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Spinal loading during manual materials handling in a kneeling posture.

Stooped, restricted, kneeling, and other awkward postures adopted during manual materials handling have frequently been associated with LBP onset. However, lift assessment tools have focused on materials handling performed in an upright, or nearly upright standing posture. Unfortunately, many of the tools designed to analyze standing postures are not easily adapted to jobs requiring restricted postures. Therefore, the objective of this study was to evaluate spinal loading during manual materials handing in kneeling postures and determine if those loads can be predicted using simple regression. An EMG-driven biomechanical model, previously validated for upright lifting, was adapted for use in kneeling tasks. Subjects knelt under a 1.07m ceiling and lifted luggage of six weights (6.8, 10.9, 15.0, 19.1, 23.1 and, 27.2kgf) to one of four destination heights (0, 25.4, 53.3, 78.7cm). Spine loading was significantly affected by both destination height and load weight. Destination height increased compression, AP shear and lateral shear by an average of 14.5, 3.7 and 6.6N respectively per cm height increase. Load weight increased compression, AP shear and lateral shear by an average of 83.8, 27.0 and 13.1N respectively per kgf lifted. Regression equations were developed to predict peak spine loading using subject height, load weight and destination height with R(2) values of 0.62, 0.51 and 0.57 for compression, AP and lateral shear respectively.

Adult↗

Effect of mood state on anticipatory postural adjustments.

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

Adaptation, Physiological↗

Effects of immersion in virtual reality on postural control.

In the present study, we examined the effects of the time lag between visual scene and the head movement in the virtual reality (VR) world on motion sickness and postural control in healthy volunteers. After immersion in VR with additional time lags (from 0 to 0.8 s) to the inherent delay (about 250 ms), the visual-vestibular conflict induced a slight motion sickness in experimental subjects, but no change was noticed in the body sway path with eyes open and closed. However, Romberg ratio of body sway path with eyes closed divided by that with eyes open after immersion in VR was significantly decreased in comparison with that before immersion in VR. Since Romberg ratio is an index of visual dependency on postural control, this finding indicates that the immersion in VR decreases the visual dependency on postural control. It is suggested that adaptation to visual-vestibular conflict in VR immersion increases the contribution of vestibular and somatosensory inputs to postural control by ignoring the conflicting delayed visual input in the VR world. VR may be a promising treatment for visual vertigo in vestibular patients with unsuccessful compensation by its ability to induce vestibular and somatosensory reweighing for postural control.

Adult↗

Identification of distinct characteristics of postural sway in Parkinson's disease: a feature selection procedure based on principal component analysis.

We selected descriptive measures of the centre of pressure (CoP) displacement in quiet standing, by means of a procedure based on principal component analysis, in two groups particularly different in terms of postural behaviours, such as subjects with Parkinson's disease (PD) in the levodopa off and on states. We computed 14 measures of the CoP: 5 measures of CoP trajectory over the support surface, 3 measures that estimated the area covered by the CoP, 1 measure that estimated the principal CoP sway direction, 1 measure that quantified the CoP total power, 1 measure that estimated the variability of CoP frequency content and 3 measures of characteristic CoP frequencies [L. Rocchi, L. Chiari, A. Cappello, Feature selection of stabilometric parameters based on principal component analysis, Med. Biol. Eng. Comput. 42 (2004) 71-79; L. Rocchi, L. Chiari, F.B. Horak, Effects of deep brain stimulation and levodopa on postural sway in Parkinson's disease, J. Neurol. Neurosurg. Psychiatry, 73 (2002) 267-274]. The feature selection, independently applied to the measures obtained in the two groups, resulted in different principal component (PC) subspaces of the 14-dimension original data set (4 PCs in the off and 3 PCs in the on state to account for over 90% of the original variance), but in the same 5 CoP measures (selected features) needed to describe the different postural behaviours: root mean square distance; mean velocity; principal sway direction; centroidal frequency of the power spectrum; frequency dispersion. The five selected features were found to provide insight into the postural control mechanisms and to describe changes in postural strategies in the two groups of PD subjects, off and on levodopa. Thus, the five selected features may be recommended for use in clinical practice and in research, in the direction toward the definition of a standard protocol in quantitative posturography.

