Proprioceptive Changes Impair Balance Control in Individuals with Chronic Obstructive Pulmonary Disease

Introduction

Balance deficits are identified as important risk factors for falling in individuals with chronic obstructive pulmonary disease (COPD). However, the specific use of proprioception, which is of primary importance during balance control, has not been studied in individuals with COPD. The objective was to determine the specific proprioceptive control strategy during postural balance in individuals with COPD and healthy controls, and to assess whether this was related to inspiratory muscle weakness.

Methods

Center of pressure displacement was determined in 20 individuals with COPD and 20 age/gender-matched controls during upright stance on an unstable support surface without vision. Ankle and back muscle vibration were applied to evaluate the relative contribution of different proprioceptive signals used in postural control.

Results

Individuals with COPD showed an increased anterior-posterior body sway during upright stance (p = 0.037). Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p = 0.047), decreased anterior body sway during back muscle vibration (p = 0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p = 0.002). Individuals with COPD with the weakest inspiratory muscles showed the greatest reliance on ankle muscle input when compared to the stronger individuals with COPD (p = 0.037).

Conclusions

Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls. These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability. Further research is required to determine whether interventions such as proprioceptive training and inspiratory muscle training improve postural balance and reduce the fall risk in individuals with COPD.     

Postural responses to vibrostimulation of the neck muscle proprioceptors in man

Postural responses to vibrostimulation (50–100 Hz, 0.5 mm, 4–8 sec) of muscles of the back surface of the neck were studied in healthy subjects. In the sitting position, vibrostimulation evoked local displacements (backward head deflection), but global postural responses (forward inclination of the whole body) developed in the standing position. The amplitude of the evoked body inclination was dependent upon the site of the vibrostimuli application along the vertebral column. Asymmetrical application of vibrostimuli to the muscles of the right or left neck side was accompanied by development of a lateral component in the postural response. Changes in the spatial orientation of the head led to the changes in postural response direction: head turning to the right resulted in right-side body deviation during vibration, and vice versa. Illusions of head bend caused by habituation to its static turning were accompanied by precisely the same changes in the direction of body deviation. It is assumed that neck-evoked motor events are mediated via central mechanisms that are involved in perception of the head and body position in space.Translated from Neirofiziologiya, Vol. 25, No. 2, pp. 101–108, March–April, 1993.     

Human Postural Responses to Vibratory Stimulation of Calf Muscles under Conditions of Visual Inversion

The authors studied postural responses to bilateral vibratory stimulation (70 Hz, 1 mm, 2 s) of the calf triceps proprioceptors or anterior tibial muscles. Anteroposterior body tilts evoked by vibration were recorded by stabilography. The authors compared the values of postural responses under various conditions of visual control, namely, with normal vision, eyes closed, right–left inversion of the visual space by prismatic spectacles, central vision, and diffuse light. Visual inversion influenced the subjects' proprioceptive postural responses. The amplitude of vibration-evoked shifts of the feet pressure center was minimal with eyes open and significantly increased with eyes closed and inverted vision. Postural responses with visual inversion were significantly stronger than with eyes closed. Since inversion spectacles enabled a subject to see only the central part of the visual field (20°), the reference point was the condition of central vision, i.e., spectacles with same visual angle and without prisms. Postural responses were significantly weaker under these conditions than with visual inversion and eyes closed. Visual field inversion by prismatic spectacles made it impossible to use visual information for stabilizing the human upright posture and, moreover, destabized it. True, this holds only for a randomized experimental protocol, which prevents adaptation to prisms.     

The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region

In clinical practice, postural correction is a common treatment approach for individuals with neck and shoulder pain. As chronic static muscle use is thought to be associated with the onset of some neck and shoulder pain syndromes, it is important to understand the impact a postural correction program might have on muscle activation amplitudes in the neck and shoulder regions. Normalized surface electromyographic data were recorded from the levator scapulae, upper trapezius, supraspinatus, posterior deltoid, masseter, rhomboid major, cervical erector spinae, and sternocleidomastoid muscles of the dominant side of each of eighteen healthy subjects. Subjects performed five repetitions of each of four seated typing postures (habitual, corrected, head-forward and slouched) and four standing postures (habitual, corrected, and head-forward and slouched). Repeated-measures analysis of variance models (α = 0.05) revealed that in sitting postural correction tended to decreased the level of muscle activation required in all muscles studied during seated computer work, however this finding was not statistically significant. Corrected posture in sitting did, however produce a statistically significant reduction in muscle activity compared to forward head posture. Corrected posture in standing required more muscle activity than habitual or forward head posture in the majority of cervicobrachial and jaw muscles, suggesting that a graduated approach to postural correction exercises might be required in order to train the muscles to appropriately withstand the requirements of the task. A surprising finding was that muscle activity levels and postural changes had the largest impact on the masseter muscle, which demonstrated activation levels in the order of 20% maximum voluntary electrical activation.     

