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[Changes in postural control mechanism after a long-time tilt].

In order to investigate the time-dependent dynamics of otolith organ-spinomotor function, we analyzed postural control biomechanically, in eight healthy adult volunteers, using a dynamic posturography (EquiTest System), before and after a four-hours lateral head and body tilt (90 degrees). After the tilt, a half of the subjects exhibited some changes. Their equilibrium scores decreased; i.e., the dependence on their vestibular inputs decreased, but in contrast, those on the visual and the somatosensory inputs increased. These changes were diminished by repeating the tests along the time course. The present findings confirmed [correction of comfirmed] the importance of vestibular gravity information for the maintenance of delicate postural stability.

Adult↗

Sway patterns in orthostatic tremor: impairment of postural control mechanisms.

Sway parameters in orthostatic tremor (OT) patients were compared with age-matched controls. The effects of vision (eyes open or closed), stance width (feet apart or together), and external support (with or without) on sway and 14-18 Hz energy were measured. Sway in OT patients decreased in the presence of each of the stabilizing factors but the extent of benefit obtained by OT patients was significantly less than controls for support for the sagittal plane (22% vs. 42% decrease; P < 0.01) and feet apart in the mediolateral plane (38% vs. 65% decrease; P < 0.01). Three patients with proprioceptive loss also had a reduced response to these factors. Energy in the 14-18 Hz range did not always change in parallel with sway levels. Vision suppresses activity at the OT frequency in patients. Postural control mechanisms in OT remain responsive to postural conditions, but patients differ significantly from normals in the degree of their responsiveness. OT appears to have disruption of the normal generation or processing of proprioceptive signals as one of its important components.

Aged↗

The role of central and peripheral vision in postural control during walking.

Three hypotheses have been proposed for the roles of central and peripheral vision in the perception and control of self-motion: (1) peripheral dominance, (2) retinal invariance, and (3) differential sensitivity to radial flow. We investigated postural responses to optic flow patterns presented at different retinal eccentricities during walking in two experiments. Oscillating displays of radial flow (0 degree driver direction), lamellar flow (90 degrees), and intermediate flow (30 degrees, 45 degrees) patterns were presented at retinal eccentricities of 0 degree, 30 degrees, 45 degrees, 60 degrees, or 90 degrees to participants walking on a treadmill, while compensatory body sway was measured. In general, postural responses were directionally specific, of comparable amplitude, and strongly coupled to the display for all flow patterns at all retinal eccentricities. One intermediate flow pattern (45 degrees) yielded a bias in sway direction that was consistent with triangulation errors in locating the focus of expansion from visible flow vectors. The results demonstrate functionally specific postural responses of both central and peripheral vision, contrary to the peripheral dominance and differential sensitivity hypotheses, but consistent with retinal invariance. This finding emphasizes the importance of optic flow structure for postural control regardless of the retinal locus of stimulation.

Adult↗

Influence of imaginary target on "dumping" of vestibulo-ocular reflexes and postural control.

Two studies explored 1) the effect of instruction set upon the well known "dumping" of the vestibulo-ocular (VOR) post-rotatory nystagmus long time constant (TC) and 2) the effect of imaginary earth-fixed targets on postural control. Imaginary targets do not produce dumping and do not improve postural stability, with or without pitch head movements.

NASA Discipline Neuroscience↗

Postural control during stance in paraplegia: effects of medially linked versus unlinked knee-ankle-foot orthoses.

