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Influence of trauma induced by judo practice on postural control.

Although high-level sports develop specific physiological and sensorimotor abilities involved in balance control, they also increase the risk of injuries. The influence on postural control of lower limb trauma induced by judo practice was examined in healthy and previously injured judoists (PIJ). During static and dynamic tests, performed with or without vision, PIJ achieved the best performances in maintaining proper balance, except for those with the most severe antecedents of trauma. The severity of the pathology appeared to be the most important parameter prejudicial to balance control while the location, frequency and diversity of trauma had only a modest impact. This shows that PIJ develop excellent sensory and cognitive adaptation abilities to constraints involving new patterns of compensation and of body scheme.

Adaptation, Physiological↗

The ankle strategy for postural control--a comparison between a model-based and a marker-based method.

When analysing postural control statistical characteristics of the centre of pressure or the ground reaction force are often used. A complement would be to analyse movement strategies as well. The purpose of this study was to determine to what extent the ankle strategy is used to maintain the balance in standing. One important question is if it is sufficient to use only force plate data in this determination, or if markers have to be used. To answer this question we studied two different methods--a marker-based method and a model-based method. The latter needs force plate data only as input to an inverted pendulum model. Different measures were calculated and used to draw conclusions of to what extent the ankle strategy was used. Experiments demonstrated that the data from the two methods provided the same general conclusions, although there were some differences in the estimated measures. By using the model-based method instead of tracking markers we can increase the clinical effectiveness considerably, get a lesser amount of data, and still get results comparable to the marker-based method.

Ankle↗

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

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

Aged↗

Contribution of the vestibular apparatus to postural control when rising from a chair.

OBJECTIVE: The everyday act of rising from a chair is known to require the combined angular control of a number of the body's joints, especially those within the pitch plane. Precisely how this control is exerted, however, remains controversial. The aim of this study was to obtain a better understanding of the contribution made by the vestibular apparatus to postural control of the body and head when an individual rises from a chair. MATERIAL AND METHODS: A total of 24 healthy controls and 38 patients with varying degrees of vestibular dysfunction were examined. Electromagnetic motion sensors were used to analyze the angular control of the head and body as subjects rose from a chair with their eyes open or closed. RESULTS: We found that unilateral vestibular dysfunction caused fixation of the head with respect to the body, resulting in a loss of spatial stability of the head which was not compensated for by visual input. Visual input did appear to compensate for bilateral vestibular loss, enabling patients with bilateral vestibular apparatus impairment or central disorders to fix the position of their head in space. CONCLUSION: The act of rising from a chair is normally controlled by vestibular and proprioceptive input; the head is aligned according to the gravitational reference so as to obtain stable visual information. In patients with unilateral vestibular hypofunction, posture is still controlled by these two inputs, although the ability to align the head is diminished. In patients with bilateral vestibular hypofunction or a central disorder, head alignment is maintained using visual input, although it may not be the sole or predominant stabilizing force.

Adult↗

The effects of selected ankle appliances on postural control.

OBJECTIVE: Although ankle braces supposedly protect the ankle by providing mechanical support of the joint and enhancing proprioceptive input, their proprioceptive effects are unclear. Measuring the center of pressure during posture provides a reasonably well-controlled evaluation of proprioceptive input at the ankle. We, therefore, compared the changes in the center of pressure resulting from wearing ankle braces and wearing no brace (control). DESIGN AND SETTING: Center-of-pressure variables were measured during a one-legged modified Romberg test with six variations. The six test conditions systematically altered the three sensory modalities that control posture: visual input, vestibular input, and proprioceptive input. Subjects performed three 16-second trials of each Romberg variation for each brace condition. SUBJECTS: Twenty-four male volunteers (age = 18 to 26 yr) with no history of ankle injuries in the past 5 years and no difficulty with balance. MEASUREMENTS: Center of pressure, transmitted through the bottom of the foot, was monitored during each trial and transformed into total distance traveled, anterior-posterior (AP) position, and medial-lateral (ML) position. RESULTS: Average AP and ML center-of-pressure positions were increased only during brace wearing when all sensory modalities were functioning normally (control condition). Total center-of-pressure distance was the same for all three brace conditions. CONCLUSIONS: Our results do not support or refute the concept that bracing enhances proprioception. The fact that subjects relocated their center of pressure only during the control condition is perplexing. If braces were to enhance proprioception, one would expect to see lower average ML and average AP center-of-pressure values when comparing the braced with the unbraced conditions. Alternatively, the relocated position may represent a more stable position resulting from enhanced proprioception.

