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At least 703 records · Page 39Linked to original sources
PubMed2001

Vertical impact increase in middle age may explain idiopathic weight-bearing joint osteoarthritis.

OBJECTIVE: To test the hypothesis that ground reaction force increases when a standard stepping task is performed in late middle age. DESIGN: Consecutive sample. SETTING: Internal medicine practice. PARTICIPANTS: Thirty-six male patients (age range, 17-72yr) from an internal medicine practice. INTERVENTION: Subjects performed 20 consecutive footfall impacts onto a force platform while barefoot and while wearing shoes. MAIN OUTCOME MEASURES: Ground reaction forces were recorded for each footfall. RESULTS: Impact is positively related to age both when barefoot (r = .84, p < .001) and when wearing shoes (r = .71, p < .001). Impact remains constant until age 50, after which it increases by 13.3% for barefoot subjects. Barefoot impact was significantly lower and less variable than impact when shod (barefoot = 1.18 body weight [BW]; shod = 1.22 BW; F(1,5) = 169.91, p < .001). CONCLUSION: An increase in impact force during locomotion was identified that occurs in late middle age, when stability declines and idiopathic weight-bearing joint osteoarthritis develops. Because impact is negatively related to stability, the impact rise is probably caused by postural adjustments to instability resulting from irreversible neurologic decline. This heightened impact may account for the accelerated rate of weight-bearing joint osteoarthritis that begins in late-middle age.

Adolescent↗
PubMed2001

Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention.

OBJECTIVE: To determine the role of symmetrical body-weight distribution training in preventing falls among patients with hemiplegic stroke. DESIGN: A prospective study using a standing biofeedback trainer. SETTING: Hospital-based rehabilitation units. PATIENTS: Fifty-four patients with hemiplegic stroke (30 in the training group, 24 in the control group). INTERVENTIONS: Conventional stroke rehabilitation program, plus symmetrical standing training and repetitive sit-to-stand training, with a standing biofeedback trainer. Training effect was evaluated by assessing the sit-to-stand performance and comparing the occurrence of falls in the 2 groups at a 6-month follow-up. MAIN OUTCOME MEASURES: Occurrence of falls, sit-to-stand performance, including body-weight distribution, rate of rise in force, and sway in center of pressure (COP). RESULTS: Significant improvement in sit-to-stand performance was found in patients in the training group. Body weight was distributed more symmetrically in both legs, with less mediolateral sway in the COP when rising and sitting down. The mean difference in body-weight distribution between the left and right legs while subjects were rising from a chair significantly decreased, from 49.5% +/- 18.9% to 38.6% +/- 15.8% of body weight (BW) (p < .005). The rate of rise in force while rising from a chair significantly increased, from 28.3% +/- 13.5%BW/s to 53.6% +/- 20.5%BW/s (p < .001). At the 6-month follow-up, 10 of 24 patients (41.7%) in the control group had fallen, compared with only 5 of 30 patients (16.7%) in the training group (p < .05). CONCLUSIONS: Symmetrical body-weight distribution training may improve sit-to-stand performance and, consequently, decrease the number of falls by stroke patients.

Accidental Falls↗
PubMed2002

The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals.

OBJECTIVE: To determine the effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. DESIGN: Weight bearing on the paretic side was measured in patients with hemiparesis during quiet standing and in conditions of compelled weight shift. SETTING: Free-standing acute inpatient rehabilitation hospital. PARTICIPANTS: Nine individuals with hemiparesis as a result of unilateral stroke who were able to stand for 3 to 5 minutes without assistance or rest, and satisfied other inclusion criteria. INTERVENTIONS: Compelled shift of the body weight was induced with different shoe wedges (5 degrees, 7.5 degrees, 12.5 degrees) or shoe lifts (0.6, 0.9, 1.2cm), which extended under the entire shoe of the unaffected limb. Weight-bearing symmetry scores were used to characterize the symmetry of stance. MAIN OUTCOME MEASURES: Weight-bearing symmetry scores. RESULTS: Without a shoe wedge or a shoe lift, weight-bearing symmetry was characterized by underloading of the paretic limb (39.90% +/-.80% of body weight). Weight shift induced by shoe wedges or shoe lifts applied to the unaffected limb promoted improved symmetry of weight bearing and stance. A shoe wedge of 5 degrees provided the most symmetrical weight distribution (51.44% +/- 1.88% of body weight). CONCLUSION: Shoe wedges and shoe lifts under the unaffected limb induced compelled weight shift toward the paretic limb, resulting in improved symmetry of stance of individuals with mild hemiparesis. We suggest that improved symmetry of bipedal standing obtained with a shoe wedge or a shoe lift applied to the unaffected limb can help overcome the learned disuse of the affected limb. We further suggest that weight distribution induced by shoe wedges or shoe lifts may help in the treatment of ambulatory hemiparetic individuals with asymmetrical stance caused by unilateral stroke.

