Neuroscience Letters 585 (2015) 9297

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Neuroscience Letters
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Short communication

The effect of aging on the center-of-pressure power spectrum in

foam posturography
Chisato Fujimoto a, , Naoya Egami a , Shinichi Demura b , Tatsuya Yamasoba a ,
Shinichi Iwasaki a
a
Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
b
Graduate School of Natural Science & Technology, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, Japan

h i g h l i g h t s

We assess aging effect on center-of-pressure power spectrum in foam posturography.

Especially, the eyes open/foam rubber condition highlights age-related changes.
Age-related changes were found in not only older but early-middle-aged subjects.

a r t i c l e i n f o a b s t r a c t

Article history: To assess age-related frequency-domain characteristics of the sway of center of pressure (COP) in foam
Received 31 July 2014 posturography, two-legged stance tasks were performed by 163 controls in 4 conditions: eyes open with
Received in revised form and without foam rubber, and eyes closed with and without foam rubber. The areas under the curve
15 November 2014
(AUCs) of power spectral density of the COP were calculated across low frequency (0.02 Hz and <0.1 Hz,
Accepted 24 November 2014
Available online 26 November 2014
LF-AUC), middle frequency (0.1 Hz and <1 Hz, MF-AUC) and high frequency (1 Hz and <10 Hz, HF-AUC)
ranges. We categorized the controls into 7 age groups and analyzed each AUC in the 4 conditions. MF-
and HF-AUCs tended to show a difference between younger and older age-groups in all 4 conditions.
Keywords:
Aging Comparing the number of pairs in which a signicant difference was shown, the condition with foam
Posture rubber, especially with eyes open, tended to highlight age-related changes. In the medial-lateral axis
in the eyes open/foam rubber condition, the MF-AUC of the 75 years group was signicantly larger
than that of the 6574 years group, and the MF-AUC of the 6574 years group was signicantly higher
than that of the 5564 years group, although there were no signicant differences of MF-AUC among
age groups under 54 years. In this condition, although HF-AUC did not change in groups over 35 years
old, HF-AUC of each age group over 35 years old was signicantly larger than that of the group under
24 years old. This result suggests that, in the medial-lateral axis in the eyes open/foam rubber condition,
MF-AUC is specically affected by age in late-middle-aged (ages 5564) and older subjects, while HF-AUC
is specically affected by age in early-middle-aged (ages 3544) subjects.
2014 Published by Elsevier Ireland Ltd.

1. Introduction age-related changes in postural control is important due to the

Static postural control is maintained by the integration of
somatosensory, visual, and vestibular components in the central
nervous system, with outputs to the musculoskeletal system [14].
As age advances, the function of all components of the postu-
ral control system declines [11]. This loss of postural control in
the elderly can be a signicant cause of falls [16]. Identifying
Corresponding author. Tel.: +81 3 5800 8665; fax: +81 3 3814 9486.
E-mail address: cfujimoto-tky@umin.ac.jp (C. Fujimoto).
major effect of postural instability and falls on health in the elderly.
Posturography is used to evaluate static postural control. It mea-
sures the position of the center of pressure (COP) that is dened
as the point on the force plate surface through which the sub-
jects center of gravity passes. For the purpose of scrutinizing the
role of different sensory inputs on static postural control, dynamic
posturography using a moving platform or a foam rubber surface
has been devised to allow selective manipulation of vision and
somatosensation [6,18]. Our group recently reported the usefulness
of posturography using a foam rubber surface, i.e., foam posturogra-
phy, for assessing peripheral vestibulopathy, both in the acute and

http://dx.doi.org/10.1016/j.neulet.2014.11.033
0304-3940/ 2014 Published by Elsevier Ireland Ltd.
 C. Fujimoto et al. / Neuroscience Letters 585 (2015) 9297 93

the chronic stages [69]. This system is able to detect dysfunction
in both the superior and inferior vestibular nerve systems [8].
The incidence of falls increases with age, and falls in the elderly
have been linked not only to intrinsic but also to extrinsic risk fac-
tors [1]. Elderly subjects have more difculty controlling posture
than young subjects when visual and proprioceptive inputs are dis-
turbed [6,13,21]. Foam posturography has great potential as a tool
to detect age-related postural change, since it can manipulate both
visual and somatosensory inputs and mimic more severe extrinsic
circumstances for static postural control.
For the purpose of investigating postural control in greater
depth, power spectral analysis of COP sway has been performed
[4,19]. The analysis is a useful technique for quantifying overall
variability of COP sway as well as specic components associated
with pathological and/or physiological effects that cause balance
disorders. It has previously been shown that elderly subjects exhibit
a shift in the distribution of spectral power from higher to lower
frequencies in medial-lateral (ML) postural forces [15]. Power spec-
tral analyses of COP sway in foam posturography might have the
potential to identify a frequency domain that is sensitive to age-
related changes and provide an initial step towards fall prevention
and the development of medical interventions for postural decline
in the elderly.
The purpose of this study is to investigate aging effects revealed
by power spectral analysis of COP sway in foam posturography. We
divided subjects by age in ten-year increments and investigated the
difference in frequency-domain characteristics not only between
younger and older age groups but also between relatively close age
groups.
2. Material and methods
We enrolled 163 healthy control subjects (84 men, 79 women)
in the present study. All subjects were free from episodic vertigo/

