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Effects of different jaw relations on postural stability in human subjects.

Authors investigated the effects of different jaws relations on body posture in a sample of 95 subjects. All subjects underwent a posturometric and stabilometric analysis using a computerized footboard. Tests were performed in three mandibular positions: centric occlusion, rest position and myocentric position, respectively determined by teeth engagement, joints position, and muscles contraction. All subjects showed variations of body posture in the different mandibular positions. Statistical analysis (analysis of variance for repeated measures) confirmed that postural variations in different jaws relations were significant: in particular, the SKN multiple comparison test showed that myocentric position improved postural balance on frontal plane with respect to the other jaw positions considered.

Analysis of Variance↗

The reliability, distribution, and responsiveness of the Postural Control and Balance for Stroke Test.

OBJECTIVES: To determine the inter- and intrarater reliability of the Postural Control and Balance for Stroke (PCBS) test and to assess its distribution and responsiveness to changes during 1-year follow-up. DESIGN: Intrarater reliability of the PCBS test was assessed by comparing the repeat ratings of videotaped test performances by each of the 5 raters. Interrater reliability was assessed by comparing the ratings of the videotaped test performances between the raters. SETTING: Hospital neurologic ward and outpatient department of physiotherapy as well as health centers in Finland. PARTICIPANTS: Fifty stroke patients (age range, 42-89 y) were measured 7, 120, and 360 days poststroke for the study of distribution and responsiveness and 19 patients (age range, 55-85 y) were measured during a period between 7 and 60 days poststroke for the reliability study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The distributions of the scores of the PCBS test, intraclass correlation coefficient (ICC) and weighted kappa values, and Wilcoxon matched-pairs tests. RESULTS: The PCBS test had limited floor and ceiling effects at 7, 120, and 360 days poststroke. The differences between scores 7 and 120 days poststroke were significant (P<.001). The differences between scores 120 and 360 days poststroke were not significant (P>.05). The Cronbach alpha for all the items combined was .96. The ICC values for the interrater and intrarater reliability of the PCBS test were .94 and .96, respectively. CONCLUSIONS: The PCBS test showed an acceptable level of reliability and the responsiveness results indicated a good level before 120 days but not between 120 and 360 days after stroke.

Aged↗

Relationship between thoracic, lordotic, and pelvic inclination and craniofacial morphology in adults.

OBJECTIVE: To analyze the correlation ratios between the spinal posture (thoracic, lordotic, and pelvic inclination) and the craniofacial morphology. MATERIALS AND METHODS: The sample consisted of 53 healthy adults (32 women, 21 men; mean age 24.6 years). Six angular skeletal measurements (facial axis, mandibular plane angle, inner gonial angle, lower facial height, facial depth, and maxilla position) were determined based on the analysis of lateral head cephalographs. Rasterstereography was used for a precise reconstruction of the back sagittal profile. From the profile parameters, the upper thoracic inclination, the thoracic angle, the lordotic angle, and the pelvic inclination were determined. The correlations to the craniofacial morphology were calculated by means of the Pearson and Mann-Whitney U-test. RESULTS: Significant correlations could be obtained with respect to the facial axis and the lordotic angle, the facial axis and the pelvic inclination, the inner gonial angle and the lordotic angle, the inner gonial angle and the pelvic inclination, the mandibular plane angle and the lordotic angle, the mandibular plane angle and the pelvic inclination, as well as the facial depth and the pelvic inclination. CONCLUSIONS: In the case of postural disorders of the back shape, an interdisciplinary treatment approach seems to be of clinical value. Further prospective studies are necessary to prove how changes in craniofacial parameters can affect the postural balance of an individual.

Adult↗

Falling and postural deficits due to acute unilateral basal ganglia lesions.

Nine patients presented with sudden falling events to one side while sitting, standing, or walking. All were initially unaware of their severe postural deficit, and five were obfuscated. The observed falls were a distinctly slow, tilting motion in a stereotypic lateral or diagonal trajectory, literally "like a falling log." The events occurred with eyes opened and were exacerbated with eye closure, but no patient had evidence of cerebellar, vestibular, or posterior column dysfunction or significant motor weakness. Unilateral basal ganglia hemorrhages or lacunar infarcts contralateral to the side of the fall were demonstrated by computed tomographic scans. The overall prognosis was favorable; eight of nine patients regained independent ambulation within 3 to 6 weeks. Our findings indicate that a distinct loss of postural balance arises contralaterally to unilateral pallidal-putaminal lesions.

