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Time-to-boundary measures of postural control during single leg quiet standing.

A novel approach to quantifying postural stability in single leg stance is assessment of time-to-boundary (TTB) of center of pressure (COP) excursions. TTB measures estimate the time required for the COP to reach the boundary of the base of support if it were to continue on its instantaneous trajectory and velocity, thus quantifying the spatiotemporal characteristics of postural control. Our purposes were to examine: (a) the intrasession reliability of TTB and traditional COP-based measures of postural control, and (b) the correlations between these measures. Twenty-four young women completed three 10-second trials of single-limb quiet standing on each limb. Traditional measures included mean velocity, standard deviation, and range of mediolateral (ML) and anterior-posterior (AP) COP excursions. TTB variables were the absolute minimum, mean of minimum samples, and standard deviation of minimum samples in the ML and AP directions. The intrasession reliability of TTB measures was comparable to traditional COP based measures. Correlations between TTB and traditional COP based measures were weaker than those within each category of measures, indicating that TTB measures capture different aspects of postural control than traditional measures. TTB measures provide a unique method of assessing spatiotemporal characteristics of postural control during single limb stance.

Adult↗

Instant equilibrium point and its migration in standing tasks: rambling and trembling components of the stabilogram.

A method of decomposing stabilograms into two components, termed rambling, was developed. The rambling component reveals the motion of a moving reference point with respect to which the body's equilibrium is instantly maintained. The trembling component reflects body oscillation around the reference point trajectory. The concepts of instant equilibrium point (IEP) and discrete IEP trajectory are introduced. The rambling trajectory was computed by interpolating the discrete IEP trajectory with cubic spline functions. The trembling trajectory is found as a difference between the approximated rambling trajectory and the COP trajectory. Instant values of the horizontal ground reaction force at a zero time lag. It suggests that trembling is strongly influenced by a restoring force proportional to the magnitude of COP deviation from the rambling trajectory and acts without a time delay. An increment in relative COP position per unit of the restoring force in mm/N, was on average 1.4 +/- 0.4. The contribution of rambling and trembling components in the stabilogram was ascertained. The rambling variability is approximately three times larger than the trembling variability.

Adult↗

Rambling and trembling in quiet standing.

The goal of this study was to explore the rambling-trembling decomposition in quiet standing. The center of pressure (COP) and the horizontal ground reaction force (F(hor)) were registered in healthy subjects standing in an upright bipedal posture on a force platform. The COP positions at the instants when F(hor) = 0 were identified (instant equilibrium points, IEP) for the anterior-posterior direction, then the COP time series, were partitioned into its components using 2 different techniques, rambling-trembling decomposition and gravity line decomposition. The two decomposition techniques provided very similar results. An unexpectedly large correlation between the trembling trajectory and the difference between COP and gravity line was found, r = 0.91 (range, 0.83 < r < 0.98). The correlation implies that the GL moves from an IEP to the subsequent IEP along a smooth trajectory that can be predicted by the spline approximation. A substantial negative cross-correlation at a zero time lag was observed between the trembling and the F(hor), -0.90 < r < -0.75. For the rambling trajectory, the coefficients of correlation with F(hor) were low, -0.33 < r < -0.05. The data support the hypothesis that during quiet standing the body sways for two reasons: the migration of the reference point (rambling) and the deviation away from that point (trembling).

Adult↗

A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques.

In order to identify useful guidelines for the clinical practitioner as regards the use of static posturographic analysis, we collected a set of posturograms from 3 groups of participants (normal participants, Parkinsonian patients, and osteo-porotic patients), according to the Romberg test. From each posturogram, we extracted global parameters (in the time domain and frequency domain) and structural parameters (based on diffusion plots and sway-density plots), with a total of 38 parameters. The discriminative power of each parameter was evaluated by means of statistical analysis in relation to the condition effect (open vs. closed eyes) and the pathology effect (normal participants vs. patients). The initial set of 38 parameters was reduced to 24 by identifying clear redundancies, and then to 18 by eliminating the parameters that did not pass the condition effect with normal participants. These parameters were analyzed for reliability and discriminative power in the general framework of a biomechanic model of postural stabilization. At the end of this analysis, we suggested that a set of 4 parameters is particularly valuable in the clinical practice: 2 global parameters (sway-path and frequency band of the posturogram) and 2 structural parameters (mean value of peaks and mean inter-peak distance in the sway-density plots).

Aged↗

Assessment of postural response after a self-initiated perturbation.