Adult↗
PubMed2002

Understanding the pusher behavior of some stroke patients with spatial deficits: a pilot study.

OBJECTIVE: To investigate whether pusher behavior (ie, a tendency among stroke patients with spatial deficits to actively push away from the nonparalyzed side and to resist any attempt to hold a more upright posture) affects only the trunk, for which gravitational feedback is given by somesthetic information, or the head as well, whose gravitational information is mainly given by the vestibular system (without vision). DESIGN: Description and measurement of clinical features. SETTING: Rehabilitation center research laboratory. PARTICIPANTS: Eight healthy subjects age matched to 14 patients with left hemiplegia resulting from right-hemisphere stroke (3 pushers showing a severe spatial neglect, 11 without pusher behavior). INTERVENTION: All participants were asked to actively maintain an erect posture while sitting for 8 seconds on a rocking, laterally unstable platform. The task was performed with (in light) and without (in darkness) vision. MAIN OUTCOME MEASURES: The number of trials needed to succeed in the task was monitored. In successful trials, head, shoulders, thoracolumbar spine, and pelvis orientation in roll were measured by means of an automated, optical television image processor. RESULTS: Compared with other patients and healthy subjects, the 3 pushers missed many more trials and displayed a contralesional tilt of the pelvis but kept a correct head orientation. This tilt was especially pronounced without vision. Spatial neglect was a key factor, explaining 56% of patients' misorientation behavior with vision and 61% without vision. CONCLUSION: This pilot kinematic analysis shows that pusher behavior does not result from disrupted processing of vestibular information (eg, caused by a lesion involving the vestibular cortex); rather, it results from a high-order disruption in the processing of somesthetic information originating in the left hemibody, which could be graviceptive neglect (extinction). This disruption leads pushers to actively adjust their body posture to a subjective vertical biased to the side opposite the cerebral lesion.

Adult↗
PubMed2003

Clinical tests for the evaluation of postural instability in patients with parkinson's disease.

OBJECTIVE: To determine which test for postural instability in Parkinson's disease (PD) is reliable, valid, and easy to perform in a clinical setting. DESIGN: Cross-sectional reliability and validity study. SETTING: Academic center for movement disorders. PARTICIPANTS: Forty-two patients with PD and 15 controls. Based on the results of a structured interview, the patients were divided in PD-unstable (n=22) and PD-stable (n=20) groups. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Several variants of the retropulsion test with differences in execution and scoring. Responses were scored on 5 different rating scales (ratings of Nutt, Bloem, Pastor; the Unified Parkinson's Disease Rating Scale [UPDRS]; the Short Parkinson Evaluation Scale). These tests were compared with steady-stance positions. RESULTS: The interrater reliability was high for most ratings, with weighted kappa ranging from.63 for the UPDRS to.98 for both the Pastor rating and steady-stance positions. Most ratings distinguished between the groups. However, the Nutt rating had the highest overall predictive accuracy, with a sensitivity of.63 and a specificity of.88. CONCLUSIONS: The most valid test for postural stability in PD was an unexpected shoulder pull, executed once, with taking more than 2 steps backward considered abnormal. This retropulsion test is easy to use in a clinical setting.

Accidental Falls↗
PubMed2001

The Alexander technique: its application in midwifery and the results of preliminary research into Parkinson's.

This article outlines the origins and theory of the Alexander Technique and how it is learnt. Recent research is listed and a description given of main presenting symptoms and medical problems of pupils coming for lessons. The paper also describes how the Alexander Technique is used by women in pregnancy and childbirth and explains why it is beneficial. The final section describes Parkinson's research results, mainly from a preliminary study designed some years ago to test a methodology for a randomized controlled trial.

