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Proprioception at the ankle: the effect of anaesthetic blockade of ligament receptors.

Seven subjects with normal joints were tested for active and passive position sense of ankle inversion, peroneal reflex reaction time to sudden ankle inversion, and postural stability during single-leg stance. The tests were performed before and after regional block of the ankle and foot with local anaesthetic. Passive position sense, assessed with the muscles relaxed, was greatly impaired by anaesthesia but active position sense, with the calf muscles activated, was preserved, and the peroneal reaction time to sudden ankle inversion was not altered. The magnitude of postural sway during single-leg stance was also unchanged by anaesthesia of the ankle and foot. The results suggest that the afferent input from intact lateral ankle ligaments is important in sensing correct placement of the foot at heel-strike, but that this input can be replaced by afferent information from active calf muscles. Afferent input from these muscles seems also to be responsible for dynamic ankle protection against sudden ankle inversion and is adequate to allow stable single-leg stance.

Adult↗

Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study.

UNLABELLED: High-frequency mechanical strain seems to stimulate bone strength in animals. In this randomized controlled trial, hip BMD was measured in postmenopausal women after a 24-week whole body vibration (WBV) training program. Vibration training significantly increased BMD of the hip. These findings suggest that WBV training might be useful in the prevention of osteoporosis. INTRODUCTION: High-frequency mechanical strain has been shown to stimulate bone strength in different animal models. However, the effects of vibration exercise on the human skeleton have rarely been studied. Particularly in postmenopausal women-who are most at risk of developing osteoporosis-randomized controlled data on the safety and efficacy of vibration loading are lacking. The aim of this randomized controlled trial was to assess the musculoskeletal effects of high-frequency loading by means of whole body vibration (WBV) in postmenopausal women. MATERIALS AND METHODS: Seventy volunteers (age, 58-74 years) were randomly assigned to a whole body vibration training group (WBV, n = 25), a resistance training group (RES, n = 22), or a control group (CON, n = 23). The WBV group and the RES group trained three times weekly for 24 weeks. The WBV group performed static and dynamic knee-extensor exercises on a vibration platform (35-40 Hz, 2.28-5.09g), which mechanically loaded the bone and evoked reflexive muscle contractions. The RES group trained knee extensors by dynamic leg press and leg extension exercises, increasing from low (20 RM) to high (8 RM) resistance. The CON group did not participate in any training. Hip bone density was measured using DXA at baseline and after the 6-month intervention. Isometric and dynamic strength were measured by means of a motor-driven dynamometer. Data were analyzed by means of repeated measures ANOVA. RESULTS: No vibration-related side effects were observed. Vibration training improved isometric and dynamic muscle strength (+15% and + 16%, respectively; p < 0.01) and also significantly increased BMD of the hip (+0.93%, p < 0.05). No changes in hip BMD were observed in women participating in resistance training or age-matched controls (-0.60% and -0.62%, respectively; not significant). Serum markers of bone turnover did not change in any of the groups. CONCLUSION: These findings suggest that WBV training may be a feasible and effective way to modify well-recognized risk factors for falls and fractures in older women and support the need for further human studies.

Aged↗

Control of fast-reaching movements by muscle synergy combinations.

How the CNS selects the appropriate muscle patterns to achieve a behavioral goal is an open question. To gain insight into this process, we characterized the spatiotemporal organization of the muscle patterns for fast-reaching movements. We recorded electromyographic activity from up to 19 shoulder and arm muscles during point-to-point movements between a central location and 8 peripheral targets in each of 2 vertical planes. We used an optimization algorithm to identify a set of time-varying muscle synergies, i.e., the coordinated activations of groups of muscles with specific time-varying profiles. For each one of nine subjects, we extracted four or five synergies whose combinations, after scaling in amplitude and shifting in time each synergy independently for each movement condition, explained 73-82% of the data variation. We then tested whether these synergies could reconstruct the muscle patterns for point-to-point movements with different loads or forearm postures and for reversal and via-point movements. We found that reconstruction accuracy remained high, indicating generalization across these conditions. Finally, the synergy amplitude coefficients were directionally tuned according to a cosine function with a preferred direction that showed a smaller variability with changes of load, posture, and endpoint than the preferred direction of individual muscles. Thus the complex spatiotemporal characteristics of the muscles patterns for reaching were captured by the combinations of a small number of components, suggesting that the mechanisms involved in the generation of the muscle patterns exploit this low dimensionality to simplify control.

