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Long-term depression.

LTD has now been established as a synaptic plasticity specific to the cerebellum. Cellular and molecular mechanisms of LTD have been elucidated to some extent, but still a number of questions are left open. The most crucial question may concern its time course, as to how long the LTD lasts beyond the limit of the present maximum observation time of 3 hr, and whether and how it is eventually transformed to a permanent memory. Molecular mechanisms underlying LTD should be investigated further in respect to Ca2+ binding and storage, protein kinase C, phosphorylation of glutamate receptors, GTP proteins, etc. The ineffectiveness of mass field potentials in representing LTD makes such studies relatively difficult, and a hope for future development may be placed in reproduction of LTD in tissue cultured Purkinje cells or even in isolated glutamate receptors in a simplified form. The cerebellar neuronal network incorporating LTD as a memory element has been conceived as a simple perceptron-like (Albus 1971) or adaptive filter-like (Fujita 1982a) parallel processing computer. Such a neuronal computer incorporated in a reflex or a more complex movement system would endow the system with subtle capabilities of adaptation and learning. The scheme of the floccular control of the VOR closely resembles that of a self-tuning regulator, a type of adaptive control system. For cerebellar control of voluntary movements, however, another version of the adaptive control system, the model reference control system, seems to be more applicable (Ito 1986). This system continuously readjusts its dynamics by referring to errors derived through comparison of its performance with that of an internal model. It is important to note that a model for an unknown system can be built based on the same principle, by feeding errors derived from their comparison to adjust the model. It may thus be conceived that an internal model is built within the cerebellum in the manner of model reference adaptive control, and that an internal model so formed is utilized for adaptive control of movement. A recent simulation study successfully reproduced learning in formation of an arm trajectory based on these principles of model reference control (Kawato et al 1987). On the experimental side, however, the complex neural organization for control of locomotion, posture, and voluntary movements still eludes full elucidation. Nevertheless, evidence is accumulating to support the cerebellar learning hypothesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Impairment in cardiac autonomic regulation preceding arterial hypertension in humans: insights from spectral analysis of beat-by-beat cardiovascular variability.

BACKGROUND: Subjects in the upper-normal range of arterial pressure have an excess cardiovascular risk, which suggests that other factors, such as impaired autonomic regulation, might be implicated. This study was designed to assess whether noninvasive markers of cardiac and vascular autonomic regulation might already be altered in subjects with high-normal arterial pressure levels. METHODS AND RESULTS: We performed an observational study on a population comprising 300 subjects of both sexes with arterial pressure ranging from 90/60 to 210/120 mm Hg, who were divided into 3 groups (each n=100) with average systolic pressures of 103, 133, and 163 mm Hg. Autonomic regulation was inferred from spectral analysis of RR interval and systolic arterial pressure variability, considering rest and stand-induced changes, to account for sympathetic excitatory components. Significant alterations in markers of sinoatrial regulation (increased low-frequency normalized units, reduced high-frequency normalized units, and alpha-index) were already apparent in subjects in the second tertile, ie, those with arterial pressure within normal limits. Markers of vascular regulation instead showed significant alterations in the third (hypertensive) tertile. In response to standing, changes in markers of sinoatrial modulations were gradually reduced, whereas those of vascular regulation were increased. A tight link between progression of arterial pressure and the continuum of changes in autonomic markers as shown by simple correlation analysis appeared strongly affected by age and was spread across many spectral analysis-derived variables. Hypertensive autonomic dysregulation was particularly apparent in the youngest group. CONCLUSIONS: RR-variability parameters might prove useful to assess, with longitudinal studies, the mechanistic role of autonomic impairment in the increased risk of prehypertensive conditions.

Adolescent↗

Clinical implications from an exploratory study of postural management of breech presentation.

The results from an exploratory study of the effectiveness of maternal knee-chest posture for producing cephalic version of breech presentation are shown. Methods are briefly described and clinical implications are presented. Among 25 women, fewer who performed the maternal knee-chest postural intervention experienced fetal cephalic version than women in the control group who did nothing to influence breech presentation. Despite limitations of the underpowered findings, trends in the data may indicate that parity and gestational age were potentially relevant covariates of version. Postural management is not an evidence-based practice. This exploratory study indicates that maternal knee-chest posture may work opposite to the expected direction, but the small sample size precludes generalizations about efficacy of knee-chest postural management. At least one adequately powered trial that controls for parity and gestational age is needed to determine whether knee-chest postural management results in no effect, a small, or small to moderate clinically significant effect.

