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Influence of instruction, prediction, and afferent sensory information on the postural organization of step initiation.

1. Our previous study showed that two distinct postural modifications occurred when subjects were instructed to step, rather than maintain stance, in response to a backward surface translation: 1) the automatic postural responses to the surfaces perturbation were reduced in magnitude and 2) the anticipatory postural adjustments promoting foot-off were shortened in duration. This study investigates the extent to which task instruction, prediction of perturbation velocity, and afferent sensory information related to perturbation velocity are responsible for these postural modification. 2. Eleven human subjects were instructed in advance, to either maintain stance or step forward in response to a backward surface translation. Four different velocities of translation were used to perturb equilibrium. To assess the influence of predicted versus actual velocity information, the surface translations were presented in both a blocked order of increasing perturbation velocity (predictable) and a random order (unpredictable). Lower-extremity electromyographs (EMGs), ground reaction forces, and movement kinematics were quantified for both the automatic postural responses to perturbation and the anticipatory postural adjustments for step initiation. 3. The instruction to step was not solely responsible for the suppression of the automatic postural response. Prediction of perturbation velocity was required for significant suppression of the early automatic postural response when subjects stepped in response to the perturbation. When compared with the stance condition, the magnitude of the initial 50 ms of the automatic response in bilateral soleus and the left limb gastrocnemius (initial stance limb) was significantly reduced only when the perturbation velocities were presented in a blocked order. The magnitude of the automatic response was not reduced in the gastrocnemius of the right limb, which was always the initial swing limb and recruited for heel-off in the step conditions. This asymmetrical reduction of the gastrocnemius suggests that modification of the response was specific to the instruction, rather than a general decrease in the extensor muscle excitability. 4. The suppression of the early automatic postural response involved a change in the bias of the response. Despite the reduced magnitude during the predictable velocity step condition, the slope (i.e., gain) of the response with increasing velocities was not different from that of the stance condition. Thus the excitability of the automatic response was reduced by a relatively constant amount for each velocity when the perturbation velocity was predictable. 5. In contrast to the importance of velocity prediction for modification of the automatic postural response, actual velocity information was used for modification of the anticipatory postural adjustments when step was initiated in response to the surface perturbation. Regardless of whether the perturbation velocities were presented in a blocked or random order, the anticipatory postural adjustments were rapidly initiated and the duration of the postural adjustments for step initiation was shortened as the velocity of perturbation increased. 6. We conclude that the CNS uses prediction of perturbation velocity to modify the excitability of early automatic postural responses when the postural goal changes. In contrast, actual afferent velocity information can be used to modify the duration of the anticipatory postural adjustments for a voluntary step in response to perturbation. Thus the CNS utilizes feed-forward prediction to modify peripherally triggered postural responses, and utilizes immediate afferent information to modify the centrally initiated postural adjustments associated with voluntary movement.

Adaptation, Physiological↗

Accelerometer systolic time intervals as fast-response sensors of upright posture in the young.

