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PubMed2000

The neural representation of postural control in humans.

Lesion of the "vestibular cortex" in the human posterior insula leads to a tilted perception of visual vertical but not to tilted body posture and loss of lateral balance. However, some stroke patients show the reverse pattern. Although their processing of visual and vestibular inputs for orientation perception of the visual world is undisturbed, they push away actively from the ipsilesional side (the side of lesion location), leading to a contraversive tilt of the body (tilt toward the side opposite to the lesion) and falling to that side. Recently, the origin of contraversive pushing was identified as an altered perception of the body's orientation in relation to gravity. These patients experience their body as oriented "upright" when actually tilted enormously to the ipsilesional side (18 degrees on average). The findings argued for a separate pathway in humans for sensing body orientation in relation to gravity apart from the one projecting to the vestibular cortex. The present study aimed at identifying this brain area. The infarcted brain regions of 23 consecutively admitted patients with severe contraversive pushing were projected onto a template MRI scan, which had been normalized to Talairach space. The overlapping area of these infarctions centered on the posterolateral thalamus. Our finding necessitates reinterpretation of this area as being only a "relay structure" of the vestibular pathway on its way from the brainstem to the vestibular cortex. The ventral posterior and lateral posterior nuclei of the posterolateral thalamus (and probably its cortical projections) rather seem to be fundamentally involved in the neural representation of a second graviceptive system in humans decisive for our control of upright body posture.

Adult↗
PubMed2004

Meta level concept versus classic reflex concept for the control of posture and movement.

Postural reflexes are replaced soon after birth by automatic reactions that allow for volition and cognition. It is still an enigma how this change in postural control is achieved. We suggest that the change involves the formation of a sensory processing level (meta level) that becomes interleaved in between the tight sensor-actuator coupling of the classic reflexes. We assume that the brain applies at this level intersensory interactions to reconstruct the physical stimuli which are causing the physiological stimuli and sensory signals. The thus derived estimates of the physical stimuli are then used as feedback signals in the posture control system. We present this concept on the background of the classic reflex concept and earlier attempts in the literature to overcome it. The earlier attempts were often motivated by the question how the brain prevents voluntary movements from being hampered by reflexive stabilisation of posture (so-called posture-movement problem). We compare our new concept with the classic reflex concept in a theoretical approach, by implementing both concepts into simple postural control models. In simulations of the two models we superimpose external perturbations (the physical stimuli) and a voluntary body lean movement. We show that it is possible to achieve successful stimulus compensation and unperturbed lean movement with both, the model derived from the new concept and the one of the classic reflex concept. With both approaches, the posture-movement problem does not arise. Based on preliminary considerations that include experimental findings from the literature, however, we conclude that the new concept provides more explanatory power than the classic reflex concept.

Animals↗
PubMed1999

Effects of the type of holds and movement amplitude on postural control associated with a climbing task.

The aim of the present work was to characterize the modifications of the postural adjustments during a climbing task as a function of postural and/or movement constraints. The variations of the horizontal and vertical forces and momentum were analyzed for different movement amplitudes and types of holds. The results show that the horizontal momentum is influenced by all experimental conditions before the onset of movement. By contrast, the vertical momentum is only influenced by the amplitude of the movement, after its onset. These results confirm the hypothesis of a dual function of the anticipatory postural adjustments. The horizontal momentum is mainly involved in the control of equilibrium. The vertical momentum contributes to the movement initiation.

Adolescent↗
PubMed1991

Orthostatic postural control in vestibular neuritis: a stabilometric analysis.

Posturographic data for 182 vestibular neuritis patients were recorded on a static posturographic platform (stabilometry) with the patients' eyes both open and closed. Three of the parameters studied are presented here: mean position of the center of pressure, area of the statokinesigram, and Romberg's quotient. Vestibular neuritis modifies the performance of the fine-postural system in unpredictable ways, varying with the subject. It may disturb either the mean position of the center of pressure or the integration of visual input. Sixty of the patients in this study did not use visual input to stabilize their position in relation to their surroundings. The value of stabilometry as a method for observing the integration of visual input in the control of orthostatic posture is discussed.

Adult↗
PubMed2002

Attentional dynamics in postural control during perturbations in young and older adults.

Temporal dynamics of attention during postural perturbations in young and older adults were investigated. Nineteen young and older subjects performed simple reaction time tasks during translational platform perturbations. Auditory or visual stimuli were presented randomly at delays from the onset of the platform perturbation. Reaction time was slowed before and during the platform movement, particularly in older subjects. Reaction times to stimuli presented at a 250-millisecond delay or later were not influenced by perturbation. The reaction times to the auditory stimuli were influenced more by perturbation than were those to visual targets. The postural response was unaltered by the presence of the reaction time task, but it differed between groups. Attention is engaged in response to a perturbation during the preperturbation time and during the initiation of the postural response in young and older adults. Sensory selection occurs in young and older adults, but to a greater degree in older subjects.

Accidental Falls↗
PubMed1990

[Can corrective lenses change the precision of postural control?].

