Falls and disorders of postural balance.
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Accident Prevention↗
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Biomechanical appraisal of some skeletal features associated with head balance and posture in the Hominoidea.
The condylar position index, condylar angle and the area of insertion of the nuchal musculature corrected for condylar position, direction of muscle pull and skull size were determined in Homo sapiens, Gorilla, Pan and the casts of two Neanderthal and two australopithecine crania. In all three attributes, the values of H. sapiens exceeded, by statistically significant amounts, those for the ape genera. The greater value for the condylar position index indicates a better balance of the head, that for the condylar angle reflects the more vertical orientation of the vertebral column while that for the corrected nuchal area suggests a less effective nuchal musculature in H. sapiens as compared to the apes. In the casts of the Neanderthal crania, the values all came within, or close to, the ranges for H. sapiens. In the australopithecine casts, the condylar angle cane within the ranges for H. sapiens while the condylar position index and the corrected nuchal area were intermediate in value between H. sapiens and the extant apes. These findings are consistent with observations from other skeletal regions that while Australopithecus had an upright posture, this creature was, in the complex of posturally significant morphological features, distinct from extant hominoids.
Animals↗
Height vertigo and human posture.
A theory is presented supporting a geometrical explanation for physiological height vertigo being a distance vertigo through visual destabilization of postural balance when the distance between the eyes and visible stationary contrasts becomes critically large. Physiological and posturographic data obtained under natural height vertigo conditions are consistent with this hypothesis.
Humans↗
Evidence that a nigral gabaergic--cholinergic balance controls posture.
The intranigral injection of kainic acid (k.a.) (3.5 nM/s.n.) produced a lesion which resulted in a decreased muscarinic receptor binding capacity and in a decreased choline acetyl transferase (CAT) activity confined to the pars reticulata. The unilateral, intranigral injection of carbachol in the substantia nigra (s.n.) produced turning, ipsilateral to the injected side, of dose-related intensity, which was antagonized by scopolamine given either i.p. or intranigrally together with carbachol. The bilateral, intranigral injection of carbachol produced rigid catalepsy, highly resistant to apomorphine administration and antagonized by scopolamine. On the other hand, the catalepsy produced by intranigral picrotoxin was much more sensitive to apomorphine and was disrupted by systemic scopolamine administration. Intranigral scopolamine per se produced either contralateral turning or stereotyped movements consistently, when injected unilaterally or bilaterally, respectively. In addition, scopolamine injected bilaterally in the s.n. but not in the caudate nucleus (c.n.), at the concentration of 64 nM side, was able to antagonize the haloperidol-induced catalepsy and to prevent the tremors and the muscular rigidity produced by arecoline. This effect of scopolamine was surmountable with a higher dose of arecoline. Finally, intranigral muscimol (0.44 nM/s.n.) prevented the occurrence of the parkinsonian syndrome produced by systemic arecoline. It is concluded that the muscarinic receptors present in the s.n. pars reticulata play a role in the control of posture opposite to that of the nigral GABA receptors.
Animals↗
Muscle stretch receptor hypersensitization in spasticity. Inapproprioception, Part III.
The author's concept of Inapproprioception, which accounts for athetoid movements in terms of defective proprioceptive feedback (i.e., distortion of afferent signals representing limb position) is extended here to explain spasticity in cerebral palsy was well. Descending activation of gamma efferents supplying hypertonic muscles may be excessive, leading to hypersensitization of stretch receptors in those muscles (the exact distribution of muscles affected varying with the individual). The result is exaggerated reflex activation of alpha motoneurons in response to the slightest muscle stretch. Even passive tension due to gravitational forces, which is inescapable, results in excessive impulse discharge from sensitized stretch afferents and thus leads to reflex contractions simply in response to shifts in body position. The affected muscles shorten to a length corresponding to the elevated level of reflexly originating motoneuron discharge, manifesting excessive tone even in the contracted state. The distribution of hypertonicity thus induced usually follows a predictable pattern and can be modified using slow passive stretch of hypertonic muscles to relax them, followed by facilitated voluntary contraction to strengthen weak antagonists, and progressing to functional reciprocal usage of agonists and antagonists to achieve proper muscle balance. Application of this procedure leads to improved posture, balance and ambulation in subjects with spastic cerebral palsy.
Adolescent↗
[Visual stabilization of free stance in infants: a sign of maturity (author's transl)].
The development of the visual contribution to postural stabilization has been tested using a large visual display rotating around the stationary subject's line of sight. This, in the adult, causes a marked optokinetic postural reaction with a shift of the body center of gravity toward the direction of pattern motion. Scalings of the reactions in children between 6 months and 16 years revealed three phases of development: (1) 6--12-month-old-babies show none or very little optokinetic disturbance of their newly acquired ability to sit. With the development of upright stance and gait, optokinetic influences become increasingly important. (2) Children between the age of 2--5 show a marked dependence of postural stability on vision. In them, the disturbing optokinetic stimulus leads to a marked ipsilateral postural deviation or irresistible fall. (3) From 5 to 15 years of age, visual effects on postural balance slowly decrease to their final strength in adulthood--moderate head and body tilt--in response to the rotating stimulus. It is concluded that the optokinetic loop participates rather late in the multisensory process of postural stabilization. The calibration of the three main loops, visual, vestibular, and proprioceptive, seems to be sequential and mutually interactive. Optimal functioning requires the continuous evaluation of the reafferent sensory consequences of self-generated body movements. Optokinetic destabilization of stance requires the maturity of opto-vestibulo-spinal pathways. Its clinical applicability as a maturity test, however, sofar seems limited.