Aged↗

Postural after-effects of stepping on an inclined surface.

In previous studies, blindfolded, healthy subjects exhibited an after-effect of leaning while standing on a horizontal surface after a period of standing on an inclined surface. We investigated whether this kinesthetic after-effect would transfer from one task to another by asking blindfolded subjects to stand on a horizontal surface after stepping-in-place on an incline. Results showed that all subjects demonstrated a forward trunk leaning after-effect lasting from half a minute to over 6 min after stepping on a 10 degrees -toes-up incline for 2.5 min. For 5/7 subjects, the amplitude of the leaning after-effect was very similar following stepping or standing on the inclined surface. The similarity of the post-incline lean between the standing and stepping conditions suggests a common underlying mechanism for the after-effect following standing and walking on a gradient and suggests that prolonged maintenance of a constant ankle or leg posture is not a prerequisite condition for the after-effect. The transfer of a postural effect built-up during a locomotor task to a postural after-effect during a standing task is consistent with a central adaptive mechanism that adjusts the surface-referenced set point for whole body postural orientation for both gait and posture.

Adaptation, Physiological↗

Better postural balance in elderly women receiving estrogens.

OBJECTIVE: The amount of bone mass and the tendency to fall are main risk factors for hip fractures and both deteriorate with advancing age. The dynamics between estrogen exposure and fracture protection seem too rapid to be explained by an effect on bone mass only. Postural balance function may be another potential mechanism for the fracture-protecting effect of estrogens. STUDY DESIGN: We examined 16 long-term users of 17 beta-estradiol implants (20 mg) (mean age 67.9 years and mean duration of treatment 17.3 years [3.3 to 34 years]) and 16 age-matched (+/-2 years) nonusers (mean age 68.3 years). Postural balance (sway velocity) was measured by static posturography before and after blindfolding and application of vibration stimulus (20 to 100 Hz) to the calf muscles to disturb the proprioception and to induce imbalance. RESULTS: Sway velocities were significantly lower in estrogen users than in nonusers (p = 0.0067) and similar to those in young premenopausal women. The differences were accentuated after provocation by blindfolding and by increasing frequencies of vibration stimulus to the calf muscle. Serum levels of estradiol and estradiol/sex hormone-binding globulin were negatively and follicle-stimulating hormone levels positively associated with sway velocity (p = 0.0194, p = 0.0036, and p = 0.0052, respectively) and independent of age (p = 0.02 to 0.005), supporting causality between estrogen exposure and postural balance. CONCLUSIONS: These data indicate that postural balance function is better preserved in long-term estrogen users than in nonusers. Effects on postural balance function may be one mechanism explaining the rapid increase in distal forearm fractures early after menopause and the rapid dynamics between estrogen exposure and hip fracture protection and may potentially reduce the fracture risk in elderly women starting estrogen replacement therapy in spite of marginal increases in bone mass.

Adult↗

Unilateral trigeminal anaesthesia modifies postural control in human subjects.

The influence of trigeminal afferences on postural stabilization was tested. Twenty-seven subjects were recruited to evaluate the impact of trigeminal disturbance on orthostatic postural control before and after unilateral truncular anaesthesia of the mandibular nerve. Balance control quality was assessed using static posturography by means of statokinesigrams and lateral deviation. Postural control monitored by measuring the area covered by the centre of foot pressure decreases after anaesthesia in the eyes open condition. Postural deviation in the eyes closed condition was observed after anaesthesia in the controlateral side of anaesthesia. These data document the effects of trigeminal afferences on postural stabilization.

Adult↗

Postural sway under muscle vibration and muscle fatigue in humans.

