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Biomedical subjects

Richard C Fitzpatrick

Publications and source records attributed to Richard C Fitzpatrick.

17 recordsLinked to original sources
PubMed2006

A tactile stimulus applied to the leg improves postural stability in young, old and neuropathic subjects.

The purpose of this study was to determine whether the application of passive tactile cues to the lower limb could improve postural stability in healthy young controls, older people and people with diabetic peripheral neuropathy. Antero-posterior sway was measured with eyes open and closed in 10 healthy young subjects (mean age 27 years, 5 male, 5 female), 10 older subjects without diabetic peripheral neuropathy (mean age 88 years, 2 male, 8 female) and 10 subjects with diabetic peripheral neuropathy (mean age 65 years, 6 male, 4 female) while a small piece of Velcro attached to a flexible mount was applied to three different sites on the leg (ankle, calf, and knee). Across all conditions, the mean sway of the neuropathic subjects was 93% greater than for the young subjects and 11% more than the older subjects. On average, subjects swayed 10% more with the eyes closed than with the eyes open. Each stimulus reduced sway, but the effect increased approximately in proportion to the height of the stimulus above the ankles (ankle 7.6%, calf 13.5%, knee 20.1% reduction compared to the no stimulus condition). This experiment demonstrates that a passive stimulus applied to the skin of the leg, which provides sensory information about body movement, significantly reduces body sway during standing. This applies to older subjects and subjects with peripheral neuropathy as well as healthy young subjects. These results have implications for novel approaches for improving stability in people with peripheral sensory loss.

Adult↗
PubMed2006

Resolving head rotation for human bipedalism.

Alignment of the body to the gravitational vertical is considered to be the key to human bipedalism. However, changes to the semicircular canals during human evolution suggest that the sense of head rotation that they provide is important for modern human bipedal locomotion. When walking, the canals signal a mix of head rotations associated with path turns, balance perturbations, and other body movements. It is uncertain how the brain uses this information. Here, we show dual roles for the semicircular canals in balance control and navigation control. We electrically evoke a head-fixed virtual rotation signal from semicircular canal nerves as subjects walk in the dark with their head held in different orientations. Depending on head orientation, we can either steer walking by "remote control" or produce balance disturbances. This shows that the brain resolves the canal signal according to head posture into Earth-referenced orthogonal components and uses rotations in vertical planes to control balance and rotations in the horizontal plane to navigate. Because the semicircular canals are concerned with movement rather than detecting vertical alignment, this result shows the importance of movement control and agility rather than precise vertical alignment of the body for human bipedalism.

Adult↗
PubMed2006

A structural equation model relating impaired sensorimotor function, fear of falling and gait patterns in older people.

Many falls in older people occur while walking, however the mechanisms responsible for gait instability are poorly understood. Therefore, the aim of this study was to develop a plausible model describing the relationships between impaired sensorimotor function, fear of falling and gait patterns in older people. Temporo-spatial gait parameters and acceleration patterns of the head and pelvis were obtained from 100 community-dwelling older people aged between 75 and 93 years while walking on an irregular walkway. A theoretical model was developed to explain the relationships between these variables, assuming that head stability is a primary output of the postural control system when walking. This model was then tested using structural equation modeling, a statistical technique which enables the testing of a set of regression equations simultaneously. The structural equation model indicated that: (i) reduced step length has a significant direct and indirect association with reduced head stability; (ii) impaired sensorimotor function is significantly associated with reduced head stability, but this effect is largely indirect, mediated by reduced step length, and; (iii) fear of falling is significantly associated with reduced step length, but has little direct influence on head stability. These findings provide useful insights into the possible mechanisms underlying gait characteristics and risk of falling in older people. Particularly important is the indication that fear-related step length shortening may be maladaptive.

Accidental Falls↗
PubMed2005

Virtual head rotation reveals a process of route reconstruction from human vestibular signals.

