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PubMed2001

Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes.

OBJECTIVE: Postural stability and neuropsychological testing are gradually becoming integral parts of postconcussion assessment in athletes. Clinicians, however, sometimes question the viability of instituting preseason baseline testing and the value of these results in making return-to-play decisions. Our purpose was to examine the course of recovery on various postural stability and neuropsychological measures after sport-related concussion. A secondary goal was to determine if loss of consciousness and amnesia, both of which are heavily weighted in most of the concussion classification systems, affect the rate of recovery. DESIGN AND SETTING: All subjects underwent a battery of baseline postural stability and neuropsychological tests before the start of their respective seasons. Any athletes subsequently injured were followed up at postinjury days 1, 3, and 5. Matched control subjects were assessed using the same test battery at the same time intervals. SUBJECTS: We studied 36 Division I collegiate athletes who sustained a concussion and 36 matched control subjects. MEASUREMENTS: We assessed postural stability using the Sensory Organization Test on the NeuroCom Smart Balance Master System and the Balance Error Scoring System. Neurocognitive functioning was measured with several neuropsychological tests: Trail-Making Test, Wechsler Digit Span Test, Stroop Color Word Test, and Hopkins Verbal Learning Test. RESULTS: Injured subjects demonstrated postural stability deficits, as measured on both the Sensory Organization Test and Balance Error Scoring System. These deficits were significantly worse than both preseason scores and matched control subjects' scores on postinjury day 1. Only the results on the Trail-Making Test B and Wechsler Digit Span Test Backward resulted in a logical recovery curve that could explain lowered neuropsychological performance due to concussive injury. Significant differences were revealed between the control and injured groups at day 1 postinjury, but a significant decline between baseline and postinjury scores was not demonstrated. Loss of consciousness and amnesia were not associated with increased deficits or slowed recovery on measures of postural stability or neurocognitive functioning. CONCLUSIONS: Athletes with cerebral concussion demonstrated acute balance deficits, which are likely the result of not using information from the vestibular and visual systems effectively. Neurocognitive deficits are more difficult to identify in the acute stages of concussion, although concentration, working memory, immediate memory recall, and rapid visual processing appear to be mildly affected. More research is necessary to determine the best neuropsychological test battery for assessing sport-related concussion.

Journal Article↗
PubMed1997

Effect of unilateral functional instability of the ankle on postural sway and inversion and eversion strength.

OBJECTIVE: The purpose of this study was to determine if individuals with unilateral functional ankle instability had decreased ability to maintain postural sway, as well as decreased isokinetic eccentric strength of ankle evertors and invertors. DESIGN AND SETTING: SUBJECTS WITH NO PREVIOUS HISTORY OF ANKLE INJURY WERE COMPARED WITH SUBJECTS WITH FUNCTIONAL ANKLE INSTABILITY ON THE FOLLOWING TESTS: isokinetic eccentric inversion and eversion strength and measures of single-limb postural sway. SUBJECTS: EIGHTEEN SUBJECTS PARTICIPATED IN THIS STUDY: 9 subjects in the functional instability (FI) group (age = 22.89 +/- 3.18 yr, ht = 181 +/- 6.0 cm, wt = 80.25 +/- 12.2 kg) and 9 noninjured (NI) controls (age = 26.22 +/- 2.34 yr, ht = 170 +/- 10.0 cm, wt = 65.08 +/- 12.03 kg). MEASUREMENTS: Subjects performed postural sway assessment on a balance system under static and dynamic conditions. Ankle inversion and eversion eccentric strength were evaluated at 90 degrees /sec using an isokinetic dynamometer. Additionally, we assessed the degree of mechanical instability in the FI group with a series of stress radiographs. RESULTS: No significant differences in single-limb postural sway measures or in eversion strength between limbs in the FI group or between groups were found. A significant group-by-limb interaction was present in inversion peak torque; however, post hoc testing revealed the only difference to be between the dominant and nondominant limbs of the NI group. CONCLUSIONS: Postural sway and inversion and eversion eccentric peak torque are not affected by functional instability of the ankle. Alternate methods of postural sway assessment and ankle strength measurement are discussed as possible areas for future study.

