Influence of light touch using the fingertips on postural stability of poststroke patients
Identifieur interne : 003725 ( Ncbi/Merge ); précédent : 003724; suivant : 003726Influence of light touch using the fingertips on postural stability of poststroke patients
Auteurs : Se-Han Lee ; Donggeon Lee ; Yunbok Lee ; Youngju Jee ; Gyuchang Lee ; Dong-Sik ParkSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2015.
Abstract
[Purpose] The purpose of this study was to investigate the influence of fingertip light touch on the postural control in poststroke patients. [Subjects] In the study, the subjects were recruited through a rehabilitation hospital, and 21 patients were screened from among 30 volunteers. [Methods] The subjects participated in an experiment that measured postural sway during the static standing posture without light touch and postural sway during the static standing posture with light touch as follows: visual information not blocked without light touch, visual information blocked without light touch, visual information blocked with light touch using fingertips, and visual information not blocked with light touch using fingertips. The measurements were performed using a force platform. The variables measured by the force platform included sway velocities of the COP in the anterior and posterior directions and, medial and lateral directions and sway velocity moments. [Results] In the results of the study, there were significant differences between the state without light touch and state with light touch in terms of the postural sway velocity and velocity moment under all conditions. The rate of decease of the sway velocity and moment velocity under the eyes closed condition were higher compared with those under the eyes open condition. [Conclusion] Through this study, we confirmed the influence of fingertip light touch on the decrease in postural sway. The results show that active light touch may be supplemental means of improving postural sway in stroke patients.
Url:
DOI: 10.1589/jpts.27.469
PubMed: 25729193
PubMed Central: 4339163
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Influence of light touch using the fingertips on postural stability of
poststroke patients</title><author><name sortKey="Lee, Se Han" sort="Lee, Se Han" uniqKey="Lee S" first="Se-Han" last="Lee">Se-Han Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Donggeon" sort="Lee, Donggeon" uniqKey="Lee D" first="Donggeon" last="Lee">Donggeon Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Yunbok" sort="Lee, Yunbok" uniqKey="Lee Y" first="Yunbok" last="Lee">Yunbok Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Jee, Youngju" sort="Jee, Youngju" uniqKey="Jee Y" first="Youngju" last="Jee">Youngju Jee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Gyuchang" sort="Lee, Gyuchang" uniqKey="Lee G" first="Gyuchang" last="Lee">Gyuchang Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Park, Dong Sik" sort="Park, Dong Sik" uniqKey="Park D" first="Dong-Sik" last="Park">Dong-Sik Park</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25729193</idno><idno type="pmc">4339163</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339163</idno><idno type="RBID">PMC:4339163</idno><idno type="doi">10.1589/jpts.27.469</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">002067</idno><idno type="wicri:Area/Pmc/Curation">002067</idno><idno type="wicri:Area/Pmc/Checkpoint">000513</idno><idno type="wicri:Area/Ncbi/Merge">003725</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Influence of light touch using the fingertips on postural stability of
poststroke patients</title><author><name sortKey="Lee, Se Han" sort="Lee, Se Han" uniqKey="Lee S" first="Se-Han" last="Lee">Se-Han Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Donggeon" sort="Lee, Donggeon" uniqKey="Lee D" first="Donggeon" last="Lee">Donggeon Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Yunbok" sort="Lee, Yunbok" uniqKey="Lee Y" first="Yunbok" last="Lee">Yunbok Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Jee, Youngju" sort="Jee, Youngju" uniqKey="Jee Y" first="Youngju" last="Jee">Youngju Jee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Gyuchang" sort="Lee, Gyuchang" uniqKey="Lee G" first="Gyuchang" last="Lee">Gyuchang Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Park, Dong Sik" sort="Park, Dong Sik" uniqKey="Park D" first="Dong-Sik" last="Park">Dong-Sik Park</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>[Purpose] The purpose of this study was to investigate the influence of fingertip light
touch on the postural control in poststroke patients. [Subjects] In the study, the
subjects were recruited through a rehabilitation hospital, and 21 patients were screened
from among 30 volunteers. [Methods] The subjects participated in an experiment that
measured postural sway during the static standing posture without light touch and postural
sway during the static standing posture with light touch as follows: visual information
not blocked without light touch, visual information blocked without light touch, visual
information blocked with light touch using fingertips, and visual information not blocked
with light touch using fingertips. The measurements were performed using a force platform.
