Models of Postural Control: Shared Variance in Joint and COM Motions

This paper investigated the organization of the postural control system in human upright stance. To this aim the shared variance between joint and 3D total body center of mass (COM) motions was analyzed using multivariate canonical correlation analysis (CCA). The CCA was performed as a function of established models of postural control that varied in their joint degrees of freedom (DOF), namely, an inverted pendulum ankle model (2DOF), ankle-hip model (4DOF), ankle-knee-hip model (5DOF), and ankle-knee-hip-neck model (7DOF). Healthy young adults performed various postural tasks (two-leg and one-leg quiet stances, voluntary AP and ML sway) on a foam and rigid surface of support. Based on CCA model selection procedures, the amount of shared variance between joint and 3D COM motions and the cross-loading patterns we provide direct evidence of the contribution of multi-DOF postural control mechanisms to human balance. The direct model fitting of CCA showed that incrementing the DOFs in the model through to 7DOF was associated with progressively enhanced shared variance with COM motion. In the 7DOF model, the first canonical function revealed more active involvement of all joints during more challenging one leg stances and dynamic posture tasks. Furthermore, the shared variance was enhanced during the dynamic posture conditions, consistent with a reduction of dimension. This set of outcomes shows directly the degeneracy of multivariate joint regulation in postural control that is influenced by stance and surface of support conditions.     

Effective tempo of the step test for dynamic balance ability in the elderly

This study aimed to examine the reliability and sex- and age-related differences of step tests with stipulated tempos as well as to clarify useful test parameters and tempos. One hundred forty elderly people and fifty young adults conducted tapping and stepping tests, matching the tempo provided by a metronome. Both tests involve movements where the subject touches a sheet with both the right and left hands or right and left legs at a designated spot. Evaluation parameters were the time difference between the beep sound and the time at which the sheet was touched in both tests as well as two-leg support and one-leg support times in the step test. The trial-to-trial reliability of the parameters in both tests was high. The time differences of both 40 bpm tests in the elderly were larger in males than in females. In the step test, the time difference and two-leg support times of the elderly were larger, in the order of 40, 60, and 120 bpm, and the one-leg support time was less in 40 bpm than 60 bpm or 120 bpm. The one-leg support time of the young subjects was larger, in the order of 40, 60, and 120 bpm. A significant age-related difference was found in the 40 bpm and 60 bpm test, and the time difference and two-leg support time were larger in the elderly while the one-leg support time was larger in the young subjects. The time difference at 40 bpm in the elderly was larger in the step test than in the tap test. There was no significant difference between both tests in the young subjects. In conclusion, the step test with the slow tempo, because it requires a long one-leg support phase, is effective for evaluating dynamic balance in the elderly. The time difference and two-leg and one-leg support times are effective evaluation parameters of the step test.     

How proprioceptive impairments affect quiet standing in patients with multiple sclerosis

To assess if multiple sclerosis patients with proprioceptive impairment are specifically affected during quiet standing with eyes open and how they can develop motor compensatory processes, 56 patients, classified from sensory clinical tests as ataxo-spastic (MS-AS) or only having spasticity (MS-S), were compared to 23 healthy adults matched for age. The postural strategies were assessed from the centre-of-pressure trajectories (CP), measured from a force platform in the eyes open standing condition for a single trial lasting 51.2 s. The vertical projection of the centre of gravity (CGv) and its vertical difference from the CP (CP-CGv) were then estimated through a biomechanical relationship. These two movements permit the characterization of the postural performance and the horizontal acceleration communicated to the CG and from that, the global energy expenditure, respectively. Both MS-AS and MS-S groups demonstrate larger CGv and CP-CGv movements than healthy individuals of the same age. Whilst similar CGv values are noticed in both MS subgroups, suggesting similar postural performances, statistically significant differences are observed for the CP-CGv component. Biomechanically, this feature expresses the necessity for the MS-AS group to develop augmented neuro-muscular means to control their body movements, as compared to the MS-S group. By demonstrating for both groups of patients similar postural performance accompanied by a varying degree of energy expenditure to maintain undisturbed upright stance, this study reveals that MS-AS patients which are affected by proprioceptive loss can compensate for this deficit with more efficient control strategies, when standing still with their eyes open.     