Journal Article↗
PubMedDate not supplied

Recovery of postural control after cerebral concussion: new insights using approximate entropy.

CONTEXT: The return-to-play decision after sport-related cerebral concussion depends in part on knowing when an athlete has fully recovered postural control after injury. OBJECTIVE: To describe the postconcussion recovery of postural control using approximate entropy (ApEn), a regularity statistic from nonlinear dynamics. DESIGN: Retrospective case series analysis. SETTING: Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS: Collegiate athletes from whom center-of-pressure and symptom data were collected at preseason, less than 48 hours after injury, and 48 to 96 hours after injury. MAIN OUTCOME MEASURE(S): Approximate entropy values reflecting the amount of randomness contained in center-of-pressure oscillations were calculated for anterior-posterior (AP) and medial-lateral (ML) time series. Equilibrium scores reflecting the amplitude of center-of-pressure AP oscillations were used to indicate postural stability. The number and severity of symptoms were described. RESULTS: Compared with the healthy preseason state, ApEn values for the AP and ML time series generally declined immediately after injury in both steady and unsteady injured athletes. At 48 to 96 hours after injury, ApEn values for the ML time series remained significantly depressed (mean difference compared with preseason = -0.268, standard error = 0.072), even among athletes whose initial postural instability had resolved. We found few significant relationships between changes in ApEn values and changes in symptoms before and after injury. CONCLUSIONS: The effects of cerebral concussion on postural control appear to persist for longer than 3 to 4 days, even among athletes with no signs of unsteadiness. Our results may reflect changes in neurophysiologic or mechanical constraints on postural control. Approximate entropy provides a theoretically distinct, valuable measurement alternative that may prove useful for reducing uncertainty in the return-to-play decision.

Journal Article↗
PubMed1990

The mechanism of symptomatic postural hypotension in the elderly.

To study the mechanism of symptomatic postural hypotension in the elderly, we collected 11 such patients to further divide them into group 1 with central nervous system (CNS) involvement and group 2 without CNS involvement. Group 1 was the so-called Shy-Drager syndrome, and group 2 was the elderly postural hypotension not secondary to the medications or other systemic diseases. All patients had various degree of autonomic dysfunction and heterogenous defects in the reflex arc of autonomic nervous system (ANS). Both groups also had normal plasma volume but reduced blood volume. Patients in group 1 had normal level of plasma norepinephrine in recumbent posture, but failed to increase normally after standing (p less than 0.05, as compared the percentage rising with that of the controls). Patients in group 2 had near normal level of plasma norepinephrine in recumbent posture and could rise normally after standing. They also had normal level of plasma epinephrine in recumbent posture, but failed to rise normally after standing (p less than 0.05 as compared with the controls). These findings suggested that impaired responsiveness of end organs as blood vessels and adrenal medulla is one of the major causes responsible for the symptomatic postural hypotension in the elderly without CNS involvement.

Age Factors↗
PubMed2007

Acute effects of a lateral postural assist on voluntary step initiation in patients with Parkinson's disease.

Anticipatory postural adjustments (APAs) for lateral weight transfer and stability precede and accompany voluntary stepping. Patients with Parkinson's disease (PD) show delays in step initiation with altered APA characteristics that may reflect impaired interactions between posture and locomotion. The purpose of this study was to examine the influence of a lateral postural assist on step initiation in patients with early stage PD while off medication and healthy controls. Subjects performed self-paced rapid forward steps. In one condition (ASSIST), the APA was assisted at onset with a lateral pull applied to the pelvis by a motor-driven robotic system. Ground reaction forces and whole body kinematics were recorded to characterize the APA and step characteristics. Overall, PD subjects had a longer APA duration (P < 0.01) and longer first step duration (P < 0.027) than Control subjects. With the ASSIST, the APA duration for both groups was shorter (P < 0.001), the step onset time was earlier (P < 0.001), and the speed of the first step became faster for PD subjects. Postural assistance affecting the interaction between posture and locomotion may have therapeutic potential for improving movement function in patients with PD.

