Dependence of joint stiffness on the conditions of visual control in upright undisturbed stance in humans

We recorded the sagittal and frontal components of the stabilogram of healthy humans in upright undisturbed stance under five conditions of visual control: (i) open eyes (OE); (ii) closed eyes (CE); (iii) visual inversion (VI); (iv) central vision (CV), and (v) diffused light (DL). Through a low-pass filter of trajectories of the center of pressure of feet (CPF), the vertical projection of the center of gravity (CG) and, consequently, the difference CPF-CG were estimated. The former represents the controlled variable, while the latter is proportional to the horizontal acceleration and assumed to express the resultant joint stiffness (mostly in the ankle joints). The stiffness was characterized through a method based on spectral analysis of the CPF-CG variable and subsequent calculations of the median frequency (MF) and the root mean square (RMS) of the spectra. The median frequencies of the spectra of the CPF-CG variable changed slightly under various visual conditions. At standing on a rigid support, they varied from 0.97 to 0.99 Hz and from 0.93 to 0.97 Hz for the CPF-CG, calculated from the sagittal and frontal components of the stabilogram, respectively. Under conditions of a pliable support, the corresponding frequencies varied within the limits of 0.79–0.83 Hz and 0.74–0.78 Hz. In contrast to the median frequencies, the RMSs demonstrated greater variability depending on different visual conditions. At standing on a rigid support, paired comparisons showed significant differences between the RMSs of the spectra of the CPF-CG variable of the sagittal direction under CE and OE conditions (0.14 ± 0.030 and 0.09 ± 0.020 mm, respectively) and under DL and OE conditions (0.130 ± ± 0.025 and 0.090 ± 0.020 mm, respectively). The RMS of the CPF-CG variable calculated for the frontal stabilogram differed significantly from each other for the VI and OE conditions (0.115 ± 0.020 and 0.075 ± ± 0.015 mm, respectively). In case of standing on a pliable support, a greater variability of visual influences on the CPF-CG variable was found. The RMS for its sagittal motion was the greatest under CE conditions (0.19 ± 0.03 mm); it was significantly greater than the respective values under OE, CV, and DL conditions (0.097 ± ± 0.020, 0.110 ± 0.020, and 0.140 ± 0.030 mm, respectively). The means of RMSs of the spectra of the frontal CPF-CG was also the greatest under CE conditions (0.20 ± 0.03 mm) and the smallest under OE conditions (0.095 ± 0.020 mm). In addition, the value of the RMS fluctuations under CE conditions (0.150 ± 0.025 mm) differed significantly from the respective values under OE conditions (0.095 ± 0.020 mm) and CV conditions (0.110 ± 0.020 mm). Thus, our findings support the statement that the influence of visual conditions on the maintenance of vertical stance is mediated (at least partially) by the mechanisms controlling the ankle joint stiffness. This regulation is mostly manifested in changes of a single parameter, the amplitude of fluctuations of the CPF-CG variable. We also found that the joint stiffness can be modulated by both nonspecific visual influences (which, in particular, reflect the perception of illumination) and specific visual influences, related to information on the position of the body and on its movements with respect to external objects. Neirofiziologiya/Neurophysiology, Vol. 38, No. 2, pp. 157–166, March–April, 2006.     

Maintenance of upright stance in humans in normal and virtual visual environments

