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PubMed1998

Soleus H-reflex gain in elderly and young adults: modulation due to body position.

BACKGROUND: The control of posture and balance in the elderly is a primary health concern. Postural instability directly leads to a greater incidence of falling in the elderly population. One important neuromuscular mechanism instrumental in the control of posture and balance is the reflex system. The purpose of this study was to examine the gain of the soleus H-reflex in young and elderly adults in two different body positions: standing and prone. METHODS: Eighteen neurologically healthy volunteers were categorized by age in two groups: young (n = 9, mean age = 23.3 yr) and elderly (n = 9, mean age = 71.7 yr). In each position, the resting H-max/M-max ratio was determined. The gain of the reflex was also assessed by instructing the subject to perform voluntary contractions of 10, 20 and 30% of their maximum voluntary contraction, using real-time EMG biofeedback. Data were sampled on-line using custom designed software (sample rate = 2 kHz). Dependent variables included the average background EMG of the soleus muscle (40 ms window prior to stimulation) and the peak-to-peak amplitude of the elicited soleus H-reflex. To examine the gain of the reflex, the peak-to-peak amplitude of the H-reflex was plotted against the background EMG activity for each contraction intensity. RESULTS: Results indicated the following: young subjects significantly depressed the H-max/M-max ratio when standing (69.3% prone, 55.1% standing), whereas elderly subjects increased the ratio (36.1% prone, 54.5% standing). Also, the young subjects modulated the gain of the reflex from prone to standing (3.30 prone, 3.68 standing), and the elderly subjects demonstrated no gain modulation in the different body positions (2.23 prone, 1.91 standing). In both body positions the young subjects demonstrated significantly higher gain that the elderly subjects. CONCLUSIONS: The results demonstrate different control strategies for young and elderly subjects between prone and standing body positions.

Adult↗
PubMed1994

Postural instability in patients with diabetic sensory neuropathy.

OBJECTIVE: Recent survey evidence suggests that sensory ataxia due to diabetic neuropathy may be a more frequent and serious problem than is commonly recognized. This view is further supported by research that confirms the major contribution of the somatosensory system to the control of posture. We therefore sought to determine the effects of significant diabetic distal symmetrical polyneuropathy on the control of posture. RESEARCH DESIGN AND METHODS: Fifty-one subjects, divided into three groups, participated in this study. Seventeen had diabetes and significant sensory neuropathy, 17 had diabetes and no neuropathy, and 17 had neither diabetes nor neuropathy. The subjects were matched across groups, and stringent exclusion criteria were applied. Postural stability during quiet standing was measured using a force platform. In addition to electrophysiological and quantitative sensory tests of neuropathy, a number of physical and functional characteristics were measured for all subjects. RESULTS: Postural instability was found to be significantly associated with sensory neuropathy, but not with diabetes per se. Patients with sensory neuropathy demonstrated between 66 and 117% more instability than did control subjects (depending on the testing condition). Based on multiple linear regression analyses, the most significant correlates of instability were the quantitative sensory measures of neuropathy and age. CONCLUSIONS: The loss of sensory perception secondary to diabetic distal symmetrical sensory neuropathy has a markedly detrimental effect on postural stability. The deficit is greatest when visual or vestibular cues are absent or degraded. Patients with neuropathy need to be informed of the postural consequences of this condition to limit the potential morbidity caused by falls.

Aging↗
PubMedDate not supplied

Visual contributions to postural stability in older adults.

BACKGROUND: With advancing age, there is a generalized reduction in visual functioning which has been associated with impaired postural stability and increased risk of falls. However, little is known about which visual abilities are the most important in the control of postural sway when standing. OBJECTIVE: To determine whether specific visual abilities predict stability when standing on firm and compliant surfaces. METHODS: Tests of visual function, peripheral sensation, strength, reaction time and sway were administered to 156 community-dwelling men and women aged 63-90 years. The visual tests included high- and low-contrast visual acuity, contrast sensitivity, depth perception, stereopsis and lower visual field size. Postural sway was measured with eyes open on a firm and a compliant foam rubber surface. RESULTS: On the firm surface, sway was significantly associated with only one sensorimotor measure: proprioception in the lower limbs. In contrast, on the compliant surface, sway was associated with all of the visual measures, quadriceps strength and reaction time. Multiple regression analysis revealed that contrast sensitivity, stereopsis and quadriceps strength were significant independent predictors of total sway when subjects stood on the compliant surface. CONCLUSION: The study findings confirm the importance of vision, in particular contrast sensitivity and stereopsis, in the control of posture under challenging conditions, and suggest some mechanisms for the association between impaired vision and falls in older people.