The variables measured by the force platform included sway velocities of the COP in the
anterior and posterior directions and, medial and lateral directions and sway velocity
moments. [Results] In the results of the study, there were significant differences between
the state without light touch and state with light touch in terms of the postural sway
velocity and velocity moment under all conditions. The rate of decease of the sway
velocity and moment velocity under the eyes closed condition were higher compared with
those under the eyes open condition. [Conclusion] Through this study, we confirmed the
influence of fingertip light touch on the decrease in postural sway. The results show that
active light touch may be supplemental means of improving postural sway in stroke
patients.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Clapp, S" uniqKey="Clapp S">S Clapp</name></author><author><name sortKey="Wing, Am" uniqKey="Wing A">AM Wing</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yoo, J" uniqKey="Yoo J">J Yoo</name></author><author><name sortKey="Jeong, J" uniqKey="Jeong J">J Jeong</name></author><author><name sortKey="Lee, W" uniqKey="Lee W">W Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nakata, H" uniqKey="Nakata H">H Nakata</name></author><author><name sortKey="Yabe, K" uniqKey="Yabe K">K Yabe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Creath, R" uniqKey="Creath R">R Creath</name></author><author><name sortKey="Kiemel, T" uniqKey="Kiemel T">T Kiemel</name></author><author><name sortKey="Horak, F" uniqKey="Horak F">F 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25729193</article-id><article-id pub-id-type="pmc">4339163</article-id><article-id pub-id-type="publisher-id">jpts-2014-492</article-id><article-id pub-id-type="doi">10.1589/jpts.27.469</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Influence of light touch using the fingertips on postural stability of
poststroke patients</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Se-Han</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>DongGeon</given-names></name><degrees>PT, BS</degrees><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>YunBok</given-names></name><degrees>RN, PhD</degrees><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jee</surname><given-names>YoungJu</given-names></name><degrees>RN, PhD</degrees><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>GyuChang</given-names></name><degrees>PT, PhD</degrees><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Park</surname><given-names>Dong-sik</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="aff6"><sup>6</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><aff id="aff1"><label>1)</label> Division of Mechanical Engineering, Kyungnam University, Republic of Korea</aff><aff id="aff2"><label>2)</label> Department of Physical Therapy, Hansol Medical Foundation Changwon Hanseo Hospital, Republic of Korea</aff><aff id="aff3"><label>3)</label> Department of Nursing, Dongseo University, Republic of Korea</aff><aff id="aff4"><label>4)</label> Department of Nursing, Kyungnam University, Republic of Korea</aff><aff id="aff5"><label>5)</label> Department of Physical Therapy, Kyungnam University, Republic of Korea</aff><aff id="aff6"><label>6)</label> Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Dong-sik Park, Department of Rehabilitation Medicine, Kangdong Sacred
Heart Hospital, Hallym University College of Medicine: 445 Gil-dong, Gangdong-gu, Seoul
134-701, Republic of Korea. (E-mail: <email xlink:href="don@hallym.or.kr">don@hallym.or.kr</email>)</corresp></author-notes><pub-date pub-type="epub"><day>17</day><month>2</month><year>2015</year></pub-date><pub-date pub-type="ppub"><month>2</month><year>2015</year></pub-date><volume>27</volume><issue>2</issue><fpage>469</fpage><lpage>472</lpage><history><date date-type="received"><day>23</day><month>7</month><year>2014</year></date><date date-type="accepted"><day>02</day><month>9</month><year>2014</year></date></history><permissions><copyright-statement>2015©by the Society of Physical Therapy Science</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p>[Purpose] The purpose of this study was to investigate the influence of fingertip light
touch on the postural control in poststroke patients. [Subjects] In the study, the
subjects were recruited through a rehabilitation hospital, and 21 patients were screened
from among 30 volunteers. [Methods] The subjects participated in an experiment that
measured postural sway during the static standing posture without light touch and postural
sway during the static standing posture with light touch as follows: visual information
not blocked without light touch, visual information blocked without light touch, visual
information blocked with light touch using fingertips, and visual information not blocked
with light touch using fingertips. The measurements were performed using a force platform.