AP,Eyes open AP,Eyes closed

1.2 1.6
1.4
1.0
1.2
0.8 1.0
0.6 0.8

LF-AU C (cm 2)
LF-AU C (cm 2)

0.6
0.4
0.4
0.2 0.2
0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

***
*** *
0.5 * 0.6 *
**
**
** 0.5
0.4
0.4
0.3
M F-AU C (cm 2 )

0.3
M F-AU C (cm 2 )

0.2
0.2
0.1 0.1

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

*** **
0.05 *** 0.12 *
* **
**
* 0.10
0.04 *
0.08
0.03
H F-AU C (cm 2)

0.06
H F-AU C (cm 2)

0.02
0.04
0.01 0.02

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

Fig. 1. Box plots of LF-, MF-, and HF-AUC of the AP axis in the condition without foam rubber in each age group. * = Signicant difference in nonparametric SteelDwass
method (*p < 0.05, **p < 0.01, ***p < 0.001).
94 C. Fujimoto et al. / Neuroscience Letters 585 (2015) 9297

dizziness or any obvious neurological or orthopedic disorders, and
had no medical history of a psychogenic disorder, head injury,
exposure to ototoxic drugs, diabetes mellitus, hypertension or
coronary artery disease. These subjects were the same as our pre-
vious report [5]. The mean age (standard deviation), height and
weight of the 163 healthy control subjects were 48.7 (22.5) years,
160.6 (11.9) cm and 59.4 (11.7) kg, respectively. The study was
approved by the regional ethical standards committee in the Fac-
ulty of Medicine at the University of Tokyo and the Kanazawa
University Department of Education. The study was conducted
according to the tenets of the Declaration of Helsinki, and informed
consent was obtained from each participant.
The detailed methods of foam posturography have been
described previously [5,6]. Briey, two-legged stance tasks were
performed under 4 conditions: eyes open or eyes closed, with or
without the foam rubber. The recording time was 60 s or until the
subject required assistance to prevent falling. We estimated the
power spectrum of the acceleration signal for the anterior-posterior
(AP) and the medial-lateral (ML) axis by using the maximum
entropy method, as we have previously reported [5]. Briey, the
area under the curves (AUCs) of power spectral density (PSD) of the
COP were calculated for each axis across three frequency ranges:
0.02 Hz and <0.1 Hz (low-frequency range, LF-AUC), 0.1 Hz and
<1 Hz (middle-frequency range, MF-AUC) and 1 Hz and <10 Hz
(high-frequency range, HF-AUC).
We categorized the healthy controls into 7 groups (24 years,
2534, 3544, 4554, 5564, 6574, and 75 years) and the non-
parametric SteelDwass method was performed for the AUC of each
frequency range of each axis in the above-mentioned 4 conditions
in order to calculate statistical signicances in pairs of multiple-
comparisons [2,20]. A signicant positive relationship was dened
as having a p-value less than 0.05 in the present study.

AP,Eyes open,Foam rubber AP,Eyes closed,Foam rubber

1.4 3.0
1.2 2.5
1.0
2.0
0.8
1.5
LF-AU C (cm 2)

LF-AU C (cm 2 )
0.6
1.0
0.4
0.2 0.5

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)
*** ***
*** ***
*** *
*** *
1.4 *** 2.5
*** ***
*** ***
1.2 *** **
*** 2.0 **
* *
1.0 *
*
0.8 1.5
M F-AU C (cm 2)

M F-AU C (cm 2 )

0.6 1.0
0.4
0.5
0.2
0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)
*** ***
*** **
0.12 ** 0.5 ***
*** ***
*** **
0.10 ** ***
*** 0.4 **
*
0.08
0.3
H F-AU C (cm 2)

H F-AU C (cm 2)

