Influence of artificial vestibular feedback on posture instability caused by asymmetric proprioceptive stimulation

Subjects kept a vertical posture, standing on a rigid support. Stability of a posture was estimated by the sizes of standard deviations (sigma) from average amplitudes of the subject's head fluctuation in respect to zero coordinates. To create a feedback on the vestibular input, transmastoidal bipolar galvanic stimulation was used. Changes of current in contour of feedback looked as linear function considering amplitude and velocity of the subject's head displacements. Varying the factors of feedback function, it was possible to reduce sigma for lateral sways increased (in comparison with their values at the quiet stance in the darkness) as a result of unilateral vibrating stimulation of m. gluteus medialis. The results specify inequality of "velocity" and "position" information for maintenance of vertical posture in different subjects. The results specify also the ability of the central nervous system (CNS) to revalue weights of various kinds of information entering via the same channel. The data confirm the hypothesis according to which galvanic vestibular input is capable to deliver in CNS and adequate information on the current orientation of the body. This information can be used for stabilization of a posture.     

Balance of the head in hominid evolution

In primates it is useful to distinguish three basic types of bipedal posture: (1) agonial, with extended hips and knees as in modern humans, (2) monogonial, with flexed hips but extended knees. and (3) digonial, with flexed hips and knees as in pongids. Early hominids retained an ancestral, forwardly inclined posture of the neck and head. Therefore the body posture of australopithednes must have differed from that in modem man, in which the centre of gravity of the head can be aligned with that of the body, other major centra of gravity, and important axes of rotation in a single frontal plane. It is suggested that in australopithednes the gravitational tilt of the head was counterbalanced by bent hips in association with hyperextended knees (monogonial posture). In australopithecines the increase in brain weight would have counteracted an improvement in the balance of the head. After the neck had assumed a more vertical posture as a consequence of shortening of the face, selection for an improved balance system in the bipedal posture favoured an increase in the weight of the postcondylar portion of the head, accentuated by selection for a posterior shift of the superior nuchal line in order to minimise the force of the nuchal muscles. At this stage the evolutionary increase in brain weight may have been largely a by-product of the process towards perfecting the bipedal posture. When the centre of gravity of the head had first become aligned with that of the body, the conditions of balance of the head had become favourable for a dramatic increase of brain size, as a result of selection for greater learning and storage capacity of the brain.     

Resolving head rotation for human bipedalism

Alignment of the body to the gravitational vertical is considered to be the key to human bipedalism. However, changes to the semicircular canals during human evolution suggest that the sense of head rotation that they provide is important for modern human bipedal locomotion. When walking, the canals signal a mix of head rotations associated with path turns, balance perturbations, and other body movements. It is uncertain how the brain uses this information. Here, we show dual roles for the semicircular canals in balance control and navigation control. We electrically evoke a head-fixed virtual rotation signal from semicircular canal nerves as subjects walk in the dark with their head held in different orientations. Depending on head orientation, we can either steer walking by "remote control" or produce balance disturbances. This shows that the brain resolves the canal signal according to head posture into Earth-referenced orthogonal components and uses rotations in vertical planes to control balance and rotations in the horizontal plane to navigate. Because the semicircular canals are concerned with movement rather than detecting vertical alignment, this result shows the importance of movement control and agility rather than precise vertical alignment of the body for human bipedalism.     

Lumbar back muscle activity during walking with a leg inequality

The influence of an artificial leg length discrepancy (= ALLD) on stride times, pelvic rotations and activity of the intrinsic lumbar back muscles (= ILBM) was investigated for 20 subjects. An ALLD was created by shoes with a raised sole. Walking with an ALLD produced an increase of the swing phase time and a decrease of the stance phase time for both feet. The influence of an ALLD on pelvic rotations in the sagittal and frontal plane and on ILBM-activity was small. Changes in pelvic rotations in the sagittal plane were too small to observe. The mean pelvic rotation angle in the frontal plane was changed 1.52 degrees when walking with an ALLD of 40 mm (6.9 degrees while standing with an ALLD of 40 mm with extended knees). Only small changes were found in activity time due to an ALLD (not in EMG-amplitude). The activity time of the ILBM around heel strike of the raised limb was increased and unilaterally shifted from toe off in the direction of heel strike with the raised limb.     

