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PubMed1991

Postural sway characteristics of the elderly under normal and altered visual and support surface conditions.

One of the most pervasive findings in the literature on the aged is the general slowing of cognitive-motor responses with advancing age. Hence, an increased slowness in the processing of information from vestibular, visual, and somatosensory systems could contribute greatly to a decline in postural stability. To examine this question, in a cross-sectional investigation, postural sway behavior of elderly (n = 18) and young (n = 10) adults was examined under conditions that stressed the slower integrative mechanisms rather than the reflexive mechanisms of postural control. The postural sway behavior of young and elderly subjects was examined for a prolonged duration (80 s), under altered visual and/or support surface (5 cm thick foam surface) conditions, and contrasted with normal stance. Results showed that the exclusion or disruption of one of the sensory inputs, alone, was not consistently sufficient to differentiate between elderly and young adults, because of compensation by the remaining sensory sources. Both alterations together (i.e., visual and surface), however, had a substantially greater effect upon the elderly than the young.

Adult↗
PubMed1992

Postural control in young and elderly adults when stance is perturbed: kinematics.

Increased postural sway and falling are associated with aging and are likely related to problems with postural control in the elderly. We investigated the motions of individual body segments in 24 healthy young adults and 15 healthy elderly adults (mean ages 26 and 72) in response to four tasks: (a) standing with feet flat on an anteriorly accelerating platform (Flat Translation); standing on a narrow beam support that was (b) stationary (Beam Standing) and (c) accelerating anteriorly (Beam Translation); and (d) standing on a rotatable but otherwise stationary springboard (Springboard Standing). An optoelectronic camera system was used to measure rotations of body segments, particularly regarding their maximum excursions, time to first rotation response, direction of initial rotation, and time to first rotation reversal. In general, larger rotation excursions were noted in the elderly compared to the young group, particularly in the Beam Standing and Beam Translation tasks, but the magnitude of rotation difference was small. All rotation magnitudes were well within the available ranges of motion of the body joints. In both excursion magnitudes and directions of initial rotation, the elderly showed greater variability than the young. In the Beam Translation task, the elderly group, compared to the young, tended to rotate their upper body segments more than in the Flat Translation task. These data suggest that healthy elderly adults with no apparent musculoskeletal or neurological impairments have small but consistent differences in postural control kinematics, particularly when more challenging conditions are presented. Moreover, these data provide the basis for biomechanical analyses of joint torques and other dynamic requirements of these responses.

Adult↗
PubMed2001

Changes in postural sway during a period of sustained wakefulness in male adults.

Nocturnal variations in postural sway during a period of sustained wakefulness were studied in seven healthy male adults. Postural sways with the subject's eyes open and with them closed were measured every hour from 22:00 to 04:00 h the following day. Parameters of postural sway [rectangle area (RA), root mean square of length in the anterior-posterior direction (RMSL-y), and medium-frequency-band (0.2-1.0 Hz) power of postural sway in the lateral (MF-x) and anterior-posterior (MF-y) directions] showed significant nocturnal variations. RA, RMSL-y, MF-x and MF-y increased after midnight and reached peaks at 04:00 h. Moreover, changes in RA and MF-y depended on visual conditions. The increases in RA and MF-y were larger with the eyes closed than with them open. These postural sway parameters showed positive correlations with subjectively rated sleepiness and negative correlations with electroencephalographic alpha activity. The results suggest that changes in postural sway during the night are influenced by the increase in sleepiness.

Activity Cycles↗
PubMed2004

Carotid artery dissection following minimal postural trauma in a firefighter.

Carotid artery dissections (CAD) are uncommon, but not rare, and are increasingly recognized as a cause of morbidity. A case of CAD following minimal sustained postural trauma is described. The causes and outcomes of CAD are discussed, with particular reference to risks that might be found in the workplace.

Adult↗
PubMedDate not supplied

Ataxia of stance in different types of alcohol dependence--a posturographic study.

The aim of this study was to assess the prevalence of ataxia of stance in different types of alcohol-dependent patients. Posturographic measurements were performed in 82 abstinent alcohol-dependent patients and 54 healthy controls in order to analyse postural control. According to Lesch and co-workers, alcohol dependence was classified as total abstinence (Type I), drinking without loss of control (Type II), fluctuating course (Type III), and persistent severe drinking (Type IV). The mechanisms of alcohol dependence in these subtypes can be summarized as follows: Type I patients drink alcohol to counteract symptoms of alcohol withdrawal; Type II patients use alcohol as an agent for solving conflicts; Type III patients drink alcohol to 'treat' an affective disorder; and Type IV patients have a history of pre-alcoholic neurological and/or psychiatric disorders. The neurological examination showed pathological findings in 39%, whereas posturographic measurements uncovered impaired postural control in 61% (chi2 = 8.8, P = 0.003). Comparing the different study groups revealed that ataxia of stance was most common in alcohol-dependent patients classified as Type IV (tau = 0.24, P = 0.005). In conclusion, posturographic measurements are superior to the clinical examination in detecting postural imbalance in alcohol-dependent patients. The prevalence of postural imbalance is highest in patients classified by Lesch as Type IV. Consequently, this type of alcohol dependence -- characterized by pre-alcoholic neurological and/or psychiatric disorders, bears the highest risk of developing ataxia of stance.

