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Dynamic performance of vibration induced anterior-posterior sway during upright posture in normal subjects.

Human postural control works as a dynamic feedback control system. The dynamic performance of postural control for anterior-posterior movements during upright posture are defined by three parameters. These parameters reflect the stiffness, the damping and the swiftness of a response to an induced perturbation. In the present study 23 normal subjects were investigated. Both with open and closed eyes, there was a negative correlation between swiftness and stiffness. With open eyes there was also a weak correlation between swiftness and damping. When the subjects were tested with open eyes there was a prominent and highly significant increase of stiffness and a reduction of swiftness of the responses. It was found that proprioceptive information from the calf muscles contributes in postural control of movements up to 1 Hz and visual information is important for movements up to 0.05 Hz. The present findings suggest that postural control changes dynamic strategies depending on the available sensory feedback.

Adolescent↗

Visual postural performance in ametropia and with optical distortion produced by bifocals and multifocals.

Visual stabilization of posture depends strongly on the performance of the visual system and declines with experimentally induced reduction of visual image quality. We studied postural performance in subjects with median and high grade hyperopia or myopia. While body sway of median grade ametropic subjects increased slightly when measured without glasses, high grade ametropia showed no significant differences between postural performance with glasses on and off. We concluded that the increase in visual acuity when wearing glasses is outweighted by concurrent dioptric distortions such as size change and prismatic effects. In addition we could not find any difference between bifocal and multifocal lenses in their effect on sway when investigated in normals with either steady fixation or saccades or foveal pursuit.

Adult↗

Analysis of body sway pattern after alcohol ingestion in human subjects.

Movements of the centre of gravity during 60 s of standing with eyes closed and eyes open were analysed before and after alcohol ingestion up to 8 h in 37 healthy human subjects. Blood alcohol and acetaldehyde concentrations (BAC and BAcHC) were measured simultaneously. Among the parameters analysed, area of posturogram was the most sensitive indicator; it increased to 3.8 times that of the control value at 60 min, after 3.5 ml/kg of ingested whisky (mean BAC of this group was 1.4 mg/ml), with the eyes open. The Romberg ratio, which denotes eyes closed relative to eyes open, remained constant. By contrast, there was little change in stabilometry in cases of 1.2 ml/kg of whisky ingestion (mean BAC at 60 min was 0.58 mg/ml). It is considered that body sway starts to increase when the BAC level exceeds 0.6 mg/ml on average; this value is only higher than the threshold of positional alcohol nystagmus. Correlation coefficients between BAC and each parameter of the stabilogram in the eyes open condition, such as area, X- and Y-axis diameters, and velocity of body sway, were 0.53, 0.45 and 0.48, respectively (p less than 0.01). There was no positive correlation between BAcHC and these parameters.

Acetaldehyde↗

Analysis of body sway in patients with cerebellar lesions.

By using the body sway test, we compared patients with the cerebellar type of spinocerebellar degeneration and with cerebellar hemisphere lesion with normal controls. In the X-direction, the Y-direction, the XY-direction, and the area, the patients with both spinocerebellar degeneration and with cerebellar hemisphere lesion swayed more than the normal controls either with eyes open or closed. In non-sequential 8-vector analysis the patients with spino-cerebellar degeneration swayed forward and backward, while the patients with cerebellar hemisphere lesion swayed right and left, especially with eyes closed. In the patients with the cerebellar type of spinocerebellar degeneration, the vermis atrophy was particularly noticeable. The patients with cerebellar lesions swayed with eyes open just as much as normal controls with eyes closed and did not sway greatly with eyes open. We concluded that the visual input plays an important role in the compensation for postural imbalance in the patients with cerebellar lesions and that the cerebellar hemisphere regulated the sway to right and left, while the vermis regulated the sway forward and backward in an upright standing posture.

Caloric Tests↗

Retro-labyrinthine disorders detected by galvanic body sway responses in routine equilibrium examinations.

