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PubMed2005

Biomechanics of changes in lumbar posture in static lifting.

STUDY DESIGN: In vivo measurements and model studies are combined to investigate the role of lumbar posture in static lifting tasks. OBJECTIVES: Identification of the role of changes in the lumbar posture on muscle forces, internal loads, and system stability in static lifting tasks with and without load in hands. SUMMARY OF BACKGROUND DATA: Despite the recognition of the causal role of lifting in spinal injuries, the advantages of preservation or flattening of the lumbar lordosis while performing lifting tasks is not yet clear. METHODS: Kinematics of the spine and surface EMG activity of selected muscles were measured in 15 healthy subjects under different forward trunk flexion angles and load cases. Apart from the freestyle lumbar posture, subjects were instructed to take either lordotic or kyphotic posture as well. A kinematics-based method along with a nonlinear finite element model were interactively used to compute muscle forces, internal loads and system stability margin under postures, and loads considered in in vivo investigations. RESULTS.: In comparison with the kyphotic postures, the lordotic postures increased the pelvic rotation, active component of extensor muscle forces, segmental axial compression and shear forces at L5-S1, and spinal stability margin while decreasing the passive muscle forces and segmental flexion moments. CONCLUSION: Alterations in the lumbar lordosis in lifting resulted in significant changes in the muscle forces and internal spinal loads. Spinal shear forces at different segmental levels were influenced by changes in both the disc inclinations and extensor muscle lines of action as the posture altered. Considering internal spinal loads and active-passive muscle forces, the current study supports the freestyle posture or a posture with moderate flexion as the posture of choice in static lifting tasks.

Adult↗

PubMed2006

Neural basis subserving the detection of postural instability: an fMRI study.

Human upright posture is a product of a complex dynamic system that relies on integration of input from multimodal sensory sources. Extensive research has explored the role of visual, vestibular, and somatosensory systems in the control of upright posture. However, the role of higher cognitive function in a participant's assessment of postural stability has been less studied. In previous research, we showed specific neural activation patterns in EEG associated with recognition of unstable postures in young healthy participants. Similar EEG patterns have been recently observed in regulation of posture equilibrium in dynamic stances. This article evaluates participants' postural stability in dynamic stances and neural activation patterns underlying visual recognition of unstable postures using event-related functional MRI (fMRI). Our results show that the "stable" participants were successful in recognition of unstable postures of a computer-animated body model and experienced egocentric motion. Successful recognition of unstable postures in these participants induces activation of distinct areas of the brain including bilateral parietal cortex, anterior cingulate cortex, and bilateral cerebellum. In addition, significant activation is observed in basal ganglia (caudate nucleus and putamen) but only during perception of animated postures. Our findings suggest the existence of modality-specific distributed activation of brain areas responsible for detection of postural instability.

Adult↗

PubMed1996

Cumulative concentrations of blood lead and postural stability.

OBJECTIVE: To study the association in a group of battery manufacturing workers between computerised postural sway parameters and present concentrations of blood lead (PPb), index of cumulative blood lead years (CBI), and cumulative blood lead at different years of exposure (CPbYs). METHODS: Postural stability was investigated with a computerised postural sway measurement system in 60 workers exposed to lead with exposure duration of 84 (range 3-366) months and in 60 control subjects. An index of CBIs in 55 workers (previous blood lead results of five workers were not available) and CPbYs were computed for each worker by calculating the area under the curve of concentrations of blood lead against time. RESULTS: The mean (SD) PPb was 36.0 (11.7) (range 6.4 to 64.5) micrograms/dl for the exposed workers and 6.3 (2.4) (range 3.1-10.9) micrograms/dl for the 14 randomly selected control subjects. Significant differences between groups for the postural sway parameters obtained when the eyes were closed were found for length of sway path (L); mean velocity of the centre of pressure along its path (Vel); area included within the path of the centre of pressure (Ao); 95% confidence elliptical area (Ae). The Romberg ratio (the relation between eyes closed and open) for the Vel, L, Ao, and Ae of the exposed group were also significantly different from those of the controls. The postural sway parameters (eyes closed) were not significantly correlated with PPb or CBI. However, the cumulative blood lead for the past two years before the postural sway assessment, CPbY2, was significantly correlated with all the postural sway parameters. CONCLUSION: The study showed that workers exposed to lead had significantly poorer postural stability than a control group. Lead may affect certain parts of the somatosensory system resulting in postural instability when the visual input is cut off. The CPbY2 was significantly positively correlated with most of the postural sway parameters. Effects of lead on postural stability may be related to recent increases in blood lead concentration among the exposed workers rather than to cumulative body burden.

