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PubMed2004

Why and how are posture and movement coordinated?

In most motor acts, posture and movement must be coordinated in order to achieve the goal of the task. The focus of this chapter is on why and how this coordination takes place. First, the nature of posture is discussed. Two of its general functions are recognized; an antigravity role, and a role in interfacing the body with its environment such that perception and action can ensue. Next addressed is how posture is controlled centrally. Two models are presented and evaluated; a genetic and a hierarchical one. The latter has two levels; internal representation and execution. Finally, we consider how central control processes might achieve an effective coordination between posture and movement. Is a single central control process responsible for both movement and its associated posture? Alternatively, is there a dual coordinated control system: one for movement, and the other for posture? We provide evidence for the latter, in the form of a biomechanical analysis that features the use of eigenmovement approach.

Central Nervous System↗
PubMed2006

Adaptive task prioritization in aging: selective resource allocation to postural control is preserved in Alzheimer disease.

OBJECTIVE: With age, the performance of multiple tasks decreases, a pattern exaggerated in Alzheimer disease (AD). At the same time, recent research, based on adaptive theories of healthy aging, indicates a preference of older adults to allocate resources toward tasks of higher immediate value (e.g., postural control). This study investigated whether such models also hold for pathologic cognitive aging. METHOD: Using a dual-task paradigm, the authors combined a working memory with a postural control task under easy and difficult conditions in patients with AD, older adults, older adults low on performance on a cognitive marker test, and young adults (N = 40). Participants repeatedly performed a cognitive and a postural control task both simultaneously and in isolation over the course of eight sessions. RESULTS: Consistent with earlier studies on divided attention in age and AD, the authors found large dual-task performance decrements with age and more so in AD. When not challenged, patients with AD showed large performance decrements under dual-task conditions in both postural control and working memory. With increasing difficulty in the postural control task, however, older adults, and more so patients with AD, maintained a high level of functioning in postural control, as compared with working memory. CONCLUSION: The findings indicate that the theory of selective optimization with compensation extends to pathologic aging and have broad implications for models of dual-task performance and executive control in aging and AD.

Adult↗
PubMed2004

Kinematic and kinetic validity of the inverted pendulum model in quiet standing.

Movements of the whole-body center of mass during quiet standing have been estimated from measurements of body segment movements. These whole-body center of mass movements have been compared with movements of the center of mass as predicted from a simple inverted-pendulum model of standing. However, the total body center of mass is a weighted average of the center of mass of all individual body segments. The question arises as to how well the total body center of mass represents the individual segments and lower limb joint angles. This study focuses on the validity of how well the individual segments and lower limb angles temporally and spatially synchronize with the total body center of mass. Eleven healthy university students volunteered to participate. Kinematic data were collected using a 3D optoelectronic camera system; kinetic data were collected using a 3D force plate. Participants stood quietly, with eyes open, for 120 s. Segment and whole body centers of mass were calculated from a 14 segment, 3D bilateral model. Segment and joint angles were calculated for the lower limbs, bilaterally, and the trunk. Segment center of mass root-mean-square displacements were strongly correlated with center of mass height relative to the ankle joint and were synchronized, or temporally locked, to the movement of the whole body center of mass. Sagittal plane ankle angular displacements were highly correlated to sagittal plane center of mass movement; stronger correlations between body center of mass and lower limb angular displacement were observed, the result of compensatory knee joint angular displacements. These data support and extend the use of an inverted pendulum model to represent quiet standing postural control.

Acceleration↗
PubMed1998

Control of spatial orientation in a mollusc.