Changes in center-of-pressure dynamics during upright standing related to decreased balance control in young adults: fractional Brownian motion analysis

We investigated the relationships between the ability to maintain balance in an upright stance and center-of-pressure (COP) dynamic properties in young adults. Included in this study were 10 healthy male subjects in each of two groups with respect to balance ability. Balance ability was evaluated according to the length of time a subject stood on one leg with his eyes closed. The means and ranges of this one-leg balancing time were 17.9 s (3-43 s) and 118.3 s (103-120 s) for the off-balance and balance groups, respectively. The time-varying displacements of the COP under a subject's feet during quiet two-leg (normal) standing were measured by an instrumented force platform. Each subject was tested in both the eyes-open and eyes-closed conditions. The COP trajectories were analyzed as fractional Brownian motions according to the procedure of 'stabilogram-diffusion analysis', proposed by Collins and De Luca (1993). The extracted parameters were the effective diffusion coefficients (D) for the short-term (less than about 1.0 s) and long-term intervals, respectively, as well as the Hurst exponents (H) for the short-term and long-term intervals, and some critical-point coordinates (i.e., critical mean square displacements and critical time intervals). The off-balance group showed significantly higher values for short-term D, short-term H, and critical mean square displacements than the balance group. No significant differences between the groups were found in the long-term D and H or in the critical time intervals. That is, for the off-balance subjects, an increase in the stochastic activity and positively correlated (persistent) behavior of the postural sway during shorter timescales may cause postural instability. These results suggest that the difference in balance ability for young adults is related to the open-loop (i.e., short-term) control mechanisms but not to the corrective feedback (i.e., long-term) mechanisms used to maintain balance in an upright stance.     

How proprioceptive impairments affect quiet standing in patients with multiple sclerosis

To assess if multiple sclerosis patients with proprioceptive impairment are specifically affected during quiet standing with eyes open and how they can develop motor compensatory processes, 56 patients, classified from sensory clinical tests as ataxo-spastic (MS-AS) or only having spasticity (MS-S), were compared to 23 healthy adults matched for age. The postural strategies were assessed from the centre-of-pressure trajectories (CP), measured from a force platform in the eyes open standing condition for a single trial lasting 51.2?s. The vertical projection of the centre of gravity (CG_v) and its vertical difference from the CP (CP-CG_v) were then estimated through a biomechanical relationship. These two movements permit the characterization of the postural performance and the horizontal acceleration communicated to the CG and from that, the global energy expenditure, respectively. Both MS-AS and MS-S groups demonstrate larger CG_v and CP-CG_v movements than healthy individuals of the same age. Whilst similar CG_v values are noticed in both MS subgroups, suggesting similar postural performances, statistically significant differences are observed for the CP-CG_v component. Biomechanically, this feature expresses the necessity for the MS-AS group to develop augmented neuro-muscular means to control their body movements, as compared to the MS-S group. By demonstrating for both groups of patients similar postural performance accompanied by a varying degree of energy expenditure to maintain undisturbed upright stance, this study reveals that MS-AS patients which are affected by proprioceptive loss can compensate for this deficit with more efficient control strategies, when standing still with their eyes open.     

Effects of training on the physiological responses to one- and two-leg work.

The effects of training resulting from one-leg exercise on a stationary bicycle ergometer have been studied. Seven subjects were habituated to one- and two-leg progressive exercise tests on 11 successive days and were then trained for 60 min-day-1 (30 min each leg) 3 times per wk for 5-6 wk at approximately 80% of their one-leg VO2 max. VE max increased (P less than 0.05) by approximately 14 1-min-1 and VO2 max by approximately 0.34 1-min-1 (+14%; P less than 0.05) in one-leg exercise. This latter increase was not, however, reflected in the two-leg VO2 max which only increased 145 ml-min-1 (4.7%). It was concluded that training is specific and in one-leg work the phenomenon is mainly peripheral in origin, but in two-leg work the limitation to maximal exercise is still provided by the capacity of the central cardiovascular system to transport oxygen to a given effective muscle mass.     

Explanation of the bilateral deficit in human vertical squat jumping.

