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Periventricular leucomalacia and preterm birth have different detrimental effects on postural adjustments.

Postural adjustments during sitting on a moveable platform were assessed by means of multiple surface EMGs of neck, trunk and leg muscles and kinematics in three groups of children, aged 1 1/2-4 1/2 years. The first group consisted of 13 preterm children (born at a gestational age of 25-34 weeks), whose neonatal ultrasounds had shown distinct lesions of the periventicular white matter (PWM). The second group was the preterm control group, consisting of 13 preterm children with normal neonatal brain scans, matched to the PWM group with respect to gestational age at birth, birth weight, sex and age of postural assessment. The third group was formed by 13 healthy children born at term and matched to the PWM group with respect to sex and age at examination. In addition to the postural assessment an age-specific neurological examination was carried out. Three of the children of the PWM group developed a cerebral palsy syndrome, nine showed minor neurological dysfunction and one child was neurologically normal. In the preterm control group one child showed minor neurological dysfunction, while the remaining 12 children of this group and all children of the full-term group were neurologically normal. The postural assessment revealed that preterm birth was associated with two types of postural dysfunction. One dysfunction was related to the presence of a PWM lesion and consisted of a limited repertoire of response variation. The other dysfunction was not related to the presence of a PWM lesion, but to preterm birth itself. It consisted of a change in the ability to modulate the postural responses. Preterm children showed a higher sensitivity to platform velocity than full-term children, and they lacked the capacity to modulate EMG amplitude with respect to initial sitting position.

Biomechanical Phenomena↗

Effect of mood state on anticipatory postural adjustments.

Static postural control has been demonstrated to link with psychological state. However, the effect of psychological state on dynamic postural control remains unclear. In this study, we examined the effect of mood state on anticipatory postural adjustment (APA), one of the most important functions for dynamic postural control. Fourteen healthy male subjects performed unilateral arm elevation tasks after completing a Profile of Mood States (POMS) questionnaire. Mood state measured by POMS and the latency or amplitude of the APA in the ventral muscles (rectus femoris, tibialis anterior) of the lower limb showed significant negative correlations. The correlation between the mood state and APA amplitude in the soleus was found to be significantly positive. There were significant negative correlations between the mood state and reaction-time. These findings suggest that it is possible that dynamic postural control is affected by mood state.

Adaptation, Physiological↗

Preparatory postural adjustments in parkinsonian patients with postural instability.

BACKGROUND: Postural instability is a common problem in patients with Parkinson's disease. This paper reports results of a study undertaken to investigate some of the possible mechanisms responsible for this instability. METHODS: Preparatory postural adjustments associated with a lateral leg raising task were studied in five parkinsonian patients and four age-matched controls. Recordings included ground reaction forces, kinematics, and surface EMG activity from multiple leg muscles. RESULTS: In normal subjects there was a well-defined sequence of events preceding the onset of leg elevation, beginning with a transfer of centre of foot pressure (CP), initially toward the moving leg and then back to the support side, followed by displacement of the trunk toward the support side. In the more severely affected parkinsonian patients, the amplitude of the initial displacement of CP was markedly reduced. The interval between the earliest force changes and the onset of leg elevation was prolonged and the relative timing of the kenematic adjustments during this interval was disrupted. In addition the alternating burst and periods of inhibition observed in the EMG recordings from the normal subjects were replaced by continuous tonic EMG activity. CONCLUSIONS: These observations suggest that abnormalities in programming preparatory postural adjustments may contribute to postural instability in some patients with advanced Parkinson's disease.

Aged↗

Anticipatory postural adjustments in conditions of postural instability.

