Société internationale de posturographie Agressologie, 1983, 24, 7 : 321-326

International Society of Posturography

© Copyright SPEI éditeur, Paris

Standardization in Platform Stabilometry being a

Part of Posturography

T.S. KAPTEYN *, W. BLES *, Çh. J. NJIOKIKTJIEN **, L. KODDE ***, C.H. MASSEN *** & J.M.F. MOL **** * ENT department
and ** Department of Neurology, Free University Hospital, Amsterdam
*** Department of Mechanical Engineering resp. Physics, University of Technology Eindhoven
and **** Department of clinical Neurophysiology, Hospital St Annadal, Maastricht

Posturography is not a clearly defined subject. Numerous in­ extra hampered by non-uniformity in presentation. At the fifth
vestigators are working in this field being active in technical International Symposium on Posturography in Amsterdam (1979)
laboratories, research institutes and medical departments. De­ this subject has been discussed. The general feeling was that
pendent on the intention and the focus of interest the problem posturography only will grow to a generally accepted clinical tool
statement is formulated and the approach is chosen. So rather when posturographic investigations in patients suffering from
different types of equipment are used to measure and study corresponding diseases deliver corresponding results in the various
postural stability and body movements either spontaneous or with clinical departments. In relation to this a need was felt for general
application of stimuli. One aspect of posturography is the recording agreements about methods and pre­ sensation of results. The
of body movements of subjects in standing position. ln this meeting decided to appoint a commit­ tee for preparing a report on
restricted sense of the word we will speak about stabilometry. A standardization in platform stabilometry to be presented in 1981 at
number of quite different methods are practized for the stabilometric the sixth International Symposium on Posturography on Kyoto. This
measurements. Without any claim or suggestion about report, introduced "to the members of the symposium, has been
completeness some sticking proves of inventivity will be mentioned. subject of a plenary discussion in the business meeting of the
Supposing certain rigidity in the body a number of authors studied society on Posturography in Kyoto 1981. In this discussion special
the movements of the head using accelerometers (Tokita, attention has been given to the result of a questionnaire distributed
Watanabe and Fukuda, 1972), light beams (Boman and Jalavisto, among 200 ENT physicians of leading hospitals in Japan which
1953; Jarrige, 1968; Kapteyn, 1972; Tokumasu and Kawano, 1976), nation wide survey delivered 115 responses out of different
strings (Fearing, 1924) and mechanical structures (Vierordt, 1864; departments. In this publication the report will be presented step by
Tokita, Miyata et aI., 1976) fixed to the head. Other authors step, as it was discussed at the meeting with the brief
measured the movement of the trunk, also using quite different considerations of ·the committee and the summary of the comment
methods as accelerometers (Thomas and Whitney, 1959) Light of the meeting.
(Hirasawa, 1973), sound sources (Guegen and Leroux, 1973);
Amblard and Cremieux, 1976), strings" (Kuhnke, 1950; Smith, 1957;
Neshner; 1971; Gantchev, Draganova and Dune v, 1972), magnetic
coils or video systems iKepteyn, 1973; Spaepen, Peeraer and
Willems, 1979). A less direct method tor studying the body stability Propositions on Standardization 1. DEFINITION.
is the recording of the movement of the body's point of pressure to
Platform stabilometry measures body movements of subjects in
the foot support using a force measuring platform.· The
standing position by means of a stabilometer, the assumption being
displacement of the point of pressure" is not only caused by a
that the stabilometer is a force-measuring platform.
possible shift of the body's point of gravity, but also by the
acceleration and deceleration forces related to the movements of CONSIDERATION: in the extended field of posturography a
the inertial mass of the body (Smith, 1957; Scott and Dzendolet, restricted part has to be fenced off to be called Platform
1972; Gurfinkel, 1973; Hlavacka and Litvinenkova, 1973; Kapteyn, Stabilometry.
1973; Geursen, Aliena et aI., 1976; Spaepen, Vranken and Willems,
1978; Massen and Kodde, 1979; Kodde, Caberg and Mol, 1982). COMMENT: none.
The contribution of this dynamic part is at least as large as that of 2. INDICATIONS OF DIRECTIONS.
the static part being the effect of the shift of the point of the body's
point of gravity. Besides that such a shift can be caused by a
movement of the standing subject as such it also can be caused by Designations used to indicate the direction of body movements
a change in configuration of the parts of the body in which case the during platform-stabilometric measurements should be:
measured shift is not representative for the subjects stability (Corti, Anterior (A), Posterior (P) Left (L) and Right (R), always defined
1959). In some platforms the static and dynamic components are from the subject's point of view.
separated. (Thomas and Whitney, "1959; Spaepen, Fortuin and
Willems, 1979). Some platform are sensitive for horizontal shearing CONSIDERATION: Although either Latin or English words can
forces as· well (Begbie, 1967; Dichgans, Mauritz et aI., 1976; be preferred here has been chosen for a connection to the common
Spaepen, Vranken and Willems," 1978). use in Neurology, EEG etc.
COMMENT: The recommended terms are preferred above
forward backward.
3. THE STABILOGRAM.