The aim of this study was to assess postural response efficiency to a self-initiated perturbation using an original method based on the inverted pendulum model. Eight young subjects were asked to perform bilateral arm raising and lowering at 3 different speeds while standing on a force plate. The time necessary to recover a steady state following the movement was computed by analyzing the time evolution of the coefficient of determination between the center of pressure and center of mass difference variable (COP-COM) and the horizontal acceleration of the COM. Results show a spatial reorganization (hip strategy) of the segments following the perturbation and a strong influence of the linear relationship to the arm velocity. However, the conditions of arm velocity did not have any effect on the time response of the postural control, suggesting that this parameter would be an invariant characteristic of the movement. These results support the existence of an internal representation of the inertial constraints related to the movement execution.

Adult↗

Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis.

OBJECTIVE: To investigate whether alleviation of knee pain influences quadriceps function, proprioceptive acuity, and postural stability in patients with knee osteoarthritis (OA). METHODS: A crossover, within-subject, double blind study design involving 68 subjects with painful knee OA. Each subject received an intra-articular injection into one or both knees (both if symptomatic) of either 5 ml 0.5% bupivacaine or 5 ml 0.9% saline. Two weeks later they received an injection of the alternative agent. Subjects and observer were unaware of the order of injection, which was randomly assigned. Knee pain (100 mm visual analogue scale), static postural sway, knee proprioceptive acuity, maximum voluntary contraction (MVC), and percentage activation of the quadriceps were assessed immediately before and one hour after each injection. RESULTS: Significant pain reduction was achieved one hour post-bupivacaine (mean difference as a percentage change 56.85, 95% CI 31.01 to 73.65; p<0.001) and post-saline (mean difference as a percentage change 41.94, 95% CI 11.57 to 76.66; p< 0.001), with no significant difference between the two. Both MVC and activation increased significantly post-bupivacaine (mean percentage differences 18.83, 95% CI -31.79 to -0.26, and -11.90, 95% CI -39.53 to 2.97, respectively; both p<0.001) and post-saline (mean percentage differences -7.64, 95% CI -21.96 to 4.73, and -10.71, 95% CI -25.19 to 2.60 respectively; both p<0.001). Proprioception worsened after bupivacaine (mean percentage difference -28.15%, 95% CI -83.47 to 19.74; p=0.009), but there was no effect on postural sway; saline injection had no effects. There was no order effect, and comparison of median percentage changes showed no significant differences between injections for change in MVC, activation, proprioception, or sway. CONCLUSION: Reduction in knee pain through either peripheral (local anaesthetic) or central (placebo) mechanisms resulted in increased MVC. This increase, however, did not result in improvements in proprioception or static postural stability, suggesting that other mechanisms play a part in these functions, at least in this acute model.

Adult↗

Detecting altered postural control after cerebral concussion in athletes with normal postural stability.

OBJECTIVE: To determine if approximate entropy (ApEn), a regularity statistic from non-linear dynamics, could detect changes in postural control during quiet standing in athletes with normal postural stability after cerebral concussion. METHODS: The study was a retrospective, case series analysis of centre of pressure (COP) data collected during the Sensory Organization Test (SOT) from NCAA Division I (USA) athletes prior to and within 48 h after injury. Subjects were 21 male and six female athletes from a variety of sports who sustained a cerebral concussion between 1997 and 2003. After injury, athletes displayed normal postural stability equivalent to preseason levels. For comparison, COP data also were collected from 15 male and 15 female healthy non-athletes on two occasions. ApEn values were calculated for COP anterior-posterior (AP) and medial-lateral (ML) time series. RESULTS: Compared to healthy subjects, COP oscillations among athletes generally became more regular (lower ApEn value) after injury despite the absence of postural instability. For AP time series, declines in ApEn values were much larger in SOT conditions 1 and 2 (approximately three times as large as the standard error of the mean) than for all other conditions. For ML time series, ApEn values declined after injury in all sensory conditions (F(1,55) = 6.36, p = 0.02). CONCLUSIONS: Athletes who demonstrated normal postural stability after concussion nonetheless displayed subtle changes in postural control. Changes in ApEn may have represented a clinically abnormal finding. ApEn analysis of COP oscillations may be a valuable supplement to existing concussion assessment protocols for athletes.

Adolescent↗

Quantitative analysis of stance in ataxic myxoedema.

Postural abnormalities in a 66-year-old woman with ataxic myxoedema were recorded by stabilography during treatment. After replacement therapy, 3 Hz power in the sagittal plane was greater than before treatment; this peak shifted to a higher frequency and finally its ratio became normal. This is the first report of recovery of a 3 Hz body oscillation in ataxic myxoedema.