Aged↗
PubMed1993

Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories.

A new conceptual and theoretical framework for studying the human postural control system is introduced. Mathematical techniques from statistical mechanics are developed and applied to the analysis and interpretation of stabilograms. This work was based on the assumption that the act of maintaining an erect posture could be viewed, in part, as a stochastic process. Twenty-five healthy young subjects were studied under quite-standing conditions. Center-of-pressure (COP) trajectories were analyzed as one-dimensional and two-dimensional random walks. This novel approach led to the extraction of repeatable, physiologically meaningful parameters from stabilograms. It is shown that although individual stabilograms for a single subject were highly variable and random in appearance, a consistent, subject-specific pattern emerged with the generation of averaged stabilogram-diffusion plots (mean square COP displacement vs time interval). In addition, significant inter-subject differences were found in the calculated results. This suggests that the steady-state behavior of the control mechanisms involved in maintaining erect posture can be quite variable even amongst a population of age-matched, anthropometrically similar, healthy individuals. These posturographic analyses also demonstrated that COP trajectories could be modelled as fractional Brownian motion and that at least two control systems-a short-term mechanism and a long-term mechanism-were operating during quit standing. More specifically, the present results suggest that over short-term intervals open-loop control schemes are utilized by the postural control system, whereas over long-term intervals closed-loop control mechanisms are called into play. This work strongly supports the position that much can be learned about the functional organization of the postural control system by studying the steady-state behavior of the human body during periods of undisturbed stance.

Adult↗
PubMed1995

The effects of visual input on open-loop and closed-loop postural control mechanisms.

In an earlier posturographic investigation (Collins and De Luca 1993) it was proposed that open-loop and closed-loop control mechanisms are involved in the regulation of undisturbed, upright stance. In this study, stabilogram-diffusion analysis was used to examine how visual input affects the operational characteristics of these control mechanisms. Stabilogram-diffusion analysis leads to the extraction of repeatable center-of-pressure (COP) parameters that can be directly related to the resultant steady-state behavior and functional interaction of the neuromuscular mechanisms underlying the maintenance of erect posture. Twenty-five healthy male subjects (aged 19-30 years) were included in the study. An instrumented force platform was used to measure the time-varying displacements of the COP under each subject's feet during quiet standing. The subjects were tested under eyes-open and eyes-closed conditions. The COP trajectories were analyzed as one-dimensional and two-dimensional random walks, according to stabilogram-diffusion analysis. Using this technique, it was found that visual input affects the performance of the postural control system in one of two different ways--either it significantly modifies the steady-state behavior of the open-loop postural control mechanisms, or it significantly alters the characteristics of the other closed-loop feedback mechanisms that are involved in balance control. This result is interpreted as an indication that the visual system is integrated into the postural control system in one of two different ways. The experimental population was roughly evenly divided between these two schemes. For the first group (13 of 25 subjects), visual input principally caused a decrease in the "effective" stochastic activity of the open-loop control mechanisms in both the mediolateral and anteroposterior directions. For the second group (12 of 25 subjects), visual input caused an increase in the effective stochastic activity and uncorrelated behavior of the closed-loop control mechanisms in the anteroposterior direction only. On the basis of these results, it is hypothesized that visual input, in both schemes, serves to decrease the stiffness of the musculoskeletal system. In the former case, this may be accomplished by decreasing the level of muscular activity across the joints of the lower limb, whereas, in the latter case, reduced stiffness may be achieved by reducing the gain(s) of the other postural feedback mechanisms, i.e., the proprioceptive and/or vestibular systems. Using stabilogram-diffusion analysis, it was also found that the two groups of subjects behaved similarly under eyes-closed conditions.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2003

The integration of multiple proprioceptive information: effect of ankle tendon vibration on postural responses to platform tilt.

