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Interactions between pathways controlling posture and gait at the level of spinal interneurones in the cat.

The properties of three interneuronal populations controlling posture and locomotion are briefly reviewed. These are interneurones mediating reciprocal inhibition of antagonistic muscles and interneurones in pathways from secondary muscle spindle afferents to ipsilateral and contralateral motoneurones, respectively. It will be shown that these interneurones subserve a variety of movements, with functionally specialized subpopulations being selected under different conditions. Mechanisms for gating the activity of these neurones appear to be specific for each of them but to act in concert. Interneurones which are active during locomotion and postural reactions are distributed over many segments of the spinal cord and over several of Rexed's laminae, both in the intermediate zone and in the ventral horn (Berkinblit et al., 1978; Bayev et al., 1979; Schor et al., 1986; Yates et al., 1989). The location of neurones discharging during neck and labyrinthine reflexes is illustrated in Fig. 1A and B but indications that neurones with an even wider distribution contribute to locomotion, scratching and the related postural reactions have been provided by neuronal markers which preferentially label active neurones (WGA-HRP; see Noga et al., 1987) or neurones with active genetic transcription (c-fos; I. Barajon, personal communication; Dai et al., 1991). Such a wide distribution indicates a high degree of non-homogeneity, since neurones of different functional types are usually located in different laminae. It has been demonstrated that some of these neurones may be particularly important for setting up the rhythm of muscle contractions specific for different gaits or scratching, as part of their "pattern generators" (see, e.g., Grillner, 1981). Other neurones may be primarily involved in initiation of these movements or in postural adjustments combined with them. A considerable proportion of neurones mediating these movements are nevertheless likely to be used not in one particular type of movement but in a variety of movements, and contribute to postural reactions and locomotion as well as to various segmental reflexes and centrally initiated movements; they are likely to operate as last order (premotor) interneurones of several spinal pathways to motoneurones. One of the indications that this is the case is the overlap between the areas of location of interneurones active during postural reactions, locomotion, or scratching and the areas of location of premotor interneurones (Fig. 1C,D). The latter were labelled by loading motoneurones with WGA-HRP and by its subsequent retrograde transneuronal transport (see Harrison et al., 1986).(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗

A review of biomechanics of the central nervous system--Part III: spinal cord stresses from postural loads and their neurologic effects.

OBJECTIVE: To review literature pertaining to neurologic disorders stemming from abnormal postures of the spine. DATA COLLECTION: A hand search of available reference texts and a computer search of literature from Index Medicus sources was performed, with special emphasis placed on spinal cord stresses and strains caused by various postural rotations and translations of the skull, thorax, and pelvis. RESULTS: Spinal postures will often deform the neural elements within the spinal canal. Spinal postures can be broken down into four types of loading: axial, pure bending, torsion, and transverse, which cause normal and shear stresses and strains in the neural tissues and blood vessels. Prolonged stresses and strains in the neural elements cause a multitude of disease processes. CONCLUSION: Four types of postural loads create a variety of stresses and strains in the neural tissue, depending on the exact magnitude and direction of the forces. Transverse loading is the most complex load. The stresses and strains in the neural elements and vascular supply are directly related to the function of the sensory, motor, and autonomic nervous systems. The literature indicates that prolonged loading of the neural tissue may lead to a wide variety of degenerative disorders or symptoms. The most offensive postural loading of the central nervous system and related structures occurs in any procedure or position requiring spinal flexion. Thus flexion traction, rehabilitation positions, exercises, spinal manipulation, and surgical fusions in any position other than lordosis for the cervical and lumbar spines should be questioned.

Biomechanical Phenomena↗

Development of hindlimb postural control during the first postnatal week in the rat.