In the literature, it has been reported that the mechanical output per leg is less in two-leg jumps than in one-leg jumps. This so-called bilateral deficit has been attributed to a reduced neural drive to muscles in two-leg jumps. The purpose of the present study was to investigate the possible contribution of nonneural factors to the bilateral deficit in jumping. We collected kinematics, ground reaction forces, and electromyograms of eight human subjects performing two-leg and one-leg (right leg) squat jumps and calculated mechanical output per leg. We also used a model of the human musculoskeletal system to simulate two-leg and one-leg jumps, starting from the initial position observed in the subjects. The model had muscle stimulation as input, which was optimized using jump height as performance criterion. The model did not incorporate a reduced maximal neural drive in the two-leg jump. Both in the subjects and in the model, the work of the right leg was more than 20% less in the two-leg jump than in the one-leg jump. Peak electromyogram levels in the two-leg jump were reduced on average by 5%, but the reduction was only statistically significant in m. rectus femoris. In the model, approximately 75% of the bilateral deficit in work per leg was explained by higher shortening velocities in the two-leg jump, and the remainder was explained by lower active state of muscles. It was concluded that the bilateral deficit in jumping is primarily caused by the force-velocity relationship rather than by a reduction of neural drive.     

Undisturbed stance on a double seesaw: Interaction between asymmetries of the center-of-pressure patterns under each foot and weight-bearing

Both center-of-pressure (CP) displacements under each foot and relative body-weight distribution intervene in the production of resultant CP movements. To better understand their respective involvement, a protocol was set up for young healthy individuals consisting in standing on a double seesaw, favoring pitch motions and laying on a dual-force platform. The postural control effects induced by two types of asymmetry, weight-bearing and the CP movement patterns, were investigated. These asymmetries were achieved by associating two seesaws with two different lengths for the radii of the ridges and by requiring specific body-weight distributions. The results indicate that the postural strategies, aimed at controlling anteroposterior sway, are related to the subjects’ capacity to minimize the CP displacements under the less stable support, whatever load is applied. In contrast, the degree of involvement of the more stable support must be viewed as a complement used to secure the appropriate motor output, i.e., the resultant CP movements. Within this objective, both the applied load and the CP amplitudes under the more stable support are taken into account. These data provide additional insights into the compensatory mechanisms between the interactions between the two feet, which are used to produce the adequate resultant CP movements and therefore upright stance control. The specificity of the double seesaw that can induce asymmetric CP patterns and/or asymmetric body-weight distribution makes it a legitimate contender to be used as a rehabilitation device for patients with neurological and/or traumatic diseases.     

Postural control during lifting

Any voluntary motion of the body causes an internal perturbation of balance. Load transfer during manual material handling may increase these perturbations. This study investigates effects of stance condition on postural control during lifting. Nineteen healthy subjects repeatedly lifted and lowered a load between a desk and a shelf. The base of support was varied between parallel and step stance. Ground reaction force and segmental kinematics were measured. Load transfer during lifting perturbed balance. In parallel stance postural response consisted of axial movements in the sagittal plane. Such strategy was accompanied by increased posterior shear forces after lift-off. Lifting in step stance provided extended support in anterior/posterior direction. The postural control mechanisms in the sagittal plane are less complex as compared to parallel stance. However, lifting in step stance was asymmetrical and thus accompanied by distinct lateral transfer of the body. Lateral shear forces were larger as compared to parallel stance. Both lifting techniques exhibit positive and negative aspects. We cannot recommend either one as being better in terms of postural control.     

Specific and Nonspecific Visual Influences on the Stability of the Vertical Posture in Humans

We studied physiological mechanisms of vision-related stabilization of the vertical posture in humans using a stabilographic technique; spontaneous deviations of the projection of the center of gravity during quiet stance and magnitudes of the postural response to vibratory stimulation of proprioceptors of the lower leg muscles under varied conditions of visual control were measured. The stability of quiet stance, as estimated according to the root mean square value of the sagittal component of the stabilogram, was the best with eyes open. Vibration-induced postural responses were the smallest also under these conditions. Spontaneous postural sway and the amplitude of response to vibratory stimulation increased when only a central sector of visual field (20 ang. deg) was preserved and, especially, under conditions of closed eyes and horizontal inversion of visual perception using prismatic spectacles. Parallel changes in the quantitative stabilographic indices and amplitude of vibration-induced postural responses show that the intensity of the latter is probably determined by the background stiffness of the musculoskeletal system. We tried to estimate separately the contributions of the stiffness factor, on the one hand, and specific visual influences, on the other hand, by testing the parameters of quiet stance and postural responses under conditions of standing while lightly touching a support with the index finger. We found that the influence of the conditions of visual control on the stability of quiet stance while touching the support was eliminated. At the same time, the magnitude of postural responses to vibratory stimulation decreased but, nonetheless, changed with visual conditions in the same manner as when standing without additional support. We conclude that vision performs a dual function in the control of the vertical posture; it forms the basis for the spatial reference system and serves the source of information on the movements of one's body.     