Galvanic stimulation applied to the head provides important information for differential diagnosis between inner ear and retro-labyrinthine disorders of the vestibular system. So far, galvanic stimulation has been difficult to introduce in routine practice because of side effects such as severe pain around the electrode area. We have developed a new method to record fine body sway elicited by low current stimulation of less than 0.4 mA and to quantitatively evaluate the responses by Fourier transform. During the past 5 years, 502 patients, showing uni- or bilateral canal paresis in the caloric test or findings of central disequilibrium, were tested by this method without producing any side effects. In 122 patients (24.8%), such as sudden deafness, acoustic tumour, vascular disorders of the CNS system and so on, findings of retro-labyrinthine disorders were detected. It has been concluded that this method was easy to perform and very useful for differential diagnosis of diseases of the vestibular system.

Aged↗

Body sway stabilization in human posture.

Electromyographic (emg) responses and joint movements of the leg were analysed in subjects standing with eyes closed on a sinusoidally moving treadmill (0.16 Hz or 0.33 Hz, amplitude 33 cm). Activity in antagonistic leg muscles was reciprocally modulated, with a predominant gastrocnemius activation during deceleration of forward movement and tibialis anterior activation during deceleration of backward movement of the treadmill. In these phases, it was necessary to compensate for sway induced by body inertia. The match between treadmill movement and emg activity was better for the gastrocnemius than for the tibialis anterior muscle. The characteristic pattern of leg muscle emg activity is suggested to be modulated predominantly by vestibulo-spinal reflexes partly because treadmill movements did not evoke muscle strength, and partly because patients with loss of vestibular function showed basic alterations in the emg pattern and could only compensate for the slow sinus while standing unsupported.

Adult↗

Significance of pressor input from the human feet in anterior-posterior postural control. The effect of hypothermia on vibration-induced body-sway.

The importance to postural control of the mechanoreceptors of the soles was investigated in thirteen healthy subjects. Body-sway velocity was evaluated before and after exposing the subject's feet to hypothermia, and when calf muscles were exposed to vibration at frequencies between 20 and 100 Hz. Subjects were tested both with eyes open and closed. Body-sway velocity was found to increase significantly during hypothermia of the feet. The difference in body-sway between hypothermal and normothermal conditions was less prominent when the subject's eyes were open though the difference was significant in both cases. The present results indicate the importance of the mechanoreceptors of the soles to postural control and elucidate their interaction with compensatory visual input in maintaining postural control. These findings also suggest, that factors affecting pressor input should be taken into consideration when assessing patients with complaints of dysequilibrium.

Adult↗

Effect of gentamicin intoxication on frog behavior.

Eighty micrograms of Gentamicin were injected into bull frogs' perilymphatic cistern for 3 days. Behavioral changes were evaluated together with morphology of the semicircular canal crista and the utricular macula. The behaviors evaluated were posture, walking, head stability, jumping and swimming. The earliest change of behavior was noticed one day after the last injection, and the changes tended to develop over the following 1 to 2 weeks. When the utricular macula was damaged, the frog tilted toward the damaged side. No tilting was observed when bilateral utricles were intact, or when bilateral utricles were equally damaged. Damage of the posterior (p.v.c.) and anterior vertical canal (a.v.c.) cristae resulted in instability of the head. Jumping ability also deteriorated when the p.v.c. and a.v.c. were damaged. These results indicate that p.v.c. and a.v.c. are involved in head stability and jumping function, while the utricle contributes to perception of gravity.

Animals↗

Compensatory process of vestibular neuronitis. From findings of combined galvanic test and caloric test.

The compensatory process of vestibular neuronitis in 7 patients was followed up and evaluated using the Combined Galvanic Test (CGT) and other neuro-otological data. CGT is the simultaneous recording of both galvanic eye movement (GEM) and galvanic body sway (GBS), and has proved to be reliable in the diagnosis of retrolabyrinthine disorders. The results were as follows: The subjective symptoms remained in 3 cases from 1 month to 1 year. The recovery of the GBS response was seen earlier than that of both GEM and caloric responses. The recovery of GEM and caloric responses was observed at almost the same time. We observed the favorable recovery process of caloric response and GEM response in some cases which had recovery of GBS response within 4 weeks and suggest that the system of GBS response is different from that of GEM and caloric response. However, the systems of the latter two may be the same. We assume that the recovery of GBS response is earlier than that of GEM and caloric responses because the otolithic system recovers more easily than the semicircular canal system. The CGT and caloric test were reliable in examining the compensatory process of vestibular neuronitis.