The development of the postural control of hindlimbs was investigated during the first postnatal week in the rat. The whole body was tilted in a vertical plane with the nose up. The proportion of animals producing a complete extension of both hindlimbs increased with age until the end of the first postnatal week. Motor responses were evoked by the pitch tilt already at birth with a slight extension of the hips, the knees and the ankles remaining bent in most cases. The extension produced at the ankle level increased gradually during the first postnatal week. This was correlated with a change in the EMG activity recorded from the triceps surae muscles (ankle extensors) during this postural reaction. There was a gradual acquisition of a tonic pattern. Characteristics of EMG responses changed significantly with age demonstrating an important increase in the use of triceps surae muscles in this postural task. These data demonstrate that the first postnatal week is a critical period for the development of postural reactions in the hindlimbs. They also suggest the existence of a proximo-distal gradient in the maturation of postural control. The mechanisms responsible for this reflex and for the maturation of posture are discussed.

Action Potentials↗

[Postural strategies and falls in elderly and in parkinsonism].

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls. MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.

Accidental Falls↗

Upright posture decreases esophageal varices flow velocity in patients with cirrhosis.

BACKGROUND/AIMS: Patients with cirrhosis tend to have esophageal variceal bleeding episodes at night, rather than during the day time. Since human beings carry on ordinary activities in the upright posture in the day time and are recumbent at night, we hypothesized that posture may be a factor related to a circadian variation of variceal bleeding. The aim of this study was to examine the effect of upright posture on esophageal varices hemodynamics in patients with cirrhosis. METHODS: Nine patients with cirrhosis and esophageal varices were included in a crossover study performed on 2 separate days. On the non-endoscopic day, cardiac output, portal vein flow velocity, and superior mesenteric artery flow velocity were measured with percutaneous Doppler ultrasonography. Plasma renin activity and plasma norepinephrine concentrations were also determined. On the endoscopic day, in addition to the above measurements, esophageal varices flow velocity was measured using transesophageal Doppler ultrasonography. These measurements were performed in the supine position and 20 min after the assumption of the upright position. RESULTS: On the non-endoscopic day, the upright posture significantly decreased cardiac output, portal vein flow velocity, and superior mesenteric artery flow velocity. Plasma renin activity and plasma norepinephrine concentration were significantly increased after assumption of the upright position. On the endoscopic day, similar hemodynamic and hormonal changes were observed. In addition, the upright posture significantly decreased esophageal varices flow velocity. Furthermore, the magnitude of the reduction in esophageal varices flow velocity (-42%) was significantly greater than that in portal vein flow velocity (-22%, p<0.01) and that in superior mesenteric artery flow velocity (-25%, p<0.01). Although the change in esophageal varices flow velocity was not significantly correlated with that in plasma renin activity (r=-0.28) and that in plasma norepinephrine concentration (r=-0.10), it was significantly correlated with the change in superior mesenteric artery flow velocity (r=0.73, p<0.05). CONCLUSIONS: The upright posture decreases esophageal varices flow velocity mainly because of the reduction in splanchnic blood flow. This effect may contribute to a low prevalence of esophageal variceal bleeding in the day time in patients with cirrhosis.

Aged↗

Chronology of upper limb anticipatory postural adjustments associated with voluntary wrist flexions and extensions in humans.

Six sitting healthy subjects were instructed to keep a constant upper limb posture while performing wrist flexions and extensions. Acceleration of the wrist, elbow and shoulder joints, and surface electromyograms (EMGs) of the upper limb's main flexors and extensors were studied. Results indicated the existence of anticipatory (APA) and corrective postural adjustments. The APAs were based on a reproducible directional chronology of postural muscle activations. As shown by a simple mechanical model, this chronology was in accordance with the muscular torque which should be applied to the joints to keep the upper limb posture constant. All these data indicate that APA are involved in segmental posture, where their general organization is similar to those of APA associated with whole-body movements. The use of constant directional postural synergies well agrees with a simplification of the motor control according to Bernstein's theory.

Arm↗

Upright posture influences salivary cortisol.