Ask for Standardization The body movements in standing position in one direction (either
AP or LR) can be presented as a function of time; this presentation
The studies using these different methods and instrumentations is to be called Stabilogram (symbol Stg). In this presentation the
deliver data and conclusions while the comparison is time scale is to be taken horizontally, and

321
the body movements in anterior and right direction, respectively, CONSIDERA TION: Dependent of the test situation or subject
should be written on the positive vertical axis, i.e. by an upward the center of a satokinesiqrarn can be situated outside the
excursion in the recording. calibration point being the place of the recording element when no
moment is exerted on the platform. This localisation has to be
CONSIDERATION: Gurfinkel c.s. use this notation and since it
shown as an essential source of information and should be
has grown to common use (Gurfinkel, Kotz and de Chick, 1965 ; mentioned expressed in units of the chosen system of refer­ ence
Helfand, Gurfinkel et al., 1964). (Baron, 1963 ; Litvinenkova and Baron, 1968)).
COMMENT: none.
COMMENT: none.
4. THE STATOKINESIGRAM.
8. RECOMMENDATIONS ABOUT THE TEST CIR­ CUMST
Body movements during standing can be presented as ex­ ANCES.
cursions of the body in the horizontal plane; for example as
excursions of the body"s point of pressure on the supporting Since the measurement of the subject"s stability can be influ­
platform. This type of presentation should be called Statokinesigram enced by the circumstances under which it takes place, the
(symbol Skg). In this presentation the UR movements should be following recommendations are made:
written on the horizontal x-axis, writing R in positive direction, i.e. as , a) The subject should remove his shoes and stand on the
a deflection to the right in the recording; the AlP movements should stabilometer platform with the heels together, at an angle of 30
be written on the vertical y-axis, writing A in positive direction, i.e. degrees between the medial sides of the feet.
as an upward deflec­ tion in the recording. b) No fixed sound sources should deliver information for spa­ tial
CONSIDERA TION: Baron c.s. use this notation. Since it has orientation in the room used for posturography; the noise level in
grown to common use (Baron, Bobot and Bessineton, 1956; Baron, the room should preferably be below ISO 40 dB(A).
1964). c) The room should be large enouqh to prevent acoustic spa­ tial
orientation, the mimimum area being preferably 3 x 4 metres. The
COMMENT: none.
stabilometer should be placed at least 1 metre
5. TIME OF RECORDING. from any wall. "
d) During registrations with the eyes open, the subject shoulo
The recording of postural movements should preferably start 10 focus on a circular area with a diameter of 5 cm, at a distance of 3
seconds before the time of analysis (i.e. the effective time interval metres straight ahead.
over which the signal is to be analysed), in order to eliminate
transient phenomeris. The time of analysis should preferably be 50 e) For recordings of visual postural stabilization the peripheral
seconds. field of vision should provide information on the verti­ cal, and the
room should have normal (diffuse) illumination of at least 40 lux
CONSIDERA TION: For a valid analysis the recording should be (lumen per square metre).