We recorded in 16 healthy subjects the sagittal and frontal components of the stabilogram when standing on a rigid motionless or movable (oscillating) platform under four conditions of visual control: (i) open eyes, OE; (ii) closed eyes, CE; (iii) central vision, CV, and (iv) virtual visual environment, VVE. Under the latter condition, subjects observed the 3D image of a room, which was generated by the computer; the image was adhered to head movements in such a manner that a peculiar connection for normal visual conditions between movements of the head and displacements of the visible visual environment was reproduced. Through a low-pass filtration of a trajectory of the center of pressure of feet (CPF), two elementary variables were received, horizontal motions of the center of gravity (CG) and the difference between the CPF and the CG (CPF-CG). Changes in these variables (CG and CPF-CG) were estimated using spectral analysis and subsequent calculation of the median frequency (MF) and root mean square value (RMS) of the spectra. The MFs of the spectra of the investigated variables were approximately identical under conditions of standing on oscillating and motionless supports and showed no clear dependence on various visual conditions. Unlike MFs, the RMSs of the spectra of body sways appeared more dependent on changes of conditions of standing and the mode of visual control (differing from each other in the higher sensitivity to modifications of conditions of standing and visual control). With standing on the motionless support, the RMSs of the spectra of both variables were the greatest under VVE and CE conditions and the smallest under OE condition. The body oscillations were considerably amplified under conditions of standing on a movable support, and a different pattern of visual influences on the RMS of both investigated variables was revealed. The RMSs had the greatest value under CE condition and were much smaller (50–40%) under other visual conditions, including the VVE condition. Therefore, our findings show that, under VVE conditions, visual sensory afferentation is ignored by cerebral structures controlling postural adjustments if standing occurs on a motionless support but is effectively used at the maintenance of upright stance on an oscillating support. Neirofiziologiya/Neurophysiology, Vol. 39, No. 6, pp. 476–485, November–December, 2007.     

Ankle intrinsic stiffness changes with postural sway

In standing, the human body is inherently unstable and its stabilization requires constant regulation of ankle torque, generated by a combination of ankle intrinsic properties, peripheral reflexes, and central contributions. Ankle intrinsic stiffness, which quantifies the joint intrinsic properties, has been usually assumed constant in standing; however, there is strong evidence that it is highly dependent on the joint torque, which changes significantly with sway in stance. In this study, we examined how ankle intrinsic stiffness changes with postural sway during standing. Ten subjects stood on a standing apparatus, while subjected to pulse perturbations of ankle position. The mean torque of a short period before the start of each pulse was used as a measure of background torque. Responses with similar background torques were grouped together and used to estimate the parameters of an intrinsic stiffness model. Stiffness estimates were normalized to the critical stiffness and the background torque was transformed to the center of pressure location. We found that in most subjects, the normalized stiffness increased linearly with the movement of center of pressure towards the toes, with an average slope of 2.11 ± 0.80 1/m·rad. This modulation of ankle intrinsic stiffness seems functionally appropriate, since the intrinsic stiffness increases quickly, as the center of pressure moves toward the toes and the limits of stability. These large changes of ankle intrinsic stiffness with postural sway must be incorporated in any model of stance 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.     

Effects of Manipulations with Visual Feedback on Postural Responses in Humans Maintaining an Upright Stance

We studied postural reactions evoked by vibrational stimulation of the anterior tibial and posterior neck muscles under three different conditions of visual control (in a darkened room): (i) upon standing with the eyes open, EO, with perception of a stationary 2D image of the visual environment on the screen, (ii) under conditions of perception of a 3D virtual visual environment, VVE, and (iii) upon standing with the eyes closed, EC. Vibrational stimulation of both muscle groups evoked forward inclinations of the body; average values of the latter under control conditions (EC) were close to each other. The VVE mimicking a real visual environment possessed two planes, a mobile foreground one, whose shifts were programmed in such a manner that they correlated with oscillations of the body, and a stable background one. The tested subjects were asked to use the latter as a visual reference. Under VVE conditions, the amplitude of postural reactions depended on the feedback coefficient between the body movements and shifts of the VVE foreground and the direction of this feedback (its synphase or antiphase, sph or aph, mode). Postural responses at the feedback sph direction became greater with increase in the feedback coefficient (i.e., with increases in the magnitude of shifts of the VVE foreground) and reached values typical of standing under EC conditions. In the case of the aph type of feedback, the responses changed insignificantly. If the lowest feedback coefficient, 1.0, was used, the postural responses tended to decrease, as compared with those under EO conditions. The difference between the values observed at the sph and aph types of feedback with similar coefficients was manifested more intensely in the case of stimulation of the neck muscles. This fact shows that postural reactions triggered by afferent signals from the neck muscles depend more considerably on the ongoing visual afferentation.     