This study was designed to investigate the influence of posture on salivary cortisol concentrations in healthy volunteers. In a balanced cross-over design 24 subjects were exposed at 1 week intervals to different body positions (sitting [S], lying [L] upright [U]) for 20 min in each condition. Before, during and after the experimental treatment measures of blood pressure, heart rate and saliva samples for determining the free fraction of cortisol were obtained. Furthermore, at corresponding time points a questionnaire on emotional states was completed. In addition, subjects were requested to complete personality questionnaires before the experiment and to rate their emotional states during saliva sampling. Results clearly indicate that the circadian decrease of cortisol concentrations was present only in the conditions [S] and [L] whereas in [U] salivary cortisol concentrations increased significantly. As expected, heart rate accelerations associated with a marked reduction of systolic blood pressure were observed in [U]. To further examine the relationship between hormonal and cardiovascular responses as indicators of autonomic activation, correlations between change scores were computed indicating that a relationship between cardiovascular responses and cortisol increases is not restricted to [U]. Positive correlations were observed between changes in systolic blood pressure and changes in cortisol concentrations in both conditions [U] and [L]. Posture does not affect emotional states indicating independence between posture induced physiological responses and experienced discomfort. Posture therefore should be adequately controlled, since those non-specific increases of hormones may interfere with state or trait dependent responses. Data are discussed with respect to the importance to control for posture in field and experimental studies and to possible mechanisms of posture induced changes in cortisol.

Anxiety↗

Evaluating sensory conflict and postural instability. Theories of motion sickness.

Two experiments were carried out to evaluate the sensory conflict and the postural instability theories of motion sickness. The central hypothesis of sensory conflict theory is that motion sickness is caused by conflict between the current pattern of sensory inputs about self-movement and the pattern that is expected on the basis of previous experience. A subsidiary hypothesis is that the degree of motion sickness is proportional to the magnitude of sensory conflict. The central hypothesis of postural instability theory is that motion sickness is caused by loss of postural control. A subsidiary hypothesis is that the degree of motion sickness is proportional to amount of postural instability, which can be manipulated by physical restraint. In both experiments there were two levels of sensory conflict and two levels of postural restraint. Dependent variables were latency of onset and severity of motion sickness. The widespread occurrence of motion sickness in both experiments clearly confirmed the main hypothesis of sensory conflict theory. The results from Experiment 1, that there was significantly more motion sickness in the restrained condition, and from Experiment 2, that there was no significant difference in symptoms between the two restraint conditions, provide no support for the subsidiary hypothesis of postural instability theory. Evidence relating to the subsidiary proposition of sensory conflict theory was inconsistent.

Adolescent↗

The influence of postural control on motility and hand function in a group of 'high risk' preterm infants at 1 year of age.

The functional outcome of a group of 75 'high-risk' preterm infants was studied at the corrected age of 12 months. Only infants with high-risk for developmental deviance with gestational ages below 32 weeks and/or birthweights less than 1500 g were included in the study. Additionally the infants were categorised according to their medical history conforming with the 'Neonatal Medical Index' (NMI I to V), with category I describing infants with few medical problems and V characterizing those with the most serious complications. In this study we included only infants with 'high-risk' as categorised in NMI III to V, since infants with 'low-risk' have been described earlier. Infants with cerebral ultrasonographic abnormalities were incorporated into the NMI categories, but also analysed separately to compare outcomes. At 12 months (corrected age) apart from pediatric follow-up, a full neurological assessment was done with emphasis on postural control, spontaneous motility and hand function. Special attention was given to symmetrical development. The infants were then categorised as having optimal, non-optimal or asymmetrical outcomes. An overall optimal outcome on postural control was found in 64% of all infants (67% in NMI III, 60% in NMI IV and 62.5% in NMI V). Too much extension interfering with postural control was found significantly more often in infants in NMI V (15%), compared to infants in NMI IV (8%) and NMI III (4.5%). Poor postural control had a significant influence on other domains of development such as motility (P=0.00), asymmetry (P=0.00) and hand function (P=0.00). Cerebral ultrasonographic abnormalities seemed to have an influence on motility (P=0.03), while no direct relationship was found with postural control, hand function or asymmetry. It is unclear whether this poor coordination of gross motor function will have consequences for appropriate visual-motor and sensorimotor integration therewith hampering later cognitive function, as often described in preterm infants. It is suggested that the poor postural control found in many infants is the result of both myogenic and/or neurogenic deviations and associated with cerebral pathology, but is also caused by the preterm birth and its nursing consequences.

