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Age differences in postural stability are increased by additional cognitive demands.

We report an investigation of postural stability in two groups of volunteers (mean ages of 57 and 77). Participants were required to stand on a force platform while performing five cognitive tasks: (1) random digit generation, (2) Brooks' spatial memory, (3) backward digit recall, (4) silently counting from 1-100, and (5) counting backward in threes (aloud). There was also a control condition in which there was no cognitive task. Postural stability was adversely affected by age in all conditions. Moreover, the difference between the two age groups was significantly greater when performing tasks 2 and 3, in comparison with the age difference in the control condition. Regression analyses revealed that the effect of age on postural stability while performing these particular tasks remained significant even after the following measures were included in the regression: postural stability in the control condition, cognitive performance, intelligence, and speed. We suggest that age differences in postural stability are increased by cognitive tasks requiring use of the visuo-spatial sketchpad component of working memory.

Age Factors↗

Anticipatory postural adjustments in older adults: are changes in response characteristics due to changes in strategy?

The purpose of this study was to determine if (a) the aging process directly affects the ability to prepare postural adjustments in advance of voluntary movements, or (b) if aging leads to longer movement times which, in turn, lead to less need for advance preparation of the postural muscles. That is, is velocity a mediating variable between age and lack of postural preparation? Postural and prime mover muscle response characteristics of young (n = 16, age 27 +/- 5 years) and older (n = 16, age 71 +/- 8 years) adults were evaluated in an arm-raising paradigm across many arm movement velocity conditions. Older and young adults did not differ in arm movement velocities. Therefore, observed differences between age groups were directly related to the aging process. Muscle timing and sequencing were affected differentially between age groups depending upon which velocity condition was specified. Age-related differences were found in the timing of two postural muscles: in older subjects the contralateral erector spinae muscles were activated later, relative to the deltoid, than in younger subjects, with fewer older subjects showing preparatory activity. Also, older subjects showed more frequent activation of the quadriceps than young subjects.

Acceleration↗

Relationship between antigravity control and postural control in young children.

The purposes of this study were 1) to determine the relationship between antigravity control (supine flexion and prone extension) and postural control (static and dynamic balance), 2) to determine the quality of antigravity and postural control, and 3) to determine whether sex and ethnic group differences correlate with differences in antigravity control and postural control in young children. I tested 107 black, Hispanic, and Caucasian children in a Head Start program, with a mean age of 61 months. The study results showed significant relationships between antigravity control and postural control. Subjects' supine flexion performance was significantly related to the quantity and quality of their static and dynamic balance performance, whereas prone extension performance was related only to the quality of dynamic balance performance. Quality scale measurements (r = .90) indicated that the children in this study had not yet developed full antigravity or postural control. The study results revealed differences between sexes in the quality of static balance and prone extension performance and ethnic differences in static balance, dynamic balance, and prone extension performance.

Child Development↗

Orthostatic hypotension: a posture-induced hyperdopaminergic state.

To explore the role of dopaminergic mechanisms in orthostatic hypotension we compared the postural responses of 20 such patients to those of a control group by radioenzymatic determination of free and sulfated catecholamines and related indices. Patients with orthostatic hypotension, unlike control subjects, experienced an increase in total plasma dopamine (DA) (free + sulfate) in response to upright posture (p less than 0.01). Of the 20 patients with orthostatic hypotension, 16 were normo- or hyperadrenergic with normal basal and posture-responsive or hyperresponsive plasma free and total norepinephrine (NE). The other 4 were hypoadrenergic with low basal and posture-unresponsive NE. Hypoadrenergic patients had, in the upright position, no increase in pulse rate and more severe hypotension, less diuresis and natriuresis, lower urinary free and total DA, lower total NE excretion, and higher plasma and urinary total DA:total NE ratio than normo- or hyperadrenergic patients or control subjects. Normo- or hyperadrenergic patients had higher PRA and plasma aldosterone in the upright position than hypoadrenergic patients or control subjects (all p less than 0.05). We suggest that an excessive increase in free DA occurs in response to upright posture, perhaps representing a compensatory reaction of the remaining autonomic nervous system to an excessive fall in blood pressure. The free dopamine may be biologically active but it is so rapidly sulfoconjugated that it can be detected only as DA sulfate. These findings, combined with reports of orthostatic hypotension precipitated by administration of dopaminomimetic drugs and relieved by administration of dopaminergic antagonists, are consistent with the interpretation that excessive DA release may perpetuate, by its vasodilating and natriuretic action, the orthostatic hypotension.

