Time course and variability of tendinous vibration-induced postural reactions in forward and backward directions

Mechanical vibration of tendons induces large postural reactions (PR-VIB) but little is known about how these reactions vary within and between subjects. We investigated the intra- and inter-individual variability of PR-VIB and determined the reliability of center of pressure (COP) measures. Bipodal postural control (eyes closed) of 30 healthy adults were evaluated using a force platform under 02 conditions: bilateral VIB of the tibialis anterior (TA) and Achilles tendons (ACH-T) at 80 Hz. Each condition consisted of 03 trials of 30 s duration (Baseline: 10 s; VIB: 10 s; POST-VIB: 10 s). The Amplitude and Velocity of the COP in the antero-posterior/medio-lateral (AP/ML) directions were recorded and analyzed according to 5 time-windows incremented every 2 s of vibration (i.e. the first 2 s; 4 s; 6 s; 8 s & 10 s), whereas the COP position/AP was monitored every 0.5 s. All postural parameters increased significantly during TA and ACH-T vibration compared to the Baseline. The reliability of the COP measures showed good ICC scores (0.40-0.84) and measurement errors that varied depending on the duration of VIB time-windows. The COP position/AP reveals a lower intra- and inter-subject variability of PR-VIB in the first 2 s of VIB. The metrological characteristics of PR-VIB should be investigated further to guide their future use by clinicians and researchers.     

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.     

Standing on wedges modifies side-specific postural control in the presence of lateral external perturbations

Standing on wedges changes the position in the ankle joints and affects postural stability in the medial-lateral direction. The objective of the study was to investigate the role of wedges and external lateral perturbations on anticipatory (APA) and compensatory postural adjustments (CPA). Ten healthy young participants were exposed to perturbations applied to the lateral part of their right shoulder when standing on a planar surface, on a medial or lateral wedges. Bilateral electromyographic activity of dorsal and ventral postural muscles and the center of pressure (COP) displacement were recorded and analyzed during the APA and CPA phases. When exposed to the lateral perturbation, reciprocal activation of shank muscles was seen on the side of the perturbation while co-contraction of shank muscles was seen on the contralateral side during the APA and CPA phases. Standing on a wedge was associated with decreased magnitudes of co-contraction and reciprocal activation of shank muscles. The COP displacements were smaller in the APA phase and larger in the CPA phase while standing on wedges compared to standing on the planar surface. The outcome of the study provides a basis for future investigations of incorporating wedges in balance re-training paradigms for the elderly or individuals with neurological impairment.     

Effect of long-duration spaceflight on postural control during self-generated perturbations.

This report is the first systematic evaluation of the effects of prolonged weightlessness on the bipedal postural control processes during self-generated perturbations produced by voluntary upper limb movements. Spaceflight impacts humans in a variety of ways, one of which is compromised postflight postural control. We examined the neuromuscular activation characteristics and center of pressure (COP) motion associated with arm movement of eight subjects who experienced long-duration spaceflight (3--6 mo) aboard the Mir space station. Surface electromyography, arm acceleration, and COP motion were collected while astronauts performed rapid unilateral shoulder flexions before and after spaceflight. Subjects generally displayed compromised postural control after flight, as evidenced by modified COP peak-to-peak anterior-posterior and mediolateral excursion, and pathlength relative to preflight values. These changes were associated with disrupted neuromuscular activation characteristics, particularly after the completion of arm acceleration (i.e., when subjects were attempting to maintain upright posture in response to self-generated perturbations). These findings suggest that, although the subjects were able to assemble coordination modes that enabled them to generate rapid arm movements, the subtle control necessary to maintain bipedal equilibrium evident in their preflight performance is compromised after long-duration spaceflight.     