The variables measured by the force platform included sway velocities of the COP in the
anterior and posterior directions and, medial and lateral directions and sway velocity
moments. [Results] In the results of the study, there were significant differences between
the state without light touch and state with light touch in terms of the postural sway
velocity and velocity moment under all conditions. The rate of decease of the sway
velocity and moment velocity under the eyes closed condition were higher compared with
those under the eyes open condition. [Conclusion] Through this study, we confirmed the
influence of fingertip light touch on the decrease in postural sway. The results show that
active light touch may be supplemental means of improving postural sway in stroke
patients.</p></abstract><kwd-group><title>Key words</title><kwd>Light touch</kwd><kwd>Stroke</kwd><kwd>Postural sway</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>It is difficult to determine the center of mass of the human body while in the standing
posture, as the base of support is narrow; therefore, it is hard to maintain the standing
posture, and this posture is fundamentally unstable<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>. In order to maintain the upright posture, the ability to control
posture is constantly required<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. While
maintaining posture, sensory information from the vestibular, visual, and somatosensory
systems is integrated in the central nervous system<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. The upright standing posture is maintained when afferent
information is integrated in the central nervous system through the vestibular, visual, and
somatosensory systems and induces reflexive control of eye and extremity movement<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>. All three sensory systems are required for
optimal postural stability; thus, impairment of any of these sensory systems may increase
sway while standing. Dysfunction in the vestibular system results in postural
instability<xref rid="r4" ref-type="bibr">4</xref>, <xref rid="r5" ref-type="bibr">5</xref><sup>)</sup>. Postural sway increases by 20–70% under visually blocked
conditions, as the ability to control posture declines under these blocked conditions<xref rid="r6" ref-type="bibr">6</xref><sup>)</sup>. Additionally, postural sway may increase
with loss of the somatosensory system<xref rid="r7" ref-type="bibr">7</xref><sup>)</sup>.</p><p>Impaired postural control is a common problem that stroke patient encounter<xref rid="r8" ref-type="bibr">8</xref><sup>)</sup>. Stroke patients usually experience
impairments such as motor paralysis, sensory loss, and muscle tone change<xref rid="r9" ref-type="bibr">9</xref><sup>)</sup>, and these impairments usually occur in the
trunk and extremity of the affected side, causing imbalance with the unaffected side. The
imbalance between the affected and unaffected sides results in asymmetric weight
distribution, with 60–90% of the weight supported by the unaffected side<xref rid="r10" ref-type="bibr">10</xref>, <xref rid="r11" ref-type="bibr">11</xref><sup>)</sup>, and this increases postural sway, thus disturbing postural
control<xref rid="r10" ref-type="bibr">10</xref><sup>)</sup>. This imbalance affects gait,
causes an abnormal gait pattern, and restricts functional activities<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup>. Therefore, it is important to improve postural control
using these methods that improve the elements described above<xref rid="r9" ref-type="bibr">9</xref><sup>)</sup>.</p><p>A previous study found that pelvic stability of stroke patients improved with light cane
support<xref rid="r13" ref-type="bibr">13</xref><sup>)</sup>. Additionally, previous
studies have suggested that light support with a fixed handrail using fingers improves
postural stability while walking on an unstable support<xref rid="r14" ref-type="bibr">14</xref><sup>)</sup>. Tactile sensation involves light touching with the fingers<xref rid="r15" ref-type="bibr">15</xref><sup>)</sup>. This sensory information, called the
light touch cue, may provide latent support to postural control<xref rid="r16" ref-type="bibr">16</xref><sup>)</sup>. Previous studies reported that light touch cue increases
sensory feedback about body movement during postural control<xref rid="r17" ref-type="bibr">17</xref><sup>)</sup>. In particular, light touch with a force under 1 N provides tactile
stimulation instead of mechanical support that decreases postural sway<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup>. Many previous studies have reported on the effects of
active touch, which reduces postural sway and improves postural stability. Another study
found that active touch reduces perturbation not only during normal standing posture but
also during the Romberg posture<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>.
