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PubMed2002

Analysis of short- and long-term effects of adaptation in human postural control.

The short-term (i.e., days) and long-term (i.e., months) effects of adaptation to posturography examinations were investigated in 12 normal subjects who were repeatedly examined for five consecutive days and again after 90 days. The examinations were conducted both with eyes open and closed, and the perturbations were evoked by a pseudorandomly applied vibration stimulation to the calf muscles. The evoked anteroposterior responses were analyzed with a method considering adaptation in the slow changes in posture and in the stimulus-response relationship. Repetition of examinations on a daily basis revealed a gradual improvement of postural-control performance. The body sway induced by the stimulation was significantly reduced and the dynamical properties changed. Most of the improvements remained after 90 days, but some parameters such as the complexity of the control system used were increased to the initial level. The results confirm previous observations that postural control contains several partially independent adaptive processes, observed in terms of alteration of posture and as a progressive reduction of body sway induced by stimulation. The method used for the adaptation analysis in this study could be applied to analyze biological systems with multiple individual adaptive processes with different time courses or characteristics, or where the adaptation processes are related to multiple internal or external factors.

Adaptation, Physiological↗
PubMed2002

Postural dynamics in maximal isometric ramp efforts.

Aglobal biomechanical model of transient push efforts is proposed where transient efforts are taken into consideration, with the aim to examine in greater depth the postural adjustments associated with voluntary efforts. In this context, the push effort is considered as a perturbation of balance, and the other reaction forces as a counter-perturbation which is necessary for the task to be performed efficiently. The subjects were asked to exert maximal horizontal two-handed isometric pushes on a dynamometric bar, as rapidly as possible. They were seated on a custom-designed device which measured global and partitive dynamic quantities. The results showed that the horizontal reaction forces and the horizontal displacement of the centre of pressure increased quasi-proportionally with the perturbation. In addition, it was established that vertical reaction forces increased at seat level whereas they decreased at foot level, resulting in minor vertical acceleration and displacement of the centre of gravity. On the contrary, the anteroposterior reaction forces increased both at foot and at seat levels. Based on a detailed examination of the various terms of the model, it is concluded that transient muscular effort induces dynamics of the postural chain. These observations support the view that there is a postural counter-perturbation which is associated with motor activity. More generally, the model helped to specify the effect of postural dynamic phenomena. It makes it possible to stress the importance of adherence at the contact level between the subject and the seat in the course of transient efforts.

Humans↗
PubMed2001

Optimal posture control of a musculo-skeletal arm model.

In this paper maximal performance posture control of the human arm is investigated by means of model simulations. Recent experiments (F.C.T. van der Helm, submitted, 2000) have shown that the reflexive feedback during postural control varies with the bandwidth of the applied force disturbances. This paper focusses on the influence of the frequency content of force disturbances on the reflexive feedback gains by means of optimization. The arm is modelled by a nonlinear musculo-skeletal model with two degrees of freedom and six muscles. To facilitate the optimization of the model parameters, the arm model is linearized. A performance criterion is minimized for stochastic force disturbances in a two-step procedure: (1) optimization of static muscle activations using an additional energy criterion to obtain a unique and energy-efficient solution; antid (2) optimization of reflex gains using an additional control effort criterion to obtain a unique solution. The optimization reveals that for the given task and posture, the shoulder muscles have the largest contribution, whereas the bi-articular muscles have a relatively small contribution to the behaviour. The dynamics at the endpoint level are estimated so that a comparison can be made with the experiments. Compared to the experiments, the intrinsic damping of the model is relatively large (about 150%), whereas the intrinsic stiffness is relatively small (about 60%). These differences can be attributed to unmodelled mechanical effects of crossbridges in Hill-type muscle models. The optimized reflex gains show remarkable similarities with the values found in the experiments, implying that humans can adjust their reflexive feedback gains in an optimal way, weighting the performance and energy. The approach in this paper could be useful in the study of various posture tasks, for example in the prediction of the relation between the control parameters of various musculo-skeletal models and different experimental variables.

Arm↗
PubMed2000

Vestibular anomalies in CHARGE syndrome: investigations on and consequences for postural development.

