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PubMed2006

Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention.

Postural control in everyday life is generally accompanied by posture-unrelated cognitive activity. Thus, mild forms of dual-tasking postural control are the norm rather than the exception. Based on this consideration and available evidence, we propose and empirically examined, in young and old adults, a non-monotonic, U-shaped relation between the efficacy of postural control and concurrent cognitive demands that reflect opposing trends of the effects of attention focus and attentional resource competition. When instructed to perform an easy cognitive task that presumably shifted the focus of attention away from posture control, the center of body pressure (COP) excursions decreased both in young and older adults relative to a single-task baseline where the focus of attention was explicitly directed towards the postural control task itself. However, when performing more demanding cognitive tasks, older adults showed increased COP displacements, in line with the predicted U-shape function, whereas young adults did not. We outline mechanisms linking postural control to cognitive demand and suggest routes for future investigation.

Adult↗

PubMed2004

Nonlinear postural control in response to visual translation.

Recent models of human postural control have focused on the nonlinear properties inherent to fusing sensory information from multiple modalities. In general, these models are underconstrained, requiring additional experimental data to clarify the properties of such nonlinearities. Here we report an experiment suggesting that new or multiple mechanisms may be needed to capture the integration of vision into the postural control scheme. Subjects were presented with visual displays whose motion consisted of two components: a constant-amplitude, 0.2 Hz oscillation, and constant-velocity translation from left to right at velocities between 0 cm/s and 4 cm/s. Postural sway variability increased systematically with translation velocity, but remained below that observed in the eyes-closed condition, indicating that the postural control system is able to use visual information to stabilize sway even at translation velocities as high as 4 cm/s. Gain initially increased as translation velocity increased from 0 cm/s to 1 cm/s and then decreased. The changes in gain and variability provided a clear indication of nonlinearity in the postural response across conditions, which were interpreted in terms of sensory reweighting. The fact that gain did not decrease at low translation velocities suggests that the postural control system is able to decompose relative visual motion into environmental motion and self-motion. The eventual decrease in gain suggests that nonlinearities in sensory noise levels (state-dependent noise) may also contribute to the sensory reweighting involved in postural control. These results provide important constraints and suggest that multiple mechanisms may be required to model the nonlinearities involved in sensory fusion for upright stance control.

Adult↗

PubMed2001

Interference between postural control and mental task performance in patients with vestibular disorder and healthy controls.

OBJECTIVES: To determine whether interference between postural control and mental task performance in patients with balance system impairment and healthy subjects is due to general capacity limitations, motor control interference, competition for spatial processing resources, or a combination of these. METHOD: Postural stability was assessed in 48 patients with vestibular disorder and 24 healthy controls while they were standing with eyes closed on (a) a stable and (b) a moving platform. Mental task performance was measured by accuracy and reaction time on mental tasks, comprising high and low load, spatial and non-spatial tasks. Interference between balancing and performing mental tasks was assessed by comparing baseline (single task) levels of sway and mental task performance with levels while concurrently balancing and carrying out mental tasks. RESULTS: As the balancing task increased in difficulty, reaction times on both low load mental tasks grew progressively longer and accuracy on both high load tasks declined in patients and controls. Postural sway was essentially unaffected by mental activity in patients and controls. CONCLUSIONS: It is unlikely that dual task interference between balancing and mental activity is due to competition for spatial processing resources, as levels of interference were similar in patients with vestibular disorder and healthy controls, and were also similar for spatial and non-spatial tasks. Moreover, the finding that accuracy declined on the high load tasks when balancing cannot be attributed to motor control interference, as no motor control processing is involved in maintaining accuracy of responses. Therefore, interference between mental activity and postural control can be attributed principally to general capacity limitations, and is hence proportional to the attentional demands of both tasks.

Adult↗

PubMed2003

Predicting the dynamic postural control response from quiet-stance behavior in elderly adults.

Human postural sway, as measured by fluctuations of the center of pressure (COP) under the feet of a quietly standing individual, can be characterized as a stochastic process. The fluctuation-dissipation theorem (FDT) provides a linear relationship between the fluctuations of a quasi-static, stochastic system to the same system's relaxation to equilibrium following a perturbation. We applied a similar linear relationship, based on the FDT, to the human postural control system to explore whether anterior-posterior (AP) fluctuations of the COP during quiet stance can be used to predict the AP response of the postural control system to a weak posteriorly directed mechanical perturbation (tug or pull at the waist). We tested 10 healthy elderly (mean age of 69yr) and 10 healthy young (mean age of 25yr) adult subjects. We found that this linear relationship was applicable to the postural control system of all 10 young and eight of the 10 elderly adult subjects. These results suggest that it is possible to predict an individual's dynamic response to a mild perturbation using quiet-stance data, regardless of age. The existence of this FDT-based linear relationship with respect to the human postural control system suggests that, for a given individual, the postural control system may use the same control mechanisms during quiet stance and mild-perturbation conditions, regardless of age.

