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Effect of long-term bedrest on lower leg muscle activation patterns during quiet standing.

It has been well known that balance instabilities after long-term exposure to microgravity (e.g., Anderson et al. 1986) or bedrest (BR) can be related to alterations and/or adaptations to postural control strategies. Little is known, however, how the reduced muscular activity affects the activation pattern of the lower limb muscles during quiet standing (QS). The purpose of this study was to investigate whether or not any changes in the lower limb muscle activation patterns during QS would occur after BR.

Adult↗

Vasopressin in the locus coeruleus and dorsal pontine tegmentum affects posture and vestibulospinal reflexes.

Vasopressin (VP) acts on both the locus coeruleus (LC) neurons and the neighbouring dorsal pontine reticular formation (PRF) neurons by exciting them. Experiments performed in precollicular decerebrate cats have shown that microinjection of 0.25 x 10(-11) micrograms VP into the LC complex of one side increased the extensor rigidity of the ipsilateral limbs, while rigidity of the contralateral limbs remained unmodified or slightly decreased. The amplitude of modulation and thus the response gain of both the ipsilateral and the contralateral forelimb extensor triceps brachii to sinusoidal roll tilt of the animal (at 0.15 Hz, +/- 10 degrees), leading to stimulation of labyrinth receptors, decreased significantly, while there was only a slight decrease in phase lead of the responses. These effects occurred 5-10 min after the injection, were fully developed within 30 min and disappeared in about 2 h. VP activation of presumed noradrenergic LC neurons had a facilitatory influence on ipsilateral limb extensor motoneurons, either directly through the coeruleospinal (CS) pathway, or indirectly by inhibiting the dorsal PRF and the related medullary inhibitory reticulospinal (RS) neurons. Moreover, because the facilitatory CS neurons fire out-of-phase with respect to the excitatory VS neurons, we postulated that the higher the firing rate of the CS neurons in the animal at rest, the greater the disfacilitation affecting the limb extensor motoneurons during side-down animal tilt. These motoneurons would then respond less efficiently to the excitatory VS volleys elicited for the same direction of animal orientation, leading to a reduced gain of the EMG responses of the forelimb extensors to labyrinth stimulation. In contrast to these findings, unilateral injections of the same dose of VP immediately ventral to the LC, i.e., in the peri-LC alpha and the surrounding dorsal PRF, where presumed cholinergic neurons are located, decreased extensor rigidity in the ipsilateral limbs while that of the contralateral limbs either decreased or increased. The same injection also produced either a moderate or a marked increase in gain of the multiunit EMG response of the ipsilateral triceps brachii to animal tilt. In the first instance the response gain of the contralateral triceps brachii to animal tilt increased slightly, while the corresponding response pattern remained unmodified, as shown for the ipsilateral responses (increased EMG activity during ipsilateral tilt and decreased activity during contralateral tilt). In the second instance, however, the response gain of the contralateral triceps brachii showed only slight changes, while the pattern of response was reversed. These effects occurred 5-20 min after the injection, developed fully within 20-60 min and disappeared in 2-3 h. We postulated that VP increased the discharge of the dorsal PRF neurons and the related medullary inhibitory RS neurons of the injected side, leading to reduced postural activity of the ipsilateral limbs. However, because these inhibitory RS neurons fire out-of-phase with respect to the excitatory VS neurons, it appeared that the higher the firing rate of the RS neurons in the animal at rest, the greater the disinhibition affecting the limb extensor motoneurons during ipsilateral tilt. These motoneurons would then respond more efficiently to the same excitatory VS volleys elicited by given parameters of stimulation, leading to an increased gain of the EMG responses. The contralateral effects could be attributed to crossed excitation by dorsal PRF neurons of one side, either of medullary inhibitory RS neurons or of excitatory CS neurons of the opposite side, respectively. We conclude that VP controls posture and gain of the VS reflex by acting on LC neurons as well as on dorsal PRF and the related medullary inhibitory RS neurons.

Animals↗

Visual influences on vestibulospinal reflexes during vertical linear motion in normal and hemilabyrinthectomized monkeys.

