hodges PW (2004) Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine 29:E107–E112

    Article  PubMed  Google Scholar 

  23. Runge CF, Shupert CL, Horak FB, Zajac FE (1999) Ankle and hip postural strategies defined by joint torques. Gait Posture 10:161–170. https://doi.org/10.1016/s0966-6362(99)00032-6

    Article  CAS  PubMed  Google Scholar 

  24. Kuo AD, Zajac FE (1993) A biomechanical analysis of muscle strength as a limiting factor in standing posture. J Biomech 26:137–150. https://doi.org/10.1016/0021-9290(93)90085-s

    Article  PubMed  Google Scholar 

  25. Kuo AD (1995) An optimal control model for analyzing human postural balance. IEEE Trans Biomed Eng 42:87–101. https://doi.org/10.1109/10.362914

    Article  CAS  PubMed  Google Scholar 

  26. Gauchard GC, Vancon G, Meyer P, Mainard D, Perrin PP (2010) On the role of knee joint in balance control and postural strategies: effects of total knee replacement in elderly subjects with knee osteoarthritis. Gait Posture 32:155–160. https://doi.org/10.1016/j.gaitpost.2010.04.002

    Article  PubMed  Google Scholar 

  27. Shiba Y, Taneichi H, Inami S, Moridaira H, Takeuchi D, Nohara Y (2016) Dynamic global sagittal alignment evaluated by three-dimensional gait analysis in patients with degenerative lumbar kyphoscoliosis. Eur Spine J 25:2572–2579

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA

    Ram Haddas, Alexander Satin & Isador Lieberman

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  1. Ram Haddas
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  2. Alexander Satin
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  3. Isador Lieberman
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Correspondence to Ram Haddas.

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The authors states that there is no conflict of interest.

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The study was approved by the Western Institutional Review Board (IRB#: 20151780).

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Haddas, R., Satin, A. & Lieberman, I. What is actually happening inside the “cone of economy”: compensatory mechanisms during a dynamic balance test. Eur Spine J 29, 2319–2328 (2020). https://doi.org/10.1007/s00586-020-06411-w

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  • DOI: https://doi.org/10.1007/s00586-020-06411-w

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