Age-related changes in posture response under a continuous and unexpected perturbation

Aging is a critical factor to influence the functional performance during daily life. Without an appropriate posture control response when experiencing an unexpected external perturbation, fall may occur. A novel six-degree-of freedom platform with motion control protocol was designed to provide a real-life simulation of unexpected disturbance in order to discriminate the age-related changes of the balance control and the recovery ability. Twenty older adults and 20 healthy young adults participated in the study. The subjects stood barefoot on the novel movable platform, data of the center of mass (COM) excursion, joint rotation angle and electromyography (EMG) were recorded and compared. The results showed that the older adults had similar patterns of joint movement and COM excursion as the young adults during the balance reactive-recovery. However, larger proximal joint rotation in elderly group induced larger COM sway envelop and therefore loss of the compensatory strategy of posture recovery. The old adults also presented a lower muscle power. In order to keep an adequate joint stability preventing from falling, the EMG activity was increased, but the asymmetric pattern might be the key reason of unstable postural response. This novel design of moveable platform and test protocol comprised the computerized dynamic posturography (CDP) demonstrate its value to assess the possible sensory, motor, and central adaptive impairments to balance control and could be the training tool for posture inability person.     

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.     

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

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

Stability and Control of Human Trunk Movement During Walking

A mathematical model has been developed to study the control mechanisms of human trunk movement during walking. The trunk is modeled as a base-excited inverted pendulum with two-degrees of rotational freedom. The base point, corresponding to the bony landmark of the sacrum, can move in three-dimensional space in a general way. Since the stability of upright posture is essential for human walking, a controller has been designed such that the stability of the pendulum about the upright position is guaranteed. The control laws are developed based on Lyapunov' stability theory and include feedforward and linear feedback components. It is found that the feedforward component plays a critical role in keeping postural stability, and the linear feedback component, (resulting from viscoelastic function of the musculoskeletal system) can effectively duplicate the pattern of trunk movement. The mathematical model is validated by comparing the simulation results with those based on gait measurements performed in the Biomechanics Laboratory at the University of Manitoba.     

Anticipatory postural adjustments in children with hemiplegia and diplegia

Anticipatory postural adjustments (APAs) play an important role in the performance of many activities requiring the maintenance of standing posture. However, little is known about if and how children with cerebral palsy (CP) generate APAs. Two groups of children with CP (hemiplegia and diplegia) and a group of children with typical motor development performed arm flexion and extension movements while standing on a force platform. Electromyographic activity of six trunk and leg muscles and displacement of center of pressure (COP) were recorded. Children with CP were able to generate anticipatory postural adjustments and produce directionally specific APAs and COP displacements similar to those described in adults and typically developing children. However, children with diplegia were unable to generate APAs of the same magnitude as children with typical development and hemiplegia and had higher baseline muscle activity prior to movement. In children with diplegia, COP was posteriorly displaced and peak acceleration was smaller during bilateral extension compared to children with hemiplegia. The outcomes of the study highlight the role of APAs in the control of posture of children with CP and point out the similarities and differences in anticipatory control in children with diplegia and hemiplegia. These differences may foster ideas for treatment strategies to enhance APAs in children with CP.     

Stability and Control of Human Trunk Movement During Walking

A mathematical model has been developed to study the control mechanisms of human trunk movement during walking. The trunk is modeled as a base-excited inverted pendulum with two-degrees of rotational freedom. The base point, corresponding to the bony landmark of the sacrum, can move in three-dimensional space in a general way. Since the stability of upright posture is essential for human walking, a controller has been designed such that the stability of the pendulum about the upright position is guaranteed. The control laws are developed based on Lyapunov's stability theory and include feedforward and linear feedback components. It is found that the feedforward component plays a critical role in keeping postural stability, and the linear feedback component, (resulting from viscoelastic function of the musculoskeletal system) can effectively duplicate the pattern of trunk movement. The mathematical model is validated by comparing the simulation results with those based on gait measurements performed in the Biomechanics Laboratory at the University of Manitoba.     

The relationship between dynamic balancing ability and posture-related modulation of the soleus H-reflex

Soleus H-reflex reveals down modulation with increased postural difficulty. Role of this posture-related reflex modulation is thought to shift movement control toward higher motor centers in order to facilitate more precise postural control. Present study hypothesized that the ability to modulate H-reflex is related to one’s ability to dynamically balance while in an unstable posture. This study examined the relationship between dynamic balancing ability and soleus H-reflex posture-related modulation. Thirty healthy adults participated. The soleus maximal H-reflex (Hmax), motor response (Mmax), and background EMG activity (bEMG) were obtained during three postural conditions: prone, open-legged standing, and closed-legged standing. Hmax/Mmax ratios were normalized via the corresponding bEMG in order to remove the effects of background muscle activity from the obtained H-reflex. Reflex modulation was calculated as the ratio of the normalized Hmax/Mmax ratios in one postural condition to another posture in a more difficult condition. Dynamic balancing ability was assessed by testing stability while standing on a wobble board. A significant negative correlation was observed between balancing scores and reflex modulation from open-legged standing to closed-legged standing. This suggests that the ability to modulate monosynaptic stretch reflex excitability in response to a changing posture is a significant factor for dynamic balancing.     