Additional studies have applied active touch to healthy adults with muscle fatigue<xref rid="r19" ref-type="bibr">19</xref><sup>)</sup>, patients with muscle vibration in the
neck and lower extremity<xref rid="r20" ref-type="bibr">20</xref>, <xref rid="r21" ref-type="bibr">21</xref><sup>)</sup>, the elderly<xref rid="r22" ref-type="bibr">22</xref><sup>)</sup>, patients with peripheral neuropathy<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup>, patients with vestibular dysfunction on both sides<xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>, and patients with visual dysfunction<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. However, studies on the effect of light
touch instead of mechanical support on postural sway during the static standing posture in
stroke patients and the range of the relevant effects are limited.</p><p>Therefore, the current study aimed to investigate the influence of light tactile
stimulation under 1 N, instead of mechanical support, on the stability or postural sway in
stroke patients. The current study investigated whether tactile feedback from a fingertip
cue, regardless of mechanical support, decreases postural sway caused by active touching
during the static standing posture and the extent of improvement in postural sway.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>Stroke patients from D Rehabilitation Center participated in the study. The subjects were
recruited through the hospital bulletin board, and 21 patients were screened from among 30
volunteers. The inclusion criteria were patients who were diagnosed with a stroke in the
past 6 months, those with hemiparesis, those who could walk 10 m independently without
assistive devices, those without hearing and visual impairments, those without neurologic or
orthopedic diseases that may influence the results of the experiment, and those not taking
medicines that may affect their stability. Patients with diabetes or a pacemaker were
excluded from the study. The characteristics of the subjects are shown in <xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title>Characteristics of the subjects</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" rowspan="1" colspan="1">N</th><th align="center" valign="middle" rowspan="1" colspan="1">Gender<break></break>(male/female)</th><th align="center" valign="middle" rowspan="1" colspan="1">Age<break></break>(years)</th><th align="center" valign="middle" rowspan="1" colspan="1">Etiology<break></break>(I/H)</th><th align="center" valign="middle" rowspan="1" colspan="1">Affected side<break></break>(R/L)</th><th align="center" valign="middle" rowspan="1" colspan="1">Disease duration<break></break>(month)</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">11/10</td><td align="center" rowspan="1" colspan="1">72.2±7.8</td><td align="center" rowspan="1" colspan="1">14/7</td><td align="center" rowspan="1" colspan="1">11/10</td><td align="center" rowspan="1" colspan="1">109.7±59.1</td></tr></tbody></table><table-wrap-foot><p>Values are frequencies or means±SD. I: Infarction; H: Hemorrhage; R: Right; L: Left
</p></table-wrap-foot></table-wrap>. After screening the subjects, the aim and procedure were thoroughly explained
to the subjects, and written consent forms were signed.</p><p>The current study was a cross-sectional study design. The characteristics of the subjects
were obtained from interviews and medical charts. The subjects participated in an experiment
that measured postural sway during the static standing posture and postural sway during the
static standing posture with light touch. The assessor provided an adequate explanation
about the procedure of the fingertip cue to all the subjects and asked them to practice.
Additionally, all the subjects practiced the standing posture five times on the ground in
order to learn the process and procedure before measurement and took adequate rest after the
practice. Before measurement, reference points were marked on the force platform in order to
minimize changes in reference points that might occur during repeated measurements. The
subjects stood on the force platform after the calibration was performed. When the “ready”
signal was given, the subjects were to stand on the force platform in an upright posture.
The 4 conditions used were as follows: visual information not blocked without light touch,
visual information blocked without light touch, visual information blocked with light touch
using fingertips, and visual information not blocked with light touch using fingertips.
Measurements were repeated three times. Each trial took 30 seconds, and subjects had a 3-min
break between each trial to minimize the adaptation effect on the measurement occurring
through the test-retest process. For the light touch with the fingertips, the subjects stood
upright, abducted the upper extremity slightly to the side of the trunk, flexed the elbow to
90°, and flexed all the fingers except the index finger to touch a piece of fabric with the
index finger. The subjects stood focusing on the fingertip and maintained the position of
touching the fabric for 30 seconds. The pressure of the light touch was set under 1 N
because external force under 1 N is at the non-mechanically supportive force level that does
not affect postural sway<xref rid="r21" ref-type="bibr">21</xref><sup>)</sup>. All subjects
wore eye patches in order to eliminate confounding variables for the measurement conditions
with blocked vision. The assessor and subjects were alone in the experiment room to control
variables that may influence the subject.</p><p>Changes in postural sway during the light fingertip touch were measured using a force
platform that records the center of pressure (COP) (Good Balance, Metitur Ltd, Finland). The
force platform used in the study was composed of a triangular board connected to 3