Accidental Falls↗

Differential approach to strategies of segmental stabilisation in postural control.

The present paper attempts to clarify the between-subjects variability exhibited in both segmental stabilisation strategies and their subordinated or associated sensory contribution. Previous data have emphasised close relationships between the interindividual variability in both the visual control of posture and the spatial visual perception. In this study, we focused on the possible relationships that might link perceptual visual field dependence-independence and the visual contribution to segmental stabilisation strategies. Visual field dependent (FD) and field independent (FI) subjects were selected on the basis of their extreme score in a static rod and frame test where an estimation of the subjective vertical was required. In the postural test, the subjects stood in the sharpened Romberg position in darkness or under normal or stroboscopic illumination, in front of either a vertical or a tilted frame. Strategies of segmental stabilisation of the head, shoulders and hip in the roll plane were analysed by means of their anchoring index (AI). Our hypothesis was that FD subjects might use mainly visual cues for calibrating not only their spatial perception but also their strategies of segmental stabilisation. In the case of visual cue disturbances, a greater visual dependency to the strategies of segmental stabilisation in FD subjects should be validated by observing more systematic "en bloc" functioning (i.e. negative AI) between two adjacent segments. The main results are the following: 1. Strategies of segmental stabilisation differed between both groups and differences were amplified with the deprivation of either total vision and/or static visual cues. 2. In the absence of total vision and/or static visual cues, FD subjects have shown an increased efficiency of the hip stabilisation in space strategy and an "en bloc" operation of the shoulder-hip unit (whole trunk). The last "en bloc" operation was extended to the whole head-trunk unit in darkness, associated with a hip stabilisation in space. 3. The FI subjects have adopted neither a strategy of segmental stabilisation in space nor on the underlying segment, whatever the body segment considered and the visual condition. Thus, in this group, head, shoulder and hip moved independently from each other during stance control, roughly without taking into account the visual condition. The results, emphasising a differential weighting of sensory input involved in both perceptual and postural control, are discussed in terms of the differential choice and/or ability to select the adequate frame of reference common to both cognitive and motor spatial activities. We assumed that a motor-somesthetics "neglect" or a lack of mastering of these inputs/outputs rather than a mere visual dependence in FD subjects would generate these interindividual differences in both spatial perception and postural balance. This proprioceptive "neglect" is assumed to lead FD subjects to sensory reweighting, whereas proprioceptive dominance would lead FI subjects to a greater ability in selecting the adequate frame of reference in the case of intersensory disturbances. Finally, this study also provides evidence for a new interpretation of the visual field dependence-independence dimension in both spatial perception and postural control.

Adult↗

Changes in postural mechanics associated with different types of minimally invasive surgical training exercises.

BACKGROUND: Doctors who perform minimally invasive surgery commonly report upper extremity fatigue or joint and muscle pain. The goal of this study was to investigate the changes in postural parameters associated with different laparoscopic training tasks and graspers. METHODS: Three different training tasks (targeted object release, rope passing, and cable tying) were performed with three types of laparoscopic graspers. Joint angles were determined using video analysis, and centers of pressure (COP) were measured with force platforms. RESULTS: Cable tying proved to be the most challenging training task and involved greater joint angle excursions and COP excursions and velocities. Grasper 2 reduced shoulder and wrist flexion-extension over the selected tasks. CONCLUSION: Training tasks should be designed to simulate surgical procedures because different tasks require distinct combinations of joint rotations. Joint rotations and postural balance should be considered when an optimal grasper is selected for a particular training task.

Analysis of Variance↗

Importance of the visual cortex for postural stabilization: inferences from pigeon and frog data.

Optokinetically induced self-motion with its consequences for postural balance is based upon visual-vestibular convergence. It is a matter for speculation which visual pathways--subcortical accessory optic tract and/or cortical striate projection--convey optokinetic information to the central vestibular system. The functional significance of the visual cortex was tested by a behavioral approach in two animals, selected for their different evolutionary stage: frog (midbrain visual center); pigeon (primitive neocortical center). Lateral postural sway during optokinetic stimulation in roll served as a measurement for induced rollvection and apparent body tilt. Roll motion elicits a tonic 'compensatory' postural adjustment towards the direction of pattern motion in pigeon as in man but not in frog. From the lack of this reaction we infer that the frog does not perceive rollvection because it has no visual cortex. This agrees with the absence of visual-vestibular convergence in the frogs vestibular nuclei neurons as well as the absence of a nystagmus velocity storage in the brainstem. The animal experiments fit human data in hemianopic patients who also only experience rollvection when stimulated in the unaffected hemifield.