Apgar Score↗

Postural control adaptation during galvanic vestibular and vibratory proprioceptive stimulation.

The objective for this study was to investigate whether the adaptation of postural control was similar during galvanic vestibular stimulation and during vibratory proprioceptive stimulation of the calf muscles. Healthy subjects were tested during erect stance with eyes open or closed. An analysis method designed to consider the adaptive adjustments was used to evaluate the motion dynamics and the evoked changes of posture and stimulation response. Galvanic vestibular stimulation induced primarily lateral body movements and vibratory proprioceptive stimulation induced anteroposterior movements. The lateral body sway generated by the galvanic stimulation was proportionally smaller and contained more high-frequency movements (> 0.1 Hz) than the anteroposterior body sway induced by the vibratory stimulation. The adaptive adjustments of the body sway to the stimulation had similar time course and magnitude during galvanic and vibratory stimulation. The perturbations induced by stimulation were gradually reduced within the same time range (15-20 s) and both kinds of stimulation induced a body leaning whose direction was dependent on stimulus. The similarities in the adjustment patterns suggest that postural control operates in the same way independent of the receptor systems affected by the disturbance and irrespective of whether the motion responses were induced in a lateral or anteroposterior direction.

Adaptation, Physiological↗

Correlates of functional disability in patients with postural tachycardia syndrome: preliminary cross-sectional findings.

The study investigated correlates of functional disability in 94 patients (89.4% women, 10.6% men; mean age=34.2 years) with postural tachycardia syndrome (POTS), a clinical syndrome of orthostatic intolerance characterized by significant functional limitations. Path analysis supported a model in which, controlling for demographic and disease variables, catastrophic cognitions were directly related to the latent variable functional disability, whereas somatic vigilance, anxiety sensitivity, and neuroticism were indirectly associated with functional disability through their relationship with catastrophic cognitions. Results suggest that modifiable psychological factors play a role in the functional limitations experienced by patients with POTS. Longitudinal research is necessary to confirm these relationships.

Activities of Daily Living↗

Spasmodic torticollis-like posture and caudate nucleus monoamine in cats: in vivo dialysis study.

In order to study the monoamine mechanism in the caudate nucleus of experimental spasmodic torticollis, the left side of the ventromedial tegmentum (VMT) was electrically destroyed in cats, and in vivo brain dialysis in the caudate nucleus was performed for determining the changes in monoamines and their metabolites. Six out of 12 animals showed the torticollis-like posture in which the head became deviated towards the side of the lesion by rotating around the longitudinal axis. In 4 of these 6 cats, this posture continued for 3 d until brain dialysis was performed. The extracellular 5-HIAA level decreased compared to HVA level in the caudate nucleus of the lesion side. In the other 2 cats, the posture disappeared on the day after the lesion was induced and the change of 5-HIAA level was less prominent or within the range of the control group. The brain dialysis method was very useful for measuring the monoamine metabolite levels of the caudate nucleus while the experimental model was still alive and presenting the torticollis-like posture. These results suggest, although inconclusively, that decreased activity in the ipsilateral caudate nucleus serotonin neuron might play an important role in the manifestation of the torticollis-like posture in this animal model.

3,4-Dihydroxyphenylacetic Acid↗

Effect of balance training on recovery of stability in children with cerebral palsy.

This study examined the effect of massed practice in balance recovery of stability in six children (four males, two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by the center of pressure over a one second period) and time to stabilization from center of pressure measures were calculated following perturbations. The intervention phase consisted of massed practice on the moving platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as demonstrated by reduced center of pressure area and time to stabilization following training. These improvements were still present 30 days following completion of training. Results suggest that postural control mechanisms in school-age children (7 to 13 years) with CP are modifiable.

Adolescent↗

Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes.