0.06
0.2
0.04

0.02 0.1

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

Fig. 2. Box plots of LF-, MF-, and HF-AUC of the AP axis in the condition with foam rubber in each age group. * = Signicant difference in nonparametric SteelDwass method
(*p < 0.05, **p < 0.01, ***p < 0.001).
 C. Fujimoto et al. / Neuroscience Letters 585 (2015) 9297 95

3. Results
The numbers of subjects in age groups of 24, 2534, 3544,
4554, 5564, 6574 and 75 years was 34, 19, 20, 17, 22, 27 and
24, respectively. No subjects required assistance to prevent falling
during upright posture for 60 s in the 4 conditions described above.
First, we assessed the frequency-domain characteristics of aging
by comparison of the AUC among each age group in the AP axis
(Figs. 1 and 2). For LF-AUC, there were no signicant differences in
any pairs of multiple-comparisons in any condition. On the other
hand, in multiple-comparisons of MF- AUC and HF-AUC among each
age group, older age groups showed signicantly larger AUCs in
comparison with younger age groups in each condition. Compar-
ing the number of pairs in which a signicant difference was shown,
the condition with foam rubber, especially with eyes open, tended
to highlight age-related changes in comparison with the condition
without foam rubber. An aging effect in the older age groups was
apparent in the AP axis: the value of 75 years group was signi-
cantly larger than that of 6574 years group though only in MF-AUC
in eyes open/foam rubber condition.
We then assessed the frequency-domain characteristics of aging
by comparison of the AUC among each age group in the ML axis
(Figs. 3 and 4). For LF-AUC, only in the condition with eyes closed
without foam rubber, was the value of the 75 years group sig-
nicantly larger than younger age groups. On the other hand, in
multiple-comparisons of MF-AUC and HF-AUC among each age
group, older age groups showed larger AUCs in comparison with
younger age groups in each condition. Comparing the number of
pairs in which a signicant difference was shown, the condition
with foam rubber, especially with eyes open, tended to generate
age-related changes in comparison with conditions without foam
rubber. This tendency in the ML axis was similar to that found in
the AP axis. In the eyes open/foam rubber condition, the MF-AUC of
the 75 years group was signicantly larger than that of the 6574

ML, Eyes open ML, Eyes closed

1.0 1.2 *
*
0.8 1.0

0.8
0.6
LF-AU C (cm 2) 0.6
LF-AU C (cm 2)

0.4
0.4
0.2 0.2

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

***
0.4 *** 0.8
** *
*
**
*
0.3 0.6
M F-AU C (cm 2 )
M F-AU C (cm 2 )

0.2 0.4

0.1 0.2

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

0.05 ** 0.20 ***

** **
*
0.04
0.15
0.03
0.10
H F-AU C (cm 2)
H F-AU C (cm 2)

0.02
0.05
0.01

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

Fig. 3. Box plots of LF-, MF-, and HF-AUC of the ML axis in the condition without foam rubber in each age group. * = Signicant difference in nonparametric SteelDwass
method (*p < 0.05, **p < 0.01, ***p < 0.001).
96 C. Fujimoto et al. / Neuroscience Letters 585 (2015) 9297

ML, Eyes open, Foam rubber ML, Eyes closed, Foam r ubber
0.8 1.2

1.0
0.6
0.8

0.4 0.6
LF-AU C (cm 2)

LF-AU C (cm 2 )
0.4
0.2
0.2

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

*** **
*** **
*** *
*** **
1.2 *** 2.5 *
** *
1.0 ***
*** 2.0
**
*
0.8
1.5
M F-AU C (cm 2)

M F-AU C (cm 2 )
0.6
1.0
0.4

0.2 0.5

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)
***
*** *
0.08 * 0.25 ***
** *
* *
* 0.20
0.06
0.15
H F-AU C (cm 2)

0.04
H F-AU C (cm 2)

0.10
0.02
0.05

0 0
-24 25- 35- 45- 55- 65- 75- -24 25- 35- 45- 55- 65- 75-
34 44 54 64 74 34 44 54 64 74
Age (years) Age (years)

Fig. 4. Box plots of LF-, MF-, and HF-AUC of the AP axis in the condition with foam rubber in each age group. * = Signicant difference in nonparametric SteelDwass method
(*p < 0.05, **p < 0.01, ***p < 0.001).

