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PubMed2002

Positioning versus postural drainage.

For the past 70 years positioning and postural drainage have played an important role in increasing lung volumes, perfusion, oxygenation and mobilization of secretions. While gravity is not a primary mechanism for normal secretion clearance, it plays a major role in depth and pattern of ventilation, perfusion, and lymphatic drainage. Changing patient position, or turning patients on a regular basis, is a powerful tool in maintaining lung health in a broad range of patients. In contrast, postural drainage requires considerable investment of time, and has been shown to have limited benefit in most patients. Postural drainage has been shown to improve mobilization of secretions in patients with cystic fibrosis as well as patients who produce, and have difficulty clearing, large quantities of sputum. The benefits of postural drainage appear technique-dependent, requiring sufficient drainage time (3 - 15 min) for each position drained. The evidence does not support the use of vibration and percussion independent of active postural drainage. Exercise offers benefit in secretion clearance, which increases when combined with a program of postural drainage. In conclusion, routine turning, mobilization and exercise is important to maintain lung health in all patients, while postural drainage, properly applied, has been shown to improve secretion clearance in a relatively narrow range of patients with cystic fibrosis and excessive sputum production.

Contraindications↗

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↗

PubMed2000

Hands/knees posture in late pregnancy or labour for fetal malposition (lateral or posterior).

BACKGROUND: Lateral and posterior position of the fetal presenting parts may be associated with more painful, prolonged or obstructed labour and difficult delivery. It is possible that maternal posture may influence fetal position. OBJECTIVES: The objective of this review is to assess the effects of adopting a hands and knees maternal posture in late pregnancy when the presenting part of the fetus is in a lateral or posterior position. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: February 1999. SELECTION CRITERIA: Randomised trials of hands and knees maternal posture compared to other postures. DATA COLLECTION AND ANALYSIS: Both reviewers assessed trial eligibility and quality. MAIN RESULTS: One trial involving 100 women was included. Four different postures (four groups of 20 women) were combined for the comparison with the control group of 20 women. Lateral or posterior position of the presenting part of the fetus was less likely to persist following 10 minutes in the hands and knees position compared to a sitting position (relative risk 0.25, 95% confidence interval 0.17 to 0.37). REVIEWER'S CONCLUSIONS: Hands and knees maternal posture for lateral or posterior fetal presentation appears to result in short term effects ion fetal position. No other perinatal or maternal outcomes were reported. There is not enough evidence to evaluate the effectiveness of a hands and knees maternal posture when the fetal presenting part is lateral or posterior, on clinically important outcomes.

Female↗

PubMed1986

Neural control of quadrupedal and bipedal stance: implications for the evolution of erect posture.

The transition among hominids from quadrupedalism to bipedalism resulted in modifications in their musculoskeletal morphology. It is unclear, however, whether changes in the circuitry of the CNS were also necessary in order to accommodate the unique balance requirements of two-limb support. This study addresses the issue of modifications in control strategies by investigating the rapid, automatic postural responses of feline and human subjects to sudden disturbances of balance in the anteroposterior (AP) direction while they stand quadrupedally and bipedally on movable platforms. Postural responses are characterized in terms of segmental adjustments, generated AP shear forces, and electromyographic activity. Feline and human subjects correct posture similarly when standing quadrupedally. Furthermore, both species correct stance primarily with their hindlimbs and use their forelimbs as supportive struts. In contrast, both species use completely different correctional strategies when standing bipedally. Morphological restrictions, however, prevent cats from adopting the pillar-like plantigrade posture of human beings. Thus, the correctional strategies of bipedal cats are distinct from those of bipedal human subjects. It is concluded that 1) automatic postural response patterns of quadrupedal Felis and bipedal Homo reflect the different biomechanical characteristics of the initial postures rather than species differences in CNS circuitry controlling stance; 2) hindlimb-dominated posture control is probably a common and relatively ancient pattern; and 3) reorganization of hominid CNS circuitry was probably unnecessary because hindlimb control was already a feature of the system.

Animals↗

PubMed1989

Variations in blood supply allocations for quadrupedal and for bipedal posture and locomotion.