Adult↗

PubMed2005

Postural control in man: the phylogenetic perspective.

Erect posture in man is a recent affordance from an evolutionary perspective. About eight million years ago, the stock from which modern humans derived split off from the ape family, and from around sixty-thousand years ago, modern man developed. Upright gait and manipulations while standing pose intricate cybernetic problems for postural control. The trunk, having an older evolutionary history than the extremities, is innervated by medially descending motor systems and extremity muscles by the more recent, laterally descending systems. Movements obviously require concerted actions from both systems. Research in rats has demonstrated the interdependencies between postural control and the development of fluent walking. Only 15 days after birth, adult-like fluent locomotion emerges and is critically dependent upon postural development. Vesttibular deprivation induces a retardation in postural development and, consequently, a retarded development of adult-like locomotion. The cerebellum obviously has an important role in mutual adjustments in postural control and extremity movements, or, in coupling the phylogenetic older and newer structures. In the human, the cerebellum develops partly after birth and therefore is vulnerable to adverse perinatal influences. Such vulnerability seems to justify focusing our scientific research efforts onto the development of this structure.

Animals↗

PubMed2006

Cognitive load affects postural control in children.

Inferring relations between cognitive processes and postural control is a relatively topical challenge in developmental neurology. This study investigated the effect of a concurrent cognitive task on postural control in a sample of 50 nine-year-old children. Each subject completed two balance trials of 60 s, one with a concurrent cognitive task (cognitive load) and another with no cognitive load. The concurrent cognitive task consisted of mentally counting backwards in steps of 2. Twelve posturographic parameters (PPs) were extracted from the centre of pressure (CoP) trajectory obtained through a load cell force plate. Analysis of variance revealed significant differences in the majority of the extracted PPs. CoP was found to travel faster, farther, and with substantially different features demonstrating an overall broadening of the spectrum in the frequency domain. Nonlinear stability factors revealed significant differences when exposed to a concurrent cognitive task, showing an increase of instability in the intervention rate of the postural control system. By grouping children through selected items from Teachers Ratings and PANESS assessment, specific significant differences were also found both in time and frequency domain PPs, thus confirming the hypothesis of an interaction between cognitive processes (and their development), and postural control.

Attention↗

PubMed1997

Effects of exercise during head-down bed rest on postural control.

BACKGROUND: The effects of exercise on postural control during walking were evaluated following exposure to head-down bed rest (BR). METHODS: Two groups of male subjects (N = 18, mean age = 21.4 yr +/- SE 1.0) were exposed to 5 d of 6 degrees head-down bed rest. The experimental group (E) exercised 90 min.d-1 (n = 12 subjects) during the BR while the control group received no intervention (n = 6). The exercise treatment consisted of a combination of isotonic and isokinetic lower extremity exercise training. Electromyographic (EMG) activity in the tibialis anterior, gastrocnemius, vastus lateralis, and biceps femoris was measured during walking before and after BR. RESULTS: Following BR, EMG activity increased in both test subject groups for all muscles (p < 0.05). However, there were no significant differences in EMG activity between the C and E groups either before or after BR. CONCLUSIONS: These data suggest that the ability of the postural control system to adjust to the gravitational environment was compromised as a result of BR. In addition, we conclude that the exercise protocol used was not an effective countermeasure to the alterations in the postural control system.

Adult↗

PubMed1995

Acoustic cues and postural control.

The effect of auditory input on postural control was evaluated in separate experiments performed in three groups of healthy volunteers. Auditory input took the form either of feedback signals generated by a force platform in response to the subject's postural control movements, or of field orientation (frame of reference) input provided by repeated clicks emitted by loudspeakers in a normally reverberative environment. The effect of these acoustic cues was measured in terms of body sway recorded on a force platform during stance perturbations induced by vibratory stimuli applied to the calf muscles either at low (120mW) or high (850 mW) intensity, the subject standing with eyes closed or open, as instructed. In the presence of feedback auditory input, body sway in response to low intensity vibratory stimulation was significantly reduced, but not that in response to high intensity stimulation. This may be due to the fact that the head and body movements induced by high intensity vibratory stimulation are so rapid and powerful that they override the information available or to the subject using other strategies for postural control in which auditory feedback, at least in the form used here, does not contribute useful information. The availability of field orientation input did not reduce body sway in response to vibratory stimulation at low intensity. This was probably due to the cognitive lag which precluded use being made of the input before the fast proprioceptive responses to vibratory stimulation had already occurred.