Immediate and remote postactivation effects in the human motor system

Postactivation effects consisting of protracted involuntary muscular contraction after 30–60 sec sustained voluntary effort were investigated. It was found that postactivation effects may be observed at the proximal muscles (uninvolved in the voluntary activity) following distal muscle contraction. Testing the state of muscles by the vibration activity of the muscle receptors showed that concealed changes persisting for 15–20 min occur apart from the direct postactivation effects already known. The point is made that postactivation phenomena reflecting the operation of certain central tonogenic structures activated by a voluntary effort or an increased afferent inflow may successfully be used in the study of postural control mechanisms.Institute for Research into Information Transmission, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologiya, Vol. 21, No. 3, pp. 343–351, May–June, 1989.     

Velocity of body lean evoked by leg muscle vibration potentiate the effects of vestibular stimulation on posture

To investigate the vestibular and somatosensory interaction in human postural control, a galvanic vestibular stimulation of cosine bell shape resulting in a small forward or backward body lean was paired with three vibrations of both soleus muscles. The induced body lean was registered by the position of the center of foot pressure (CoP). During a quiet stance with eyes closed the vibration of both soleus muscles with frequency (of) 40 Hz, 60 Hz and 80 Hz resulted in the body lean backward with velocities related to the vibration frequencies. The vestibular galvanic stimulation with the head turned to the right caused forward or backward modification of CoP backward response to the soleus muscles vibration and peaked at 1.5-2 s following the onset of the vibration. The effect of the paired stimulation was larger than the summation of the vestibular stimulation during the quiet stance and a leg muscle vibration alone. The enhancement of the galvanic stimulation was related to the velocity of body lean induced by the leg muscle vibration. The galvanic vestibular stimulation during a faster body movement had larger effects than during a slow body lean or the quiet stance. The results suggest that velocity of a body postural movement or incoming proprioceptive signal from postural muscles potentiate the effects of simultaneous vestibular stimulations on posture.     

Comparison of Leg Muscle Responses to Transcranial Magnetic Stimulation upon Standing on Stable and Unstable Supports

The role of supraspinal structures in postural adjustment upon standing on stable and unstable supports was studied in healthy individuals. For this purpose, transcranial magnetic stimulation (TMS) of the motor cortex was used in the region of leg representation. The subject stood with the eyes closed on a firm floor or on an unstable support in the form of a paperweight (20 cm in height, with a base radius of 32 cm) with mobility in the sagittal direction. Electric responses of four muscles—the soleus muscle, the anterior tibial muscle, the femoral biceps muscle, and the femoral rectus muscle—were recorded. It was shown that, in all the muscles, the response to TMS upon standing on an unstable support increased by 1.8–2.7 times as compared with the response upon standing on a firm floor. Since the increase in the tonic activity of the muscles studied was statistically insignificant upon switching over from standing on a firm floor to standing on an unstable support, it is hypothesized that the increase in the amplitude of muscle responses is connected with an increased activity of the supraspinal structures or with an increase in the effectiveness of corticospinal connections. The results are discussed from the point of view of the role of the motor cortex in maintaining balance on an unstable support.     

Human postural responses to different frequency vibrations of lower leg muscles

We analyzed human postural responses to muscle vibration applied at four different frequencies to lower leg muscles, the lateral gastrocnemius (GA) or tibialis anterior (TA) muscles. The muscle vibrations induced changes in postural orientation characterized by the center of pressure (CoP) on the force platform surface on which the subjects were standing. Unilateral vibratory stimulation of TA induced body leaning forward and in the direction of the stimulated leg. Unilateral vibration of GA muscles induced body tilting backwards and in the opposite direction of the stimulated leg. The time course of postural responses was similar and started within 1 s after the onset of vibration by a gradual body tilt. When a new slope of the body position was reached, oscillations of body alignment occurred. When the vibrations were discontinued, this was followed by rapid recovery of the initial body position. The relationship between the magnitude of the postural response and frequency of vibration differed between TA and GA. While the magnitude of postural responses to TA vibration increased approximately linearly in the 60-100 Hz range of vibration frequency, the magnitude of response to GA vibration increased linearly only at lower frequencies of 40-60 Hz. The direction of body tilt induced by muscle vibration did not depend on the vibration frequency.     

