Saccades Improve Postural Control: A Developmental Study in Normal Children

Introduction

Dual-task performance is known to affect postural stability in children. This study focused on the effect of oculomotor tasks like saccadic eye movements on postural stability, studied in a large population of children by recording simultaneously their eye movements and posture.

Materials and Methods

Ninety-five healthy children from 5.8 to 17.6 years old were examined. All children were free of any vestibular, neurological, ophtalmologic and orthoptic abnormalities. Postural control was measured with a force platform TechnoConcept®, and eye movements with video oculography (MobilEBT®). Children performed two oculomotor tasks: fixation of a stable central target and horizontal saccades. We measured the saccade latency and the number of saccades during fixation as well as the surface, length and mean velocity of the center of pressure.

Results

During postural measurement, we observed a correlation between the age on the one hand and a decrease in saccade latency as well as an improvement in the quality of fixation on the other. Postural sway decreases with age and is reduced in the dual task (saccades) in comparison with a simple task of fixation.

Discussion - Conclusion

These results suggest a maturation of neural circuits controlling posture and eye movements during childhood. This study also shows the presence of an interaction between the oculomotor system and the postural system. Engaging in oculomotor tasks results in a reduction of postural sway.     

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.     

How performing a repetitive one-legged stance modifies two-legged postural control

The proprioceptive cues in the control of movement is recognized as playing a major role in postural control. However, little is known about its possible increased contribution to postural control consecutive to repetitive muscular activations. To test this, the short-term effects induced by a 1-legged exercise on 2-legged postural control with the eyes closed were assessed in healthy subjects. The center-of-pressure (CP) displacements obtained using a force platform were split into 2 elementary movements: center-of-gravity vertical projection (CGv) and the difference (CP - CGv). These movements assessed the net postural performance and the level of neuromuscular activity, respectively, and were processed afterward (a) through variances, mean velocity, and the average surface covered by the trajectories and (b) a fractional Brownian motion (fBm) modeling. The latter provides further information about how much the subject controls the movements and the spatiotemporal relation between the successive control mechanisms. No difference was found using the classical parameters. In contrast, fBm parameters showed statistically significant changes in postural control after 1-legged exercises: The spatial and temporal coordinates of the transition points for the CG movements along the anteroposterior axis are decreased. Because the body movement control does not rely on visual or vestibular cues, this ability to trigger the corrective process of the CG movements more quickly in the postexercise condition and once a more reduced distance has been covered emphasizes how prior muscular activation improves body movement detection. As a general rule, these data show that the motor systems control body motions better after repetitive stimulation of the sensory cues. These insights should be of interest in physical activities based on a precise muscular length control.     

Effect of an additional manual motor task on the maintenance of equilibrium in the frontal and sagittal planes in standing subjects

The postural oscillations of a standing subject during an additional manual motor task consisting in holding a movable ball in the center of a flat box were studied. The movements of the center of pressure (CP) in the frontal and sagittal planes were studied when subjects were standing on a stable rigid support and on a movable unstable support. The effect of the additional motor task on the movement of the CP depended on the stability of the support. When the additional task was performed, the sagittal movements of the CP increased in the case a movable support and did not increase when the support was stable. The additional task decreased the frontal movements of CP in the case of a stable support, and it did not change the frontal movements of CP when the support was unstable. Thus, the performance of an additional motor task led to a reduction of the efficiency of the postural control system in maintaining equilibrium on an unstable support. This decrease may be due to a greater cortical influence on the posture control system in subjects standing on a movable support in comparison with this influence in the case of a stable support.     

Listening to action-related sentences impairs postural control

According to the mirror neurons data there exist areas in the premotor cortex that are activated both during action perception and action execution. It was hypothesized that posture maintenance would be impaired by simultaneous action perception in concordance with cognitive dissonance theory. A test was conducted during which 23 neurologically normal humans were to maintain their posture erect on the forceplate and to listen to the action-related sentences. Tests of differences and Friedman analysis of variance proved that listening to sentences that describe different actions and movements in the first and the third person impairs postural control in comparison with listening to sentences that describe objects of nature and everyday life.     