BACKGROUND: Sensors of posture may improve rate-adaptive pacing in syndromes where syncope occurs in the upright posture, particularly in the young. No sensor of posture has been described to date. Previous studies suggest that two sensors currently under investigation (preejection period [PEP] and left ventricular ejection time [LVET] systolic time intervals [STIs] and accelerometers) may be affected by posture. A PEP-sensing pacemaker is available commercially in which heart rate (HR) decreases with an increase in PEP (delta(HR)/delta[PEP]< 0). In patients with upright syncope, it is not known how such algorithms respond to posture. Also, it is not known whether STIs correlate with posture independent of autonomic tone. METHODS AND RESULTS: We studied accelerometer-derived STIs in head-upright tilt-testing with beta-blockade and catecholamine stimulation in patients with syncope or presyncope using an ultra-low-frequency accelerometer placed on the chest. Thirty-two patients age 6 to 22 years with unexplained recurrent syncope or presyncope underwent tilt-testing involving two to four tilts (60 degrees) at baseline, during esmolol infusion (500 micrograms/kg load, 50 to 140 micrograms/kg per minute), after esmolol withdrawal, and during isoproterenol infusion if not contraindicated. PEP, LVET, and other indexes were quantified, and their relations to posture and to autonomic state were determined. With tilt, PEP increased from 98.9 +/- 2.2 to 109.1 +/- 2.8 msec (P < .0001), and LVET decreased (supine-to-upright) from 295.5 +/- 4.5 to 247.2 +/- 4.7 msec (P < .0001). PEP/LVET changed from 0.337 +/- 0.01 to 0.45 +/- 0.02 (P < .0001). Similar postural changes were observed during tilt with beta-blockade and esmolol withdrawal, and during isoproterenol infusion. STI changes occurred immediately on postural change and were stable. Postural change of PEP was greater than the beta-adrenergic effect by 6:1. Postural change of STIs was independent of vagal tone. CONCLUSIONS: First, accelerometer-derived STIs detect postural changes. Because these changes are independent of autonomic tone and are rapid and stable, they may be useful as fast-response sensors of upright posture in rate-adaptive pacemakers. Second, with postural change, HR increases when PEP increases. However, PEP-sensing pacemakers presently under investigation assume the opposite (inverse) mathematical relationship. Therefore, current PEP-sensing pacemakers use an incorrect algorithm for physiological postural responses in syncope patients. These data predict a paradoxical tachycardic response to the supine posture in patients implanted with these devices.

Adolescent↗

Bilateral subthalamic nucleus deep brain stimulation improves certain aspects of postural control in Parkinson's disease, whereas medication does not.

Postural control requires precise integration of sensory inputs and motor output, but clinical assessments of postural control do not differentiate between these. Previously, we found that this differentiation is important in Parkinson's disease (PD) as there was a dissociated effect of medication versus pallidotomy on sensory aspects of postural instability. In this study, we address several questions that emerged from that work in 28 different patients with PD off and on medication, before and after bilateral subthalamic nucleus deep brain stimulation (B-STN DBS): (1) In a different cohort is there still an unusually large percentage of patients with postural instability in sensory-deprived conditions? (2) Are more specific measures of motor aspects of postural control using dynamic posturography (postural movement velocity [MV] and reaction time [RT]) abnormal in PD as seen clinically using the Postural Instability and Gait Disorder score of the Unified Parkinson's Disease Rating Scale? (3) What is the effect of B-STN DBS versus medication on sensory versus motor aspects of postural instability in PD? The results included (1) substantially more patients (39%) versus controls (5%) exhibited postural instability in conditions of limited sensory feedback; (2) postural MV and postural RT were abnormal off medication preoperatively (N(subset) = 23; P < 0.001 for both); (3) B-STN DBS improved abnormal sensory aspects of postural instability (P < 0.05) and postural MV (P = 0.005), whereas medication did not. Neither B-STN DBS nor medication improved postural RT. For the group as a whole, STN DBS plus medication was better therapy than medication preoperatively for sensory aspects of postural control (P = 0.003).

Brain↗

Electromyographic and biomechanical characteristics of segmental postural adjustments associated with voluntary wrist movements. Influence of an elbow support.