Journal Article↗

Effect of expertise and visual contribution on postural control in soccer.

This work analyzes the postural performance and the use of visual information in soccer players according to their level of competition. Two groups of healthy soccer players were investigated at the mid-competition season: an amateur (AM) (n=15) group composed of regional-level players and a professional group at a national level (PRO) (n=15). Posture was assessed by measuring the center of foot pressure (COP) with a force platform during a test (51.2 s) of bipedal quiet standing posture. The test was completed with eyes open (the subjects looked at a fixed-level target at a distance of 2 m) and closed (they kept their gaze in a straight-ahead direction). The statistical analysis showed that PRO soccer players were more stable than AM soccer players. Moreover, the contribution of vision in postural maintenance was less important in the PRO players than in the AM players. The present study suggests that intense training allows PRO soccer players to become less dependent on vision to control their posture such that vision can be dedicated to treating the information, that emanates from the game.

Adolescent↗

Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders.

OBJECTIVE: The aim of this study was to determine postural responses before and after a vestibular rehabilitation program (VRP) in 14 patients with central vestibular disorders (CVD). MATERIAL AND METHODS: The confidence ellipse (CE) of the center of pressure distribution area and the sway velocity (SV) were the parameters used for the quantitative assessment of postural control (PC). These two parameters were analyzed before and after a VRP for two visual conditions. Behavioral postural responses were studied by means of the time-frequency scalogram using wavelets and the sway frequency content was measured in arbitrary units of energy density. RESULTS: Ten patients showed a significant decrease in the CE and SV after the rehabilitative treatment, thus improving their PC. Seven of these patients were assessed again after a period of 12 +/- 5 months, during which they had not received any physical training. All of them showed increases in the CE and SV, indicating an impairment of PC. CONCLUSIONS: Many CVD patients damage the neural mechanisms involved in retaining the plastic changes in the PC parameters after rehabilitative treatment. Continuation of training may be necessary in order to maintain the improvement in PC obtained with a VRP.

Adaptation, Ocular↗

Contributions of altered sensation and feedback responses to changes in coordination of postural control due to aging.

We used multivariate kinematics and joint torque measurements during dynamic posturography to determine the relative contributions of changes in overall control gain, relative weighting of sensors, and noise-like effects on posture control in the elderly. Our results show that sway coordination and amplitude both change with age, but that changes in overall feedback gains do not explain these differences. We propose that increased sway of elderly subjects in platform sway-referenced conditions is due to sensory noise or decreased ability to detect small motions of the platform, while increased sway during visual sway-referencing is due to re-weighting of the various sensors.

Adult↗

Sensorimotor integration in human postural control.

It is generally accepted that human bipedal upright stance is achieved by feedback mechanisms that generate an appropriate corrective torque based on body-sway motion detected primarily by visual, vestibular, and proprioceptive sensory systems. Because orientation information from the various senses is not always available (eyes closed) or accurate (compliant support surface), the postural control system must somehow adjust to maintain stance in a wide variety of environmental conditions. This is the sensorimotor integration problem that we investigated by evoking anterior-posterior (AP) body sway using pseudorandom rotation of the visual surround and/or support surface (amplitudes 0.5-8 degrees ) in both normal subjects and subjects with severe bilateral vestibular loss (VL). AP rotation of body center-of-mass (COM) was measured in response to six conditions offering different combinations of available sensory information. Stimulus-response data were analyzed using spectral analysis to compute transfer functions and coherence functions over a frequency range from 0.017 to 2.23 Hz. Stimulus-response data were quite linear for any given condition and amplitude. However, overall behavior in normal subjects was nonlinear because gain decreased and phase functions sometimes changed with increasing stimulus amplitude. "Sensory channel reweighting" could account for this nonlinear behavior with subjects showing increasing reliance on vestibular cues as stimulus amplitudes increased. VL subjects could not perform this reweighting, and their stimulus-response behavior remained quite linear. Transfer function curve fits based on a simple feedback control model provided estimates of postural stiffness, damping, and feedback time delay. There were only small changes in these parameters with increasing visual stimulus amplitude. However, stiffness increased as much as 60% with increasing support surface amplitude. To maintain postural stability and avoid resonant behavior, an increase in stiffness should be accompanied by a corresponding increase in damping. Increased damping was achieved primarily by decreasing the apparent time delay of feedback control rather than by changing the damping coefficient (i.e., corrective torque related to body-sway velocity). In normal subjects, stiffness and damping were highly correlated with body mass and moment of inertia, with stiffness always about 1/3 larger than necessary to resist the destabilizing torque due to gravity. The stiffness parameter in some VL subjects was larger compared with normal subjects, suggesting that they may use increased stiffness to help compensate for their loss. Overall results show that the simple act of standing quietly depends on a remarkably complex sensorimotor control system.

