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PubMed2007

Postural development in school children: a cross-sectional study.

BACKGROUND: Little information on quantitative sagittal plane postural alignment and evolution in children exists. The objectives of this study are to document the evolution of upright, static, sagittal posture in children and to identify possible critical phases of postural evolution (maturation). METHODS: A total of 1084 children (aged 4-12 years) received a sagittal postural evaluation with the Biotonix postural analysis system. Data were retrieved from the Biotonix internet database. Children were stratified and analyzed by years of age with n = 36 in the youngest age group (4 years) and n = 184 in the oldest age group (12 years). Children were analyzed in the neutral upright posture. Variables measured were sagittal translation distances in millimeters of: the knee relative to the tarsal joint, pelvis relative to the tarsal joint, shoulder relative to the tarsal joint, and head relative to the tarsal joint. A two-way factorial ANOVA was used to test for age and gender effects on posture, while polynomial trend analyses were used to test for increased postural displacements with years of age. RESULTS: Two-way ANOVA yielded a significant main effect of age for all 4 sagittal postural variables and gender for all variables except head translation. No age x gender interaction was found. Polynomial trend analyses showed a significant linear association between child age and all four postural variables: anterior head translation (p < 0.001), anterior shoulder translation (p < 0.001), anterior pelvic translation (p < 0.001), anterior knee translation (p < 0.001). Between the ages of 11 and 12 years, for anterior knee translation, T-test post hoc analysis revealed only one significant rough break in the continuity of the age related trend. CONCLUSION: A significant linear trend for increasing sagittal plane postural translations of the head, thorax, pelvis, and knee was found as children age from 4 years to 12 years. These postural translations provide preliminary normative data for the alignment of a child's sagittal plane posture.

Journal Article↗

PubMed2002

Relations between standing stability and body posture parameters in adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective study of standing imbalance and body posture in 71 able-bodied girls and subjects with adolescent idiopathic scoliosis was conducted. OBJECTIVE: To test the hypothesis that postural parameters are related to standing stability parameters. SUMMARY OF BACKGROUND DATA: Spinal deformity not only modifies the shape of the trunk, but also changes the relations between body segments affecting posture in scoliotic children. These postural adaptations to the scoliotic curve progression could be linked in part to increased body sway in upright standing. This has not yet been related to specific postural parameters involving the head, trunk, and pelvis in nontreated idiopathic scoliosis. METHODS: The head, trunk, and pelvis orientations of each subject were measured by a Flock of Bird system. An AMTI force platform was used to assess quiet standing stability and to monitor the position and displacement of the center of pressure (COP). The center of mass (COM) excursion was estimated from a biomechanical model using force plate information only. Analyses of variance (ANOVAS) were performed to determine the statistical differences between the scoliotic and nonscoliotic subjects, and backward stepwise multiple regression analyses were performed to identify any correlation between measures of quiet standing stability and body postural parameters RESULTS: The scoliotic group was characterized by a decrease in standing stability. There was an increase in the sway areas measured by the variations of the COP and COM. From the backward stepwise multiple regression analysis, it appears that for the able-bodied girls, the body posture parameters were correlated only with the mean anteroposterior center of pressure (COP(AP)) position. For the scoliotic group, the sway areas and the mean position of the centers of pressure and the COP(AP)-COM(AP) were correlated significantly with body posture parameters. The higher COP-COM differences for the scoliotic group were attributed to a greater neuromuscular demand to maintain standing balance. The coefficients of correlation of the multiple regression analyses ranged from 0.64 to 0.85 for the nonscoliotic group and from 0.55 to 0.72 for the scoliotic group. CONCLUSIONS: The use of backward stepwise multiple correlations highlighted the interaction between several body parameters and their relation to standing stability in both able-bodied girls and scoliotic subjects. The scoliotic group displayed a much larger number of correlations between standing stability and body posture parameters than the nonscoliotic group. Standing imbalance was related to altered body posture parameters measured in the frontal and horizontal planes only. Although the correlation coefficients were relatively high, factors other than body posture parameters appeared related to standing imbalance in adolescent idiopathic scoliosis. These findings support the concept of either a primary or a secondary dysfunction in the postural regulation system of scoliotic subjects.