Adult↗

PubMed1992

Calf blood flow and posture: Doppler ultrasound measurements during and after exercise.

To investigate the joint effects of body posture and calf muscle pump, the calf blood flow of eight healthy volunteers was measured with pulsed Doppler equipment during and after 3 min of rhythmic exercise on a calf ergometer in the supine, sitting, and standing postures. Muscle contractions seriously impeded calf blood flow. Consequently, blood flow occurred mainly between contractions and reached a plateau that lasted at least the final 100 s of each exercise series. After exercise the blood flow decreased much faster in the sitting and standing postures than in the supine posture. There was no difference in blood flow between various postures during the same submaximal exercise. However, subjects in the standing posture were able to perform exercise with a higher load than in the supine posture, and blood flow in the standing posture could become twice as high as in the supine posture. We conclude that calf blood flow is regulated according to needs; available perfusion pressure determined maximal blood flow and exercise; and compared with the supine posture, the standing posture and calf muscle pump increase the perfusion pressure.

Adult↗

PubMed2005

Development of postural control during the first 18 months of life.

The present paper reviews the development of postural adjustments during infancy. In the control of posture, two functional levels can be distinguished. The basic level deals with the generation of direction-specific adjustments, meaning that dorsal muscles are primarily activated when the body sways forward, whereas ventral muscles are primarily activated when the body sways backward. The second level is involved in adaptation of the direction-specific adjustments. Postural development starts with a repertoire of direction-specific adjustments suggesting that the basic level of control has an innate origin. At first, during the phase of primary variability, postural activity is largely variable and can be minimally adapted to environmental constraints. At 3 months, postural activity shows a transient period during which few postural muscles participate in postural activity. From 6 months onward, the phase of secondary variability starts, during which the second level of postural control becomes functionally active and infants develop the ability to adapt postural activity to the specifics of the situation. Initially, adaptation can be accomplished in a simple way only, but from 9-10 months onward, it can be performed by the subtle adaptation of the degree of muscle contraction. Around 13-14 months, anticipatory postural adjustments emerge. It is concluded that the development of postural adjustments is characterized by four periods of transition occurring at the ages of 3, 6, 9-10, and 13-14 months. The major transition occurs at 6 months, when infants move from the phase of non-adaptive, primary variability to the phase of adaptive, secondary variability.

Adaptation, Physiological↗

PubMed1983

Postural changes in rib cage and abdominal volume-motion coefficients and their effect on the calibration of a respiratory inductance plethysmograph.

Volume-motion coefficients were determined for the rib cage and abdomen in normal human subjects in upright, supine, and semirecumbent postures by the isovolume calibration technique of Konno and Mead (J Appl Physiol 1967; 22:407-422, using the respiratory inductive plethysmograph (RIP) to measure displacements of rib cage and abdominal walls. Volume motion coefficients changed systematically with posture; those for the rib cage were smallest in the upright posture, and for the abdomen, greatest in the upright posture. These volume motion coefficients were then used to estimate tidal volume during resting breathing in the different postures, and compared with estimates of tidal volume derived from calibration by the change in posture technique reported by Sackner and coworkers (American Review of Respiratory Disease 1980; 122:867-871). Estimates of tidal volume derived from RIP signals using both calibration techniques were compared with independently measured spirometric volume changes. Errors in tidal volume averaged 6% with the isovolume technique and 9 to 23% with the change in posture technique (depending upon whether the calibrating postures were upright, supine or semirecumbent supine). The larger errors with the change in posture calibration method are attributable to both the change in volume motion coefficients with posture and the change in distribution of tidal volume between rib cage and abdomen compartments with change in posture.

Abdomen↗

PubMed1997

Toward a quantitative definition of manual lifting postures.