Adaptation, Physiological↗

Adaptation of postural control to weightlessness.

Adaptation of motor control to weightlessness was studied during a 7-day spaceflight. The maintenance of control of upright posture was examined during a voluntary raising movement of the arm and during the voluntary raising on tiptoe. In order to evaluate the contribution of visual cues, three types of visual situations were examined: normal vision, central vision, and without vision. On the basis of cinematographic and mechanographic data, the postural perturbations consecutive to the movement of a body part in conditions of weightlessness were found to be similar to those observed on earth. However, in weightlessness, in contrast to the ground-based situation, erectness of posture was maintained primarily due to the predominant contraction of the ankle flexor muscles. The sequences of postural leg muscle activity associated with the arm or foot movement were well structured and varied slightly in the course of the flight. In addition, the initial posture, that is the erect posture before the movement was executed, changed throughout the flight from an exaggerated oblique position to a terrestrial standing position. Visual information was preponderant at the beginning of the space mission for the recalibration of other sensory cues affected by weightlessness. The findings are indicative of two types of adaptation of the central program of posture regulation to weightlessness: fast, short-term adaptation, characterized by a quasi-instantaneous redistribution of motor commands between ankle flexors and extensors (an "operative process") and slow, long-term adaptation, exemplified by the loss of anticipatory activation of certain muscles by the end of the flight (a "conservative process").

Adaptation, Physiological↗

Age-related changes in human postural control of prolonged standing.

The aim of this study was to characterize prolonged standing and its effect on postural control in elderly individuals in comparison to adults. It is unknown how elderly individuals behave during prolonged standing and how demanding such a task is for them. We recorded the center of pressure (COP) position of 14 elderly subjects and 14 adults while they performed prolonged standing (30 min) and quiet stance tasks (60s) on a force plate. The number and amplitude of the COP patterns, the root mean square (RMS), speed, and frequency of the COP sway were analyzed. The elderly subjects were able to stand for prolonged periods but they produced postural changes of lesser amplitude and a decreased sway during the prolonged standing task. Both the adults and the elderly subjects were influenced by the prolonged standing task, as demonstrated by their increased COP RMS and COP speed in the quiet standing trial after the prolonged standing task, in comparison to the trial before. We suggest that the lack of mobility in elderly subjects may be responsible for the observed sub-optimal postural changes in this group. The inability of elderly individuals to generate similar responses to adults during prolonged standing may contribute to the increased risk of falls in the older population.

Adult↗

Interactions between pathways controlling posture and gait at the level of spinal interneurones in the cat.

The properties of three interneuronal populations controlling posture and locomotion are briefly reviewed. These are interneurones mediating reciprocal inhibition of antagonistic muscles and interneurones in pathways from secondary muscle spindle afferents to ipsilateral and contralateral motoneurones, respectively. It will be shown that these interneurones subserve a variety of movements, with functionally specialized subpopulations being selected under different conditions. Mechanisms for gating the activity of these neurones appear to be specific for each of them but to act in concert. Interneurones which are active during locomotion and postural reactions are distributed over many segments of the spinal cord and over several of Rexed's laminae, both in the intermediate zone and in the ventral horn (Berkinblit et al., 1978; Bayev et al., 1979; Schor et al., 1986; Yates et al., 1989). The location of neurones discharging during neck and labyrinthine reflexes is illustrated in Fig. 1A and B but indications that neurones with an even wider distribution contribute to locomotion, scratching and the related postural reactions have been provided by neuronal markers which preferentially label active neurones (WGA-HRP; see Noga et al., 1987) or neurones with active genetic transcription (c-fos; I. Barajon, personal communication; Dai et al., 1991). Such a wide distribution indicates a high degree of non-homogeneity, since neurones of different functional types are usually located in different laminae. It has been demonstrated that some of these neurones may be particularly important for setting up the rhythm of muscle contractions specific for different gaits or scratching, as part of their "pattern generators" (see, e.g., Grillner, 1981). Other neurones may be primarily involved in initiation of these movements or in postural adjustments combined with them. A considerable proportion of neurones mediating these movements are nevertheless likely to be used not in one particular type of movement but in a variety of movements, and contribute to postural reactions and locomotion as well as to various segmental reflexes and centrally initiated movements; they are likely to operate as last order (premotor) interneurones of several spinal pathways to motoneurones. One of the indications that this is the case is the overlap between the areas of location of interneurones active during postural reactions, locomotion, or scratching and the areas of location of premotor interneurones (Fig. 1C,D). The latter were labelled by loading motoneurones with WGA-HRP and by its subsequent retrograde transneuronal transport (see Harrison et al., 1986).(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗

Analysis of postural control synergies during quiet standing in healthy children and children with cerebral palsy.

OBJECTIVE: To estimate the contribution of body transverse rotation using weighted differential center of pressure signals during quiet standing in healthy children and in children with cerebral palsy. DESIGN: Body sway was indirectly measured through center of pressure data, which was calculated using dual force platforms. BACKGROUND: Assessment of postural control synergies using center of pressure data provides a unique method for center of mass data analysis in characterizing complex balance sway. METHODS: Using dual force platforms, linear expressions for the coordinates of right and left center of pressure signals were developed to identify and characterize balance control synergies during quiet standing. Subjects were also tested during eyes open and eyes closed trials to determine the significance of visual input on these control synergies. RESULTS: The limb protraction/retraction control was found to be dominant during medial-lateral sway, whereas the estimated body transverse rotation contribution was found to be more significant than the previously reported measures of anterior-posterior balance. These findings were consistent in healthy children and in children with cerebral palsy during both eyes open and eyes closed trials. CONCLUSION: The weighted differential center of pressure signals show that the estimated body transverse rotation contribution is significant in healthy children and critical for postural stability in children with cerebral palsy. RELEVANCE: This study identifies the significance of body transverse rotation control contribution in upright posture. Children with cerebral palsy with relatively poor ankle control demonstrate the importance of body transverse rotation for postural stability.

Ankle Joint↗

Stability analysis for postural control in a two-joint limb system.

The stability behavior of a multi-joint limb with electrically activated muscles provides important clues for postural control of motor tasks. The stability property of the musculoskeletal system can be characterized with its eigenvalues evaluated at operating postures in the workspace. A planar arm model with shoulder and elbow joints and three pairs of antagonistic muscles was constructed in ADAMS. Stability behavior of shoulder and elbow joints was analyzed using the loci of eigenvalues in the s-plane. In the analysis of open-loop cocontraction of antagonist muscles with increasing activation from 5% to 100%, the eigenvalues of the shoulder and elbow joints were confined within the left half of the s-plane in a stripe of +/- j 0.5, and moved toward left onto the real axis. The shoulder eigenvalues were generally nearer to the imaginary axis than the elbow ones, indicating a more oscillatory behavior at the shoulder joint than that at the elbow joint. The effects of joint configuration evaluated within the workspace from 40 degrees to 110 degrees for the elbow and from 40 degrees to 120 degrees for the shoulder showed that the elbow eigenvalues were more prone to configuration changes, particularly elbow angles. We also developed a simulation paradigm for sampled data FES control systems that contain a mixture of continuous time components and sampling and hold effects. This simulation paradigm is useful for realistic simulation of local feedback controller performance.

Computer Simulation↗

Effects of anterior cruciate ligament (ACL) injury on postural control and muscle activity of head, neck and trunk muscles.

The aim of the study was to evaluate the effects that an anterior cruciate ligament injury of the knee has on postural control and activity of neck, head and trunk muscles to investigate the existence of connections between the masticatory system and body posture. Surface electromyographic activity of the muscles at mandibular rest position, and during maximal voluntary clenching and posturometric and stabilometric measurements of 25 adult patients having pathology on the left knee were compared with a control non-pathological group. At rest, the patients showed a higher muscular activity of anterior temporalis, masseter, sternocleidomastoid and lower trapezius, compared with the control subjects (P < 0.05). At maximal voluntary clenching, the patients showed a lower muscular activity of the right anterior temporalis and masseter and a higher muscular activity of the lower trapezius, compared with the control subjects. For the stabilometric measurements, all the subjects showed a significant reduction in the postural centre of pressure path length during the test with eyes open and cotton rolls, compared with the test with eyes closed and mandibular rest position (P < 0.05). In addition, the patients showed a significant displacement of the postural centre of pressure in a forward direction (P < 0.05) and into the right side (P < 0.05), compared with the control subjects. Anterior cruciate ligament injury appears to be associated to a change in the activity of head, neck and trunk muscles and to a change in the position of the postural centre of pressure. Cotton rolls seem to improve the stability of the subject.