Accidental Falls↗
PubMed1992

Automatic control of limb movement and posture.

Studies are reviewed that address the problem of the variables controlled by the central nervous system in the maintenance of body posture and limb movement against disturbing forces. The role of global variables of control, which take into account the dynamic state of the limb, is discussed. Neural substrates that are involved in the distributed control of kinematic and dynamic parameters are also considered.

Adaptation, Physiological↗
PubMed2004

Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis.

OBJECTIVE: To examine trunk stability in unstable sitting posture in 2 different functional activities. DESIGN: A randomized crossover design. SETTING: Rehabilitation center in Italy. PARTICIPANTS: Ten healthy subjects and 10 patients with multiple sclerosis. INTERVENTIONS: Subjects were seated on an unstable support surface. A task in which the subjects had to keep their trunk as stable as possible was compared with tasks in which they had to track an object with the head or grasp an object.Main outcome measures Angular displacement and mean absolute angular velocity in the anteroposterior and mediolateral planes of the support surface. RESULTS: Angular displacement showed differences between patients and healthy subjects both in the sagittal plane (P<.0001) and frontal plane (P<.002). Velocity of angular displacement differentiated between the groups in both planes (P<.0001). Differences between velocity of angular displacement in different tasks were also detected (P<.0001). Correlation coefficients between sitting balance scores and laboratory measures were low and not statistically significant. In the healthy subjects, instability in the frontal plane correlated positively with the subjects' weight and height. CONCLUSIONS: Both patients and healthy subjects had more difficulty with frontal plane stability than with sagittal plane stability. Angular velocity for a given task showed the greatest difference between the groups and between postural challenge tasks within a group. Patients were more unstable than healthy subjects during head movements in the frontal plane; conversely, arm movements produced larger angular displacement, especially in the sagittal plane.

Abdominal Muscles↗
PubMed2004

Integration of multiple motor segments for the elaboration of locomotion: role of the fastigial nucleus of the cerebellum.

This chapter provides a conceptual overview of the role and operation of higher structures of the central nervous system (CNS) in the control of posture and locomotion in the mammal, including the nonhuman primate and the human. Both quadrupedal and bipedal locomotion require the integrated neural control of multiple body segments against gravity. During development, and in selected instances in the adult, motor learning is required, particularly for merging anticipatory and reactive CNS processes, the latter being necessary after tripping and stumbling. We have recently found that the fastigial nucleus (FN) of the cerebellum in the cat plays a particularly important role in the control of locomotion, by virtue of its critical position in uniting the cerebro-cerebellar and the spino-cerebellar loops of neural activity that participate in the integrated control of multiple body segments. Further understanding of the CNS structures that achieve this integration has come from our recent study of an intact nonhuman primate, the Japanese monkey, Macaca fuscata, as it learns to elaborate bipedal locomotion rather than its normal quadrupedal fashion. Based on findings from these two animal species, we now present a model of the overall integrated control of posture and locomotion that features the combined operation of parallel and distributed neural circuitry throughout the CNS.

Animals↗
PubMed1999

Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task.

By manipulation of movement reaction time we investigated the co-ordination between the motor command for arm movement and the associated 'anticipatory' postural response of the abdominal muscles. Limb movement reaction time was varied by changing the expectation of limb movement direction required in a choice-reaction-time task. Timing of the 'anticipatory' postural contraction of transversus abdominis (TrA) was invariant while the limb movement reaction time varied with changes in expectation of required response. In contrast, the timing of 'anticipatory' postural activity of the other abdominal muscles co-varied with limb movement reaction time. Dissociation of the behaviour of TrA and the other abdominal muscles suggests that TrA may be controlled independently of the motor command for limb movement in contrast to the other abdominal muscles.

Abdominal Muscles↗
PubMedDate not supplied

Comparison of heteronymous monosynaptic Ia facilitation in young and elderly subjects in supine and standing positions.

