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Biomedical subjects

Y C Pai

Publications and source records attributed to Y C Pai.

At least 19 recordsLinked to original sources

Relative stability improves with experience in a dynamic standing task.

This study tested the hypothesis that subjects improve their relative stability as they learn a dynamic pulling task. Healthy adult subjects practiced making brief horizontal pulls (<300 ms) on a handle to a range of target forces ranging from 20 to 80% of their estimated maximum for 5 days. They were instructed to always keep their feet flat and begin and end their motion in an upright posture. In order to do this, subjects had to develop the appropriate body momentum prior to the pull and then recover their balance following the pull. We analyzed relative stability during balance recovery, using two measures: spatial safety margin (minimum distance of the center of pressure, COP, to the edges of the feet) and temporal safety margin (minimum extrapolated time for the COP to reach the edges of the feet). We hypothesized that: (1) spatial and temporal safety margins would be uncorrelated; (2) safety-margin means would increase with practice; and (3) safety-margin standard deviations would decrease with practice. Two experiments were conducted: one where subjects practiced three force targets and positioned their initial COP in a small window, and one where subjects practiced two force targets with no initial COP constraint. Results showed that spatial and temporal safety margins were correlated but shared less than 6% variance, indicating that they reflected different aspects of control. Safety-margin averages increased with practice and standard deviations decreased with practice, indicating that the stability of balance control in the execution of this task became more robust. We suggest that the nervous system could use safety margins in both feedback and feedforward control of balance.

Adult↗

Thresholds for step initiation induced by support-surface translation: a dynamic center-of-mass model provides much better prediction than a static model.

The need to initiate a step in order to recover balance could, in theory, be predicted by a static model based solely on displacement of the center of mass (COM) with respect to the base of support (BOS), or by a dynamic model based on the interaction between COM displacement and velocity. The purpose of this study was to determine whether the dynamic model provides better prediction than the static model regarding the need to step in response to moving-platform perturbation. The COM phase plane trajectories were determined for 10 healthy young adults for trials where the supporting platform was translated at three different acceleration levels in anterior and posterior directions. These trajectories were compared with the thresholds for step initiation predicted by the static and dynamic COM models. A single-link-plus-foot biomechanical model was employed to mathematically simulate termination of the COM movement, without stepping, using the measured platform acceleration as the input. An optimization routine was used to determine the stability boundaries in COM state space so as to establish the dynamic thresholds where a compensatory step must be initiated in order to recover balance. In the static model, the threshold for step initiation was reached if the COM was displaced beyond the BOS limits. The dynamic model showed substantially better accuracy than the static model in predicting the need to step in order to recover balance: 71% of all stepping responses predicted correctly by the dynamic model versus only 11% by the static model. These results support the proposition that the central nervous system must react to and control dynamic effects, i.e. COM velocity, as well as COM displacement in order to maintain stability with respect to the existing BOS without stepping.

Adult↗

Does laxity alter the relationship between strength and physical function in knee osteoarthritis?

OBJECTIVE: Since strengthening interventions have had a lower-than-expected impact on patient function in studies of knee osteoarthritis (OA) and it is known that laxity influences muscle activity, this study examined whether the relationship between strength and function is weaker in the presence of laxity. METHODS: One hundred sixty-four patients with knee OA were studied. Knee OA was defined by the presence of definite osteophytes, and patients had to have at least a little difficulty with knee-requiring activities. Tests were performed to determine quadriceps and hamstring strength, varus-valgus laxity, functional status (Western Ontario and McMaster Universities Osteoarthritis Index Physical Functioning subscale [WOMAC-PF] and chair-stand performance), body mass index, and pain. High and low laxity groups were defined as above and below the sample median, respectively. RESULTS: Strength and chair-stand rates correlated (r = 0.44 to 0.52), as did strength and the WOMAC-PF score (r = -0.21 to -0.36). In multivariate analyses, greater laxity was consistently associated with a weaker relationship between strength (quadriceps or hamstring) and physical functioning (chair-stand rate or WOMAC-PF score). CONCLUSION: Varus-valgus laxity is associated with a decrease in the magnitude of the relationship between strength and physical function in knee OA. In studies examining the functional and structural consequences of resistance exercise in knee OA, stratification of analyses by varus-valgus laxity should be considered. The effect of strengthening interventions in knee OA may be enhanced by consideration of the status of the passive restraint system.

Adult↗

Simulated movement termination for balance recovery: can movement strategies be sought to maintain stability in the presence of slipping or forced sliding?

