Predictors of weight loss in Parkinson's disease: is weight loss the chicken or the egg?
Explore the source record for details and available documents.
Disease Progression↗
Biomedical subjects
Normand Teasdale
Publications and source records attributed to Normand Teasdale.
Plasma concentration of organochlorine compounds is associated with age and not obesity.
It has been suggested that obese individuals, because of an increased dilution space (body fat) for lipophilic organochlorines compounds, may have greater levels of toxic pollutants than lean sedentary individuals. It is important to further examine this possibility because of the potential contribution of organochlorine pesticides in the development of Parkinson's disease and other neurological diseases. The aim of this study was to further investigate the relationship between the magnitude of obesity and the plasma concentration of organochlorines for a wide range of BMI (with participants at steady state body weight). Fifty-three individuals were selected on the basis of their body mass index (BMI): lean controls (n=16; mean BMI 22.8+/-2.2 kg/m(2); mean age 38.8+/-9.4 years), obese individuals (n=19; mean BMI 33.4+/-3.0 kg/m(2); mean age 38.6+/-7.6 years) and morbidly obese individuals (n=18; mean BMI 49.3+/-6.5 kg/m(2); mean age 44.3+/-9.2 years). Blood samples were analyzed for organochlorine compounds. The relationship between the total plasma organochlorine concentration and BMI was tested using a multiple regression analysis. Age was included in the model. There was no relationship between the total plasma organochlorine concentration and BMI. Organochlorine concentrations, however, were correlated with age (BMI-adjusted R(2)=0.46; p<0.001). At steady state body weight, toxic pollutant concentrations are not associated to obesity but strongly correlate with age.
Adult↗
Altered sensory-weighting mechanisms is observed in adolescents with idiopathic scoliosis.
BACKGROUND: Scoliosis is the most common type of spinal deformity. In North American children, adolescent idiopathic scoliosis (AIS) makes up about 90% of all cases of scoliosis. While its prevalence is about 2% to 3% in children aged between 10 to 16 years, girls are more at risk than boys for severe progression with a ratio of 3.6 to 1. The aim of the present study was to test the hypothesis that idiopathic scoliosis interferes with the mechanisms responsible for sensory-reweighting during balance control. METHODS: Eight scoliosis patients (seven female and one male; mean age: 16.4 years) and nine healthy adolescents (average age 16.5 years) participated in the experiment. Visual and ankle proprioceptive information was perturbed (eyes closed and/or tendon vibration) suddenly and then returned to normal (eyes open and/or no tendon vibration). An AMTI force platform was used to compute centre of pressure root mean squared velocity and sway density curve. RESULTS: For the control condition (eyes open and no tendon vibration), adolescent idiopathic scoliosis patients had a greater centre of pressure root mean squared velocity (variability) than control participants. Reintegration of ankle proprioception, when vision was either available or removed, led to an increased centre of pressure velocity variability for the adolescent idiopathic scoliosis patients whereas the control participants reduced their centre of pressure velocity variability. Moreover, in the absence of vision, adolescent idiopathic scoliosis exhibited an increased centre of pressure velocity variability when ankle proprioception was returned to normal (i.e. tendon vibration stopped). The analysis of the sway density plot suggests that adolescent idiopathic scoliosis patients, during sensory reintegration, do not scale appropriately their balance control commands. CONCLUSION: Altogether, the present results demonstrate that idiopathic scoliosis adolescents have difficulty in reweighting sensory inputs following a brief period of sensory deprivation.
Adolescent↗
The effects of moderate fatigue on dynamic balance control and attentional demands.