Adolescent↗

PubMed1990

[From posture to initiation of movement].

Purposeful motor acts are subjected to two contradictory constraints. One is to move one or several body segments toward a goal, the other is to stabilize other segments in order to maintain posture and equilibrium. One of the major tasks of the central nervous system is to coordinate posture and movement. Human posture is built up from the superposition of several "modules' from the ground to the head. Each module, tied to the next one by muscles, has its proper central and reflex regulation which permits to maintain its position in relation to the underlying one. In addition, a global regulation of posture is apparent (postural tone). Equilibrium is maintained under static conditions when the center of gravity projects onto the ground within the supporting surface (feet). Sensory error detecting signals (visual, labyrinthine, proprioceptive) are correcting, through a feedback loop, the reference regulated value according to a "postural' body schema based on "metric' and "dynamic' inputs. Corrections are continuous (and slow) or discontinuous and phasic through a repertoire of synergies allowing fast corrections. During movement performance, posture and equilibrium are stabilized by "anticipatory postural adjustments'. Some are aimed at maintaining the equilibrium notwithstanding the displacement of body segments due to the movement; others stabilize one or several segments such as the head, the trunk or the arm, which serve as reference value for the calculation of the movement trajectory and for the accurate performance of the movement. The anticipatory adjustments are learned during childhood or during training for specific tasks. The adaptative networks built up for a given movement are then controlled by the movement related command signals. The central organization of these anticipatory postural adjustments relies on central brain structures involved in movement execution and movement organization. Deficit is seen in spastic patients, to some extent in cerebellar patients. Basal ganglia and premotor areas, including the supplementary motor area, are of importance for coordination between posture and movement. This suggests that one of their function might be to stabilize posture during movement performance in order to ensure precise reaching of the goal. A specific pathology of the anticipatory postural adjustments should thus be considered.

Animals↗

PubMed1998

Scaling anticipatory postural adjustments dependent on confidence of load estimation in a bi-manual whole-body lifting task.

Anticipatory control of motor output enables fast and fluent execution of movement. This applies also to motor tasks in which the performance of movement brings about a disturbance to balance that is not completely predictable. For example, in bi-manual lifting the pick-up of a load causes a forward shift of the centre of mass with consequent disturbance of posture. Anticipatory postural adjustments are scaled to the expected magnitude of the perturbation and are initiated well before the availability of sensory information characterising the full nature of the postural disturbance. However, when the postural disturbance unexpectedly changes, the anticipatory adjustment of joint torques is not equilibrated and may result in a disturbance to balance. In a previous study, it was demonstrated that apart from anticipatory postural adjustments, corrective responses after load pick-up are used to further compensate the postural disturbance. In this study it was examined whether the central nervous system (CNS) assembles a strategy that incorporates both anticipatory control and corrective responses, in which the magnitude of the anticipatory postural adjustments depends on the perceived level of predictability of the postural disturbance. Subjects performed series of lifts in which the magnitude of the load was never revealed to the subject. Two boxes equal in size and colour, but different in mass (6 and 16 kg), were used. Differences in expectation were created by several lifts with the 16-kg load before the 6-kg box was presented. It was observed that the number of strong corrective responses (stepping) varied with the number of 16-kg trials that formed the prior experience when the final 6-kg trial was presented. The follow-up question was whether control relied more on anticipation in the stepping trials, compared with trials in which such gross signs of imbalance were absent. In this study it was shown that subjects when stepping (i) exhibited differential anticipatory postural adjustments in comparison with 6-kg trials in which expectation was not shaped by preceding 16-kg trials, and (ii) scaled the anticipatory postural adjustments similar to those preceding lift-off of the 16-kg trial preceding it. These findings emphasise the programmed nature of the anticipatory postural adjustments and the ability of the CNS to selectively tune the anticipatory postural adjustments to stored information gained during the previous lift(s).