Adult↗

Are there deficits in anticipatory postural adjustments in Parkinson's disease?

We studied anticipatory postural adjustments in patients with Parkinson's disease who dropped a load from extended arms while standing. Anticipatory postural adjustments were seen when load dropping was induced by a fast, bilateral shoulder abduction but not when it was induced by pressing a trigger with the right thumb. We conclude that anticipatory postural adjustments in patients with Parkinson's disease can change with the magnitude of an action which is used to trigger a predictable postural perturbation. Thus, the described deficits in anticipatory postural adjustments in patients with Parkinson's disease are likely to be of quantitative rather than qualitative nature.

Aged↗

Levodopa does not aggravate postural tremor in Parkinson's disease.

Characterization of postural tremor in Parkinson's disease (PD) is incomplete. It was suggested to be an exaggerated physiological tremor and to be enhanced by the action of levodopa. We compared the magnitude of postural tremor to the magnitude of rest tremor and to plasma levodopa levels in 20 PD patients, 10 with stable motor response to oral levodopa, and 10 with the wearing-off phenomenon. Tremor assessment included motor scores of the Unified Parkinson's Disease Rating Scale and accelerometric measurements. Accelerometric data showed that the absolute power of both rest and postural basal dominant tremor frequencies significantly diminished with the increase in plasma levodopa levels and increased with their decrease. Tremor frequencies were also significantly changed by levodopa, which slowed rest tremor and increased postural tremor dominant frequency. This latter, however, did not reach the 8- to 12-Hz frequency band said to be typical of exaggerated physiological tremor. No significant differences between groups were found in their tremor response to levodopa. This study shows that the net postural tremor exhibited by PD patients is improved by levodopa, that levodopa does not augment tremor in the 8- to 12-Hz range, and that this effect is independent of the patient's motor response pattern of oral levodopa.

Aged↗

Change in posture during sleep causes errors in non-invasive automatic blood pressure recordings.

When measured with automatic non-invasive monitors blood pressure is seen to fluctuate during sleep. The recorded blood pressure is influenced by the vertical distance between the heart level (zero reference) and the level of the brachial artery at the point of compression by the inflated cuff. In 20 randomly selected men, blood pressure was measured every 20 min during the night. The difference between consecutive recordings was 7.6 mmHg +/- 5.7/5.0 (s.d.), range 0-23/0-20 mmHg. The maximum blood pressure difference was 19 +/- 6.8/15 +/- 6.0, range 7-32/6-26 mmHg. These results were compared with the difference in blood pressure recorded on the left arm in 20 volunteers changing posture between four standardized recumbent postures. The posture change caused an average blood pressure difference of 9 +/- 6.1/9 +/- 6.5 mmHg, range 0-28/0-30 mmHg. The maximum blood pressure difference was 15 +/- 5.1/12 +/- 5.5 mmHg, range 5-27/(-)2-23 mmHg recorded between lying supine and lying on the right side. The similarity between differences and the variation in blood pressure during the recumbent posture indicates that changes in posture cause most of the night-time blood pressure variation recorded with non-invasive devices.

Blood Pressure↗

Reproducibility of intra-arterial ambulatory blood pressure: effects of physical activity and posture.

OBJECTIVE: To examine the effects of physical activity, body posture and sleep quality on the reproducibility of continuous ambulatory blood pressure monitoring. METHODS: Measurements were performed in 35 subjects (18 hypertensive, 11 male), mean +/- standard deviation age 49 +/- 13 years. Blood pressure (BP) was measured in the brachial artery, and beat-to-beat values of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure and heart rate (HR) were computed. Physical activity and posture were continuously measured with five accelerometers. Subjective quality of sleep was assessed with a questionnaire. Reproducibility was expressed as an intraclass correlation coefficient and as the standard deviation of the within-subject differences. RESULTS: Posture and activity significantly influenced BP and HR. From lying to sitting, the SBP, DBP and HR increased 6 mmHg, 8 mmHg and 8 beats/min, respectively. From sitting to standing these respective increases were 4 mmHg, 2 mmHg and 13 beats/min. A further rise in activity (from standing to moving generally or walking) increased the SBP by 7 mmHg and the HR by 7 beats/min, and decreased the DBP by 8 mmHg. For daytime SBP, DBP and HR, the intraclass correlation coefficient (standard deviation of the within-subject differences) values were 0.93 (7.2 mmHg), 0.94 (3.8 mmHg) and 0.90 (4.1 beats/min). For night-time these respective values were 0.98 (4.4 mmHg), 0.97 (2.5 mmHg) and 0.96 (2.2 beats/min). Correction for physical activity level and posture hardly improved the reproducibility of daytime BP and HR. Reproducibility of night-time BP and HR was not improved by correction for physical activity, supine position or self-reported sleep quality. CONCLUSIONS: Within-subject differences between ambulatory BP recordings cannot be explained by differences in physical activity and body posture.