BACKGROUND: During daily activities, the active control of balance often is a task per se (for example, when standing in a moving bus). Other constraints like fatigue can add to the complexity of this balance task. In the present experiment, we examined how moderate fatigue induced by fast walking on a treadmill challenged dynamic balance control. We also examined if the attentional demands for performing the balance task varied with fatigue. METHODS: Subjects (n = 10) performed simultaneously a dynamic balance control task and a probe reaction time task (RT) (serving as an indicator of attentional demands) before and after three periods of moderate fatigue (fast walking on a treadmill). For the balance control task, the real-time displacement of the centre of pressure (CP) was provided on a monitor placed in front of the subject, at eye level. Subjects were asked to keep their CP within a target (moving box) moving upward and downward on the monitor. The tracking performance was measured (time spent outside the moving box) and the CP behavior analyzed (mean CP speed and mean frequency of the CP velocity). RESULTS: Moderate fatigue led to an immediate decrement of the performance on the balance control task; increase of the percentage of time spent outside the box and increase of the mean CP speed. Across the three fatigue periods, subjects improved their tracking performance and reduced their mean CP speed. This was achieved by increasing their frequency of actions; mean frequency of the CP velocity were higher for the fatigue periods than for the no fatigue periods. Fatigue also induced an increase in the attentional demands suggesting that more cognitive resources had to be allocated to the balance task with than without fatigue. CONCLUSION: Fatigue induced by fast walking had an initial negative impact on the control of balance. Nonetheless, subjects were able to compensate the effect of the moderate fatigue by increasing the frequency of actions. This adaptation, however, required that a greater proportion of the cognitive resources be allocated to the active control of the balance task.
Journal Article↗
Body weight is a strong predictor of postural stability.
Proper balance control is a key aspect of acitivities of daily living. The aim of this study was to determine the contribution of body weight to predict balance stability. The balance stability of 59 male subjects with BMI ranging from 17.4 to 63.8kg/m(2) was assessed using a force platform. The subjects were tested with and without vision. A stepwise multiple regression analysis was used to determine the independent effect of body weight, age, body height and foot length on balance stability (i.e., mean speed of the center of foot pressure). With vision, the stepwise multiple regression revealed that body weight accounted for 52% of the variance of balance stability. The addition of age contributed a further 3% to explain balance control. Without vision, body weight accounted for 54% of the variance and the addition of age and body height added a further 8% and 1% to explain the total variance, respectively. The final model explained 63% of the variance. A decrease in balance stability is strongly correlated to an increase in body weight. This suggests that body weight may be an important risk factor for falling. Future studies should examine more closely the combined effect of aging and obesity on falling and injuries and the impact of obesity on the diverse range of activities of daily living.
Adult↗
Increased plasma levels of toxic pollutants accompanying weight loss induced by hypocaloric diet or by bariatric surgery.
BACKGROUND: Weight loss reduces the risk of several diseases. Increases of plasma organochlorine and pesticide compounds, however, have been observed with weight loss induced by a dietary intervention and by a gastroplasty. This increased concentration of toxic pollutants could be a side-effect of weight loss and a risk for health problems. The aim of this study was: 1) to observe if there is a relationship between the plasma concentration of organochlorines and BMI at steady state weight, and 2) to determine, after a bariatric surgical intervention, if the magnitude of the weight loss has a direct effect on this concentration. METHODS: Weight loss was obtained in obese individuals by a hypocaloric diet program until resistance and in morbidly obese individuals by a bariatric operation (biliopancreatic diversion - duodenal switch [BPD-DS]). Normal-weight individuals were tested to serve as controls. Blood samples were analyzed for organochlorine and pesticide compounds at baseline in all groups, after resistance to weight loss in obese individuals, and at 3 months and 1 year after surgery in morbidly obese individuals. RESULTS: At steady state weight, organochlorine and pesticide compounds were found in all groups, and the sum of all organochlorine compounds correlated with age and not BMI. Weight loss averaged 12.1% of the initial body weight after dieting and 20.9% at 3 months after surgery, respectively. This weight loss yielded significant increases in total plasma organochlorine concentration (increase of 23.8% for obese and 51.8% for morbidly obese individuals). For morbidly obese individuals, the weight loss at 1 year after surgery (46.3%) yielded a 388.2% increase in total plasma organochlorine concentration. CONCLUSION: Plasma organochlorine concentration increases with weight loss and is related to the magnitude. Future research will have to determine if: 1) this pollutant concentration remains elevated over time and 2) there are long-term effects of this high concentration on health.
Adult↗
Coordination between posture and movement: interaction between postural and accuracy constraints.
