Pelvis morphology, trunk posture and standing imbalance and their relations to the Cobb angle in moderate and severe untreated AIS

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27°) and severe (more than 27°) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27°. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.     

Types of body posture and their characteristics in boys 10 to 13 years of age

The main goal of the study was to determine the types of body posture of boys (n = 273), 10 to 13 years of age, by means of the body posture assessment method based on the software Posture Image Analyzer. The results should enable better understanding of postural issues, as well as timely and more precise selection of kinesitherapeutic procedures. Values of 5 front view and 4 sagittal view indicators of standing body posture were measured by means of subjects' photographs and software Image Posture Analyzer Cluster analysis (K-means method) revealed three types of body posture in both the anterior and sagittal plane. Their characteristics were determined with discriminant analysis. In sagittal indicators three posture types are recognizable: (a) correct sagittal body posture (29.3%), (b) mild impaired sagittal body posture (41.8%), (c) marked impaired sagittal body posture (28.9%). In anterior indicators also three posture types are recognizable: (a) correct anterior body posture (19.4%), (b) mild scoliotic body posture in the lumbar region (47.6%), (c) mild scoliotic body posture with double curvature (33%).     

Truncal changes in children with mild limb length inequality: a surface topography study

Background

Limb length Inequality (LLI) in children and adults may affect posture, gait, and several truncal parameters, and it can cause spinal scoliosis. In literature, however, there is a paucity of assessment of truncal and spinal changes due to mild LLI in children. This report presents children with LLI, and it aims to provide information in pelvic imbalance, spinal posture, and scoliotic curve, using surface topography analysis which is a novel methodological approach for this condition.

Study design

This is an ongoing prospective research study on patient series suffering LLI.

Material and method

Twenty children, attending the Scoliosis Clinic of the department, 7 boys, 13 girls, 9–15?years old, range 7.5–15, mean 15.5?years, having mild LLI, were assessed. The LLI was 0.5 to 2?cm, mean 1.2?cm. There was not any post-traumatic LLI. We evaluated the LLI in correlation to pelvic and spinal posture parameters. The 4D Formetric DIERS apparatus (4DF) was used for the surface topography assessment. The following were assessed: in the coronal plane, the coronal imbalance, the pelvic obliquity, the lateral deviation, and the 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, the 4DF kyphotic angle, the kyphotic apex, the 4DF lordotic angle, the lordotic apex, the pelvic tilt, and the trunk inclination; and in the transverse plane, the pelvis rotation, the pelvic torsion, the surface rotation, and the 4DF vertebral rotation. LLI was measured using a tape. The data were statistically analyzed, and reliability study for the LLI was also performed.

Results/discussion

The LLI was statistically significantly correlated to the 4DF reading of pelvis rotation, pelvic tilt (pelvic obliquity), and surface rotation. The scoliometer readings (angle trunk rotation ATR or trunk inclination ATI) in the lumbar region were statistically significantly correlated to the 4DF readings of pelvic tilt (pelvic obliquity). The normally symmetric truncal parameters were also statistically significantly changed (all these deviating from the line of gravity through the vertebral prominence). Interestingly, LLI was not correlated to the scoliosis angle and the scoliometer reading at the lumbar level.The following 4DF readings are presented: in the coronal plane, the coronal imbalance, pelvic obliquity, lateral deviation, and 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, kyphotic angle, kyphotic apex, lordotic angle, lordotic apex, pelvic tilt, and trunk inclination; and in the transverse plane, the pelvic rotation, pelvic torsion, surface rotation, and vertebral rotation.

Conclusions

Previous studies have reported the results after simulation of LLI in order to evaluate the effects on the pelvic balance and spinal posture parameters. This report is not a LLI simulation study but it presents the effects of mild LLI on truncal changes in the main cardinal planes in children suffering LLI. These changes undoubtedly affect not only the standing truncal posture but also the gait’s economy as well.As mild LLI affects the pelvic balance and spinal posture parameters, our therapeutic approach is that mild LLI (less than 2.0?cm) has to be corrected using shoe elevation, in order to equalize the pelvic obliquity and, consequently, the spinal posture parameters.