Adult↗
PubMed2002

Treadmill exercise negatively affects visual contribution to static postural stability.

This study was undertaken to explore the nature of impaired postural stability following physical exercise. Nine healthy subjects (aged 24 +/- 3 years) were subjected to 30 min of treadmill walking or running on two separate occasions. Walking and running speeds (1.9 to 2.2 m/s) were chosen to induce equal energy expenditure. During treadmill exercise, kinematic analysis of head movement was performed. Prior to and immediately following exercise, postural sway was evaluated as mean velocity of centre of pressure (VCOP), measured on a force plate during 30 s quiet stance with eyes open or eyes closed. The results indicate that exercise increased two-dimensional postural sway by 9 - 19 % in eyes open, but not in the eyes closed condition. The deteriorating effect of exercise was both evident in the sagittal and in the frontal plane, although the effect on the former was slightly more transient. Post-exercise sway values were significantly higher after running than after walking. Kinematic analysis of head movement confirmed larger vertical displacement and acceleration pattern in running compared to walking. It is concluded that exercise of moderate intensity deteriorates visual contribution to postural stability. The effect is evident as an initial destabilisation in the sagittal direction and a less transient loss of latero-lateral stability. Running tends to disturb postural stability more than walking, possibly due to more excessive head movement and disturbance of vestibular and visual information centres.

Adult↗
PubMedDate not supplied

[Can an insufficient posture of children and adolescents be verified instrumentally?].

UNLABELLED: 144 children aged 6 to 17 years were examined with the Lasar-Posture device which raises a perpendicular through the centre of gravity. To make an indirect postural examination possible and to classify posture, the courses of the gravity perpendicular, the shoulder centre, the greater trochanter femoris and the lateral ankle and their change during the Matthiass' test were determined. Additionally, spinal alignment, spine flexibility and the sufficiency of posture were assessed. RESULTS: The ability to achieve a sufficient posture correlated with age (p = 0,0004). The spinal alignment itself did not differ in the age groups but the hollow-round back showed a decreased ability to attain a sufficient posture (p < 0.0001). The spine flexibility measured with the Ott's test decreased with age (p = 0.0001). In relation to the gravity perpendicular, the shoulder centre moved forward with increasing postural insufficiency (p = 0.0379). The course of the gravity perpendicular did not differ in the different types of spinal alignment but was always found in front of the lateral ankle. The greater trochanter of the children with a II degrees insufficiency at the beginning (p = 0.03/0.01) and end (p = 0.2/0.05) of the Matthiass' test was always in front of the gravity perpendicular in contrast to the other children. As expected, the shoulder centre was always behind the gravity perpendicular. It was found to be more ventral in healthy children than in those with a postural insufficiency (p = 0.01/0.004/0.005). CONCLUSION: Overall, a high rate of children with postural insufficiency was found. It is impossible to determine or classify them with the Lasar-Posture device. The future aim should be to develop a measuring technique that allows a standardised definition of posture and age related developmental variants.

Adolescent↗
PubMed2005

[Specific effects of boxing on functional parameters of the locomotor system].

PROBLEMS: Boxer that take part on contests regularly are characterized by high strains on the locomotor system. Especially the area of shoulder girdle and neck can be overused by the fighting posture and standard techniques, that are often associated with non-physiological patterns. METHODS: Of 11 young boxers (age 14.6 +/- 0.6 years; 7.3 +/- 0.6 training units per week) and a control group (CG) of 52 male pupils (age 15.4 +/- 0.4 years) the static of head, shoulder girdle, and pelvis was detected by somatoscopy. Additionally, cyclical rotations of the cervical spine were measured using the 3-d-motion recording system CMS70 (Zebris, Germany) and the active range of motion was analysed. RESULTS: In comparison to the CG, head and shoulder of the boxers were ventralised more often (p < 0.01). Furthermore, highly significant group differences in the bilateral position of the shoulder heights and the iliac crests were detected in the frontal plane. On average, the active maximal rotation of the boxers was decreased by 17.8 degrees (p = 0.006; d = 0.800). DISCUSSION: Our study was able to detect significant differences in the analysed functional parameters of the locomotor system that may be explained by boxing specific strains and which are prerequisites of optimal performance. As long-term pathologic effects can not be excluded, adequate compensational exercises should be integrated in the training.