Echoencephalography↗

Effect of head posture on cephalometric sagittal angular measures.

The definitions of cephalometric landmarks include relative terms that are dependent on the orientation of the head (e.g., lowest, most posterior) and head orientation differ widely during cephalometry (e.g., Frankfort plane horizontal, natural head posture). The purpose of this study was to quantify the effect of head posture changes on the commonly used sagittal angular measures SNA, SNB, and SNPogonion (SNPg). The sample comprised 30 Chinese skulls. Cephalograms were taken in a purpose designed skull holder with the Frankfort plane horizontal and at +10 degrees, +20 degrees, +30 degrees, -10 degrees, -20 degrees, and -30 degrees. A geometric grid was used to locate the deepest landmarks, and the landmarks were digitized followed by computer superimposition on the S-N line. To compare the values of the SNA, SNB, and SNPg angles in the different head postures, t tests were used. Head (skull) posture changes produced significant effects on the cephalometric values even at +/- 10 degrees of tilting. Overall, the angles were underestimated by approximately 1 degrees. In general, the angular differences and their standard deviations increased as the skull rotation increased with most of the differences for the SNB and the SNPg angles being clinically significant and also statistically significant at the 0.1% level. It was concluded that head posture needs to be standardized during cephalometry. Changes in posture significantly affect the location of some landmarks and the subsequent data obtained.

Asian People↗

The development of instrumentation for the dynamic measurement of changing head posture.

Cranial posture and its possible relationship to the morphology of the skull has been studied in some detail, as have the relationships between cranial posture and such functions as respiration and jaw movements. To date, cranial posture has been assessed mainly with techniques that give static interpretations of the angular relationships between intracranial and extracranial reference lines. The present project was undertaken to develop a system of instruments capable of the continuous measurement and recording of cranial posture for extended periods of time. A number of aspects of this system were tested. The results indicate that the experimental array of instruments measures head posture accurately over a defined range of cranial movement. This new technique should make it possible to measure cranial posture in a more dynamic and physiologic manner.

Adult↗

Sitting posture and prevention of pressure ulcers.

The aim of this study was to gain insight about the influence of body posture on the pressure at the seat surface and to establish to what extent different seat cushions designed for incontinent patients reduce maximum pressures. Pressures were measured for 56 healthy volunteers in eight postures using four cushions. The posture in which the lowest maximum pressure was measured was the sitting-back posture with the lower legs on a rest. If the seat could not be tilted back, the maximum pressure in the upright sitting posture with the feet on the ground was significantly lower than sitting upright with the legs supported on a rest. Sliding down and slouching caused the highest maximum pressure. Regular checking of the posture and using positioning cushions should form part of any pressure-ulcer prevention protocol. The four selected cushions each have different pressure-reducing effects. A thick air cushion (Repose) has the lowest maximum pressure and is significantly better than the other cushions at reducing the high pressure when slouching or sliding down.

Adult↗

Automatic postural response systems in individuals with congenital total blindness.