In the present investigation, we have analysed the visually induced modulations of muscular responses during falls at different rates of acceleration and performed in five different visual conditions: Normal vision (NV), Darkness (D), Stabilized vision (SV), with visual motion cues being enhanced (EV), or reduced (RV). This study was conducted on normal and hemilabyrinthectomized baboons. EMG activities were recorded in the alert monkey from three pairs of muscles (splenius capitis, soleus and tibialis anterior). For testing, the monkey was seated in a special chair unexpectedly dropped by 0.9 m. Five peaks of maximum acceleration were used (8.8, 6.6, 4.4, 3.3, 2.2 m/s2). Conditions EV, SV and RV were tested by way of projector, the input of which consisted of the integral of vertical acceleration and output, the output of which controlled film motion. In the normal baboon the visually induced modulation of EMG responses in the SV, EV, and RV conditions was larger for slow falls than for fast ones. This modulation was direction-specific, at least for slow falls, and depended on the relative speed of the visual scene. Between certain limits, the energy of the responses was roughly proportional to the relative speed of the visual scene. These modifications were most accentuated in the splenius and soleus muscles. Condition D only produced a slight reduction of the EMG response. All these findings eliminate the possibility that the observed effects represents a startle response. Thus, we can conclude that there is a fact directional role of vision in postural control in the normal falling baboon. In the hemilabyrinthectomized animal, greater modulations were recorded only when the visual manipulations were performed during the first two postoperative weeks. This confirms the above results on the normal baboon and previous data on the role of vision in the recovery process.

Animals↗

Wheelchair seating: a state of the science report.

Regardless of the field, agenda-setting processes are integral to establishing research and development priorities. Beginning in 1998, the National Institute on Disability and Rehabilitation Research mandated that each newly funded Rehabilitation Engineering and Research Center (RERC) hold a state-of-the-science consensus forum during the third year of its 5-year funding cycle. NIDRR's aim in formalizing this agenda-setting process was to facilitate the formulation of future research and development priorities for each respective RERC. In February 2001, the RERC on Wheeled Mobility, University of Pittsburgh, conducted one of the first such forums. The scope encompassed both current scientific knowledge and clinical issues. In preparation, expert interviews were carried out to establish the focus for the forum. Because a stakeholder forum on wheelchair technology had recently been held, opinion favored wheelchair seating as the focus and included the following core areas: seating for use in wheelchair transportation, seated postural control, seating discomfort, and tissue integrity management. The aim of this report is to present a summary of the workshop outcomes, describe the process, and increase awareness of this agenda-setting process in order to enhance future participation in a process that critically influences the field of wheeled mobility.

Persons with Disabilities↗

[Influence of vibration on the equilibrium of patients with unilateral labyrinthine dysfunction].

To determine the role of proprioceptors of different skeletal muscles in posture control in patients with unilateral labyrinthine dysfunction (ULD), we studied the effect of vibration on those muscles by postulography. Subjects were 59 healthy people and 20 ULD patients. We measured the length of the displacement of the center of gravity, maximum sway length, and sway area. Significant differences were observed between healthy and ULD subjects on stimulation of the muscle groups of the upper and lower extremity during vibration. In patients with ULD, vibration to the dorsal neck muscles caused a deviation toward the diseased side. We speculate that the upper dorsal neck muscle plays an important role in maintaining body balance in the frontal plane in patients with ULD. The upper and lower extremity muscles play a significant role in adjusting standing posture.

Adult↗

Spaceflight influences on ocular counterrolling and other neurovestibular reactions.

Exposure to extended periods of weightlessness in orbital flight has profound effects on the neurovestibular system and influences head and eye movements, postural control, and spatial orientation. The associated space motion sickness is among the earliest of the signs of adaptation to this new environment. This report both reviews the prominent neurovestibular phenomena associated with going into space and returning to earth and relates the issues to vestibular compensation and rehabilitation. New results from the Spacelab SLS-2 mission are included, showing significant reductions in postflight ocular counterrolling and changes in ocular counterrolling left/right asymmetries after 2 weeks in space.

Humans↗

Effects of trunk position on back surface-contour measured by raster stereophotography.

A study of the contour of the surface of the back was conducted using the Quantec spinal image system (QSIS; raster stereophotography) and the Vicon 3-dimensional (3-D) motion analysis system with a plaster model of the scoliotic spine. With postural changes in 3 dimensions came alterations in the surface shape of the back. Most changes in QSIS parameters occurred in the coronal plane. The study showed that model 1, with 9 degrees of Q angle (similar to Cobb angle in the coronal plane) in right thoracolumbar scoliosis, altered 3-D metrics less than model 2 did, with 54 degrees of Q angle in scoliosis. The change in the position of the trunk in the transverse plane had a more significant impact on the QSIS parameters. Raster stereophotography has been used clinically to monitor curve progression. Changes in transverse rotation of the trunk correlate significantly with variations in Q angle and axial rotation. Clinicians using a raster stereophotograph system to assess scoliotic deformity need to control postural sway, as doing so results in more stable and reproducible measurements that can be used for clinical follow-up.