The main function of postural nervous mechanisms in different species, from mollusc to man, is to counteract the force of gravity and stabilize body orientation in space. Here we investigate the basic principles of postural control in a simple animal model, the marine mollusc Clione limacina. When swimming, C. limacina maintains its vertical orientation because of the activity of the postural neuronal network. Driven by gravity-sensing organs (statocysts), the network causes postural corrections by producing tail flexions. To understand how this function occurs, we studied network activity by using a new method. We used an in vitro preparation that consisted of the central nervous system isolated with the statocysts. Output signals from the network (electrical activity of tail motor neurons) controlled an electrical motor which rotated the preparation in space. We analysed the activity of individual neurons involved in postural stabilization under opened or closed feedback loop. When we closed this artificial feedback loop, the network stabilized the vertical orientation of the preparation. This stabilization is based on the tendency of the network to minimize the difference between the activities of the two antagonistic groups of neurons, which are driven by orientation-dependent sensory inputs.

Animals↗
PubMed1982

A two compartment model of the stepping generator: analysis of the roles of a stage-setter and a rhythm generator.

Recent studies on locomotion of the mesencephalic cat demonstrated that activation of the spinal stepping generator and the postural control system are dependent phenomena (Mori et al., 1978, 1980). This has motivated the construction of a new model of the stepping generator to account for interactions with the postural control system. The present model consists of two main compartments, the rhythm generator and the stage-setter. The rhythm generator generates rhythmic bursting discharges of extensor and flexor alpha motoneurons. The function of the stage-setter is to set and reset the excitability of extensor alpha motoneuron to a number of desired levels. This study analyzes interactions in this model between rhythm generating and postural control system. By adding a concept of "stage-setting" to the rhythm generator model, we succeed in simulating a variety of locomotor patterns observed in the mesencephalic cat, including "stepping automatism" (Mori et al., 1979).

Animals↗
PubMed1991

[Photoelastic studies of the position of plantar pressure center and its changes at standing upright: analysis on Down syndrome].

With a photoelastic method, contact pressure patterns between foot and the floor surface were recorded, occasionally for one minute. The aim of this study is to evaluate the development or maturity of postural control. As a clinical model to be tested, Down syndrome characterized by marked muscular hypotonicity was chosen for quantitative analysis. The following results were obtained; (1) the center of contact pressure is shifted significantly forward in Down syndrome, (2) the position tends to move forward on the left side in both normal and Down syndrome groups, and (3) there was no distinctive laterality of weight loading on either side. Flaccidity of ankle joint movements such as abnormal eversion was indicated by a special parameter, which was obtained for the first time by this method.

Child↗
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

A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion.

Recent research suggests that traditional biomechanical models of postural stability do not fully characterise the nonlinear properties of postural control. In sports medicine, this limitation is manifest in the postural steadiness assessment approach, which may not be sufficient for detecting the presence of subtle physiological change after injury. The limitation is especially relevant given that return-to-play decisions are being made based on assessment results. This update first reviews the theoretical foundation and limitations of the traditional postural stability paradigm. It then offers, using the clinical example of athletes recovering from cerebral concussion, an alternative theoretical proposition for measuring changes in postural control by applying a nonlinear dynamic measure known as 'approximate entropy'. Approximate entropy shows promise as a valuable means of detecting previously unrecognised, subtle physiological changes after concussion. It is recommended as an important supplemental assessment tool for determining an athlete's readiness to resume competitive activity.

Athletic Injuries↗
PubMed2005

Comparing internal models of the dynamics of the visual environment.

It is well known that the human postural control system responds to motion of the visual scene, but the implicit assumptions it makes about the visual environment and what quantities, if any, it estimates about the visual environment are unknown. This study compares the behavior of four models of the human postural control system to experimental data. Three include internal models that estimate the state of the visual environment, implicitly assuming its dynamics to be that of a linear stochastic process (respectively, a random walk, a general first-order process, and a general second-order process). In each case, all of the coefficients that describe the process are estimated by an adaptive scheme based on maximum likelihood. The fourth model does not estimate the state of the visual environment. It adjusts sensory weights to minimize the mean square of the control signal without making any specific assumptions about the dynamic properties of the environmental motion. We find that both having an internal model of the visual environment and its type make a significant difference in how the postural system responds to motion of the visual scene. Notably, the second-order process model outperforms the human postural system in its response to sinusoidal stimulation. Specifically, the second-order process model can correctly identify the frequency of the stimulus and completely compensate so that the motion of the visual scene has no effect on sway. In this case the postural control system extracts the same information from the visual modality as it does when the visual scene is stationary. The fourth model that does not simulate the motion of the visual environment is the only one that reproduces the experimentally observed result that, across different frequencies of sinusoidal stimulation, the gain with respect to the stimulus drops as the amplitude of the stimulus increases but the phase remains roughly constant. Our results suggest that the human postural control system does not estimate the state of the visual environment to respond to sinusoidal stimuli.