Postural Responses Evoked by Vibrational Stimulation of the Shin Muscles under Conditions of Virtual Visual Environment

We studied the effects of unexpected shifts of the visually perceived artificial surroundings (virtual visual environment, VVE) on postural reactions evoked by vibrational stimulation of proprioceptors of the shin muscles; tests were performed in a standing position of the subject. The VVE possessed two planes, a mobile foreground, whose displacements correlated with oscillations of the body, and a stationary background. The subjects were asked to use the latter as a reference system in corrections of the posture. The VVE parameters were controlled by a computer; shifts of the VVE foreground were combined with similar, in their duration and profile, stimulation-evoked displacements of the body. Despite the fact that the subjects had a possibility to use the stationary background as the reference system, the magnitudes of the evoked postural responses under conditions of perception of the VVE significantly exceeded the respective magnitudes upon standing with the eyes open in front of a completely stationary visual image. Postural responses progressively increased with increases in relative values of the shifts of the VVE foreground but always remained smaller than the responses under conditions of testing with the eyes closed. Augmentation of the postural responses at a synphase pattern of interrelations between the body movements and VVE shifts was more significant than at antiphase relations. Thus, shifts of the VVE foreground, on the one hand, destabilized the maintenance of the vertical posture, which resulted in intensification of the postural responses. On the other hand, such shifts allowed the subject to use them as feedback signals and to modulate the magnitude of postural responses when there was a change in the direction of interrelations between the body movements and the perceived visual image.     

Influence of passive tactile contact of arms on the maintenance of upright posture in humans

The influence of light passive contact of the forearm with a pliable external object (flexible plate) on the maintenance of upright posture was studied in healthy subjects in several conditions, with the eyes closed and on immersion in a virtual visual environment (VVE). The visual environment was either stable or unstable as a result of a synphase (SP) or antiphase (AP) association between the environment and body sway. The posture maintenance analysis focused on estimating the amplitude and frequency characteristics of two elementary variables, which were calculated from the foot center of pressure (CoP) trajectories in the mediolateral and anteroposterior directions. The variables were trajectory of the vertical projection of the center of gravity (variable CG) and difference between the CoP and CG trajectories (variable CoP–CG). In both the absence and presence of passive tactile contact, the root mean square (RMS) values of the oscillation spectra of the two variables were the lowest in the stable visual environment and in the case of the antiphase association of the environment with body sways and the highest in the cases of the synphase association and standing with the eyes closed. Passive contact decreased body sways in both directions, and the RMSs of the spectra of the two variables decreased in all visual conditions. A greater decrease in RMS was observed for the CG variable. Body sways changed not only in amplitude, but also in frequency. Tactile contact increased the median frequencies (MFs) of the CG variable spectra calculated from the anteroposterior and mediolateral body sways. In contrast, a significant increase in MFs calculated for the CoP–CG variable was observed only for anteroposterior body sways. The results showed that passive contact of a forearm with a pliable external object, which does not provide a mechanical support for the subject, significantly improves the maintenance of the upright posture even in an unstable visual environment.     

Spectral analysis of the human body sway during standing on firm and compliant surfaces under different visual conditions