The vestibular organs can feed perceptual processes that build a picture of our route as we move about in the world. However, raw vestibular signals do not define the path taken because, during travel, the head can undergo accelerations unrelated to the route and also be orientated in any direction to vary the signal. This study investigated the computational process by which the brain transforms raw vestibular signals for the purpose of route reconstruction. We electrically stimulated the vestibular nerves of human subjects to evoke a virtual head rotation fixed in skull co-ordinates and measure its perceptual effect. The virtual head rotation caused subjects to perceive an illusory whole-body rotation that was a cyclic function of head-pitch angle. They perceived whole-body yaw rotation in one direction with the head pitched forwards, the opposite direction with the head pitched backwards, and no rotation with the head in an intermediate position. A model based on vector operations and the anatomy and firing properties of semicircular canals precisely predicted these perceptions. In effect, a neural process computes the vector dot product between the craniocentric vestibular vector of head rotation and the gravitational unit vector. This computation yields the signal of body rotation in the horizontal plane that feeds our perception of the route travelled.

Adult↗
PubMed2004

Otolith and canal reflexes in human standing.

We used galvanic vestibular stimulation (GVS) to identify human balance reflexes of the semicircular canals and otolith organs. The experiment used a model of vestibular signals arising from GVS modulation of the net signal from vestibular afferents. With the head upright, the model predicts that the GVS-evoked canal signal indicates lateral head rotation while the otolith signal indicates lateral tilt or acceleration. Both signify body sway transverse to the head. With the head bent forward, the model predicts that the canal signal indicates body spin about a vertical axis but the otolith signal still signifies lateral body motion. Thus, we compared electromyograms (EMG) in the leg muscles and body sway evoked by GVS when subjects stood with the head upright or bent forward. With the head upright, GVS evoked a large sway in the direction of the anodal electrode. This response was abolished with the head bent forward leaving only small, oppositely directed, transient responses at the start and end of the stimulus. With the head upright, GVS evoked short-latency (60-70 ms), followed by medium-latency (120 ms) EMG responses, of opposite polarity. Bending the head forward abolished the medium-latency but preserved the short-latency response. This is compatible with GVS evoking separate otolithic and canal reflexes, indicating that balance is controlled by independent canal and otolith reflexes, probably through different pathways. We propose that the short-latency reflex and small transient sway are driven by the otolith organs and the medium-latency response and the large sway are driven by the semicircular canals.

Adult↗
PubMed2004

Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy.

OBJECTIVE: To evaluate, in older people with diabetic peripheral neuropathy (DPN) and in age-matched controls, acceleration patterns of the head and pelvis when walking to determine the effect of lower-limb sensory loss on walking stability. DESIGN: Case-control study. SETTING: Falls and balance laboratory in Australia. PARTICIPANTS: Thirty persons with diabetes mellitus (age range, 55-91 y) and 30 age-matched controls. INTERVENTIONS: Acceleration patterns of the head and pelvis were measured while participants walked on a level surface and an irregular walkway. Participants also underwent tests of vision, sensation, strength, reaction time, and balance. MAIN OUTCOME MEASURES: Temporospatial gait parameters and variables derived from acceleration signals. RESULTS: Participants with DPN had reduced walking speed, cadence, and step length, and less rhythmic acceleration patterns at the head and pelvis compared with controls. These differences were particularly evident when participants walked on the irregular surface. Participants with DPN also had impaired peripheral sensation, reaction time, and balance. CONCLUSIONS: Older people with DPN have an impaired ability to stabilize their body when walking on irregular surfaces, even if they adopt a more conservative gait pattern. These results provide further insights into the role of peripheral sensory input in the control of gait stability, and suggest possible mechanisms underlying the increased risk of falling in older people with diabetic neuropathy.

Acceleration↗
PubMed2004

Probing the human vestibular system with galvanic stimulation.

Galvanic vestibular stimulation (GVS) is a simple, safe, and specific way to elicit vestibular reflexes. Yet, despite a long history, it has only recently found popularity as a research tool and is rarely used clinically. The obstacle to advancing and exploiting GVS is that we cannot interpret the evoked responses with certainty because we do not understand how the stimulus acts as an input to the system. This paper examines the electrophysiology and anatomy of the vestibular organs and the effects of GVS on human balance control and develops a model that explains the observed balance responses. These responses are large and highly organized over all body segments and adapt to postural and balance requirements. To achieve this, neurons in the vestibular nuclei receive convergent signals from all vestibular receptors and somatosensory and cortical inputs. GVS sway responses are affected by other sources of information about balance but can appear as the sum of otolithic and semicircular canal responses. Electrophysiological studies showing similar activation of primary afferents from the otolith organs and canals and their convergence in the vestibular nuclei support this. On the basis of the morphology of the cristae and the alignment of the semicircular canals in the skull, rotational vectors calculated for every mode of GVS agree with the observed sway. However, vector summation of signals from all utricular afferents does not explain the observed sway. Thus we propose the hypothesis that the otolithic component of the balance response originates from only the pars medialis of the utricular macula.