Adaptation, Physiological↗

PubMed1999

Acquisition of anticipatory postural adjustments in a bimanual load-lifting task: normal and pathological aspects.

Anticipatory adjustments of forearm posture are associated with a voluntary load-lifting movement in bimanual load-lifting tasks. Three aspects of these adjustments are analyzed: their goal, their central organization, and their acquisition. The goal of the anticipatory adjustment in this task is to minimize the perturbation of forearm posture that occurs during unloading. The central organization is based on two parallel controls responsible, respectively, for the lifting movement of the moving forearm and the anticipatory postural adjustment of the postural forearm, their coordination depending on a central timing signal. The acquisition of the anticipatory postural adjustment was tested using a paradigm where the voluntary movement performed by one hand triggered, via an electronic switch, the load release of the postural forearm. It was achieved after 40-60 trials and was not graded as a function of the voluntary movement parameters, but of the disturbance of the postural arm about to occur. The learned anticipation was not transferred when, after a first acquisition session with one forearm as the postural forearm, a second learning session was performed with the other forearm as the postural forearm. The acquisition was tested in Parkinsonian and in hemiparetic patients with capsular lesion. The highest acquisition deficit was observed in hemiparetic patients, when the contralateral forearm was the postural forearm; the deficit was less important when the ipsilateral arm was postural. Surprisingly, the anticipatory postural adjustments in hemiparetic patients were rather well preserved when the natural load-lifting task was tested. These results suggest that the basal-ganglia SMA circuit and M1 premotor areas are important in the acquisition process.

Adaptation, Physiological↗

PubMed2004

Anterior thoracic posture increases thoracolumbar disc loading.

In the absence of external forces, the largest contributor to intervertebral disc (IVD) loads and stresses is trunk muscular activity. The relationship between trunk posture, spine geometry, extensor muscle activity, and the loads and stresses acting on the IVD is not well understood. The objective of this study was to characterize changes in thoracolumbar disc loads and extensor muscle forces following anterior translation of the thoracic spine in the upright posture. Vertebral body geometries (C2 to S1) and the location of the femoral head and acetabulum centroids were obtained by digitizing lateral, full-spine radiographs of 13 men and five women volunteers without previous history of back pain. Two standing, lateral, full-spine radiographic views were obtained for each subject: a neutral-posture lateral radiograph and a radiograph during anterior translation of the thorax relative to the pelvis (while keeping T1 aligned over T12). Extensor muscle loads, and compression and shear stresses acting on the IVDs, were calculated for each posture using a previously validated biomechanical model. Comparing vertebral centroids for the neutral posture to the anterior posture, subjects were able to anterior translate +101.5 mm+/-33.0 mm (C7-hip axis), +81.5 mm+/-39.2 mm (C7-S1) (vertebral centroid of C7 compared with a vertical line through the vertebral centroid of S1), and +58.9 mm+/-19.1 mm (T12-S1). In the anterior translated posture, disc loads and stresses were significantly increased for all levels below T9. Increases in IVD compressive loads and shear loads, and the corresponding stresses, were most marked at the L5-S1 level and L3-L4 level, respectively. The extensor muscle loads required to maintain static equilibrium in the upright posture increased from 147.2 N (mean, neutral posture) to 667.1 N (mean, translated posture) at L5-S1. Compressive loads on the anterior and posterior L5-S1 disc nearly doubled in the anterior translated posture. Anterior translation of the thorax resulted in significantly increased loads and stresses acting on the thoracolumbar spine. This posture is common in lumbar spinal disorders and could contribute to lumbar disc pathologies, progression of L5-S1 spondylolisthesis deformities, and poor outcomes after lumbar spine surgery. In conclusion, anterior trunk translation in the standing subject increases extensor muscle activity and loads and stresses acting on the intervertebral disc in the lower thoracic and lumbar regions.

Biomechanical Phenomena↗

PubMed1987

Effect of posture on expiratory muscle use during breathing in the dog.