Previous studies have looked at co-processing of multiple proprioceptive inputs but few have investigated the effect of separate dynamic and tonic predominantly proprioceptive disruptions applied concurrently at the same segment. The purpose of the present study was to investigate how simultaneous ankle tendon vibration, a tonic stimulus, with a dynamic toes-up (TU) or toes-down (TD) platform perturbation (1) affects postural stability and (2) influences the adaptation process. Sixteen normal subjects (ten male, six female, mean age 26 +/- 4.8 years) stood blindfolded on a moving platform with vibrators attached bilaterally over the Achilles tendons. Participants were tested in quiet stance (QS), and with five successive TU and TD tilts. All tests were conducted both with (QS+V, TU+V, TD+V) and without vibration. Centre of pressure (CoP) displacements and pitch angular trunk velocity were recorded. Results for QS+V showed a significant 1.02-cm backward CoP displacement (P<0.01) and a significant increase in trunk velocity (peak-to-peak amplitude, P<0.05; SD of trunk velocity, P<0.05). TU+V resulted in a non-significant increase of maximum backwards CoP displacement when compared to TU alone. In addition, no notable effect of vibration on other measures of CoP (pre-tilt position, SD and area of sway) and trunk velocity (peak-to-peak, SD and area of sway) indicates that TU+V does not introduce significantly greater instability compared to tilt alone. In the TD condition, vibration was found to be a stabilising influence, causing a significant shift of the mean pre-tilt position 0.85 cm backwards (P<0.01) and a substantial decrease in the area of forward CoP displacement (P<0.01). However, maximum forwards CoP displacement and trunk velocity measures were not significantly altered during TD+V. Furthermore, in neither TU nor TD was the time-course or pattern of adaptation disrupted by the additional application of vibration. In conclusion, although vibration significantly affects postural measures when applied in isolation, this finding does not hold when it is applied in combination with a more dynamic stimulus. Instead it seems that once postural stability has been disrupted the central nervous system can rapidly assess information from a weaker tonic input and utilise or suppress it appropriately, depending on its effect towards overall postural control. It can be concluded that postural responses to the concurrent application of different predominantly proprioceptive stimuli are dependent upon the type of stimulus and the ability of the central nervous system to rapidly assess and re-weigh available sensory inputs.

Adaptation, Physiological↗
PubMed2006

Modeling postural instability with Galvanic vestibular stimulation.

In this study the effect of a pseudorandom binaural bipolar Galvanic stimulus generated by a sum of nonharmonically related sine waves on postural control was functionally assessed using computerized dynamic posturography (CDP), and the results compared to vestibulopathic patient populations and astronauts exposed to microgravity. The standardized CDP test battery comprised six sensory organization tests (SOTs) that combined three visual conditions (eyes open, eyes closed, and sway-referenced vision) with two proprioceptive conditions (fixed and sway-referenced support surfaces). Subjects (12) performed 18 randomized trials (three trials of each of the six SOTs) as a baseline, repeated the 18 trials with Galvanic vestibular stimulation (GVS), and then performed a post-GVS baseline. A 10 min rest period was inserted between each test battery. Anterioposterior postural sway increased significantly and was in the abnormal range (fifth percentile) during GVS for SOTs where visual input was compromised (sway-referenced surround) or absent. Postural stability returned to baseline when GVS was removed. An analysis of sensory input scores (somatosensory, visual, and vestibular) demonstrated the specificity of GVS in distorting vestibular input to postural control. The SOT scores observed in astronauts on landing day did not differ significantly to that generated by GVS in our normal subjects. GVS also induced a similar pattern of instability on CDP as profound bilateral vestibular loss, although not as severe. The results suggest that unpredictably varying GVS quantitatively and qualitatively models postural instability of vestibular origin.

Adult↗
PubMed2007

Adaptive changes in postural strategy selection in chronic low back pain.