     

Postural kinematics of trumpet playing

This paper examines the effects of anthropometry on body posture of trumpeters playing in standing position. Sixteen virtuosi trumpeters were photographed while hitting three notes (low C, high F and high F sustained) during performance of musical tasks. Initial standing posture and anthropometric data were recorded. Six body segment angles were computed and a vectorial sum was obtained to describe whole body posture in neutral and playing conditions. Horn angle and dental overbite were also computed. Earlier results showed that the musical task has no effect on playing posture. One-way ANOVA showed notable differences between the neutral posture and the note-related playing postures. A multiple regression model showed that in addition to the note effect, anthropometric variables, mainly neck length, explain the changes in playing posture. Horn angle is determined by the dental overbite. The importance of the anthropometric variables in playing the more demanding notes indicate that anthropometry may act to constrain trumpeters' performance.     

Relations of the morphological characteristic latent structure and body posture indicators in children aged seven to nine years

With the aim of determining the connection between the indicators of body posture and latent structure of morphological variables in children aged 7 and 8 years, first and second grade of primary school, a set of 17 morphological measures and 12 body posture indicators were longitudinally applied to a sample of 110 boys and 114 girls. The latent structure of morphological variables in both sexes was defined by three factors but at a different order of significance: in boys, the order was longitudinal dimensionality, voluminosity, mass and subcutaneous fat tissue and transverse dimensionality, whereas in girls the order was voluminosity, mass and subcutaneous fat tissue, longitudinal dimensionality and transverse dimensionality. The latent structure of torax body posture indicator was defined by two factors, the status of body posture of the rear part of the thorax, and status of the body posture of the front part of the thorax. The results obtained by canonical correlation analysis between predictive variables, morphological latent structure and criterion variables, latent structure of thorax body posture indicators with two posture indicators of the chest and one of the foot status, showed two important pairs of canonical roots on each measurement, suggesting a significant association between these two sets of parameters.     

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

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

Head posture and craniofacial morphology

The associations between craniofacial morphology and the posture of the head and the cervical column were examined in a sample of 120 Danish male students aged 22–30 years. Two head positions were recorded on lateral cephalometric radiographs, one determined by the subject's own feeling of a natural head balance (self balance position), and the other by the subject looking straight into a mirror (mirror position). Craniofacial morphology was described by 42 linear and angular variables, and postural relationships by 18 angular variables. A comprehensive set of correlations was found between craniofacial morphology and head posture. The correlations were similar for both head positions investigated. Of the postural variables, the position of the head in relation to the cervical column showed the largest set of correlations with craniofacial morphology. Extension of the head in relation to the cervical column was found in connection with large anterior and small posterior facial heights, small antero-posterior craniofacial dimensions, large inclination of the mandible to the anterior cranial base and to the nasal plane, facial retrognathism, a large cranial base angle, and a small nasopharyngeal space. The possible role of functional factors in mediating the relationship between morphology and posture was discussed.     

Gait Pattern Differences between Children with Mild Scoliosis and Children with Unilateral Cerebral Palsy

This study was conducted to investigate the effects of asymmetrical body posture alone, i.e., the effects seen in children with mild scoliosis, vs. the effects of body posture control impairment, i.e., those seen in children with unilateral cerebral palsy on gait patterns. Three-dimensional instrumented gait analysis (3DGA) was conducted in 45 children with hemiplegia and 51 children with mild scoliosis. All the children were able to walk without assistance devices. A set of 35 selected spatiotemporal gait and kinematics parameters were evaluated when subjects walked on a treadmill. A cluster analysis revealed 3 different gait patterns: a scoliotic gait pattern and 2 different hemiplegic gait patterns. The results showed that the discrepancy in gait patterns was not simply a lower limb kinematic deviation in the sagittal plane, as expected. Additional altered kinematics, such as pelvic misorientation in the coronal plane in both the stance and swing phases and inadequate stance phase hip ad/abduction, which resulted from postural pattern features, were distinguished between the 3 gait patterns. Our study provides evidence for a strong correlation between postural and gait patterns in children with unilateral cerebral palsy. Information on differences in gait patterns may be used to improve the guidelines for early therapy for children with hemiplegia before abnormal gait patterns are fully established. The gait pathology characteristic of scoliotic children is a potential new direction for treating scoliosis that complements the standard posture and walking control therapy exercises with the use of biofeedback.     