BACKGROUND: The control of posture and balance is a primary concern among the elderly. Postural instability has been identified as a contributor to the greater incidence of falling among this segment of the population. One important neuromuscular mechanism identified as important in the control of posture and balance is the segmental reflex system. The purpose of this study was to examine the role of presynaptic inhibition in modulating the reflex system in young and elderly subjects. METHODS: To estimate the influence of body position on presynaptic inhibition to the soleus motor pool between young and elderly subjects, 11 young (mean age=23.9 yrs.) and 9 elderly (mean age=72.1 yrs.) subjects were examined in two different body positions: supine and standing. This study utilized the heteronymous facilitation protocol, as described by Hultborn et al. (1987), to estimate presynaptic inhibition of the Ia afferent pathway onto the soleus alpha-motoneuron pool. Maximal soleus H-reflex (H-max) and motor response (M-max) amplitudes were determined prior to testing at each condition, and the H-max/M-max ratio at each body position was determined. To estimate presynaptic inhibition at each body position, subjects received 24 test soleus H-reflex stimuli ( approximately 15% M-max), and 24 soleus H-reflexes conditioned by stimulation of the ipsilateral femoral nerve. RESULTS: Results demonstrated a significant decrease in H-max/M-max ratio from supine (66.1%) to standing (56.8%) for the young subjects, whereas the elderly subjects demonstrated no changes in the H-max/M-max ratio between body positions (39.8% supine; 39.8% standing). The conditioning stimulus produced a significant change in the test reflex for the young subjects during supine testing (51.1% increase) but not standing (3.4% increase). The elderly subjects demonstrated no significant changes in the test reflex produced by the heteronymous conditioning at either condition (17.6% increase supine; 4.9% increase standing). CONCLUSIONS: These results demonstrate differential effects of both H-reflex modulation and heteronymous conditioning for elderly subjects when compared with young adults. These differences may be an adaptive phenomenon of the aging neuromuscular system, exemplified by a decreased ability to modulate the reflex system in the elderly group.

Adult↗
PubMed2006

Compromised autoregulatory control of ocular hemodynamics in glaucoma patients after postural change.

PURPOSE: The autoregulatory control of retrobulbar blood flow in response to postural challenge was investigated in normal-tension glaucoma (NTG) patients in comparison with primary open-angle glaucoma (POAG) patients and healthy volunteers. DESIGN: Prospective cohort study. PARTICIPANTS AND CONTROLS: Twenty POAG patients, 20 NTG patients, and 20 control subjects. METHODS: Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI) in the short posterior ciliary artery (SPCA), central retinal artery (CRA) and ophthalmic artery (OA) were recorded after a change from sitting upright to a supine body position using color Doppler imaging. MAIN OUTCOME MEASURES: Peak systolic velocity, EDV, and RI. RESULTS: Ten minutes after postural change to a supine position, blood flow velocities in the SPCA remained unchanged in controls, whereas a significant increase of PSV and EDV was found in both glaucoma groups. The RI in the SPCA was significantly lowered in the NTG group. Recordings for the OA and CRA showed a significant increase in EDV and significant decrease in RI in all 3 groups; a significant increase in PSV in the CRA was detected only in the NTG group. CONCLUSIONS: The unaltered flow velocities in the SPCA of healthy controls may indicate tight autoregulatory control, whereas the flow velocities in the CRA and OA appeared to follow alterations in hydrostatic pressure. In contrast, NTG and POAG patients demonstrated an insufficient compensatory response to postural change, leading to accelerated flow in the SPCA. This compromised autoregulatory control could represent another contributing factor in the pathogenesis of glaucoma.

Blood Flow Velocity↗
PubMed2001

Plasma endothelin-1 and big endothelin-1 levels in superior and inferior vena cava during protracted antiorthostatic hypokinetic/hypodynamia in rats.