Dynamic forces over the interface between a seated human body and a rigid seat during vertical whole-body vibration

Biodynamic responses of the seated human body are usually measured and modelled assuming a single point of vibration excitation. With vertical vibration excitation, this study investigated how forces are distributed over the body-seat interface. Vertical and fore-and-aft forces were measured beneath the ischial tuberosities, middle thighs, and front thighs of 14 subjects sitting on a rigid flat seat in three postures with different thigh contact while exposed to random vertical vibration at three magnitudes. Measures of apparent mass were calculated from transfer functions between the vertical acceleration of the seat and the vertical or fore-and-aft forces measured at the three locations, and the sum of these forces. When sitting normally or sitting with a high footrest, vertical forces at the ischial tuberosities dominated the vertical apparent mass. With feet unsupported to give increased thigh contact, vertical forces at the front thighs were dominant around 8 Hz. Around 3–7 Hz, fore-and-aft forces at the middle thighs dominated the fore-and-aft cross-axis apparent mass. Around 8–10 Hz, fore-and-aft forces were dominant at the ischial tuberosities with feet supported but at the front thighs with feet unsupported. All apparent masses were nonlinear: as the vibration magnitude increased the resonance frequencies decreased. With feet unsupported, the nonlinearity in the apparent mass was greater at the front thighs than at the ischial tuberosities. It is concluded that when the thighs are supported on a seat it is not appropriate to assume the body has a single point of vibration excitation.     

Method to Measure Tone of Axial and Proximal Muscle

The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs¹, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the vertical axis during stance, so as to twist the neck, trunk or hip regions. This twisting imposes length changes on axial muscles without changing the body''s relationship to gravity. Because Twister does not provide postural support, tone must be regulated to counteract gravitational torques. We quantify this tonic regulation by the restive torque to twisting, which reflects the state of all muscles undergoing length changes, as well as by electromyography of relevant muscles. Because tone is characterized by long-lasting low-level muscle activity, tonic control is studied with slow movements that produce "tonic" changes in muscle length, without evoking fast "phasic" responses. Twister can be reconfigured to study various aspects of muscle tone, such as co-contraction, tonic modulation to postural changes, tonic interactions across body segments, as well as perceptual thresholds to slow axial rotation. Twister can also be used to provide a quantitative measurement of the effects of disease on axial and proximal postural tone and assess the efficacy of intervention.     

Effects of lateral perturbations and changing stance conditions on anticipatory postural adjustment

The study investigates the role of lateral muscles and changing stance conditions in anticipatory postural adjustments (APAs). Subjects stood laterally to an aluminum pendulum released by an experimenter and were required to stop it with their right or left hand. Stance conditions were manipulated by having the subjects stand in the following positions: on a single limb (SS), with feet together (narrow base of support, NB), and with feet shoulder width apart (regular base of support, RB). Bilateral EMG activity of dorsal, ventral, and lateral trunk and leg muscles and ground reaction forces were recorded and quantified within the time intervals typical of APAs. Anticipatory postural adjustments were seen in all experimental conditions, and their magnitudes depended on the stance and the side of perturbation. Accordingly, APAs in lateral muscles increased on the side of perturbation in SS condition, while simultaneous activation of dorsal muscles occurred on the contralateral side. Smaller APAs were seen in lateral muscles in conditions with a wider base of support (NB, RB) and APAs in dorsal muscles were smaller in NB – in comparison to RB – stance. The results of the present study provide new data on the role of lateral, ventral, and dorsal muscles in anticipatory postural control when dealing with lateral perturbations in conditions of postural instability.     

Vibration-Induced Frontal Postural Reactions in Humans Standing on Unstable Supports of Various Types

The authors studied the influence of the direction of support stability the vibration-induced frontal postural reactions of healthy humans during unilateral vibration of three lateral muscles, namely, the long peroneal muscle, tensor muscle of fascia lata, and abdominal external oblique muscle. The subjects stood on a movable blotter- shaped support. Its base was cylindrical or spheric; its height was 24 cm, and its base radius was 40 cm. The platform turn angle and sagittal and frontal horizontal shift of the upper part of the subjects' bodies were recorded. Reacting to vibrations, the subjects tilted their bodies contralaterally to the vibrated muscle, irrespective of the support type. These reactions were strongest when the subjects stood on a stable support and were weakest when the support was unstable. The reaction values were also influenced by the distance between the vibrated muscle and general center of gravity of the body. As a rule, all other things being equal, vibration-induced reaction strengthened when the stimulated muscle was closer to the center of gravity. The authors concluded that vibration-induced frontal reactions of a standing human depend on the support properties and reflect the features of the participation of the lateral muscles in the standing posture regulation. The information received from the lateral muscular receptors by the control system may be used in different manners, depending on the internal body–support interaction model formed by the CNS.     