The electromyographic (EMG) activity of the triangularis sterni and abdominal external oblique muscles was studied in 10 lightly anesthetized, spontaneously breathing dogs during postural changes from supine to head up and head down. The triangularis sterni was active during expiration in all animals when breathing in supine posture, whereas the external oblique was active in only 6 animals. A change from the supine to head up posture elicited a marked increase in triangularis sterni and external oblique expiratory EMG activity in all animals. A change from the supine to head down posture conversely caused the triangularis sterni expiratory activity to decrease and the external oblique expiratory activity, when present in supine posture, to be markedly reduced or abolished. The external oblique was generally silent after bilateral cervical vagotomy and no longer responded to posture. In contrast, bilateral vagotomy had no clear-cut effect on either the active use of the triangularis sterni in supine posture or on the muscle response to posture. These results indicate that: the active nature of spontaneous quiet expiration in the dog is not specific to the supine posture; the adoption of the head up posture actually is associated with considerable phasic expiratory recruitment of the triangularis sterni and abdominal muscles, so that moving the chest wall during breathing is proportionately more an expiratory act and less an inspiratory act than in supine posture; and in contrast to the abdominal muscles, the postural changes in triangularis sterni use during breathing are largely independent of vagal inputs.

Animals↗

PubMed2005

Physical limitations and musculoskeletal complaints associated with work in unusual or restricted postures: a literature review.

INTRODUCTION: The vast majority of ergonomics research has addressed the demands of work in standing or sitting postures, and understandably so. However, many workers (e.g., underground miners, aircraft baggage handlers, plumbers, agricultural workers, mechanics, and others) are often required to adopt postures such as kneeling, stooping, squatting, or lying down for significant periods of the workday. METHOD: A literature search was performed using the ISI Web of Science database (for years 1980-2004). Articles retrieved from this search were evaluated in terms of relevance to assessing physical capabilities of workers in these postures and/or the musculoskeletal epidemiology associated with these postures. RESULTS: Work in unusual and restricted postures was associated with significantly higher rates of musculoskeletal complaints compared to workers not adopting these postures in epidemiology studies (Odds Ratios ranging from 1.13 to 13). Some studies suggested a dose-response relationship, with longer exposures leading to increased musculoskeletal complaints. Physical strength and psychophysical lifting capacity vary significantly as unusual or restricted postures are adopted, with lower lifting capacities evident in the kneeling, squatting, and lying positions. CONCLUSIONS: Workers who adopt unusual or restricted postures appear to be at higher risk of musculoskeletal complaints and often exhibit reduced strength and lifting capacity. Research needs in this area include improved exposure assessment tools, studies of intervention effectiveness, adaptations of the body in response of work in unusual postures, and elucidation of relevant injury pathways. IMPACT ON INDUSTRY: Workers who adopt unusual or restricted postures in their work often experience higher musculoskeletal injury rates. If awkward postures cannot be eliminated in the workplace, jobs should be designed in accordance with the reduced strength and lifting capabilities observed in these postures.

Back Injuries↗

PubMed1997

Measurement variability in upper extremity posture among VDT users.

Hand and arm posture while keying is frequently mentioned as a risk factor for upper extremity musculoskeletal disorders (UEMSDs) among video display terminal (VDT) operators. However, many epidemiologic studies have not included measures of posture of VDT operators, in part, because of the difficulty of assessing posture rapidly and reliably among large numbers of subjects. For a single measure of posture to be useful for estimating dose-response relationships between posture and risk of UEMSDs, the within-subject variability of the postural measure must be smaller than the between-subject variability of the postural measure. In addition, the measure must be stable over time. We estimate the ratio of between- to within-subject variability for manual goniometry by measuring six postural angles on six occasions among 19 subjects using VDTs. For each postural angle, between-subject variability was substantially and statistically significantly larger than within-subject variability. Stability of postural measures over time was sufficient to justify a single postural measurement in epidemiologic studies. We conclude that manual goniometry can provide useful information about upper extremity posture among VDT users for use in epidemiologic studies of UEMSDs.

Adult↗

PubMed1996

Posture effect on seating interface biomechanics: comparison between two seating cushions.