Manual lifting techniques are commonly defined in terms of the postures adopted at the start of the lift. Quantitative definition is problematic, however, because the absolute joint angles adopted to lift an object are influenced by task parameters, such as the initial height of the load. We present an argument for the use of a postural index (the ratio of knee flexion from normal standing to the sum of ankle, hip, and lumbar vertebral flexion) to define the postures adopted at the start of lifting. Stooped postures adopted at the start of a lift correspond to postural indices close to 0, whereas full squat postures correspond to postural indices close to 1. We use angular kinematic data gathered from 71 individuals lifting loads of varying mass from a range of starting heights to illustrate the utility of this index. Although average absolute joint angles were influenced by load mass and initial load height, the average postural index remained unchanged. For example, changes in starting height from 9 cm to 63 cm accounted for between 19% and 67% of the variance in joint positions at the start of the lift but only 1% of the variance in average postural index. This suggests that the postural index provides a method of defining lifting posture that is independent of specific joint positions.

Adolescent↗

PubMed1992

Comparative effects of posture on pressure and shear at the body-seat interface.

This study considers the effects of seated posture and body orientation on the pressure-distribution and surface shear (tangential) forces acting at the body-seat interface. Nine postures typically assumed by wheel-chair users were studied. Comparisons were made within and between two study groups, made up of 12 subjects with spinal cord injuries (SCI) and 10 nondisabled subjects. Both interface pressure and the surface shear were measured simultaneously in each of nine reproducible, seated postures. The same seat cushion was used for all trials. The Oxford Pressure Monitor, a pneumatic cell device, was used to measure and record the interface pressures. Instrumentation for measuring and recording the surface shear force was constructed specifically for the study. Analysis consisted of statistically comparing changes in pressure values and shear forces derived from eight sitting postures with reference to values recorded in a defined neutral sitting posture. The pressure-distribution findings suggest that in the postures studied SCI subjects have maximum pressures that are higher than nondisabled subjects in all postures, ranging from 6% to 46% depending on the posture. Maximum pressures can be reduced by postural changes: forward flexion to 50 degrees, -9%; backrest recline to 120 degrees, -12%; and, full body tilt, -11%. On average, the SCI group members have peak pressure gradients (PPG) that are 1.5 to 2.5 greater than the nondisabled group. The maximum reduction in PPG occurred at backrest recline of 120 degrees, -18%. Tangential shear force acts at the body-seat interface in all nine postures studied. Extrapolation of results suggests that full-body tilt to approximately 25 degrees reduces the surface shear force to near zero. In contrast, a backrest-only recline of 20 degrees causes a 25% increase in the surface shear force. These results suggest that caution must be taken when using nondisabled subjects as surrogates for people with SCI because of the inherent differences between the groups. Also, researchers and clinicians should recognize that posture and body orientation in space are additional variables that can have a profound effect on the interaction between a seated person and his or her supporting surface.

Adult↗

PubMed2000

The role of ocular oscillations upon visually dependent postural stabilization in patients affected by congenital nystagmus.

Visually dependent postural stabilization decreases as a consequence of a long-standing reduction of visual cues in patients affected by congenital nystagmus. The aim of the present study was to verify whether the changes in postural control in this group of patients are due to ocular oscillations or to reduced visual acuity. Therefore, postural control was evaluated when the nystagmus was blocked by the blocking position or by prisms and compared with the postural score observed in a group of normal controls whose visual acuity had been artificially reduced to the same level as that of the patients using Bangerter's filters. The results show a statistically significant improvement of visually dependent postural stabilization when ocular oscillations are inhibited either by the gaze blocking position or by prisms. They also show that postural control in normal subjects with Bangerter's filters is reduced, but is still significantly better than that observed when ocular oscillations are inhibited in patients affected by congenital nystagmus. Our data strongly support the role of ocular oscillations in visually dependent postural control, since postural impairment recovered under any condition in which ocular oscillations were abolished, despite differences in visual acuity. Our data also show that reduced visual acuity decreases visually dependent postural control to a lesser degree than ocular oscillations. This could be due to the fact that ocular oscillations are a disturbing input, usually inhibited centrally, in order to avoid oscillopsia. This mechanism is probably responsible for the reduced role of visual cues in the postural control in this group of patients. The reduction of visual acuity, by comparison, merely causes a decrease in visual cues, depending on the degree of visual loss. It can be concluded that the impaired postural control in patients affected by congenital nystagmus is mainly due to ocular oscillations, with reduced visual acuity creating a secondary effect.