This study re-investigates the characteristics of segmental postural adjustments associated with rapid mono-articular movements and analyses their dependence on initial postural conditions. Subjects performed rapid voluntary wrist flexions and extensions while maintaining their upper limb posture as stable as possible, with or without an elbow support. Surface electromyographic activity (EMG) was recorded from Flexor carpi ulnaris, Extensor carpi radialis, Biceps brachii, Triceps brachii and Deltoideus anterior. The kinematics of the three joints and kinetics in the support condition were also recorded. A planar mechanical model was used to determine the muscle torque required to keep the upper limb posture constant while performing wrist movements. All subjects showed anticipatory postural adjustments (APA) which, unlike those described for whole-body postural control, could not counteract in advance the perturbing inter-segmental forces created by the movement. Postural muscles were activated before the wrist movement with a chronology specific to the direction of the wrist movement. Some postural muscular activities anticipated that of the prime-movers in accordance with muscle torque, which had to be applied to the joints to keep the upper limb posture constant. These results reveal that the central nervous system (CNS) uses the same organization of the motor command for the control of both segmental and whole-body posture: APA and corrective postural adjustments (CPA), which are based on well-organized anticipatory postural muscle activities (APMA), except that APA can be non-efficient in segmental postural control. The presence or absence of an elbow support influenced the level of activation of postural muscle but not their chronology. This result suggests that the CNS uses a sequence of APMA: a postural muscle synergy which is predetermined as a function of the intended direction of the movements and modulates the gain towards certain muscles, in accordance with the gravitational effects, and supports reaction changes.

Action Potentials↗

Nursing, maternal postures, and fetal position.

The objectives of this study were to (a) determine if a safe, simple, and economic nursing procedure--maternal posturing--would result in the rotation of a fetus in the posterior or transverse position to the optimal anterior position and (b) evaluate the relative effectiveness of a series of maternal postures for facilitating anterior fetal rotation. One hundred healthy women at term pregnancy were randomly assigned to four treatment and one control posture for a 10-minute period. At two nurse-midwifery clinics, one certified nurse-midwife postured the subjects and one midwife measured the dependent variable (fetal position) with Leopold's maneuvers. Hypotheses I-IV, which predicted that the four rotation postures would have a greater proportion of anterior fetal rotations than the control posture, were supported (p less than .000). Essentially all four postures were effective and there was little difference between the treatment postures. A second posturing was performed to determine if an additional 10 minutes in a treatment posture would result in an anterior fetal position. There was a greater proportion of anterior fetal rotations with the four rotation postures than the control posture. The Sims posture was used as a maintenance posture for anterior positions, and was successful when done on the opposite side of the fetal back. The theoretical explication of how maternal postures effect fetal rotation remains sound.

Adult↗

Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?

Postural control is no longer considered simply a summation of static reflexes but, rather, a complex skill based on the interaction of dynamic sensorimotor processes. The two main functional goals of postural behaviour are postural orientation and postural equilibrium. Postural orientation involves the active alignment of the trunk and head with respect to gravity, support surfaces, the visual surround and internal references. Sensory information from somatosensory, vestibular and visual systems is integrated, and the relative weights placed on each of these inputs are dependent on the goals of the movement task and the environmental context. Postural equilibrium involves the coordination of movement strategies to stabilise the centre of body mass during both self-initiated and externally triggered disturbances of stability. The specific response strategy selected depends not only on the characteristics of the external postural displacement but also on the individual's expectations, goals and prior experience. Anticipatory postural adjustments, prior to voluntary limb movement, serve to maintain postural stability by compensating for destabilising forces associated with moving a limb. The amount of cognitive processing required for postural control depends both on the complexity of the postural task and on the capability of the subject's postural control system. The control of posture involves many different underlying physiological systems that can be affected by pathology or sub-clinical constraints. Damage to any of the underlying systems will result in different, context-specific instabilities. The effective rehabilitation of balance to improve mobility and to prevent falls requires a better understanding of the multiple mechanisms underlying postural control.

Accidental Falls↗

On the mechanism of L-dopa-induced postural hypotension in the cat.