Animals↗

Physical therapy during in-patient rehabilitation for a patient with Stiff-Person Syndrome.

BACKGROUND AND PURPOSE: Patients with Stiff-Person Syndrome (SPS) typically show stiffness and spasms, primarily of the trunk and proximal lower extremities. The purpose of this case report is to provide an overview of SPS and a description of the specific physical therapy management strategies used during a brief inpatient rehabilitation stay for a patient with SPS, illustrating the use of the patient/client management model in the Guide to Physical Therapist Practice. CASE DESCRIPTION: The patient was a 33-year-old with a 3- year history of SPS. He spent 10 days in an in-patient rehabilitation hospital where he received physical therapy daily. The initial examination revealed impairments of pain, range of motion, reflex integrity, and motor function, along with abnormalities of posture, balance, and function. The procedural interventions included therapeutic exercise and functional retraining. Stretching exercises were categorized according to their priority and level of difficulty to accommodate for the patient's varying symptoms, and relaxation exercises aimed to reduce the severity of the patient's spasms. The functional retraining program included transfer and progressive gait training. OUTCOMES: The patient showed improvements in ankle range of motion, posture, and gait (distance, speed, and independence), despite continued problems with stiffness, spasms, and pain. DISCUSSION: Physical therapists working with patients with SPS have challenges related to the paucity of information in the literature. The chronic, progressive, and variable nature of SPS indicates the need for life-long management, with the inclusion of an exercise program that can be adjusted accordingly, given the frequently changing symptoms experienced by the patient. As is shown with this case, it appears that physical therapy can improve function and some of the impairments associated with SPS.

Adult↗

Postural sway and diabetic peripheral neuropathy.

The focus of this paper is to evaluate the relationship between postural sway assessed by a gravicorder and peripheral neuropathy in patients with type 2 diabetes. Posturography (GRAVICHART), electrophysiological tests, and power spectrum analysis of heart rate fluctuations were performed in the following age-matched subjects: 123 type 2 diabetic patients without peripheral neuropathy, 32 type 2 diabetic patients with peripheral neuropathy, and 55 healthy control subjects. All diabetic patients with a history of clinical neurological dysfunction were excluded from the study. Significant correlations were found between parameters of GRAVICHART and some parameters of the electrophysiological tests as well as the parameters of heart rate variability. The envelope area and the length per time were larger in type 2 diabetic patients with peripheral neuropathy than in patients without peripheral neuropathy and the control subjects. There were no significant differences in the GRAVICHART parameters between diabetic patients without neuropathy and the healthy control subjects. Type 2 diabetic patients with peripheral neuropathy exhibited an inability to maintain an upright posture. The GRAVICHART can indicate the early stage of postural balance impairment.

Albuminuria↗

Overuse injuries.

Stress injuries common to running athletes are always associated with a breakdown of the protective mechanisms normally inherent in healthy posture and gait. It is more important to identify and treat these breakdowns of the motor process than the resulting injury itself. Simple motor screening of athletes can identify functional abnormalities that lead to stress injuries. This screen includes assessment of flexibility of all major joints, responsiveness of primary postural muscles, posture, balance, and gait. Present definitions of physical fitness are focused on cardiorespiratory function and strength and do not properly determine the ability of an athlete to run or walk. The basic motor screen outlined in this article has been shown to be of value in correcting this shortcoming.

Athletic Injuries↗

Vestibular imbalance associated with a lesion in the nucleus prepositus hypoglossi area.

BACKGROUND: The nucleus prepositus hypoglossi (NPH) is known to be a neural integrator of horizontal eye movements. Although the role of the human NPH is not well known, it may also function in postural balance, in view of its anatomic connections with the vestibular nuclei and vestibulocerebellum and of lesion studies in experimental animals. OBJECTIVE: To show that the human NPH contributes to vestibular function in addition to eye movement control. DESIGN: Case series. SETTING: University hospital. Patients Six patients with small and discrete brainstem infarctions that predominantly involved the NPH region.Main Outcome Measure Findings on magnetic resonance images. RESULTS: The NPH was affected at the lower pontine level in 2 patients and at the upper medullary level in 4. In addition to gaze-evoked nystagmus, all patients had vertigo, vomiting, and postural ataxia, suggesting vestibular dysfunction. The patients typically fell contralaterally or bilaterally to the lesion side. CONCLUSION: The NPH serves a vestibular function in addition to its oculomotor control function.