The Effects of Backward Adjustable Thoracic Support in Wheelchair on Spinal Curvature and Back Muscle Activation for Elderly People

Objectives

To investigate the effects of backward adjustable thoracic support on spinal curvature and back muscle activation during wheelchair sitting.

Methods

Twenty elderly people were recruited for this study. The backward adjustable thoracic support sitting posture was compared with the slumped, normal, and lumbar support sitting postures. Spinal curvatures (pelvic, lumbar, and thoracic angles) and muscle activations of 4 back muscles on both sides (maximal voluntary isometric contraction of the lumbar multifidus, lumbar erector spinae, iliocostalis lumborum pars thoracis, and thoracic erector spinae at T9) were measured and compared between the different sitting postures using one-way analysis of variance with repeated measures.

Results

The backward adjustable thoracic support sitting posture showed a relatively neutral pelvic tilt (−0.32±4.80°) when compared with the slumped (22.84±5.27°) and lumbar support (−8.97±3.31°) sitting postures (P<0.001), and showed relatively higher lumbar lordosis (−23.38±6.50°) when compared with the slumped (14.77±7.83°), normal (0.44±7.47°), and lumbar support (−16.76±4.77°) sitting postures (P<0.05). It also showed relatively lower back muscle activity when compared with the normal and lumbar support sitting postures (P<0.05).

Conclusions

The backward adjustable thoracic support sitting concept was suggested because it maintains a more neutral pelvic tilt, higher lumbar lordosis, and lower back muscle activation, which may help maintain a better sitting posture and reduce the risk of back pain.     

Characteristics of the maintenance of the upright posture in subjects touching an external object while standing on a moving or immobile platform

Postural sway was compared for humans touching an external object while standing on an immobile or slowly moving posturographic platform. When the platform moves, the central nervous system may interpret the movement of the point of the contact with the external object as the movement of the body relative to the support or as the movement of the support itself. Thus, the information concerning the body position that is provided by the touch becomes ambiguous. It was demonstrated that contact with an external object during standing on an unstable support leads to a decrease in support sway. When a subject stands on a moving platform, this decrease is smaller than in the case of an immobile platform. Contact with an external object causes a decrease in postural responses to shank muscle vibrations on an immobile platform. On a moving platform, this decrease is nonsignificant. The change in postural sway depending on the unambiguity of afferent information is discussed in terms of the interaction between afferent signals of different modalities on the basis of the body scheme in subjects maintaining balance.Translated from Fiziologiya Cheloveka, Vol. 31, No. 1, 2005, pp. 59–65.Original Russian Text Copyright © 2005 by Kazennikov, Shlykov, Levik.     

Effect of movement and illusion of movement on human vestibulomotor response

Lateral stabilographic response to galvanic labyrinth stimulation was investigated in healthy subjects in the standing position. Vestibulomotor response increased during forwards volitional body tilt as well as involuntary tilt occurring in response to stimulating (by vibration) the proprioceptors of the anterior tibial muscles. An illusion of the forward body tilt induced by stimulating (vibrating) the proprioceptors of the triceps surae muscles with the trunk fastened in a fixed position was accompanied by practically the same intensification of vestibulomotor response as during actual body movement. It was concluded that reinforcement of vestibulomotor response during volitional movements is brought about by the spatial perception system.Institute for Research into Information Transmission, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologiya, Vol. 20, No. 2, pp. 250–255, March–April, 1988.     

Interaction between the vertical posture and movement control systems during a quick voluntary arm raise

The study was aimed at a deeper understanding of the interaction between the system of vertical posture control and the system of voluntary movement control based on the analysis of postural muscle activity components resulting from the action of the former or the latter system. For this purpose, a quick arm raise was performed in the standing and sitting positions with body fixation at different levels, when the task of maintaining a vertical posture was simplified or completely eliminated. Under these conditions, the muscle activity associated with posture control was supposed to change, while the activity of muscles raising the arm was supposed to remain invariable. The results showed that the simplification of the posture control resulted in a decrease or elimination of anticipatory changes in the activity of some muscles. However, most of the muscle activity variations were retained even in the sitting position, and these variations appeared simultaneously with the activity of muscles raising the arm. The so-called “anticipatory postural activity” during an arm raise in a normal standing position is supposed to consist of two components: an initial component reflecting the work of the posture control system and a later component reflecting the work of the movement control system. It is suggested that the planning of muscle activity and exchange of information between these two systems take place only before the beginning of the movement; after that, they act independently and in parallel.     