1. The effects of L-DOPA on postural hypotension and carotid occlusion pressor effect were studied, mainly in cats; the recovery of the blood pressure upon tilting was used as a measure of postural hypotension.2. L-DOPA (30 mg/kg) partially depressed the carotid occlusion pressor effect and caused some degree of postural hypotension, L-DOPA (100 mg/kg) had more marked effects; the responses returned to control after 90 to 150 minutes. L-DOPA itself caused a pressor response in all cats.3. The dopa decarboxylase inhibitor N(1)-(DL-seryl)-N(2)-(2,3,4-trihydroxybenzyl) hydrazine (RO4-4602, 50 and 10 mg/kg) had no effect itself on the tilt response but completely prevented the effects of L-DOPA on the carotid occlusion pressor effect and postural hypotension.4. After RO4-4602 (3 and 1 mg/kg), L-DOPA (100 mg/kg) caused a brief rise of blood pressure followed by a longer lasting fall in horizontally-orientated cats (i.e. ;supine' hypotension). No postural hypotension was observed after L-DOPA under these conditions.5. Noradrenaline elicited only small and transient effects on postural hypotension, but dopamine's effects were more marked and longer lasting. Pressor dose-response relationships for noradrenaline were the same before and after L-DOPA, as well as in cats pretreated with L-DOPA for 4 days.6. In cats with kidneys and intestines removed, the tilt reflex was still present. Dose-response curves to L-DOPA were the same as in normal animals. RO4-4602 (3 mg/kg) prevented postural hypotension and block of the carotid occlusion pressor effect; supine hypotension was also observed after L-DOPA.7. The recovery response to tilting in spinal cats was markedly depressed or absent unless the blood pressure was elevated by angiotensin, in which experiments L-DOPA depressed the recovery upon tilting (i.e. induced postural hypotension).8. Blood pressure responses to tyramine were increased after 10 mg/kg of L-DOPA, but depressed after 100 mg/kg. The response to tyramine was not depressed, however, when RO4-4602 was given to block the dopa-dopamine conversion.9. The response to sympathetic stimulation in pithed rats was depressed after L-DOPA and dopamine, but not after alpha-methyldopa.10. alpha-Methyldopa (300 mg/kg) given acutely caused a moderate degree of postural hypotension and a more marked postural hypotension if given for two days.11. It is concluded that it is possible to differentiate between the supine and postural hypotension caused by L-DOPA and that supine hypotension is due to a central effect and postural hypotension to an extracerebral effect. Postural hypotension is discussed in relation to six hypotheses presented to explain its effect. Postural hypotension after L-DOPA is probably not due to a-adrenoceptor blockade, a central effect or any effect on the kidney. The most likely hypothesis is that L-DOPA forms dopamine which acts as a false transmitter in the peripheral sympathetic nervous system.

Adrenergic alpha-Antagonists↗

Coordination between posture and movement in a bimanual load lifting task: putative role of a medial frontal region including the supplementary motor area.

The aim of the present experimental series was to investigate the role of the medial frontal region including the supplementary motor area in the coordination between posture and movement in a bimanual load lifting task. The seated subject was instructed to maintain in a horizontal position one forearm (postural arm) which was loaded with a 1 kg weight. The unloading was performed either by the experimenter (imposed unloading) or by a voluntary movement of the other arm (voluntary unloading). In normal individuals, with the voluntary unloading, the movement control was accompanied by an anticipatory adjustment of the postural forearm flexor activity, which resulted in the maintenance of the forearm position despite the unloading. The anticipatory postural adjustments were impaired in 4 out of 5 patients with unilateral lesion of the SMA region; the defect was observed mainly when the postural forearm was contralateral to the lesion. No change in the anticipatory postural adjustment was observed in one patient with complete callosal section. This finding indicates that the coordination between the posture and movement in this task is not organized through callosal fibers linking the cortices on both sides but rather at a subcortical level. The anticipatory postural adjustments were abolished in two patients with spastic hemiparesis when the postural forearm was the spastic arm. It is suggested that the SMA region contralateral to the postural forearm, together with other premotor or motor areas, may select the circuits responsible for the phasic postural adjustments which are necessary to ensure postural maintenance, whereas the motor cortex contralateral to the voluntary movement controls both the movement and, via collaterals, the preselected circuits responsible for the associated postural adjustments.

Adult↗

The visual control of stability in children and adults: postural readjustments in a ground optical flow.