OBJECTIVES: The purpose of this study was to investigate anticipatory postural adjustments (APAs) in standing subjects who performed a standard motor action triggering a standard postural perturbation (releasing a 2.2 kg load from extended arms) in conditions of different stability requirements. METHODS: The degree of stability was varied either by balancing on special boards with long and narrow support beams or by instructions to the subjects. In the first series of experiments 13 subjects stood on the board facing either perpendicular to the beam (instability in a sagittal plane) or along the beam (instability in frontal plane); different widths of the beam were used to vary the degree of instability. During the second series of experiments (6 subjects) inclined and one-legged postures were used to induce instability in sagittal and frontal planes respectively. EMG activity of rectus abdominis, erector spinae, rectus femoris, biceps femoris, tibialis anterior, and soleus muscles were recorded. Statistical methods included repeated measures analysis of variance (ANOVA) with direction of instability and level of instability being major factors, descriptive statistics, and post hoc Student's t tests. RESULTS: The integral measure of changes in the background electromyographic activity of postural muscles during APAs depended on two factors related to the postural task: (1) standing on a platform with a narrow support area led to an attenuation of the APAs; and (2) these effects were stronger when instability was in a sagittal rather than in the frontal plane. The anticipatory component in the displacement of the center of pressure did not show a clear attenuation that would depend on the direction of instability. CONCLUSIONS: We suggest a hypothesis that, in conditions of high stability demands, the central nervous system may suppress APAs as a protection against their possible destabilizing effects. These effects are more pronounced when the direction of an expected perturbation is in the plane of instability.

Adult↗

Interactions between automatic postural adjustments and anticipatory postural patterns accompanying voluntary movement.

In order to examine interactions between centrally initiated postural activity preceding voluntary arm movements and compensatory postural activity, we studied patterns of postural muscle activity preceding a vigorous bilateral reach and grasp task or triggered by support surface motion. The reaching task required movement onset to be coincident with a predictable stimulus, and in some trials a brief backward platform perturbation was timed to occur before, during, or after the reach onset. Centrally initiated anticipatory postural activity was subject-specific and was very often absent when perturbation-induced postural activity was elicited just prior to movement onset. Likewise, compensatory postural activity patterns elicited by the platform perturbation did not occur when they would have coincided with the anticipatory postural activity. These data support the idea that the central neural processes which determine the specific activation pattern of the supporting limb musculature are influenced by both the intended dynamic outcome and the current dynamic status of the body.

Adult↗

Could a motor action that has no direct relation to expected perturbation be associated with anticipatory postural adjustments in humans?

Anticipatory postural adjustments (APAs) in standing subjects were studied using different motor actions. We tested the hypothesis that a direct relation between the forthcoming perturbation and motor action is needed to trigger robust anticipatory postural adjustments. The same postural perturbation of a standard load release was induced by either a shoulder abduction, utilizing a motor action with a direct relation, or a biting or blowing action that had an indirect relation with the forthcoming perturbation. Electromyogram activity of trunk and leg muscles as well as the displacement of the center of pressure was recorded. Reduced APAs were observed in experimental trials using motor actions with an indirect relation to a perturbation as compared to the control series with perturbations induced by shoulder abduction. These results suggest that a direct relation between motor action and expected perturbation is important in the generation of anticipatory postural adjustments.

Adult↗

Properties of postural adjustments associated with rapid arm movements.

1. We have examined rapid postural adjustments associated with a class of voluntary movements that disturb postural equilibrium. In the text that follows, these motor activities are termed associated postural adjustments and voluntary focal movements, respectively. Standing human subjects performed a variety of movement tasks on a hand-held manipulandum, resulting in disturbances to their postural equilibrium. The experimental use of movements that interact with the subject's environment in a relatively simple was permitted a more precise comparison of the postural adjustments with their associated focal movements. 2. Subjects either pulled or pushed on a stiff interface (the handle) or they responded in a predetermined way to handle perturbations. These activities were carried out with various degrees of steady-state postural stability. Prior to and during these movements, support surface and handle forces, electromyographic (EMG) signals, and body sway were monitored. 3. In addition to previously shown postural adjustments associated with reaction-time armed movements, we have demonstrated these postural activities occur in concept with segmental stretch reflexes and self-initiated (untriggered) movements. Postural adjustments were initiated shortly before all focal movements tested except the short-latency component of the biceps stretch reflex (25- to 30-ms latency). However, this reflex component was rarely elicited by handle perturbations in free-standing subjects; therefore, postural adjustments usually preceded any biceps activity under this condition. 4. By varying the degree of steady-state postural equilibrium, a reciprocal gain/threshold relationship between postural and focal components was documented, i.e., when stability was high, postural activity was reduced or absent and focal activity enhanced. Conversely, the biceps stretch reflex was difficult to elicit under any condition where the subjects was not fully supported in the direction of movement and reaction times of focal movements were prolonged. 5. Postural activities associated with focal movements were found to share a number of organizational properties with automatic postural adjustments to support surface movements. Specifically, the postural muscle synergies were equivalent in muscle composition, relative activation magnitudes, and relative temporal sequencing. Furthermore, both types of postural adjustments were highly specific in locus and magnitude to the quality of steady-state postural equilibrium (e.g., postural "set"). 6. A conceptual model is proposed that suggests one simple way in which the reciprocal influence of postural set on postural and focal movement components and their temporal sequencing might be accomplished. Furthermore, we propose in this model a common central organization of postural adjustments associated with focal movements and those elicited by support-surface movements.

