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Biomedical subjects

Marjorie Woollacott

Publications and source records attributed to Marjorie Woollacott.

10 recordsLinked to original sources

Accuracy and underlying mechanisms of shifting movements in cellists.

Accuracy of shifting movements between two notes was examined in nine cellists (intermediate-professional skill levels). Three pairs of notes separated by different distances were tested under the same movement rate. Finger position on the string was measured by a circuit. Angular velocities of the left upper arm and forearm were measured by two angular velocity sensors; thus elbow angular velocity during shifts was estimated. Results showed that with increased elbow velocity and shifting distance endpoint variability stayed constant. The force of gravity assisted elbow extension during shifts toward higher pitched notes compared to flexion towards lower pitched notes, but faster movement velocity did not result in increased landing variability. Performance for note E on the A string was found to be less variable than other notes, suggesting that physical cue from the cello body geometry was used as a landmark for finger position. Cutaneous feedback from the thumb when hitting the body-neck junction enabled faster elbow extension velocity compared to shifts towards other notes. Cellists who showed higher performance accuracy also showed higher perceptual ability and performance proficiency. These results suggest that long-term over-training of fast and accurate movements enables musicians to maintain accuracy and variability across different movement distances and velocities. Higher perceptual ability and performance proficiency are correlated with increased accuracy but not lower variability, indicating although perceptual ability and performance proficiency are important for pitch accuracy, movement variability is still constrained by the capacity of the motor system, which is highly fine-tuned and different than non-musicians.

Analysis of Variance↗

Ankle force and rate of force production increase following high intensity strength training in frail older adults.

BACKGROUND AND AIMS: The most common cause of accidental injury and death in people over age 65 results from impacts associated with falling. Balance impaired older adults have poorer balance control than healthy young adults or healthy older adults. Lack of sufficient lower extremity strength and inability to rapidly produce muscle force may contribute to diminished balance control in the elderly. This study evaluated the effect of a 10-week high intensity strength-training program targeting key lower extremity muscles for the purpose of improving postural control in frail older adults. METHODS: Thirteen experimental and fourteen control subjects, all balance impaired older adults were evaluated in response to unexpected platform perturbations that simulated slips. RESULTS: Following strength training the experimental group was significantly stronger than the control group. Mean ankle moments improved in the experimental group following strength training during forward sway (Right: p=0.067, Left: p=0.009) and backward sway (Right: p=0.031, Left: p=0.058). For the backward sway condition the ankle rate of torque production increased significantly in the experimental group (Right: p=0.016, Left: p=0.031). CONCLUSIONS: Enhancement of lower extremity strength contributed to improvements in balance stability demonstrated by greater ankle force production, in response to balance threats.

Accidental Falls↗

Association between sensorimotor function and functional and reactive balance control in the elderly.

OBJECTIVES: Postural disturbances can arise from performing functional tasks and from external perturbations. Identification of sensorimotor factors associated with both types of balance control in the elderly can help us to understand better the balance problems facing older adults. DESIGN: Cross-sectional. SUBJECTS: Healthy young, stable older, and functionally unstable older adults with 16 participants in each group. METHODS: Clinical vibration sense and muscle strength of the lower extremity, and functional balance (FB) tests were conducted. The timing and amplitude of the reactive postural muscle responses of the leg postural muscles, recorded from standing subjects following support surface backward translation, were also examined. RESULTS: Young and older subjects differed significantly in the amplitude of their postural muscle responses, while the two older groups differed significantly in muscle strength and FB. When age was controlled, the strength of the ankle dorsi- and plantar-flexors was the only significant predictor for FB. For reactive postural muscle responses, none of the sensorimotor factors was significant. CONCLUSION: Functional and reactive balance abilities differed in their associating factors. The difference in the patterns of association for functional and reactive balance implies the need for separate assessment for these two categories of balance control clinically.

Adult↗

An intensive massed practice approach to retraining balance post-stroke.

