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PubMed1994

Posturally induced vasoconstriction in diabetes mellitus.

In healthy subjects, standing elicits a reduction in blood flow to the skin of the foot. In adults with insulin dependent diabetes this posturally induced response is deficient, resulting in capillary hypertension when the foot is in the dependent position (that is, below heart level). Such functional abnormalities of the microcirculation in diabetes may precede any evidence of clinically detectable microangiopathy. This study investigates the posturally induced change in blood flow to the skin of the foot in prepubertal and postpubertal patients with insulin dependent diabetes. Laser Doppler fluximetry was used to assess the postural change in blood flow at the pulp of the great toe. Postural vasoconstriction (dependent flux value/supine flux value x 100) was greater after puberty in normal subjects (median (range) 60.4 (7.0-164.9)% prepubertal v 20.5 (5.9-101.0)% postpubertal). Prepubertal children with diabetes did not differ from their healthy peers (69.8 (7.2-192.7)% with diabetes v 60.4 (7.0-164.9)% controls); however postpubertal children with diabetes had a significantly impaired postural vasoconstriction (40.6 (7.9-140.2)% with diabetes v 20.5 (5.9-101.7)% controls). Abnormalities in the normal reduction of blood flow on standing occurred in young postpubertal children with diabetes, most of whom were free of complications.

Adolescent↗
PubMed2004

No acute changes in postural control after soccer heading.

BACKGROUND: Soccer heading has been proposed as a potential cause of cerebral dysfunction. OBJECTIVE: To examine the acute effects of two types of soccer heading on postural control. METHODS: Collegiate soccer players were randomly assigned to one of four groups: control, linear heading, simulated rotational heading, or rotational heading. Each subject completed a baseline postural stability assessment on day 1. On day 2 the same assessment was completed for the control subjects. The simulated rotational heading group completed a simulated heading drill before postural stability testing. The linear and rotational heading groups performed a heading drill with 20 balls at 88.71 km/h (55 mph), before postural stability testing. Separate one between (group), three within (surface, eyes, and day), mixed model, repeated measures analyses of variance were conducted on values for total sway and mean centre of pressure. RESULTS: The mixed model analysis of variance of results showed no significant differences (p>0.05) for the interactions of interest for either variable. Results suggest no acute changes in measures of postural control in soccer players completing either a linear or rotational soccer heading drill of 20 balls at a fixed speed. CONCLUSION: Non-significant interactions between surface, eyes, day, and group indicate that sensory interaction of the balance mechanism components are not be compromised by the heading drill. This research supports previous studies suggesting that there are no acute risks associated with routine soccer heading. A direct comparison between these findings and those suggesting long term chronic deficits, however, cannot be made. Other studies that report chronic cerebral deficits in soccer players may have resulted from factors other than soccer heading and warrant further examination.

Adolescent↗
PubMed1984

Postural adjustments associated with rapid voluntary arm movements 1. Electromyographic data.

Normal subjects made bilaterally symmetric rapid elbow flexions or extensions ("focal movement") while free standing or when supported by being strapped to a firm wall behind them (different "postural set"). In some trials a load opposed the movement two thirds of the way into its course. Electromyographic activity in leg and trunk muscles ("associated postural adjustments") demonstrated specific patterns for each type of movement. Activity in these muscles began prior to activity in the arm muscles and demonstrated a distal-to-proximal order of activation. The EMG patterns were characterised by alternating activity in the antagonist pairs similar to the triphasic pattern seen in the arm muscles. When the movement type was changed change of the pattern of the postural muscles occurred over several trials. It is concluded that the associated postural adjustments are pre-programmed motor activity linked to the focal movement, specific for the focal movement including anticipated events and the postural set.

Adult↗
PubMed1991

The effect of posture on the normal and pathological auditory startle reflex.