Afferent Pathways↗
PubMed2003

Effects of galvanic vestibular stimulation on human posture and perception while standing.

This study examines three hypotheses that have been proposed to explain the effects of galvanic vestibular stimulation (GVS) in standing human subjects. The first assumes realignment to an altered representation of vertical. GVS-evoked body tilt produced under conditions of different stability was compared with perceptions of the vertical which subjects indicated by two means, a visual line and a manipulandum. GVS produced body tilt that increased in unstable conditions but there were no differences in the perceived vertical in any condition. The second hypothesis is that the altered vestibular signal is interpreted as a tilt of the support surface. The postural response evoked by tilting the support surface was compared with the GVS response under conditions of varying stability. These responses were different, particularly for the lower body where movements were oppositely directed. Standing on foam augmented GVS responses whereas standing with feet apart augmented platform-tilt responses. The third hypothesis is that GVS produces an illusion of movement, and this causes a reaction in the opposite direction. Perception of movement during GVS was determined in standing and immobilised subjects. Although immobilised subjects experienced illusions of movement in the direction opposite the sway response, this only happened after long periods of stimulation and never for standing where subjects accurately reported the true direction of sway. Thus, the results do not support any of these proposals. Instead, they and other observations support a simpler interpretation that the GVS signal is consistent with head movement and evokes an automated response to stabilise the head in space.

Adult↗
PubMed2003

Acceleration patterns of the head and pelvis when walking on level and irregular surfaces.

The aim of this study was to evaluate acceleration patterns at the head and pelvis while subjects walked on a level and an irregular walking surface, to develop an understanding of how the postural control system responds to challenging walking conditions. Thirty young, healthy subjects walked on a level corridor and on artificial grass underlain with foam and wooden blocks placed in an arbitrary manner. Temporo-spatial gait parameters and acceleration patterns at the head and pelvis were measured. The results revealed that when walking on the irregular surface, subjects were able to maintain their velocity, but adopted a slower and more variable cadence and a significantly longer stride length. The magnitude of pelvis accelerations increased, however head accelerations were not affected by the walking surface. When considered as an overall pattern of movement, these findings suggest that one of the primary objectives of the postural control system when walking on irregular surfaces is head control, and that subjects adapt their stepping pattern on irregular surfaces to ensure that the head remains stable.

Acceleration↗
PubMed2003

Age-related differences in walking stability.

BACKGROUND: a large proportion of falls in older people occur when walking; however the mechanisms underlying impaired balance during gait are poorly understood. OBJECTIVE: to evaluate acceleration patterns at the head and pelvis in young and older subjects when walking on a level and an irregular walking surface, in order to develop an understanding of how ageing affects postural responses to challenging walking conditions. METHODS: temporo-spatial gait parameters and variables derived from acceleration signals were recorded in 30 young people aged 22-39 years (mean 29.0, SD 4.3), and 30 older people with a low risk of falling aged 75-85 years (mean 79.0, SD 3.0) while walking on a level and an irregular walking surface. Subjects also underwent tests of vision, sensation, strength, reaction time and balance. RESULTS: older subjects exhibited a more conservative gait pattern, characterised by reduced velocity, shorter step length and increased step timing variability. These differences were particularly pronounced when walking on the irregular surface. The magnitude of accelerations at the head and pelvis were generally smaller in older subjects; however the smoothness of the acceleration signals did not differ between the two groups. Older subjects performed worse on tests of vision, peripheral sensation, strength, reaction time and balance. CONCLUSION: the adoption of a more conservative basic gait pattern by older people with a low risk of falling reduces the magnitude of accelerations experienced by the head and pelvis when walking, which is likely to be a compensatory strategy to maintain balance in the presence of age-related deficits in physiological function, particularly reduced lower limb strength.

Acceleration↗
PubMed2003

Acceleration patterns of the head and pelvis when walking are associated with risk of falling in community-dwelling older people.