Muscle synergies reveal impaired trunk muscle coordination strategies in individuals with thoracic spinal cord injury

Spinal cord injury (SCI) can result in paralysis of trunk muscles, which can affect sitting balance. The objective of this study was to analyze trunk muscle coordination of individuals with thoracic SCI and compare it to able-body individuals. A total of 27 individuals were recruited and subdivided into: (a) high thoracic SCI; (b) low thoracic SCI; and (c) able-body groups. Participants were seated and asked to lean their trunk in eight directions while trunk muscle activity was recorded. Muscle coordination was assessed using the non-negative matrix factorization (NMF) method to extract muscle modules, which are the synergistic trunk muscle activations, and their directional activation patterns. Our results showed that individuals with SCI used less muscle modules, more co-contractions, and less directional tuning, compared to able-bodied people. These results suggest impaired and simplified muscle coordination due to the loss of supraspinal input after SCI. Observed variability in muscle coordination within SCI groups also suggests that other mechanisms such as spasticity and muscle stretch reflexes or individual factors such as experience and training contributed to the postural muscle synergies. Overall, muscle coordination deficits revealed impaired neuromuscular strategies which provide implications for rehabilitation of trunk muscles during sitting balance after SCI.     

Trunk response to sudden forward perturbations – Effects of preload and sudden load magnitudes,posture and abdominal antagonistic activation

Unexpected loading of the spine is a risk factor for low back pain. The trunk neuromuscular and kinematics responses are likely influenced by the perturbation itself as well as initial trunk conditions. The effect of four parameters (preload, sudden load, initial trunk flexed posture, initial abdominal antagonistic activity) on trunk kinematics and back muscles reflex response were evaluated. Twelve asymptomatic subjects participated in sudden forward perturbation tests under six distinct conditions. Preload did not change the reflexive response of back muscles and the trunk displacement; while peak trunk velocity and acceleration as well as the relative load peak decreased. Sudden load increased reflex response of muscles, trunk kinematics and loading variables. When the trunk was initially flexed, back muscles latency was delayed, trunk velocity and acceleration increased; however, reflex amplitude and relative trunk displacement remained unchanged. Abdominal antagonistic preactivation increased reflexive response of muscles but kinematics variables were not affected. Preload, initial flexed posture and abdominal muscles preactivation increased back muscles preactivity. Both velocity and acceleration peaks of the trunk movement decreased with preload despite greater total load. In contrast, they increased in the initial flexed posture and to some extent when abdominal muscles were preactivated demonstrating the distinct effects of pre-perturbation variables on trunk kinematics and risk of injury.     

健康青年静态立位平衡功能的研究

目的:完善健康青年静态立位平衡参数常模和探讨人处于不利站立条件下姿势控制变化规律。方法:从某军校本科学员中随机抽取108名,对8种不同站立条件下的立位平衡功能进行测试,同时比较不同站立姿势下重心晃动的变化。结果:与睁眼站立相比,闭眼站立和闭眼站立于脚垫上,人体重心会不自主地向脚掌移动,同时重心晃动的轨迹长度和面积明显增加,而单位面积轨迹长度明显降低。另外,人体前后方向晃动的程度较大,而左右晃动的程度稍小。结论:健康人姿势控制由视觉、前庭和下肢本体感觉等共同维持的,任何系统受到限制,都会影响平衡功能。当人处于不利站立条件时,人的身体会本能地向前倾斜来维持平衡,同时本研究为涉及人体立位平衡方面的研究提供了新的研究方法和思路。     

Gender differentiations of cognitive-motor functioning in prepubertal and pubertal children

The aim of this study was to determine cognitive and motor status factors in female and male children aged 10-14, as well as developmental and/or integration functions according to gender. The study included 162 girls and 134 boys aged 10-14, divided into four groups: 84 girls aged 10-12 (mean age 11.26, SD 0.68), 84 boys aged 10-12 (mean age 11.41, SD 0.50), 78 girls aged 13-14 (mean age 13.52, SD 0.63) and 50 boys aged 13-14 (mean age 13.21, SD 0.53). The significance of quantitative differences between boys and girls in the overall system of variables was defined based on the results of canonic discriminant analysis of variance, and within each variable based on the results on univariate analysis of variance (ANOVA). In the younger age group (10-12 years), girls were superior to boys in a test assessing flexibility (Seated straddle stretch), whereas, compared to girls, boys had greater strength of the trunk (Crossed-arm sit-ups), greater explosive strength ofjump and sprint type (Standing broad jump and 20 m dash), and coordination (Obstacle course backwards and Steps laterally). In the older age group (13-14 years) differences in flexibility were even more prominent in favor of girls, whereas the differences in explosive strength increased in favor of boys, especially of the throwing type with better agility (Steps laterally), balance (Board balance) and greater static strength of arms and shoulders (Bent-arm hang). In order to determine qualitative differences between pubertal and prepubertal girls and boys, the matrix of variable inter-correlations was factorized by the procedure of principal components procedure, that were then transformed to promax solution. The results showed that cognitive functioning had a significant role in the motor efficacy of girls and boys aged 10 to 14. In the age group of 10-12 years, in females, cognitive functioning is related to the motor system which integrates the regulation of muscle tone with agility/coordination, whereas in males there is a relation between cognitive abilities and the regulator of speed of upper extremities movement frequency. In the age group of 13-14 years, in females, cognitive functioning is involved in forming the factors for regulation of coordination and the intensity of energy mobilization in lower extremities, and to some degree, in the factor for regulation of intensity of energy mobilization in upper extremities and strength of the trunk, whereas in males the integration of synergetic regulation of movement in terms of balance and agility in terms of speed of direction change is carried out with significant involvement of cognitive abilities.     