Hemodynamics and orthodynamics were investigated in quadrupeds (dogs) and in bipeds (humans). The subjects were investigated at rest in supine or lateral posture, in quadrupedal and then in bipedal posture, and during locomotion. Quadrupedalism in humans was with subjects on their hands and knees. Bipedalism in dogs was on hindlimbs with the forelimbs held by a technician. Blood flow in the main arteries of the body (aorta, external and internal carotid, subclavian, and femoral) was measured by sonography. Positional variations between the main bones of the body were determined from X-rays. This study investigated the reallocation of blood supply to different regions of the body when it switches from quadrupedal to bipedal posture and locomotion. Compared with resting posture, the principal findings are 1) cardiac output shows a minimal increase for humans in bipedal stance and a noticeable increase for dogs as well as humans in quadrupedal stance; 2) quadrupedal stance in humans and dogs and bipedal stance in dogs require increased blood supply to the muscles of the neck, back, and limbs, while human bipedal stance requires none of these; 3) cerebral blood flow (internal carotid) in humans did not change as a result of bipedal posture or locomotion, but showed a noticeable drop in quadrupedal posture and an even further drop in quadrupedal locomotion. The conclusion is that erect posture and encephalization produced a noticeable readjustment and reallocation of blood flow among the different regions of the body: This consisted in shifting a large volume of blood supply from the musculature to the human brain.

Adolescent↗

PubMed2006

The effect of single oral low-dose losartan on posture-related sodium handling in post-TIPS ascites-free cirrhosis.

Post-TIPS ascites-free patients with cirrhosis and previous refractory ascites demonstrate subtle sodium retention when challenged with a high sodium load. This is also observed in pre-ascitic patients with cirrhosis. This phenomenon is dependent on an intrarenal angiotensin II (ANG II) mechanism related to the assumption of erect posture. We investigated whether similar mechanisms were involved in post-TIPS ascites-free patients, by studying 10 patients with functioning TIPS and no ascites. We measured the effect of changing from supine to erect posture on sodium excretion at baseline and after single oral low dose losartan (7.5 mg) which has been shown to blunt proximal and distal tubular sodium reabsorption in pre-ascites. At baseline, the assumption of erect posture produced a reduction in sodium excretion (from 0.30+/-0.06 to 0.13+/-0.02 mmol/min, P=.05), which was mainly due to an increase in proximal tubular reabsorption of sodium (PTRNa) (69.7+/-3.1% to 81.1+/-1.8%, P=.003). The administration of losartan resulted in a blunting of PTRNa (supine 69.7+/-3.1% to 63.9+/-3.9%, P=.01 and erect 81.1+/-1.8% to 73.8+/-2.4%, P=.01), accompanied by an increased distal tubular reabsorption of sodium in both postures, with no overall improvement in sodium excretion on standing. In conclusion, post-TIPS ascites-free patients with cirrhosis exhibit erect posture-induced sodium retention. We speculate that (1) this effect is partly mediated by the effect of ANG II on PTRNa and (2) that the inability of low dose losartan to block the erect posture-induced sodium retention may be related to the erect posture-induced rise in aldosterone which is unmodified by losartan.

Administration, Oral↗

PubMed2005

Quantifying the effect of posture on intracranial physiology in humans by MRI flow studies.

PURPOSE: To quantify the effect of posture on intracranial physiology in humans by MRI, and demonstrate the relationship between intracranial compliance (ICC) and pressure (ICP), and the pulsatility of blood and CSF flows. MATERIALS AND METHODS: Ten healthy volunteers (29+/-7 years old) were scanned in the supine and sitting positions using a vertical gap MRI scanner. Pulsatile blood and CSF flows into and out from the brain were visualized and quantified using time-of-flight (TOF) and cine phase-contrast techniques, respectively. The total cerebral blood flow (tCBF), venous outflow, ICC, and ICP for the two postures were then calculated from the arterial, venous, and CSF volumetric flow rate waveforms using a previously described method. RESULTS: In the upright posture, venous outflow is considerably less pulsatile (57%) and occurs predominantly through the vertebral plexus, while in the supine posture venous outflow occurs predominantly through the internal jugular veins. A slightly lower tCBF (12%), a considerably smaller CSF volume oscillating between the cranium and the spinal canal (48%), and a much larger ICC (2.8-fold) with a corresponding decrease in the MRI-derived ICP values were measured in the sitting position. CONCLUSION: The effect of posture on intracranial physiology can be quantified by MRI because posture-related changes in ICC and ICP strongly affect the dynamics of cerebral blood and CSF flows. This study provides important insight into the coupling that exists between arterial, venous, and CSF flow dynamics, and how it is affected by posture.