Separate studies have demonstrated that vibration and fatigue of ankle muscles alter postural control. The purpose of the present experiment was to investigate the effect of ankle muscle vibration on the regulation of postural sway in bipedal stance following ankle muscle fatigue. Center of foot pressure displacements were recorded using a force platform. Results showed a similar increase in postural sway under muscle fatigue as well as under muscle vibration. Interestingly, under muscle fatigue muscle vibration did not induce a further increase in postural sway. Two hypotheses could, at least, account for this observation: (1). fatigued muscles are less sensitive to muscle vibration and (2). the central nervous system relies less upon proprioceptive information originating from fatigued muscles for regulating postural sway.

Adult↗

Biased postural vertical in humans with hemispheric cerebral lesions.

This study was aimed at demonstrating the existence of a biased postural vertical in humans with a recent cerebral lesion. The postural vertical of patients and controls was analysed comparatively using a self-regulated balancing task, performed in sitting posture. Patients displayed a quite constant (19/22) contralesional tilt of the postural vertical (mean -2.6 degrees), varying with the severity of their spatial neglect and hemianaethesia. Eight of them showed a pathological contralesional bias (mean -5.5 degrees) as compared to normals. This result indicates an asymmetric process of somatic graviceptive information due to some cerebral lesions. When patients were subjected to a transcutaneous electrical stimulation applied onto the contralesional side of the neck, body verticality was especially improved in those who showed a pathological bias in the postural vertical. This effect could thus be due to a reduced distortion in the egocentric co-ordinate system for spatial information processing.

Cerebral Cortex↗

Postural activity of constrained subject in response to disturbance in sagittal plane.

This study examines the postural activity of partially constrained subjects for three different initial standing postures in response to disturbances in the sagittal plane. When the ankle strategy suffices for disturbance rejection in response to anterior disturbances, a mostly linear relationship between the ankle torque and ankle angle was observed, resulting in a constant stiffness at the ankles. However, when the ankle torque saturation was reached, a combined ankle-trunk postural strategy was utilized mainly in response to posterior perturbations due to the properties of the base-of-support. This caused a nonlinear scaling of ankle responses, thereby increasing variability of ankle stiffness. Distinctions in the ankle responses were also observed for different initial standing postures. The anterior initial stance generally increases the overall postural stability and renders the utilization of ankle strategy feasible, even for the rejection of posterior disturbances. Therefore, a linear torque-angle relationship at the ankles was observed for the anterior initial stance, regardless of the perturbation parameters.

Adult↗

Fingertip touch improves postural stability in patients with peripheral neuropathy.

The purpose of this work was to determine whether fingertip touch on a stable surface could improve postural stability during stance in subjects with somatosensory loss in the feet from diabetic peripheral neuropathy. The contribution of fingertip touch to postural stability was determined by comparing postural sway in three touch conditions (light, heavy and none) in eight patients and eight healthy control subjects who stood on two surfaces (firm or foam) with eyes open or closed. In the light touch condition, fingertip touch provided only somatosensory information because subjects exerted less than 1 N of force with their fingertip to a force plate, mounted on a vertical support. In the heavy touch condition, mechanical support was available because subjects transmitted as much force to the force plate as they wished. In the no touch condition, subjects held the right forefinger above the force plate. Antero-posterior (AP) and medio-lateral (ML) root mean square (RMS) of center of pressure (CoP) sway and trunk velocity were larger in subjects with somatosensory loss than in control subjects, especially when standing on the foam surface. The effects of light and heavy touch were similar in the somatosensory loss and control groups. Fingertip somatosensory input through light touch attenuated both AP and ML trunk velocity as much as heavy touch. Light touch also reduced CoP sway compared to no touch, although the decrease in CoP sway was less effective than with heavy touch, particularly on the foam surface. The forces that were applied to the touch plate during light touch preceded movements of the CoP, lending support to the suggestion of a feedforward mechanism in which fingertip inputs trigger the activation of postural muscles for controlling body sway. These results have clinical implications for understanding how patients with peripheral neuropathy may benefit from a cane for postural stability in stance.