Adult↗

Does the change of anterior chamber depth or/and episcleral venous pressure cause intraocular pressure change in postural variation?

PURPOSE: Previous studies have found that the intraocular pressure (IOP) variation from postural change is due to the obstruction of aqueous outflow by an increase in episcleral venous pressure. This study investigated if any shift of anterior lens position from postural variation would be another contributing factor. METHODS: Thirty-three Chinese subjects were recruited with their IOP and anterior chamber depth (ACD) measured in the sitting, supine, and prone postures. The IOP was measured using a Pulsair 2000 noncontact tonometer and ACD with a Nidek US-2000 EchoScan unit. RESULTS: The highest IOP was obtained in the prone position and this value was significantly different from the IOP obtained in other postures, whereas there was no significant difference in ACD. CONCLUSIONS: Because no significant variation in ACD was demonstrated, the prone and supine IOP variation could be due to something other than the change in lens position. However, a higher IOP in the prone position rather than in the supine position also suggests that it is not merely the episcleral venous pressure causing the IOP change. Investigation of the entire iris profile at different postures would be more informative in future studies.

Adult↗

An epidemiologic study of the relationship between postural asymmetry in the teen years and subsequent back and neck pain.

This epidemiologic study examined the relationship between postural discrepancies in the posterior plane and the subsequent development of back and neck pain. The study population comprised women who were members of the graduating classes of 1957, 1958, and 1959 of an eastern U.S. women's college. Information on postural asymmetry was gathered from two sources: (1) measurements made from posture pictures taken early in the freshman year of college and obtained from each woman in the study, and (2) subjective evaluations made by the physical education department faculty at the time of examination. Information on the development of back and neck disorders and associated risk factors during the subsequent 25 years was obtained by a postal questionnaire. Three parameters of postural asymmetry were examined from the posture picture measurements: elevation of one shoulder, elevation of one hip, and deviation of the spine from the midline of the body. None of these parameters nor the physical education department evaluations was associated with a subsequent report of low-back pain, mid-back pain, or neck pain.

Adolescent↗

Postural control in siblings to scoliosis patients and scoliosis patients.

The etiologic importance of postural dysfunction, as shown by many authors in adolescent idiopathic scoliosis (AIS), has been under great debate. The authors' hypothesis was that a factor that is involved in the development of the scoliotic curvature, would be present also in nonscoliotic siblings to scoliosis patients, as AIS is a hereditary transmitted disease. Postural function in 100 siblings to scoliotic children was investigated by means of stabilometry, and compared with a matched control group of healthy children, as well as a group of scoliotic children. The siblings showed a postural control function that was significantly different from both of the other groups. The siblings had a postural sway that was less than the sway measured in both controls and scoliosis patients. The sway was also more asymmetrical than in the two other groups. In the authors' opinion, the presence of this postural aberration in siblings indicates that it is a factor in the etiology of AIS.

Adolescent↗

How does posture affect coupling in the lumbar spine?

