{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T18:14:05Z","timestamp":1778264045715,"version":"3.51.4"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Falls, a major cause of injury and disability, particularly among older adults, present a significant public-health challenge. Existing methods of balance assessment often lack the sensitivity and specificity needed to identify subtle deviations from normal patterns, hindering early intervention. To address this gap, we introduced a novel artificial intelligence-based tool that leverages anomaly detection to provide a comprehensive assessment of balance performance across all age groups. This study evaluated the tool\u2019s effectiveness in 163 individuals aged 18\u201385 years who were assessed using a force platform under four conditions: eyes open and eyes closed on firm and foam surfaces. Data analysis, employing an artificial neural network with 19 socio-anthropometric and postural variables, showed the tool\u2019s exceptional accuracy (R = 0.99998) in differentiating among balance profiles. Notably, the model highlighted the significant impact of age and education on balance, with older adults demonstrating increased reliance on visual input, especially when somatosensory information was reduced on foam surfaces. In contrast, younger, more educated individuals exhibited a more integrated sensorimotor approach. These findings demonstrate that our anomaly-detection tool can identify subtle balance impairments often missed by traditional methods, offering valuable insights for personalized fall-risk assessment and intervention. This AI-based approach can provide a holistic assessment of balance, leading to more effective strategies for fall prevention and rehabilitation, particularly in aging populations.<\/jats:p>","DOI":"10.3390\/life15040632","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:46:20Z","timestamp":1744274780000},"page":"632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Development of a Tool for Comprehensive Balance Assessment Based on Artificial Intelligence and Anomaly Detection"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4382-0159","authenticated-orcid":false,"given":"M\u00e1rcio Fagundes","family":"Goethel","sequence":"first","affiliation":[{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"},{"name":"Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal"}]},{"given":"Klaus Magno","family":"Becker","sequence":"additional","affiliation":[{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"},{"name":"Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-6475","authenticated-orcid":false,"given":"Franciele Carvalho Santos","family":"Parolini","sequence":"additional","affiliation":[{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"},{"name":"Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4528-4644","authenticated-orcid":false,"given":"Ulysses Fernandes","family":"Ervilha","sequence":"additional","affiliation":[{"name":"Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal"},{"name":"Laboratory of Physical Activity Sciences, School of Arts, Sciences, and Humanities, University of S\u00e3o Paulo, S\u00e3o Paulo 03828-000, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4109-2939","authenticated-orcid":false,"given":"Jo\u00e3o Paulo","family":"Vilas-Boas","sequence":"additional","affiliation":[{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"},{"name":"Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"key":"ref_1","first-page":"i3","article-title":"The global burden of falls: Global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017","volume":"26","author":"James","year":"2020","journal-title":"Inj. Prev. J. Int. Soc. Child Adolesc. Inj. Prev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1186\/s13256-023-04296-z","article-title":"Assessment of spatiotemporal characteristics of gait, trough the Phyphox\u00ae app: A case series","volume":"17","author":"Cabo","year":"2023","journal-title":"J. Med. Case Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2025889","DOI":"10.1001\/jamanetworkopen.2020.25889","article-title":"Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial","volume":"3","author":"Dykes","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s00221-001-0968-6","article-title":"Anticipatory control of center of mass and joint stability during voluntary arm movement from a standing posture: Interplay between active and passive control","volume":"143","author":"Patla","year":"2002","journal-title":"Exp. Brain Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S1050-6411(02)00085-8","article-title":"Motor mechanisms of balance during quiet standing","volume":"13","author":"Winter","year":"2003","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/0021-9290(93)90027-C","article-title":"Control of whole body balance in the frontal plane during human walking","volume":"26","author":"MacKinnon","year":"1993","journal-title":"J. Biomech."},{"key":"ref_7","first-page":"601","article-title":"The analysis of COP and joint position sense in university soccer players with and without ankle instability","volume":"30","author":"Neto","year":"2016","journal-title":"Rev. Bras. Educ. F\u00eds. Esporte"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.arr.2014.12.005","article-title":"Acquiring visual information for locomotion by older adults: A systematic review","volume":"20","author":"Uiga","year":"2015","journal-title":"Ageing Res. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1177\/00315125221149147","article-title":"Multifractal Nonlinearity Moderates Feedforward and Feedback Responses to Suprapostural Perturbations","volume":"130","author":"Lee","year":"2023","journal-title":"Percept. Mot. Skills"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.archger.2018.04.007","article-title":"Age-related changes in the range and velocity of postural sway","volume":"77","year":"2018","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ihlen, E.A.F., van Schooten, K.S., Bruijn, S.M., van Die\u00ebn, J.H., Vereijken, B., Helbostad, J.L., and Pijnappels, M. (2018). Improved Prediction of Falls in Community-Dwelling Older Adults Through Phase-Dependent Entropy of Daily-Life Walking. Front. Aging Neurosci., 10.","DOI":"10.3389\/fnagi.2018.00044"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Amirpourabasi, A., Lamb, S.E., Chow, J.Y., and Williams, G.K.R. (2022). Nonlinear Dynamic Measures of Walking in Healthy Older Adults: A Systematic Scoping Review. Sensors, 22.","DOI":"10.3390\/s22124408"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1590\/S0100-879X2009000700012","article-title":"Estimation procedures affect the center of pressure frequency analysis","volume":"42","author":"Vieira","year":"2009","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e15067","DOI":"10.14814\/phy2.15067","article-title":"A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code","volume":"9","author":"Quijoux","year":"2021","journal-title":"Physiol. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Pastor-Mira, M.A., L\u00f3pez-Roig, S., Mart\u00ednez-Zaragoza, F., Le\u00f3n, E., Abad, E., Lled\u00f3, A., and Pe\u00f1acoba, C. (2019). Goal preferences, affect, activity patterns and health outcomes in women with fibromyalgia. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.01912"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"ii7","DOI":"10.1093\/ageing\/afl077","article-title":"Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls?","volume":"35","author":"Horak","year":"2006","journal-title":"Age Ageing"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature14539","article-title":"Deep learning","volume":"521","author":"Lecun","year":"2015","journal-title":"Nature"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.media.2017.07.005","article-title":"A survey on deep learning in medical image analysis","volume":"42","author":"Litjens","year":"2017","journal-title":"Med. Image Anal."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"90","DOI":"10.35784\/acs-2024-18","article-title":"Application of Eemd-Dfa Algorithms and Ann Classification for Detection of Knee Osteoarthritis Using Vibroarthrography","volume":"20","author":"Machrowska","year":"2024","journal-title":"Appl. Comput. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43","DOI":"10.35784\/acs-2024-15","article-title":"Modeling the Optimal Measurement Time with a Probe on the Machine Tool Using Machine Learning Methods","volume":"20","author":"Kulisz","year":"2024","journal-title":"Appl. Comput. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Niethammer, M., Styner, M., Aylward, S., Zhu, H., Oguz, I., Yap, P.-T., and Shen, D. (2017). Unsupervised Anomaly Detection with Generative Adversarial Networks to Guide Marker Discovery BT\u2014Information Processing in Medical Imaging, Springer.","DOI":"10.1007\/978-3-319-59050-9"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1590\/S1413-35552010000300003","article-title":"Revision of posturography based on force plate for balance evaluation","volume":"14","author":"Duarte","year":"2010","journal-title":"Rev. Bras. Fisioter."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e2648","DOI":"10.7717\/peerj.2648","article-title":"A public data set of human balance evaluations","volume":"4","author":"Santos","year":"2016","journal-title":"PeerJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.apmr.2014.06.021","article-title":"Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: A scoping review","volume":"96","author":"Sibley","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.gaitpost.2011.02.008","article-title":"Non-linear re-calibration of force platforms","volume":"33","author":"Cappello","year":"2011","journal-title":"Gait Posture"},{"key":"ref_26","first-page":"25","article-title":"Bayesian regularization of neural networks","volume":"458","author":"Burden","year":"2008","journal-title":"Methods Mol. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Parolini, F., Goethel, M., Becker, K., Fernandes, C., Fernandes, R.J., Ervilha, U.F., Santos, R., and Vilas-Boas, J.P. (2023). Breaking Barriers: Artificial Intelligence Interpreting the Interplay Between Mental Illness and Pain as Defined by the International Association for the Study of Pain. Biomedicines, 11.","DOI":"10.3390\/biomedicines11072042"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Winter, D.A. (2009). Three-Dimensional Kinematics and Kinetics. Biomechanics and Motor Control of Human Movement, John Wiley & Sons.","DOI":"10.1002\/9780470549148.ch7"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Avanzino, L., Gueugneau, N., Bisio, A., Ruggeri, P., Papaxanthis, C., and Bove, M. (2015). Motor cortical plasticity induced by motor learning through mental practice. Front. Behav. Neurosci., 9.","DOI":"10.3389\/fnbeh.2015.00105"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1097\/00004647-200003000-00006","article-title":"Neural substrate for the effects of passive training on sensorimotor cortical representation: A study with functional magnetic resonance imaging in healthy subjects","volume":"20","author":"Carel","year":"2000","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/j.1600-0404.1998.tb00622.x","article-title":"Implicit and explicit learning in an auditory serial reaction time task","volume":"97","author":"Zhuang","year":"1998","journal-title":"Acta Neurol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1068\/p100029","article-title":"The dominance of touch by vision: Occurs with familiar objects","volume":"10","author":"Power","year":"1981","journal-title":"Perception"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1126\/science.143.3606.594","article-title":"Vision and Touch: An Experimentally Created Conflict Between the Two Senses","volume":"143","author":"Rock","year":"1964","journal-title":"Science"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0926-6410(02)00068-X","article-title":"The ventriloquist in motion: Illusory capture of dynamic information across sensory modalities","volume":"14","author":"Lyons","year":"2002","journal-title":"Cogn. Brain Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"681","DOI":"10.4065\/77.7.681","article-title":"Achieving and maintaining cognitive vitality with aging","volume":"77","author":"Fillit","year":"2002","journal-title":"Mayo Clin. Proc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"42","DOI":"10.3928\/02793695-20100331-03","article-title":"Interventions to reduce cognitive dfecline in aging","volume":"48","author":"Williams","year":"2010","journal-title":"J. Psychosoc. Nurs. Ment. Health Serv."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/4\/632\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:54Z","timestamp":1760029914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/4\/632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,10]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["life15040632"],"URL":"https:\/\/doi.org\/10.3390\/life15040632","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,10]]}}}