Relationships between cognitive and motor abilities in female children aged 10-14 years

The aim of the study was to determine cognitive and motor status factors in female children aged 10-14 years and to identify developmental and/or integration functions according to age. The study included a sample of 162 female schoolchildren aged 10-14 years divided into two groups: 84 girls aged 10-12 (X 11.26, SD 0.68) years and 78 girls aged 13-14 (X 13.52, SD 0.63) years. Study results showed a statistically significant between-group difference in the overall system of variables (MANOVA), with the level of significance determined for each individual variable (ANOVA). The older group of subjects showed significantly superior results in comparison with the younger group in the motor tests assessing flexibility, agility, psychomotor speed, explosive strength of throwing type and repetitive strength of the trunk, as well as in the test assessing cognitive functioning. Qualitative differences between the two age groups (prepubertal and pubertal) were determined by use of the matrix of variable inter-correlations factorized by the procedure of principal components that were then transformed to promax solution. The results thus obtained indicated cognitive functioning to take significant part in the motor efficacy of girls aged 10-14 years. In the younger age group (10-12 years), cognitive functioning was related to the motor system that integrates muscle tone regulation and agility/coordination. In the older age group (13-14 years), cognitive functioning was involved in the formation of the first and third factor isolated, i.e. in the factor regulating coordination and intensity of energy mobilization of lower extremities (general motor efficiency) and, to a lesser extent, in third factor regulation the intensity of energy mobilization of upper extremities and trunk strength.     

The three-dimensional easy morphological (3-DEMO) classification of scoliosis – Part III, correlation with clinical classification and parameters

Background

The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle.

Methods

Cross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years), Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography.

Results

Cobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant). The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main curvature was 8.4° ± 2.7°in braced and 11.4° ± 2.7° in un-braced patients (difference extremely significant, p = 0.0003). The value of the sum of angles of trunk rotation at three levels of the trunk was 12.8° ± 4.6° in braced and 16.5° ± 3.8° in un-braced patients (difference very significant, p = 0.0038). The POTSI did not differ significantly between the groups (p = 0.78), the Hump Sum values were not quite different (p = 0.07).

Conclusion

(1) Adolescent girls wearing the brace for idiopathic scoliosis of 25 to 40 degrees of Cobb angle, reveal smaller clinical rotational deformity of their back than non-treated girls having similar radiological deformity. (2) evaluation of the results of treatment for idiopathic scoliosis should consider parameters describing both clinical and radiological deformity.     

Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope

The incidence of falls in the elderly is increasing with the aging of society and is becoming a major public health issue. From the viewpoint of prevention of falls, it is important to evaluate the stability of the gait in the elderly people. The pelvic movement, which is a critical factor for walking stability, was analyzed using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. The subjects were 95 elderly people over 60 years of age. The criteria for instability were open-eye standing on one leg for 15s or less, and 11s or more on 3m timed up and go test. Forty subjects who did not meet both of these criteria comprised the stable group, and the remaining 55 subjects comprised the unstable group. Pelvic movement during walking was compared between the two groups. The angle, angular velocity, and acceleration were analyzed based on the wave shape derived from the device worn around the second sacral. The results indicated that pelvic movement was lower in all three directions in the unstable group compared to the stable group, and the changes in the pelvic movement during walking in unstable elderly people were also reduced. This report is the first to evaluate pelvic movement by both a triaxial accelerometer and a triaxial gyroscope simultaneously. The characteristics of pelvic movement during walking can be applied in screening to identify elderly people with instability, which is the main risk factor associated with falls.     