Slipping during various kinds of movement often leads to potentially dangerous incidents of falling. The purpose of this study was to determine whether there was evidence to support the theory that movement strategies could be used by individuals to regain stability during an episode of slipping and whether forced sliding from a moving platform accurately simulated the effect of slipping on stability and balance. A single-link-plus-foot biomechanical model was used to mathematically simulate base of support (BOS) translation and body segment rotation during movement termination in sagittal plane. An optimization routine was used to determine region of stability [defined at given COM locations as the feasible range of horizontal velocities of the center of mass (COM) of human subject that can be reduced to zero with respect to the BOS while still allowing the COM to traverse within the BOS limits]. We found some 30% overlap in the region of stability for slipping and non-slipping conditions. This finding supports the theory that movement strategies can be sought for restoring stability and balance even if slipping unexpectedly occurs. We also found that forced sliding produces effects on stability that are similar to those of slipping, indicated by over 50% overlap in the regions of stability for the two conditions. In addition, forced sliding has distinctive effects on stability, including a "shift" of the region of stability extended beyond the BOS in the direction of sliding. These findings may provide quantifiable guidance for balance training aimed at reducing fall incidents under uncertain floor surface conditions.

Accidental Falls↗

Induced limb collapse in a sudden slip during termination of sit-to-stand.

Despite repeated demonstration of how balance can be restored with protective stepping after the initiation of an induced fall, little is known about how accidental falling to the ground with the participant's body resting in a non-standing posture can be avoided during balance recovery. This is due to the difficulties inherent in experimentally eliciting such an event. The purpose of this study was, therefore, to determine failure rate and the characterization for balance recovery after young adults exposed to an experimentally induced novel slipping perturbation. Twenty-four healthy young adults first performed three to nine trials of regular sit-to-stand. In the following trial, slipping suddenly occurred during the termination of the sit-to-stand when the low-friction platform on which the participant stood was released. Participants were given no prior practice or knowledge of the experiment design. Slipping was then repeated in the subsequent trials. The results demonstrated for the first time that a high percentage (62%) of participants failed to recover standing balance, despite the fact that 14 of these 15 participants had initiated stepping at their first encounter of a sudden slip. Such failure was avoided immediately after the first encounter. It was postulated that a delay in the step initiation might have contributed to substantial vertical descent of the center-of-mass, leading to failure of balance recovery in limb collapse. To verify this and other hypotheses, a shift in experimental paradigms is warranted to include the study of spontaneous protective responses elicited when individuals first encounter previously unfamiliar balance perturbation as in real-life situations.

Accidental Falls↗

Static versus dynamic predictions of protective stepping following waist-pull perturbations in young and older adults.

The purposes of this study were: (1) to determine the frequency of protective stepping for balance recovery in subjects of different ages and fall-status, and (2) to compare predicted stepping based on a dynamic model (Pai and Patton, 1997. Journal of Biomechanics 30, 347 354) involving displacement and velocity combinations of the center of mass (COM) versus a static model based on displacement alone against experimentally induced stepping. Responses to three different magnitudes of forward waist pulls were recorded for 13 young, 18 older-non-fallers and 18 older-fallers. The COM phase plane trajectories derived from motion analysis were compared with the model-predicted threshold values for stepping. We found that the older fallers had the highest percentage of stepping trials (52%), followed by older-non-fallers (17.3%), and young (2.7%) at the lowest perturbation level. Younger subjects stepped less often than the elderly at the middle level. Everyone consistently stepped at the highest level of perturbation. Overall, the dynamic model showed better predictive capacity (65%) than the static model (5%) for estimating the initiation of stepping. Furthermore, the threshold for step initiation derived from the dynamic model could consistently predict when a step must occur. However, it was limited, especially among older fallers at the low perturbation level, in that it considered some steps 'unnecessary' that were presumably triggered by fear of falling or other factors.

Accidental Falls↗

Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis?