This study examined the effects of the absence of vision from birth on automatic postural responses to platform displacements during stance. Postural responses were induced by producing randomly four types of perturbations which consisted of forward and backward translations, and toe up and down rotations. Nine congenitally totally blind and nine sighted adults served as subjects. EMG signals were recorded from four muscles in the right leg, and reaction time to somatosensory stimuli generated by platform displacements was measured by pushing a hand-held button. To assess the ability to control postural balance, the root mean square (RMS) values for lateral and antero-posterior sway before, during, and after perturbations were calculated. The EMG amplitude in the gastrocnemius muscle of a blind subject was smaller than that of a sighted subject with eyes closed. No significant differences were found between blind and sighted subjects in EMG latencies of the lower extremity muscles in response to perturbations. The blind subjects had significantly faster reaction times to somatosensory stimuli triggered by platform displacements, but in toe down rotations no significant difference was found between blind and sighted subjects. The difference in the EMG latencies and reaction times between the two groups suggests that blindness from birth may not affect the spinal stretch reflex, but may affect a volitional act mediated through the motor cortex. There were also no significant differences in the RMS values for postural sway between blind and sighted subjects with eyes open or closed, although blind subjects swayed more after backward translations than did sighted subjects with eyes open. Results suggest that the ability to control postural balance during perturbations was not affected by vision loss from birth. Our findings suggest that the automatic postural response systems of humans are unaffected by the absence of vision from birth and are rather hard wired.

Adaptation, Physiological↗

Postural adaptation to walking on inclined surfaces: I. Normal strategies.

This study investigated the postural strategies to adapt to uphill and downhill treadmill inclination (0, 5 and 10%) during walking and standing in eight healthy subjects. Increasing the treadmill grade from 0 to 10% induced an increasingly flexed posture of the hip, knee and ankle at initial foot contact as well as a progressive forward tilt of pelvis and trunk. These postural changes were accompanied by a progressive decrease in pelvic lateral drop toward the swinging limb and a gradual increase in stride length as the uphill slope became steeper. Decreasing the treadmill grade from 0 to -10% lead to a decreasingly flexed posture of the hip at initial foot contact as well as an increase in knee flexion during weight acceptance and late stance. These changes were accompanied by a gradual decrease in stride length, a progressive backward tilt of trunk and pelvis and an increase in pelvic lateral drop toward the swinging limb as downhill slope became steeper. Changes in trunk and pelvic postural alignment in the sagittal plane might be used to facilitate power generation or absorption in adapting to slope changes during walking. During quiet standing, however, the trunk and pelvis remained aligned with respect to earth's vertical at any surface inclination. These results showed that postural adaptations are task-specific and the control requirements are different between standing and walking on an inclined surface.

Adaptation, Physiological↗

Oculographic and clinical characterization of thirty-seven children with anomalous head postures, nystagmus, and strabismus: the basis of a clinical algorithm.

BACKGROUND AND PURPOSE: We studied children with nystagmus who also had anomalous head postures and strabismus to determine the etiology of the conditions and present a diagnostic clinical algorithm. METHODS: The patients for this study were among the 560 patients evaluated in the ocular motor neurophysiology laboratory between the years 1991 and 1997. Clinical characteristics, infrared oculography data, and medical and surgical treatments were entered into a database for analysis. Oculography was performed on all patients according to a standard protocol, and data were stored and analyzed off-line. Etiology of anomalous head posture was determined with both clinical and oculography information. RESULTS: Thirty-seven children are the subjects of this report. The etiology of anomalous head posture was a "gaze null" due to congenital nystagmus in 23 (62%) patients, an "adduction null" due to manifest latent nystagmus in 12 (32%) patients, spasmus nutans in 1 (3%) patient, and strabismus in 1 (3%) patient. The patients' ages ranged from 9 months to 12 years and averaged 4.4 years. Sixty-nine percent were male patients. Nineteen (63%) of 30 patients had abnormal recognition (linear optotype) acuity in at least 1 eye on monocular cover; the recognition remained abnormal in 5 (17%) of 30 patients under binocular conditions. Thirty percent of patients had amblyopia, 16% had some structural disease of the eyes, 22% had some systemic syndrome or abnormality, 57% had a significant refractive error, and 27% had some ability to fuse. CONCLUSIONS: The major etiology for anomalous head posture in these patients was to adopt a gaze null due to congenital nystagmus (62% of patients) regardless of the direction of their anomalous head posture or type of strabismus. Moving the fixing eye as the first step for the anomalous head posture, combined with moving the nonfixing eye for the resulting strabismus may help treat these patients.