Age-Related Differences in Motor Coordination during Simultaneous Leg Flexion and Finger Extension: Influence of Temporal Pressure

Although the effect of temporal pressure on spatio-temporal aspects of motor coordination and posture is well established in young adults, there is a clear lack of data on elderly subjects. This work examined the aging-related effects of temporal pressure on movement synchronization and dynamic stability. Sixteen young and eleven elderly subjects performed series of simultaneous rapid leg flexions in an erect posture paired with ipsilateral index-finger extensions, minimizing the difference between heel and finger movement onsets. This task was repeated ten times under two temporal conditions (self-initiated [SI] vs. reaction-time [RT]). Results showed that, first, temporal pressure modified movement synchronization; the finger extension preceded swing heel-off in RT, and inversely in SI. Synchronization error and associated standard deviation were significantly greater in elderly than in young adults in SI only, i.e. in the condition where proprioception is thought to be crucial for temporal coordination. Secondly, both groups developed a significantly shorter mediolateral (ML) anticipatory postural adjustment duration in RT (high temporal pressure) than in SI. In both groups, this shortening was compensated by an increase in the anticipatory peak of centre-of-gravity (CoG) acceleration towards the stance-leg so that ML dynamic stability at foot-off, quantified with the “extrapolated centre-of-mass”, remained unchanged across temporal conditions. This increased CoG acceleration was associated with an increased anticipatory peak of ML centre-of-pressure shift towards the swing-leg in young adults only. This suggested that the ability to accelerate the CoG with the centre-of-pressure shift was degraded in elderly, probably due to weakness in the lower limb muscles. Dynamic stability at foot-off was also degraded in elderly, with a consequent increased risk of ML imbalance and falling. The present study provides new insights into the ability of elderly adults to deal with temporal pressure constraints in adapting whole-body coordination of postural and focal components of paired movement.     

Dynamic stability of a human standing on a balance board

The neuromuscular system used to stabilize upright posture in humans is a nonlinear dynamical system with time delays. The analysis of this system is important for improving balance and for early diagnosis of neuromuscular disease. In this work, we study the dynamic coupling between the neuromuscular system and a balance board—an unstable platform often used to improve balance in young athletes, and older or neurologically impaired patients. Using a simple inverted pendulum model of human posture on a balance board, we describe a surprisingly broad range of divergent and oscillatory CoP/CoM responses associated with instabilities of the upright equilibrium. The analysis predicts that a variety of sudden changes in the stability of upright postural equilibrium occurs with slow continuous deterioration in balance board stiffness, neuromuscular gain, and time delay associated with the changes in proprioceptive/vestibular/visual-neuromuscular feedback. The analysis also provides deeper insight into changes in the control of posture that enable stable upright posture on otherwise unstable platforms.     

Interaction between the vertical posture and movement control systems during a quick voluntary arm raise

The study was aimed at a deeper understanding of the interaction between the system of vertical posture control and the system of voluntary movement control based on the analysis of postural muscle activity components resulting from the action of the former or the latter system. For this purpose, a quick arm raise was performed in the standing and sitting positions with body fixation at different levels, when the task of maintaining a vertical posture was simplified or completely eliminated. Under these conditions, the muscle activity associated with posture control was supposed to change, while the activity of muscles raising the arm was supposed to remain invariable. The results showed that the simplification of the posture control resulted in a decrease or elimination of anticipatory changes in the activity of some muscles. However, most of the muscle activity variations were retained even in the sitting position, and these variations appeared simultaneously with the activity of muscles raising the arm. The so-called “anticipatory postural activity” during an arm raise in a normal standing position is supposed to consist of two components: an initial component reflecting the work of the posture control system and a later component reflecting the work of the movement control system. It is suggested that the planning of muscle activity and exchange of information between these two systems take place only before the beginning of the movement; after that, they act independently and in parallel.     

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.     