Atypical task-invariant organization of multi-segment tremors in patients with Parkinson’s disease during manual tracking

The objective of the study was to investigate the interplay between involuntary tremulous activities and task performance under volitional control for patients with Parkinson’s disease (PD) during position tracking. A volunteer sample of nine untreated patients and nine age-matched healthy subjects participated in this study. They performed a sinusoidal tracking maneuver with a shoulder and a static pointing task; meanwhile, a position trace of the index and accelerometer data in the upper limb were recorded to characterize tracking performance and postural–kinetic tremors. In reference to postural tremor, the kinetic tremor of control subjects during tracking was considerably modulated, leading to a lower regularity and greater spectral deviation. In contrast, patients with PD demonstrated greater postural and kinetic tremors than control subjects, and tremulous movements of the patients were comparatively task-invariant. The prominent coherence peak, which occurred at 8–12 Hz in control subjects, was atypically presented at 5–8 Hz for PD patients with poorer tracking performance. Functionally, congruency of position tracking was related to amplitude of kinetic tremor after subtracting from amplitude of postural tremor. In conclusion, task-dependent organization of tremulous movements was impaired in patients with PD. The inferior tracking performance of the patients correlated implicitly with kinetic tremor, signifying some sharing of neural substrates for manual tracking and tremor generation.     

How proprioceptive impairments affect quiet standing in patients with multiple sclerosis

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

Effects of coupled upper limbs movements on postural stabilisation

The preference for in-phase association of coupled cyclic limbs movements is well described (mirror-symmetrical patterns) and this is demonstrated by the ease of performing in-phase movements compared to anti-phase ones. The hypothesis of this study is that the easiest movement patterns are those with minor postural activity. The aim of this study was to describe postural activity in standing subjects in the sagittal and frontal planes during the execution of three upper limbs tasks (single arm, in-phase, anti-phase) at four different frequencies (from 0.6 to 1.2 Hz).We employed six infrared cameras for recording kinematics information, a force platform for measuring forces exerted on the ground, and a system for surface electromyography (SEMG). Outcome measures were: upper limb range of movement and relative-phase, centre of pressure displacement (COP), screw torque (T_z) exerted on the ground, and SEMG recordings of postural muscles (adductor longus, gluteus medius, rectus femoris, and biceps femoris).Our results show that in both the planes the in-phase task resulted in less COP displacement, torque production, and postural muscles involvement than the anti-phase and single arm tasks. This reduced need of postural control could explain the ease of performing in-phase coupled limb movements compared with anti-phase movements.     

Effect of hip and ankle muscle fatigue on unipedal postural control

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

Postural maintenance during movement: Simulations of a two joint model

Voluntary movements of the upper body are accompanied by anticipatory postural adjustments to the lower body in a standing subject. The long-standing hypothesis is that these anticipatory adjustments serve to counteract the perturbation to the body's center of gravity caused by the voluntary arm movement. This paper presents model simulations investigating the possible roles of anticipatory postural activity that accompanies a rapid, upward arm swing. The model encorporates two (idealized) antagonistic muscle pairs controlling the movements of a double-joint system, with a shoulder joint between the arm and stiff body links, and an ankle joint between the stiff body-leg segment and the ground. Each muscle is represented by a nonlinear viscoelastic element and also includes proprioceptive feedback. Four inputs to the model define the motor control signals for muscle force generation in both the arm and the postural muscle pairs. The neurological component of the model describes consequences of alternate strategies for cocontractions, stretch reflex activity, and anticipatory and synchronous postural activities (or combinations thereof). Simulations with this model show that: (1) none of the postural maintenance schemes considered in these simulations (including varying anticipation) could suppress the initial backward thrust on the body link; (2) the more important destabilizing perturbation is a subsequent forward sway that, left uncountered by postural activity, would eventually leave the body to fall flat on its face; and (3) anticipatory silencing of the postural extensor followed by a brief period of extensor activation (descending control) and synchronous reflex activity (feedback control) appears to be the most likely postural stabilizing strategy that inhibits the continuous forward sway and is consistent with the experimental evidence.     

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.     

Corticospinal Excitability of Trunk Muscles during Different Postural Tasks

Evidence suggests that the primary motor cortex (M1) is involved in both voluntary, goal-directed movements and in postural control. Trunk muscles are involved in both tasks, however, the extent to which M1 controls these muscles in trunk flexion/extension (voluntary movement) and in rapid shoulder flexion (postural control) remains unclear. The purpose of this study was to investigate this question by examining excitability of corticospinal inputs to trunk muscles during voluntary and postural tasks. Twenty healthy adults participated. Transcranial magnetic stimulation was delivered to the M1 to examine motor evoked potentials (MEPs) in the trunk muscles (erector spinae (ES) and rectus abdominis (RA)) during dynamic shoulder flexion (DSF), static shoulder flexion (SSF), and static trunk extension (STE). The level of background muscle activity in the ES muscles was matched across tasks. MEP amplitudes in ES were significantly larger in DSF than in SSF or in STE; however, this was not observed for RA. Further, there were no differences in levels of muscle activity in RA between tasks. Our findings reveal that corticospinal excitability of the ES muscles appears greater during dynamic anticipatory posture-related adjustments than during static tasks requiring postural (SSF) and goal-directed voluntary (STE) activity. These results suggest that task-oriented rehabilitation of trunk muscles should be considered for optimal transfer of therapeutic effect to function.     