Characteristics of the maintenance of the vertical posture during standing with an asymmetrical load on the legs

Movements of the common center of pressure (CP) and the CPs of the right and left legs separately were studied during the maintenance of the vertical posture by subjects standing with symmetrical load on their legs or with the shift of the load to the right or left leg. It was shown that standing with a symmetrical load on the legs was accompanied by the movement of the CP of an individual leg along the straight line with small deviations aside, whereas movement of the common CP represented the curve with frequent changes in direction and filling up some space. The shift of the load to one leg resulted in the movement of the CP of the loaded leg that was similar to that observed during a symmetrical load on the legs. The movement of the CP of the unloaded leg was chaotic. The shift of the load to one leg decreased the correlation between the movements of the CPs of the left and right legs compared to standing with a symmetrical load on the legs. The velocity of movement of the CP of the leg loaded increased in the sagittal direction but remained stable in the frontal direction. The velocity of movement of the CP of the unloaded leg remained stable in the sagittal direction but increased in the frontal direction. We suppose that during standing with an asymmetrical load on the legs the role of the single in the maintenance of the vertical posture depend on the load on the leg.     

Comparative analysis of the dynamics of human postural control during fixation and pursuit of a visual target

The properties of the system maintaining the upright posture were compared in different states of the oculomotor system: during target fixation and horizontal fast and slow pursuit (0.1 and 0.01 Hz), recording the trajectories of the center of pressure in the frontal and the sagittal planes. Methods of nonlinear analysis were applied to assess the similarity in pairwise comparisons. The overall similarity of the frontal plane dynamics proved to be higher than that of the sagittal plane dynamics. However, differences were revealed in fast pursuit versus slow pursuit or fixation in the frontal but not in the sagittal plane. Such differences may reflect the different inertia of the oculomotor and the balance control systems. In general, the results are consistent with the current notions on the two orthogonal subsystems of postural control.     

Spatial perception and vestibulomotor responses in man

A study was made on normal human subjects, using a stabilograph to investigate changes in posture produced in response to transcutaneous galvanic stimulation of the right labyrinth. Results were obtained for different head positions and under the illusion of head and trunk rotation produced by stimulating (vibrating) the gulteus maximus muscle. In the absence of illusion of movement, the direction of the vestibulomotor response was determined by the position of the head in relation to the feed: with the normal head position, the body swayed on a frontal plane, and on a sagittal plane when the heat turned through 90°. Vestibulomotor responses were sagittally oriented, as with real head turning, when illusory head and trunk turning through 90° was produced by vibration. When the illusion of head rotation (in relation to the feet) was not produced by this stimulus, the direction of the postural response was not produced by this stimulus, the direction of the postural response was determined by the real orientation of the head. It is concluded that the spatial perception system plays a major part in controlling spatially oriented vestibulomotor responses.Institute for Research into Information Transmission, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologiya, Vol. 18, No. 6, pp. 779–787, November–December, 1986.     

Artificial vestibular feedback in conditions of modified body scheme

Subjects standing in darkness on the rigid support, kept a vertical posture which was destabilized by vibration of the Achilles tendons. To create a feedback on the vestibular input, transmastoidal bipolar galvanic stimulation was used. Changes of current in the feedback contour looked as linear function considering amplitude and velocity of the subject's head displacements in reference to the vertical. To change the body scheme we used some posture configurations: turning of the head in relation to the trunk; turning of the trunk with the head fixed; joint turning of the head and trunk. As a result of these configurations, the head could be turned approximately at right angle in relation to the feet. In addition turning of one foot at right angle in relation to the other foot was used. Artificial feedback reduces body fluctuations caused by vibration only in the vertical plane which passes through interaural axis of the head. The authors assume that directional changes of vestibulo-motor responses and results of application of artificial feedback during changes of orientation of the head in relation to the feet can be connected to change of ensembles of vestibular hair cells, which signals dominate in responses of vestibulo-spinal neurones.     

Biomechanical impairments and gait adaptations post-stroke: Multi-factorial associations

Understanding the potential causes of both reduced gait speed and compensatory frontal plane kinematics during walking in individuals post-stroke may be useful in developing effective rehabilitation strategies. Multiple linear regression analysis was used to select the combination of paretic limb impairments (frontal and sagittal plane hip strength, sagittal plane knee and ankle strength, and multi-joint knee/hip torque coupling) which best estimate gait speed and compensatory pelvic obliquity velocities at toeoff. Compensatory behaviors were defined as deviations from control subjects’ values. The gait speed model (n=18; p=0.003) revealed that greater hip abduction strength and multi-joint coupling of sagittal plane knee and frontal plane hip torques were associated with decreased velocity; however, gait speed was positively associated with paretic hip extension strength. Multi-joint coupling was the most influential predictor of gait speed. The second model (n=15; p<0.001) revealed that multi-joint coupling was associated with increased compensatory pelvic movement at toeoff; while hip extension and flexion and knee flexion strength were associated with reduced frontal plane pelvic compensations. In this case, hip extension strength had the greatest influence on pelvic behavior. The analyses revealed that different yet overlapping sets of single joint strength and multi-joint coupling measures were associated with gait speed and compensatory pelvic behavior during walking post-stroke. These findings provide insight regarding the potential impact of targeted rehabilitation paradigms on improving speed and compensatory kinematics following stroke.     

