Experimental quantification of balance using whole-body stability regions from postural sway exercises

Experimental quantification of balance using whole-body stability regions from postural sway exercises | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experimental quantification of balance using whole-body stability regions from postural sway exercises Kübra Akbaş, Neethan Ratnakumar, Rachel Jones, Marianne Doss, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8139023/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Mar, 2026 Read the published version in BioMedical Engineering OnLine → Version 1 posted 13 You are reading this latest preprint version Abstract Background Comprehensive balance assessment is essential for evaluating balance deficiencies, particularly in individuals with limited mobility and increased fall risk. However, clinical balance assessments often rely on subjective scoring and simplified models that may not capture the full dynamics of human postural control. Additionally, center of pressure (COP)-based metrics and inverted pendulum models offer limited insight into whole-body balance ability. Balance regions (BRs) offer a more holistic approach by quantifying balanced center of mass (COM) states. Previously, BRs were used to assess the balancing capabilities of bipedal systems and humans in simulation; however, there is a lack of real-world implementations of whole-body BR analyses in human balance. Methods This study presents a novel experimental framework to quantify human balance using COM-based BRs derived from large postural sway tasks. The subjects comprised 22 healthy young adults who performed voluntary, supported, and perturbed anterior–posterior (AP) sway exercises while standing on force plates, with a full-body motion capture setup. COM trajectories were obtained from individualized musculoskeletal models in OpenSim to construct BRs, which were compared with linear inverted pendulum (LIP) limits. Key COM-based metrics included maximum AP margin of stability (MoS), maximum AP velocity, extrapolated COM (XcoM) range, and BR areas. COP measures (root mean square (RMS), range, 95% confidence ellipse area, mean AP velocity) and joint kinematics were also analyzed. Results COM trajectories largely stayed within the LIP-based analytical boundaries, with BRs capturing individualized balance envelopes. Significant sex differences were observed in the maximum posterior MoS ( p = 0.01974), XcoM range metrics ( p < 0.03924), and BR areas ( p < 0.045). COP metrics varied significantly across tasks in the RMS, 95% confidence ellipse area, and mean velocity ( p < 0.02046), and inverse kinematics revealed distinct joint coordination patterns during sway; there was a significant sex difference in the COP range during perturbed backward sway ( p = 0.03053). Conclusions This study presents a novel, COM-based experimental framework for balance assessment that captures whole-body stability regions from dynamic postural tasks. BRs provide a quantitative and individualized measure of balance capacity beyond traditional metrics. This framework has potential for fall risk evaluation, balance training, and integration with wearable or markerless motion capture in clinical and neurorehabilitation settings. Balance musculoskeletal modeling motion capture center of mass center of pressure inverse kinematics Full Text Additional Declarations No competing interests reported. Supplementary Files Additionalfile5.mp4 Additionalfile4.mp4 Additionalfile3.mp4 Additionalfile7.docx Additionalfile1.mp4 Additionalfile8.docx Additionalfile6.docx Additionalfile2.mp4 Cite Share Download PDF Status: Published Journal Publication published 07 Mar, 2026 Read the published version in BioMedical Engineering OnLine → Version 1 posted Editorial decision: Revision requested 29 Dec, 2025 Reviews received at journal 21 Dec, 2025 Reviews received at journal 10 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviews received at journal 07 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 02 Dec, 2025 Reviewers invited by journal 02 Dec, 2025 Editor assigned by journal 20 Nov, 2025 Submission checks completed at journal 20 Nov, 2025 First submitted to journal 17 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8139023","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554837025,"identity":"89fbf762-7c1b-433c-b01c-2a76e8d93bf2","order_by":0,"name":"Kübra Akbaş","email":"","orcid":"","institution":"New Jersey Institute of Technology","correspondingAuthor":false,"prefix":"","firstName":"Kübra","middleName":"","lastName":"Akbaş","suffix":""},{"id":554837026,"identity":"0e6e2454-35db-4537-92fb-75633eda0582","order_by":1,"name":"Neethan Ratnakumar","email":"","orcid":"","institution":"New Jersey Institute of 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exercises","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"biomedical-engineering-online","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmeo","sideBox":"Learn more about [BioMedical Engineering OnLine](http://biomedical-engineering-online.biomedcentral.com/)","snPcode":"12938","submissionUrl":"https://submission.nature.com/new-submission/12938/3","title":"BioMedical Engineering 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However, clinical balance assessments often rely on subjective scoring and simplified models that may not capture the full dynamics of human postural control. Additionally, center of pressure (COP)-based metrics and inverted pendulum models offer limited insight into whole-body balance ability. Balance regions (BRs) offer a more holistic approach by quantifying balanced center of mass (COM) states. Previously, BRs were used to assess the balancing capabilities of bipedal systems and humans in simulation; however, there is a lack of real-world implementations of whole-body BR analyses in human balance.