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Striatal influences on paravermal cerebellar activity.

Units were recorded extracellularly in paravermal cortex (lobule VI) of the cerebellum of chloralose anesthetized cats. Electrical stimulation of the striatum evoked excitation followed by inhibition in these neurons. In addition, the somatosensory properties of these cells were also affected by the striatum. A conditioning-test paradigm (C-T) was used in which conditioning stimulation was applied to the striatum. Test responses were evoked in cerebellar neurons by facial stimulation. As a function of the C-T interval, striatal stimulation could either enhance or suppress the test facial responses. In another procedure, a moveable electrode was used to map the thresholds for affecting the cerebellum from different points in the striatum. The lowest mean threshold was in the putamen followed respectively by the internal capsule and caudate nucleus. Control experiments suggested that striatal effects on the cerebellum were due neither to extra-striatal current spread nor antidromic activation of corticostriatal fibers. These data were discussed with regard to models of striatal motor functioning that indicate a role in postural control and sensory gating.

Action Potentials↗

An ultrasonic-operated kinematic measurement system for assessment of stance balance in the clinic.

This study describes the application of a kinematic measurement system based on ultrasonic technology to enable the assessment of stance balance in the clinic. The system is composed of 1-8 ultrasonic transducer markers which transmit ultrasonic waves, and three ultrasonic receivers. The spatial position of each marker is monitored by calculation of the time interval between transmission and reception of the wave. Sway data from the waist of 44 healthy subjects and 15 hemiparetic patients were collected during quiet stance. The results distinguished between data collected with and without vision, between patients and controls, and between the two sides of the body. The findings were found to be valid and reliable in repeated measurements. RELEVANCE:--Assessment of stance balance in the clinic is a requisite for quantifying disability and measuring improvement in patients with postural control deficits. Due to high costs and complexity of operation, the use of prevailing equipment for these purposes is mainly confined to research facilities. This paper describes a unique kinematic measurement system whose low price and ease of operation make it feasible for clinical use.

Journal Article↗

The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash.

Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The results indicated that over all subjects, significant but weak-to-moderate correlations existed between all comfortable stance balance tests and both the SPNT and rotation cervical JPE tests. A weak correlation was found between the SPNT and right rotation cervical JPE. An abnormal rotation cervical JPE score had a high positive prediction value (88%) but low sensitivity (60%) and specificity (54%) to determine abnormality in balance and or SPNT test. The results suggest that in patients with persistent WAD, it is not sufficient to measure JPE alone. All three measures are required to identify disturbances in the postural control system.

Adult↗

Responses to efferent activation and excitatory response-intensity relations of turtle posterior-crista afferents.

Multivariate statistical formulas were used to infer the morphological type and longitudinal position of extracellularly recorded afferents. Efferent fibers were stimulated electrically in the nerve branch interconnecting the anterior and posterior VIIIth nerves. Responses of bouton (B) units depended on their inferred position: BP units (near the planum semilunatum) showed small excitatory responses; BT units (near the torus) were inhibited; BM units (in an intermediate position) had a mixed response, including an initial inhibition and a delayed excitation. Calyx-bearing (CD-high) units with an appreciable background discharge showed large per-train excitatory responses followed by smaller post-train responses that could outlast the shock train by 100 s. Excitatory responses were smaller in calyx-bearing (CD-low) units having little or no background activity than in CD-high units. Excitatory response-intensity functions, derived from the discharge during 2-s angular-velocity ramps varying in intensity, were fit by empirical functions that gave estimates of the maximal response (r(MAX)), a threshold velocity (v(T)), and the velocity producing a half-maximal response (v(1/2)). Linear gain is equal to r(MAX)/v(S), v(S) = v(1/2) - v(T). v(S) provides a measure of the velocity range over which the response is nearly linear. For B units, r(MAX) declines by as much as twofold over the 2-s ramp, whereas for CD units, r(MAX) increases by 15% during the same time period. At the end of the ramp, r(MAX) is on average twice as high in CD as in B units. Thresholds are negligible in most spontaneously active units, including almost all B and CD-high units. Silent CD-low units typically have thresholds of 10-100 deg/s. BT units have very high linear gains and v(S) < 10 deg/s. Linear gains are considerably lower in BP units and v(S) > 150 deg/s. CD-high units have intermediate gains and near 100 deg/s v(S) values. CD-low units have low gains and v(S) values ranging from 150 to more than 300 deg/s. The results suggest that BT units are designed to measure the small head movements involved in postural control, whereas BP and CD units are more appropriate for monitoring large volitional head movements. The former units are silenced by efferent activation, whereas the latter units are excited. This suggests that the efferent system switches the turtle posterior crista from a "postural" to a "volitional" mode.