Acoustic Stimulation↗

PubMed2006

The effects of trunk stiffness on postural control during unstable seated balance.

This paper focused on the relationship between trunk stiffness and postural control during unstable seated balancing. We hypothesized that an increase in trunk stiffness would degrade postural control, and further hypothesized that signal dependent noise (SDN), resulting in increased muscle force variability, was responsible for this impairment. Ten subjects balanced on an unstable seat during four randomized conditions: normal balancing (control condition), trunk muscle co-activation (active stiffness), arm muscle co-activation (attention control), and belt (passive stiffness). Center of pressure (CoP) and EMG data were collected during three 20 s trials. Postural control was quantified by CoP velocity (total path divided by sample time in seconds). Trunk muscle co-activation resulted in significantly higher CoP velocity than the control (P < 0.001) and arm co-activation (P < 0.001) conditions. EMG data confirmed that the trunk co-activation condition had significantly higher muscle activity than the control (P = 0.001) and arm co-activation (P = 0.001) conditions. The belt condition, which increases passive trunk stiffness, showed no degraded postural control, but interestingly produced slightly lower levels of trunk muscle activity than the control condition (P < 0.001). Increased active trunk stiffness from muscle co-activation degraded postural control. Since the arm co-activation condition showed no impairment, attention demands cannot explain this result. Furthermore, since passive trunk stiffness from wearing a belt did not affect performance, it is believed that SDN from increased trunk muscle recruitment, and not an altered postural control strategy from increased joint stiffness, was responsible for the impairment.

Adult↗

PubMed2004

Abnormal resonance behavior of the postural control loop in Parkinson's disease.

Human postural control of upright stance sporadically can show an oscillatory behavior. Based on previous work, we assessed whether an abnormal tendency for such oscillations might contribute to the motor impairments in patients with basal ganglia dysfunction such as Parkinson's disease (PD). We investigated postural control during unperturbed stance in normal control subjects and in PD patients off and under treatment, focusing on stabilogram diffusion analysis (SDA) of the foot center of pressure (COP) excursions and conventional measures of the sway amplitude and velocity. We found abnormal 1 Hz body sway oscillation in the SDA curves of PD patients that differed significantly from the body sway typically observed in control subjects during quiet stance. The 1 Hz body sway oscillation was associated with abnormally large and fast sway in the patients off treatment. Under treatment with levodopa, with 'deep brain stimulation' (subthalamic nucleus) and even more so with combined treatment, the oscillations in the SDA curves vanished and the sway became slower. The loss of oscillation and reduction of sway velocity were highly correlated with the improvements of patients' clinical motor assessment score. However, sway amplitude was not correlated with the patients' motor assessment score and patients reported clinical improvement under therapy even though sway amplitude increased on average. A simple feedback model of the postural control system with abnormally large internal noise could predict experimental measures both on and off treatment. The off treatment condition was consistent with a high motor gain in the feedback loop, and the on treatment condition with a reduced motor gain.

Basal Ganglia↗

PubMed2003

Fear of falling and postural control in Parkinson's disease.

This study investigated the relationship between fear of falling (FOF) and qualitative and quantitative postural control in Parkinson's disease (PD). Fifty-eight nondemented PD patients were studied along with age-matched healthy controls. The degree of FOF was estimated using the Activities-specific Balance Confidence scale. Qualitative postural control was evaluated using a component of the Unified Parkinson Disease Rating Scale. Postural control was quantified, using centre of pressure measures obtained from a force plate, for eight standing balance tests of different challenges. The results showed that FOF was more evident for PD patients when compared with healthy individuals of similar age. Furthermore, FOF was significantly associated with a qualitative estimate of postural control in PD; individuals with PD who had a greater degree of posture impairment reported greater FOF. The results also showed that an estimate of FOF may help to explain quantitative postural instability in PD. FOF, when coupled with a qualitative estimate of postural control, was able to explain a greater amount of variation in quantitative balance performance for five of the eight balance tests. When considered independently, the qualitative measure of postural control, in general, could not well predict quantitative balance performance. The greater degree of FOF and its possible association with altered postural control suggests that FOF should be considered as an important, independent risk factor in the assessment and treatment of postural instability in patients with PD.