Back↗

A biomechanical perspective on spinal mechanisms of coordinated muscular action: an architecture principle.

A principle of organization of spinal circuitry which emerges from the studies reviewed here is that the structure of the distributed network of pathways in the spinal cord contains a detailed representation of the corresponding three dimensional architecture of the musculoskeletal system. The pertinent architectural features for a given muscle include (1) the number and identity of spanned joints, and (2) the line of action at a joint with respect to the torque directions of other muscles and to the gravity vector. In accordance with established ideas, muscles with common primary actions (synergists) at the ankle are linked by excitatory, length-dependent pathways. Those muscles which have opposite actions are linked by reciprocal inhibition, although muscles which are not principally involved in postural control are not connected in this way. Among antigravity and stabilizing muscles, force-dependent, inhibitory pathways link (1) muscles crossing different joints, and (2) members of different synergistic groups which exert torques in different directions. Therefore, each muscle has a unique set of actions in terms of joints spanned and line of action, and each muscle receives a unique combination of reflex inputs. The cross-joint coordination resulting from actions of force-dependent pathways becomes stronger at higher forces with a consequent reduction in degrees of freedom of the musculoskeletal system. Length-dependent pathways link muscles which share some, but not all, mechanical actions at a joint and may have different patterns of activation during locomotion. Length-dependent pathways appear to coordinate muscle responses to postural disturbances and enhance joint stiffness.

Animals↗

Instrumented Walkway Gait Analysis Predicts Fallers in Neurological Disorders: Identifying Digital Biomarkers for Balance Monitoring.

Assessing balance is crucial in neurological rehabilitation, yet while wearable sensors enable real-world monitoring, identifying reliable digital biomarkers remains challenging. This study utilized a high-fidelity instrumented walkway to determine which gait parameters best predict balance impairment, providing robust targets for future wearable applications. We analyzed 49 steady-state gait metrics from 140 individuals with diverse neurological conditions. Using statistical analysis and machine learning, we evaluated these parameters against objective force plate sway scores and clinical fall-history labels. Group analysis identified 16 parameters significantly distinguishing fallers from non-fallers, and a neural network classified fallers with an area under the curve of 0.75. Across all analytical approaches, overall gait variability, e.g., Stride Width S.D. and the Gait Variability Index, emerged as a universal predictor of balance impairment and fall risk. Furthermore, while traditional linear models emphasized spatial postural control, machine learning classification uniquely identified inter-limb asymmetry as a premier driver of fall prediction. These findings indicate that instrumented gait analysis effectively identifies digital biomarkers for balance deficits. Isolating these specific metrics provides a clear blueprint for meaningful metrics required for continuous objective monitoring and future development of personalized, adaptive rehabilitation strategies.

Humans↗

Use of the Alberta Infant Motor Scale to characterize the motor development of infants born preterm at eight months corrected age.

The Alberta Infant Motor Scale (AIMS) was used to examine variations in motor development of infants born preterm. Sixty infants attending a Developmental Follow-up Clinic participated. Infants were assessed by physical therapists using the AIMS and independently judged by physicians to be neurodevelopmentally and neurologically "normal," "suspect," or "abnormal." The AIMS clearly differentiated infants in these three categories. Compared to the normative sample, infants judged to be "normal" demonstrated similar motor behaviors, infants judged to be "abnormal" were significantly different across a wide range of items, and infants judged to be "suspect" were significantly different on items requiring antigravity postural control, lower extremity dissociation, and trunk rotation. The AIMS can be used to identify infants developing abnormally, to affirm normalcy in infants developing typically, and to identify motor differences in infants who are neurologically "suspect." In the latter group of infants, the AIMS can be used to provide anticipatory guidance to parents regarding the components of movement they might expect their infants to be developing next.

Developmental Disabilities↗

Visual deficiency and scoliosis.