The wearing of corrective lens may disturb the functioning of the fine postural system, at least in some circumstances which have to be specified. The first condition of this deleterious effect could supplying of badly centered lenses. But this clinical hypothesis have to be tested experimentally.

Contact Lenses↗
PubMed2004

Postural control: toe-standing versus heel-toe standing.

Toe-standing is observed in a number of populations who are able to stand without loss of balance and also those who have balance problems. Intuitively, individuals who stand on their toes are able to successfully regulate their whole body movement in order to keep themselves stable. Force platform data were collected for ten able-bodied subjects during three quiet standing postures, (a) heel-toe standing; (b) half-toe standing and (c) standing en demi pointe (full toe-standing). Differences in control mechanisms with each posture were compared using stabilogram diffusion analysis. During open-loop control (short-term), toe-standing is less stable than heel-toe standing (P<0.05). There is greater stochastic activity when toe-standing (P<0.05), suggesting that any short-term instability is being compensated for by an increase in muscle activity across the lower joints. During closed-loop control (long-term), there is no difference in mediolateral (ML) stochastic activity (increased activity has been linked to falls) between toe-standing and heel-toe standing. In addition, toe-standing is more stable than heel-toe standing (P< s0.05). Toe-standing, in and of itself, may not be responsible for balance problems in populations who compulsorily toe-stand.

Adult↗
PubMed2005

Kinematic characteristics of postural control during reaching in preterm children with cerebral palsy.

The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1) the kinematics of the reaching movement itself and 2) functional performance during daily life activities (PEDI) were assessed in 51 sitting preterm children with cerebral palsy (CP). The children were 2-11 y, 33 had spastic hemiplegia (SH) and 18 bilateral CP (Bi-CP). The data were compared with those of 26 typically developing children (TD). Sitting posture before the onset of reaching of children with CP differed from that of TD children: they sat with a more reclined pelvis and a more collapsed trunk. The more reclined pelvic position was associated with a better quality of reaching movements. The different sitting postures of pelvis and trunk were not related to functional performance during daily life activities. Displacement of the head, trunk, and pelvis of the children with CP did not differ from that of the TD children. Nevertheless, in the children with CP a more stable head, a more mobile trunk, and a more stable pelvis were related to better functional performance and/or a better quality of reaching. This suggests that physiotherapeutic guidance of children with CP should focus rather on the latter postural parameters than on the different sitting posture of pelvis and trunk.

Biomechanical Phenomena↗
PubMed2006

[Performing saccadic eye movements modifies postural control organisation].

AIMS OF THE STUDY: To assess to which extent performing saccadic eye movements modifies the postural strategies aimed at maintaining balance. MATERIALS AND METHODS: Twelve healthy adults were tested on a force platform in several conditions including one in which they were required to stare a visual target and four in which small and larger saccadic eyes movements were performed vertically and horizontally. The displacements of the centre of pressure (CP) were then processed through frequency analysis and modelled as fractional Brownian motion (fBm). Through the latter, one may objectively assess from which distance and after which delay corrective process are initiated. In addition, the degree with which the CP movement is successively controlled is determined. RESULTS: A decrease of the magnitudes of the CP trajectories is observed during saccades, especially along the anteroposterior axis. The fBm modelling emphasises the setting of a particular postural strategy whose main effect consists in more delayed corrective processes associated with a better capacity to control the corrective CP displacements. CONCLUSION: This particular strategy could be linked to the difficulty for the subjects to detect pertinent visual information in this very axis and/or an increased cognitive constraint due to the saccades. On the whole, these data underline the necessity, when performing postural protocols, to ask the patients to stare a visual target in order to limit their eye movements.

Adult↗
PubMed1997

Aging and the mechanisms underlying head and postural control during voluntary motion.

The quality of sensory information that is necessary for balance and postural stability will depend to a great extent on head stability as the body moves. How older persons coordinate head and body motion for balance during volitional activities is not known. The purposes of this article are to present a basis for understanding the influence of aging on head control during voluntary motion and to discuss some data that demonstrate how elderly people might control head movement to improve gaze and the quality of vestibular inputs. A "top-down" or "head-first" control scheme is proposed as the mechanism that elderly people without disabilities use to maintain head position during self-initiated motion. This type of control ensures that the angular position of the head in space remains relatively constant--through the use of a head-stabilization-in-space (HSS) strategy--regardless of the magnitude or direction of displacements in the body's center of force. The HSS strategy is thought to reduce potential ambiguities in the interpretation of sensory inputs for balance and is derived primarily from a geocentric (orientation to the vertical) frame of reference. Egocentric (orientation of the head with respect to the body) or exocentric (orientation to objects in the environment) frames of reference, however, refine the control of head stabilization. Preliminary research suggests that elderly people use the HSS strategy to control head pitch during difficult balance tasks. These findings, if supported by more definitive studies, may be useful in the treatment of patients with balance disorders. The treatment of patients with balance dysfunction is discussed within the conceptual framework of a "head-first" organization scheme.

Adult↗
PubMed1968

Behavioral engineering: postural control by a portable operant apparatus.