BACKGROUND: Postural hypotension with a decline of 20 mm Hg or more in systolic blood pressure on standing is considered a potentially dangerous hypotensive response. Postural dizziness is often strongly associated with postural hypotension. However, there is conflicting evidence, and previous studies have been confined to the elderly, not specifically to patients with diabetes. Thus, we evaluated the association between postural hypotension and postural dizziness, and determined the factors most likely related to postural hypotension in patients with diabetes. METHODS: The subjects were 204 consecutive noninsulin-dependent patients with diabetes and 408 age- and sex-matched control subjects. Postural hypotension was defined as a decline of 20 mm Hg or more in systolic blood pressure 1 minute after standing. Postural dizziness was any feelings of dizziness, lightheadedness, or faintness that occurred while standing during the examination. RESULTS: The prevalence of postural hypotension and postural dizziness in patients with diabetes was higher than in control subjects. Those patients with both diabetes and postural hypotension were older and had higher supine systolic blood pressures and higher plasma glycosylated hemoglobin and fasting glucose levels. They had higher prevalence of postural dizziness, hypertension, and cerebrovascular disease, and lower standing systolic blood pressures than those without postural hypotension. They also were more often being treated with antihypertensive agents. Only 32.8% of patients with diabetes with postural hypotension suffered from postural dizziness. Postural dizziness, hypertension, cerebrovascular disease, and plasma glycosylated hemoglobin levels were independently associated with postural hypotension in patients with diabetes. CONCLUSIONS: Postural dizziness, glycemic control, hypertension, and cerebrovascular disease were important determinants of postural hypotension in patients with diabetes. Postural hypotension was associated with postural dizziness, but it cannot be determined clinically just from the presence of postural dizziness because the sensitivity for diagnosis of postural hypotension is low.

Aged↗

[New approaches to diagnosis of hysteria].

Postural stability or fluctuation of general centre of gravity (GCG) was investigated in 14 patients with hysteric motor disorders(alterations of statics and walking, pseudopareses) by means of stabilograph. Comparative groups included 7 patients with hemipareses of vascular origin, 7 patients with multiple sclerosis with spastico and atactic disturbances and 7 healthy individuals. The amplitudes of GCG fluctuations in both sagittal and frontal planes as well as their correlations were analysed. It was shown that amplitude of GCG vibration was maximal in hysteriac patients. However patterns of regulation of postural control in hysteriac patients (correlation of amplitudes of vibrations in sagittal and frontal planes) were similar to those of healthy individuals and differed significantly from organic models.

Adult↗

Once more on the equilibrium-point hypothesis (lambda model) for motor control.

The equilibrium control hypothesis (lambda model) is considered with special reference to the following concepts: (a) the length-force invariant characteristic (IC) of the muscle together with central and reflex systems subserving its activity; (b) the tonic stretch reflex threshold (lambda) as an independent measure of central commands descending to alpha and gamma motoneurons; (c) the equilibrium point, defined in terms of lambda, IC and static load characteristics, which is associated with the notion that posture and movement are controlled by a single mechanism; and (d) the muscle activation area (a reformulation of the "size principle")--the area of kinematic and command variables in which a rank-ordered recruitment of motor units takes place. The model is used for the interpretation of various motor phenomena, particularly electromyographic patterns. The stretch reflex in the lambda model has no mechanism to follow-up a certain muscle length prescribed by central commands. Rather, its task is to bring the system to an equilibrium, load-dependent position. Another currently popular version defines the equilibrium point concept in terms of alpha motoneuron activity alone (the alpha model). Although the model imitates (as does the lambda model) spring-like properties of motor performance, it nevertheless is inconsistent with a substantial data base on intact motor control. An analysis of alpha models, including their treatment of motor performance in deafferented animals, reveals that they suffer from grave shortcomings. It is concluded that parameterization of the stretch reflex is a basis for intact motor control. Muscle deafferentation impairs this graceful mechanism though it does not remove the possibility of movement.

Journal Article↗

An update on falls.