UNLABELLED: Recently, vestibular anomalies have been described as a frequent feature in children with coloboma-heart-atresia-retarded-genital-ear (CHARGE) syndrome. They are likely to play an important role in the psychomotor retardation affecting these children. In order to test this hypothesis, we prospectively performed complete vestibular investigations in a series of 17 CHARGE syndrome patients including inner ear CT scan and functional vestibular evaluation of both canal and otolith functions. These results were correlated with the postural anomalies observed during the children's development and showed that vestibular dysfunction is a constant feature in CHARGE syndrome and has very good sensitivity for confirming the diagnosis. Anomalies of semicircular canals were frequently found (94%), easily detectable on CT scan and associated with no response on canal function evaluation. They were considered as partly responsible for the retardation of postural stages. Vestibular functional tests were consistently abnormal but allowed detection of residual otolith function in most patients (94%). All children of this series had an atypical pattern of postural behaviour that we consider to be related to their vestibular anomalies. Residual otolith function seems to have a positive influence for postural development. CONCLUSION: Vestibular investigations are valuable for diagnosis, developmental assessment, and adaptation of specific rehabilitation programmes in CHARGE syndrome patients.

Abnormalities, Multiple↗
PubMed1999

Upright posture blunts postprandial splanchnic hyperemia in patients with cirrhosis and portal hypertension.

The aim of this study was to compare postprandial hemodynamic changes observed during assumption of the recumbent posture and upright posture in patients with cirrhosis and portal hypertension. Eleven patients with cirrhosis and portal hypertension were studied. Echo-Doppler examinations were performed to measure flow volume in the portal vein (PV), superior mesenteric artery (SMA), and splenic artery (SA) in the fasting condition. Collateral blood flow was indirectly calculated by determining the difference between the sum of SMA, SA, and PV blood flows. After these measurements were done, each patient received a standardized liquid meal and was then randomly assigned to either maintain supine or upright posture, in a crossover design, on 2 different days (recumbent day and upright day). On each study day, the above-mentioned measurements were repeated 30 min and 60 min after the meal. PV blood flow increased significantly after the meal on the recumbent day (P < 0.01) but not on the upright day (P = 0.78). Although there were significant postprandial increases in SMA blood flow on both study days (P < 0.01, P < 0.01), the effect was less pronounced on the upright day than on the recumbent day (P < 0.01). Postprandial SA blood flow showed no change on the recumbent day (P = 0.64), but decreased significantly on the upright day (P < 0.01). The calculated postprandial collateral blood flow increased significantly on the recumbent day (P < 0.05), but showed no change on the upright day (P = 0.53). These results suggest that the upright posture blunts postprandial splanchnic hyperemia in patients with cirrhosis and portal hypertension.

Aged↗
PubMed2004

Spinal muscle forces, internal loads and stability in standing under various postures and loads--application of kinematics-based algorithm.

This work aimed to evaluate trunk muscle forces, internal loads and stability margin under some simulated standing postures, with and without external loads, using a nonlinear finite element model of the T1-S1 spine with realistic nonlinear load-displacement properties. A novel kinematics-based algorithm was applied that exploited a set of spinal sagittal rotations, initially calculated to minimize balancing moments, to solve the redundant active-passive system. The loads consisted of upper body gravity distributed along the spine with or without 200 N held in the hands, either in the front of the body or on the sides. Nonlinear and linear stability/perturbation analyses at deformed, stressed configurations with a linear stiffness-force relationship for muscles identified the system stability and critical muscle stiffness coefficient. Predictions were in good agreement with reported measurements of posture, muscle EMG and intradiscal pressure. Minimal changes in posture (posterior pelvic tilt and lumbar flattening) substantially influenced muscle forces, internal loads and stability margin. Addition of 200 N load in front of the body markedly increased the system stability, global muscle forces, and internal loads, which reached anterior shear and compression forces of approximately 500 N and approximately 1,200 N, respectively, at lower lumbar levels. Co-activation in abdominal muscles (up to 3% maximum force) substantially increased extensor muscle forces, internal loads and stability margin, allowing a smaller critical muscle coefficient. A tradeoff existed between lower internal loads in passive tissues and higher stability margins, as both increased with greater muscle activation. The strength of the proposed model is in accounting for the synergy by simultaneous consideration of passive structure and muscle forces under applied postures and loads.