Afferent Pathways↗

Early development of postural adjustments in standing with and without support.

This study investigates the early development of postural adjustments during external perturbations in two different standing positions: standing with support and standing without support. The aim of the study was to assess a group of 13 infants four times during the period in life when independent standing is achieved; at 8, 10, 12 and 14 months. However, longitudinal data could be achieved only in four infants. Muscle activations of the neck, hip and ankle were recorded using surface electromyography. Based on earlier studies and controversies, three main issues were addressed: (1) Is direction specificity present before independent standing is established? (2) How do postural adjustments change with increasing age (8-14 months)? (3) Are postural adjustments task-specific in the young child? The results showed that our small sample of infants aged 8 and 10 months, who were not yet able to stand independently, exhibited direction-specific postural adjustments both during standing with and without support, though not consistently during all trials and at all body levels. Therefore, we argue that direction specificity might constitute a prerequisite for the development of independent standing. We also found that the development of postural adjustments in standing with support resembles that of sitting, i.e. great variation in the postural adjustments at early age, and fine-tuning to the situation with increasing age and experience. This, we find that this is in agreement with the proposal that postural control develops through a selection process of the most suitable postural adjustments for the situation from a repertoire of direction-specific postural adjustments. The development of postural adjustments during standing without support is discussed. Additionally, differences in response rates were noted between the two standing positions, indicating that even before independent standing is established, sophisticated sensorimotor integration enables task-specific postural adjustments.

Age Factors↗

Are there deficits in anticipatory postural adjustments in Parkinson's disease?

We studied anticipatory postural adjustments in patients with Parkinson's disease who dropped a load from extended arms while standing. Anticipatory postural adjustments were seen when load dropping was induced by a fast, bilateral shoulder abduction but not when it was induced by pressing a trigger with the right thumb. We conclude that anticipatory postural adjustments in patients with Parkinson's disease can change with the magnitude of an action which is used to trigger a predictable postural perturbation. Thus, the described deficits in anticipatory postural adjustments in patients with Parkinson's disease are likely to be of quantitative rather than qualitative nature.

Aged↗

Anticipatory postural adjustments in the back and leg lift.

This study examined anticipatory postural adjustments in a dynamic multi-joint action in which a relatively fast voluntary movement is being executed while balance is maintained in the field of gravity. In a bi-manual whole body lifting task, the pickup of the load induces a forward shift in the position of the center of mass, challenging the dynamic balance regulation while simultaneously impeding the ongoing extension movement. We investigated whether anticipatory postural adjustments are an addition to a voluntary motor command or an inherent component of this command. Using a global mechanical analysis of the movement, we found that anticipatory postural adjustments are present in bimanual lifting, both in back lifting and leg lifting, and that lifting technique had a significant influence on the pattern of the adjustments. If the mass of the object was reduced unexpectedly, balance was disturbed in 92% of the mass-reduced trials. These findings suggest that the anticipatory postural adjustments to be performed are specified in advance such that the expected changes in the mechanical interaction with the environment are taken into account. The observations lend support to the hypothesis that the control of the observed anticipatory postural adjustments is an integral part of the control of the lifting movement itself. Consequently, the strict dichotomy in the control of posture and movement is being questioned.

