Workshop III--information processing in the normal and abnormal human postural control systems.
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OBJECTIVE: To investigate whether balance is associated with mental functioning after mild traumatic brain injury (MTBI). DESIGN: Experimental two-group design. SETTING: Outpatient rehabilitation department. PATIENTS AND OTHER PARTICIPANTS: From a consecutive sample of referred MTBI patients, 15 subjects who complained of imbalance were included (8 men and 7 women, age 35.9+/-8.6yrs). Subjects with detectable neurologic impairments were excluded. Twenty healthy control subjects of the same age group also were tested. MAIN OUTCOME MEASURES: In both groups, a force platform recorded center-of-pressure (CP) fluctuations during standing and weight shifting in different conditions. For the patients, attention and mental speed were assessed with the Symbol-Digit Substitution Test of the Wechsler Adult Intelligence Scale (Dutch version), verbal learning and memory were assessed with the 15-Words Test, and emotional distress was assessed with the Symptom Checklist-90. RESULTS: Compared with controls, patients showed an overall increase of 60% in CP velocity and an overall weight-shifting speed 25% slower (p < .005), indicating static and dynamic postural instability. Only performance on the Symbol-Digit Substitution Test was associated with both static and dynamic balance (p < .02), giving an explained variance of over 40%. CONCLUSION: The results indicate a possible association of balance with cognitive performance but not with emotional well-being after MTBI, suggesting an organic rather than a functional cause of postural instability. Further research is needed to assess the possible clinical implications.
OBJECTIVE: To investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patients. DESIGN: A total of 40 chronic stroke patients with hemiplegia and 22 age-matched healthy subjects were included in this study. Data of a motion analysis system and three force platforms were collected in a rehabilitation unit of a medical center. RESULTS: Laboratory sit-to-stand measurement and gait analysis were evaluated in both groups via three AMTI (Advanced Mechanical Technology Inc.) force platforms and a Vicon 370 system (six high-resolution cameras and one AMTI force plate), respectively. The sit-to-stand and gait parameters of hemiplegic patients were correlated significantly, especially in rising speed and the maximal vertical force of both legs during rising. CONCLUSIONS: Hemiplegic stroke patients, who could stand up within 4.5 sec or who had a maximal vertical force difference of less than 30% of body weight between both legs, had better gait performance than the others did.
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People can feel and report the direction of very small movements which cause changes in the tension of the forearm's hairy skin. This subjective sensory function may perhaps reflect more fundamental sensorimotor tasks. The hypothesis was investigated by measuring body sway and movement of six female and male volunteers who were performing the tandem-stance Romberg test with open and closed eyes. The increase in sway and movement after eye closure was reduced significantly when the subjects were allowed to use one forearm to touch a spatially fixed object from below. Three objects were used, a solid Perspex rod, an easily rotating steel ball, and a pointed metal peg whose tip was attached to the skin with a droplet of contact glue. Possible mechanical support could be excluded on basis of the objects' technical properties and the magnitudes of forearm movements. Movement of the forearm relative to an object could provide spatial information about changes of the forearm's position in space. Likewise, changes of skin tension that were caused by such movements could be useful. The Perspex rod and the steel ball might provide both types of information. However, the glued peg only caused changes of skin tension, but reduced sway and movement equally effectively. Therefore, information from tension receptors of the forearm's hairy skin underlying the accurate subjective directional sensibility also appears to participate in basic motor control.