OBJECTIVE: Neuromuscular joint protection requires proprioceptive input and motor output. Impairment of proprioception in knee osteoarthritis (OA) may contribute to, and/or result from, the disease. If this impairment was exclusively a local result of OA, a between-knee difference would be expected in patients with unilateral OA (UOA). To explore causal directions, 2 hypotheses were tested: 1) proprioception is worse in UOA patients versus elderly controls; 2) proprioception is worse in the arthritic knee versus the unaffected knee in UOA patients. METHODS: Twenty-eight UOA patients (Kellgren-Lawrence grade > or =2 in 1 knee and <2 in the other knee) and 29 elderly controls were enrolled. The unaffected knee of each UOA patient and both knees of the elderly controls were required to meet symptom, examination, and radiographic criteria. Proprioception (detection threshold of joint displacement after slow, passive, automated knee motion), body mass index, pain, functional status, range of motion, and laxity were measured. RESULTS: UOA patients had worse proprioception than did elderly controls, in either knee. A between-knee difference was not found in UOA patients. CONCLUSION: Impaired proprioception is not exclusively a local result of disease in knee OA. The relative importance of impaired proprioception in the development and progression of knee OA will require longitudinal study.

Aged↗

Effect of age and osteoarthritis on knee proprioception.

OBJECTIVE: To test the hypotheses that 1) knee position sense declines with age; 2) patients with osteoarthritis (OA) have worse knee position sense than elderly controls; and 3) knee position sense is correlated with functional status. METHODS: The threshold for detection of knee joint displacement was measured in 30 patients with bilateral knee OA (Kellgren/Lawrence grade > or =2 in both knees), 29 elderly controls (who met clinical and radiographic criteria for exclusion of OA), and 25 young controls. Range of motion, laxity, radiographic severity, and functional status were also assessed. RESULTS: A moderate correlation was found between joint displacement detection threshold and age (r = 0.598 and r = 0.501 for the right knee and the left knee, respectively). The threshold was substantially and significantly different between the OA patients and the elderly controls. Proprioceptive impairment was associated with worse disease-specific functional status. CONCLUSION: Proprioception declines with age, and is further impaired in elderly patients with knee OA. Poor proprioception may contribute to functional impairment in knee OA.

Adult↗

Center of mass velocity-position predictions for balance control.

The purposes of this analysis were to predict the feasible movements during which balance can be maintained, based on environmental (contact force), anatomical (foot geometry), and physiological (muscle strength) constraints, and to identify the role of each constraint in limiting movement. An inverted pendulum model with a foot segment was used with an optimization algorithm to determine the set of feasible center of mass (CM) velocity-position combinations for movement termination. The upper boundary of the resulting feasible region ran from a velocity of 1.1 s-1 (normalized to body height) at 2.4 foot lengths behind the heel, to 0.45 s-1 over the heel, to zero over the toe, and the lower boundary from a velocity of 0.9 s-1 at 2.7 foot lengths behind the heel, to zero over the heel. Forward falls would be initiated if states exceeded the upper boundary, and backward falls would be initiated if the states fell below the lower boundary. Under normal conditions, the constraint on the size of the base of support (BOS) determined the upper and lower boundaries of the feasible region. However, friction and strength did limit the feasible region when friction levels were less than 0.82, when dorsiflexion was reduced more than 51%, or when plantar flexion strength was reduced more than 35%. These findings expand the long-held concept that balance is based on CM position limits (i.e. the horizontal CM position has to be confined within the BOS to guarantee stable standing) to a concept based on CM velocity-position limits.

Accidental Falls↗

Electromyographic analysis of postural responses during standing leg flexion in adults with hemiparesis.

The purpose of this study was to examine muscle activation patterns during standing leg single leg flexion in adults with hemiparesis. Specifically, the electromyographic activation patterns of the flexing limb biceps femoris and gluteus medius, and the stance limb gluteus medius muscles were analyzed as a function of whether the muscles were paretic or not. Delayed activation of the affected flexing side gluteus medius, as compared with unaffected flexing side gluteus medius, resulted in it being activated simultaneous with the flexing biceps femoris rather than preceding it as was previously found in healthy subjects. This suggests a temporal change in the sequential mode of coordination of the postural and intended components of the task. In addition, the magnitude of the electromyographic integrals of both the affected and unaffected flexing side gluteus medius in the early propulsive phase of the task was significantly reduced in comparison with healthy subjects. These alterations can be attributed to spatial alterations in the sequential form of organization or to a shift to a different mode of neural control in order to perform a relatively novel task. These results suggest a potential adaptive capacity in these individuals.

Adult↗

Impaired proprioception and osteoarthritis.