Adult↗

Postural adjustments accompanying fast pointing movements in standing, sitting and lying adults.

The present study evaluated the effect of different positions, which varied in the amount of bodily support, on postural control during fast pointing movements. Fourteen adult subjects were studied in standing, various sitting and lying positions. Multiple surface electromyograms (EMGs) of arm, neck, trunk and upper leg muscles and kinematics were recorded during a standard series of unilateral arm movements. Two additional series, consisting of bilateral arm movements and unilateral arm movements with an additional weight, were performed to assess whether additional task-load affected postural adjustments differently in a sitting and standing position. Two pointing strategies were used--despite identical instructions. Seven subjects showed an elbow extension throughout the movements. They used the deltoid (DE) as the prime mover (DE group). The other seven subjects performed the movement with a slight elbow flexion and used the biceps brachii (BB) as the prime mover (BB group). The two strategies had a differential effect on the postural adjustments: postural activity was less and substantially later in the BB-group than in the DE group. Anticipatory postural muscle activity was only present in the DE group during stance. In all positions and task-load conditions the dorsal postural muscles were activated before their ventral antagonists. The activation rate, the timing and--to a lesser extent the amplitude of the dorsal muscle activity was position dependent. The position dependency was mainly found in the caudally located lumbar extensor (LE) and hamstrings (HAM) muscles. The EMG amplitude of LE and HAM was also affected by body geometry (trunk and pelvis position). Position and body geometry had only a minor effect on the activity of the neck and thoracic extensor muscles. This difference in behaviour of lower and upper postural muscles suggests that they could serve different postural tasks: the lower muscles being more involved in keeping the centre of mass within the limits of the support surface, and the upper ones in counteracting the reaction forces generated by movement onset. Increasing task-load by performing bilateral movements and--to a minor extent--during loaded unilateral movements affected the temporal and quantitative characteristics of the postural adjustments during standing and sitting in a similar way. The effect was present mainly during the early part of the response (within 100 ms after prime mover onset). This suggests that feedforward or anticipatory mechanisms play a major role in the task-specific modulation of postural adjustments.

Adaptation, Physiological↗

Influence of pyramidotomy on limb flexion movements induced by cortical stimulation and on associated postural adjustment in the cat.

Flexion movements induced by cortical stimulation and the associated postural adjustments in bilaterally pyramidotomised cats have been studied by means of an apparatus which measures separately the changes of force under each limb in the upright position of the animal. The results show: (1) The general motor behaviour of the animal is not affected by the lesion. The principal deficit is loss of tactile placing reaction in the forelimbs; there also appears a state akin to a vestibular syndrome when a light restraining harness is placed around the back and chest. (2) Stimulation of the motor cortex continues to evoke flexion movements of the contralateral limbs together with associated postural adjustment. Coordination between movement and postural adjustment is generally similar to that observed before pyramidal section, and response thresholds are unchanged. (3) Measurements reveal great quantitative modification both of the movement and the postural adjustment after the lesion. Weight shift latencies are increased and more dispersed in time, while the weight shifts themselves are reduced in amplitude and speed. (4) All these changes are more marked in the case of forelimb, rather than hindlimb, flexion, emphasising the greater degree of pyramidal influence on forelimb activity in the normal animal. (5) The results as a whole underline the ability of non-pyramidal systems, under the control of the motor cortex, to bring about both limb flexion and the associated postural adjustments in the absence of the corticospinal pathway.

Animals↗

Acquisition of anticipatory postural adjustments in a bimanual load-lifting task: normal and pathological aspects.