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%).     

The relationship between trunk muscle electromyography and lifting moments in the sagittal and frontal planes

In this study, we explore the relationship between moments in the frontal and sagittal planes, generated by a lifting task, vs the electromyographic (EMG) activity of right and left trunk muscle groups. In particular, we postulate that the functional dependence between erector spinae muscle activity and the applied lifting moments about the spine is as follows: the sum of left and right erector spinae processed EMG depends on the sagittal plane moment, and the difference of left and right erector spinae processed EMG depends on the frontal plane moment. A simple out-of-sagittal plane physical model, treating the lumbar spine as a two degree-of-freedom pivot point is discussed to justify these hypotheses. To validate this model, we collected surface EMG and lifting moment data for ten males performing a grid of frontal and sagittal plane lifting tasks. A digital RMS-to-DC algorithm was developed for processing raw EMG. For these tests, we measured EMG for the left and right erector spinae and for the left and right external oblique muscles. The processed EMG signals of the left and right erector spinae muscles are summed and differenced for comparison to the measured sagittal and frontal plane moments. A linear correlation (r2) of 0.96 was obtained for the sum of erector spinae EMG vs the sagittal plane moment; a corresponding value of r2 = 0.95 was obtained for the difference vs the frontal plane moment. No correlations (r2 less than 0.004) was found for the sagittal plane moment and the difference of the left and right erector spinae EMG, and the frontal plane moment and the sum of the left and right erector spinae EMG.     

Accuracy and repeatability of joint angles measured using a single camera markerless motion capture system

Markerless motion capture systems have developed in an effort to evaluate human movement in a natural setting. However, the accuracy and reliability of these systems remain understudied. Therefore, the goals of this study were to quantify the accuracy and repeatability of joint angles using a single camera markerless motion capture system and to compare the markerless system performance with that of a marker-based system. A jig was placed in multiple static postures with marker trajectories collected using a ten camera motion analysis system. Depth and color image data were simultaneously collected from a single Microsoft Kinect camera, which was subsequently used to calculate virtual marker trajectories. A digital inclinometer provided a measure of ground-truth for sagittal and frontal plane joint angles. Joint angles were calculated with marker data from both motion capture systems using successive body-fixed rotations. The sagittal and frontal plane joint angles calculated from the marker-based and markerless system agreed with inclinometer measurements by <0.5°. The systems agreed with each other by <0.5° for sagittal and frontal plane joint angles and <2° for transverse plane rotation. Both systems showed a coefficient of reliability <0.5° for all angles. These results illustrate the feasibility of a single camera markerless motion capture system to accurately measure lower extremity kinematics and provide a first step in using this technology to discern clinically relevant differences in the joint kinematics of patient populations.     

Temporal pattern of the control actions accomplishing stabilization of the vertical posture of man

The problem of determination of the temporal patterns of control actions, which accomplish the process of the vertical posture stabilization, was considered. On the basis of stabilogram analysis, it was concluded that the temporal pattern of the trajectory components of pressure center (PC) motion consists of interval sequences. Motion velocity is practically constant within each interval. Transition to the following interval is accompanied by a spasmodic change not only in the velocity magnitude but also in its sign. It was shown that velocity constancy at the linear interval is the result of linear time change in control actions. A conclusion was drawn about the presence of two separate mechanisms realizing the process of stabilization of the vertical posture. They form independent control actions oriented in the frontal and sagittal planes.     

Interaction between Visual and Proprioceptive Analyzers in Vertical Posture Control

The CNS can precisely assess the spatial position of the human body only by simultaneously processing and integrating the visual, proprioceptive, and vestibular inputs. Postural stability data make it possible to estimate changes taking place in the function of analyzers involved in the maintenance of the upright posture. The vertical posture stability was assessed in healthy children and children with spastic diplegic cerebral palsy from their postural responses to the presentation of single optokinetic or somatosensory stimuli. The visual analyzer was found to play a significant role in maintaining the upright position under natural gravity conditions in healthy children. A single exposure of the proprioceptive system to variable forces directed with the gravity of the earth (vertical) decreased the contribution of the visual analyzer. Healthy children maintained the upright position relying on the direction of movement of the optokinetic stimuli, which, however, produced no effect on the maintenance of posture in the patients. A hypothesis is proposed that prenatal or early postnatal CNS lesions decrease the contribution of phylogenetically newer brain structures to the regulation of upright posture.     

