Analysis of the Relation Between Balance Control Subsystems: A Structural Equation Modeling Approach

Balance plays a crucial role in human life and social activities. Maintaining balance is a relatively complex process that requires the participation of various balance control subsystems (BCSes). However, previous studies have primarily focused on evaluating an individual's overall balance ability or the ability of each BCS in isolation, without considering how they influence (or interact with) each other. The first study used clinical scales to evaluate the functions of the four BCSes, namely Reactive Postural Control (RPC), Anticipatory Postural Adjustment (APA), Dynamic Gait (DG), and Sensory Orientation (SO), and psychological factors such as fear of falling (FOF). A hierarchical structural equation modeling (SEM) was used to investigate the relationship between the BCSes and their association with FOF. The second study involved using posturography to measure and extract parameters from the center of pressure (COP) signal. SEM with sparsity constraint was used to analyze the relationship between vision, proprioception, and vestibular sense on balance based on the extracted COP parameters. The first study revealed that the RPC, APA, DG and SO indirectly influenced each other through their overall balance ability, and their association with FOF was not the same. APA has the strongest association with FOF, while RPC has the least association with FOF. The second study revealed that sensory inputs, such as vision, proprioception, and vestibular sensing, directly affected each other, but their associations were not identical. Among them, proprioception plays the most important role in the three sensory subsystems. This study provides the first numerical evidence that the BCSes are not independent of each other and exist in direct or indirect interplay. This approach has important implications for the diagnosis and management of balance-related disorders in clinical settings and improving our understanding of the underlying mechanisms of balance control.