Synergistic co-activation in multi-directional postural control in humans

To examine the muscle synergies of multi-directional postural control, we calculated the target-directed variance fraction (η) and net action direction of each muscle using the electromyogram-weighted averaging (EWA) method. Subjects stood barefoot on a force platform and maintained their posture by producing a center of pressure (COP) in twelve target directions. Surface electromyograms were recorded from 6 right-sided muscles: tibialis anterior (TA), soleus (SOL), lateral gastrocnemius (LG), medial gastrocnemius (MG), fibularis longus (FL), and gluteus medius (GM). η was calculated from COP with duration of 20-s, during which the COP was relatively constant. The EWA method was applied to the EMG and the two COP components to estimate the net action direction of each muscle. The results showed that η values in all directions did not cross the 0.8 threshold. This suggests that human postural control is achieved by synergistic co-activation. The EWA revealed that the net action directions of TA, SOL, LG, MG, and GM were 277.6°, 71.1°, 87.7°, 94.0°, and 2.2°, respectively. This suggests that postural maintenance by muscle synergy can be attributed to the relevant muscles having various action directions. These results demonstrate that muscle synergies can be investigated using COP fluctuations.     

Early postural adjustments in preparation to whole-body voluntary sway

We studied postural adjustments associated with a quick voluntary postural sway under two conditions, self-paced and simple reaction-time. Standing subjects were required to produce quick discrete shifts of the center of pressure (COP) forward. About 400-500 ms prior to the instructed COP shift, there were deviations of the COP in the opposite direction (backwards) accompanied by changes in the activation levels of several postural muscles. Under the reaction-time conditions, the timing of those early postural adjustments did not change (repeated measures MANOVA: p > 0.05) while its magnitude increased significantly (confirmed by repeated measures MANOVA: p < 0.05). These observations are opposite to those reported for anticipatory postural adjustments under simple reaction time conditions (a significant change in the timing without major changes in the magnitude). We conclude that there are two types of feed-forward postural adjustments. Early postural adjustments prepare the body for the planned action and/or expected perturbation. Some of these preparatory actions may be mechanically necessary. Later, anticipatory postural adjustments generate net forces and moments of force acting against those associated with the expected perturbation. Both types of adjustments fit well the referent configuration hypothesis, which offers a unified view on movement-posture control.     

Trunk acceleration for neuroprosthetic control of standing: a pilot study

This pilot study investigated the potential of using trunk acceleration feedback control of center of pressure (COP) against postural disturbances with a standing neuroprosthesis following paralysis. Artificial neural networks (ANNs) were trained to use three-dimensional trunk acceleration as input to predict changes in COP for able-bodied subjects undergoing perturbations during bipedal stance. Correlation coefficients between ANN predictions and actual COP ranged from 0.67 to 0.77. An ANN trained across all subject-normalized data was used to drive feedback control of ankle muscle excitation levels for a computer model representing a standing neuroprosthesis user. Feedback control reduced average upper-body loading during perturbation onset and recovery by 42% and peak loading by 29% compared with optimal, constant excitation.     

Transfemoral amputee’s limit of stability and sway analysis during weight shifting exercise with a vibrotactile feedback system

Amputation in the transfemoral amputee (TFA) results in loss of sensory feedback of the amputated limb and therefore results in the poor postural stability. To assess the postural stability, the limit of stability (LOS) is a reliable parameter. In this study, we have investigated the effect of vibrotactile feedback (VF) on the LOS during the weight shifting exercise (WSE) for a TFA. The data of centre of pressure (COP) during WSE was collected from five TFA and five healthy individuals using a zebris force plate. The VF was provided on the amputated/healthy limb’s anterior and posterior part of the stump/thigh during forward and backward WSE, respectively. A customized foot insole with 24 embedded dielectric sensors was used to drive the vibratory motor. The effect of VF was analyzed by pre and post-test. Results show that with the use of VF, TFA significantly improved (t-test, p?<?.05) the sound limb’s LOS during forward WSE. Also, ANOVA analysis between WSE divisions shows that the prosthetic limb does not follow the path of WSE. We further examine the spectral power using the Welch method to determine the dominant sway frequency of COP. It shows a decreased frequency between 0.5–2?Hz in the healthy and decreased frequency between 0–0.5?Hz and >2?Hz in the amputee with VF. It concluded that VF could improve the LOS of TFA during WSE which ultimately leads to postural stability enhancement.     