An active balance board system with real-time control of stiffness and time-delay to assess mechanisms of postural stability

Increased time-delay in the neuromuscular system caused by neurological disorders, concussions, or advancing age is an important factor contributing to balance loss (Chagdes et al., 2013, 2016a,b). We present the design and fabrication of an active balance board system that allows for a systematic study of stiffness and time-delay induced instabilities in standing posture. Although current commercial balance boards allow for variable stiffness, they do not allow for manipulation of time-delay. Having two controllable parameters can more accurately determine the cause of balance deficiencies, and allows us to induce instabilities even in healthy populations. An inverted pendulum model of human posture on such an active balance board predicts that reduced board rotational stiffness destabilizes upright posture through board tipping, and limit cycle oscillations about the upright position emerge as feedback time-delay is increased. We validate these two mechanisms of instability on the designed balance board, showing that rotational stiffness and board time-delay induced the predicted postural instabilities in healthy, young adults. Although current commercial balance boards utilize control of rotational stiffness, real-time control of both stiffness and time-delay on an active balance board is a novel and innovative manipulation to reveal balance deficiencies and potentially improve individualized balance training by targeting multiple dimensions contributing to standing balance.     

Postural control system

The postural control system has two main functions: first, to build up posture against gravity and ensure that balance is maintained; and second, to fix the orientation and position of the segments that serve as a reference frame for perception and action with respect to the external world. This dual function of postural control is based on four components: reference values, such as orientation of body segments and position of the center of gravity (an internal representation of the body or postural body scheme); multisensory inputs regulating orientation and stabilization of body segments; and flexible postural reactions or anticipations for balance recovery after disturbance, or postural stabilization during voluntary movement. The recent data related to the organization of this system will be discussed in normal subjects (during ontogenesis), the elderly and in patients with relevant deficits.     

Spinal Mechanisms May Provide a Combination of Intermittent and Continuous Control of Human Posture: Predictions from a Biologically Based Neuromusculoskeletal Model

Several models have been employed to study human postural control during upright quiet stance. Most have adopted an inverted pendulum approximation to the standing human and theoretical models to account for the neural feedback necessary to keep balance. The present study adds to the previous efforts in focusing more closely on modelling the physiological mechanisms of important elements associated with the control of human posture. This paper studies neuromuscular mechanisms behind upright stance control by means of a biologically based large-scale neuromusculoskeletal (NMS) model. It encompasses: i) conductance-based spinal neuron models (motor neurons and interneurons); ii) muscle proprioceptor models (spindle and Golgi tendon organ) providing sensory afferent feedback; iii) Hill-type muscle models of the leg plantar and dorsiflexors; and iv) an inverted pendulum model for the body biomechanics during upright stance. The motor neuron pools are driven by stochastic spike trains. Simulation results showed that the neuromechanical outputs generated by the NMS model resemble experimental data from subjects standing on a stable surface. Interesting findings were that: i) an intermittent pattern of muscle activation emerged from this posture control model for two of the leg muscles (Medial and Lateral Gastrocnemius); and ii) the Soleus muscle was mostly activated in a continuous manner. These results suggest that the spinal cord anatomy and neurophysiology (e.g., motor unit types, synaptic connectivities, ordered recruitment), along with the modulation of afferent activity, may account for the mixture of intermittent and continuous control that has been a subject of debate in recent studies on postural control. Another finding was the occurrence of the so-called “paradoxical” behaviour of muscle fibre lengths as a function of postural sway. The simulations confirmed previous conjectures that reciprocal inhibition is possibly contributing to this effect, but on the other hand showed that this effect may arise without any anticipatory neural control mechanism.     

Modifications of anticipatory postural adjustments in a rock climbing task: the effect of supporting wall inclination.

The aim of this study was to analyse the influence of initial postural constraint on the realisation of a leg release in a rock climbing task. Two conditions were tested: a vertical posture and an overhanging posture. The overhanging posture was characterised by a large sustentation base, which enhanced the mechanical possibilities of the system. Subjects had to release their right foot in both postural conditions. In the vertical posture, movement's effectuation was associated with anticipatory postural adjustments (APAs). In the overhanging posture, the movement was performed without APAs. The results indicated that APAs were modulated according to the possibilities of force creation of the system. Hence, the disappearance of APAs in the overhanging posture was explained by the efficiency of the system to create the impulse necessary to perform the task.     

Models of Postural Control: Shared Variance in Joint and COM Motions

This paper investigated the organization of the postural control system in human upright stance. To this aim the shared variance between joint and 3D total body center of mass (COM) motions was analyzed using multivariate canonical correlation analysis (CCA). The CCA was performed as a function of established models of postural control that varied in their joint degrees of freedom (DOF), namely, an inverted pendulum ankle model (2DOF), ankle-hip model (4DOF), ankle-knee-hip model (5DOF), and ankle-knee-hip-neck model (7DOF). Healthy young adults performed various postural tasks (two-leg and one-leg quiet stances, voluntary AP and ML sway) on a foam and rigid surface of support. Based on CCA model selection procedures, the amount of shared variance between joint and 3D COM motions and the cross-loading patterns we provide direct evidence of the contribution of multi-DOF postural control mechanisms to human balance. The direct model fitting of CCA showed that incrementing the DOFs in the model through to 7DOF was associated with progressively enhanced shared variance with COM motion. In the 7DOF model, the first canonical function revealed more active involvement of all joints during more challenging one leg stances and dynamic posture tasks. Furthermore, the shared variance was enhanced during the dynamic posture conditions, consistent with a reduction of dimension. This set of outcomes shows directly the degeneracy of multivariate joint regulation in postural control that is influenced by stance and surface of support conditions.     