We examined the interaction between the control of posture and an aiming movement. Balance control was varied by having subjects aim at a target from a seated or a standing position. The aiming difficulty was varied using a Fitts'-like paradigm (movement amplitude=30 cm; target widths=0.5, 1.0, 2.5 and 5 cm). For both postural conditions, all targets were within the reaching space in front of the subjects and kept at a fixed relative position with respect to the subjects' body. Hence, for a given target size, the aiming was differentiated only by the postural context (seated vs. upright standing). For both postural conditions, movement time (MT) followed the well-known Fitts' law, that is, it increased with a decreasing target size. For the smallest target width, however, the increased MT was greater when subjects were standing than when they were seated suggesting that the difficulty of the aiming task could not be determined solely by the target size. When standing, a coordination between the trunk and the arm was observed. Also, as the target size decreased, the center of pressure (CP) displacement increased without any increase in CP speed suggesting that the subjects were regulating their CP to provide a controlled referential to assist the hand movement. When seated, the CP kinematics was scaled with the hand movement kinematics. Increasing the index of difficulty led to a strong correlation between the hand speed and CP displacement and speed. The complex organization between posture and movement was revealed only by examining the specific interactions between speed-accuracy and postural constraints.
Adaptation, Physiological↗
Isometric force production parameters during normal and experimental low back pain conditions.
BACKGROUND: The control of force and its between-trial variability are often taken as critical determinants of motor performance. Subjects performed isometric trunk flexion and extension forces without and with experiment pain to examine if pain yields changes in the control of trunk forces. The objective of this study is to determine if experimental low back pain modifies trunk isometric force production. METHODS: Ten control subjects participated in this study. They were required to exert 50 and 75% of their isometric maximal trunk flexion and extension torque. In a learning phase preceding the non painful and painful trials, visual and verbal feedbacks were provided. Then, subjects were asked to perform 10 trials without any feedback. Time to peak torque, time to peak torque variability, peak torque variability as well as constant and absolute error in peak torque were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak torque achieved. RESULTS: Absolute and constant errors were higher in the presence of a painful electrical stimulation. Furthermore, peak torque variability for the higher level of force was increased with in the presence of experimental pain. The linear regressions between peak dF/dt, time to peak dF/dt and peak torque were similar for both conditions. Experimental low back pain yielded increased absolute and constant errors as well as a greater peak torque variability for the higher levels of force. The control strategy, however, remained the same between the non painful and painful condition. Cutaneous pain affects some isometric force production parameters but modifications of motor control strategies are not implemented spontaneously. CONCLUSIONS: It is hypothesized that adaptation of motor strategies to low back pain is implemented gradually over time. This would enable LBP patients to perform their daily tasks with presumably less pain and more accuracy.
Adult↗
Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects.
STUDY DESIGN: A control group study with repeated measures. OBJECTIVE: To compare trunk repositioning parameters in chronic low back pain (LBP) and healthy subjects. SUMMARY AND BACKGROUND DATA: Recent evidence suggests that chronic LBP patients exhibit deficits in trunk proprioception and motor control. Trunk repositioning and the various spatio-temporal parameters related to it can be used to evaluate sensori-motor control and movement strategies. METHODS: Fifteen control subjects and 16 chronic LBP subjects participated in this study. Subjects were required to reproduce different trunk position in flexion (15 degrees, 30 degrees and 60 degrees) and extension (15 degrees). In the learning phase preceding each condition, visual feedback was provided. Following these learning trials, subjects were asked to perform ten consecutive trials without any feedback. Movement time, movement time variability and peak velocity were obtained and a temporal symmetry ratio was calculated. Peak angular position variability and absolute error in peak angular position were also calculated to evaluate spatial accuracy. RESULTS: Two subgroups of LBP patients were identified. One subgroup of LBP subjects demonstrated longer movement time and smaller peak velocities and symmetry ratios than normal subjects. No group difference was observed for peak angular position variability and absolute error in peak angular position. CONCLUSION: Chronic LBP patients, when given a sufficient learning period, were able to reproduce trunk position with a spatial accuracy similar to control subjects. Some LBP subjects, however, showed modifications of movement time, peak velocity and acceleration parameters. We propose that the presence of persistent chronic pain could induce an alteration or an adaptation in the motor responses of chronic LBP subjects.