Correlation between EMG and COP onset latency in response to a horizontal platform translation

This study examined the relationship between onset latencies estimates from EMG and center of pressure (COP) in young (five female, five male; mean=24.2+/-2.3 years) and older (six female, four male; 78.4+/-2.3 years) subjects during anterior or posterior platform translations. The latencies to onset of activity were estimated for the tibialis anterior (TA; mean=119.8 ms across both age groups) and COP (mean=139.7 ms across both groups) for anterior translations, and the soleus (SOL; mean=122.4 ms across both groups), gastrocnemius (GAS; mean=126.0 ms for young, and 115.9 ms for old subjects) and COP (mean=160.0 ms across both groups) for posterior translations. Average within-subject correlations (r') among these measures showed a high correlation between TA and COP onset latency (r'=0.667, young; r'=0.482, old), and relatively low correlations between the plantar flexors (SOL and GAS) and COP onset latencies (SOL: r'=0.292 for young, r'=0.249 for old; GAS: r'=0.126 for young, r'=0.143 for old). The SOL and GAS onset latencies correlated well with each other, especially in the older subjects (r'=0.762), suggesting that the contribution of two muscles creates some variability in the relationship with COP onset latency. The strong correlation between TA and COP for anterior perturbations, coupled with the weaker correlations for the plantar flexors suggest that the COP method may be preferable for studies interested in determining timing of postural responses to multidirectional perturbations.     

Predicting the dynamic postural control response from quiet-stance behavior in elderly adults

Human postural sway, as measured by fluctuations of the center of pressure (COP) under the feet of a quietly standing individual, can be characterized as a stochastic process. The fluctuation-dissipation theorem (FDT) provides a linear relationship between the fluctuations of a quasi-static, stochastic system to the same system's relaxation to equilibrium following a perturbation. We applied a similar linear relationship, based on the FDT, to the human postural control system to explore whether anterior-posterior (AP) fluctuations of the COP during quiet stance can be used to predict the AP response of the postural control system to a weak posteriorly directed mechanical perturbation (tug or pull at the waist). We tested 10 healthy elderly (mean age of 69yr) and 10 healthy young (mean age of 25yr) adult subjects. We found that this linear relationship was applicable to the postural control system of all 10 young and eight of the 10 elderly adult subjects. These results suggest that it is possible to predict an individual's dynamic response to a mild perturbation using quiet-stance data, regardless of age. The existence of this FDT-based linear relationship with respect to the human postural control system suggests that, for a given individual, the postural control system may use the same control mechanisms during quiet stance and mild-perturbation conditions, regardless of age.     

Large postural fluctuations but unchanged postural sway dynamics during tiptoe standing compared to quiet standing

The purpose of this study was to detect the characteristics of center of pressure (COP) movement during tiptoe standing (TS) compared to quiet standing (QS). Eight healthy subjects were asked to perform QS and TS on a force platform. During standing, surface electromyograms (EMGs) were recorded from the soleus (SOL), flexor hallucis brevis (FHB), medial gastrocnemius (MG), lateral gastrocnemius (LG), and tibialis anterior (TA) muscles. The path length and rectangular area of the COP trajectory were significantly larger during TS than during QS. In contrast, irrespective of standing condition, the scaling coefficients in the short and long regions were above and below 0.5, respectively. The coherence spectrum between the COP and EMG from the SOL and FHB muscles was statistically significant during TS at frequencies up to 17 Hz, while that for the QS was only significant below 1 Hz. In conclusion, the control of COP movement during TS was similar to that during QS despite large COP fluctuations during TS. Our results suggest that unstable posture during TS is compensated for by the activities of the SOL and FHB muscles, which enhance postural control.     

Effects of two passive back-support exoskeletons on postural balance during quiet stance and functional limits of stability

While occupational back-support exoskeletons (BSEs) are considered as potential workplace interventions, BSE use may compromise postural control. Thus, we investigated the effects of passive BSEs on postural balance during quiet upright stance and functional limits of stability. Twenty healthy adults completed trials of quiet upright stance with differing levels of difficulty (bipedal and unipedal stance; each with eyes open and closed), and executed maximal voluntary leans. Trials were done while wearing two different BSEs (SuitX™, Laevo™) and in a control (no-BSE) condition. BSE use significantly increased center-of-pressure (COP) median frequency and mean velocity during bipedal stance. In unipedal stance, using the Laevo™ was associated with a significant improvement in postural balance, especially among males, as indicated by smaller COP displacement and sway area, and a longer time to contact the stability boundary. BSE use may affect postural balance, through translation of the human + BSE center-of-mass, restricted motion, and added supportive torques. Furthermore, larger effects of BSEs on postural balance were evident among males. Future work should further investigate the gender-specificity of BSE effects on postural balance and consider the effects of BSEs on dynamic stability.     