Adaptation, Physiological↗
PubMed1989

[Posturographic biofeedback training in equilibrium disorders].

In addition to the usual physical training for treatment of ataxia, individually adaptable biofeedback training programs by means of a stationary posturographic platform and feedback via the screen of a connected microcomputer were developed, including not only static, but especially dynamic exercises. Through an open randomised study of 72 patients with ataxia of cerebellar, brainstem and vestibular origin the effect of this training was examined by analysing the training courses parameters, which were compared with the courses of 10 normal subjects, and by the patient and the physician rating the unsteadiness of stance and gait under everyday's conditions. In particular, a significant improvement of the common function could be shown at the biofeedback training group in comparison to the group only with physical training. It is therefore concluded, that this--highly accepted--training may be a valuable tool in neurological rehabilitation of atactic patients.

Adolescent↗
PubMed1999

[Bechterew phenomenon in the human].

BACKGROUND: Vestibuloocular and vestibulospinal reactions following the bilateral loss of vestibular function are designated as Bechterew's phenomenon. In vestibular physiology, under experimental conditions, this phenomenon has played an important role for understanding the mechanisms underlying vestibular compensation. However, clinical reports about this phenomenon in humans are extremely rare. PATIENTS AND METHODS: Bechterew's phenomen was observed throughout every stage of its development in a patient with consecutive bilateral loss of vestibular function. The disorder was documented by electronystagmography and posturography. DISCUSSION AND CONCLUSIONS: Bechterew's phenomenon depends on different states of vestibular function developing in a certain succession, whereby the varying relations between failure and compensation are decisive. The phenomen very impressively demonstrates the resilience of the central nervous system in adapting to varying peripheral functional states. From a clinical standpoint, knowledge of these relationships is important for understanding vestibular compensation.

Electronystagmography↗
PubMed1996

[Age dependence of the interaction between proprioception and vision--a posturographic study].

BACKGROUND: The influence of fixation on the vestibulo-ocular reflex and the synergistic stabilising effect of vision on the body equilibrium are well known. In this study interactions between the visual and the proprioceptive systems in patients of different ages are analysed. We tried to find out whether body equilibrium reactions, recorded by posturography, are influenced qualitatively and quantitatively by visual inputs. METHODS AND PATIENTS: 349 neurotologic patients aged between 3 and 80 years were included in this study. We applied different optical patterns by means of a videoscreen to the patients standing on a posturographic platform. The patients were asked to follow the pattern with their centre of the gravity, which was also shown on the video screen. The patterns consisted of a line that had to be followed in the anterior-posterior and in the lateral plane and of a circle which had to be followed clockwise and counterclockwise. RESULTS: We recognised definite age-related changes in all tests used. The precision to follow a visual target with the body equilibrium increased with increasing age to the age of forty. With the beginning fifth decade this postural ability decreases slowly and decreases particularly markedly in patients of over 70 years of age. CONCLUSIONS: Posturography in combination with visual feedback is a valuable technique for testing visual-proprioceptive interactions. It can be employed over a large age bracket.

Adolescent↗
PubMed1995

[Quantitative evaluation of the Romberg test].

Simple and economical measuring platforms are available to aid the ENT clinician in examining vestibulospinal disorders. The aim of our study was to quantitatively interpret Romberg test measurements. Calculating the area between the zero line and the curves in sagittal and lateral direction--for the Romberg test with closed and open eyes--enables a quantification of body sway. For the evaluation of data, we developed a triangular diagram which allows a graphic representation and quantifies vestibulospinal reaction at a glance. We assessed a group of 80 persons without any symptoms of peripheral or central vestibular system disturbance. Selected patients complaining of vestibular disorders are helpful in demonstrating the objective and quantitative interpretation of the Romberg test, which is often analysed in a more subjective way.

Adult↗
PubMedDate not supplied

[Asymmetry of posture and truncal musculature following unilateral arm amputation--a clinical, electromyographic, posture analytical and photogrammetric study].