The aim of this research was to analyse the development of postural reactions to approaching (AOF) and receding (ROF) ground rectilinear optical flows. Optical flows were shaped by a pattern of circular spots of light projected on the ground surface by a texture flow generator. The geometrical structure of the projected scenes corresponded to the spatial organisation of visual flows encountered in open outdoor settings. Postural readjustments of 56 children, ranging from 7 to 11 years old, and 12 adults were recorded by the changes of the centre of foot pressure (CoP) on a force platform during 44-s exposures to the moving texture. Before and after the optical flows exposure, a 24-s motionless texture served as a reference condition. Effect of ground rectilinear optical flows on postural control development was assessed by analysing sway latencies (SL), stability performances and postural orientation. The main results that emerge from this experiment show that postural responses are directionally specific to optical flow pattern and that they vary as a function of the motion onset and offset. Results showed that greater developmental changes in postural control occurred in an AOF (both at the onset and offset of the optical flow) than in an ROF. Onset of an approaching flow induced postural instability, canonical shifts in postural orientation and long latencies in children which were stronger than in the receding flow. This pattern of responses evolved with age towards an improvement in stability performances and shorter SL. The backward decreasing shift of the CoP in children evolved in adults towards forward postural tilt, i.show $132#e. in the opposite direction of the texture's motion. Offset of an AOF motion induced very short SL in children (which became longer in adult subjects), strong postural instability, but weaker shift of orientation compared to the receding one. Postural stability improved and orientation shift evolved to forward inclinations with age. SL remained almost constant across age at both onset and offset of the receding flow. Critical developmental periods seem to occur by the age of 8 and 10 years, as suggested by the transient 'neglect' of the children to optical flows. Linear vection was felt by 90% of the 7 year olds and decreased with age to reach 55% in adult subjects. The mature sensorimotor coordination subserving the postural organisation shown in adult subjects is an example aiming at reducing the postural effects induced by optical flows. The data are discussed in relation to the perceptual importance of mobile visual references on a ground support.

Adaptation, Physiological↗

Is lower leg proprioception essential for triggering human automatic postural responses?

It is unknown to what extent automatic postural responses are triggered by lower leg proprioception. This issue was addressed by studying postural control in five carefully selected patients with subtle diabetic polyneuropathy (restricted to the lower legs) and 15 healthy subjects. All patients had bilaterally absent Achilles tendon reflexes and weak or absent patella tendon reflexes, but muscle strength was fully preserved. Subjects were tested while standing on a supporting, movable force-plate. The contribution of lower leg proprioception to automatic postural responses was investigated by randomly exposing the subjects to either a 4 degrees 'toe-up' rotational perturbation ('normal ankle input'), a simultaneous 4-cm rearward translation and 4 degrees toe-up rotation ('enhanced ankle input'), or a simultaneous 4-cm rearward translation and 4 degrees 'toe-down' rotation ('nulled ankle input'). We recorded surface EMG (stretch reflexes and balance-correcting responses) from leg and trunk muscles, ankle torque and angular velocities of the upper and lower legs and trunk. We argued that automatic postural responses that have abnormally small amplitudes in patients and are modulated in controls with the velocity of different types of ankle rotations must receive a major input from lower leg proprioception. Conversely, automatic postural responses that are weakly modified in amplitude or onset by different ankle perturbations and are present despite nulled ankle inputs and, finally, are unaffected in patients with distal polyneuropathy must be triggered or modulated by inputs other than from lower leg proprioception. Normal postural synergies and strategies were maintained in patients, although within a given synergy the timing and amplitude of some automatic postural responses were abnormal. A few automatic postural responses appeared to be triggered or modulated by lower leg proprioception. Thus, early stretch reflexes in soleus and medial gastrocnemius were severely diminished in patients, while in controls these stretch reflexes were modulated by different ankle perturbations. Furthermore, balance-correcting responses in tibialis anterior were diminished and delayed in patients, while in controls these balance-correcting responses were modulated by different ankle perturbations. Other automatic postural responses were apparently not triggered or modulated by lower leg proprioception, but likely received a major input from more proximal sensory systems. Thus, in both groups prominent balance-correcting responses were present in several muscles (soleus, gastrocnemius, quadriceps, paraspinals and trapezius) during the 'nulled ankle input' condition, where ankle position was stabilised over the first 250 ms. During the 'enhanced ankle input' condition, where prominent ankle dorsiflexion occurred during the first 200 ms, amplitudes of balance-correcting responses were only marginally weaker in patients than in controls. We analysed body segment displacements to unveil the potential nature of proximal triggers for automatic postural responses. As opposed to the 'inverted pendulum' concept of postural control, early movement occurred in the knees, hips and trunk well before the onset of automatic postural responses. For example, during the 'nulled ankle input' condition, the lower leg moved forward with early knee flexion, followed by knee extension. The trunk extended backwards at 80 ms, which was followed by forward flexion. The absent stretch reflex and weaker balance-correcting responses in patients produced changed trunk velocity profiles (mainly a reduced initial backward motion of the trunk), but lower-body segment movements showed no consistent differences between the two groups. Considering these body segment displacements, any automatic postural response with an onset within the first 200 ms could well be triggered by receptors located at the knee, hip or trunk. (ABSTRACT TRUNCATED)