Algorithms↗
PubMed2001

Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence.

A longitudinal study was undertaken to analyse the development of posture and spinal mobility during growth and its relationship to low back pain and sports activities. A total of 90 children were examined at 5-6 years of age and re-examined at 15-16. Sagittal configuration and mobility were measured using Debrunner's kyphometer. Information about pain and activities was acquired by interview with the parents of the 5- to 6-year-olds and by a questionnaire to the 15- to 16-year-olds. Posture changed significantly during the study period: thoracic kyphosis increased by 6 degrees and lumbar lordosis increased by 6 degrees. The relationship between kyphosis and lordosis was independent of gender at age 5-6, but kyphosis in relation to lordosis was significantly lower in girls among the 15- to 16-year-olds. The total sagittal mobility of the spine decreased significantly during the 10-year study period: in the thoracic spine by as much as 27 degrees and in the lumbar spine by 4 degrees. About one-third of the children at the age of 15-16 years stated that they had occasional low back pain. This complaint was more frequent in those stating they had suffered some type of back injury, but low back pain was not related to gender, regular physical training, posture or spinal mobility. The results of the study showed that kyphosis and lordosis increased and mobility decreased in the 90 children who were examined both at age 5-6 and 15-16 years. The relationship between kyphosis and lordosis decreased in girls but not in boys. Occasional low back pain was reported by 38% of the children at the age of 15-16 years, but back pain was not related to posture, spinal mobility or physical activity.

Adolescent↗
PubMed2001

Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients.

The objective of this study was to identify acute spinal and three-dimensional postural adaptations induced by a shoe lift in a population of idiopathic scoliosis (IS) patients. Forty-six IS patients (mean age: 12 +/- 2 years) were evaluated radiologically and with a stereovideographic system for pelvic obliquity. Based on the initial postural and radiological evaluation, a pertinent shoe lift height was chosen for each with the result that 12 patients were tested with 5-mm (S5) lifts, 20 patients were tested with 10-mm (S10) lifts, and 14 patients with 15-mm (S15) lifts. The posture for all 46 patients was then re-evaluated and a spinal radiograph obtained for 14 patients. The implementation of a shoe lift independent of the type of curve and amplitude significantly decreased the Cobb angle. As expected there was a change in the vertical height of the left tibial plateau and greater trochanter that induced a change in pelvic tilt. There was also a significant increase in the vertical height of S1 and T1. There was a significant change in the left and right iliac bone version, as well as a decrease in the difference in version between these two bones. The implementation of the shoe lifts also changed the lateral shift of the pelvis. A relative change between the shoulders and pelvis for tilt and anteroposterior shift was also found to be significant. In conclusion, using a shoe lift resulted in acute postural adaptations which specifically affected the spine and the three-dimensional position and orientation of the pelvis and shoulder girdle.

Adaptation, Physiological↗
PubMed1987

Effects of upright posture on anterograde and retrograde atrioventricular conduction in patients with coronary artery disease, mitral valve prolapse or no structural heart disease.

To assess the effects of posture on anterograde and retrograde atrioventricular conduction, electrophysiologic testing was performed in 25 patients in both the supine and 45 degrees upright positions on a tilt table. Retrograde conduction was present during ventricular pacing in 17 patients in the supine position; all 17 continued to manifest retrograde conduction in the upright position. In all patients with absent retrograde conduction while supine, retrograde conduction could not be demonstrated while upright. Upright posture significantly (p less than 0.05) shortened the sinus cycle length (from 808 +/- 34 to 678 +/- 26 ms, mean +/- standard error of the mean), AH interval during sinus rhythm (78 +/- 6 to 69 +/- 6 ms), and AH interval during atrial pacing at cycle length 500 ms (123 +/- 13 to 91 +/- 9 ms). Total atrioventricular conduction time during atrial pacing shortened significantly (from 169 +/- 13 to 136 +/- 10 ms), as did ventriculoatrial conduction time during ventricular pacing (from 192 +/- 9 to 178 +/- 7 ms). Upright posture also significantly shortened both anterograde block cycle length (390 +/- 20 to 328 +/- 17 ms) and retrograde block cycle length (466 +/- 27 to 354 +/- 18 ms). However, the effect of upright posture on retrograde block cycle length was significantly greater than on anterograde block cycle length: a 21% decrease retrograde vs a 14% decrease anterograde (p less than 0.05). These effects may produce clinically important changes in characteristics of arrhythmias that depend on the properties of anterograde and retrograde conduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrioventricular Node↗
PubMed1991