Postural response characterization of standing humans to multi-directional,predictable and unpredictable perturbations to the arm

When the arm of a standing human is perturbed in an unpredictable direction, postural muscles are activated at latencies as short as 50–110 ms. While the motion of the body clearly progresses in hand-to-leg sequence, there is no systematic muscle activation sequence from the arm to the leg muscles, suggesting that the activation of the muscles is not likely the result of local stretch reflexes. In fact, the lower limb muscles are activated before the upright posture is significantly disturbed. The short-latency activation amplitude and the activation probability are clearly tuned to the direction of the arm perturbation for both rostral and caudal muscles. The effect of central set on the short-latency response has been investigated by manipulating the predictability of the perturbations. Possible underlying neural mechanisms have been discussed.     

Spatial perception and vestibulomotor responses in man

A study was made on normal human subjects, using a stabilograph to investigate changes in posture produced in response to transcutaneous galvanic stimulation of the right labyrinth. Results were obtained for different head positions and under the illusion of head and trunk rotation produced by stimulating (vibrating) the gulteus maximus muscle. In the absence of illusion of movement, the direction of the vestibulomotor response was determined by the position of the head in relation to the feed: with the normal head position, the body swayed on a frontal plane, and on a sagittal plane when the heat turned through 90°. Vestibulomotor responses were sagittally oriented, as with real head turning, when illusory head and trunk turning through 90° was produced by vibration. When the illusion of head rotation (in relation to the feet) was not produced by this stimulus, the direction of the postural response was not produced by this stimulus, the direction of the postural response was determined by the real orientation of the head. It is concluded that the spatial perception system plays a major part in controlling spatially oriented vestibulomotor responses.Institute for Research into Information Transmission, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologiya, Vol. 18, No. 6, pp. 779–787, November–December, 1986.     

Musculature and biomechanics of the trunk in the maintenance of upright posture

Surface perturbation has been used for decades to study balance and postural control; however the behavior of the trunk in these postural responses has been largely overlooked. Thirteen healthy males (18–23 yrs) were exposed to horizontal support surface translations delivered randomly in one of eight different horizontal directions in both sitting and standing. A 4-segment model of the trunk was used to estimate the kinematics and kinetics associated with the postural response, while surface EMG was acquired, bilaterally, from seven trunk muscles and one hip muscle. Multi-segmental movement was observed in the trunk in both test postures. Both the biomechanical and neuromuscular aspects of the trunk response were significantly affected by translation direction and test posture, with an interaction effect between these variables. The response in sitting was closely tied to the movement of the support surface, while the response in standing occurred in two phases: the first related to the dynamic response in the lower limbs, and the second tied to the movement of the support surface. As such, the observed postural responses could be largely explained by the biomechanical constraints of the system, such that the neural control of trunk equilibrium is simplified.     

The effect of textured surfaces on postural stability and lower limb muscle activity

Textured insoles may enhance sensory input on the plantar surfaces of the feet, thereby influencing neuromuscular function. The aim of this study was to investigate whether textured surfaces alter postural stability and lower limb muscle activity during quiet bipedal standing balance with eyes open. Anterior–posterior (AP) and mediolateral (ML) sway variables and the intensity of electromyographic (EMG) activity in eight dominant lower limb muscles were collected synchronously over 30 s in 24 young adults under three randomised conditions: control surface (C), texture 1 (T1) and texture 2 (T2). Repeated measures ANOVA showed that the textured surfaces did not significantly affect AP or ML postural sway in comparison to the control condition (p > 0.05). Neither did the textured surfaces significantly alter EMG activity in the lower limbs (p > 0.05). Under the specific conditions of this study, texture did not affect either postural sway or lower limb muscle activity in static bipedal standing. The results of this study point to three areas of further work including the effect of textured surfaces on postural stability and lower limb muscle activity: (i) in young healthy adults under more vigorous dynamic balance tests, (ii) post-fatigue, and (iii) in older adults presenting age-related deterioration.