The effect of posture on the EMG pattern of the normal auditory startle reflex was investigated. The startle response to an unexpected auditory tone was studied in eleven normal subjects when standing, and in six normal subjects when sitting relaxed or tonically plantar flexing both feet. Reflex EMG activity was recorded in the tibialis anterior and soleus about twice as frequently when standing, than when sitting relaxed. In addition, the median latencies to onset of reflex EMG activity in the tibialis anterior and soleus were about 40 and 60 ms shorter during standing, than when sitting relaxed. No short latency EMG activity was recorded in the calf muscles during tonic plantar flexion of the feet, while sitting. The effect of posture on the EMG pattern of the pathological auditory startle reflex was studied in five patients with hyperekplexia. In three patients the latency to onset of reflex EMG activity in the tibialis anterior was shorter when standing, than when sitting relaxed. The EMG pattern of the reflex response to sound was studied in detail in two of these patients and consisted of up to three successive components. The expression of each EMG component depended on the postural set of the limbs. In particular, a distinct short latency component was found in posturally important muscles following auditory stimulation. This short latency component was not recorded when sitting relaxed. It is concluded that the EMG pattern of the physiological and pathological auditory startle response is not fixed, but may change with the postural stance of the body. This finding supports the theory that the normal startle reflex and the abnormal startle reflex in hyperekplexia have a common brainstem origin.

Adolescent↗
PubMed1998

Postural responses to changing task conditions in patients with cerebellar lesions.

OBJECTIVE: To investigate the role of the cerebellum in postural adaptation for changes to the stimulus type of support surface displacements (backward translations v "toes up" rotations). METHODS: A group of 13 patients with chronic, isolated lesions of the cerebellum and 15 control subjects were tested. Automatic postural responses of the medial gastrocnemius and anterior tibial muscles were recorded. The first paradigm consisted of 10 rotational perturbations followed by 10 backward translations of the platform, and 10 backward translations followed by 10 rotations. The second paradigm consisted of 18 rotations and two randomly interposed translational perturbations, and 18 translations with two rotations randomly interposed. RESULTS: When the type of perturbation changed from an expected translation to an unexpected rotation and vice versa both control subjects and cerebellar patients showed an immediate and significant change in the response amplitude of the medial gastrocnemius and at the same time an immediate and significant change in the response amplitude of the anterior tibial muscles. Neither controls nor cerebellar patients showed effects of prediction in surface displacements of unexpected types of perturbation. Both controls and cerebellar patients showed no gradual increase in the gastrocnemius response in subsequent trials of surface translations following a block of 10 surface rotations and no gradual increase in the response amplitude of the anterior tibial muscle in subsequent trials of surface rotations following a block of 10 surface translations. CONCLUSIONS: Despite postural hypermetria, the integrity of the cerebellum does not seem critical for adaptation of postural synergies to changing stimulus types of surface displacements. The present results support previous findings suggesting that the main role of the cerebellum in automatic postural responses may be gain control.

Adult↗
PubMed1983

Postural relief of dyspnoea in severe chronic airflow limitation: relationship to respiratory muscle strength.

Maximal static inspiratory and expiratory pressures (Pimax and Pemax) were measured in six different positions in 40 patients with advanced chronic airflow limitation and in 140 normal subjects to determine whether posture influences respiratory muscle strength. Patients with chronic airflow limitation were studied on days 1 and 5 of an acute exacerbation. There was no postural effect on maximal static pressures in the normal subjects. We divided our patients with chronic airflow limitation into "moderate" and "severe" groups on the basis of a Pimax in the standing position greater or less than 35 cm H2O. The seated leaning-forward position was the preferred posture in 22 of the 23 "severe" patients and 13 of the 17 "moderate" patients. Pimax was greater in the seated leaning-forward position than in the other positions studied (p less than 0.001) on days 1 and 5 in the "severe" patients and (p less than 0.05) on day 5 in the "moderate" patients. Posture had no influence on Pemax in patients with chronic airflow limitation. There was a significant improvement in both Pimax (p less than 0.01 for the "severe" group and p less than 0.05 for the "moderate" group) and Pemax (p less than 0.01 for both groups) between days 1 and 5. The seated leaning-forward position was the optimum posture for the patients to generate maximum inspiratory pressures and to obtain greatest subjective relief of dyspnoea.

Adult↗
PubMed1993

Effects of posture on carbon dioxide responsiveness in patients with obstructive sleep apnoea.