Effects of different visual conditions on the vertical posture maintenance were compared in subjects standing on a firm or compliant surface. These visual conditions included a motionless visual environment (MVE), eyes-closed condition (EC), and a virtual visual environment (VVE). The VVE consisted of two planes: the foreground and background. The foreground displayed a room window with adjacent walls, and the background was represented by an aqueduct with the adjacent landscape. The VVE was destabilized by inducing either the cophased or the antiphased relation between the foreground of the visual scene and the body sway. We evaluated changes in the amplitude spectra of two elementary variables calculated from the trajectories of the plantar center of pressure (CoP) displacements in the anteroposterior and lateral directions, namely, the trajectories for the center of gravity projections on the support (the CG variable) and the differences between the CoP and CG trajectories (the CoP–CG variable).The CG trajectory was considered as a controlled variable, and the difference between the CoP and CG trajectories were considered as a variable related to the body acceleration and reflecting changes in the resultant stiffness in ankle joints. The rootmean-square (RMS) values for the spectra of both variables calculated from the body sway in the anteroposterior direction in standing on a firm support decreased proportionately with antiphased relation between the foreground and the body sway and increased with the cophased relation, compared with the RMS calculated for the MVE conditions. RMS for the spectra of the CG variable in the cophased relation were nearly the same, as in standing with eyes closed (EC), while the RMS for the spectra of the CoP–CG variable were significantly less than with EC. The body sway during standing on a compliant support significantly increased in both the anteroposterior and the lateral directions under all visual conditions. RMS for the spectra of both variables with EC increased considerably higher than in the cophased relation. Furthermore, the RMS for the spectra of the CG variable calculated from the body sway in the lateral direction on a compliant support was substantially higher in the antiphased relation than in the cophased relation, whereas the RMS for the spectra of the CoP–CG variable under both conditions had similar values. The analysis of body sway and the results under some visual conditions have shown that the amplitude characteristics of the CG and CoP–CG variables changed not always proportionately with the passage from standing on a firm support to a compliant support. It is suggested that the found disproportion of changes in these two variables is probably associated with the contribution of another additional factor to the process of postural control, the passive elastic component of musculo-articular stiffness generated by fascial-tendon tissues.     

Relative contribution of the pressure variations under the feet and body weight distribution over both legs in the control of upright stance

The resultant centre of pressure (CP(Res)) trajectories are aimed at controlling body movements in upright stance. When standing on two legs, these trajectories are generated by exerting reaction forces under each foot and by loading-unloading mechanisms intervening at the hip level. To assess the respective contribution of each of these factors in stance maintenance, a group of healthy individuals were tested in several conditions including standing quietly and voluntarily producing under each foot larger CP displacements in phase and in opposite phase along medio-lateral (ML) and antero-posterior (AP) axes. The results, based on the computation of coefficients of correlation between CP(Res) trajectories and various time series including the relative body weight applied to one leg and plantar CP trajectories, highlight some differences according to the axes along which the displacements take place and the amplitudes of the movements. Furthermore, the comparison of the CP(Res) trajectories resulting from each one of these two factors reveals the predominant role played by the loading-unloading mechanisms intervening at the hip level for the movements along the ML axis and those of the plantar CP displacements along the AP axis. Increasing the plantar CP displacements in phase or in opposite phase substantially modifies these contributions although without inferring a shift to the benefit of the other mechanism. The specific morphology of the ankle and hip joints implicated in this postural task plainly explains this postural control organisation. In particular, the link between the segmental configuration of the lower limbs and these mechanisms are discussed.     

The effect of plantar flexor muscle fatigue on postural control

Objective

Previous studies have demonstrated that ankle muscle fatigue alters postural sway. Our aim was to better understand postural control mechanisms during upright stance following plantar flexor fatigue.

Method

Ten healthy young volunteers, 25.7 ± 2.2 years old, were recruited. Foot center-of-pressure (CoP) displacement data were collected during narrow base upright stance and eyes closed (i.e. blindfolded) conditions. Subjects were instructed to stand upright and as still as possible on a force platform under five test conditions: (1) non-fatigue standing on firm surface; (2) non-fatigue standing on foam; (3) ankle plantar flexor fatigue, standing on firm surface; (4) ankle plantar flexor fatigue, standing on foam; and (5) upper limb fatigue, standing on firm surface. An average of the ten 30-s trials in each of five test conditions was calculated to assess the mean differences between the trials. Traditional measures of postural stability and stabilogram-diffusion analysis (SDA) parameters were analyzed.

Results

Traditional center of pressure parameters were affected by plantar flexor fatigue, especially in the AP direction. For the SDA parameters, plantar flexor fatigue caused significantly higher short-term diffusion coefficients, and critical displacement in both mediolateral (ML) and anteroposterior (AP) directions. Long-term postural sway was different only in the AP direction.

Conclusions

Localized plantar flexor fatigue caused impairment to postural control mainly in the Sagittal plane. The findings indicate that postural corrections, on average, occurred at a higher threshold of sway during plantar flexor fatigue compared to non-fatigue conditions.     