Achilles Tendon↗

Back posture education in elementary schoolchildren: a 2-year follow-up study.

Within the scope of primary prevention regarding back functioning in children, research on the stability of intervention effects is indispensable. Along this line, the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological demands related to adolescence. The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up, in youngsters aged 13-14 years, on back posture knowledge, fear-avoidance beliefs and self-reported pain. An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters' lifestyles. At 2-year follow-up, the study sample included 94 secondary schoolchildren in the intervention group (mean age 13.3 +/- 0.8 years) and 101 controls (mean age 13.2 +/- 0.7 years). The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes. A questionnaire was completed comparable to the pretest, posttest and follow-up evaluations. The current study demonstrated at 2-year follow-up stability of the improved general (F = 1.590, ns) and specific (F = 0.049, ns) back posture knowledge in children who had received early back posture education. Back posture education did not result in increased fear-avoidance beliefs (F = 1.163, ns) or mounting back and/or neck pain reports (F = 0.001, ns). Based on self-reports for postural behavior, youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior. The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence. Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential.

Back↗

Accuracy and validity of observational estimates of shoulder and elbow posture.

This study investigated the accuracy of video-based observational posture analysis for the elbow and shoulder. Posture analyses were conducted by 28 ergonomists for four jobs presented on a traditional VHS format video recording. Estimates of posture from the observational-based methods were compared with values measured directly with an optical motion capture system. Ergonomists used categorical posture scales and a continuous visual analog scale to estimate the peak and most frequently occurring or average posture for each job. Use of a three-category scale resulted in misclassifications of peak and most frequently occurring elbow and shoulder posture with a probability averaging 30.1%. With the six-category posture scale this average probability of misclassification increased to 64.9%. Using a continuous visual analog scale peak shoulder elevation was the only posture for which the average error among ergonomists' estimates was significantly different from zero (p<0.05). Correlations between the estimated postures and measured postures were higher and statistically significant (p<0.05) for elbow flexion and shoulder elevation (r2 between 0.45 and 0.66) but were considerably lower and not significant (r2 between 0.03 and 0.18) for the peak and average horizontal shoulder abduction. Ergonomists' estimates of the temporal distribution of shoulder posture, indicating the duration severity of the posture, appeared to be biased such that the percentage of the cycle time in each posture category was estimated as more uniformly distributed than the measured values indicated.

Elbow↗

Accuracy and validity of observational estimates of wrist and forearm posture.