Evaluation of time-to-contact measures for assessing postural stability

Postural stability has traditionally been examined through spatial measures of the center of mass (CoM) or center of pressure (CoP), where larger amounts of CoM or CoP movements are considered signs of postural instability. However, for stabilization, the postural control system may utilize additional information about the CoM or CoP such as velocity, acceleration, and the temporal margin to a stability boundary. Postural time-to-contact (TtC) is a variable that can take into account this additional information about the CoM or CoP. Postural TtC is the time it would take the CoM or CoP, given its instantaneous trajectory, to contact a stability boundary. This is essentially the time the system has to reverse any perturbation before stance is threatened. Although this measure shows promise in assessing postural stability, the TtC values derived between studies are highly ambiguous due to major differences in how they are calculated. In this study, various methodologies used to assess postural TtC were compared during quiet stance and induced-sway conditions. The effects of the different methodologies on TtC values will be assessed, and issues regarding the interpretation of TtC data will also be discussed.     

Postural control in healthy young adults using a double seesaw device

Postural control on single and double seesaws was investigated in young healthy adults required to stand as still as possible on two side-by-side seesaws favoring pitch motion and lying on two separate force platforms. The device offers the possibility to get associated or dissociated seesaws and, if dissociated, to induce asymmetric patterns for the centers-of-pressure (CP) under both left and right feet by using different radii for the two seesaws. Substituting a parallelepiped volume to one seesaw offering a firm contact to one foot is also possible. The results indicated that dissociating the two seesaws led to increased resultant CP (CP_Res) and vertically projected center-of-gravity movements (CG_v) only along the mediolateral axis, whereas a slight decreasing tendency characterized these movements along the antero-posterior axis. When standing on two independent seesaws with different radii, significantly larger CP displacements were seen along the antero-posterior axis under the foot lying on the more stable support, i.e., the seesaw with the longer radius or the parallelepiped volume. In these two asymmetrical conditions, the CP_Res output results from a compensatory mechanism, i.e. larger movements under one foot to compensate for the decreased movements occurring under the opposite foot. This postural control strategy is aimed at allowing sufficient CP_Res displacements in order to appropriately secure balance. Because of the complex sensorimotor coordination induced, involving differentially in certain cases both legs, the double seesaw device can be viewed as a possible tool for challenging postural control by inducing asymmetrical patterns between left and right feet CP movements.     

Effects of postural muscle fatigue on the relation between segmental posture and movement.

The purpose of this study was to examine whether fatigue of postural muscles might influence the coordination between segmental posture and movement. Seven healthy adults performed series of fifteen fast wrist flexions and extensions while being instructed to keep a dominant upper limb posture as constant as possible. These series of voluntary movements were performed before and after a fatiguing submaximal isometric elbow flexion, and also with or without the help of an elbow support. Surface EMG from muscles Delto?deus anterior, Biceps brachii, Triceps brachii, Flexor carpi ulnaris, Extensor carpi radialis were recorded simultaneously with wrist, elbow and shoulder accelerations and wrist and elbow displacements. Fatigue was evidenced by a shift of the elbow and shoulder muscles EMG spectra towards low frequencies. Kinematics of wrist movements and corresponding activations of wrist prime-movers, as well as the background of postural muscle activation before wrist movement were not modified. There were only slight changes in timing of postural muscle activations. These data indicate that postural fatigue induced by a low-level isometric contraction has no effect on voluntary movement and requires no dramatic adaptation in postural control.     

Origins of Balance Disorders during a Daily Living Movement in Obese: Can Biomechanical Factors Explain Everything?

Obese people suffer from postural deficits and are more subject to falls than their lean counterpart. To improve prevention and post-fall rehabilitation programs, it seems important to better understand the posturo-kinetic disorders in daily life situations by determining the contribution of some key factors, mainly morphological characteristics and physical activity level, in the apparition of these disorders.Twelve severe android obese and eight healthy non obese adults performed a reaching task mobilizing the whole body. To further determine the origin of the postural and motor behavior differences, non obese individuals also performed an experimental session with additional constraints which simulated some of the obese morphological characteristics. Impact of the sedentary lifestyle was also studied by dissociation of the obese in two subgroups: physically « active » and physically « inactive ». Movement kinetics and kinematics were characterized with an optoelectronic system synchronized to a force platform. The mechanical equilibrium pattern was evaluated through the displacements of the Centre of Mass (CoM) and the centre of foot pressure within the Base of Support (BoS).Results showed that obesity decreased movement speed (≈−23%, p<0.01), strongly increased CoM displacement (≈+30%, p<0.05) and induced an important spatio-temporal desynchronization (≈+40%, p<0.05) of the focal and postural components of the movement during the transition between the descending and ascending movements.The role of some morphological characteristics and of physical activity on obese patients'' postural control disorder is discussed and set back in the more general context of overall factors contributing to postural deficits with obesity.     