Adult↗

Effect of alcohol measured by dynamic posturography.

Thirteen healthy male volunteers aged 21-42 years (mean 27 years) were assessed by dynamic posturography before and after ingestion of alcohol. Each subject was given 0.6 g alcohol per kg body weight in fruit juice to be drunk within 10 min. Alcohol levels in blood samples at 15, 45 and 75 min after ingestion were assessed by gas chromatography. Posturographic measurements were conducted at 30 and 60 min after alcohol administration. Dynamic posturography comprises a sensory organization part in which the support surface and visual surround are either stable or referenced to the patient's sway and the test conditions are eyes open or eyes closed. In a movement coordination part the platform makes active movements. Alcohol levels were 0.40% (SD 0.14) after 45 min and 0.51% (SD 0.14) at 75 min. All subjects presented positional alcohol nystagmus and gaze nystagmus after 45 min. In the sensory organization part of the dynamic posturography in test conditions with eyes closed and the head in neutral position, both with stable (p less than 0.039) and sway-referenced platform (p less than 0.017), alcohol effects were found. In the test condition with sway referenced platform and stable visual surround the effect of alcohol was close to significance (p less than 0.069). When the head was tilted to either side, no effect of alcohol was detected, nor in the movement coordination test. It is concluded that dynamic posturography can detect the effect of alcohol on static and dynamic equilibrium. Test conditions with absent vision appear to be the most sensitive. The results in static conditions are well in agreement with previous studies; the findings under dynamic conditions are new.

Adult↗

Repeatability and effect of instruction of body sway.

The effect of instruction and repeatability of posturography measurement was studied in 24 healthy volunteers. In an instruction, "stable" (inverted pendular model) and "relaxed" (segmental oscillating model) positions were studied. In addition, the effect of habituation adaptation, and day-to-day variation were investigated. Sway velocity and average and maximum displacement during vibration perturbated stance were analysed. In individual responses, no statistically significant day-to-day variation could be observed and the individual variation was small. In the "relaxed" condition, the instability was greater when maximum displacement was analysed. No significant changes in sway velocity and average displacement were observed. The results demonstrated remarkable stability of normal postural control mechanism.

Adult↗

The Tullio phenomenon in patients with Menière's disease as revealed with posturography.

The effect of low frequency sound (LFS) on postural stability was studied in 55 healthy volunteers and in 50 patients with Menière's disease. The sound levels ranged from 130 to 132 dB and were given at frequencies of 25, 50 and 63 Hz. The patients with Menière's disease displayed increased body sway during stimulation. In the individual response, 26% of the patients with Menière's disease experienced significant body sway. The results demonstrate that subjects with Menière's disease are sensitive to low frequency sound. The activation of vestibulo-spinal responses by low frequency sound seems to be a result of the Tullio phenomenon, in which sound energy activates the vestibular end-organ.

Acoustic Stimulation↗

Dynamic posturography in cervical vertigo.

Cervical vertigo, the entity of neck disorder and associated vestibular symptoms, was investigated in 15 suspected subjects and results were compared with 15 age-matched controls. A modified dynamic posturography investigation with different head positions was used. Head position was recorded 3-dimensionally with electrogoniometry. Differences on a sway-referenced forceplate were found.

Adult↗

Effect of proprioceptor stimulation on postural stability in patients with peripheral or central vestibular lesion.

Body sway in upright stance at rest and after inducing proprioceptor stimulation, elicited by vibration applied to the calf or neck muscles, was studied in 11 patients with peripheral lesion and in 17 patients with central vestibular lesion. The responses were compared with those of 20 normal subjects. Vibratory stimulus was applied at five different frequencies, ranging from 32 to 150 Hz, and at a constant amplitude of 2.1 mm. Postural stability was measured with a force platform in terms of average deviation of body position (ADBP) analyzed in relation to the individual maximum support distance in the anterio-posterior direction. In patients with peripheral vestibular lesion ADBP was moderately increased, compared to normal subjects, when the calf muscles were exposed to vibration under eyes closed conditions (i.e. no visual information available); stimulation of neck muscles both under eyes open and eyes closed conditions and stimulation of calf muscles with open eyes produced an ADBP of the same magnitude as in controls. In patients with central vestibular lesion, proprioceptor stimulation of calf and neck muscles caused increased ADBP whether with eyes open or closed. The ADBP induced by stimulation of neck muscles was significantly greater in patients with a central lesion than in those with a peripheral vestibular lesion. The results indicate that patients with peripheral lesion differ from those with central vestibular lesion in their reaction to proprioceptor stimulus; and that in patients with central vestibular lesion proprioceptor stimulation of the neck muscles produces disproportionately powerful cervico-collic reflexes.