Algorithms↗

Environmental changes in soleus H-reflex excitability in young and elderly subjects.

The purpose of this study was to examine the role of task complexity on soleus H-reflex modulation in young and elderly subjects. Twelve young (mean age = 29.2yrs) and 10 elderly (mean age = 75.1 yrs) apparently healthy individuals were examined under four experimental conditions: (1) eyes open on normal floor surface; (2) eyes open on foam floor surface; (3) eyes closed on normal floor surface; and (4) eyes closed on foam surface. Under each condition, soleus H-reflexes, and background electromyography (EMG) (40 ms window prior to stimulation in both the soleus and the tibialis anterior) were recorded. Postural sway in each condition was also assessed using a Kistler force platform. Results indicated differential reflex modulation between young and elderly subjects. Specifically, young subjects depressed the amplitude of the reflex as task complexity was increased. Elderly subjects, on the other hand, increased the amplitude of the H-reflex when utilizing visual cues, but decreased H-reflex amplitude when vision was occluded. Postural sway in both groups increased as task complexity was increased. There existed a significant difference in the relationship between tibialis anterior activation and soleus H-reflex between the two groups. These results demonstrate differential reflex adjustments between young and elderly subjects as task complexity is increased, and may provide useful information pertaining to postural control in the elderly.

Adult↗

Postural sway with earth-fixed and body-referenced finger contact in young and older adults.

Sensory information from lightly touching a reference with the hand is known to influence postural sway in young adults. The primary aim of this study was to compare the influence of finger contact (FC) with an earth-fixed reference to the influence of FC with a body-fixed reference. A second goal of this study was to determine if FC is used differently by older adults compared to younger adults. Using a force plate, center of pressure at the feet was recorded from blindfolded young and older subjects during several conditions. Subjects either did or did not lightly touch a force-sensitive plate that was either earth-fixed or moved forward and backward in synchrony with body sway (that is, sway-referenced). In addition, support surface conditions were also varied, including a fixed floor and a sway-referenced floor using an Equitest. Results showed that the type of FC, floor condition, and age each had an effect on postural sway. Touching an earth-fixed plate decreased postural sway as compared to no touching, while touching a sway-referenced plate increased sway. This influence of FC was enhanced when the floor was sway-referenced. Although older subjects swayed more than young subjects overall, no age-FC interactions occurred, indicating that FC was not utilized differently between the age groups. This study suggests that FC cannot be disregarded as erroneous, especially when proprioceptive information from the legs is distorted. Further, FC is integrated with other sensory information by the postural control system similarly in young and older persons.

Adult↗

Visuo-vestibular integration in the development of posture and gait.

This paper will mainly review recent data on the visual and/or vestibular contributions to the development of posture and gait in humans. Some animal data will also be reported in the attempt of clarifying the functional role of both these sensory inputs. Because it carries the visual and vestibular sensors, the privileged role played by the head in the control of balance will be particularly emphasized. An hypothetic scheme will be proposed for the time course of the early visuovestibular integration, which simply assumes that it roughly follows the descending, cephalo-caudal progression with age of the infants' ability to control postural muscles (101).

Animals↗

The multicomponent nature of equilibrium in persons with parkinsonism: a regression approach.

Lower extremity strength and joint range of motion, body sway, and electromyography responses have all been determined to be factors in balance control of healthy older individuals. The purpose of this study was to identify variables which effect balance control (equilibrium scores) of persons with Parkinsonism, and examine their relationships and predictive abilities. The composite equilibrium score from the sensory organization protocol of the Equitest was used as the dependent variable for the regression analysis. The independent variables included: 1) strategy score; 2) path sway during voluntary body displacement; 3) percent peak torque of knee flexion relative to that of knee extension (%PTKFKE); 4) peak torque of inversion of the ankle at (PTINV); 5) dorsiflexion ROM; and 6) medium loop latency (EMG). The model produced a significant overall relationship accounting for 88% of the variability in equilibrium scores. Positive and significant coefficients indicated a predicted increase in the equilibrium composite score with increases in the strategy score, PTINV and %PTKFKE. These results suggest that postural control of persons with Parkinsonism can be strongly predicted by these three variables.

Aged↗

Internal models in sensorimotor integration: perspectives from adaptive control theory.