Chronic low back pain (CLBP) patients achieve postural stability during challenging stance conditions by increasing sway speed. We investigated the mechanisms underlying this behavior, and whether postural strategy selection may be influenced by short-term experience of postural perturbation. Thirteen CLBP patients and thirteen age-matched controls underwent posturography tests. Subjects were asked to stand quietly: (a) with eyes open and eyes closed, and (b) while expecting a series of four backward translations of the support surface. Data from condition (a) was subjected to sway density analysis (SDA). This computes the number of consecutive spaces and respectively time samples during which center of pressure (COP) displacements remained inside a 2.5 mm radius. Three parameters of this analysis were considered: the mean number of peaks (MP), reflecting the time spent by COP in regions of stability, the mean time between peaks (MT) relating to the rate of production of posturographic commands, and the mean spatial distance (MD), reflecting the distance between stable regions. In condition (b) the mean COP positions were analyzed during the time (500 ms) preceding each translation. The MD was significantly increased in the CLBP group as compared to controls (P < 0.01), while the MP and MT did not present any significant difference. The expectation of backward translations initially produced a different COP positioning between the two groups (P < 0.0001) which decreased with repetition of platform translations (controls: PDelta1-4 < 0.002; patients: PDelta1-4 < 0.005). The findings show that the timing and the rate of the balance motor commands is comparable between the two groups. On the other hand, there is greater distance between regions of stability in the patient group. Such modification of motor control patterns might be the consequence of a reweighting of sensory input, possibly due to a deterioration of its reliability. Platform translation findings show that both groups aimed at optimizing their posture selection strategy based on prior testing experience. CLBP patients make use of a different postural motor strategy to maintain quiet stance. This is probably the consequence of an imprecise internal estimate of body sway, due to reduced accuracy in the sensory integration process.

Adaptation, Physiological↗
PubMed1998

Effect of head position on postural orientation and equilibrium.

This study examined (1) how changes in head position affect postural orientation variables during stance and (2) whether changes in head position affect the rapid postural response to linear translation of the support surface in the horizontal plane. Cats were trained to stand quietly on a moveable platform and to maintain five different head positions: center, left, right, up, and down. For each head position, stance was perturbed by translating the support surface linearly in 16 different directions in the horizontal plane. Postural equilibrium responses were quantified in terms of the ground reaction forces, kinematics, dynamics (net joint torques), body center of mass, and electromyographic (EMG) responses of selected limb and trunk muscles. A change in head position involved rotation of not only the neck but also the scapulae and anterior trunk. Tonic EMG levels were modulated in several forelimb and scapular muscles but not hindlimb muscles. Finally, large changes in head orientation in both horizontal and vertical planes did not hamper the ability of cats to maintain postural equilibrium during linear translation of the support surface. The trajectory of the body's center of mass was the same, regardless of head position. The main change was observed in joint torques at the forelimbs evoked by the perturbation. Evoked EMG responses of forelimb and scapular muscles were modulated in terms of magnitude but not spatial tuning. Hindlimb responses were unchanged. Thus, the spatial and temporal pattern of the automatic postural response was unchanged and only amplitudes of evoked activity were modulated by head position.

Animals↗
PubMed2001

Postural coordination patterns associated with the swinging frequency of arms.

Voluntary arm movements frequently perturb body equilibrium in an upright posture. The motions of leg joints need to be coordinated according to the properties of voluntary arm movements in order to maintain body equilibrium, and this may cause a change in postural pattern. The purpose of this study was to determine whether the kinematic pattern generation of upright posture is influenced by a change in the swinging frequency of arm movements and whether the pattern generation is correlated with a change in joint torque about the shoulder joint. Four male subjects in an upright posture were instructed to swing their arms at seven different frequencies, determined by the maximum swinging frequency of each subject (35%max, 40-60%max, 65%max). Segment rotations around the shoulder, hip, and ankle joints were analyzed at kinematic and kinetic levels. The results of kinematic analysis indicated that tight coupling between motions of the shoulder and hip joints was generated in lower-frequency trials (under 40-45%max), whereas tight coupling between motions of the shoulder and ankle joints was generated in higher frequency trials (more than 40-45%max). Furthermore, the results of kinetic analysis revealed that changes in the joint torque patterns about the shoulder and hip joints occurred in trials at 40-45%max. The mean value of 40-45%max was close to the eigenfrequency of each subject's arm. We concluded that (1) postural patterns associated with a gradual change in the swinging frequency of the arms can be divided into two coordination modes (a hip-shoulder in-phase mode and an ankle-shoulder in-phase mode), and (2) these two patterns may be divided by the eigenfrequency of the arm.