amplifiers and a computer with built-in Bluetooth. The signals recorded on the force
platform were amplified into measurable signals through the amplifier. The signals were
transferred to the computer through Bluetooth and digitalized through a 12-bit converter so
that data could be saved on the computer. The computer transformed the signals using a 50 Hz
sampling rate, performed filtering using a 12 Hz low frequency filter, and analyzed the
saved values. The variables of postural sway include sway velocities of the COP in the
anterior and posterior directions and medial and lateral directions, and sway velocity
moments. The reliabilities of the force platform were found to be 0.51 and 0.74 in the
anterior and posterior directions, respectively, and 0.63 and 0.83 in the medial and lateral
directions, respectively<xref rid="r24" ref-type="bibr">24</xref><sup>)</sup>.</p><p>SPSS 15.0 was used for statistical analysis in the study. Normality tests of the variables
were performed by using the Kolmogorov-Smirnov method, and descriptive statistics were used
to analyze the mean and standard deviation of all the variables. An independent t-test was
used to compare the influence of the light fingertip touch. The level of statistical
significance (α) was set at 0.05.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>The results of the study are shown in <xref rid="tbl_002" ref-type="table">Table
2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title>Comparison of the postural sway in without light touch and with light
touch</title></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="2" align="center" rowspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Without light touch</th><th align="center" rowspan="1" colspan="1">With light touch</th><th align="center" rowspan="1" colspan="1">Changes</th></tr></thead><tbody><tr><td align="left" rowspan="3" colspan="1">Eyes open<break></break>(mm/s)</td><td align="left" rowspan="1" colspan="1">AP sway velocity</td><td align="center" rowspan="1" colspan="1">7.0±3.0</td><td align="center" rowspan="1" colspan="1">2.0±0.9</td><td align="center" rowspan="1" colspan="1">5.0*</td></tr><tr><td align="left" rowspan="1" colspan="1">ML sway velocity</td><td align="center" rowspan="1" colspan="1">8.9±3.5</td><td align="center" rowspan="1" colspan="1">4.3±1.5</td><td align="center" rowspan="1" colspan="1">4.6*</td></tr><tr><td align="left" rowspan="1" colspan="1">Velocity moment</td><td align="center" rowspan="1" colspan="1">16.7±8.4</td><td align="center" rowspan="1" colspan="1">3.8±2.4</td><td align="center" rowspan="1" colspan="1">12.9*</td></tr><tr><td colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="3" colspan="1">Eyes closed<break></break>(mm/s)</td><td align="left" rowspan="1" colspan="1">AP sway velocity</td><td align="center" rowspan="1" colspan="1">10.5±3.4</td><td align="center" rowspan="1" colspan="1">3.1±1.3</td><td align="center" rowspan="1" colspan="1">7.4*</td></tr><tr><td align="left" rowspan="1" colspan="1">ML sway velocity</td><td align="center" rowspan="1" colspan="1">13.8±5.4</td><td align="center" rowspan="1" colspan="1">6.1±3.4</td><td align="center" rowspan="1" colspan="1">7.7*</td></tr><tr><td align="left" rowspan="1" colspan="1">Velocity moment</td><td align="center" rowspan="1" colspan="1">25.8±12.6</td><td align="center" rowspan="1" colspan="1">5.9±3.4</td><td align="center" rowspan="1" colspan="1">19.8*</td></tr></tbody></table><table-wrap-foot><p>Values are frequencies or means±SD. AP: anterioposterior; ML: mediolateral</p><p>* Statistically significant at p<0.05 between without light touch and with light
touch</p></table-wrap-foot></table-wrap>. The sway velocity of the COP and moment velocity under the eyes open and
closed conditions were significantly decreased in the state with light touch compared to the
state without light touch (p<0.05) (<xref rid="tbl_002" ref-type="table">Table 2</xref>).
The rates of decrease of the sway velocity and moment velocity under the eyes closed
condition were higher compared with those under the eyes open condition (<xref rid="tbl_002" ref-type="table">Table 2</xref>).</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>The present study aimed to investigate the influence of active light touch on the
improvement of postural stability in chronic stroke patients. The study showed that the sway
velocity of the COP and moment velocity improved significantly during active light touch
compared with without light touch. This result is similar to the results of previous
studies. Cunha et al.<xref rid="r13" ref-type="bibr">13</xref><sup>)</sup> found that the
COP decreased because of light touch provided additional sensory information for decreasing
postural sway of patients with hemiparesis resulting from stroke. Dickstein et al.<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup> found a significant decrease in the COP of
32 patients with peripheral neuropathy compared with a control group because of fingertip
touch that was used for improvement in postural stability.</p><p>The decrease in postural sway due to tactile feedback through active touch also occurs
during the application of passive touch such as rubbing the lower extremity or shoulder in
the standing position<xref rid="r25" ref-type="bibr">25</xref><sup>)</sup>. The tactile
stimulation from passive touch may provide additional sensory input for decreasing postural
sway. Previous studies found that passive touch at various parts of the lower extremity
improved postural stability while standing through tactile stimulation<xref rid="r26" ref-type="bibr">26</xref><sup>)</sup>.</p><p>The equipment used for passive touch was for tactile feedback rather than for mechanical
support. Considering this, the study of Menz et al.<xref rid="r26" ref-type="bibr">26</xref><sup>)</sup> suggested that postural sway may be controlled by tactile feedback.