Adult↗

PubMed2005

Working postures of dentists and dental hygienists.

A joint study was conducted by a manufacturer of dental stools in the Midwest of the United States and Marquette University to measure the occupational postures of dentists and dental hygienists. The postures of 10 dentists and 10 dental hygienists were assessed using work sampling and video techniques. Postural data of the neck, shoulders and lower back were recorded from video and categorized into 30-degree intervals: o (neutral posture of respective joint), 30, 60 and 90 degrees. Each subject's postures were observed while they were treating patients during a four-hour period, during which 100 observations of postures were recorded at random times. Compared to standing, dentists and dental hygienists were seated 78 percent and 66 percent of the time, respectively. Dentists and dental hygienists flexed their trunk at least 30 degrees more than 50 percent of the time. They flexed their neck at least 30 degrees 85 percent of the time during the four-hour duration, and their shoulders were elevated to the side of their trunk (abducted) at least 30 degrees more half of the time. The postures of the trunk, shoulders, and neck were primarily static. This database of postures can be used by dental professionals and ergonomists to assess the risk dentists and dental hygienists are exposed to musculoskeletal disorders, such as low back pain or shoulder tenosynovitis, from deviated joint postures. They could use these data to select dental furniture or dental devices that promote good body posture, i.e., reduce the magnitude and duration of deviated joint postures, which, in theory, would decrease the risk of musculoskeletal disorders.

Dental Hygienists↗

PubMed1990

Pharmacodynamic characterization of posture-related diuretic and saluretic responses to furosemide in humans.

To characterize the postural effect on the pharmacodynamic response to furosemide, seven healthy female subjects received the drug (30 mg i.v.), and the diuretic response and urinary drug excretion were monitored either in the supine or upright posture more than 5 h after dose. Six days later the same procedure was repeated, each subject being assigned to the other posture. Diuresis, chlor- and natriuresis were about 50% greater (P less than .01) in the supine than in the upright posture up to 45 min after dose, despite no significant difference in urinary drug excretion between the postures. Creatinine clearance and fractional sodium excretion were also significantly (P less than .05) greater in the supine posture. Pharmacodynamic analysis with the Emax model revealed that the maximum drug response (Emax) to furosemide in the upright posture was significantly (P less than .01) attenuated by about 65% of that in the supine posture, with no significant difference in either ER50 (urinary drug excretion rate producing 50% of Emax) or slope between the postures. Plasma norepinephrine concentration was significantly (P less than .05) greater, whereas urinary kallikrein excretion was significantly (P less than .05) less in the upright posture. There were no significant differences in blood pressure, plasma renin activity and atrial natriuretic peptide as well as in urinary excretion of prostaglandin E2, dopamine and adenosine between the postures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Does increased arterial stiffness increase the risk for postural hypotension?

This study tests the hypothesis that increased arterial stiffness is associated with postural hypotension in older adults. Aortic pulse wave velocity and postural blood pressure (BP) response were assessed in 49 nondiabetic community-dwelling normotensive (n=27) and hypertensive (n=22) older adults (mean age+/-SD, 71+/-6.7 years) who were not receiving vasoactive medications. During the 5-minute period of upright posture, 13 subjects had no change or a postural increase in systolic BP (SBP)(+10.6+/-14.6 mm Hg), 27 had a postural decrease of <20 mm Hg (-9.3+/-4.2 mm Hg), and nine had a postural decrease of >20 mm Hg (-29.1+/-8.1 mm Hg). Contrary to the proposed hypothesis, pulse wave velocity was significantly greater in subjects with a postural increase in SBP than in those with a postural decrease in SBP<20 mm Hg (10.2+/-0.68 m/sec vs. 8.3+/-0.37 m/sec; p=0.03) and tended to be greater than in those with a postural decrease in SBP>20 mm Hg (10.2+/-0.68 m/s vs. 8.5+/-0.73 m/sec; p=0.11). Higher pulse wave velocity was associated with a more positive postural SBP response at 1 minute (r=0.42; p=0.024), 3 minutes (r=0.38; p=0.007), and 5 minutes (r=0.45; p=0.001). This study does not support a relationship between arterial stiffness and a postural decrease in BP among healthy older adults; other age-related factors regulating BP homeostasis likely play a greater role.

