Reorientation to vertical modulated by combined support surface tilt and virtual visual flow in healthy elders and adults with stroke.

We explored how changes in visual attention impacted postural motor performance in healthy elders and adults post-stroke within a virtual reality environment, including when vestibular information was not perceptible. Visual dependence in 13 healthy (50-80 years) and 13 adults post-stroke (49-70 years) was assessed with a rod-and-frame task. Three degree support surface dorsiflexion tilts at 30°/s were combined with 30° and 45°/s continuous pitch rotations of the visual environment. The support surface remained tilted for 30 s followed by a 0.1°/s return to neutral during continued visual field rotation. Body displacement and ankle muscle responses were recorded, and wavelet transforms calculated. Muscle frequencies and kinematic measures were examined with functional principal component analysis, and weights compared through mixed model repeated measures ANOVA. Both populations exhibited increased backward sway with pitch upward visual field motion; adults post-stroke produced significantly larger muscle responses. Lateral sway was most regulated when visual flow velocity matched platform velocity. Visual flow summed with direction of support surface instability and visually dependent individuals produced more controlled lateral sway when viewing a dynamic visual field. Provoking postural instability within a dynamic visual flow field could serve as a training tool for postural stabilizing actions, particularly when visual dependence is exhibited.