STUDY DESIGN: A transversal study involving group comparison was performed. OBJECTIVE: To investigate whether children who are visually impaired have a higher rate of spinal deformity. SUMMARY OF BACKGROUND DATA: Evidence has accumulated pointing to an association between idiopathic scoliosis and postural control in which vision is involved. An association between scoliosis and ocular troubles is present in many diseases, but no study on a large blind population has yet been undertaken. METHODS: Data was obtained from an official school screening campaign involving two consecutive classes in a regional school for the visually handicapped and from two consecutive classes in three public vocational schools. This study included 75 children who were visually handicapped (mean age, 11 years and 7 months) and 728 healthy control participants (mean age, 10 years 2 months). Trunk deformity was assessed by Moire topography and measurement of any trunk hump by the forward bending test. The children with visual impairment who had evidence of trunk deformity underwent radiographs of the spine a few months after the back surface assessment, then again 12 to 24 months later. RESULTS: Occurrences of trunk deformity were significantly different in the two groups (P < 0.0001), with five times more back surface abnormalities in the blind population. Of the 26 children with both visual impairment and trunk deformity, 18 had a structural scoliosis on radiographs, with an average Cobb Meyer angle of 14.1 degrees (range, 10-28 degrees ), but there was evidence of an evolving condition in only three cases. CONCLUSIONS: These findings are compatible with a postural etiology of scoliosis in the visually impaired population.

Adolescent↗

[Neuro-ophthalmologic and posturographic studies of patients with idiopathic torticollis].

The pathophysiology of idiopathic spasmodic torticollis is still unknown. In addition to genetic and other factors, one of the possible causes under discussion is a disturbance of the vestibular system. In order to analyse vestibular influences we investigated 40 patients with idiopathic torticollis using electronystagmography, fundus photography, measurement of the subjective visual vertical and posturography. The results of the neuroophthalmological investigations and the measurement of the visual vertical were within the normal range. 53% of the patients examined showed a slight central vestibular preponderance in the electronystagmography, whereas 38% demonstrated a slight pathological monocular torsion in the fundus photography. Posturographically, there were some indications of a slightly decreased gain in visual contribution to the postural control process. None of the results could be correlated to the extent of torticollis in the individual case. We propose that these results do not confirm the hypothesis of primary vestibular lesion in the pathogenesis of torticollis. A possible explanation of the results described could be a common basic lesion which causes the torticollis on the one hand and also affects the central vestibular system on the other hand.

Adult↗

Subjective visual tilt and lateral instability after vestibular deafferentation.

CONCLUSION: Defective utricular function, reflected by deviation of the perceived visual horizontal or vertical, cannot by itself explain increased postural sway in the lateral direction for patients with unilateral vestibular deafferentation (uVD). OBJECTIVE: It is not known why some patients with chronic uVD report distressing unsteadiness while others do not. The objective of this study was to test the hypothesis that impaired utricular compensation, reflected by pathologic tilt in the subjective visual horizontal and vertical (SVH-V) test, would affect postural control in the lateral direction after uVD. PATIENTS AND METHODS: The SVH-V was tested in 28 patients 6 months after translabyrinthine surgery for unilateral vestibular schwannoma, and correlated with posturography results. RESULTS: No increase in lateral and anterior-posterior sway, or the quotients between them, or for Romberg quotients, was found with increasing SVH-V tilt.

Adult↗

Crayfish muscle receptor organ: role in regulation of postural flexion.

Recordings were made from postural-control motor nerves with antagonistic functions in the crayfish abdomen through flexible suction electrodes. During unrestrained flexion of the abdomen, output from the tonic stretch receptor neuron of RM(1),(SR(1)) is sufficient to drive an extensor motor unit in the same segment. However, this intrasegmental "resistance" reflex is normally blocked by an intersegmental reflex in which output from SR(1)'s in caudal segments inhibits SR(1) discharge in more anterior segments.

Abdomen↗

Effects of long-term bed rest on H-reflex and motor evoked potential in lower leg muscles during standing.

Maximal H-reflex amplitude (Hmax) compared with maximal M-response (Mmax) has been generally used to assess the efficacy of the monosynaptic transmission from Ia afferents to alpha motoneurons in spinal cord. In previous studies, it has been demonstrated that H-reflex in soleus muscle (SOL) is inhibited during free standing due to an increase in presynaptic inhibition of the Ia afferent terminals to SOL motoneurones (Katz et al. 1988, Koceja et al. 1993). Transcranial magnetic stimulation (TMS) of human motor cortex excites the corticospinal system monosynapticaly connecting to spinal alpha motoneurones. However, it is not clear whether or not the motor evoked potentials (MEPs) in SOL and tibialis anterior (TA) muscles induced by TMS are modulated during standing (Ackermann et al. 1991, Lavoie et al. 1995). Considering that postural control functions change with exposure to weightlessness, we supposed that the excitability of SOL and TA spinal motoneurons from Ia afferents and/or corticospinal tracts during free standing would change after long-term bed rest (BR). The aim of this study was to investigate the effect of BR on H-reflex and MEP in SOL and TA during free standing.