Internal models and adaptive controls are empirical and mathematical paradigms that have evolved separately to describe learning control processes in brain systems and engineering systems, respectively. This paper presents a comprehensive appraisal of the correlation between these paradigms with a view to forging a unified theoretical framework that may benefit both disciplines. It is suggested that the classic equilibrium-point theory of impedance control of arm movement is analogous to continuous gain-scheduling or high-gain adaptive control within or across movement trials, respectively, and that the recently proposed inverse internal model is akin to adaptive sliding control originally for robotic manipulator applications. Modular internal models' architecture for multiple motor tasks is a form of multi-model adaptive control. Stochastic methods, such as generalized predictive control, reinforcement learning, Bayesian learning and Hebbian feedback covariance learning, are reviewed and their possible relevance to motor control is discussed. Possible applicability of a Luenberger observer and an extended Kalman filter to state estimation problems-such as sensorimotor prediction or the resolution of vestibular sensory ambiguity-is also discussed. The important role played by vestibular system identification in postural control suggests an indirect adaptive control scheme whereby system states or parameters are explicitly estimated prior to the implementation of control. This interdisciplinary framework should facilitate the experimental elucidation of the mechanisms of internal models in sensorimotor systems and the reverse engineering of such neural mechanisms into novel brain-inspired adaptive control paradigms in future.

Adaptation, Physiological↗

A training program for operation of a head-controlled electric wheelchair.

A biofeedback training device providing auditory and visual feedback regarding head position in space was used to teach the head control necessary for the operation of a head-driven electric wheelchair. A case study of an adolescent with severe athetoid cerebral palsy is presented. The training program consists of four short-term goals: to provide trunk stability; to promote limb and postural control; to teach static head control; and to teach dynamic head control. The authors found that the biofeedback training device was a useful tool for teaching the head control required to operate a head-driven electric wheelchair. Among the recommendations discussed in the conclusion of this paper is the suggestion that certain pieces of equipment, such as a time-event counter and videotape equipment, would be very useful tools for collecting objective information about the patient's progress.

Hospital Bed Capacity, under 100↗

Standardizing performance-based criteria for support surfaces.

Due to the sparsity of prospective, controlled, clinical studies on the efficacy of and the lack of standardized information about support surfaces, current literature does not clearly define how these surfaces address patient needs. Standardization would help healthcare professionals make better informed decisions about the use of support surfaces. Standardization would also help researchers design and implement controlled, clinical studies by defining characteristics of surface evaluation, making it possible to replicate research activities. The first step toward standardization is to develop a performance-based set of criteria for classifying these surfaces. With respect to the three purposes identified: comfort, postural control and pressure management, only parameters that can be measured noninvasively, have been considered. The nine parameters are life expectancy of the surface, skin moisture control, skin temperature control, redistribution of pressure, product service requirements, fail safety, infection, flammability, and patient/product friction. Specific guidelines for each of these nine parameters are discussed in depth. With testing and evaluation of support surfaces standardized, clinicians will be able to choose a surface to meet the needs of patients the same way they make other treatment decisions: based on outcomes and the results of controlled, clinical studies.

Beds↗

Respiratory components of human postural sway.

The effects of respiration on postural sway in normal human subjects was studied using averaging and spectral techniques. During voluntarily paced respiration a substantial proportion of sway was found to result from respiratory activity. The magnitude of the respiratory contribution to sway was approximately constant over the normal range of respiratory rates and linearly related to respiration amplitude. Respiration evoked similar changes in reaction torque in seated subjects. These results indicate that body movements associated with paced respiration are an important disturbance to the postural control system. Furthermore, these disturbances are not reduced by compensatory movements of the hip as has been suggested by others.

Humans↗

Effects of kinematics constraints on hand trajectory during whole-body lifting tasks.

Trajectories of the hands and whole-body center of mass were studied during whole-body lifting tasks. The movements of different parts of the body were monitored with the ELITE system. Subjects were instructed to lift to shoulder height an object placed at one of two distances (5-45 cm) before them on the floor. The lifts were performed both with and without kinematics constraints (i.e. to produce a straight hand trajectory while lifting, and to lift without any instructions, respectively). Hand trajectories were roughly straight when performed under the constrained condition, but curved when performed without instruction. Hand velocity curves showed bell-shaped profiles. In both groups, body centers of mass (whole-body, upper and lower part) were calculated and their trajectories showed invariant sagittal displacements. These results support the idea that movement contributes to postural control and, reciprocally, that whole-body center of mass is a robust and controlled variable which plays an important role in hand trajectory formation.

Adult↗

A video-polygraphic analysis of the cataplectic attack.

OBJECTIVES AND METHODS: To perform a video-polygraphic analysis of 11 cataplectic attacks in a 39-year-old narcoleptic patient, correlating clinical manifestations with polygraphic findings. Polygraphic recordings monitored EEG, EMG activity from several cranial, trunk, upper and lower limbs muscles, eye movements, EKG, thoracic respiration. RESULTS: Eleven attacks were recorded, all of them lasting less than 1 min and ending with the fall of the patient to the ground. We identified, based on the video-polygraphic analysis of the episodes, 3 phases: initial phase, characterized essentially by arrest of eye movements and phasic, massive, inhibitory muscular events; falling phase, characterized by a rhythmic pattern of suppressions and enhancements of muscular activity, leading to the fall; atonic phase, characterized by complete muscle atonia. Six episodes out of 11 were associated with bradycardia, that was maximal during the atonic phase. CONCLUSIONS: Analysis of the muscular phenomena that characterize cataplectic attacks in a standing patient suggests that the cataplectic fall occurs with a pattern that might result from the interaction between neuronal networks mediating muscular atonia of REM sleep and neural structures subserving postural control.