Anticipatory adjustments of forearm posture are associated with a voluntary load-lifting movement in bimanual load-lifting tasks. Three aspects of these adjustments are analyzed: their goal, their central organization, and their acquisition. The goal of the anticipatory adjustment in this task is to minimize the perturbation of forearm posture that occurs during unloading. The central organization is based on two parallel controls responsible, respectively, for the lifting movement of the moving forearm and the anticipatory postural adjustment of the postural forearm, their coordination depending on a central timing signal. The acquisition of the anticipatory postural adjustment was tested using a paradigm where the voluntary movement performed by one hand triggered, via an electronic switch, the load release of the postural forearm. It was achieved after 40-60 trials and was not graded as a function of the voluntary movement parameters, but of the disturbance of the postural arm about to occur. The learned anticipation was not transferred when, after a first acquisition session with one forearm as the postural forearm, a second learning session was performed with the other forearm as the postural forearm. The acquisition was tested in Parkinsonian and in hemiparetic patients with capsular lesion. The highest acquisition deficit was observed in hemiparetic patients, when the contralateral forearm was the postural forearm; the deficit was less important when the ipsilateral arm was postural. Surprisingly, the anticipatory postural adjustments in hemiparetic patients were rather well preserved when the natural load-lifting task was tested. These results suggest that the basal-ganglia SMA circuit and M1 premotor areas are important in the acquisition process.

Adaptation, Physiological↗

Development of postural adjustments during reaching in infants with CP.

The development of postural adjustments during reaching movements was longitudinally studied in seven infants with cerebral palsy (CP) between 4 and 18 months of age. Five infants developed spastic hemiplegia, one spastic tetraplegia, and one spastic tetraplegia with athetosis. Each assessment consisted of a simultaneous recording of video data and surface EMGs of arm, neck, trunk, and leg muscles during reaching in various lying and sitting positions. The basic organization of postural adjustments of the children developing spastic CP was intact. Their main problem was a deficient capacity to modulate the postural adjustments to task-specific constraints - a deficit which was attributed to a combination of an impaired motor coordination and deficits in sensory integration. The child with spastic-dyskinetic CP showed distinct abnormalities in the basic organization of postural adjustments.

Cerebral Palsy↗

Do anticipatory postural adjustments occurring in different segments of the postural chain follow the same organisational rule for different task movement velocities, independently of the inertial load value?

Dynamic phenomena, termed anticipatory postural adjustments (APA), are known to precede the onset of voluntary movement. Their anticipatory nature confers a particular status on APAs: as they cannot be triggered reflexly by afferent signals induced by a voluntary movement, it can be asked whether the APA parameters are centrally programmed as a function of some task movement parameters or are only the peripheral consequence of control variables. To this end the present study aims to determine whether the APAs occurring at the different sites of the postural chain yield the same accelerometric patterns and follow the same organisational rules when the task movement velocity changes, independently of the inertial load value. Subjects performed unilateral shoulder flexions at maximal and submaximal velocities, with (IUF) and without (OUF) an additional inertial load. Accelerometers were attached to the wrist and trunk, and on both sides of the body at shank, thigh, hip and shoulder. The results show that: 1) there was evidence of anticipatory acceleration in all segments of the postural chain; 2) each acceleration profile for the anticipatory phase was maintained over different focal movement velocities whether there was an additional load or not; 3) there were significant linear relationships between the amplitude of each segmental anticipatory acceleration and the square of the task movement velocity, the slope of which differs as a function of the inertial load; 4) there were close intersegmental correlations between these anticipatory accelerations which did not depend on the inertial load. In addition the correlation between the lower limbs and the opposite side of the body was positive, suggesting a diagonal postural pattern. A comparison of the present kinematic data with the corresponding EMG data reported in the literature argues in favour of a centrally determined kinematic pattern. It is proposed that the diagonal postural pattern between postural segments be considered as one of the order rules which could simplify the control process of asymmetrical movement. The anticipatory kinematics of each of the body segments would be calibrated with the velocity and the inertial load and scaled to the other segments to counteract the perturbing effect of the asymmetrical focal movement on body balance.

Acceleration↗

Perturbed step initiation in cerebellar subjects: 2. Modification of anticipatory postural adjustments.