Unilateral upper limb amputation causes changes in statics of the spine. As a result asymmetrical posture of the spine, muscular asymmetries follow. In this study a population of upper limb amputees (above and below elbow amputees) is examined by clinical, electromyographical analysis and gait analysis. Upper limb amputations cause in correlation to weight loss a shift of the trunk to the side of the amputation, a scoliosis with a bowing to the side of the amputation, an elevation of the shoulder on the amputation side and a torsion of the trunk. Muscular asymmetries result from loss of function (muscles of the arm, M. latissimus, M. trapezius) and by shifting of the center of gravity. In order to get the center of gravity over the legs, the amputee compensates the loss of weight by shifting the upper trunk to the side of the amputation. As a result the shift of the segmental center of gravity at the lumber height to the side of the normal arm with muscular asymmetry in the erector trunci lumbalis results. As well we saw an overactivity of musculus glutaeus medius and resulting stress of the amputation sided hip joint. There was a remarkable difference between above and below elbow amputees caused by differences in weight loss. Muscular and static asymmetries in amputees who lost their arm only a short period before could be reduced by compensating the weight loss. Results for technical orthopaedic fitting and stress on gymnastic procedures to compensate these statistical problems are discussed.

Adult↗
PubMedDate not supplied

[Spatial orientation and postural regulation in patients with idiopathic scoliosis].

QUESTION: Etiology of idiopathic scoliosis is unknown. In literature a primarily neurogenic disturbance of postural regulation is discussed with subsequent changes of the spine. In the present paper, individual functions of postural regulation in patients with idiopathic scoliosis were examined by neurophysiologic investigations and compared to a normal population. METHOD: The body sway of 28 patients was investigated in upright position under various testing conditions by means of a force measuring platform, allowing examination of the efferent part of postural regulation as well as the sensory systems involved. Registration of the eye movements (ENG) made it possible to investigate the function of the vestibulo-cerebellar system. Furthermore the optokinetic capability of scoliotic patients was tested by determination of the subjective visual vertical (SVV). RESULTS: It turned out that none of the neurophysiologic test procedures showed clearly pathological findings in scoliotic patients as compared to a normal population. CONCLUSION: It has not to be considered as probable that idiopathic scoliosis is caused by a disturbance of postural regulation.

Adolescent↗
PubMed1992

Maturation of set-modulation of lower extremity EMG responses to postural perturbations.

To analyse the influence of different "postural sets" on stance stabilizing EMG responses in children, EMG responses to toe-up tilt perturbations were recorded in 70 children between the age of 9 months and 10 years, as well as in a control group of 10 adults under different postural set conditions, using either bilateral destabilization with eyes opened, eyes closed, or introducing additional minute upper extremity support. Recordings were also made with the children seated in front of the platform with the ankle joint angle being identical to that in the standing condition. Also recordings were made after unilateral destabilization in bilateral lower leg muscles, to determine if there is a generalization of EMG response patterns to the mechanically not disturbed side. Across all age-groups the principal modulation of EMG response changes according to postural conditions was identical. Long latency (LL) EMG responses were down-regulated when additional upper extremity support was provided. LL-responses were abolished in the sitting condition. With unilateral destabilizations throughout all age-groups short latency responses were restricted to the perturbed side, whereas long latency responses could be obtained symmetrically. The proximal to distal gradient of recruitment of muscle groups, remained identical across all age-groups. The data indicate that the basic organizational principle of stance stabilizing EMG responses and their modification by postural sets remains invariant across development. This indicates that the involved organizational principles are present as soon as a child is able to stand upright and are not subject to further shaping by motor learning.

Child↗
PubMed1988

The perception of an optical flow projected on the ground surface.

In most experiments in which the importance of visual control on postural stability is studied, optical stimuli attached to vertical surfaces are used. Analyses of long-term standing readjustments generally involve back-and-forth movements of a visual scene or its projection on vertical circular screens. In a natural environment, however, visual information is largely available from the ground. The aim of the experiment reported was to assess the effect of a flow pattern simulating an open outdoor setting on motion perception and postural control. Subjects were presented with an optical texture projected onto the ground. Periods of motionless texture alternated with equivalent durations of unidirectional flows. The change of position of the subject's centre of gravity over time was recorded on a force platform. Results show that the direction of body sway corresponded with that of texture motion. Important aftereffects, as shown in linear vection experiments, were also observed. However, the latency of postural responses was much shorter than with prolonged unidirectional flows produced in other locations of the visual environment. The hypothesis of an ecological specificity of the flows perceived on the ground during terrestrial displacements is discussed.

Adult↗