Algorithms↗
PubMed2005

An optimal state estimation model of sensory integration in human postural balance.

We propose a model for human postural balance, combining state feedback control with optimal state estimation. State estimation uses an internal model of body and sensor dynamics to process sensor information and determine body orientation. Three sensory modalities are modeled: joint proprioception, vestibular organs in the inner ear, and vision. These are mated with a two degree-of-freedom model of body dynamics in the sagittal plane. Linear quadratic optimal control is used to design state feedback and estimation gains. Nine free parameters define the control objective and the signal-to-noise ratios of the sensors. The model predicts statistical properties of human sway in terms of covariance of ankle and hip motion. These predictions are compared with normal human responses to alterations in sensory conditions. With a single parameter set, the model successfully reproduces the general nature of postural motion as a function of sensory environment. Parameter variations reveal that the model is highly robust under normal sensory conditions, but not when two or more sensors are inaccurate. This behavior is similar to that of normal human subjects. We propose that age-related sensory changes may be modeled with decreased signal-to-noise ratios, and compare the model's behavior with degraded sensors against experimental measurements from older adults. We also examine removal of the model's vestibular sense, which leads to instability similar to that observed in bilateral vestibular loss subjects. The model may be useful for predicting which sensors are most critical for balance, and how much they can deteriorate before posture becomes unstable.

Brain↗
PubMed1993

Control of whole body balance in the frontal plane during human walking.

A whole-body inverted pendulum model was used to investigate the control of balance and posture in the frontal plane during human walking. The model assessed the effects of net joint moments, joint accelerations and gravitational forces acting about the supporting foot and hip. Three video cameras and two force platforms were used to collect kinematic and kinetic data from repeat trials on four subjects during natural walking. An inverse solution was used to calculate net joint moments and powers. Whole body balance was ensured by the centre of mass (CM) passing medial to the supporting foot, thus creating a continual state of dynamic imbalance towards the centerline of the plane of progression. The medial acceleration of the CM was primarily generated by a gravitational moment about the supporting foot, whose magnitude was established at initial contact by the lateral placement of the new supporting foot relative to the horizontal location of the CM. Balance of the trunk and swing leg about the supporting hip was maintained by an active hip abduction moment, which recognized the contribution of the passive accelerational moment, and countered a large destabilizing gravitational moment. Posture of the upper trunk was regulated by the spinal lateral flexors. Interactions between the supporting foot and hip musculature to permit variability in strategies used to maintain balance were identified. Possible control strategies and muscle activation synergies are discussed.

Abdomen↗
PubMed1997

Coupling of fingertip somatosensory information to head and body sway.

Light touch contact of a fingertip with a stationary surface can provide orientation information that enhances control of upright stance. Slight changes in contact force at the fingertip provide sensory cues about the direction of body sway, allowing attenuation of sway. In the present study, we asked to which extent somatosensory cues are part of the postural control system, that is, which sensory signal supports this coupling? We investigated postural control not only when the contact surface was stationary, but also when it was moving rhythmically (from 0.1 to 0.5 Hz). In doing so, we brought somatosensory cues from the hand into conflict with other parts of the postural control system. Our focus was the temporal relationship between body sway and the contact surface. Postural sway was highly coherent with contact surface motion. Head and body sway assumed the frequency of the moving contact surface at all test frequencies. To account for these results, a simple model was formulated by approximating the postural control system as a second-order linear dynamical system. The influence of the touch stimulus was captured as the difference between the velocity of the contact surface and the velocity of body sway, multiplied by a coupling constant. Comparison of empirical results (relative phase, coherence, and gain) with model predictions supports the hypothesis of coupling between body sway and touch cues through the velocity of the somatosensory stimulus at the fingertip. One subject, who perceived movement of the touch surface, demonstrated weaker coupling than other subjects, suggesting that cognitive mechanisms introduce flexibility into the postural control scheme.