Although ataxias of stance and gait are frequent manifestations of cerebellar disease, the number of human studies examining stance or gait in cerebellar subjects is limited. In the present study, we examined whether anticipatory postural adjustments were impaired in cerebellar subjects during perturbed and unperturbed step initiation. The first aim was to show possible abnormalities in timing, force and kinematic parameters of anticipatory postural adjustments in unperturbed stepping in cerebellar subjects. Second, we examined the ability of cerebellar subjects to modify anticipatory postural adjustments associated with step initiation in response to a backward translation. Finally, we asked whether cerebellar subjects (and controls) make use of predictive knowledge of perturbation amplitude in perturbed stepping. Only few abnormalities of anticipatory postural adjustments were found in cerebellar subjects compared to controls. Both in the unperturbed and perturbed step conditions, force production as well as step length and step velocity were reduced in cerebellar subjects compared to controls, suggesting compensatory slowing. Cerebellar subjects also appeared to be less able to use predictive information of perturbation amplitude to scale anticipatory postural adjustments than control subjects. Nevertheless, in unperturbed steps, temporal parameters of anticipatory postural adjustments were preserved in cerebellar subjects. When subjects voluntarily initiated a step in response to the surface translation, both control and cerebellar subjects adapted by executing the anticipatory postural adjustments for step more rapidly. Furthermore, both control and cerebellar subjects were able to use online information regarding perturbation amplitude to scale parameters of step initiation in perturbed stepping. Overall, our findings suggest that the cerebellum is neither critical for the basic motor program underlying unperturbed step initiation nor for many adaptive changes occurring during perturbed step initiation. Like its role in predictive scaling of automatic postural responses to external perturbations, the cerebellum appears to be important for predictive adaptation of anticipatory postural adjustments during step initiation.

Adolescent↗

The scaling of postural adjustments during bimanual load-lifting in traumatic brain-injured adults.

Previous postural studies of traumatic brain injury (TBI) patients have been limited to identifying deficits in static and quasi-dynamic postural control tasks such as weight shifting. In this study, we examined whether or not patients with TBI are able to scale adequately their postural adjustments during the performance of the dynamic task of bimanual load-lifting. An age matched group of healthy adults served as controls. We used the Tetrax posturography system that calculates a stability score (ST) based on fluctuations in vertical ground reaction forces, normalized for body weight. During quiet standing, the ST scores of the TBI group were significantly higher than the control group. Forward weight shift and percentage change in the vertical ground reaction forces (lift postural adjustment (LPA) and post-lift postural adjustment (PLPA) scores) linearly increased with increasing load weight in both healthy and TBI subjects. Group differences were found in the magnitude of forward weight shift but not in the relative increase of the LPA and PLPA scores during the lifting and post-lifting phases respectively. The forward weight shift of the TBI group was lower-than-normal and asymmetrical--there was significantly less forward weight shift on the more affected than on the less affected limb. In addition, a significant amplitude coupling was found between the scaling of the weight shift of the heel and forefoot of each limb. However, no coupling was found between the weight shift amplitudes of homologous parts of both limbs in the TBI group. The results showed that scaling based on prior experience was preserved in the TBI group, though some TBI subjects demonstrated absent scaling in either the more affected or less affected heel or forefoot. The differences between the normal and TBI groups in postural adjustments are not necessarily a sign of pathology; rather they may represent a deliberate choice of the central nervous system to counteract predictable disturbances.

Adult↗

Postural adjustments associated with rapid voluntary arm movements in patients with Parkinson's disease.

To determine the extent to which deficits in coordination between posture and movement are influenced by postural disorders, postural adjustments associated with rapid voluntary arm movement were studied in PD patients and controls. EMG activity in postural muscles of the lower limbs and the trunk and local anteroposterior accelerations of the upper part of the leg were recorded in subjects who rapidly raised their arms to a horizontal position in response to a visual signal. The arm movement was characterized electromyographically by EMG activity from the deltoid muscle (anterior portion) and kinetically by acceleration of the arm. Study of characteristics of voluntary movement showed a nonsignificant increase in RT (simple-reaction time task) and an important increase in MT. There were important differences between PD patients and control subjects with regard to postural adjustments. Timing between voluntary movement and postural movement was anticipatory in 5% of PD patients, whereas it was anticipatory in 100% of control subjects. In PD patients, organization of early postural adjustments was not specific to voluntary movement; in control subjects, organization of early postural adjustments was specific to the forthcoming movement. Last, a possible functional relation between the "quality" of postural adjustments and a reduction in motor performance of normal subjects is suggested.

Adult↗