The supplementary motor area is implicated in the coordination between posture and movement in man

The aim of the present experimental series was to investigate the central organization of the coordination between posture and movement in a bimanual load lifting task. The seated subject was instructed to maintain horizontal one forearm (postural arm) which was loaded with a 1 kg weight. The unloading was performed either by the experimenter (imposed unloading) or by a voluntary movement of the other arm (bimanual unloading). With the bimanual unloading, the movement control was accompanied by an anticipatory adjustment of the postural forearm flexors activity, which resulted in the maintenance of the forearm position despite the unloading. No change in the anticipatory postural adjustment was observed in one patient with complete callosal section. It was reduced in 5 patients with lesion of the SMA region, but only when the postural forearm was contralateral to the lesion. It is suggested that the SMA region contralateral to the postural forearm may select the circuits responsible for the phasic postural adjustments which are necessary to ensure postural maintenance, whereas the motor cortex contralateral to the voluntary movement controls both the movement and, via collaterals, the preselected circuits responsible for the associated postural adjustment.     

Balance control is impaired in adults with sickle cell anaemia

Abstract

Background: Musculoskeletal involvement and cerebrovascular disease are common in sickle cell anaemia (SCA). These changes are potentially important factors that modify the control of balance in this population.

Objective: To assess balance control in adults with SCA and investigate the associations among balance, posture and muscle function.

Methods: Twenty neurologically intact (i.e. without previous episodes of overt stroke or transient ischaemic attack) adults with SCA and 18 controls were evaluated. All participants underwent static balance measurement through stabilometry, postural evaluation through photogrammetry and assessment of muscle function through handgrip and respiratory muscle strength.

Results: Compared to the controls, the adults with SCA exhibited greater displacement of the centre of mass, particularly in the mediolateral direction. Moreover, the adults with SCA exhibited greater postural deviations for the following variables: angles of the right and left hip, horizontal asymmetry of the scapula in relation to T3, angles of the right and left leg-heel and horizontal alignment of the pelvis. Handgrip strength, respiratory muscle strength and haemoglobin (Hb) levels were significantly correlated with postural balance measurements. Significant correlations between balance and posture were only observed between the variables of balance and the postural parameters that involved the angulations calculated from the vertical alignment of the pelvis, hip and ankle.

Conclusions: Neurologically intact adults with SCA exhibit damage in static balance, particularly in the mediolateral direction. These patients present postural deviations due to changes in the hip and ankle joints. In addition, balance control is related to posture, Hb level and muscle function.     

The influence of initial posture on the sit-to-stand movement

Head movements, ground reaction forces and electromyographic activity of selected muscles were recorded simultaneously from two subjects as they performed the sit-to-stand manouevre under a variety of conditions. The influence of initial leg posture on the magnitude of the various parameters under investigation was examined first. A preferred initial leg posture resulted in smaller magnitudes of head movement and ground reaction forces. EMG activity in some muscles, trapezius and erector spinae, decreased, while in others, quadriceps and hamstrings, it increased in the preferred leg posture. The decreases seen correlate with reductions in head movement observed. The effect of inhibiting habitual postural adjustments of the head and neck, by comparing "free" and "guided" movements was also examined. In guided movements there are significant reductions in head movement, ground reaction forces and EMG activity in trapezius, sternomastoid and erector spinae. It would appear that both initial leg posture and the abolition of habitual postural adjustment have a profound influence on the efficiency of the sit-to-stand manouevre. This preliminary study high-lights the practical importance of head posture in the diagnosis and treatment of movement disorders, as well as in movement education.     

Modelling 3D control of upright stance using an optimal control strategy

A 3D balance control model of quiet upright stance is presented, based on an optimal control strategy, and evaluated in terms of its ability to simulate postural sway in both the anterior-posterior and medial-lateral directions. The human body was represented as a two-segment inverted pendulum. Several assumptions were made to linearise body dynamics, for example, that there was no transverse rotation during upright stance. The neural controller was presumed to be an optimal controller that generates ankle control torque and hip control torque according to certain performance criteria. An optimisation procedure was used to determine the values of unspecified model parameters including random disturbance gains and sensory delay times. This model was used to simulate postural sway behaviours characterised by centre-of-pressure (COP)-based measures. Confidence intervals for all normalised COP-based measures contained unity, indicating no significant differences between any of the simulated COP-based measures and corresponding experimental references. In addition, mean normalised errors for the traditional measures were 相似文献