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Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies

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A special issue of Journal of Functional Morphology and Kinesiology (ISSN 2411-5142). This special issue belongs to the section "Kinesiology and Biomechanics".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 7862

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Prof. Dr. Vasiliki Sakellari

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Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Agiou Spidonos 28, 2243 Athens, Greece
Interests: physiotherapy; human balance; gait analysis; neurological rehabilitation; ergonomics; fall prevention; motor control; geriatrics; sensorimotor integration; clinical education in physiotherapy
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Prof. Dr. George Gioftsos

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Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Athens, Greece
Interests: physiotherapy; rehabilitation; gait analysis; biomechanics; musculoskeletal disorders; kinesiology; human movement science; exercise science; motion analysis; injury biomechanics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Posture, balance, and gait are fundamental aspects of human movement and play a vital role in maintaining individuals’ mobility, independence, and quality of life. Disorders affecting these functions can significantly impact older adults, those with neurological conditions, or individuals recovering from injuries. Advances in assessment techniques and rehabilitation strategies offer new opportunities regarding the management and improvement of these critical functions.

This Special Issue, entitled Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies, seeks to compile high-quality research, reviews, and case studies that explore innovative approaches and interdisciplinary perspectives in this field. The scope of this Special Issue includes, but is not limited to, the following topics:

Novel tools and technologies for assessing posture, balance, and gait;
Mechanisms underlying postural control and balance;
Rehabilitation strategies for neurological and musculoskeletal conditions;
Fall prevention strategies and ergonomic designs for postural health;
Technological advancements, including wearable devices and virtual reality, in balance and gait rehabilitation.

This Special Issue aims to provide a platform for advancing clinical practices, promoting interdisciplinary collaboration, and fostering innovation in this vital area of healthcare. We look forward to receiving your valuable contributions to this Special Issue.

Prof. Dr. Vasiliki Sakellari
Prof. Dr. George Gioftsos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Functional Morphology and Kinesiology is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

physiotherapy
human balance
gait analysis
neurological rehabilitation
ergonomics
fall prevention
sensorimotor integration
motor control
geriatrics
clinical education

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Related Special Issue

Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies—2nd Edition in Journal of Functional Morphology and Kinesiology

Published Papers (9 papers)

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Research

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15 pages, 958 KiB

Open AccessArticle

Can Plantar Pressure Distribution During Gait Be Estimated from Quiet Stance in Healthy Individuals?

by Marta Mirando, Chiara Pavese, Valeria Pingue, Stefania Sozzi and Antonio Nardone

J. Funct. Morphol. Kinesiol. 2025, 10(3), 301; https://doi.org/10.3390/jfmk10030301 - 5 Aug 2025

Viewed by 502

Abstract

Objectives: We assessed the difference between quiet stance and gait in the spatial distribution and intensity of foot plantar pressures and whether it is possible to estimate the distribution during gait from data obtained during stance. Methods: A total of 60 healthy subjects with a mean age of 31.0 ± 9.4 years performed two trials for quiet stance and four trials for gait on a baropodometric walkway with their eyes open. Foot plantar pressures were recorded from 10 areas of the foot sole. Results: During quiet stance, the highest plantar pressure occurred at metatarsal heads (M2 to M4) and the medial (MH) and lateral halves of the heel (LH). During gait, the profile of plantar pressure values was like that during stance, but significantly higher. The differences concentrated at the big toe (T1), M2 to M4, MH, and LH, whilst toes (T2,3,4,5) and midfoot (MF) showed the smallest difference. A significant positive correlation was found between the corresponding areas of foot pressure during gait and stance. Conclusions: During quiet stance and gait, the overall profile of plantar pressure distribution was similar. During quiet stance, the subjects loaded more on the heels, in keeping with the known position of the center of pressure just in front of the ankles. During gait, higher pressures on the metatarsal areas are related to the forward propulsion of the center of mass. The correlation between the corresponding areas of foot pressure during gait and stance suggests that the pressure distribution during gait can partly be estimated from that during stance. This finding might be useful in most clinical settings when a single sensorized platform rather than a complete walkway is available. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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12 pages, 396 KiB