years group and the MF-AUC of the 6574 years group was signi-
cantly higher than that of the 5564 years group, On the other hand,
there were no signicant differences of MF-AUC among age groups
under 54 years.
MF-AUC of the ML axis in the eyes open/foam rubber condition
was specically inuenced by an aging effect on static postural con-
trol in late-middle-aged (ages 5564) and older subjects. In the eyes
open/foam rubber condition, although HF-AUC did not change over
35 years old, HF-AUC of each age group over 35 years old was sig-
nicantly larger than that of the <24 years age group, suggesting
that HF-AUC in the ML axis in this condition was specically inu-
enced by changes in static postural control in the early-middle-age
period (ages 3544).
4. Discussion
For LF-AUC in both the AP and ML axes, there were no signif-
icant differences in pairs in each condition between the younger
and older age groups. On the other hand, for MF-AUC and HF-AUC
in both axes, older age groups showed signicantly larger AUCs in
comparison with younger age groups in each condition. The anal-
yses demonstrated that disturbance of somatosensory inputs by
using foam rubber tended to generate a difference in MF-AUC and
HF-AUC between younger and older age group. An aging effect on
postural stability could mainly be seen in the frequency component
above 0.1 Hz as a result of disturbance to the somatosensory inputs.
In both the AP and ML axis, the value of the 75 years group was
signicantly larger than that of the 6574 years group in MF-AUC
only in the eyes open/foam rubber condition. Additionally, only in
the ML axis in the eyes open/foam rubber condition, was the MF-
AUC of the 6574 years group signicantly higher than that of the
5564 years group, while there were no signicant differences of
MF-AUC among age groups under 54 years. Therefore, it appears
that MF-AUC of the ML axis in the eyes open/foam rubber condi-
tion was specically inuenced by an aging effect on static postural
control in late-middle-age and older subjects. On the other hand,
in the eyes closed/foam rubber condition, no obvious differences
in the AUC were found among the 5564 years group, 6574 years
group and 75 years group. The eyes closed/foam rubber condi-
tion causes not only a degradation of somatosensory input but also
 C. Fujimoto et al. / Neuroscience Letters 585 (2015) 9297
an absence of visual input and makes the value of MF-AUCs larger
[5]. This condition may be too physically demanding to generate a
difference in postural instability among late-middle-age and older
groups.
For the ML axis in the eyes open/foam rubber condition, HF-AUC
increased up to 35 years old but remained unchanged over 35 years
old, suggesting that HF-AUC of the ML axis in the eyes open/foam
rubber condition was specically inuenced by an aging effect on
static postural control in the early-middle-age period. So far, little
is known about the change in postural control in the early-middle-
age period. It has been previously reported that the differences
in balance control between subjects belonging to different age
categories were already apparent among young and middle-aged
subjects, although these differences were small and only detected
by the more accurate force platform measurements [3]. The age-
specic HF-AUC change in the eyes open/foam rubber condition in
the early-middle-age period might be related to an early change in
plantar cutaneous sensation.
In the ML axis, both MF-AUC, and HF-AUC were specically inu-
enced by an aging effect in the eyes open/foam rubber condition:
MF-AUC in late-middle-aged and older subjects, HF-AUC in early-
middle-aged subjects. The characteristic difference between the AP
and ML axes in the frequency of COP sway during aging has been
reported previously [15]. The study showed that elderly subjects
exhibited a shift in the distribution of spectral power from higher
(>0.5 Hz) to lower frequencies (<0.5 Hz) only in the ML axis in the
eyes open condition. It is not known what causes the characteristic
age-related differences frequency between the axes. A possible rea-
son could be different movement strategies between the two axes
in order to maintain stability. For the ML axis, it has been proposed
that the hip strategy is commonly used in response to perturba-
tions designed to disrupt balance [12,17]. On the other hand, for
the AP axis, the main movement strategy in response to perturba-
tions is the ankle strategy, although the hip strategy is also used
[10]. Therefore, the selection of the control strategy may reect the
age-related difference between the two axes.
5. Conclusions
We assessed age-related frequency-domain characteristics of