BACKGROUND AND PURPOSE: Falls are highly prevalent and a significant source of complications post-stroke. This study tested the efficacy of standard physical therapy (based on the task-oriented approach) delivered in a massed practice paradigm. The purpose of this study was to test if the intensive massed practice intervention (6h/day for 2 consecutive weeks) could significantly improve balance function post-stroke. METHODS: A single-subject multiple baseline design across subjects with probes was utilized with ten subjects with chronic stroke disability. Clinical tests and time to stabilization (TTS) of the center of pressure in response to a platform perturbation were calculated during baseline, intervention, and the maintenance phases. RESULTS: The ability of the subjects to recover from a balance threat improved, with mean TTS decreasing from 2.35 +/- .51 s during baseline, to 1.58+/-.23s during training, and further still to 1.45 +/- .29 s during the maintenance phase, ending 3 months post-intervention. Clinical findings demonstrated improvements in anticipatory and steady-state balance control. In addition weight-bearing symmetry improved and the number of falls sustained reduced. CONCLUSIONS: Intensive massed practice of standard physical therapy produced significant results in balance retraining with patients post-stroke. Our finding support the need to offer additional practice to maximize the efficacy of physical therapy sessions.

Adolescent↗

Effect of high-intensity strength-training on functional measures of balance ability in balance-impaired older adults.

OBJECTIVE: The aim of this study was to evaluate the effect of a 10-week, high-intensity strength-training program targeting key lower extremity muscles for the purpose of improving postural control in balance-impaired older adults. METHODS: A quasi-experimental, delayed entry controlled design was used to evaluate balance ability in balance-impaired older adults after participation in 10 weeks of high-intensity strength training focused on the quadriceps, hamstrings, tibialis anterior, and gastrocnemius muscles. Participants were evaluated using validated clinical measures of functional balance ability: the Berg Balance Scale, the Timed Up and Go, and the Activities-Specific Balance Confidence Scale. RESULTS: After strength training, the exercisers were significantly stronger than the control subjects. They improved significantly on the Berg Balance Scale (P = .030) from a mean score of 48.8 +/- 2.4 of 56 before training to 51.2 +/- 4.3 of 56 after training. The Timed Up and Go (P = .045) and the Activities-Specific Balance Confidence Scale (P = .038) also improved significantly in the experimental group. These changes are associated with a decrease in fall risk. CONCLUSIONS: High-intensity strength training can safely and effectively strengthen lower extremity muscles in balance-impaired older adults, resulting in significant improvements in functional balance ability and decreased fall risk.

Aged↗

Effect of balance training on muscle activity used in recovery of stability in children with cerebral palsy: a pilot study.

This study explored possible neural mechanisms that contribute to improvements in balance control produced by reactive balance training in children with cerebral palsy (CP). Six children with CP (four males, two females; mean age 9y 4mo), two with spastic hemiplegia (Gross Motor Function Classification System [GMFCS] level I) and four with spastic diplegia (GMFCS level II,) were given 5 days of intensive training in reactive balance control (100 perturbations per day on a moveable force platform). Surface electromyography was used to characterize changes in neuromuscular responses pretraining, immediately posttraining, and 1 month posttraining. Training in reactive balance control resulted in improvements in directional specificity of responses (a basic level of response organization) and other spatial/temporal characteristics including: (1) faster activation of muscle contraction after training, allowing children to recover stability faster; (2) emergence of a distal-proximal muscle sequence; and (3) improved ability to modulate the amplitude of muscle activity (increased amplitude of agonist and decreased amplitude of antagonist, reducing coactivation). Each child with spastic hemiplegia or diplegia showed a different combination of factors that contributed to improved performance; the level of change in neural factors depended on the severity of involvement of the child: hemiplegia vs diplegia, and level of involvement within each diagnostic category.

Adolescent↗

From egocentric to exocentric spatial orientation: development of posture control in bimanual and trunk inclination tasks.