Adult↗

[Evaluation of the static equilibrium in a population of hearing impaired children].

A random sample was organized with 42 children with congenital sensorineural auditory deficit (severe and bilateral) from special education schools in Campinas. Chronological ages ranged from 4 to 7 years of age. This sample was compared with two control groups of 42 children of the same chronological age but attending normal classes. All were submitted to 9 tests of the set of static equilibrium of the Evolutive Neurologic Examination. It was observed that in the position of equilibrium with opened eyes (test 8) there were no differences between the groups. In the Romberg position, the hearing impaired children of 4, 5 and 6 years of age showed a significant decrease in the ability to do the test (test 9); those of 7 years of age had equal ability whether of the control or the deficient groups. Hearing impaired children were less able to do other static equilibrium tests (heel-toe or one foot or tip-toe standing tests, with opened or closed eyes: tests 10, 12, 16, 20, 24, 25 and 26). The use of detailed neurological semiology allowed us to support the alteration of the static equilibrium in this group of hearing impaired children.

Child↗

[Surgical treatment of scoliosis in spinal muscular atrophy].

OBJECTIVE: To describe the early and late postoperative data from SMA patients with surgical procedure. METHOD: Clinical data and radiographic imaging from 14 SMA patients with surgical treatment of scoliosis were reviewed, and all were reassessed clinically with new spinal radiographs and a questionnaire. The mean follow-up were 22 months. The mean preoperative Cobb angle was 78.4 . All patients presented pelvic obliquity (mean 25.5 ) and 11 had cifosis. The mean age at time of surgery was 12 years and 3 months. All patients were treated with posterior spinal fusion with Luque-Galveston instrumentation in 12 and Cotrel-Dubousset instrumentation in 2. RESULTS: The average curve correction at the immediate postoperative was 64.3% for scoliosis and 36.4% for cifosis, with the pelvic obliquity correction of the 70.9%. The complications were liquoric fistula and infection earlier in one case, and lately wire looseness of T1 in 2 patients. It was detected mean lost of the correction at the final assessment of the 0.26 of the scoliosis and the 1.28 of the pelvic obliquity. Relatives and the patients related good improvement regarding to esthetic aspects, posture balance, body care, as well as respiratory problems. CONCLUSION: The spinal fusion for scoliosis in SMA patients has a satisfactory impact for esthetic, quality of life and respiratory function, with minimal lost of corrected deformities and few complications.

Adolescent↗

Comparison of head- and body-velocity trajectories during locomotion among healthy and vestibulopathic subjects.

The optimal strategies for improving locomotor stability in people with vestibulopathy remain unclear. To help identify likely targets for intervention, we sought to determine whether vestibulopathic postural control impairment during locomotor activity was more localized to either the head or the whole body. We used high curvature analysis (HCA) to quantify the smoothness of head- and body-velocity trajectories during repeated stepping in 18 vestibulopathic and 17 healthy subjects. We employed a mixed-model repeated measures analysis of variance to compare differences in head- and body-trajectory HCA scores. Pearson coefficients were used to describe relationships between head- and body-trajectory HCA scores within each group. The results revealed that neither head- nor body-velocity trajectories were relatively more impaired in subjects with vestibulopathy. Importantly, however, the smoothness of head and body trajectories was more strongly related in subjects with vestibulopathy compared with healthy subjects, suggesting that the fundamental motor control impairment produced by vestibulopathy may be related to an abnormal coupling of head and body motion. We discuss implications for locomotor training in patients with vestibulopathy.

Adult↗

Effect of restricted spinal motion on gait.