Adaptation, Physiological↗

PubMed1995

Ergonomic analysis of working posture in nursing personnel: example of modified Ovako Working Analysis System application.

A postural analysis system was developed using a biomechanical approach to identify low back pain related working postures of nursing personnel. The Ovako Working Analysis System (OWAS) was modified for doing postural recording. Chaffin's biomechanical model was used to calculate the associated work stress on the L5/S1. The system was applied to examine the working postures of 64 nurses of 16 departments. The frequency distribution of the trunk showed 15.9% of the 8,629 observed postures were bending more than 15 degrees. Based on the calculated stress, 17.0% of the observed postures generated forces higher than the recommended action limit of the National Institute for Occupational Safety and Health (NIOSH). In addition to patient transfers, potentially health hazardous postures were identified in nursing tasks of inspection, nursing techniques, instrumentation, physical examination, taking inventory, and documentation.

Adult↗

PubMed1984

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↗

PubMed1994

Epigenetic development of postural responses for sitting during infancy.

This study examined whether postural responses emerge in children in a predetermined way before independent sitting is achieved, and in what respect postural responses in infants differ from those in adults. Children just able to sit independently and children not yet able to sit were exposed to surface perturbations (translation and rotation) while body movement and electromyographic (EMG) responses were recorded. Perturbations causing a backward sway of the body (i.e., forward translation and legs-up rotation), elicited consistent patterns of muscle activity in ventral hip, trunk, and neck muscles in the independently sitting children. A high tonic EMG background activity in trunk and neck extensor muscles was inhibited at the onset of the ventral muscle activity. Kinematic analysis revealed that backward rotation of the pelvis was the first detectable body movement, while head movements (linear and angular displacement) were irregular and occurred later than the pelvis movement. Perturbations in the opposite direction, causing a forward sway, evoked variable responses in dorsal trunk and neck muscles, suggesting that the excitability level for postural responses was set according to the stability limits of the body. Children not yet able to sit without support were tested when the support around the waist, given by the experimenter's hands, was released prior to the onset of the platform perturbation. Postural responses were elicited in ventral muscles following a backward sway in all children and in about 60% of all trials. Often, only some of the ventral muscles were activated. No distinct responses were evoked during perturbations imposing a forward sway. These results suggest that (1) backward rotation of the pelvis triggers the postural adjustments in the independently sitting children; (2) a basic form of the postural adjustment develops in a predetermined manner before children practice independent sitting; and (3) the basic structure of ventral muscle activation pattern resembles that of adults, while the activation of the dorsal muscles (inhibition) differs in several aspects. These findings are in agreement with a recent model of central pattern generators for postural responses consisting of two operative levels. At the first level, which is triggered by backward rotation of the pelvis, the basic activation pattern is generated. At the second level, the pattern is shaped and fine-tuned by multisensory interactions from all activated sensory systems.(ABSTRACT TRUNCATED AT 400 WORDS)

Electromyography↗

PubMed1987

Influence of event anticipation on postural actions accompanying voluntary movement.

