Robotic balance assessment in community-dwelling older people with different grades of impairment of physical performance

  • Alberto CellaEmail author
  • Alice De Luca
  • Valentina Squeri
  • Sara Parodi
  • Matteo Puntoni
  • Francesco Vallone
  • Angela Giorgeschi
  • Valentina Garofalo
  • Ekaterini Zigoura
  • Barbara Senesi
  • Lorenzo De Michieli
  • Jody Saglia
  • Carlo Sanfilippo
  • Alberto Pilotto
Original Article



Impaired physical performance is common in older adults and has been identified as a major risk factor for falls. To date, there are no conclusive data on the impairment of balance parameters in older subjects with different levels of physical performance.


The aim of this study was to investigate the relationship between different grades of physical performance, as assessed by the Short Physical Performance Battery (SPPB), and the multidimensional balance control parameters, as measured by means of a robotic system, in community-dwelling older adults.


This study enrolled subjects aged ≥ 65 years. Balance parameters were assessed by the hunova robot in static and dynamic (unstable and perturbating) conditions, in both standing and seated positions and with the eyes open/closed.


The study population consisted of 96 subjects (62 females, mean age 77.2 ± 6.5 years). According to their SPPB scores, subjects were separated into poor performers (SPPB < 8, n = 29), intermediate performers (SPPB = 8–9, n = 29) and good performers (SPPB > 9, n = 38). Poor performers displayed significantly worse balance control, showing impaired trunk control in most of the standing and sitting balance tests, especially in dynamic (both with unstable and perturbating platform/seat) conditions.


For the first time, multidimensional balance parameters, as detected by the hunova robotic system, were significantly correlated with SPPB functional performances in community-dwelling older subjects. In addition, balance parameters in dynamic conditions proved to be more sensitive in detecting balance impairments than static tests.


Physical function Physical performance Balance Assessment Robotic device 



There was no external source of funding for this research.

Compliance with ethical standards

Conflict of interest

A.D.L., V.S., J.S. and C.S. are employees of Movendo Technology (Genova, Italy). S.P. is a consultant for Movendo Technology (Genova, Italy).

Research involving human participants and/or animals

The study conforms to the ethical standards laid down in the 1964 Declaration of Helsinki, which protects research subjects, and was approved by the ethics committee of the regional health authority (reference number: 169REG2016).

Informed consent

All subjects involved in the study signed the informed consent form.