Spinal orthoses are common in the treatment of various conditions that affect the spine. They encompass both the spine and pelvis and thus have implications for pelvic and lower-limb motion during walking in addition to a direct effect on spinal motion. The role of the spine in walking is largely ill-defined, and the consequences of restricted spinal motion on walking have yet to be explored. This study investigated the effect of spinal restriction on gait in able-bodied persons. Gait analyses were performed on 10 able-bodied subjects as they walked at five different speeds that were distributed across their comfortable range of speeds. Data were collected during walking with and without spinal restriction by a fiberglass body jacket, which is similar to a thoracolumbosacral orthosis (TLSO). With spinal restriction, peak-to-peak (PP) pelvic obliquity and rotation were significantly reduced across all walking speeds (p < 0.001), while PP pelvic tilt was significantly reduced at only the fastest walking speeds (p = 0.017). PP hip abduction-adduction motion was significantly reduced with spinal restriction across all speeds (p < 0.001), while PP hip flexion-extension significantly increased at only the slow and very slow speeds (p < 0.001 and p = 0.023, respectively). A better understanding of the effects of restricted spinal motion on gait may help clinicians predict and avoid development of additional problems from TLSO use or surgical restriction of spinal motion. An awareness of these issues will enable clinicians to monitor patients for problems that may result from decreased spine and pelvic motion.

Adult↗

Feasibility of functional electrical stimulation for control of seated posture after spinal cord injury: A simulation study.

We performed this study to determine the feasibility of controlling and stabilizing seated posture with functional electrical stimulation (FES) after paralysis from spinal cord injury (SCI) using computer simulations and a 3-dimensional model of the hip and trunk. We used the model to approximate the range of postures in the sagittal and transverse planes attainable by a seated subject and to estimate the maximum restorative moment that could be produced in a neutral posture in response to a disturbance. The simulations predicted that approximately 28 degrees of forward flexion in the sagittal plane (combined hip and trunk) and 9 degrees of lateral bending in the transverse plane should be possible with FES and that a maximum disturbance rejection moment of approximately 45 newton meters could be expected with the chosen muscle set. We tested a subject with a motor complete thoracic SCI and implanted electrodes in a subset of the selected muscles to compare the moments the subject required to maintain various hip and trunk positions with those predicted by the model. Although a significant range of seated postures was possible with FES, the data demonstrated that more complete activation of the paralyzed muscles would be needed for the subject to fully achieve the theoretical range of motion. With further refinements, we could apply these techniques to the design of control systems for regulation of seated posture and dynamic motion of the torso.

Computer Simulation↗

Weight distributions on soles of feet in the primary and early permanent dentition with normal occlusion.

This study investigated the differences of weight distribution on the sole of the feet in the primary and the early permanent dentition by the modifying Morton staticometer. The distribution of body weight in the outer forward part on soles of feet in the permanent dentition group was significantly greater than that in the primary dentition group. The distribution of body weight in the heel on soles of feet in the permanent dentition group was significantly smaller than that in the primary dentition group. These results indicated that the weight was shifted from the heels to the forefeet from primary to permanent dentition.

Adolescent↗

Body sway increases immediately after strabismus surgery.

The purposes of this study were to examine whether body sway is altered immediately after strabismus surgery in children and to find preoperative clinical factors associated with body sway. In a prospective study, body sway was measured on 1-3 days before surgery and on the third day after surgery; for the measurements, computerized static stabilometry was carried out on 28 consecutive patients with strabismus (age range: 3 to 12 years old; mean: 7.4) who underwent strabismus surgery under general anesthesia. The linear length of the sway path (cm), the linear length of the sway path in a particular unit of time (cm/second), and the area of the sway path (cm2), indicative of the extent of body sway, all increased significantly among a total of 28 patients in both conditions of the patient's eyes open and closed, as well as among those in a subgroup of 16 patients with exotropia, after they had undergone strabismus surgery (p < 0.05, Wilcoxon signed ranks test). The center of pressure along the Y axis of orientation from the toe to the heel was found to deviate significantly toward the heel postoperatively, as compared with the preoperative center in the subgroup of 16 patients with exotropia (p < 0.05). Before surgery, 15 patients with no stereoacuity exhibited a greater amount of body sway when their eyes were open than did 13 patients with measurable stereoacuity (p < 0.05, Mann-Whitney U-test). In the subgroup of 16 patients with exotropia when their eyes open, 3 patients with abnormal head posture exhibited more extensive body sway than did 13 patients without abnormal head posture (p < 0.05). Body sway was found to significantly increase immediately after strabismus surgery in children with strabismus. Stereoacuity and abnormal head posture are 2 clinical factors associated with preoperative postural instability.