Visual and proprioceptive contributions to postural control of upright stance in unilateral vestibulopathy

Preserving upright stance requires central integration of the sensory systems and appropriate motor output from the neuromuscular system to keep the centre of pressure (COP) within the base of support. Unilateral peripheral vestibular disorder (UPVD) causes diminished stance stability. The aim of this study was to determine the limits of stability and to examine the contribution of multiple sensory systems to upright standing in UPVD patients and healthy subjects. We hypothesized that closure of the eyes and Achilles tendon vibration during upright stance will augment the postural sway in UPVD patients more than in healthy subjects. Seventeen UPVD patients and 17 healthy subjects performed six tasks on a force plate: forwards and backwards leaning, to determine limits of stability, and upright standing with and without Achilles tendon vibration, each with eyes open and closed (with blackout glasses). The COP displacement of the patients was significantly greater in the vibration tasks than the controls and came closer to the posterior base of support boundary than the controls in all tasks. Achilles tendon vibration led to a distinctly more backward sway in both subject groups. Five of the patients could not complete the eyes closed with vibration task. Due to the greater reduction in stance stability when the proprioceptive, compared with the visual, sensory system was disturbed, we suggest that proprioception may be more important for maintaining upright stance than vision. UPVD patients, in particular, showed more difficulty in controlling postural stability in the posterior direction with visual and proprioceptive sensory disturbance.     

Alterations in evertor/invertor muscle activation and center of pressure trajectory in participants with functional ankle instability

Participants with ankle instability demonstrate more foot inversion during the stance phase of gait than able-bodied subjects. Invertor excitation, coupled with evertor inhibition may contribute to this potentially injurious position. The purpose of this experiment was to examine evertor/invertor muscle activation and foot COP trajectory during walking in participants with functional ankle instability (FI). Twelve subjects were identified with FI and matched to healthy controls. Tibialis anterior (TA) and peroneus longus (PL) electromyography (EMG), as well as COP, were recorded during walking. Functional analyses were used to detect differences between FI and control subjects with respect to normalized EMG and COP trajectory during walking. Relative to matched controls, COP trajectory was more laterally deviated in the FI group from 20% to 90% of the stance phase. TA activation was greater in the FI group from 15% to 30% and 45% to 70% of stance. PL activation was greater in the FI group at initial heel contact and toe off and trended lower from 20% to 40% of stance in the FI group. Altered motor strategies appear to contribute to COP deviations in FI participants and may increase the susceptibility to repeated ankle inversion injury.     

Time-to-boundary measures of postural control during single leg quiet standing

A novel approach to quantifying postural stability in single leg stance is assessment of time-to-boundary (TTB) of center of pressure (COP) excursions. TTB measures estimate the time required for the COP to reach the boundary of the base of support if it were to continue on its instantaneous trajectory and velocity, thus quantifying the spatiotemporal characteristics of postural control. Our purposes were to examine: (a) the intrasession reliability of TTB and traditional COP-based measures of postural control, and (b) the correlations between these measures. Twenty-four young women completed three 10-second trials of single-limb quiet standing on each limb. Traditional measures included mean velocity, standard deviation, and range of mediolateral (ML) and anterior-posterior (AP) COP excursions. TTB variables were the absolute minimum, mean of minimum samples, and standard deviation of minimum samples in the ML and AP directions. The intrasession reliability of TTB measures was comparable to traditional COP based measures. Correlations between TTB and traditional COP based measures were weaker than those within each category of measures, indicating that TTB measures capture different aspects of postural control than traditional measures. TTB measures provide a unique method of assessing spatiotemporal characteristics of postural control during single limb stance.     