A model of the basal ganglia in voluntary movement and postural reactions

A basal ganglia central pattern generator (CPG) is developed and its role in voluntary movements on the ground and postural reactions on a disturbed platform are studied and analysed by simulation. Biped dynamics and platform kinematics are utilised. The effects of agonist–antagonist muscular co-activation and joint stiffness are formulated. The implementation of the necessary counter-manoeuvres for maintaining balance and postural stability is studied. A control strategy, applicable to large systems, is formulated. The biped manoeuvres and transitions terminate in pre-specified intervals of time. Gravity is included and compensated for. Certain voluntary and postural adjustment strategies are the same but are initiated differently. Further experimental/computational research may identify the central nervous system and sensory paths that lead to the CPG. All actuator forces linearly evolve in time from their original values to their terminal values. There are no central continuous feedback loops present. Monitoring and sensing, however, are ongoing. The counter-manoeuvres are based on learned human-like voluntary movements that are triggered by the disturbance. The required central inputs to the musculoskeletal system are designed in the CPG. A functional structure for the CPG is proposed. The effect of certain disorders and malfunctions of the CPG are studied by simulation.     

Activation timing of soleus and tibialis anterior muscles during sit-to-stand and stand-to-sit in post-stroke vs. healthy subjects

Introduction. Sit-to-stand (SitTS) and stand-to-sit (StandTS) are very important functional tasks that become compromised in stroke patients. As in other voluntary movements, they require an adequate postural control (PC) involving the generation of anticipatory postural adjustments (APAs). In order to give clues for more efficient and directed rehabilitation programs, a deeper knowledge about APAs during challenging and daily life movements is essential.

Purpose. To analyze the activation timing of tibialis anterior (TA) and soleus (SOL) muscles during SitTS and StandTS in healthy subjects and in post-stroke patients.

Methods. Two groups participated in this study: one composed of ten healthy subjects and the other by ten subjects with a history of stroke and increased H-reflex. Electromyographic activity (EMGa) of SOL and TA was analyzed during SitTS and StandTS in the ipsilateral (IPSI) and the contralateral (CONTRA) limb to the side lesion in stroke subjects, and in one limb in healthy subjects. A force plate was used to identify the movement onset.

Results. In both sequences, in the stroke group SOL activation timing occurred prior to movement onset, contrary to the pattern observed in the healthy subjects. Statistically significant differences were found in SOL activation timings between each lower limb of the stroke and healthy groups, but no significant differences were found between the IPSI and the CONTRA limb. The TA activation timing seems to be delayed in the CONTRA limb when compared to the healthy subjects and showed a better organization of TA timing activation in StandTS when compared to SitTS.

Conclusion. Compared to healthy subjects, APAs seem to be altered in both limbs of the post-stroke subjects, with the SOL activation timing being anticipated in both SitTS and StandTS.     

Evidence for an exposure-response relationship between trunk flexion and impairments in trunk postural control

Prolonged trunk flexion alters passive and active trunk tissue behaviors, and exposure-response relationships between the magnitude of trunk flexion exposure and changes in these behaviors have been reported. This study assessed whether similar exposure-response relationships exist between such exposures and impairments in trunk postural control. Twelve participants (6 M, 6 F) were exposed to three distinct trunk flexion conditions (and a no-flexion control condition), involving different flexion durations with/without an external load, and which induced differing levels of passive tissue creep. Trunk postural control was assessed prior to and immediately following trunk flexion exposures, and during 10 min of standing recovery, by tracking center of pressure (COP) movements during a seated balance task. All COP-based sway measures increased following each flexion exposure. In the anteroposterior direction, these increases were larger with increasing exposure magnitude, whereas such a relationship was not evident for mediolateral sway measures. All measures were fully recovered following 10 min of standing. The present results provide evidence for an exposure-response relationship between trunk flexion exposures and impairments in trunk postural control; specifically, larger impairments following increased exposures (i.e., longer flexion duration and presence of external load). Such impairments in trunk postural control may result from some combination of reduced passive trunk stiffness and altered/delayed trunk reflex responses, and are generally consistent with prior evidence of exposure-dependent alterations in trunk mechanical and neuromuscular behaviors assessed using positional trunk perturbations. Such evidence suggests potential mechanistic pathways through which trunk flexion exposures may contribute to low-back injury risk.