Child↗

Effects of malathion on survival, growth, development, and equilibrium posture of bullfrog tadpoles (Rana catesbeiana).

Bullfrog (Rana catesbeiana) tadpoles were exposed to malathion in water in a 28-d static renewal test. The effects of malathion on survival, growth, development, and loss of equilibrium posture were determined. Survival was significantly decreased at malathion concentrations of 2,500 micrograms/L and higher. Development of tadpoles was delayed significantly by malathion exposure as indicated by a dose-related decrease in developmental stage over time. Development of tadpoles in the 1,000-microgram/L and higher treatment groups was significantly delayed from that observed in the control. The effects of malathion on developmental stage suggest that malathion may decrease thyroid function in tadpoles, as it does in other species. Maintenance of equilibrium posture following agitation of the test containers was significantly impaired in tadpoles in all the malathion treatment groups (500 to 3,000 micrograms/L) relative to the control. Maintenance of equilibrium posture was thus the most sensitive end point measured in this study. Loss of equilibrium posture could increase predation losses and decrease feeding in populations of bullfrog tadpoles in the field. However, concentrations of malathion that produced adverse effects in our study are higher than published, measured concentrations found in wetlands or streams.

Animals↗

Gender differences in body-sway factors of center of foot pressure in a static upright posture and under the influence of alcohol intake.

This study aimed to examine gender differences in 4 body-sway factors of the center of foot pressure (CFP) during a static upright posture and the influence of alcohol intake on them. Four body-sway factors were interpreted in previous studies using factor analysis (the principal factor method and oblique solution by promax-rotation) on 220 healthy young males and females as follows; unit time sway, front-back sway, left-right sway and high frequency band power. The CFP measurement for 1 min was carried out twice with 1 min rest. The measurements of blood pressure, heart rate, whole body reaction time, standing on one leg with eyes closed, and CFP were carried out before and after the alcohol intake using 11 healthy young males and females. The measurement device used was an Anima's stabilometer G5500. The data sampling frequency was 20 Hz. Reliability of 4 body-sway factors was very high. Significant gender differences were found in the left-right sway and the high frequency band power factors, but the influence on body-sway is, as a whole, can be disregarded. These four sway factors can determine the influence of alcohol intake as efficient as 32 sway parameters.

Alcohol Drinking↗

Body sway characteristics during static upright posture in healthy and disordered elderly.

This study aimed to compare body sway characteristics of the healthy elderly and the disordered elderly. The subjects were 38 healthy elderly and 24 disordered elderly with disequilibrium. The latter consisted of two groups: 12 elderly with vestibular organ or central nervous systems disorder (central nervous disorders), and 12 elderly with disorder in other systems (other disorders). The measurement device can calculate the center of foot pressure (CFP) of vertical loads from the values of three vertical load sensors, which are located at the corners of an isosceles triangle on a level surface. The data sampling frequency was 20 Hz. Four body sway factors with high reliability (unit time sway, front-back sway, left-right sway, and high frequency band power) were used to evaluate body sway. As compared with healthy people, central nervous disorders had larger unit time sway, high frequency band power, and left-right sway factors. Other disorders were larger in unit time sway and high frequency band power factors. Central nervous disorders, as compared with other disorders, had larger unit time sway and left-right sway factors. Disorders produced large and fast sway, and central nervous disorders in particular showed a marked sway in the left-right direction. The existence of disease influenced body sway more than decline in various functions related to posture control with aging, because even with the same elderly, disorders showed a larger body sway.

Aged↗

New directions in the drug treatment of Parkinson's disease.