OBJECTIVE: This study aimed at investigating the effects of sitting posture on ischial pressure and pelvic orientation for two types of cushions. DESIGN: Two types of seating devices, Roho and Polyurethane (PU) Foam cushions, six predefined postures, and two subject groups, Normal and Paraplegic, were tested. Ischial pressure and pelvic orientation were monitored. The sequence in which the cushions were tested were randomized, and the postures were tested according to a preplanned sequence. SETTING: The experiments were carried out in the laboratory of a rehabilitation engineering centre in Hong Kong. PARTICIPANTS: Six paraplegic subjects (referred sample) and 8 normal volunteers were tested. At the time of study, no subjects showed any signs of pressure sore or other health problems. MAIN OUTCOME MEASURES: It was hypothesized that sitting posture could significantly affect pelvic orientation as well as pressure distribution. It was also hypothesized that cushion selection was a critical factor in compensating the adverse effects of postures on pressure distribution. RESULTS: With the paraplegic group, the maximum ischial pressure recorded on Roho for various postures ranged from 88 mmHg for the Trunk-Bent-Forward (PF) posture to 146 mmHg for the Trunk-Bent-Right (PR) posture, whereas on PU foam cushions, the values ranged from 106 mmHg for the PF posture to 221 mmHg for the PR posture. With the paraplegic subjects sitting with their trunks bent laterally, it was found that the mean pressure difference between the left and right ischial tuberosities was more prominent on the PU foam cushion than on the Roho. CONCLUSION: Sitting posture can significantly affect pelvic orientation and ischial pressure. This study was also showed that the Roho cushion was significantly more efficient in compensating the adverse effects of sitting posture on pressure distribution.

Biomechanical Phenomena↗

PubMed2003

Cells in monkey STS responsive to articulated body motions and consequent static posture: a case of implied motion?

We show that populations of visually responsive cells in the anterior part of the superior temporal sulcus (STSa) of the macaque monkey code for the sight of both specific articulated body actions and the consequent articulated static body postures. We define articulated actions as actions where one body part (e.g. a limb or head) moves with respect to the remainder of the body which remains static; conversely non-articulated actions are actions where the equivalent body parts do not move with respect to each other but move as one. Similarly, articulated static body postures contain a torsion or rotation between parts, while non-articulated postures do not. Cells were tested with the sight of articulated and non-articulated actions followed by the resultant articulated or non-articulated static body postures. In addition, the static body postures that formed the start and end of the actions were tested in isolation. The cells studied did not respond to the sight of non-articulated static posture, which formed the starting-point of the action, but responded vigorously to the articulated static posture that formed the end-point of the action. Other static postures resembling the articulated end-point posture, but which were in a more relaxed muscular state (i.e. non-articulated), did not evoke responses. The cells did not respond to body actions that were less often associated with the effective static articulated postures. Our results suggest that the cells' responses were related to the implied action rather than the static posture per se. We propose that the neural representations in STSa for actual biological motion may also extend to biological motion implied from static postures. These representations could play a role in producing the activity in the medial temporal/medial superior temporal (V5(MT)/MST) areas reported in fMRI studies when subjects view still photographs of people in action.

Action Potentials↗

PubMed1989

Shoulder posture and localized muscle fatigue and discomfort.

In many industries workers perform manual assembly tasks with hands postured above the shoulders. Awkward shoulder and arm postures are often viewed as acceptable given costs of workplace modification, postural exertions which are in compliance with current design recommendations, ready availability of strong workers, and numbers of electromyographic studies which fail to detect significant signs of localized muscle fatigue (LMF). An experiment was conducted to: (a) study the onset and severity of (LMF) in the shoulder when performing a stylus-to-hole Fitts reciprocal movement task under a range of postures, hand loads, ratios of work-to-rest, and task durations, and (b) to evaluate the efficacy of three techniques (i.e., changes in EMG behaviour, postural tremor, and cross-modal matching estimates) in detecting and monitoring posturally-based LMF and discomfort in the shoulder complex. Experimental findings showed that posturing hands above shoulder level significantly increased the risk of LMF and postural discomfort even in light-weight manual assembly environs where postural exertions are small, and that cross-modal matching estimates and postural tremor were more sensitive metrics of LMF in the shoulder complex than EMG RMS voltage and mean spectral power frequency metrics. The basis for experimental findings, as well as potential application of LMF metrics in future postural stress investigations, are discussed. Recommendations for workplace posture are provided for job designers facing work height decisions in manual assembly environs.