Aged↗

The effects of movement velocity, mass displaced, and task certainty on associated postural adjustments made by normal and hemiplegic individuals.

The activation times for trunk and leg muscles were examined in normal and left hemiplegic subjects who raised their right arms at different velocities in self-paced or reaction time conditions. Activity in these postural muscles preceded arm displacement, and they were activated in a similar sequence during all types of rapid movements. The presence and sequencing of associated postural adjustments were more variable during slow movements.

Adult↗

Postural sway during retinal image stabilisation.

Posturographic measurements using a piezoelectric platform were made in normal subjects while wearing a combination of spectacle and contact lens providing partial stabilisation of the retinal image (RIS). The amount of postural sway seen while wearing the device at rest is intermediate between the "normal vision" and "eyes closed" conditions, and increases with increasing amounts of RIS. However, when large active head-and-eye movements are performed, postural sway is dramatically increased when using RIS, and is then worse than while performing the same task in the "eyes closed" condition. It is concluded that patients who use the partial-RIS device for the treatment of severe oscillopsia may benefit only when performing tasks in which the head is relatively still, such as reading, writing or watching TV. It is also proposed that the partial-RIS device can serve as a model in normal free-standing subjects for the postural effects of oculomotor disorders.

Adult↗

EMG responses in leg muscles to postural perturbations in Huntington's disease.

This paper compares leg muscle electromyogram (EMG) responses to sudden toe-up tilts of a moveable platform in patients with Huntington's disease (HD), clinically normal offspring at risk of developing HD (HD risks) and healthy controls. The EMG pattern in standing subjects and patients consisted of short- and middle-latency responses (SL and ML) in the stretched triceps surae muscles and long-latency responses (LL) in the shortened tibialis anterior muscles. The SL response could be further divided into two distinct subcomponents termed SL1 and SL2. An ML response was identified in only 50% of normal subjects and patients. HD patients differed from normal subjects by showing delayed onset latencies and prolonged durations for the LL response, and smaller amplitudes for the ML response. The subjects at risk also showed diminished ML amplitudes and prolonged LL durations, but normal LL onset latencies. In the sitting condition, the EMG responses of the HD patients and of the HD risks did not differ from those of controls: in all groups SL1 was reduced and delayed, SL2 slightly enhanced, while ML and LL were absent. Because both afferent and efferent conduction times are normal in HD, the delayed LL onset reflects abnormal supraspinal organisation of postural control in HD, and indicates that basal ganglia may have a modulatory effect on the LL responses. The normal EMG responses in the sitting patients suggest appropriate regulation of these responses according to postural set in HD.

Adult↗

Influence of sensory manipulation on postural control in Parkinson's disease.

Postural control was assessed on a tilting platform system in 20 patients with idiopathic Parkinson's disease and 20 age-matched controls. The amount of information provided by vision and lower limb proprioception was varied during the experiment to investigate the influence of changes in sensory cues on postural control. The patient group with clinical evidence of impaired postural control (Hoehn and Yahr III) had significantly higher sway scores over all sensory conditions than either the Hoehn and Yahr II group or controls. The pattern of sway scores indicated that no obvious deficit in the quality, or processing, of sensory information was responsible for the postural instability observed in this group. The patients in both Hoehn and Yahr groups were also able to respond appropriately to potentially destabilising sensory conflict situations and significantly improved their sway scores when provided with visual feedback of body sway. The results indicate that in Parkinson's disease, the main site of dysfunction in postural control is likely to be at a central motor level.

Adult↗

Individual characteristics in occupational accidents due to imbalance: a case-control study of the employees of a railway company.

BACKGROUND: Falls are frequent occupational accidents, and are responsible for a significant amount of lost working time and, more importantly, for a high mortality. The factors involved in falling mechanisms can be of external or individual origin, the latter being less well identified. AIMS: To assess the relations between certain individual characteristics and occupational accidents due to imbalance. METHODS: A total of 427 male employees, who had been victims of at least one occupational accident with sick leave due to imbalance (cases) and 427 controls were recruited among the employees of a large French railway company. A standardised questionnaire on life conditions and professional factors, and a description of the accidents was filled in by an occupational physician for each subject. RESULTS: Some job categories were more affected by a specific release mechanism of work related falls. Certain individual characteristics such as smoking, alcohol consumption, inactivity, sleep disorders, and request for a job change were correlated with the occurrence of occupational accidents. Sick leaves of eight days or over were more frequent in older and overweight injured workers. Some lesions were linked with the specific fall released mechanisms. CONCLUSIONS: Individual characteristics can increase the risk of occupational accidents, especially falling. This study identified subjects most at risk on whom prevention related to working conditions and falls could be focused.