BACKGROUND: It is well known that upper airway resistance increases with postural change from a sitting to supine position in patients with obstructive sleep apnoea (OSA). It is not known, however, how the postural change affects the ventilatory and occlusion pressure response to hypercapnia in patients with OSA when awake. METHODS: The responses of minute ventilation (VE) and mouth pressure 0.1 seconds after the onset of occluded inspiration (P0.1) to progressive hypercapnia (delta VE/delta PCO2, delta P0.1/delta PCO2) both in sitting and supine positions were measured in 20 patients with OSA. The ratio of the two (delta VE/delta P0.1) was obtained as an index of breathing efficiency. The postural changes in response to carbon dioxide (CO2) after uvulopalatopharyngoplasty (UPPP) were also compared in seven patients with OSA. RESULTS: There were no significant changes in the resting values of end tidal PCO2, P0.1, or VE between the two positions. During CO2 rebreathing, delta VE/delta PCO2 did not differ between the two positions, but delta P0.1/delta PCO2 was significantly higher in the supine than in the sitting position (supine, mean 0.67 (SE 0.09) cm H2O/mm Hg; sitting, mean 0.57 (SE 0.08) cm H2O/mm Hg), and delta VE/delta P0.1 decreased significantly from the sitting to the supine position (sitting, 4.6 (0.4) l/min/cm H2O; supine, 3.9 (0.4) l/min/cm H2O). In seven patients with OSA who underwent UPPP, delta VE/delta P0.1 improved significantly in the supine position and postural change in delta VE/delta P0.1 was eliminated. CONCLUSIONS: These results suggest that in patients with OSA the inspiratory drive in the supine position increases to maintain the same level of ventilation as in the sitting position, and that the postural change from sitting to supine reduces breathing efficiency. Load compensation mechanisms of patients with OSA appear to be intact while awake in response to the rise in upper airway resistance.

Female↗
PubMed2001

Central volume expansion is pivotal for sustained decrease in heart rate during seated to supine posture change.

During prolonged, static carotid baroreceptor stimulation by neck suction (NS) in seated humans, heart rate (HR) decreases acutely and thereafter gradually increases. This increase has been explained by carotid baroreceptor adaptation and/or buffering by aortic reflexes. During a posture change from seated to supine (Sup) with similar carotid stimulation, however, the decrease in HR is sustained. To investigate whether this discrepancy is caused by changes in central blood volume, we compared (n = 10 subjects) the effects of 10 min of seated NS (adjusted to simulate carotid stimulation of a posture change), a posture change from seated to Sup, and the same posture change with left atrial (LA) diameter maintained unchanged by lower body negative pressure (Sup + LBNP). During Sup, the prompt decreases in HR and mean arterial pressure (MAP) were sustained. HR decreased similarly within 30 s of NS (65 +/- 2 to 59 +/- 2 beats/min) and Sup + LBNP (65 +/- 2 to 58 +/- 2 beats/min) and thereafter gradually increased to values of seated. MAP decreased similarly within 5 min during Sup + LBNP and NS (by 7 +/- 1 to 9 +/- 1 mmHg) and thereafter tended to increase toward values of seated subjects. Arterial pulse pressure was increased the most by Sup, less so by Sup + LBNP, and was unchanged by NS. LA diameter was only increased by Sup. In conclusion, static carotid baroreceptor stimulation per se causes the acute (<30 s) decrease in HR during a posture change from seated to Sup, whereas the central volume expansion (increased LA diameter and/or arterial pulse pressure) is pivotal to sustain this decrease. Thus the effects of central volume expansion override adaptation of the carotid baroreceptors and/or buffering of aortic reflexes.

Adaptation, Physiological↗
PubMed1999

Upright posture reduces forearm blood flow early in exercise.