Open AccessArticle

Surf’s Up for Postural Stability: A Descriptive Study of Physical Activity, Balance, Flexibility, and Self-Esteem in Healthy Adults

by Guillermo De Castro-Maqueda, Miguel Ángel Rosety-Rodríguez, Macarena Rivero-Vila, Jorge Del Rosario Fernández-Santos and Teppei Abiko

J. Funct. Morphol. Kinesiol. 2025, 10(3), 290; https://doi.org/10.3390/jfmk10030290 - 29 Jul 2025

Viewed by 401

Abstract

Background: This study examines balance, flexibility and self-esteem among healthy individuals who engage in surfing compared to those who do not surf. Methods: A cross-sectional study design was conducted with 124 participants divided into the following groups: Group 1: Surfers n = 42; Group 2: individuals performing over 3 h of physical activity per week n = 43; and Group 3: individuals performing fewer than 3 h of physical activity per week n = 39. To assess balance, the Star Excursion Balance Test (SEBT) and the Flamenco Test (FBT) were used, the sit-and-reach test (SRT) was used to measure hamstring extensibility, the Rosenberg Scale was used to measure self-esteem, and the International Physical Activity Questionnaire (IPAQ) was used to measure physical activity levels. Results: Regarding descriptive characteristics, G1 participants were significant older than those of G2 and G3 (p < 0.05 and p < 0.001, respectively). Moreover, there was a higher proportion of females in G3 than in G1 and G2 (p < 0.05). The results revealed significant differences in balance between the surfers and those engaging in fewer than 3 h of activity per week (p < 0.05). G1 obtained significantly higher results in SEBT-left leg than G2 and G3 (p < 0.001) and higher result in SEBT-right leg and FBT than G3 (p < 0.05) but no significant differences in self-esteem were found. Significant differences in flexibility were observed between males and females (p < 0.001). Conclusions: This result suggests that surfing could have a positive effect on balance. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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11 pages, 246 KiB

Open AccessArticle

Wearable Sensor Assessment of Gait Characteristics in Individuals Awaiting Total Knee Arthroplasty: A Cross-Sectional, Observational Study

by Elina Gianzina, Christos K. Yiannakopoulos, Elias Armenis and Efstathios Chronopoulos

J. Funct. Morphol. Kinesiol. 2025, 10(3), 288; https://doi.org/10.3390/jfmk10030288 - 28 Jul 2025

Viewed by 439

Abstract

Background: Gait impairments are common in individuals with knee osteoarthritis awaiting total knee arthroplasty, affecting their mobility and quality of life. This study aimed to assess and compare biomechanical gait features between individuals awaiting total knee arthroplasty and healthy, non-arthritic controls, focusing on less-explored variables using sensor-based measurements. Methods: A cross-sectional observational study was conducted with 60 participants: 21 individuals awaiting total knee arthroplasty and 39 nonarthritic controls aged 64–85 years. Participants completed a standardized 14 m walk, and 17 biomechanical gait parameters were measured using the BTS G-Walk inertial sensor. Key variables, such as stride duration, cadence, symmetry indices, and pelvic angles, were analyzed for group differences. Results: The pre-total knee arthroplasty group exhibited significantly longer gait cycles and stride durations (p < 0.001), reduced cadence (p < 0.001), and lower gait cycle symmetry index (p < 0.001) than the control group. The pelvic angle symmetry indices for tilt (p = 0.014), rotation (p = 0.002), and obliquity (p < 0.001) were also lower. Additionally, the pre-total knee arthroplasty group had lower propulsion indices for both legs (p < 0.001) and a lower walking quality index on the right leg (p = 0.005). The number of elaborated steps was significantly greater in the pre-total knee arthroplasty group (left, p < 0.001, right: p < 0.001). No significant differences were observed in any other gait parameters. Conclusions: This study revealed significant gait impairment in individuals awaiting total knee arthroplasty. Although direct evidence for prehabilitation is lacking, future research should explore whether targeted approaches, such as strengthening exercises or gait retraining, can improve gait and functional outcomes before surgery. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