OBJECTIVE: To investigate the effect of medially linking knee-ankle-foot orthoses (KAFOs) on postural stability and sway during (1) quiet standing and (2) functional activities for persons with spinal cord injury (SCI). DESIGN: A randomized, mixed design, with the factors being activity (quiet standing and two function-mimicking tasks), SCI (present or not), and type of orthosis used in SCI group (linked or unlinked KAFO). PARTICIPANTS: Nine men with T5 to T12 paraplegia, 8 of whom had complete lesions and 1 with some sacral sparing (American Spinal Injury Association grade B) without proprioception, matched to 9 able-bodied men. MAIN OUTCOME MEASURES: Mean amplitude of sway and sway path in anteroposterior and mediolateral directions, derived from center of pressure measurements on a force platform. RESULTS: All men with SCI were able to stand unsupported and perform function-mimicking activities in medially linked KAFOs; however, when wearing unlinked KAFOs only 5 could maintain balance during quiet stance and 3 could maintain balance during activity. Significant differences were found between linked and unlinked KAFOs; side-to-side mean amplitude of sway was less and sway path was greater for SCI subjects when they wore the linked KAFOs. CONCLUSION: Medial linkage of bilateral KAFOs provides an effective strategy to improve stability and increase postural control for persons with SCI, facilitating performance of functional activities during standing without upper limb support.

Activities of Daily Living↗

Postural control in nurses with and without low back pain.

BACKGROUND: Low back pain (LBP) is common in nurses, but it is unclear if the pain is associated with measurements of postural control. Objective measurements of function might be useful in the evaluation of patients with LBP in order to evaluate and predict disability, and in the study of the pathophysiology of chronic LBP. METHODS: In a cross-sectional study, we measured the number of postural adjustments, and degree of posterior-lateral sway in 81 nurses, using a computerized postural sway four-platter measurement system. RESULTS: There were 41 (56.6%) nurses who complained of LBP at the time of testing, and another 12 (14.8%) with a past history of LBP. Nurses with LBP consistently used more postural adjustments to keep their balance (p<0.003), and in some positions postural adjustments were positively associated with the degree of past and present pain. LBP was not significantly associated with the degree of lateral sway. CONCLUSIONS: Nurses either with present or a past history of LBP use an increased number of postural adjustments to maintain balance. Studies are warranted to determine if postural testing can predict the development of LBP or aid in determining appropriate preventive measures.

Adult↗

Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls.

OBJECTIVES: To investigate the influence of dual tasks, cognitive strategies, and fear of falling on postural control in geriatric patients with or without cognitive impairment and with a history of falls resulting in injury. DESIGN: Experimental three-group design. SETTING: Geriatric hospital. PARTICIPANTS: Twenty young healthy adults (mean age+/-standard deviation=25.4+/-4.4), 20 geriatric patients with a history of severe falls without cognitive impairment (mean age=82.6+/-5.5, mean Mini-Mental State Examination (MMSE) score=27.8+/-2.0) and 20 geriatric patients with a history of severe falls and cognitive impairment (mean age=83.2+/-5.5, mean MMSE=19.2+/-3.3). MEASUREMENTS: Motor performance: sway area and lateral and anterior-posterior sway angles. Cognition: semiautomated calculation steps (serial 2 forward) and nonautomated calculation derived from MMSE (serial 7 retro). Motor and cognitive performances were examined as single and dual tasks. Strategy decision, fear of falling, and subjective perception of motor and cognitive performance were assessed as covariates for dual-task performances. RESULTS: Motor performance decreased significantly during all dual tasks in geriatric patients with cognitive impairment and a history of falls resulting in injury. Cognitive performance was different depending on the task and group. Choice of cognitive strategies or fear of falling did not influence the dual-task performances. CONCLUSION: Even simple additional tasks substantially decrease postural stability due to attention-related cognitive deficits in cognitively impaired geriatric patients with a history of severe falls. The findings may help to explain the increased incidence and severity of falls in geriatric patients with cognitive impairment and a history of falls resulting in injury.

Accidental Falls↗

Effect of age at thyroid stimulating hormone normalization on postural control in children with congenital hypothyroidism.