Feedback equilibrium control during human standing

Equilibrium maintenance during standing in humans was investigated with a 3-joint (ankle, knee and hip) sagittal model of body movement. The experimental paradigm consisted of sudden perturbations of humans in quiet stance by backward displacements of the support platform. Data analysis was performed using eigenvectors of motion equation. The results supported three conclusions. First, independent feedback control of movements along eigenvectors (eigenmovements) can adequately describe human postural responses to stance perturbations. This conclusion is consistent with previous observations (Alexandrov et al., 2001b) that these same eigenmovements are also independently controlled in a feed-forward manner during voluntary upper-trunk bending. Second, independent feedback control of each eigenmovement is sufficient to provide its stability. Third, the feedback loop in each eigenmovement can be modeled as a linear visco-elastic spring with delay. Visco-elastic parameters and time-delay values result from the combined contribution of passive visco-elastic mechanisms and sensory systems of different modalities     

Comparative analysis of the regulation of vertical posture in athletes of different sports qualifications

The goal of study was to investigate the regulation of balance in athletes with different sports qualifications: masters of sport (MS, n=18) and candidates for master of sports (CMS, n=13). Balance examined by means of stabilographic complex ("Rhythm". Russia) in the static tests: in simple bipedal stance (BS) and squat positions (SQ), as well as in the dynamic tests: "Involute", evaluating the tracking movement and "Step input", assessing the reaction of the whole body on the visual-motor task. It was found that the MS with the same anthropometric data, PWC 170 and trunk power did not differ in linear and angular velocity of oscillations of the center of pressure (CP) in BS and SQ positions. MS had a relative dominance of low-frequency oscillations in the spectral analysis in the BS test with eyes open. In the test "Step input" MS had a lower latent period of reaction, a greater speed and an accuracy of the body motion forward and back in response to the step input signals, while they had a relative dominance of high frequency oscillations. Thus, the results showed that the masters of sport have improved postural regulation, which manifested itself mainly in the dynamic test on the speed and accuracy of the vertical body reaction to input visual signals.     

Short-term effects of electrical stimulation superimposed on muscular voluntary contraction in postural control in elderly women

Thirty-two women between 62 and 75 years old were randomized into 3 groups. Each group performed a program of 4 sessions a week over 6 weeks. Group SC (n = 11) climbed up and down stairs, group ES (n = 11) practiced electrostimulation, and group SC + ES (n = 10) superimposed the 2 activities simultaneously. Using a force platform and a seesaw platform, static and dynamic balance in eyes-open and eyes-closed conditions were analyzed before and after the programs for each group. After the programs, the results indicated that dynamic balance improved for the 3 groups, but the contribution of visual information in the control of oscillation amplitude was lower in the SC group than in the ES and SC + ES groups. In the SC + ES group, the electrical stimulation interferes with neurophysiologic afference integration in postural control in relation to voluntary movement. Voluntary exercise appears to be more efficient than electrical stimulation and the superimposed techniques to change balancing tactics in the elderly.     