Adult↗

[Equilibrium and falls in the elderly].

Falls are the leading cause of injury-related visits to the emergency departments and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial ethnic groups, with falls accounting for 70% of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. The evaluation of a patient who has fallen includes a focused history, a direct physical examination and simple tests of postural control and overall physical function. The physician should also evaluate potential obstacles in the living environment of his patients. A progressive program of balance and gait training and muscle strengthening seems to induce compensation for sensory deficit. Healthcare activity should also address psychosocial issues such as the fear of falling and self-imposed restriction of activity. These measurements can reduce the fear of falling and the number of falls altogether. We should encourage measures to promote autonomy and independence in older people.

Accidental Falls↗

M.I.T./Canadian vestibular experiments on the Spacelab-1 mission: 1. Sensory adaptation to weightlessness and readaptation to one-g: an overview.

Experiments on human spatial orientation were conducted on four crewmembers of Space Shuttle Spacelab Mission 1. This introductory paper presents the conceptual background of the project, the relationship among the experiments and their relevance to a "sensory reinterpretation hypothesis". Detailed experiment procedures and results are presented in the accompanying papers in this series. The overall findings are discussed in this article as they pertain to the following aspects of hypothesized sensory reinterpretation in weightlessness: utricular otolith afferent signals are reinterpreted as indicating head translation rather than tilt, sensitivity of reflex responses to footward acceleration is reduced, and increased weighting is given to visual and tactile cues in orientation perception and posture control. Three subjects developed space motion sickness symptoms, which abated after several days. Head movements, as well as visual and tactile cues to orientation influenced symptoms in a manner consistent with the sensory-motor conflict theory of space motion sickness. Six short duration tests of motion sickness susceptibility, conducted pre-flight, failed to predict sickness intensity in weightlessness. An early otolith-spinal reflex, measured by electromyography from the gastrocnemius-soleus muscles during sudden footward acceleration, was inhibited immediately upon entering weightlessness and declined further during the flight, but was unchanged from pre-flight when measured shortly after return to earth. Dynamic visual-vestibular interaction was studied by measuring subjective roll self-motion created by looking into a spinning drum. Results suggest increased weighting of visual cues and reduced weighting of graviceptor signals in weightlessness. Following the 10 day flight, erect posture with eyes closed was disturbed for several days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

Anti-sympathetic ganglia antibodies and postural blood pressure in IDDM subjects of varying duration and patients at high risk of developing IDDM.

We examined the sera of 94 subjects with insulin-dependent diabetes mellitus (IDDM) for the presence of complement-fixing sympathetic ganglia (CF-SG) antibodies. In a cross-sectional analysis (duration 0-43 yr), 22% had detectable CF-SG antibodies. Subjects at high risk for IDDM were also studied. Four groups were studied: group 1 (aged 4-64 yr) islet cell antibody-positive (ICA+) prediabetic subjects, 10 of 19 (53%) were CF-SG+; group 2 (aged 6-14 yr) ICA- prediabetic subjects (first-degree relatives of IDDM subjects with either transient hyperglycemia, impaired oral glucose tolerance, and/or first-phase insulin release after intravenous glucose tolerance testing), 4 of 9 (44%) were CF-SG+ (2 of the 4 ICA- CF-SG+ subjects have progressed to IDDM); group 3 (aged 1.5-43 yr) ICA+ IDDM subjects (less than or equal to 1 yr duration) 6 of 10 (60%) were CF-SG+; and group 4 (aged 8-59 yr) ICA- IDDM subjects (less than or equal to 1 yr duration), 2 of 11 (18%) were CF-SG+. All groups had increased CF-SG compared with controls. Postural blood pressure and simultaneous CF-SG antibody measurements were performed in 28 IDDM subjects. The drop in systolic blood pressure was greater in the CF-SG+ subjects (P less than .05), and the frequency of CF-SG was greater in the mean to -2SD group (P less than .03) when data were analyzed within mean +/- 2SD of the normal blood pressure response.

Adolescent↗