Adult↗
PubMed2004

Effects of lumbar extensor fatigue and fatigue rate on postural sway.

Falls from heights resulting from a loss of balance are a major concern in the occupational setting. Previous studies have documented a deleterious effect of lower extremity fatigue on balance. The purpose of this study was to investigate the effect of lumbar extensor fatigue on balance during quiet standing. Additionally, the effects of fatigue rate on balance and balance recovery rate were assessed. Eight center-of-pressure-based measures of postural sway were collected from 13 participants, both before and after a protocol that fatigued the lumbar extensors to 60% of their unfatigued maximum voluntary exertion force. In addition, postural sway was measured for 30 min after the fatiguing protocol, at 5-min intervals, to quantify balance recovery rate during recovery from fatigue. Two different fatigue rates were achieved by fatiguing participants over either 10 min or 90 min. Results show an increase up to 58% in time-domain postural sway measures with lumbar extensor fatigue, but no change in frequency-domain measures. Fatigue rate did not affect the magnitude of these postural sway increases, nor did it affect the rate of balance recovery following fatigue. Statistical power for the latter result, however, was low. These results show that lumbar extensor fatigue increases postural sway and may contribute to fall-from-height accidents.

Adult↗
PubMed2003

Evaluation of the lambda model for human postural control during ankle strategy.

An accurate modeling of human stance might be helpful in assessing postural deficit. The objective of this article is to validate a mathematical postural control model for quiet standing posture. The postural dynamics is modeled in the sagittal plane as an inverted pendulum with torque applied at the ankle joint. The torque control system is represented by the physiological lambda model. Two neurophysiological command variables of the central nervous system, designated lambda and micro, establish the dynamic threshold muscle at which motoneuron recruitment begins. Kinematic data and electromyographic signals were collected on four young males in order to measure small voluntary sway and quiet standing posture. Validation of the mathematical model was achieved through comparison of the experimental and simulated results. The mathematical model allows computation of the unmeasurable neurophysiological commands lambda and micro that control the equilibrium position and stability. Furthermore, with the model it is possible to conclude that low-amplitude body sway during quiet stance is commanded by the central nervous system.

Adult↗
PubMed1996

Postural stability and skilled performance--a study on top-level and naive rifle shooters.

Posture control during aiming over a period of 7.5 s preceding the shot was studied among national top-level rifle shooters as well as among national level shooters and amateurs familiar with rifle shooting. Movement of the center of forces (COF) was analyzed in terms of the speed and amplitude of the movement. These calculations were carried out in 1.5 s windows, the first window beginning 7.5 s and ending at 6.0 s prior the shot. The last window ended at the trigger pull. Posture control data differentiated the studied groups according to their level in competitive shooting. The male top-level shooters could stabilize their posture significantly better than female top-level or male national level shooters, who were, in turn, much more stable than naive shooters. The experienced shooters were able to stabilize their posture even better during the last seconds preceding the shot, whereas in naive shooters there were no significant differences when the successive windows were compared with each other. When a comparison was made between the best and worst 20 shots of each subject, a significant difference in balance parameters was only observed among the naive shooters, who showed more pronounced movement of the COF in the less successful trials. Among the highly trained top-level shooters a miss in whole-body posture stabilization apparently seldom is a reason for a poor result.

Adult↗
PubMed2004

One-leg stance in healthy young and elderly adults: a measure of postural steadiness?