Numerous observational methods for analysis of working posture of the wrist/forearm have been reported in the literature yet few of these methods have been validated for the accuracy of their posture classification. The present study evaluated the accuracy of estimates of working posture made by 28 experienced ergonomists using methods of scaling upper limb posture typical of those reported in the literature. Observational estimates of wrist/forearm posture of four jobs presented on video-recording were compared with posture levels measured directly with an electrogoniometer system. Ergonomists using a visual analogue scale tended to underestimate peak and average wrist extension with mean errors of -29.4% and -10.5% of the joint ROM, respectively (p<0.05). While estimates of wrist flexion, pronation and supination resulted in less bias, variability in observer error was large for all wrist postures. The probability of an analyst misclassifying the most frequently occurring posture using a three- and a six-category scale was 54 and 70%, respectively. The probability of misclassifying peak posture was 22 and 61% using a three- and a six-category scale respectively. This suggests a trade-off between the degree of precision afforded by the categorical scale and the likelihood of posture misclassification. Estimates of the temporal distribution of posture among the categories appeared to be biased towards more neutral postures than were measured for the jobs. This indicated the possibility of a trend towards underestimation of posture duration severity by the ergonomists.

Bias↗

Quantitative postural load assessment for whole body manual tasks based on perceived discomfort.

Many Korean workers are exposed to repetitive manual tasks or prolonged poor working postures that are closely related to back pain or symptoms of musculoskeletal disorders. Workers engage in tasks that require not only handling of heavy materials, but also assuming prolonged or repetitive non-neutral work postures. Poor work postures that have been frequently observed in the workplaces of shipbuilding shops, manufacturing plants, automobile assembly lines and farms often require prolonged squatting, repetitive arm raising and wrist flexion and simultaneous trunk flexion and lateral bending. In most manufacturing industries, workers have to assume improper work postures repetitively, several hundreds of times per day depending on daily production rate. A series of psychophysical laboratory experiments were conducted to evaluate the postural load at various joints. A postural load assessment system was then developed based on a macro-postural classification scheme. The classification scheme was constructed based on perceived discomfort for various joint motions as well as previous research outcomes. On the basis of the perceived discomfort, postural stress levels for the postures at individual joints were also defined by a ratio scale to the standing neutral posture. Laboratory experiments simulating automobile assembly tasks were carried out to investigate the relationship between body-joint and whole-body discomfort. Results showed a linear relationship between the two types of discomfort, with the shoulder and low back postures being the dominant factor in determining the whole body postural stresses. The proposed method was implemented into a computer software program in order to automate the procedure of analysing postural load and to enhance usability and practical applicability.

Humans↗

Computer users' postures and associations with workstation characteristics.

This investigation tested the hypotheses that (1) physical workstation dimensions are important determinants of operator posture, (2) specific workstation characteristics systematically affect worker posture, and (3) computer operators assume "neutral" upper limb postures while keying. Operator head, neck, and upper extremity posture and selected workstation dimensions and characteristics were measured among 379 computer users. Operator postures were measured with manual goniometers, workstation characteristics were evaluated by observation, and workstation dimensions by direct measurement. Considerably greater variability in all postures was observed than was expected from application of basic geometric principles to measured workstation dimensions. Few strong correlations were observed between worker posture and workstation physical dimensions; findings suggest that preference is given to keyboard placement with respect to the eyes (r = 0.60 for association between keyboard height and seated elbow height) compared with monitor placement with respect to the eyes (r = 0.18 for association between monitor height and seated eye height). Wrist extension was weakly correlated with keyboard height (r = -0.24) and virtually not at all with keyboard thickness (r = 0.07). Use of a wrist rest was associated with decreased wrist flexion (21.9 versus 25.1 degrees, p < 0.01). Participants who had easily adjustable chairs had essentially the same neck and upper limb postures as did those with nonadjustable chairs. Sixty-one percent of computer operators were observed in nonneutral shoulder postures and 41% in nonneutral wrist postures. Findings suggest that (1) workstation dimensions are not strong determinants of at least several neck and upper extremity postures among computer operators, (2) only some workstation characteristics affect posture, and (3) contrary to common recommendations, a large proportion of computer users do not work in so-called neutral postures.

Adult↗

Evaluation of posturing in macular hole surgery.