Accidental Falls↗

PubMed1997

Postural control and strength and mood among older adults.

Falls are a significant problem among older adults. Reported correlates of older adult falls have included determinations in leg muscle strength and declines in postural control. However, some investigators have reported low correlations between measures of strength and postural control among older adults. Other investigators have reported that attention demands in this group are inversely related to their postural control. No study has attempted to predict postural control from mood precursors or from knee and ankle strength among older adults. The purpose of this study was to examine relationships between postural control and strength and mood precursors to attention among older adults. Twenty-seven older adults (m = 73.8 years) completed the 16-item Mood Response Scale, which measures total mood, and three subscales conceptualized to be precursors of the subject's ability to focus attention: alertness, contentedness, and calmness. Measures of each subject's isometric knee and ankle strength and postural control also were collected. Using stepwise regression analysis the investigators found that alertness accounted for the greatest amount of variance in all three measures of postural control (R2 = 20 to 27). Additionally, ankle strength, calmness, and age considerably increased the explained variance in postural sway with eyes closed (total R2 = 416). Age was not a significant predictor of the other two measures of postural control. The findings suggest that alertness, a precursor to attention among older adults, is a significant predictor of postural control when vision is intact but that other factors assume importance when vision is impaired. These findings indicate that the postural stability of older adults may be improved, and falls reduced, through interventions which enhance the alertness and attention among older adults.

Accidental Falls↗

PubMed2007

Multisensory information for postural control: sway-referencing gain shapes center of pressure variability and temporal dynamics.

The authors investigated the multisensory control of posture by altering sensory information across the visual and somatosensory systems. The support surface and visual surround were sway-referenced to anterior/posterior center of mass sway and the gain between postural sway and degree of sway referencing was manipulated (gain settings were 0.2, 1.0, and 1.8). These alterations in the sensory environment lead to observed changes in the temporal structure of the center of pressure (COP) trajectories. COP path length increased across gain settings while COP coefficient of variation decreased. The COP became increasingly more deterministic across more challenging sensory organization test (SOT) conditions and with increasing gain, and more nonstationary across more challenging SOT conditions and when the support surface was sway-referenced using a 1.8 gain setting. These findings indicate that changes in the responsiveness of the support surface and/or visual surround within each of the sway-referenced SOT conditions had functional consequences for the control of posture as evidenced by the variations in postural sway dynamics.

Adolescent↗

PubMed1995

Postural control in Menière's disease and acoustic neurinoma when studied on a linearly oscillating platform.

We investigated the effect of visual control on postural stability on a moving platform in 36 patients with Menière's disease (MD) in 25 patients with operated acoustic neurinoma (AN) and in 19 healthy controls. The force platform was placed on rails and oscillated linearly at frequencies from 0.2 to 5 Hz at a constant velocity of 30 mm/s. In all subjects, the support surface oscillation produced postural instability that differed significantly from the base line stability. The body sway velocity increased almost linearly with the increase of stimulation frequency. The MD patients swayed more than the AN patients at base line measurements in non-visual conditions but not during platform movement. In visual conditions the AN patients stabilized their posture significantly better than the MD patients, who showed deteriorating visual control of posture during platform movement. The controls differed from the patients in all test conditions except 5 Hz stimulation, which causes the body segment to fall into resonance. The Romberg quotients (RQ) in MD patients was significantly poorer during platform movement than in controls, except at 5 Hz stimulation. The AN patients had higher RQ values than controls, and mainly used vision to compensate their vestibular deficit. Thus, patients with MD fail to control their posture efficiently with vision during movement which may explain the visually induced dizziness in MD patients.

Adult↗

PubMed1995

The effects of spaceflight on open-loop and closed-loop postural control mechanisms: human neurovestibular studies on SLS-2.