Aged↗

The role of the human cerebellum in short- and long-term habituation of postural responses.

The aim of the present study was to investigate the role of the human cerebellum in short-term (STH) and long-term habituation (LTH) of postural responses to repeated platform perturbations. Ten cerebellar patients and ten age- and sex-matched healthy controls participated. Twenty backward platform translations were applied on each of 5 consecutive days. Changes of postural response size within each day were assessed to determine STH and changes across days to determine LTH. Both controls and cerebellar patients showed a significant reduction of postural response size within each day (i.e. STH). No significant reduction of postural response size was observed across days (i.e. no LTH). Both controls and cerebellar patients, however, showed a tendency of response size to increase across days suggesting long-term sensitization. The amount of changes within and across days did not significantly differ between groups. The present findings suggest that changes of postural response size to repeated perturbations do not depend upon the integrity of the cerebellum.

Adult↗

Influence of artificial saddle riding on postural stability in children with cerebral palsy.

Stability of quiet upright stance was investigated in 25 children with cerebral palsy at the beginning and the end of a 3-month period of therapy involving 20 min microprocessor-controlled saddle riding, performed twice a week. The traditional parameters of postural sway based on the centre-of-pressure analysis (range, standard deviation, mean speed and mean radius) dropped significantly over time confirming advantageous influence of this treatment. As a complementary tool, an autoregressive modelling technique was used allowing us to establish after each single ride considerable decreases in the frequency of the feet adjustments, which represent the control variable of the postural system in sagittal plane. These changes reflect diminished ankle joints stiffness resulting from a single session, and are supposedly a basic reason for substantial progress of the patients. The autoregressive approach proved to be a powerful method, which corroborates and reinforces stabilographic investigations. The findings confirm that the therapy led to a noteworthy improvement in the postural performance of the CP children in sagittal as well in frontal planes. Moreover, they let us to infer about biomechanical properties of joints involved in maintaining posture, thus giving more insight into the operation of the neuro-muscular system and allowing us to better understand the reason of progress in motor control of posture.

Animals↗

Specificity of postural sway to the demands of a precision task.

We examined a precision aiming task in which a handheld laser pointer was controlled by the postural system. The task was performed in two orientations of the body's coronal plane to the target. In the parallel orientation medio-lateral (ML) sway had to be minimized, in the perpendicular orientation antero-posterior (AP) sway had to be minimized. In the parallel orientation ML sway decreased and AP sway increased with target distance and size. The pattern reversed in the perpendicular orientation. Nonlinear measures found independence of the two directions of sway and differences in their deterministic structure. Apparently a postural organization for upright standing and aiming (as in archery) entails two independent postural subsystems with different but reciprocally related dynamics. Furthermore, it seems as if some amount of postural variability is needed to ensure stability in quiet standing; if postural activity is reduced in one direction it is compensated for in the other direction.

Adult↗

Postural disturbance in patients with normal pressure hydrocephalus.

The postural function in 52 patients with normal pressure hydrocephalus (NPH) and in 19 patients with subcortical arteriosclerotic encephalopathy (SAE) was analysed bedside and in 17 of the NPH, 10 of the SAE and 23 healthy individuals (HI) also examined with a force platform. At the bedside examination, no differences in postural functions between NPH and SAE patients were found. The NPH patients improved more in the postural than in motor functions after shunt surgery. The NPH patients had a larger sway area and a higher backward directed velocity of centre of pressure than HI. The direction of the inclination in the sagittal plane was neutral or forward in the NPH and the SAE patients while it was backward in HI. The postural function was better in positions with open eyes in all 3 groups, but significantly less in the NPH patients, indicating a misinterpretation of afferent visual stimuli in the brainstem postural centre.

Aged↗

Sitting position - posture and performance in C5 - C6 tetraplegia.