Adult↗
PubMed1989

Drugs affecting postural stability and other risk factors in the hip fracture epidemic--case-control study.

A parallel rise in hip fracture incidence and the rate of prescription of drugs affecting postural stability have been investigated by a case-control study. Other risk factors were also considered. One hundred and seventy-three cases and 134 hospital emergency surgical controls were interviewed and briefly examined, and drug data were corroborated by letter to general practitioners. The analysis revealed no significant difference between consumption of benzodiazepines in cases and controls, major tranquillizers, diuretics or other anti-hypertensives. However, they differed significantly in their average body weight and incidence of stroke. It is suggested that hip fractures on the whole occur in a particularly frail group of elderly people and that the increased fracture incidence over the last 20 years results from the survival of a more frail or less active group than hitherto.

Age Factors↗
PubMed1984

Automated measurement systems for clinical motion analysis.

I present a computer-based data acquisition and processing system for human motion analysis. The Motion Analysis Laboratory, Children's Hospital at Stanford, exists to provide excellence in clinical evaluation, research, and teaching. The laboratory provides an objective base for assessment of locomotor dysfunction in four general areas--muscle function, energy expenditure, postural equilibrium, and motion data acquisition. Muscle function studies are used to determine the magnitude and timing of muscle activity patterns. An energy-cost index with heart rate as an estimate of energy expenditure is used to evaluate the energy demands of walking. A postural equilibrium measuring system is used to quantify the amount of body sway during stance. I describe a method for three-dimensional coordinate processing of human motion. Use of modern technology facilitates the rapid transfer of useful knowledge from the laboratory to the clinic team in an easily interpretable visual form.

Biomechanical Phenomena↗
PubMed1986

Postural reactions in infants with Down syndrome. Relationship to motor milestone development and age.

I examined the emergence of automatic postural reactions (righting, equilibrium, and protective reactions) in a group of infants with Down syndrome and in a developmentally matched group of nonhandicapped infants. I assessed the relationship of postural reactions to chronological age and to motor milestone development (as measured by the Bayley Scales of Infant Development). The relationship of postural reactions to chronological age was weaker in the infants with Down syndrome; a regression analysis revealed a slower rate of postural reaction development evident at an age of about five months and older in infants with Down syndrome. The association between postural reactions and motor milestone performance was remarkably similar for both infant groups in degree of association and pattern across the span of motor development tested. The results indicated that, even though the rate of development differed, the association between postural reactions and motor milestones was similar in normal and delayed development. These results support the current rationale that promotes intervention efforts focusing on the facilitation of postural reactions to enhance motor milestone development in infants with Down syndrome.

Age Factors↗
PubMed1987

Reliability of computerized surface electromyography for determining the onset of muscle activity.

The reliability of a computerized analysis system (CAS) for determining muscle burst onset was compared with the subjective assessments of three trained examiners. A sample of 154 randomly selected, full-wave rectified and filtered electromyographic recordings was evaluated using a test-retest paradigm. Percentages of agreement, Pearson product-moment correlations, analyses of variance (ANOVAs), and intraclass correlation coefficients (ICCs) were used to measure the reliability. The between-rater agreement, which included the computerized EMG assessments, was only 23%. Within-rater agreement and Pearson correlation coefficients were perfect for CAS. The trained examiners' within-rater assessments averaged only 51% agreement, but test-retest correlations were high (r = .78 - r = .82). All ICCs were statistically significant, ranged from .46 to .60, and tended to be higher when the CAS onset determinations were deleted from the analysis. The ANOVAs revealed that trained examiners were more consistent among each other than when their assessments were compared with CAS assessments of EMG recordings. This finding, however, may be facility-specific in that any generalization to other examiners was limited. In contrast to trained examiners, the CAS was free of variations in judgment, ensured perfect reproducibility of trial assessments, and was highly useful for analyzing multi-channel EMG recordings. Although the CAS ensures perfect reliability, validity determinations require visual inspection of trial data.

Adult↗
PubMed1987

Clinical measurement of postural control in adults.

Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Effective approaches for clinical measurement of postural control remain to be developed. This article summarizes important neurophysiological and clinical considerations for developing measurement tools to assess postural control in adults. The postural control system is divided into three basic functional components for assessment: 1) biomechanical components, 2) motor coordination components, and 3) sensory organization components.