There is evidence to suggest that abnormal coupling patterns in the lumbar spine may be an indicator of low-back problems. To quantify the normal coupling patterns, fresh cadaveric human lumbar spine specimens (L1-S1) were used. A pure axial torque or lateral bending moment of 10 N-m (in five equal steps) was applied to the specimen, in five spinal postures, and three-dimensional motions were measured at the five vertebral levels. The results indicated that the coupling patterns changed significantly with the intervertebral level. For example, in neutral posture, the left axial torque produced coupled lateral bending, which varied from approximately 2 degrees right lateral bending at L1-2, to approximately 0 degrees at L3-4, and to approximately 2.5 degrees left lateral bending at L5-S1. Additionally, there was coupled flexion of approximately 1 degrees to 2 degrees at all levels. Application of left lateral bending moment resulted in approximately 1.7 degrees of coupled right axial rotation at all levels, except at L1-L2, where it was 0 degrees. Additionally, there was coupled flexion of 0.7 degrees to 2 degrees at all levels. For example, at the L2-3 level, the left axial torque produced coupled right lateral bending that ranged from approximately 0.5 degrees at full extension to approximately 2.5 degrees at full flexion. There was also accompanying coupled flexion of approximately 0.4 degrees to 1.7 degrees. Application of left lateral bending moment at the L2-3 level produced axial rotation of approximately 2.5 degrees, which did not vary with the posture, while the other coupled motion varied from approximately 1.7 degrees flexion at full extension posture to approximately 0.8 degrees extension at full flexion posture.

Biomechanical Phenomena↗

Kinetic potential of the lumbar trunk musculature about three orthogonal orthopaedic axes in extreme postures.

Many studies have examined the mechanics of the lumbar spine in various planes, but only a limited number of three-dimensional investigations have been reported. Analysis of the low back during complex, dynamic postures demands rigorous representation of the trunk musculature. The data of this study demonstrated the force and torque contributions of approximately 50 laminas of various trunk muscles to flexion-extension, lateral bending, and axial twisting torque at the L4-L5 joint. This analysis was conducted with the spine in an upright standing posture and when fully flexed (60 degrees), laterally bent (25 degrees), and axially twisted (10 degrees) together with two examples of combined postures. Maximum moment potential, muscle length excursions, and the resultant compressive, anteroposterior shear, and lateral shear forces on the joint were also computed. The results indicate that the position of the vertebrae and their orthopaedic axes, which are a function of spinal posture, are an important factor in the reasonable determination of joint compressive, lateral shear, and anteroposterior shear loads. Muscle length changes that exceeded 20% of their respective length during upright standing were not observed during a full axial twist, but were observed in portions of the abdominal obliques during lateral bending, and in some extensors during full flexion. Extreme postures tended to change the torque potential of some muscles and influence joint load. Various portions of erector spinae were observed to have appreciable potential to generate torque about all three orthopaedic axes. This observation supports the notion held by some therapists that conditioning of the erector spinae is of utmost importance.

Biomechanical Phenomena↗

A comparison of the effects of two sitting postures on back and referred pain.

This study compared the effects of sitting with portable supports in either a kyphotic or lordotic posture on low-back and referred pain. Two hundred ten patients with low-back and/or referred pain were randomly assigned to either a kyphotic posture or lordotic posture group. The kyphotic and lordotic postures were facilitated by the use of a flat foam cushion or lumbar roll, respectively. Pain location, back pain, and leg pain intensity were assessed over a 24-48-hour period under both standardized clinical settings and general sitting environments. When sitting with a lordotic posture, back and leg pain were significantly reduced and referred pain shifted towards the low back. This study demonstrates that in general sitting environments a lumbar roll results in: 1) reductions in back and leg pain; and 2) centralization of pain. These findings do not apply to patients with stenosis or spondylolisthesis, whose symptoms may be aggravated by use of a lumbar roll.

Adult↗

Intramuscular pressure in the erector spinae and intra-abdominal pressure related to posture and load.

STUDY DESIGN: Intramuscular pressures in both Erectors Spinae and intra-abdominal pressures were measured during different holding tasks. OBJECTIVES: To investigate the potential for using intramuscular pressure measurements in both Erectors Spinae to better quantitate the role of muscles during different lifting tasks in vivo. SUMMARY OF BACKGROUND DATA: Intramuscular pressure and intra-abdominal pressure were measured previously under isometric and dynamic conditions. However, no previous study systematically has addressed the relation between intramuscular and intra-abdominal pressures and different loads, tasks, and postures. METHODS: Intramuscular and intra-abdominal were measured simultaneously with microtip pressure transducers in 10 healthy volunteers performing 24 different static holding tasks. Tasks included different weights (10 kg and 20 kg), postures (squat or back lift), and positions of the weight. RESULTS: Intramuscular pressures were dependent on posture. Kyphotic back posture produced intramuscular pressures of 120-130 mm Hg, compared with the 10-25 mm Hg produced when volunteers were in the erect position (P < 0.001). Holding a 10-kg weight at the thighs close to the body produced significantly (P < 0.001) lower intramuscular pressures (25-32 mm Hg) than that produced by holding it 25 cm in front of the body (47-56 mm Hg). In all tasks, intramuscular pressures were significantly higher with the 20-kg weight than with the 10-kg weight (P < 0.001). Highest values (> 300 mm Hg) were measured when the 20-kg weight was held in the kyphotic posture above the floor and 25 cm away from the body. CONCLUSIONS: Intramuscular pressure measurements in the erector spinae seem to be a valuable tool for quantitating the role of back muscles during different lifting tasks.