The central organization of anticipatory postural adjustments was investigated by examining the influence of preparatory set on the temporal relationship between postural and arm (focal) muscle activation. Surface EMG was recorded from the right tibialis anterior, lateral gastrocnemius, anterior deltoid and posterior deltoid muscles when pushing or pulling on a stiff handle. Preparatory set was manipulated by informing the subject of the upcoming direction of responding with a 80, 50 or 20% certainty. This created high, neutral and low levels of preparatory set, respectively. All six subjects showed activation of postural muscles in advance of focal muscles for both push and pull responses. However, only three subjects showed the expected effect of preparatory set on reaction time performance, i.e., an increase of reaction time with decreasing response probability. For these three subjects, the time between the activation of postural and focal muscles was the same for the high and neutral levels of preparatory set, but increased with a low level of preparatory set. The increased postural-focal latency for the low preparatory set condition was due to a longer delay for the activation of the focal muscles but not the postural muscles. This finding suggests that anticipatory postural adjustments and the activation of focal muscles are triggered by separate motor commands.

Adult↗

PubMed1988

Postural adjustments induced by simulated motion of differently structured environments.

We have investigated how visual information of a scene, moving along the line of sight of a subject, affects postural readjustments made by a subject when instructed to maintain an upright posture. Two different types of stimulus patterns were presented each inducing a different optic flow field. In one case an optic flow field was induced by simulating motion of a subject relative to a wall and in the second case by stimulating motion of a subject through a tunnel. In both cases clear effects on postural balance were observed. It suggests that postural responses are invariant for the structure of the moving environment. The amplitude of the postural responses did not depend on the velocity of the simulated motion, and therefore did not depend on the absolute magnitude of the optic flow components. The amount of texture in the moving scene proved to be an important factor. In addition, it was found that the control of postural balance is not exclusively dominated by information provided by the peripheral part of the subject's visual field. Moreover, the results indicate that the divergence component in the optic-flow field alone is not sufficient to control posture in forward/backward direction.

Humans↗

PubMedDate not supplied

Quantitative determination of urinary protein components of children with postural proteinuria.

Twenty-one protein components were measured in urine specimens from 12 subjects with postural proteinuria in the recumbent posture and after a period of upright lordotic posture. The lordotic posture produced an increased urinary excretion of total protein and 19 protein components, particularly of albumin, IgG globulin, and transferrin (128, 68, and 167-fold, respectively). However, 90 min after the lordotic posture, most of the protein components returned to initial values, whereas albumin, IgG globulin, and transferrin remained high. beta 2-Microglobulin, retinol binding protein, and lysozyme showed the smallest increases after the lordotic posture. These findings suggest that proteinuria occurring after the lordotic posture may be characterized by an increased glomerular permeability.

Adolescent↗

PubMed1989

The influence of initial posture on the sit-to-stand movement.

Head movements, ground reaction forces and electromyographic activity of selected muscles were recorded simultaneously from two subjects as they performed the sit-to-stand manouevre under a variety of conditions. The influence of initial leg posture on the magnitude of the various parameters under investigation was examined first. A preferred initial leg posture resulted in smaller magnitudes of head movement and ground reaction forces. EMG activity in some muscles, trapezius and erector spinae, decreased, while in others, quadriceps and hamstrings, it increased in the preferred leg posture. The decreases seen correlate with reductions in head movement observed. The effect of inhibiting habitual postural adjustments of the head and neck, by comparing "free" and "guided" movements was also examined. In guided movements there are significant reductions in head movement, ground reaction forces and EMG activity in trapezius, sternomastoid and erector spinae. It would appear that both initial leg posture and the abolition of habitual postural adjustment have a profound influence on the efficiency of the sit-to-stand manouevre. This preliminary study high-lights the practical importance of head posture in the diagnosis and treatment of movement disorders, as well as in movement education.

Humans↗

PubMed1992

Postural control in children with autism.

Postural control was evaluated in samples of autistic, normal, and mentally retarded children in this pilot study using a recently developed, computerized posturographic procedure. A battery of postural positions was administered including postures involving some degree of "stress" (e.g., occluded vision or standing on pads). The postural patterns of children with autism differed from those observed in normal children, in mentally retarded children, and in adults with vestibular disorders. In comparison to normal children the autistic subjects were less likely to exhibit age-related changes in postural performance and postures were more variable and less stable with more lateral sway. Autistic subjects also exhibited a "paradoxical" response of greater stability with more "stressful" postures, putting excessive weight on one foot, one toe, or one heel. The implications for neuroanatomical models of autism are discussed.