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study presents a novel experimental framework to quantify human balance using COM-based BRs derived from large postural sway tasks. The subjects comprised 22 healthy young adults who performed voluntary, supported, and perturbed anterior\u0026ndash;posterior (AP) sway exercises while standing on force plates, with a full-body motion capture setup. COM trajectories were obtained from individualized musculoskeletal models in OpenSim to construct BRs, which were compared with linear inverted pendulum (LIP) limits. Key COM-based metrics included maximum AP margin of stability (MoS), maximum AP velocity, extrapolated COM (XcoM) range, and BR areas. COP measures (root mean square (RMS), range, 95% confidence ellipse area, mean AP velocity) and joint kinematics were also analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCOM trajectories largely stayed within the LIP-based analytical boundaries, with BRs capturing individualized balance envelopes. Significant sex differences were observed in the maximum posterior MoS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01974), XcoM range metrics (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.03924), and BR areas (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.045). COP metrics varied significantly across tasks in the RMS, 95% confidence ellipse area, and mean velocity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.02046), and inverse kinematics revealed distinct joint coordination patterns during sway; there was a significant sex difference in the COP range during perturbed backward sway (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03053).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study presents a novel, COM-based experimental framework for balance assessment that captures whole-body stability regions from dynamic postural tasks. BRs provide a quantitative and individualized measure of balance capacity beyond traditional metrics. This framework has potential for fall risk evaluation, balance training, and integration with wearable or markerless motion capture in clinical and neurorehabilitation settings.\u003c/p\u003e","manuscriptTitle":"Experimental quantification of balance using whole-body stability regions from postural sway exercises","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 22:46:57","doi":"10.21203/rs.3.rs-8139023/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-29T14:35:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T18:52:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-10T13:21:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14407643777423059051143449118176079419","date":"2025-12-08T09:12:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T10:46:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264622920421127574316224348706525513095","date":"2025-12-04T22:15:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108409767958104098313718443477755863671","date":"2025-12-03T17:50:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311345006403491540037235232612715897655","date":"2025-12-03T15:24:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328688298811260900719374846430169276817","date":"2025-12-02T20:22:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-02T20:13:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-20T22:46:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-20T22:46:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BioMedical Engineering OnLine","date":"2025-11-17T20:57:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"biomedical-engineering-online","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmeo","sideBox":"Learn more about [BioMedical Engineering OnLine](http://biomedical-engineering-online.biomedcentral.com/)","snPcode":"12938","submissionUrl":"https://submission.nature.com/new-submission/12938/3","title":"BioMedical Engineering OnLine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c121866-cade-4705-8964-b92c5c329ea8","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:05:55+00:00","versionOfRecord":{"articleIdentity":"rs-8139023","link":"https://doi.org/10.1186/s12938-026-01546-1","journal":{"identity":"biomedical-engineering-online","isVorOnly":false,"title":"BioMedical Engineering OnLine"},"publishedOn":"2026-03-07 15:59:58","publishedOnDateReadable":"March 7th, 2026"},"versionCreatedAt":"2025-12-04 22:46:57","video":"","vorDoi":"10.1186/s12938-026-01546-1","vorDoiUrl":"https://doi.org/10.1186/s12938-026-01546-1","workflowStages":[]},"version":"v1","identity":"rs-8139023","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8139023","identity":"rs-8139023","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}