Recent studies suggested a general behavioral engineering approach to behavioral disorders by portable operant treatment instruments. The approach was applied to the problem of poor posture, specifically rounding of the back or slouching. An apparatus was developed that provided a warning stimulus followed by an aversive tone for the duration of slouching. Slouching was thereby punished by onset of the tone, and non-slouching was reinforced by tone termination and postponement. Twenty-five adults wore the apparatus during their normal working day during alternate periods in which the aversive tone was connected and disconnected experimentally. A miniature time-meter recorded the duration of slouching. The results showed that slouching decreased for each subject during each period in which slouching produced the aversive tone. For two subjects, a second control procedure was applied in which slouching terminated the tone. The result was an increase of slouching, demonstrating that the postural changes were controlled by the scheduled relation between the aversive tone and the response, and not by other factors such as simple response feedback. The substantial changes in posture indicate that the present procedure may prove to be an effective treatment alternative and suggests the general value of the behavioral engineering approach.

Journal Article↗
PubMed1999

Effect of pallidotomy on postural control and motor function in Parkinson disease.

OBJECTIVE: To investigate the effects of pallidotomy on postural reactions and other motor parkinsonian deficits. DESIGN: Comparison of performance by patients before and after pallidotomy on tests of balance and function. SETTING: A Parkinson disease Center of Excellence and Center for Human Performance Testing at a university hospital and research center. PARTICIPANTS: Twenty-nine patients with Parkinson disease undergoing pallidotomy. MAIN OUTCOME MEASURES: Performance results on the United Parkinson's Disease Rating Scale (UPDRS), activities of daily living and motor subscales (parts II and III). and posturography (sensory organization test), which were collected before and 3 and 6 months after surgery with patients in the practically defined off state (medication withheld for at least 12 hours). RESULTS: Data were analyzed with a paired Wilcoxon and Spearman correlation. There was a significant improvement in mean +/- SD UPDRS motor subscale score after pallidotomy (before surgery, 52.43+/-13.46; after surgery, 43.93+/-15.15; z= 3.63; P=.003). There were no significant changes in the UPDRS activities of daily living subscale or average stability scores when the group was examined as a whole. However, examination of individual data revealed that 9 (56%) of 16 patients who could stand independently before surgery showed improvement in either the number of falls or the average stability score. No patient who was unable to stand independently before surgery was able to stand independently after it. CONCLUSION: Pallidotomy helped improve overall motor function in patients with parkinsonism and, for some patients, also improved postural stability.

Aged↗
PubMed1994

Postural control in sitting the SAM system: evaluation of use over three years.

The most appropriate posture in which to support the person with severe disability and diverse symptoms as a result of complex pathology remains more a matter of opinion than the result of research. This work reviews some of the studies which have attempted to identify definitive criteria for seating in such cases. Factors relating to measurement and conditions which threaten to invalidate the results of research in this field are highlighted. A description of the Seating and Mobility (SAM) system is given, together with a report of the monitoring of nine children with cerebral palsy using the system for a period of three years. The difficulties inherent in this work are noted and questions for future considerations are raised.

Activities of Daily Living↗
PubMed1978

Galvanic disruption of vestibulospinal postural control by cochlear implant devices.

All subjects with implanted cochlear stimulators demonstrated evidence of abnormal postural stability without their stimulators activated. Instability increased when they were tested with cochlear stimulation units turned on, and additional instability was demonstrated in four of these subjects when tested in noise. These findings suggest that the electrical stimulation delivered by the cochlear prosthesis is not limited to the auditory system. The precise characteristics of electrical stimulation devices designed for stimulations limited to the cochlea and their spurious effects upon motor performance should be investigated. The design of future intralabyrinthine auditory electrical prostheses must include hardware designs and stimulus paradigms that avoid undesirable vestibular system stimulation.

Adult↗
PubMed2003

Postural control in the rabbit maintaining balance on the tilting platform.

A deviation from the dorsal-side-up body posture in quadrupeds activates the mechanisms for postural corrections. Operation of these mechanisms was studied in the rabbit maintaining balance on a platform periodically tilted in the frontal plane. First, we characterized the kinematics and electromyographic (EMG) patterns of postural responses to tilts. It was found that a reaction to tilt includes an extension of the limbs on the side moving down and flexion on the opposite side. These limb movements are primarily due to a modulation of the activity of extensor muscles. Second, it was found that rabbits can effectively maintain the dorsal-side-up body posture when complex postural stimuli are applied, i.e., asynchronous tilts of the platforms supporting the anterior and posterior parts of the body. These data suggest that the nervous mechanisms controlling positions of these parts of the body can operate independently of each other. Third, we found that normally the somatosensory input plays a predominant role for the generation of postural responses. However, when the postural response appears insufficient to maintain balance, the vestibular input contributes considerably to activation of postural mechanisms. We also found that an asymmetry in the tonic vestibular input, caused by galvanic stimulation of the labyrinths, can affect the stabilized body orientation while the magnitude of postural responses to tilts remains unchanged. Fourth, we found that the mechanisms for postural corrections respond only to tilts that exceed a certain (threshold) value.

Animals↗