Accident Proneness↗

Observer-rated ataxia: rating scales for assessment of genetic differences in ethanol-induced intoxication in mice.

Identification of genetic and physiological mechanisms underlying a drug's or mutation's effects on motor performance could be aided by the existence of a simple observation-based rating scale of ataxia for mice. Rating scales were developed to assess ataxia after ethanol (2.75, 3.0, and 3.25 g/kg) in nine inbred mouse strains. Each scale independently rates a single behavior. Raters, blinded to dose, scored four behaviors (splay of hind legs, wobbling, nose down, and belly drag) at each of four time points after injection. The severities of hind leg splaying and wobbling were quantifiable, whereas nose down and belly dragging were expressed in all-or-none fashion. Interrater reliabilities were substantial (0.75 0 at some time), but all doses were equally effective. Incidence of nose down and belly dragging behaviors increased strain dependently after ethanol, but strains did not differentially respond to dose. Ethanol-induced splaying was modestly, and negatively, genetically correlated with wobbling. Nose down and belly dragging tended to be associated with splaying and wobbling at later times. Four distinct ataxia-related behaviors were sensitive to ethanol. Strains differed in ethanol sensitivity for all measures. Modest strain mean correlations among behaviors indicate that these behaviors are probably under control of largely different genes and that ataxia rating scales should rate separate behaviors on discrete scales.

Alcoholic Intoxication↗

Lumbar and cervical erector spinae fatigue elicit compensatory postural responses to assist in maintaining head stability during walking.

The purpose of this study was to examine how inducing fatigue of the 1) lumbar erector spinae and 2) cervical erector spinae (CES) muscles affected the ability to maintain head stability during walking. Triaxial accelerometers were attached to the head, upper trunk, and lower trunk to measure accelerations in the vertical, anterior-posterior, and mediolateral directions during walking. Using three accelerometers enabled two adjacent upper body segments to be defined: the neck segment and trunk segment. A transfer function was applied to root mean square acceleration, peak power, and harmonic data derived from spectral analysis of accelerations to quantify segmental gain. The structure of upper body accelerations were examined using measures of signal regularity and smoothness. The main findings were that head stability was only affected in the anterior-posterior direction, as accelerations of the head were less regular following CES fatigue. Furthermore, following CES fatigue, the central nervous system altered the attenuation properties of the trunk segment in the anterior-posterior direction, presumably to enhance head stability. Following lumbar erector spinae fatigue, the trunk segment had greater gain and increased regularity and smoothness of accelerations in the mediolateral direction. Overall, the results of this study suggest that erector spinae fatigue differentially altered segmental attenuation during walking, according to the level of the upper body that was fatigued and the direction that oscillations were attenuated. A compensatory postural response was not only elicited in the sagittal plane, where greater segmental attenuation occurred, but also in the frontal plane, where greater segmental gain occurred.

Adult↗

Interaction between acoustic startle and habituated neck postural responses in seated subjects.

Postural and startle responses rapidly habituate with repeated exposures to the same stimulus, and the first exposure to a seated forward acceleration elicits a startle response in the neck muscles. Our goal was to examine how the acoustic startle response is integrated with the habituated neck postural response elicited by forward accelerations of seated subjects. In experiment 1, 14 subjects underwent 11 sequential forward accelerations followed by 5 additional sled accelerations combined with a startling tone (124-dB sound pressure level) initiated 18 ms after sled acceleration onset. During the acceleration-only trials, changes consistent with habituation occurred in the root-mean-square amplitude of the neck muscles and in the peak amplitude of five head and torso kinematic variables. The subsequent addition of the startling tone restored the amplitude of the neck muscles and four of the five kinematic variables but shortened onset of muscle activity by 9-12 ms. These shortened onset times were further explored in experiment 2, wherein 16 subjects underwent 11 acceleration-only trials followed by 15 combined acceleration-tone trials with interstimulus delays of 0, 13, 18, 23, and 28 ms. Onset times shortened further for the 0- and 13-ms delays but did not lengthen for the 23- and 28-ms delays. These temporal and spatial changes in EMG can be explained by a summation of the excitatory drive converging at or before the neck muscle motoneurons. The present observations suggest that habituation to repeated sled accelerations involves extinguishing the startle response and tuning the postural response to the whole body disturbance.

Acceleration↗