The hypothesis that upright posture could modulate forearm blood flow (FBF) early in exercise was tested in six subjects. Both single (2-s duration) and repeated (1-s work/2-s rest cadence for 12 contractions) handgrip contractions (12 kg) were performed in the supine and 70 degrees head-up tilt (HUT) positions. The arm was maintained at heart level to diminish myogenic effects. Baseline brachial artery diameters were assessed at rest in each position. Brachial artery mean blood velocity (MBV; Doppler) and mean arterial pressure (MAP) (Finapres) were measured continuously to calculate FBF and vascular conductance. MAP was not changed with posture. Antecubital venous pressure (Pv) was reduced in HUT (4.55 +/- 1.3 mmHg) compared with supine (11.3 +/- 1.9 mmHg) (P < 0.01). For the repeated contractions, total excess FBF (TEF) was reduced in the HUT position compared with supine (P < 0.02). With the single contractions, peak FBF, peak vascular conductance, and TEF during 30 s after release of the contraction were reduced in the HUT position compared with supine (P < 0.01). Sympathetic blockade augmented the FBF response to a single contraction in HUT (P < 0.05) and tended to increase this response while supine (P = 0.08). However, sympathetic blockade did not attenuate the effect of HUT on peak FBF and TEF after the single contractions. Raising the arm above heart level while supine, to diminish Pv, resulted in FBF dynamics that were similar to those observed during HUT. Alternatively, lowering the arm while in HUT to restore Pv to supine levels restored the peak FBF and vascular conductance responses, but not TEF response, after a single contraction. It was concluded that upright posture diminishes the hyperemic response early in exercise. The data demonstrate that sympathetic constriction restrains the hyperemic response to a single contraction but does not modulate the postural reduction in postcontraction hyperemia. Therefore, the attenuated blood flow response in the HUT posture was largely related to factors associated with diminished venous pressures and not sympathetic vasoconstriction.

Adult↗
PubMed1980

Postural effects on lung volumes and asynchronous ventilation in anesthetized horses.

Quasi-static pressure-volume curves and single-breath nitrogen washouts were performed simultaneously on eight anesthetized horses (average body wt = 485 kg) in left lateral, right lateral, prone, and supine postures (sequence randomized). The shift from prone to lateral or supine posture decreased expiratory reserve volume (ERV), vital capacity (VC), residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC); RV and FRC expressed as %TLC were unchanged, suggesting that in the lateral and supine postures a significant portion of the lung volume was not recruited by VC maneuvers. Phase III slope increased from 0.13 %N2/l in prone horses to 0.34 %N2/l in the lateral and supine positions. The onset of phase IV was not significantly different from FRC in the prone or laterally recombent animal, but exceeded FRC in the supine horse. The sequence of body positions had no effect on any of our results indicating that all changes in lung volumes and regional asynchronous ventilation c;n be reversed by placing the horse in the prone posture. The reduction in lung volume and increased asynchronous ventilation in the lateral and supine horse suggests that impaired gas exchange in anesthetized horses is predominantly related to posture, and not general anesthesia.

Anesthesia, General↗
PubMed1980

Thermoregulation during rest and exercise in different postures in a hot humid environment.

The time course of whole-body sweating and thermal regulation during rest and exercise in a hot humid environment was investigated in three body postures. After 45 min rest in the upright, low-sit, or supine posture, five unacclimatized men exercised for 45 min on a bicycle ergometer in the same posture in an environment of 49.5 degrees C, 28.9 Torr. Exercise was performed at two different work loads, corresponding to about 30 and 45% of VO2max. During exercise auditory canal temperature, rectal temperature, and mean skin temperature increased linearly being highest in the supine and lowest in the upright posture. Percentage of evaporated sweat from the skin to secreted sweat was 65% in upright, 52% in the low-sit, and only 46% in the supine posture during the last 20 min of exercise regardless of work load. The time course of the rate of body heat storage was different from predictions based on the thermal balance equation. Evaporative heat loss was not 100% effective in cooling the skin surface.

Adult↗
PubMed1984

Effect of posture on thoracoabdominal movements during CO2 rebreathing.

To determine whether the rib cage and abdomen-diaphragm contributions to tidal volume (VT) during CO2 rebreathing are affected by postural change, using respiratory inductive plethysmography, we measured in eight healthy volunteers the compartmental VT responses to progressive hypercapnia in both seated and supine postures. The ventilatory, frequency, and VT responses to CO2 of the total respiratory system were not significantly different between postures. VT responses, corrected for body size, ranged from 1.67 to 3.71% vital capacity (VC) X Torr-1 (mean 2.27) in seated subjects and from 1.08 to 3.79% VC X Torr-1 (mean 2.06), in supine subjects. In both postures, the VT response of the abdominal compartment was nearly uniform among subjects and independent of the total respiratory system VT response (slope = 0.091, r = 0.210 P greater than 0.3 seated; slope = 0.043, r = 0.077, P greater than 0.3 supine), whereas the VT response of the rib cage varied among subjects and was significantly correlated to the total VT response (slope = 0.815, r = 0.84, P less than 0.01, seated; slope = 1.125, r = 0.859, P less than 0.01, supine). Thus high tidal volume responses to CO2 rebreathing are determined largely by recruitment of the rib cage compartment in both seated and supine postures.