The Degrees of Freedom Problem in Human Standing Posture: Collective and Component Dynamics

The experiment was setup to investigate the coordination and control of the degrees of freedom (DFs) of human standing posture with particular reference to the identification of the collective and component variables. Subjects stood in 3 postural tasks: feet side by side, single left foot quiet stance and single left foot stance with body rocking at the ankle joint in the sagittal plane. All three postural tasks showed very high coherence (∼1) of center of pressure (COP) - center of mass (COM) in the low frequency range. The ankle and hip coherence was mid range (∼.5) with the tasks having different ankle/hip compensatory cophase patterns. The findings support the view that the in-phase relation of the low frequency components of the COP-COM dynamic is the collective variable in the postural tasks investigated. The motions of the individual joints (ankle, knee, hip, neck) and couplings of pair wise joint synergies (e.g., ankle-hip) provide a supporting cooperative role to the preservation of the collective variable in maintaining the COM within the stability region of the base of support (BOS) and minimizing the amount of body motion consistent with the task constraint.     

Influence of an asymmetrical body weight distribution on the control of undisturbed upright stance

Postural asymmetry in humans is generally associated with different pathologies. However, its specific influence on undisturbed upright stance is poorly understood. To evaluate its separate effects on each support, the centre of pressure (CP) displacements were recorded through two force platforms. In a second step, the complex resultant centre of pressure trajectories (CP(Res)) were computed and decomposed into two elementary components: the horizontal displacements of the centre of gravity (CG(h)) and the difference in the plane of support between the vertical projection of CG(h) and CP(Res) (CP-CG(v)). These motions were then processed through a frequency analysis and modelled as fractional Brownian motion to gain some additional insight into their spatio-temporal organisation. Ten healthy adults were tested in three conditions consisting of various weight distributions. The quality of the mechanism involved in the control of the unloaded support CP motions appears to decrease as the asymmetry becomes more pronounced. To be precise, larger increases of the CP displacements are observed for the unloaded support compared to the loaded one. As a result, the CP(Res) motions are themselves augmented in the ML direction, inducing in turn larger CG(h) and CP-CG(v) motions. Postural asymmetry thus constitutes an important constraint on the control of upright undisturbed stance by generating changes in the control of both supports and by reducing the efficiency of the hip load/unload mechanisms. On the other hand, by inducing larger body sways, postural asymmetry necessitates higher energy expenditure and the setting of particular control mechanisms.     

Lower extremity corrective reactions to slip events.

A significant number of injuries in the workplace is attributed to slips and falls. Biomechanical responses to actual slip events determine whether the outcome of a slip will be recovery or a fall. The goal of this study was to examine lower extremity joint moments and postural adjustments for experimental evidence of corrective strategies evoked during slipping in an attempt to prevent falling. Sixteen subjects walked onto a possibly oily vinyl tile floor, while ground reaction forces and body motion were recorded at 350 Hz. The onset of corrective reactions by the body in an attempt to recover from slips became evident at about 25% of stance and continued until about 45% into stance, i.e. on average between 190 and 350 ms after heel contact. These reactions included increased flexion moment at the knee and extensor activity at the hip. The ankle, on the other hand, acted as a passive joint (no net moment) during fall trials. Joint kinematics showed increased knee flexion and forward rotation of the shank in an attempt to bring the foot back towards the body. Once again, the ankle kinematics appeared to play a less dominant role (compared to the knee) in recovery attempts. This study indicates that humans generate corrective reactions to slips that are different than previously reported responses to standing perturbations translating the supporting surface.     

Simulating mechanical consequences of voluntary movement upon whole-body equilibrium: the arm-raising paradigm revisited