Algorithms↗

Influence of two different sitting positions on postural adjustments in children with spastic diplegia.

The present study addressed the question whether the deviant postural adjustments in children with spastic diplegia can be attributed to their crouched sitting position or primarily to their neural deficit. Postural adjustments during sitting in an erect and in a crouched position on a movable platform were assessed in 10 children, aged 3 to 7 years 6 months, with mild-to-severe forms of spastic diplegia and 10 age- and sex-matched control children. Multiple surface EMGs of neck, trunk, and leg muscles and kinematics of head, body sway, and pelvis were recorded during forward and backward translations. The children with normal motor development showed a distinct adaptation of postural adjustments to sitting position. The children with cerebral palsy (CP) had a deficient adaptational capacity which was more pronounced in the erect than in the crouched position. Thus, the crouched sitting position did not induce postural deficiency but seemed to offer a solution to the sensory-motor problem of the instability experienced. Children with severe diplegia exhibited a lack of direction specificity in the leg muscles during backward body sway, which points to a basic deficit in postural control. In addition, these children showed marked dysfunctions in the precise tuning of the postural adjustments to task-specific conditions. In the children with mild-to-moderate forms of CP the basic level of control was intact.

Adaptation, Physiological↗

Physiological effects of posture on mask ventilation in awake stable chronic hypercapnic COPD patients.

Stable chronic hypercapnic patients are often prescribed long-term mask noninvasive pressure support ventilation (NPSV). There is a lack of information on the effects of posture on NPSV. Therefore posture induced changes in physiological effects of NPSV in awake stable chronic hypercapnic patients were evaluated. In 12 awake chronic obstructive pulmonary disease (COPD) patients breathing pattern, respiratory muscles, mechanics and dyspnoea (by visual analogue scale: VAS) were evaluated during spontaneous breathing (SB) in sitting posture and during NPSV in sitting, supine and lateral positions randomly assigned. Arterial blood gases were evaluated during SB and at the end of the last NPSV session (whatever the posture). As expected NPSV resulted in a significant improvement in carbon dioxide tension in arterial blood (Pa,CO2) (from 7.4+/-0.85 to 6.9+/-0.7 kPa). When compared with SB, sitting NPSV resulted in a significant increase in tidal volume and minute ventilation and in a significant decrease in breathing frequency. Inspiratory muscle effort as assessed by oesophageal pressure swings and pressure-time product per minute (from 14+/-4.8 to 6.2+/-3.5 cmH2O, and from 240+/-81 to 96+/-60 cmH2O x s x min(-1) respectively), intrinsic dynamic positive end expiratory pressure (from 2.7+/-2.3 to 1.4+/-1.3 cmH2O) and expiratory airway resistance (from 18+/-7 to 5+/-3 cmH2O x L x s(-1)) decreased during sitting NPSV, whereas VAS did not change. Changing posture did not significantly affect any parameter independently of the patients weight, whether obese or not. In awake stable hypercapnic chronic obstructive pulmonary disease patients changing posture does not significantly influence breathing pattern and respiratory muscles during noninvasive pressure support ventilation suggesting that mask ventilation may be performed in different positions without any relevant difference in its effectiveness.

Aged↗

Random change in cortical load representation suggests distinct control of posture and movement.

Accurately maintaining a fixed limb posture and quickly moving between postures underlies both everyday skills, including holding and lifting a cup of coffee, and expert skills, such as an Olympic wrestler's holding and throwing an opponent. A fundamental question in limb motor control is whether the brain manages these contrasting goals of posture and movement through a single, robust control process or whether each engages a specialized control process. We addressed this question by examining how individual neurons in the primary motor cortex of macaque monkeys represent mechanical loads during posture and movement tasks. Notably, approximately half of the neurons that expressed load-related activity did so exclusively during either posture only or movement only. Further, those neurons with load-related activity during both tasks randomly switched their magnitude of response between tasks. These random changes in load representation suggest specialized control processes, one for posture and one for movement.

Action Potentials↗