PURPOSE OF REVIEW: Falls among elderly persons create immense social problems because of their association with physical decline, serious psychosocial consequences, negative impact on the quality of life, and markedly reduced survival. In addition, falls pose high costs to the public health service. For these reasons, falls remain a popular topic for research. Here, we review several interesting developments that have been published during the past year. RECENT FINDINGS: Considerable attention has been focused on early identification of fallers and prevention strategies for falls or injuries. A remaining challenge is to implement such strategies into daily clinical practice, at acceptable costs and with good acceptance. New evidence has been generated to suggest the importance of high-level processing for postural control, but it remains difficult to predict falls based upon a simple dual tasking test. Neuroimaging studies are now beginning to provide new insights into the role of cortical structures in balance regulation, and how cortical dysfunction might contribute to falls. Posturography studies using multidirectional moving platforms or computer models of balance have provided new insights into falling mechanisms, in particular the role of abnormal protective responses (stepping or grasping) and the negative effects of stiffening. Other studies have shown how a fear of falling, a common sequel to falls, may lead to secondary degeneration of postural control, thus completing a vicious loop. SUMMARY: While these examples illustrate that falls research is very much ongoing, one cannot speak of true progress until the scientific evidence can be implemented into real life, with falls being prevented effectively in individual cases.

Accidental Falls↗

Active stiffness of the ankle in response to inertial and elastic loads.

Effective stiffness of the musculoskeletal system was examined as a function of the characteristics of an external load. Thirteen healthy subjects provided active contraction of the ankle plantarflexion musculature in a neutral ankle posture to support an external load. Musculoskeletal stiffness was computed from kinetic data recorded in response to dorsiflexion/plantarflexion perturbations. Ankle dynamics were recorded while supporting external loads of 19 and 38 kg with and without antagonistic co-contraction. External loads were applied using pure gravitational mass. In separate trials external loads were applied from stretch of steel springs in parallel with the plantarflexion musculature that also provided added parallel stiffness to the system. Adding external stiffness of 4.9 and 8.1 kN/m surprisingly failed to significantly change the stiffness of the ankle-plus-spring system. This suggests contributions from intrinsic muscle stiffness and reflex stiffness declined in response to added external stiffness. This could not be explained by load magnitudes, ankle postures, or co-activation as these were similar between the inertial and elastic loading conditions. However, non-linear parametric analyses suggest mean intrinsic stiffness of 35.5 kN/m and reflex gain of 11.6 kN/m with a constant reflex delay of 70 ms accurately described the empirical results. The phase response between the mechanical dynamics of the musculoskeletal system and delayed neuromotor feedback combine to provide robust control of system behavior.

Acceleration↗

Forms of forward quadrupedal locomotion. III. A comparison of posture, hindlimb kinematics, and motor patterns for downslope and level walking.

To gain further insight into the neural mechanisms for different forms of quadrupedal walking, data on postural orientation, hindlimb kinematics, and motor patterns were assessed for four grades of downslope walking, from 25% (14 degrees slope) to 100% (45 degrees), and compared with data from level and downslope walking at five grades (5-25%) on the treadmill (0.6 m/s). Kinematic data were obtained by digitizing ciné film, and electromyograms (EMGs) synchronized with kinematic records were taken from 13 different hindlimb muscles. At grades from 25 to 75%, cycle periods were similar, but at the steepest grade the cycle was shorter because of a reduced stance phase. Paw-contact sequences at all grades were consistent with lateral-sequence walking, but pace walking often occurred at the steepest grades. The cats crouched at the steeper grades, and crouching was associated with changes in fore- and hindlimb orientation that were consistent with increasing braking forces and decreasing propulsive forces during stance. The average ranges of motion at the hindlimb joints, except at the hip, were often different at the two steepest slopes. During swing, the range of knee- and ankle-joint flexion decreased, and the range and duration of extension increased at the ankle joint to lower the paw downward for contact. During stance the range of flexion during yield increased at the ankle joint, and the range of extension decreased at the knee and metatarsophalangeal joints. Downslope walking was also associated with EMG changes for several muscles. The hip extensors were not active during stance; instead, hip flexors were active, presumably to slow the rate of hip extension. Although ankle extensors were active during stance, their burst durations were truncated and centered around paw contact. Ankle flexors were active after midstance at the steeper slopes before the need to initiate swing, whereas flexor and extensor digit muscles were coactive throughout stance. Overall the changes in posture, hindlimb kinematics, and activity patterns of hindlimb muscles during stance reflected a need to counteract external forces that would accelerate angular displacements at some joints. Implications of these changes are discussed by using current models for the neural control of walking.