Stabilogram-diffusion analysis was used to examine how prolonged periods in microgravity affect the open-loop and closed-loop postural control mechanisms. It was hypothesized that following spaceflight: (1) the effective stochastic activity of the open-loop postural control schemes in astronauts is increased; (2) the effective stochastic activity and uncorrelated behavior, respectively, of the closed-loop postural control mechanisms in astronauts are increased; and (3) astronauts utilized open-loop postural controls schemes for shorter time intervals and smaller displacements. Four crew members and two alternates from the 14-day Spacelab Life Sciences 2 Mission were included in the study. Each subject was tested under eyes-open, quiet-standing conditions on multiple preflight and postflight days. The subjects' center-of-pressure trajectories were measured with a force platform and analyzed according to stabilogram-diffusion analysis. It was found that the effective stochastic activity of the open-loop postural control schemes in three of the four crew members was increased following spaceflight. This result is interpreted as an indication that there may be in-flight adaptations to higher-level descending postural control pathways, e.g., a postflight increase in the tonic activation of postural muscles. This change may also be the consequence of a compensatory (e.g., "stiffening") postural control strategy that is adopted by astronauts to account for general feeling of postflight unsteadiness. The crew members, as a group, did not exhibit any consistent preflight/postflight differences in the steady-state behavior of their closed-loop postural control mechanisms or in the functional interaction of their open-loop and closed-loop postural control mechanisms. These results are interpreted as indications that although there may be in-flight adaptations to the vestibular system and/or proprioceptive system, input from the visual system can compensate for such changes during undisturbed stance.

Humans↗

PubMed1988

Effect of ankle disk training on postural control in patients with functional instability of the ankle joint.

The postural control of ten male soccer players with functional instability (FI) of the ankle joint, i.e., recurrent sprains and/or a feeling of giving way, was studied before and after ankle disk training. Postural control was studied by means of stabilometry and an optoelectronic movement recording system. In the present study, we found increased postural sway in men with functional instability, which is in line with previous studies. We found improved postural control after ankle disk training as shown by stabilometry. Postural correction patterns were restored, and segmental displacement amplitudes reached even supranormal values. A subgroup of players with unilateral FI also decreased postural sway when standing on the non-symptomatic, untrained foot after ankle disk training. This bilateral improvement and the restored postural correction pattern do not tally with Freemans proprioceptive theory for postural control, but stresses the importance of central motor programs.

Adult↗

PubMed2003

The effects of visual input on postural control of the lumbar spine in unstable sitting.

Postural control of the lumbar spine in unstable sitting was quantified through the analysis of the center of pressure (CoP) movement recorded by a force plate situated underneath a seat that incorporated a hemisphere. Thirteen healthy subjects were tested under conditions of increasing seat instability and elimination of visual input. The purpose of this study was to determine the relative effects of visual input and support surface instability on open and closed loop postural control mechanisms in sitting and to determine the association between traditional summary statistics and random walk analysis of CoP movement. The effects of the seat instability level and visual input on the CoP movement parameters were tested with a two-factor, repeated measures ANOVA (p<0.01). In all summary statistics CoP movement parameters increased significantly due to the seat instability level and lack of visual input. The random walk analysis identified two regions, short- and long-term, which has been postulated to represent open and closed loop control mechanism, respectively. While short-term scaling exponents were independent from visual input, CoP displacement in the short-term region was significantly increased in the eyes closed condition. Summary statistic of CoP total path length per second correlated highly with critical point coordinates and short-term diffusion coefficients. The CoP movement in the long-term region was consistent with a closed loop control mechanisms. The findings of visual influence on what is assumed as an open-loop control mechanism does not, at face value, support the hypothesis that two separate mechanisms are working to achieve postural control.

Adult↗

PubMed2000

Effect of exposure to lead on postural control in workers.

OBJECTIVES: To examine the effect of lead on postural control of workers who have been exposed to lead. METHODS: 63 Male, lead battery workers mean (SD) age 41.0 (7.4) were compared with 48 age matched male controls after excluding those with acute or chronic diseases. Exposed workers had mean (SD) past blood lead concentrations of 37.5 (9.2) micrograms/dl and 11.2 (5.7) years of employment. Postural control was measured with a computerised postural sway measurement system which measured both sway and total movements. RESULTS: Workers standing straight with eyes open on the bare plates had sway and total movements which were not notably different from controls. On the other hand increased movements were needed in the exposed workers to maintain stability (the general stability quotient 18.2 (5.4) v 15.4 (4.4) in controls, p < 0.01) when standing directly on the foot-plates with closed eyes,, and with the head tilted (15.0 (3.8) v 11.5 (3.0) in controls, p < 0.001). Exposed workers also had a trend for less ability to synchronize anterior posterior and lateral sway in the stress positions (0.0625) than had non-exposed workers. Significant but low correlations were found between the estimate of the chronic internal dose of lead and three of 10 of the postural control measurements, and present lead blood concentrations and only one of the 10 measurements and (r values ranged from 0.21 to 0.31, p < or = 0.03). CONCLUSIONS: These findings suggest that lead affects postural control in asymptomatic workers. Further studies are warranted to find whether workers with decreased postural control are at increased risk of accidents and the relation, if any, of these measurements with subsequent morbidity.

Adult↗