Adult↗
Pointing to a target from an upright standing position: anticipatory postural adjustments are modulated by the size of the target in humans.
To examine the influence of the target size onto postural EMG activity, eight subjects performed, from a standing position, rapid and accurate pointings to a target located within reach. The target size was varied across blocks of trials. Hand movement time increased when the target size was decreased. Interestingly, the magnitude of the integrated EMG activity of lower limb muscles (TAi, TFLc, RFi) decreased with a decreasing target size, while that of the erector spinae increased. The effects were observed as early as 200 ms before the hand movement onset. When standing, these early commands could influence the control of the hand during the acceleration phase. The target size was specified within the postural command before any hand movement took place suggesting the characteristics of the pointing task were integrated in a feedforward manner.
Adult↗
Force production parameters in patients with low back pain and healthy control study participants.
STUDY DESIGN: A control group study with repeated measures. OBJECTIVE: To compare isometric force production parameters in low back pain and healthy study participants. SUMMARY AND BACKGROUND DATA: Recent evidence suggests that chronic patients with low back pain exhibit deficits in trunk proprioception and motor control. The control of force and its between-trial variability are often taken as critical determinants of performance. We compared various force time characteristics in patients with low back pain and healthy study participants. METHODS: Fifteen control study participants and 16 patients with low back pain participated in this study. Study participants were required to exert 50% and 75% of the maximal trunk flexion and extension. In a learning phase, visual and verbal feedback was provided. Following these learning trials, study participants were asked to perform 10 trials without any feedback. Time to peak force, time to peak force variability, peak force variability, and absolute error in peak force were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak force achieved. RESULTS: Two subgroups of patients with low back pain were identified. Controls and patients with low back pain with more pain showed faster time to peak force than patients with low back pain with less pain (331 ms and 341 ms vs. 574 ms, respectively). Linear regressions showed that, for control study participants and low back pain study participants with more pain, peak dF/dt explained 94.0% and 97.0% of the variance observed in peak force while 84.4% was explained for low back pain study participants with less pain. Peak force variability and absolute error in peak force were similar for all groups. CONCLUSIONS: Patients with low back pain were able to produce isometric forces with an accuracy similar to control study participants. The longer time to peak force and the smaller percentage of variance observed for the linear regressions suggest that some patients with low back pain adopted a control mode that was less "open-loop." It is possible that this mode of producing forces results from an adaptation to chronic pain or tissue degeneration.
Adult↗
Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study.
OBJECTIVE: To document the potential role of maintenance chiropractic spinal manipulation to reduce overall pain and disability levels associated with chronic low-back conditions after an initial phase of intensive chiropractic treatments. METHODS: Thirty patients with chronic nonspecific low-back pain were separated into 2 groups. The first group received 12 treatments in an intensive 1-month period but received no treatment in a subsequent 9-month period. For this group, a 4-week period preceding the initial phase of treatment was used as a control period to examine the sole effect of time on pain and disability levels. The second group received 12 treatments in an intensive 1-month period and also received maintenance spinal manipulation every 3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated with a visual analog scale and a modified Oswestry questionnaire, respectively. RESULTS: The 1-month control period did not modify the pain and disability levels. For both groups, the pain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the postintensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their postintensive treatment scores. The disability scores of the other group went back to their pretreatment levels. CONCLUSIONS: Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.
Adult↗
Effects of intensity and locus of painful stimulation on postural stability.
Stimulation of small diameter afferents can influence motor behavior. Little is known about how a prolonged painful stimulation of these small afferents may affect essential motor behavior such as the maintenance of an erect stance. The present study documents the effects of 10-s weak, moderate and extreme painful stimulations applied to the dorsum of the feet on the postural stability. Also, the moderate painful stimulation was applied to the metacarpal heads to determine if a painful stimulation to a limb not involved in the maintenance of the erect stance affects the postural control mechanisms. Increasing the intensity of the painful stimulation applied to the feet yielded larger postural oscillations whereas stimulation to the hands did not affect the control of posture. This suggests that the painful stimulation mainly affected the postural control mechanisms via sensorimotor processes rather than via cognitive resources related to the perception of pain.