Assessment of total head excursion and resting head posture.

Clinicians typically evaluate head posture and cervical range of motion in both standing and sitting positions. There are currently few quantitative data available regarding resting head posture (RHP) or total head excursion (THE), a retraction-protraction gliding range of head motion in the sagittal plane, and where the RHP lies within THE. The purposes of this study were to describe quick and simple methods to determine quantitative measurements of THE, RHP while sitting, and RHP while standing, to provide preliminary data on these postural measurements for men and women in four age categories; and to determine the effects of gender and age on these measurements. Subjects included 218 able-bodied adults. Measurements of THE, RHP while sitting, and RHP while standing were taken. A two-way multivariate analysis of variance followed by two-way analyses of variance showed only the main effect of gender to be significant (p less than .05) for each of the dependent measurements. Across the age groups, men had a greater excursion distance from retraction to protraction than women. Within THE, women held their heads more forward than men. Men held their heads farther from the vertical than women while standing. These results indicate that normal head and neck posture is different for men and women and should not be judged by the same standard. The methods used in this study are clinically advantageous in that they produce objective, quantitative measurements of THE and RHP that may be obtained quickly and with minimal equipment.

Adult↗
PubMed1978

Unitary acitvity of ventrolateral nucleus during placing movement and associated postural adjustment.

The activity of neurons in the ventrolateral nucleus of the thalamus (VL) was analyzed in the cat during placing movements of both the right and left forelimbs. The purpose was to determine if thalamic neuron discharge patterns could be related to movement and/or to postural changes. Placing tests were conducted on animals maintained in a standing position and partially restrained by a hammock. Each of the forelimbs rested on a flat surface containing a strain gauge which allowed the stance forces to be measured. Two mobile plates, one on the left and one on the right, were used to elicit a contact placing reaction. The response was composed of an isometric phase, during which the body weight was shifted from the stimulated limb to the opposite forelimb while the stimulated limb was gently pushed backwards, and a movement phase during which the stimulated paw actually accomplished the placing reaction. (1) About half the recorded neurons (47/86) in the VL region demonstrated a change in activity, generally an increase of discharge frequency, during placing of the right of left forelimb. (2) Almost all the reactive units (45/47) responded to contralateral placing. Two units changed their activity with ipsilateral placing only, whereas 18 units were active during placing of both forelimbs. The discharge pattern of cells activated during ipsilateral placing was considered as related to the isometric postural adjustment of the contralateral limbs. (3) Cells reactive during contralateral tests were located preferentially in the ventrolateral part of VL. Units reactive during ipsilateral tests (postural units) were also clustered in the ventrolateral half of VL which is the zone controlling limb musculature. Some of the 'postural units' were identified as receiving afferents from cerebellar nuclei and projecting to motor cortex. (4) Changes in discharge frequency were observed during either the isometric phase, the movement phase, or both. The same type of patterns were observed during contralateral and ipsilateral placing. About half of the cells responding during the contralateral placing movement did so throughout the entire duration of the movement, and were not specifically related to either the flexion or the extension phase of the placing. (5) The timing of the discharge of VL units with respect to the isometric phase and to the movement phase of the motor sequence varied from cell to cell. No topographic arrangement of neurons with the same pattern of discharge could be found within the nucleus.

Afferent Pathways↗
PubMed1983

Effect of interruption of bulbospinal pathways on lordosis, posture, and locomotion.