Voluntary arm-raising movement performed during the upright human stance position imposes a perturbation to an already unstable bipedal posture characterised by a high body centre of mass (CoM). Inertial forces due to arm acceleration and displacement of the CoM of the arm which alters the CoM position of the whole body represent the two sources of disequilibrium. A current model of postural control explains equilibrium maintenance through the action of anticipatory postural adjustments (APAs) that would offset any destabilising effect of the voluntary movement. The purpose of this paper was to quantify, using computer simulation, the postural perturbation due to arm raising movement. The model incorporated four links, with shoulder, hip, knee and ankle joints constrained by linear viscoelastic elements. The input of the model was a torque applied at the shoulder joint. The simulation described mechanical consequences of the arm-raising movement for different initial conditions. The variables tested were arm inertia, the presence or not of gravity field, the initial standing position and arm movement direction. Simulations showed that the mechanical effect of arm-raising movement was mainly local, that is to say at the level of trunk and lower limbs and produced a slight forward displacement of the CoM (1.5 mm). Backward arm-raising movement had the same effect on the CoM displacement as the forward arm-raising movement. When the mass of the arm was increased, trunk rotation increased producing a CoM displacement in the opposite direction when compared to arm movement performed without load. Postural disturbance was minimised for an initial standing posture with the CoM vertical projection corresponding to the ankle joint axis of rotation. When the model was reduced to two degrees of freedom (ankle and shoulder joints only) the postural perturbation due to arm-raising movement increased compared to the four-joints model. On the basis of these results the classical assumption that APAs stabilise the CoM is challenged.     

How experienced alpine-skiers cope with restrictions of ankle degrees-of-freedom when wearing ski-boots in postural exercises

The present study investigates the mechanisms underlying changes in postural strategy that occur to compensate for mechanical ankle joint restrictions induced by wearing ski-boots during postural exercises. Fourteen experienced skiers were asked to stand as still as possible in a stable (STA) posture and in 2 postures with instability in the medio/lateral and antero/posterior (ML and AP postures) direction. Postural tasks were performed with eyes open or closed and while wearing or not wearing ski-boots. The electromyographic (EMG) activity of representative lower limb muscles and positions of centre-of-foot pressure (COP) were recorded and analyzed. Our results illustrated enhanced postural performances with ski-boots in the STA posture, whereas postural performances remained unchanged when wearing ski-boots in the ML and AP postures. Analysis of COP sways in the frequency domain did not illustrate any modification in the contribution of different neuronal loops when the study subjects wore ski-boots. EMG showed that the mechanical effects of wearing ski-boots were compensated by changes in postural strategy through the reorganization of muscle coordination, made possible by inherent redundancies in the human body. The preservation of postural performances, despite restrictions of ankle degrees-of-freedom induced by ski-boots, emphasizes the subjects’ capacity to exploit the additional support provided by ski-boots by adequately adjusting muscle coordination to control posture in different balance conditions.     

Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance

In order to determine the type of somatosensory information for postural control that is most affected by neuropathy, we compared the relative effects of three methods of sway-referencing the surface in a group of subjects with profound loss of somatosensory function associated with sensory polyneuropathy from diabetes with age-matched control subjects. Sway-referencing disrupted somatosensory feedback for postural control by servo-controlling the dorsi- and plantar-flexion rotation of the support surface in proportion to anterior-posterior excursion of (1) ankle angle, (2) center of body mass (CoM) angle or (3) filtered center of pressure (CoP). Postural sway in subjects with somatosensory loss was significantly larger than normal on a firm surface but not on the sway-referenced surfaces, suggesting that sway-referencing disrupts somatosensory information for postural control already disrupted by neuropathy. Control subjects standing on any sway-referenced surface swayed significantly more than neuropathy subjects who stood on a firm surface, suggesting that sway-referencing disrupts more somatosensory information than disrupted by severe neuropathy. CoP sway-referencing was less sensitive than ankle or CoM sway-referencing for distinguishing postural sway in subjects with somatosensory loss from age-matched control subjects. Given that filtered CoP sway-referencing disrupts the ability to utilize somatosensory information related to surface reactive force to a greater extent than the other two methods of sway-referencing, then these results support the hypothesis that subjects with diabetic peripheral neuropathy have lost more CoP information, than ankle or CoM angle information, for controlling postural sway in stance.     

Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance

In order to determine the type of somatosensory information for postural control that is most affected by neuropathy, we compared the relative effects of three methods of sway-referencing the surface in a group of subjects with profound loss of somatosensory function associated with sensory polyneuropathy from diabetes with age-matched control subjects. Sway-referencing disrupted somatosensory feedback for postural control by servo-controlling the dorsi- and plantar-flexion rotation of the support surface in proportion to anterior-posterior excursion of (1) ankle angle, (2) center of body mass (CoM) angle or (3) filtered center of pressure (CoP). Postural sway in subjects with somatosensory loss was significantly larger than normal on a firm surface but not on the sway-referenced surfaces, suggesting that sway-referencing disrupts somatosensory information for postural control already disrupted by neuropathy. Control subjects standing on any sway-referenced surface swayed significantly more than neuropathy subjects who stood on a firm surface, suggesting that sway-referencing disrupts more somatosensory information than disrupted by severe neuropathy. CoP sway-referencing was less sensitive than ankle or CoM sway-referencing for distinguishing postural sway in subjects with somatosensory loss from age-matched control subjects. Given that filtered CoP sway-referencing disrupts the ability to utilize somatosensory information related to surface reactive force to a greater extent than the other two methods of sway-referencing, then these results support the hypothesis that subjects with diabetic peripheral neuropathy have lost more CoP information, than ankle or CoM angle information, for controlling postural sway in stance.     

Effects of Near-Threshold Stimulation of the Vestibular Apparatus on Postural Responses Evoked by Displacements of the Visualized Surrounding

In healthy subjects in the relaxed upward stance and perceiving a virtual visual environment (VVE), we recorded postural reactions to isolated visual and vestibular stimulations or their combinations. Lateral displacements of the visualized virtual scene were used as visual stimuli. The vestibular apparatus was stimulated by application of near-threshold galvanic current pulses to the proc. mastoidei of the temporal bones. Isolated VVE shifts evoked mild, nonetheless clear, body tilts readily distinguished in separate trials; at the same time, postural effects of isolated vestibular stimulation could be detected only after averaging of several trials synchronized with respect to the beginning of stimulation. Under conditions of simultaneous combined presentation of visual and vestibular stimuli, the direction of the resulting postural responses always corresponded to the direction of responses induced by VVE shifts. The contribution of an afferent volley from the vestibular organ depended on the coincidence/mismatch of the direction of motor response evoked by such a volley with the direction of response to visual stimulation. When both types of stimulations evoked unidirectional body tilts, postural responses were facilitated, and the resulting effect was greater than that of simple summation of the reactions to isolated actions of the above stimuli. In the case where isolated galvanic stimulation evoked a response opposite with respect to that induced by visual stimulation, the combined action of these stimuli of different modalities evoked postural responses identical in their magnitude, direction, and shape to those evoked by isolated visual stimulation. The above findings allow us to conclude that the effects of visual afferent input on the vertical posture under conditions of our experiments clearly dominate. In general, these results confirm the statement that neuronal structures involved in integrative processing of different afferent volleys preferably select certain type of afferentation carrying more significant or more detailed information on displacements (including oscillations) of the body in space.     

Effects of repeated ankle plantar-flexions on H-reflex and body sway during standing

The study investigated relations between effects of repeated ankle plantar-flexion movements exercise on the soleus Hoffmann (H) reflex and on postural body sway when maintaining upright stance. Ten young volunteers performed five sets of ankle plantar-flexions of both lower limbs. Assessment of the feet centre-of-pressure (COP) displacement and H-reflex tests were carried out in quiet stance before, during and after the exercise. H-max and M-max responses were obtained in 8 subjects and reported as the peak-to-peak amplitudes of the right soleus muscle electromyographic waves. Mean dispersion of COP along the antero-posterior direction increased significantly during the exercise; whilst the overall H-reflex response indicated a reduction without a concomitant modification in the M-max response. H-reflex responses, however, varied between participants during the first sets of exercise, showing two main trends of modulation: either depression or early facilitation followed by reduction of the H-reflex amplitude. The extent of reflex modulation in standing position was correlated to the concentric work performed during the exercise (r = 0.85; p < 0.01), but not to the antero-posterior COP dispersion. These results suggest that during a repeated ankle plantar-flexions exercise, modulation of the H-reflex measured in upright stance differs across individuals and is not related to changes of postural sway.     

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.