18 pages, 1665 KiB

Open AccessArticle

Comprehensive Associations Between Spinal–Pelvic Alignment and Muscle Shortening in Healthy Young Men: An Analysis of Individual and Interactive Effects in the Sagittal Plane Using SHapley Additive exPlanation

by Minami Akao, Yuna Ishikura, Takuma Isshiki, Shinnosuke Tsukada, Hayato Shigetoh and Junya Miyazaki

J. Funct. Morphol. Kinesiol. 2025, 10(3), 259; https://doi.org/10.3390/jfmk10030259 - 9 Jul 2025

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Abstract

Objectives: To comprehensively examine the association between spinopelvic alignment and muscle shortening in healthy young men, focusing on the individual and interactive effects of thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt using SHapley Additive exPlanation (SHAP) analysis. Methods: Forty-one healthy young adult men participated in this cross-sectional study. Thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt were measured using a flexible curve ruler and inclinometer. Muscle length indices for six muscles (iliopsoas, rectus femoris, gluteus maximus, hamstrings, back extensors, and abdominals) were assessed via standardized physical examinations and image analysis. A machine learning model was developed, and SHAP analysis applied to determine individual and interactive contributions of spinopelvic angles to each muscle length index. Results: SHAP analysis showed that hip-related muscle shortening (iliopsoas, rectus femoris, hamstrings, gluteus maximus) was influenced by both individual alignments and interactions, especially between thoracic kyphosis and lumbar lordosis. Lumbar lordosis was most associated with iliopsoas shortening (SHAP = −0.09), while anterior pelvic tilt was linked to hamstring shortening (SHAP = −0.30). Thoracic kyphosis was the key factor for rectus femoris shortening (SHAP = −0.05). Interactive effects exceeded individual contributions for the rectus femoris, gluteus maximus, and hamstrings. In contrast, spinal alignment had minimal influence on the back extensors and abdominals. Conclusions: Both individual and intersegmental spinal alignments are associated with muscle shortening, particularly in hip-related muscles. The interaction between thoracic kyphosis and lumbar lordosis plays a pivotal role. These findings underscore the importance of evaluating segmental spinal interactions when assessing muscle flexibility and posture. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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17 pages, 840 KiB

Open AccessArticle

May Patients with Chronic Stroke Benefit from Robotic Gait Training with an End-Effector? A Case-Control Study

by Mirjam Bonanno, Paolo De Pasquale, Antonino Lombardo Facciale, Biagio Dauccio, Rosaria De Luca, Angelo Quartarone and Rocco Salvatore Calabrò

J. Funct. Morphol. Kinesiol. 2025, 10(2), 161; https://doi.org/10.3390/jfmk10020161 - 6 May 2025

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Abstract

Background: Gait and balance alterations in post-stroke patients are one of the most disabling symptoms that can persist in chronic stages of the disease. In this context, rehabilitation has the fundamental role of promoting functional recovery, mitigating gait and balance deficits, and preventing falling risk. Robotic end-effector devices, like the G-EO system (e.g., G-EO system, Reha Technology, Olten, Switzerland), can be a useful device to promote gait recovery in patients with chronic stroke. Materials and Methods: Twelve chronic stroke patients were enrolled and evaluated at baseline (T0) and at post-treatment (T1). These patients received forty sessions of robotic gait training (RGT) with the G-EO system (experimental group, EG), for eight weeks consecutively, in addition to standard rehabilitation therapy. The data of these subjects were compared with those coming from a sample of twelve individuals (control group, CG) matched for clinical and demographic features who underwent the same amount of conventional gait training (CGT), in addition to standard rehabilitation therapy. Results: All patients completed the trial, and none reported any side effects either during or following the training. The EG showed significant improvements in balance (p = 0.012) and gait (p = 0.004) functions measured with the Tinetti Scale (TS) after RGT. Both groups (EG and CG) showed significant improvement in functional independence (FIM, p < 0.001). The Fugl-Meyer Assessment—Lower Extremity (FMA-LE) showed significant improvements in motor function (p = 0.001, p = 0.031) and passive range of motion (p = 0.031) in EG. In EG, gait and balance improvements were influenced by session, age, gender, time since injury (TSI), cadence, and velocity (p < 0.05), while CG showed fewer significant effects, mainly for age, TSI, and session. EG showed significantly greater improvements than CG in balance (p = 0.003) and gait (p = 0.05) based on the TS. Conclusions: RGT with end-effectors, like the G-EO system, can be a valuable complementary treatment in neurorehabilitation, even for chronic stroke patients. Our findings suggest that RGT may improve gait, balance, and lower limb motor functions, enhancing motor control and coordination. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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13 pages, 343 KiB