Abdominal Muscles↗
PubMed1986

In vivo length and shortening of canine diaphragm with body postural change.

Using sonomicrometry, we measured the in vivo tidal shortening and velocity of shortening of the costal and crural segments of the diaphragm in the anesthetized dog in the supine, upright, tailup, prone, and lateral decubitus postures. When compared with the supine position, end-expiratory diaphragmatic length varied by less than 11% in all postures, except the upright. During spontaneous breathing, the tidal shortening and the velocity of shortening of the crural segment exceeded that of the costal segment in all postures except the upright and was maximal for both segments in the prone posture. We noted the phasic integrated electromyogram to increase as the end-expiratory length of the diaphragm shortened below and to decrease as the diaphragm lengthened above its optimal length. This study shows that the costal and crural segments have a different quantitative behavior with body posture and both segments show a compensation in neural drive to changes in resting length.

Animals↗
PubMed1986

Regional respiratory clearance of aerosolized 99mTc-DTPA: posture and smoking effects.

We studied 10 healthy nonsmokers and 8 healthy smokers, in both the upright and supine position, to investigate whether regional differences in respiratory clearance of technetium-99m-labeled diethylenetriamine pentaacetic acid 99mTc-DTPA (RC-DTPA) existed and to assess the influence of posture and smoking on the regional RC-DTPA. RC-DTPA was assessed by the lung clearance rates (%/min) of aerosolized 99mTc-DTPA (0.8 micron MMD; 2.4 GSD), using data corrected for recirculating radioactivity, in the upper (zone 1), middle (zone 2), and lower (zone 3) posterior lung fields. In nonsmokers, RC-DTPA in zone 1 was faster than in zone 2 or 3 in both the upright (P less than 0.001) and supine positions (P less than 0.0). No effect was produced by changes in posture on the regional RC-DTPA. In smokers, RC-DTPA was increased in all zones compared with the nonsmokers (P = 0.004), with a further increase in RC-DTP in zone 1 in the upright posture compared with the other regions (P less than 0.001). We conclude that in nonsmokers regional RC-DTPA is faster in zone 1 than in other zones, and this is not related to recirculation of radioactivity; posture does not modify the regional RC-DTPA of nonsmokers; smoking increases RC-DTPA in all zones and more in zone 1 in the upright posture.

Adult↗
PubMed1986

Modification of pulmonary gas mixing by postural changes.

Mixing for two gases of markedly different gaseous diffusivity, helium (He) (mol wt = 4) and sulfur hexafluoride (SF6) (mol wt = 146) has been studied by a rebreathing method in different postures. In nine normal subjects duplicate measurements were made in the erect (seated), supine, and lateral decubitus posture, at a constant tidal volume (700 ml) and frequency (1 Hz) starting from functional residual capacity (FRC). Additional measurements were made on four of the subjects, rebreathing seated erect at a volume similar to the relaxed FRC supine and supine at a volume similar to the relaxed FRC seated. In the supine posture the mean breath number to reach 99% equilibrium (n99), was not significantly different for the two gases, 8.9 for He and 9.8 for SF6. There was a difference (P less than 0.01) when erect; n99 (He) = 8.2 and n99 (SF6) = 10.9. The greatest He-SF6 difference (P less than 0.001) was in the lateral decubitus position n99 (He) = 10.1 and n99 (SF6) = 15.9. The mean relaxed FRC as percent of seated was 71% supine and 75% in lateral decubitus posture. Rebreathing seated at a lower volume did not abolish the He-SF6 mixing difference nor did rebreathing at a higher volume when supine induce a He-SF6 mixing difference. Thus the effect of posture on gas mixing cannot be due solely to lung volume and must represent a convective and diffusive dependent change in the distribution of ventilation per unit lung volume.

