Gait analysis is an important tool for the early detection of neurological diseases and for the assessment of risk of falling in elderly people. The availability of low-cost camera hardware on the market today and recent advances in Machine Learning enable a wide range of clinical and health-related applications, such as patient monitoring or exercise recognition at home. In this study, we evaluated the motion tracking performance of the latest generation of the Microsoft Kinect camera, Azure Kinect, compared to its predecessor Kinect v2 in terms of treadmill walking using a gold standard Vicon multi-camera motion capturing system and the 39 marker Plug-in Gait model. Five young and healthy subjects walked on a treadmill at three different velocities while data were recorded simultaneously with all three camera systems. An easy-to-administer camera calibration method developed here was used to spatially align the 3D skeleton data from both Kinect cameras and the Vicon system. With this calibration, the spatial agreement of joint positions between the two Kinect cameras and the reference system was evaluated. In addition, we compared the accuracy of certain spatio-temporal gait parameters, i.e., step length, step time, step width, and stride time calculated from the Kinect data, with the gold standard system. Our results showed that the improved hardware and the motion tracking algorithm of the Azure Kinect camera led to a significantly higher accuracy of the spatial gait parameters than the predecessor Kinect v2, while no significant differences were found between the temporal parameters. Furthermore, we explain in detail how this experimental setup could be used to continuously monitor the progress during gait rehabilitation in older people.

Electroencephalographic (EEG) research indicates changes in adults’ low frequency bands of frontoparietal brain areas executing different balance tasks with increasing postural demands. However, this issue is unsolved for adolescents when performing the same balance task with increasing difficulty. Therefore, we examined the effects of a progressively increasing balance task difficulty on balance performance and brain activity in adolescents. Thirteen healthy adolescents aged 16–17 year performed tests in bipedal upright stance on a balance board with six progressively increasing levels of task difficulty. Postural sway and cortical activity were recorded simultaneously using a pressure sensitive measuring system and EEG. The power spectrum was analyzed for theta (4–7 Hz) and alpha-2 (10–12 Hz) frequency bands in pre-defined frontal, central, and parietal clusters of electrocortical sources. Repeated measures analysis of variance (rmANOVA) showed a significant main effect of task difficulty for postural sway (p < 0.001;d = 6.36). Concomitantly, the power spectrum changed in frontal, bilateral central, and bilateral parietal clusters. RmANOVAs revealed significant main effects of task difficulty for theta band power in the frontal (p < 0.001,d = 1.80) and both central clusters (left:p < 0.001,d = 1.49; right:p < 0.001,d = 1.42) as well as for alpha-2 band power in both parietal clusters (left:p < 0.001,d = 1.39; right:p < 0.001,d = 1.05) and in the central right cluster (p = 0.005,d = 0.92). Increases in theta band power (frontal, central) and decreases in alpha-2 power (central, parietal) with increasing balance task difficulty may reflect increased attentional processes and/or error monitoring as well as increased sensory information processing due to increasing postural demands. In general, our findings are mostly in agreement with studies conducted in adults. Similar to adult studies, our data with adolescents indicated the involvement of frontoparietal brain areas in the regulation of postural control. In addition, we detected that activity of selected brain areas (e.g., bilateral central) changed with increasing postural demands.

Balance training (BT) is a well-established training type in many sports and is used to improve postural control. There is evidence that performance enhancements after BT can even translate to other physical fitness measures such as muscle strength and jump performance. Accordingly, this narrative review summarizes the effects of BT on balance performance in youth/young athletes and describes how acute and chronic BT-specific adaptations translate to other physical fitness outcomes. In addition, recent findings on sequencing effects of balance and strength training will be reported. Finally, established dose-response relationships with BT in youth will be presented together with a progression sequence.

The concurrent performance of cognitive and postural tasks is particularly impaired in old adults and associated with an increased risk of falls. Biological aging of the cognitive and postural control system appears to be responsible for increased cognitive-motor interference effects. We examined neural and behavioral markers of motor-cognitive dual-task performance in young and old adults performing spatial one-back working memory single and dual tasks during semitandem stance. On the neural level, we used EEG to test for age-related modulations in the frequency domain related to cognitive-postural task load. Twenty-eight healthy young and 30 old adults participated in this study. The tasks included a postural single task, a cognitive-postural dual task, and a cognitive-postural triple task (cognitive dual-task with postural demands). Postural sway (i.e., total center of pressure displacements) was recorded in semistance position on an unstable surface that was placed on top of a force plate while performing cognitive tasks. Neural activation was recorded using a 64-channel mobile EEG system. EEG frequencies were attenuated by the baseline postural single-task condition and demarcated in nine Regions-of-Interest (ROIs), i.e., anterior, central, posterior, over the cortical midline, and both hemispheres. Our findings revealed impaired cognitive dual-task performance in old compared to young participants in the form of significantly lower cognitive performance in the triple-task condition. Furthermore, old adults compared with young adults showed significantly larger postural sway, especially in cognitive-postural task conditions. With respect to EEG frequencies, young compared to old participants showed significantly lower alpha-band activity in cognitive-cognitive-postural triple-task conditions compared with cognitive-postural dual tasks. In addition, with increasing task difficulty, we observed synchronized theta and delta frequencies, irrespective of age. Task-dependent alterations of the alpha frequency band were most pronounced over frontal and central ROIs, while alterations of the theta and delta frequency bands were found in frontal, central, and posterior ROIs. Theta and delta synchronization exhibited a decrease from anterior to posterior regions. For old adults, task difficulty was reflected by theta synchronization in the posterior ROI. For young adults, it was reflected by alpha desynchronization in bilateral anterior ROIs. In addition, we could not identify any effects of task difficulty and age on the beta frequency band. Our results shed light on age-related cognitive and postural declines and how they interact. Modulated alpha frequencies during high cognitive-postural task demands in young but not old adults might be reflective of a constrained neural adaptive potential in old adults. Future studies are needed to elucidate associations between the identified age-related performance decrements with task difficulty and changes in brain activity.

Evidence-based prescriptions for balance training in youth have recently been established. However, there is currently no standardized means available to assess and quantify balance task difficulty (BTD). Therefore, the objectives of this study were to examine the effects of graded BTD on postural sway, lower limb muscle activity and coactivation in adolescents. Thirteen healthy high-school students aged 16 to 17 volunteered to participate in this cross-sectional study. Testing involved participants to stand on a commercially available balance board with an adjustable pivot that allowed six levels of increasing task difficulty. Postural sway [i.e., total center of pressure (CoP) displacements] and lower limb muscle activity were recorded simultaneously during each trial. Surface electromyography (EMG) was applied in muscles encompassing the ankle (m. tibialis anterior, medial gastrocnemius, peroneus longus) and knee joint (m. vastus medialis, biceps femoris). The coactivation index (CAI) was calculated for ankle and thigh muscles. Repeated measures analyses of variance revealed a significant main effect of BTD with increasing task difficulty for postural sway (p < 0.001; d = 6.36), muscle activity (p < 0.001; 2.19 < d < 4.88), and CAI (p < 0.001; 1.32 < d < 1.41). Multiple regression analyses showed that m. tibialis anterior activity best explained overall CoP displacements with 32.5% explained variance (p < 0.001). The observed increases in postural sway, lower limb muscle activity, and coactivation indicate increasing postural demands while standing on the balance board. Thus, the examined board can be implemented in balance training to progressively increase BTD in healthy adolescents.