Adolescent↗
The coordination of posture and voluntary movement in patients with cerebellar dysfunction.
Postural adjustments associated with the task of rising on tiptoes were investigated in a reaction time paradigm in 10 normal subjects and 18 patients with cerebellar disorders. Cerebellar dysfunction was due to either degenerative cerebellar disease, tumor, or ischemia. Displacements of the center of foot pressure (CFP) were recorded. The task, accomplished by the triceps surae muscle (executional activity, mean latency of 411 ms), is mechanically effective only if the center of gravity has been shifted forward in advance. To this effect, a phasic burst of preparatory EMG activity in the tibialis anterior normally occurs at a mean latency of 163 ms, shifting the center of gravity forward. Shortly thereafter, activity of the quadriceps femoris (175 ms) extends the knee and aids the forward shift of the center of gravity. Different aspects of this motor sequence were disturbed in individual patients: Latencies of preparatory and executional activity were uncorrelated in 15 of the 18 patients. Executional (n = 16) or preparatory (n = 13) EMG activity was tonic instead of phasic. Latencies of either preparatory or executional EMG activities or both were prolonged (n = 10). The time interval between motor preparation and execution was increased (n = 9). The trial-to-trial variability of biomechanical parameters and EMG latency was increased. Preparatory EMG activity in the quadriceps was entirely missing (n = 9), resulting in knee bending at the unsuccessful attempt to rise on tiptoes. Patients who were most severely affected had no preparatory activity at all (n = 2), and therefore were unable to perform the task.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Compensation of postural reactions to fall in the vestibular neurectomized monkey. Role of the reamining labyrinthine afferences.
The electromyographic (EMG) responses from soleus and tibialis anterior muscles and the monosynaptic H- and T-reflex responses from soleus muscles were recorded bilaterally from conscious baboon while unexpectedly dropping it with unrestricted vision. These responses were recorded either after unilateral vestibular neurectomy (U.N. Baboons) or after bilateral neurectomy performed in one stage (B.N. 1 baboons) and in two stages (B.N. 2 baboons). A positive correlation was found between modifications and development of EMG responses and reflex data. In the U.N. baboons, some differences were observed when comparing data from the H- and T-reflex methods, suggesting that recovery of normal responses to fall is achieved both by means of direct influences on alpha-motoneurons and via the gamma-loop. In the U.N. baboons postural reactions to fall developed in three distinct periods. The first or critical stage showed asymmetrical EMG and reflex responses with increased responses from contralateral soleus muscle and decreased responses from ipsilateral soleus. Opposite effects were recorded from tibialis anterior flexor muscles. The second or acute stage which began around 4 to 7 days after surgery exhibited symmetrical, but very reduced, responses when compared to the control in soleus muscles, and symmetrical, but increased, responses from tibialis anterior muscles. This stage lasted until about the end of the second postoperative week and was followed by the third or compensatory stage during which EMG as well as reflex responses developed towards the control pattern in all tested muscles. Almost normal responses were recorded on both sides 3 weeks after surgery. Only a partial recovery was found in the B.N. 1 baboons, indicating that the contralateral remaining labyrinthine afferences constitute a necessary condition for the full compensation of postural reactions to fall in the case of unilateral vestibular neurectomy. The Bechterew's compensation was obtained in the B.N. 2 baboons. These results are discussed in relation with the general organization of the vestibulospinal pathways and with those concerning development of the postoperative activity at the vestibular nuclei level. A model of vestibular compensation achieved by means of a multisensory substitution process is suggested.
Afferent Pathways↗
Vertigo and drop attacks caused by acute transient monocular disequilibrium (Halpern's syndrome).
Among the causes of acute vertigo the syndrome of sensorimotor induction in unilateral disequilibrium (Halpern's syndrome) should be considered. This syndrome was found in a patient and described in detail. The major features of this syndrome are the displacement of vertical and horizontal axes induced by looking with the "affected" eye only, which are further aggravated by applying red filters to the eyes only, which are further aggravated by applying red filters to the eyes and corrected by blue filters. The symptomatology is described and discussed in detail. Theories causing this syndrome are discussed.
Acute Disease↗
[A caloric vestibular test with increased positive evidence (author's transl)].
The positive evidence of the caloric test increases, when the time-course of the induced heat wave in the petrous bone was eliminated, which differs from man to man. This is possible by changing head position during calorisation, so that a nearly rectangular stimulus results.
Caloric Tests↗
Head movements mediated by halteres in the fly, Musca domestica.