OBJECTIVES: To investigate how sitting position and seating affect posture and performance (balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration) in persons with C5 and C6 tetraplegia. SETTING: Outpatient clinic 'Spinalhälsan', Göteborg, Sweden. METHOD: Baseline measurements of sitting position and performance were performed followed by an intervention period. The intervention was individually adapted to each person with emphasis on reduction of kyphotic posture and pelvic obliquity. Furthermore, a functional requirement was that the new sitting position was used in everyday life and did not impair balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration. RESULTS: Four persons with complete C5 - C6 tetraplegia who reported dissatisfaction with posture and seating took part in the study. A comparison of photographs before and after the intervention showed a reduction of kyphotic posture and pelvic obliquity. Balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration were affected by the sitting position in an individual manner. CONCLUSION: Solution of problems concerning sitting and posture for persons with C5 - C6 tetraplegia requires good knowledge of the physical impairment, wheelchair adaptation, seating systems and cushions as well as an understanding of the individual's demands and wishes. Due to the complexity of the issue, standard solutions are not applicable. Thus, an analytical working method is required and co-operation between professionals - occupational therapists and physiotherapists - is important.

Adult↗

The effect of refractive blur on postural stability.

The effect of refractive blur upon postural stability was investigated under three conditions: normal standing, standing with input from the somatosensory system disrupted and standing with input from the somatosensory and vestibular systems disrupted. Standing stability was assessed using the centre of pressure (COP) signal from force plate data in four young subjects (mean 23.9+/-3.1 years) and five repeated sets of measurements were taken. The subjects looked straight ahead at a horizontal and vertical square wave pattern of 2.5 cycles (degree)(-1). Under each of the three test conditions, standing stability was measured with the optimal refractive correction and under binocular blur levels of 0, + 1, + 2, + 4, and + 8 D and with eyes closed. In the normal standing condition, dioptric blur had only a mild effect on postural stability. However refractive blur produced large increases in postural instability when input from one or both of the other two sensory systems were disrupted. We hypothesized that dioptric blur would have an even great effect on postural stability if the visual target used was of higher spatial frequency. This was confirmed by repeated measurements on one subject using a target of 8 cycles (degree)(-1). The study highlights the possible importance of an optimal correction to postural stability, particular in situations (or people) where input from the somatosensory and/or vestibular systems are disrupted, and where the visual surrounds are of high spatial frequency.

Adult↗

Attentional demands for static postural control after stroke.

OBJECTIVE: To assess the attentional demands associated with postural control among people who have had a stroke. DESIGN: Nonrandomized matched case-control study. SETTING: University research laboratory in Canada. PARTICIPANTS: Six individuals who had suffered a left or right cerebral ischemic attack in the past year and a sample of 6 age- and gender-matched controls. Participants in the stroke group had a mean age of 64.17+/-13.14 years; control participants had a mean age of 64.00+/-13.91 years. Mean National Institute of Health Stroke Scale scores for these patients were 7.67+/-4.92 at the time of stroke and 1.66+/-1.36 at the time of testing. None of the patients were taking medications that would alter cognitive status or balance abilities. INTERVENTION: Participants performed a verbal reaction-time test while engaged in 3 postural tasks (sitting, standing, standing with feet together). MAIN OUTCOME MEASURE: Reaction time: latency between visual stimulus and verbal response. RESULTS: Reaction times in the stroke group differed significantly in all conditions from the controls (410+/-72 ms vs 320+/-54 ms, P<.01). A significant interaction was found between group and postural task (P=.05), with reaction-time scores showing a progressive increase in postural task difficulty among participants who had suffered a stroke. Post hoc comparisons revealed that sitting reaction-time scores were significantly slower than reaction-time scores for feet together standing (P=.008) among participants in the stroke group. CONCLUSION: Individuals who have suffered a stroke showed increased attentional demands for tasks of static postural control compared with healthy, age-matched participants.

Aged↗