Animals↗

Work organization is significantly associated with upper extremities musculoskeletal disorders among employees engaged in interactive computer-telephone tasks of an international bank subsidiary in São Paulo, Brazil.

This study was designed to verify the risk factors for developing upper extremities musculoskeletal disorders (UEMD) among workers engaged in customer service tasks performed by telephone at a private banking corporation in São Paulo, Brazil. The monthly incidence of UEMD in hands and/or wrists in this group was studied retrospectively from January 1993 to June 1995. The statistical analysis was done by using multiple linear regression with the monthly incidence of UEMD considered as dependent variable in models controlled for age, seniority, mean daily regular worktime and overtime per operator, time pressure at work, rest/work schedule, management status, personnel training on postural and muscle stretching, and ergonomic hazards. The variables associated with UEMD were the following: time pressure at work (coefficient = 0.049; p = 0.008) and rest/work schedule (coefficient = -0.047; p = 0.02). The results indicate that working conditions are significantly associated with UEMD, and changes in the working schedule may decrease the incidence of this problem in workers assigned to tasks related to the interactive use of computer-accessible databases during telephone contacts.

Adult↗

Dynamical structure of center-of-pressure trajectories in patients recovering from stroke.

In a recent study, De Haart et al. (Arch Phys Med Rehabil 85:886-895, 2004) investigated the recovery of balance in stroke patients using traditional analyses of center-of-pressure (COP) trajectories to assess the effects of health status, rehabilitation, and task conditions like standing with eyes open or closed and standing while performing a cognitive dual task. To unravel the underlying control processes, we reanalyzed these data in terms of stochastic dynamics using more advanced analyses. Dimensionality, local stability, regularity, and scaling behavior of COP trajectories were determined and compared with shuffled and phase-randomized surrogate data. The presence of long-range correlations discarded the possibility that the COP trajectories were purely random. Compared to the healthy controls, the COP trajectories of the stroke patients were characterized by increased dimensionality and instability, but greater regularity in the frontal plane. These findings were taken to imply that the stroke patients actively (i.e., cognitively) coped with the stroke-induced impairment of posture, as reflected in the increased regularity and decreased local stability, by recruiting additional control processes (i.e., more degrees of freedom) and/or by tightening the present control structure while releasing non-essential degrees of freedom from postural control. In the course of rehabilitation, dimensionality stayed fairly constant, whereas local stability increased and regularity decreased. The progressively less regular COP trajectories were interpreted to indicate a reduction of cognitive involvement in postural control as recovery from stroke progressed. Consistent with this interpretation, the dual task condition resulted in less regular COP trajectories of greater dimensionality, reflecting a task-related decrease of active, cognitive contributions to postural control. In comparison with conventional posturography, our results show a clear surplus value of dynamical measures in studying postural control.

Aged↗

Effect of the "squat protective response" on impact velocity during backward falls.

Risk for injury during a fall depends on the position and velocity of the body segments at the moment of impact. One technique for reducing impact velocity is to absorb energy in the lower extremity muscles during descent, as occurs during squatting or sitting. However, the protective value of this response may depend on the time during descent when the response is initiated. We tested this hypothesis by conducting backward falling experiments with young women (n = 23; aged 21-29 years), who fell onto a soft gymnasium mattress after being suddenly releasing from an inclined position. In trials where subjects were released from a 5 degrees lean, average impact velocities were reduced by 18% when squatting was utilized as opposed to inhibited. Furthermore, increases in the release angle caused an increase in average impact velocity of 8% between lean angles of 2 degrees and 5 degrees, and 7% between lean angles of 5 degrees and 12 degrees. This was due to declines in peak extensor torques and peak flexion rotations, and corresponding reductions in both joint work and potential energy at impact. These results suggest that squatting during descent reduces impact severity, but the effectiveness of the response depends on the stage during descent when it is initiated, diminishing in benefit as the fall progresses and the state of imbalance grows increasingly severe.

Accidental Falls↗