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Animals↗
Modifications and development of spinal reflexes in the alert baboon (Papio papio) following an unilateral vestibular neurotomy.
Unilateral vestibular neurotomy performed on 6 baboons was followed by the classical postural and locomotor postoperative disorders. Postoperative spinal reflex excitability was studied in these awake baboons by measuring monosynaptic recruitment ratios in soleus motoneuronal pool and the recovery cycle of the monosynaptic response. Vestibular neurotomy induces: (1) asymmetrical spinal reflexes with a decrease of the recruitment on the side of the section and an increase on the opposite side. (2) a modification of phases IV and V of the ipsilateral recovery cycle. The recovery during postoperative days of normal recruitment curves and recovery cycles is described. This recovery is relatively fast and relates closely to the compensation of postural and locomotor disorders. We note the importance of an early active motor exploration on the time-course of recovery: postoperative disorders in posture and locomotion are reduced much later when baboons are submitted to a motor restriction. These findings suggest a combined alpha and gamma-hypoexcitability of the ipsilateral hindlimb. The study of the recovery process suggests that the cerebellum is involved in the compensatory mechanisms. The regression of postural disorders, observed both in restrained and unrestrained baboons, demonstrates the importance of central regulations using proprioceptive afferents for recovery.
Animals↗
Cerebellar modulation of reflex gain.
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Animals↗
Reactions to overbalancing.
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Biomechanical Phenomena↗
Aging and postural sway in women.
The effects of aging on postural sway in upright and forward lean stance were investigated. Postural sway was measured on a center of gravity apparatus using two age groups of female subjects 20 to 30 years old and 70 to 80 years old. The older adults demonstrated significantly larger sway areas than the young adults in both stance positions. The patterning of the center of gravity projections on the base of support tended to be similar under all conditions except in the young adults/upright position where the antero-postero excursion was larger than the medial-lateral. The mean locations of the center of gravity projections were often posterior and to the left of the geometric center of the base of support. The distance between the two points was least in the older adults/forward lean position, i.e., the experimental unit which demonstrated the largest area of sway.
Adult↗
Postural stability, tardive dyskinesia and developmental disability.
The postural stability of four adult populations was examined through force platform methods. The four groups were classified as: (1) developmentally disabled (severely and profoundly mentally retarded) with tardive dyskinesia; (2) developmentally disabled but with no history of neuroleptic medication; (3) tardive dyskinetic but of normal intelligence; and (4) a normal and healthy control group. Postural conditions included standing still with arms at side, standing still with one arm or both arms parallel to the ground, and standing still while swinging both arms in the sagittal plane. The findings showed that both tardive dyskinetic and/or developmentally disabled groups exhibited greater sway and variability in centre of pressure motion in contrast to the control group. The developmentally disabled with tardive dyskinesia group also exhibited a strong tendency to produce a different form to the postural sway strategy in that they produced rhythmical centre of pressure motions during stance that were, to some degree, task dependent. The findings show that the combined effects of developmental disability and tardive dyskinesia produce qualitatively and quantitatively different features in postural stability patterns. The data suggest that postural stability measures may be a useful index to assess tardive dyskinesia.
Antipsychotic Agents↗
Statoacoustic properties of utricular afferents.
1. We classified the utricular afferents on the basis of their spontaneous acitivity and responses to tilts and vibrations. 2. Type I afferents fire spontaneously in a regular pattern; their responses to tilts consist of a phasic-tonic change in firing rate. They may respond to vibrations by increasing or decreasing their rate and show no adaptation. 3. The spontaneous activity and the responses to tilts of type II are similar to those observed in type I afferents. The differences become apparent when the preparation is subjected to a vibrational stimulus, since type II neurons increase their firing rate regardless of the stimulus frequency and show adaptation. 4. Type III neurons have no spontaneous activity. They respond to tilts by firing during the transition from one position to the other. They respond to a vibrational stimulus with maintained firing and show no adaptation. 5. We studied the dynamic responses of each type of neuron. We used sensitivity curves for the study of type III afferents and proposed a statistical method to define gain curves for the study of the other types. 6. The gain curves generated by type I neurons reach their maximum at frequencies of stimulation close to the spontaneous rate of firing. 7. In the gain curves of type II afferents the maximum corresponds to frequencies higher than their spontaneous activity. 8. Sensitivity curves and gain curves give similar results for type III fibers. The sensitivity curves of these afferents were classified into four subtypes. 9. We studied the responses of the three types of afferents to bursts of sinusoidal vibrations. 10. We concluded that the properties of types I and II fibers are fit to carry information about movements and position of the head, but also transmit acoustical information. Type III fibers are more adapted to provide information about acoustical stimuli, but can also convey information about head movements.
Acoustic Stimulation↗
Spectral analysis of body sway.
The frequency spectrum of the center of gravity in normal subjects while standing was recorded by using a platform-strain gauge system and a digital computer. Individual differences of the spectral patterns resulted in the classification of three types. Averaged divisional frequency of each type was calculated in the range below 1 Hz in which the main change between the values with eyes open and those with eyes closed appeared as the frequency shift.
Adolescent↗