The plasma levels of endothelin-1 and big endothelin-1 were evaluated in blood of rats in the superior and inferior vena cava, in normal posture (synchronous controls), and after 12 days head-down suspension and 1 day recovery in normal posture. In synchronous controls, the mean plasma concentration of endothelin-1 in inferior vena cava or superior vena cava was almost the same (5.89+/-0.63 pmol/l and 5.67+/-0.64 pmol/l, respectively), whereas the mean plasma concentration of big endothelin-1 was higher (p<0.05) in superior vena cava compared to inferior vena cava (5.49+/-0.75 pmol/l and 1.39+/-0.15 pmol/l, respectively). In samples from superior vena cava of head-down suspended rats big endothelin-1 levels were significantly lower (p<0.05) up to day 9 of suspension, compared to non-suspended synchronous controls, whereas endothelin-1 values were higher (p<0.05). Big endothelin-1 concentration was higher (p<0.05) in inferior vena cava compared to non-suspended synchronous controls. The behaviour of endothelin-1 was more complex, endothelin-1 levels were lower (p<0.05) on day 1 of head-down suspension and higher (p<0.05) in samples taken on days 9 and 12. After 1 day recovery endothelin-1 and big endothelin-1 concentrations returned to normal in both superior vena cava and inferior vena cava. These data indicate that the endothelial system involvement for the two venous beds is different and suggest that local rather than systemic evaluation could better explain endothelial involvement and the contribution of different anatomic sites to the biosynthesis, conversion and clearance of the various involved molecules.

Animals↗
PubMed1999

Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes.

BACKGROUND: Postural hypotension with a decline of 20 mm Hg or more in systolic blood pressure on standing is considered a potentially dangerous hypotensive response. Postural dizziness is often strongly associated with postural hypotension. However, there is conflicting evidence, and previous studies have been confined to the elderly, not specifically to patients with diabetes. Thus, we evaluated the association between postural hypotension and postural dizziness, and determined the factors most likely related to postural hypotension in patients with diabetes. METHODS: The subjects were 204 consecutive noninsulin-dependent patients with diabetes and 408 age- and sex-matched control subjects. Postural hypotension was defined as a decline of 20 mm Hg or more in systolic blood pressure 1 minute after standing. Postural dizziness was any feelings of dizziness, lightheadedness, or faintness that occurred while standing during the examination. RESULTS: The prevalence of postural hypotension and postural dizziness in patients with diabetes was higher than in control subjects. Those patients with both diabetes and postural hypotension were older and had higher supine systolic blood pressures and higher plasma glycosylated hemoglobin and fasting glucose levels. They had higher prevalence of postural dizziness, hypertension, and cerebrovascular disease, and lower standing systolic blood pressures than those without postural hypotension. They also were more often being treated with antihypertensive agents. Only 32.8% of patients with diabetes with postural hypotension suffered from postural dizziness. Postural dizziness, hypertension, cerebrovascular disease, and plasma glycosylated hemoglobin levels were independently associated with postural hypotension in patients with diabetes. CONCLUSIONS: Postural dizziness, glycemic control, hypertension, and cerebrovascular disease were important determinants of postural hypotension in patients with diabetes. Postural hypotension was associated with postural dizziness, but it cannot be determined clinically just from the presence of postural dizziness because the sensitivity for diagnosis of postural hypotension is low.

Aged↗
PubMed2001

The influence of postural threat on the control of upright stance.

In order to utilize static posturography as a tool with which to diagnose pathological balance disorders, it is necessary to understand the contribution of psychological factors such as fear of falling. In this study we examined kinetic and kinematic parameters during quiet stance of eight young healthy adults standing under three conditions which posed increasing levels of postural threat. Participants were required to stand quietly, both with and without visual information and with normal or reduced vestibular information for 2-min periods at each of three surface conditions: ground level (low threat), 81 cm above the ground completely surrounded by a support surface (medium threat) and 81 cm above ground at the edge of the surface (high threat). In addition to calculating displacement and frequency measures for movements of centre of pressure (COP) and centre of mass (COM), a measure of stiffness was derived from the difference between COP-COM signal. Mean EMG activity was recorded bilaterally from anterior and posterior muscles of the lower and upper leg. A stiffening strategy was adopted when individuals stood under high threat conditions involving significant changes in kinematic, kinetic and EMG variables. The A-P stiffness constant increased significantly (27.5%) for the high threat compared to low threat condition, independent of vision or vestibular information. Changes in stiffness were accompanied by: (1) backward shift of the mean A-P position of COP and COM, (2) increased mean power frequency and decreased amplitude displacement of the COP and (3) decreased amplitude displacements of the COM. Of the significant changes observed in mean EMG activity with increased postural threat, only tibialis anterior was significantly correlated with increased stiffness, while activity in soleus, medial gastrocnemius and rectus femoris was highly correlated with mean position of COP.