Open AccessArticle

The Predictive Capacity of the 3-Meter Backward Walk Test for Falls in Older Adults: A Case–Control Analysis

by Luis Polo-Ferrero, Javier Torres-Alonso, María Carmen Sánchez-Sánchez, Ana Silvia Puente-González, Fausto J. Barbero-Iglesias and Roberto Méndez-Sánchez

J. Funct. Morphol. Kinesiol. 2025, 10(2), 154; https://doi.org/10.3390/jfmk10020154 - 30 Apr 2025

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Abstract

Background: The early detection of fall risk in older adults is crucial for prevention. This study assessed the 3-Meter Backward Walk Test (3m-BWT) as a predictor of falls. Methods: A retrospective observational case–control study was conducted with 483 community-dwelling participants (mean age 76.3 ± 6.5 years), including 101 individuals with a history of falls in the previous 12 months. A standardized battery of functional assessments was applied. Results: Significant differences were observed between fallers and non-fallers across all functional variables (p < 0.001), with fallers demonstrating slower performance on the 3m-BWT (6.8 ± 3.4 s vs. 5.1 ± 1.3 s). The 3m-BWT showed moderate correlations with Short Physical Performance Battery, 5-repetition Sit-to-Stand, gait speed, and 4-Square Step Test, and a moderate-to-strong correlation with Timed Up-and-Go (r = 0.632), even after adjusting for age, sex, and BMI. Although the 3m-BWT exhibited superior discriminative ability compared to other tests (AUC = 0.655), its predictive power in isolation remains limited. The optimal cut-off point was identified at 5.5 s (sensitivity: 59.5%; specificity: 68.6%), while a threshold of <3.5 s yielded high sensitivity (98%) but low specificity, supporting its use in fall risk screening. Conclusions: These findings support the integration of the 3m-BWT as a complementary tool within comprehensive geriatric assessments, particularly in contexts requiring high sensitivity. Given the multifactorial nature of falls, combining the 3m-BWT with other clinical evaluations and fall history is recommended to enhance risk stratification and inform preventive strategies. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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19 pages, 2534 KiB

Open AccessArticle

Effects of Functional Partial Body Weight Support Treadmill Training on Mobility in Children with Ataxia: A Randomized Controlled Trial

by Alexandra Lepoura, Sofia Lampropoulou, Antonis Galanos, Marianna Papadopoulou, Georgios Gkrimas, Magda Tziomaki and Vasiliki Sakellari

J. Funct. Morphol. Kinesiol. 2025, 10(2), 123; https://doi.org/10.3390/jfmk10020123 - 6 Apr 2025

Viewed by 1641

Abstract

Background/Objectives: Ataxia is quite common in pediatric neuromotor disorders and has a highly heterogeneous etiology. Mobility difficulties and functional limitations reflect the lack of coordination in this population. The aim of this study is to assess the effectiveness of an intensive program of Functional Partial Body Weight Support Treadmill Training (FPBWSTT) on the mobility and functionality of children with ataxia. Methods: Through a stratified randomized control trial, a sample of 18 children with progressive and non-progressive ataxia and GMFCS II-IV (mean age: 14 years; standard deviation: 2.5) was assessed prior to the intervention, post-intervention, and 2 months after its end. Motor and functional skills were assessed with the Gross Motor Function Measure (GMFM, items D-E), the Pediatric Balance Scale (PBS), a 10 m walk test (10 MWT), a 6 min walk test (6 MWT), the Scale for Assessment and Rating Ataxia (SARA), the TimedUp and Go (TUG) test, spatiotemporal gait parameters, and kinetic and kinematic variables of the pelvis and lower limb. Results: Statistically significant interactions and changes in favor of the FPBWSTT were found in all functional assessments and spatiotemporal gait parameters (p < 0.05), the majority of which were maintained for two months. There was no statistical interaction or change in kinematic parameters (p > 0.05), while kinetic variables were insufficiently collected and were not statistically analyzed. Conclusions: The FPBWSTT is more effective on the mobility and functionality of children with ataxia who are 8–18 years old, compared to typical physiotherapy. Kinematic variables may not be sensitive indicators of change over a short period of time and/or in this population. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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21 pages, 7009 KiB