Adult↗

Is body balance more perturbed by respiration in seating than in standing posture?

The perturbing influence of respiration on balance was studied in sitting and standing subjects. The pneumograms and displacements of the centre of pressure of 10 normal subjects were recorded during quiet breathing, deep breathing and apnoea. The usual stabilometric parameters were measured, and a power spectrum density and time-locked averaging were used. The sway path was longer in seated subjects than in standing ones, suggesting that instantaneous compensatory phenomena are less efficient. The respiratory component of the sway path was larger in seated (0.16) than in standing subjects (0.09). It is concluded that respiration is a significant input for postural control, and that sitting entails less instantaneous steadiness. The concept of respiratory synergy is discussed.

Adult↗

Masseter muscle responses to forelimb nerve stimulation in the guinea pig.

These experiments were aimed at clarifying the spinal-masseteric connections by observing the effect of electrical stimulation of radial nerve afferents on masseter muscle activity. Spontaneous and evoked electrical responses of the masseter motor units were recorded with tungsten microelectrodes and analysed on computer. Results show that electrical stimulation of both radial nerves induces responses in single masseter motor units. The response patterns were characterized most frequently by excitation, but also by a sequence of excitation inhibition. The latency in masseter muscle responses were found to be lower in contralateral recordings: 18.26 +/- 4.04 msec (x +/- SD) compared with a latency of 24.3 +/- 5.25 msec in ipsilateral recordings. These observations confirm the hypothesis that somatosensory impulses eminating from the radial nerve participate in the postural control of the masseter muscle aimed at maintaining correct jaw position during forelimb displacement.

Animals↗

A new translational platform for evaluating aging or pathology-related postural disorders.

CONCLUSIONS: Dynamic posturography using a translational platform and new parameters for quantifying postural reactions to linear displacements were suitable for differentiating between aging and pathological effects in upright postural control. These tools should be used on a wider scale in the near future for both routine tests and rehabilitation purposes, including the prevention of falls in elderly people. OBJECTIVE: To demonstrate that dynamic posturography using a translational platform and new parameters for quantifying postural reactions to linear displacements constitute a more suitable way of discriminating age and/or pathology-induced postural effects. MATERIAL AND METHODS: Three groups of young healthy, elderly healthy and elderly unstable patients were tested on a translational platform using ramp (0.03, 0.07 and 0.1 m/s) and sinusoidal (0.25 and 0.5 Hz) stimulations. Their dynamic performances were compared to their postural evaluation on a static platform using classical stabilometric parameters (surface, length, etc.) and stabilogram-diffusion analysis (critical point coordinates and short-term diffusion coefficient). RESULTS: The translational platform, the new parameters elaborated for quantifying postural reactions (energy and time for postural stabilization, phase and gain of the postural response) and the visual condition under which the subjects were tested (eyes open versus eyes closed) discriminated all groups better than the classical methods.

Adult↗

Effect of orthotics on postural sway following inversion ankle sprain.

Orthotic devices have been shown to successfully modify selected aspects of lower extremity mechanics and enhance foot stability during the support phase of running. It was hypothesized that orthotic intervention would relieve excessive strain on the ankle ligaments and reduce postural sway, especially in subjects with acute ankle sprains. The primary purpose of this study was to determine if orthotics would reduce postural sway in injured and uninjured subjects. Thirteen subjects with acute inversion ankle sprain and 12 uninjured subjects were assessed for postural sway on the Balance System under two treatment conditions (orthotic and nonorthotic) and four platform movements. A three-factor repeated measures analysis of variance revealed a significant group X treatment interaction, suggesting that postural sway with orthotic intervention improved significantly more in injured subjects than in uninjured subjects. A significant platform movement X treatment interaction, furthermore, revealed that postural sway for the four movement conditions was dependent upon treatment (orthotic vs. no orthotic). Tukey post hoc analysis revealed that orthotic intervention significantly reduced postural sway when the platform moved in the medial/lateral plane and inversion/eversion plane. This research suggests that custom-fit orthotics may restrict undesirable motion at the foot and ankle and enhance joint mechanoreceptors to detect perturbations and provide structural support for detecting and controlling postural sway in ankle-injured subjects.

Acute Disease↗