Adult↗
PubMed2000

Postural stability using different neck positions in normal subjects and patients with neck trauma.

Subjects with neck problems, such as whiplash injuries, often complain of disturbed equilibrium and, in some instances, provocation of the neck position can elicit such problems. The importance of neck proprioceptors for maintaining balance is gaining increased interest, moreover the function or malfunction of the otoliths may disturb equilibrium in certain head positions. The aim of the study was to create a reference material for postural control and its dependence on head position in healthy subjects and to compare this with a set of patients with known neck problems and associated vertiginous problems. A total of 32 healthy subjects (16 men, 16 women, age range 21-58 years) as well as 10 patients age range 27-62 years (mean 44 years) with neck problems and associated balance problems since a whiplash injury were tested for postural control using the EquiTest dynamic posturographic model. The normal subjects were initially split into four age groups in order to estimate the effects of age on performance. The postural stability was evaluated for dependence of support surface conditions (stable or sway-referenced), visual input (eyes open or closed) and head position (neutral, left rotated, right rotated, extended backwards or flexed forward) using analysis of variance (ANOVA) with Tukey's post hoc test in case of a significant factor effect. As expected, visual cues as well as stable support surface improve postural stability (p < 0.001). Postural stability is statistically different in the head extended backwards condition compared with the other four head positions (p < 0.001 in all cases) in both patients and controls. Eliminating this test condition from the analysis, only a slight (p < 0.05) difference between head forwards and head turned left remained. This pattern of results remained if the normal subjects were only split into two age groups instead of four. Finally, the patient group exhibited significantly lower postural performance than all the groups of normal subjects (p <0.01), but none of the normal groups differed significantly from each other. It is concluded that the postural control system is significantly challenged in the head extended backwards condition in both normal subjects and patients with previous whiplash injury and persistent neck problems. The patient group differed statistically from all groups of normal subjects. This suggests that neck problems impair postural control, and that the head extended position is a more challenging task for the postural system to adapt to. Whether this is due to utricular malpositioning, central integrative functions or cervical proprioceptive afferents is not within the scope of this study to answer.

Adult↗
PubMed1999

The role of vision on postural strategy evaluated in patients affected by congenital nystagmus as an experimental model.

The role of vision in postural control is crucial and is strictly related to the characteristics of the visual stimulus and to the performance of the visual system. The purpose of this investigation was to evaluate the effects of chronically reduced visual cues upon postural control in patients affected by Congenital Nystagmus (CN). These patients have developed since birth a postural strategy mainly based on vestibular and somatosensorial cues. Fifteen patients affected by CN and 15 normal controls (NC) were enrolled in the study and evaluated by means of dynamic posturography. The overall postural control in CN patients was impaired as demonstrated by the equilibrium score and by the changes of the postural strategy. This impairment was even more enhanced in CN than in NC group when somatosensorial cues were experimentally reduced. An aspecific pattern of visual impairment and a pathological composite score were also present. Our data outline that in patients affected by CN an impairment of the postural balance is present especially when the postural control relies mainly on visual cues. Moreover, a decrease in accuracy of the somatosensory cues has a proportionally greater effect on balance than it has on normal subjects.

Adult↗
PubMed1996

European Spine Society--the AcroMed Prize for Spinal Research 1995. Unexpected load and asymmetric posture as etiologic factors in low back pain.

Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of "sudden load" on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain patients. The subjects were fatigued by holding a 20% maximum voluntary contraction for 1 min. A functional restoration program was tested for its efficacy in reducing reaction time and EMG amplitude in chronic low back pain patients. Reaction time was longer and EMG amplitude lower in patients than in their matched controls. EMG reaction time and magnitude decreased in patients after a 2-week rehabilitation program, including specific training of coordination and posture control. The results of the modelling showed higher spinal compressive load and lower shear forces when the load was expected than when the load was unexpected. The effect of sudden loads can be exacerbated if a worker is not standing on a flat surface or is fatigued. Chronic low back pain patients have less ability to protect themselves from sudden loads, but they can be trained to improve their response by means of an appropriate rehabilitation program.

Adult↗
PubMed1995

Role of somatosensory and vestibular cues in attenuating visually induced human postural sway.

The purpose of this study was to determine the contribution of visual, vestibular, and somatosensory cues to the maintenance of stance in humans. Postural sway was induced by full-field, sinusoidal visual surround rotations about an axis at the level of the ankle joints. The influences of vestibular and somatosensory cues were characterized by comparing postural sway in normal and bilateral vestibular absent subjects in conditions that provided either accurate or inaccurate somatosensory orientation information. In normal subjects, the amplitude of visually induced sway reached a saturation level as stimulus amplitude increased. The saturation amplitude decreased with increasing stimulus frequency. No saturation phenomena were observed in subjects with vestibular loss, implying that vestibular cues were responsible for the saturation phenomenon. For visually induced sways below the saturation level, the stimulus-response curves for both normal subjects and subjects experiencing vestibular loss were nearly identical, implying (1) that normal subjects were not using vestibular information to attenuate their visually induced sway, possibly because sway was below a vestibular-related threshold level, and (2) that subjects with vestibular loss did not utilize visual cues to a greater extent than normal subjects; that is, a fundamental change in visual system "gain" was not used to compensate for a vestibular deficit. An unexpected finding was that the amplitude of body sway induced by visual surround motion could be almost 3 times greater than the amplitude of the visual stimulus in normal subjects and subjects with vestibular loss. This occurred in conditions where somatosensory cues were inaccurate and at low stimulus amplitudes. A control system model of visually induced postural sway was developed to explain this finding. For both subject groups, the amplitude of visually induced sway was smaller by a factor of about 4 in tests where somatosensory cues provided accurate versus inaccurate orientation information. This implied (1) that the subjects experiencing vestibular loss did not utilize somatosensory cues to a greater extent than normal subjects; that is, changes in somatosensory system "gain" were not used to compensate for a vestibular deficit, and (2) that the threshold for the use of vestibular cues in normal subjects was apparently lower in test conditions where somatosensory cues were providing accurate orientation information.

Adult↗
PubMed2000

Multisensory information for human postural control: integrating touch and vision.

Despite extensive research on the influence of visual, vestibular and somatosensory information on human postural control, it remains unclear how these sensory channels are fused for self-orientation. The focus of the present study was to test whether a linear additive model could account for the fusion of touch and vision for postural control. We simultaneously manipulated visual and somatosensory (touch) stimuli in five conditions of single- and multisensory stimulation. The visual stimulus was a display of random dots projected onto a screen in front of the standing subject. The somatosensory stimulus was a rigid plate which subjects contacted lightly (<1 N of force) with their right index fingertip. In each condition, one sensory stimulus oscillated (dynamic) in the medial-lateral direction while the other stimulus was either dynamic, static or absent. The results qualitatively supported five predictions of the linear additive model in that the patterns of gain and variability across conditions were consistent with model predictions. However, a strict quantitative comparison revealed significant deviations from model predictions, indicating that the sensory fusion process clearly has nonlinear aspects. We suggest that the sensory fusion process behaved in an approximately linear fashion because the experimental paradigm tested postural control very close to the equilibrium point of vertical upright.

Adult↗