  1. 1.
    Ambrose AF, Paul G, Hausdorff JM (2013) Risk factors for falls among older adults: a review of the literature. Maturitas 75:51–61PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    van Lummel RC, Walgaard S, Pijnappels M et al (2015) Physical performance and physical activity in older adults: associated but separate domains of physical function in old age. PLoS One 10:e0144048PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:85–94CrossRefGoogle Scholar
  4. 4.
    McGough EL, Logsdon RG, Kelly VE et al (2013) Functional mobility limitations and falls in assisted living residents with dementia: physical performance assessment and quantitative gait analysis. J Geriatr Phys Ther 36:78–86PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Veronese N, Bolzetta F, Toffanello ED et al (2014) Association between short physical performance battery and falls in older people: the progetto veneto anziani study. Rejuvenation Res 17:276–284PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Sing DK, Pillai SG, Tan ST et al (2015) Association between physiological falls risk and physical performance tests among community-dwelling older adults. Clin Interv Aging 10:1319–1326CrossRefGoogle Scholar
  7. 7.
    Kim JC, Chon J, Kim HS et al (2017) The association between fall history and physical performance tests in the community-dwelling elderly: a cross-sectional analysis. Ann Rehabil Med 41:239–247PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Dunsky A, Zeev A, Netz Y (2017) Balance performance is task specific in older adults. Biomed Res Int 2017:6987017PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Mancini M, Horak FB (2010) The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med 46:239–248PubMedPubMedCentralGoogle Scholar
  10. 10.
    Sibley KM, Beauchamp MK, Van Ooteghem K et al (2015) Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review. Arch Phys Med Rehabil 96:122–132PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Park SH (2018) Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clin Exp Res 30:1–16PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Palumbo P, Becker C, Bandinelli S et al (2019) Simulating the effects of a clinical guidelines screening algorithm for fall risk in community dwelling older adults. Aging Clin Exp Res 31:1069–1076PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Ni Scanaill C, Garattini C, Greene BR et al (2011) Technology innovation enabling falls risk assessment in a community setting. Ageing Int 36:217–231PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Lin D, Seol H, Nussbaum MA et al (2008) Reliability of COP-based postural sway measures and age-related differences. Gait Posture 28:337–342PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Lafond D, Corriveau H, Hébert R et al (2004) Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Arch Phys Med Rehabil 85:896–901PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Swanenburg J, de Bruin ED, Favero K et al (2008) The reliability of postural balance measures in single and dual tasking in elderly fallers and non-fallers. BMC Musculoskelet Disord 9:162PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Ickenstein GW, Ambach H, Klöditz A et al (2012) Static posturography in aging and Parkinson’s disease. Front Aging Neurosci 4:20PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Perrin PP, Jeandel C, Perrin CA et al (1997) Influence of visual control, conduction, and central integration on static and dynamic balance in healthy older adults. Gerontology 43:223–231PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Abrahámová D, Hlavačka F (2008) Age-related changes of human balance during quiet stance. Physiol Res 57:957–964PubMedPubMedCentralGoogle Scholar
  20. 20.
    Howcroft J, Lemaire ED, Kofman J et al (2017) Elderly fall risk prediction using static posturography. PLoS One 12:e0172398PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Muir JW, Kiel DP, Hannan M et al (2013) Dynamic parameters of balance which correlate to elderly persons with a history of falls. PLoS One 8:e70566PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Nguyen US, Kiel DP, Li W et al (2012) Correlations of clinical and laboratory measures of balance in older men and women. Arthritis Care Res (Hoboken) 64:1895–1902CrossRefGoogle Scholar
  23. 23.
    Berg KO, Maki BE, Williams JI et al (1992) Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 73:1073–1080PubMedGoogle Scholar
  24. 24.
    Desai A, Goodman V, Kapadia N et al (2010) Relationship between dynamic balance measures and functional performance in community-dwelling elderly people. Phys Ther 90:748–760PubMedCrossRefGoogle Scholar
  25. 25.
    Nardone A, Schieppati M (2010) The role of instrumental assessment of balance in clinical decision making. Eur J Phys Rehabil Med 46:221–237PubMedGoogle Scholar
  26. 26.
    Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Hunova Sistema riabilitativo robotico. Accessed Apr 2019
  28. 28.
    Saglia JA, Tsagarakis NG, Dai JS et al (2013) Control strategies for patient-assisted training using the ankle rehabilitation robot (ARBOT). IEEE/ASME Trans Mechatron 18:1799–1808CrossRefGoogle Scholar
  29. 29.
    Saglia JA, Luca A, Squeri V et al (2019) Design and development of a novel core, balance and lower limb rehabilitation robot: hunova®. IEEE Int Conf Rehabil Robot 2019:417–422PubMedPubMedCentralGoogle Scholar