The authors investigated the emergence of independent control of body segments in bimanual tasks involving either voluntary or involuntary trunk motion by tracking the transition from an ego- to an exocentric mode of postural control during childhood (i.e., from body-referenced orientation to externally referenced action). A paradigm combining a seated manual task and various trunk manipulations described the coordination strategies used by 24 children at different ages (2 to 9 years) and by adults. The following questions were asked: (a) When do children begin to dissociate upper limb movements from those of the trunk? (b) What segmental strategies are exhibited by each age group (2-3, 4-6, and 7-9 years, and adults)? Kinematic analyses revealed that younger children (2-6 years) used either the trunk or the support surface as reference to orient the limbs. Older children (7-9 years) began to use a gravitational reference frame similar to that of adults; they uncoupled upper limb motion from the trunk in either voluntary or imposed conditions. Young children patterned the forearm trajectory after the initiating segment (support surface or the trunk), thus reducing the degrees of freedom during the dual task. Echoing previous reports, 7-9 years of age appears to be a critical period in which children master postural control and develop an internal representation of body scheme.

Adult↗

Effect of balance training on recovery of stability in children with cerebral palsy.

This study examined the effect of massed practice in balance recovery of stability in six children (four males, two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by the center of pressure over a one second period) and time to stabilization from center of pressure measures were calculated following perturbations. The intervention phase consisted of massed practice on the moving platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as demonstrated by reduced center of pressure area and time to stabilization following training. These improvements were still present 30 days following completion of training. Results suggest that postural control mechanisms in school-age children (7 to 13 years) with CP are modifiable.

Adolescent↗

Developmental changes in compensatory responses to unexpected resistance of leg lift during gait initiation.

The development of the ability to integrate postural adjustments into the gait initiation process was investigated in children, using both kinematic and electromyographic (EMG) analysis. Subjects included children of 1 year of age (1-4 months' walking experience), 2-3 years of age (9-17 months' walking experience), 4-5 years of age (3-4 years' walking experience), and adults. We perturbed the balance of the children during gait initiation to determine the point at which infants begin to develop and finally master the ability to respond to external threats to balance during the gait initiation process. A magnet attached to the force platform on which the child stood was activated and served to resist the child's gait initiation (metal plaques on the soles of the shoes were attracted by the magnet) and thus served as an external perturbation during the gait initiation process. Kinematic and EMG analysis indicated that, while the ability to use preparatory postural adjustments in the gait initiation process emerges early in development, the ability to react efficiently to perturbations during gait initiation does not develop until after about 4-5 years of age. Though even the youngest age groups showed some response to the perturbation, it was highly variable, indicating its primitive form. The main response to the perturbation was a slight decrease in latency and increase in amplitude in the muscles used for push-off for gait initiation. Interestingly there was a shift in response pattern at 4-5 years of age, in both kinematic and EMG patterns. The amplitudes of the lateral and anteroposterior trunk and stance leg oscillations were significantly increased. In addition, the muscle response amplitudes (hamstrings and second quadriceps burst) of the swing leg were significantly increased and delayed (hamstring and gastrocnemius), with coactivation of agonist and antagonist muscles at the knee and ankle joint, concomitant with an exaggerated foot height of the first step.

Adaptation, Physiological↗

Attention and the control of posture and gait: a review of an emerging area of research.

Research on the relationship between attention and the control of posture and gait is a new and expanding area with studies on young adults revealing the role of cognitive factors in the control of balance during standing and walking. The use of dual task paradigms to examine the effect of age related changes in attentional requirements of balance control and age-related reductions in stability when performing a secondary task has shown that these are important contributors to instability in both healthy and balance-impaired older adults. The attentional demands of balance control vary depending on the complexity of the task and the type of secondary task being performed. New clinical assessment methods incorporating dual-task paradigms are helpful in revealing the effect of disease (e.g. Parkinson's disease) on the ability to allocate attention to postural tasks and appear to be sensitive measures in both predicting fall risk and in documenting recovery of stability.

Accidental Falls↗