The effect of interruption of descending bulbospinal projections arising from (i) the medial medullary reticular formation: nucleus reticularis gigantocellularis (NGC) and nucleus reticularis magnocellularis (NMC), (ii) nucleus raphe magnus, and (iii) nucleus subceruleus on the lordosis reflex, posture, and locomotion was examined. After interruption of descending NGC-NMC fibers, time-dependent deficits in lordosis were observed during the first two postoperative weeks with subsequent reflex recovery. A syndrome of postural and locomotor deficits occurred after NGC-NMC lesions. Postoperatively, postural reflexes were dominated by increased extensor tone which resulted in limb hyperextension. Specific time-dependent deficits in the control of extensor and flexor muscle groups involved in locomotion resulted in a motor syndrome that is detailed. After interruption of NMC fibers alone, no postural or locomotor deficits occurred and effects on lordosis were limited to the first few postoperative days. The NMC data suggested that the majority of the functional deficits seen after NGC plus NMC lesions were due to destruction of the NGC descending projections. Interruption of NSC bulbospinal fibers resulted in a significant depletion of spinal cord noradrenaline (NA) but not serotonin (5-HT). Functional deficits, when present, were limited to the first few postoperative days. Although interruption of descending NRM fibers resulted in a significant depletion of spinal cord 5-HT concentrations, greater depletions occurred in the NGC plus NMC group. No functional deficits were observed in the NRM group. These data suggest that interruption of NGC-NMC fibers destroyed the descending output from neurons which integrate the hormonal and sensory information necessary for lordosis.

Animals↗
PubMed1991

Nursing posture is elicited rapidly in maternally naive, haloperidol-treated female and male rats in response to ventral trunk stimulation from active pups.

Maternal responsiveness in rats can be induced in virgin females and males, without hormonal priming, following several days of cohabitation with pups. Because antagonism of dopamine (DA) facilitates nursing behavior in lactating rats, the response of nonlactating, maternally naive rats to effective stimulation of the ventral trunk (ventrum) from pups following similar treatment was investigated. Lactating dams, virgin females and males, both intact and gonadectomized, were treated with a catalepsy-inducing dose of haloperidol (5 mg/kg), a DA receptor antagonist, and tested with hungry pups 1 hr later. Subjects were placed over 8 pups and postures assessed every 3 min for 30 min. The nursing posture occurred in most subjects. Lactating and nonlactating females were similar in occurrence of the nursing crouch, though the intensity was somewhat higher in the former; females scored higher than males in terms of likelihood and intensity of crouching; and there was no effect of gonadectomy. The nursing posture was not elicited in intact virgin females if the stimulus pups were anesthetized or if the subjects were treated with saline instead of haloperidol. There were no sex differences in onset or intensity of catalepsy in response to the dose of haloperidol used. These results suggest that the nursing posture occurs reflexively, is not directly dependent upon ovarian hormones, and is diminished by the effects of androgens, prior and current.

Animals↗
PubMed1987

Postural stress in geriatric nursing.

An assessment has been made of the static and dynamic forces and postures involved in the nursing day using direct observations and an assessment of truncal stress by means of intra-abdominal pressure (IAP). Subjects were nurses working in the specialty of geriatric nursing in four health regions. Levels of postural activity with regard to stooping, standing, walking and sitting accounted for 98% of the total shift time. Stooping activity was observed at a level of 22% overall which, from the literature, would suggest an increased risk for back pain. Of further concern was the uneven distribution of postural stress with respect to the component hours within shifts. Comparisons of IAP data with other studies indicate that the subjects examined in this study are neither within the 'low' nor 'high' back pain risk categories. This finding, however, should be taken in the context of the high levels of static postural stress reported and the possible cumulative and interactive effects of static and dynamic load. The implications of these findings are discussed in terms of the work system as a whole and attention is drawn to recent recommendations with respect to the prevention of back pain within the nursing profession.

Abdomen↗
PubMed1989

The effect of complete dentures on head posture.