Neonatal screening programmes allow early treatment to limit the consequences of congenital hypothyroidism on maturation of the central nervous system, and on psychomotor and educational outcome. Consequences of age at thyroid stimulating hormone (TSH) normalization on postural control were evaluated in 17 children with congenital hypothyroidism (14 females, three males; median age 12 years 1 month, range 7 to 14 years) and in 11 control individuals (eight females, three males: median age 10 years 6 months, range 8 to 14 years). Children with congenital hypothyroidism were split into two groups according to time of TSH normalization: before (group 1) or after (group 2) 3 months of age. Posturography (static and dynamic tests), educational (school performance), and psychomotor (WISC and revised Bruininks Oseretsky tests) evaluations were carried out. Group 2 results showed significant abnormalities in postural, educational, and psychomotor aptitudes in comparison with group 1 and control children (stability, Bruininks-Oseretsky, school performance: p < or = 0.05 or p < or = 0.01). Early TSH normalization is necessary to allow for normal development of the neurosensorial afferent pathways (vestibular, proprioceptive) and of central integration (cerebellum, vestibular nuclei).

Adolescent↗

Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities.

The primary purposes of this article are to review the literature on seating assessment and to describe the development of a clinical evaluation scale, the Seated Postural Control Measure (SPCM), for use with children requiring adaptive seating systems. The SPCM is an observational scale of 22 seated postural alignment items and 12 functional movement items, each scored on a four-point, criterion-referenced scale. A secondary purpose of this article is to report the reliability of the seven-point Level of Sitting Scale (LSS). Interrater and test-retest reliability of the SPCM items and the one-item LSS were evaluated on a sample of 40 children with developmental disabilities who sat with and without their seating systems. Kappa values of .75 or higher were considered excellent, .40 to .74 as fair to good, and less than .40 as poor. The interrater reliability tests for the two seated conditions and the two test sessions conducted 3 weeks apart yielded overall item Kappa coefficient means of .45 for the alignment section and .85 for the function section. Test-retest results for the SPCM items were less satisfactory, with item Kappa coefficient means for the two seating conditions and raters of .35 and .29 for alignment and function, respectively. Reliability results did not appear to be consistently better among seating conditions, raters, or test sessions. Kappa coefficients for the LSS were fair to good for both interrater and test-retest reliability. Plans for future development of the SPCM and LSS are discussed.

Adolescent↗

Do ankle foot orthoses modify postural control during bipedal quiet standing following a localized fatigue of the ankle muscles?

The purpose of the present experiment was to investigate the effects of wearing ankle foot orthoses (AFO) on postural control during bipedal quiet standing following a localized fatigue of the ankle muscles. To this aim, eight young healthy subjects were asked to stand upright as immobile as possible with and without AFO in two conditions of non-fatigue and fatigue of the ankle muscles. The center of foot pressure displacements (CoP) were recorded using a force platform. Larger CoP displacements in the fatigue than non-fatigue condition were observed without AFO along both the medio-lateral and antero-posterior axes. Interestingly, with AFO, these destabilizing effects were not observed along the medio-lateral axis. Altogether, the present findings suggested that the AFO allowed the subjects to limit the postural perturbation induced by a localized fatigue of the ankle muscles during bipedal quiet standing.

Adult↗

On the functional aspects of variability in postural control.

Current research in nonlinear dynamics and chaos theory has challenged traditional perspectives that associate high variability with performance decrement and pathology. It is argued that variability can play a functional role in postural control and that reduction of variability is associated with changes in balance with aging and neurological disease.

Aging↗

Developing an "anchor" system to enhance postural control.

This article uses an anchor metaphor to explain the dynamic interplay between the human body's active uses of nonrigid tools to mediate information about its adjacent environment to enhance postural control. The author used an "anchor" system (ropes attached to varying weights resting on the floor) to test blindfolded adults who performed a restricted-balance task (30 s one-foot standing). Participants were tested while holding the anchors under a variety of weight conditions (125 g, 250 g, 500 g, and 1 kg) and again during a baseline condition (no anchors). When compared with the baseline condition, there was a significant reduction in the amount of body sway across the anchor conditions. The author found that mechanical support provided by the anchor system was secondary to its haptic exploratory function and that an individual can use the anchoring strategy with a dual purpose: for resting and for reorientation after intrinsic disruptions.

Adolescent↗

Consequences and assessment of human vestibular failure: implications for postural control.