Human upright posture control in a virtual visual environment

The sagittal and frontal components of the stabilogram were monitored in 14 healthy subjects standing on a rigid or pliant support under three different conditions of visual control: with the eyes opened (EO), with the eyes closed (EC), or in a virtual visual environment (VVE). Under the VVE conditions, the subjects looked at a three-dimensional image of elements of a room (a 3-D artificial room) that was generated by a computer and locked to the fluctuations of the body center of gravity (CG) so that the visual connection between body sway and shifts of the visual environment typical of normal visual conditions was reproduced. Frequency filtration of the fluctuations of the foot’s center of pressure (FCP) was used to isolate the movements of the vertical projection of the CG and determine the difference between these two variables. The changes in the variables (CG and FCP-CG) were estimated using spectral analysis followed by the calculation of the root mean square (RMS) amplitudes of their spectral fluctuations. In subjects standing on a rigid support, the RMS amplitudes of the spectra of both variables were the highest under the VVE and EC conditions and the lowest under the EO conditions. In subjects standing on a pliant support, body sway was considerably enhanced, which was accompanied by a different pattern of visual influences. The RMS values were the highest under the EC conditions and were lower by a factor of 2–2.5 under the EO and VVE conditions. Thus, it has been demonstrated that the cerebral structures controlling posture ignore the afferent input from the eyes under VVE conditions, if the subject is standing on a rigid support and the CG fluctuations are relatively small; however, this afferentation is efficiently used for maintaining the posture on a pliable support, when the body sway is substantially enhanced.     

Influence of a movable support under one leg on human vertical posture during standing with asymmetrical load on legs

Changes in the vertical posture maintenance were studied when the legs were placed on supports of different degrees of mobility and part of the body weight was voluntarily transferred to one leg. The aim of these experiments was to explore how the mobility of support under the feet affects the balance and how this effect depends on the load distribution between the legs during standing. When both legs were on rigid immovable supports, the vertical posture was maintained by control of the center of pressure (CP) on both legs. When the subject transferred the weight to one foot, the posture was maintained mainly due to the control of CP of the loaded leg. When the legs were on supports of different degrees of mobility, the balance was maintained by the leg on the immovable support. This result was observed both when the subject stood with symmetrical load on the legs and when the load was transferred to one leg. Even when the leg was unloaded but placed on the immovable support, its CP moved more compared to the CP of the loaded leg on a movable support. The results obtained show that the support mobility is a factor that determines the mechanisms of posture maintenance, and this factor is more significant than load distribution between the legs. Thus, the upright posture is maintained with the physical properties of support under the feet taken into account.     

Effect of posture on vital capacity

The influence of some extreme body postures on vital capacity (VC) was examined in young adult humans. Two postures required full support of body weight by the arms: arms up, hanging from a bar, and arms down with hands gripping parallel bars. Three involved muscles that flex and extend the trunk: a partial sit-up position while supine and nearly maximal spinal extension and flexion while standing. Changes at the inspiratory and expiratory volume extremes were recognized by having the subjects do two VC efforts: the first standing and the second in the posture in question while continuing to breathe on the spirometer. Control observations in which the second of a VC pair was performed in an unstressed posture allowed correction for the influence of rebreathing. The changes in corrected VC were small, the greatest being an average reduction of approximately 8% in the partial sit-up position. During full support of body weight by the arms, the VC was slightly increased due to a significant increase in the inspiratory extreme and no change in the expiratory extreme. Spinal extension produced small increases in lung volume at both extremes with no significant change in VC, whereas spinal flexion did not influence the upper extreme but did increase lung volume at the lower extreme. The changes are discussed in terms of trunk muscle action.     

A comparison of methods to determine center of mass during pregnancy

Balance changes during pregnancy likely occur because of mass gains and mass distribution changes. However, to date there is no way of tracking balance through center of mass motion because no method is available to identify of the body center of mass throughout pregnancy. We compared methods for determining segment masses and torso center of mass location. The availability of a method for tracking these changes during pregnancy will make determining balance changes through center of mass motion an option for future pregnancy balance research. Thirty pregnant women from eight weeks gestation until birth were recruited for monthly anthropometric measurements, motion capture analysis of body segment locations, and force plate analysis of center of pressure during quiet standing and supine laying. From these measurements, we were able to compare regression, volume measurement, and weighted sum methods to calculate body center of mass throughout pregnancy. We found that mass changes around the trunk were most prevalent as expected, but mass changes throughout the body (especially the thighs) were also seen. Our findings also suggest that a series of anthropometric measurements first suggested by Pavol et al. (2002), in combination with quiet standing on a force plate, can be used to identify the needed components (segment masses and torso center of mass location in three dimensions) to calculate body center of mass changes during pregnancy. The results of this study will make tracking of center of mass motion a possibility for future pregnancy balance research.     

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.