The increase in the prevalence of osteoarthritis (OA) with age may be due in part to increased joint load resulting from age-related declines in neuromechanical factors, including joint position sense or proprioception. Several studies have demonstrated that knee proprioception is worse in knee OA patients versus age-matched control subjects. Functional consequences of impaired proprioception may include lower gait velocity, shorter stride length, and slower stair walking time. Some studies have shown that proprioception can be enhanced by wearing an elastic bandage or similar orthoses and by muscle training. A variety of other interventions have been proposed as well. To date studies of proprioception in OA patients have been cross-sectional. Theoretically, impaired proprioception might contribute toward or result from OA. A paradigm depicting directions in the relationship between proprioception impairment and OA is offered. Longitudinal data are badly needed to elucidate cause and effect and to determine the relative importance of impaired proprioception in disease progression. The relationship between sensory input and protective or damaging muscle activity has been minimally evaluated in the setting of OA. In studies of clinical conditions related to OA, experimental effusions had no effect on proprioception. Proprioception was worse in hypermobility syndrome patients versus age-matched controls. Anterior cruciate ligament insufficiency is associated with a decline in proprioception.

Humans↗

Organization of preparatory postural responses for the initiation of lateral body motion during goal directed leg movements.

Postural responses preceding single leg flexion movements were examined in human subjects with respect to a hypothesized primary role of the hip joint abductor-adductor musculature in initiating lateral body motion during alterations in stance. The results indicated a speed sensitive interlimb response organization compatible with predictions based on a mechanical model. In conjunction with other recent studies, the findings may be indicative of a common organizational substrate for the initiation of laterally directed motion of the body.

Adult↗

Reliability of measurements of body center-of-mass momentum during sit-to-stand in healthy adults.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the reliability of measurements of momentum of the body's center of mass (CM) during a sit-to-stand (STS) transfer in healthy adults. SUBJECTS: Nineteen healthy adults aged 25 to 38 years (mean = 31.7, SD = 4.2) participated. METHODS: Horizontal and vertical components of CM momentum were computed for STS transfers made at three movement speeds (fast, natural, and slow) with the aid of a motion analysis system. Two force platforms detected the time when the subject lost contact with the chair and the propulsive and braking impulses in the horizontal and vertical directions. Separate intraclass correlation coefficients (ICCs) were calculated for three temporal variables (time to peak horizontal and vertical momentum and time to when the subject lost contact with the chair) and two magnitude variables (peak horizontal and vertical momentum). RESULTS: The ICCs for magnitude variables were > or = .81 for all speeds of movement. The ICCs for temporal variables ranged from .28 for fast movements to .75 for slow movements. CONCLUSION AND DISCUSSION: Measurement of peak vertical and horizontal momentum magnitudes is highly reproducible during STS transfers. Measurement of temporal variables exhibits a range of reliability estimates. Implications include consideration of the speed at which STS transfer is performed and its effect on reliability estimates and the potential differences between reliability estimates for magnitude measurements versus temporal measurements.

Adult↗

Alteration in multijoint dynamics in patients with bilateral knee osteoarthritis.

OBJECTIVE: To document the alterations of joint motion and torque in patients with bilateral knee osteoarthritis (OA), using a well-defined functional maneuver, the sit-to-stand (STS) task. METHODS: Twelve patients with bilateral knee OA and 12 age-, sex-, and height-matched control subjects performed the STS maneuver from a stool of a standard height at their natural speeds. A motion analysis system and 2 force platforms were employed to determine the dynamic joint motion and the resultant joint torques at the ankle, knee, and hip joints. RESULTS: The results showed that OA patients exhibited substantially reduced knee extension torques, accompanied by other alterations in initial sitting posture (more extended knee and more plantar-flexed ankle), movement duration (increased), dynamic range of motion at the knee (reduced), and extension torques at the hip (increased). CONCLUSION: The alterations in joint dynamics among patients with knee OA may have revealed an adaptive motor behavior characterized by redistributing the load from impaired to less-impaired or nonimpaired joints through multijoint dynamics. Two major potential pitfalls of such a movement strategy have subsequently been postulated.

Aged↗

Effect of a terminal constraint on control of balance during sit-to-stand.