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.     

Stabilization of the gaze in chameleons: visual and vestibular reflexes

Some visual, vestibular and proprioceptive reflexes which contribute to gaze (head + eye) stabilization were quantified in the chameleon. All the reflexes were analysed in the horizontal plane, and the visual reflexes were also studied in the vertical plane. In restrained-head animals, both the optokinetic nystagmus (OKN) and the vestibulo-ocular reflex (VOR) had low gains. In free-head animals, the head (opto-collic or vestibulo-collic reflex) and eye (OKN or VOR) responses added their effects, thus improving gaze stabilization, especially during vestibular stimulation. Cervical stimulation provoked both a cervico-ocular reflex (COR) in the compensatory direction and a large number of saccades. The saccadic response was especially marked in the presence of patterned visual surroundings.     

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.     

Ocular and stabilization feedback: an evaluation of two EMG biofeedback control procedures

This study evaluated the adequacy of two novel EMG biofeedback control procedures. During a single training session, 36 subjects received either contingent EMG feedback from the frontal region (Veridical), contingent feedback for vertical eye movements (Ocular), or a feedback condition where the signal increased with deviations in any direction from baseline EMG levels (Stabilization). The results supported the use of Ocular but not Stabilization feedback as a control procedure in frontalis EMG biofeedback studies. Ocular feedback did not produce reductions in frontalis EMG but did lead to changes in subjective measures of nonspecific treatment effects that were at least comparable to those obtained with Veridical feedback. Stabilization subjects produced small but significant reductions in EMG, felt the most bored as a result of their feedback training, and were the most likely to rate themselves as having received false feedback. The implications of attribution theory and multiprocess relaxation theory for the evaluation of nonspecific treatment effects are discussed.     

Lumbar and cervical erector spinae fatigue elicit compensatory postural responses to assist in maintaining head stability during walking.

The purpose of this study was to examine how inducing fatigue of the 1) lumbar erector spinae and 2) cervical erector spinae (CES) muscles affected the ability to maintain head stability during walking. Triaxial accelerometers were attached to the head, upper trunk, and lower trunk to measure accelerations in the vertical, anterior-posterior, and mediolateral directions during walking. Using three accelerometers enabled two adjacent upper body segments to be defined: the neck segment and trunk segment. A transfer function was applied to root mean square acceleration, peak power, and harmonic data derived from spectral analysis of accelerations to quantify segmental gain. The structure of upper body accelerations were examined using measures of signal regularity and smoothness. The main findings were that head stability was only affected in the anterior-posterior direction, as accelerations of the head were less regular following CES fatigue. Furthermore, following CES fatigue, the central nervous system altered the attenuation properties of the trunk segment in the anterior-posterior direction, presumably to enhance head stability. Following lumbar erector spinae fatigue, the trunk segment had greater gain and increased regularity and smoothness of accelerations in the mediolateral direction. Overall, the results of this study suggest that erector spinae fatigue differentially altered segmental attenuation during walking, according to the level of the upper body that was fatigued and the direction that oscillations were attenuated. A compensatory postural response was not only elicited in the sagittal plane, where greater segmental attenuation occurred, but also in the frontal plane, where greater segmental gain occurred.     

Ocular and stabilization feedback: An evaluation of two EMG biofeedback control procedures

This study evaluated the adequacy of two novel EMG biofeedback control procedures. During a single training session, 36 subjects received either (1) contingent EMG feedback from the frontal region (Veridical), (2) contingent feedback for vertical eye movements (Ocular), or (3) a feedback condition where the signal increased with deviations in any direction from baseline EMG levels (Stabilization). The results supported the use of Ocular but not Stabilization feedback as a control procedure in frontalis EMG biofeedback studies. Ocular feedback did not produce reductions in frontalis EMG but did lead to changes in subjective measures of nonspecific treatment effects that were at least comparable to those obtained with Veridical feedback. Stabilization subjects produced small but significant reductions in EMG, felt the most bored as a result of their feedback training, and were the most likely to rate themselves as having received false feedback. The implications of attribution theory and multiprocess relaxation theory for the evaluation of nonspecific treatment effects are discussed.This research was supported in part by grants from the National Institutes of Health (AM31500) and the Robert Wood Johnson Foundation. Portions of this research were presented at the Sixth Annual Meeting of the Society of Behavioral Medicine, New Orleans, March 1985.