Age and Muscle-Dependent Variations in Corticospinal Excitability during Standing Tasks

In this study, we investigated how modulation in corticospinal excitability elicited in the context of standing tasks varies as a function of age and between muscles. Changes in motor evoked potentials (MEPs) recorded in tibialis anterior (TA) and gastrocnemius lateralis (GL) were monitored while participants (young, n = 10; seniors, n = 11) either quietly stood (QS) or performed a heel raise (HR) task. In the later condition, transcranial magnetic stimulation (TMS) pulses were delivered at three specific time points during the task: 1) 250 ms before the “go” cue (preparatory (PREP) phase), 2) 100 ms before the heel rise (anticipatory postural adjustment (APA) phase), and 3) 200 ms after heel rise (execution (EXEC) phase). In each task and each phase, variations in MEP characteristics were analysed for age and muscle-dependent effects. Variations in silent period (SP) duration were also examined for certain phases (APA and EXEC). Our analysis revealed no major difference during QS, as participants exhibited very similar patterns of modulation in both TA and GL, irrespective of their age group. During the HR task, young adults exhibited a differential modulation in the PREP phase with enhanced responses in TA relative to GL, which was not seen in seniors. Finally, besides differences in MEP latency, age had little influence on MEP modulation during the APA and EXEC phases, where amplitude was largely a function of background muscle activity associated with each phase (i.e., APA: TA; EXEC: GL). No age or muscle effects were detected for SP measurements. Overall, our results revealed no major differences between young adults and healthy seniors in the ability to modulate corticospinal facilitation destined to ankle muscles during standing tasks, with maybe the exception of the ability to prime muscle synergies in the preparatory phase of action.     

The role of anticipatory postural adjustments in compensatory control of posture: 1. Electromyographic analysis

Anticipatory (APAs) and compensatory (CPAs) postural adjustments are the two principal mechanisms that the central nervous system uses to maintain equilibrium while standing. We studied the role of APAs in compensatory postural adjustments. Eight subjects were exposed to external predictable and unpredictable perturbations induced at the shoulder level, while standing with eyes open and closed. Electrical activity of leg and trunk muscles was recorded and analyzed during four epochs representing the time duration typical for anticipatory and compensatory postural control. No anticipatory activity of the trunk and leg muscles was seen in the case of unpredictable perturbations; instead, significant compensatory activation of muscles was observed. When the perturbations were predictable, strong anticipatory activation was seen in all the muscles: such APAs were associated with significantly smaller compensatory activity of muscles and COP displacements after the perturbations.The outcome of the study highlights the importance of APAs in control of posture and points out the existence of a relationship between the anticipatory and the compensatory components of postural control. It also suggests a possibility to enhance balance control by improving the APAs responses during external perturbations.     

Paraspinal muscle vibration alters dynamic motion of the trunk

Loss in dynamic stability of the low back has been identified as a potential factor in the etiology of low back injuries. A number of factors are important in the ability of a person to maintain an upright trunk posture including the preparatory stiffness of the trunk and the magnitude and timing of the neuromotor response. A neuromotor response requires appropriate sensing of joint motion. In this research, the role of this sensory ability in dynamic performance of the trunk was examined using a simple pendulum model of the trunk with neuromotor feedback. An increased sensory threshold was found to lead to increased torso flexion and increased delay in neuromotor response. This was confirmed experimentally using paraspinal muscle vibration which is known to alter proprioception of the muscle spindle organs. Before, during and after exposure to bilateral, paraspinal muscle vibration for 20 minutes, the dynamic response of subjects to an unexpected torso flexion load was examined. Subjects were found to have a 19.5% slower time to peak muscle activity and a 16.1% greater torso flexion during exposure to paraspinal muscle vibration. Torso flexion remained significantly increased after vibration exposure relative to before exposure. These results suggest that the neuromotor response plays an important role in trunk dynamics. Loss in sensitivity of the sensory system can have a detrimental effect on trunk dynamics, increasing delays in neuromotor response and increasing the motion of the trunk in response to an unexpected load.     

Study of age-related changes in postural control during quiet standing through Linear Discriminant Analysis

Background  

The human body adopts a number of strategies to maintain an upright position. The analysis of the human balance allows for the understanding and identification of such strategies. The displacement of the centre of pressure (COP) is a measure that has been successfully employed in studies regarding the postural control. Most of these investigations are related to the analysis of individuals suffering from neuromuscular disorders. Recent studies have shown that the elderly population is growing very fast in many countries all over the world, and therefore, researches that try to understand changes in this group are required. In this context, this study proposes the analysis of the postural control, measured by the displacement of the COP, in groups of young and elderly adults.