long enough to eliminate a first part disturbed by possible transient f) During registrations with the eyes closed, some low-Ievel dim
phenomena and to keep th an a period usable for a valid analysis light (about 20 lux) should be. presented ln the room in order to put
(Fearing, 1924; Kuhnke, 1950; Smith, 1953; Corti, 1959; Cantrell, the subject at ease and enable the investigator to observe him (her).
1963; Begbie, 1966, Jarrige, 1968; Sugano and Takeya, 1970;
Soames, Atha and Harding, 1976). CONSIDERA TION: Besides the instrumentation and the de­
fined test position the measuring results may be influenced by
COMMENT: The feeling is that up to now there is no evi­ dence secondary factors concerning the test circumstances (Thomas and
for an optimum length of the period of analysis. In Japanese centres Whitney, 1959; Cantrell, 1963; Begbie, 1967; Spaepen, Fortuin and
various periods are used for example 20 sec (23 0/0), 30 sec (37 0/0), Willems, 1979).
50 sec (7 0/0) and 60 sec (30 0/0). The meeting wishes results of
studies before making a decision in this. ad. a) the position of the feet and the possible support of shoes
will influence the result of the measurement (Fearing, 1924 a;
6. THE MENTIONING OF SCALE UNITS.
Begbie, 1967; ,Owen Black, O"Leary and Wall, 1976; Soames and
ln the presentation of Stabilograms, scale units should be defined Atha, 1978; Okubo, Watanabe et aI., 1979; Brauer and Seidel,
in Newton-metre-second units. Dependent on the stabilometer used, 1980).
the vertical axis should represent the dimen­ sion of force (Newton), ad. b) a fixed sound source can be a point for orientation and
moment of force (Newton-metre) or dis­ placement (metre). The reduce the measure of instability (Edwards, 1946; Takeya, Sugano
presentation should indicate the deflec­ tion in the Stabilogram due and Ohno, 1976; Marne-Karelse and Bles, 1977).
to a steady moment of force of 1.0 Newton-metre.
ad. c) reflection of sound against a wall can deliver spatial
CONSIDERA TION: Measuring platforms can measure quite orientation as used intensively by blind people (Edwards, 1942 1946;
different physical units (force, moment of force, displacement). For
Takeya, Sugano and Ohno, 1976; Marme-Karelse and Bles, 1977).
a good understanding of the presented data the scale units have to
be mentionedin a uniform system of reference. ad. d) the value of a test situation "eyes open" in relation to "eyes
COMMENT: none. closed" depends completely on the usability of the total potential of
the visual system. A fixation point must be situated within 5 meters
7. THE LOCALIZATION OF THE STATOKINESIGRAM. distance from the subjects head (Bles c.s.) (Edwards, 1946;
Guegen, Leroux et aI., 1976; Bles, Brandt et aI., 1978).
ln the presentation of the Statokinesigram, the centre of the figure
(Le. the intersection of the two axes) should be defined by the ad. e) The peripheral eye field must be saturated with infor­
situation in which no moment is exerted on the stabilometer. The mation about the vertical illuminated at a sufficient level (Ed­ wards,
dimensions should again be expressed on the axes in Newton- 1942, 1946; Wapner and Witkin, 1950; Fukuda, 1952" Begbie, 1966;
metre-second units. The presentation of a Statokinesigram should Litvinenkova and Baron, 1968; Hlavacka and Lit­ vinenkova, 1973;
state the coordinates of the mean value of the deflections in both Bles and de Wit, 1976; Lee and Lishman, 1976; Amblard and
directions. Carblanc, 1978; Kapteyn, Bles et aI., 1979"