Somatosensory influence on postural response to galvanic vestibular stimulation

We investigated how postural responses to galvanic vestibular stimulation were affected by standing on a translating support surface and by somatosensory loss due to diabetic neuropathy. We tested the hypothesis that an unstable surface and somatosensory loss can result in an increase of vestibulospinal sensitivity. Bipolar galvanic vestibular stimulation was applied to subjects who were standing on a force platform, either on a hard, stationary surface or during a backward platform translation (9 cm, 4.2 cm/s). The intensity of the galvanic stimulus was varied from 0.25 to 1 mA. The amplitude of the peak body CoP displacement in response to the galvanic stimulus was plotted as a function of stimulus intensity for each individual. A larger increase in CoP displacement to a given increase in galvanic current was interpreted as an increase of vestibulospinal sensitivity. Subjects with somatosensory loss in the feet due to diabetes showed higher vestibulospinal sensitivity than healthy subjects when tested on a stationary support surface. Control subjects and patients with somatosensory loss standing on translating surface also showed increased galvanic response gains compared to stance on a stationary surface. The severity of the somatosensory loss in the feet correlated with the increased postural sensitivity to galvanic vestibular stimulation. These results showed that postural responses to galvanic vestibular stimulus were modified by somatosensory information from the surface. Somatosensory loss due to diabetic neuropathy and alteration of somatosensory input during stance on translating support surface resulted in increased vestibulospinal sensitivity.     

Age-related changes of human balance during quiet stance

Certain aspects of balance control change with age, resulting in a slight postural instability. We examined healthy subjects between 20-82 years of age during the quiet stance under static conditions: at stance on a firm surface and/or on a compliant surface with eyes either open or closed. Body sway was evaluated from centre of foot pressure (CoP) positions during a 50 sec interval. The seven CoP parameters were evaluated to assess quiet stance and were analyzed in three age groups: juniors, middle-aged and seniors. The regression analysis showed evident increase of body sway over 60 years of age. We found that CoP parameters were significantly different when comparing juniors and seniors in all static conditions. The most sensitive view on postural steadiness during quiet stance was provided by CoP amplitude and velocity in AP direction and root mean square (RMS) of statokinesigram. New physiological ranges of RMS parameter in each condition for each age group of healthy subjects were determined. Our results showed that CoP data from force platform in quiet stance may indicate small balance impairment due to age. The determined physiological ranges of RMS will be useful for better distinguishing between small postural instability due to aging in contrast to pathological processes in the human postural control.     

Relationship between Spectral Characteristics of Spontaneous Postural Sway and Motion Sickness Susceptibility

Motion sickness (MS) usually occurs for a narrow band of frequencies of the imposed oscillation. It happens that this frequency band is close to that which are spontaneously produced by postural sway during natural stance. This study examined the relationship between reported susceptibility to motion sickness and postural control. The hypothesis is that the level of MS can be inferred from the shape of the Power Spectral Density (PSD) profile of spontaneous sway, as measured by the displacement of the center of mass during stationary, upright stance. In Experiment 1, postural fluctuations while standing quietly were related to MS history for inertial motion. In Experiment 2, postural stability measures registered before the onset of a visual roll movement were related to MS symptoms following the visual stimulation. Study of spectral characteristics in postural control showed differences in the distribution of energy along the power spectrum of the antero-posterior sway signal. Participants with MS history provoked by exposure to inertial motion showed a stronger contribution of the high frequency components of the sway signal. When MS was visually triggered, sick participants showed more postural sway in the low frequency range. The results suggest that subject-specific PSD details may be a predictor of the MS level. Furthermore, the analysis of the sway frequency spectrum provided insight into the intersubject differences in the use of postural control subsystems. The relationship observed between MS susceptibility and spontaneous posture is discussed in terms of postural sensory weighting and in relation to the nature of the provocative stimulus.     

Velocity of head movements and sensory-motor adaptation during and after short spaceflight

To investigate to time course of sensory-motor adaptation to microgravity, we tested spatially-directed voluntary head movements before, during and after short spaceflight. We also tested the re-adaptation of postural responses to sensory stimulation after space flight. The cosmonaut performed in microgravity six cycles of voluntary head rotation in pitch, roll and yaw directions. During the first days of weightlessness the angular velocity of head movements increased. Over the next days of microgravity the velocity of head movements gradually decreased. On landing day a significant decrease of head rotation velocity was observed compared to the head movement velocity before spaceflight. Re-adaptation to Earth condition measured by body sway on soft support showed similar time course, but re-adaptation measured by postural responses to vestibular galvanic stimulation was prolonged. These results showed that the angular velocity of aimed head movements of cosmonauts is a good indicator of sensory-motor adaptation in altered gravity conditions.     