Adult↗

PubMed1994

An OWAS-based analysis of nurses' working postures.

The working postures of Dutch nurses (n = 18) in an orthopaedic ward and a urology ward were observed using the Ovako Working posture Analysis System (OWAS). During observation, both working postures and activities were recorded. A specially developed computer program was used for data analysis. By means of this program, it was possible to calculate the working posture load for each activity and the contribution of a specific activity to the total working posture load. This study shows that some activities of the nurses in both wards were performed with poor working postures. In the orthopaedic (resp. urology) ward two (resp. one) out of 19 observed postures of parts of the body were classified as Action Category 2. Moreover, 20% (resp. 16%) of the so-called typical working postures was classified in Action Category 2. This suggests, that in both wards working postures that are slightly harmful to the musculoskeletal system, occur during a substantial part of the working day. Differences between both wards with respect to working posture load and time expenditure were determined. Activities causing the workload to fall into OWAS higher Action Categories were identified. The data show that poor working postures in the nursing profession not only occur during patient handling activities but also during tasks like 'administration'. Focusing on patient-handling (i.e., lifting patients) in order to determine the load on the musculoskeletal system would therefore lead to an underestimation of the total working posture load of nurses.

Adult↗

PubMed2005

Is postural control affected by expertise in alpine skiing?

OBJECTIVES: This study examined the postural performance of two groups of male skiers competing at different levels and the consequences on postural control of the suppression of visual afferences by eye closure. METHODS: Seven national level (NAT) skiers and 7 regional level (REG) skiers were asked to stand as still as possible on a force platform with eyes opened and closed and while wearing or not wearing their ski boots in a stable posture and in two unstable postures (in the sagittal or frontal plane). Postural performance was assessed with centre of foot pressure measurements. RESULTS: REG and NAT skiers were similarly influenced by the absence of visual information and presented similar postural performance when tests were performed with ski boots. However, without ski boots, REG skiers displayed better postural performance than NAT skiers. CONCLUSIONS: The inferior postural performance of NAT skiers without ski boots could be a long term effect of repetitive wearing of ski boots, which impairs postural performance by restricting the range of motion of the ankle-foot complex. Since individuals with decreased postural performance are believed to be more susceptible to ankle injury than those with finer postural control, NAT skiers should benefit from specific training aimed at improving postural ability and preventing ankle injury.

Adolescent↗

PubMed1989

Influence of central set on human postural responses.