The speed at which sit-to-stand (STS) motions are performed and the subsequent terminal constraint upon upright stance can present subjects with contradictory goals. Previous findings suggested that subjects might adopt a strategy of limiting the peak horizontal momentum of the center of mass (CM), and perhaps of body segments as well, regardless of the speed of ascent. The primary purpose of this study was to test the hypothesis that the limitation in CM momentum is related to the constraint on upright stance at the termination of the task. The secondary purpose was to describe the contribution of the shank, thigh, and upper body (head-arm-trunk) to the peak horizontal momentum of the CM under each test condition. Nine healthy adult males rose from a seated position under the following three conditions: (a) at natural speeds (natural STS); (b) as fast as possible (fast STS); and (c) as fast as possible, followed by falling forward while keeping the feet fixed and using the arms on a support bar to stop the fall (fast STS+fall). The results showed that the peak horizontal momentum of the CM did not change substantially from the natural to fast STS, but increased significantly from the fast STS to the fast STS+fall. These findings are consistent with the hypothesis that limiting peak horizontal momentum of the CM may reflect a movement control strategy related to maintaining equilibrium at the termination of the voluntary task of rising from a chair. The momentum profile of the upper body, but not of the thigh or shank, remained constant across all experimental conditions, suggesting that the motion of the upper body may be tightly controlled in STS, regardless of the altered constraint on balance.

Journal Article↗

Alterations in weight-transfer capabilities in adults with hemiparesis.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to examine the position and displacement in the frontal plane of the body's center of mass (CM) with respect to the base of support during single-leg flexion movements in adults with hemiplegia and (2) to examine their relationship with other clinical scores. SUBJECTS: Fourteen ambulatory adult volunteers with hemiparesis of the right side of the body due to cerebrovascular accident participated in the study. METHODS: Subjects performed single-leg flexion movements with the paretic and nonparetic limbs while standing on two separate force platforms. Motion analysis and force platform data were used to determine the displacement of the CM. RESULTS: Successful performance of the transfer and holding single-limb stance occurred for 48% (to the nonparetic side) and 20% (to the paretic side) of the trials. Lack of success was due to insufficient displacement of the CM (26% of the trials to the nonparetic side and 17% of the trials to the paretic side) or a failure to maintain single-limb stance (26% of all trials to the nonparetic side and 63% of the trials to the paretic side). Overall, the final position of the CM with respect to the single-limb support region did not differ between sides. Successful performance was highly to moderately associated with clinical assessment scores for motor function and balance. Its association with gait velocity, however, was poor. CONCLUSION AND DISCUSSION: A classification scheme that can distinguish between four categories of bipedal to single-limb stance transitions has been established. Issues concerning clinical assumptions pertaining to the relationship between static and dynamic motor dysfunction in adults with hemiparesis are discussed.

Adult↗

Kinetic analysis of dynamic transitions in stance support accompanying voluntary leg flexion movements in hemiparetic adults.

The purpose of this study was to examine the extent to which adult hemiparesis due to cerebrovascular accident may alter the dynamic transitions from bipedal to single limb stance that accompany rapid voluntary single leg flexion movements while standing. Eight postacute hemiparetic adults performed rapid single-leg-flexion movements with the paretic (PL) and nonparetic (NL) limbs while standing on two separate force platforms that recorded the individual and resultant lateral horizontal (FY) ground reaction force (GRF) components acting on the body in the frontal plane. The results showed that for NL movements, the ipsilateral FY force-time integral contributed a significantly greater proportion to the resultant FY than that recorded beneath the upcoming stance PL, whereas PL movements showed a reverse trend indicating differences in the spatial distribution of GRFs. For some subjects, delays in the initial FY onset times between limbs and reversals in the normal direction of initial force application beneath the PL were observed. Such changes in the spatial and temporal aspects of GRF production may affect dynamic lateral weight transfer function regardless of the direction of total body motion. Implications for clinical practice pertaining to interventions that emphasize speed as well as magnitude of paretic muscle torque production, and factors related to the selection of movement activities for the retraining of dynamic weight transfer function are discussed.

Adult↗

Speed variation and resultant joint torques during sit-to-stand.

The purpose of this study was to test the hypothesis that a progressively faster speed of ascent requires significantly greater peak resultant joint torque (RJT) at major load-bearing joints of the lower limb during the sit-to-stand (STS) transfer. Eight healthy adults performed the STS at slow, natural, and fast speeds. A motion analysis system and two force platforms were employed to record kinetic data, and equations of motion were applied to compute the RJT for the ankle, knee, and hip. The results of the study supported the hypothesis that when the speed of ascent increased progressively, the peak hip flexion, knee extension, and ankle dorsiflexion RJTs increased disproportionately. However, the peak hip extension and ankle plantar flexion RJTs remained relatively constant across the range of the speeds. Implications for clinical practice pertaining to the timing and magnitude of RJT, as well as for interventions that emphasize the adaptive characteristics of movements, are suggested.

Adult↗