Abdomen↗

Muscle activity, internal loads, and stability of the human spine in standing postures: combined model and in vivo studies.

STUDY DESIGN: The load in active and passive spinal components as well as the stability margin in standing postures +/- load in hands are studied using both computational model and in vivo studies. OBJECTIVE: To investigate muscle activity, spinal loads, and system stability in standing postures. SUMMARY OF BACKGROUND DATA: Study of the human trunk yields a redundant system, the satisfactory solution of which remains yet to be done. Existing biomechanical models are often oversimplified or attempt to solve the problem by equilibrium of loads at only one cross section along the spine. METHODS: In vivo measurements are performed to obtain kinematics (by skin markers) as input data into model and EMG activity (by surface electrodes) for validation of predictions. A thoracolumbar model, while accounting for nonlinear ligamentous properties and trunk musculature, solved the redundant active-passive system by a novel kinematics-based approach that used both the posture and gravity/external loads as input data. In both studies, neutral standing posture was considered with weights up to 380 N held in hands with arms extended close to the body either in front or on sides. RESULTS: Predicted muscle forces were in satisfactory agreement with measured EMG activities. The activity in extensor muscles significantly increased with the load magnitude when held in front, a trend that disappeared as loads were held on sides. Abdominal muscles remained relatively silent. Large compression forces of approximately 2000 N were computed in lower lumbar levels when 380 N was held in front. Coactivity in abdominal muscles markedly increased internal loads and stability margin. CONCLUSION: A tradeoff exists between lower loads in passive tissues (i.e., tissue risk of failure) and higher stability margins as both increase with greater muscle coactivation. Greater muscle activity observed under load held in front did not necessarily yield larger stability margin as the position of load appeared to play an important role as well. The strength of the proposed model is in realistic consideration of both passive-active structures under postures and gravity/external loads, yielding results that satisfy kinematics, equilibrium, and stability requirements in all directions along the spine.

Adult↗

Phobic postural vertigo: body sway during vibratory proprioceptive stimulation.

Phobic postural vertigo patients might rely more on proprioceptive than visual cues to regulate stance. We tested 14 phobic postural vertigo patients and 24 healthy subjects with posturography during quiet stance and periods of vibratory proprioceptive calf muscle stimulation, both with eyes open and closed. During quiet stance phobic postural vertigo patients showed higher torque variance than healthy subjects, especially above 0.1 Hz. Vibratory proprioceptive stimulation increased the differences between healthy subjects and phobic postural vertigo patients. The patients were less able to use vision to counteract vibration-induced movements. Phobic postural vertigo patients are more sensitive to proprioceptive disturbances than healthy subjects are, and less apt to use visual information to control upright stance. This might be part of an anxious mode of balance control.

Adult↗

Stretch reflex sensitivity: effects of postural and muscle length changes.

In this study, a combination of clinical evaluation, laboratory testing, and model simulation of spasticity is performed under various postural conditions to investigate the changes in the sensitivity and specific mechanisms of spasticity. Fifty-nine multiple sclerosis patients participated in the study and received spasticity evaluation based on both the Ashworth scale and the pendulum test. Spasticity was found to increase in the pendulum test when the subjects were tested in a supine posture, compared to when they were sitting. Three patterns of stretch reflex response were seen for similar leg swing trajectories. While it was clear that the increased stretch of rectus femoris in the supine posture contributed to the increased spasticity, the results of modeling showed that other more complex factors were also involved. The supraspinal descending modulation associated with postural control may play a more dominant role in the severity of spasticity. The results suggest that the biomechanical test of spasticity should be performed for several different postures or ranges of movement with muscle activities monitored simultaneously, so that the effect of various factors can be examined. The work also indicates that a neuromusculoskeletal model with detailed muscle dynamics and stretch reflex loops is a valuable tool for investigating the neural mechanisms of spasticity.

Adult↗