322
Okubo, Watanabe et aI., 1979; Seidel and Brauer, 1979; Bles, 12. INDIVIDUAL DIMENSIONS.
Kapteyn et aI., 1980).
The subject's body weight and height influence the
ad. f) subjects feelings of unsteasiness as weil as a possible posturographic data, but no distinct correlation has so far been
peeping through eyelids have to be prevented (Edwards, 1946; established which could justify a uniform method of correlation. The
Begbie, 1967). subject's height and weight should therefore be specified in the
presentation, which should also mention the correction used in the
COMMENT: The foot position and the wearing of shoes has been
analysis in view of these factors.
discussed profoundly. As the basic question has been formulated
"What instruction is given to the patient about his way of standing". CONSIDERATION: ln literature no general accepted calculation
A situation of relaxed standing is incompatible with a obliged foot methods are presented concerning corrections for interindividual
position or a put off of the shoes. Especially in "some cultures the differences in weight and height reducing the standard deviation of
last event can be experienced as unpleasant and making the the platform stabilometric data in a population of healthy subjects.
subject uneasy. In the case that the subject is investigated in a Therefore in case of presentation individual stabilometric data the
special body attitude for exampie the military attitude the situation individual weight, height and age should be reported (Fearing, 1925;
can be defined as complete as whished. Hellebrandt, Tepper et aI., 1937; Wapner and Witkin, 1950;
Thomas and Whitney, 1959; Sugano and Takeya, 1970; Bessineton,
Concerning the sound in the testroom, usage of headphones or Bizzo et aI., 1976; Kapteyn, 1978; Hlavacka and Saling, 1979).
earplugs has been discussed and rejected. The feeling was that a
level of diffuse noise of 40 dB (A) might be tolerable but no spatial COMMENT: none.
orientation might be possible by means of a fixed sound source or
13. SAMPLING OF THE SIGNAL.
reflections of sound against fixed objects.
ln Conclusion: The recommendations about the visual aspects When the posturographic signal is sampled for analysis, the
got general agreement. The meeting asked for results of studies components in the higher frequencies should be eliminated by
about the effects of the instruction to the subject about the way of means of a low-pass filter. The sample rate to be used should be 20
standing on the results of the investigations (Fearing, 1925; Kuhnke, per second, i.e. 1024 samples in 50 seconds and 512 samples in
25 seconds, if it can be managed.
1950; Wapner and Witkin, 1950; Smith, 1953; Corti, 1959).
CONSIDERATION: The results of calculations can be influenced
by the sample rate with which the signais is digitized: so an
agreement is wanted. In making a decision one has to consider the
facilities of current instruments and the frequency considered as
9. THE STANDARD TEST CONDITION. being the highest valuable component in the stabilometric signal.
The standard stabilographic measurement condition (SC) is Taking 10Hz as being the highest valuable component the minimum
defined by the recommendations 8a, b, c, d and e. sample rate is 20 samples per second. For elimination a possible
disturbing effect of higher components should be filtered out before
CONSIDERATION: "The results of the stabilometric measure­ the sampling.
ments in healthy subjects show a large interindividual difference. So
no sharp normal values can be defined and the large standard COMMENT: The recommended sample-rate has been
deviations exclude a sharp criterium (Fearing, 1924 a, b, Kuhnke, experienced as being minimal. The cut-off frequency and the
1950; wepner and Witkin, 1950; Cantrell, 1963; Begbie, 1967; steepness of the filter should preferably be mentioned in a publica­
Litvinenkova and Baron, 1968; Sugano and Takeya, 1970; tion. The effect of various sample procedures has been mentioned
Bessineton, Bizzo et aI., 1976; Njiokiktjien and van Parys, 1976). as a subject for study and further discussion at the next symposium.
COMMENT: none. 14. MEASURES OF STABILlTY.