Aged↗

PubMed2003

Fear of falling and postural control in Parkinson's disease.

This study investigated the relationship between fear of falling (FOF) and qualitative and quantitative postural control in Parkinson's disease (PD). Fifty-eight nondemented PD patients were studied along with age-matched healthy controls. The degree of FOF was estimated using the Activities-specific Balance Confidence scale. Qualitative postural control was evaluated using a component of the Unified Parkinson Disease Rating Scale. Postural control was quantified, using centre of pressure measures obtained from a force plate, for eight standing balance tests of different challenges. The results showed that FOF was more evident for PD patients when compared with healthy individuals of similar age. Furthermore, FOF was significantly associated with a qualitative estimate of postural control in PD; individuals with PD who had a greater degree of posture impairment reported greater FOF. The results also showed that an estimate of FOF may help to explain quantitative postural instability in PD. FOF, when coupled with a qualitative estimate of postural control, was able to explain a greater amount of variation in quantitative balance performance for five of the eight balance tests. When considered independently, the qualitative measure of postural control, in general, could not well predict quantitative balance performance. The greater degree of FOF and its possible association with altered postural control suggests that FOF should be considered as an important, independent risk factor in the assessment and treatment of postural instability in patients with PD.

Accidental Falls↗

PubMed1983

Visual influence on postural control in the cat.

The influence of horizontal optokinetic stimulation on posture and postural readjustments, induced by horizontal rotation of a turntable, were studied in the cat. Optokinetic stimulations at constant velocities lead to modifications of posture depending on the velocity of the stimulus. However, habituation as well as interindividual variability of these postural responses make difficult a systematic and quantitative approach to the phenomenon. Optokinetic stimulations at sinusoidal velocities induced reproductible postural responses, whose phase and gain were studied at different velocities and frequencies of stimulation. At low frequencies (from 0.05 Hz to 0.2 Hz) the postural responses tend to lead the position of the optokinetic stimulus while a lag appears at higher frequencies (up to 1 Hz). In these conditions the gain increases and seems to depend on the performances of the simultaneously elicited oculomotor response. Induced postural readjustments are also modulated by the relative velocity of the visual stimulation with respect to the cat. A given visual input is more effective on an induced postural readjustment than on the posture of a static animal, especially at low frequencies (from 0.05 Hz to 0.3 Hz). These data extend to the cat the strong visual component of the postural control system previously described in other species.

Animals↗

PubMed2002

Anticipatory control of center of mass and joint stability during voluntary arm movement from a standing posture: interplay between active and passive control.

Anticipatory control of upright posture is the focus of this study that combines experimental and modeling work. Individuals were asked to raise or lower their arms from two initial postures such that the final posture of the arm was at 90 degrees with respect to the body. Holding different weights in the hand varied the magnitude of perturbation to postural stability generated by the arm movement. Whole body kinematics and ground reaction forces were measured. Inverse dynamic analysis was used to determine the internal joint moments at the shoulder, hip, knee and ankle, and reaction forces at the shoulder. Center of mass (COM) of the arm, posture (rest of the body without the arms) and whole body (net COM) were also determined. Changes in joint moment at the hip, knee and ankle revealed a significant effect of the direction of movement. The polarities of the joint moment response were appropriate for joint stabilization. Net COM change showed a systematic effect of the direction of movement even though the arm COM was displaced by the same amount and in the same direction for both arm raising and lowering conditions. In order to determine the effects of the passive forces and moments on the posture COM, the body was modeled as an inverted pendulum. The model was customized for each participant; the relevant model parameters were estimated from data obtained from each trial. The ankle joint stiffness and viscosity were adjusted to ensure postural equilibrium prior to arm movement. Joint reactive forces and moments generated by the arm movements were applied at the shoulder level of this inverted pendulum; these were the only inputs and no active control was included. The posture COM profile from the model simulation was calculated. Results show that simulated posture COM profile and measured posture COM profile are identical for about 200 ms following the onset of arm movement and then they deviate. Therefore, the initial control of COM is passive in nature and the observed joint moment response is for joint stabilization and not for the control of COM.

Adaptation, Physiological↗

PubMed2002

Fear of falling modifies anticipatory postural control.