Labyrinthine afferents respond to both angular velocity (semicircular canals) and linear acceleration (otoliths), including gravity. Given their response to gravity, the otoliths are likely to have an important role in the postural functions of the vestibular apparatus. Unilateral vestibular ablation has dramatic effects on posture in many animals, but less so in primates. Nevertheless, bilateral vestibular lesions lead to disabling symptoms in man related to disturbed ocular and postural control and impaired perception of slopes and accelerations. While seimicircular canal function can be assessed through its effects on vestibular ocular reflexes, assessment of otolith function in man has traditionally been much more difficult. Recent definition of a short latency vestibulocollic reflex, activated by sound and appearing to arise from the saccule, shows promise as a new method of non-invasive assessment of otolith function.

Animals↗

[Analysis of human posture control under weightlessness].

Dynamic equations of human trunk and limbs in weightlessness were established, and the motions in 6 dimensions were resolved into 3 motions in 3 dimensions. The feasibility and operability of human posture control in weightlessness by using simple actions were described directly with analysis, calculation and dynamic simulation, and the training methods on the Earth were proposed.

Aerospace Medicine↗

Modeling postural control in the lamprey.

A phenomenological model of the mechanism of stabilization of the body orientation during locomotion (dorsal side up) in the lamprey is presented. The mathematical modeling is based on experimental results obtained during investigations of postural control in lampreys using a combined in vivo and robotics approach. The dynamics of the model agree qualitatively with the experimental data. It is shown by computer simulations that postural correction commands from reticulospinal neurons provide information sufficient to stabilize body orientation in the lamprey. The model is based on differences between the effects exerted by the vestibular apparatus on the left and the right side.

Animals↗

[Alterations in postural control: the use of spectral analysis in stability measurement].

UNLABELLED: Static posturography studies the frequency at which the center of gravity in the human body oscillates. There is no universal agreement as to the importance of this index or whether it is specific in identifying alterations in the postural control systems (vestibular, proprioceptive and visual). Nevertheless, some hypotheses appear generally accepted: a) visual information dominates; b) proprioception affects anterior-posterior oscillation; c) relatively low frequency body oscillation is affected by vestibular input while higher frequency oscillations are controlled by proprioceptive information. In order to check these hypotheses, four groups of patients underwent spectral analysis of bodily oscillations recorded with static posturography. The four groups of patients were similar in terms of age and broken down as follows: Group A-peripheral diabetic neuropathy (10 cases); Group B-diabetic neuropathy-free patients (10 cases); Group C-pure peripheral vestibulopathy (10 cases); Group D-normal subjects (20 cases). Analysis was performed dividing the frequency spectrum (FFT) into three groups: gr. I) 0.01-0.7 Hz; gr. II) 0.7-1 Hz; gr. III) > 1 Hz. Analysis of the spectra for Group A showed a significant increase in high frequency bodily oscillation (gr. III) with the eyes open in the anterior-posterior direction (M = 8.6 +/- 5.5; p < 0.05) and in the lateral direction (M = 4.0 +/- 2.0; p < 0.05); an increase was also found in both directions with the eyes closed (M = OCX II: 7.4 +/- 1.5; p < 0.05) (M = OCX III: 5.6 +/- 1.6; p < 0.01) (M = OCY II: 16.8 +/- 5.0; p < 0.05) (M = OCY II: 9.2 +/- 4.4; p < 0.05). In Group B the increase was limited to high frequency anterior-posterior oscillations (gr. III) at open eyes (M = 3.6 +/- 1.6; p < 0.05) and at closed eyes (M = 4.4 +/- 1.5; p < 0.05). In Group C there was an increase in high frequency lateral oscillations (gr. III) at open eyes (M = 4.2 +/- 0.5; p < 0.01) and panfrequency oscillations at closed eyes (M = OCX I: 47.7 +/- 5.6; p < 0.01) (M = OCX II: 23.2 +/- 4.9; p < 0.01) (M = OCX III: 7.2 +/- 2.3; p < 0.05). CONCLUSIONS: The diabetic proprioceptive deficit appears to lead to multiplanar destabilization at the medium-to-high frequency range. The labyrinthine deficit, on the other hand, appears to cause lateral destabilization at all frequencies. The method of analysis used appears to provide useful parameters with which to evaluate static posture since they can specifically identify alterations in orthostatic bodily control of various origins.