Adult↗
Postural stability is altered by the stimulation of pain but not warm receptors in humans.
BACKGROUND: It is now recognized that large diameter myelinated afferents provide the primary source of lower limb proprioceptive information for maintaining an upright standing position. Small diameter afferents transmitting noxious stimuli, however, can also influence motor behaviors. Despite the possible influence of pain on motor behaviors, the effects of pain on the postural control system have not been well documented. METHODS: Two cutaneous heat stimulations (experiment 1: non-noxious 40 degrees C; experiment 2: noxious 45 degrees C) were applied bilaterally on the calves of the subject with two thermal grills to stimulate A delta and C warm receptors and nociceptors in order to examine their effects on postural stability. The non-noxious stimulation induced a gentle sensation of warmth and the noxious stimulation induced a perception of heat pain (visual analogue scores of 0 and 46 mm, respectively). For both experiments, ten healthy young adults were tested with and without heat stimulations of the lower limbs while standing upright on a force platform with eyes open, eyes closed and eyes closed with tendon co-vibration of tibialis anterior and triceps surae muscles. The center of pressure displacements were analyzed to examine how both stimulations affected the regulation of quiet standing and if the effects were exacerbated when vision was removed or ankle proprioception perturbed. RESULTS: The stimulation of the warm receptors (40 degrees C) did not induce any postural deterioration. With pain (45 degrees C), subjects showed a significant increase in standard deviation, range and mean velocity of postural oscillations as well as standard deviation of the center of pressure velocity. The effects of heat pain were exacerbated when subjects had both their eyes closed and ankle tendons vibrated (increased standard deviation of the center of pressure velocity and mean velocity of the center of pressure). CONCLUSIONS: A non-noxious stimulation (40 degrees C) of the small diameter afferents is not a sufficiently intense sensory stimulation to alter the control of posture. A painful stimulation (45 degrees C) of the skin thermoreceptors, however, yielded a deterioration of the postural control system. The observed deteriorating effects of the combined stimulation of nociceptors and Ia afferents (when ankle tendons were vibrated) could result from the convergence of these afferents at the spinal level. This could certainly lead to the hypothesis that individuals suffering from lower limb pain present alterations of the postural control mechanisms; especially populations already at risk of falling (for example, frail elderly) or populations suffering from concomitant lower limb pain and sensory deficits (for example, diabetic polyneuropathy).
Adult↗
Self-initiating a seated perturbation modifies the neck postural responses in humans.
When seated subjects are submitted to a linear acceleration, reports indicate that the kinematic and electromyographic (EMG) responses of the head-neck system can be modulated with the magnitude of the linear acceleration. There is no evidence, however, that head kinematics or neck EMG activity can be modulated when specific knowledge and active control about the onset of platform acceleration are available. Sixteen seated subjects were given forward linear accelerations in two different conditions nested within subjects: reactive and predictive. In the reactive condition, the acceleration was initiated following a variable delay unknown to the subjects whereas in the predictive condition, subjects manually self-initiated the perturbation. All neck muscle activities were decreased 50-100 ms after platform movement onset in the predictive condition relative to the reactive condition, whereas head and neck peak angular positions and velocities were not different between the two conditions. These results suggest that feedforward control could use the self-generated timing information of platform movement onset to scale the appropriate neck motor output.
Acceleration↗
Attenuation of human neck muscle activity following repeated imposed trunk-forward linear acceleration.