Aged↗

Compartmentalized cerebellar functions upon the stabilization of body posture.

This paper reviews the features and topodiagnostical meaning of pathological body posture in cerebellar disorders and presents knowledge as to the physiology and pathophysiology of postural disturbances attributed to the cerebellum. Lesions of the spinocerebellar (upper vermal and intermediate) part of the anterior lobe lead to spontaneous anterior-posterior body sway, with a frequency of about 3 Hz with mild or absent ataxia of the upper limbs, but prominent ataxia of the lower limbs. The tremor is provoked by eye closure and by body displacement. Increased gain and poor cerebellar control of the duration and gain of stabilizing reflexes may be the mechanisms of this oscillation. Lesions of the lower (vestibulocerebellar) vermis cause postural ataxia of the head and trunk while sitting, standing, and walking. Postural ataxia is omnidirectional, sometimes of excessive amplitude and contains frequency components below 1 Hz. Dysmetria of the upper and lower limbs is not prominent. Visual stabilization is less than in the other groups of cerebellar patients. Lesions of the cerebellar hemispheres alone, do not cause an increase of postural sway. Lesions of spinocerebellar afferents (Friedreich's disease) lead to a low frequency large amplitude lateral sway with the most of its power below 1.1 Hz. Visual stabilization is preserved. Latencies of early and late EMG responses to sudden displacements are normal in patients with cerebellar disorders. The cerebellum is, therefore, unlikely to be the primary generator of these reflexive responses. On the other hand, the temporal composition of the orderly time sequence of a complex motor program--be it a voluntary act or its postural balancing--is deranged in cerebellar lesions. It is hypothesized that the cerebellum helps to coordinate the timing not only within but also between the single components involved in each subunit of a complex movement in three-dimensional space and that is scales the size and duration of each muscular action. The cerebellum possibly specifies the cortical movement command and sends it back to the motor cortex. The basic structure of a motor program, however, does not seem to be generated within the cerebellum.

Cerebellar Diseases↗

[Vertical stability of schoolchildren with spastic diplegia before and after complex physical rehabilitation].

The paper presents the results of a study of vertical stability of 18 children and teenagers (mean age 12.5) with spastic diplegia as observed before and after complex treatment including the use of the method of phase electrostimulation of muscles and of methods developed at the Physical Exercise Department, Pediatric Neurological Hospital No. 18. The patients were examined by Romberg's test on the KSK-123 stabilographic unit with open and closed eyes. The results testify indirectly to a treatment-conditioned improvement in the CNS and receptor apparatus as observed during regulation of the vertical posture balance in the examinees. Thus, with visual monitoring, the mean square deviation in the frontal plane dropped on the average by 48% and, without such monitoring, it went down by 34%; in the sagittal plane, the values decreased by 51% and 35%, respectively. The area of statokynesogram shrank by 38% with open eyes and by 27% with closed eyes. The posttreatment prevalence of sagittal fluctuations in the body's center of gravity as observed versus frontal fluctuations is also typical of the health condition of the examinees.

Adolescent↗

Efficacy of physical restoration in the elderly.

Studies of the effects of physical exercise programs have shown that such programs can improve older persons' functional capacity. Research was conducted to determine the efficacy of two different types of physical restoration regimens--active and passive--in improving the performance of elderly persons with chronic pain conditions. Data from elderly persons admitted for back and pain rehabilitation to the Comprehensive Pain and Rehabilitation Center (CPRC) at the University of Miami are presented. The active approach consisted of the aggressive rehabilitation program at the CPRC, a 4-week program of daily physical therapy, occupational therapy, behavioral modification, and counseling. Treatment goals were improved strength, flexibility, posture, balance, gait, and overall well-being. The passive approach was based on the use of functional electric stimulation (FES) as an adjunct treatment to strengthen lower extremity muscles weakened by disuse. To evaluate the effectiveness of these approaches to physical restoration, we performed ergonomic assessment of subjects' functional abilities, including static strength and range of motion. Findings indicated that both methods were valuable in physical restoration in the elderly. Specifically FES proved effective in strengthening weak muscles in the lower extremities and shows great potential for neuromuscular conditioning in older cohorts.

Aged↗

[The study of natural head posture in edentulous patients before and after oral rehabilitation].