The decrease in tactile feedback from tactile stimulation without mechanical support
increased postural sway<xref rid="r27" ref-type="bibr">27</xref><sup>)</sup>. Active light
fingertip touch can also provide tactile feedback such as passive touch. These previous
studies found that compressive ischemia in the upper arm during active light touch decreased
tactile feedback, which then increased postural sway. A few studies found that haptic cues
input through a fingertip touch decreased postural sway<xref rid="r19" ref-type="bibr">19</xref>, <xref rid="r28" ref-type="bibr">28</xref><sup>)</sup>. For stability while in
the standing posture, in terms of mechanical aspects, strong supports are needed<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>, but various studies found that a light
touch cue can decrease postural sway in a manner similar to a strong touch cue<xref rid="r23" ref-type="bibr">23</xref>, <xref rid="r29" ref-type="bibr">29</xref><sup>)</sup>. The results of previous studies and the current study confirm that
an increase in tactile feedback, instead of mechanical support, through active touch with a
force under 1 N may change postural sway.</p><p>Additionally, the current study results showed higher rates of decrease of sway velocity
and moment velocity under the eyes closed condition compared with under the eyes open
condition with and without active touch. Although interferential statistics were not
performed, the descriptive statistical analysis showed a decrease of 4.98 mm/s in the
anterior and posterior directions, a decrease of 4.57 mm/s in the medial and lateral
directions, and a decrease of 12.92 mm/s in the velocity moment under the eyes open
condition, as well as a decrease of 7.42 mm/s in the anterior and posterior direction, a
decrease of 7.68 mm/s in the medial and lateral directions, and a decrease of 19.84 mm/s
during velocity moment under the eyes closed condition. Balance is the ability to maintain
the center of gravity in the body with minimum postural sway on the base of support<xref rid="r6" ref-type="bibr">6</xref><sup>)</sup>. The ability to maintain balance may
decrease due to increased postural sway under the eyes closed condition when visual
information is blocked<xref rid="r30" ref-type="bibr">30</xref><sup>)</sup>. Horvat et
al.<xref rid="r31" ref-type="bibr">31</xref><sup>)</sup> and Ray et al.<xref rid="r32" ref-type="bibr">32</xref><sup>)</sup> found that patients with visual
dysfunction had increased postural sway compared with healthy adults, which resulted in an
increased risk of falls. The result showed that the rate of decreased of postural sway was
higher when light touch was available under the eyes closed condition. Patients were highly
dependent on the somatosensory system in order to compensate for impaired vision, and the
increased somatosensory system improved the efficiency of light touch<xref rid="r28" ref-type="bibr">28</xref><sup>)</sup>. In addition, when people with visual impairment tightly
held a cane, an assistive device, and when people held a cane lightly, static postural sway
decreased, which supports the assertion that the effect of light touch on postural sway
under the eyes closed condition is greater<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. Stroke patients were to perform a light fingertip touch with a
force under 1 N while postural sway with and without touch was measured for comparison. The
results of the current study were similar to the results of previous studies that found that
light touch decreases postural sway<xref rid="r16" ref-type="bibr">16</xref>, <xref rid="r28" ref-type="bibr">28</xref><sup>)</sup>. Light fingertip touch does not act as a
mechanical support, rather it creates tactile feedback that improves balance<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>.</p><p>The present results show that active light touch contributes to improvement of balance and
decreases postural sway. However, the current study has limitations; that is, due to the
small sample size, it is difficult to generalize the results, and we did not investigate the
changes in postural sway with touch involving various other body parts. Therefore, future
studies should be conducted in order to provide useful information to patients with
neurologic diseases.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="r1"><label>1</label><mixed-citation publication-type="journal"><person-group><name><surname>Clapp</surname><given-names>S</given-names></name><name><surname>Wing</surname><given-names>AM</given-names></name></person-group>: <article-title>Light touch contribution to balance in normal bipedal
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