This study investigated the influence of fear of falling or postural threat on the control of posture and movement during a voluntary rise to toes task for 12 healthy young adults. Postural threat was modified through alterations to the surface height at which individuals stood (low or high platform) and changes in step restriction (away from or at the edge of the platform) creating four levels of postural threat: LOW AWAY, LOW EDGE, HIGH AWAY and HIGH EDGE. To rise to the toes, an initial postural adjustment must destabilise the body so that it can be moved forward and elevated to a new position of support over the toes. Centre of pressure and centre of mass profiles, as well as tibialis anterior (TA), soleus (SO) and gastrocnemius (GA) muscle activity patterns were used to describe this behaviour. The results showed that the performance of the rise to toes task was significantly modified when positioned at the edge of the high platform. In this situation, the central nervous system reduced the magnitude and rate of the postural adjustments and subsequent voluntary movement. Although the duration of the movement was lengthened for this most threatening condition, the sequencing and relative timing of TA, SO and GA muscle activity was preserved. These changes in rise to toes behaviour were accompanied by evidence of increased physiological arousal and participant reports of decreased confidence, increased anxiety and decreased stability. Evidence of fear of falling effects on anticipatory postural control is clinically relevant as it may explain deficits in this control observed in individuals with balance disorders. For example, individuals with Parkinson's disease or cerebellar dysfunction demonstrate impaired performance on the rise to toes task as reflected in alterations of both the timing and magnitude of their anticipatory postural adjustments. Our findings suggest alterations in the magnitude of postural adjustments may be magnified by fear of falling while changes in the timing of postural adjustments may reflect underlying pathology.

Accidental Falls↗

PubMed2005

Role of cerebral cortex in human postural control: an EEG study.

OBJECTIVE: It was our primary objective to provide evidence supporting the existence of neural detectors for postural instability that could trigger the compensatory adjustments to avoid falls. METHODS: Twelve young healthy subjects performed self-initiated oscillatory and discrete postural movements in the anterior-posterior (AP) directions with maximal range of motion predominantly at ankle joint. Movements were recorded by the system and included force plate and EMG, and EEG measures from 25 electrode sites. The center of pressure dynamics and stability index were calculated, and EEG potentials both in voltage and frequency domains were extracted by averaging and Morlet wavelet techniques, respectively. RESULTS: The initiation of self-paced postural movement was preceded by slow negative DC shift, similar to movement-related cortical potentials (MRCP) accompanying voluntary limb movement. A burst of gamma activity preceded the initiation of compensatory backward postural movement when balance was in danger. This was evident for both oscillatory and discrete AP postural movements. The spatial distribution of EEG patterns in postural actions approximated that previously observed during the postural perceptual tasks. CONCLUSIONS: The results suggest an important role of the higher cortical structures in regulation of posture equilibrium in dynamic stances. Postural reactions to prevent falls may be triggered by central command mechanisms identified by a burst of EEG gamma activity. SIGNIFICANCE: The results from this study contribute to our understanding of neurophysiological mechanisms underlying the cortical control of human upright posture in normal subjects.

Adaptation, Physiological↗

PubMed2006

Stability of sitting postures: the influence of degrees of freedom.

Observational studies of sitting have shown that, during spontaneous sitting, people adopt a variety of postures. Various researchers have formulated theories to explain why people adopt their sitting postures. Branton (1969) hypothesized that there is continual need for postural stability while sitting. Dempster (1955) stated that additional stability could be obtained through temporarily closing chains of body segments, or, in other words, through decreasing the number of degrees of freedom of the body. The present study elaborates on Dempster's theory. The aim of this study was to determine the influence of the degrees of freedom of the body on postural stability in sitting postures. For 21 different sitting postures, the total number of degrees of freedom was determined. Postural sway, a measure for postural stability, was determined using a 3D motion and position measurement system with ten healthy subjects. This study shows that the mean path length at the level of the second thoracic vertebra (PL0.05), a measure derived from postural sway, increases significantly (p < 0.0001) with an increase of the number of degrees of freedom of the body (DoFB). Closer examination of the data showed that a model taking into account only the degrees of freedom of the lumbar and thoracic spine and pelvis seems to be a better predictor of postural sway than the total number of degrees of freedom of the body.

Biomechanical Phenomena↗