BACKGROUND: A large proportion of falls in older people occur when walking, however the mechanisms underlying impaired balance during gait are poorly understood. This study evaluated acceleration patterns of the head and pelvis when walking on a level and an unpredictably irregular surface to determine whether older people at risk of falling demonstrate an impaired ability to stabilize the body under challenging conditions. METHODS: One hundred community-dwelling older people aged between 75 and 93 years were evaluated for their risk of falling using a range of physiological tests previously found to be accurate predictors of falling in prospective studies. Temporo-spatial gait parameters and acceleration patterns at the head and pelvis were then measured in three orthogonal planes while subjects walked on a flat corridor and an unpredictably irregular walkway. Harmonic ratios of head and pelvis accelerations in each plane were calculated to provide an indicator of stability. RESULTS: Subjects with a high risk of falling exhibited reduced temporo-spatial gait parameters and increased step timing variability. Harmonic ratios of acceleration patterns were reduced at the head and pelvis in the vertical and antero-posterior directions. These differences were particularly evident when walking on the irregular surface. CONCLUSION: Older people at risk of falling adopt a more conservative basic walking pattern, but this does not ensure that the movements of the head and pelvis are stable. The irregular pelvis and head accelerations evident in the high risk group suggests that these subjects may have difficulty controlling trunk motion and maintaining a stable visual field when walking, particularly on irregular terrain.

Acceleration↗
PubMed2002

Galvanic vestibular stimulation evokes sensations of body rotation.

Psychophysical experiments identified effects of galvanic vestibular stimulation (GVS) on the perception of whole-body angular rotation. Subjects lay supine on a platform that could rotate about a vertical axis through the vestibular axis so that linear movements were excluded. Movements were applied sufficiently above perception threshold to enable a reliable report of direction and movement size. In some trials, binaural GVS was applied concurrently at 1-2 mA. When GVS that was incongruent with the movement was applied, subjects reported lesser spin, on average cancelling the movement perception. When the GVS and movement were congruent, subjects reported greater spin. We conclude that GVS produces a vestibular signal of rotation, probably though an effect on semicircular canals.

Adult↗
PubMed2002

Position and velocity responses to galvanic vestibular stimulation in human subjects during standing.

Galvanic vestibular stimulation (GVS) in animals modulates the firing of otolith and semicircular canal afferents alike. Here, we look for postural responses evoked by GVS from the otolith organs and semicircular canals. To minimise the modifying effects of somatosensory input on the response, low-intensity (0.3-0.5 mA) GVS was applied for 8 s while subjects stood on foam rubber with the feet together and strapped to the floor. The response had three phases: (i) a rapid movement during the first second, (ii) a slower movement that persisted throughout the stimulus, and (iii) a rapid partial return movement after GVS stopped. The three movement velocities were significantly different. The GVS response therefore appears to be the sum of a step response that returns to the starting point when the stimulus stops, and a constant-velocity ramp response for the duration of the stimulus without a return movement. Subjects' responses differed in size and profile, some with the step or ramp responses almost exclusively but most with a combination of both. The 'step-plus-ramp' model was tested by comparing the three velocities. If the responses add, the initial velocity should not be different from the sum of the velocities during the ramp-only period and the step-only period at offset. ANOVA and pairwise comparisons confirmed this. It is concluded that postural responses to GVS arise through stimulation of both otolith and canal afferents.

Adult↗
PubMed2002

What does galvanic vestibular stimulation stimulate?

The technique of galvanic vestibular stimulation (GVS) has been used for a long time. The stimulus produces stereotyped automatic postural and ocular responses. The mechanisms underlying these responses are not understood although they are commonly attributed to altered otolith output. Based on animal studies, it seems reasonable to assume that vestibular afferents from the otoliths and semicircular canals are affected similarly by GVS. With this assumption, and anatomical knowledge of the vestibular apparatus, a model is developed to describe the expected responses of vestibular afferents to percutaneous GVS and the physiological implications of this altered sensory signal. Bilateral bipolar GVS, the most commonly used technique, should produce a canal signal consistent with a strong ear-down roll towards the cathodal side, a smaller nose-to-cathode yaw, but no pitch signal. Bilateral bipolar GVS should also produce an otolith signal consistent with tilt towards the cathodal side or a translational acceleration towards the anodal side. The expected responses for other configurations of GVS are also described. The model appears consistent with published data on the ocular and postural responses to GVS, and suggests other testable hypotheses concerning postural, ocular and perceptual responses to GVS.

Animals↗