10. THE WEIGHT OF THE VISUAL CUES.

A measure of stability can be calculated in several ways.
The influence of visual information can be expressed in the so Two possibilities are suggested:
called Romberg quotient of the measure of stability obtained in the
a) The line integral per second (L) is the sum of the absolute
situation defined by 8a, b, c, f and the corresponding measure of values of the line segments between two successive samples of the
stability obtained in the standard condition (SC) (Njiokiktjien and de Statokinesigram (Skg), divided by the time of analysis (T). This
Rijke, 1972; Njiokiktjien and van Parys, 1976; van Parys and gives the equation:
Njiokiktjien, 1976; Owen Black, O"Leary and Wall, 1977).
CONSIDERATION: The weight factor of the visual information in 1 N 2 2
stability is unequal for the different subjects. So it is reasonable to L= "
T i=1
( xi ! xi!1 ) + ( yi ! yi!1 )  
define a relative factor.
COMMENT: none.
b) The root mean square (RMS) is the root of the quotient of the
11. THE WEIGHT OF SPECIFIC TASKS.
sum of the squares of the distances of the samples of the Skg to
The influence of factors or circumstances on the subject's the mean value of these samples and the number of samples.
stability can be related to the standard condition (SC) in a way This gives the equation
similar to that described for the Romberg quotient.
CONSIDERATION: Just as the influence of visual information the
effect of other tasks will be dependent on the situation and personal N
factors, so its reasonable to define relative measures.
&"#( x ! x ) + ( y ! y ) $%
2 2
i i
i=1
S=  
COMMENT: none. N
 CONSIDERATION: Two possible measures for stability are COMMENT: Before a possible decision about frequency bands,
presented as being examples (Agajan, 1967; Sugano and Takeya, more basic studies have to be made about sample rate, time of
1970; Njiokiktjien and de Rijke, 1972; Kapteyn and Bles, 1976; van analysis and methods of frequency analysis. A profound discussion
Parys and Njiokiktjien, 1976; Kodde, Caberg and Mol, 1982). should be prepared to be held, at the seventh symposlurn in
COMMENT: none. Houston. (Wapnerand Witkin, 1950; Thomas and Whitney, 1959;
Helfand, Gurfinkel et aI., 1964; Begbie, 1967; Gentchev, Draganova
15. FREOUENCY ANALYSIS. and Dune v, 1972; Leroux, Baron et aI., 1973; Dichgans, Mauritz et
aI., 1976; Njiokiktjien and van Parys, 1976; van Parys and
Njiokiktjien, 1976; Soames, Atha and Harding, 1976; Tokite, Miyata
When a frequency analysis is made, for example according to et aI., 1976; Seidel, Brauer et al., 1978).
Fourier, the presentation of results should show the frequencies
plotted on the horizontal axis in a logarithmic scale between 0.02
Hz and 10Hz; the amplitude of the spectrum should be presented
vertically in a linear scale, with dimensions and units indicated. 17. MENTIONING OF THE RECOMMENDATIONS ABOUT
STANDARDIZATION.
CONSIDERATION: The recommended presentation is a con­
solidation of what has been grown as common use (Agajan, 1967; A presentation of a stabilometric study should state whether the
Sugano and Takeyda, 1970; Aggashyan, 1972; Scott and above mentioned recommendations were or were not followed. If
Dzendolet, 1972; de Wit, 1972; Gueguen and Leroux, 1973; Leifer not, then the experimental conditions should be described in detail.
and Meyer, 1-975; Owen Black, O"Leary and Wall, 1976; Matsuoka, CONSIDERATION: The use and mention of the
1977; Taguchi, 1978; Brauer and Seidel, 1979; Watanabe, Okubo recommendations will promote the standardlzation.
and Ishida, 1980).
COMMENT: The meeting agrees the intention for growing to
COMMENT: none. standardization in stabilornetry and recommends studies about
16. FREQUENCY BANDS. subjects mentioned before for having a useful and good prepared
discussion at the Houston Symposium in 1983.
The frequency content of an analysis can be presented by an
THE COMMITTEE FOR STANDARDIZATION OF STABILOMETRIC
integration of the amplitudes within frequency bands, the limits of
METHODS AND PRESENTATIONS,
these bands being 0.02 Hz, 0.2 Hz, 2 Hz and 10 Hz.,
CONSIDERATION: The selectivity of a frequency-analysis
depends of a number of factors and the sharpness of a peak is not
necessarily indicative for a diagnostic event. In connection to this it T .S. Kapteyn {et President ISP)
may be useful to integrate the spectrurn within frequency bands Ch. J. Nijkoktjien (Secretary ISP)
W. Bles
related to physiological movements or specific diagnoses.
L.Kodde
"C.H. Massen
J.M.F. Mol

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