It has been suggested that, after a passive linear acceleration of a seated subject which resembles a small, rear-end car impact, sensory information from proprioceptive, vestibular, and visual systems elicit stabilizing neck muscular responses. These neck muscular responses are presumably reflex based and are modified with the magnitude of the perturbation. A key issue that remains is to determine whether the neck and head postural responses can be modulated by a previous experience of the acceleration and not only by the magnitude of the acceleration. This question is of interest because, contrary to cadaver studies, one could expect that humans apprehending a rapid trunk acceleration would adopt a bracing behavior to minimize head movements. The aim of the present experiment was to verify whether neck-muscle activities can be modulated when prior knowledge about whole-body acceleration onset, direction, and magnitude are unknown compared with when only acceleration onset is unknown. Nine seated subjects were submitted to 11 imposed, forward linear accelerations (1.1 g). For the first trial, subjects were completely unaware of the platform acceleration characteristics (onset, direction, amplitude, and acceleration magnitude). For the subsequent ten trials, subjects knew they would be submitted to a forward linear acceleration, but the onset of the acceleration was unknown. Head kinematics and EMG responses of the neck muscles to the first perturbation were similar for all subjects (6.2 degrees head extension, EMG activity starting from 55 to 72 ms after platform onset). Following the first trial, however, all subjects showed a decreased neck EMG activity. Moreover, subjects responded in one of two ways across trials: one group of subjects ( n=5) maintained a constant head angular position and velocity, whereas the other group ( n=4) showed an increased head angular position (up to 12.6 degrees ) and velocity. This suggests that the first perturbation trial revealed a completely reactive response. After this initial trial, the responses observed may present a mixture of feedforward and feedback control. It is likely that whiplash injuries occur under conditions resembling those observed for the first trial only. If this is the case, the behavior for the following trials cannot be representative of injury mechanisms occurring in whiplash-like motion. Altogether, our results strongly suggest that, following repeated trunk linear accelerations of a constant magnitude, the nervous system prefers to minimize muscle stress instead of adopting a bracing strategy.
Acceleration↗
A non-invasive technique for measurement of cervical vertebral angle: report of a preliminary study.
Non-invasive methods have traditionally been used to assess spine positioning and range of motion. Recently, the use of prediction models derived from external stick markers and videographic analysis has been shown to be effective at predicting lumbosacral and segmental lumbar vertebral angles. The objective of this study was to develop a similar non-invasive method to predict cervical vertebral inclination in forward head flexion. Fourteen subjects with no history of trauma or inflammatory or arthritic disorders (mean age: 25+/-1 years) participated in this study on a voluntary basis. Radiographic and videographic measurements of four external markers (C0, C2, C6, C7) were taken for each subject at three different static head positions (neutral, and 30 degrees and 60 degrees of flexion). The data obtained from nine subjects with normal cervical configuration (lordosis) were used to develop statistical models predicting the radiographic segmental angles (dependent variables) from external markers (independent variables). A multiple regression model was developed for each vertebra (C1 to C6). These regression models predict the inclination of each cervical vertebra at three different neck angles with positional data derived from the four external skin markers. Adjusted R2 values of 0.97, 0.93, 0.93, 0.96, 0.95 and 0.89 were obtained for C1, C2, C3, C4, C5 and C6, respectively. The prediction models developed in this study can explain a large part of the variance for the relative contribution of each vertebral segment to global neck flexion and provide a greater accuracy then using external stick markers only. These models were not able to adequately predict the vertebral angular positioning of subjects presenting a cervical alordosis or kyphosis.
Adult↗
Perturbation of the postural control system induced by muscular fatigue.
In this experiment, we induced muscular fatigue of ankle plantar-flexors to examine how it deteriorates the regulation of bipedal quiet upright standing. Postural stability was assessed in conditions with and without vision over 60 s period to examine not only classical postural variables (time- and frequency-domain analyses), but also structural variables (stabilogram-diffusion analysis). Muscular fatigue was induced with repeated plantar-flexion of both legs. With muscular fatigue, subjects exhibited an increased postural sway (faster center of pressure (CP) velocity, and greater CP mean and median frequency) and a decreased long-term scaling exponent compared with the control conditions. The fatigue conditions, however, did not modify the range of oscillations and the variability of the postural oscillations around the mean position of CP. The effects of muscular fatigue were similar with eyes open and eyes closed. These results suggest that fatigue did induce some changes in the control mode of postural stability, but the detection/action capabilities of the sensorimotor system remained partly efficient when the ankle plantar-flexors were fatigued. Furthermore, the decreased long-term scaling exponent observed with fatigue suggests that the control of upright stance operates in a less stochastic and more antipersistent manner when fatigue is present (i.e. past and future behaviors were more negatively correlated and thus more tightly regulated). Altogether, the present results suggest that, compared with the no-fatigue conditions, fatigue places higher demands on the postural control system by increasing the frequency of actions needed to regulate the upright stance.
Adult↗