Autistic Disorder↗

PubMed1987

Non-invasive estimation of afferent inputs for postural stability under low levels of alcohol.

The maintenance of human equilibrium is a complex process. Several physiological systems provide afferent information for postural stabilization. This study describes a noninvasive methodology to estimate the relative roles of interacting afferent inputs relevant for postural control. A multiaxis force platform in conjunction with specially designed test procedure provided semi-quantitative insight into the roles of vision, proprioceptors and vestibular apparatus in controlling postural sway when it was perturbed by a central nervous system perturbator such as alcohol. Experiments were conducted on 10 male and 10 female subjects. The males did not show statistically significant increases in body sway at these low levels of alcohol. For the females, the present methodology could detect subtle changes in postural sway at low blood alcohol levels ranging between 0.015% and 0.03%. At these low levels of alcohol, the results from females show that when the vision was excluded and the proprioception was modified, the postural sway was most affected. The postural instability experienced in this condition is probably due to inappropriate responses to proprioceptive inputs and lack of vision. Both male and female subjects showed a strong "eyes by standing surface" interaction. The proprioceptor manipulation alone did not affect the postural stability.

Adult↗

PubMed2001

Coupling of posture and gait: mode locking and parametric excitation.

We investigate the temporal coordination of human gait and posture and infer the nature of their coupling. Participants viewed a sinusoidally oscillating visual display which induced medial-lateral postural sway during treadmill walking, while display frequency was varied (0.075-1.025 Hz). First, postural responses exhibited the usual low-pass characteristic but with an additional resonance peak near the preferred stride frequency, although shifted downward by 0.12 Hz; this provides evidence of a coupling from gait to posture. Second, the step cycle adapted to mode lock with the visual driver and postural sway, as well as displaying instances of intermittency (slipping in and out of phase) and quasiperiodicity (phase wandering); this provides evidence of a coupling from posture to gait. We observed a spectrum of integer mode locks, including a large 1:1 trapping region about the stride frequency and superharmonic entrainment (stride frequency > driver frequency) at lower driver frequencies. A coupled-oscillator model that incorporates a novel parametric coupling from posture to the gait "stiffness" term reproduces these features of the data, including the resonance peak shift. Biological coordination patterns may thus emerge naturally as properties of a system of appropriately coupled oscillators.

Adult↗

PubMed2002

Vestibular stimulation affects medium latency postural muscle responses.

This study explores whether galvanic vestibular stimulation can alter automatic postural muscle responses triggered 100 ms after surface translations. Our previous study concluded that a step of bipolar, galvanic vestibular stimulation delivered 500 ms prior to a platform translation tilted the internal representation of vertical because subjects' final center of foot pressure and center of mass equilibrium position shifted toward the anode and this tilt was larger than the sum of effects for platform translations and galvanic alone. In the current study, we show that 0.2-0.4 mA of galvanic vestibular stimulation produced significant changes in the tilt of the trunk in space that was realized by changes in the magnitude of the medium latency postural muscle responses at the ankle. The galvanic-induced changes in latency and magnitude of the first 50 ms of gastrocnemius muscle burst in response to the backward surface translation were consistent with changes in background muscle tone induced by the direct vestibulospinal effects of the galvanic current. However, the galvanic-induced changes in the second 50 ms of the gastrocnemius response were in the opposite direction and consistent with the forward- or backward-tilted, final postural equilibrium goal. Kinematic analysis showed that galvanic-induced tilt was first initiated in the trunk and that the shank and thigh segment angles were not altered by galvanic stimulation prior to platform translation such that changes in gastrocnemius and soleus postural responses to translations were not due to an effect of galvanic stimulation on initial ankle angle. More proximal muscles and antagonist muscles involved in the postural response were not altered by the galvanic stimulation. These results suggest that galvanic vestibulospinal stimulation can alter medium latency, automatic postural responses in prime movers by changing the postural equilibrium goal.

Adult↗