1. The effect of central set on automatic postural responses was studied in humans exposed to horizontal support-surface perturbations causing forward sway. Central set was varied by providing subjects with prior experience of postural stimulus velocities or amplitudes under 1) serial and random conditions, 2) expected and unexpected conditions, and 3) practiced and unpracticed conditions. In particular, the influence of central-set conditions was examined on the pattern and magnitude of six leg and trunk electromyograph (EMG) activations and associated ankle torque responses to postural perturbations with identical stimulus parameters. 2. The scaling of initial agonist integrated EMG (IEMG) and torque responses to postural perturbation amplitude disappeared when perturbation amplitudes were randomized. This finding suggests that the initial magnitude of postural responses were centrally set to anticipated postural perturbation amplitudes based on sequential experience with the stimulus. 3. Expectation of postural stimulus amplitude had a significant effect on initial torque responses; subjects overresponded when a larger perturbation was expected and underresponded when a smaller perturbation was expected. Expectation of postural stimulus velocity had a smaller effect on initial torque responses, and subjects consistently overresponded when the velocity of the perturbation was unexpected. This difference in amplitude and velocity expectation may be because of the capacity to encode stimulus velocity, but not amplitude information, into the earliest postural responses of the current trial. The relative strength of amplitude and velocity central-set effects varied widely with individual subjects. 4. Central-set conditions did not affect initial EMG response latencies (100 +/- 20 ms, mean +/- SD) or the relative onset of proximal and distal agonists and antagonists. Unexpected or unpracticed stimulus amplitudes, however, were associated with significant late activation of ankle antagonist, tibialis. Thus errors in initial response magnitude because of central-set effects appear to be partially corrected by reciprocal antagonist activity. Agonist IEMG, however, did not always reflect significant changes in torque responses with central-set conditions. 5. Expectation of postural stimulus amplitude and velocity had two different types of effects on the magnitudes of postural responses: 1) a directionally specific, central-set effect consisting of either increased or decreased responses, depending on expectation of stimulus amplitude; and 2) a nonspecific enhanced response to novel stimulus velocities with a gradual reduction when a velocity was presented repeatedly. Two different neural mechanisms are proposed for these two adaptive effects. 6. Reduction of postural response magnitude and antagonist activity during practice may be partially explained by adaptive mechanisms based on expectation because of prior experience with stimulus velocity and amp

Adult↗

PubMed1996

Effects of dopamine on postural control in parkinsonian subjects: scaling, set, and tone.

1. This study investigates the effects of parkinsonism and of dopamine replacement therapy (levodopa) on scaling the magnitude of automatic postural responses based on sensory feedback and on predictive central set. Surface reactive torques and electromyographic (EMG) activity in response to backward surface translations were compared in patients with parkinsonism ON and OFF levodopa and in elderly control subjects. Correlations between the earliest postural responses [initial rate of change of torque and integrated EMG (IEMG)] and translation velocity provided a measure of postural magnitude scaling using somatosensory feedback. Correlations of responses with expected translation amplitude provided a measure of scaling dependent on predictive central set because the responses preceded amplitude completion. 2. Parkinsonian EMG responses in six leg and trunk muscles were not later than in elderly control subjects. In fact, quadriceps antagonist latencies were earlier than normal, resulting in coactivation at the knee not present in control subjects. EMG activation was fragmented, with short burst durations and high tonic levels that often returned to baseline with multiple bursts. In addition, parkinsonian responses showed smaller-than-normal agonist extensor bursts and larger-than-normal activation in tibialis and rectus femorus antagonist flexors. 3. Although parkinsonian subjects scaled postural responses to both displacement velocities and amplitudes, their torque response were smaller than those of elderly controls, especially in response to the largest displacement amplitudes. The gain (slope) of postural response magnitude scaling to displacement velocity was similar for parkinsonian and control subjects, although parkinsonian subjects had smaller torques. Parkinsonian subjects were also able to use prediction to scale responses to small expected displacement amplitudes, but many patients did not generate the larger plantarflexion torques required at larger displacement amplitudes. Reduced torque at large amplitudes was associated with less agonist gastrocnemius IEMG, increased tibialis antagonist burst responses, and increased tibialis tonic background activity. 4. Levodopa further reduced the already low magnitude of initial torque and IEMG responses to displacement velocities and amplitudes in parkinsonian patients. The ability to scale postural responses to velocity feedback was not affected by levodopa, but the ability to scale responses to large displacement amplitudes based on central set was worsened by levodopa. Levodopa also significantly reduced the tonic, background levels of EMG, particularly the distal gastrocnemius and tibialis activity. 5. High baseline muscle tone was apparent in parkinsonian subjects from their high background EMG activity in quiet stance, especially in tibialis and quadriceps, and the slow initial velocity of center of mass falling in response to displacements. By reducing tone, levodopa reduced passive stiffness to perturbations without increasing EMG burst magnitudes, resulting in less resistance to external displacements and thus faster center of body mass (COM) displacements. 6. The biggest postural deficit in parkinsonian subjects was not in response latency, pattern, or reactive or predictive scaling of response magnitude, but in quickly generating an adequate level of postural force. Dopamine improved tonic background postural tone but further weakened automatic postural responses to external displacements. Thus the basal ganglia may participate in postural control by regulating appropriate levels of background postural tone and by enabling adequate force generation for resisting external displacements.