Accidental Falls↗
PubMed2000

Dental occlusion modifies gaze and posture stabilization in human subjects.

Repercussion of dental occlusion was tested upon postural and gaze stabilization, the latter with a visuo-motor task evaluated by shooting performances. Eighteen permit holders shooters and 18 controls were enrolled in this study. Postural control was evaluated in both groups according to four mandibular positions imposed by interocclusal splints: (i) intercuspal occlusion (IO), (ii) centric relation (CR), (iii) physiological side lateral occlusion and (iv) controlateral occlusion, in order to appreciate the impact of the splints upon orthostatism. Postural control and gaze stabilization quality decreased, from the best to the worst, with splints in CR, IO and lateral occlusion. In shooters, the improvement in postural control was parallel to superior shooting performance. A repercussion of dental occlusion upon proprioception and visual stabilization is suggested by these data.

Dental Occlusion↗
PubMed2005

Application of cross time-frequency analysis to postural sway behavior: the effects of aging and visual systems.

In this paper, the effects of visual feedback and aging on postural sway systems and signals are investigated by analyzing the transient phase difference between "input" and "output" which correspond to center of pressure (COP) and center of mass (COM), respectively. In order to analyze the transient phase difference characteristics of COP and COM, a relatively new cross time-frequency analysis technique that provides time- and frequency-localized phase difference information is utilized. The feedback control process in the postural sway is interpreted in terms of a feedback compensator which is characterized in terms of a phase difference. Using the experimental results of the transient phase difference obtained from the cross time-frequency distribution, it is demonstrated that the postural control of young persons are more stable and rely more on visual sensory feedback to stabilize postural control compared to that of the elderly persons.

Adaptation, Physiological↗
PubMed1991

Postural dizziness and transient hypotension in two healthy teenagers.

Neurocardiovascular control during postural change was investigated in two teenage females with complaints of dizziness almost immediately on standing up. Blood pressure and heart rate were monitored continuously with a Finapres device. On standing there was a brief but marked fall in blood pressure between 5-10 s after the onset of the manoeuvre. The maximum fall in systolic and diastolic blood pressure was 65 mmHg and 40 mmHg respectively in the first subject, and 58 mmHg and 29 mmHg respectively in the second subject. In both, postural tachycardia was present after 1-2 min of standing with heart rate increasing by up to 39 beats/min in the first subject and 60 beats/min in the second subject. On a follow-up examination 3 years later these changes had disappeared in the first subject while they persisted in the second subject, when she was studied two years later. We conclude that in these patients initial postural dizziness is related to an excessive fall in blood pressure upon standing.

Adolescent↗
PubMed1997

Postural orientation, equilibrium, and the spinal cord.

In summary, adequate control of postural orientation and equilibrium is a prerequisite for virtually all skilled motor acts, even those apparently simple tasks of standing and walking. In the cat, certain aspects of postural orientation appear to be organized at the spinal level. In contrast, postural equilibrium is not achieved by spinal circuits in isolation, but seems to require input from higher centers. The challenge is to identify those higher centers and the means by which they produce appropriate postural reactions for maintaining balance. If, indeed, postural equilibrium is a function of descending systems, then in the future, the amount of recovery of postural equilibrium after injury and/or treatment could provide a quantitative measure of the degree of sparing and/or re-establishment of functional connections between higher centers and the spinal cord.

Animals↗
PubMed1998

Cerebellar control of the cardiovascular responses during postural changes in conscious rabbits.

In conscious control rabbits, tilting the head 30 degrees up from a position 30 degrees down induced initially an inhibition in the renal sympathetic nerve activity (RSNA), however this inhibition immediately released and became a transient increase. Following these responses in RSNA, blood pressure (BP) initially decreased but recovered to the control level within 3-5 s. After bilateral destruction of the lateral nodulus-uvula in the cerebellum, in contrast, the same tilting of the head caused an immediate large increase in RSNA without early inhibition, which was sustained at a high level. BP increased transiently, but then decreased and remained at a level lower than the control. These results indicate that the timing and duration of this transient increase in RSNA during tilting the head up are controlled by the lateral nodulus-uvula and may be important in the rapid adaptation of blood pressure. In addition, this suggests that the lateral nodulus-uvula may play an important role in the cardiovascular control under conditions of consciousness during changes in head position and body posture.

Animals↗