Modulation of soleus H reflex due to stance pattern and haptic stabilization of posture

The quiet stance is a complicated motor act requiring sophisticated sensorimotor integration to balance an artificial inverted pendulum with the ankle musculature. The objective of this study was to characterize the effects of stance pattern (bilateral stance vs. unilateral stance) and directional influence of light finger touch (medial–lateral vs. anterior–posterior) in unilateral stance upon responsiveness of the soleus H reflex. Sixteen healthy volunteers (mean age, 24.25 ± 1.77 years) participated in four postural tasks with the eyes open, including the bilateral stance (BS), the unilateral stance without finger touch (USNT), and with finger touch in the medial–lateral direction (USML) and anterior–posterior direction (USAP). Meanwhile, the soleus H reflex, the pre-stimulus background activity of ankle antagonist pairs, and center of pressure (CoP) sway were measured. In reference to the BS, the USNT resulted in a significant stance effect on suppression of the soleus H reflex (H/M_max) associated with enhancement of CoP sway. Among the conditions of unilateral stance, there was a marked directional effect of finger touch on modulation of the H/M_max. A greater disinhibition of the H/M_max in consequence to light touch in the ML direction than in the AP direction was noted (H/M_max: USML > USAP > USNT). This directional modulation of the soleus H reflex concurred with haptic stabilization of posture in unilateral stance, showing a more pronounced reduction in CoP sway in the USML condition than in the USAP condition. However, alteration in postural sway and modulation of the soleus H reflex were not mutually correlated when stance pattern or touch vector varied. In conclusion, gating of the soleus H reflex indicated adaptation of an ankle strategy to stance pattern and haptic stabilization of posture. Relative to bilateral stance, postural maintenance in unilateral stance relied less on reflexive correction of the soleus. When finger touch was provided in line with prevailing postural threat in the lateral direction, postural stability in unilateral stance was better secured than finger touch in anterior–posterior direction, resulting in more pronounced disinhibition of the monosynaptic reflex pathway.     

Effect of hip and ankle muscle fatigue on unipedal postural control

Fatigue and deficits in postural control may predispose musculoskeletal injury. The purpose of this study was to examine the effects of fatigue at the hip and ankle during frontal plane movements on postural control during single-leg stance. Thirteen healthy volunteers completed two testing sessions 1 week apart consisting of isokinetic fatigue of the frontal plane movers of either the ankle or hip with measures of static unipedal postural control taken before and after fatigue. Postural control was assessed during three 30-s trials of unilateral stance with eyes open before and after the fatigue protocol at each testing session. Mean center of pressure (COP) excursion velocity in the sagittal and frontal planes was compared between pre- and post-fatigue across the two joints. Fatigue of the hip musculature led to postural control impairments in the frontal and sagittal planes, while fatigue of the ankle musculature did not significantly impair postural control in either plane. Our results suggest that there is a greater effect of localized fatigue of the frontal plane movers of the hip compared to the ankle on maintenance of a postural control in single-leg stance.     

A new method to analyze postural stability during a transition task from double-leg stance to single-leg stance

Time to stabilization (TTS) has been introduced as a method to analyze dynamic postural stability during jump and landing tasks, but has also been applied during the transition task from double-leg stance (DLS) to single-leg stance (SLS). However, the application of the originally described TTS technique during the latter task has some important limitations. The first goal of this study was to present an adapted version of the TTS technique to provide an effective alternative method to better analyze postural stability during the transition from DLS to SLS. The second goal was to study the influence of pathology and different speeds on postural stability outcomes. Fifteen healthy control subjects and 15 subjects with chronic ankle instability (CAI) performed the transition task on their preferred speed and as fast as possible, with eyes open and with eyes closed. Subjects with CAI performed the transition significantly slower when moving at their preferred speed with eyes closed. The time subjects needed to reach a new stability point was not discriminative between groups and largely dependent on movement speed. However, the amount of sway after this new stability point was significantly increased in the CAI group and when eyes were closed. The results of this study suggest that subjects with CAI have a decreased ability to overcome the postural perturbation created by the voluntary movement from DLS to SLS. Focusing only on TTS during the transition from DLS to SLS may lead at least in some cases to misinterpretations when assessing postural stability.