Antiparkinson Agents↗

PubMed1996

The effect of posture on gastroesophageal reflux event frequency and composition during fasting.

OBJECTIVE: To examine the influence of three postures (upright and left and right recumbent) on gastroesophageal reflux event (RE) frequency and composition and a possible mechanism for the observations. METHODS: A) Forty fasting patients with (E+, n = 20) and without (E-, n =20) esophagitis were studied. Simultaneous manometry and pH monitoring were conducted in the left and right recumbent (10 min each) as well as the upright posture (20 min). RE were classified by the pH probe and/or the manometry catheter as acid or gas RE. B) In 23 patients referred for UGI series, radiographs were taken in the left and right recumbent and upright postures after barium and Fizzies. RESULTS: A) Upright RE were similar in frequency in E+ and E- patients (2.6 +/- 0.5 vs 3.05 +/- 0.6). However, E+ patients had more recumbent RE (16.3 +/- 3 vs 0.65 +/- 0.2, p = 0.0001) than E- patients; moreover, the left recumbent posture had more recumbent RE than the right (10.9 +/- 2 vs 5.3 +/- 1, p < 0.02). Moving from recumbent to the upright posture had an opposite effect on RE in the two groups; RE decreased sixfold in E+ patients (16.3 +/- 3 vs 2.6 +/- 0.5, p = 0.0001) but increased fourfold in E- patients (0.65 +/- 0.2 vs 3.05 +/- 0.6, p = 0.0001). In examining RE composition in the E+ patients, RE were twofold more likely to be gas in the left recumbent posture (7.6 +/- 2 vs 3.3 +/- 1, p < 0.1); in direct contrast, RE were eightfold more likely to be acid in the right recumbent posture (4.7 +/- 1 vs 0.6 +/- 0.5, p = 0.0001). As expected from this observation, acid exposure was greater in the right than left posture (52 +/- 8 vs 15 +/- 6%, p < 0.0001). Although RE were too infrequent in E- patients to reach statistical significance, the effect of posture on the composition of the few RE that did occur mirrored that of the E+ patients. B) In 17/23 (74%) radiographs in the right recumbent posture, the EG junction was submerged in a barium pool below the air-barium interface in the stomach. In contrast, this occurred in 0/23 patients in the left recumbent and 1/23 patients in the upright postures because the EG junction was in the air above the barium pool. CONCLUSION: Posture has an influence on RE frequency and composition while fasting, and the latter is likely due to whether the EG junction is submerged below liquid gastric contents or in the air above the liquid gastric contents.

Adolescent↗

PubMed2003

Effect of simulated rock climbing finger postures on force sharing among the fingers.

OBJECTIVE: To study the forces applied by each finger in different joint postures simulating rock climbing gripping postures. DESIGN: Subjects in sitting posture applied fingertip forces perpendicular to horizontal force sensors in three different finger postures. BACKGROUND: Data provided by the literature indicate that middle and ring finger are commonly injured. However, no quantitative assessment of the forces applied by each finger related to the joint postures has been made. METHODS: Six elite rock climbers performed finger flexion in a single-finger task and a four-finger task. The tests were conducted in an extended posture, a curved posture (the joints belonging to the finger were flexed) and an intermediate posture (the joints were flexed, except the distal one which was fully extended). Each fingertip force was expressed in absolute value and in percentage of the maximal force capacity of the finger. RESULTS: The greater force was applied by the middle finger (20.8 N), whatever the posture. The relative involvement amounted to 105% for the ring finger in the curved posture. CONCLUSIONS: The great force applied by the middle finger and the great relative involvement of the ring finger in the curved posture seem to be the main factors of injuries of these fingers. RELEVANCE: The analysis of force sharing among the fingers during different joint postures mimicking rock climbing is essential to a better understanding of finger injuries.

Adult↗