Parkinson's disease, a clinical syndrome with 4 cardinal features (bradykinesia, resting tremor, increased muscular rigidity and impaired postural balance), is mainly caused by the loss of dopaminergic neurons in the substantia nigra pars compacta. Although levodopa remains the 'gold standard' in the treatment of the disease, several emerging strategies are currently being developed. The first concerns new symptomatic drugs that either potentiate the effects of levodopa (e.g. slow-release preparations of levodopa, catechol-O-methyltransferase inhibitors and new dopamine agonists) or target clinical symptoms resistant to dopaminergic drugs (e.g. glutamate antagonists). The second strategy is to find drugs that are able to prevent or delay the neuronal death observed in Parkinson's disease. Several neuroprotective drugs are now in development in experimental research, but clinical trials in this area are still lacking. The development of these new drugs also depends on the validation of new clinical methodologies.

Antiparkinson Agents↗

A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion.

Recent research suggests that traditional biomechanical models of postural stability do not fully characterise the nonlinear properties of postural control. In sports medicine, this limitation is manifest in the postural steadiness assessment approach, which may not be sufficient for detecting the presence of subtle physiological change after injury. The limitation is especially relevant given that return-to-play decisions are being made based on assessment results. This update first reviews the theoretical foundation and limitations of the traditional postural stability paradigm. It then offers, using the clinical example of athletes recovering from cerebral concussion, an alternative theoretical proposition for measuring changes in postural control by applying a nonlinear dynamic measure known as 'approximate entropy'. Approximate entropy shows promise as a valuable means of detecting previously unrecognised, subtle physiological changes after concussion. It is recommended as an important supplemental assessment tool for determining an athlete's readiness to resume competitive activity.

Athletic Injuries↗

Body sway induced by depth linear vection in reference to central and peripheral visual field.

PURPOSE: A significant correlation between the magnitude of linear vection and the degree of body sway induced by a visual stimulus perceived as moving in depth was previously described (Jpn J Physiol 49: 417-424, 1999). The purpose of this study was to examine the role of the central and peripheral visual fields in inducing vection and body sway. METHODS: Ten healthy volunteer students who had no vestibular or neurological disorders served as subjects. A depth optokinetic stimulus (DOKS) was projected onto a head-mounted display (HMD) and was perceived to move in depth. Different amounts of the central or peripheral visual field were masked independently. The magnitude of the linear vection induced by the DOKS was evaluated by verbal assessment and compared with the magnitude of induced body sway. Body sway was monitored by a video-motion-analyzer that recorded the movement of the head, shoulder, hip, knee and ankle. RESULTS: The magnitude of vection was correlated with the frequency of DOKS and also with the amplitude of body sway (r = 0.74). When the central visual field was restricted by 10 to 30%, there was almost no change in the induced body sway and vection. However, when central occlusion was greater than 40%, depth perception and induced body movement were greatly reduced. With increasing amounts of peripheral field occlusion from 50 to 90%, there was a greater reduction of both vection and body sway. CONCLUSION: Vection is strongly correlated with body movement, and vection and body sway were more dependent on stimulation of the peripheral visual field.

Adult↗

Hindlimb suspension inhibits air-righting due to altered recruitment of neck and back muscles in rats.

Effects of 9-week hindlimb suspension and 8-week recovery on air-righting reaction in response to drop from a supine position were studied in adult rats. The righting time in rats at the end of suspension (approximately 220 ms) was longer than the age-matched controls (approximately 120 ms, p <0.05). The unloading-related change in righting time was accompanied by lowered activities of electromyogram (EMG) and altered recruitment of both neck and back muscles at a specific stage of drop. After 8 weeks of reambulation, righting time recovered toward the control level (approximately 153 ms, p <0.05), but the EMG activity of back muscle was still less than controls. In contrast, the EMG of neck muscle during fall was even increased. The differences in the characteristics of the muscle fibers between two groups were minor. It is suggested that inhibition of recruitment, rather than the changes in the fiber characteristics, of neck and back muscles is one of the major causes of the slow air-righting.

Adaptation, Physiological↗