Adult↗

Visual pathways for postural control and negative phototaxis in lamprey.

The functional roles of the major visuo-motor pathways were studied in lamprey. Responses to eye illumination were video-recorded in intact and chronically lesioned animals. Postural deficits during spontaneous swimming were analyzed to elucidate the roles of the lesioned structures for steering and postural control. Eye illumination in intact lampreys evoked the dorsal light response, that is, a roll tilt toward the light, and negative phototaxis, that is a lateral turn away from light, and locomotion. Complete tectum-ablation enhanced both responses. During swimming, a tendency for roll tilts and episodes of vertical upward swimming were seen. The neuronal circuitries for dorsal light response and negative phototaxis are thus essentially extratectal. Responses to eye illumination were abolished by contralateral pretectum-ablation but normal after the corresponding lesion on the ipsilateral side. Contralateral pretectum thus plays an important role for dorsal light response and negative phototaxis. To determine the roles of pretectal efferent pathways for the responses, animals with a midmesencephalic hemisection were tested. Noncrossed pretecto-reticular fibers from the ipsilateral pretectum and crossed fibers from the contralateral side were transected. Eye illumination on the lesioned side evoked negative phototaxis but no dorsal light response. Eye illumination on the intact side evoked an enhanced dorsal light response, whereas negative phototaxis was replaced with straight locomotion or positive phototaxis. The crossed pretecto-reticular projection is thus most important for the dorsal light response, whereas the noncrossed projection presumably plays the major role for negative phototaxis. Transection of the ventral rhombencephalic commissure enhanced dorsal light response; negative phototaxis was retained with smaller turning angles than normal. Spontaneous locomotion showed episodes of backward swimming and deficient roll control (tilting tendency). Transections of different spinal pathways were performed immediately caudal to the brain stem. All spinal lesions left dorsal light response in attached state unaffected; this response presumably is mediated by the brain stem. Spinal hemisection impaired all ipsiversive yaw turns; the animals spontaneously rolled to the intact side. Bilateral transection of the lateral columns impaired all yaw turns, whereas roll control and dorsal light response were normal. After transection of the medial spinal cord, yaw turns still could be performed whereas dorsal light response was suppressed or abolished, and a roll tilting tendency during spontaneous locomotion was seen. We conclude that the contralateral optic nerve projection to the pretectal region is necessary and sufficient for negative phototaxis and dorsal light response. The crossed descending pretectal projection is most important for dorsal light response, whereas the noncrossed one is most important for negative phototaxis. In the most rostral spinal cord, fibers for lateral yaw turns travel mainly in the lateral columns, whereas fibers for roll turns travel mainly in the medial spinal cord.

Animals↗

Short-term effects of electrical stimulation superimposed on muscular voluntary contraction in postural control in elderly women.

Thirty-two women between 62 and 75 years old were randomized into 3 groups. Each group performed a program of 4 sessions a week over 6 weeks. Group SC (n = 11) climbed up and down stairs, group ES (n = 11) practiced electrostimulation, and group SC + ES (n = 10) superimposed the 2 activities simultaneously. Using a force platform and a seesaw platform, static and dynamic balance in eyes-open and eyes-closed conditions were analyzed before and after the programs for each group. After the programs, the results indicated that dynamic balance improved for the 3 groups, but the contribution of visual information in the control of oscillation amplitude was lower in the SC group than in the ES and SC + ES groups. In the SC + ES group, the electrical stimulation interferes with neurophysiologic afference integration in postural control in relation to voluntary movement. Voluntary exercise appears to be more efficient than electrical stimulation and the superimposed techniques to change balancing tactics in the elderly.

Adaptation, Physiological↗