OBJECTIVE: To investigate postural steadiness during 30 s of one-leg stance in healthy young and elderly adults, by analysing the pattern of the ground reaction force variability. DESIGN: A laboratory set-up was used to analyse the variability of the ground reaction forces in relation to time as a measure of postural steadiness. BACKGROUND: The one-leg stance test is a measure considered to assess postural steadiness in a static position by a temporal measurement. The common notion is that a better postural steadiness, i.e. less force variability, allows for longer time standing on one leg. However, there is lack of evidence how postural steadiness during one-leg stance changes over time. METHODS: Twenty-eight healthy elderly and 28 healthy young adults were tested by means of force plates assessing ground reaction forces while performing one-leg stance. RESULTS: During one-leg stance, two phases could be identified in both groups: First a dynamic phase, a rapid decrease of force variability, and thereafter a static phase, maintaining a certain level of force variability. During the first 5 s of one-leg stance the force variability decreased significantly more in the young group resulting in a lower force variability level during the static phase than in the elderly. CONCLUSIONS: The difficulties in maintaining the static position in elderly seems dependent on the reduced initial decrease in force variability and/or musculoskeletal components. We suggest that the first 5 s are crucial when assessing balance during one-leg stance.

Adult↗
PubMed2005

Intramuscular hemodynamics in bilateral erector spinae muscles in symmetrical and asymmetrical postures with and without loading.

BACKGROUND: Although attention has been paid to the relationship between the changes in blood circulation in erector spinae muscles and back pain, little is known about their hemodynamics in several various comparable postures with and without loading. Studies on hemodynamics of erector spinae muscles using near-infrared spectroscopy have been performed on subjects and patients mainly in forward flexion positions. METHODS: Two near-infrared spectroscopes were used to measure oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin in bilateral erector spinae muscles at L2-3 in subjects in 9 postures, and holding no load, 10 kg or 20 kg in maximum flexed and lateral bending. Those three values in each posture and loading condition were expressed as a percentage of their corresponding values obtained in the standing upright position, and designated and statistically analyzed as %Oxy-Hb, %Deoxy-Hb and %Total-Hb, respectively. FINDINGS: %Total-Hb and %Oxy-Hb in maximum flexion were the most decreased. In maximum lateral bending, %Oxy-Hb only in the contralateral erector spinae muscles was decreased. When the load was 20 kg, the decreases in %Oxy-Hb were the largest in maximum flexion and lateral bendings. INTERPRETATION: Using two near-infrared spectroscopes allowed us to measure simultaneously the hemodynamics of bilateral muscles. They demonstrated different responses in each side. Asymmetrical posture and loading were accompanied by asymmetrical changes of the bilateral erector spinae muscles. Stretched muscle had less blood volume and oxygenation, both of which decreased with increasing load. These results showed that these postures and conditions might lead to fatigue of the ES muscles.

Adult↗
PubMed2005

The effect of backpack weight on the standing posture and balance of schoolgirls with adolescent idiopathic scoliosis and normal controls.

Concerns have been raised regarding the effect of carrying a backpack on adolescent posture and balance, but the effect of backpack loading combined with other factors affecting balance, such as adolescent idiopathic scoliosis (AIS), has not been determined. This study examines the effects of backpack load on the posture and balance of schoolgirls with AIS and normal controls. The standing posture of 26 schoolgirls with mild AIS (mean age 13, Cobb angle 10-25 degrees ) and 20 age-matched normal schoolgirls were recorded without a backpack and while carrying a standard dual-strap backpack loaded at 7.5%, 10%, 12.5% and 15% of the subject's bodyweight (BW). Kinematics of the pelvis, trunk and head were recorded using a motion analysis system and centre of pressure (COP) data were recorded using a force platform. Reliable COP data could only be derived for 13 of the subjects with AIS. Increasing backpack load causes a significantly increased flexion of the trunk in relation to the pelvis and extension of the head in relation to the trunk, as well as increased antero-posterior range of COP motion. While backpack load appears to affect balance predominantly in the antero-posterior direction, differences between groups were more evident in the medio-lateral direction, with AIS subjects showing poor balance in this direction. Overall, carrying a backpack causes similar sagittal plane changes in posture and balance in both normal and AIS groups. Load size or subject group did not influence balance, but the additive effect of backpack carrying and AIS on postural control alters the risk of fall in this population. Therefore, load limit recommendations based on normal subjects should not be applicable to subjects with AIS.

Adolescent↗