This study investigated possible changes in head posture after insertion of complete dentures in patients who had been edentulous for at least 6 months. The craniovertical angle was measured with a plastic ruler and protractor assembly, which was aligned with dots made on the skin over the zygomatic arch. Readings were made before denture insertion, immediately after insertion, and 15 and 30 minutes later. Two-way ANOVA was used to analyze the results. When the predenture insertion values were included, statistically significant changes (p less than 0.01) in head posture were found. However, when the predenture values were excluded, no statistically significant differences were found. The results support the conclusions that head posture is significantly altered immediately after insertion of dentures in edentulous patients but within the next 30 minutes there is no statistically significant alteration in head posture.

Denture, Complete↗
PubMed1991

Norepinephrine and epinephrine responses to postural stimulus in orthostatic hypotension due to brainstem ischemic lesions.

Norepinephrine (NE) and epinephrine (E) responses to upright posture were investigated in 25 patients with orthostatic hypotension due to brainstem ischemic lesions and in 25 control subjects. In controls the postural stimulus induced constantly a rise in NE urinary excretion and a reduction in E excretion, while in patients with orthostatic hypotension it caused a depression in NE urinary excretion and a rise in E urinary excretion; the last alteration was noticed in all but one patient. The E discharge induced by posture in patients with orthostatic hypotension may be involved in the reduction of vascular peripheral resistance and then in postural fall of blood pressure displayed by such patients.

Adult↗
PubMed1995

Postural reflexes in Parkinson's disease during 'resist' and 'yield' tasks.

Postural reflexes in leg muscles appear to be set at a fixed gain in Parkinson's disease. To further investigate gain adaptation, we instructed 16 patients with idiopathic Parkinson's disease (studied during the 'off' phase) and 21 healthy controls to either 'resist' or 'yield' in response to 20 serial 4 degrees toe-up perturbations of a supporting platform on which they were standing. We bilaterally recorded destabilizing medium latency (ML) reflexes from stretched gastrocnemius muscles and corrective long latency (LL) reflexes from shortened tibialis anterior muscles. We also assessed changes in center of foot pressure (CFP) and center of gravity (COG). During the 'resist' condition, patients had increased destabilizing ML reflexes, decreased corrective LL reflexes, increased backward displacement of the COG and increased forward (destabilizing) displacement of the CFP. In addition, the backward (corrective) displacement of CFP between 150 and 250 ms was delayed. During the 'yield' condition, reflex gains were modified in controls: LL reflexes were markedly attenuated, whereas ML reflexes were markedly increased. Although this reflex pattern resembled the 'resist' condition in patients, it was not associated with an increased forward displacement of the CFP, but only with a strongly delayed backward displacement of CFP which started after 150 ms. In patients, ML reflex amplitudes remained unchanged during the 'yield' condition, suggesting a fixed reflex gain. LL reflex amplitudes were reduced in patients but significantly less compared to controls, which again suggests a fixed reflex gain. This 'inflexibility' of postural reflexes was reflected by the CFP which showed much smaller changes between 0 and 250 ms in patients than controls. These results could not be ascribed to a different ability to yield because posterior displacement of the COG was identical in patients and controls during the 'yield' condition. We conclude that (1) patients with Parkinson's disease have abnormal and 'inflexible' postural reflexes, associated with delayed corrective movements about the ankle joint and increased body sway; and (2) the increased forward displacement of the CFP in patients likely reflects high stiffness in ankle muscles because reflex changes in controls only affected the CFP more than 150 ms after the perturbation. The increased muscle stiffness and inflexibility of postural reflexes in Parkinson's disease may contribute to balance impairment in daily life.

Adaptation, Physiological↗
PubMed1988

Self-assessed and examiner-assessed writing hand posture in Swedish left-handers.

Writing hand posture was studied in 48 male and 54 female left-handed Swedish college students. Inverted posture was more common with examiner-assessment than with self-assessment and was more common in males. Examiner-assessed inversion frequency was lower than that reported from American samples but higher than that from Australian samples. Writing style was related to hand posture, printing being more common in non-inverted writers. Degree of lateral preference, presence of familial sinistrality and birth complications were not associated with writing hand posture.

Achievement↗