  30. 30.
    Nashner LM, Peters JF (1990) Dynamic posturography in the diagnosis and management of dizziness and balance disorders. Neurol Clin 8:331–349PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Hamid MA (1996) Dynamic posturography. Otolaryngol Head Neck Surg 114:842–843PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Corna S, Tarantola J, Nardone A et al (1999) Standing on a continuously moving platform: is body inertia counteracted or exploited? Exp Brain Res 124:331–341PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Nardone A, Grasso M, Tarantola J et al (2000) Postural coordination in elderly subjects standing on a periodically moving platform. Arch Phys Med Rehabil 81:1217–1223PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Borghuis J, Hof AL, Lemmink KA (2008) The importance of sensory-motor control in providing core stability: implications for measurement and training. Sports Med 38:893–916PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Peterka RJ (2002) Sensorimotor integration in human postural control. J Neurophysiol 88:1097–1118PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Marchesi G, Casadio M, Ballardini G et al (2019) Robot-based assessment of sitting and standing balance: preliminary results in Parkinson’s disease. IEEE Int Conf Rehabil Robot 2019:570–576PubMedPubMedCentralGoogle Scholar
  37. 37.
    Paillard T, Noé F (2015) Techniques and methods for testing the postural function in healthy and pathological subjects. Biomed Res Int 2015:891390PubMedPubMedCentralGoogle Scholar
  38. 38.
    Duncan PW, Chandler J, Studenski S et al (1993) How do physiological components of balance affect mobility in elderly men? Arch Phys Med Rehabil 74:1343–1349PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK et al (2018) Interventions to prevent falls in community-dwelling older adults: US preventive services task force recommendation statement. JAMA 319:1696–1704CrossRefGoogle Scholar
  40. 40.
    Masud T, Morris RO (2001) Epidemiology of falls. Age Ageing 30:3–7PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Shimada H, Suzukawa M, Ishizaki T et al (2011) Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people. BMC Geriatr 11:40PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Granacher U, Muehlbauer T, Gollhofer A et al (2011) An intergenerational approach in the promotion of balance and strength for fall prevention—a mini-review. Gerontology 57:304–315PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Cooper R, Kuh D, Cooper C et al (2011) Objective measures of physical capability and subsequent health: a systematic review. Age Ageing 40:14–23PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Ward RE, Leveille SG, Beauchamp MK et al (2015) Functional performance as a predictor of injurious falls in older adults. J Am Geriatr Soc 63:315–320PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Pua Y-H, Matchar DB (2019) Physical performance predictor measures in older adults with falls-related emergency department visits. J Am Med Dir Assoc 20:780–784PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Cho KH, Bok SK, Kim YJ et al (2012) Effect of lower limb strength on falls and balance of the elderly. Ann Rehabil Med 36:386–393PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Nardone A, Galante M, Pareyson D et al (2007) Balance control in sensory neuron disease. Clin Neurophysiol 118:538–550PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Granacher U, Lacroix A, Muehlbauer T et al (2013) Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology 59:105–113PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Suri P, Kiely DK, Leveille SG et al (2009) Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study. PM R 1:916–924PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Ward RE, Beauchamp MK, Latham NK et al (2016) Neuromuscular impairments contributing to persistently poor and declining lower-extremity mobility among older adults: new findings informing geriatric rehabilitation. Arch Phys Med Rehabil 97:1316–1322PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Viscione I, D’Elia F, Vastola R et al (2016) The correlation between technologies and rating scales in gait analysis. J Sports Sci 4:119–123Google Scholar
  52. 52.
    Ito T, Sakai Y, Kubo A et al (2014) The relationship between physical function and postural sway during local vibratory stimulation of middle-aged people in the standing position. J Phys Ther Sci 26:1627–1630PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alberto Cella
    • 1
    Email author
  • Alice De Luca
    • 2
  • Valentina Squeri
    • 2
  • Sara Parodi
    • 2
  • Matteo Puntoni
    • 4
  • Francesco Vallone
    • 1
  • Angela Giorgeschi
    • 1
  • Valentina Garofalo
    • 1
  • Ekaterini Zigoura
    • 1
  • Barbara Senesi
    • 1
  • Lorenzo De Michieli
    • 3
  • Jody Saglia
    • 2
  • Carlo Sanfilippo
    • 2
  • Alberto Pilotto
    • 1
    • 5
  1. 1.Department of Geriatric Care, Orthogeriatrics and RehabilitationEO Galliera HospitalGenoaItaly
  2. 2.Movendo TechnologyGenoaItaly
  3. 3.Italian Institute of Technology (IIT)GenoaItaly
  4. 4.Clinical Trial Unit, BiostatisticsE.O. Galliera HospitalGenoaItaly
  5. 5.Department of Interdisciplinary MedicineUniversity of BariBariItaly

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