Adult↗

Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles.

Pain changes postural activation of the trunk muscles. The cause of these changes is not known but one possibility relates to the information processing requirements and the stressful nature of pain. This study investigated this possibility by evaluating electromyographic activity (EMG) of the deep and superficial trunk muscles associated with voluntary rapid arm movement. Data were collected from control trials, trials during low back pain (LBP) elicited by injection of hypertonic saline into the back muscles, trials during a non-painful attention-demanding task, and during the same task that was also stressful. Pain did not change the reaction time (RT) of the movement, had variable effects on RT of the superficial trunk muscles, but consistently increased RT of the deepest abdominal muscle. The effect of the attention-demanding task was opposite: increased RT of the movement and the superficial trunk muscles but no effect on RT of the deep trunk muscles. Thus, activation of the deep trunk muscles occurred earlier relative to the movement. When the attention-demanding task was made stressful, the RT of the movement and superficial trunk muscles was unchanged but the RT of the deep trunk muscles was increased. Thus, the temporal relationship between deep trunk muscle activation and arm movement was restored. This means that although postural activation of the deep trunk muscles is not affected when central nervous system resources are limited, it is delayed when the individual is also under stress. However, a non-painful attention-demanding task does not replicate the effect of pain on postural control of the trunk muscles even when the task is stressful.

Abdominal Muscles↗

Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review.

OBJECTIVE: To establish whether bilateral standing with visual feedback therapy after stroke improves postural control compared with conventional therapy and to evaluate the generalization of the effects of visual feedback therapy on gait and gait-related activities. DESIGN: A systematic review. METHODS: A computer-aided literature search was performed. Randomized controlled trials and controlled clinical trials, comparing visual feedback therapy with conventional balance treatments were included up to April 2005. The methodological quality of each study was assessed with the the Physiotherapy Evidence Database scale. Depending on existing heterogeneity, studies with a common variable of outcome were pooled by calculating the summary effect-sizes using fixed or random effects models. RESULTS: Eight out of 78 studies, presenting 214 subjects, were included for qualitative and quantitative analysis. The methodological quality ranged from 3 to 6 points. The meta-analysis demonstrated non-significant summary effect-sizes in favour of visual feedback therapy for weight distribution and postural sway, as well as balance and gait performance, and gait speed. CONCLUSION: The additional value of visual feedback therapy in bilateral standing compared with conventional therapy shows no statistically significant effects on symmetry of weight distribution between paretic and non-paretic leg, postural sway in bilateral standing, gait and gait-related activities. Visual feedback therapy should not be favoured over conventional therapy. The question remains as to exactly how asymmetry in weight distribution while standing is related to balance control in patients with stroke.

Adult↗

Developmental sequence of postural control in prone position in children with spastic diplegia.

The aim of this study was to assess the development of postural control in the prone position in children with spastic diplegia and triplegia, and determine the influence of clinical characteristics, visual acuity and cognitive performance on that development. We also analysed the relation between these early motor achievements in the prone position and the subsequent acquisition of motor competence in the sitting position. We followed 24 diplegic and triplegic children from before age 2 years (mean age 12 months) to mean age 41 months, videorecording motor behaviour every six months and abstracting acquisitions in alignment and balance using a standardised procedure. We confirm a developmental sequence of all the acquired movements in the prone position. 83.3% of the children completed the uprighting sequence in the sagittal plane, acquired good balance, and ability to rotate the head and trunk. 70.8% of the children (all but one of the diplegic children and none among triplegic children) acquired symmetric posture in the frontal plane and 83.3% reduced leg hyperextension. Development was not uniform, and at 12-18 months two groups began to emerge: diplegic children who rapidly achieved all or most of the steps in the sequence and had a favourable prognosis for subsequent motor development; and triplegic children who achieved these steps at a much slower rate or in some cases not at all and had a less favourable prognosis for future development. Diplegic children with normal visual acuity, and general quotient GQ>70 did better than triplegic children with compromised visual acuity and GQ<70. Acquisition of the full uprighting sequence in the prone position before the age of two related to the later acquisition of autonomous sitting.

Cerebral Palsy↗