the sway of COP in foam posturography, The condition with foam
rubber, especially with eyes open, tended to highlight age-related
changes. In the ML axis in the eyes open/foam rubber condition,
MF-AUC is specically affected by age in late-middle-aged and
older subjects, while HF-AUC is specically affected by age in early-
middle-aged subjects. This study claried age-related changes in
the frequency-domain characteristics of postural control on pos-
tural control in two-legged stance tasks. The result may be helpful
for development of research related to fall prevention and medical
interventions for the postural instability in the elderly.
Conict of interest
The authors declare that they have no competing interests.
97
References
[1] A. Bueno-Cavanillas, F. Padilla-Ruiz, J.J. Jimenez-Moleon, C.A. Peinado-Alonso,
R. Galvez-Vargas, Risk factors in falls among the elderly according to extrinsic
and intrinsic precipitating causes, Eur. J. Epidemiol. 16 (2000) 849859.
[2] M. Dwass, Some k-sample rank-order tests, in: I. Olkin, S.G. Ghurye, W.
Hoeffding, W.G. Madow, H.B. Mann (Eds.), Contributions to Probability and
Statistics, Stanford University Press, Stanford, 1960.
[3] P. Era, P. Sainio, S. Koskinen, P. Haavisto, M. Vaara, A. Aromaa, Postural
balance in a random sample of 7979 subjects aged 30 years and over,
Gerontology 52 (2006) 204213.
[4] M. Ferdjallah, G.F. Harris, J.J. Wertsch, Instantaneous postural stability
characterization using time-frequency analysis, Gait Posture 10 (1999)
129134.
[5] C. Fujimoto, T. Kamogashira, M. Kinoshita, N. Egami, K. Sugasawa, S. Demura,
T. Yamasoba, S. Iwasaki, Power spectral analysis of postural sway during foam
posturography in patients with peripheral vestibular dysfunction, Otol.
Neurotol. 35 (2014) e317e323.
[6] C. Fujimoto, T. Murofushi, Y. Chihara, M. Ushio, K. Sugasawa, T. Yamaguchi, T.
Yamasoba, S. Iwasaki, Assessment of diagnostic accuracy of foam
posturography for peripheral vestibular disorders: analysis of parameters
related to visual and somatosensory dependence, Clin. Neurophysiol. 120
(2009) 14081414.
[7] C. Fujimoto, T. Murofushi, Y. Chihara, M. Ushio, M. Suzuki, T. Yamaguchi, T.
Yamasoba, S. Iwasaki, Effect of severity of vestibular dysfunction on postural
instability in idiopathic bilateral vestibulopathy, Acta Otolaryngol. (2013).
[8] C. Fujimoto, T. Murofushi, Y. Chihara, M. Ushio, T. Yamaguchi, T. Yamasoba, S.
Iwasaki, Effects of unilateral dysfunction of the inferior vestibular nerve
system on postural stability, Clin. Neurophysiol. 121 (2010) 12791284.
[9] C. Fujimoto, T. Murofushi, K. Sugasawa, Y. Chihara, M. Ushio, T. Yamasoba, S.
Iwasaki, Assessment of postural stability using foam posturography at the
chronic stage after acute unilateral peripheral vestibular dysfunction, Otol.
Neurotol. 33 (2012) 432436.
[10] F.B. Horak, Clinical measurement of postural control in adults, Phys. Ther. 67
(1987) 18811885.
[11] F.B. Horak, C.L. Shupert, A. Mirka, Components of postural dyscontrol in the
elderly: a review, Neurobiol. Aging 10 (1989) 727738.
[12] B.E. Maki, P.J. Holliday, A.K. Topper, A prospective study of postural balance
and risk of falling in an ambulatory and independent elderly population, J.
Gerontol. 49 (1994) M72M84.
[13] D. Manchester, M. Woollacott, N. Zederbauer-Hylton, O. Marin, Visual,
vestibular and somatosensory contributions to balance control in the older
adult, J. Gerontol. 44 (1989) M118127.
[14] J. Massion, M. Woollacott, Posture and equilibrium, in: T. Bronstein, M. Brandt
(Eds.), Clinical Disorders of Balance, Posture and Gait, Arnold, London, 2004,
pp. 119.
[15] B.A. McClenaghan, H.G. Williams, J. Dickerson, M. Dowda, L. Thombs, P.
Eleazer, Spectral characteristics of aging postural control, Gait Posture 4
(1996) 112121.
[16] L.V. Moncada, Management of falls in older persons: a prescription for
prevention, Am. Fam. Physician 84 (2011) 12671276.
[17] S. Moore, D. Rushmer, S. Windus, L. Nashner, Human automatic postural
responses: responses to horizontal perturbations of stance in multiple
directions, Exp. Brain Res. 73 (1988) 648658.
[18] L.M. Nashner, F.O. Black, C. Wall, Adaptation to altered support and visual
conditions during stance patients with vestibular decits, J. Neurosci. 2
(1982) 536544.
[19] R.W. Soames, J. Atha, The spectral characteristics of postural sway behaviour,
Eur. J. Appl. Physiol. Occup. Physiol. 49 (1982) 169177.
[20] R.G.D. Steel, A rank sum test for comparing all pairs of treatments,
Technometrics 2 (1960) 197207.
[21] M.H. Woollacott, A. Shumway-Cook, L.M. Nashner, Aging and posture control:
changes in sensory organization and muscular coordination, Int. J. Aging Hum.
23 (1986) 97114.