AIM: To objectively evaluate the postoperative face down posturing in macular hole surgery. MATERIALS AND METHODS: An electronic device called 'Maculog' was developed consisting of three basic components, a mercury switch triggered by the angle of tilt placed inside an earpiece, a data-recording device connected to the earpiece with cables and a windows based software program, specially written to analyse the recorded data in the form of tables and graphs. Ten patients undergoing macular hole surgery were fitted with the device on the first postoperative day before discharge. They were also asked for a subjective record of their posturing times. Four patients were given a posturing chair to take home. The device was retrieved after the first week and the data were downloaded to a PC for analysis. The actual posturing times recorded on the device were compared to the patients' own recollections. Results In all ten patients the actual posturing time was less than the time they had recorded themselves. The average actual posturing time was 48% of the perceived posturing time. The worst time for posturing, as expected, was between midnight and early morning. The compliance was better in patients who used the posturing chair. CONCLUSIONS: It is feasible to quantify the time of posturing using an electronic device and computer analysis. The study has shown that the actual posturing time is significantly less than the perceived posturing time. A further large study using 'Maculog' is now planned to correlate actual posturing time to the results of macular hole surgery.

Aged↗

Kinematics of the human mandible for different head postures.

The influence of head posture on movement paths of the incisal point (IP) and of the mandibular condyles during free open-close movements was studied. Ten persons, without craniomandibular or cervical spine disorders, participated in the study. Open close mandibular movements were recorded with the head in five postures, viz., natural head posture, forward head posture, military posture, and lateroflexion to the right and to the left side, using the Oral Kinesiologic Analysis System (OKAS-3D). This study showed that in a military head posture, the opening movement path of the incisal point is shifted anteriorly relative to the path in a natural head posture. In a forward head posture, the movement path is shifted posteriorly whereas during lateroflexion, it deviates to the side the head has moved to. Moreover, the intra-articular distance in the temporomandibular joint during closing is smaller with the head in military posture and greater in forward head posture, as compared to the natural head posture. During lateroflexion, the intra-articular distance on the ipsilateral side is smaller. The influence of head posture upon the kinematics of the mandible is probably a manifestation of differences in mandibular loading in the different head postures.

Adult↗

Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria.

BACKGROUND: Abnormal motor posturing is often observed in children with cerebral malaria, but the aetiology and pathogenesis is poorly understood. This study examined the risk factors and outcome of posturing in Kenyan children with cerebral malaria. METHODS: Records of children admitted to Kilifi district hospital with cerebral malaria from January, 1999 through December, 2001 were reviewed for posturing occurring on or after admission. The clinical characteristics, features of raised intracranial pressure, number of seizures and biochemical changes in patients that developed posturing was compared to patients who did not. RESULTS: Of the 417 children with complete records, 163 (39.1%) had posturing: 85 on admission and 78 after admission to hospital. Decorticate posturing occurred in 80, decerebrate in 61 and opisthotonic posturing in 22 patients. Posturing was associated with age > or = 3 years (48.1 vs 35.8%, p = 0.01) and features of raised intracranial pressure on funduscopy (adjusted OR 2.1 95%CI 1.2-3.7, p = 0.009) but not other markers of severity of disease. Unlike decorticate posturing, decerebrate (adjusted OR 1.9 95%CI 1.0-3.5) and opisthotonic posturing (adjusted OR 2.9 95%CI 1.0-8.1) were, in addition, independently associated with recurrence of seizures after admission. Opisthotonus was also associated with severe metabolic acidosis (OR 4.2 95%CI 3.2-5.6, p < 0.001). Thirty one patients with posturing died. Of these, 19 (61.3%) had features suggestive of transtentorial herniation. Mortality and neurological deficits on discharge were greatest in those developing posturing after admission. CONCLUSION: Abnormal motor posturing is a common feature of cerebral malaria in children. It is associated with features of raised intracranial pressure and recurrence of seizures, although intracranial hypertension may be the primary cause.

Brain Stem↗