Biomechanical Phenomena↗
PubMed1987

Effects of approximation on postural sway in healthy subjects.

The effect of approximation on the postural sway of healthy subjects wearing a weighted belt around their pelvis was measured. Twenty subjects between the ages of 23 and 30 years stood on a polyurethane foam platform that amplified their postural sway and were filmed from a lateral view. All subjects wore markers over their mandibles, hips, and knees and were filmed three times with the weighted belt worn on a randomly selected trial. Frames from a 10-second interval of film from each trial were studied, and the summed displacement at each bony landmark between each frame of film was calculated. A significant decrease in displacement at the mandible (p less than .02) was found when the weighted belt was worn. The decrease in displacement was not significant at the hip or knee. Approximation was shown to decrease the postural sway of healthy subjects. Further study is indicated to investigate the effect of approximation on patient populations.

Adult↗
PubMed1989

A model for multisystem evaluation treatment of individuals with Parkinson's disease.

In this article, we present a model of Parkinson's disease based on pathophysiology, impairments, and disabilities. The model provides a format for deciding what to assess, for interpreting assessment findings, and for deciding which impairments can be corrected by physical therapy intervention and which cannot. From the model, we can predict effective treatment approaches. We can also use the model to identify specific research questions related to the efficacy of physical therapy intervention.

Central Nervous System↗
PubMed1990

Life-span development in functional tasks.

A life-span concept of motor development is presented as a framework for interpretation of a series of studies of righting tasks. Beginning with the task of rising from the floor, the use of a component approach for movement pattern description and for the identification of developmental sequences of motor patterns is reviewed. Studies applying this approach to a wide range of age groups and to various functional righting tasks are discussed. Recent studies investigating factors related to movement patterns used to perform one of the righting tasks are also reviewed. Suggestions concerning the ways in which this information could be applied to physical therapy practice are included.

Adolescent↗
PubMed1990

Coordination of posture and movement.

Movement is performed against a background of subtle postural adjustments that counteract destabilizing forces imposed by the movement. Despite the importance of these postural adjustments to the safe and efficient performance of movement, little is known about the properties of these postural accompaniments. The purpose of this article is twofold. First, it provides a review of properties of postural adjustments that accompany a variety of limb and trunk movements. Second, a schema for the coordination of posture and movement is proposed. This schema suggests that a central nervous system model of body dynamics is essential to anticipatory control of posture during movement.

Biomechanical Phenomena↗
PubMed1990

Postural control in standing following stroke: test-retest reliability of some quantitative clinical tests.

Despite their importance to stroke rehabilitation, appropriate clinical tests of postural control in standing appear to be inadequately developed. Several quantitative clinical tests, therefore, were constructed. These tests were used to measure functionally relevant aspects of postural control in standing in 24 stroke patients within a mean time interval of two months following a cerebrovascular accident. Subjects were tested in two stance positions (step and parallel) for five tasks that assessed their ability to withstand perturbations produced by self-generated body movements during functional activities. Intrasession reliability coefficients were very high (r = .94-.99). Intersession reliability coefficients were also high (r = .85-.94). Because the test battery requires minimal training and equipment, it can be easily applied in the clinical setting. The high reliability obtained justifies further evaluation of these tests, which appear to be very promising for use in stroke rehabilitation.

Activities of Daily Living↗
PubMed1992

Trunk kinematics during locomotor activities.

We investigated upper-body (ie, trunk) angular kinematics (motions) during gait, stair climbing and descending, and rising from a chair in two reference frames--relative to the pelvis and to room coordinates. Bilateral kinematic data were collected from 11 healthy subjects (6 female, 5 male), who were 27 to 88 years of age (mean = 58.9, SD = 17.9). During stair climbing, maximum trunk flexion relative to the room was at least double that during stair descending and gait. Arising from a chair required the most trunk flexion/extension range of motion (ROM) but the least abduction/adduction and medial/lateral (internal/external) rotation. Trunk ROM during gait was small (mean less than or equal to 12 degrees) and consistent with previous literature. Trunk range of motion relative to the room during stair climbing and descending was greater than trunk ROM during gait in all planes. The pelvis and trunk rotate in the transverse plane in greater synchrony during stair descending (mean = 8.1 degrees, SD = 5.6 degrees) than during gait (mean = 12.0 degrees, SD = 4.2 degrees). For all activities, trunk frontal and sagittal ROM relative to the pelvis was greater than that relative to the room coordinates. This finding suggests that trunk/pelvis coordination may be used to reduce potentially destabilizing anti-gravity trunk motions during daily activities. We conclude that upper-body kinematics relative to both pelvis and gravity during daily activities are important to locomotor control and should be considered in future studies of patients with locomotor disabilities.

Activities of Daily Living↗