Brain Stem↗

Abstinent chronic alcoholics investigated by dynamic posturography, ocular smooth pursuit and visual suppression.

Eleven male chronic alcoholic volunteers aged 44-65 years (mean 57 years) were investigated by dynamic posturography, ocular smooth pursuit and visual suppression of the vestibulo-ocular reflex (VOR). Their drinking time ranged from 8-30 years (mean 20 years) and they had been abstinent for the last 1-20 years (mean 7 years). Ocular smooth pursuit showed abnormalities in 8/11. Abnormalities were found in 5/11 in the visual suppression of the VOR. The results of dynamic posturography tests were compared to an age-matched reference material. Dynamic posturography (EquiTest) comprises a sensory organization (SO) part in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed. In the SO part the chronic alcoholics had lower equilibrium scores in all test conditions, and the differences were significant in 4 tests out of 6. In a movement coordination part the platform makes active movements, the latencies to which were significantly prolonged in the 2 larger of the 3 translational amplitudes. Adaptation to repeated tilting of the platform was estimated to be pathological in 4/10, compared to none of the controls. The abnormal pattern found in dynamic posturography correlates well with the pathology in ocular smooth pursuit and visual suppression tests, suggested to be due to alcohol induced cerebellar lesions. It is concluded that dynamic posturography is a valuable test for assessing dysequilibrium in chronic alcoholics, even abstinent.

Adult↗

Visual influence on postural reactions to sudden antero-posterior support surface movements.

Visual influence on force reactions to sudden antero-posterior (AP) translations of the support surface in 10 healthy men 23-58 years old (mean 36 years) were studied. Displacements ranged between 13 and 127 mm in both backwards and forwards directions. The experiment was conducted using a modified EquiTest dynamic posturography apparatus. An interactive menu-driven software enabled selection of a suitable translation pattern (i.e. square wave) in the AP direction. Data from four vertical force transducers were acquired and the position of centre of pressure (CP) in the AP direction was computed as function of time. The movement of CP in response to AP translation was characterized by the amplitude of the maximum CP displacement relative to the platform and the latency until maximum CP displacement occurred. The experiment unveiled that the latency to maximum CP displacement was larger for conditions with vision present. Furthermore, both the amplitude and latency to maximum CP deflection were increasing functions of translation amplitude. It is proposed that visual feedback influences the neural control on the postural reactions to sudden support surface translations. Absence of visual cues seems to cause a more rapid correction of the body position.

Adult↗

Influence of subjects' height on the stabilization of posture.

In order to investigate the influence of subjects' height in stabilization of body sway, postural EMG reactions were analysed following perturbation of posture during stance on a force measuring platform. Perturbing momenta of different strengths were unexpectedly applied at the back (level of the center of gravity) after being matched to the body weight of each subject. EMG activity of the antagonistic leg muscles and head, hip and ankle joint movements were recorded. There was a close correlation between displacement amplitude at the ankle joint and height of the subject, with the largest displacements in small subjects. The consequence of this relationship was that 1) The compensatory reactions consisted of larger gastrocnemius responses and a stronger coactivation of the tibialis anterior; 2) Momenta of increasing strength resulted in a larger increment of both ankle joint displacement and gastrocnemius EMG responses in small compared to larger subjects. In analogy to tip-toeing movements, it is concluded that the coactivation pattern is typical for stance conditions with a restricted area of support in order to reduce body sway. On the basis of latency measurements it is suggested that the response pattern is induced by proprioceptive information from the impact site of the momentum.

Adolescent↗