OBJECTIVE: To study the natural head posture (NHP) of edentulous patients compared with dentate people and to understand NHP shift immediately inserting complete dentures and three months after denture wearing. METHODS: The NHPs of twenty edentulous patients and twenty-two dentate subjects were recorded with cephalometric technique. The NTPs of edentulous patients were exposed three times, before inserting, right after inserting and three months after inserting dentures. The NHPs of dentate subjects were recorded once as a controlled group. Six angles measured from the radiographs were evaluated for the NHP and three angles and two linear measures for the mandibular position. RESULTS: Compared with dentate subjects, the craniomandibular angles of the edentulous patients increased and the camber of the cervical columns decreased, but changes of the NHP were not significant. The mandible showed a significant upward moving (P < 0.05) and an insignificant forward moving. At the time of denture insertion, the camber of the cervical columns significantly increased (P < 0.05). Three months after using the dentures, the craniomandibular angles of the patients obviously decreased. (P < 0.05). CONCLUSION: The shift of NHP after denture inserting does exist. The shifted NHP of the patients with dentures is a new balanced posture and closer to the normal position than the NHP of them without dentures.

Adult↗

Abnormal turning behaviour, GABAergic inhibition and the degeneration of astrocytes in ovine Tribulus terrestris motor neuron disease.

OBJECTIVE: To observe the clinical signs of sheep affected by Tribulus terrestris motor neuron disease, to ascertain their response to striatal dopamine reducing drugs, and to examine their brains and spinal cords for microscopic changes. PROCEDURES: Twenty-eight sheep displaying well developed clinical signs of the disorder were observed. Twenty-two of these and 22 normal sheep were then randomly allocated to three groups and treated with diazepam, chlorpromazine, or xylazine. The time that it took an animal to return to a standing position following drug administration was recorded. The brain and complete spinal cord were removed from each of the other six affected sheep and fixed in formalin. Brains were sectioned throughout at 5 mm intervals and spinal cords at 10 mm intervals. All tissues were paraffin embedded and examined by light microscopy. A few samples were examined by electron microscopy. RESULTS: Clinical signs included postural asymmetry with a right:left body-side dominance within the group of 50:50, unequal flaccid paresis in the pelvic limbs, extensor muscle atrophy and adduction of the weaker pelvic limb, and concurrent abduction of the stronger. Forward motion followed either a fixed left or right hand curved trajectory, the sheep no longer being able to choose which. Twelve animals intermittently displayed rotational behaviour that involved loss of postural balance without locomotor activation. The administration of diazepam, chlorpromazine, or xylazine caused limb paresis and sedation, with affected sheep being slower than normal sheep by factors of 8, 3 and 2 respectively, to return to a standing position. There were scattered areas of mild Wallerian degeneration throughout the spinal cord, and in both the brain and the cord there were small numbers of degenerate astrocytes containing novel cytoplasmic pigment granules. CONCLUSIONS: Affected sheep had a dysfunction in the control of directional change and this provides a new insight into the normal mechanism for 'turning' in quadrupeds. Directional change requires a functional asymmetry or lateralisation within the upper motor neuron to accommodate a difference in the rate of forward progression of each body side and, simultaneously, a lateral shift of the centre of gravity. The sensitivity of affected sheep to diazepam is consistent with a pre-existing elevation in GABAergic neuronal inhibition, probably as a result of a reduction in glutamatergic neuronal excitation. The cytoplasmic pigment found in degenerate astrocytes was novel and its presence in the brain nuclei known to contribute to turning behaviour could have aetiological significance. The motor output of the basal ganglia in Tribulus neurotoxicity appeared to be excessively inhibitory to the pelvic limb extensor muscles and was asymmetric, causing fixation of the turning posture but not locomotor activation. An intoxication of specific purine sensitive, glutamate releasing astrocytes, located in nuclei controlling turning, was suspected.

Animals↗

Muscle function and mobility biomechanics in the elderly: an overview of some recent research.

Many old adults have difficulty in performing activities of daily living, in maintenance of postural balance, and in recovering from impending falls. It is not yet fully clear to what extent these difficulties arise from age, or disease-related declines in muscle function. The strength requirements for the performance of many common physical tasks are not often large. When the time available to make an appropriate response is short, maximum joint torque strengths may not be as important a consideration as abilities to develop joint torques rapidly. Even old adults who are fit and healthy, compared to young adults, have substantially diminished abilities to do this. Recent findings suggest that the source of this decline, at least sometimes, lies in muscle physiology more so than in central processing delays. A considerable amount of research to explore the issues relevant to the relations among muscle function and mobility is currently underway, but much remains to be learned.

Accidental Falls↗