Adult↗
PubMed1999

Mechanism for the posture-specific plasma volume increase after a single intense exercise protocol.

To test the hypothesis that exercise-induced hypervolemia is a posture-dependent process, we measured plasma volume, plasma albumin content, and renal function in seven healthy subjects for 22 h after single upright (Up) or supine (Sup) intense (85% peak oxygen consumption rate) exercise. This posture was maintained for 5 h after exercise. Plasma volume decreased during exercise but returned to control levels by 5 h of recovery in both postures. By 22 h of recovery, plasma volume increased 2.4 +/- 0.8 ml/kg in Up but decreased 2.1 +/- 0.8 ml/kg in Sup. The plasma volume expansion in Up was accompanied by an increase in plasma albumin content (0.11 +/- 0.04 g/kg; P < 0.05). Plasma albumin content was unchanged in Sup. Urine volume and sodium clearance were lower in Up than Sup (P < 0.05) by 5 h of recovery. These data suggest that increased plasma albumin content contributes to the acute phase of exercise-induced hypervolemia. More importantly, the mechanism by which exercise influences the distribution of albumin between extra- and intravascular stores after exercise is altered by posture and is unknown. We speculate that factors associated with postural changes (e.g., central venous pressure) modify the increase in plasma albumin content and the plasma volume expansion after exercise.

Adult↗
PubMed2004

Effect of posture on regional gas exchange in pigs.

Although recent high-resolution studies demonstrate the importance of nongravitational determinants for both pulmonary blood flow and ventilation distributions, posture has a clear impact on whole lung gas exchange. Deterioration in arterial oxygenation with repositioning from prone to supine posture is caused by increased heterogeneity in the distribution of ventilation-to-perfusion ratios. This can result from increased heterogeneity in regional blood flow distribution, increased heterogeneity in regional ventilation distribution, decreased correlation between regional blood flow and ventilation, or some combination of the above (Wilson TA and Beck KC, J Appl Physiol 72: 2298-2304, 1992). We hypothesize that, although repositioning from prone to supine has relatively small effects on overall blood flow and ventilation distributions, regional changes are poorly correlated, resulting in regional ventilation-perfusion mismatch and reduction in alveolar oxygen tension. We report ventilation and perfusion distributions in seven anesthetized, mechanically ventilated pigs measured with aerosolized and injected microspheres. Total contributions of pulmonary structure and posture on ventilation and perfusion heterogeneities were quantified by using analysis of variance. Regional gradients of posture-mediated change in ventilation, perfusion, and calculated alveolar oxygen tension were examined in the caudocranial and ventrodorsal directions. We found that pulmonary structure was responsible for 74.0 +/- 4.7% of total ventilation heterogeneity and 63.3 +/- 4.2% of total blood flow heterogeneity. Posture-mediated redistribution was primarily oriented along the caudocranial axis for ventilation and along the ventrodorsal axis for blood flow. These mismatched changes reduced alveolar oxygen tension primarily in the dorsocaudal lung region.

Animals↗
PubMed2003

Postural muscle responses to multidirectional translations in patients with Parkinson's disease.

The postural adaptation impairments of patients with Parkinson's disease (PD) suggest that the basal ganglia may be important for quickly modifying muscle activation patterns when the direction of perturbation or stance conditions suddenly change. It is unknown whether their particular instability to backward postural perturbations is due to specific abnormalities of parkinsonian postural muscle synergies in that direction and not present in other directions. In the present study, we test this hypothesis by comparing the patterns of leg and trunk muscle activation in 13 subjects with PD and 13 control subjects in response to eight randomly presented directions of horizontal surface translations while standing with either narrow or wide stance. The direction of maximum activation for each muscle was similar for PD and control subjects, suggesting that the basal ganglia is not critical for programming externally triggered postural synergies. However, antagonist muscle activation was earlier and larger in PD than in control subjects, resulting in coactivation. PD subjects also did not increase the magnitude of muscle activation as much as did control subjects when changing from wide to narrow stance. These results are consistent with the hypothesis that PD results in an inability to shape the pattern and magnitude of postural muscle responses for changes in perturbation direction and in stance position.

Adaptation, Physiological↗