Open AccessArticle

Effects of Tactile Sensory Stimulation Training of the Trunk and Sole on Standing Balance Ability in Older Adults: A Randomized Controlled Trial

by Toshiaki Tanaka, Yusuke Maeda and Takahiro Miura

J. Funct. Morphol. Kinesiol. 2025, 10(1), 96; https://doi.org/10.3390/jfmk10010096 - 17 Mar 2025

Viewed by 1104

Abstract

Background: Aging is associated with a decline in both motor and sensory functions that destabilizes posture, increasing the risk of falls. Dynamic standing balance is strongly linked to fall risk in older adults. Sensory information from the soles and trunk is essential for balance control. Few studies have demonstrated the efficacy of targeted sensory training on balance improvement. Objectives: To assess vibratory sensation function in the trunk and sole using a vibration device and evaluate the effects of trunk and sole tactile sensation training on dynamic standing balance performance in older adults. Methods: In this randomized controlled trial, eighteen older adults were randomly assigned to three groups: control (n = 8, mean age 66.6 ± 3.4), trunk training (n = 5, mean age 71.0 ± 1.9), and sole training (n = 5, mean age 66.4 ± 3.6). The training lasted for 10 weeks, utilizing vibratory stimulation at 128 Hz through tuning forks for 15 min during each session, conducted three times a week. The primary outcomes were vibratory sensitivity, assessed with a belt-fitted device on the trunk and a plate equipped with vibrators on the soles, and dynamic balance, evaluated through force plate testing that measured limits of stability (LoS) in multiple directions. Results: Correct response rates for trunk vibratory stimulation significantly improved in the trunk training group (p < 0.05). The rate of two-stimuli discrimination improved in both training groups. Significant advancements in balance metrics were observed in the trunk and sole training groups when compared to the control group, especially regarding anterior–posterior tilts (p < 0.05). A positive correlation was identified between two-point vibratory discrimination and LoS test performance. Conclusions: Sensory training of the trunk and sole enhances balance performance in older adults, suggesting potential benefits for fall prevention. Future studies should assess long-term effects and explore optimal training duration with larger sample sizes. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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Review

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Open AccessReview

Associations Between Visual Accommodation and Cervical Muscle Activity and Symptomatology: A Systematic Review

by Miguel Ángel Lérida-Ponce, Miguel Ángel Lérida-Ortega, Ana Sedeño-Vidal and Alfonso Javier Ibáñez-Vera

J. Funct. Morphol. Kinesiol. 2025, 10(3), 252; https://doi.org/10.3390/jfmk10030252 - 1 Jul 2025

Viewed by 481

Abstract

Objectives: The aim of this study was to investigate the potential anatomical and physiological interconnections between the visual system and the cervical muscular system, as well as to examine the role of the visual system in the etiology and manifestation of cervical musculoskeletal pain or discomfort. Methods: A systematic review was conducted following the PRISMA guidelines, using databases such as PubMed, Scopus, Web of Science, CINAHL, and PEDro. The protocol was registered in PROSPERO. The included study designs comprised experimental studies, randomized controlled trials (RCTs), and pilot RCTs. Results: The literature search was conducted between January and May 2025 and yielded 51 studies across all databases. Seven experimental studies were finally included, all of which met the inclusion criteria and presented a mean methodological quality score of 5 on the PEDro methodological quality scale. The studies included data from a total of 308 participants (n = 261; 84.74% females). Subjects in the intervention group reported cervical pain or visual fatigue. Conclusions: Our results indicated a relationship between visual accommodation and increased electromyographic activity of the trapezius muscle, suggesting that accommodative stress may induce cervical muscle fatigue and pain. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies)

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